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HomeMy WebLinkAbout018-1000-60-050 St. Croix County Planning and Zoning Detail Sanitary Information Computer 018-1000.60.050 Thursday, October 12, 2006 at 10:35:53 AM Parcel 01.29.17.4A10 Sub/Plat: Water's Edge Municipality: Hammond, Town of Lot 2 Section: 1 Page 1 of 1 CSM: V01.05 Pg. 1301 TN/RNG: T29N R17W Owner: Boldt, Glen 2076 117th Ave. Baldwin, WI 54002 1/41/4' SW 1/4 NE 1/4 State Permit: 75032 Issued: 03/25/1986 County Permit: 0 Installed: 06/19/1986 POWTS Dispersal: Non-Pressurized In-ground POWYS Dip; Permit: New Bed -Seepage Notes POWYS Pretreatment: NA Bdrooms: 3 WI Fund: issuerllns+ ' Built Plumber Tom Nelson Yes Other Reoufr Tom Nelson Signed Off; No Bird, Shaun Additional Notes Maintenance check both .85 and 86 archives for permit data Scheduled PumO Date Pum 1st Notification from notecard only $0.00 - - 2nd Notification - _ _ _ 6/19/2005 _ _ - - - 3rd Notification D~ /ODO -lad-DOd ~ B6L17f GLENN SW NE Se n 1 Hammond, (i11 - T29N-R17W. WK-04 Hammond; bC-- I Lo.t 2, Btt 2 San,PeAmit#75032 3-25-86 E. Botdt Conventionat, New Insed: 6-19-86 Parcel 018-1000-60-050 10/12/2006 10:32 AM PAGE 1 OF 1 Alt. Parcel 01.29.17.4A-10 018 - TOWN OF HAMMOND 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 GLEN & DORIS (LE) BOLDT 0 - BOLDT, GLEN & DORIS (LE) 2076117TH AVE BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2076 117TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 5.850 Plat: N/A-NOT AVAILABLE SEC 1 T29N R1 7W PT GOV 2 6.1AC TO WATERS Block/Condo Bldg: EDGE LOT 2 OF CSM 5/1301 FKA (4A) 018-1000-60 EXC AS DESC IN QC-1669/282 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 01-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 06/26/2001 649533 1669/282 QC 07/23/1997 858/573 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/13/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.850 64,200 65,300 129,500 NO Totals for 2006: General Property 5.850 64,200 65,300 129,500 Woodland 0.000 0 0 Totals for 2005: General Property 5.850 64,200 65,300 129,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 09/27/2005 Batch 05-19 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC N-R % W f` ADDRESSf ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•TZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM .1 ~ zve77 ~ . SZ z~ o /000 lZ~ t~ 35 Sep " 3.2 :F-- 50 CIO Z, INDICATE NORTH ARROW JVo. BENCHMARK: Describe the vertical reference point used 0~ ' eil c i &f42 - 4 F' , 11 Elevation of vertical reference point: O- 0 Prolllcl~ posed slope at site: SEPTIC TANK: Manufacturer: h~c°c°5C Liquid Capacity: /DOU Q Number of rings used: o~ Tank manhole cover elevation: Tank Inlet .Elevation:/Q/.,?Q Tank Outlet Elevation: f013 -900 Number of feet from nearest Road: Front,0 Side, (TA Rear, O feet • From nearest property line Front 10 Side, 0Rear, ® feet Number of feet from: well 7, building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE ~ w PUMP CHAMBER Manufacturer: Liquid spa ty Pump Model: Pump/S n Manu actur r: Pump Size Elevation of inlet: Bott of a 1 vation: Pump off switch elevation: Gal o p (r cycle: Alarm Manufacturer: . Al Swi Type:. Number of feet from nearest prope t line: Fron , 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: Lendth: . Number of Lines: Area Built:_ZZO 12 Fill depth to top of pipe: 20 Number of feet from nearest property line: Front © Side, Rear, it. so Number of feet from well: Number of feet from building: -3~ (Include distances on plot plan). SEEPAGE PIT Size: Number of'p t eter: Liquid depth: Bot o of see ag pi el vation: Area Built: Has either a drop box O or dist butio b b en u d on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: ev do df bot of tank: Elevation of inlet,.' ide, O Rear, 0Ft. S Number of feet from nearest pro erty li r KO Number of fe t from w 11: Number of feet om bui d ng: Number of feet from nearest oad: Alarm Manufacturer: / Inspector: Dated:-2d CA Plumber on job: .!Dill License Number: 3/84:mj DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS INSPECTION REPORT FOR P.O. BOX 7969,..... L PRIVATE SEWAGE SYSTEMS SAFETY & BUILDINGS MADISON~ WI 53707 DIVISION y-y~y BUREAU OF PLUMBING "L-r`E:ONVENTIONAL ❑ALTERNATIVE El Holding Tank State Plan I.D. Number: ❑ In-Ground Pressure ❑ Mound (If assigned) NAME OF PERMIT HOLDER: Gtenn $otdt ADDRESS OF PERMIT /HIO'7LDER: INSPECT JN HATE Hammond, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: p / ! JI V 3 SPll NF, Section 1, T29N-R 17G1, Town ob Hammond, Lot 2, Btk 2 REF. PT. Name of Plumber. ELEV.: CST REF. , ELEV : EvC/(• e Aett Botdt MP/MPRSW No.: County; 4 /t G!7 Sanitary Permit Number: SEPTIC TANK/ DING TANK: 407 St. GAoix 75032 MANUFACTURER: I 1 1 LIOUI\D O CAPACITY 1/: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOR W 'f~ ,/VJ1,K/J` 1 Cl //1 / 97 PROVIDED: CKING PROVIDED: COVE BEDDING: VENTDIA.: /V/ /V7 / v WYES ❑NO - J-0 VENT MATL.. HIGH WATER ❑YES ❑YES IC4 C / ALARM NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH O ❑YES FEET FROM LINE 7 ' / AIR INLET: DOSING CHAMBER: NO NEAREST MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUF IRER: ❑ YES ❑NO WARNING LABEL LOCKING COVER GALLONS PER CYCLE: vROVIOeD: PROVIDED: (DIFFERENCE BETWEEN PUMP AND CONTROLS OPERATIONAL: DYES ❑NO ❑YES ❑NO PUMP ON AND OFF) ES BER OF PROPERTY WELL BUILDING: V NTTOFRESH F AIR INLET: SOIL ABSORPTION SYSTEM. Check the soil mois ❑ Y ture at the depth of plowina O ET FROM LINE or excavation. (If soil can be rolled into a wire, construction shall cease until - I EAREST FORCE 'H DIAMETER: MATERIAL AND MARKING the soil is dry enough to continue.) CONVENTIONAL SYSTEM: MAIN BED/TRENCH WIDTH: LEN TH NO. OF _ O TRENCHES. DISTR, PIPE SPACING: COVER DIMENSIONS l / M ERIAL: INSIDE DIA 1 #PITS: PIT LIQUID ~HAVEL UEPTN FILL DEPTH DISTR. PIPE DISTR. PIPE IDISPIPE MATERIAL DEPTH: BELOW PIPES: ABOVE COVER: ELEV. INLET ELEV. END: ( 7 ' PPEDISTR. FNUMBER OF PROPERTY WELL (J O d X72 " EET FROM LINE: 7 BUILDING: V NT T FRESH 1 c ~O J AIR INLET: MOUND SYSTEM: S Mound site plowed perpendicular to slope and furrows thrown upslope: Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES ONO meets the criteria for medium sand. OIL COVER TEXTURE TIONS MEASURED. PERMANENT MARKERS: OBSERVATION WELLS: DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: ❑YES ❑NO ❑YES CENTER: EDGES. ~NO SODDED: MULCHED PRESSURIZED DISTRIBUTION SYSTEM: DYES ❑NO ❑YES ❑NO ❑YES ❑NO BED/TRENCH WIDTH LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: DIMENSIONS TRENCHES: FILL DEPTH ABOVE COVER: MANIFOLD PUMP MANIFOLD ELEVATION AND ELEV.: ELEV.: - DIA DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE PIPES: DISTRIBUTION PIPE MATERIAL & MggKING: DISTRIBUTION Dln.: INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED COM ❑YES ❑NO PLANS: MENTS: PERMANENT MARKERS: ❑ YES OBSERVATION WELLS: ❑NQ ❑YES ❑NO NUMBER OF PROPERTY WELL: BUILDING: ❑YES FEET FROM LINE: ❑NO NEAREST ketch System on everse Side. Re tai in county file for audit. SIGNATURE ILHR SBD 6710 (R. 01/82) nrL - - ""x`°"51" APPLICATION FOR SANITARY PERMIT (PLB 67) lid COUNTY 'LHR ~ OEPFiRTTEI-IT OF UNIFORM SANITARY PERMIT # - InouSTRV, LRBOR& HLIMRn RELRTIOnS -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERLY WN~oEN~ MAILIN ADDRESS (~•!T Aram oNc~ G~i+ S' PROPERTY LOCATION CITY: v .5~w114NE 1/4, S / aq ~7 , T , N, R E (o ownl oF. ArnMO~ LOT NUMBER BLOCK NUMBER SUBDIVISION NAME 7REST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER /11/14. !A/ e- LaMe- TYPE OF BUILDING OR USE SERVED - Q! _ lea6 _4::~ a_ Ov, 1 or 2 Family Number of Bedrooms: ~G✓O ❑ 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. XSeepaye Bed ❑ Seepage Trench ❑ 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 Gallons #of Prefab. Site Steel Fiberglass Plastic Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: 100- e 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: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): (030 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for in Iation of the private sewage system shown on the attached plans. Name of Plumber (Print): igna ur MP/MPRSW No.: Phone Number: mP 44P9 1115-)6A4~7Y Plumber's A Name of Designer: f~/~ W 1 S COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved „ ❑ Owner Given Initial Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County; One Copy To; Bureau of Plumbing, Owner, Plumber I 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 pipe(s). 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. i APPLICATION FOR SANITARY PERMIT . STC - 100 the owner(s) of the This application form is to be completed in full and signed b delays of the permit property being developed. Any inadequacies will only result in 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 0z L e- j ~ - • SW k• Z ,9 - Location of Property It Nw Section T N R W . Township .4 M L cl w i,J t• S p Address A to- Subdivision Name D /I Lot Number ~w o SAM ~ Previous Owner of Property ~la e- S Total Size of Parcel 76~ c, . Date Parcel was Created Yes No Are all corners and lot lines identifiable? Is this property being developed for resale (spec house) ? Yes No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. - _ _ _ _ r _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ r... _ _ _ _ PROPERTY OWNER CERTIFICATION I (We) cvLU6y that a t btatementa on thiA 6onm ane true to the beb,t o6 my (oulO . knowtedge; that I (we) am (axe) the ownen.(6) o6 the ptopeAty de cAibed in thi4 .tee o6 the .,n6oxm by viAtue o6 a deed neeoxded in the 066 ati.on 6oxm, 51 O 0 ; and that I (we) County RegAtex o6 Veed6 a6 Document No. i ob bybtem (ax I (we) have pn.ebent4y own the pkopoaed 6 ito bon the 6ewage p the obtained an eabement, to Aun with the above de cAibed pnopaty, 6ox eoatxueti.on o6 bard bybtem, and the tame hab been duty neeoxd,d in the 066ice . o6 the County Regd.6teA o6 Ueeda, ab Document No. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 3_ DATE SIGNED DATE SIGNED V3 c k-, ~iw 110 ARTHUR L ; WEGE4ER 5-963 ; ELLSWORTH GS.C~2 ; W S, NOTE: CURVE DATA TABLE AND DESCRIPTION ON REVERSE. ''•.,NO SURD CERTIFIED SURVEY MAP LOCATED IN THE NEI/4-NE 1/4,SE1/4-NE 1/4 AND THE SWI/4-NEI/4,SECTION'i T29t' R 17W'STo 09 4QF HAMMON~D, ST. CROIX COUNTY, WISCONSIN. Affidavit 668-175-- 3767.20 Z.--f 1498.76 N114 CORNER SECTION OWNED BY: GLEN BOLDT ^I ROD' REC. AS SOU I, T29 N, R17W.II"IRON S1/4 CORNER SEC. 1, W 1453.05' RT. 2 , BALOWlN , W 1S. T29N, R17W. ( I"I.P. I y g~ O:z PIPE FOUND) FOUND.) N N-S QUARTER SEC. LINE. 3 NO049'05"E 66.02 3 .OI 33.01 Z M Pit E~ 1983 1 A%461983 00 is ' Gel; ••di • C nt L. 4 -1-5 O = SET 1 Od/ .Z r, "X 24" IR v0 v r 1.13 LBS. PER LI Qr 'D .r N0041 '48"W • ' 1" IRON PIPE FOUND. •Z .D I 43.55' ° '-q APPROVED :rn ~J o - ,v r ~ See 33lo 3a, JUL 61983 F, N Iw s\w 2g . m 34is~ ST. CROIX COUNTY 6 FOMP-MMEN3IVE PARKS PLANNING 024 Off ' S64 .0 5140 ZONING COMMITTEE er- 6 6.00 of 14 Iw \ p`~po a,, 49058 ,00115.85 ) I 1 9~e7 F 01, (REC. AS I 66'WIDE ROADWAY ~ N5049.58~W 66 ~ EASEMENT IA N ~w 1 Z 3313, Z SCALE N79°01'52"E I ~1 ao O► m Oo Iv 0' 50' 100' 200' o - `~O® p NOTE: BEARINGS REFERENCED TO THE ro I~° N-S QUARTER SECTION LINE OF SECTION 1. (ASSUMED BEARING ? 'm 3c1 .v, S0009'34"E). O to ' D o A `So S A Ip N ro \~aOD_ A GARAGE low /rte n ° 580 ` N10 14..00 0 ~ - co N10°58 08 W Z LOT 2 4 a' 4.765 AC. TO M.LINE X63 LOT ,Id I co . W 0 (207,567 SO. FT.) X02 2.981 AC.TO'M. 6.1 AC-TO EDGE H20 (129,859 SO.FT HOUSE 03.66 AC. TO M.L. AND EASEMENT LINE. to 3.2 ACZ TO EDGE (159, 635 S0. FT.) 2.754C.TO M.L AN N EASEMENT LINE. m b (119, 769 SO. FT.) OI e 01 ul$ SEPTIC W TANK O Jg11Z.45 68„E 3o A VENT oN/nN 4 9° ' 32 ~9! W /00 83 d6 4~ b 0=/ 4 `59,17"tv 0 y I 01 2 e3, O 33 2~ W / S 83-83 ss 71.15'-0/ Volume 5 Page 1301 n 5 2°04'41"E THIS INSTRUMENT DRAFTED BY -Ar CURVE DATA TABLE CURVE RADIUS CENTRAL CHORD NO. ANGLE ENGTH CHORD BEARINGS ARC 1-2 LENGTH TANGENT BEARINGS 50.00' 73°35'26 60.13' N42004'09"E 64.51' ATI N79° 0 52 E 3-4 80.00' 163°55'26" 158.43' N 87°04.09"E 228.88' ATE N 0 06 26 E ° DESCRIPTION It Arthur L. Wegerer, registered land, surveyor, hereby certif : That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St.Croix County Sub- division Ordinance and under the direction of Glen Boldt, owner of said land, I have surveyed, divided and ma d said parcel of land, that such plat correctly represents all exterior boundaries and the subdivision of the land surveyed; and that this land is located in the NE4 of the NE4, 'the SE4 of the NE4 and the SW4 of the NE4, of Section 1, T29N, R17W, Town of Hammond, St.Croix County, Wisconsin, to-wit; Commencing at the Nk corner of Section ~1;l then e68S07 09134 " along the North-South Quarter Section Line 1498.761 (Rec• as- South 1453.051) to the centerline of a Town .Road • thence N89.18112"E along said centerline 1436.60' (Rec. as 1440.661] to the point of beginning; Thence NO.4910511E 33.011 to the southerly line of the Certified Survey Map recorded in Volume 2 of Certified Surveys, Pa e N89.1811211E along said line 170-95'; thence NO°411481r g 445; thence easterly line of said Certified Survey Ma S1. W along the along the southeasterly line of said Certified SurveheMance p 320 071181TE theneS64•24151"E 6.001 to the be innin of a meander line3along Pine Lake; thence S18°3311611W along said meander line -1; ° 1811211E 114-131; thence N36.1315211E 125-071; thence 56•, thence 689 thence S84°43' 2911E 170.941' • thence N t1N10 51' 25"E 96.61' ; 2911E 163.41'• thence N 2• + 1145 32 57 E 221.111; thence N17.211 ' 4 53 22 E 48.76'; thence N85.11' 01fE 60.051; thence S10°46159"E 112.451; thence S75•0212 "E 94.2.6f; 4 17"W 83.771; thence S33.1510811E 160.081• thence S2.0 ; thence 11'•591 ~ 1 1f 4 41 E 71 thence 12102715611W 149.831; thence • 3 W 141.26; , 45'4411E 43.38' to the end ofthemeander line; thence1N88'16119"W4° 509.091 (Rec. as N88.41'431'W 520.561); ° 1011 (Rec. as 115.851) ; thence 589.1812 W 386.1891; thence NO%15.14'• 33.01' to the point of beginning, 49'05"E Contains 9.3 acres± including all lands lying between the meander line and the water's edge. Subject to roadway easement as shown. Dated this ` day of :g'wyj 1983. ~ Arthur L. Weger r S-9 3 Kozel, Wegerer and Assoc. River Falls, WI ARTHUR L• ; C WEGEM S-9'53 } ELLSWORTH WIS. •`~'~,4D SUR,41 Volume 5 Page 1301 z En H 9 STC - 105 r r 9 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z d 9 OWNER/BUYER Gl_& ' OLg~~' ROUTE/BOX-NUMBER Fire Number .CITY/STATE V.4L.4"J W~,S ZIP 0Z. PROPERTY LOCATION: c5'W 14, /✓uJ ;4, Section / T oZ7 N, R__~7 W, Town of ITRi+'fmowcal St. Croix County, Subdivision &Z2 Lot number A 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. o E 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- ro ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE _af-6 6 St. Croix County Zoning Office P.0. Box 98< Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. SANITARY PERMIT- . ~ D of ■ oEPCwmIEi n,LH GROUNDWATER SURCHARGE County W%3„s„VV,UaERM&1- „ ar Sa~nyltary Permit Na. 5-C2 3 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. Ground abew Signature of Issuing Agent: Groundwater Fee: Date: WISCO i#'S I 7$- buried ttet#ftt DILHR SBD•7289 (N. 05184) ! t gEPARTM,NTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS II~L~iJSTF3Y, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN REtATIQNS` 1 / MADISON, WI 53707 (H63.090) & Chapter 145.045) L A SECTION: T ! TOWNSHIP/MUNICIPALITY: OT NO.: BILK. NO.: SUBDIVISION_NAME: ,j I/ I/ j /1 IR 1 (or W f~J/f COUNTY: ` O N 'S YE S NAME: MA LI ADDRESS: Z217 Z& USE DATES OBSERVATIONS MADE NO. BE ,MS.: C M ALD SCRIPTIO lPR ) TESTS: ~ffResidence : ANew ❑Replace RATING: S= Site suitable for system U- Site unsuitable for system ll sa* l car„ O ONVEJNTIONAL: MOUND: IN-OR f} ESSUR ST M-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) IV s l F-1 r~ ou sou Lis au ((If Percolation Tests are NOT required D SIGN RATE: I I If any portion is the tested area is in the :Under s.H63.U$(5)Ib1, indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPIH O R UNDWATE -'-INCH S CHARACTER OF IL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH ' NUMBER DEPTH IN. ELEVATION 'OBSERVED EST. T S TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) A;9/ j1' s-2 07, a? S s- ~.0' 10.3 aye B 9 tom. ` L'„f / Off(.. k~ p 5/1, /I~ y~f ! z7 r S/ l e. J# e - /~2~2 0~~' .da t~- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP 'I WATER LEVEL-INCHES RATE MINUTES NUMBER -MOMM AFTERSWELLING INTERVAL-MIN. PERI D P I PER INCH P /D r /3 P- U 0 15 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 location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION /r1 or3 50 e. k X Demo ../ho, CI 41? 1-C tN 4 f. , - ~/,7 "re e _B-Is e o J a We, A;1 ee -117 01C15 1'~e2 r 5 a "?i e .e a n ~ 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print ' TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): C1 Uj ;Q 0j I'S 0- 4,?11- 3574? L: URE; w t e (b ~ d p 11 ~ ' n O b 0 o c 0 Q A •b -eq , al