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HomeMy WebLinkAbout040-1113-20-200 § � 0 _ } 0 % 2 ) � 7 Cm \/ ] � � 4 00 CX \ a /f � ) Z CD , 522 . U. 0 4) E < c� § f $ � @ § 7 a m ) \ Z 2 \ t « § ® \ 2 / \ E ( & e n ) ( j = f � 7 ƒ § o / < t .. c \ R \ ) = k & � . ' - ■ E \ � 2 k ) ) / k \ < 0 ( 0 ■ ■ U § E \ k / z > ' 2 k k k UL ® $ 2 \ 2 a a # E k \ § LL k k a j § \ 2 k k � a a = ° E $ $ ; I � � / . 7 2 f k < ƒ / ) 0 § IA \ o ' § E C « = o 6 ® o ; 0 0 0 0 , 2 k \k §/ \0 k § ) R§ �§ §§ f§a o ) CO / e / \ k/�k ) � � ® � 2 L: COL » § & § ` k . o u IL e u Parcel #: 040-1113-30-000 12/16/2005 09:39 AM PAGE 1 OF 1 Alt. Parcel M 30.28.19.466 040-TOWN OF TROY 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-STOCK,ALVIN C&LYNN F ALVIN C&LYNN F STOCK 165 CTY RD F RIVER FALLS WI 54022 Districts: SC=School SP=Special Property Address(es): "=Primary Type Dist# Description " 165 CTY RD F SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 30 T28N R19W SW NE EZ-UT-1499/354 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 30-28N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 840/198 2005 SUMMARY Bill M Fair Market Value: Assessed with: 102900 Use Value Assessment Valuations: Last Changed: 09/06/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 36.000 4,300 0 4,300 NO UNDEVELOPED G5 1.000 100 0 100 NO PRODUCTIVE FORST LANDS G6 2.000 5,250 0 5,250 NO OTHER G7 1.000 10,000 93,400 103,400 NO Totals for 2005: General Property 40.000 19,650 93,400 113,050 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 24,900 93,400 118,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 216 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 PUMP CHAMBER /� Manufacturer: /lam# Liquid Capacity: R 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,© Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: 5 Length: 5 o Number of Lines: '? Area Built: Fill depth to top of pipe: Ix Number of feet from nearest property line: Front, O Side, O Rear,O Ft . �'10 Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box� or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: �� Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: /U, -Z-/ Plumber on job: �y '^..� License Number: 3/84:mj i Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT • A, yl OWNER /l L dim► 5 16C TOWNSHIP �.-`�U</ .., SEC. T -bT N-R 1 ,9 W ADDRESS __ ST. CROIX COUNTY, WISCONSIN SUBDIVISION // LOT /y17Z' LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM o A/�f ,0 / i/urj Ju 5b Sys 0 54' INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used �e��/ ,� ,ate/ ,c-cK C'e- �L Elevation of vertical reference point: /0z6 Proposed slope at site: C SEPTIC TANK: Manufacturer: 4�141 Liquid Capacity: /�lJIJ Number of rings used: a Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: ront,O Side 0 Rear, O / feet From nearest- property line : ront10 Side 10 Rear,0 lD/ feet Number of feet from: well lG?J '" , building: (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,''#Vj 53707 NW'-,, NE-, S30-T28N-R19W [CONVENTIONAL ❑ALTERNATIVE State Plan I.D.Number: Town of Troy f assigned) Y ❑Holding Tank ❑In-Ground Pressure ❑Mound CTY Road F NAME OF PERMIT HOLDER. ADDRESS Of PERMIT HOLDER: INSPECTION DATE: Alvin Stock Route 3, River Falls, WI 54022 lb-,?J-47 It).' U BENCH MARK(Pe(manent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT,ELEV. Name of Plumber MP/MPRSW No.: County: Sanitary Permit Number: , Roger Timm i3224 St. Croix 99120 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER A . ,���/-,^, t e.7� n PROVIDED PROVIDED l�.L bl` ' to CD q 1\�� % �Qlnn YES ONO OYES RNO BEDDING. VENT DIA.. VENT MATL.: HIGH WATER NUMBER OF ROAD' PROPERTY WELL: BUILDING.(VENT TO FRESH FEET FROM ALARM LINE'. AIR INLET �(-� ,� OYES- /CVO 1 �. ❑YES 4NO NEAREST 1 � \0O 41 DOSING CHAMBER: MANUFACTURER 17YES G. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. ONO [—]YES ONO DYES ❑NO GALLONS PER CYCLE: PUMPANDCONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM uNE AIR INLET PUMP ON AND OFF) DYES 1:1 NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH IDIAMETER 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- LENGTH NO OF DISTR.PIPE SPACING COVER INSIDE DIA =PITS LIQUID BED/TRENCH S� TRENCHES MA RIAL: PIT DEPTH DIMENSIONS 2 GRAVEL DEPTH FILL DEPTH [ELCV ISTR PIPF DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR. NUMBER OF PROPERTY WELL BUILDING V NT TO FRESH BELOW PI s I ABOVE COVER .INLET ELEV END. PIPES LIpNE� llzzlo AIR INLET Gf 3� (a ,4 qs, 9naq NEAREST------p- LOD wd� GJ(o-4- 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- ❑YES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER ITEXTURE PERMANENT MARKERS JOBIE11VATION WELLS 1:1 YES NO ❑YES F-1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. 1:1 YES ❑NO 1:1 YES 1-1 NO F-1 YES NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE IMANIFOLDMATIRIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEVATION AND ELEV. ELEV.. DIA. ELEV. PIPES DIA DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES 1-1 NO OYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PR OPERTV WELL: BUILDING 8 l FEET FROM LINE DYES NO ❑YES NO NEAREST °6 gl Sketch System on Retain in county file for audit. Reverse Side. ITITLE ' DILHR SBD 6710(R.01/82) C, Zoning Administrator i i INFORMATION & INSTRUCTIONS�FOR COMPLETING A SANITARY PERMIT ' APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly,maintained:The septic tank(s) should be pumped by a licensed pumper Whenever necessary, usually every 2`to`3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin-, V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/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 etef included the creation of surcharges (fees) for a number of regulated practices which Wisco WS can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasu.r is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) �- SANITARY PER IT APPLICATION COUNTY 7 DILHR In accord with ILHR 3.05,Wis.Adm.Code 67, Ae STATES NITARY PERMIT# -Attach complete plans(to the county copy only)for the system, n a er 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 P 1OPERTY LOCATION /.tJ'/k '/a, S T ` , N, R If �(or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK N),IIyJBER SUBDIVISIO�J�J�E CITY,STATE ZIP CODE PHONE NUMBER CITY/df 'dIV/�+ NEAREST ROAD, AKE OR LANDMARK (�� !1 Z Z VILLAGE: r�rU II. TYPE OF BUILDING OR USE SERVED: �" 0410-111,3 -ao1006 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.�X Replacement c. ❑ Replaceme�tt 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 condit ons meet minimum requirements. 4. ❑ The System is shared by more than one owner/buildin 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 Tan k V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b.RrSeepage Trench c. ❑ ee 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): _Ili6l �� �7' Feet CO Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total ##of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper. INFORMATION New xistin Gallons Tanks Concrete stCon- glass App. Tanks Tanks Septic Tank or Holdin Tank / / 1 El Lift Pump Tank/Siphon Chamber El I ❑ F�FH_ 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 S mps) MP/MPRSW No.: Business Phone Number: 4/ 7/ 772- -?Z/Ott Plumber' dress Street,City,State Zip Code): Name of Designer: - Vlll. SOIL TEST INFORMATION Certified��oil Tester(CST)Name CST## CST's A DRESS treet,City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapprove d Sagitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) I�[1 Approved ❑ Owner Given Initial KsCJ> c rge e / I ` Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber 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. - - - - - - - r - - - - - r - - - - - - - - - - - - - - - Owner of Property Location of P arty „ `3�, Section T _N-R C2 W Township Nailing Address ze � oe yea 21 7 Address of Site Subdivision Name ly Lot Number ' Previous Owner of Property Total Size of Parcel &0 Date Parcel Was Created Are all cornera and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? _�- Yes _ X No Volume - 3 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) m4ti6y that att 6tatement6 on thfa 604M cute true to the bebt o6 my (out) knowledge; that I (we) am (ahe) the owner(,6) o6 the pnopeA ty de cubed in th i a .cn 6oAmation 6oAm, by vi tue o6 a wamanty deed tec ded in the 06 ice o6 the County RegiAten o6 Ueeda as Voeument No. aW8 ; and that I (We) pneaently own the pnopos ed bite 6oh the sewage diApo4at b ya em (on I (we) have obtained an eaeement, to hun with the above deacA bed pnopehty, 6ot the conbtnuction o6 aaid eystem, and the dame hab been duty keeakded in the 066.iee o6 the County Reg.ieten o6 Veede, a Voeweent No. ) . SIGNATURE Oh` OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATES 1GKdD DATE SIGNED A u�, e` I, 260874 � BOOK O �PACE230 • This Indenture, Made this...... . 15th lag of.... ... ... F662`113.r. .,.__... ... ......._...A. D., 19...60...., between_--..Mar y. Trebus,, als.q„known as Mary A. Trebus, an unmarried woman ....._........._._...................... ..... a of the first part and Alvin C. Stock or Lynn F.-"Stock;..as "Joint"-Tenant§;'.dnd.'riot as'Te�JK �”co + ...................................................................................... __....._..............................._........�n.z.................. W i t n e a s e t h, That the said part.Y..................of the first part,for and in consideration of the um of._--.•" of the second part, Seven,Thousand and no/100 - - - - - - - - ($7 000) .. . ._� - .............. to... @r..........in hand paid by the said part----- e$........--of the second part, the receipt whereof is hereby confessed and acknowledged, + ha.S.. ......given, granted, bargained,sold, remised, released,aliened, conveyed and confirmed,and by these presents does... give, grant, + bargain, sell, remise, release,alien, convey and confirm unto the said partleS. .........of the second part,..AOX...._.........heirs and assigns forever, the following described real estate situated in the County of......Si ' CY'o17C a -............. nd State of Wisconsin, to-wit: The North Half of the Northeast Quarter (N2N ) of Section Thirty (30), Township Twenty--eight (28) North, Range Nineteen (19) West. 80 acres more or less. Subject to easements of record or otherwise. i j J wry A. Trebus swears that she is the widow of Emil Trebus, who with her, is named a s one of the Grantees in a Warranty Deed, dated March 6, 1919, recorded in Vol. 159 of Deeds, page 283° That said Emil Trebus and Mary Trebus named therein, are one and the same as Emil A. Trebus and Mary A. Trebus named in the Final Judgment dated January 29, 1960, recorded in Vol. 364, page 595, as Document No, 260721. Further, that said Mary Trebus is the same person as Mary A. Trebus, the Grantor herein. $7.70 Revenue Stamps affixed and cancelled. ®J 1 Together with all and singular the hereditaments and a ppurtenances thereunto belonging or in any wise appertaining;and all estate right, title, interest,claim or demand whatsoever, of the said part.V................of the first part, either in law or equity, either in possession or expectancy of,in and to the above bargained premises,and their hereditaments and appurtenances. To Have and To Hold the said premises as above described with the hereditaments and appurtenances,unto the said paries..................... of the second part,and to.....................their......................................heirs and assigns FOREVER. And the said......)jai fY..Trebus.,•..also..•knowp-as.,Niary-A, Trebus�. an unmarried woman ! .......................__................................................_...................... for......heraelf,...her.......................................heirs, executors and administrators, do....................covenant, grant, bargain, and agree to and with the said part...l ........of the second part................the3r. ..................heirs and assigns,that at the time of the enscaling and delivery of these presents........................................well seized of the premises above described,as of a good,sure,perfect,absolute and indefeasible estate of inheritance in the law,in fee simple,and that the same are free and clear from all incumbrances whatever......eXCefft....easements of ...r-eoord...or other wise............................................ ............................................. ............................................................... and that the above bargained premises in the quiet and peaceable possession of the said part.les..............of the second part...trheir.......heirs and assigns,against all and every person or persons lawfully claiming the whole or any part thereof,.....she...............will forever WARRANT I AND DEFEND. I In Witness Whereof, the said party....................of the first part ha.....................hereunto set............her...........hand...: _.........and ' seal..................this..................l5th..........day of...........FebT'U3I`Y A. D., 19..6 ..... ' ... .. ........ . . ( ) SIGN D AND SEALED IN P NCE Ma , �S� Oar IFrank E. Proctor _ ......................................................................................................(SEAL) ........... .............................................. ......................---.................(SEAL) h E. Senn is Jn,trt�m..rt�d:�s ;�tfted�' i alc�w� an: 7z�n, Aitar>St!y® ...................(SEAL) .......................................................... . yVillaari 1.. � i:wen STATE OF WISCONSIN, Ralph . Senn Pierce F ........................... ......m fore....................._.......County. Personally came before this............... 1.jth..,;- day of....................Fie ...................................... A.D ... the above named..........Nt`y..Trebus„ of kja Mary A....Trebus� an unmarr a woman A,I11 tt' ;t 179Y • ................................ ..............................a......... ......�r y to me known to be the person..........who executed the foregoing instrument and acknowledged the same. ���' •�. `r s .1: Received for Record this. ..2nth. „day of .Febru�ry........A.D,�.,19.60...at..Q1 Q...o'clock.Aa.M. f•. • ' �.�t �'•�K•G� l,�: (.SEAL) FrAnk F.. Pro .ey+: „IC G; Notary Public......................Zierme.. t- 7 ' Cou�nt�y,Wit.'0* � ~» t ... Deput............ester of Deeds Permanent Commiaeioh •� � `�°\ �u+n1Ut�+ttt�—' „ t WARRANTY DEED-STATE of WISCONSIN,FORM NO.1 -- - -- -- r M.C.MILLIN CO..MILWAUK99 .i H z , H a ST C - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT St . Croix County z d a ;� � H OWN ER/ Bid4 X/y(, �TiLc�L tin ROUTE/BOX NUMBER if Fire Number /p p .CITY/STATE ZIP A PROPERTY LOCATION:/Y; 3 AL k, Section , T �N, R / q W, Town of St . Croix County, �► Subdivision Lot numberJ� . I Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior . to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 0 E I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning OfficeQQ W , in 30 days of the three year expiration date . .. 1G "Y% SIGNED DATE 1,,)1,-7 St . Croix County Zoning Office P.O. Box 98j- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address . DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& B.UILDIN INDUSTRY, DIVISION LABOR HUMAN N RELATIONS PERCOLATION TESTS (115) MADISON WI PERCOLATION 53 69 (H63. 09(1)III Chapter 145.045) LOCATION:,j SECTION:� OWSWIP UNICIPALITY: O N LK NO. SUBDIVIS N NAME: /d W 1/4 fi 0 COUNTY: O!W�� ER!'S ' S1'C06Ix �vr -roc CTN F; 1Q`1'✓ESP rP44 tN 4 DATES OBSERVATIONS MADE ,Residence G(N K ❑Now Replete ` 'SUPT 2 7 /98? 'SEPT �9 9 b 7 So L,& 6)6ti MA4.r 16-11 1a4t6"TA RATING:S�Site suitable for system U-Site unautUbie for system VCIV• U so� =Sclu S Elul EIS G TI�u RECnO1 NV4L ED SYSTEM:( gional) (�iGfl{/� L. N] IA�JN L If Percolation Tests are NOT r fired DESIGN RATE: � If any portion of the tested area is in the under s.H63.0915)(b),indicate: IG 1 ROSS ' Floodplain,indicate Floodpiain elevation: cFT PROFILE DESCRIPTIONS BORING TOTAL -1 MIS CHARACTER COLOR,TEXTURE,AND DEPTH NUM BER tbt, ELEVATION TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.)ERVEQ___ EST B- 1 9 so loo 04 o c 7�.s v / '&.SC,S 16'eeft MS f 4e 16' AA B- 26� hr, 19e, BAWt'S 4-rt@'.MS 36 CTBRNA1S /Z�L-&MCS B- Z f3.?5 97.42- E$.?S %"&scTS /6"JR9,4SC 3�"BaN> {�f<Sp"'LT$aN /'►'JS B- B- 3 MAX �}7•` pNLr . & 4 R 6g~ r SN 4, B' P� aK $�a /yS rBrtN+4S �E�CT PERCOLATION TESTS DEPT WATER IN HOLE TEST TIME S NUMBER AFTER SW ELLING INTERVAL-MIN. PER INCH P. 1 3.6 x.03 < P. Z 3j:3 1 P. P- P• AT ION AT l,RL P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the horn zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION A 0 _.._ - _ jr tN 5 � i , ; f1 *AO I,the undersigned,hereby certify that the soil tests reported on this form wereL by me in accord with the procedures and methods specified in the Wi.consin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NA Zvcy'rint Scpram&QTE�O /g�7 Jor1 e sc+� Su�v�.riNC, R / CERTIFICATI N NUMBER: PHONE NU BER(optional): �C-CON A �7 /YUl�< Sda 1� -RW 1 1196- p€o CST S U E: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR•SBD-6395(R.02182) —OVER — DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY., DIVISION LABOR AND PERCOLATION TESTS (115 P.O. BOX 7969 HUMAN RELATIONS 1 MADISON,WI 53707 (H83.09111$t Chapter 146.046) LOC'XTION:r4 OWNSHIP UNICIPALITY: N LK.NO.: SUBDIVISION NAME: fvinl I)��>j� �SNJfl/9�(or COUNTY: /� r S;C�0 IX LVI 7taC. C T 'F I ✓ESP 1 44"S 1 DATES ON ERVATIONS MADE qq NOL ICOMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: EFICOLATION TESTS: ,Residence �N k ❑New WReplace Z 7 /967 SENT 2 1 9fi'7 +C btiT�6Q! Spll_Z ItCZ - bAICOTA RATING:S­Ske sukelele for system U-Site unwkeNa for eystern S �� I'M�Y =Scy VL O^LDI TfOU ECnOMO MENDED SYSTEM:i tionoD If Percolation Tests are NOT required DESIGN RATE: i�JY 1. eQ If any portion of the tested area is in the under s.1­163.09(5)(b),indicate: LASS Floodplain,indicate Floodpiain elevation: c.F-T PROFILE DESCRIPTIONS BORING AL -1 I I COLOR.TEXTURE,AND DEPTH NICER }R, ELEVATION TO BEDROCK IF OBSERVED SEE ABBRV.ON BACK.) B. I 9 Sp /00.04 D c 7�•SU /o-'$csc-rs ice"BeN fps 44k 'Ze S t-Cc,R tots 110 B- 26 hK 'Bert BAutas t-r$6NH'I'S 3C &&Nms /2oC-r&Ncs B- _Z $.7� 914Z �f$,?� �"&S�n �6•$,e�lS C 3�",BaN ttiF C�R sue"GT$aN !'►'r'S B- B- 3 0,6% `��, oNLr ?/0.08 0'0 < vs 20"&eNL 31"' ft Bie 'S-06t 6g" LT 19R#4 & /n aK &N MS 6a144;S �E�FT PERCOLATION TESTS DEPTH. W H 1 RATE MINUTES NUMBER AFTER SWELLING INTERVAL.,MINJ PERIOD I PERIOD 2 —MIOD 3 PER INCH P. Z 3.31 1 Z <3 P- 711 Ov 1 CM& Z < kyj% Ali P- GL P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil&ran. 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 ELE ATK)N AO 1 I i r v Pz I 4 : ' r 4Mltgtw;-,SAIkQ t1ry �i 1 '4A� � . � /i • �__. t rso 1,the undersigned,hereby certify that the soil tests reported on this form were rnade by me in accord with the procedures and methods specified in the Wi,.consin Administrative Code,and that the dam recorded and the location of the tests are correct to the best of my knowledge and belief. NA ,j print : \ p t. R COMPLETED N: NOVEY JGH IC - q Su kVLY1NC� Se,PTCm w ;,?,O , / CERTIFICATI N NUMBER: HONE NU BER(optional): 4a? Scco�,A S� /Yu�SQN ► Sda�6 34� IF_ �G_ CST S URE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILIAR•SBD-6395 (R.021821 --OVER — DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY C DIVISION LABOR HUMAN N RELATIONS PERCOLATION TESTS (115) MADISON W BOX 53 69 (HS3.09( 1)&Chapter 146.046) I N OWNSHIP UNICIPALITY: N ]SUBDIVISION N NAME: oy W i/&1� SN/W*or % COUNTY: Q (�'' S-1 Ck0 I k V 1 TUG (._ T)4 '►`t I ✓E 1(� f 1011.5 1 r DATES O1111SERVATION8 MADE /� c�PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence �^/K ❑New Replace U PT' 291 /W7 S E r l •!/ 9 T 7 �pttt: &V, HA47r"0 Spu_i �cCZ " �AKaTiv RATING:Sm-Site suMebh for eyrbm U-She unit"for system ICONVRNTIONAL; G AjVK.R I tiona S ou SOY =Sperms� EIS _ C-5 V&FVTIO+JAL, — If Percolation Tests are NOT required O iSIGN RATE: If any portion of the tested area is in the under s.1,183.09(5)1b),indicate: (_ U4SS I Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING AL 1 L TEXTURE,AND DEPTH NUMBEq M% ELEVATION O BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- 9 so X00.04 46N c /o'9L'S1, S ,o"BeN Ms f 4e le S 44 R B- 26'D< $Qn &M hS C-r&.MS X &&'Ms feL w-S B- _Z $.7S 914-L �,� 8"i-SZTS 16"&,4SC 3?" DRN1�iSfC�R �Lr ORN S B- B- 3 0,08 9�. 's oNL >/b.og /o'0 si_n Zo'BaNL 32' Rn gQ g � fig" LT$RN B- /e'1 DK $kill MS ISANA;S PERCOLATION TESTS TEST DEPTH NUMBER . AFT R ER EHLOLIN LE TEST INTERVAL-MIN. R PER INCH 3.6 9�+.a3 '� `� < P. L 33-7 r4 Lit. ? Z 3 P- 3 < P- P- IR.G.. 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 A 0 4 ' r- ' - __,___ __. ___. .__ _ . , 1} I , , - -i 'N { i we A, Ce—L II I 1 i No 3CA\.d 1,the undersigned,hereby certify that the soil tests reported on this form were lade by me in accord with the procedures and methods specified in the Wi.consin Administrative Code,and that the daft recorded and the location of the tests are correct to the best of my knowledge and belief. A�40\(,Ly print : M LETED N: JON e scN Su'-VLYIAj47 Ski4rP_/k&Q �:o '//� // ERTIFICATI N NUMBER: PHONE NU BERloptionatl: Srrca"N h, ST A-tsc>N ) Sao f'O SIGN �9G 40$0 CST S U E: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. l DILHR-SBD-6395 (R.02/82) —OVER — Timm JOB , SHEET NO. OF Excavating Co. CALCULATED BY GP I' �- �"- DATE ,­��+ R 1, BOX 192, Wilson, Wl M7 CHECKED BY_-------- D t T C-- SCALE_----- __ r _ Q, �/yf- /✓lci� In���'tKCF floc/ 1 bbu>77 yf r 1; /Mb ' �.� / 14 ` 0 z ,��en,ies �X �O a J f A. I o 0 a { r nc Gaon M... 11411 ' Timm JOB G Uii7 ��oc� Z t SHEET NO. OF--- �/ LCT cEr //N� • Excavating Co. CALCULATED BY DATE /0— 7 —&7� R BOX 192, Wilson, Wl 54027 CHECKED BY SCALE — — ---- j i.S�. s !` Lk, ` b r :a. r:rae the Groton Mau OIQI