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HomeMy WebLinkAbout014-1074-40-000 s 0 o Q' 3 o O v r ~ y q y lT~ C a G f.7 ~ N ~ O L c o m LL CD c a_ cn 0).0 N N n E O d a Y E E" > Co 7 r t- 3 m z M O C O L "O LL C N N O c) j,l~ C C :3 p V N 0 (D E Q 2 NN Occ) U CO O N r X y in > O Z a (D a co c') F- U) C C7 O Z d U r cn (n N r 2 c O • 0 O = Z Z N M o V J N N cacti N V) C 2 N D W i O ~ 0 Uc o a ° _ c o O O d u) 2 IL CL 0- Z a . CO N rn rn U Ln M o `n CO o o = 0 04 r~ m O O N C C6 O Q O O O O O r V C O U) U) v Lr) 3 n n U~ p ui I-O o o V r 20 0) E E • O co LL U- O =5 Z, Zoe 51 V 0 d a a a • c~ a m .2 d y c r1~1 E o c c (i A 0CL2 0i0 FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SECTION Z/ T -R W ADDRESS/ (e3 ST. CROIX COUNTY, WISCONSIN a/A, SUBDIVISIONLOT_A~CLOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM eof f, INDICATE NORTH ARROW BENCHMARK: Elevation and description: L..w t Alternate benchmark SEPTIC TANK:Manufacturer: Liquid Cap. Rings used: Manhole cov elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from arest road:Front , Side , Rear Ft. From nearest rop. line:Front , Side , Rear Ft. No. of et from: Well , Building: clude this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: iquid Capacity Pump Model: Pump/Siphon anufact.: Pump Size Elevation of inlet: B tom of tank elevation Pump on elev.: Pump f elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from ne est prop. line: Front, Side, Rear_Ft. Distance Well Building _ SOIL ABSORPTION SYSTEM Bed: Trench: Se age Pit: Width: Length Number of Lines: Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top pipe: No. feet from earest prop. line:Front , Side , Rear Ft. No. feet rom well: No. feet from building HOLDING TANK / Manufacturer: / C `f PYP Capacity : 02 p 0 1 ' No. of rings used: 2-1 Elevation of bottom tank: eZ f, Elevation of inlet: No. feet from nearest prop. line:Front Side , Rear Ft.6c:~0 No. feet from: Wel1140', building_7D ' , nearest road Alarm Manufacturer: Ftic i / INSPECTOR: DATE:. ` PLUMBER ON JOB : LICENSE NUMBER: v7 Z 6/90:cj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LADOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION ~1;5WYVI,~Sec.34 T31-R15 State Plan I.D. Number: ' ❑ CONVENTIONAL ❑ ALTERATIVE (Ifassigned) Town of Forest Co. Rd. S Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Forest Ridge Hunt Club 1963 310th Ave. Glenwood City, BENCH (Permanent reference inI) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST FIEF PT. ELEV.: ____7 Id. 001 Name of Plumber: MP/MPRSW No.: County: anitary Permit Number: Gar Steel 3254 St. Croix 1 149047 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED 93.6,o EZ 3* ENO ~❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER JWUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALAR FEET FROM LINE: r AIR INLET: ❑ YES ❑ NO E~TYES ❑ NO NEAREST----00' > .5'" DO ANUFACTURER: 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 ❑ YES ❑ NO NEAREST 111111~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the th of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction sl a ease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE S CING: COVER INSIDE DIA.: # PITS: LIQUID DIMENSIONS TRENCHES: MATERIAL: PIT DEPTH: 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: FEET FROM LINE: AIR INLET: NEAREST ~ MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the 'II material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make c rtain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medi sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PE MANENT MARKERS: OBSERVATION WELLS; YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ N ❑ 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. NJ~Z_. DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VS8TICAL LIFT CORRESPONDS TO INFORMATION AP OVER PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROP Y WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST-► IA- zo Sketch System on eta, In county file for audit. Reverse Side. SIGNATURE- TITLE: SBD-6710 (R. 06/88) DtLH I SANITARY PERMIT APPLICATION .COUNTY e~._ In accord with ILHR 83.05, Wis. Adm. Code St. Croix STATE SANITARY PERMIT # Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 8% X 11 inches in size. Check if revis on co previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S91-40285 PROPERTY OWNER PROPERTY LOCATION Forest Ridge Hunt Club SE t/4 SW t/4, S 34 T31 , N, R 15 Mor) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 1963 310th. Ave. n/a n/a CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Glenwood City, Wi. 54013 715 265-4533 n/a 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State owned a VILLAGE :Forest Co. Rd. ##S EiPublic ❑ 1 or 2 Fam. Dwelling-# of bedrooms - PARCEL X NUMB 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 103H 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 90 Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. Il 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 ❑ 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 520 n/a n/a n/a n/a n/a Feet n/a Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App INFORMATION LTanksf!a!ks structed Holdin Tank 2 00 2 Midwestern SUCCAM or Lift Pum Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber' Signature: (No S m )MBtMPRSW No.: Business Phone Number: Gary L. Steel 3254 715 246-6200 Plumber's Address (Street, City, State, Zip Cod-e): 1554 200th. Ave., New Richmond, Wi. 4017 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved San' ry Permit Fee (Includes Groundwater a e ssue Issuing Agent Signature (No Stam Approved El Owner Given initial Surcharge Fee) gel! Adverse termination 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 W 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. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete fine 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'/z 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; (lose 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) 4028 IN O RY, OF REPORT ON SOIL BORINGS -AND SAFETY 81-11-1711ING, INI`~US t1S1 DIVISION LABOR ' P.O. BOX HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53969 (H63.09(1) & Chapter 145.045) LOCH 10 €c-TT-W.- TOWNSHIP/nRarnfFue"ITY: OT NO.:BLK. NO.: SUBDIVISfar\ NAME: SE '/W 1/4 34 /T31 N/R 15k (or) w Forest n /E n/a n/a COUNTY: OWNER'S/BUYES S NAME- . MAILING ADDRESS St. Croix Forest Ride Hunt Club 1963 310th. Ave. Glenwood City, Wi. 14013 USE DATES OBSERVATIONS MADE Residence I n/a hunting club l ~ew Bmplace 5-1-90 n/a TS]I RATING: S_ Site suitable for system U- Site unsuitable for system RECOMMENDED SYSTEW(optioxd► CONVE TT jU M ❑SOUND:®U =b4U IN.G SY D S -IN®U LL ~ BOLDING ❑ U TANK: R holding tank ~Sfl If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)Ib), indicate: n/a f ( Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 24 SaC2 B()HING TOTAL ELEVATION DEPTH T R U DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, r =XTURE, AND DEPTI4 NUMBER DEPTH 1 OBSERVED ES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK) _ B_1 3.59 n/a 1.00 .42 .42bl.1. 3.17bn. mot. s.l. B_2 3.08 n/a 1.42 .33 .33bl.1. .75bn.mot. sil. 2.00bn.mot. s.l. B 3 2.75 n/a 1.33 .50 .50bl.1. .83bn.mot. sil. 1:42bn. mutt. s.l. B- 4 2.83 n/a 1.58 .58 .58bl.1. 1.00bn. mot. sil. 1.25bn. mot. s..l. B-5 5.67 n/a .75 .75 .75b1.1. .67bn. mot sil. 4.25bn mi`t. s.l. B_ 6 3.84 n/a 1.92 .50 .50bl.1. 1.42bn. mot. sil. 1.92bn. itot. sA. NN pp~~,~ T PERCOLAtION TESTS tJl1MBEft NCHES ATERSW6~lINO INTERVALI IN. f DROP IN WATER LEVEL-INCHES P R INC P - - P---- -iLa - P - P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. (Ict-tribe what are the hori 7ontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and ,:he direction and percent of land slope. SYSTEM ELEVATION n/a Irr ~~.AE-S _ l otiFS - f 1 i I i I ~ i I TH C,i ~ I I i j I ► i I i t~ I ~a- vv~ ~ i ~ I I I I ~ s jl F,~,, 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods so-icified in the Wisconsin Administrative Code, and that the date recorded and the location of the tests are correct to the best of my knowledge and belief. N'nnnF-1PIon1j. - TESTS WERE COMPLETED ON: Gary L. Steel 5-1-90 nl)f)ItFSS'' CERTIFICATION NUMBER: PHGI'f NUMB Enlopiional►' 988 N. Shore Dr. N , New Riclunond, Wi. 54017 2298 715_.246-6200 CST SIGN E: DI97 RIRUTION: nrininal and one cnpv to Local Authority, P,(ir- iv anrf Soil Tester. { , Gj , S91-40285 STEEL'S SOIL SERVICE 1554 200th. e. teary L.. JIE'L'l ?AA AI Chnrn ive C.S.T. 2298 holding tank New Richmond, WI 54017 MPRSW-3?54 for (715) 246-6200 Forest Ridge Hunt Club S04SW4 s.34-T31N-R15W form of Forest, St. Croix co. pages #1----------plan approval application #2----------project detail data sheet #3----------holding tank agreement #4----------holding tnak servicing agreement #5---------- plot plan #6---------- soi.l boring data #7----------holding tank profile Mai Gary L. Steel ~ 4-25-91. Wiscorisin Department of industry, ONSITE SEWAGE SYSTEMS Cinsite Sewage Section Labor and Human Relations 201 E. Washington Ave., Rm. 141 -Safety and Buildings Division P.O. Box 7969, Madison, WI 53707 PLAN APPROVAL APPLICATION (608) 266-3615 - ~a~ ®709 R INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be r w AN II all fees are received. The reverse side of this form describes most of the required plan information. Further requirements may be contained in the Wisconsin Plumbing Code, which can be purchased from the Department of Administration, Document Sales and Distribution, 202 South Thornton Ave., P.O. Box 7840, Madison, WI 53707, Telephone (608) 266-3358. 1. PROJECT INFORMATION (Type or print clearly) Plan Number Previously Assigned Name of Submitting Party (plans returned to same) Project Name Gary L. Steel Street Address, P.O. Box # or Rural Route Project Addressor Legal Description 1554 200th. Ave. SV4SW1S34-T31N-R15W City or Village State Zip Code City ❑ County i4ew Richmond. Wi. 54017 Village ❑ of Forest St. Croix Telephone No. (include area code) 715-246-6200 Town Designer Name of Owner Larry McNamara al eA Telephone No. (include area code) Telephone No. (include area code) 715-265-4533 Street Address, P.O. Box # or Rural Route Street Address, P.O. Box # or Rural Route 1963 310th, Ave, City or Village State Zip Code City or Village State Zip Code Glenwood City, Wi. 54013 2. APPLICATION FOR: ❑ Experimental ❑ Mound System Q Holding Tank U New Construction ❑ Large System ❑ Conventional Gravity System ❑ Groundwater Monitoring ❑ Replacement ❑ At-Grade ❑ System in Fill ❑ Petition For Variance ❑ Revision ❑ Pressurized System ❑ System in Flood Plain (attach SBD-6698) ❑ Other Alternatives 3. FEE COMPUTATIONS (include existing tanks) FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO SAFETY & BUILDINGS DIVISION. a 750- 1,500 gallon septic tank $ 50.00 b 1,501- 2,500 gallon septic tank $ 60.00 L. 2,501- 5,000 gallon septic tank $ 80.00 d. 5,001- 9,000 gallon septic tank $100.00 e. 9,001- 15,000 gallon septic tank $150.00 f. Over 15,000 gallon septic tank $ 250.00 g- 500- 1,000 gallon dose chamber $ 30.00 h. 1,001 2,000 gallon dose chamber $ 50 00 _ i. 2,001- 4,000 gallon dose chamber $ 70.00 J_ 4,001- 8,000 gallon dose chamber $ 90.00 k. 8,001- 12,000 gallon dose chamber $110.00 L Over 12,000 gallon dose chamber $150.00 m. 500- 5,000 gallon holding tank $ 30.00 30.00 n. 5,001- 10,000 gallon holding tank $ 55.00 o Over 10,000 gallon holding tank $100.00 p Revisions $ 20.00 q Groundwater Monitoring - Per Site $ 32.00 (other than a proposed subdivision) r. Petition For Variance: Setback $ 25.00 Site Evaluation $ 50.00 Subtotal: _ 3o no s Priority Plan Review: Enter same amount as Subtotal Total Fee: SBD 6/48 (R 10/90) NOTE:Fees are pursuant to Wis. Adm. Code, Chapter Ind. 69, and OVER are subject to Change annually Plb.'# 60 1/78 PROJECT DETAIL DATA SHEET NAME OF BUSINESS Forest Ridge Hunt Club LEGAL DESCRIPTION SE%SW-k S.34-T31N-R151-1 town of Forest, St. Croix County OWNER _Larry McNamara - MAILING ADDRESS 1963 310th. Ave. Glenwood City ZIP 5401' ARCHITECT, ENGINEER, Gary L. Steel ADDRESS 1554 200th. Ave. PLUMBER OR DESIGNER New Richmond, Wi. ZIP 54017 TELEPHONE NUMBER 715-246-6200 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed. Please consult Section H 62.20. Existing building x New building Addition x (x) Apartments and condominiums . . . . Number of bedrooms 3 ( ) Assembly hall . . . . . . . . . . Seating capacity ( ) Bar . . . . . . . . . . . . . . . . Seating capacity # of meals served ( ) Bowling alley . . . . . . . . . . . Number of lanes ( ) With bar ( ) Campground and camping resorts . . . Number of sewered sites Number of unsewered sites Total number of sites ( ) Camps . . . . . . . . . . . . . . . ( ) Day use only Number of persons ( ) Day and night Number of persons ( ) Catchbasin . . . . . . . . . . . Number ( ) Church . . . . . . . . . . . . . . . ( ) No k-3_tchen Number of persons ( ) Dance hall ( ) With kitchen Number of persons . Number of persons ( ) Dining hall . . . . . . . . . . . . Number of meals served daily ( ) Dog kennels . . . . . . . . . . . . Number of enclosures ( ) Drive-in restaurant . . . . . . . . Inside seating capacity Car-service Number of car spaces ( ) Dump station . . . . . . . . . . . Number of dump stations ( ) Employees ( total of all shifts) - . Number of employees 1 (1) Hotel ( ) Motel ( ) Cottages . . . . Number of units with 2 persons per unit Number of units with 4 persons per unit ( ) Medical and dental office bldgs. Number of doctors, nurses, medical staff Number of office personnel Number of patients ( ) Mobile home parks . . . . . . Number of sites ( ) Nursing homes . . . . . . . . . Number of beds ( ) Parks . . . . . . . . . . . . . Number of persons ( ) Toilets ( ) Showers ( ) Restaurant . . . . . . . . . . . . . Seating capacity ( ) Dishwasher and/or disposal? ( ) 24-Hour service Retail store . Total number of customers Schools . . . . . . . . . . . . . . Number of classrooms _T7 Meals ( )'Showers ( ) Self service laundry . . . . . . . . Total number of machines ( ) Service station . . . . . . . . . . Number of cars served daily ( ) Swimming pool bathhouse . . . . . . Number of persons (x) OTHER . . . (Specify) . . . . . . . outdoo- Sn r f .~.pp~t s-- it i tT-, hunt c liib COMPLETEO ppOTHERpp..lSIDEr day 05 gal x 10=50gal.x5=250 gal., ,x j ,2. Indicate whether the following facilities are present. -1 - 4 0 2 8 5 Floor drain yes no Number of drains Food waste grinder yes no x Dishwasher yes no x Automatic clothes washer yes x_ no Number of clothes washers 1 3. Septic tank capacity 00 gal. al. per apartment Holding tank capacity 2 ¢al 2GW al. per employee Septic or holding tank manufacturer 25 outdoor sports facility M~ trite-S'a+~ 1?9LQCAs-r~. 4. SEEPAGE TRENCHES: total square feet n/a width of trenches length of trenches depth number of trenches ~I SEEPAGE BEDS: total square feet n/a width length of bed depth SEEPAGE PITS: total square feet n/a ' outside diameter depth below inlet total depth from top to bottom of pit Signatur person com leting form: FOR DEPARTMENTAL USE ONLY 10 f?wt-c- x 5 = Address 1554 200th. Ave. X38 4So New Richmond, Wi. Zip 54017 S x S 6oa~.Q Telephone Number 715-246-6200 z© Z O'er` Date 4-25-91 ONSITE SEWAGE SYSTEM A P--YPROVt:u DEPARTMEP F INIDUSrRY, LABOR ANN AN RELATIONS IS ON W-*ND 1NGS x SEE CORK SPO NCE STEELS SOIL SERVICE t ve. 1554 ZOO. Gary L. Steel C.S.T. 2298 plot plan New Richmond, WI 54017 MPRSW-3254 Forest Ridge hunt Club (715) 246-6200 SE%SW4 S.34-T31N-R15W town of Forest, St. Croix Co. Nei 'H)Se.wi~- ku'i s. W n V- p g t, S ~E r/t e~-~S M/! W 4461 ~ s'C, µrL 83. 18C+~a CA) S1-.f-! n B~, i5 f`~~CH~ T7SNK IWSTA~~...d~ori St~,{`.t, B~ ASS 2'Ev- ILNR $3, iS 1 ~r GF SYS A u w e6,+ W 3~ ~s ~-c • ►C Ng~~' E g~W e tlonJ4 10 oN I F y~ UMpP, RE~,P,TI Uj ~R9OR A U p~NGS 10 Ft, M rw S~tRV►tE E QF lyOUS~R pN POA© AIJ "~'+a•Vk SEW(CE N1IV1~ItM OGPAR~~, iV1SlON .a.i pENGE °o~ SEE COR 2 i t 1 J1 W n i S91-40285 HOLDING TANK SERVICING CONTRACT This Agreement is made an' entered into this day of ( 19~~ by and between Q.,~t~.L[ CL.t (A D. A 1 hereinafter called the "owner" and ~ZO'bAJ (fete hereinafter called the "pumper." We hereby acknowledge the installation of (a) holding tank(s) on the following described property: 1. The owner agrees to file a copy of this contract with the local governmental unit hereinafter called the "municipality", which has signed the pumping agreement required in ch. ILHR 83.18 (4) (b), Wis. Adm. Code and with the County of (iu 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code and to the county a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to submit a report which shall include: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipality and the County of ,c within ten (10) business days from the date of change to this service contract. I EXAMPLE 9 - i SIGNATURE OF OWNER(S) : I1 J SIGNATURE OF PUMPER (Include License Number): Lam. i State of Wisconsin )came before we this day of A.D., 19 11, )to me known to be the person who executed the foregoing County of CAA-Ll )instrument and acknowledged the same. Subscribed and sworn to before ' Me this 5 day of LC Cr ~ lg Notary i my commission expires & ~ . ~ Tg I i I i This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations, Bureau of Plumbing. EXAMPLE 10 - 4GS 774 ~ 9001`01302 REGISTER'S OFFICE ST. CROIX CO., WI Recd for Record APR 2 91991 C 10:30 A. M "OWING TANK AGREEMENT Register of Deeds 0285 1 This Agreement is made and entered into this day:of by by and between the n,e hereinafter called the "municipality" hereinafter called the "owner." and We hereby acknowledge that application is being made for the installation of (a) holding tank(s) on the following described property: k) '14 S,3V 74 A) 12.16 tt~ 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. We also acknowledge that said property cannot now be served by a municipal sewer, any other type of private sewage system as permitted under ch. ILHR 83, Wis. Adm. Code, or ch. 145, Stats., and that the property of soil suitable for any other type of private sewage system as area does not contain an permitted by ch. ILHR 83, Wis. Adm. Code. to issue a Therefore, as an inducement to the County of sanitary permit for the above described premises, we hereby agree and bind ourselves as follows. 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. and 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. Stats. 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 •aner within thirty (30) days from the date of notice. In the event the owner does not pay tie costs within thirty (30) days, the owner hereby specifically agrees that all of the cots and charges may be placed on the tax roll as a special assessment for the abatement ,f a nuisance, and the tax shall be collected as provided by Wisconsin Statute. 3. The owner, except as provided by s. 146.20 (3) (d), Stats., agrees to contract with a person who is licensed under ch. NR113, Wis. Adm. Code to have the holding tank serviced and to file a copy of the contract or their 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 r days fraAm the date of change to the service Fontract. - EXAMPLE 7 - 4. the owner agrees to contract with a person 1'icensed under ch. N11113, Wis. Adn. Cody 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), Stats., the owner shall submit the report to the municipality and the county. f 900 PAGE 3(" S. 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 file the agreement with the register of deeds which 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 ~isinstalled. SIGNATURE OF OWNER(S): SIGNATURE OF MUNICIPAL OFF CIAL (Include Title): Y State of Wisconsin )came efore me this day of A.D., 19 91. )to Me known to be the person who executed the foregoing County of SjCA" _ )instrument and acknowledged the same. Subscribed and sworn to before ee /I Me this day of 19 L kc , Notary .r My commission expires 19 q1 RECEIVED FOR RECORD 29 day of April A.D., 19 gl, at tp_;.3po'cIockA. M. and recorded in Volume 900 of Yster & 303 Deeds 4t r'rni x County This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations. Bureau of Plumbing. - EXAMPLE 8 - #A ~.4re sg too sI~N OOe+ro •w MM to sats>'ec, P4 44 t' 94 0 •t as W + P. 0. n N O 44 CA rc PI s-4 in N ' M A N r O 4 0 • i IV a C ~ j • h A. M r w a lot • r ~ N d w i • o ~ I ~ ~ (D • C • • W Ul c ^ r w •n ,4 i W • Zl . y • : 11 r, A y' r M c n to p ,r r n R I = r C1 c w [h w~~+ne`v/ s H Id r w w r s~ O i 9 s o A z 30 ipj r~ N Ct.~ ` vl :s1 ; r-1 i In ,t1 = H 1, a lip or a -4 o-4 M w , O ^ ~ S 6 n ~r L-1 n i o M if r r y~ p .M 0%9 00 i♦ n • a ^ ~ r . r• w A Tommy G. Thompson SAFETY & BUILDINGS DIVISION Governor Gerald Whitburn Secretary State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Western Regional Office 2226 Rose Street LaCrosse, Wisconsin 54603 GARY L. STEEL Owner: FOREST RIDGE HUNT CLUB LARRY MCNAMARA 1554 200TH AVENUE 1963 310TH AVENUE NEW RICHMOND WI 54017 GLENWOOD CITY WI 54013 RE: Plan Number: S91-40285 Date Approved: May 8, 1991 Gallons Per Day: 520 Date Received: May 3, 1991 Project Name: FOREST RIDGE HUNT CLUB Location: SE,SW,34,31,15W Town of FOREST County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - REPLACEMENT HOLDING TANK Inquiries concerning this approval may be made by calling (608) 785-9348. Sincerely, r~ \ GERARD M. SWIM Section of Private Sewage Division of Safety and Buildings PPP039/0009n/34 cc: FOREST RIDGE HUNT CLUB X Private Sewage Consultant SBU-6123 i H. 07/901 r - • APPLICATION FOR sAHITART PERMIT • 9TC-100 This opplicatlon form Is to bo conplatod In full and signed by the ovnet(s) of the property being developed. Any Inadequacies wi11 only result In delay3 of the pztmlt Issuance. -Should this development be Intended for resale by owner/contcactoc,(epec house), thon a second torn should be retained and completed when the property is sold and submitted to this office vith the appropriate deed recording. Ovntr•of property Forest Ridge Hunt Club Location at property SE 1/4 sal/4r section X34 3_JI-R 15 Y Township Forest Matling address 1963 310th. Ave. Glenwood City, Wi. 54013 Address at s i t a _ ~a • ~ ~__(a° r _C~~>I;k, . C[~~ • ~ ~3 subdivision name n/a • Lot number n/a Ptavlous owner of property FHA Total sl:a of parcel 160 Acres ' , Date patcal was created 2-27-90 Are all corners and lot lines ldentlflable? x_Yas _ Ito Is this property being developed for resale (spec house)?,,,__Yss X Mo volures ,(e(050-nd Page Humber a■ cacotdod with the Register of Deeds. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - INCLUDE WITH TNIB APPLICATIOH THIf FOLLOW1HCt 11 VAARANTr D11D which Includes a DOCUMENT NUMBER, VOLUNIt AND PAGE XU1ls[R, and the 81,kL OF VIE RSOIBTRR OF DRBDA. In addition, a eectltled survey, it available, would be helpful so as to avoid delays of the teviewing process. it the deed description teterencas to a Cattlfled sutvay Hap, the Cattilled survey Hap shall also be required. PROPERTY OVNER CRRTIFICATION I(ve) certify that all statements on this torte are true to the best of .y (ovc) tnovledget that f (we) am (are) the owner(s) of the property descclbed In this information form, by virtue of a warranty dead recorded In the office of the county Reglstst of Deeds as Document No. V-5-te (o ,~j 1 and that I (ve) presently own the proposed site for the sewage disposal ayate~n (oc I Ivel have obtained an easement, to tun with the above described property, for the consttuctlam of sold system, and the same has been duly recorded In the office of the Coynty, ~pegister of Deeds, as Document No. signature at ownee 819natut• of Co-owrec (IL J►ppllcaDle) 5-9-19 Data of elgnatute Date of signature 45667 pos► REGISTER % ()FFICE ST. CRO IX Q., WI 9 Ree 4 for'Noewrd (Revv. 0-2 , IV8--81) 81) UNITED STATES DEPARTMENT OF AGRICULTURE Olt' MAR J 5 1po 1:55 ~~JJMn~ FARMERS F IOME ADMINISTRATION - CM Q U I T C L A I M U E E U Regt:fer of Deeds The UNITED STATES OF AMERICA, acting through the.Administrator of the Farmers Home Administration, United States Department of Agriculture, CONVEYS and QUITCLAIMS to FOREST RIDGE HUNT CLUB, INC., Grantee, for the sum of FORTY-FIVE THOUSAND ONE HUNDRED FOUR AND NO/100 DOLLARS ($45,104.00) all interest in the following described real estate situated in the County of St. Croix, State of Wisconsin, to wit: Southwest Quarter (SW1/4) of Section Thirty-four (34) in Township Thirty-one (31) North, Range Fifteen (15) West, St. Croix County, Wisconsin, EXCEPTING therefrom parcels previously conveyed for highway purposes and further subject to existing easements of record. Conservation Easement Reservations in the United States By this instrument there is reserved in the UNITED STATES OF AMERICA, its successors and assigns, a perpetual conservation easement on the property conveyed by this deed. This easement is under the authority and in furtherance of the provisions of federal law, including sections 331 and 335 of the Consolidated Farm and Rural Development Act (7 U.S.C. 1981, 1985), Executive Order 11990 providing for the protection of wetlands, and Executive Order 11988 providing for the management of floodplains. The restrictions and covenants contained in this easement constitute a perpetual servitude on and run with the property. The Grantee and all successors and assigns ("landowner") under this deed covenant with the United States to do or refrain from doing, severally and collectively, the various acts mentioned later in this easement. The United States is reserved the rights enumerated in this easement for itself and its successors, agents and assigns. dog 865PA~E`3~~ ~r Description of the Easement Area. 7j, 31N., R. 15 W., 4th P.M., Section 34 as•shown on Exhibit A and described on Attachment A, with.access across the SE1/4, Section 34. For additional reference: See the attached Exhibit A for a map delineating the general area included in the easement reservation. II. Covenants by the Landowner A. No dwellings, barns, outbuildings or other structures shall be built within the easement area. B. The vegetation or hydrology of the described easement area will not be altered in any way or by any means or activity on the property conveyed by this deed, or property owned or under the control of the landowner, including cutting or mowing; cultivation; grazing; harvesting wood products; burning; placing of refuse', wastes, sewage, or other debris; draining, dredging, channeling, filling, discing, pumping, diking, impounding and related activities, or diverting or affecting the natural flow of surface or underground waters into, within, and out of the easement area. C. Notwithstanding the provisions of paragraph 11-B above, the landowner shall be.responsible for compliance with all federal, state and local laws for the control of noxious or other undesirable plants on the easement area. The responsibility for such plant control may be assumed in writing by and at the option of the easement manager where the control or manipulation of such plants is deemed by the manager to affect easement management programs or policies. a. y iV0! 865 PAGE 474 Page 3 of 6 D. Cattle or other stock shall.;not be permitted on the easement area, except that the easement manager shall permit access to and use of waters within the area necessary for stock watering under such terms and conditions as the easement manager deems necessary to protect and further the purposes of this easement, provided: (1) the easement manager bears the costs of building and maintaining fencing or other facilities reasonably necessary to preclude stock from entering the easement area; and (2) access for stock watering need not be permitted where other waters ere reasonably available from other sources outside the easement area. III. Rights Reserved in the United States. The United States, on behalf of itself, its successors or assigns, reserves and retains .the right, at its sole discretion, to manage the easement area including the following authorities: A. The right of ingress and egress to conduct wetlands management, monitoring, and easement enforcement activities. The easement manager may utilize any reasonably convenient route to access to the easement area. However, the landowner may provide a designated route to and from the easement area so that damage to.farm operations can be reasonably avoided. B. The right to install, operate, and maintain structures for the purpose of reestablishing, protecting, and enhancing wetlands functional values including the taking of construction materials to and from said sites. C. The right to establish or reestablish vegetation through seedings, plantings, or natural succession. D. The right to manipulate vegetation, topography and hydrology on the easement areas through diking, pumping, water management, excavating, island construction,'burning, cutting, pesticide application, fertilizing, and other appropriate practices. E. The right to conduct predator management activities. F. The right to construct and maintain fences in order to prevent grazing or other types of encroachment on the easement area. I c Page 4 of 6 G. The right to survey the easement area and to correct the description set out above in Paragraph I through the issuance and recordation of a-corrective quitclaim deed at the expense of the United States. IV. Easement Manaaement an-d Administration. A. All right, title and interests of the United States in this easement are assigned to the Secretary of the Interior for administration by the United States Fish and Wildlife Service as part of the National Wildlife Refuge System pursuant to the,Nat konal Wildlife Refuge System Administration Act, 16 U.S.C. 668dd et.seo. The U.S. Fish and Wildlife Service may enforce all the terms and conditions of this easement, along with exercising all rights and powers reserved in this easement through such general or specific regulations or orders as have been or may be, from time to time, promulgated under the authority of the Secretary of the Interior. Notwithstanding the above 'rights in paragraph(s) A - I retained by the United States, the U.S. Fish and Wildlife Service may permit the landowner to pursue such activities on said sites as would be consistent with the preservation and enhancement of floodplain and wetlands functional values. B. As-used in this easement, the term "easement manager" shall refer to the authorized official of the U.S. Fish and Wildlife Service.' V,., General Provisions. A. The agreed upon purposes of this reservation are the preservation and maintenance of the wetland and floodplain areas existing as of the date of this conveyance as well as protection and enhancement of plant and animal habitat and populations. Stich,purposes shall constitute the dominant estate within the easement area. A "wetland":`is defined by reference to section 7(c) of Executive Order, 11990 and a "f I oodp I a i n" is defined by reference to section 6(c) of Executive Order 11988. Any ambiguities in this easement shall be construed in a manner which best effectuates wetland preservation and fish and wildlife purposes. • I r~c V.'. ~USPAu41V t~ ;.~#ge 5 of 6 8. Any subsequent amendment to or repeal of any federal law or ion shall not affect the order which authorizes this res•ervat rights reserved by the United States or subsequently held by its successors or assigns. C. For purposes of this ea-sement, wetland management rights reserved by the United States include, but are not Aimited to, inspection for compliance with the terms of this easement;.research regarding water, wetlands, fish and wildlife and associated ecology; and any other activity consistent with the preservation and enhancement of wetland functional values. D. The United States, its successors and assigns, including the easement manager, shall have the right to make surveys, take photographs and prepare such other documentation as may be necessary or, desirable to administer the provisions of this easement. Any such map, plat or other suitable document may be recorded in the land records of the respective county in which the property. is located. E. The easement reservation does not authorize public entry upon or use of land. Unless the easement manager prohibits public entry, the landowner may permit it at the landowner's discretion. F. The landowner and invitees may hunt and fish on the easement area in accordance with all federal, state, and local game and fishery regulations. G. This easement shall be binding on the landowner, and the landowner's heirs, successors or assigns. The landowner covenants to warrant and defend unto the United States, its successors or assigns, the quiet and peaceable use and enjoyment of the land and interests in the land constituting this reservation against all claims and demands. H. The easement manager shall be the agent of the United States or its successors and assigns. The manager shall have all discretionary powers of the United-States under this easement. In the performance of any rights of the United States under this easement, the manager may permit, contract or otherwise provide for action by employees, agents, or assigns which may include the landowner. 01 , " • , ~ ;f..~ ~ 'age 6 of 6 865 Pa614'7'7 P This deed is executed and delivered pursuant to the provisions of the accepted offer dated January 30, 1990, and'the authority set forth in 7 CFR 1900 Subpart A. THIS INSTRUMENT WAS DRAFTED BY THE'UNITED STATES DEPARTMENT OF AGRICULTURE. No member of Congress shall be admitted to any share or part of this deed or to any benefit that may arise therefrom. Dated February 27, 1990. UNITED STATES Or AMERICA (GRANTOR) By CHARLES E. WALLEN, Acting'State Director Farmers Home Administration United States Department of Agriculture In the presence of: Francis E. Kuhls Kathy Bleskey ACI<NOL4 ILE:Q13 LE:MT STATE OF WISCONSIN-) ) SS COUNTY OF PORTAGE ) I, Susan E. Kohnen, a Notary Public in and for said County and State, do hereby certify that on this 27th day of February 1990, before me appeared Charles E. Wallen, Acting State Director, personally known to me to be the person and officer of the Farmers Home Administration, United States Department of Agriculture, described in and who executed the foregoing instrument, and being by me duly sworn, he/she - acknowledged to me tt,,iobs--",,his/her free and voluntary act and deed, Fie/she executed s;p";FJ%stp;ument for the uses and purposes therein set forth. U-) Susan E. Kohnen, IJot•ary rwe'g~c P9~, Commission Expires: arri1 7, 1991 • ~ . `71.1 rPAGE4 (p UNITED STATES DEPARTMENT OF AGRICULTURE FARMERS HOME ADMINISTRATION CONSERVATION EASEMENT EXHIBIT "A" Map 1 of 1 St. Croix COUNTY, STATE OF Wisconsin Easement authorized by Consolidated Farm and Rural Development Act (7 U.S.C. 1981, 1985). Legal description of area(s) covered by provisions of conservation easement: T. 31 N R. 15 W 4th Principal Meridian Section 34 As described on Attachment A. 1 .40 SCALE: 8 inches 1 mile This map delineates area(s) reserved as a perpetual conservation easement by the United States. i LEGEND: FmHA property boundary ® Area(s) covered by provisions of conservation easement Wetland(s) S ATTACHMENT A V J S6 1 PASE 9 St. Croix County T. 31 N. R. 15 W., 4th P.M. Section 34. E1/2 NW1/4, SW1/4;• N1/2 NE1/4 SW1/4 SW1/4; the West 495 feet of the N1/2 NW1/4 SE1/4 SW1/4; the East 825 feet of the S1/2 SE1/4 SW1/4; E1/2 NE1/4 SE1/4 SW1/4; the South 495 feet of the E1/2 SW1/4 NE1/4 SW1/4; NW1/4 NE1/4 SW1/4; SW1/4 NE1/4 SW1/4 except the East 165 feet of the South 495 feet; NW1/4 NW114 SE1/4 NE1/4 SW1/4; W1/2 W1/2 NE1/4 NE1/4 SW1/4. H z c H r STC - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a H OWNER/EWMR Forest Ridge hunt Club ROUTE/BOX NUMBER 1963 310th. Ave. Fire Number CITY/STATE Glenwood City, Wi. ZIP 54013 PROPERTY LOCATION: SE k. SW Section 34 T 31 N, R 15 W, Town of Forest St. Croix County, Subdivision n/a Lot number n/a 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 z I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- It 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. SIGNED DATE 5-9-91 St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. DEPAIRfMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, 1 c DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISO N WI 3707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSH I P/MWERDMI TY: LOT NO.: BLK. =SUBDIVISION NAME: SE %430/ 34 /T31 N/R 15E(or)W Forest n/a n/a COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: St. Croix Forest Ride Hunt Club 1963 310th. Ave. Glenwood City, Wi. 54013 USE DATES OBSERVATIONS MADE TION: PROFILE DES RIPTIONS: PERCOLATION TESTS: NO. BEDRMS.: COMMERCIAL DESCRIP Leplace ❑Residence in/a hunting club Calew l 5-1-90 n/a RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESI1S'~URE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑ S QU ❑ S ®U ❑ S L RE~iu ❑ S ®U CAS ❑U holding tank If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5) (b), indicate: n/a Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 24 SaC2 BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH I ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-1 3.59 n/a 1.00 .42 .42bl.1. 3.17bn. mot. s.l. B 2 3.08 n/a 1.42 .33 .33bl.1. .75bn.mot. sil. 2.00bn.mot. s.l. B 3 2.75 n/a 1.33 .50 .50bl.1. .83bn.mot. sil. 1.42bn. mot. S.l. 4 2.83 n/a 1.58 .58 .58bl.1. 1.OObn. mot. sil. 1.25bn. mot. s.l. B- B-5 5.67 n/a .75 .75 .75bl.1. .67bn. mot sil. 4.25bn mot. s.l. B-6 3.84 n/a 1.92 .50 .50bl.1. 1.42bn. mot. sil. 1.92bn. mot. s.l. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- P- n /a P- 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 n/a ; ' 4,0 33 1 r ' - s i t - - s- w i- i E E E 5~5 FBI s 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: Gary L. Steel 5-1-90 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 988 N. Shore Dr., New Richmond, Wi. 54017 2298 715-246-6200 CST SIGN U E: /J DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - r INSTRUCTIONS FOR COMPLETING FORM 115 - SI I - 6595 To be a complete and accurate soil test, your report must include: 3. Complete legal description; 2. 1 ion must clearly indicate whether this i . nce or coma eject; 3. " ember of bedrooms or commercial fed; or replacerno- system; 5. Complete - suital- '.ing boxes. A SITE IS A13LE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS. , ULED OUT BASED )IL CONDITIONS; 6 PL=ASE u- the s shown here r.)rofile descriptions > plot plan; I. n -curatel- your test locations, I ;eferred, A f desired; S. I< k and veMt', t Jerence point a ~ ei manent; 9. Corn e boxes as ~i mes, addresses, flood p P test exemp- tion, 103 If t., flood plain, ~:i vatiori} does riot apply, place N.A. in th ;te box; 11. Sign tF your current address and your certification number; 12= 'Fake d distribute as required. ALL OIL. TESTS MUST BE Fl . 3 kAJITH THE LOCAL r STY VVITHIN 30 DAYS OF GOMPL' . J. ABBREVIATIONS FOR CERTIFIED SOIL. TES. .a t and Textures Other Symbols F mE= jover 10") - rI. - Cobble (3 - 10") - & rJstone gravel (under 3") LS Limestone s - S:, d HGVV - ..,jh Gi runc' C ° Pe; c at n Fin Bldg is - Loamy -r That) 'sl - Sandy Loam C Than II - Loam 8n stI Silt Loam BI si - Sill Gy cl - Clay Loam Y scl - Sandy Clay Loarn R - sicl - Silty Clay Loam mot rrles Sc Sandy Clay wi' sic - ; 'try Clay fff one, faint c - c;c - 'i,c pi rnrn - "it lit rn m Muck d ( > ; ninent HWL - f° water level, Six general soil textures utrfac^ water for liquid waste disposal E:;h Mark -ical Ref- fit 4i, I