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HomeMy WebLinkAbout020-1016-00-002 a O °� o N �Y m a - y C w CL O O)O CL O N O O (J CL o 3 ti o LL o X 3 , v bo rn Q I � 3 Cl) v d N Z H �I W E \\o _ p z a m rn N C14 C z p O Z � C f0n H r Iii 01 N ca O C C (D N N O O O •A, d N L_ R l4 N o Z 000 Z Z O O Z o I od _ � o v C> _ aI �+ z (•> > a o1j o E EECLmm V CL � , s B oco co 1V N N N N N E \ O O w N N m N C a (p O W O N p l W N C �i C `y O O (t1 C) (d �' w O N o lC0 a N N N N F- N N C O O C N . -0 N y 7 N O N N i. � O � N � '� Z C � FBI O N N O p O i J 0 � u CD UO) a y a � a �j *. ed v .c c °: C rr�� �1 A (.) CL 0 U) 0 PUMP CHAMBER r, 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 nearestl property line: Front, O Side, O Rear,Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: 1,K Length: �5 4 . Number of Lines: Area Built: Y Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Q Rear, Pt". -/0 Number of feet from well: 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: 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: III $ Inspector: Dated: Plumber on � ob: � Y m License Number: 3/84:mj j Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER " Oi✓ We, 16 ��v TOWNSHIP SEC �( T N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN JAL / r SUBDIVISION { • l�etCh1�V' LOT _ LOT SIZE PLAN VIEW 3 5 3 �� v. /Q. I`l s- - Distances and dimensions to meet requirements of I1HR 83 (7i ,,SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i � J �45 ! V` s'-- /0/ 1 =ttt��� IND CATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: />G Proposed slope at site: SEPTIC TANK: Manufacturer: �y ` ,.. Liquid Capacity: ;UOO Number of rings used: j Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest- Road.: Front,O Side Rear, O �Cj feet From nearest property line Front 10 Side,O Rear,o feet P./a Poo-k Number of febt from: well 1,oO building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE Parcel #: 020-1016-00-002 01/19/2005 08:31 AM PAGE 1 OF 1 Alt.Parcel#: 12.29.19.71 E 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 *MERTENS, KIP R&PAT KIP R&PAT MERTENS 1013 MOONBEAM RD W HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description * 1013 MOONBEAM RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.350 Plat: N/A-NOT AVAILABLE SEC 12 T29N R19W 3.35 AC SW SE LOT 3 CSM Block/Condo Bldg: 5/1417 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 12-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 03126/2001 641275 1607/134 WD 07/23/1997 1147/82 WD 07/23/1997 779/311 07/23/1997 733/78 more 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 47686 235,800 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.350 51,400 131,000 182,400 NO Totals for 2004: General Property 3.350 51,400 131,000 182,400 Woodland 0.000 0 Totals for 2003: General Property 3.350 51,400 131,000 182,400 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 305 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 001-WATER SPECIAL ASSESSMENT 0.00 Special Assessments Special Charges Delinquent Charges 00 Total 27.00 0.00 �QWNERS DRAWING OF HOUSE & SEPTIC S�STEM LOCATION TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes ❑No Soil series per SCS Soil Survey: � sheet # Type of soil absorption system: k elow grd ❑At-Grd ❑Mound Approx. size ' X ❑Gravity ❑Dose ❑Pressurized Ft.2 ❑Bed ❑Trench ❑Dry Well Molding Tank 00utfall pipe OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank sue) Setbacks: ❑House ❑Well ❑Prop. line a '1 ❑Other Dose tank Setbacks: ❑House_ ❑Well ❑P qp: line ❑Other ❑Locking coffer""N ❑Warning la�ael ❑Pump/Floats ❑Alarm i` � ❑Elec. wiring Soil Absorption System Setbacks: ❑House ❑Well ❑Prop. line ❑Other ❑Ponding: ❑Discharge: ��__.,�•� General comments: - � - , , t, INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title M gs- , .�. T. CROIX COUNTY r RECEIVED WISCONSIN AI'R 1 9 1993 ZONING OFFICE ~l'""'° },r vim"•` ST Cflax �.w CROIX COUNTY COURTHOUSE COUNTY ZO�.b�IGGt�p� FOURTH STREET • HUDSON,WI 54016 - _ (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM 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 a time when entry can be gained. 0 Water (VOC's) $185. 00 W Septic $25. 00 ❑ Water (Nitrate & Bacteria) $35. 00 (Visual inspection) Owner: 7"'A Requested by: Address A �l�', ,�,2rr , Address: City & State: J��„ �� _, V Lv City & St. , Zip Code• r,[,i 7j 6 Zip Code Telephone N4: Telephone N4: ( ) Property address (Fire N4 & Street) Location: ; , ; , Sec.�'Y T N, R W, Town of,> St. Croix Co. , WI. Tax ID N4 Parcel ID N4 _ 02- o - /�- -7 ,- House color: Realty firm: Lock Box Combo: Water sample tap oca i n: C S1� �q1 -7 .TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM Is the dwelling currently occupied? :T'Yes ❑ No If vacant, date last occupied: Septic system installed by: Year: Septic tank last serviced by: 2. Date: r Previous Owner's Name(s) : p TT#.. ) a e Have any of the following been observed? ❑Y Slow drainage from house. ❑Y Sewage Back-up into dwelling. ❑Y Sewage discharge to ground surface, road ditch or body of water. OY Slow drainage from the dwelling. OY Foul odors. Other comments relative to system operation: I certify that the above information ip comple a and/true to the best of my knowledge. OWNERS SIGNATURE: . � ! DATE: N U U m m M V L N M M M M M M J N J OM1 f., M W U U Q W m m W 6 WUm U co M QmQ Q Q m m W OJOVW Q U V U Q Q U W U U U W U N N V V M v OC Ix O L L m u ✓i > MW w v M_ CP m O fy0 _ v U A O C C ppl�y C N ,; M OC Y C Of �+ WJL O N •.-0..�. i0 J •E OCt� 'p T J C O O U 3 N ` D _W N OI L. Im pEl O L f0 • O 4 C7 Y N t .0 L = O --1 m �wa0+ A a xyG ce C C L) Cgc 3 rL-• .�i O LO .Y C. O J spa---•• m m m > L L L U 2 d L •L y C�,d O. N ow a �+ EN �E0 L. O 1. L C `r �+ m r OI G�W U a+ 0 L L . L.m L A V � C O C •C d ~ C QQ' >>N N O d d 7 Om W L Z Z Z Z O O O d d d dda YZpf pc y N N N tnN to N 4 gym. ] > 3 3 3 3 3 3 3 _00 O O $ O 00 U 0 O 0 W _ _ _ _ _ _ _ __ _ I ao 006 W ti O C— — — — — o 'NMl N3aaVM +Q tea. ALEXp�� �ZO al OVWf1S ��pp p b O 2 008 Oa A3NNIN I Vl k3NNV1 w p �y ON 3 �o _ 13WW O I p6 yr iH fn lIH 'Oa 3L 30NVO Vl N N 8 M 0 � p N x W O j w OOL as A1'13N — I 'oa N3�NbB � i 'Oa 11008 W L►J I N = m N S N IVI M I m 9 NCH Q •I w 009 � m vow WI bJ c=i v. VIOumv co DI b 3NbV b N 44 O~ a) � `'u N3Sa V l a b cF' I V7 O�VNO dv N -e oy N fn C w 4 a mpO�j �'Oa M31A i M J n V14 009 $ as A�IVa w J G�i''rtM� Tg d 00 c ssrn � _. a_��a1�Nnoo,I• S N QCROIX -7�I�PECEIVEQ ST. E 3 1 s`: St. Croix County Courthouse R(N w 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning Of f ice of fern the service of septic and water inspections to Lending Institutions, Realty Firms, and / private individuals. Completion gf this form Ja essential 22 that JtAhg =perty can. bg located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail , along with form to the above address. Testing will be done as soon as possible after fee and form are received.. WATER TESTING----------------------------FEE: $ 35.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: . $25.00 (Determines if system is properly function ng at ;time of inspection) PROPERTY OWNER'S NAME: PROP. ADDRESS: �O�`� /"//9���fg� � CITY Legal Description 1/4 of the 1/4 of Section , T N-R Town of Lot Number Subdivision: FIRE (ASR �0�� C BOX NUMBER Color of house 10 Realty sign by house?/,4-0—If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: Telephone Number REPQJZT TO B SENT TO: CLOSING DAT q�, Signature COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 FAX - 715 962 - 4030 _. ST. CROIX ZONING REPORT NO.: 39253/01 PAGE 1 ST. CROIX COUNTY REPORT BATES 4/09/93 COURTHOUSE DATE RECEIVED: 4/07/93 HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER: Steven Bierke LOCATIONS 1013 Moon Beau Rd., Hudson COLLECTOR: M. Jenlins BATE COLLECTED'+ 4-06-93 TIME COLLECTEDt 2:00pm SOURCE OF SAMPLE: Kitchen faucet BATE ANALYZED:4-07-93 TIME ANALYZEL':2:0Opm COLIFORM: 0 /100 ml INTERPRETATIONS Bacteriologically SAFE NITRATE-N: 6 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L ....0EDEAfh_ LAB TECHNICIANS Pas, Gane L v = WI Approved Lab Not 19 s f. A J Means "LESS THAN" Detectable Level Approved by PROFESSIONAL LABORATORY SERVICES SINCE 1952 (3 RECEIVEO N MAR 3 1 1993 ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse +� OI NTY w 911 4th Street ' �lT Hudson, WI 54016 �9:; ;S Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion 2f this form Ja essential 5-Q that �Q Vro_perty can bg located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail , along with form to the above address. Testing will be done as soon as possible after fee and form are received.. WATER TESTING---------------------- -FEE: $ 35.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) . SEPTIC SYSTEM INSPECTION-----------------FEE: . $25.00 (Determines if system is properly function ng at ;time of inspection) PROPERTY OWNER'S NAME: PROP. ADDRESS: �O/, /�//ryQ17 � j�� CITY Legal Description 1/4 of the 1/4 Of Section , T N-R Town of Lot Number Subdivision: FIRE NUMBER LOCKBOX IJMBER Color of house i0 Realty sign by house?/4-0If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOR, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged. by running the water for several hours before the test can be conducted. WINTER .TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: Telephone Number REPO T TO B SEGO 0: i q CLOSING DAT : 4/- q- signature GQ i�� x ST. CROIX COUNTY ta .. WISCONSIN ZONING OFFICE ST.CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 - (715)386-4680 April 22 , 1993 Steven Dierke 1013 Moonbeam Rd. Hudson, WI 54016 Dear Mr. Dierke: An inspection of the septic system on the property of Steven Dierke, located at 1013 Moonbeam Rd. , Hudson, WI was conducted on April 22 , 1993 . At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact his office. Si cerely, Mary J. Jenkins Assistant Zoning Administrator cj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABQR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 CONVENTIONAL ❑ALTERNATIVE State Planl.D.Number: t (If assigned) . ❑Holding Tank ❑ In-Ground Pressure ❑Mound NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: r Roger Hetchler R. R. 5, Box 5509, Hudson, W1 54016 Q;� a BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: jCSTREF.FI.ELEV.: " SW SE, Section 4, T29N—R19W, Town of Hudson, Lot- #3, Roger Hetchler Sub. r Name of Plumber: MP/MPR SW No County Sanitary Permit Number: Roger Timm 3224 St. Croix 74954 t SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: 0. L7 � OYES ONO DYES ❑NO BEDDING: VENT DIA.: VENT MATLL. HIGH WATER NUM 'ROAD: LINE ERTV WELL: BUILDING: A R INLET FRESH ALARM: J ❑YES ❑NO / ❑YES ❑NO [NEARIEST,,M © s /� DOSING CHAMBER: ILOCKING MANUFACTURER: TEDbING: LIQUIDCAPACITY PUMP MODE L. PUMP/SIPHON MANUFACTURER. PROW ED: PROVIDED COVER YES ❑NO ❑YES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL ROPERTY WELL ' P : BUILDING: VENT TO FRESH FROM LINE. AIR IN LET. (DIFFERENCE BETWEEN BEET ❑ PUMP ON AND OFF) DYES NO NEARES7 SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until fE? IE the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO.OF _ DISTR_PIPE SPACING- COVER INSIDE DIA_ #PITS- LIQUID TRENCHES MAT���IA L' "' DEPTH. GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR_PIPE DISTR.PIPE MATERIAL- NO. ISTR � ��+` PROPERTY WELL: BUILDING: VENT LE FRESH BELOW PIPES- ABOVE COVER. ELEV.INLET E V.END PIPES. LINE AIR INLET: ds Flo MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES 1:1 NO PERMANENT MARKERS: OBSERVATION WELLS SOIL COVER TEXTURE DYES ONO DYES 0 N DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED: MULCHED: CENTER: EDGES. ❑YES ONO OYES ONO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER I • ' TRENCHES: �P MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. ju,S,R.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.: ELEV.: CIA.: ELEV.: PIPES. DIA.: E �rj HOLE SIZE HOLE SPACING. DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: ®A ❑YES ❑NO El YES ONO COMMENTS: PERMANENT MARK : WELL: MARKERS: OBSERVATION WELLS: PROPERTY BUILDING: e 1 LINE: ❑YES El NO ❑YES El NO Sketch System on Retain in county file for audit. Reverse Side. SIGNAT TITLE: DILHR SBD 6710(R.01/82) I JOB ROHL & TIMM EXCAVATING SHEET NO.-I CF Z • 310 Arch Street Yn. D/p 7 HUDSON, WIS. 54016 CALCULATED BY �� ' "^ DATE / r 7 Z 2 Y y (715) 386-8664 CHECKED BY DAT p _ / SCALE 026- -71 l D l 3O1f YI l ' n iu Vic- sv�J�J . ............. .......... BIYI L _Ibo L z =c 6 km by ►m Y'a.uo 4 w . Av pNA• 4 o- - - . � V Y�IGG�I y/�\_ 9r, LIL Qv i a . q ........... Li PRODUCT 2041 ees Inc.,Grotm,Mass.01471. INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 ' To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment,30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system,circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis.Adm. Code will be applicable. 10. A new permit will be needed if there is a change in,estimated wastewater flow, (number of bedrooms,etc.), location of the system, depth of the system,type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan,drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate,tank locations,effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit.Private sewage systems must be properly maintained.Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years.If you have questions concerning your system,contact your local code administrator or the Bureau of Plumbing,DILHR,State of Wisconsin. wisconsin APPLICATION FOR SANITARY PERMIT p,� a� COUNTY 67) UN7�R SANITARY PERMIT InOt sTiV.LR BOR6 MUTin RELQT10n5 # —Attach complete plans in accord with s. H 63.05,Wis.Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROP RTY OWNER MAI ING ADDRESS PROPERVY LOCATION arm: b41i�SF S 01 h6 1/4, S , T2TN, R /7 (or TOWN OF: LOT NUMBER I BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D.NUMBER 3 /?/A r 9�6 �►�P�' x /� TYPE OF BUILDING OR USE SERVED /n��/ 1 or 2 Family Number of Bedrooms. 3 E-1 Public (Specify): /UJ4 THIS PERMIT IS FOR A: X New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. X_ Seepage Bed ❑ Seepage Trench U Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity AW FT Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 9 X 641� 6 7e- ;K Private ❑ Joint ❑ Public I,the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name qi lumber (Print Signature. MP/MPRSW No.: Phone Number: Plumber's rje�ss: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signatur of Issuing Agent: Fee: Date: ❑ Disapproved ❑ Owner Given Initial � Approved Adverse Determination .t Reason for Disapproval: Alternate course(s)of Action Available: i DILHR-SBD-6398 (R.5/82) 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. - - - - - - - - - - - - - - - - - - - - - - - - - -llrr- - - - - - - - - - - -- - - - - - - Owner of Property kTc Location of Property 3w ;, se T 1_ N - R 1 c' W Township /-1 12 Q S d Mailing Address kT Subdivision Name &?Gc 2 -��(L�� �y� y�rlLL.� Lot Number .3 Previous Owner of Property /�9e`2. G rt-z- J-x , Total Size of Parcel , j 5 l � { Date Parcel was Created AA LrN O CA�D Are all corners and lot lines identifiable? 1/ Yes No Is this property being developed for resale (spec house) ? _� Yes No Volume and Page Number L7� as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. • Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to. avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) eeAti.jy that att e.ta temen to on th i.a 6otm ate tAu.e to the beat o s my (om) knowEedge; that 1 (we) am (ate) the owner(A) o6 the ptopen ty des eh,ibed in thi.6 injonmation 4otm, by viAtue o4 a waua.nty deed teeatded in the 066ice o4 the County RegiAtet og Deeda as Document No. �lp L� ; and that I (we) ptuentty own the proposed 6 to jot the aewage diAposaZ byatem (ot I (we) have o tun with. the above dea cn ibed to on the obtained an ea.aeme►tit, � p ply, � 0 "c condttucti.an o aa.id a stem and the name had been duty teeotded in the ���. e y of the County Re u tvn o6 Deeds, as Document No. ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) � 8S DATE SIGNED DATE SIGNED v DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3-1982 THIS SPACE RESERVED FOR RECORDING DATA QUIT CLAIM DEED � J: r 18 PAGE 424 REGISTERS OFFICE �- — ST. CROIX CO., WIS. Roger E. Hetchler Jr. and Julie Hetchler, husband Recd• for Record this 15th -- ----- - ---- --------- -• --- ----- --------------------------------------------------------- day and wife,-_as point tenants -•_ -- y of Aug q,p. 1985 1 at 2:15 P quit-claims to __-Roger E Hetchler and Mar I. Hetchler, # a husband and wife ----------- James O'Connell 199bla of ----------------------------------------------------------------------------------------------------------------- • ` Qc�. `9 Deed ----------------------------------------------------------------------------------------------------------------- the following described real estate in _.-.St. Croix Deputy .......................................... Count y, State of Wisconsin: RETURN To Lot 3 of that certified survey map as recorded in Volume +' 5, Page 1417 as document number 393111, St. Croix County l register of deeds. �= It is agreed, if Purchaser, their heirs or assigns, con- Tax Parcel No: __ -...,.. structs a residence on the property herein conveyed, said Purchaser, their fiei'rs or assigns, shall assist in maintaining, repairing and improving of existing driveway, on a prorata basis, based on the number of residences using said driveway. As Seller is retaining property adjoining the property conveyed, it is agreed by and between the parties that if either party, their heirs or assigns, wish to have livestock on their respective properties, such party, their heirs or assigns, shall be responsible for payment and construction of all fencing. If both parties, their heirs or assigns, wish to have livestock, the costs of fencing and labor shall be equally shared. i is I� I i is not This --------------- ------------ homestead property. (is) (is not) 21st December 84 Dated this ........................................... day of --•••-••-- ......................................................... 19......... •------------- (SEAL) -------•----------- -- - ------ -- --- -•-•-( L) --------••--------•--------•----•---------------•--------------- ge Hetchle Jr. ----------------------------(SEAL) ------- •- --------•---•---------•••---•--- •- - -- - --•- •--(SEAL) i -Jiil. etclile E AUTHENTICATION ACKNOWLEDGMENT i Signature s ______________________ STATE OF WISCONSIN SS. -------------------------------------------------------------------------------- St. Croix ......................................County. 84 z 3!4-iiay iqf authenticated this�7.----day of_D�celnber._-.•-.•-, 19-..._. Personall came before me this ...______ __ _ _ � r--- •---- ----------- 19.�$rthe above named ------------------------------------------------• ------•- -----------------• �togex..E, - � �k�l * r��• , ' ------------------------•---- - - -----------------------------------------• .buskaz��l._end_��,.�:�--------------------,�:�-- - ..V..,,,.,....._ � s TITLE: MEMBER STATE BAR OF WISCONSIN (If not, .............................................. y' 1 authorized b- - ...................................................... �- ---t------------- -� ••• � �� y § 706.06, Wis. Stats.) r : 40 to me known to be the person ._._._•..__4twho;e�ecuted tl+e foregoing i trument and acknowledge;thosim� THIS INSTRUMENT WAS DRAFTED BY 0 �•• } North--Ea.9t._)?ea_lty.,__2191_Silver Lake Road, �/G If IY �� , 1-��_`" rr t�©. ''r}+ ' �- * --------••--•------ -• ---.. •.. -- P�- jNew__Brighton, Minnesota_ 55112 Notary Public _•_--_-- -• -._�_ o!-._ ____•_•-.County,+Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. are not necessary.) date.•--------------------------------------------------------- 19--------- jl JUIT CLAIM DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 3-1982 Milwaukee, Wis. I F � SLED .. � MA 8 of Oft CERTIFIED SURVEY MAP Located in the SE 1/4 of the SE 1/4 and in the SW 1/4 of the SE 1/4 of Section 12, T29N, R 19W , Town of Hudson, St. Croix County, Wisconsin Surveyed for: B. & H. Excavating APPROVED 836 St. Croix St. No. ' Hudson, Wi. MAY 0 8 1984 N 1p% $1. C 2OIX COUNTY 1p,� cownVIENSIV! PAWLS PLANT" m m a 'a A tOrNNG GONW� P.cow m Din N62o A-4 i a• ••ti�•• BOO /JAW mz m i_�,y`t M• �^ UNPLATTED LANOS zo 31 p p .001 fA C-4;0 •+ N0 •..7.��.'U w. a�H Izz cn 145,961 SQ.FT. o z z r 3.351 ACRES 0-m Cl b o T (r X20 a o�� Dry In o = 2*joa '�'► ^ 105,884 SQ.FT. 1 O N 88°32'39"W 2`I' 2.431 ACRES o �'A z m oo rte? 343-3d 2 z Z ro ryb. a� 0 0 9 8°32' E = stir Fi i I-4 320.66 \ 2 d 0\ �► Ab -1 X. 159017'4e c \hh b� 1O • N 88°32'40°W �� 0 a'b b p0° i^ J Ir 387.88' a. ? II8 437 90.FT. Iz ! i9 i 2.l�73ACRE3 -4 u t I \ 10 �p v ?J 00, FENCE \ \ 00• O �N� 969°s7'� b 6"E 66' roadway easement �° b P\ 9 (R)EAST ti NZZJ'; Certified _Survey Ma y 4 156°28'53' G8 8a V_ol_._l,Page 174 - 507,028 SQ.FT. 11.640ACRE3 oai z INCLUDING PRIVATE ROADWAY O EASEMENT o 6' T-0F-WAY LINE 001 d i NORTHERLY RIG H- 163.00' SbPOINT OFBEGINN$NO 1071.32' I a S 1/4 CORNER SECTION 12 -r' S.E.CORNER LOCATION FROM TIES-CORNER ��f SECTION 12 FALLS IN LAKE / a, i T29N,R19W. NOTE, THIS MAP 15 INTENDED TO REVISE AND REPLACE THAT CERTIFIED SURVEY MAP RECORDED IN VOLUME 5,PAGE 1388. SCALE IN FEET 1"=200' 200 100 0 200 400 LEGEND • I"IRON PIPE FOUND SECTION CORNER MONUMENTS SERNTSEN CAP NOTE:THIS MONUMENT NOT 0 OX 24"ROUND IRON PIPE WEIGHING 1.68 LBS./ SET DUE TO ITS.FALLING LINEAL FOOT SET IN THE ROADWAY (R) SLANT DATA INDICATES PREVIOUSLY RECORDED 9eO INFORMATION oo 019 3/4"STEEL BAR FOUND a�� 46-72' 'r A..J EXISTING BUILDING /69033, �9� NSI°32�51nE w O9, V O Page 1417 N STC - 105 r 4} H E t s X� SEPTIC TANK MAINTENANCE AGREEMENT o ? St . Croix County z d a OWNER/BUYER (i ROUTE/BOX NUMBER / ' .� Fire Number � CITY/STATE cjJ ZIP PROPERTY LOCATION : _'L, SL 'k, Section, T 9 N, R� W, Town of St . Croix County , Subdivision , V V QZ � �Ca(*a0t' number 3 -r I Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper . What you put into the system can affect the function of the septic tank as a treat- i ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for ° of a cost of a maximum of 60/ the replacement of a failing system,p was in operation prior to Jul �---, which erat P P Y 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. Ho E I/WE, the undersigned, have read the above requirements and agree cz„ to maintain the private sewage disposal system in accordance with x H 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 . SIGNED l� DATE t 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 . ° N .+ .-► N N N 3 O NQJ N 7 CDCa a `< O O ° g Noa ° 'cf° � 0w � w O cu v a N CD n N N = N m C 5 a v 0 a 7r M w w A OD CD tC _ CD CD Cl. N : =1 qto 7 (� .. ? n O CD CD w t° 03a O M ccco0 �' OO � .. 3 ° 0 c S. 3 0 aO 5 �� msowN CD N p N C -- >o N Q to cr o. u (CD co C O D_ C 0 n O N O n rt a = 0 to - w c ° o. a00 C N a p! (OD t0 7 :r'O m W N co Z D ON �D NcDwCDg t7 Z CA CD mM -D3 -+ e M C iD w 0 ? o CA CL cr CA CD 0 060 mow ° va0 � � ? C� 3m ° ^' O N m -- � ••* a t0 —.fin-. � C-►tp. rt 0 ? N C O n m o0f � - 0M° tn0 w ?2. 0 a CL n £ a ? y _ ° S C co 0 to 7 O y N CD 0 �p r n C CL 0 w Q a ° ° � _00 3 a c 3 c > O r- 7 a CD a 5a O < w ..w CD 'Z CD MIN- ...fs . PORT ON SOIL BORINGS AND SAFETY& BUILDINGS RE 1vlsloN DEPARTMENT OF i P.O.PO BOX 7969 INDUSTRY, PERCOLATION TESTS (115) MADISON,WI 53707 LABOR AND HUMAN RELATIONS W68,pg(i)&Chapter 145.045) t_ A t TOWNS I T NO.:BLK NO.: SUBDIVISION NAME. ,W 14'L1/'4 1z I�N��/9if tor a&�vv / � r�17 COUNTY: "fog NUI t15.C)N S'r CRolx �WxYgT►ley' 836 DATES OBSERVATIONS MADE E 5: Is tRstidenq a ' .New ❑Replace 'SEAT. 29 /t)a< Qcf Z , r�Q� Un,K n ` coCZ- cNt-rE {�j�QKNnr2l1->' RATING:S-Site suitable for system U-Site unsuitable for system 1fj M- -FILL OLDING T NK:RL . ,MMENDED SYSTEM:(optionall L�S ❑u" M .'oU ❑s ❑U ❑s U <ONVC.Nrr6NA 41f Percolation Tests srt NOT required DESIGN RATE: if any portion of the tested area is in the , / /1 under H53.091511b1,indicate: ,LASS Ftoodplain,indicate Floodplain elevation: N /y s. PROFILE DESCRIPTIONS �fG !BORING A -1 CH A A OIL WITH HICKNESS,COLOR,TEXTURE,AND DEPTH 'NUMBER ELEVATION T BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.)ERVCIZ 0-67 kLL -A,-,a�L /.4-z.7 �• 46� 3.�-7,�r.•�ISiGrc7.s-iD�� MC��S B- Z TZO 9a..s-� NoNb 7 7.zo s•s-�Z '011i{ PN ,,,o�r t <r. L 0,7-1.1 $2N S L�GQ /•�-6 7 StG� Cnn, �. 3 g.So' 9`.a'7, NoNi: ?g,so 6'-81.s 'S d JP 6 1 B. 4 /•O,O . > 7.60 6.1-7.p hie. 6t �ce,� 0.0.5 L tl q.o - -t Ge c�r� 4 coo (B- 7.*< :89.'-z I' N4N9 >"7.50 B. T PERCOLATION TESTS HOLE I RATE MINUTES TEST NUMBER PTH APT N L INTER VAL-MIN. PER INCH P. ► "A 8.7(i d I /' 4 I' 6 y.4 P. z 3.67'.. 1'/ I L4 r /'Z P. P. Leda-rib.) P. 'LOT PLAN: Show 10CStiM of PW001e4110n tasa,0011 borings end the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori rontel and vertical eeaatlon 1iferanae poiftts and SIMV dtair location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. `SYSTEM El"A'TON Qz.ao' t ct: Wills-rl►NI;< oc L.oT 3 i *' 40 L ,e Ass:' i �• i I,the undersigned,hereby tleetafy that the WWI tee reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Cbda,WW that dW drb t6a4rded and the location of the tee"ere correct to the best of my knowledge and belief. TESTS N pr t): R COMPLETED ON: �! t 1 ',�/ CERTIFICATION NUMBER: PHONE NUMBER(optional): ?�L tFT$4 37 1 0 '1 N /`►UQ� V YY 1 4616 A C� S�eC� 5.S41C MT S TORE: =vim! nISTRIBUTIONt Orioinal.Wdbttd rite,Property Owner and 5611 Tester. - r W% PAGE OF IYe Cro5S See4ton O � A Ze0 Syster" r Fresh Air Inlets And Observation Pipe (�—Approved Vent Cap Minimum 12"Above Final or ode s 20-42"Above Pipe _4"Cast Iron To Final (trade Vent Pipe Merth May Or Synthetic Covering Min. 2"Aggregate Over Pipe 01strlbullon —Tee —' Pipe 0 0 .--a 0 i Be Beneath o Perforated Pipe Below eoth Pip Pipe t o Coupling Terminating At Bottom Of System J • r `9 re cl{ r/ 1 SOIL FILL DISTRIBUTIOF,1 PIPE APPROVED S4MIETIC COVER ° MATrp \1_ OR 9rr OF STRAW Z"OF/►6GREGATE, -�� / OR MARSH HAy e for 0 F1Z-zi/2 AGGREGATE �LEV. OFI�' FEET� i -d: DIS'►-RIF-�UTIOkj PIPE TO BE AT LEAST /2 INCHES BELOW ORIGINAL GRADE AND AT LEAST20 INCHES BUT MO MORE THAM 42 IAICHES BELOW FINAL GRADE MAXIMUM OWN OF EXCAVATim►j FKoM oRi&OJAL 6KAoF. WILL BE 0177 INCHES M141MUM 9EPm OF E'XCAVATicM FROM *41I AL GR49€ WILL BE L(,27 INCHES SIGNED: LICENSE DUMBER: r DATE :