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HomeMy WebLinkAbout032-1062-60-000 a + 2 $ t 0 a % (D R ° 7 � . \ � C 0 § / � G 5® § R\ . m k (D . 16 75. % zaq LL k ) moCD , e a E <1 3 n � B .. o z k k 2 R § I © .. � k z \ § \ a # ■ e = § § � \ / { § \ § § Q 0 \ / \ \ k co k z } % % � t � CL E \ ® k k . E e � CD o 0 0 V a a n � � ■ � LO J j L) � 7 \ k 2 k ) § / 2 k \ \ E B a = 0 § § R = A ca 2 a , k $ 0) f CD ■ ƒ ; ° % - 0 - \ m % ) # E m n 9 \ 9 ° j a \ k j § § k \ ED § n I 1 A { \ § , a . ) � . S z E Q B § \ / k ) o z k / k \ � « � / . k CL( 0. »\ �E ,a k J a �� o U) Q ST. CROIX COUNTY ZONING OFFICE St. Croix Count Courthouse � Y I 911 4th Streeter t Hudson, WI 54016 Telephone - (715)386-4680 e t. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. CoMRletion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the' above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25.00 (For nitrates and coliform bacteria) FEE: $175.00 WATER TESTING (For VOC'S) SEPTIC SYSTEM INSPECTION---------- - -FEE: 00 (Determines if system is roperly functioning at time of inspection) Property owner's name Property owner's address C. r" Legal Description X1/4 of the 1/4 of Section _, TAN-R Town of 5'am� ��` Lot Number Subdivision Name i FIRE NUMBER '�_ O �2 (:r U2M BOX NUMBER Color of house Realty sign by house? If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, , WITH LOCATION SHOWN AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If an ements with this is g thi s the case P lease make proper arrangements office to ensure time when entry may be gained. Firm or individual requesting servi es: Telephone Number REPORT TO BE SENT TO: v Lzy y Closing ate Signature Form - S T C - 104 AS BUILT SANITARY SYSTEF4 rLPORT �G TOWNSHIP .r�- r`5� SEC. 7�j T �/ N-R W OWNER �d �It�/�h/I _ �� ,�,G— -•� ADDRESS v;W(: �7 ST. C1tojX COUI41 , WISCONSIN SUBDIVISION LOr LOT SIZE PLAN VIEW Distances and dimensions to meet requlremente of I•LHR 83 SHOW EVERY 1'11I14G WITHIN 100 FEET OF SYSTEM /" f�e'l 35 (1 6 • _ 74 INDICATE NORTH ARROW � n SENCNMMI Describe the vertir.nl reference rnint used 11o, 5�cl el-/Z)" 91e1wation of vertical reference point: 6� / Proposed slope at site: SEPTIC TANK: Manufacturer: _ _ ��� l LI-juld Capacity: Number of rings used: �� Tank wnhul.e cover elevation: Tank Inlet Elevation: Oul.l:_t. L.t.cvation: , Number of feet from nearr i r- .,d: Front,; C; ,ORear, O feet From neareet pruj,c.i. ; line : I'ront,C 11� ,Q Rear,O �j�Scz_' feet 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 Switch Types Alarm Manufacturer: Number of feet from nearest property line: Front, 0 Side, O Raar,Q '- Number of feet from well: . Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: _ v /oZ � � Len , �. Number of Lines:_,__ Area Built: F Widths Till depth to top of pipe: , Front, �Side. Rtar,OYt . Number of feet from nearest property line: - Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PITj! Sizes Number of pits: Diameter: ' Liquid depth: Bottom of seepaae pit elevation: Area Built: Has eithei a drop box O or distributif)n box O been used on any of the above soil abiorbtion sytems? (Check one). HOLDING TANK Manufactureri Capacity: used:Number of rings --------- Elevation of bottom of tank: --- Elevation of inlet: property Front Side, ORear, OTt.�„_, Number of feet from nearest line: • O Number of feet from well: Number of feet from building: Number of feet from nearest roads Alarm Manufacturer; Inspector: _ Plumber on i ob t a� Dated! _ " License Number's b cr: 3/64smi DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING e_ABOR&HUMAN RELATIONS DIVISION P.O.BOX,7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION JY]/fD'S�Q�1NI'`fie C. 2 3,T 31-R19 State Plan I.D.Number: To of J ❑ CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of N. Somerset Hw . 35 ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPEC I ATE: Ed Janhke 12026 Hwy 35 Somerset WI 54025 16' -V 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: ,Byron Bird Jr. 3318 St. Croix 135353 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO I ❑YES [YNO BEDDING: VENT DIA.: VENT MATL.: I HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH C I ALARM. FEET FROM 9 0 LINE:C` �S j AIR INLET: E]YES ®NO `-I ❑YES ❑NO NEAREST--- 77 DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: I PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO [__1 YES ❑NO [__1 YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: I BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) ❑YES ❑NO NEAREST---1110- 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: MAATERIAL: DEPTH: DIMENSIONS 2 53 — G J PIT GRAVEL DEPTH IFILLIDEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: : ABOVE COVER: E V.INLET: ELEV..END: ^ PIPES: LINE: AIR INLET:FEET 41' 1(. '' � .93 R A1.71 1 7c2c/ NEAREST�� 3-1 �i y .� MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO DISTR. I DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEVATION AND ELEV.: ELEV: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS' PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: 2 ❑YES ❑NO ❑YES ❑NO INEAREST-� �d Sketch System on etain in county file for audit. Reverse Side. SIGNAT TITLE: SBD-6710(R.06/88) SANITARY PERMIT APPLICATION COUNTY 7DILHR In accord with ILHR 83.05,Wis.Adm.Code 5/41 STATE SANITARY PERMIT# -Attach complete plans(to the county copy only)for the system,on paper not less than ❑ JjZ;.3 8%x 11 inches in size. ion to 1 iious 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 S T , N, R E(O PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# 1 pl7?Pis�� CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 62S /'S z II. TYPE OF BUILDING: (Check one CITY NEAREST OAD State Owned VILLAGE V,. C ❑ Public 1� •1 or 2 Fam.Dwelling-#of bedroom PARCEL TAX NUMBER(S) 111. BUILDING USE: (If building type is public,check all that apply) 03a _104? -4410 006 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. RLReplacement 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 6 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 REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) ELEVATION L Feet 7,7—/Feet CAPACITY VII. TANK Site in aallons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New gxisting Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holdina Tank .G Q 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 ame(Print): j Plumber's Si re:(No Stamps) MP/MPRSW No.: Business Phone Number: o ,1� 6` 2�. Plu r' A dress(Street,City,State,Zip Code): t •l.0- a, O IX. C LINTY/ EPARTMENT USE 014LY ❑ Disapproved Sanitary Permit Fee(includes Groundwater Date Issued Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial 00 Surcharge Fee) Advers Determin tion 1 t16-7 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SB0=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-?66-3815. 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) APPLICATION FOR SANITARY PERMIT STC - 100 This application form Is to be completed in full and signed by the ownet(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 J4_,, Location of property X1/4 5-a— /!, Section a 3 , T_2_1N-R_ZS W Township Mailing address 2 ,1>_-2,4- Address of site Subdivision name Lot number r Previous owner of property t X_q V t �Ci''�,COh Total size of parcel , �� Date patcel was created P77�`� �G/___/�5' Are all corners and lot lines identifiable? V as _�10 Is this property being developed for resale (spec house)? as o Volume -// and Page Number z:� as recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PACE 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. ---------------------------------------------------------7--------------------- 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 warranty eed records] in the Office of the County Register of Deeds as Document No. , ; 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 bee duly recorded in the Office of the County Register of Deeds, as Document No. Signature of #4ner Signature of Co-Owner (If Applicable) Date of Signature Date of Signature vOLk 348 PAnE6 6 %-n.200. wnmtsiv Deed—To Hushatid and Wife as Jomt PublIshed by Ilan Claire Seek&dtatl. Tbig bibenture, Made this 27th• day of May ,1958 , between Oliver P. Baillargeon, a single man, of the Town of Somerset, . . St. Croix County, Wisconsin . part y of the first part, and . Edward Jahnke and Doris Jahnke, of the same place - husband and wife, as joint tenants, parties of the second part. MitntOOtto, That the said paro? of the first part, for any. in consideration of the sum of . Six thousand ($6000.00) and no/100 - - - - - - - - Dollars, to him in hand paid by the said parties of the second part, the receipt whereof is hereby confessed and acknowledged, has given, granted, bargained,sold,remised,released,aliened, conveyed and confirmed, and by these presents does give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said parties of the second part, as joint tenants, the following described real estate situated in the County of St. Croix , Wisconsin, to-wit: Starting on the Section line between Sections Twenty-three and twenty-four (23-24) , at the Southeast corner of the Northeast quarter of- the Southeast quarter (MkSE�) of Section twenty-three, Township Number Thirty-one 31), North of Range Number Nineteen (19) West; thence North One hundred fifty-five (155. ) feet; thence West Five hundred sixty-three (563 ) feet; thence SoUth One hundred fifty-five ($5) feet; therica East Five hundred sixty-three (5631, feet to place of beginning; I Cogttbee, with all and singular the hereditaments and appurtenances thereunto belonging or in anywise appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said part y of the first part,either in law or equity,either in possession or expectancy of,in and to the above bargained premises,and their hereditaments and appurtenances. Co babe ano to i?oib, the said.,premises as above described with the hereditaments and appurtenances, unto the said parties of the second pert, as joint tenants. 91no tle ftib, Oliver P. Baillargeon, a single man, party of the first part, for himself, his heirs, executors and administrators, does covenant, grant, bargain and agree to and with the said parties of the second part,and to and with the survivor of them, his or her heirs and assigns,that at the time of the ensealing and delivery of these presents he is well seized of the premises above described, as of a good, sure, perfect absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever. and that the above bargained premises, in the quiet and peaceable possession of the said parties of the second part, as joint tenants, against all and every person or persons lawfully claiming the whole or any part thereof he will forever WARRANT AND DEFEND. Jn MitntOO Mbertot, the said part y of the first ha s hereunto set his hand and seal this 27th, day of iN �..___ , 19 58. I ,L__ _ ....._......__..� sal) Signed,•Sealed and Delivered in Presence of OliverTP. Ba __ 8rgeoII _..__._.._......._..._._..._........... __ J: --__._...__................_...__._._._..._.__.._........ Eva G. vnch %tatt of Ulioconoin, St. Croix ss. County. On this the 27th, day of May , 19 5$ before me, Joseph W. Hughes , the undersigned officer, personally appeared Oliver P. Baillargeon,a single Man,known (or satisfactorily proven) to be the person whose name subscribed to the within instrument and acknowledged that he executed the same for the purposes therein contained. In witness whereof I hereunto set my hand and official seal. Joseph We Hughes 0 _ Notary Public, St. Croix County, Wisconsin. My Commission expires June 14 , j959 . (To be filled In It signed by a Notary Publicr) (N.H.—Ch.59 win. Stata. provides that all instruments to be recorded sball have plainly printed or typevrrltten thereon the names of the grantors.irrantees.scita4ases and notary.) i : w � '• tp CV W � 11t ttoo l Q V N � � 'r1 W .�ti•- 2s v � .,,, !Q 'tf r_ (� (� Q by ° c� ' o ty E W H N3 •; to � A � c C_ 3 tiff C r :1? cei F+ ° Pi q n w as o w - c� v 1 3. ;n f"'� �• 10 0.i s 04 Is • O of W; w � to . von 348 'ASE"127 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY DIVISION HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: OWN UNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: 1/.5,�4/ /T NI I (o - CO NTY: MAILING ADDRESS: Y Ova Sri O�Z USE DATES OBSERVATIONS MADE r NO.BEDRMS.: COMMERCIAL DESCRIPTION: r� S: A ES jat S: Residence ❑New Replace RATING:S=Site suitable for system U=Site unsuitable for system ONVENTIONAL: MOUND: ►N-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) �S ❑U ®S ❑u [ZS ❑u ❑$ ❑S � If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: �� I Floodplain, indicate Floodplain elevation: '0� PROFILE DESCRIPTIONS BORING TOTAL PTH T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIG HET TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- B- B— �� PERCOLATION TESTS EST DEPTH . WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL-MIN. P RIO 1 PERIOD2 PERIOD3 PER PERINCH P— ! P- P- L P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION �<r? Ap a , ' a c t - T N a E- a_ t . £ - r _..--- . 7 � .e _ i j f 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. NAME (print): iTESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): �i �O 7 CST SIG NAT DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R. 10/83) —OVER — INSTRUCTIONS FOR COMPLETING FORM 115- SBD - 6395 ' To be a complete and accurate soil test,your report must include: 1. 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; Drawing scale is refered.A se arate sheet 7. MAKE A LEGIBLE diagram accurately locating your test locations.D g p p � may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all apropriate boxes as to dates, names,addresses,flood plain data,percolation test exemption,if appropriate; 10. If the information (such as flood plain,elevation)does not apply, place N.A.in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10") BR — Bedrock cob — Cobble (3 - 1U') SS — Standstone gr — Gravel (under 3") LS — Limestone 's — Sand HGW — High Groundwater cs — Coarse Sand Perc — Precolation Rate med s — Medium Sand W — Well is — Fine Sand Bldg — Building Is— Loamy Sand — Greater Than 'sl — Loamy Sand — Less Than '1 — Loam Bn — Brown 'sil — Silt Loam BI — Black si — Slit Gy — Gray cl — Clay Loam Y — Yellow scl — Sandy Clay Loam R — Red sicl — Silty Clay Loam mot — Mottles sc — Sandy Clay w/ — with sic — Silty Clay fff — few, fine, faint 'c — Clay cc — common, coarse pt — Peat mm — Many, Medium m — Muck d — distinct p — prominent HWL — High water level, surface water Six general soil textures BM — Bench Mark for liquid waste disposal VRP — Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance.A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit.The sanitary permit must be obtained and posted prior to the start of any construction. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ct h i ROUTE/BOX NUMBER O �Z w `/ 3 FIRE NO. oZ 0 .2� CITY/STATE k ZIP �3- PROPERTY LOCATION: x_1/4 5"_e_ 1/4, Section , T N, R W, Town of St. Croix County, Subdivision , Lot No. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists 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 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 a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after Inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED �J DATE %U - / St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address / PLOT PLAN PROJECT �l ������� ADDRESS V20.– — J� /��t/4,f� 1/4/$✓Z /T3/ N/R! TOWN Off'' Sa cam, MPRS Byron Bird r. 3318 DATE %p�-- _ COUNTY BEDROO CLASS PERC�_CONVENTIONAI,LIN-GROUND P SURE CONVE N NAL LIFT MOUND HOLDING TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA _ 4� PERC RATE G.7 BED SIZE 16 Benchmark V.R.P. As-suryfe Elevation 100' } Location of Benchmark * H.R.P. M Borehole Q Well Scale = Feet 0 Perc Hole System Elevation cent 12" rirndp TYPAR COVERING 2" - ---� 12" 3' 4 6' 40 3' 1 6M Sewer Rock 12' r r 1 -' �- 4W t ( Parcel #: 032-1062-60-000 02/12/2007 12:46 PM PAGE 1 OF 1 Alt. Parcel#: 23.31.19.3156 032-TOWN OF SOMERSET Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner 0-JAHNKE, DORIS (LE)&TERRY L DORIS (LE)&TERRY L JAHNKE 2026 HWY 35 SOMERSET WI 54025 Districts: SC= School SP=Special Property Address(es): *=Primary Type Dist# Description '2026 HWY 35 SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 2.000 Plat: N/A-NOT AVAILABLE SEC 23 T31 N R19W 2A SE COR OF NE SE SEC Block/Condo Bldg: 23 TH N 155'W 563'S 155'TH E 563'TO POB Tract(s): (Sec-Twn-Rng 401/4 1601/4) 23-31N-19W Notes: Parcel History: Date Doc# Vol/Page Type 01/02/2001 636103 1571/423 QC 08/16/2000 628248 1534/574 GD 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/23/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 32,000 83,000 115,000 NO Totals for 2007: General Property 2.000 32,000 83,000 115,000 Woodland 0.000 0 0 Totals for 2006: General Property 2.000 32,000 83,000 115,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 219 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00