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HomeMy WebLinkAbout020-1040-30-000 o O vy o c a o ~ I I N ~°Q5 O~ I T y t M'N m O. c O c a~ mc - E°c 3.o .Q co O Z L 01 N i> 0 0 C 0 3 0 V) ~L C c E O W C 0 « O co j " t6 N E '00 N 0•pvL C 0 - C Y (D -0 C C Z L V1 > 0 7 (6 C E 2 LL 0 N E R y m y ~ m c I 3 ~S E Q Qv,'QOm U M M r ~ H CD W U) = O Z 00 N W L co r H Z O O Z a C Z N ~aci O c E v Q) m M 'S 7 ~ I U CD o II a c C C O U Q Z H Z z y d c C I 'o o R Lo 0 ~i N 41 N ~ O ~ c c a m U) U) E y a~ o 0 o Z IL CD 0) o 0 N J U o rn co Z co O O 0 o ~ m E O O ~ •a d LO U) CD rn~ d Q}~ co I V) cl ~ O ~ N N C 9 CD :3 to CD W c CL C, M O O ° O y € c v c o ai D 0 C~ cc € a 9. u CL • ~e d c A 0 at 0 U) L) Parcel 020-1040-30-000 02/24/2006 07:53 AM PAGE 1 OF 7 Alt. Parcel 18.29.19.170 020 - TOWN OF HUDSON Current j k ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-owner 0 - ANDERSON, LEIF LEIF ANDERSON C - ANDERSON DANIEL J ANDERSON DANIEL J 2214 WEDGEWOOD DR BEAVERCREEK OH 45434 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.500 Plat: N/A-NOT AVAILABLE SEC 18 T29N R19W PT NE SE PRT AS IN VOL Block/Condo Bldg: 172 PG 314 ORD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-29N-19W NE SE Notes: Parcel History: Date Doc # Vol/Page Type 06/08/2004 765229 2591/233 AFF 05/13/2004 762468 2570/631 PR 01/24/2001 637279 1578/243 PR 07/23/1997 793/281 2005 SUMMARY Bill M Fair Market Value: Assessed with: 91690 185,300 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.500 83,000 106,000 189,000 NO 05 Totals for 2005: General Property 3.500 83,000 106,000 189,0000 Woodland 0.000 0 Totals for 2004: General Property 3.500 49,000 92,700 141,7000 Woodland 0.000 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges 00 Total 27.00 0.00 Form-STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER I.j reo c e A(l °U'SBJTOWNSHIP ~.W~)!Q SEC. 1G T ~N-R~W ADDRESS % O ~~ee, CC IX COUNTY WISCO//- a t NSIN IN /4 f SUBDIVISION LOT --'LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM T, lei aL~~! c 116CD c3,e it d n~ ~ f IDD~O INDIC TE NORTH ARROW loci !aS` BENCHMARK: Describe the vertical reference point used )S l u Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: e 4C~ ~Ne5(Liquid Capacity: Number of rings used: _ Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front, Side,O Rear, O feet .From nearest` property line Front, 0Side ,8Rear, 0 (j feet r Number of feet from: well 6U building: I~ (Include this information of the above plot plan)( 2 reference dimensions to septic tank) CPR PRITVPQF__QT7)V PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevations Pump.off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, © Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Len.ith: Number of Lines: Area Built: 60 Fill depth to top of pipe: av r Number of feet from nearest property line: Front, Q Side, O Rear, 0 Pt Number of feet from well: /DD Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: , Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box ,0 or distribution box0 been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: _ Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, Q Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: / Inspector: Dated: to Plumber ua job License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7+369 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: NE 4, SF 4, S18, T29N-R19W ® CONVENTIONAL ❑ ALTERATIVE (If assigned) Town, of Hudson ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound L ADDRESS OF PERMIT HOLDER: INSPECTION DA : Lawrence Anderson 950 Trout Brook Road, Hudson, WI 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.- Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Ali Thomas A. Wang 3231 St. Croix 119492 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD' PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: El YES [:1 NO [:1 YES ❑ NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ 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) I ❑ YES ❑ NO NEAREST 110- 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 INSIDE DIA.: # PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: 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: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: 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. sIGNATURE: TITLE: SBD-6710 (R. 06/88) Zoning Administrator DILHR 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 119V92 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROP TY OWNE QW /ti PROPERTY LOCATION -'/a S T N, R If E (or~ PRO ,E TY O ~S MAILING ~DDRESS LOT # BLOC ,ATE ZIP_ ODES PHONE NUMBER SUBDIVISION N M IjC$M NUMBER C ER 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned ❑ VILLAGE : g NEAREST fi D Trm ❑ Public ®1 or 2 Fam. Dwelling-#~ of bedrooms ~ A AX NUMBER( ) III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo (J cJIJ 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 90 Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. P Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ® Seepage Trench 22 ❑ In-Ground f y/0 0' 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 995 " 3 . <,/40 ! p l Q Feet /,A0 -Q Feet S O VII. TANK CAPACITY Site in gallons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank i e$ /"C4 _X~_ 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. Plumb 's Name (Print): Plum r Signature: (No Stamps) rP/MPRSW No.: Business Phone Number: A L. AQ Id a 331 9 s~ lumber dress (Street, City, State, fp Code): 3 ff IC r'v~~ Zvi 1 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) ,j 'T C7 Adverse Determin tion 06) X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 Plb-67 R. 11/88 DISTRIBUTION: Original (formerly to County, One Copy To: Safety 8 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 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) 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) ~O~rce ( ' 1Uv: 1°7v l~~v'ny " APPLICATION FOR SANITARY PERMIT S T C - 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 _ l- Ate( ~Z-C-2 1 C. t= A t%_) 7 = ec ~ YV Location of property x_1/4 S C. 1/9, Section (AT 19 N-R 10 W Township _ IT~i'3 S ut1i Mailing address So C, ST" C-LO- s i V. T-2 F T" _ 0 S O io l Address of site ci'5 0 t aL)u r r~zoo iL L-) Subdivision name' Lot number Previous owner of, property T-44 n I'/1 Ps C-4 ,k ,2 1'0 . Total size of parcel A. Date parcel was created 17-- Z~1 - 135 Are all corners and lot lines identifiable? es No Is this propertybeing developed for resale (spec house)? Yes X No Volume Z38 and Page Number 5 3(- 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. ---------------------------------------------------------7--------------------- PROPERTY OWNER CERTIFICATION ( We) certify that all statements on this form are true to the best of my (ate) knowledge; that (~D (vW am (gam) the owner() of the property described in this information form, by virtue of a warranty deed recorded V(gnl a Office of the County Register of Deeds as Document No. 1-,-'~~D.Sthat I (Mt) presently own the proposed site for the sewage disposal system (as I (OF) have obtained an easement, to run with the above described property, for the co t.ruction of said system, and the same has been duly recorded in the Office of he my Register o of Deeds, as Document No. Sig atu a of Owner Signature of Co-Owner (If Applicable) 1 g Date A Sign ure Date of Signature rn ~n ct P w o R w ° m y ct 03 CD pj. 0 ~j (D CD C03 ct ct ° m In (t (D " m O " A' `C H 9 P 1 C~ m cat 9.N Df (M co f'' d c+ tj P " 0-3 F.. h' H 1 1], 0 SD CD co & P ,O y±± Ora so i f+j `C Cn 1 cD & P o N SD PD .1 ::r 0 A, 6.1 (n 0 W-4 %P 0 P* On 02 s Oll P- P O F.. (D tt Ot7 " N. y ~y Cr1 1 (p ~ K n ~ ct 11, I-t 1 to q p ~i F~~• tz "I Cf. 1 W ',O fD ~Ci 0 CD "I (D 02 It. (D ct. O O Fy to C " (4 4 ct ct ` t cf. W O w co 0 J N I- Ct t (D N P. cf- (D 04 ca co 0 0 y P. ^ 111---1~~~ "i Ft « 41 0 C4 C+ % 0 a 8 " N C1 1 0 v, F" P. yV.•1 W P-1 cf ffi~ " Y. ~ cwt 1 'S p ca CD CD pt ca Pd 0 P te, 0 y~ ((DD y P) M 0 O tD (D 'LY P h 1-1 CD 0 ,tit rn w m (D y cf co (D V 9 (D C4 CD P, aq `Y (D N F' (n ct cf P 1 cu .Y P 0 ti a P• ! (D v. p C+ co ~j u CA CD SD cl- (p P f'' a v tY tj 1 Its o) pj. ` to Ov (A W a P :3 ymm c~+ o k't' 1 c i fA W Ct a " y (D rr( cf- (D [z~ 1 _.,m......,..,........... CMP (C i 1 YL W Cf. F.. pp~ "CD ~ ~ 1 ~ 04 1 O P Fri. y (D ~''v P_. 10 ~l cC M (n m O g P P CI- ct (D la, P, 0 SD 0 ct \ N 03 9 It '(7 cf- cf. 10 CD ct P. \0 CA m 'd O 0) ct O N (D O 1 O m fl. 10 N • ::s (D t:f ,y P :1 C-4 (D "1 1 " 0 to cf- Cj a c+ ~-h 0 O c t ° • .7 (D c) ca • ct O ct 9 a O W ! O ►t . :31 O P o a r•g F.. rn y 1i• (a 5 9 FJ- (D CD Is CA 0 m ;Y cf- W (o P. p car 0 :r ~ 9 0 1 V ova m a O lJ ol fn ~h cPt ° N Oa (D ct (D 1 j. 1C+ fD z o Cf- cf- CD r 0 W o (Oj m a N O' N (D i (p 1 ~ y CD SD R p rn 1 (D . P ' IN P Y `f• N Cf. N• 0 a m rj cf- Cn ID 0 CD 0 :j P, 0 \10 Y F/. " ~ h ct- CD r0 (6 + 1 ~ito ~y o4 ° N ( (D P. (D w n c to 1- (D y M co 4- (4 O c O ct 1 y O p, O t:j cq CD SP U) 0 to O, p FOy • 5 1 O K O O n CD ~ y Cf. N cG P t'' $ (D P h 5- co c O P. c+ o 13 O C4 C/) cc C+ K 0 Cf. ID 0 CA M 9 r O O O O V 1 0 a 04 F . y 0 CD P oNw O a c~ (a 11 cf- 0 C+ rZ6 a (D i- t Fso 0 r. (D F1'' • ct lu Q 0 m P• 1 p 'Y ct o P• P. O P " 1 • Jb ct l2i ct (b m 0 ct P 1 O O ib O N ►s ~,f C4 C+ 8 cm 04 i z 1 low 30-8-0. Warranty De*dl. Sea 286.16, Wls. Statutes. (STATE OF W3190ONSIA) rabHo" by [sa elan seek a elation" Co. For, No.9 ~ j nbenture, Made by d. W. Thompson, a widower grantor of Ramsey County, Minnesota aaammoyQA3'Stareno" hereby convey s and warrant s to Lawrence 0. znderson and Harriet Anderson, husband and wife as joint tenants and not as tenants in common, , grantee s of Sf.. Croix County, Wisconsin, for the sum of Fifteen 11-undred and No.100 Dollars the following tract of land in a;. . Croix County, State of Wisconsin; That part of NE4 of SE] in Section 18, Township 29 north, of Range 19 West described as follows: Beginning at a point on the E and T Section line of said Section 18, which point is 114.95 feet W of El Section Corner of said Section and at the point of intersection of the northerly line of the County highway; thence S 530 0' I a distance of 639.4 feet along said Right of tay line; thence N 330 15' At 308.5 feet; thence N 590 52' W-2 253.3 feet; and thence E along said E and Wj Section line of said Section 18, a distance of 900.4 feet to point of beginning and said tract contains 3.5 acres. ~I R Witness bereof, the said grantor ha s hereunto set his hand and seal this 5th day of May , A. D., 19 44 Signed and Sealed in Presence of »».(SEAL) ~......¢:..v ~'J.»» J '....:.....1 »».........»»...».......»»»..»......(SEAL) » » » » ---(SEAL) _ » » _ _ (SEA L) » » » . Fa - - Mate of I t TA RAMSEY County} . ss. Personally came before me, this 6th day of May , A. D., 19 l+1~ . the above named N. W. Thompson, a widower to me known to be the person who executed the foregoing in ment and acknowledged the same. m Notary Public,_-... _ _ »..County, jw, My Commission expires , A. D., 19 Emma. H. Tmttin, Notary Public, Ramsey Cevnty, llins. I Comm?~aion expires Nov. 4, 1947. fa~ J V1u1.1.Wtlaw~lYUltlfiWYY.7MIb11MIY4YrM/iWIYWYWI.iW_Yp~ WY711W~iIWmY.Y = 3 ~ ~ i Ir i = S 1 i j ~ i n ~ ~ ~ S Pw i t fb zil y A C-r 1.4 w ~ ~ ~ ~ ~ n :a cz =yam ti a o C4 ` STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER LAW 12- M AN, ~ (2Sc~t ROUTE/BOX NUMBER q71 y t 20 u T s~ Ro o tC J FIRE NO. c15() CITY/STATE_ 4-L" O S t"_ W rS o tkj5 ik_~ ZIP PROPERTY LOCATION: N E 1/9 S1/9, Section (a , T 2-9 N, R_0 W, Town of ~1 u~Svu , St. Croix County, 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 for a MAXIMUM of $3000 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 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. 5),01 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 x County Zoning Office within 30 days of the three year expiration date. SIGNED Gi-LAJ"U(^0 a DATE 4" l _ r St. Croix County Zoning Office St. Croix County Courthouse 911 9th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address s s 00, U C~ h ~f f1'g6 r? fly wllft~ ~ W 4*) -u rvt & Qj - _3 ? 3 ccc~ sou tot"- ~go1z, 5' 3v II 14"wih Coufwl ~ar' Ile r;. O ~pp to 14,%in 3 yStCO ` 6D to vHZ-` . S~ dr ~a 2 tl°~~~ w1 rE~ ~ L 1 ~doc7 a l 1J~ h s e r l } ~ g3 S moo oor•t fo e 1ov' +`o New Cation i ~6d Ix k k k ~c X x X ~c F le 1 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, , - DIVISION LABOR'AN P.O. BOX 76 HUMAN REDATIONS PERCOLATION TESTS (115) MADISON WI 53707 AIE p~ (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TO NSH UN IPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: 1/4s'/ /T N/R9G~ / FG for ~Q C UNT OWNER'S UYER'S NA E: MAILING ADDRESS: ~ • ~o'o i 1'10 re T rook VZ d USE r-A It A. P DATES OBSERVATIONS MADE N EDRMS.: COMMERCIAL DESCRIPTION: PROFILE/ESCR PTI NS: ER 0 T ON ESTS: A [~~e EINew Replace 1 5' ~ I G RATING: S= Site suitable for system U= Site unsuitable for system d CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SY TEM:(opti al) a ®S ❑U CAS ❑U N S ❑U ❑S CCU ❑S ®U Vxeoo r Tre/t If Percolation Tests are NOT required DESIGN RATE: I 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 GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- a .~o ook67. mob. ~o Oeo 91 sd B- 3 14.~o hm, o Ib.' 'o ~.oo R 1 tic 2e S4 r Lh Q, B- I C 7 31 3, e3 131 s i A 6 6 ie g~~ l; o~ SAD AA S B- S' 1 /A 00 P6,~ yoo ( 3 i C f,go Cr 1,.66 g B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERI D2 R PER INCH P_ 1 s, bo © /D I P_ O lit 17:!~2 Ire, P- ~~®U co 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 17 -L-V ~Ie a I tit i € E 1 1 ! I I -4- art- lei 1 1 ~ f i o i ( l r 6,e i i P 3 I I i SPIT t ~qi C Fens ~C S P~ I, 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 (prir 14 ~ TESTS WERE COMPLET ~ N: 5 a^L U' (Q ADDRESS: CERTIFI ATI N NU ER: PHONE NUMBER(o ional): CST SI URE: L 91BUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. SBD 6395 (R. 02/82) - OVER - ee a ® ° ICTIONS FOR COMPLETING ® M 115 - SRt3 - 6395 " To be a co I rz,_e soil test, your retort must incamde: 1. Compl pti,)n; 2. The use se u:uorly indicate whelh- is is a residence or commercial project; 3, MAXIIUiUi of bedrooms or comm planned; 4. Is this .ement system; 5. Co n7 rating boxes. A' ITABLE FOR A HOLDING TANK ONLY IF ALL RULED OUT BAS ON SOIL CONDITIONS; r,ns shown here for . rriting profile descriptions and comp' inch the plot plan; im accurately lort;atilsg your test locations. Drawing preferred. A it desired; end vertical elevation reference point are clearly sh{ rmanentt; ,uxes as to dates, names, addresses, floor! !,loin data, tent exemp- rc,friar,, irmation (such as ,`food plain, elevation) does not apply, , ~riate box; orm . J Flare Your + ~rrei 7. address and your certification 1 and dis as requircd= ALL SOIL TES `:,T BE FILED WITH THE LCD Y WITH ',AYS OF COMPLETION. :E` IATIONS FOR CERTI SOIL -TE-~IS Soi. d Sy rl ! t any -r '?anl HuVL V TO R. sanitary le county c ~+ay request n ' the private ul' su' r 1 ar, order to ,i CtiflCtl r i1iiO. to