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HomeMy WebLinkAbout006-1019-90-000 !C o 3 ° II M ti p va o~ ~ I h o d ~ ~ I b O N n y ti 'tl aNi II c Z L (6 LL ~ Q 3 `e) z (L m 0) z o I o z a C ~ ~ 7 N GOi Z :!t O fA F- Z C ~ -a ` N N 3 =3 m • N N p Ai a m L - co 'o 0 O O N Q Z m z z N a c N -R E 0 O ~v Grr rO nrr. m N < co U) U) N ~ o l ZL m Z x 3 3 3 C) 0 0 0 Z Ioaaa v, IL ; w C4 C'4 y N J U~ rn rn ~ L_ r CD O N N - O n co O~ a m 04 N w d d Q } fn c6 C ' .R O O N N C w 00 w ~ O E LO O N C C N C C C a rn 0 O O N C 00 N N C N N X a m lD d 0 U) *4 (6 ce) • =^)1 O O U J O Z N U) C/1 N i0 d V ~ • as C 5 m a c `1 z E E c r t r A 100 a o ;om oi Parcel 006-1019-90-000 08i17i2006 10:59 AM PAGE 1 OF 1 Alt. Parcel 9.31.16.126A 006 - TOWN OF CYLON Current XI 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 - LUKE, KEVIN J & JENNIFER a d„ .,r. KEVIN J & JENNIFER LUKE V`~ v`~ 2237 220TH ST DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 2237 220TH ST SC 0119 AMERY SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 36.950 Plat: N/A-NOT AVAILABLE SEC 9 T31 N R1 6W 36.95 AC NE SW FRL Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 09-31N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 950/404 07/23/1997 946/568 07/23/1997 921/165 07/23/1997 910/581 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.000 25,000 357,200 382,200 NO UNDEVELOPED G5 12.000 12,000 0 12,000 NO PRODUCTIVE FORST LANDS G6 20.950 50,000 0 50,000 NO Totals for 2006: General Property 36.950 87,000 357,200 444,200 Woodland 0.000 0 0 Totals for 2005: General Property 36.950 87,000 357,200 444,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/1712001 Batch 512 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N WI 53707 HUMAN RELATIONS (H63.090) & Chapter 145.045) LOCATION/: / SECTION WNSHIP/ NICIpAAL~IITY: OT NO.:BLK. NO.: SUBDIVISION NAME: T N/R CO NTY: O ER'S UYER'S NAME: AILING ADDRESS: Groi e , 4a DATES OBSERVATIONS MADE 36 O 7 USE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFIL DESCRIPTIONS: ATION TESTS: 50 Residence New ❑Replace 7! 17-27„r RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) MS ❑u s ❑u 0s ❑u EIS EIS If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, cate Floodplain elevation: -e-1 -.4r] PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. CHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-a > B- Gt~ PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER ININIIIIIS AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER PER INCH P- . a P Gam, P P- P- _ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION , i jot E F - - aAA L......,_. s I . I k , f c 1 ~ l E Y 1 13 3 r m tv I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the pr d methods s the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge a el' Z NAME (print): I TESTS WERE COMPLETED ON: _2 4CIjr ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - t t INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 61395 To be a complete and accurate soil test, your report must inclucle. 1. Complete legal description; 2. The use sectic~ _nust clearly indicate whether this is a residence or commercial project; 3. MAXIMUM i of bedrooms or commercial use planned; 4. Is this a r ',cement system; 6. Complet4 .I'- r rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYS, Ells ; ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 0. C =1 appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10, If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box,; 11. Sign the form and place your cur.,:it address and your certification number; 12. Make -iible copies and distr' r as required. ALL SOIL TESTS MUST ICE FILED WITH THE L i _~`HORITY WITHIN DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other-Symbols st - Stone (over 10") BR - Bedrock cols Cobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone *s - Sand HGW - High Groundwater cs - Coarse Sand Perc - Percolation Rate coed s - Medium Sand W - Well fs Fine Szn<' Bldg Building Is - Loy Grcc:ter =n sl Sar in _ Less The `I - Loz-:n Bn - Brown sil - Silt Lo: it 131 Black si - Silt Gy - Gray 'cl C' Loam y Yellow scl - Cl^y Loam R F sicl :y Loam mot l -clay w' - lay fff, f,nv, fine, faint cc~ - common, coarse pit - MITI Many, rsredrum ni Muck d distinct p prominent HW.L - F gh water level, Six general soil textures face water foa liquid Waste disposal BM '.''.ark. VRP , real Referent TO THE OWNER: T`-is -)iI Iest report is ` in securin a y permit. The county or the Department may request ation of this soil . field prin.:. nit. issuance. A cornpl- -t of plan„ for "~e private :.:tem and a permit licati.an must be sui3nlitted to 11~ appropri~ ~:al auth, y order to a permit, The sanitary permit must be obtained and po it3r to b l y QE,PARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 769 N WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: O HI /MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: 4Sw ~ 4. 9 I I T N/VIE COUNTY: MAILING ADDRESS: I"4 / ~G! p-d~Y j~i ~O USE DATES OBSERVATIONS MAD 2~-,57 df OFILE DESCRIPTIONS: PER OLATION TESTS. NO. BEDRMS.: COMMERCIAL DESCRIPTION: PR E Residence New ❑Replace SCR IO -/S^ f6 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ?~j s ❑u F_] s ©u ❑ s ES ❑u 2S ❑u F If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Gi/°LJ~.S "P,-- I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- ( '::K 5 B_ B- Y B- B- PERCOLATION TESTS ct ~ TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 1iiINWk8 AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P. 1 ; G P_ G G 3 P- G L P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all bo the direction and percent of land slope. SYSTEM ELEVATION << goe I - i i a a. _ o Act.- t r , 0 3 1 if, I ; 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 the location of the tests are correct to the best of my knowledge and belief. NAME (print), TESTS WERE COMPLETED ON: i ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIG TUBE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - l INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS: 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well fs - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand < - Less Than '1 - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point r TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county,or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SECTION__~T `~N_R~W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 6A I' r / INDI ATE NORTH ARROW BENCHMARK:Elevation and description: Alternate benchmark de, SEPTIC TANK:Manufacturer: Liquid Cap. Rings used:6;?Manhole cover elev: ~/--,Final grade elev: Tank inlet elev.: - -3Tank outlet elev.: No. of feet from nearest road: Front ^ , Side Rear Ft. ~Gd From nearest, prop, line: Front , Side , Rear Ft. ~ No. of feet from: Well / Z Building: ~o Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE i i i PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front-, Side_, Rear-Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: i ~ Width: /a - Length 6'11 Number of Lines: oZ Area Built -,7 0 Exist. Grade Elev. ----`U~ Proposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side, Rear Ft._,4~ i No. feet from well: No. feet from building 0 I7 e ~t/~,'- -2, HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side Rear Ft. No. feet from: Well building , nearest road Alarm Manufacturer: c INSPECTOR• L DATE : /c-2 -,2,7' PLUMBER ON JO &~a4 LICENSE NUMBER: 6/90:cj LOCATION: CYLQN 9.31.16.126A N 1/2 OF S 1//2 222ND AVE. isconsin Department o Industry, PRIVATE SEWAGE SYSTEM County: Labor an"d Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: .GENERAL INFORMATION 175648 Permit Holder's Name: ❑ City ❑ Village [XTown of: State Plan ID No.: LUKE, KEVIN ICYLON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: ©_a , S~ fy, r a s s 006-1019-90-000 TANK INFORMATION ELEVATION DATA A9200308 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (~fe e-/<s l ,5,oU 4 / Benchmark 5 Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet ~,~5 $ 5S TANK SETBACK INFORMATION St/ Ht Outlet Cl, ~j , of TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 1-7 a I 0 / NA Dt Bottom Dosing NA Header / Man. 10A C' ~ , 3 Aeration NA Dist. Pipe v+ 1 Holding Bot. System A Of G PUMP/ SIPHON INFORMATION Final Grade 1-7 9 2, $ Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. m Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS v / DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O n .ll cto v/,3 / CHAMBER D CHAMB Moe Number: System: J OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s f +j x Hole Size x Hole Spacing Vent To Air Intake Length A- Dia. Length ~ Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 1 8JS -7 C~ li Yr ID 41 Plan revision required? ❑ Yes ❑ No Use other side for additional information. 1,27 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' : Y SANITARY PERMIT APPLICATION aOILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than .6 /V 8% x 11 inches in size. 1:1 1.7d .i-. n to a ous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY WNER PROPERTY LOCATION -e17 f r u ~r S T , N, R E ~O PROPERTY O ER'S MAILING DDRESS LOT # BLOCK # ~ P CI STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) El State Owned VILLLLAGE NEAREST ROAD : :VL PARCEL TAX NUMBER(S) ❑ Public R1 or 2 Fam. Dwelling-# of bedrooms Ill. BUILDING USE: (If building type is public, check all that apply) ' l0~ f~©► 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 1130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. eck line B if applicable) A) 1.X New 2. ❑ Replacement 3.E1 Replacement of 4. ❑ Reconnection of 5.0 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 ?J 14 ❑ System-in-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION /15-o 1 7120 ® ~ L ~`-.2_Feet V! ,O. Feet VII. TANK CAPACITY Site INFORMATION in allons Total # of Manufacturer's Prefab. Fiber- Exper. New istin Gallons Tanks Name Concrete 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. Plumber's Name (Print): Plumber's SW nature: (No Stamps) MP/MPRSW No.: Business Phone Number: 1^O~ rck r S'7eSl Plum Address Street, City, State, Zip Code): r IX. COUNTY/DEPAR MENT USE ONLY 1000, Y I ❑ Disapproved Sanitary Permit Fee (includes g rouunnd water Date sued/ I uing Agent Signature (Notamps) Approved ❑ Owner Given initial fn a/ Adverse De ermination d X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: crv SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1 A.saniWy-permit is valid for two (2) years. 2. Your sar}it4ry'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. 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 licens_edd 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 holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% 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)'spil test data on a 1,15,form; and F) Q sizlrig information.,I 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) . STC-100 71lis application form is to be completed il the ocqmer (s ) of the property in full and signed by will only result in delays of bthegpermit~issuance Y inadequacies develo should pment be intended for resale b owner this house th by /contractor s the e n a sec . c and form should be retained ( p the pro ert and completed when a prop Y is sold and submitted to this ppro riate office with t p deed recording. he Owner of property e4! Location of property S Section Township Hailing address ~vX SC o- Address of site ~c rr~ subdivision name c--- Lot no. other homes on property? yeS..-ec-No Previous owner of property Total size of parcel Q Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume-f-->2and page Numbers as recorded. with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRAIITY DEED which includes a DOCUMENT NUHBER, VOLUME AND PAGE. NUMBER & TIIE SEAL OF THE REGISTGIt 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(wc) certify that all statements on this form are true to the best of my (our) knowledge that I we am the property described in this information f(are) the owner( orm, by virtue sofoa warranty deed recorded in the office of the County Register of Deeds as Document No. 14' own the proposed site for the sewage di p salt system ) rr I e(we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded No. 45 office of County Register of deeds as Document 4ga tur e licant Co-applicant i Date of Signature Date of Signature -t .rtT No. WARRANTY DEED STATE BAIL OF WISCONSIN FORM 2-1982 Y0L ~~PQ,- REGISTER'S OFFICE Sydney B. Hovde- a married. person„_ ST C"XCO..N L Redd for Record I MAY 151992 _ aarr;mt; to Kevin.-J.. Luke _and. II 01 8:30 A. M Luke husband and wife,.as survivorship_marital..p y. V ( . RepWa of Deeds . - - - L_ _ .,Ing described real estate in ~St.. CXDIA... County, II An undivided one-sixth (1/6) interest in the following described property: The North Half of the South Half (NJ of S}) of Section Nine (9), Township Thirty-one (31) North, of Range Sixteen (16) West, EXCEPT the railroad right of way, being 150.5 acres, more or less. •li. I. is not hnmestr.,d property. (is) (is not) E-ptiou t. "turanties: 19 . ..30 r~. day of April 92 J 5deyTH .......(SEAL)....(SEAL) d . . . . - .Sy..e_.. _ . _...(SEAL) AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ss. .......r Sra~t(JN _......County. -'tcatd this ..--....dap of........................... 19--°° Personally came before me this . day of t..... the above named ' Sydney.l},...Havde 't F : ME4(BER STATE BAR OF WISCONSI N1\~~(yt~, (If not - 4~. ...,a Qo mo >nown to be the person who executed the . authored by $ 70fi.OG, Wis. SLatsJ rument and acknowledge the - e jreggivg G INSTRUMENT WAS DRAFTED BY t O Q.L. stra, Van Dyk & Needham, A S..C , ~ J A T C-r- REln - Hgr.. _ - of Box 127 ~ 201 South Knowles Avenue, s .Count , Wis. New R4chmond,-WI -3491-7'--'-- " hr,nrJ Public S .•Commission is Permanent. ([f not, atate cspiration iSi_natures may be, authenticated or acknowledged . $bth. y I f n. 10.9j I. are not necessary.) date: .QVP"l.~ gnin¢ nnv <anx<itY should be t,. -j , iokal below their aonn:uren. .ar. ~ e[ ae W15censin Legal Blank CoBAR i.RRA VTY DEED STATE FORM No. 9 1U`SIN Mi 1.11" ec, W"cons,n i r WARRANTY DEED I STATE BAR .21? WISCONSIN FORM 71 REGISTER'S OFFICE' v1L 950PAGf 5_ - ;T CROIX Co., W1 1Li,,.,. Hovde, a single person.._ Recd for Record MAY 151992 V~ - 8:30 A. M Kevin J, Lukean d Jennifer WaideIich- :uke d wife as-_aurvivOrship marita]..Erepetty.. (~frYrtt~Gl(. ' . husband. . and Regolerd0eed>< ~J - "lull . I't• , cubed r I estate in St-Croix . County, Tax Parcel No.... ...,...sided one-sixth (1/6) interest in the following described property: Jw Half of the South Half (N} of SD of Section Nine (9), Township / •I[` (31) 14)rth, of Range Sixteen (16) West, EXCEPT the railroad gay being, 150.5 acres, more or less. nAW!"E' S FEE 71 is. not homestead property. (is) (is ",A) i:.cccptwu W --Lies: /19C1 9 Dal, day of 92 -.-..(SEAL) oha..J.,_HOY.d.?._.._. .(SEAL) ....(SEAL) _ . AUTHENTICATION ACKNOWLEDGMENT Sit, i.:rci<1 STATE OF WISCONSIN 1{{ ss. .......County. __ca - 19...... Personally came before me this ........day of . ,.rcd this _.._day of _ air.,.... 1992.... the a6ov¢ named Aloha..J...H. vde . T, y ' ",f P.\IBF,R STn rf, 13AR OF WISCONSIN _ i~.o ~.d. )zed by $ 101,.06, Wis. Stats.) to me known to be the person atio .fR000tcB. the foregoing instrument and ueknowIcifW0`t~+]Y~( Id i T • INSTRUMENT WAS DRAFTED 61 Re era, Van Dyk & Needham, S.C. ~t~Vlota 2C xluth Knowles Avenue, Box' I27 . 'I - t~f Ne 'ichmond, W1- 54017 Notary Public ..4n a n L4 '.IYN Via tc res may be authenticated or acknowledged. Both My Commission is perman t IIt1~l V,. osarY.) date: { M A; ' - -twm pobUc,`ppittee of 23 X993 BIQnPt Vu ,,irrMi i b^MM May p. ¢nm¢ -p-ity .hoWd be t-A or printed beta their W Wisconsin Legal Blank Co.. Inc. v `:TY DEPn STATE BAR OF WISCONSIN Milwaukee. Wisconsin FOAM No, e- IvaT DOCUMENT NO. S'1'A'1't BAN UI' WISCUNSIN-FORM 2 WARRANTY DEED • • 482351 IIBER J 6PQGE~ THIS SPACE RISERVED FOR RECOROINI: UAIP FFF- - - REGISTER'S OFFICE sr, CROIX Co. Wl - Roed for RocW APR 231992 c, r;s and warrants to Kevin J.-Luke apd Jenn:fEr_ Of 8:30 A. M Waidelich-Lr a husband gnd-- ife.,_..as.survivorship.._ marital Pror rty, 0 a.& R@ Wer of Doe& _ _ RETURN TO--_--___ the fol:owing described n I estate in__ County, Stale cf Wisconsin: .__yr \ yet,` iC1F of ti- L F- 1 ]f .J' L ~Oi't:flr 11 LliloC lC Tax Key No. L ,~_,.ry, beir.C .5 ~L 0 h .-to-i property. (is) (is not) rl:<Ception to warran f N Dated this day o( -~.i:.------"- . 191_. 2 (SEAL) (SEAL) - - - ------'-(SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signatures auth:ntmated this Tray of STATE OF WISCONSIN 19_ ss. ----Pier-ce_______ County. ` 21st Personally came before me, this day of April - the above named MEMBER STA] BAR OF WISCONSIN Milton D. HOvde :i not. -i-d by 4706. Wis. Slats.) instrument wa - afted by IA In Ine I(nnwn +o the person whoa l'ed tiE9 (gre- .c going instr t and nckn +Iod • t QnCj'•,' rn t a s may be auth~ ticated or acknowledged. Both ' Gerald- R..-.Lee... AU-V1014-j 0 7}' c ,-essa,y.) Notary Public _S_tate.. Q.f--W15,0P~26-i71✓Q + b My Comm'sin is permaner (If not; '$rd,; YRpi. Y1S dale, ~epr~.e er a. ..Y nFF.n-STA'r1- - OF WISCONSIN. FORM No 2-1911 I SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER-U,~ ~~er✓1~~~ ADDRESS:-, FIRE NO: LOCATION: Y ~ ~,U#~4, SEC.~T_Z1 N-R_Z4~L_W1 TOWN OF:-- /o~ ST.•CROIX COUNTY X SUBDIVISION: LOT NO. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the.system can affect the function of the septic tank as a treatment stage in the waste disposal system: St. Croix County residents may be eligible to receive a grant to help with the cost of the replacement of a failing system, which was in operation prior to July 1, 1978. St Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to the St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman. plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating 'condition and (2) after inspection and pumping (if necessary),, the septic tank is less than 1/3 full of sludge and scum. Certification from will- be sent approximately 30 days prior to three year expiration. I/WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system-in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification form must be completed and returned to the. St. Croix County.Zoning Officer within 30 days of the three year expiration date. SIGNED: I. DATE: St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 ~,1.1;u+MW ~YiI:rIW4WW1Ui~:u/.a.~..+uwttY$ DEPARTMENT OF, REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: WNSHIP/ NICIPALITY: LOT NO.: BLK. NO.: SUBDI VISION NAME: JJ14 V /T;~2 N/R/c-, E ( W oil CO NTY. OWNER'S/BUYER'S NAME: AILING ADDRESS: /7 i e r- 41 / Gtr Y 5 `7/ USE DATES OBSERVATIONS MADE NO. BED MS.: COMMERCIAL DESCRIPTION PROFILE DESCRIPTIONS: PE LATION TESTS: Residence I New ❑Replace V~-_ 7,~ 7y RATING: S= Site suitable for system U= Site unsuitable for system ) CONVENTIONAL: MOUND: IN- R PRESSURE:SYSTEM -IN-FILLHOLDINGTANK: RECOMMENDED SYSTEM: loptional L.-~►s_asau _ LId"S EIS EIS I I Percolation Tests are NOT re(4 ff:17IGN RATE: If any portioNU ;7,,2o_25x4 n of the tested area is in the under s.1163.09(5)(1)), indicate: Floodplain, indicate Floodplain elevation: ~tJ -4d I PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-1,7 0rz - B- pct PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH P_ 07 P_ / ' P_ P- I'- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of lend slope. , SYSTEM ELEVATION • . r f'~ r 3 r , ~o i~ 1, they 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 the location of the tests are correct to the best of my knowledge and belief. INANIF Iprin0: TESTS WERE COMPLETED ON: i,C.)LiFiESS r CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGN TUR OISTF;113UTION: Ot.ginl and one copy to Loral Authority, Property Owner and Soil Tester. ~:iu c~n,zo~c to n•~:e~l (1 \!FR -r-.+~_.-~.. ......~..........r..wY.+~AY.. ..-i.wwYY.AYI'i.Y►w.W W PLOT PLAN - PROJECT//ey,h ~ 44 /f ADDRESS O fy 1S Gj /T?~N/R /5W TOWN COUNTY - MPRS Byron Bird r. 3 18 DATE BEDROOM CLASS PERC CONVENTIONAL,eAjN-GROUND PR URE CONVENTIONAL LIFT_ MOUND-HOLDING TANK SEPTIC TANK SIZES LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA -,Z2~ PERC RATE _~~gED SIZE /o? X,~ o ► Benchmark V.R.P. Assume Elevation 100' Location of Benchmark * H.R.P / ❑ Borehole Q Well Scale = Feet O Perc Hole System Elevation Uent 12" Grade TYPAR COVERING 2 " _ 12" 3' 4 6' O 3' I 6' Sewer Rock i 12' a Ile o X07 ~J/D REPT131 CYLON ST. CROIX COUNTY ZONING PAGE 1 10/27/92 09:04 REQUESTS FOR INSPECTION WORK SHEETS FOR: 10/27/92 AREA: MJ Activity: A9200308 10/27/92 Type: CONVSEPT Status: PENDING Constr: Address: CYLON 9.31.16.126A,N 1/2 OF S 1/2, 222ND AVE. Parcel: 006-1019-90-000 Occ: Use: Description: 175648 Applicant: LUKE, KEVIN Phone: Owner: LUKE, KEVIN Phone: Contractor: BIRD, BYRON JR. Phone: 268-7616 Inspection Request Information..... Requestor: BIRD, BYRON Phone: Req Time: 11:10 Comments: //0'36 Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION c~IC~ 7'yc~ Inspection History..... Item: 00012 FINAL INSPECTION III