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042-1012-40-000
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Outside water lines are ofte ` `~#s~,trned dYi o.~.f ` ring winter months, making access to the home neces~;-y ";~Ir-ase make arrangements with this office to insure that entry ~~i be gained. ❑ Water (VOC's) $185.00 fkSeptic $50.00 fk Water (Nitrate & Bacteria) 45.00 0 Nitrate & Bacteria retest $15.00 Owner: J. SCOTT & HOLLY WAGNER Requested by: DALE JOHNSON, WESTERN WI/ Address: 1016 - 110TH AVE, Address: 235 CEDAR DRIVE WEST R.E. CO ROBERTS, WI ZIP 54023 HUDSON, WI ZIP 54016 ,a,Telephone N°: ( 71$ 749-3549 Telephone NQ: (_21_1 549-6058 Property address (Fire N4& Street) : 1016 - 110TH AVENUE Location: SE SW Sec.IN5 , T 29 N, R 18W, Town of WARREN Realty firm WESTERN cWo,Eock Box Combo: Closing Date: 6-10-96 o 4 A : -1401a -4 0 - 000 65. 01? . /g. TO BE COMPLETED BY PROPERTY OWNER PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: a--+-c xj S-;.j Is the dwelling currently occupied? XKYes 0 No If vacant, date last occupied: N/A. Age of septic system: NINE YEARS Septic tank last pumped by: Previous Owner's Name(s): Have any of the following been observed? ❑Y 5N Slow drainage from house. ❑Y N Sewage Back-up into dwelling. ❑Y ~N Sewage discharge to ground surface or road ditch. ❑Y ~"N Foul odors. Other comments relative to system operation: 0L). I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE DATE : 1/94 aF OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION IN a f~ . 5 `1'Y' e y~~< TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system: ❑Below grd ❑At-Grd OMound Approx. size 'X OGravity ❑Dose ❑Pressurized Ft.2 OBed OTrench ODry Well ❑Holding Tank OOutfall pipe OBSERVED DEFICIENCIES OOther OUnknown Septic tank Setbacks: OHouse OWell OProp. line ❑Other Dose tank Setbacks: OHouse OWell ❑Prop. line OOther ❑Locking cover OWarning label OPump/Floats OAlarm OElec. wiring Soil Absorption System Setbacks: OHouse ® OWell ®/<OProp. line 00ther ❑Ponding: VC5 ODischarge: 11 aAe, General comment : INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title ST. CROIX COUNTY WISCONSIN ZONING OFFICE 1I son If op■ KIM"b ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 May 21, 1996 Western Wisconsin Realty Attn: Dale Johnson 235 Cedar Drive West Hudson, WI 54016 RE: Wagner septic evaluation and water testing Dear Mr. Johnson: An inspection of the septic system serving the Wagner property at 1016 110th Ave., located in the town of Warren, was conducted earlier today. This inspection was based upon a surface evaluation of said system and did not involve any excavating or chemical analysis. Accordingly there may be hidden defects in the system not discoverable by this inspection. At the time of inspection, this system appeared to be functioning, but not at full capacity. I noted that there was approximately 5" of sewage effluent ponded within the drainfield, indicating that the drainfield is clogged, and the ability of the system to dispose of sewage effluent has been decreased somewhat. Because the failure of a septic system is a progressive process, I cannot predict how advanced this clogging is nor how long this system will continue to dispose of sewage effluent. Neither can I predict how soon the system will fail completely. Most septic systems consist of a septic tank which traps the solids and greases from the sewage stream and then allows the remaining sewage effluent (liquid) to drain into a subsurface drainage area. Once the liquid reaches this point it seeps away by percolating through the soil surrounding the system. Failure results when microscopic bacteria and sludge plug the soil forming a clogging mat. As time goes on, this clogging mat becomes progressively thicker, allowing less and less liquid to seep away from the system. When this clogging becomes severe enough, liquid sewage is trapped in the drainage area, a condition known as ponding, and results in backup of sewage into the structure or the discharge of sewage to the ground surface. In an effort to prolong the system's life, I recommend that steps be taken to minimize the wastewater flow which enters the system. For example, repair leaking water fixtures and/or replace them with water conserving fixtures, reduce shower time, wash clothes and dishes only when there is a full load, use a washing machine with a suds saver feature, etc. I would also recommend that the septic tank be pumped at least once every three years. Please feel free to share this report with anyone who may have an interest in its findings. Should there be any questions or concerns that I can clarify, I can be reached at this office between the hours of 8:00 am. and 5:00 pm., Monday through Friday. ely, ;e,. hompson K. T Assisant Zoning Administrator cc: file ST. CROIX COUNTY WISCONSIN ZONING OFFICE a"q"■ r"r"~ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road - Hudson, WI 54016-7710 (715) 386-4680 May 30, 1995 Mr. Dale Johnson 235 Cedar Drive West Hudson WI 54016 RE: Water Results for Residence Located at 1016 110th Avenue, Roberts, Wisconsin 54023 (J. Scott & Holly Wagner) Dear Ms. Johnson: Enclosed is the original test results from Commercial Testing Laboratory, Inc. for water inspection of the above property. Please take special note that the "Nitrate-N" is at the upper limits recommended for Public Drinking Water Standards. If you have any questions regarding these results, please do not hesitate in contacting our office. S' cerely, mes K. Thompson Assistant Zoning Administrator bjp Enclosure - ?~i - S Cs ~vl ~'1 S ~2- - 1012-4 COMMMCIAL 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 41 17835/01 PAGE i ST.CROIX CTY GOV.CTR REPORT DATE: 5/28/96 1101 CARMICHAEL ROAD DATE RECEIVED' 5/21/96 HtlDSON, WI 54016 ATTN' THOMAS C. NELSON OWNER' Scott Holly Wagner LOCATION' 1016 110th Ave., Roberts COLLECTOR: DATE COLLECTED: 5-20-96 TIME COLLECTED: 3100pm SOURCE OF SAMPLE' DATE ANAL:YZED:5-21-96 TIME ANALYZED: 2'04pm COLIFORM,MFCC' 0 /100 mt INTERPRETATION. Bacteriologically SAFE NITRATE-N' 10 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L z ...mar LAB TECHNICIAN' Pam Gane .V y°30196 ~ s WI Approved Lab No. 19 w ?~1HMfaOrFtCF { Means "LESS THAN" Detectable Level Approved by: PROFESSIONAL LABORATORY SERVICES SINCE 1952 n(4 0 1 3 d 'a 0 o d '0 3 co rv Z o W 0 I `2 c°n a `C ~ • D O p jV N Cn "s CA D=i a n < d N O pp O S O CD a) >r I S R. < 0O CD (D CD 3 7 d o N N I CD O F+, O 3 7 p• O N OD OD ~I Q CD p tb o OD N W r G~ G7 W O V A CD CU @ N• p v A CD N N 0) N N T O O N ~ N C1 3 a a- O CO C. CO -D O 01 CD (D 7 CD 0 D N C O O O DD C N O ~7„ p O O 00 O O 3 cn mom 3 y y 0 0 cn o o c0 (n z u> D U. Z 5 CD N a f m m (D m D c N o M~ CD co D c? N co CD m cW o V co CD m c O. a o co D Q c 3 O n O O O CO CD ° o CCOO ` to C Z p N OD OD fD I O C p CD N CA fA OA 3 c* Q "me 0 0S 0 0S O p O T T 0 i y C G Z 0 co c°n 0 m COD 3 C G I o D CD ~-13 cr 0' CD CO M :3 0 CD CD N CD I. ~ a ~ ! N a o ° z 0 o O O o m m y "W• 0 CD CD N M CD CD Co N CD a C. m n m -I N a CD z f° c I A z CD Z U) o v O N d i P. Z 3 0 Sll ^ i O O Cn m CD I z a ~ z z H I ~ co CD A O 'O N N N Q o O O O. O N B. - d c O ID 0 7 0 fl- S CD A E X O G CD n.. ' -.CD O ~ O 1 ct S• U3 7 CL S T C/) N N N 0 0 97 [n N O 0 CD Cv 7 nnm o z Qfl m ° m o a O D _ CD % CD CD O O N U) CD = 06 N N C1 (D C 7 0 y N Oa 0 0 m M CD a a n n n m 3 E c m° E; 3°m mNx 3~m CDN>r fi °D -(D o ~O-Oop A L CD CD CL CL 9~ CD 0) Ca m3co 3 x pi° 0) ° m xp O WOm 00 W0CD s° 0°- o =ro a ~c 3 o m m S' o° m CD ! 0-0 O 7. CD CL C N d j O y 0) CC CD N 7 CD C0 n CD O = D<° o Df° o W C Cp tP N m I' 71 o b ~ ° CD oa °o CD f0 iv ti N C) O O b 0 oO O O d p O d N O O r ~ ST. CROIX COUNTY 1~) WISCONSIN ZONING OFFICE ' M W M r~rrr ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road 'N•' - Hudson, WI 54016-7710 _Y (715) 386-4680 FAX (715) 386-4686 August 27, 2004 BRAD ALIEN FILE COPY 1016 110TH AVE ROBERTS, WI 54023 RE: House addition, Town of Warren, St. Croix County Parcel 042-1012-40-000(75F) Dear Mr. Alzen: You have requested the Zoning Office to review your remodeling/addition project for compliance with the state sanitary code (COMM 83). When remodeling or adding onto a dwelling you are required to examine whether or not the construction involves an increase of wastewater. I have reviewed your construction/addition plans that were submitted to this office. You have indicated that the project will involve removing one of the existing bedrooms but will be adding two additional bedrooms in another part of the structure. The net result will be one additional bedroom to the structure. The septic system was designed and installed based on wastewater flow for four bedrooms. This project will increase the total number of bedrooms to five. In such cases the septic system can be sized based on occupancy of the residence. Only eight people will be allowed to reside in this structure unless the septic system (POWTS system) is modified to accommodate the increase in wastewater load. An Occupancy Affidavit is also required to notify any future owner of the septic system sizing. This affidavit must be recorded at the St. Croix County Register of Deeds office. You have had this document recorded. The original system was installed in 1986 by David Fogerty, and was inspected by zoning staff to be code compliant at that time. A visual system inspection by David Steel on July 17, 2004 found no evidence of system failure on that date. As a reminder, to prolong the life of the system, remember to have the septic tank pumped once every three years or when the tank becomes 1/3 full of sludge and scum. Other efforts to prolong the life of the system could be as simple as fixing or replacing plumbing fixtures with water conserving fixtures, reducing shower time, washing dishes when the dish washer is full, avoid using a garbage disposal, using a wash machine with a suds saver feature, etc. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. r If at this system should be found to be failing at any time in the future, the system will be ordered to be replaced according to current code requirements and all appropriate permits will be required. The addition shall comply with all applicable setback standards. Please contact the town of Warren to obtain a building permit. Should you have any questions, please contact this office. Sincerel , K vin Grabau Zoning Specialist rnAv. MMMMMM 10 16 110`h Avenue Roberts, WI 54023 (715) 749-3977 (home) • (715) 749-1777 (office) (715) 749-1776 (fax) Bradley W. Alzen August 11, 2004 Kevin S. Grabau Zoning Technician St. Croix County 1101 Carmichael Road Hudson, WI 54016 Dear Kevin: Enclosed you will find the following four documents: (1) A Plat Drawing from 1992 that shows the placement of our home on our property; (2) the Septic Inspection from David Steel performed on 7/20/04, (3) a sketch that that shows the placement of the septic system relative to the home, and (4) a nearly final draft of the architectural drawings for our planned addition to our home. To refresh your memory, we have had a few conversations regarding our planned home addition as it relates to septic system capacity requirements. Our home currently has four bedrooms as well as a septic system that is designed for a four-bedroom house. We are planning an addition that will eliminate one of our four bedrooms, but will add two bedrooms. Thus, the project will result in a net gain of one bedroom, leaving us with a five- bedroom house. Both the septic inspection performed by Steel's Soil Services, Inc. (documents enclosed) as well as a visual "inspection" by the original installer of the system in 1986 (Dave Fogerty of Fogerty Plumbing) revealed a system that is functioning very well and is apparently still in very good shape. Thus, we would like to request that we be allowed to retain the existing septic system until which time an update is necessary, but be allowed to proceed with the addition based upon the fact that we do not plan to increase our home occupancy beyond the maximum of eight (8) currently designed for the septic system in place. Once again, thank you for your attention to this matter. If you need any additional information for your review, please contact me at 715-749-1777. Sincerely, 6z61-V 1 Bradley W. Alzen Enclosures Have a great da.y! S t N LAND SURVEY I NG HUDSON, Wi. 386-2007 NAME River Valley Abstract & Title Inc. 206 Second St. ADDRESS Hudson, Wi. 54016 DESCRIPTION Lot 1 of Certified Survey Map, Vol. 4, Page 11783 Stc 4 imm T291N, RAW, St. Croix County, Wisconsin. 92-3238 Wagner PLAT DRAWING N This is not a complete Land Survey N89038100"E 288.001 0 0 0 0 0 0 N N (D c0 O O O O C. U o° Enclosed porch o 0 on deck Shed C, Deck r L- House Gar. Underground Telephone Overhead Electric S890 38'00"W 288.001 Town Road fhe Location of improvements on this drawing are approximate and are based on a visual inspection of the premises, the lot"dimensions are taken from plats and deeds of county records. This dr'aainy i's' for informational purposes only and should NOT be used as a complete Land Survey. River Valley Abstract & Title Inc. has agreed to waive these requirements of V E7.02, n-E1.0a, A-E7.04, A-E7.05 (1)-(5), AE7.06 (1)-(5), and A-E7.07. The purpose of this paragraph is to comply Erich A*-E7.01 (2). ,~,py-.,;....~,•, Ilap No. 92-01-502 Date .12-14-92 Drawn By E.F. r 1~ ~J,.,. ~ Y~ I 1 Scale 100, a• I. 7 j,.:i (y L .Dfn~n pop { I ~aCA J lo 16 - 1 Tq I D 4ve~o OAz~-h, Lv:l~ 5-110;~ 3 0ca0! 3m0 d C M O c vl T (D (D m o ft) 3 Ar l ) I ~ 0 chi v o v', o O co D * al A ~ !r • S (D N I N IV N H C W V C ro CD n N = 0 p C fD O W OD ^ 0 co CL s O co fD (D Qo = T O O N O a W CD S O r. F+ ~ ~N N N j~ ~ O C c ro ~ ~ 0) A N ~ CL m 0 3 © crx Z D ID s y (D to D N O ` V a w a - O W m O N 3 Q C O o -4 -4 m r 3 O C 0 3 (O ID O t ? ? S A to ! V O Oco 8 D OD o r co 3 / rn rn 3~ Q H• w v c !I T M M f 3 o o 0. c v m z d A 3 CO) to CO) N III g D i° oNO a y m j O O v 0 9 3 D vim, in S2o G M N O W p 3 A D N 01 W _a > ~ Q. Ov0 p N V m z a o V z ° C Z Z D 0 ~ I 7 I ~ CD I W a 3 m -4 co O A Z m ? (Z 7 ^ 3 !I f\ \I Cn -1 cn m to a, Z O 3 ~ ~ 3 ~co :E A O O x- CD m c _ Z A o a c co 3 N ~a I II o CD a o oho O i l A. j.<6A/ p eAlv L~ WARREN PLAT 18 W E' ' ` Gx D[JNTY. ; S N w' a 112 For Additio/ta1 Names. _W I (Lando wners) RICHMOND PAGE 48 E Clarence & ten a aid & Gar Inc 78 G HREE gem , I=a1..~ Connie Game UnRd KES r Martln 7 40 °ei° u 65 c Mueller Mary Robert O'I Hntg Club In\ c is s AVEn = Maloney Derrick p. 158y Trust 158 275 N A o~ick 0. ' i 167 G a c elson Vernon Nelson x 1 Mcnoael enny AVEn Thomas o~o a @ A. & RoItt 120 1 36 Maloney _ Q H s O w 8 6` Allen g ,xm.v= r n-u Donald am" ^ tr K Greenfield we9 U 154 318 240 r O 3 tr 39 03 ~l Br1-40 216 2 39 -v 180 J Dale & 110th AVE t; $ xa.~3 a $ Frands 1101 E a t[ us p 9, Jett && Kenneth & 3 Ronald Vtr~nia 80 sow+ Lan6 7s 1 ° Redmon Pamela w Ror Frederi RHK I~ 33 : 107th AVE m -4 9 a 60 Herlnk x Meyer ~ a 4y ey Farms N, Br d c M~on~ -Mary 80 Inc a 310 120 1t.3t 40 Frederick u) 1 Randall I 3~ 1~ a 5 f 9 67 FJUs 54 m` zz I 40 are to 160 n om- cr_ s Rusmar I~~SA05th Raymond& Thomas `Gordon Farms I 104th qs 40 I Paced suNona llwold w Truesdill Inc 9 Seliski AVEP 142 160 160 470 160 4 <J _145 sass 138 200 rans =o 150 ` 1 100th AVE Burl 25 sr I~ IS a = as vld& R NeWal chhvvgle VanBeek ~I tr DO ma a 60 Kenneth rr 80 80 5 cKenna Frederick y r a I N St Croix Vly Las Girl th ST ggg IS is \ 9€ I stouts ~ ro Bloo Mary 96t q ^ ° tr N hvgle to AV tr r aac 168 8U Eugene & 195 o sss Viola F & 13 232 Ix 4t 1 mnfier w Tepe Delores Gillis s Dean & Trust = Schulte Farms I! !d I D & Land ~tm Trust Inc w u Loan s DaLane vid avid t Corp Mueller 15 Camille Q is lsrown t McKenna a z ell Holden 00.-.5: 7 crust fi % lac EM x 3 Mal 24 150 160 12 240 16 t s5 ° tr O 2 2 a^ 148 80 119 = 78 H s 344 a<Ba 7 n KS 0 ^ zs ao x sac 8 mJ R nataaes 0 ~~6 c e ro Gillis = a ~2 • 2 37 (~A Flu 3 Farms 97! yi 'y ac 10 t3 Rohl 39 D e a 5 ~ oCr(l s Carpenter Inc p 5~ P 4 160 ladd s Land~jj'~~ 8 1NDoonmthy 5 zs n y139 78 G'^~ 3 LiX a Companyy I 79 - eth V ^ a °w 158' E Sonnenta8 1 t L \ Earl n ~1 ,°e Bpm F v g a^ 32 tr Fully Vioazdiner& t 31 116 Pechuman p 8~c Gillis AVF t a $ A E Pttnr Graham lms Marl` to o° q U u I 67 rn cars s z 1r 8, a ~ 122 2 2S 9 .~.,oGO0 6,1 Inc Grace& 163 ROB 108 154 Gary z..ra t z g , tr H°➢~ _ 90 9 . z c a 1 zl = lames & s s °n a3 9 t e 7 ro oxds uth cm.sa I Phillip & 99th 6ta~ier rn 4 gam' - • 2 FJIa KatAt'ine& : Bloom OConneB Honor 1 00 a3a T 65 I PO I n Maq 34 V ~t ward " ~ g l 't o ~ 3 3 Mlliet ss Mark 80 Hatter 40 w ED- °o- 1 \ w Trust ¢1 _ 3 6 20- E 307 Hamlin 2 160 Ni ,,,ne P g ~ M 239 s9 ' Donald & 2 tr ry 98 ana to C[tL a' Fdie tr ^ b Earl etal u Boys John & Anderson 4 C77iK Pechuman ry & hem 110 a ~Ca N Chrlsu a 61 c s aEli smiGl Prirkta Hudson snm 40 164 t YJ- KIM & And W jar °r e LAKES soumar p~ = 9 65 Karen Z o.d 30 Reed 6 85 160 143 rave to 70th AVE 187 80 I W 39 1 Mal[9 !aP 6 1 3 k& 75 \G ttss« odie N g 60 & Farms 4 i Meboid 45 U,C 87 1^I-F~entag CLva / F~ sinx K\N\ \~a~ ,I 94 c a Ltd Inc Z Trust 1 ALEX Richard & M ear n Glen 110 Inc 40 UN Janet 13 99 223 2 = ` 3o a sa" eM tr Z 115 160 F9F9 m Cat. in N 64t 5 tl6iT H - Il b I Roberta 'STAR Andrew& 3F/ a K10 A fad ^ LN Dean & m $ F N w a tt Rernadme 88 Roar Rudesill n Hansen u) n ,o am Came Brenda Steven Rertau ECKER 7 ---ttt Ames $ 3o t ~u i S xt CO 6 tr • gny sum a : v . LN tr en 92 L1y s,..m 4 F a 4 Anne v x N,aee a 126 B°tke @ 3ai.b bg 194 a~ 1, y aam Lenertr ..o ro or ' zb tr $ v i $ ~3a 50 176 31 ~ro San AVE KINNICKRVNIC PAGE 18 856A Hwy. ROBERTS GROCERY 5 P.O. . Box Box 14 14 `t Roberts, W1 54023 Phone 715-749-1718 MEATS • GROCERY • PRODUCE Fax 715-749-1719 HOURS: Northland Surveying, Inc. Monday-Sat4rday 7:30 a.m. to 9:00,P.m. Sunday 9:00 a.m. to 6:00 p.m. Boundary Surveys • Certified Survey Maps • Major Subdivisions • Topography Surveys r7,~) 494840 Edwin Flan11m Michael Erickson IkOBtg"S• WISCONSIN R.L.S. No. 2487 R.L.S. No. 2592 -32 • j T-29-N • R-18-W WARREN DIRECTORY - a Fain At He?" PublWsrrz, Lbi. ST. CROIR COUN*) WISCONSIN See Pages 135-140 For Additional Names. (Residents - Owner or Renter) 103rd ST ZiC}fNi'ON°ICE 4'9 THREE ■ Fr ■ Bgq ■ ■ ■ A Gerald ■ ■ 7-7 E s7 LAKES Clarenc Frn pp tm; V \ Po ■ ■ Martin a Mitchell AV Eh a 6` .6 65 Mueller s- elson n Jon Sherley Johnston. ■ C ~C DRY ,wh,~ ■ 115th AVE ■ ads Gwrencc ■ °.V w I DAM c ■ lot"' Aeblr 3 2 Michael Q L 1 ■ t ■ ■ i loss ■ Kevin Burton 4 Robert ■ Shaver LAKE 6 1 Nelson ■ 1 0 ~4n~wmn F. 112th 8 11 ■ Kenneth ■ C ■ C na la4nv~ NAVE of !Louis welch 114th 1 ■ ■ O1Z■ .e ceorer i Rolf ~naCV AVE e7 aCmg W Wtlllam ■ 4 7 ,n .m an ■ ,n o ■cnx- I ■e rd 110th AVE ■ 01 Mark ■ O - - - - ■ ■ ■ ■ s. ' Jeff - - ,..d P Ck 11 ■ In Bv° Ma~a oe4enbuqKern■ ■ gloss 1--3 g a 4. ■ Redmon He nk P~ ch Glen )ama ■ ■ 107th AVE if 11 ° F- m Dale ■ Nelson can : ,6/7 \ ^3~q Y ■ t ! q ~H Frederick Stevrn 1 ■Jezs~ys ■Todd E ° Bruce ua Wesley FrKamdm Garden ■ Kama I Stue55y ■ Hcrink Libby 'i Frederick 105th AVE 9 ■ Ron 1 0 06' 11 ■ 12 6 D ■ 1044th °i 3 ■ Harold Brown Meyer K ■ o ■1i lE;I a6y~'-wnmm ■Bolhazdp RiK ~d V aan8 ek 15 x.~-.V ■ ■ ■ ■I Booth 0 \ DDarren onahue Dan Thomas ■ 0WC jr ■ Rueb- oleman ■ ■Brin old ■ Sullwold 100th AVE ■ 16 14 IMmta 4 ■ ■ ■ C ■ ,~O ■ IN ■z ' ■ Arlen Strate ■ ■ 100th AVE Boomaa ■ ■ ■ 11 ■waym 1/3 6/8 Russell ■ BOU1dO° Lowell V tonld ■ Adsit ■ 3 I ■ Strate F j«~ Johnson • ■ 96th p 'h5 AVE So i' \ in G Fred !Thomas fl x o. ■ m 3 o■ g y Pa Yang :ech-He Jambor cr 18 9 17 ~ql . 16 15 Mona. 14 .Steven 13 O J o ■ James Ted ■ Brandeen j i od~x n Q-Ift Gullch b !Bruce Fred 01 Joseph u Elliott E yg~ °o 'O °vg I W I I Jim i ■3\ J~,.*- Scim dder ~ y Eugene Glen o `~y 2 4 a Thomas J xleau" itt u ° Harhnon $ u David ■ z 5 4 lr~ CS Earl Tepe Rasmussen p 8 ■ Frederick 1 • Brown ■ ■ ■ ■ ■.4 ■ McKenna ■ 1 ■ ■ ■ Bloom ■ ■ Mueller 111 12 ■ ■ ■ IN ■ ■ O ■ pp D D ■ 4M ■ ■ ■ ■ ■ Richard ■ ■ L~~ Z iyla~rscltaB lorkelson ro 1-6 Haugen Rohl 1-3 89th AVE 8 ° wtdrc _ ' ■ Richaz Schaaf D ■ m 1Yllaam 5 0. s y N Braun OMalky I 86th AVE F- p Glen . ■3i uy )nettrer k ■ 6 L 1Va~ ROB SNOWMOBILrEET~RL 14 Wilbur 19 96th 83rd I 20 8' ° 21 A / G~7 Mi ru n it ■ Robert ST' AVE , wwn,- ■ stomas G ■B tz Albright 73 b .6 84th AVE. RR ■ ■ 14 ■15I p Pad B Gardiner■ i -P Gary■ 80th ■ ■ 9 o y °y Wil, 8 JonesNewel Graham ■ ■ / Robert D Earl David Harry Max William i i Hoyer AV ■ ' Kevin Mark ■ ohnson Pechuman Platson Hansen Gillis ft E c m b~ ■B suck a~ rw Sx ■i _ iJ _ L _ j IN ■ ■ ■ r ■ ff 1117 ■ N ■ ■ ■ IN ■ ■ ■ ■ ■ 1■ ■Todd ■ .1 m 'Guy ■ ■ Pant ■ 1 ■ ■ Bloom Howley omas ■ r 99th Gene ■ Maier Hd d 2 4 1 M fu Richard Rick ■z ,im ■N osmeB S w ■ ST Ha"SO" ~ carom, ■3 r r z Senich u p \Miller Graf ■ David ~OODH! Gilds w - I N I N F- Refsnider f. P Jr N 0=- ■rcoa,ne W Ogburn ■ m n N'4O 3 N Blair o C 0 30 ' 29 5■ ■ 6tE 65 27 ~°o He 26 L ■ Randy 2 merge ■ v_, I ohs Dowld D 7 ■ sH ■ ■ ■ Sra ■ p 'Fhoen Bowman ■ ibert Anderson ■ Daniel L s es x I ■AIIdy $ I aaa ■ TWIN Schwalm! Haase PiDan; nk.Delande ke Bear a n~4r ■ Greg ■ ■ Patrick ■ M-111t 1th 1-6 °.a P- 4lan ■ LAKES ■j D J . ■ An eson Trent Delauder. Darrell en ■ ~ ■ - a""Naumann Pert ■ ■Kowalchyk ■ ' !Nelson ■Ha - - - - ■ Gerken 0th AVE rnaaar IS ■ ,t,eeH Chad. C ■ u ■ F ■ Dean 70th AVC ■ on Peskar o a / 3 ^ AustiNN\ ALEX ar6aa 2-6 ,nF q qU pV BIKEWAY ■Mrra so. F~= SYSTEM ■ a.a..w ■7a' lJ..M. 33 / WX Glenn ■ $ )Gi 35 Haas y " u v Noso AVE m 32 $ c~~n ' ■ 'STAR 34 Glbb/ IerrY I aono ILN ■ li no, BB ■ Wager ■ w z C akru Baan ■ 1 Dean ■ nom 11 crou M E Bruce ■ Stoe$ C Sorlie Jeff N . I ECKER LN xabk I / Con .s. ■ ■AUan € 00 14 T4 srd ~J `O M .u a N Kdt _ N eked ■ I ■ m ' - ■r B n ■ • B>; ■ 1 VE 60th AVE laNNICKINNIC PAGE 19 THE ROBERTS LIONS CLUB Proudly serving the Community of Good Neighbors since 1959. Sponsor of Roberts Good Neighbor Days the first weekend of June. Also, sponsor of Cub, Boy and Girl Scouts, TBall, Little League, Flag Football and various programs at St. Croix Central High School. Active participation in Wisconsin Lions Camp for blind, deaf and mentally handicapped. 31 0+ 20 04 001414 Steel's Sail Sevice Inc. 715-684-3445 p.1 EXISTING PRIVATE SEWAGE SYSTEM INSPECTION REPORT AO*W y s ` 1 O;23 Zip Code Pruriaw oMtds narno(s) C.l~t ~H-+l~'"~-^ County • C Ts' V •C 1o i ,r 1-4001 --T- Doilwag to mmly occupied? Y p .N ❑ Permit iaforrrugon available* Y N ❑ Sai! f9patt on file wit!! county? X N C3 NIr Ins Y NQ hack-ups Y N ❑ Pr= Y❑ N acepage X Q w C3 saw draiaaga YQ N ❑ Paul 'odors YO N ❑ Other PW of 40 $Wdc tack servicing' . 4~ Owttses si Date o........ li Lffor Onsite IHSUectiOD IYIWIY~MJIWYYf.WCYI1h.W~t. ?yp¢ of private sewage ryFtetos: Below rude At grade To Dosed Pressure ravity d Trench t E Privy ther Holding tank . line Tr"p lpt tank ;etbac* compliance: Well lding 1a: Poool surface water Other t7ROP# m* scdmk compliance: well attQt~ng t.at lint Poo Surface water Other srok compliance: Rli Building F it Pool --RSurfacc water Other Supiata oclee~s)• t a 20 04 08t4la Stool's Soil Sevice Inc. 715-684-3449 p.3 C mgnon_en_l Condition Tt"tMeat tti* Size: Gallons Rafflas: Q Functional Q Need replacement Manhole cover: D Replace D Locking device a Warning laL-cl Infiltration: D Y ON Hawing bwolp Sire: Gallons Manhole cover. Q Replace ❑ Locking e p Warning label Alarm functionsi: O Y Q N lnaluWon: O Y i Do wn$ W*. Sim: Gallons Ole cov Q Replace C1 Locking device q Warning label Alarm functions!: D Y 0 N Pump fin c6oasl: p Y Q N Infiltration: Cy O N SAS: TOW area: Square feet POndinS depth: inches System depth below grade: 3 - inches VerWobiervation pips functional: -Q-Y 0 N Seepage or surface discharge: O Y -$N Potential repiscppant am available: N Clogging lost farWA4. 11- D N Comaggg ggd Recosnt®ettldatiorts i :LZ4 Ce>i tificalion and Disclaimer The inspection was based upon a surface inspection of said systeut, 39-ICA d 1d r1C!. inw4ve any excayating or chemical analysis. Accordingly, there i the Possibility of hidden defects in the system not discoverable by thi:a inspecciox:.. W does not in any t or guarantee the continued cperati,:,n ct PIT* ,Jul 20 04 00:41a Steels Soil SEvi6f fhb 715-604-3449 Wj Steel's S-A Service, Inc. Invoice David Steel 994 200 TH St , , ; irivtstr Baldwin, IVI 54002 7/20/2004 370 Phone # 715-684-5680 Bil! To Brad Alien 1016 l 10th Ave. Roberts, WI 54023 t~r"rn: ode dptm tftcipt Description Aare>UM septic inspection 125.00 f hank you for your business. Total $125.00 n CO) 0 3 'o n d ~1 O r m O w I >v p ID V) A - S O CD N K) N FBI OD O OD -I Q A Op- n N N N w_ O li j j CD = W O co ' co O N N 1 N N L4 N O CD O 8 p Q O. O U1 O QD O OD A f~D (M T A9 CT CO O co 3 C C) O O~ O 0 r. = N 0 N N = Q N 0 W ti C N Co m vD CL a C? M x'o~oN ao N V ((D ro (D~ ~3 co o-4 C ray , H COO ~ 4 _ ° ° H. Ul 8 > o r• ¢ rrt lZ N co co < n r Cl) ert :1 N O W= CD CO) 3 a U) x CD L rt t~ rn Ul H o OOOQ (D N !.n C/1 /yam $ O' F a E CO) CA CO) N p D q W IQ G 0 :E O F-i CD o w A CD < CD H m w N =3 -4 Q co t-I 0 t~ p I D co o 0 FD' m CD N iv 010 Q` H H v N O lv :E! CD ~ :3. ON ` Z U) CD m Cl) ~a O 1-tl ~ a 3 v z (D O p z I _ _ m F (D c N A z t-I G) CL o H s Lr ~ cn W M N tt CO rt Ln CL z a 9 a M C M ao y Z CD a oo Q oD C v - o a a I I I A I O O I O N O H A CD prAq CAn p 0 N ° o- ` J p Aar) Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. s' T Z2 -N-R~W ADDRESS ST. CROIX COUNTY, WISCONSIN off. SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I114R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Well I 3 aG , 3y t, mod 2 y0 lee. O I to Yl ` -~o INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used, ~i sr Elevation of vertical reference point: ler_e Proposed slope at site: S SEPTIC TANK: Manufacturer: ~l/1C~S Liquid Capacity: /Q7®~ Number of rings used: ---0- Tank manhole cover elevation: Tank Inlet Elevation: /o y,,g4 Tank Outlet Elevation: Number of feet from nearest Road: Front,(kide 0 Rear, O 7 / 5'0 00 feet From nearest property line r Front,O Side ,Rear, 0 > 7r feet { v Stet. s Number of feet from: well > 5'0 e&) , building: 1 11 (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: V- Trench: Width: / Length: y$ Number of Lines: 3 Area Built: y Fill de th to top of pi e: d Number of feet from nlrarest q'o ert line: Front, O Side, 0 Rear, O Pt.>Sb P'z' P y ' Number of feet from well: > /Sd r Number of feet from building: -7.2 (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, 0 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: License Number: 3/84:mj Y~ a -zz 1 o n Qr 00 n ti n t 7N V s w ~ W %14 4~ o V, o 0 Q` ~ w 3 v x 0 F a- 0 NO -PIZ- DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY dE BUILDINGS P.O. B9x 7969, PRIVATE SEWAGE SYSTEMS DIVISION ,MADISON, WI 53707 BUREAU OF PLUMBING JCONVENTIONAL ❑ALTERNATIVE State Pianl.D.Number ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (If assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER Kent Drinkwine 16811 15th St. S INSPECTION AT Lakeland, MN 55043 ;®_~~'74 BENCH MARK (Permanent reference pomtl DESCRIBE IF DIFFERENT FROM PLAN SW SW, Section 5, T29N-R18W, Town of f Warren REF. PT, ELEV.: CSTREF.PT. LEV Name of Plumber: MP/MPRSW No Cnunry. Sanitary Permit Number- Dave.Fo;erty 3289 St. Croix 83862 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV WARNING LABEL LOCKING COVER ? PROVO DEO PROVIDED ISEDDING. VENT DIA.. VENT MAiI HIGH WA EH YES DNO [DYES DNO ALARM NUMBER OF ROAD. PROPERTY WELL BUILDING. VENT TO FRESH YES DNO FEET FROM LINE )4 AI ET ! [DYES LINO NEAREST ~QC)` DOSING CHAMBER: MANUFACTURER BEDDING LIQUID CAPACI IY PUMP MODE I p UMP. SIPHON MANUI ACiIIRE'I WARNING LABEL JLOCK:NCVER ED] ONO PROVIDED PROVDED GALLONS PER CYCLE: PUMP AND CONTROLSOPERATIONAL [DYES LINO DYES LINO (DIFFERENCE BETWEEN NUMBER OF PHOPF HTY WELL BUILDING VENT TOFRESH PUMP ON AND OFF) FEET FROM LINE 41R INLET DYES ONO NEAREST----I,. SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I I NI,TfI I)IAM( TE It MATt HIAE AND MARK IN(, or excavation. (If soil can be rolled into a wire, construction. shall cease until LRCE the soil is dry enough to continue.) AIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH n LENGTH. NO OF UISTH PIPE SPACIN(, COVER 111, TRENCH `!/Y/n INSII)L 11IA SPITS LIQUID DIMENSIONS III . MAT HIAL: PIT DEPTH. G AVEL OE BE LOW PIP. FILL DEPTH UISTH PIPE UISTH PIPE DISTR PIPE MATERIAL O It ABI COVER Et I if I EL E U NUMBER OF PROPERTY WELL BUILDING VENT FRESH PIP FEET FROM L'"E ~j/°~ y(~ AIR INLET : / F"' LJ-? ;NEARESTtS ~aZ MOUND SYSTEM: 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 ON REVERSE SIDE. SHOW ELEVA- [D YES LINO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEx TURF Pf 1(h1ANf N I h1Al(Kf HS UHSEN VAI ION WELLS DEPTH OVER TRENCH BED OEPTHOVtR TRENCH HED - DYES ONO DYES DNO CENTER I)[ Vi/1 U{ i(1VSUIL 111UI)f l) JEE Uf D EDC,ES MULCHED [DYES. PRESSURIZED DISTRIBUTION SYSTEM: DNO D YES OPO [D YES DNO BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH HF LUW PIP( TRENCHES. FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL Nf) UISTH UISTH PIPE UISTHIBUIION PIVE NG ELEVATION AND ELEV. ELEV. DIA ELEV. PIPES Dln MATERIAL &MAgKI DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING UHILLEDCOHRECILV COVER MATERIAL VERTICAL LIF T LORRESPONDS TO APPRQV ED PLANS [DYES LINO DYES DNO COMMENTS; PERMANENT MARKERS- OBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING FEET FR [D YES O NO D YES LINO NEARESTM LINE Sketch System on Reverse Side. Retain in county file for audit. S N U TITLE DILHR SBD 6710 (R. 01/82)/ J D1~_ .HR SANITARY PERMIT APPLICATION COUNTY r _ In accord with ILHR 83.05, Wis. Adm. Code STA E SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than D. 8% X 11 inches in size. STATE E PLAN I.D. NUMBER -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 '/a S S TZ , N, R ,,v E (or PROPERTY OWNER'S MAILING ADORES LOT NUMBER BLOCK NUMBER SUBDIVISION NAME S. CITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, t~41EE~R~ANBhfikit}f tr5~7 Y7 02r TOWN OF7 O ILLAGE : y`! G zS /.r rrc %/G II. TYPE OF BUILDING OR USE SERVED: 0C_/a _ /QlOV -C/Q OZ Number of Bedrooms if 1 or 2 Family V OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. a 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 rOF~SYSTEM: (Check only one in ##1 and only one in ##2) 1. a. L~ G'onventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPT N SYSTEM INFORMATION: (Check one) 1. a. See page Bed b. ❑ seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 900 Feet R Private Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in allons 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 Holdin Tank 12Q % / - ❑ 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's Signature: (No Stamps) •W/MPRSW No.: Business Phone Number: `V r• -C Y-- ca Plumber's Address (Street-, -Pity, State, Zip Code): Name of Designer: / 41 GIV, -I z- VIII. OIL T ST 1 ORMATI N C ified Soil Te ter ST) e CST # 3233 CLJ' S ADDRESS (Street, City, S Zip Code Phone Number: cY' 4-S Y, o ex- 'S k~T 59D13 ~/S qy - 3G S~ IX. C UNTY/ PA TM T USE ONLY X❑ Disapproved Sanitary Permit Fee Groundwater Date Iss ing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge e Z Adverse Determination w,~/y V 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 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 p ,vat, sewage systes;?, contact yc:ur local code administra?or or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the !egal description where the system-is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/2 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 mok,e cgmmonly known as the groundwater protection law. This change in statutes was the result of over 2 year!srof'steady negotiation and public debate-The groundwater `bill Gro6nd,#at6r included the creation of surcharges (fees) for a number of regulated practices which Wiscorl"I M's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried tfeasure is used in, your building is returned tQ 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- ~ - w ~ water, groundwater contamination investigations and establishment of standards. Groundwater, g it's worth protecting. SBD-6398 (R.03/86) a n) a W+ ~ w M IND n 0 I Alb N y e 1 ~J _ ~ 3 O o ~ r 4 R 3 C til r . f I Q r DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS .INDUS RY, ' DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS \ 1 MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION:s SECTION: OWNSHIP/1444111"GIPPcEffly, LOT NO.: BLK. NO.: SUBDIVISION NAME: IT,?,? N/R IA 1 r COUNTY:/n OWNER'S MAILING ADDRESS: __5 t=1 / 11 e I /4~ F 11~ / -f- V r-/- _ro, USE DATES OBSERVATIONS ADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFI E DESCRIPTIONS: R OLATION TESTS: M esidence New ❑ Replace / 6,/ 1 RATING: S= Site suitable for system U= Site unsuitable for system . I ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMEND D SYSTEM:loptional) ~S ❑U [DS ❑U as ❑U ❑ S CCU CgS ❑U ! ~ ~ P 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 DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 74 16v, .9 NOS h/f ?8 mS. B- Z > 77 -.7WAS r ew 5, B- Zy Ap 'j- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P. P- P- 3 Awe > > P-_ - P- G'X t 2- JI/ ? - . s 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 ?s, 7 ' __T_ V E i E ; I 7 ~ i i r s F c f ~ P I E S 1 1 , i,.^~ E , r , i z E f f ~ € 1 i E i i ~ ~ 1 l I a 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. =NArint): TESTS WERE COMPLETED ON: a ESS: CERT FICATION NUMBER: PHONE NUMBER (optional): o 6Pr c,~s ea Z33 - 3 56 CST SIGN IURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DI LHR-SBD-6395 (R. 02/82) - OVER - TO I l test, y orr mercial project; 3. 4, r ~Y .SHE i t 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 _ ate- .21"h1 ha"ge Location of ~~Property GcSection T ;ZN-R W Township W~ Mailing Address Address of Site Subdivision Name Lot Number Previous Owner' of Property,, Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes k-' No Volume and Page Number 117J 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 I (We) eenti.by that att ztatements on thi-6 6onm ane ttr.ue to the but of my (oun) knowledge; that I (we) am (ake) the owneA(.s) o6 the pnopehty denscAibed in th..s in4mmati,on Sonm, by viAtue o4 a waA arty deed %eco&ded in the 044.iee o6 the County Register ob Deeds ass Document No. 2. ; and that I (We) peesentey own the pnopozed site jot the sewage duspos System (on 1 (we) have obtained an easement, to nun with the above deg nibed pnopenty, jon the con6tAuction ob Said zy6tem, and the same has been duty recorded in the 044.iee o6 the County Reg.usten o6 Deeds, ad Document No. a r SA NATURE 0 +OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED L • a STC - 105 r a SEPTIC TANK MAINTENANCE AGREEMENT ryi St. Croix County z d a 4- OWNER/BUYER` onzmlc t w~ e - ROUTE/BOX NUMBER 161 Fire Number CITY/STATE An. ,SSOy ZIP PROPERTY LOCATION: SLtJ , 54y k, Section T iZfN, R /JV W, Town of &L44_~ St. Croix County, Subdivision 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 z 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 Q -*DATE St. Croix County Zoning Office P.O. Box 9B- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. L