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HomeMy WebLinkAbout020-1309-30-000 D O dr O O tl• y evi Oq C N O N Q. ~ C n I O O N O •i 4 rC e ~ I II', I 0 0 I! Z o c C,. LL o x o o. Q •o U') Z N cn " G rn W O z'' d d O d m 04 c U G z Q~ ! cn .p 0 N Z d' ~ N Z N H c a N = d a~ fly_ N 2 •'ri I d C U 0 a) O Z F- z Z. N C > ° C I d s. N T O y d EI N U co ~fnfAN _3I0 s- tw U- z I I a Oa a N a g cC N 0- (0 N J U v~ rn r C') LO a) _ S ao o O o C M C) _ m N N CD M ~ co O O a CL ~ m N 7 H 1~1 Ci N C3 O N O 75 o C U d pOj O O rO OCM LO 30 Co N E Y tl Oy = N V F a O o c I' m ~aoi ) n` L r O N t Q5 N O Z C N yy CV -p N O y O Kffi U • = LL 04 O N Z 2 2 Cn O ~ E 1 ea = E CL ak a a w a d c E c c r'~w1 c 0 L) (L Parcel 020-1309-30-000 04/10/2007 02:23 PM PAGE 1 OF 1 Alt. Parcel 16.29.19.1552 020 - TOWN OF HUDSON 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 - FISCHER, PAUL J & JOAN M PAUL J & JOAN M FISCHER 935 WAXON LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 935 WAXON LA SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.120 Plat: 2335-PLEASANT VIEW SEC 16 T29N R19W PT NW SE LOT 13 Block/Condo Bldg: LOT 13 PLEASANT VIEW 2.12 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1137/394 WD 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.120 69,500 284,100 353,600 NO Totals for 2007: General Property 2.120 69,500 284,100 353,600 Woodland 0.000 0 0 Totals for 2006: General Property 2.120 69,500 284,100 353,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 137 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r , nsin Department or Industry, SOIL AND SITE EVALUATION REPORT P il~ ! and Human Relations age Of Divwon of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Sr. c Ro 1' Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, ~u. 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 REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION IV64100 E• 4V A X O N GOVT. LOT '->EST• S6 1/4,S 4 T 2 9 N.R. ,I q E (o~ PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # S 9 cry- 'Rio. A 13 PIE*4SflrVT UtEk3 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OWN NEAREST ROAD Dosch gz) ' S. SYo/C (7/5) 96.3938 HUDSO.J cry w0 1+ (-fNew Construction Use [ Residential / Number of bedrooms _ 3 40 y [ [ Addition to existing buildOg j J Replacement M- [ ] Public or commercial describe Code derived daily flow &cv gpd Recommended design loading rate - L bed, gpd/ft2 ' 7 trench, gpolltl Absorption area required bed, ft2 trench, ft2 Maximum design loading rate - 7 bed, gpd/tt2 • 8 trench, f Recommended infiltration surface elevation(s) 6-e2 p .3 ft (as referred to site plan benchmark) Additional design / site considerations Parent material scs S 8 R t Tif /Flood plain elevation, if applicable N • It S = Suitable for system CONY IONk MOUI& IN•G90UN❑D U PRESSURE 77, DE❑ U SYSTEjt w FLL HOLDING TANK U = Unsuitable fors stem LAS ❑ U B S ❑ U BS i ❑ U ❑ S Bir- SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bmi- 3y Roots GPD/ft 13 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed wxh -18 /a yX 313 - s/ 244 56,E dS Cs .s •C Ground • y0 ?•S y~ y/G - C . s• , s elev. 99. -/ft o 'I`3 /o ye s/ Depth to limiting factor 2-S G/ Si P f f4W 40 fJ Q'e • . y S- S"l~ t Remarks: ~~i ¢ ~~1U %•v c ~~l~oaS ,UDa,- C~,~~%~vp o_s' o~ S~ Boring # o-~ is ye 311-- s/ 2,4" sg,~ 411' s 3 t s• 61 El /o rR 3 If v s/ - ~R c/S cs • S Ground elev. d 3 /o y/L S/ fl L'.S• f', s G~.~ IL Depth to limiting face„ Remarks: CST Name:-Please Print Ro 13E R r 21 L 13 R, i c h r Phone: 715, 3 404 ' 8 f 8 S Address: (055 C' PeCL 'RD. t+uOSonj CoI.S . Syo"' ,f - CSrh 248E Sgnature: Date: CST Number: PROPERTYOWNER Del fo wptX D'J SOIL DESCRIPTION REPORT Page 3,' _Z_S PARCEL I.D.# ~o t t 3 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bmcxi3y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed WK:h 3 I /a /Z 3/ 1 S 2'., r~k s s 2 f . s Z . i2 A0 y e 3/ v Ground 3 2-3'P 7•s ye Y/6 9~ tt~yS O= S W, CS elev. Depth to limiting t factor 7 Remarks: Boring # 6-F /©M 3/L S/ Liu, f14'r ds S 3 f- • -S = • G s _ z /a yA 3/f~ , s . Ground 3.3 ?•s - 9 fly 0 , S C S 7 elev s o A 51 C• S o► S • 7 i y,S eft. _ Depth to i limiting = factor n ~ Remarks: Boring # o -M yie 3/2- A. s~iK 45 -rs 3-f .5 i . G 10M 2~ a •3 7•s viz s/ ~~~r s aQ1L ~S - • 1 Ground / i S t ~ ~fL s l• Depth to 0 /6 ,e ~ •.S . S . i limiting factor ft I y~ I Remarks: Boring # LU Ground elev.. Depth to limiting factor Remarks: can 01212^10 nconm f iPo~~s, ~v o ys ' y ~ H W 'O C h n '1 can d~ 3 00 11 rv N Z Z o t o s m Vila N r - v o N . r o~ ~ r 0 / ~ 10 11 STC 10 4 AS BUILT SANITARY SYSTEM REPORT F~ 71996 _ -A S.T CROIX OWNER ~iXGrG -C"'s~~y1 OlF►cs= 'V ZOivlraG rJ~ ADDRESS ?Zr ryi9L~o~y L/c• l~Gr•~S'~ G~.~ c moo/ SUBDIVISION / CSMt 4XrWA,7 1r•X rt1 LOT t i3 SECTION T 19 N-R_ZI_W, Town of ~~iDSOrD ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM _ 33 L r`r C /6y SX9a o sX~c INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. y ~ # / s•T Q,M • rs ,u. N • ~ov62 ~ .~~saM~ i~~p ' BENCHMARK: L %vp of A4-re- j<,ffr- 0,z' G~r~ ',tJ F6 ~ ~osT ALTERNATE BM: %li.v A410- Nv7- ) SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ,LE Liquid Capacity: Setback from: Well House Other Pump: Manufacturer- Model# ~ e Float seperation Gallons/ Alarm Location :SOIL ABSORPTION SYSTEM Width: 5 Len th g fo Number of trenches 2 Distance & Direction to nearest prop. line: /I/ Setback from: well: House--Ze.T ' Other ELEVATIONS M. H. rd cl ? lew-a ~ M Building Sewer P6.O ST Inlet. ST outlet PC inlet PC bottom Pump Off rr-s y - Header/Manifold.z ''`f 3 ss'Nl~S ~i ~7s QY•-f-' Bottom of system-ej!.i ,.z' rf i 9Y•'y Existing Grade lp fr Final grade DATE OF INSTALLATION: 7 ~6 PLUMBER ON JOB: LICENSE NUMBER: .Z INSPECTOR: 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 PerF1St# : mVAUL ❑ City ❑ Village [Town of: State Pla CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV_ Septic Benchmark /by c~3 Dosing 107, Aeration Bldg. Sewer g, q 9S ;,9 Holding St/Ht Inlet 9 y 45.5.2 TANK SETBACK INFORMATION St/ Ht Outlet 45,0 - Vent TANKTO P/L WELL BLDG. Airito ntake ROAD Dt Inlet Ar Septic 5 l j p NA Dt Bottom Dosing NA Header/ Man. aog qF%o~ 7 5' Aeration NA Dist. Pipe 1, ,0? Y. ~3.8 C«, .,ct Holding Bot. System q3s 6 PUMP/ SIPHON INFORMATION Final Grade 't 0, Manufacturer Demand Model Number GPM TDH Lift Lricti System TDH Ft Forcemain L gth Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSIONS / , DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of nL,,..; CHAMBER Model Number: System:,,,/,- p.k~r i--r 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.) LOCATION: HUDSON..16.29.19W, NW, SE, LOT 13,'WAXON LANE r Plan revision required? [3 Yes []No Use other side for additional information. 6 SBD-6710 (R 05/91) Date Inspector'sSignature Cert. No. r ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ti r SANITARY PERMIT APPLICATION BureaSafetyu o oand ff Building lWatWaterr Sy eSy stem: In accord with ILHR 83.05, Wis. Adm. Code 201 E. Washington Ave. 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 1/2 x 11 inches in size. 94O • See reverse side for instructions for completing this application State Sanitary 1Permit mber The information you provide may be used by other government agency programs ;.6 l 7 (Privacy Law, s. 15.04 you (o de E) Check it revision to previous application State Plan I.D. Number 1. APPLI ATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location 1/4 1/4, S 14 T IN, R E (or~ Property Owner's Mailing Address Lot Number Block Number City, tate 2- /9 Zip Code Phone Number Subdivision Name orG9IYl-Nrrm{Xr I. TYPE OF BUILDING: (check one) ❑ State Owned ems ❑ city Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms` ,t~ village Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 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 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. la New 2. ❑ Replacement 3. ❑ Replacement of 4 Reconnection of _-System -----__-System E] 5. E] R ting Sys Tank Only-----------_-- Existing System Exis-ti tem 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 110 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12,0 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 Required (sq- ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) OLI Elevation L Feet Feet VII. TANK Capacity in gallons Total # of Manufacturer's Name Site INFORMATION Prefab. Fiber- Aper. New Existin Gallons Tanks Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank _ 1,46 ❑ 0 ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber, ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the site sewage system shown on the attached plans. Plumber's Name: (Print) Plumb is Si nature: (N mps) M WMPRSW NO.: Business Phone Number: r' lumber's Address (Street, City, State, Z Code): t 7 A4 /,ro, m~ © 2 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa ry Permit Fee (Includes Groundwater ate Issue Is ing Agent ure (No Stamps) ,4'Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: `D-6398 (R. 05194) DISTRIBUTION: Original to County. One copy To: Safety a Ruildings Diw;ion, Owner, Plumber c -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. Onste 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, orrepair_ 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 4 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) fora 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. u' i r PLUMONG Tester & Plu~r UCeraed pork #3288 #3289 RoBe°~ ss . ~ Vloots s'"° 0023 pwo 749! 7 3/ a/f6 r ~fv T 51, 1 Icc ~ 0 cut xv t/ e~ 41 #i3 ~.~i i4ccE5 ~F'i = 13M~ To/' Df ,v.~2L /1-T BASE D r ~GY//.~ A ffr'c~ /~~5% /=Lio~GE j ~zFr = t7• s ~ s 'X 90 O = /hod c sl- S.T. „i~tt o rgo* F, T. ~.~~s~uiu S~7'~Ks ,~lcou,v~c A~C'ourlTF~ r~~ FOGERTY P & 1-UMBING PERK TESTING, IIVC. R08f P-0- BOX WI154023 t~ ~r ~GO~'E /a'- ZOO r.Z r Wiscon'sin'Def>artment of Indus LaborahdHumanRelations SOIL AND SITE EVALUATION REPORT Division of Safety & Buildings Page L of 3 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 ST C/zo~ not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. PARCEL W. # APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION PROPER I Y OWNER':S MAILING ADDRESS GOVT. LOT w 1/4 1/4,S 6 T N R E (orv S Z Q'*£u/pQp LOT # BLOCK # SUED. NAME OA CSM # CITY, STATE ZIP CODE- PHONE NUMBER - LE T (]CITY QIIILLAGE (MOWN NEAREST ROAD JJD - lo/ 7 ,y~~ ~v SOti L1, (/J New Construction Use [A Residential / Number of bedrooms 5 j J Replacement [ J Public or commercial describe [ J Addition to existing building Code derived daily flow Z.LO gpd Recommended design loading rate Absorption area required bed, ft2 2 --~-b~~ g=~~ench, gpd/ft2 93~ trench, ft Maximum design loading rate 7_( , gp 2__- I_trench, gpd/ft2 Recommended infiltration surface elevation(s) 97 S' ! Z Additional design /site considerations ~ ~ 93~ ft (as referred to site plan benchmark) Parent material IN ✓ -,-Z' 7TC.9L To F " sfrLG lortvrDar~ ~T Flood plain elevation, if applicable ft S =Suitable for system CONVENTIONAL MOUND U = Unsuitable fors stem Z S ❑ U E3S IN-GROUND F-11 PRESSURE AT-GRADE SYSTEM M FILL HOLDING TANK [au p s u ❑s IZU Ds tau Ds du SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles in. Munsell Texture Structure Consistence GPD/ Qu. Sz. Cont. Color Gr. Sz. Sh. BoirdaY Roots Bed Trerxtt 0-3 3 Z_ f V2--V 1z,eo 2--_z) S M Ground elev. /!~3. -Z1/ o-y ~ I Depth to V 3 limiting factor S O SG ` - - 7 Remarks: Boring # A93 G 6/- i o -s ®s6 /VI L - ,B Ground elev. m 74 ft. - - S O Sir /\A G - Depth to imiting actor Remarks: CST Name: Please Print Ur E2T Phone: Address: s-,G /3a '.Signature: ~ Date. 'PROPERTYOWNER _ /W'6 6rS11AFlz SOIL DESCRIPTION REPORT Page -2 of 3 PARCEL IA # /9 T W/ 3 Depth Dominant Color Mottles Structure Roots GPD/ft Boring # Horizon Texture Consistence Boundary in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench F/Z S , 2 3 Ground Z 2q-~Z /D - S SG ~M <ge elev. _ .8 ~o ft. 3 G z ~ - S o S~ M e- Depth to limiting factor Remarks: Boring # tV...:.. / o-y r s Z r,-Z0 AMA 16 - 93.3 2 y/_6s o gr~ 3c s~X 72/- 2 3 Ground elev. 3 6s - p7 - s ®S6 /YI - - y1, do ft. Depth to limiting factor f9 ~G Remarks: Boring # _ / 0-ib lD - 3 LS Zszi_N S r SL Z,~~U o2,E ~s q7 yd 3 3 - io - V / s-7 3 c s ~ s . ~ 5 77 Ground _ elev. _ S SG L Y 77 57 Io3,?,v ft. P Depth to limiting factor , 2y, /6 L Remarks: Boring # ZE,i) mss. 3 - -3 0 - 3 LS ©zE~i 2F , z - d - s IT, sL A~ wFA -7 0 -y s L sd FS - Ground elev. _ 1 _ S ®l~ /YI L 8 /42,1 ift. Depth to limiting factor , Qnm~r~,c• c DAVE FORTY P.UMSM licensed Park Tester & Plumber $3233 HeiQ 3299 d ROBEIIfS, ~ WISCONSIN 54023 Phone 749-3655/ ~~y L fif~icr~ t i ~w 701 ~3 zs5 ro ®A ~e IV i F . 12 4c e s d d = A*t' TAP AF 1vAz'c /-7 ,~iP3F of E f t~ovDEn/ /~F'Nf~ dos % ~c/¢G'6,cv< cvOOD~~v f=~~uc~ I ~sT, \ ~ . = nor ~.rzKFIZS - ~cc f~.rvv . c~Ev~i = 97>- ' ,ECEV~ i = ~3<z 1sNE Ubbr and Department ment of Relations Industry, SOIL AND SITE EVALUATION REPORT P~__a 3 Labor and Division of Safety 3 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but s*' G RO 1• not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 6164100 E-- 44)(OAJ GOVT. LOT wE5 r SS' 1/4,S 4 T Z 9 N.R. 19 E ( W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # S 9 C-r - Ra . A /3 PlEhsANT UtEcv CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OWN NEAREST ROAD vOSo.~ 4~ts . SYo /G (7i5) k6- 3913S, H~DSo,J cry. wp. I- 7/5 New Construction Use [ Residential / Number of bedrooms 3 'Foy Addition to existing buiwg j I Replacement (I Public or commercial describe Code derived daffy flow boa 9pd Recommended design loading rate . bed, gpd/ft2 trench, 9pdtft2 Absorption area required bed, ft2 trench, 112 Maximum design loading rate • ~l bed, gpdfit - 8 trench. gpdVft2 Recommended infiltration surface elevation(s) 6,w- 0 y .3 ft (as referred to site plan benchmark) Additional design / site considerations Parent material SCS ro TiF Flood plain elevation, it applicable N It S - Suitable for system CCOONV~r10NAL L4 4W IN-GrND U ESSURE AT-G~1DE❑ U Sy-STEW W FILL HOLDING TANK U= Unsuitable for system Cry ❑ U LA'S ❑ I S❑ U E$ BI- ❑ U ❑ S SOIL DESCRIPTION REPORT ..r Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh.is Roots Bed fsandt ( p Z- /a /Q -4-11 S 244, . Co Ground y0 7•S f pie ~/~G _ C . s'. ,S elev. 99• i fL p `f-3 lo y,,e7011 4i6 Depth to limiting factor t- ~pff 44 7)• _ Remarks: f/o~Pi'Zo✓ Aw %.v c Lv.f~'D.~s .tiD~v - Cev %v~rp v .s o~ S~ Boring # 0-6 /a ye 31Z s~e ~ s S 3 f s • ~ P'f V. El ~11 fit ds CS Ground G 7'5 YR I"/~ - . S . o► S eS ~ . ~ elev. flLe Depth to limiting factor n J Remarks: CST Name ease Print Ro 8Et2 r -uLiaRc k r Phone: 715- 38G- Sr'f85 Address: & 55 4` N EC L 'R i>. V l7,so co, f1j l S. Sqo141 677' j- CS r/ t 2 4 8L Signature: Date: CST Number: 7~/I. ; PROPERTYOWNER UCOO W~4X0►J SOIL DESCRIPTION REPORT Pap 3 ' =of ff Lo f 13 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 tench 3 77 T /O 2 3/L S 2 t s .3 .s Z. i2 /o y e 31 If L WS Cs• 3 • S • G ys Z Ground 3 2-3P 7•s ye y/(, p t-.•ys o, S CS Depth to Wiling factor 7 Remarks: Boring # 6-f /o r2 3/Z-- s/ L s dS s 3 .S • G .Z /o R3/f~ ~e WS cf 3 .S 43-35 e?•S P- /y Q ► S aQ,e- CS Ground • 7 elev. -1 S 4~ /0 F5*. S5. Depth to limiting factor .Z i~ a Remarks: Boring # - 16 3/2 5 1•-10 /o ,2 9 s z,,,.•► S cs 3-F . s Ground ~ .3 7•.S ,qvF'/ C'~ S ~:Q. cs ~ • 1 elev 57 o /6 yAe Depth to limiting factor ~ it . Remarks: Boring # Ground elev. fL Depth to limiting factor Remarks: eon 01JoM10 ncmni 7ieeloo , o Sys 4 1` ~ a W Z C It n ~ `MT r ~ rn N G ~ owl LS) -l " b o } o m \ G h to o c c -C i o I w~ o to) lb C N V e y r o. z 0 S'I'C - 10.5 SEPTIC TANK MAINTF,NANCI; A(;IZI;I,'Nlf?N"I' St. Croix County OWNER/BUYF,R NU1-II,ING ADDRESS slo 2 O`lJFGyOO~j s~lJ ~l 170& N rS'//S PROPERTY ADDRESS ~3r Gr✓l4XSOrtI Gj¢q/t (location of septic system) Please obtain from the Planning Dept. CITY/STATE _&64goo/ Gvs S"~p/6 PROPERTY LOCATION 1/4, s,E 1/4, Section "I'?N-R TOWN OF. hqd:~;p^/ ST. CROIX COUNTY, WI SUBDIVISION R/-4&#,f/7- LOT NUMBER - 12 CERTIFIEDSURVEY MAP , VOLUME f , PAGE 7-/ 0, LOTNUMBER1_ 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 Jul), 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. I 0, the undersigned have read the above requirements and agree to maintain the private sewage disposal systern 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 - - W / L?2L~Pf2 . nn n ~ St. Croix County Zoning Office Government Center 1101 Carmichael lZoad Hudson, W1 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the ewner(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, _ ,'4A'1 Location of propertyXA,~_1/4 1/4, Section T.Z f N-R. Z W Township /,/NpSDAU Mailing address Address of site 6-j_r Subdivision name PL&g&-r Lot no. Other homes on property? Yes 1_~ No Previous owner of property UE,e,(~ Gr1/siXlO~ Total size of property Total size of parcel Date parcel was created lf22S Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes ✓ No Volume 11;7 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.;~ z 3 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. S 3Z / i 3 ZeZ-.1Z_ 0) 1 M. Ic.er Signatu e o Applicant Co-Applicant / 9 96 /~'?zcA /C/, /m"' Date of Signature Date of Signature i~ 1 State Bar of Wisconsin Form 2 - 19W .523 1 WARRANTY DEED - - OOCiJMENT NO. _ r7 199b I Vernon Waxon, a/k/a Vernon E. Waxon, and BUG 78 ` ----fIFen xonarrene axon, it 11:40 A. i I~ conveys and warrants to Paul J. Fischer Jean I) Fischer husband and Lfe, l I THIS SPACE AEScRVED FOR RECORDING DATA NAME AND RETURN ADDRESS /V 40. St croix the following described real estate in County, State of Wisconsin: /309 S' (Parcel Identification Number) ~i Lot 13, Plat of Pleasant View in the Town of Hudson, St. Croix County, Wisconsin. WalF r. g f~ not hod propaty. : (ice not) Exception to warrantiex Easeaflents, restrictions and rigk►ts-of-way of record, if. any. day of August , 19 95 Dated this (SEAL} (SEAL) _ - - s Vernon. a Vernon E. Waxon (SEAL) (SEAL) . Irene Waxon a Irene S. Waxon AUTHENTICATION ACKNOWLEDGMENT Vernon Waxon, a/k 'a Vernon E.: SrATEOF WISCONSIN { Signature(s) SIL Waxon, and Irene Waxon, a/k/a Irene S. Wa~oan County. authenticated this Ir day of Lst 19 9 Personalty came before me this day of ~F- Tt~ 19 the above named f Kristin Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, I to sae known to be the person who executed the authorized by §706.06, Wis. Stats.) sasegoing instrument and acknowledge the same. ar" IPA i N1t aVaO"W-.13.1! • . O { V 1 N I • • :f 1 = 1 ~ e ~ o :M I izaAVi'8;iliillaNA . 1:2 po •a I 1 •1. ~1 ` ` i • N ~ N • - M _ e ~ A No a • • i A • r 1 8 a • 1 r N r ~ • M r ` • V G' ~ • 1 • 1 - w ' ~ • A• A ~ N N y In O • CN■ • • •8 tip . o ! ~{S •~i o CID « N ' = MrOW 1~ r"r M u.• 1 • N I i * ~ / \ r • • 25. w e •r r • f i w"w►N ♦ v