HomeMy WebLinkAbout026-1008-60-000
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-Parcel 026-1008-60-000 04/06/2006 09:33 AM
PAGE 1OF1
Alt. Parcel 3.30.18.311 026 - TOWN OF RICHMOND
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
CAMERON L & CLAUDETTE J VASSER O - VASSER, CAMERON L & CLAUDETTE J
1243 175TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 0.530 Plat: N/A-NOT AVAILABLE
SEC 3 T30N R1 8W PT NE SW W 100' OF E Block/Condo Bldg:
472'OF N 233'OF NE SW
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
03-30N-18W
Notes. Parcel History:
Date Doc # Vol/Page d Type
11/09/2004 779451 2692/326 WD
11/09/2004 779448 2692/320 TI
09/10/1998 586880 1356/296 SD
07/23/1997 1100/540 WD
more...
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/19/2002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.530 22,500 131,300 153,800 NO
Totals for 2006:
General Property 0.530 22,500 131,300 153,800
Woodland 0.000 0 0
Totals for 2005:
General Property 0.530 22,500 131,300 153,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 026-1010-50-000 04/06/2006 09:18 AM
PAGE 1 OF 1
Alt. Parcel 3.30.18.36B 026 - TOWN OF RICHMOND
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 - VERBUNKER, TODD J & DEBRA J
TODD J & DEBRA J VERBUNKER
1273 175TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1273 175TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 0.990 Plat: N/A-NOT AVAILABLE
SEC 3 T30N R18W.99A IN NW SE COM NE COR Block/Condo Bldg:
TH S 240' TH W 180' TH N 240' TH E 180'
TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
03-30N-18W NW SE
Notes: Parcel History:
Date Doc # Vol/Page Type
02/08/2001 638243 1585/041 WD
07/13/1999 606764 1441/485 WD
07/13/1999 606763 1441/484 WD
10/02/1971 307219 477/125 LC
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/1912002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.990 27,000 97,200 124,200 NO
Totals for 2006:
General Property 0.990 27,000 97,200 124,200
Woodland 0.000 0 0
Totals for 2005:
General Property 0.990 27,000 97,200 124,200
Woodland 0.000 0 0
Lottery Credit: Batch 550
Claim Count: 1 Certification Date:
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
ADDRESS /~S6S~ /i1Lt~~~
yy/~
SUBDIVISION / CSM# / LOT #
SECTION___,_f_T,_S'~0 N-R 1Q W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
r
wolf
' r
CLL t
S1E.d
-441 f B/'
s"
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
/lls~o ~
BENCHMARK:
ALTERNATE BM• sf
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity:
Setback from: Well House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop. line: 4),.s.=/ 2
Setback from: well: House Other
ELEVATIONS
Building Sewer ST Inlet. /a-,7r 1~ ST outlet ~Za.2
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system 9-
Sg/
-
Existing Grade 99,-2 Final grade DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER: S29
INSPECTOR:
3/93:jt
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 residence located at:
Z 1/4, SGT) 1/4, Sec._ TjrLN, R_,4~T_W, Town of
2&4e~~ Upon inspection, I certify that I have found the
tank and baffles to be in good condition, and it appears to be
functioning properly.
Last time serviced 2~ 27-
Did flow back occur from absorption system? Yes No-z(if no, skip
next line)
Approximate volume or length of time: gallons minutes
Capacity:
Construction: Prefab Concrete-Steel Other
Manufacurer (if known):
Age o T nk 04 k own) :
(Signature) (Name) Please tint
(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
inspetio o ne-nin ver outlet baffle).
Name-; Signature MP/MPRS
5/88
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
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State P
DOWD, JOHN F. X
CST BM Elev.: Insp. BM Elev.: BBIV fjD~ scription: Parcel Tax No.:
TANK INFORMATION
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 63
Dosing f
Aeration Bldg. Sewer
Holding St/Ht Inlet 1/011, 77
TANK SETBACK INFORMATION St/ Ht Outlet q2, 2, /Ua,
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic ? y v V NA Dt Bottom
Dosing NA Header / Man. / 6 Gj(o
Aeration NA Dist. Pipe
Holding Bot. System ;
PUMP/ SIPHON INFORMATION Final Grade /3, ;.-L-
Manufacturer Demand
Model Number GPM
TDH Lift Lriction System TDH Ft
mead
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Tre ches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ~ `l-
SETBACK DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION Type O / CHAMBER 4 C / 4 OR UNIT Model Number:
System: G 1 (v
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 1 xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center rt~ Bed / Trench Edges = Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
d
COIV~`ME JjS% (Include code dis47pancies, persons present, etc.)
LOCATION: Richmond.JA30 18W, NE, SW, 175th Avenue j
4 -4
LL Cil
C V,(_ 4L
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: s
I
,
R sANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY
~ H
Ezz
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than 9410
8% x 11 inches in size. ❑ Check If reAsT n to'pSous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPER OWNER PROPERTY LOCATION
X_Sd '/4, S , N, R ,e(or)L*
PROPERTY OWE? MAILING A DRESS OT # BLOCK
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVI ON NAME OR CSM NUMBER
11. TYPE OF BUILDING: (Check one) CITY NEARE T ROAD
❑ State Owned ❑ VILLAGE ; edeE ~ =N OF:
❑ Public 0 1 or 2 Fam. Dwelling-# of bedrooms
_4 PARCEL III. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/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 in line A. Check line B if applicable)
A) 1.0 New 2. R 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 # - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 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/da /sq. ft.) (Min /I ch) ELEVATION
Feet Feet
VII. TANK CAPACITY Site
In gallons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumbe s Na a (Prir►t): PlVer's ign r o ps) MP/MPRSW No.: Business Phone Number:
r - q
lumbers Add Ill& (Street, City, tats, Zip Code)•
i
IX. COUNTY/ EPARTMENT USE ONLY
I F1 Disapproved Sani ry Pe mit F e (Includes Groundwater Dave ssue Issuing ignatu ps)
Approved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination /U, - O
X. CONDITIONS, OF APPROVAL/REASONS FOR DISAPPROVAL:
4L Al "L jr ► n 5~ i.'
SBD-6398 (formerly Plb-67) (R. 11/88) 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 may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
1 All revisions V) this perm f must be approved by the permit i,suing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Pen,>vNaJ Form ;Sr l? 6329) to be
submitted to ftrr ounty prior.to installa.lon.
5. Onsite sewar,-- ~ rrs must be propet';y rnaintai-red. The -ic tan' _ -t be puniped y~ I cQnsed
pumper whP!,e,:<.r necessary, usually every 2 to 3 years.
6. If you have que~hons concerning your onsite sewage system, contact your local code . dodnistrator or the
State of Wisconr gin, Safety & 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 nt..mber(s) of
where -e 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 apple.
IV. Type of permit. Check only one in 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 in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total ga.!Ons. 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 it 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% 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, 'ocation of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water rnafn iwater service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption system.;: replacement system
areas: and the location of the building served; B) horizontal and vertical elevation reference anoints;
C) complete specifications for pumps and controls; close volume; elevation difterences fricti~.n 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 T15 form; and F) all sizing information.
- - - - - - - - - - - - - - - - - - - - -
GROUNDWATEf4 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 .rased for nioni*o-lr dro~ndwater, ground-
water contamination ;nvestigat ons and estabhshrrie-n of s`arviards
SBD-6398 (R.11/88)
ee
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01.7K1I3U710L1 PIrc
APPRp`1cG S`(!1-P1ETIC COW
2" of &GGREGI►1E -MTCR1^4 OR 1' Or S-rgA-..
01l MAR>>^ N,Ay
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AG6RCGAIT C ELEV. OF FErT O
OISfKIpUYlO►J ♦1rC •7 L c A7 4C4 i1'r IWCHC3 9000W O 16•IUAI, •,r,~oe
ALJU AT. LCAITZo IWCKrr, OUT 1.10 MOKC THAN 42, IuCNCi DELOW FINAL. f,1lAOC
M~X1MUr1 OEQTH OF EXCAVAT1,00 FXom ot{I vvu 61(i\vE WILJ_ el_ _4&_
IucHes
MIMUM OEFT-11 OF EACAVATIoN ff WN, 0R,141WAL GRADE wit-L, ec INCHCS
SlGIJC ~ ~~at '
LIGCIJSC UUMBCIi:..
p1
t. 10
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Numan.Relabons-
D`ryis,)n of 'Safety & Buildings in accord with ILHR 83.05. Wis. Adm. Code COUNTY
Attach complete site plan on paper not less than 8 1/2• 11 in n must include, but St. Croix
not limited to vertical and horizontal reference point' gm), direction an pe, scale or PARCEL I.D. #
dimensioned, north arrow, and location and dista cta nearest road. 026-1008-60
APPLICANT INFORMATION-PLEASE P :!ALL INFORMATION REVIEWED BY DATE
~ A
PROPERTY OWNER: R., PROPERTY LOCATION
Jack Dowd GOVT. LOT NE 1/4 SW 1i4,S 3 T 30 N,R18 xfk(or) W
PROPERTY OWNER':S MAILING ADDRESS LOT BLOCK# SUBD. NAME OR CSM #
158 Williams Ave. 00, sn na Ina
CITY, STATE ZIP CODE PHbA? CITY []VILLAGE MOWN NEAREST ROAD
New Richmond, WI. 54017 (715 g~M, 10,
ichmond 18th. St. City of
[ J New Construction Use,-bd Residential / Number of bedrooms 3 [ J Addition to existing building
GcJ Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate_ _4_bed, gpd/ft2_.5 _trench, gpd/ft2
Absorption area required 1125 bed, ft2 900 trench, ft2 Maximum design loading rate .4 bed, gpd$ . 5 trench, gpd/ft2
Recommended infiltration surface elevation(s) 95.92 It (as referred to site plan benchmark)
Additional design / site considerations na
Parent material pitted outwash plain Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for s stem us ❑ U )a S ❑ U ❑ U l~ ❑ U O S C,~k1 ❑ S)a U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxiary Roots GPD/ft
in. Munsell Du. Sz. Cortt. Color Gr. Sz. Sh. Bed Trerxfr
1 0-27 10yr2/2 none 1 2mgr mfr 9w if .5 .6
2 27-38 5 r3/3 none scl 2msbk mfr C1w if .4 .5
Ground 3 38-78 5yr4/3 water at 72" co s Osg mvfr na na .7 .8
elev.
98 - 92 ft.
Depth to
limiting
factor
72"
Remarks:
Boring #
:4m# 1 0-24 10yr2/2 none 1 2mgr mfr if .5 .6
2 2 24-39 i0yr3/4 none sl 2mgr mfr gw if .5 .6
3 39-8 5yr3/3 water at 76" is Os mvfr na na .7 .8
Ground
elev.
98.80 ft.
Depth to
limiting
factor
Remarks:
CST Name: Please Print Phone:
Gar L. Steel 715-246-6200
Address: 1554 200 . Ave., New Richmond, WI. 54017
Signature: Date: CST Number:
4-6-94 cstm 2298
PROPERTY OWNER Tack Dowry SOIL DESCRIPTION REPORT Page•2 of ,3
PARCEL I.D. # 026-i nnR-6n
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourbary Roots GPD/ft
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed 1Trerch
3 1 0-17 10 r2 2 none 1 2m r mfr 1f .5 .6
2 17-27 10yr4/4 none scl 2msbk mfr gw if .4 .5
Ground 3 27-33 5yr4/4 none sl 2msbk mfr gw na .5 I .6
elev. I
99,2,0 ft. 4 33-86 5yr4/4 water at 80" co s Oag ml na na .7 .8
Depth to
limiting
factor
801,
Remarks:
Boring #
w•4iii:`vii
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
,,.xoC•i:
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft. ~
I
Depth to
limiting
factor
l
Remarks:
SBD-8330(8.05/92)
i
STEEL'S SOIL SERVICE
Gary L. Steel Jack Dowd 1554 200th Ave.
CSTM2298 NE4Sw4 S3-T30N-R18w New Richmond, WI 54017
MPRSW 3254 town of Richmond (715) 246-6200
N
1"=40'
BM= top of 1" steel pipe at el. 100'
alt. bm= top of sw lot stake at el. 98.05
`l
A 1,
►a.
ze)x('o'
5j I k,(
Gary L. Steel
4-6-94
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER 0_~a 14)
MAILING ADDRESS
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION ~/-1/4, 1/4, Section T-:fo N-R_Z W
TOWN OF ~A,✓n ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY 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.
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 th?yeex iration date.
SIGNEDATE:
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 2,n
Location of property _ Aljz- 1/4_5. 1 1/4, Section TQN-RW
Township Mailing address A
)tL. LL
Address of site
Subdivision name Lot no.
Other homes on property? Yes 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)? >C Yes No
Volume ~Iyll/ and Page Number 1, 6 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. k2:/ / , 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'g ture o Applicant Co-Applicant
Date of Sianature nata nf gi"nattira
.DOCUMENT NO. WASRANTY DEED THIS SPq C RGERYED FoR RC ORGIN4 DATA
STATE u iR OF WISCONSIN FORM 2 -
492414
nu 130
AOL
, REGISWRI OFFIV
r A. ST. $x 00•, W,
LaVern I Kattre and Rosella/.Kattre,.husband and wife Reed for RBCOPd
as point tenants........
. OECD 3 M2
of 10:40 A M
conveys and warrants to ...John-_F-._•Dowd /y n QQ
V v° ' ,`v~ 1
532 S. Knowles Ave.
I Mi' 4%st Federal: -
. New richmond, WI. 54017
the following described real estate in St-Croix ......................County, L
State of Wisconsin:
Tax Parcel No:
The West 100 feet of the East 472 feet of the North 233 feet of the
Northeast Quarter of the Southwest Quarter (NE} of SW}) of Section
Three (3), Township Thirty (30) North, of Range Eighteen (18) West.
This ....is homestead property.
(m) (L not)
Exception to warranties:
Dated this day of November 19 92....
----------(SEAL) - --------(SEAL)
LaygrA j.t..Rattre -
O
(SEAL) .......(SEAL)
. Rosella~ttre
AUTHENTICATION ACKNOWLBDGMBNT
-
Signature(s) STATE OF WISCONSIN
SCroix.................. County.
authenticated this day of 19...... Personally came before me this . ...day of
November
- 19.92.._ the above named
LaVern__I.:_ Kattre and Rosella Kattre
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not-
authorized by 1 706.06. Wis. State.) s who executed the
to me known to be the perso
g (nstru and n wledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Reiustra, Van Dyk & Needham, S.C.
iSI Souffi Knowles Avenue; "goa 1ZT------------- -
Now-Richmond-,__WL --51+D_L7---------------------------------- Notary Public ....St. _Cf ~pN,~unty, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is pernil~st. f no -Y, state expiration
are not necessary.)
date- I9--------•)
Names of persons signing in any espaeity should be typed or printed below their signatures.
STATE Bl.It OF WrgCONfirN Wisconsin Legal Stank Co., Inc.
• i lW♦ VL\1
"E'ER TOWNSHIP ,0 740j SEC. T,-3n N, R f~' W
0. AD RESS , ST. CROI COUNTY, WISCONSIN. 4. 7, ley, '3DIVISION LOT LOT SIZE ~
PLAN VIEW
-Distances & dimensions to meet requirements of H62.20 Od ' a q'7D
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM WJ S3~-b~
o Ale 61 Silo
'TIC TANK(S) i]~~ - J CONCRETE STEEL
NO.~ on cover Depth DRY WELL
>NCHES NO. of width length area
no. of lines Z_ width ._1 length Z area-7---
of pipe
d h o t7
REGATE f
r/pt4 U, , Qc
RATE L AREA REQUIRED AREA' AS BUILT
,claimer: The inspection of this system by St. Croix County does not imply complete %
=pliance with State Administrative Codes. There are other areas that "t-is not possible
inspect at this point of construction. St. Croix County assumes no liability for
?tem operation. However, if failure is noted the County will make every effort to
-.eruine cause of failure.
'ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYST9i.
'INSPECTOR ` r ,]]]III
DATED
PLUMBER ON JOB
LICENSE NTAM R ,
i
~Q o~ ~ 2~ 233 izoo
j(o v t,
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REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
San.itany Permit 90
OJA,,. State S P ptic p
EC%Q 6 fownbhip St. Croix County
Locatiox 6154L Section
SEPTIC TANK
size _ r gattonz. Number o.6 Compantmentz
Distance Fnom: Wett t. 1 % on greaten ztope 6t
Building 6 t W t eand~s 6.
H ighwaten it.
DISPOSAL SYSTEM
Distance Fnom: Well it. .12% on greaten ztope ~ .
Bui.lding G, fix. Wextanda F.
• H ighwaten ~ .
FIELD DIMENSIONS:
Width o6 trench it. Depth o6 tco ck b etow t.ite / E-,--in-
Length o6 each tine J7 it. Depth o6 rock oven t.ite _.r .in.
Numbers o~ tines Depth ob tite below grade
Totat .length o6 tines it. Slope o6 trench in pen 100 it.
Distance between .Lined i ' it. Depth to bednocfz
Total absonbt.ion akea .'6t2 Depth to gnoundwaten it.
Requ.itced axea 2 Type o6 Cove: Papeh.~. n Straw
PIT DIMENSIONS:
Number o6 pits Gnavet around p.it.6yea no
Outside d.iamete Depth below inlet ~t•
I
2
Total abzo,%bti n' AAnea it z
A
Area 4quijLed it2 R'
r
INSPECTED BY" ► J r ~;t~l
TI TLE
t
r
APPROVED DATE Cy-~197
REJECTED DATE 197.
EH 115.
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
yy]] REPORT ON SOIL BORINGS AND PERCOLATION TEST~j
LOCATION: Section , TZA, R ARjor) W, Township or Mftftiw ~ty i t,4/;I ~ Q/
Lot No. , Block No. County`-
Subdivision Name
Owner's Name:
Mailing Address: 4"' i
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT /
DATES OBSERVATIONS MADE: SOIL BORINGS~& 4T• 7~,,&aPERCOLATION TESTS 5~7. 776, t/4Dr
SOIL MAP SHEET SOI L TYPE
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P
7_ 5
Ifo
P3 3~ 3 (d
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
7,7 At AZ A,,
B- -7 Zjo~q k
5~2_ .41
PLAN VIEW (Locate perco lat ion tests,soi I bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area
needed for building type and occupancy. ~Zc' 17/ Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
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1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures
and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct
to the best of my knowledge and belief.
Name (print) C 'fication No.
Add ress 04
Name of installer if known
CST Signatur
Y A -LOCAL AUTHORITY 7
State and County State Permit #
PLB67 Permit Application County Permit #
for Private Domestic Sewage Systems County 41
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY q Mailing Addr
A14 14) ol
B. LOCATION: V UO '/o2( Y4, Section Qom, N, R/ (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance
Single family ✓ Duplex No. of Bedrooms No. of Persons__
D. TYPE OF APPLIANCES: Dishwasher ✓~ES NO Food Waste GrinderYES Ih'O # of Bathrooms
Automatic Washer Z----q-ES NO Other (specify)
E. SEPTIC TANK CAPACITY /h?,ft? Total gallo s No. of tanks
*Holding tank capacity Jot 2l ~JNo. of tanks
New Installation Addi ' n Replacement _ Prefab Concrete
*Poured in Place Stee Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total Absorb Area sq. ft.
New Addition Replacement L----- *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length __A~rZ/ Width Depth Tile Depth Z " No. of Lines -Z-
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land t'7 Distance from critical slope
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Ce . ied Soil Tester,
NAME n 'Y' V 4 . C.S.T. # Z 7_ and other information
obtained from -1 1 (owner/builder).
Plumber's Signature MP/MPRSW# ~C l Phone ` - S y~
Plumber's Address 4~ 12W_40
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
I
e,,5 1,54 1 (V5
t~' F
. k
1Zj
10'
Do Not Write in Space B ow FOR DEPARTMENT USE ONLY
Date of Application S 7 Feed Paid: State , County ~(f Da
Permit Issued/Reject (date) S` Issuing Agent Name
Inspection Yes No Valid* Date Recd
county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
tate (pink copy) 4. plumber (canary copy)
Revised Date 6/1/76