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HomeMy WebLinkAbout020-1266-60-000 o 03 Gn. h c a 0. I h o I N ~ I I O C I I r4 1 I I aNi I a z c LL c vO Q I Cl) (D z y E I z = °o v `m d CD r N CO ! a m i 0 o Z a c V r 0 w ~ O fA H r C N zz E '2 'D M N c rn N (6 CL N N 0 N C a .y.. O L O i C Q zcoD z° = c N y R CL R c v It 1) m °o LO O D a I E m c~ U) ~~ww E m wo o v ° a a a a tan J U O :a m rn } v O N~ N ~o = E L) O 0 o o 2 m w a Lev m Q~v~ m 00 CD O C O w Q vi c O O r.+ O C U C N Cl) L C~ 9 1- O 0 :3 O 7 O O O O f00 M O m` a C a 0 0 0 r -O N r N C O Qj ~ p E C N t d' N o c o H t5 a v' r~ 00 N y C~ a~. N H C L N 7 7 fln O N E t6 U •Oki O N S m r 0 z c N O U ~ - I a L: a d • ~ a d ° I d y c o m l 3 o A uaA 0 v)c) 2c/- �3�7 ST. CROIX COUNTY ZONING OFF CE l "1 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix Co. Zoning Office offers the service of septic and water inspection to Lending Institution, Realty Firms , and private individuals. COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN BE LOCATED. Please provide the following information, enclose appropriate fee made payable to ST. CROIX CO. ZONING, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING--------------------------------FEE:$ 25.00 (For nitrates and coliform bacteria) WATER TESTING--------------------------------FEE:$175.00- (VOC'S) SEPTIC SYSTEM INSPECTION---------------------FEE:$ 25.00 PROPERTY OWNERS NAME: �.UG � .. ^l�/`� t��,r �) J4=f U PROPERTY OWNERS �tDNS S: c: 1 jf 8TY: f4 u 00-0 Legal De criptio � 1/4, .1/4, Sec. Z TAN-R fC) W, Town of So ,Lot: No.�_,Subdivision vT f FIRE NO.&S9 LOCK BOX NO. -� Color of house .,t,�-{ Realty sign? Firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i.e. , COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the 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:J 2u<__Cdi Telephone No. REPORT TO BE SENT TO: CLOSING DATE: - Signature: f &��� �� Laboratories ~ ���� � �� �� ������m�� ����= ����� ���������'�����= ����� mo1 West County Road cu. St.Paul. Minnesota om/o Phone(mmsox'nm FAX(61maoo-71ru LA�O�ATORY AN�4LYSIS J 347 PABE 1 � 1O/1?b/9� � � �er�iaI Test zng Laboratory Box 526 DATE �ECEI�ED: �0/02/91 �I 5473� C�LLE�TED DE��VERED BY SAMPLE TYPE : wAJER Atzn: --amela Gane St. Croix Zoning 8udoso' WI 540I6 SERCO SAMPLE MO: 104 1 SAMPLE DESORIPTlON: Bran*ner 1l12 ANA- zz: ---------------------------------------- ________ �romo or an um/� �romofCrm, ziromomecinane, ug/L (Met y oromzde) <� . 3 C��rbon tetrachloride 2 Cnlor�benzene, ug/L Cnlm~oet'hane, ug/L (Ethyl l�rioe) !0.4 2-C�loroethylvin)II etner, ug/L <0~4 Cnlor��orm, ug/L �0.5 Chloromethane, u cf-lorzde/ <0. 6 �ibromochloron���ane, u�/L �0.4 2-Dichlorobenzene, ug/L <1.O ko-Dichloro�-enzene) 1 ,3-DIc orobenzene, ug/L <�~ 0 (m-Dich.1 orobenzene) 1 ,4-DichIorobenzene, uc./L \1.0 (p-Dichlorooenzene) 1 , 1-DI chi oroethane, ug/L <0. 1 1 ,2-Di chi oroethane, ug/L <O. 2 (Ezhylene dichloride) 1 , 1-Dichloroethene, ug/L <0.2 trans-1 ,2-Dichloroethene, ug/L <0~ 1 1 ,2-Dichloropropane, ug/L <O. 1 cis-1 ,3-Dichloropropene, ug/L <1.5 trans-1 ,3-Dichloropropener ug/L <0. 9 Methylene chloride, ug/L <5.0 (Dich%oromethame) < means "not detected at this level ". 1 mg = 1000 Ug. | wvmo° | :N , SERCO Laboratori es 1931 West County Road ou. mm"/. Minnesota 55113 Phone(612)636-7173 FAX m1msm'r1m LABORATORY ANALYSIS REPORT NO: 8_7�47 PAGE 2 10/16/91 SERCO SAMPLE NO: 104661 SAMPLE DESCRIPTION: Brantner 1112 ANALYSIS: ---------------------------------------- -------- � s1 ,2,2-Te�rachloroethane, uL <0. 2 , 1-Tric�loroetnane, ug�L <5.0 1 , 1 ,2-Trichloroethane, ug/. <O~ 1 Trich%oroethene, ug�L <0.4 Trichloro9lueromethane, u /L <Freon 7 Vjny� chlorioe, u�/L ! 1 . 0 Tet�achloroet�ene, u�/L <1.5 ��eozene� ug/L ' I . 0 benzene. u�/� <1 .0 roluene, ug/L < 1 .0 This sample' s -anaIyi results are below the U. S. -EPA's Maximum � Contaminant level -f 1/30/91 for those requested wnzcn are also on the SDWA te-CL lis�. A11 analyses were rtormed using EPA or other accepteo methogologzes. Samples that may of an environmentally ha.zardous nature will be -eturne� to you. Other samples �ill be stored for 3O �ays frmm tne date of this report, t.hen ciisposed of by SERCO LaboratorzeE. Please contact me o­ber arrangements, are needed. This repart may not be --ep,oduced , except zn i±s entirety, without prior writte� apprcval +�om SERCC' Lanoratories. Report suomit-ted by, ol At Diane u. Anderson Project Manager < means "not dey-ected at this level ". 1 Mg = 1000 ug. | Member s~ Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~KUc_RKAM- f If TOWNSHIP kj i h.; SEC. ~r T 2N-R 9 W ADDRESS 9% NAuD CjgQjP ST. CROIX COUNTY, WISCONSIN SUBDIVISION _SU, K C F LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1,HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM (1101 Pay 6 3$~ 3 3 3 DQ~IZUJr~. INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used {'~pQ Elevation of vertical reference point: ~UU.U' Proposed slope at site: SEPTIC TANK: Manufacturer: We,Q Liquid Capacity: (000 Number of rings used: 0 Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: QQ, Q3 Number of feet from nearest Road: Front,Q Side,O Rear, O 00 feet -From From nearest property line Front,0Side ,0Rear,O 130 feet Number of feet from: well `.5building: (Include this information of t'ze above plot plan)( 2 reference dimensions to septic tank) L ec~ nFT7FP C~ __S`7T1P. PUMP CHAMBER Manufacturer: Liquid Capacity: " Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle:. Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, © Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). Sk°tJog o o Pkpo,,. 9 - (x.47 10 t, .td ~Nb ~5 9~ gs.go SOIL ABSORPTION SYSTEM If 60 J 0 Bed: Trench: 1 14 Width: Length:Number of Lines:_ Area Built: 9 q5 Fill depth to top of pipe: 7 Q Number of feet from nearest property line: Front, O Side, ® Rear,O Pt. 8 Number of feet from well: Number of feet from building: ~1U1 (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or 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, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated : ~e Plumber on job: _ 6WY~ C-1110 License Number : 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 RR~ qq State Plan I.D. Number: NW,SW - SW,Mi,NW4,.Sec.24g2C90~1VENTIONAL El ALTERATIVE (If assigned) Town O t Hudson iarmid r Holding Tank El In-Ground Pressure ❑ Mound A-90 0 el -7-7 cD. Lot NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Bruce A Brantner 14A9 6 Maud Circle Hudson WI 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: C R F. PT. ELEV Name of Plumber:' MP/MPRSW No.: ounty: Sanitary Permit Number: Jim Bo eester 3404 St. -Croix 135508 SEPTIC TANK/HOLDING TAN : ' . o eG t(-= 3~ •.2 MANUFACTURER: LIQUID CAPACITY: TANK I OUTLET ELEV. WARNING LABEL LOCKING COVE .A PROVIDED: PROVIDED: 0.'40- ?9.93 S /C/U•a/ YES E NO EYES NO BEDDING: DIA.: uE#F MATL.: HIGH WATE UMBER OF RO PROPERTY WELL: BUILDING: VENT T ESH AIR INLET C,d, or ALARM: FEET FROM LINL NO ❑ YES NO NEAREST E YES A 1 DOSING CHAMBER: MANUFACTURER: LIQUID CAPACITY: PUMP MOD MP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES E] NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMB PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM AIR INLET: PUMP ON AND OFF E YES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue. CONVENTIONAL SYSTE -vr) 5 e - r O BED/TRENCH WIDTH: LEN NO. OF DISTR. PIPE SPACING: VER INSIDE DIA.: # PITS: DEPTID r t TRENCHES: r MATERIAL: DIMENSIONS J 3 ~ ( I k.+- GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DIST PIPE MAT IAL: NO. ISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: a PIPES: LINE: / ' AIR INLET: FEET FR f76 I/ 3Dt A 4SUne ✓ei NEARESTO-~ ~Uia/~ 7aS MOUND SYSTEM: p ion Mound site plowed perpen Ic6lar 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 OF TOPSOIL: SEEDED: MULCHED: CENTER: EDGES: DEPTHS DDED:S ❑ NO ❑ YES E NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BEL IPE: FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIP TRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES E NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST Sketch System on eta n in county file for audit. Reverse Side. GSIGNATE: TITLE: 71 R. 06/ SBD 6 0 ( 88) =a"701ILtHFA SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNT C, STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ /U. 8% x 11 inches in size. f 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 kOPEIR W CATION Q RU ST'Q / , N, R + E (or) PROP R OWNER'S MAILING A DRE BLOCK # ,-f C M r, Rc k 0 A CI , STATE CODE PHONE NUMBER SUBDIVISION ME OR CSM NUMBER kbSoU ~ZIP S to toi D 17-1 CITY NEAREST OAD e II. TYPE OF BUILDING: (Check one) State Owned VILLAGE : =N QF: kD ~b P~~c ❑ Public K 1 or 2 Fam. Dwelling- # of bedrooms PARCEL TAX NUMBER(S) ORO_ la* 0_00 III. BUILDING USE: (If building type is public, check all that apply) I1 El Apt/Condo /307 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. XNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] 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 ISv RE IRE~sq. ft.) PR POSE (sq. ft.) (Gals/ a /sq. ft.) (Mi /inncch) LE ATION 1 0 Feet 1• Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. New lExis,ting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App INFORMATION Tanks Tanks structed Septic Tank or Holdin Tank V b J Lift Pump Tank/Siphon Chamber, El 0 El F1 I El El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: E43 n ees 31fU C ' 3 ~-i' a PI ber's Address (Stre@t City, State, Zip Code ft 51 U)p Sri o IX. C NTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Ile.suing gent Signature o Stam ) / Surcharge Fee) Approved ❑ Owner Given Initial 4- v 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 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, reconnecjion, 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 'y septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8'f x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soitrtest data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractot,(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 /d',/ Location of property '/4 N7V 7~_1/4, Section , T N-R W Township Mailing address Address of site ` D Subdivision name Lot number ! b Previous owner of property tzl/ Total size of parcel Date parcel was created-7- Are all corners and lot lines identifiable? es No Is this property being developed for resale (spec house)? Yes 0 Volume and Page Number '71 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. y -i 17,-LL) ; 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 const ction of said system, and the same has been duly recorded in the Office of Dee s, as Document No. C- ) . of LCojn1 Re ster L Signatur o Owner Signature of Co-Owner (If.Applicable) 76 Date of Signature Date of Signature L WARRANTY DEED 4 Greenwood Enterprises, Inc. This Deed, made between Grantor, and--- Delta_.Construction4. C~ . Witnesseth, That the said Grantor, for a valuable consideration------ RETURN TO conveys to Grantee the following described real estate in -_St..-CrOlX------- County, State of Wisconsin: Lot 10 of the Plat of SunRidge filed in the Office of the Register of Deeds for St. Croix County, Wisoonsin, on Tax Parcel No:----------------------------------- September 22, 1989 in Volume 5 of Plats, at Page 71, as Document No. 451750. This is--nOt........ homestead property. (kk (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And- Greaerlwood'k ter rhtes Ific- - warrants that the title is good, indefeas ble in f1e slurp a and free and clear of encumbrances except easements and protective covenants or restrictions of record, if any and will warrant and defend /t~he same. 19.~Q._.. Dated this /93!k.-..--••---•---........ day of my................ _ (SEAL) (SEAL) .J E...RU esi.dwt.------------- (SEAL) . (SEAL) . MAR RUSCH, Secretary/Treasurer ACM94LEDGMU ACKNOWLEDGMENT STATE OF WISCONSIN) STATE OF WISCONSIN ss. ss. St<.- Loix-~outitg••--~ St. Croix County. PersonaiLy-r,Ww before-me--this /5A) Personally came before me9Vis .__°A.~_Y..`... d of ay of May 1990 the above named Mary R. Apx-U........... 19..-u----. the above named Rusch, to me kna~m to be the person who ---•James.-E..--Rusth----------------------- executed tile--foregoing--ipstct'! ment---agO acknowledge the• same. j to me known to be the person . who executed the Notary Public, St. Cr Count , WI foregoing instrument and acknowledge the same. My commission -11 -L ~ ' Q,~. z2m . IF :)y nStrlai[t..Y..~x>fted... l--........ Marlis P. Maki Heywoocl-&--Cari.,..P.O.Box..229.,..Hudsm...W1. Notary Public .....St-.--Croix ...................County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. ([f not, state expiration are not necessary.) date- 313-1-/-9.1----....----......., 19--------•) •Naines of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 1-1982 )Milwaukee, Wis. S, • STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d OWNER/BUYER ~•~-C~ V v ROUTE/BOX NUMBER yq l_.tI~ Fire Number CITY/STATE ZIP A16-1 PROPERTY LOCATION: L~4, ~iu, 77~, Section, TN, R i~_W, Town of St. Croix County, Subdivision Lot' number/D Improper use and maintenance of your septic system could result in I 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 IE 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. 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- do ment of Natural Resources. Certification form must be completed and returned to the St. Croix County 7.oni g Office within 30 days of the three year expiration date. SIGNED DATE 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. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS N INDUSTRY, DIVISION LABOR AND C P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (115 MADISON, WI 53707 A 4(,I 5u) (ILHR 83.09(1) & Chapter 145) 1. LQG A' ~ ~ (c TOWNSHIP MUNICIPALITY: 0i10.: LK. NO.: SUB ~ ~~ION MEN V Qt/ VV TY W 'S NAME: M 1/ USE DATES OBSERVATIONS MADE T STS: New ❑Raplacs s qa s G~0 Residence MR RATING: S- Site suitable for system U- Site unsuitable for system OUND- / M:loptional) SYSTE r 0S I I r E] S (RU V~ TaU IONAL: MIx IN PgS OU S[]S ®UL L I G TANK: REC OMMENDED If Percolation Tests are NOT required DESIGN /T If any portion of the tested area Is in the under s. ILHR 83.0915)Ib), Indicate: 3E I Floodplain, Indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION MOR R UND ATER-INCHES ARAC R O L IT THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER EPT1f MF D ST. HIMITIf- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 75 / >7 W/ Z 4 3 , 3. 7 Asir 925 silo. /.sr I,&,/~ 7,0Ir s Sr A 7, /70. 15-f 2, 2 5" ell B.y 90 ~ >~o B-S 9.2~ a, 2S B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME RATE MINUTES NUMBER IflCFIE'; AFTERS ELLING INTERVAL-MIN. PERIOD I PDRIOD T= PER INCH P. S /L P. 2 5" 2 A P- 7 3.2- P_ P_ P_ -4- PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- PLOT ontal 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. O / . SYSTEM ELEVATION 5 _ i. 1 P.. r-7 I, the undersigned, hereby certify that the toil 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 ( t TESTS WEJ[E MPLETED ON: ADDRESS. CERT I TI N NUMBER: PHONE NU BZ E (optional): .S~ Also. &)i dell A 44~s~y 3883/ T 1 /OOF DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. nlt_HRSBD$395 (R. 10/83) dER - _ ~?B-L. 67 PLOTA N 1) SS 5 E C R N A M Egr- v cjz ri Ne>? M E >~.o rn ee e ~R- ;L 0CAT 10 N....._,S R~AIJ IC E NS E=~-_ 3.yby TT ' ~ > 30 s o '3 _ P, Nine (JJSn~ vt Q- - 61.3 6eD Oxa' , ;t ' C'' ~ I\k~e ~~.1 e~ 1 s rnr~r i~,,. n ti ~ (0 0' fi I , I i„ l -o t] . I Crl r a M lot CorcNe f. S~a ~p ~y u~ T A c 0= QOM hule C > k " ~c r~-(, ku) ~..I LJ "P-r' I''rPe1k) 1 , FRESH AI1: INLETS AND OBSERVATION PIPE C1;OSS SECTION f.. Approved Vent. Cap Minimum 12" Above k~RQ Final-G]'.sZ MPV Cast Iron Above Pipe Vent Pipe To Final Grade* ' Marsh IIay Or Synthetic Coveri. iig Min. 2" Aggrogl-rl _ Over Pipe 'lr Distribution, Tee • Pipe I _1 . Aggregate rer-f.ora L-ed Pipe Below 13eneath Pipe Coupling Tel:minai:ing T :9'S. Q Qvvr~ ~e~ Bo-L• tom of System d tr "'poi , ~.'•n" ti a Si ~ 4 ~ t f w 1 ~ 7 , a t e f( t; t t0 ct Ito fro QQjo Q a p ravla: P nQramic views, w4lkautsfi; w09, u19 Ilw~ s :':#t>~'r $ r 4~ Y, (715) 386-3363 F}. FY' yr M1 }q on or p 03 µ L 612) 43 6 .w r .4 V r ' 1 sllapp «a(~y,,J~.y~~ 1~ fSKb.. ; Y.'.. LOt"22 ;.LOT12$` , _t 2 qc 4.14 N WAS LOT 2 2~ r ~ i+l/r~g.~i• w~ r ,F i~J4,,.. i1,it .wr 1 ~ tt N~J',~ ~pl~YGr47i Nrr: ~ L ~ ~ 4~+.^.r. ~ . LOT 20 za Lt'24~' :LQT,;25`= 2.019 AC w. a 4`f haw S 4; HUTTON HILL ROAD- fit 4 f [,41",:.11 ti f Y s} ♦ h -A a S t " 1 V 11 V ~I}M ,L M Y . ' ~ LOT 19 ; LOT 18' "LOT, 17 LOT12 A;q ~+MKAc i ,-LVI•f } w i 2.104 " P 4 1 LOT 9 LOT, s . o LOT 16 A-M AC' LOT.'8 t • "4 fifwa {#~F}f!.' .2.= Ar J " 4 , r,. ~O~` :.i ~l°~ l,, ~ 'r pt. , ;rt! c :~~N LOT 7 2.914 AC d OT 2 L to s. 4n r.n.w4+~,'~ AC 7. K r { t L i 1 u Id. ~ LOT1 LOT 6" 2.008 AC r u.:r a ,l'~~` a LOT LOT 3:' LOT 5 r ' h Ell i;