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HomeMy WebLinkAbout026-1062-90-000 c; > d) o 0 M c U. 0 ce) :!t (D z co :t E U) ; .4; 0 1 .9 2 FE I 'I 0 Cl) Z — : 41 ■ 0 3: :4 m 04 U) .0 :t 0 z 4) c z '2 U) CL ca 0") C0 (D 0 0 V z 0 4)co z z V c C,41 0 a 93 CL E (L U) E o 0 o z • IL iL 0. IL k \ § m Z 0) M 4) 0)CO CO 0 z 04 04 0 E IL ca cc cl 9 0 CD - 1 . . a Df m 0 0 C*4 6 Cl) Cj M, T co 400 0 Lo CD z z co M E -C c4 N 0 04 0 0 C-4 Ea cl IL '*Si 0 cl E CL Z 'E 0 Za u 0 M 00 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT ,Ii/C / n OWNER TOWNSHIP— TOWNSHIP ,� !s,,J�� SEC. T .Sr N-R_ W ADDRESS y ST. CROIX COUNTY, WISCONSIN I SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•I,HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f j� 1 '?U i INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Aj,/'; Elevation of vertical reference point: &117 Proposed slope at site: f P SEPTIC TANK: Manufacturer: ra�r��'/, , Liquid Capacity: ,.Vg-0 t / Number of rings used: _ Tank manhole cover elevation: Tank Inlet Elevation:_.._ Tank Outlet Elevation: � S' Number of feet from nearest Road: Front, Side 0 Rear, O f �f3lJ�'� feet From nearest" property line Front.0Side,QRear,0 f_iaa feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE y,yr rp` Pule 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,Q Ft• Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ?< Trench: Number of Lines: - Area Built: �`2 Width: /L) Length: — Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, Ft . Number of feet from well: YL,1 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 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 nC bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of fef!t from build-tng: Number of feet frr.)m nearest road: Alarm Manufacturer: Inspector: n r, Dated: Plumber on job: License Number: 3/84:mj 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 .MADISON,WI 53707 O SW, SE, 20, 30, 18W X (it a Number: assigned) Town Of Richmond `CONVENTIONAL ❑ ALTERATIVE ❑ Holding Tank El in-Ground Pressure El mound /T kl'yom NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Darryle Powers Route 4 New Richmond, WI BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Calvin Powers 1563 St . Croix 128629 SEPTIC TANK/HOLDING TANK: MANUFA U LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV: WARNING LABEL LOCKING COVER 18 PROVIDED: El NO P❑YES KNO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WE L: BUILDING: VENT TO FRESH L ALARM FEET FROM h LINE: ` -44 AIR INLET: ❑YES NO ❑YES PUo NEAREST—� �✓ JOO R! �} DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO E]YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO 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: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID TRENCHES: / MATERIAL: PIT DEPTH: DIMENSIONS ' ,f] & GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO. STR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET. ELEGV.END: PIPES: FEET FROM LINE: AIR INLET: lD I\ cat r 1 1 f �� a• NEAREST No �5co o 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: N0.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND i DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: iAREST----MBER OF PRNOPERTY WELL: BUILDING: ET FROM ❑YES El NO ❑YES El NO � 12.03 f Sketch System on Retain in county file for audit. R2V2YSe Side. SIGNATURE- 4" ZONING ADMINISTRATOR TITLE: SBD-6710(R.06/88) Thomas C. Nelson co I L H R SANITARY PERMIT APPLICATION COUN In accord with ILHR 83.05,Wis.Adm.Code STATE SANITY PE T# —Attach complete plans(to the county copy only)for the system,on paper not less than Z '�I(/8%x 11 inches in size. 1:1 ck if revision to pr vious application -See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. PROP TY OWNE PROPERTY LOCATION '/ t/4, , N, R d E(or PROPTY R'S MAILING ADDRESS LOT# BLOCK#/ Cl 'S AT ZIP CO E I PJJONE NUMBER SUBDIVISION NAME CSM NUMBER 417 a II. TYPE OF BUILDING: Check one CITY NEAREST OAD ( ) State Owned VILLAGE �+h . ❑ Public 141 or 2 Fam. Dwelling—#of bedrooms A EL TAX NUMBE _ ( III. BUILDING USE: (If building type is public,check all that apply) �� C ` � �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. rLYJINew 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.) PROPOSE (sq.ft.) (Gals/day/ q.ft.) (Min./' ch) ELEVATION CAPACITY , Feet Feet VII. TANK Site INFORMATION in allons Total ##of Prefab. Fiber- Exper. New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdina Tank r Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT 1,the undersigned,assume responsibility for installation of the sites wage system shown on the attached plans. Plum is me(Pri Plumb 's Signature:(N Stam MP/MPRSW No.: Business Phone Number: 3 P mb r' Addr as(Street, ity, late, i de): 1X. COUNTY/DE ARTMENT USE ONLY ❑ Disapproved Sa ' ry Perm't Fee(Includes Groundwater Date Issued IssilingAgent Signature( Stamps) Approved El owner Given Initial t Surc arge Fee) /���' Adverse Determination OP ( X. CONDITIONS OF APPROVAL/REASONS FOR DIS PROVAL: SBD-6398(formerly Plb-67)(R.11/86) 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: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete##of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers;wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398(R.11/88) Y APPLICATION FOR SANITARY PERMIT STC - 100 i his application form is to be completed in full and signdd by the owner(s) of the roperty being developed. Any inadequacies will only result in delays of the permit ssuance. Should this development be intended for resale by owner/contractor, ("spec ouse"), then a second form should be retained and completed when the property is old and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - er of Property �4.t'��s s✓� Location of Property 1�1 k ^k, Section _, T_'39 N-R- ,� W Township - i )Ap Nailing Address Address of Site .e Subdivision Name Lot !lumber Previous Owner of Property � // f &-,-rzz Total Size of Parcel Date Parcel vas Created Are all corners and lot lines identifiable _ Yes No Is this property being developed for resale (spec house) Z Yes No Volume and Page Numberc;,�, 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 ((00-1 Ccll i.6y that aU s.tcttementh on tI" ohm ahe tAue to Vie but o6 my (owt) hncwtedge; that 1 (we) am (ahe) the owne k o6 the phopehty dehcAibed in titer .in601mation 6okm, by vi/Ltue 06 a waAAdnty ed neconded in the 06 ice o6 the Count RegiAten o6 Deedsah Document No. and that i �We) phehent.ty 15 R�'n th¢ p�topoa¢d a i,te 604 the sewacte di�5 (on I (we) have obtained an CaAcm¢n.t, to nun with .tile above deg uLibed phopehty, 6oh. the conbtAuction 06 adid a ys t", amd the came here been duty neconded Xn the 066.ice o6 the County RegiAteh Vctda, " Document No. SIGNATURE tVCYWNER SIGNATURE OF CO-OWNER (IF I DATE SI D DATE SIGNED I ` i DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 450818 le,J_ S49 PAGE 240 REGISTER'S OFFICE ST. CROIX CO., WI This Dee mace between ___Lorraine Merkt a/k/a _____ Rec'd for Record Lorraine A, erkt -------------------------------- --- - ----------------------------------- ----------------------------------------------------------------------- --- - - - AUG---- ---------- at 98 8 2 0 A.M ------------------------------------- -----------------------------------------------------------. Grantor, /�finn and._-Darrle___L. Powers and Renee A. Powers , - --------------------------------------- - ------- hu s b an-- and wife Register of Deeds --------------------------------------------------------------------------------------------------------------- Grantee, Witnesseth, That the said Grantor, for a valuable consideration__-._ ---------------------------------------------------------------------------------------------- --------------- • conveys to Grantee the following described real estate in __-St ------ r0 i X--------- RETURN TO County, State of Wisconsin: The Southwest 1/4 of the Southeast 1/4 of Section 20 , Township 30 North, Range 18 lVest . Tax Parcel No- ----------------------------------- See attached Schedule A for further conditions of this deed. � FEE This _-_._1_S _ ------_____ homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; Grantor And - -•------------------------------------------------------------------------------------------------- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except municipal zoning ordinances and easements of record. and will warrant and defend the same. Dated this ------------- --------------•----- day of --------------------August 89 ?'•.Z ------------------(SEAL) - -------------(SEAL) ------------- ---------------------------------- Lorraine Merkt - a k- -a--L;orraiiie A-.--M-67t1 t--- ---•----------------(SEAL) --------•------------(SEAL) AUTHENTICATION ACKNOWLEDGMENT Signatures) Qf---Lo-rr-aina--A1erkt...a./-k4a---- STATE OF WISCONSIN Lorraine A. Merkt ss. -------------------------------------------------------------- ---------------- --------------------------------------County. authenticated thi3� __'_2_day of----- UgUS-t-------- 19$_9- Personally came before me this ________________day of - — -tom ------------------------------------------1 19-------- the above named -------------- ------------------------------------------------------------------- --- -•----E-----N-oxa n-------------------------------------- -------- -------------------------------------------------------------- TITLE: MEMBER STATE BAR OF WISCONSIN ----------------------------------------------------------- ------------------------------------------------------- XXyXX�Y-6A( 'X' to me known to be the person -------- foregoing instrument and acknow), THIS INSTRUMENT WAS DRAFTED BY Bakke Norman & Schumacher, S. C. ---------------------------------------- -------- -------------- ------------- 1-2-GO e i t a e Drive *-------------------------------- New Richmon lVI 54017 Notary Public --------- - ---,---------------- (Signatures may be authenticated or acknowledges. Both My Commission is are not necessary.) date: -- •Names of persons signing in any capacity should be typed or printed below their signature, WARRANTY DEED STATE, BAR OF WISCONST FORM No. 1-1982 :y C! 849 PAGE 241 SCHEDULE "A" 1. By acceptance of this deed, Grantees and their successors and assigns, agree to the following restrictive covenants as to the use of the property: A. The property will only be used for residential and agricultural purposes. B No business enterprise shall be conducted on the property except as may be incidental to its residential and agricultural use. C. There shall be no commercial raising or breeding of dogs on the property. Grantees agree no more than 3 dogs shall be kept on the property as pets. D. There shall be no storage of unused or non-operational vehicles or machinery on the premises which are not used at least on a seasonal basis. 2. Grantor further grants to Grantees the exclusive right of first refusal for a period of one year, commencing on the date of this deed, to purchase the adjoining 40 acres of property described as the Southeast 1/4 of the Southwest 1/4 of Section 20, Township 30 North, Range 18 West, St. Croix County, Wisconsin, on the terms and conditions set forth in the Offer to Purchase executed by Grantor and:Grantees dated April 13, 1989. IVIJIUV i sr sn MCaoaNir"-vC30o b � M • �Oa a a ; t: to M .a Cf gp, '0 p H rn o VOtnO+0 a a "hut 1AMOO m� "+ h M1—CDao:. 3 m utar-+o r` ' X - •- OJ O to No+ V r-Zk .,, 3111 ft- IL !a. a ' 0 0 0 to vr-• Ln- • , w 4 ago I i O z ` o a a z �, : aF-WZ t 1" 0 0 CCY ! Zu:03 a r.J>E V Z , Q Y MIUIIAMtA; M "' ►� i H € off, ;o W 09 w In 3 • J N O .. la• O 7 rt . ' rE ,W 0 1 Z ►� E f v O = E 4O� J.I V C~D Z N. - c t u3 n M CO 0x a F a p 5 ;�oo tL mL1 Y r t J j W =0 �+ ' 0. �i OCMM ' IN 00 CCS 3 Mao ^ 401-3 W1- 1 N -•i u =1-Crz 1-Z J 4 fr f,,., >_MAL= $qp a WulO,it rr 7T 4� I r4':M1 �. y.u. '�. aa��r..S1L:$.i"�bf's"IgfC,"@,t t. :t;±a •,. ki-UlWtr „•.,, aarm• :es<.... ,,,,,..._. ...,. .. _., _ "....... ,..... __ __ L • to H a STC - 105 t-4 a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z Cl a n H OWNER/BUYER �,P,(Ji/J� �A2- S � NJ ROUTE/BOX NUM .ER Fire Number CITY/STATE ZIP _Tiz PROPERTY LOCATION: , 14„ Section , T _N , R__4<1 _W, Town of 4"Z,6zlo St . Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper . What you putt into i[ the system can affect the function 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 operation 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 . 0 E I/WE, the undersigned , have read the above requirements and agree Cn to maintain the private sewage disposal system in accordance with x the standards set forth , herein , as set by the Wisconsin Depart- v 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 g 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 . 1 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.090)&Chapter 145.045) SECTION: TO HIP/MUNICIPALITY: LOT N .:BLK. : SUBDIVIS N NAME: ,Sid �j ' /13tf N RIQ E la COU Y: R'S BUYER'S NA ]VAILI%G A DDRESS: USE DATES OBSERVATIONS MADE NO.BE MS.:1COMMERGIL DESCRIPTION: PROFILE-DESCRIPTIONS: E LATION TESTS: Residence New ❑Replace. RATING:S=Site suitable for system U=Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMEN�T :(optional) aS ❑U AS ❑U �S ❑U ❑S ©U ❑S 2U C If Percolation Tests are NOT require 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,AtN DEPTH NUMBER DEPTH 110, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK JE OBSERVED (SE A BRV.O B C .) $,- i• — i 7 ff4S,4, N S v B- ? _ 7a JJam�)) (+--��J � �- �+ q - , .0/s�`/��T'��J L�/✓S� ViJ "'�.J B P /I AWS B- C B- R. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IfdeMES' AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI 2 PER PERIODA PER INCH fz- 3 P- 3 P- 462 Sr 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 th directiqn and percent of land slope. / 34.i/l�i-tZ SYSTEM ELEVATION I -- x r CK _ T i -� I i —1— I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the 4r a 4d�2t�ods specifiedin 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( nt : TESTS WERE COMP ETED ON: reor _ q ADD E S: CERTIFICATION NUMBER: PHONE NUMBER(optional): Xl�cze/ a 4b 5�� s a CS NA U DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER— t INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6595 To be a corn plete and accurate soil test,yoUr report Must include: 3. Complete legal description; 2, The use section mUSt clearly indicate whether this is a residence or commercial project; 3, MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes, A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6, PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; : MAKE A LEGIBLE diagram accUrateady locating your test locations. Drawing to scale is preferred. A separate sheet may be Used if desired; S. Make sure your hrenchmark and vertical elevation reference point are clearly shown,arid are permanent; 6. Complete all aplsrarpriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate; 16- If he inforrnaiion (such as flood plain,Elevation) dues not apply, place N.A. in the appropriate box; 11. Sign the forte and place your current address and your certification number; 12. Make legible copies and distribute as reclUired, ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY VVITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Sod Separates and Textures Other Symbols St Stir-"e (over 10") BR Bedrock cols - C olohle, (3- 10") SS ... Sandstone cgr - Gravel (cinder 3") LS - Limestone "s - `uric:# I-IGift' _. High Groun,',vatcr is -..... Coals; Sind i-`€:xrt; _. P Icolsation i'}4ile, r,, Fiw.' Srwd t3ldcl B oil cl?nrt Lf 'flnv 5';irf€ — GreOti<r Tihan si Sand"', !etas < I — E cinr Rr, _._ p f1,vn i by r'I - C't;ty i...ourt? 1` _- '�t.rrC2v;: c; =rtay Cl ay, Loam R Reed -1 — S rtv rki' rnor M es t " -- S Vii:,"",' .. fix Merl{r soil iex:ures -;:Irlacc o .. i r;f3 wa>i=l d spar a' BM --- 13-n i1 i l}hail;; TO THE OWNER: This soil test report is the first stop in securing a sanitary permit. The county or the Department rimy request verification of this soil tost W the field prior to permit isscrance. A complete, set of plai3s for the private _vvv; ige system and a permit application rlust be, submitted to the appicipriale local auitho ty in order to vburin a permit. The sanitary pe>rmil must be obtained and posted prior to thr�start of any c.,on struciiorr. I I i -- J - -- J� I I i I I , I II- I i ! I Y -- I i 1 I � 1 I J -_I- g ! (v� _..�_-- i -}- I —---- I— —- — 1--�— —� -- — --�—— — -- - -- I I � I I I I , ! • I I I I I, I � I I I I --f----t--�—I� �--±---�—j --ter— -r �--�i--�----�---±_—I-- -i----- --- - --- I --t---i- r--- - - - ---E - - -- - -� - - - - I 1 1 1 7 I i I i j I j I - - ....... - - -- - - - -- - - ---- --r I , I _ -- -a-- - - - - - - - -- --------- -- -- - --- -- i I - --- --- r I � I , I IiI j I i i ! • I I --------------- f i I I 1 ' I j I I - I -' I I i , PAGE OF CrvSS A Zco SV51en-) .9�t'iP lk 40,.�,ms Fmh Air 1111616 And Obeervollon Pipe L+� �-J L ,, -�—Approvid vanl Cop i � P°V+w� MMlmum 12'Above flnei Grade 20-42'Above P1pp _4"Coll Iron To final Grade vent Pipe MorM Lot Synthetic Covering min 2*Aggregate Over Pipe - Distribution Pipe —' 0 0 0 —Too - 6"Apyreyote Beneath Plpe ° Perloroled Pipe below Coupling Terminellnp At Bollom Of 6ye16m SOIL FILL DISTRIBUTIOVI PIPE APPROVED S`MPETIC COVCR '"'"MATERI&I- OR 9" OF STRAW 2"OF/,6GREGATE --�� OR pJARSN HAy � Ie�0 FJ2 -21/z AGGREGATE �E V. OF F- FEET—► MST11151JTIOM PIPE TU BE AT LEAST C2LC---" INCHES BELOW ORIGIMAL GRADE AkJU AT LEASTtO INCHES BUT 1.10 MORE THA" 42 MCHES BELOW FINAL GRADE MAXIMUM DEPTH OF EXCAVAT160 ROM OKIGWu 6XADF. WILL BE �– INCHES MINIMUM OEPr'tt OF EXCAVATION TOM. OlIkI4INAL C3RAVf- WILL BE INCHES i 1 SIGMEO: d.4 I LICEUSE DUMBER: DATE : e —--- — ---- 110 11arcel #: 026-1062-90-000 02Jo9i2007 09:57 AM PAGE 1 OF 1 Alt.Parcel#: 20.30.18.310 026-TOWN OF RICHMOND 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-PAULSON, BERNARD H&CARRIE M BERNARD H&CARRIE M PAULSON 1068 140TH AVE NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *1068 140TH 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 20 T30N R1 8W 40A SW SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-30N-18W Notes: Parcel History: Date Doc# Vol/Page Type 12/05/2002 701085 2069/539 TD 11/25/2002 699785 2059/354 QC 01/08/2002 667587 1809/439 EZ 02/28/2000 618924 1492/437 WD more 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/30/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 22,500 228,000 250,500 NO UNDEVELOPED G5 38.000 57,000 0 57,000 NO Totals for 2007: General Property 40.000 79,500 228,000 307,500 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 79,500 228,000 307,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 127 Specials: User Special Code Category Amount I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00