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HomeMy WebLinkAbout032-1028-50-200 2 + 7 § � § 0 _ w 0 \ � m � \ � $ \ 0 § 2 � $ § } 7 ƒ § 3 \ \ � < _ � � � « { M _ § a m / § \ z « 7 \ k k ® z ƒ E { 2 . n � \ / (D � E } ) k j $ � t � { � ƒ CL M % c = C 8 \ o 0 2 ] 0 2 8 8 Z n } G ■ ) ƒ ) \ § \ 0 0 0 k \ •� : 7 a a a \ g B U) -1 Q \ CO CO z « > = a 2 / \ WAWA \ § k 2 r (L ' § ; 2 3 � 2 J � m CD 16 04 U) § _ § E N LO co% §) #cl k §S ) § \ § CO a \ � / I ) @ £ k ® / % a 4 § _ \ z z f \ ® � - § \ \ § o } $ k / 2 \ I E I IL � E$ 'E k a § & v 0 a 2 2 . > � 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: Trench: Width: J Zi Length: 5- Number of Lines:_ Area Built: 03a X Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, (�rJ Rear,O Ft Number of feet from well: 7 Number of feet from building: (Include distances on plot plan). SEEPAGE PIT �l 1 Size: r" A 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 �' /A Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: / Number of feet from building: a Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated:�f Z Plumber on job: I- mLt (_, License Number: mac? 3/84:mj Form — S T C — 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP �� �' - SEC. to T�N-R / W ADDRESS ST. CROIX COUNTY, WISCONSIN LXJ 1 5%14C)-7 S7 SUBDIVISION rte- LOT LOT SIZE k PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I C 31 1� z INDICATE NORTH ARROW i BENCHMARK: Describe the vertical reference point used Nun�i� `,avT Elevation of vertical reference point: 12)6,() Proposed slope at site: ._ SEPTIC TANK: Manufacturer: quid Capacity: Number of rings used: _ Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front Side 0 Rear, O / feet 11 r From nearest property line Front,0 Side,0 Rear,O ? feet r Number of feet from: well J Z.5 , building: 9� nclude this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE i D€PARTMI�NT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR St HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISbN,WI 5,3707 NW',,, SW1,4,S10,T31N—R19W (CONVENTIONAL ❑ALTERNATIVE State Plan ID "umber: nedi Town of Somerset ❑Holding Tank ❑In-Ground Pressure ❑Mound Lot 3 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DA C- 'Z-7 t�L Cam) Dennis Benson Route 1, Box 95A, Somerse t, WI 54025 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: John P. Sykora III 3212 St. Croix 92518 SEPTIC TANK/HOLD TANK: MANUFA R LIQUID CAPACIT V: TANK INLET ELEV. TANK OUTLET ELEV.: IWARNING LABEL LOCKING COV PROVIED: PROVIDED. f��IIJ�M•`J//' OYES ❑NO DYES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM FEET FROM LINE: AIR INLET DYES ❑NO ❑YES ONO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO OYES ONO I OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROP ERTV WELL BUILDING- AIR NLOT RESH (DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) OYES ❑NO 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 INO.OF DISTR.PI E SPACING. COVER INSIUE DIA. #PITS LIQUID BED/TRENCH ^ �( TRENCHES / M ERIAL: PIT DEPTH DIMENSIONS 2 GRAVEL DEPTH FILL DEPTH UISTR.PIPF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: V NT TO FRESH BELOW PIPES. f/ ABOVE COVER. ELEV.INLET.ELEV.END. PIPES: FEET FROM LINE �/ NEAREST--► / y 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. ❑YES NO OIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES: OYES 0 N DYES ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF. 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 HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION a PLANS ❑YES El NO iJ ❑YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE. ❑YES 0 N ❑YES NO NEAREST 0' 2 Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. Zoning Administrator DILHR SBD 6710(R.01/82) -qqq 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 ype 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'/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ----------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground after— included the creation of surcharges (fees) for a number of regulated practices which Wisco intS can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasu. is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. a The monies collected through these surcharges are credited to the groun wwater fund adminis- tered by the Department of Natural Resource.. These funds are used for rnon'*,oring ground- t water, g oundwater contamination ink estigations and establishment of standards. Grour•dwater, � is wort! protecting. 3D-6398 03'36) SANITARY PERMIT APPLICATION COUNTY R In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT## a sib -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� 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES VxJ NO PROPERTY OWNER PROPERTY LOCATION �y N W% %, S 10 T31, N, R `� �'O W PFJQPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAML% 3 CITY,STATE ZIP CODE PHONE NUMBER Q CITY If- EAREST ROAD AK OR LANDMARK 'S ,� VILLAGE:s�,,aerSC r` .�f at e 14 II. TYPE OF BUILDING OR USE SERVED: J�� /eazt, /W . = 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. FX 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. XConventional 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): L/ 3 G/115- 6Z� !C}A`'41 Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed Septic Tank or Holding Tank 111MA ? Q ❑11 11 ❑ ❑ Lift Pump Tank/Siphon Chamber VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): PI mber's Si�nature,.:(No m ps) M l P SW Business Phone Number: �r-12- 7/5 6 1`Yfg b is Ad ress( et,City,State,Zip Code Name of Designer: rf S VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST## 23Z� C 's ADDRESS(StreeLpity,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate d Issuing Agent Signature(No Stamps) IN Approved ❑ Owner Given Initial `Ubf{//�11 Surcharrgge�Flee` 6 Adverse Determination fCl�`) X. COMM NTS/REASONS FOR DISAPPROVAL: �.2 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 ,_.s &u. st�2 h Location of Property , Section N-R 19 W Township k,, a& �- Mailing Address Address of Site Cc rh P Subdivision Name . Lot Number Previous Owner of Property Total Size of Parcel /_6 6 , 0 4 ,'„ rL��,' ,�c�= rL—T y Date Parcel was Created Are all corners and lot lines identifiable? y Yes No Is this property being developed for resale (spec house) ? Yes 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 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 1 (we) centi.6y that att b.tatemenfi6 on fih,ivs 60nm me tAue to the best 06 my (OUR) hnowtedge; that I (we) am (cue) .the owner(.$) o6 the pnopeActy dez ch i.bed in .thiA in6oAunat.ion 6onm, by viAtue 06 a waAAa.nty deed neconded in the 066ice o6 the County Reg.i s ten o6 Veedz ass Document No. ,X5__W ; and that I (We) p4mentPy own the pnopoded bite bon the sewage di�spob ayes em (on I (we) have obtained an easement, to stun with the above described pnopeAty, bon the constAuc.ti.on o6 said zystem, and the dame ha.s been duty teemded in the O66.ice o6 the County Reg.ia.ten o6 Veede, ae Poeument No. ) , SIGNATURE 01► OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 00 DATE DATE SIGNED DATE SIGNED State Of Wisconsin,. CotRity of S}. Croix 1 hereby certify that this intriMmIt it a full We and correct copy of the dololm t an NO and of record in niy ci fidt and her bon compared by me. fittest: April 7 . 19 87 James O'Connell lames O' Connell Register of Desib - Deputy l >ry•� A. Tium JI "W iilA 3 foot'. i .W 4, ftpia t of 200.?! o ig ! #ng 14.iat acres, aura" x r i` �s�ptative Is y ,this Deed s ' til .#Mel 'ints4*st in.'the Property .;&ic& a xY prior to"Do Godent•r 4"th, and f all oaf .. ° tioti�d�thia 10th da3► Ot` llay,� �3. C a � � �* 'L Personal re atj�" �AtQl Aobert > dern s i t icatad �this 10th day of Th" I it lik w. r a g FI( a 4 �. � ° s 40te of Wisconsin County of St. Croix I hereby certify that this instrument is a fulL true and corred copy of tM docu>wnt an fiie and of record in my office and has been compared by me. Attest April 7 19 87 James O'Connell 1 )Ames Connell Rester of D*O* �+■ D a . _ L 419917 � Kt /----z�/� , e t DEC G A� D a AUM O O O N O O w a ( -1 0 !- n W N r om h+ 7 Z 14 `wk M ao m• M Wpm+ i t o m o rr o m 7 z -T1 ID 0 CD w .W-. t0 Z -1..1 ;'. n = w 7mO -n p d N r N rn- :1--- 4 rn a _ m •-•' --I 0 0 o m y m N Its :- m T C + + ' + APPROVED 4 cn w rr = a� m rn CD / n o -< W O F N D ° 'n Z NOV 2 F 1986 -ate° rn rn � � -n o / Z � = ST. C:(OIX COUNTY'-. -1 m CD n> N m COMPREHENSIVE PARKS PUQ NI aD ° U w � AND ZONING CON,HfuTEE/ ,>,Y�=�� !u M a M c , O na C6 .r o N r- o °o+ °o+ °o+ m o �yQ bCO a�/o icp� w N o.r -n -n z yiy N Z H N m O o Y y�r0 p ti z m O � CD+ 1 + 1 + p ' Q a0 jp� 2/ z z 3 z i v / CID CD 0 /O'1+ o a z i O -41 /Oo' \f'' ,p iv / -0 m C7 N r/A / Z o 1 oL PF J rn 9 o-11, w x O � 1441.83' _� _ ~' ,r\ east line of section 9 N00 024'00"E v,?� C west line of section 10 m to�° A z z c zc m a �' ❑� ��a 9s�`� \ CD z m z C7 C> \00\X.. O- 6) \ 0 0 z °� �G om ate, o �`. N070 �\ w z z a z 7 � c rn 04 3B„E m C) `� V-1 'm��,^ m/S 3 2 0 6 1' S \ o r o � � C Cn Cn to \ 8.9 N_ g /6.\ / C°N D C O O 3 m m d� �° \s .�°3 \rl. \ tCl- 3 T T C-) o n� N�9O 19, 8` �' °9?, 3fi`, of rn -' C c Cn ys„ I ° o to ``` °2 I ` ° cz a° o' o w .. o IV ` 3 ��' c o w w°D m o0 I b 90°�ZN ?q? S' m �^rn Zo O • ~I w \O Lgb wp --- LLS3 rO 0 z 40 \ cr ` G CA ` N to � I � - to � r rn -m TEMPORARY CUL-DE-SAC a,� ,may X ►� = O �' I v p row Rc80' C''�”' o \\ rn t, ti S73 36'16' W w r z z o Z �'� v_ 489.57' o m 96,02' \, N .. o ��" z O 779.88' w 120.12' ` w i m m v N00°12'24"W_ w 900.00' 25'± *+ -n m bb —516—.88' ,r -o m o ° O C -n Al 0 o c z o of o ° o ew, u n p I a t t e d lands owned by others o m "'� iTl O -------------------------------- .. °c = w0 I- D CF) o C/) �o of (D r, U) ° n w czi w iO �3 (TI < -n Z y (D U) (D D O r ^' w ft –� O o rn w rn N• v rn ° m u, M - i ° Bearings are referenced to the east line Nn :'' —� z of Section 9 assumed to bear N0002410011E. rc O. TI Cr z O x W n D v fr► 0o n (D n "' -n 00 O I ° o n 5:, [V h -� (D :� CO S1 0, (D y U) a rn v O N 1 0 ' rh N• o Volu(ne G Pae 1751 I'� SURVEYOR' S CERTIFICATE I, Allen C. Nyhagen, registered Wisconsin-Land Surveyor, hereby certify that by the direction of Dennis Benson, I have surveyed described and mapped the land parcel represented by this Certified Survey Map ; that the exterior boundary of the land parcel surveyed* and mapped is described as follows : A parcel of land located in part of the NE4 of the SE4 of Section 9 and part of the NW4 of the SA ,of Section 10, all in T31N, R19W, Town of Somerset, St. Croix County, Wisconsin; further described as follows : Commencing at the SE corner of said Section 9 ; thence N00024 ' 00"E along the east line of said Section 9 , 1441. 83 feet; thence N14017 ' 40"W along the centerline of the Town Road, 75. 00 feet to the point of beginning of this description; thence N64044143"E, 200 . 81 feet; thence N19008' 45"E, 167 . 91 feet; thence N89 025 ' 36"E, 502 . 47 feet; thence N00012124"W, 900 . 00 feet to a point 25 feet more or less from the water' s edge of Pine Lake, said point being the beginning of the meander line along said Pine Lake; thence S73036 ' 16"W, 96 .02 feet; thence S34001' 46"W, 163 . 45 feet; thence S54037146"W, 49 . 59 feet; thence S04015 ' 18"E, 59 . 13 feet; thence S33042124"W, 304 . 66 feet; thence S68012117"W, 89 . 50 feet; thence S47 009 ' 07"W, 163. 54 feet; thence S61005 ' 13"W, 224 . 38 feet; thence. N67027 ' 04"W, 284 . 17 feet; thence N63025' 59"W, 188. 54 feet to the northeasterly right-of-way of said Town Road; thence N55012 ' 20"W, 162 . 73 feet to 'the centerline of said Town Road and the end of the meander line along said lake; thence S43030 ' 20"E, along said center- line, 860. 50 feet; thence S24010133"E, along said centerline, 60. 00 feet to the point of beginning. Including all lands lying between the meander line described above and the water ' s edge of said Pine Lake lying between true extensions of the east line (described as N00012 ' 24"W) and the northwesterly line (described as S49053 ' 40"W) . Together with and subject to a 66 foot wide Private Road Easement as shown on this map, also subject to right-of-way for the Town Road as shown on this map and subject to all other easements of record. That this Certified Survey Map is a correct representation of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236 . 34 Wisconsin Revised Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. C>'�J'� .ry ALLU C. R� NYHAGEN rj S-1407 l H Ku UDSON, l • r V Allen C. Nyha�en date X. I vQ S U RJ b•; The Eroadway��showth� lon this map is a Private Roadway. Any maintenance costs of the Private Roadway after its approval by the Zoning Administrator as a standard road, shall be shared pro-rata by the adjoining property owners. should the private roadway be taken over by a municipality as a public road, maintenance costs thereafter would be a public expense. Volume 6 Page 1751 W X ve W G J z H a STC - 105 r ' a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d a n H OWNER/BUYER ROUTE/BOX NUMBER -7t A- Fire Number CITY/STATE,50,,, .,l• s�'y� , L.l�i ZIP PROPERTY LOCATION : Nid' �4, -SLk) _�4, Section , T N , R W, Town of <<jpE�- �— St . Croix County , Subdivision Fire X4,1<e 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 I) 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. Ho E I/WE , the undersigned , have read the abpve requirements and agree to maintain the private sewage disposal system in accordance with x 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 . SIGNED _ � p�ggi►,___�l DATE X4 -- -� 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 . ofts NOW.— 0 tn2; " .. C. , o point: E E at _ .? ,. ,.,, 'icy f._., ,-'i:<. _ `.7 _ J ? 1. 'a.,.,1 t`_ .,�>. ,, l `•,_ ,.-'d�._ S -� £,. E -„} H A P_..,- 3 ..c. s to .e: Cal in n c0,0 `Eg wo c. ic_, , sv- .. _'t=' :,v' t OnAm 410,01 00 Yn a `.e: s ,:i.4 € Z�P'Wq Sol Sopm ms and Tcxnm'f% OHM; svmbQ' -- .. ais r? Wman- LONG `a s< LS on, r .._. . .:`•j E f q 4, qv if M 4 E Pie Mqmnwrl ma v i equps lr.,iUMbn of thn N A €r the 1,6d `.' loo n,r .,5)�.k, .�'. ,', lap.A , 91 01 Wans or j_W #3i'1m?, 4 Er , < .,_ ,. �� ,. EE,_ '3 r, ,.r.. ,T1, t +a .z T3.,I�C�� iF 3YiC_: �;�.(t F£:' �£,7i.t1 ,�ix EGt y i� U.S�`; ..£, .fit. 'a_ a ramaht. 1hpS.n,.."o; Perna 11mm ho£1?E_uiW Ind I ,md rail " S ” . .. _no apy c i ElC(an, DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, _ _ _— _ DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON,WI 53707 _ (ILHR 83.09(1) & Chapter 145) L9CATION: SECTION: OWNSHIP MUNICIPALITY LOT NO.:BLK.NO.: SUBDIVISION A NtJ'/ '/ I /T 31N/R1?E ( )W S , 3 -- Poe COUNTY: NER' YER'S NAME: MAILING ADDRESS: d y, QS A Sa--4er�sd- 0 lbj(�6 2u US-E DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: R OLATION TESTS: Residence 1 -3 AMA New ❑Replace I-PR-5-Fl-L-E-DESCRIPTIONS: q`Z/ 8', MIA RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MO❑UND.NU ING�� POURE: SYS❑TEM-IN-FILLHOSG�U • CONI✓ewl-iot�(M:(optional) (/Z�� , If P��erJJcolation Tests are NOT required DESIGN RATE: //�,���((�A q If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: A//,4 Floodplain,indicate Floodplain elevation: O Ovu Coo' �ROFILE DESCRIPTIONS A14 Z P e BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, LOR, TEXTURE, AND DEPTH NUMBER DEPTHH IN. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE / IIAB,BRV.ON BACK.) O-�S~�1 � 119% SC � ! L p� Q Y B' 7g I/ �D � ���� 42 3 " g h _ �' '' � /a=Z B- 8 97''y" "DKe_ > 406 0 .oTS/ 2 G., 8. s/�2z"-36''86? 3(""- " je., r �i �. `�61 air, S I -rs. yes zZu�y h s /ZZ"-�Fa '�1�H B- 3 /DZ 98`7 h�Ke - /b2 N-I H �qe • Y B- LA<t F S B- 1114 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DF30P I V WATER L E L-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD P PER INCH P- P- At V"G 0 1 a l a Ck ft 4r8 vN i e P- t 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 931'B'/ o f' bAf �Z tA E Colt rz3 E .�8 oaf r� s l( D' � ._ �. _ u gas IN 77 30 0 fl�QCec�4t<.A -_,�-z: -, , , _ _�Sc�___ �? S; ._r a�e. e. �-o ago cr'_ fie _rv � _ `.,'� wesr i 144e, P 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: AD DRE S CERTIFICATION NUMBER: PHONE NUMBER(optional 2 go K -75' loo Z 2 7 71S S(a$- Y-446 CS SIGNATU DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R. 10/83) —OVER — DEFARiMEW OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LAROR AND' PERCOLATION TESTS (115) MADISON HW,�N RELATI-i*S (ILHR 83.09(1) & Chapter 145) WI 53707 I.00A110N `iECTIOW IOVVNSHIP MUNICIPALITY: LOT NO.:9LK.NO.: SUBDIVISION NAME:AIA Nw'/4 SW lo /M N/11/9, AIL A NA A!A C0L,NTY: OWNER'S/BUYER'S NAME: MING DD ESS St• G�ol _ E1V1V_1S— -S0 /. O WS rVQ USE DATES OBSERVATIONS MADE NO.�BEDRMS.: COMMERCALDESCRIPTION: P OF S 0NS: A O ESTS: esidence /A New ❑Replace I �r A�/Ot� /�. 8S RATING:S-Site suitable for system U=Site unsuitable for system •[ 7 ;ONVENTIONT-L MOUND: IN-GROUNQ RESSURE: SYSTEM-IN-FILL ros OLDING TANK: RECOMMENDED SYSTEM:(optional) �8 x (, S D U D S WU jS S ❑U 0S xU ®.0 A 17*1O,4,AIQ EP� DESIGN If Percolation Tests are NOT required RATE: I If any portion of the tested area is in the undor s. ILHR 83.09(5)1b),indicate: NA Il Floodplain,indicate Floodplain elevation: A)Q A)"s PROFILE DESCRIPTIONS B0R111G TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER OEPTN IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVE (SEE ABBRV.ON BACK.) B- 1 7.0 98.9 A/OAJF >0 7 1.7' 70' Pale Bh sy'ra l' ilea( art - C 5 i- • , D- o. 3 i✓. ��py!3n S 0.3 - 0.8 1DK QJy So 0.8- /•3 B-,? 7.D 9?- 3' A/O QUA_QUA_ '7 � Dk YOn dit-T $ 0.8- 7.0W4 n„<C S w sO.s►Q r B3 75� �77 ' IVO�� 77s' 0-0.3�KDK�yl3n �s�0.3 - .O AKa."Is� .O •%7' A r �; /7'y$DkY 5*samf r N.g= 7 S"rad RM S Q- O.a Cil l O.Z' O. 'Qti s, �•p -/.S Lt By it B- (,D 9S..Z Am A)a 7 6.0 B ' d wE } 6.3 vAK�y t.► �S,o.a ,0.8 4,14 < 6.3 9S( Al - a 5 � - a B ILB- / Top c� Co✓ex PERCOLATION TESTS rb �eS are en.t.h c3. 1I s Sei Sur✓e S .f4o ` �+fe E - Er,+wt ES,l DEPTH W ER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES IER INCHES AFTERSWELLING INTERVAL-MIN. PE IOD 1 P RIOD P PER INCH l L5_ oNE — 3 1 P. G P- P' n ,/ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil area 'Inpicate jA o/. t dis,<af s. ribe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surfs eaevatio� t 56r b;4;1 gs an'' direction and percent of land slope. (��• /'.� SYSTEM ELEVATION 9y. y j rL-i -r /vcaTien o (�l.e.y, ¢ were Y�mv Carer v�e�-f'L. o-r • T j CT SAee S 0/095 �,-e e G edroori eou l� be o el r 1-n�t:1' • � A/zst rt caul- base m� alesf" s�r�e a f /�f�e 2ecCO.Vk- 3S �w, -0 e� e o� N - S �v//�e. .25 �a oT hoi-14 ebe W,,,galle, , - /GO N of 4)r 1 vewd c• /o C z�/h . (A/ c,L7 S b o w fi i/o,r /ih e ef/o ra/0 ee" � H �e�e e klo0jed' 4Ar94)6A1 �YI ar wi j 4 reWJ17feo' ' p�oAW4- /A�roun�� �Q.t a."d Is- e. rrAo-r el_ GecC a.a't±d, Is � w cw,ct� l S a� 6M.C�RPTT�'ASso�r����tv�iarT/e4o� � 4,,��7; 17 - So �or H�s - Aue lie t aoOrr er �" / (� rCo lcZt/o►'1 1 e St.� `�1� `aln� � � �_ Sv�{a.� 1P S o f l 8►'PZ3 -�o r Q.g " < 4- - L&4 Sfa,�es . JJ Zss� qv fo h 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, 'VAME(print): TESTS WERE COMPLETED ON: IAUI)11 S: / CERTIFICA ION N BER: PHONE NUMBER(optional): P., 9 S-3 CST SI URE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. HR-SBD.B395(R. 10/83) OVER J _P DT PLAN for DEF4"IS BE/VSOtJ i-I )3ox9.sA $'oMsRsffr wr T--?l Al, IV 00 0 �-► J D CP�ro) �s to %7,5 ♦ Poro>'t�o n {�. �..� /IQs ♦ 4f, 40'`K�rS V 12P-3 2a 3-3;ol a e ° K 1� w sz Not �C) SG e, 40 �� vlley ct ° I r 1 Vtw -P MFRS JAI -sot'"2v�S slope., cRoss sic?!ed � 20' 1a o �,Z Q _ LI t!A` C16Ile. crilq� spa � N D �c ce O fig. Pa &k w. o� N-s Gku� , � z5# pR Al. o ,i!:-w C--NMoP(j14 rho ' t,wwVe Aare -1 ice.© PW .8/�'� Z 39' b = 4- bu4-el- -Acte .) -to LO I � Z pe-Cc � = s�•►,�ab�e tea, � a s L o+ c o",-4 ems,^ 1 � .P E C S• {� 0 ga(< sz LZ o' ►�r- ol:s-f cis `{� ctt�� C,bjp- rg eves ° �NI 4�2 ;s �e ��� S-ar crep(aceuce tt, s.� Cl C) ,A N / , W H .+ O � O 1 W N Go LAJ LLJ 6 W o O J ' z L �#m�,, 300hZo00N jeaq o3 pownssv 6 U0t 00S 3 0 autl 3sea 0y3 0; pa0uaiapi aye s6utieag ,_., °o W W o • J O Q g N N� nr 7 N Q (D Q. W spay; o � q pauno_spuej_pe;;ejdun �� Z o 3c O 2 W �6 W O O ►+ O N a o ,. 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