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HomeMy WebLinkAbout008-1010-90-000 ry o m ° I d N ~ a~ I a 0. c I d' c N I .N ~ I N x in N o~i c o a m ~ I co V) cc0 j Y o o e ~a o 0 , z x f6 c LL c a) o U 9) a y f0 ¢ ~ m Z H ~ Z = °o z r `m co am 0 c O Z a m a~i 2 a z v) F r v C c ° g c c p z zr-) z c ~ c I d C N tl1 C. r r c c N H d N y O j o C c a y - oc °v m U) vs = ami 00 5 a = o a a a y Pftb 4i in J U m rn rn D M m CD O > N N N N Lr.- CY) E LO :3 U') co N c a o a _d ¢ in f6 CO 3 O y cm N V) v Ej 'O y c c E 00 LO O m In ) 0 = d O a) CD O U c o E a a w H ° N = w w rn 0) ooow a o z ~=i °'at a ma • e~ am.E da E ` c c r r A U a m 0 w 0 . Parcel 008-1010-90-000 11/17/2004 08:12 AM PAGE 1 OF 1 Alt. Parcel 4.28.16.55 008 - TOWN OF EAU GALLE Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): * = Current Owner * PETERSON, GERALD & MARY ANN GERALD & MARY ANN PETERSON 1300 FRANKLIN ST BALDW IN WI 54002 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1300 FRANKLIN ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 4 T28N R1 6W 40A SW NW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 04-28N-16W Notes: Parcel History: Date Doc # Vol/Page Type 2004 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/15/2004 Description Class Acres Land Im Total State Reason RESIDENTIAL G1 1.500 18,800 121,000 139,800 NO AGRICULTURAL G4 25.500 2,400 0 2,400 NO UNDEVELOPED G5 13.000 6,000 0 6,000 NO Totals for 2004: General Property 40.000 27,200 121,000 148,200 Woodland 0.000 0 0 Totals for 2003: General Property 40.000 33,300 121,000 154,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04117/2001 Batch M PRGRM Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 138.00 Special Assessments Special Charges Delinquent Charges Total 138.00 0.00 0.00 STC - 104 AS BUILT SANITARY SYSTEM REPOR OWNER ADDRESS/ / 3n--> SUBDIVISION / CSM#___ LOT # SECTION Z-1j T N-R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i CY~'k.vri I3~' r P u, P" 0 I v INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. e BENCHMARK: oj'r7~ ALTERNATE BM: SEPTIC TAN / PUMP CHAMBW HOLDING TANK INFORMATION II1~ Manufacturer: 0C,C Liquid Capacity: 1 5- j Setback from: Well 13'5- House an/ Other Pump: Manufacturer Model# ~C!3~ Size Float seperation 7 4 ~ Gallons/cycle: Alarm Location -:SOIL ABSORPTION SYSTEM Width: Length S _ Number of trenches G~tE Distance & Direction to nearest prop. line: Setback from: well: /1/8 House 3/ i Other ELEVATIONS Building Sewer SO ST Inlet ; -14-/,03 ST outlet 3 , $ PC inlet PC bottom Pump Off _q1,17 Header/Manifold Bottom of system /0/,c4 Existing Grade u Final grade DATE OF INSTALLATION S- PLUMBER ON JOB: LICENSE NUMBER: /Lll`' S INSPECTOR: y~,,~~`~~n <<) 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and }lumanRelations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) SanitaryPerm itNo.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town o : State PI o.. PETERSON, GERALD X CST BM Elev.: Insp. BM Elev.: BM Description: r Parcel Tax No.: TANK INFORMATION ELEVATION DATA 4.~ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV ' Septic (z~ 20 Benchmark Jar S 07 /G . Dosing lbrnl - Aerati Bldg. Sewer p 77~ 4-420 g Stl)Wlnlet Q 9, G 3 TANK SETBACK INFORMATION St/Xf Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic /74 NA Dt Bottom Dosing NA Header / Man. t/6 Aeratio NA Dist. Pipe HolBot. System ' ' ti PUMP ORMATION Final Grade two Manufacturer ~F Demand X Model Number, ? OGP l~E~~ y L TDH Lift q~ Friction ~a System.)s~ TDH Ft oss V\ Head Forcemain Length 7 Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / LengtSX r No. Of renches PIT No. Of Pits I ia. Liquid Depth DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LE ING SETBACK HAMBER INFORMATION Type 0 Y1 0,..,.r- Model Number: System: ,IA,,, / >/(b OR UNIT DISTRIBUTION SYSTEM Headec:Wani o d Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. C;2 tI Length o24 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 C] Yes ❑ No C] Yes [I No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Eau Galle.4.28.16W, SW, NW, 55th Avenu Plan revision required? ❑ Yes 9-14o / Use other side for additional information. f p 2C~ SBD-6710 (R 05/91) Date Inspector's Signa ure Cert. No. 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 4 SANITARY PERMIT APPLICATION Bsafeureaty u anofd Bildi uildiinng Water gs ter 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 than 81/2 x 11 inches in size. ST CROIX • See reverse side for instructions for completing this application State Sanitary Permit Number 0?~07l~ The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION S95-40691 Property Owner Name P ioperty Location (pJ~) W GERALD PETERSON SW NW S 4 T 28 , N, R 16 /E/ Prop erty Owner's Mailing Address Lot Number Block Number 1300 FRANKLIN N/A N/A City, State Zip Code Phone Number Subdivision Name or CSM Number BALDWIN WI 54002 54002 1(715) 684-3836 N//A Road 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cityage EAU GALLE .5Nearest5TH AVENUE Public 13 1 or 2 Family Dwelling - No. of bedrooms 3 ❑ vill Town OF 111. 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. Ij 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 ution Experimental Other 11 ❑ Seepage Bed 21 [:a mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 n- round 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 S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 450 900 900 .5 N/A 102 Feet 103.39 Feet VII. TANK Ca in g Capacity Total # of r Prefab. Site Fiber- Ex per. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank 1000 1000 1 MIDWESTERN PRECAS [ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 65U-- 1 1 MIDWESTERN PRECAS © ❑ ❑ ❑ ❑ ❑ 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's Signature: (No Stamp MP/MPRSW No.: Business Phone Number: BENNIE HELGESON S 3215 715/772-3278 Plumber's Address (Street, City, State, Zip Code): W1229 770TH AVENUE, SPRING VALLEY, WI 54767 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial 19 Surcharge fee) ? 1/ Adverse Determination 019 1 7--7 S X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SRU-6398.(8. 05/94) DISTRIBUTION; Original to tounly, 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 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. V111. 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 spec; fications not smaller than 8 112 x 11 inches must be suk,rr tted to the : of-, Ity. Tl-je plans must c~~fo'1ow;nq A plot plan, dr6vs,,n ~ =-ale orwith complete dimensinr, lo,,- tie: i :~ing tanDa), septic tr. ink,, bu i• ,,yells, water mail slv4Ut, pu np or siphon ''?ls, replaCemenl-sys?.r3r 1rE'<?~, ~C r' 2 Lidcd `.'gserved: r 2 C; V~r ~IF?vc ')i' Joln,ts, } ~C >>!P ''pe6 c>5e VClUm t' n lG>i; .•'"Tlt". nerformLime Curve'_; pump mo<el •_7! '.'iTiiJ'71-`. f J er; r~l c=' )ss>ecuon O {u.,U( ylterTl I I r_ount', soi''! ? St da;; ~~t !n rlf rmc]tiGn_ GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) fora urcrU :r of re-gated pr,-;e : ces which can effect groundwater. The monies coliected through these surcharges are used for monitoring groundwater .:c,nlamir atio- evesigations and establishment of standards IaE ~IU~, X95_40691 G~ 5 I -*J Co `~1ds ~ ~ NEE ~ RE~~'iVE D So ► 1 ~ 1995 SAS `TY & BLDDS, DIY ~GbEI` \7ii~EVr\t^~ t /~sc M a V R P. laO- Oc) ~SL.~4,L/Pc.~,f Ctld-6.* tAcw, 6+k- Slf~ CrV n~tr e~' » 4 i I 1 tec, ~ J Zell, gL ACRES S-s 7k 411 8 95 " 406 9 1 PageOf Straw, Marsh Hay, Or Synthetic Covering Asrm c'-3, Distribution Pipe Medium Sand E~z~ X3.3 Topsoil H_ o J,), " E\tj. 102, - r I F 3 E D PRiVA'f E SEWAGE SYSTEM.- Elev. too, % Slope. ~ M N c~nditionai~y Bed Of 2- 2 i Force Main Plowed F mv,, Aggregate From Pump Layer ;rum ~ s PR0VL..-jL-J DEFT. OF INDUSTRY, LABOR a HL4,MVP REL WIQDNS D Ft. DIVISION OF SAFETY I L1 Cross Section Of A Mound System Using E Ft. F Ft. A Bed For The Absorption Area CC; F F :up 1 Ft. A 7 Ft. H I. S Ft. Signed: B Sy Ft. License Number: K Ft. Date: 7-7-55 L 7.S- Ft- j 95_Ft . T 1 Ft. Force Main w .2, (C-y Ft. L u Observation Pipe-,, Forc A e Main W o Distribution Bed Of 2-"- 2 Pipe Aggregate I Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Perforated Plpe Oetoll / 0 End Vlew Perloraled End Cop y" PVC Pipe ,%a O' • • a, Permanent End Markers s Holes Located on Bottom are Equally Spaced \ PVC Force Main * F.om Pump ENb PVC /P J Monltold Pipe Pvc. oislribullon... . Pipe Last Hole Should Oe Next To End Cop ally istribution Pipe Layout w too W 11 P P all 5 ` h Pao 0 1NDV5t 1►ND R P ~N~NG~ S i SSE ~s X Y 1 Signed: Hole Diameter _ Inch License Number: Lateral " Inch (es) Date: Manifold " Inches Force Main " Inches 7 h41, S ~e~ a~e~ca1 1 n r) lTetoJ l t Is 04-- Page Of COMBINATION SEPTIC TANK/PUMP CHAMBER S95-40691 4" CI Vent Pipe with (No Scale) Approved Cap, +25' ,Approved Locking Manhole Cover From Buildings With Warning Label Attached Weatherproof Approved _ .Warning Label Junction Box . Vent Cap 12 Minimum Final Grade-.\ 6" Minimum - 4" Minimum 6" Maximum Quick 4" C.I. ' 18" Minimum Insp. Pipe Disconnect 1 /4" Weep ooo Hole Baffles i Approved Joint , A 4 w/C.I. Pipes C Extending 3 C Alarm a B Approved Joint Onto Sol i 1 r' On 61, w/C. I . Pipe C Extending 3' Onto Solid Soi Off T D r"' 0oab Conc. Block " to L ],K- PON U 3" of Bedding Under Tank-/ Not ump and Alarm Are on Separate Circuits Number of Doses: Per Day Gal l qns Per Day/# of Doses: 1 (a •s Gallons Volume of Backflow:........ +7jL,~_Ga11ons Tank Manufacturer: ~,~~~L•<-~~Fr~. Total Dose Volume:........= 1~. Gallons Tank Size-Septic/Pump: it >f / C" Gallons Alarm Manufacturer:1~~~, ,.kL~',s 3 inches or 3'~ .S Gallons Model Number: Capacities: A _Q? 1-4 ~ , a ~ CA~ ~Cam _ + B inches or~~ Gallons Switch Type: Pump Manufacturer: + Cinches or vil) Gallons + D inches or_g3_8 Gallons Model Number: L L Minimum Discharge ate: ,s GPM Total....._ y_inches or;'-- Gallons Vertical Difference Between Pump Off and Distribution Pipe: l~Feet Minimum Required Supply Pressure: Feet /j22Feet of Force Main x Friction Factor/100Feet: + Feet Inch Diameter Force Main Total Dynamic Head:...=1 .X Fee"tL Internal Tank Dimensions: Length' Width 'M" Liquid Depth ,,3 /7- i Gr 1. P,?-,. Signature <,.,-----License Number//,j/;V5_3~'~,rl)ate 7-,-y5 Performance ./,/W' 3~,5 Submersible Effluent Curves' u s METERS FEET J 90 MODEL 3885 ' 25 80 SIZE 3A" Solids c WE15H 70 X 20 WE10H J H 60 WE07H F- 15 50 - W E05' 40 10 30 WE03M WE03L 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM I 1 I I 0 , 10 20 30 m'/h CAPACITY MGOULDS PUMPS, INC. q y SB*CA FALLS WW YM 13146 METERS FEET 120 MODEL 3885 35 SIZE 3/4" Solids 110 WE15HH 30 4- 100 90 25 80 70 2 20 Q i 60 0 50 WE05HH 15 ~ 40 10 30 20 5 t , 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM L I _ 1 1 0 10 20 30 m°/h CAPACITY ®1985 Goulds Pumps, Inc. Effective July, 1985 Wi9consin Department of Industry, SOIL AND SITE E V ION REPORT Page L of 3 Labor aqd Human Relations Division of Safety & Buildings - in accord with Code - COUNTY Attach complete site plan on paper not less than 8 1/2 x 1 ~`"s in sizev'~ . Aust in ut not limited to vertical and horizontal reference point (BM) ion a O % o Cale PARCEL I.D. # dimensioned, north arrow, and location and distance ton a►et road u'H' " 6U Q~ /~~6 -91 d REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT AL 11-ft MAti40N PROPERTY OWNER: / :PROPERTY ION ,,,-GOVT. L ) 1/4 /4,S T N,R 1E, E (o W ~ I'ez ~ ~ q t, l.~ PROPERTY OWNER':rS MAILING ADDRESS; T 'Jr SUBD. NAB OR CSM # D U T ►^4 17 - CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE 2170WN NEAREST ROAD c.v ~r• 6oZ l /5)l<, - G- 6`712 ~ve. [ ew Construction Use ( Residential / Number of bedrooms _3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow : ~gppdd Recommended design loading rate y bed, gpd/ft2~_trench, gpd/ft2 2 ft2 Maximum design loading rate 5 bed, /ft2_trench d/ft2 Absorption area required bed, ft ~Sy `trench, g gpd , 9P Recommended infiltration surface elevation(s) 101. tosw Roy aft as referred to site plan benchmark) -76 ° ' USl= /s,, d ~~c •S Additional design / site considerations -6-7G-' Parent material S; { 0 U t2 Tk 1_ L_ Flood plain elevation, if applicable -,&A)ft S = Suitable for system CONVENTION MOUN IN-GROUNLD PRE$SURE AT-GRADE SYSTEM IN FILL HOLDING TANK Old- El S ❑-U--- ❑ S ' F 1 El S 1~" 11 S U = Unsuitable for s stem ❑ S EFS~ ❑ 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 f Ground - c~ s 6 w. S elev. C a et 9 ft. 3Y I 0 s R s s sbl- ~3P Depth to ol-I-11) 7. 7. s i2 F c b - 3 limiting factor Remarks: Boring # 3 r u 0-/0 1 Q5 -I P, t L4 1 C5 lip, Ground elev. -:3b S`12 ~.S } c I sb Y,,`-F t _ - 3 ICS' ~ ft. Depth to limiting factor ~S Remarks: CST Name:-Please Print Phone: . rt s c.-. t - -7 Addresstk) Tit U _5 rr~yl UC ( 1110 ~iL Signature: D te: CST Number: 4< -~y 9s--- 3 o y PROPERTY OWNER ~~eTPrx"OIL DESCRIPTION REPORT Page of - PARCEL LD. # ! J /0 /0 -1?0 Depth Dominant Color Mottles Texture Structure Consistence Bandary Roots GPD/ft?- Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmnch A L) l u S b Ground t 3 n1 sl w t o y elev. _ ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # a >k Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) o~ne~r ; Gera-id- Ae-f--ersort 3o9y r i Floc - r_ItJ. q~.oo i '3 3ccQ ~Xi s~-~n~ .v r How. e.h•.40P P. 100.06 a lr_ ir:56fte" a- -Cis SIcoi~S ~OK40u,, Fie" Eye.,, B% \a$3 ~tL~ fo ?r ' i 61 W cAl f i ~ ~ s lopes / Q f i (-ppe rf~ ICI ~-Q ~ ~3o,, gQ ~}GR~S - - _ 5s 4LV---- STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER . GERALD PETERSON MAILING ADDRESS 1300 FRANKLIN, BALDWIN WI 54002 30 PROPERTY ADDRESS -1'- ~'ST/~~ENc~L (location of septic system) Please obtain from the Planning Dept. CITY/STATE 13A-6z-) ! r c~.~ PROPERTY LOCATION SW 1/4, NW 1/4, Section 4 , T 28 N-R 16 W TOWN OF EAU GALLE ST. CROI K COUNTY, WI SUBDIVISION No li LOT NUMBER V N-W CERTIFIED SURVEY MAP No , 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. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification 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. s SIGNED: e4' ~ DATE: qcS~ V St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 • . 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 GERALD PETERSON Location of property SW 1/4 NW 1/4, Section 4 , T 28 N-R 16 W Township EAU GALLE Mailing address 1300 FRANKLIN BALDWIN, WI 54002 230.7 idf ~]yFitl~cE Address of site BALDWIN, WI 54002 Subdivision name Lot no. No,n.o- Other homes on property? Yes x No Previous owner of property Total size of property Q0 AC,0,5 Total size of parcel Cie) C Date parcel was created plte-~~'►o~~~. _ Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume 54A and Page Number 1/58 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. Y PROPERTY OWNER CERTIFICATION -I- twQ4-. certify that all statements on this form are true to the best of my fcxi-r) knowledge that I (wv_-j am (a-re) 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. 3 14 3 51 7 L , and that I (tea) presently own the proposed site for the sewage disposal system or I (ve) 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 of Signature Date of Signature s STATE RAR Or * YtK' Foam 1 NT NO. T►116 SPACE RESERVED pt ata1o11te oATA DoCuME ..56? FA-"A58 - X43876 ` VOL REGISTERS OFFICE known-Jen,"a, ST. CROIX CO., WISM By i711a DEED. Freda K. J a woman, , Reed. for Record ff&_,jUh ay of October.. A. D 1977 *In A- taq M, Greater coo----- warrest.- to T YTtMN TO for a valuable cosstderatios t. Cro County, State o1wiscoaelat tM following described rest estate is Tax Rey - This x is TA} Aostead property. West Half of Northwest Quarter of Nw%) and Northwest a Quarter of Northeast Quarter of Northwest Quarter (Nit of Thin NOS of NW10 of Section Four (4), Township Twenty-eight (28) North, of Range Sixteen a6) West, St. Croix County, Wisconsin. i This deed is given in fulfillment of a certain land contract between the above rtthe, !f dated September 25, 1972 and recorded November 24, 1972 in Volume 492, page 1{ office of the Register of Deeds for St. Croix County, Wisconsin. I~ I{ THANSERN $ ROD FEE Exception to warranties: day o< OCtobnr _ , Wisconsin enia 13th_ 191Z• Baldwin, Executed at ~a ~ ~ ~ tm _ eSEAL) li SIGNED AND SEALED IN PRESENCE Or T- Y Ii II {SEAL) j !SEAL) I {SEAL) {I i. Signatures of authenticated this day of li Title. Member State Bar of Wisconsin or Other party is Authorized under Sec. 706.06 via STATE Or WISCONSIN 1j ss. ! St. Croix County. j 13th day 19, Personally came before ate, this ~i the above nameA, Freda M. Jensen also known as Freda who executed the foregoing instrument and acknowledged the same. ~ -Ali i' ' ruiti1in>B1t P-eird by _ St. Croix County, Wis. I : Jr•;•p~g~` Notary Public -Atty- permanent S a• Q F My Commission ($sp~s) (Es)._ 1, The use'bl'rVff{il)sses is optional. i i~ or printed below their signatures. 1 Names of persons signing in any capacity should be typed Pr WARRANTY DIED-STAt* BAR OF WISCONSIN. FOR14 NO. 9 - 1971 Ili Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of -_3 Labor and Human Relations Division of Safety 8 Buildings in accord with 7= m. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 1~in On, es in size, *LUS e, but not limited to vertical and horizontal reference point (BM , ction, I sc PARCEL I.D. # dimensioned, north arrow, and location and distance to artist roa r CSO ~j " Did -~1 O ~.'r ; REVI E DAT r/ APPLICANT INFORMATION-PLEASE PRINT A b1~F RM>ATI IY .o f Q / ~r PROPERTY OWNER:/ j //J~ z~ p n P ERTY1LOCATION ) C~ t•f,C~IO~~ 1--e-t- -~N e~cs GOVT. L O`f 5~(d~ 1/4 "1/4,S T N ,R E (o W PROPERTY OWNER':S MAILING ADDRESS 1.0~' BLOCK # SUBD. NAME OR CSM # ~G%T/ CITY, STATE ZIP CODE PHONE NUMBER []CITY EIVILLAGE WN NEAREST ROAp [ ew Construction Use [ Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow~gpd / Recommended design loading rate bed, gpd/ft2 .(o trench, gpd/ft2 Absorption area required bed, ft2 ;S `trench, ft2 Maximum design loading rate S bed, gpd/ft 2 . ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) 10 P - -4, Rock (as referred to site plan benchmark) Additional design / site considerations 376 ° 3e k- 0&S -Z°~ Parent material S; O U t{Z Tk I_ L Flood plain elevation, if applicable ft S = Suitable for system CONVENTION MOUN IN-GROUND_PRE~SURE AT-GRADE E~W- EIS SYSTEM IN ~FI' LL HOLDING TANK U= Unsuitable fors stem El S M C ❑ U El S 1' ❑ 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 t cW Ground c~ S ryv w• r elev. c a d qy ft. - 3 0 . s u s 11 s ~ttl vJ C_ 3 Depth to S '7. -sy2 f C 1 b Ln~ 4 - 3 limiting factor Remarks: Boring # 0-/0 o S 0. Lo tr ~c o tvF _ Ground' L v+~H i co S t elev. ft. -A 7_3-Y!_ 7•S 6' I l C sb If~~ t - - lenk Depth to limiting factorr-•G_L Remarks: CST Name:-Please Print Phone: Address U) 7T/i u r i ` Uc, I e C~j 7 _ Signature: D te: -~y 9S CS30b 37- 5~ PROPERTYOWNER ya `off` `f-kr---"OIL DESCRIPTION REPORT Page of PARCEL I.D. # c $ /U %O `7 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Bed Tre in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench Lk CLO (U s~ S 3 1 ~ . Ground U-) elev. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # M.; Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) QC A%11 if ~e'ra aQ P-e t-e r 5 o rL 309 y z i ~~oPesrcQ ~.iSC+tiew` ~'1co.- CI<~. 91.00 p~ 3 I-XiS7inc~ ~ Now.L Q.M• 4oP. P. loo. 06 9N•S A3 9 L'OeAt Slope / 1 / St 0.h_ a3oy SoGR1=S