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Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
`OWNER " AIJAM/ TOWNSHIP 6=? 41- 5'C'f SEC. T ~N-R
ADDRESS ST. CROIR COUNTY, WISCONSIN
~22 61
A7
SUBDIVISION LOT LOT SIZE G J
PLAN VIEW ,
Ditstance@ and dimensions to meet requirements of I14R 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
_ 171. i1.-i.. .K . r .:f{ fl ~ / ' C 1•~~+ -I'J
k%
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference oints
P Proposed slope at site:
t SEPTIC TANK: Manufacturers Liquid Capacity: L000 C
' '''-Number of rings used: Tank manhole cover elevation:
• Tank Inlet Elevation: Tank Outlet Elevation:
r
Number of feet from nearest Road: Front,O Side, Rear, O feet
From nearest- property line : Front, OSide,QRear, 0 U 0 feet
Number of feet from: well IYIA building.: ~ ~ '
(Include this information of.•th above plot p1an)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
17
la
PIMP CHAMBER
Manufacturer: --Liquid Capacity:
Pump Model: Pump/Siphon Man rfacturer: Pump Size
Elevation of inlet: Bottom of tank elevations
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from•neareat property line:'. Front, O Side, O Rear, O Ft.
'Number of feet from well:
Number of feet from building:
(Include distancee.on plot plan).
SOIL ABSORPTION•SYSTEHM:
Bdd:' Trenchs
ti---
Width: Lenith: --Number of Linea: Area Built:
Fill depth to top of pipe:
Number of feet f m nearest property line: Front, O Side, Rear, 1t.
O O
Number of feet from well: ^I/VAL L
N 'ber of feet from building: 3D / .
(Include di tances on plot plan).
SEEPAGE PIT
Size: Number of pits:. Diameter:
Liquid depth: Bottom of seepage pit elevatioRh "
Area Built:
t
Has either a drop box O or diet-ibution box O been used on any of the above soil
absorbtion sytems? (Cieck one).
- a
HOLDING TANK
Manufacturers Capacity:
Number of'.rings used:- Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearast property lines 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 Numbers
3/84:snj
.i .
~}QQ loo dad
'DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
I,,ABOR & HUMAN RELATIONS DIVISION
P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
MADISON WI 53707 State Plan I.D. Number:
NE 4i S 4, Sec. 6,T31-R19 CONVENTIONAL ❑ ALTERATIVE (If assigned)
Town of Somerset ~`i "
El Holding Tank In-Ground Pressure ❑ Mound
NAME OF RMIT HOL 0 1-1 OF PERMIT HOLDER: INSPECTION DATE: ,
Girard Ave. S M is MN 5540
2129 _9
BENCH MARK (Pe anent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST _
O
llfD,v
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
'x 135476
Q- ~ SEPTIC TANK/4qWjWC=T K_ 6(, as ^ er'= d CP-15'_~~
MANUFACTURER: LIQUID CAPACITY: TANK t TANK OUTLET• ARNING LABEL LOCKING COVE
Q 5 r _ Z~ i / "DED. PROVIDED:
CSNES ❑ NO ❑ YES NO
BEDDING: VChl~DIA.: VENfiiv1ATL.: HIGH WATER k1JIMBER ROAD: PROPERTY ELL: BUILDING: VENT T FRESH
Q .-v. ff Q J-4-ALARM- FEET FROM LIN / AIR INLET:
❑ YES XNO ❑ YES NO NEAREST
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
S NO F-1 YES E:1 NO ❑ YES ❑ NO
ONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: AHAPER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET LINE AIR INLE .
PUMP ON AND OFF ❑ YES ❑ NO NEAREST '
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL A
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.) / t~
CONVENTIONAL SYSTEM: 0 ~d ° f-d . = d f - Q r? D /
BED/TRENCH WIDTH: LEN TH: NO. OF DISTR. PIPE SPACMCOVER IN # PITS: LIQUID
t ( TRENCHES: ~f PIT DEPTH:
DIMENSIONS S /
GRAVEL DEPTH FILL DEEPTH DISTR. PIPE DIST R. PIPE DIST . PIP AT IANUMBER OF PROPERTY WELL: VENT TO FRESH
BELO P~eE ABO If COVER: ELEV. INLET E EV END: & ~IJFEET FROM / AIR INLET: f 6TfK NEAREST LINE : 1 d"
MOUND SYSTEM: $,2 '
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 ❑ YE NO
DEPTH OVER TRENCH/BED EPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDE SEEDED: ULCHED:
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO F_] YES ❑ NO
PRESSU ED DISTRIBUTION SYSTEM:
BED/ ENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
DIM SIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
ELEVATION AND
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:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST
r LL~ ~~iLCHx'e
s '
'180
91
I
Sketch System on Re ; in county file for audit.
Reverse Side. SIGNATU TITLE:
SBD-6710 (R. 06/88)
®ILHR SANITARY PERMIT APPLICATION COUNTY
In accord with ILHR 83.05, Wis. Adm. Code St Croix
~.e
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than El
8% x 11 inches in size. c f vision o re ous 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
Dan Murphy NE t/4 SE 1/4, S 6 T 31 N, R19 E (or
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
2129 Girard Ave. S. N/A I N/A
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
M ls., MN 55405 1(612 77-8224 N/A
11. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILL GE NEAREST ROAD
Delona Rd ./River Rd.
❑ Public 01 or 2 Fam. Dwelling- # of bedrooms3- AR ETANUMBER( , 5) 111. BUILDING USE: (If building type is public, check all that apply) s --fJ z3,
1 ❑ Apt/Condo
2 ❑ Assembly Hall 60 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. 0 New 2. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5.0 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 [?9 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
91.8 Feet 99.0 Feet
450 615 636 .71 2
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holdin Tank X 1000 1 Weeks Conc. Pr. Lift Pump Tank/Si hon Chamber El I El El El FIR T~
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/MPRSW No.: Business Phone Number:
Byron R. Bird 1309 715 268-8317
Plumber's Address (Street, City, State, Zip Cod :
Rt. 1 - Box 228 - Amery, WI 54001
IX. COUNTY/DEPARTMENT USE ONLY
Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing gent Signature (No Sta
XApPZejdE1 Owner Given Initial Surcharge Fee)
Adverse Determination `
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/86) 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, 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; (Jose 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 PERMIT
aTC-100
This application form is to be completed in full and signed by the ownet(s) of
the property being developed. Any inadequacies will only result In delays of
the permit issuance. -Should this development be intended lot 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 tecotding.
Owner of property E 3 ,a-- /1'
Location of property ~ E1/4 /4, section 6 ~ T. -ate-V
Township -9 7-
Mailing address f_ J_6'
Esc ~a J~~J d
Address of alto .~._5 °C/ C
subdivision name G-_ /9 E ve l- 0 P,>-" 7- -
Lot number
previous owner of peopetty ~4--___~ )?17_4R '6 Total size of parcel e:3 4~lrE~
Date parcel was created `'3,0
Are all corners and lot lines Identifiable? as 0
Is this property being developed tot resale fspec house)? as 0
Volume P,'!nd Page Number as recorded with the Register of Deeds.
• - - - r r r - r r - r - r - r - - - - - - - r - -r - r - ~ - r.... r• r r-- - -
INCLUDE
WITH THIS APPLICATION THE FOLLOWINCt
A VARRANTY DESD which Includes a DOCUMENT NUM8NR, VOLUM2 AND PAGN NUMAIM& and
the SEAL OF THN REGISTER OF DEEDS. In addition, a certified survey, it
available, would be helpful so as to avold delays of the reviewing process. 11
the deed description references to a Csstitled 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 (out)
Rnovledges that I (we) am (are) the ownet(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. G/`IV GJ j and that I (We)
Presently own the proposed site for the sewage disposal system tot 1 (we) have
obtained an easement, to tun with the above described property, tog the
construction of said System, and the same has be*
,D duly recorded In the office
of the S:ounGtReglsker I Deeds, as Document No
~ 41
signature of Owne SI natute of Co-Owner 11 Applicable)
ate Of Slgn tuse Date of Signature
in" and dw0 at ww; (waa e
( ) ( ) net 2+agtdnd
l~eliARO1e d R..t >eetW valor No. a. CNOo( #)a.
II {
1Me'd for
AIR 31 Y
County Auditor a 8230~
a ~.a~.e d oa+r 1
L7 Deputy
y. 9
WATT DUD TAX DUB HEREON. _ g {
Dab.. July 21 , 19 88 t ,
(ewv for
lW YALUARLS CONSIDERATION, Barbara M. DeLaittre >ry1 { T'
eHnd wmmwt (s) to Daniel W. P. Murphy and Deborah
r~. Staack husban an wife
Mrtr. wd ynoWty in St. Croix Count Wis s s,
See attached`
F
EXEMPT
} (M rnew IPM is "8604, ooatb%w on bade) "t
*WOW v ft ON Iw mdtta nts and amwtm p baiooft #mw@1 , wi1)jaot to ~ foisw~#l a Sst
f We of A mpaid WWW mem m b mW intm* tlwron; 1
Barbara M. DeLaittre
t Affix D"d Tax Stanm ff#Frv
STATE Or 11INl1 EWA
COUM (W HENNEPIN
7!N hrhntment wart acknowledpd baton mo thib ~day of
by +
t r- INi1MA6~_ AM
44
OR 4" om OTNRR MIS OR RAM) t,, afi
-#A AAA
fIGNATVRR OF FRRiON TAKINO IMM"
iCsssslla~tr:MkcttS
Mr. & Mrs. Daniel W. P. Murphy k
~ww~nnv..w vr.w►. ••w,
At{ DRAFTW9T(1AX8ANDAODRRaa)1 r' Thomas D. Carlson
i Best i Flanagan
3500 IDS Center
!l mmapolis, MN 55402
16121339-7121
_ _ r
s,
N Ali"
'ry
¢53'1 ay''1 7-7
pow"
Part of NM 1/4 of SN 1/4 of Section 5 and part of NE 1/4 of Si
104-09 Section 6, All in 31-19 described as follows: Commencing
et',tAe 1W corner of Section 5; thence S5036'40"w along the
seetiOS line 1165.52 feet; thence N88019'05-E 1335.07 feet;
t x84017040-W 1287.63 feet; thence S01037'10-W 1287.69
fMti tb0M*'S88013.35-W 1334.96 feet; thence 589.21'00-W 149.90
fee: to P0INT OF BINNING: thence S890214'00-M 1170.71 feet;
a 00•01'10'M 660.0 feet; thence N89-21-E 335.0 feet; tbencj'
459''35*55•R 690.41 feet; thence S640101150E 67.0 feet; thence
iil• ~SO'6 53.03 feet; thence S73032.30-E 151.04 feet; thenee,'
X1': Z-1411264-35 'E 90.31 feet; thence 560.08'50-E 94.94 feet; thenc! feet; thence S01037'10-W 637.06 feet to POINT
1~t~i1t1
e. WITH and SUBJECT TO a 66 foot road easement as
deecrtbed:ia volume 05170, page 595. (No. 17)
Phis"is mot homestead property.
t his s he second of two corrective deeds to correct tlae~
z k
34f04t in deed dated June 2, 1987 and recorded on June 8," -
It'116ok.781, page 261, as Document No. 426668, in the
is
fir's Office, St. Cross County, Wisconsin.
i443s 1
r
,r
_ S
1Mtt) NR. 27-#A-OAT CLAN DEED Minasesota uniform Conveyancing Blanks (1978) Wbw-oens Co. ►annnaaW.s
' i ' ~J11M11~11r b irldlllidYN (a)
• V 440994 I e o' 82-1 FA-;[339
No delinquent taxes and transfer entered; Certificate
of Real Estate Value ( ) filed ( ) not required
Certificate of Real Estate Value No.
,19 REGISTER'S OFFICE
ST. CROIX CO., WI
Roc'd for Record
County Auditor 1908
Q I I r 21 7vo
Deputy at 8:30 A M
STATE DEED TAX DUE HEREON: $ Reyaser of DO*&
Date: July 20 19 88
(reserved for recording data)
FOR VALUABLE CONSIDERATION, Daniel W. P. Murphy and Deborah L. Murphy
f/k/a Deborah L. Staack, us an an wi a ,Grantor(s),
(marital status)
bereby convey (1$ and quitclaim (4) to Barbara M. DeLaittre
, Grantee 8)s),
real property in g t- r rn i x rn t o g , W i n nnn sti r QwxvtKh%Vzjt a MWdescribed as follows:
See attached
~a
EX..PTr7
(if more spaq is naaded, continua on back)
to dwir with all hereditaments and appurtenances belonging ereto.
Daniel W. P. Murphy
Affix i~c4•ri'1.ixsta'n)~1(-rc v
D Borah L. Murphy
STATE OF MINNESOTA _
as.
COUNTY OF . r .
The foregoing instrument acknowled before me this By of , 19 88.
by Daniel P Murphy and Deborah L Murphy, f/k/a Deborah L. Staack,
husband and wife raptor(s).
NOTARIAL STAMP OR SEAL (OR OTHER TITLE OR RANK)
SIONATUR Of PERSON TAKING ACKNOWLEDGMENT
A Tax Statements for the real property described in this instrument should
i _nuQ[[4 .4. Orrrtt
Irotwar ,~K _ M004solr be sent to (Include name and address of Grant**):
RA IV COUNTY
My aa`-I een -viws Mach 1990
TUM MaTRUMRNT WAS DRAFTED BY (NAME AND ADDRESS):
Thomas D. Carlson
Best & Flanagan
3500 IDS Center
Minneapolis, MN 55402
(612)339-7121
ec~x 8?1 ~ ~3~~0
Part of NW 1/2 of SW 1/4 of Section 5, and part of NE 1/4 of
SE 1/4'of Section 6, All in 31-19 described as follows:
Commencing at the NW corner of Section 5; thence S 5036'40" W
along the Section line 1165.52 feet; thence N 88019'05" E
1335.07 feet; thence £ 04°17'40" W 1287.63 feet; thence S
01037110" W 1287.69 feet; thence S 88°13'35" W 825.0 feet to
point of beginning; thence S 88°13'35" W 509.96 feet; thence S
89°21' W 1320.61 feet; thence N 0001'10" W 660.0 feet; thence N
89°21' E 335.0 feet; thence N 59°35'55" E 690.41 feet; thence S
64010'15" E 67.0 feet; thence S 61020'50" E 53.03 feet; thence S
73032130" E 151.04 feet; thence N 81037'10" E 90.31 feet; thence
S 60°08'50" E 94.94 feet; thence S 35028' W 284.35 feet; thence
S 01°37'10" W 300.0 feet; thence S 01°37'10" W 340.0 feet to the
point of beginning.
TOGETHER WITH and SUBJECT TO a 66 foot read easement as
described in Vol. "517", page 595 (No. 17).
This is not homestead property.
This deed is the first of two corrective deeds to correct the
description in deed dated June 2, 1987 and recorded on June 8,
1987 in Book 781, page 261, as Document No. 426668, in the
Register's office, St.~Croix County, Wisconsin.
• • 4 4 S
i i7 ~x~ }3 ~t=~ e 2ai #7Ii~'Y JAT cv..i<.S1 ,y Y~+~..
r
OT R10,
-April . -15, 90.
James 0' Connell__., ,
.~a .
C Deputy
- w
SEPTIC TANK MAINTENANCE AGREEMENT rt
St. Croix County
r
OWNER/BUYER %0 o
ROUTE/ BOX NUMBER 17'f r Fire Number-,;:,,
ZIP --4/v2~
CITY/ STATE m
PROPERTY LOCATION: ,,~i't Section T N, R L
Town St. Croix County,
Subdivision Lot number
Improper use and maintenance of vour 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 pum er. What you put into
the system can affect the function or the-septic tank as a treat-
ment-stage in the waste disposal system.
St. Croix County residents may be eligible to recieve a grant for
a maximum of 60% of the cost.of replacement of a failing system,
whit 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 system properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a mater plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and .(2)-after inspection and pumping (if nec-
essary), the septic tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year-expiration.
H
I/WE, the undersigned have read the above requirements and agree
to maintain the private sewage disposal system in accordance with y
the standards set forth, herein, as set by the Wisconsin Depart-
meet of Natural Resources. Certification form must be completed •d
and returned to the St. Croix County Zoning Office within 30 days c
of the three year expiration date. d1
SIGNED
DATE
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016 t
386-4680
Sign, date and return to the above address.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTfi;Y, DIVISION
LABOR AND PERCOLATION TESTS (115 P.O. BOX 7969
HUMAN RELATIONS \ MADISON, WI 53707
(H63.090) & Chapter 145.045)
LOCATION: SECTION: ~TONSOH MUNICIPALITY: OT NO.: BLK. NO.: SUBDIVISION NAME:
N~ /~S0/ /T31 N/R 1,1✓(or ,E AR -5 FT- %vA Al COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
o DAN At v H 21,29 2► A M1NA1E P u MATS
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTIO PROFILE DESCRIPTIONS: PERCOLATION TESTS:
0flesidence 3 J N:j XNew ❑Replace
AIA 3 7Z%'0 -3 a Z &O
RATING: S= Site suitable for system U= Site unsuitable for system
~-GROUr❑~ ❑ S ❑ S [ ~ Go,v v~EAIT/a~u/4L BED / 2 'XS3')
F rcolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the r s.H63.09(5)(b), indicate: A Floodplain, indicate Floodplain elevation:
1'V /V G
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GR UNDWATERIoNG4;€8 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ELEVATION OBSERVED EST. GHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
V. dAFY E p~ ~.0'32.4'St t3851 15{.7. /'~-y. v~d yS5/ - 2.a'~ KBn r S,
B-' 16.0 98. 6 Al0A) , 0 r. h rr)ry s.
/.3- ,2.3' AA- 8rt Ary Si 3= p'
B- Q.0 r(/0/V~ /0. if Sfr.On8rIs-clrffyS~3.0'~58'Bn /a erPd /s-f
f / / }J A; ~.7%7.7. D k J9h 11V I/
B-,3 /0.9 8. ~ WE 2.7'- 3.6 OK 13n s t a 5/ t l3 f, r ~ 36' ~f!S'//3n Ortfy S - / ~
Y. bkvyPih $i l J ~7 - B. 'Di oil A ry,
B- o.0 6 AJa ANE ~/o o t 3.y Sir. a 5 rd . /s r Sl-li~1b'- Oi
B- - /'Z'; 3.0ok sn AV 511#
o.8 4AJ 3.0'-~/~! n d/rlyS~ w~grI:~ vpp~c8u;ys/ G.0,41 A 5-/do Y
E
B- •C $n a fd n Ind s'I 0, IS; 7.2-/08 OKYBrr 5 ra - 5; 1,
PERCOLATION TESTS v
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER ING AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI0D2 PERIOD PER INCH
P-
P- ' p
P- y' Al 0 112,& < /
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 q/_9 ~ P Iskem-eml s / go l
M R11 5 de i MRIr e W r-r nl rl fo }
G
1)1,4-104, ✓_et t!Ct!d~lofn.-~/QD,
D ° f c n5
Ids
sr .!"o co 40 i -
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:
C- 3 2 O
ADDRESS: CERTIFICATION N BER: PHONE NUMBER (optional):
4Ake
AvA IS- x'
CST N T E:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
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