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HomeMy WebLinkAbout020-1084-90-300 0 \ \ ■ § ) \ C*4 \ \ �2 ( 0 ƒ \ 0) co $ 0 § 0 ! ) z 0 ! £ ` G$# \ 22m � E ) �_ @ f \ § � � } \ 0 Z N § k a ■ , % � k § + ) ) U) k k Q k a E \ k & � � § E j - e -� ƒ '$ %q /S Q } Mz / . } k 2 � / � k � k 0 ~ � I � = E2 ( o ® ■ & 2 % 9 � k � > E ¥) �\ . 0 .� e 0 0 0 a e a a a CL 0 ) co _ , o m = � 2 *Oft- u \ 7 7 \ / 2 � } � > 00 © \ 0 E � C E \ / $ % $ o S ; 9 R / E § 2 \ B f 7 / 0 : $ m � j ) f \ \ , - o a « . § \ } � \ / o k / / \ 2 ; . k \ IL%IL Z E) k LL k / o a 2 , o § v , sACIAL TESTING LABORATORY, INC. in Street, P.O. Box 526 Wisconsin 54730 �tj r 962- 3121 i 800- 962- 5227 ST. CROIX ZONING REPORT NO. 10989/01 PAGE 1 * ST. CROIX COUNTY REPORT DATE* 9/18/91 COURTHOUSE DATE RECEIVED* 9/17/91 HUDSON, WI 54016 I� ATTN. THOMAS C. NELSON 026 _ 10t - 96--3�Z * Sae Ni t lei LOCATION* 482 Country View, Hudson COLLECTOR* Mi. Jenkins SOURCE OF SAMPLE* Kitchen faucet COLIFORM04 0 /100 ml INTERPRETATION* Bacteriologically SAFE NITRATE—N'# 4 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L 9 7Q LAB TECHNICIAN* Pam Gane 0 � WI Approved Lab No. 19 Means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 4 `COMMERCIAL TESTING LABORATORY, INC. 5 a e 14 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 i ST. CROIX ZONING REPORT NO.** 13757/01 RAGE i ST. CROIX COUNTY REPOT DATE*# 11/14/91 COURTHOUSE R D*# 11/13/91 HUDSON, WI 54016 ATTN*# THOMAS C. NELSON // — �" /l3 ?- tkJR*# Barry Nei LOCATION*# 770 Larsen Lane, Hudson COLLECTOR*# MU. Jenkins SOURCE OF SABLE: Kitchen faucet COL.IF'ORMI*# 0 /100 tt INTERPRETATION*# BacteriotoaicalUy SAFE NITRATE-N*# 6 ppt Above 10 ppt exceeds the recommended Public Drinking Water Standard. Colifort Bacteria/100 tU Nitrate-Nitrogen, tg/L I LAB TECHNICIAN*# Pat Gane WI Approved Lab No. 19 OF.\NDEDEN,,. G L VY o Means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 i COMMERCIAL TESTING LABORATORY, INC. i 514 Main Street, P.O. Box 526 i Colfax, Wisconsin 54730 715 -962 . 3121 800 . 962 . 5227 I i ST. CROIX ZONING REPORT NO.'. 13737/01 PAGE 1 ST. CROIX COON r, REPORT DATE: 11/14/91 0"THUM DATE R9CEIVED2 11/13/91 HUDSON, WI 54016 ATTN: THOMAS C. NELSON i i i OWNER: Barry Neyer LOCATIONt 770 Larsen Lane, Hudson ; COLLECTOR; M# Jenkins i SOLRCE OF SNIPLEt Kitchen faucet i COLIFORM: 0 /100 st INTERPRETATION: Bacterioto4icatly SAFE I NITRATE-N: 6 ppa Above 10 Ape exceeds the, recomendod Pubtic Drinking Water Standard. Cotifora Bacteria/100 el Nitrate-Nitrogen, mg/L i i I i I i I LAB TECHNICIAN: Pan Sane I WI Approved Lab Not 17 I Ot.W�IVFN,� : Means "LESS THAN" Deter+able Level ; Approved by: PROFESSIONAL LABORATORY SERVICES SINCE 1952 i ST. CROIX COUNTY ZONING OFFICE 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix Co. Zoning Office offers the service of septic and �j water inspection to Lending Institution, Realty Firms , and private individuals. V" 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 CO. ZONING, 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 y/ (For nitrates and coliform bacteria) WATER TESTING--------------------------------FEE:$175.00 SEPTIC SYSTEM INSPECTION---------------------FEE:$ 25.00 PROPERTY OWNERS NAME: G PROPERTY OWNERS ADDRESS: %zt ITY:gf Legal Des ri tion 1/4, 1/ , Sec. , T N-R W, Town of '01 g�h '­� ,Lot No.,'aj _,SubdivisiorO,u(5�j (A..) FIRE NO. 77o LOCK BOX NO.�, CIv Color of house 1yl,nun�, Realty sign? UC/j)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: life-' Telephone No. ��- z Q REPORT TO BE SE TO.: X70 z w CLOSING DATE: Signature: ' k ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 (715)386-4680 Nov. 13 , 1991 Sharon Raley Edina Realty 700 2nd St. Hudson, WI 54016 Dear Ms. Raley: An inspection of the septic system on the property of Barry Meyers, located at 770 Larsen Lane, Hudson, WI, was conducted on Nov 12, 1991. A water sample was also 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 operation of this system. It is recommended that the system should be pumped once every three years . Therefore , the prolonged life of this system may be dependent upon proper maintenance of the system. Sits,perely, l r� Mary Jenkins Assistant Zoning Administrator cj -�c( -13-x1 lob—`� S . CROIX COUNTY ZONING OFFICE 911 4th Street CV Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix Co. Zoning Office offers the service of septic and water inspection to Lending Institution, 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 CO. ZONING, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. oo WATER TESTING--------------------------------FEE:$ 25.00 /1 (For nitrates and coliform bacteria) WATER TESTING--------------------------------FEE:$175.00 (VOCIS) SEPTIC. SYSTEM INSPECTION---------------------FEE:$ 25.00_ • r PROPERTY OWNERS NAME: S /'Yl 'A L PROPERTY OWNERS ADDRESS: 102 b")CITY: y Legal Desc iption 1/4, 1/4 , Sec. , T N-R W, Town of (/OSOA7 ,Lot No. ,Subdivision FIRE NO. gvZ LOCK BOX NO. /U417 Color of house r5� Realty sign? C _Firm: Qi;U4- 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 requestin services: •-6DIAJ4 Telephone No. REPORT TO BE SENT TO CLOSING DATE: "' Signature• ST. CROIX COUNTY WISCONSIN n ZONING OFFICE ST.CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 (715)386-4680 Sept. 17, 1991 Kernon Bast Edina Realty 700 2nd St. Hudson, WI 54016 Dear Mr. Bast: An inspection of the septic system on the property of Sam Miller located at 482 Country View Hudson, WI was conducted on Sept. 16, 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 operation of this system. It is recommended that the system should be pumped once every three years. Therefore , the prolonged life of this system may be dependent upon proper maintenance of the system. NOTE: House looks as as if it has been vacant for a long time. Stnerely,MJenkins = Assistant Zoning Administrator cj ca o � g °- 3 cn5 -i o o SOS N s y s co a S 0 .a -0 ti m t�7 I y , a CD . cp CD R5. ID CD ) O C X• o � e o � Q � p 3. � � !v cn p 0 vo a 00 3 <D m o at CD ca,)) 3oc � g � 3v, `,�D N aoi ono tOn �' y a� 0 R';9 77' o ° u�i a 0 m C) �. � o _ -o �° m a < c o CD �n o a- o cCDi c� Q O c -a 3 '2 (Q CD c7 3 c .�ID c ° Cl �o o m � o c a� o' 3 �• a � y � x OQ in nom ID (D p^`� D O -0 U a) CD 'ac�D � cC w0o C �_-� m m c 0 � co am coo �- o m �' cc'v (A a� R7 � a ai n Q CD 3 _. (/) 0 (r N CD c a ni m -c a ZR- (/) C N �r t cDD o vm , � - o �j -Q a.' CD z 7a C a� CD O -t CD CD ° °�' N � ma 7 o� _ cn o v CD D (D R_ 0 t w CD �• T cn cl) i D O E :3. 0 y < -A Po 0 � :3 � N N (CD i 0 CD CD G �' 3 3 N ca I s cn � � O m m m < 0 c CD 3 CA m 0 can n n a a O• � 0 r�;. � `� , 0- O m y � - NCl) s f � • 1.v t N , G) c� Parcel #: 020-1084-90-300 02/07/2005 12:39 PM PAGE 1 OF 1 Alt. Parcel#: 29.29.19.339E 020-TOWN OF HUDSON Current X', ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): *=Current Owner * RICKEY R&ANGELA RAVEN RAVEN, RICKEY R&ANGELA 482 COUNTRYVIEW RD HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *482 COUNTRY VIEW RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.400 Plat: N/A-NOT AVAILABLE SEC 29 T29N R1 9W NW SE 2.40AC LOT 2 CSM Block/Condo Bldg: 7/1956 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 06/02/2004 764490 2586/60 WD 07/23/1997 917/201 07/23/1997 910/129 07/23/1997 824/419 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 48308 259,200 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.400 42,400 158,100 200,500 NO Totals for 2004: General Property 2.400 42,400 158,100 200,500 Woodland 0.000 0 0 Totals for 2003: General Property 2.400 42,400 158,100 200,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 118 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 I VG48C West line of the SE}- N00024116"W, 2602.661 N00024'1611W 1399.97' N to n _ co CD C7 CA N C'1 7 O (D 44- r-I rt rt c O rt c n - 1 3 10 z co '7 r• N I W I O - rt r. 0 o -3 > > 1+ 1 0 3 (D 1 I W O 'O N tf O N 7 I C I• O �• � 7 t0 1 �O I - c O �--' iC-1 O CI1 N � � I I•7 - /D m o � Iul Irt rt It0 I� S00010 ' 37"E ;' ; 190. 00 ' \d�K \ 10 1� \ ✓ 1 0 1< Ito \ d Oy Or \ 0 0 CD I o (D (A , \\ �( �n \\\ f1+ > h s In to,• �x �rr N r I i !+t N`I f ro CD _ _r tj O 0) G) `' I r �. %D S 1 O r.} O• 2 7' .p• 7 7 Gj co 1 -tl p / c AM _ o a o rn .Oc,2 Z� a B V (n rt' o, r < Cr c c I \\L �{ M n *'o1 S28°14 ' 37"E O M CD N _ - 69 . 61' CD CD CD n -n.Y — — — — a, o� - - 0 ' 1 O O 01 COUNTRYVIEW ROAD M o to 1 G fi ►b-, wt p 11 o o K :31 C!) C) I w N m —I (D C Z ® W p 1 0 N O a � En 00 m 10 1 z F' l=1 M o i o 1 - p ' ✓ w r m ? ° I rt 1 m c X y 111 1 In o a A a't' -< rn v" .P m o 11 w T .- ° O O 3 n =_ 1 � 11 7 N "0 I •o N � x o a v i n N w °� 11 o N c Z (D O 1 w v 0 n W �Ot) - O ' 1 -n O 1 H II rt o "' I c O H'' lJl w 1 'm o O in Io „p 11fi rn n C" 1'7 --1 - !r o N N O o :C. c 1� m . 1 tD 3 :3 1 _ la m -n y ' z n r 89.201 i O 210.001 N ` ro � ^w+ o N00017 55 E 299 . 20 ��-East line of the NWJ of the SEJ-"'—" ? y e,'` ELa _ Unplatted lands owned by others ` tl APPROVW 0 �.: V) •1 N 4 > St. \I� UNF Y of W o o s t� t 1 PLAN m m z x �- 0 Ln N ei H o � 4 Z N � '^ ° Izi Bearings are referenced to the M West line of the SE} of Section 1 a t-3 29 assumed to bear N00024116 11W. o_ .17 N C N O• O. VOLUME 7 PAGE 1956 r CURVE DATA CURVE CHORD CHORD CENTRAL ARC TANGENT TANGENT NO. RADIUS LENGTH BEARING ANGLE LENGTH BEARING BEARING 1-3 577.091 154.811 S2003210811E . 1502415811 155.271 S28014'3711E S12049'3911E 1-2 577.091 121.09' S2201311711E 12 0021401' 121.311 S2801413711E S1601115711E 2-3 577.09' 33.95' S140.3014811E 302211811 33.96' S16011157"E S12049139 11E 4-5 511.091 123.211 N2101911311W 130501481' 123.511 N14 023149"W N28014'37"W 6-7 1230.00' 371.781 N8002511811E 170231061' 373.21' N8900615111E N71 043145"E • ':� SURVEYOR'S CERTIFICATE I, Allen C. Nyhagen,,`registered Wisconsin Land Surveyor, do hereby certifiy that by the direction of Sam Miller, I -have surveyed, described and mapped the land parcel which is represented by this Certified Survey .Map, that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in part of the NW4 of the SE4 of section 29, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; further described as follows: Commencing at the S4 corner of said section 29; thence N00024116"W along the west line of said SE4, 1399.97 feet; thence N89006151"E along the north line of Lot 3 of Certified Survey Map recorded in volume 5, page 1500, 380. 00 feet to the point of beginning of this description; thence continuing N89006 ' 51"E along the north line of the Plat of Country View, 944 .32 feet; thence N00017 ' 55"E along the east line of said NW4 of the SE4, 299 . 20 feet; thence S80031' 34"W, 397 . 50 feet; thence S75000 ' 00 11W, 131. 93 feet; thence S28014 ' 37"E, 69 - 61 feet to the point of curvature. of a 577. 09 foot radius curve concave southwesterly whose central angle measures 15024 ' 58" and whose chord bears S20032 ' 08"E and measures 154 :81 feet; thence southeasterly along the arc of said curve 155. 27 feet; thence S89006 ' 51"W along said north line of the Plat -6f Country View, 67. 66 feet to the beginning of a 511. 09 foot radius curve concave south- westerly whose central angle measures 13050148" and whose chord bears N21019 ' 13"W and measures 123.21 feet; thence northwesterly along the arc of said curve, 123. 51 feet to the point of tangency; thence N28014 ' 37"W, 250. 26 feet; thence S61045123"W, 321. 49 feet; thence S00010 ' 37"E, 190. 00 feet to the point of beginning. Above described parcel is subject to all easements of record. That this Certified Survey Map is a correct representation of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. " rah?�E?�t1?$•?' Ls� C. Allen C. Nyhag D to 'A :7 VOLUME 7 PAGE 1956 77 wG r�L M.r I\j r ��✓ ... Su s " + Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Sayn 111.Ild►' TOWNSHIP 4 SEC. T j!j�N-R��W ADDRESS �/L# / box 2tr2 ST. CROIX COUNTY, WISCONSIN 8w&'SC>K WZ 101y q�JY SUBDIVISION RoS�ih Ccur,'fr�� ;,uy LOT Z L T SIZE Z- �/ fa /S PLAN VIEW 2 U` - /G" -3 ' • - , 33��j � Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Joe ` s 5y I Z� ; -� 40 0 � 0 s 2_ 1' I • ss IT15A INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used + (o+jQ Via �ZS I(/.pi,c' S E , lot'�e�-� Elevation of vertical reference point: /�.Q/ Proposed slope at site: O � SEPTIC TANK: Manufacturer: �gQr Liquid Capacity: (0 .t Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: , 1-1) 3 Tank Outlet Elevation: 9 Z 1 Number of feet from nearest Road: Front,O Side,n Rear, O 12,0 - feet From nearest- property line Front,OSide10 Rear,® 9Z feet Number of feet from: well Q�_, building: .1 a2?-7fc-VK,`iE Cot Ma✓ 4S-t. (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE F r ` 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, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: /on Jtu"tio"&- k Trench: -- r� T Width: I Z' Lengjth: S 2. Number, of Lines: Ci Area Built: Fill depth to top of pipe: 14 Z Number of feet from nearest property line: Front, O Side, O Rear,0 Ft . 3r� i Number of feet from well: —/00 Number of feet from building: (*0 (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 Capacity: Manufacturer: Ca_ j� _ p y' Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj L'EPARTMC-NT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 NW4, SE4, S29,T29N—R19W CONVENTIONAL ❑ALTERNATIVE (IlaassPlan )D.Number Town of Hudson ❑Holding Tank El In-Ground Pressure ❑Mound Lot 2 Countryview Rossing Addition f NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: t Sam Miller Route 1, Box 282, Hudson WI 54016 BENCH MARK(Permanent reference Point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber'. MP/MPRSW No.: County'. Sanitary Permit Number: Doug Strohbeen 5432 i St. Croix 106093 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV_ WARNING LABEL LOCKING COVER ROVIDED PROVIDED. }.A 1 " I"`' q� d ECM YES ENO OYES NNO BEDDING: VENT DIA.. VENT MAIL.'. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. VENT 70 FRESH ALARM. LINE'.�7 C /) .S ZO AIR INLET FEET FROM / J 7 U ❑YES `L9 NO `-� OYES NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON N )PER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED'. ❑YES ❑NO OYES ❑NO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL N MBER OF PROPERTY WELL BUILDING V NT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) 1:1 YES ❑ O NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER 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 NO.OF JDISTR.PIPE SPACING COVER JINSIDE DIA -PITS LIQUID BED/TRENCH L rHE HES / MATERIAL: PIT DEPTH DIMENSIONS (( ,- GRAVEL DEPTH ;ABOVE DEPTH UISTH PIPF DISTR.PIPE DISTR.PIPE MATERIAL. N R. NUMBER OF PROPE RTV WELL BUILDING VENT TO F HESIt 7 BELOW PIPES COVER ELEV.INLET ELEV.END' PIPES LINE AIR LETj/ FEET FROM ' ���" Y7 7 / NEAREST-i MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER ITEXTURE PERMANENT MARKERS OBSEHVATION WE LLS OYES 1:1 NO DYES F-1 NO DEPTH OVER TRENCH/BED D ED EPTH OVER TRENCH/B DEPTH OF TOPSOIL DDED SEEDED MULCHED CENTER EDGES SO DYES ONO OYES E:1 NO OYES 0 N PRESSURIZED DISTRIBUTION SYSTEM: WIDTH'. LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVEN BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL IND DISTR DISTR.PIPE DISTHIBUTION PIPE MATERIAL&MARKING ELEVATION AND ELEV.. ELEV.. DIA.. ELEV. PIPES DIA: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING'. DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO El YES El NO COMMENTS: PERMANENT MARKERS: OEISERVATION WELLS'. NUMBER OF PROPERTY WELL'. BUILDING. FEET FROM LINE: r12 ❑YES ❑NO ❑YES ❑NO NEAREST i5 5 5 I y� SSA 0 D 1 Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE DILHR SBD 6710(R.01/82) Zoning Administrator G: SANITARY IL R PERMIT APPLICATION COU , �� x Z In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# E to –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 L No PROPERTY OWNER PROPERTY LOCATION :Sa In /, /4 E '/4, S Tat , N, R/ E( W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,STATE ZIP CODE PHONE NUMBER F1 CITY NEAREST ROAD,LA OR LANDM K j 1S X7 VILLAGE: �� Vi• II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family —3 OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. New b. ❑ Replacement 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. I IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a.XConventional b. ❑Alternative q. ❑ 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. (] 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): PROPOSED(Square Feet): t� �- 3 7es Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank ❑ ❑ Lift Pump Tank/Siphon Chamber Li VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: $u ess Phone Number: o,t k 6�.h A A" — Z umb 's Address(Street,City,State,Zip Code): Name of Designer: ,Qr A D Vill. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# /S CST's ADDRESS(Street,City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater PZ�40-VIKIh e Agent Signature(No Stamps) Approved ❑ Owner Given Initial rcharge Fee Adverse Determination I Z o �� � n; 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 it --- -- 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 bed- 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 tank(s) 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: 1. Property owner's name and mailing address. Provide the legal description where the system is to be installed; ll. 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; Ill. 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% 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; 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 Ground ater—. included the creation of surcharges (fees) for a number of regulated practices which Wisco EfI'S ° can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried re'1sur� is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. ! a 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 �1% Section o�� T <99 N-R,� Township L 40 1-7 Mailing Address _#,et Address of Site Subdivision Name Cou w7r,/ �� �r [ D SG Q Lot Number Z-- Previous Amer of Property Total Size of Parcel Af -5 Date Parcel was Created -;t Are all corners and lot lines identifiable? �' Yes No Is this property being developed for resale (spec house) ? _ 1� Yes No Volume � and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1 (We) ceAti.6y that att statementb on this 6onm cite true to the best o6 my (oun) k.now.tedge; that I (we) am (ahe) the owneh(s) o6 the pnopen ty dens c4 bed in this .in6onmation 6onm, by vi tue o6 a waAAanty deed neconded in the 066.ice o6 the County RegiAteh o6 Veeds as Vocument No. (1S' ; and that I (We) pnesent,ty own the pnoposed site bon the sewage didpos sys em (on I (we) have obtained an easement, to nun with the above desextbed paopehty, bon the constnuati.on o6 said system, and the same has been duty neconded in the 066.ice o6 the County RegisteA o6 Veedd, as Voeument No. . ,1 SIGNATURE Olt OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) -) ZI — �? i DATE SIGNED DATE SIGNED .......... _ eooK 808 acE 52 ! 'I I THIS SPACE RESERVED FOR RECORDING DATA ,. DocuMervT No. STATE BAR OF WISCONSIN FORM 1-1982 � 'I WARRANTY DEED 43G56i - II- ------- -- ---- — -= Ii REGISTER'S OFFICE ST. CROIX CO., WI This Deed, made between ..FSxx� >z._ .,.•RQs ---an_d.._.__ ..... Recd for Record -.-Ruby_-Dailey-------------------- ----------------------- I� ! --------------------------------------------- ------------------------------ Grantor, APR 2 5 1988 and $ In.R, M 11eY,-a.single•man------------------------------- -------------- -- at 8:30 A M 11 -� ------------------------------------------------------------ -------------------------------------- ------ ------ ';; ---------------------------•---------•-------- --•---------------------------------------------- Grantee, Register of Deeds Witnesseth, That the said Grantor, for a valuable consideration_._._ ----- __-- -- - ------ — ---- + conveys to Grantee the following described real estate in __St. Croix RETURN TO 1 _ , County, State of Wisconsin: Two parcels of land in the NW14 of the SFh of Section 29, j _°'t`_� T29N,R19W described as Lots 1 and 2 of the Certified Survey Map filed in the office of the Register of Deeds for Tax Parcel No- ----------------------------------- St. Croix County, Wisconsin on April 22, 1988 in Vol. 7 of C.S.M. , Page 1956, I Document #436486. Also a.._non.-exclusive easement to use as the 66 foot strip of land shown on said map as "Proposed Town Road" for an access road and for the installation of utility lines so located as not to interfere with .use of said road by others having similar rights. Two parcels of land located in the NW-14 of the NEk of Sec. 29, T29N, R19W described as I Lots 3 and 4 of the Certified Survey Map filed in the office of the Register of Deeds for St. Croix County on April 22, 1988, in Volume 7 of C.S.M., Page 1957, Document #436487. This deed is given in partial fulfillment of..the land contract between the parties I recorded in the office of the Register of Deeds for St. Croix County on November 17, 19871 in Volume 797, Page 49, Document 4432230. i 40's, P4/,P 1 EXEN" is not This ......_______--------------- homestead property. II (is not) f Together with all and singular the hereditaments and appurtenances thereunto belonging; i And_.Forrest--F•: Rossing_and_Ruby_Dailey warrants that the title is food, indefeasible in fee simple and free and clear of encumbrances except 1 Easements of record, if any, and liens or encumbrances,. if any created by the act or j• default of the grantee. ;I j� II and will warrant and defend the same. Dated this .----------------------------------------------- day of --•Ap--------------------------------------------------------------i 19..U... l ' AL) (SEAL) I * __Foxr_es_t_E.__Rossing---------•----------------- * --Rub_y__,Da_],ey---------------------------------__------ l •---------------------------------•-----------------------..----•-----(SEAL) ------•--•--------------------------------------------------•-------(SEAL) ll AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN Signature(s) __Q£._Fs2zzasz__E,.__RQSSxng_.aus1- ._.___ ss iiul2y__ps� ey---------------------------------------------------------- ------------County. ----------- authenticated this ?2--day of---AP-ri -------------- 19-�$_ Personall y came before me this ..-----------.--day of d ------------------------------------------- 19-------- the above named ' ---------------------------------- *-_John•-D,_-Heywood___- TITLE: MEMBER STATE BAR OF WISCONSIN -------------------------------------------------------------------------------- (If not, authorized by § 706.06, Wis. Stats) p II to me known to be the person -----_------ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BV Oha D� Heywood He` ood Cari & Murra -------------------------------------------------------------------------------- Hudson., WI 5406 ----------------- -----------•-----------------------------------•-----------P.O. Box 229 ------ --- Notar y Public ------------------------------------------County, Wis. I I (Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration '( are not necessary.) date- --------------------------------------------------------- 19--------- -Names of persons signing in any capacity should be typed or printed below their signatures. 1 WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc- FORM No. 1-1982 Milwaukee, Wis. • cn H a r ST C - 105 ra H SEPTIC TANK MAINTENANCE AGREEMENT Ho St . Croix County z d a (IL H OWNER/BUYER _ ROUTE/BOX NUMBER n X Fire Number CITY/STATE !i ISor1 (1J17_ ZIPSY'C? PROPERTY LOCATION : 4�� .1&, S,E- 14, Sectionoaf, T N , R W Town of , St . Croix County , Subdivision �aSS'r �o4�,fiyyLot number z- • I 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 may 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 St . 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 . yo E 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- 'o 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 . SIGN ! _ D ATE - St . Croix County Zoning Office P . O. Box 98- Hammond , WI 54015 715-796-2239 or 715-425-8363 Sign , date and return to above address . RY, OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUS TRY, INDUS DIVISION LABOR HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.0911)& Chapter 145.045) LOCATION: e, SECTION: TOWNSHIP UUaUrioni iT*. TITZ NO.:BLK.NO.: SUBDIVISION AME: k/ '/a a /Toz9 N/R/7 1 (or d/ err c.s v COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: s . USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIO S: PER OLA ION TESTS: Residence New ❑Replace I —Z J— s°"/M,410 6)( O y J� •�d — RATING:S=Site suitable for system U=Site unsuitable for system /fit!,- 6 6 rNS ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) ❑U S ❑U ®s ❑u ❑s ®U Mu e / If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: /V PR FI E DESCRIPTIONS PG BORING TOTALS ELEVATION DEPTH TO GROUNDWATER CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTHW. OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) e A/ BI/, .7 Al,/, - Ys'/, /.3 UAyw- /e5 B- Z- �,0 9 . / /( 7 0 r SB t/, . `l n�� . 3 40--0 , • ,-I r„/s/ . 7 if A /cS, z ,(� � /. p c s/ t s a B-� �•O' J�� , /�Gvl�t� � Qt `s O//� �.�Bn �/ • ( PK S/' r9 !! OAto- e-C, ,d' /1 r'3 B/d/ 7,12- Cs 3 d S S R Bn v d Gr /ICVu r B- 0 /, . Qs/, B- PERCOLATION TESTS TEST DEPTHi WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 14df"ff AFTERSWELLING INTERVAL-MIN. PERIOD 1 PE PERINCH R P- 7./` 10 Z 6 6 co G_3 P- AID -e--3 P- .6` 0 6 10, - - 3 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 �9• / �-� - "" = �`O .3 _ I e lie,�.c l� 7`""" C 1 _ T _. / E I CS Bo jOr'1�s E v T4 0 E KA j$. 0 1 J s € a t 441,e n .6 � ,��- _� �_ _ _ 110 to ! s m*// C K-f Ae v.�. j B car 03 P-) HAk `rr/ Atp/� /qC auJr.�04&-4s I,the undersigned,hereby certify that the soil tests reporte on this f��7{�e�r>��e in d with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the loca ion f th; tK correct to the I my knowledge and belief. s� ST Cf ox .v NAME(print): TESTS WERE COMPLETED ON: � ZONINCsOFME ADDRESS: r S i °"1 CERTIFICATION NUMBER: PHONE NUMBER(optional): CST URE: Ile atzti� DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER— f � y INSTRUCTIONS FOR COMPLETING FORM 115- SBD - 5395 To be a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3, MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sliest may be used if desired; 8_ Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain,elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stoma (oiler 10") RR - Bedrock cob Cobble (3- 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone *s - Sand HGW High Groundwater cs - Coarse Sand Pere, Percolation Rate rned s - Medium, Sand VV - Well I's Fine Sand Bldg - Building Is - Loa€ray Sand > - Greater Than "sl - Sandy Loam Less Than 'I - Loam Bn - Brown �-si? - Silt Learn B1 - Black si - Silt Gy - Gray *cI Clay Loam Y Yellova sci - Sandy Clay Learn R - Red sicl -- Silty Clay Loam mot - Mottles sr - Sandy Clay vv/ - with sir - Silty Clay fff few,d fine, faint Y c - Clay cc, - common, coarse pt - Peat: rurn - Many, rr et:diurn m Muck d distinct p — prominent HWL - Nigh water level, Six rieneral soil textrarss surface water fOl li(t4rid waste disposal BM - Bench Mark VRP - Vertical Reference Point TO THE OWNER: i This soil lest report is the first step in securing a sanitary perriiit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans fr)r the private sewa(w systcon and a permit application must. be surmi{ted to the appropriate local authority in order to obtair3 Lk i"T�rr`,*-Tl1C'sanitary porrnit must be ontained and posted prior to the start of any Cons ructiwl, �o �8 g p�►fit .a �� � a �� f \ 14 P OL�+' Qr o b I S y� w z t r -k 00 �v V� o L►►1� i ' J o\ � � � �I � � W t ti '" d c t- 6 ti o. J. P- a W ? r vr � I -POO Id S �p d Qern .. ..� - •. Q- .. c�