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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 State Plan I.D. Number:
Hold E] ALTERATIVE (If assigned)
SE 47 NW 4,, Sec. 15, T31-R1~ CONVENTIONAL
Town of N. Somer ❑ Mound
Ott ing Tank ❑ in-Ground Pressure
u
NA IT ER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Mark Reyer 13603 Granda Ave, Burnsville, MN 5 337 761 4 1
REF. PT. ELEV.: CST REF. PT. ELEV.:
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: /m ,G
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Byron Bird Jr. 3318 St. Croix 135511
SEPTIC TANK - ` n,, r . / ,
LOCKING
MANUFACTURER: ~i LIQUID CAPACITY: TANK INLET EL TANK OUTLET ELEV.: PROVIDEDLABEL pROVIDED:OV,Q,G ,
L( q Q / l S / 000 YES -1 NO ❑ YES NO
BEDDING: VE T-DIA.: v;OITMATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENTT FRESH
e ,v . „ G 0, ALARM: FEET FROM LINE ~ ^ II i AIR INL T:~
E:1 YES NO Cis C~ ❑ YES NO NEAREST
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WAR I G LABEL LOCKING OVER
PROVIDED~
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF P OPERTY WELL: BUILDING: VENT TO FRESH
FEET FROM AIR INLET:
(DIFFERENCE BETWEEN
PUMP ON AND OFF ❑ 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 SYSTEM:
WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID
BED/TRENCH / TRENCHES: MATERIAL: DEPTH:
DIMENSIONS 1-2 GRAVEL DEPTH FILL DEPTH DISTR. IPE DISTR. PIPE DISTR. PIPE MAT RIAL: N . ISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT LE FRESH
BELOW PIPES: ABOVE COVE : ELEV. INLET: ELEV. END: f ~G PIPES: LINE: AIR INLET: i
rR h FEET FROM
p~ - 8.5 ~37d1•0~7 d NEAREST
MOUND SYSTEM
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
❑ YES ❑ NO ❑ YES ❑ NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑ YES El NO [:1 YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
DIMENSIONS
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 L: BUILDING
COMMENTS: FEET FR❑ YES ❑ NO ❑ YES ❑ NO NEARES~ LC/f~'" ~<~~•r ~~~'t ~ ~ .cam - '
etai in county file for audit.
Sketch System on TITLE:
Reverse Side. SIGNAT E:
GPIs
SBD-6710 (R. 06/88) - `r ~ _
i
SANITARY PERMIT APPLICATION
7DIL.HR In accord with ILHR 83.05, Wis. Adm. Code COUNTY
STATE SANITARY PERMIT #
ENO
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑
8% x 11 inches in size. check if revlsio o e 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
4y Ak, S N, R / E (orYV
PROPERTY OWNER'S MAILING AD ESS LOT # BLOCK #
TY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NA E OR CS- NUMBER
~7 a ~ o h a
-ID NEAR ST ROAD
II. TYPE OF BUILDING: (Check one) ❑ State Owned VITLLAGE : ,~e^~ c f
❑ Public 1 or 2 Fam. Dwelling-# of bedrooms IWACEL TAX NUMBER(b)
III. BUILDING USE: (If building type is public, check all that apply) Q 3a _ Q _
1 ❑ Apt/Condo v
2 ❑ Assembly Hall 60 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. VN New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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 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. EFINAL LEVATION GRADE
REQUIRED (sq. ft.) PROPOSED sq. ft.) (Gals/day/sq. ft.) (Min./inch)
/5- A * 7 L. ~;~CFeet Feet
VII. TANK CAPACITY Prefab. Site Fiber- Exper.
in gallons Total of Manufacturer's Name Concrete Con- Steel glass Plastic App
INFORMATION New istin Gallons Tanks structed
Tanks Tanks
Septic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Si tune: (No Stamps) MP/MPRSW No.: Business Phone Number:
rDr~ ~rc/ ~Y
Plu be s Address (Street, City, State, Zip Code): i
d C,
IX. CON /DEP RTME T USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing ent Signature (No Stam
Surcharge Fee)
Approved El Owner Given Initial
Adverse Determina ion
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS dr
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 instaNation.
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.
111. 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'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) 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)
r
APPLICATION FOR SANITARY PERMIT
9TC- 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 for resale by
owner/contcactot,(spec house), then a second forth should be retained and
completed when the property is sold and submitted to this office with the
appropriate deed recording.
- - - - - - - - - - - - - - -
Owner of property
Location of property /4. 8ectlon T
Township Y
Malling address
Address of site n4n
subdivision name V V S
Lot number q
Previous owner of property , 1 Qh~ ~a►►r~~o--~~
Total size of patcal
Date parcel was created ?
Are all cotners and lot lines Identifiable? Yes 0
Sa L o
Is this property being developed lot resale use)T_,__Yes No
Vale" 71 nd Page Number //Y'-- as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION TITS FOLLOWINCs
A WARRANTY D22D which Includes a DOCUMRNT NUMBRR, VOLUMZ AND PAOR NVMBER, and
the BEAL OF THE REOI8TER OF DEEDS. In addition, a certified survey, 11
avallable, would be helpful so as to avoid delays of the reviewing process. tf
the deed description references to a CertlEled survey Map, the Certified Survey
Map shall also be required.
PROPERTY OWNER CERTIFICATION
I(We) cettlly that all statements~on this form are true to the best of my (out)
knowledge; that I (we) am (ate) the ownet(s) of the property described in
this Intotmalion form, by virtue of a warranty deed recorded In the office of
the county Register of Deeds as Document No. 711 . t and that t (we)
ptesently own the proposed alto for the sewage disposal system (ot I (we) have
obtained an easement, to run with the above described Ptopetty, tot the
c! uction at said syat , and the same has been dui tacorded In the office
C n tee of ds, as Document No. ~7//
00111
P
gna t of wnec Signature of co-owner (tt Applicable)
Z
Date of aigna ute V Date of signature
J
r' MO @E IJND la0q ALL 7th rM+IBE OVEN -
E FKV CW AND N 071#11 NON,OONBIJttEA
T • ACTS " s=
. mow. by and between Pater P_ T 1 u A e w A w r P_ h+
4. 71-se
t fted for
~
Y18
M1MthMarNOrmOreland~tcer i e i nn Hnmoe ins 11:
Vendor «eea and 1"Phrcthasar", whether one all more). ~wnaret •
press to convey to Purchaser, upon the prompt and fun par-
Ibrasance of this contact by Purchaser, the following prop", together with the
h
in C+ rgs. Profits. fixtures and other apip re iX t interests (all called the ..Pr
County. stale d Wisconsin: rETUM TO '
Lot 9, Plat of Northern Oaks in the Town of Century 21
Somerset, Wi
Somerset.
Tax Plat No.
f
n,rn. is not
i homestead property.
the aurrn d a to ichass the Property and so pay so Vendor at h 1 S r e s i d e n c e
at the axacuMonop this V u 0~ 00 in the following manner. (a) $ 2. 3 0 0. 0 Contract 0
and (b) the balance o f$ 9.200.00 logedw with interest from date
hereof an
here paid it tut, lance follows:outstanding from time to time at the rase of ten per cent PW annum
Principal payment of $9,200.00 PLUS interest due and
payable on or
before August 1, 1990.
Provided, however, the entire outstanding balance shall be paid in full on or before the 1 c t
t_ Au USt 1890 day of
FaNorMnp any dshult in payment interest span accrue at the rate of T e n (the maturity date(.
f in default (which shall include, without limitation, delinquent interest and, upon accelera
% r annum or tion or matutr~ty,nt e entire
PrM+cipal balartce).
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici-
polad annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor,
Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of
taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
unless otherwise required by law.
Payments shall be applied first to interest on the unpaid balance at the rate specified and then 10 pri i . An
ar1101r1>t may be prepaid without premium or fee upon principal at any time after P Y
wdeaaaeeMitr~abt~hoaacx ~ 1/„ .19doA►1
In this event of any prepayment, this contract shall not be treated as in default with respect to payment so long
as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated
as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been
made as first specified above: provided that monthly payments shall be continued in the event of credit of any proceeds
of msurance or COndwrination, the condemned premises being thereafter excluded herefrom
Purchaser states that Purchaser is satisfied with the title as shown by the title ev donee Submitted to Purchaser
for examination except:
recorded easements and rights of way.
rs,;
Purchaser agrees to pay the cost of future title evidence if Irt e eviden':er is in the form of an ab<;Iract •t shall
t be retuned by Vendor until the full purchase price is paid.
Purchaser shall be entitled to take
- - , „
on
~ ~ '1.`11asGu-Oru. possession of the Property
..k~a~ualand STATE BAR OF WISCONSIN wISCONSjN REAL TOPS` AS~c/ ilpry 3
FORM No 1 f - 1982 4e0t Hives Road. MaAt4Wt Y4 8311Qi- 3 ,,y
` fteam rIMAM b PW Stan to of A 111M j
s ~ " . it ~ and bMlla► en OsfaMtd re0l~lt attNt ~ ` ' "
` PtrldmM tithe an the PlapMtP bared ~ Ills
etrohbi~ Vrdr malt ne"
ded wimp Mtille ore
la
• NONE , but vMhdor shall eel wqt~ cs~~ tR r ,
V Isy Veltdor. fa the shush d ft
gran gw bel nos Owed under Mies CarMracl Ptrclhaar ah~ pair b Mtufrartoe perrhitala aAtsrt 1M
d amain des almdard cruse in bus of res. V~8 irttNeal and. UrAm Vandot aMlMwiee aNii M
q of as pof ho ooust" the Properl~r be deponNed 11111111111 Verhdr. PWCONW sham pia 44 w
:ar.ano. eoaip I and varhdor. t Purchaser and Vantim adatwi.. apps in we im-t_ w «.o..d. ri+
-go On or repair of the Property darn q prOVided #0 Vendor ds«ns to wOoraron cur wpdr b 6
s
Purchaser Oonsrtum not to cumin walls nor slow web to be can -0 k, an fro Pm" to Mp trite Pbp!1q► k
in good isr Nhl oorhdMfon and n~air b hm Mhe flee Iran mm SUPwkw to ft lien of Oft OOn1111a, M/
w b cur I^ htM al lade, n dirartoas and re/ulalora adaclktpkP M 1P~aparlfr•
Va dor agrees tal in case the plc d price wllh inbteat and otar moneys shall be fully paid and all condgMM
shall be fully parlornad at fhe tlmes and in fM rlwvw above specdo4 Vendor veil on dsmartd. eueaAe and dM1111►16 a
h the Purchaser. a Warranty Deed in foe simIft of fine Property. 6" and clear of cur Mara and enournbnam an o
any ins or anamlbnnoeeerralad by Ma act of dM" of PUlthe r, and ONO"*
jJ
w
X ( Purchaser agrees that time is of the essence and (a) in tfhe event of a dalauN in the paynhent of any prirclpal at
interest which corMkwss for a period of 30 days foln - Vw opeci W due date or (b)in the evert d a ds&Ain
ot 3 C days.
of hoowing wrilerh .
any anther obMpa~on of Purchaser which oorhtirnree for a If
W or bafinoa u11dM fhis~0lt sOl y
F Veor kNMpsr or mailed by csrtiGed mein. tin Mte slows otAeta'
W" b due and payable in full. at Vendor's option and wdhoul mice jwMch Purchaser fANeby
lowirq rights and remedies (subfsct to any IinavMorhe povided by Mal N i
welves), and VZ shd also haw the fol
addition b Mace provided by law or in equity: (i) Vendor may, at his option. lorminate Mus Contact and Ptaohasar'a
rights, Mlle and I inrisl in the pcop and recover the Property back through strict foreclosure wilh any Ogt1My d
c; Ndsrrhplio to be oondMiorad upon Purchaser's full payment of the entire ou~t~d~tg balance. wilt NNsr - Mareefi Mi01a
Ma dab drh ditM a> fM rate in ailed on such dab and older amounts due hereunder fin which event all snto- ' penifNrliy
t Purchaser shah be forefeited as liquidated damages for failure to fulfill this Contact and as reftlsl IOr 111te
E; N purdhaar fails to redeem): or (u) Vendor may sue for specific perfornrhsnce d Mhls Contract b oomph
s h inrneddle and full payment of to woo outstanding balance, wish interest hereon at Mhe rate in easct an Mho date of
- delatrN and athr anhauts due hereunder. in which event to Property shall be auctioned at judicial safe and Purch ar
shall be life for any deficiency; or jiii Venda may sue at law for go entire unpaid purchase price or any
r IM Vendor may declare On Contract at an and and remove to Conrad as a cloud on Ills in a qubiI
colon M " **IN" rMSnsl of Purchaser is irripnificanc and (v) Vendor may he" Purchaser *Clpd Itonr poll>llwien
c d the and have a receiver appointed b Doled any rent, tissues or pro11e during ft pert Ft r If d ng► colon
under (ill. l) or (fai) above. Nalhtrilhprhdinp any oral or wrNbn statements or actions of Vendor. an eNNb1t d rg► .
P1 tM %ovum".1111 remedies shall only be bkhdtng upon Venda 9 and when pursued in and aN Coals and erpsraM
including rwsahabls amm"s fees of Venda incurred to erriorce any remedy hwwnder (wimOm abated or noq b Ma
extent not prdtibiNd by law and expenses of title evidence "I be added b principal and paid by Pumhaar. as in-
aurod. and ahal be mcluded in any judgment.
Upon ft commencarlert or dun IttesrpyendencyrOf any action of forocbsure of has C inrad, ftcl aer.cpo~M0"
Judi homestead ea 10 Collect #0 ferft "M and of
to to ow-n
receiver of the Property during of
dK Of such action, and such rents, issues.aandd probes when so collected shall be held and
applied rift court
Purchasr " not transfer. sell or convey any le r equtable interest in Mhe Property (lby asslprnmm of any
of Purchaser's rights under this Contact or by option, brig-term lease or in any other way) wNhotA Mhe prior ONO ~
T corhssra of Vendor unless eil her the outstanding balance payable under this Contract is firs! paid in full, or ft, fnlMMl
conveyed is a pledge or aeeignn wvt of Purchaser's interest under this Contract solely, as txecurily for an'mdsbbtMS d
Purchaser. M MN event of any such transfer. sale or conveyance without Vendor's written consist t, the entire OhAetMhdNhg
balance payable under this Contract shall become immediately due and payable in full, at vendor's option without nobs.
Venda shah make all payments when due under any mortgage outstanding against the Properly an ft dab d
this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provdad PurehoW
makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments dkeCay b
the Malgagee d Venda fails to do so and all payments so made by Purchaser shall be consdet payments made On
t This Contrsct.
Verdes may waive any default without waiving any ocher subsequent or giver default of Purchaser.
All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal repreeentaliN...
successors and assigns of Venda and Purchaser. (M not an owner of the Property the spouse of Vendor,br a valuiew
consideration joins herein to release homestead rights in the subject Property and agrees to join to to execution. of ft
deed to be made in fulfillment hereof.)
Sa
Dated th - day of to
(SEAL) g*AQ -
i Peter P. Taubenberger
(SEIW
(SEAL) Precision H nes, I c
Y
• _ Mark L. Reyer,its President.
AUTHENTICATION AC
Signature(s) - - - - - STATE OF WISCONSIN
St. C r o i x Co<,nty. }
authenticated this day of 19 Personally came; fore me this day
P.' 'Yabben'~erger
- _-et. e r
TITLE. MEMBER STATE BAR OF WISCONSIN
•s•~.a~„••,,~~~~ (If not.
onzed by § 70606 Wts Slats I - k
••••a O~ to me known to be the person- whoelleClMd
f y,. INSTRUMENT WAS DRAFTED By foregoing instrument ano acknowledge Mte same.
lec
e" * lnhn li _ ! > a I s h 'ids 4"
y = fsf t y be authenticated or ac-r;)w1Pdged Both Notary Public -
stall
.fi R.•w are aryl My Com sion is permane . (N. not,
~w date T~
ybn. gnmq . ,..nVnrir tiM,,a •n 4;».,. . a,..w ryy.,r ti,~naterrti r.
CONTRACT - tnrnvoua'. ana Corporate scare Par rn wssconsm. Form No. 11 - 1982 `
I W
SEPTIC TANK MAINTENANCE AGREEMENT `7
~ I
St. Croix County
OWNER/BUYER \f Pc,S~~-• 4ks
f''
0
Fire
ROUTE/BOX NUMBER Number
ZIP 5 p2 C
CITY/ STATE S C Yy-~ L'~?
PROPERTY LOCATION:_ Section S T_ILN, R
Town of St. Croix County,
Subdivision n tom,' ~ Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes.- Proffer maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed. •s'e t'ic tank um er. What you put into
the system can aect t e -unction o. t e septic.tank as a treat-
meet 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,
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 .system s 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 °
v,
to maintain the private sewage disposal system in accordance with
the standards set forth, herein, as set by the Wisconsin Depart-
Certification form must be completed
meet of Natural Resources,
and returned to the St. Croix County Zonin ffice hin 30 days
of the three year expiration-date -
SIGNED A~\OW, UO- jqq,~
DATE
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
386-4680
Sign, date and return to the above address.
• SAFETY & BUILDINGS
''N RT~sjENTOF REPORT ON SOIL BORINGS AND DIVISION
' ,"~i1STRY, P.O. BOX 7969
LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707
HUMAN RELATIONS (H63.09(1) & Chapter 145.045)
LOCATIO ' ON: r TOWNSHIP/MUJQ}@LXY: OT NO.: BLK. NO.: SUBDIVISION NAME:
SE /NW/4 15 /T31 N~RI9NXIor)W Somerset 9 n/a Northern Oaks Estates
COUNTY: OWNER'S BUYER'S NAME: MA U
St. Croix Steve Erchul R.R.#2 Somerset Wi. 54025
DATES OBSERVATIONS MADE
USE RO U~TpT1(uNVS: STS:
NO. BEURMS.: COMM R D R T O
15-1-90 5-1-90
~sesidence 3 n/a Mew OReplace
1
r:•
RATING: S- Site suitable for system Um Site unsuitable for system
ONVENT MOUND: IN-GROUND T -FILL ai,i~ TANRECOMMENDESYSTM:loptionall
S E Q S ❑U R S ❑U ❑ SOU ®U conventional _7=
If Percolation Tests are NOT required DESIGN RATE: [#sin, ortion of the tested area is in the n/a
under s.1163.091511h), indicate: n/a _ indicate Floodplain elevation:
decimal' PROFILE DESCRIPTIONS page 10 Pr-C
BORING TOTAL ELEVATION DEPTH T GROUNDWATER-IN HES TO BEDROCK IOF I S' OBS RVEO (SEES ABBRV. ON BACK IEXTUF3E, AND DEPT H
NUMBER DEPitInt B ERVED G
13-1 7.00 100.86 none >7.00 .83bl.1. 2.50bn.l.s. 3.67bn.c.s.
B 2 7.33 100.96 none >7.33 .58bl.1. 2.50bn.l.s. 4.25bn.c.s.
3 7.08 101.06 none >7.08 .83b1.1. 1.42bn.l.s. 4.83bn.c.s.
B-
4 6.75 100.24 none >6.75 .83bl.1. 2.50bn.l.s. 3.42bn.c.s.
B-
B-5 6.67 100.91 none >6.67 .75bl.1. 2.00bn.l.s. 3.92bn.c.s.
B-
PERCOLATION TESTS
decimal' RATE MINUTES
P VEL-INCHES PER INCH
TEST WATER IN HOLE TEST TIME DROP IN WATER LE
NUMBER - AFTERSWELLING INTERVAL-MIN. !33~T2- 3 3 1
none 3
-5- 5
none z
P
P none 5- b b <3
p-
P °
s. Descr
P orin
what PLOT PLAN: Show locations of percolation tests, how the iglocattiionh onl henplots planof suitable soil areas. Indicate scale or
Show the surface elevati n at all bo ingseand the'diir cl onaand lpercent
Rental and vertical elevation reference points and s
of land slope.
SYSTEM ELEVATION 97.36
1-0
. • ~ p~ -}FS-fir- I _ _ Z~ I
I I_
• j ~ I s
. 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 llte Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
TESTS WERE COMPLEI EU ON:
NAME print
Gar L. Steel CERTIFICAT OON NUMBER: P11014E NUMBER(opiional):
nDUrtES :
988 N. Shore Dr., New Richmond, Wi. 54017 2298 715 46-6200
CST SIG A RE:
DISTRIBUTION: Original and one copy to Locni Authority, Property Owner and Soil Tesler.
DII.iin Sr)D (*,95 in. 02/137) - OVER -
L PLAN
. RROJE•CT 10'a,714- ADDRESS ~J~E- 1/4 /Y~,) 1/4/S/:3-/f y N/R //,!p W TOWN/ COUNTY
arn,c~ 5~'
MPRS Byron Bird Jr. 3318 DATE . a o
BEDROOM2 CLASS PERCCONVENTIONALY IN-GROU PRESSURE
CONVENTIONAL LIFT- MOUND_ HO ING TANK
SEPTIC TANK SIZE a LIFT TANK SIZE
DOSE TANK SIZE HOLDING TANK SIZE
ABSORPTION AREA PERC RATE BED SIZE
111h, Benchmark V.R.P. Assume Elevation 100'
Location of Benchmark
* H.R.P. /P/o
O Borehole Q Well Scale = Feet
O Perc Hole System Elevation
Uent
12"
Grade
TYPAR COVERING
2"
12" 31 4 61 4O 3' 3, 40 3'
" Sewer Rock
6
12' 18'
r
;0 J~
(P,Z - G /3-57--
I
~D
M
-d
R
ro f
~L Ho4ry