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HomeMy WebLinkAbout020-1176-80-000 a o g § � c G ® ° � I � k � ¢ � \ � � f � � k � it $ � 2 I U. ° 2 3 \ f < c t / 7 E E $ 0 ( $ \ / L a c § § z :!t 2 t / k k z / E \ k & CD § E 42 } c g \ a < z = z \ \ � t 7 � I } k a . F ■ E I ) ) E / \ CL C.0 \ U) m _ U) E - = K 2 k z 0 0 •W,a t : 3 a a 2 IL \ § � o k§ k / §§ 5 2 § } § § % % E £ - > 5 < ; t . ± ® p 2 J ¥ m m < § 2 § o % $ _ E 2 ) c E 1- u o e ; § g E § / o 1 ? ° § § c o c o \ k / 3 / 5 E @ 1 CD & 6 © - \ / f ) & ® - } ) j k d § o z $ \ O ® : « � k 2 ) I CL . % E 2 0 4 E e c ` - § - a , o J a o k 0 , � PUMP CHAMBER i Manufacturer: Liquid Capacity: Pump_Wodel: 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: x Trench: Width: �' Length: Number of Lines: 3 Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front,, O Side, O Rear,0 Ft .Y Number of feet from well: > 5 G� Number of feet from building: 7 a (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: 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: Y / Js Plumber on job: License Number: �� 3 3/84:mj Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER AG TOWNSHIP G (�S GI� SEC. T N-R214 W 1 ADDRESS ST. CROIX COUNTY, WISCONSIN fA, r r SUBDIVISION C� �� �/1ls LOT LOT SIZE 14cr e S - 2 PLAN VIEW Distances and dimensions to meet requirements of IZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM W �y7 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference poinAi�sed , 0 ek N-L) to-L. Elevation of vertical reference point: Proposed slope at site: 1 SEPTIC TANK: Manufacturer: 11�� uJN j ir�N Liquid Capacity• 1 00D Number of rings used: 0 Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,©Side 10 Rear, O i� feet From nearest property line Front,OSide,®Rear,O (/ feet 3 T Number of feet from: well ��� building: �0 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) _CFF AF{TFACF gTT)F _ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS t-A-BOR&'HUMAN'RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING M/,a (SON,VU1 53707 E , NE14, S28,T29N,R19W CONVENTIONAL ❑ALTERNATIVE State Pion I.D.Number: Town of Hudson El Holding Tank El In-Ground Pressure El Mound (If Lot 9, Cedar Hills Estate ' NAME OF PERMIT HOLDER: FADOR_Et�_OF PERMIT HOLDER: INSPECTION DATE: Gary Wang ue 2, River Falls, WI 54022 7 � w 82 - BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.EL LIV.. Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Thomas A. Wang I3231 St. Croix 88476 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV: WARNING LABEL LOCKING COVER 000 9� I �' ^ PROVIDED: PROVIOEO: VLC/. nVWTV 7� YES ONO ❑YES NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF IROAD: fRQPERTY W ELL: JBUILDING: VENT TO FRESH ALARM: FEET FROM INE: AIR INLET. DYES ❑NO ❑YES ONO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING:, LIQUID CAPACITY: PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ❑YES ONO 1 [:]YES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. VENT LE FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ONO NEAREST SOIL ABSORPTION SYSTEM. eck the soil moisture at the depth of plowing LENGTH: DIAMETER MATERIAL AND MARKING or excavation. (If soil can\�e ro ed into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO.OF DI STR.PIPE SPACING: COVER INSIDE DIA. *PITS LIQUID BED/TRENCH Q /� TRENCHES Mt PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH IDISTR,PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES: ABOVE OVER: ELEV.INLET EL4,END: PIPE FEET FROM LINE �.� AI INLET` �tI I ,g '13��( � 7 Z5 NEAREST--► l7 MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ONO OIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES. [1)YES ED NO 1:1 YES ❑NO OYES El 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 IMANIFOLDMATERIAL: NO.DISTR. DISTR.PIPE DPIPE ATERIAL&MARKING ELEV.. ELEV.. DIA.. ELEV.: PIPES DIA.. ELEVATION AND (e! DISTRIBUTION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL ERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION / PLAnIs DYES 1-1 NO ❑YES 1:1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMB R Op� PROPERTY WELL: BUILDING: f FEET ONI NE: t IJ S� DYES ❑N ❑YES ❑NO 14FA 5 f Sketch System on R.et-' in county file for audit. Reverse Side. TM' SIGNATURE_ •� TI iLE -' - ~' ' DILHR SBD 6710(R.01/82) -- Zoning Administrator elson Thomas C. N 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 s tem, or type of system; 4. Changes in ownership or p r requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to ins 5. Private sewage systems must be properly e pumper whenever necessary, usually every 2 to e`9. The septic tank(s) should be pumped by a licensed 6. If you have questions concerning your private sewage sys + ct 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 owners name and mailing address. Provide the legal description where the system is to be a 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; Ill. 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 8iz 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 ! t included the creation of surcharges (fees) for a number of regulated practices which Wisco yUas can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that Wisco tn's is used in your building is returned tc� the groundwater through your soil absorption buried reasure system or the disposal site used by your holding tank pumper. ° The monies collected througt; these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds, are used for monitoring ground- v' ater, groun-dwater contamination investigations and establishment of standards. Groundwater, � t s worth, protecting. sBD-6398(R.03/86) s SANITARY PERMIT APPLICATION COUNTY —� D'L.H� In accord with ILHR 83.05,WIS.Adm. Code ST C Roi x STATE SANITARY PERM IT# —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 F-1 YES NO PROPERTY WNER PROPERTY LOCATION F'/4, S E(o W OL LOT N MBER B E P ORTY OW ER' MAILING ADDR S CI Y LAKEOR LANDMARK Or TY STATE ZIP CODE PHONE NUMBER p VIT den t , ox wv s 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): Ill. PURPOSE OF APPLICA heck only one in P. Check#2,3 or 4,if applicable) 1. a. SCNew b.❑ Replacement c. El Replacement of d.❑ Reconnection of e.El 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. El 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 eX3S' elej 1. a. Kseepage 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(Squa�Feet): PROPOSED(Square Feet): 90+C� Gj �, �(� . � 7 Feet X Private ❑Joint ❑ Public VI. TANK CAPACITY Prefab. Site Fiber- Exper. in alIons Total #of Manufacturer's Name Concrete Con- Steel glass Plastic App INFORMATION New xistin Gallons Tanks structed Tanks Tanks Septic Tank or Holding Tank 1 a�Q � e S ❑ ❑ Li FR 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. PI u ber's Name(Print): a.sSignature:(No tamps) MP/MPRSW No.: Business Phone Number: A, 5, Plumber's Address(Street,City,Statqf,Zip Code): Na esigner: / VIII. SOIL TEST INFORMATION Ce Vifiedl o il Tester(CST)Na re �� 1 CST# old je)CS 's ADDRES (Street,City, tat ,Zip CP � / ' u R Phone Number: C v GGJ(J/ S� IX. COUNTY/DEPARTMENT SE ONLY Issuin A ent Si nature(No Stamps) ❑ Disapproved Sanitary Permit Fee Groundwater ate 9 9 g S charge Fee Approved Owner Given Initial Qd 4 v C v� a �' 7 M O.R,�t� Adverse Determination �J X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,�Qne Copy To:Bureau of Plumbing,Owner,Plumber 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 S�.r�l Z C, �a y\ 1A Location of Property ' ' , Section , TN-R/9 W Township \ � � Hailing Address . Address of Site IL)�A 1� L1 I ` fda,s ���.1\(�. S� �s:. sf;� Subdivision Name ; Lot Number Previous Owner of Property l2V\ a M (, - a C­J Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? x Yes No Is this property being developed for resale (spec house) ? _ Yes No Volume and Page Number � as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPFRTy OWNER CERTIFICATION 1 (We) cexa6y that a t bta'tementd on this 6onm ane tAue to the best o6 my (oun) know.tedge; that I (we) am (cue) the owneA(s) o6 the pnopeh ty des cA bed in this in6onmctti.on 6onm, by vi tue o6 a wa Aanty deed neconded in the 066ice o6 the County Regcsten o6 Deeds as Document Na. , :-.? ; and that I (We) phesentty own the pnoposed 6 to bon the .sewage dispod d s em (on I (we) have obtained an easement, to nun with the above desc, i.bed pnopeAty, bon the condtnucti.on o6 said system, and the bame has been duty neconded in the 066ice o6 the County Reg.iaten o6 Heeds, as Document No. SIGNATURE V OWNER SIGNATURE OF CO—OWNER (IF APPLIC LE) T DATE SIGNED DATE SIGNED a• RIVER VALLEY ABSTRACT&TITLE, INC. It i NUMBER R V 12 6 1 k RIVER VALLEY ABSTRACT & TITLE, INC. z ST. CROIX COUNTY, WISCONSIN Lot 9, Cedar Hills Estates in the Town of Hudson. 3 i 1 i 220 LOCUST STREET P.O. BOX 149 HUDSON, WI 54016 IL 5 Y I i� i ii DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982;; THIS SPACE RESERVED FOR RECORDING DATA �I WARRANTY DEED @00 /�V P4Gf R�C�I S OFFICE S ST, CROIX 00., WIS. This Deed, made between Cellar'.Hl]__s..D,-ve1Qpmnt----_._--.. Rec'd. for Reaxd this 13th � - �'---- ---- -- do O� Feb. A.D. W7 -- I1:.�` .. . ----.._._....--- ----- ... at -------------- ---------------------------- --- -- - - - - Gras tor, James O'Connell r. and--------Gas'y.WarZ-a d.,Susan--Wang-,--husband.-and-.wife................. ----------------•-----------------------------------------•-----------•-- ................................ i- �� .nl, ' ----------------------------------------------------------- --------------------------- deputy ------------- - ----- -- Grantee Witnesseth, That the said Grantor, for a valuable consideration.._-._ I' Grantor 'j RETURN TO conveys to Grantee the following described real estate in St..._.Cr0tX------......... I� County, State of Wisconsin: Lot g, Cedar Hills Estates in the Town of Tax Parcel No- ----------------------------------- Hudson, St. Croix County, Wisconsin. FEE i 1S not This homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And.......Grantor-------------------- -------- -------- - - ------ _ .- ---- ---- . ---- . - -- - ---------------------------------- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any. I and will warrant and defend the same. I Dated this .................13th------------------------ day of . . . . ..February------_--------------------- ------, 19.87.... Cell Hills Devel ment, fc. , by: ---------•------------------------- ------ ---•------------- ------- (SEAL) �^-� �-�' (SEAL) * ------------------------------------------------------- * Dean -----Larson ..... ---- ........ ---(SEAL) L- - t (SEAL) II * *William C. Harwell --------------------------------------------------- ------ AUTHENTICATION ACKNOWLEDGMENT Signature(s) _.D!�an_.R_,__LarsOn,_W111 am____________ STATE OF WISCONSIN C. Harwell ss. ------------------------------------------------------------------------ ------ authe/nti ted this .l3----day of•Feb?"uaz'y--------, 198-7.. Personally came before me this ----............day of �1 Q/}�Gt�221% lL ytGl'�i LG�r Gam, --------•---••---- 19..... the above named ....................................-f�-------------------------••--•----------- * Kristina 0gland Lundeen -•--------•---•----------------------------------------------------------------- -------------------------------------------------------------------------. ----------••------•--------•--. --- TITLE: MEMBER STATE BAR OF WISCONSIN (If not- ----------------------•------------•---•• ----------•------ ------- ---------------------------------------------------------------- authorized by § 706.06, Wis. Stats.) to me known to be the person ------------ who executed the forenoiing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY i Kristina 0gland Lundeen ------ Attorneyat Law ---•------------•------------ ------------------------------------------ .......................................................................... Notnr Public •-•---------- ----------•--..County Wis. (Signatures may be authenticated or acknowledged. Both Vii.• Commission is permanent. (if not, state expiration are not necessary.) (late: ---------------- --••---------._, 19......... •Names of Persons signing in any capacity I:h.mbl hr It7.,,J ­j I. I, t!r it =ign:w!rc . 31 WV*a 1�ECi8ft:� OFFK.� n►M5 w�► !v rf 3 n. c>ROOc r Recd. for Record 06 UnL " CEDAR HILLS ESTATES �of �R 19 8i 8:30 A DECLARATION ESTABLISHING PROTECTIVE COVENANTS t_ j � r ` sir THIS DECLARATION is made by Cedar Hills Develop ent, Inc. , ^t ylezeinafter referred to as the Declarant, owners of the following ibed lands Commencing at the E1/4 corner of Section 28; thence 5890 3T!!6 0w 23.78' to the point of beginning (bearings referenced to the "s " AOr'th line of the NE 1/4 of Section 28, assumed S89023151 0E) ; thence x =a ;', 1i058'll'N along the westerly right-of-way line of U.S. Highway "12" 1604.76' ; thence S89 001149 0W 35.001 ; thence N0058111"W 514.13' ; thence 88902S109 0W 812.871 ; thence N0004' 11"W 493.42' ; thence N89024' 45"W i° ; 1733.36' ; thence S0 011145"W 1358.00' along the West line of the NE 1/4 .Of Section 28, thence S89 024145"E 320.23' ; thence N84 053' 21"E 67.69 ' ; thence N69 000'18' E 440.08' ; thence N5 011'45"E 127.501 ; thence N0O �^ 1116518 417.391 ; thence S89048115"E 159.5311 thence N52036109"E 422.001 ; thence S69039'59"E 330.87' ; thence N89025'09 0E 122.001 ; thence S10 008153"W 386.761 ; thence S15 017157"E 502.211 ; thence southwesterly 164.76' along the arc of a 8F4.00' radius curve concave to the southeast whose chord bears S6p02114"'W 164.521 ; thence 5380 12105 0E; thence S38039'36"W 313.61 ' ; thence S3037124"E 760.001 ; thence N89 037146"E 972.00' to the point of beginning, containing 3458356 square feet- (79.393 acres) more or less and being subject to all easements, restrictions and covenants of record. I The Declarant has developed a residential subdivision of said land known as Cedar Hills Estates consisting of Lots 2-63 and intends to develop adjacent land in subsequent phases of 1 or more additional z plats. i The Declarant, for the benefit of the above described land and its present and future owners and any adjacent land subsequently developed by Declarant, hereby imposes upon the land above described the following conditions, restrictions, covenants and chargee which shall run with the land and be binding upon and inure to the benefit of the owners thereof, their heirs, successors, administrators, grantees and,,assigns until January 1st of the year 2000, after which time said covenants shall be automatically extended for successive periods of five (5) years each, unless an instrument signed by a majority of the then owners of the parcels has been recorded, agreeing { to change these covenants in whole or in part. i ARTICLE I Land Use and Building Type No lot shall be used except for residential purposes. No buildings E' .11 be erected, altered, placed or permitted to remain on any lot except a single-dwelling house (except on lots which have been specifically designated and approved as multiple family dwelling lots) designed for the accomodation of one family only, together with a garage designed to accomodate a minimum of two (2) automobiles, and one out building (the maximum size of outbuilding to be 730 square I 1i jj ii H N H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d a H OWNER/BUYER l� ROUTE/BOX NUMBER j{-} - 1 _l � Fire Number 1s r CITY/STATE _ �C ZIP PROPERTY LOCATION : _14, 14, Section LIV T 0 N , R W, Town of St . Croix County , Subdivision�f'/ 1,11 ii rC _ y Lot number. i 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. 0 0 E z I/WE, the undersigned , have read the above requirements and agree (, to maintain the private sewage disposal system in accordance with H 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 . /� 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 . INSTRUCTIONS FOR COMPLETING FORM 115- SBD - 6395 To be 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; 3. 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; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; S. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate; 10 If the information (such as flood plain, elevation)does not apply, place N.A. in the appropriate box; 11, Sign the form and place your current address and your certification number; 12, Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10") BR — Bedrock cob Cobble Q- 10") SS — Sandstone gr — Gravel (under 3") LS — Limestone *s — Sand HGW — High Groundwater cs -- Coarse Sand Perc — Per colation`Rate coed s — Medium Sand W — Well Is Fine Sand Bldg -- Building Is Loarny Sand > -- Greater Than s -- Sandy Loam < - Less Than *I Loam Bn — Brown `sil Silt Loam BI Black si Silt Gy --- Gray �cl — Clay Loam Y Yellow sc:l — Sandy Clay Loam R — Red sicl -- Silty Clay Loam mot - Mottles sc - Sandy Clay W12 — with sic — Silty Clay fff few, fine, faint Y c - Clay ce - common,coarse pt — Pear rnr-n — Many, mediun7 rn — Muck d - distinct p — prominent HWL - High vrater level, Six ,general soil textures surface water for liquid waste disposal BM — Bench Mark VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a perr-nit application rnust be sut)mitted to the appropriate local aulthority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the,start of any construction. L rDEPARTMENTOF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR A4UD PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.09(1)&Chapter 145.045) LsOiCrA.TI'/ ` SECTION: (o TOWNSH LAM NIaC�ALa ITY: OT NO.:BLK.NO' SUBDIVISION AM / �T u/D r COUNTY: OWNER' I YER'SNA MAILIN�bDDRESS: �e r- �1 s ,'s. USE ± DATES OBSERVATIONS MADE NO.BERMS.: COMMERCIAL DESC IPTION: PROFIL DES RIPTIONS: PER O TI N TESTS: PResidence RNew ❑Replace / RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYS EM:(optional) DU IBS ❑u S ❑u ❑S u 0 S .C�u Ceh u. � : op If Percolation Tests are NOT required DESIGN RATE: If any y 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 GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HR!HEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) .�,e, KT J ,i, . SOL . ? I64sVCr, B- ,� 7,as e. i L A„ �b K 6 Sal B- 3 �W To 8 jsnL 1A) A "_3V4r B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 P 3 PER INCH P- 3./`7 / P- p_ 6 1) 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. � It SYSTEM ELEVATION N_NO 9" I ' - N_ ; E I � � � � _�°_ f __ .. t , _..__..__ ..... 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 C .PLE ED N: Qs l� �Q7 � , ADDRESS: // CERTIFICA Oil MBE PHONE NUMBER(optional): �� C� 6 CST SIGN E: 'STRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. S-SBD-6395 (R.02/82) —OVER — ' J t+�par �oueYW/Mih �st �i►1 l rk Ohl "E srteAt Flev , ?P- 67 N o- to It Z,C) SePt,C 3► 1Q11'Cr'. `r fCo._ Highway UU a29 M N PARK ( 3 z,%l 3 ' N 3 28 R 21 N ' 5Y' N a 27 � ^► 22 h 54 � � © �1. N O N c O O 5 5 h N •� h N h 53 17 �' SZZ1 � 2 6 N '�► 2 3 5 6 ,h 3 �zd� 33n 5° ao' N 332' yo �' s°p, 18 ►� T h 8 h 5 7 51 ?O us ,(� N N 25 N 24 1n O , 2 O z43o' " 33Z' 6 3 >fts m 3 50 `p 31 M `q5� _ 60 � �►� ��� °7a 1 1 N y72 x 32 61 49 4 ` !O 33 'gi 48 M 3 y93 N 34 35 n Z yG.N N h� 46 ii5/ N � 45 h , eels Md O 38 37 36 {� rya, m CEDAR HILLS oar 44 ESTATES myh a yo ED Edina Don Bracht 40 � 41 42 Realty Ray Huppert (715)386-8236 39 JOG, SKI, and .Approximately 8 Acre Park CALL: BIKE TRAIL �� .21/2 Acre Lots Bill Harwell 386-8135