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HomeMy WebLinkAbout020-1133-40-000 � o R j2 ? \ 0 # . � \ -$ƒ � \ f0c i Mc0 § $ e) $ _] CO 2 = 2�\ § 2 @L § § �P & 2G74) 2 \ E0 2 � M cu ) _ __ eee E \kkk\ c « L B c g , o z _ § $ a ■ k j \ ) k U) - / K = CD N \ U) / \ $ -� � / \ O 2 z m z % " C - ) \ © ■ a f CL e ) � » t : © ® / 2 2 % G o 0 a co \ k k ELch \ \ t - 4 0 a a a k \ � \ \ z M � Z ® E . J \ a ca » 0 2 $ z m � ~ E e : _ , 04 o LO 7 k } 0 E § % k k k § 2 / - - ) I - _ - - § § R , z f f d d ) \ § § 2 5 z / n � � ® � L 'S EL 0 f § c v a 0 2 . ,�o rn. ��`e�se.✓_ sE�/s,E���---Sec l g` '?—��J,�c1le=.. /�? T �.��.vo� � v i S I CP 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 State Plan ID.Number: SE ,SE ,S18,T29N-R19W CONVENTIONAL ❑ALTERNATIVE (Ilauigned) Town of Hudson ❑Holding Tank ❑In-Ground Pressure ❑Mound Lot 36 Willow Ridge II NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER: FINSPECTION DA FE: Tom Nielsen Route 5 Willow Ridge Rd, Hudson, WI 54 BENCH MARK(Permanent reference pomtl DESCRIBE IF DIFFERENT FROM PLAN: T.ELEV.: CST REF.PT.ELEV.. Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number. William Schumaker 1 6382 St. Croix 102830 SEPTIC TANK/HOLDING TANK: MANUFACTURER. JILIPUID CAPACITY TANK INLET ELEV.: TANK OUTLET ELEV.'. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. OYES ❑NO 10YES ONO BEDDING: VENT DIA.. VENT MATL.. HIGH WATER NUMBER.OF ROAD: PROPERTY WELL. BUILDING. (VENT TO FRESH ALARM. FEET FROM LINE. AIR INLET DYES ❑NO ❑YES ❑N6 NEAREST DOSING CHAMBER: MANUFACTURER BEDDING'. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. ❑YES ❑NO DYES ❑NO OYES NO PROPERTY WELL BUILDING VENT TO FRESH GALLONS PER CYCLE: IPUMPANOCO TROI_soPERATIONAL NUMBER OF j��� 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: LENGt NO.OF DISTR.PIPE SPACING COVER ENUMBER INSIUE DIA #PITS LIQUID BED/TRENCH ;1 �_ TRENCHES. MATERIAL: DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTH.PI F DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR. PR OPERTV WELL. BUILDING VENT TO FRESH BELOW PIPES ABOVE COVER ELEV INLET ELEV.END. PIPES. LINE AIR INLE7 —� 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 ❑NO SOIL COVER ITEXTURE PERMANENT MARK IRS OBSERVATION WELLS DYES ❑NO 1:1 YES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED J.EPT.OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. ❑ ❑YES NO DYES ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL SPACING.JGRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATE HIAL&MARKING ELEV.. ELEV.. DIA.. ELEV.'. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANICAL LIFT CORRESPONDS TO APPROVED ❑YES ONO El YES ❑NO COMMENTS: .> ( PERMANENT MARKERS: JOBSERVATION WELLS NUMBER OF PROF ERTV WELL BUILDING FEET FROM DYES El NO DYES 1:1 NO NEAREST--� (, rr � Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE Zoning Administrator DILHR SBD 6710(R.01/82) i INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewace 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: 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'%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 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 ate included the creation of surcharges (fees) for a number of regulated practices which Wisco in'$ can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried re3Sur a 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 purr per. a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t Ovate!, groundwater contamination in-estigations and estaDlishment of standa•ds Groundwate!, s worth protecting. S9D 6398(R.03/66) SANITARY PERMIT APPLICATION COUNTY ;=H�71LF-IR In accord with ILHR 83.05,Wis.Adm. Code �r ' �v X STATE SANITARY PERMIT# /),� —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 W NO PROPERTY OWNER PROPERTY LOCATION T97, N, R a E (or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER I BLOCK NUMBER SUBDIVISION NAME. j ,f AJ.110 Ae", c fF �t f%t✓ /�lG� d CITY,STATE ZI CODE PHONE NUMBER 0 CITY NEAREST ROAD,LAKE OR LANDMARK _ ❑ VILLAGE: /��--�,._�_�q LSLTIQWN II. TYPE OF BUILDING OR USE SERVED: 0110 �` ��—�"�/ `e6 Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b. 0 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. 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. W]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(Square Feet): PROPOSED(Square Feet): e5 —S Ypf v j Feet An Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gall2ns Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name C Concrete str cted Steel glass Plastic App Tanks Tanks Ll Septic Tank or Holdina Tank �d �� ❑ ❑ L1 Lift Pump Tank/Siphon Chamber ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system sho p on the attached plans. Plumber's Name(Print): 1 Plumber's Signature:(No Stamps) MPRSW No.: Business Phone Number: Plumber's Address(Street,City,State,Zip Code): Name of Designer- C G' �..�,.� i - VIII. SOIL TEST INFORMATION Certified Soil Tester(CST) me CST# G T's ADDR (Street,-City,State,Zip Code) Phone Number: ,s 5,7 Cd �C t'�.� Cam! 41 �"' IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) c� rcharge Fee 4Q Approved ❑ Owner Given Initial `Hr ]�`, O� Q wnd Adverse Determination f V X. COMMENTS/REASONS FOR DISAPPROVAL: I la, 0,0,00") I'-4wzA C. aj-o k SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber a s 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 -i'LSO J� e� �x-E('.-lv W C',t: Z, Location of Property �''_ �' , Section _� _, T N-R W Township Nailing Address __ �_� /c�aL_S ,x (✓ `Gh f 1._L'P> �e Address of Site Subdivision Name . Lot Number 3 C Previous Owner of Property Aly, o ��.- A-0t Total Size of Parcel f �� Date Parcel was Created Ctw, e/_ (,5� 77 Are all corners and lot lines identifiable? Yes X No Is this property being developed for resale (spec house) ? Yes X No Volume SS — and Page Number 1-,5-7 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 1 ((ve) ceAti.6y that ate 3.tdtement5 on ZW ane tAue to the but o6 my (ouh) hnowtedge; .that 1 (we) am (aAe) -the ownefc(sfoAm 06 the pnopeAty deg c4i.bed in .this in6o4ma.Li,.on 6onm, by vi-ttue o6 a waAAanty deed neconded in the 066ice 06 .the Count Reg uszen o6 Ueedh as Voeument uo. �o?F' ; and that I (We) pnezen,tty sun .the p40poaed 6 to bon the sewage di�spo3 dy3tem (on I (we) have obtained an easement, to nun with the above debcAi.bed pnopeAty, bon the eon.6tAucLion o6 said aye.tem, and the dame has been dut neconded in the 066.iee o6 the County RegiAten o6 Veeda, as Document No. SIGNATURE Op OWNE SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED I DOCUMENT NO. STATE BAR OF WISCONSM-FORD 2 WARRANTY 16EED ii 3 �)(7 ���'�- C�55� Y s K THIS SPACE RESERVED FOR RECORDING: DATA !! Y I� BY THIS DEED, A. R. Bertelsen and Sam E. Miller REGISTERS OFFICE w. ST. CROIX CO., WIS. Rec'd. for Record His-15th day of Au IjGrantor conveys and warrants to Thomas K. Nielsen and lit 19 77 li Constance A. Nielsen, husband and wife, H--9_L3_Q__ A NA. j, as joint tenants . Register of Deeds Grantees iE for a valuable consideration RE URN TO f St. Croix Abstract Co. ;- the following described real estate in Si-- rrniX County,State of Wisconsin: if i� Tax Key p i This is not homestead property. +I Lot 36, Willow- Ridge Second Addition, Town of Hudson, except the a parcel described as: Beginning at the Southwest corner of said Lot h 36, thence N 79 003150" E, 386. 9-3 feet to the Westerly R/W line of iG Willow Ridge Road; said point also being the point of curvature of a curve to the Southeast havin g a central angle of 10°11140" and a radius of 281. 38 feet; thence Southeasterly, 50.0.7 feet along the arc of the curve, the long chord of which. bears S 01°33122" WE , 50..00 feet, to a point of tangency thereof, said arc also being the " aforesaid Westerly R/W line of Willow Ridge Road; thence S 86 027' 321' Wjj j along a line common to Lots 35 and 36 379. 27 feet to the point of f� g f p beginning, AND, Lot 37, except the parcel described as : Beginning at the Northwest h corner of said Lot 37, thence S 89 048110" E .along the North line , !' of Lot 37, _ 150. 00 feet; thence S 500411561' E along a line common to Lots 37 and 38 365 W line of Willow. 09 feet to the Westerly R/ Ridge 4 .. Road; thence N 7105110911 W, 457.07 feet to the West line of Lot 37, _! thence N 01009 150" E along the West line of Lot 37, 89. 42 feet to the point of beginning. Subject to recorded easements, covenants and restrictions. j Executes at Hudson W r , i G _ona i n thin_`_day of Au t 19_7. k) SIGNED AND SEALED IN PRESENCE OF (SEAL) `j SEER A. R. Bertelsen (SEAL) 4i Sam E. Miller ii - i� (SEAL) (S$AL) Signatures of NZA f1. authenticated this day of 19 !; Title: Member State Bar of Wisconsin or Other Party Authorized under Sec. 706.06 viz. {. I STATE OF WISCONSIN ST. CROIX County. Personally came before me, this day' of August 19 ? f the above named A. R. Bertelsen and Sam E. Miller I! j, to me known to be the person S who executed the foregoing instrument and acknowledged the same. This instrument was drafted by Hugh F. Gwin, Atty. Hudson , Wi sr-nnsi in Notary Publi County, c.�� �J�3.Qx Win. I The use of witnesses is optional. My Commissiur4(Expires (IsL ! '7 1 es I 0 Names of persons signing in any capacity should be typed or lrinted below their signatures. I �Y. x �i�` KCMMxaCowrv® WARRANTY D6HD—STAI,Jl BAR OF WISCONSIN, FORM NO. 3 — 1971 5 • — 1.-+eJfY@irxur�i. Rx�d..r $ Gf�`•T 1.. MORTGAGE �3` . IL i_oAiY/(tt90 n� DOCUMENT No. c F 34232y a� 55�r -i,�� i ,U IIS SPACE RESERVED FOR RE'.ORDINO DATA j3 KNOW ALL MEN, That the undersigned.. ma K. Nielsen and"" D j Corr tance A. Nielsen, husband and wife. it .. . ... .. ... ....................................-...................... REGISTERS �� ICE . .. .......... Mortgagors, ST. CROIX CO., WIS. of.._ . t• Croix ""County, Wisconsin, hereby mortgage to Recd. for Record this 15th First Federal Savings and Loan Association of Eau Claire a Corporation, '- Eau Claire day of Au us t Mortgagee, of County, Wisconsin. for the sum of yA. . 19 77 Thirty--five Thousand and No 100---------- 41a�j,3 D L - 0 A.----------------------------------------Doll .....----......". .... .--- -------- ..............- ------.... ars the following described real estate in...St... CrOi*x- -. -.. ........ -..-..County, Wisconsin: Rsplst Gf Deeds Lot 36, except commencing SW corner of said Lot 36; thence �/ N 79'03#--0" E 386.93' to the Wily line of Willow Ridge 'load-. TAX KEY NO. thence SE'ly 50.07' on an arc of curve, radius 281.381, long RETURN TO MORTGAGEE ASSOCIATION AT: chord bears S 1°33'22"W 50.0', said arc being td'1-- line of St Croix Abstract Ca. Willow Ridge �o-?d; thence S 86°27'32" W on line between Lots � �R 35 and 36, 379.27' to the place of :,eginning. Also, Lot 37, x>�1ieK except commencing NW corner of said Lot 37; thence S89 0481;10"E on the N line of said Lot 37, 150.0'; thence S 50°41 '56`' i on line between Lots 37 & 389, 365.09' to the W'ly line of Willow Midge Road; thence N 71 °51 '09" W 457,07' to the W line of said Lot 37; thence N 1009150" E on said W line 89.42' to place of beginning. All being in Willow Ridge 2nd Addition to Township of Hudson. II -Being rerecorded for the sole purpose of indicating that the correction on the it description has been made.- 1 I� including all apparatus, equipment, fixtures or articles, whether iri single units or centrally controlled, used to supply heat, gas, air conditioning, water, light, power, refrigeration, ventilation, or otherwise, and any other thing now or hereafter therein or thereon the ' furnishing of which by lessors to lessees is customary or appropriate, including screens, window shades, storm doors and windows, 1, floor coverings, screen doors, awnings, built-in stoves and water heaters (all of which are fixtures and a part of said real estate whether physically attached thereto or not), together with the privileges, hereditaments, appurtenances and improvements now or i! hereafter belonging to or erected thereon, and all the rents, profits and income which shall arise or be had therefrom, hereby releas- ing and waiving all rights under and by virtue of any Homestead Exemption Laws, and all right to retain possession of said premises t after any default in payment of the above obligation, or breach of any of the covenants or agreements.herein contained. This mortgage is given to secure an indebtedness to the Mortgagee in the above mentioned sum,and such additionaI'sums subsequently 3 advanced in accordance with and pursuant to the terms of a mortgage note of even date, executed by the Mortgagors, which note is made a it pan hereof. It is the intent hereof to secure payment of said note whether the entire amount shall have been advanced to the Mortgagors at the a date hereof or at a later date, or having been advanced, shall have been repaid in part and further advances made at a later date, } but at no time shall this mortgage secure ad ances on account of said original note together with additional advances in a sum in excess of I? Thirty-five Thousand and N01100--------------------------------- -----po .............................------------•-----•------•-•------•----._..._----- ----•-------------••-•-------------------------------------•--------•--•----••----...._"_.._.....- Dollars, 000.00) ar , ($-.- __z_______________. , providing that nothing herein contained shall be considered as limiting the amounts that shall be secured hereby when advanced to protect the security,or in accordance with covenants contained in the mortgage and the note hereby secured. The Mortgagors agree that in the event of the foreclosure of this mortgage they will be bound by the provisions of Section 846.101 ( of the Wisconsin Statutes. In the event of the non-performance of any of the agreements contained in the note or mortgage,said Mortgagee is hereby authorized to grant, bargain, sell and convey said real estate at public auction, and make all needful deeds of conveyance to the sI Y purchaser thereof. I In the event that the mortgaged premises or any part thereof are sold, conveyed, or transferred, or in the event that either legal or equitable title shall vest in an other g j Y persons than the Mortgagors for any reason whatsoever,the entire indebtedness pursuant to this mortgage II and the note that it secures, shall become due and payable forthwith, at the option of the Mortgagee, without further notice. If only one person executes this mortgage,the term "Mortgagors"and the use of the plural number herein shall be read and construed j accordingly. In Witness Whgreof,said Mortgagors have executed and sealed this instrument at.........:�'lasuzos'th..................................Wisconsin, i '-tit"- this..................'._�.-r�.-___""_-day of."Aldgtl-,a.t a.---....__..._...-......__..... 19.77._ -.. Executed,sealed and delivered in presence of: I R�EGiSTERS"IOFEiCE ~""� ................ S ) , (SEAL Them?g K Ni Pl gPn ST. CROIX CO., W IS. � ...... :_._` Q-R-ec'd.--#or--•Recor-d._this 6th .. - .. - .........(SEAL) ay of Sept A.D. 197 C°ngtan A,�jj-P1 aaT� �.0 8.• (SEAL) Raylstar of Deeds ..... •....... ..................................... 1. ..._._...- ......... ............. ....(SEAL) STATE OF WISCONSIN, "' ' Pierce "e•""-•- jar/ ..............:. OUNTY. }�,•'Pq�Y�cna qam_11 of re me this....."...� 9 ............................11977_...._.. the above named.-l`}1pma8..K....I1 ie1PaE t°yi1'1^� _ SZF3;8 �1. Ni.el e1 hu � sh,and--And••W3 feR ........... ...... _ .........................----••-••--•---------•-•-•.._._..._...------•--.........._._.._._..._....__............ to me known to be the persons who executedithe%regping4nstrur*aent and ack led ed the same. THIS INSTRUMENT WAS DRAFTED SY - j •/ Q Y 1 David L. Johnson :.. .aa�.. J. J. Falde - (SCAL) Notary Public,State of Wisconsin. r My commission .. ........-........................._..----......_._.......... _ Form SL 30 (Revised by Wisconsin Savings and Loan LIMorms Committee 5/73) �j KCMagrConp�y � s i H • 'l. N H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT c St . Croix County x d OWNER/BUY ER—,_/_ �r#S /l/�ELS� M ROUTE/BOX NUMBER 9J'7 ��/how 1��%.e �0+4o Fire Number X27 .CITY/STATE 4"(S.-'j (,J ; ZIP Sq0 /L PROPERTY LOCATION:.-5-'jr fit, , Section , T .__j N, R W, Town of J��L S'�./ St . Croix County, Subdivision l�,f,.°%�� ,� � 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 pdt 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 . Ho ' E I/WE, the undersigned , have read the above requirements and agree z„ to maintain the private sewage disposal system in accordance with x the standards set forth , herein, as set by the Wisconsin Depart- b 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 . SIG 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. o f)E PAR TIVRf.T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY _. n1S10N 796,LABOR AND PERCOLATION TESTS (115) MADISON W 53707 HUMAN RELATIONS (H63.090)& Chapter 145.045) OCAT10N:�� —SECTION: UNIGIPALITY: LOT NO.:BLK.NO.: SUBOIVISIO NAME: S& '/�'/ T�`�N/R1�1 E (Amu SdN -;;�� -- k/r«o� �,k4t 2Nd COUNTY: ER WIILLS411/ER'S NAME: M ILIN AL ST Q01 A /o T S ►(,�btat �Agt b v�Sd� USE DATES OBSERVATIONS MADE NO.BEDRMS.:1COMMERCIALDESCRIPTION: I PROFILE DESCRIPTIONS: A STS: Residence ! ,NK ❑New *Replace VI �icS x A4L S7 �pILS - �M� - Lr/hi`''�RT' RATING:S-Site suitable for system U°Site unsuitable for system E: S� TI . N I L G R YS91SJU � SXU ❑U �S ❑UOS ❑ R LOW r_XtSrI&x' Syvm If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the /A under s.H63.0915)I1t),indicate: tnt_/4� Floodplain, indicate Floodplain elevation: �vN PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROU NDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE,AND DEPTH NUMBER DEPTH1.5. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) B- 9 33 161 ,40 At > /J.83 �,,,$«zs 6 �� 4�,e 3s"4&eN nr S w �Aru B- Z 9.so ,oa.3� o > �.�a 14"8LL s SYrnM c-< B- B- I,cG�T PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES N_UM_BER I W2ff S AFTERS WELLING INTERVAL-MIN. PERIOD t PERIOD2 PERIOD PERIOD PER INCH 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 hors 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 9A oy IJ�w S'/s-r M W►Lt. 13C /N A�L`n $dNCUn•,aRr- IcP of 6hC,' Ci0.6LN (fur 'LsT4L- E4-6.4 loo •40 . '1u' / -AALC J4 '2- J I I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with thn 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 tpr int : TESTS WERE COMPLETED ON: Y4 IQ JINN SU Aj _ iptJSr-1d r_��_ 7 ADDRESS: ) CERTIFICATI N NUMBER: PHON N MBER(optionall: 41 'SEC vru Q sago CST SI PPTIJII E: DISTRIBUTION: thupnal mul nimropy ut I oral Authrntty,Ptnitt•tty Ownet anti smi rester. _DILHR-1,R11D fi39!t IR . !11/I:R