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HomeMy WebLinkAbout038-1127-20-000 4 0 ~ I a°i °p I v I a oc y M 4 ~ I € I rn I b N N X qb co f.- N N O N M p~j O y c a li N E Ol c .7 0 N r N tl S m L i N I N p CD 0 N O N L N p N V P c Z C Z .X L CD N 5 (D LL c !n LL C -O N to 0 c N L V U 3 o c 3 c~ n v o v yrn a~ Q m E Q 3 M M CL C~0 Z II i.i ~ a+ 0 zt CL c~HZ ct' a co O O z c O y O` Y O N ~ i v I v rn ~ M I N G> 7 N a 'y D. .y 0) CD a) w N N G N O N • a 0 a z Q omz z oi`z N I Z I d 1 d = d C N N CL a° c. V c 1 , y d N y d N v`i O O G D a a m 0 0 a i0 o otr~rmtr~ Ev ormrrnar> o Z c., > 3 3 3 ° m 8 3 3 3 a. ° o z •►v ~ 000 aaa 3aaaa a (v .O a+ y co co (a y O O y 1~ O O V) (D U) ° Erns co Q J V E - - O o a °p fA N Y 0 fn O N U o O U p p j m y c co N c a 0 d QI Cn > y d Q} fn (d Ca O ~ ~ 7 ~ C..1 7 +y+ ~ ~ y y O 3 co Vy! C 01-0 y C c E CD CD -0 i05 0 0 :3 Q o m~ !I N 1 r 0 U) (n U a °O °p c, .2 0) a CL C N e- N e- C ~ .c 2 N O vi I o = E E 10 a°i N W N 000 CO C m N X O O G> > 00 b a $ o Z = o y ~~n IL- IL- c_ a°i E co C"a N w p y N O y N O Vj E E y tLi • ~y O M fn 7 n co z N 2 H r O z- =7 L5 .rt UJ cis Q c V = I € a € a oit a ::a L: aj- - - Cd CL E` c c O O A c0 ao !bvici 0U)U • FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT rrs~ , OWNER WrOZZ.--l' TOWNSHIP SECTION_,f T24_N-R_JLW ADDRESS ST. CROIX COUNTY, WISCONSIN 1 3/~ SUBDIVISIOLOT,-_,~LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM S1 1 r A B~ 8 r INDICATE NORTH ARROW BENCHMARK:Elevation and description: - m Alternate benchmark SEPTIC TANK: Manufacturer:r,cr~ Liquid Cap. 1j!2 ele_41 Rings used: Manhole cover elev:Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front , Side , Rear Ft. From nearest prop. line:Front , Side , Rear Ft. No. of feet from: Well Building:_ ~,P y (Include this information in the above plot plan) (2 reference dimensions.to septic tank) SEE REVERSE SIDE i PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front-, Side-, Rear Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench:Seepage Pit: Width: yC =Length_ 90 Number of Lines:_ Area Built Exist. Grade Elev. 9zll Proposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest prop. line:Front, Side , Rear A_Ft..Is::- No. feet from well:,No. feet from building HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR: ] DATE: PLUMBER ON JOB: ~J LICENSE NUMBER: fS 6/90:cj INSPECTION REPORT FOR SAFETY & BUILDING "DEPARTMENT OF INDUSTRY, 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: NW 4 , NE 4 , Sec . 31 , T31-18 CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Lfnoldin Tank ❑ In-Ground Pressure E] Mound ri c. 9 734 ME RMIT OLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Robert Thell 1933 Sicard Ln.,Somerset, WI 5402 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. P . EL V ST REF. PT. ELEV F,Q. 6k) - ® Sanitar Permit Number: . Y Name of Plumber, MP/MPR No.: County. Calvin Powers Jr. 1563 5t. Croix 128701 SEPTIC TANK/ MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: JTLEP ELEV.: WARNING LABEL LOCKING COV PR VIDED: PROVIDED: 5 ,E'n OIID ~J YES NO ❑ YES NO BEDDING: a/E"T DIA.: ~c~ MATL.: HIGH WATER NUMBER OF ROAD: OPERTY WE L BUILDING: VENT O RESH KALARM: FEET FROM y~ / ti AIR INLET: L] YES E] NO ❑ YES 4 NO NEAREST DOSING CHAMBER: MANUFACTURER: I BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED:- PROVIDED: El YES El NO ❑ YES F1 NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: ❑ PUMP ON AND OFF YES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIALANDMARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: , ;'3 ' WIDTH: LEN NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH TRENCHES: i MATERIAL: PIT DEPTH: DIMENSIONS T GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIP MATERIAL : NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT LE FRESH BELOW PIPES: ABOVE COV R: ELEV. INLET: ELEV. END: c~-,.q0 PO PIPES: LINE 1 / AIR INLET: / / FEET FROM . If 57" -Q' c~ 7 I NEAREST w 10'17 20 1-16 >,)S 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 et in county file for audit. Sketch System on Reverse Side. SIGNA RE: TITLE: SBD-6710 (R. 06/88) i DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code coYPERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than STATE F/p71 SANITARY I/ 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. PROP TY OWNER / PROPERTY LOCATION %a %4, S T ~Iy , N, R Le (o PROPERTY OWNER'S MAILING A DRE LOT # BLOCK # 'A, .10- Al~ ~ CITY, STATE zIP CO E PHONE NUMBER SUBDIVISIO NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) F-1 State Owned VILLAGE NEA ST RO D ❑ Public 1 or 2 Fam. Dwelling-#of bedrooms A EL AX NUMBERO O 3?- 11') 4 O( c-) /V ~6 III. BUILDING USE: (If building type is public, check all that apply) b 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ 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 5.0 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. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION Feet Feet VII. TANK CAPACITY Site INFORMATION in allons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. New xistin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank 1 1/60 /,006 0. El -T 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. (No t mps) MP/MPRSW No.: Business Phone Number: Plum r' ame (Pri t): Plum bar 's Signatur 1PI Y, SI PPlumtfe 's Add ess (Street, Cl , State, ip C 01 IX. CO NTY/DEPA TMENT U ONLY Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing gent Signature ( s Approved ❑ Owner Given Initial Surcharge Fee) r Adverse Determination ' - / on1 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: ` SBD-8398 (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 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. ll. 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'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; (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. ` . I 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) 3 i . APPLICATION FOR BANITART PZRMIT ETC - 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 got tessle by ovnet/contcact0c,(spec house), then a second form should be retained and completed when the property Is sold and submitted to this allies with the appropriate deed recording. - - - - - - - - - - - - - - - - Owner of property 7,2 - Location of pcopetty W i/4 1/4, Section J' T.2..11_1t_Y_Y Township r/l /'P - Mailing address _ C Address of site Subdivision name - • Lot number Previous owner of property f)C4' Total slss of parcel lgzor''F Date Parcel was created - / Ate all cornets and lot lines Identlflable? on 0 is this property being developed log resale Cspsc house)? as a Volume and Page Number as recorded with the Register of Deeds. - - - - - - - - - - - - - - • - - - - • - • INCLUDE WITH THIS APPLICATION T119 FOLLOWINat A VARRAXTY DEED which Includes a DOCUMENT NUMBIR, VOLVMt AND PAOt NUM11<R, and the BaAL OF THR RSOIBTER OF D29D9. In addition, a cattltled survey, it available, would be helpful so as to avoid delays of the reviewing process. It the deed description references to a Ceitllled Survey Map, the CattIliad survey Map shall also be required. PROPBRTT OWNER CERTIFICATION 1(Ye) cettlfy that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the ptopetty described in this !n[oematlon form, by virtue of a warranty de d recorded In the OtLlee of the county Register of Deeds as Document No. ,~~d ) and that I (we) presently own the proposed alto for the savage disposal system (at I (we) have obtained an easement, to tun with the above described ptopetty, tot the cons! of seed system, and the same has been d 1 recorded in the office at,-t s c Re c of D ads, as Document No. _1. signature at Owner Signature of Co-owner (it Applicable) G yd ate t signature Date of Signature *&AM mono Maw NO. a TATC O► . Mr1oca"mc • peow TMtu 9"Ca asaaalrt0 Tots ttswwwtta. tawTa ..C PAGE 401 MGOWS oma DURAND FEDERAL AVINGS AND LOAN This indeuwic, made by f►SSOCIATION 308 Third Ave. W.,.•Durand, WIC a Ctxporstion duly organized and existing under and by virtue of the laws of the State of ed %r DECO "1109 t WiK01111in, gtantor, of............ Pepin County. Wisconsin, hereby quitclaims to.... R.obert...L, ..Aad..,5h rna..JQ...T.h.~1.1 of 8::3`0 A~Me 1 n.iD...D1'QD&:C:tY O • grantee........... , of.....rls.r.... C.MiA i IIII, allows! 0106 County, Wisconsin, for the stem of.....Fifty-Fight..Thousand••Dollars•.•_.•_••••.... ' ooo.r,4.9.1.......... . St •...l.t' )1X Count L03SO. n" To the following tract of land in d Federal Savings & 100 State of Wisconsin: 2nd St. ' I r t ; I i $ i Part of the NW 1,4 0 NE 1/4 of section 31, Township 31 tlurth, Range let I West, St. Croix County, Wisconsin described as follows: Lot 2 of Certified Survey Map filed April 27, 1983 in Vol. "5", Page 1275. Together with an easement over the following described tract of land: All j that part of the NW 1/4 of NE 1/4 of said Section 31 described as follows: The point of beginning of said easement tract is a point on the Easterly line of County Highway "C", 1244.0 feet North and 4t,2.7 feet East of the SW corner of said NW 1/4 of NE 1/4 of Section 31; thence Easterly 63.0 feet; thence 1422'22130"E 69.15 to the North line of said NW 1/4 of NE 1/4; thrnCO West along said North line for 5i.9 feet to its intersection with sail Easterly line of County !!i h•.:ap "c"; thence'SouLh©rly along said Ld!;ter'ly line of County Highway "C" for 71.25 feet to the point of beginning. Alt:u all of that strip of land lying between the Easterly line of the abuve described easement tract and the Westerly shoreline of the Apple River inA between the North and South lines of sa.3 tract each extended Easterly to the Westerly shoreline of the A1,111e River. i t i fII 1+ ii I It -s f I nbeck_ In Witness \Y.'hereof, the said l;ranh,r has cause l tl:c•c pccstnts to be sihn l} r) its Pr den an u)unttrs.Fnrd by d • its St:cretary at 308 Third A'r-:. ~ISCOnsln, and its r r,oratc stal to he hcteuntn affixed this , 4th 'A. L`. ! t day of 191.E i f ~~1 .':GA[I...ASSCCLATION O t r (:-p,tate Name I SIGNED AND SEALED IN P1tf Ei:C£ F ' f I 11 7..... ...r Ptcsident ~ r,ufN, Slt.. atr . _ _ , , STATE OF WIScgMkN, ...........R.U.kP n 198S Personally came before me. this Tay of A. sectary . Noel F. H01inherk PresL!cr,t, amf rc i' d of the above named Corporal o~, to ;n• 1tdfan ti f r t'!r ;,cr?rns oho exr uteri the ( rrj -in- nr't i,! rnt, an I t•, 'ne kunnn to be SgCI President and Secretary of said Cr,lpocati ]n,_ .,cl.rn Ir i1eJat thrr c~ecutrd tl r fr rcp• in1 in~n,rn:rnt ac spch olfircrs ns the dent of said Corporation, bti its sut?r nt. . THIS INSTRUMENT WAS )A ~./'l:: nv pat r:k to M. KadLe (Sleet}.) tut Public. 1'cp I n ( ntnn• Wis -30-90 DURAND FEDEnh;. .:N t5ertion •7 st rt S o-( r• , r. t•. rer ,r I oil I~ ~ the nrntr of tFr F•-n!.rs c•o..t•. ,t'+, - n 11t ~m larlr r r rt r n f N 'r<..n .,h, ~•r Rn. rrn ! ~lAl` •tl .r •t• anu 1 t!.-. ,t Ir,,.!•r j mental agency wi tnouner.) 1' - rct:, dnltcJ Su , r n 1; nF ~tt~CI1~CIN t%'t.ron"tn 1,eiral Stank CVIN4httlr w THIS SPACE RESERVED FOR RECORDING DATA I•. ' la I 1 I This indenture, made by DURAND FEDERAL SAVINGS AND LOAN ASSOCIATION If 308 Third Ave : -W.. Durand, _.WI....... a Corporation duly organized and existing under and by virtue of the taws of the State of I Wisconsin, grantor, of epin County, Wisconsin, hereby quit-claims to...110 C ..6.2 ...4nd =1M.0 ..JQ..MIP1.1 I Jl1arl g1...xy1.Y.9 shJI p...Pr.9P?,Xly grantee............, of......51.f.....Cmq x...................................... County, Wisconsin, for the sum of.....Fift-V.,Eight_,Thousand„Dollars,,,,,,,,,,,,,,, tj. . and,. No..1..... $5B.r.R4Q.:.. Q.Q.) . j the following tract of land in.......... St CirOiX y, Count RrrunN To State of Wisconsin: i I II I I I Part of the NW 1/4 of NE 1/4 of Section 31, Township 31 North, Range 111 West, St. Croix County, Wisconsin described as follows: Lot 2 of Cartifie(i survey Map filed April 27, 1983 in Vol. 11590, Page 1275. 7'uyetlier •with art easement over the following described tract of land: All that part of the NW 1/4 of NE 1/4 of said Section 31 described as follows: The point of beginning of said easement tract is a point on the Lastur-ly lisle of County Highway "CR, 1244.0 feet North and 452.7 feet East of the sW corner of said NW 1/4 of NE 1/4 of Section 31; thence Easterly 63.0 feel: thence 1422'22,'30"E 69.15 to the North line of said NW 1/4 of NE 1/4; thence West along said North line for 57.9 feet to its intersection with naid Easterly line of county -Highway "co-; thence''SouCherly along said >a;lerly line of County Highway "Cr' for 71.25 feet to the point of beginniny. Al no all of that strip of land lying between the Easterly line of the above described easement tract and the Westerly shoreline of the Apple River- and. between the North and South lines of said tract each extended Easterly to the Westerly shoreline of the Apple River. I I: II In Witness Whereof, the said grantor has caused these presents to be signed by...NOe1,.,F.,,,. HQl lllb ~ . . its President, and countersigned by.... SOna/a.... J . Hansen . Ave . its Secretary, at 308..Third . W Du.randi ' isconsin, and its corporate seal to he hereunto affixed this I I . 4th December 89 day of.... A. D., 9 I SIGNED AND SEALED IN PRESENCE OF DURAN FE .ER NGS AND LOAN.., ASSOCIATION Corporate Name • " Prrsidcnt oel F. Holinbeck CuuNr siGNUD: L!: ; ~Li. ;1: J j i Secrelary STATE OF WISCONSIN, I ! , ss. ...........P.uP~:h county. Personally came before me, this day of....... December A. D. 1989....-, Noel F Holinbeck Sonya J. Hansen President, and Secretary of the above named Corporation, to me known to be the persons who executed the foregoing instrument, and to me known to be such President and Secretary of said Corporation, and acknowledged that they exrcuhed the foregoing instrument as officers as the deed i I of said Corporation, by its authority. 1 1 /-~v.. THIS INSTRUMENT WAS DRAFTED BY --p-atria DURAND FEDERAL SAVINGS AND LOAN ASSOCIA'~W Notary Public. ................Pt?pin............................. County, Wis. Dfy comntission (expir(s) NX).... 9:73.Q-.QQ f (Section 59.71 (1) of the Wisconsin Misuses provide that all invtumenta to be recorded shall havr plainly I'rinud nr type arittea therrvm I the naa/es of the p3ntors. granters, witnesses and notary. $cction 79.7U similarly rrquirr% Ihat the name of the pprison who. nr govern- i mental agency which, drafted such instrument, shall be primed, type:.nnen, ounp°d w r itwn thci~on in a IrritIle mminet.l ~1•~11' Irl' tt 1•:r'n '.1^; "'1 .,.~i,i I., ~ nl 1". 1• w L SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/ BUYER ' LL - / -e l ROUTE/BOX NUMBER ' leis' J- Fire Number 0 CITY/STATE Cpl) i ZIP rt PROPERTY LOCATION:~W k,B).6 34, Section_ T N, RJ W, Town of Sf~ v.~r~ Nr c _ _ 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 's*e t'ic tank um er. What you put into the system can affect t e' unction o, t e septic tank as a treat- ment stage in the waste disposal.system. St. Croix County residents M~X 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 .sys'tems 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. y 0 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- a' ment of Natural Resources. Certification form must be completed •d and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNE 57 v 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 INDUSTRY, DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO SUBDIVISION NAME: / - LINTY: OWNE 'S BU ER'S N AYE: MAIL G ADDRESS: 1.4jr DATES OBSERVATIONS MADE USE NO. BEDRMS.: COMMER A DESCRIPTION: PROFILE DESCRIPTIONS: ATION TESTS: Residence ❑New Replace 111 a e , RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND PRESSUREYSTEM-IN-FILL HOLDING TANK: RECOMMENDED STEM:(optional) r 1 Du ®sou ~s❑u IS as~.u os~u os - If Percolation Tests are NOT require DESIGN ATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: - Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DE TH NUMBER DEPTH HL ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- B- B- B- - - i B- B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCH ES NUMBER 1 AFTERSWELLING INTERVAL-MIN. PERIODA, PERIO 2 PER P- /r 3 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 and percent of land slope. SYSTEM ELEVATION (1? X ! - - - - op I f N _ _ - 1 I, th undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and ethods 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 rint) TESTS WERE COMPLETED ON: 1 ADDR S J CERTI ICATION UMBER: PHONE NUMBER (optional): C T GNAT RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - - I t I I ~ . I I , ~ i I I I i I C I . i I --"III ' I I I t I I Ile i ~ I } I I I ~ _L i I t I► I r~ _ li I 1~ I i I I I ~ I I I r I I I t s i l I~ i! rt l l~ l i I i, i ~ I I C I ~ t i ' I I I ' i T i I ! ! I I I I I I i --I- I I ' I i I I( I I f I I i vi l I' I _ ~ I I I PAGE OF Cro S`C~IUr A Ur17 ~~S~c:n'1 Fldlh Al, In1e1e And ODIUvallon PIPa OApplovld V$nCap ulnla u 12- Above Final G,ade Z 142-ts 20•4 2'ADOr•PIDj _4"Caen/on To final Glade Vent PIP$ W,eh Iloy 0! $ynlhollt Co.ulny um 2- Ayy,eyal$ - 0 Plp$ Dleulbrllon i pIP$ 0 0 0 -Too 6- Apa!$pol$ ° Puloroled PIVa B$lor PIP o ~Corplln0 Te,min$llno Al Bollom 01 Syelem iD P, P. i ~.~cJ~ r I orl ~ SOIL FILL DISTKIBUTIpf.l PIPE APPfIOVED $wPETIC COVER OK 9" OF STRAW v' JhATE RIM- 2"OFhGG9EGAlE - OR MARIN HAy (o0F1Z-Zt/2 AGGREGATE ELEV. OF FEET-....' A DIS'rRIP!I'JTI0kJ PIPE TO BE AT LEA5T~~ INCHES BCLOW ORIGIQAL GRADE AUU AT LEAST ZO IIJCHEL BUT 1.10 MORE THA1J 42 IAICNES BELOW FINAL GRADE MAMMUM MrVi OF F-XeAVAT100 FKOM 0K1bVJAL 60,K WILL BE IIJCHES YUNjnvM pEPr1i OF FACA"IlATIOW r-F~OM OA ►1641AL. GRADE WILL. BIC f~L INCHES S16►JED: LICEuSC L1UMBER: Ct- DATE 1 1 O r 384.99 ST. CROIX COUNTY CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW 1 /4 - NE 1/4 OF SECTION 31, T 31 N , R 18 W, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WI. N 1/4 COR. EAST 19 NE. COR FD. I/2" I.P. (NORTH LINE NE 1 /4, SEC. 31) SECTION 31 S 00°- 55'-10"E SMALL TRACTS/ / CO. MON. rl•o' / 346.46' - N -I 454 N 89°- 45'-45" W _ / _SEE N m , - DETAIL 6,12 ch 0 y I ~~o (REC. 62269!6') o ~O 3h /R/W LINEN 890-45-45 S 262.61• m = Fencsline o I O / o m o Ln o, co 0 - m ~ ` ~ v +t 8 9 mm rn LOT - I m r^ CPS 52,044.76 SO, FT. qj i FI > z 1.195 ACRES ti ? /cd. / APR 271963 M boblar W E N 66 0 33 33. / ow, * a 0 o m m ' 1, 9, W[~oa,n>m In S n OD m Da) •02, w / z w J EXISTING w HOUSE LOT - 2 o Oo 48, 876.98 SO. FT. 1.12 ACRES co tp / co O ~Np~P.~PtJO . - ,AA o Q OQ o 1 0 ar / 100' 75' 50' 25' 0' IOC N m ~ --j co / SCALE I" = 100' 40 LEGEND m o s 0= I" X 24" IRON PIPE SET r o WEIGHING 1.68 LBS. /FT m W / • FOUND 1/2 IRON PIPE co U O APPROVED n 2 / FOUND I" IRON PIPE i m h / APR 2 71983 m Lo 33' OWNER 8k PLATTER ° RI W LINE ST. CROIX COUNTY A BRUCE JEZIOR COMP~IEHENSWE PARES PLAv?-:,nG R.R. I, BOX 162 H AND ZONING CON•n'.ri ; tc m / SOMERSET, WI. 54025 / S t .rte ~ . N:. :H 1,W 11:1• ` 3 i 3 ♦ r / It k;. NYi A01 :r~ / ,s ~ ads^F=t,p ~ `a 150 7.98' S 00°-55'-10" E f `k. .•;~.C'' , SIGNED DATE ~s VOLUME 5 PAGE 1275 Allen C. Nyhagen R.L.S. 1407 CERTIFIED SURVEY MAP CENTER SECTION REVISED 1/08/82 NE.COR. LOT-I ST. CROIX COUNTY, WI. FD 1 1/4" RE-BAR THIS INSTRUMENT WAS DRAFTED SECTION 31 , T 31 N, RIB W BY A.C.N. JOB NO 81 - 46 1 384.99 r ST. CROIX COUNTY CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW 1 /4 - NE 1/4 OF SECTION 31 , T 31 N , R 18 W, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WI. N 1/4 COR. EAST NE. COR FD. 1/2" I.P (NORTH LINE NE 1/4, SEC. 31) SECTION 31 S 000-55'-10"E CO. MON. 11.0 346.46' SMALL TRACTS- N = 4,54 N 890- 45'- 45" W / _SEE cDn z I 19 2 6 2.6 1 / DETNI 890- 45'-45 6.12 (n 0 I ~o (REC. AS 269:G) o ~O R/yy LINE c o S 12 / 262.61 m = F~es/Me o I O. / O om co o cn 8 co 0 m -n v rt rn LOT- I / m z OE~P~ 52, 044.76 SO. FT. C,N _ ~IL Lu8 m 1.195 ACRES A PR 2 1983 \ o 1 c' 1C) A4413 0, ught CONNgiI 0 ow W E N v 6601 33, r 3,/ Q'h 0 n m m 3 4e , yy h~,~ S m D m 4e (n J w m i P.G~S. EXISTING w HOUSE / SMP~L 0 LOT - 2 00 48, 876.98 SO. FT. - EO 1.12 ACRES W ( / p~P~~ PNpS , u' n (b O 0 co 17 17 0 o L v co / 100' 75' 50' 25' 0' IOC N m ` - co / SCALE I" = 100' LEGEND ~ o z tr 0= I" X 24" IRON PIPE SET WEIGHING 1.68 LBS. /FT, O m oy U • FOUND 1/2" IRON PIPE `b APPROVED 2 / FOUND I" IRON PIPE m h / APB 2 1983 m 33 R/w LINE OWNER & PLATTER 0 ST. CROIX COUP;TY a - /33' BRUCE JEZIOR COMNIEMENSIVE PARKS rah < : nG cn R.R. I , BOX 162 H AND ZONING COi,-vaf,i.c m SOMERSET, W1. 54025 / / Gam. ~f .Xy / A "rm C:. 14, 7 150 7.98' /:'t• oa. ` i' S 000-55'-10" E ci SIGNED ~.w. DATE] 16.51 C PAGE 127, Allen C. Nyhogen R.L.S. 1401 CERTIFIED SURVEY MAP CENTER SECTION REVISED 1/08/82 NE. COR. LOT-I ST. CROIX COUNTY, Wt. FD 1 1/4" RE - BAR THIS INSTRUMENT WAS DRAFTED SECTION 31 , T 31 N, R IS W BY A.C.N. JOB NO 81 - 46 • AS BUILT SANITARY SYSTEM REPORT ,JNER • .U , TOWNSHIP Lk~~ SEC T, I f N, R `4 W .0. ADDRESS Q , ST. CROIX COUNTY, WISCONSIN. ,UBDIVISION CJ' LOT LOT SIZE C I~ C /L. l PLAN VIEW `'/1 n Distances & dimensions to meet requirements of H62.20 - SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 'IPTIC TANK(S) MFGR."v r AAA CONCRETE STEEL NO. of rings on cover Depth DRY WELL TENCHES -N0. of width 'length area 'aD no. of lines width Iength_a~area_--L-/-34- . depth o top of pipe- IyGREGATE r_ aRK RATE AREA REQUIRED AREA AS BUILT S, sciaimer:-The inspection of this system by St. Croix County does not imply complete' Tmpliance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for i ',stem operation. However, if failure is noted the County will make every effort to termine cause of failure. "-;EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. --INSPECTOR DATED L Q I ' PLUMBER ON JOB 44-Cl LICENSE NUMBER REPORT OF IIISPECTION--IidDIJIDUAL SE14AGE DISPOSAL SYSTEM Sanitary Perm, ivW r State Septic 1."-411 1E T&INSHIP «J~C~C~~ _ t. Croix County SRPTIC TAN11 e.A C Size gallons. `lumber of Compartments Distance From: Well ft. 12% or greater slope 4~ ft. Building' / ft. Wetlands ft Ilighwater ft. DISPOSAL SYSTEM Tile Field or Seepage Pit(s) Distance From: i.7ell ft. 12% or greater slope ft if .0 Building 3 ft. Wetlands - f:. FIELD G righwat er ft. , Total length of lines ` ft. !lumber of lines c2" Length of each line ft. Distance between lines ft. Width of the trench ft. Total absorption area sq. ft. Depth of rock below the 4~=in. Dp-pth of rock over the Z• in.. Cover ...nver.rock, Depth of tide below grade '36 in. Slope of trench in ner 100 ft. Depth to Bedrock ft. Depth to ground water 51 f t. PITS ' (lumber of pits si meter ft. Depth below inlet ft. Gravel aro : `yes no. Total absorption area sq. ft. Square feet of seepage trench bottom area required vquarQ feet of see _ ea requ ed - Snsneate Title': _ Approved Date 197 Rejected Date 197. ER 115 .E WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES • DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 /V K! REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: Section '?_J, T-?]N, R ja E (or)& Township or Municipality Is r& .~✓~i•E'.. W7 Lot No. , Block No. County Subdivision Name Owner's Name: Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS ~d SOIL MAP SHEET "~c SOIL TYPE .+I PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P_/ N Pe ' r L SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) - -914 - "Age: 42 Z 4Z--S i12 'Z ti PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square ee of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy.S Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. ( 1 ~a a~ % yLl t N 77 tr r i 1 _L L LZ 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 location of test holes are correct to the best of my knowledge and belief. Name (print) G G' vCL Certification No. Address~n`" C~cs Name of installer if known r" ,l CST Signature COPY A - LOCAL AUTHORITY - Y k, i ! i L. V Y v PL B67 State and County State Permit # Permit Application County Permit for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: Section N, R E (or) Lot# City Subdivision Nam W nearest road, lake or landmark Blk# Village Township A9 C. TYPV1 F OCCUPANCY: ''Commercial Industrial *Other (specify) *Variance Single family _ Duplex No. of Bedrooms 3 No. of Persons. 3 D. TYPE OF APPLIANC S: Dishwasher YES NO Food Waste Grinder_YESX-NO # of Bathroom Automatic Washer YES NO Other (specify) E. SEPTIC TANK CAPACITY Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement _ Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLU T DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total Absorb Area l/~Ssq. ft. New Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length,16~ / Width Depth Tile Depth_ No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Distance from critical slope 1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tee r, NAMEL LJ~r~ 1 ~c`~w end C.S.T # 5-57.31 and other information obtained from xv. ( wner uilder►. _ Plumber's Signature MP PRSW /s-63 Phone Plumber's Address C -3 17 F e;' C PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). v f ~ V Do Not Write in Space elo F DEPARTMENT USE ONLY GL'S / p Date of Application Fees Paid• State County i Date S` O Issuing Agent Nam 2 e, Permit Issued/Rai€e~d (date) Inspection Yes No Valid* Date Recd L1. county (whit copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) f Revised Date 6/1/76_ i i ~Rf s ~ . , I ~6 i f. 7 1 - ~ ~ _ j'` • r A _ ~ J wl t \