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Home My WebLink About012-1014-60-000 St. Croix County Planning and Zoning Friday, October 30, 2009 at 3:45:14 PM Page 1 of 1 Detail Sanitary Information Computer 012-1014-60-000 Sub/Plat: NA Section: 5 Parcel 05.30.17.67C Lot: 2 TNIRNG: T30N R17W Municipality: Erin Prairie, Town of CSM: Vol. 02 Pg. 480 1141!4: SW 1/4 NW 114 Owner: Sylte, Steve 1769 160th Street New Richmond, WI 54017 State Permit: 75051 Issued: 0412211986 POWTS Dispersal: Non-Pressurized In-ground Permit: New Bedrooms: 4 WI Fund: County Permit: 0 Installed: 07122!1986 POWTS Detail: Bed -Seepage POWTS Pretreatment: NA Notes Money Owed Issuer/inspector As Built Plumber Other Requirements Additional Notes Mary Jenkins Yes Powers, Calvin 2009 foreclosure - fax info to prospective Powers 1200 gal. tank to 18'x 84' bed (sandy $0.00 buyer loam soil). verified Sylte purchase on WD 727-102 Tom Nelson Signed Off: Yes 1995 water & septic report Maintenance Scheduled Pump Date Pumped 7/2212006 5!7!2007 517/2010 - - r ST. CROIX COUNTY WISCONSIN ~~■~~MEMO ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER - 1101 Carmichael Road Hudson, WI 5Q16-7710 (715) 386-4680 December 18, 1995 Ms. Karen Sylto Jb/ - 0--060 1769 160th Street New Richmond, Wisconsin 54017 RE: Water Results for Residence Located at 1769 160th Street, New Richmond, Wisconsin Dear Ms. Sylte: Enclosed is the original test results from Commercial Testing Laboratory, Inc. for water inspection of the above you have any questions regarding these results property. If hesitate in contacting our office. please do not in rely, ames K. Thomp on Assistant Zoning Administrator mz Enclosure w COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800-962-5227 FAX - 715-962-4030 d C ST. CROIX COUNTY ZONING OFFICE REPORT NO., 97532/01 ST.CROIX CTY GW.CTR REST DATE: 12/13/95 PAGE 1 1101 CARMICHAEL ROAD DATE RECEIVED: 12/07/95 HUDSON, WI 54016 ATTNi THOMAS Co NELSON QWNERS Karen Sylte LOCATION. 1769 1600 St., New Richmond COLLECTOR: Jim Thompson DATE COLLECTEDS 12-06-95 TIME COLL.ECTED'# 1:45pm SOLIRCE OF SAMPLE! Kitchen tap.. C- DATE F .YZED:12-07-95 TIME ANALYZED: 2.00pm COLIFO RM,MFCCi 0 /100 mt INTERPRETATION1 Bacteriologically SAF~ NITRATE-NS 10 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIANS Pas Gane WI Approved Lab No. 19, < Means "LESS THAN" Detectable Level Approved by: PROFESSIONAL LABORATORY SERVICES SINCE 1952 J~ ST. CROIX COUNTY WISCONSIN taarraaai - ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 540 1 6-771 0 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. ❑ Water (VOC's) $185.00 ❑ Septic $50.00 Water (Nitrate & Bacteria) 45.00 ❑ Nitrate & Bacteria retest $15.00 Owner: Requested by: Safv~ Address: ~ 5.{. Address: N~Wc~nrn W1 _ ZI~PZIP Telephone W: (1 )o'ZL_ Telephone W: ( ) Property address (Fire W & Street) (01 I (00~" Location: W ;l, NW 31,-, Secs , T N, R W, Town of Re lty firm: _owr1 bock Box Combo: Closing Date:-22-9b TO PR OVIDE A SKETCH OF HOUSE &SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: Is the dwelling currently occupied? Yes ❑ No If vacant, date last occupied: Age of septic system: Septic tank last pumped by: Previous Owner's Name(s): Date: Have any of the following been observed? OY ON Slow drainage from house. OY ON Sewage Back-up into dwelling. OY ON Sewage discharge to ground surface or road ditch. ❑Y ON Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: DATE: 1/94 V OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION IN TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes ONO sheet # Soil series per SCS Soil Survey: Type of soil absorption system: OBelow grd OAt-Grd OMound Approx. size 'X ❑Gravity ODose OPressurized Ft.2 ❑Bed OTrench ODry Well OHolding Tank OOutfall pipe OBSERVED DEFICIENCIES ❑Other OUnknown Septic tank Setbacks: OHouse OWell OProp. line OOther Dose tank Setbacks: OHouse OWell OProp. line 00ther Mocking cover OWarning label OPump/Floats OAlarm OElec. wiring Soil Absorption System Setbacks: OHouse OWell OProp. line ther OPonding: ODischarge: General comments: ,.r INSPECTORS SKETCH OF SYSTEM LOCATION N I nspector- Title i i I St. Croix County Planning and Zoning Friday, February 02, 2007 at 4:38:52 PM Detail Sanitary Information Page 1 of l Computer 012-1014.60-000 Sub/Plat: NA Section: 12 Parcel 05.30.17.67C Lot: 2 TNIRNG: T30N R17W Municipality- Erin Prairie, Town of CSM: Vol. 02 Pg. 480 1141!4: SW 114 NW 114 Owner: Sylte, Steve 1769 160th Street New Richmond, WI 54017 State Permit: 75051 Issued: 04/2211986 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: 07/2211986 POWTS Detail: Bed - Seepage Bedrooms: WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Reauirements Additional Notes Money Owed Harold Barber Yes Powers, Calvin data from notecard - verified Sylte purchase on $0.00 Tom Nelson Signed Off: ~S WD 727-102 Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7122/2006 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - T"~~r i SVT.TV STEVE SW NW, Section 5 725 Mary Avenue T30N-R17W New Richmond, WI 54017 Town of Erin Prairie San.Permit#75051 2-86 C. Powers Conventional, New INSTALLED 7-22-86 i Parcel 012-1014-60-000 02/02/2007 04:32 PM PAGE 1 OF 1 ' Alt. Parcel 05.30.17.67C 012 - TOWN OF ERIN PRAIRIE 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 JEFFREY J SR SEAR O - SEAR, JEFFREY J SR VALERIE A KING C -KING, VALERIE A 2153 84TH AVE OSCEOLA WI 54020 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1769 160TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.650 Plat: N/A-NOT AVAILABLE SEC 05 T30N R17W 2.65A IN SW NW LOT 2 Block/Condo Bldg: CSM II PG 480 ORD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 05-30N-17W Notes: Parcel History: Date Doc # Vol/Page Type 05/24/2006 826059 WD 06/07/2000 624421 1517/228 WD 07/23/1997 WD 07/23/1997 727/102 2006 SUMMARY Bill Fair Market Value: Assessed with: 155670 348,900 Valuations: Last Changed: 11/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.650 39,800 301,700 341,500 NO Totals for 2006: General Property 2.650 39,800 301,700 341,500 Woodland 0.000 0 0 Totals for 2005: General Property 2.650 39,800 301,700 341,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 550 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I ~ 1.5 LI l'l ~5 E SUR E OR S RECORD Document No. 343881 CERTIFIED SURVEY MAP WEST 1/12-NW. 1/4-SEC. 5, T 30 N , R 17W N. W. COR SEC. 5 FD. NAIL ° " S 89- 26-07 W' _ C. T. H. ~E K 511.23' 50.0' 'go° .o HO DS I~ g1 / ) l b Y BEARING ARE ASSUMED SOUTH I EXISTING Ocr1 ON THE WEST SEC. LINE I ; d'4dfEg 91927 RESIDENCE ®¢4ia of p'~MA( LEGEND IJ l Iy,A~ oty,/1 BARN S 8 ~ U ON: I " X 24" I. P. SET, WT. I 1.68 LB. /LIN. FT. . LOT - o m ml 18.00 A. M 0' 50 100' 200' 300' 'm too °0 I d z N o SCALE 1= 200' t I APPROVED o ~ I SEP 21 197 66' TOWN RD. CRQIX GOUs"SY ST• s tu►►~a CCwtP+~Ner►E P~ WEST LINE SEC. APPROVAL OF THIS MINOR SUIlDiVISION DOES NOT MEAN APPROVAL FOR I I BUILDING SITE OR SEPTIC SYJEM. REFER TO H62.20. 0 N 87~511~.56' THIS INSTRUMENT DRAFTED BY A. C. N. 35.60' 294.40' ' 181.56' JOB NO. 77-76 - I L09 >1H1>s0 CON zy LOT- 2 M ALf.FJ~t C. 2.65 A. 4 NYI~iAGEN ' • 8.1407 T I 36.44' a . • tiUD30 N870-51-34E. IS. Q`o►~~ 330.0' it'a 4 .►~JE~ ~~w VOL. 2 PAGE 180 tip suR°~ 0 CERTIFIED SURVEY MAPS j14 1 ST..CROIX COUNTY, WI. Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP /]~/.r) l '~P~t/.~/•~ SEC._ T , N-R~W ADDRESS y7~ uar' ST. CROIX COUNTY, WISCONSIN V7 C!~Iln SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t ~ I off, i 33 R r INDICATE NORTH ARROW a - BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer:a Liquid Capacity: Number of rings used: - Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Roads Front 10 Side, Rear, O feet .From nearest property line Front,O Side,Mi Rear,O 7 feet Number of feet from: well -s' building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank). SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: /g Length: Number of Lines: _ Area Built:,,j/ Fill depth to top of pipe: r--'271' Number of feet from nearest property line: Front, O Side, O Rear, pt Number of feet from well: `y Number of feet from building: :4 (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 O 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: 1^~~ License Number : 3/84:mj DEPARTMENT OF,INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS DIVISION LABOR 8i HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.0.80X 7969 mber: MADISQN# W 1 53707 W N V E NT ❑ ALTE R NATI V E t I O N A L ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound INSPECTIONAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: ~ ~ Steve Sylte 725 Mary Ave. , New Richmond EF. PT. ELEV. REF. PT . EBENCH MARK (Permanent reference point) DESCRIBE IF DIFFERT FROM PLANSW NW, Section 5, T30N-R17W, Town of Erin Prairie Sanitary PeCal Powers, Jr. MP/MPRSW 1563 S t~ Cr01% No.: County: 750Name of Plumber: MANUFACTURER: LIQUID CAPACITY:, TANK INLET ELEV.: TANK OUTLET EL V. WARNING LABEL LOCKING COVER SEPTIC TANK/HOLD G TANK: N ED: PROVIDED: t y ~ q~, ~ YES ❑NO ❑YES NO ` A " 2-o v ` v PROPERTY WELL: BUILDING: VENT FRESH VV" HIGH WATER NUMBER OF ROAD: LI A AIR I ET. BEDDING: VE T A.: VENT nnayL.-. ALARM: FEET FROM r(((t/4 j ❑YES NO NEAREST ( ❑YES NO DOSING CHAMBER: PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVE . PUMP ODEL . PROVIDED: PROVIDED: : MANUFACTURER: BEDDING: LIQUID CAPACITY ❑YES ❑NO ❑YES ❑NO H ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING AIR INLET: LINE . PEtET FROM (DIFFERENCE BETWEEN ❑YES ❑NO NEAREST SOIL LENGTH DIAMETER. MATERIAL AN-1.1-111,114- PUMP ON AND OFF) or ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) LIQUID BED/TRENCH CONVENTIONAL SYSTEM: \V(~~ INSIDE DIA : #PITS' DEPTH: WIDTH: LE TH DISTR. PIPE SPACING: iv1g1`EF~IAL: PIT NO.OF ~ TRENCHES : DIMENSIONS PROPERTY WELL: BUILDING: V Ni TOTRE GRAVEL - f FILL DEPTH DIS PIP . DISTR. PIPE DISTR. PIPE TERIAL: P PESIST NUMBER OF uN@. ~ ~ T3 BELOW r ABE COVER ELEV. INLET ELEV. END: ~j FEET FROM f NEAREST MOUND S STEM: 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 TON REVERSE SIDE. ONS MEASURED, SHOW ELEVA- meets the criteria for medium sand. PERMANENT MARKERS: OBSERVATION WELLS ❑YES ❑NO OIL COVER TEXTURE ❑YES ❑NO ❑YES NO SEEDED. MULCHED. DEPTH OVER TRENCH/BED EDEPTH DGES OVER TRENCH/BED DEPTH OF TOPSOIL SODDED : ❑YES NO CENTER ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH ABOVE COVER: WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO DISTR. DIA.R PIPE DISTRIBUTION PIPE MATERIAL & MARKIN : ELEV., ELEV.: DIA.: ELEV.: PIP S, ELEVATION AND VERTICAL LIFT CORRESPONDS TO APPROVED ❑ISTRIBUTION COVER MATERIAL: PLANS. INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY ❑YES ❑NO YES ❑NO COMMENTS: 1O PROPERTY =LDING: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF LINE: ❑YES ❑NO FEET FROM ❑YES ❑NO NEARES- 9-1 ,q4 county file for audit. Sketch System on TITLE: _ Reverse Side. SIGNAT 7~. DILHR SBD 6710 (R. 01/82) w,sco EZ nsn APPLICATION, FOR SANITARY PERMIT D I L H R (PLB 67) COUNTY UNIFORM SAN-ITARY PERMIT inDU5TRV,LRBOR6 MUTRr7RELRT10n5 2505/ -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNE R MAILING ADDRESS :ie~25 7'-Z57 IA~ PROPERTY LOCA N C+T-Y: V AGE: 1/4 Alk) 1/4, S N, R l (Or TOWN OF: _Sj LOT NU ER BJSUBDIVISION AM NEAREST ROAD, LAKE OR LA pMARK STATE PLAN I.D. NUMBER /i TYPE OF BUILDING OR USE SERVED - - IN 1 or 2 Family Number of Bedrooms: U Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. X Seepaye Bed ❑ Seepage Trench U Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity i Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: Eli PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Squa/Feet): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installati of th private sewage system shown on the attached plans. Nam of Plumber (Pri Sign r 000, MP/MPRSW No.: Phone Number: Plumber's ddress: Name of Designer: 0. _21J COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ~ ❑ Disapproved ~ ❑ Owner Given initial -,z Approved JJ'''' b Adverse Determination Reason or Dis rov : Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County; One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.) ; 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipes). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. DEPARTMJEN-T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, , DIVISION LABOR AND PERCOLATION TESTS (115) MADISON, P.O. BOX 76 HUMAN RELATIONS WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MU1#te P*My: OT .:BLK. ISUBDIVISPN NAME: (o 414', rE CO NTY: OWNER'S BUYER'S NAME: MAILING-AD ADD SS USE DATES OBSERVATIONS MADE NO.BEDRMS,: COMMER DESCRIPTION: PROFILE DESRIPTIONS: E LA TESTS: Residence ICJ New ❑ Replace RATING: S= Site suitable for system U= Site unsuitable for system ONVENTI NAL: MOUND: IN-GROUNcDPRESSURE: S STEcM-((N-FIL LDcNG TANK: RECOMMNDED YSTEM:(optional) ®S E:1U QS 'J/ 42 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: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH ROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH MC OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BAC B_ ~ ryolf S.6 - - fJ B_ ~8- y~ CstJ B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IfdGH66' AFTERSWELLING INTERVAL-MIN. PERT D 1 PERI 2 -PERIOD PER INCH P- P- S P- 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 to on on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 116 s - - - _ _ r l i - ~ : ~ _ e E gym. "aW ! 3 € I f 3 i i f { y....... 1 t / I, the undersigned, hereby certify that the soil tests reported on this form were made by mein 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. NAM print).. TESTS WERE COMPLETED ON: I _'i4e . o . AD E S CERTIFICATION NUMBER: PHONE NUMBER (optional): .,n 1 7j, CS I N URE: ' ION: Original and one copy to Local Authority, Property Owner and Soil Tester. 3D-6395 (R. 02/82) - OVER - L- - A INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5, Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N,A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required, ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob Cobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone *s - Sand HGW - High Groundwater cs Coarse Sand Perc - Percolation Rate med s - Medium Sand W - Well fs Fine Sand Bldg - Building Is - Loamy Sand > - Greater Than "'sl - Sandy Loam < Less Than ' i - Loam Bn - Brovvn *sil - Silt Loam BI Black si - Silt Gy - Gray *cl - Clay Loam Y Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loarn mot - Mottles sc - Sandy Clay w1 - with sic - Silty Clay fff few, fine, faint *c Clay cc - common, coarse pt - Peat corn - Many, medium m - Muck d - distinct p - prominent HWL - High water level, Six general soil textures surface water for liquid waste disposal BM - Bench Mark VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. 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 Location of Property Section , T~N-R W Township A zZ Mailing Address 7S Address of Site Subdivision Name Lot Number 1 p \ 1 Previous Owner of Property Total Size of 'Parcel`s 2._ Date Parcel was Created Y,Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume Z2 2 and Page Number 14.2-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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPFRTV OWNER CERTIFICATION 1 (we) centi.by that att statements on this bonm aice true to the best ob my (oun) k.nowtedge; that I (we) am (ate) the owner (s) o6 the pho peh ty des ch i bed in this inbonmafii,on bourn, by vi tue ob a waA&anty ged teco&ded in the Obbice ob the County Register ob Deeds" Document No. and that I (we) pneaenfi,ty own the pnoposed.site bon the sewage diApod .dyd em (on I (we) have obtained an easement, to nun with the above deackubed pnopenty, bon the construction ob.said system, and the same has been duty neconded in the Obb.i.ce ob the County RegiAten ob Deeds, as Document No. 1. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) w ~ DATE SIGNED - DATE SIGNED H z H a S T C - 105 r r ,a H SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County z d a OWNER/BUYER 2v ROUTE/BOX NUMBER p Fire Number .CITY/STATE_~~~\ ZIP PROPERTY LOCATIONSection_T~lgj N, R1W, Town lof _z~ l °lL St Croix County, f Subdivision Lot number 9 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 pdt into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant/for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank.is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior,to three year expiration. 0 "I/WE, the undersigned, have read the above requirements and agree --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 Office within 30 days. of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 9&X` Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. wscon,n SANITARY PERMIT n ~ GROUNDWATER SURCHARGE Sanitary Parmlt No. 17 On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com- monly 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 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. E gnature of Ground Groundwater Fee: Date: WISCO DILHR S :z-J~ buried z = 28 r u. e sybi7 ,l3,EO S'i z v ~ S,-"Al, C,E .~•Cde,J o~J,~,K's 1?l~°,f siJ /s'~.~ I ~ a 90 6 46, 9s!7 ao~' ias 9~ la3 R _ _ . _ ~ y3- F d.lmt ..Li.JF PAGE OF E~ .T.c lra~o ~t C. r c) S S S c I o o 13 t~ S y 5 er-j S~/7 Fresh Air Inlgle And Observation Pipe Approved Vent Cop Minimum 12" Above ~FIU Grade 20- 42" Above Pipe _ 4" Cost Iron To Final Grade Vent Pipe Marsh hey Or Synthetic Covering tam. 2" Aggragote Over Pipe Distribution -Too Pipe o 0 6" Aggragole o Perforated Pipe Below Bassof Pipe 0 Coupling Terminating At Bottom Of •16100 PrppO~eU T'►naI 9rA~lt ~ SOIL FILL DI5TRIBUTIOI.1 PIPE APPROVED S4N"fHETIC COVER 'MATIM4 OR 9~' OF STRAW Z"OFt1►bGRE~AIE e OR (JARSN HAS FO Y2-2'I2 AGGREGATE tLEV. OFZ FEES(- DISTRIf5L1T10kI PIPE TO BE AT LEAST s INCHES BELOW ORIGIKJAL GRADE A►JU AT LEASTZO ►AICHES BUT AIO MORE THA1.1 H2 IAICHES BELOW FINAL GRADE /MIM14 DEPTH OF EXCAVAT1,00 FROM oKi&*JNI 6RADE WILL BE INCHES PUNiMUM 09f" of FACAVATIOW FRoM'oIKl(AWAL GRAPE WILL BE _ INCHES 51GKIED: LICEUSE DUMBER: ,L.s'l3 ' DATE* 110