The URL can be used to link to this page

Home My WebLink About038-1121-60-000 fA O p (n 0 d O A 7 v h. n Cn C Gt 3 CD CD = CD CD d r•-~ Fes- H K A CD (D co Q t ri (D FJ C--i I w o S h 0) Cl) H• (t o LTJ o rn Cn 2= ° o w C• O H. 9 0 m v m v v° rn v v j rt W (o CD o o m m m co j ~ O o N N m w a CD a s `(D FJ H 5C W m D m m co N m m a • 9 ON F- H CAD n -I o'm m o n° ei N In U1 ~4 o _ 3 ° 3 ° 3 N °O (D ON -P- %.o O 7 N N A O O !V H ui ,i CD, o z CD CD CA N ° a n m N m a c? CD I o a C. (D C: _ °m °w n t_q 00 0 C) d In z m z m CC) Co m n o C 00 co C o ~ n cn cn 7 3 t v -u :7 3 0 0 0 3 Z O O O o ` po H H Cn o a 3 C") N cn D C O W :V, T_ U -0 0 0 6 1 0 o F- I CD G) FA G) co -0 77 (A O m J Fn H CD j r cn N Cn (D z O rr r z~z ° z~z Cn !v rt D o 7ii D 3 s. E CD m ~d r t r 0 3 E :7 F~ CD m N W CD CD Z CD v H o " rt o w (°D o CD _ v Z A Z co n U) cn in' O W O 'd u p z 0 C (D r H co (D m v o w o rt r{ (D G_ L-4 0) '0 H• rt U t~] W m a Z O H• w JC Q 3 O ~ rt 1 - 00 - O m OC) V rn H Ul 3 3 H w z N A Q\ ',D H CD ( O w w (DD H n r v o n on o ~3 o _ a c (D 5' T w c n ° ° o m °Z o. a ~ m v 0 o v°, A N CD (D n '00 00 :3 0 0 V] H Cn 7 J a I rt w :2~ In w -0- o cO ° ri co~ o F-d ~d m m c N Q N O_ C) G~ H• rt N < m ::r o • (D r-7 H• 3 No (n O p 0 CD 3 a N A rt N Cl) (D O W (D (D rt O O CD ° ~ N Fh CAD UO ~N• O t0 W o O O C a O p a ti 00'0 00'0 00'0 Ie301 sa6ae4 3 uenbuiIaa sa6ae4a leioadS s;uawssessy leloadS I ;unowy fuo6a;ea apoa Ieloads aasn :sleioadS 666 4O3ea :Ole(] uol;eoigpoa :;unoa wlelo :}Ipaao Ajoijo1 0 0 000'0 puelpooM 000'bS6 009'LZL 009'Z£ 060'Z AljadoJd IWOua0 :170OZ ao; Slelol 0 0 000,0 puelpooM 000'b96 009'626 009'Z£ 060'Z A:padoad IWOua0 :9002 J03 slelol ON 000'tbs6 009'LZL 009'Z£ 060'Z LJ WiN~IaISEI2J uoseam a;e;S le;ol anoadwl pue-I saJOV ssela uolldposaa b00Z/SL/OL :pa6ue4a Ise :suol}enlen 00L'99 L 9026 L L :4;!nn passessv :anleA;a PM pled We kNviNwns 5002 ~ ~ 98~/99L b8~/ 688 OO 6/ 600 6 (IM Z6Z/98bZ 99909L b00Z/L01 L0 adA 1 abed/10A # Ooa a;ea :fuOlslH laoaed :sa;oN ajow Oda L£ S Hl , L£'Sb 3 9~1a LL S Hl. L VttZ A `Jda 9£ N Hl .89'£L M `Jd(I 68 N Hl M8L-NL£-0£ `80d Ol,t,6'66Z M Oda 68 N 1NOO Hl't,94 (ti/L 096 b/L Ob 6u2]-uMl-oaS) :(s);oejl BOA WSO Z 1M HOO DS Ol.6£'£ M `Jda 68 N 'Naat/ MEIIAiSd2]O NOO EN iV WOO 09 3JHd L :6p18 opuoo/moola IOA WSO 710 Z 10-1 ~]N ES Mg6H NL£10£ 03S D-19VIlVAV lON-V/N :field 0607 :sa.iov :uol;dliosea le6a-i O11M OOL L dS ldSHEMOS :AO Cl HOS Z£b9 OS M MDIA'6EMJ 0866. uol;duosaa #;sla odA1 Ajewud :(so)ssaappy AlAodoJd leloadS = dS IoouoS = OS :s3OIJIS!a LLObS IM aNOWHOI2J MEN GH HJI~3WH 9066 SIAtf2J1 `H11WS - O H11WS SIAVHi 1auMp-oo juaiino = 0 'jaumo juaiino = 0 :(s)JauMO :ssaippv xel 0 00 adAjL I!waad #;!w-Jad # uolleollddy eaay saleS # deal a;ea IeOlao;slH a;ea uol;eaJa NISNOOSIM 'J.1Nnoo xioHo 'lS X ;uai.ina E]1 j11 1 Jd 2]ViS d0 NMOl - 8£0 OZOS'9 V 6£'0£ IaOJed '31`d Z =1O 6 3IDVd WV L9:20 9ooz/Wzo 000-09- ~Z WM 4183aed COMMERCIAL TESTING LABORATORY, INC. ..514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 Cj:A w , tj 715-962-3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 CROIX COUNTY hUORT DATE: 4/0i, I'JRT lt1SE ,T RU;ETGED: 3 ,l.. GON, WI ~(z~ 7 PAT J LLEC ' W" . M , .der` JE COLLECTED: 3-2` tME COLLECTED: 3.0~' 3-3 UFORM a 'JERPRETATION*4 Bacte•- .e _ lit;(IP.j W.1 a ]t.ti~(33iu- g ~ 10 s ti 1 L ~ J OF.NDEVfNOENr b No. 19 J P O y a .n0 « ~ r,•. ti„ ~fa:" ~ ~4D`f.?\%EtV icy. PROFESSIONAL LABORATORY SERVICES SINCE 1952 ct ~i NN ONt f• try ST. CROIX COUNTY ZONING OFFICE ~\~~p St. Croix County Courthouse 911 4th Street b`f Hudson, WI 54016 wd Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion o this dorms gssentia-j Q that -tllg property can ~e located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 35.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VCC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at time of inspection) PROPERTY OWNER'S NAME: PROP. ADDRESS: CITY A ~k' ,1, Legal Description 1/4 of the 1/4 of Section , T N-R~\ Town of Lot Number - Subdivision: l kl- ' _ Z / FIRE NUMBER LOCI BOX NUMBER Color of house Realty sign by house?1., If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A IIAP,i.e,COPY OF PLAT BOOK, WITti LOCATIOII SIIMRI, AND A. COVY OF THE LISTING SHEET. Testing of residential b.wter --c-quires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting service::'~O,,'(f I~ Telephone Number REPORT TO BE SENT TO: CLOSING DATE:-._._.I Signature •t ST. CROIX COUNTY r WISCONSIN ZONING OFFICE x, - ST. CROIX COUNTY COURTHOUSE T 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 March 30, 1993 Michelle Dunckel MidAmerica Bank Hudson P.O. Box 71 Hudson, WI 54016 Dear Ms. Dunckel: An inspection of the septic system on the property of Mary E. Kurschinski, located at 1980 Riverview Lane, Somerset, WI was conducted on Mar. 29, 1993. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact his office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator cj Parcel 038-1121-60-000 02/10/2006 08:51 AM PAGE 20F2 Parcel History: cont. 716/60 Legal Description: cont. W ALG WLY LN OF SAID LOT 2, 215.65' TO THE POB EXC PART TO CO HWY AS IN 791/03 0.08ACRES PARCEL ALSO INCLUDES LAND DESC IN 881/484-486 ADDED LAND IS EAST OF 66' PRIVATE RD EASEMT & WEST OF LOT 2 CSM 1/54 i I ' r 4') j CrU,1;r~ 31OS90 C E R T I F I E D S U R V E Y M A P Certified Survey Map number Vol, 1, Page 54 Sheet 1 of 2 sheets 33.00' ~,~q~ttuuN~~~~ S 5602110011E ~SGOI~si 197.66' a G. ROBERT z~ rr: SHEFFERS O s-908 3 M EAU CLAIRE lit WIS, Q r Z 0 LOT I i~`o~O • J ~ vim. ti U - N 3 "E 0 0 4400 S 199 gga , C.T.H. C SCALE: i 60' co M nA _ M 0 LOT 2 r, fv 1 lf~j ~i'.. t(D, F I L E D 02 lit z 0 11 ro J UMNi2y q 197,.,_ Y/ ~ I7 _ i won N 33.00 0 M 0 29 f'fl{d;,vit 6(%1-li90 00 N *r f i da v i t 6,j1-L91 'mss, O 111 x 24" iron pipe weighing 1.13 pounds per lineal foot SOUTH ;T CORNER 30-31-18 EP This instrument drafted b Pars 1 Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER T I-m o-t h f")A +EjL°AAI TOWNSHIP SEC. T 3 N-R / 9 W ADDRESS 3,) X 1,5 ST. CROIX COUNTY, WISCONSIN S o R 5 3- z-m / SUBDIVISION LOT LOT SIZE } -t PLAN VIEW Distances and dimensions to meet requirements of 1LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM a~ n I Q l i' CAI ~s 61 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point:- Proposed slope at site: - SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: 77 Tank Outlet Elevation: i Number of feet from nearest Road: Front ,n Side, Rear, feet r From nearest property line Front, 0Side, 0Rear, 0 feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: /Liquid Capacity: Pump Model: Pump/Siph-on Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevat Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of fe from nearest property line: Front, O Side, O Rear, Ft. _ Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: )Width: Length: C) Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front,/ O Side, Rear, 0 Ft Number of feet from well: 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 op box O or distribution box O been used on any of the above soil absorbtio sytems? (Check one). HOLD :G TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet:' Number of feed 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: i` Alarm Manufacturer: Inspector: Dated: 01S 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 BUREAU OF PLUMBING MADISON, WI 53707 ®CONVENTIONAL ❑ALTERNATIVE slate PlanL2N-be, Ilf assigned) D Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. 7R.R.I. DDRESS OF PERMIT HOLDERINSPECTION DATETimoth Maitre' can Box 159A, Somerset, I 54025 BENCH MARK L ermanent reference point) DESCRIBE IF DIFFERENT FHOM PLAN REF. PT. ELEV.. CST REF. PT ELEV SW% NE% Section 30, T31N-R19W, Town of Star Prairie, Lot#2 _ _ Narnr= of Plumber. MP/MPRSW Nn Co~iity Sanitary Permit Numt~ Gar L. Steel 3254 St. Croix _ 69626 SEPTIC TANK/HOLDING TANK: Q MANUFACT\\\UHER. qqq LIQUID CAPACITY T NK INL TAN O L E EV wARNiN LABEL LOCKING COVER PROVIDEG D. PROVIDED. D O YES LINO DYES LINO BEDDING. VENT DIA it VENT Mn7 L HIGH WnTFH NLIM BER OF ROAD. PROPERTY WELL. BUILDING. VENT To FRESH _j X / (ALARM LINE D / AI N T YES LINO FEET FROM L_iYES LINO- NEAREST L DQS NG CHAMBER: MANUFACTURER BEDDING I (QUID f:nPnCl rv i'l)MP (1DE L PL1 n,~P SIFHC)N ,1nNDl .~c.i11I+L f7 WARNING LABEL LOCKING COVER PROVIDED PROVDED. DYES LINO EYES LINO DYES LINO GALLONS PER CYCLE: PuMIANDCONTROLSOPERATIONAL NUMBER OF PROPERTY U_ - HDILOwI, VENT TO FRESH (DIFFERENCE BETWEEN - FEET FROM "E wF (AIR INLET PUMP ON AND OFF) DYES L_JNC~ _ NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ( nn+t rL II [1AT~ HIn: AND MARKING, or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH v LENGTH NO Of nl~n= PIPF sPnL_InI , ~:r/Vri+ Nsn)t uIn =Pi uoulD ~D el rwE"cl,[~ ~.wn Fei.:I PIT DEPTH DIMENSIONS p~ GRAVEL DEPTH FILL DEPTH I)' SIR PIPE DISTR PIPE DISTR. PIPE MATERIAL NO Ili NUMBER OF PROPERTY WELL BUILDING VENT TO J HEL/)W PPESG~ ABOVE VEH III EV NIf I7 ELEV fND rr~~ ~O VIP LINE AIR LE FEET ~•q NEAREST 1W J V , 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- OYES LINO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE 11%iNIMAH fWS R6 oPSEI/vannNwFLLs DYES LINO DYES _ NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH HED DE PIII /)F Tt)PS~)II S()ODF I) SFF U[D MULCHI FD CENTER EDGES DYES LINO DYES LJNO ~I❑YES NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF LA TFRAL SPACINC~ (BRA IL L DEPTH BE LOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTH. PIPE MANIFOLD MATERIAL. NO DISTH DISTH PIPE UISTHIBUTION PIPE MATERIAL. & MARKING ELEV. ELEV DIA ELEV PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILL ED coma (77 L Y COVER MATEHIAL VEHCAL L ITT CORRESPONDS TO APPROVED PLAn~Ts EYES LINO LJYES NO COMMENTS: PERMANENT MARKERS OBS ERVATION WELLS IFUMB DYES ER OF PROPERTY WELL BUILDING EET FROM LINE LINO DYES LINO __EARES Sketch System on Retain in county file for audit. Reverse Side. (~N TURF TITLE DILHR SBD 6710 (R. 01/82) r wisronsin APPLICATION FOR SANITARY PERMIT DILHR COUNTY OEPGiRTTT (PLB 67) IEnT OF UNIFORM SANITARY PERMIT # - InOUSTRY,LRBOn 6 HumAnRrLFT10n5/ -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PRO ERTY OW ER MAILING ADDRESS . 6 ( fit, P OPERTY LVCA ON CtTIr 1 /4 "L--1 /4, S g, T3 N, R f (Dr) W TOWN OF: LOT NUMBER BLOCK NUMBER ISUBDIVISION NAME NEAR EST(R OAD,. AKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED ,A-1 or 2 Family Number of Bedrooms. Public (Specify): THIS PERMIT IS FOR A: V~NNevv System ❑ Tank Replacement ❑ Repair El Replacement Soil Absorption System ❑ Revision ❑ Privy Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure L ❑ Vault Privy ❑ it Ppriv ❑ Existing, For Which A Previous Permit Is On File, Permit # l(/ ~ / issued ~a ❑ 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 L 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 Gallons Tanks Concrete Constructed Steel Fiberglass Plastic 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): ~Zl .1Q rj f Private ❑ Joint ❑ Public jkl I, the undersigned, hereby assume responsibility for installati of the private sewage system shown on the attached plans. Name,4A Plumber (Print): Signatur MP/MPRSW No.: Phone Number: Plumber's Address: Name of Designer: Z l c J;`4( COUNTY/DEPARTMENT USE ONLY Signatuyie of Issuing Agent: Fee: Date: ❑ Disapproved Approved Owner Given Initial Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-Sao-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitarv Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit 9. This permit may be renewed, and at the time o' 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. v_ x w g cn N 3 p X m n n :3 COD m CD ° 3 =r =r C :0, C C ca cn N 7r `G Z S O 3 CD CD on A y O ID C I N CD N N ` 13 to m O d w p CD O CD g 0 CD H M O CD ~ CD w w A ~ OL (n m W 0 m ca 3 0 d C (0 W > =r to O w O CC r p 0 c _ N 3-^c Oc3on' p Z c,~ Q m W E ~ w ?r1 to p C=D (on O p a p w ,,COD ~N ar Q8 A ^ O C O C_ L N -1 In O D CD O n p O C ? w o w o aQC1~ w O n~ O N a :3 5~ w N C ~ ((77aall m~ (1) A w N Z D w g ca' o Z ~ _ cc w CD CD CD F) =r CD CD (1) a N - m E;* -4= m R r- a ww=r wo - c) > > p~ Q N CD ? CD cn =r CL (a a c n CD C rn o f~ 3o' 'o(DM(D (n CD O. cn w CD Co N l o c rCD: c A w w p m no f d a, cc o.a~i o m mw CD -~m(nm « p n. a a d ~ a~vi Q 9G) ~ccn ' ~fD 3 rn n FD' n C L7 co a o (n CD 0 m 0 7 e CL 0 7 O co C CD C CD m CL 0) -0 0 6- = c CD o 3'10 n~3 p~ O°3 w a= CD O p 3 w - CD N c° 0 ~`o DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, 1 G DIVISION N WI 79069 REL DA710NS PERCOLATION TESTS (115) MADP.O.ISONBOX HUMAN N (H63.09(1) & Chapter 145.045) LOCATION:,0 SECTION: p TOWNSHIP/ Y: LOT~7NO.: BLK. NO.: SUBDIVISION NAME: S ,L 1 R ~lor) W COU1NTY: OWNER' BUYER' NAME: M ILING ADDRESS: la:-),'/ g-x / 4 'S G nC6T 4lJ - USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence ~ew 1:1 Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FI11F OLDING TANK: RECOMMEN ED SYSTEM: (optional) ❑u ❑u s ❑U ❑ s u o S U 'iz 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 elevatio i PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEP`"N, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B ,e'7 i~ b7 00i 9 2 4 Is. 1Z 67 B a r s 5~~ 5 7" 150 -35-~ 02 B- ts< 4 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER +We#ES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERF-0-5-7- PER INCH P- 3 ijo 3 3 3 P- 9 P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION _ w ti 100, E Q API ~ f 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: ADDRESS: I CERTIFICATION NUMBER: PHONE NUMBER (optional): J'O' ivy J. L Z 'a lS 2l~~o dZ CST SIGNAT E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) OVER - k3r, .t~ et and af,( sJ~h XtF_r'.' .3t1 C'~..t fr``L'.= -,31):73'; w a f]a Pvg 31"C .h,~.«` a . hit; r TA B;.~~ „ t_ fFc..1.) r BASED G..,sa?~. D f fas P„S~ -'h_ uvif _ierEt ztaf"sw -,he plot plar, t ,edt o u i r .m.e~ ec} - ri . CC, S , *.7'n ?ice i S-`.'> Gravel 3") t y ' a t o - 4ET Ye; 1, . v r ~ r3 ,e>uF ! D Ac- /4 s . 3 0 ..7L- a 4 64-,-) H su-~, ADZ , ve, I ov xwz 5 2 1 'SS@Ippp anoqu oa uznaaz pup aapp 'UBTS £9£8-SZ~-9IL zO 61ZZ-96L-STL STOP g IM `Puowwuli .96 XOg • 0' d a3T330 2UTUOZ ZaunoO xTozO -Is ~tdQ Q3NOIS aapp UOTapzTdxo jv@A aazga aqa 3o sXvp 0£ uTgaTM a5T330 $uTuoZ AjunoO xTOaD -IS aqa oa pauznaaz put, paaaTdwoo aq asnw wzo3 UOTIVOT3Taz99 •saoznosag TpznjuN 3o auaw rw -azpdaa uTsuoDsTM eqa Aq aas SP 'Ulazaq 'gazo3 aas sparpupas aqa H x gaTM aauppzoooP uT waasAs Tesodsip a~?t,MaS aaEnTzd aqa uTPjUTEw oa aai2v pup sauawazTnbaz anoqu aqa pPaz anpq 'pau9Tszapun aqa 'gM/I 3 0 H •uoTapzTdxa zpaA aaaga oa zoTzd SAPP 0£ ATaaPwTxozddp auas aq TTTM wzo3 UOTIP3T3iazaO •wnos pup aBpnTs 30 TTn3 £/T uuga ssaT ST NuPI. oTadas aqa '(Sarssa -oau 3T) 2UTdwnd pup uOTjoadSUT zaa3u (Z) pup uoTaTpuoD BuTapzado zadozd UT ST waaSAS TPSOdSTp zaapMaaspM OITs-uo aqa (T) at,ga BuTA3 -Tzan zadwnd pasuaDTT p zo zagwnTd paaoTzasaz 'zagwnTd uuwAauznof `.zagwnTd zaaspw p Xq pup zauMo atla Xq pau?Ts 'wzo3 UOTIPDT3Tazao v 2uTuoZ AjunoO xTozO -IS oa aTwgns oa saaa8p zauMo Aazadozd aqt •pauTpauTpw ATzadozd swaasAS JTaga daax oa aaa2u swans s Mau TTp 3o szauMo apga aUawazTnbaz aqa gaTM `086T 3o asn9nd uT wuj2ozd sTga paadaoop AaunoO xTOJD 'IS '8L6T `T ATnr oa zoTzd UOTapzado uT srm gDTgM 'waaSXS BuTTTP3 u 3o iuawaouTdai 3o asoo aqa 3o /09 3o wnwTxpw t, 10) allUl'i? V anTaoaz oa algTc,?TTa aq Tr~_w sauapTsaz XaunoO xTozO •iS •waasAS TusodSTp aqspM aga UT a2UIS auaw -apaza p sP Nupa z)Tadas aila 3o uOTaaun3 aga :1Oa33p uuo waasAs aqa oauT and noA aPgM •za uin(T ~juuI oTiJas pasuaoTT p Aq 'papaou 3t '.ZauOOS ]o szpaA aazga Azana ~JUpa aTadas aqa ano SuTdwnd 3o sasTs -uoo aoUpuaaUTPw zadozd •saasuM aTpuuq oa aznTTp3 aznapwazd SIT UT aTnsaz pTnoO waasAs otadas znoK 3o aaupuaauTpw pup asn zadozdwl I zagwnu ao'I ' uOTSTnTpgnS ' XaunoO xTOJD 'IS 3o uMot `M 2I `N t uoTaaaS :NOItdOO'I AtxadoNd dIZ atdtS/xllO zagwnN az13 NagNIIN XOg/gjnOI FW+ 2IRAn9/XHNMO Q z AjunoO xTozO • aS 0 H tNHNHR IOd HONdNHtNIVN )INdt OItddS H 6 a SOT -01S N 7 H k ST. CROIX COUNTY WISCONSIN ZONING OFFICE 796-2239 (HAMMOND) } 425-8363 (RIVER FALLS) HAMMOND, WI 54015 August 5, 1985 State of Wisconsin, DILHR Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Attn: Carom Haag Dear Carolyn: Permit X669602 issued on 7-18-85 to Timothy Maitrejean has been rescinded, due to change in the elevations. Permit6669626, issued 8-5-85, replaces the previous permit. Attached please find permit6669602, along with new paperwork for permit#69626. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, 4-~t I Mary J. Jenkins, Secretary St. Croix County Zoning Office d _0 _ _ w °o ~ E `o c n O c c Q m c - Y> o o f `2 o 3 v°na > - Q O ti om cQE ' £ t W d' o, v 0 0, c E y m W, C' C E o M c o C. 3 f„ 3 £d~ o m > o C) I a `o m F o ° m > z ° w N H N H C O c v1 m « ` Z „m E Nac°~ m = d ° V 'Ea a o° 3U > w m ao t8 ' 1 CC v~ a d E E yr O > O. .m„ C 'E O 7 O 7 ~ m M c > o Sri Ha d E 3 o d oo 3 m . c_ M Ecm° c Hm Ed ~m LI.J cc - o' t m E 5 w o£ IL2 °'ma~m I~ o£ 2- m y m- >.n > o m d o^ 'o° « d~ d T O W J Q a„ a: m mw E ~0 30 c E N $ o U am m~ c c rn° 3 a mm 'E S W m m c m c E w z f0 ° A td t~ r °3c cm,z m r~ wa W F- F- c 1- m o ° c~f0 U. ccm3 Q z - - - _ C) > _ £ W o a o o o° o N d ~ _ /V z . a w ~ z z z L) U) F- O O LL LL LL) z F- U ° ° OC) 5 D 1 "cc LL ~ a n U U) U) ~ c~ JN) cr o Q z z N O O U = W o U Y Q F z J O p m or w w J (n o0 Ni x C003 F- w O L N J ~ W O Ir Ir co co w w z O I Z 19 O co D o U) m 1 3: a a 0 d Q F-- o DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING UtONVENTIONAL ❑ALTERNATIVE state Plan l.D. Number Holding Tank ❑ In-Ground Pressure ❑ Mound (lfassigned) NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER'. INSPECTION DATE: y`~,Il Timothy R. Maitrejean R. R. 1, Box 159A, Somerset, WI 54025 N BENCH MARK IPe rrnanen[ reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF PT. ELEV SW4 NE4, Section 30, T31N-R18W, Town of Star Prairie, Lot #2 .I / Name of Plumber. MP/MPRSW No County tai rt Number: Gary L. Steel 3254 St. Croix 02 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. EYES ENO EYES ENO BEDDING: VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL'. BUILDING. J VENT TO FRESH ALARM . FEET FROM LINE: AIR INLET: EYES ENO EYES ENO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. DYES ENO EYES ENO EYES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING IVENTTO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET' PUMP ON AND OFF) EYES ENO NEAREST 10 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENC;TH DIAMETER MATEHIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF DSPACING COVR nPITS DIMENSIONS TRENCHES MATERIALGRAVEL DEPTH FILL DEPTH DISTR PIPE DISTRPIPE DISTRERIAL. NO. . NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BE LOW PIPES ABOVE COVER EL FV. INLFI ELEV_END PIPEDS IS T R FEET FROM LINE. AIR INLET: NEAREST------w-1 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 ENO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PE HM AN ENT MARKERS OBSERVATION WELLS EYES ENO DYES NO DEPTH OVER TRENCH BED DEPTH OVER TRENC H. BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES EYES NO DYES ENO EYES ENO PRESSURIZED DISTRIBUTION SYSTEM: BE WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER TRENCHES'. DIMENSIONS MANIFOLD PUMP MANIFOLD =ELEV. NIFOLD MATERIAL. NO DISTR DISTR. PIPE DISTRIBUTION PIPE MATEHIAL & n;1ARKING ELEVATION AND ELEV ELEV CIA PIPES DIA DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS EYES ENO DYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE EYES ENO DYES ENO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. D I L H R SBD67101R.01/82) ~onsln APPLICA TION FOR SANITARY PERMIT 51ZCOUNTY RT Y, R OF 1EnT (PLB 67) UNIFORM SANITARY PERMIT # gY, LRBOR 6 HUTRn RELRTIOns s //y~//~J//` Yf~~0&/ -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 PROPERTY OWNER MAILING ADDRESS 1-7 Ls PROPERTY LQCATI N 1/4, S Jr~ , T,:?/, N, R (or) W OWN F: c~ t L NUM ER BLOCK NUMBER SUBDIVISION NAME NEAREST ('ROAD,) LAKE OR LANDMARK STATE PLAN I.D. NUMBER I r C~J k_c1 . _j T F BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): THIS PERMIT IS FOR A: ligNevv 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. ❑ 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: ZA 7%-Z 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): $QPrivate ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Nam f Plumber (Print): N Signature: MP PRSW No.: Phone Number: Plumber's A ress: ( Name of Designer: A~, 0j1/1C_:_T_1_) ~110 COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: F Date: ❑ Disapproved ! 0 ❑ Owner Given Initial / d Irr Approved Adverse Determination Reason for Disapproval Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.) ; 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, 13. Horizontal and vertical elevation referE - 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. APPLICATION FOR SANITARY PFRMPI, S I C - Iou 1'lris application iornc is to b~ coucpl_ett-d in tul_l 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 /con tracto r,("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 Location of Property ~.tJ Township M<, i 1 int Address y -tea s6~% , Subdivision Name Lot Number t'r(,v ious Owner of Property 'T'otal 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 No Volume and Page Number as recorded with the Retgr stcr of Deeds - INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING. I. Warranty Deed 2. Land Contract 3. Other record iu~;:; I i ied with t Iw kugister o1 Deed 01t-ice In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description r-eterences to a Certified Survey Map, the the Certified survey Mai. 511,-11 1 .rlso be required. - - - - - - - - - VROPERIY OWNER CERTIFICATION I (We) eeAti~y that aXT Sta-tement5 on thin 6onm ane_ Muc~ to the beet o~ my (oun) {inowkedge; that I (we) am (ane) the owneh (S) o6 .the pnope~ety dMCAibed in _th(.-6 .i.n(jonunation jonm, by viuLtue o6 a waAAanty deed neconded ~.n .the. 066Xee. o6 .the County Reg-6a vc o4 Deeds xs Document No. t, 3 - _-_and that I (we) p~tcsentXy own the p~i.opoSed site bon the Sewage po.SaX.~syStern (on I (we.) h11V(1 obtained an (-a~se.men,t, to nun wcth the above desncbed phopen-ty, bon- t6re eonz thuction o6 s a.td S yS=tern, and the .s a.rne ha- been d(te y rceeonded in ti w 0 Ai 6.z c e o6 the Courttt Regis-ten oA Dee&, aA Voe.iune.n-t No. ) . SIGNATURE 01 OWNER SI( NATU hl' OF C(i-OWNEA ((F APPLLCABIA") DATE SIGNED DATT? H H ST C- 105 . a SEPTIC TANK MAINTENANCE AGREEMENT ry+ 0 St. Croix County z O~WNEI~./BUYER ROUTE/BOX NUMBER Fire Number CITY/STATE 7 6,,t : ;cam` Z I P PROPERTY LOCATION:,.5L.) 4i NE Section0o T ~y N, R~W, Town of 2'r 1,9-r f 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. ti 0 E I/WE, the undersigned, have read the above requirements and agree Cn to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- i 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. SICNED DATE St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. ` O - r. to S m S ~ m CD ~ ~ N -•I N ~ (n (n N ~ O O (n w ~ ~ O (D ~ ~ < p ~ N\ fD a m (Q S A W O 3 a 7~ w Z c (p o c O N w =r 2- 3 aC 7c m C2, m ocpsm -am~ u, D CD W CD ~ N N $ m p OR o o w o_ 6 m 7 CD g • W D C ?i a . 'COO n . 0 m 3fD 0 W O (D p =r O C O w 00 O 3° c 'oO C 3 C Oa w= n CD C, 7 p~ (D O p a CD OD -0 > :3 M W :;Z a, CD r- < tD C (O Q A N (A O D C (D .a L/ O n ~ W n n O C O = O (D a O m U2 w o :am w O a . m (o Q N C N o-~► 0 w N-~~ ~~~~0) w (J Z D ~m =aw gym Z a (D m ~ = o 3 (D m cD ? a I D D 1 0 Nam 0=r oM m was ::R ? co w o M ~wa CDU,~a~w N 'fl =rw o CL to m _D C m y~ 3D O =r C O g co ( . 7 7 CD (D (a m N« N n O a (0 ~ 9- (D ` -6O N p -,Ctp D w O m m n Cn s ao * a (cn c c caw o' n1 aw aaam N M CD a Cy. C cc M U) 0 L) (D n C (O 7 0 W n m O 7 C a O :3 O (p a C~ " (n " m 2 C a a C a C (D w r. o +s" f a3 p o 3 w a m o 3 w p o < CD $ M ~ z t