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HomeMy WebLinkAbout020-1021-10-100 (2) a o ° h � o IL o qb N N -p o 13 Z N a y N M N \\O� O C V' I 00 N r o 0 m O N L C V � 1 c z 3 o D Li c m o o m m Ry t O U I z n rn z i o z � I i 0 v N d m 1- z 25h /0� 0 Z .4 cn 5 P C � I (D �tj/pd N0 •N a N r 0 Y N U/YY� f Q zmz I w N G) CO ca c }}yy a a m Z y O d '. to U.) D O d Z .- > FN- H FN- cc EL N � 3 3 •N i, v a a a (L _ S; � oN N fA J C) } M N N .r O O co 0 V 0 E N .U.. m a N N I N C ly �. Cl 0 0 0 O� C I i O j N (O O QL 3i N N C V n- 00 0 00 C N H c m e N N 7 N c — N o Y n U) � 'v z w v 1 o ry x o C w E - • ' o 2 li rn o z �' 2 1c- U Q r L a 3 II c a rL Q u a 0 N U RECEtV j 2260 Wisconsin Department of ommerce OIL EVALUATION REPQ ORIGINAL page 1 of 2 DiviSi0n of Safety and Buil ings SEP 2 7j n ith Comm 85,Wis.Adm.Code A.C.E.Soil&Site Evaluations County Attach complete site an on psmrgtQ�ff&, in size. Plan must St. Croix include,but not limit to r te&IU81 (BM),direction and percent slope,scale o d distance to nearest road. Parcel I.D. 0A-1021-10-100 Please print all information. Rev'!we d Personal you provide may be used for secondary purposes(Privacy Law,S.15.04(1)(m)). , I-r Property Owner Property Location Bohlen Properties 2 LLC-Tom Bohlen Govt.Lot NW 1/4 NW 1/4 S 14 T 29 N R 19 W Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 300 Bates Ave. Suite 200 1 CSM Vol. 15, Pg.4194 City State Zip Code Phone Number J City J Village ..0 Town Nearest Road Saint Paul MN 1 55106 1 651-501-0000 Hudson 1 718 McCutcheon Road J New Construction Use: A Residential/Number of bedrooms Code derived design flow rate GPD e Replacement J Public or commercial-Describe: Parent material Glacial Outwash Flood plain elevation,if applicable na General comments and recommendations: Evaluation completed to determine maximum daily hydraulic loading rate of existing POWTS dispersal cell. See Memo page for details. Boring# J Boring W1 Pit Ground Surface elev. 98.00 ft. >96" in. Soil Application Rate Depth to limiting factor ppl' Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ttz in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 I *Eff#2 1 0-7 10yr3/3 none sil fill 2fgr dsh CS 2vf,fm na na 2 7-18 10yr3/2 none sil 2fsbk dsh cw 2vf,fm 0.6 0.8 3 18-41 10yr4/3 f2f 7.5yr4/6 sil 2msbk ds cw 2fm,1c 0.6 0.8 4 41-45 10yr4/4 none gr Is Osg dl cw 1vf 0.7 1.6 5 41-79 7.5yr4/6 none s Osg dl cw - 0.7 1.6 6 79-96 10yr4/6 none gr cos Osg dl - - 0.7 1.6 Redox.concentrations found in H#3 obsery ' n lowest 4"of horizon and are associated with greater matric potential of finer textured sil ing rectly over coarser gravely loamy sand. *Effluent#1 =BOD5>30<220 mg/L a d TSS>30< 50 mg/L "E nt#2=BOD5<30 mg/L and TSS<30 mg/L CST Name(Please Print) Signat e: CST Number James K.Thompson S.- 3602 Address A.C.E.Soil&Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane,Osceola,WI 54020 9/2/2011 715-248-7767 qv� G 0.(o d �� /S f''OGV )7• SOIL AND SITE EVALUATION 2260 Page L of 2 PROPERTY OWNER: Bohlen Properties 2 LLC-Tom Bohlen PARCEL I.D.# 020-1021-10-100 A.C.E.Soil&Site Evaluations REPORT MEMO NOTE: THIS EVALUAITON HAS BEEN COMPLETED FOR THE EXPRESS PURPOSE OF DETERMINING SOIL CONDITIONS AT THE EXISTING POWTS DISPERSAL CELL INFILTRATIVE SURFACE. THIS EVALUATION DID NOT INVOLVE ANY ASSESSMENT OF THE EXISTING POWTS DISPERSAL CELL OR ANY OTHER SYSTEM COMPONENTS. ACCORDINGLY, THIS REPORT MAKES NO WARRANTIES AS TO THE CONDITION OR FUNCTIONALITY OF THE SYSTEM OR ANY OF IT'S COMPONENTS. The existing POWTS dispersal cell elevation = 95.50'. The soil profile at this elevation consists of moderate silt loam with a soil application rate of 0.6 gpd/sq.ft. A soil application rate of 0.7 gpd/sq.ft. is located at an elevation of 94.58'. The existing dispersal cell was installed at 18'x 36'comprising 648 sq.ft. of absorption area. 648 sq.ft. with a soil application rate of 0.6 gpd/sq.ft. will accomodate 388.80 gallons per day flow rate or any equivalent of 5.18 household residents. 3 0 d o t7 n T rn N 0. 7 7 � n :3 �jo o ° O D o o � f o O `� 3 O I � co) O C til !r. I!II o D `�y C I � °p I O I -4 N A ? m N < OD Z A II I ! Z i II a m I � N V N O ti A w JI W N N n co O 3 m n d I o � c � o > > p 3 •+ 1 N O N Nn O O O O C A • 3 3 3 C '► (T X Q N (D = (� tD O y P O O j v C = N N = y J N ! j N N N N N O. D) N 0 q( S --1 jo O O O p = fD _D �_ O (D O O O K 7 y O C O 91 A j (D (O N ID y C \ O W p N 3 A A (D O w `X w y W -J Q K C CL CO)+ O O O o l�l. I CA ai N � p D ` IQ v m G m r. chi am rc I m (D N D m o O Q = o H. (p c N y —1 fD p< C N N 3 N (D w m c6 --I N o' A Z 0 (D Q A (D Q _ w Z W M I * A co v C Z a R A 0 3 y Z CD A N <a N_ <0 Or CO O'< y.M'o CO O D w Q3 Sm cD z'v'w°o a ? m a) o d - D) =•3 3 N(D =(n 7 -1 (D Co O y O Q .O _ N v s3 =Qw0 Q� Z a dX ^O^N N (QD C_7•�AfD O NNpC. - 1 :1, (DN (pB A 3 � SfD y d y'QSQ-p w CDC< in CO �-O Q = _x y y m 9 3 0 (D (R y D)-O 0 Q a' .o p 3 ,,.'p C C (D o O vC (D c f Q p 0 = a OD 3-o - � D� Dix = ; o3mvfDi N O NO!n1-N C K7 �'i o• cn3 y mac -3p_(3 N y CD I N ;a CL 2 OO Dpi j'CO 7 N oo CD —O (D QMU3 S r.Q N CD 5 cx o NSC pO y O co co Q N A ti V A 0 N W I � 0 ti W i � ' Parcel #: 020-1021-10-100 06/29/2005 10:38 AM PAGE 1 OF 1 Alt. Parcel M 14.29.19.96B-10 020-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 *SCANLON, MICHAEL J 718 MCCUTCHEON RD HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *718 MCCUTCHEON RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.190 Plat: 1376-CSM 15/4194 020/01 SEC 14 T29N R19W PT NW NW BEING CSM Block/Condo Bldg: LOT 01 15/4194 LOT 1 2.190AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-29N-19W NW NW Notes: Parcel History: Date Doc# Vol/Page Type 02/23/2004 754814 2513/521 QC 10/02/2003 742150 2425/543 WD 09/28/2001 657717 1727/581 QC 08/26/1999 609350 1452/205 mo(2..0 . 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/26/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.190 38,400 133,200 171,600 NO Totals for 2005: General Property 2.190 38,400 133,200 171,600 Woodland 0.000 0 0 Totals for 2004: General Property 2.190 38,400 133,200 171,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 8023681 State Bar of Wisconsin Form 6-2003 Tx:4017334 i. SPECIAL WARRANTY DEED 934169 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED,made between Federal National Mortgage Association,a 03/28/20114:18 PM corporation organized and existing under the laws of the United States of America and EXEMPT#: 2 authorized to do business in the State of California ("Grantor,"whether one or more),and REC FEE: 30.00 Bohlen Properties 2 LLC PAGES: 1 ("Grantee,"whether one or more). Grantor for a valuable consideration,conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St.Croix County,State of Wisconsin('!Property")(ifmore space is Recording Area needed,please attach addendum): Name and Return Address Part of the Northwest One-quarter(114)of Northwest One-quarter(114)of Section Fourteen (14),in Township Twenty-nine(29)North,Range Nineteen(19)West in the Town of Bohlen Properties 2 LLC Hudson,St.Croix County,Wisconsin,described as follows: Lot One(1)of CERTIFIED 300 Bates Avenue,Suite 200 SURVEY MAP file October 25,2001 in Volume 15,page 4194,as Document No. 660049. St.Paul,MN 55106 Exempt from fee and transfer per Wis.Stat. Sec.77.25(2). 020-1021-10-100 Parcel Identification Number(PIN) This is not homestead property. (is)(is not) Grantor warrants that the title to the Property is good,indefeasible, in fee simple and free and clear of encumbrances arising by, through, or under Grantor, EXCEPT the following deed restriction: Grantee herein shall be prohibited from conveying captioned property to a bonafide purchaser value for a sales price of greater than $162,000.00 for a period of 3 month(s) from the date of this deed. Grantee shall also be prohibited from encumbering subject property with a security interest in the principal amount of greater than $162,000.00 for a period of 3 month(s) from the date of this deed. These restrictions shall run with the land and are not personal to grantee. This restriction shall terminate immediately upon conveyance at any foreclosure sale related to a mortgage or deed of trust. Dated 3,21a Z// FED L IONAL MORTGAGE ASSOCIATION (SEAL) — (SEAL) yan H. otter,authorized agent and attorney-in• ct r O'Dess &Associates,SC,attorney-in-fact for Fannie Mae Mortgage Association (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on )Ss. WAUKESHA COUNTY ) * Personally came before me on / /4" 1/ , TITLE:MEMBER STATE BAR OF WISCONSIN the above-named Ryan H. Wolter (If not, 9 authorized by Wis. Stat. §706.06) to me known to be the erson('f execute egoing instrume nd acknowl eAXO�RON j THIS INSTRUMENT DRAFTED BY: P. t 11 IL Ryan H.Wolter,Esq. A3 otary Public, State of Wis onsinM, 9l s My Commission(is perrrrdnettt)(ex�l ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. SPECIAL WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORM NO.6-2003 *1 pgname below signatures. 660049 .ATHLEEN H. WALSH ' ST. CROIX CO. WI RECEIVED FOR REHRD THIS INSTRUMENT DRAFTED BY KEVIN REED JOB NO.6097-01 DATE:9/17/01 10-25-2001 8:00 AM BEARINGS ARE REFERENCED TO THE COPY FEE: WEST LINE OF THE NW1/4 OF SECTION RECORDING FEE: 13.00 14,ASSUMED TO BEAR S00°29'52 M PAGES: 2• APPROVED Eta 300°29'52"W 2639.36' ST.CI?(J;X 0001AITY Fl:rnni q Z.o-li n as WEST'LINE OF E NW1/4 cr 2 4 2001 m, 1319.68' z M 1319. /6 m ` Fill, OO ( p vplr'.^.r�':i'�� r,l:(ri ..I Si1<;II L'i " .,u' 1 zAA z z fr iz .6 z to -; I ,. .� m A 70 � ��, WOd°_4a4Q pC�o_0�34 Ir c � z $ (Soo-07'20W I zoo M N 00°29'40"E 405.02' I��'ti` `o`` i'`-4 mo 261.50' 367.40' 105.90' �: •r :�''0 K m 1� 37.62' `�•�'� . > 0082 m v � z 1 a rn O = c I� 13 � C O N mN r �' mp o O z N m �QQ w�0 I rnz � a o °DQ �D� O IP o K_ Wn A sc.) I@° M "�._ OM - O�7D 0 D O N(�t 38.13' 301.09' m _ SOO°29'40"W 339.22 SO T-n ,919 9) A IO Z m .o M M �� I `0 `0 ;cog (D �� 0 0 ' y I 'p o -� zI p W „ () mn1 P �' v � o �N � °° Z = m M o x 0 • = NMz Z -O .. I fit! 5 � 0 0 I ( EAST LINE OF t0 i(S? 15�? i = 0 I O I THE NW1/4 OF lO I o y M(—n I i I N THE NWI/4 M to N N — j—�IO� I O O O i ST LINE OF THE NE1/4 OF A c K D r V I� A I� 83 x O C fl1 THE NWI/4 N I I o N = n .. I 0 czz O cl �� � Omm O n I@ ( Im m z m Z iON i� Z G D I I O ( 31 -7 -n 8 v p N I .i lO D r O O C p? �t�'-1 II Z - fl1 IZ1 Iz v zm z z a� mwp r I(n�r� Cc A Z oo iO m O D rn co A O I� _ Z M 8-1 y( 1� O M I ID om 0-1 Qm 0min n it X I 8 `1 = r II .E .EE m M ? 0 r A o° 00 I = tor N 39.48' 365.52' __ • __ o o m C co I - S00°00'49"E 405.00' °z Z n IO (NOO°23'09"Vi) O Z VG Vol. ,5'r Page 4194 k s 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,0 Ft. - Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: 3, Trench: Width: /$ Length: 94 Number of Lines: 3 Area Built: G , /f Fill depth to top of pipe: s Number of feet from nearest property line: Front, O Side, O Rear,QA�FFt . Number of feet from well: SI Number of feet from building: S5 (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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: o n Dated: Plumber on job: License Number: 3/84:mj T7 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ��� ,,, /`v;� TOWNSHIP U��,� SEC. TN-R / W ADDRESS z-27. 6- ST. CROIX COUNTY, WISCONSIN „fl/L1�'aS L�A,i nk 1-4-r-/ am p5-/yig9( SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM JunRT PRnP�RtYL.��uE VEN f tF6fl& n -- — — / 1 - RvPos[4 -/,— " 5� �M b 0 S 10 AAV C 9 ^ rt� N� SC,& i y9" < Rot INDICATE NORTH ARROW k BENCHMARK: Describe the vertical reference point used /y,6, -0'0uA0AfiV0 zf.,ew Elevation of vertical reference point: /0D' Proposed slope at site: 9g•tl,y' SEPTIC TANK: Manufacturer: GyiESe/? Liquid Capacity: 00 G' AL. Number of rings used: O Tank manhole cover elevation: 9�'��It Tank Inlet Elevation: ,(fie. ' Tank Outlet Elevation: 9�e . 91 Number of feet from nearest Road: Front, Side,o Rear, O /(p�/ feet From nearest property line Front,0 Side,aear,O y feet Number of feet from: well sg , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 . a BUREAU OF PLUMBING MADISON,WI 53707 NW',4,NW�4, ,S14 T29N—R19W RCONVENTIONAL ID ALTERNATIVE State Plan l.D.Number: (lf assigned) Town of Hudson El Holding Tank ❑In-Ground Pressure ❑Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION CANE: p�1 Kevin Fox Route 5, 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: �ary Zappa I3300 St. Croix 192507 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: T K I LET E TANK OUT LE EyEV.: WARNING LABEL LOCKING COVER i PRWVI ED: PROVIDED: �yp,� yi / LTYES ❑NO ❑YES NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY IW36:3 BUILDING. VENT TO FRESH ALARM: FEET FROM J LI,"f ,S AIR INL DYES No Lid OYES 'NO NEAREST ` W DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO ❑YES ❑NO J OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING'. AIR NLOTRESH (DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) ❑YES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moistureat the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: L INO.OF DISTR.PIPE SPACING. COVER =PIT INSIUE CIA 12 PITS LIQUID BED/TRENCH ) TRENCHES M/rF ERIAL: DEPTH DIMENSIONS �J GRAVEL DEPT FILL DEPTH DISTR.PIPF DISTR.PIPE DISTR.PIPE MATERIAL: N IsrR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES:` s` ABOVE COVER/FAR/ E EV. ,L E EV END/' �� PIPE FEET FROM LINE / / S t AlSr.MOUND SYSTEM: -+( Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES 1:1 NO OIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ❑NO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL ISODDED IMULCHED["'U'UOYEs CENTER: EDGES. ❑YES El ONO OYES El NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH'. LENGTH. NO.OF LATERAL SPACING T RAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO DISTR. ID ISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV.: CIA.: ELEV.. PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL PLANS CAL LIFT CORRESPONDS TO APPROVED DYES ONO I DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING: FEET FROM LINE DYES 1-1 NO ❑Y ONO NEARE T. f �D "AL AYL Ske System on n in county file for audit. Reverk Side. SIGNATURE TITLE. Zoning Administrator DILHR SBD 6710(R.01/82) 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 S years; 6. If you'have tluestions 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; If. 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'% 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 'esult of over 2 years of steady negotiation and public debate. The groundwater bill Ground ater ncluded the creation of surcharges (lees) for a number of regulated practices which Wisconon'$ can effect groundwater. The surcharc_,� took effect on July 1, 1984. All of the water that buriedf85tltf3 ° s used in your building is returned t, the groundwater through your soil absorption o system or the disposal site used by your holding tank puriper c The ;;conies collected through these surcharges are credited to tha groundwater fund adminis- tered by t'nie Department of Natural Resources. These funds a:e used for monitoring ground- � t water, groundwater contamination investigations and establishment of standards. Groundwat{,,, it's worth protecting. SSD-6398 M.03%86) D'L SANITARY PERMIT APPLICATION COUNTYn In accord with ILHR 83.05,Wis.Adm.Code �A. �r x tl STATE SANITARY PERMIT# —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 I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES 0 NO PROPERTY OWNER PROPERTY LOCATION Iy✓'/4 AIW4, S T,2 , N, R E (or) PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LAND M RK E-1 VILLAGE ., -VA CL II. TYPE OF gUILDING OR USE SERVED: POAC,- 1• C IRO —lfla 1 1Q--0�96 Number of Bedrooms if 1 or 2 Family 2 OR ❑ Public(Specify): III. 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. 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 Tan k V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a.N 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): ZIP e<Jj Q C1 �j 106.33 Feet ®Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total #of Prefab. Fiber- Exper. INFORMATION New xis tin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank b o a— ❑❑ 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): P ature:(No Stamps) MWMPRSW No.: Business Phone Number: r. - / .3a�6- 01` 0 Plumber' Address(Wdbt,City,State,Zip Code): Name of Designer: s" r. �l�cicv =s S G� VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# <<_ 6 /► CST's ADDRESS(Street,City,State pp Code) / Phone Number: IX. COUNT /DEPARTME T USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) S rcharge Fee Approved El owner Given Initial ( ' f��y O� /� lD^g� M t Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: Isere u 1,e 0Qcl by 7"hv was . r�ds v n SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber EH .115 Rev.9/78� c _ 9! Pal REPORT ON SOIL BORINGS R LATI STS �i4�ES , > WISCONSIN DEPARTMENT OF H A� A ` AL E VICES P.O. BOX 309,MADIS N_ I Ica � G LOCATION:/v '/a, NW/a,Section ,T?9 N,RItE (or)W,T hip or tONllr ill pality!` OSO/✓ Lot No. , Block No. 1. D5' ,4CAom � C Sf e/PO/X �PF V, �f/M. �• 6AAj rvision Owner's Buyer Name: /� Mailing Address: I92(0 Vtf)0O1* AVjE• .57 MVL M/NN SS TYPE OF OCCUPANCY: Residence K No.of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT X ALTERNATE SYSTEM OTHER DATES OBSERVATION ADE: SOIL BORINGS QCT, L (q7 PERCOLATION TESTS OCT, 3 1177 SOIL MAP SHEET So SC,S NAME OF SOIL MAP UNIT sr Q JA77A*5 SiL T L PERCOLATION TESTS - �M TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER ? 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- 1 3 4 & s,l P-J 3 15Av 0 Z0"L/• . si/ f �� 2- ..d _ 3d /o d P— P— P— SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES �, M B- t 7Z ivo,VE > 72 �o �,�Q,v f'//7 �tBN,S+/1J`0-$V. sb e.o.s.j B- L 72- NOWE 1 72 s• N N Z ,. S"tt. Li�I sI; .l5"r+u)•S 13'CS 3 B- 3 72. NONE ? 7Z �o1if' I. I 1"!#&V B- 79= A6WE 1p ®/! i 12"Z I-fil S%1 *AV AC/OW1 0. lyOf's w B– CO v,QSE O, S RNp 3 f R. B- ANQ Z Aw 8840 IPE TW 0-1V 7ZST .vuh 81=yes .f' 4--ot PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy /000 'Foe, ff%exW Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. `roR �F WA TO P, 4 /. �11�7�. . . . _ ��_ . e. . v .,.. K.. © _ P/0W f W I1N � fC O' � E , . . . D �"� �_ /ST/�NdCE� E/Ei/m Ake T` 4e t�E Zo g 3, �6 a3 0 /oo 0 0 I 3 O t N Jj�02 w a t- �¢.w__ ;Q .m,. .m ►. _ !l � .5�,. �. m � 4/0.5 AC�if S CM � xE� _✓ti re`s�- �Ill���1 . , cl� 3'r . - E _i_® ._...§ I,the undersigend,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 location of test holes are correct to the best of my knowledge and belief` ✓+�`r Name (print) Abgg r P/kf 1e-4 7 Certification No. O2 y,02" Address uDSDA J .Name of installer if known Copy A—Local Authority CST Signature / EH' 115 1' GC Z o f Z' �,96es REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O.BOX 309,MADISON,WISCONSIN 53701 LOCATION:NE '/a,N�'/a,Section Z_,T=LN,RLfE (or)W,Township or Municipality Lot No. ,Block No. A' County �� , uJM. ubdivision Name Owner's/Buyers Name: Mailing Address: 2. 4 NoMolk 14mc St P4 VL MIAAAJ. SS// TYPE OF OCCUPANCY: Residence X No.of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT � ALTERNATE SYSTEM OTHER • DATES OBSERVATIO ADE: SOIL BORINGS OCR' 2 M 7 /q PERCOLATION TESTS QC* 1 I If 2 SOIL MAP SHEET � NAME OF SOIL MAP UNIT 5-146 ` , -TT0E :VcT 4- ' PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- P- SF�' P- P— Soil- /9E/Dw 60IMA0E' T ON / .Si IS P- 0A ME P- �D� 1A?5MIIEA0 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- ,� 72 NONE 2-Y /Z"2,1e&/. SiL, /0 " Cf• Qtj . SQL ' ZO" f//dkj B- Co . MOTS - le",O V .f/ . B— 72 iVONE 2 "N,13,v // ' ti. Bid• SC L w i dY, fAiNT B- 1j"'r C.0mM one O-iP MOTS 3L " CS ' fA . B- PLAN VIEW(Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy ,Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. I i } i t. j tSR i, a E 1,the undersigen 1,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 location of test holes are correct to the best of my knowledge and belief. Name(print) Certification No'rf 02-70 K/ 7 Address b/ RT 3 ,�IXoiV /s. �y L. .Name of installer if known Co PY A—Local Authori ty CST Signature look IOR o�.,�► FARM #OUSE / Mi : .. . tRs r OF Cou,v7x o w A4 Ct.Tae,�., Access AMP /PZ v. Grew► +' .�. i /q, 4 W- fw1pSoAj T wNS�Yi/� &XI ST/N DLL 6 e'4,*vsE H OPSaN ?WAk S C3 C1 MC CuredrEw ROAD BAEk FARM t r f vc &4s w ., �.:,a s -" cam.. f . . i�• Rl T-4- TV 4f A� A" CJ a.c;s�4=s : 4 W S o- �r RM ' .. Al Alr" f •5<' „Y. ,Y. uTZ.s._ti�^i '� r�kw: R �- [,y. 6 {I.�,...-..a.. _s!:_�-'- -F <-T" a 4 a .� �• s s r Vii, as. •s'S�§".�,�N t3y +J �'�' t � 1 a } r ;04, d5 � ina s r . Tg ���' t. =n- � ri i ,�" � � y sr � •. >"°r r,�' �a. $y:; x� 4 PrOWS *� f vi Wtvi*by P!`o I TTI br r .wn.. Cy,"n�4 t1 Ct18 f A NA " } I OLAT -MAIF UNIT WA#APof Soft" a *� IL p S t 4 TES ' � —yt1AV YR �,r u.. TEXTUflf�FY�Vf [' tk#1 R11I tF t ; ,"S r s soil areas:} t lfe °91x the I i, ry Y;. ..'N w ol ',. t A � �► M1 .i x 4 " f�1 4 1 Q r f„ R n 'li a �,�y� 1 -a a'�*r.�aa:avaAs"�.u+.`�:d- �"''^.�:,-._ x:°e�.atNa..f, a....d,��.,..rt,.t4,��,c •, ,�' �,� i°a... 10, b N..'P.. � » +RAT+ �f '�y bx3 •�� �Y+ k� ��#E f` i r � bh P i •i$ � � s 5 � t � '# "� #' � �`r{r* � I I zp,� .., use.^ ° �} �i ��:`•, ¢a k 4'. I I �4 S k .c` d # 3 � Y .F4 ;j"j a, f kuc� " a � o41;# i _ "�✓ yfy tC f �a�.• f 'f�i �y�. S^' ..W_ .K:,1' } � �` �� i mi {:• f Vii" h`, iY +.t- ,Ft 5 s,'/z•:� S^Gv —. 9 r� � 5J �nf � FF^ �{y��/' �r„ i� _ u- , # E , E. k 4T ? t65^A F k ' v 3 ..�. „ a' r it, t jr Yy _ i r � Y S th -4r. cy. 4 i .. .: w h � .d T -yy��, '' ail” Itisa `this i�t n ere�rr mode., v Rte '. a a , 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 kE if/A) F©k Location of Property _' , Section _1! , T�R W Township LLdsn�, Mailing Addresb'.r rJ`��`t� d[j T/4 L-r. hn , Address of Site S . Subdivision Name Lot Number Previous Owner of Property n Total Size of Parcel 00 7 151 Date Parcel was Created L 7��, Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes _� No Volume �]3 and Page Number I ' � 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. I - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) eeAtiby that att statements on this bon.m arse treue to the best ob my (ouk) knowtedg e; that I (we) am (ace) the owner(-s) o6 the prco peat y dens c4 i.b ed in this .inbaemation boAm, by vi tue ob a wavcanty deed eeonded in the Obb.ice ob the County Reg.i,6terc ob Deed-sas Document No. ;L, ; and that I (We) pte6entty own the proposed site bore the -sewage dis'pozat system (orc I (we) have obtained an easement, to rcun with the above desehibed ptopenty, bon the eonstAucti.on ob said ,system, and the same has been duty rceconded in the Obb.ice ob the County Reg.isten ob Dee as Do No. ) . SIGNATURE 0 9 0 ER SIGNATURE OF CO-OWNER (I APPLICABLE) /,5 gy DATE SIGNED DATE SIGNED • DQCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED OFHCE "'RCNX CO., WI& i. nor Record this 2nd Rev William K. Gamber, a single person »s.a -f May A.D. 19 86 t 12:10 P conveys andwarrantsto Sheila A and Kevin M. FOX, husband and wife as marital property with rights of survivorshipMly r1 Dff�tr RETURN TO The State Bank of Hudson the following described real estate in St. Croix County, State of Wisconsin: Tax Parcel No: Part of the Northwest Quarter of Northwest Quarter of Section 14, Town- ship 29 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Commencing at the Southwest corner of said Northwest Quarter of Northwest Quarter; thence East along the centerline of the Town Road 837 . 0 feet to POINT OF BEGINNING; thence North 293. 0 feet; thence 157 . 0 feet; thence South 293. 0 feet to the centerline of said Town Road; thenc West along said centerline 157 . 0 feet to POINT OF BEGINNING. J ,� I., • 0 0 This is not homestead property. (is) (is not) Exception to Warranties: 1st day of Ma 19 86 . Dated this � (SEAL L SEAL) ) R v. William K. Gamber (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN SS. St. Croix County. authenticated this day of 19 Personally came before me this 1st --day of May 119 86 the above named Rav wi 1 1�_ i�a �m K umber- I TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me know to be the person _who executed the authorized by§706.06,Wis.Slats.) foreg4amlin§trument a ackkngvviledge the same. THIS INSTRUMENT WAS DRAFTED BY ✓�� I'('y 1 Robert B.G.1rou ware c! Notary Public s—� County,Wis. (Signatures may be authenticated or acknowledged. Both My Commission Itr po r��nent. (If nod state expiration 8 are not necessary.) date: Febr,.tka�Ip { C ,19 .) r Ana Names NTF 2280 of persons signing In any capacity should be typed or printed below their signatures. t WARRANTY DEED STATE BAR OF WISCONSIN Nelco Forms,P.O.Box 10208,Green Bay,WI 54307-0208 Form No.2—1982 H 2 N H a r STC - 105 a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County x d a OWNER/BUYER Kev I'j Foy, ROUTE/BOX NUMBER-• Fire Number .CITY/STATE ( ►I.LUS� ]'` lA J 1 ZIP �� ' PROPERTY LOCATION: NO ]%, Section , Tjkq_(N) R W, Town of 4,1111SC) , St . Croix County , Subdivision N CL Lot number �i 4_ 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 pdt into the system can affect the function of the septic tank as a treat- :rent 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-eite 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. Ho I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x rr the standards set forth, herein, as set by the Wisconsin Depart- ho 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. SIGNED_,ZA1,�_1 ej__( � DATE -T 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. r2r � 2 N /"GOT /o•^'O l./�oir p►33 l . 3,0' f C,T2w rLANs "vo S'LOPE — - —Vr-T I rAC,li / 6VEIL �oU Ta t/m r� II2[)T�CT 36 4' l<nvr.v l-�x Q A SYJ'TJ_r, Qa- � Town/ DP Nuoson/ ST coo=x co. w ES T /ono PE2T Y ZX vE Ss 40 L•"xxsTlrvG �Vron ow�LL /�i.'STr?oYEQ--)o �XZSTZniL� !CPTSC /AN1� S�' Ex2ST1.�G i,,ELL ArvD ):AXLE0 D11YI,ELL �' / L'xsSTSN G Con.,vEti OF 12Esxo�NCE /'oa,�J,rr�onl 7D# ELV.=/60.00 No SCALE IvoTE= I_xrSTSN6 SFPT=c Tio►�►C A,vo FAZLEO OILY1.4r, L ,'o/XoPDSFO DAXVA-„ Y Tv /3F- ,t�csrnoYe,o /ya' 11c Cr4TG14E1\1 /206 d FRESH AIR INLET AND OBSERVATION PIPE APPROVED VENT CAP MAXIMUM 12" ABOVE FINAL GRADE 4" CAST IRON PENT PIPE MAXIMUM OF 42" ABOVE PIPE TO FINAL GRADE SIGNED:� 11— MARSH HAY OR SYNTHETIC COVERING LICENSE: .? MIND" 2"AGGREGATE DATE: OYER PIPE DISTRIBUUTION PIPE i 10 TEE SOIL TESTING BY: &1-3r,'vr, :Z�CAIT ELEVATION BED 6"AGGREGATE BOTTOM PER SOIL, BENEATH PIPE PERFORATED PIPE BELOW TEST IS • COUPLING TERMINATING 9S• 23 FT. AT BOTTOM OF PIPE