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HomeMy WebLinkAbout026-1001-50-000 Q f o \ 0 a \ � � 7 � § � � A � $ � ) � � a ) } U. 7 � 3 i � � 7 � � � a \ E 2 7 � z 8 � k M / \ a 2 $ � . ) § t \ \ k k 7 \ $ 7 7 I a) -� in } . Q } ) k j § § 2 CL E k k d r L 2 0 & 2 k .-0 E E k } 5 U) U) § k k k k E 2 k § -� k � } a a a z � CL 3 � j v co c ) � « o c 2 § \ + 2 k \ - § 5a 2 ) a 2 J \ e e � � ■ � � d 2 \ j a@ 8 8 � 0 3 a c o b 2 @ D R = a � o o ; (2 � 2 ) a , $ . ■ o f E c o 2 \ / ) / § o } / k / t : 7 2 2 k ' � � . — � _ Ei a » E ) ) k a § / J a : 0 3 0 . . - Parcel #: 026-1001-50-000 12/12/2005 11:53 AM PAGE 1 OF 1 Alt.Parcel#: 1.30.18.7C 026-TOWN OF RICHMOND Current i X I 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 J&LINDA L OLIEN O-OLIEN, ROBERT J&LINDA L 1741 140TH ST NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description * 1741 140TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.180 Plat: N/A-NOT AVAILABLE SEC 1 T30N R18W SW NW 1.18AC LOT 1 CSM Block/Condo Bldg: 7/2014 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 01-30N-18W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 821/336 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 95287 186,300 Valuations: Last Changed: 06/19/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.180 29,300 130,500 159,800 NO Totals for 2005: General Property 1.180 29,300 130,500 159,800 Woodland 0.000 0 0 Totals for 2004: General Property 1.180 29,300 130,500 159,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 315 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form — STC — 104 AS BUILT SANITARY SYSTEM REPORT 'OWNER ... TOWNSHIP SEC. T N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f Yi a a�' 8/ a a ' Bra l °�60 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /���� Proposed slope at site SEPTIC TANK: Manufacturer:��� � Liquid Capacity: z�rffl ��1 Number of rings used: Tank manhole cover elevation: "��� Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road.: Front,O Side, Rear, O / f,-,' . From nearest- property li a Front,O Side,O Rear, Number of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to sept_ SEE REVERSE---SIDE PUMP CHAMBER Manufacturer: y 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 Bed: Trench: Width: �a Length: Number of Lines:L Area Built Fill depth to top of pipe: i� Number of feet from nearest property line: Front, O Side, O Rear, Pt . _, 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: `j/ Plumber on job: License Number: G 3/84:mj DEPARTMENT OF`INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&7 RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION �IIADISON P.O.6 ON,W)969 53707 BUREAU OF PLUMBING SW;,NGO%,S1,T30N-R18w LftONVENTIONAL ❑ALTERNATIVE State Planl.D.Number (lf assigned) Town v4 Richmond ❑Holding Tank ❑ In-Ground Pressure ❑Mound Town Road NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTI N DATE 1!-3�Se 3 ' 3 v Rvbe�ct U.P,%en Route 1, NewR�.chmvnd, (,VI 54017 , BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.' Name of Plumber: MP/MPRSW No Cnunty Sanitary Permit Number: Catvin Poweu Jn. 1563 S - Choix 112822 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID ACITV. K INLET ELEV. TANK OUT ET ELEV.. WARNING LABEL COVER PR VIOED'. I'L.CK:NG ROVDED. - ,L C�1 ROAD: 1PROP E TV WS L LNOBUILDD E e To NOSH BEDDING: VENT DI VENT h#,A T, HIGH WATER NUMBER OF ! ALARM FEET FROM / y LIN I LAIR INLET'. YES NO ❑YES NO NEAREST / f� Z-T DOSING CH MBER: 4 1 - MANUFACTURER BEDDING- ILI(UIO CAPACI TV PUMP"I'll" PUMP;SIPHON MANUI ACTLIREH WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: [:]YES ON O ❑YES ❑NO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER GI:F PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES ONO NEAREST 0J SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing I E NI,TH 1111AMF TE 11 MATT HIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORGE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: / WIDTH JLEN$TH NO.OF DISTH PIPE SPACIN(I COVER INSIDEDIA spITS LIQUID BED/TRENCH . l `' THE NCf4FS hNREftIAL' DIMENSIONS PIT DEPTH �y ; GRAVEL DEP H FILL DEPTH DISTR PIPF DISTH PIPE DISTR.PIPE MATERIAL NO TH NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIP S ABO E COVER, EJ.�V. ELj EN r^ PIPES �'• E•T•FROM LINE /� gyR.�N�T. NEAREST'----1► / 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 ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER ITEXTURE 1 11 H1,IANI NT MARK IHS OBSERVA TI(1N WELLS _ OYES ONO _❑YES ONO DEPTH OVER TRENCH BED DEPTH OVER TRENCH HEU 11FPTH OF IOpS(11L SODUFD J MULCHED CENTER EDGES 1:1 YES LINO ONO DYES ONO PRESSURIZED � DISTRIBUTION SYSTEM: BED/ TRENCH WIDTH LENGTH NRENCH ES: LATEHAL SPACING IGHAVEL DEPTH HE LOW PIPE- FILL DEPTH ABOVE COVER OIMENSIONS MANIFOLD PUMP ANIFOLO DISTR.PIPE MANIFOLD MATERIAL INO DISTH DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV. ELEV. DIA. ELEV, PIPES DIA ELEVATION°AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT L COVER M t RI / VERTICAL LIFT CORRESPONDS TO APPROVED J\ PLANS DYES ONO ❑YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: IZUM)ER PROPERTY WELLER LINE❑YES ❑NO ❑YES ❑NO EST--w- �Ir L i4 C7 Sketch System on p in county file for audit. Reverse Side. SIGNATURE: T DILHRSBD6710(R.01/82) " y ~j ILHR SANITARY PERMIT APPLICATION COUNTY c�?o� In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# // a $a a -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 El YES� NO PROP TY OWNER PROPERTY LOCATION '/4 '/a,S T , N, R OD e(or)4 PROP TY OWNER'S MAILING ADDRESS LOT NUJvIBER BLOCK NUMBER SUBDIVISI N NAME CIT ,STA ZIP CODE PHONE NUMBER 0 CITY NEAREST ROAD KE OR LANDMARK VILLAGE: 11. TYPE OF BUILDING OR USE SERVED: 0,41 Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): 411,14 Ill. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. ® New b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit¢# Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. ®Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e.❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ® seepage Bed b. ❑Seepage Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Feet Z1 Private ❑Joint ❑ Public VI. TANK CAPACITY Site in aa ons Total ##of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holding Tank f ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installationgLtke private sewage system shown on the attached plans. Plumber's Name(Print): PI bar's Signa re:(N Stam 7) MP/MPRSW No.: Business Phone Number: Plumber' Addres (Street,C y,State,Zip Code: Name of Designer: VIII. SOIL TEST INFORMATION Certifia Soil ester(C )Name CST# v� J jz CS s DRESS d(.,St e at,City,St e,Zip Code) Phone Number: IX. COUNTY/DEPAR MENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial S rchtarg�e—Fee Adverse Determination ��0 or� OVJ Q�l�' ��JXGI/� • X. COMMENTS/REASONS FOR DISAPPROVAL: #/Zj&V /,-,, M0,4,t/J.- 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 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; Vlll. 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'h 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 BtEf-- included the creation of surcharges (fees) for a number of regulated practices which Wisco ER'S 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 a system or the disposal site used by your holding tank pumper. 0 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- 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 _ Z aFj 0"�L't 0*j Location of Property 5V4 k w^1t, Section 1 , T N-R 1*0 W Townshipt:;�rt�N(� Mailing Address _ 27C, �. t�—w �►w►�� �Y � Simko tZ . Address of Site �ChEM 0 HrJ- vi Subdivision Base . Lot Number Previous Owner of Property —FIWL. JV4 Fr t4P, Total Size of Parcel Date Parcel was Created P Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes X No Volume g —`- _ ZI . and Pea Number '3 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 1 Iwe) cohtl•6y that att a.tatementJs on titi�s ohm ah.e tAue to the best 06 my (ouh) hncwtedge; .that 1 (we) am (ahe) the owneh (a� 06 the phopehty de�schibed in Chia in�o�tr++ation 6ohm, by vihtue o6 a waAAanty deed heconded in the 066ice 06 the Corinty RegiAteA o6 Ueedsah Document No. 4-401f1l ; and that i (we) pneaewtty c.un �tJ�e phoposed bite 6oh the zewage diApozaZ system (oh. 1 (we) have obtained an edAement, to nun with the above deAcn,i.b•ed ph.opehtq, 6oh. the conatAur-ti.on o6 aaid aya.tvn, and the name has been duty h.econded .tn the 066ice o6 the County RegiAteh. o6 Vet 4q, aA DOGUAent No. 4A-0 c%a I ) . SIGNATURE 01►&QNE SIGNATURE OF CO-OWNER (IF APPLICABLE) to -- ( I -TA b DAIE SIGNED DATE SIGNER CERTIFIED SURVEY MAP Located in part of the SWh of the NA of Section 1, T30N, R18W, Town of Richmond, St. Croix County, Wisconsin. OWNER , v Paul Swenby v NW Corner of Box 21 ' w Section 1 New Richmond, WI 54017 N o = a+ o Unplatted lands • a► as 1' SOUTH OF FENCE o =, North line of the SW} of the NW} of Section 1 LO.41 I 661 S89°35'34",E 260.04' ., o 218.261 00 = I ILT-41.781 7\-5.5' 30UTH OF 4_ I FENCE C_ 0 v N o Ell All y°•► I G�]j ^' m WW in I �� to LOT 2 co s _ ao �+ \ M ao N; ti '^ SCALE_ IN_gEET fI o I p Wo o y, 0 FIN 50 100 200 U's N. e_r ii'I C I La b =I ao i LOT AREAS I N .ti' . • �i 0 N c CL >i c 00 m i n 260.041 00 i Lot 2: oG a Z20.28� 0 Area Including R/W: s I Z 39.76 a 79,398 Sq. Ft. = I 1.82 Acres o xl co Area Excluding R/W: N NI I~ LOT 1 N 660949 Sq. Ft. C�j o 1.% Acres I Lot 1: Area Including R/W: I 38.461 51,271 Sq. Ft. 221,581 1.18 Acres I N89035'34"W 260.04 ' Area Excluding R/W: 43,560 Sq. Ft. Un–platted Lands 1.00 Acres CO M In O coo O i LEGEIJD County Section Nonument O 1" x 2411 Iron Pipe Set, weighing IWJ Corner of 1.68 lbs. per linear foot. Section 1 �� y9E9icl�l -M--- Existing Fence–line ce+ �►i'�r„ ' NYMAG �i r 0420k, f This instrument was drafted by Fran Bleskacek Job No. o®� a� �>S a s � ' r a�pQ uabEgAN •0 uaTTK "tins ma Lot." r�6ir 6+q�zy�i� �:•1 •awpS butddpw pup buTAanans UT XTOID •4S 3o Aquno, aq4 3O 80UPUTpap uoTSTnTpgnS pupZ age pup s9qn4v4S uTSUOOSTM 944 3O V£'9£Z aagdpgo 3o suOTSTnoad 4uaaano aq4 44TM paTTdwoo hTTn3 anpq I gpg4 ipagTaosap pup paAanans dappunoq aoTaaqXa aqq 3O OTpOS o4 oTgpquasaadaa goaaaoo p ST dpW AananS paTMaOO STq� 4p44 AMaaO osTp 'I •paooaa 30 SWawaspa a9g4O TTp pup dpw stgq uo uMogs sp ppog uMos ao3 AgM-30-4gbTa off. 4oa[gns ST TOOapa •BUTUUTbaq 3o 4UTod aqq o4 4aa3 W 09Z 't4„V£ ,S£069N 9OUa144 : POGUMENT NO. ST ATE BAR OF WISCONSIN FORM 1-1985 THIS $PACs R@@fdtYSD FOR R[CORDINO DATA WARRANTY DEED 49 09931 eooK 821 ma 33u _ .. -- REC7ISTEWS OFFICE This DQed, made between Kathryn• G, Pederson,_. obe t ST. CROIX CO., WI E,_ Ahlin aid haul Q t•_See }by,•,ar1..undivided- one_ thi d Roed for Record i ............. p ....... ., Grantor. Q U Q 3 .11988 and.AQt?.e�.':�.�I t..Q.4.911-and Lida !: 41iet!.>,_.hi�sba�?,4�... and..W;� f e.,. ..%s..OUKV.i.Y.S??C:tZ hip... !ari ?�,.-Prgperty............... at 8:30 A��Mnn . ............ ......... ..... ........ ..................................... ......... .. Grantee, I&In �} $ X q� Repkter of Deeds — — Une lloliafTanPoLler valuatVe conslgeration .........................•••--•-•-.................... conveys to Grantee the following described real estate in ............0..rOfX NiOW"rBor Mortgage & Financial County, State of Wisconsin: P.O. Box 228 Part of the SIV-. of the N11T4 of Section 1-30-1_Hudson, WI 54016 1$ described as follows: Lot 1, Certified Survey Tax Parcel No: ................................... Map filed August 22, 19$$ in Volume "711 , Certified Survey Maps, page 2014, as Document 440705 • TR FER This ....IS NOT. ... ... homestead property. Tpgether with all and singular the hereditament@ and appurtenances thereunto belonging; Ahl .ri. ari4�.. ell� ..Q,t.. Wnhy...oabkl..>�rid.1/3 warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except interest AND NO EXCEPTIONS and will warrant and defend the Same. Dated this .....tiW.I)AY.."AlAth.............. day of ...................QAgust.......................... ......... 18. .. i..,C ......(SEAL) ..... ............... ........ ... ..........(SEAL) ..Yen G, .rson. ......... • .......Robert...S.%. Ahlin ............ . ...... ...... .(SEAL) ................. ......... ......... ........ ..... .........(SEAL) Paul 0; , Swenby, . , ............ ............................ j&.'gTH3INTI0AT11ON ACBNOWLRDOMSNT bj/ !..G. Pedersonr Robert STATE OF WISCONSIN aAT�I-P-i�.. d''• 13 0 ..............Swenby @' . ........ t _„_aft l�e)t .ws sex• - .:r:n_san.._ aaae,a .. .County.... ..... .;. ................. A ust hat cme.. of ...., 18........ the above named .... ....... ...........................•............. ...... ..... ............... �. '�,�.... ... ............ . ................................... . .. ....... ........ TITLE'w� .. ...- ••- °k #X- . ................................................ .......... St . 'r ?ublic� .Croix,,WI uWt 'heel 7 :08. b l c St .......•.................................. ... ....................... "a 'by, P+1 commission expires 7 2 90 to me known to be the perwn ............ who executed the My 9� foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ...._..PAUL...Q A.-WEND. .....RUAM.................. ........................................... ............. . [F�yl-J.;i��ir7 AP.0..j�VISSONSIrJ .�1�51�.... Notary Public .................. ...... .............County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration are not necessary.) date: ........................................................1 18....... . +Names of penone si nlat to ass eat% 1ty should be typed or printed below their.lanature•. L --.............. .......... 111P1TQ AIR ALA W10f..n a1L v� H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County 2 0 a OWNER/BUYER -Vv- ROUTE/BOX NUMBER Fire Number I CITY/STATE VIC-+k MO"tD w1 'LIP 4'04-1 PROPERTY LOCATION: 5W k, Nw 14, Section , T '50 N , R IS W, Town of [,(.+AmONn St . Croix County, Subdivision ---- Lot number Improper use and maintenance of your septic system could result in I Proper maintenance its premature failure to handle wastes . Pro p con- sists of pumping out the septic tank every three years or sooner , I i if needed , by a licensed septic tank pumper. What you put into � the f septic tank as a treat- ment system can affect the function o p stage in the waste disposal system. St . Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping ( if• nec essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form wi11 be sent approximately 30 days prior to three year expiration . HH E I/WE, the undersigned , have read -the above requirements and agree C to maintain the private sewage disposal system in accordance with x the standards set forth, herein , as set by the Wisconsin Depart- ro ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . , SIGNED DATE 10 -i 1 ' $ St . Croix County Zoning Office P.O. Box 9S Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address . DEPARTMI NT OF REPORT ON SOIL BORINGS AND S"o INDUSTRY, LABOR AND PERCOLATION TESTS (115) HUMAN REhATIONS (H63.0911)&Chapter 145.045) LOCATION: SECTION: TOW HIP/MUltlf&FPAtTY: LOTNO.:BLK. .: SUBDIV �/ I/ / N/R t(or COUNTY• OW R'S BUYER'S NAME: MAILING ADDRESS: �� Z, AIL USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIA DESCRIPTION: I� (PROFILE DESCRIPTIONS: O A ON TES 3: Residence Q +cyNew ❑Replace I � ����� -_ RATING:S=Site suitable for system U=Site unsuitable for system t ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYST :(optional) Cz�S DU DS DU ®S DU DS ©U OS ®U M If Percolation Tests are NOT require DESIGN RATE: If any portion of the tested area is in the _ under s.H63.09(5)(b),indicate: 13 i I Floodplain,indicate Floodplain elevation: /'11 PROFILE DESCRIPTIONS _ BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL IT THICKNESS,COLOR,TEXTU E, AND DE H . NUMBER DEPTH R6{ ELEVATION OBSERVED EST.HIGHEST TO BEDROC IF OBSE VED(S E BRV.ON BAC .) B- B- B-3 7 _ B- 00 B_ PERCOLATION,TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 'NellfS AFTERSWELLING INTERVAL-MIN. P RIO t PE PER PER INCH P- 3, 7 P P- ' 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 e, _ ,-{ i I r i ' -- E l + [ � I _ E I,the undersigned, hereby certify that he soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisc nsilh ,� Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief, yi NAME ri ): TESTS WERE COMPLETED ON: ADD CERTIFICATION NUMBER: PHONE NUMB (optional): CST SLGNATUR J DISTRIBYTION:Original and one copy to Local Authority,Property Owner and Soil Tester. ?, DILHR-SBD-6395 (R.02/82) OVER — ~ I INSTRUCTIONS FOR COMPLETING FORM 115- SB® - 6395 ' Tc he a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. is this a new or replacement system; E_ Cornplete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 0. PLEASE use the abbreviat.ions 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 he used if desired; 3. Mel<e sure your benchn-rark 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 riot apply, place= NJ A.in the appropriate box; 1 1. Sign the form and place your current address and your certification number; 12. Make iesjihle copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL'AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR C=ERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st .._.. Store (over 10") BR — Bedtrock colt C obble (3 - 10"} SS — Sandstone I; fa' — GraVe1 {und',!V 31`°) LS Limestone s — ~a��d Ht�yV — ligh Crounciwater s Coarse Sated Perc Percolation Rate W rne,d s — fY�,!diurn Sand qty -- �,fqS-iii i5 pine Sand Bldg - Building Is - Lolamy Sand 3 Greaten Than `sl S,,,ndy Loam _ Less Than 'r ! Loam Bn -- Rrovvn 0` silt !_iai+m BI ..._ InIasc;k Sih Cy — Gray ci — Clay Loan) Y Yel,oav _6 --- Sandy Clay Loarn R — Rey; sic; — Silty Clay Loam mot — Mottles C S,i ndy Clay tV1 vaith s>c — S.ity C I a y iff — few, fine,fa=rt �c Clay cc cornmon, coarse I,! Peat rniti — Miry, nnedtrtr11.1 n Muck d — distinct P --- prominent HVVL — High water level, Six aerwral soil textures surface water for hquid r,taste disposal BCC! — Bench Mai V P — 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 ;t, the field prior In, permit issuance. A complete set of plans for the private sevvage syst:ern and a permit, application must he suhnnitted to the appropriate local authority in order to bbt:ain a perrrlit. The sanitary permit merit be obtained and posted prior to the start of any constructiOn, ,n8�� Size -/�:►'9��=//a� /r/f3PStiJ /S"�3 3 9i PAGE OF CC`USS Fro6h Air Inlets And Ob6orvatlon Pipe n Approved Vent Cop Minimum 12"Above Final Grode 20-42"Above Pipe _4"Cost Iron To Final Grade Vent Pipe Marsh Hoy Or Synthetic Covering Mln 2" Aggt*gate Over Pipe Oleiributlon —Tee Pipe 0 0 0 0 0 6"Aggregal* Beneath Pip e o Perforated Pipe Below 0 —Coupling Terminating Al Botlotn 01 System o5e17 T'►ne-I 1grc.�l< i �It.�•.T ton ���%��� SOIL FILL DISTRIBUT101.1 PIPE S4MTH APPROVED ETIC DOVER 0 e MATERIht- OR q" OF S?RAW it OF/AGGREGATE —�� r 4R MARSH HAy e p e (o10F12-Zl/2 AGGREGATE tLEV. OF - DIS-7­111195UTIOM PIFE TO BE AT LEAS? _ IUCHES BELOW ORIGIQAL GRADE AtJU AT LEAST LO IUCHES BUT AIO MORE THAI) LIP- IAICNES BELOW FILIAL G-KADE MAXIMUM DEPTH OF I~XCAVATICIP FKoM oRitwitAL WK. WILL BE —.11 IQC14ES PUI41MUM AEf" OF EXCAVATION POM 0�14114gt" GRAPE WILL BE -LO IMCHES SIGHED: LIGE►JSE AJUMBER: i DATE:�l R�t� �. 110