HomeMy WebLinkAbout022-1058-20-000 7 j 2
7 c
0
f �
2 )±
Em
Q)
A �k
. / § §
. 3k2
4)
k \ �0
c °° o
LL 7 )D
<
E J 0
kc)
\ j B .
0
q § 0 :
q � �
0 z
k 7 / E \
] o
�
-� & f )_ q
\
) k
� ..
k
1 " ° c .
: )
LA . a
ƒ NE % £ a
\ : \ & k 2 .0 §
k >: D }
® z «
a a 2 z �
IL
LL
:
2 ] v 2 2 .
2 - )
\
§ /_ e D
$
_ / E /
� V � ; / } ®
§ o ( � k 2 2
§ o / 9 � = E
§ § § \ / f ) \ §co
2 a / I / 0 2 ! I °
,
40* a \ / c § s \ ] f k ®
§ \ ƒ / / z z $ z / 2 \
2 .. .
£ " )
7 cl
2 k C CL
« E � ' »
� ) ƒ 2 c 2 §
� � & v a � : o � v �
"Parcel #: 022-1058-20-000 04/04/2006 09:29 AM
PAGE 1 OF 1
Alt. Parcel#: 20.28.18.319C 022-TOWN OF KINNICKINNIC
Current _XJ 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
ROBERT L&THERESA A ELLERTSON O-ELLERTSON, ROBERT L&THERESA A
1073 RIVER DR
RIVER FALLS WI 54022
Districts: SC=School SP=Special Property Address(es): *=Primary
Type Dist# Description * 1073 RIVER DR
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 4.130 Plat: N/A-NOT AVAILABLE
SEC 20 T28N R1 8W 4.13A IN S 1/2 SE1A Block/Condo Bldg:
LOT 1 CSM VOL 3 PAGE 714
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
20-28N-18W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 1076/434 WD
2005 SUMMARY Bill#: Fair Market Value: Assessed with:
143577 223,900
Valuations: Last Changed: 08/10/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.130 65,000 161,400 226,400 NO
Totals for 2005:
General Property 4.130 65,000 161,400 226,400
Woodland 0.000 0 0
Totals for 2004:
General Property 4.130 32,000 124,300 156,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 306
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
352634
Part of the Southeast One Quarter (SEJ) of the Southeast One Quarter (SEJ) of Section
Twenty (20) and part of the Southwast One Quarter (SWt) of the Southeast One Quarter S
of Section Twenty (20) , all in Township Twenty-eight 28) North, Range Eighteen (18)
West, Town of Kinnickinnic, St. Croix County, Wisconsin described in Volume 3_ of
Certified Survey Maps on Page 71_); as Certified Survey No. 711
Sr CRO/X COUNTY CERT IF IED SURVEY NO. 714 ^ , .�
by
rSU Qd � 7.. E•1/4
CORNER
COUNTY tD '�'•l �i T28N20
S RECORD q, o RIB W
.
>� S
APPROVED APPROVAL OF THIS MINOR SUBDIVISION 0h6� rn
DOES NOT MEAN APPROVAL FOR
_3UILDING SITE OR SEPTIC SYSTEM. W =
0 C T.215 1978 Ri«FER TO He2.20. o�6`� W
J
Z'OY egf.HENSI:Vc FAixS F.LANNING 5
r1ND ZCJNING G01Mbh4rMyFZ ~
Q
W
TOWN ROAD
� M
S 890 55' E 300.00 M P.O.B.
M
$O 300.00 , ——
UNPLATTED
t ..
t LANDS
g 8
UNPLATTED GOT 1
4./3 AC.
LANDS W 8 g
8
HOUSE
o PLAT BRGS REF. TO THE
EAST LINE SE 1/4 SEC. 20
§ ASSUMED BRG. NORTH-SOUTH.
Z N
SCALE IN FEET
100, 0' 100
SHED O. 13/8" IRON PIPE
O R
0
300.00
N 890 55° W ~j
UNPLATTED
LANDS
. . ......
'x
Volume 3 Page 714 ....
TUrIDLE QQ
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER `
TOWNSHIP ,��,,��, SEC. _� T,r'2 N-R W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION �w LOT w /" LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of IIHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
35- IS7A
� I
71
I
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity: c�
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,o Side,o Rear, o feet
From nearest property line Front,0 Side 10 Rear,o feet
Number of feet from: well building:
(Include this information of the above plot plan) ( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
r
PUMP CHAMBER
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, Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM 10)S V'/!J
Bed:
Trench:
r $/O
Width: `j Length: Number. of Lines: Area Built:
Fill depth to top of pipe:
Number of feet from nearest property line: Front, ers, O Rear, Ft .
Number of feet from well:
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
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:
Dated: Plumber on job:
License Number:
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&H;JMYN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.0,BOX 7969 BUREAU OF PLUMBING
MADISON,WI 53707 �(
SW4-,SE�,S20,T28N-R18W MCONVENTIONAL E]ALTERNATIVE State Plan 10.Number:
11f assigned)
Town o6 Kdnnick nnic ❑Holding Tank ❑ In-Ground Pressure ❑Mound
NAME OF PERMIT HOLDER! ADDRESS OF PERMIT HOLDER: IN TION DATE.
Benedict Grant Route 2, Box 200, Rivet 1=aM, W1 54022 0_ ,g 2i
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF,PT.ELEV.-
Name of Plumber. MP/MPRSW No Counly. Sanitary Perron Number:
Henry Nech.vitte 3258 St. Ctoix 112806
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. ` LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
I ✓l JJ+ v 1-1 YES ❑NO I DYES ONO
BEDDING: I VENT DIA. ' VENT MATT HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING: JVENTTOFRESH
ALARM FEET FROM LINE AIR INLET.
❑YES ❑NO DYES LINO NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING: IL I QUID CAPACI TV PUMP MODEL JPUMP SIPHON MANUF ACTUFIEH WARNING LABEL LOCKING COVER
PROVIDED-. PROVIDED:
❑YES ENO EYES ❑NO DYES ONO
GALLONS PER CYCLE: 7ND CONTROLS OPERATIONAL NUMBER OF 11 OPIRTY WELL BUILDING I VENT TO FRESH
(DIFFERENCE BETWEEN FEET-FROM' LINE AIR INLET
PUMP ON AND OFF) ❑YES 1:1 NO NEAREST—jo
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing I f N(,TH JDIAMI TI H IIIIATI HIAL AND MARKING
or excavation. (If soil can be rolled into a wire,construction shall cease until FO MAIN N
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH LENGTH IN111 DISTR PIPE 11A(:I11, COVE, '.INSIDE OIA -PITS LIQUID
BED/TRENOH S I THEN4c;t+rs / M TI/ aL PIT DEPTH.
DIMENSIONS, L V 4�1Or�
GRAVEL 8EPTH FILL DEPTH I)l Sil.PIPE DISTH PIPE DISTR PIPE MATERIAL NO DISTH NLIMER�F PROPERTY WELL BUILDING. VENT TO FRESH
BELOW PIPES ABOVE COVER EI EV.INLfI ELEV END PIPE LINE AIR INLET:
Ir FEET FROM
C 3 2 2 ? Z� NEAREST--sk
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-
meets the criteria for medium sand. TIONS MEASURED.
EYES NO
SOIL COVER TEXTURE PFHNIANINT MARKERS 013SEHVATIONWELLS
_
1 1:1 YES ONO _❑YES ❑NO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH BF.0 DEPTH OF TOPSOIL SODDED ISE F DFD MULCHED
CENTER EDGES
El YES. 1:1 NO El YES 1:1 NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
REUITI�E,NcH TRENCHES
OIMENSIONS
„.MANIFOLD PUMP MANIFOLD DISTR.PIPE M INO-DISTH DISTR.PIPE DISTHIBUT ION PIPE MATERIAL&MARKING
ELEV.'. ELEV. DIA. ELEV. PIPES DIA.:
ELEVATION,AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING CHILLED COHRECI I V COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES NO 1:1 YES NO
PERMANENT MARKERS. OBSERVATION WELLS. K. LINE
PROPERTY WELL: BUILDING:
� COMMENTS: FEE BFEFtOM., _
,3 01 YES ONO 1:1 YES ❑NO NEAREST
5 0
g.o3 3.�y
Sketch System on Retain in county file for audit.
Reverse Side.
' SIGNATURE: TITLE.
DILHR SBD 6710 (R.01/82) Z AdmiyU,6tutot
C�f�.H Mill SANITARY PERMIT APPLICATION COUNTY ��
In accord with ILHR 83.05,Wis.Adm.Code
°..........Q. 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 NO
PROPERTY OWNER PROPlfRTY LOCATION {�
'/4 %, S ,90 T Q , N, R1F E(o
PROPERTY WNER'S MAILING ADDRESS LOT NUMi� BLOC��ER SUBDI I l�NAME
2. 2�
CITY,S ATE ZIP CODE PHONE NUMBER 7n CITY NEAREST ROAD,LAKE OR LANDMARK
'YO/�/� 7/S O LLAGE
Q-10414 0
II. TYPE OF BUILDING OR USE SERVED: - 114 • Da7oZ—/Q -20-0
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. El Holding c.❑ Pit Privy d. 1:1 Vault Privy e.❑ Mound f. El
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. ❑ seepage Bed b. I See a e Trench c. ❑Seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4, ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Mint �)* 6 REQUIRED(Square Feet): PROPOSED(Square F et):
�o f� " 0 ��� Feet Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in allons Total ##of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tap
structed
Septic Tank or Holding Tank Qa CC/-
Lift Pump Tank/Siphon Chamber
VII. RESPONSIBILITY STATEMENT
1,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Print): Plumber' Signature:(No Stamps) M /MPRSW No.• Business Phone Number:
#i1it'r A7-c)y IX/�'s � '2L4d I
Plumber' ddre (Street,City,State,Zip Cod Name of Designer:
VIII. SOIL TEST INFORMATION
Certified oil Te ter(CST)Name CST## DD
CST's ADDRESS(Stree, ity,St ip Coe _,C'ij/7 Phone Number:
!;I- .� 7
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved S Itary Permit Fee Caroundwater Date issuing Agent Signature(No Stamps)
Approved ❑ Owner Given Initial Wclaarge Fee
�l �QD,
1� /\�
�
Adverse Determination VU v (p v y r
X. COMMENTS/REASONS FOR DISAPP OVAL:
f� or ��
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 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 nedessary, usually every 2 to 3 years;
6. if you have questions concernirsrl 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 systern is to be
installed;
II. Type of building or use served: If public is checked, iidicate 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;
1!l. 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 ii 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; dis,;ribution 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 11.5 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 Nil GrounGwater
included the creation of surcharges (tees) for a number of regulated practices which Wiscorl�wn a
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried irea Wre*
is used in your building is returned to the groundwater through your soil absorption u
system or the disposal site used by your holding tank pumper.
a
The ;iron es collected through these surcharges are credited to the groundwater fund adminis-
tered. by :tie Department of Natural Resources. These furies are used for monitorir•g grou. d- f
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
SBD-6398(R.03B6)
APPLICATION FOR SANITARY PERMIT
STC - 100
his application form is to be completed in full and signed by the owner(s) of the
roperty 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 — zEeledi C� �az
Location of Property Is .S4'_ hr, Section 2 D , T N-R W
Township C
!tailing Address /f�f'j � �DX z 00
Address of Site
Subdivision ion !lame .
'. Lot Number
Previous Amer of property C7
Total Size of Parcel
Date Parcel was Created 9 7Z
Are all corners and lot lines identifiable? ` Yes No
Is this property being developed for resale (epee house) ? Yes No
Volume and Page Number 16f- 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 refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
I (We) cmti.6y that of a e.tatemeftU on thi-S ohm ahe #Aue to .the beet o6 my tom)
hnowtedge; that I (we) am (ane) the owneh(e 06 the phopeh,ty de6cAi.bed in .thiA
in6o4mati.on 6ohm, by viAtue o6 a waAAan.ty deed kecokded in the 06 ice o6 the
Cc utty RegiA teh o Veeds as Doeumen.t No. 3 :?S ; and that I (We) pneeentty
avn I phopoeed site 6oh the sewage dLspo� bye em (on I (we) have obtained an
ea.eemen.t, to hun with the above duc&i.bed phopehty, bon the eone.thuction o6 said
eye.tem, and the dame ha.e been duty hecohded in the 066.tce o6 the County Reg.i.e.ten o6
fleedd, d6 Docment No. ) .
SIGNATURE Op OWNER C� �} SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
ItfoCtf NO.
m. STATE BAR'OF ei
VOL rr�t19Z WHIM AOM
7 J THIS 9 CoOeillfsD ll.
+..i .:
SPACE RESERVED FOR MCC
- REGISTERS 9fFtC,1P"
THIS DEED mad bet een Gary L. Curti s and Sharon S. ST. CRG!y CO., WI&
Chrt ia. bas�aa�an wife _ _ ------_ _
• Rec d. fcr k,cord !`its_ 'S
De�� ,
day of A.D. 199.k
and J. Grant and $arbara Grant, _husband and at_ :30 A
wife. as Joint tenants.
Witnesseth That the said Grantor, for a valuable constderatton
arty Three 'Izhoasand and noj-H00_i43a000. 00)Dollars--- t RETURN TO
' Conveys to Grantee the following described real estate in St,--Croix I ,
Comity, State of Wisconsin:
Y.
That certain parcel of land described in Certified
Sarver Map, dated July 24, 1978, and filed on —
October 26, 1978, as St. Croix County Certified T:,. Rf,
Sar"V No. 714a in Volume 3 of Certified Survey Maps, on Page 714, as 'f
Z_, Document No. 352634, in the office of the Register of Deeds for St. Croix Counw, f' "
�j�4.
Wisconsin.
-t
T AN5Ff'
FEE
t * Y
This is homestead property.
4
�i
Together with all and singular the hereditament~ and appurtr•,, nct a thereunto belonging,
And
warrants that the title is good, indefeasible to fee simpie and easements,
reservations and restrictions of record;
and will warrant and defend the same. g
3rd November 78
Dated this __- _-- _-_--dad of 1 u
t?
(SEAL i 1" ` ��� (SEAL) ,
• Gary L. Curtis `. I
(SEAL) - ` �= (SEAL)
I . . Sharon S. Curtis
• -- -- - -
AUTHENTICATION ACKNOWLEDGMENT
Signatures authenticated this day of Sl ',l F: "I. N Is(o q%
19 x.
-- -- ---- Pierce t
( . . . . . '. m, 3rd day of
ki
November,197E Gary L.
a:
TITLE: MEMBER STATE: BAR OF %USCONSIN Curtis and Sharon S. Curtis, husband and
(If not,
authorized by >706.06, Nis. Stats ) wife,
This instrument was drafted by
Charles E. White Attorney at Law, ;A'F',r s .k'.,, executed the fore-,.
t;oinj� tt sttumen, ;wd eckn"c&!edgod the same. �t
River Falls, Wisconsin 54022.
i
(Signatures may be authenticated or acknowledged. Roth
ate not necessary.) �, t.r, Publtc' fit.�$r _County, Nis,,. t
-- -
11v Cummt lion` -
=23C 0Xpixes-
*Names of persons signing in any capacity must be typed of pnnt�d t-l— their.:Knatuie%t
WARRANTY DS&D STATS sot M uncoam, ro" NO i-iv77 Aft c+
s
r
r.
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER ����� C / C_f�( t)?AI// _
ROUTE/BOX NUMBER V Z �D)C 000 FIRE NO. c�22
CITY/STATE ZIP
PROPERTY LOCATION: Sk)1/4 . 5?F 1/4, Section 20 , T_N, R_zff_W,
Town of /T /AVIL '//" C , St. Croix County,
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.
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
R
y
3
QNIDUS T Y, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
IE�JbUSTRY, _ DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS MADISON,WI 53707
(ILHR 83.09(1) & Chapter 145) Page 1 of 2
LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO:. SU_BDIVISION NAME:
SW 1/4 SE 1/4 20 /T 28 N/R 18 K(or)W I Kinnickinnic -- -- --
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS:
St. Croix Benedict Grant R#2, Box 200 River Falls WI 54022
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESIPTION: PROFILE DESCR PT ONS: EAR OOH ON TESTS:
®Residence CR ❑New [Replace
I 3 -- I August 27, 1988 --
RATING:S=Site suitable for system U=Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional)
❑S 0 0 S 0 0 S 0 ❑S ❑U EIS ❑X U liconventional Trench
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s. ILHR 83.09(5)(b),indicate: Class II I I Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- 1 80" 95.18' None 63" Described on page 2
B_ 2 83" 97.89' None >83" same as above
B- 3 1 65" 95.90' None >65" same as above
B- 4 74" 98.33' None 56" same as above
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD2 PERIOD3 PERIOD PER INCH
P
P-
P- Exempted as er ILHR 83.0(5)(b)
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 94.0'
Detailed plot plan on page 2
TN
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:
Michael Hel eson August 17, 1988
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
2932 North Plum Tree Circle, Menomonie, WI 54751 1980 (715) 235-7250
CST SIGNATURE: b"e"PIL2
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) -- OVER —
Page 2 of 2
.0 IrrI.AA Pr,.YI —
RIGHT Oi L.Jr '
T 00 - 08" 10 YR 3/2 sl
1 08 - 17" 10 YR 3/1 is
17 - 27" 10 YR 3/4 is
27 - 41" 10 YR 3/6 med s
41 - 46" 10 YR 5/8 med s (dense with sm. %" - i" gravel)
46 - 63" 10 YR 6/6 med s
63 - 80" 2.5 Y 6/6 med s w/cmd 7.5 YR 5/6 mottles
T2 00 - 08" 10 YR 3/3 sl
08 - 32" 10 YR 3/2 is
32 - 45" 10 YR 4/6 med fs
45 - 83" 10 YR 5/6 med fs
T3 00 - 07" 10 YR 3/1 sl
07 - 23" 10 YR 3/2 sl
23 - 29" 10 YR 3/4 fs
29 - 42" 10 YR 3/4 fs w/1/2" - 3/4" sm. gravel)
42 - 65" 10 YR 5/6 med s parting to cs
N
T4 No description provided -- mmp 7.5 YR 5/6 SCr�lc; I" No
mottles at 56"
Bench mark equals 100.0' Concrete slab of back door
Outlet of existing septic tank 95.88'
Grade T1 95.18'
Grade T2 97.89'
Grade T3 95.90'
Grade T4 98.33'
WEII
3 hertIRO C'Y'
Nvu •t
A. _._t3eac,i molik
EAST Lc-,T UI if
GtY,,c T11NK
X RRCA of Eves,„a
RREw useo r�s Pla•,,,.z�
i
1 � Ret •a.�e..e SY S.e rv,
I
73
- - - - -- - -- - - - -
r 0
1,1
DEPARTMENT OFtEPORT ON SOIL BORINGS AND SAFETY& BUILDING
INDUSTRY, REPORT DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145) Page 1 of 2
LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME:
SW 1/4 SE 14 20 /T 28 N/R 18 0(or)W I Kinnickinnic -- -- --
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
St. Croix Benedict I Grant R#2, Box 200 River Falls WI 54022;
USE DATES OBSERVATIONS MADE
[X]Residence ❑New ]Replace NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS:1PERCOLATION TESTS:
3 -- I August 27, 1988 --
RATING:S=Site suitable for system U=Site unsuitable for system
CONVEcNTIONAL: MOUND: IN_ -GROUND-PRESSUREIANK: RECOMMENDED SYSTEM:(optional)
fl S E]U �S ❑U M S ❑U U Conventional Trench
If Percolation Tests are NOT re wired DESIGN RATE:
q If any portion of the tested area is in the
under s. ILHR 83.09(5)(b),indicate: Class II Floodplain,indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- 1 80" 95.18' None 63" Described on page 2
B- 2 83" 97.89' None >83" same as above
B- 3 65" 95.90' None >65" same as above
B- 4 74" 98.33' None 56" same as above
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D PER INCH
P-
P-
P- Exem ted as er ILHR 83.00)(b)
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 94.0'
Detailed plot plan on page :2
N
-77
3
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:
Michael Hel eson August 17, 1988
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
2932 North Plum Tree Circle, Menomonie, WI 54751 1980 (715) 235-7250
CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395(R. 10/83) —OVER —
Fr
INSTRUCTIONS FOR COMPLETING FORM 115 - SBO - 5395
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 cormincrcial project;
3. MAXIMUM number of taedroorris or Commercial use planned;
4. Is this a new or replacement systems;
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;
B. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheet may be used if desired;
B. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent;
B. 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
Soil Separates and Textures Other Symbols
st - Stone (over 10") BR - Bedrock
cob Cobble (3- 10") SS Sandstone
gr - Gravel (under 3") LS - Limestone
*s Sand HGW High Groundwater
cs - Coarse Sand Perc - Percolation Rate
med s Medium Sand W - Well
fs - Fine Sand Bldg -- Building
Is - Loamy Sand > - Greater Than
`sl - Sandy Loam < Less Thar)
"I Loam Bn - Brown
'40 Silt Loam BI Black
si Silt Gy Gray
�cl Clay Loam Y - Yellow
scl Sandy Clay Loan) R Red
sicl - Silty Clay Loarn mot - Mottles
sc - Sandy Clay wr,' w ith
sic - Silty Clay fff few, fine,faint
.0 Clay CC COITrmon, cow so
pt Peat MIT) - Many, medium
rn MLICk d — distinct
p -..... prominent
HWL -- High water level,
Six genes'al soil textures surface water
for liquid waste disposal BM - Bench hark
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.
M
pp—
Page 2 of 2
Rlrri? Oi LJ>ar
T 00 - 08" 10 YR 3/2 sl
1 08 - 17" 10 YR 3/1 is
17 - 27" 10 YR 3/4 is
27 - 41" 10 YR 3/6 med s
41 - 46" 10 YR 5/8 med s (dense with sm. i" _ i" gravel)
46 - 63" 10 YR 6/6 med s
63 - 80" 2.5 Y 6/6 med s w/cmd 7.5 YR 5/6 mottles
T2 00 - 081, 10 YR 3/3 sl
08 - 32 10 YR 3/2 is
32 - 45" 10 YR 4/6 med fs
45 - 83" 10 YR 5/6 med fs
T 00 - 07" 10 YR 3/1 sl
3 07 - 23" 10 YR 3/2 sl
23 - 29" 10 YR 3/4 fs
29 - 42" 10 YR 3/4 fs w/1/2" - 3/4" sm. gravel)
42 - 65" 10 YR 5/6 med s parting to cs
T4 No description provided -- mmp 7.5 YR 5/6 Scr�\
mottles at 56"
Bench mark equals 100.0' Concrete slab of back door
Outlet of existing septic tank 95.88'
Grade T1 95.18'
Grade T2 97.89'
Grade T3 95.90'
Grade T4 98.33'
Weil
I
I
EV�eANooyn CwRwG(
e ,.
i
I
II
LAST Lo-r Li,�E
}( i1`RER o4 £.xlsTliaU
GEPC\L S1aWK
X RRfA of �Y.IST�1G
RCtEw usex) As PASCVae
� Re P•_a „e.� SY srF„ '(y
-T3 1
I
I
i
—
Page 2 of
- - --- - - — - t ,,, „ V --- - --—_ ---
r. IT S tJr
T1_ 00 - 08" 10 YR 3/2 sl - -
08 - 17" 10 YR 3/1 is
17 - 27" 10 YR 3/4 is
27 - 41" 10 YR 3/6 med s ,
41 - 46" 10 YR 5/8 med s
46 - 63►► (dense with sm. i" _ i" gravel)
10 YR 6/6 med s
63 - 80" 2,5 Y 6/6 med s w/cmd 7.5 YR 5/6 mottles
T2 08 _ 08ft 10 10 YR 3/3 sl
10 YR 3/2 is
32 - 45" 10 YR 4/6 med fs
45 - 83" 10 YR 5/6 med fs
T3 00 - 07 10 YR 3/1 sl
07 - 23" 10 YR 3/2 sl
23 - 29" 10 YR 3/4 fs
42"29 - 42
- 10 YR 3/4 fs w/1/2"
42 - 65" 10 YR 5/6 med s _ 3/41'to s gravel)
parting to cs
T i
No description ption provided
-- mmP 7.5 YR 5/6
mottles at 56"
Bench mark equals 100.0' Concrete slab of back door
Outlet of existing septic tank 95.88'
Grade T1 95.18'
Grade T2 97.89'
Grade T3 95.90'
Grade T4 98,33'
wru
I�
I
j
I
iEF1ST L'T
ARtR n
x
777777
s r
1