HomeMy WebLinkAbout006-1022-10-000
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Parcel 006-1022-10-000 09/27/2007 11:30 AM
PAGE 1 OF 1
Alt. Parcel 10.31.16.142 006 - TOWN OF CYLON
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - BOE, RONALD & RITA
RONALD & RITA BOE
2328 222ND AVE
DEER PARK WI 54007
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ` 2328 222ND AVE
SC 1127 CLEAR LAKE
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 10 T31 N R1 6W 40A NE SW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
10-31N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 414/397
2007 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 09/11/2007
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 25,000 160,200 185,200 NO
AGRICULTURAL G4 9.000 1,200 0 1,200 NO
UNDEVELOPED G5 19.000 13,000 0 13,000 NO
AGRICULTURAL FOREST G5M 10.000 15,000 0 15,000 NO
Totals for 2007:
General Property 40.000 54,200 160,200 214,400
Woodland 0.000 0 0
Totals for 2006:
General Property 40.000 39,200 160,200 199,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 512
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
L
ADDRESS i q,, - /~C1 Nui
SUBDIVISION / CSM$ LOT
SECTION-__4& T--3 J N_R-Town of
n
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
1
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide
J
BENCHMARK:-Ave
ALTERNATE BM:
EPTIC TANK PUMP CHAMBER / BOLDING TANK INFORMATION
Manufacturer:
Liquid capacity: Q
Setback from: Well
House ~ Other
l Pump: Manufacturer Modell
r-- Size Float seperation
Gallons/cycle:
Alarm Location
:SOIL ABSORPTION SYSTEM
Width: Length
Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well:
•-LHouse ,SS Other
ELEVATIONS
Building Sewer
ST Inlet: ST outlet
PC inlet PC bottom
Pump Off
Header/Manifold Bottom of system
Existing Grade
Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB: \
LICENSE NUMBER:
/►'L c~/
INSPECTOR: ~1MA C~
3/93:jt
Wisconsin 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 284170
Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.:
EOE, RONALD CYLON
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
/eo a)
TANK INFORMATION ELEVATION DATA 9/ f
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/ Inlet 7.79 94TANK SETBACK INFORMATION St/* Outlet 2
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
'
Septic (D X4 NA Dt Bottom/rA
i
Dosin NA Headers e9
i
Aeration Dist. Pipe 130
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer 1 1 Demand ~a,.; a}e,`T' 36"
y~na 4 Csi.r'
Model Number GPM
TDH Lift Lriction tem TDH T
Force n Length Dia. Dist. To e
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Length No. Of Tre ches PITT No. Of Pits Inside Dia. Liquid Depth
DIMENSION l~ DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE STREAM LEACHIN anufacturer:
INFORMATION TypeO he4.. y~ O A NIT R Model Number:
Ls-
DISTRIBUTION SYSTEM
Header /~(Iaa+eict' p Distribution Pipe(s), !7 x Hole Size x Hole Spacin Vent To Air Intake
Length / 2 7 Dia ( Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Gra ystems 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.)
LOCATION: CYLON.10.31.16W,,gNE, SW, 222ND AVENUE
f~`G ~ ~a1 ~ ~ C`Y7 ✓ °l .
cc~
Plan revision required? ❑ Yes M-AFo'
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: I
Safety and Buildings Division
vp`riR 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 't^ ,
than 8 112 x 11 inches in size. 5 ~ r
• See reverse side for instructions for completing this application state sanitary Permit Number
,:V, 7
The information you provide maybe used by other government agency programs ❑ Check it revis on to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Pro rty Owner Name A Property Location
31- , N, Rr/~j E (o W
}L C114 C 1i4, S16 T
Property Owner's Mailing Address Lot Number Block Number
ry/'
CA ,State Zi Code Phone Number S Subdivision Name or CSM Number
110,2 A- 1(71s- 2
. TYPE OF BUILDING: (check one) ❑ State Owned o v (age Nearest Road vl / f
❑ Public EN~l or 2 Family Dwelling - No_ of bedrooms Town OF
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Numbe//r(
rnC9 r/t✓ r~~ -
1 ❑ Apartment/ Condo c.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 online B, if applicable)
A) 1. New 2. ❑ Replacement 3- ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
__ystem System Tank Only Existing System Existing System
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 , j 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. Fina[ Grade
50 Required (sq. ft.) Proposed (s . ft_) (Gals/day/sq. ft.) (Min,/inch) Elevation
ZY Feet 160 Feet
VII. TANK Ca
in galloaccts Total # of Prefab. Site Fiber Plastic Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steed glass App.
New Exist in strutted
Tanks Tanks
Septic Tank or Holding Tank ~~C.--~-~ ❑ ❑ ~
Lift Pump Tank /Siphon Chamber El [I El n' El 0
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber" gnatur : (No Sta p P MPRSW No.: Business Phone Number:
Plumber' Address (S eet, City, State, Zj Code):
exn
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes groundwater ate issued Issuing Age t Signatur (No Sta p
P❑ e, s„rrharge fee) Owner Given Initial J jl~ t~
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to Counly. One copy To: Safety & Buildings Divi ion, Owner, Plumber
•
INSTRUCTIONS
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 gystem, 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'rnust 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- 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 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.
•
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wiscpnsin Department of Industry, SOIL AND SITE EVALUATION
Labol) and Human Relations Page of
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM); direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I D# , w j r P~~v
APPLICANT INFORMATION - Please print all information. Re)r*Wgd by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
W
/'L Govt. Lot/4f [JI/4 S L~ T to E d ,q V :C - - -
Property Owner's Mailing Addre Lot # Block# S bd. Name or CAM#
City State Zip Code Phone Number
[:1 City El Village Town -N4e;rest,Road
New Construction Use: 13Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate . 2 bed, gpd/f12% trench, gpd/ft2
Absorption area required bed, ft2,trench, ft2
~ > Maximum design loading rate , -2 bed, gpd/ft2_trench, gpd/ft2
Recommended infiltration surface elev tion(sr ft as referred to site pl n benchmark)
Additional design/site consideration
Parent material Flood plain elevation, if applicable ft
S = Suitable for system Conventional rM,~ound In-Ground Pressure ,ATT-Grade System in Fill Holding Tank
U = Unsuitable for system S❑ U ICJ S❑ U 5eS ❑ U t.Zr1 S❑ U ❑ g R U ❑ S U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2
Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
S >K rn, 'C~' . a
Ground
e A 10 n4 7
Depth to
limiting
f ,
,Min.
3 Remarks:
Boring # .
OC,
s 05 ,
Ground 1 Y1~- /Vw / o
Depth to
limiting
In. Remarks:
,a&
CST Name (Please Print) Sign re Telephone No.
76 71.5:'j OW
Address, 6J j S OW 6- /62 Date 4, CST Number
ell,
SOIL DESCRIPTION REPORT '
PROPERTY OWNER; Page of PARCEL l.D.#
Boring # Horizon Depth Dominant Color Mottles Structure 2
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Rests
Bed Trench
Azy,~ Q?
Ground [73 ~S
ee.
Depth to
limiting ;
3, a Remarks:
Boring #
1 - i r` , 5
oo~~ Ground
Depth to
limiting
fa o~
Ain.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # 0_10 "A w--- 5'
Ground - ✓ ' ✓ ~ A114 J
Depth to
limiting
2-min. Remarks:
07
Boring #
J-0 J- 716 pig
5
Ground
Depth to
limiting
to
'7in. Remarks:
2
SBDW-8330 (R. 08/95)
,y Soil Test Plot Plan
Project Name Ronald Boe B on Bird Jr.
, ~3
Address 2366 222nd Ave
Deer Park Wi 54007 TM #3479
Lot Subdivision Date 6/12/96
NE 1 /4 SW 1/4S1 0 T 31 N/R 16 yi/
TownshipCylon
Boring O Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft.Base of 2' Metal Rod Red Ribbon
System Elevation 97.1 * H R P Same as Benchmark
10'B-1 40' B-4
Rep A Pri A
45' 5%
Slope
30' B-3 25' B-6
45
40'
10' 25'
15' B-2 B-5
Note: Rep Area
*B.Mrequires a .4 or .5 load
Late. Pro 3 Bedroom
House
0
b
c~
1150'
r
222nd Ave
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER RD0aI Q0C J
-y V
MAILING ADDRESS O'~~a .p-'
d ltd
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION t\) E 1/4, SW 1/4, Section /0 -1, N-R 1CP W
TOWN OF 0,0 ](j(~ ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIEDSURVEY MAP , VOLUME , PAGE , LOT 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.
The property owner agrees to submit to St. Croix Zoning 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.
VV'e, 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 stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED~
DATC
St. Croy County Zoning Office
Government Center
1101 CannIellaCI Road
Hudson, W1 54016
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 l 0r% . 6
Location of property LS\ E 1/4 SLW 1/4,^Section 1D , T N-R__j W
Township C-a ton Mailing address 83 WO aac~j
Address of site
Subdivision name Lot no.
Other homes on property? Yes.. j _No
Previous owner of property
Total size of property
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 _4~_No
Volume and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY 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
shall 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. , and that I (we) presently
own the proposed site for the sewage disposal system or I (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 of Deeds as Document No.
Signature of Applicant Co-Applicant
Date If S gnature Date of Signature
• A DOCUM€NT NO. '
pp 9 STATE BAR T~MTNSD 1~ FORM 2
vOL 614 em,459 THIS SPACE 099ERVED FOR RECORDING DATA
B
REGISTERS OFFICE
._...-_..t A..:n_......
ST. Citom CO., WIS.
ROC'd: for Record this 3-5t h
day of J11 ly /L D. 1980
.sa gs and warrants to ...Ronald.A.._Ile..alld.Rl?.A..I3.A~a--,~..._.- at 11.45
A. -
tti ae n*-Lenarsts
°t oaa4~
I RETURN TO
the feDawing State Sacese ibad real estate in 3ti. _C;rQJX-----------------County,
Tax Hey No.
The West Half of the Northeast Quarter (WI-NEI), the Nor-U, Falf of the
Southeast Quarter (NJ-SEJ) and the Northeast Quarter of theSouthwest
Quarter (NEI-SWJ) of Section Ten (10), Township Thrity-one (31) North,
Range Sixteen (16) West.
This deed is in satisfaction of Original Land Contract dated April 3, 1971
and recorded as Docwhent 0 304430 in Vol. 470, pages 332 and 333.
FEE
#A-F
0 0.
This is homestead property.
(is) (is not)
breeption to warranties: Toning regulations and easements of record.
Dated this ....15M! day of ---------'-JP.2j
19__
,~J
--•--••-.-.....(SEAL) ,G~:.S-~J '.."~..`.._...i'~ ' ----(SEAL)
Nellie Dlson
•---•-••---••--••-•----•-•--••-•-----•-•---------------•----••--•---(SEAL) .---•-•---•---•--•-•-----....------°--•---•----•--•--•--•---•-----.(SEAL)
AUTHRNTICATION ACBNOWLBDOMBNT
Signatures authenticated this day of STATE OF WISCONSIN So.
t-•-~.rQ1A County.
. Personally came before me, this 15th..... day of
• July.158C...... the above named
TITLE: MEMBER STATE BAR OF WISCONSIN -•-•-•--•_.......__..I3ellie_3•. Olson
(I1 not .
authori7>d by § 706.06, Wis. Stats.)
TNIS INSTRUMENT W4kS DRAFTED BY I...... tq m known the perso~4 who executed the
,ice\~~- i $pf s! ,ent jVc!/flowldgetame.
. • c f~~ /i1A