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HomeMy WebLinkAbout040-1112-30-200 qr Ales 5,�3 1 .,,�) Lover Pip U-) t� Pc.r qlf le X �j�oga � Pu�P I/aao It/ oo,d Se f�7QC j X 70' 6, la B� 3� X �o, 1°ID &3 P� � ga Ioo.D a6' n f �� � JA" % > CD 0 x ts —0 ts c (D U. c m 0 Me'a 4) E 12 c) CL E 0 cn i 0 z 0) co $ CL ca C, i 0 0 z z c U) P (D z E 20 N Oka ca (D 0 0. U) c m / 0 z < 0 co z 4i CD 0 041 Its ■ m 2a § E 0 g LO LO U) IL .0 U) E L= Z L=L EL 0 0 0 z CL IL CL V5 m Of 0 U) co co CO CO a) C) 0) cc 0) C) 0) 0 E co 4) CL 0 41 U) U) E 2 0) 04 00 — 0) 16 01 a. 0) C? Lo 0 04 — g M Cl) 7 LO 00 c 0) E C14 -60 g ■ 14 4i 0 2 CL r C E 0 0 IL LI) W Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNERi:4A 1,, jk�aw TOWNSHIP SEC. � T Ce7'1U'0N-R W ADDRESS 3 �/AST. CROIX COUNTY, WISCONSIN �A �90 a 6 "� LOT SIZE SUBDIVISION L OT PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i 'I L✓ r D Q j puy� p tai 710 ' 11coo i O I6�t INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: lQ(�_ Proposed slope at site: SEPTIC TANK: Manufacturer:114�"w5l flpC4X3S Liquid Capacity: �Q(� Number of rings used: 7' Tank manhole cover elevation: � Tank Inlet Elevation: Tank Outlet Elevation: (A V , � Number of feet from nearest Road: Front,®Side,O Rear, O zo'-) feet From nearest property line Front,(D Side,O Rear,O ���' feet Number of feet from: well �, building: (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE _REVERSE SIDE f PUMP CHAMBER y • Manufacturer: Liquid Capacity: Pump Model: PGv.�I�a2 Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: 7` Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,Q Ft. 1 Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: �>o Trench: Width: a,5/ Length: Number of Lines:— Area Built: !O� Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, &\ Rear,O Ft . Number of feet from well: �/ll� Number of feet from building: 8 1 (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: � I Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3C)3 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 MADISON,WI 53707 �y,, SE%,.;W�,S2V,t28N—R19W PgCONVENTIONAL E:1 ALTERNATIVE State Plan 1.D.Number: Town of Troy ❑Holding Tank E:1 In-Ground Pressure El Mound (If assigned) CTY MM NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER INSPECTION DATE. David C. Olshawsky Christine A. Olson Route 3, River Falls, WI 5402 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber. M No IC,u,,Iy Sanitary Perm,l Number: Thomas A. Wang 3231 St. Croix 106065 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES E1 NO I OYES ONO BEDDING: VENT DIA.: VENT MATT HIGH WATER NUMBER OF ROAD. PROPERTY WELL: BUILDING: VENT TO FRESH ALARM FEIw r FROM LINE AIR INLET: OYES EN O EYES ONO NEAREST DOSING CHAMBER: MANUFACTURER. BEDDING- LIQUID CAPACI TV PUMP MODEL jP11MP,S1PHIIN MANLIF ACTIIHEH WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. DYES ONO OYES ❑NO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF `JPRIIPEHTY WELL BUILDING JVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF( —71:1 YES ❑NO NEAREST--]II SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing IF N(,TH JOIAMFTEH 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: LIQUID WIDTH LENGTH NO.OF IDIST11 VIPE SPACING, COVER OE O IA API TS BEQ/TRENC.rH TRENCHES NIATEHIAL TM71'7s_' DEPTH DIMENSIONS . : I GRAVEL DEPTH FILL DEPTH DISTH PIPE JOIST H PIPE DISTR.PIPE MATERIAL NO DISTH NUMBER OF "PH OPERTy WELL BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER ELEV INLF I ELEV.END PIPFS LINE. AIR INLET: FEET FROM NEAREST---w MOUND SYSTEM: I 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 JPI IIIIANI NI MAHKI FIS oBSEHVATTON WELLS ❑YES ❑NO _❑YES ❑NO CENTER OVER TRENCH BED IDEPT DGES OVER TRENCH BED DEPTH OF TOPSOIL S SEE DF I) MULCHED E]YES ❑NO ❑YES ONO ❑YES ONO PRESSURIZED DISTRIBUTION SYSTEM: '.BEQ/ R+.ENCH WIDTH. LENGTH TRENOCHES. LATERAL SPACING JGRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTH DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ci.ELEV.. ELEV. CIA. ELEV. PIPES D A ELEVATION AND DISTRIBUTION I`NFt)RMATION HOLE SIZE HOLE SPACING LRILLED COHHECT Ly JCOVIR MATERIAL PLANS LIFT CORRESPONDS TO APPROVED ❑YES El NO OYES ❑NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING: FEET'FROM LINE 11 OYES 1:1 NO ❑YES ❑NO NEAREST C la 1 5Cr F4 , Sketch System on Retain in county file for audit. Reverse Side. SI GNATURE. TITLE. DILHR SBD 6710 (R.01/82) i Zoning Administrator • DIL SANITARY PERMIT APPLICATION COUNTY ��d l In accord with ILHR 83.05,Wis.Adm. Code �S STATE SANITARY PERMIT## A) —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO PROPERTY OWNE PROPERTY LOCATION u i� C D7S iuS U'lS��he a Sah % S&) %, S T9 g,N, R -F E (or 10 PROPERTY OWNER'S MAILING ADD.$ESS LOT NUMBER BLOCK NL ER SUBDIVISION NAME ITY,STA�/k ZIP ODE PHONE NUMBER CITY _ NEAREST—ROAD,LAKE OR LANDMARK a !1 E:1 E;i TOWN OF VILLAGE: �`,(1 C II. TYPE OF BUILDING OR USE SERVED: o-17/01 " DU " Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. ❑ New b. `Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a.NConventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. R Seepage Bed b. ❑Seepage Trench c. ❑seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(S re Feet): PROPOSED(Square Feet): l D { � x 1 D"�Cg / v Feet 9 Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank a r �✓�°$ Lift Pump Tank/Siphon Chamber 175� C r ❑ 1:1 VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plu er's Name(Print): Plu e ' Signature:(No st mps) MP/MPRSW No.: Business Phone Number: 4k 39 3 / lumber's Add ess(Sire ,City,St e,Zip ode): O'S��'v G✓ ` J Y- pip? Name 9f Designer: � l IV p 9 Vlll. S911,TEST INFORMATION Certifi I Tester(CST) m CST## �� CST's DDRES,S(Street,Cit ,State,Zi C de �/ Phone Number: t3 IX. COUNTY/DEP A RTMEN1r USE ONLY ❑ Disapproved S Hilary Permit Fee Groundwater ate uing Agent Signature(No Stamps) Approved ❑ Owner Given Initial rcharge Fee G� Adverse Determination ���'� �� X. C MENTS/REASONS FOR DISAPPROVAL: _ SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new i 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: 1. Property 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; 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, addrjZss, and phone number. IX. County/Department Use Only; r, X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/z 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 ove 2 years of steady negotiation and public debate. The groundwater bill Ground er included the creation of surcharges (`ees) for a number of regulated practices which Wiscol in` can effect groundwater. The surchare�ui took effect on July 1, 1984. All of the water tha? buried treasure is used In. yo_ir building is returned t.. the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. Q T'le Tionies collected through these surcharges are credi'ed to the groundwater fund adminis terec by The Department of Natural R-!source.. Thes_ `un 1 e Lsed for nion�toririg grourrd t touter groundwater contflmirlatic-t investigations and 'alt ill;;: Y -it of standa ds faro Inc1,atF 's pr(.,.tec, ng. sib-F,X98 iR.031:36) 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 ; y �Sf7Cu,U T11 U�OJL1 T— Location of Property LL tL 4 :5 GU 34, Section , T_2_�L_N-R W Township / ✓�U 7` Mailing Address 7 3 O X Z271)1 er F& z Z. T Address of Site SCI)) e__ Subdivision Name Lot Number Previous Owner of property -'CZ �7 �' S ✓/° 1 t/CL Total Size of parcel y cc D �2 C re S Date Parcel was Created Are all corners and lot lines identifiable? X, Yes No Is this erty being developed fqr resale (spec house) ? Yes X No Volume and Page Number;Z as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a .Document number, volume and pa&e 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 I (We) ceAti,by that att .6tatement6 on tW boAm cute thue to the beat ob my (ouA) knowledge; that I (we) am (cute) the owneAW ob the pAopenty descAibed in this inbonmation bonm, by viAtue ob a wantcanty deed teco&ded in the Obbice ob the County Regi6teA ob Deec6 a3 Document No. qj aS and that I (We) pnesentty own the ptopoaed .6 to boA the sewage diespops .6y6 m (oA I (we) have obtained an easement, to nun with the above ducni.bed pnopenty, bon the constAucti.on ob said system, and the zame has been duty %econded in the Obb.i,ce ob the County Reg.usteA ob Deeds as Document_*. ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED * a DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 43253(; PA,c 616 MOISTER'S OFFICE ST. CROIX CO., WI Ree"d for Record ----------- ------- ------------------------------------- ------- NOV 3 01987 ------------------------------------------------- ----------- ­---- ------------- --------------------------------------------------- ------------- --------------------------------------- -------------- ------------ 'C I Z Oal(0) -----­-----­------- ---------------------------------------------- ------------------------------------------- ck4.j conveys and warrants to ......David__C_-_01shawsky.-and------- ------ ------ ♦ bow of On& ----Christine--A-. Olson.,_as--tenants._in--comm n-------------------------- ---- ---------------------------------------- --------------------I.......... ------ .................•..•. ------- --------------------------- ----------------------------------------------------- ------------------ -- --------------------------------------------------- ------------------------I---------------------_--- ---------- ------------------------------------------------------------------------------------------------------ RETURN TO -------------------------------------------_._--------- --------------------- ------- ----------I---------I------------------ --------------------------------------------- --------­-------------- - the following described real estate in .......S_t.._.-C.ro.ix ---------- ----------county, State of Wisconsin: Tax Parcel No: .............................. Lot One (1) of Certified Survey Map dated October 2, 1987 and recorded November 17, 1987, at 2:30 p.m. in Volume 7 of Certified Survey Maps, page 1916, as Document Number 432231, in the office of the Register of Deeds for St. Croix County, Wisconsin, said Certified Survey Map being located in the Southeast Quarter of the Southwest Quarter (SEj of SWj) of Section 29, Township 28 North, Range 19 West. R11NSrLO FEE This ........ s...no-t--------- homestead property. 1(k) (is not) Exception to warranties: easements, restrictions and rights of way of record, if any. Datedthis ----------------- -------------------- day of --------------- -------------- --------------------------- 19. -------------- ----------------------------------------------------(SEAL) C? 1widw.of/W re------------ (SEAL) ------- ---------------------------------------------------- * _---James- R_-WahrenhrQck ------------------- ----------------- --------------------------------------------------(SEAL) ----- - -------- --------------- ........... ------ -------(SEAL) ----------__---------------------------------- ----------------- --------------_............ -----_------------------ AUTHENTICATION ACKNOWLEDGMENT Signature(a) -_•--------------------•_•--_--..........._._..._.._._...._. STATE OF WISCONSIN ss. ................................................................................ .........I.... ­*------ --- - ----------County. - authenticated this -------_day of................•.--....._1 19...... Personally came before me this ---- day of ------------------='_.:-- ----------------0 19—..... the above named ------------------------------------------------------------------------------ -------------------------------------------------------------------------------- TITLE: MEMBER STATE BAR OF WISCONSIN -------------------------------------------------------------------------------- (If not- --------------------------------------- ---------------- ------­------------------ authorized by § 706.06, Wis. Stets.) ••••....... to me known to be the person ------------ who executed the N> .. #?Tegoiag instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY I<�11 '/, . . '. J, Keith Rodli, Att Ljai7 .............. .......•.. ................. ............... ' ' 4 0 *'-;:�_' ­_' -,-��---- ---------- ----------------------- River Falls, Wisconsin 54022 1— ; - ............ .............................................................C7--- ;;) N,6,*y Public ---------*­_:-------------- _-______County, Wis. (Signatures may be authenticated or acknowled 16-*64. Bath 0- A'�'Qommission is permanent.(If not, state expiration are not necessary.) ------------ ----­------------------------ •Names of persons signing in any capacity should be typed or prin -b"tWltheir signatures. STATE BAR OF WISCONSIN H.C. iIIerCor4wVFM—I FORM No. 2— 1982 Stock No. 13002 C= n1omh CERTIFIED SURVEY MAP JAMES AND BARBARA WAHRENBROCK Part of the Southeast 1/4 of the Southwest 1/4 of Section 29, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin. OWNER'S ADDRESS: UNPLA T T ED LANDS 1104 Wasson Circle S 88•s9'3s"E 373. 00' River Falls, WI 54022 r 3 3 v� ku = M 1. q � h O LOT / UJ co J 4,000 ACRES C,Z LM y P 174, 240 SO.FT. y j j b 3.716 ACRES O � Z b 161,863 SO. FT. ku Q Q u Q X 3 Q M BARN M 3 W W 2 N a Ct Q �I p SHED N ~ u up ku Q jlSHED h jl m h DWELLING I � O SCALE I "' 100' 4 11 O 30' 100' 130' 200' 230' SPLIT RAIL FENCE x -r S 89.39'33"E 373.00' S I14 COR. SEC.29, T28N, g 8 R 19W,(2"IRON PIPE 432.31'FOUNDI M 1� �� 373.00 ' _ M SW COR. S£C.29,T 28 N,R 19 W, N Be*59' 35 W „ ICOUNTY SURVEYOR'S MON.I S LINESW 1/4 AND C. C.T.H. 1MM Dated: 10-2-8 UNPL A TTED LANDS —� O Indicates 1" x 24" iron pipe 7 _ 66' weighing 1.13 lbs./lin. ft. set. Description: That certain parcel of land located in the Southeast 1/4 of the Southwest 1/4 of Section 29, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin, more fully described as follows; Commencing at the South 1/4 corner of said Section 29, thence N 88 59'35"W (assumed bearing on the South line of the Southwest 1/4 of said Section 29) a distance of 452.32' to the POINT OF BEGINNING, of the parcel to be herein described; thence continue N 88059'35 11W 75.00' on said line; thence N 01000'25"E 464.64'; thence S 89059'35"E 375.00' ; thence S 01 00125"W 464.64' to the POINT OF BEGINNING, containing 4.000 acres, being subject to easement over the Southerly 33.00' thereof for C.T.H3 "MM" R.O.W. purposes and also being subject to easements of record. State of Wisconsin) County of Pierce) Registered Land Surveyor, do hereby �� �\Soo/vs/���i� I, Laurence W. Murphy, g �. certify that by direction of the 'Owners, James and �� •� ap Barbara Wahrenbrock, I have surveyed and divided the = LAURE E• lands as shown hereon in accordance with official records, = m ,W U Y ; o Chapter 236.34 of the Wisconsin Statutes and the Ordinances 71 of St. Croix County and that this map and description are Z CP *•.iiv R FALL a true and correct representation thereof. �N•'••. WISC. Q ..........••ca LAND .•' Vol. 7 Page 1916 APpRO Certified Survey Maps Laurence W. Murphy St. Croix County, Wisconsin Registered Land Surveyor ov low S1. --im COL41M Ca ' ,cm9W ►Alai n MW9 lt qi) ZOM40 COMkA i H z • cn H STC - 105 9 SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d l /(/�) 5 k OWNER/BUYER2ir,J/U - 1�%-W-5� � ROUTE/BOX NUMBER /x'7 3 So xi In 7 Fire Number CITY/STATE 161!P ZIP SS�O G, PROPERTY LOCATION: S� ' , JCS , Section / T ,Z _N, R W, Town of /16 l/ 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 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 E z I/WE, the undersigned, have read the above requirements and agree E, to maintain the private sewage disposal system in accordance with rx, the standards set forth, herein, as set by the Wisconsin Depart- 'b menu of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoni Office w ' h 'n 30 days of the three year expiration date . SIGNED 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 . DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, G DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WBOX I 3707 HUMAN RELATIONS �. (H63.090)&Chapter 145.045) LOCATION: SECTION: TOWNSHI MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: 0/ � /T�N/R E (or o COUNTY: OWNER'S/BUYER'S NAME: M LIN A DRES • f ' . ra pawl d s s 'u e Q s l�l USE L" r is TO DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILEDESCRIPTIONS: ER AT N TESTS: Residence ---= []New ®Replace. � � S RATING:S=Site suitable for system U=Site unsuitable for system CO®ENTIO�NAL: MOUND ❑� IN G®� Pa� E• ��-l��L H OS G©�TANK:RECOMMENDED SYST M:(optional) If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUND ATER-INCHES CHARAC ER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGRE'ST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B Lid ~ to q PA 3.�o e/lo.;Ss El? S¢ r. 1,06 Se S'�Ad re B- ` /DD. 0 B- B- 3 6. to /OO.2S' ��. DU ,oD s ' Iv S t� Gt /B- e Sfae lure lob &' 4 B- — ��o�lC y 60 El�Otv;3 G� ail S��r Dose S�t�t�'f/� PERCOL ION TES S TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIPP 1 PERIOD2 PERI PER INCH P_ l D Q /0 !d /§ P- D �'� b l '10 P- S 60 GG 6 #-- 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 ��• D f t I Sid k,c L 0 Ut �_"KA j I _ it tH C r ke- _ fl f`I � _ro rat I — - 0 C16 i d tLd Q C Y rh W, 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(prin TESTS WERE C MPL TED ON: 3 1 S'? ADDRESS: A CERTIFICAT (�N N BER: PHO E NUMBER(optional): CST S URE: �� DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. -)ILHR-SBD-6395 (R.02/82) —OVER— mow INSTRUCTIONS FOR COMPLETING FORM 115 - SID - 6395 To he a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence;or commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; v. PLEASE use the abbreviations shown here for viriting profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; B. Make sure your benchmark and vertical elevation i efe rence point are clearly shown and are permanent; 9. Complete all appropriate boxes as to dates, narnes,addresses,flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain,elevation) does riot apply, place N.A.in the appropriate box; 11, Sign the form and Iflaee your Current address and your certification nurnber; 12, Make legible copies and distribute as recluire;d. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY'vViTHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL. TESTERS Sorl Separates and Textures Other Symbols st Stone (over 10,x) BR -- Bedrock cola C =bhle, (3- 10") SS - Sandstone .)r C r�ivHd Bider 3") LS - Limestone s — sat id NG Vv' Nigh Gromidwater CS -- E oj;sf,S.arid Pf�rt. In•e f;t,>Iatl+tri Ralf; zt'n ed 4,;4! _._ ` ',cti z ._.. F i to '""'' t3<<Ig ._. I lei rte k - L atray ,a,arl > - C, E.te_t T ho-I st -- umd,r L ta�iwt � .- [ .. ffaa , E_L)t':rTl 131 t?fidi;l 11 Oy Gtay Y ..... 3 1,,v v st,i s,,'fd ( lay' Loan' R Reel .__ =Lty� Cl-v Loam r 1'i •it -- It Ft;S ,. Y.y d d 'o M t .Six r ra r t _.E fry, iici,tei ast' zi,posa€ BItr1 — H r ch 111 aa'k V R P F,`f-lerence Point TO THE OWN ER; This soil test report: is the I irst slop in securing a sanitary permit.The county or the Departrncnt may request vet ification of this soil 'test in the field priot to peri-nit issuance, A compete seat of plans for the private 1r vagea sysi:ein and a pe t-i-nit application must cfe sulirnitted to the appropriate local authority it', order to bia;n a permit.The sartiiary hermit must. Eye oblamed and pcstod prim to the start of arty co�lstructror3.