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HomeMy WebLinkAbout040-1036-70-110 � \ § j 2 w K c � I � \ ` ° / 0 / o k . � � b tee i ¢ % §/ C ƒ k/#k § Ee � § �$_// � � @$ 2 � kar $ z eee- » _£ 7 .2 o � E ) ED o 2 /f]/ _« z co R ;j § z i 2 /co . � � d 0 k K k / $ / / $ D z f e E 2 .� to 2 & % \ § ) z w k 2 £ / » g E @ & ƒ } © § m c : s � » c c _ CL 2 \ � .� � / a E IL � 2 � CL a a � k o B ' $ m e � � � / \ \ Cal; 6 2 . m a _ _ 2 . k j } J ƒ - a 7 U) c E k § \ 7c 82S \ . o / ® : 2 _ k i \ ) 7 \ , a q / « m A 7 F 2 0 3 § o 0 z _ £ k 2 \ % CL .0 � § M § ( / Q Q a o■ u) J§ Parcel #: 040-1036-70-110 02/07/2007 02:44 PM PAGE 1 OF 1 Alt.Parcel#: 8.28.19.118D 040-TOWN OF TROY Current X ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner JAMES P,&SOLIE O-SOLIE,JAMES P, & ROY HEATHER L C-ROY HEATHER L 443 RED BRICK RD HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): "=Primary Type Dist# Description *443 RED BRICK RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.187 Plat: N/A-NOT AVAILABLE SEC 8 T28N R19W 2.187 ACRES E1/2 NW1/4 Block/Condo Bldg: LOT 3 CSM 6/1653 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-28N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1089/404 WD 07/23/1997 823/422 07/21/1997 1252/248 WD 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.187 51,000 190,500 241,500 NO Totals for 2007: General Property 2.187 51,000 190,500 241,500 Woodland 0.000 0 0 Totals for 2006: General Property 2.187 51,000 190,500 241,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 124 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROIX COUNTY WISCONSIN -----_____'" ZONING OFFICE r r a r a a r a■ — ,,,■ap ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road �.;. - - Hudson, WI 54016-7710 (715) 386-4680 July 13 , 1994 Ms. Carrie Johnson Edina Realty 700 Second Street r 2 Hudson, Wisconsin 54016 RE: Water Results for Vinc Burkhart �(�d Address: 443 Red Brick d Hudson nsin Dear Ms. Johnson: Enclosed is the original test results from Commercial Testing Laboratory, Inc. for water inspection of the above property. If you have any questions with regard to said report, please do not hesitate in contacting me. S ' cer ly, J es Thompson Assistant Zoning Administrator mz Enclosure i COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O, Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 FAX - 715 962 - 4030 i ST. CROIX COUNTY ZONING OFFICE REPORT NO.' 65859/41 PAGE 1 ST.CROIX CTY GOV.CTR REPORT DATE: 7/11/94 1101 CARMICHAEL ROAD DATE RECEIVED'. 7/06/94 HUDSON, WI 54016 ATTN1 THOMAS C. NELSON i OWNER'. Vince Burkhart LOCATION*# 443 Red Brick Rd., Hudson, WIC.«' J COLLECTOR: Jim Thompson DATE COLLECTED17-5-94 TIME COLLECTED'#10130ata Co L� f SOURCE OF SAMPLE: Kitchen Faucet DATE ANALYZED'#7-06-94 TIME ANALYZED142100 pm COLIFORM,MFCC: 0 /104 mi INTERPRETATION'# Bacteriologically SAFE NITRATE-N: 9 ppm Above 10 ppm exceeds the recommended Public } Drinking Water Standard. Coliform Bacteria/100 mt_ Nitrate—Nitrogen, mg/L I LAB TECHNICIAN! Pam Gane `yDE.\NDEGENDEHr` WI Approved Lab No. 19 g g < Means "LESS THAN" Detectable Level Approved by: i A O PROFESSIONAL LABORATORY SERVICES SINCE 1952 C� ST. CROIX COUNTY ' ^•� WISCONSIN ZONING OFFICE W �h I I M Y I N q■ rn�i ST. CROIX COUNTY GOVERNMENT CENTER �^.. 1101 Carmichael Road �y �• _._ '---- Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. 0 Water (VOC's) $185 . 00 X Septic $50. 00 "54 Water (Nitrate & Bacteria) 45. 00 ❑ Nitrate & Bacteria retest $15 . 00 Owner: I�' -� .u,� Requested by: Address: 3 (/ A 4 Address• '"G' ' / ZIP 5 a 72/ ZIP � ro�� Telephone N°: Telephone NO: ( Property address (Fire NO & Street) Location: L/ �, Sec. T_, N, R_Z_�_W, Town of Realty firm: &"Lo_ Lock Box Combo: CATS Closing Date: TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Water sample tap location: ki+c� avN ALLsr.- I". Is the dwelling currently occupied? X1 Yes 0 No If vacant, date last occupied: N/A Age of septic system: 5� years Septic tank last pumped by: 7- 1 Gl. y S,*.►*, to►n Date:1;2 C),t 93 Previous Owner's Name(s) : N/A Have any of the following been observed? ❑Y MN Slow drainage from house. OY U1 Sewage Back-up into dwelling. ❑Y UN Sewage discharge to ground surface or road ditch. OY 33N Foul odors. Other comments relative to system operation: I certify that the above information is complete an rue to the best of my knowledge. OWNERS SIGNATURE: '� TE: 30 Jun 94 1/9 4 a.v- �o co"+I c3 u C ` y 4 � U)-eo PJ OWNERS DRAWING OF HOUSE & S.EPTIC SYS LO ATION 1 N f 10 O TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? OYes ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system: OBelow grd OAt-Grd OMound Approx. size ' }X OGravity ODose OPressurized Ft. 2 OBed OTrench ODry Well Molding Tank OOutfall pipe OBSERVED DEFICIENCIES OOther OUnknown Septic tank Setbacks: ❑House &9, OWe1l OProp. line 0!< OOther S Do ank t cs: OHouse OWell OProp. line 00ther - Oking cover OWarning label OPump/Floats OAlarm OElec. wiring Soil Absorption System Setbacks: Wouse OWelloKoProp. line OOther OPonding: ODischarge: General_ comments: INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title _i t � � � �, Mari , 12�.�.0 � � — �a a��986 CERTIFIED SURVEY MAP (� GLEN WIESE Al Part of the Northeast 1/4 of the Northwest 1/4 and the Southeast 1/4 of the o west 1/4 of Segtion ,8, Township. 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin.' ' 0 Indicates 1" x 24" iron pipe weighing 1.13 lbs./lin. ft. se E�LA�ff � �PPp®\� t =�A� __C1 tOWN ROAD 1� v. \ N E , C n R�/ABLE WfDT H1S 114 Lf fa 567.23 L� Trr=�N / gp0. 09�52n 3 8 338700, " N P-`A—�� _ ��/� 00 3 commHE ,,,N,►TG O" O I " N y T28N. Rj9W, �,. / y(� 3 m a N 114 COY SURVEYORS h,oN•! / ^O" 1D N 4411/ /�y !� Q ti ? h J ki N . fCOU ry b 4 y 0 0 r'0 h� 0 N 0•b • 2 ` O . y 00 41 r0 rNE N/S I/4 " 0 Mh 00,001, a Q�Q ALL BEARI X68 RT 28 N,S i-9 W./ h 2 °� 3B� 4'9�4 i1j. ?� 2 LINE F AS NOO•p9 RECUR — --- I -r^• Q / 4y y N C.) Dated• 0 August 19 m / W CV 0 ti �� to ? /� 9 O 0• O N ° ?�• 0� \ O � 00,. J'a aIR 9 P�R J a Oy 0 . Y V y O O' b Q0 "� p ^" Q 14 o •fop 04 O� � 0. . " 00 °O'pp, 4 A? e / !y ha� J �\S N S Sgi •9g� �I a _ ` • , do LAURE / ^� ? �• m W Y 2 A, 71 e �N 4EF ALLS,; J� • 9 V �D LAND 0 / Laurence W. Murphy 420 p0, _-X - Registered Land Surveyor / --x,_20 „E aas.74 Vol. 6 Page 1653 3s.7 �J N p0 P A rrE �a Nf Certified. Croixx County, Wisconsin St sconsin u SHEET / Ole 2 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER L In t � �r n T TOWNSHIP QS SEC. T N-R f� ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISIONP_e&b�- L-mi LOT 3 LOT SIZE c. PLAN VIEW fd Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM,"', �w ,t Lv <j li r /o00 A5\1 I O1 INDICATE NORTH ARROW M BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: ;" � , I° ' ±C'. . . ^Liquid Capacity: Number of rings used: K Tank manhole cover elevation: ,' �'r Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road.: Front,GrSide,O Rear, O ,;2 /Z P�' e° d r � From nearest- property line . , Front 10 Side,ORear,O 1 feet Number of feet from: wel , building: tM1 _ '_ i ) L' (Include this information of the above plot plan)( 2 reference d mensions to septic tank) SEE REVERSE_SIDE f t 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: � . _ + t Alarm Manufacturer: Alarm Switch Type: J �- AA�� - JI Number of feet from nearest property line: Frdht RO V, R�r 10 Ft. :20Y y 12. �► Number of feet from well: Number of feet from building: / (Include distances on plot plan). f SOIL ABSORPTION SYSTEM Bed: Trench: Width: _L Length: d Number of Lines:��, Area Built: 3 Fill depth to top of pipe: z Number of feet from nearest property line: Front, a4ide, 0 Rear,O It �OQ Number of feet from"well: ' ;s. Number of feet from building: / - (Include distances on plot plan): SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: I Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). ' S HOLDING TANK g` 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, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• Dated: Plumber on job: Q License Number: ✓ k'r 3/84:mj , J n ��u� K�narrt" p\a►�1��r q3� C,8 0. WLLyne, �cr er)`z, ,e _(�)n `e-e-0 , 11 s E /V^W 0-iV/K rq UJ � y 9 1 ,& a I I o, v 04A ZA- ell _L, DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION DISO P.O.BOX VI 53707 BUREAU OF PLUMBING M.Aa� N 4VI S �,kW,14,S8,T28N-R19W XX CONVENTIONAL 1:1 ALTERNATIVE IState Plan I.D.Number (lf assigned) Town o6 Tnoy ❑Holding Tank ❑ In-Ground Pressure ❑Mound Lot 3 Red 8tc,%ch. Addition NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Vince BuAkh,aftt 443 Red Bxick Road, Hudson, W1 54016 ? ;F BENCH MARK(Pe(manent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber. IMP/MPRSW No County Sanitary Permit Number Wayne Lonenz 934 CAoix 112815 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO ❑YES ONO BEDDING: VENT DIA.. VENT MATT HIGH WATER NUMBER OF ROAD. PR OPERTV WELL: BUILDING. VENT TO FRESH ALARM FEET FROM LINE. AIR INLET'. DYES ONO ❑YES ONO NEAREST DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY FUMY MODEL 71IN MANUI ACTIIHFH WARNING LABEL F COVER PROVIDED: D: OYES ONO DYES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER.( PROPERTY IWELL VENT TO FRESH (DIFFERENCE BETWEEN FEET FRfO LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST t- SOILABSORPTIONSYSTEM.Check the soil moisture at the depth of plowing I IENIJH I TI It JIIATI HIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORGE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH NO OF DISTH PIPE SPnE,IN(i COVER INSIDE OIA SPITS DEPTH BED/TR'ENCIi' TRENCHES COVER DEPTH DIMENSIONS GRAVEL R DEPTH FILL DEPTH I)S I TIt PIP E UIS7H PIPE DISTR.PIPE MATERIAL NO DISTH NUMBER OF I'.PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER El EV.INLE T ELEV.END PIPES FEET FROM LINE. AIR INLET. 1 _ NEAREST- R--1r 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 TEXTURE PEHNIANI NT MAHKERS IIIIISIIIVATIIINVIIILS _ DYES ❑NO OYES NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED DEPTH O )D F TOPSOIL $OIf I) SEE UFU JIVULCHED CENTER EDGES DYES. ONO DYES ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRNCFI WIDTH LENGTH THE NCHES LATERAL SPACING GRAVEL DEPTH HE LOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS j�� ?.MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTH DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEVATION AN(}ELEV. ELEV, DIA. ELEV. PIPES DIA.'. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHRECT LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES 1:1 NO 1:1 YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF - PROPERTY WELL: BUILDING: — FEET FROM LINE: .3 ❑YES ❑NO ❑YES ❑NO NEAREST ID Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. DILHR SBD 6710 (R.01/82) Zoning Admini6 tratot 77 DILH SANITARY PERMIT APPLICATION COUNT.,C f�� In accord with ILHR 83.05,Wis.Adm.Code :5 STATE SANITARY PERMIT 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 Side. -See reverse side foIr instructions for completing this application. PETITION 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES 54 NO PROPERTY OWNER PROPERTY LOCATION In % ' S 91 Tam, N, R::*1q E (or PFOPERTY OW R'S AI NG AD RES LOT NUMBER BLOCK NUMBER SUBD VISION NAME CITY,STATE ZIP CODE PHONE NUMBER NEAREST ROAD,LAKE OR L DMARK II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. USJ 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. I�1 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. R9 Seepage Trench c. ❑Seepage 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): / -Sr ���_ Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concre Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank O ` ❑ 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(Pri t): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: /. er s Ad ress eet,Ci Zip Code): Name of Designer: / P e- C� III. SOIL TEST INFORMATIO ertif' d Soil Tester(C e CST## a- 0 2__ T. AD RE S(Street,City,411atey3ip Code) r Phone Number: e 1 - G IX. COUNTY/DEPARTMENT US ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial urcharge Fee rn Adverse Determination cc '� X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Pib-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION F 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. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. 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 81/2 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 lrfl can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure'. 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. c 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) r APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owners) 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 L)i h c e- ' " B L4 Location of property S, E . 1/4 �, U),_1/9, Section _, T_c�N-RaL19W Township pip Mailing address / `� R•-�J l r t d—\ U Address of site - rr,-r �' iavli,� �•#rsYv' U Subdivision name�� e�� �r i C K tl miGC ►� 10 r) Lot number Previous owner of property ilkkl Total size of parcel �' �.�r�S• Date parcel was created Are all corners and lot lines identifiable? _ Yes No Is this property being developed for resale (spec house)? Yes x 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 references to a Certified Survey Map, the Certified Survey Map shall also be required. ------------------------------------------------------------------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a ranty deed recorded in the Office of the County Register of Deeds as Document No. • ; and that I (We) presently own the proposed site for the sew a disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. ) . Signature of Owner Signature f Co-Owner (If Applicable) 1J . 1 194L 1"tj /�' lqg�I- Date bf Siq ature Date o Signa ure �ylK;'�� -Flltl}i' �. ...,. ..................... ............................................ I ` ... a.. 1�1 $ .. .. b?' .J!................rk ` �!► �: d' ip ................. ..... That tie said tiraator.�s valoabM�...... +�0."......................,.............................................. 1 ttarutw To �— w _Iris dohavaias described real estate in ...s3. t...C ......... i. Tat Parcel Me:...... '. tr of ,Eh of NWN of Section 8, T28N, R19W, St. Croix County, ~�l.iskiOisin, described as follows: Lot 3, Certified Survey Map filed May 21, 1986, in Vol. 6, Page 1653, Doc. No. 412110. VIL 4' i } i T sa r w. 1 a Thin __...... ...... hosaeaad peeperty. (is) tie not) TeveMer wM 90 and Moir tie hereditasenb and appurtenances thereunto belonging; Ql n'M.-Wiese. ---.... . ---... ....... And ......... .9 ._....... ......_ . . .. wavanee that tie title a pod,intMf"w" in fee supple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any,: '. MA will warrant and ddead tw wee dr.P.,iG September 88 , 1Da0sti leis ._....................... day of ..... _. ..... ..... -... ..._ .. .. .... ...._ .. ...... 19......... Sri, ...... .. ............ ......(SEAL) / eti /}�, -..�•a$ .....(Sz") I . • ......................................................... Glen M. Wiese ..................................................... .(SEAL) _. --..(SEAL) ..t, ............................... .................... - . IAUTUNUTICATION AC=NOWLZVGKZMT p � (a) _._..S7J.'XA..Ma.. e---...--••----..._.---• STATE OF WISCONSIN , ......... .................................................••-••--...-- County. t , thisa"da9 ..................... a ...-.. of_..ai')?t............. 19.a 8 Personally came before me this ...........-....der r �.✓ . ................................ 19 the above naaseid' ...........................7Ie; ...t..� ----rr� ----------------- ................................. ............ <z S r Kri tiima...Rgl.and._iLurndeen...................... 1 " TMX:XZVBER STATE BAR OF WISCONSIN 1' .. . . .. (It not,................ ........... ..". ` X" anetiaod by 1706.06.Wis. State.) _ . .. _. . to me known to be the person ....:. ._ who execute�,)Ite foregoing instrument and acknowledge the saiue. f Shia tNeTRUMENT WAS DRAFT"6Y Eris fna Q►gland Lundeen .. . . .......... ... ..... _..... .. ........ a�" tt . ..._...-- --- -----------------------------------_- -----•- _.. . Notary Public CQi>sntp 2• Elfin Red. g„th My Commission is permanent.(if; not, tRate j � may be au ticated or acknowledged. 1rY•) a: dat • , ,. . �.y Itw�tiM siRular fa any q^weitr sbwtd be typed or printed Wow tMir si[nawre.. Ai STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County � ` r OWNER/BUYER U i n C QA. A6 U V /1 ROUTE/BOX NUMBER _ I J fJ FIRE NO. CITY/STATE .a1''d_JSC'/1 , W1 ZIP - ! "�f�1� PROPERTY LOCATION: Si E&1/4 N& V) , 1/4, Section Z_, TJ_N, Ra Iq W, Town of �(`p�/ , St. Croix County, Subdivision Reds J f' i A Ado ,\ro ll, Lot No. 3 Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. g P Y St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED` .v DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address III f DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INbUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON W 53707 HL4MAN, RELATIONS (H63.090)& Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ LOT I BLK.NO.: SUBDIVISION NAME: '/, / N/ ro e s r-t 'ck '+0'o COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: `rCrd; $tj r V USE DATES OBSERVATIONS MADE /j NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFI LE DESCRIPTIONS: PERCOLATION TESTS: 't ❑Residence %New ❑Replace , C- RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIO❑N�: MQND:❑� IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLD]NG TANK:RECOMMENDED SYSTEM:(optional) SS ®SS ( 1"S ❑U ❑S ❑S 14U Govje-a )"C' If Percolation Tests are NOT re wired DESIGN RA 4 If any portion of the tested area 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.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 9I31 B-7 6 15 it"s 1, {/ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH r P-. i 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 -I T_. j ._ _ 1 - 1 { 1 3 E T, tN E ' € i € € 3 3 ,.. .. _. _ ,.. _ .. 3 I E ' € i — - € E 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 W RE COMPLETED ON: LjGr\e_n7z_ ESS: CERTIFACAIPN NUMBER: PHONE NUMBER(optional): z G CST SIGNATURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) OVER — J 1 INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6395 � • 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 re1f3acernent 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; 0. PLEASE use the abbreviations shown here for vvriting profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scaly; is preferred. A separate sheet may he used it desired; 8. Make sure yo€sr benchmark and vertical elevation reference point are clearly shown,and are permanent; `1. 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 arad place your current address and your certification number; 12. Make legible, copses 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 Stolle (over 10") BR - Bedrock co}:, - Cobble (3- 10") SS -- Sandstone gr Gravel (Under 3") LS - LiMestone Xs - Sand H G W - High GiOLIndwater es Coarse Sand Perc Percolation: Rate rued c - Medium Sand W Well fs - Fine Sand Bldg - Building Is Loamy Sand .-. greater than xsl - Sandy Loam Less Than Loans far) _. Bro vn psi, - Silt Loam BI - Black - Silt Gy - Gray c> - Clay Loarn Y - Yellow sci - Sa:)dy Clay Loam R Red sicl -- Silty Clay Loam mot --- Mottles sr _ a;;dy Clay sic - SJly clay fff - frv+,, fjn' faint C ci"<y cc - corn non cearse Pt - 11e-at Imn Italany, rued mm err Muck d -- distinct. p -- prominent Hk&/L - High water level, Six general soil textures surface wa"ef for liquid waste disposal BM Bench Mark VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test it) the field prior to permit issuance. .A complete set of plans for the private sF gage syst:ern arT1 a permit application mast be submitted to the appropriate local autho,ity in order to San:t . «t�trarr a permit. Tlae aa�<�a�y perrrrit must be obtained and faosted pi for to the stark of any construction, ncepu KAnar-r P\ av-Ab-e.r 0- n e, eO : I ( s E new L.0 , ,9 a co 9 04A 1 i i a� G ,t p /