HomeMy WebLinkAbout040-1029-50-100 4)
c
ao 0
qb
(D
CL
0
(D
r-
0
Zcc
C cc
LL
0
Cl)
z iii
Lu
E
C,4 W
co
0
0 z
'6
0 z :t
Z
'2
ce)
0) 0
4)
O (D
z co z
co 04
Cb 41 d CD
a.
co 1 co A 0
0 CL
CO
E
U) U) U) E
F-
0
0 0 0 z
CL IL IL
IL 0
In
0 U) z
0
00 w
d) 0)
LL (D C14
LL v
tF
CC,,'
0
0 0 0 T3 E
LO
(D (D
c
0
E N LO
8
:3
CD c (L CD
cn
C14 N 0)
0
40. jz:
O
(n
co 0 z 75 to
C CD
C, LO
E
't c6 2 0
o o 0) CD z 12 fn
C9 CL IL
0 m
() CL 2 0 U) u
PUMP CHAMBER
Manufacturer: �V 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� Length: Number of Lines: L Area Built:
Fill depth to top of pipe: '���
Number of feet from nearest property line: Front, O Side, 0 Rear,0 Ft. . /,'
Number of feet from well: 'Z
I �
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: !l//7 Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation .of inlet:
i
Number of feet from nearest property line: Front, O Side, O Rear, O Ft.
` Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: 1G-- Plumber on job:
License Number:
Number:
I
3/84:mj
IT- i
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER --. 'y/c�l�r �cJi1� TOWNSHIP 'Tc�S! SEC. T N-RAW
ADDRESS - ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT /��J LOT SIZE f'Uy
PLAN VIEW
Distances and dimensions to meet requirements of I•IHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
� Zoo
Lb
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used e, Ca;ilr'r
Elevation of vertical reference point: Z5i` Proposed slope at site: 7CF
SEPTIC TANK: Manufacturer: l k Liquid Capacity: 116
Number of rings used: f Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,O Side@Rear, O 16to feet
From nearest property line Front,�Side10 Rear,O ,� � feet
Number of feet from: well , building: j
(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
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON,WI 53707
SEA, ,SEk, S6,T28N-R19W TIONAL ❑ALTERNATIVE (Itt ass 9lnn�iD.Number
Town of Troy olding Tank ❑ In-Ground Pressure ❑Mound
CTY Road FF
NAME OF PERMIT HOLDER: i ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Gerald Wilk Route 3 Hudson WI 54016
BENCH MARK(Permanent reference point) ESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PL ELEV.
Name of Plumber: MP/MPRSW No.-. Cou my Sanitary Permit Number:
Roger Timm 3224 St. Croix 96050
SEPTIC TANK/HOLDING TANK:
MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
1 ,�.,�) PROVIDED: PROVIDED: � /
W I V v " �YCS ONO ❑YES LINO
BEDDING: VENT DIA.: VENT MAIL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING:JVENTTOFRESH
C ALARM FEET,FROM LINE AIR INLET.
❑YES NO DYES NO NEAREST
DOSING CHAMBER:
MANUFACTURER. B 1NG: 11-11111111 CAPACITY PUMP MODEL_ JIUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO DYES ONO I ❑YES ONO
GALLONSPERCYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET.
PUMP ON AND OFF)
EYES ❑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,constructions all cease until FORCE
the soil is dry enough to continue.) I MAIN'
CONVENTIONAL SYSTEM:
WIDTH IE Nj',TH NO OF I D I STE.PIPE SPACING. COVER .INSIDE DIA. #PITS: LIQUID
BED/TRENCH ( TR ENCH>— / MATERIAL: (,IT DEPTH
DIMENSIONS �L
GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR PIPE DISTR.PIPE MATERIAL. NO.DISTR NUMBER OF PROPERTY WELL: BUILDING. VENT TO FRESH
BELOW PIP ( ABOVE I R. ELEVR INLE r ELEV.END. ,2r -7 ^ C/ PIPES. FEET FROM LINE'. AIR INLET'.
K L L NEAREST-----�Ir
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.
OYES ❑NO
SOIL COVER TEXTURE PERMANENT MARKERS 711SERVATION WELLS
❑YES ❑NO ❑YES 1:1 NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED'.
CENTER EDGES.
❑YES ONO OYES 1:1 NO ❑YES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH: LENGTH: TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER
'.[sIMEN3(ONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING.
ELEV,. ELEV,. DIA.. ELEV. PIPES.
ELEVATION AND
D SiTTIIBUT#ON� HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION PLANS.
DYES ❑NO
1:1 YES ❑NO
COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY W
FEET FROM LINE:
DYES 1:1 NO EYES 1:1 NO NEAREST
.s
/ `qS 111
o
Sketch System on oo Retain in county file for audit.
Reverse Side.
SIGNATURE: TITLE:
DILHR SBD6710(R.o1/82) ` Zoning Administrator
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
APPLICATION
t
TO THE APPLICANT: i s
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:
1. Property owners name and mailing address. Provide the legal description where the systern 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;
111. 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'h 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 GroundWater
included the creation of surcharges (fees) for a number of regulated practices which Wisco rn`s
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried treasilro
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 ,
T'he monies collected through these surcharges are credited to the groundwater fund adminis-
terec by the Department of Natural Resources. These funds are used for monitoring ground-
ter, groundwater contamination investigations and establishment of standards. Groundwater, .
s worth protecting.
QBD-6398(R.03,86)
SANITARY PERMIT APPLICATION COUNTY
TDILHR In accord with ILHR 83.05,Wis.Adm.Code 1
STATE SANITARY PERMIT#
a —Attadh complete plans(to the county copy onl y)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 NO
PROPERTY OWNER PROPERTY LOCATION
(3,e (,U' JE % SLY,,, S T , N, R (or)
PROPERTY O ER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
IVI
CITY,STATE ZIP CODE--] PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK
e/1b r VILLAGE: ✓J `
II. TYPE OF BUILDING OR USE SERVED: - "' QelD/D 5V
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. Z 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. [�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. X1 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):
51O Feet Private ❑Joint ❑ Public
CAPACITY
VI. TANK Site
in gallons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New xistin Gallons Tanks Concrete strutted glass App.
Tanks Tanks
Septic Tank or Holding Tank Ec 1 /Qc'?ty !! k 11 1:1 El
Lift Pump Tank/Siphon Chamber ❑ El El El VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Print): Plumber's Signature:(No tamps) 14W N Business Phone Number:e. 774 Viz/
Plumbejfs Address(Street,City,State,Zip Code): Name f Designer:
/Si5 � Z7
Vlll. SO L TEST INFORMATION
Certified Soil Tester(CST)Na
�tr/,rfo CST#
CST's ADDRESS(Street,City,State,Zilf Code) Phone Number:
Z",,el UP A44ev/5'e7i " 6V6 f�- 7�s ,b- 5�/
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved S nitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
Approved El Owner Given Initial /(0V rchargeF1e�e /,/ p
Adverse Determination �✓ �/7` O AJ
X. CO MENTS/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
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 _ _a C C aid 08 0 AUy / L
Location of Property ' ' , Section , T o? N-R / W
6 ��
Township �' p
Mailing Address Q�
Address of Site FF
Subdivision Name C
Lot Dumber
E
' Previous Owner of Property
Total Size of Parcel a.,a 3 / o/, /� c - o _ a
Date Parcel was Created Q Ql« /,�, If f 6
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? ��- Yes X No
Volume and Page Number 6c;� 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 certifisd 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) eeAti.6y that aee 6tatementt6 on thiA onm ah.e true to the beat o6 my (ouA)
hnowtedge; that t (we) am (eAe) the owner(d o6 the properr ty dea cAibed in thi4
in6oAmation 6oAm, by vi tue o6 a walveanty 4ed neeonded in the 06 .gee o6 the
County Re9iAten o6 Deedaab Voeament No. and that I fWe) peedentty
awn the pnopoe¢d acte bon the sewage diepob eye em (o% t (we) have obtained an
eabement, to nun with the above de c i.bed property, bon .the" eomtnucti.on o6 &aid
eyetem, and the eame hae been duty neeonded in the 066ice o6 the County Reg,iater o6
Deede, ab Vocament No. ) ,
Icedlrrr -
SIGNATURE 01 OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE
D E S IGN6 DATE SIGNED
DOCUMENT No. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED F.R RECORDING DATA
WARRANTY DEED
840K I��pAGE REOWEtS OFJJ
CE
This Deed made between _William_F.__Lpk _ ley_a ci_________ 5T. CRDIX 00,4 Wig,
___Marie__E._ Loughney,_ husband_and_wl few__ _________ _________ �!
Recd. for Record this 15th
- ---
------------------- -------------------------------------------------------- y of Aug A.D. 1986
------------------------- Grantor,
and-__Gerald L. Wilk and Bonnie L. Wilk, husband and wife 3:45 P
------- -- ------------------------- ------- M.
as survivorship marital property------ -------- ---•--
-- -
---------------------- ---- ---------------- ---------------------------------------------------- Grantee, dobly M 0��
Witnesseth, That the said Grantor, for a valuable consideration__Of
one dollar and other valuable consideration
--
conveys to Grantee the following described real estate in Sty _C? q'i-------- RETURN ro
'I
County, State of Wisconsin: ;!
Part of SE 1/4 of SE 1/4 of Section 6-28-19 described --- ''
,I
as follows: Lot 1 of Certified Survey Map filed
July 3, 1986 in Volume "6„ Tax Parcel No: ___.----------------------
page 1679, as document
�!
#414079.
TRANSF A R
FEE
i
�.I
i
II
I,
j' This ____________________________ homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging; �(
William F Loughne and Marie E. Lou hn y
And. ------------ y g e
------------------------ -----------------------------------•---- ----•--••-••-•--•.....--•-----•-
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
easements, restrictions and covenants of record' if any,
and will warrant and defend t e same.
Dated this 'J- ------------------------- day of ------------ --_.------•------- 19
------------
(SEAL) .(SEAL
William F. Lo e I,
---------------------------------------- y
yy� ------------ --- ---- ----- -----------
---------------------------------------------- ------------- ........(SEAL) Gi�lCG
-
-------------- --- -------- ---••-(SEAL)
* Marie E. Lou e
_9. .
'i
Ir
I AUTHENTICATION ACKNOWLEDGMENT
Signature(s) --------------------------------..................... STATE OF WISCONSIN
•-------------------•----------------------------------------------------------- St. Croix as.
------------------------------County.
authenticated this ________day of___________________________ 19______ Pe nally came before me thi �h?2...day of
fiL , •.
-� --- --- 19 --- he above named
William F .ugYiriey an Ia�e E. 41
-- ---------------��
*----------------------------------- Loughney Q; y •t------
--------------------------------------------_--x ......�...a__�.
TITLE: MEMBER STATE BAR OF WISCONSIN ..T
(If not fi' ~ . .,J M_. V
---------------- -
-0 -
' authorized by § 706.06, Wis. StatsJ---------------•- --------------------------------------------"I---«-..------to me known to be the person S?�._.-7 wItoCc#d the
foreg ' g 1 tr ent a d acknow dyke t •saxe.0
THIS INSTRUMENT WAS DRAFTED BY
t
Robert F. Wall
--•-
---RT-�2D6,--SAL,L--&--I�RI�S-•--------•--------------------
522 Second Street, P.O. Box 151 *-____--•-_-. - _ �f--_.._ ...,_ _
Hudson,-.WI----54016--------------••-----•• 1_
Notary Public St. CrOlX County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration
are not necessary.)
_ date.
................................. 19.........
*Names of persons signing in any capacity should be typed or printed below their signatures.
1
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc.
FORM No. 1-1982 Milwaukee, Wis.
414,079 JUL a;1986
C.ER `°f IFIE D SURVEY PEA
Located in the SE 1/4 of the SE 1/4 of Section 6, T28N, R 19W, _ A
Town of Troy, St. Croix County, Wisconsin • moo
E 1 /4 corner "'a
Section 6 ; °„
Surveyed for: Wm. F. Loughney
414 So. 10th St .
Hudson, Wi. 54016
00 o\°
SCALE IN FEET I"= 100` °
50 0 100 200 i� '� \ 'I �► ^�
ss�o
LEGEND
z3, i
COUNTY SECTION CORNER MONUMENT h �}
° 1° ROUND IRON PIPE FOUND 1
O I"X24° ROUND IRON PIPE WEIGHING 1.69 LOS/LIN FT. SET �' A
'JUL 03
198 S
DESCRIPTION G ST. CROIX COUNI 1<�
A parcel of land located in the SE 1/4 of the SE 1 /4 00ja►aeHe"YvE PAP.KS PLANNING
of Section 6, T28N,R19W , Town of Troy, St. Croix AND Z014ING COMMITTEE
County, Wisconsin, described as follows: N
00 LOT 1 y
Commencing at the SE corner of said Section 6;
thence N 101 1'40"E (assumed bearings referenced 00 = 89397 sq.! ft. or
to the monumented East line of said SE 1./4 of the 01 2.052 a.cxes 0 0
SE 1/4, bearing N 1011140"1) 618.96' along said - excluding ;right-of- °,
East line to the point of beginning; thence way! w
N88048120"W 200.00'; thence'N foll'40"E 558.61''2 , 1 1' °_ c�
to the centerline of County Trunk Highway "FF"; 97496 sq ft. cr Cn
thence S 53023'E 245.43' along said centerline; 2.238 a res
thence S 1011140"W 416.36' along said East line 144 in cludin right-of-
to the point of beginning, containing 97496 sq. ft. jam way
(2 .2363 acres) and being subject to County "FF" �' p,
right-of-way over the Northerly 33' thereof, IA W cn
and also being subject to an undelineated reser- z Point of Beginning
vation of mineral rights in the 100' strip ofN
former C & NW Railroad right-of-way (being 0
approximately parallel with and adjacent to the a,
Southerly right-of-way line of the County Highway) 20 .001
as recorded in Vol.427. page 144, and also being
subject to an easement to Wisconsin Telephone Co. N88048120t1W �z
being Southerly 70' of and parallel and adjacent to r
said Cclllnty Highway,as recorded in Vol. 591, pave tltVpLgTTED 491YA$
155. ptii111l1 -
0%
OD p
ed this 6th day
of June, 1986. SE Corner
.. Section 6
1r T28N R 19W Io
ih�saa, ' IN
EL
�� a
R t` is Bred Wisconsin Land Surveyor, do hereby certify that
I ' Jarnee E. u-ech, re t Y
8
I have surveyed and mapped th e above described property; that such plat is a
true and correct representation of the exterior boundaries of the land surveyed; ,
and that I have fully complied with the provisions of Section 236.34 of the Wis-
consin Statutes, this St. Croix Couaity Subdivision Ordinance, and the Town of
Troy Subdivision Ordinance to the best of my professional knowledge, under-
standing and belief. Volume 6 aiV 1679
486-988
H
z
H
9
STC - 105 r
9
H
• SEPTIC TANK MAINTENANCE AGREEMENT o
St . Croix County z
ty
OWNER/B t Sera /d Y- UD/!/1111,E �'✓/G/C �
17 r
ROUTE/BOX NUMBER Fire Number
CITY/STATE Z I P
PROPERTY LOCATION : Section to T ,2,? N , R ?0 W,
Town of St . Croix County ,
Subdivision a LbuFgti Doti LF 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 rx,
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 .
S I G N E
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 `
z
To be a cornplete.and accurale soil test,your report must in�;IUCI : o
1. Complete legal description;
2. The use section must clearIV indicate,whether this is a residence or cginmercial projevt;
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 RVL.ED OUT BASED ON SOIL CONDITIONS;
6.'PLEASE tis�a the abbreviatioras 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.rtlay be .ued iI des ired';
$. 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-
t€or, if appropriate;
10. If the information (such as flood plain, elevation)does not apply,place N.A.in the appropriate box;
11, Sign the form and palace your current address and your certification number;
12= Mahe legible, copies and distribute as reocrired. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
F
� n
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures 'Other,Symbols
st - Storw (over 10") BR - Bedrock
coke Cobble (3- 10") SS Sandstone
gr - Grave! (under 3") ` LS Limestone
*s - Sand HGW -- High Groundwater
c - Coarse Sand Pere Percolation Bate
rh d s - Medium Sand W - Well
is Fine Sand Bldg __ Building
Is - Loamy Sand '> - Grcater Than
sl Sandy Loam .._ Less Than
'I
-_. Loarra Bn - Brr�wn
sil -- Salt Lo arn BI - Black
sr - Silt. Gy (-rra,
cl - Clay Loam Y yeMtow ,
SO_ - Sandy Clay Loarn R = Rod
sic! Silty Clay Learn rnot - Mt3ttl S
sc - Sandy Clay w1 -- with
sic - Silty Clay fff '=- fe�v, fine, faint
c Cia_y, Cc common,coarse
P1 Peat mr#W- Many, medium
rn __ Muck d - distinct
p - plot
nirient
HWL - Hiah water level,
Six general soil textures surface water
for liquid waste disposal BM - Bench Marl<
VRP Vertical Reference Point-
t
'11-0 THE OWNER: �
4ai- sc i t.xst retrorr is the first step ill seccirirxl a sanitary perrnit. The county or the Department inay re(11,1est
it cf pit s so-1 test�in the field prier, ro peran,t issu.anee. A aye t plrar�z set of }sla,s for tPae private
ra system rind « })emit applicati.ara must tae submitted to the appropriate local authority in order to
r,cnnd. T) s<ar,it.irY° ;._;mit. rrat.sl he of?Cainec#and posted prior to the gart df any :orstiucticzra.
L Joi
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN'REL4ATIONS MADISON,WI 53707
. (H63.0911)&Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/fl^� ^��r 1°dL'TY: LOT NO.:BLK.NO.: NAMESE �/��/ Co / N/R/90(0 '7;a y ._. o�a•r w �d
COU TY: OWNER'S/BUYER'S� NAME: MAILING ADDRESS: ,,[� �—�/
t 7C b_er / EY 967 .`vty- S/_t f Ow6k J G 0/fo
USE DATES OBSERVAT ONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence —3 WIVew ❑Replace I S Ao
50.1 t~? ,BX C // ` l V
RATING:S=Site suitable for system U=Site unsuitable for system -3 d 7 .e C Lj(
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:
�s au xs ❑u , KS au as ®u ❑s XU ll `x36
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation:
• PR FI E DESCRIPTIONS
BORINGI TOTAL+ DEPTH TO GROUNDWATER CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER IDEPrTH,,6W ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- JL .0` /4` oL— ;,7S.
B S
B- 3 0 t �� At 7 i 0' A. S- S n IF
11,B- `f' .d` /0' au.e
ts
B-
PEIRCOLATION TwS
TEST DEPTH. WATER IN HOLE • TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER W#O"L'S AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD PERIOD 3 PER INCH
• C3 L 3
P- X. 2 (. L 3
P- 15, AJQ at L 3
P__
P-
PLOT PLAN: Shy 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 the location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. 0
SYSTEM, ELEVATION �.�6.V
kit
t
:.._
' Lift
'�
r
E
i
A01 I� ' , aye c�L� e 1 _v
+. 83 `
1 6 4
I I f
_ h - ' i {�_ ►._
I
�o' e-
/0 . � ��'' 1/1fI -i.� M
:I�• S![1...
//Y'/ �t ► owcr se, ;s�2 S ,�/ A,as
I,the undersigned, hereby certify that the soil tests reported on t is form were mao me in accord wit(/he procedures and metho s 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.
/o' W OF O wty. two
NAME (print): 0 / TESTS WERE COMPLET D ON:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
Pel >Q. udfo,u Wvs, S- o/jg S-3/6-JW/
CST E:
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
DIVISION
INDUSTRY,
LABOR AND PERCOLATION TESTS (115) MADISON WI 537907 9 53707
HUMAN RELATIONS
1 (H63.09(1)&Chapter 145.045)
LO ATION: SECTION: TOWNSHIP �LOT NO.:BLK.NO.: SUBA1i 0 NAME:
S f �/ �/ G / N/R/ p(0 7 r o y .— .._. �.�./Kr 4a�11
COU TY: OWNER'S BUY R'S NAME: MAILING ADDRESS:era al I kid s tom. G/4, 0�
USE __ DATES OBSERVATIONS MADE
*� NO. RMS: COMMER IAL DESCRIPTION: I r/4 f� S: �!o STS:
esidence ,///d low ❑Replace .. ,.
/� /7 /�50. t. ? BBC C J. /
RATING:S=Site suitable for system U=Site unsuitable for system -3 O 4 to
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:S TEM-IN-FILL DING TANK:RECOMMENDED SYSTEM:(optional)
S DU 1S EA ZS ❑U ❑ HOL
S ®u IS ®U /1 `�3 •
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: ,,,iV ,4
PR FI E DESCRIPTIONS
BORING TOTALi P H T N
R UDWATER - CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER DEPTH ELEVATION BSERVED yy H TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.)
B- / `Ci .a s.. 7 Os d B/ 8 n S.
B- 3 •a' •S` mot- 7 ,Or / d s s,
/
`f ,d r �.0• au.� 7 •6 8/l, /.o gn , • Y 41n Sly /. A t /S,
B-
S .
B-
PERCOLATION TESTS
TEST DEPTH• WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER Mde"M AFTERSWELLING INTERVAL-MIN. I~D 1 RI D PER INCH
P-
• A ,Z 4 3
P_ S ' 0 2 c L 3
P- S' O Jx 3
P-
P-
P- 1
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 s 1;_.
:>1 ti
ION
E E
I I I
E
I
to _
' 8i
I ItCN l I c e !
103�.. --
_.
___
ArZA
E
lE //Y/ r�i ,-ode ���� �� fir �s aS'�✓ g�
1,the undersigned,hereby certify that the soil tests reported on t ks form were ma� me in accord wit he rocedures and methods specified in the Wisconsin
Administrative Code,and that the data recorded and the location of the tests are corr ct to the best of my knowledge and belief.
/o' W o F J4w4 A/0
NAME(print): TESTS WERE COMPLETED ON:
0-4adit'ir le.
ADDR SS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
l Q. ii o W 't, S O/ S-3llc- /
CST � r
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —
Timm JOB G e.C, ld i l k
SHEET NO. _
OF 2
�Xcavating � '7-/0-S7 7
Co. CALCULATED BY E` / I � DATE p �/
v R BOX 192, Wilson. W) SQ27 CHECKED BY eA7E-
SCALE
• Iry `�`
/&)00
0r�C S '
�'"
� � L rdo
FC. �1, �.i
,use_"
—
22 i6
30 o
81
a3 _
... ...
,. ,,—r!Inc c,"I.,Mess.01477.
JOB
T imm OF Z
SHEET NO. _
• CALCULATED BY DATE r
�X cavating Co -� 1
R BOX 192, Wilson, W1 SQ27 CHECKED BY /11�it"�` ✓ L2y
SCALE
fill
:IL p
i�
< � r
Al V