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C) CD ~ N N 7 y j V cn CD U) Co tv O N O O A O o d b @ yp po O O CD 0 1 N :5p6 Ike 6 - .N 0 ~ ik. ST. CROIX COUNTY ~ WISCONSIN ZONING OFFICE IIN ON Ito ar ROW COUNTY GOVERNMENT CENTER 0x>JNT V 1101 Carmichael Road cta;fGUFtG VI Hudson, WI 54016-7710 (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 S •ig-Water (Nitrate & Bacteria) 45.00 ❑ Nitrate & Bacteria v V retest $15.00 ~s owner: j o6 ee4n Sehmi Requested by: }&.+Wctin Sch m '-N- Address: Se(o Valleu ew TY• Address: ,,le- So e r -S ZIP you 5 ZIP 0 Telephone W: (115) V9-6,&51 Telephone W: ( ) (o 12-~f3(~-(o(~5U OR g Property address (Fire N° & Street) : 13(0(0 rown's C-avie i4ou1-Ivn wz 5Lfo~z Location: 5 V1i J(V\/ Sec. 30 , T 30 N, R W, Town of S4-."o5e_ b (flDurkv,) Realty firm: Lock Box Combo: Closing Date: weed Ke' Close ~ before -Nhe evert 30 30. 19.3m y of- sePftm6e,,r CIS 030 -10$ 7-,ZD-000 a TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Water sample tap location: ~JlnereVer y6u Wanf Is the dwelling currently occupied? Yes ❑ No If vacant, date last occupied: Age of septic system: 10 y eats o.F iRcyy L► Septic tank last pumped by: 'l ir\KN `5 Date: -4 Previous Owner's Name(s) : Bohr, k^,,%'++ kui l t' Douse i r\ lgg(o Have any of the following been observed? ❑Y RN Slow drainage from house. ❑Y tRN Sewage Back-up into dwelling. ❑Y Sp Sewage discharge to ground surface or road ditch. M ❑Y RN Foul odors. Other comments relative to system operation: ~ I ~ I certify that the above information is complete and true to the N best of my knowledge. s ~ 1 ~ C"~ OWNERS SIGNATURE: G~vm&~ DATE: 131,o o 3 1/94 C N OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION IN d r 3 seph ~ b 12d to TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes ❑No soil series per SCS Soil Survey: sheet # Type of soil absorption system: ❑Below grd ❑At-Grd ❑Mound Approx. size 'X ❑Gravity ❑Dose ❑Pressurized Ft.Z ❑Bed ❑Trench ❑Dry Well ❑Holding Tank ❑Outfall pipe OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank Setbacks: ❑House ❑Well ❑Prop. line ❑Other Dose tank Setbacks: ❑House ❑Well ❑Prop. line ❑Other ❑Locking cover ❑Warning label ❑Pump/Floats ❑Alarm ❑Elec. wiring Soil Absorption System Setbacks: ❑House ❑Well ❑Prop. line ❑Other ❑Ponding: ❑Discharge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title ST. CROIX COUNTY WISCONSIN - ZONING OFFICE ° M"""' p ` M~■~i ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 y (715) 386-4680 September 26, 1996 John•& Kate Schmitt 586 valley View Trail Somerset, W 54025 RE: Correction of water sample location Dear Mr. & Mrs. Schmitt: Thank you for pointing out the error I made in completing the information sheet that accompanied the water sample submitted to Commercial Testing Laboratory for analysis. Specifically, I incorrectly listed your home address as the address from which the water sample was obtained. As you know, the sample was actually obtained from your rental property located at 1366 Brown's Lane in the Town of St. Joseph, St. Croix County, WI. I apologize for any inconvenience that this may have caused. Please share this information with any one who may be concerned with this issue. If further clarification is needed or if you have any concerns which I can answer for you, please contact me at the Zoning office between the hours of 8:00 am through 5:00 pm, Monday through Friday. Sincer ly, mes K. Thompson Assistant Zoning Administrator cc: Town Clerk Corp. Counsel file COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 { Colfax, Wisconsin 54730 XtA 715-962-3121 800-962-5227 FAX - 715-962-4030 ST. CROtX'COUNTY 20NING OFFICE REPORT NO# 26062/01 PAGE 9 ST.CROIX CTY GOV.CTR REPORT DATE: 9/24/96 1101 CARMICHAEL ROAD BATE RECEIVED: 9/18/96 RJDSON, WI 54016 ATTN t THOMAS C. NELSON yaj..r .sa OWNER. John Bate Schmitt LO c,T 7 CDJ Vry `i LOCATION. 13" Brown's Lane, Houlton ~c'~~~G FC!_' COLLECTOR; DATE COLLECTED; 9-17-96 TIME COL.LECTEDS 10.30as SOURCE OF SAMPLE! Kitchen f auce+ DATE ANALYZED; 9-18-96 TIME ANALYZED. 2:00poi COLIFORM,MFCC: 0 /100 mi INTERPRETATION! BacteriotogicaLly SAFE NITRATE-N: 1.4 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 gal Nitrate-Nitrogen, mg/L LAB TECHNICIAW Pam Gane WI Approved Lab No. 19 < Means "LESS THAN" Detectable Level Approved by' PROFESSIONAL LABORATORY SERVICES SINCE 1952 COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800-962-5227 FAX - 715-962-4030 ST. CROIX`COUNTY ZONING OFFICE REPORT NO,: 26462/01 PAGE ST.CROIX CTY GOV.CTR 1 REPORT.TraTEY 9/24146 1101 CARMICHAEL ROAD DATE RECEIVED: 9/18/96 HUDSON, WI 54016 ATTN: THOMAS C. NELSON l7WrERt John & Kate Schmitt LOCATION:a(dr4SS COLLECTER+# DATE COLLECTED: 9-17-96 TIME, COLLECTED! 10 30am SOURCE OF SAMPLE Kitchen faucet DATE ANALYZED29-18-96 TIME ANALYZED: 2+'00pm COLIFORM,WCC: 0 /100 mt. j INTERPRETATION: Bacteriologically SAFE NITRATE-Ni 144 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIAN: Pam Gane Y _ ri w b 19C WI Approved Lab No. 19 Sr CRQX f< ar7-Y ; NIyG o plce t deans "LESS THAN" Detectable Level Approved by: PROFESSIONAL LABORATORY SERVICES SINCE 1952 nfnp 3v0 t_ d `+1 C CO) O 0 0, c obi o 0 co n ~ o °w 3 =r N OD A 0) cn I C- -0 -4 O •D p 7 7 CD ? O R O 3: 6 3 O 3 N W O C ch 0) 0) d (n (D D C o 4) o m n 3 a p I lot CD CL :3 ~r ~ (D 11 N H N CO CO o co) Q C W rat G7 H _ 3 . Q O W O o ~ ~o H ~ Z I o 000, 1~1,i11 0 o =r CA CO) (a CD `D \ N 0 ~ !D Q lV d. y N o tz) Ln z (WD o O UQ O a 00 w = v 00 CD CD CD H En CCD D) a cc O; W E _ N ON rfO CL - W <p i a 3 o = o A z } C!] rt 7 o ooh ~o° A z rt (D W A` :0 rt b O I I a a ~ o - o a I ~ N I R p. I A I ~ O V o v A o b CD hC c p o . Parcel 030-1087-20-000 02/07/2007 04:51 PM PAGE 1OF1 Alt. Parcel 30.30.19.314H 030 - TOWN OF SAINT JOSEPH 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 KARL JASON & SANDRA DEE SOLIE O - SOLIE, KARL JASON & SANDRA DEE 1366 BROWNS LA HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1366 BROWNS LA SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 3.260 Plat: N/A-NOT AVAILABLE SEC 30 T30N R19W SW NW COM 788 FT E OF Block/Condo Bldg: SW COR OF SW NW, TH N 473 FT TO POB: E 33 FT, N 468 FT, W 303 FT, TH S 468 FT, Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) TH E 270 FT TO POB 30-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1203/88 WD 07/23/1997 733/436 07/23/1997 536/297 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.260 78,700 147,100 225,800 NO Totals for 2007: General Property 3.260 78,700 147,100 225,800 Woodland 0.000 0 0 Totals for 2006: General Property 3.260 78,700 147,100 225,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 134 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 • e Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER T ~~ic ry1 TOWNSHIP Ss~ Tp _5 SEC. T _?Q N-R~W ADDRESS R ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE r„ Z y~{,PFS PLAN VIEW Distances and dimensions to meet requirements of I•hHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM A 39 I° i i P'r, ~C I~ 1 ~ ti° ~Qta~~ 13M =/On SOUTH 'L07T LIVE _ TOP 5 'k1 O rv 1 k~ ST,q fit= INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 5VL CQftfe LIjT 7-,Okj Elevation of vertical reference point: 'A 100.dC1 ' Proposed slope at site: 0--2 A, SEPTIC TANK: Manufacturer: t'L, E C- K S Liquid Capacity: /,?-()0 6111. Number of rings used: - Tank manhole cover elevation: j p Z. IC, Tank Inlet Elevation: f C`f~,.S3 Tank Outlet Elevation: JQEj~ Number of feet from nearest Road: Front,Q Side o Rear, 0 ~S Z feet From nearest property line Front,0 Side,Q Rear, Q feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER facturer: Liquid Capacity: Pump Model. Pump/Siphon Manufacturer: p Size Elevation of inlet: Bottom of tank elevat' Pump off switch elevation: Gallon er cycle: Alarm Manufacturer: Switch Type: Number of feet from nearest p erty line: Front, Side, O Rear, 0 Ft. Numb of feet from well: tuber of feet from building: clude distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: ) 0 Length: Number of Lines: Area Built Fill depth to top of pipe: 6 Number of feet from nearest property line: Front, O Side, O Rear,®Vt . 7 Number of feet from well: AI, J 7 ' `1 T' Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liq . 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 HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevatio f bottom tank: Elevation of inlet: Number of feet from nearest property ne: Front, Side, O Rear, 0Ft. Number of t from well: Number feet from building: Nu r of feet from nearest road: A Manufacturer: f/ Inspector: , Dated: Plumber on job: License Number : ---s 3/84:mj 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 CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: ( El Holding Tank El In-Ground Pressure ❑ Mound If assigned) NAME OF PERMIT HOLDERI ADDRESS OF PERMIT HOLDER: INSPECTION DATE: John Schmitt Rt. 2, Box 295A 0 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. SW NW, Section 30, T30N-R19W, Town of St. Joseph Name of Plumber: MP/MPRSW No.. Cnumy Sanitary ermit Number: P Donavin Schmitt 3205 St. Croix 79162 SEPTIC TANK/HO DING TfANK: MANUFACTURE - LIQUID PACITV TANK INLET ELEV.. TANK OUTLET ELE V.. Y71ROPERTY ING LABEL LOCKING COVER O'dj, ,.`-y ICED: PROVIDED: 0n/~dr YES ❑NO ❑YES b(NO BEDDING: V NT DIA.: VENT MATI f HIGH WATE NUMBER OF ROAD: WELLBUILDINGVENT TO FRESH 4, c J ALARM FEET FROM INE JAIR INLET. ❑YES NO ❑YES ❑NO NEAREST DOSING C AMBER: MANUFACTURER BEDDING'. LIQUID CAPACITY PUMP MODEL IPIIMP,SIPHON Mn NUF ACTtIHEH WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE; PUMP AND CONTROLS OPERATIONAL NUMBER OF 'HOPE FtTY WELL BUILDING JVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM uNE AIR INLET. PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 1 AAME TEH 111ATI HIAL 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: BED/TRENCH WIDTH. LENGTH NO OF IDIST11 PIPE SPACIN❑ COVER [N11101 UTA -FITS LIQUID TRENCHES ht tIAL' PIT DEPTH'. DIMENSIONS DEPTH' FILL DEPTH jl'~SlllP E UISTN PIPE DISTR IPF M ERNO DISTI i NUMBER OF PROPERTY WELL. BUILDINGET BELOW IPES AB Vjr,COEEV. INLF 1 ELEV END PIPES LINE AIR INLET: 'jJw 0 • p Vt _~t'7 FEET FROM 111 Lp« NEAREST--- MOUND SYSTEM: /Ij Mound site plowed perp ndicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑ YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE 1111111ANINTMAHKIIIS IIIIISEIIVATIIINIVELLS _ ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BEU DEPTH OF TOPSOIL SOUOFU SEEDED MULCHED CENTER EDGES ❑YES. ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: tVIDTH. LENGTH NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO UISTH DISTR. PIPE DISTHIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.. ELEV. CIA. ELEV. PIPES DIA DISTRIBUTION INFORMATION HOL _SIZE HOLE SPACING CHILLED CORRECT L Y COVER MATER IAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS. 7ATION WELLS: NUMBEROF PROPERTY WELL: BUILDING: FEET FROM LINE' - ❑YES ❑NO ❑YES NO NEAREST t Sketch System on ~J in file for a'S u it. i t/ Reverse Side. Is 01 TITLE fill DILHR SBD 6710 (R. 01/82) ~ I wtsconsin APPLICATION FOR SANITARY PERMIT LJ DILHR (pLB 67) COUNTY inous inDUSTTaY.LR00 ~aeoasHumanaeLanons UNIFORM SANITARY PERMIT # / lo -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 PROPERTY OWNER MAILING ADDRESS PROPERTY LOCATION CITY: 7^ 54e1114 fL1 /4, S 0, T N, R E (or TOWN OF ' f ~ l7US~ ff LOT NUMBER BLOCK NUMBER SUBDIVISION NAME EST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER IVA 7_7c C, 7~4 4 E_ TYPE OF BUILDING OR USE SERVED 0,3 - 1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair El Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holdiny 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 , 0 ~3 6 Lift Pump Tank/Siphon Chamber ~s Holding Tank capacity 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: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): [X Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signatur MPRSW Phone Number: aj,Z~ X k 73.ie i_ Plumber's Address: Name of Designer: oz ~,4 S'c T r- COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ❑ Owner Given Initial Approved Adverse Determination !!~YA44 Y Reason for a ov 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 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. 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 wili on1v result in delays of the permit issuance. Should this development be intended for resale by owner/contrac WV,("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 y Location of Property Section , T N - R W Township Mailing Address Subdivision Name^ Lot Number _ Previous Owner of Property Total Size of Parcel Date Parcel was Created /~2 5' Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes _ No Volume Z5 and Page Number ._.t 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. f PROPERTY OWNER CERTIFICATION I (We) ceAti.6y that aU btatementa on tt.%6 4onm ane tAue to the befit o6 my (ouA) k.nowtedge; that 1 (we) am (ane) the owneA (b) o j the pnopeh ty deb cAibed in -th iz , injonmation 604m, by viAtue of a waAna-nty deed neconded in the 0jjice o6 the County Reg.cd.ten o6 Deed6 ab Document No. a? and that I (we) pneb entty own. the p to poa ed .6 to bon the .a ewage dizpoa a s y-6 tem ( an I (we) have obtained an,?,azement, to nun with the above de,6eAi-bed pnopenty, jon the con,6tnuction o6 baid 46y6tem, and the bame hab been duty neconded in the Oj6ice of the County Regi6teA of Deeda, aa. Document No. NATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 62 _-?'r~ t) PATE SIGNED DATE SIGNED z . cn . H 9 ST C- 105 r' r 9 SEPTIC TANK MAINTENANCE AGREEMENT ~H+ 0 St. Croix County z _ t7 OWNER/BUYER ROUTE/BOX NUMBER &KFire Number CITY/STATE ZIP S y~ 6 PROPERTY LOCATION:,5j{1 14, oV'I&l 14, Section ,30 T 0 N, R j ;F W, Town of .5; oTr~ F St. Croix County, Subdivision WA- Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect„ the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 0 ' E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x 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 K lz ~ ~i DATE 0 C Y 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. v • p to x x o t0 v,w~~ Macc^'30 v O a 0 A n ID O O O v3 ~ 0w w O C o O w w , N W, l< =c°~ 3 ccoco `n = o U C? (D '0 a 0 M0 O N a N O' M N m cn m CD CD CL 00 o -CD N f "ao m;K-Nww~ ~r 0 m CD Ca o3a Oti 10 OD (a w ■ w 0 o w O o a w c wws cl<Qmao "cam (n _.cDw~N ¢ 0 1 CD o O a CD a{ CO r In O CO f~D C , A < FD L) CD Cnc cny`~Q- U) O n O n• (D 7 N O - a - w ~ QCD to o a= w O 0 U) CD ANN (a"~wy c N cn CD CD 0 =r CD o M 0 3~ DM CL CD D cc 0 Q N a CD N. ~ > > aco ~m 3c? va5w3.~ C Al 0 CL CD c n ~A ~C m O a c0 cu ~D Q _ - P, M 0 C (n, p w C m-' CD ao~ (aaCCC~ 'n a w o RI w 3 w m 0. C a (D Cn CL o 0 CD O CD 0, S* C a O `G cc w 3 (D m n C G) co fD @ 3 ca O f 1 a 0 = O n a Ou 0 COOi 0 3 e a C-4 w (D -i (D C O m y (A O O a -+S w O _-x C O _3 O j O 0 O O In - w a 0 a CD O NIN (a CL .7 co CD v 0 z r` . DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, , GG DIVISION LABOR AN BOX HUMAN R€LATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: j COU TOWNS"UNICIIPALI~TY:LOT :BLK O.: SUBDIVI N NAME: a p 5 TY. ,4 WNER' UYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIA ESCRIPTION: [PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: Residence ZNew ❑Replace L /s A/W RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMM N D SYSTEM: (optional) 91 S ❑u ❑U 4, ~SS ❑ S ERU El S 21U If Percolation Tests are NOT re q DESIGN RATE/ q If any portion of the tested area is in the under s.H63.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: lei PROFILE DESCRIPTIONS / BORING TOTAL AL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, &OCOR, TEXTURE, AND DEPTH NUMBER ^ -P;FI1 ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B i9 oil em. 5. B3 B- 1o3 >oo "o 6 460 B-, 58 X38 ~8 tea' 00 S..t . s'~~ ,oc B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER NC S AFTERSWELLING INTERVAL-MIN. PERIOD I PERIOD 2 PERIOD PER INCH gy P_ © 3 ~v < 3 P- Z S-~ o'os P- .3 P FEET PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale i nces. Describe wza re the hori- zontal and vertical elevation reference points and show their location on'Pe - plot plan. Show the surface elevation at rings at~ trectlr' d percent of land slope. C3 co ~ ;CC SYSTEM ELEVATION y77 , hIp" . G E '-_P-iP I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best 4" knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIG T E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - T INSTRUCTIONS FOR COMPL -LTING Ff . 11 - D - 6395 To be a complete anri Accurate sail test, I. Compl- in-1 rip 2, The Lis Jo rr a ;ate whether this is project; 3. Ii+11A;, commercial use 4. , A SIT o n TAnty C'NL`t' IF ALL T E A' . plot plan; preferred. A e permanent; I test exemp- - e box; ITH THE C 'L- --AT- --R CER' m c'OIL T177 -1 c' *I L E P" - c3 - T p rr )Y MCJLle ~ 1.GA5 r 'A OL. l fO?,acj /OI`f • C fA Pa C(32~ PRAlly 13 Ilk b~ . 1 7S' 7-7 SepvC T'AHr QJ~t yL a p 1-0`f ''ASE sw 4 o r 5 OU T11' ~ L I AV'G 363* C,O r .2 ~ftc/~ S Ic'i~' ~c1~ 5'Si4 Y