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HomeMy WebLinkAbout040-1217-30-000 c a) o a p E» I ~ I o ~ I r. o N I N ~ i ti I Q I I e a z LL c O Q Cl) ~ E c Of I' z ~ a m 00 r` ~ 0 c ~ o z z c w a r. N _ o N H y o c E o -a ~ ch I Q) N 0) CL W ~ C N O O z m Z N d Q co y E E C14 I is Y N o m -It p co LL N al i Q) C O O w G C d rz c ~ oN ) co 1- F- U ~L- N a O 15 U) Z • i a a a E g e N a) t!~ ~ V j 0 rn rn } Y ~ oo I LL t r o O O E ,n 7 u~ a) ~ M Q } a a3 ^i O O O N C 9 to ' O c C E V rn "a o f 4 a a a 01 o,lc coo Q)C5~I N~ co N C<! Q) H F- 3 N cn E E U I ~V O y?' o o E 2 o z N :=5 U) O ca « I a #6 L 0 0. CD `10; E 'c c 3 A V a m o U-) V • ST. CROIX COUNTY WISCONSIN - I I Mpp If x if ZONING OFFICE _ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 II August 30, 1995 ~ 4 Ms. Carroll Farrell Edina Realty t b~ 400 Second Street South Hudson, Wisconsin 54016 l~ RE: Water Results (lead) for Residence Located at 431 South Fork Drive, Hudson, Wisconsin Dear Ms. Farrell: Enclosed is the original test results from Commercial Testing Laboratory, Inc. for water (lead) inspection of the above property. If you have any questions regarding these results, please do not hesitate in contacting our office. Sincerely, `A IV'~ Mary J! Jenkins Assistant Zoning Administrator mz Enclosure COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 ST. CROIX COUNTY ZONING OFFICE REPORT NO.; 90727/01 PAGE 1 ST.CROIX CTY GOV.CTR REPORT DATE. 8/28/95 1101 CARMICHAEL ROAD DATE RECEIVED: 8/17/95 HUDSON, WI 54016 ATTNI THOMAS Co NELSON WI INR LAB CERTIF30617013980 GW1366 Robert Montagne 8-15-95 - w Lead. ppb 15 The maximum contaminant level (MCL) for lead in community drinking water systems is 15 parts per billion (PPB). Lead analyzed by the Atomic Absorption Furnace Techni-jue, EPA Method 239«2 of "Methods for Chemical Analysis of Water and Wastes► 1983. oF,NDEDFNpFNi `p ( Means "LESS THAN" Detectable Level Approved by: Zg A 6 4.n O PROFESSIONAL LABORATORY SERVICES SINCE 1952 ` ST. CROIX COUNTY WISCONSIN - t ZONING OFFICE ! b a A u r u - .~..e ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road f = Hudson, WI 54016-7710 - (715) 386-4680 August 24, 1995 Ms. Carroll Farrell Edina Realty 400 Second Street South Hudson, Wisconsin 54016 RE: Septic Inspection and Water Test Result for Robert Montagne Property Located at 431 South Fork Drive, Hudson, Wisconsin Dear Ms. Farrell: An inspection of the septic system located at 431 South Fork Drive, Hudson, Wisconsin, was conducted on August 15, 1995. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Also, water samples were taken. The results for the bacteria and nitrate are enclosed for your review. Should you have any questions in the meantime, please do not hesitate in contacting this office. Sincerely, Mary Jenkins Assistant Zoning Administrator mz Enclosures COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 FAX-715-962-4030 ST. CROIX COUNTY ZONING OFFICE REPORT NO.. 90351/01 PAGE 7 ST.CROIX CTY GOV.CTR REPORT DATE: 0/22/95 1101 CARMiICHAEL ROAD DATE RECEIVED' 8/17/95 HUDSON, WI 54016 ATTN. THOMAS C. NELSON I 1 OWNERS Robert Mioutagne LOCATION: 431 South Fora; Ir., Hudson COLLECTORS M4 .lenk i ns Q DATE COLLECTED. 8-15-95 co TIME COLLECTED: 8245am SOURCE OF SAMPLES Outside faucet off, DATE OIALYZED 4 8-17-95 i TIME ANALYZED*#2*+00pm COLIFORMi,MIFCC. 0 /100 m( INTERPRETATION. Bacteriologically SAF'F NITRATE-NS 0.6 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L RESULTS: LAB TECHNICIANS Pam Gane FAKD ON: PHONED ON: frlyZitir WI Approved Lab No. 19 CALLER: • OF.\NDEVEI.~ENl Means "LESS THAN" Detectable Level. Approved by. J D dd 4•^ OO PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY WISCONSIN _ ZONING OFFICE I~arraaar u■■f ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 S (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. ❑ Water (VOC's) $185.00 )0 Septic $50.00 OR Water (Nitrate & Bacteria) 45.00 0 Nitrate & Bacteria 1 act 0( rest $15.00 -c .czar Owner: X11 F Requestejbii~o Add ress : 14n f.4 I ~ Address : (zz IP s-, 0 ~ ZIP (P Telephone N2: ( ) Telephone W: Property address (Fire If & Street) : 4SI 3, roY~ r5 S on Loc~~~ rJ Z- Sec.__7_, T_Q_RN, R_J__7_W, Town of 'FEo Realty firm: Lock Box Combo:, Closing Date: TO BE COMPLETED BY PROPERTY OWNER PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: Is the dwelling currently ccupied? 0 Yes No If vacant, date last occupied: a)u~~v Age of septic system: has ~ L:A r, s, Septic tank last pumped by: v ~szf- Date: Previous Owner's Name (s) Have any of the following been observed? OY XN Slow drainage from house. OY .KN Sewage Back-up into dwelling. OY XN Sewage discharge to ground surface or road ditch. 0Y 2rN Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: DATE: 1i9, rO OWNERS DRAWI OF HOUSE & SEPTIC SYSTEM LOCATION IN ~u)e~i C7 \A -4 4~v TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? Offs ONO Soil series per SCS Soil Survey: sheet # Type of soil absorption system: ©Below grd OAt-Grd OMound Approx. size /,I,' X 40' 'Gravity ❑Dose OPressurized 12,3,0 Ft.2 Oted OTrench ODry Well OHolding Tank ❑Outfall pipe OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank Setbacks: ❑House ❑Well OProp. line ❑Other Dose tank Setbacks: ❑House /l.' ❑Wel l ie$ " ❑Prop. line >/oo '❑Other OLocking cover OWarning label OPump/Floats OAlarm OElec. wiring Soil Absorption System Setbacks: ❑House,)7' ❑Well SS's ❑Prop. line 757'❑Other ❑Ponding: 11 6x L, ❑Discharge: QYu~ General comments: INSPECTORS SKETCH OF SYSTEM LOCATION I~ i ~ i i i EF Inspector I Title Zl FORM - STC - 104 l~ AS BUILT SANITARY SYSTEM REPORT OWNER&i,,I- ,i A , 42, TOWNSHIP SECTION ` T,2,'f N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION_ S LOT_ELOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i z5 S8 Wr// INDICATE NORTH ARROW BENCHMARK:Elevation and descri tion: /_~1jDD o Alternate benchmark - SEPTIC TANK:Manufacturer: Liquid Cap. -op Rings used: - Manhole cover elev: 22/~jFinal grade elev: /Qn -'R'" I If Tank inlet elev.:~Tank outlet elev.: No. of feet from nearest road:Front , Side, Rear Ft.42,!~)' From nearest prop.' lins:Fron/t Side, Rear Ft. No. of feet from: Well d Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE I PUMP CHAFER 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:,-~ront_, Side_, Rear-Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: ~C Trench: Seepage Pit: Width: Length /n Number of Lines: ,2Area Built,~D~ Exist. Grade Elev. Proposed Final Grade Elev. lD[~ Fill depth to top of pipe: No. feet from nearest prop. line:Front Side, Rear Ft.-ZL- No. feet from well:, No. feet from building ~y 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: INSPECTOR: DATE:_Z--~- /o/_ PLUMBER ON JOB: LICENSE NUMBER:9 6/90:cj 4N4sc6rN,n Department of Industry, PRIVATE SEWAGE SYSTEM County: • Labor and Human Relations INSPECTION REPORT St. Croix Safety and Buildings Division (ATTACH TO PERMIT) Lot $ Sanitary Permit No GENERALINFORMATIONSEQ SE4 Sec.7 T28-T19 Town Rd. 149122 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: obert Monta he Troy CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 040121730000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 6,)veA~5 cc.-Ie. Pro Benchmark a;, p ' ,70 16Z) . 60' Dosing A&-& • A At-0 / 96. 70 3 r 3 .97 Aeration Bldg. Sewer Holding St/ Inlet TANK SETBACK INFORMATION St/ Outlet i Ventto TANK TO P / L WELL BLDG. Air Intake ROAD Dt Inlet Septic 8 ' ~L r NA Dt Bottom Dosin NA Header/1tWF' Aeration NA Dist. Pipe g,9p r 517, Holding Bot. System y 67d 7,03 ' PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 5 7S Model Number GPM TDH Lift Friction FS etem TDH Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length / No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSIONS O DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEAC G Manufacturer: SETBACK CHAMBER Model Number: INFORMATION TypeO Cc-v. S-~ OR UNIT System: 60-d o~ DISTRIBUTION SYSTEM Header / I>AartrFtrhi- y Distribution Pipe(s) ( x Hole Size x Hole Spacing Vent To Air ~~take Length Dia Length Dia Spacing /y (o B'S 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 prese t, etc.) dam'-,~ ern C 6~ y0 zLc> d. a,^ 1 ?:L Plan revision required? ❑ Yes u'90- Use other side for additional information. 9 9/ / „n i., ..r n~~o Inc nArtnr'c Cin nafi irP Cert No FORM - STC - 104 l~ AS BUILT SANITARY SYSTEM REPORT OWNER_71 e,,-ALj4aa, TOWNSHIP- SECTIO] .2~N-R 1_W !j ADDRESS ST. CROIX COUNTY, WISCONSIN zz AL tlL SUBDIVISION LOT- q LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i a W<~~ INDICATE NORTH ARROW i BENCHMARK: Elevation and descri ti:-on : Alternate benchmark J - SEPTIC TANK:Manufacturer: - Liquid Cap. Rings used: - Manhole cover elev: 22~~~Final grade elev:,leo ~R Tank inlet elev.:Tank outlet elev.: 2S 9,~; No. of feet from nearest road:Front , Side, Rear Ft.42,!5)1 From "`dearest prop." l ins : Front , Side, Rear Ft. No. of feet from: Well 'S'8 r Building: /z, (Include this information in the above plot plan) (2 reference dimensions to septic tank) s SEE REVERSE SIDE C a a ~ r 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:,--~ront_, Side, Rear-Ft. Distance from: Well ,,Building SOIL ABSORPTION SYSTEM Bed: ~C Trench: Seepage Pit: Width: Length /n Number of Lines:'..,,ZArea Built, Exist. Grade Elev. Proposed Final Grade Elev. fprj a`/~, Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side, Rear Ft._ZS:- No. feet from well:, No. feet from building I 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: INSPECTOR: DATE: - PLUMBER ON JOB: LICENSE NUMBER: _s9 6/90:cj [g I Wiscbnsint9egartmentof Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT St. Croix Safety and Buildings Division (ATTACH TO PERMIT) Lot $ Sanitary Permit No.: GENERAL INFORMATIONSE 4 SE 4 Sec. 7,T28-T19,_ Town Rd. 149122 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: obert Monta he Troy CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 0.40121730000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURERn CAPACITY STATION BS HI FS ELEV. Septic (Cclnc. Wro 0D ,#-lP, Benchmark V /GYb,eO Dosing a,97 7d , Aeration Bldg. Sewer Holding St/ Inlet 98,8 TANK SETBACK INFORMATION St/ Outlet a~ TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ?/mf 4 ' /61 4A NA Dt Bottom Dosi n NA Header / f6pTF g, G 1 Q8 Q~ Aeration NA Dist. Pipe :9. 9o 97,3 r ' Holding Bot. System 67' 97,03 PUMP/ SIPHON INFORMATION Final Grade 9 Manufacturer Demand Model Number GPM TDH Lift Friction Sy em TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS O DIMENSIONS SETBACK G Manufacturer: SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEAC INFORMATION Type O C u- CHAMBER Moe Number: System: 6,LSd YLd ? .T7 AA OR UNIT DISTRIBUTION SYSTEM Header / Me"+fe}d- y Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length ~ Dia. Length ( ~ 2- r' (o ° f~ Dia. Spacing ~f gs 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 prese t, etc.) _ yt~e. QR- cell a -4 Plan revision required? ❑ Yes IZW0_' Use other side for additional information. 9 9 9 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. 701LH 0 SANITARY PERMIT APPLICATION 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 ❑ Lk e sion / o 8% X 11 inches in size. i r previous application i -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPE OWNER PROPERTY LOCATION T61 WE a '/a, S , N, R It (Or) PROPE TY OWNER'S MAILING ADDRE LOT # BLOCK # c`7t CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION N ME OR CSM NU BER 7e~ Ydi Y t7~' II. TYPE OF BUILDING: Check one CI NEAREST ROAD ( ) State Owned VILLAGE [A 'JOWN OF: ❑ Public 1 or 2 Fam. Dwelling-## of bedrooms P ARCEL TAX NUMBER(S) IIII. BUILDING USE: (If building type is public, check all that apply) m 44 G /c~ o z as o d 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 120 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. [X New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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 ~ rtn Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 420 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/day/sq. ft.) (Min./inch) ELEVATION Feet Feet VII. TANK CAPMTY Site INFORMATION in allons Total of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. New xistin Gallons Tanks Concrete strutted glass App. Tanks Tanks Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for inst lation of the onsite sewage system shown on the attached plans. Plumb 's Name (Print): Plu er' Signature: (Np S pal MP/MPRSW No.: Business Phone Number: Plumber' Address (Street, City, State, Zip Cod IX. GOUNTYIDEPARTMENT USE ONLY ❑ Disapproved aitary Permit Fee (Includes Groundwater Date Issued issuing gent Signatur No Stamps Surcharge Fee) Approved El Owner Given Initial 21~L 60-1-0 Adverse Det rmination 7O?T 9 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 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. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system. is to be in`stalled.'. 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) 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 monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) f e APPLICATION FOR SANITARY PERHIT 9TC-100 This application form Is to be conplntod In full and elgnad by the ovnetla) of the property being developed, Any Inadoquacles will only result In delays of tht pztrnlt Istuance, -Should this davelopment be Intended for rttals by ovntr/contractot,(spac house), thon a second farm should bt taIt aImtd and completed vhan the property Is cold and submitted to t h I a off lea vlth the ■ppropclatt deed tteotding. - - - Oxn:r at property Location of property 19 TovnshIp Pialll g a dtts r S • d Address o[ altt ltubdLyle Ion nai" Lot number Pctelous ovntr of property ` Total alto of parcel . ' I Data parcel vas created Jars ■ll corners and lot llnsr ldentlflable? _____Yas o, is thl■ pro petty being developed for resale (spit house)? Yes ~~Ito volnrsa 7U~ and Page Ifumbar 110 a~ 2 recorded Wlth the Raglstec of Daads. 1HCLUD1t WITH THIS APPLICATION Till POLLOWIHCI A VA.ARANTT D¢tD which Includes a DOCUHRHT 1ILMD 111 VOLUMS: AND PA01t IuMjtA, and tht 9 1AL Or TIIt RSOISTHR Of DB&DS. In nddltlon, a ctttltltd survey, if available, would be helpful so as to avoid delays of the tovltVing protest. It the deed description references to a Cat'tlflad Survey Hap, the Cettltled turvty Hap (hall Ito be required, PROPERTY OWIltR-CERTIFICATION---• live) certify that ell statements on this form ate true to t best of my lour) knovltdge) that I (we) am (are) the owner(s) of the p operty dtscrlbtd In this Intotmatlon form, by virtue of a Nerranty + the county iteglattt of Deeds as Document I{ tca dad In the office of 11 Pttatntly own the proposed alto for tho neWage disposal a aten, and that 1 have (or I t) ave obtalntd an easement, to run With the above daIcrlbtd prop erty,(vIar h1.ha cone tuctlon of sold system, and the same lieu been duly a ardt In o tic °f a ov t a t o Daedsj as Document 1jo. Sign v t Owner - atu a oL Co vnar (IL App II la) of a no a Data Sig Lure 4 a STATEBMOf MONMM0CM rNlatl tt' { 111110 . WARRAN" DEED r VOL 9R!P*c 27 RK3WWS ST. CROIX CO., WI Reed for Recarld JUL 171991 10:225 AM conveys and to V (~fM RETURN TO the following described real estate in C County' State of Wisconsin: Tax Parcel NO: _H ~'o R ,I p r7i aN 411 a L o c, -T k D Z Al ~iG} ZT sF~ i` • This N6r) homestead property. (is) (is not) . Exception to Warranties: A Dated IN ^day of fact C i (SEAL , i ISEALI ISEALI AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ` ss a County ) authenticated this day of Personally came before me this-- : - - -day of a 19--the above named TITLE` MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person----,-who executed the authorized by § 706.06. Wis Slats foregoing Instrument and rcknowledge the same. . l ------~~i- THIS INSTRUMENT WAS DRAFTED BY Ire f T CF Notary PublicCounty. (Sign ure may be authenticated or acknowledged Both My Commission is oermaneru (1) not. state expiration are not necessary l date .19-7-1 -A 1 'Names of persons signing- any caoa,Ir should be typed or panted below thou s.gnatwes f WARRANTY DEED STATE BAR OF WISCONSIN Nsloo Tax Fora P.O. Sox to &GileaagatlriliNW14001 Fo.m No 2 - 1982 i SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ADDRESS: FIR O: LOCATION: _1/4, 1/4, SEC. 7 T4L_N-R_dW, TOWN OF: ST. CROIX COUNTY SUBDIVISION: p LOT NO. _K 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: DATE: G - St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53707 HUMAN RELATIONS (H63.0911) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.: BLK. O.: SUBDIVI ION NAME: a / N/R t (or) W jor COU TY: OW S U ER'S NA IL N ADDRESS : r USE DATES OBSERVATIO S MADE rrc~~ NO. BEDRMS.: COMMERCIA DESCRIPTION: DESCRIPTIONS: 1PERCOLATION TESTS: I~aJResidence ? ®New ❑Replace 1PROFILE 91 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED YSTEM: optional) [AS ❑U [AS ❑U CAS ❑U ❑ S 2U ❑ S ®U If If Percolation Tests are NOT require J DESI N ATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER-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.) _ 1 I B / r B_~ - r B- Z B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE EST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P- Y9 -1~7 I/ P- P- 4 3 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 "JrK I i ~ _ c c i 7 I i i { l z i 1 40 - f e 1, the undersigned, hereby certify that the soil tests re orted 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 r" : TESTS WERE COMPLETED ON: AD S: CERTIFICA ION NUM ER: PHONE NUMBER (optional): 1,4 3 - ~l CS S G TUR DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - J ~97SA /9A C.''o 04 ys~ Goy r B KSt' - A~4,1 pp ~ r ~0~/f~ (~2u/ -1~x -S,fC ' PAGE OF . C.roSS S~c}I~n o~ A 3C1~ S, z~~~-~ • / i • • I'mit Ali Inlol► And Ob6byvallon Plp• Approve Vaal Cop ++W-wo 12' Above Final Geode 20• .2v Above Plpp Coal Iron To flag! 01400Veal Pipe Wean )Jay Of synihols +uia 2' Ayyeyole On/ Pipe Olalrlb'lion o 0 0 --Teo + No s~ AOa/eyoig Pollowued Pie bole. Benulb Pipe ° V o ~Coypllny Ton°IaUlay AI 6olloa 01 Sy+leal ~Icv•.~' ton I' ~ SOIL FILL DISTRIBUTIOM PIPE APPROVED S`MPETIC COVER "-JUTERIM- OR '1" OF STRAW 2" OF hr-GRE&A-M OR MARSW HAj ' ELEV. O F97e FEAT !."OF."2-212 AGGREGAT E. DISTRIBiUTIOM PIPE TO BE AT LEAST IMCHES BELOW ORIGIMAL GRADE AAJU AT LCASTLO MCHES BUT MO AORC THAI) 42. ILICIIES BELOW FIMAL GRACE. MAXIMUM DEPTH OF F-XCAVATIOIJ FROM ORIGINAL 6XPDF- WILL BE. yL_ IWCHES 1NNIMUM OEPT}1 OF EACAVATION rAOA 0~14I14AL GRAPE WILL 5C INCHES I SIGUCO: LICEUSC LJUMBEIi: DATE: L~~ I 110 _