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HomeMy WebLinkAbout020-1266-90-000 Q o m °o a ~ I °o I N n tl I I ~ I I I I ~ I ~ Z I c LL o Q I M N Z N 00 Z fl O d m N I- Z O O Z U w o 4) Z 0) c Z m I- c .o C7 N 0I y O. L 0 .2 C 'O Y U O N c w z CD D p Z O C NI E 3: 1 O N d f6 = ° ° c o a` n E - c cD o acn z 3ao.a IL 0 • t% J U rn rn ai } O 2 ~ ~ -O p N QOM O E" EOO CM m w p d Q <A m C ~ O 0 r.+ O O C O c O N et M LO O O 3 N N V d N N O N 1 Y O O W O m 0 r- co E 10 CH O C n O u .a ~ M Ci 0) y Er' QN1 N H c N n a+ L ~O O N 2 H O Z c fn 4 - - ~ m U ~ E v1 E m m a 3 a ` CL rr`1~~1 E 2 c c ST. CROIX COUNTY ZONING OFFICE' /' 217, 1 911 4th Street Hudson, WI 54016 Telephone - (715)386-4681'\ The St. Croix Co. Zoning Office offers the service septic water inspection to Lending Institution, Realty F rms , 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: "I 1 �' �. +-k> ► �yi'i PROPERTY OWNERS ADDRESS: 0'�Co 1 1�n G )1 CIT1�Y: D�oaJ Legal Des ription 174, 5 W. 1/4, Sec. , T a N-R_t W, Town of p sc? ,Lot: No. )3 ,Subdivision FIRE NO. 6S-�, LOCK BOX NO. Color of house 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:\-] 1h/L Telephone No. -50(f,- M REPORT TO BE SENT TO: CLOSING DATE: l4 L-0,06 -r c vim► c Signature: � � �J�� Laboratories � �� � �����o��� _�������'��"��'��� � `yo,West County Road ox. St.Paul. Minnesota ooro Phone«mwo36-7,n FAX(6,wo36-7,/o �AGCFATDRY ANALYSIB REFORT NO: 8345 PAGE 1 10/16/91 �ommerC Test Ing Labors,tory ��� Main 5t. �ox 526 DATE RECEIVED: 1O/02/91 Co�fax , WZ �4730 CJLLECTED BY : CLIEMT DELIVERED BY : CLIENT SAMPLE TYPE : WATER n ne St. Croix Zoning Hudson, WI 540I6 SERCO SAMPLE NO: 104641 SAMPLE DESCRIPTION: Thome 1113 AN:ALY5IS: ________________________________________ ________ �romooichlorome ane, ug/L <0. 2 �romof��m, ug/L 5 Bromomet�ane, ua/L (Methyl bromide) <1.0 Carbo� �e�rachlorz�e, ug/L �0. 2 ChloroiDenzene� Chloroet�ane, ug/L (Ethyl chlorzde- <0. 4 2-Chloroethylvinyl ether, ug/L <0.4 Chloroform, ug/L <0. 5 �hloromethane, ug/L (Methyl chlorzde� <�.6 D�bromochloromethane, ug/L �O. 4 1 ,2-Dzchlorooenzene, ug/L <1.0 (o-Dic�Iorobenzene) 1 ,3-Dzcnlorobenzene, ug/L <1~0 � <m-DichIorobenzene) 1 "4-Dicrj lorobenzene, ug/L <1.O (p-Dichlorooenzene) I-Dichloroethane, ug/L <0. 1 1 ,2-�icnloroethane~ ug/L `0. 2 (Ethylene (3;ichioride} Dz chi oroethene, ug/L <O. 2 trans--� ,2-Dichloroetheme, ug/L <0. 1 1 ~2-Dichloropropane, ug/L <0. 1 cis-1 ,3-Dichloropropene, ug/L <1.5 trans-1 ,3-Dichloropropene, ug/L <O. 9 Methylene chloride, ug/L �5~0 (Dich%oromethane) < means "not detected at this level ". 1 mg = 1O0� ug. 0 X mvmm* SERCO Laboratories 1931 West County Road C2. St.Paul. Minnesota 55113 Phone(612)636-7173 FAX(612)636-7178 kJ SHE F LE DESCRIPTION: i home r_ { ---------------------------------------- -------- u t.j X_ _.ii.O _=tn ane LIC3IL Ja 0 Z- )!'.t-!-€ioroethane, U.a.i _ : ..r_..f. - �_i- S i -0i ' _tiG.r C. This sample 's analytical results are below the U.E. EPA 's EIDWA Maximum ! ntams t�ant love: f 1I _ilftr'.'- for ¢ eructs com au � r arc " � t?'to� r .tom _�e� ..p n � w :2 Ci 3 _ - tr~a a1. co �?€':• to€= L`��:i- €ti=L list. All an l '{ e we -a pej -r or med usin - EPA or other accepted methodologies. am-les that may be o+ an environmentally hazard.ous na.-ure will be y o• }[-P n?r~. 3l. �t o r-e [ �-o _5l._? a +_--- _ �' :. � r sa...�I es wi 1 t _ r E.'•�}r8 rep€:+ === rep=_. t ! -heL1 lisposea ot `}t SzE 1 U Laf".€ira�l= Iev. P!ease r:-r _i - r a acv _r' .3r€4� €T€e t 5 L?rS= ° ° . This TaeoGY ± m�is r€o1 �e �Pv?utcea except _, n 1--s entire=y7 without prior written appro.ai - o€ E.f_n ! L•ao.,oratcr-es. g000r't_ =_ubmitted ny: C%tG1-� Diane Anderson Project !tanager mean= "not detected at this level ". 1 mg = 1000 Ug. Member j Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. T N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION cL•,rJ '~2 LOT f LOT SIZE 2 cr.~ PLAN VIEW Distances and dimensions to meet requirements of IIIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f -r it -0 z 04 fit ~ _ Cif 'r r `t 4 jr, INDICATE N RTH ARROW t i BENCHMARK: Describe the vertical-reference point used M Elevation of vertical reference point: f~>rr Proposed slope at site: 3 SEPTIC TANK: Manufacturer: &-Liquid Capacity: Number of rings used: 6 Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road.: Front, Side, Rear, O feet` ..From nearest-property line Front,OSide ,ORear, O feet Number of feet from: well ; building: j/ l (Include this information of the above plot plan)( 2 reference dimensions to-,se tank) 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). SOIL ABSORPTION SYSTEM Bed: Trench: Width: / Length: r Number of Lines:- Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side , Rear,O Pt. 6 Number of feet from well: 6)i~ eV 75` Number of feet from building: (Include distances on plot plan). SEEPAGEPIT 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: License Number : J~.~' c-,,Z 7;2 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 MA ISON, WI 53707 Number: NW 4, SW,-, Sec. 24, T29-R19 ( (If assigned) Town of Hudson Lo 13 CONVENTIONAL El ALTERATIVE Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: TRt. ESS OF PERMIT HOLDER: INSPECTION DATE: 'dike Thorne Hudson, WI 54016 75 BE/NCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: RE'. PT. E ST REF. PT. ELEV.: ff do~r.-~ o~~Olc~F' midi a-'E /•ll r ur'< -P n'c.~,~^ a Y /~i'7.4 Name of Plumber: MP/MPRSW No.: County: ' Sanitary Permit Number: Wm. Schumaker 6382 -St, Croi _ 135477 SEPTIC TANK/H-VL.U!NG 99.6 . MANUFACTURER: LIQUID CAPACITY: INLET ELEV.. TL T EL WARNING LABEL LOCKING COVE PROVIDED: PROVIDED: g, , drams L C~' x' • /it / (J~C~ r~• f 0 P~- YES E;J NO ❑ YES NO BEDDING: VE*T DIA.: Vr1W MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING: VENT T FRESH C,d. rl ¢.O. ALARM: FEET FROM LINE: AIR INLET- ❑ YES NO ❑ YES O NEAREST > 02 3s ' 16 .A, DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: MP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL, BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF PU ❑ YES El 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 'nto a wire, construction shall cease until MAIN the soil is dry enough to continue.) - CONVENTIONAL SYSTEM ry 6•>C 4c,4yl c GTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH WIDTH: EN / TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS /'r 36 4 GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: N D STR. NUMBER OF PROPERTY WELL/ BUILDING: VENT TO FRESH BELOW PIPES: ABO E COVER: ELEV. INLE ELEV. END:, y'IQ ! , </p .4JI(_ PIPES: FEET FROM LINE: ry / AIR INLET: \D 9 Nr I`. {v L a7d f 1~ NEAREST --111i 85" oO ~S MOUND SYSTEM: i,',~ Mound site plowed per endicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: Q ❑ YES ❑ NO ❑ YES ❑ NO NEAREST---- V croLkell Sketch System on etain in county file for audit. Reverse Side. SIGNAT E: ~ TIT SBD-6710 (R. 06/88) CSILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code W STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 / q'7 8% x 11 inches in size. check i revision to previ us 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 yul'/4'/a, S Ta , N, R / E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # ud rJ 4/' v% /3 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD ) State Owned VILLAGE : ❑ Public 01 or 2 Fam. Dwelling-# of bedrooms-3- PARCEL AX NU BER( ) III. BUILDING USE: (If building type is public, check all that apply) 4to 1 ❑ Apt/Condo c/ 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ 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. NJ New 2. ❑ Replacement 3. ❑ Replacement of 4.E] 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) q ELEVATION _V -7 ' S , J j Feet . Feet VII. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank _Ik~ F-I F-1 - Ej El I Ll El Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system sho on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stam s) MP MPRSW No.: Business Phone Number: 4'n.n k 3 ~G 3 (V Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPAR ENT USE ONLY X❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing A nt natu a (No Stam Approved ❑ Owner Given initial ) Surcharge Fee) 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 or 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. 11. 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. SBD-6398 (R.11/88) APPLICATION FOR SANITARY P4KMLT STC - 100 i This application form is to be completed in full and signed by the owner(s) of tile. pruj,urty being developed. Any inadequacies will only result in delays of the permit Issuance. Should this development be intended for resale by owner/contractQr,("spec house"), then a second form should be retained and completed when the property is suld and submitted to this office with the appropriate deed recording.. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - owner of Property ~ ems ' Wcat Luu of Property /V/ k -5-6j k, Section Z T 2y N - R Z2 W Tuwuship 170d5 0 Mailing Address Z-.,7- /3 ,/le, / a' rr j d rr ✓e~ Subdivision Name 61k, Lot Number Previous Owner of Property 91-4t-7 woe)d 'rutal Size of Parcel 21 2-29/ a(,. DJLe Parcel was Created 4LX D1 1 89 Arc all corners and lot lines identifiable? K _ Yes ~'No lb Lhls property being developed for resale (spec house) ? _ Yes No Vu ltunu and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 1. Land ,Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays 01 Lhe reviewing process. If the deed-description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTV OWNER CERTIFICATION I (we) ceAt i.6 y t%at aZe 6 ta.temen t6 on .thiA. 604m ane tAuue to tile beat o6 my (uuA) kiiuwtit(Ige; .tKat I (we) am (ane) the owneh (a) o6 the ptope/Lty de.6cAi.bed in VaA u►6unmat on 6onm, by viAtue 06 a waAnanty deed necon.ded in .the.066ice o6 Vie Cuu►i t y Reg-i a.teA o j Deeds as Document No. SASS ~f ; and that 1 (we) pn"entxy own .the. pnopoaed 4ite bon the sewage poa ayatem (un I (we) have ubtained an ea.aemen.t, to nun with the above de cA.i.bed pnopeAty, bon the L!4M6tnu,;ti.un o6 said aya•tem, and Cite same has been duty %econded in the 066.ice ~l0 1 u6 the County RegiAten o6 Deeds, ab Document No. V5-6-61 -Idli ILL: SIGNATUKE OF OWNER SLGNATUKE OF CO-OWNER (IF APPLICABLE) y Z 5--- 9v DATE SIGNED DATE SIGNE'U a y r : MR'll,....a..A j • - 4i- +,7ti a»».• + RiTY11N TO _ ...Y • Md tee Satat/ ~1 K•.Tau ....................Connty Tax Pw Ne:..... ................o Lepl Deseriptiaa i.. it , .'.Y ~Y Tim is.ust.......... homestead ~operty. ;1 >0 (is not) Mwvtim b vanmda seasaests and restrictions of record, if any ( Dat•t. ...........d2......._............... &W of lF.ebcuary....... 1x.89 t 4'VWlya (SEAL) . ..............(SEAL) E. >iesop . Arl L. Denoy ............:......(SEAL _ . ..,....(SEAL) . AUTKUNTICATION ACENOWI&XVIG UNT { C Sip~e(a) STATE OF WISCONSIN # St. Croix . es. ;r County t andmidwAsd this day of 19...... Personally came before me this ................day it porllaKY 19651.... the abm as%W » ...AX]=.E...Remy....Ar1,yn.I....JWtnoy._-AOQ....... • - - . WSYJAe..A...AMOy............................................... TlTLi;: ILTiNBEE STATE WISCONSIN . (If nat. • - • : ~ I r:- by f 4 + astheeissd b.) Z- to me mown to be the person Q *60 OWN" t ru tan w THIS INSTRUMENT WAS DRArrao SY E .Lnii_ A_. I61ILa;[,..HEYY F 'X S•. vrv'A ~ P.O. Box 229, Hudson. iii $4016 F ' I $L..Al+i.. fftalwas asiy be mfto i " > b permanent. (If smik 7a are alit MUMMMY.1 n loom" is wrf'~i,. " ~R R t It 4lt "Ale ems` " , - so~erfe~ #IRi" 11 tad ?mss it ";So* to tM lorltsrtim-l- r#dbb' 11"Ars ~`'<tlrea~et ~.M' a&~ iii11~~ ~3*+li~i~►.IL~R _ • a iostseito a6ori bows ~ ~ :~~~i~~b s~ a.osaNwiOsd asst litw; tMaa~~ ~ ~ ~ . imld "MONh+1 ft" lire to the plat O ; a k ` y ! *Vow toot (G.I IU wow) o gad beige ssb*mt to R aster swbs slows the itsstoely aid soatbrestorlr shiest woo=1~ ` t 404U 4*bw its. restrktiess ad eovessmts si i it - - hA o 6 ri r r ST C- 105 r v SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County 0 v H OWNER/BUYER M {,C~ //~~tIYJK~ ROUTE/BOX NUMBERZ.:7 3 /4 I' !Cl ~iVFire Number / 1 JiG `rr P CITY/STATE 1-71vdSoJ L CP ,5-Yo PROPERTY LOCATION: MV 14, .SoJ 14, Section r'2~ N, R-/Y -W, I St. Croix Count Town of y' Subdivision hook) riJ_& Lot number 1-.3 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- inert 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 H three year expiration. a I/WE, the undersigned, have read the above requirements and agree cn to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- 10 ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. S I C N E D 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 INDUSTRY, _ DIVISION LABOR F.G. BOX 76 'HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/OT NO.:BLIC NO.: SUBDIVISIOANAME: Nw /sW 1/ z4 /T-z? N/1119 E (or CO NTY: MAILING-ADDRESS: %T~~dIX USE DATES OBSERVATIONS MADE NO. BED roM-WEATIAL DESCRIPTION: PROFILE DESCRIP IONS: q ~~s~II Residence UN~ r.-- C1JNew ❑Replace I Md~ z 94 3 28 9Q EW; P4, Sg Sores BBC? - ~Q.kNa~1~7- RATING: Sm Site suitable for system U- Site unsuitable for system (C NVE []U . M ID: IN G l~S a~ E: S ST IL~~LHD ~ : RECOMMENDED D SYSTEM: ( O A/y1L ptiory~lt~ ft S (1 ® I[p WJ( 0UNV k;)J If Percolation Tests are NOT required DESI RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: NA PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH Wr OBSERVED H TO T BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) I B- ► 6,Sd 96.03 NONIC 7C.Sv /619L L_rS /*7"&vS,&P "If4 ebvF4I 5 B- Z S'23 94,63 1`46NE A,ZS /o''$L Lis 41 B~ +~S'~G~t I~JtQ Sit. - 0 Mor B-3 75a g"9LL-M 4 ,eStd, "geNCSI&t 4q„8A.'r-S-4 Cr yl~ 17~~ ti B=4 S.Oa Ca ZO Z /,."91LVIS C; Q.,Cr,*0e 7"6RN FS @~2d$•R~ F'~ -P"k 1451. B- ~ ~,Q3 9 ~ .O 1 3 zS i3 gp 116 1CRIlep"4cS -Zi "'Zttk" 7S C~tft P-Irr B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERS WELLING INTERVAL-MIN, PER190 1 P RI PER INCH P. Z' U) 9f;.-Z6 30 t / t Z4 P- 7- a tN1-,AC 3 >Z >z < P. 3,'16 No 97.S6 p We 1 Q P- P 44 IOn► A-T Pike- _P_ PLOT PLAN: Show locations of percolation tests, soil borings and the d mensions 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. k A 4Q1~_ ~ dP oV, At A T SYSTEM ELEVATION. . _ .T Spa - - - I x ; 1- i -E P "q 4 r TN Suc zc I - 30' ` 4 7 4-7~ ro . 07 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in acc wi h tL 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: AfeVr-y 301 So►V JON~SoK `Jv2 / n/4 NL Mjq lP< N 28 1996 ADDRESS: CERTIFICATION NUMBER: PHONE NUJIVIBER(optional) 467 Scc--,a ~A616 ~ 8 9 USG CST SIG URE: ~~'VXA6- r' i DISTRIBUTION: Original and one copy to Local Authority. Property Owner anci Soil Tester. DILHR-SBO.6395 (R. 10/83) - OVER - r 02 ' Y ~21 d a 1 i i ev y3^6o u