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040-1169-95-000
of 0 a 0. 0 c I 0 o I N ti i •O O O j I y I T p P Q7 � LL 2O O 3 i Q Cl) CD Z E J c Of z oo co a o a m M o I O Z :i C V d Z a O c O M H r P Z j d a O y_ N_ O `7A Q Q N C •IV d (� L O O O Z co Z N Z d N to 0 COO �• ui N N N E CD E > LL LL � O •� a a a a o � o � c rn rn J V y Z u� 1 m � O O O 5 _0 E m m y C d U) o r _ c 7 ++ O C CD Oco O N C N 0 n- O O f�0. C O O O. -p N V � � 3 N N cc� C W N 3 M Z L �i 00 T d ? It (D O Cl) F- �2 O Z N 5.cO � Pik a I L: IL • R a o A a. L) 2 0U) U ' t Parcel #: 040-1169-95-000 10/18/2006 09:18 AM PAGE 1 OF 1 Alt. Parcel#: 36.28.20.646E 040-TOWN OF TROY Current LX' 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 DR R M MAGRAW O-MAGRAW, DR R M 5256 ASHLAR DR BLOOMINGTON MN 55437 Districts: SC=School SP=Special Property Address(es): "=Primary Type Dist# Description * 104 BLACK BASS RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 12.500 Plat: N/A-NOT AVAILABLE n SEC 36 T28N R20W PT G L 1 FROM NE COR G Block/Co d o Bldg: L 1 GO S 50',TH W 400 FT,TH SLY 325 FT,TH SLY 890 FT TH SELY 657 FT TO POB: Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) TH WLY 493 FT,TH WLY 187.2 TO LAKE ST 36-28N-20W CROIX,TH SLY 135.3 FT ON MEANDER LINE, TH SLY 200 FT,TH SELY ALONG CEN LINE OF more... Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 857/418 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.500 354,200 100,700 454,900 NO PRODUCTIVE FORST LANDS G6 12.000 63,000 0 63,000 NO Totals for 2006: General Property 12.500 417,200 100,700 517,900 Woodland 0.000 0 0 Totals for 2005: General Property 12.500 417,200 100,700 517,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: 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 -e SEC. T ?j N-R20 W ADDRESS /97 1'(r(cIP ST. CROIX COUNTY, WISCONSIN %ry . lyres S� Y36 SUBDIVISION LOT �- LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM DAVI ?OGEWY PLUMBING Licensed Perk Tester & Plumber #3233 #3289 Fogerty Heights Road g NNIN ROBERThoneI 749 3656 84028 r, r w ,,�dy,e ;o /7 I'oov ee �/ e to/ d ' �6v xfy� INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 11 ° J /©d.d Elevation of vertical reference point: 1pyc, f Prop sed lope at site: �> SEPTIC TANK: Manufacturer: G4/«lc5 Liquid Capacity: /coo Number of r4gs used: Tank manhole cover elevation: lew o Tank Inlet Elevation: 966 7 Tank Outlet Elevation: fd.y6 Number of feet from nearest Road: Front 10 Side ORear, 0 feet From nearest property line ' Front 10 Side ORear,0 Imo feet Number of feet from: well > So building: YP� (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE i PUMP CHAMBER Manufacturer: Liquid Capacity Pao ' Pump Model: Pump/Siphon Manufacturer: �,t,/��r Pump Size 41 Elevation of inlet: gT-t Y( Bottom of tank elevation: 9i s6 Pump off switch elevation: s , 4(1 Gallons per cycle: .2'Ap Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. � srr Number of feet from well:—;, 3S� Number of feet from building: - 3Sa (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width• Y l� Len�th:3 � Number of Lines: 3 Area Built:1/ Fill depth to top of pipe: ,z Number of feet from nearest property line: Front, id,e, O Rear,O It Number of feet from well: Number of feet from building: ��O (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: , Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest 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• �l Dated: O 1 Plumber on job: c License Number: Z ;�-r 7 3/84:mj 'l _ ,:�V .. '�' � � - 'r �'0(in S:. � :.: 1�,_ __ ,„� _ �� `,:� , -f ,_--: i 4-� ..r�"" :' a', _ _... ��.. e� c n! �`�°-�. e_a �l i �. �,, �� ' � •1 i.* �y � ,- —�'� f�— L ' it } r i j iII 1. �'� i - �- - � a .` � ' _ n. 5 �r+.,- j - _ , '3 �_` -. �� __ �� ^e �,. `�,:- ., �; __ '�__ F" N r - . y,-� .. � Y ,n �, ,! i i '! / � i � s - j i DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOFJ&HUMAN RELATIONS DIVISION P.O.BOX 7969 r ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: R- S ,W,-,S25,T28N-R2OW CONVENTIONAL El ALTERATIVE (If assigned) Town of Troy ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound O ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Richard Ma.Graw 6221 Hillside Road, Edina, MIN 55436 10—d 3�q 3,1 0 B CH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PL REF.PT.ELEV.: CST REF.PT.ELEV.: /OD. b Naffne o lumber MP/MPRSW No.: County: Sanitary Permit Number: David Fogerty 3289 St. Croix 119443 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: / ES ❑NO ❑YES Z NO BEDDING: VENT DIA.: VENT M .. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM INE / lJ / AIR INLET: ❑YES NO E:1 YE NO NEAREST 3 DOSING CHAMBER: MAN ACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER /� PRRO�OVI��ED: PROVIDED: ❑YES NO �j U % 3 Zpe He r L�TYES ❑NO ES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE UMP ON AN OFF BETWEEN YES ❑NO NEARESTO—� LIN%:3 zo 3So 3 AIR INLET 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 r TRENCH ATERIAL: PIT / ' DEPTT% DIMENSIONS ✓✓1 GRAVEL D PTH - FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: STR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PI ES: AB OVER: EL V.INL T: L .E D: D� PI LINE: AIR INLET:FEET O(� 4 X� i NEAREST v 7.3 U 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 TDEPTH 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: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION n g SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION Nq�L_ APPROVEDPLANS ❑YES ❑NO I ❑YES ❑NO COOMENT it PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: P, .- ❑YES ❑NO ❑YES E]NO NEAREST ©, r Sketch System on Retain in county file for audit. Reverse Side. Sl ATU TITLE: SBD-6710(R.06/88) Zoning Administrator DJL.H M SANITARY PERMIT APPLICATION CO C�v In accord with ILHR 83.05,Wis.Adm.Code _ 7r STA SANITARY PERMIT# )9 4q3 —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 •1. APPLICANT INFORMATION1—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES S NO PROPERTY OWNER PROPERTY LOCATION '/4 %4, S T , N, R ra E(or PROPERTY OWNER'S AILING ADDRESS LOT NUMBER I BLOCK NUMBER SUBDIVISION NAME 2. ! t �- CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,L ❑ VILLAGE : II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family -J OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. 1:1 New b. [J 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,,O,F��SYSTEM: (Check only one in#1 and only one in#2) 1. a. L`dConventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tan k V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ER/seepage Bed b. ❑See a e Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): 3 615, S'- Feet ERIP-1rivate ❑Joint ❑ Public VI. TANK CAPACITY Site in al Ions Total #of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper. INFORMATION New xisting Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank AO® ®®o { ❑ 11 Lift Pump Tank/Siphon Chamber ❑ ❑ I ❑ :113-. ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): umber's Si s %kWMPRSW No.: Business Phone Number: 75M 340 PPlu„mber's Address(St t,City,Stat ,Zip Code): Nam esi ne -2 O III. SOIL TEST INFORMATION Certifie T) ame CST# =DDRESS(STMet,City,State,Zip Code) Phone Nu'beer IX. CO TY/DPOIARTMENT USE ONLY fC� ❑ Disapproved Sanitary Permit ,e�a Groundwater ate Issuing Agent Signature(No Stamps) L1hA roved LQ � Surcharge Fee pp ❑ Owner Givenlnitial � _/�� ,( Adverse Determination U 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 `y t 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 r 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. Prcperty owners name and mailing address. Provide the legal description where the system is to be installed; II. 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'/2 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 ate[ included the creation of surcharges (fees) for a number of regulated practices which disco in`S a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure, 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 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/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 ,<G��l S� ( S Imam u/ Location of property -�L�1/9 S� 1/4, Section 3 , T -)o' N-R �)Ld W Township �l10 Mailing address �7'Ih s 5 5f 3 61 Address of site Fuld. x Subdivision name Lot number Previous owner of property C uuct,,� y Total size of parcel Date parcel was createde ` Are all corners and lot lines identifiable? V---Yes No Is this property being developed for resale (spec house)? Yes `� No Volume 3 3 Y and Page Number � 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. ---------------------------------------------------------7--------------------- PROPERTY OWNER CERTIFICATION jftWe) certify that all statements on this form are true to the best of my (our) knowledge; that Pg� (we) a* (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded 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 (o (we) have obtained an easement, to run with the above described property, for the :54W construction of said system, and the same has been duly recorded in the Office of the County Register -Register of Deeds, as Document No. °P.5-0 k) yy J Signature of Owner S gnature of Co-Owner (If Applicable) Date of Signature Date of Sign tune Nu.260. w rrnut , �0P77� VjW 3iibenture, Made this 15th day of WY ,1957 , between C. E. Webster and Marian H. Webster, his wife, I i III part ies of the first part, and Richard M. Magraw and Shirley/f.�viagraw , husband and wife,as joint tenants, parties of the second part. (SitntOOttD, That the said part ies of the first part, for an, in consideration of the sum of . Four Thousand Seven Hundred Fifty ($4750-00) - - - - - - - - - - - -Dollars, to them in hand paid by the said parties of the second part, the receipt whereof is hereby confessed and acknowledged, ha ve given, granted,bargained,sold,remised,released,aliened,conveyed and confirmed, and by these presents do 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: A parcel of land located in'Government Lot One (1), Section Thirty-six (36), Township Twenty-eight (28) North, Range Twenty (20) 'nest, St. Croix County, Wisconsin, containing 12.5 acres further described as follows: from the northeast corner of Government Lot One (1), Section Twenty-five (25), Town- ship Twenty-eight (28) North, Range Twenty (20) West, go south a distance of 50.0 feet, thence west parallel with the north line of said Goverment Lot One (1) a distance of 400.0 feet, thence South 24030' West a distance of 325.0 feet, thence South 10045' East a distance of 890.0 feet, thence South 31015' East a distance of 657.0 feet to point of beginning for parcel to be conveyed; thence South 65025' West a distance of 493.0 feet, thence South 82051' West a distance of 187.2 feet to an iron pipe stake on the shore of Lake St. Croix, thence South 13049' "molest a distance of 135.3 feet on a meander line, thence South 4017' East a distance of 200.0 feet on a meander line (including all land between meander line and Lake St. Croix) to an iron pipe stake, thence southeasterly along the centerline of a rocky gully to the south line of said Government Lot One (1) a distance of 400 feet, more or less, thence east along the south line of said Government Lot One (1) to the northeast corner of Government Lot Two (2) of said Section Thirty-six (36), thence due north a distance of 876.0 feet, thence North 310150 West a distance at.129.0 feet to place of beginning; together with an easement for an access road to the above described parcel north and east to connect with the present town road as now opened and traveled. 3 ------------------ - Cogetbtt, with all and singular the hereditaments and appurtenances thereunto belonging or in anywise a_vpertaining, and all the estate, right, title, interest, claim or demand whatsoever, of the said part ies 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. Za ysbt anb to 1?010, the said premises as above described with the hereditaments and appurtenances, unto the said parties of the second part, as joint tenants. Anb the Seib, C. E. Webster and Marian H. Webster, his wife, part ies of the first part, for their heirs, executors and administrators, I' do 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 they are well seized of the premises above described, iij � warty W —....� ;. eb fb ct 0 S ' i n Q r• !�7 .,7 Ui rA IIQ In • .'� C: V I i(y iµ t eb �II .r. r3 I 11 :ry III y f W 1 I ' r•t•r::,n�u r'm eaaraeuw.0 **"a (t9A!M.ao;Cci ! a'R} 10 aarmtu ap n04aagl aalltaAiadt) i0 W#¢lad .irula!d asWq ttayy p4gs0aaa ark 0l M)aa[,I"4ft9) 113 i®e j oapµ0ad •r►ul$ 'W[1i JAI �:�..xau� •d aaua�MC-I Fq pe2jnjp SPA !�uaums4s= stt[j' <'�tl4r*a faelo\a ,Cq pouSle 11 ul pali6 eq Ob) 6561 gT A.T nuep sarrdra uorssraurroo AN 'ursuobsrM ',';irno,? xto.10 •4 'arlgnd Az&;oN ,��•zaq� ' •d a�ua,zMeZ ei° as lerawo pue pueq Xas;o;unaJaq ;3caraq.r►scar Jit r�� •paure;uo-) uraragz sasodind aqt 'mv�r12 pa;noaza A^aq ;eq; pa2palmou-lae pue Xuaurn.r;sur urq;TAi aqX o; paquasgns sauJeu jwoVA s ags'jpd':A ,Q, Q aq; aq o; (uanord dluo;aelsr;es ro) untaJJM T '.ta:;sg9M •H motaeTq pue jegsgeK •� ,� ieadde 611euos.rad 'raargo pau8rsrapun aqa ` A4x9tgz) •a e0ua.zMR1 'aru a,roIaq ',LS 61 ` Ate 30 6ep tm t aga srga u p Xwnoo XToxO •fig •ss 'ut5u0301M 30 349M uo spunw -W aolejo fleas)............------........ __._......_...._..._...__..._............. ._..._.....__ (leas)`" sates •a aaus,uKeZ •� �sgaM •Ht��id IT fl S)'"" ' _• Jro a3ua4rd4f ParOAltaa Pure pale4�ftlrSr 10 dep lq4 ST srq; s leas Pure s pueq .TT ago ;as oXunaraq Oa eq ;srr1 aq; jo GOT ;red pres aq; 130J324M OOMM q[ vi,- iza (INS' .LNVZfg AJ raea.rol IIrM AeTm ;oaaaq; tied Aare ro aloq a aq; 2ururrelo Sllnlmel suosrad ro uosiad 6raea pue lle ;sure8e 's;ueuaa ;carol se 'Ped puoaas ag; 10 sapred pres aq; 10 uorssassod algeaaead pue ;arnb aq; ur 'sasrruard paure8.req aeoge aq; ;eq; pue •Jana;eq.n saauerqurnaut lle woJ1 Jealo pure aaJ1 ale arises ag; ;eq; pue 'aldurrs oat ur 'mel aq; ur aaue;uaqur ;o areXsa algrsealapur pue amfosge Xaapad 'afns 'poo.Y a to SR STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER _RIC'4l,�U `k v' y S ROUTE/BOX NUMBER �� y /c��a; f" a�a �c� �3 ref FIRE NO. CITY/STATE >�lyer I ul�s ��e� ZIP a PROPERTY LOCATION: 1/4 =34; Section 3Co , T �W N, R an W, Town of -rkv�/ , St. Croix County, rt 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. 'e/ y),� SIGNED Z� /rl �jZ/tFir �G.v Cud 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 t, c TON HEAD CAPACITY CURVE ' • N tL _ YJ H WItI I W 0 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE 30 — EFFLUENT AND DEWATERING 95 SERIES $3.55-57-59 97 1 137.139 163 165 28 M - LTRS LTRS ' tl LTRS -1L.LTRS LTRS v �O 5 t 52 r '� 163 i 248- a 391 .1 231 231 EFFLUENT AND DEWATERING 305 1 1 129 216 a 300 231 231 5 457 ? 72 43 163 A4 242 00 227 227 26- ,5 ` 610 7 104 io 136 +1223 227 \` SEWAGE AND DEWATERING 62 - -- a 30 216 223 \ 9 14 \ 1219 46 172 206 \ 0 1524 >J 125 191 75 ` 18 29 — -- — •5 -57 t61 22--- �♦ 2134 -- --- -•71114 70 80 2438 - -- -- 111 53 MODEL-,% MODEL Lock Valve +9 245 __ 26 - 66 - 87- 20 GS 163 \ 165 TOTAL DYNAMIC HEAD CAPACITY PER MINUTE SEWAGE AND DEWATERING 18 f+n ♦ \ SERIES 267 268 282 264 293 v � cT M ;.4L1 LTRS ..tt! LTRS �;4L; LTRS :I•.Li LTRS ••.l{LTRS M R ' 1 i 152 31 408 •21 386 +;O 492 1,1q 681 55 ` '0 305 1 227 2 j 273 980 8 598 + 16 \ ; 4 57 76 :s� 163 ;3. 238 S 511 SV \ 6 10 - - _8 30- J. 1z9_ t. 401 \ , 762 - - - -� 288 14-45 , ) —9_11 --`- - — — a 163 292 I \ _ 1017 F J 227 \ ; 40 12 19 _ ab 174 /1 y \ a5 1-- 4-- _ - .'9 106 12 Y --- ___ - _ - \\ 1 50 1524 12 45 MODEL L, Valve 1 e 21 26 35'— 53 I3' 293 10 i-- 1 30 8 MODELS 25 137 139 6 20 MODEL 4 15 284 `-f268 DEL MODEL 10 ' — -- 282 2 __ MODELS �►\ - 53, 55, — MODEL MODEL 0--. ... 57. 59 97 1 267 U.S GALS. 10 20 30 401 50 60 1 70 80 90 100 110 120 1130 140 150 160 170 10 1O do-1, — . .. � ...,_dih., I -_ l LITERS 80 160 240 320 400 480 560 640 650 FLOW PER MINUTE 3280 Old Mlile7s Lane Manufacturers of. . . Z ZA9TZZEfr' O, Box 1 Kentucky Louisville. Konfucky 40216 „ (502) 778-2731 QUA!/rY PUMPS Sl*rf /49a�9 8 �J I ._-r' '-- :, ; - /i 1 /' � . I • ,i i ., i � } -� �, i � • � _ � 1, .y�. c�. +- C I � � F� '.; �\ I '� ., i � �� i � �,� -a , ,�,I \1 �.'. w � ' ' � ` .,' � S �� 0 T '.2 � 1 � � Q � r ..,,.,,,.,..,,�,,,,.......,,.,....��.e....�.e..� ._..._ .... ._.. .. PAGE OF PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS VENT CAP 4"C.I. VENT PIPC WEATHER PROOF APPROVED LOCKING 25' > FROM DOOR, JUNCTION BOX MANHOLE COVER WINDOW OR FRESH 12"MIU. AIR INTAKE GRADE `I°MIAJ. ILr CONDUIT–/ ID"MIA1. -------- fAll_.E 1 PROVIDE I ----- AIRTIGHT SEAL I I APPROVED JOINT A I I I APPROVED JOINTS W/C.I. PIPE. I III W/C.=. PIPE EXTENDMIC" 3' I II ALARM EXTENDING 3' ONTO S01.10 SC;;. B I I ONTO SOLID SOIL Ii# I I I c ON . I I I i PUMP-1 - J OFF D ~ CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SPECIFICATIONS SEPTIC AND �+ DOSE TANKS MANUFACTURER:Alle" 5 NUMBER OF DOSES: Z PER DA-4 TANK ;IZE : �� GALLONS DOSE VOLUME "f�2 s ALARM MANUFACTURER: �r/G� ll`YN1 hNlClue!�!C ;,;,CY,FLOW: J73 so% GALLONS MODEL NUMBER: -oUG YS'QTY/ CAPACITIES: A= INCHES OR Z96 GALLONS SWITCH TSPE: B= 2 INCHES OR 2/- GALLOUS PUMP MANUFACTURER: C: /9•INCHES OR —?.— GALLONS MODEL NUMBER: INCHES OR GALLONS SWITCH TYPE: NOTE_: PUMP AND ALARM ARE TO BE PUMP DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BJ'JNWLEU PUMP OFF AND DISTRIBUTION PIPE.. J-2 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . , . , 2-`.r FEET + _ac -_ FEET OF FORCE MAIN X .Li F�ooIrT.FRICTION FACTOR.. FEET d iy�e TOTAL 64MAMIC HEAD = 3s,G FEET INTERAIA-L RIMEWSIONC OF TANK: LENGTH — ;WIDTH ;LIQUID DEPTH _ LICEMSE NUMBER' 31 R 9 DATE: Z/ 9 -117- INDUS I Y, OF" REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUST,�Y, DIVISION L-ABO`I AID w PERCOLATION TESTS (115) MADISON WI 3707 HUMAN RELATIONS (1-163.090)&Chapter 145.045) LOCATION �SION:ECT TOWNSHIP/QTY: LOT NO.:BLK.NO.: SUBDIVISION NAME: '/4 wa /T N/ E O �� ICOUNTY: NER'S M ILING ADDRESS: USE ® l�lo—�? O T (o 't DATE OBSERVATIONS MADE yy NO.BED MS.: COMMERCIAL DESCRIPTION: IT—RO F I LED S RIPTIONS: PER LATION TESTS: URResidence IaVew Replace b RATING:S=Site suitable for system U=Site unsuitable for system r ONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-Fl LLHOLDING TANK:RECOMMENDED SYSTEM:► tional) D S ❑U I DS ❑U CAS ❑U I CAS DU 12 S ❑U p s If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: / T Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) S I�it s' B- 3 I -' c B- f4 /8.2. 3 � B / Ar 4y B- `� / S' .z yd 4 X.4 'B c d sn r.- B- B- PERCOLATION TESTS TEST DEPTH. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERI0132 PERT D PERINCH P_ P- P Z 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 afkalk.porings and the direction and percent of land slope. SYSTEM ELEVATION F _ g _ _ ._ .__. �� ------ 'i 4 gg 4 ...._ _. ..- BB a. z _ A i t 1 F I j 3 E w � I t k f _ � I I,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): TESTS WERE COMPLETED ON: Licensed Perk Tester & Plumber f ADDRESS: FO 9 He t! RoadCERTI ICA ION NUMBER: PHONE NUMBER(optional): �l! CST 8iu4m.ARE: 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 - 5595 To be a complete and accurate soil test,your report must include: r 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 1 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 Aran; 7, MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferreiE 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 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. Sian the form and place your current address and your 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 Sail Separates and Textures Other Symbols St -- Stone (over 10") BR - Bedrock Coto -- Cobble (3- 10") SS - Sandstone r - Gravel (under 3") LS - Limestone *s - Sand HGW - High Groundwater es Coarse Sand Pere - Percolation Rate med s - Medium Sand W - Well fs Fine Sand Bldg - Building Is - Loarny Sand > -- Greater Than sl - Sandy Loam < - Less Than .1 - Loarn Ian _- Brown *sil - Silt Loana BI -- Black si - Silt Gy - Gray "cl Clay Loam Y - Yellow set - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot Mottlw' sc - Sandy Clay N;` - with sic - Silty Clay fff few, line,faint .c - Clay cc -- common, coarse pt - Peat min - Many, niediurn m -- Muck d -- distinct p - prot-mr,writ HWL -- High wat€i level, Six general soil textures surface water for liquid waste disposal BM - Bench Mark VRP -- Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county orthe Department may request verification of this soil test in the field pilot to laerrnit issuance, A complete set of plans for the private system and a per nit application riiust t(I sr,rrsr,aia:ted t f;oriJer to c,,atain a mrinir. Tlie samtr:iy permit mrast t)e obtained and Posti4jilt icor tp,the start o,4qay c;a,r3stt,rrctron. yt .4:.