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Parcel 004-1032-95-000 10/13/2006 12:29 PM
PAGE 1 OF 1
Alt. Parcel M 14.28.15.221 B 004 - TOWN OF CADY
Current X', ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
HANG O - HANG, YIA
YIA H
YIA AN G C - XIONG, MAI
323 310TH ST
WILSON WI 54027
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 5586 SPRING VALLEY
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 9.000 Plat: N/A-NOT AVAILABLE
SEC 14 T28N R15W 9A N 18 RDS OF SW SW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
14-28N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
06/06/2005 796779 2815/498 WD
04/07/2005 791690 2780/130 WD
06/13/2003 725798 2275/437 TI
05/22/2003 722536 2250/579 EZ-U
more...
2006 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 04/17/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 28,000 38,100 66,100 NO
PRODUCTIVE FORST LANDS G6 7.000 21,000 0 21,000 NO
Totals for 2006:
General Property 9.000 49,000 38,100 87,100
Woodland 0.000 0 0
Totals for 2005:
General Property 9.000 49,000 27,000 76,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch M PRGRM
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
4f 10'4 vG: S / 7PAGE 504
Document No. This space reserved for recording data
HOLDING TANK AGREEMENT
Agreement Date
This agreement is made between the REGISTER'S OFFICE
County or Local Governmental Unit I Holding Tank(s) Owner(s)
ST. CROIX CO., WI
iYl / pl Ff E . Recd for Record
(Called Municipality below) I t A U G 0 3 1990
We acknowledge that application is being made for the installation of (a) holding O1;. 8.00 A M
tank(s) on the following property, (Provide legal land description:) `
RegisterofDeeds
C Z,-r,4 _ 1 8 1-24rns-_ o _ Sc. IN o+' sOVY)
) Return To
------~2--~
or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of
sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under
Ch. ILHR 83, Wis. Adm. Code, or Ch. 145, Stats.
As an inducement to the County of 5Y V i>d 1 X to issue a sanitary permit for the above described property,
we agree to the following:
1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the
holding tank properly serviced in response to orders issued by the municipality to prevent or abate a nuisance as described in ss. 146.13 and
146.14, Stats. the municipality may enter upon the property and service the tank or cause to have the tank serviced and charge the owner by
placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by
s. 66.60, Stats.
2. Owner agrees to pay all charges and costs incurred by the municipality for inspection, pumping, hauling or otherwise servicing and maintaining
the holding tank in such a manner as to prevent or abate any nuisance or health hazard caused by the holding tank. The municipality shall notify
the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the
costs within thirty (30) days, the owner specifically agrees that all of the costs and charges may be placed on the tax roll as a special assess-
ment for the abatement of a nuisance, and the tax shall be collected as provided by law.
3. The owner, except as provided by s. 146.20 (30) (d), Slats., agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code to
have the holding tank serviced and to file a copy of the contract or the owner's registration with the municipality and with the county. The owner
further agrees to file a copy of any changes to the service contract or a copy of a new service contract with the municipality and the county within
ten (10) business days from the date of change to the service contract.
4. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code who shall submit to the municipality and to the county a
report in accord with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code for the servicing on a semiannual basis. In the case of registration under
s. 146.20 (3) (d), Stats., the owner shall submit the report to the municipality and the county.
5. This agreement will remain in effect only until the local governmental unit responsible for the regulation of private sewage systems certifies that
the property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83, Wis. Adm. Code. In addition, this
agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit
the existence of the certification to be determined by reference to the property.
6. This agreement shall be binding upon the owner, the heirs of the owner and assignees of the owner. The owner shall submit the agreement to
the register of deeds and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement
to be determined by reference to the property where the holding tank is installed.
Owner(s) Name(s) (Print) I Owner(s) Signature(s)
)d I ` ' - - - Subscribed and sworn to before me on this date:
Municipal Official Name (Print) I Municipal Official Signature Notary Public
r A b~Q My commission expires:
Municipal Official Titl rint) I ~
Me I
SBD-6123 (R. 10/85) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations, Bureau of Plumbing.
ST. CROI X COUNTY
WISCONSI N
x Z O N I N G O F F I C E (715) 386-4680
g 911 Fourth Street
- Hudson, WI 54016
O W N E R
P U M P E R
A G R E E M E N T
PLEASE BE ADVISED, rhaz untie you ate again noti6ied, I wilt
conttacx with~Fljrl o 6
Wisconsin, ( Pumper) , Jot the putpod a o6 removing aUwabte 6tom the
.aanitaty system to be tocated on the ptopetty and 6utute home site
tocazed in St. Ctad,x County, Wisconsin, Township o6 (AA0
being in the 14- o6 the ~ o6 Sec. , T. N.-R.,Z&_W.
(0t mate butty de.detibed as 6ottow.6: )
Dated this 2nd day o6 May X19 90
OWNER)
State ob Wisconsin)
Dunn bd
County o6 S%XXZk=X )
Petaonnattyappeated be6ate me this 2nd day o6 May , 19~.
the above named Mike J. Heck to me known to e
petban who execute the 6ategoing ind.ttument and achnowtedged the name.
Susan Sims
otat y u .cc, SAWftv*x aun y,
My Comm. (is petmant) (Expi4ez) 10-12-92
~r
0 heteinbeJate neb erred to ad Pumpers,
join 'in the ab ve agteementto th extent that I have a eon.ttae# with
Owner as above stated.
PUMPER I
FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP=
SECTION 2,,,~T 2 L N-R~W
ADDRESS_ ST. CROIX COUNTY, WISCONSIN
Lfj (,f l
SUBDIVISION LOT= SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Al
I. w-4-
az`
a
4t c n%G a
INDICATE NORTH ARROW
BENCHMARK: Elevation and description:-
Alternate ~ilc~,t1 E B~
benchmark
SEPTIC TANK:Manufacture Liquid Cap.
Rings used: Manho cover elev:_Final grade elev:
Tank inlet elev.• Tank outlet elev.:
No. of feet f om nearest road:Front , Side , Rear Ft.
From nearest prop. line:Front , Side , Rear Ft.
No. of feet from: Well , Building:
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
l
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
Beds Trench: Seepage Pit:
Width:_ Length Number of Lines: Area Built
Exist. Grade Elev. Proposed Final Grade Elev.
Fill depth to top of pipe:
No. feet from nearest prop. line:Front , Side , Rear Ft.
Q
No. feet from well: _-No. feet from building
HOLDING TANK
Manufacturer:,-"
~~,~C3~-/mar ~T capacity:
~iP~Qc~
No. of rings used:,_ _Elevation of bottom tank:-
Elevation of inlet: Qm L3
No. feet from nearest prop. line:Front\, Side, Rear Ft." Mpg
No. feet from: Wellbuilding ?Q_, nearest road -5
alarm Manufacturer:
INSPECTOR: ,J ~•r~ i~,~so,J
DATE: PLUMBER ON JOB: e.
LICENSE NUMBER: 2 /'0
6/90:cj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR & HUMAN RELATIONS DIVISION
P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
MADISON, WI 53707 State Plan I.D. Number:
SW4iSW4,Sec. 14,T28-R15 ❑ CONVENTIONAL ❑ ALTERATIVE (If assigned)
Town of Cady ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
W i P T HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
r4ike Hecky RBox 183, Wilson, WI 54027
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. E V.:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Lyle M 6219 St. Croix 128729
SEPTIC T K/ % N
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK O4Ttfi-ELEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
.5 J10 I 99%, 3 S g E❑ NO ES ❑ NO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM: FEET FROM / LINE: AIR INLET:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST S~ 5 i cD
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑ YES El NO ❑ YES ❑ NO E_] YES ❑ NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF ❑ YES ❑ NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER PIT INSIDE DIA.: # PITS: LDIE UIID,
TRENCHES: MATERIAL:
DIMENSIONS
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET:
NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
❑ YES ❑ NO ❑ YES ❑ NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
ELEVATION AND
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑ YES ❑ NO ❑ YES ❑ NO
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
COMMENTS: FEET FROM LINE:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side. r IGNA TITLE:
SBD-6710 (R. 06/88) 61 V
DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COu
.a...M..e,....,.. ,~,,,e,~
STATE SANITARY PERMIT
#
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑
8% x 11 inches in size. Chec if revis on to p vious application
-See reverse side for instructions for completing this application. STAT LAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 3 Q q-0 Q
PROPERTY OWNE PROP RTY LOC TION d
'/a S T.Z~ , N, R E (or
' r A ~6_r= 9 4 0 /
PROPER 0 NE 'S MAIL G ADDRESS LOT # BLOCK #
,0~(
CITY T/ TE ZIP CODE PHONE NUMBER SUBDIVISION NAME ~CSM NUMBER
11 -h 6/~ A
11. TYPE OF BUILDING: (Check one) State Owned VC ITYLLAGE NEAREST ROAD
i~ J
❑ Public 01 or 2 Fam. Dwelling- # of bedrooms -PARCEL AX NUM ER() N
111. BUILDING USE: (If building type is public, check all that apply) Q i
z l
1 [1 Apt/Condo
2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1.0 New 2. 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 41X Holding Tank
12 El Seepage Trench 22 1:1 In-Ground 42 Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
Feet Feet
VII. TANK CAPACITY Site
In allons Total #of Prefab. Fiber- Exper.
INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Hold In Tank 0 C 1
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 ignature: (No Stamps) MP PRSW No.: Business Phone Number:
1.4 le- J_,Mye12_S. Plumb s Address (Stye , City, te, Zip Cod
Z z -q72-!S
IX. COUNTY/DEPARTMENT USE ONLY
Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Approved ❑ Owner Given initial Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVALIREASONS 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.
1 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:
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/wate!r 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)
IN
INDUSTRY, .T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
NDUSTRY, DIVISION
LABOR HUMAN REDLATIONS PERCOLATION TESTS (115 MADISON WI 53707
(ILHR 83.0911) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/ LOT N .:BLK. NO.: SUBDIVISION N E: 4 (org Ga- 06 1 A AIA A
C UNTY: MAILI ADDRESS: n
USE DATES OBSERVATIONS MADE
~ 1NO..BEDRMS.: ICOMMERCIAL ESCRIPTION: PROFILEVESCRIJFTIONS: A TESTS:
V idence ❑ New Replace
I /
RATING: S= Site suitable for system U= Site unsuitable for system
CONaVENTI®AL: MOUND: IN-G~ND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: REC MM§NDED SYSTEM- loptional
S U S ®U S U EIS NU I S U
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: I A Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HEST TO BEDROCK IF OBSERVED ( EE ABBRV. ON BACK.)
~ ~ 7r 'ttuo'~•~z St: i
B. 30 C 6,~ y c7' c3 )t s►~ 1'3 i3.2s~ 1, Si3ms~c
y r, t.4'~ i~I-3c-
~X e3n s, & 6 _s~ / 43 ns/c/
`3 r
~a.i r r
B-
B-
B-
OLATION TESTS
DEPTH. WATER IN HOLE TEST TIME DR TER L VEL-IN HES S
N AL-MIN. PERIOD 1 PE PER1003 PER INCH
P-
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 w QCL~Q 9
E
E
€ E t ~
4 _
3
_ m~
r7
E
Yo _
the undersigned- if that he soil tests reported on this form were made b ccord with a procedures and methods specified in the Wisconsin
Administrative Code, and that the ata recorded and the location of the tests are correct to the best of my nowledge and belief.
r
TED ON:
NAME ( ' t : i TESTS WER COM7CFo
ADDRES : CERTIFICATION NUMBER: PHONE NUMBER (optional):
r ~ ~ c..k ,•-C, / i !x.,1.1• .3t~,--; ,~2
CS NAT RE:
C
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
To be a complete and accurate soil test, your report must include:
1. Complete legal description;
2. The use section 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
Is - Fine Sand Bldg - Building
Is- Loamy Sand > - Greater Than
'sl - Loamy Sand < - Less Than
'I - Loam Bn - Brown
'sit - 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 fit - 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
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.
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HOLDING TANK CROSS-SECTION
Approved Weather Proof
Vent Cap Junction Box
4" C.I. /Approved Locking Manhole Cover
Vent Pipe With Warning Label Attached
Minimum 12" And Padlock
-t..
/Final Grade
4" Minimum
_T7
f Approved Joint '
18" Minimum
Water Tight--" jh1\
peal High WateSPECIFICATIONS Alarm Swi t 1
f TANK New Existing
/ Manu acturer: Approved Joint
Tank Size: w/ C.I. Pipe
Blind C.I. allons Extending 3'
Plug ALARM Manufacturer: Onto Solid Soil
_5, ~ , EL ~''7~n O t2. Sc .-1 U~
Model Number:
Switch Type P0C
NUMBER OF BEDROOMS:,,
GALLONS PER DAY:_i~5__
3" of Bedding Under Tank
Owner's Name:
Address:
Legal Discr p ion: uj/5,.
Township/blun~ici~ a,l,ity:
County:
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PLUMBER/DESIGNER c~
Signature:
License N d~~
Date:
QNSITE S '
Mob, oft Eah,
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AFFAKUY
DEPARTMENT DUSTRY, LABOR AND H AN T#OC~S
i N OF SA
E CORRESPU DENCE
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STC - 105 a
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SEPTIC TANK MAINTENANCE AGREEMENT 0
St. Croix County z
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-
OWNER/BUYER CYL
ROUTE/BOX NUMBER ~1 Fire Number
CITY/STATE W d -ZIP %-7
PROPERTY LOCATION: !41 14, Section, TN, R~ W,
Town of~ , St. Croix County,
Subdivision Lot number
I
I
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into Ik
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix. County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on- site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration.
0
z
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with H
the standards set forth, herein, as set by the Wisconsin Depart- 'v
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning OF.,fice with 3 days
of the three year expiration date.
SIGNED
i
DATE
St. Croix County Zoning Office
P.O. Box 98
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
1 APPLICATION FOR S n r •AKrII~-~c.-.~
rnAR'i PERMIT
-
STC-100
This application form is to be completed in full and signed by the owner(s) of
the property being developed. Any inadequacies will only result in delays of
the permit issuance. Should this development be intended for resale by
owner/contractor,(spec house), then a second form should be retained and
completed when the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property re
Location of property,~Lj 1/4 _ /9, Section , T,:~~N-R W
Township 'A D Y
Mailing address _ lol qTy r L/ilf ,r jC MEE
Address of site QT I 9J'~ U tj l 156a W
Subdivision name
Lot number 1
Previous owner of property ~(~lJ~" j~ 4~~ t/S(~►~
Total size of parcel
Date parcel was created _
Are all corners and lot lines identifiable? es No
Is this property being developed for resale (spec house)? Yes X_No
Volume ~and Page Number L as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and
the BEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if
available, would be helpful so as to avoid delays of the reviewing process. If
the deed description references to a Certified Survey Map, the Certified Survey
Map shall also be required.
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (our)
knowledge; that 1 (we) am (are) the owner(s) of the property described in
this information form, by virtue of a warranty deed recorded in the Office of
the County Register of Deeds as Document No. 3 s 3•// ; and that I (We)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
of the Cau Qy Re ist r of Deeds, as Document No. 3
Signature of Giwner Signature of Co-Owner (If Applicable)
i~I ~ 9D
Date of Sign ure Date of Signature
STATE BAR OF WISCONSIN-FORM 1
DOCUMENT NO, !
WARRANTY DEED
' I THIS SPACE RESERVED FOR RECORDING DATA
35431 vc:. I ~.f
REGISTERS OFFICE
THIS DEED made between Douglas G. Willson and Asuncion
Willson, husband and wife and each in their own ST. CROIX CO. WIS.
right, Rac'd. for Record this--- 1i
and Mike J Hecky and Marion E Hecky, husband and Grantor a day of Jan. A.D. 19_79 }
as joint tenants at 11:30 A , M.
Grantee,
W i to e s s e t h , That the said Grantor for a valuable consideration Reg f' `of heeds
Six Thousand Two Hundred and no/100 Dollars
conveys to Grantee the following described real estate in St. Croix -County, RET N TO
i
State of Wisconsin:
North 18 rods"of Southwest Quarter of Southwest Quarter
(SW4 of SW4j- of Section 14, Town 28, Range 15, consisting
of nixie acres, more or less. Tax Key W
f
This is not homestead property.
his Deed is given in consumation of that certain Land Contract between the parties
dated the 26t,by of August, 1969 and recorded in the Register of Deeds office for
!j St. Croix County on the 11th day of September , 1969 in Volume 455 , page 89-90-91 !I
as Document No. 297802 E
FEE
EXEMPT
Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining;
EE And Douglas G. Willson and Asuncion Willson
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
and will warrant and defend the same.
Executed at Minneapolis, Minnesota this- 17th day of August 19_L6.
SI ED AND 'SE LED IN P SENCE OF ru I (SEAL)
Q
Douglas G. Willson
Harry H war ^ (SEAL)
Zj r 4?71 Asuncion Willson
(SEAL) lI
Luanne Lun een
I1 •~a~r~,c...C~.,tILaQ-- ~ I
(SEAL)
j
Signatures of
I
authenticated this day of 19
li
Title: Member State Bar of Wisconsin or Other Party
!i
Authorized under Sec. 706.06 viz.
i
Minnesota
STATE OF
County. ss.f'Gj
Personally came.before me, this day of August , 1976,
the above named- ouglas G Willson and Asuncion Willson
to me known to be the person- who executed the foregoing instrument and ackno edged the sam .
• i
V C;
This instrument was drafted b Harr
oward
Robert R. Gavic, Attorney at Law Notary Public eouhiy,f ;
The use of witnesses is optional. My Commission (Expires) us).,-
Names of persons signing in any capacity should be typed or printed below their signatures.
H.M Myl'erComWW
WARRANTY DEED-STATE BAR OF WISCONSIN, FORM NO. 1 - 197 1