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HomeMy WebLinkAbout030-1053-80-000 0 g T § 7 � _■ m z \ o m 0 2 = @ ƒ E o t r- W c, £ a - m \ ( a « 0 % 2@_± E w E- o m § 2/ i§ i J i e e 8 8 ; r %; CD & co Ln O § f § % \ En gn o k m ID / / ƒ 7 E O -a $ k # § ) § C) CD j 7 $ { @ $ 0 r ca a $ S £ ®° K � � rr cr � �; "a T 'D a : ■ �. 0 0 0 =. £ 7 2 k \ 0 § . ■ . \ m \ or % ®)\ cr ] m E - OC co 2 r § \ k / k 0 o R E - 0 g E$ 0 \ \ k { } / $ § j • Eo ?§ CL % CL OIQ /(§ 2 � ƒ S / 0 k U) (a [ { z E . $ j R R / E § 0 � / \ b ° CL 0 } M § c } ` ; _ ° $E± m \ \ ƒE& §a / \) \ k / \/� Z CL °Em z \ -! ° 7 K$ it CD » co =r c E j a e mm ; � \ g& ) 0 IE a 0 � ; \ A \ 2 / ) o � .. u * Page 1 of 1 Pam Quinn From: Alex Blackburn Sent: Tuesday, February 08, 2011 11:47 AM To: Kevin Grabau; Pam Quinn; Daniel Sitz; Ryan Yarrington Subject: Another wedding operation To everyone, I thought I would let everyone know that I talked with Colleen Gray. She lives in section 23 in the Town of St. Joseph. It's an unusual property that has lake frontage and then some more land across the road to the east. Colleen wants to have "about six weddings per year, nothing big." I talked with her for an hour and explained the whole situation and how we can't permit it as a home business. It turns out she is friends with the Kovaleski's (the people in Richmond that wanted to do the same thing) I encouraged her to talk with her county board representative, Linda Luckey, and maybe Linda could influence the CDC to amend the ordinance so we can have a "small event gathering permit" It's a long shot, but maybe it's time. Alex Blackburn 2/17/2011 0 0 3�� d � c of o ° • eD CD c�D m — \ 1 rr r: 3 D) co O �I OD N N N O W W f' O N m O !G O O f L W 0 * ` Z FL N Ui m a a� N y CD y m y v l v W m m O CD n fD (DD m O O O n O q 0 O N fyl! O O 7 N O C D O U) D a' 2 D O 0 CD to m to m W a G O to G _ O N W A_ O IW 0 O O O 0 0. 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CROIX COUNTY ZONING DEPARTMENT,- -- • AS BUILT NARY REPORT 9 Owner Y E Property Address City /State ,A ,f zy &ECA Gli ,a Legal Description: ti�ti ti g P Lot Block Subdivislon/CSM # r aj '/4 �e'/4, Sec. ;, TvN -R Town of S �' �s`o� PJ4 -� / 3 - SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: 1 1060 ?1-e Tank manufacturer oo W ize ST/PC / Setback from: House X11 P Pum manufacturer Model Alarm location I (HOLDING T O Y) Setbacks: S ' e r Vent to fresh air intake Water Line Meter locat' n Alarm loc o SOIL ABSORPTION SYSTEM Type of system: Width -3 Length g �t of Trenches Setback from: House „ _ Well L_ P/L 5 Vent to frJsff intake , 7 100� fD23 ELEVATIONS �,o = 0&1 Description of benchmark / .���^"�� �� � Elevation � 3� Description of alternate benchmark Elevation Ie a u s�' 1 /0 . 39 Building Sewer ST/HT Inlet '9 F b ST Outlet 9S 2 2 -PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover - 93_ ;4 Distribution Lines ` / � J Bottom of System ( d 2 9 O 9 , • 27 Final Grade 3 Y # V38 Date of installation / ermit number State plan number Plumber's signature 16 � A License number D 32) 5 Date 7 / ! Inspector )KWt t7 ( rab o u Complete plot plan NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW LV Al Sd w5 IE7- -L— 7"57 tb .�- � � ��- day• N r v INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -: IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 344538 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: GRAY, COLLEEN ST. JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: t / 030- 1053 -80 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic k �+s +VV Benchmark a.3 L 1 /02.3 co Dosing • g �,vt a.33 9®!. 9 Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION S / Outlet _ to •�o `l S SZ TANK TO P/ L WELL BLDG. Air R Iii. Inlet 6 - `�2. � p Septic,. )86' - 4/ ' a l •S, NA (�` ;./e 9S. Z, Z_ / VE 12 I 4C,2 NA Header / Man. t • 7, " 93.`2 $• 9 3. s` Aeration NA Dist. Pipe a #, }i. S 1. } Holding ot. System z JO.. 9 i :7- g y .a %x.e PUMP/ SIPHON INFORMATION Final Grade �� �' 9s SZ, Manufacturer Demand ( I g.LS 11-6 o 7- Model Number GPM _ -+o le,., fr. 3 9 3. 99 TDH Lift L oss Ion ea em TDH Ft - �--� �" 4a(. a� �~t�' g ' 1 9 3• / Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM ,, � ? f•%—L- ;z %.."4$ / RENC width Length No. O renches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN 3 3 DIMEN I N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufa u rea SETBACK --- Z✓+•�' - S', o2ac.ze •t INFORMATION Type O C ,� �� g8 7 3" OR UNIT R Mod N = D er. System: DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) r x Hole Size x Hole Spacing Vent To Air Intake Lengt ';L Dia. Len th Dia. Spacing 10 7 �e0 SOIL x ressure Systems Only xx Mound Or At -Grade Systems Only Depth Over !1 Depth Over xx Depth Of xx Seeded I Sodded xx Mulched Bed/ Trench Cente K O'�" A . Bed /Trench Edges Topsoil E] Yes E] No []Yes ❑ No COMMENTS. (Include code discrepancies, persons present, etc.) ,� LOCATION: ST. JOSEPH 23.30.19.197W,SW,SE 1416 RIDGE RUN S� c ✓� +' 3 6 ) " 1 a' 2 Plan revision required? ❑ Yes No Use other side for additional Information. 2. ( SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: a i , , . a a ...j E r ` t F i f d t 3 „.. r,,., ..� , ..... ..,. t E F , � r S a . �.,.. a. ,�.. e p y, a = 3 . ; a F s m. r e 1� I t A , E M. n E f � ` r ...... . �.,.,. . y._,.. z— ....... ... . .._.. _ _... .,.. ., k— . ,.. .. ...... ,�, ... .,_,.. ....— ., _. , a { , v 3 € t f i f € f ,an , s ® a � t , am a f tt � I _ a 0 e f f J € t m E e � x 3 t { k ; Safety and Buildings Division v ■■..r■r. SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. 51 . • See reverse side for instructions for completing this application State Sanitary Per 544��3 The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location 4 Q5A1 /� � 010 (0 1/45 1/4, S 2 3 T 30 , N, R E (o QW 4 Property Owner's Mailing ddtes Gov i Lot Number? O f / Block Number �.� Cit tate j qtZip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUIL ING: (check one) ❑ State Owned ❑ cit Ne re st Road Q J, Public 1 or 2 Family Dwellin - No. of bedrooms v ows of �(25 //( j lJ eC ry III BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 6 ,70 -to 5- 3 — —0O® O. 14 W 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2 ggo eplacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an _____System ________ System___________ __Tank Only______________ Existing System ________ Exi sting -- -- - yytem B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 [:]Holding Tank 12 o eepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 1 43 ❑ Vault Privy 14 ❑ System -In -Fill 3 s VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp- Area 4. Loading Rate 5. Perc. Rate 6. SystenElev. 7. Final Grade Required (sq_ ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) 93� El �t�o� 2QQ .A00 i -5 4 Feet V ! t VII. TANK in allo 5 Total # of r Prefab. Site Fiber- Q Exper. INFORMATION g Gallons Tanks Manufacturers Name oncrete Con- Steel glass Plastic App New Existing Ns `� strutted Tanks Tanks 1 04 tic Tank (din Tank lOQO l a ©� �V id-C/W l Llft Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Pri t) ' Plumb is Signature: (No St mps) MP / MPRSW N o.. Business Ph��Numb 7 is - g� Plumber's A dress (St eet, City, State, Zip C e): IX. COUNTY / D15PAR TMENT USE ONLY ❑ Disapproved y �y y nitary Permit Fee (includes Groundwater Lat sU� Issuing Agent Si ur No to s) A roved - �SUrcharge tee) pp ❑ Owner Given Initial t} x ' j Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divi ion, Owner, Plumber INSTRUCTIONS - _ I i 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III_ Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair- V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber isto fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks, distribution boxes, soil absorption systems; replacement system areas, and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls, dose volume; - elevation differences, friction loss, pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. i 4 . A "I ^ `r + ` 1 Y Se- l r . S � 9 x ,�. � l l o c �! sn ti Q 13 g7 Iq , 1 ( P AO d P. 3 u S � SCALD 1" = 26 BM 1 'ro p o A n S G D p Q T f f1 D f "' i, G J e ^� ""�-• t., sivc 2 TO p �� n G ti, h o I c e r ; kr r T � Wisconsin t)epartmentof SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Environ mental By Design Attach complete site plan on paper not less than b' /z x 1 i inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I D # APPLICANT INFORMATION - Pleas ' formation. Personal information you provide may be used for �(QrivaCy Law, s. 15.04 (1) tml). Reviewed By Date - - 1 Property Owner T Property Location Gray Colleen Govt. Lot 1 1/4 1/4 S 23 T 30 N,R 19 W Properly Owners Mailing Address Lot # I Block # Subd. Name or CSM# 1416 Ridge Run - - - City 40 Zip Cod one 4.. ❑ City ❑ Village ®Town Nearest Road New Richmond 40 1 ��Olx St ,Joseph I, Ridge Run ❑ New Construction Use. siden tie rooms 4 ❑Addition to existing building 7 ❑ Replacement u I Rd =comirriended ibe Code Derived daily flow 600 I design loading rah 4 bed, gpd/ftz 5 trench, gpd/fP Absorption area required 1500 bed, ff 1200 trench, fts Maximum design loading rate .4 bed, gpolfe .5 tr ench, gpd/fts Recommended infiltration surface elevation(s) 93.50'93.50'& 89.50' ft (as referred to site plan benchmar Additional design / site consideration Recommend lnfrltrator Tubes to obtain deeper system for lowest trench Parent material LOESS OVER OUTWASH SAND Flood plain elevation, if applicable Na ft S= Suitable for system I Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ®S ❑ U ® S❑ U N S❑ U ❑ S M U EIS Z U ❑ S® U SOIL D ESCRIPTION REPORT Depth Dominant Color f Mottles Structure GPD/fF Boring# Horizon in. Munsell I Qu. Sz. Cont Color Texture Gr. Sz. Sh. �nsisnc Boundary Roots Bed Trend 1 0 -4 l Oyr4 /3 - sil 2msbk mfr cw 2f .5 .6 2 445 1Oyr4/4 - sil 2msbk mfr cw if .5 i .6 Ground 3 45 -50 7. Syr4 /6 - s Osg ml cw - .7 .8 elev 97.50' ft 4 50 -57 7.5yr3/4 vfs Om mfi cw - .4 .5 Depth to 5 57 -68 7.5yr4/6 - s Osg ml cw - 7 ! 8 limiting 6 68 -69 1 4/6 - Ifs 2fsbk mvfr cw - .5 .6 factor ' 7 69-1061 7.5yr4/6 - s Osg n1 - - .7 ! .8 Rerl>aft 1 0 10yr4 /3 - i fs 2fsbk mvfr cw Zf 5 6 2 6 -35 10yr4/4 - Ifs 2fsbk mvfr cw if .5 .6 Ground 3 35 -43 7.5yr4/4 - lfs 2fsbk mvfr cw - .5 .6 elev 97.19 ft 4 43 -49 5yr4/6 - s Osg ml cw - .7 .8 Doh to 5 49-69 1 Oyr4 /6 - lfs 2fsbk mvfr cw - .5 .6 limiting factor 6 69 -85 7.Syr4J6 ��' - s Osg ml cw - .7 .8 85" 7 85 -90 7.5yr4/4 saturated Ifs 2fsbk mvfr - - 5 .6 Remarks: Saturated sands are restrictin g depth CST Name (Please Print) Signatu �_ p Telephone No. Thomas C. Nelson ✓�''� 715- 246 -2454 Address Environmental BY Design Data CST Number Ref # 1432 120th Street, New Richmond, W1 54017 6/3/99 227387 237 PROPERTY OWNER: r_g_y. ccnym SOIL DESCRIPTION REPORT zip Rage 2 of 3 PARCEL I.D.# Environmental By Design Horizon Depth Dominant Color Mottles Texture Structure onsistence Boundary foots GPM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 3 1 0 -5 10yr3 /2 - sl 2msbk mvfr cw 2f .5 .6 2 5 -18 10yr5 /4 - is 2fsbk mvfr ew if .7 .8 Ground elev 3 1843 7.5yr4/6 - s Osg ml cw - .7 .8 95.06 ft 4 43-62 7.5yr4/6 - s* Osg ml cw - .5 .6 Depth to 5 62 -104 7.5yr4/6 - s Osg ml - - .7 .8 limiting factor x >104 Remarks: * la of Ifs 7.5vr3 4.......install below lavered sands Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: IV 1.432 120 "' STREET, NEW RIC�IMOND, WISCONSIN 715 -246 -2454 IR)IAA [I �7 $ Tom Nelson ('ertiied Soil Tester- 227387 - -- Registered Sanitarian 514,00713 V i r 1 �� ,} 1 1 1 " b o SCALE 1" t Tom N -1son BM 1. _T6 j D _ ✓� BM 2 - Wismnsm Department of C.e mmem SOIL AND SITE EVALUATION Page 1 of 3 Divisionbf Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Enviroiuneutal By Design Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), diction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel ! D # APPLICANT INFORMATION - Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). Property Owner Property Location Gray, Colleen Govt Lot 2 1/4 1/4 S 23 T 30 N,R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1416 Ridge Run - - - City State Zip Code PhoneNumber ❑ City E] Village ®Town Nearest Road New Richmond W1 54017 St,Jgseph I Ridgc Run Z New Construction Use; �_ Residential / Number of bedrooms 4 ❑Addition to existing building U Replacement LJ Public or commercial describe Code Derived daily flow 600 gpd Recommended design loading rate 4 bed gpd/ft� 5 trench, gpdffF Absorption area required 1500 bed, fF 1200 trench, ft Maximum design loading rate •4 bed, gpolftz .5 tr ench, gpdff Recommended infiltration surface elevation(s) 93.50'93.50'& 89.50 ft (as referred to site plan benchmar Additional design / site considerations Recommend Infiltrator Tubes to obtain deeper system for lowest trench Parent material LOESS OVER OUTWASH SAND Flood plain elevation, if applicable Na tt S= Suitable for system Conventional Mound In Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuftable for system ®S ❑ U ® S ❑ U ® S ❑ U ❑ S ® U ❑ S ®U ❑ 3 ® U SOIL DESCRIPTION REPORT GPDIf� Borin Horizon Texture Consistency Boundary Roots 9# Depth Dominant Color Mottles Structure in. Munsell Qu. Sz. Cont Color Gr, Sz. Sh. Bed Trend 1 0 -4 1Oyr4/3 - sil 2msbk mfr cw 2f .5 .6 2 4 -45 10yr4 /4 - A 2msbk mfr cw if S i 6 Ground 3 45 -50 7.5yr4/6 - s Osg ml cw - .7 .8 elev 97.50'ft 4 50 -57 7.5yr3/4 = zfs Om mfi cw - .4 .5 Depth to 5 57 -68 7.5yr4/6 - s Osg ml cw - 7 ! 8 limiting 6 68 -69 1Oyr4 /6 - Ifs 2fsbk mvfr cw - .5 .6 factor >106 7 69 -106 7.5yr4/6 - s Osg ml - - .7 .8 Remarks= 1 0 -6 20}74/3 - Ifs 2fsbk mvfr cev 2f S 6 2 6 -35 10yr4 /4 - Ifs 2fsbk �mvfr cw If .5 i .6 Ground 3 35 -43 7.5yr4/4 - ifs 2fsbk mvfr cw - 5 6 elev 97.19 ft 4 43 -49 5yr4 /6 - s Osg ml cw - 7 i 8 Depth to 5 49 I Oyr4 /6 - !fs 2fsbk mzf'r cw - 5 6 limiting _ factor 6 69 -85 7.5yr4/6 - s Osg ml cw .7 .8 85" 7 85 -90 7.Syr4/4 saturated Ifs 2fsbk mvfr - - .5 .6 Remarks: Saturated sands are restrictiAg depth CST Name (Please Print) Signature: Telephone No. Tho C Nelson 715- 246 -2454 Address Environmental By Design Date CST Number Ref # 1432 120th Street, New Richmond, WI 54017 6/3/99 227387 237 1 L �Y 0[514M 1432 1 20' x ' STREFT. WM RICHMOND, WISCONSIN 715-246-2454 Tom Nelson Cmificd S6i Tester 227387 - -- Registered Sanitarian SFk)0'71,3 fro 4 n c� C 3 ( �01� �, rG -y SCAT I" I' Tom Nelso BM I c- t)p Q ) i BM ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owne r/Buyer Mailing Address Property Address _ -2 (Wrificatioa required from Planning Deparhncat for new coashuctioa) _ C i ty/State / i9 ` c k n� Parcel Ideatification Number ( :9 -3 3 -St ' LEGAL DESCRZPTXON Property Location -15 UJ V4. S V(, Sec, N Town of $t1bdIvLA0II 0 Lot # Certified SmTey Map # *d CS Volume . Page # Warranty Deed Page # g Spec Jv0use ❑ yes L'i'mo Lot lines ideatifiable Y [� es C1. no . SYSZE1Vi•�'IAINT�IANCE - Im opcttrsemd Ofy Ws;pWSyS kmfts " tohandlewastes.pt%= e Consists of pamrping oat the ft* evmy d= y= or soon; if acodcd by a Ucensedpampm What you put.into the system can =ffxttba of tb�e sc�c taa�•as -a tncatmeat:bg�e is t5e �aasted"isposai �ysbc�. . - - - - T Y owner agrtcs to Submit,to St. Crone Zug Department iL as f omr, signed by &c ow= and by a lgcr p hmbc ; j om= ymanphmix;rcs 6 ctcdphmLbworalk=sodpmmpaveffykgtLd(l)& coa -dt owa d ma tcr&qx=iqstc& u m P� �� won and/or (2) after iaspoctioa and pamping.(�f aeassary), the septic- tankis less �aa I!3 •tr11 of siudge. . >�. the tmd�crsigaod baverad the above nerd sgcoe to maiat:ia �e private sewage disposal system vvi�r 6ae staadaids � fod �. set by the of +oe and the DVactm cat of * Nat ud Res mc!;-. Stmtc of w - =onsio t ewficaa6a that Yom 6 cPfic syst= has borer maintained attsst be comp1dodandrdmmed to the St: Cmix.Couaty Zoaiag - Office vAd& 30 days-of the thnce yrar expi atioa date. 4 M - T & UR : E ± 0 - F APPLICANT / l DAT OWNER• CT ON I (we) cm* drat all st=ems on this fornr am tore to the best of my (our) knowledge. I (we) am (are) the owner(s) of the Pmpcdy decd above. by virtue of flood recorded is Register of Deeds Office. SIGNATURE OF APPLICANT 1.0 / DATE ss44 44 Any information that is tak4eprescutodmay M& in tho sanitary permit being rcvokod by the Zoning Department. ac`s•.. as Indccde Wlih this application: a ttampod warranty dood from the Register of Dads office a Copy of the certified survey map if rcfer+enoc is made in the warranty dood ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK I This is to certify that I have inspected the septic tank presently serving the w residence located at: E ;, Section ;2 3_ , T 30.. R �'2(D Town of Upon inspection, I certify that I have found the t nk and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: (7 � — • �® 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_ Steel Other Manufacturer: (If known) : k j l) MOO � a Age of Tank (If own): �f (Signa (Name) Please print (Title) (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 ' & / Y'-y ��� & ignature P /MPRS �3Z� r .� _ "02 00 "V Tt-- * ` M 3fws.♦ et[s [!"V$D fO.t M_'toRD!!d0 DATA lam). y ! S'> AT BAR (?F WISC�!? SIt F()31 M I I IM i AND WRA ♦_ �s TO 32 UXX0 MR ALL TRANSACTIONS WHERM OVER ffi 6" Is TIN.�Yt'(ySy AND IN t�'rX?Lit I19* . Y)N8SI3� R ACT TR.&. LOTIONS) - tae _ RE416 « 'S DEED O. 06q zt-. Ok oar _ _ St nl� C a r a sir Ie Rs� ' and � IT , 1lll .�. ......._ ._ ..... ........................ ..•............... ....._............ ("Vendor'". i � . . .... ... ..... .. .. {:oI t ... ... ' JUL _.� k ? .. of 1 AM � ....................... ( «Pnrc'+o+er", whether ono or more) All t V k&&r w1a a:+d agross to onvey to Purchaser, u", on the prompt and full pe_ - f t # esiance of this toatreet by Purchaser, the following property, together with the P*W o } /e tatty p ti'y it Q other appurtenant interasts (all called the -- ----- ---- - --- -- ----- — --------------------------------------- ConAty, state of Wisconsin- 11[TU11F. TD t I See Attached Legal Description Tax Parcel No.... .. .....................__.. i s t � 1 t.. This ---- iS- M ---- - -- -- - . homestead property. .'is) (is not) Purchaser q agrees� to purchase the Property ant to pay to Verdor at - -- P_ lace CS1g,TIdC2C_! 111 •. - _ tae sum 01 __._. 6a1C111_eQQ ............... ..................... in the follpwhlg m$pner: (a) ; 2, .Q4i ......... ... ........ j(j t1UU OO at tiro execution of this Contract; and (b) the balance of f z_ __- _.'__ -•. , together w a interest from date here7f on the balance outstandin f n ti a ti a at a rate of ---------- O. per ent pe annum sAtit paid in fall as follows: �� pr t' pa � and interest to be paid in morlth..y 1nsta�!lrents (+ of $1,'300.00, or more, cmmlencing the 1st day of t , 1988. Int --,,rest shall calmence the 24th day of June ; 1988. T.nterll be computed monthly on each month - unpaid pRnc`Tpa - balance and first deducted from ach monthly payment with the balance remaining credited to principal. Foliowing any default in payment, interest shal rue at the rate of ._ _ _. % per annum on the entire amount Ar default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire Principal balance). Purchaser, unless ercueed by Vendor, agrees to pay monthly to Vend•.)r amounts sufficient to pay reasonably antici- p;.'ad an .ual taxes,!-P'-;AA assessments, fire and required insurance premiums when due. To the extent received by Vendor, Ven:ior agrees to apply payments to these obligations when due. Such amounts receited by the Vendor for payri -.exit of taxes asamments and insurance will be depositosl into an escrow fund or trustee account, bait shat! not bear in °ere -t other-:Ise required b* law. Payment shall be applied first to interest on the unpaid balance at the rate specified and then to pr ncipal. Any ass -junt may be prepaid without premium or fee upon principal at any time Sisi{X 1� In the event of any prepayment, this contract shzll not be treated as in default with respect to payment so lo- as 0 4e unpaid. balance of principal, and interest (and in such case accruing I), erect from month to month shall be treecer as unpaid principal) is less than the amount that said indebtedness would have beer. had the zonthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except; i ' Purc:,as— s ea ±o pay the cost of frture title evidene• If title evidence it ;-, the form of an abstract, it be -rte ,gd by Vendor a -tit the t.:ii t -F a =� I: tc� is - si:'.. dates`, of thi.; ('OYItraCt -- P•archater shall be entitle to take cssessien of the Property on .............. 19 .._.- -Cram. Ou. One. MCIe9b.r�pgr STA RAR or No. 1[wIs9 YN4iN _.. 5t..)ck No. 13011 ,a 15 sinkois t• pair when t a»� tames sad aroatrs2maris lay; on the Pr9y4rty or upon VaWi°'a lntft V k and f1s d+�iiv r t. Vsrsdmr oa desir , 51y4a 0A, --iF4 such payo wnt, frsreh" - Qe aball ka" the lava mss= , :ta eg USIs ]E'TORMy insured AaC41nat loan or d• a by fira, 4111- tended oo rago perl�► azt euoia et a► Vey a.ay re iuiae. wiLlswuR so iraxttrZaAe,�gb insiarers spprioved hy Vendor, 1s the seise of ; Vacant ----...., bui Vendor shell nos s ro L *Y"Ap Ia nv% amount snore ihsa the bake owed m* i;hau 4&w The policias shall contain the standard elaaate is favor of than V s i�a and. unless Vendor rtherw &grow In writf ug, the original of all pollcia covering the Prof -only s#? ill b.c de wills Yrn3or. Purclsmaer shall prumptly give - 0;10 of loss to insurance companiar r'.ti , inssrsa" pme•ees shall be applied to restor aura or repair of the Pr riy� 3d, prnvldad !'r.s Vendor dev ns :its reatoratioA or repair to be econ f satl+ie. f arehaser covenants not to commit w .a aw allow waste to be eornruitted on the Property, to keep the Property In good bnantsbk .,ondition and rvrpalr, to keep the Property free from liens superior to the lien of this Contract, end to cc:ter:y with all laws, ordluantw LaJ rog— alatfora &Vftitins the Property. Vardor agrees that in Cass %1141 PUTChadl pries. wit:. Int0i'"t and other mono,'s 611411 be . "n1ly paw and an co -rditiona +ball be fully performed at the tiraec and In the sex above spocifled. Vendor will on dom lad, execute usd deliver to the Pureh:c*er. a Warranty I),W, In fee simple, of On Property, free and clear of all fleas and encumbrw oss, excey any liens " encunibrancss ereatee3 by the act or dtafanit of Purchaser, and except : ................ ............................... ................................... ................................. ___.......... ........... .................................................................... ...................................... ............................. .• •- -- ° --• •.............. ............................... ..................................................... ............................... ................................. _-- ........... ... ............ -_.........................._.... ............._................. Purchaser agrecaa that time Is of the essence sad (a) in the event of a default in :lie payment of any principal or interest which continu-m for a period of .. .._ days following the apf-cified due date or (b- in the event :.f a default in performance of any other obligation of Purchaser which continues for a period of .W..-- days following ritten notice thereon by Vendor (delivered personally or .nailed by certified mail), then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by Iaw) in addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict fo,aclosure with any equity of redemption to be conditioned upon Purchaser's f-dl payinent of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amountadue hereunder (m v.hich event all amounts previously said by Purchaser shall be forfeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interesi thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet -title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possersion of the Property and have a receiver appointed to collect any rents, issues or pr -)fits during the pendency of any action under (i), (ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any t the foregoing remedies shall only be binding upon Vendor if and when purse -d in litigation send all costs and expenses including reasonable attorneys fees of Vendor incurred to enforceany remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall be included in any judgawnt. Upon the commencement or during the pendeaclI of any action of forecic:rure of this Contract, Purchaser consents to the appointment of s receiver of the Property, i=Uiag homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the co.rt shun 'lirect. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long -term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract soley as security for an indebtedness of Purchaser. In the event of any such transfer, isle or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become i nmediatelydue and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding egxinst the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legsl representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights he the subject Property and agrees to join rn the executior of the deed to be made in fulfillment hereof.) Datedthis _ ... .. -- ---- - -- --- -- - - -- day of ...... _._._.._ -- .__- ... ... ..._.- .. .............. 19-- -- - - -- _ (SEAL) -- -------- ---- ----(SEAL) `�Z�a rk Stanley rber bEarP. Gray __ ... ................ - - - - -- -- - - - -- ......... ......... . (SEAL) �. :.'�C�,- .. (SEAL) s� Colleen M. Sullivan --Cray AUTHENTICATION ACSNOWLNOG)MRN7'i Signature(s) ._....... • -- -•- - -----•-- ---• -- - •- ---- ----------- - -- --- STATE OF ,mil to or4 ss. ..----• ....................•----•--•-----------••......--......---------- - 1!?��y!-- -••---- •---._..County. authenticated thin __. -... -day of .................._______. 29_ -____ ersonally came before me the "�i{!...day of --- --- -- --- ----- ------ - --- 19 . the above named • . .. .............•------------------ --•------ ---------------------- --- - --- -- _Mar-- __Sts_._- ey_....... _ -A._S ngle.persozl_and • Earl P. Gray and M. Su -Gray - - - - - -- TITLE: MEMBER STATE BAR OF WISCONSIN as Joint Tenants and riot as Tenants in -•---------•- •---- •-- •--•- • ... .............. •--•-•........_....._............-- (If not- --------- ----- ---- --- --- -- ---- --- - -- - --- - --- --- -- - --- - CO[Tiildn authorized by d 706.06, Wis. Stats.) to me known to be the person .: ..._.._ who executed the foregoing instrument and ackt- •T�wledge the same. THIS INSTRUMENT WAS DRAFTED Ev Q-1RISTENSEN &- G RISTENSi P.A. - - - -._ .... ......................... _. . J Robert I. Christr*nsen, 386 :+1. Wabastaa, l � «..... �CT fit' 1- 3E;..3f:: T : � �. -�- �_•> G�Z .. Notary Pui;;ic ly.'f�le.tfLt ' ` .P wr . Al ,M ?IE (Signatures may be authenticated or acknowlniged. Roth My Commission is pe-:r j� are not necegs,ry.) /�f /6t •o of Der. ns signing in e, any capaty should be tap ur printed date: hmes he!nvr their ±,gn .t fns. - — 'isei' MY tOlte M +vo ^. e>.� r s d -1 -qt ( I �Y'rs'n**.�.. 4Y`..+c t S °°`°R..vH , -, �.xa+.... —^^•° +-s t z';. ,..,e 'c47s� Z*; �F' R� A parcel of Lard located in the SE of Section 23- 3D-19, further as follows: $° From the iron pipe stake at the Ek corner of said Section 23 Io feet, thence West 1981.4 feet, thrice Forth 21 degrees 05 mim ten ldl4 feet theme North 33 degrees 00 minutes East 120.0 feet to M 51 M stake at the POINT OF IN Niw for the, MrCel to be comwlied he,-In; tlwrttce North 68 degrees 50 minutes West h6.1 feet to an iron P40 49141 un the share of Baas Lske, thence North 32 deWmes 12 minims East along` the sh►r:e of said lake a distance of 60.0 feet to an iron Pipe stska, thence South 69 degrees 53 minutes Fast 2 feet to ar, iracz pe ads E theme South 34 de .s 02 sd.nutes West 64.5 feet to place of O=A �g. ' Together with an sa -drw'� £oi an access road from the aloe to the to,n road on the S margin of said Section 23. A parcel of land located in the SE's of Section 23- 30-19, further described as follows: From the iron pipe stake at the Fast quarter corner of said Section 23 ggoo South 1700.0 feet, thence West 1981.4 feet, thence North 21 degrees OS minutes East a distance of 66.0 feet, thence North 33 degrees 0000 mirnt" East 120.0 feet, therti::e North 34 degrees 02 minutes East 64.5 feet to an iron pipe stake at the POINT OF BEGIiUM for the parcel to be cori4"8d herein.; thence North 69 degrees 53 minces West 213.0 feet to an iron p* stake on the shore of Bass Lake, thence North 32 desrees 12 minces East 60.0 feet al the shore of said lake to an iron pipe staLes thence South 70 deg--r-es 56 minutes East 215.9 feet to an iron pipe stake, thence South 34 degrees 02 minutes West 64.5 feet to point of beginning. Together with an easement for an access road from the above described parcel to the town road on the S margin of said Section 23. A parcel of land located in the SEk of Section 23- 30-19, further described as follows: From the iron pipe stake at the Fast quarter corner of said Section 23 ggP South 1700.0 feet, thence West 1981.4 feet, thence North 21 degrees 05 minutes East 66.0 feet, thence North 33 degrees 00 minutes Fast 120.0 feet, thence North 34 degrees 02 minutes East 129.0 feet to an iron pipe stake at ttts POINT OF BEGINNING, for the parcel to be commyed herein; thence North 70 degrees % minutes West 215.9 feet to an iron pipe stake on the shore of Bass Lake, thence North 32 degrees 12 minutes Fast 60.0 feet along the shore of said lake to an iron pipe stake, thence South 68 degrees 53 minutes East 216.0 feet to an iron pipe stake, thence South 34 degrees 02 minutes West 52.5 feet to point of beginning. Together with an easement for an access road from the above described paxvel to the totes: road on the South margin of said Section 23. E 4 '1 Wisconsin Department of Health and Social Services Plb..#67 10/J69 J� Division of Health PEFtaT APPLICATION JAPE Oi S IC WAGE SYSTEMS f S PRIVATE D 1E T E r A. OWNER OF P ROPEFTY TYPE OR USE BLACK INK Name Address (Street, City, Zip Code) County B. LOCATION OF PROPERTY WFX 2E SYSTEM WILL BE CONSTRUCTED, ALTERED "R EXTENDED Check One: CITY VILLAGE LEGAL DESCRIPTION: /i TOW`lSHIP C. IS LOCAL PEWIT REQUIRED FOR THIS M't<? Z- -- YES NO /I J PERMIT NUMBER D. SEPTIC, TANK CAPACITY l— Gallons NEW INSTALLATION V REPLACUWT ADDITION nATERIALS: Prefab Concrete ' Poured in Place Steel other 5u^3ER OF TANKS TO BE INSTALLED: E. TY?E OF OCCUPANCY Check One: One or Two Family Residence ( commercial Industrial Other (Specify) Number of Persons to be Accommodated (_./ Number of Bedrooms T F. A ?.'LIANCES, ETCs Food Waste Grinder Y'dS �~ NO Automatic Clothes Washer i YES NO Dishwasher YES NO Automatic Potato Peeler YES NO Other (Specify) G. EFFLUENT DISPOSAL SYSTEM NEW - EXTEVSION ADDITION REPLACEMENT Tile Size No.Lin.Feet Trench Width Depth Number of Lines Seepage Beds Length Z=` :Width t;` ',- Depth �:Tile Size - 2 ' No. Lines - ` Seepage Pit: Inside dia .ter % Liquid Depth " P E R C O L A T I O N T E S T Test Depth Character of Soil Hours Water Test Time Drop in Water Level Inc Minutes ?lumber Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall lst Wetted Overnight in Minutes East Period Last Period Period One Inch � Example P— 0 36" OD Soil 10" Clay 26" 25 yes or no i 30 1/2 1/2 2 60 I r � RECORD DATA FROM MINIMUM OF 3 TEST HOLES oe:puts vizs of absorption area in accord with H 62.20 Wis. Administrative Code. S O I L B 0 R I N G S- Minimum 36" Below Prop osod Absorption System _ oring Total Depth Depth to Ground Water Depth to Bedrock umber Inches Observed I Estimated Observed Estimated Character of Soil with Thickness in Inches xampls 0 72" 72" Black Top Soil 12" Sand lE "• Gravel 24 Pot Ff - /0 RECORD DATA FROM MINIMUM OF 3 BORE HOLES COMPLETE OTHER SIDE I, the undersigned, hereby certify that the percolation tests reported on this form'wers made by me or under by supervision in accord with the procedures and method specified in Chapter H 62.20 (3), Wisconsin Administrative Code, and that the data recorded and location of test holes are oorrect to the best of my knowledge and belief. NAME ,' /� % G TITLE ;. (Type or Print) REGISTRATION NO. ` '� C/ or MASTER PLUMBER LICENSE No. ADDRESS ��,_ /' /i r• - .- 'F � -i:. ..� G = DATE SIGNATURE MAS'PER PUA13ER MAKING APPPLICATTIION MP Signatures License Number; MP Rsw 1' (To b Com Fee Paid leted by Issuing Agent) � / / �' Date of Application Permit Issued (dat� �� / / �, _ Permit Number Agent (name) " - ? ; L� ; ( . 2 ") For: Town, Village, City, County, etc. (Specify) Notes The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of th Permit (yellow copy) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY DATE RECEIVED 9 — : 3 - - 7 O ACCEPTED BY o_� " ° 1 RETURNED _ (Initials) (Date) S Corres. FEE RECEIVED ✓ VALID. NO. _ ? PERMIT NO. 7 Yes or No) REVIEWED BY APPROVED _ DATE (Initials) (Yes or No) COMMENTS: i Parcel #: 030 - 1053 -80 -000 03/23/2005 12:27 PM PAG IOF1 Alt. Parcel #: 23.30.19.197W 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 COLLEEN M GRAY " GRAY, COLLEEN M 1416 RIDGE RUN NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1416 RIDGE RUN SC 3962 NEW RICHMOND SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A -NOT AVAILABLE SEC 23 T30N R19W PT GL 1 COM SE COR SEC Block/Condo Bldg: 23, W 1948 FT N 327.66 FT, N 25DEG W 122.5 FT, N 1 DEG W 318.26 FT TO POB: N Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 180.38 FT, TH N 21 DEG E 66 FT N 33DEG E 23- 30N -19W 120 FT TH E 601.37 FT, S 325.97 FT, W 720.41 FT TO POB Notes: Parcel History: Date Doc # Vol /Page Type 11/19/1999 614164 1472/311 QC 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 5175 430,900 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 103,500 320,400 423,900 NO Totals for 2004: General Property 5.000 103,500 320,400 423,900 Woodland 0.000 0 0 Totals for 2003: General Property 5.000 55,300 272,600 327,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 542 Specials: User Special Code Category Amount 040 -OTHER ASSM'T SPECIAL ASSESSMENT 358.84 Special Assessments Special Charges Delinquent Charges Total 358.84 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT OWNER q TOWNSHIP 7 jda sA­k SEC A 3 T.;P N -RaW ADDRESS LJ.� _�� y,,� ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LOT SIZE PLAN VIEW t r Distances and dimensions to meet requirements o f H63 YTHING WITHIN 100 FEET OF SYSTEM LA HP 4 i I di a e 1,4o#hj Arrow ; SC ALL �_. BENCHMARK: (Permanent reference Point) Describe: /� [ ,, L 0 00 ft. �-- Elevation of vertical.,reference point: Slope at site: SEPTIC TANK: Manufacturer: qeA 5 Liquid Capacity -y Number of rings on cover Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set tor a cyc a gallons; total capacity o distribution lines gallon: size of pump head; gallon per minute horsepower brand name of pump and model number Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: Number ot pits teet diameter feet liquid depth seepage pit in e� t pipe- elevation bottom of seepage pit elevation feet. <, SEEPAGE BED SIZE: number of lines __ width length 60 depth 34P SEEPAGE TRENCH: width length PERCOLATION RATE l� A REQUIRED q y 5 - __ AREA AS BUILT 9 a INSPECTOR DATED ; PLUMBER ON JOB LICENSE NUMBER 0 5 g it 1 REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM Sanitary Permit State Septic DAME / id TOWNSHIP f�` St. Croix County .00ATION (SOW Section 23 Lot # Subdivision ,EPTIC TANK Size gallons Number of compartments )istance from: Well Building 12% slope Highwater ' UMPING CHAMBER Size gallons Pump Manufacturer Model Number i OLDING TANK Size gallons Number of Compartments Pumper Alarm System .)istance from: Well Building 12% slope Highwater 1 BSORPTION SITE Bed Trench I )istance from: Well Building 12% slope Highwater g �' k BSORPTION SITE DIMENSIONS Width of trench ft Required area ft. Length of each line Cf ft Depth of rock below tile in. Number of lines Depth of rock over tile 2-- in. - g otal length of lines ft Depth of tile below grade in. Distance between lines ft Slope of trench in. ,per 100 ft. Total absortptton area ft Type of Cover: y' P IT DIMENSIONS Number of pits Gr 1 around pits yes no Outside diameter 'ft D h below inlet ft Total absorption area �T_ t f , Area required ft INSPECTED TITLE APPROVED DATE 198 REJECTED DATE 198_ REASON FOR REJECTION PLB67 State and County State Permit Permit Application County Permit # - „ for Private Domestic Sewage Systems Count *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: �SUJ Y _ ' /4, ion �, T3A N, R 7 (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk # 15,tg s /- &if /illage Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms 73 No. of Person D. TYPE OF APPLIANCES: Dishwasher L--- Y - ES NO Food Waste Grinder YES 4- +40 # of Bathrooms , Automatic Washer 4- — ES NO Other (specify) E. SEPTIC TANK CAPACITY J A'2-0 Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement _ Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) _,I, 2) /A 3) 6 Total Absorb Area C)p sq. ft. New Addition Replacement L- *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length f _ 6,tLWidth Depth � Tile Depth AO No. of Lines 2-- �r Seepage Pit: Inside diameter Liquid Depth Tile Size y Percent slope of land D - G Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified Soil Tester, NAME / v li g a� �_T J !q S C.S.T. # 1 y / '�i and other information obtained from (owner/builder). Plumber's Signature MP /MPRSW# /D �� 9 Phone # yd Plumber's Address ` PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). Do Not Write in Spa Below p OR DEPARTMENT USE ONLY Date of Application o? 0 Fees Paid: StateCount Date Permit Issued /Re�j (date) �0-� � _Issuing Agent Name Inspection Yes /l No Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) i Revised Date 6/11/76 JI tiRr is 1 EH 115 Rev. 9/78 \� 1 2 REPORT ON SOIL BORINGS AND PERCOLATION TESTS PF /' WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES ' Q, ,�G t '! P.O. BOX 309, MADISON, WISCONSIN 53707 IO 1 19� N�,� LOCATION ' /< '/4, Section ,TsM N,RZZE (or) W, Township or Municipality Lot No. ,Block No. County S C°ro - S ubdivision Name Owner's /Buyers Name- � Mailing Address: 01 ��- •� -u-s� �/l�'� > yQ / TYPE OF OCCUPANCY: Residence I.-' No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS — .2 - KI PERCOLATION TESTS SOIL MAP SHEET 3 y NAME OF SOIL MAP UNIT PERCOLATION TESTS D C TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN.INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN BER ' 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P - '&5�0Z P— P— P— 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 l 7 /,P- " de " ' D B /Sr- L L /2 B— B— B— PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location a od feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy �S '� Ind icate scale or distances. Give horizontal and vertical reference points. Indicate slope. s - E i tie i i - M _ 1 m a f Aj .......,. -. _...... -., e..._ -.e. ......m.. ...,.�.....,a �.....ee� .... .., i .... �.e..... »� ...,.a.. � _ m..� ...p.. �.......- d --._,. .^^— »111..'_^ _ .. _., ..s i t e e ] s i 4 i 0 �m 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. 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