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HomeMy WebLinkAbout026-1043-30-000 o Q to (D op a ~ ~ I ~ I n ~ O I O ` N d i E N $ I 0 o I x N I U O I h O I U 3 ayi c~ I 0 26 I V Z 'ov _ Ec m a) m 3 o co i c 12 N5 N m E ¢ ~i I M I C ~ I co E I Z ~ € I Cl) ~ a CL m o I oza ~ I m Z a c o I N Z c E v ~ M I N (D p O) •C O O I a y I y ~ C I a CO = p O o a) o Z m Z o N _ Z ~l c N 10 I js if 0 z z o 0 o N ° • _-;j a a a ;,o y I (L p O vii O o 0) 0) rn z I v»c~ rn rn ~ ~ M co oo 0o ~l = o o = N N a0 p r co y C a o 1l') U ~ Vj O OI d C 4f Q U) fa O O ~v► p O U e C O 6 0 N U O O a) O O o o M O d d C CL Sr M (YYg C E E C N N w O O U ` L L ad. -=O n o M ~ M L .c y N C CD ~n I N v o o N E E R V~ `m A a se a L: a • a m d ~w m r o A c~ a V) C~ • Parcel 026-1043-30-000 01/24/2007 08:47 AM PAGE 1 OF 1 Alt. Parcel M 14.30.18.20962 026 - TOWN OF RICHMOND Current X', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner WILLIAM H & MARY ANN D C C I PROPERTIES LLC O- D C C I PROPERTIES LLC, WILLIAM H& MARY ANN 1505 HWY 65 PO BOX 445 NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1505 HWY 65 SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 14 T30N R18W PT SW SW LOT 2 OF CSM Block/Condo Bldg: VOL 3/775 ASSESSED WITH P209B3 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-30N-18W Notes: Parcel History: Date Doc # Vol/Page Type 12/11/2001 664827 1787/275 WD 10/08/2001 658541 1733/531 QC 10/08/2001 658540 1733/530 QC 10/08/2001 658539 1733/529 QC 2006 SUMMARY Bill M Fair Market Value: Assessed with: 176927 873,400 Valuations: Last Changed: 06/20/2005 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 5.000 71,700 609,300 681,000 NO Totals for 2006: General Property 5.000 71,700 609,300 681,000 Woodland 0.000 0 0 Totals for 2005: General Property 5.000 71,700 609,300 681,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 . b Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER rr rc (a) >\.s 4,9r TOWNSHIP sG SEC. .L T_ N-R _W ADDRESS ST. CROIX COUNTY, WISCONSIN p~ )SDI (Q~ SUBDIVISION LOT /4 LOT SIZE PLAN VIEW Distances and dimensions to meet re remelts of IT.HR 83 SHOW EVERYTHING W T N 100 FEET OF SYSTEM ~ rte' o~ fi 13~ INDICATE NORTJARROW w AGE BENCHMARK: Describe the vertical reference point~uAed S wC,csr„ Elevation of vertical reference point: lD 0 Proposed slope at site: '200 SEPTIC TANK: Manufactures: P~,,x,,oCoy►w.t~r~ Liquid Capacity: /67yz, Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: ' Rear, O feet Number of feet from nearest Road: Front,Q Side, 0 From nearest property line Front,( Side,O Rear, O feet Number of feet from: well 7, building: -31 (Include this information of the above plot plan)( 2 reference dimensions to septic tank). SEE REVERSE SIDE I 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 liner Front, O Side, O Rear, © Ft. 'Number of feet from well: Number of feet from building:_ (Include distances on plot plan). SOIL ABSORPTIONtSYSTEI Bed: X Trench: Width: Length: S Number of Lines:_ Area Built Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side,ear,O Pt.J, Number of feet from well: / 01 Number of feet from building: a `1 (Include di Lances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth:,. _ Bottom of seepage pit elevation: Area Built: S" Has either a drop box 0 or distribution box O been used on any of the above soil absorbtion sytems? (C ck 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: Plumber on job: License Number : I 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 SW~DI UJy WISeC.30 T30N-R18W State Plan l.D.Number: 4j 4i ' ❑ CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Richmond Hw . 65 ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Derrick Construction Rt.l New Richmond WI 54017 '0yf` ,V 3. It BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Calvin Powers Jr. 1563 St. Croix 135454 SEPTIC TANK/HOLDING TANK: MAN CTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER ~Qr q o I b g j a g Y PROVIPED: PROVIDED: YES E] NO ❑ YES @I-NO BEDDING: VENT IA.: V T4LB~Fl.: HIGH WATER NUMBER OF ROA(D~ PROPERTY WELL: BUILDING: VENT TO FRESH FEET I' ~ A❑ LARMYES O NEAREST 7 LINE: AIR INLET: FROM ❑ YES E? NO ~ DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACI Y: PUM DEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑ YES DNO1 f, ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: M AND ONT LSI OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH FEET EAREST LINE: AIR INLET: PDUIMP ON AND OFF) YES ❑ NO N SOIL ABSORPTION SYSTEM. Check the soil mois ure the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wi e, construc ion shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PI E SPACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHES: MATERIAL: DEPTH: 5 60 PIT DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE AL ISTR. PIPE DISTR. PIPE MATERIAL: NO. D TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELO PIPES: ABO C VER: LE INL T: . EN ~j a PIP.~jS: FEET FROM LI E: AIR INLET: • 11 h -4 1. / NEAREST /01 d 01', MOUND SYSTEM: i 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 PTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: DE ❑ 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 COMMEN PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑ YES E] NO ❑ YES ❑ NO NEAREST `s e _ .4 _ ,k Sketch System on Retain in county file for audit. Reverse Side. SIGNA RE: TITLE SBD-6710 (R. 06/88) SANITARY PERMIT APPLICATION 701LHR In accord with ILHR 83.05, Wis. Adm. Code 72. =11111111 Ems STATE SANITARY PERMcI~ # -Attach complete plans (to the county copy only) for the system, on paper not less than ,3S" ~ 5- T 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. U ' goo 027 PROPERTY OWNFR PROPERTY LOCATION tf 1-- C;iy a-- 5; i.) % 5kt Y., S _30 T3e5, N, R `0br) W PROPER OWNER'S MAILING ADDRESS LOT # ' r BLOC A4 C TY S T~ ZIP T U L ~CODE PH ONE NUMBER 2 SUBDIVISI N NAM~nO/,R SM NUMBER 14 1 El CITY : ,V ~jT1 NEAREST ROAD . TYPE OF BUILDING: (Check one) II State Owned ❑ r_1 TQWN.QF: 1" TILLAGE yvi4yti>7 65 X Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms - PARCEL AX NUMB III. BUILDING USE: (If building type is public, check all that apply) Q 7 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 OfficefFaWery 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. fff'New 2 T Replacement 3. ❑ Replacement of 4.0 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) i Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 *15 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 420 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 q. ft.) (Gals/d7 / q, ft.) (Min./inch) ELEVATION p ~(O Q . 42 8 t ~ j 3, / Feet ge q a Feet CAPACITY Site VII. TANK in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank ~n"r0-`° Lift Pump Tank/Si hon Chamber Fx~[ I L1 I Li VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for instaliati f the onsite sewage system shown on the attached plans. P7ber's Name ( tint): Plumber's Sig atur : (No Stamps) /MPRSW No.: Business Phone Number: ut n ~.-s1~ ~573 7/ S~ a - S/3s' Plu er's Address (Street, City, State, Zip Code): ! 2~ lG /!1 d»9~ GfJ S 4~'v/ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) 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 r 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 perrrfit 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 f 'PI b. #'6O S90-40029 1/7.$ `f PROJECT DETAIL DATA SHEET NAME OF BUSINESS , r ~c~.uc^~cow~nC, LEGAL DESCRIPTION A K OWNER _ 1'n r r i ca< . - MAILING ADDRESS R 61 1 R1 C~ may ZIP S t/ D I 1 A CT, ENGINEER, Gq.)U hN D6'6j'-0-rs JI - ADDRESS K 9 3 19 ft-~ IV 9 LU ER R DESIGNER TELEPHONE NUMBER .1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed. Please consult Section H 62.20. Existing building New building Addition ( ) Apartments and condominiums . . . . Number of bedrooms ( ) Assembly hall . . . Seating capacity ( ) Bar . . . . . . . . . . . . . Seating capacity # of meals served ( ) Bowling alley . . . . . . . . . Number of lanes ( ) With bar ( ) Campground and camping resorts . Number of sewere3-sites Number of unsewered sites Total number of sites ( ) Camps . . . . . . . . . . . . . . . ( ) Day use only Number of persons ( ) Catchbasin Day and night Number of persons ( ) ( ) Number Church ()No kitchen Number of persons ( ) With kitchen Number of persons ( ) Dance hall Number of persons { ) Dining hall . ~1~. r°. Number of meals serves daily ( ) Dog kennels Number of enclosures ( ) Drive-in restaurant . . . . . . . . Inside seating capacity Car-service Number of car spaces Dump station . . . . . . . . . Number of dump stations Employees ( total of all shifts) . . Number of employees Hotel ( ) Motel { ) Cottages . . . . Number of units with 2 persons per unit Number of units with 4 persons per unit ( ) Medical and dental office bldgs. Number of doctors, nurses, medical staff Number of office personnel Number of patients ( ) Mobile home parks . . . . . . . . Number of sites ( ) Nursing homes . . . . . . . . . Number of beds Parks . . . . . . . . . . . . . . Number of persons ( ) Toilets Showers Restaurant . . . . . . . . . . . . . Seating capacity ( ) Dishwasher and or disposal? ( ) 24-Hour service ( ) Retail store . . . . . . . . Total number of customers ( ) Schools Number of classrooms -~C7 Meals ( ) Showers ( ) Self service laundry . . . . . . . . Total number of machines ( ) Service station . . . . . . . . . . Number of cars served daily ( Swimming,pool bathhouse . . . . . Number of persons OTHER . . . (Specify) . . . . . . p~,~Cps ~tZC Ha~~ S~Lu~~L~ 3~Sr~Y~S-- A~`f COMPLETE OTHER SIDE 2. Indicate whether the following facilities are present. Floor drain yes no Number of drains. Food waste grinder yes no Dishwasher yes no Automatic clothes washer yes T no Number of clothes washers 3. Septic tank capacity 166),o a Holding tank capacity nn Septic or holding tank manufacturer 4. SEEPAGE TRENCHES: total square feet width of trenches length of trenches depth number of trenches SEEPAGE BEDS: total square feet 8 width /a length of bed 57 depth SEEPAGE PITS: total square feet outside diameter depth below inlet total depth from top to bottom of pit Signature of r on completing form: FOR DEPARTMENTAL USE ONLY oct,~P:n us~.o Address R9.3 43mx o? /(.lam /Pi~~rxs~n c.~ l.Jl z i p s~ D Telephone Number Date - / 9 9 - I I y i - - -i , - II 71 i I I I I ' I I I I - - I - 'C' I' I I F - i I i I '~I ~ ~ ~ I I ~ I I I~ I ~ I I Sri L I t --i- - O I T I i - ~ ~ I ikJ •'A.. .fir I 1• -f- -y-- -j---"~-- _ I_ 1.Aj I I I SE CpRRE 6 -f ---=-f-- i I I I - I -T---- I i f I I I i I - _ I ~ - I I 11 l _ M8 (Asd ' I I i I I , I I I ~ I _ i 10 I I . V11 -7 I ' -I--- I I I V71 I , I rL - - - I I 51 - - I o'o YS E ^Ia - f - - - - -da f AUS I I i f--- I i I I 40 u ~~rrr~l~ C s~ S 9 / PAGE OF /UX~✓ '6 k r o S S Z C I U r'l p l U r 1~ J S I n~ Syoi 7 F10611 Ali 101016 And Obtetwallon pipe Approved V4141 Cap Miritnum 12. Above final Grade 20- 42r Abo,o P1pp Cau Iran To final IC ;led* Vonl Pipe 1/er eD Moe Or S~n1h.1 overlny A Min 2' poropol• Over PIPS Olelrl0rllon ' PIPS o 0 0 _ T•• . Aaaeagal • 6•nealll Plp• ° Perforated Pipe Irelor o Covpllnll T•rminallnp AI 6911041 Of Sielem Pru~o~eDc~i~e.~ CI ('act 9~. LItJw~ Io~1 / • SOIL FILL DISTRIBUTIOI.1 PIPE APPROVED $19'PETIC COVER 2"OFhGGREGAlE -.It, ATf-RI tt- OR 4" OF STRAW sz. OR MARSH HAy ELEV. OF'94/ FEET,~ (eOPlY-2l/2 AGGREGATE op ..._.._~~i DIS-rRIF)UTIOM PIPE TO BE AT LEAST S20 AQU AT LEAST LO IAJCHES BUT 1.10 MORC THA" 4Z INCHES BELOW FINAL GRADE. MAXMM Mr vi 0F.EXe:RVAT100 FXOM ORIGINu 6RAoa WILL BE nNIMUM OFF" OF EYCAVATION FROM Olk16I14AL GRAPF- WILL BE ONSITE SEWAGE SYSTEM 51GUED: COft jldlioila ~I LIGEI.)SC AJUMBER: ~S pr's' r'R GE('ARTt rit' 1s''3~.lS! I-AuoR "J' HL'h'iAN 3ELA- i IONS DATE: ,2 9 e-) 1"10N O Y 1ANGS SEE CCN SP6NCENCt - DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS -INDUSTRY, DIVISION LABORAN • HUMAN Pi EDATIONS PERCOLATION TESTS (11§9 0 +r 0 GA2#- BOX (H63.09(1) & Chapter 145.045) LOCATION: SECT N: gTOWNSHIP/MUNICIPALITY: OT NO.:BLK. NO.: SUBDIVISION NAME: 5W 1/450/ / /T3ON/R/B0(or)W &I N AJh COUNTY: OWNER'S BUYER'S NAME: MAlLING ADDR SS: 7~~ ro 1 I'1 (J -P -5y a / USE DATES OBSERVATIONS MADE IND. BEDRMS.: COMM R AL DESCRIPTION: _P_Rb_ffU DESCRIPTIONS: PERCOLATION STS: [Residence O LL` ❑ New Replace 3 / _ 9 3 Z RATING: S= Site suitable for system U= Site unsuitable for system ROUND-PRESSU CONVENTI❑NAL: MOUND: ❑U IN G®~ Elu R . S M-1N-FILL HOaLDING N : RECOMM~ SEM:IpPtiq If Percolation Tests are NOT required DESIGN RATE: QJ If any portion on of the tested area is in the under s.H63.09(5) (b), indicate: C I g S S Y, I I Floodplain, indicate Floodplain elevation: 04r- PROFILE DESCRIPTIONS 'Z5 A - WCft St ~,ocrnr., BORING TOTAL DEPTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OT,, ELEVATION OBSERVED EST. I HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 8 97,8 wore m-.115/ (1 , ,7 -~~7 si►1/ ~.Ys7s1 , Jrn zz ,a - f 4-C, S 11. Bns I. hs 1/ 8&-S IQI (I, S - 4 7 5 / f~ ll~ A a/ 5, /'0 O'a-•3.~ 5. B- a Q 910111" n C S D r k 3, IS 3.S B-3 70 Norte 6/¢iU/ 'e?,'/-3.z em f ?-2--?,e B- B- B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER. AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RI PER INCH P. / j• 8 D 30 3 /.7- P- 117! S/ a -s-k> .3 P- .3a 3 8 -3 3 1 X_ P-- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori. zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 9•/ \ C ~ ~ n 5 r i J oc'q If V V1 t _ f { I v bt ` I I _L A ~I I 1, the undersigned, hereby certify that the soil tests reported on this form w me Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and beli NAME (print) TESTS WERE COMPLETED ON: C Iola. 9 2> a. ADDRESS- CERTIFICATION NUMBER: PHONE NUMB ER (optional): IL 3 'C22 V9 v3I 71S -~V6 CST SIDISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - v SEPTIC TANK MAINTENANCE AGREEMENT r- St. Croix County c OWNER/BUYER W1wJ A M 4- DeQ Pzi LV_ ~II ROUTE/BOX NUMBER ~jpX Iq 4 n1 Fire Number JScS rr~~CITY/STATE WSHV ►2ICM*AVtAC~ W1 ZIP 540 ►-7 i PIOPERTY LOCATION: SW 14, 5W Section T _JO N, R W, i Town of t2A c14 M0 t4 4 St. Croix County, . I Subdivision GS Lot number Improper use zrnd 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 Eunction 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. C 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 Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office withi 30 days of the three year expiration date. SIGNED DATE ~G I St. Croix Countv Zoning Office P.O. Box 227 Hammond, :1I 54015 715-796-2239 Sign, dare ;ind return r.o above address. Agi r ' . + moo' P5 x CAWY. a ♦ Tear It 14 r r y t located in the southwest emitu of Section rourteen (14 ~ , ' f *mees (18) "atI From .,the ti t Fx. 16 Bast an the soath Una at "td` thence North 0037'400 11st _a "s r WSgiAaiAS t thence NOath#0224 Nit ♦r v 300379 West a distsm* of 1 *,3' ,l Of 335.31 fsatt tbance *v theme ' t Worth 1910434 B"a #1 ' # "'i• Sant a distasce ge 320 > lighMY '6't theme ; a3 ?rmk Highwy "C' a dim i t Baal satisfaction of tut 3 Id , Qe, the "$i:tet of fts* to j':,',, _ =+o# ft*MKAW On Page iii as Dooumw*-, { Ehee/ tW &V of D~#pha= 101 ell 'fir? r* (SEAL) g4Adacu- ih 01 MOO 4-61 ISO. (SEAL) ' ANT"O"CAT10N ACRNOWL BDO#iIENT ~ ar1~. .r:. of STATE OR wI900lISIII ' PeesomsUy cw bsIn se, dds. ~cI! y A!= the abavo nomw : . Tt' U- »s STATE au of wncwUN &~fe a0v"W by 17OLIK Wis. Ststs.) . L... D 180, b '1li0RM ►N,byHJ1Rlcg, H .L i IRS to we Meows to be the M stM goiet it MMsnt sad: aci~asMiDai R ~ ~ s~_e Misao~uein St017 t~ r i r (34POkues MY be satleeticalad or ackwwtedSed. Doll • an set seoasaery.) Notary Powic • my Co issios is basest. - r date: n a. . tif~1fo11lyP,^fit•Stat4otYM' ~ri hLSi!JR ~X} Ku. Oct. ~ _ ~ ' ill . M , ~ M o.w. llo► .~-t.» - r APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property W1 wIAly1 RJR-1 C-+(, Location of Property 6W ;4 SW ~4, Section T 30 N - R 1% W Township [ZIC44IMC7NQ Mailing Address QO N T%-- ~ boy, 19 4 IM Q.c1N je-1t-4-)M0p10 WI S4aI1 Subdivision Name ~.S M 3'1"15 Lot Number Z Previous Owner of Property f40 6%Z 4 C44" W E M A N Total Size of Parcel 5.00 Ae a& v,- S. Date Parcel was Created Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes No Volume 5( and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract - 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTy OWNER CERTIFICATION 1 (We) eett%Ay that a.f,- statements an this 6otm ate true to the best o6 my (out) know.-edge; that I (we) am (ate) the owner (s ) o6 the ptopetty descdubed in this in6o,Funafii.an 6otm, by virtue o6 a waAanty deed. & ea ed in the 064ice oA the County Regis te."! o A Deeds nA- Documex* Ne. and that I (we.) ptesentXy own the proposed s.cte. Got the sewage dispeSat system (ot I (we) have obtained an. easement, to tun with the above descA be.d ptopetty, Got the eon.stAuetti_on o6 said system, and the same has been, duty teeo)rded in the 0 6 6ice oA .the. County Register oA Deeds, as Document No. ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED