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Parcel 15.30.18.227F 026 - TOWN OF RICHMOND 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 - HUBMER, JOEL & JUDITH JOEL & JUDITH HUBMER 1624 SEQUOIA LN NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1540 HWY 65 SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.430 Plat: 1454-CSM 05/1454 SEC 15 T30N R18W PT NE SE 3.03A LOT 4 OF Block/Condo Bldg: LOT 4 CSM 5/1454 EXC CSM 13/3769(RD) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 15-30N-18W NE SE Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 698/125 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/19/2002 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 2.430 60,000 94,000 154,000 NO Totals for 2006: General Property 2.430 60,000 94,000 154,000 Woodland 0.000 0 0 Totals for 2005: General Property 2.430 60,000 94,000 154,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - S T C - 104 L~'b yy~ AS BUILT SANITARY SYSTEM REPORT OWNER j TOWNSHIP / SEC. T_.,2 N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN T~ 1 SUBDIVISION LOT % LOT SIZE i PLAN VIEW Distances and dimensions to meet requirements of ILHR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /r9f ~C i ~ f' fr , a~ /r I t INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ~J Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: - S s? iquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: 957 6 _1 Number of feet from nearest Road: Front , Side n Rear, O T /feet From nearest property line Front,t7~Side,0 Rear, O feet Number of feet from: well building: ~ql (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE L - l 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: X Trench: Width: Length: Number of Lines:_ Area Built Fill depth to top of pipe: Number of feet from nearest property line: Front,) O Side, O Rear,~l~t. Number of feet from well: ~J Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. 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 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 MADISON, WI 53707 BUREAU OF PLUMBING i~E CONVENTIONAL DALTERNATIVE State Plan I.D. Number: ❑ Holding Tank 1:1 In-Ground Pressure ❑ Mound 111 assigned) NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE: Hubmer's RV Center 415 Greaton Rd, New Richmond, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV." NE SE, Section 15, T30N-R18W, Town of Richmond N-e of Plumber. MP/MPRSW No.. County. Sanitary Permit Number: Cal Powers 1563 St. Croix 58930 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. J`- `!`lLr ? YYES ENO EYES NO BEDDING. VENT DIA.. VENT MATL. 11HIGH WATER ROAD: PROPERTY rl_!_~ BUILDINGVENTTOFRESH AARM NUMBER OF FEET FROM uNEAIR E YES E YES ENO NEAREST J DOSING CHAMBER: MANUFACTURER 7ING L IQUID CAPACITY PUMP MODELPUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDEDPROVIDEDES NO DYES ENO OYES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING ( VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) EYES ENO NEAREST 0-1 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing JLEN(,TH DIAMETER MATERIAL AND MARKING or excavation. (If soil can he rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH. LENGTH JNO01 DISTR. PIPE SPACING. COVER INSI UE DI A.. 'PITS LIQUID BED/TRENCH f { l TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTH. PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO. D.1 7NEAR NUMB ER OF PROPERTY WELL: BUILDINGVENT TO FRESH BE LOW PIPES ABOVE COVER EI NLET EL EVEND PIPES FEET FRO LINEAIR INLETEST-M /✓s~ y41.. 4 Ay 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- EYES NO meets the criteria for medium sand. PIONS MEASURED. E SOIL COVER TEXTURE PERMANENT MARKERS JOBSERVATION WELLS EYES ENO EYES ENO DEPTH OVER TRENCH BED DEPTH OVER TRENCH: BED 1011TH OF TOPSOIL SODDED SEEDED MULCHED. CENTER EDGES EYES ENO EYES ONO EYES ENO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. 7LENGTH. NO.OF LATERAL SPACING: JGRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.'. ELEV.'. CIA.. ELEV.. PIPES'. DIA.: ELEVATION AND . DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ENO EYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE. DYES ENO DYES ENO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE DILHR SBD 6710 (R. 01/82) ■ W'5con5ln APPLICATION FOR SANITARY PERMIT 64'C~ COUNTY DILHR OE-Rq En-r OF (PLB 67) UNIFORM SANITARY PERMIT # IPICIUSTq .LgBOq&HURlgnqELRTIOnS ^r -Attach complete plans in accord witn 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 PROP RTY WNER MAILI ADDRESS PROPERTY LOCATION C_{-{Y; 1/4 ,F 1/4, S !c' , T3 N, R E (o0Qw' TOWN OF LOT NUMBER IBLOCKNrBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPEOF BUILDING OR USE SERVED / ❑ 1 or 2 Family Number of Bedrooms: Fx Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. X Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total # of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber 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): o~ r~ ? 0 Private El Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of he private sewage system shown on the attached plans. Nam~of P umber (Pnrlt): Sign re: - MP/MPRSW No.: Phone Number Plum is Address: / i Name of Designer: / COUNTY/DEPARTMENT USE ONLY Signatu,re of Issuing Agent: Fee: Date: ❑ Disapproved i C P ) ~j~ ❑ Owner Given Initial d 1-d J Approved Adverse Determination Reason for Disapproval: $,5-oa0o5 Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To, Bureau of Plumbing, Owner, Plumber?kA DILHR PLAN APPROVAL Safety and Buildings Division Bureau of Plumbing P.O Box 7%9 El General Plumbing P f Madison, wl 53707 ❑ Private Sewage PI Telephone: (608)266-3815 119 OFFICE USE ONLY Plan Identification No. Gallons Per Day 7~ w - V PRIORITY PLAN REVIEW ONLY Plan Review Petition For Modification Project Name Project Location - Street No. or Legal Description County ❑ City ❑ Village ❑ Town of: The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. ❑ FOR PRIVATE SEWAGE PLANS: This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. Comments: By: James Sargent Bureau Director If Questions Plans Approved By: Date Approved: Contact I cc: ❑ OWS ❑ DPS ❑ H&R & Rec. San. Section ❑ County ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other P1 b. # 60 1/78 ' 4 PROJECT DETAIL DATA SHEET NAME OF BUSINESS I - ' - LEGAL DESCRIPTION 4 7 /s' j OWNER MAILING ADDRESS ARCHITECT, ENGINEER, J,, ADDRESS PLUMBER OR DESIGNER /VlJ,I ~~/rr~~„lc~GJ~ I P ~ O/7 TELEPHONE NUMBER y/S~3.5 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed. Please consult Section H 62.20. Existing building New building- Addition ( ) Apartments and condominiums . . . . Number of bedrooms ( ) Assembly hall . . . . . . . . . . . Seating capacity ( ) Bar . . . . . . . . . . Seating capacity # of meals served ( ) Bowling alley . . . . . . . . . . . Number of lanes ( ) With bar ( ) Campground and camping resorts . . . Number of sewered sites Number of unsewered sites I Total number of sites ( ) Camps . . . . . . . . . . . . . . . ( ) Day use only Number of persons ( ) Day and night Number of persons Catchbasin . . . . . . Number ( ) Church . . . . . . . . . . . . . . . ( ) No kitchen Number of persons ( ) With kitchen Number of persons ( ) Dance hall . . . . . . . . . . Number of persons RV,CEVVED ( ) Dining hall . . . . . . . . . . . . Number of meals served daily ( ) Dog kennels . . . . Number of enclosures IAN 2 1985 ( ) Drive-in restaurant . . . . . . . . Inside seating capacity Car-service Number of car space!pL 1MBING BUREAU ( ) Dump station . . . . . . . . . . . . Number of dump stations i -O Employees ( total of all shifts) Number of employees _ ( ) Hotel ( ) Motel ( ) Cottages . . . . Number of units with 2 persons per unit Number of units with 4 persons per unit ( ) Medical and dental office bldgs. Number of doctors, nurses, medical staff Number of office personnel Number of patients ! ( ) Mobile home parks . . . . . . . Number of sites I ( ) Nursing homes . . . . . . . . . . . Number of beds ` ( ) -Parks . . . . . . . . . . . . . . . Number of persons ( ) Toilets I ( ) Showers ( ) Restaurant . . . . . . . . . . . . . Seating capacity ( ) Dishwasher and/or disposal? 24- ( ) Hour service Retail store . . . . . . . . . . Total number of customers S- ( ) Schools'... . . . . . . . . . . Number of classrooms _FT Meals ( ) Showers ( ) Self service laundry . . . . . . . . Total number of machines ( ) Service station . . . . . . . . Number of cars served daily ( ) Swimming pool bathhouse . . . . Number of persons ( ) OTHER . . . (Specify) . . . . . . . COMPLETE OTHER SIDE 85-10005 i • 2. Indicate whether the following facilities are present. Floor drain es no y x Number of drains Food waste grinder yes no Dishwasher yes no ,c Automatic clothes washer yes no y Number of clothes washers 3. Septic tank capacity looq- . / Holding tank capacity Septic or holding tank manufacturer 4. SEEPAGE TRENCHES: total square feet width of trenches length of trenches depth number of trenches SEEPAGE BEDS: total square feet Z/ width length of bed q~ depth F3 SEEPAGE PITS: total square feet outside diameter depth below inlet total depth from top to bottom of pit I Signature of per completing form: FOR DEPARTMENTAL USE ONLY l v Address ~ 41,,,11"&f1&2 14 z i p Telephone Number 71,S = Date pL~~,,~glt~l4 pNS GiR c1N~N(G)f pE p!ViW~ i J/ /12 -SS /9,(-/ / , ~u~~s~or1D s 017 n m 7S O p I4-Al - ~C~/avow / C~ s.x 1, 5a 1 : -7S ` BE) p~~\Me\~G 5 X, 03 X ago 1 d titu~ 79 gg P.t i ~ 85 00005 Cµl- a~ . I o 1 a ~ ~ti I' LO L rS r,`LL` 1\ 1C I~YVIDY~U W\S C S y~ 1 1 ~h C r t~ C C~ p $5 1~ ~ c~,rn D,~c~ i ~.s~• s ~ ~ ~ R~CE1vED ~ ~g85 ' ,1 AN 2 10~. ~ ~ - ~ ~ - ~ s~ pt-UMBING BUREAU ~ I M , 2Sw ►s~~ 5yai ~ / r lG 3 lT lp~~1NQ IONS a ~ ROES PACE OF /Y61JCh rC~ S J Z C 1 U (l Q / i e 17 S c' n 1 4144.) Fresh Ali Inlelc And ODcervallon pipe offe, ID 0 0 O~ Approved Vent Cap minlmam 12" Aoore Final Grad• 20- 42" ADore Pip• _ 4" Cast Iron To Final Grad* Vent Pipe Mor en Moy Or SrnlMtlc Covering _ Mtn 2° Aggregate re, Pipe OInrlDutlon O 1 j{1, ``r~.y{ Pipe 0 0 0 0 0 Tee 44~~~ 1N'~ 6` Aggregate r1_ MW31- GoneolD Pipe 0 Perforated pipe Belo. o Coupling Terminaiing At 00,10011, Of sy6fom 11,11,11" 9-5,/ / ~~cJR~ f orl -F SOIL FILL DISTRIBUTI0f.1 PIPE APPROVED Sj)JT{ETiC COVER 2"OF AGGREGATE o MATERIAI- OR - ~OR /~ARSN NAB / OFAGGREGATE tLEV. OF a + 1FEET, DISTRIFjUTI1DQ PIPE TO BE AT LEAST ~c?_ INCHES BELOW ORIGIUAL GRADE AkJL) AT LEASTZO IKJCHE-- BUT 1.10 MORE THAf,J tit IAICHES BELOW FILIAL GRADE MAXIMUM DEPTH OF EY,(AVATid)Q FROM 0K1&WgI (J0XADF- WILL BE ~ INCHES MINIMUM Wr)t OF EACAVATIoM FPOM (*141WAL (RAp€ WILL BE ~b INCHES S16►.JEO: N~ LICEIJSE AJUMBER:_~l T~USiRYr 1 I r DATE: aj+1DENC wtsconsin APPLICATION FOR SANITARY PERMIT ~ DILH R COUNTY (PLB 67) 'nOiJ5 -I O 0 UNIFORM SANITARY PERMIT # - InIXJSTRV.gV,L RBa BOR6HUTRn RELRTIOnS Q © O ~.7 5 go -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROP RTY 77ER MAILI ADDRESS PROPERTY LOCATION G4-TY: VIL. _ . Z__ 1/4 F_ 1/4, S T3 , N, R (or)L~) TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST R AD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE'OF BUILDING OR USE SERVED ❑ 1 or 2 Family Number of Bedrooms: L l, A Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair i~ Replacement Soil Absorption System ❑ Revision ❑ Privy Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. X Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total # of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity I~ Lift Pump Tank/Siphon Chamber 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): Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of he private sewage system shown on the attached plans. Nam~of P umber (Pi Signre~ MP/MPRSW No.: Phone Number Plum is Address: Name of Designer: J COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ❑ Owner Given Initial Approved Ad se Determination Reason for Disapproval: 'LZ 40 Alternate course(s) of Action Available: P tY~ DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber 0 r x m M d v Y _ cc: cc f\-) 3 N " CD (D M n (7 (D 0 O CL n y 0 3 -o, =r =r w 01 w o c o w , < w S. 5 3 cc cc N CD to --X CD ~o CD - p CD cn p a p y p° co o ° a. 00 2) 2) 0-- 0 w ~o CD CD CL -4L N CD 0 co (a a n 0 (D (D ODD P 3 N - > > o w o C w > :3 = 0 < 0 0 C- c c 3 -ten o c 3 0 =a0 =r 0 °ww =-0CLDo \ :3 w A M " 0 < fD c c- co uo Y o 0 _-o D w p gyp m C ' - S '0 ° a CL CD 0 w. (p O r a = w O 'V E (O y 3 --x -0 :5 :3 y p N w N. N Z =r c<n :E j CD m W .Z a(Do 3mm0 0. --I 1 D En C Q O A F ca (a cn - 0 =r 0 =r m v ?m0 van'wwm~. C m CD -0 N CD w (D , v' n o ° m vw = CL c gy 0 0 y o_ co D w 3~ CD 0 w In CL. ~ ao f a, c c° aw o' ITI w 3 w a a a CD N a o CD a Q un", v3 *,=r v' < =r CD 0 0 G) co =3 < CD a o o cp c cn a caw m -~mcw ac a cw .=.0 _3 0 o o a a :3 w a o a m 0 :3 CL 0 < co (D - 0 C z o DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, LABOR AND PERCOLATION TESTS DIVISION P.O. BOX 7969 HUMAN RELATIONS. 1115l f MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWN HIP/M1JWC-tPALITY: LOT NO.:BLK. NO: SUBDIVISION NAME: COUNTY: O NER S/B YikS NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE / NO. BEDRMS.: C MERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: ❑Residence ZNew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system - > ; CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) S DU D S DU S DU D S ©U D S ®U J - ercolation Tests are NOT required DESIGN RATE: / If an / y portion of the tested area is in the er s .H63.09(5)(bI, indicate / Floodplain, indicate Floodplain elevation: F PROFILE DESCRIPTIONS G - BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH t%, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 7 7 B- 7 `~'y j i I r B > - 991 - __S' PERCOLATION TESTS CJAG f't TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INC''TES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PER 2 PERT 3 PER INCH P- S 5 P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dime ons 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 dirgction a rd percent of land slope. f _ SYSTEM ELEVATION _ C11\ ' 63 SCE f IVED r S t SoS ~s~~ pLl1MB1 1. N f~ T _ 69 I, the undersigned, hereby certify that the soil tests reported on this orm were made by me in accord with the pr cedures and methods speci ie in the iscohsin 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: A SS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SLAT RE:/ i DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER l y S T C - 105 r y H • SEPTIC TANK MAlN'TENANCE AGREEMENT o St. Croix County z d y r H OWNER/BUYER-.`G4+r C'fZ-.'clV- ROUTE/BOX NUMBER Number----- CITY/STATE L h rn~~ al ZY f- ---ZIP _ Ql-7 - k PROPERTY LOCATION: ' bko 1-4, Section [ _tJ N~ R.~_W 11 c"+ct____-----_--' St. Croix County, Town of (%C~J 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 sej>tic 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 maw 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 ehat owners of a_1__l_ 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 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. S 1 C N E U I St. Croix County Zoning Office j P.O. %ox 93 lfammu ad , W 511015 715-096-2239 or 715-425-8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT S T C - 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 ` ' O f' L L Location of Property J1J"f~, .5 -14, Section T N - R W Township d Mailing Address Subdivision Name Lot Number Previous Owner of Property 4 e r j-1, 'T'otal Size of Parcel 0Q [v'- S 6 U `!vim Date Parcel was Created fit. ~4 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number /y 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (we) eeht 6y that aU statement6 on this 6ohm ate -true to the bmt o~ my (out) knowledge; that I (we) am (an.e) the owner (s) ob the pnopenty dacA bed in th,&s in6onmation 6onm, by viAtu.e o6 a waiAanty deed teeonded in the 066ice o6 the County Registet ob Deeds o-5 Document No. , and that 1 (we) pneseyWy oun the p'nopo.ded she ion the sewage d~osat system (on I (we) have obtained an eabement, to nun with the above desct bed pnopeAty, jok the eonst&ucti.on o6 6aid system, and the same has been duly heeohded in the 066.iee o4 the County Regi6teA o6 Deeds, as Document No. ) . GNATURE, OF OWNER SIG ATURE OF CO-OWNER (IF APPLICABLE) IFI~l DATE SIGNED DATE SIGNED