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HomeMy WebLinkAbout042-1102-50-500 v o I ~ 0 3 0 o ti O 64). N O O o a ~ 0 0, E N ~c O U U c m CL CL N O O O O C U 00 co (o N CD U O p z cc U. O aU.- 3 co t Q c o v M Z y 3 E Op €V z d m rCOi H cA a co I o m o z :t c 13 95 N z~ o o 2 p Z v rn co; d m g 1 :3 ~ (D a~ m D c t • Ai ~ t o a o ( Q O zf- Z ° Lo C N _ Z W m E p N ` d = li Oo. i a ~ ~ c o a I El 3 '5 co U) w U) ((O^~~1V1 Z M> O a Z Z CL IL IL N a 3 I N C:, 0 3 O N 'B O O Z N U M rn rn co 0 N Nom. ~ p0 A _ O d U m co m a~ m 05 O Q Q oo u _p N y E E co c p N tD rO r ~ C U) v 0- 0 0 9 CL r- N E N N `p p ' O O cc0 C y C d L 'p n r e- N C O N H C N p co no o f a 04 • o co 3 U ~ o z y Z~ m to r~ ~ i = = I z m R E a V fit a ::ate u d 0 CL "E E c c 0 0 0 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, , DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 3707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/MtIf9IUJPALI 1 Y: OT NO.:BLK NO.: SUBDIVISION NAME: - sk) sw'/ 3 /Tz f N/R IFE ( rl es P 000NTY: Buy"; MAILING ADDRESS: r1•Te1=F Co...PweI1 c.33 0W' ST A1013eA-TS S. sgo23 USE DATES OBSERVATIONS MADE NO. B DRMS.: COMMER IAL DES RIPTION: r~cV~y, TS: RIFTIONS]PER Residence 344- LNew ❑Replace -/yfv W/~ 6- ~^O RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:(optional) DS EA ©S C]U CIS DU ❑S DU DS DU T2CNGtt5 0,0t-y- w/ aRcp ~3oK y i ST I ro Pj - If Percolation Tests are NOT required DE SIGN RATE: If any portion of the tested area is in the y under s. ILHR 83.09(5)(b), indicate: Cr%/}S S Floodplain, indicate Floodplain elevation: O ~i-yore- . PROFILE DESCRIPTIONS 5CS 4 ~'~tc?~TT ? S,~ vT lr 0 BORING TOTAL P H TO R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED E TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ~ B- / v 166.5, r > D sU o~.r7y IS,, S', 71 U S- dN. S, S T9.~ 4,1.f,e w a' B,r~os de„sEe 8N SL B •75'17F. TS, .9,j' 8-, TO) I. C9' 8.r-Sy. Blocky S,'l O~ f~~j S , ~ " Hi'Y. o f 13.E . 5P~ ot~ l.? R S 13 L-I . R,., . IS B. 3 4 0 ' '67,. s, B.. 'T /a C.~r r ~o S/ ,4!; ASoUE fue SI Z B- p . r y9" / A T I P, o /.Q' Cis . 5,11 I 1 $ ' B,,.,• Si I I S ' B"_ u t, C" r T_c P'f'. - 4- S I I. p ' BN ~t;,,..► S( 3. p ' ";e Ba - Sl B- w/ ff-F. OR t4 OTS B- S 0 ~Sa , j 1.0 0 ' 3.~ . u ~•y Gov pie C-4 sI w ff ote PERCOLATION TESTS Alots . TEST DEPTH . WATER IN HOLE TEST TIME DR I WATER LEVEL-INCHES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PE 10D 1 p RI RAPER INCH MINUTES P- / 3 S' 30 S115-6 /4 ~.a I . S P_ 3. S' ~-ccr 3 d I j I I ,1 /7,2-- P-3 d D % G P f'" O 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. 7 N '00U C Ala 1~ec. /0 a h 7-,0 '1 IU4 ON - $1 Tg Utz'Irle4 1949-0k1.v1sr,aR, AN D v, T,"~ s4~, 49,S7-- TH y Zp ' .ca i4 D l-i A 0 l' L 141 t Y % Pt-or P 1, --f j L ~At~~ Txb I , the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures an rs etfied to 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 : OMESITE SEPTIC PLUMBING CO. TESTS WERE COMPLETED ON: 655 O'NEIL RD., HUDSON, WIS. 54016 I l- I 170 ADDRESS: ROBERT CERTIFIT~2NUMBER: PH3Nf. NUMBER (optional): VIS. MASTER PLUMBER LIC. N0.3307 M.P.R.S. 31 o_Bi~S CST SIGNATURE: j~ ON: Original and one copy to Local Auity, Property Owner and Soil Tester. 95 (R, 10/83) th r - OVER - C 3 0` SeT / " f~UG 33 , 3V 3 60 ~ . ~,aobD ~ ~ 7S - • ~fEAicr pos7' gs A P, 140 a o~ i P j3~4CKffaE ~i % S aC = PK-~~- SlTES HOMESITE SEPTIC PLUMBING CO. 856 0WEIL RD., HUDSON, WIS. C:?t 2 S 5~pZ- ROBERT ULBRIGHT Va. MISTER PLUMBER LIC. N0.3307 M.P.R.S. MINN. INSTALLER & DESIGNER UC. N0.00883 r Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER - - e6 TOWNSHIP C~ t l a kK,4't_ SEC. ~ T e %N-R ` W ADDRESS t, SST. CROIX COUNTY, WISCONSIN 4?3 / #0 U). SUBDIVISION LOT &1 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILI1R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 0 6AI f ~ \ s ~ r ~ iV? go i 41 I / 6/ jl~-- /38 1 I /Vos i 3 INDICATE NORTH ARROW BENCHMARK: Describe ,the vertical re er~ei~ce point used yC , Gt, qa,p► ~ Elevati n of vertical reference point: J106",0 ~ Proposed slope at site: SEPTIC TANK: Manufacturer: u1,2~- Liquid Capacity: A-9ee9 Number of rings used: Tank manhole cover elevation: 4 Tank Inlet Elevation: / /y g'~ Tank Outlet Elevation: Number of feet from nearest Road: LFront,O Side,(Rear, O feet - From nearest property line Front, 0Side 10Rear, 0 'y2 feet Number of feet from: well - 41, building: 3 ri (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE t 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, OSide, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Q Number of Lines:-Z- Area Built Fill depth to top of pipe: 3 Number of feet from nearest property line: Front, O Side, O Rear, (l~Ft. Number of feet from well: /7,-2, Number of feet from building: l~ (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector.-- IX' Dated : - Plumber on" job: License Number: 3 3/84:mj i~ 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 YpI O 15 07 State Plan I.D. Number: Whys S~GX,ec. 36,T29-R18 (If assigned) Town of Warren 1 CONVENTIONAL El ALTERATIVE 140th St . ❑ Holc IingN'Tank El In-Ground Pressure El Mound I-cmaw NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTIO DATE: Jeff Conwell 633 140th St. Roberts WI o BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. EL CS REF. PT. ELEV Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Henr Nechville 3258 S Croix j 128794 SEPTIC TANK/' 64A CCIIAV=/~ MANUFACTURER: LIQUID CAPACITY: TAN EV.: TANK OUTL V.: WARNING LABEL LOCKING COVE e PROVIDED: PROVIDED: ~,cJee~S . I7K~ g~( • S YES ❑ NO ❑ YES NO BEDDING. VENT DIA.: dIG>YT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELLCOI BUILDING: VENT T FRESH Coo. ARM: FEET FROM LINE: AIR INLET ❑ YES NO Ca ❑ YES NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LI CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERAT NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN I FROM LINE: AIR INLET: PUMP ON AND OFF) I ❑ YES ❑ NO N SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: 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.) 0 CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH TRENCHES: MAT RIAL: PTH: DIMENSIONS 4-- GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE ;)ISTR. PIPE MATERIAL: NO I TR. NUMBER OF PROPERTY [WEL BUILDING: VENT TO FRESH BELOW PIPE: ABOVE COV: ELEV. INLET: 4LEV. END: ~ k7, y Lt PIPES: FEET FROM LINE: AIR INLET: 1,0 30 -36" 9' L r~J a NEAREST t~ - 4J /3t~' 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 O meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO SO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED THS OF TGPSOIL: DDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES E-1 NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: N0. DISTR. DISTR. E 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: 1/ .1 FEET FROM LINE: ❑ YES [__1 NO ❑ YES ❑ NO NEAREST-~ X6-74 ~ 1 fain in county file for audit. Sketch System on T ITLE: Reverse Side. SIGLUURE: SBD-6710 (R. 06/88) SANITARY PERMIT APPLICATION DI~HR COUNTY c,~<~ K In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than p((j~"`Y(~'j 8% x 11 inches in size. ❑ Ch /k 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 I'EfF_ CON 49 G7,(/ ~Lt1 Y.Sx) Y., S 3Cp T Zf , N, R l~ E (or (W PRRO E RTI' OWNER'S AI ING DRESS LOT # BLOCK # 63 5 d-K ~ CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME O SM NUMBER 3E Ts 4j/ 9 SyoZ~ 3 Q_3 1111, NEA E R q6P CITY .7 ST-' 11. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE ; &,CA,7 El Public 1 or 2 Fam. Dwelling~# of bedrooms A Ax u BER ) 1 - J/ 4 III. BUILDING USE: (If building type is public, check all that apply)V A 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 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ 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. ~ New 2. ❑ Replacement 3. El Replacement of 4. ❑ Reconnection of 5. El 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 11 Seepage Bed 21 ❑ Mound 30 El Specify Type 41 Holdin9Tank 12 [9 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure r~ i 43 ❑ Vault Privy 14 ❑ System-In-Fill Z) 1,1;aey 6t w,- s VI. ABSORPTION SYSTEM INFORMATION: 1 G Z ` 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM E V. 17. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) FO, ELEVATION 750 d S 74- O 77,0 Feet /0/ Feet VII. TANK' CAPACITY Prefab. Site Fiber- Exper. in allons Total # of Manufacturer's Name Con- Steel gloms Plastic App INFORMATION New istin Gallons Tanks Concrete structed Tanks Tanks Septic Tank o L• bar L 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 Phone Number: Nfw R .lice, 41V 1 l/oe 7/5 1,7if-33:Z-21 Plumber's Addre (Street, City, State, Zip Code): 7(01 / 65 /20 S J rrrV 3 IX. COUNTY/DEPARTMENT USE ONLY Issuing ent Signature (No Stamp Disapproved Sanitary Permit Fee (i3urcha perFee Water a e Issued 1.4 Approved ❑ Owner Given Initial Adverse X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6388 (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 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; :eater 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) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property ~f✓ CrLI~_ CAI~wGL-~- Location of Property 5l.(J k S~V Section T N-R Ido W Township 60AaA10_1Q Nailing Address 3 3 $T ~O~s2f-S, 1t11/ .540 Z 3 . Address of Site xX x ~7fl S77 ~o~ s I~SI~ 5 v 23 Subdivision lime 6, r4 110WAVE. g p4c9c Z2S8 .Lot Humber Previous Owner of Property O ~O/,lGc~ELL Total Size of Parcel Date Parcel was Created ~-7 - 4 O Are all corners and lot lines identifiable? A Yea No to this property being developed for resale (spec house) ? Yes x No Volume g and Page Number / 70 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION 1 (too I cvt,L(.6y that afe statements on .thus ohm ahe trcue to the best 06 my (0un) hncwtedge; that 1 (we) am (ahe) tile owner k) 06 the phopehty descA bed in thiA .i"AonmaLi.on 6ohm, by v.ih.tue 06 a waAAanty deed tecmded to the 066ice 06 the Countyy RrgiAte>< o6 Deeds a~5 Document No. ZF(o/ Sg / and that i (We) pneaen.t.£y cun I pnopoaed .bite bon the sewage d zpos .6y,6 em (oh. I (we) have obtained an easement, to kun with .the above deAcnibed phopeAty, 6orc the conathuct,i.on o6 said eyatem. and the same has been dut kecoaded .in the 066.ice o6 the County Reg.i•a.teA o6 Veeda, ae Doe ment No. 1 fo l 5`1 / 1. S 'NA OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED pQCUMENT NO, STATE SAA OF WISCONSIN FORM 2-1222 THIS APACE REaaAVED FOR aaCOA01N0 D~T~ '"f WArAA(RANTY DEED 461591 v,; S79PA5E ' REGISTER'S OFFICE $T. CROIX CO., WI e-11 Recd for Record AUG211990 a~ 8: 30 A. M conveys and warrants to 14"Jzea~rof Asada RETURN TO the 101jowlRQ describes real estate in County, State of WieoOASIA: Tax Parcel No; Pt. of We$t one-half of Southwest one-fourth (W}-SWU of Section 360 T29N, R18W# as Lot 2, CSWIfled Survey Map in Volume 6 Page 2258. FIRE I ~l I i This homestead property. (la) (is not) Exceptlon to Warranties: dayor ,sue. D ed this (SEAL) (SEAL) aJCA.M,-P4 e f•r ft. e (SEAL) (SEAL) 11an, &v G ,I AUTHENTICATION ACKNOWLMDOMPNT I 1 8TATE OFVYISCONAIN w . • ..,.n $fpneture(al I w.. j9t. Cr03.X-.-County, 17tH authsntlbated MIS .day Of Personally came before me this, day Of ` et 19-2-CL- the above named ,I TITLE. MEM9ER- 8 ATE BAR OF WISCONSIN I known to U, t 4,pere0n who sxa0utetl the I, (It not, to np Inetrumrin nd'a )ed9 authorized by 4 708Ae, Wis. Stalls') TH IS INSTAUMENTWAS OAAFTEOBY I' J s 0' Conti' Zia NJ 1 .411 Nolar uOllc Ct!0 county, Wis. QMtWea may be au hentl"lod or ackno"1041110, SON) My commission'-Is par 1arlt.,(If; not. stale expiration are not naoeaeary,) dater 19 ^ ) - 8BR NTF DWI ,NSmu of persons Signing in any r •+p,suy should pe tro,o or w nted Oelaw lnur 419n4l,✓sa. 10200. Green Bay, WI b490T.o2oa 11 STATE SAA OF WISCONSIN Nslco Tax Forms, P.O. hex WARRANTY DElb rorln No, 9 - 1907 6JU~-_13731 HIMG709 96:'O 06, SE 83S ~•d SEPTIC 'ANK MAINTENANCE AGREEMENT Sr_. Croix County OWNER/BUYER JEEI'~/ trOtJW~~I_ ROUTE/BOY NUMBER (O3 3 `40 Sj- Fire Number CITY/STATE J`fl/~7E/LTS W1 ZIP -540z-3 P^OPERTY LOCATION: 5W SW `t, Section 7 T Z°! N, R /9 W, Town of L(/ age;4 St. Croix County, /VI $b 2-2,90 Lot n umber Z. Subdivision Improper use Xnd maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the Eunction of the septic tank as a treat- ment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operaci.on prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth; herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED &XzVe_0 DATE -ZS - gQ St. Croix County Zoning Office P.U. Box 2'27 Hammond, WI 54015 715-796-2.Z39 Si.4n. 0ar.- rind rernr.n to above address. Fresh Air Inlets And Observation Pipe N, Approved Vent Cap F Minimum 12"Above Final Grade - _ 4" Cast Iron 3(p'' Above Pipe Vent 'Pipe' -to Final Grade Me-th "my ()r Synthetic Covering Min. 2" Aggregate , Over Pipe Distribution 3-7 3-517 Tee Pipe 0 0 0 0 0 Aggregate o Perforated Pipe Below ~.f Beneath Pipe ' • V o Coupling Terminating At Bottom Of System 70 Imo: v ~ v Fresh Air Inlets And Observation Pipe h J - Approved Vent Cap Minimum 12" Above Final Grade /040 .a, 4" Cast Iron 3(p Above Pipe - Vent Pipe' -to Final Grade Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe T Distribution pipe 0 0 0 0 1: (e "Aggregate 0 Perforated Pie Below Beneath Pipe p 0 Coupling Terminating At Bottom Of System • "h 1 ~ r A i 1U o zz v L r. j C O 3 4 Et cIO$ ~O llo V Q M r------- - dry y -e _ 0 'pl ~Gx,s q Y , v A VID M,O,AND PERCOLATION `TEST'S (115 P.o. BOX 7969 HUfVl~N RELATIONS MADISON, WI 53707 ' (ILHR 83.0811) & Chapter 146) - -fQTNOIBLKNoil5UBDIVISIZRNXMB: awl SHlP Y: ` 3 T.Z' NIR ~d E t ri ' ; t • f~0„ IYI ! LMAMINU * l r~ rst. s i ,~~r.~t x rs ~x • .s ~d , I'll DATE$ 059IRVATIONS MADQ 1PORUMATI OR T9 Residence , ' - /•r'¢9NrW ❑Filptrce r~ore t RATING: So site awitabla fqr ayetem Us $Ite unsuitable for system Yes Ait'4I:ve/E6~ 1' t -FILL TAN : REGOMM NDED 6 M: optlenel , f~ S ❑Y L:JS ❑ S DU X u Tj!eAjeA5 041-y- Wit QR•DP 40K. f 1 sO Z Q 1 7rl.,,,Y PH I'd N A If Percolation Tests are NOT required ATE; if any porti on of the tested arse Is In the under a. ILHR 83.09i61(bh indicate,- C4 4S S ~ [Floodplain, indicate ~IpgdPiiin elevation: ~rw -DC'V. 0e_ f4 • PROFILE DESCRIPTIONS $C'j p ~•+~4T"r Tr tSA,j i--TOTAL 0 OR BOR N H HA S I TRiCKNESS 421WERONC- -0- L-WITH COL TO E R 0 E . ON 8 ' lJR ' AN EP NUMBER IN ELEVATION 4 ' A*7r a1ko ,r; r ; , 0 ' -Pe'VJ:e- 8,4,. x . s • T.~.~ y rq~.r~,,~e V 51 V/ I, Ztwee, .7S' A&, .7S' D.~.S/I~ I. r,' ><N•SY. flfocky fil ' S, lr,Y• o~ Sa. iG►+wfhp S(~ Li' as , ~S• ' dice 44; ,'61e.$W v- W.*yn,i,o•~~,~ rr.~ If ,1f AR pwr f t 5( • d/ D r ~q' o r p m r i6t, o $t,vv; l a s I 1 I' 3r s// Q• kr~ }''1 F. O R rt 0 T S D d ' S 1 0% .rU~y~ GO(Jipl~[ Sly, 46A f f oil B• 4 'r , r is~ 00 ~.7 Qe PERCOLATION TESTS JY01'S' . NUMBER INECH R N96t l TERVAL- PE 30 OT PLAN; Show locations of percolation tests, soil borings and the dimensions or suitable roil areas. Indicate scale or disunae, Describe what are the horn ptal and vertical plevatldn rgferena points and show their location on the plot plan, Show the surface elevation at all borings and the dirrotlon and percent i land slops c. 7: C, r YSTMVI'LVI#TIQN taws ST 00 Ala { AA ' ~ ©N - Ui~~i°~/~~Cr! T~4nJ ~r'~,. ~D.~•1 ~~/~'d.J L~'p.~si'.i.9 ~►/~VJ! S7""/~~'~/E' , r~1 w p wi ~ ~t s"o...~ ~4 S s 7` • ~ I~ SCI PLOT" P1•rfA.) . J ie un0a(slpned, hereby certify 'teat the sal, lost$ rr~WOrted' an this form ware made by me in accord with the procedures and methods specified in the Wisconsin pinistrol!yi Cogle, and that fhb dmi recardeti and the ioeeiimi of the tests are correct to the best of My knowledge and belief. Homearre UPTIC PLUMBING 00,• TES MP D ON: 0 O'NEIL RD., HUDSON, W18. Wig /j~/Ci ~R CERTIFICAT opt once WIS. MASTER PLUIOSR LIC, NO. 07 M.P.R.B. Y iN NUMB Rs 3 PHON) NUMB NVM5' R 00 Ri8U1'ION: Original and one copy to Local Authority, Property Owner and Soil Tester, A BgD#j3! 'dl. 101831 - OVER - 1.40'D3_131 HIMQlHS LZ :EZ OG, t T J.Ukl sad" ~u h . N Er ~ t t ~ y PO lo: y. ! ,;t r 1 I j.. !r .~1 1! , 7 ' + ' Sa l,O1 E r 14 Igo ~ 3 I-J 'r r ~ ~C~CI`faG~ pr TS , S1 7V .9 tiOMESITE SEPTIC PLUMBING CO. 05 OINK RD., HUDSON, WIS. 11 ROBERT ULBRIOHT . Firgr- 2- Ypa, . - MI MASTER PLUMBER LIC. NO. NN•r 14TALLER MIONIC3307 M.F.A.S. NO, 00083 E'd 140--3-131 NIIG-1H9 8Z:EI 86, 0 Z AHW