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HomeMy WebLinkAbout022-1080-50-003 • 0 to O K-0 0 d O " d O v v (D m ~ m 1 3 'Z M ~T O chi o a co o m r' S. 00 N .C a) co C co S j N N ICI (v C- ~►7 (D CO Q N N (O f~ co c Z O OD Oo A CD Z) N N t=!~ j~P O ^t N O O (D O~ O cn n N 0 co o O O N C o O O 7 N p. it F w O m (D CD cn ~ c 3 ci o o I c m' I 0 (o v m Q i !ri 8 z! r- cn CD < O C N w co R I Cl) - 3 c O O O A o ::E 0 < w z o c f/J fA f/! p ° D O O CD fD v yv N (71 rn S y V N O " = ' O N 2) y N 3 a = m 00 z N Zco Z o D CD o O a M 0 m 3 ~ y t~~11 .1 co (D N C O N N C (D w d Z O (n A Z 0 N a 0 , 7 0 O Z N 00 m m Z 00 1 3 A .Z~1 3 Z W Z (D w N A Q x a ~ AO T N C CD Z C O O ' O N N y N m A (NCD O` 7 R N N ' N O O. O O V R ti 'S @I R ti 69 O ti a O O ti Parcel 022-1080-50-003 o2i2oi2oo7 11:41 AM PAGE 10F1 Alt. Parcel 28.28.18.4381 022 - TOWN OF KINNICKINNIC Current 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 - LICHT, STEVEN M & DONNA J STEVEN M & DONNA J LICHT 1110 PINE RIDGE DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ` 1110 PINE RIDGE DR SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 3.540 Plat: N/A-NOT AVAILABLE SEC 28 T28N R18W 3.54A NW NW LOT 3 CSM Block/Condo Bldg: VOL 5/1487 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 28-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 784/249 07/23/1997 784/249 I 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.540 65,000 183,100 248,100 NO Totals for 2007: General Property 3.540 65,000 183,100 248,100 Woodland 0.000 0 0 Totals for 2006: General Property 3.540 65,000 183,100 248,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 306 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 C1 ~ C~ ~ _~rJ v~W%a, Section 28 ?.T WTI of Rlsw, i oiberty Road STEVE T28N- LICHT, xt. 7 nnickinn County TWI 54023 R1~~ Roberts i rt address of site Cody 7_9-87 ~ Thomas H. permit No. 96039 Cony, New Form- S T C - 104 t AS BUILT SANITARY SYSTEM REPORT OWNER -'~rTL-4f- LzcN-r TOWNSHIP KxN~ x rca xc. SEC. T N-R W ADDRESS A-T,42. ST. CROIX COUNTY, WISCONSIN SUBDIVISION W `.a AUM11,1W LOT LOT SIZE (81. (P44.711 PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM WELL Q ~Aownr. 7.r WW1 IOt~ , ctl INDICATE tORTH ARROW BENCHMARK: Describe the vertical reference point used ~&txCZ-'Ta aAs 4 Elevation of vertical reference point: I(k).00# Proposed slope at site: z°jo SEPTIC TANK: Manufacturer: V i .`he-yL- Liquid Capacity: )OW 4&14tLyN 1 Number of rings used: 2. Tank manhole cover elevation: qs. W Tank Inlet Elevation: q`.~.~1D Tank Outlet Elevation: 1455' Number of feet from nearest Road: Front 10 Side,O Rear, O feet From nearest property line Front, 0Side, 0Rear,© "7 0feet Number of feet from: well (,S 1 -0 , building: 1'7 , -7" (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SRR. RFVFRSR RTT)R PUMP CHAMBER t 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: X Trench: Width: ~4 Length: 101,01 Number of Lines:_ 4 Area Built: Fill depth to top of pipe: awl Number of feet from nearest property line: Front, O Side, O Rear, ©Ft . Number of feet from well: al-6' Number of feet from building: 31d' (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: Plumber on job: License Number: 3/84:mj DIEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P^.-QOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 NW4,NW%,S28,T28N-R18W NCO VENTIONAL ❑ALTERNATIVE State Plan Number: Town, of Kinnickinnic ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound \ Liberty Road .4 1~7 NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Steve Licht County "TT" Apt. 7, Roberts, WT 54023 8u 7 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. Name of Plumber: MP/M RSW No.. rc- ySanitary Permit Number: Thom-s H. Cody 6 93 t. Croix 96039 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLE]ELEV, TA NK OUTLET ELEVWARNING LABEL LOCKING COVER PR~VIDEDQQ ci 0'~OVIYD~ED: PROVIDED ❑NO ❑YES 54NO BEDDING: VENT CIA.. VENT MATL.. HIGH WATER 'NUMBER OF ROAD: PROPERTY WELL BUILDING: IVENTTO FRESH ALA M. FEET FROM Q7 LINE. p ^ AIR INLET: ❑YES ~10 Cz YES I~TJO NEAREST DOSING CHAMBER: OVER MANUFACTURER . JBEDDING'. LIQUID CAPACITY . PUMP MODEL PUMP/SIPHON MANUFACTURER . WARNING LABEL PLOCROV IKIN DE COVER I PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: FU-MP A DCONTRO LS OPER ATIONAL NUMBER OF PROPERTY WELL BUILDING VENT LE FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) ❑YES ❑No NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at t e depth of plowing " DIAMETER MATERIAL AND MARKING, or excavation. (If soil can be rolled into a wire, construct on shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH ILENGT - NO. OF DISTR. PIPE SPACING. COVER INSIDE DIA. #PITS. LIQUID BED/TRENCH TRENCHES 1 - MATERIAL: PST DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. IPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DI R. NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BELOWI PIPES. ABOVE COVER. ELEV. INLET ELEV. END. PIPES FEET FROM ,LINE. C7~ AIR INLET. lL,t q.SD q4f3~ O~ 4 NEAREST--i MOUND SYSTEM: Mound site plowed perpendicular to slope heck 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- eets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DE TH OF TOPSOIL. as :DD E D SEEDED. JMULCHED CENTER. EDGES. ❑ YES ❑ NO ❑YES ❑NO ❑YES ❑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: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.. ELEV.: DIA.. ELEV.: PIPES. DIA.: ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING DRILLED CO RECTLY R MATERIAL PLANS: ❑ ES ❑NO COVE _ ❑YES ❑NO COMMENTS: ]PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: Q ❑YES ❑NO ❑YES ❑NO NEAREST A- q4 1 Sketch System on Retain in county file for audit. Reverse Side. IGN TUBE: TITLE. DILHR SBD 6710 (R. 01/82) Zoning Administrator EA~ 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 sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1 Property owners name and mailing address. Provide the legal description where the system is to be installed: I! 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; Ili. 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'h 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 cornmon;y known as the groundwater protection law. This change in statutes was the result of ove: 2 years of steady negotiation and public debate. The groundwater bill Groundwater - ~ - included the creation of surcharges (fees) for a number of regulated practices which Wisconsin's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried treasure 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- terea by the Department of Natural Resources. These funds are used for monitoring ground- ~p water , groundwater contamination investigations and establishment of standards Groundwater, 77-777-77 s kvorth protecting. ~3 D-6398 1, R M /36) SANITARY PERMIT APPLICATION COUNTY • DILHFi In accord with ILHR 83.05, Wis. Adm. Code S ` (f PC)/ Z STAT ANITARY 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 ❑ No PROPERTY OWNER/f PROPERTY LOCATION a 8 E (or& L.: N V% /W/,, S ~ T N, R (Q PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME eo 3 vdr 1W CI , TATE ZIP CODE PHONE NUMBER CITY t NEAREST OAD, LAKE OR LANDMARK ~y~ 7 # ?4?-30'(~ VILLAGE : '6tk0Ck~+uta 11; 6 , N II. TYPE OF BUILDING OR USE SERVED: 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. ~j 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. 5j 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. IT 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): a U 96 Q G f ~~SO Feet 50 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 Septic Tank or Holding Tank ow 1 4-0 i'"dr- ❑ Lift Pump Tank/Si hon Chamber I . I Li I ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plume Signature: No Stam ) PRSW No.: Business Phone Number: 3 ~~g 33Sy 1 ber's Address (Street, C y, Stat i Cod Narpe of Designer: K., e jgt:~ I- 0 3 f,QJY w Kin VIII. SOIL TEST INFORMATION Certified Soil Tester sCST) Name CST Pr1-~tt.tr L. - r^er-- 5, ~ CS 's ADDRESS (Street, City, State, Zip Code) Phone Number: R, 4 ag(,, tells, L-,~ 1. 5©r~ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) Approved ❑ Owner Given initial S charge Fee ll Adverse Determination ~ \1-9-R7 ~ X. COMMENTS/REAS NS FOR DISAPPROVAL: 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 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 $TEV EN Al 4- ~pN*!A S u5jim Location of Property Section Z.t6 , T ZEN-R j W Township KiNt4Uc.I,tNg11{ - Mailing Address lse' c4 # So- U Address of Site ~bAp Subdivision Name Tt}* 1~,►~,e " Lot Number3 Previous Owner of Property L 1- 'D wN~ ~i,a Nc i4 t. Qi> Total Size of Parcel Date Parcel was Created f3~ Z3 - Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for resale (spec house) ? Yes V No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be I helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I PROPERTY OWNER CERTIFICATION 1 (We) celttti.6y that att 6tatement6 on this 604m ane true to the befit o6 my (oun) knowledge; that I (we) am ( cute) the owner (s) o6 the pnopenty deb cued in this .in6ollmati.on 6onm, by vi tue ob a waAAXEnty deed neconded in the 06life) e o6 the and that I pnebentey Co" RegisteA o6 Deeds as Document No. 44 2:1-2 j2 own the proposed A to bon the sewage dizpoaat ^dy- btem• (on I (we) have obtained an easement, to nun. with the above de cA bed pnopenty, bon the comt ction o6 said system, and the same has been duty recorded in the 046.ice ob the Cbunty Registen o6 Deeds, a6 Document No. y,~ Z `t G O ) SIGNATURE OF OWNER SIGNATURE OF CO-OWNER _~IF APPLICABLE) DATE SIGNED DATE SIGNED s - i DOCUMENT NO. I WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA , STATE BAR OF WISCONSIN FORM 2-1982 _ CVJ Herbert..D....Cudd..and..Constance__Mae__Cqdd.,,..hq,$b?ncI....4nd_......._ wife Ovcu'".ewc' cpnve s a d warrants to Steve M. Licht and Donna J: Licht! • . . riUS an and wife as survivorship marital_.propertx_____________ j THE FIRS ~IATl. r, - RETURN T rj 1JD R1V.FR FALLS, WISCONSIN 54022 the following described real estate in .....St....Cxclix .........................County, State of Wisconsin: Tax Parcel No: Lot Three (3) of Certified Survey Map in Volume 5 of Certified Survey Maps, Page 1487, l as Document Number 397707, filed in St. Croix County Register of Deeds.Office on November 12, 1984, being part of the Northwest Quarter of Northwest Quarter (NW 1/4 of NW 1/4) and the Southwest Quarter of Northwest Quarter (SW 1/4 of NW 1/4) of Section Twenty-Eight (28), Township Twenty-Eight (28) North, Range Eighteen (18) West, j Town of Kinnickinnic. Subject to an easement for Liberty Road right-of-way on the West 33 feet of said parcel. St. Croix County, Wisconsin. i This s. not homestead property. JqW (Ws wt) Exception to warranties : easements, restrictions and rights of way of record, if any. ; Dated this 30th day of ..................June 19.8.2.... li .._.....---••-•--.....-•---••----.....-•--...(SEAL)..... ~ . ....................(SEAL) - Her rt. D:.. cuss.-•.._..-••-.-•--........~.._.... (SEAL) ~~'1....... .(SEAL) i * * Constance Mae Cudd I AUTHENTICATION ACKNOWLEDGMENT s Herbert D. Cudd and Signature STATE OF WISCONSIN I Constance Mae Cudd SS. County. au a ated this 30 day u11e 19_.87 Personally came before me this ................day of une 19.... . the above named Herbert..D --.Cudd and. Constance__Mae__Cudd Leo A. Beskar TITLE: MEMBER STATE BAR OF WISCONSIN (If not- authorized by § 706.06, Wis. State.) to me known to be the person . who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Joseph D. Boles, Attorney at Law 219 North Main Street River Falls, I.. WI 54022 Notary Public County, Wis. ion is permanent. If not, state expiration (Signatures may be authenticated or acknowledged. Both My Commiss ( are not necessary.) date: 19.........) -Names of persons signing in any capacity should be typed or printed below their signatures. STATE BAR OF WISCONSIN ii.C.MillsrCar4mv FORM No. 2 - 1982 stock No. 13002 ruo...., w~.conan ti a S'T C - 105rr} ft 4 y SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County x tj a. H OWNER/BUYER 'C-5~W M • i~ Dor iwA S uct+7- ea ROUTE/BOX NUMBER FxbX * 507 f LISdz7 r 9-a&,b Fire Number .CITY/STATE ZKETL l-i,~tS WI ZIP S.gpzz i J PROPERTY LOCATION: t4W _x'14, Section-Z-& . TAN, R_I _W, 4a Town of k►titjjc.1<jNNtc St. Croix County, ~t Subdivision "T4iE piktCS~ Lot number >3 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 Zonng.a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank.is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H - E I/WE, the undersigned, have read the above requirements and agree 'y 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. SICNED__-.~_=-_- DATE r 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. 4 ~ r Y INSTRUCTIONS FOR COMPLETING FORM 115 - SED - 6395 To be complete and accurate soil test, your report must include- 1. 0 t legal description; 2. TV ection must clearly indicate ! ~s is a residence or 'cial project; 1 MP JM numt - of bedrooms or :ial use planned; 4. Is , Uw r- r= r-ment system; 5. Cot ~ `ic su: ,lily rating boxe -E IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OF" SYSTEM-: ARE RULED OUT J ON SOIL CONDITIONS; 6. PL use the abbreviations show, iriting profile descriptions and completing the plot plan; 7. 11" A LEGIBLE diagram accurr." ating your test locations. Drawing to scale is preferred. A a sheet may be used if desired; £f suF) your benchmark and vertu ation reference point are clearly A are permanent; 9, C< le' ' all a i ~ropriate boxes as to ck narnes, addresses, flood plain data, pe ti<;n test exemp- 6 i,pro " 1 flood plain, does n(_. in the zap; )x; 1 1 . I~ ; cWr current acs your c nu_,aL. _r; 12. k i1.71e copies I distribute as ALL SO TESTS MUST BE FILED WITH THE LC ; ;L AUTHORITY WITHIN 30 DAYE", ~.)MPLETION, ABE-. 'ATIONS FOR CERTIFIED SOIL. TESTERS Soil Separates and Textures Other /rnbols Stcj:, (over 10") BR ock t 3 1311) SS f Istone der 3"} LS - Limestone s HGW - P ih Grou ras ? Pere. - f' med s - V IV fs - Bldg L Irf" is - L and > Than sl Lt m < ,l - I Bn - sil .Cap BI St Gy -C. L:-yarn R 1, mot - P vv i 'c sic ay fff t 11 C CC PI - mm - l _ n1 d - p HVV L_..t' _i BM VRP TC L, ' y r D~PARTMUNT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUV,RY, DIVISION P.O. BOX 76 LABGR AND PERCOLATION TESTS (115) MADISO N WI 3707 HUMAN RELATIONS (H63.0911) & Chapter 145.045) LOCATION: SECTION: TOWNSHI MUNICIPALITY: [LOT NO.: BLK. NO.: SUBDIVISION NAME: 4 Z-8 TZ8 N/R 1$E NC-11 i 1,~,~cc1 M&J IC - _SM VUL S )4E_? COUNTY: WNER S UYER'S NAME: MAILING ADDRESS: At14T * ST'_eaIx S ~ l lc ~>3~2-T s, w 1 SI/ oZ3 USE DATES OBSERVATIONS MADE NO.BEDRW COMMERC AL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: Residence UNew ❑ Replace I Z 3 - b RATING: S= Site suitable for system U= Site unsuitable for system CONV~NTI . IMOUNDCK~. IN-G IS RE: S EM-INFILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) SS u rUI Jr aUU ❑SS I/~U Z0 ~ 'X`-! D COuVFzW~ OA*l- L3 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Q, L_ AcSS Z Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-IP4&*F9 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH I ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 i.0' NFU E rna tZ r~~T- o a'~k 3~1~s TS ~•Z~ Qn '~S Q ~•S J B- C8-2 1 0)9.0 B- 3 q . 3' S' N > Q,3' o.$' ~r V1• S B- S JUh 291987 6- 1 PERCOLATION TESTS ZURING OFFICE J TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MI NUMBER II~b~S AFTER SWELLING INTERVAL-MIN. P RIOD 1 PERIOD 2 P R P- Z S-6' 6"o F Ste, / N 2. )'711U U'MS 9 8 P_ S , 8 < 3 9Kt•s 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. 11'3t_'INU't R. L"-&l ~JT 9J ~LA►►.~FIQ.D IS SYSTEM ELEVATION 93• So' NS_ o 1_ S 8 l 1`] - X17 S !z - _ fi I i i IA U t4- r 1 E tY`f (1 s G'Rfr - w I i Lti~STlza 8v uN Pi( ?-s #J, t ~ ~ ~ t t S - - ~U 4TC E 94- E t -iA VA b b'8 _ iRZ4 CIS. 9 2 'scltLtE 4o' Seer- z8 7. 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: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): L L % W 0 w s U) S 6 1 S- 4/ zS-o16 CST SIGNA~ o~ - DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX 7960 ON WI 3707 HUMAN RELATIONS (H63.090) & Chapter 145.045) NAME: : SUBDIVISION LOCATION:SECTION. TOWNSHI MUNICIPALITY: LOTNO.:BLK.NO. low 1/al~ z8 Tzg 0 ]8E ( ) icy) u~ IC 3 - cs Vote 5 ~4a~ COUNTY: WNER S UYEI S NAME: MAILING ADDRESS: C`1"W T-rr ST-e-zvIX S L1C TZ~~3 Z-s, ►•v 1 SL/ oz3 USE DATES OBSERVATIONS MADE TO . BEDRMS.: COMMERCIAL DESCRIPTION: I PROFILE DESCRIPTIONS: T (Residence N J11-1- ZS RATING: S= Site suitable for system U= Site unsuitable for system CONV NTIONAL: ~I10UN. -TIN-GROUND-PRESSURE: r2`23S YSTEMINFILLHOLDING®NKREDED SYSTEM:(optional) S ~U®S ❑u I 0S ❑u ❑U ~S U ~4 ~xy o Couv1~ ouA 3ETZ) DESIGN RATE: If Percolation Tests are NOT required I If any portion of the tested area is in the under s.H&'.09(5)(b), indicate: C ~--14C.SS Z II Floodplain, indicate Floodplain elevation: J v ' P"N PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-IN6a•I•E-S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH I ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 ~•oI q1.~,' NoUE VA ~Zsur o,e'~~3nl~sTs,~.z Q>7 ~s B- 0L - C19 B- x1101 qB-G B_ I B- S C1 > B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INeldES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH LEL. P_ 1 S.3` PcS )L},,ii i 3.o CS )C4 < 3 9U' P- Z S. b' G'~ o f W t'c -ST-2- SJE~- ! LGS:S I)-tf M Z n)A) U MS C 3 9 8 P S-8 • < 3 X19.3 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. 1►-3VTI NL Q ?_E LJI " P_*uT FIN-GE 91 ~~~1 B FI Q'D ~ s SYSTEM ELEVATION C~ `'?3• so' 10 ~[1 uE G ~ ) erx J ~~$E ~ _ I ! I l t 17 1. r r t , ; i W ' rT D1 ST1~'v ONE Pu PAS ^ SWPE ' ; 90 I j ~ C" ~ ' ~ _ r .S i ~~1';D O 4'tc>~ WLlLh'T1CYV lcFTzN' I Iz. IS 4- 4w- j I I I ~ 1T1~L R RA} I C ( REN N61 s" SIT ~1 z 1 d ( _ - t - I ~ Zf I I ~ I I ' ! ~ ~9b 1B'. v~j Etrgs.7 x.97.21>S:h t.Is )"=YD i SEC Z$ 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: v~ L. wEC'tFT?_ Z 6-Z6-S"7 ADDRESS: at k Z CERTIFICATION NUMBER: PHONE NUMBER (optional): L_ L_I (WoR w 5 0) Sib /S-yzS-016 CST SIGIG A~ DISTRIBUTION:. Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - Owner's name San. Permit o. H63.05 PLOT PLAN Snow: N1t Location of building served Dosing chamber Septic tank Vertical/horizontal reference point Building sewer Q System elevation is C(3• Sa r/ Effluent system Well Replacement system area Property lines w/in 50' of system Distribution boxes Scale = =%4o' , or dimensioned FN-j]' Pump and controls: Mfr. & Model No. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Gal. per Min. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan,below: ~ LoT 1.,1N S I s~~~~3-~ry W ~u t~ c+rt~N - ~FzA1N1~~ZD S 1-~ovSE I` ~OUO GPrL. W tESZ CU7UCRETB ro oFy'~Cr do Q ~ I ~ ( ~~''~~~5~ uvblchTLS FNIS1tED_ ~ ~ ZS. 38, GR.kDE ~l_EURT'~OtJ 3 I v -pL F q~ 5' 133 F-OP- sukFil)c e CL iy ~By_ 2 ' ~~o pRliJlCG~ ~0 DITCN r I I 7•Z,~ij 3 0 ~ SAttz.e 1' ~BuVE 96.8 ~ ~ ~ 3 ib Ib I ~ 3 q~ 8, ~N~- EL, 100.00 ,1 G~outi►D ~Na'I I !31 ~o-~ I ~ptu CAiVC,~:~/~SE S' d zv,S BZ ~l5 - - -s OF ELQ@ . BUX 1~lPe 9rl.5' vtYJT 'Pipes FL9S.1 ' CL,9b.`f EL g1.2 ~l CCb{ ~R uhTE. 2 U h~ By the granting or approving of the above plan, or upon the event of a subsequent permit being issued, St. Croix County and the St.CroixCounty Zoning Administrator, does not assume or hold itself liable for any defects in plans or specifications, plan omissio examination oversight, construction,-or any damage that may result in or a'f ter ' n tallatio PZu n r s signa -ure icense-No. ~'te p. 3 /R ~J1J~2.5 tiP.1~E V `=s.~T 1~1A C, wl k Pp': D t~ E:~= C P ~~i. `Z" ABDVE FIIJtSH~ GT?.AD° ~K! G'n1V G - S~ yZ"HAX\►~Uh AI~PRDU`~ S~f3J`~ `T'1 C 1~ CIA. pVC pl_TiZ1$~Tl~ ^-OU~S2 OR S"OF FI~L S'Ti2.htJ oSZ R R SN _ 1-l AY - a oV ~ Z pF A G Gr ~ GATT: 8' v o o / r .J G° fC - i'a J G „O F 1/~ y i/Z"AGG>r o.97~ _ j I _ C U pERF-URATED P 1 C' S ~ p o'S TU Y'o~ 3'~ L` DISTRI{3UTIOU PIPE TU BC AT L1 0.5T --1-- INCHES BCLOv✓ ORiGI~AL GRAD1 THAI) AT LCA ST ZO WC.HCS BUT UO MORE 'i2 1►.ICHCS B1 [ OW FINAL GRADE II.ILHES J1AYIMUN~ DEPTH U} LXCAVATIOU FROM ORIGIUAL GRADE WILL BC 1'111JIrAL3.M DEPTH OF EXCAVATIOU FROM ORIGIUAL GRADE WILL '5C _1-12 wCCHES i SiGTJED: LIGE65C UUMBER: 65 I DATE: 0 0 0 K m 0 o m o C7 Lo~ 10 3 m F co - o" T I Oa ; ~ 1 m 3 _ v O C/> m z o co r N o O O N N O 0)0 F). O O N `C 0-0 S 3 C IV a z C- m M cWC co o s CD CD 5 00 Oo Oo A CD taOt N : N < 7 ? O N r~ N d 6 O O O T f`s j O W CD C) (D 0 N n w 0 A7 \i CJ O N O O N N O ~ W ~ ~lwl D1 A N v.° C f CD C G N li m <ri °i a ;n c V c (DD o m CD o o L w ~ CD to 0 ao 00 N p G { N 4 v 3 N h• R C) Z C 0 C c0c C0C yCC M A O 0 G< G C G CO Z o n Ca CO) N D O O -I N 0 0 N O O O~ i N N to H ~1 ' y 3 d ' I A l~1 oo v CL = M N z z co O Z O 0 O D O. !r !ri CD CD CD y y N C CD N W O. d 7 I - -1 Ch z N O A Z CD Z O 0 d A 7 0 N W * ~ W CL z 0 A 17 O ZZC OGo 3 f11 Z < A Cl) A Q N x a ~ Ii A r-. Q T i O N C O O Q CL m n u, I w I~ N N N O I 3 I U N N a i a N O O V O w Q O N b A Ea O r N p ~ O '0 I ~ p_ ~ y 'r ~l It' . CTIONS FOR COMPLETING FORM `B 15 - SBD - 6395 ~I To be a com id accurate sail test, your report must include: w; 1. Couplet ion; 2, u fly indicate wheth . a residence or comrrterci4~ 15Nject;. ~11u1110er -ems or cornmer:anned; Or- t system; 5. C re suitabil ing boxes, A SITE TABLE FOR A HC i-DING TANK ONLY IF ALL OTH SYSTEMS ARE RULE BASED ON SOIL CONDITIr' 5. B' , the abb iations ; for writing profile descripti, -s .4 the plot plan; A, EGIBLF "-ram a,- locating y test locations. D preferred. A sl, rat may 1 i o I sr, e your b 'k < eleuati( n ice point are clearly shown, ==-nd are perrnanent; i:~te boxes to dates, names. 'dresses, flood plain data, percolation test exemp- ate; _ al 4iuch as flood [)I, , ~a±ion) does not apply, ox; i r :.7d place your c:ur rer- and your certification ni pies and distribut+ auired= ALL SOIL TESTS MUST BF FIl JITH THE AUTHORITY WITHIN F COMPLETION. AE IEVIATIONS FOR CERTIFIED SOIL TESTERS ;I Textures C _~Ols BR S H+" - !s nr arl y._- `t R siC P1 - r T ~R: c. >t DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY ' DIVISION P.O. BOX 7969 LABOR , RELATIONS PERCOLATION TESTS (115) MADISON WI 3707 HUMAN RE (H63.09(1) & Chapter 145.045) LOCATION: tt SECTION: TOWNSHIP/ LOT NO.:BLK. NO.: SUBDIVISION NAME: NYC 114N614 28 /Tze N/Rie2(or f(iNN/c.y1NNic 3 G°~EeTiFiED S1I,P!/E 1,V4 ,,O COUNTY: OWNER'S NAME: MAIL NG ADDRESS: sT ~eai,c E~BEkt._.;`" .~/v~-2 L//LGs ~3'4oz z USE DATES OBSERVATIONS MADE NO. BE)RMS.: COMMERCIA D SCRIPTION: PROFILED S R)PTIO S: PERCOLATION TESTS: Residence New ❑Replace ~ ~,L 41114 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) S ❑U S ❑U ® S ❑U El S ®U ❑ S XU ~oNd~'~f/T+aNgG 8E0 30X33 If Percolation Tests are NOT required SIGN RATE: If any portion of the tested area is in the / under s.H63.09(5)(b), indicate: Gr Z 11.5.5 2 Floodplain, indicate Floodplain elevation: p '0 PROFILE DESCRIPTIONS BORI TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUM ERG DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BED OCK IF OBSERV (SEE ABBRV. O BACK.) 24J -CZ ; ,r , B' 1761 810 ,1/E > ~D g JA.~~ art 4elrv Z `f, Z 94 NdNE 29 B- 790 /1ldN~ >9 / 8i ~cu~L .din- ~g Bin J B- 3 194- 915% 4 ~-d B- 8df 9~5 ; 0 /✓O lvo 78 lyd Ale B- PERCOLATION TESTS ENUMBER DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER PER INCH ..~ti L D cS' P-_ 1 10 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. O,pi G is QG. 94.3 SYSTEM ELEVATION 41 7- IVA7:e 92, S- . lee 'V 1 a,evcullw~ _ ~y.PXN' %VGlE~ '9 T+N 3 a % 3 E 3 I e 7-1 ~7 g a t { s 1 s i i a d ; $6 G4+2. OF 7'3_ 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and metho 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: R/A,CT"_ (~~PE D - D rsDE E/1/Gi~r/EE.Pi v 7/217184 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): lZ 3 gerz/.12, s"~-. '~vE',Q F,gLLs ~s`~o zz 3S 13-88 7/j--40r CST SIGN TUBE: DISTRIBUT"ON: Original and one ropy to :_ocal Auii»rity, Prope Ly Owner Tester. JQS NG - 8` - 1470 D11 110-SFD -5x395 32/8?~ _