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HomeMy WebLinkAbout026-1041-80-000 5 E G o .—� rt cn i ! IU N z F C() to a DC -. 0 H Ui O N r. • rt (U V H W - 3 c N is i. ry1 co m 2 m cn Q 3 o R Pa ry �• ,(5 N V p_ g cp a) v, v ,G 3 0o 4" O r rt S rn a m a o ? m 0 a N = 0 a) •• O ® O N m 0 a o oN co A0 P., 3 o F o `' o O 0 a) A U7 _ co N A a a Iv m a," g N a o CO \ V I N 3 7.7 (71 'PC1 H V) oo 0. iv N W W t'1 < -• Z Al N D Z �� y 3 .. C lri CT 5 sir d ' f 0 r o Z O O O o • V U m VN 1(21. o o N v o U) p m .. o o • cr O O < .' N v c K a • O 4 o. v a Z Z D O O. h •N N N N 11��1111{ N N N CM N C 0 co N a a 3 3 z CD 6 A Z CND N c v a • 0 Q. D3 ' m w. P 0 a Z C rT z m N x A -o W N m a 3 a 0 v c o c. FD" cn a et CS" N fi Q q N O N O V A K O cp ho b < f0 • A 0 O E O O O o- Parcel #: 026-1041-80-100 02/20/2007 03:16 PM PAGE 1 OF 1 Alt. Parcel#: 14.30.18.202C-10 026-TOWN OF RICHMOND Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 11/12/2004 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner O-CROSBY, DAVID C&CONNIE DAVID C&CONNIE CROSBY 1568 140TH ST NEW RICHMOND WI 54017 Districts: SC = School SP= Special Property Address(es): *=Primary Type Dist# Description * 1568 140TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 14 T3ON R18W 1A IN SE NE COM NE COR Block/Condo Bldg: SE NE TH S 208.8'TO POB CONT S 208.8' TH W 208.8'TH N 208.8'TH E 208.8'TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) POB& INCLUDES COMM E 1/4 COR SD SEC 14 14-30N-18W SE NE TH N 00'W 860.96FT TO POB; TH S 89'W 242.80FT; TH N 00'W 242.80FT; TH N 89' more... Notes: Parcel History: Date Doc# Vol/Page Type 11/12/2004 779720 2694/253 AFF 11/12/2004 779719 2694/252 QC 07/23/1997 498/449 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/20/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.350 32,000 99,100 131,100 NO it Totals for 2007: General Property 1.350 32,000 99,100 131,100 Woodland 0.000 0 0 Totals for 2006: General Property 1.350 32,000 99,100 131,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 PUMP CHAMBER :111111 Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: /( Trench: Width: b` / Length: /( / Number of Lines: c Area Built: 2 Fill depth to top of pipe: �Q Number of feet from nearest property line: Front, Side, O Rear,Ft . 29 Number of feet from well: _ Number of feet from building: (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() 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: 5-- ,--42C—(37 Plumber on job: [ �J,y ©�if',S 4!„0" License Number: / 7-3 3/84:mj /11!!" - Form - ST C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER figdit/ ().4 TOWNSHIP 1Lt� 4,4 SEC. l7 T N-R / W ADDRESS �g Ap ' ST. CROIX COUNTY, WISCONSIN �r i Ilrs SUBDIVISION LOT //� LOT SIZE /f%%/ I 1( PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM X14/. >/ oei ,cs' - Z A IP _ 7� SN 44 ifio \HJ � INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used .//,,/ 4 Elevation of vertical reference point: /0D,0 Proposed slope at site: s=� SEPTIC TANK: Manufacturer:Waes ;,,,4 iquid Capacity: l/40!! / Number of rings used: / Tank manhole cover elevation: 9„2.3R Tank Inlet Elevation: 7 Tank Outlet Elevation: g),9. Number of feet from nearest Road: Front,Side,Rear, O /RI/ feet From nearest property line : Front,O Side,O Rear, l feet Number of feet from: well /C., , building: 77 1 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE r- DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969° BUREAU OF PLUMBING ) MADISON,WI 53707 SE 3--i,,NE4,S14,T3ON—R18W $BCONVENTIONAL ❑ALTERNATIVE State PlannII.D.Number: II f Town of Richmond ❑Holding Tank ❑In-Ground Pressure ❑Mound Town Road ,1-R7 OUC'/ NAME OF PERMIT HOLDER: 'ADDRESS OF PERMIT HOLDER: INSPECTION DATE: David Crosby Route 1, Box 243, New Richmond, WI 54017 S•-dLe,'g? 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: Calvin Powers Jr. 1563 St. Croix 92557 SEPTIC TANK/HOE G TANK: - MANUFACTIT: LIQUID CAPACITY: TANK INLET ELEV..: T NK OUT ET E EV.: WARNING LABEL 'LOCKING COVER n ' PROVIDED: PROVIDED: {V!I I 00° iC .2, r V . KYES 0 N ❑YES NI NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATEI7 NUMBER OF Riot 'PROPERTY WELL:WELL: BUILDING: VENT TO FRESH 4 AIR INLET: r ALARM: FEET FROM Q t_I LE �� �7 /�'�- ❑YES NO �° OYES L 1O NEAREST-4. u '"'� DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER . PROVIDED: PROVIDED: 1111 YES ONO ; OYES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH' (DIFFERENCE BETWEEN FEET FROM . LINE AIR INLET PUMP ON AND OFF) OYES ❑NO NEAREST Yr SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH: DIAMETER •MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH: NO.OF DISTR.PIPESPACING COVER INSIDE DIA. SPITS LIQUID 40.BED/TRENCH I TRENCHES' / (MATERIAL: PIT DEPTH. DIMENSIONS (v—` _ 1r�(�/ \J • GRAVEL DEPTH FILL DEPTH DIS R.PIPE IDI R.PIPE IDISTR.PIPE MATERIAL: NO. TR. NUMBER OF PROPERTY WELL BUILDING. V� T Tjj��RESH ■ BELOW PJ�ES. ABO O .`N -IE �ENQ. S 2_ PIP FEET FROM LI Z� III /� I IT NIf r • ((��7 tt `// . NEAREST-► ,r`/ fjar p/� • MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. CI YES ONO COIL COVER'TEXTURE. MARKERS. OBSERVATION WELLS LIVES ❑NO OYES ONO DEPTH OVER TRENCH/BED 'DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED CENTER: EDGES: OYES ONO OYES ONO OYES ONO • 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 INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED OYES 0 N OYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING: FEET FROM LINE • () OYES 0 N OYES ❑NO NEAREST >. 9(,, . 6 . ID ___J_C- Z 1 10 ° 6eg � f. z Ci I.s Sketch System on .._ file for audit. Reverse Side. ��. SIGNATUR .' TITLE. .... .. Zoning Administrator DILHR SBD 6710(R.01/82) 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 sewagesystems must-be-properly maintained-The septic-tank(s) should be pumped by a-licensed • •. . - pumper whenever necessary, usually every 2-to 3years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau_of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be " installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.). address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; , X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/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; welts; 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 • i for—1 included the creation of surcharges (fees) for a number of regulated practices which Wisco can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure! 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- �,� � �tlf tered by the Department of Natural Resources. These funds are used for monitoring ground- maluimp' water, groundwater contamination investigations and establishment of standards. Groundwater, , it's worth protecting. SBD-6398(R.03/86) TY ILHR SANITARY PERMIT APPLICATION COU"V CR " x �� � In accord with ILHR 83.05,Wis.Adm. Code STATE SANITARY PERMIT# P 9,266- 7 –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 I. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES W NO PROPERTY OWNER PROPERTY LOCATION PR ERTY OWNER'S NG ADDRESS LOT U/46ER ,/BLOCK UMBER SUBDIVVI ON NAME ?-, A � 1 CI Y,ST ME ZIP CODE PHONE NUMBER CITY NEAREST ROAD AKE OR LANDMARK VILLAGE 1ivi L1 ,.� ' .7 �sye/7 (7 IVI- >7 R WN QF - oJ4f,Ard—tr)a II. TYPE OF BUILDING OR USE SERVED: • 7 J Oo� /D� Number of Bedrooms if 1 or 2 Family �� OR ❑ Public(Specify): �/� J III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b.gi 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. RT 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. M 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): ,..5-7 , ' i� ,0dc-- _ 7 Feet ®Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total #of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks /�hd ) strutted Septic Tank or Holding Tank 1 ) /tlic) C,iEj}i. s icy ❑ ❑ ❑ ❑ ❑• Lift Pump Tank/Siphon Chamber 1 ❑ ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of private sewage system shown on the attached plans. Plumber' Name(Print): Plum 's Signatur :(No tamps) MP/MPRSW No.: Business Phone Number: Pru�m� 's Address treet,City, te,Zip Code): ) Name of Desi er. — -_ ,' ? .) ede 9.v4 it)Z „s--4ii7 A/ VIII. SOIL TEST INFORMATION Certifi SoyTester(5,5-T)Name CST# i ,24/4) ).9a)eiti5 cI jf �S CST's DDRESS,}(S�eet,City,S e,Zip ode) Phone Number: ( IS--. ),---D/ C-7,&S-- IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) Fig Approved ❑ Owner Given Initial S rcharge Fee �j �//� Adverse Determination /bv `�a �5do ]s- DD-sr ``Y1�dc�c�...fv) • e .0 X. CO MENTS/R SONS FOR DIShPPROVAL: P/ % / �K y hoary LT, �-i ki.:,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 S T C - 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 bauid C o r,d &on n,e S, C ros b y Location of Property S e" /Ve h, Section , T30 N-R 12-14 Township R i CYO rn oh e) • Mailing Address R Q I 8 O K,013 • l u e cv Q i ch.rnond, /.l)13 ,cy0! Address of Site ei* / 2,,,, c1113 • „Amor.", 4 •s 6 '/O/7 Subdivision Name Lot Number Previous Owner of Property S P.ozD 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) ? Yes K No Volume and Page Number S37' 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 IS Seal of the Register of Weds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) centi6y that all statements on thAi 6oAm ane tnue to the best o6 my (ouh) hnowtedge; that I (we) am (are) the owner(s) o6 the pnopenty des ci i.bed in this .in6onmati.on 6onm, by vL' tue o6 a wa Aawty deed n.econ.ded in the O66.ice o6 the County Reg.s ten. o6 Veed3 as Document No. ; and that 1 (We) phew en tCy own the proposed site bon. the sewage dispos sys em (on I (we) have obtained an easement, to nun with the above described pnopenty, bon the conatnuction o6 4aid eystem, and the same has been duty neconded in the O66ice o6 the County RegAsten o6 Veedo, ab Vocument No. ) . 0092ouLse/624sail( SIGNATURE OIL OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 5=02!- 2 � ai�� DATE SIGNED DATE SIGNED h.+ UO<:UMENT NO STAY[ DAR OF WISCONSIN- •FORM a �q 1 Art 53 WARRANTY DID THIS SPAGl TTTTT9((0 ION asco aoINO DATA •t i J 9 , Duane D. Spoo and Ruth L. Spoo, husband and wife REGISTERS as joint tenants a/k[a Duane Spoo & Ruth Spoo f OFFICE ( ST. CROIX CO•A�NIS. Recd. for Record (firs 18th d David C. Crosby and Connie S. Crosby, goy Of "'�itisbaand wati�`w� °e, as joint tenantsr4.D. 1977 Ot30 A•,AA. kora«of OW I nil URN ,L5 the following described real estate in St. Croix County, State of Wisconsin: Tax Key No. . A . ....... .. ...... parcel of land, oneacre more or less, more particularly described as follows: Commencing at the Northeast' corner of the Southeast Quarter of the Northeast Quarter (SEJ of NEk); thence South along the section line a distance of 208.8 feet to,the point of beginning; thence continuing South along the section line a distance of 208.8 feet; thence West at right angles a distance of 208.8 feet; thence North at right angles TRANSFER a distance of 208.8 feet; thence East at right angles to the m point of beginning, a distance of 208.8 feet. Said parcel be- " Eis ing immediately to the South of, and adjacent to, a one acre parcel previously conveyed to Wayne Coleman, by deed dated December 26, 1972, and recorded January 2, 1973, in Volume 493 on page 277, as Document #314081. All located in Section 14, Township 30 North, Range 18 West. • i This IR homestead property. (is tis not) Exception to warranties: Subject to municipal and zoning ordinances and recorded easements and restrictions of record, if any Dated'this ... .,14 th s day of October ,7 , 18 1 ISFAL1 .. e 071:71e- 0 8. ~ (SEA!.) /a ane Spoo poo a/ /a Ruth Spoo (SEAL) (SEAL) • • AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this .... day of STATE OF WISCONSIN , 18.... .. i ••. . . Counts. Personally came before me, this .1..,!;...-. ..... day of • ...."^'•"C`.:..: ^ the aI ove Hurled TITLE: MEMBER STATE BAR OF WISCossI Duane D. Spoo and.Ruth L. Spoo. (!( not. .. .. . . a/k/a Duane Spoo & Ruth $poo • authorized by $ 706.06, Wis. Stets., • THIS INsi Tiu ENT WAS DRAFTED E`• to me known to he the person S. i P Cwayna, Novitzke, Byrnes, Gust & who excttttcd tt.c o•el utn Williams n;t a nt and u nnwlnci-e t .r ,•om∎/ By Don Paul Novitzke ; u (Signature, may he authenticated or acknowledged. Both '•;rT' At. ' ..0.1 ar(• not - 7 6 ,+1•, Ifnent (I' rot .:ntr expnatio• •N•m • ,.f Is,r.on, ••snrnl In a:., r.parll■ .1••nl;d II, t• '.•.1 I 33* *� •o• I r it..l In•I��w th v ••,,,t1,r/A 1 WARRANTY DEED STATE BAR OF K13CON41N POEM No. Y-1977 U(Iwai.in Legal Itlan% CO. Iur Mllwaukm. Wm. i.Lb 3776..1 2 U) H . 9 STC - 105 r . a . H SEPTIC TANK MAINTENANCE AGREEMENT o #- St . Croix County z a OWNER/BUYER Uhl ✓j( art) 12608ie Grvs6y m ROUTE/BOX NUMBER Rest 1 13ox c113 Fire Number aas CITY/STATE Neto •Rick en0nd# (.t) /5, ZIP 541017 3o PROPERTY LOCATION: 54- 1/4, lUr 1/4, Section T N , R W, . Town of R iC�. mend , St . Croix County, Subdivision , Lot number . I Improper use and maintenance of your septic system could result in E ' 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, I,°-- 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. HH I/WE, the undersigned, have read the above requirements and agree w to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- w 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 �G.� DATE 5"a/-d"7 '-- ' St . Croix County Zoning Office P. O. Box 98- Hammond, WI 54015 E 715-796-2239 or 715-425-8363 Sign, date and return to above address . 4 t • 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 it desired; 8. 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; lb, 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 tt. - Stone (over 10°') BR — Bedrock col -- Cobble (3 - 10") SS -- Sandstone gr -- Gravel (under 3") LS -- Limestone s — Sand HG`JV -- High Groundwater es -- Coarse Sand Pere — Percolation Rate mod a -- Medium Sand IN --- Weil !s -- Fine Sand Bldg -- Building Is -- Loamy Sand -- Greater Than "sl -- Sandy Loam _ Less. Than — Loam Bri --- Bo:win E till _._ Silt. Loam El - Ll3ck. si Sir cry Cray ci -. Clay Loam Y ---- Yellow sci -- 5airray Clay Loam R ---- Red sic — Silty Clay Loam out -_.. Mottles so -- Sandy Clay wi -- with sic -- Silty Clay fff --- few, tine, faint c -- Clay cc -- comfu0rs, waive p, -- Pcar runt — Many, medium • rr -- Muck d — distinct p -- prominent HV/L -- High water 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 permit application must he submitted to the appropriate local authority in order to obtain is permit. The sanitary permit must be obtained and posted prior to the start of any construction. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION ,LABOR AND PERCOLATION TESTS (115) MADISON W 53707 HUMAN RELATIONS (H63.09(1)&Chapter 145.045) LOCATION:: SE/CTI+N: i TOW IP/MLINteIFALITY: LOT ,O.:BLK. O.: SUBbI ISION NAME: '�4 '� / /. N/R ; E (or ti► A . A . ■ , 4 .i COUNTY: OW ER'S BUYER'S NAME: M.I NG ADDRESS: USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCI DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence A/ ❑New ®Replace >/ 9 2 5--/..9-s2 RATING:S=Site suitable for system U=Site unsuitable for system 6E ,, if R ��`�Jc 4./1` /.4i1r7 CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM•"(optional) 1S DU MS 011 NS DU 0S ®U EIS C U ,+/0,110 . 4„, If Percolation Tests are NOT require DESIG RATE: If any portion of the tested area is in the / under s.H63.09(5)(b),indicate: 1/ �� '� Floodplain,indicate Floodplain elevation: i/� J�r�G//' /V PROFILE DESCRIPTIONS /' BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH Pd. ELEVATION EST.HIGH ST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B-4. IIMIPMMllgglIl ' : Jr. .1l B- , r. _ ♦mpieemmiimi r B- B- B- PERCOLATION TESTS /''f7' TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I. AFTER SWELLING INTERVAL-MIN. PERIO• 1 PER •D2 �;j[•i PER INCH P- / 4400 `3v w /// • .Sr3.3 . 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. SY w the surface elevation at all borings and the direction and percent of land slope. 4 ' lot 4Il y ,, i , i .1 1 .f._, I SYSTEM ELEVATION 89'7 _ _ 4A0,1-i 't=” al- -'" �d'.�. I 4 , l � � j ` � ' n _..._ !` - d M ! ?y /%„... 1 I i __ / r�) ! 1 Ak;. ,, 1,5 2 ; _ Q I f ' ; - ; ;, it� € � �_ � N , , r T -7 '- 1 I -I- ,_;.? ; , , . ; 1 ; ; 1 1 ; ; I i I.,-' I Ir." t 1 I i j I I• t t 1 I r f II I 1 i 04. '/. ",_ 9. ._ _ 1 __. i_ .._ 1 L-.‘ . -. . 1 i_...,i_i_ 4_.m. i. _..._,tj$. .. 1 - i z .. _ _ r A.., ' I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accdrd 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 r NAM (pri t): TESTS WERE COMPLETED ON: l r�i // I % is!S 1 ,0/12 •S':��-87 A TO�D SS: CERTIFICATION NUMBER: PHONE NUMBER(optional): CSTGNATU DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — Z)yek580 Ww 417#744/4 hiT S- /7 rd/7/22644o 7676//,cio74,41 X/ 4215 CEP,/e 7�4, it ` �evo l Acleeto S'J —s.7 494-7/45 ad41--tP9--) 11/.i_o, 2t)A 4 I I ,79' ', X9 / ,)\I Q 94( /33 A /S% ./3n) . 14041.2 4 J s A PAGE OF r• CroSS Stchol, oc a Z c13 Sys /•en-, r 1 414)A0 c.7itz isg } / )/ . .2V3 Fresh Air Inhale And Observation Pipe r,I } c /7 22 -`4 Q Approved Vent Cap Minimum 12"Above T �0/7 ....F1.221.6.01.............4... 20-42"Above Pipe ,�_ _4"Cast Iron To Final Grade Vent Pipe Wish Hay Or Synthstk Covering _ Min 2"Apprepole Over Pipe r—i Distribution - Pipe S 0 0 0 0 0 —Tee 6"Amigos L-1 Per laratea Pipe Bs::• o Beneath Pipe ...—_ v r0 —Cor ting Terminating AI Bottom 01 System Pr„P Q cI nw 9 rh At . , c..1t0w-V Ion �%/��.CY/- if: lb SOIL FILL DISTRIBUTIOM PIPE APPROVED $itsrTHETIC COVER • ` `ti=36111 '..# 'MATERIAL. OR 9" OF STRAW 21'06/%52E4AIE -- 4) 0 • OR MARSH % Ay •�e (o�OFJ2 -21/2 AGGREGATE �te°8 ,ir1�Nr•• tLEV. OF FEET , b ,_ !r:. ,\ /.ice X31 / DISTRIBUTIOAI PIPE TO BE AT LEAST .3O r INCHES BELOW ORIGINAL GRADE AAJU AT LEAST LO INCHES BUT MO MORE THAN 42 IAICHES BELOW FINAL GRADE MAXIMUM DEPTH OF EXtAVATIo►J FRoM oRi&wm. b, ivg WILL BE. INCHES /Nt4U'WM AEPni of EXCAvATloN CROP yoR161MgL (,RAP€ WILL BE INCHES SIGIJED. (#7. ige2n"/d& LICEAJSE NUMBER: AS----- -:-----� J DATE: ,. .57-4- 7 110 . L _.