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HomeMy WebLinkAbout036-2004-10-000� \ ° \ Co / ¥ @ 0 \ m � \C § 2/ � \ /§ � 2 %i o � / ac0 ) \ k0) 2 ) 7 § CL R LU B m o � f � • o z IL m R § % \ § I B z ¥ 2 } . « k 7 / & E \ N / } S n - ƒ k 0 0 ) k z" Ott e / k k � C - \ 2 o § ° q � E k k (L cn , 000 z .2 a a n t § ; z 2 j v � $ k 2 ƒ I ' 3 R Do E � R J 2 7 Q. let, / % � $ J ƒ f 2 a ; , a ° E % . 2 2 E E o w § § o \ } 7 0 c a a 8 E / ® � / k k k k \ j \ a . z z a g $ - a q § m a S E E i { - g co (n a o 2 $ / s m ® J ' DI I E73 .2 # E ; a § k v a 2 0 3 U . Parcel #: 036-1081-60-050 07/1112006 02:02 PM PAGE 1 OF 1 Alt.Parcel#: 32.31.17.501A-10 036-TOWN OF STANTON Current X. ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-COOK, GARY L&NANCY JEAN GARY L&NANCY JEAN COOK 1515 HWY 64 NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description " 1515 HWY 64 SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 32 T31 R1 7W PT NW NW EXC CSM Block/Condo Bldg: 11/3020&EXC CSM 12/3418 FKA 036-1081-60(501A&EXC AS IN WD 1675/112 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 32-31N-17W NW NW Notes: Parcel History: Date Doc# Vol/Page Type 07/06/2001 650352 1675/110 WD 07/23/1997 1151/110 EA 07/23/1997 955/36 07/23/1997 934/348 more 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/23/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 27,000 229,600 256,600 NO UNDEVELOPED G5 27.850 28,000 0 28,000 NO Totals for 2006: General Property 32.850 55,000 229,600 284,600 Woodland 0.000 0 0 Totals for 2005: General Property 32.850 55,000 229,600 284,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 10/10/2005 Batch#: 05-30 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 7 PUMP CHAMBER Manufacturer: Liqui apacity: Pump Model: Pump/Siphon nufacturer: 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 arest property line: Front, O Side, O Rear,© Ft. umber of feet from well: Number of feet from building: nclude distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: 2 Width: Len the ..SA Number of Lines: Z Area Built: S-OYa Fill depth to top of pipe: /"ev s_ � � Number of feet from nearest property line: Front, o Side, �Rear,O Pt Number of feet from well: y ` pL Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Numb of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop ox O or distribution box O been used on any of the above soil absorbtion syt s? (Check one). HOLDING K Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet fro nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: umber of feet from building: N ber of feet from nearest road: Alarm Manufacturer: Inspector• Dated: '/�" U Plumber on job: License Number: .5� 3/84:mj [ - - Form S T C 104 04 AS BUILT SANITARY SYSTEM REPORT OWNER l �(r TOWNSHIP � � SEC. T`31 N-R- 7 W ADDRESS -I�C ` ST. CROIX COUNTY, WISCONSIN 4�1 SUBDIVISION lV�-IL �, Q LOT ZC) LOT SIZE 1A�� PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM� i� A o� p $6 I d V� INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used °01 a Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: _ Liquid Capacity: Cqw l Number of rings used: �nJIVIanho24 cover elevation: Tank Inlet Elevatio Tank Outlet Elevation: Number of feet fro a est Road: Front,O Side 0 Rear, O feet From nearest- property line - Front,O Side,@Rear,O � feet Number of feet from: well,!�i� y- , building: eR (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE I ` r DEPARTMEN,T OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS DIVISION LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O.BOX 7969 MADISON,WI 53707 SW4 (If assigned SEk, S31,T31N-R17W DaCONVENTIONAL ❑ALTERNATIVE State gned ID.Number. I Town of Stanton ❑Holding Tank ❑In-Ground Pressure ❑Mound Co. Road K INSPECTION DATE: NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER: p Patrick Cody Route 3 New Richmond WI 54017 7 7L CST REF PT ELEV BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN'. Name of Plumber. MP/MPRSW No.: Coumy: Sanitary Parma Number: Gary L. Steel 102819 St. Croix 102819 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV,. TANK QUTLET ELEV.. WARNING LAB L LOCKING COVER fY//� VJl PROVIDED: PROVIDED' / OYES ❑NO DYES ❑NO PROPERTY WELL. BUILDING. VENT TO FRESH BEDDING: VENT DIA. VENT MATL.. HIGH WATER NUMBER OF ROAD. LINE /O (AIR INLET ALARM FEET FROM DYES ONO ❑YES ❑NO NEAREST ` v DOSING CHAMBER: MANUFACTURER �JNG LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDEDO OYES ON O OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING AIR INLET FRESH (DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENCrH 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 LEN N0 0. F DISTR.PIPE SPACING CO,y�R INSIDE DIA >1PIT5 LIQUID BED/TRENCH TRENCHEES I rj TOR AL' PIT DEPTH DIMENSIONS \/ GRAVEL DEPTH FILL DEPTH UISTH PIP STR.PIPE DISTR.PIPE MATERIAL: NO. R NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BELOW PIPE$ t 1 ABOVE COVE Ey,E;INLEr ELF�y,� D. � /I/� PIPES FEET FROM LINE AIR IN l/o% C(/jY!/ (J1� uI/ L—// 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- meets the criteria for medium sand. TIONS MEASURED. OYES ONO SOIL COVER TEXTURE PERMANENT MARKERS OBSEH NATION WELLS OYES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCHlBED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. OYES : NO ❑YES ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE OISTHIB�IOON PIPE MATERIAL&MARKING E LEV.'. ELEV.. DIA.. ELEV. PIPES CIA.. S ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS F-1 YES ❑NO ❑YES ONO COMMENTS: PERMANENT MARKERS: JOBSERVAIIN WELLS: NUM F PROPERTY IWELL: BUILDING. LINE' DYES El NO 90 YES 1:1 NO NEA OM I i � Sketch System orl I- -y �►6�^ Ret i in county file for audit. '�I Reverse Side, I�J� BI AT _,,,�,- TITLE Zoning Adminis t rator DI LHR 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; k 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 3ryears; 6. If you have questions concerning your private sewage system, contact your local code administrator or the I 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'/z 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 &t+er included the creation of surcharges (fees) for a number of regulated practices which WiSco in"s: can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried I'ei3llrB! 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. o 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- f water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) ILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm.Code Croix 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 D?NO PROPERTY OWNER PROPERTY LOCATION Patrick Cody SW %SE 1/4, S31 T 31 , N, Fa7 Z(or)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME R.R.0 n/a n/a Oak Ridge CITY,STATE I ZIP CODE PHONE NUMBER 7M CITY NEAREST ROAD,LAKE OR LANDMARK Neww Richmond, Wi. 1 54017 n/a o VILLAGE: Stasthon Co.Rd 4#K II. TYPE OF BUILDING OR USE SERVED: 1&3. Number of Bedrooms if 1 or 2 Family 3 OR Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b.)LiReplacement 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. U 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. ❑ Seepage Bed b. [-see a e 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): 7 495 500 94.56 Feet ®Private ❑,joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank X 1000 Hop ins X El El Pum Tank/Si hon Chamber ❑ El ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installatioggpf the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Si lure:(No St s) CMFMPRSW No.: Business Phone Number: Gary L. Steel 3254 715 246-6200 Plumber's Address(Street,City,State,Zip Co NV9 of Designer: 988 N. Shore Dr. , New Richmond. ,Wi. 54017 Vlll. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# Gary L. Steel 2298 CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 988 N. shore Dr. , New Richmond, Wi. 54017 715 246-6200 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) pvf Approved ❑ Owner Given Initial ur'c�hCarge Fee S�J may, Adverse Determination %A19b aS�a ''—' X. COMMENTS/REASONS FOR DISAPPROVAL: byarrtC e, f`�KY)I-) SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber f , • APPLICATION FOR SANITARY PERMIT STC - 100 his application form is to be completed in. full and signed by the owner(s) of the roperty 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 Location of Property��_It _hr, Section 0 t , T,�-N-R W Township Nailing Address Address of Site Subdivision Name p, Lot Number Previous Amer of Property c�/ Y� �, f ' -'�-J- j Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yea 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 I (tue) ccAti.6y that ate statements on thiA for ane true to .the best o6 my (ouh) hnowtedge; .that I (we) am (ahe) -the owneA(s the pnopeAty de�scAi.bed in this .in6oimation 6o&m, by v.ihtue o6 a waAAanty deed neconded in the 066.ice o6 the Cc"mtyy Reg ' eA o6 Deeds as Document No. 3j�jj ; and that 1 (We) pnesenttCy sun the pnoposed site bon the sewage CUApos sysZe_m (on I (we) have obtained an easement, to nun with the above deg cAibed pnopeh ty, bon the consthuc ti.on o6 said system, and the sane has been duty neconded .in the 06b.ice 06 the County Reg•iaten o6 Veed6, as Voemnent No. ) , SIGNATURE Op OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) - ( ) 1{•- P DATE SIGNED DATE SIGNED DOCUMENT NO. ARANTY DEED T"IS RACK RESERVED FOR RECORDING DATA STXI,� e WISCONSIN FORM 2—im a a Diane B. tjAlpygki.j.....a sin q1 ! .................................. ............................................................ ................................................................................................................. ................................................................................................................. Conveys and warrants to ...Patrick E. Cody and ......................................................Kathy.............. fe.,...4A.jR4rita1..p:K5?p ....... ............ ...s.ur.vi.vQr.s.h!,p............................................. ............................. ................................................................................... ........................................... ..................................................................... .................................................................................................................. RETURN To .................................................................................................................. ............................................................... .... iF6.................................... the following described real estate in .....St. d..........1.x..... .. .. ................County, State of Wisconsin: Taz Pared No: .. .......................... Lot Twenty (20) , Oak Ridge Estates to the Town of Stanton. ? jq I. This ........i.S................ homestead property. (is) •(is not)., Exception to warranties: AL October, 87 .. '- .: - ............ ...... Dated.this .................... day of.......... .......... ..............(SEAL) . .... ........................(SEAL) ............................................... ...... Diane Majew ki .............................0......I............... ............ . .............. .................... ........... ....... .................................. ..................................(SEA ......................................................................(SEAL) .................................................................. .................................................................. AUTHENTICATION ACKNOWLEDGMENT li Signature(s) ....................................._•-----..............._. STATE OF WISCONSIN ................................................................................ St. Croix ' .. ...................................County. authenticated this ........day of.......................... 19_.._.. Personally ame before me this J ..day of lI October 19-8.7—the above named ................................................................................ —67 -------------- -----1ane...ftjq3gg!kA............... ...........I............... .............................................................................. ...........................................................-----•--•--•-- .. TITLE: MEMBER STATE BAR OF WISCONSIN ........................................ ...........I.................. (If not, ..................................................•..•...... ............. .. .... ..;............................ authorized by § 706.06, Wis. State.) tom wn to the person ...........- who executed the 0 in the Pere 0 got ins en and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY it Reinstra, Van Dyk & Needham, S.C. .... .......... .... .............. ............ Nj��a j�4��..... ---------- -------------------------------------- Scott Needham ................... ......................................................... New--,Ri,chmoad,...-Wis.cnns-in.....5011-D127 No ..............County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission Is permanent.(if-4wtret&t9-4wpiwAi9*- are not necessary.) .... ......... *Mama of persons sliming In any capacity should be typed or printed below their signatures. li it STATE BAR OF WISCONSIN FORM No. 2— 1982 Stock No. 13002 H z • cn H 9 . r ST C - 105 r9 H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d OWNER/ai�*•E � ROUTE/BOX NUMBER Fire Number CITY/STATE �147173 + I')`W�14 yJ �+ ZIP 7 PROPERTY LOCATION4*�V) k,o�_14, Section, T �N , R_1 ;7 W, Town ofc5 74" St . Croix County, Subdivision &444 i ��� , Lot number 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. H 0 I/WE, the undersigned, have read the above requirements and agree V) to maintain the private sewage disposal system in accordance with H 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 within 30 days of the three year expiration date . SIGNED DATE 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 . ` . INSTRUCTIONS FOR COMPLETING FORM 115- SBD - 6395 To be a complete and accurate soil test,your report most 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 sale is preferred. A scrrarate sheet may be used if desired; S� Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 0. 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 appropriate box; 11. Sian the form and place your current address and your certification number; 12= Make legible copies and distribute as rertuired. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIES} SOIL TESTERS Soil Separates and Textures tither Symbols st - Stone {over, 10"} BR Bedrock cob - Cobble (3- 10") SS -- Sandstone gr - Gravel (under 3") LS - Limestone *s - Sand HGW - High Groundwater es - Coarse Sand Perc _- Percolation Rate coed s - Medium Sand W - 'AleII fs - Finn Sand Bldg Building Is - Loamy Nand > -- Greater Than sl Sandy Loarn _ Less Than �l Loam B - Brown Silt Loam BI - Black si - Silt Gy Gray cl Clay Loan Y Yellow scl Sandy Clay Loarn R - Red sicl - Silty Clay Loarn mot - Mottle, sc - Sandy Clay wl - with sic - Silty Clay fff few,fine, faint x. c - Clay cc - common,coarse or - Peat rrtr - Marsy, medium m - Muck d - distinct p - prominent WAIL - High water level, Six general soil textures 3 surface wate=r for i;efuid waste disposal BM - Beach 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 v°erifica ion of This soil test in the field prior to permit issuance. A complete set of plans for the private s ewage system and a permit application must be subrnitted Lo the appropriate local authority in order to obtain a perrnit. The sanitary permit most be obtained and posted prior to the start of any Collstt-U(,ti W. L—_ DEP'ARTMINT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 3707 HUM44N RELATIONS (H63.09(1)&Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MAY: LOT NO.:BLK.NO.: SUBDIVISION NAME: SW 1/4 SE�4 31 /T31 N/R 171 (or)w Stanton n n/a COUNTY: OWNER'S BL# 'S NAME: MAILING ADDRESS: St. Croix Patrick Cody R.R.0, New Richmond, Wi. 54017 USE DATES OBSERVATIONS MADE NO.BEDRMS :JCOMMERCIACUESCRIPTION: PROFILE DES RIPTI NS: PER OLATION TESTS: ®Residence 3 n/a ❑New ®Replace 111-12-87 11-13-87 RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) oU S �U �U 1U El S conventional If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the n/a under s.H63.09(5)(b),indicate: n/a Floodplain,indicate Floodplain elevation: decimal' PROFILE DESCRIPTIONS page 20 PMC BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH=ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B-1 6.92 98.11 none >6.92 .67bl.1. 1.58bn.s.si1. 2.00bn.m.s. 2.67bn.l.s. B-2 6.83 97.31 none >6.83 6.83bn.m.s. B-3 16.83 97.06 none >6.83 1.00bn.s.l. 5.83bn.m.s. B- B- B- decimal' PERCOLATION TESTS TEST P H WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER S AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- none 5 1 3/4 3/4 P- 2 2.75 none 5 14 P- 3 2.50 none 5 2-32 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 94.56 .... T s 3 Qc .'Psc _..._ ._- 56 E E V 3 r -- 7 T � t ' � ` T N E 1 - I - a ✓CJ!C�` `" � � I E J I ( � j� I i i E i E E 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: Gary L. Steel 11-13-87 ADDRESS: CER�IW&TION UMBER: PHONE NUMBER optional): 988 N. Shore Dr. New Richmond, QWi. 54017 LL`770 1 46-6200 CST SIGNAT E: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — H� z H a STC - 105 s C'' H SEPTIC TANK MAINTENANCE AGREEMENT H 0 St . Croix County z d a OWNER/BUYER ROUTE/BOX NUMBER Fire Number CITY/STATE ZIP PROPERTY LOCATION : , , Section T N, R W, Town of St . Croix County, Subdivision , Lot number 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 . H 0 E I/WE, the undersigned , have read the above 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- ro 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 DATE 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 . �7Z � �4LA 81 ry SKS15q,n5 p� 6 �,zs ���i-� s