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HomeMy WebLinkAbout161-1093-50-000 03 d ou (U h a crj O � � O O � 11 N m M p � 3 I i U I i w I Ito. c I y N aNi N > z° 8� I c � @ {L C N C Q o a Cl) w z N N z v z a m M H z o I O z ! v c 6 1 v o z tJ H r E N O 3 cc O Nr O o a) ¢ �� z m z z Y O N N co ,• E � *� C — 0 1 O O N d O v o o a co U) o • _ = aaa a r N J U I Z rn rn o I }mil co N CD 0 Y 0 0 m c d ICN _rn � N w -6 ¢ Q > > t I N N N p O = N C 00 N .E7 � O CO z N N C C °� a C) r O = N V M n '6 CO 1 p O O O -Oi to C N y 7 N Li m � ONE O) O Z C N fD • •- 5 LL O z N z H .rt fn O _ I V CL 1 L 1 A C1 a 2 O N 0 I -COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 ST. CROIX ZONING REPORT N0.*# 01040/01 PAGE 1 ST, CROIX COMITY REPORT DATE*# 1/30/91 CMTHOUSE DATE RECEIVED. 1/29/91 HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNERt (James Fogg I ` -73 LOCATION*# 218 Station Circle N., Hudson COLLECTORt M. Jenkins SOURCE OF SAMPLE*# Kitchen faucet COLIFOR!*#*# 0 /100 ml INTERPRETATION. BacteriologicallY SAFE NITRATE—N10 Qpm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate—Nitrogen, mg/L e LAB TECHNICIANS Pam Gane WI Approved Lab Not 19 0FA1ADEPEAfa,., 0 O g A < Means "LESS THAN" Detectable Level Approved by*# o PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY ZONING OFFICE St . Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - ( 715 ) 386-4680 The St . Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals . Completion of this form is essential so that the property can be located . Please provide the following information, enclose appropriate fee made payable to St . Croix County Zoning Office, and mail, along with form to the above address . Testing will be done as soon as possible after fee and form are received . WATER TESTING----------------------------FEE: $ 25 . 00 (For nitrates and coliform bacteria ) WATER TESTING FEE: $127 . 00 (For VOC' S ) SEPTIC SYSTEM INSPECTION-----------------FEE: $25 . 00 (Determines if system is properly functioning at ti e of inspection ) Property owner ' s name Property owner ' s address 2-11 / J� _csm 0--u r'' " Legal Description 1/4 of the 1/4 of Section , T N-R _ Town of Lot Number Iq _Subdivision Name S�� c/ r niX 5ic,_h6-VA FIRE NUMBER LOCK BOX NUMBER Color of house Realty sign by house? If so, list firm: PLEASE INCLUDE, IF ALL POSSIBLE, A MAP, i .e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted . WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be /g�a�ined . i�n� __ _pp �� � (� Firm or individual requesting services : k&A U ,_o b1114- G Telephone Number REPORT TO BE SENT TO: r 5c;� Closing date - Signature ST. CROIX COUNTY F �y YT WISCONSIN ZONING OFFICE ST.CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 (715) 386-4680 Jan. 28, 1991 Doreen Plotz First Nat'l Bank of Hudson 307 2nd St. Hudson, WI 54016 Dear Ms. Plotz: An inspection of the septic system on the property of James Fogg, located at 218 Station Circle N, Hudson, WI was conducted on Jan. 28, 1991 . At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. 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 operations of this system. It is recommended that the system should be pumped once every three years . Therefore, the prolonged life of this system is totally dependent upon proper maintenance of the system. Should you have any questions, feel free to contact me at this office. Sincerely, Mary J Jenkins Assistant Zoning Administrator cj 5 W Deed. wade hetwMa .s1sl1R..�a..xitRBt1R ' .. ..................... ` 4 aeinMe1t_N_:.P►a;i.al]Ala. [.lt.. :...................... ................... . } ._..._....- .........................•-•-----•- --•_._. - ana .-.............................. ......... Iea .................... ' witaeslseth. That the said Grantor,ter a valuable consideration..._.. v -- .................... . .......................... ...... .. ate. conveys to Grantee the feilowinas described real estate m ._.- .$t...-Croix- .-•---• s ? C49097, stab of Wisconsin: Y Lot 14, St. Croix Station in the Village of North Hudson. Tax P"1104as,...,.....» � c 4 subject to nay easesruts of record and to the covenants set out is t1iae recorded in the Office of the Register of Deeds for St. Croix County. i Yb aVw 46S-469, Document 345153, except Corrnant 22, from which the released by the Consent to Variation recorded in Vo lume .568, Paga 4 . and which Covenant 22 was subsequently deleted by the AmendmeAt ta`*iel mfr covenants recorded in the Office of the.ltegistes of Dseds for.Nid t'= Volnne 589, Page 435, Document 355069. 4 :' L fi This deed is given in performance of the Land Contract betweta tke Taicr d" PAY 27, i988, recorded June 1, 1988 in the Office of the Sic stst o Deeds for St. Croix County in Book 812, Page 277. t r ' iry.3 AeF�4�•"f# ¢ This ........ not .... homestead propertymh wi (is not) Together:with all and singular the hereditansents and appurtenances therennte beMwtlMHg 4 - And.... - - -------- -- - warrants that the title is good, indefeasible in fee simple and free and clear of encnwbrancp +accept tasents and covenants as stated above ' r ssa will warrant cad defend the same. June T)11tad this 19th.- day of - ...... ..._ . . ......_ ...-.. (SEAL) � Jahn R. Isaacson--- (SEAL)..... .. ... .... ....... <., A>1TTHSlfTICATIOW ACKNOW t s . ..• ilipsAean(e) ..JaA.. R. Isaacson..... .. .......... STATE OF <. ................. ................................... this June , 1984 Personally icatasoa�i► � .m►e ,. . W .:.....:.... ............._...�. ..._.. saa� John L -. °= '`1[6`IiBLr1i STATE BAR OF WISCONgIN .. r -._..� � � �v�• � A seth4xltdld hg 70646 Wis. . b me know. to ..a . .A " "'i '- • a r:' •,.y `ti + r��u� �'llli it 11.. awla aesd �.1 '';�'r ;..:� �... a. a�'. �;, w .. • ;: _„e: �.���. ,� _3r Parcel #: 161-1093-50-000 03/2312006 03:53 PM PAGE 1 OF 1 Alt. Parcel#: 13.29.20.738 161 -VILLAGE OF NORTH HUDSON Current rX] 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 JAMES W&JANET M FOGG O-FOGG,JAMES W&JANET M 218 STATION CIR N HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *218 STATION CIR N SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 04/38-ST CROIX STATION 1977 ST CROIX STATION LOT 14 VIL NH Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-29N-20W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 844/182 07/23/1997 812/277 2005 SUMMARY Bill M Fair Market Value: Assessed with: 108571 778,300 Valuations: Last Changed: 05/20/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 333,000 428,600 761,600 NO Totals for 2005: General Property 0.000 333,000 428,600 761,600 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 180,000 271,600 451,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 133 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 x Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER i". � SEC. Z T _ZLN-R o-10 W ADDRESS jt z ST. CROIX COUNTY, WISCONSIN c / < SUBDIVISION J- L'✓J<,r S�':- ,3�+ LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1HR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM E. f I S i � , N _ _ _. -- -----._----- INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /00 Proposed slope at site: SEPTIC TANK: Manufacturer: is Liquid Capacity: Number of rings used: --E) Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,Q Side,(D Rear, O /60 t feet From nearest property line , Front,O Side,O Rear,/7% 7 feet Number of feet from: well %S ' , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE s PUMP CHAMBER Manufacturer: /// / Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: X Width: 5 Length: ( Number of Lines: Area Built: to D Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,(D1?t . Number of feet from well: Number of feet from building: 2 (Include distances on plot plan). i SEEPAGE PIT p� Size: / Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box 0 or distribution box O 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, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: �7 Dated: 7 Plumber on job: License Number: r =� 3/84:mj DEPARTMFjJT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION SW, WI 537070 i�1 SW, SW, 12, 29, 20W State Plan I.D.Number: ® CONVENTIONAL ❑ ALTERATIVE (if assigned) TW?Wi0f 'Io. 1�ud on ----------- a lon irC e ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Fogg, James Route 2 Hudson WI 54016 // —!'1-gq 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: Roger Timm 3224 St. Croix 119526 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER GOO�*�' /�J 1 PROVIDED: PROVIDED: (a� `"'�I f� M� ®YES ❑NO ❑YES NO BEDDING: ENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM ��� LINt. ` A AIR INLET: ❑YES NO C.� ❑YES NO NEAREST---► 1 rC1ay -- DOSING CHAMBER: MANUFACTURER: I BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER:ER: WARNING LABEL LOCKNG COVER PROVIDED: PROVDED: ❑YES ❑NO [DYES ❑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) ❑YES ❑NO NEAREST—I► 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: &OF DISTR.PIPE SPACING: COVER EINSIDE #PI TS: LIQUID DIMENSIONS � M RIAL P DEPTH: GRAVEL DEPTH FILL DEPTH DIS R.PIPE TR.PIPE MATERIAL: NO.D TR. NUMBER Y WELL: BUILDING: VENT TBELOW PIPES: ABOVE COVER: ELEV.INLET: PIPE AIR INL97, a� -1 I NEARESTT fop+- 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: SO7YES: SEEDED: MULCHED: CENTER: EDGES: ❑NO YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.-OF NC LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: DIMENSIONS TRENCHES: 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 COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: El YES ❑NO ❑YES ❑NO NEAREST--* c D 4 Sketch System on / Re tad in county file for audit. Reverse Side. SIQNATU TITLE: SBD-6710(R.06/88) t � '_ Zoning Achninistrator omas U. . e s '[-�,' SANITARY PERMIT APPLICATION �3 01LHR In accord with ILHR 83.05,Wis.Adm.Code cou .e...„...a.,.�.,...,�� SANITARY PERMIT# –Attach complete plans(to the county copy only)for the system,on paper not less than STATE SANlI g 5' 8'f 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 I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION E 5-0 Y. S j Z T Z%, N, R (or PROPF,IaTal OWNER'S MAILING Ab 01RESS LOT# BLOCK# CITY,STAT� ZIP CODE PHONE NUMBER SUBDIVISION NAME OR C M MBER 11. TYPE OF BUILDING: Check one CITY NEAREST oAD ( ) State Owned ,®'VILLAGE: � �f - J ❑ Public 1 or 2 Fam. Dwelling,##of bedrooms PA EL ff Rl BER(S) ill. BUILDING USE: (If building type is public,check all that apply) / _ >3 ` 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.FK❑ 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 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VII. 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 1, GVeet VII. TANK CAPACITY Site in ailons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed Septic Tank or Holdin Tank /27c:6 Lift Pump Tank/Siphon Chamber Vlll. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): - Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: CZ 3 z z 71 77z 3 z r Plumbe dress(Street,City State,Zip Code): f Z IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved itary Permit Fee(Includes Groundwater Date Issued Issuing Agent Signature(NOS MpS Approved El Owner Given Initial Surcharge Fee)/[/� �y; Adverse Determination 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 r t 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 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) INDUSTRY, OF REPORT ON S�NL BORINGS AND SAFETY>!t BUILDINGS DIVISION INDUSTRY, � DIVISION LABOR AND P.O.BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.09I1)I!(Chapter 145.00 //51 OT O-- MUNICIPALITY: NAME: SW '/ /2 /r zq N/R IGE SO /4 ISTCtoj X ST14TI a COUNTY: WN R' S AM MAILING �T Lev f X "t7la E DATES OBSERVATIONS MADE N0. CO R CIAL DESCRIPTION: Residence f/(Nk4 WNew DRepface �utilt Z�,lc��9 JUN ZZ /9k RATING:S-Site suitaWa for system U-Site unsuitable for system _ {� M D: ii�l--G _. S FILL rOLDING T K: E COMMENDED SYSTEM:(op' nal) CI L�(S DU S ❑ O S U ,,rf- L Q4 a. If Percolation Tests are NOT required DESIGN RATE: / 'If any portion of the tested area is in the under s.1-163.09(0Ib),indicate: C LA­,S I LFloodplain,indicate Floodpfain elevation: N c PROFILE DESCRIPTIONS BORING TOTAL R INCH CHARA T R OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH Ep ELEVATION OB E V TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) l ,5U ct ai 4 6 .�U /9 BLS<TS k ,B NC,S14t QlaCon, B. Z S �fi 9 s� r46'y 7.58 v3 s.1' C S 14 co b Corn B- � ,1-7 `► l.—,O � �, 17 2►"glSL7S 17''�3AN CS�4R C.o�Con, ON /%" s 4Z' teH c-r-.4- /Z Cot$ Ge-vr e- 4- �{ Z� drv>i > .�3 f%"�sZTS r9"84 CCS�cm CraB Goat 264 8Roj OI S iN Lei�tSl'T� byBP+•r�S�K»2 Co E1Ga 2t"Be,%Yt 5 El- S �,�3 �.4`z nl��t� > R.33 �a''f3r� c` Ccs� t PERCOLATION TESTS DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER t NQM AFTER SWELLING INTERVAL-MIN. PERIOD I PER INCH P- Z =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 am 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 TN 1,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods six:cifiod in(fie Wisconsin Administrative Code,and that the data rocorcled and the location of the tests are correct to the bast of my knowle.dW and belief. TESTS WERE COMPLETED ON: )UNir ZZ A —` _ CERTIFICATION NUMBER: PHONE NUMBER(optional): CST SIC TUBE: DISTRIBUTION:Orielinai and one col.iy to (ocal Aullimity,Pioite'ttY Own'' :11141 SMI 11!All r`11LHR-SBD-6395 (R.02 182) 0VF.R J r .N 'Q9 T5 po-pot = A�� ' duanlx,, ,�a d c?_!_ NI .�7f�t cf•S -�l�v�v t nn.�� P Li 1-<A i v - / { G 9►sada ld { t i i M J V ' L • 4 APPLICATION FOR SANITARY PERMIT S r C 100 f{. This application form is to be. completedin 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/contractgr, ("spec u ;. . '. , , erty is house")•,.-.then.,,a�, , q:nd form shpuld be ..repined gained and completed when the probe 4YJ :ry,,,rrr 'sold and submitted to , this ofEice 'with the appropriate deed recording. Owner of PropertyYV+�S Location of Property SL .Sa (A) 16, Section �2., T 41 N - R W Mall Lng Address �� � A141 �StP/Y] � 16Jyo66 0 \ Subdivision Name ZO-�` i Lot Number Previous Owner of Property©� SC: 4f ySCh/1 Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property' e n•g'�'devel'ope'd` for resale (spec house) ? "Yes No VOLUme j-'Z- and Page Number as :recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION •ONE Or THE FOLLOWING: 1 . Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays pf the reviewing process. If the deed description references to a Certified .Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) ce/ ti.6y that atx 6tatement.6 on th.ia 6onm ane true to the but 06 my (auA) k.nowtedge; .that I (we) am (aae) the owneA(a) o6 the pnopeAty ducA bed in .thi4 .in6o4mati.on 6onm, by viAtue o6 a wa,4Aanty deed &eeo/.ded in the 066.iee o6 the County Regi-61ten o6 Deeds ab Document No. ; and that I (we) pn ee entey own .the phopm e.(4 •s.ite 60h. the sewage Ls o,6 .s ys t^,n (on I (we)..have obta.i ned an ea4 emen:t, to nun with .the above des cxi.b ed pnopv t y, bon the conb.tAuc t i.on,o 6 chid 6 yis tem, and the same hag been duty uco)Lded in the 0 6 6.ice 06 the County Reg.ia.ten ,o 6 Deeds, ab Document No. ) . 61,J -r� SIGNA�OF9WNE , ✓ SIGNA' RE OF CO-OWNER (IF APPLICABLE) 9 DA'rE SIGNED DATE SIGNED .,, STC - 105 r SL1'TIC 'DANK. MAIN TLNANCL' AGRLEMLN'T' o St . Croix County H OWNER/ I�ie Number ItOU'1'I:/B0X NUMBER ___•.__._. 'r 1'it l3 l'1s K'1'Y L U C A'C I O N (J !r� ,. , S o c L.i o 11 ZG( N , It-- w � . 1, , Sc . Croix Cuun'cy , Subdivisiun._ � �21 =cam--Lnt number • I Cmproper 'sult in use and . maintenance of your septle systt:n► could -re; its preu►ature *1failure to handle wus,tUs - proper . main'te:nance cull- si5ts of pumping out the septic tank every three years or. Sooner , . r : What you pit into If needed , by a _ licensed stic tank L►l►►► �e ep the syscem can affucc the function of the septic } ank as a treat' n►eett stage In chn wasce disposal system . u receive a gral1C ur SL Croix County residents max be e'lig'ible c s stem u .maximum pf 60"/., of. the case of replacement of a , f;ailiny, Y , wl►ich wa:; *.ln• operation prior to- .July 1 , ' ic�78 . St : Croix' County • accepted this program in Aul;usc of 11980 , w1c1► the rOqulren►cnt . that h uwners of all 'new systems agree to keep their syscetns properly u►:aintained . : rile property Owner agrees . to subn►ic to St . Croix . County Zoning a ' certification form, signed by the owner and by a master plumber , • dumber or a licensed . pumper veri- tl-lccc.d journeyman plumber , re-s plumber s stem.. is in proper . •water di::pesal y ast� . c �t. on- w , f .in thuc.,.,(1), 1 � 'p1n it• nec- Y b- operating '.condi.cion and (2) after inspection and yumy g.. essury) , the septic 'cank is less than 1./3 full of sludge and scum. Certification form will be sent approximately 30 days prior to 0 three year expiration . x/Wli, the undersigned , have read the above recluiren►ents and agree H ! aincain the private sew:►y;c: disposal system in ac to . b to n iScons I�! h t I►c. W Che standards sc:'t forth , he rain , �+� sit Y ►ueaC of• NaC,urtiul . Kesuurces . C�:rtilicaci.u�� OU'fC1T1ceLw thln'�►3p`,days and returned to the SC - Croix County 'Li'n`ing 1,. of the three year expiration dace . SIGNED ----- , . DA-1 L' St.. •C•�:.A. >�.,�: ,i� n 'L•onIng;;'0[ fic:e u ,�5.y y �,,. ►,., . ► ,a, >, P . O . ! lox 9b• mo- d ' W1 54015 ► t an .. Il , 6 715-7•l6-2231 or 715-425-8363 Sign ,,.; date and return above. address. x. ,.j. ,'I:°.5...eilr>r`•h. d. ..e . , .. i- i.� .. r. . . , .. .t,.;,,.r .,.,»,N'b�• •.,.., .. �' . MPRS 3224 WI ++ MPCA 696 MN t ��e doe s Timm SHEET NO. OF Z ! CALCULATED BY ,t�aG� J//"�' DATE Excavating Co. CHECKED BY DATE R I, Box 192, Wilson, WI 54027 SCALE 715-366-5443 JER TIMM 715-772.3214 !_ ..... _ ITa' ti r . ...... . ..._....... ................................. ........ ..... i . ....... . 1;'1 1.,G`",Mw 01471. MPRS 3224 WI MPCA 696 MN I ros -firimm r SHEET NO. O 2 F • CALCULATED BY Excavating Co. CHEC�ED BY DATE_ R I, Box 192, Wilson, WI 54027 SCALE 715-386-5443 ,_R TIMM 715-772-3214 Irv- . . ........ ....... ... ............ ...... ............. ! ve creel nk.c�aati w.0 outt.