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HomeMy WebLinkAbout030-1098-10-000 ti (D 00 0 3 0 ti p d � I v a o c � I N I � I N t' I I t3 I s• I y I G•L I C � I I o� � I c I z li c 0 � I Q I � I � z H I 0) E � O z `m c') a m o o z v c 0 o w a�i Z w o CO F °�' W z E M � I N I y •�N1 O O CL L O O Q v Z Z a Z N d c t6 E f0 it CL In 0 IL N N R U d L Y m U co N C y p_ _ - 6 •N aaa z L a � o <n to U rn rn CO 7 O O O�. m U N y C d D a=a N C .o d Q�16 0 :O E O O L N O LO CD 0 N W O U) c y c O f7 N n N IN n 00 « N _ C N _ L O :+ £ = E L a y a . .. 0 _ L: CL T • Q d G1 u c E- E « O W 3 .. O A U a 0 to U l -+ I M � , Parcel #: 030-1098-10-000 02/23/2005 04:25 PM PAGE 1 OF 1 Alt. Parcel#: 32.30.19.355H 030-TOWN OF SAINT JOSEPH Current X, ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): *=Current Owner * JERALD A&MARY BETH WILSON WILSON,JERALD A&MARY BETH 1206 52ND ST HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description * 1206 52ND ST SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.010 Plat: N/A-NOT AVAILABLE SEC 32 T30N R19W SE SE LOT 2 OF CSM 1/97 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 32-30N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 786/153 07/23/1997 774/504 07/23/1997 600/582 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 5637 319,600 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.010 129,700 184,700 314,400 NO Totals for 2004: General Property 5.010 129,700 184,700 314,400 Woodland 0.000 0 0 Totals for 2003: General Property 5.010 58,600 140,300 198,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 105 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 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: (Include distanc s on lot plan). W, ;?,U lag k' 93,oS g3, a5 SOIL ABSORPTION S STEM 0 v C v 91 f I 0a.v 103160N^ Bed: Trench: Width: I Length: Number of Lines: 3 Area Built:�(� Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,�l�t . Number of feet from well: -�- of 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 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: J Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj Form - S T C - 104 ! _ AS BUILT SANITARY SYSTEM REPORT OWNER RRU W'115&j TOWNSHIP 5 �J v .>> �' SEC. T , ON-R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT BLOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM J7 Ya, o WOO 2r/ y 8"o 0ry\ Not&__�' INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used man h Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: £��j5 Liquid Capacity: Number of rings used: O� Tank manhole cover elevation: C1 t Tank Inlet Elevation: 1Q. �p Tank Outlet Elevation: 9G.09 Number of feet from nearest Road: Front, Side 0 Rear, O /..1�_!_ feet From nearest property line : Front,0 Side,O Rear,® feet ' Number of feet from: well , buildin g: �5 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT'OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION MP.O.BOX BUREAU OF PLUMBING � IDISQ:N 4WI 53707 WI SEk;SEk,S$2,T30N—R19W kkCONVENTIONAL ❑ALTERNATIVE State Plan I.D.Number: ❑ of assigned) Town of St. Joseph Holding Tank ❑ In-Ground Pressure El Country Acres 52nd Street NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE —Jerry Wilson St. Croix St. North, Hudson, WI 54016 14—q— g 0:�� 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: Richard Hopkins 1059 St. Croix 99060 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER Lo, PROVIDED: PROVIDED: I. �l➢,�lv R V DYES ONO DYES ®.NO BEDDING: VENT DIA.: VENT MAT L.: HIGH WATER NUMBER OF .ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: OYES r9NO G= ❑YES )�NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO OYES ONO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF r PROPERTY WELL: BUILDING. VENT LE FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) OYES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing FORCE LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: .s WIDTH. LENGTH. NO.OF DISTR.PIPE SPACING. COVER :INSIDE DIA.- #PITS: LIQUID SEDITR04CH �� �� TRENCHES �� MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO TR NUMBER —OF PROPERTY WELL BUI LOING: VENT TO FRESH BELOW PIPES. ABOVE COVER. ELEV.INLET.ELEV.END. PIP LINE- AIR INLET: } �1a q3 ,a9 93,0? a� � NEAR s°M 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- ❑YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER ITEXTURE PERMANENT MARKERS JOBSERVATION WELLS OYES ONO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED. CENTER JEIIES ❑YES ❑NO DYES 1:1 NO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BEQ/TRENCH TRENCHES: t)IMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: 0 IN O .DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.: ELEV.: DIA.. ELEV: PIPES: DIA.: rn EgvATyFON APtM IS'i`fkIOUTI©0 1 HOLE SIZE HOLE SPACING: DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED INNFiIftTIYN PLANS. ❑YES ONO ❑YES ❑NO COMMENTS: JVLHMANENT MARKERS: OBSERVATION WELLS: NUMEICR® L NE:ERTY WELL: BUILDING: DYES El NO DYES ❑NO NEAREST- 9 r v ) A -Ful Sketch System on Retain in county file for audit. Reverse Side. SI TUBE //aa TITLE: DILHR SBD 6710(R.01/82) 1..� Zoning Administrator PP­ s c ' 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, usuaiiy,eveey 2-to 3 years; 6. If you have questions concerning your private sewage system, cor�F Ct your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I Property owner's 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; 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, c rtification 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 coriRlete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; lls; 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 E result of over 2 years of steady negotiation and public debate. The groundwater bill Groundyatsr-- included the creation of surchairges (lees) for a number of regulated practices which Wiscor, in'S can effect groundwater. The surchar��-s took effect on July 1, 1984. All of the water that buried rea.sure used in your building is returned to the groundwater through your soil absorption o , -tem or the disposal site used by your holding tank pumper. 0 ponies collected through these surcharges are credited to the groundwater fund ac'minis- ° by the Department of Natural Resourcer;. These funds are used for monitoring ground- t groundwater contamination investigations and esta`;lishment of standards Grourd at= t cW! protecting. 1981;R.03!86) SANITARY PERMIT APPLICATION COON Y � DILHR In accord with ILHR 83.05,Wis.Adm. Code S-t' CFai STATE SANITARY PERMIT## —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION f. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ❑ NO PROPERTY OWNER PROPERTY LOCATION i 'S 5 F '/as %, S 3a T.3 N, R I 4 E (or W PROPERTY OWNER' ILING AD RESS LO N BER BL CK MBER S BDIVISIO NAME 0 \A ISO N /� CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST R_ OAQ K OR LANDMARK N. O ❑ VILLAGE II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): CW Ve )p,I fl d III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. LnJNew 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. RConventional 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.K seepage Bed b. El Seepage Trench c. ❑ Seepage Pit 2, PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes er'nch): REQUIRED Square FFeee�t): PROPOSED(Square Feet): r� <- Va" Feet lL`lPrivate -]Joint ❑ Public VI. TANK CAPACITY Site in gallons Total ##of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper. INFORMATION New xisting Gallons Tanks Concrete stCon- glass App. Tanks Tanks Septic Tank or Holding Tank OC (JQ Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT 1,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's ame(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: HovkiNs I�� 7i5 3�c� bao Plu er's ddress reet,City tate,Zip Cpde): Na a of esigner: 14 erg c�mm �� Vlll. SOIL TEST INFORMATION Certified S�Tester(CST ame� N � CST#�o e 34y CST's ADDRESS(Str t,City,State,Zi Cod ) Phone Number: 80 fob S OA) Q,/,Sc . S Cpl S 8(0-031 IX. COUNTY/DEPARTMENT USE ONLY ❑ proved S itary Permit Fee Groundwater ate Issuing gent Signature(No Stamps) rchar e Fee �t� �f� Approved Given Initial ) g �Wh /o i , Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber l 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 Jara/ao Q, uv e--LA a Location of Property 56 3%, Section 3,;, , T__3,0 N-R / q W Township . Mailing Address //o/ St • Cro« _54-• N, l�u LJ�, ,m00% Address of Site /;-y(o Subdivision Name Coco q Z d c.✓ej : Lot Number a Previous Owner of Property J a MQ 42 p rot 46"r 1S Total Size of Parcel ,5 49 8 -c.rr5 Date Parcel Was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume ` and Page Number 4� as recorded with the Register of .Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY 6WNER CERTIFICATION 1 (We) ceAt i..6 y that att statements on th is 6oAm cute tAue to the best o6 my (ouA) hnowtedg e; that I (we) am (one) the owneA(s) o6 the pAopen ty des ch i.bed in thiA .in6oAmation 6oAm, by vi tue o6 a waAAanty deed Aecokded in the 066.ice o6 the County Reg.usteA o6 Deeds as Document No. 3.) 0 and that I (We) pAesentty sun the pAoposed .bite box the sewage di,dpoa sys em (oA T (we) have obtained an easement, to nun with the above dachibed ptopeAty, bon the constAucti.on o6 said bystem, and the same has been duty AecoAded in the 066.ice o6 the County Reg.isteA o6 Veeda, ab Vocument No. 3X Glo/ ). un SI TURE OIL OWNER SIGNATURE F CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED j 1)oCUn1 FrJT No. STATE: BAR OF WISCONSIN FORM i—1982' THIb aYACK hESERVED FOR RECORu1N0 DATA WARRANTY DEED REGISTERS OFFICE +428409 pp 786PA,E r ST. CROIX CO., WIS, Rec'dl. for `?ecord this 24th This Deed, made between ---James H. Burtis and qY of Ju_ 1ap• 1987 _Carol--G.--Burtis------- 12.40 P ------ ----- - • --- - -- ---- - ----- ••-------------------- ------- Grantor, and Jerald A. Wilson and Mary Beth Wilson, husband • an wife as survivorship marital property ---•-- - --- -- ------- - --- ------------ - .--------•-----_-•-- Grantee, Witnesseth, That the said Grantor, for a valuable consideration.._--- conveys to Grantee the following described real estate in RETURN To •..St_._-Croix--_--_.__-__ County, State of Wisconsin: A parcel of land located in the SE1/4 of the SE1/4 of Section 32, Township 30 North, Range 19W, more Tax Parcel No: ----------------------------------- particularly described as Lot 2 of the Certified Survey Map recorded in Volume 1, Page 97, as Document Number 326101, Town of St. Joseph. Containing 5.008 acres more or less. This ------is not __-_- homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And-------James.-H-.-.Burtis--anal.Carol.G...Burt Is..................... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except - easements of records, if any and will warrant and defend the same. Dated this -- ------A-3-r_Cb- _--------------. da y of July --•- , 19...87 . (SEAL) ......... 9 . `: ._(SEAL) * J S H. BURTIS ---- --- •--- -------------------------(SEAL) :.. ..........(SEAL) * -------- ---- --- - ------ = CAROL G. BURTIS ------------------------------------------------------------------ AUTHENTICATION ACKNOWLEDGMENT Signature(s) -----------�.�4.-_ �'i•--/W_ ��Kk, STATE OF WISCONSIN ------------------------•------•... . . St. Croix ss. ------------------ -- ------=-------._County. authenticated this,-,�-- ay of......... -_-j 19 _ _2 v J Personall came before me this ........ .......day of ---------------- JulX 19.87... the above named * v ____.. __. ......... -----------------------•------•--------------•----------------------•----------- TITLE: M MB STATE BAR OF WISCONSIN ---------------------------------------------------------------------------•---- (If n -----•......---• -------_--- ....�,�,N, authorized by § 706.06, Wis. Stats.) '•- --------------------------------------------------------------- - -- ----- `'�� Paa"int known to be the person$----------- who executed the for ping instryrtfient an� ackno ledge the same. THIS INSTRUMENT WAS DRAFTED BY ,� an -- HEYWOOD, CARI & MURRAY, By: Samuel% R. Cari C '�,,� .x..•c_:.. Hudson, Wisconsin 54016 ! _. n ...... t c - ----------------------------- - --- - 1_ dtaly Public .... ' � --- ••---___-County, Wis. (Signatures may he authenticated or acknowledgecri`:3oth.,, ,,,My,��ommission is permanent. (If not, state expiration are not necessary.) �'� dater �-� *Names of persona signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Cereal Bleak Co. Inc �,. FOR14 No w.._,toss ---_ •3 G 6,1 U i �'• 7' NORTH 927. 28' `s3�y. o '�.. 864.21' o(b ••,�� Fs,� IV Q 00 9• 1 1109 ? NORTH - 534.R6' 1 (� N P 0 497.37 NORTH 812.41' � w 774 m .48 cn o nY 9D 0 n'� ��Ly2� �� w CD N �S� 0 N t<`• ® �` X00 576.43 SOUTH 610.39 w 666.92' W i SOUTH 700.14 . N ' N P rm _ (n rn . 33 33 0 NORTH 628.97 D ro Z: z g n 595.95 o� o m =a �4• o $ - Lm. cm � X0 n CP o m u+ .P_O m m n .tee. ! a m O C Zm � zN cmi N (� � i� �. m z -ocn � mD • r' D �+ o v rn W c) —p (D -4 W Z i C o °° O' N m < o .�.. Z rn N W W N O� O Go _ a N m _ N 0 N co N W N m U N R D cn W Oi N O to — g_ D C 8 ° p0 $ °o CL m — � Z Q � � i�A ro .s:.. �. , �,�q.; jf �fr Mme• .ti Ai' .f,. +� �2•iY k n 'L a;'I'�.•` .� N to * a vi cn cn z z z U) m= as 00o ° ° Imo r T ti W_ N W ti W W Z `� O I W p pp 1� A G7 p C) Nj, m O O V! Q m m m m CD pp N ° O co O ° ° N Z �O� �• O w O 8 tND. m r Ao U $ t0 $ W A rnD Volume I Pale 97 SO°14 45 c 014,24 ST C - 105 r r SLP'TIC 'TANK MAIN'I'LNANCE AGREEMENT ry+ St . Croix County OWNER/BUYER _Iff ld m ROUTE/BOX NUMBER Idol, 67o °P St Fire Number �L� i CITY/SPATE ?H�sun li/� _ZIP 5 y0 16, --- PROPERTY LOCATION : -5C 14 , Section T 30 u, It W , Town of St . Croix County, Subdivision( Qc.re5 Lot number o2 f Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance can sists of pumping out the septic tank every three years or sooner , if needed , by a licensed suLtic tank: LmLer . What you -put into the system can affect the function of thu svhLic tank as a treat- ment stage In the waste disposal system. St . Croix . Cuunty residents nLy be eligible Lu receive a grant fur a maximum of ''60% of the cost of replacement of a . failing system, , which was in operation prior. to Jul 1 , - 1978 . St . ,Croix Count accepted this °prugram in August Of 1980 .wiLh the rcqulrument that owners of all new systems agree to keep their systems properly maintainud , The property owner agrees to submit to St . Croix County Zoning a^ certification form, signed by the owner and by a master ` jrlumher , journeyman plumber , restricted dumber or a licensed pumper veri fying that (i) the on-site wastewater disposal sysLelnjs' 1n 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 I/WE , the undersigned , have read the above requirements and agree ,cLn to maintain the private sewage disposal system in accordance with x the- standards set forth , herein , as set by the Wisconsin Depart- 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 . SICNEll & CL, Ljj h, DATE �9'/Sf 87 St . Croix C.aunty Zoning Office P . O . f-ox 98 Hammond , WI 54015 715-7S6-2239 or 715-425-8363 Sign ,' date and return to above address . MENT,OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INbUSt INDUSTRY, DIVISION P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS _ (1-163.090)&Chapter 145.045) LOCA,TION:. + SECTION: TOWNSHIP/�: OT NO.:BLK.NO.: S BDI VISION NAME: S 1/se 1/ 3� /T 3oN/R/quo Sb. ToSe � AGkfS. COUNTY: OW_NER'S BUYER'S NAM / M L D Ud 5 vZ Cro;� err( i 1 Sow • ��. �o ��Y �f` R4' s 3/a/& USE DATES OBSERVATIONS MADE NO.BEDRMS,: COMM R A S RIPTIO S: A T STS: tAesidence .ni INNew ❑Replace V'7 P 'v RATING:S-Site suitable for systern U-Site unsuitable for system ��T❑�.I.. �,a� IN �� �� S��-IN-FILLHO�LDING®V :RECOMMENDED SYSTEM:(optional)RU If Percolation Tests are NOT required DESIGN RATE: /0 If any portion of the tested area is in the cate: lFloodplain, A l under s.H63.09(5)(b),indi indicate Floodplain elevation: /V PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH Yd, ELEVATION OBSERVED H TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) x,,25► ,`/� " p x, 25" , sft15;/ .os v , V3'8,n 6:5 40 B- r '-7 ?7,B- > � 7 . 1177615; ,/ yz r s; yl S yrj.o� q , Bncs�yr .s 8„s 17J3. G S 6r, , r3'B,,s 3 L 3,01- Q,- r disi/,-. ff 9"3: ,/.Q 15, S;O'QhS��r B- 3 � O' 91,/7 'o B- q 7/7' 97 Sx' > 7, /7' +s'ats;l, 2,98»s•, y o B s% , 2.a>i dg+- B- 7�1 9g,� 7- S W A 4 y + FFF rW L / 3,so' 8A Set.).- w ofof B- 170 ' �2i 7p' 2.f3 a , FFI� PERCOLATION TESTS TEST DEPTH ATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER LW.H% AFTERSkVELLING INTERVAL-MIN. PERI EERIQD 2 PEF3100 3 PER INCH P. I 33" PJ/); 3 yY Z Zy 3.7 . P. 2 S./7' 0 2 N Zr P_ /7' u 3�' 0 P-. i P- i 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 92T7 __ _ i 1 L >^c f f - n to g 50 -- --- 1 _ ._�._L -- 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 ERE OMPLETED ON: �C-1q (.fie r 7 ADDRESS: CE IFIC TION NUMBER: PHONE NUMBER(optional): c f'� �f G GJ) o/L 0035/5/7 3 e 66-3/ 12 CST Sl T R / DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR•SBD-6395 (R.02/82) —OVER— �', L 7 P L OT t I 0 S S S E C: T- I ICI_ _ - PRO `JEC; T -- f LUM � � I_ I Q E N S E - 1 ATE PLU -- - 3 tv' P� xp� BED X 41 ay' Aga 8� lo' ©V P. 30 1 301 ' I I�ER Nf 1.�• a FASr 1 es pay 01 w = t3 iN�Rd 3 Bugoorn NE. to"T feNCt V0ST wt+k 1�1 A Top 601=z�ev. IOU.O •-PAONe RD IN 5W. CORNER lo- °` o �Ojgf ol� Sides 314 r Rekolf. S��ES cve,�r a x � e l l i s mo��-Ehpr� NOtF. . ThE W 5a -. f Rorn DRra►A4i lA 5f-ptic v phoNe W FRESH AI1'. IN J,"J'S AND OBSERVIITIOU PIPE CP,nSS STCTION Approved Vent Cap _ 76. (D 7 Minimum 12" Above < Final Gra...Q,__._.-._.. -- - • I 4" CasL Iron Above Pipe Vent Pipe To Final Grade,,- -- Marsh Hay Or Synthetic Covering Min. 2" Agg reg'.l 1 ,, Over Pipe Distribu.tio ��' - �— — Tee Pipe I P Aggregate _. Perforated Pipe Below C� , n Beneath Pipe �,- Couh7.ing Terminating At ao�a� ���---- �/ Bottom of System