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HomeMy WebLinkAbout004-1031-50-100 N o" d N Oq O 0 C I O O N O~ ~ II y o I O I I ~ I i s o ti v z c U. E 3 . ~ a 3 `e) Z y ` E z o 0 a m 'r C\l H Z C 0 E Z a> z c N H S ~ o z I c E N O M 'S N C O C • d V L C C O U O Z H Z Z N N a a ` '0' C co H d N O C) mecca Q o O w v) U) :3 U Z > 3 5 z •N aaa IL o I (~1 O N O O 0) z U) J V OOi O N U') Lo o O O L O O 7 E O 0 30 -p S m r 0 a ao N •C r/7 C O ~ Cl) • i m d rn cv Cl) v O O N C lV j'•"a 0 _ N O C C N (D O O O O N N y v 0 0 lf) N C n n C O O ce) m Lo - co F- 0.0 m o~ o o E E ~ •O o U m o z N col V c% R € a L: &E E c c C r~ L) (L U Form - S T C - 104 AS BUILT SANITARY.SYSTEM REPORT OWNER V6 beC=Jb 5A gr"C- TOWNSHIP SEC. Iq T.YN-RA~S_W 2-11 ADDRESS.IlSO ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE /O .2C PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1~E der . EL_ 7y, 97 0 AJ, L,` n, L 6L• 7'f, F 9 Aj- Liue_ EL qr UeuT N, 75 5, Lj'ii e,E-L. 93,77 muse. 2 L ,u e- Ue M7-. 93 $ /ood Callow 240 +K r~ ieo'Ut- TPult f1=2'L~C1 / W / `W { _PT. 'e lit Qa ~t 5 X/00, ~i INDICATE NORTH.'.ARROW BENCHMARK: Describe the vertical reference point used'oe'r'ew i'N 24 j Elevation of vertical reference point: /06.`00 Proposed slope at site: "O 7a SEPTIC TANK: Manufacturer: A4dj0esT- Pre c44-Sf-Liquid Capacity: /004 Number of rings used: / Tank manhole cover elevation: 72,3S Tank Inlet Elevation: L ,ZS Outlet Elevation: g i1.o 7 Number of feet from nearest Road: Front, Side, Rear, feet From nearest property.line: Front, Sid Rear, feet 'g 7 Number of feet from: well I ,building: j (Include this information of the above plot plan)(2 referece dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Numbe7 of feet from nearest property line: Front, O Side, O Rear , Ft. Number of feet from well: -1+ Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: _ Trench:-X Width: i 0' Length: /Dd Number of Lines; _P_ Area Built Fill depth to top of pipe: ,I Number of feet from nearest property line: Front, O Side, O Rear, o Ft. Number of feet from well: 11p9 ` Number of feet from buuilding: 4o j (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: ' Area Built: Has either a drop box O or dis.tribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: © Inspector: Dated: ~y / -o) 7- Plumber on job* License Numider: &y cab 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICDIVISION ATION P.O. BOX 7969 ~,.AhP,Dl~fy~Wlssg7`Q7.14,T28-R15 State Plan I.D. Number: Town of Cady / CONVENTIONAL ❑ ALTERATIVE (If assigned) Lot 1 ❑ Hol/ding Tank ❑ In-Ground Pressure ❑ Mound A Ct~_10C9 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INS CT N DATE: Robert Bosshart Boyceville, WI 7 a O BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. EL Name of Plum r: /MPRSW No.: County: Sanitary Permit Number: Joe Menter MP5658 St. Croix 135453 SEPTIC TANK/~ MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.:ET ELEV.: WARNING LABEL LOCKING COVF~ PROVIDED: PROVIDED: fJ6W 7UT S YES ❑ NO ❑ YES NO BEDDING: V6W DIA.: Nvf-~NT'rMATL.: HIGH WATER NUMBER OF ROAD: PROPERT WELL: BUILDING: VENT TO FRESH C .0) ,f C.O. ALARM: FEET FROM LINE: AIR INLET: ❑ YES NO ❑ YES NO NEAREST FAO "'3 DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: MP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF PU [:1 YES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: i J BED/TRENCH WIDTH: LENGTH: TRENCHES: OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: DEPTH: Nf a r " W TMATERIA~ PIT DIMENSIONS Is 6b LIQUID ~f GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MAT RIAL: NO. ISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOV3E©CO41VER: ELE FILET ELEV ND: q 1, /)tr4`,PIPES: FEET FROM LINE _ i AIR INLET: Ulf 40 PLY NE _ >S `~Jb CP5 o?S Q~ MOUND SYSTEM: /or r rr, r li 5 0 7 Mound site plowed perpendicu Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS nid MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND a DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: >S b ~1 vie (_,(kJ4 d ❑ YES ❑ NO ❑ YES El NO NEAREST" ~~l(.,Q>>~i~,(,A ,.(,,~,e.,ds.: CJ ~ ~ ~ ~ i1M-'=+^~v+-s'7.ts-r7^I~r~~ M r -~FC.c..ci~-'1 G~•~.~•.i? mod, 9 _3 91,27" 92-IF' Sketch System on a in county file for audit. Reverse Side. GSIGNAT E: TITLE: '4 7 __j SBD-6710 (R. 06/88) -NMI SANITARY PERMIT APPLICATION ®ILHR couNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than El ~ 8% x 11 inches in size. Chec if revision o previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. P OPERTY OWN R PROPERTY LOCATION 701 b, r -T S j L '80 s `j-gr'Y- ti' 1/4 /r 15 1/4, S / TA 97, N, R /,S_ E (orW PROPERTY OWNER'S MAIL *4G ADDRESS LOT # BLOCK # 9~0 C e. V "L L ~e_ 6V i `'s CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned VILLAGE ❑ Public ®1 or 2 Fam. Dwelling-#of bedrooms - PARCEL TAX NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) C~ I l 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 17. FINAL GRADE RE U ED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ,"Y-17 ELEVAATTION /000 ~ , a2 70"1 Feet 70' 7/ Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete structed Con- Steel glass Plastic App Tanks Tanks Septic Tank or Holdin Tank ~~Db M 1 GieST -C;i7s Lift Pump Tank/Si hon Chamber F-1 F1 El 0 F] VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): umber's Signature: (No Stamps) P/ PRSW No.: Business Phone Number: ,66 e. ?,k W -r-r- Sg- 7~ 5 a 35- 73 Plumber's Address (Street, City, State, Zip de . v 0,-0 A-d Ur P_ A./ O N( O AU J -e- W l' S S S~ s IX. COUNTY/DEPARTMENT USE NLY Disapproved Sanitary Permit Fee (Includes Groundwater as ssue Issuing Agent Signature (No Stamps) ❑ Approved ❑ Owner Given Initial Surcharge Fee) -f Adv rse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 's 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. 111. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) APPLICATIONFOR SANITARY PERMIT STC-100 This application form is to be completed in full and signed by the ovner(a) of the property being developed. Any inadequacies Will only result in delays of the permit lssuance. Should this development be Intended for resale by a second form should be retained and ouse), then owner/contcactot (sec h completed when the ptopecty is sold and submitted to this office with the PPoPlate deed recording. a t c Owner of property ~e b er'fi ~f~L G ~o ~s ~rT Location of property N~l1/4 1/4, Section T •it -Y ~~d y Township Melling address _ ~i` 1 s ooh Address of site Subdivision name Lot number Previous owner of property JCS ~A_] 74'- 'c- . Total also of parcel l0 ~Date parcel was created Ate all corners and lot lines Identifiable? „_Yes o is this property being developed for resale tapec house)? as X 0 Volume and Page Number d17 as recorded with the Register of Deeds. • • - - • - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - INCLUDE WITH THIS APPLICATION THE FOLLOWING: A VARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER Of DEEDS. In addition a certified survey, If available, would be helpful so as to avoid delays of the reviewing process. It the deed description teference■ to a Cestltled Survey Map, the Certified Survey Map shall also be requited. PROPERTY OWNER CERTIFICATION I(We) cettlfy that all statements on this form ate true to the best of my (our) knowledge; that I (we) am (ate) the owner(s) of the property described in this information form, by vlttue of a warrant eed r corded In the office of the County Register of Deeds as Document No. and that I (We) presently 9 own the proposed site for the seva a dlsPosal system (at I (we) have obtained an easement, to run with the above described property, tot the construction of said system, and the some has been duly recorded in the Office of the County Register of Deeds, as Document No. signature of net Signatur f Co-Owner (If Applicable) ~=qC) H/3/9O Dale of signature Date of Signature • FORM NO. 985•A ` NC WI„. C•n••..~ Stock No. 26273 453583 CERTIFIED SURVEY MAP NO. 2172 VOLUME 8 , PAGE 2172 . BEING A PART OF THE NORTHEAST 114 OF THE NORTHEAST 114 OF SECTION 14, T.28N., R.15 W., TOWN OF CADY, ST. CROIX COUNTY, WIS. NORTH V4 CON. UNPLA_TTED LANOS BY OTHERS N.E. CORNER 14-28-15 NORTH LINE - N. E. 114 - _ 14-28-15 ~33 13 FOUND COUNTY MONUMENT FOUNDALUMINUM MONUMENT 616 N 89925 - ' 49.~~~ " N 89O - 2514 9~~E 660.00 I 1996.03' 627.00 33.00' H CI ~ ~ wl O h1 of lu O H O W~ \\\\`\\\\\\N\111it1O111111111////// o o V~ ~ 01 LOT I 01 STEVEN J. ;V mi 0 too 435,599SOXT./10.00 ACRES w O h - WAAK c~ OO tp EXCL. R./W, f It S-1810 i el Z 413,818 SO..FT/ 9.50 ACRES q r ~I a a al - 7~~~ MENOMONIE "►~-A' J~ a Vv 9 WIS. • Q wl 1 Wj O 148 ~-j • v C SUR '/ligq Ills n►!\!t:\\\~' z' I ~I M Isv 33.00 ' S89225-'49"W 660.00 M 166'I UNPLATTED LANDS BY SUBDIVIDER « 13 3'I NORTH IS REFERENCED TO THE NORTH LINE OF ~z 3 THE NQRTHEAST 114, WHICH IS ASSUMED TO 4i 20. BEAR N89425=49"E. ? 2 O r„. F. S h GRAPHIC SCALE / 1 200 w O 100 200 300 400 600 EAST 1/4 CDR 14-20-15 FOUND 1W"IRONPIPE LEGEND 0........ EXISTING GOVERNMENT CORNER (AS NgTED) PREPARED FOR *.........FOUND I " IRON PIPE MR. JOE MENTOR p......... SET 3/4 'x24 " RE- ROD WEIGHING 1.502 LOS./LINEAL FT. 1120 N. BROADWAY -x-........EXISTING FENCE MENOMONIE, WIS. 54751 V ........SET 60d A £ FILED e PIPI OIT- D Nov 2 019Rq'` NOV 1 i~~g JAMES O'CONNELL 9 FWgWer 01 U'cas ST. CROI;< COUNTY SL Croix CO., WI -'0°p -14rNSIVE Pg1... Fw$vkvl , Inc; zorvvG Cana, T?rr CEDAR CORPORATION 604 WILSON AVENUE VOLUME 8 PAGE 2172 MENOMONIE. WI 54751 (715) 235-WSI PAGE OF 2. i SURVEYOR'S CERTIFICATE I, Steven J. Waak, Wisconsin Registered Land Surveyor, hereby certify that I have surveyed, divided and mapped a part of the Northeast 1/4 of the Northeast 1/4 of Section 14, Township 28 North, Range 15 West, Town of Cady, St. Croix County, Wisconsin, and more particularly described as follows: Commencing at the Northwest corner of the Northeast 1/4 of said Section 14; Thence N 89025'49" E, along the North line of said Northeast 1/4, a distance of 1996.03 feet to the point of beginning; Thence continuing N 89025'49" E, along said North line, a distance of 660.00 feet to the Northeast corner of said Northeast 1/4; Thence S 00004'40" W, along the East line of said Northeast 1/4, a distance of 660.04 feet; Thence S 89025'49" W, a distance of 660.00 feet; Thence N 0000440" E a distance of 660.04 feet to the point of beginning; Said described parcel contains 435,599 square feet more or less, or 10.00 acres. That I have made such survey, land division and map at the direction of Mr. Joe Mentor, 1120 North Broadway, Menomonie, WI 54751, Owner of said lands. That such map is a correct representation of the exterior boundaries of the land surveyed and the subdivision thereof made. That I have fully complied with the provisions of Chapter 236.34 of the Wisconsin Statutes, Chapter AE-7 of the Wisconsin Administrative Code and the subdivison regulations of St. Croix County in surveying, dividing and mapping the same. Said survey is subject to existing roads and easements of record and as shown. Dated this ~'~day of 1989 00 G,,,,,,lll,,,,, SS ..o.NSA STEVEN J. W Wisconsin Registered Land Surveyor SIEVEKJ. _ . WAAK • S-1610 y MENOMONIE WIS. aS11U VOLUME 8 PAGE 2172 PAGE? Of 2. V. C DOCUMENT NO. STATE BAR OF WISCONSIN FORM i-i988' THIS SPACE RESERVED FOR RECORDING DATA l; i WARRANTY DEED I! ! 454G79 tr 86UPacE 1" c l 10 REGISTER'S OFFICE i' This Deed, made between Joseph J. Menter and ST CROIX CO. WI ii s ing as I Reed for Record Audrey L._ Menter, husband and _w_ ife Bold urvivorship. marit al. property _ I JAN 3 'D490 I of - - - Grantor, f . 8:30 Q. M and_.Rober.t .J.._ _Bosshar, --anal S.al_1 D Bosshart-,--.-+ Y C~~.r,;,QQ husband. and wif_e_as _survvo.rship. marital- - _ I I . proper t y - - - - Re91s~e► of Deeds - i , Grantee, - - - - i Witnesseth, That the said Grantor, for a valuable consideration II One-.dollar-- and---other valuable consideration--- I, • St* Cro1 RETURN TO conveys to Grantee the following described real estate in .X County, State of Wisconsin: Part of the Northeast ~ Quarter (NE 1/4) of the Northeast Quarter (NE 1/4), of Section Fourteen Tax Parcel No (14), Township Twenty-eight (28) Range Fifteen _ . 7.L 1 (15), described as follows: Lot One (1) of Certified Survey Map filed November 20, 1989, in Volume "8", Page 2172. TRANS i FEE I' it II This is no t----- homestead property. j II (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; A„d..... _ Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except I - - and will warrant and defend the same. I. I Dated this - - --l day of December 89 - - - - - - 19......... i j (SEAL) L. x 0 / CiL........ (SEAL) a Joseph -.J. -.:Mente.r----• (SEAL) - - - - 1 - - -.....-(SEAL) * Aud ey L. Menter i AUTHENTICATION ACKNOWLEDGMENT Signature (s) STATE OF WISCONSIN !I Dunn ss. County. authenticated this day of 19 Personally came before me this .'?ytl-_--day of ! -DaCeRlbe-r 19..8-9.. the above named * Joseph J. Menter and !I TITLE: MEMBER STATE BAR OF WISCONSIN Audrey L. Menter - !j (If not- authorized b by § ?06.06, Wis. . Stats. ) to me known to be the person ~gecuted the 1C~,'•~•-- ~i•ho foregoing instr ent and acknowledge4helsame. THIS INSTRUMENT WAS DRAFTED BY : - ROBERT G. WALTER Attorney aE-•~a"w"------------------------------- I. Notary Public Du_ n_ is. (Signatures may ri Y be authenticated or acknowledged. Both My Commission is permanent. (if Q: iration 11 are not necessary.) date: - . *Names of persons signing in any capacity should be typed or printed below their signatures. ~ ntr~ STATE FORM No. 1µl 1982NSiN Stock No. 13001 STC-105 c~ SEPTIC TANK MAINTENANCE AGREEMENT ~ St. Croix County OWNER/BUYER 4 _9,9-L G r, op ROUTE /BOX NUMBER l' i S o i.J Fire Number d CITY/ STATE W S ZIP r PROPERTY LOCATION: ,/Cdr k', Section, T -N, R W, Town of ~i}d St. Croix County, -Subdivision Lot number Improper-use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed 'septic ~tank pumper. What you put into the system can attect the-- ufunnctioon o -t-ti septic .tank as a treat- ment stage in the waste disposal system. St. Croix County residents maybe eligible to recieve a grant for a maximum of 60% of the cost.of replacement.of a failing system, whic was in operation prior to July 1, 1978. St. Croix County accepted this. program in August of 1980, with the requirement that owners of all'new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or.a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic.tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H I/WE, the undersigned have read the above requirements and agree o to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources, Certification form must be completed .d and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED SxR~ 3c DATE H /3 CJ St. Croix County Zoning Office 911 4th St. Hudson, WI 54016. 386-4680 Sign, date and return to the above address. INDUSTRY, ~~L'rYC/6t) DIVISION INDUSTfiYENT F Da QPQ0T ON SOIL BORINGS AND SAFETY & BUILDINGS l FOR APED PERCOLATION TESTS P.O. BOX 7969 HUMAN RELATIONS (115) MADISON, WI 53707 3707 (H63.090) & Chapter 145.045) L,OCQTI S / TIO~~/~/~ (o TO HI /MUNICIPALITY: OT NO. BLK. NO.: SUBDIVISION NAME: C UNT O ER'S ~,U1Y R•s NAME: ,pnhG_I/ rAZIG ADDRESS: ~et- C L ~i~1 tl Z r USE DATES OBSERVATIONS MADE NO. BED MS.: COMMERCIAL DESCRIPTION: PROFI DE PTI S: E TION ESTS: Residence XNew ❑Replace /O 7/F7 /Q Z O~ b RATING: S= Site suitable for system U= Site unsuitable for system ! Q ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) s ❑u ®s ❑u sou a s os u MA)CA, S ST`S. If Percolation Tests are NOT required DESIGN RATE If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 9Jjo 72- TS, 21,"ez • ~yI6,jmA G" ,AC B- 2 'z 2. tid 72- B-3 72 q& do y BA ti o ? B-s 7 gq, L4 Au © y 7.1, B- 76L /0/1 2S 1/0 > 7d, PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PER PER INCH P- I 0 1? 'O / • 3O P- 2 3& k o 3 0 N Yr P- .6 Rio 3o t/ 8 P-_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 9.31 4_ -4 , , 3 . i X25 u1e 1V PoL N 3 w 7 i A. (ZF A- 0 ~ (T Fe ~J~( U S"l¢. P6 r sp PTA S yS1"e Z E - I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (pri TESTS W RE COMPLETED ON: a 6 A fJ r e ADDRESS: CERTIFIC ION NUMBER: PHONE NUMBER (optional): I`l 2® rogdw~ ~ontio,v~`e -K 8` 35-734 1 IGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. uILHr-SBU-6395 (R. 02/8A -OVER - L INSTRUCTIONS FOR COMPLETING FORM 115 - SRC} - 6395 To be a . # accurate soil test, your report mast include; 1. Cc 11; 2. The u4_ ~ indicate is is 'l r ~:e or commercial project; 3. MAXI zms or( al use 4, Is " is systam; , Cr i, • _ .=r"ng boxes ITE 1S SUITP _E FOR A HOLDING TANK ONLY IF ALL OTHER RULED OG QED ON SOIL CONDITIONS; PLEA w. - + r writing profile descriptions and completirig the plot plan; 7. ~n accu sating your test locations. Drawing to scale is preferred. A nent; i nd vetti on refererrce point: are clearly shovvn, and are p(m tia S _ )riaLe boxes i , names, addresses, flood plain data, percolation test exemp- ~ra plait i, ale.va+;r„ } cnn<. , fl, . in the appropi iate box; Trent address ar:1 yo:,r r =ti 12 c ;trlhute ALL TESTS MUST BE FILED WITH THE LOC,8 AUTHORITY WITHIN COMPLETION. .13i wS FOR CERTI -OIL TESTERS -)the St - F con - C Sa Limy ;tor High C°;vatc>-r P e r Than sl ,r; all t - ow•. 'sal _ _ rack si - Silt Gy - Gray Clay L Y ,low Sac Learn Sill Learn mot Sal r wl - sic - Silty C fff lint c y ce )arse p! mm riedium „ d - p -tt HWL - HigF. ; ,el x .....wral soil textures li !uiti waste disposa€ BM Bench VRP Verti TO I to f l I D A -L,o-C Cer-r ~,v rv e y LoT n ~~oberT- ~S.4LL L~o I~RrZ ME Ai L- Se- cJ / y r28 i5.- t J o F- Clad r S T, 1-"ro K 0( w S' Lo P~ qQ- br nw u b y M P- S o Pe d ~LoP~ T f3A 7i ~ ~5o 3 0 5 ~ 20 I,Uh i TG OA-X trL-( Q . )C1orv' ti Screw ulit1A-Mer iAJ ?re-e.. 5 P P 2~ ~ S S YS I C. A- eL - q3, 78 I a~