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HomeMy WebLinkAbout020-1118-70-000 0 Op ~ C o M O U O N O t� N � O y C Z � to N QQ U) Q X N N U � � m Y 0 c N N N ` Qy N 0 2 O N C Z N C O 7 O _ O LL cm O a > E Q O Q v ° Z rn W !, c v Z m m w a m � z a 0 z d c c � v N O O m 7 N V tp N *� O O N Z z 0] Z N N co 7i E Y N O U 00 N — (D '.. ui a .. m a G o a a C o LO to to to 2 $ H F- H F: d 2 O O O •ny a a a a _ o 0 00 00 00 00 * N O } 0 Q O �1 O 0 E O O Y m LL 0 N O o ° (—' Q O �l m LO ° U) r)�V —Z O O Cl) N 0 E O O C c C) 0 0 yyy 00 N C C a d o V O a0 a� a� 0 0 � � z z � co ~ O N '00 O O U • V L O Co U) r :3 a L: a r ti c� CL °' s3 °' m ° .. E c c A v a O rn U � e Form - STC - 104 L AS BUILT SANITARY SYSTEM REPORT Sub d• ' OWNER D e I`1 HENSO[j TOWNSHIP ui )r,) SEC. T ajN-R�W cy?JRESS �ST. CROIX COUNTY, WISCONSIN SUBDIVISION FQ Ut 3 �'n�ij LOT IV 1R- LOT SIZE , Wt)o n PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM -rn,k UR�k ROAo &NGk _- mARk QS, q5' yV Ben I6' \ � p \ 315cplzoom- i K�rr4� INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: ��Q. Proposed slope at site: �a SEPTIC TANK: Manufacturer: —(JLF_K5 Liquid Capacity: Q00 ' b Number of rings used: I I Tank manhole cover elevation: Tank Inlet Elevation: 5, Tank Outlet Elevation: 15.47 Number of feet from nearest Road: Front,Side, Rear, O feet From nearest property line Front,0 Side,0 Rear,0 ) feet Number of feet from: well v I Pj , building: 3 ' (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE i PUMP CHAMBER a 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).Sit 3.v He-AMR. 9(P,0 �O 103.0(o-00 FNc 9s,?V - 7!5*. a SOIL ABSORPTION SYSTEM • 4 MGm Oerj Bed: v/ Trench: Width: Lend h: S Number of Lines: Area Built: y I Fill depth to top of pipe: _t Number of feet from nearest property line: Front, O Side, O Rear,©Irt .$ Number of feet from well: Nok it') 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 o been used on any of the above soil ,r 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, Side, o Rear, 0 Ft. 0 Number of feet from well: _ Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• i o Dated: c g;- Plumber on job: C�' ri License Number: 'TPKQ3�0- 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINGS LABOR,&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOXY 69 BUREAU OF PLUMBING MADISON, 53707 NE ,SEi, 19,T29N-R19W UCONVENTIONAL E]ALTERNATIVE State Plan I.D.Number: III assigned) Town ojj dbon ❑Holding Tank ❑ In-Ground Pressure ❑Mound out Rook Road NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Dean Mawson 311 GaUahad Road, Hudson, W1 54016 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN 12-9-Y01 RIET.PT.ELEV.: CST REF,PT.ELEV.- Name of Plumber: MP/MPRSW No. Cnunry. Sanitary Permit Number a�cd Hv haws 1059 St. C&Oix 112791 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER P O DED: PROVIDED. �D �! S YES ONO OYES ONO BEDDING: VENT DIA.: VENT MATI HIGH WATER NUMBER OF ROAD/(''�� n PROPERTY WELL. BUILDING: T O FRESH ALAHM FEET FREIM LINE 2 „ ` IVENT AIR INLET. OYES NO DYE! l NEAREST lI S pl^/' DOSING CHAMBER: MANUFACTURER BEDDING'. L IOU ID CAPACITY PUMP MI I III JPUMP SIPHON MANUE ACTIIRER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED ❑YES ❑NO ❑YES ❑NO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF�JDIANII PROPERTY WELL BUILDING JVENTTOFFIESH (DIFFERENCE BETWEEN FEETFROM' LINE AIR INLET. PUMP ON AND OFF) EYES El NO INEAREST—� SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing It I NGTTf TI li 1111ATIHIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH INOOF UISTH PIPE SPACING COVER JINSIDE OIA -PITS LIQUID 8ED/TRENCH THE +ES r MAr IAL PIT DEPTH. DIMENSIONS / 2 S�- RAVEL D TH -FILL DEPTH U PIPF UISTH PIPF. DISTR.PIPE MATERIAL NO DI VI NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH BELOW PIPES AB V VER INLE I ELEV. N ^ PIPES - UN AI NL Tr 2 L FEET FROM NEAREST- a-s MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES ❑ meets the criteria for medium sand. TIONS MEASURED. NO SOIL COVER TEXTURE PERMANENT MARKERS OBSEHVATTONWFLLS _ EYES ❑NO ❑YES 1:1 NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH REU DEPTH OE TOPSOIL SOOUEO SEEDED MULCHED CENTER EDGES =E S. 1:1 NO ❑YES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: eED/TRr:NCH WIDTH LENGTH TRENCHES DIMENSIONS, LATERAL SPACING IGHAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS' MANIFOLD PUMP MANIFOLD DISTR.PIPE IMAN11OLDMATERIAL NO DISTH DISTR PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEVATIELEVATION AND "ELEV.. ELEV. CIA. ELEV. PIPES DIA ' DISTRIBUTION, INFORMATION' HOLE SIZE HOLE SPACING DRILLED COHHE(1 LY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS 1:1 YES 0 N El YES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBI:.R OF PROPERTY WELL: BUILDING. F ER'"FRf)II LINE OYES ❑NO ❑YES ❑NO NEARIEST a - Sketch System on Retain in count iIlk audit. Reverse Side. SIG RE: TITLE. �-- Zoning Adminis�c.I DILHR SBD 6710 (R.01/82) SANITARY PERMIT APPLICATION COUNTY , TDILHR In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# —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 INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES L1V NO PROPERTY OWNER PROPERTY LOCATION fJ IAN S C %S f, '/a, S 4f Ta I , N, R- E(or)W PROPERTY OWNER'S MAILING ADDR SS LOT ER B SUB�IVIISIONNA E OIS CIT ,S ATE ZIP`CODE PHON UMBER CITY �\ N RES ROA ,LAK KR L NDMARK 1A4.101J �I S7 U �Q VILLAGE : II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. 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.- nonventional 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) 1. a. 'C Seepage Bed 6. ❑Seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (M�tes er inch): REQUIRED(Square Feet): PROPOSED Square Feet): , (.0 Feet D�Private ❑Joint ❑ Public VI. TANK CAPACITY Site in oallons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete strr cted Steel glass Plastic App Tanks Tanks El Septic Tank or Holding Tank d U e ❑ Lift Pump Tank/Siphon Chamber ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plu is Si nature:( Stamps) MP/MPRSW No.: Business Phone Number: uo I N 6 15 34 v PI a 's res trreet, ity ate,tyNA4 p Code) C� Nam Des' ner: U I J 90p6mo VIII. SOIL TEST INFORMATION Certified Soi Tester CST)N e CST#603 CST's ADDRESS(StXeet,Cit State,Zip Cod ) n Phone Numbe�I �— b S 1,,1 s�c. V`1 1)5 (8J IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater r�ate Issung Agent Signature(No Stagtps) �-Approved ❑ Owner Given Initial �D S charge Fee /Adverse Determination �" �°vd �Sg P ")n In. `&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 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:p1wmit issuing authority. A new permit may needed, if there is a change in your building plans, system location, estimated wastewater flow (number'of bed-r' :rooms, etc.), depth of system, or type of system; 4. Changes iri ownerghip or plumber requires a Sanitary Permit Transfer/Renewal Form JSBD 6399) to­be submitted to the.county prior to installation; 5.' 'Private sewage systems must be properly maintained.The septic tank(s)Gould be pumped by"a.lic'ense'd 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; 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% 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 included the creation of surcharges (fees) for a number of regulated practices which Wisco ttf'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure a is used in your building is returned to the groundwater through your soil absorption e system or the disposal site used by your holding tank pumper. 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 ,D/__XAJ z �iJSO All Location of property 4W71/%5,1/9, Section / - , T_a_?_N-R P? W Township ' Mailing ddress 3�� �/Z/� � �� • /� �iu� s'1 r��vs'd.✓ c� ,' nn Address of site /r, vac Subdivision name T/�Ov �� Odk 0 d -S Lot number / Previous owner of property , _ 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 and Page Number J� 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 1(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 xecorded in,tbe,dfice of the County Register of Deeds as Document No. � � 6 4 — yY/X6*-*hat 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 runty Rpister Deeds, as Document No. ) . Signature of Owner Signature of Co-Owner (If Applicable) Date of Signature Date of Signature MFK 9ffl BROOK �'I_ . �JJC1C7L7 Vol 4- Awe IS'S lit _ • � �t `� •ors .m .. •[j "''r.i� �•. S� j �� orrtoor w alai �:'='!, • K' s�[ �•' 11 •Mw � r � . II i'••w s - - p � � _ oaf�' �Y. ..�i' •� ..C'j• 1 �J '�, - v :a !Vii.• �5 � � s r �1• A ,rG•t. i' �.'. �• 'Y'��� r -'Y.•+t•=11 j Z -z j i `•'� t t•� �!, yy : BRA •L 8+ 'r.. :�: ��1; � im go • � 6 71.0"� o,�{s� 1 �u���i'Y•�'�4' c .F}rK...•Y�'• w i w�- 1:• r= I �•PIY• •� ti pq W0,90 9 I IE " ,w • �� •• 'i 1 1 t 1 E ssl �,� �r ttt ,. wwr •�•••1• T r � �} UMILATT[0 u1409• •1 ; tr�� �L� ............ v �I• 1�$�� � + ,+ i! iI DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-198211 THIS SPACE RESERVED FOR RECORDING DATA r WARRANTY DEED 11 44150G i' i1_ BOOK _r' ,i _ _ REGISTERS OFFICE This Deed, made between _Robert F Wall , Trustee- ST. CRClX CO.,'WtS; ---for---Daniel---Richard s-, --Robert_.Richards--and------------ ---Martha---R�ichards-,-------------------------------•------ --------------------------------- 11 R4c'd. for Record this 19th ------------------ - ---- ----------------- ---------------------------------------- d , Grantor, i1 SeAt: A.D. 1988 and --Dean K.---Hanson----- - ------------- --"----------- ------------------- -... ------ I� t Y 1:20 ---------------------------- ---- - ----- ----- ---------- a, -------- -- ---- ---------------------- -------------- --------------- ----------------- Grantee, of ,! Witnesseth, That the said Grantor, for a valuable consideration_0le ! ($1_OD}--Dollar__and.o--they_valuable_sxonsiderat ioxx--------------------- __:- --- - ---- --- conveys to Grantee the following described real estate in St.__-Croix--------------- RETURN TO i County, State of Wisconsin: i i An undivided one-half interest in: �< Lot 1, Trout Brook 647oods Addition, Town of - - - - Hudson St. Croix Count Wisconsin. G --- i � County, Tag Parcel No: -------°-------------=-°---------- II �i i r 'A ISa , FEE l ,j ,I This _____1S not __........ homestead property. (is) (is not) �i Together with all and singular the hereditaments and appurtenances thereunto belonging; And ----- --- -- -------------------------- �I warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except II unrecorded protective covenants , easements , and utilities, if any. II II fl and will warrant and defend the same. 1 19th p-- 19 Dated this _______________________•__ _____-________-""_-.. day of --- Se September 8 8 II ------(SEAL) ----- -- i - . . (SEAL) ----------------------------------------------- --- - --- ------ - ------ - - - - -- - �' Robert F. Wal , Trustee for Daniel, Richard ......•Robert---RlChaxds-,--- and -------------------------------------------------------------------(SEAL) ----Martha_Richards----------------------- ----(SEAL) * ----------------------------------------------- ------------------------------------------------------------------ I I AUTHENTICATION ACKNOWLEDGMENT I; Signature(s) ------------------------------------------ ----------- STATE OF WISCONSIN ----------------- SS. i ._ST, RIX --------- --------------------_ County. i! authenticated this --------day of___________________________ 19...... Personally came before me this ----- .9-th_.day of 1i _-September------------------- 19---- the above named i! --Robe-rt_-:F_.___Wall _.Trust_ee...fox_.D4niel j! R4= ._Ric hard s-,---Robex_t__-Ric ands- aDa------ ,I ! (If not, ---------- ^_Martha--RLChards�JJu,I;J;;" 'I TITLE: MEMBER STATE BAR OF WISCONSIN ,a t/j authorized by § 706.06, Wis. Stats.) r to me known to be the'�p�xsbn ,�_._t`!,:' v o executed the fore om ins'truipenf�and acknow same. L THIS INSTRUMENT WAS DRAFTED BY - 1 CHARLES B ---HARRIS-------------------- - -------- * Charles R. Flarri l --------- ICHARDS_, p7ALL & HARRIS --------------Skate-"of------;'.--� -- -------- Notary Public ------------------------ Xy, Wis. - t - jl (Signatures may be authenticated or. acknowledged. Both My Commission ,ors bermancnt, (If not; ate expiration II are not necessary.) date ,. �. *Names of persons signing in any capacity should be typed or printed below their signatures. ! WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 1—1982 Milwaukee. Wis. i '�• DOCUMENT NO. j STATE BAR OF WISCONSIN FORM 1-1982 ;1 THIS SPACE RESERVED FOR RECORDING DATA j WARRANTY DEED !I 441.505 - @OOit 823 WOE 'J REGISTERS OFFICE ST. CROIX CO-, WAS• This Deed, made between -----Frs1}~1.k--- ............... !; Recd. for Record this_1 . --------------------------------------------------------------- ---------------------- ----------------- ------- t:., A.D. 19$8 ------------------------------------------------------------------------------------------------------ - - oy of Sep_ ------------------------------------------------------------------------------------------------- Grantor, !i O 1:20 p,.., 8 and----Dean-_K__-11an-son---------------------------------------------------------------------- !� MW ot ----------------•-------------------------------------------------------------------------- ----- Grantee, 11 Witnesseth, That the said Grantor, for a valuable consideratioiQAP her_-valuable---consideration j RETURN TO conveys to Grantee the following described real estate in ___fit-__Cro ix--------- .I County, State of Wisconsin: An undivided one-half interest in: Tax Parcel No: -- ---------------------------- Lot 1, Trout Brook Woods Addition, Town of ! Hudson, St. Croix County, Wisconsin. j TRANSFE 2 � /-VU EEE II j ! j! ! This ---iS---r1Qt........... homestead property. (is) (is not), Together with all and singular the hereditaments and appurtenances thereunto belonging; And_ -•-----•-•----------•-----•----•----•--------•••---"_"-"•---•_-- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except I unrecorded protective covenants, easements, and utilities, if any. i and will warrant and defend the same. i Dated this ------1 nth--------------------------------- day of -- Septem$er---------------------------------•-------- 108_.... e I, - ------------------- ------------ ---------------------------------(SEAL) t,� -------- --- --•- - (SEAL) ------------------_ ----------- --------------------------------- Frank A. Rorvick ------------------------------------------------------------------ j •-------------------------••----------------- --------- ------(SEAL) --------------------------------------------------------------------(SEAL) �j AUTHENTICATION ACKNOWLEDGMENT Signature(s) ____________________________________________________________ STATE OF WISCONSIN ss. - ST. CROIX County. authenticated this ________day of___________________________ 19...... Personally came before me this ------19tb day of September-------------------- 19A 8__ the above named ------------------------------------------------------------------------------- Frank A. Rorvick --------------------------- - -------------------------------------------------- --------------------------- -------------------------------------------------------------------------------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not- ------------------------------------------ ---------------- �- - -"----"°---" r'•------ � authorized by § 706.06, Wis. Stats.) ` . to me known tc=b #11e person _ who executed the foreg 'ri .instz�l �t,and,aekn 14 -q thy`"same. ., THIS INSTRUMENT WAS DRAFTED BY _________CHARLES___B_..__HABRZS__________ RICHARDS, FALL & HARRIS _ esn LHarris ---------------------- - ---- ------------ Notary Public -`-S " . _ ---------06my, Wis. (Signatures may be authenticated or acknowledged. Both My Commission'•••1s permanen •.(if-mtr state_expiration are not necessary.) date: 19--------- i i *Names of persons signing in any capacity should be typed or printed below their signatures. !i STATE BAR OF WISCONSIN - WARRANTY DEED Wisconsin Legal Blank Co. Inc- FORM No. 1—1982 Milwaukee, Wis. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER D A • /-// iJG'`, ROUTE/BOX NUMBER '�f��f/l1 /.� �'� FIRE NO. CITY/STATE //y ,� / i~ Ya f ZIP PROPERTY LOCATION: p,/ s� 1/4, Section , T_, -!�N, R__Zy W, Town of y�s°� , St. Croix County, Subdivision 7/ae17 92aaf� 40-4 e/ , Lot No. I/ Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED 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 ANO PERCOLATION TESTS (115 MADISON w 5370 HUMAN RELATIONS (H63.09(1)&Chapter 145.045) LS�UBDIWSIO NAM Lo • h O �/ T011/ 11(or MAILINU ADDRESS:USE DATES OBSERVATIONS MADE I TS: NO.BEDR O DESCRIPTION: e L Lesidence ❑Rplace � RATING:S-Site suitable for system U-Site unsuitable for system O VE_ Q�. MQ�.a� IN [:]S �� . •' LEIS ��L OLDING-TANK:RECOMME�yE% YHTEM:Io Tonal�� ✓ s� - S IN U ( MM If Percolation Tests are NOT required DESIGN RATE—If any portion of the tested area is in the under s.H63.09(5)(b),indicate: 3 [Floodplain,indicate Floodplain elevation: Al PROFILE DESCRIPTIONS BORING TOTAL P H T R N WATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER D LEVATION OBSERVED TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) / 5'f' 01�- � qi f�/ ,t B/, f/,Sp'B>tis;y,�i'd�►s�l,-- .. a- B- 7.9� >7,9L y�,B/JI 2, 91 , B- ,d O /, S8' s �f B- -I 7 7 ,1 ' Z17 ' s, Z /H S i/>9 � � � /.92't!U/ , zs'��r s/./. St'Zf�rfj� 2,t�'Q,r•s' . 33 B- PERCOLATION TESTS T DEPTH ATER IN HOLE TEST TIME O I WATER LEVEL-INCHES MINUTES NUMBER AFTERS ELLING INTERVAL-MIN. PER INCH P- ,/J' Z P_ I .Sf► 2 3 G < P- 3 0 6 P-. .P, PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their. location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM E ATION a / -1 tN N 9 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 i 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 WE E�O�LETEO ON- NAME 417 Z Q©o ADDRESS:' CERT 7_0 J ON U PHONE NUMBER(optional): b /� —J r / � c CST SI N R ' DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R.02/82) —OVER— R B. _._...__... NAME INS- =� LOCA�!T 10 N t �. _ aobs. I_ ICE_ N S E » I )A E DO ` = 13M _-t ECI Pipe, S LJ Cow'ZR lot %Kt w-lo ° S lies x- �rzc.�ol� Secs nil Men s u Rt r tats '1�ieou� QRooK ROAD Art t(3 U a oT W a �• A S0(f ;`Mote . be(hs i►ttief, f6m �°• 5oft'• pRKPAeld S� •iG IKiNh' e: Ad• peen . I&S PRA::: VACW�A .,. ,,.. FRESEi A11, INLETS AND OIISERVA'J'IQ1� PLeE CP,QSS SECTION r f Approved Vent Can Minimum 12" Above Eina ,ra�lerr_ �«tt ft,A)< 41' Cast Iron Above Pipe Vent Pipe To final Gracie Marsh Hay Or Synthetic MCove r i.ng Min. 2" Aggrey -11 ! Over Pipe Tee Distribution Pipe _............�, Aggregate t� Perforated Pipe Below -' �• 13 Heath Pi e < Courl.ing Terminating At Bottom of System _-- -- ��