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HomeMy WebLinkAbout020-1006-10-000 a o 30 o 0vj, M a C O O _ N N ~ CO) .Q C ~ ~ O f0 i GL c_ v v ai y(D z 0) 7 m E LL O c :3 m 3 E 3 Cl) z rn Z L: 0 z m d f2 a m w ~ C 0 O z a c v o w w o v N H C N N 7 Q CL •~y a~i 3 r o o m c 0 z co o N z N C14 m c V O N v 'ti O N m N O O c 0 a ` 0 a bap ZMI § 5 a= o c 0 0 0 z •N oaaa IL ° N O MW to J C) ~ OOi Oi ~ j O N y E O co j 11~~ D a) co O 'O w N N ) p 'p d Q ~ fn N O 00 0 H C a O O Q O N V n- ° a a -0 i r Y CO r O C O W O C p fV U = 7 N l~ d co N U) 14, • ~ N co 'a t0 0) p C m 0' o 0 2 o z cn 7b fl' L: a a • a d d `1y E ` c 3c A V a 3 N 0 a 01/28/2005 04:29 PM Parcel 020-1006-10-000 PAGE 1 OF 1 Alt. Parcel M 08.29.19.15A3 020 - TOWN OF HUDSON ST. CROIX COUNTY, WISCONSIN Current ~Xj Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * WOJTOWICZ, MARK D & LYNETTE J MARK D & LYNETTE J WOJTOWICZ 1040 DEER RUN RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1040 DEER RUN RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.180 Plat: N/A-NOT AVAILABLE SEC 08 T29N R19W SW NW LOT 3 CSM VOL Block/Condo Bldg: 4/1022 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 04/19/2004 760104 2552/323 WD 06/27/1997 1248/257 QC 2004 SUMMARY Bill M Fair Market Value: Assessed with: 47624 449,600 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.180 34,000 313,800 347,800 NO Totals for 2004: General Property 2.180 34,000 313,800 347,800 Woodland 0.000 0 Totals for 2003: General Property 2.180 34,000 313,800 347,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 217 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 SPECIAL ASSESSMENT 0.00 001-WATER Special Assessments Special Charges Delinquent CharO 00 Total 27.00 0.00 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~R 01~e R~ ~U ~rJ S UN TOWNSHIP O SOF SEC. U T Q j N-R f 9 W ADDRESS erg RUN FoRn ST. CROIX COUNTY, WISCONSIN Nuasoh► wisc- CSV~ 4/1 o z z SUBDIVISION LOT LOT SIZE PLAN VIEW o ?,o- 100 (p c 0-`K-41. s A-3 Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i Ne I8 5 B~ S' dl' n 0 ~ yy GrArc~ e .j g 9 ep2~,,~ I t INDICATE NORTH ARR:pW BENCHMARK: Describe the vertical reference point used i e_JtiJ gROUrJO Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Wee Liquid Capacity: L000 A Number of rings used: Tank manhole cover elevation: 06,/0 Tank Inlet Elevation: Tank Outlet Elevation: 5 8 Number of feet from nearest Road: Front, Side,O Rear, O I IO feet .From nearest property line : Front,OSide,ORear,Q 17) feet Number of feet from: well Lbuilding: _ 1' (Include this information of the above plot plan)( 2 reference dimensions to septic tank) PUMP CHAMBER i 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, © Ft. Number of feet from well: Number of feet from building (Include distances on plot plan). HeAclR Q$• ~(O b SkA to. 8d SOIL ABSORPTION SYSTEM 40 END: 98.83 M83 Bed: V ~rench °M Bcb Width: t Length: Number of Lines: Area Built: 3(0 Fill depth to top of pipe: ►~-y a„ Number of feet from nearest property line: Front, O Side, ®Rear,(~Pt . SU Number of feet from well: 80r Number of feet from building: YS (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 box0 been used on any of the above soil a'sZr~ ion sytems? (Check one). HOLDING TANK Man~ifacturer : Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from.nearest property line: Front, O Side, Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road Alarm Manufacturer: Inspector: Dated: Plumber on job: ©'jj"j_j License Number: 3 Q 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING DIVISION P.O. BOX 3 7969 HUMAN RELATIONS ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION ~ P.O. BO MADISON, WI 53707 State Plan I.D. Number: (If assigned) SW-'-,,NA,S8,T29N-R19W ~ CONVENTIONAL El ALTERATIVE Town of Hudson ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound O :(Peerrmanent R: ADDRESS OF PERMIT HOLDER: INSPEC 10 DAT Rober:ma hnson 874 Willow Ride I, Hudson WI 54016 9-_21 V- 19 10 REF. PT. ELEV.: CST REF. PT. ELEV.: BE H MARreference point) DESCRIBE IF DIFFERENT FROM PLAN: l mber. MP/MPRSWNo.: Sanitary Permit Number: a` l 0"("' .r- tt~~:;:Oi; Nameo Plu Richard Hopkins 1059 119452 SEPTIC TANK/HOLDING TANK: MANUFA TUBER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER P2y, IED: PROVIDED: e e /000 ES YES ENO BEDDING: VENT IA.: VENT MAT , HIGH WATER NUMBER OF ROAD PROPERTY WELL: BUILQQQING: VENT TO FRESH ' ALARM: LIN l AIR INLET: FEET FROM a ~ f ❑ YES NO ❑YES O NEAREST J DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP ODEL PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PUMP ND C NTROL OPE NAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH GALLONS PER CYCLE: FEET FROM LINE: AIR INLET: (DIFFERENCE BETWEEN PUMP ON AND OFF YES ❑ O _ NEAREST : DIAMETER: MATERIAL AND MARKING: SOIL ABSORPTION SYSTEM. Check the soil moisture t th epth of lowi g FOR E LENGTH or excavation. (If soil can be rolled into a wire, con ;tr ctio hall cea e u it MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH LENGTF NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # :SPITS: LIQUID BED/TRENCH I r TRENCH TERIAL: PIT , ../r DEPTW DIMENSIONS I/J~✓1 GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: N0. R. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH PIPE FEET FROM LINE: AIR INLET: BEL W PCES: A OVE C ELEV. INLET: ELEV. END~ Y 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: F-1 YES ❑ NO El YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TNO.OF RENCHES: 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 OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST --1111l' I Retain in county file for audit. Sketch System on ` T TLE: Reverse Side. AT R ~ J t ZOLl7~1 AC~111111 SBD-671 0 (R. 06/88) SANITARY PERMIT APPLICATION couNTY :EQ%.HR In accord with ILHR 83.05, Wis. Adm. Code Cam) STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 11 / l 174 a 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. PROPE TY WNER ~ PROPERTY LOCATION `Jo 56N SW % 0%, S Ta , N, R 1 E (or PRO ERTY OWMR'JVAILIN DRLOT # BLOCK # ~1t ~Q /D ZIP ODE PHONE NUMBER SUBDIVISION NA OR CS NUMBER J CMsow ATE ) c. SVOIG NA CJ II. TYPE OF BUILDING: (Check one) DIN NEAREST ROAD ❑ State Owned ❑ M@ JQWN VILLAGE : PLAN Q ❑ Public IR 1 or 2 Fam. Dwelling-# of bedrooms- -PARCEL TAX NUMB R( ) 111. BUILDING USE: (If building type is public, check all that apply) O lei oi~o J 5A3 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 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. New 2.E] Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.E] 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 ER Seepage Bed 21 El Mound 30 El 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 q v REQUIRED (sq. ft.) PRO OSE (sq. ft.) (Gals/day/sq. ft.) (Min./inch) C~ ELEVATION (y~ 0000 u~O. F? I Beet d 2. (Feet VII. TANK CAPACITY Prefab. Site Fiber- Exper. in allons Total # of Manufacturer's Name Concrete Con- Steel glass Plastic App INFORMATION New xistin Gallons Tanks structed Tanks Tanks Septic Tank or Holdin Tank - DD Q 0 f' t 1 -1 IF-1 Lift Pump Tank/Si hon Chamber 1 F7_ El 1 1:1 F] VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumb ' Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: X'~ C6kl o s - 477 ) 1/_ f._j os 9 Plum is A dress Street, i ,~Sta e, Zip Code): rn6>v~ ~ ts~ S b IX. COUNTY/DEPARTMENT USE ONLY ❑❑D Oisapproved Sanitary Permit Fee (Includes Groundwater a e Issued Issuing Agent Signature (No Stamps) Surcharge Fee) Approved wner Given Initial co Adverse Deter ination ~f X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 4 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 esfiablishment 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 T~VC~.v.~ ~~~~~n Sv Owner of Property Location of Property N Section , T G N-RW Township Mailing Adgresd"~U~ 40 e e Y J r RciAddress of Site ~,~LSs-, I ~4 v/6 Subdivision Name Lot Number Previous Owner of Property ~eVV~ r S Total Size of Parcel 2 CtGV2s Date Parcel was Created Are all corners and lot lines identifiable? a Yes- No Is this properly being developed for resale (spec house) ? Yes V No ~z Volume and Page Number '2-4as recorded with,the Register of Deeds. f INCLUDE WITH THIS APPLICATION THE FOLLOWING: 3 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 ((Ve) centi6y that att 6tateme.nt6 on thin 6onm ane true to the but o6 my (ouA) knowledge; that I (we) am (an.e) the ownen(.a) o6 the pnopenty deAcAibed in this .in6onmat.ion 6onm, by vi tue o6 a wa4Aant de rc Bonded in the 066ice o6 the County Regizten o6 Deedsab aoeument No. 5(0 ; and that I (we) pneaentey own the pnoposed 6.ite bon the .sewage di.dpob dy6 em (on I (we) have obtained an easement, to nun with the above deacAi.bed ptopehty, bon the eon6thuction o6 &aid system, and the name has been dut tecokded in the 066ice o6 the County Regizten 06 Veed6, a6 Document No. ~~a ) SIGNATURE Old OWNER SIGNATURE O/F~ -OWNER (F APPLICABLE) SIGNED DATE SIGNED / j I STATE BAR OF WISCONSIN-FORM 1 DOCUMENT NO. WARRANTY DEED • VOL + THIS SPACE RESERVED FOR RECORDING DATA 368894 RECoI~Y~RS O#iCE made between -Terry This Deed, y-- I ST. CROIX CO., Wt6. Wed. for Record this 15th -------Grantor I of January A.D. 19. ana__Beyerly___A.__ Johnson__and__Robert__ husband-• arld__wfe- at 2'00 P. r" - Grantee tdw~ Witnesseth, That the said Grantor, for a valuable consideration__ conveys to Grantee the following described real estate in t.__-CY'!~_1X-.__ I' County, State of Wisconsin: Tax Key Na Part of SW-43- of NW4 of Section 8-29-19 described as follows: Lot 3 of Certified Survey Map filed December 18, 1980 in 'I Volume 11411, page 1022 ~I TMNSFER FEE i This iS not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; II And warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except i and will warrant and defend the same. Dated this _2nd day of ------D2C2Tilber'----------------------- j ---------(SEAL) _ 1. --~-~1. ••---------(SEAL) * * TERRY PIRIUS (SEAL) (SEAL) I; AUTHENTICATION. ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN 19 ss• ST--•--- CROIX County. = - Personally came before me, this _?__1ld._---day of December'-,_1989 the above named _Terry..E*.... - TITLE: MEMBER STATE BAR OF WISCONSIN Pirus_______________________________________•---__-----_____•___ (If not- - authorized by § 706.06, Wis. Stats.) - THIS INSTRUMENT WAS DRAFTED BY 1 4p known to be the person who executed the t~? Cforegoing instrument an acknowledge the same. . vvZ - G ------P - b J Notary Public t.e___CrOlX ---__._...__County, Wis. j (Signatures may be authenticated or acknowledc-d Both i`~~'My Commission is permanept. (If not, state expiration are not necessary.) dale--------------------------- `~5---/ 19,x/ fames of persons signing in any capacity should be typed or grin 411,beluw•tleir signatures. !ARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No.1 - 1077 Milwaukee, Wis. (Job 84886) MEMO T29N, R19W~ FENCE c* ,1" PIPE SET 1-4 to N ti co 1C SCALE IN FEET co Q IZ 4 D "o N i~ 6 ' TRUE 100' 200' 2.41 ACRES + + I I BEARING Q, UNPLATTED LANDS a O I ~v ~ i I--I ~ j 126.55' ~ . J N89014'W ® 202oi8'p3n I to 90 138°53'_.. ~ -18, 860 a} lip cc1je4 o, o+ ~Yss o:.g4 !6r , , r^ ! N o2 I S- PRIVATE SS~S7 S~, 134°50103n g1.4'.e' r.°i + -1 589°14'E tj 0 1 2 126.55' atj.> CPO 1 70 VT r.- r] 09, V d)o < o ISE 6 &'ACRES { c t 03'1' O `mom 1 113°43'19?\ 40 t0 i CIO 3.46 ACRES off 7 2950091 41 0 a +'~r 3311-131 71. 1 l R'_~ a k? ebb C~ j rl 1 f j. R y s rik. R=801 p 1C Ft ' r?F ~ t 1z A' r I 165° 37' 20" S MCI v ~ in \ K f lBdbF~ } N I to of • 99, . f '-1 o, 1 Z Ir ° 0 9~ in I cOn O 1 fD \ v~ ;o r 1~`\O 2.98 ACRES O N 0 V3 oo L^ z 12 1\33' 57.46' 182040' °D :E s0 1 Ir 1 ul ra z 17A v+ %.A `Do o ~ 1rn 11 s r o O c BERNTSEN 1 o POINT OF Iva MONUMENT BEGINNING 9~O FOUND r 04" W1 /4 CORNE 1 N ; 9o09,5Sa 330.00' 1Sa SECTION 8 91.44' 238.56' T 2 9N, R 19W 105.01' 1 10 91' 120.44 450.44' " N 89°22' 45" 2 8.92' N 89022 45t'E EACLE_ 68,13 E-W 1/4 SECTION LINE _KIDEE_ UNPLATTED LANDS I T -,e - - . . 'L N ' Y . STC - 105 r - y _ H si., 'IC 'TANK MA f NTLNANCE ACREE'MEN'1' St. Croix County o OWNER/BUYER ~y62V J 0 y~SJ✓' m ~b4o b(zeY ku,, 1:i re Number PAO ROUTE/BOX NUMBER If ~G CITY/STATE C(SuY1 I _ZiP U. SW YROPEwa LOCATION: Sec t i 6 n M R W , 'town of ~~-~S uv^ _ St.' Croix County, Subdivision Lot number Improper use and maintenance of your "septic system, could result in. Its premature failure'to . handle 'wastes. Pr'oper maintenance.cun- silts -of pumping Out the septic tank every-;three years or sooner, if needed, by a licensed suLtiC ';tank Lmler. W!Iat you-put intu the system can affect'the function of tile-SVIlLic tank as a treat ment stage in the waste disposal system. St. Croix. County residents matj;be eligible `tu rece,ivC a.gra11L ur a maximum of. 60" of the cost of ;-rep1acuni6n'L'kof a failing system, , Cruia" 000nty which was in operation 'pr'i"ur to July ,1, L97.8 St acce>Ce'd `this Iire6gram>in .:Au ,ust,sof__~19 O8 !%,iuII thy' rec ulr~ment. chat ! . i owners uf iiil new, s st`eel'`, agree to" keep the Lr systems `proper'ly Ilia i~itain4ed. s_ 1'I►e pruperty owner agrees to submit to 5t. Cruix Cuunty Zoning a ' certification form, signed by the owner and by a master plumher, journeyman plumber, res.tricLed.;.plumber 'or,-a licensed pull iper. ver'i- fying that (1) the on-'Alte wastewater 'dispusal ;systeut is in ?pruper; operating condition an'd -(2) after inspection and pujnpin6 (ifrnec'- 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: o E I/WE, the undersigned, have read.the above requirements and,. gree to maintain the"private sewage disposal system in accordance with M the•standards .set forth, herein, as set by-"the Wisconsin Depart- o meet-of Natural Resources. Certification f6rill must be completed and returned 'to, the Croix County Zo►iing- Office "within 30"-:days of the three yea-r expiration `date SICNED DATE St. Ctjoix County Zoning Of f ice R.O. f•ox 98 Hammond, WI 54015 715-7S:6-2239 or 715-425-8363 Sign; date and return to above address. 1 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY,, C DIVISION BOX LAbORI RELATIONS PERCOLATION TESTS (115) MADISON WI 7969 UUMAI (H63.090) & Chapter 145.045) LOCATION: SE ON: OWNS LINICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: 4 f COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: Cro l y I/~ USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL SCRIPTION: PR I D R PTIONS: R OL O TESTS: Residence Jew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-G ROUND-PRESSURE:YSTEM-IN-FILL HOLDING 0:1 RECOMMENDED SYSTEM: (optional) WS ❑U ,9S ❑U ~S ❑U ❑S 2u ❑S ~hrr fi ' ~ If Percolation Tests are NOT required DESIGN RATE: 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 DEPTH" NUMBER DEPTH ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- /a/, 33 ` n 9L ` s / 3 As, za„ B-2 70/ /42,5$ > 7`7' ~~3'B /.yz A, 57" y, U44 S,/.~ y / rc 4~ A /f Cri1 / 3 cJ B- 547 , 6 . • ~►7j ~3 ~n s7'' yap eyG ds%.. n eh'e-~. 44 h/4 B- 45-Z B- 6 PERCOLATION TESTS y g._ TEST DEPT WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTE SWELLING INTERVAL-MIN. PERIOD 1 PE IOD 2 PERIOD PER INCH P- O 3 c „ r6 37 ,.t P- 3 P- 3 f O % / / 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 9TK I - i F I ~ I 45 t z I~ ,p E . I 7 ~ I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): 1 TESTS WE MPLETED ON: I~ ~e ( ay,, l I nal): ADDRESS: S A-6A IA/' a4 CE ®~3T~ fV_ YBER: PHONE NUry 1`7 ~(1 ~ *4 CS S AT Y 3 G` G DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SBO - 6395 To be a comp and accurate soil test, your, repe clude: 1. Complete 1, ation; 2. The use sectio, i, clearly indicate wha r this is a sidence or commercial project; 1 MAXIMUM not J bedrooms or - 'cl I u -sed; 4. Is this a new r dent system; 5. Complete - , ing boxes. A "TE IS SU FOR A H_ 3 TANK ONLY IF ALL OTHER SY-1 RULED OUT BASED C L C ONDITIONS; 6. PLEASE use t is shown here for writir ()fil(- descriptions and completing the plot plan; 7. MAKE A k n accurately locating yOW' test locations. Drawing scale is preferred. A separate sir__ - i desired; 8. Make sure your -)d vertical elevation referer point are clearly nd are permanent; 0, Corr, =fete all -,q = - ,es as to dates, names, food plain data, colation test exemp- f 10. in~_, n,, plain, elevation) does n fly, place N.A. in the appropriate box; 11. 1 the form and pl,-. yt r it address and your c .ion number; 12. ' e legible copies and dis ' Lite as required. ALL SO ' TESTS MUST BE FILED WITH THE LC _ UTHORITY WITHIN 30 DAYS OF COMPLETION. °IATIONS FOR CERTII 31L TE Soil Set=;>s; tes and Textures Other Symbols st - ever 10") BR Bedrock cot) - -1011) SS - Sandstone gr ~r 3") LS - Lii irk p^ ant I•r, cs - G -f. - coed s - f W Well Is Fine Sa Bldg Bu Is Loamy Sand > - C,1 sl - Sandy Loam < L~ s.s 'I - Loam Rn - F;-ovvn 0 Silt Loam BI Black si Silt Gy - Gray cl - Clay Loam y - Yellow sc! Sandy Clay Loam R FPt siel - Silty Clay Loam mot - R, sc Sandy Clay w/ - v.t sic - Silty Clay fff - f.w, fim 11'c - Clay cc - _ ,r,;, c ; pi - Peat IT1m I IT m - Muck d - d._tinct p prominent HiAlL - High v_it 5i~: -ral soil textures sur • waste disposal BM - Bench IV : i VRP Verti:. d TO THE of ~I I . ICI Q.L. 67 PLOT AHI) (J" OSSEC PROJECT IDLUM13 Ek ` l5- .T N N A M E i c- ,z-o r) NAME ~ ~ . f t= I o L O C AT 10_NI._.1~l_ IC _E Nis E= 1.:) A.T E... P L. 0 I M A_P NAV K NE laf cueno: Vpt Wcjgd) EL- 100.0' (3Ur<.cII{,ule 5,1~~.~ X' Pr KC,hOIe a+'s' 40= Rom 1617 hu 4 ~ ys+ a i v NIts So ~gu o food ,1 d ti ~1~~e' Ad~~er~~' ln~'sr l~el~s 00 1 Doff \ ARe ~X~K.~~fL 'l'I~A►~ F 7 40kek tAAN : Well is S o 4t '~jt,oM Scp~ i+ AQp~~~f field ' FRESH ATI:AND OBSERVATION PIPE C1XOSS SECTION • - - 1 Approved Vent Cap ►Np~ ~r`ppe Minimum 12" Above Final Gra00-..____.. 10 7~~ 1 4" Cast Iron Above Pipe `yl Vent Pipe To Final Grade,- - Marsh Hay Or Synthetic Covering Min. 2" Aggreg+tH - Over Pipe Distri_buLi24-- Tee Pipe - • j .I Aggregate Perforated Pipe Below Q 1 •70 Beneath Pipe ~ Couh].i.ng Terminating At Bottom of System