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HomeMy WebLinkAbout020-1281-70-000 (3) a Oto Q6°a m M O O C c O O 0 -0 C t ~ 0o ay_~ N C N y C O N c O O L L C T N O (D M I U O C O O =~U m . rn aNi 'o O 4) a m c .a O Z 0. 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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * COOK, WILLIAM G & ANNETTE WILLIAM G & ANNETTE COOK 669 EDIE LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 669 EDIE LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.275 Plat: 0170-CHERRY HILL ADDITION SEC 34 T29N R19W PT SW1/4 & PT NW1/4 LOT Block/Condo Bldg: LOT 19 19 CHERRY HILL ADDITION Tract(s): (Sec-Twn-Rng 401/4 1601/4) 34-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 859/155 2004 SUMMARY Bill Fair Market Value: Assessed with: 49396 464,500 Valuations: Last Changed: 04/29/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.275 41,700 317,600 359,300 NO Totals for 2004: General Property 2.275 41,700 317,600 359,300 Woodland 0.000 0 0 Totals for 2003: General Property 2.275 41,700 317,600 359,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 204 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 SANITARY PERMIT APPLICATION ILHR COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than El Eevko, 8% x 11 inches in size. ceck if klo.s application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. AV ' PROPERTY OWNER / PROPERTY LOCATION p AR,A't(C~i,OuJr /pies-.,;Q5; l f 6T &M o4C NUJ% SGT/ Y4, S 3 T N, R /f E (or (o PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # too 81/ e CITY, STATE ~~S ZIP CODE P / HONE NUMBERSUBDIVISION NAM /CSM NUMBER 11. TYPE OF BUILDING: (Check one) e CITY NEAREST ROAD ❑ State Owned VILLAGE ' 11&J 410A1 ❑ Public Z 1 or 2 Fam. Dwelling-# of bedrooms R L AX NUMBER(5) III. BUILDING USE: (If building type is public, check all that apply) 0 Z V /1 7 Z -0) 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 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. M New 2. ❑ Replacement 3. ❑ 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) 5- 'X ( 4 2- G/, 4,,6-5 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 14 ❑ System-In-Fill z,1 VI. ABSORPTION SYSTEM INFORMATION: 00'_ 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM LEV. 7. FINAL GRADE (0(50 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gal ay/sq. ft.) (Min./inch) p3. /ELEVATION 6640 660 -/0 ! ,3 ~ . 3w Feet . ' Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. New istin Gallons Tanks Manufacturer's Name Con- Steel lass Plastic INFORMATION App Concrete structed g Tanks Tanks Septic Tank or Holding Tank Lift Pump Tank/Si hon Chamber El - ~0 I E] Fj 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 Signature: (No Stamps) P/MPRSW No.: Business Phone Number: Ro steer' lbRi r 7 3 0 h/s ltl ~0A) ~ Pber's.4ddr© ess ((A)Ejstreet, city, state, Zip Coda : 55 JJCC I IX. COUNTY/DEPARTMENT USE ONLY Iss in A [_j Disapproved Sanitary Permit Fee (Includes Groundwater aes e 9entSi9n ature(NoStamps) Surcharge Fee) Y I Approved El Owner Given Initial / QC Adverse Determination / X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: C• - SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber f 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.acgurate 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. ll. 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; (lose 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. SBD4M (R.11/88) S i APPLICATION FOR SANITARY 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 Location of property 1/4S W 1/4, Section , T_~f N-RjW Township j! lPr6A.) Mailing address PO-3 7T 3 4 t2g 4 0 /1 Address of site fL d Subdivision name Lot number Previous owner of property Total size of parcel -a, /lam, Date parcel was created Are all corners and lot lines identifiable? es No Is this property being developed for resale (spec house)? Yes ~No Volume and Page Number 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 SEAL 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. J PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (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. ; 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 constru Ton of said system, and the same has been duly recorded in the Office of the y.Register D e , as Document No. S ature Owner Signat of Co-Owner (If licable) Date of Si nat a Date o ignature t 'k" .A rL P' iR '-f Ruh 48 :T` r.}. a .~'rg_ NPATE BAIL 0? WUCpM "jtM it _ JM T.10 MACE Msermw pans cle-{1~fll' (TO as usRD FM AL', ~ '~ua+ucnoxs WRZRZ ilr,NO IS ![IfAIiCap AIfD IN anQa !(ONCONBUYSs Aar rws.croxs► - REGISTER'S QOFM* ~ ST. CROIX M" M 1......... Redd for ftMd DE0161988 ' +d+~-- 1lA/.is.. Akl&.& ("Vendor". Of 12:45 i** .t .e. one or me;Y w~ t_ V w .waft t0 uncap to Pasabaaae, npea the prompt mad full per- t w, 'b! Purebase•, the h1lowbw property, together wu the BrM mid edws Dt iatuwd (au 'W" the r ?,.ss< County, state of Wisconsin: asruaM aVh/a Avbeet G.. P'ykeell, Hm asd boob ! MOs all by their AottMTW in Fact, • r ; mad DOUIUB PWcmm a;/k/a Douglas A. Y and Betty Jam Pykem, Wife of Ta: Pored Na %d& P*m and Betty Jane Pfil w heire no interest in the " fd $01111 in this CM*Mct only as to the b&Uun of the PtWelfty ; I 14 01f 8M 1/4 of M, 1/4 of Section 34, ftewhip 29 North, MW 1! r "t -111LOwnsin Lot 1 of Certified ' 9tarvey MeP in Vbltae "T", Lot 1 Of OWtifled StWvoy► !ftp in Volume "70, Pegs 1g06. '2 t AA of BE 1/4 of Of 1/4 and M 1/4 d H/ 1/4 of Section 34, ~ -0900 ftnP 19 M t, 3Ft. CVC dx COunty, ftecoasin. } '!!do tin lit...... homestead peapesa. is rdmr as Property and to pay to Viaeer at .805 Vi)1e _ 9~:~ . H} tea lweeali~m W thin friihast and (b) the bmi~amwi safaris: (a) i_ :~IsQQQ.Q • of .ca to • ~ M 1M ~ nether with intRewt tta_ t°~ 111011120M from time d time at Mb of _4.53........ ~ d be ly, on Mlareh15, 1Z ~d t as M.111 1S, 19f9) of each year hereafter With Pd*WW pun my aooi~ed !fit due in full on hum 15, 1991. Aftew plat nx Y 9 ital bodies, mad a t, rlellibef t►l]1 s~lsasa ltlld3WAS1 rtau lots upon reoeipt of $3,600; ~ Cw P i of, In the lot to be released, plus qtt;" tAK ehsll p W the cost of pceparatisn s+ gi n in PsttW satisfaction (i.e. rele of MINE r i g*#W#W 0111i dolt in paymnt, balerast shall acerue at the rate of % ' 40 (wbisit OW iodide, without limitation, ddi per annum on the entire asodo n9wnt Interest and, upon acceleration or maturity, the 46680, boa a 1 Fwiel"le, 80108 weaned by Venda 61014 Special aseemments fire and to pt' Moi tilt' to Vendor amounts sufficient to pay reasonably on. 46r- required insurance premiums when due. To the extent received by Y, 4 Ally pmts to these oblipatioos whim due. Such amounts received by the Vendor for payaw" opt b Rhi`, seasnlnlMo amd inoaraaee will be deposited into an escrow fund or trustee account, but ahall not bear lateraa ~Mhia,~hae+rlss .-9r od by law. ftfam o dM be applied first to interest on the Us Paid balance at the rate speeilied and then to wiaai" A1q• ' M Mepabi without premium or fee upon principal at any time after.$.... NftMWOMM Aster that purchaser is satisfied with the title as shown by the title evidence submitted to 10a of the Mow* of the down paYnaent. Veradar shall give a wearr> KI Oft of this land contract to 15 acres, of pumbaser's . alwjoc road required as opera of the plat has already been oae=. ' sa alf~eisei , but prior to blaclctopoim. a19 to pay the eat of 'future title evidence. If title evidence is in the for-n'of an abst act, ISM'16}r-Vew6W,_o tie the fun purebase price is paid. "mss ilwii aball boaatitled to tabs possession of *a property oa. ddte' of this ,CQIt rac Tom---- _ w------ - rd ...c. SYIIiS ^!T ~r JAW P" emsm- - x; x*. r; sd low T il•~ , 16M w1r ~aa1a to b• eeoemwitty ow tha " ri.. h N S ✓ ~ iiM+ In war RAW or. Y I 016W mown Am be f -aloft qpeg&4 V404ii IN an 14arm* odd PNO"A Am@ and =of all Iwo- mmid=g: Iftrehum, and Move: NNXXW _ - . - it - -----.~the a 414411M atrr tteiy 30 Iieve 'Amin. W neat of a dataalt is lw Mlauat ftgftft and (8) m 411OWN of . in do P* 114 4. d* awt atit~i pommuft or Now UP&" endow* hr a kdd *f 4!- on"Oftil man), than % AI~aentire ;VIa in '~A option ow w ~ r~ttit#~ t1! illY (t Y4l41r may,,I«M (Sub* to any r ~ at Pr° bbterminate, aet it ofthe ~ =rovicb !trkt Y lip amen ft i eF Taader jnq~ aoe f failure to fulfill this mo enft NR lialaaoa...ith iMojam t i ~ raeo of yi ~•l•rty 'M be arleet tR;4 °avetimad raw e = M _ one at Jump hr the ~id pa"fra~j sr K lraeyt~C - ked m em and and Fon"Oo Cnm tom. traotaaa 1e aoilaet aay ~ have 1s am[ )i_a" K tie reahL anal or to ofita 2' g alea laiador if aad .rhea"now orInaetsoos r,, r aa/ nd to oetoreaany, remedy b tication aad a~alilllr tai _ t~ f~„at o'ideaee chap be addd t. ps•;,ctw rbetrtar It se tali b " K ~if or forodomv of t1~ ~.anaoaad~wintend to eoiieot ti• talrr, _ ; ten4ta Whm AI4 s: 410 1110 or Um tra"Ws et or b o~tioa► 1on!' oori inneerat is tho , _oi ~a~ umdar thY 6Z in fV-1, X~1111 ~t h aea4 osae•lana without Veadprea Melon #t, by Pftvbiw~) or under any nab the d! Fd%munder d w ~ enj this co ntraet•~ 1r to PaJawnte 1o ma/e by . a Pumbamer 1" a~rW t ~i11► gift any iefadt I Gill aay other so6eegaeat or prior of aefto t of z rF-~ iir aad AIa>raeer. t aWftot s a" few" ft ~ beaeAb K y,e hy~rhftimfi~ i ` jorwt 1 ~Sbd 1n tiM p °Parl7 the tPerw of '~e'~ this Forty a" ai=oar M j~ ~ ea day of a _ . - - •---!SEAL) _ ~r , lrlf ' a A....._ ~a~ (STEAL) ai e yCt Amid Bftty ( iRltlICATION F e ACENO W LsD Y STATE OF WISCONSIN ated this of...._._... ST. CROIX Peraonaliy cu. be ~ fore TjrL* ty. . , ..Dougla's ~ y. an NEN$EB STATE RA$ OF WISCONSIN Yn.__a !lf 116k George N. Ditc t;'_y 4111111101-13W 6y 4 zOC%06 Boo .'wia: siai~:i _ ►+Ia IN to me khamm-tn the person rwu fo 8 T WAS tm AF7ED 8Y A ins dent and s s .4. 6 be F. WaLZ #rr. or ackno Notary Pnblk 51► , ftot am",* . agars,) *kdgerl, loth v, c,,mtnh►sion u A at fIf ' dsoe: Pexyd..rfent ~ W' STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ROUTE/BOX NUMBER FIRE NO. ZIP CITY/STATE PROPERTY LOCATION: Lw1/4 ~ (1/4, Section s T_ • R- I--W• Town of St. Croix County, Subdivision C~1F~ry'v.►`~ , 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 thePgseptic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK . 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 restive a grantwforin „operation $3000 of the cost of replacement of a failing system, which prior July 1• 1978. tthatrownersuofyALLcNEWeSYSTEMSpagreemtonkeepustheir 1980, with the requirement 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 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 form 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 Department of Natural Resources. Certification form must be completed and returned to the St.Cr ix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE l-^ St. Croix County Zoning Office St. Croix County Courthouse ` 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address