Loading...
HomeMy WebLinkAbout030-1017-70-000 0 3 oc v ~ 0 6.3, of o 2 E c0 c ° c N w p 3 � O� E O� - U x X01 N .O..75 LO d N .U. -0 V O O C O Y C L x O f0 N U 7 O O .L� p C C Z . J C N U LL c' CO N'p L m E'.tY cOO O O N O w 0 Q to N 3 � z y rn w c T Z w G z T 0) w a m L z O c C7 ° z .0 v' c 0 T O n W d Z !t C p U) T m O Z C E "a '0 CD O N Cl) N a 0 C O O N O d •� O C L r 0 IL m ° O w z z� o N Z w 0 N O y w 0 d L E @ N Z N > N N N al F- 0 U o 9 Z p •N � aa IL o 3 C N `° ° o = U) J U rn rn Z 0 CD N r .- O O N Q4 O O � 0 E D m y C c W T O u7 O LO 7 y d Q } (n @ to E v 0) o CD o L' C C O O O_ O O n N of O C C-4 LO 7 YN OT N p L 00 U Z C ID N • co O O O c 0 R O OO o O !n = .w v� d a EL • am 2 da r`Iv +� E ` c c 3 L A u(L2 ; O co L) S Parcel #: 030-1017-70-000 02/18/2005 11:40 AM PAGE 1 OF 1 Alt. Parcel M 05.29.19.74G 030-TOWN OF SAINT JOSEPH Current XI ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): "=Current Owner PAULA&JANET L KELSON KELSON, PAUL A&JANET L 486 BLUEBIRD DR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description `486 BLUEBIRD DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.580 Plat: N/A-NOT AVAILABLE SEC 5 T29N R1 9W NE NE LOT 2 CSM 4/949 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 05-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 956/555 07/23/1997 807/304 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 4838 286,400 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.580 70,400 211,400 281,800 NO Totals for 2004: General Property 2.580 70,400 211,400 281,800 Woodland 0.000 0 0 Totals for 2003: General Property 2.580 41,200 166,100 207,300 Woodland 0.000 0 0 Lottery redit: Batch#: 117 � Claim Count: 1 Certification Date: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 y Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.*# 05740/01 PAGE 1 ST. CROIX COUNTY REPORT DATE* 5/30/91 COURTHOUSE DATE RECEIVED*# 5/29/91 HUDSON, ICI 54016 ATTN: THOMAS C. NELSON v �t o 76 *# Randy Hoh ler S-- . Z / �-7 LOCATION*# 486 Bluebird Dr., Hudson COLLECTOR*# M. Jenkins SOURCE OF SAMPLE*# Outside faucet COLIFORM*# 0 /100 ml INTERPRETATION*# Bacteriologically SAFE NITRATE-N*# < i ppm Dove 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIAN*# Pam Gane uI Approved Lab No. 19 Ov%,AVEPENOEH � T, O A u s a < Means "LESS THAN" Detectable Level Approved by'* o PROFESSIONAL LABORATORY SERVICES SINCE 1952 i �t ST. CROIX COUNTY ZONING OFFICE 911 4th Street J� Hudson, WI 54016 Telephone - (7-15)386-4680 X" The St. Croix Co. Zoning Office offers the service of septic and 6$/ -"L�Water inspection to Lending Institution, Realty Firms , and private individuals. COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN BE LOCATED. Please provide the following information, enclose appropriate fee made payable to ST. CROIX CO. ZONING, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING--------------------------------FEE:$ 25.00_ (For nitrates and coliform bacteria) WATER TESTING--------------------------------FEE:$175.00 (VOC'S) SEPTIC SYSTEM INSPECTION---------------------FEE:$ 25.00�� PROPERTY OWNERS NAME: y�' PROPERTY OWNERS ADDRESS: Yq-L< Ott.&6,:.n Rr CITY: 1L(.>a;r1� Legal Description 1/4, 1/4 , Sec. , T N-R W, Town of Lot No. ,Subdivision FIRE NO. 41q-e</ LOCK BOX NO. Color of housejaiu _ Realty sign? 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. tAV c LA,i- Firm or individual requesting services: &� inpnrcif)L &AK Telephone No. REPORT TO BE SENT TO: CLOSING DATE: ' Signature: "O"z'� A , 4�- k ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST.CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 (715)386-4680 May 30, 1991 First Financial Bank/Eau Claire 1305 Main St. Stevens Point, WI 54481 Dear Sir: An inspection of the septic system on the property of Randy Hohler, located at 486 Blue Bird Dr. , Hudson, WI was conducted on May 28, 1991. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis . Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or 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. Si cerely, P M n in Assistant Zoning Administrator cj • -COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.: 24493/01 PAGE 1 ST. CROIX COUNTY REPORT DATE; 6/22/92 COURTHOUSE DATE RECEIVED: 6/18/92 HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER: (R:andy:Hohter LOCATION: 486 Bluebird Dr., Houlton COLLECTOR: M. Jenkins DATE COLLECTED: 6-17-92 TIME COLLECTED: 10:30am SOURCE OF SAMPLE: Outside faucet DATE ANALYZED:6-18-92 TIME ANALYZED:2 00pm COLIFORM: 0 /100 ml INTERPRETATION± Bacteriologically SAFE NITRATE-N: t i ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L I LAB TECHNICIAN: Pam bane F.\NDEPENpE, WI Approved Lab No. 19 t Means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 4r 1 19 ST. CROIX COUNTY ZONING OFFICE - -., St. Croix,'County Courthouse 91104th Street Hudson, WI 54016 �( elephone - (715)386-4680 e St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail , along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING-----------------------------FEE: $ 35.00 X (For nitrates 7 . 2 coliform bacteria) WATER TESTING _ FEE: $185.00 (For VOC°S) SEPTIC SYSTEM INSPE -oN-----------------FEE: $25.00 (Determines ;` tem is properly functioning at time of inspection; PROPERTY OWNER'S NFi' })o\A'otJ S: g So : �.►� C"adY °+M , CITY PROP. ADDRESS: Legal Description ,_1/4 of the 14 of Section e5 Town of .,s!t I3ur - bdlV`xsi: . 7lfG -7 FIRE NUMBER '�`Z �° _ LUCK BOX NUMBER 070— l o 7p-o66 Color of house Realty sign by house? eA If so, list firm: j � 'c, P ECLUD IF-. Z POSSIBL��, A NAP,i.e,COPY OF PLAT BOOK, C WITH LOCATION SHOWN AND A COPY OF THE LISTING SHEET. ' Testing of residen*_ .y water requires a sample that is fresh. If the home is vacant, -nd has been so for some time, the water line must be purged by r,_nning the water for several hours before the test can be conducted. WINTER TESTIN T any times water lines are turned off, or sill cocks are tutr _ = , making access to the home necessary. If this is the = please make proper arrangements with this office to enc _::° °-1--e when entry may be gained. Firm or ind- - : requesting services: - Telephone N 9 Li � _- REPORT TO CLOSING Liar: O; 1�0t U" ST. CROIX COUNTY WISCONSIN ZONING OFFICE x., _. ST.CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 -- (715)386-4680 June 17, 1992 Coldwell Banker Don Sukowatey Realty, Inc. 126 Second Street Hudson, WI 54016 Dear Mr. Sukowatey: I An inspection of the septic system on the property of Randy Hohler located at 486 Blue Bird Dr. , Holton, WI was conducted on June 16, 1992 . 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 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. S'ncerely �� enkins Assistant Zoning Administrator js Ir , Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP J-`, SEC. T---""9 N-R�W ADDRESS ,Ce ST. CROIX COUNTY, WISCONSIN r SUBDIVISION CJ (l �� �yl/ LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of II,HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t , / I I �D i INDICATE NORTH ARROW I S'(�-� �1' Co�✓tCr i10n f�t (�n� � BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: �dU Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Opacity: /2 vo Number of rings used: Tank manhole cover levatio�n�: Tank Inlet Elevation: " Tank Outlet EIevatio Number of feet from nearest Road: Front 10 Side 10 Rear, O ��� feet From nearest property line Front,O Side,tO Rear,® feet Number of feet from: well �}b , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) :WZ RFVF.RSF. UDE 1 , f 1 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,O Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench:Z T /- 410 Width: Leng�th.rZ - 7Z Number of Lines: Z Area Built: 4 6 6 Fill depth to top of pipe: -1/Z // Number of feet from nearest property line: Front, n Side, O Rear,0 Ft . Number of feet from well: Number of feet from building: 02� (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, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspectors Dated: �'~- I I - t. Plumber on job: License Number: /1�'�IPs .32 Z�/ 84:m 3/ '� DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.-BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 NE4, .NV-4, S5,T29N—R19W KXCONVENTIONAL 1:1 ALTERNATIVE State Plan I.D.Number: Jgwn of"St. Joseph ❑Holding Tank ❑ In-Ground Pressure ❑Mound (if assigned) Bluebird Road NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DA E: Randy Hohler Route 2, Hudson, WI 54016 Is—) )_W 3° BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV. CST REF.PT.ELEV.. IN,m,,l Plumber: MjRSW Nu.. County. Sanitary Permit Number: Roger Timm 224 St. Croix 106066 SEPTIC TANK/HOLDING TANK: MANUFACTURER. 500 CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED PROVIDED .YES ❑NO ❑YES NO BEDDING: VENT DIA.. VENT MATI HIGH W NUMBER OF ROAD. PROPERTY WELL. BUILDING: JVENTTOFRESH ALARM LINE AIR INLET: n ��pI�� FEET FROMr.._ 4 � ❑YES E%qo C-L. DYES �YVO NEAREST "I DOSING CHAMBER: MANUFACTURER BEDDING. JLIOUIDCAPACITY PUMP MODEL JPUMP SIPHON MANUI ACTUREFI WARNING LABEL LOCKING COVER PROVI O. PROVIDED'. EYES ❑NO ` ❑Y ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPEHT WE L I'NILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) 1:1 YES ❑NO NEAREST' 40 N SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing t E N(-1 it DAME TE H 1AT IAL AND AHKwG 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 DISTH PIPE SPACI N(� COVE INSIDC OIA -PITS LIQUID BED/TRENCH t THEN f ��I MATERIAL* PIT DEPTH: DIMENSIONS G. GRAVEL DEPTH FILL DEPTH UIST R.PIPE DISTH PIPE DISTR.PIPE MATERIAL NO Dl� 7 NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER EI EV.INLE I ELEV.END ~� PIPES LINE AIR I LET'. FEEI NEARES°--- f Ion + 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- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER ITEXTURE PERMANENT MARKERS 013SEF VATTON WELLS _ 1:71 YES 1:1 NO _❑YES 1:1 NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED D TOPSOIL SODDFO SEEDED MULCHED CENTER EDGES 1-1 YES. ❑NO ❑YES ❑NO DYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH - WIDTH LENGTH NO OOF ES LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO D U1ST ISTH R.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEVATIQ ELEV.'. ELEV. DIA. ELEV. PIPES DIA N ANQ. tiSTRIBUTIDN HOLE SIZE HOLE SPACING DRILLED CORRECT Lv COVER MATENIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION,. PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER DF PROPERTY WELL: BUILDING. l) / FEET FROM LINE C I/2 1 ,�, ❑ pS, ❑NO ❑YES NO NEA# ES / Or s � � s o Cb 01 io2 Sketch System on 1.- S•� Retain in county file for audit. Reverse Side. SIGNATURE. TITLE: Zoning Administrator DILHR SBD 6710(R.01/82) SANITARY PERMIT APPLICATION COUN (�t DILHR In accord with ILHR 83.05 Wis.Adm.Code 'cRa/ X STATE SANITARY PERMIT# ��Co 0& =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 O PROP TY OW ER PROPERTY LOCATION Lr / /Z#,!�'/4 VL'/4, S 5 T Z , N, R PROEERTY OWf R'S MAILING ADDRESS LOT NUMBER I BLOCK NUMBER SUBDIVISION NAME 2 Z ' 1AI CITY TAT ZIP CODE PHONE NUMBER 0 CITY NEAREST ROAD,LAKE OR LANDMARK .VILLAGE : e „' It TOWN QF- 11. TYPE OF BUILDING OR USE SERVED: - G3U-/Ol`� 0-006' Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a.;9 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. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. Conventional 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. ❑ Seepage Bed b. 21 Seepage Trench c. ❑ See age 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): �j , Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons I Total #of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank ❑ El 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's Name(Print): Plumber's Signature:(No Sumps) MP/_MPRSW No.: Business Phone Number: /i'fi rye 3 2Z 15 772 Plumber's Address(Street,City,State,Zip Code): Name of D r: / z Vlll. SOIL TEST INFORMATION Certified Soil Tester(CST ame CST# �� CST's A RESS Street,City,State,Zip Code) e Phone Number: 47 .�e r6 1/,6 _?&, 4,'�) IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved I S nitary Permit Fee Groundwater Date Issuing Agent Signature(No S ps) Approved ❑ Owner Given Initial charge Fee [� / �,�//� Adverse Determination /20,&0 . / / f W�lC.�/'l X. COMMENTS/REASONS FOR DISAPPROVAL: T�co_l aw\61" bl� mn 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 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: I. Prcperty owner's name and mailing address. Provide the legal description where the system is to be installed; 11. 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; III. 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 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 in`S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasur @' ° is used in your building is returned to the groundwater through your soil absorption a 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) 1 APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the .property being developed. Any inadequacies will. only result in delays of the permit issuance. Should this development be intended for resale by owner/contractq-C, ("spec house") , then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property � l Location of Property _�' '-L Pc.�. 14, Section , T N - R W r Township Mailing Address 62�� Z. Z4 t/--j Subdivision Name ( Lot Number Z � I Previous Owner of Property Total Size of Parcel Date Parcel was Created zL2 Are all corners and lot lines identifiable? _ Yes No Is this property being developed for resale (spec house) ? Yes >< No volume and Page Number 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 I (we) eeAti6y that a.i;Y statements on this 6o4m a4e t4ue to the beat o6 my (oun) knowyedge; that 1 (we) am (a4e) the owne4(s) o6 the p4openty des cA ibed in this injo4mati.on 6o4m, by viAtue o6 a waAAanty deed teco&ded in the 066ice o6 the County Regis#te.4 o6 Deeds as Document No. (U and that 1 (we) pnesentty own the p4opo,ler+ nite bon the sewage dispo4 ay,,; I (on I (we) have. obtained an easement, to sun wLth the above dedenibed pupeAty, 6o4 the const4uct i.o n o f said system, a ad the same has been duty 4eco4ded in the O j 6.ice o6 the County Re9i6te4 o6 Deeds, as Document No. 1 • SIGNATURE OP OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) C. DATE SIGNED DATE SIGNED jj DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA 11 WARRANTY DEED 43606 I I. 000x== —�.aE 304- REGISTER'S OFFICE I� Dean K. Lindstrom and I ST. CROIX CO., WI 11 This Deed, made between .......................................................... R @C'c� far Record 1 Linda C. Lindstrom, husband and wife -- ----- ------ ---------+ .••• - -----------------------•---- ..............................................., Grantor, APR 8 1988 and_._•Randy L, Kohler and Cinda Hohler, husband and wife•, I qt ©i �1Jr /�M I survivorship marital property ••-•- ......... .... -•• V i •---•---•----••------•-••••-- ,! ......._----• -•--•.................••--•--•--------._..........•--------•--•-•----....-•------_., Grantee, Register of Deeds Witnesseth, That the said Grantor, for a valuable consideration_...__ I ••..................................•--------...------•----•--.._..----•--•----•--•-•--••--•-••-•-------_..._:._. St CYOiX•••-•_--•• RETURN TO II conveys to.Grantee the following described real estate in ......:............ _.___ ; County, State of Wisconsin: 4 Part of Northeast Quarter of Northeast Quarter of Section I 5, Township 29 North, Range 19 West, St. Croix County, Tax Parcel No_ ___________________________________ " i Wisconsin described as follows: Lot 2 of Certified f Survey Map filed May 23, 1980 in Vol. 4, page 949, Document Number 364370. IF FIB L I +i This .....is-sot........... homestead property. (A� (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And....Dean K. Lindstrom and Linda C. Lindstrom, husband and wife • ........................ ............................ ....... ........•• -. ....._......---•---• - --•- --•---._....._..._._..._._........ JJ� warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants and restrictions of record, if any, and will warrant and defend the same. Dated this .......... day day of April_____•________-•-•............................... 1958.._. .....-•••----....••----••••---•-- ••••----•- r ( j' ---------------(SEAL) sz osu�-/ a (SEAL) l; Dean K. Lindstrom " ......................... ......... �___.(SEAL) (SEAL) f ............................................................. _•-_ Linda C. Lindstrom i AUTHENTICATION ACKNOWLEDGMENT Signatures) ------------------------------------------------------------ STATE OF WISCONSIN 1 -SZ,__•Cro�.x...................County. ^'f authenticated this ........day of-------------------------- 19------ Personally came before me this ._..._.... day of April 1988T the�abova named ..... - ---- Dean K. LLntisom and --- -------------- -• ----- * Linda C h >�i�dstroln .� •- TITLE: MEMBER STATE BAR OF WISCONSIN � °- �� (If not, ---------•-------------••----------------------------------- ...................................... �y ` •--:.. _..._..t �•� authorized by § 706.06, Wis. Stats.) to me known to be the persoxlr; , :,.�who @xecuted the;-IL I !� foregoing instrumen n(} ck'no e d thCiame. r' ` THIS INSTRUMENT WAS DRAFTED BY I L I HEYWOOD, CARI & MURRAY p.0. Sox . ...._---by Samuel ---------- *..------ •-• ...__._. r : ---_. • _.... . - - - Hudson,..h-1........5D1b......................................... Notar y P blic ------• ----- -- •--'�-=---•--.Courit� QPVI§ (Signatures may be authenticated or acknowledged. Both My,_ Conm 'ssion permanen '(If not,,,§tote'(exp`, '. are not necessary) date -- ----------- •- , 19 b, t *Names of persons signing in any capacity should be typed or printed below their signatures. Wlxconsin Legal WARRANTY DEED STATE BAR OF WISCONSIN Plank Co. Inc FORM No. 1-1982 Milwaukee, Wis. U) ' H y r STC - 105 r" - Y H SEP'T'IC TANK MAINTENANCE AGREEMENT o St . Croix County o y OWNER/BUYER ROUTE/BOX NUMBER Dire Number _ _ __ C 1 TY/ S'f A'I'T's____&G1_ �'1.--_._. _.-------__-_. _ 1 i PROPERTY LUCATIoN : &'a, la, Section ___5 P z N , R_ Town of f� e,� �, St . Croix County , C, B( `� ifs Lot number 2- Subdivision -<: �, �_� 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 punter . 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 maw+ be eligible to receive a grunt 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-bite 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 H three year expiration . o G I/WE, the undersigned , have read the above requirements and agree U, to maintain the private sewage disposal system in accordance with H the standards set forth , herein, as set by the_ Wisconsin Depart- ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoi Of'f:Lge ithin 30 days of the three year expiration date . t 4,0" S I G N E D DATE St . C :'oix County Zoning 'Office P .O. 4 iox 94, llammo'�d , WI 54015 715-7 6-2239 or 715-425-8363 Sign , date and return to above address . INDUSTRY, OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUS DIVISION LA AND PERCOLATION TESTS (115) MADISON WI 53707 9.HUMAN MA (N63.090 Chapter 145.046) f7N SHIP UNICIPALITY: OT NO. NO.: SUBDIVISION�+IAME:E t f % 5 /Tz9 N/�q 40,M ,. sE1�N Z — CSI+ - 0 4 94`� COUNTY: C�)X 6144 MNAY lj/2 Ikil� 1k+Vti �SuN USE DATES ODSERVATIONS MADE)IJ, esidence =`_ New ORaplaca � [AVIL 6 /9,A�8 � fie►+_7 i 9f$IQ So>r_s- -Sig RATING:S-Sib suitable for system U-She uewsitabM for syabm 1CQn%WFT611"AL* U D: L OLDI TANK:RECOMMENDED SYSTEMaoptional) S EIV S QV S IIV S [IV OS ®11 C 6nrnoti�i T&NcNEs If Percolation.Tests are NOT required EST RATE: If any portion of the tested area is in the under s.1-163.09(5)(b),indica-I. "dSS t Floodplain,indicate Floodplain elevation: NA PROFILE DESCRIPTIONS BORING AL NUMBER ELEVATION V A H 'CHARACTIER OF SOIL WITH THICKNESS.COO TEXTURE,AND DEPTH TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) >-a.7 a- bkNE *>8.5 " f.t-TS C& "RA s-i(%x A' C Igo ms s- 4 a-0 lad.3 2.0 '44 St 4 e& /p3+ 68 0 7'• '8�u1 "e G �,"$MGRS B. 6 f b d/,9 ffi 4 8"&L i3' l )- SL 29" CAS S PERCOLATION TESTS NUMMER D AFTERSWELLIN INTERVAL-MIN. APER INCH p- � o�•� 3 y� > t P- 1 <3 _P- ,d �, > P- P_ NT P. 'LOT PLAN: Show locations of percolation tests, soil borings and the dimensions f suitable soil areas. indicate scale or distances. Describe what are the hori• untal and vertical elevation tieference points and show their location on the pi on.BShow the surface elevation at all borings and the direction and percent 4 land slope, YSTEM ELEVATION 4`1.7 • I I 1 t 4 i f pTi ? IL i r , i _ 3 _ , pT LON te the undersigned,hereby certify that the soil tests reported on this form were made by me in acco►d with t�fte8!procedures and methods to me s apse ied in the Wisconsin dministrative Code,and that the data recorded and the location of the tats are correct to the bat of my knowledge and belief. z (print 14kVf_y 1. ` TESTS LE TED ON: i CERTI ICATIO NUMBER: PHONE NUMBER(optional : �.aCct Ali '�- l�� N 1�✓� Sqo 4 8 Ns6-4orso 8>�6 E ISTRIBUTION:Original and one copy to Local Authority.Property Owner and Snit Tester. i Timm JOBS SHEET NO. _ OF • Excavating Co. CALCULATED BY 4¢' im � DATE_ _. R 1, BOX 192, Wilson, WI 6 027 CHECKED BY- _ __ DAIF-•<=-/� '� SCALE------ .�151�9cv ►"�� llJ�l�� b���IG , �enc hes T/-5 x55 Tz — 5 77 8 M 7.._ o lZ !",ran i SI.J pyD� i i M t. lot' Jewk41 , 30 M, 0141 JOB Timm Gc«C7 U zed Lr�G�✓' ' SHEET NO. ',7 OF 7i 1 Excavating CO• CALCULATED BY `v 4— DATE _ t R 1, BOX 192, Wil6on, WI 6027 CHECKED BY - SCALE I ol�'I ,6 fi 'Y I,h b Sky ,r , tra r:!:ac,CWM,.M,m L411