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HomeMy WebLinkAbout030-2028-20-000 'rC o ~ ~I o° N ~ O d a~ a a' o o L l~ U O r Q C Q a O d i 0 ~ E E 0 U f6 N y U f0 0 Z N O ~ _y y a ° 3 CD z y O E G N Elf~ €o z ° o a m cq c) N F- C7 I ~ O O z v N Z 2 (A H r O 0 z c E -0 N U) N ' 0 - ` a L L_ - C C 0 U O O z w N z~ N Z co r+ o LO d E N E L9 IL C w a N y C O O y d L U N O 0 in a -0 N Z N :3 U) U) U) E E S d m .U O 0 `Oaaa Z 0 L lA IL N NN M o 0 U) y I~ m m z ° LO E D N d N L d Q}~ 0 C, cc = O m 9 y ❑ CO 0 ° 3 H c C, F? Z 0 a) 70 C~ C" L E C co CL M (D lyv~, W N N y y U C C (co C~ c, 0 (n 00 N N • O F~ O N U) N N O z cL (n ) M € • ~ o m;2 ya ~1 A c~a2 ~ovic) Parcel 030-2028-20-000 04i07i2005 09:36 AM PAGE 1 OF 1 Alt. Parcel 22.30.20.440C1 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 * ZAK, KENNETH A & BARBARA J KENNETH A & BARBARA J ZAK 1019 WEBSTER ST N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 418 HWY 35/64 SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 4.870 Plat: N/A-NOT AVAILABLE SEC 22 T30N R20W PT GL 4 LOT 2 CSM Block/Condo Bldg: 4/1081 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1151/508 QC 07/23/1997 919/29 07/23/1997 820/635 07/23/1997 804/245 2004 SUMMARY Bill M Fair Market Value: Assessed with: 5937 1,046,200 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 4.870 190,200 839,100 1,029,300 NO Totals for 2004: General Property 4.870 190,200 839,100 1,029,300 Woodland 0.000 0 0 Totals for 2003: General Property 4.870 111,900 533,200 645,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r ' `4 6 L e STC - 104 1, e '"r ,gyp _ ,1 CROI r AS BUILT SANITARY SYSTEM REPORT ZONING ZON I s NG OFF/Cii OWNERS ADDRESS ~1 J 4- / CSM# qj. q pq (U - LOT # SECTION _T ~N-R ~ W, Town of -JUSqk ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~~N~ Stoa~~ No. Off' c 021 1 ao' 1000 S'r c 0 D I.83x y3."15 rrue ,jck V I.~ A t uS!r' Cr.i + i fiKfyu(. $ p y N INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: Top 0i S W Cor- ro'j` U t ~'cJG r~ t~~.' ION I V~ - UU,o ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: W e Q~ S Liquid Capacity: w u') `a f Setback from: WellNoi u House j Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location - SOIL ABSORPTION SYSTEM USe O Tr~4 ! r--~;,z Width: 3 Length 3- Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House Other ~eAoe{~ I ~Nr) 9S ! c Irv i rf"' , ELEVATIONS CoUR 9~,sa Building Sewer ST Inlet, ST outlet 9~-I(o PC inlet PC bottom Pump Off Header/Manifold Bottom of system 93'30 - I' SANS Ad14 fu F dj~c"' QR1-TS i fi Existing Grade ~ .3U Final grade 3U DATE OF INSTALLATION: PLUMBER ON JOB: 4~Ct~rk-''T LICENSE NUMBER: INSPECTOR: 3/93:jt wiscc;nsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284291 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: ZAK, KENNETH A. & BARBARA J. ST. JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 030-2028-20-000 TANK INFORMATION ELEVATION DATA A970 QA7 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic i3T . Benchmark a 55- , ~Gd, !%l3 Dosing Aeration Bldg. Sewer Holding-- St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic j~j NA Dt Bottom Dosing NA Header/ Man. 3 Aeration NA Dist. Pipe A- Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade o- as Manufacturer Demand SC~ ~ ;=7 ~Model Number GPM TDH Lift Friction System TDH Ft Loss H Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSIONS DIMEN I N LEACHING Manufacturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM INFORMATION Type O CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. 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 Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.).S`` LOCATION: ST. JOSEPH 22.30.20.440C1,SE,SW GVT LT 4 Plan revision required? ❑ Yes ❑ No T1 Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: , tttr~li~~iilrs Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau Of Building Water Systems 201 .O E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P 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. 0r / % x • See reverse side for instructions for completing this application State Sanitary Perrmmit Number The information you provide maybe used by other government agency programs "2r - ` 9j [Privacy Law, s. 15.04 you (o de E] Check if revision to previous application State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Property Location ty- ~u.rC Z_1A 1/4, S T , N, R bE (or) W Pr pe y Ow er's aili g Address L t Numb r Block Number ityf Stage Zi Code Phone Number Sub ivision Nam o CSM umber J&i l~U ( )3 It S~ (~a~. /09( ~ II. TYPE F BUILDING: (check one) ❑ State Owned ❑ ity Nearest Road 56 Public 1 or 2 Family Dwelling - No. of bedrooms ° To wan of ZQ4a,~ W4 3 5 ~ G III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) f C\ .1 1 ❑ Apartment/ Condo 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 S ❑ 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. ❑ Replacement 3. E:] Replacement of 4 Reconnection of ______System System Tank Onl Y E] Existing System 5. ❑ Re Exisstiting Existing System s 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 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade O Required (sq. ft.) Proposed (sq. ft.) (Gal daly/sq. ft.) (MI /inch) Elevation - U -7 U t~ 1 o ?U Feet 04,-60 Feet VII. TANK Capacity INFORMATION in gallons Total # of Prefab. Site Fiber- Ex er. Gallons Tanks Manufacturer's Name Concrete Con- Steel Plastic p New Existing structed glass App. Tanks Tanks Septic Tank or Holding Tank - too o ~c e, Kf ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATE-MENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu er's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: 3 V o V g '10 r1%1 Plumber's Add ess (Street, City, State, Zip Cie)-, 0 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Salitary Permit Fee (Includes Groundwater ate Issued Issuing A nt Signat o St Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination 0'//~eej X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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: 1. 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- In 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 1/2 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 SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations March 27, 1997 2226 Rose Street La Crosse WI 54603 BOUMEESTER & SONS EXCAVATING JIM BOUMEESTER 1070 HWY 35 HUDSON WI 54016 RE: PLAN S97-40148 FEE RECEIVED: 110.00 ZAK, KEN & BARB GL4,SE,SW,27,30,20W TOWN OF ST JOSEPH COUNTY OF ST CROIX NON-PRESSURIZED IN-GROUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50-64, Wisconsin Administrative. Code. - The gravelless system components must be installed in accordance with the manufacturer's printed instructions, the plan approval, and ch. ILHR 83 system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. SUDA•7997 (x.10/94) 1 SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations BOUMEESTER & SONS EXCAVATING Page 2 March 27, 1997 PLAN S97-40148 Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, G and M. S m Plan Reviewer Section of Private Sewage (608) 785-9348 SHDA-7887 (K.10/84) COMMERCIAL SEPTIC SYSTEM DESIGN S+AF ~'4jP2 /~~Q FTy~e 599) ~Qc Zak Mini Storage Facility `S Q~v Office restroom PLAN ID# S97-40148 Review Date: March 27, 1997 Plan Reviewer: Gerry Swim PROPERTY LOCATION: PROPERTY OWNERS Gov't Lot 4, SEC. 27, Ken & Barb Zak T.30N., R.20W., Tn of 1019 Webster St. St. Joseph, St. Croix Hudson, WI. County, WI. 54016 INDEX TABLE PAGE 1 OF 4 TITLE SHEET PAGE 2 OF 4 WORKSHEET PAGE 3 OF 4 PLOT PLAN E S,~sTEta PAGE 4 OF 4 SYSTEM CROSS SEFWWNCn ATTACHMENTS SOIL REPORTV j-V `A 0011ally C,! IOU ' tm ' SAN IiEV►T~6''A~ Lpg® & Nu ~~~qm5 S~~Y0 8 PREPARED BY., Jim Boumeester NO~NGE 1070 Hwy 35 N. Sp0 Hudson, WI 54016 sE GO (715) 386-9020 SIGNATURE : DdUqv%"-a-)j-P~ MP # 3 4 0 4 DATE: / _ f a.C, q WORKSHEET JOB DESCRIPTION: Conventional system to serve Mini Storage office with two employees, one shower. Infiltrator leach chambers proposed, Model #EQ36 @ 22" X 12" X 101h". ABSORPTION AREA SIZING: 1. Daily wastewater load: (2 employees)(20 gal/employee) = 40 Gpd 71 shower) (15 qpd) (2 employees) 30 Gpd Total daily wastewater flow = 70 Gpd 2. Existing grade elevation: 98.80' at B-1 3. Depth to limiting factor: 8.50' (elev. = 90.301) 4. System Elev.: 93.30' at interface of 12" ASTM- C33 sand blanket and natural soil. Gravel/sand interface = 94.301. 5. Infiltrative capacity of natural soil = 0.8 gpd/sa.ft. 6. Infiltrative capacity of ASTM-C33 sand = 1.2 gpd/sq.ft. 7. Absorption area required 66.07 sq. ft. 70gpd/0.8 = 87.50 sq. ft. X 75.5% = 66.07 sq. ft. trench width (A) 1.83' trench length (B) 36.11' (use 42.18751) SEPTIC TANK CAPACITY: 1. Code derived daily wastewater flow 70 Gpd 2. Minimum required capacity 750 Gal. 3. Minimum liquid capacity 820 Gal. 4. Proprosed Capacity & Manufacturer: 1,000gal Weeks Concrete proposed I ,V^ 4 _ 4 40* 0- 150* 0- Posed _ 0 5a . U1 OFFICE \ A o 07 1 tn4-ti-raAA-- lead 0141-64- O 1 I Gross Area I Z I Berm O ■ ~ (0 I / 6-3 i t E x C / I v I- I ~o I I b 0 I ~ v I / I -s y I Q I I 4-µ■ 1 I I Go_ 11 I U) 0 IT N I I I ~ \ o0, ~ I 390.00' This approval does not Include review cf any plumbing upstream of the septicincidinn,;, tank. See sectign Il_HR 821.20, Wis. Admin. Code to determine whether plan submittal and approval is required for that plumbing. 0 LL I- I P~. of- IY FNa ~ ccA •T Lll V- 7' p P c z, N 2 it ~ U A CA ~-11-~~ 0-0 Q, C-1 IN4 C~ 4, • o o O ~ 31 2 (A .6:., esp. C ~ ~ti~ tom- o ro C n ~1 U y T~ (A., 1 i v A* VAiMonsin Department of Industry, SOIL AND SITE EVALUATION REPORT 3 age of Labor and Human Relations DNtsion of Safety & Buildings in accord with ILHR 83.05., Wis. Adm. Code 2 Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or fVIEWEDff D. # dimensioned, north arrow, and location and distance to nearest road. APPLICAN T INFORMATION-PLEASE PRINT ALL INFORMATION D COX PROPERTY OWNER: PROPERTY LOCATION tNQ GOVT. LOT S- 114 5 E (eW PROPERTY NER':S MAILING ADDRESS LOT # BLOCK # SD99,NAME M 6 20 2 - L&V-1 It/ CITY, STATE ZIP CODE PHONE NUMBER "IN, []CITY []VILLAGE GOWN NEAREST ROAD W& o (38A New Construction Use Residential / Number of bedrooms Addition to existing building j I Replacement Public or commercial describe r r°ro eAG'G a441~V) srzz-,~~ ~s Code derived daily flow 3 gpd Recommended design loading rate , 7 bed, gpolft2__Z_jrerich, gp ' Absorption area required 4o1? bed, ft2 37S trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surfaceelevation(s) Z 9? rl 4 ofs 1 ft (as referred to site plan benchmark) Additional design / site considerations To ecy/ R cs e-g Tifss _S J9lra'indt f~ tAl.riyr'=rL-tZ. rsoltl ,cLEV.~rxon/s. Flood plain elevation, if applicable ft S =Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem B S El U [3 S [3U B S ❑ U ❑ S O U ❑ S 12L ❑ S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Borrbry Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench E'3 - - 3 1 SL A& 44 Fg S 7 3,17 --e A4 L oc!c .2 J" .10 15 Ground 3 _ q - S 6 G elev. fZL ft. Depth to limiting factor > p9 Remarks: 13 Boring # U7]t"i' 6-10 /ri FR S .?M - ,3 SG p c s 2 5- _j/ 1A1 4, 71 Ground elev. J4 -7 ft. Depth to limiting factor > Remarks: 2 so ~d T Nam Please Print Phone: dres c"7 a1 ~ ~ ~~133 Signature: Date. CST Number: PROPERTYOWNER SOIL DESCRIPTION REPORT Page -2 of- - 3 PARCEL I.D. 8 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounclary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Q- 2 S 3 MF S ,S L G-S~ 3 - D S c .3 Ground - S © L elev. ft. Depth to limiting factor Remarks: 2 AX Ll t/ s 7' >LAte/F Boring # Z - - T' S L GS F .p -a LNintlll Ground i/Y elev. Depth to limiting factor BPS Remarks: Boring # r ^ 2 - S L S -2 Al -570,k W F?- CS !ezs .07 Ground elev. P~L2 ft. Depth to limiting factor > Remarks: Boring # vi4: N'• Ground elev. ft. Depth to C~/rT t s ` vF E limiting factor Remarks: SBD-8330(8.05/92) Dave Fogerty Plumbing SEWER SYSTEMS & PERK TESTING FOGERTY HEIGHTS ROAD ROBERTS, WISCONSIN 54023 (715) 749-3656 # ~.z3 3 'P/cr-vl4 rl 3 x 03X6- 9.2oy~ /~U~'oa r wS x 70 AfAx. Gis pTN 1 LvT * ?.-r Aex Er sc.4t~ l h6 /,d = ~M , Tv~ of s~ tflR.vE2 4I~ Fou vn~rro,v . ~ss'tiMG ioo. n i 1 .d = t3/YI ~ T®~ O/' S['~.tE Loft rF.D -Z/L SfR vrct e p 4E /ASS a~ +E /DO • Z i X = 1o,~r-x~~ . I j . i • ~ 1'701..v4 LoT fo^'/IiSRS w/ ^f S V R VE yox- ?-r p-ES. 3 ° 3S Rt~R/Y1 Srzr[v~, 360°,t/ NoT / f4Nl~ Z yurCC~ 7-o x~r? 3y i 76I, !7,V QED DuF Tb CS/die ~S ~RrkrAR~ i ! ! po t sz•r¢~^EU n L _i i pCD 0 ? I _ FouNr~A~ c onJ S T C - 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/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property P n v~ A x yj Bal-v-)aca : zcLk Local ion of property 1/4L~'f 1/4, Section 2Z. T , j N-R_ W Township ~o✓~Nn Mailing address ILL 1 2 Addr. ess o C site tc z- , Z Subdivision name Lot no. Other homes on property? Yes No Previous owner of property rl-rf'l(Sf-T' Total size of property !b 1 GIcrr-S Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume and Page Number h as recorded with the Register of DeedFi. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRAIVPY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. 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 Certified Survey Map sha 1 also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on, this form are true to the best of my (our) knowledge that I (we) am (are) the owner (s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No !-10(, 12oG -Pr-ce "0 , and• that I (we) presently own the proposed site for the sewage disposal system or'E=Z (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register ot.. Deeds as Document No. Signature of Applicant Co-Applicant q STC - W5 SEPTIC TANK MnIN'1'h,NAN(:I, nCltl;P.1111:N'1' St. Croix Count}. o«►Nr:IVrnrYr'•it M"ANG- ADDRESS PROPERTY ADDRESS c ~ en (location of septic systcm) Please obtain from the Planning; Dept. I'ROI'I?IZ'T1' LOCATION I/4, 1/4, Section TOWN 01 ~ ~zT ST. CROIX COUNTY, NN'I SUBDIVISION LOT NUMBF,R CERTIFIED SURVEY MAP , VOLUME, PACT; 3K32. 1,01' NUMBER 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 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 for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. llic property owner agrees to submit to St. Croix "toning a certification form, signed by the owner and by a mater 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 I/We, the undersigned have read the above requirements and aprce to maintain the private sewage disposal systcm in accordance with the standards set forth, herein, as sct by the Wisconsin DNR Certification stating; that your septic has been maintained must he completed and returned to the St Croix Count} %.olling, Officer within 10 days of the three year expim6on dale DA I'1=. tit (r~~n (onnly l.oning, Oghee / Q l iovc~nmcnl l ~c•nlci 1101 r'arnruchavi Road (ndsom. \VI '1401o t g /'I t w0.1A outs 111 J.,21Vd . blot ~t i I-) a.w + its (leutud dbjilabyl~aM 1~~u3ti s~IH~11t1 utJaq ►ca (auo 15ea1 IL 10! CC~C V ~O j STA1E l3AR OF WISCON 55 WARRANTY DEED Ii DOCUMENT NO. Vol. ~ )PAC[5,50 This Deed, made between The Ernest E. Gustafson Livin Trust dated March 7 1991 b -----Ernest_E-.-Gustaf so n,_ Trus.tee'NOV Grantor, and Kenneth A. Zak and Barbara J. Zaki husband u1 1:30 P.. and wife as survivorship marital-property -i_ - - - Grantee, I - i Witness eth, That the said Grantor, for a valuable considetatioti_ Of one dollar and other valuable consideration conveys to Grantee the following described real estate in S t- C r o 1 X - THIS SPACE RESERVED FOR RECORDING DATA County, State of WlSconsm. i~ NAME AND RETURN ADDRESS Kenneth A. & Barbara I. Zak 1319 Webster Street North Part of Government Lot "I" of Section 22, i Hudson WI 54016 Township 33 ]Iortli, Ran ,-e- 20 Wo,;t, St. Croix 11 County, .)iscon.;in described as follows: II I Lot 2 of Certi?`.ied Surv y lfa;-) filed II June 29, 19:31 in Vol. "4" Pane 13;1 030-2028-20 ii DO C . NO . 3 7 1 7 7 It PARCEL IDENTIFICATION NUMBER it Subject to a non-exclusive easement over the following; described l portion of Lot 2 for ingress and egress to Lot 1: The North 66 ~I feet thereof. ii The North 22 feet of the easement shall remain open at all times. The South 44 foot portion of the 66 foot easement may be used for a parking area by purchaser, his successors and assigns. 1.I ANS ER This is not homestead property. d (is) (is not) Together with all and singular the hereditaments and appurtenances thercurau bclunging; C And The Ernest E. Gustafson Laving; Truster dated tlarch 71 1991 warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants, and restrictions of record, if any, !I and will warrant and defend the same. L,, Dated this _ day of - 0- ~'Jt' ,19-9 6 (SEAL) 1~ (..!lea c--. (SEAL) TThe-Ernest E. Gustaf on Living - *_Trus_t- da-ted I1arr-11 1-991 BY Ernest E. Gustafso ' Trustee - - (SEAL) - - _ (SEAL) * * 'I AUTHENTICATION ACKNOWLEDGMENT State of Wisconsin, ss. ST. C RO I X Count. Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT age of Labar~and Human Relations 2 3 Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but S not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or CEL I.D. # VC-Lf dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION VIEWED§T C;, X PROPERTY OWNER: PROPERTY LOCATION LNG Re, f GOVT. LOT s- 1/4 51M Sr` E PROPERTY NER':S MAILING ADDRESS LOT # BLOCK # SuB9-1GE M 6 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [ZrOWN NEAREST ROAD / Cl O &RD [/J New Construction Use [ ] Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement Public or commercial describe ssc~,v rro.~ L - ~t.~ei~► s~ zz-.v~ 'Oes Code derived daily flow JM gpd Recommended design loading rate 7 bed, gpd/ft2 r nth, gp ft Absorption area required bed, ft2 375- trench, ft2 Maximum design loading rate bed, gpd/ft2 _ trench, gpd/ft2 Recommended infiltration surface elevation(s) Z - 4r. 4 _,3 y - 9s3' ft (as referred to site plan benchmark) Additional design / site considerations / ~E~ s wvf7 Rce~.r rEy 70 e'dv1E-R cs /G,~ Ties rs v~^ ,~t'_ N ,rvFrL~.a rxgzA) ~LFV~r~NS, Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem OS ❑ U ❑ S [ZLI B S ❑ U ❑ S Z U ❑ S 12U ❑ S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots tBe D/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Tw Ich { ( 3 2 _ s L All F9 s AA Z 8 Ground 3 r 4 3 .S 6 N1 L elev. .t' L ft. Depth to limiting factor > g4 Remarks: dwx 41`_7 302 d~e- L10/3 Boring # 2 } L p 7 .z , - 3 SG O e s ? -tiha k. v•.;.v f ~Gl ~7 ` _ 3 S S !r $ Ground elev. ?4 -7 ft. Depth to limiting factor > Remarks: > S0 7d CST Nam Please Print Phone: C7' - ddres . r w oa-~~ 33 Signature: ate: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Page-? of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Borndary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends .:w 6P 2 S va /0 F S ,s Fy .3... L G-S7 3 3 5 D S~ C = Ground elev. ft. Depth to limiting factor > io Remarks: -Z .7-07, cold 2 7r ~LAcf Boring # ( d-T o 31z-- -S L lytsqX 2 4S /M '.5 -Z. S Ground elev. ft. Depth to limiting factor > pg' Remarks: Boring # sL S-1 4 -2 4d F?- x7s M S" z g-..7 Es use l o Ground elev. p~ ft. Depth to limiting factor >y-e Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) Dave Fogerty Plumbing SEWER SYSTEMS & PERK TESTING FOGERTY HEIGHTS ROAD ROBERTS, WISCONSIN 54023 (715) 749-3656 tPA V-V $4 7'A x x jv .H~►X. LY' PT~+ 1 LET # ~ ~ sa cma, ~k 9..s` eR Er SCrtLF ~ rr _ yO . # 4= , Tvv a F s J o,e.v 2 ' i 4I~ Fop ~Ah-T~o.V . ~sSGrMC ioa• O i ~l 1 d = B/N Tai Olc Slt4,t c Zoe,4 rF O .z/!i sfe~rc€ R.D ~ #S'sa~tE f /oD • 2 ~ • ~ ~ti.vi~ Lv7` Co/~~i~'RS u~ 3~0 f ~~y " ~ v2 ~E yo/L Pr~FS • -3-5 ~ I r /3t)R/Y1 Sr zs~v 360° Al X it3 3y ~ ~ 6 ~ /vor/ t ~~A. f~1NA ,Z 9G/s,CGO 7-0 Imo/ L2N€ ~~D DuE 7b K 10/ ~7FU t . L ocd ~OUA/v~}7Sf~Al - I Ar if" v0 V.1 00 IV; 40 (y CUUNTI CLERK 10002,,003 r- _ r - Jo, F1E-ED w JUN x'91981 ~ 371774 MW oomm ofwo ST CRO/X COUNTY CERTIFIED 5URVE'Y MAP LOCATED IN PART OF GOVERNMENT LOT 4 OF SECTION 22, T. 30 N., R. 20 W., TOWN OF ST JOSEPH, ST. CROIX COUNTY, WISCONSIN NE CORNER OF GOVEf7NMENT LOT 4 RA/LROAO SP/KB FOUND - VPL,Q.r LA~YP~s 50' 50 . S. 899 46' 26"E. ( EAST) 660.00' .0 604,44' + 55.56' k z I ~ T 2 33a 1o 10; a 212, 203 50. FT. (4.872 ACRES) TOTAL Cie \x -~b!O I y r 198, 828 SO. FT. (4.584 ACRES) EXCLUDING R/W \ I^ o k ~ x % r All rn s I~, to OcO~ 0 Z O 336.22' 'x3.78' i ;R N. 890 55' 00'' W. (WEST) 390.00' 1 y a APPROVED 1 0. JUN 17 1981 N Z ti g wY b o m U O O (1NPLAT~O AN ; Si. CROIX COUNTY COM"t"GH51W PARKS MANNINO m _ AND IONINO C00AMITT11 . W ~x 9,9oS•~, IC ~ . r N. 891155'00" W. 270.00' 001, 390.00' 62.17 - _ ~ 05243' ~ ' TOTAL LIME A-p= N.890 00" W. 752.17' ( WEST 730') .liE/271£(EQ $S1QVE~ M6P L~¢C ~ .l'BG£_$2~ EXISTING 20 W OAD N LEGEND , ~ C) N z 0 I"X 24" IRON PIPE SET a WEIGHING 1,88 LBS./LIN. FT, S 114 cofimEp yi • I" IRON PIPE FOUND SECT/ON 22 - 30 - 20 Z COUNTY B•fC. vwENT Q 2" IRON PIPE FOUND O d~ ( 1nere AV nrrnmm Visond Human Department Relations Industry, tabor r and SOIL AND SITE EVALUATION REPORT Page / of _ 3 Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWEDBY DATE PROPERTY OWNER: PROPERTY LOCATION te," Qom' K GOVT. LOT S~ 1/4s4,0 1/4,S.22 T 3o ,N,R ..21 E (or)O PROPER OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM 2 daL. . /df/ CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN REST ROAD LCfije_?14 ca-'r 0/6 ( )_?89 - sys s'7, 7Z&~aA EA 6 New Construction Use[ J Residential/ Number of bedrooms [ j Addition to existing building j J Replacement Public or commercial describe /rri~ , s>r~x~ - z l~0/zrri ssL.cr~~ Code derived daily flow gloo gpd Recommended design loading rate gibed, gpd/ft2__trench, gpd/ft2 Absorption area required V-> 9 bed, ft2 375 trench, ft2 Maximum design loading rate -bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) z 7,6- - 9S' / " 4 Z V - 95: 3 'ft (as referred to site plan benchmark) Additional design/ site considerations To /eVFC rS/6Z . 7,Y-Cr _gr Ar Parent material CrzuAjL ~ J^ )f7 Z& .2 F ~a)e,* 7-xrv Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system ~Z S ❑ U ❑ S O U OS ❑ U ❑ S ❑ U ❑ S O U ❑ S VI U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 0 L L nr ~3~ -r y'yp ~ Z Ground o - G /IFS .7 -P elev. ft. ! Depth to limiting factor Remarks: z 107 e~e_' -ISOo 3 0 0 . X 06. _ Boring # / o ~~2 2 -57 2.5- 3 4 G T CS ~O ,ta Ground elev. X991 ff,.Z ft. V MA Depth to R limiting factor Remarks: 2 ? 51-7 7- C - CST Name: Please Print Phone: S~ Address: S' o23 .2 96 #3 33 Signature: Dat : CST Number: PROPERTY OWNER Z4~ SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench /0- ZM Py 3 -1 Ground Os niL - elev. _ ft. Depth to limiting factor > Remarks: L so?` v G~cE Boring # l b ~9 - 2 s1 s 2AA s- Ground elev. _ ft. Depth to limiting factor Remarks: x s'07. 424, AX Boring # -S7 z.S- O S Gs - D-!~:fr ~L Ground elev. ft. Depth to limiting factor Remarks: 2 ? 70 Boring # Ground elev. ft. Depth to l limiting factor Remarks: