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HomeMy WebLinkAbout038-1009-30-000 (2) N o 0 Ors �. d � 1 I ° 2 t y qb o U) o a m c o d o T ? Cm Z N C C j 03 7 6 L OO cc� LL \J o 2,6 77 C 3 M E Q y o 0) to N v CL (D N Z , w O M W d m M H Z ! I o I II O z a°i Z v w o F ! z ° 2 M rn � � I •� o c Co U m w N a Z Z I "Its N � I 7 ^ y�y E N N 0 � Ca U-) L4 G oG $ a ! E M N Co Co = CO d z - o �. r 6 o E O 0 O z •N aaa IL oU) } (Drn N Q } cn O In w O U) C N O C� W O O L? M O C U O O L M M O C N N fn 42 p � O O N y 7 N_ 0 � d Y O d N Z C N O ►.� AMY c N mt �O oocn W` ro z = � min V� y it a a € o � a • e G 6 :V d m c _1 A vt jOmti IL Y N 8 90 321 E YS 3 O o, 246.76 iV) 0 � M ti 2 4 0. 1 45) ry 223.19' S 86'16 F 4C z C& V1. 4 B ° Q; 200.91' 4XII zoo. y. .t . 2 02 G '• 'y t 01 ^ 5 • 1 2004 I • jj I t • : , � J • I i �P } . Ory�!VJ IN- Y:. e�[VP •t 7 260' ' Scaled - 100 r e NJ N 860 I F; .W �:�. May 27, 1968 w a,y ..... .. How and R .(rust , Re a Q. 9 7 4 11' c., .. Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. _ T _ N-R _W ADDRESS ST. CROIX COUNTY, WISCONSIN -him t SUBDIVISION LOT LOT SIZE /ilk 7 5_ PLAN VIEW l Distances and dimensions to meet requirements of I•I,HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /TQ CL. j' 6 o' v of l Q wo to �� 721 o57' INDICAT TH ARROW BENC . De-scribe t errt'icpl eferene . int`used Elevation of vertical reference point. �;oD-- ,06_ Proposed slope at site: SEPTIC TANK: Manufacturer: �� eaW, /r4A,L.Lk1uid Capacity: 1--Bea-2W Number of rings used: Tank manhule cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet fr m pea e,:L Road: Front,O Side,O Rear, G_40/ feet From nearest property line FronL,O Side,0 Rear,G____ze_46 feet Number of feet from: well _ building: (Include this information of the above plot plan)( z_reference dimensions to septic tank) c PUMP CHAMBER Manufacturer: � � �M• Liquid Capacity: . T� Pump Model: _ :2 __ Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: f Lac Alarm Manufacturer: ,� � �. Q 4pAlarm Switch Type: Number of feet from nearest property line: Front, Side, O Rear,efoFt. A Number of feet from well: J Number of feet from building: (Include distances on plot plan). /a SOIL ABSORPTION STEM �^ "`-'F-'�•-�-v Bed: Trench: Width: s�P Length: Number of Lines: Built: ;® ll Fill depth to top of pipe: �/ fv Number of feet from nearest property line: Front, O Side, O Rear,�pt . /Y Number of feet from well: J�� � 5 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). 1P TANK -Manufacturer: Capacity: At Number of rings used: Elevation of bottom 04f,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: IV d Inspector: Dated: '— Plumber on job: L-O7� License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS .LABOq-&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 NE%NUI%,Sec. 3, T3-R18W El CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: Town o4 Stan Pna,(tie (If assigned) El Tank In-Ground Pressure El Candinat Dn. NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Jon Etickson Rt. 2 Box 111 New Richmond, wI 54017 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.EL V.: 1 CST REF.PT.ELEV.. Name of Plumber-. MP/MPRSW No County Sanitary Permit Number: Henry Neeh.vitte 3258 St. Croix 128656 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER /�.�JJ d PROVIDED: PROVIDED: t/V < v� 0 361 V` V? ES ❑NO 1 OYES NO BEDDING: VENT DIA.: VENT MATE.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING VENTTO FRESH ALARM: LINE: 2� FLAIR INLET: FEET FROM `3 q /v � -]YES O �. / ❑YES ❑NO NEAREST S` DOSING CHAMBER: MANUFACTURER 1BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. 1WEVES ARNING LABEL LOCKING COVER J /,�,� !� PROVIDED: P CKING : i/ YES ONO / vvv / (TZ�C �I 1:1 NO YES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PINE WELL B iDING. AIR IN FRESH (DIFFERENCE BETWEEN / < FEET FROM LINE > AIR INLET PUMP ON AND OFF) V✓ ES ❑NO IN SOI L ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing FORCE LENGTH DIAMETER MATERIAL AN MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN �L 7 the soil is dry enough to continue.) J CONVENTIONAL SYSTEM: WIDTH: ILENGTH NO.OF DISTR.PIPE SPACING. COVER JINSIDE DIA.. *PITS LIQUID B Hst� / TRENCHES. MATERIAL: FIT DEPTH'. GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR NUMBER(}F t PR UPERTy WELL: BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV.INLET ELEV.END PIPES. LINE: AIR INLET: �7 FEET FR(;1M r 5 6 /' 5 6 NEAREST 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. El YES ONO SOIL COVER ITEXTURE PERMANENT MARKERS: 7BS E RVATION WELLS❑YES ❑NO DYES NO DEPTH OVER TRENCH DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED SEEDED: MULCHED. CENTER. EDGES. DYES ❑NO ❑YES ONO IIll YES El NO PRESSURIZED DISTRIBUTION SYSTEM: eye _ WIDTH-. LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: C7!tIREIH, TRENCHES: i MANIFOLD PUMP MANIFOLD DISTR.PIPE �MANIFOLD MATERIAL. INOEDISTR, DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKINGELE VELEV.. DIA ELE PIPS: CIA: t13iT _S -l o twoflMATION HOLE SIZE HOLE SP�NG DRILLED CORRECTLY COVER MATERIAL: PLANS LIFT CORRESPONDS TO APPROVED S°4��,� ES 0 N ES El NO PERMANENT MARKERS: OBSERVATION WELLS: PROPERTY WELL: BUILDING: RO COMMENTS: NU1E,R a13F ,;LINE, YES ❑NO ES ❑NO NEB E$ IBS � rt Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: � TITLE. DI LHR SBD 6710(R.01/ SANITARY PERMIT APPLICATION aJUILHR In accord with ILHR 83.05,Wis.Adm.Code couN v Cv -TT-AT-9 SANITARY PERMI # –Attach complete plans(to the county copy only)for the system,on paper not less than ❑ / �Ce 8%x 11 inches in size. neck if revision to p evious application -See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION `C'��(/ �''/a iv%,S R E(or W PROPERTY OWNER'S MAILING AD ESS i CO-T# BLOCK# T Cl ,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAMEFXUMBER f? 7 CITY f NEAREST ROAD l 11. TYPE OF BUILDING: (Check one) ❑State Owned ❑ LAGE: ❑ Public 1 or 2 Fam.Dwelling–#of bedrooms PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public,check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. 2 Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit## — Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 El Maund 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/da s ft.) (Min./inch) ` ELEVATION r Feet Feet VII. TANK CAP Site in allons Total of Manufacturer's Name Prefab. Con- Steel Fiber- Expp. INFORMATION New Existing Gallons Tanks Concrete glass Plastic App Tanks Tanks struct d Septic Tank or Holdina Tank Lift Pump Tank/Siphon Chamber Y VIII. RESPONSIBILITY STATEMENT [,the undersigned,assume responsibility for installation of the onsite sewage system s own5altilt attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) M MPRSW NO: Business Phone Number: Plumber'd Address(Street,City,State,Zip Cod d)- w e� S­ s- av ' IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(Includes Groundwater ate Issued issuing Agent Signature(No Stamps) Surcharge Fee) ^ A Approved F-1 owner Given Initial / �t �o Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: f SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber INSTRUCTIONS , 1. A 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. 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. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety &'Buildings Division, 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 and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete##of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. 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. IX. County/Department Use Only. X. County/Department Use Only. 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; pump or siphon tanks; 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; and F) all sizing information. ti GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398(R.11/88) k � o 0 2 E- ? o � O k (1) V) OL w aLQk Cj 0 � � 3 ku i4j O � cA C h Ln I I l 0 O CA- Se �. M Ck P 5lope M \ 1 i � : DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, c DIVISION LABOR HUMAN AND PERCOLATION PERCOLATION TESTS (115) MADISON BOX 969 0LHR 83.0911)&Chapter 145) LOCATION-� j SECTION: u/D/ ( 1 TO S��P� �lE OT NO.:BLK.NO.: SUBDIVISION NAME: COUNTY: OWNER'S BUYER'S NAME: ILIN ADAR ESS: 51-- coeoi x 3-0,j �����cso•� 1 +.2: cm u1 AitA , R t c 14At=, ,D wt S . USE Z 30 DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DES RIPTION: S: A N TESTS: Residence 2 /y i /� ❑New�p Replace /v//4 3D_ f> /T Q l RATING:S=Site suitable for system U=Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(o tional) ©S ❑U ❑S ®U R S ❑U ❑S U ❑S ZU ?� 6';&ot�w F1-kE-ssuPr~ >: CeC iV t-o E ' .X - 33'CD DESIGN RATE: If Percolation Tests are NOT required DGG If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: S S ' Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS )nJ _;e77— BORING TOTAL DEPTH TO GROU NDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED I HES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- g.0� 93,`IS yip y 00, S/, .P3 ' �sy. s �.Z " 40A ,c u.,,� o S , a R V'Q_ B-6 97.00 > �S ( •�O� ' t7,r (3� . sI. �, 33 ` _ ,�, . S1 � 1. 0 ' Gy �'l o B- B- 7 �• 5 q7 �6� AO 9, 5 ' • �9 ' ��-. ,¢.o . s 42S ' E a s B- eo�2� S wl` 5,p B_ 1A-) 'DecimA L f4- - PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL-MIN. P 10 1 P RI D PER INCH P- t t P_ / P- 2- 5150 O 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. / � �jV vre�i�TS /�T�/���5 !.!��T l�L.- SYSTEM ELEVATION / _ I / -D ' c .4A�> `" T tN 4 i : i I i F .. .._,_ RS E''- - E I ' I , _ } °r - i I I L i i �_ .. 1 I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME print : TESTS WERE COMPLETED ON:16 ' HOMESITE SEPTIC PLU,'ABIN6 CO. �J_ / -- � ADDRESS: ROBERT ULBRIGHT CERTIFICATION NUMBER: PHONE NUMBER(optional): WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. � Y .11 54P l S MINN.'!STALLER 8 CC-SIGNER LIC.NO.00663 CST SIGNATURE. DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R. 10/83) —OVER— S89 - 40323 I ,L .H.R. 83, 08(2) PROJECT INDEX SHEET - Owner: OAJ (!5�eiG/C',-o/J Address : CAP-PiVAL �Z)Ri UE Site Location : 3 , T Tow of ST�Q PQ�1lal� y dr S�+ G.o I'X co ry Project Description : X i ST►�1 Coa �'"'f i ,1 L Sy S�E� <iN Mo7`1�'LEO ;. 50iL - See 115 M�Y 8 I i efl s Fq�c �a w . svifitQIc- s�fE- X09- 4 R&pi-ACE-4eAJT- 10410 1 t�• (,� c ` FI AL) 4e l AJ 7�' flf ">��`'1�E tiJ 7�" / S +7 � C Ae S f I. SOILS IIJ 12U POSED P�'i}CE�-tEv'�' /g"121�'9� •..7'f�Q�' i 5 0(T-ok f3 t r- Fo P,. ,�- CD,v � �+t cw L S y STEM .( ,��A S s - � . A./ �N�1 �ou�O p�2�sSve�- SYST�� IBS ��� C'OS�� • ' 0. ft- -L- eZAILy wS-i iEr flow Fay Z U . ` a 40 At� sr2,16�47 Page 1 . PLOT PLAN VIEWS Page 2. -CROSS SECTION & SYSTEM PLAN VIEWS Page 3. PIPE LATERAL LAYOUT "~°~• Page 4. DOSING CHAMBER CROSS SECTION Page 5 . PUMP PERFROMANCE SPECS • I PLUMBER : , PATE: SITE EVALUATER/ DESIGNER SIGNATURE HOMESITE SEPTIC PLUMBING CO. 666 O'NEIL RD.,HUDSON,WIS.$1016 ROBERT ULBRIGHT WIS.MASTER PWMBER LIC.NO.3W M.P.R.S. MINN.INSTALLER W$IG1ER LIC.NO.00663 I d � p< a. now IT ar 0 s q�s v p�. .f r • • • d 0 -4 } it �o 7D C co a aM -)0 V% Zi 187 d Ab i � N i m 4. -� � y o rn RI r p Ln Cr, N " n c„n P 7'1 • 1 �, e�t— r-•r. 2 1 s P• � r ,s N - ti . a cp cP ' .......ti► li —TJ (� T cn a G S -o Ot o � Y c i C*j PAGE PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP 'i"C.I. VENT.PIPC WEATHER PROOF APPROVED LOCKING � 25' FROM DOOR. JUNCTION BOX MANHOLE COVER 41401,00-IAW WINDOW OR FRESH / AIR INTAKE I �E�.t70N es.0 GRADE I i 'I"MM. yN CONDUIT —�---- I 3.0 ` i � ` PROVIDE ( ------ INLET is -T " 0 E SEWAff WSYEk4 APPROVED JOW 0/A I I I APPROVED JOIWTS W/C.T. PIPE C��Y' ,^ �; I V I I I W/C.I. PIPE EXTENDIM& 3' �1 �' ( I B a i , Y I M EXTENDING 3' ONTO $O ALA OWTO SOLID SO IL„ Lr i C DEPARTti;E4S O7ri„'W”, 'yJR APt I 4N D HUMAN RELATIO S d OF E7` IVD.BUSLDIN6SLLEV. FT. �J S U M P OFF ° ��i fi E Tit ESPOHDENCE %fi►,J K ��D p1a 6- �/�v>�tf�oJ COLICKETE BLOCK 9i RISER EXIT PERMITTED ONLY IF TANK MAIJUFACTIJRE HAS SUiGr.H�-APPROVAL SEPTIC SPECIFI�CArI0M S DOSE i 1, TANKS MANUFACTURER:wEE�s IJUMBER OF DO ES: `' PER DAB I I' TAWK SIZE: IOOO GALLOWS DOSE VOLUA4 S?t) ALARM MANUFACTURER: AUle l— 4ko.4f � • INCLUDING BACKPLOW: /� GALLONSr MODEL ►DUMBER: I.U. L CAPACITIES: A=!!�W N SS ORT*Q GIiG.LO NS SWITCH TYPE: - lj 1k Co R Z 36 r 5= IWCHEa OR WILLOIJS PUMP MANUFACTURER:- C=$ IWGHES OR AA1.L01J5 � MODEL NUMBER: 9 7 %2 �+ 2" i INCHES OR G LO S SWITCH TYPE: L&,184ck H"cu//c/ F 0.4 S NOTE: PUMP AND ALARM ARC TO At ' MINIMUM DISCHARGE RATE 50 GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. '� FE ET' ^A�k SPELS ♦ MIAIIMUM NETWORK SUPPI.y PRESSURE . . . . .. . . . . . 2.5 FEET EA f- 'I) Ly�^^ P ♦ FEET OF FORCE MAIN X L 23 FYo FRICTIOW FACTOR- 09 FEET TOTAL OtIWAMIC. HEAD = / ' 3 FEET., INTERNAL. DIMENSION& OF TAWK: LE H ;LIQUID DEPTH -- A ;WIDTH �.r� q f SI(LNEO: LICEWSE DUMBER: DATE:..___ I i' I HEA DI ,1S %� %� 105 30 100 — CURvwmbm zs 90 26 as ONS'iTi' SEVJAL SYSTEEFFLUENT 24 MODEL O 75 MODEL 189 4 r, ��9 and a 22 ,65 r DEWATER/NG W 70 n r 20 65 I DEPARTMENT Oi INDU✓; '= 05 '89 10:02 BAKKE NORMAN SCHUMACHERA P.2/7 s EASEMENT AGREEMENT This agreement made this �Tday of 1989, by and between Keith E. Maxwell and Nancy Maxwell, husband and wife (hereinafter MAXWELLS), and Jon A. Erickson and Gloria Erickson, husband and wife (hereinafter ERICKSONS). MAXWELLS are the owners of certain property described in the deed recorded in the St. Croix County Register of Deeds office in Volume 836 of Records on Page 136 as ?document No. 446251. ERICKSONS are the owners of certain property described in the deed recorded in the St. Croix County Register of Deeds office in Volume 537 of Records on page 313 as Document No. 333057. MAXWELLS have agreed to grant an easement to ERICKSONS across a portion of the MAXWELLS' property and this agreement is made to evidence the grant of that i easement all on the terms and conditions set forth herein. Therefore, in consideration of the mutual covenants contained herein, the parties agree as follows: 1. MAXWELLS grant to ERICKSONS an easement to install and maintain a t. residential septic system on and under the property described in Schedule "A" attached hereto, which easement is subject to the conditions set forth in Paragraph 3 of this agreement, j t 2. In connection with said easement and sanitary residential septic system ERICKSONS agree as follows: A. To pay for the installation of the septic system according to present required standards of the State of Wisconsin. B. To maintain the septic system in good working order at their expense so 'as to cause the least interference with the remainder of the MAXWELLS' property. ' C. After the installation of the septic system to bring the property to the same approximate grade and sod or seed the same to bring it to a lawn condition. 3. This easement shall extend for a period of 99 years commencing with the date of this easement agreement and shall run with the land owned by ERICKSONS during that Vac �Si7 R4 c Z, `1 Jk I O c O > m N f S '99 10:03 HAKKE NORMAN SCHUMACHERA p.3/7 period. The parties agree, however, that the easement will terminate under either of the following conditions: A. As such time as the ERICKSONS'property is served by a public sewer system and ERICKSONS are afforded a reasonable opportunity to Connect to such system. B. At such time as a subsequent purchaser of the MAXWELLS'property would be unable to finance the purchase of the property using a real estate mortgage on the MAXWELLS' property as security solely because of the location of the ERICKSONS' septic system on the MAXWELLS'property. Any subsequent purchaser would be required to give 60 days notice to ERICKSONS of the fact that he or she is unable to obtain such mortgage. ERICKSONS would then have the right during that 60 day period to assist the purchaser of the MAXWELLS' property to help him or her secure a mortgage. If a mortgage cannot be secured and the matter could be resolved by ERICKSONS purchase of the easement property, then ERICKSONS shall have the right to purchase the easement property for its fair market value as determined by an appraisal. If the condition cannot i be removed by ERICKSONS purchasing the easement property then the easement will expire one year after the 'end of the 60 day notice. 4. This agreement shall be governed by, construed and enforced according to the i laws of the State of Wisconsin. 5. This agreement shall constitute the entire agreement between the parties. Any modification of the agreement or additional obligation assumed by either party in connection with this agreement shall be binding only if evidenced by a writing signed by both of the parties. 6. This agreement shall bind the parties hereto, their successors and assigns and rights given to either party and the terms and conditions of this agreement shall bind and inure to the subsequent owners of the MAXWELL and ER' ICKSON properties. 7. This agreement is an amendment to the Easement Agreement recorded in the St. Croix County Register of Deeds Office in Volume 848 of Records on Page 508 as 2 0 ti 0 "_• 05 '89 10:04 BAKKE NORMAN SCHUMACHERA P.4i7 9 Document No. 450570 and intends to amend only the legal description of the easement but in all other respects confirms the original agreement. IN WITNESS WHEREOF the parties agree and have set their hand seats on this agreement the day and year first above written. eith E. M eIl Z Ad-1- cy M ell J. 2 r n A. Erickson Vj Io is Erickson C STATE OF WISCONSIN SECRO t K COUNTY ss. Personally came before me this *day.of - 07t 19 th E. Maxwnen Nancy Maxwell to me known to be the persons who executed the egoigg instru nd c o wle ed the same. ' Y Notary Public S'.( County State of Wisconsin My Commission &pires p" j 3 �w III _* ed ..w I -- - _ � e s I ' '89 10:04 BAKKE NORMAN SCHUMAO.HERA P.5/7 STATE OF WISCONSIN { I ss. ST. CROIX COUNTY ) f Personally came before me this.�ay of p z) 1989, the above named Jon A. Erickson and Gloria Erickson, to me known t e the person who executed the foregoing instrument and acknowledged the same. to anie A. Desino Notary Public, St. Croix County STEPHANIE A. DESINO State of Wisconsin Notify Pub is-State of Wisconsin f My Commission Expires January 10, 1993 I I 4 o .� 7b a fi c 169 A:05 BAKKE NORMAN SCHUMACHERA y SCHEDULE "A" A sufficient area of land in the Southwest corner of that parcel described in the deed i recorded in the St. Croix.County Register of Deeds Office in Volume 836 of Records on Page 136 as Document No. 446251 (PROPERTY) to construct the drainfield, pump chamber and connection lines in accordance with the map attached hereto and marked Exhibit "B" with the following conditions: I. The drainfield will be constructed as far South and West on the PROPERTY as the 'Wisconsin Administrative Code regulations will allow so as to use as little area-of the PROPERTY as possible. 2. There will be an "as built" map drawn up by the person or entity that constructs the drainfield showing its location in relation to the South line' of the PROPERTY and the East line of the road known as Cardinal Drive. h' is I � i h ;1 !I L€ t - F iI • 'I ,I Li t i. 'ff 1 it I , A w Ik C f�- -� raw > fi •► tz ZIlk 7b ..h qtr i ......................... w N ? v 3do�5 0 tp kln t � I 1 tn 1 � ao Z6 It O R _ cn rn rn c m IA Q c� CD rn C m 0 —� h n n cn C in n 1 Ic tn L �' _ r DO j C R 0 S S S EGTiUti1 — 1N G�oy�t7 �QFSSv R€. BED sC Ait : jiv,'s NCO 9�P.ioE , jY.�(/ n oFF 0E coutA OA i ,gppRovE� i 1 � syN t-�cfi•� ii Al a 9 L�iRFA�tlS' 5ySr6A 91.so., Ii A66'RE�^-r..^ - TO '(3E whS RED • = bleu T(o•a of INU£2 "r- of i y '' LArEieAls u,tbw of To p of I ,q LATEAM S Z , o Pt; A JJ V l LJ OF I M 6-Rlou/,.-)L-) F§ SS O RE BAD i it ya pie w SlAt-1-1411 O b o Sewn// r Cp�QGE , ' C�t�tSt�'� S�'EIVAtx� SYSTEM n.. ;l AWJ HUMAN RELAT10 A Si ;u lir '--:TY i t ��3 r�nt:�c 5 9 t . , L t i DFEPARVI ENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, DIVISION LABOR AND - PERCOLATION TESTS (115) MADISON,°53707 HUMAN`RELATIONS (ILHR 83.09(1)& Chapter 145) LOCATION: SECTION: TOWNSHI LOT NO.:BLK.NO.: SUBDIVISION NAME: Nc- 1/mu) '/ 3 /T 3/ N/R V E( )W S7"fj�E' 14ftlPiE COUNTY: OWNER'S MAILING ADDRESS: 51,�`.PpI1( �bv Z ICIfTO AJ C,¢,PDi,fJ.9 L viP�:l P , /V�LtI /P%G�iMO 6"O/S•. USE DATES OBSERVATIONS MADE NO.BEDRMS.:ICOMMERCIAL DESCRIPTION: PRO IL RIP 1 NS: PERCOLATION TESTS: Residence New RATING:S=Site suitable for system U=Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:Poldi06-1-ECOMMENDED SYSTEM:(optional) IS ®u ❑$ ©u ❑$ ©U ❑$ ®� $ ❑U °oe l'4auao w►�G, If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS 70 'DEC.iMItL -C+ BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. I HES TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) / , r Gy- Ra . 51 6_E"1' 72-r RJQ-OQ CO-MP C7rO B- Z /D/ '74 47' 33 s( -�;I( .67 'f,64 y ,9477. o Ab)9S .83 ' L267N4E O*-fy B- S� fill Hof4t,-O 1,33 ' O ,tF� i- ilk-, oQ *J C_ 5/j, Q C/ 5 "tie-ie- Si l ��I�� , 6 7' 9y DE�.t£ r0-AA4CTED 5; / B- 0 �0 � Z . .S 72 (_-Cal ,S' pie. 0.0 +jie- A"Sr S!/ f ff. OR H6 S 2 S P' ,e,ey SArvDy 0 14% o•l-t ``'/""u'"`� c)iSTi,J, r B- / / B-3 S o .. loS.GG r 3, o 1 . 33 ( I.3 3 ' �Q`Qa �F'�.Sfz S r �I•�� , ,.� ' 01 AAJ IC S; �l w f�-f 0 1 .6 4 k�l S,gNoy e-"y 10-4" w/ 4xs y A57 OA . B- MofS . PERCOLATION TESTS — To /.�E 71 C) y�-7— TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD2 PERIOD PER INCH 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. —_ This test Site NOT APPROVED SYSTEM ELEVATION for a conventio"Ina! septicsys#o ,__ See expla6avoh. ! I S i4 idt, Co t),A.) T 20A.) / --,e_) G--- i �T`D.N1; SD-J h S o,,�rL _.. _ N 000 � - 7'S SiY _..;WOOLD_ WV610 - 1 114/f gvCE _ _.. I `"7t v p}j 7-/;0✓ z COH AC;""J ° T°�' 2`� 3 . L _ 7. C � P :. _� _ ¢',r/ ,c,�r�X��/S � -F�l� sir���� s (y�_�x cuss�v>`- s/o,p>�s ��� N►o o ��_ 11E 16 rTj 1,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin 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): HOMESITE SEPTIC PLUMBING UU, TESTS WERE COMPLETED ON: �+ 655 C'NEIL RD.,hi`I,DSON,WIS.54016 M,I/• is (?7 ADDRESS: ROBEW CERTIFICATION NUMBER: PHO E NUMB (o ttionall: NIS.MASTER PLUM6ER UC.N0:3307 M.P.R.S. y Y P L 3 1 ,F6— ,NO.0%63 CST SIGNATURE L. / r-- - DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHRSBD-6395(R. 10/83) —OVER — o j � � W rw °tom OWL L W yc C6. (J-v O� qe • -tic- W v, %n M a( a- 09 i \ 4t y J � , p d 1 co �c " o CO i I Ai r I 3 � { Qi I H N M ce ,aka$ z a .1 Z ai �? Z oz c? — W IL LI Wu °` °° 3W ro1a' !a, ►, ui cr a _J Lu Z W co o i I; ¢ u; z V � \ STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER E N ROUTE/BOX NUMBER FIRE N0. CITY/STATE 5-a) iaffuo o>, ZIP T N, PROPERTY LOCATION: �1/9 �I�V' _-1/4, Sect ion R�_W,__.� , 4 � Town of 1�j1Zl� _, St. Croix County, Subdivision , Lot No. —&_. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after Inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification farm will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St-C ix County ML ithin 30 days of the three year expiration date. SIGNED t DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address • 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 j e'>/4/ - Location of property 1/4 1/4, Section , TN-R _W Township d^ /" l� l Mailing address ^Cl .&2 �-u�- �� Address of site =3�� Subdivision names . Lot number c Previous owner of property Total size of parcel %tt�Z_fi itC� r Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes No Volume and Page Number 1� as recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ------------------------------------------------------------------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. -3 _13th`7 ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the co s ruction of said sys m, and the same has been duly recorded in the Office o t e Cou ty " 5 Deeds, as Document No. 1 . r sl nature of Owner Signature of Co-Owner (If Applicable) e of gnatu a Date of Signature v � M Q r