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HomeMy WebLinkAbout036-1003-95-000 7 f 2 / 0 ACl) \ x \ § % . A u ; $ $ $ i :2 aE) � \ / E 2 [ $0 � ■ § §f _ _D, < . f Cl) $ § & � � § 7 � a ■ § � § z 2 k . ■ _ � e z k k 7 / E 2 (D f ) [ a) -� } J - q } 2 z } z N % { C.£ � CL \ § 8 2 CS ) / £ \ < _ 0 § F � / > \ k § � -� a m a a a R a B \ k \/ ƒ � � } § k § n k § ca @ 2 § < ƒ / ) � C, ° ' § � I b § § � 0 � k k @ % , o = R 4 . _ 0) B § r, ) @ m CO 2 § ¥ \\ k\ k K k o _ CM z _ I I s m ad 0 0C 0 " � » � \ E ) ' k § , o 0 a 2 o w J Parcel #: 036-1003-95-000 11/27/2006 11:12 AM PAGE 1 OF 1 Alt. Parcel#: 2.31.17.30E 036-TOWN OF STANTON Current XJI 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-OTTO,TIMOTHY J&ANDREA M TIMOTHY J&ANDREA M OTTO 2327 185TH ST DEER PARK WI 54007 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description "2327 185TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 4.420 Plat: N/A-NOT AVAILABLE SEC 2 T31 R1 7W LOT 4 OF CSM VOL 1/202 Block/Condo Bldg: ORD 4.42A IN NW SE Tract(s): (Sec-Twn-Rng 401/4 1601/4) 02-31N-17W Notes: Parcel History: Date Doc# Vol/Page Type 12/02/2005 813368 2937/337 WD 02/24/2003 710937 2152/68 QC 994/156 WD 929/578 more 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/05/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.420 25,000 123,700 148,700 NO Totals for 2006: General Property 4.420 25,000 123,700 148,700 Woodland 0.000 0 0 Totals for 2005: General Property 4.420 25,000 123,700 148,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 126 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - S T C 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP �'6'1) SEC. T N-R 2 W -h q ADDRESS ST. CROIX COUNTY, WISCONSIN 7 SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet_ requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �o f � a d INDICATE NORTH ARROW � / I BENCHMARK: Describe the vertical reference point used Elevation of vertical reference oint: p r1 -0 Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: _ Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,0 Side,O Rear, O feet From nearest property line Front,0 Side 10 Rear 10 feet Number of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) PUMP CHAMBER Manufacturer: quid Capacity: e Pump Model: Ldc Pump/Siphon Manufacturer: Pump Size � dd�7Y 4L'&"dZj- Elevation of inlet: Bottom of tank elevation: Pump ff switch elevation: p Gallons per cycle: 1r6 -v Alarm Manufacturer: �S /� ,�,� _�?,S„�.SAlarm Switch Type: �� o i Number of feet from nearest property Line: Front, 0Side, Rear,4 Ft. Number of feet from well: Number of feet from building: �a (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: � _ Length: � � . Number of Lines:_ Area Built:J(JdO _ Fill depth to top of pipe: 6�9 Number of feet from nearest property line: Front, O Side, O Rear,OPt . Number of feet from well: 2 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 been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property liner Front, O Side, 0Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: / Inspector: ll Dated: (y Plumber on job: 6 /T OMK�• ��lr.J C S J/ �I License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HgMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION IAADISON,WI 53707 �*T State Plan I.D.Number: W,,,Yi4}SE 4j S2,T311V—n1 T.T (it assigned) iVW J iCl W �CONVENTIONAL ❑ ALTERATIVE Town of Stanton ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound P ER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Harlan Clark Route 1 Deer Park WI 54007 Lv--s- g ,zf C ,-3 O 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 Jr. 1563 St. Croix. 119494 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑YES ❑NO [:]YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑YES ❑NO [--]YES ❑NO NEAREST�� 1. DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑YES ❑NO ❑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---111111- 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 GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: PIPES: FEET FROM LINE: AIR INLET: 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: ❑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 I 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 EAREST NO N —� U� / Retain in county file for audit. Sketch System on Reverse Side. SIGNATURE: TITLE: SBD-6710(R.06/88) Zoning Administrator SANITARY PERMIT APPLICATION 70ILHR In accord with ILHR 83.05,Wis.Adm.Code COUNTY STATE SANITARY PERMIT –Attach complete plans(to the county copy only)for the system,on paper not less than r 1 8%x 11 inches in size. E] Check if revision to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. PROP R OWNER PROPERTY LOCATION '/a '/4, S T , N, R (or PRO TY OWNER' MAILING ADDRESS LOT# BLOCK# Z. CITY,STATE ZIP CODE PHONE NUMBER SUBDIV16104 NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check One) El State Owned ? ❑ VILLAGE NEAREST ROAD� ❑ Public b°1 1 or 2 Fam. Dwelling—#�of bedrooms�l PAR AX NUMBER(S) III. BUILDING USE: (If building type is public,check all that apply) 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/C r W 5 El 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. Eg 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 Feet Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New 'sons Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App. Tanks Tanks structed Septic Tank or Holdina Tank Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT 1,the undersigned,assume responsibility for installation of the site sewage system shown on the attached plans. Plumber's Name(Pri Plu is ignatur No m ) MP/MPRSW No.: Business Phone Number: Plum Addr s(Stre t,City,State ip Code): IX. OUNTY/ ARTMEN USE ONLY ❑ Disapproved Sanitary Permit Fee(Includes Groundwater Date Issued ssu((((tti�tttgq Agent Signature(No Stamps)/ Surcharge Fee) Approved El Owner Given Initial Surcharge 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: 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. 11. 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'f 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. i 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) I 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 inte AW . oz resale by owner/contractor, (spec house), then a second form should be'-''iii*U' ed and completed when the property is sold and submitted to this office with the appropriate deed recording. -_ _ ------ ----------------------------------------------- ------ Owner of property / Location of property AW 1/9 s�_l/9, Section , T j?�N-R17—W Township Mailing address address �! M ZAI � �7 Address of site ,,►„f 44S 46& Z r Subdivision name Lot number Previous owner of property �&.0,ow� � Total size of parcel Date parcel was created Are all corners and lot lines identifiable? /� Yes No Is this property being developed for resale (spec house)? Yes /" No Volume /, 22 .-and Page Number a22�. 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 deed recorded in the 'Office of the County Register of Deeds as Document No. 3�9 q 7e _; 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 Cou y �tf eeds, as Document No. ) . Sf4sCature of owner Signature of Co-Owner (If Applicable) Date of Signature Date of Signature jl O��M��f��OQtSl�iLt ion kw Id omNahr�to GrsaReai tM Wlot+el�described rtal estate to .. �,�.G1�Q Coattty, Stag at Nrtecoww' f Nom ,". Tax is P Cif the SM of Section 2-X31-17. described as ► .C+1 "UAW SUrAY tieP filed Decaaber 18. 1975. in Mohsoe 1, Y° P"10 2 , as Docu■eat #330707. reeft.%stiong. Mr, righU of *00"0"Property_ a x To{tlt t i ill OW starlet the Iw a it+stsems M*W..�appurtenances thereunto Wei-kind ad wattaats the tee t to 00W. ilowaasible in fee ss'npie and free and clear of encumbrances attea�t '_ rqW W sd eefo d The saws June dmy�of All 1. (SEAL.) 1 �r�. � ► � /f �. � - =- _: .. _. _ Stn K. Irle AtitiltNTiCl1 fit N ACItM�ht 5tRrtateres adthentrcatrd t1NS_._ �.:_. .... _ day of STATE OF WISCONSittl °*. Personally came befpre ;= ~~ . 1978 %SCO SIN A. Irle and Sde Sri STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County— &.d� OWNER/BUYER / ROUTE/BOX NUMBER/ FIRE NO. CITY/STATE, G�.�C le1�S.'1� �A ZIP PROPERTY LOCATION: 1/4 1/4, Section a2 _, TJL_N, R_ZZ_�_W, Town of , St. Croix Cou ty, Subdivision , Lot No. Improper use and maintenance of your septic system could result in its premature failfire 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 /Zz DATE 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 i �k DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, c DIVISION LABOR HUMAN AND,LATIONS PERCOLATION TESTS (115) MADISON WI 969 (H63.090)&Chapter 145.045) LOCATION: SECTION: T NSHIP/ UMt&I1"90TY: LOT O.:BLK. O.: SUBDI SION NAME: /I3 N/R✓ NT OWN S/BUYER'S NA E: w IM4G ADDRESS: Y. USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMER IPROFILEDEC I TIONS: R LATIONTESTS Residence : ❑New Replace. RATING:S=Site suitable for system U=Site unsuitable for system ONVENTIa� . MOUND:®� �� IN-G®ND-PQ URE: SYSTEM-IN-FILLHO❑LDING�NK:RECOMMnE�ND'E/D�SYZM:7nal) SS U S S UL/�dl, .f If Percolation Tests are NOT require DESIGN RATE` any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS Me—BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER O OIL WITH THICKNESS,COLOR,T XTURE, AND DEPTH NUMBER DEPTH IRT ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- B- B- B- Cf/ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER PWoWrxS AFTERSWELLING INTERVAL-MIN. PERJO 1 PERI PERLW 3 PER PE INCH P- 1 i P- P- / 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 locatio on the plot plan, how the surface elevation at all borings and tlldirection and percent of land slope. ��� ' SYSTEM ELEVATION k2 , 'Air I10 � ( s! L" — I k4 I I _ N D-it iE 3 t I � I E i 1,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with fha rocs €s a l ods 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 rin : TESTS WERE COMPLETED ON: 21A�Z . C, 1/ s^ -0 ADD CERTIFICATION NUMBER: PHONE NUMBER(optional): CS S TUBE: 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 - SBD - 6395 To be a complete and accurate soil test,your retort racist include: 1. Cornplete legal description; 2_ The use section must clearly indicate whether this is a residence or commercial project; 1 MAXIMUM number of bedrooms or commerciai use planned; 4. Is this a new or replacement system; 5, G0111pirtr, 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; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A sepsis-ate sheet may be used if desired; B. Make cure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates,names,addresses, flood plain data, percolation test exemp- tion, 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 your certification number; 12. E1 ke legible conies and distribute as re<tuired. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AU`I HORITY VVITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols ST Stonc Lover 10") BR — Bedrock !;ul Coo s),ra 13- 10 w SS S3na,°<tonr -- Gravel iun'der S') LS — L irnos'ton= ' s -- Sand HvVI — I-iioh C1 rr;u � t;uzrfer Sand F'c:rc - P�rcolanor' hate .�,� .... r <rn _ G <it r Tna=j Sandy L i n w L cis i ri-ai Sit_ I_.oam Bl B;;.('k '�3 1,11 Gy — Gra'I y a3?€:(v $ Pj t lr - zi itfl 'S x°61-ss ftt -_ fr"r. iine �,IEn3t t nir7l ft1 = d — distinct p -- 6eroE�ur,r3rrr HVVL. High evel, SIX yrJ-f r ! >Oil #,XUfli',c tier v s t k1I hIlOid v"'e' t.dispo."al 13 M ._. fZ t,:J'; I! Aik VRP V,,Ii;Gc:ai ise iet;lnr'; Po€3,t TO THE OWNER: : This soil test report is the first step in securing a sanitary permit.The county or the Department may request ve�Hicatson of this soil test in the field prior to perrnit issuance. A complete set of pians for the private 5°stage system and a perruit applicat OrI must he submitted to the apt7ropriatre local authority in order to obtain a permit. The sanitary permit must he obs wined and posted prior to 11w S-o of any' c rrstructic3n. oef F-AY-Y eS- Y2 -------- IT a Zr- ----------- Wile- J/Y I - - 1 i s I i I I 1 ' i --- - - - - - - 1- I I i _......... _.. - - - I I j ' i I I i : I I I , i I I ; I i �__-_ _ 1-4 I � I II I I I - i -- - -- '- - m L � (t t a MODEL lipilliq mom mom mom ONE r ■®��i■mss■ ,® ®�®� •!�®�■ice■■®®� ®■ M©DEL r GOU L05 ■::::::::'::■:■:'■ ' `rr ■■■■.■■.■C.■■■..5.�� ■. ■ IN ENENK No ■■■■■■■■■■■■m■■ ■■■■■■■ i.:�i�l®■■■It■■®®.■�®.■■■■■ �.�.NM ;��■M■■■■■■■■ ■ ®■■■boom mwq-m _■''°�I�■mom!■■■■■■■■■■�■ ■■�ii.�■■momm■■■■■■■■ ■ eof■■ 191■"M■■■■■■■■■■■ no mommomoms MEN BOBBIE MEN mo " PAGE OF �rc� SS zc � ► vn o � Zito Systes -) / Fre6h Air Inlelc And Obcarvallon Pipe � KQ >✓ W I C�----APDrowd Vent Cap Mlnlmwn 12*Above Final Grade 20-42"Above Pipe _4"Cost Iron To Final Grade— Vent Plpe Margin May Or Synthetic Covering win 2"Aggregate Over Pipe Oistrlbution Pipe �' 0 0 0 0 --Tee Bo Aggregate Perforated Pipe Below Baneotb Pipe ° P o _Coupling Terminating At Bottom Of Syetem Pru�ose � �►��-I qr�,�l< �IcJ•.�- ton SOIL FILL DISTkIBUY101,1 PIPE APPROVED S49PETIC COVER " " PIATERIAX OR 9" OF ST. RAW 2"OFhGrJREGATE --- OR (AARSN HAY Co OF%2 -2i/2 AGGREGATE OISTRI?-;TIOIJ PIPE TO BE AT LEAST �_ INCHES BELOW ORIGIUAL GRADE AQU AT LEAST?-0 INCHES BUT 1.10 MORE THAJ y2 imuu BELOW FINAL GRADE MAXIMUM DEPTH OF EXCAVATicmi FAoM oKit ju 6KADF- WILL BE 52� _ INCHES MINIMUM ®EpT'H OF E•XCAVATIOW FROM 01KI(OWAL GR49E WILL BE _��_ INCHES SIGUED: LIGEusc DUMBER: ' DATE : �S— �� � l PAGE OF C Pl1MP CHAMBER CROSS SECTION AND SPECIFICATIONS S Vf UT CAP r• 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING > JUNCTION BOX MANHOLE COVER 25' FROM DOOR, 7 WIUDOW OR FRESH 12"MIL • I AIR INTAKE GRADE I I 4"MIN. CONDUIT le"Mlti. \ IAII_.F;l" PROVIDE AIRTIGHT SEAL I I APPROVED JOINT A I I'I APPROVED .101AITS W/C.I. PIPE. I III W/C.I. PIPE EXTENDIM& 3' I II EXTENDIAIG 3' OWTO SOI.IO SC:;. ALARM B I I ONTO SOLID SOIL I I I c ow I I All PUMP-1 --� OFF D CONCRETE BLOCK RISER EXIT PERMITTED OULd IF TANK MAWLIFACTURER HAS SUCH APPROVAL SEPTIC AND SPECIF I C,ATIOUS DOSL TANKS MANUFACTURER: NUMBER OF DOSES: PER PA4 TANK :IZE:--ZO _ GA LOIJS DOSE VOLUME •_ ALARM MANUFACTURER: �� ,���tL,sec. s p INCLUD!�!C ynCN,RLpW: GALLONS MODEL UUMBER: 1.44A4j CAPACITIES: A- INCHES OF. GALLOWS SWITCH TtJPf: B=�IAICHES OR GALLOAIS PUMP MAMuFACTURER: �� C=-IAICHES OR �GALLOLIS MODEL NUMBER: __��6� ��F 13 Dw._ INCHES OR ,AM if GALLONS SWITCH TYPE: ----T MOTE:_ PUMP AND ALARM ARE TO BE PUMP DISCHAR(.E RATE - s! GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEKEMCE B1 WGEAS PUMP OFF ARID DISTRIBUTION PIPE.. J t-c FEET + MIAIIMUM NETWORK SUPPLY PRESSURE . . . . • . . . • . • 2.5 FEET ♦ FEET OF FORCE MAIN X FYofLFRICTION FACTOR.. FEET TOTAL DyUAMIC HEAD = FEET IUTERMAL QIMEMSIOMS AUK: LEKI&TH ;WIDTH ;LIQUID DEPTH SIGNED: LICEMSE MUMBER:��b Z DATE:�� -117- CERTIFIED SURVEY NO. 2 2 FIL, ED ST cROR coE 0 DEC 181975 SU Part of the NW% of the SE'4, Section 2, 17W, OR'SRECO 4 T31 fJ, R 17W, ow A"u o'coNNUL ti, Stanton, St. Croix County, Wisconsin W a fed„ Qb. 1 UNPLATTED LANDS . .. . . . .. . . . . . . . . _... . TOWN - ROAD EAST 614.09' TRAVELED WAY NOT CENTERED ON 2000.01• m 33.01_ EAST_ 33.00 N. LINE OF SE 1/4 CENTER OF r1l 581.08 SECTION I , ho E 1/4 COR, SEC. 2 ,y T31N, R17W M JJa oh M LOT. I h !2 193,269 SO, FT. MIM M 4.44 + ACRES 0 O •9 A 09 W � O M 90 613.15 S 89° 57' 36 W mm 580.14' h a m W 00 �O t-z a M _ o o Wow 9° N w~ r U W W ; N H M " LOT 2 _ a WIC I - _z N 192,974 SQ. FT. v_ p. 0 ;3:0 �• J 4.43 ±ACRES M Z; ~-t- MIM p 3 Q. Wwaa Z' z Fes, l J• mzio Q• -o \0 1990 W J =M . ¢I to 91 m+ z 0 F Lij p. tw M 9° 612.31 S 89° 55 13 W 19 I­_ W• wI 69° 579.30' F-- �� �2F2•, °0 J: LEGEND a' o �. J; zl Z, 11/4"x 30" ROUND IRON ROD "�,I LOT 3 �• WEIGHING 4.17 LBS/FT. Z; 3I= — a n 192,710 SO. FT, v �. al o MIM 4.42 + ACRES M u W J o ° SCALE w o ¢>I 199 O c 6 F-I Z �I y 9A 5 o/F Iii: 200+ M 42., 9° 611.46' S 89° 52' 51° W Q� I 1990 578.45' �p 200 100 0 200 5 O: I Os°F•. 9°°o, e�`�L11916da3/p�o _ v 0 dd�A Z; I nI 192,446 SO. FT. - V v� 1l1 + �. I M� M 4.4�+ ACRES M � �•� JOHN F. Ot �..�� '' KLOVNING ` S-1085 Ma°52 1990,19 it t MENOMONIE, _(� 0 577.60' 16 3�, T1 •• WI$. 'o 7 :y *� d® S 89° 50' 26" W "O••••••......+•••••�� eQ► SOUTH LINE OF THE� 66 SE I/4ROFF THEEUNPLATTED •LANDS NW I/4 OF THESE I/4 �J �Sjl � 1 � WEST LINE I I I OF THE SE 1/4--IO I , John F. Klovning, registered land surveyor, hereby certify: That I have surveyed, divided and mapped a part of the NW-14 of the SE-4, Section 2, T31N, R17W, Town of Stanton, St. Croix County, Wisconsin more particularly described as follows: Commencing at the East 4 corner of said Section 2, thence West 2000.01 feet along the North line of the SE-14 of said Section 2 to the point of beginning; Thence S 000 52' 59" E 1292.04 feet; Thence S 89° 50' 26" W 610.61 feet to a point on the West line of the SE4 of said Section 2; Thence N O1° 02' 05" W 1293.77 feet along the West line of the SE-14 of said Section 2 to the Center of said Section 2; Thence East 614.09 feet along the North line of the SE-14 of said Section 2 to the }� point of beginning. Said parcel contains 17.71 acres more or less. That I have made such survey, land division and plat by the dirction of Calvin Powers That such plat is a correct representation of all exterior boundaries of the land surveyed and the subdivision thereof made. That I have fully complied with the provisions of Chapter 236 of the Wisconsin Statutes'` and the subdivision regulations of the County of St. Croix and the Town of Stanton, in surveying, dividing, and mapping the same. Volvume 1 rage 2 G2~ Dated this da'v of (% 1975 �� • AS BUILT SANITARY SYSTEM REPORT �;,I , TOWNSHIP SEC. T�`N, R W 0. ADDRESS x +� , ST. CRO X COUNTY, WISCON ,SIN. --T— '3DIVISION C.5 AA ' LOT LOT SIZE,'/" ,�e:5 I w PLAN VIEW �. -Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Z Y Q Vie pA . �. ��a 1 V TIC TANKS) DDo MFGR._ LC J CONCRETE STEEL NO. of rings on cover Depth DRY WELL ".NCHE'S N0. of width length area no. of lines_ width length area ld pt to top of pipe ,3 ` 3REGATE .K RATE T)d �_ AREA REQUIRED f%L/, AREA AS BUILT 9 , ,claimer: The inspection of this system by St. Croix County does not imply complete j pliance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for _.tem operation. However, if failure is noted the County will make every effort to ermine cause of failure. ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEIrf "INSPECTOR 5 � r DATED c_/ PLUMBER ON JOB � LICENSE NUMBER - z .- 1REPORT OF INSPECTION_INDIVIDUAL SEWAGE SYSTEM San.itaxy Pexm.it, II State Septic/,,? NAME - �/�� �� . Nl - � Tawnb h.Lp, S-�. Cxo.ix County . Locatox 1'G Section i _ SEPTIC TANK Size ga.ttonz . Numbers o6 Compaxtmentb I Distance Fxom: We.t.t St. 12$ on gxeatex a.tope St Bu.i.td.ing St. W et.tands fit. H.ighwatex St. R DISPOSAL SYSTEM Distance Fnom: We.t.t St. . 12% ox gxeatex b.tope St. Bu.i.td.ing St. W et.tandb Ft. • H.ighwatex St. FIELD DIMENSIONS: �. Width o6 txen ch St. Depth o6 xo ck b e.tow t.i.te in. f • Length oS each tine St. Depth oS xock oven t.ite .in. N'umbex• o6 tines Depth o6 t.i.te be.tow gxade .in. Tota.t .length oS .t.inea St. S.tope oS txench in pen 100 St. Distance between tines---it. Depth to bedxock St. Tota.t ab.s oxbt.ion axea 6t2 Depth to gxoundwatex St. i -_ Requ.ixed axea St2 Type o6 Covet: Paper ox Stxaw PIT DIMENSIONS: I • Numbex o6 pits Gxave.t around p.itA yeA no Outside d.iametex St. Depth be.tow .in.tet St. . 2 Tota.t abaoxbt.i.on axea it A. Axea %equ4%ed it INSPECTED BY TITLE APPROVED -,DATE REJECTED ,DATE 197 - - h f^?""t,. • ­77F- 7-11 „a , �"' t � + ... N[)EPJ4RTAAEN?OF 44EALTH AND SOCIAL SER%gCI~S- ` H1rAL1H, B... RE AUOF'E NYtROkAENTAL'HERL'7`F# v i 4 .16.Box lift � .• � T�}i,�,, MADISON, � .WI8Ct1N 53701 REP bRT ON SOIL BORINGS-AND°PERCOLATION TES **��} , ,SP04oq,1�.. t N,RZZ E (06Z?ownship or Municipality ficle`No. County Subdivision Name PdCY: Residence: i _ No.of Bedrooms Other s I30 EM: NEW. ADD„JITION REPLACEMIENT a RVAm '- DE: SOIL BORINGS ERCOLATION TESTS k` SOIL TYPE ;< a PERCOLATION TESTS HOURS WATER"IN TESTTIME DRO1b1Nl CHARACTER OF 501E SINCE HOLE LE AFTER INTERVAL R THICKNESS 111 INCHES, '7 1ST WETTED SWELLING IN MIN UT1r$ t+ERIO�l t'PEI" ` a ` Il t f4 � r T a� < f V 1r �rP SOIL BORING TESTS "� TI IALDEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOiL'11111TkTH INI HirS. QBSERVED " ESTIMATED HIEIHI:ST IDE"HJUSE K.W688 RI fs L7 , y«. r k 'and suitablwsoil'areas.) ` I eaon the Fan the­h$.=lCtc�dGi squarw°� +o !e reap..., Mdicat .umber o need for buionil type word cYY: or, stsioa.. Qive horizontalridvert+e I refennct points. Indicates pe. Nm Y 3 berob certify that the soil texts I�ioioo on this form were made me ail +rrrith.tl�pray lies � r i 1d' s fi I iro �Viscarosin Ad Cade,and that the data reeor'tl `arid, Saticon of tesCl O >srs trr '' x y +tin No n nom. a � u Tw a ,CSTSignatur e 3 r R � , e OV ek ` 4 N v Y R a, K 9Mjk { � t FF �L f 7 j - � • - � � ;AK 'YES,?p"�>+MNI' .. . --+ss '"�!'R�"'^°°s."'.'.RSrm,.� :mow:«.,,.r,�.y.np,.,,G-. �s�;,;, 't'�.+'� �?�'� �;.� •F�'�: M f • a� ti Vii;k , C _ _ - : •F�a' ,d.• f ugh c� 4'^ g 2 p- a s � s t 4d' t LL_ State and County State Permit # PL- B67 Permit Application County Permit for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQtJIRED Date Approval Received from State. if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: *s C, LOCA ION: '/4 7,0r Yo, Section �, T Rq E (or) W Cot# City_ Subdivision Nam nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family _ Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste GrinderYES,4-NO # of Bathrooms Automatic Washer YES NO Other (specify) E. SEPTIC TANK CAPACITY 1d d G Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation Addition_ Replacement_ Prefab Concrete !t *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) L 2) 3) Total Absorb Area q{/ sq. ft. NewX Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Lengthjrj Width ZR Depth _Tile Depth�` No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size y Percent slope of land a Distance from critical slope ad e- 1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Tester, NAME it 11 l 0 C.S.T. and other information obtained from AiA (owner/builder). / Plumber's Signature MP/MPRSW# 7 Phone # �� Plumber's Address l PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). le, 1 xue P u f n. ✓me- Z.L of IL u � _ ►00 I r Do Not Write in Space Bel FOR DEPARTMENT U�E ONLY ,,}} Date of Application l-� Fees Pai State f_),c Co my�l`t �O Dat Permit Issued/Rejt0;g* (date) - !- -/ Issuing Agent Name Inspection Yes-X—,No Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON,WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1/76