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HomeMy WebLinkAbout042-1020-30-000 0 3 °c M ti O ra M o W a N _ Vl 16 c N w Z ~ C i > O V ~ C V; C N 'O o aD o _ C c Z O w I U. ~ 3 m, Q O a 3 M g o 3 w z E CO z z co - Z d m IN 0 o O Z a a L) z w p N F- r z E '2 O) M R N i C . = s O 0 c O 0 ~z w Z H Z o N _ _ Z N Cl) M~ V 0D M N is ~ d a l0 w Y C ,It M N d N O N G 0 a ° E m Z M j N N N a~ Z •%oil 0a.00 IL N M M O C N J V d' Obi Obi Z r aQ+ N N Y O O ca y C CL ~ N N ~ N Q } Cn (6 O O C N C LO O c Q C li p y - A O I? C C~ a N O N M~ N O~ C 7 N C~ CC rC N t L w N O r= n • o I Y o Z C: Z cn V ~ m ~o € a CL • CC a m d r A 0 CL ~ ~ Q -Parcel 042-1020-30-000 07/11/2005 04:18 PM PAGE 1 OF 1 Alt. Parcel 08.29.18.114A 042 - TOWN OF WARREN Current X', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner * JOHN A KURKOWSKI KURKOWSKI, JOHN A 1059 110TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1059 110TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 23.510 Plat: 1011-CSM 14/3813 FKA CSM 14/3780 CSM Block/Condo Bldg: LOT 3 14/3780 LOT 3 23.511AC NKA CSM 14/3813 LOT 3 21.099AC EZ-U-1527/85 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 08-29N-18W NW NE Notes: Parcel History: Date Doc # Vol/Page Type 03/17/1998 575223 1306/365 QC 07/23/1997 1050/610 WD 07/23/1997 886/468 07/23/1997 862/203 more... 2004 SUMMARY Bill M Fair Market Value: Assessed with: 37928 Use Value Assessment Valuations: Last Changed: 07/11/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 25,000 166,000 191,000 NO AGRICULTURAL G4 21.510 2,800 0 2,800 NO Totals for 2004: General Property 23.510 27,800 166,000 193,800 Woodland 0.000 0 0 Totals for 2003: General Property 23.510 27,800 166,000 193,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 119 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of .=Human Human Relations Divisron~ Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code I, ' COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but D. # rr~ not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PRROOP'ERTY OWNER: PROPERTY LOCATION ,0A A~ q- ik' GOVT. LOT LJ 1 /4 Al r 1/4,S T Z 9 N,R E (or) W PROPERTY OWN' ER':S MAILING A`DDDR LOT # BLOCK # SUBD. NAME OR CSM # rNTY STATE _ ZIP CODE PHONE NUMBER (]CITY ILLAGE OWN INEAREST}i0 Jkp New Construction Use [kj Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow S~ gpd Recommended design loading rate _Z-bed, gpd$. S trench, gpd/ft2 Absorption area required bed, ft2 $7trench, ft2 Maximum design loading rate . 7 bed, gpd/ft2 , S trench, gpd/ft2 Recommended infiltration surface elevation(s) _ fr; i 9 ' S ec !f 758 ft (as referred to site plan benchmark) Additional design/ site considerations &L., 2".-*0 f- 4 Cwt~}r81,0 4z Corrs• 0l& Parent material Flood plain elevation, if applicable It S = Suitable for system ONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOS NG TAM( U=Unsuitable fors stem 19S O U S U E3 S 1'U O S (3111 ❑ SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed ranch -3 3 Sl l ~bk 2- 7 yvi r- e - ' l 11,0k i~^ f t JiF Ground 7 y d C 3 Y C C ty a' l _ft /0 )e S r' 3 A" Depth to limiting 10clor v3 Remarks: Boring # 11"=27' 7, j' ,e 4 - / G lug C ~ S Ground lay 'oJ'~ 3' 6 - Q S M I 7 el a Depth to limiting ctor o Remarks: CST Nam se Print / Phone: /G Address: it) Aj Signature: Date: T 'umber: / oo.~yy7 .........~.,..~.{r ~vw ncrvn r Page. Z of 3 PARCEL I.D. # , Depth Dominant Color Mottles Structure Boring # Horizon Texture Consistence Bourxiary Roots GPC%/ft .rt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer~ Ground ' t o /X b~ S ~ S ~s N~ I Il, .Zft. Q Depth to limiting for Remarks: Boring # 313 VO 1-5 14 Ground 3 ~7 ~ 77 ft. Depth limiting r Remarks: Boring # E7 7, 5 W Y/I -wr 1-5 1,40 #1 5 G Ground 17'-z7, 7 Y12 YO - ~S p3 L ~ ~ ~ fl Depth to limiting factor Remarks: .Boring # fS Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) pcj, 3 3 'L lao'O z p;~S A y~ ~pSa- S ~ Lesnrrr a A9, G s. /j/o L- lb Sc.: ¢ 17 93 0 g5 ~~~hc; is 0 ~`Sr Sf 7 Z S' po rl d 2 0~ STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ,T66~ [l ADDRESS Zjaci 8~"hc Gv . SUBDIVISION / CSMW LOT ,20- yD~rer,~eSECTION_eT?f N-R__,e!~~W, Town of /.clen^e ST. CROIX COUNTY, WISCONSIN PLAN VIER SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Ya i s fi INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. i BENCHMARK: r ALTERNATE BM: 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: S Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well: Housed Other ELEVATIONS Building Sewer ST Inlet: ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt 1AQMX0*;rtrl APJMaLstW.29.1.8.34*I%JA*L0TIVAVM$%TEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) SanitarMi;pitMIX GENERAL INFORMATION Permit Holder's Name: E] City E] Village E] Town of: State PI1 X 'CHFIREFR-K-1: v.. Descriptio Parcel Tax No.: Adj , 610~ss `zL 0 0 TANK INFORMATION ELEVATION DATA 0- 0- Aqinni - - : TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Benchmark pi /~Q,Gc~ Septic Dosi K9___ Aeration Bldg. fewer Z Holding St/ Inlet 11 TANK SETBACK INFORMATf6N St/Outlet TANK TO P/ L WELL BLDG. vent to ROAD Dt Inlet Air Intake Septic 14 NA Dt Bottom 04 Dosin NA Header / Man. Aeration A Dist. Pipe d.7 Holding Bot. System z% _-7 J PUMP/ SIPHON INFORMATION Final Grade Manuf urer Demand Model Number PM TDH Lift I Friction S m Ft L Forcemain Length ia. Dist. To Well SOIL ABSORPTrON SYSTEM BED/TRENCH - Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 c~ DIMENSIONS SETBACK Manufacturer: LEACHING SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION TypeO e,.a m CHAMBER Mode Number: System: OR UNIT DISTRIBUTION SYSTEM Header4*Aen4ekP Distribution Pipe(s) „ x Hole Size Hole Spacing Vent To Air Intake l Spacing Length Dia. Length 1 ~ Dia. c/ I SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systerr~ only Depth Over Depth Over xx Depth Of _„xx--Se`ded /Sodded xx Mulche d /Trench Center *&61 Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOC,A~TII ON : WARREN 0 8.22 99.18 215y , (110TH AVENUE) t% -7 . /e~~" I C <l+~ ° wG.! ! #.r / Q/.z~rr,F c`j, f.7c1 4 Plan revision required? ❑ Yes to / 14-ld Use other side for additional information. b7l SBD-6710(R 05191) Date Inspector's Signature Cert. No. i T ADDITIONAL COMMENTS-AND SKETCH SANITARY PERMIT NUMBER: DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code 7 STATE S N AR PER I # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ ~ 3 _ 8% x 11 inches in size. ch k if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION J !r/'/a Y., S T ,Zg N, R I E (or)do PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ❑ 0 TOWN VILLAGE : d Q.v •r~ ARCEL TAX Nu BE ( ) ❑ Public LEA or 2 Fam. Dwelling- # of bedrooms I- III. BUILDING USE: (If building type is public, check all that apply) `S--L_ 0 1 ❑ Apt/Condo 20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check 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 - 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 140 System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. ;S;;ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft(Min./inch) ELEVATION 4 Feet yo Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank ¢ T Lift Pump Tank/Si hon Chamber Vill. 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 Stamps) PRSW No.: Business Phone Number: r I ( ?1-` o -31s, Gr/ sr2 S 3 -2 Plumber's Address (Street, City, State, Zip Code): /07d c a 4 G IX. COUNTY/DEPARTMENT USE ONLY Groundwater rate Issued Issuing Agent Signature (No Stamps) ❑ Disapproved Sanita Permit Fee (Includes Surcharge Fee) 1 ~ 9 Approved ❑ Owner Given Initial Adverse Determination /910 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 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 r€nevnval 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 (r;BD 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 & 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 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 gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holdirig 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 B% 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; close 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 monic^_; collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) AMICATION FOR BAHITARY PERMIT • 9TC-100 form Is to bo conplatod In full and signed by the owner(s) of This application the prerty being developed. Any lnadaquacles w111 only result In delays of the ptrn►lt l6suance. -should this development be intended for resale by owner/eontractot,(spee house), then a second form should be retained and completed when the property Is sold and submitted to this office vlth the appropriate deed recording. OYttir of property .1011. h r, . L4, kocJC Location of property 1/4 -.AJ /4, Beetlon V Tovnshlp 0.r -,re Ka IIIng address L c e'er S~©"3 • Address of site -it/Esc subdivision nom* 1&/~ Lot number Previous owner of property "e- A/ J." Total size of parcel 2 7- 'S I~- A Crc.q Date parcel was created _71 6-/ q1 All all cotnsts and lot lines Identifiable? as No Is this pcopetty being developed for resale ('spec house)? Yas X0 Volume gfj~2-2_~and Page Number a so recorded with the Reglstsr of Dead - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - INCLUDE VITH THIS APPLICATION THE FOLLOVINCt I~ VAARANTT DRID which Includes a DOCUNRHT HUMBIR, VOLUNI AND PA01 Numa[R, and the OR-kL OF Tlia R90I8TIR 0P D81D8. In addition, a certified survey, It avallable, would be helpful so as to avoid delays of the tavlevlnq process. It the deed description talerenees to a Cettlfled survey Map, the Cattltled Survey Map shall also be required. 7 PROPIRTY OVHER CERTIFICATION I(Ye) certify that all statements on this form are true to the best of my (out) Anovledgel that I (we) am (are) the owner(s) of the property described In this Intotmatlon (orm, by virtue of a warranty deed recorded In the office of the County Register of Deeds as Document No. Al K" Sro4 ) and that I lvel presently own the proposed alto for the sewage disposal system (at I (we) have obtained an easement, to run with the above described pcopetty, for the conettuctlon of said system, and the same has been duly tecotded In the office of the County pollster of Deeds, as Document NO. Im lddIW4,1~11,k I gnat re of owner Signature of co-owner (11 Applicable) 744/ t 7/ ;.(If) Date of nlgnstur Date of Signature I LAND CONTRACT DOCUMENT NO. STATE BAR OF WISCONSIN FORM 11-1982 TN15 SPA(-& RESERVED FOR RECORDING DATA j{ ' Indi,idual and Co,porata II _ 45.5426 ITO BE USED FOR ALL TRANSACTIONS WHERE OVER i j$26,000 IS FINANCED AND IN OTHER NON-CONSUMER REGISTER'S OFI'tt,~ ACT TRANSACTIONSL, _ - 1 ST. CROIX CO., WI i; Contract, by and between Bank__of__New Richmond_,_ a..... i Ree'd for Record duly organized and_ existing Wisconsin banking, JAN 2 915-1-10 corporation------------------------------------------ ("Vendor", 8:30 AM whether one or more) and_.._John A: Kurkowski___and..Anne T ` Kurkowskihusbartd.--and]_.wfp ~._s-_s.y_ivorship.._....~ jI marit al rt ~ .................E..r..o .F..e.... Y. ("Purchaser", whether one or more). $Wft*& i Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- formance of this contrast by Purchaser, the following property, together with the rents, profits, fixtures and other appurtenant interests (all called the "Property"), I _===-BANK OF -NEW-RICHMOND = ~_________________St......C.....ro..... Croix County, State of Wisconsin: "RETURN TO 355 South Knowles Avenue New Richmond, WI 54011 Tax Parcel No. Qya 1d;Z0-11-0 The Northeast 1/4 of Section 8, Township 29 North, Range 18 West, EXCEPT all that part l of the following described tract lying therein: beginning at the Northeast corner of said { Section; thence South 00048' West along the East line of said Section 8, 561.66 feet; thence South 86D17 West 47.1 feet to the center of a town road as reconstructed during 1973; thence North 31°23' West along said centerline 168.5 feet; thence North 34°53' West 348.2 feet; thence North 42011' West 100 feet; thence North 45034' East 82.9 feet; thence North j 69059' East into the Southeast 1/4 of the Southeast 1/4 of Section 5; 374.13 feet to the East line of said Section 5, thence South 00'51' West along said line 125 feet to the point of beginning, also EXCEPT beginning at the Northwest corner of the Northeast 1/4; thence South 660 feet; thence East 660 feet; thence North 660 feet; thence West 660 feet to the point of beginning. l This i_SI14t.....___. homestead property. (is) (is not) 1 Purchaser agrees to purchase the Property and to pay to Vendor at .NeW__RiChmOnd.,,__WiSCOnSlri II the sum of $1-02,-0 QA.a.QQ In the following manner. (a) at the execution of this Contract; and (b) the balance of $_4_3,QQ0...0.0________________ together with interest from date hereof on the balance outstanding from time to time at the rate of---- ten -110 0)___ per cent per annum until paid in full, as fellows: Monthly payments of $600.00 commencing on ?larch 1, 1990. There shall be an additional payment of $3,310.00 due each December 1st during the term of this contract. Provided, however, the enti~ outstanding balance shall be aid in full on or before the........ ISt.......... day of February_________________' 19....._.. ( the maturity date). p R0(jXtfXD(1M?(eX*) 0X)b x"D(tC7i gx*xx%xYo ma)(SX)MUIXWAXXXX, 00►Yr➢G)fLU:E1{em"Xd(df, K XIK K~(~J~X4i~ D~ ~C Xi)t<)t ~(>~l(~l(~{ X+XLX~X X ~ K~K)LJ~~b sib ti X~ttr3~5X ?~l(di Xis KnX 3Ic~(~I~f ~ )63[ kl()bdfalG,~F ~X X KeX Ki4f i)Ea C I ~W~~Kt~~~XX Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- gated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligaticne when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest I unless otherw=.se required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any 3 amount may be prepaid without premium or fee upon principal at any time X"X___•______________________X?~~CX.-__ + M"JWWOW WK&v,"*,X)6XX"W(%3MXtXWf>4tY's)'O )6XV)M)W In the event of any prepayment, this contract shalt not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would bave been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: None. tI, t II _ f! Purchaser agrees to pay the coat of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. Purchaser shall be entitle to take possession of the Property on.... da.t.C_._0.f ._tjii-s...C9.AC across Out One. f ~/LClllillmr STATF BAR FORK N OFiWI - 19@2 CO.N1;IY S10CIC No. 13011 SEPTIC TANK MAINTENANCE AGREEMENT w r~ St. Croix County n a4J~ky ~akw~hn 1~ _ o OWNER/BUYER H. d ROUTE/BOX NUMBE Fire tdumber R ZIP i CITY/STATE PROPERTY LOCATION:'.'N Section-2 T N, R_LR W. Town of St. Croix County, Lot number Subdivision Improper use and maintenance of your wasteseptPropertmaintenancescon-in its premature failure to handle sists of pumping out the septic tank every three years ut sooner, into if needed, by alis~degeunct -unction tmeesepticttank es a treat- the system can affect in the waste disposal system. St. Croix County residents'-MaX be eligible to recieve a grant for a maximum of 60% of the cost.of replacement 978of a failing County, whic was in operation prior to-July accepted this program in August of 1980, with the requirement that owners of all new 'sys't'ems agree to keep their system properly maintained. a The property owner agrees to submit to St. Croix County Zoning certification form, signed by the owner and by a mater plumber, journeyman plumber, nesitecwastewaterrdisposalcsystempisper in pveri roper fying that (1) the o if nec- essary), condition and •(2)•after inspection and pumping (ethe septic.tank isless than 130fdaysdpriordtoc~• Certification form will be sent approximately three year-expiration. y 0 systemrequirements accordanceagree with M I/WE, the undersigned ea8ewaeed dithe sposalabove Co maintain the privat g the standards set forthherCertificationyfothe rm mustobeicompleted o ment of Natural Resources. and returned to the St. Croix County Zoning Office within 30 days of the three year exp , SIGNED DATE /oZ eel3 St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. LaboE and Department ment of Relations Industry, SOIL AND SITE EVALUATION REPORT Page of Labor a Aiv4wn of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Att ach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but 2 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 1o~j A) *J= GOVT. LOT W 1/4 Nr 1/4,S 15r T 2 9 N,R E (or) W PR01?FRTY OWNER':S MAILING ADDRE LOT # BLOCK # SUED. NAME OR CSM # STATE ZIP CODE PHONE NUMBER ❑CITY VILLAGE OWN NEAREST JaO A ^ G><1.~ . YQ-43 (7V 7~9- fit? Pf New Construction Use Residential / Number of bedrooms [ J Addition to existing building j J Replacement Public or commercial describe Code derived daily flow S~ gpd Recommended design loading rate .7 bed, gpd/ft2 . ~ trench, gpd/ft2 Absorption area re uired bed 2 -573 q ~ , ft trench, 112 Maximum design loading rate 7 bed, gpd/ft2 ~ trench, gptirft2 Recommended infiltration surface elevation(s) - Pr; g 92 ' s ec 87, 5Vft (as referred to site plan benchmark) Additional design / site considerations 2 ",vim t 2e 4^4-A ~f dz ",V4,P1 60 .112e, ri-A Parent material Flood plain elevation, if applicable it F=Unsultable table for system T CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRAD SYSTEM IN FILL HO S NG TANK fors stem f$S ❑ U SU 11 S t'U - ❑ S I~u SOIL DESCRIPTION REPORT - Boring # Horizon Depth Dominant Color Mottles Texture Structure Y Roots GPD/ft . in. Munsell Cu. Sz. Cont Color Gr. Sz. Sh. Bed rends l o'-/y'' a -3 3 S/ l SA Ground 7 S' y d S C 14 e r 7 ~ Depth to limiting ctor „ Remarks: Boring # o 10 y s~ l S6 y,s El 27 7, s ' / lay' c Ground yyaY ~n yr S l - -5 o S M- l 7 el Depth to limiting factor Remarks: _ T Nam ase Print / Phone: Address: v L~ 3 5 Signature: - - Date: CST Number: G~ s~ oo jyy7 a~vvnlP s avly ncrvn i Page Z of -3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Cons GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Bour>ciery Roots Bed Trench z 1 7, 5 YO Ground 51n J Viz. Depth to limiting oa° Remarks: Boring # ` - is gar ,,4 r 5 L 3 _ Ground ~ t 7 5 L - S 0 S W, - 7 7 7 ft Depth W IrMing Remarks: Boring # , Z' 7, 5 1.5 Abk 7SyR Ground y~ t" S O S L C/ r 7 ~l , vp, Depth to Imilling Remarks: .Boring # Elltc Ground elev. ft ' Depth to limiting factor Remarks: SBD-8330(R.05/92) Pq, 3 3 t a A _1'~o hot, i ~"L ho'D ~ pi J5 0 e ~^/t.e.2 PaSf S ~ fe.Wer a < yyP ` 3~ ~o y GSA 7~ ,/pl pe p 8s yo' 7 H Gl~roct s Q j ,B L Q !3 3 0 2 8' o'er Sys . Q V S~ 7`-C yAot tPag ~ yyOTo we9 ~QBI ask n Sa a7'h 1- v i N -e- r I