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HomeMy WebLinkAbout020-1130-80-000 z C) Q z ,0 0 N O F» v N U ~ O C ~O 0 O N U f0 O N O ~ O ~ Q i a~moE Ol U > O O p t N w O > V 3 N ° Co o C c U !0 O C O O p~N CM C v z .N io -o E EE C XM m u'. C d X C aQ O N 50 m L6 Y y C C C C ~ N N N E Q C m 0--) U O M V N x N O z C O z v d z a m c o c o I. O Z 'a U OUi Z d' O O N H m 0) z .O 2 M N U VJJ cO ll y CL ~ N • N N N C *Vr L Cn _ _O m C N Q z m z o N z c : C E E c +S y d ~ W L !v O CL m w y C LO brp 0 0 0 0 z 0 ~ Lnaaa a a..g o (n V) C rn rn V! J U O rn rn } In _ LO r.w ° Mo Q °o T- I O O O M C_ DO 6 m N O 7 _ a O O N C OY.+ O C cl' C C E O w O O co 3 y o N 0 U N N a 0 0) C) (6 O C. C. -O N w co _W C C O EO M co Y ^ L L 1 iz: O 0 N C Cl) N I- H - N •y' a~ N E E U e© y O 2 N O N CA ~i r r+ I V ~ L e N M a dt _ L a w • C. y U d M C rr~~l oj E iC C 7 ~1 A ua~''ov)L COMMERCIAL TESTING LABORATORY,' INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.'. 25627/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 7/13/92 COURTHOUSE DATE RECEIVED! 7/09/92 HUDSON, WI 54016 ATTN'. THOMAS C. NELSON OWNER'. Gary Hopkins 211 LOCATION. 495 Park Lana, Hudson, WI COLLECTOR'. Mary Jenkins DATE COLLECTED'. 7-08-92 TIME COLLECTED! 2'.30pm SOURCE OF SAMPLE'. Kitchen Faucet DATE ANALYZED'. 7-09-92 TIME ANALYZED'. 2'.00pe COLIFORM'. 0 /100 mU INTERPRETATION'. Bacteriologically SAFE NITRATE-N'. 4 ppm Above 10 ppe exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIAN! Pam Gane ~.\NOEOENpFNr WI Approved Lab No', 19 a < Means "LESS THAN" Detectable Level Approved by: ~1;:11t ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 r ST. CROIX COUNTY ZONING OFFICE w`""C`"\\rv\ St. Croix County Courthouse r. 911 4th Street 0\ •,tr Hudson, WI 54016 u ~1~1✓ Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and rivate individuals. `N C mpletion this or is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, o along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 35.00 vv" (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 _ (For VOC' S ) 1 SEPTIC SYSTEM INSPECTION---------=-------FEE: $25.00 X (Determines if system is properly functioning at t of inspection) 3 11;~IOPERTY OWNER'S NAME : ~av c~WS PROP. r'_DDRESS : °i V, CI*iy v a-Sa~ Legal Description 1/4 of the 4 f S N 17 T a N-R~ Town of Num k,~~~ Y is U i._.. Q 13 FIRE Nt3MBER q LOCK BOX NUMBER Color of house -Realty sign by house?,,~T-If so, 1:7t firm: C ltA ire\~ 'C3 arv\~Q,r- PLEASE INCLUDE, IF AT ALL POSSIBLE, A NAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fr If the home is vacant, and has been so for some time, the wat._r line m'.1st be purged by running the water for several hours bef~--,)re the test can be conducted. WINTER TESTING: Many times water lines are turned --ff, or sill cc--ks are turned off, making access to the home If this is the case, please make proper arrangement. with this office to ensure time when entry may be gained. i or incx u. requesting services.-fib ~r S~\Cowg_ Tcsi~ -none Nutr In---~:- 3gLF:)-- ,RT TC) TO: C O\~J.12~~ \ JQN~`~`4V ~ _ .'1_CSING DATE: i • - A MEMBER OF THE $FARC FINANGIA! NETWORK 9 1ST CHOICE REALTY, INC. 1262ND STREET HUDSON, WI 54016 BUS, (715) 386-3942 FAX (715) 386-674+ 0826 CB RELOCATION 495 PARK LANE-HSN s PRICE: $82,500 1 ALmR,_?' _ BR HOME IN GREAT Ci~DlTION-LOCATED ON v,. PROFESS? vi ALLY LANDSCAPED ACREAGE-ttiOODBURING STOVE . IN FAM ll."~ ROOM-LARGE DECK 4L~- fir7 _Qpft. B ~t 7 Tr RFES DIRECTIONS: DIMENSIONS: FEATURES: CTY RD A-EAST TO LR•1r: `4 TOTAL SQ. FT:1040 DAILY RI, LEFT TO DR:` . _ HEAT A McCUTCHEN-GO LEFT KIT:. TAXES:c 9c'-1990 1 BLOCK-TURN RIGHT MBR: LOT:? BR:' SIDING: BR: APPLIANCES:RANGE & REFRIG FINANCING: BR: HEAT COSTS:2 1/2 CORDS FR:+ 5100 LP GAS SUBMIT BATHS:, SCHOOL DIST:HUDSON PRESENTED B": EX-R; GARAGE: LA R' BU-. T . 19 78 DON SUKOWATEY COTDWELL BANKER T' r. W-7: E, r) 11 200 y a o 2 ON 1 ~b$~ ^ O o' u"- 3 I b -l 1~- 1 Y C L ~NwT. Ruc! 300 ^ G n o - n$ I---ter n 1 y c' 1 DCR~. A Mr ~w~ur TT - I--- gRD.~ - - _ I fOVTN DIR Ytf. 1 ~ I;^ n - ^ _ mfr^~:, CARNICNAf A ~A ~ ~ ~ '\444 0 0 0 - !AN Toy ui r•, ` D wx'EN Dn. T R '~..^i J m p °y ^ o o « ^ n > p g al' -C1, RIN RD 40" nEw QA 4 f of f14 tC+'1 I °a °a n 2 a 1 O-W no.. ~I 4'p 10t•00 @ D•l Ap'% ` °i'> RD 'iAi _ o. rv n'i n 1 N \7-9 tF3i N +7 Ss 1 ti v w N w ° .yI Ar C N +A Y' .7 rQ i DDRwO IN RD. ,/V~ J MfRT C w m i I~ : z z x z s s ^ w .ROI I Co"MTRT VICW Ro. Mµ uT I CASSIC L4 y i NAM o n - zl Y a~t ~I 7 7 ' ° - o a o I DAar RD. 500 yn MA n w . V u.v ...u n.n- a v n N I I l`OOMALD LA. LARSEN to m tilt t y q0~ 1 O a l4. '1 ° ° m 3001Y1tltld i n f1M It RCAD \ { C, 1 I ~ _ ^ ~ , ^ t1ND1"1 N~~N ~ 1 ~ D IZ f ell n n li a i I lAK~ SCOTT AC. i- g n^- s o n I ><EILL-_ j I K X RD, eno i e I 700 x q 4 j n n 1^ I to W i3 y I ' 1 a ° ^ u f" 4 N w to 1 I C4 %1T I,A SAR6ES R0. D %INN EY ^ `-7 - IBRUMM(7.- u 1 KIMNfT RD C~~~ I VVV ~ - C - [ ~ - 1 2 I I I 1300 X i -Y;? -o F 1 I ,11~ { 7 n n n i°- o c I _ A a K y SUMAC TR\ A _ ~,x31r oor - { ^ , ° 1 - I ~11 T ~ t^ aA0 N I O1 ti WARREN TWN. I - - / - _ - mti v V O O O pm _--____j -goo u W on O O O ~ O O 0 IS 18 17 3 7 14 13 8 3 8 20 9 i8 19 If 12 12 4 2 HUDSON 10 ST. CROIX COUNTY WISCONSIN ZONING OFFICE a IND 11 ~rC J, _ ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 July 1, 1992 Don Sukowatey Coldwell Banker 126 2nd St. Hudson, WI 54016 Dear Mr. Sukowatey: An inspection of the septic system on the property of Gary Hopkins, located at 495 Park Lane, Hudson, WI was conducted on July 1, 1992. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. S'n rely, Mar -J.. enkifis Assistant Zoning Administrator cj NOTE: This home has been vacant for more than six months and there was no electricity at the time of the inspection. •t f V STC AS BUILT SANITARY 104 OWNER SYSTEM REPORT JAC..k o ADDRESS e LANe SUBDIVISION / CSMg SECTION__L7 Akk eW T A N-R~W LOT ST. CROIX COUNTY ~ Town of • WISCONSIN SHOW EVERYTHING PLAN VIEW WITHIN 100 FEET OF SYSTEM 301 94k, V IV(, 3 , Norma lp~ 0/4 TyftP 79-1 YO' TtiQ~ ~J~f b r ~$x 3(, Qep 01'0" p Rock t4 1 p Re(t4;reorhojf Provide se IN CATE NORTH $ tback ARROW,,: and elevation information on 2 dimensions to center of se reverse of this form. ptic tangy; manhole cover. ~ o~ 5 ~Q~ V~ Nfi - BENCNMARK• ALTERNATE BM: HOLDING TANK INFORMATION SEPTI~, TANK / P~MP CHAMBER / city* ~dU~ QA~ w5ev Evs 1N9 TpwI` y Liquid Capa Manufacturer: Other = We114v~R ~d~ House Setback from: Size Model# Pump: Manufacturer Gallons/cycle: Float seperation Alarm Location SOIL ABSORPTION SYSTEM Length Number of trenches Width • ~ • line• Distance & Direction to nearest prop Q / House Other Setback from: well:OVC T t'1ep 9 3, ~I~ - 9 3A 7 9 3. 3 V 4 3 3 0 ELEVATIONS l' ~N b ST outlet Sewer '-ST Inlet: Building r ~ Pump Off PC inlet PC bottom Q Bottom of system 91.3 Header/Manifold 95.(03 Final grade Existing Grade 5~ ~O3 DATE OF INSTALLATION: PLUMBER ON JOB: 3yo~ LICENSE NUMBER: INSPECTOR: 3/93:7t Wisconsin Department Industry, PRIVATE SEWAGE SYSTEM County: Labor'and Human Relations tions INSPECTION REPORT r Safety and Buildings Division (ATTACH TO PERMIT) Sanitary PermitNo.: GENERAL INFORMATION 262371 Permit Holder's Name: ❑ City ❑ Village [R Town of: State Plan ID No.: JELINEK, JACK HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: xz,) cts ~ . A9600182 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic zz4t Benchmark 0,610 Dosing Aeration Bldg. Sewer r - . How n-g St/ Inlet ( TANK SETBACK INFORMATION St/ Outlet 0 (-7 97 /O Ventto TANK TO P/ L WELL BLDG. A i Intake ROAD Dt Inlet Septic > 16 / A- NA Dt Bottom Dosing NA Header/ Man. / iv, uo 93 ~3 Aeration NA Dist. Pipe A9 6 ~d 50, Hold' Bot. System 0 / PUMP/ SIPHON INFORMATION Final Grade an urer Demand ~,f x,53 7,V1 1 Model Number GP TDH Lift Friction TDH Ft L e F emain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM DIMENSIONS widthl ~7 Lengt3/ No. Of Trenches PIT No. Of Pits Inside Di Depth (o DIMEN CH BER SYSTEM TO P/L BLDG WELL LAKE/STREAM LEI~ I Manufacturer: SETBACK T INFORMATION Type O r OR stem:~~ ~j 3 ^30~~ 79 >`z /4- UNI o DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) „ ole Size a Spacing Vent To Air In ke Length _::2 Dia. Length 33 Dia. ~ Spacing SOIL COVER x Pressure Systems Only xx Mound t-Grade Systems On Depth Over Depth Over xx De Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) y~'....f , LOCATION: HUDSON.17.29.19W, NE, NE, LOT 42, PARK LANE V Plan revision required? ❑ Yes a NO Use other side for additional information. _ s l~ 9 SBD-6710 (R 05/91) Date Inspector's Signa ure Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: + Safety and Buildings Division ~~■Z.ril'~ SANITARY PERMIT APPLICATION Bureau of Building Water System! 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number ,p 37 ( The information you provide may be used by other government agency ~6 Y Y programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEA E PRINT ALL INFORMATION Pr9ppay O ner Na , Property Location C 1/4 -v4, S T A , N, R /CI E (or~ Prope Owne ' iIin Addr ss Lot Number Block Number 4 -7 City "te Zip Cod Phone Number S ion Name or CSM Num r ( s~ st Road I. TYPE F BUILDING: (check one) ❑ State Owned E] qty 171/1- Public 1 or 2 Family Dwelling - No. of bedrooms ~ ❑ Town OF 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(ss))~ 1 E] Apartment/ Condo cq~ 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. Replacement 3. Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System 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 1 1JASeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12E] Seepage Trench 22E] In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14E] 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 Requft.) Prop se (q. ft.) (Gals/da /sq. ft.) (Min./inch) Elevation 0 01- 91.33 Feet .(p3 Feet. VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. - Fiber- plastic Exper. New Existin Gallons Tanks Concr Con structed steel glass App. Tanks Tanks e Septic Tank or Holding Tank WOO I 1Z_ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I n101010 1 1:1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum er's Name: P Plumber's Sign ure: (No Stamps) MP/MPRSW No.: Business Phone Number: 3~zo Plumber's Address refit, ity, Stat , Zip Code): Ile a~ O &42 A&J5,6 JJ azE IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A nt Si ure (No amp Approved ree>❑ Owner Given Initial /7 Adverse Determination 1 01~F6~ X. CONDITIONS OF P I~QVA / R •ASO FOR DI PP OVAL: I t -Tdo 4e 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 inay be renewed before the expiration date, and at a time of renewal any new riteria 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 syste,n type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. V! 1. 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 sepi. c, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII Responsibility statement. Installing plumber isto fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than.8 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. 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 TP_ k residence located at: 1ZE A14- h, Sec. / 7 , T N, R_Z_~ _W, Town of udsan , St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good co dit'on, and it appears to be functioning properly. Last time serviced o b Did flow back occur from absorption system? Yes No / (if no, skip next line. Approximate volume o length of ti e: gallons minutes capacity: 1 00 Construction: Pre ab Concrete Steel Other Manufacturer (if known): Age of Tank (if known): ~Ln~ 37rv -ems (Sign ure) (Name) Please Print mPJAP- Bimbtf 3YOV (Title (License Number) (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name J YIN f 3OlkwyU ~ S ignature ~ bLt, MP/MPRS V R- B. L PLOTA 1-11) R 0 S P 1--\'O J E C 'I L U-M-B~L N A M E _e- N A M Zm nalme e's'15 1) Al _ PLO -1 A P ~ = S3 M Te p o-'~ ve*'~ ~ ~'Lav = Ioo, D ~j ~ r~20~ r Q 7a I~~lll f(4N VAIVe QO iovd Rrrew • Iv aQ rNs~'CIPC} 9A/ y 1 N4.t ltl I IONA I ?-7 N a u e to ' 0 dG' p F,, SV' ~20►~ • ~ St ~ 1, ~ S~1~i ~ e/, NO R : A )QC4 IBS o?I~ k 3~ 13e) ~Je~I P~ ~r:,€t•r~ -fir-r. c 10- NO, AK LMt FRESH AI11 INW-.-rS~AND ODSERVA` iON I'LQE C11OSS SECTION - - Approved Vent Cap Minimum 12" Ahovc G9,40 I tt ~ Cast Iron Above Pipe Veni Pipe To Final Grade:- F, Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor-and Human Relations DiAsiu.n of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY y Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but V ~0 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 PR RTY OWNER: PROPERTY LOA IN ' GOVT. LOT 1/499. 1/4,S / / T N,R E (or)&V PROP PITY OWN MA LING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 'f✓ Cl =TAT ZIP CODE PHONE NUMBER [:]CITY QV LAGE OWN NEA T R D [ ] New Construction Use>, j Residential/ Number of bedrooms [ J Addition to existing building eplacement ( J Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 _trench, gpd/ft2 Absorption area required bed, ft2 S 6f° trench, ft2 Maximum design loading rate i -7 bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) / ' 33 ft (as referred to site plan benchmark) Additional design / site considerations '"C'S' ' r c k h f it A1C,wr k,*, 6~ ~s Parent material Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑S ❑U ❑S ❑U ❑S ❑U OS ❑U ❑S ❑U ❑S ❑U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell QU. Cont. Color Gr. Sz. Sh. Bed Tmnch >:a L~'~2 h C~ L Z sN AAA Ink iJ ✓ t S 0 Ground j SL~61' 0 111 S l I n;,, 5~ !?s?~+ ss y~v c i✓ - ev~ ~L`-~ cam- S D S r''► r Depth to limiting rn~ Remarks: QAj Boring # , . , Lo ife A~ P61-4, 4D" Id o _ 3 Nom- S / cH, S $ yss ti pj 1 G _ , Z Ground 3 /10 Ili Alt Ta q [sq,41 7 '/0 /9 A)o-^e- OAS Depth to limiting P7 Remarks: T Name:-Please Print r `rye Phone: 1713 38 10 a o ress: 0. 2 !s~' l oz, v. Signature' Date: s / CST Number:? ' PROPERTY OWNER SOIL DESCRIPTION REPORT Page?-of PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Barry Roots GPD/ft Boring # Horizon in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Q L.~• Z S^ 2-fly /n IT7 /V • S Ground Von. S~ ~ l fly 5 s 1 Depth to limiting Remarks: Boring # Ground elev. It Depth to limiting factor - Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: Boring # E3 Ground elev. ft. Depth to limiting' factor Remarks: SBD-wo(R.05412) pipe- e U Q /10 Sn- i 66 I J 77 gEi r~/ g P r l9 50 Gi r D 1 ff 7 YA C' 1 f I g~ Z 03 79~ a P i f ° 8 T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. An inadeacies 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. t-------------------------------------- owne r of property Local ion of property_l/4 1/4, Sectiojq T Township _ A~ ~ _ N-R-W w n address 5lJQt~ Addr. ess o C site y r Subdivision name ~Qr Vleu: ~S es Other homes on property? Yes Lot no. _ 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 Is this property being developed for (spec house) ? Yes No Volume r- ~_No /M and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRAWPY 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 r I (we) certify that all statements on, this form are true, to the best of my (our) knowledge that I we property described in this information (aform, by w vi rtue oof ha warranty deed recorded in the office of the County Register of Deeds as Document No. own the _ / and-that I (we) presently proposed site for the sewage disposal system or we obtained an easement, to run the above described pro pert ( ) y, for construction of said system, and the same has been duly re cordedtin the office_ of the County Register of. Deeds as Document No. igna re, f Applicant ~ ~ • Co-Appl, cant 1+,Ih, of ure Date of signature r S 'I' - 105 SEPTIC TANK MAINTENANCE AGREEMENT I St. Croix County OWNERAMYEIZ / MAILING ADDRESS PROPI RTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/ST'AT'E; PROPERTY LOCATION lIL I/4, 1/4, Section 1 -R TONNIN OF ~Lu_d5c_rn C ST. CROIa COUN'T'Y, ~~'I SUBDIVISION f Qrk Vt'e(,0 E_54/es LOT NUMBER CERTIFIED SURVEY MAP VOLUME , PAGE ' LOTNUMBER 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 I, 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/We, the undersigned have read the above requirements and agree to nraintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR Cell Ific;ltloll sating that your septic has been maintained must be completed and returned to the St. Croix County /onllip, Officer within 30 days of the three year expiration date I )A I-f` SI (,lulx (-bounty Zoning Olfirc (iOvcrnn)cnt Ccnici 1101 Carmichael kwid ! luds~~n, At`1 ','1010 1 1/10 *,♦,S „•A:.. RC'-F:H`I!7 FOR PCC=Rn,No OA,A uocUr-i~rrT rau ~l'.\'i I: BAU nF %Vl-; t1No::: 1532 DUIT CLAIM DEED _ . _ ~C 13 1996 Debra D. -Adams,f /k/a Debra D. Jeline . 4:45 P•'..~ quit-claims to l t. _ _ t Y Jack..L Jelinek.. r, St.,. Croix count?. the followinj descrihed real estate in ~,._R4 *o State of Wisconsin: Ada~mS r'. ~K;2t~er r>7~S 55 333' t _.Y ' Tax Parcel No: - Lot 42, Park View Estates lst Addition S; 29 North, d located in Section 17, Township i} Range 19 West, Town of Hudson, Count=oximate St. Croix, Wisconsin, comprising PP 1.380 acres ♦ a fy~ t This ......xS homestead property. This deed is beilig given pursuant to ti (is) .(is . not) a Judgment of Divorce. 11 July _ s........ tinted this - day of . . . . . r Adams f k a D. Debra . ' . bebra- D-.-' Jeiinek•.............. . (SEAL) (SEAL) v « ACKNOWLEDGMENT i AUTHENTICATION STATE OF WISCONSIN ~ ss. Signature(s) St-,- Croix - County. r3 Personally came before me this day of authenticated this ........day of------------------ 19 ' July------ 19.9.... the above named y Debra Adams uvp « .........Debra__Jelinek......... TITLE-. NTEMBER STATE BAR OF WISCONSIN . IL (if authorized b Wis. ta' who executed the authorize ed by 700,.06, Nis. Sa:s_) to me known to be the person • --_«_.....e..! wnfi acJe4ia''414 M ,'thR same.