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HomeMy WebLinkAbout012-1021-80-025 4 0 p O~ - N p o ~ I c e 0 N M C CO _ N O (D 0 0~ o c m a) EEE w~ N ~ U N N N N• C Z L N N U. C O Co O U - ~ y ~ L C E ¢ U~~ II M N 3 E z = o Z y d a m co ~ o I c o z Z d Z a c o to F- Z c E -o t N Cl) O N 7 N Q. C •~J d U N O z H z Z N ~I E N N Lo CL m co y d `ml 3 C G a - E 75 a o crrnU) U) z 0 3 FL ,A o I z •w,i E(L IL IL ~ I a ~y o p N J V Z 0) 0) z ti C N N U O O m C . 0 _T N O ca Cl) ca O n 7 N O 3 y c p O C LO Ln ~ O L) N N C V n. p O N h E C C p N O N 'c6 ! o N C EL CD ~ N Cl C O O N E O U • O O W U 0 Z 19 Z OO r \ cl V V~ w Ta ~ a ~ a w CL m ! m r`I~i CL E E _ 0 '0 t FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER. G(J.1L114TOWNSHIP. SECTION- LJ _ T ~O' N-R-Z,~' W ADDRESS_ ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT "LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~i L. sl. Ae-~ i INDICATE NORTH ARROW BENC1iMARK: Elevation and description:_ Tv 3• z/ Alternate benchmark ~od ~Gr/cam SEPTIC TANK:ltanufacturer:_ G 3 e-, G S Liquid Cap. a-a-d o Rings used: Manhole cover elev: -:~E,,rFinal grade elev: Tank inlet elev.:_Tank outlet elev.: f No. of feet from nearest road:Front , Sid, Rear Ft.p From nearest prop. line:Front , Side , RearZ Ft. No. of feet from: Well-.&a c,,' G Building:_ /j (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE } PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front_, Side, Rear-Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: , j Width: 2. / Length 5 / Number of Lines;6Area Built Exist. Grade Elev.- yam. yProposed Final Grade Elev. lam. Fill depth to top of pipe: 0? !1-e No. feet from nearest prop. line:Front , Side RearFt.-!LY No. feet from well: D0. feet from building- HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR: DATE: p PLUMBER ON JOB: v-~z LICENSE NUMBER: ~-'~7/5?' 6/90:cj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN 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 , NE 4 ,See . 4 , T 3 0 - Rl 7 (If assigned) Town of Erin Prair,~g ❑ CONVENTIONAL ❑ ALTERATIVE LJ Holding Tank ❑ In-Ground Pressure ❑ Mound d. K A E IT R: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: BE A ermanen •re .rent) point) DESCRIBE IF DI R N FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: SEP IC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST -40- 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: 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 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: WIDTH: LENGTH: NO.OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH / C~ TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS J GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: IFEET FROM LINE: AIR INLET: NEAREST 110- MOUND SYSTEM: Mound site plowed perpendicular to 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 MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: 4AREST MBER OF PROPERTY WELL: BUILDING: COMMENTS: ET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO - 0 `Z 4.2- Retain in county file for audit. Sketch System on Reverse Side. SIGNATURE: TITLE: SBD-6710 (R. 06/88) S LHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 J~ 8%x 11 inches in size. c r i nt eviousapplication -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWN / PROPERTY LOCATION A)% '/a, S T , N, R ~ E (o PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 11. TYPE OF BUILDING: (Check one CITY ~ i NEAREST ROAD ) State Owned VILLAGE ~ ~^in /~Yf/f,~ ❑ Public 1 or 2 Fam. Dwelling# of bedrooms ICEL =W OF AX NUM ) /~--o?pOaZ - 111. BUILDING USE: (If building type is public, check all that apply) 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. L4 New 2. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5.0 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. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION Feet 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 structed Septic Tank or Holdin Tank .G e X4- F] F1 1 7- 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: Plum is Address (Str t, City, State, Zip Code): r ,,x, < IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing A ent Signature (No Stamps) Approved ❑ Owner Given Initial surcharge Fee) Adverse Determination / ` EA /a - ?j 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 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. 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 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. Vlfl. 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 Iess; 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) 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/contractgr,("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. - - - - - - - - - - - - - - - - - - - - - - = - - - - - - - - - - - - - - - - - - - f / Owner of Property 4c,- ,gk -z Location of Property k A~-14, Section , T N - R W Township ri/! ~j^6t ni ~G Nailing Address~~ ~d~ /~7 G~e~ ~'~~-•--e .r~J~` -Veer- Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel a2a ir 32=- Date Parcel was Created Are all corners and lot lines identifiable?_ Yes No Is this property being developed for resale (spec house) ? Yes- No Volume ®2 5~ and Page Number Z- C as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office 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 Nap, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) eeAti.6 y that ate a.tatemen is on .thiA 6onm ane #Au.e to the beat o6 my (ouA ) know.eedge; that I (we) am (ahe) the owneA(a) o6 the pnopehty deaeAibed in .thib in 6onma ti,on 6onm, by viA tue o6 a wauanty deed teco ided in the 06 6ice o S the County RegiAteA o6 Deeda as Document No. ; and that I (we) pneae►~y own the ptopoaed dito bon the dewage~ayd.tem (oh I (we) have obtained an easement, to Aun with the above du cA i.bed pnopeAty, bon the conat4ucti.on o6 6aid system, and the came has been dut neco ed in the 066tee o6 the County Reg.csteA o6 Deeda, as Document No. u ) . /I ~ OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) Z O `/0- DATE SIGNED DATE SIGNED DOCUMENT NO. I ASSIGNMENT OF LAND CONTRACT STATE OF WISCONSIN -FORM 97 369283 I Vol. 625 Page 125 I THIS SPACE RESERVED FGR RECORDING DATA i~ Received for record February 10, 1981, at 8:30 a.m, For and in Consideration of Three Thousand Five Hundred Twenty - one and 67 /100 ($3,521.67 ) Dollars, - to..... him....... in hand paid, -------~o.Bert--` Ifonse.---• u--m - er- an Bar - •--r o-n of-......-•----------••-•-------•--------•---.....•-----. County of i State of Wisconsin, do es... hereby grant, bargain, sell, assign, transfer, arbara A. Wilhelm. lhelmI....._a... s ingle convey and set over unto. woman a certain Land Contract, executed by____Wiiliam W. Ward and - Isabel E. Wardt husband---- usband and wife = RETURN TO of.....__. St -Croix of New Richmond Coun17th State of Wisconsin, and dated the-_-._•_-____-________________________________ day of - July. A. D., 19_._78, to Robert-J............... Alfonse I on certain lands in the County of St. Croix and State of Wisconsin, to-wit: Lots 3, 4, 5, 6, 7, 8, 9, 10, 29, 30, 31, 32, 33, 34, 35 and 36, together with Lots 11 and 28 excepting the South 15.98 feet therefrom, all being in Block 78, Plat of Jewitt Mills, St. Croix County, Wisconsin, >fux>s> t Ada dxxitct ~sCgcffiX________________________•-_-----•----.....---------------.._...__. =altZXJcmfx1Xk=gW together with Dbxx._reaL..P_s_tat.e----------------------------------------- therein referred to and all the right, title and interest conveyed by said Land Contract, in and to sai lands which Land Contract was duly recorded in the office t Register of t. 'Croix °4K Deeds in and for the County of________________________ State of Wisconsin, on the.......................... d of _-ja1 p-~•------------•-------•-- A. D., 19_Z$__, at----- $_t. 0_ o'clock A,..M., in Volume-----------578---- o i o page 4........................... Document No. 350318 This is not homestead property. ~l Assignor represents and warrants that there are no unpaid mortgages, ;j judgments or any other liens of record and that he will hold Assignee harmless and pay for any such mortgages, judgments or liens which are unknown or undisclosed. I real estate To Have and to Hold the said and Land Contract and the debt thereby Secured, and all right, title and interest conveyed by said Land Contract, in and to the lands therein described, to the said _.___._.__$arbara__A_t_ _Wilhelm....• her heirs, executors, administrators and assigns forever, for heY and their use and benefit. And........... hereby covenant...... that there is now owing and unpaid on the said f, and and Land Contract, as principal, a sum not less thanTwo_ Thousand Nine Hundred Fifiy- /.1QD_..($_2.,_955_5.a).__Dollars_ .._a.nd__also_..interest-..~of.T~aenLy~Ian_atd 80/100 and as--- . ha--Ve----- good right to assign the same. In Witness Whereof, have hereunto set......... MY hand-------- and seal.. this........ 9 th day Of...... February A. D., 19. 81 SIGNED AND SEALED IN PRESENCE OF A SEAL) Robert J. Alfo e ...................................(SEAL) .......(SEAL) (SEAL) State of Wisconsin, l Polk } ss. County JJJ Personally came before me, this-..... 9th February 81 day of - A. D., 19.: the abo%e named ...Robert J. Alfonse to me known to be the herson.... who executed the foregoing instrum and acknou'le be same. THIS INSTRUMENT WAS DRAFTED BY Bert D. Petersen Bert D. Petersen NOTARY Attorney at Law F t iA L Notary Public . Polk County, Wis. Clear Lake,' Wiscons-in-54005 Nty commission InQ* ct os)••parmanent (Section 59.51 (1) of the Wisconsin Statutes pn,vides that all instruments to be recorded shall have plainly printed or typewritten thereon the names of the grantors, grantees, witne•s.se, and notary. Section 59.513 similnrly requires that the name of the person- who, or govern- j mental ag•.ncy which, drafted Saute insttumcn:. shall b, printed. Isr•c.eritr ~i. ! ' or n eittcu thcrtm in .1 Ir••eLle manner.) STATE OF WISCONSIN Wiseonsin Lncnl Blank Cnmpnniv OP LAND CON'TRAC'r Pnnvt Nu 37 \Ttltvn ulc~n„ Wiiq, (Job :1114 ) H z Y 1 (n H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a OWNER/BUYER i ROUTE/BOX NUMBER At ~ /yep( /9 5 Fire Number CITY/STATE All' ZIP 0C7.S- t PROPERTY LOCATION:^-) 14, Section, T~N, R/,,7 W, Town of /~-ai/V 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 affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% 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 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 0 E I/WE, the undersigned, have read the above requirements and agree En to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ro ment 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. S I G N E D~~~ Q Qsd~ ~'J~ DATE /la A ~O St. Croix County Zoning Office P.0 Box 98=- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. e DMIMTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION SECTION: TOWNSHIP MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: 111446C 1/4 T o 111/11/,;i, E to r 'C- 7 f d~-S«~>y`,~,%/ - Ohl OUNTY: MAI ING ADDRESS: C/ectr a~~- r U+o - r0 o USE DATES OBSERVATIONS MADE A- f NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: IPERCOLATIONTFRTS: Residence New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:loptional) S ❑U 1 S DU ~ S ❑U EIS ~U EIS YU - - If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the h~ under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: /yy 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- a 40~7 C/ B- 3 1r~• J~•-~--c _ IVY $,/,2 ~f ~IV n $ B- fS %r ~rOxsv B- GC f PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IA111=16 AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R D PER INCH P_ a- ~ d-' 3 P P- P- EP-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. Igor SYSTE ELEVATION g F ~ 19 r 14 T N 3 m _.o`~ _ j74 o~ ~7,~_ o I, the uncle signed, hereby certify that the soil tests reported on this form were made by mein 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): /nom CST SIGNATUR : r r DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - r k W + INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction 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 scale is prefered. 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 apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, 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 yur 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 T*xtures Mar Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under W) LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well is - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand < - Less Than '1 - Loam Bn - Brown 't 'sil - Silt Loam BI - Black si - Slit 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 III - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal 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 prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. PLOT PLAN PROJECT ADDRESS &14)1/4/YZ- 1/4/S /T~~N/R,17W TOWN s~ c-COUNTY Sf.- MPRS Byron Bird Jr. 3318 DATE - - .42 BEDROOM~ CLASS PERC__/_ CONVENTIONAL IN-GRO PRESSURE CONVENTIONAL LIFT_ MOUND_ HOLD PG TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE BED SIZE k6 Benchmark V.R.P. Assume Elevation 100' Location of Benchmark * H.R.P. C7 Borehole Q Well Scale Feet O Perc Hole System Elevation TYPAR COVERING 2" ~I 12" 3' g' Q 3' 3' 4 3' 1 Sewer Rock 12' 18' 3 yo 6 0 3~ i ~6 D VI-a 101 io tir "INN ~~N c►. 6f iP f s` iry o 6 G L ~7 L✓ ~'r `l /7`r Form - S T C - 104 i AS BUILT SANITARY SYSTEM REPORT ''t'OWNSR`' • ~ (=d ~iyl ' "-TOWNSHIP ; vy'1 l~ sir j~ SEC. _ T 30N-R-7 _W IGA i ADDRES f a ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT _ iA_ LOT SIZE` PLAN VIEW Distances and dimensions.to meet requirements of'II,HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1-0 - yr, 't - :IZ;al..r I_% i i:fl~R}a!', r+ 1J;:ri Q 3Z 11 A + t $r . .L c- ►2 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 7 Elevation of vertical reference point: f / Proposed slope at site: ~a SEPTIC TANK: Manufacturer: Liquid Capacity. / "'"Numbec of rings used d r Tank manhole cover elevation: Tank Inlet Elevation Tank Outlet Elevation: / 'go Number of feet from nearest Road: FrontA61 Side 0Rear, O feet From nearest- property line : - Front,OSideQRear,O Z feet Number of feet from: well building: &"::P `J" (Include this information of..the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE r PUMP CHAMBER Liquid Capacity: Manufacturer: hon Man Pump Size Pump Model: Pump/Sip Bottom of tank elevation: Elevation of inlet: ' Gallons per cycle: Pump off switch elevatio Alarm Switch Type: Alarm Manufacturer: Rear, © Ft. -Number of fee rom'nearest property line:'. Front, O Side, 'Number of feet from well: Number of feet from building:_ (Include distances.on plot plan). SOIL ABSORPTION, SYSTEM Bdd r Trench: Number of Lines: Area Built, Width: • Length: Fill depth to top of pipe: Front, O Side,)o Rear•0Yt)•2- Number of feet f om nearest property line: i (Number of feet from well: r~ N ber of feet from bu ing: ` (Include di lances on pl plan). SEEPAGE PIT umber of pits: Diameter: Size: Liquid depth: Bottom of seepage pit elevation: Area Built: O or distribution box O been used on any of the above soil Has either a drop ox~ absorbtion sytem (C eck one). HOLDING TANK a ' Capacity: Manufac urer: N Elevation of bottom of tank: ' umb of'.rings used:• E vation of inlet: Front, `.,J Side, O Rear, 0Ft. Number of fast from nearest property line: .Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer : Inspector:•. ' . Plumber.on job. Dated License N er: 3/84:mj a • DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING f LABOR & HUMAN RELATIONS DIVISION pP..gO. BEM 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION 'Number: SlN 4D, LVW3yvl,eC . H , T30-R17 (Ifassigned) Town of Erin Prairie ❑ CONVENTIONAL ❑ ALTERATIVE Co. Rd. GG n Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Tom Coughlin 1167 Ct Rd. GG, New Richmond, WI 4-/CV /1130 ,,~NCH MARK (Permanent r ferenc point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: loo, lo Name Plum MP/MPRSW No.: County: Sanitary Permit Number: Gar . Steel 3254 St. Croix 135467 SEPTIC TANK/HOLDING TANK: MANUFACT RER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER L~ 0 (l PROVIDED: PROVIDED: 1~ ~DO S~ 1160,3 3 2rYES ❑ NO ❑ YES NO BEDDING: VENT DI VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH / LIN AIR INLET: (I ALARM: FEET FROM 0 ❑ YES 11/NO ❑ YES IQ NO NEAREST Z I0/O l0 J DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: JPUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OP R TIO A NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑ YE NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth to in ORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall c a unti MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID 5 I TRENCHES: M TERIAL PIT / DEPTH: DIMENSIONS l,.1;1 GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DI TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELO PIPES: ABOVE CO ER: EV. INLET: EpLEVp. E PIPES. FEET FROM LIN q AIR INLET: I" NEAREST Z J4O 0 7 g MOUND SYSTEM: Mound site plowed perpendicular to 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 MANIFOLD PUMP MANIFOLD DISTR, PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO INEAREST 1~-0 Sketch System on Retain in county file for audit. Reverse Side. FSIGNAT E: TITLE: SBD-6710 (R. 06/88) 1 7 SANITARY PERMIT APPLICATION In accord with ILHR 83:05, Wis. Adm. Code o N Y 7UILHR ~v St. Croix STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ y 8% x 11 inches in size. Chet f revision t rle ous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Tom Coughlin SW % NW S 8 T 30 , N, R 17 xFqor) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 1671N. Co. Rd. #GG, R.R.#l n/a n/a CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER New Richmond, Wi. 54017 715 246-4318 n/a 319 acres CITY NEAREST ROAD 171 II. TYPE OF BUILDING: (Check one) -1 State Owned ❑ VILLAGE Erin Prarie Co. Rd. ##GG a/ 1 ~ ❑ Public )2 1 or 2 Fam. Dwelling-~# of bedrooms 3 PARCEL TAX NUMBER(5) (50 III. BUILDING USE: (If building type is public, check all that apply) 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.E] 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 ❑ 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. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 450 495 50, .91 1 98.30 et 101.96 Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank x 1000 Weeks Concrete x Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for inst Ilation of the onsi a sewage system shown on the attached plans. Plumber's Name (Print): Plumb s ignatur]ice/MPRSW No.: Business Phone Number: Gary L. Steel 3254 715 246-6200 Plumber's Address (Street, City, State, Zip e): 988 N. Shore Dr. New Richmond 4Ji. 54017 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater e Issued issuing Agent Signature (No Stamps) Surcharge Fee) Approved El Owner Given Initial ~U Advers D terminate n L<11-c2(4 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 f INSTRUCTIONS ` a 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'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; 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) ^ 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 Tom Coughlin Location of property SW 1/9 14W 1/4, Section 8 , T30 N-R17 W Township Erin Prarie Mailing address 1671N. Co. Rd. #GG, R.R.#l, New Richmond, Wi. 54017 Address of site same Subdivision name n/a Lot number n/a Previous owner of property Total size of parcel 319 acres Date parcel was created Are all corners and lot lines identifiable? x Yes No Is this property being developed for resale (spec house)? Yes x No Volume 1--* and Page Number J5) as 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 Map shall also be required. ---------------------------------------------------------7--------------------- 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 virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. -3td 7/e2 ; 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 has been duly recorded in the Office of the County Register of Deeds, as Document No. Signature of Owne Signature of Co-Owner (If Applicable) -z3 Date of Signature Date of Signature . . nu, wisun snr "~1$~ Vu! '726 PAGE ST. CROIX STATE OF WISCONSIN CIRCUIT COURT COUNTY IN PROBATE IN THE MATTER OF THE ESTATE OF BRIDGET C. COUGHLIN, a k a ABRIDGMENT OF ~ FINAL JUDGMEN"'e of Wisconsin -County of St. Croix a full, BRIDGET COUGHLIN I hereby certify~th17ithAs do¢ume opy Deceased true and corf&t,Z of 'fhe'.or~gi bit flle and of record In office aga,~I1, t~aen my compared by►e{' ' " I` FE y9~ ERS OFFICE Attest i ~~~r, r/9,,;~~►19 i ST, (7tt >IX CQ., V,11S. ~'~rl. ~t13 I;e ~~rd f ils 19th !fA a►` Nov A.D. 19 A .55 Regl tJn(C►flw~}s . ~7f RAE t File No. YJ • ~R- /7 The fi I judgment entered in the above entitled estate, on November 19, 1985 contains the following findings of fact and decisions, that: 1. The decedent died on October 28, 1984 2. Inheritance and income taxes have been determined and paid and all claims and charges have been paid. .r 3. Real property and secured interests in real property were assigned or terminated as follows: TO: Thomas P. Coughlin, the following described real property: The Northwest Quarter (NW4) of Section Eight (8), Township Thirty (30) North, of Range Seventeen (.17) West, St. Croix County, Wisconsin, EXCEPT the following described parcel: Commencing at the Southwest corner of the Northwest Quarter (NW4) of said Section. 8; thence _...North 743 feet to the Point of Beginning of this description; thence East 300 feet; thence North, at right angles, 116 feet; thence West, at right angles, 300 feet; thence South to the Point of Beginning. I hereby certify that the foregoing abridgment of final judgment in the above entitled estate is true and accurate. Dated November 1 9., 1 9 R n, By the Court, Reinstra, Van Dyk & Needham, S. C, J' f~~,~ 'may 71 Attorney John G. Bartholomew Circuit Judge 201 South Knowles Avenue, Box 127 Address New Richmond, WI 54017 Address No. 30-A (1980) ABRIDGMENT OF FINAL JUDGMENT s.863.29(2) STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/R Tom Coughlin ROUTE/BOX NUMBER 1671N. Co. Rd. #GG FIRE NO.1671N CITY/STATE New Richmond, Wi. ZIP 54017 PROPERTY LOCATION: SW 1/4 NW 1/4, Section 8 , T 30 N, R 17 W, Town of Erin Prarie , St. Croix County, Subdivision n/a , Lot No. n/a 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. rnj~Lry-,, DATE ` Z - ~f 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 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS }NDUST~iY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 769 N W1 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/CITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: SW 1/4 W14 8 /T 30 N/R1716or► W Erin Prarie n/a n/a n/a COUNTY: OWNER'S BU NAME: MAILING ADDRESS: St. Croix Tom Coughlin 1671N Co. Rd. GG,R.R.#1, New Richmond, Wi. 54017 USE DATES OBSERVATIONS MADE No. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILEDESCRIPTIONS: R A 1 N TESTS: RgrResidence 3 n/a ❑New Replace 14-18-90 -18-90 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURETE]MU STEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) 49S ❑U @tS M ❑U ❑ S TU conventional If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the /a under s.H63.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation: n decimal' PROFILE DESCRIPTIONS page 29 W BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHXK ELEVATION OBSERVED EST. IGHE T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 1 7.41 102.40 none >7.41 .83bl.1. .75bn.sil. .58bn.s.l. 5.75bn.c.s.&gr. B 2 7.25 101.96 none >7.25 1.00bl.1. 1.75bn.s.l.&gr. 4.50bn.c.s.&gr. B 3 6.82 101.80 none >6.82 1.00bl.1. 2.00bn.sil. 3.92bn.c.s.&gr. B- B- B- decimal' PERCOLATION TESTS TEST WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IW& AFTERSWELLING INTERVAL-MIN. P IOD 1 PERIOD 2 PERIOD3 PER INCH P_ o no 2 p_ Z_ 3.66 no 3 6 6 6 <3 P- 3 3.50 no 3 6 6 6 <3 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 horn 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 98.30 _ _ i I - - J_._._, a E . / le', q~r'~- I N . o ( 1,f -7 lff~t ~~Op 4- I `,,<fl "-VL A 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: Gar L. Steel 4-18-90 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 988 N. Shore Dr. New Ricbmond Wil 54917 229 7/15-246-6200 CST SI URE: D OSf 11 J DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - .I INSTPI )CTIONS FOR COMPLETING. FORM 115 - BD - 6595 To be a com curate soil test, your rer-i t i rrclude: 1. Comb, on; 2. The w Ay indicate wl his is a residence or commercial project; 3, MAXI' .~drooms or corn > 'cial use planned; 4. Is = nent system; 5. Cc rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL O"i YS11 ~ RULED OUT BASED ON SOIL CONDITIONS; 8. P' - 'rse tfi. ions shown here for writing profile descriptions and completing the plot plan; 7. LECt-1 yam accurately locating your test locations. Drawing to scale is preferred. A t f if desired; 8. k and vertical elevation reference point are clearly shown, and are permanent; 3. C. boxes as to (fates, names, addresses, flood plain data, percolation test. exemp- t 10. i as flog-I iin, elevation) do^- r .,?ply, place N,A. in the appropriate box; 11, your jr address and yoi : ,t>>Jon number; 12. rd distril, as required. A_ L 'IL TESTS MUST BE FILED WITH THE LOCAL AUT1 `Y WITH IN ~ tAYS OF C(-" ON. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS tes and I Other Symbols ne (over 10") FAR - Bedr~ Q - 10") SS - S, r(. - g avel (under 3") LS - Limes:. , s - ; )d HGW - High G, rter cs - rc- Sand Perc Perco' 'sat.; coed s sum &md W - Well is - Sand Bldg - Bu Is - L my S : > - Gr, fy L( < - Less r i ~.n A Bn - Bross:. ',1t Loam BI - Black; Sill, Gy - Gray Clay Loam Y Yellovy - Sandy Clay L. R Red Silty Clay L, mot - Mottles Sandy Clay wl - 4vith sic Si' 7 Clay fff - fi' st' nt ~c ( y cc - 0K)r lit - mm Mangy, : m nn - ck d - distinct' p - prom HWL - High . Jet, c,v xral soil textures stir li a taste disposal BM - Bench VRP Vertical` ice Point n r TIC = R vy c, ti'.. The co;ty or the Dep. may request . ni: et M w f, r th., nriVat(' l i or ~er to tart of zr Tom Coughlin rw, WIWI S8 T30N R17W Erin Prarie, Township )JDO L{- I4 77f dcl14- '76 t eo o po v 5 S7 ~Zoe .r ~a 7z Pin 30 Gary L. Steel 988 N. Shore dr. New Richmond, Wi. 54017 r~ MPRSW 3254 4-19-90 71z 32QzE, FEB 2 6 2003 11L 0 200? VOL 16 PAGE 4429 XATKEEA H. WALS ST. CROIX COU,YTY REGISTER OF DEEDS SURVEYOR'S_RC~?~?De~ ST. CROIX Co., WI RECEIVED FOR RECORD CERTIFIED S V RrV'EY MAP 12'20'2002 02:00PH REC FEE: 13.00 LOCATED IN PART OF THE SW1/4 OF THE NW1/4 COPY FEE: PAGES: 2 3.00 OF SECTION 8, T30N, R1 7W, TOWN OF ERIN PRAIRIE, ST. CROIX COUNTY, WISCONSIN. NW CORNER SECTION 8 SCALE IN FEET 1" = 100' OWNE 0 PAT 1682165TH AVENUE / a 100 0 100 200 NEW RICHMOND, WI 54017 Im / SURVEYOR EDWIN C FLANUM NOTE: 1 z THIS LOT IS CREATED UNDER NORTHLAND SURVEYING, INC. FARM CONSOLIDATION 856 A HWY "65" VARIABLE ROBERTS, WI 54023 RIGHT-OF-WAY NORTH LINE OF THE SW1/4 OF THE NW1/4 - a~ n I ~OdDdO[~G °a pro N LO N I (S86°30'0U" ' N83°30'47"'E 430.77 \ m~ o z° z 6.96'''..1 0 I 1 BARN ~ co o o a 0 W_ ❑ LOT P) N EXISTING 3.20 ACRES INC R/W o 0 Q M DRIVE 139,488 SQ. FT w N ~I 00 I ^ w 3.13 ACRES EXC. R/W ~ ° c=0 L91 O b 136,323 SQ. FT. 0 aI I = z HOUSE ❑ SHED y ~I 0I Z SEPTIC VENT GARAGE ~I Q I V g (TOP,) ❑ ❑ SHEDS w 13.75 421.12' u- S88°06'04' W 434.87 ~I ° Z MI~L?dLQ~'CD dGQGvJD~ 3 O~~1GD ~ ~ G°~dLa~r4CG3 40' 3' LEGEND N 40' 55' ALUMINUM COUNTY SECTION CORNER Z MONUMENTFOUND w0 0 0 1" X 24" IRON PIPE SET WEIGHING F- V m Q I S 1.13 LBS, PER LINEAR FOOT O N , p o 0O LL w 00 3/4" IRON REBAR FOUND w r z CV 0 I 91 100' ROADWAY SETBACK LINE w w O ¢ , r z m RAILROAD SPIKE FOUND o q: c\' LU LU a) d (xxxxxx) PREVIOUSLY RECORDED DATA Z Z _ z z W1/4 CORNER Z =I Z) U mo SECTION 8 SHEET 1 OF 2 SHEETS Vol. 16 Page 4429 LKIN HHAIRIE T•30N-R.17W. SEE PAGE 57 I /eo rH SEE PAGE 59 AVE. m y K O PO 7 E ETI LLOW F// cB D z. s e - v NVE. N by " Mike •D%//74 Ma,Baa 39 Zy/e z~ 239.2v a f WILLOW , /70TH a ti RI ER a9 //ei~P.n\a_~ s° y C d "v i• o flow ~ tl~ .dye/` .~s7. ~a 9 tl v ~y mm C7/%/ o w ~o'~d l .l Oyu h/ice M.cha-e/q .yii b.a Cd~ srph \ tl J^~ V. C -ao m Q Dav%d 9 R.E. s Don 4 0\ v //e~ .Q Te nesa. ~onnee¢ Nanc yy .F tl O /l/asen y tl J~ v ~ ~ S.Srj L° wren e QO e~a✓ /~sY Pe/cnson Sch t s- '.F CT Q ..v. C Co P Hare \ 165 TH 76 4° iPJ' O o ; 3 ' /bo AVE. 4o U 1547 • Ly/B ,r n/.;op o/dt c O 28° b be - Z Louse //6 G f7ndnew a.~8. s °¢se .z 4 0 .0,1 - Fonnesf eC7eo~ o. i~ \ 0 Robes Rzguet}c E/ea.~a/`e A/ .0 race //A zse y f7 be/'f ~ ~ N zz/ g Pa.t /5,3si go .Eioys/~oln C7i//en etaJ tl AVE. /60TH GX 7s • • Micha.e/F s • o: A Te ne s a. 9m F!/b en> n°~ o n - ~ \ o Petenso 4° ~ i ee 0 0 v Eugqene f C h cTohr. t Ida Bo Kink 96 C1n~ p Ten-Rae Fan cs Raymon .eo ~.Y o H° k hs .~x~ 240 IJeii~.s .9 Nci/i /so.b `Q I/o ¢h~e Geu Inc. ~T M/tch- ~y-oddand 16 G e/%e{u70 M f bucf FD. P i//p F /bo v ✓ /a• qo Yr. Mi/fon Si; zoo O •tl0 /09 !in{{if/i F Donoth 'Bu~~ow SiZ /00.5 Pete,-son ~O Cr, Q Thomas Bo DaiyInc v ~tl Fiday H 140 rna/ cTef/' U Uohn L. ,Bun~ow Q C tl Ca 70 : y F• n rockPah/e ljeuink J ~nev2 s20 40 C7 B er 9h~y . /s9 s 4 3o C lels4n 80 G tePhen • • do G W q 3 Caro/ n yO e R N ER/- SJenn7 Gnare a mi o /s9 not er vpy % /s7 B4 99 ® Emmert mke E C. Lemke • o ~~a M 38 iYeo l x", uc~ite cTO/i - A`4C y Derma/s frji~zce 320 X33- ~Q M¢/only ~n ~w , n Emme~-f Cemk F7tnm,5 dames zoo Do othyE 9nnaMar/e ' 4 RI-U nC~a Hano/d P ibnow Con ter Ku.EusR¢ yv0, ~o~n~an 71 /60 etal ~.Co C~~v •Ka ~n zoo a an P/-rihPS •vo/y oohs c CI lO ~i• f Kana.~ /5/aS ,3/B.os .9i7.so,7 ro/y tl C L /-zo a/>z,• ~Q~ g ze9.64. . Kann /Go /40TH -v-o .0 /6 0 • •/o z AVE fJnihu~ E men>,- C v o qo R y„ 70 /6 denfi~cz L. flnthonL. t efcix v ~ V uam He i/buc% h/deed . ~ C /7o z4a ~ C "+tl w ~y Nora. ¢o obe~s>e, O Etc'. Ler~ E E i C C ry Q 4d zoo o e //oo ~v. JV ~ ~tl Q1CwO ene ~d~ En._r erq z4-o Q o 7s ~9 Y ne UZ fE el' 40 Rchorct ~ Zl i7°n y _e Louis H f ~Tud J ennis e M uan yy y c~ra-ce a . s¢n,,,,~,~i ti L//fenY,s y v cv " E/i nron' tafsY-~o/t 0 °y /6o go y-0 Ch:/~~ ai/s.~t c Emm~/-t C vo~° ~ ~ /<t ~v~0 m. CcS~o JS t. /3 ~e1a .Be C q Tom ~ C:z no / ~ / h ~ Ka / N V ~m eC o0 444 99 o h ER .ea .nnn F/o/i- tlno~.vp "z / is yo F Y3 . A ~J• g° Bo J30TN 4. o'a ~ ` ill .3 f 90 AV ~ • h~/d ,Qfcfiar~ duds • ; 4o B now w ~l sconsi La ~y K h/.,-,a.~ !Nz/ke0 Sto-fsho/t 23o B ~ b e ~ ~ ~y ward cc C D. . R. Ouam /zo HO C o s a p Bo :v b tl ~tl /zo /s_s i h 4 ~W¢lke¢ 63 /sbs `C q C GPh/ - 6anr /eo T ulo qu0 e/h 0 30¢ \ o ev va b S Y L. ee ~9 3 2 O 4a 'j n /69 e4- ir -11 40 Ke/7Ga ~~o \ q O uM tl 0 C onah-z, ~a o /orea,e* Na/so aQs i „e h E ~¢~e/r x Sic. 3 c Fa °~o j' MO/-_y 'C .Or• 40 Snc~y o eye shen C o~• 99 S f. ry oo V\ n L¢~d y W //ia.n7 R cTohi C n w C o 20 `1 - yy"w ~U ~ CC o '7 CO ti £MaKi~e ~ 'C ~ l•v /zo o Cp nyC FJnthun wv /ao~ ~ 3 0~ v~ vin yd ,c5 E 3tl 0 /60 • Vtj,~ Perionso~ .z7a f s ~tl N~ ooaF a era o Th~ p hu/ 3 zaTH Z 7z Q w E,eas Y o/9gS~poc.E•Lon M¢,o SEE PACE 31 cSt Cno:x uy w's FARM COUNTRY SERVICE NEW RICHMOND FIRESTONE PHONE: 246-4238 ON THE FARM SERVICE RIVER FALLS Tractor Tires • Light Truck Tires PHONE: 425-7671 Car Tires LAKELAND PLANT New Richmond 54017 PHONE: 436-8886 or 386-3922 Route 3, Box 317A SAND GRAVEL READY MIX CONCRETE P/2 Miles East on County K 246-5040 ' h -7 1 398 FTFMAY 1 1 2004 VOL 17 PAGE 4500 KATHCEEK H. WALSH~- REGISTER OF DEEDS ST. CROIX CO., WI CERTIFIED SU FNEV MAP RECEIVED FOR RECORD 04/23/2003 09:50AN LOCATED IN PART OF THE SW1/4 OF THE NW1/4 CERTIFIED SURVEY NAP OF SECTION 8, T30N, R1 7W, TOWN OF ERIN REC FEE: 13.00 PRAIRIE, ST. CROIX COUNTY, WISCONSIN. COPY FEE: 3.00 PAGES: 2 SCALE IN FEET 1" = 100' 100 0 100 200 OWNER PAT McNAMARA 1682165TH AVENUE NEW RICHMOND, WI 54017 SURVEYOR NW CORNER EDWIN C FLANUM 11 SECTION 8 NORTHLAND SURVEYING, INC. 856 A HWY "65" Z ROBERTS, WI 54023 w 1~ y o I UJi dQ4~ CSo~oG o Z i Mi ( MOL 0 ~_05, P@. 4410 C5 I - - ~I I I 13.75' 0 3 N8$`06'04"E 434.87' cl W 421.12' 1 a - - - - y- - - - - - - -1 IA N SHED 0D 1 I w V 0 I r c~~ a l ?'F co ~ o r I LOT 2 di ~I r ~~~~a~ 1.77 ACRES INC R/W O I I Z T l g 22.00' 77,093 SO. FT. N 1' 1 ~I 1 I l!. - - I 1.73 ACRES IXC. RNV N ~1 0o ~I 00 1IN88°22'~8"W' `r - - - - 75,245 SO. Ff, c 1191 a I no 1 38.46 40' 5. C ~I I N L i i i 11iu S89001'11 41W 398.91' a~ a O; co - owl -aG------ dC~ ~i 0 mil OMMM) @ w [PRAU C R zi OBI ~ I °I z W1/4 CORNER SECTION 8 Approved on Y12 /a b _ Zoning Department. THIS INSTRUMENT SHOWS THE RESULTS OF A PARCEL OF 0.97 ACRES REZONED FROM AGRICULTURAL TO AG-RESIDENTIAL FOR THE PURPOSE OF ADDING IT TO AN EXISTING PARCEL OF 0.80 ACRES WHICH IS ZONED AG-RESIDENTIAL. NO NEW LOTS ARE CREATED BY THIS INSTRUMENT. LEGEND N ALUMINUM COUNTY SECTION CORNER Z IS MONUMENT FOUND z Z w0 0 1"X 18" IRON PIPE SET WEIGHING U w 'L 1.13 LBS. PER LINEAR FOOT vwi m~ • 1" O.D. IRON PIPE FOUND z r g 2 o a 100' ROADWAY SETBACK LINE w z co ° Lu m RAILROAD SPIKE FOUND w p o ~cD ~zM zz .J ~o m SHEET 1 OF 2 SHEETS Vol. 17 Page 4500