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HomeMy WebLinkAbout040-1192-40-000 n w O 3 v n d _1 O :e C O O I'D T (D (n +y' -I z O co I~ N O ~y n 0) O O O co (D o a a `C `G IV Iii ' CAD 7 3 lMD C.0 CO CL O N O j C = N D O O O O N N O. 7 O 7 7 CO A, co 0 0 O O Q O co O N C O p A7 O I ~ lu ~ ~ ! O m cc m C6 a a v cn Q O I r3~ p L'pf _ w~, I a ° to C ~ A ! n or w Cl) < c ~r I rn rn m ~ ~ rr "40 I o 0 0 0 1 ~o a4 o' mee x I = ~ m ~ m v nNi a o m N .y W m I M z I z o O D O 7 o m =r m N• co c CD CD c w c° n EL 3 m -I CO) z CD m a o F! 0 co N r w M m co a ' z o' g a O co N z I ~=r N ~ D N o D) U1 0 a ~ `m CM O O CMO o = y o acv ° z m c CD =r "ao x a a~iNaa N ' 0 CO)_7 00 ' N Q ~ m vcn' 01 D =r n < 'm a, CD nvo, c CD b O Vi ~ 0'o p CD t A N O N N I ur _ I I W ~ ~ A o b O oq CD V p a ti Parcel 040-1192-40-000 12/2012005 01:11 PM PAGE 1 OF 1 Alt. Parcel M 24.28.20.860 040 - 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 - STEWART, CHARLES W REV TR CHARLES W REV TR STEWART C - CHARTRAND SHIRLEY C CHARTRAND SHIRLEY C 217 PLAINVIEW DR ' RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 217 PLAINVIEW DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.400 Plat: 0234-CROIXRIDGE SEC 24 T28N R20W PLAT OF CROIXRIDGE LOT Block/Condo Bldg: LOT 14 14 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 24-28N-20W Notes: Parcel History: Date Doc # Vol/Page Type 03/15/1999 599367 1410/391 QC 07/23/1997 872/516 07/23/1997 834/231 07/23/1997 766/345 2005 SUMMARY Bill Fair Market Value: Assessed with: 103547 320,000 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.400 72,600 235,400 308,000 NO Totals for 2005: General Property 1.400 72,600 235,400 308,000 Woodland 0.000 0 0 Totals for 2004: General Property 1.400 72,600 235,400 308,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 118 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 O d f l d 0 CD C n d m # U) 0 00 O d o d N O 3 co CD `OG N Q ICI o xro INS-4 Zo y SOD, lA\ H N N Q d CO 0~1 ai ? O O N 1 3 0 O 0 O H OD 0 0 o o (DD o! 0 0 (D co cy) r- a O I 3 O o A~ OD Lr N y e o ~ 03 H d (n D a (D (n CL In r- p N cc i V 3 a gyp' (D O O Z N p N °o CD ° w p w co n r (A y OD o O C O) 0 (49) z :7 Q cn / M L 9 !~1 • H 1 O C C O (n _v~ aQ =r CO) co w - jr3- i s cr ~vv x l7 O ~ f~ !~D w D A N yy,, I e~ Yl A N a N ` O d A (DD 00 O O N ON rt O z ` Z ZD -I oZ 0 m d I-h f N V Q p n D 0 =r Cf) CD n n n m 0 0 • rt (D eC. N ~Q O i+ w m a s rt a o m a a z CD 4- IZN c N w a A 3 I (n-rN m a m z A CL AX O r: (n N N CD a CA I 7' 0 O d cno G m 006 0vcimW' a N d If ~ O I acv a m c CD 0 =r x 0.2 m c. o a N o a = a) 0 0 y S O - CD N c CD d d 3 y N 7 ~ fp f/l O n' ! \ 'oo.. O 4i ~ Qp 0 C O d y y fD hd O G1 ~ V w p b O CD O 2222` Al C 2 yV ti a ~ Fo rm - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER SU/V W,!E~T%L c S©& TOWNSHIP SEC. Z~ TQ N-R;1-6 W ADDRESS j% ST. CROIX COUNTY, WISCONSIN r r/' K VVvVV~"~" SUBDIVISION (O LOT LOT SIZE i PLAN VIEW Distances and dimensions to meet requirements of I1,I4R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM OL ij, _ /g2 a ; AIVICS v 5cPn~ ~ ~CNCrFc~S 3 5 A55' I i ~U j=P vAiT L iNE / ~5. %5 3y L;Nt z - y3, S3 ,v //V 4~:- 3 - 3/, Ov 5 AOc2 75-3 ~ IND CATE NORTH ARROW BENCHMARK: Describe the vertical reference point used T Elevation of vertical reference point: 166), 0 Proposed slope at site: - SEPTIC TANK: Manufacturer: WiF2FA-S Liquid Capacity: _hlC') Gvc Number of rings used:_ Tank manhole cover elevation: iI Tank Inlet Elevation: Q Tank Outlet Elevation: Number of feet from nearest Road: Front 10 Side , Rear, O feet .From nearest property line Front,0 Side, Rear, O ~„?(1 feet Number of feet from: well -Vp/V~ , building: % (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP C Manufacturer: Liquid Capacity: _ Pump Model: p/Siphon Manufacturer: p Size Elevation of inlet: Bottom of tank eleva Pump off switch elevation: allo per cycle: Alarm Manufacturer: Alarm itch Type: Number of feet from nearest operty line: Front, ide, O Rear, 0 Ft. N er of feet from well: Number of feet from building: Include distances on plot plan). SOIL ABSORPTION SYSTEM / Bed: Trench: Width: Lj r Length: 67 Number of Lines: Area Built Fill depth to top of pipe: Ya- ' L2 -1Z y-/~ Number of feet from nearest property line: Front, O Side Rear,Olit. Number of feet from well: PlYt= Number of feet from building: (Include distances on plot plan). S AGE PIT S Number of pits: Diameter: Liquid the Bottom of seepage pit elevation: Area Built: Has either a drop box or distribution box O been used on an of the above soil absorbtion sytems? (Check one HOLDING TANK Manufacturer: C city: Number of rings used: E1 tion bottom of tank: Elevation of inlet: Number of feet from n rest property line: Front, Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector, Dated: f1 Plumber on job: License Number: "~J,2 0 J` 3/84:mj EPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS ABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION .O. BOX 7969 BUREAU OF PLUMBING ADISON, WI 53707 91CONVENTIONAL ❑ALTERNATIVE Some Plan I.D. Numbet - (II nb11nM1 ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE j Ron Wettleson P. 0. Box 501, Hudson WI 54016 - BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REf PT ELEV SE SW, Section 24, T28N-R20W, Lot # 14, Croix Ride Twn,of Troy rv M Plundrer. JMPIMPRSW No.. County Sannary Per mrt Number: Donavin Schmitt 3205 St. Croix 88390 EPTIC TANK/HOLDING TANK: _ -9 - r7 co MANUFACTURER ILIMUID CAPACITY TANK INLET ELEV. TANK OUTLET ELE V WARNING LABEL LOCKING COVER 1, 0 L P, OVI ED PROVIDE( © "{(1. 3 ° 5.50 YES ❑NO C] YES NO BEDDING VENT DIA. VE ATL. iE-j I 1/I( H WAT R NUMBER OF ROAD. PROPERTY 11 WELL BUILDING VEN T( f0F51/ /felt Aln INLFT 4 C I ALARM FEET FROM LINE ❑YES ONO ❑YES ❑NO NEAREST o~0 E~ (SING CHAMBER: MANUFACTURER BFD ANG LI QUIT) CAPACIT Y PUMPMOUEL PUMP. SIPHON MANUf ACTUREN WARNING LABEL LOCKING COVER PROVIDED PROVIDED [:]YES ❑NO ❑YES ONO ❑YES LINO GALLONS PER CYCLE: vuMPANOCONTROLSOPERAr L NUMBER OF PN(IPfit IY Wfu HunulN(, VENT rnFH15n '(DIFFERENCE BETWEEN FEET FROM LINE aw1NLET !PUMP ON AND OFF) ❑YES ❑NO NEAREST-> Ih OIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing L I N(.1 It JOIA1,11 1114 111AII H1A1 AND rIA14KIN(, r excavation. (If soil can be rolled into a wire, construction shall cease until FORCE e soil is dry enough to continue.) MAIN ONVENTIONAL SYSTEM: WIDTH LENGTH NO Of UIS7R PIPE SPACING COVER JIN11111 7 sPIIS :,10t BED/TRENCH / Sr TRENCHES F MATERIAL: PIT u0Pt1, DIMENSIONS (.NAVEL OEPft4 FILL UEP"I U15 I0 PIP( UtSTN PIPE. ISTR. PIPE MA ERIAL NO DIS1H NUMBER OF P1(UPEIt1Y WELL HUILUING VENT 1D 1111 t;n ItF LOW PIP q E (I AHDVE COVEN 1 I~V INI f 1 ELEV END PIPES FEET FROM ,LINE II INIE 1 IL2 510 z7a~ NEAREST- 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 ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TFx1-1f Pt I4NIAN1 NI MA14KI HS OWA HVATION W1115 _ (DYES ONO _ DYES LINO UFPTH OVEN THEN<:H HFb DE V114OV(N tOENCH RED (EPTf/OF T.. PS, SOUD.I) afl UlD MUILUI I) Cf NIEN EOGFS ❑YES ❑NO ❑YES ❑NO ❑YES C_JNO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LE N(,T1, NO.OF LATERAL SPACIN(i IiHAVEL DEP714 HI LOW VIP1 f It L OF VIH ANUV( COVI 11 BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIF OI.II DISTR PIPE T{DLII MATE It1AL NO 11,111, 015111 PIPE Ili' 11114T)-F NPII'I Nt1l11 MAI Rn.1A14KIN(. ELEVATION AND ELEV ELEV DIA ELEV. PIPES DIA ' DISTRIBUTION r NFORMATION ROLE Sllf HOLE SPACING 0I4ML (1) C0I41t1 Cl I Y COVFH MATERIAL VI H11('At 111 T (;(000 SN)NDS TO AVPHOVI I) PL nN5 ❑YES ❑NO ❑YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL BUILDING FEET FROM LINE 0 [:]YES ❑NO [:]YES ❑NO NEAREST 0 4k 0 o. r 173 b 3 Z , S S._ ° S 5~ Sketch System on ~f0 O tailYin county file for audit. Reverse Side. V' $IC NA TUBE TIi LE DILHR SBD 6710 (R. 01/82) ✓'G" SANITARY PERMIT APPLICATION COUN U1LHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY # -Attach complete plans (to the county copy only) for the system, on not less than paper STATE LAN I.D. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER PROPERTY LOCATION l-4 / S'&1%,S T ,N,R 0E(or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME ITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK V ILLAGE : o i TOWN OR II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): ill. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. 56 New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2) 1. a. R-JI Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. E1 IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepage Bed b. See a e Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYST~ ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): t# 1 77' ° O 5- ;e Z Z Feet Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in gallons Total of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank ❑ ❑ ❑ ❑ Lift Pump Tank/Si hon Chamber ❑ ❑ ❑ ❑ ❑ 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' Signature: (No Stamps) M PRSW No.: Business Phone Number: / s - ~C✓~ Plumber's Address (street, City, State, Zip Code): Name of Designer, VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # _ 2 CST's ADDRESS (Street, City, State, Zip Code) Phone Number: #tlasgv- ` I IX. COUNTY/DEPARTMENT USE ONLY ~j ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuin Agent Signature (No Stamps) - J~J Approved El Owner Given Initial D~ Sur hargre 01 / Adverse Determinationp2 C! y 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 INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT Y 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 privat. sewag systr; contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-381551 To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Providt_ the legal description where the system is to be installed; ll. 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; Ill. 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 Groundwater - included the creation of surcharges (fees) for a number of regulated practices which Wiscor~irt's a can effect groundwater. The surcharge took effect, on July 1, 1984. All of the water that buried ~reasure 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 credi'ed to the groundwater fund admnis- tered. by the Department of Natural Resource SL These funds are Used for monitoring ground ~w~t t eater, groundwater contamination in.esVgat.;)ns and establishment of standards. Groundwai r, ~ it's worth protecting. SBD-6398 (R.03/86) 4 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 4- Q& Location of Property 14 Section - , T_N-R W Township Mailing Address 0 daSZ-2 ,de o 5 ~v fl y' Sys'/ ; Address of Site Subdivision Name Lot Number Previous Owner of Property ~44 4 &2C A"2114 Total Size of Parcel _5 Date Parcel was Created Are all corners and lot lines identifiable? Yes No X Is this property being developed for resale (spec house) ? Yes _X'_ No Volume _ J and Page Number 3 `fo 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 I (We) centi.6y that att statements on thi.6 Sonm ane true to the best o6 my (ouh) knowledge; that I (we) am (ane) the owne& (s) o j the pnopenty de 6 CA bed in this injohmation 6onm, by vi tue ob a waAvranty deed teco&ded in the 064ice ob the County Regi6ten o6 Deeds as Document No. IV/ 7 , and that I (We) pnesentey own the pnoposed site bon the sewage dfepos system . (on I (we) have obtained an easement, to nun with the above dacA bed pnopenty, bon the eonstnuc ion o6 said system, and the same has been duty tecokded in the 046ice o6 the County Regizten ob Deeds, as Document No. ) s SIGNATURE OP OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED 1 79 ACRES _ Zl q J m O _ \l91 X90 m 77 ' fib'' 6" ;y Iv '`pia C)y YFo~~?? C, j b~ Gam, M , j / \/•o 3€1 o~101 \ . l f , iJ,, 0 QQt- w • 160 ACRES r 34 90 , o 14 t5 o0,t ~o s ° 12 t 7 3f M~'~ c'g9s~'• 2.43 ACRES 1,33 5. AT 3cp2 13 0 lie 1.75 ACRE~a Fp 'I 69 ACRES i w .7 'po T OF BEGINNING fOR of N To o 1'h o R WAY A• r o w `N; CMD 03, 2T°Q 0 06; k 4~ cv i r T" % 21 w \ W \ t O co N ~N n ' A rn ° 43 N 5 1.48 ACRES f,' 3 ~ 1 s ' ~ ~ 0 are ~ ~ \ y 109.89 66.001 ' 134.001 t~ i' tic, 71: 1 ,^^--'!~"""Z;"' 4• y p Q~ r t f z f,~ 1 i .~'•~}rSJ i .Fr.~,t '.R, to, ,w„ 3 2 309.85: 1 I• 19 N 89°57" 32 N W f-, OA X09,89 X00 00 b 1 co 1 N 1 W _ 0.W N ~7 l7 N - J ~s. t 23 22 f:49 4CflE S p. ;~GHES o l N 6 ACRES r IN 0, 1 294.9e 200.00' 278.50 " - I _ t x.+ <h !4~; )•w +i y / ° i• r rtl 14~.v. 1, f ,Ih'1~x•rl l..t !t ! ♦{d) r tT~-,.~..At?d'I, "h y ~)r~yr r'f •rS ~'If. 1 r r~ r` 7 r r ~I .:"f 1 •'S. .•h . tl~W,, 1. a Tx; tfi * iw'"5 J t ,P3r. ti h~ +1 .ur } xx t•Y ~{~'r a C 1, ~ ' - ~11 Hli r SZ~w,'t'~' i,. ,'.Y.~ 1P:: {f.'~ M'~rl •~Y r t ;•j-.••t wIF.. .dam ••r}`•' >,n.. f. ♦.r $Cjle[-75 ig to_be -,T c_onditTcn conid-Mr-by this ogreement. A commitment such o n><le cwnPon j!! Mu!_ ! Jf`% M voi ~cr aPg} dtieumenTs off SQ1l8ZI?iliiilif,3Ao11 8eoffw;rsuftFiclenjpeoimonce: y tale 1 u ~>Fe recording- U tRe` H I z t y • ST C- 105 r y SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County z d q C 9 OWNER/BUYER ROUTE/BOX NUMBER '57 Fire Number CITY/STATE / A( ZIP PROPERTY LOCATION:_ Section T N, RG~_W, Town of St. Croix County, Subdivision C(oy.z//aGL Lot' number Ly 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 606 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. y 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- 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$• 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 & BUILDINGS II~IDUSTRY, C DIVISION LABOQ AN P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.090) & Chapter 145.045) LOCATION:-fIVA'd ~4 SST/ iTZpN/RZOE co W TOW~AP ~~R4 jT NO.:BLK. NO.: SUBDIISN NAME f COUNTY: OWNER'S BUYER'S NAME: n !C MAILING ADDRESS: /L/ 51 .JG; t 1( Rom Cc~ETTcFS o.✓ ~y3 ? Wizzk */3 110,&Ow IV USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPT NS: ~fCO LAT ION TESTS: Residence ~ 'v Xew ❑W-/. -.4- -X RATING: S= Site suitable for system U= Site unsuitable for system ASa,ee 4"~ - '5;,e T J CONVEN ©TIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-F ILL HOLD INGTANK:RECOMMENDED SYSTEM: (optional) Se. S ❑u ❑S U ®S ❑u ❑S ESU ❑S X❑u T~CV44ey o,Q &v~k ~z Ess SLO F 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: C44SE T Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS J>ECjM,{L . BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) e,3 2-3 41- ISO- sf'li S"3 r1fAj WAY CS s;i o' ati , j-1 7 v, cs E; 97 (P 6 r 1r~ > ~j' O #I E;-3 0 73. 6' 9 0, o t, z o -rAa V o t,~ 7 J0 X1 2-3 es -A ti-AL. g Cj /n B-,~j' / tOd' 7~ S • cs Qom. Si ; yc 4/. Q,v• 7 6 7 ~ rA•J i4u~L_ a- ~~~UfiiiBNS PERCOLATION TESTS TEST DEPTH, WATER IN HO E TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER WELLI G INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIO PER INCH P- '~('o•O P- P-_ i 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 ELEVATIONS jV 00 Ali , w ? i i 3 , f i 3 E r : Aj~ I - - - _M- E 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 of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: / HOMESRE SE K PLUMBING 00, 5 is - I Q ~t,rJ wig ADDRESS: CERTIFIC TFON NUMBER: PHONE NUMBER (optional): WERT ULSRICK 2 y 3.P ~ 00S MAWR PLUMINR 0G. NO. 3307 All-FILM MINN: INSTALLER & DESIGNER LIC. NO. OM CST SI ATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - Y I STRU_7_' r, L n~ e16-S C -6596 Tn lip a ro l 4 au t. 4)I_V IF Al L 6. 7. THE r -ESTERS H~i I I r REPORT ON SOIL BORINGS & PERCOLATION TESTS 115 PLOT PLAN Project I.D. L'iC~OIX ~l v Lopy LEG T1D HOMESI(E SEPTIC PLUMBING CO. At B WNEIL RD., HUDSON: WIS, 51016 ROBERT ULBRICHT Ba c kh o e 7 i t s WIS. MASTER PLUMBER LIC. NQ 3307 NLP.IRt MINN. INSTALLER & DESIGNER LIC. 40. 00 X Perc Locations C.S.T. 2482 Q = -Existing Well -Vertical Reference Point ; `OP of PROA)r P.=# 2-gy-10 F' evation of Vertical Reference Point 100.0 ' -Lot Line i N i SCALE :1" . 30 CL, \ RR'o at'FV ~ r 2 , S, 8 WPM 55 7~ - TiPfvfA Ps $ I ~ 3 i 'lP.?IoV- A4eu-r S 67 C~ v S h , i i i b I ~ m ~j}s7 I 4'N f~ OrC f~p+k 3c ~q.2 ' ~RvPas~r~ ie~ ffv~rS~ ._z X5. j.' 61 F~. ;~E~~ ~I 9y a~ Li I q32 ft~-~ ~ ~ L 'Pull #01nS av a)6 ` -