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HomeMy WebLinkAbout020-1181-30-000 -0 C) 0 61) V Ile 0 o LO x m 0 Z O LL r 0 CD co C14 0. co c,j I. O z :t 0 rn CD (D (D N cc CL U) (DIa a) < z o co z 0) A 0 E m E E :3 CD U) U) U) a: U) 0 0 0 CL a. CL 0 co co Ce) (D wo c, 0 C5 a 0) 0) 0) 0 Q Q Q I a. E In cD cj :z m IL 00 0 co (D '6 cc E 9 N a 04 co 0) v 0 'T 3' t E :, o o o �; I c') 0 CD o C) c) a it F- U) 12 0. M- C, U) co O c : 0 U) o co co 0-0 6 -5 0 S, = E C) 0 (A 0 fC U) a) o z !2 2 EL 0. a. (D >. CL a r E o 3 o 0 (L 0 U) / c « CD .§ 0 � t k ¢ : � § � $ � k � ƒ � i 2 � $ § ? } $ U. 7 § 2 \ < _ � � « LL, B � \_ \ \ IL m e z : E % z . - R f 7 / ] (D _ -� cD ) q Q = kcok / . E } CD 0 3 2 3 $ ~ E k ƒ CL M ) c % � § k 2 .5 E \ \ 7 \ U) m ƒ / i _ ■ k k z - k � a 2 2 « I 0 U) U) _3 § k k : _ z Cl) a § f e D S C) k E e ) \ 3 7 J ƒ f c 2 0 § ) § � c � C? o : 2 § k § E @ § ) M % . f / I o 2 k k LO . K / k § \ { / ) } ~ £ § _ = o @ o E o 2 3 c o z _ e ■ (on ■ I cl zk 2 M : { C � L: % f � / \ CL 2 k ) k . � - I 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: i (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length:Ste . Number of Lines: Area Built: , Fill depth to top of pipe: ly r2 Number of feet from nearest property line: Front, O Side, ®Rear,0 Ft . d Number of feet from well: &/♦ 7' V Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: _ Diameter: i 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj � Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER d� TOWNSHIP SEC. T 2'? N-R_ W ADDRESS � C�G?„�, ",y'� ST. CROIX COUNTY, WISCONSIN i SUBDIVISION �� „ ,' r�� LOT d�tl LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t t 1 I INDICATE NORTH ARROW i BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: ,Q� Proposed slope at site: jr SEPTIC TANK: Manufacturer: Liquid Capacity: /(-100 Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: "— Tank Outlet Elevation: -- Number of feet from nearest Road: Front,O SideQ Rear, 0 feet From nearest property line Front,0 Side,O Rear,© feet Number of feet from: well 1 1P V �I r� building: �'1 Q (,t (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE i DrePARTMtNT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX-7969 BUREAU OF PLUMBING MADISON,WI 53707 yy NW',,, SE%,S28-T29N-R19W T1 CONVENTIONAL 1:1 ALTERNATIVE State Plan l.D.Number: (if assigned) Town of Hudson El Holding Tank ❑ In-Ground Pressure El Mound Lot 41 Cedar Hills NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION E: Sherman Sutter 1027 6th Street, Hudson, WI 54016 3-' 4)6 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: William Schumaker 6382 St. Croix 99080 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER ' �1 /'ll �j p, P OV OED: PROVIDED: W ��• ' ( U )� 1 1 YES ❑NO ❑YES O BEDDING: ]�VENT DIA.. VENT MATL.: fGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILD G: VENT TJO FRESH LARM. ET FROM J LINE: J : ❑YES ❑YES ❑NO NEAREST /{/ 1_ �� DOSING CHAMBER: MANUFACTURER. BEDDING: JLIQUIDCAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WAR rE LOCKING COVER PRO PROVIDED: ❑YES ❑NO NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF P OPERT WELL: BUILDING: VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM I"E AIR INLET: PUMP ON AND OFF) DYES 1:1 NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER IMATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: c� WIDTH: LENGTH. NO OF MIPE SPACING. COVER INSIDE DIA.. #PITS. LIQUID BET/TRr�NCk TRENCHES. 7NO. ERIAL' PIT DEPTH: DIMENSIONS �Z S Z � GRAVEL DEPTH FILL DEPTH IDISTR PIPE DISTR.PIPE DISTR.PIPE TERIAL DISTR NUMBER OF PROP FV WEL BRNG:jVENTTOF RESH BELOW PIPE ABOVE COVER. ELEV.I LET ELEV.END. �"1 FEET FROM LINEC/ IY,V�I AIR IJU LET: Syr o q ty t� Z- 7 L NEAREST--- 1 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 ❑NO SOIL COVER ITEXTURE PERMANENT MARKERS: OBSERVATION WELLS. DYES ONO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED. IMULCHED: CENTER: EDGES. El YES El NO I DYES 1:1 NO DYES 1-1 NO PRESSURIZED DISTRIBUTION SYSTEM: WI DTH. LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER. BEQ/T'RENICH '.. TRENCHES: ,QfMEN �NS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.: ELEV.. DIA.. ELEV.: PIPES. DIA.: EILEVATiON ANgi 'DISTRIBUTION,, HOLE SIZE HOLE SPACING DRILLED CORRECTLY T7ATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMAtION PLANS. DYES El NO OYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER%OF L NE:ERTV WELL: BUILDING: S ❑YES ❑NO ❑YES ❑NO NEARES Sketch System on Re in county file for audit. Reverse Side. SIGNATURE: . TITLE. �-� Zoning Administrator DILHR SBD 6710 (R.01/82) 1 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,-usuajly.every 2 t 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 applica:ion must include: I. Property owner's name and mailing address. Provides the legal description where the system is to be installed, ll. 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. They groundwater bill Ground#ater included the creation of surcharges (tees) for a number of regulated practices which Wiscor*i 'S ° can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried f eBStlre is used In your bu.ilding is returned tc-, the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. a The monies coiie;teci through these surcharges are credited to the groundwater fund adminis- tered by `fie Department of Natural Resources These funds are used for monitoring ground- f khlater, wourdwaier contamination investigations and establishment of standards. Croundwate r, s wort;, pt(tecting. X37-6398 ,.-I ,16) L- SANITARY PERMIT APPLICATION COUNTY ®ILHR In accord with ILHR 83.05,Wis.Adm. Code t, 1 0, STAT SANITARY PERMIT# D 0 —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8'/z 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 I NO PROPERTY OWNER PROPERTY LOCATION S e S» �' '" TR N, R / E rYV PROPERTY OWNER'S MAILING ADDRESS d LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,S ATE ZIP CODE PHONE NUMBER 0 CITY NEAREST ROAD,LAKE OR LANDMARK • ,� — O VILLAGE: �. ✓. 11. TYPE OF BUILDING OR USE SERVED: 1 2&tc-116' ccad 0 —(20 Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): Ill. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. 9 New b.❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. 54Conventional 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. X Seepage Bed b. ❑Seepage Trench c. ❑See a e 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): S / - Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed _g: El Septic Tank or Holding Tank El 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) P MPRSW No.: Business Phone Number: ff'GL Jvf S' fig= J' .�, . Y� l / Plumber's Address(Street,City,State,Zip Code): Name of Designer: fi i4.�s c zzx VIII. SOIL TEST INFORMATION Ce ified Soil Tester(%T)Name CST# CST's AD 7,174- et,City,State,Zip Code) / Phone Number: A, , L�` ��t� C✓ a `� C'i' 3 1r IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S nary Permit Fee Groundwater ate Issuin Agent Signature(No Stamps Approved El Owner Given Initial /+�`` charge Fee Adverse Determination �-�V 19-9-(�71 X. COMEN TS/REAS DISAP VqL: al jr�e� i �S SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One 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 a 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 Pro ert 1 �. � 1"�L• ' ITS u Location of Property 5E J&r Section 2?-27-19 T N - R W `township feu c(3 ao Ma.i.l inb Address Subdivision Name: f4(2 ,1 l�s 7 S Lot. Number Previous Owner of Property Lco Total. Size of Parcel Date. Parcel was Created -� Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) 7 _ Yes No Volume - and Page Number ` o -7 ":recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION .ONB OF THE FOLLOWING.: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the dead description references to a Certified Survey' Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) cen•ti. y that a U 4 t ten ent4 on th ib akin au thus to the bet 0j Mfj (out) knowtedge; that 1 (we) an lane) the om#A(e of Ott p/topeAty deecai.bed in this .in j oAma ti.on 60AM, by vi tue o 6 a wwamnty deed neco*ded .in the O j jiee o f the County Regi.egeA o6 'Weeds oA aoewnent No. Z 13 1 � , and that T (we) pnesentty own the p&opoised .e.ete box the aewag�by6tem Ion 1 (we) have obtained an easement, to A.un uzith the above de4cxibed pnopehty, Jan the conAtAueti•on o6 said 4y4tem, mad the dame ha4 been tee nded in the Mice. o6 the County Reg.rateh"o6 Deeds, a4 Pocwnent No. r. q Sj,(,NATUitE ON OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNET) DATE S f t.NED A"e)hli;E AXar ��- ' PACE RFSERVED FOR RECORDING DATA =DC."uMENT No: STATE OF WISCONSIN F M 11 -1982 LAND CONTRACT 't Indiidual a Corporate F"SMS OFF ' (TO F NAN FDL AND N OTHERNNONHONSU ER ST. CRO'X CO., WIS. ACT TRANSACTIONS) Recd. for Rewrd Ibis 11th s4 day of June A.D. 19 86 Contract, byllid between .._Harry J.- Stewart�_-_as-_Personal y __._A Re resentative of the Estate of Aldro Larsen__..%k%a_-John at 11 :45 A M. l' .. ------•--------•-•--------•-----... ("Vendor", James O'Connell Aldro Larsen of kf a•.John_Aldro Myren Larsen,_• *_ whether one or more) and_. William ..__Harwell--__••____________________________ D"d / ------- 000, *single man ("Purchaser", whether one or more)- ��G ----------------------•-•--- deputy Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- formance of this co*tract by Purchaser, the following property, together with the rents,profits,fixtures and other appurtenant interests (all called the"Property"), in St. Croix____________________________________ County, State of Wisconsin: RETURN TO See legal Description on Addendum Tax Parcel No. .--.----- •-- ---- -- ----- C This not -_-" homestead property. Y. (is not) such dace as he shall name Purchaser agrees to purchase the Property and to pay to Vendor at ............... the sum of $ x 192 500.00 ................... in the following manner: (a) $-.--60-+OU0.,00----.----"_-.-"__._.------- at the execution of this Contract; and (b) the bal:ulce of --13- -----(��� - together with interest from date hereof on the balance outstanding from Wile to time, at the rote oC.. L.�-ci.•�1.4 )• """ per cent Per annum until paid in full, as follows: See Payment Terms on Addendum 11th .--.. day of Provided, however, the entire outstanding balance shall be paid in full on or b(fore the ..-...._._. .........d1111£................-....... 19__9.Q. ( the maturity date). Following any default in payment, interest shall accrue sit the roil of ...1...: .": per annum on the entitheaentire in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor iunounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required insurance premiums when due.To the extent received by Vendor, Vendor agrees to apply payments to these obligation a when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any time.KOf ?ixxxxx7SJt�S?�X # Xx7+(7 tl�7axacvc:bx�mcl�almtec�t�t'x1mi0�il�ixtRatieQUt7� 7alfxl(ealdaR!k In the event of any prepayment, this contract shall not he treated as in defanit with respect to Payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be as unpaid principal) is less than the amount that said indebtedness would have been had the f credit of made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: Purcha:er agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid• the da e he eof %Sx.--.•• Purchaser shall beentitledto take possession of the Property on._.-.-._......••-_._.t..••• .................... •Crow Out One. STATE BAR p4WISC(tNSlh wiscunsin Legal Blank Co. Inc. LAND CONTRACT--Individual and Milwaukee. W is. FORM tin. 11--106. XL 1743eml. 87 LAND CONTRACT ADDENDUM Legal Description The N} of the N} of the SEI.of Section 28-29-19 , except the South 100 feet of the East 565 feet thereof, and except a parcel of land located in the NE} of the SEI of Section 28 , T29N, R19W, Town of Hudson, St. C"Oix County, Wisconsin, described as follows: Commencing at the Ej Corner of said Section 28 ; thence S89 037146"W (assumed bearing referenced to the monumented East-West I Section line of said Section 28 , bearing assumed S89 037146 11W) 23. 78 ' along said East-West line to the point of beginning; thence continuing S8903714611W 1301 .481 along said line to the West line of said NEi of the SE} ; thence S 0 003144"W 661 . 63 ' along said West line; thence 'N89634148"E 761 . 971 ; thence N 0°05112 11W 100. 00 ' ; thence N89 034148 11E 535.401 ; thence N 0 030138"E 560. 56 ' along the Westerly right=of-way line of U. S. Highway "12" to the point of beginning. NEi of Section 28-29-199 except that parcel described as Lot 1 of a C. S.M,. reeo'rded in Vol . 3 of C. S.M. ' s , page 862 as Doc. No. 359579 and except that parcel described in Vol . 583 , page 527 as conveyed to the State of Wisconsin. r S T C - 105 r S1 PT I.0 TANK MAINTENANCE AClcEL'MENT St . Croix CUnlit y � o Y /CLl rn OW, �i re Numbur It )LT E/ BOX N LM 1f E' Z Cf 'I'Y/ STATE / 4-t�s � � z 111 I,I(t;I'1,R'I'Y 1.00ATLON : AIa/F - .I� , iuct iou / 1_ .!__N + R /_.� __W , _-. - - 'Town of 1 " -s� n St . Crui.x CuunLy , Subdivi1si.ou � y L'ot number- /. t to ) roper usie and maintenaltct, of your selwLic systeu, could result in l �remature "tailure to handle wastes . Proper Al2i ill tejlult.:u curl- I l. L :� L Sists of pumping uuL the septic tank every three years or suotier. , _ _ank ►tlM ,e r . Wllat you put into i 1 needed , U y a 1_i is e ns e d s c:1-t_i c t k_._.. 1_..._ t the system cart affect the fuuctiuu of Like supLic tank as a treat - mltcnL stake ill Like waste disposal systelu . St . Croix CuunLy residents I be eligible Lo receive a grant for it mlaximum of 607, of file Bust of replaceu►er►t of a failing system, which was ilk operation prior to July 1 , 1978 . St . Croix County requirement that act;eli't�:c► this program► in August of 1980, with tt►e l s stems a r e e to keep their systell's pruperly. l new , f a l f. ml<.► intai tied . The property owtiur agrees to submit to St . Croix County 7o1►in9 a certifieatiun form, signed by the owner and by a master plumber , _jourueyman plumber , resLriCLed plumber or a licensed pumper veri- fying that (1) the ort-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 1/14E , the undersigned , have read the above requirements and agree Et r:o maintain tl►e private sewage disposal system in accordance with H the standards set forth, herein , as set by the Wisconsin Depart- Merit of Natural Resources . Certificatiuu form must be completed and returned to the St . Croix County Zoning; O1fi'Ce within 30 days of the three year expiratiou date . S I C N E llATE—` - ---- - St . C .-oix County Zoning 'Office 1' . 0 ,to x %, kiannno';id , WI 54015 715-7 +6-2239 or 715-425-8363 Sign , date and return to above address . i - 4F e, ' N M (MO LLtr7�" _ = W M Y d! 0 tvw arm DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUIL DINGS INDUSTRY, DIVISION N LABOR AND P.Q. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,WI 53707 IH63.090)&Chapter 145.045) LOCATION NU '/,5' /� S !MUNICIPALITY: [OT NO. M1IO.: SUBOIVISI�O�NAME: NG1 It / 28 /,a Rl910(or Ul�SON 41 J C��A21`f►LLSES7 COUNTY: OWNER' AJYER' A • SrCreo,�t 5>, S�r�-rr .e /027 6 l � //vDSdN V) USE DATES OS'SERVATIONS MADE 9 Rssidenee U> � - — New ❑Rsplsce aT 1 RB7 `�PTg I�? RATING:S-Site suitabe tar syMm t im Site tnleuiasNe for system ri. - G A,r4 E;RT S S o� S OY S ❑ . ECOMMENDED SY LTE� to Tonal) If Percolation Tests are NOT required D $ ATE: If any portion of the tested area is in the under s.N63.0916)(b),indicate: ulss f Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORIN R 1 H A H ICKN SS,C LOR,TEXTURE,AND DEPTH NUMBER ELEVATION V TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) 3 S" t_ io ..I L 3E" P,,j r>, Y 6.R .2 99•S 4014 x/0.25 v"'Rc-$ m -�C-L ,rvct. TroNz w o ��^forras .,PocKers oc tit/ E /OZ )� I�Dtir~ //. J� �7 7-S 15�Qt4r�SL /U( L MS o� /Jotf e-� F8.33 /6-Z o, 8.3� 4"6oLi� 11' � 6F"' Ste M-,CC �z''�&aN I'S>�C�►� /09.69 /Jo u>r 14" c S 33"Bit. MS�� 73"�3e S,SL �6"Cr$4 F 14 /03. 7 o /1,33 8'b.Lis 21''$ St /07� $a MS �G(t B- PERCOLATION TESTS DE H WA O T - RATFMINUTES NUMBER I AFTERSWELUN INT RVAL-MIN. PER INCH q.z) oNti 9• 1 0 > >3 < P. 2 4.4o r 1.00 t` 4 9 /'4 P. P- P- PLOT PLAN: Showf locations of percolation tests, soil borin and the dimensions of suitable soil areas. Indicate sale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION Q-dE�-66 sotr.'T"es�AR �cvAi'1n,�N�s �WERSf2�n�c, sys-t�;w 3�t�Z � 12�EGtJ�14 R So)rr Noi21 ZOrV s iN �tjoLE' �,-� Lc.T 4 r BEifaCU�tllfZ� ' 3t"�� 6Z �N Ap ' "frtcnApr ' g_3 s�dtC �LEifAT)d� �N; b ♦ IOl�.oO z 4TF RN)a-r-Y rp I ♦ 33' 6OFT R grrnaEEN ® Lor L,NL ANA Sysr6hts g-4 1,the undersigned,*hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. 4 A print : TES *TED ON: `P / P'QVA-Y -a Ah R' /J�NN'S�N SCR! �t�vEY/ ! /9%7 A ERTIFICATION NUMBER: PHONE NUMBER(optional): aq CST SI AT RE: Q�� DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. OILHR.SRD-639, IR Mffs " C1VFIi Se.. 7"�ey e� s' �c r' 97- i 1 I S � y �J D� h 0 ooeb Al f n rf R d ll c7v ,Mt,- I I'I �I, ' � r I' x, 31 L w M s 1- = W • Y s � v 0 J •iA o"m Now N 1•o is DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUIL, OS DIVISI 1'IVDUaTRY, C SION .LABOR-AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS • (H63.09(11 b Chapter 145.045) LOCATIO /� p NS /MUNICIPALITY: OT NO. LK.NO.: SUBDI VIS�O�NAME: �W t� �� 28 !1 !� for w UJ�sC)N `l� a&AP,/`t rLLS EST COUNTY: STCRO)), -Su Scr`'c�re /O27 USE DATE$OBSERVATIONS MADE 9 INCL BEURMV rzwwRI!IXL DESCRIPTION: �PR15FIL DESCRIPTIONSS: ERCOLATION TESTS: Residence UN� -� *Now ❑Rsplsca Saar f Rg*7 fir / !�7 cat Eel< ��� � So�t.b �Z- vkKN#jA T RATINtit$-Site srritaati.for syalns► u-$ae anatsitsYM for syaam rt» - Cow,r%t.A r S ®�JCQNYENTIONAL: ionatl Soul S oY Q eou N& NjA If Percolation Tarts we NOT required SIGN FIXTIE. � If any portion of the tested area is in the �� under s.1,163.09(6)1b),indicate: Floodplain,indicate Floodplain elevation: VrT PROFILE DESCRIPTIONS BORING %4R-I%H CHARXCTER OF SOIL WIT14 THICKNESS,COLOR.TEXTURE,AND DEPTH N~ ELEVATION TO BEDROCK IF OBSERVED(SEE A88RV.ON BACK.) B` 2 99 S 40,4 ICE 1/4.35 A0"hr-$ -�C-L ,NCB %'QAZ v o W46'"" ., „Pocv-es ac- cst6k 6" W 71/.JU /7 T% /5 9*4SL /U( G MS av- 14,%Le - B- 4"6«i-75 //' 6� � Q Ms�'c /z''BaN14S64A BA 9.0 /03,69 / 0mu 14" r_ s �3"Ba..►+hS 23"B.e s,St� 46 &gT FMS I1.33 io3. -7 a // 33 8"accts 21"B St /07~ hkku MS E4 ft 8- t PERCOLATION TESTS PT R T RA NUMBER 1 AFTERSWELLIN INTERVAL-MIN. 0 0 2 PER INCH Av htoNli. q? 1 0 >3 t P. 2 6.46 1 240 t` 4 ' 4 /'4 IS P- a 4.717 A Ze 776— 8. P- PLOT PLAN: Show locations of percolation toots, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- :ontol.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 Qs.66 Sctt��tSTLR e6coyll#-,eA/&'S �!�RS►Zl/v�� SySrzr� aV'� � /Q�EC.L)t.,41� Salt. Noi21�Ory 5 1N �aLf �-r iE4Aia,TTjW Si� b 3p• I ''3o' S` b' • 4kTE RN ion� •R I • �3, S- p1oTe:- to, 8c R �s.TWEEN Lor L1NL ANA SYSTi_r+s g-4 1,the undo s4nod,'hweby comfy that the coil 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 dote recorded and the location of the tests are correct to the best of my knowledge and belief. print : TESTS WERE COMPLETED ON: 14k-eve-y �wKv s<,lry �P xu 5c.>f�vrrY/ / -_; PTv, Q 9 i9% CERTIFICATION NUMBER: PHONE NUMBER(opt ional): 407 S �, 34 3�6-4ac, CST SI AT E: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester, DILHP-.,,I4ILF3o, in.t>h/s OVIER I II M M W�1�S U s � All DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BS UILpIN INDUSTRY, DIVISION -LABOR-AND C P.O. BOX 7069 PERCOLATION TESTS (115) MADISON,WI 53707 HUMAN RELATIONS • (H63.09(11&Chapter 145.045) .(r ,// p /� y� S /MUNICIPALITY: OT NO. NO.: SUBDIVIS O NAME: LOCATION,o SECTION:NW %2�� .28 / e RIQ tor R U F')14 — CE6A2 If_CS EST COUNTY: N A MAILINQ ADDRESS: ST Cf 6o' s xi ScrTT A- USE DATE$OBSERVATIONS MADE rnftmm: OMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ERCOLATION TESTS: Residence U•')i - A(New ❑Replace La&pT- $ l R g7 �e iAT �� 7 5o t�s RATM:s-Site atriteble for eyetso U-Eke wtwlalw for sllosio t Yb - lE!Mra EA-r •IMQWD. :�V � �Y �• � �� � : ECOMMENDED laiTE��a optional) If Percolation Tests we NOT required D SIGN RATE: If any portion of the tested area is in the under s.H63.09MI(b),indicate: F CLASS I I Floodplain,indicate Floodplain elevation: a PROFILE DESCRIPTIONS BORING IDTAL 02PTH IQVAT&R-IN H CK SS,C LOR,TEXTURE, AND DEPTH NUMBER IM ELEVATION TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) 3,S /o N L r'k 14 A 8' mas 99-S oN lE >16.2S A0''R<$ M S tj C-L IMCL 1100- U o ��Me7T�s 8-�?- I 111 S4 /ca.I , �oN t !/.j O Pocacfts oc' cs•t6k ow W �7" -r-S >S��Q>e,�SL /U6"[ MS or Notf .. MS 8-4 g.b? 103.69 /Jo>u� > 9X7 7 4 t_ s �3 Ba..i+'�S� 23 lie s,Sc 46 CrBe F �41� iO3- 7 >// 33 8"BcLTS 21''$ Sl /07b $a MS V<% 8- PERCOLATION TESTS TEffr A NUBR I AFTER S YELLING INTERVAL-Ml PERIOD 2 EIRIOD 3 PER INCH P. I A•-L I Nowu 47al 10 1>7t >3 L P. 2 4-40 2 / .00 l' 4 ' 9 /�4 p- 3 6.2119 qa#AIj 161.1% /YIR i d P- ELr4krlom Ar R�- P- P- PLOT PLAN- Show locations of percolation tests, soil borings and the dimensions of suitable mil areas. Indicate scale or distances. Describe what are the hori- zontol 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 9S.60 ' 'Vas art asfz�nlc� sysre� 'Dui '� I R�'E6(�tt4{� Soll /{0121 ZOrV S /N �tjo�C �'l LD;v &a: g-s Lc T 4 a. I � , am} uM MLV-- j ��y t N +1 tc�.f�o �z � Ai.T�Rn1 ATC aP l • 33' 4' NOTE 10' FSOFT R gCTWE.bty ® 4-r L.1-4L +1NA SySTt_/ttS � g 4 1 1,the undersigned,'fiereby 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. A (print),. TESTS WERE COMPLETED ON: 7XkkvA-y AKN sa.y yC Sc�l BSc SIP VEY � AV C 'i c 9 /9 A — 7 CERTIFICATION NUMBER: PHONE NUMBER(optiunal): 407 s 3g 3�6-4o v CST SI AT RE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR•Sf�l�-(,3515 IR,Q?/tt` OVER _I ♦ r ' • • 1 Ili �S .vow W�.LSds = i U N I"' m W Y tZ 8Z Z _O Q U • O 'AM vn w w J NAI►N '14 DEPARTMENT OF REPORT ON SC L BORINGS AND SAFETY BUI DIVISION �iNDWSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 KIMAN RELATIONS (H63.09(a)III Chapter 145.045) LOCATIO-W--c SECTION: TOWNSHI UNICIPALITY: OT NO.- t NO.: SUBDIVISI,OrN NAME: ,�w ( C" Ze / e R/94IOr U�SUN 4 CE�e12 Nrr.�S ESQ, COUNTY: C M Sr Cf�oix SNEQM A&4 �CfTTkik /0 Z7 G i'1J Sr I� 12��ory W r E DATES ODURVATIONS MADE NO.BEORM: Omig RIPTION] 'MOFI S: PERCOLATION TESTS: us Residence UNK &New Replace . 3!r /cN7 'Ski /,, OW7 'SOIL% �ifJQK a�� 66 moo)(-s z _ *K94 *6T RATING:S•Ske su(t"for systaM Um 1�unsuft"for sys"M &4t — FM M C#� -F TANK:RECOMMENDED SYSTEM:(optional) S ❑If MR$ ou s nu s d ❑s d co If Percolation Tests are NOT required ESI N RATE:1 if any portion of the tested area is in the under s.H63.09(5)(b),indicate: `t.r4SS Floodplain,indicate Floodplain elevation: r Yµ PROFILE DESCRIPTIONS BORING A NC A I THICKNESS,COLOR, TEXTURE, AND DEPTH �BER 1K ELEVATION Flom" TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- 1 9.13 /Ot. E >4.83 ' c.TS 89" k&Uq MS - Gk B- Z A Z /o/, (7 NONE >//.9i 9 d !9"gQNS, !s I;aBa M<_,-g62 6- 3 !Z-b? /012S t4oq C 7 /1.67 M5 8. 4 1 7.25 97.18 t4g,4 L > 7.7-S "&s�� 3?' SL 4Z" T8R�1 M-cS*6e. /6•Z<5' g'.B�sc-rs z�„$aN SL:Sctz 88°LT$Q M-cs B- PERCOLATION TESTS TEST DEPTH WATER L TEST TIME RATf MINUTES NUMBER INCHES AFTERS YELLING INTERVAL-MIN. PER INCH P- z C-161 /anx 3 >z < 3 P- S.9'L. 14.1. 2 >2 >2 L P_ I I E 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. SYSTEM ELEVATION 97 o 0 a ' R-4 St-re cam, )ZCOd1ZSC , ";`0 T so &3' , � • p�z � � tJ ' { l A I �� geNC AIMIkP.K oVN�A IRcN RQE g- g Z rrLt,�teYtoN - /OO.00 '-� 6S- S�r�i (.tnit ca= 6� ,r toi 4 A14& CEa,�NI�IS 1,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. I rADDRESS-AM pr int : TESTS WERE COMPLETED ON: itt Y �ou o ,1Q Scu scar �(' ltyC SHPT yh 13 /9 CERTIFICATION NUMBER: PHONE NUMBER(optional): CST SIG ATURE: 1 DISTRIBUTION:Original and one copy to Local Authority,Properly Owner and Soil Tester. DILHR-SRD-6396 (R 091f?"! --OVER --