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HomeMy WebLinkAbout038-1007-30-000 -0 C, o N O h ~ O 3: C5 oa Ui ao a) QO o w 2 t H °o N (D N m a x fV Y C ~ I d d h ~ I C Z O LL C O O N ~ N Q Cl) v y z E I uc z °o g € v z - 0 GN I N tM- ~ a co o I O z i o o U) H c (D zz E v ~ M I N 7 C CL N CD ~ c I I~D a U) L Q z m z z N N c ~ d N w~ C O ~T 7 1 E ~ C = CL I ca o c 3 ~ N v N N 41 O m D D a D m O E 'm a U z a 3 a) J Z O O M U p rn rn a~ m m o a) Cl) ~I U o o .0 E a) ~ con m m 2 0 U) co U') 04 o „ 0 3 v H c I O O 00 d 7 N co O O T". 89 CL -M i r N C E N N O O O N w p 75 n o. a CD • M N w 7. O c E 1 U O o 0 CO d' O z- r2 (n V~ d € a EL L IL r.~ V •C c E rm. C Form - S T C - 104 i AS BUILT SANITARY SYSTEM REPORT t " E? NG~ TOWNSHIP -GG1- ~ec~.~'y ~ SEC. T ?N-R,) W t ADDRESS ST. CROIX COUNTY, WISCONSIN • ~1~~~-f~ n s .sue :SUBDIVISION LOT LOT SIZE VIEW fit Distances and dimensions to meet requirements of ILHRt83l SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM e L t ff • b ~7 ~a 1 ~`7 ,tr \ INDICATE NORTH ARROW . BENCHMAM: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer'.dt Liquid Capacity: 1-%';Numb4t of rings used: Tank manhole cover elevation: } Tank Inlet Elevation:9~i4l"7 Tank Outlet Elevation: Number of feet from nearest Road: I / Front .0 Side Rear, O 3 d feet From nearest-property line Front 10 Side 0Rear,(D feet Number of feet from: well A/6- Gd L , building: Joe (Include this information of..the above plot. pl.an)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 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, 0 Ft. ` Number of feet from well: Number of feet from building:_ (Include distances on plot plan). SOIL ABSORPTION~SYSTEM Bedr • Trench: Width: Tar Length: I • ~ %7 .-Number of Linea: Area Built: Fill depth to top of pipe: d /-7t- ~2 / Number of feet f om nearest property line: Front, O Side, O Rear,n Yt ,Number .of feet from well: 'Vo c.." L l~ N 'ber of feet from building: 0~6 (Include di tances on plo plan)*-7-- /41 9 ~ r SEEPAGE PIT .0 5 Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box o or dist►-ibution box O been used on any of the above soil t absorbtion sytems? (C eck one). HOLDING TANK Manufacturer: Capacity: Number of'.ringa 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: /a Plumber.on job: lx~ License Number: } 3/84:mj 1;. 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 „[VI D1$S~NIjN 637 ; 18W Sfat s fiPlan I.D. ned) Number: Town a6 StaA Pttaitie ® CONVENTIONAL ❑ ALTERATIVE Co. H ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTIO DDA E: GeAatd R ta.ndear. 424 We6t Mutbm StiUwateA MN 55082 5`40-40 H! UO 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: B tcon Bi d, J&. 331 St, C x 135459 SEPTIC TANK/ 5 ;a r4' ,{16 oig-C- MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OtJTCET ELEV.: WARNING LABEL LOCKING COVER ~j I PROVIDED: PROVDED: &V 7. 3 6 - 89 YES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑ YES NO NEAREST---* > 07 DOSING CHAMBER: ` MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑ 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 ❑ NO NEAREST 11111- 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: ~.g BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHES: / MATERIAL: PIT DEPTH: DIMENSIONS ) GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DJJySTR. IRE MA ERIAL~ N D STR. NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIPES: ABOV COVER: ELEV.INLETr ELE/V.END:, y~<t~c'i-•,}~d~ .PIPES: FEET FROM LINE: LJ AIR INLET: T 11 Cv r~ 02 9(D. 112 NEAREST _S ~S/ ~o7S 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 ❑ 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: ❑ YES ❑ NO ❑ YES NO NEAREST-~Q 1 Sketch System on ,eftjain in county file for audit. Reverse Side. SIGNAT E: TITLE: SBD-6710 (R. 06/88) -Zoning AdmindiStt(.Iftn . / r• n R SANITARY PERMIT APPLICATION ~DILH In accord with ILHR 83.05, Wis. Adm. Code COUNTY ®ILH rio swn„~+rv ~ v STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than / .3 57 V-S79 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. PROPERTY OWNE PROPERTY LOCATION er&ld Y, !,S T N,R / E(O PROPERTY O,WNrER'S MA l ADDRESS LOT # BLOCK # CITY TE P CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER CITY NEAREST ROAD [ZI II. TYPE OF BUILDING: Check one ( ) F-1 State Owned VILLAGE ; e _ 0. ❑ Public Ei~-1 or 2 Fam. Dwelling-# of bedrooms PARCEL AX NUMBER(S) 07 111. BUILDING USE: (If building type is public, check all that apply) Ov 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 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 0 New 2. 9 Replacement 3. ❑ Replacement of 4.E1 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) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 RSeepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43F-]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 (s q. ft.) PROPOSED 7( q. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION A G S Feet . $Feet VII. TANK A CITY Site INFORMATION in gallons Total # of Manufacturer's Prefab. Fiber- Exper. New Existing Gallons Tanks Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Cam' L:F. El El 1 0 F] r_1 ift 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 ~t(N StamMP/MPRSW No.: Business Phone Number: Plum ' Address (Street, City, State, Zip Code): IX. COU /DE ARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial surcharge Fee) r -1y Z~ S D G y- f6 QO Adverse Do X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety s Buildings Division, Owner, Plumber a ~ INSTRUCTIONS ` a 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; 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) a SANITARY PERMIT APPLICATION COUNTY DILIAR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach completh plans (to the county copy only) for the system, on paper not less than / --d 5- V-47(? 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. PROPERTY OWNER, / PROPERTY LOCATION 4"1 a Y4 S T , N, R i ~ ~E (o PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 11. TYPE OF BUILDING: (Check one CITY _ NEAREST ROAD ) ❑ State Owned VILLAGE H: 4 i 1 i { ''t Q. =6 w: 177- ❑ Public D 1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX O 0 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreationafl Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ RePa k 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 El Specify Type 41 El Holding Tank 12 Seepage Trench 22 ❑ In-Ground 420 Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-ln-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( s . ft.) PROPOSED( q. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION Feet I-l Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New istin Gallons Tanks oncret structed glass App' Tanks Tanks E - i Se e ~L• ~ tic Tank or Holdin Tank Z 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 Signature: (No Stamps) MP/MPRSW No.: Business one Number. l Plum Address (Street, ity, State, Zip Code): -S IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No StemPs) ~ Surcharge Fee) Approved ❑ owner Given Initial (~5ILA Adverse Determination X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: I SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your s4anitary permit may be renewed before the expiration date, and at the time of renewal any now., criteria in the Wisconsin Administrative Code will t?o.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,0e submitted to the county prior to installation. - 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by,gA ftenseo pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning- your ons to sewagd-system, contact„your tocal,code administrator or the State of Wisconsin, Safety & Buildings Division, 80131266-3815. 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~zof R 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 g1l.: l<ppropriate bQ es I;hat apply. IV. Type of permit. Check only one in line A.:Comple line B,,if Rermit is for tank replacement, reconnectfgr},r 'repair. V. Type of system. Check appropriate box depending on system type..;, , VI. Absorption s tram information. PrbvIde all information on requested in ##1=7. VII. Tank reformation. Fill in the ca ~ ~ - ' of every new and/or existing tank, list the total gallons, numbeF of - tanks and manufacturer's nameAndicate prefab bi-sile constructed,and tank materia.l.,Complete for a!.•=;, deptia:pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product,approval from DILHR. Vllt: Responsibility statement. Install ingplumber is to fHl m name, Ircenswnumber writhvippropriate preffx-(e ` MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. y X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the'dounty. The' e"r plans must include the following: A) plot plan, drawn to scale or with-domplete dimensions, locatI6661! holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water serfrift!" - streams-and lakes;-pump or siphon-tanks; distribution boxes; soil absorption systems; replace"mntsystem- areas; and the location of the building served; B) horizontal and vertical AVatibh reference1polnts.-` I;F C) complete specifications for pumps' and controls;-close volume; elevation differences; friction loss; pump, performance curve; pump model and pump manrifacturer, b) Bross section of the-soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing informatiorA GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. 1 - The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD4M (R.11/88) APPLICATION FOR SANITARY PERMIT 8TC-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 tot resale by owner/contcactoc,(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 ~A±1- Location of property =1/4 _/4, Section Z T,•aY Township PA? A Mailing address Address of alto Sdbdivlsion name Lot number Previous owner of property L,+*Pe_o< Total also of parcel - C /f Date parcel was created Acs all corners and lot lines identifiable? _Yes No Is this property beinlj developed for resale spec house)? Yes No Volume 4' :and page Number _Yf~ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMAno and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. if the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. T PROPERTY OWNER CERTIFICATION live) certify that all statements on this form are true to the best of my (our) knowledge; that t (we) am (ate) the owner(s) of the property described In this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. W3 re-l-r.3 / and that I (We) Presently own the proposed alto for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of sold system, and the same has bee'~, `dy~1, recorded In the office of the Count Register of D ads, s Document No. ~.~1. Ignature of Owner Signature of Co-O er (If Appllcabl ) O'3©/ O Date of signature Date of Signature M . ti C804MU454 Tx. It~i ttib 7 1.11 ley d Iris rnh v ~Y~on• a t~,e1_cr~, s :inQle~. MAR '11 t to 4S 1S th 1M p.et - d e Am pw% aed dr 4ltrttlil~ e r _ ~esar•.aaadpat. sstsss is 1 wttt01ee464i, llat do am PA x_d do Am pare. toe ad is ooMMwadw :.wi i Ar and 0f-her Goo a..A Valuable . „ pry to him it had paid by tM said panj.ead dw pooped p-t do wait wbnsd it bMdV etalr~Il aril a~sasdri/d.1i a. tom. ttffix" b~had. odd. nam4 nkaad. ad q" tshiad, ad by tloa P=IF e M - IN% y" neater nbaa ad gdteiaia alto dw pail pan it Of do aoooad part &W to lht33sliea ad aasira tasrarr. do * w-tisissed wd astat-r sitsat-d b dra C9eaty d S t Unix - and State d Wisoos K tow W 1►n undivided one-half (1/2) interest in and to the following: Ccmrsncing at the Southeast corner of the Northwest Quarter (till~i) Of Section Number Two (2), Township Thirty-one (31) North of Range Eighteen (18) West, thence West on the Quarter line Four Hundred feet, thence North to Cedar Lake, thence Northeasterly along } * 'Ain said Lake to the North line of the southeast Quarter of the Marthvest Quarter (SEAT of Nw%) of said Section Two (2), thence East to the northeast corner of said Southeast Quarter of the Northwest Qwwter of said Section Two (2), thence South to beginning, also the right of egress and ingress over the highway along the South r aide of this property connecting with County Trunk Highway aH". r. r. h j*mews MA Tq mdl des aeon. ftV&W with aU and dKwuthe appsewwum a and pr eihqa dwrrata bdw4taS or i• arFadw *0000 "Pwabb • and am as notate. eight Ms. b"" and edaia whatw~ d do said pan Vt_ of dw tint pet "w is law ar et%. d dw L pone" w a -paetaaey d. to Ma ody peopar us% bere6t ad bahod d dw said part iA8_ d Mw aaoosd PM% e; bin ad aster tweva 7 i Munn Wiar4 do said put Y__ of do AM pan ha L heeeesto eat _ head _ aad &W d • March . A. D. it ~ . , piAW ' ` AND >i1tALED IN ?RZ8ZNCE OF ame Wayne A. Lockrem. MOS OIBAM LadV S MOAT *TATR OF r . Yid a• . ~9th day of MI"h' A. D.. 14 tin...tyrare hsloee a.. this ' an Awn swd YAffi IDC1tal4L. a single rson, M sr brews to bs dra paraoe~ho -secaad the toegninp iaatrsseeot sad admowh dpd t~ K4I YACI~ 'R %GTA "rr r tMOt WTOY itAai t1iG1Mt C WL W CL•~ 9i~'F~Vr 1. t') 11.92 Notary Pubtk may. Win. 'ltiis AIMM E. UM. Laajer My Coamiaios (Espies) Us) r ♦ MaMes. eleaereeeeteree+e w 1 Mae as teea*wra M N caewiM AM time aWa* ptMed M Ord deeew Me i WA Of 00 err ai si rea QVM GWUM D@MD- ffA7! OF >t l "MA .L i Jtah of Wisconsin 6owy of Croix { hereby certify that this instrument is a fuh, im and cord copy of the document on file and of -cord In my office and has beer eoopared by me. AMW March 30 .19 90 James O'Connell J~ a FAOrA Register of Deed! Deputy w STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT rt St. Croix County OWNER/BAR G'/1'fl DZ~L ~,~N~,t/iti~ ~~G/~/yI>g/~ r 0 ROUTE/Br= P Fit 74 /cFire Number Z2=4 :J d CITY/STATE all zip PROPERTY LOCATION:. lVey 34, Section 2 T31 N, R~W, Town of T,/~ P f}/~~F St. Croix County, Subdivision Lot number 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 l'ic'en's'e'd"se t'ic tank pumper. What you put into the system can a ect the .unction o 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, whicT 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 s*ys'tems agree to keep their system properly maintained. 1 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 0 to maintain the private sewage disposal system in accordance with w the standards set forth, herein, as set by the Wisconsin Depart- a' ment of Natural Resources, Certification form must be completed b and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning.Office 911 4th St. Hudson, WI 54016, 386-4680 Sign, date and return to the above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IhiDWSTR.Y, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LO ATION: SECTION: ,I UNICIPALITY: OT NO.: BLK. NO.: SUBDIVISION NAME: COUNTY: MAILING ADDRESS: ALI&, USE ATES OBSERVATIONS MADE iZ.2 NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCHIPIIUN5: PERCOLATION TESTS: sKlAesidence ❑ New Replace 0. RATING: S- Site suitable for system U- Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL ms ING TANK: RECOMMENDED SYSTEM:(opti nal) ❑s❑u osau as au asou ou If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: ~Q PROFILE DESCRIPTIONS BORING' TOTAL DEPTH TO P. UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 0 > 7 B- A/rz-e > 7d ~n fir" .S /f✓ ~'y~ ~ may-. B- B- 6- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DR I WATER LEVEL-INCHES RATE MINUTES NUMBER III''S AFTER SWELLING INTERVAL-MIN. -PERIOD 1 P RI 2 PERIOD PER INCH P- n~ C o~ r G P. P- 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 rcent of land slope. SYSTEM ELEVATION I ` fo" o i 7 i 4 .~-i - "IF +~l I, the undersig ed, hereby certify that the ests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative ode, and that th recorded and the location of the tests are correct to the best of my knowledge and belief. NAME p TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNA E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR•SBD-6395 (R. 10/83) - OVER .PROJECT w X, ADDRESS ~tj ,-a ~/4Vk ) 1/4/S~ /T ~N/R/ W TOWNTYByron Bird Jr. 3318 DATE / / BEDROOM CLASS PERC._,/_ CONVENTIONS IN-GR ND PRESSURE CONVENTIONAL LIFT MOUND_ HOLDING TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA ~tT PERC RATE BED SIZE J -;2- x 11116 Benchmark V.R.P. Assume Elevation 100' Location of Benchmark g~~ * H. R. P. - E--3 Borehole Q Well Scale Feet 0 Perc Hole System Elevations Uent 12" Grade TYPAR COVERING • ( 2" 12" 3' O 6' O 3' - I 6 " Sewer Rock i 1.2' OD ';U 12 t6 r r c. +a c , , if