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HomeMy WebLinkAbout030-2004-50-000 c d o f 3 d p d c c > > "o 3 A. (D (D CD CD CD rr Q S CD (j) o w a [,-, O w w °w • ° 3 rn w is 00 0 S co n o o m = a w p 0 C f J O 0 W. O 7 N W 7 N W O C y C Ui . C al rZj CD CD N M m T z D CD a a v> D a s (D (� D Co fl. (o N (n d 3 O ° m O CL m V � rn c j cN�n �+ a f1 CD CD CD 0 N 0) � 7 . C Q z 0000 000 N• �, s rn �-3 0) 0) Cl) CD 0 CD '° S v N E a Q a _ (D _X m = Q O H C N C1 z 00 z w z Q CD 0 v O D a CD o c O D Q m CD a N CD N � CD A CD O m CD d O ( N 1. C CD 3 C CD CD W CD O a a 3 m 3 C CD O ' ( A 7 o. m O W Z O w Cp CD CD CD Z CL c 3 0 o ^f z CD f C4 ET Cl) 0 CD a CD m d 3 o s o- C C A 7 0 G m CD m 7 3 � a Q N c . z d x Co a Q Z d O :3. W N N CD O (n o a CD M n N• CD W ?. c z S, 5 [D A CD d S O A N OQ= CT CD O CD :E 3 m( � �•CD cn° sy�3 c CL 0. u, CD A O� Q b tA CD (D CD O O D A O Q O tA CD a i (:) Parcel #: 030 - 2004 -50 -000 02/28/2005 09:46 AM PAGE 1 OF 1 Alt. Parcel #: 33.30.19.365G 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 * LEER & SUSAN L BROWN BROWN, LEE R & SUSAN L 1243 52ND ST HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1243 52ND ST SC 2611 SCH D OF HUDSON SP 1700 WITC �( 6 k L— Legal Description: Acres: 5.430 Plat: N/A -NOT AVAILABLE SEC 33 T30N R1 9W NW SW COM SW COR SEC Block/Condo Bldg: 33, TH W 57.61 FT TH N 628.97 FT, N 87DEG E 120.15 FT, N 44DEG E 444.26 FT, Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) N 1 DEG E 1091.23 FT TH N 10DEG E 266.29 33- 30N -19W FT TQ POB TH CONT N 10DEG E 305.31 FT. TH E 760.13 FT, TH S 300 FT, W 818.11 FT more Notes: Parcel History: Date Doc # Vol /Page Type 11/24/1997 568878 1278/331 QC 07/23/1997 997/184 QC 07/23/1997 867/549 07123/1997 755/206 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 5701 268,400 Valuations Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.430 132,400 131,700 264,100 NO I Totals for 2004 General Property 5.430 132,400 131,700 264,100 Woodland 0.000 0 0 Totals for 2003: General Property 5.430 77,600 99,400 177,000 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch #: 213 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 430388 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village X Township Parcel Tax No: Brown, Lee St. Joseph Township 030 - 2004 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: Co . D / CID .O / evC-• = r - S7 P, it ( 33.30.19.365G TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic r _ � � I Benchmar ( 1 Dosing J Alt. BM ` � _ d S Aeration W J / Bldg. Sewer Holding St/hit Inlet St/Ht Outlet A / TANK SETBACK INFORMATION I/ 90. a TANK TO P/L WELL tBLDG. nt to Air Intake ROAD R Inlet Septic t ' �s t DI�MW -5r Bea 1 OP _ Header /Man. 7+ ^-3 }S' Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manu 1jQmand St Cover Z A 3,d GP Model Numbe O. .� 93.2o f TDH Lift c' Loss System Head TDH Ft ! Forcem Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM + Z RE CH Width I Length t No. Of TrencheEr PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMERSTM 1 C SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING ManufQctur INFORMATION CHAMBER OR t I L Type Of System / ' i` UNIT Model Number: • v ��• DISTRIBUTION SY TEM A- 40, PAL Header /Man' old _ J Distribution x Hole Size x Hole Spacing Vent to Air Intake 1, 9�'►' i e(s) ' 2- Length Dia Len Dia Spacing SOIL COVER x Pressure Systems Oniy xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil (J, Yes E'] No 1 1] Yes etc. resent persons CO MEL 1r cod di r encies, P P ) Ins , ection #1:�a Inspection #2: .a.Q /� – (00 b -tom P Location: 1243 52nd beet Hudson, WI 54016 (NW 1/4 SW 1/4 33 T30N R19W) NA Lot L92� — Parce o: 33. . .365G tea 1.) Alt BM Description = gad ��.. �, 2.) Bldg sewer length = �Nn � C 3,04 � I 01. amount of cover :,,, �as Plan revision Required? l] Yes X No b _ A �� Use other side for additional information. L_ -_' SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. I �1 �? aZ � Safety and Buildings Division County 1*i1 201 W. Washington Ave., P.O. Box 7082 ! / X sconsin Madison, WI 53707 – 7082 Sanitary Permit umber (o be filled in by Co.) Department of Commerce (608) 261 -6546 2 4 30 3Q Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal ' . p may be used for secondary purposes Privacy La s15.11 en E I V E D Project Address (if different than mailing address) I. Application Information – Please Print All Information h Property Owner's Name ' Parcel # B tFP 5120 Property Owner's Mailing Address c C Property Location -�3 1 City, State Zip Code dr ' /a, 1/. Section ,3 3 i5 o rM ruses (circle II. Type of Building (check all that apply) F iu +l �1 au u R�E of vv� 11 1 or 2 Family Dwelling — Number of Bedrooms 3 Subdivision Name CSM Number ❑ Public/Commercial — Describe Use 2 ( C ayl, ❑ State Owned — Describe Use ❑City ❑Village Wo wnship of III. Type of Permit: (Check only ne box on line A. Complete line B if ap - Y P PP ) A. ❑ New System yst � Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. 11 Permit Renewal ❑ Permit Revision ❑Change of 11 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl ❑ Non — Pressurized In -Ground 0 Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 0 53. 1 '71? -7/.7 9 .2•2 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Tack Existing s Tanks Septic or Holding Tank c 2C Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the undersigned, a ssume responsibility for install of the POWTS shown on the attached plans. Plumber's Name (Print) Plu 's Signature MP RS umber Business Phone Number sy --�s i � )ITA,.4fjiAl' umbers ddress (Street, City, State, Zip Code) A6 LIA L( UJ /Z S� y0 VIII. County /De artment 10se Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Is in Agent Signatu (No Stamps) Surcharge Fee) �?-5D — ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval ' SYSTEM OWNER: 3 1 v t o� Jae �3 � �`^'`� S n 1 Septic tank, effluent filter ana �� t S �w �,�bG r w V; dispersal cell must all be serviced I maintained W i'� �+� 83 — $S• as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attack complete plans (to the County only) for the system an paper mot less than 81/2 x it inches In size SBD -6398 (R. 08/02) - - - — r ego - - -- - -- -- - - - - -- - yA -- - -- At 7 -- - - - -- — R 03 z�r� -- - - -Av - y-- � two GL ST r -- - -- � t to 8•�- — - y- - -- — — - -- . — r — T Qi o BOO B�6 /riw ?f 0 3 z 1I' 012A -� 315, r :.7TH r . -- - -- o 1760 - - – -- – - - — - -- s�.t4Lt< . — a2L!�4_ 51 - — r 1139 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan Plan must St. Croix include, but not limited to: vertical and horizontal reference point BM), direction and percent slope, scale or dime n lance to nearest mad. Parcel I.D. 030 - 2004 -50 -000 Plea a pn r►na on, =By Date Personal information you pro vi a may be used for secondary purposes (Priv y Law, s. 15.04 (1) (m)). Property Owner Property Location � J Brown, Lee And Sue Govt. Lot NW 1/4 SW 1/4 S 33 T 30 N R 19 W Property Owner's Mailing Addre ZONING OFFICE Lot # Block # Subd. Name or CSM# 1243 52nd St. City State Zip Code Phone Number J City _J Village e Town Nearest Road Hudson WI 54016 1 715 - 549 - 5393 St.Joseph I 52Nd St J New Construction Use: i/ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD I✓ Replacement J Public or commercial - Describe: Parent material Outivash Plain Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.7 gpd/sgft rating. 3 trenches are recommended, elevations are: High 92.2' Mid 917 Low 91.2' Boring # J Boring 101 Pit Ground Surface elev. 94.20 ft. Depth to limiting factor 84 + in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz 'Eff#1 I 'Eff#2 1 0-4 1 Oyr4 /6 none Is 1 msbk mvfr gw 2m, 2f .7 1.2 2 4 -84 1Oyr5/6 none grms Osg ml — -- .7 1.2 (oo Boring # J Boring bel Pit Ground Surface elev. 94.50 ft. Depth to limiting factor 84 + in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft *Eff#1 *Eff#2 1 0 -3 1 Oyr5 /4 none Is 1 msbk mvfr gw 2m, 2f .7 1.2 2 3 -70 10yr5 /6 none grms Osg ml gw --- .7 1.2 3 70 -84 1Oyr4/6 none sl 2msbk mfr — .5 .9 rte' qZ • Z� �G ' Effluent #1 = SOD ? 30 < 220 mg/L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg/L and TSS <-,0 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt �'*� 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 8/23/03 715- 247 -2941 Property Owner Brown, Lee And Sue Parcel ID # 030 - 2004 -50 -000 Page 2 of 3 3] Boring # J Boring IJ/ Pit Ground Surface elev. 93.50 ft. Depth to limiting factor 85+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots T *Eff#1 *Eff#2 1 0 -5 1 Oyr4/6 none Is 1 msbk mvfr gw 2m, 2f .7 1.2 2 5 -72 1Oyr5/6 none grms Osg ml gw .7 1.2 3 72 -85 1Oyr4/4 none sl 2msbk mfr - --- — .5 .9 ]Boring 1/ Pit # Boring Ground Surface elev. 93.50 ft. Depth to limiting factor $4+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0-4 1 Oyr5 /4 none Is 1 msbk mvfr gw 2m, 2f .7 1.2 2 4-64 1Oyr5/6 none ms Osg ml gw -- .7 1.2 3 64 -84 10yr4/4 none grsl 2msbk mfr — -- .5 .9 F-5-1 Boring # I Pit Boring Ground Surface elev. ft. Depth to limiting factor $5+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0-6 10yr3/3 none sl 2msbk mfr gw 2f .5 .9 2 6 -18 1Oyr4/4 none sl 2msbk mfr gw - - -- .5 .9 3 18 -85 1Oyr5/6 none firms Osg ml - -- — .7 1.2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD -S_30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. Pa9 e 3 6' 3 p�' c �x;s�• � / �''t i toA S7� r -9 6 if al qq l = Vv �'- , 6 f , al'o f�e —3 c AP Z&- a T ct• �/, .� v e t 0�,-- C Ue,- /(9a GEi, k f C AO- bAO'S -G' o - P '? `/ we �a "4-e e L , 16 o � 02 it /0, �o-e x —� Po o'; Le e ate/ 5**- as h rp,%,J ," 6V, T �. .� S • S c !. �„ 1� /a 0 s { - C STS f cim swl? IV4 J S�J � 5337 3 oral A /9r,J (7/0 2V7- 29Y( 7o op s/• Tas A ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the L ,6F 06U)/66 residence located at: A&1 2 1-,, �&/ — %, Sec. 33 , T _.LQ N, R 9 W, Town of �7SE17 A St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced = 7M. , zy G X00 3 Did flow back occur from absorption system? Yes No (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete X Steel Other Manufacturer (if known) : / Age of Tank (if known)- r - (Signature) (Name Please Print (Tit (License Number) (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle) . Name u MAai�i r�Cfir/' /trr Sig ture M /MPR a==.-- /7y/ r POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al 9NA Permit # 3� Septic Tank Manufacturer � DESIGN PARAMETERS Effluent Filter Manufacturer — ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model A — 49, 0 ❑ NA Number of Public Facility Units ® NA Pump Tank Capacity gal ■ NA Estimated flow (average) 3oQ gal/day Pump Tank Manufacturer s NA Design flow (peak), (Estimated x 1.5) p g al/day Pump Manufacturer i NA Soil Application Rate 7 gal/day/ft2 Pump Model ® NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ■ NA Fats, Oil & Grease (FOG) 530 mg /L 1 ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L M In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: & _ ❑ NA Other: ❑ NA Other: IJ NA *values typical for domestic wastewater and septic tank effluent. Other: ❑ NA , MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ■ year(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) 3 9 y ear(s) (s) (Maximum 3 years) ❑ NA At least once every: Clean effluent filter At least once every: f , ❑ month(s) ❑ NA ® years) ❑ month(s) M NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ' ❑ month(s) ■ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: ❑ month(s) i NA At least once every: ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals on IY or more of the tank volume,_ the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cellls). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of pump effluent. To avoid this situation have um the contents of the tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ales in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ■ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name — Name Phone _ _ G Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name _ Name u Phone Phone s — 1 11U 42 This document was drafted in compliance with chapter Comm 83.22(2)Ib)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _ Mailing Address 1 q3 Property Address T (Verification required,from Planning Department for new construction) City /State 912 cant /,/)f' Parcel Identification Number 030 030 —Aoo y- 6 L EGAL DESCRIPTION Property Location NO'/., .ScU '/4, Sec. 3.3 ,, T �.Q_ N -R_L�—W, Town of S . r %SFn!/ Subdivision , Lot # Certified Survey Map # , Volume . .Page # Warranty Deed # 5 - 6 , ?? 7 e , Volume —.12 2 . Page # 3 3 l Spec house ❑ yes 8 no Lot lines identifiable W yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, joumeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. L p� 2 l SIGNATURE OF APPLICANT DATE « «"" "" Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. " " * " «« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed y w DOCUMENT NO. QUIT CLAIM DEED 5 ��i'7F3 Lee R. Brown, quit - claims to Lee R. Brown and Susan L. Brown, REGISTER'S OFFICE ^.� CO.. �'•''' husband and wife as survivorship marital property, the following ST. C R Oik WI described real estate in St. Croix County, State of Wisconsin: w4:d °�r 71c ^rd Part of the NW 1/4 of SW 1/4 of Section 33 -30 -:9 described as follows: NOV 2 4 1997 Commencing at SW corner of said Section 33; thence West on South line 10.00 of Section 32- 30 -19, 57.61 feet; thence Worth 628.97 feet; thence A N87.5S'S 120.15 feet; thence N44.48 444.26 feet; thence N1.41 1091.23 feet; thence NIO.42 266.29 feet to the Place of Beginning; 7` r< c✓siaJn !� +" thence M10.42 305.31 feet; thence East 760.13 feet; thence S0.14145 "E Rs !afsr of Dsads 300.00 feet; thence West 818.11 feet to the Place of Beginning. 1 11' r• w , NAME AND (�RETUnRRN.. ADDRESS (� , I Mac 6tlspf,� C m's + FEE 030 - 2004 -50 This is homestead property. Parcel Identification Number (PIN) Dated this day of November, 1997. y b (SEAL) � �. V_ (SEAL) Lee R. Br6wn I j (SEAL) (SEAL) I AUTHENTICATION ACKNOWLEDGMENT signature(s) STATE or WISCONsni ) sa, _ ptC( C COUNTY ) authenticated this day of 19_ Personally came before me this T h day of i t , D v Q ab2 t" , 19 g'T_ the above named Lee R. Brown to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. TITLE: MEMBER STATE BAR OF WISCONSIN �Q�Q�LYI��(J.1��U !If not authorize y (706.06, w s. Stats. � 3arbarn � (.e m6hlnuts _ T8I8 INSTRUMENT WAS DRAFTED BYs \� Notary Public �1e f C� County, Win. � �►) 0 1 commission s periranent (If not, expiration date: Joseph D. Soles ��► sssss6 ���''a Rodli, Beskar, Boles i Krueger, S.C. '�14L. e P.O. Box 138 River Falls, WI 54022 +� " �°»• r. v . 1 0 s �q f�, i ., "ON- tICAA'_ H, -r-%: �R� °.�Th.'t _ _4s: a A id ; .oft lr s V. r Parcel #: 030 - 2004 -50 -000 12/01/2009 09:12 AM PAGE 1 OF 1 Alt. Parcel #: 33.30.19.365G 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - BROWN, LEE R & SUSAN L LEE R & SUSAN L BROWN 1243 52ND ST HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 1243 52ND ST SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 5.430 Plat: N/A -NOT AVAILABLE SEC 33 T30N R1 9W NW SW COM SW COR SEC Block /Condo Bldg: 33, TH W 57.61 FT TH N 628.97 FT, N 87DEG E 120.15 FT, N 44DEG E 444.26 FT, Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) N 1 DEG E 1091.23 FT TH N 10DEG E 266.29 33- 30N -19W FT TO POB TH CONT N 10DEG E 305.31 FT, TH E 760.13 FT, TH S 300 FT, W 818.11 FT more Notes: Parcel History: Date Doc # Vol /Page Type 11/24/1997 568878 1278/331 QC 07/23/1997 997/184 QC 07/23/1997 867/549 07/23/1997 755/206 2009 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.430 132,400 131,700 264,100 NO Totals for 2009: General Property 5.430 132,400 131,700 264,100 Woodland 0.000 0 0 Totals for 2008: General Property 5.430 132,400 131,700 264,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 213 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 T. X 0 COUNTY ZONING OFFICE P. 0. Box 98 1' Hammond, WI 54015 , f/TheSt. Telephon e - (715)796 -2239 or (715)425 -8363 roix County Zoning Office offers t e servic f septic and water inspec- tions to Lending Institutions, Realty Firms, and pri ate individuals. Completion of this form is essential so that the property can be located Please provide the following information,enclose appropriate fee made payable to St. Croix County Zoning, 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 . . . . . . . . . . . . . . O FEE: $25.00 (For nitrates and coliform bacteria) SEPTIC SYSTEM INSPECTION . . . . . . . . . . . . . . FEE: $25.00 (Determines if system is properly functioning at time of inspection) Property owner's name kb ,A �CJc�. k ) 1�, - � 2 - Legal Description _ 1 L of the s of Section 3 3 T 3� _ N - R _ L W Town of Lot Number Subdivision Name FIRE NUMBER /vim - LOCK BOX NUMBER Color of house ale— Realty sign by house? If so, list firm: P� .:2d PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i.e,. COPY OF PLAT BOOK, WITH LOCATIO14 SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires 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 arrange- ments with this office to ensure time when entry may be gained. Firm or individual requesting services: �i4.L� / Phone No . - &c 207 REPORT TO BE SENT TO: z / ,c �,�� �D (o / i n!7` CLOSING DATE: / '� _ <I� ' d gne �°-, e 12 /85:mj Si T Agent or Individual Making Request � � � � � �' � �� �� �_ �� . �I �_ � F - T - r COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 Czj k4j 715 - 962 -3121 800 962 - 5227 ST. CRO IX ZONING REPOR NO #: 02197/01 PAGE 1 ST. MIX COUNTY REPORT DATEi 3/05/90 C"THOUSE DATE RECEIVEDS 3/01/90 HUDSON, WI 54016 ATTNS THOMAS C. NELSON 0-30 -ZaU�( -� �Z�-� 2,0 to — Lee, 3ro�. OWNERS Ron 6 Gail Morrell 3 z 3. J LOCATIONS Town of St. Joseph / q3-6 Z nd S4- COLLECTORS St. Croix Zoning SOURCE OF SAMPLES Kitchen faucet COLIFORMS 0 /100 ml INTERPRETATIONS Bacteriotogicatty SAFE NITRATE -NS C 1 ppm Under 10 ppm is safe for human consumption, Coliform Bacteria /100 ml Nitrate - Nitrogen, mg /L I LAB TECHNICIANS Pam Gane WI Approved Lab No. 19 �.NDEVEA,,D V • 1 A ( Means "LESS THAN" Detectable Levet Approved byi ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 i 7 T M..> 17!I Syr if OWS AND 81-21T 1MA In 524 an .1 u . i W.-, one; ps a'.. I .. ~_ C&MERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.** 01724/01 PAGE 1 ST, CROIX COUNTY REPORT DATE: 2/19/90 COURTHOUSE DATE RECEIVED; 7J15/90 HUDSON# W I 54016 ATTNS THOMAS C. NELSON OWNERS Ron & Gait Morrett LOCATIONS St. Joseph Township COLLECTORS Thomas Nelson SOURCE OF SAMPLES COLIFOWS 7 /100 at INTERPRETATIONS Bacteriologically UNWE NITRATE- -N ppm Under 10 ppm is safe for human consumption. Cotiform Bacteria /100 at LAB TECHNICIANS Pam Gane WI Approved Lab No. 19 .O F• \NDEVENDE A C Means "LESS THAN" Detectable Level Approved by! 4� yt� ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 l :a r A 7,710 WIN! vi J Atg r (( L Y "40n;H � . _.... AME CIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 k4j 715 - 962 -3121 800 - 962 - 5127, ST. CROIX ZONING REPORT NO.. 01276/01 PAGE 1 ST. CROIX COUNT` REPORT DATE. 2/07/90 COURTHOUSE DATE RECEIVED. 2/01/90 HUDSON, W. 5 i4016 ATTN. THOMAS C. NELSON -i OWNER: Ron 6 Gait Morrell E �, LOCATION. Town of St. •Joseph COLLECTOR; St. Croix Zoning SOURCE OF SAMPLE. Kitchen faucet COLIFORMS 9 /100 ml INTERPRETATION: Bacteriologically UNSAFE NITRATE - < 1 ppm Under 10 ppm is safe for human consumption. Cotiform Bacteria /100 m► Nitrate - Nitrogen, mg /L TECHNICIAN: LAB dam Ga WI Approved Lab No. 19 OF.tNDEVENpEM �9 O A V 1 J? < Means "LESS THAN" Detectable Level Approved by: m PROFESSIONAL LABORATORY SERVICES SINCE 1952 .. ST. CROIX COUNTY � WISCONSIN , ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 II (715) 386-4680 February 1, 1990 Carroll Farrell 706 19th St. S Hudson, WI 54016 Dear Ms. Farrell: An on site investigation of the septic system on the property of Ron & Gail Morrell at NW 1/4 of the SW 1/4 of Sec.33, T30N -R19W, Town of St. Joseph was conducted on January 31, 1990. At the same time I also obtained a water sample and submitted it to the laboratory 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 the inspection, the sanitary system appeared to be function properly for the existing use. 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 is totally dependent upon proper maintenance of this system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerel 1-0—'�e9L. Mary n ns Assistant Zoning Administrator TCN:cj . .. .. .. .......... .... ... ... ... .. .... -- ....w. :aww.,.a.ir+ar; ,..; ....mrtw+uwww;a+.rw t , Form - S T C - 104 • AS BUILT SANITARY SYSTEM REPORT r OWNER `. �1�, s TOWNSHIP SEC. T N -R Ll W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT �' LOT SIZE PLAN VIEW D30 - �i � -QUZJ Distances and dimensions to meet requirements of IIHR, 83 / ' SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM j a , INDICATE NORTH ARROW 0� r� BENCHMARK: Describe the vertical reference point used V # Elevation of vertical reference point: C ',;'_ _ Proposed slope at site: SEPTIC TANK: Manufacturer: � — Liquid Capacity P y Number'of rings used: Tank manhole cover elevation: J Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front ,O Side, Rear, O _ feet r From nearest property line Front 1 0 Side 1 0Rear,(g feet 1 Number of feet from: well (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, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION / SYSTEM Bed: `•J Trench: Width: Lengtth: — , � Number of Lines: _ Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Rear, O Ft. Number of feet from well: Number of feet from building: T (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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: I Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: L �� 3/84:mj DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P,O, BOX 7909 BUREAU OF PLUMBING • MADISON , W 1 53707 ❑ ERCONVENTIONAL ALTERNATIVE I State Plan LD.Number: ❑ Holding Tank El In•Ground Pressure ❑Mound (lf ..signed) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPEC ON D E: Ron Kiel 420 N. 3nd, StUtwatVL , MN 55082 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN rF. PT. LEV.: CST REF. PT. ELEV.. SW Sw, Section 33, T30N- R19G1 Tow og St. Joseph Name of Plumber: I MP/MPRSW No County Sanitary Permit Number: Ri.chand Hop kins 1059 St. cuix _ 83769 SEPTIC TANK /HOLD NG TANK: MANUFACTURER: LIOUID CAPACITY. TANy LET TANK OUTLET ELEEV WA NING LABEL LOCKING COVER /�](J' may /e / P V ED: PROVIDED: �L L; ( / j/ ( YES ❑NO DYES O BEDDING: VENT DI A VENT j HIGH WATE ENT TO FRESH NUM OF ROAD PH BER OP���RRRT WELD BUILDING V ALARM �A I LIN� P IAIR INLET ❑YES NO ❑YES O NEAREST � O `� P_ DOSING C AMBER: MANUFACTU ER BEDDING. LIQUID CAPACITY PUMP MODEL P 111:T1111111 WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. DYES ONO E:] YES ❑NO I DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOPEHTV WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM I LINE AIR INLET PUMP ON AND OFF) ❑YES E NEAREST' ---1rj SOIL ABSORPTION SYSTEM. Check thesoilmoistureatthedeptho'Plowing FORGE If11,T11 I WANIF TEH J MATIHIAL AND MARKING or excavation, (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYST WIDTH LENGTH NO OF IDISTR PIPE SPACIN(, COVER INSII)E OIA -PITS I LIOUID BED /TRENCH t ^ THE f�AIErs M�R AL' PIT DEPTH DIMENSIONS l S GRAVEL D TH FILL DEPTH UIS1H PIVF DISTH PIPE DISTR. PIPE MATERIAL NO OIS I NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES ef t ABOV OyEH IEV IN i E V EN PIPES FEET FROM LINE Ir AIR INLET. �(_ �) to 2 . 7 2 NE AREST ---i O `ZCJr Le 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- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PE HMANI N f MAHKE HS OBSERVATION WE LLS _ ❑YES ❑NO ❑YES El NO DEPTH OVER TRENCH BED DEPTH OV111 TRENCH 11111 DEPTH OF TOPSOIL SO UIIFD SEEDED MULCHED YES. ❑NO ❑YES 1:1 NO ❑YES 1:1 NO CENTER EDGES ❑ 11111 PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO OF LATERAL SPACING 1 6HAVI L DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSI ". MANIFOLD PUMP MANIFOLD DISTR. PIPE J MANIIOLDMATEHIAL NO DISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING i- .ELEV. ELEV. DIA. ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATI HOLE SIZE HOLE SPACING DRILLED CORHECI LY COVER MATEHIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES El NO DY ES ❑NO COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE ❑ YES 1:1 NO ❑ YES 1:1 NO I NEAREST LA Sketch System on Retain in county file for audit. Reverse Side. SIGNATU TITLE DILHR SBD 6710 (R. 01/82) &J'scons'r, APPLICATION FOR SANITARY PERMIT L �7 f • UNTY DILHR (PLB67) DEPRRI'fT1E1 - 1T OF UNIFORM SANITARY PERMIT # - - inou5TRV, LR80R 6 HUMArl RELRT10 S'3rld9 — 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 PROPERTY OWNER MAIL G A 1 PROPERTY LOCATION CITY: , VILLAGE: 1 �. U1A S. , T3(�N, R 9 E (or�IN TOWN OF /4_,� j LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROA4 LAKE OR LA DMARK STATE PLAN I.D. NUMBER ' TYPE OF BUILDING OR USE SERVED EJ 1 or 2 Family Number of Bedrooms: F-1 Public (Specify): QN\ THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump / Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOS (Square Feet): �!' Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. N e of P A ber (Pri t): Sign e: ` MP /MPRS No.: Phone Number: h�R �...� -� t D 5' (7�S'► r.y �� Plu er's Address: ` Na f Des'gner: to s COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved t'AO / C�86 ❑ Owner Given Initial J (p J V Approved Adverse Determination Reason for Di p al: Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber r APP'LICA'TION FOR SANITARY PERMIT STC - 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 /contractgr,( "spec house "), then a second form should be retained and completed when the proper is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property 1 2A/ Z Q If k i�,e / Location of Property -3 '� S �'-� ' , Section -2 3 T --? O N - R W Township S 7 0 , -s - p- +e h__ Mailing Address ? 1J) nm t Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel .S`'°, 0 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 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) ee4ti.6y that aU 6tatementa on tk a 6oAm aAe true to the but o6 my (ouA) hnow.eedge; 'hat I (we) am (one the owneh (6) o6 the pnopehty de6eAi.bed in this in6onmati.on bonm, by vi tue o� a wWtAanty deed neconded in the 066ice ob the County Reg -i a ten o� Deed6 ass Do eumera No. -q g ; and that I (we) pne6entey oun the p4opo6ed 6ite bon the 6ewage po6HT (oA I (we) have obta.i.ned an ea6ement, to )tun wZth the above descA be.d pnopeAty, t (on the con6t.ucti.or 6a, o� id 6y6 tem, and the ha6 been dO-u, neconded in the 066ice o6 the Count y Reg-usten o5 Deeds, a6 Doewnent No. 3� yk_ if g' ) . SIGNATURE OF OWNER SIGNATURE OF CO -OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED [ WAIRRANTY DEED | ' VmL 63 9 PA E 6 8 STATE OF WISCONSIN—FORM I THIS SPACE RESERVED FOR RECORDING DATA -~ ` -~~~ '~-- U THIS INDENTURZ Made this ... . .. . ......... d f October A D. 19A., REC4STERS OFfICE . ' � r � EM .. .... Rec'd. for Record this � Witnessct6,T6ut the said � ^ part, for and in consideration in hand paid by the said part_A% ... of the second part, the receipt whereof is hereby confessed and acknowledged, - -_-- .... g iven , , gran _ barga so re mi s ed , - re a c onv ey ed an- co -- a by --- -~- remis re a `~~``/ and " confirm d _��. of the second part described real estate, situated i f ���� North, A parcel of land located in the NW1/4 of the SW1/4 of Section 33, Township ~ ' Joseph, being further described follows: Comnencing at the Southwest corner of Section 33; thence West along the South vuEl line of Section 32 a distance of 57.6l'; thence North 628.97'; thence North 87 East 120.15'; thence North 44'48' East 444.26'; thence 1*41' East --'-'-- ' thence County, — ^`�^^' � � ---_' -- _ ___- __-'_' -- __ � ! Ilience continuing North 10 East 305.31 thence East 760.13'; thence South 0 East 300.00'; thence West 818' to the point of beginning. � \ The above described l com��zzu� � 4JV oz ���z aoo]�oc oe ^ cm c � - '----_-, -- being - for -__ '__- � --- (IF NECESSARY. CONTINUE 000nu/rru.mnm n�v�"""�,"/ with all and o{ogu}ur in any vwi,c appertaining; and all the ,stuu; right, 68e, interest, claim or demand n,6utsorvrr, of the said p^,t-Jl....... of the first part, either in law or r9oity, either in po,,c,,iou or expectancy of, in and to the above 6xqyuioe6 premises and their herc6dmurooxod appurtenances. To Have and to Hold the said preonior, as above Gr,c,i6r6 with the 6c,e6itumocom and uppn/tcnuucco, unto the said part...-'-i gq of the second part, and tn. , -��.. --. heirs and uoi&u* FOREVER. And the said - A.-' ^-/�-g1PZ1.g'30Jg�Jl..--_.--_--_---------------.-----'- i � ...... .................................................................................. - .................................................................................... ................... ........ ' heirs, executors and u6/uioiotmLoo. 6u���'' covenant, grant, bargain, and agree to and with the said 9urtAes-' of the second ---'-' their .-- heirs and uooigoo, that at the time of the cuoeal�o�uoJ�6�rc��n��6c�cp��oco�o---'-----'�g�-�g'--- ... well oeiar6 of the prcunioca u6nvc described, as of u gan6 sure, perfect, absolute and indefeasible.. estate of iu6r6tuocc in the law, in fee simple, and that the xuooc are ! free and clear from all iocu/ubmoces,v6utevcr . ....... - ...... - ...... -............................................................................................. ! '----------''---'---'--'---------'-----'---'--'---'---------------'--'---------'-'------'-------' --'----------'-------'----'---------'---'-----'-'---'-----'-'-'-'—'-----'--'—''--'---'—' and that the above bargained premises in the quiet a� possession of the said o{ the second �� _�e�_' heirs and � i � u�io� �i��� �� person o� 9�amo l��Uv claiming �� ��o6 � �y �� | '"� ^ } thereof, She ................. will forever WARRANT AND DEFEND. In Witne Whereof, the said p^, ---'o{ the first part 6a .---'S. 6c,eoutn set -'---her-----' 6uo^L--' and � xo�---L6i�----'I�����-_- day u�------ October .-- Rl 7 SIGNED AND SEALED zm PRESENCE OF X------'- � ___ ------------ ---------- ----------------- -------------- ...................................... (SEAL) ! --------------- ------------ ............... ......... _________ ---------- _______------_(asAL) � / _________________________--.-__--'��4c) Minnesota / State nf IC Personally came before me, this � �{]� A. U l9' 8l ___' County. ) -'----- » '---'--' . .` -_` the above oumocY'_------.-----']��I��JIEZ�.��... -.��..G .}��P��----------_.------ _----_-----_--.---_-----__--------------_------'-.--_---.-.-.------'--.---------. to me kmnm to 6r the person .... who exe�utcJ the foregoi / THIS INSTRUMENT WAS nn^rrso BY AUCE mnr^»r Notary oiy\ Wis. | BEU ARQkND & FWM 4 �Dk Nov. is, 1g81 ----�----------'-------- ��yu`mmb ����» v'^«�����V������ Vnv �� °, 0 �� ' `------' - printed or typewritten �`"" | t names ° the who, of g overn - me a whic d such instr shall = stamped or written thereon in " .�.~~ m"""`,�` STATE OF . �mx� w " - P lank WARRANTY DEED FOR� m°^ » �N��m��� ���al'v"". NV m M 0 to W � • w 00 Z 0 7D cD ) "W 1320.07 N0°46' 15 "E 117 9.03' 6514d 3 373.42 707 58 v 1 rn rn ao o ci� w cn '� r► N — � o � � �� J' 4 ti a o � � m �� n0 N Q�f� N N —2730 `� m `.29' _ X - 380 3p531 _'�N1p�42E�_ cn I %x CD r — �q 7• co O n ° O rn O O a O I� m � u �° to cp 0 a NO 14 45 W cn p ° g °_ 591.52 w ° ° v Ln �_ � 1> v O m o O � � 1. m [► 'Q m (f) C j s J A c I-- N U) cwD A 1 0 r) n ` O \ O O O W om o o � o - N O ^? m 591.52 .00, 325 00' 268.28' 3526.00' w N� ` I PROPERTY SURVEY REV : DESC RIPTION sc� -� 3CON S I N 54016 DRAW .r = DATE a V H S4 . STC - 105 r r • y ,r y SEPTIC TANK MAINTLNANCE AG'REE'MENT H 0 St. Croix County :a OWNER /BUYER t�© (y A ( Q d li , k/8 L� ROUTE/BOX NUMBER �Zd `V 3 Fire Number CITY /STATE d�lll w4ll, In _ _ZIP PROPERTY LOCATION: �y� 4, � � ` -4, section 33 T 3c m, It_P? W, Town of jot e' e p_•-l!L_ , St. Croix County, Subdivision _ Lot number 4 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 sejLti tank Lum )+ L +_. What you put into the system can affect the function of the - Ivl)Li.0 tank as a treat- ment stage in the waste disposal system. St. Croix County residents m be eligible to receive a grant for. a max 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, will+ the requirement that owners of al n systems agree to keep their systems properly maintained. _ The pr.uperty owner agrees to submit to 5t. Cruix 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. o I /WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x H the-standards set forth, herein, as set by the Wisconsin Depart- rd went 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. e_'l SIGNED DATE �Q��IY� � St. CYloix C':)unty Zoning Office P.O. fox 98 Hammond, W1 54015 715 -7� :6 -2239 or 715 -425 -8363 Sign, date and return to above address. ° LA x m a yr _. v 4 4 CD acD 0sw ::3 o : 0 3 o ?�• � 3 a m m -.. i c m C) :3 Cl o o- �.c�u� o � CD w co m : a woCD �CDV,.< R 3o3a ono COD CD M o CD c ` o wo � > > = O w 0 0 ,� C- c 9 j N 3z c�crm�0 w w cn w - m : o 30 _ - (D - 00o -.•0 v 0 < to Q A � a O A (D U1 1 O D c (D wow °oID O -, 0 d 0 w SUm oNC 'Cve Z N `1m a, - ,�D�ca C D CD cD - ► s cD o CL Ch 3`�D > D CD * c m o ?� �' m c m ..w ?cwo "C a -« s - �w ac cD C 171 bum 3c� va� 3? w CD CA cD ..aCa w 3 c o c N vi p cwC.Coa0� IT1 :-- CL Q. W ao C L ° 5vi c � N - - < �cD 3 M . a c DC O o N 7 n cD o 0 aoa o�° c� ��(DD O,nSi CD CL 3 0 fD =00 m 0 a3 a� = o v3 CL o < � CD t�lr N Co a c .. F i TMENT O F REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS vUSTRY, DIVISION B OR AW PERCOLATION TESTS ( 115 1 P.O. BOX 7969 HUMAN RELATIONS 1 / MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: fP1W.U" "Nr.. OT L O.:BLK. NO.: SUBDIVISION NAME: 5 U , 33 /T:I /R 14 � ( or) W I TOWNSHIP/M _ k COUNTY:: v O EERR''S BUYER'S NAME: MAILING f AI DDRES�S: T 1 �. V1 Q /► is 2 v 1 '3 ,,.•��qq// , USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFI DESCRIPTIONS: I PER Qt TION T ESTS: Residenc 5 e �j CY VNew ❑Replace Ll v-(4 RATING: S= Site suitable for system U= Site u nsuitable for system CON NTIONAL: MOUND: IN- GROUND - PRESSURE: S STEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑U S ❑U S ❑U ❑ S ❑ S -}-) onaA l If Percolation Tests are NOT required DESIGN R; ' 3 45 If any portion of the tested area is in the /�� under s.H63.09(5)(b), indicate: J� Floodplain, indicate Floodplain elevation: ►" PROFILE DESCRIPTIONS BORING TOTAL PTH TO GROU NDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HI HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ofl;m s d- r B- - 7- `� � d a 2 �. "� ��' `� g is 1, 1 • l �5� s 1 , '-fa 16r) .S y . 1 7'64 Gs f r �h C r & � ' IOI. �, � • ' 1.Oa 1 , � � ?.q rci. 3q B- 6 '7, 0' q,. y 0 > �. 1 33 ' 8! s�, , 7S' Bn s /, /• ;Zr" 617 /, . s B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 7 P RIOD 2 PE RIOD PER INCH P- I %" nA 9 //(0 15133 P- j�" J ;a. � yj to q6 P- I y1b�.� P P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale.or dist c scribe wh r �e hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all bo nd thgoirep"n and percent of land slope., SYSTEM EL t✓ F. _ 3 t X63 3 A 1 y ea_ _ p _•_. I tN 1 , / !I____.' I �� 7 �L°&A S 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 WVJO E PLE 0 ON: ADDRESS: C TIFICA 10 N ER: PHONE NUMBER (optional): `3 60 3 n w) 3N (5 - - CST I R �� L ,UTION: Original and one copy to Local Authority, Property Owner and Soil Tester. mossolk 'BD (R. 02/82) — OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3, MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6, PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan.; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be cased if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 0. Complete all appropriate boxes as to dates, names, addresses, flood }Main data, percolation test exemp- tion, if appropriate; 10 If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12, Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OPGOMPLETION. i ABBREVIATIONS FOR CERTIFIED SOIL TESTERS y Soil Separates and Textures Other Symbols st Stone (over 10 ") BR - Bedrock cob - Cobble (3 - 10 ") SS Sandstone gr - Gravel (under 3 ") LS Limestone *s - Sand HGW - High Groundwater cs - Coarse Sand - Nrc Percolation Rate med s - Medium Sand W - Well fs - Fine Sand Bldg - Building Is - Loamy Sand > - Greater Than 'sl - Sandy Loarn < Less Than *1 - Loarn Bn - Brown * sil - Silt Loam BI -- Black si Silt Gy -- Gray * cl - Clay Loarn Y -- Yellow scl- Sandy Clay Loam R -- Red sicl - Silty Clay Loam mot- Mottles sc - Sandy Clay wl - with sic - Silty Clay fff - few, fine faint Y + c -- Clay cc; - common, coarse pt - Peat r ar -- Many, rnediurt, m - Muck d - ,distinct p -- prominent HWL - High water level, Six general soil textures surface viiater for liquid waste disposal BM Bench Mark VRP -- Vertical Reference Point I TO THE OWNER: This soil test report is the first strap in securing a sanitary perrnit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be subrrfitted to the appropriate local authority in order to obtain a perglit. The sanitary permit mast be obtained and posmi pi for to the start of any construction. J P .L .,. 6 7 PL OT A N (1 ) 0SS FC T I 0{ l_ PROJECT A M E j N A M E 1clb_ a s - k P L 0 _�_ �d A_ T 13 ^ : ,;Pt , F, 01, YS v 0�1�0 ® , Pry'F: 17 L � j 1 4 J AY+ 1 i% e, 8 " FRESH AIR :1-NLETS AND OBSERVATION PIPE CI,OSS SEC Approved Vent Cap Minimum 12" Above ' Final 4 Cast Iron Above Pipe Vent Pipe To Final Gradt- ^ Marsh Hay Or Synthetic Covering Min. 2" Aggreg�l I c Over Pipe �� Distributi�> ly„ - i �— -- Tee Pipe .... Aggregate `� Perforated Pipe Below 9 ta Beneath Pipe 4 Coupling Terminating At (� },r• { (, . �� . Bottom of System