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HomeMy WebLinkAbout040-1102-70-002 CD . § / C5 0 2 C) o Cj 0 CD r- C'4 a) 0.0 IN ' C�a o E a) Cl- U) cc E 8 7«- ;) o U V z UL Q) W W E 0 E 0 E 2 z 0 CL W b 0 0) o 0 z co 4) U)w IL co 0 0 z 0 z U) 04 0 04 E col N a (D C6 CO % . LL :5 - I C 0 L) 0 z o < z z Lo 1 c 0 r- .0 t z a CD .0 (L E 0 Oc w ca (a Z c) > EL P 0 0 0 0 z CL CL IL cc V; IL cc 0 0 co co LO 00 00 0 U) -j Cl) 0) 0) z (D C14 0 0 CD ;5 1 .0 E CD W 04 E Ln U. 0 9 u 0 :3 (D 0 (D c c a- 00 CD i Cl) a 0 0 C'4 (0 (n w m CD C-4 0 s 75 Z co 04 0) -0 M z z E p c (D OZ 2 U')clq C', E E CD C,4 CD U) 2! 2 2 { L L: CL 0 CL 2 i 0 C E ,c : 0 m o IL 0 U) Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Chgt,K 440 R g 14 TOWNSHIP -,e go U SEC. off, S• T pJ E3 N-R_L9 W mgej N ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION 1V LOT 3 LOT SIZE ,O&C t- i PLAN VIEW Distances and dimensions to meet requirements of I•LHR, 83 I SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Bench Mork S.E. corner blacktop properiy ! in - ele. 100` parking lot • B6 • B 8 Re p la cement area Parking lot � � p 0%° slope —55 — — • B7 Building \observation 913 9 pipes a, Scale 1/4 — 10 d ^�_ C. ) .{{ p L L INDICATE NORTH ARROW No LU eI1 Ot -tf,e time o SeWeR i.vstQ1IQ�f-,aN BENCHMARK: Describe the vertical reference point used s E (±oajap, Of 'Qa9 )pt- Elevation of vertical reference point: 10 Proposed slope at site: �T SEPTIC TANK: Manufacturer: L0 I f___ 615 P, Liquid Capacity: o, — D d O Qa J , ' a# :S I eQ 0i Number of rings used: -T'a ri k Tank manhole cover elevation: 115--�-7-,,,,k q q.3._ 15T 97,0 sr " TctaK 98.83 Tank Inlet Elevation: 204 � ,Jo;ZTank Outlet Elevation: q(i'7 IOD� ICI 100� t Number of feet from nearest Road: Front,O Side, Rear, O feet A 00 From nearest property line Front,OSide,0 Rear,� feet . r io is/ Number of feet from: well $0 building: 0 jk 3g' (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: N Liquid Capacity: N Pump Model: -fo A_ Pump/Siphon Manufacturer: N A Pump Size Elevation of inlet: t2 6 Bottom of tank elevation: 82 4 Pump off switch elevation: � _ Gallons per cycle: N A Alarm Manufacturer: [Q 4 Alarm Switch Type: (U# Number of feet from nearest property line: Front, &Side,Rear,a Ft.(UR Number of feet from well: fv A Number of feet from building: (Include distances on plot plan) . SOIL ABSORPTION SYSTEM Bed: Trench: 1 r Width: S' Length: Q 5 Number of Lines: L4 Area Built: I q 00 rl lI Fill depth to top of pipe: a 1001-t- 7 i 1S Number of feet from nearest property line: Front, O Side, O Rear,O Ft . Number of feet from well: Number of feet from building: S 5 (Include distances on plot plan) . SEEPAGE PIT Size: rV Number of pits: Diameter: fU Liquid depth: {U Bottom of seepage pit elevation: {U Area Built: -0)f} Has either a drop box or distribution box®been used on any of the above soil absorbtion sytems? (Check one) . HOLDING TANK Manufacturer: (V A Capacity: -lv �► Number of rings used: _N Elevation of bottom of tank: 0214 Elevation of inlet: R Number of feet from nearest property line: Front, © Side, Rear, &Ft. Number of feet from well: N 1, Number of feet from building: Nn� Number of feet from nearest road: A Alarm Manufacturer: 1V( Inspector: Dated: Plumber on job: �� k License Number: m P S a aS 3/84:mj i DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS DIVISION P.o7SSOx 7,966 PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING MADISON,WI 53707 fp� SE�,SE4tS25,T28N—R19W UCONVENTIONAL 1:1 ALTERNATIVE State Plan l.D.Number: )If assigned) Town of Troy El Holding Tank ❑ In-Ground Pressure 1:1 Mound STH 35 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Chuck & Harry Dettmann Route 2, Deronda, WI 54008 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber: MP/M*IfIR7 No County: Sanitary Permit Number: Rick Troff 3225 St. Croix 112662 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO DYES ❑NO BEDDING: I VENT DIA.: JVENTMATL.. HIGH WATER NUMBER_ ROAD: IPROP WELL: BUILDING: VENT TO FRESH ALARM. FEET „,11 LINE: AIR INLET: ❑YES ❑NO ❑YES ❑NO NEAREST. DOSING CHAMBER: MANUFACTURER: B LIQUID CAPACITY PUMP MODEL. JPUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ONO E:]YES ONO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL I NUMBER OF PROPERTY WELL. BUILDING.JVENTTOFRESH (DIFFERENCE BETWEEN FEET:FROM LINE AIR INLET: PUMP ON AND OFF) OYES 1:1 NO NEART;,. SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER JMATIRIAI AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until MAti+ the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH NO.OF DISTR.PIPE SPACING. COVER INSIUE DIA.. #PITS. ILIQUID p TRENCHES. MATERIAL: P+� DEPTH- GRAVEL DEPTH FILL DEPTH IDISTR.P I PE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR ! BER OF : PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES- ABOVE COVER. ELEV.INET ELEV,END. PIPES. VEET°FROM, LINE: AIR INLET: WEAKEST' 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 ITEXTURE PERMANENT MARKERS: JOBSERVATION WELLS ❑YES 1:1 No 1-1 YES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED =TOPSOIL. SODDED. SEEDED. MULCHED. CENTER EDGES. 1:1 YES ❑NO DYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: e WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: HE MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: �A 00"tauT i �. HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL. pLANSCAL LIFT CORRESPONDS TO APPROVED �J 1 ❑YES ONO DYES ONO PERMANENT MARKERS: OBSERVATION WELLS: PROPERTY WELL: BI�ILDING: COMMENTS: LINE: I�� ❑YES ❑NO ❑YES ❑NO �s c± 0 6-- Sketch Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710(R.01/82) Zoning Administrator \ b° b o lb b `b \ o� lob L 2z �� SANITARY PERMIT APPLICATION COUNTY I�O/ X DILHR In accord with ILHR 83.05,Wis.Adm.Code V °.�... �..a. STATE SANITARY PERMIT# // aC060z —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. 5 „0© —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES 9 NO PROPERTY OWNER PROPERTY LOCATION C � S IF '/a S 5 '/a, S ,� T as, N, R I q Q(Orw PROPERTY OWNER'S MAILI ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME 3 N R AJ CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK �eRe LZ 1,�►w,� .1+� ``147 ❑ IM TOWN VILLAGE:�ev 11. TYPE OF BUILDING OR USE SERVED: �G 7 H o _r R ©VeR Ro_ j Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): -'- -�- �A 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. E] 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. 5C 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. 3 Seepage Trench c. ❑ See age 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): Q .S e_e )A 9 a ©Q 9S.*;L9 Feet %Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed Septic Tank or Holding Tank 000 �1 ❑ Lift Pump Tank/Si hon 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): P ber' ignat�(No Stamps) NWMPRSW No.: Business Phone Number: k e� V -3aas' a S,as� Plumber's Address(Street,City,State,Zip Code j: Name of Designer: notq VIII. SOIL TEST INFORMATION Certified Soil ester(CST)Name CST# of*1C a3 v`7 CST's ADDRESS(Street,City,State,Zip Code) Phone Number. Vep.-OAACL WX 540de IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary ry Permit Fee Groundwater ate Iss ' g Agent Signature(No Stamps) Approved ❑ Owner Given Initial Su_rcharge Fee Adverse Determination i�1�4 X. COMMENT$/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 T t r . 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 revisslpns;.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; r 5. Private sewage systems must be properly'maintained"�Th&`septic tank(s) should be pur'nped by wlicensed ' pumper whenever necessary, usually every 2 to 3 years; 6. If ybu 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. Prcperty owner's name and mailing address. Provide the legal description where the system is to be installed; 11. 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; 111. Purpose of application: Check only one in ##1. Complete 42 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/Departmeil Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8/2 X 11 inches must be submitted to the county. The plans must include the following- A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; 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 andcpump manufacturer; D) cross section of,the soil absorption system if required by the county; E) soil test data on a 115 form. -------------------------------- ----------------- -=-----------------------------------x------ ------------------------—-- ------------------------- 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 s result of over 2 years of steady negotiation and public debate. The groundwater bill Ground al~ included the creation of surcharges (fees) for a number of regulated practices which Wisco ih:t can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. o 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) z N � (ID OD (XI N O a "# 41 X ri OD OD o sz ' OX :t, t t ! f N �� x r-- Z U, O o• C COD z M f?1 m z rn as 0 ro r� < N Q C 4. 0 o M C7 � -t• `� N r) � 0o N r0 x -'' (1) 0) C M ODOp C r v a.�z rn c O � �0 rn N u'3 — OD M4 o o-- -A • Z o cr' C) OD �v %D o° � � o 0 10 rn DILHR apartment of Industry, INSPECTION . - Leroy Jansky P.S.C: uman Relations 13 E. Spruce Street Idings.Division REPORT Chippewa Falls, WI 54729 lumbing (715) 723-8786 ate amises *ddreesor Legal Description -"Township County `t ST mber Name and Address, Master Plumber Firm Name and Address Plan I.D.No. (� Sanitary Permit No. man Plumber/Soil Tester ensed Person's Name(e)and License Number(s) gg ggme and Address � ,.',,-s is i tom-+. S.>•r t- °��{(�! => i a1/ e f. 4 JT r V • 11 � - '� v tt I i r., Page I of_J_ Signature of Responsible Licensed Person(only one needed) Sig a of Plumbin o nt/Pri to Sewage Consultant Copies to: (Check all , Original: atapply '� f _— SBM192(8.11/85) District 0 DILHR Plumber XO er C6 my/Loc99,Insp. 40ther ___ N .U) N � _ 0 m ;7 In ° TV -ts N rl 0 a) V' 00 -D E 9 a0 0 a --') — ( rn� 1 � N O) 0 OD OD D CO 0 O 4s 00 � m i N Y N N (-Tm q : leL • o ul c 1 O p 00 rn N` r n o -EA 0 a- C) (� `� o � %00 U) N �^ _. --h m ()-j _ O x o 0 % cn °_' o z ° o N ,p� m n °D 3 _ o ° . S 0 Olt y o = T V l O � n 7 8. w � 0 o y a 0 o ° D c .rc • � ° v o ° D [ II m rr ca 17% 0 1,1z m < rl 0) 0 0 OD (f 0, =3 OD C�L 0 a x OD o OD 0 0 > -.0 0 -V z rn x (Do 0 0 0 (f) 0 CC) ) o OD (A tyl N) < N U5 m 0 (A 0 --1- :3 oil. al 0 OD I N) 0 0 LP Z 1% cm N0 + 0.x --t%0 rn (p cD -N OD o 0 --1 = T 0 oI M m U) CL 0 0 -% a 0 N) OD OD- 3 > 0 0 %D OD (31 z ai W I = O > 0 I u) ::E C/) -0 m co -- -V Ou C) m o > m r. UD > �� m OD II �Q X Tom' V� o Y-, A 17 o� �.' 5t) 5 b Al 5 vriz%,�q- 41 6 � x oaF � � C o � ixfi' xh p State of Wisconsin Department Of Industry, Labor and Human Relations PRIVRTE SEWAGE PLAN APPROVAL SAFETY&BUILDINGS DIVISION office of Division Codes and. Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 RICK TRDFF Owner: CHUCK & HARRY DETTMANN ROUTE 2, BOX 170A ROUTE 3 DER0ND#, WI 54008 DERONDA' WI 54008 RE: PlanNLmkber: Date Approved: April 0, 1988 Gallons Per Day-: 410 Date Received: April b, 1988 Project Name: DETTMANN, CHUCK & HARRY Location: SE,SE,G,28, 19W Town of TROY County: ST CROI% Fees Received (Priority Review) : 120.00 The plumbing plans and specifications for this project have been reviewed for compliance with applicable code 'requirements. This approval in based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved' . This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department' s approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires . The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. 'These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative node. This approval in for the following components only: , NEW CONVENTIONAL Inquiries concerning this approval may be made by calling (608) 266-3037. Sincerely, JAMES QUINLAN Section of Private Sowage Division of Safety and Buildings, PPP012/0009n/15 cc: CHUCK & HARRY DETTMANN ___Prixate Sewage Consultant CountV ___UW-SSWMP ___Plumbing Consultant Owner ___Plumber -----Environmental Health U 000'6423(n.10/87) " `DEPARTMENT OF REPORT ON SOIL BORINGS ANTE SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O.MADISON WI 53707 HUMAN RELATIONS „ (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOOWNSHIP/MUNICIP AL, LOT NO.:BL,K�r..Nd. SUBDIVISION NAME: n(or)(0 COUNTY: 'S UYEER'S NAME: MAILING AD)DRESS: ��� 7/�/S_�Q6 �V Qf'P �f�'/i✓7Qi✓4 !/l/1' ST�Oo USE DATES OBSERVATIONS MADE NO.BEDRMS.:ICOMMERC Al_DESCRIPTIO�i ��/ PROFILE DESCRIPTIONS: PERCOLATION TESTS: ❑Residence Tu.eR�'�� 7 LJNew ❑Replace p p ? ew O8 3-3/- 80 RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: -IN-FILLHOLDING TAN K: RECOMMENDED SYSTEM:(optional) Z S o u ZS o u a S o u a u EIS a u (0,Viol" 61 d-77 a. � If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.0915)Ib),indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- � 111-14 9�,3�� -T /�� ° -/8" /7, / -38 /s ar h 38-g3 Sv�yr /'y , J- %r ev, 14 eodIer B- 7 �-1 L �`�•,S /va W^ S /T 3--/ 9 r o-ao s a o -, o /S d ,r h Sd - 45e, JS2 n e S� B- / / T / / /,/ 1��� ���� o �/9 /rr /a - a!' ,erg /r 54�-`/"Z ",ot �T{f A n.. ��- 5 /.' lfAl S S3 — B- �r f'p 4 1, X, , B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD3 PERIOD PER INCH P- 4 ,§'l /Uo / .3 3 3 , P- S 5'0 Al 3 3 o Se-c, P- P- P- P- PLOT PLAN: Show locations of percolati n tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation ref rap' i is and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope.Xa../,r � //GG' M l//70,dD SYSTEM ELEVATION 1 _ 9�.a; . .0-/ j« Ga E , 0 'PQ P c ► e Jao' i ° TN 8-7 '1 -i 7 f7 -n I I Xl ? I I –i- _ _ E 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): / Al rr TESTS WERE COMPLETED ON: // ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): CST SI URE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R. 10/83) —OVER — INSTRUCTIONS FOR COMPLETING FORD 115 SE C? - 6395 Tee kae a com,,�eteand accurate ate soil test.,your report must include: 1. Car plate legal descript ion; 2. Tlhe use sectigRv'nust-cEarly indicate,�,,v ee her this is a residence pr cyr""wiercial project, 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 6. Complete tf) °sUilcr a1i { rating boxes. ;= SITE IS SU I TABLE FOR A j Oa._DING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED JUT BASED ON SOIL CONDITIONS; 6. PLEASE rise the abbreviations shown here for writing profile descriptions and completing the plot plan, 7, BRAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate shee:,tylmy bo used if desif'4; B, Make sure your benchmark and vertical elevation referer-Ice point are clearly shown,and are perrnanerit; R. ComoJete all appropriate boxes as to dates, names,addresses,flood plain data, percolation,test exemp- tion, if appropriate; 10. if the informaiJon (such as flr)od plain,elevation)dogs not apply, plane: N.A.in the applopriate box; 11, Sian the form and place your current address and your car tification number; 12, Make legible copies and distribute as required, ALL SOIL. TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. { A,138REViATIONS FOR CERTIFIED SOIL TESTERS Sail Separates and Textures Other Symbols st Stone (over 10") BR - Bedrock cob Cobble ('3- 10") SS Sandstone g -_ Gravel (cinder 3") LS -- Limesione "s Sand HGW High Groundwater €°s Coarse Sand _ Perc - Percol4or, Rate med s Medium Sand W Well fs - Fine Sand Bldg -.._ Building Is Loamy Sand - Greater Than `sl -- Sandy Loam < Less Than I Loam Bn _.. Brown %l Silt Loam BI - Black Silt Gy - Gray "cl Clay Loam Y - Yellow sc;l - Sandy Clay Loarn R ....... Reel sicl - Silty Clay Loam ti snot lr otlies - sc --Sandy Clay - w.•`_ w i�t sir; - Silty Clay f(f - few,fine,faint Clay cc -' cornmon, coarse pt Peat mm Many, medium r III - Muck d - distinct p - prominent HWL - Hi gh Crater ievel, Six general soil textures surface water fear liquid waste disposal BM - Bench Mark VRP Vertical Reference Point i TO THE OWNER: This soil test report is the first step in securing a sanitary permit.The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION '76,LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION:T TOWNS HIP/MUNICIPALITY: LOT NO.:BLK.AN�O.: SUBDIVISION NAI1/IE: I S_'/41.57 .'� �� /1 � (or _ /uWh °�� �cc 3 4 111. COUNTY: S ' MAIL�I 71S-2CS </9L3 (51 o 5^�° p USE DATES OBSERVATIONS MADE NO.BEDRMS.:ICOMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS:1PERCOLATION TESTS: ❑Residence T[ `�Lt�ACft ¢ LrJNew ❑Replace _ -8g 3-/^88 RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSUR70S YSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) aS ❑U RIS ❑U ®S ❑V RU ❑S E 471."oi / DESIGN RATE: If Percolation Tests are NOT required D I If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) e,-/Y/­,9'/7s /s �"- iO /3;�17 h 14.7 Of -/Of 113 ` /s *4"- B- S >®e2 Ice?, ?l08 0-/8�ir /off' 4 yh�84 ,f' B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD PERIOD3 PER INCH P_ I si�_,' 44 3 3 :?o 5-u, P- 3 59 a- WU 0 3 73 3 ziree- P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale r " tance � _ e what ark ori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation a Kllb-rin�tN dir and i ant r � of land slope. o,� _4�(' SYSTEM ELEVotION �s ® ' tov fb scu:fe- _ T N ,1 O — f _ . 1 0. � r E F 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 kdministrative 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: ;i167,- 77, f 3 - 3 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): , � o� (f��0-Z34 715-.7,6 . 7979 CST SI Ar;AeA DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R. 10/83) —OVER — 1 INSTRUCTIONS FOR COMPLETING FORM 115 - S3D - 5395 To be-a corriolate and accurate soil test,your report €trust include: 1:.Complete legal desc-ript.ioll; . The use section rnust-clearly indicate whether this is a residence rat orrzjr�ercial project;., 3- MAXIMUM number of bedrooms or commercial use planned; 4, Is this a new or replacement systtrn; B. Complete the'suitability rating boxes. A SITE IS SUITABLE FOR A AbILDINGJANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; B. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; � 7, MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet r€iay be used if desire�rl3 B, Make sure your be rich mark and vertical elevation reference point are clea rly shown,and are pe rmanent; 9. Complete all appropriate boxes as to dates, names,add resses,flood plain data,percolation test exemp- tion, if appropriate; lt}. .if_tlre info,mation-(such as flood plairi,.e-kiwatioiol)does not apply, place N,A.(ti the apps opriat;e box, 11. Sign the form and piace your currerit address and your ce€-tificat:ion number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 3B DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10") BR — Bedrock cob Cobble (3- 10") SS .. .Sandstone gr Gravel (under 3") LS -- Limestone *s Sand H G VV High Groundwater cs Coarse Sand Pere — P ercolatio n Rate med s Medium Sand W — ir"stell fs — Fine Sand Bldg Building Is Loamy Sand — Greater Than ­sl`__'Sandy Loam < :..:.. Less Than `I - Loam Bn Brown *sil Silt Loam BI Black Silt Gy _.. Gray *cl Clay Loam Y -- yello%w scl -- Sandy Clay Loam R Red sic[ — Silty Clay Loam€ rnot Mottles sc — Sandy Clay W/ .. Willi G sic; — Silty Clay fff — few, fine,faint 'c Clay cc co€rinion, coarse pt -- Petit min Many, medium ni — ML€ck d — distinct p prominent HWL — High water level, . ;tiX general soil tQXtu€'eS ._ __. _sufface_water -- for liquid Waste disposal BM f3enc;Ii Ma€k VRP _ Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of-any construction. H z H ' 9 STC - 105 r 9 y SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d T 9 OWNER/BUYER Ch LLCk + NQR ? U�' .)'YIaNP ROUTE/BOX NUMBER R:0 of 13 n It Fire Number CITY/STATE_ I)g2AOft)A _axr ZIP 54009 PROPERTY LOCATION :9F '-4, SJ5 k, Section, T 018 N , R�'7 W, Town of ►_kctj , St . Croix County , Subdivision , Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists sists of pumping out the septic tank every three years or sooner , What you put into if needed , b a licensed septic tank pumper . y p Y P 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. 0 E I/WE, the undersigned , have read the above requirements and agree En to maintain the private sewage disposal system in accordance with x H the standards set forth , herein , as set by the Wisconsin Depart- ro ment of Natural Resources . Certification form must be completed and returned to the St . Croix County 'honing Office within 30 days of the three year expiration date . SIGNE4A DATE St . Croix County Zoning Office P . O. Box 98 Hammond , WI 54015 715-796-2239 or 715-425-8363 Sign , date and return to above address . t 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 Cb Q ck 4 H a R A_ *b g_±m q,]fin! Location of Property k S , Section a s , T cR 8 N-R L3_ W Township R 4 y Nailing Address HO ER L p elt ma tyri Address of Site Subdivision Name . Lot Number . 3 Previous Owner of Property C u D A t (v k ('to '� �;`'f'a �'TEN 1"N Total Size of Parcel R e f Date Parcel was Created 3 / ) )88 Are all corners and lot lines identifiable? C Yes No Is this property being developed for resale (spec house) ? Yes No Volume .__ 13 and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION T (toe) ce&UN that att statementA on tW oAm ane thue to the but o6 my (oun) hncwtedge; that I (we) am (cute) the ownerc(,5f 06 the pnopehty d"cA bed in ,thiA i"Wma.ti•on 6o4m, by vi tue 06 a waAAan.ty deed heconded in the 066.ice o6 the Co1u1t Reg�sxeh o6 Ueed�s ah Document No. , and that I (we) pnebentty yy aun �ilte pnopoaed 6 to bon the -sewage di�spo3 ayb em• (on I (we) have obtained an ea.aement, to Aun with the above de% ox bed phopehty, 6ok the conbtAucUon o6 Said system, and the dame hae been duty heconded .tn the 066ice o6 the County Regi,6ten o6 Peede, as Ooement No. ) . SIGNATf 011 OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED > f 8 DATE SIGNED ' DOCUMENT NO. WARRANTY DEED THIS sp^ca RgsaRVED FOR R[CORDIND DATA i STATE BAR. OF WISCONSIN FORM 2-1982 43810,,3 _ BOOK. , REGISTERS OFFICE .DQuj;laa..J.eakins.,---also..know.n...as...Doug.las..11................ ST. CROIX CO., WI nkins and_.Rita..Jenkins. alsn..knc s wn...as...Rit ... R®C'd for Record .Je ... ile................ JUN conveys and warrants to ..1I4xI~Y..F.....1?�t �} Z};}...ancl-•,C17uck........ of �: M .D.ettmann.,...as..j.oi.nt...tenants................................................. ..................................................................................... ........................ .........................•-••-•---.................._......... ......-----................---................. R"%W of Doak •..............................:.........................................................•-•-•-................_. - C9win fit iv;* ................................................................................................................. RETURN TO PU. 8.9k - .............................................----.................................--•-••---•--•-------......_.... l�uo�on, &hl. X40 110 the following described real estate in ............$:;.t....CXg4-4..............County, State of Wisconsin: Tax Parcel No: &6-//...Z.:�.........D Lot Three (3) of Certified Survey Man, filed April 2.0 , 1988 in Volume "7" of Certified Survey Maps, page 1955 , as Document No. 436411, being a part of the Southeast Quarter of the Southeast Quarter (SE4 of SE'h) of Section Twenty-five (25) , Township Twenty- eight (28) North, of Range Nineteen ( 19) West. SUBJECT TO 66' Roadway Easement as shown on said Certified Survey Map herein described. t�.� Sp VOL, J Viz, oel i This ....is riot •_ homestead property. (is) (is not) Exception to warranties: Dated this 26th........................ day of ­May......... ....-••............. 188$.... ......................................... ........................... .._ Doi �c�.n�........................... ......................................_..............................(SEAL) (SEAL) • ... .........................•-•- - * ...R its..-Jsnki.ns.................................. AUTHENTICATION ACKNOWLBDGIMBNT Signature(s) .....Douglas_.Jenkins and......... STATE OF WISCONSIN Rita Jenkins gg' ................•---...........---....---........---........------....----...... -•---.....................-•-•--------County. authenticated this .2 6 thy of........M ax..........., 18. $ Personally came before me this ................day of ...ZX... . ..... ........ ................•---................... .........---• ,. .�................... 18.. .. the above named TI ER S .T BA�iP vFISCONSt �. .. ................ ............................................................... (I;not, •. - - - .................... ...................................................................---.......... ...... ... .... ... .. ..... ...... authorized by § 7 6.06, Wis. State.) to 1ne known to be the person .4......... who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY I Rs.insixs,..Yaxl. Wyk...&..Needhamt..&...C_. .................................................................•----.......... s 201 South Knowles Avenue, Box 127 ..................•-•----•--------------•--.....--""".....---.............. Ii 14ew--)23:Ch ffien&y---I43;.---•h4017........... ............. notary Public ......................... ................County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is parmanent.(If not, state expiration I� are not necessary.) date: ...............•--...... ............................... 18....... .) �f •Names of persons signing in any capacity should be typad or printed below their signatures. ...____......_..... -----....---. _ STATE BAR OF WISCONSIN Stock No. 13002 NCMSgrCumprrp� FORM No. 2-- 1882 NEW FILED N APR 2 01988 JAMES 0'=O NEIL Register of Deeds w 436411 St.Croix Co..W1 CERTIFIED SURVEY MAP LOCATED IN THE SE1/4 OF THE SE1/4 OF SECTION 25, T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY., WISCONSIN E1/4 CORNER t ^ SECTION 25 �� 'M SCALE IN FEET T28N, R193.6' N � S ,' 0' 120' 240' T T D L A 26,E) 3 3.46 3,58 NI 0 U N p L A � 26126�� 354.88' ra I 358;46' zl 'E) 5, �I 00 4 3 �18.,E al X17 4 50 wl \ 60 < mobile ,house W I home \ 1 X70 shed ,,+ LOT 2 a I N \ 3,43 AC± ,� � wl SPIELHAUS 1� / 149,613 S•F•- ^ zl BAR � 1 w 1 I p o � J ° Al 1 1 �t LOT 1 ��t _ c") C) C± ` ° a,\�1 1 41 A c 1 .- 148,677 S.F•± 1 I'� 1 2.94 a> AI 11 a 1%11 ;�,` 128086 g•Ro+adway 1 w3.0 W1 clod It `, Ease-ment _ -A" H x NI 1 3 t 2 236.07' o 1 at I' cn Y ' ROADWAY EA 99; 550.06` wo cn 1318„E w �1 ' N � 1 1 ' I N79 50 1 66 / a cnl I ca l ce. 1 H zl � �I H I LOT 3 N I o I W 00 AC± ca z l ' Ir I 5. 800 S.F•± oo wi o cn 1 I I� 217 ' M HI H �¢ I I 4.383 A t C- w cwa °'II 1 I I 190,915 S' Easement 61 w All 120' 11 X66' I Excluding ai P41 I l w I 2 60• o/ /3 "E I , /zl x \ al l N54810 z w 60 60' 85044'E) I 2.61 xl F-4 cn A I 1 __I 2.6' � w l I I � —DRAINAGE F � as H H I I , , 1 T 0 j :=)ca E-1 H I I I °o �DITCN 580 7 9 5g3 �p) BEG DIy119G W --41 i p.18"W X580• _ al I S 15004 1 D ti A D 94 co H z1 I 11 � 4LA � 1L - zo w A l 60' 60, I U APPROVED x I i � OWNER AND SUBDIVIDER Iii APR 20 DOUGLAS W. JENKINS & RITA J. JENKINS SE CORNER BOX 213 SECTION 25 RIVER FALLS, WI. 54022 28N, R19W� This instrument drafted by James T. Swanson Volume 7 Page 1955