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HomeMy WebLinkAbout040-1211-60-000 a o (D o° ° 06M � i O M a O w � C p h C O I @ CD � X L C c i CN � N y C f0 N N Y N O C p 7 m — LL O 0100 3 O CO O 6 X Q r In V N z y rn E O z c0o w a m c O O z a m Z cn I- r rn N Z C E O -p (D � co N 0) a 0 0 N U) •N m O _ �+ p � p �io O Z H Z N Z i z > 2 R p N CL M!� d —:- CV O H d N L O D G d v a � o z •N � aaa IL C 0 p O N O O O y to J U = co rn � > o o — a E [b c d C9 p rn y m 2 to m 04 N O M H C E O0 lO w V7 a) 0 0 CO O C E p C Q- O p N 40. r O = `- p N C co U O �i W ~ (U V y N z C CU O ICI O N ` y0 fA p N E .� L •O y�,� 0 0 F- r 0 z C Fp- (n CO a d ECL 2 CD c c °: S A L) (L IOinV Parcel #: 040-1211-60-000 04/07/2005 03:28 PM PAGE 1 OF 1 Alt. Parcel#: 07.28.19.1005 040-TOWN OF TROY Current X, ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): *=Current Owner *EILERTSON, DAVID A DAVID A EILERTSON HOPKINS TERI M HOPKINS TERI M 321 W GROVE RD HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *321 W GROVE RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.360 Plat: 2597-WEST GROVE ESTATES SEC 7 T28N R19W LOT 6 WEST GROVE ESTATES Block/Condo Bldg: LOT 06 AND AN UNDIVI-DED 1/12 INTEREST OF OUTLOTS 1 AND 5 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 07-28N-19W Notes: Parcel History: Date Doc# Vol/Page Type 11/15/1999 613825 1470/537 WD 07/23/1997 859/499 07/23/1997 845/605 07/23/1997 784/400 2004 SUMMARY Bill M Fair Market Value: Assessed with: 27792 333,700 Valuations: Last Changed: 07/22/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.360 80,800 253,600 334,400 NO Totals for 2004: General Property 2.360 80,800 253,600 334,400 Woodland 0.000 0 0 Totals for 2003: General Property 2.360 77,000 234,100 311,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 113 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT l 'Oy / OWNER �Ff TOWNSHIP 7 T N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION tOE t 6W11-t— LOT LOT SIZE 5 1 PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM pw� S� INDICATE NORTH ARROW for �F �" ���E N�,�j %O BENCHMARK: Describe the vertical reference point used Gv 00 col ue-g te��VGz_ Elevation of vertical reference point: /001 0" &Proposed slope at site: /O LUEE�S nO v ct f R- lZ o o SEPTIC TANK: Manufacturer:AA)E k) Rle&'10A112 Liquid Capacity: Number of rings used: Tank manhole cover elevation: X03' Tank Inlet Elevation: �- '� � Tank Outlet Elevation: /o �' Number of feet from nearest Road: � , O �ZS / Front X O Side Rear, feet From nearest property line : , Front,©Side,O Rear,O Z S feet Number of feet from: well 931 , building: 3 / (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE i R1= GRAN39R.— Manufacturer: Liq Capacity: Pump Model: Pump/Si on Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch ele tion: Gallons per cycle: Alarm Manufac er: Alarm Switch Type: Number o 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 C0 S X Ce ' Bed: Trench: Width: Ji Lenjth: Number of Lines: Area Built: Fill depth to top of pipe: 7 y Number of feet from nearest property line: Front, y Side, O Rear, O Pt Number of feet from well: ��- � / Number of feet from building: a / (Include distances on plot plan). Size: Number of pits' Diameter: Liquid depth: o tom of seepage pit elevation: Area Built: Has either a dro ox O or distribution box O been used on any of the above soil absorbtion terns? (Check one). HO K Manufacturer: Capac' Number of rings used: E1 ion of bottom of tank: Elevation of inlet: Number of feet from arest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated:Dated: T G Plumber on job: License Number: HOMESiTE SEPTIC PLUMBING CO. 655 O'NEIL RD.,HUDSON,WIS.54016 ROBERT ULBRIGHT WIS.MASTER PLUMBERLIC.NO.3307 M.P.R.S. AAINN.INSTALLER&DESIGNER LIC.NO,00663 3/84:mj t��iSTW�- Ot l • yLof # � I AoArrE 0 b tvEtt'S CovC,,�f�- � tn2oDucfS . 0 pop of --- �. I ' sysTl�r, ,�aLET %o — + - - - - - - - -- --5 X4p6 — - --+-- � VleV4 rev ,o loo. 3o ' , �' s'��8, Tie CAW-" s - ---- -- - -- y�.30 r=L o s R s r . 'Tor o f i� �� o I _�—T.-- �, OF - P�p� : 9y.13 PLOT vE r �. 1)a4 7- = -To p AF �1�v�7ioa = ipo . 0 s pFc s CQ �� 012 4.0-p E- OF w.A SfI ED 31k r` uA3DER SG�. 272Y T>ISTP1IBL)I o-3 - �� pEs . �,VS'6111E4? SkP 7 �, !t 2�i� P kp 12 ocK HOMESITE SEPTIC PLUMBING CO. ` r6 L9 CR arw W I�^- 655 O'NEIL RD.,HUDSON,WIS.54016 ROBERT ULBRIGHT T Y�/rie I G WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. MINN.INSTALLER&DESIGNER LIC.NO.00663 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING "ABOR&,HUMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: SE! ,SW4-,S7,T28N-R19w [CONVENTIONAL ❑ ALTERATIVE (If assigned) Town o4 Tnoy ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound MAVE)OF PEPKArr 11101-DER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Mopseh Homes Inc. 213 Locu,6t Sttteet, Huctson, WI 54016 q q-0 9_ /qx 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: Robext VbAicht 3307 St. cuix 119401 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER d `�0 �Oa. 1� ,Ot �� \ PROVIDED: PROVIDED: IaYES ❑NO []YES 491 NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM L ^� AIR INLET: 4, ❑YES NO �— F-1 YES %NO NEAREST--- ,a`S ll 8 3 a3 DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: P PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO I 1 ❑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—1110- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: I 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 6(o f 6� TRENCHES: 1 I MATERI PIT DEPTH: DIMENSIONS T &, fU•/, GRAVEL DEPTH FILL DEPTH DISTR.PIPE I DISTR.PIPE DISTR.PIPE MATERIAL: NO. TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: nELEV.INLET: QQELEV.END: PIPES: O LINE: r1 A/IR- NEAREST----10- I50 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 [DYES ❑NO DEPTH OVER TRENCH/BED I 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. 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 PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING: COMMENTS: FEET FROM LINE: ( [--]YES ❑NO ❑YES ❑NO NEAR T-­41- Sketch System on Retain in county file for audit. Reverse Side. SIGNA E: TITLE: SBD-6710(R.06/88) �"� Zon SANITARY PERMIT APPLICATION COUNTY , X ILHR In accord with ILHR 83.05,Wis.Adm.Code Z: a ... �..o� STATE SANITARY PERMIT# 9 v/ —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION �j 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE El YES AND PROPERTY OWNER PROPERTY LOCATION -70 �y "44 af�/ ME S sE'/a 511 '/a, S ? T tx Q N, R ( E (o W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISIO A 7V Go��° T S T Co cvc-s r lCovrL- ITY,ST TrE // � ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LAN MARK �j�1✓ Wf S G�(r 'v/ f VILLAGE: �XQ CT/Wvo. 11. TYPE OF BUILDING OR USE SERVED- Number Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a.&New b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e.❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) G�;v�c� �� CJ /��•7 1. a. ❑ seepage Bed b.,&Seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: *, (Minutes per inch): R�(l®(Square Feet): PROP (Square Feet): �a / 1/e C./ ��jj Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App [Tanks Tanks structed Septic Tank or Holdin Tank Lift Pump Tank/Siphon Chamber 'v ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: �. ?.Gcl3uC4 ?— 3307 Pi er' Address(Street,City,State,Zip Codde.):/� Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name :,HUDSON,WIS.54016 CST# Z G/f9 iT IJLBRIGHT ` X CST's ADDRESS(Street,City,State,Zip Code) R I..IC.N0.3307 M.P.R.$• Phone Number: 'NER LIC.N0.00663 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S Hilary Permit Fee I Groundwater ate Is ing Agent Signature(No mps) c rge Fee Approved ❑ Owner Given Initial r1,� � _ ,(1/�h� ' Adverse Determination W ltd, ' I X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT. APPLICATION e TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/z 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; dosing or pumping chambers; 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. ---------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground <AtF.f included the creation of surcharges (fees) for a number of regulated practices which Wisco can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried T is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of* the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. --------------------------------------------------------------------------------- Owner of property Itf e sc"- f— *,,y S Location of property sZE 1/9 571V 1/4, Section 7 , T N-R W Township Mailing address -2 I-O eV S T Sy- - Address of site //wly. / -V - If) ST Subdivision name _ -- Lot number Previous owner of property Total size of parcel y q�.2 S Date parcel was created T IP 7 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? X Yes No Volume 1 / and Page Number 4/0 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. r ------------------------------------------------------------------------------- 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 deed rec rded in the Office of the County Register of Deeds as Document No. , and that I (We) y �3 presently own the proposed site for the sewage disposa 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 Register of Deeds, as Document No. ) . Signature of Owner Signature of Co-Owner (If Applicable) Date of Signature Date of Signature D1110 MENT Na , 4Z7835 '.. 7��p= O ' 6a leer 931 14 wle000:lo atstutae I i` ' z) . - IQIOW ALL MBN, that .. B jornstad Builders, Inc., a Wisconsin corporation, •• )dlerein called Assignor,whether one or more, in consideration of one dollar and other valuable consideration, in hand paid. receipt whereof is hereby acknowledged, i, Wayne F. Moser and Murray A. Knecht, as hereby grants, assign. transfers and conveys to...................................................... .... ..... .. tenants in commons , .._...............................................................................................................................herein tailed Assignee,whether one or more. ` a certain Land Contract dated the..............................19th..........................day of................ ....May. . .. .., Eby Rue R. Elston and Clara L. Elston, husband and wife, aaVerldor � ' ... .......B jornstad Builders, Inc., a Wisconsin corporation, asPurchaw .... .... ............ . ..... ........ ... ....................................... ..... ..... on certain lards in the County of...................t....Cnoix.................,State of Wisconsin, together with all right,title and ! interest of the Assignor, in and to said lam* which Land Contract was recorded in the Office of the Register of Deeds b Record of said County, on the................................day of.... 19. 19th ...........May ..... erg. Vol 740...: x 7- ..... ....... .... [ Asaicjnor also quit=c-Ur iB tom all ri zt, on 114 as Document No......-..412030 title and interest to the lands now ooviered by page..................... said Land Contract, as described in ADDENDUM. , To Have and to Hold said Land Contract,and all right,title and interest of the Assignor in aril to the lards therein described, to said Assignee, his heirs, personal representatives, successors and assigns forever. I The Assigner hereby covenants that there is now owing and unpaid on said Land Contract, a sum not more than One Hundred Seventy—Four Thousand Four Hundred Seventy Five and no/10n OW �ks pop I�- ........................................................................... ....f.�.i•�•4;•���:•aarWWWWWWWY•-+Y�,Y��-����w.���.�.R�l,l. I Y"i 3 !i ........................................................... and that he has good right , to assign said Land Contract. IN %MNM - 87, this assignment has been executed and delivered this.........................0.** ......day of (� , ............................7 .�/.........19........... BJORNSTAD BUILDERS, INC. !! !I SIGNED AND SEALED IN PRESENCE OF _ i .............. .............. L/fit �titi �SBAL. ................................ Orin B real en's' i! �01�� , ouUtera•igned� J.0.1-CA/ �(sEAI, Donald E. ornstad', eare£a y '! Oto of Wiscosuln, t i . I! County oL.................................. ..................... IPersonally carne before me, this......... ..................day of....................................... ., 19.. ., the above " I! named.......................................................................................... ................................................... .......... ....... ... II to me known to be the persons who executed the foregoing ins and acknowledged the same. li ................................................ ... ..... i' Notary Public.................................. .,.. ..Coon is, � � f My commission expires..._............... ... r, I I' Caapacate ACknowledgnmt State of Wba�ssaini, SS. !� County oL...........St....Cnoix...................... I a 87 Personally carne lest me, this........ day-of.. . r .......o1a..... .... t .. :. 19...... Orin 8. B ornsta orlald"1;' ' 'B jota .....................................�...............................................,President and................ ................................. ......... of the above named corporation, to me known to be such persons and officers who executed the (p�leoin$ instrument `: and knowledged that they ciao same as such officers by its thority, for the rpose coWined.. keeeived for Record tAi.. oy.of J�Lle .. A. D.. 19.1.7 at..d• -......oclock. I►1. ..M. .... (�.. .........�.... Q .. .. * i . .'�• zE and in d .74Y d Deeds _.'Y!p.�.. �SEALJ '•..Q 4 � _„ Notary IC..........�t..w...frlQ.l�?4 ty, Wis. r .' My commission expire&........ June 14, a9 ........., Drafted : Charles E. its ,•., . Drafted i...W..... era s a,ow:r (s«tlaa f9.l1(1)d th.wYm,wa stave.o�+dr�ap M.[nrnww a!�wmwld.MII haw �. Wewr prtnred«t>oe.rNten tltwran tlr nrnw or tb sue+.ti.naea.Anr..w otd tot.q). ' •e 'S* ,�, 4 0 'r ' ` i STC - 105 r SEPTIC TANK MAINTENANCE AGREEMENT ►'� : St . Croix County ` OWNER/BUYEROs ROUTE/BOX NUMBER 2-1 -3 Loeus7— Y7- ' Fire Number CITY/STATE � �"� ZIP PROPERTY LOCATION : S� �, , Section 7 , T N, x t' W, Town of l h y St . Croix County, �e--S 7 i �., i Subdivision u-� Lot. number_. Improper use and maintenance of your septic system could result 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 pit into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Crolx. 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 - I accepted this program in August of 1980, with the requirement that owners of all new stems 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. i Certification form will be sent approximately 30 days prior to three year expiration. c I/WE, the undersigned, have read the above requirements and' agree to maintain the private sewage disposal system in accordance with W M the standards set forth, herein, as set by the Wisconsin Depart- ►d ment of Natural Resources. Certification form must be completed and returned to the St . Croix County Zoning Off:Lge within 30 days. of the three year expiration date. 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 . ��' DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, DIVISION ,•.; LABOR AND PERCOLATION TESTS 1 P.O. BOX 7969 115 HUMAN RELATIONS � / MADISON,WI 53707 (1,163.090)&Chapter 145.045) LOCATION: SECTION: TOWNSHIP/%*N+etP*t-tTY: OT NO.:BLK.NO.: SUBDIVISION NAME: 1/ N/ 7 /T iF N/R ff E -0/v wtr 7- 16'Wo ate-- COUNTY: OWN R'S 9e*EA194ii�W: MAILIN ADDRESS: z g0st-e_ o�c 3 Lo e 0 s T H- t�so.� IS S4 olL USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMER IAL 3 02 DESCRIPTION: PROFILE. �� S: N ES Residence ❑Replace %X Ne RATING:S=Site suitable for system U=Site unsuitable for system �s C73 �ti1�1 rf�%� U /C _9 O GRD•PRESSUR ANK:RECOMMENDED SYSTEM:(optional)®S ❑u U �otiUE.t�fiG� L If Percola tion Tests are NOT required DESIGN,RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: t-,//f �— Floodplain,indicate Floodplain elevation: eo.uDiT1o�s ' SuAw — PROFILE DESCRIPTIONS �iNO6�- ?NO oS y BORING TOTAL DEP TH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN ELEVATION OBSERVED EST.HIGFE—ST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- I �� 0 X03, �1j > �,' D /,O ' 13/� S� �.p ' �iJ�✓ �' c S G i2 . B- Z b '� ��yl�y/ �i0 > �7. s ��°7�/'�•�' s� d'3 ' B�•S• 4 y�2 , 70 Tiles �e5 6—P- 43 3 4`3 '/�/,� s, . G 7 ' B.�. s. 3 y�2, 7. S ,., a,&f 5 e- �/ ,� /a/, 3L' > e. S v B-� 3! N S G>03 J� � �S S B- 4 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER INCH }" P_ 2 Z P —2— Y k p_ s i 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 51j, of land slope. SYSTEM ELEVATION 3 23- lB y R5_ ! �. -- - --- f I �I i a _ J. a SEA �049 r _ k`I ! I I T u ,l ctia 1 C 1 ! ac ti url , MW Nac R I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods speed in the Wisconsin p+ 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): TESTS WERE COMPLETED ON: (;`^ESITE SEPTIC PLUMBING CO. ON WIS.54016 D� 7' ADDRESS: ROBERT ULBRIGHT CERTIFICA ION NUMBER: PHONE NUMBER(optionalF c' A LUMBER LIC.N0.3307 M.P.R.S. Z-- DESIGNS CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority,Propel ty Owner and Soil Tester. s YP DILHR SBD-6395 (R.02/82) —OVER — � � � n 1 bb r Al All 19, 0� s � ' a� JJ J ,a 1138WVal%4 �WpIS30' Id d 01 ON oN•01' , S1M �dw sn(.•QaIV. \JU �h Z 9 'S1M'N 'J AS 3i►S3W0kA .00IDS16Wn d wn,l 5 88800'ON'011 a3h-, . — — —— — — _-`'— — — — —. •s'b d w tom�o a nia���;: y 1 }/ Z/o s� 'su�'NOSanH 1 •��1ewm� 1 � 1 I }iIS YH'(211 Q.7Sodo1/d OL � I � aL !1--7,ey �a S-j,� $f pr Ldf . f F ,ve,xi Ta Gvodv e"Ooeve?e k: eQ°Qp6�� PRvpoSFD 5 �- $ �^ A 4 PLUMBING CO. wls.�ao1s On ).,HUDSON, ULBRIGHT 7 M.P.R.S. „�► Amr-R LIC.N0. -,;DER LIC.N0.00663 �a8 0 15 4I B1NG CO• S SEPTIC PLUM WIS.5g016 N0MES1tE D NUDSON,� C S M P S �� M'►� �: 6550�NE1L 6E U1G 330? P' oc N0• 40.006* S�Ea P RM ER MP P.DES ►GNER L1C• WIS �;fticI.WSSA S�PTic �k; ��� . w/F1E� •A �,: ti c� Rt plhtFHeaT ft kC, N 4 � ' -' oRop AoX \ O � � �; #fit• rw 1 i G� \ � •�� ' 1 . wal<sAS l0 woNo6 p .' 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