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HomeMy WebLinkAbout020-1150-80-000 � I a `c I o I N h d q I I I o I z I LL c I o I I 3 M v aD _ Z y rn W E O Z y d °' a m N H fn O I C O z Z V a- O N O d Z c H r C E 7 N M N 7 � f/J N C C v 0 L O O N C O E a -1.1d Z [0 D p N Z @ C d m C W i0 E O N I � C CL M 0 C c a p- y ca` Er 2 CD m to v> > O o 0 1 z CL a a y aA CL ro CD 3 0 N O rn rn (D•� m J U � y O _ CO N � N N j 00 O .+ E •C O O 'O � o m a N O) e+ Q O a y C to r•O 000 co a; p c 'e C -p N V rw � Qj : I fn m G 7 N b a) O . N O O N p t6 V • O N 2 cM0 O Z c 2 fn O 0) dt m a ` �/�• c� a m .� m a c A 0 (L Il 0 U) L) Parcel #: 020-1150-80-000 12/15/2004 09:29 AM PAGE 1 OF 1 Alt. Parcel M 29.29.19.816 020-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 *FERGUSON, DEVAUN&TANYA DEVAUN&TANYA FERGUSON 718 GLENNA DR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description 718 GLENNA DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.704 Plat: 2356-PRESIDENTIAL ESTATES SEC 29 T29N R19W PRESIDENTIAL ESTATES Block/Condo Bldg: LOT 7 LOT 7 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 11/17/1998 591788 1378/028 WD 07/23/1997 1019/25 WD 07/23/1997 759/01 07/23/1997 718/129 more 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 48902 262,900 Valuations: Last Changed: 06/09/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.704 36,100 167,300 203,400 NO Totals for 2004: General Property 1.704 36,100 167,300 203,400 Woodland 0.000 0 0 Totals for 2003: General Property 1.704 36,100 167,300 203,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 212 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 wit PUMP CHAMBER Manufacturer: ry' Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: vdK \i py�q. Trench: �-- Width:—/ Length: Number of Lines:—j Area Built:-4-7/r Fill depth to top of pipe: $�� Number of feet from nearest property line: Front, O Side, O Rear, Pty Number of feet from well: Number of feet from building: o� ,(Include distances on plot plan). SEEPAGE PIT Size: Numt*r 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: J Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• PV Dated: �3.• Plumb'r on job: 3 License Number: 3/84:mj - Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER d, O TOWNSHIP //tt�ISa� SEC. ,;�.6— ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION&S,Wtrr/j' l,6_Ao;,y,LOT -?r7 LOT SIZE -b PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM to VVI 5��. 1�. pry '°_ ►o' � �-' __--_.� w r r' w � x LA � P ,Al fi N - INDICATE NO!k ARJOW BENCHMARK: Describe the vertical reference point used 3/y�i �07� t�; r?C. lYl�/Ler 9dr Elevation of vertical reference point: /O©' t Proposed slope at site: SEPTIC TANK: Manufacturer: Sir Liquid Capacity: L000T4 f Number of rings used: / Tank manhole cover elevation: Tank Inlet Elevation: S Tank Outlet Elevation: i Number of feet from nearest Road: Front Side, Rear, O feet From nearest property line Front.0 Side 10 Rear, ('00 feet Number of feet from: well _, building: j���10 ea(H�Garat` 38� Irle/Cor Na1Hb,, St (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE _REVERSE.. SIDE _._.I IEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS .ABOR&HUMAN RFELATIONS PRIVATE SEWAGE SYSTEMS DIVISION '.O.BOX X966 ` BUREAU OF PLUMBING e MADISON,WI 53707 OCONVENTIONAL ❑ALTERNATIVE fit ns,lenl.D.NumMr 111 xopnMl ❑Holding Tank ❑In-Ground Pressure ❑Mound AME OF PERMIT HOLDER. ADORES S OF PERMIT HOLDER. INSPECTION bATE - Sam Miller Rt. 1, Box 282, Hudson, WI 54016 1?-23- -W ENCH MARK IPermenent ref. aPoint)DESCRIBE IWDIILfERENT FROM PLAN REF.PT.ELEV: jsTHEF PT.ELEV SE SW, Section 29, T29N-R19W, Twn.of Hudson,Lot#7, Presidential Est 7­1 Plurnlrn. MPIMPRSW No.. County Santlary P,,,-,t Numlt.r: Doug Strohbeen 5432 St. Croix 83838 EPTIC TANK/HOLDING TANK: A LIQUID CAPACITY TAI K INLET ELEV. TANK OUTLET ELEV WARNING LABEL LOCKING COVER PROV IDED PROVIDED ( / S� TS� YES ❑NO ❑YES F-JNO EDGING. VENT OIA. VENT MATE. HIGH WA NUMBER OF ROAD: PROPER Ty WELL BUIIUtNG VENT LE fRF SI/ %i ALARM FEET FROM "LINE AIR INLET YES ❑NO C YES ID NO NEAREST OSING CHAMBER: MANUFACTURER Bf UUING LIQUID CAPACITY VUn1V MIIDEL PUMP.SIPHON MANUI AC TIMER WARNING LABEL LOCKING COVER PROVIDED PROVIDED ❑YES NO DYES ONO I DYES UNO ALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF VNt11'F llty Wf Li HUH OINK, VENT TO FHI Sit (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST 30: OIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing It NGtfill lf nlnn+l fill TIA 11111AI AND MANKINI, r excavation. (If soil can be rolled into a wire,construction shall cease until FORCE MAIN he soil is dry enough to continue.) ONVENTIONAL SYSTEM: WIDTH LENf.iH NO Oi I11STR PIP VA(' C COV INtill if 111.1 aVIIS LH)lnO BED/TRENCH THE NC M EI AL: PIT OUPIU DIMENSIONS I,H VfLUfV I/ FILL EP H UIS II Ptl'1 UI TH PIPE DISTFI. . MAT- IAL Nq UISIR NUMBER OF PHl)PERTY WELL HUILUING Vf NT 1 11 IIF tit, IIF LOW PIP S�,. AHOVE�VEH F I!V 1 11 t ELEV END / PIPES/ LINE AIH INLE T 11/x/ _L�1 �/ NEARESTO—+• OUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it . ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO _ IL COVER TFK111Rf PtRntANINIMAHKIHS OHSIIIVAt1ONWI1IS _ ❑YES ONO DYES LINO UFPTHOV HTRINCII Hf 11 OEP111 )VFR TRENCH BED DEPTH Of t(PSOIL SI)UUlO akF UfU MIR I:HrU Cf NIER ELIDES ❑YES ONO [--]YES ❑NO ❑YES EINO RESSURIZED DISTRIBUTION SYSTEM: _ BED/TRENCH WIDTH Lt NGTH TRENCHES LATE HAL SPACING 14HAVEL OF PT If HI LOW PIN I It L 1)f PIH AHOVf COVI H DIMENSIONS — ---- -- MANIFULU PI1M MANtI OLD UISTH PIPE 11A ANY(ILU MATE HIAI UISI11 PI'! 111tiOUH111 R1N 1'11.1 n1 P,I11lIA1 )Y NArtK INt. ELEV ELEV OIA ELEV. PIPES UTA ELEVATION AND DISTRIBUTION HOLE SIlF ,IDLE SPACING UIlILI EI/Cnrol[Cll Y GOVIH MA IE RIAL V1 II 1ICAt 1 11 1 C,H1H1 SN)NOS IO AVPIfOV IU INFORMATION rl nNs ❑YES ONO CJYES El NO OMMENTS: PERMANENT MAREAS OBSERVATION WELLS NUMBER OF PROPERTY WELL BUILDING FEET FROM LINE ❑YES El NO ❑YES ❑NO _— NEAREST- —_=— I I Sketch System on Retain in county file for audit. Reverse Side. SI<i H IIT LE DILHR SBD 6710(R.01/82) INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT , APPLICATION y 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`awthority. 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.Zto 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 na, ;e and mailing address. Provide the legal description where the system is to be installed; 11. Type of building or use served: If public 'ts checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 111. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; Vi. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill ;n 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 81A 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 Groundwatet included the creation of surcharges (fees) for a number of regulated practices which Wisco in can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasuro 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. 0 The nionies collected through these surcharges are cred'ted to the groundwater fund adminis- recl by ?he 'department of Natural Resources. These funds are used for monitoring ground- t iter, groundwater contamination in 1,estigations and establishment of standards. Groundwater, "'3 worth protecting. ED-6398(R.03/86) SANITARY PERMIT APPLICATION Coy Y ItirLN� In accord with ILHR 83.05,Wis.Adm.Code 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 1. OPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ❑ NO PROPERTY OWNER PROPERTY LOCATION ,SQ r" KIM_, 5E % 5W'/4, S 22 T t , N, R E(or PROPERTY OWNER'S MAILING Ac SS LOT NUMBER IBLOCKNUMBER SUBDIVISION NAME CITY,STATE ZIP CODE PHONE NUMBER ED CITY NEAREST ROAD,LAKE OR LANDMARK cc h 01- S o/16 7S 8$ -) ❑ VILLAGE: H,,is o� /�rina II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family _� OR ❑ Public(Specify): i III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a.,N 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. P 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. X 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): C 3 /s G y$ 5 aT 9S-Z aFeet Private ❑Joint ❑ Public VI. TANK CAPACITY #of Prefab. Site Fiber- Exper. in gallons- . Total Manufacturer's Name Con- Steel Plastic INFORMATION New xisting Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holding Tank / OC (.tJ¢j-S y ® ❑ 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 Stamps) MP/MPRSW No.: Business Phone Number: -Pow 4 5 o 4 b4�c h Z MR-_f"`/-3 z Z 7 z 3 Plumbe s Address(Street,City,State,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Cert if'ed Soil Tester(CST)Name CST# p ` �• iL O CST's ADDRESS(Street,City tatb,Zip Cole) G � Phone Number: IX. COUNT /DEPARTMENT USE MY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial / Surcharge Fee Adverse Determination ! � �� X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber 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 Sa,V7 �,'//✓ Location of Property ' ��w ' , Section z9 , T 2�? N-R /9 Township Mailing Address Roe"t / z 8'Z Address of Site S;� /e N N o, �.(� �� cx�d�7` Si�� a le" 5'4%d� Subdivision Name �ia s •fmn f,'a/ �st_,7`�5 _`Lot Number r Previous Owner of property 1&4k— ZZL12c- Total Size of parcel Date Parcel was Created Are all corners and lot lines identifiable? iY Yes No Is this property being developed for resale (spec house) ? X Yes No Volume and Page Number LC� L— as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) centi.by that att statement6 on thi6 bonm ane true to the but ob my (oun) knowtedg e; that I (we) am (are) the owner(,$) o6 the pro peA ty dens cA bed in th.i,6 inbonmation bonm, by vi tue ob a warranty deed neconded in the 066ice o6 the County Regi6ten o Deed6a6 Document No. pg_.; and that I (We) pnesentty own the pnopo.6 ed .6.c to ban the sewage diSpozat 4z em (on I (we) have obtained an easement, to nun with the above de6n bed pnopenty, bon the eon6tnuCti.on ob Said aybtem, and the .same ha6 been duty neconded in the Obbice ob the County Regizten ob Heeds, a6 Document No. '16 f, 2 os� I i SIGNATURE OP,OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H � H 9 STC - 105 r a ` H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d 9 H OWNER/BUYER_Srrhl /V, ROUTE/BOX NUMBER �'�- � Ty Zei(2 Fire Number CITY/STATE /7u40/11 lit/I ZIP S,Yv/A PROPERTY LOCATION : SF �, 5 t-cJ 14, Section, T L9' N , R Town of �lk� h , St . Croix County , Subdivision/-d., ,'cl „ zt�S Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper . What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior . to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber ,er restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration . Ho I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- ro 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 . D DATE l S 6 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 . 1 INSTRUCTIONS FOR COMPLETING FORM 115 - S D - 6395 To be a complete and accurate soil test,your report must include: 1. Co"ph te: lryW v5scription; 2. Tbs., use seubn awn WHY itsdicate wtedwr this is a residence or commercial project; 3, MAXIMUM number of bedrooms or mmmemial use planned; 4. Is this a nevw or replacement system; d, Complete, the suitability rating boxes.A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abKoviati<ms shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately I«catirrg your test locations. Drawing to scale is preferred. A separate shot=t may ire rased if desired; S. fViake wer e y ur berrchrnark and vertical elevation reference point:are clearly shown,and rare permanent; 9. COnapW Al appropht€> boxes as to dates, immes,addimmes, flood plain data, percolation test exemp- iforn ifapprolviale; 14 If We it ormalOn (sisch as flood plain, elevation)does not apply, place N,A,in the apprrop:ariate box; i 1. Sian the farm alyd place your can ent address and your certification numh"; 12, ,Make legible coopies wid distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Sep#aatate.s and Texurres Other Symbols -t -- 'St nit {v rar 10"} BR B Brock �t <;aa,� _ .t�talr[e f� 0 S.ra _. Sandstone car gravel sunder 3",l LS — Lirimone 4 — Swift HGW — high t1mindwam c s C i,F,e iii Part: __ P .€-Er',t,tIn Rate nod s _, Mahan a d W 911i k; — Lowry _€aid i -- (-,ixat�,r r hwi 41 __. Smdy Loam � -- Low Than - 1[ — l,..o n"i i Bl Lowo i -- WT Gy .--- Ch ay Chy Loma Y ` hm"" sc -_ Sandy ( lay Loarn R Red hj Silty Clay Want mot — Wron�s ;c wdy Ckay air=` Coy,,C -- Sky C. y f,f t , I`ir,e=, faint 1 a. Cloy no — co_inrron, mam P1 ._. Iv at: inar -_. Many, i11aj E.;rn p — por i nrnew, }-9WL — High eater level, Six £lE:coral sail textures surfaco Water f. !"r Waste disp ml E 11 — Bench f.,wk VRP WNW Retemma Point TO THE OWNER 'f ._ `,od test r4 oort is too first stop in r-,cur€r g -i saribary p}€rrith, The county or the Departmoni tray t"equest t.= t.,.. kin of this sod 'test m the ti�frd p 6or €o psrmit issi.mme,. A cotnplete set or paians for the private: v age 'Y.`;..en mid a p:'rntl_ B,a.Pp1mmom e u6t be sim rnitted to 'the dfq#'1:1Gnme Oct aUtl1m 4y w Order to o, _, ;:a i.i3Ot, The s=annary ImmAt mum be ohudAmd and p fisted prr£rrto the start of any immmommOn, DEJ1*AF3T,MENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS 111ZDUSTRY, UIVISJO.N LABOR AND• • ' PERCOLATION TESTS (1'15) MADISON WI 53707 HUMAN RELATIONS SW (H63.09(1)& Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: 5, 1/ 1/ 19 /T�9 N/R l9 E l )W __ H UDS'o1cl fl ms's COUNTY: O NER'S BUYER'S NAME: M (LING ADDRESS: C p Gr, FP4 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence XNew ❑Replace /0 J 3 W'f'11Kv RATING:S=Site suitable for system U=Site unsuitable for system . �fl4Z W 7 l S4'0,0 CO��TI❑� . M��.❑� IN �� ❑�RE: SYSTEM-IN-FILLHO�LDING©NK: RECOMMEN ED SYSTEM:(optional) ('pNUF,uT�O�tIt S EM S U DAIRi")fr Etv If Percolation Tests are NOT required DESIGN RATE: r' �If any portion of the tested area is in the under s.H63.09(5)(b),indicate: /'— 84X0dJ" /�D2 Floodplain, indicate Floodplain elevation: fT �i�jj/.tJF�ELl7 PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-IMe4ES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH rW. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- J //,0 161,/o ' ?ir,•- > //o ' 9.,?3 ' D e 8AJ. Ls, 1j-',8A1, Z s, 6.(07 ' TAN CaU44_S. p /"OX' ,N/3N. 4s, 0ff',84•Ls &VAAa. e'e1 9 83 ' / N "S L5� /0001 1-Y aN LS, B- 3 /0'0 ,v 1/6R C //,, 33' 8,v- > 1,,f3 /,f s .�'3' u. h•s�P S, > o ' "Y o 'N'/3a -� o , B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 ---PERIOD 3 PER INCH P_ s.v 4,-c 0,4,p w dk S'e-S - doAr- Div,t71oAI P_ E L E A Al e-xi 7-5 41 sS P- 7/ P__ % iG% t % 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. 1?0 0M of- /vtP oe //PEiVvvies �r /"�C sX4c7-1_ SYSTEM ELEVATION Y- Ix �� — ut�7�?Az- _ �... _ . u i [(t ..d. E I 3 I F f t F � 3•_ E S 7 1 1 E TN I � -7 — _ I a _.f_ I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TEST WERE COMPLETED ON: begF W1,0i111ti /d '003 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): CST SIGNATUR DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) OVER — ,r REPORT SOIL SORM &S PERCOLATION TESTS 11S . Po T� ®N 1-67 7 A Pe SiP£ 4 L 144-m-5 Paor PLAM PPOTECi =. D. yvosey was pA rE /o r0'3 gv yc k " mli ek k�O�lEsiTE TESTING CCU. G` ;AIPA- H���a,o Cvi f R T.3, O'NEIL ROAD BOB 71L,t;h"�L'��� . iriUlCT�ONO WIS. -- 54016 C57_ SS�02 Yf Z PROPOSED HORSE mosr LdE 7,� Fr. oR MORE FiPdM ALc TEST f3,PE�4S, PRo POSED W L u M vsr w E 50 r FfeM i9c� TEST �,PE'�S, SACeM E f;Ts O dPCiMI.4 6- WELL. X g �E�G �oCg7"iDNf A fIANh &yekev et s4mel- l.3oefS r = fNo,Piz BM s4ml-f- Tic,#L V£R 2nsco er ParA)r 7ol" � �RV -YO/' � As U£,2r' /?rf PT 3�y" DoT coQ�v��2 P�,�E . LE bE N p o` 11",r. feF /°1." % 0, D oBy �a a i � z lr, L o r s �3 ya �, 30 , �o 'o h M Q • /3S • 60 wooD Lo 9L• FEpGE" G%�V c fro,ese- pro s TOR NA 0 N kA 0 Wa o o x P ova 3 La P ,ir X Q N f = P o ` sP A Qu - -4, �k y ti LA i1 rn o o a i ly P w 4, Vk � I r cI I ! , w L1 N V - u 4 i . H z S T C - 105 9 14 r SEPTIC TANK MAINTENANCE AGREEM 0 St . Croix County V. _� tv a OWNER/BUYER ROUTE/BOX NUMBER8R�t CITY/STATE�I� lvt I� ),! ZIP PROPERTY LOCATION:�36, :� _`'14, Section��, T �� N, R 1 ! W Town of�'-F L'_ 4 S D St . Croix County , nn f - Subdivision T(�5a i `sot number_. I Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper. What you pdt into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration . 0 0 E I/WE, the undersigned , have read the above requirements and agree M to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- 'v ment of Natural Resources. Certification form must be completed and returned to the St . Croix County Zoning Offkge within 30 days of the three year expiration date. SIGNED DATE 3- ) 8 ? St . Croix County Zoning Office P.O. Box 98, Hammond, WI 54015 715-425-8363 'R 10, x1 APPLICATION FOR SANITARY PERM S T C 100 This application form is to be completed in full and signed by � ' r(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 On 5 �� C) [1c Location of Property Sw 14, Section T ZN-R W Township /TLc G rS[�'ir-o Mailing Address , Q Address of Site Subdivision Names " S; Z, 4.. �� "---- - Lot Number Previous Owner of Property Total Size of Parcel 7 c a,$/5 Date Parcel was Created / Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume r 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 pa&e number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION 1 (We) ce ti6y that att statements on this 6o&m a&e. true to the best o6 my (oun) hnowtedge; that 1 (we) am (an.e) the owneA(s) o6 the pnopeAty descAi.bed in th.i.d in6onmati.on 6onm, by viAtue o6 a waA.anty deed kecoAded in the 066.tce o6 the County Reg.i6teA o6 Deeds a�5 Document No. ; and that I (We) pne.aentfy own the pnoposed e.ete bon the sewage duspoe dye em (on 1 (we) have obtained an easement, to nun with the above de6cA bed pnopeAty, bon the eond.tAuction o6 6a.id eydtem, and the Game has een duty keco&ded in the 066ice o6 the County Regi,6ten o6 Deeds, ab Document No. ) , #GNAIURE OIL OWNA SIGNATURE OF CO-OWNER (IF LICABLE) DATE SIGNED DATE SIGNED TA R ur N 1 4 r.,,. A SUBDIVISION LOCATED Rl THE SE 114 OF THE SW 1/♦ OF SECTION 25, `•���r+C'U�'^,��" T29 N, R19W, TOWN OF f!UUSON, S CROIX COUNTY, W�SCUNSIN ,e. i- M1 L ' fnIS:,H . y W.r EARL WL .--LOC/TIOM SKETCH— SCC il01' 29,T28N,NI9M iyi,'1,• t CURVE DATA TA■LC TO AN OI HyoscZR 4 a ]VN''►y,\� 1 "1.1 Hats IC.4 fIL01 C ILNOaD. CHONO CE NTR• 1Y!,G[Nf I NO f.- l fN6TH R tNIN A4_�f -LR�ry N f __• 1lSTJG�2°_!9 a 3s_C„FIe4•a a �.-' veet Y •e�('y _ E�.i I g t .,..Ij�) Tj Sa• i 2G NI99 ] 3! 169: 11.`9 �I L "I S IO )E ]•s +i•• !ti 1.7sW ..,. , yp qT 7 i%t L. 1 :. a20_,_Q...—„-as 1 .7'3E, • ►°.i •1.._y�,� u= 11 r ,♦ I 3 �60, T671'-s�9 4-0 13 I cx•tc oe a Sp]9 r ri_ uT. -- 40 1i9 71 c1 373 la I •7.711 01 VL ♦ . ..• -IS — — Lzaaro T � . I♦ 6i5♦T3♦1.2 00W161'•2 10 SECTION CONM[R MONUMENT,9[RNTa[N CAM ` _ ft-.2 29 57•.6 a• I 0 EX19TIN0 f[NCE G 4000 02 11 TS Oa 09 112 2O J31 a) ••al LITILI7T fAS[NLNT PARALLEL TO 107 LEN[ _■ 91 20 9 0 1& I -EXISTING 6/4.OIA 9T((L SAN 1 ♦ lI • •' 127.OIA X 30• iR•D[ GO ROUND STEEL R[IN FORCING MAR VICIMNG �w "j. 7 T 2 5 I 0 H•G s {J0a LEI a'/L./T. 2[T °� 167 S.17,16 4• ° ICI ALL OTHER LOT CORNERS aTAN[0 WITH.75'E 2♦•GRADE GO ROUND Ifs Q STEEL R[INIORCIRS GARS 1PE16MING Lt02 LIP 11./L.IT. wr AlL LINEAR N[ASUR[M[MTS NAVE SEEN MADE TO TIN NEAREST ONE �r SCALE IN FEET HUNDA[OrH or f007.ALL ANGULAR NEASURENINTS MAVE SKIM 1 \ MAO[ TO HE NEAR[5T 20 SECONDS AND COMPUTED TO THE 10a ! 0 $00 • VALUE& SNOTYN. + f Z 111/{EDaNaR N.9`•.T ST. EASIL-910T.Rt C011Otc IR VOIuNE rtcnor zr, 230.PASS 3121,OF[ To TNI►wus Ar A UNPLATTED LANDS_ t39r.a 19W ___-_---__-_. - WALK W♦1-&UGJ ECT TO R[rTRICT1Vl raV[RARr&. 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