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HomeMy WebLinkAbout020-1121-90-000 ry o °o (L) °O M y 03 6 0 C=; ON N y ar O O 2 O c_ ti h Y C y y E O f0 M N N CL) p �V >m o C O O M N O " X O O L 20-00 O_ O _ C N i O 3 C N O N a y E V c m r N N c c N d Y-0 V'y f0 c'O O` y y c y 9 co c o m LO o rny3a� 0 z o (j) y > o z °a ` .0 m cLi G axia�o LL o a� c`o LL o -o m 3 3 3 X,�,o . aD ` o y =_CO -6 u E c Qi °r?i� E Q mF-v Cl)I U _N _ N O Z N fA E E U) ;. O ;. O z d 0 d d °' n a m a m H 0 o z v r o w o m z � ° U) F- a a Z 7 Y) C E c E o .O N 2 M O N O O N D c N N cc N O y n y d y y C •Ai N ) Q7 N L O a L o (L O Q z m z z m z d rn d 'o c R E o tVl1 0' y G� N N Cp y d ` C O 0 000. EL o 'c0CL EY LL N N N O N N N O Oa 0 3 CL U) 3 3 ° = z •N ' aaa � aaa IL (Oi OU) C N N y 7 GO op N (A J V OOi OOi } CD T z C o ) OO N w 0 J O OO 0 O O .0 (D O O 'O �. J 0] c c0 c Q.. >. M y N 0 N -6 y N (v d Q d O Q U7 Q LO N 7 .�,• (O 7 r O O N C M N C C� 9 Q c O N O O a) O a) O O oi O O - O N m O O ~ f0 Y p C l\ co t , c V! U .V l y U X ICI O N O N •+ O O c O f C r • N O O O C O O O O O U Q 0 0 2 cV 0 z - 2 2 O Z - F- 2U) r/ m € a � a � xt a L: CL Lam r A V a O v) V O U) V t y , COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800-- 962 - 5227 c r, ST. CROIX ZONING REPORT NOA 09199/01 PAGE 1 ST. CROIX COUNTY REPORT RATE: 8/23/90 COURTHOUSE DATE RECEIVED: 8/21/90 HUDSON, WI 54016 ATTNS THOMAS C. NELSON OWNER: ry 6 Rose l la �' �� LOCATIONS 365 Kratttey lane, Hudson COLLECTORS M. Jenkins SOURCE OF SAMPLE: Kitchen faucet COLIFORIIS 0 /100 ml INTERPRETATIONS Bacteriologically SAFE NITRATE—NS 1 ppm Under 10 ppm is safe for human consumption. Coliform Bacteria/100 ml Nitrate—Nitrogen, mg/L LAB TECHNICIANS Pam Gane WI Approved Lab No. 19 OF.\NDEDEN E,y O O` �P V D 5 A < Means "LESS THAN" Detectable LeveL Approved by: d,, v o PROFESSIONAL LABORATORY SERVICES SINCE 1952 4 I st National Bank of Hudson 307 lyd S t -c-t Hudson, W1 54016 Fes`' Q► >";;.. C.��b ST. CROIX COUNTY ZONING OFFICE on ` ` St . Croix County Courthouse 911 4th Street / U Hudson, WI 54016 VTeleId 9�1 phone - ( 715 ) 386-4680 he St . Croix County Zoning Office offers the service of septic nd 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 v ( For nitrates and coliform bacteria) WATER TESTING FEE: $127 . 00 (For VOC' S ) 3 I p l SEPTIC SYSTEM INSPECTION-----------------FEE: $25 . 00 SPA ( Determines if system is properly functioning at time o V� �� inspection ) - 3 Property owner ' s name Property owner ' s address Legal Description 1/4 of the 1/4 6f Section , T N-R Town of Lot Number Subdivision Name FIRE NUMBER LOCK BOX NUMBER Color of house Realty sign by house? If so, list firm: PLEASE INCLUDE, IF AT 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 gained . Firm or individual requesting services : Telephone Number � � Y REPORT TO BE SENT T0: Closing date Signature 1St National Bank of Hudson 307 2rd 3 t i Z%,",L L Hudson, WI 54016 ' per„ OND f 411 NUMBER 17094 RIVER VALL EY ABSTRACT & TITLE, INC. ST. CROIX COUNTY, WISCONSIN Lot 7, in Eagle Ridge, a rural subdivision located in the SE4 of Section 7-29-19, Town of Hudson, EXCEPT that part more fully described as follows: Beginning at the NE corner of Lot 6, in said Eagle Ridge, being the point of intersection of the common boundary line between said Lots 6 and 7 with the SEly right-of-way line of Krattley Lane; thence N56002'30"E along said right-of-way line, 60.0 feet to the NE corner of said Lot 7; thence S33057'30"E along the NEly line of said Lot 7, 173.0 feet; thence SO0038102"W 105.68 feet to the NEly line of said Lot 6; thence N33057'30"W along said NEly line of said Lot 6, 260.0 feet to the point of beginning. TOGETHER WITH and SUBJECT TO a non-exclusive easement for ingress and egress and utilities over the following parts of Lots 7 and 8 in said Eagle Ridge: Beginning at the NW corner of said Lot 8, being the point of intersection of the common boundary line between said Lots 7 and 8 with the SEly right-of-way line of Krattley Lane; thence N56002130"E along said right- of-way line 60.0 feet to the NE corner of said Lot 8; thence S33057130"E 191.68 feet; thence SO4 0 38.02 11W 105.68 feet to the Sally line of said Lot 8; thence S33057'_�Q", along said Sally line of said Lot 8, 265.40 feet to the SW corner of!'saiyLot,B thence S89004'52"W 71.57 feet to the SE corner of Lot 6 in said EAgle Ridge; thence N33 57'30"W along the NEly line of said Lot 6, 245.06 feet:;, thence N00038102"E 105.68 feet to the Sally line of said Lot 8; thence'', T33 0 57'30"W along the SWly�1`ine- of said Lot 8, 173.0 feet to the poirit,,of beginning. This easement to serve Lots 7 and 8. TOGETHER WITH and SUBJECT TO any other easements, covenants,,. reservations or restrictions of record, if any, but this shall not be deemed to extend any such other recorded""encumbrances beyond the term established by law therefor. ` ♦ t • r„ ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST.CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 (715) 386-4680 Aug. 21, 1990 Kathy Macknick First Nat'l Bank, Hudson 307 2nd St. Hudson, WI 54016 Dear Ms. Macknick: An inspection of the septic system of the Terry & Rosella Hendricks located at 365 Krattley Lane, Hudson, WI was conducted on Aug. 20, 1990. At the same time I also obtained a water sample for testing. The results of that test 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 inspections. This not 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 regarding this subject, please feel free to contact this office. Sincerely, Mary J @nklns Assistant Zoning Administrator cj Parcel #: 020-1121-90-000 03/31/2005 03:04 PM PAGE 1OF1 Alt. Parcel M 07.29.19.536A 020-TOWN OF HUDSON Current X I ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): *=Current Owner * KELLY W&ANNETTE W MASSIE MASSIE, KELLY W&ANNETTE W 365 KRATTLEY LA HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *365 KRATTLEY LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.910 Plat: 1925-EAGLE RIDGE SEC 07 T29N R19W EAGLE RIDGE LOT 7 EXC Block/Condo Bldg: LOT 7 P536B IN 648/243 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 01/10/2000 616757 1483/292 WD 07/23/1997 1042/500 QC 07/23/1997 695/419 2004 SUMMARY Bill M Fair Market Value: Assessed with: 48624 232,400 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.910 51,500 128,300 179,800 NO Totals for 2004: General Property 3.910 51,500 128,300 179,800 Woodland 0.000 0 0 Totals for 2003: General Property 3.910 51,500 128,300 179,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 132 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 a Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER I; ?,� HQ-N�V,'l AS TOWNSHIP J�Ua SO I,I SEC. T � I N-R � W ADDRESS )c 31u� ST. CROIX COUNTY, WISCONSIN 11 SUBDIVISION lA LOT 13 LOT SIZE _ l' PLAN VIEW Distances and dimensions to meet requirements of I•1HR 83 �. SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 3, � O Fi_,1 lei( 5�1~►"1 T V f?� ' V - INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used To OUN o- tow NE CCZNQit cj boLA,$e o Elevation of vertical reference point: 00A) Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front 10 Side O Rear, 31S feet From nearest property line Front,0 Side,O Rear,® C 3 feet Number of feet from: well � 3 , building: 15 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) I� SEE REVERSE SIDE r 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,Q Ft. Number of feet from well:. Number of feet from building: (Include distances on plot plan). Skat, 3.13 HeAMR -9311 M7 °1°.0u E-rvo -9333 93.33 SOIL ABSORPTION SYSTEM 103.1 Bed: Trench: 10°"` Width: Ip Lenjth:- 3(p Number of Lines: 3 Area Built: �1$ Fill depth to top of pipe: 4)<< Number of feet from nearest property line: Front, o Side Rear,0 It .�_ Number of feet from well: 110 Number of feet from building: 3a (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 O 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, Side, O Rear, Ft. 0 0 Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on Job: YY'�St License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS ON I LA0Q3"++0MAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMB DIVISING P.O.BOX 7969 MADISON,WI 53707 SW%,SW%, S7,T29N—R19W CONVENTIONAL El ALTERNATIVE state Plan l.D.Number. If assigned) Town of Hudson ❑Holding Tank ❑In-Ground Pressure ❑Mound Lot 7 Eagle Ridge NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DAT Terry Hendricks BOx 365 Krattley Lane, Hudson, WI 5401 //_ $t' 91? BENCH MARK(Permanent reference pomt1 DESCRIBE IF DIFFERENT FROM PLAN'. REF.PT.ELEV.: CST REF.PT.ELEV. Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Richard Hopkins 1059 St. Croix 106057 SEPTIC TANK/HOLDING TANK: MANUFACTURER. ILIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ❑YES FIND DYES ONO BEDDING: VENT CIA. VENT MAT L: HIGH WATER NUMBER F PROPERTY WELL. BUILDING.IVENTTOFFIESH ALARM FEET FROM LINE AIR INLET DYES ONO DYES ONO N DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUF ACTIIRER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. [:]YES ONO ❑YES ONO DYES ❑NO NT GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING AIR INLET HESH (DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) OYES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETLH MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH'. LENGTH.JNO.OF r7i�_�SPACING COVER INSIDE DIA -PITS LIQUID BED/TRENCH I TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH OISTH.PIPF DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR. NUMBER OF PR OPERTV 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 slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE JPERMTNENI MARKERS OBSERVATION WELLS ❑YES 1:1 NO ❑YES 1:1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. , DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. No.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL.&MARKIN6 'I ELEV.. ELEV.. CIA.. ELEV, PIPES ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLARtTSCAL LIFT CORRESPONDS TO APPROVED ❑YES ❑NO 1 1:1 YES NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. INUMBER OF LRNEPERTV WELL. BUILDING FEET FROM OYES 0 N ❑YES 1:1 NO NEAREST 0 Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE Zoning Administrator DILHR SBD 6710(R.01/82) — SANITARY PERMIT APPLICATION COUNT`1 L DILHR In accord with ILHR 83.05,Wis.Adm.Code • STATES- MIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO PROPERT WNER PROPERTY LOCATION C � '/a, S T Q 9 N, R E(or P OPERTY OWNE AILIN ADD E S LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CJX K tv, LA CITY,ST TE ZIP COD PHONE N BER p Ej CITY VILLAGE: NEA ST A AKE OL M ARK sow W' S c, o II. TYPE OF BUILDING OR USE SERVED: M- 09 0"`7Cx� Number of Bedrooms if 1 or 2 Family. OR ❑ Public(Specify): N I U p gf_D III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. ❑ New b. XReplacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit# Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. Xonventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a.54 seepage Bed b. ❑Seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPQSED(Square Feet): t (V 7 ' Feet X Private ❑Joint ❑Public VI. TANK CAPACITY Site in allons Total ##of Prefab. Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New misting Gallons Tanks Concrete structed glass App. --- Tanks Tanks Septic Tank or Holding Tank �00 0 F-1 ❑ Lift Pump Tank/Siphon Chamber VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber' Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: IG A PT ubgr's Address( treet,Ci ,Stat Zip Code)• (� Na f De igner: VIII. SOIL TEST INFORMATION Certified Soil Tester( ST)Na a CST#0 c. b . VAM e CS s DoDRl ESS I(Str t,Cits y, ate,Zi Code Phone Number: b so IX. COUNTY/DEPARTMENT USE ONLY F-1 Disapproved Sanitary Permit Fee Groundwater ate Is ing Agent Signature(No Stamps) ®Approved ❑ Owner Given Initial '\\ charge Fee Adverse Determination V` � 7�` X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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: A new permit may be needed if there is a change in your building plans, system location, estimated wastewater-flow (number of fled-` rooms, etc..), depth of system, or type of system; 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. Private sewage systems must-be properly maintained. The septic tarik(a) should be pumped by a'licensed pumper whenever necessary,usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the 'State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; Il. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 111. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'h 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 sdwers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground19r included the creation of surcharges (fees) for a number of regulated practices which Wisco ir>" can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried real; t'p . is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. o The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) 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 - '� '4 _L, Section , T ---�.- N - R J� W Township G��D.SD�/' Mailing Address Subdivision Name h C- Lot Number 7 Previous Owner of Property � �� Total Size 'of Parcel Date Parcel was Create s 3 / J?�P U Are all corners and lot lines identifiable? Yes No Is this roperty being developed for resale (spec house) ? Yes No a Vo lum � - and Page Numbeg..�, L as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF 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 of 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 1 (we) ceA ijy that aU statements on this Jonm ane xAue to the beat of my (ouA) knowledge; that I (we) am (ane) the ownen.(s ) o6 the pnopetty de n bed in this �cn4otcmati.on Jonm, by vittu.e o6 a wa4Aanty deed teco&ded in the Oj4ice of the County RegdeteA bj Deeds as Document No. a ; and that I (we) pnea entt y own the pnopos ed site jon the sewage duposat system (OA I (we) have obtained an easement, to nun with the above descA bed pnopeA-ty, bon the constAuction o6 said system, and the same has been duly Teco&ded in the 06jice o i e County Regsten oA Deeds, as Document No. 39g�y ) . SIGNATURE OF OWNER �7 SIGNATURE OF CO-OWNER (IF APPLICABLE) -?D m"z O DATE SIGNED DATE SIGNED Nry` u x M, s Y ~"fie T'P'^' A'4T.yr FOP- ��.� ��i. � ... ,q♦ At- 410, tt ........ .... ii.tklia�il{��eJYI � Mey. A .fib .,. �•'� .� iYt �. ow '7777 a 4.. 'jo, -Alk w4t...-frF no- fZ lit" -Jkl ;l0f 4`4 �T*' '44 W, 4 on « H y ST C - 105 r r y y SEP'T'IC TANK MAINTENANCE AGREEMENT 0 St . Croix County 0 OWNER/BUYER ROUTE/BOX NUMBER I-) /`�/ i Fire Nuinber 10� CITY/ STATE 'A�1 .Oly ZL�/,�� `Z I P ,�/Mlo. PROPERTY LOCATION : 52�l %4i Section , T_,:g q_N , RJ__W , Town of St . Croix County , Subdivision Lot n•umber_�. Improper use and maintenance of your septic: system could result in its ' premature"failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper . What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system . St . Croix County residents ma be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980 , with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to 5t . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2 ) after inspection and pumping ( if nec- essary) , the septic 'tank is less than 1/ 3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 0 I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth , herein , as set by the Wisconsin Depart- w ment 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 . SICNED­J DATE_ , L� s '/iL�• d"� a St . Croix County Zoning Office P . O . Box 98 Hammond , W] 54015 715-71i6-2239 or 715-425-8363 Sign-, date and return to above address . R DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR HUMAN NDATIONS PERCOLATION TESTS (115) MADISON WI 5370 (1-163.090)&Chapter 145.045) L R TO HI(�r� OT NO.:BLK.NO.: SUBDIVIS O N E: COUNTY: O— ER'S BUYE,R/'S NAM�E: / MIN ADORE S: Sk Co,p /'/' �leylQ'�'ir,r�S ru 4 kwe. .JSl, G.l,' _5 00 USE DATES OBSERVATIONS MADE NO.BEDRWIS,: COMM DESCRIPTION PR F D S: TESTS: ►Residence 3 New �ieplace LbY RATING:S-Site suitable four system U-Site u�n`suitable for system c N� CONV ST0U M®J �� IN G J �� Sa J I��L o S'mU .RECOMM�U�l1 OhiS�o In If Percolation Tests are NOT required DESIGN RA E: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: V I Floodplain,indicate Floodplain elevation: / PROFILE DESCRIPTIONS BORING TOTAL PTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH,^ ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE AB RV.ON BACK.) B- �l qQ (� A t� . ' 7.f W,11,W,11,9z �,s,z,tie'�/s +✓6., ,mss N6 �-i�s� n..,.r� 3 83' / 9.yy /8r /02 �0/'� � r�LS i�1 C cffS 41 `rw�rizG ' I A0'B//%.�IL'Sjt/ 2.l7BA s, 33�.tf 5, �/7' eS., Z S- ,O'm 5e— ' mot AD I7 nL5 .4Y n yl w tG Oft B- W �. . AS 4 Y SA M,tirk�y w, s:tG B-3 Q �/ i (�7 p �8I .33' s 30 COOS •5L 'gw fs .E &. L,��s •'+ �P U� 72 // /� Alp- 72 .S dVit¢, C r/'4 J�-r ' ."1-Iremcsop- B_ w jU OppaOs R y yy'�., S�k r ✓</1 4i-, W Ilse Veep* L_r 5d5 0., BtiCs �-rLo.-, � PERCOLATION TESTS `-� �Lj TEST DEPT WATER IN HOLE TEST TIME DR ATER L VEL-INCHES RATE MINUTES NUMBER I.NQ++E-S AFTER SWELLING INTERVAL-MINu _ H P P- Z S 3 yt 3%Fl 6 Isr S, 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 1 1 � i � ! �`D!�►� �t! Ct �wOAF{s N�(JO!hAt/0 i t Br''► L ' IO�.a' _ P TN»k �� e o=fire' t Ppfc. o�e.a 5,k s O"44 , b b A TH fX11*3 p _ Coat ( .;rt�►+�^�S [_ %AS 61 �3 I f ; 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 : / TESTS WER COMP ETED ON: cl+ae� 's We V 3 Z 8 Std ADDRESS: CERTIF CATIO UMBER: PHONE NUMBER(optional): 01 e"& 51 H Sovf G✓, ,� 0/� po' g� 683/ CST/SIGN DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R,02/82) —OVER — __' OSS SECTK 1\1 - 67 # \ R. B. L. , PLOT A 11 h (" I 1-1 E k P 1'3 0 J EC 4 V E Ti-Kx�U�-u _.TOL OC AT 10 N �q� LICE NIS E A(4 I-? L C I.,) ATE A P PLO T y 170 A 01 0 01 C) 4 Y)w Ai 6k, —LU - PT C) 6-3 MAtK for A 'Fou#,Jd;oP NE IE L. luo.0, CoRPRR i 6�t 0= POWk 61 t Sits X1 p4tr,( pule S'l es Ac-goss plo'la"(W nAst bt ctt to FRESH All", NLETS AND OBSERVATION P-.-- CnQSS SECTION Approved Vent Cap FIWAI jrx�v Minimum 12" Above Final Gr % rn A)( 4" Cast Iron Above Pipe Vent Pipe To Final Grader-- q1t Marsh Hay Or Synthetic Coveri.ng Min. .2" Aggracil Distribut i2p- Over Pipe Tee > Pipe Aggregate Per•forated Pipe Below Bencath Pipe Coupling Terminating At Bottom of System AS BUILT SANITARY SYSTEM REPORT %0 OWNER 5 a Al X1 f l � � TOWNSHIP f f u � � ®'`1 SEC.7� _T jqN-R1 q W ADDRESS 7–,"- u ly �O r`� J ST. CROIX COUNTY, WISCONSIN. SUBDIVISION_ /0 y P LOT 7 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of 1-163 W- EVERYTHING WITHIN 100 FEET OF SYST1,14 ��... a I di atte ' or, th� A row 1 1 .A III CA ,SI-I' . I _._ _ BENCHMARK: (Permanent reference Point) Describe : T°/' ° o f /V"' Lot L i,IA Elevation of vertical reference point : � o O Slope at site : SEPTIC TANK: Manufacturer: W( e f '4., Liquid Capacity : ® 6'a rs Number of rings on cover i Tank manhole cover elevation: ' Tank Inlet Elevation: Tank, Outlet Elevation: C PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cycle gallons ; total capacity of distribution lines gallon: size of pump head; gallon per minute horsepower brand name of pump and model number ; Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: Number ot pits eet diameter feet liquid dept seepage pit in e-t pipe-elevation bottom of seepage pit elevation feet . �- ile de th SEEPAGE BED SIZE: number of lines width length -tile p SEEPAGE TRENCH: width- length PERCOLATION RATE AREA REQUIRED ARE AS BUILT INSPECTOR DATED L PLUMBER ON JOB LICENSE NUMBER 44 P--- r r � TO Drive wo y � Ouo yQ � �4 s 13 � pri „ e c w� l ( DEPARTMENTOF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: (if auisned) ❑Holding Tank ❑In-Ground Pressure ❑Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DA BENCH MARKIPbrmaneiit reference pointl DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.E EV.: ICSTREF.PT.ELEV.: Name of Plumber: MP/M RSW No.: ounty: Sanitary Permit Number: mss Ic 6 eola x Z e F1,7 4/- SEPTIC TAN /HOLDING TANK: MANUFACTURER: . LIQUID CAPACITY: TANK INLET ELEV.: S TANK OUTLET ELE111��� ARNING L LOCKING COVER I� n PROVIDED: PROVIDED: EYES ❑NO ❑YES ❑NO BEDDING: VENT OIA.: VENT MAT L.: HIG w NUMBER OF ROAD: ROPERTY WELL: N G: V NT TO FRESH . ALARM: FEET FROM �t LINE' , AIR INLET9YEs ❑NO y c. ❑YES ❑NO NEAREST �� �z ISUILDI z / DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: YES ONO DYES ❑NO ❑YES ❑NO. GALLONS PER CYCLE: PUM AN N L A oNAL: NUMBER OF PROPERTY ELL: BUILDING-MV R H (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) DYES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH IAMETER MA ERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH`. LEN TH: DISTR.PIPE SPA ING INSIDE DIA. *PITS. LIQUID BED/TRENCH �i TRENCHES / , MA IAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH UIS R. 1 DISTR.PIPE 1 MATERIAL: NO.DISTR. MBE OF WELL: BUILDING: V NT TO FRESH BELOW PIP ABOVE COVER. ELEV.INLET ELEV.ENP: /� n PIPES. FEET FROM LINE: T AIR INLET. r NEAREST /D rJ � I MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES E]NO OIL COVER ITEXTURE. PERMANENT MARKERS; OBSERVATION WELLS ❑YES El NO ❑YES 1:1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED. SEEDED: MULCHED. CENTER EDGES: DYES ❑NO DYES ED NO ❑YES 1-1 NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH. TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE LL E H AB V O R DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE A I OLD MA EHIAI. NO.DISTR. DIS R. 1 DISTRIBUTION PIPE MATERIAL&MARKING ELEV, ELEV.. DIA. ELEV.. PIPES DA. ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING 14ILLE CCOHNEEI LY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS Y ID NO DYES 1:1 NO COMMENTS: PERMANENT MANKERSP OBSERVATION WELLS: NUMBER F PROPERTY WELL: BUILDING: FEET FR LINE: ❑YES L_.]NO 1:1 YES ONO INEAREOAM Sk etch System on Retain in county file for audit. Reverse Side. SIGN N 1 r DILHR SBD 6710(R.01/82) •PLB7 State and County State Permit # 6 Permit Application County Permit # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: Y4 Y4, Section �7— T N, R O"r) W Lot# _City Subdivision Name; nearest road, lake or landmark Blk# Village Township CG h C. TYPE OF OCCUPAN *Commercial *Industrial *Other (specify) Variance Single family Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY I 610'd-20(Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation — Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other(Specify) E. EFFLUENTyDISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq.ft. New �/ Replacement Alternate (Specify) Seepage Trench: No.of Lin al Ft. Width Depth Tile depth (top) No.of Trenches Seepage Bed:—�Length� Width Depth � Tile depth (top)--L�No.of Lines Seepage PIt: In 'de diameter Liquid Depth No.of Seepage Pits Percent slope of land t Distance from critical slope WATER SUPPLY: Private Joint❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME P 04 C.S.T. # l SY and other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# Phone # ;?51Z ?fz3 Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20.Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. s E , m s, .-y..R a ....�.. .:.,...e... ems..», d..,.a.. .L :.«...... ee f # f E 7 € i t a e i fl _.­ . _ _ ,.. �._ k t e we -..m m...,._ _•a m ate.., .,. _ J.E • f t E 7 f ; t r d 7 t Do Not Write . in Space Below FOR COUNTY AND ST TE D ARTMENT USE ONLY Date of Application � s Fees Paid: Stated County- ,. Dat Permit Issued�efeete c L l (date) :�. Issuing Agent Name (Z,�p4„��rt/_ Inspection Yes No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/11/78 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WBOX 76 I 537907 9 53707 HUMAN RELATIONS LOCATION: SECTION: " OT NO.:BLK.NO SUBDIVISI ON NA^ o � 15 /r04 or ,0Ad 6_ Q M / COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: S: STS: FxResidence iA Ne;wEO);ep O_/�I_ p _/" V OA`�RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN ULHOLDING�TAANK: RECOMMENDED SYSTEM:(optional) S ❑U S ❑U ®S ❑U ❑S U ❑S RU COA1 VtAr_ Peo 4 If Percolation Tests are NOT required DESIGN RATE:S STEM ELEV If any portion of the lot 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.HIGWE-ST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B-2 1 C76" ! 7" e— � � �'' On 7":$' J' (3 n &1 s•, -Ah s/ v0" /Z/`4 S B-3 /t /t( t 7" Ah .S/ P ` Bit ��1� S B- << -,�-" 7 IC'' / ,Bit T- / S• " l'�e AS B- B_ PERCOLATION TESTS 4PUTWER DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERI D 2 PERI D PER INCH f /0 •9 / y P-_ P- P- PLAN VIEW: Show locations of percolation tests, soil borings and the imens'ins of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on plot plan. Show the surface elevation at all borings and the direction and percent of of land slop. T S'fY tG S 4.@ a Fz"t.e_ /oar f tOA;a/-0► SYSTEM ELEVATION 91 - � B� El. _log'' ToP°, i"Lot©`Pa_ I E .. ...e .. e� stile_ ' . .11 a posh Ali E ' ..� � G 4� aka�q m.. p�e� �� F .. AI'PROVE .b E _ /ASIA �'.P L S/, JI .4-A� Il . 1, the undersigned, hereby certify that the soil tests r ,grted 4this�Fq were by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code,and that the data recorded and the ation of the tests are to the best of my knowledge and belief. NAME(print): � TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): w,, Sol CS r /.� /j-1_ �g SV CST SI RE: n DISTRIBUTION:Original-Local Authority,2nd page-Bureau of Plumbing,3rd page-Property Owner,4th page-Soil Tester. DILHR-SBD-6395(N.03/81) � q J ` 1 J R lk 1 i •3 ��- '� �i`a gin'��5� ��s°rh p� ,� .�'r t � �t►h.G � � u S' f � a f y fp sry 4 f a h y� T6 fri Let DID .4 l to-P-to �4�eoi P-2. of V/A salt[ on Lat Lrh� o u SC °4 f`' �inf orahya 7� to c S � Fa � s 455 24, 32 4 99 , 12 ASS° 1.09 ACRES �� ao % 38 20"w S 2g 25 4,g0, 4 /s `10.-, 3.93 ACRES 98°40'40 !.49 ACRES v ASS° c�0,, 29° / r �h' 4- 2919d' 138.00, S 89°04'50i,W LBS.i � 'rU 4 N 8 SOo� ��_ \ 103°53 I 0 CORN '^ PIPE, \ � _ .23 ACRES 3.68 ACRES v /' LBS./ �9 123°35� 0 Q� LBS.i 0, aD � ` OD 1.68 l 01 CD 3 � \- N �' 33U 00 F -2 40.9 � A 2 2 8. 14_ 101.86 204.46 BEEN ).00 S 89-0450"W 570.92 O <: D� _pdL Q- :� THE r COMPI : Al SOLAI LL 0 SITE. 4.32 ACRES L6 �9 N N °o M 556. 77' 42 151. 57 405.20 268°294