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HomeMy WebLinkAbout040-1117-50-100 n cn o 9 -0 n r_ m o C `i1 m n c~u CD -D ~ n 3 Ul -I - ° cn N CO ° h Q CD Z n ° oi M ~ = o :E CD cn n N C- 0 O C N v CJ7 O O N Q T CD 7 (D S ro w m ° N CO ° C N C n O R C~ cn m n N N o n ~l o a m `mil x ° ° O c~n r (D j N Z7 O (D H ~7d CL rt (D CD 0 CD Z 0 N (fin co T N Q • Fl- I rt N w C 0 ,S tom'' z o00~' aQ CD > n 3- 0 -0 o q po o E y m ~ l p_' (D , CD N m - ~ (o d 9 N 3 °f (D C) r r Q N d N 0 C W Z n 7 (D 0 N 77 U-, v. O 0 CL :3 -D N I `s I N l0 ~ c H Cn - N (D 00 c 00 w 3 Z ~ I L~7 Z CD (q 4~ Z M (D 0 d A z 7 y n H rt H- Cf) 7 Q7 - ° M (D co t O p 3 Z oG h W 0 FF C/) O co o CD a ~ a X Q W p' - Cn -n Q ~ C { (D Z o Q 0 N ~ N N 3 o c `ca S O b C S ° ! (n CD N (D ai I N I I O ii A 0 b o a N (D da v O • a ° g o a- ST. CROIX COUNTY WISCONSIN ~ - ppp■ ZONING OFFICE IlBllflll w~~~~ - ST. CROIX COUNTY GOVERNMENT CENTER • b 1101 Carmichael Road L - Hudson, WI 540 1 6-771 0 (715) 386-4680 October 31, 1994 Mr. Don Sukowatey Coldwell Banker lst Choice Realty, Inc. 126 Second Street Y- Hudson, Wisconsin 54016 RE: Water Inspection for Steve Van Someren's Property Located at 373 County Road MM, River Falls, Wisconsin Dear Mr. Sukowatey: Enclosed is the original test results from Commercial Testing Laboratory, Inc. for a water inspection of the above property. If you have any questions with regard to said report, please let me know. Sincerely, f Mary Jenkins Assistant Zoning Administrator mz Enclosure COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 ~4~ i Aaw i 800 - 962 - 5227 Cj:: 16iccl FAX - 715 - 962 - 4030 :s. CROIX COv .Ch't3IX CTY 6 i,r.i;Tk REFORi DATE. i01*126/. 101 CARMICHAEL ROAD - IS~;ftt~lx Wi ~a^ `,TION: .ECTOR: COLLE COLLE. _ ,:'4E OF SAMPLE! Kit,, Y71-r -7-94 1100 mI :RPRETATIOW Bacterio .?ATE-N: 6 ppr, Above 10 r' CAB rECHNI%.tAN' Pam E=ane ^ rte/ .'•j•.v WI Approved Lab No. 19 QF.%NDEGfNOEHl. STy^l'/f~~'~~ 0` 90 A ~~TYV v' r y s wft +fy E4 i'u~ fi J4. ca te, S'i~ `ippk"r)5J NG1 3wb. PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY WISCONSIN ~~~IiIIIIIIIIIIptlM - ` ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 - (715) 386-4680 October 19, 1994 Mr. Don Sukowatey Coldwell Banker lst choice Realty, Inc. 126 Second Street Hudson, Wisconsin 54016 RE: Septic Inspection for Steve Van Someren Address: 373 County Road MM, River Falls, Wisconsin Dear Mr. Sukowatey: An inspection of the septic system for Steven Van Someren's residence located at 373 County Road MM, River Falls, Wisconsin, was conducted on October 18, 1994. 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. Also, water samples were taken. Once we receive the results we will forward the same on to you. Should you have any questions in the meantime, please do not hesitate in contacting this office. Sincerely, Mary j: Jenkins Assistant Zoning Administrator mz - ti- ST. CROIX COUNTY _ WISCONSIN rrxarnani - ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER _Tj 1101 Carmichael Road =s~~ Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit apfe with application. Outside water lines are often tup ned eoffe during f winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. ❑ Water (VOC' s) I' Water (Nitrate & Bacteria $18" ~ Septic 0.'00 45.OO,a El Nitrate & Bacteria retest $15.00 Owner: Address. Requested by; hv, Address: -3 R W\ Telephone N4: (-l.is) 3< - i~S ~iSTelephonNQ.`r(e~- ZIP Property address (Fire N' & Street) : 3 Location: S c. ~ ; S4 T N R W, Town of Realty firm:c,:Ac\ ~c\N Lock Box Combo:_ Closing Date: k~ a l TO BE COMPLETED BY PROPERTY OWNER PROVIDE A SKETCH OF HOUSE & SEPT C SYSTEM ON REVERSE OF THIS FORMS 1 Water sample tap location: Is the dwelling currently occupied. yeS ❑ No If vacant, date last occupied: Age of septic system: Septic tank last pumped by: i Y Previous Owner's Name(s): Date: Have any of the following been observed? ❑Y Slow drainage from house. ❑Y 'gslN Sewage Back-u ❑Y p into dwelling. W Sewage discharge to ground surface or road ditch. ❑Y )<N Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: DATE: 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION 3~qr 1~ TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? OYes 0No sheet # Soil series per SCS Soil Survey: DMound avityrd DAt-Grd Type of soil absorption system: U Approx. size x Ft.' ❑Bed ❑Trench ❑Dry Well []Holding Tank OOutfall pipe ❑Other BUnknown OBSERVED DEFICIENCIES Septic tank Setbacks: []House 0Well []Prop. line []Other Dose tank Setbacks: []House - 0We11 OProp. line []Other ❑Locking cover OWarnin g label OPump/Floats []Alarm BEfec. wiring Soil Absorption System Setbacks: OHouse_ BWell []Prop. line Bother []Ponding: []Discharge: r, General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title WEST ART T R 0 1 T. . 28N-. R.20 19W 13 M SEE PAGE 25 lQ[ h u c s ~ „ s~otJ s'e F b a o /eo./ /20 enerr~ ' Mal . ~ a" Kafh/een ao LAKE S N W~ na crt lNi l,Sbn Ho st n z ST CRO/x S{Pau/ A'' 'Kathryn ° tv//am rrn ok .y.. r B Tu/9r en = ! >/nr^. 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IaU ai - ~s3yttk ~'tvvlnt~ 3 dp 0 Wanda C w us 1... ~ ks t~ /99 JolMttS V n~ A ~e .4 D nt ' JrJ 4 K ^l~ P f. 4 y 3 z / S h~n~h 'U yCh Los X ,m U~•~' Ccrn°Aa us o ass a°. LEN Nnh ` ,a es5 ~ / ~ ~ 7f K~/Kr-/N 1Redr? Ra.r t~Q /60 U 1 N R.-h RS Fa/m. Lrc. n 4 f ° ¢r es xaaubc D r . MM • o Enter r i ~i /c~.~., t' rTOmcsJ Ln P LsCS' l ,/l.~vn <,.f J •rb x Geo - f 9r~d eyyG "°Y [>`.L! ~7cnK°s/en F tTohru n Ho<ze 9 k¢uphufrh5n ieeyd /47 Michael h , ba~pp~ r, ust tt7u/Je snrnu: 6 t5:ty ¢ WACO'O llnhn rant 1. _7 rGO W d3 bC'lh l4' S1anB 7J /ce - r.,.M. R1u/f ~ ~ t Nanayy L. P ~ • r.3 v..z 3 / ~o semar- ~ ~ Cla~r~en - S Jrl~ ` J ~ wsv .IJe7sek o c r ram /?rte er N v C~ ant Cam. .ro rnJ 191, IT. e -cc 'AMD ' a 9 She= 40 wee V~u 7efl %RR9 ck~'o P 6/sy I c PIERCE CO(YNTY ; Tna1 ~R:. O R. 20 W. I 1 R. / 9 W. O 200 300 q p ~ 500 i 10/27/94 THU 15:55 FAX 1 715 962 4030 COMM. TEST LAB X001 COMMERCIAL TESTING LABORATORY, INC. - 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 Post-it'' Fax Note 7671 #0 f 715 - 962 - 3121 L,:zl-C pages► 800 - 962 - 5227 To Date FAX - 715 - 962 - 4030 Co./Dept. . S From ~dC i' r Co. 11 Phone # v Phone # Fax# Fax # CT. CROIxyi:TY1C,01' Lr~`~:iivf, OF= ~ k'`~:;'i'~f: T in?.: ?28;•~1i4~ r„-~ ' C'!'R D(JE. ie/26/94 1~ 1 ~;!i1r~iP~L ;;~3fi~? ';R?'C R'ECI-1lr:_7: s,4~i1Si94 "1 Y 1 V f~ JTIIl: T'rMS? :S t:„ 01-LECT0R. DATE C0L [.E'['.TED: 1 [3-!P-94 'IME CCLLi:CTCD: 1:'TLpP ! SCii1nC~ OF BAmP!_E: Kit hpl, f al, :i>7, DATE At~1FtL' £lf:,i;?~-1,9-94 TIME ANALY7ED:2: t 0pn C0LAF'Cf,,M, M "C.- 0 913 nl > INT£RPR£TATIN.- I1actori.olo ically SAFE NITRATE-N; 8 pprt /above .l R' ppm exceed= the recommantlf-a Flublic Drinki.ric; Water Standard. 3ar_teria /100 nl wT ApjiV Qved Lab No. 19 C Means "L£SS THAW Detectable Level Approved by: 10/27/94 16:11 COUNTY CLERK Q001 ~xc~Nck~Ne~eNe~cNe:kNe:k~Ne~ck~c~:k~Ae~:kNc:R ACTIVITY REPORT TRANSMISSION OK TX/RX NO. 4501 CONNECTION TEL 93866741 CONNECTION ID START TIME 10/27 16:11 USAGE TIME 00'42 PAGES 1 RESULT OK 10/27/94 THU 15:53 FAX -1 715 962 4030 COMM. TEST LAB ~ ool COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O, pox 520 a~ - COl f", Wisconsin 54730 715 - 962 - 3121 Post-it" Fax Nate 787y oar # a~ 800 - 962 - 5227 TO -7 • Pages S F~o2~ . (~d "X Al FAX - 715 - 962 - 4030 Co./Dept. , Ca. Phone # Phone # Fax # Fax # q6 lp it ";~C3k >rC;1f~;v ar;d,~f !1F~ICE . +;I:'rf;RT 140.:2Eil/4~ i'AGC r cr, CROIX C?Y Gpv- C'Fk °3~~,Tr_~NFL ROAD WORT DATE: 16/26194 kiilt}'?i~ti EI ~4'7 a :;R?E PFCEI:ED) 14i15i?4 ~ `rrlt,{iltl:~!: ?!'1 - a~/~lu I.~;;Pr Falb !'!7f.LECTpt; DATE COLISPED: TPE ` OLLCCTED; 1r z R~ SGURCF OF SAMPLE: Kz*- _nEf; DATE ANIALY:ED:.19,14-94 TIME pyALYZrD.-2: flgph Cf,',L VVRM, K~ 1Ca !I6 nl INTEr&RET.ATltrK I~actariol igz~a?ly SAFF NITRATE-M; 8 Rpm AbovE 0 PPR exceeds the recommenoFv Public Drinking Water Standard. .5l:tor:: Ka~terxoft$9 h? -='"r'~1YCd4h1: Pan `=one (~I An v r-yed Lab No. 19 LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF TROY COMPUTER NUMBER 040-1117-50-100 Parcel Number 30.28.19.478E OWNER NAME: First KIM R & JEAN M Last WEBB PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment 373 CTY RD MM SECTION 30 TOWN 28N RANGE 19W '/4160 1/40 Line Description Line Description TOTAL ACREAGE 2.152 PLAT LOT BLK 01 SEC 30 T28N RI 9W 2.15AC 15 02 SW SE LOT 1 OF CSM 6/1502 16 03 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit Form-STC- 104 > AS BUILT SANITARY SYSTEM REPORT OWNER J TOWNSHIP SEC T,,7V N-R 1 W ADDRESS ST. CROIX COUNTY, WISCONSIN CS ~ SUBDIVISION Yh (~WLOT ~ LOT SIZE v Z PLAN VIEW Distances and dimensions to meet requirements of IIRR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM l~ INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: i SEPTIC TANK: Manufacturer: N a r Liquid Capacity: !)1 Number of rings used:_ Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front, Sideo Rear, O O feet From nearest property line Front,0 Side,0 Rear, O feet Number of feet from: well L- building: ' V (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE A ~ 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: Lenith: 5 Number of Lines: Area Built: /Ye4 Fill depth to top of pipe: Number of feet from nearest property line: Front ,0 Side, /Q'Rear,OFt . Number of feet from well: ej- s' 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: ~ e Dated. Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR. & HUMAN RELATIONS SAFETY & BUILDINGS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING 1 CONVENTIONAL ❑ALTERNATIVE state Plan LD. Number: ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound ass;gnedl NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: Douglas Zahler NSPECTION DATE R. R. 3, River Falls, WI 54022 110-11-540 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: SW SE, Section 30, T28N-R19W, Town of Troy FEE. PT. ELEV. CSTREF PL ELEV Name of Plumber. MP/MPRSW No. County Sanitary Permit Number: Tom Wang 3231 St. Croix 58940 SEPTIC TANK/HOLDING TANK: MANUFACTURER. V~ ^ `~~LIQUID CAPACITY. TAN N ET E V. TANK OUTLET ELEV.. WARNING LABEL /x (f PROVIDED: LOCKINGC ER h_ PRO ED BEDDING: VENT DIA. VENT MATL. HIGH WATER U ( YES ❑NO S ❑NO L ALARM NUMBER OF ROAD: PROPERTY WELL BUILDING VENT 70 FRESH ❑YES p C FEET FROM !~U LINE LAIR wLET ❑Y NO NEAREST ! O (pC~ DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY p UMP MODEL PUMP SIP MANUFACTURER WARNING LABEL LOCKING COVER ❑YES ❑NO PROVIDED PROVIDED: GALLONS PER CYCLE: PUMPANDCO r o SOP RArIONA ❑YES ❑NO ❑YES ❑NO (DIFFERENCE BETWEEN NUMBER OF PROPERTY WELL BUILDING VENT ToFRESH PUMP ON AND OFF) FEET FROM LINE AIR INLET SOI ES ❑ O NEAREST L ABSORPTION SYSTEM. Check thesoil moistureat the epth of plowing LFNCrII DIAMETER MATERIAL 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 DISTR. PIPE SPACINC+ COVER TRENCHES - INSIDE DIA y DIMENSIONS MA+IERIAL Plrs uoulD ' PIT DEPTH: GRAVEL DEPTH / FILL DEPTH DISTR. IPE DISTR. PIPE DISTR. PIPE . R BE LOW PIPES ABOVE COVER ELEV.( T MATERIAL. NO D T G ELEV END3 NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH PIPES FEET FROM LI"E' / ~ AIR INLET NEAREST-~ / Z~ GCJ 2 MOUND SYSTEM: Mound site plowed perpendicular to slope and furrows thrown upslope: Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DEPTH OVER TRENCH BED DEPTH OVER TRENCH: BED D ❑YES CENTER ❑NO ❑YES ❑NO EDGES. DEPTH OF TOPSOIL. SODDED SEEDED MULCHED PRESSURIZED DISTRIBUTION SYSTEM: ❑ YES ❑NO ❑YES ❑ No DYES ONO BED/TRENCH WIDTH LENGTH NO'OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE TRENCHES. FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD ELEV ELEV DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE -MATERIAL & MARKING ELEVATION AND CIA ELEV. PIPES CIA DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING. DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS COMMENTS: ❑YES ❑NO ❑YES ❑ND PERMANENT MARKERS OBSERVATION WELLS: - NUMBER OF PROPERTY WELL BUILDING: ' FEET FROM LINE. ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Z Reverse Side. rrr ty file for audit. (GNAT TITLE DILHR SBD 6710 (R. 01/82) 0 wlsronsln APPLICATION FOR SANITARY PERMIT ~ f COUNTY r ' ' DILHR (PLB 67) ~ 0 DEPRATMEnT oP UNIFORM SANITARY PERMIT # - InOUSi TRY, LRBOR 6 Humpn RELRTIOnS Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY WNER MAILIN(~ADDRESS PROPER, LOCATION CITY: S't01 /4 S `1 /4, S 3C , , T d f" N, R ~ ' E V I GE (Dr W ;j TOWN LOT NUMBER BLOCK NUMBER SUBDIVISION NAME ARES ROA LA E OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): THIS PERMIT IS FOR A: IM 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. 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 Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity U / Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: 4 W C S 1 %"N l`, S T" 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 I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name pf Plumber (Print): Signa MP/MPRSW No.: Phone Number: / A C" ) , .i -f vLJI ( ) Plumber's Address: Name of Designer: COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved El Owner Given Initial XApproved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: i'.HR-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 perco square feet to be installed 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. APPLICATION FOR SANITARY PERMIT 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 kq~~? Cr,~ h Location of Property `j Section , T N - R W Township Mailing Address Subdivision Name 45-o ` Lot Number ---~T~ ' Previous Owner of Property ~~u i~ ht7Sr„ Total Size of Parcel Date Parcel was Created juh, Q 3, Are all corners and lot lines identifiable? - 2 - - Yes No Is this property being developed for resale (spec house) ? Yes _ No Volume and Page Number 1~ ~J 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. PROPERTV OWNER CERTIFICATION I (We) eenti.6y that ate d,tatemen,te on .thi.6 6o4m ahe tAue to the best o6 my (ouA) knowledge; that I (we) am (cute) the owner (6) o6 the pnopehty dedeAi.bed in .th,i,a in6o4mati,on 6o4m, by viAtue o6 a wa4,a.nty deed neeonded in the 066ice o6 the County Regia-ten. o6 Deedd ae Document No. ; and that I (we) pneeentty own the pnopoeed A to bon the bewage po. ey.6 tem (on I (we) have obtained an eae ement, to n.un with the above ded e&ibed pnopeh ty, bon the conatnueti.on o6 aaid ayd.tem, and the dame ha,d been duty neeonded in the 066ice o6 the County Regizten o6 Deedb, as Document No. - ) - SIGNATU OF E SIGNATURE OF CO-OWNER,. APPLICABLE) Q Z DATE SIGN6 DATE SIGNED SURVEYOR'S CERTIFICATE I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby certify that by the direction of Paul Johnson, I have surveyed, described and mapped the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in part of the SW 1/4 of the SE 1/4 of Section 30, T28N, R19W, Town of Troy, St. Croix County, Wisconsin; further described as follows: Commencing at the S 1/4 Corner of said Section 30; thence N00022'08"E, along the north-south one quarter line, 1118.20 feet; thence EAST, 912.16 feet to the centerline of C.T.H. "MM", ' said point also being the point of beginning of this description; thence S86023154"E, along said centerline, 200.32 feet; thence S00022'08"W, 462.36 feet; thence WEST, 200.00 feet; thence N00022108"E, 474.94 feet to the point of beginning. Above described parcel is subject to an easement for C.T.H."MM" as shown on this map and all other easements of record. That this Certified Survey Map is a correct representation of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 Wisconsin Revised Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. Allen C. Nyh en atc. -1407 ~ir^nhl y Vol. 6 Page 1502 F-I H S T C- 105 r r a SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z c7 OWNER/BUYER r-.J hl! a 4 CIf ROUTE/BOX NUMBER Rl Fire Number CITY/STATE I=cill Z IP ~U PROPERTY LOCATION:4, Section (,1 TN, R W Town of ,{,i:?St. Croix County, Subdivision _~j V; /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 pit 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 I/WE, the undersigned, have read the above requirements and agree Cn 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. S ICNEU' 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 N r x m s d v~ ~ w~cncnN3O CD 77, 0 -4 cD 0 CD CPO o* 3 -0c y o W c}~ p c 3 3 cG p (D CD p A p Z to '0 p? (D -0 c fn > CD w n * m = Er 'D o3a o °(n CD w 0CD 5 cocowo-, A w =r > O r p o c 3 ~n oc3oEL 0 ZS c~ Er 5 0 N tD 2. 8 0 a ~ - D 3 ' CD w To oc < p Q• a Q o v (D o D c ID Ch 0 0 C=) 0 (OD- g w CD ~=r.0 w' n C N m 0 N N (D w Z = w w CD CD CD omm?0 m CL m0 3 , w cn D -i CD to > n 0' En CD =r 0 = = a CD =r a(a g CO) a,'~- ac0~CD C rn m 3cCD -84 3 oCL n 0 Cn (D CD .•CD w 3 ~v'w = i o a p to p 0 _ w to a ~ cn 0 c r. ~ 9 0= Ch i w a cDo~ c rn a 0 W ' a w p wvw m •~ov,v N - M. La. =r U) cn r<co a' BCD (n o O~ r< m o 3 d g 0 !n (D O aon caw ccD jD CD a a~ 3 0 0 ° 3 CD 0 N n O CD z 0 O DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS \ / MADISON, WI 53707 ` (H63.09(1) & Chapter 145.045) LOCATION: SECTION: OWN$tlkPtMUNICIPALITY: LOT NO.:BLK.NO.:SUBDIVISIONNAME: S GU 1/~ 0/ /T-,I-z( N/R j E (or r,, COUNTY: OWNER'S/BUYER'S NAME: MAI RG ADDRE l L~i r / ll 1 ~J, tr USE DATES OBSERVATIONS MADE NO. BEDRMS.OMMERCIAL DESCRIPTION: PROFIL D, SARI PTIONS: PERCPLATIO TESTS: Residence T L~New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-G P RE: SYSTEM-I©ILLHOLDING TA~j : RECOM ~E~DED SYSTEM: (optional) ®S [:]U ZS ❑U ❑ yS ❑A EIS KU ~S❑ l If Percolation Tests are NOT required DESIGN RATE: ~Floodplain, If an y portion of the tested area is in the under s.H63.09(5)(b), indicate: 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' .J B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- 1G. P- Lh P- 7 s s s' 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 '~f rZ 11Q1~S~s~LE t Q~'pi"31l P)?=~1;` E ot= Pews iN f-'fIMM pf~ e;Hr1 Ir;a 1kc (kX11 Act 4~r,~lCd feC-t TN , o _ E4 5 >k tAr" Kyle d )cc P"ca STAke i" ip{p~' jr,P hoc` I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methodds 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( prin TESTS WERE COMP~ETE,D ON: tLa 4 S ~f )4;,I ADDRESS: CERTIFIC TN NUMBER: PHONE NUMBER (optional): 7E CST SI URA - K : : 1 L~J r DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - s r nUnl"Der C)f ;~E,t3C ::f€)7-€15 o G %S?i•~' ~.F~ ~,ie8€ t 4f. t.. a mc '.:i 1. C., n, the s... ,rr,!'~3rscNutfs,x.a A E 9S S.€.,=F ? .,yu ,_``I... AN!`. MLYM YNAER SYSTEMS ARE RULED VIT A .turd SOIL CONDITIONS: PLEASE ve One <af-A v o ad.E'?rld ;;h'. vvn hero for Mtiv Pr t ,e desc0tIt m and ccB6nplet ng the Qt (3k, ~ ~ y kwMk3 fir:wr et'si lcwat.n,sn It awing to Me t.. (mdevtd. SUr y Ottt" int. o' q cc"Vitre all apt, i nor, Eaa. t p ..s Ann he f ,3t a F. z x. onz Ono IN) BR Bahwk C " F SMdAnnu 'an 5;zFtae a.,r ly;~;a t f7t y.-o, 4c n B mm B _ Kann 1 L Sill k~yi T Grnv - , c. o Gov L oast CF sayli ` t t `h (A sus' Hi Wdue P"a NIM 1, 4 ! t Matsu MUC, d _..ls. tf , wa: o on n iN VOP V- c 0~ e k f- ~PK S' ~I\d~~ A lJn, 3 ~ 3 l 3 ~d 3 v Fcr~'PlY rk i3 ur,~cr ~,~t 5(aka Flcr~;:~etl 3f~ed Nome 0 dvv ~a !T j~er ~q'hC Pe r rwi n n a~ 7s~ ~1 /00 Pit