HomeMy WebLinkAbout042-1086-30-000 (2)and Zonin County PlanningMoitday, October 03, 2005 at 9:49:22 AM
St. Croix
Page I q
Detail Sanitary
Information
Computer #:
042-1086-30-000
Sub/Plat: NA
Section: 31
Parcel #:
31.29-18.482B
Lot: 1
TN/RNG: T29N R18W
Municipality:
Warren, Town of
CSM: Vol. 01 Pg. 221
114 114: SW 1/4 NW 1/4
Fogerty, Dennis 652 93rd-9i"reet
Robe' �;,,YVI 54023
Owner:
State Permit:
186550 Issu
01/25/1993 P,OWTS Dispersal:
Non -Pressurized In -ground Permit: Reconnection
County Permit:
0 In alled:
01/25/1993 OWTS Detail:
Trench - Seepage Bedrooms: 3 WI Fund:
/POWTS Pretreatment,
NA
Notes
Inspector As Built Plumber Other Requirements
None No Fogerty, Dave
Signed Off: No
Maintenance
Scheduled Pum Date Pumped 1 Notification 2nd Notification 3rd Notification
6/25/2006
Additional Notes Money Owed
not inspected - find original permit in archives and $0.00
add to 1993 file
Parcel #: 042-1086-30-000 10/03/2005 09:45 AM
PAGE 1 OF I
Alt. Parcel #: 31.29-18.482B 042 - TOWN OF WARREN
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address:
JEFFERY W & JODY A OLSON
652 93RD ST
ROBERTS WI 54023
Districts: SC = School SP = Special
Type Dist # Description
SC 2422 ST CROIX CENTRAL
SID 1700 WITC
Legal Description: Acres:
SEC 31 T29N R18W PT SW NW LOT I CSM
1/221 (6AC) & PARC DESC IN QC-1436/469
(0.017AC
Owner(s): 0 = Current Owner, C = Current Co-owner
0 - OLSON, JEFFERY W & JODY A
Property Address(es): Primary
* 652 93RD ST
6.017 Plat: N/A -NOT AVAILABLE
BlocklCondo Bldg:
Tracts): (Sec-Twn-Rng 40 1/4 160 1/4)
31-29N-1 8W
Notes:
Parcel History:
Date
Doc #
Vol/Page
Type
07/09/1999
606546
1440/521
QC
06/23/1999
605556
1436/469
QC
07/23/1997
1098/415
WD
07/23/1997
1098/414
WD
more...
2005 SUMMARY
Bill #: Fair Market Value:
Assessed with:
0
Valuations:
Last Changed:
10/22/2001
Description
Class Acres Land
Improve
Total State
Reason
RESIDENTIAL
G1 6.017 51,500
155,400
206,900 NO
Totals for 2005: General Property 6.017 51,500 155,400 206,900
Woodland 0.000 0 0
Totals for 2004: General Property 6.017 511500 155,400 206,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 12/04/1998 Batch #: 523
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER— TOWNSHIP
SECTION T N — R—ZL—W
ADDRESS Os ST. CROIX COUNTY, WISCONSIN
SUBDIVISION
PLAN VIEW
4r,LOT LOT SIZE -
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Ir
14
, . . . . . . . . . . .
INDICATE NORTH ARROW
BENCHMARK:Elevation and description: I&Vte 14e
WIZ4
y '
SEPTIC TANK:Manufacturer: --Liquid Cap.
��'
1% _L 11 "-j %'-V 1", S-P ed.A ralav; g_--ada
C �C 1► +
Tank inlet elev.:,, --Tank outlet elev.:
No. of feet from nearest road :Front ----Side --Rear --Ft.---
From nearest prop. line:Front_ —, Side—, Rear
No. of feet from,: Well Building:
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
141-7
Z
A�zez-ll
4
PUMP CHAMBER
Manufacturer: Li uid Capacity:
Pump Model: Pu /Siphon Man fact.: Pump Size
Elevation of inlet: otto of tank elevation
Pump on elev.:_ Pump off a Gallons/cycle:_
Alarm: Man.: witch T Location
Distance from nearest pr p. line: Front_, Side , Rear Ft.
Distance from: Well Building
SOIL ABSORPTION SYSTEM
Bed: t% Trench: Seepage Pit:
Width: 2- _Length d Number of Lines: Area Built
Exist. Grade Elev. Proposed Final Grade Elev.
Fill depth to top of pipe:
No. feet from nearest prop. 1 izW : Front,,,, Side , Rear Ft . .;> A!;W
No. feet from well : S� No. feet from bui ldinq 3 J*�
HOLDING TANK
Manufacturer:
No. of rings used: Elevati n of
Elevation of inlet:
No. feet from nearest prop. line* r
No. feet from: Well bui ding,
Alarm Manufacturer:
DATE : �-
6/90:cj
Capacity:_
ttom tank:
t_, Side , Rear_Ft.
\, nearest road
INSPECTOR: �~
PLUMBER ON JOB:
LICENSE NUMBER:
T.-I -A T_% T1% T-1 Ik T _% It r1% r% T-t %,.-f Ik T r.7 *-N _w TM%
rM rt r4PAT� " " st r� A GifY S T E M
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division
A V (ATTACH TO PERMIT)
GENERAL ,INFORMATION
I
Permit Holder's Name- I-] City [] Village DZown of
W I ak. rR R Ej N
N
:?QGE'Rr"y
CST BM Elev.:Insp, BM Elev.: BM Description:
eo
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
y" rn
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TAN KTO
P / L
WELL
BLDG-
vent to
Air Intake
ROAD
Septic
NA
Dosing '------.
NA
Aeration
Holding s.
PUMP/ SIPHON INFORMATION
T
Manufacturer Demand
Model Number GPM�
TDH Lift Friction em T D H Ft
eadr7
Lgss ead
Forcemain Length Dia. Dist. To Well
IN IPVATInKi nATA
5_ , %Y:
ell %7 T
Sanitary Permit No--.
0 L " 86550
State Plan ID No.:
Parcel Tax No-,
'0 4 2% 0- 60- 0
A93"0007
STATION
BS
H1
FS
ELEV.
Benchmark
Bldg. Sewer
St/ Ht Inlet
v, U
St / Rf Outlet
6z
oe
Dt Inlet
Dt Bottom
Header- . _
yew
Dist. Pipe
-X, 75
Bot. System
/1)
Final Grade
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of TrenchesNo- Of Pits inside Dia. Liquid Depth
DIMENSIONS DIMENSION 5
SYSTEM TOP L BLDG WELL LAKE/STREAM LEACHING M a n-uf a ct u re r:
SETBACK CHAModel Number-"
INFORMATION Typeof J,41
UNIT
System:
DISTRIBUTION SYSTEM
Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia Length �7 Dia. 4 Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only�
Depth Over Depth Over xx Depth Of _--XX Seeded/ Sodded xx Mulched
14- Topsoil E] Yes N o ❑Yes No
Bed /,T,ter Bed d /d g e s a Cje_4� ,TTip*+T-E or I y
COMMENTS: (include code discrepancies, persons present, etc.)
e% L
,i i r.,T iL irrj 9N '13 11"Z* D A/
OCA. -ION WARREN '33 1 21" 9 4 8 2% r
B Z) VV 14 VV T
tel-
17S
6/
OF
Plan revision required? [j Yes Q__o
Use other side for additional information. 6i;) /X
..z I rc -Ze Cert No
Date inspector's S gnat
SBD-6710(R 05/91)
UMOCZ2MANIn SANITARY PERMIT APPLICATION
DILHR In accord with ILHR 83.05, Wis. Adm. Code
—Attach complete plans (to the county copy only) for the system, on paper not less than
8% x 11 inches in size.
—See reverse side for instructions for completing this application.
I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION.
PR RTY OWNER PROPERTY LOCATION
FR&C
7 %Is
2::
co JV /4 OZ jW
T
LOr#
PkOPERTY OWNER'S hfAILING ADbRESSG Sz 93 s
COUNTY/i
STATE SANITARY PERMIT #
/❑ P&5—��)
ChecrIf revisionto previous application
STATE PLAN I.D. NUMBER
T2?, N, R E (or)
I BLOCK #
CITY, SJATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
(7
=�6
E:1 CITY NEAREST ROAD
111. TYPE OF BUILDING: (Check one
State`Owned 0
'Wned
E]Public ]�rl or 2 Fam. Dwelling—# of bedrooms PARCEL TAX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply)
1 0 Apt/Condo
2 El Assembly Hall 6 D Medical Facility/Nursing Home 10 El Outdoor Recreational Facility
3 FICampground 7 ElMerchandise: Sales/Repairs 11 ElRestaurant/Bar/Dining
4 El Church/School 8 ❑ Mobile Home Park 12 El Service Station/Car Wash
5 0 Hotel/Motel 9 ❑ Office/Factory 1130 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ElNew 2. F-1 Replacement 3. ElReplacement of
System System Tank Only
B) [aA Sanitary Permit was previously issued. Permit#
V. TYPE OF SYSTEM: {Check only one)
Non -Pressurized Distribution Pressurized Distribution Experimental
11 El Seepage Bed 21 F-1 Mound 30 0 Specify Type
12 F"Seepage Trench 22 El In -Ground
130 Seepage Pit Pressure
14 El System-ln-Fill
V1. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY
2. ABSORP. AREA
3. ABSORP. AREA
REQUIRED (sq. ft.)
PROPOSED (sq. ft.)
7:z o
1�?
I e, Z./I
VII. TANK
CAPACITYin gallons
Total
# of
INFORMATION
New
xisting
Gallons
Tanks
Tanks
Tanks
4. LOADING RATE
(Gals/day/sq. ft.)
, Z, -3
Manufacturer's Name
Septic Tank or Holding Tank
I
Lift Pump TanWSiphon Chamber
M
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewa
5;9
PI ber's Name (Print): Plu s Si nature���M
0, rqol' 7 C
p!j, y-
sc / 4
Plu er's Address (Street, City, SIrate, ode):
ZA/
Ix. UNtY/DEFFARrTMENT US 9 ONLY
Disapproved XSan, ary Permit Fee (includes Groundwater
j Surcharge Fee)
Approved [] Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
Fv_1 F%-/l
4. L-nd Reconnection of 5. I.Ad Repair of an
Existing System Existing System
i Date Issued 4P 7-2-
Other
41 ❑Holding Tank
42 ❑Pit Privy
43 ❑Vault Privy
5. PERC. RATE
6. SYSTEM ELEV.
7. FINAL GRADE
(Min./inch)
e it C-A,
ELEVATION
15
0
e; Feet
I f/.. Feet
Prefab.
Site
Con-
Steel I
Fiber-
Plastic
Exper.
Concrete
structed
glass
App•
system shown on the attached plans.
h7P7MPRSW No.: T Business Phone Number:
EN
77 suing Ag,#lt 7, 0
ssue suing— Ageht Signatu o Sta s)
T let
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
r
ft
1. .A ,saga itary permit is valid for two (2) years.-
-
2. Your sanitary permit may be renewed before the expiration date, and .at the 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
ysubmitteo to the county prior to installatiqn.
5.-Qnsite sewage. s stem —is mustbd properly maintained. The septic tanks must .be um e� � - �ak�
9 Y P P Y P} p p y 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 & Buildings Division, 608--266-3815.
To be complete�apd.:accurate this soni ?i y permit application must include:
L
of w
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 ofiuilding 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 in 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 in #1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and rhanufacturer'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
experi mentat product approval from DILHR.
Vitt. Responsibility statement. Installing plumber is to 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% x 11 inches must be submitted to the county. The
plans must include the following: Aj 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 f35-fQrm; 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. f
The monies - oltected through=thes�ewsurcharges are useo'jor %mQ ari.ng groundwater, ;ground
v)al'ei�ontai�n i•nation investi ationsan - #. `
g d establishment of'standard$.
SB D-fi398 (R.11 /88)
I)AVF , FOt3ER'tY' PLUMBING
Licensed Perk Tester & plumber
e3�y#tHeiiR 28F s3d0%9tjgt4 54023
R WS WISCO
OBEphone 749-3656
W1
'004 C64, p
O 7114
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AZf,, ol'L' 7
t�
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OOC)
rV
k in
aeft
Dave
og ..y
SEWER SYSTEMS & PERK TESTING
mb
-3656
UL
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DEPARTMENT OF
INDUSTRY,
LABOR AND
HUMAN RELATIONS
REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS
DIVISION
PERCOLATION TESTS (115) MADIS P.O. W 53707
(ILHR 83.0911) &Chapter 1451
LOC TION: I SECTION: TOWNSHIPI LOT NO.: BILK. NO.: SUBDIVISION NAME:
1py N/R E (o
COUNT : OW R'S/Btf''F! MAILING ADDRESS:
> (2X"� Z + � � 15�to�a
nr IIATF'C nRCFRX/AT1nK1S MAnF
���----,// NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
I Residence w Replace
RATING: S= Site suitable for system U= Site unsuitable for systemf a
CONVENTIONAL: MOUND: IN -GROUND -PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
c�5 []U EIS Lj_b F E:]S
1:1 S r
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING
NUMBER
TOTAL
DEPTH IN,
ELEVATION
DEPTH TO GROUNDWATER
OBSERVED
-INCHES
EST. HIGHEST
CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- r
r % j
B-
B- 21
t% 3
l r t
/7 f r nc�
B-
B-
.� •c..
B-
PE RCO LATION tE-STS �� ' l nr� •.l _ f /�� _ ., __ G..._
TEST
NUMBER
DEPTH
INCHES
WATER IN HOLE
AFTER SWELLING
TEST TIME
INTERVAL -MIN.
DROP IN WATER LEVEL -INCHES
RATE MfNUTES
PER INCH
PERIOD I
PERIOD 2
PERIOD 3
P -
.s
-
PJ?
A -A.&
#e0a;(
P-
-�
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION
f
- C
1_ 93
vx�
Yo C w_ `7
PyIJy7h�F 1
11. — 4fSGt U4 (19 !_... _._.. _ ..,...._.... __., A tiT[I 6 ` �r r,c-•
7.
,�.
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the prr'edures 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.
DAVE FOGERTY PLUMBING
NAME (print): LiCen3ed Perk @S e TESTS WERE COMPLETED ON:
3289
3233 " hts Road
ADDRESS: IISGONS IN CER IFI ATION NUMBER: PHONE NUMBER (optional):
CST PATURE:
2,
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) — OVER —
INSTRUCTIONS FOR COMPLETING FORM 115 - S D - 6395
. MAXIMUM nurnber of bed c;cns € r si' 'Planned;
4. is this rr r 101b, (M- r'-placement syml—e n I
, Complete the suitabihty r-ating boxea, A SITE IS U ABLE FOR A HOLDING TANK ONLY IF ALL
THEE SYSTEMS ARE RULED OUT BASED ON OILCONDITIONS;
6, PLEASE use the abbrevianons shove .r a..r rse for writing profile desc"ipti€: ni and complatingtheplat plan,
7, MAKE A LEGIBLE dMffaM {�rCl.aratel y locating ou'r test locations. Drawing in to scale is preferred
, Make sure your bemchniark and vertical Plevation Hefei nce j)oi r't are clearly sho,,fi,n and are permanent;
9. Complete all appropriate boxes as -t �� t:�st names, address es, flood Plain data, Percolation test exem -
ti C { i-1 appropriate;
, if the information (such asflood Plain, e'levation) dos riot apply, Place N,A4 In the apj)i wri t: box;
, Sign the f rni and puce okjk c urr i;lmt address and yot.ir certification number;
, Make legible copi,:,�s ncdistribute, s rg.quh-ecL ALL SOIL TESTS IMUST BE FILED WITH THE
LOCAL AUTHORITYWITV-11N 30 DAYS OF COMPLETION,
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Boll Separate5 and Textums
cob
n' _
a F
r�ifaa3 ���r�LE;r` 3
�;�
�h..x'�rw€:'• wig
Mvadium� sand
ss _ "
e S r
a
(r�., , sa L ( C'a � i 5
{v 5E
,f yY1
slity UayLoam
r .
Silty Day
C .,,,...
�y
Day
Pt
q�3
Six Qener-cfl Son' uextw-es
•
Other Symbols
1,-I GW 1-`i r g
Perc _ P(..ireola" K€:)n Rake
Than
Bn Bs y vii n
f -`'f .�v
V Y, Iv
R R e
r �E.�I 51VI01t 3s
HWL
rface wate
This soil test report is the first step In securing a sanitary permit. The county or the Department may request
verification of this soil test In the field prior to Permit issuance.-eto. set of, plans tQr.the private
sewage syst rn and a permit application must be submitted to the ap-propriate local autiigri't'i`rl`' rder to
obtain a permit. The sanitary permit must be obtained and posted prior to,tbe. t rt of any C01IStrUction.
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 residence located at.
_1 4 1 4, Sec, T_ 2 � N R /S-_ W Town of
Upon Inspection, I certify that I have found the
tank and baff'les to be In good condition, and it appears to be
functioning properly.
Last time serviced 1119
Did flow back occur from absorption system? Yes No .Aif no, skip
next line)
Approximate volume or length of time: gallons minutes
Capacity:
Construction: Prefab Concrete V-_ -Steel Other
M a n u f a c u r e r ( if known) : J\.
Age of Tank (if known):
7 L7 _
e-j
T
(Name) Please Print
(Signature)
4 j! t-
(Title)
/ /,-? 5-Ate,
(Date)
(License Number)
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 f o r
inspect" n opening over outlet baffle).
Name. 4, Signature Z.MP/MPRS J2
5/88
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER
ADDRESSfs vI0) FIRE NO: . , <
LOCATION: 1/4, 1/4, SEC* .7L T 2 N- ZR J W TOWN OF: STe-CROIX COUNTY
SUBDIVISION:
LOT NO.
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 septic tank pumper. What you
put 'Into the system can affect the function of the septic tank as
a treatment stage in the waste disposal system;
St. Croix County residents may be eligible to receive a grant to
help with the cost of the replacement of a failing system, which
was in operation prior to July 1, 1978. St Croix County accepted
this program in August of 1980, with the requirement that owners
of all new systems agree to keep their system properly
maintained.
The property owner agrees to submit to the St. Croix County
Zoning a certification form, signed by the owner and by a master
Plumber, journeyman plumber, restricted plumber or a licensed
pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of
sludge and scum. Certification from will be sent approximately
30 days prior to three year expiration.
I/WE, the undersigned have read the above requirements and agree
to maintain the private sewage disposal system�in accordance with
the standards set forth, herein, as set by the Wisconsin DNR,
Certification form must be completed and returned to the St.
Croix County Zoning Officer within 30 days of the three year
expiration date,
k-A
SIGNED:
DATE:
St. Croix County Zoning Office
911 4th Ste
Hudson, WI 54016
Pau/ Cudd er Sons /nc.
1047 South Wasson Lane W1 License No. MPRSW2739
River Falls, Wisconsin 54022
715-425-2049
January 22, 1993
RE: Dennis Fogerty
652 93rd Street
Roberts, WI 54023
TO WHOM IT MAY CONCERN:
This letter is to inform you that on January 22, 1993,
we pumped the septic tank on the property at 652 93rd
Street, Roberts, Wisconsin, which is owned by Dennis
Fogerty.
This is a 1000 gallon septic tank with fiberglass
baffles and it is in good condition.
If we can be of further service to you, please contact
US.
Sincerely,
PAUL CUDD & SONS, INC.
Paul R. C u d %d
President
PRC: mly
S T C - 100
q""'c- application form is to be completed in full and signed by
the 0c,' mr(s) Of tile PrOperty being developed. Any inadequacies
will only result in delays Of the permit issuance. Should this
devel-OPment be intended for resale by owner/contractor, ( spec
House), then a second form should be retained and completed when
tile property is sold and submitted to this office with the
appropriate deed recording.
Owner of property
Location of property .E,,� 1/4 1/4, Section T W
Township
mailing address
Address of site
Subdivision name I Lot no,
Other homes on property?Yes No
Previous owner of property
L fz�'4
Total size of parcel 7 --------------
P
Date Parcel was created jj!! 0111111
Are all corners and lot lines identifiable? Yes
No
Is this Property being developed for (spec house)? ' YeS No
volume.,�5� and Page Number 1�3- as recorded.with of Deeds. the Register
--------------------------- ---- ------------
- - - - - - - -----
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARIWITY DEED w1licl, includes a DOCUMENT NU1WE
14"BER & THE SEAL OF, THE REGISTE'R RF VOLUME AND PAGE
OF DEEDS
certif'e(l sul.vc. In addition, a
y, if avaable' il-Yould be helpful
delays Of the reviewing process ., pr SO as to avoid
references If the deed description
shall to n cOrtified Survey Map, the Certified Surve also be required., y Map
PROPERTY OWNER CERTIFICATION
I(we ) certify tilat S4
j - I statements on this form are true to the
best of nY (our) knowledge that i (we)
the property described in this am (are) the owner(s) of
information form, by virtue of a
warranty deed recorded in. the offica
Deed- U of the County Register of
D current Sao and that I
own t h e -oposed site for the sewage disposal (we) presently
P C
obtained an easement sYstem or I (we)
1ZC-1- rt' I to run the above described property, for
the con ruction of I
recorded Said system, and the same has been duly
t1le Office of County Reg'ster of deeds as Document
No
A' si 9Z T-r- -e: 7o r 4
1 ant Co-applicant
Date of
Signature
Date of Signature
77`F_
BAP Of INT'scoNsm-1 PC" 2
`,TAI 4",
WUMFNT NO VVARAANTY OM
�op Atcuor.),tiNri PAITA Ali
336
VOL 54 4
t 410 9EGK5T*.PS CFFICE
BY THIS DKED, Jr. also known as ST. Or'),,, Co 0 Wis.
r P, - wrij th;s 2 9
Clapp
191'76
/ /01)
�A.
Dale E. Fogerty and Susan Ann
Grantor conveys imnd warrants to
�. .husband,&nd wife As )pint tenants,
Fogerty
-of i
S
;4F
for a valuable consideration
,
tht following described real estate in Ste CrCount
oix
A parcel of land located in the Southwest Quarter
of the Northwest Quart,_,r of cs�^tion 31, Township 29
riot
North, Range 18 west, descr.$J-�eQ as Lot 1 in the
Certified Survey Map filed in the office of the Register of Deeds for E
Croix County, Wisconsint on March 9, 19761 in VolLr,e lo Pacre 221, docur,�..
331901.
Together with a non-exclusive easeirent i�,r an access ioad 3 rods ir,
along the East side of said Parcel as showi, on said map.
This deed does not convey any interest in lz,,d in the southeast Quarter c-dl
r of said Section 31, arl if any part of the above de -
the Northwest Quarte aid Southeast Quarter of. the Northwest
scription or easement lies in s
Quarter, it is "cepted from this leed.
The grantor reserves fee title to the 3 rod road shown on said neap and if
any part thereof lies in the Southeast r)uarter of tl,,.e 1�orthwest Quar-I-r of
A
said Section 31, he reserved so much of I.and lyina along tl,e
boundary of said Lot 1 as may be necessar, to rovide hirr with a 3 rod road
p
`-
Nz orthwe�,t Quarter cf said
lyiextirel"in the southwest Quarter. Ae .
kxxmw xx Section 314
17 76
ctol-,
26th er lo
Hudson, is
F.Ycl ulvd iit
SIGNED AND SEALED IN PRESFNCE OF
Signatures of Willi= Clapp, Jr., also known a5z W. ClaPP
6
authenticated thisth day of October 7
Jolin
Y
'.r,TATE OF WISCON',q1%
jimt. N,f,ry
the mho%f nanict"I
to me k n o kv 11 lil N, 1110
'rhis in*;trument wit%, diraftv-(i � w
John D. Heywood, Attorney at%_" Law
Hudson, Wisconsin
Thc usu of w it tl*
� 00
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET 9 HUDSON, WI 54016
(715) 386-4680
EXISTING SEPTIC SYSTEM AFFIDAVIT
The existing septic system which serves the dwelling being added on
to must be inspected by a licensed soil tester for compliance with
high ground water and/or bedrock seperation requirements as set
forth in s. ILHR Chapter 83.10(2) WI. ADM, CODE. The results of
that inspection must be made available to this office. If the
existing septic system meets these minimum requirements, and is
properly functioning, an addition may be added to the dwelling
without updating that system. This addition must not, however,
encroach upon the required septic system setbacks as setforth in s.
ILHR Chapter 83.10(l).
Property Owner(s) gnn_'
Property Mailing Address:
Property Legal Description: Loti CSM/S-Uabdivision
1/4,1% 1 �4 Sec. T w� �,,IN N. y Re We Tn. of
I, as the owner of the above described property, hereby affirm that
the septic system serving this dwelling meets the above referenced
state prl*v'ate sewage system codes. I realize that this addition
may cause the existing septic system to become undersized for a
dwelling of the resulting size, and I will make this information
available to any future parties interested in purchasing this
property.
Signed:bAn2�
�j
Date:- J - S-
q3
County Approval:
Date:
Notary Public
Subscribed and sworn to
46 10
before me on this da e a
V
My commission expires:
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET 0 HUDSON, WI 54016
(715) 386-4680
January 18, 1993
Division of Safety and Building
Bureau of Plumbing
P.O. Box 7/90,59
Madison, WI 53707
1*
To whom it may concern.
An onsite soil investigation of the Dennis Fogerty property,
located in the SW1/4 of the NW1/4, Sec.31, T29N/ R18W, Town of
WarrenSt. Croix County, WI., has been conducted with the assistance
of Dave Fogerty, CST# 3233.
This onsite revealed suitable soil for onsite sewage disposal to a
depth of 8211 while meeting the requirements of the A + 411 rule.
This site should be suitable for new construction utilizing a
conventional septic system,
Should you have any questions, please feel free to contact me at
this office*
Sinceroly,
..-James. T h ompson
Assistant Zoning Administrator
cc: file