Loading...
HomeMy WebLinkAbout032-2022-80-200 (2) F d ,d W ° 0CA 0 ', 3 -0 n ri ri N d � � ID n � 9 � • r. fD U1 ak .Ci r cn V N Vr eo d �A7 N H co g -1 -1 Z G ccoo a ! o 0 w °C 0• 0 o A y CL ra z z (A a m ° o CCAy P A D y a—i a—i a r ca n O O c O 7 7 (D O '� N O O co N C w 0 N p) D a ao QO co W a m co y W a U So W m _ a 00-be rt O N O \ 00 P� i m n r N r~rt (D .. v r 3 Q !r rt o Z Oro ° ` ° =r Q v v D rn � o O `CD A t� N 4 z CL ` (p Z rt E D c0°o 0 0 O a m � �• CA C CD m (yam c m m Z CD (6 -� N I o o A Z n �i a Az0 I 3 I z w rn ao �CD mo CD z p r: fn M to z CD W ? I N a C 3 v c O O C N fD I a I o I � I � a. I I I �o I N °o I a A o 00 CD d0 00 CA O G {� �a y Parcel #: 032-2023-30-120 07/03/2006 08:38 AM PAGE 1 OF 1 Alt. Parcel M 06.30.19.562A-20 032-TOWN OF SOMERSET 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 LEO MARK DURAND O-DURAND, LEO MARK 1721 38TH ST SOMERSET WI 54025 Districts: SC=School SP=Special Property Address(es): "=Primary Type Dist# Description " 1721 38TH ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 12.750 Plat: N/A-NOT AVAILABLE SEC 6 T30N R19W PT NE SE COM E1/4 COR Block/Condo Bldg: SEC 6,TH S 0 DEG E ALG E LN 65070 POB;TH CONT S 0 DEG E 670'TO S LN NE Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) SE, TH W TO W LN NE SE,TH N 0 DEG TO S 06-30N-19W SE LN CSM 5/1003 E 450', N 0 DEG W 242', N 89 DEG E 140.53',TH N 57 DEG E 366.45', more... Notes: Parcel History: Date Doc# Vol/Page Type 04/11/2000 621012 1501/521 MIS 07/23/1997 783/245 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 48,000 165,300 213,300 NO UNDEVELOPED G5 9.750 19,500 0 19,500 NO I, Totals for 2006: General Property 12.750 67,500 165,300 232,800 Woodland 0.000 0 0 Totals for 2005: General Property 12.750 67,500 165,300 232,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 09/14/2005 Batch#: 05-12 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 - r PUMP CHAMBER �.. Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet-*'--, Bottom of tank elevation: Pump off switch elevation: Ga s per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nest property line: _Fret, O Side, O Rear Ft. ' Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number of Lines:- L/ Area Built:_�� Fill depth to top of pipe: T� Number of feet from nearest property line: Front, ®Side, O Rear,O Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid dept Bottom of seepage pit elevation: Area Built: Has either a drop box O distribution box O been used orr`any of the above soil absorbtion sytems? (Check one HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevati of bottom of tank: Elevation of inlet: Number of feet from nearest property line: ont, O Side, O Rear, OFt. 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 TOWNSHIP _�. S �1�1cj'�':' ;f" SEC. f? T N-R Z4W p. ADDRESS _-� `" `.' ST. CROIX COUNTY, WISCONSIN 1 SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM s hD 1 ' i INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation:'; `T Tank Outlet Elevation: Number of feet from nearest Road: Front,Q Side 0 Rear, O feet From nearest property. line Front, `e: Side 10 Rear,0 feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic an SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS P.O.BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING rMADr�S�IV WI 53707 NE14, SIN,- S6,T30N—R19W ]CONVENTIONAL El ALTERNATIVE State Plan I.D.Number: Town of S. Somerset (lf au fined) ❑Holding Tank ❑ In-Ground Pressure El Mound \ 38th Street NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION 01 W- 0a2:7 Leo Durand Route 2, Somerset, WI 54025 BENGH MARK(Permanent reference point)DE CRJBE IF DIFFERENT FROM PLAN REF.PT.ELE .. CST REF.PT.ELEV.: � If _ Na Plumber: MP/MPRSW No County Sanitary Permit Number: Gale W. 'Smith 5690 St. Croix 99074 SEPTIC TANK/HOLDING TANK: MANUFA TURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: WAR NG LABEL LOCKING COVER 1 P DED: PROVIDED: ��� �;: C� J YES ONO EYES ❑NO BEDDI G: ' VEN lDIA.� VENT MATL:_ gLAR MATER NUMBER ROAD: N rPq OPERTV ELL: BUILDING: VENT TO FRESH N0 �� % Fi:•.ET FROM! ( LINE IAIR INLE YES ❑NO 1 ❑YES ❑NO NEAREST' DVSN G CHAMBER: ANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OYES ONO ❑YES FIND ❑YES ONO GALLONS PER CYCLE: j �JP MP A D C NTROLS OPERATIONAL NUMBER'OF PROPERTY WELL BUILDING JVENTTOFRESH (DIFFERENCE BETWEEN t FEET FRONT LINE AIR INLET: PUMP ON AND OFF) ❑YES ONO NEAREST 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: LENGT N OF DISTR.PIPE SPACING. COVER INSIDE CIA.. #PITS. LIQUID BEGITRENCFI / ( TH NCHES MATERIAL'S /� PIT DEPTH: pIMENSION3 xU (NV GRAVEL DEPTH FILL DEPTH DISTR.PIP DISTR.PIPE DISTR.PI E MATERIAL: NO. R NUMBE R',dF ':.PROPERTY WELL: BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER. ELE�.INLET.ELE V.END: PIPE LINE: O �^ AIR INLET FEET FROM /`V1 'X1 NEAREST---- + 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 0 N meets the criteria for medium sand. TIONS MEASURED. SOIL CO_ ER ITEXTURE PERMANENT MARKERS JOBSERVATION WELLS 1:1 YES 0 N ❑YES 1:1 NO DEPTH OVER TRENCH/BED FIG-TES VER TRENCH/BED rff"F TOPSOIL. SODDED. SEEDED: MULCHED: CENTER: El YES ONO ❑YES 1:1 NO 1-1 YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH: NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER 13901TR NOH ! TRENCHES: D11l�tEN;;lt3N ','.. f MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. JDISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. '.. ELIw\tAT10N AN ELEV.: ELEV.: CIA.. ELEV.. PIPES. DIA.: 019TRIOUTION 1N1F60MATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. ❑YES ONO 1 ❑YES El NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: / ❑YES 1:1 NO ❑' Eh El NO 1N15AJkF_ST­-----v I ; ,^ ► I t / n J ' I Sketch System on Retain in county file for audit. Reverse Side. -7 I SIGNATURE: TITLE: DILHR SBD 6710(R.01/82) Zoning Administrator 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: 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% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground :f -- included the creation of surcharges (fees) for a number of regulated practices which Wisco iCl'5 can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried TBatSmB is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. !.. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) SANITARY PERMIT APPLICATION COU TY � DILHR In accord with ILHR 83.05,Wis.Adm. Code 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 1. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES KI NO PROPERTY OWNER PROPERTY LOCATION p 4J Ajd '/aSZ- %, S / T p, N, R / loor)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,STATE ,[ ZIP CODE PHONE NUMBER CITY :S� NEAREST ROAD,LAKE OR LANDMARK So ly Se/— / e2 �- ❑ VILLAGE:SO E II. TYPE OF BUILDING OR USE SERVED: - Q —o� C�-d�O�` Number of Bedrooms if 7 or 2 Family OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in P. Check##2,3 or 4,if applicable) 1. a. � 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 nnO F SYSTEM: (Check only one in##1 and only one in##2) 1. a. CO 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. 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): �/ .2 0( `7.,0 Feet Z Private ❑Joint ❑ Public VI. TANK CAPACITY ##of Prefab. Site Fiber- in allons Total Manufacturer's Name Con- Steel Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete structed glass App. Tanks I Tanks Septic Tank or Holding Tank Q El Lift Pump Tank/Siphon Chamber- V1111. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): I Plumber's Signature:(No Stamps) P PRSW No.: Business Phone Number: G �L�� -M �yfo 26s 7,2 9.S Plumber's Address(Street, ity,State,Zip Code): Name of Designer: .2 � te VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST## J CST's DD ESS(Street,City,State,Zip Code) Phone Number: �S' DOl 7/.3' �v/�- 7,11Z IX. COU TY/DEPARTME T USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) S rch�ar�ge Fee Approved ❑ Owner Given Initial Adverse Determination I C,,cd X. C07MENTS/REASONS 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 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 d G1 A/ Location of Property ��4 _;q, Section b , T20 N - R W Township S Sa M e 5-e7 —j Mailing Address 4Q t— ,cram©X .2 - 7 Subdivision Name Lot Number Previous Owner of Property 7,4 Alas Total Size of Parcel Off- 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 3 and Page Number -//--5—as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 9. 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 deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTy OWNER CERTIFICATION 1 (We) celti6y that oXt statements on this 6otcm cute tAue to the best o6 my (ouA) hnow2edge; that I (we) am (aAe) the ownec(s) o6 the pnopenty deGc&i,bed in this .injonmation 6otm, by viv tue o6 a waf.anty deed ntecoAded in the 066.ice o6 the County Re.gizteA o6 Deeds as Document No.fjR-2ge� and that I (we) pnesentty own the pnopobed site bon the ;6o-tem (an I (we) have obtained an easement, to ku.n with the above deQcAibed ptopeAty, bon the conbtAUCtio, . -paid bye , and the same has been duty neconded in the O6j.ice o6 the Ca y R g " Deeds, as Document Na, r SIGNAT E OF OW3ER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED i DOCUMENT No. STAT BAR OF WISCONSIN FORM 3-1982 IRIS SPACE RESERVED FOR RECORDI NG DATA QUIT CLAIM DEED II 447397 _�� �`�• ' $ �A X45__._ REGISTERS OFFICE ST. CROIX CO., WIS. rd E. DuRand a ..AQxQX1y..�L..._AuAexlsl._.......... 25th Rica Redd for Record ihls June A.D. dray* .D. 19 $7 quitclaims to Leo Mark ...................................................... -•-•------------------••---• •-••----•--................... ........................... ...... .... ...............•----.....---..............._.--••--.................. James O'Connell ...............................................­­111_11_1"­11-------- --------------------- OMb ••-•--•-••- ••. --....•...--------•---•--•--....----•--•-•---•--•..............................•-•------ I' the following described real estate in ....S.t...-Croix...................... County, I I State of Wisconsin: RETURN To A parcel of land located in the NE; of the SE; and in the i' I' SE; of SEA of Section ,- , Township 30 North Range -- - 119 West, Town of Somerset, St. Croix County Wisconsin, being furthery. ,�! IIdescribed, as follows : I Tax Parcel No I� Commencing at the Ea- corner of Section 6 , Township 30 North Range 19 West; Thence so039110" East along the East line of the 98 a distance of 650.00 ' to the point of beginning: Thence continuing S0039 '10" East along said line a distance of 957. 70 ' to a point on the northerly line of S.T.H. "35" ; it Thence S54020 '50"W along said right-of-way line a distance of 336. 27 ' ; Thence southwesterly 30. 10 ' along said right-of-way line also being the ' arc of a 2915.00 ' radius curve concave southeasterly whose long chord '; bears S54003 '05"W 30 .101 ; Thence N0039 ' 10"W 342.811 ' ; Thence S88050135"W 1043. 88 ' to a point on the '; West line of the Eh of the SA of said section 6, also being the centerline of 38th street; Thence NOoll '25"W along said line a distance of 390 . 74 ' ; �' Thence N89059114"E along the South line of the Certified Survey Map Irecorded in Volume 4 of Certified Surveys , Page 1003 a distance of 450.40 ' ; 1, Thence N0011125"W along the East line of said Certified Survey a distance kof 242.001 ; Thence N89059114"E 140.531 ; Thence N57056159"E 366. 451 - I!, Thence S0039 '10"E 38. 66 ' ; Thence N89059114"E 435. 00 ' to the point of beginning. Contains 20.47 acres—of land subject to 38th Street right-of-wa_v. over the westerly 33 ' thereof. Also subject to 33 ' wide access easement ; over the northerly portion described as follows : H"A 33 'wide strip of land for ingress and egress purposes located in the NE of the SEA of Section 6 , Township 30 North , Range 19 West, Town of ! Somerset, St. Croix County, Wisconsin, further described as follows : Commencing at the E4 corner of said Section 6; REST OF LEGAL DESCRIPTION ON This ....._' ...not........ homestead property. x }s (is not) REVERSE SIDE 24th i' II Dated this �Urie 19 day of _...........----............................................. 7 rJ �' ..................................................................(SEAL) -0y . t� '?c:`�. , .......(SEAL) .Ri.chax'd..R._..IluRand.. I .................. .........................---------------..........(SEAL) ... .........(SEAL) Dorothy DuRand ................................................................ AUTHENTICATION A.CKNO W LED GMENT Signature(s) ----------------------------•---._........_.....--•--•11.1-• STATE OF WIMNbM , MINNESOTA I . WASHINGTON SS. ......................................County. authenticated this ........day of..........................1 19..._.. Personally came before me this ---24.tl?.._day of Ume....................•-••--...1 19..87-. the above named •--•..................•--•-•--......---•---••----1111--...---1.11--._._......... !; Richard--E...DuRand.-dnd--Dorothy-.__:-.-_- •........................... . . ..---•-• ---• -- ............ - I...DuRand TITLE: MEMBER STATE BAR OF WISCONSIN .......................................................... I, i --•- -•--•-•• --•--•----.......••----•..........................•-......... (If not. ............................ II authorized by § 706.06, Wis. Stats.)' ............. ••--•-..... . .. --••-_.... ..._._.--5••---•-- to me known to be the person ._.......... whq`executed the foregoing instrument acknowledge a same. i THIS INSTRUMENT WAS DRAFTED BY RQlert G. Briggs........................................ ���CCC�j�........... 1835 Northwestern. Ave. . =............................................................/ ... .. .......... St'rYlwateri MN--•--5.50.92............................ Notary Public ....... 8�ty.•wis. (Signatures may be authenticated or acknowledged. Both My Commission i,Kppiration are not necessary.) I date: ................... . �NINGM COU � v,t. ... .) *Names of persons signing to any capacity should be typed or printed below their signatures. KGMillarcomimv 81-ATF. UAR OF WISCONSIN FORM No. J—19U Stock No. 13003 : 4 V,. •783PAGE 246 CONTINUED FROM FRONT Thence S89059 ' 14"W along the East-West Quarter line a distance of 218. 50 ' ; Thence S0039 ' 10"E parallel with the East line of the NE4 of SE4 a distance of 300 . 001 ; Thence S89059114"W 216 . 501 ; Thence S0039 '10"E 311. 34' to the point of beginning: Thence S57056159"W 366.451 ; Thence S89 059114"W 140.63 ' ; Thence S0011125"E 33.001 ; Thence N89059114"E 150 .001 ; Thence N57056 '59"E 355. 791p�, Thence N0039110 11W 38. 66 ' to the point of beginning. ^ :•11JyMyjMA�Wi1AMMM�• :!4!Pn .? TAM Ilk'—.1UflA lrm" "D A)MAtmaw ro•trc3 r�q rli :^fr1•:/YtiMH/Y101/yYypd K H z N H y ST C - 105 r r 9 H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z ty n 9 OWNER/ Zee> '04/a'4/V4� � ROUTE/BAR , Fire Number .CITY/STATE Selw6?R :5:'g.e 7` �� � ZIP 1500 ;2- PROPERTY LOCATION: , �I ' , Section_, T_�N , R W, Town of S,. So Me13 .fe7"- , St . Croix County , Subdivision Lot number I Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- v ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office thi 3 - days of the three year expiration date. SIGNED DATE _ d St . Croix County Zoning Office P.O. Box 98. Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date an-d return to above address . INSTRUCTIONS FOR COMPLETING FORM 115 - SBO - 5395 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; 1 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 €.€serf if desired; B. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate= boxes as to dates, names,addresses,flood plain data,percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain,elevation)does not apply, place N.A.in the app€opriate box; 11, Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10") BR — Bedrock cob Cobble (3- 10") SS --- Sandstone gr — Gravel (under 3") LS — Limestone *s Sand HGW .._. High Groundwater cs — Coarse Sand Perc - Percolation Rate rued s Medium Sand W Well fs — Fine Sand Bldg - Building Is -- Loamy Sand > Greater Than Isl --- Sandy Loam < - Less Than �I — Loam Bn Brown �0 - Milt Loam BI Black si — Silt Gy Gray *cl Clay Loam Y — Yellow scl Sandy Clay Loam R Red sicl - Silty Clay Loarn mot — Mottles sc Sandy Clay w,` with sic — Silty Clay fff — few,fine,faint *c Clay cc — common,coarse pt - Peat mrr --- Many, mediurn in Muck d — distinct p ..... prominent HWL - High water,level, Six general soil texture's surface water for liquid waste disposal BM — Be=nch 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 be submitted to the appropriate local authority in order to obtain a 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, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS ' (ILHR 83.09(1) & Chapter 145) V LOCA,�fy: ,/ SECTIO�T pN/R� (o TOWNSHIP/ ��P`ALITYe LOTNO.:BLK�_NO.: SUBDIVISIONNAME: COUNTY: OWNER'S/BUYER'S N`A�ME: MAIL^NG AdDD�SS: USE C are DATES OBSERVATIONS CMADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: � IPROFILE-DE^C�LIONS: �—L� ON�S�TS: Residence 3 —�., New ❑Replace Il RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND•PRESSURE: SYSTEM-IN-FILLHOLDINGTANK:RECOMMENDED SYSTEM:(optional) ®S ❑U .®S ❑U XS ❑U EIS RU ❑S 1 02 Coy If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: G�G Floodplain,indicate Floodplain elevation: O PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) p B- o n � 7� y`—y� ea:l -5,7,,W- B- 3 /F 7 An c- B- d /olfr ''3•+ �,-�/D ,l�n.Si y���fir 6- j��f PERCOLATION TESTS TEST /DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER WWWR AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI D PERIOD PER INCH P- /G P- 30 P- ,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. SYSTEM ELEVATION c2c2lc7 I r E f i ? OFFI4 I tiff a 5 c *t 7 . '� 0, __,�'... a i✓_.�X. r i _. ...__....�...._ 711._ N / ,fo pop 51 Q m .._ _....__ _.� 70 r/g r 2 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: 1 ADDRESS:: CERTIFICATION NUMBER: PHONE NUMBER(optional): CST SI ATURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHRSBD-6395(R. 10/83) —OVER — Smith Plumbing & Heating PHONE (715) 265-4838 GLENWOOD CITY, WISCONSIN 54013 v Ni R S� .> Gar 6"y_-a 13 Rex p 0� y a ws e 1�.►���. ,}l to R Nh fie, A Re.4 a ACRe e, N -rep s-o/L 17177ZIZZT17T�r�,,.,,t-V!'A� 0 0 © 0 0 0 0 a ,,ie o © 3, pipe p cl X r 1>1 ,v Z u rry r+L Qss i� k r3 �a ��- � � � � � 2 �� -�-- �� � � � � � �� � � ��� ���r � � � L � �� c a� �.