HomeMy WebLinkAbout030-1032-20-300
p E» p i»
c
o
~ N
O O
ell p _ NN °~f
O N > _
00 a
E > j w cc p
c
0
EpZa~
w E F= °
a) (6 C 7 'O N
T,~3 E rn p Q Co c
Ol N N O. CD V 7
'b co 0 N B Co
7a -00 U)
0 -1 m
LO E F-
(D °O =0 101.4 0 CU a> N d m N
C Z w •d c Z N C m~ w E
io 3N m a~~30
U. a r~ LL o
o EaNO0>v,
1)-x a-
Q)
Q U-U E Q tnmQm o
{ U
M (0
3 a
z N tl!
~wI
rn E E
z °o = °o
z
NF- w a m a
co m
Z c
0
c C7 3 m
O z g c c p v
O
a~pi 2 O LL Z
!n F- r O) ~ m N d
c w E o
N C Y).
o E m o.
N N N N N
3 a N N
N
2 CD 'w 0
•ova d -c O LL N
O O C > O U
d' p O N Q Q
O Z m z LO Z (9 Z q
Z
~r =
d C d N m
O
d• CO ~ EN H ~ N
O _ M •j L d Y
CL to a m = a R.
0 o a
E a m v~ v~ E 0
V~ Q o N - c F FN - F es - p ca F- F- F- p p
Z > ) 3 53: CL N N3:~:3: d Z
• m = a a a a a a
IL c `O„
7 O U) J 03 N N o o o y
fn U E rn rn a~ Z o o y
c M O O
O -p
to Cl) (N
D ° r d
^V LL M O
0 O 0 O O E
_ O
N x co
z N Q N Q
o y'ji Q Z 06 N l6 Q Z 0
= w
.7 O O c Y INA C N C c
M O O 0 L U N Sa 0 0
O! o C y U p c n LL°
c~ _ 0L a Y E i c N I
CL (n
U) 0 O M N c O N Y c y l- c 7 •N'-4 u) -
O N 'O C c N° li
° O N N F- N
~ m =
o N m rn a w E m °r' 0 o
tom,' Cl) o U) U o z N v o z Z
0 ca I i
V ~ a ~I' ~a I ~a
o it a n w L:
a
• c~
c
o m o 3 o o
A 0 (L 2 0 U) 0 0 v) o
D~LH 2 SANITARY PERMIT APPLICATION . TY
In accord with ILHR 83.05, Wis. Adm. Code couNa/
5...- °.......~~q`
4,44
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than 11 144 1 a 51 8% x 11 inches in size. Check if revision to pre lour 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
£ '/4 A) -j::-1/4, S g To?:?, N, R / E (o
e47iV4,_-4,yA4 -62
PROPER O ZAJT-~_-e SMAILIN ADD ESS LOT # BLOCK #
CITY STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
~cI Gam, -,5_41U14 s -,12 3
II. TYPE OF BUILDING: (Check one) 11 State Owned ❑ VILLAGE NEAREST ROAD
❑ Public X1 or 2 Fam. Dwellingof bedrooms ~'CSa V E
~ R EL TAX N BER )
Ill. BUILDING USE: (If building type is public, check all that apply) /42
1 ❑ Apt/Condo -9-0
20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash
50 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 El Specify Type 41 El 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. f.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
zr / ~o t~ /a0 i rT 4/ 5 • cle 0 3 . 00 Feet -456- ' 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 Holding Tank /000 1/000
E
Lift Pump Tank/Si hon Chamber
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumbs ' ign re: (No S MP/MPRSW No.: Business Phone Number:
ZA-W P S 3395 2i~ 38' --m-0
Plumber's Address (Street, City, State, Zip Code :
/S tD SvAD c-Je . '-Yci
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved San' ry Permit Fee (Includes Groundwater a e ssue issuing A nt. Signature (No Sta s
Approved ❑ Owner Given Initial tJa Surcharge Fee) 9
Adverse Determination 1 ?A<5
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
i
S 8 ° 52~ W
109TH AVE. ~
W
FENCE 356.19 FENCE 2 7'
POST POST
L
N
t`
0)
fT
RIBBON Z
h
9i 3 3 w
N O Z
0) O N ti O
W N O
cf ~ ~ W
_ b z -
(D U) J3
FENCE w Z
POST 3 O
533 ACRES g
3o 9 a o
'o CD
cli N
Z
O ~ .gyp'
Z 1A O ~
to N tZu
0 W2
to N
W
FENCE
POST y
0
!r3
O
N
FLAG
O
0
C3
LATH 545.00' PO TE I,- 0.00
1
RILABON IN TREES
AROUND IRON PIPE
~cvcf/if'1 To T E~.~~ ioo_ooIJo,Prd P?o Q ~7 AQS PLB 67
PLOT & CROSS SECTION PLANS
~~Nf sinir~ aT y AL7 ZAPPA BROS. EXCAVATING INC
4C,4Ac .5, re PLUMBING UNIT
~cuF~ A 13,3 snot ~ ~ rE.•
PROJECT
ALNG T -
°,o
~ ~ ~fMT S O ,fPT10N +rf A
+ To 6E CUT AN ,f i
7 N~~cT MAY QcPT/L w etJ
A A c sow
62 a~r~ o s
ti ~ s
OAK lZ2,
D ~~if1AiN /
MIST
0 o g ° ~,pvAc~i
(,cJEs~ S p~ 034 1
~~OQOSeO
117-,Ag 1000 ,tt'5Loric -rt,K
wlrN . Z:A-jVze7w7 is Alt 6f'v®o5e0
NO
t'ou~-r,4 SCALE
140,04Pr-, NNE
FRESH AIR INLET AND OBSERVATION PIPE
- APPROVED VENT CAP
MAXIMUM 12'
ABOVE FINAL GRADE
4' CAST IRON VENT PIPE
MAXIMUM OF 42' ABOVE
PIPE TO FINAL GRADE
SIGNED: _
MARSH HAY OR SYNTHETIC COVERING LICENSE: 'Wes 3.395
I .
MINIMUM 2' AGGREGATE DATE:
-7
OVER PIPE41
DISTRIBUTION PIPE
TEE SOIL TESTING BY:
ELEVATION BED 6' AGGREGATE
BOTTOM PER SOIL BENEATH PIPE PERFORATED PIPE BELOW
TESTIS COUPLING TERMINATING
q~o,W . FT. AT BOTTOM OF SYSTEM
l Ojpy~~ f` 1-07 Se-A Q lsr VyC
/li/Ii~ IQD,~/~
I
I
o'
I
I
~
~ toy -
j f~M
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY'" • DIVISION
LABW AND- PERCOLATION TESTS (115) MADISOP.O. BOX N W1 7969
HUMAN RELATIONS
A : SE TAN: ,r. TOWNSHIP/MUNICIPALITY: OT NO.:BLK. NO.: SUBDIVISI'N AME:
41'r 1/ 1/ /T29 N/R/9 E (or) W TosP h`- 9 .3 A. 5~:¢1fl~c
COUNTY: OWNER'S BUYER'S NAME: MAIL N A D E :
/x "D 11010bA)
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL D S R TION: TS:
Residence 3 New ❑Replace 2Z- /9~L 11~v7~D
Fxv 1 1 41+ 7
RATING: S= Site suitable for system U= Site unsuitable for system ~10 4 /0,qLr -%1T D
5f 4V
LUNV1tN11L)NAL: MOUND: IN-GROUNDPRESSURE:S TEM-IN-FILLHOLDINGTANK:R COMMEND ED SYSTEM: (optional)
$ ❑ U S ❑ U S ❑ U ❑ S U ❑ S ®U ovvfvr~,v~L l34c:P_ 6i s4 /mar.
If Percolation Tests are NOT required DESIGN RATE: S I If any portion of the lot is in the
under s.H63.09(5)(b), indicate: ~dJ S~ ~p 6 Floodplain, indicate Floodplain elevation:
nq PROFILE DESCRIPTIONS
BORING TOTAL DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED H TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 11p,/ Fr ) 9 /0 ° N-G'/• L S, /a. " AA" SG , 12 " OR-AV. SL-
q ~o C
P&6 - " /~N~Gy. , ~3 " s~ , 2z 00-5V 51- , %P
B- Z / ~O /00.3 F r- 13
B- 90 > 90 /c' y -6y
B. /00.f fr > 9✓~ 9c 4-6y 4s 7> N. _o,f
B. ~Z- /00•~fr - > yZ 9C v-(ry GS, rV 5~ 16"61C. IfL G3" ill d/p
:B:-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. p RI D t P RI D PER INCH
P- W F/~V /.tJ
P- SC SO/L .y r..
&Pldel E0
P-
P- en L
PLAN VIEW: 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 slop. 1507TOM of AA041A7f1EZD /_;Wo CEX69vAP0A)) 51141,L GiC_ E*fCTLy
SYSTEM ELEVATION y.o Fr, fie 4Ow Qa?'rkAL PEF. Pair Mgr- F lF uoTrof.~ or- y6.0 F'I
I} I s
1 ~ I ~ G,~SgG►EL
~ R~ Rdk op ~ ro C~fEX~ c~ i -
VFer~c~4L . F`. P a7' Etr Tr u AF
;os s /op. p _ Fr.
-
t e404 .6
V'0'r P17
fon
f, 110V _
1/3 u
V13
a-i
k y , era
€ i
I
j
oelc, i,
,~57!
tvoh55 ,idsT" m . 5-0
I, the undersigned, hereby certify that the soya 1' ported on this form were made by me in accord with the procedures methods specified in the Wisconsin
Admimistrative Code, and that the data recor e location of the tests are correct to the best of my knowledge and belief.
NAME print,86h ~T Zl/he/'C~~ TESTS WERE COMPLETED -
/ /3 / 9fADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional :
•3 V fo v G(~/S 5-y01ss =oz yp2_ 3~(-~id'~
CS IG ATU
'OIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
f
i
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYE C . ~
In r
(~~e
ADDRESS:_ 03 rfiV-4rn "O FIRE NO:-60-5
LOCATION: 101/4, MC 1/4 SEC.
__8__T_52a N-R I W,
TOWN OF:
ST. CROIX COUNTY
SUBDIVISION•
LOT NO. 7
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 pum. What
put into the system can affect the function of thepseptic tankyas
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 pumper verifying that (1) the on-site wastewater disposallsystem
is in proper operating condition and
( after
pumping (if necessary), the septic tank is less thansp1/3tfull aof
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
DATE:
c ~
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
ACUMENT NO. STATE BAR OF WISCONSIN FORM 2•-1982 THIS SPACE RESERVED FOR RECORDING DATA
f y . WARRANTY DEED
6204G 7vot 8,90PAGE 3J
REGISTER'S OFFICE
William E. e.rki.ns and Jane M. Perkins, ST. CROIX CO., WI
-
_ hl.tsband--and_ wife, Recd for Record
- indivicully- end each
in, their own right, SLf 0 5 1990
at
Patrick 11:25 A.M
conveys and warrants to C. Crawford and.
Kathleen M. Crawford, husband and wife,
as marital survivorship property Register ofDee&
RETURNTO GWIN LAW FIRM
430 Second Street
St. Croix Hudson, WI 54016
the following described real estate in County, I_
State of Wisconsin:
Tax Parcel No: 30-1032-20
A parcel of land known as Parcel #9 located in the 111-14 of 1-1E14 of Section 8-29-11), Tuwn
of St. Joseph, described as follows: Part of' NE; of NE14 of Section 8-c9-19 described as
fc,llows: Commencing at the N14 corner of said Section 8; thence SO°42'10"W (true
bearinu) 1313.15 feet along the W line of the P!W14 of 14(:14 of Section 8; thence 1180''37'50"
1326.6 feet alorg the S line of said NI,11n or" NE14; thence N0039' 10"E 330.01 feet along
he E lin,, of a N14 of NEa; thence N89°37'50"E 941.34 feet to point of beginning;
thencu NO 22'10"W ul.'' , 8 feet; thence N 81-i"' c,?' E 356.19 feet along the Sly right of v. air
line of the town road; -~henca S0°36'E vo1.44 feet; thence C189'.137'50"W 345.00 feet to
-int of beginning.
, gtther with an oricivided 1/15th interest in a non-cYcl.isive perrilflont roadway
ease ant in Roadway b, and an Undivided 1; :5th uanership interest in the Cormlunity Purk~
both of which aye located in the NEa of 1,,014 of Section 8, and the N1,41; of N'.d'y of Section
9. all in M:1, RAW, F,s specified and described in Affidavit Establishing Easements
dat.i 4-29-73 and recorded 5-9-73 in the Office of the Register of Deed- fur _it. Croix
(:aunty, Wisconsin in Vol. 497, pages 410-412, as Doc U11101rt 110. 51' j8b.
Std j:_~ct to r~icerded easoinonts and Declaration Establishing Protective Coven.rlts
ct,:ted 4-24-73 and recorded 5-0-73 in the office of th,~ Register of DE. ds for St. C.•oix
County, Wisconsin in Vol.497, page 407, as Documr!nt No. 315687.
TR AP's,
This is not homestead property. 6
(is) (is not) 'S 1
Exception to Warranties:
i
Dated this 21st day of August 199 0
~ I
(SEAL)
• William D. Perkins
(SEAL) `c -
• Jane M. Perkins
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) M/A STATE ~JF WISCo SIN
y1 ~1C SS.
- County.
authenticated this day of _ 19-- Personally came before me this -.day of
1--AH-_ , 19 the above named
11-1 LE: MEMBER STATE BAR OF WISCONSIN
(If not, _ to me known to be the person who executed the
authorized by § 706.06, Wis. Stats.) foregoing instruehent and acknowledge the Sam .
THIS INSTRUMENT WAS DRAFTED BY ~
-
Atty. Hugh __H. _Gwin, Gwin_ Law_ Firm
430 Second St. Hudson, WI 54016 Notary Public-
(Signatures may be authenticated or acknowledged. Both My Commission i permanent.
n
are not necessary.) date: AXil
i
Names of persons signing in any capacity sho,,!d he typed or printed below their Signatures NOTARX PT'fR>;,
„u
WARRANTY DEED STATE BAR OF WISCONSIN COLUMk0(,'CAGR'L 8_0?075 G
Form No. 2 - 1982