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HomeMy WebLinkAbout161-1094-40-000 ~ N O h Q EA h C O O N O i ,o I [� I I I � I y � c Z c I LL E _ o g w 3 (D a' 3 z �+ CD z E 8 r, NW IL � 4z 0 c C9 o z 'g' I c aoi z j ° c o N F- Z �' E N n ►i o a> c a) t o •N 'i a (n ' O o zo m z N _ _ Z c O d',. N E N C .. y o G % a a m E CL �^ U) N ZtnNttn r Z •N L) IL v , � o N '� O co N J U ', u) rn rn z ti � o Boa E II N a Cal y i' o 'a °_' Q i4 io D C M '., S H N C O ai cl O L c E 0 a O o o v Z o O g I N z z C coo C O O R U • L� > o7 r O Z F H !n �O cl CL m `b►� o R o r-, o A vat ; Ornc) . S Parcel #: 161-1094-40-000 02/09/2007 08:38 AM PAGE 1 OF 1 Alt.Parcel M 13.29.20.747 161 -VILLAGE OF NORTH HUDSON Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner ROXANNE E&DOUGLAS C SUNDET O-SUNDET, ROXANNE E&DOUGLAS C 278 STATION CIR N HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *278 STATION CIR N SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 04/38-ST CROIX STATION 1977 ST CROIX STATION LOT 23 VIL NH Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-29N-20W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 836/22 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/20/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 120,000 355,100 475,100 NO Totals for 2007: General Property 0.000 120,000 355,100 475,100 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 120,000 355,100 475,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 304 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 012-1041-20-000 02/08i2007 04:19 PM PAGE 1 OF 1 Alt. Parcel#: 18.30.17.269 012-TOWN OF ERIN PRAIRIE Current X ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-LANGNESS, DAVID A&TINA M DAVID A&TINA M LANGNESS 1593 160TH AVE NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description " 1593 160TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 18 T30N R17W NE NE 40AC Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-30N-17W Notes: Parcel History: Date Doc# Vol/Page Type 09/16/1998 587142 1357/327 WD 07/23/1997 1131/603 WD 07/23/1997 1076/462 WD 07/23/1997 1065/630 TI more 2007 SUMMARY Bill#: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/31/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 45,000 231,900 276,900 NO AGRICULTURAL G4 36.000 5,100 0 5,100 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2007: General Property 40.000 50,200 231,900 282,100 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 50,200 231,900 282,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 138 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 T f Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER i�� �,�,F�oV.E.tJ,I SrWp4T%Wff5Hff ff[�c�[o.t/ SEC. . T �N-R�W ADDRESS , ST. CROIX COUNTY, WISCONSIN � LOT SIZE SUBDIVISION�T�,PoixT/oitJ _ LOT o 3 _ PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �g7TL EY CI�LL.� �o,q Sri �iPo O�fTf/ /Ad_ nnF�S L..ivb 8" y INDI AT NORTH ARROW Wo BENCHMARK: Describe the vertical reference point used ou RAr "4r 54 A07- 60'fwee m Elevation of vertical reference point: /00.00 ' Proposed slope at site: a Z SEPTIC TANK: Manufacturer: Liquid, Capacity: /,?<-0 ��L Number of rings used: Tank manhole cover elevation: 1D y• 3.? Tank Inlet Elevation:Zoo. VY' Tank Outlet Elevation: ,�06. 1.3 � Number of feet from nearest Road: Front,Q Side,O Rear, feet O" 7�' From nearest property line .' Front,0Side 10 Rear, feet Number of feet from: well (r � building: �� S (Include this information of the above plot plan)( 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 Bed: �,[�✓. Trench: Width: o,9 Length: 34 Number of Lines:___ "'7/_ Area Built: Fill depth to top of pipe: 3 ' Number of feet from nearest property line: Front, O Side, aear,0 pt . I T Number of feet from well: Number of feet from building: (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 0 or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK 4 Manufacturer: Capacity: Number of rings used: Elevation or 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 fef,t from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• Dated: y Ary Plumber on job: License Number: 335 3/84:mj DEPARTM ANT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS tAhOR k+kHUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 SL',-SA, S12 ,T29-R20W 1:1 CONVENTIONAL 1:1 ALTERNATIVE State Plan I.D.Number: Town of Hudson El Holding Tank ❑ In-Ground Pressure El Mound I If Krattley Lane NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: 1 s Sundet e-1 5+0.jiO ejF Hudson , WI FqO BENCH ffRK(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: Z a Bros . Inc. 3395 St. Croix 128649 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV.: WARNING LABEL [F—]YES OCKING COVER PROVIDED: ROVIDED: D ❑ YES NO AND BEDDING: VENT CIA, I VENT MATL.. HIGH WATER NUMBER OF ROAD: PROP ERTV WELL: BUILDING VENT TO FRESH Q Cz ALARM FEET FROM n LI ' AIR INLET: ❑YES 19NO 9 ❑YES NO NEAREST 't DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: EYES ONO EYES ENO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER...OF PROPERTY WELL BUILDING. V (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) OYES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: w,iy WIDTH. LENGTH. NO.OF DISTR.PIPE SPACING. COVER JINIIDE DIA.-. #PITS: LIQUID BED/TRENCH r TR EW.HES I MATERIAL: PIT DEPTH ;5(0 GRAVEL DEPTH FILL DEPTH DISTR.PI PE DISTR.PIPE DISTR.PIPE MATERIAL: NO.D R N'.UMBER OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER ELEV.INLET ELEEGV.END: � P' PIPES- FEET FROM LIN'� AIR INLET. 6,1 15(P IW,D 4 7 r i f NEAREST t3�tL7~ MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES 1:1 NO SOIL COVER ITEXTURE PERMANENT MARKERS SERVATION WELLS ❑ ❑ OB YES NO DYES 1:1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. JSEEDFD MU LCHED. CENTER. EDGES. ❑YES El NO OYES ❑NO ❑YES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER. ,, e, TRENCHES: 0110 as k 6* i °'.MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR, DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV.. ELEV.V.. DIA.-. ELEV,V.. PIPES: DIA.: I�R� ICN HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED i9RIVtATfON PLANS: ❑YES ❑NO DYES FIND COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NI�.IBER�jF PROPERTY WELL: BUILDING: LINE: V OYES 1:1 NO ❑YES El NO NEA1afiT � quo q., / z Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. DILHR SBD 6710 (R.01/82) 1 a- C z."#,,' h#n Ir1j1 f' SANITARY PERMIT APPLICATION 7DILI""'IFR In accord with ILHR 83.05,Wis.Adm.Code COUNTY STATE SANITARY PERIAI # —Attach complete plans(to the county copy only)for the system,on paper not less than JJ /_ �7�J 8%x 11 inches in size. ❑ /hik if revision to p evious application -See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 5 f ,v,(i� Sc c,�/Q J £7' s� '/a S& %,S T a9', N, R o E(or PROPERTY OWNER'S MAILING ADDRf4S LOT# BLOCK# Sf U . 3 ,CITY TATE ZIP CO D PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ST reo/k STET/ON 11. TYPE OF BUILDING: (Check one) CITY j 'L NEAREST ROAD State Owned VILLAGE�. 7r4 ❑ Public �1 or Fam.Dwelling-#�of bedrooms 3—/ R ELTAX. UMB ( ) 111. BUILDING USE: (If building type is public,check all that apply) v 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.x New 2. ❑ Replacement 3. ❑Replacement of 4. ❑ 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 ❑ 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 co rao 99 Feet Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks strutted Septic Tank or Holdina Tank 50 i SO Lift Pump Tank/Siphon 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): Plumb igna re:(No MP/MPRSW No.: Business Phone Number: �s ��s Sir(.-a Tsc;, Plumber's Address(Street,City,State,Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(Includes Groundwater a e Surcharge Fee) ssuLEI gent Signature(No Stamps) VApproved ❑ Owner Given Initial Gf Adverse Determination 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 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 numbers) 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. SE1134 8(R.11/88) • f • s APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owners) 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. ----------------------------------C-----p------------------------ Owner of property J)Owjac )�4142 14 he Location of property S t 1/9 S W 1/4, Section , T Z9 N-R Z W Township L4 vi nn Mailing address - yZ C� - l-���C Address of site Subdivision name Lot number 2-1 Previous owner of property A;f)r�ey+ d C k F. Lars r3 k\ Total size of parcel aore Date parcel was created G>//R b- Are all corners and lot lines identifiable? _, Yes No Is this property being developed for resale (spec house)? Yes o Volume F 3& and Page Number _ 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 references to a Certified Survey Map, the Certified Survey Map shall also be required. ------------------------------------------------------------------------- PROPERTY OWNER CERTIFICATION I(We) certify 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 property described in this information form, by virtue of a warrant de d recorded in the Office of the County Register of Deeds as Document No. 13- V ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Regis er of Deeds, as Document No ) Signat a of Owner Signature of Co-Owner (If Applicable) � III N9 q111 lffq Date of Signature Date of Signature I THIS SPACE RESERVED FOR RECORDING DATA DOCUMENT NO. i STATE BAR OF WISCONSIN FORM 1-1982; WARRANTY DEED VOL 83S_=-Pau REGISTE s � ..E d ST CROIX CO., VV This D eed, made between ---Nor-2ert... Re:'d for Rerord 111 _ _ te.Hants---�n__c_omman__�1k1_�.•�i,ar��s---�-�-C�-�---- -�rec-ntoas ' Ot 8:30 A. Grantor, and----Raxann-a-_E.....Sunde.t---anal Onug_Las.__C. ..Sunde.t*__._-___ husband-__and.._wi f e__,_-as-as --_-----------• - Register of Von* Grantee, i Witnesseth� or'That the said Grant for a valuable consideration-___._ i I! ND_rb_ert...T..._.Kac.Fi,._--Jr......and...Char-Les._.E.••_LaCSOn..._.._ RETURN TO conveys to Grantee the following described real estate in ---------- ;I County, State of Wisconsin: i I Lot 23 , St . Croix Station in the Village of Tax Parcel No: ----------------------------------- I North Hudson , St . Croix County , Wisconsin . j I li I MRAN PER I I i This -------i.%--j-Lot------- homestead property. j (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And.... __�.har.1es ---------------- --- -- ------------•---------•-•- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements , restrictions, and rights—of—way of record , if any . i i and will warrant and defend the same. Datedt 3 --------------•--- day of -----Februa .. . -- ^-•----•-- ................... ......... I (SEAL) -----------------••(S,E'AL) y ert T . Ko h J__ Charles E. Larson a/k/a Charles i ' --------------- --•-----•-------•--------•----•• . E . G . Larson i ------(SEAL) ----- -----•--..----.......................................(SEAL) �'. AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN SignaQure(s) = = ----------------- rM Commission Ex ires Oct - --- Mi------------------ ---- ----- 5,_1989--- -------r------------ County.ss ,authenticated this"_A ..day of----- --.-----, 19t� Pe a came before me this ________________day of I � - 9 �,l ithe a�named .... `c�A; •;D�T�, ----------- ,Y..�; ... ------ ------ II ------------------------ -----------Tl--_-------_•f• �.� _.-._-.__-__--_-----.-.-_-.•---.-----------_-__--_---_----._. _-_ I TITLE: MEMBER STATE BAR OF WF �TARY°;'� ---------------- ---------- (If not- ------------- ------------------- ------------ authorized by § 706.06, Wis. Sta �� t n to be the person-------------- who executed the P ,� oing ins ument and acknowle dge the same. I! THIS INSTRUMENT WAS DRAFTED BY ` r!`°f UB •o•�`� �� "e"7 Kristina 0 land Lundeen 7TH°••....•• O ------------------------------------------------ ------------------ g --------- 'L--49f-a jl�� � -7'12 C / ©fl C.r Attorne at Law - -- - ------------------- -----------•--------------------------- ------------•- Notary Public -"5zO---•=-•°--- ..............Count-,.-, Wis. �i (Signatures may be authenticated or acknowledged. Both My Commission permanent. (If not, state expiration are not necessary.) date: __ -_ -----42 .........../ -______--, j *Names of persons signing in any capacity should be typed or printed below their signatures. STATE BAR OF WISCONSIN Wisconsin Leal Blank On. Inc. WARRANTY DEED -- - -- STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ROUTE/BOX NUMBER 27�_ ) CITY/STATE C1S VL/1 FIRE N0. ZIP yp/� PROPERTY LOCATION: S t 1/4 SW 1/4, Section , T2-1_N, R Z l) W Town of �,NS St. Croix County, Subdivision St. Cr o ",, S ,per , Lot No. �_. Improper use and maintenance of your septic system could result in its failure to handle wastes. Proper maintenance consists of Premature tank every three years or sooner, if needed, by a LICENSED mSEPTICuTANKePUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for $3000 of the cost of replacement of a failing system, which was in oopperion prior to July 1, 1978. St. Croix County accepted this 1980, with the requirement that owners of ALL NEW SYSTEMSpagreemtonkeegust of systems properly maintained. p their The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master restricted plumber, Plumber or a licensed pumper verifying that°u(1) the plumber, wastewater disposal system is in proper operating condition and inspection and pumping (1) the on-site sludge and scum. Certification sform)will hbessentcapproximately tas less than 1/3)fulltof three year expiration. 30 days prior to I/WE, the undersigned, have read the above requirements and agree the private sewage disposal system in accordance with the standardstset forth, herein, as set by the Wisconsin Department of Natural Resources. form must be completed and returned to the St.C�oix County Zo 'ng Office 30 days of the three year expiration date. /v within C. SIGNED DATE_ St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 (715) 796-2239 or (715) 425-8363 Sign, Date, and Return to above address SAFETY & BUILDINGS INbUSTRY,TMEIyTOF REPORT ON SOIL BORINGS AND DIVISION NDt?S LABOR AND PERCOLATION TESTS (115) MADISON W 53707 HUMAN RELATIONS (H63.0911) &Chapter 145.045) LO ATI N:S SECTION: Hff'i'NIUNICIPALITY LOT NO.:BLK.NO.: SUBDIVISION NAME: SF �/4W1/ �-Z /T2l N/RZOM(or ,cLrQ4E OF N ►� l�Iv SON z� SO Md25 LbNqjNc, COUNTY: OWNER'S/BUYER'S NAME: MAILIN ADDRESS: USE DATES OBSERVATIONS MADE NO.BEDR : COMMERCIAL DES RIPTION: R DESCRIPTIONS A I N TESTS: [Residence CArgY -- . New ❑Replace v 14 /98la tj, /s t 9 --so1LS r- "l s6i CS - C- �IC1"►t I�:L RATING:S-Site suitable for system Ua Site unsuitable for system ,r - q t C NV STC�� . IMQQND:� Q� IN-G � ❑U R . S �-Ia�LHO�LDING TANK. ���V E � O�YA`EM:lo£io�nal) If Percolation Tests are NOT required DESI N RATE:' If any portion of the tested area is in the under s.H63.09(5)(b),indicate: �L✓�ZS (Floodplain,indicate Floodplain elevation: aA DEr PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- B- Z 9.Z S /06.0 z cs L-rs i-a pa Cy tS 2 "sh.80ti Y11-'S 46 ku CS B- 3 19,60, /o1 Az > 9,00 /9 9N Lea t l"Beta,, 4Z"eRN M_'s Z $e,,,C'S k B- d Ito.-K /03.33 Hwa- >10.?s 2A`'9LL_T= LMS 4 13"19R,MS go"ak"I CS'-&f' B- 6- �� PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER Ife5F1 S AFTERSWELLING INTERVAL-MIN. —PERIOD 1 D PER INCH P- 1 .4o CU-J E 1(03.40 �. > Z < P. 2 4.30 r/o i 03.3 0 >Z . Z < P. 3 7.AO rol.4o >>_ > < P-. P_ VAT%l0 J AT E RL PLOT PLAN': Show locations of percolation tests, soil borings and the di sions of suite b I reaidicate sca r distances. Describe what are the hori- zontal and vertical elevation reference points and show their location ory*e plot plapr bn5lw the surfa`le-'elevation at-all borings and the direction and percent of land slope. SYSTEM ELEVATION 9 9_ov r L z TN T 4�� ScA ._ ._ � . i r i 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. t1s� 11`� ►J �U Q / F n C. OMPLETED ON:N E(print): TESTS WE R /9$ �4Q J !V O . /s ADDRESS: CERTIFICATION NUMBER: PHONE N MBER(optional): vase 1 'S 45) 1( 3 g 8�- o€� CST SIGN URE: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. 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EXCAVATING INC PLUMBING UNIT �G PROJECT Ew S s Tc.`i r ��' ��pQC�Sc/� Y�kv94o5L.0 ST v,x STif c�t1 4s� -SAE SLPT/C T.4.✓K � i i � �/1/6 �.,�ve' y l07 E A Bi 11 6R NO SCALE LCT f+ �OPO��RTY�/�C7B /-F,•�/�PK - �.�JN A,.at A-T SLd L�OT �'c7C�/6JC I FRESH AIR INLET AND OBSERVATION PIPE 0�---- APPROVED VENT CAP MAXIMUM 12' ABOVE FINAL GRADE 4- CAST IRON VENT PIPE MAXIMUM OF 42' ABOVE PIPE TO FINAL GRADE SIGNED: L �_ MARSH HAY OR SYNTHETIC COVERING LICENSE: MINIMUM 2'AGGREGATE DATE: 9//r / �g OVER PIPE DISTRIBUTION PIPE TEE SOIL TESTING BY: ELEVATION BED 6'AGGREGATE • BOTTOM PER SOIL BENEATH PIPE PERFORATED PIPE BELOW TEST IS • COUPLING TERMINATING AT BOTTOM OF SYSTEM