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HomeMy WebLinkAbout030-1083-10-001 I H 0 � I o I 0 N � ' I j I A I I I •� I � I o ;o v Z c ii 0 Q c I M r Z fl! °' Z °o V I d d N H Lu ! d m 0 co O z a c d Z o 0 fA F- (D E -o '0 _� M N 0) O c cc 4 7 a i to N •N a� _ O a o Q z m z N C z' r N .. E CO r O N � N d - a _ a �g c ,, f0 C7 LO G G a n cd d N OD 5 O Z IL a ;: 00 00 to J V U) CID 0) (D z �i p a ti� CID O (D 0 1 � E 1. LL O O = 'O 7 = N 4 f- in C y N d o y y c o N E O O 0 O ;Q;)' O f0 r }^� C ~ C C V d p V M N I 7 t) U) U) M a) N O O y Ccy) M � yd Z Z� = c*4 . E E - .c r Q O N f4 r O Z N H H rd U1 C� # L • a y .2 a rV�l *0 E r A ti IL 0U)i0 Parcel #: 030-1081-70-002 12/13/2006 12:23 PM PAGE 1 OF 1 Alt.Parcel#: 29.30.19.294D 030-TOWN OF SAINT JOSEPH Current I X 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 O-MCCONAUGHEY, KELLI S KELLI S MCCONAUGHEY 1377 FOX RIDGE TR HOULTON WI 54082 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 29 T30N R1 W SW NE THAT PART OF LOT Block/Condo Bldg: 141 SESS WITH P293C,296F,299D Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-30N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 853/634 07/23/1997 755/131 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 030-1083-10-001 Valuations: Last Changed: Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 030-1083-10-001 12/13/2006 12:24 PM PAGE 1 OF 1 Alt. Parcel#: 29.30.19.299D 030-TOWN OF SAINT JOSEPH Current IX 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 KELLI S MCCONAUGHEY O-MCCONAUGHEY, KELLI S 1377 FOX RIDGE TR HOULTON WI 54082 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description * 1377 FOX RIDGE TR SC 2611 HUDSON SP 1700 WITC I Legal Description: Acres: 4.930 Plat: N/A-NOT AVAILABLE SEC 29 T30N R19W SE NW THAT PART OF LOT Block/Condo Bldg: 12 OF CSM 5/1414 ASSESS WITH P293C, 294D,296F(PORTION OF LOT 12 CSM 5/1414 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) IS LOCATED IN HUDSON SCHOOL DISTRICT) 29-30N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1014/66 07/23/1997 853/634 07/23/1997 755/131 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 169229 454,400 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.930 128,300 265,900 394,200 NO Totals for 2006: General Property 4.930 128,300 265,900 394,200 Woodland 0.000 0 0 Totals for 2005: General Property 4.930 128,300 265,900 394,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 107 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER /y,&c VA 1_ ���/:�1 TOWNSHIP SEC. T .30 N-R 19 W ADDRESS ST. CROIX COUNTY,/WISCONSIN SUBDIVISION LOT 02 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•Z.HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Q � F c4 'N VeNT StA l3oxa°s � INDICATE NORTH ARROW /UO SfALt� BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /C o Proposed slope at site: o SEPTIC TANK: Manufacturer: Liquid Capacity: Q Number of rings used: t Tank manhole cover elevation: Tank Inlet Elevation: C s Tank Outlet Elevation: --7) Number of feet from nearest Road: Front,O Sidej(3rRear, O feet From nearest property line Front,0 Side,erlrear1 O 2!VO feet Number of feet from: well � building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE v 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,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM A Bed: Trench:G Width: �; ` Length: jU Number of Lines: / Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,(vet . Q Number of feet from well: f�- y Number of feet from building: f d y (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) . HOLDINGS 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, QFt. Number of feet from well: �J Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj i DEPARTMENT OR'INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS DIVISION `LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O.BOX 7969 MADISON,W 1 53707 State Plan I.D.Number: CONVENTIONAL ❑ALTERNATIVE (If assigned) SO4,NEt4,S29,T30N—R19W ❑Holding Tank ❑In-Ground Pressure ❑Mound Town of St. Joseph A E R I ADDRESS Of PERMIT HOLDER: INSPECTION DATE: Michael and Kelli El ea 142 Ward �] -�2. �� /,PT ELEV 3 U BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT. .. Name of Plumber MP/MPRSW No.: County Santar iy Permit Number: Gary Zapper 3300 St. Croix 112659 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY. 7EST----7jlIaj NLET ELEV.'. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER / ,/ PRO IDED PROVIDED. 0 -�`� 110.7 2 YES ❑NO ❑YES IRNO BEDDING. VENT DIA.. VENT MATL: HIGH WATER ROAD: PROPERTY WELL: BUILDING VENT TO FRESH NUMOF LINE AIR INLET ALARM FEEM t1 5 {� �,❑YES NO ❑YES O NEACo '1 DOSING CHAMBER: MANUFACTURER IIIEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED-. ❑YES ONO ❑YES ONO ❑YES ❑ FR GALLONS PER CYCLE: JPUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH LINE AIR INLET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER IMATER-L ANQ MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO.OF DISTR.PIPE SPACING COVE INSIDE DIA #PITS LIOUIU BED/TRENCH - TRENG S t ( MAT IAL. PIT DEPTH DIMENSIONS ^ T I GRAVEL DEPTH FILL DEPTH UISTH PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DI NUMBER OF LINE PROPERTY WELL BUILDING VENT TD FRESH BELOW PIPES ABOVE COVER. ELEV 1 LET ELEV END �, PIPES FEET FROM LINE �/,2 AIR I LF.T ar Iatt� /01.19 zN 1 NEAREST AD$ / e /OJT / 1L Xj MOUND SYSTEM: /oo.5a I00 .3� 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. 1:1 YES FIND SOIL COVER TEXTURE Pf.RMANENTMARKERS OBSEHVATIONWELLS ❑YES ❑NO OYES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDEU MULCHED CENTER EDGES DYES ❑NO ❑YES ❑NO ❑YES El NO_ PRESSURIZED DISTRIBUTION SYSTEM: WIDTH'. LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MO DISTR. DISTR.PIPE UISTHIBUTION PIPE MATE HIAL&MAHKINC� ELEV.. ELEV.. DIA.. ELEV.. IPES DIA.'. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY RIAL VERTICAL LIFT C ORRESPONDS TO APPROVED PLANS DYES ❑NO DYES El NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL'. BUILDING FEET FROM LINE DYES ONO S ❑NO NEAREST 0 Al,2'1 , Sketch System on Ret in in county file for audit. ' /t C� 97 Reverse Side. TITLE SI R Zoning Administrator DILHR SBD 6710(R.01/82) SANITARY PERMIT APPLICATION COUN !�11 � DILHR In accord with ILHR 83.05,Wis.Adm.Code V� STATE SAJNITARY PERMIT# 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 ❑YES ISNO PROPERTY OWNER PROPERTY LOCATION % A,, '/a, S T p, N, R 2g E (or PROPERTY OWNER'S MAILING ADDRESi6 LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CI Y,ST TE ZIP CODE PHONE NUMBER Ej CITY NEAREST ROAD,LAKE OR LANDMARK 6� VILLAGE:.TOWN OF* II. TYPE OF BUILDING OR USE SERVED: 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.9 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. ❑ Seepacie 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): 994. 0.A,00 S /04 Feet ®Private ❑Joint ❑ Public VI. TANK CAPACITY Site in aallons Total ##of Prefab. Fiber- Exper.Con- INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete strr cted Steel glass Plastic App Tanks Tanks Septic Tank or Holdina Tank ❑ 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): Plumber's Signature:(No Stamps) 4dPIMPRSW No.: Business Phone Number: Iumb s Addre (9treet,City,State,Zip Code): Name of Designer: rp. v 01 dr VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# 44 CST's ADDRESS(Street,City,State,Zip Code) Phone Number: s IX. COUNTY/DEPARTMENT SE ONLY ❑ Disapproved Sa nary Permit Fee Groundwater ate I ing Agent Signature(No Stamps) Approved ❑ Owner Given Initial S harge Fee Adverse Determination 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 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 property 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; 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 ate�� included the creation of surcharges (fees) for a number of regulated practices which Wisco Ih`s can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried TeasuCQ! a 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. 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 I . 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. wi - �- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property M1Lt'1aL and hejh I iP_a■ Location of Property 5W It NE Section 2-°j TAO N-R W 1oanship .� T P... Mailing Address r-6 F B 3.� u Address of Site ya P / 4 I eft ;. ■ ■ St Arj4�� f��— S�OZ �if� subdivision rte F � Lot Number 2 e previous Owner of Property ,f Total Size of::parcel c4cre_,■S insDate Parcel wBS :.Created P: ;Are g11 corners and lot lines identifiable? X Yes No r .` s this pV6pirty being developed fo resale (spec house) ? Yes No $i .. N r as recorded with the Register of Deeds. ... lume it, .• and Page umbe �, g 4 6• 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. r .i iP — - — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — PROPERTY OWNER CERTIFICATION I (We) evettby that a t .statements on this bonm au true to the beat ob my (oun) knoweedge; that I (we) am (au) the owner(.a) o6 the pro pe&ty des eh,%bed in th i s inbonma#,%on bonm, by vi tue ob a waA arty deed neeonded in the Obbice ob the County Regi6ten o Deeds as Document No. fA k-1 ` sue ,_ and that I (We) pneAentty wn o the pnopo,s ed 6 to bon the .sewage d i a po.a i ybtem• (on I (we) have obtained an easement, to nun with the above de,6ctibed pnopehty, bon the constnucti.on ob said 4eyb#em, and the tame has been duty neeonded in the Obbiee ob the County Regiaten ob • s lla4 as Document No. 1 . b i S10M URE 01 OWNER SIGNA URE OF CO-OWNER (IF APPLICABLE) v µ ATE"S �: DATE SIGNED a , 5 — — -- 1 I.TE BAR OF WISCONSIN FORM 2—li, a 800K 5�PAGE Terr E. Pxrxus AtfiStERS QMCE Y.. ,. ................................................ ST. GROIX ON WI& ReK'd. for " 29th ....... .. day °ffp ,�......�1.D. 1; co v Ps and warrants to J4 .� Y�s . .an 4AA. d.. el3.>4_.S, a ,eA. j . ........ ...... 'f .... ....................................................... ...................................................._. RETURN TO the following described real estate In St,. Croix State 4 Wisconsin: County, + Tax Parcel Na.. .. ........ ,xa , Lot 12, Foxridge, Certified Survey Map in Volume 5, page 1414,, Document 393027 filed in the office of the Register of` Deeds : ' .for Sty Croi.x County., Wisconsin ; TOGETHER WITH AND SUBJECT TO a 66 foot non—exclusive easemextt ' for access purposes 66 feet wide located in the West 1/2 of 4 the Northeast, 1/4 and the East 1/2 of the Northwest 1/4 of Section 29--30-19 'shown on the following documents. Certified Survey Maps in Volume 3, page 613; Volume : 3, page 614; `Volume '653, page 461a, as document #380483; Volume 659, page .428, 'as document #382764; Certified Survey Map in Volume 5, page 1414; Volume' 640, page ,542, ` as document # 375434; Volume 6411 page 133, {'as " document #375593; and in Volume 559, page 507, gas ,i documgnt #342599. i w k <x ;f I This 1S .IlOt homestead property. 1RANSFM 06) (is not) Exception to warranties: FEE Dated' this day,of _SL?t:eIR2£x. .. 19.$ (SEAL) (. .... •.. {SEAT.) w .._... Te Pirius ...... ri;................................. SEAL) .: (SEAL) A.UTHI6NTLCATION ` ACKNO,WLEDGMISNT $TBnature(s) ,. .,r„_ STATE OF WISCONSIN • A !. -• ...county, as, auth@uttcaled Mill' 4t ..sdgy ...... ._.... 19 a. ” �^•-••....., ;Personally came before me this � - .. . ..._.....day of .., ... ._. SePtCIII�? . ., 19_14.."the above lume,c ��, �. ,. "' Terrx. E: i? u.................................. s. TITLE: ............. MEMBER,STATR�BAR QF WiS.CQNSiN _... .................................... .._. r (If not, .. authorized by ?06,08, '9P--- ----- ) .. •- .. ... -.. ..._._. ....................i .................. I to me known to be the pergon Q%i;...�..... who executed the foregoi s ru a and AekOpiledge the sane. ( ; THIS INSTRUMENT WAS DRAFTED BY Q'f A �� ina O (+ Y Krist .,cland:.L nde ...... �«• ,. • • Jobe Sign N s •'G Notary Public . ..t Cx' ,i my Wis, .........natur r� (S�,� eil may bq aAU en M v t# ticated;or s�ckl►ogrled-ed. Both Commission is erma n R P � iratio Mrs not necesw,ry,) � •. �� axp n date: ...... ..ORG aaw« pt Aem= 1it4la0 in,aPP.oeDaattsT tlloYld bR b7P+d or Printed bdov their eliaatur«. I tNARRA3V�'1Y BTAT$ BAR OF WISCONSIN FORM No. P— 18132 wi►eorsia Lesa Bunk CAL Inc. A.14...:walh— %via_ x S T C - 105 r y 1 ��F SEPTIC TANK MAINTENANCE AGREEMENT St . Croix County ; OWNER/BUYER , h_�. I end lli i' as ROUTE/BOX NUMBER�/��d`7 G(.h IC/ Fire Number I✓ CITY/STATE �If,� C) kJ `- �V�� ZIP { '� 1 i.n PROPERTY LOCATION : SVV -k Nom , Section, T 30 N, R Town of ��,, J�' �c� 1 , St . Croix County, i Subdivision ��r �C1� , Lot. number f�, Z. Improper use and maintenance of your septic system could result in x its premature failure to handle wastes . Proper maintenance con- F.! sists of pumping out the septic_ tank every three years or sooner, if needed, by a licensed septic tank pumper. What you pit into the system can affect the function of the septic tank as a 'treat- ment stage in the waste disposal system. I 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. 1•� 4 The property owner agrees to submit to St . Croix County Zoning 'a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri . fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank. is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to -j 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 Depart- ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Offl,pe within 30 days_ of the three year expiration date. SIGNED . ; DATE St . Croix County Zoning Office P.O. Box gal ,s Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. $vYCA : R;,- gay t- 7A(-1- / G F y INDUS TRY,RY OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUS DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN-RELATIONS Alij . (H63.090)&Chapter 145.045) '41 40)(. /6 /}�e S LOCATION: SECTION: TOWNSHIP/T*U11IC1FALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: t/ �/ L9 /T3aN/R/9E (o )W - - ToSAFPP — >Z �c �wxF- COUNTY: OWNER'S S NAME: MAILING ADDRESS: ' 5T e toe T4 ?i R�vS 137AOyw a� t �P fwoJo.J wiS. USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: R JA ION TESTS: t Residence 2_ - 3 N 14 New El Replace I4 Ab-A 9 RATING:S=Site suitable for system U=Site unsuitable for system r ONVENTIONALrE UND: �IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) S ❑U S EA ZS ❑� EIS 9� ❑S U Ti�'ENC� o,�cy — SN�}�ow, 4iie �X ZT E �S�-D ff O X v f0 t f��✓E.t� V.�+ Elm, DESIGN RATE: If Percolation Tests are NOT required D If any portion of the tested area is in the under s.H63.09(5)(b),indicate: li6/11 t lFloodplain,indicate Floodplain elevation: s yz 58 L42- PROFILE DESCRIPTIONS au 5 .gyL 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.) D G13 tD S' 7 0 's f ox. 4 oR . udc[/,tp A T ' ' •3d A�'�SJ / -�3' Ba• S•/ 1 0 ' 4".d. s/ 3000 , B- Z �• �OZ.7 �•� �'� ix, et B , s i s s wC7 ,}r r i r 3,3' y►- �, .2.,;'�S,v. Si d �l%X-Of A_J• S s B-�3 .a 16Y y �,� G �' IS w � s,�Av ,f 4 T 6. B- 0 A L G . 13 / r,Y of a�,. s /s wE, ' .� %f /� 1p*y MAX o�-,(ia 5 1. ' r�,✓ Gs wfT T Co.C. ' B- � c &&0 W(W PERCOLATION TESTS LNUMBER DEPTH WATER IN HO E TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES INQ"6S AFTERSWEL NG INTERVAL-MIN. PERIOD 1 PERIOD 2 PE PER INCH Q z ' 30 /G 2 r i iG P_ d 16'Y. �G 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 11 of land slope. L 01VES T 7'e6QCA C,4j ff 6 ' # f/E l T' SYSTEM ELEVATION "''DA's 7���cG�, (1) ��J J7 1 [ P11 s 100 pi d S 70 E 3 3 I,the undersigned, hereby certify that the soil tests reported is for accord with the procedures and methods specified in the Wisconsin mm(�vde(� rrl�`4� Administrative Code,and that the data recorded and the locati the tLf r r o t st of my knowledge and belief. NAME(print): HOMESITE SEPTIC PLUMBING CO. a TESTS WERE COMPLETED ON: RT.3 O'NEIL RD.,HUDSON,WIS.5401 S� JC J ' ✓� v `' ADDRESS: CER'IFIC46TIIO NUMBER: PHONE N_ UMBER tional WIS.MASTER PLUMBER LIC.NO.3307 M.P.R. MINN INSWEER&DESIGNER I;'G NO 00662 CST SIGNATUR4. / DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — ' INSTRUCTIONS S FOR COMPLETING FORM 115 - SRIJ - 6395 To be a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the-SUitabili€ty'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 Iocating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; S. Make sure your benchnrlark and vertical elevation reference point are clearly shown,and are permanent; S. Complete all appropriate boxes as to elates, names,addresses, flood plain data, percolation test exemp- tion, iI appropriate; 10, if the information (such as flood plain, el€tvation)does nor apply, place N,A, in the appropriate (lox; 11. Sign the form and place your, current address and your certification number; 12, Maker 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 C)iI Separates and Textures Other Symbols , s — :alone (over 10"? BR Bedrock co,b Cobble, (,3- 10") SS Sandstone gr — Cravvl (under 3") LS Limestone �s Sand I-IG V -- Nigh Groundwater cs Coarse sand Perc ._ Percolation Rate rme1 s - Wilium Sand k11 — Er°f{?(I is Fire Satin Bldg --- Building Is Loarny Salad _ Greater fh« l Sandy Loam — Less Than Loarn Bn — Brovvri s l - Silt Lo arra 131 _ Black si Srlr Gy Cray 0 Clay Loam Y -- Yellow s(A <i"ndy, Clay Loam R pearl sic; — Silty Clay Loam n=ot Mottles sc Sa+acly Clay Vs' sic — Silly clay lff - fevv' fine faint Clay cc _. k,'orramora, course t _ p'-'at nirn — Many, aaaediurn r,r - Muck d -- distinct p — p ominerat HfVL — High vvister level, Six gerneral soil textures Surface vvater fear liquid waste disposal BM - Bench Mark VRP _.- Vertical Reference Point TD THE OWNER: sail test r epos; is tile, first stop in securira<l a sanitary permit. The county or the Department may request s..i-`={'��4.ii�n of ihis 5th➢il i:'si: all the iic d Prim to Pertrarl: issuance. A cornp)l:te s{'1: of plaris to!- the private �1e �' sierra and a p)e,- ai, arwlicati,,ara rust be ss )ranted to ihe appropriate local authority in order to a h S� lE faiy p O-rllit rnlist, be t3'l"mr?FC rar'.{'j postect p7io'�r to th(', Star( Of 3 )Y{'s I)SD'UCt On- P�bE" to F DEPAReWNT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS DIVISION INDUSTRY, G LABORAND' PERCOLATION TESTS (115) MADISON WI 3707 HUMAN RELATIONS (H63.090) &Chapter 145.045) LOCATION: SECTION: TOWNSHI�tiiY: LOT NO.:BLK.NO.: SU�3 IVISION NAME: jr 1/ 1/ y /T?a N/R/I E l ST� T a Jii� �- /L- / T/°6-.0— COUNT(/Y: OWNER'S BUYER'S NAME,V $7��WD�� St �0I T�/e /0i4 • USE DATES OBSERVATIONS MADE rrr���yyy NO.BEDRMS.: COMMERCIAL DESCRIPTION: �yy (PROFILE DES IP IONS: E AT�_TESTS: L�Residence ❑Replace RATING:S=Site suitable for system U=Site unsuitable for system r ONVENTIONAL: MOUND: IN-GROUND-PRESSURE:IEEI SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED,SYS `M optional) ,�E' of ❑S U ©S ❑U ❑S NU S ©U ❑S �IU �s 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: I I Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAPTL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEH IN; ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OB ERVED(SEE ABBRV.ON BACK.) �s ' /ro , 2,yl �y B-6, ?[per" � /.6G'ZLeAAf 0•�, 2.17 ' /!o0AIII f/P� r� yZ._,Q;cuy. s t 6� -yy t:, /& y^Y B-f 3. p �-0� J? � w nh may �'CT,ow-G�R 1°¢S . /D BY 17o �Fi mR— /KO'fS /�/ ,v. /h`-+riP• S 2.33 ' &ey-dV. s . B-� 7 D z. rI V. 3 f/E� DErtld cc+�, G7Fb +F S/� 2.p B� f+iX• o f s� S� w PoLTS �f B- �to�/GFV Sil s�v �s .a rtcFD iP►ivEL PERCOLATION TESTS Sf.9i•��o hE'1v��y kU�T CogTi�JU s TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCHES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD ( PERIOD2 P R P- 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 i F E 1 - i a T -- j tH F I � _ _.. c � E s 3 ' f t 3 I,the undersigned, hereby certify that the soil tests reported on i rm we ade by mk-in-a6cord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of K is are correct to-thebest of my knowledge and belief. NAME(print): TESTS WERE COMPLETED ON: L HOMESITE SEPTIC PLUMBING CO. `SE"7e' �—/ F I ADDRESS: CERTIFICATION NUMBER: P N NUMBERIo tional): ROBERT ULBRICK -2-1$4 00 4 " CST GNATUR MINN.INSTALLER&DESIGNER LIC.NO.DOM 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 - 6395 , To be a cornplete xarrd accurate soil test,your report must include: 1. Cornplet€c 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 nevm or rcplacernent system; 6. 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,,vriting profile desc riptions and completing the plat plan; 7e INTAKE A LEGIBLE diagram accurately locating your test locations. Di-awing to scale is preferred, A sepal ate sh€am may be used if esiror ; S. 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, percolaiion test exemp- tion, if appropriate; 10, If Me information (Such as flood plain,elevation)does not apply, place H.A. it-'the box; 11. Sign the form and place your current address and ycau,-certification Mlmt)er; 12. Make legible copies and distHbUte as re(Juired. ALL. SOIL TESTS MAST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAPS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols Srom (aver 10"( BR - Bedrock cob - Cobb! (;1- 10") SS Sandstone gr - Caravel (undF a 3"7 LS - Lirnestone Is - Sand HGt='`V - High Gimindvvater c5 .. Coar5e sand perc .._ Perccfiatlrjn Rate riled c -- M==diurt:,jc:tYi.i VV ' £'=`.i - Flrie Sand Bldg _- Bu Iding s - Loa€ v Sand Greal:er Ti err �sl - Sandy Loa ) Less Than i -- Loarn Far; RrovY,r= `sir Silt Loam FBI - Black s -- Sill G - Gray cl Clay Loa-n Y ._. Ye11o'vv sc.i - Sandy (:clay Loam R - R(,d sicl - Silty Clay Loam not - Mottles SC Sandy Clay w/ _. "with Sic - Silly Clay fff ;ew, fine, faint IC --- Clay CC --- Common, uoars(, pI -- Pew Inm - many, medium rf Muck d - distinct p - prorntnes€st HVVL - High vvatcr level, Six general soil iext€res surface;ivater for liquid waste disposal BM - Bench Mark VRP -- Vertical Reference Point TO THE OWNER: f�s so tes'i rF p o t is 14-te first Step in Securing a sanitary permit. The county or the Department may request lca:tion ol+ 'his soil test r ih#; field s)r for 10 pert-nil issuance, A complete ;m of miens for the private a o,,,,r pEj_ s1I��l1C�<1.tt:1"? 3" us1. be, submitted (t? the ;tpl"33"U,r3rldte jt`H£sAl authority E?..p f,)Y{aE:r to fit'-'sl r"Iai F!" 'r'mt rtt ',. be ohtaarae,i and pr ste d p;€o2 to the start of any co is'.it.rction. r REPORT ON SOIL BORINGS & P.ERCOLATION TESTS 115 PLOT PLAN Project' I.D. LEGEND 11T. SEPTIC FLUMWNG m RT.9 O'NEII RD.,HUMN,M&501i ROBERT U A CHT • s Backhoe fits MS.jRURLIC NM X Perc Locations 0 = Existing Well C.S.T. 2482 Vertical Reference Point : - / P1^5 SET ' �in2&�t- Elevation of Vertical Reference Point 160' Lot Line SCALE: � .. - 3d • as 15 fo a � 9 \ !f�o 7-S' _ sv�CF'�E �,� I • V ew /00 �• g0019 ;° 10 r04 iyoU,vp �z 3 B-- - - - — - B3 APO A I � Z90 ,� 5 � 5 �► • c � E,vTE cF 5 /f14vp SIPE- A op foX �i17 pipj IP r� r 7qq No. o I � a 1 No Zl CD DO . o ) a •� N i � I O � � N � zw Zy �� rrtoz _! L `` Azl z 6� 1 . . .. //ZoAEr �/1L�T �.vo CrzD.rr O✓E'2 ADO STD AVO/L" /t_T /-=A/)g v EGT.TO/'U 11219Nf //to posy 0 .O/t2V6b✓AY 71_zevcN — A L3 C S ' , Al � S Qy F--/voArN 13 A Zs /_/toAv /Qi of No-E:PA.POSEO smckE tL1'eV. _ /'00.00' SFPTiG S>T EA / _T's omit yoo' y—� /ZoJ,&'CT k,Err /o�svprvirY .('1TE (3Q / �1cNA�L 1-,-2>,&g ` > 'rD� NOTE=/�hoAaSFO J c/�TYG �EW �Yf7�Irl S1'1_r7,5M IS 0V61L T w/hJ OF J7 Ul2f'Ep/,� 69L,SOrza TAivK `/s v'F/ton, 6,ur G7 C0 ' o aY fh°PV o. Lair fT CAazx Cow,-r>, M ®<--SONTN A /71 Z3. 11 .A.' AZPE 30� 6I 6I EL Ev. /n0/�DSGO /5 /zECZoFnc� DROP A OXES OVE& .9,Do To .SDuTI,I PicvKt, p L./c1L 0 A,,-EA7>' 1s vF JYop,E � No sCAL15 FRESH AIP INLET AND OBSERVATION PIPE: � .'SFFF'OVED YENT !..AP I.MXMUM 10-211, ABOVE rUNA.L GRADE F -. .l M-Wh- fN;t OF 42° AE,OYE PIPE TO FINAL GRADE WASH HAY OR 3YNTHEI IC-_ I L6f._s''dE. -W Q OYER PTE rtr_TFilef_fjiON PIPE f! 7 �T m...�.�.®,.... �.........�..., .�... f- -- i Tel= w w 1 E 1S[.t IL TIIsJG 8V. s I xaQ 1i3,zrc„�� BOTTOM PER SOIL-. RG-NE TH, PIPE � l � --�-- PERFORMED PIPE BELOW TEST IS r:0 tl'ff_IN' TERMINATING 13_J00.S c, /o/, Y