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HomeMy WebLinkAbout008-1096-20-100 Q o' 3 Oo � � c 0 a c 0 N o c 2 -o U N mz 0000 m 2 o C 6 C C v_ O m N }0 c^a cx m 0 C N y C C O O O Z+ ql O N N N X- N 'O O moo `— C C v 7 f4 C N y d=d LL 0 -000 � �� 3u1i a 0 m a� '0 a > m 0 a1 m E Q Q N mLLv- m M 0_ N r � N y O Z C 3 a m M 1- Z O Z $ V (� •- N N H N aEi � I Y 0) m O o 0 •� C t m U N U 0 S Z Z p p C) Z Z O N I N y m c E N O m m 06 CL N N E 0) C N N a a fl O E o N N N > j 0 0 0 a 2 24: d d d 'N a a 3 0 O 0) -O 01 01 N (n J U m o °� } "0 0 a CO O 01 O O e- e- N N M V V w 0 0 0 0 0 m M MO p 0 0 0 0 0 0 0 0 0 0 0 0 0 0 m - N N N N N N N N N N N N N _ to M Lo 0 LO �'. m O7 N O e- LO (f) O N O w U 0 Q Z Co O o m w c O0 ?� N O C E m N N CO M T � (t) (n (0 I- t` �O p' v F° y C h tpl d 01 0 0 0 0 0 0 0 0 0 0 0 0 0 0 N O a p d Cp N N N N N N N N N N N N N N C N C M M N (O r" M v°', N N a`1 Z FL- c a°i ao u1 h 0 o u1 u1 o Cb E E N O O 0np O N •�V ' O M W d �2 O Z 21 L9 O � U E € � I a a a • eC a 75 A .2 y v c N 2 U a O U c� ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST.CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 (715)386-4680 November 28 , 1989 Jackie Prosser 29 BB Baldwin, WI 54022 Dear Jackie, An inspection of the septic system for Dale and Harriet Sorenson on property located in the NW4 of the SW4f Sec. 34, T28N-R16W, Eau Galle Township was conducted on Nov. 27 , 1989. The results of the inspection revealed the system was in a state of failure and would have to be replaced with a code complying system. Should you have any additional questions please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator cj ST. CROIX COUNTY ZONING OFFICEq �1� St. Croix County Courthouse 1 911 4th Street Hudson, WI 54016 Telephone - (715 ) 386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail , along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25. 00 (For nitrates and coliform bacteria) WATER TESTING FEE: $175 .00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25 . 00 (Determines if system is properly functioning at tim of inspection) Property owner's name f Property owner's address Legal Descript' n�_1/4 of the � 1/4 of ection , TN-R�L� Town of Lot Number. Subdivision Name FIRE NUMBER LOCK BOX NUMBER Color of house 4} Realty sign by house?-,4z if so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i .e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. if the home is vacant, and has been so for some time, the water line must be purged by running the wat.er. for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off , or sill cocks are turned off, making access to the home necessary. If this is the case, please make, proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services : ' Telephone Number 2 360 REPORT TO BE SENT TO: Closing date _ Signature ,` �y Parcel 008-1096-20-100 11/03/2005 08:25 AM PAGE 1 OF 1 Alt. Parcel 34.28.16.514A 008 - TOWN OF EAU GALLE Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-owner RANDY E WOLFE O - WOLFE, RANDY E 29 CTY RD BB BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ` 29 CTY RD BB SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE SEC 34 T28N R16W PT NW SW S 1/2 OF NW1/4 Block/Condo Bldg: OF SW1/4 EZ-UT-1503/330 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 34-28N-16W Notes: Parcel History: Date Doc # Vol/Page Type 08/10/1998 585431 1350/53 WD 03/05/1998 574360 1302/437 WD 07/23/1997 1206/455 QC 07/23/1997 858/625 2005 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/04/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 22,500 68,400 90,900 NO AGRICULTURAL G4 11.000 1,200 0 1,200 NO UNDEVELOPED G5 6.000 2,700 0 2,700 NO AGRICULTURAL FOREST G5M 1.000 700 0 700 NO Totals for 2005: General Property 20.000 27,100 68,400 95,500 Woodland 0.000 0 0 Totals for 2004: General Property 20.000 27,700 67,900 95,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 513 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR &4WMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: NW, 4, SW 4,, Sec. 34, T28-Rl CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Eau Galle HoldingTank ❑ In-Ground Pressure ❑ Mound E OF PEFMIT H R: ADDRESS OF PERMIT HOLDER: INSPEC ION DATE: / / Daryl Prosser 29 Co. Rd. BB, Baldwin, WI ?T J Y BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Dale Hudson 6629 St. Croix 128723 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER _ PROVIDED: ~ PROVDED: c , ?fF!_S ❑ NO DYES ❑ NO Z VENT DIA.: VENT MATL.: HIGH WATER UMBER OF ALARM: FEET FROM ROAD: P NOPERTY/ L BUILD G: AER NLOT RESH - g i ( J YES ❑ NO S ❑ NO NEAREST-► DOSING CHAMBER: MANUFAC R: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑ NO El YES [11 NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑ YES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil mol re at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, cons ction all cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO. OF DIS PIPE SPACING: COVER INSIDE DIA.: PITS: LIQUID BED/TRENCH TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MA IAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET F LINE: AIR INLET: NE T MOUND SYSTEM: Mound site plowed perpendicular to Check the texture fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound syste o make rtain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the Iteria for medi sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PE ANENT 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 SY EM: BED/TRENCH WIDTH: LENGT TRENCHESNO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. E DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION H SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION PPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF OPERTY WELL: BUILDING: COMMENTS: FEET FROM L E ❑ YES ❑ NO ❑ YES ❑ NO NEAREST ► (L~~ Qy/C~~/y/2 1 ~4<r4Z~ G Cu-ra'~C~'r~.~"• etain in county file for audit. Sketch System on ReVe Side. SIGNATU TITLE: SBD-6710 (R. 06/88) SANITARY PERMIT APPLICATION q~©1 3 . U ®ILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY ro; .~7 STATE SANITAF37rS PEBMITS -Attach complete plans (to the county copy only) for the system, on paper not less than 1 ld1° 6' 8% x 11 inches in size. ❑ check revision to previous application -See reverse side for instructions for completing this application. STATE PJAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. y PROPERTY OWNER / PROPERTY LOCATION J l,W %5W114, S 3 T ZS, N, R (or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK J~ ~Q CITY, sTATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER a /c~w NX _0 CITY II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE NEAREST ROAD ~q . Ear Salle-,-v,~©I +3 8 ❑ Public 12 1 or 2 Fam. Dwelling-# of bedrooms - A L TAX N MB R( Ills. BUILDING USE: (If building type is public, check all that apply) -'1T 1 11 Apt/Condo /~J ' 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 80 Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 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. ❑ 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 ;ff]-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 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSES (sq. ft.) (Gals/day/sq. ft.) (Mi'./inch) ELEVATION 50 AIW AIX Feet /V~9 Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank D00 GUO Lift Pump Tank/Si hon Chamber. VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: aXf wr.~?'V-51-4A Om, Z" G~ Z 46' -337$ Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes groundwater ate Issued Surcharge Fee) ISSUin Agent Signature (No Stamps) Approved E-1 Owner Given Initial Adverse Determination 1 f6 01 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 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 subnlgtted to the county prior to installation. 5. Onsite sewage systems must be properly maintaineb. 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. III. 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 pe*r-;t 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'f 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; close 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) BOO w r • - R~ h Woo, 6 N- c~ ® g -rr i ? u ~MI _ k O to Jb q - o, --~j~ W m n v o s c L a Eli 4C c n ` m Q b_ L a C-D -CM s~ (~-tip L 1 ' Propie,4 Y n M '\Q "V ~ - 0 r ~ cn o a Z v in r% cn 09 D < o rn 3= rq v 4 in t.' trt r LI N In o ,n _ u :pb m I _r c m r- 0 x bd x 2 r 0 f 0 3p, r m; c L Ot p o L LD 71 LL p~° _ ON ~p N ~m pv O X vO ~Z N< ^ i ;a rni O p D N < A (P In 0 r L v Zop o ao~! OL L ate- x ~c Z~ A oc,i< x r<i D A 3 n 1n -i v r o z Wr~ r►t < -0 3 v F >r p v c D r'0 ln L ~ C ~ r U~~ n °U SOD C) O -j f~ n -1 fn tp C: e 'n Cy -i VP In La 4p X v p X v z m oo r C m 0 Pi m ~ ~ (b RRO 3 I v = v t~` V \ O 1 r 1 Q w B G i s 80 F'+, o (14o ; - O r ~ e Ch R1 ~1 q 6t LA w ZN • V• = X 9 T ~ LI) ~ i ZIP Q a l A~ H- 1 ~ n 7 Clb 7° r ~ A ~ S 1 ProFer~y U x . z o Z 4 "V U 0 a (A rn r% OSU rte = Z rt p d ~jl .0 X ra r, r "J r7 k, ` N P , ~ 1 ~ «a 1r 1 Ire 1 Y ~ r- W O r y m = U s r O rlv Z o LoD 0~= cJ La m -I ' z o 0 Ap I:p LZ Q X v v000 AZ o M L s I ~ rn Ito 4 ~ O D D N M Z r- 11 U 0 ZOP A O ~v! vZ L< b'1 X x s Z: f A C W< ( < O -10 3 n N-~ OD -O r0 to r X G D r~ 0 Z C (q r in ~ r' o ~ 1 tFX LC OD 0 j-4 jro -f c[ xIn O to a, O r7 ~mr- C ye 0 A L O W- C 0 3 p r' 0 in A v n0 } Z 1 13 3 N Li r Y ~~I ~ m O h• b~ °o p m e•o v a w T ~ o Q r rn ~ nom. - - - - r rr1 r,, = 7 s t r) ~G Q 4- r ~ O ~ 3 Cfl ('1 N A CIZ 1 J/ o Q W 4-1 Ul V NS c L4 C70 o "S ,I Li a k OZ ~ -C ~ 4 -rat p ---jL~ O CA 03 ~ ~o Z bo kA S o L - - - - -~J J , Q :I N ~1 3 T H _1 > U _ 1p A ~ Cb ~ '~G tCp o \ ; c~ r ~ A C~Q 1 a AN All 1 31 proper/ y llz_ ~~~~o 8 76PA451 Document No. This space reserved for recording data 4f 051.5 HOLDING TANK AGREEMENT Agreement Date c t~ q (t/~ - - This agreement is made between the REVI~TER1 OFFICE' County or Local Governmental Unit I Holding Tank(s) Owner(s) J1. CROIX =4 WI 1 I Payyl ra~~.~~c J1Rec'd for Rel*erd v '~y- u_ t 1 I ,ash ~a c~y i,A ( > ~S Cl (Called Municipality below u I at J U L 16 P90A& We acknowledge thatapplication is being made for the installation of (a) holding 2 : 10 tank(s) on the following property, (Provide legal land description:) (~1 .44 I ifNfOf °eef.~"` ~ Db Return To - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83, Wis. Adm. Code, or Ch. 145, Stats. As an inducement to the County of J~ ` fdt to issue a sanitary permit for the above described property, we agree to the following: 1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the municipality to prevent or abate a nuisance as described in ss. 146.13 and 146.14, Stats. the municipality may enter upon the property and service the tank or cause to have the tank serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.60, Slats. 2. Owner agrees to pay all charges and costs incurred by the municipality for inspection, pumping, hauling or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any nuisance or health hazard caused by the holding tank. The municipality shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all of the costs and charges may be placed on the tax roll as a special assess- ment for the abatement of a nuisance, and the tax shall be collected as provided by law. 3. The owner, except as provided by s. 146.20 (30) (d), Slats., agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code to have the holding tank serviced and to file a copy of the contract or the owner's registration with the municipality and with the county. The owner further agrees to file a copy of any changes to the service contract or a copy of a new service contract with the municipality and the county within ten (10) business days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code who shall submit to the municipality and to the county a report in accord with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code for the servicing on a semiannual basis. In the case of registration under s. 146.20 (3) (d), Slats., the owner shall submit the report to the municipality and the county. 5. This agreement will remain in effect only until the local governmental unit responsible for the regulation of private sewage systems certifies that the property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner and assignees of the owner. The owner shall submit the agreement to the register of deeds and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. Owner(s) Name(s) (Print) I Owner(s) Sign at ~(3►C~, P(dS ~ I Subscribed and sworn to $ fnPhis date: I ~T 1990 Municipal Official Name (Print) I Municipal Official Signature =4,. Notary Public My commission expiQs- GU 61, Municipal Official Title (Print) -~~Z t~~ I pt1~C- jib. VY~. 1Av C.attntiaaiort Exoire6 SrOt. 10, 1903 + I SBD-6123 (R. 10/85) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations, Bureau of Plumbing. fib,;; 4 ~ ~ ~ ~ • •i • ' N all aed si~ul~r tM Mir a~/ ia~M~~s a►~~~ ti~~; rietlaw { aai rtrita-ot viay of zVowd. 1~ . aMM ra irR ~!M tv son& ay at ...~alt~ ) . .Nsrri~L.sotaaao~ - - ..................{sLL► ♦ . - ~ #~T>ll*~I>Klta~lt0>I1 •O>t>DO~L>ON °:~ti t4 r s!A!t OF WILOO~ oik at. d slA! EAR OF wl8t?0maQ1»»... to no fa be, ~'!d~. s~~JMRM*` ORAFM sY Oft LnsdNEn - - - - . . y..a ,,...:.t.,,~ M tM i~wwir ~1A~1~it to «lip JAC US , OF REPORT ON SOIL BORINGS AND SAFE `fY&BUILDINGS JWON~USTRY DIVISION ' LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 HI~MAN RELATIONS N WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: S SECTION: TOWNSHIP/MUNI IPAL TY: OT NO.:BLK. N0: SUBDIV777 AME: Nw H/R/6d (o w .6--aid I Q r ,v NA COUNT Y: OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES OBS VATIONS MADE PROFILE DESCRIPTIONS: ~4Resiclence NO. B DRMS : CQMM R RTO ❑New ,Replace S: 13- .30_ qD JI RATING: S- Site suitable for system U- Site unsuitable for system ' ONVENT(ONA~L: MOUND: IN-GROUND-PRESSURE : STEM-IN-FILLHOLDING TANK: RECOMMENDED SY TEM:(optional) ❑S EIS ®U ❑S U S❑S U ❑U ' -1 M 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: /,VJ Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS 1 BORING TOTAL ELEVATION DEPTH TO GROU DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. OBSERVED ESF. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- j '3, p' ' 33 • S~ ls% .Z-~Z rom n, 13- Z 0 1004 B-3 3•d' SB,gZ 3.01 0/7 ~ •33 31s;1• .G7" •p'~ B- 5,0 90,GZ 3,0" - /7 •33 al s; 1•% 7' B- . z a,, wzo /•z5' •U to ~3Y 5131 -f' , .s e- G •?•0 boo • 33' • ~/2 ~1 s;1 • /•sB II n PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTE$ NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p RI D 1 P RI D PER INCH P- P- P- P-- P-I- z 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 A6, ' i i - TN - I ' _ __.-....-tti 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 (print). TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): .33/3 -684 -360.6 CST S UHt: / / DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; - 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;• ' 7. MAKE A'LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain; elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone *s - Sand HGW - High Groundwater cs - Coarse Sand Perc - Percolation Rate med s - Medium Sand W - Well fs - Fine Sand Bldg - Building - Is - Loamy Sand > - Greater Than *sl - Sandy Loam < - Less Than *1 - Loam Bn - Brown *sil - Silt Loam BI - Black Si - Silt Gy - Gray *cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff few, fine, faint *c - Clay cc - common, coarse pt - Peat mm - Many, medium m Muck d - distinct p prominent HWL - High water level, * Six general soil textures surface water for liquid waste disposal SM - Bench Mark VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field l:ricr to permit issuance. A complete set of plans for the private sewage systern and a permit applicatioli must be submitteci to the appropriate local authority in order to obtain a permit. The sanitary permit must .,e obtained :end posted prior to the start of any construction. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER tJ / asset ROUTE/BOX NUMBER Z/ Cty BS FIRE NO. -1 CITY/STATE Ral4t, ,Y) , 4?J" 1 ZIP -5-7~'et'19z- PROPERTY LOCATION: NO 1/4 5G0 1/4, Section -sue , T2? N, R 1~ W, Town of ~ 0a (rQ Ile , St. Croix County, Subdivision /l) , Lot No. AX Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists 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 affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), 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. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIG DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address APPLICATION FOR SANITARY PERMIT STC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property a7" / SSe Location of property AW 1/4 1/4, Section -3 , T-2f _,N-R_ZK-W Township llr-a-u ~67 Mailing address 9 Cf l 13 S Address of site sgY-Y) e Subdivision name Lot number Previous owner of property -L~Q P_ ~ore~ spr) Q Total size of parcel c 113n~0" Date parcel was created ` Are all corners and lot lines identifiable? , Yes No Is this property being developed for resale (spec house)? Yes ^IlNo Volume F59-and Page Number e~~7as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY 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. If the deed description references to a Certified Survey Map, the Certified Survey I Map shall also be required. PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form by • vi t F ruc of a warranty deed' recorded in the Office of the County Register of Deeds as Document No..~~Z, O~ ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same h as been duly recorded in the Office of the Count e i r of Deeds, as Document No. Y 9 , Si natu of owner S' natur of Co Owne (If ApplicablE) Date of Signature Date of Si natur r