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HomeMy WebLinkAbout040-1119-92-100 « \ & 4 K } . 0 (D � m to c A E2 ) A f� ) } � i E / — m= =o ° M E � 0 §� 2 �) RE CL) ; o e Eƒ= 2` E �� \ � a \ k 2 § 0 oc z ƒ%7 } c U. ME2E ) 5f� .0 0 / � � \ E J /] @ � S � f 2 (D z z K § \ \ 0 0 V Q C co IL.4 \ m a m 0 0 z ¥ 2 ) 2 « m J \ G U)4) z _ ® 2 2 ® e £ E 2 / E _ & e ® = e E e N & � 5 8 m § E U) n Q -� / \ '001 2) { z / k z ca k � � . � . .. } I .. � o c f -E E ~ m Q C _ ' 04 a0 e a _ - ■ b 0 E p! .!e 2 b L) k \ � } 2 2 M \ k } � _ 2 U \_ ƒ k k k ?L a a a ) a a a=\ a L . LL & , o k 00 co 2@ o � \ 0 m co Q z e a z f § e 2 � 2 � e )2 \ / _ E � 0 \ = \ r o 0 2 � a / \ cc § o f � � \ � j j � � z m � , . / ! / # = EO � / 0 cl 2 C*4 ; � ƒ 0 CD t . 0) k ! f \ E & 2 e $ $ /m / • o § I $ c S a @ 2 /E \)7 %K o 2 o f o o � w e _\ mm z f o £s m m § o z 2 e z . k k 2 ¢ k EL . . w a E 2 ' k a § 2 - § & 3 ao v . � o Parcel #: 040-1119-92-100 06/20/2006 04:43 PM PAGE 1 OF 1 Alt. Parcel#: 31.28.19.491 C 040-TOWN OF TROY Current r X'. ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-STOKES,WILLIAM&BETSY WILLIAM&BETSY STOKES 327 ILWACO RD RIVER FALLS WI 54022 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description "327 ILWACO RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 10.000 Plat: N/A-NOT AVAILABLE SEC 31 T28N R1 9W SE SW 10AC LOT 1 CSM Block/Condo Bldg: 6/1790 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 31-28N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 775/438 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 10.000 99,000 226,700 325,700 NO Totals for 2006: General Property 10.000 99,000 226,700 325,700 Woodland 0.000 0 0 Totals for 2005: General Property 10.000 99,000 226,700 325,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 A Fo rm - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 6 SrDktS TOWNSHIP 7f-2,Oy SEC. _ T 2�N-R A_j_ W ADDRESS R1 3 Go)( )34,6 ST. CROIX COUNTY, WISCONSIN EALL 5 W►S SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM F a 93 y(5u5_ vii (000 GAI. / a' (Q 175 ►7 CL4 n ---- - ----— — 0 'Y ti H ►i INDICATE NORTH ARROW �o7t"o,r of s;a�M9g �eb.59 BENCHMARK: Describe the vertical reference point used SP/kj )m R" 0.9k UEE Elevation of vertical reference point: )DO,0o' Proposed slope at site: f ° SEPTIC TANK: Manufacturer: 'W)C-se" Liquid Capacity: 1oo0 Number of rings used: -- Tank manhole cover elevation: - 100, 5'/ Tank Inlet Elevation: Tank Outlet Elevation: Q 49 Number of feet from nearest Road: Front,(Side,Q Rear, O '57004 feet From nearest property line Front 10 Side G Rear,O �-4 p feet Number of feet from: well go , building: a4 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER ` Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: ,6 ' Length:__7.6- Number of Lines::.._ Area Built: 750 L , doT Tre,!, a' I 94.72 (44US3 N 43,4 Fill depth to top of pipe: 30 W "1 Z 92,95 43.11 f38( Number of feet from nearest property line: Front, O Side, O Rear,O Ft . 14 Number of feet from well: � ?p Number of feet from building: jD 3 (Include distances on plot plan). . SEEPAGE PIT Size: NA 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: —hd Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: caz License Number: MPRS 3 3 9 3/84:mj L `6EPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS DIVISION LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O.BOX 7969 MADISON,WI 53707 S�'4,$GIi,S31,T28N-,SW! CONVENTIONAL El ALTERNATIVE State Plan LD.Number: Ili assigned) Town G�y Thay ❑Holding Tank ❑In-Ground Pressure ❑Mound NAME OF PERMIT HOLDER'. JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Route 3 Sax 134B Riveh Fa,?,�s W1 540 2 ' x'88 �JUv BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber. MP/MPRSW No.: County: Sandary Permit Number: Ca4t P. He-i�6e 3378 St. Chaix 112703 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. =TTF:7y5—LOCKING COVER L/J\ PROVIDED. ❑YES ONO BEDDING:./ VENT DIA.. VENT MATE, HIGH WATER NUMBER OF ROAD: PERTY LL: ILDING.(VENT TO FRESH ALARM '. AIR INLET FEET FROM DYES ONO OYES ❑NO NEAREST DOSING CHAM BER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED'. ❑YES ❑NO ❑YES FIND DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL'. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH LINE AIR INLET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) OYES [11 NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH-. LENGTH NO.OF DISTR.PIPE SPACING. COVER INSIDE DIA -PITS LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR PIPF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE COVER. DISTR NLET ELE V.END'. PIPES FEET FROM LINE AIR INLET NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ONO OIL COVER TEXTURE PERMANENT MARKERS JOHSEHVATION WELLS ❑YES ONO DYES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES. —]YES ❑NO OYES ONO DYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL fO DISTR DISTR.PIPE DISTRIBUTION PIPMATERIAL&MAHKIELEV.'. ELEV.. DIA.. ELEV.. IPES DIA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANSCAL LIFT CORRESPONDS TO APPROVED El YES ❑NO DYES ONO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS-. NUMBER O PR OPERTV WELL. BUILDING F FEET FROM LINE: ❑YES ONO DYES El NO NEAREST I Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE i DILHRSBD6710(R.01/82) Zoning Admcni6ttatdh j • COUNTY DILHR SANITARY PERMIT APPLICATION �7- dpo�X In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# 1a yo —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 X NO PROPERTY OWNER PROPERTY LOCATION kes S % 51.01/a, S '31 Ta 8, N, R E (or) PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER IBLOCKNUMBER SUBDIVISION NAME 9ji I G o x 134 13 CITY,STATE ZIP CODE PHONE NUMBER E] VILLAGE: NEAREST ROAD,LAKE OR LANDMARK II`b i.e. aA S L�L5 40 rjl s "R TO4N OR 11. TYPE OF BUILDING OR USE SERVED: —�d 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. XLNew 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## /V 6 0 LJ3 Date Issued c.3_A6 92 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. XConventional 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.X Seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSZE ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet):*t: # `f g./6 0.5 r 7 56 4 2`1'1.01 Feet Private F-1 joint El Public VI. TANK CAPACITY Site in llons Total ##of Prefab. Fiber- Exper. a INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete stCon-d Steel glass Plastic App Tanks I Tanks Septic Tank or Holding Tank wie Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MRaLRSW o.: Business Phone Number: arl Q, /�z°� P 3 ? ® 7IS 425--211) 5' Plumber's Address(Street,City,State,Zip/Code): �- Name of Designer: _ / `,,, IL-'t ve Lill s 5402'L C0.r FA PI e VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# Ve- 3490 CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 96 X 1,42-4 Gidleau, fle W s 5400 ,; "7l - 36 1 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Is ing Agent Signature(No Stamps) 59 Approved ❑ Owner Given Initial S rcharge Fee 7 01 Adverse Determination '0 °�' `^1" �A X. COMMENTS/REASONS FOR DISAPPROVAL: Aeor'\j 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 r APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit maybe needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary,.usually every'2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in-designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'f2 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 tdnks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983; Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground isltBr ° included the creation of surcharges (fees) for a number of regulated practices which Wisco in'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried Ts'3SL1Cf3 is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) h pP R ov,E v VI NT CAP ` A M OK_Ill ) ST E • W S .. Zl8 W,CNARWTTEST. MAY 42" C.oVgR RIVER FAILS WIS 54022 SrTE - TRby TOWN SN 1 P � fIPPROUEfl 5YN7N�r1C FA$k►C -?�As6R.aTE VRP - SPIKE �N 9"0AK 7KEE El kw-0a ' - 4``Pf�Rr"o R,drFD Pa�� _._TRENCN ':*l EL.. M78 M14 "A6�r� �? � q8.�8 TRENCH 2 1~i- 1701 DES) N Ev YY GARc t'.EJFISE TLWAco RoAv 0 WELL 0 0 V x 0. 0. f � HOUSE- 94 I At PPRovs Bi 1000r-AL V�Nt CPP r75 5FPT" .9 -9 o- - o #Z BM SPIkI iN 8 OAk 'MFE ��_ ►06,06 i B3 �' i 51dPE LL x Y o . ^a AlTr-RNATE AREA w z S z y � 0. �o a w X i DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION 'LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON,WI 53707 (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHIP/Pv4UN'81P0+a;F": LOT NO.:BLK.NO.: SUBDIVISION NAME: s>= 1/4 s 1/ 3 1 /T2s N/R 19'F(or)W -n- oy — — — COUNTY: OWNER'S MAILING ADDRESS: S-r.CROIX BILL STOKES IRT. 3 IROX 134- 5 RIVER FAL.LStWI • S40z�, USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PER OLATION TESTS: ®Residence 3 N. A, New ❑Replace N,A A. RATING:S=Site suitable for system U=Site unsuitable for system l CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTE�`M-IN-F-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) ©J ❑v ❑�+ ®U ❑J ©� ❑S LLyU ❑S OU 2-S'f6 75'TRE4CNES If Percolation Tests are NOT required DESIGN RATE: Q If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: 1CLA!SS 2 Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS PL4 1i1/F/EG.o LOAM P. 89 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- / 85 99.56 NONE ? 8 0-11 Dk 31, -Fs I I I-SS 13h-P SSi I�SS-65��_E n 1-nS 5- SS 0 BPN c5 B n S 3i I 13 AV\at 6 O-lo " bk Br` fal ; 10-4 " Sn-f' Sl; 42- '1I " En rns B- 2 $4 S8.Oro NONE rr� 2 UJ/DK Br\+SSI I Bsr,ds • -84"Bhc.Sw 01<OwF5511 Eca►.ds B- Z. 93,50 NONE > 82 o- 12" OK 3r\f s1 ; 1-2-42" Sri fs 1;42.- 82" 3h n,.S w Ok ss1 ) SiCki,01S B- q, 9j. 4 ,�tfON� > 81 O- 12" Dk Bn -FSI J 12-�24 6nf l5 J/9ri 24-3'7 " Qn rn 311-VI c B- S' 83" 90.// Na/V O-I I Pk f3`` s I ; 11- 13" C3n-F s 6- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- P- -ST ClRoty COON-rY SOIL. SURVEY P- INDICATE G.L 5=3 2 PE�COt-� ION �A-C� 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. 0- SYSTEM ELEVATION TkCNCH#2 - 97- 0/ � E O wE�-L �G 34- Htzv � ❑ . x:31 ; . a_ a RE. _Ci.. , � IN NAIL IN 8 .0AK ' TREE w/R1XlK R18S V .. 3 , , o_ . _ o sr_aPe ❑ . 3 1 BZ 1 W C RD N Z ..SGHL,Ef O� M ' r� 3 L �., _'___; c w pcA loN r a 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: Pc,ekv G-o c 10101 N 4- "7- //- 78' ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): RT, / COX 142 A ,QE'G4E N V14 L E, WIS , ':54003 3430 (7/6)2'73-3(o Z I CST SIGNATURE: e o�C4. +tea-.C.I DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R. 10/83) —OVER — � , . . 0�q,rPUC`5 -JS FOR COW1PLETMG FO�PUl15 ' SBD ' 6395 ' '^ To b* acono��aandouo�,meuoi/ �o 'you, nanur� mw� iodu6e� 1 �omp|me |oga| da��iptmn� 2 Tho uma�o)on mm�doer|y indioam�haber�his i�o �oidenm�or unmmo,oim� �oja�� 3. A Ui"A numberof ��monmmmummmC"a| uoep anmd. 4 bthioo namar rp�or�nem nom�m� , 5, Cmm��ad`omu�abi|�r/ ru/ingbnmw� A S\TE |SSU|TABLEPD8 NOLQ\ N L . �THERSYS TE��ARERULEDOUT8ASEDON0]|LCO00T0NS� G PLEA8E une�he mbb,*"iu,mn�oh*mn ho,e for�ritin8 pmh|m d+muipvions and unmp|,u7ng�hyu|oto|an� J Al K aoo/�tmy A oepum�auh*amuvtmu�di�deirod� ` �, NA1n, v�uray�urbon*hmark andve,tioo( o|mation ,cfornnce po\n�a,mu|eor|yyhu�n.onda,e ponnmoen�� 9 0nmn|.�o aU ep�,unriu�e boxmo ao �odano^' numes'addmmmo. Unnd o|ai^ �u�a. pe,00|*d"n to� axnmp' c/on. ifoppmp,�-1e1 �D |f�hn {nforn���on �uohm, �cmd n|ain.o|e"atkm>dua not a�dv. �oxe �.A�inmeupnnoAri�� box� 11 !�ign "he hnmaodcdamyourounencuddmo and yourcortiho�b»nn�mber� 12� KAake |eg��|o mopiom and dis�ribme ay ronuied, ALL S0L TE�T� K3UST BE F|LED VV}TH THE LOCALAUTHOR|If-YVV|TH|N 30 DAYS OF C0KPIPLET0N. "\,36REV|AT|ONS FOR CERTIFIED SOIL TESTERS ` �oU &,ua/atcn and Te,xmunm svmLui, o - Guone (ovo, lO'') BR - 8odmck cob - Cubb|o <3 lO^> 8� - 3ondgone V, - G,ave| (under3~) L� - Limo�one HighGmundmmmr co - Cua�eSund Paru - Pa/no|a�ien Rmoo med » - �ediumGund VV - ��U Fine5o,d 8|dg - BuJdinn |a - bmmy5and - Geato, Thnn °d - Ga^dy Loam ( - Lom Tnao °sii - Si|� Loam B| - B|ack G G raY °� - C1evLuam Y od - ��ndvCiav Loom R �iu| - �i|ry C|oy Loam nno� ri�h ~o - C1ay __- co - cmmmon'ooure, p« - Pcac mm - M"anv, me ium d - di�incz -- p - pmmin^nu H kA)L - Highmunor |me!' ° Gi�gane�| ooi| cexmn� uur�oe�ma, _ fo, Uquid wau�dmpou| 8&o - Bcnoh K4ark � _ VRP - Ve,�ic^| Pow-, ' -'- - - TO THE OWNER: This soil test reportiu the Vr�t stmin securing m sanitary permit, Th000un�yor the Decm�mcmmayequest verification ot this soil test in the field prior to mmrrmc issuance, Acomplmm, spt of p|nns for the private osvvaqe system and u permit appUm�ion must be submitted to zhe appronriatm local au,hority in mrder to obtain a permit. Theoanizary permit must be,obtained and pmSted phortothe mm� ufany consIIruCtion� .DEPAR.TM_NT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING P.O.BOX 7969 MADISON,WI 53707 state Plan I.D.Number. SE y,SW%,S31,T28N—R19W CONVENTIONAL ❑ALTERNATIVE IIf assigned) Town of Troy ❑Holding Tank ❑In-Ground Pressure ❑Mound Ilwaco Road NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: p William Stokes 218 W. Charlotte Street #108, River Fa ls, WI 54022 Q BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN:- REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber MP/MPRSW No.: County: Sanitary Permit Number: Carl P. Heise 3378 St. Croix 106043 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET JELEV.. WARN'1D DLABEL PROVIDED OVER ❑YES ❑NO ❑YES ❑NO BEDDING. VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF RDAD: PROPERTY WELL. BUILDING.IVENT TO FRESH ALARM LINE. AIR INLET FEET FROM DYES ❑NO DYES ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING OVER PROVIDED: DYES ONO DYES ONO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONA L. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH LINE AIR INLET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) DYES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH. LENGTH. NO.OF JDIITR PIPE SPACING. COVER INSIDE DIA st P1T5 LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTH PIPF DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR NUMBER OF �P _ WELL B UILDING V NT TO f HESN BELOW PIPES ABOVE COVER ELEV.INLET ELEV.END'. PIPES FEET FROM AIR INLET NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ONO SOIL COVER TEXTURE PERMANENT MARKERS WELLS ❑ 707N YES O ❑YES ONO F.EPT. R TREN CH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED EDGES. 1-1 YES 1:1 NO DYES ❑NO DYES F-1 NO_ PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO.OF ES LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED/TRENCH TRENCH DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DfSTHIBUTION PIPE MATERIAL&MARKING ELEV. ELEV.'. DIA. ELEV. PIPES DIA.. ELEVATION AND DISTRIBUTION INFORMATION MOLE SIZE HOLE SPACING. DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS 70 APPROVED PLANS ❑YES ❑NO DYES ONO COMMENTS: PERMANENT MARKERS: JOESLHVATION WELLS: NUMBER OF JPROPERTY WELL: BUILDING: FEET FROM LINE. DYES ONO DYES ONO NEAREST ut�lp f Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. Zoning Administrator i DILHR SBD 6710(R.01/82) DILHR SANITARY PERMIT APPLICATION COU� C In accord with ILHR 83.05,Wis.Adm.Code VV E :3��• �.,,�+. STATE SANITARY PERMIT# 10 ,�e 6�1,3 —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 19 NO PROPERTY OWNER PROPERTY LOCATION 1 S]i '/4 5 W '/a, S 31 T , NCR W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER I BLOCK NUMBER SUBDIVISION NAME CI Y,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE O LANDMARK ' Cr Fw 1 J� do�o� (17/-4-14:13'#4 El VILLAGE: YO Q IM TOWN OF- 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. lefXNew b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit# Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. ,Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. XSeepage 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(Square Feet): PROPOSED(Square Feet): ,,,rw 1 9d, 1;?0 -_ 5 eF 5 /r- 25, Feet R Private ❑Joint ❑ Public afi VI CAPACITY. TANK Site in Ions Total #of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank 00 /00 0 :; v n Lift Pump Tank/Siphon Chamber � ❑ I LF T E F1 El Ll VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: Car P, Weise e Plumber's Address(Street,City,State,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# r./ a- Id-ef race J CS 's ADDRESS(Street; ity,State,Zip Code) Phone Number: -r Q F AS LQ0 tl 4 s 5-401 15- -a/Lq IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuin Agent Signature(No Stamps .Approved ❑ Owner Given Initial r rcharge Fee - Adverse Determination X. COMuENTS/REASONS FOR DISAPPROVAL: Y SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR`COMPLETING A SANITARY PERMIT APPLICATION ` TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time.of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system;, 4. Changes in ownership or plumber requires a Sa�itary`Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is 10 be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete#2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed., number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix,(e.g, MP, etc.), address and phone number. Plumber must.sign application form. Fill in designer name if . applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/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 over 2 years of steady negat aticn anc, public debate. The groundwater b;:l GroundA4ter included the crea`ior of surcharges es fog o urnbur of regulated F,act es which Wisp or{sirt'S can effect group lwatE�, ne surcha! fE c, an Jule 1 1984 Al' of the water tha' ur;e� (reasure . is used in your E•g - re,,urnn l roue°, e ; o r system or the d;suobai s,tc tjsed oy rrrr iron iC.j tank pu 11pev The rotors s w a ., !d tared by ilit water, gr_3J- ,iW. wl 1 c,:'tii, 1: +'s ;°,orth proiect;,ng. _.,su-x=398(8.03/36) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the roperty 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 t i G /v1 -4- uc 471t�I S Location of Property ;t 3t, Section f , T N-R L�_ W Township Nailing Address f �J C-1-V;'40 Klle Address of Site ) -� 3 � Subdivision Name Lot Number Previous Owner of Property �� 11;/1 _S�j�(�,`�;� sel� L,-1 C 27 2 Total Size of Parcel l h e� c- rc S Date Parcel was Created Are all corners and lot lines identifiable? L/- ' Yes No Is this property being developed for resale (spec house) ? Yes _ 2!' No Volume _ and Page Numbe as recorded with the Register of Deeds. X75 ��- 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 1 (wel cen.ti.6y that att statements on thin oAM aAe th.ue to the beet 06 my (ouh) hnowtedge; that 1 (we) am (ahe) .the owneh.(,5 06 the pnopenty de�seh,i.bed in this .in6o4mation 6o4m, by viAtue o6 a waAAantV deed kecokded in the O66ice o6 the Coftntyy Reg-k'Ateh. 06 Deeds m Document No. . c (, C-�; and that I (We) pneaen.tty sun the pnopoeed site bon the selvage di�spoe eye em (on 1 (we) have obtained an ea.a emen.t, to nun with the above deAcA,bed pnopeA ty, bon the eonetnuctti.on 06 said eye-tem, and the same ha.e been duty neeohded .in the 066.iee 06 the County Reg,i.eteA o6 Veed6, ad Oocwnen t No. ��t/(�'��� J . SIGNATURE Op O6iNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED UOCUMENT NO. STATE BAR OF WISCONSIN FORM 16-1882 THIS SPACE RESENVED FOR RECORDING DATA l/ TRUSTEE'$ DEED l 424G70 V 74PAGE REGISTERS OFFICE Audre J. Schweizer ST. CROIX CO., WI& - ---•--A. - _r_ey.,-----.....--•-.......--- e _ k u:*d. for Record this 20th .. ......•--Schwe-i -----r ...rl--------•--------•-----•------..... ad Trustee of Gy o,I April AD. 1987 l7.................. .:. .....?�l.. Y_. F4. 1 ........................ 8:30 A QA� I ----------------------------------------------•---------•--•---------.---•-----------.-.----------------------.- i n u vuluuhle consideration wnvcys without warranty to .............................. �� William Stokes and Betsy, Stokes , ................ husband and . as survivorship marital property. RETURN TO f .. ..........._.................... ................................................................. ......... --"'----------------•--•----•-••--............•------•--------`------.........................-•--Grantee, the following described real estate in .... ......_ St ._ CroiX.............County, State of Wisconsin: Tax Parcel No: ............................. i Lot One (1 ) , Volume 6 , Certified Survey Maps , page 1790 , being a part of the SEk of the SWk of Section 31 , , Township 28 North, Range 19 West , Town of Troy . i MN SM FEB i Dated this 16th ---- day of APr- .-1................................. 18....&Z ROLLIN SCHWEIZER FAMILY TRUST •.....................(SEAL) B Airu � J (SEAL) . AudrSchweizer Trustee AUTHENTICATION ACKNOWLEDGMENT Signature Audrey__ J. Schwe_ ze _______ STATE OF WISCONSIN b ( ) ss. ------ ---------•y-----•-----.-.County. aut} mica e is _ a f....-. .APr l l•• _- 19g�. Personally came before me this ................day of ..........................................1 19........ the above named .. •-•---. .... ... ...... •--•- ------------------............... •._ ..-�.�.. L SAY o d •....................••-•------.........--•---..........................._...... ------------------------------------------ -------------------------------------------------------------------------------- T1TLE: MEMBER STA E BAR OF WISCONSIN ......................................................... ...................... (If not. ----------- --- authorized.by § 706.06, Wis. Stats.) to me known to be the person ------------ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ' CL Ga lord At ----------••-------•.............. River Falls , WI. 54022 ------------ ------------- -----------•---- ................................. ..--.... ---•---•---•-- -- - Notary Public .---- -------------I—- - •- - --_County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: •Nadirs of persons signing in any capacity should be typed or printed below their signatures. STATE BAR OF WISCONSIN H.C.M�UerC ry�. FORM No. to— 1982 Stock No. 13016 423370 CERTIFIED SURVEY MAP LOCATED IN THESE 1/4 OF THE SW 1/4 OF SECTION 31 , T28N , R19W , TOW N OF TROY , ST. CROIX COUNTY , WISCONSIN. OWNED BY . ROLLAND SCHWEIZER FAMILY TRUST C/O ROLLAND SCHWEIZER R T. 3 SURVEYED FOR: RIVER FALLS,WI 54022. WILLIAM AND BETSY STOK&SEE SHL'TFT 2 OF 2 FOR DESCRIPTION** 218 W. CHARLOTTE ST. RIVER FALLS,WI 54022. O= SET 1"X 24" IRON PIPE WEIGHING 1.13 LBS. PER LINEAR FOOT. ISCALE 1 = 150' 0 75 150 300' UNPLATTED LANDS NWCOR.SE- SW ' NORTH LINE OF THE SEI/4-SWI/4 �-r WAC� M _ S88° 36'OO��E 450.00 _ M • M N88'36'00"W 450.00' _ M_ — _ — — — — — — _ — - -- o �right-of-way Itna a X %rulnuge ditch W I W 3 N� a oz I t-►- v °w \ y�J V J W N WVN N• F N' LLvc O; LL Z. o Z. 3 w W y R Q• 2 Q• aW> 2� J. J o o J. U)F' 0 0 �'L o W CO LOT I to W z 3 (O jz� 0 W J V O: 0 10.00 ACRES o O, co z (435,600 SQ. FT.) „j W• WHz F,•. p 9.66 AC.TO R.O.W. M �• o o W W. (420,750 SQ. FT.) 1"'• Zwo Q• N Q. 0- N N Z• W E Z. ° ° O' z '� � .�� cn • APPROVED s MAR f71 8 "Aq of UGMW of OR 12 1987 it p ST. CROIX COUr:iY S 1004 °PR1'1"= VALLEY COME."};_!.iS1Yc FAPKS PLAfIKING "`" ANJ 110NING COMhUnEli a WIS. <d 10' W N 8 8°3 6 '0 0'W 450.00 ' ,�^/� ; � UNPLATTE•D LANDS - �. SW COR. SE-SW (V 1: . . . . . . .. . JAMES M. WEBER S- 1804 . ° Z M DATED THISb-DAYOFFEB•i98T. S88'39'06"E 1184.9 N88°39'06"W 1309. 37 SW CORNER OF SECTION SOUTH LINE OF THE SWI/4 S I/4 CORNER OF SECTION 31 , T28N,R19W.(COUNTY I MO NU M N, R19W. ( COUNTY M MONUMENT FOUND). MONUMENT FOUND). SHEET 1 OF 2 . Volume 6 Page 1790 THIS INSTRUMENT DRAFTED BY: *SEE SHEET 1 OF 2 FOR MAP INFORMATION" DESCRIPTION A parcel of land located in the SE4 of the SW4 of Section 31, T28N, R19W, Town of Troy, St.Croix County, Wisconsin, more fully described as follows: Commencing at the S4 corner of Section 31, T28N, R19W: Thence N88039106"W i ' to the along the South line of the SW of said Section 31 a distance °of 1309.37 Thence Nl 2 ' 2"E along the the SW of said Section 31• Th 3 4 g SW corner of the. SE4 of 4 � West line of said SE4 of the SW4 a distance of 347.50' to the point of beginning: Thence continuing N1o23'42"E along said line a distance of 968.00' to the NW corner of the SE4 of the SW4 of said Section 31; Thence S88°36'00"E along the North line of said SE-14 of the SW4 a distance of 450.00' ; Thence S1o23'42"W 968.00' ; Thence N88 0 36'00"W 450.00' to the point of beginning. Contains 10.00 acres of land subject to Ilwaco Road right-of-way over the northerly 33 feet thereof. Also subject to any and all easements, right-of-ways or conveyances of record. SURVEYOR S CERTIFICATE I, Tames M. Weber, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St.Croix County Subdivision Ordinance, I have surveyed, divided and mapped said parcel of land and that such plat correctly represents all exterior boundaries and the subdivision of the lands surveyed. Dated this(oZ day of FEB0.vA0.y ,1987. James M. Weber S-1804 Wegerer, Weber and Assoc. River Falls, WI ®0���Q3sE'4��' 9�, C;c;C)/V�s�i�rres JAMES WEBER .4 S- 1804 S SPRING VALLEY WIS. 0 • ®� ,9 �.r ,moo 18118210% Volume 6 Page 1790 SHEET 2 OF 2 . THIS INSTRUMENT DRAFTED BY J H I z H r r STC - 105 9 H SEPTIC TANK MAINTENANCE AGREEMENT Ho St . Croix County z d 9 OWNER/BUYER not Ssued ROUTE/BOX NUMBER I��X l Fire Number y1 CITY/STATE �i 11Q� �z� s �1 -�C >v1S•'o ZIP 7 1C' PROPERTY LOCATION : _14, S te' %, Section f T c N , RI W, Town of I-L'V 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 I! 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 H three year expiration . 0 z I/WE, the undersigned , have read the above requirements and agree L„ to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- lid ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SIGNED 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 . 115 Rev.9/76 - 13 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES �J p7S f P.O. BOX 309, MADISON,WISCONSIN 53701 t ,T ION: �•, �•.Section 3' ,TZ�.R L9F&(�)W, Township,,44,1,�eif�ai+ Y Count STS X Y ,).---, Block No. ub ivision ame ,ti/Buyers Name:V�� — 5�� 5 ,y Address: OF OCCUPANCY: Residence ✓—No. of Bedrooms COMMERCIAL UENT DISPOSAL SYSTEM: NEW✓' REPL__A//CEMENT ALTERNATE SYSTEM OTHER S OBSERVATIONS MADE: SOIL BORINGS�LNM0 �V PERCOLATION TESTS �-.- r.1AP SHEET NAME OF SOIL MAP UNIT--_ PERCOLATION TESTS T HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE JE CHARACTER OF SOIL SINCE HOLE HOLE AFTE INTERVAL MIN/IN t THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 � 6Z- Z y� i SOIL BORING TESTS DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, ST TOTAL DEPTH TEXTURE,MOTTLING AND DEPTH TO BEDROCK 1MBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES ! oc+ k ,, z 5- �� 3 - }e 3 t� t.�a� - �► 91� �+ 8 • +• 9 '8 6r s 1Z ' s 14 7 9� v ii ��, rn o s y D >N V IEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. icate number of square feet of absorption area needed forbuilding type and occupancy -6J S QE� Indicate scale or distances. e horizontal and vertical reference points. Indicate slope. I 2� ,' B ,_»�^ -83 R��u1���r nom:-(%i'woo `�•�� io 3 't�i1�i 'B b tu ( � N M� I S 5 - 'S9 z Sle N l ' j F I!Qpi JL Oise I , r 4 r V , � I ! C!A LL 1 . y o I, the undersigend,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 location of test holes are correct to the best of my knrnvledge and belief. Certification No. lame (plint)������, --- Addr ess-_---- ?4ame of installer if known CST Signature r'--- A — I nenf Authority - - �G/ ro�� ✓Gtit C.a� . William STokes ,— --- __ 21 B _�[__C k a Y)a 7Tc--ST, M&V- Cover R Ivey F& LL S W16 94022— Mih o?o"Cover TowNShilc, VRP IXQ 5Tahc. f!l. 100,4_ -- Mph oil " Ia9 p9^��a � 4 ��p d.,.t e 1'V r' DesiSn by Garl /�ets e,__- MPRS3378 rr► ry G ��J rey--4 (3a TTp m [3c d B B App►°r _- _ -___--------- 3 Ytr�accn►cw� wrtA- € 'AJ& 40 Ise 36 « O a.5'MIN }i0a cr �roPoS®a well