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HomeMy WebLinkAbout030-1077-10-000 a ~ ocno 3 v0 d ` o y f c~ o m r+1 c ~ ~ ~ n 3 cti, l # (D ` 1 3 N) C) o cng zz 5-12 Q 3 CD CL (D N N 5~ (j) .~J lAl N C= 9 W 7 '0 CD 8 -4 J ° y 7 N ► O 0 c m CD cam, i a o W o o 3 , W CD 7 C7 0 lD A N (/3 Z D CD Cfl O Cn G CD 'd c Q W ° V 3 O N v l~ b rn CO (z) i CD C7~ _I Z Cp CL N O c r CA Q rn ° ~ = 3 Q X a v_ V tom- v v 0 3 z ° cn v * * g < z z N~ d m 3 3 N N D J\v o' m CD m v CD N 7 0 (DD O fu U) N A 7 N z co z ' ~ z rt o D CD 0 i O C1 7 oc, "D w t~ a CD m (D CD C (D D CD W CD a Q W ' d 3 7 E -1 cn cS Z O N O I'I n Eta ;o d Q 7~ CL A Z O 0 ci w co -0 v o C zz c Q Q a 3 o ° -St ~1 N ~ CD A m 0 a m a C CD p (n (n l< :3 0 w c CD m < T 3 0 0 (Iii : z CL GS CS CAD CD CD Cp c 0 c N O O V a 3o m 3-0 jCU O CD n ` 3 CD CD b 3 ''a < CD CD 7 7 r-nO Zt j CD N 0 cr t C)p S 7 c-. ~ O a p N N O p 00 CT 3 m CD p~ A o b ti CD A n ~ m o tn O v o :E c .b °o n. 4 00 ,0 00 ,0 su le;ol se6jeya;uenbullaa soBjeya leloadS awssassd leload S ;unowy AjoBa;ea apoa leloadS aasa :slehads yo;ee :a;ea uo!;eogrpoa 0 :;unoa wlelO ;}lpaa:D tia440l 0 0 000'0 puelpooM 006`88 009'6 0017`6L 000'9 A:podoad leaauaO :9002 ao; sle;ol 0 0 000'0 puelpooM 006'88 009'6 0017'6L 000'9 A:padoad lejauaO :9002 Jo; sle;ol ON 006'88 009'6 0017`6L 000'9 1J IVUNMIS32J uoseaa a;e;S le;ol anoidwl pue-1 sajod ssela uol;dl.iosea 170021801LO :paBueya;se-I :SUOljenlen 009'ZO 1 191,691 :y;lnn possessd :anleA je4mW sled IHEI Audwwns 9002 EEZ/EL9 L66W£Z/L0 E09/Z99 L661/EZ/LO ZL91008 L661/EZ/L0 adAj, aBed/IoA # ooa a;ea :i(ao;s!H lowed as;oN M61-NO£-LZ (17/1091 17/1017 buy-unnl-oaS) :(s);oejl :BPIB opu03ploo18 1789/Z WSO 30 1 101 3S MS M6 18 NO£1 LZ 03S 3-19V-11 /M/ lON-V/N field 000'9 :sa.iov :uol;dl.iosea leBa O11M OOL1 dS 13S2i3WOS Z£179 OS Qy 3)4V-1 H0213d 1799. uol;dl.iosaa #;s!a edAl tiewud :(so)ssaappy A:podoad leloadS = dS I004oS = OS :s;ola;s!a Z9099 NW y31`dM-jIIlS 1SH19NZ161 3(inviO '3113AV-10 - O 3113A` -10 3cinviO jaumo-oo;uaiino _ 0 'Jaumo }uajjno = 0 :(s)ieumo :ssaippv xel 0 00 adA .L;lw.Jad #;IwJad # uol;eollddb eaab seleg # deW a;ea leolao;slFl a3ea uol;eaaa NISNOOSIM `A1Nf1O0 X10210 '1S ;ua~~na Hd3SOf 1NIt/S .10 NMOl - OEO 817LZ'61'OE'LZ # la4ued ' o L d0 L 3°Jb~d Wdb9:Zl 900Z/s~/Z1 000-0 VLL0VO£0 183.1ed f 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 MICONVENTIONAL ❑ ALTERNATIVE state Plan LD Numher (lf assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER INSPECTION DATE: Catu.de C.2avette P. 0. Box 89, StiUwaten, MN 55082 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. SW SW Section 27, T30N-R19W, Lot#1, Town o6 St. Joseph Name of Plumber IMPIMPHSW No.. County. Sanitary Permit Number. Don Schmitt 3205 St. Croix 54932 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. DYES ONO OYES ONO BEDDING: VENT DIA.. VENT MAIL HIGH WATER TNUj~BER OF ROADPROPERTY WELLBUILDING1VENTTO FRESH ALARM ET FROM LINE AIR INLETDYES ONO DYES ONO AREST DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL JPUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. DYES ONO DYES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing EN(,TH uIAMFTFH 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: WIDTH LENGTH JNO. OF DISTR. PIPE SPACING. COVER INSIDE DIA. -PITS LIQUID BED/TRENCH TRENCHES MATERIAL DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTR PI PF DISTR. PIPE DISTR. PIPE MATERIAL NO. DISTR NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH BFLOW PIPES ABOVE COVER ELFV. INLFT ELEV. END PIPES FEET FROM ,LINE. AIR INLET. NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- DYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS JOBSERVATION WELLS EYES ONO DYES ONO DEPTH OVER TRENCH: BED DEPTH OVER TRENCH,BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES DYES ONO DYES ONO 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. [STR P IPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEVELEV. DIAELEVPIPESA.. DISTRIBUl ION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES NO DYES ONO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL. BUILDING. FEET FROM LINE. DYES ONO DYES ONO NEAREST Sketch System on Retain in county file for audit. Reverse Side. DILHR GNATURE ITITLE. SBD 6710 (R. 01/82) 1 ~ wiscons'n APPLICATION FOR SANITARY PERMIT ~ ®1 L H R COUNTY (PLB 67) inousi ~ Y lEnT ,LOOF UNIFORM SANITARY PERMIT # ~ mous a~+ ~i~eoa s Human aeLanons 92 2) 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 PROPERTY LOCATION CITY: 1/4. 1/4, S. T. ; N, R E (or) W t TOWN of r LOT NUMBER BLOCK NUMBER SUBDIVISION NAME EAREST ROAD, LAKE 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: N New System El Tank Replacement ❑ Repair l Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. M Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank Ll 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 ` 1 A 4 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: s } Y i' IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks o ret 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 of Plumber (Print): Signs e: MP/ RSW No.: Phone Number: ~-L Plumber's Address: Name of Designer: } ( r COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved / Q~' w. ❑ Owner Given Initial 6 _1 -I PV X 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 6198` 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. o o C r1 c > > 3 7 CD n (D 'a CD m m o O n Z S fn Z O A C7 v ~1 • (D (D O O N W O O p C2 d N N N , O rye l/~ 73 , m(D O CA v Q 1 CO n Q CD N p O O (b 3 m 1 Q F W p 7 N (D = O Q N C (r O 'S D) N A m U) Z CQ D (p a ~ (D O (n CL (D O C CD C p 7" 3 rn r (OD (NO s a (D 70 O 00 O- o O c A = rT sr (n O M AI• 7 ltVil c N N N O D 3 6 v p 0 a o N C N O N (n co < CD 3 N D W o O 3 Cn ~ ~ s CD N N ~jRA`x N V D to f, C1 C CD (D ~f O (D (o -i cn O A CD N C ~ ~ M A Z O C1 ~ 7 Cn ~ N V W Cl) O O O a z o 3 i, O cn 3 m N Z :E A W (n m - !Z D 3 7 O N CL O 0-3 SL C N 00 7 O T °n 3 3 m c CD 0 N Z O. N S~ CD CD O CD D 0_ 0 O O C1 D co O O -0 O u 0.03 4 7 cn q ' a 70 O (n (D 7 3 N L CD (D Q C 7 3 = O G O N m o (D v O V W (p hp ~i En O O * c Z O (D 0 Cl- EH 1 1 Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION:,'/4,x'/4, Section Z- 7 J50 N,R ~ W, Township oi- Mtmis~-' Lot No. , Block No. I CF'L> ~0 "a - Oyl ~I> County S7-" ~ubdivlsron ame Owner's/Buyers Name: L c r=0,2- PCC~-,. Ef ~UcSt4 Mailing Address: i:! ~dvTc .NjEW jZJC_HMCAJA TYPE OF OCCUPANCY: Residence- X No. of Bedrooms -3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW _X REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 942-175 PERCOLATION TESTS ~~z Z~79 SOIL MAP SHEET 4Z_ NAME OF SOIL MAP UNIT_ "z fA4-1 - - PERCOLATION TESTS TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATr- r NUM- DEPTH CHARACTER SOIL SINCE HOLE HOLE AFTE INTERVAL MIR'/IPI. INCHES THICKNESS IN INCHES BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- ( 5ea e L-m DA-T74 4-33 e N c o 9 9/1(. 5-3 L4, SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- I Ncpsf - 8 4 S. I S ° ~a,L 8o B- 84 A > v" Pv9 1, B- 94 NO > (S, B- CAS oNe- `f j 5 S {e-L 94-- B- / g ~ 7 Err 4-.o S ; T'S " S l c ~+-_i PLAITVIEW (L percolation , O bore h6f; s9&Bitable soil 4feas`.~4h'4c 9o lad a location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. 0I ~ I- 0 r , _~m _ c s► - , s ILI L6 IIJ D" C, F_ Tl"IZ U F 0 PJ g_r_ t(oo-r~ 0 r 2Io i c e t7 - l p ~>Qi< A!n _ . N r IR K.f+oL= t4t-E5 40 p:, t a E 04 - lo 0 1!6, a :S-0 v I, the undersigend, 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 location of test holes are correct to the best of my knowledge and belief. Name (print) `JAM r5 Certc tion No. Address A) r6_T 1 ✓ FA i, S (A Name of installer if known Copy A - Local Authority CST Signature Lt ~f 1 jl.~ 1 t li I 34b 1. 9 .L CERTIFIED SURVEY MAP Located in the Southwest Quarter of the Southeast Quarter of Section 27,T 30 N, R 19 W, St. Joseph Twp., St. Croix Co.,Wis. ~ /she I I 1 /V 89°36 E /3.26.30 330.00 330. 00 330.00 3'.36.30 ' i I I33 37,1 I O O ~ 0 Lof / L0+2 W o L o4 3 o 14 o W p Lo* /f I W a S. 00 q o S. 00,q S-.0 o q o S. 06,q 41 M w ° o o o D J h 5• 9U4rfe r / dAi 7M pipe, 11 o comer, 5ec.27, y /0~?9, I T3o/V, ,Q / 9 W 13 /~f v 200 3 331 330.00 330.00 330.00 33 2.20 , I m M M ^ - 1 (:>wrJ ROQd - S 8 36 W /3 22.20 - Sec_Zine - - - M - - - I I I DESCRIPTION: That certain parcel of land or tract of real estate located in the southwest quarter of the southeast quarter of Section 27, T 30 N, R 19 W, Town of St. Joseph, St. Croix County, Wis., more fully described as f ollows:BEGINNING at the south quarter corner of said Section 27; thence N 000 03' E a distance of 660.00 feet; thence N 890 36' E a distance of 1326.30 feet %9 the centerline of C.T.H. "I"; thence with said centerline S QO 24, W a distance of 660.00 feet to th8 south line of said Section 27; thence with said section line S 89 36' W a distance of 1322.20 feet to point of beginning. CERTIFICATION: I hereby certify that I have surveyed and divided the lands shown hereon; that the map and description shown hereon are true and correct representations of the lands as surveyed; and that I have complied with all provisions of Chap. 236.34 of the Wisconsin Statutes in surveying, dividing and mapping said lands. Surveyed for Roger E. Eckstrom April 21, 1975 St. Croix County James R. Grubb Certified Survey Maps RLS 722 Voi.2_ Page ,58 APPROVE) Dated Jan 28, 1976 APPROVAL OF TH S Pa1i~ ;t~R SUBDIVIS(CN w ' DOES tJ.:7 A.'?;2i)VAL FOR BUILDING S.f-: G:Z SEPTIC SYSTEM. MAR 15 1978 r REFER TO H62.20. Lint W COMP.iEHENSIVE PARKS PLANNING AND ZONING COMMITTEE ` f CY ~t~` ~ 1 Volume 2 Page 584 1 APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) )f 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 C C L Location of Property I-) 4 SeJ ~4, Section T 3c~ N - R 19 W Township Mailing Address O , as ~X ~7 Subdivision Name F C. S-T K4Z Y" Lot Number Previous Owner of Property Total Size of Parcel - A Date Parcel was Created n'17~ 16, °7 cz Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes f No Volume and Page Number 5 qn'eK 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) eeAti6y that aU 5tatements on this ~onm cute tAAue to the best o~ my (oun) knowkedge; that 1 (we) am (a.,e) the owneh (b) o6 the pnopeA,ty de cAibed in this in~oAmation 6ohm, by vihtue o6 a waAAanty deed AeeoAded in the 066 ice ob the County Regi6t n o6 Deeds as Document No. 3 W 10 ; and that I (we) pneserWy own the pAopo6ed site 6oA the sewage dispaaat system (oA I (we) have obtained an easement, to nun with the above des n bed pnopeAty, 4oA the eons,thAuetion o{ said system, and the same has been duty AeeoAded in the 066ice o6 the County Regis,teA o6 Deeds, as Document No. 3 91 ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED 1 CERTIFIED SURVEY MAP Located in the Southwest Quarter of the Southeast Quarter of Section 27,T 30 No R 19 W, St. Joseph Twp., St. Croix Co.,Wis. /V 89°36"E /326.30 330.00 330. 00 330.00 3.36.30 ' i 133 33 O I~ o Lof / o Loft W Lo43 p LOf 1 44 S. 00'q n S. 00 A o Q S. 00 A C3 ° S.06q 0 N N u N oO N I ° tp 0 t9 l9 0 0 R/: or Be . ; O 0 ~ O o (h 0 h S. gCWQr fe r / c~iom pipe, h~ o corr7er, 3e c. Z7, T-TO/V, R/ 9 W /3 4 I v 200 , Y 330.00 1730-00 P3 33I - -t ~ _ - ~ - ~ 330. po 33 2.20 - I r-- - - - - - - - - - - 6 / I ~ A A 7-OWr7 Roc7d I i DESCRIPTION: i I I That certain parcel of land or tract of real estate located in the southwest quarter of the southeast quarter of Section 27, T 30 N, R 19 W. Town of St. Joseph, St. Croix County, Wis., more fully described as follows:BEGINNING at the south quarter corner of said Section 27; thence N 000 03' E a distance of 660.00 feet; thence N 890 36' E a distance of 1326.30 feet to the centerline of C.T.H. "I"; thence with said centerline S QO 24' W a distance of 660.00 feet to th$ south line of said Section 27; thence with said section line S 89 36' W a distance of 1322.20 feet to point of beginning. CERTIFICATION: I hereby certify that I have surveyed and divided the lands shown hereon; that the map and description shown hereon are true and correct representations of the lands as surveyed; and that I have complied with all provisions of Chap. 236.34 of the Wisconsin Statutes in surveying, dividing and mapping said lands. Surveyed for Roger E. Eckstrom April 21, 1975 R St. Croix County James A. Grubb Certified Survey Maps RLS 722 Vol. 2 Page 4 APPROVED Dated Jan 28, 1976 APPROVAL OF T!';'S SJ1- DMS(CN DOES N --T A. P.,"C- VAL FOR BUILDING S.T.: 0,; SE TIC SY-TEM. MAR 1 5 1978 REFER TO H6220. COAL' -r L;A ilV- PA,;`S f i,,t.RiNG i - ' ; I AND ZONING COMMITTEE `s 1 G) -1 y S T C - 105 r r SEPTIC TANK MAINTENANCE AGREEMENT ~ O St. Croix County 1 I! V~ p _ y O W N L: k / B U Y E R e_LA L? 13 C - C TY ROUTE/BOX NUMBER ilo. znY Fire Number CITY/STATE i„i ✓ ynkn /IP PROPERTY L.UCATf-ON Section o~7 T N, R j~ W, Town o1: c C)~Q J St. Croix County, Subdf v is lull JR. Lot uuuiber Improper use and mal"L euance of your septic system could result in its premature failure to handle wastes. Prober maintenance con- sists of pumping ouL the septic tank every three years or sooner, it needed, by a licensed sehtf_p tank humEyr. What you put into ~ the system can atlvct the function of the scp Lic Lank an a LrcaL- wcnL sLagn Ln the wasLe disposal systew. St. Croix Count-; tosidenLS may be eligible Lo ruceivc a grant I"r a maximum of 60% UI the cost. of replacement of a tailing sysLew, 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 5Y.-.-- -t.___-em.s agree to keep their systems properly mafntained . The property owner agrees to submit to St. Croix County Loniag a certificatlon 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), Clue 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. o I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards seL forth, herein, as set by the Wisconsin. Depart- u meat of Natural Resources. Certification form must: be completed and returned to Lhc St. Croix County Zoning Office withLn 30 days o'i tine three year expiration date. SIGNEll DATE St. Croix County Zoning Office P.O. box 98 Hammond, WI 54015 715-706-2239 or 715-425-8363 Sign, date and return to above address. MINOMM DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS 115 P.O. BOX 7969 HUMAN RELATIONS l / MADISON, WI 53707 • (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: '/a 17 /T0N/R"9E(or)W ~•T054 s *0 ksfRoj COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: S'f.AV/x JOE ELCxA'r O/o A,~ ~ l~r>:_ 0 l K j~'Avc_ 84 der,w USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION 7TEjSTS: Residence New ❑Replace 22 l 1 2, 3 if I, IV IF RATING: S= Site suitable for system U= Site unsuitable for system ~C 7Z S J% ~/7 %-'r ✓"L- I L • w;d~l 4 SL 5 %3 5tehr' CONVENTIONAL: MOUND: I IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) f_20S4- fT ©S ❑U ©S ❑U [Y S ❑U ❑ S [9U ❑ S DU ~~Vv,FV /~v,~~ ~CD If Percolation Tests are NOT required DESIGN RATE:~ I If an ~ any portion of the tested area is in the 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 BBRV. ON BACK.) B- l & 0'~ .7a fr ? - ~ y :,Cq s, /'11Y • 3v. -V e. ;X s. SQL ,5'0 -so 9 wqt~! S&--t . B b f~ - 5 //Q ~y SiL4 7 U.'34. Nsx. C'L .3o B- B / l!j ~d.•&~ ? ~I ri~v 1L' ~N. SiL 1Q"G~ J V L C~•Ia'~ B y Sao, ti3 7,.~,ys~`; a3•' 0B~. s;L,,p~- LJ.13N--0,e. -15 B ~S 97,7 //„9y S"L, .Zs „ 4 7r• 5i L, 4u U loo. St tee. Wet. ASP 5L, -so 9o 2 loa Si- 7"' 56 4- PERCOLATION TESTS wi~ <Qur-F4wr TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PER INCH P_ ~7C 3o 17 P- P Z 0 M02- /O P- P- i & P- T PLcP iu {~r OT 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. 13Q7'd.N! of Rep fX~,q~I~T/d.td VA1,L 41E Ar c~X~9~T~y 0 '0'7r SYSTEM ELEVATION ok ;A/ o16two eG~ ~ =f-XPg,ec jty z fr. 6e%~ 9~ a Py. P Pr. Z 1¢0,e1. 57TEL jFp j reties- PQs i V 30 s~~ ~5' E~ U V TN g5aa i w _J 10 \j ZZ O '~K a. a ....r. lot; 1-*6 5P0 r- 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 l bgr Zllv`JeAlch~ T STS WERE COMPLETED ON: io F 23 It ADDRESS: CERIIFIC TION NUMBER: PHONE NUMBER(optionalj: / ~.~V 2_ 13 6 1 _ CST SIGNATURE 111111 . ' ARW emu„„ ,7. i t trtYt;i - - eal-lt. X I Ni U rV, t,ls { i ,i,>fl, t. aINL, I A t , , E ra u ; fL . , ~.a'i'_ e u_ t c , iw iY? ,i 1 snt ii '$ttig the F-.3h^.t plan sl! IB L r:, rEi ac, 2e--t 3f3ux ~t_Yl:x. _v;nq to :scale, i., f),,e E..iic 3 erg:' _ .iov ,~;'O<,3 Beet; e tit f v - ie - t rti 13 F 4 F' _ r 3." d l ~Y nl 13 33 ( ~G, C • 0 r3 f ✓ ~j SLL~i4 C- F !'cD v~ { 1 qC' f ti Gf • n< P 1'~~ PCX 9 9, /~T 1