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Parcel 030-1068-60-000 02/22/2005 11:18 AM
PAGE 1 OF 1
Alt. Parcel 26.30.19.250E 030 - TOWN OF SAINT JOSEPH
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): Current Owner
RM ENGELHART FAMILY LP
RM ENGELHART FAMILY LP
769 132ND AVE
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 3962 NEW RICHMOND
SP 8040 BASS LAKE REHAB DIST
SP 1700 WITC
Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE
SEC 26 T30N R19W PT GL 1 COM ON SHORE Block/Condo Bldg:
BASS LK 1091.1 FT N & 896 FT E OF SW COR
GL 1, TH S 40DEG E 386.6 FT, N 49DEG E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
345 FT, TH N 40DEG W = TO & 345 FT NWLY 26-30N-19W
OF LAST LN TO LAKE TH SWLY ALG SHORE TO
POB
Notes: Parcel History:
Date Doc # Vol/Page Type
12/29/2004-'- 783760 2723/34 EZ
01/12/2000 616864 --4-4153/580 QC
07/23/1997 424/350 ~2
Wrr
2004 SUMMARY Bill Fair ket -V alue: Asses
5298 210,900 Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 146,700 60,800 207,500 NO
Totals for 2004:
General Property 3.000 146,700 60,800 207,500
Woodland 0.000 0 0
Totals for 2003:
General Property 3.000 103,500 50,400 153,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
040-OTHER ASSM'T SPECIAL ASSESSMENT 175.65
Special Assessments Special Charges Delinquent Charges
Total 175.65 0.00 0.00
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Parcel 030-1068-65-000 02/22/2005 11:19 AM
PAGE 1 OF 1
Alt. Parcel 26.30.19.250F 030 - TOWN OF SAINT JOSEPH
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): Current Owner
* RM ENGELHART FAMILY LP
RM ENGELHART FAMILY LP
769 132ND AVE
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 777 132NJDVE
SC 3962 NEW RICHMOND SP 8040 BASS LAKE REHAB DIST
SP 1700 WITC 2
Legal Description: Acres: 7.160 Plat: N/A-NOT AVAILABLE
PT GL1 COM SE COR SEC 26 TH N ON E LN Block/Condo Bldg:
1298.53' TH S 89 DEG W 607.28' TO POB:
TH S 15'E 580.99'S 89 DEG W 537' NLY Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
TO PT 1132'W OF E LN TH E ALG N LN TO 26-30N-19W
POB
Notes: Parcel History:
Date Doc # Vol/Page Type
01/12/2000 616862 1483/576 QC
ALkA-Ik~~
2004 SUMMARY Bill Fair Market Value: Assessed with:
5299 327,900
Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 7.160 115,400 207,200 322,600 NO
Totals for 2004:
General Property 7.160 115,400 207,200 322,600
Woodland 0.000 0 0
Totals for 2003:
General Property 7.160 73,500 159,800 233,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
040-OTHER ASSM'T SPECIAL ASSESSMENT 273.08
Special Assessments Special Charges Delinquent Charges
Total 273.08 0.00 0.00
Cta l r
ST JOSEPH `E' DIRECTORY N
T2930N R19W A
g%
I : „M N~ttf~ , z
Al"A . G ~M~ r.~w.,~.~..,
r - (Residents -Owner or Renter)
Z 1 ~ See Pages 135-140 For Additional Names. SOMERSET'S' PAGE 63 ~
I
150th AVE AVE
_ i _ _ 3 ■
■George ■t 2 3 ■R xoanw1 ■ Richard rd Glen ■ Ikob
e,rt
1 M Glad ■Tam Yates Berna~ I !■~~I■ ■ ■'4 rdan g,,, ■I ■Simon Ba nrenkman
Schottler Krattley Doa y
ome ■ F
I l- john 148th I< NORTH e ~ s' e~e~■ mhristopher Myer
uz M,rty AV E BAY jr, Q- v mar s NI
D O a^4 IjI
bbey
g■ R ~
~ ~ OP I I Allen i. ~^,°'r~'■ i lon. I OAK TRL ■ 4
21 2`Z Rrakke ■ !4~J, ■L-) Raymond n
P RIGHT WEST ISHORE ■lfi hto Lartgness
■6 a9/4j W L
IDa e 'O 13i
F C AKE •r~ ru,~ Weft I a°. 1143rd ■ s d z■ I P Thomas .itlcw v o O
Marty Gregg c p A ■ ■c°<ras AVE s v s is ■ W3 ■ u u'~ p',~ Z
■ Brakke q v, n3 Bert I Lyle e <~iey o z I John i~ 'go .n I C
■ ■ ■ Michael ston< ■u,~_ I Ela 2 ■ ■zo ■Oman ■ 9
■ ■ 'Tl
B _ 1 z!- VALLEY VIEW TEL crony■ ■ TERRI.R z4-zs 26■ ■Don,40th AVE
Donald ■ O ■r, ■ ■ ■ ¢ ID •k I LN zz ~ `■20 I F- ■ Clark I M
I' I ■Bmc< Q am• 9 10 Raffel To Sontag cometnl eaa ■ 6ASS i I a Anthony
► - Waag t'r`r ■ John ■ vr< ■ LB KEFfiOG Kilian
■ vj1 Lawrence Schcttler■I K<°a<u I soaa, B 9-v < FONO Z~, I m ■le 'eY
Emert ■ J- 1 ■24 50 LN Bass B
Wilson llItOR
2p c ■ 25 de
acher Sontag 27 I ■ ■27 `t 26 I'pieff
0 ■Tim 25
E ■ CC77 Michael W Martin I C a:t- ■2e . ■ 29 ■ ,:,<o"ve Lange
28
IPE L E Morn IM t Ran opher Ids ■ U e' 19 In„monr 133rd AVE
Ryan ~2' ; a132Dd ■ cnma,
■Dav
Ht ° w y I 8 AVE 16 17
AVE c~ Q R' back
E m n Iona ma-
■ ysybrant W h ■ c ■
Scott SNI ■ ■ I • ■ ■ ■ ■ ■EV e1haK I erring
nann Mark
7 cda°. Mitche8
C~ 0 Rothe ■ ■I A 'SIAWATU
6 o
q ■ g aaaar ■ ■ 3 _ I
C O ■ ■5■ ■ w<n ~7RL ee ■ so Ad
0 - -I
y T PERCH LAKE RD ace ■]osePh Ebert,
■4s ■ ■t■ Cad ■3 ■s ■ -'I- . _ N
lnnarat ■Erank Gerald
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t! 3 CC ■az 46 ■m e m ■3o PINE VALLEY Brada I ■ ■ cadaft
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a ' n ■z 1,31- ~ ■ ■
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SEE R
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011 I N )e c ■Ferainson Tam IBURK- mail 11YE/~
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I` T J ° Elmer r c y a ~IHARDT / I e
~E9 ~`a 11-17 ■Ebbe I cam ■ 3 ■ / 3~ I 1 9
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Robert ~I /
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FALLS, -
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'ALL
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HUDSON'E' PAGE 31
E S & N LAND SURVEYING, INC. Eric Bohl, LLC
(715) 386-2007 Dr. Eric Bohl, D.V.M.
` PROPERTY SURVEYS, TOPOGRAPHY SURVEYS, Veterinarian
SUBDIVISION & CERTIFIED SURVEY MAPS Farm Animals • Horses • lets
Farm Calls • House Calls
■ Auth•Consulting/Associates 1513 220th Avenue • New Richmond, WI 54017
■~■y (715) 381-5277 (715) 246-0625
~J ENGINEERS, BUILDING ENGINEERS 248-7808 Fax{ (715) 248-7619
(715)/
BOTH LOCATED AT: 2920 ENLOE STREET • HUDSON, WI Cell \715) 760-0108 ericbohl@pressenter.com
"Success through service"
Dyk., O'Boyle & Siler, S.C. Town &
s
x Country
Hendrik van 1)yk= Realty Eileen Holland
REALTOW,
~1t ' •
kristirza E. O'Boyle Corporation
E ;w Partnerships & LLC
• Ronald L. Siler 227 Meridian Drive, Suite 1 -
i'119 TY#13t5 & 15ro13at~_ • Criminal/Traffic
ePlaatzlrts • Divorce New Richmond, Wl 54017
E ,-nall,t
• Bankruptcy office 715.246.5010
r (715) 246^6806 toll free 888.738.7777
fax 715.246.9821
FAX (715) 246.6899 res. 715.246.5832 • cell 651.247.0904 SIM
201 South Knowles • New Richmond email eholland®pressenter.com
{also 1 sense ! in Minnesota) www.pressenter.com/-eholland
Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
/y~
OWNER /.`l 4 R ~l G J~~ ~~a c. {i G R TOWNSHIP SEC. T~ R W
, t~ t G
ADDRESS =t ST. CROIX COUNTY, WISCONSIN
v 3v --106j- 60- OC) 11/1
7 6 ~ (3 2ri d ~ • 1 ~-Gvc~
SUBDIVISION LOT 3c-C/LP~
PLAN IEW -7-7 -7
30 l b - s'~Qvb~
69
Distances and dimensions to meet requirements of H 63~r
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
60 Li
I
I
I
I
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used i, c'it
Elevation of vertical reference point: Proposed slope at site:l`/ `0
SEPTIC TANK: Manufacturer: Liquid Capacity:
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,O Side,o Rear, O feet
From nearest property line Front,0 Side,0 Rear, O 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/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, Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: N Length: Number of Lines: Area Built:
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, O Rear, O Ft.
1
Number of feet from well: r'
Number of feet from building: t~ 5
(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, ( Rear, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:.
r
Dated: Plumber on job:
License Number:
3/84:mj
DEPARTMEN 1 OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LA•OR,& HUMAN RELATIONS t PRIVATE SEWAGE SYSTEMS DIVISION
,P.C( BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number
[If assigned)
El Holding Tank ❑ In-Ground Pressure E Mound (
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE.
Mcut.ycucet Engethcut. R. R. 2, HuAon, W1 54016 .2 f--~ . `Ua
BENCH MARK (P-nnaneni reference point) DESCR IF F <DFERENT FROM PLAREF. PT. EPT. ELEVSLY SF, Section 26, T2 0N-R19W, Town of St. Joseph
Name of Plumber. JMPIMPRSW No.. County Sam[a,y Perm,[ Number:
Stephen Aaby 5184 St. Cnoix 58860
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEqNO LOCKING COVER
_ ~j PROVIDED: PROVIDED'.
~~..5 DYES ODYES ONO
BEDDING'. VENT DIA VENT MATL. HIGH WATER NUMBER OF ROAD: ROPERTY WELL: LDI NG VENT TO FRESH
L~ , y ALARM FEET FROM LINE y LAIR INLET.
YES ❑ NO / DYES NO NEAREST P
U
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED.
DYES ONO DYES ONO OYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PH OPERTY [11 LL BUILDING. I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) DYES ONO NEAREST 31111.
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 1ENCITH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH: LENGTH INO1 ODISTR. PIPE SPACING. COVER INSIDE DIA -PITS. LIQUID
BED/TRENCH TRENCHE 671 MAT-ERIAL. PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL DEPTH OISTR PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH
BELOW PIPES ABOVE COVER ELEV. INLET ELEV. E D. PIPES. FEET FROM ,LINE ./S AIR/INLET:
¢ NEAREST-► VD A
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-
meets the criteria for medium sand. TIONS MEASURED.
DYES NO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
DYES ONO DYES ONO
DEPTH OVER TRENCH: BED DEPTH OVER TRENCH;BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES.
DYES NO DYES NO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH. 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
ELEVATION AND ELEV. ELEV.. DIA. ELEV.. PIPES DIA.:
DISTRIBUTION
INFORMATION HOLE SIZE. HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYES ONO EYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING'.
FEET FROM LINE
❑ YES 1:1 NO ❑ YES ❑ NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
STITLE
DILHR SBD6710(R.01/82)
Wisconsin APPLICATION FOR SANITARY PERMIT
®L H R OUNTY
(PLB 67) UNIFORM SANANI TARY PERMIT #
~EnT of
nOUSTRV, LRBOR 6 HUmAn RELRTIOnS
-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
p ~itl
PROPERTY LOCATION G CITY:
!3W1 /4S El /4, S,~ 6- , T Z, N, R /CE (or Qw~n ci~0 5~
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
•L I
TYPE OF BUILDING OR USE SERVED
1
1 or 2 Family Number of Bedrooms. ❑ Public (Specify):
THIS PERMIT IS FOR A:
❑~New System ❑ Tank Replacement ❑ Repair
Ek<Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
J<Seepaye 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. n c'. 2d u c ~i "
IF THIS IS AN ALT RNATIVE SYSTEI'd 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):
/`%'~l1~+ LA Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signature - MP/MPRSW No.: Phone Number:
Plumber'Address: c IName7i- of Designer:
, L<<? t d Al -6- 4,
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
❑ Owner Given Initial
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, 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
STC - 100
This application form is to be completed in lull 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.
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L
Owner of Property
Section T 30 N - R W
Location of Property
Township ~7 c~ vi P >
Mailing Address L(~~ Y✓9 ~U~7L
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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_ No
Volume and Page Number 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
fn 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.
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PROPERTY OWNER CERTIFICATION
I (We.) ee.n_I;(~y that at statements on this 6onm ahe P.ue to the best ob my (ouh)
hnow.eedge; that 1 (we) am (arse.) the owne. (s) o{ the pnopexty d"cAibed in ,thin
(-YtAonmation ~onm, by vittue o{ a waftAanty deed neeonded in the 066ice o6 the
County Regii 6teA o A Deeds as Document No. Z 4 G% 2. ; and that I (we)
p.n e s en t-X y own the pno pos ed site { oA the sewage pos system (on I (we) have
obtained an easement, to nun with the above de~sni.bed pnopeAty, 4on the,
co"tAuction o~ said system, and the same has been duty neeonded in the O~{ice
o6 the County Regis-ten oA Deeds, as Document No. )
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SIGNA'1I'URE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
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SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
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OWNER/PUYER j%')RY S, r Y-"
ROUTE/&G* nor R > Fire Number.
CITY/ STATE - !!tl-11; ~r ~U Z LP
PROPERTY LOCATION: , ~4, Section T N, R W,
Town of St. Croix County,
Subdivision Lot number
I
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
I
the system can affect the function of tfie 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
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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-
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 I G N ED v( G7 a -;G
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DATE
St. Croix County Zoning Office
P.O. Box 9s
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND P.O. BOX 7969
HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707
S^~ (H63.09(1) & Chapter 145.045)
LOC TOWNSHIP/MUNICIPALITY: LOT NO.. BLK. NO.: SUBDIVISION NAME:
<-a) 11 ~1 , 5 XJN/R/~E (or aS i1
COUNTY: OWNER'S BUYER'S NAME: MAILIN ADDRESS:
~~CRo r 1 rk r-rr, NGif li~ UGC S"GGl ,t/f ~ ! Q
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
nce ❑New .Replace
Reside v A f ! U /
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TA=RrECOMMENDED SYSTEM: (optional)
2s ❑u ❑s Zu Ns ❑u ❑s ❑u ❑s ❑y~v,
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the i
under s,H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- ,E / O- V1 S `f, LI ' L I )<'-7 S
B LS_ j?a.t,SL ~~1vt Fes-/
B- NO 24 f'c~- ,O Bt, Lr l?vr cl L/. G~k"
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 PER INCH
P_ / 6-0 d/a 3 3 3 3' ri-t 1 k
P- .2 .7 A10
P- T 3. S c 3 3 _ c~, 1 t t
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
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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'.
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ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
yL i 1~ I Lt C' ' o c~u , C, Lc 4-. 06 CST IGA E:
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DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) OVER -
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