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HomeMy WebLinkAbout030-2040-30-000 c 0 � E a m CD I o I � I U) 0 0 6 c Z w o v 3 EA a > g I M y 3 z " C) w E z € a°i N � z a m c o Z v c a r w Q z ° o N F- � y Z E u N iI N � M h m o J CL a .� a o z° mz O N z co r N c� E 1° O y ~ c C') co p G d blp Z C14 Co o � 300o z° C CL a a CL o U) v 0) 0)!y to U = rn rn o Z �i A -6 o o _ 0 o o E V V ml N tm IL H c _O 7 V co co ~ ci a o I o o a y U) 0 m 0 eO} y li c c Z 75 C4 a Ci N C O y M W z Z d M -' > cco)o °•2 E E c oc 0� O N (!1 J � 0 Z y H lo- g � .fir y d �% dt EL € a a 'v 0, a. E �1 A c°� CL Ovid J Parcel #: 030-2040-30-000 02/09/2007 11:02 AM PAGE 1 OF 1 Alt. Parcel M 25.30.20.489D 030-TOWN OF SAINT JOSEPH 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 GREGORY W&CONNIE M GOVE O-GOVE, GREGORY W&CONNIE M 1330 CTY RD V HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): •=Primary Type Dist# Description " 1330 CTY RD V SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 5.980 Plat: N/A-NOT AVAILABLE SEC 25 T30N R20W NE SE LOT 2 OF CSM Block/Condo Bldg: 3/853 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 25-30N-20W Notes: Parcel History: Date Doc# Vol/Page Type 06/22/1999 605421 1436/101 QC 07/23/1997 1192/614 QC 07/23/1997 854/49 (/ 07/23/1997 2007 SUMMARY Bill#: Fair Market Value: Asses with: 0 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.980 104,200 243,100 347,300 NO Totals for 2007: General Property 5.980 104,200 243,100 347,300 Woodland 0.000 0 0 Totals for 2006: General Property 5.980 104,200 243,100 347,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 201 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 1 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER JAG �� (/f�rU�E^ TOWNSHIP �+" ToSEp ff-- SEC. 2-5 T 7" N-R___�? W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION ps �S3 _ LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 OA) ' SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM SEE S p7tTE7 PL o T_ INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used SST Elevation of vertical reference point: IcI20,0 " Proposed slope at site: SEPTIC TANK: Manufacturer: 6"Ve Liquid Capacity: lenod Number of rings used: 3 / Tank manhole cover elevation /D Tank Inlet Elevation: 7. Tank Outlet Elevation: � 7• Z Q -ic- o Number of feet from nearest Road: Front,O Side Rear, O '> 7 O 0 feet Sv � � From nearest property line Front.0Side,ORear,0 �� feet t0tll doT o,i,c- Number of feet from: well , building: ' i C S fiy� (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Ca ty: pump Model: Pump/Siphon Mil acturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet fr 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). 2 SOIL ABSORPTION SYSTEM ( I) s ' x 5 7 Bed: Trench•_ L� s /X (o Z �,^ l A 2^ 1�3 Width: S Length: Number of Lines: Area Built: Fill depth to top of pipe: YZ „ sov Number of feet from nearest property line: Front, O Side Rear,0 it ._� Number of feet from well: 60el NOT Number of feet from building: 3 / (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: _ Diameter: Liquid dep Bottom of seepage pit elevation: Area uilt: Has ther a drop box 0 or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacture,r: Cr pacity: Number of ring sed: Elevation or bottom of tank: Elevation inlet. — Side,O Rear, Ft. Numbe of feet from ne est property line: Front, O Number o feet from well: Number of fact from building: Number of feet from, nearest road: Alarm Manufacturer: 1 C� Inspac'or: Dated: QC"/ • 7, ' C Plumber on job: License Number: PVAESITE SEPTIC PLUMBING CO. 655 O'NEIL RD.,HUDSON,WIS.54016 ROBERT ULSRIGHT WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. 3/84:mj MINN.INSTALLER&DESIGNER LIC.NO.MW 13 of Ll- IPLoT P1-4A) ............ �: �� �O •JOEL L/4 UE�vRE cod �Qoj 2 o V - N 5-t q8. 31 Y 5 A- =o ,� f f pe ys, \31 o of �i OY T or 'ro vtoP �1 , 1 fox 1 � �Ir 1 t 11, 30 1 cP f QED a7 Pdc . /% y sT� To �, aF g5 So P - yq.g sY sTEOIL, sYs?��, serfs 17isy tsoy, ' fE&vS Zcpp�R- �NoR't k Liof-) i ST, �ss��s� S waste 3�4 P c ,�.,-,-� s�1 17 Ly ?v "D IS T. ?l p i U G-- �S 5 QtSATE (00E .E D 3 S ,a kA c "ITIPA �" NOMESITE SEPTIC PLUMBING CO. 0 R0s3E RD..HUDSON. 5016 WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. i MINN.INSTALLER i DESIGNER LIC.NO.00683 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER L� y JCA11U0e6_ TOWNSHIP �+ SEC. T N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN csr vo/. 3 f SUBDIVISION � . �S3 LOT Z LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM SEE- S E PEP7f?E PL O T- INDICATE NORTH ARROW 7V BENCHMARK: Desciibe the vertical reference point used 567 Elevation of vertical reference point: '9'0 Proposed slope at site: o d - SEPTIC TANK: Manufacturer: �D.�G . Liquid Capacity: / � Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: ! Tank Outlet Elevation: 7• S o , Number of feet from nearest Road: Front,©Side Rear, O /00 feet Sv � From nearest- property line : ' Front,OSide�Rear,O > z©a feet WWI/ iUor IvSl",111,0 Y,.--T jo 0�1iE Number of feet from: well , building: �� z C.S fi (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE tM'oN.on a3�s 3��d''a��isvw •S'kfd'YU�'ON' lHowein iimou $►0 9NiMewnNOda3jjd�iis3Ho� :aagmnN osuaoTZ :pa38Q �adsul Q — - -• :aasn3o8;nutsy� msBTy :l,eo� 3saaBau mu.l; 3833 3o aagmnN ;2uTPTTnq moa; a:).,3 3o aaquu►N TTa•y moa3 19a j,_ o aagmnN —.330 •seag O `opts O `Zuoad :auTT �C3aadoad qua au moa3 39al to agmnH .33TuT uoTIBnaT3 ;xu83 3o mo33oq ]•, uoT3BnaTg - ;pas SuTa to sagamN :�C3T�eJa� .s�nZos3nuBy� \� -SKYJ ONIQ'IOU i r •(auo Xoag0) Lsma3ds uoT3gsosg8 TTos anog8 sqa 30 Aug uo pasn uaaq Oxoq uoT3ngTa3sTp ao O xoq doap B saga sBU ;3TTn Basy :uoT38naTa 3Td aSedaas 30 m03309 op pTnbTfl :aa3amBTQ :s3Td 3o aagmnN :02TS ,ZId aaas •(uBTd 3old uo saouBZsTp spnToul) :BuTPTTnq moil Seel 3o aagmnN :TTam moa; 3aa3 3o aagmnN •auo.xd :auTT �S3aadoad 3seasau mos3 Zeal to sagmng "'_"_• ZaO'saag `opts O Q P/ < �OS -c d o do3 o3 3dop TTT3 � .a d 3 T .g :3TTng Beay :sauTZ 30 aagmnN :g3�uaZ S :g3PTM :gouaay peg .00 L S x , S �� Y1 ins NOIZaIOSeV "OS a n ou •(ueld Zold uo saouvIsTp p T I) :guTpTTnq moll 3aa3 3o sagmnN ;T18m moll 3aa3 3o aagmnN O•asag O `aPTS O 63uoa3 :auTT A3aadoad 3saasau a3 3aa; 3o sagmnN :ad6y g33TMS =ETV :aaan3o83nu8H maBTy ;ajoAo dad suoTTeO :uoT3sn31a g33TAS 33o dmnd - :uoT38nala xuB3 30 m01309 :3aTuT 30 UOTZBnajg azTS dmnd :aaan3oB u14 uogdTS/dmnd :TapoW dumd Bo PTnbTZ :aaan3oBlnuBw IM MO dHnd 3 ao>rL t-,A +U RE �f VOW „ 2 d r9g.� 31Y - .,a ysI,3f of pine Off` '(0 r r qtr 30 fop t ' o t Tnl° /00-0 Art of Tic Tn P gS.So jq' 5Y STEM �q,p 5Y5 51 S 'ipo/J /Sol( P TI�E-,u� �No�-tom. L AJuF) I s r, +p � � S�^ • i�Ly �u • A-S 5 QtSA`CS:F' 40 0E-P-E-D v w �Nn Sys- { c �6 t.i L • T�T�� So. Fr s �Aj S-f,j lltf-v --•- s IS NOMESITE SEPTIC PLUMBING CO. o' BEu BT s.Vils ROBERT RIGH MS.MASTER PLUMBER LIC.NO.33D7 M.P.R.S. MINN.INSTALLER i DESIGNER LIC.NO.00983 1 DEPARTMENT CC INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR 4�HUMAN RE4.ATIONSO DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 �y� State Plan I.D.Number: NE, SE, 25 , 30, 20W 'I "P CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of St. Joseph ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound Al 9Z)ZPVj Lot AME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTI N ATE: Joel LaVenture 308 Willow St . #7 ;66 BE\NC`H MARK ,I (P rm1ent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.REF.PT. LEV.: CST REF. .ELEV.: 1 I' Y Rj '1R,•�G t�, r' Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number Robert Ulbricht 3307 St . Croix 128633 SEPTIC TANK/HOLDING TANK: MA CTURE U LIQUID CAPACITY: TANK INLET ELEV. TANK OUTLET ELEV: WARNING LABEL LOCKING COVER ) O n]r S PRO DED: PROVIDED: I O 00 1-7, 7 I YES ❑NO DYES BEDDING: VE IA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY I WEW BUILDING:I VENT TO FRESH I) n ' ALARM: FEET FROM > �/ LINE, n AIR INLET: E:1 /J YES 1 NO ` E:1 YES 0 NEAREST--- / O U S DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP DEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES E:1 No ❑YES ❑NO GALLONS PER CYCLE: PUMP A79YID s OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF NO NEAREST—11111- SOIL ABSORPTION SYSTEM. Check the soil moistu at h pth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire,con io shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID BED/TRENCH / 7\ THE HES: MERIAL: '\ PIT �_. DEPTH: DIMENSIONS "Jl✓ /1,—'� � GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.D TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELr�VJ PIPES: ABOV R: ELEV INLET: ELEV END PIP S: LIN AIR INLET /Y�n FEET FROM NEAREST— . 7 J 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 I 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 Y S ❑YES ❑NO COMMENTS' PERMANENT MARKERS: °\ BSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: }� ❑YES ❑YES ❑NO (NEAREST—� <D �b Sketch System on Retain in county file for audit. Reverse Side. �tiom'ws IGNAT R TITLE: SBD-6710(R.06/88) . {„ Administrator, Zoning ; a son SANITARY PERMIT APPLICATION DILI R • In accord with ILHR 83.05,Wis.Adm.Code COUNTY r STATE SANITA HERMIT -Attach complete plans(to the county copy only)for the system,on paper not less than K//Q��`(Jg/(/J!_ 8!z x 11 inches in size. c eck if revision to previ ous 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 T DFL 44 1/,64J 74V apt' E '/4 SE '/4,S X57 T36 N, R E(olrwD PROPERTY OWNER'S MAILING ADDRESS LOT# Z BLOCK# 3D� (,tji tow Si • -7 CITY,STATE ZIP ___FPHONE NUMBER SUBDIVISION NA CAM NUMBER mRSET L3; 15*1/40_2_1F r41O F6 CS & 061. 7 -F53 II. TYPE OF BUILDING: Check one CITY NEA9EST ROAD ( ) ❑State Owned VILLAGE: 54, tF' ❑ Public X 1 or 2 Fam.Dwelling-#of bedrooms P RCEL AX NUMBER(S) III. BUILDING USE: (If building type is public,check all that apply) 1 jI 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.X 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) 2 l j,V`cS, �'/� s r X S,5 Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 e1 Seepage Trench 22 El In-Ground 42 ❑ Pit Privy 13 E:] Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill q b VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. ' ELEVATION GRADE�/ REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) C c ff 5 �SD a O L S• 7 Feet !•J r Feet VII. TANK CAPACITY Site in allons Total #of Prefab. 7g'lbae.r.- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel Plastic App Tanks Tanks structed Septic Tank or Holdina Tank 00F000 Lmt an i Ph Chamber �'V '� I L1 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) MP/MPRSW No.: Business Phone Number: Ro$oor =P_�C0_ I 1 v 30 21 3*6 PI u ber's Address(Street,City,State,Zip Code): �SS 6'N&74_ ,ep. #VP5'0..,-o) IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved $$$ggg����tary Permit Fee(Includes Groundwater a e Issued Issui g ent Signature(No Stamps) , L Surcharge F / C1 pproved El owner Given Initial � 9-1 � �r Adverse Determin ion X. CONDITIONS OF APPROVAL/REASONS FOR ISAPPROVAL: SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber INSTRUCTIONS ; , , 1. A sanitary permit is valid for two (2) years. 2. Your sanitary,permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399)to be submitted to the county prior to installation. a 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 8 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. Vill. 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 secfion 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) ' r 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 Se--�, F— k 4 , / 4, V-4,— •c! r'u 'T �E Location of property N 1/4 S 4 1/4, Section Z , T 3 O N-R Z ow Township �,5 T• X0 r Mailing address C, 1,9 Address of site 3 3 a C v U,,4 /f' IFV ✓ Subdivision name 'A V"S/? -k/ 4f �4 k 0 iz�Z s c .� Lot number Z- Previous owner of property A VA I�e I<---A .� A,-,O I= 2 Total size of parcel �� g 7 9 A G 2 K S Date parcel was created u G u /S - / 9 7 9 Are all corners and lot lines identifiable? x Yes No Is this property being developed for/ resale (spec house)? Yes X No Volume I 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. ------------------------------------------------------------------- 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. G*7 ,3 4 '1' _; and that I (We) presently own the proposed site for the sewage disp sal system (or I (we) have obtained an easement, to run with the above described property, for the construction f said system, and the same has been duly recorded in the Office of t e un gi ter of Deeds, as Document No. ) , Signa re o Owner Signature of Co-Owner (If Applicable) i Date of Signature Date of Signature �e 1 h And ; WE- to goo All, 1777� gam.,2 0 oww z e k ry 5 Zip: SO t xL a p a i � I a ri i e ; } a m' s v " } z k iL f � M1� � �► lr4sMY i1l�et ii Y ON V-. tmw' md or in #1�IIIr11 16 Diu .»...................................... ill�t 40l W /a► Y i..................... ev"at a.rhUt m 14 Pon"rt�.....� + } 491- ft—d w tombs dw n 'aw Mb w 0) in as SON!" llpwk s hMi)r tew�w!"4 aq. ataW � of ue d wM AV aid bw I WIN be wrl� vile i�wet��eR lir M E �I elp► M' ti a f�t .......... .......actimb ........... ......... .. . rr } tine', .. .:1 ►L) Laverne Anderson ... .. . .,... , E�i� eh..,Arlsraa�. ��� lltt"OM •Q!lOw�ti MAU O WNCOMM w................ ... . ............... I lie' y� ...........w.bY..... 31110 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER O /= 4 - L A V• .w/"v >'�', sE ROUTE/BOX NUMBER N a A O V. FIRE .NO. CITY/STATE Wt—) 1�> -S 0 W f ZIPS'Vu PROPERTY LOCATION: Al 4 1/4 s - 1/4, Section 2-6— , T 3®N, R 2. d W Town of S T• �~ ° s `= /m. , St. Croix County, Subdivision 4AVIEfit6If ��Q��'-f; of No. 2- Improper use and maintenance of your septic system could result in its premature failbre 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. 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.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATEe 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 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION P.O. BOX 7969 LABOR HUMAN RELATION PERCOLATION TESTS (115) MADISON W1 53707 (ILHR 83.0911)& Chapter 145) LOCATION: SECTION: TOWNSHIP/MttNtetP*t:+T-Y: OT NO.:BLK NO.: SUBDIVISION-NAME: ,uF�/ Sty/ 2-S' /T N/R��E(or)W 57-. ''o S l: p ti Z �sy COUNTY: OWNE S StfYER'S NAME: MAILING ADDRESS: s�. V DoE( L E�f uip�" 3b //a w S"7�' 7 SO H E&�If USE G DATES OBSERVATIONS MADE ��,,(( NO.BE : COMMERCIAL DES RIPTION: rn TESTS: N Residence 3 New ❑Replace I _2 2 S RATING:S=Site suitable for system U=Site unsuitable for system ONVENTI NAL: MOUND: IN_-GROUND-PRESSURE:SYSTEM-IN-FILL HOLDING TANK:17;65.RECOMMENDED SYSTEM:(optional) S ❑U $ ❑U ®$ ❑U ❑$ QU ❑$ ©U dvS - w/Apo p Rox i r o.J —� If Percolation Tests are NOT required DESIGN RATE: Q If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: ti L'/`SS Z_ Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS IN Ze-c-IHerL FEET Q• BORING TOTAL PTH T GR LI DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH ' NUMBER DEPTH IN. ELEVATION OBSERVED EST.HITH—ESj2'-TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- 9,v! �Q 40 I �p 9 d /10 ' o�F �,a Si I . 3 3' acv. S,' /.33 6.33 a,P, B- qq c B- 2- 90 , // �� , > / d Si/ S. 3 ST�'�IT/FiEl7 n,ti .'.►M-4Q. S". a. `4 �1 B- A , , �•Al B-3 s / 3o �'lp y.�, S /,p' elf. i , S a.r a. i 3 Sy _ / dof- B- la Dec i-14-1- f-}- - PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER LUGOES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P 1 PER INCH P- / y �Q I kF /¢ S P- d Il Ir Iz i X11. P- y P- rO P- rn y 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 �vPPCn TReAuc 1,- = 9 1 i I , F _ j ta N, Az tN Tlex _. _ _ 11 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 print HOMESITE SEPTIC PLUMBING CO. TESTS WERE COMPLETED ON: 655 O'NEIL RD.,HUDSON,WIS.54016 sp - 21 - P ADDRESS: ROBERT ULBRIGH 1 CERTIFICATION NUMBER: PHONE NUMBER(optional): WIS.MASTER PrUMBER LIC.NO.3307 M.P.R.S. -IV 00 1___- CST SIGNATURE: _ DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHRSBD-6395(R.10/83) —OVER — a � p Hwy U . 210 woo Z�i x 1Z0 r / 100 k' zD S•>E-S �3 • �3 fptDF cg�tvilT/o 05 rf5 T.M, 3 V"7 . Pep -PTS_ P� Pip FS Abp 4o TQE�S X r 10 \ •�ey Z�Q ��Tloa I � k k S 0 f I, �2 ID // 0 5 q 11 7�ST�es �• r q- Z I i y' Affpo A'Ta t .5 D fA NEIL �- / S HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD.,HUDSON,WIS.54016 30 I ROBERT ULBRIGHT f7'1#'� 9p2— WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. E MINN.INSTALLER&DESIGNER LIC.NO.00663 .J `�]�•:"'•�°'•t!!�'R!v'F+r•y/.ar..:h f.'j♦'�"".;;er..,�.,,s..vr.ka.:..,,�;.�....,,r-r••....w��.-,.Tr•Ya•.�a D tea.-,..,,..�....... .•n,r PART'R ®F REPORT ON SOIL BORINGS AN • ' :- S AFETY&BUILDINGS INDUSTRY, � .: • DIVISION LABOR AND ' PERCOLATION TESTS (115) i' P.O. BOX 7969 HUMAN RE,L*TOONS : , �f. ,t: MADISON,WI 53707 (H63.090)& Chapter 145.045) LOCATION: SECTION: TOWNS MUNICIPALITY: OT NO.-BLK.NQ: SUBDIVISION NAME: ' NE '��s�'/ z�/T3cN/R co W ST• JosEPH -Z COUNTY: OWNER' BUYER'S NAME: MAILIN ADDRESS: , ..,:.. r: S-t• cRO��C L.�►VE� PrNOER�N 'RT.Z �vOSO� v�l°�•. • S��� USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMME IAL•DES RIPTION: PROFILE DESCRIPTIONS: N STS: Vaesidence 3 I New ❑Replace• $ RATING:S-Site suitable for system U-Site unsuitable for system •1 ONVENTI NAL: MOUND: 11(9-GROUND•PRESSU E r0S YS EM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:loptional) �s ou ES ou 19S ou Nu oS Ou 3 � - S•Y. so' If Percolation Tests are NOT required - •4ESIGN RATE: ��- It any portion of the tested area is in the under s.H63.09(5)(b),indicate: CL(�SS _�.] [Fl,,dplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS .r:i ;. : '• BORING TOTAL DEPTH T 0 GR UNDWATER•INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR.-TEXTURE.AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST.HI HE TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) -. B- B-7?_ B-3 a"D�QN z:\TSB 1C�•' �.J S>>•�• S�" $tJS B- 4 1Z. •93•S -1 Z.• B' Jc 1Z. �4' 'NC�N� 7 �Z �Kn •� Z .. • 3Z." '�� PERCOLATION TESTS > - TEST DEPTH-• WATER IN HOLE TEST TIME DROP IN WATER EL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD PER INCH P- - 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 hor(- 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. "%TIRL -Ma.+CIAes NkeP aI=n9yTS PG-'A X G-b1X�!r(1—= —0Ntit%'-%t1. SYSTEM ELEVATION b' TSK � a S l y-% I E E1! . VI/ 1C.Pyl _ 1N (. f (• S y e t r 1" �ow� P� 45 ► na t1 CV E Ev• t O 'O ' f - •-Z R W I 0 • U�e-04 It 3'T ZS� + TO D V ( S W117 t.aca s7 So' �`T P• SCPN_Z I -LoQ�•-E XGE7% 'AS I&VC • 1,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 bast of my knowledgeand belief. sa•!' !,•:i>f NAME(print): ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): RT• g- $O�G "ZZIo ELLS \ � Spa\ 5110 . 11S-4ZS-o��4. 1.1CRE.'• 30R\ut. :OVA �'�-:_ irRo�"�'e�-�� 9..\ 't•�E.• T IG TURF, �- :��C'CrG�:,;$-3 1(�q."�V►\S.QED-��pS�S���vJS�•ys?�.�(IC�R�ovq� w.• t. °9 �r'f��'��S it�� \V�Q� D�•��'rC.�� ��'V 17` tMi �'f,N"'A' �GJ•.YjN.7'�`P•t ,�yN. ..�• r. DISTRIBUTION:Original and one copy to Local Authority;Property Owner and Soil Tester. nor ue_eoH.-O9oF to fl9/0'21'. .river +.�,:°�7f1"i"L'�'ie'�C�•i: ' �•�.a.::�T . .!r"`'•:L,wH.-•i» �.� e ti - - d Y �Ssti60 CERTIFIED SURVEY • MAP r � L-: rr ft � - jt Ir rG n , ,227� .n +�'; ��Iy� • CURVE DATA TABLE CuRVcJ�RADIUS CHORD H GEN7RAL� NO. I LENGTH LENGTH BE4RING AN,G1:tr � 1- 2 667. OU' 230.48 S19'40'50'lE 19 053'54' APPROVED 3-5 583.00 • 375.34 NIO°5I 0r."'w. '37033,22 3-4 583.00' 87.27' S25°20'14%• 8 035'06" 4-5 583.00' 291 .66' S 6 033'33"E 28°58'16" AUG 15 1979 6-8 550.00' 354.09' N10 0 51'06"W 37033'22" S1. C<O.X ti . , 6-7 550.00' 287.41' NT°13'11"W 30°17'32" 0A'JVi!-lcrvi rARXS PLI..,d%O 7-8 550.00' 69.68' N25°59'52*W 7 015'50" ��a ZO�e-�G eoM,.urlee 9-10 700.00' 122.05' N24°37'42'1ht 10 000'10 VA! OF THIS MINOR SUEDIVIS; N E 1/4 COR. d.. AS ' so' I NOT MEAN AppROVAL SI F R SEC.25,730Nr ( I NG SITE OR SEPTIC'SYSTEM. — - 20W ► 1 � TO H62.20. C.T. N. — H8S°36 24'€ _ - '" 233.01 NOTE: HOLDING TANK REQUIRED Ti'_ 200.00' I ON LOT I . O i 1 . I O ,_. �� _ n�REnGE TO � pl_ 1 „ � ti SCALE 1" c 200' LOT 1 = I.925 ACRES -W 04 1. 501 LOT 2: 6.372 ACRES n ACRES I 1 0 100 . 200 400 ^ ' LOT 3= 3.306 ACRES 0 1 LOT 4 -- 3.274 ACRES 2 200.00'`? PI • 589"38 2< W h 233.01' I �I • I pal e = IRON PIPE FOUND. „1 j 'NE NE—SE ' O = SET I"BY 24"IKON PIPE WEIGHING I v 4'03"E N89 053'29"E 300. ' 1.13 LBS. PER LINEAL FOOT. 1 2.41' 1 1 _ l 1 r: : ORIti£H•AY FOR LOT 2 TO 8E.BUILT I 1 1 °. ADJACENT TO THE SOUTH LINE OF 131 JI � � v Li S, , _ gyp_ LOT. CAUTION SOILS MAYBE UNSTABLE 1 �'�I 4 . .` POND I c . �\ ��` `r-�. DUE TO PROXIMITY OFPOND. \� 4 p l' z • �� �oQ 3.021 ACRES I �I C.TR"V.. 1 ` es.oo, \\ ` 35. 9' .• ' \ ql` %'FS°5329 E 420.12' ti'DS°Si' 9" 7:4 e3' 1 f _ %4 364.63 •.711.43' .4;l 3 My 1 v _o'1 '� ;, !r'9•I2'06'w 17.0 - ' ,,I .2 .2. 1 3.019 ACRES ^- � •�p � I. Fn XISTir.S E :! .r< �'� _F:.:D ml sa' SJ'1 „° • I —SEE Q Z). 979 ACr?ES t 1 !LS L 44 54 1` - o N� ^ 1 C i I O '• ,� �..:�, 7 ` o 69`x.10' ^•V sc •1" .T 'SS 15'c I � ':.�3' -` . , i"wr 11i5. e3 �. ' , 5 35' -`•`. r;; 1 It r c 1, r,t .1/4 .1• �, 1 Fresh Air Inlets And Observation Pipe N.' Approved Vent Cap Minimum 12".Above Final Grade " e 4" Cost Iron Above Pi 3 p Vent 'Pi e' 'fo Final Grade p i A Synthetic Covering Min. 2" Aggregate Over Pipe Distribution� $' +.2?27 Tee Ripe — 0 0 0 0 0 , Aggregate Beneath Pipe o Prerfbrated Pipe 8elow 0 Coupling Terminating At Bottom Of System 3-0 1/ V Fresh Air Inlets And Observation i � ..,• � erva tion Pipe 1� h A 0. " Approved Vent Cap Minimum 12 Above Final Grade " lcxv/S y�U 4" Cast Iron 3� Above Pipe to Final .Grade Vent Pipe, Synthetic Covering Min. 2" Aggregote Over Pipe Pi Distribution Tee Pipe F0 0 0 0 0 " Aggregate 0 Perforated Pie Below Beneath Pipe p o Coupling Terminating At S YS 727 yQ , Bottom Of System . ;ipv.L I�OaI� ,SZ� /Pa6 r! 'Jae 05 Q gSockoaja �o� 54��. O C M'ON'011d3NO1630'Q!!3'�1r13N1'NNIW v / S'd'd'WI LOSE'ON ail S�ElWt�d kl3111lM'SIM %M SIM'Nosam"ad 113N.0 M '00 ONismid OI1d36 us3NOH �5 ° i �y3�a�dad a �i5 ray '211 400' co Lp.L j o l �oS \\\ \\ \\\ \\ S,L(t 'iad -.L"a '�,, Sal -Zos N\\ \ \\ O\ Sc►oUl<<l �� ill f%Y,� w h� 6 0 roll a21 0 x QL d c �Olt o � J ,C"? >� Ix co uNf ry u59M80 CERTIFIED SURVEY MAP 9 IO SLED Aus 22 19 c JAAft 0. 7v . ComNgLt 84w, °"'°o '� CURVE DATA TABLE �oa►sh CURVE RADIUS CHORD CENTRAL Z NO. LENGTH LENGTH BEARING ANGLE 1J 1-2 667.00 230.48' S19 0 40'50'E 19 053'54" APPROVED 3-5 583.00 375.34 N10°51 06"W 37 053'2 2 3-4 583.00' 87.27' S25 020'14"E 8 035'06" 4-5 583.00' 291 .66' S 6 033'33"E 28°58'16" AUG 15 1979 6-8 1 550.00' 354.09' N 10 051'06"W 37°33'22" 6-7 550.00' 287.41' N 7 013' I I"W 30 017'32" ST. C tOiX ... ,. , , 7-8 550-00' 69.68' N 25 05952'4 7 015'5 0" COMNEHENSIVE PARKS PLANNING AM ZOMNG COMMlTTEB 9-10 700.00' 122.05' N 24°37 42'W 10°00 10 i E 1/4 COR. 1 kI'PROVAL OF THIS MINOR SU'BDIVISI N I33'I so'I >OES NOT MEAN APPROVAL FOR R2OW ,T30N, I_ UIL©ING SITE OR SEPTIC SYSTEM. h It N89°38 24'� 1 t_ HER TO H62.20. C.T. H.-E-- - -lc, - 233.01 - - +_ in 200.00'_ r- -- NOTE: HOLDING TANK REQUIRED o I I ON LOT 1 . I ACREAGE TO q 0 _ I to I SCALE 1" = 200' LOT I = 1.925 ACRES 19�> v M 1. 501 MI LOT 2= 6.372 ACRES ^ ACRE 0 100 200 400 I r LOT 3= 3.306 ACRES 0 I f�V 0 - z V 200.0'33.01 �I ri�Q LOT 4- 3.274 ACRES S89038'240 W_1 �'?1 1� 1 233.01 I a /X • : IRON PIPE FOUND. •1 W.LINE NE-SE 13 331 O = SET I"BY24"IRON PIPE WEIGHING I I �_ ,. 1.13 LBS. PER LINEAL FOOT. I I w NO°54'03"E N89 053 29 E 300. 122.41' 1 1' N 1 � NOTE: DRIVEWAY FOR LOT2 70 BE BUILT I 31 I / "i�� ADJACENT TO THE SOUTH LINE OF I�a I It \ ICJ,`"`) �, LOT. CAUTION: SOILS MAYBE UNSTABLE POND I °1~ I z DUE TO PROXIMITY OF POND. u�� l w \\ 4 3.021 ACRES \ 9 x, I 1- „ w N29°3747"W \. 1 1 w 88.00" �6 0(l) \ 35.49' 744.43'-N89 05329"E 420.12' N89 053'29"E 1 7 i4 384.63 '1711.43' 133 50 o ' co Z 50 N89 012'06"W 17.00 I 1 � 2 � I 1 3.019 ACRES ✓ I 1 12.52' 1 1 M I I m 1 3 W 2' POND o' so'1 1 lrOO �� I EXISTINGEASEMEN M o` I a 5.979 ACRES N I O' 1 SEE ENLARGMEW C°1 ~ I 10* 8 1.95' 4.50: I ° �"I M 0 I I II-12=R 265.0 ® I Z jj 50.90' I 13-14=R 235.00' `.3 7.00' 6 95.10 I N7 055'35°E 1 1 33.33' S89°5329 W 1 135.43 R,R. E 88.35 I I OUTH LINE NE 1/4 -SE 1/4 1 50' 41.25'N I I I I I ' CL TOWN RO, D�1 1 ' O CT X53 1 ���'• "� '+ '� THIS INSTRUMENT DRAFTED BY -� l,JS*e� .