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HomeMy WebLinkAbout020-1269-50-000 (5) ° ° pN o 0 0 0 0 o p (s► p °cn m ^aO~ c c I c I ~ 0 0 ~ I, I I o I (D I N O C ~ I a I ce) c Cy M (ti N co L CL a) 7 N M _O o o Z M~ Z c _ C CO v c L U. 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CROIX COUNTY, WISCONSIN Lk) a tWgnq SUBDIVISION ..J,,- J, U) LOT SIZE la,X P ~ LAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM <c~ l~ '4 l w~11 36'x• systa 1.=92.4(o 36 r yJ~~, E 9v. -0 8z.4j)~.~ I_x~ Otis 0 0 ~a $5' 7z' D I T V I u i +I I ~ I o~° H i ~ I I ~ r ~ I I I 3~ t I ~ i I o _ \o ff 8' a) fin' v _ T N ~.-.T-~~-_ D- I O Ot 1 O W2I _ S ~or Kc✓ & m- i K A 12 i E L a TH ARROW 3SL BENCHMARK: Describe the vertical reference point used1ov Qo~~Qr {~~d Qi SL ln'rCo~Kar Elevation of vertical reference point: 100.0 Proposed slope at site: 7 SEPTIC TANK: Manufacturer: S Q„r Liquid Capacity: ~C7 Q Qcx_ Number of rings used: 3- Tank manhole cover elevation: -7 7 Tank Inlet Elevation: (2~g Tank Outlet Elevation: 7.30 i Number of feet from nearest Road: Front 10SideoRear ~/S feet From nearest property line 'Front 10 Side 10 Rear,0 ~S feet Number of feet from: well building: 3U (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE i t PUMP CHAMBER Manufacturer: N77 'Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Ca,~ ~A= u-~ ;rn.~ I Trench: Width:~Len$th: Number of Lines: Area Built:Cp SS Fill depth to top of pipe: '112- Number of feet from nearest property line: Front, O Side, Rear,© Ft.3S Number of feet from well: ? S Number of feet from building: G 0 (Include distances on plot plan). SEEPAGE PIT tL Size: Number of pits: Diameter: Liquid depth: _ Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: ` Inspector: Dated: ! 7 ~Y Plumber on job: ti W`~1 License Number: y 3 3/84:mj t ,EPA-KiWENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING L.RBOfi & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 NWT; , N l 4 , Sec. 21, T 2 9 - State Plan I.D. Number: 191•1 CONVENTIONAL El ALTERATIVE (If assigned) Town of Hudson Lot FF Flol ying Tank ❑ In-Ground Pressure ❑ Mound -rni-riin T. F PERMIT HOUR: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: -NAME T. •T 94016 AV BEN K (Permanentreference po A int) DESCRIBE IF DI 96 T ; LAN: REF. PT. ELEV.: CST REF. PT. E G--rytl-~ <7.U 3 Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Doug Strohbeen 5432 St. Croix 135444 SEPTIC TANK/ c6tr= 99.68 6. MANUFACTURER: LIQUID CAPACITY: TANK INLE : TANK OUTL V.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: 45,6 J 600 6. ~7' ~ 96. 1--5- YES ❑ NO El YES NO BEDDING: V"f DIA.: V&9-MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH C.c C-4 ALARM: FEET FROM LINE: e / 30' AIR INLET: Ad X ❑ YES NO ❑ YES NO [NEAREST YI MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: NO ❑ YES ❑ NO ❑ YES ❑ NO GALLO YCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENTTO FRESH FENCE BETWEEN T FROM LINE: AIR INLET: UMP ON AND OFF ❑ YES El NO NEA ~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: ETER: 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 SYSTE : 9 0' _et/. = S " BED/TRENCH WIDTH: L H: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHES: / MATERIAL: P T DEPTH: DIMENSIONS ~p V GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DI TR.ppIPE MATERI NO TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOV VER: ELEV. INLET ELEV. END: "7 PIPES: FEET FROM LINE: f /O / AIR INLET: a9-~ u 4I C NEAREST t V MOUND SYSTE .5.33 g•W' 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 DIST TION SYSTEM: UEPIFI~ OW PIPE: FILL DEPTH ABOVE COVER: BED/TRENCH WI LENGTH: NO. OF LATERAL SPACING: GRAVEL DIMENSIONS Z- 11 TRENCHES: MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATI AND DISTRI TION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFOR ATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST Sketch System on R I in county file for audit. Reverse Side. SIGNAT E: TITLE: c SBD-6710 (R. 06/88) Loll-HR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNT STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than 8% X 11 inches in size. ❑ Check if revision to previous 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 /1/f; CQJI/a (,QJ%, S Z T2-9 , N, R / E (o PROPS NER'S AILING ADDRESS LOT # BLOCK # Z 3 Du CITY, TATS ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CS N BER L5 0 in lv- ~/b (.m )27(.9 Za r, 3r II. TYPE OF BUILDING: (Check one) $tat@OWn@d CITYLLAGE : NEAREST ROAD Ch V a f , r a~.. / ❑ Public 1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER(5) 111. BUILDING USE: (If building type is public, check all that apply) I Z 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.E1 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 120 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 130 Seepage Pit Pressure 43 ❑ Vault Privy 140 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 ovp Gzs elf b G 3 7• S~ Feet Feet VII. TANK CAPACITY Site in allona Total of Prefab. Fiber- Exper. INFORMATION New )Existing Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank 0bO 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 Stamp@j MP/MPRSW No.: Business Phone Number: Sv 4 3 2 Z 1-/ J 3 Z Plumbe ' ddress (Street, City, State, Zip Code): Q.t %g ; C_~^, yys~ o w cs t IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued Issuing Agent Signature (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial /q57- °1 L1 K Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: - SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS . 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 prio~ 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 line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD4M (R.11/88) APPLICATION FOR SANITARY PERMIT STC - 100 A 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 _SL"Orz-4~ Location of propertyjZ,(-z? 1/4 4:GKL-.1/4, Section Township #e-ds-. Nailing address Address of site a,`~,~ Subdivision name 3 Lot number Previous owner of property :A i 1,11i A "-C40; . Total size of parcel 3, ~d „ .,o 5 Date parcel was created -7k Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? -,A'- Yes No Volume 90-5~' and Page Number 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. 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. ; and that I (We) presently own the proposed site for the sewage si posal 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 f Deeds, as Document No. 5~ 3 Sy~7 Slgnatute of Owner Signature of Co-Owner (If Applicable) Date of Signature Date of Signature L i n(N.II11A1 NI NO WARRANTY DEED I-S 51. 1. arernvrn form nr,. n,. r. STATE: BAR OF WISCONSIN FOWM 2-1982 43i41'7QJHI,•c am REGISTER'S OFFICE t:. ST. CROIX CO., WI Recd for Record w. Virl;tnia M. Hanson, a single woman MAR 12 X499 « 8:00 A ^M rmHr)~ an,l -.,..moot: try Sam E. Miller. a single mall /'0 n, J/(/ tl v~~, "~.^a"6"vv"^^ the fnllwvtnl: rlc,crlhc,l real cwtate in St. Croix l,alct~. Stale Ta: I'nrcel No: _ West Half (10,) of the Southwest Quarter (SW';,) 1r) Section Twenty-one (21), Township Twenty-nine (29) North, Range Nineteen (19) West, St. Croix County, Wisconsin except that part South of the ,ublic highway and except Lots 5, 6, 7, and 8 of Certified Survey Map n Vol. 6, Page 1747, Doc. No. 419479. That part of the West Half (W!f) of the Northwest Quarter (NW'L) of Section Twenty-one (21), Township Twenty-nine (29) North, Range Nineteen (19) West, St. Croix County. Wisconsin lying; South of the right of way of the Chicago, St. Paul, Minneapoliti and Ihnaha Railway Company. 0 FEF This is not hnnlr<1,•ad pnga•rt~:. folk (IS not ) E:xee1.'i:rn 1,• warr:uttirs: easem-_nts of record and protective covenants and restrictions of record, if any. oZ ~ 4 II11I1'd Uus da. of m r ( . 14 88 1 F::\1.1 ClGsc-Qcn -C-~[J~f•~"-t/ 1SLA1.1 • Virginia M. Hanson ISLA1.I I i AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE: OF %VISCONSIN I 59. Count%'. nuthenticated this day of 19 I'vi-malk came before me this ` da%. of (,Y\ frot ,L. L- , 1:1 88 the abonve nante.l Virginia M. Hanson TITLE: %IESIBElt STATE: BAR OF WISCONSIN (1 f not, authorized by S 70ri.0r). Wis. Stat.,,.) In me I,nmrn In he the irer:on 10'.. a\ecuted the f-m-unin •.i, Irnmenl :tilt) ai'knnw'Ie,Ive tiro :Inu•. T .,i INSTRUMENT WAS DRAFTED nV V Lois..A. Murray, lleywood,. Cart S Murray 1',U,'Uox 229, Itudson W1 54016 ^c`~' yf u111i,• P f'nunt, . \Ci (Sienntures cony ho :utlhentienled or acknny~ied~e,l. troth \I, r • .11,10 inn `f3,," (if nnl, slat'. (..%I, r':ttinrl art, not nec(•saar}'.) d:ll„• 'ZT 1!1° / .1 "Names of p•r-- •itnin[ in any rat-a,ity .L..,,•1 I.. 1,,.., 1. •1. r- WARRANTT DI:rD ATA IF. PAR OF W 1':( F•yQM tlo 2 t ~ yt a STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER. asp ROUTE/BOX NUMBER k0 / nx z"r z--- FIRE NO. CITY/STATE' 3 7 ZIP SyC~/G PROPERTY LOCATION:P l/4 &4&Z /9, Section T NT R~ Town of A u, St. Croix County, ,s , Lot No. ~ Subdivision : a.c4zd 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. SIGNED DATE 3 Zd ~d 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 INDUST Y, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, I DIVISION LABOR AND P.O. BOX 7969 PERCOLATION TESTS (115) MADISON W HUMAN RELATIONS 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: W5WNSH P/IM!lMYflfPl4li?Y: ILOT 0. B NO.: UBDIVISI NAME* ! ~IW ~4 Z I Azl N/R1 4 E for Nu&soiv 1 ,3A caas LAa,4,►rv< 3 COUNTY: q LING APPRESS: Srcoo ►x SAM MI LlC; Q ACicm. a /~1 V ~ I USE DATES OBSERVATIONS MADE Residence (/IN1G ~--_r New ❑Replace ~ 9 0 3 9v jc~Its Gt SOILS _ ~►d- Ac'Le" RATING: S- Site suitable for system U- Site unsuitable for system OS DU 27 S OT J U E: ISYSTEM ONV N L: IMOLOVD: ''tt IN c ~ - N- LL OLDING TA K: RECOMMENDED SYSTEM: (optional) ZS J S (C0AIVEN710i-JAL [under f Percolation Tests are NOT required rl RATE: LFloodplain, any portion of the tested area is in the s. ILHR 83.09(5)(b), indicate: L /4-Ss / indicate Floodplain elevation: ~T PROFILE DESCRIPTIONS BORING TOTAL R UNDWATER-INCHES CHARACTER I WITH THICKNESS. COLOR, TEXTURE. AN DEPTH NUMBER DEPTFIIR ELEVATION 19 9 V TO BEDROCK IF OBSERVED EE ABBRV. ON BACK.) B' it. 63" Rkp, A5 ~4 R B- 9.42 ioo.oc 4o-.jL 9.qZ /l „ c i4" N<,,tL K."PU, CS'4Gie 694&e4 M's B- 3 /~zS 9g•7Tt p E > /O.ZS 9'r@L4. Yg~w '~J ► L 25' gaL,CS vGlR 7J' $Piu B• 4 9.~ JUC~.36 >9•SV 9•Bcc 11jrYd S L /2 Ra CS~G,Ie /4' 8Q~ csr6,~ S 6840, 4►., Va W, B- ID,pQ 9~.9Z o,.►IL > 0,U$ Q"ei:c. Jrt"Y@ w S.l Z ' R..CS~#G'► ~`$IP~. MS~cc PERCOLATION TESTS •r DEPTH. WATER IN HOLE TEST TIME TE5T NUMBER I S AFTERSWELLING INTERVAL-MIN. PERIOD 2 RAPER INCH P. J 1/0 N 7.60 Z f 3 P. 2 S•So is > >*21 >Z < P. O - 2 ~3 P- - P f4T10Tr Al pt P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scat or distances. Describe what the the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation a all borings and the direction and percent of land slope. SYSTEM ELEVATION. ~q So 1 I I i~ 1 i ti?!~ T J.- i 1 -i i 467 , i I Lf71 Y 1 a n TN fE>rsTNa. ,ors S£ (,OT ;s L7 i I Z I SV f -41 I i I I 6~1 I ~ i I 1 I . N Ni~ 1, 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. NAM print : ITESTS WERE MP ET ED ON: aR NtoN ~ok~►Sa~ ►nK, 3 8 4a A ' (Qptional 07 ' ECGN& Wt Sto / / CERTIFIT N NUMBER: PFjpN ~G~ J 7 b 3O Cl S I R DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. f 30 3, z i Sw 40 C S (0. 1ti ~ ~ ~ S s tt S E 1~ C or k~,r- E I V =loo. o S Y 3t~,,,, F I V 3 _ Al r - y- 3 r 3,.~v o Q ~ 3L wES T 34 EAS`P H~o s < 6 I 9 c z~-xyL' Q_ !A o d m ~ A S B-7 1. 11•- ® ~ 'h~4 T i_~ S6 I I ~ ~ 3 RE ~1"q' _ Q I I D gay Z. E ~ ra~r,a, I L ~ I j•. Sr Y .Vy L,, ' ~ . d 6 • M 'ate - ,X ~ ~ ~ H s~ . + v a ' 6 p I s A d ~ 11 c~ A ~ ~ ~ II d r v .N o Cz: tee; , ~ LU ~ \ i iL . COMMURCIAL TESTING LABORATORY, INC. 5`14 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 FAX-715-962-4030 1 q qa el 1 S l --f I 1 ST. CROIX ZONING REPORT NO.: 40022f01 PAGE ST. CROIX COUNTY REPORT DATE: 4/26/93 COURTHOUSE HATE RECEIVED*# 4/21/93 HUDSON, WI 54016 ATTNI THOMAS Co NELSON OWNERI Paui Heikkinen LOCATION: 500 Prairie Lane, Hudson COLLECTORS M. Jenkins DATE COLLECTED: 4-20-93 TIME COLLECTEDS 2:00pm SOURCE OF SAMPLES Laundry Room Fauce+ DATE ANALYZEDS4-21-93 TIME ANALYZEDI2S0Opm COLIF'ORMS 0 /100 ml INTERPRETATIONS Bacteriologically SAFE NITRATE-NS 3 ppm Above 10 ppm exceeds the recommended Public Pr,inkipq Water,Standard. 9 10 Coliform Bacteria/100 mi Nitrate-Nitrogen, m9/L F .oF.,NClVENGEMr LAB TECHNICIAN! Pam Gaw ,y o WI Approved Lab No. 19 Means "LESS THAN" Detectable Level Approved by: PROFESSIONAL LABORATORY SERVICES SINCE 1952 ~o 3~-g-3 ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse r„ pS,T0. ~,S> 911 4th Street YQ./~ 93 N Hudson, WI 54016 O 'oF c,, Telephone - (715)386-4680 Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and rV private individuals. Completion gf this form ig essential &Q that = property. can DQ located. ,)Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received.. WATER TESTING-----------------------------FEE: $ 35.00 X (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) k SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at.*time of inspection) .Q~ PROPERTY OWNER'S NAME: PROP. ADDRESS: Sri ?-21/,el:~7- CITY Legal Description 1/4 of the 1/4 of Section , T N-R Town of AUDronl Lot Number 3C Subdivision: J,9cog ~6 FIRE NUMBER SV® LOCK BOX NUMBER Color of house Realty sign by house?Ao If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A NAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the waterline must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: Avs Telephone Number 3~6-7.T9.T REPORT TO BE SENT TO: L ti -v rW.n /y G S'Sy CLOSING DATE:- W signature /*&P- vow, 7..__ _.._~_.__...~~.e~.,r._ ~r ` \ ~ , ~ ~ k ~y ' r I t a i { ~ i r o ,e, ~h ~ ~ t.." ~ ST. CROIX COUNTY WISCONSIN ` Y t,i.Y t a ZONING OFFICE e ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 - - (715) 386-4680 w April 21, 1993 Paul Heikkinen 500 Prairie Lane Hudson, WI 54016 Dear Mr. Heikkinen: An inspection of the septic system on the property of Paul Heikkinen, located at 500 Prairie Lane, Hudson, WI was conducted on April 20, 1993. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact his office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator cj NOTE: Septic tanks must be recovered after pumping. Form- S T C - 104 AS BUbJl, St'.tiI ~.TAkY SYSTEM RETORT ..a - ..l SEC. -R. Ai) -S CROI-`•: GVTJN 'Y, WISCCNSIN r- , • , 't 1- LOT ~C 2,() LOT SIZE_ PLAN VIEW Disza..1ces and diiensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 'Sra ~,mtr 3 Sy'i 1, 9elSO 1 444 //O ~ I ~ ~ ~ ~ f t ~ S li r t 1 7 rz' p % I V I 0 p ! I i I 4 ~ I ~ ---NBI6~A=Fz~-A~AI~TH ARROFv Describe the vertical reference point used a ~t- ..s eva; ion of vertical reference point : 1.0010 Proposed slope at site: Sa~~i SZP-IC TANK: Manufacturer: Liquid Capacity: ~~OO c, 1 Number of rings used: 9~1 Tank manhole cover elevation: T"_-.k inlet Elevation: ~ Tanr-. ' °ui let Elevation: ?.'1` f feet Number of feet fro-,c; nearest Fron.t'0 Side Rear, From nearest property line iront,0Siue;~Rear,~ ~1-- feet Number of feet from: Well .:uild!n,: ~In:iuv ; .is Ln: formation of the anbove t plan)( 2 reference dir.ension to septic tank) S%B REVERS SIDE A • L ~ PUMP CHAMBER Manufacturer: Liquid Capacity: Pinup Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of ti-ink elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Y Number of feet from nearest property line: Front, 0 Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: CoN.,~<•,f"cn,n. I Trench: Area Built:(,VS Width: Length: Number of Lines: Fill depth to top of pipe:. Number of feet from nearest property line: Front, O Side, Rear,O Ft Number of feet from well: //0 i Number of feet from building: 7 7 (Include distances on plot plan). SEEPAGE PIT i Size: rl Number of pits: Diameter: Liquid depth: _ Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box 0 been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, 0 Rear, O Ft Number of feet from well: Number of feet from building: Number of feet from nearest road: Manufacturer: Inspector: F ~7 / 7~ a"~ e Plumber on job: License Number: . DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING DIVISION LABQ;Z & HUMAN RELATIONS ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION P.O. BOX 7969 MADISON WI 3707 State Plan I.D. Number: Nw i~, ? e c . 21 , T 2 9 - X19 (If assigned) Town o f. Buds on , Lo ~-,36t~~ XCONVENTIONAL ❑ ALTERATIVE LJ 6W ank El In-Ground Pressure ❑ Mound p Z 1 ADDRESS OF PERMIT HOLDER: INSPECTION DATE: NAME OF PERMIT HOLDER: Sam Mil er Box 282, Hudson WI 54016 a~ RE K PT. EL V.: CST REF. PT. ELE BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: 4 2 St. 135443 SEPTIC TANK/ Cxx = ./0' 7. MANUFACTURER: LIQUID CAPACITY: TANK INLET ELE TANK OUTLET EV.: WARNING LABEL LOCKING COVf_R/ PROVIDED: PROVIDED: 040, QS, 49 YES NO ❑ YES NO BEDDING: YErFFDIA.: VE",TMATL.: HIGH WATE NUMBER OF ROAD: PROPERTY WEL BUILDING: VENTT ESH AIR INLET L`.,F!„ .s LINE: st 9 C_-0 ALARM: FEET FROM 0 % [11 YES NO • Cl 0.31 ❑ YES NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: PROVIDEDLABE PROVIDED:OVER Y ❑ YES ❑ O ❑ YES ❑ NO TO FRESH PUMP AND CONTROLS ATIONAL: NUMBER OF PROPERTY WELL: BUILDING: AIR T INLET: GALLONS PE E: FEET FROM LINE: (DIFFER BETWEEN PU AND OFF ❑ YES ❑ NO NEAREST -110- LENGTH: DIAMETER: MAT IAL AND MARKING: SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue At CONVENTIONAL SYSTE 5 J = c~. WIDTH: L NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH TRENCHES: i MATERIAL: P DEPTH: DIMENSIONS rYAR WELL BUILDING: GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PE DISTR. PIPE M TERI L' O. TR. NUMBER OF PROPERTY AIR VENT TO FRESH INLET: BELOW PfiPS: ABO,yE CQV ELEV. INL E EV. END' SOU - PIP s: FEET FROM LINE: 169 t t Jv ~U S 6-C -1 e~ NEAREST LO 7 MOUND SYSTEM: os' io,3 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 SID SHOW ❑ YES ❑ NO ets the criteria for medium sand. ELEVATIONS MEA URED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERV ION 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 PRESSURI DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO. OF LATERAL SPACING: GR EL DEPTH BELOW PIPE: FILL D H ABOVE COVER: BED/TREN TRENCHES: DIMENS NS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. PO. DISTR. DIATR PIP DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: EL ATION AND DI RIBUTION HOLE SIZE: HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS I FORMATION I ❑YES ❑ NO ❑ YES E] NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST c e- 'zd al-xalo~- ~ ,,Leff,84 ors tag in county file for audit. Sketch System on IGNATU TITLE: ~ Reverse Side. SBD-6710 (R. 06/88) SANITARY PERMIT APPLICATION COU L13ILHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than El 35'' t/c/3 8% x 11 inches in size. Check1l revision to previous 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 G4,,I'/4 GU/a, S 2 T0j , N, R /7 E (o W PROPERTY OWNE 'S MAILING ADDRESS LOT # BLOCK # QO OP 2-f 1i- 3lP kJ 1 4a CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CS Z NU BER (gee, /6- ihl, a CITY NEAREST ROAD 11. TYPE OF BUILDING: (Check one) ❑ State Owned O VILLAGE : ❑ Public Nor 2 Fam. Dwelling-# of bedrooms. R E NUMB III. BUILDING USE: (If building type is public, check all that apply) Z 1 ❑ Apt/Condo 2 El Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 [__1 Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 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. ~I New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection 5 El Ex isatiir of an System 1P System System Tank Only 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 El Mound 30 El Specify Type 41 ❑ Holding Tank 12 An 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. EFINAL LEVATION GRADE _ REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) i405. ~S d I S t'PC~ -7 0 G 3 qZ'YO Feet 17 set CAPACITY Site VII. TANK Fiber- Exper. in allons Total # of Prefab. Manufacturer's Name concrete Con- Steel glass Plastic App INFORMATION New istin Gallons Tanks structed Tanks Tanks Septic Tank or Holding Tank 000 Lc'~ S a Lift Pump 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's Signature: (No Stamps) MP/MPRSWN oNumber: umb 's Address (Street, City, State, Zip Code: IX. COUNTY/DEPAR MEN U NLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date-issued Issuing Agent Signature (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial Adverse Determination S - - 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 41 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. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) APPLICATION FOR SANITARY PERNIT 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 SsN4 All may Location of property /-/-1j,-/l/4 &k,1-114, Section Township ;;17 Nailing address _L,FtT" y ' Address of site Subdivision name c ® b Lot number ~i~ Q Previous owner of property i l r5' i N As 4,- q Total size of parcel L -7 .4,f c Date parcel was created 2-2 2- FCC Are all corners and lot lines Identifiable? as o Is this property being developed for resale (spec house)? as No Volume 5~0.5--and Page Number4-(,,Z,-as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUNBER, 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 Nap, the Certified Survey Nap shall also be required. PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. (jZ S'-c/ /7 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. Y 3 S el l 7 1. Signature of owner Signature of Co Owner (If Applicable) Date of Signature Date of Signature noc.uPgrNI NO WARRANTY DEED I0415 SeA,.It etstnvco roe ectomlr,nl: STATE BAIL OF WISCONSIN FORM 2-1982 43%4117 j ` ~v~ REGISTER'S OFFICE L~• ~1ASt>11U~. ST. CROIX CO., WI Recd for Record Virginia M. Hanson, a single woman M~q Z2 19t9 « 8:00 A M come}!, an,l ,rrnul: to Sam E. Miller, a single man RNb19r of 0911% the followinc described real estate in St. Cruix State of Wi4consin: Tax Parcel No: West Half (W')) of the Southwest Quarter (SW'&) 1i1 Section Twenty-one (21), Township Twenty-nine (29) North, Range Nineteen (19) West, St. Croix County, Wisconsin except that part South of the Public highway and except Lots 5, 6, 7, and 8 of Certified Survey Map n Vol. 6, Page 1747, Doc. No. 419479. That part of the West Half (W!j) of the Northwest Quarter (NW't) of Section Twenty-one (21), Township Twenty-nine (29) North, Range Nineteen (19) West, St. Croix County, Wisconsin lying South of Lite right of way of the Chicago, St. Paul, Minneapolis and Omaha Railway Company. ~F Thi, is not hnottM,•ad pr/rt'ert;:. link l is not) F:xett•'.i:.11 t•' allrranlies: easements of record and prot-ective covenants and restrictions of record, if any. 111111.41 this If W (A r 1 L, Is 88 '-V (SEA 1.1 Virginia M. Hanson I~EAI.r ISEA1.► AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE: OF WISCONSIN ss I County. authenticated this day of 1 1 I't r•onall} came before me this ` day of ['Y\ P, rL L.. , 111 88 . the above named Virginia M. Hanson TITLE: MEMBER STATE RAIL OF WISCONSIN (If not. authorized by § 704.06, Wis. Slats.) In n)1. Lnr,ten to he the la:r:on Who 1.s1.1-11ted 111e forecoill • I1*11111ellt Wid ni'k no W lerltre the w1nw. T•,'i INSTRUMENT WAS DRAFTED nV V'• Lois. A. tlurray,,.lleywprd, Cart S Murray P.O. '1)ox 229, Hudsona.W1... 54016 `:nl:l• 11h1jr P L ('Hanle. Wic. (Sienntures mny he nuthenticateil or acknow1r,j;:ed. Both ?l'• 1.. II'li•:V'n U ❑g116KIIlelt).I if not. Mail. a-o, r'atinn arc not necessary.) dat1,. s •Nmmm of ver,nn• mtnine in mny ••mpA. ity • I.•.•,'.1 1.. "1.4 1. .1.• v ,•WARRANTT DEED STA'f F. RAR OF Rlti(•1)Nf11j K,. n+io 1•*r.1 1!I:,• • 1•nItH ISO 2 1.... .,r to I STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ROUTE/BOX NUMBER f~ l ~nT Z-,F FIRE NO. CITY/STATE ZIP R-- PROPERTY LOCATION: ~1/4 &"Z /4, Section T- _N, Town of 1.1-~.t~s~n , St. Croix County, Subdivision Jz eelpS Lot No. 34; 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 $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is In proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGN DATE 3 Z© -5`O St. Croix County Zoning Office. St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS tNDUSTAY,. DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/ OT NO.'BLK. NO.: S BDIVISIO/N NAME: NW 1/ r-4W1/ Z1 /T29 N/R0A(or NuLSON 1-3~ Sr ~IA<o$s C'ANA IIj4, COUNTY: MAILINU ADDR ~ -1-CPo~x SAM LLB)2 "T?~w'r ~IPoo~c 4,0Ab / uQS6rl W► ,r,4 O USE DATES OBSERVATIONS MADE mr!"ErMCRIPTION PERCOLATION TESTS: NO. B DR OMM R AL DESCRIPTION: O New LA r4 , r 0. NO1 New Replace /V~dQG 11 7 / 990 Ma#<u 8 996 Sofas i~ 41 4t 561144 " P1 4 - PILLOT- RATING: S- Site suitable for system U- Site unsuitable for system O~V,ENTI~ U NAL: MOUND: IN G IL G TIJV : RECOMf ~NDED SYSTEM:(optional) ®®SS S 0 U S ou WS ~u DS otiv~ I z $roD If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the w / under s. ILHR 83.09(5)(b), indicate: CLASS I Floodplain, indicate Floodplain elevation: /V NCc7-' PROFILE DESCRIPTIONS BORING TOTAL DEPTH T R UNDWATER•INCH S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH to ELEVATION OBSERVED E TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- ri 1-7 g~.9S WIK >1,11 4'$u. 6'/ Y$etiStl. r 19,eu (n4 &e B- 1 oz. 9-L 97.T~ t4intj ~ g. JZ S^& ZO~Y8 Jr~. ~+GaDQN~5~~~ ~,''JQNI-IJ~~12 B- 8 $7Is 9S.O/ N L > 6.7~ '9"94.Lc. 1S*"SAI MS 23~B~ti~~.~(C,►~ 5~"~~NYr►S B-9 1.2.5 9< ,1 c > is 7"$u 9,eNC-iGV2 B-/V 6.Z~ 91 ~6 ot~t~ > 6.~5 grr1~~C 3"~y$Qr~src ~3~ $Qry r~S~C,~ B- PERCOLATION TESTS 3 TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER L V L• N H RATE MINUTES NUMBER lt=tES AFTERSW LLING INTERVAL-MIN. P I t P RI PER INCH P. 1 0 ONC 7.70 >Z > > < P_ 2 z. CV tjomt 9s. 3 P. >11 >Z >Z < P- P_ rC1-~o, ► T E 2cr 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. t I I 9 ! o pl_ V1- -Al. t i prcI4a j - - - - &`4 A9 - P l 1 r AL E-S-, 141 A7_ 467! C~P~ #TV anti )oo.~,," qS 3 7 _T . t j I i I I ' L_._ 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: 4\ ~vQ %IMG C /~N~2cu `6 X990 AZVLy JOHN50N JO 111- AD RESS: , CERTIF TI N NUMBER: ip ONE N MBERfoptional): 07 SEc ~ s Nul~r~r.► Solt N XM Fo CST SIG UHt: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR•SBD•6395 (R. 10/83) - OVER - 3v3_ zi Sa CO ~ S ~Q 1ti ~ ~ ~ 5 I` 'r,''= lo'S of # 3 a ~C,I~yc 34WI 3GE ~ ~ora.3 Cd~cL/ 1~~) t1 ~~r~s ~ B . M• of ~o w~,r 1~~~~s-I'o..~ s E 1 ~ ca,, k , y st~,~ ply. 3e, w = q z. yo 4.~r c/sloe Sw EIV.=loo.o s y st~,,,~ E IV. 3lo E i 3 v l7o ~~II W r I~ ~ N A 3L %VES7 34- EAS`r J J+ou rLA .o M ti y9 ~ g~ ~ ; ~ y', r L ~ A s6~ I ~ ~ E a- ,a Y A rs ~o, ~ p. i E ~ x ~ I ss z i ` o 4- I r I cr i ' P o P )r.'~ L pit . Qp ; BOA 1 ~ ~p o, H y 3• I:. s