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HomeMy WebLinkAbout040-1199-90-000 \ ¥ \ \ § \ © ® 2 � � . � / § ) 0 \ 2 m E . � f \ ! � z \ / i > { 2 \ / \ \ CL m S � § $ :!t \ 2 \ / D k . E \ r m \ § D \ ® E •� k $ / ) 3 ) Q \ z ) z \ z 3 k E CL I e a ` CL 0 ; \ j 2 k } ) & S \ 3 « m % ) \ \ \ k \ k \ z E \ a a a ) 0 _ oo 2 ] q \ ƒ / / z i @ } ® 2 § j @ $ I \ E 0 & � ■ � � @ � ° � / ( \ � k ) E (0 � § 6 » $ 2 S £ § . / \ \ } \ 6 / } \ \ $ 2 - - < ( \ J \ z z ƒ (D- 4 § . w / / ( & » 5 g § § ® o C e m - o z _ e w 3 m \ E 7 $ G \ k2 - , + \ - � » \ E J .2 \ k a § = 3 a \ A 3 0 COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 CpItax,.Wisconsin 54730 800 - 962 - 5227 f ST. CROIX ZONING REPORT NO.*+ 16379/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 1/09/92 COURTHOUSE DATE RECEIVED*+ 1/08/92 HUDSON, WI 54016 ATTN*+ THOMAS C. NELSON OWNER*+ Richard h trudy Loney J(J LOCATION', Rt. 3, 589 Sykora Lane, River Falls COLLECTOR*+ N. Jenkins DATE COLLECTED*+ 1-07-92 TIME COLLECTED*+ 2*+30pm SOURCE OF SAMPLE: Kitchen faucet DATE ANALYZED*+ 01-08-92 TIME ANALYZED. 2100pe COLIFORM, 0 /100 ml INTERPRETATION: Bacteriologically SAFE NITRATE-N*+ < 1ppm Above 10 ppm exceeds the recommended PubLic Drinking Water Standard. CoIiform Bacteria/100 ml Nitrate-Nitrogen, mg/L � 9 �O LAB TECHNICIAN*+ Pam Gage yOF,\NDEVENpENl WI Approved Lab No. 19 A� C Means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 • • •/�� )-*7 1 q/ . 4 / I ` ti. 111j ST. CROIX COUNTY ZONING OFFICE 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix Co. Zoning Office offers the service of septic and water inspection to Lending Institution, Realty Firms , and private individuals. COMPLETION 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 CO. ZONING, 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 X (For nitrates and coliform bacteria) WATER TESTING--------------------------------FEE:$175.00 (VOC'S) X SEPTIC SYSTEM INSPECTION---------------------FEE:$ 25.00 PROPERTY OWNERS NAME: Richard and Trudy Loney PROPERTY OWNERS ADDRESS: Rt. #3, 589 SykoraC e.- River Falls, WI 54022 Legal Description SE 1/4 , NE- .1/4 , Sec. 28 , T? N-R_12_W, etc. Town of- _ Troy ,Lot: No. lo ,Subdivision Sundown C,Hills FIRE NO. 589 LOCK BOX NO. -a ! y `� / I q 'I l,6 'ard . Color of house Redwood Realty sign? No Firm: PLEASE INCLUDE, IF AT XLL 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 this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: Richard Lone '2 Telephone No. 715-425-5583 REPORT TO BE SENT TO: Richard Lone Rt. #3, 589 Sykora Lane River Falls WI 54022 CLOSING DATE• Est. J C6 Signature: December 31 1991 s `CA.) to Ji`i li tlt.l' \\ } } / ST. CROIX COUNTY WISCONSIN .' y , , ZONING OFFICE ST. CROIX COUNTY COURTHOUSE r 911 FOURTH STREET • HUDSON, WI 54016 _ (715) 386-4680 Jan. 8 , 1992 Richard Loney Rt. 3 , 589 Sykora Lane River Falls, WI 54022 Dear Mr. Loney: An inspection of the septic system on the property of Richard & Trudy Loney, located at 589 Sykora Lane, River Falls, WI was conducted on Jan. 7, 1992 . At the same time a water sample was obtained for testing. The results of that test will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis . Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system: It is recommended that the system should be pumped once every three years . Therefore , the prolonged life of this system may be dependent upon proper maintenance of the system. S.in ere y/ a -1 r 4-� Ma4-J. J nki s Assistant Zoning Administrator cj • Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �U1�Ti�. TOWNSHIP SEC. '—U T Z 8 N-R 1 7 W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISIONuAbuJ(� o ('-i LOT V LOT SIZE Z 0.c�f2 S i PLAN VIEW Distances and dimensions to meet requirements of 11HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I r to I �'I POP 41 teta aW� / 94 I INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used iu bm* 2. Elevation of vertical reference point: /08 -'0 Proposed slope at site: SEPTIC TANK: Manufacturer: wt*15, Liquid Capacity: lobe Number of rings used: Z rr Tank manhole cover elevation: Tank Inlet Elevation: b� g Tank Outlet Elevation: '7t)3,460 Number of feet from nearest Road: Front 1(9 Side,O Rear, 0 feet t From nearest- property line ' Front,OSide,MRear,0 /D feet Number of feet from: well Z 5 , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE. REVERSE SIDE PUMP CHAMBER J Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: _ Trench: p / Width: /2 Length: / Number of Lines: 2 Area Built: ffZi Fill depth to top of pipe: Q e/ UJ fie . Number of feet from nearest property line: 2-6,) / o Front, Side, Rear, Pt . Number of feet from well.• • Number of feet from building: Zes (Include distances on plot plan). SEEPAGE PIT Size: Al" Number of pits: Diameter: y e Liquid depth: Bottom of seepage pit elevation: 1 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 line: Front, O-Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: P1LSc:yl Dated: (�/5��9 �- Plumber on job: LJ License Number: 3Zl/L 4 V e 3/84:mj - DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING ` LABOA&HUMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: SL 4,NO-,,S28, 128N-R19W CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Troy ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound -�atEaAE$Vn4CW ADDRESS OF PERMIT HOLDER: INSPECTI 'DATE: Peter Sykora Route 3, River Falls, WI 54022 (0-/ -gc( 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: John P. Sykora 111 3212 St. Croix 119501 SEPTIC TANK/HOLDING TANK: MANUFACT RER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER n / PROVIDED: PROVIDED: • / q`3 `i YES ❑NO ❑YES PqJqO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH J� ALARM: FEET FROM LI TT AIR INLET: DYES O `�� El YES O NEAREST�� �°� t� DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: P PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ❑NO YES NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PRO PE WEL KA4DIMARKING:UILDING: 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: DIAMETE ERI 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 1 � TRENCHES: �1 MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.1PrPE I DISTR.PIPE DISTR.PIPE MATERIAL: NO. TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BE ; PES: OV COVER: E-d NLET: PIP LINE, All (INLET:FEET' e 1 O^ NEARESTT---- 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 I TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES ❑NO ❑YES ❑NO FIETH ER TREN CH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/FRENCH 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: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION C APPROVED PLANS ❑YES ❑NO ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM ❑YES ❑pN�O ❑YES ❑NO NEAREST I I Sketch System on •3 Retain in county file for audit. Reverse Side. SIGNATUA TITLE: Zoning Administrator SBD-6710(R.06/88) [:(��EMLHM SANITARY PERMIT APPLICATION 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 ❑ //95d 8%X 11 inches in size. Check if revision to pre ious application -See reverse Side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. PRO RTY OWNER PROPERTY LOCATION 4�� S C, Sr, 1/4 { '/4,SZ19 T?$, N, R /g E(o W PROP�E,RTY OWNER'S M ING ADDRESS LOT# BLOCK# II CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM N MBER .tmt- L4 _0 11. TYPE OF BUILDING: Check one CITY � NEARE T ROAD ( ) El State Owned 1-2 El . S Vz RA ❑ Public 1 or 2 Fam.Dwelling-#�of bedrooms ­2' E PAR TAX NUMBBER( ) 4 Z � �'y' N III. BUILDING USE: (If building type is public,check all that apply) `r O 4 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. F New 2. El Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.F-1 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 F-1 Mound 30 El SpecifyType 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 19-5-b Z � / g Af // // 43 . -RMF 9 7� � Feet VII. TANK CAPACITY Site In aa ons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdina Tank / /000 C F1 n Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): PI mber's Signature:(No Stamps) M MPRSW No• Business Phone Number: �ztZ_ �iS sdf?- 9a Plumber's Address( et,City,State,Zip Cod : �1 2 .ad of- 7� IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(includes Groundwater ra ssue Issuing Agent Signature(No S mps) rlSurcharge Fee) Approved ❑ Owner Given Initial d L\ Adverse Determin tin 0 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 4 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 numbers) of where the system is to be installed. II. Type of building being served. Check only one and complete## of bedrooms if 1 or 2 Family Dwelling. Ill. 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, P um / i h n 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 requisad 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 S T C - 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/contractQ7z, ("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 Rej� : �dc-o+ Location of Property �� , Section 2S , T 78 N - R W Township g '^ Mailing Address ?a _ Subdivision Name cQac� � Lot Number Previous Owner of Property �tf / ��1^_gyp Total Size of Parcel 2 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 and Page Number � as recorded with the Register pf Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) ce4ti 6y that aU statements on th,ie 6osm ate true to the best of my (out) k.now2edge; that I (we) am (ate). the owneAas) ob the psopehty desc4 bed in thin in6oAmati.on johm, by vi4tu.e o6 a wa4Aanty deed seconded in the 066ice of the County Reg:JteA o� Deeds as Document No. 3 2 2 v 8 0 and that I (we) ptesentty own the ptoposed .6 to jot the sewage poaasystem (as I (we) have obtained an easement, to tun with the above de�scA bed ptopeAty, 4os the con t�.ucti.or, o6 said ay.6tem, and the same has been duty tecotded in the 06jice of the County Reg-usteA of Deeds, a,s Document No, IA— ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED I DOCUMENT NO. 1 STATE BAR OF WISCONSIN-FORM 1 fI 322080( WARRANTY DEED / (HIS SPACE RESERVED FOR RECORDING DATA , I Earl Cernohous, REGISTERS OFFICE i TFIIS DEED, made between Bernard CernOhous, Roselle Cernohous Hendrickson, Margaret Cernohous Ahrena� ST. CROIX Co., WIS. Lillian Cernohous Blake Rec'd for Record this-_2$th and Sykora L8t1d COm Grantor day Of__]IAY_______A.D.197L _ parry, Inc., a scone Corporation at-----3�.0 4:, M. Grantee, Witneseeth, That the said Grantor for a valuable consideratiorr "�"�Txenty Reg a Cf Dee s One Thousand and No/100----($21,000._00)--------..__Dollars conveys to Grantee the following described real estate in Sf. t"=ig County, RETURN TO State of Wisconsin: The Southeast Quarter of the Northeast Quarter (SZkNI9k) of Section 28, Towwhip 26 North, Range Nineteen West. Tax Key r This is not homestead property. ( fi TRANSFER y FEE f' t. Together with all and singular the hereditaments and appurtenances thereunto belonging or in an wise a ` And said five Rrantors and each of them a g Y appertaining; warrentithat the title is good, indefeasible in fee simple and free and clear of encumbrances except aasaMn'A of ranard and will warrant and defend the same. Executed at_ giver Fal Is, WiSCOnsin and t s 2nd day o[ 19 74 St. Paul, Minnesota SELL) i�1• r -'� e O 033e / SIGNED AND SEALED IN PRESENCE OF ergo C On (SEAL) .e cernohous Lillian Cer4ohous Blake MII&garet CemohOUs Ahrens Signatures of Earl Cernohous, and Rosella Cernohous Hendrickson authegtiC'dEeitthfe /V00 day of 19 • 'f.j;+- Gagas LC. :Banta :! 0 Title: Minnesota Other Party Authorized under Sec. 706.06 STATE OFD viz. Notary Public , State of Wisconsin Ram County. as' My conmission expires: 6/6/76 Personally came before me, this 13th day of 1974 the above named Bernard Cernobous, Lillian Cernohous B]�e�a�rgare t Gemonous s to`n%knern to be the person 1_ who executed the foregoing instrument and acknowledged the same. v �:T6� 'yl6trumgnt was drafted by Earl He Plante • Notary Public R8108ey Count ..Rive Falls, Wisconsin H• pl•ppJTE Th'Use of witnesses is optional. My Commission(Expire a) Mwr. Notary F•:d.l.• tl•_ust'ET• Ps1X111111SS1Jh i:.AINI" 04)' Names of persons signing in any capacity should be typed or printed below their tx res. — BOOK 511 FA E 413 1"M""'`'°""'® WARRANTY DEED-STATE BAR OF WISCONSIN, FORM NO. 1 — 1971 H z H 9 • y STC - 105 t" 9 H SEPTIC TANK MAINTENANCE AGREEMENT 0 St . Croix County z c7 9 H OWNER U Y E R ROUTE/BOX NUMBER Fire Number ()bV14L_aSSf CITY/STATE ecc ��,�� ( ZIP PROPERTY LOCATION: �� '�, _ Section T 06 N , R J7 W, Town of Tl!`a�l St . Croix County, Subdivision -S"6". 41111Q Lot number A) . I 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 pdt into 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 to maintain the private sewage disposal system in accordance with x H 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 DATE co 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; c DIVISION BO.LABOR-AND PERCOLATION TESTS (115) MADISON W X 7969 HUMAN RELATIONS (ILHR 83.0911)&Chapter 145) LOCATION: SECTION: WNSHI UNICIPALITY: OT NO.: NO.: SUBDIVISION NAME: �/���/ 28 /T�SH/R /9E ( �d /o -- �aUNC�OWIN }�i/fs COUNTY: MAI LING ADDRESS: USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: A TESTS: Residence —S fi jk New ❑Replace ��� /fib/gf� RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROJND•PRESSURE: SYSTEM-IN-FILL TANK:RECOMMENDEDSYSTEM:(optional) Inj sou 0s ❑u sou asou as u o 9* ' DESIGN RATE: If Percolation Tests are NOT required D If any portion of the tested area is in the ,( under s. ILHR 83.09(5)(b),indicate: MIA- I lFloodplain,indicate Floodplain elevation: Sal. �+JaAo &1* daAA j PROFILE DESCRIPTIONS Page -63. BORINGI TOTAL DEPTH TO GROU NDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER IDEPTH IN, ELEVATION OBSERVED TT. HEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- � /7`/d !°!d's� / s /" `�`=G 3'� �:/ 3 r- 7�'��'« is �`- �y�irJ a� 117'6 i. g� O'-y�•s:/ T; 1.i� -If- ci// -;Q�� X6`19. �/ocky Ss , B-z 9 hoKe o ,. ' 0'-�72"B.. / 72�'96!k ' 8806 �h LS r i a . I w, B-� 8 �_ Z �,BM =:/ ze= � `'L>'., ,s/a� y 3 95 9 63�--8 / S B� �& s; yra19l s:/ Ts yt"-2g`r�'.. S./ Z>�f"4-*"An L�ldU5 B- PERCOLATION TESTS EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH Al V P- :7 6 iy P_ P- 2 _ ' P- it « _ ro 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. Z3` � y Zo' E v t R1 .__- � _ foil �,/ ___ . ._ _ i 3 l ; • W E E I I J 71 ' 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): tc 7/S 568-49 Q C SIGNAT E• D ISTRIBUTION: Original and one copy to Local Authorit Y.Property Owner and Soil Tester. DILHR-SBD-6395(R. 10/83) —OVER — t ' 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; 7. MAKE A LEGIBLE diagram accurately locating your test locations.Drawing scale is prefered.A separate sheet 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 - 10") 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 fs — Fine Sand Bldg — Building Is— Loamy Sand > — Greater Than 'sl — Loamy Sand "'- — Less Than '1 — Loam Bn — Brawn '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. { � J rd, eG /-d� # /b -#,Its � ! s pl z" Se - A-rawer b3w111^ , Ja - .� Del �� J 1 tlg P^ a� A C J All Q O = PeAf c,(-_ 7� In^ k71 F,[Q 647" �-•a '� `�3 I S i -- Ll`� a�k�.h ��s� � �v •tea- -`lam �� f`e�[,�c •z i� f WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS � • DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of Location 1/4, 1/4, Sec. T N, R E (or) W Town or Municipality Street Address Lot No. Block Subdivision Landowner's Name: The application for this site is for: ❑ new construction use. replacement system use. If this is NEW CONSTRUCTION USE the alternative private sewage system is: ❑ to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota numbers-�sued to you.) �_A one of the applications needing a quota number. The quota number assigned to this application is - - ❑for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. ❑for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. ❑for an application on file prior to February 1, 1980. ❑for a lot that meets the criteria for a conventional private sewage system. 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