Loading...
HomeMy WebLinkAbout032-1003-80-000 4 o a°i °o• a°i °O h r b0 y y O C c c h 0 0 w �O C N y N f0 O _ C O N co co O O` p C ° o im T� o N 3 'pEE co €� m °- m CD O O O > aCom (D m°� coaxi� � y p j N= U > p O N Om y N m a O L O ca� C U o LL C p p N LL C C a o E - 0 m 0 oar TOc `�O ¢ w N w CLO M co r Z O E Z E Zi+ O O z a m a m N _o o o z c m m N FZ- aci Z Z c E c E •O Cl) V M ` O N N '7 O '3 •� N N O d w cp N y t o _ o d O O Q Q O N (C p w Z m Z o Z m Z o N N c d I C N N c �o E R E �' .. C ca 4 d .0 N S O H d 41 >` O oo ro ra n E -o m 3 ro ro �a n m E X333 n m c33 •N a a a y L a a a z° U N 2 co co co U) -j ', Zrnrn z° IZ � z° M ° CD Lo� O N Q c ° ° M N 0 m m o o E rn E V w (D rn w m p 1 Q co CO v 0 3 L H e O E L N c `o v j AQi O m Oa m c v °i CO c a a°i a \ N N Y O = N O N y l6 v p `o W -) c aci m c c ao o c D c a� E M N • Z a 0) W � Z v C -:03 O (D N M Cl) E N y U O p N O > O o N U O Z �!' F— Z 2 (n v� :3 Q ma a (L e a • CL d c m d c rr`I��v y E r- c ° c �1 A ciao U) ov �ici Parcel #: 032-1003-80-000 03/23/2006 12:34 PM PAGE 1 OF 1 Alt. Parcel M 2.31.19.21 B 032-TOWN OF SOMERSET Current 1XI 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 JOSEPH J TR RIVARD O-RIVARD,JOSEPH J TR 2378 HWY 35 NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *2378 HWY 35 SC 5432 SCH D OF SOMERSET SP 1700 WITC I Legal Description: Acres: 9.450 Plat: N/A-NOT AVAILABLE SEC 2 T31 N R19W 9.45A E1/2 NW1/4 COM CEN Block/Condo Bldg: SEC 2 S 88 DEG W 126.83'TO WLY R/W HWY 35 N 11 DEG W 1311.43'ALG R/W TO POB S Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 89 DEG W 951.58'N 460.11'E 89 DEG E 02-31N-19W 825.81'S 15 DEG E 444.64'S 11 DEG E 31.33'=POB Notes: Parcel History: Date Doc# Vol/Page Type 09/22/1999 610819 1458/241 WD 07/23/1997 823/136 07/23/1997 808/352 07/23/1997 785/163 2005 SUMMARY Bill M Fair Market Value: Assessed with: 76560 228,100 Valuations: Last Changed: 07/22/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 9.450 80,200 103,400 183,600 NO Totals for 2005: General Property 9.450 80,200 103,400 183,600 Woodland 0.000 0 0 Totals for 2004: General Property 9.450 80,200 103,400 183,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 121 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �O e (� , �a��/ TOWNSHIP 171 SEC. pZ T _N-RW ADDRESS /�j�X/70 C � ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM - INDICATE NORTH ARROW 2 BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: 1/0.:,*1 :5 SEPTIC TANK: Manufacturer: Liquid Capacity: ,2-�� Number of rings used: 3, Tank manhole cover elevation--- _ _ r / 'v Tank Inlet Elevat n: % Tan Outlet Elevation: Number of feet from Barest Front Side Rear, d feet From nearest property line � Front,O Side, Rear,O .Ji feet Number of feet from: well building: ,Y' (Include this information of the above plot plan)( 2 reference dimensions to seftic tank) SEE REVERSE SIDE 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 Bed: Trench: Width: Lengfth: rj'3.� Number of Lines: Area Built: 6� r Fill depth to top of pipe: Q .d Number of feet from nearest property line: Front, O Side, 0 Rear,0 Pt .0 Number of feet from well: to .dL S o / Number of feet from building: (Include distances on plot plan). , / ,Q SEEPAGE PIT 9y, 7A / 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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector. Dated: �a~ �� Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINGS LABOR& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISONI,WI 53707 NEz,NW!4-jS2,T31N-R19G/ CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: (If assigned) Town o4 SomeA.6et ❑Holding Tank E:1 In-Ground Pressure El Mound Highway 3 5 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Jae R.i,vGAd Rowe 1, Box 170C, Somex6et, W1 54025 „tilt BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.'. Name of Plumber: JMPIMPRSW No Cnumy. Sanitary Permit Number: Byron Bid Jtc. 3318 St. Croix 112792 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. ANK OUTLET ELLL,,,EEEV RNING LABEL LOCKING COVER 016440 Id-D /V S.3� n�/ / P OVI E S PROVIDED: \r/f V V i-1r YES ONO ❑YES NO BEDDING: VENT DI-A.'. VENT MATT HIGH WATER NUMBER OF ROAD: PR ERTY WELL'. BUILOING'. (VENT TO FRESH ALARM FEET'FROM. E' AIR INLET'. DYES ONO EYES 1:1 NO NEAREST DOSING CHAMBER: MANUFACTURER. BEDDING- LIQUID CAPACITY PUMP MODEL PUMP;SIPHON MANUE ACTHREH WARNING LABEL LOCKING COVER PROVIDED'. PROVIDED: ❑YES ONO ❑YES ONO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER %PHOPERTY WELL BUILDING VENT LE FRESH (DIFFERENCE BETWEEN FEET FROLINE AIR INLET PUMP ON AND OFF) ❑YES 1:1 NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing I E N(iTTI JOIAMF TER MATERIAL AND MARKING, or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: -WIDTH LENGTH LN OF UISTH PIPE SPACI NCB COVER JINSIIA DIA -PITS LIQUID BED/TRENCH �� NCHES MATERIAL PIT DEPTH. DIMENSIONS GRAVEL P H _FILL DEPTH U .PIPE OISTPE DISTR.PIPE MATERIAL NO DISTH NUMBER OF '.'.PROPERTY WELL. BUILDING'. VENT TO FRESH BELOW PIPES ABOVE COVER INLI I ELE V.E PIPES 'LINE AIR INLET'. i=I:ET FROM NE�IRI=ST-�=-lr► 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. ❑YES NO SOIL COVER TEXTURE 1,011 HMANI N 1 11 HKEHS OBSERVATION WELLS _ ❑YES ONO DYES 1:1 NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BEU DEPTH OF TOPSOIL S()DDF I) SEEUFD MULCHED CENTER EDGES ]YES ONO DYES ❑NO ❑YES 0 N PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. :BED/TRE.WCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL No DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELE V.. ELE V. DIA. ELE V. PIPES DIA.'. ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECT I Y COVER TEHIAL VERTICAL LIFT CORRESPONDS TO APPROVED 160. VMt7 INFORMATION 5� PLANS EYES ❑NO o P� 1:1 YES NO PERMANENT MARKERS: OBS A EL IN UMBT:R OF PRQPE RTV WELL: BUILDING. COMMENTS!: T N FEET'Fi;OM 7 ' LI NE: I f� ❑YES ❑NO ❑YES ❑NO NEAREST-- i a p � Row Pds � � � 8�� �J � aa. 0 3 I `{ v u S Key l , l �.� -7 73yrand,�( SSO 0, Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE: DILHR SBD 6710 (R.01/82) Zoning AdmminiztAatotc DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING ,MADISOIN,WI 53707 NB%,NGI% �-pI,S2,T31N-R19W CONVENTIONAL El ALTERNATIVE State Plan l.D.Number: Town G4 N. Someuet ED Holding Tank El In-Ground Pressure El Mound (If assigned) Highway 35 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Jae Riva&d Rodte 111, Box 170C, Someuet, W1 54025 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County Sanitary Permit Number: Bynan Bitd J,%. 3318 St. C)Loix 112&30 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OYES ❑NO OYES ONO' BEDDING: VENT DIA.: I VENT MATLL. HIGH WATER INUMBER OF' ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM. FEET FROM LINE: AIR INLET: EYES ENO EYES ❑NO NEAREST. DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES FIND ❑YES ❑NO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: Nli)MS fr^fi OF PROPERTY WELL. BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) ❑YES 1:1 NO t*AR�T' .SOIL ABSORPTION.SYSTEM.Check the soil moisture at the depth Of plowing 1 LENGTH DIAMETER. MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until 1=fSfC the soil is dry enough to continue.) + CONVENTIONAL SYSTEM: y WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING. COVER ;INSIDE DIA.. #PITS: LIQUID TRENCHES. MATERIAL: P, DEPTH: GRAVEL DEPTH FILL DEPTH DISTR_PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR .OIx 'PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES- ABOVE COVER: ELEV.INLET.ELEV.END. PIPES: I"w�wT :`.LINE: AIR INLET: 1V.EA'REST 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 PERMANENT MARKERS OBSERVATION WELLS 1:1 YES 1:1 NO DYES 1-1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED. JSEEDFD MULCHED: CENTER. EDGES. ❑YES ❑NO ❑YES 1:1 NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: y� a WIDTH: LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: t�F Nyy ELEV.: ELEV: DIA.: ELEV.'. PIPES'. DIA_: 1 � MIM HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: 1:1 YES ONO ❑YES 0 N COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: Ov PROPERTY WELL: BUILDING: "Tf-ce � LINE: L1 YES 1:1 NO El YES 1:1 NO � F Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710(R.01/82) Zoning Admini-St a tan SANITARY PERMIT APPLICATION COUNTY CILHR In accord with ILHR 83.05,Wis.Adm.Code 5, 6 r / ATE SANITARY PERMIT# V —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 I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO PROPERTY OWNER PRO ERTY IQCATION S T , N, R E (o PROPERTY OWNER'S MAILING ADD SS LOT NUMBER BLOCK NUMBER SUBDIVI O NAME 12e a CITY,STATE ZIP CODE PHONE NUMBER CITY EAREST ROAD KE OR LANDMARK c, VILLAGE' G II. TYPE OF BU DING 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.RI New b. El Replacement c. ❑ Replacement of d.1:1 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. ZConventional 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) r 1. a. ee a e Bed b. ❑seepage Trench c. ❑Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION ARE 5.SYSTEM E TER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square F et): I;p L �/� �jZFeetP ivate ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Na Concrete Con- Steel glass Plastic App Tanks Tanks cted Septic Tank or Holding Tank El ❑❑ ❑ ❑ Lift Pump Tank/Siphon Chamber El 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) MP/MPRSW No.: Business Phone Number: �-F 7;zo' 7X5 0- Plu er's Address(Street,City,State,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil ster(CST)Name CST# 112 � 7 CST's AD ESS(Street,Cit ,State,Zip Code) / ! Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Is ,ng Agent Signature(No Stamps) Approved ❑ Owner Given Initial urcharge/Fee Adverse Determination ` �2v'Uj .� 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 i INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION x 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. A(I,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; 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 biH Ground included the creation of surcharges (fees) for a number of regulated practices which Wisco can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried rec33tlfQ is used in your building is returned to the groundwater through your soil absorption e system or the disposal site Used by your holding tank pumper. 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- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) DEPARTMENT OF REPORT _ON SOIL BORINGS___A_ND SAFETY& BUILDINGS, INDUSTRY, __ _ DIVISION P.O. BOX 769 'LABOR AND PERCOLATION TESTS (115) MADISON WI 53907 HUMAN RELATIONS (ILHR 83.0911)& Chapter 145► LOCATION: SE B_LK.N_O SUBDIVISION NAME: � W / 11 D tr COUNTY AME: ADDRESS: �st Q C CJ USE DATES 6tSERVAT14 NS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE IONS: PERCOLATION TESTS: �esidence �- _ New ❑Replace � �S�,Qt„r '3 RATING:S-Site suitable for system U=Site unsuitable for system ONVENTIONAL: MOUND: IN-G ROUND:PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) S ❑U 1 00 S ❑U S ❑U I ❑S LOU I ❑S OU I 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),i icate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL EL V TION P H T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER EPTH IN, OBSERVED S I HES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- � a � � 3a dr /.S .tea --"-/ .5 B- Z off• �� B- PERCOLATION TESTS TEST DEPTH ATER IN 0LE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AF R S LLING INTERVAL-MIN. PERIOD 1 PERIOD 'PER INCH P- G P- .2 L rP 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. L d e 7p 1. SYSTEM ELEVATION /dG DPI ys ..�. �v o 0 ,Ba n Lc A f 644o V � o w� - s �� �IU• �00 � � �r S\ i 192o,,-AC/ 1 t 00ytip-a 1 W Io``L. .c. P f oZ b 1 * a� It A 1, tneWdersignea,hereby certi y at a sot tests reportea on this torM were made by me in accord with the procedures and methods specified in the s nsins�� 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: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): CST SIGNATURE: 1 DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester, nit WR-ccn Az or iR Iniaof __ SANITARY PERMIT APPLICATION COUNTY ` EZ DILHR �,.,ov�..,,..,�...o,. In accord with ILHR 83.05,Wis.Adm. Code STATE SANITARY PERMIT# //,g ,-/92 —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 9 NO PROPERTY OWNER k PROPERTY LOCATION /a `(/�'/a, S T , N, R-If E (or PROPERTY OW R'S MAILING ADDRESS LO NUMBER BLOCK NUMB SUBDIVII N NAME G ;O =_ CCI ,STATE ZIP CODE PHONE NUMBER CITY NEAR RO AKE OR LANDMARK Q --- 0 TOWN OF*VILLAGE: ! 40 11. 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. �(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. Deseepage Bed b. ❑Seepage Trench "c. ❑Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA SYSTEM EL ATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): L Col Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total ##of ab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic A Tanks Tanks structed pp. Septic Tank or Holding Tank El 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): I Plumber's ' nature:(No Stamps) MP/MPRSW No.: Business Phone Number: /7 er's Address(Street,City,State,Zip Code): Name of signer: VIII. OIL TEST INFORMATION Certified So Tester(CST)Name f CST## CST ESS Street,City, ate,Zip Codel Phone Number: Ae%plz 4,IX. CO NTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee V5��dwater ate Issuing Agent Signature(No Stamps) Approved arge Fee pp ❑ Owner Given Initial 13 12.E OCR � _ �.��Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: _ ktk--,o 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; \/I. 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; (lose 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 ncluded the creation of surcharges (fees) for a number of regulated practices which Wisco i t1'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried Sur 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 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- f water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) APPLICATION FOR SANITARY PERMIT a STC - 100 Ia I} 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/contractAr•, ("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. - - - - - - - - - - - -.- - - - - - - Cj Owner of Property �S�✓�#$ Vv4aaz�) Location of Property _, W k, Section , T 3a N - R W Township C ?tTT Mailing Address �JaX 1"�l� C. Subdivision Name Lot Number — ' Previous Owner of Property ,�pt}«L �,A0 Total Size of Parcel +� Date Parcel was Created b Are all corners and lot lines identifiable? x Yes No Is this property being developed for resale (spec house) ? Yes X No Volume Z!?7 and Page Number 3So as recorded with the Register of Deeds _--INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty De 2. Land Contract 3. • Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to. avoid delays of the reviewing process. If the deed description references to a Certified Survey' Map, the the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTV OWNER CERTIFICATION 1 (We) eenti6y that a t statements on this 6onm aa.e true to the but o6 my (our) knowledge; that 1 (we) am (ate) the ownerla) o6 the pnopenty desehi.bed in th" in6onmation 6onm, by viAtue o6 a wavLanty deed n.eeon.ded in the 066ice o6 the County Reg.i.&ten o6 Deeds as Document No. 44A 5170 ; and that I (wei p4es entty own the proposed site bon, the sewage pos a ys tem (on. i (we) have obtained an easement, to nun. with the above desenibed pnopen.ty, bon the con, ucti.on o6 said bystem, and the same has been duty xeeo)Lded in the 06jtee o6 the County Reg"ten. o6 Deeds, as Document No. 441 Sci© ) . n S NATURE OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED DOCYYEN STATE BAR OF WISCONSIN—FOAM 2 • I ^'.• WARRANTY DEED 44 0 Boax 823 'Pa-t 136- T"MALLnf/ ft=MM0M"DATA John Hans Stockstead, an individual ReGi5TERS OFFICE ST. CROIX Cg.,-,W4&_. • Reed. for Recd this20th� conveys and warrants to J09011 J. Rivard 7 Of Sep-- �• 19gs 11 :15 A. AA. i wsktv'v!tHad� a'4M T. LUDVMN S.C. the following deeorll»d real estate In—St- rrn i Y Attomey at Law state of Wisconsin: CO1"�� P.O. Box 337 208 Cascade Street Part of the Eli of the NWh of Section 2-31-19 Osceola, Wisconsin 54020 described as follows : Commencing at the center of said Section 2; thence S 88058147" W ,126.83 feet to Tax Key No. a point in the Westerly Right-of-way line of State Trunk Highway "35" ; thence N 11016'09" W 1 ,311 .43 feet along said Right-of-way line to the Point of Beginning; thence S 89001108" W 951 .58 feet; thence N 00014'00" W 460.11 feet; thence N 89001 '08" E 825.81 feet to a point in the Westerly Right-of- way line of State Trunk Highway 1135" thence Southeasterly along said Right-of-way' line on a curved line, concave Southwesterly, having a radius of 2,764.79 feet and long chord bearing S 15052'35" E. and arc distance of 444.64 feet; thence S 11 0 16 09 E 31.33 feet along said Right-of-way line to the Point of Beginning. gK NSF�n . Thlsaq(is SQ�o homestead property, Exception to warranues: easements* reservations, and rights of way of record. Dated this � day of September 88 (SIL44 (116044 • John Hans Stockstead (SEAL) (gL44 AUTHENTICATION ACKNOWLEDGEMENT SIQMtw"authenticated this day of STATE OF WISCONSIN County. Personally came afore me. this _..L� day of • September '19 88 TRLE: MEMBER STATE 8AA OF WISCONSIN pt not, __._r , _the above named P__afi _ _ Ln H 9 STC - 105 r r a y SEPTIC TANK MAINTENANCE AGREEMENT H 0 St . Croix County z cy 9 �` �V A R OWNER/BUYER �� �= � ROUTE/BOX NUMBER bzoul-e T30yC 1--to G Fire Number CITY/STATE �r�tE�SET� W1 ZIP �4o'ZS PROPERTY LOCATION : lip 4 44, Section T N , R 19 W, Town of SpMF'WSV'= St . Croix County, Subdivision ----- Lot number I Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists 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 treat- ment 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 will be sent approximately 30 days prior to three year expiration . H 0 I/WE, the undersigned , have read -the above requirements and agree 09 to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- w 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 h DATE— „ZI� 88 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 . i DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS, ' INDUS•TRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O.MADISON WOI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) CAT EC ON: !!T UNICIPALITY: LOT No .:BLK.NO.: SUBDIVISION NAME:�/ �1�/ /T / N/R/ (or)W TY: N ER' NAME: MAILING ADDRESS: USE DATES 611SERVATIONS MADE 13 NO.BEDRMS.:1COMMERCIAL DESCRIPTION: � IPROF S: A TESTS: lesidence _ New ❑Re lace RATING:S-Site suitable for system U=Site unsuitable for system ONVENTI NAL: MOUND: ItV-GROUNUPRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) S eau eau osRJu [is oxe; If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the Ole under s. ILHR 83.09151(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER EPTH IN, OBSERVED EST.HIGHEST— TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) dr 15 .tea - -5 B- I a z � > ��< &--4dl- AS -Orl ga B- oel < G/ B- ��f- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD PER INCH P_ I AOil.-< G gr P L 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 Z&4- • a Rev y5 f@l>:- /• 0 0 Aj lob P-s.c"I t 44o ..i ♦ rte 10?w To/ a `/e Ay w� f e1b N I�C/ ( ad1,,1 y ��� /4,s 6 w o °0 I - 105t., BR0 �f• j 10 . OP f ia �' S1�ra y //e 0 10 • o' To 140 .0-j0.4, I, Trye NVaersignea, Hereby certl y a e soil tests reportecl on this form were made by me in accord with the procedures and methods specified in the s nsinsro 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: ►: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): t" 0 76/ CST SIGNATURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. i_ 1111 wo car)cone ro In/Q�l ` PLOT PLAN P-R OJECT � G ADDRESS E D 1/4 INA/4/SeA /T /N/R� TOWN e COUNTY MPRS Byroi Bird Jr. � e DA E BEDROOM CLASS PERC/CONVE TIONA _ IN-GROUND PRE RE CONVENTIONAL LIFT MOUN HOLDI G TANK SEPTIC TANK SIZE / - IFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA —� PERC RATE BED SIZE Benchmark V.R.P. Assume Elevation 100' Location of Benchmark * H.R.P. 0 Borehole Q Well Scale Feet 0 Perc Hole System Elevation Uent 12" Gradp TYPAR COVERING 2" 12" 3' 4 s. D 3' I 6" Sewer Rock 12' 3y ��'by