Loading...
HomeMy WebLinkAbout020-1183-50-000 vN " p 6 Q; 0. a I 0 N 1 ti I I � I o ' a m a � N I o ,a Z y m LL a 3 - N rn v rn Cl) 3 z o'IT N FN- Z a m c � I O Z c � o I N O Of 7 cL O C O O O N N d � L IBC f0 N 1� 0 O Q -_ 0 w `� O N O Z m Z 0 Z o N N Z I 2 0 m c > „ _ d o a E •� i CL LO Loo FL U) ` J '` = aaa 0 � n mJUX ° co LL N N - 0 C O � _ 0 N N V _ = O C N C m a � I = rn (D O� '- tn N N N - ,L o ; _ ca m �n o v }0 G In o LO o = = o a °0 0 o N N M 0) O O y Z Z L N .Q+ = E E C L r Qo N 2 N O Z L F- F 2 (n Aj r at o a CL rr�w1 y E v '� c _1 A cia � j' 0QiL) Parcel #: 020-1183-50-000 01/07/2005 04:26 PM PAGE 1 OF 1 Alt.Parcel#: 20.29.19.1155 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 * ANN E,&KAREN A EBBEN NEIDERMIRE NEIDERMIRE,ANN E,&KAREN A EBBEN 484 FOX CIR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *484 FOX CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.670 Plat: 2328-PINEGROVE HEIGHTS 1ST ADDITION SEC 20 T29N R19W NE SE LOT 15 PINEGROVE Block/Condo Bldg: LOT 15 HEIGHTS 1ST ADDITION TOWN HUDSON Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 982/251 WD 07/23/1997 816/209 07/23/1997 794/303 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 49195 204,200 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.670 26,700 131,300 158,000 NO Totals for 2004: General Property 1.670 26,700 131,300 158,000 Woodland 0.000 0 0 Totals for 2003: General Property 1.670 26,700 131,300 158,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 221 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 COMMERCIAL TESTING LABORATORY, INC. `T 14 Main Street, P.O. Box 526 ax, Wisconsin 54730 715 962 - 3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.: 30921/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 10/19/92 COURTHOUSE DATE RECEIVED; 10/15/92 HUDSON, WI 54016 ATTN: THOMAS C. NELSON r; --7 OWNER: James Omland 162 -79 LOCATION: 484 Fox Circle, Hudson COLLECTOR: M. Jenkins DATE COLLECTED: 10-14-92 TIME COLLECTED; 2:45pm SOURCE OF SAMPLE; Outside faucet DATE ANALYZED210-I5-72 TIME ANALYZED:2:00pm COLIFORM: 0 /140 ml INTERPRETATION: DacteriologicaLLy SAFE NITRATE-N: 4 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 mL Nitrate-Nitrogen, mg/L 0 O Nk r-3 to 9p C-) r LAB TECHNICIAN; Pam Gane WI Approved Lab No. 19 < Means "LESS THAN" Detectable Level Approved by; ST. CROIX COUNTY ZONING OFFICE • � St. Croix County Courthouse A 911 4th Street Hudson, WI 54016 lTelephone - (715)386-4680 he St. Croix County Zoning Office offers the service of septic water inspections to Lending Institutions, Realty Firms, and private individuals. Completion 21 this form I& essential &Q that -the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail , along with form to the above address. Testing will be done as soon as possible after fee and form are received.. WATER TESTING- --------------------------FEE: $ 35.00 3 S' or nitrates and coliform bacteria) WATER TESTING FEE: $185.00 SEP --- FEE: $25.00 (Determines if system is properly functioning at .,time of inspection) PROPERTY OWNER'S'/NAME: �R��5 ©/Kj 4D PROP. ADDRESS: ^Fg41 t7JX C4(leejr-- CITY_4DSOA-) Legal Description 1/4 of the 1/4 of Section , T N-R Town of Tower rJIS�c�Lot N tuber 1�Subdivision: Au 6 �WJATS FIRE ER '�- o N $3 -S�-5 Color of house ,6d�tx+�4 Realty sign by house?�_If so, list firm: �/S�' �64),4 aQe PLEASE INCLUDE, IF AT ALL POSSIBLE, A NAP,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: = �T"��£�I 'Ty Telephone Number - 9 REPORT TO BE SENT TO: CLOSING DATE: + • Signature ST. CROIX COUNTY . • '� WISCONSIN ZONING OFFICE r Ay. ST.CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 (715)386-4680 October 15, 1992 Kernon Bast V r Edina Realty : 700 - 2nd St. Hudson, WI 54016 Dear Mr. Bast: An inspection of the septic system on the property of James Omland, located at 484 Fox Circle, Hudson, WI was conducted on Oct. 14, 1992. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Sincerely, Mari Jf Junk'ns Assistant Zoning Administrator cj k g h �, T��"{ ' x t � J�711,: �'If Y ��4 ,r ,�aQ� -p.'�M � t • t f�'�• k )F " n K 4�y t t•Ct it ,t':' r �' F � y% 7 t K A. � :� �s✓ Fni �+ � °�b� �Gt�y� ..NdMll560 �7b0 +{�n' �i Y��, P-4 '•`� T.!,' II W y, .,,• y"S 1". V�"• t..�,�3G 'G� •�t` r�i'� '� t y � yi kt-s 7 'r t ': r: Cr k Y +f's • ) � i rr n f'EC• e?,? r• - x n '� �"c ° !�. �•�''''� �� �k Si �Y 7 ¢kf. 7r y w; Pi Ji' 5r `iN�j� ?i*^a������rt��+�fy;��: �H �R� �•, `��if'� K al"C��k'( .B'ti�����7�'��"' � t�'`�` �„7� � � ' s�7a :,� di. •�' ' ;¢w�°'''��`' ��t +-A ro F 4$ y # ��" k ..t;� e�,rra r''• clf+t v + i .,7� :� �1 'r+"n Nib IL SOT w 4 " "n S i" Y 7 yO �4g>, ! � "� ^A � �•� Wit+ �R r A p � ��b:p ;.�' •'t� � R t.` s'7 i:,r '� �r�rY ,�t}.N A Y 1:;�i�fc•j� `y. �r,Y Z��IW? � r}� •.�„���` t �. x ■ ' � t „ '. � �.�� � � � N �� ,y5 F / �' �� 'S°�r 1� :U x yfl. � Il f u ..• 4,�'�•t` a,;.: f � � ��.� �y I t _ • � ri9r .! � Tl�� , � y M t+L x ; a w L- �: _ r, `• w A v ',ts.. "�'J`.. r*.a t `"z.: r�.,*, r'. " � ),`v IN IF ti:I i r T 4 � yy � sy r r a f, • M-w•• s 'a.lei v :� � *,�, '`r� Z� iA 3!n. �� ;'�, � � w'��`� y �"Y � �s 4° t,; } r; 9u A- et*' :4"• k"r v a,,. �t. ig � �� v� �� t�,rF .��'^� � �S k.. S ; R.. �'. s.�� t�' �z �'� t k S.M; ; ;if�■'� � erg �°. n �t *f T4� Y � 1 b ,e M !I� 4 r vvn sv t.,E ;« �g BYgn ,r' f sh c ¢kja,} u e'pt �� t �� {� �` P� � ��yy Sf�' ���* f t� �^ � + :�'�wtl$�r'',• • 6r' $ '�� a ♦1�� Y� {:'�T 'tr W3",�l�' rfr f; 'S+�'7}. A k��"��, " FF Wy *' Rl qx � Ki p ###t33S yy yy O Mil yy�n �t3ed.!� �• c 9 D ' ;$' • # fy j*�yy`'.i°��N t+i. 1" 4Q7 l f ¢ : Jn xz, �. 1r1: rA ,d S N #1 ar..'F 'A�+ K: Qt. .. ,{ ! ':. i S 7¢M s s ''k 7 S` A 't S� :�' ,,• .1 lia ^!` Z►,y'� .:'s, Q 7 yl.. y i<:. '.:{. p v! ,x •Tw "",F�+z d r � �,O Sk�`�.'�fiZ � IM•°„iS- of f11777fff W�s � *�'�" � r1�� j� RJ:., �`,xS'"✓K t rfy f�� ���' 7J! �h A,.�i r ��k� � ��� i� r r{rte��� .1tJ+l mmm�m Nam PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Mod Pump/Siphon Manufacturer: um p Size Elevation of" n Bottom of tank el on: Pump off switch elevation: G ons per cycle: Alarm Manufacturer: rm Switch Type: Number of "feet from near property line: Front, Side, O Rear,0 Ft. mber of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: 1Z Len$th: S Number of Lines: _ Area Built: 4z y Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,Pt . .3i� Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT ize: Number of pits: Diameter: Liqui the Bottom of seepage pit elevation: Area Built: Has either a drop box O o distribution box O been used on any o he above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Ca ty: Number of rings used: Elev on of bot of tank: Elevation of inlet: Number of feet from near property line: Front, O Si Rear, 0Ft. ber of feet from well: umber of feet from building: Number of feet from nearest road: arm Manufacturer: Inspector• Dated: ���� ��a' 7 Plumber on job: Aal ,. — License Number: ,?2 p 3/84:mj Form - S T C - 104 A AS BUILT SANITARY SYSTEM REPORT OWNER J& 7"77 TOWNSHIP f� D s o�u�' _ SEC. T N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN Sy__w RSRr SUBDIVISION(/'/AtAr ,e aU LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM EL.bO.o N art �R Seep Jyc rT� � � rx�s� �gd 9S, 43 r 1 1 .. L f no �b . yo' u� aE �.*c INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used A(W L,a T S r_*)tt' Elevation of vertical reference point: 0611 0 Proposed slope at site: % SEPTIC TANK: Manufacturer: GV49�eIr`S Liquid Capacity: / ®Q Number of rings used: / ,60M&F Tank manhole cover elevation: l0 y,2 Tank Inlet Elevation: 400 Tank Outlet Elevation: 100,60 Number of feet from nearest Road: Front 10 Side,\,31 Rear, O &jq feet 0 From nearest- property line Front 10Side, Rear, 9� / feet Number of feet from: well , 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 Ir,ASOR&,HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O'..BOX 791619 BUREAU OF PLUMBING MADISON,WI 53707 NEB, SE�4,S20,T29N-R19W MCONVENTIONAL El ALTERNATIVE State Plan I.D.Number: III assigned) Town of Hudson El Holding Tank ❑In-Ground Pressure ❑Mound Lot 15 Pine Grove Heights NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DA E: 7 John Schmitt Route 2 Box 295A Somerset 3'3L BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF,PT.ELE V.. Name of Plumber JMPIMPRSW No.: County: Sanitary Permit Number: Donavin Schmitt 3205 St. Croix 102791 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKI NO COVER a / PROVIDED PROVIDED l( O U 0 d. I SOS VYES ONO ❑YES 3TNO BEDDING. VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WEL BUILDING.(VENT TO FRESH ALARM. FEET FROM 2- 10 `INI �� AIR arL DYES NO C ❑YES NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING'. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ON O ED YES ONO OYES ❑NO GALLONS PER CYCLE: JPUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM `I"E AIR INLET PUMP ON AND OFF) —]YES NO NEAREST 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 FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH IND.OF DISTR.PIPE SPACING COVER INSIDE DI A SPITS LIQUID BED/TRENCH TRENCHES r M RIAL: PIT DEP H DIMENSIONS /.2 S� — (� GRAVEL DEPTH FILL DEPTH DISTR PIPF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DI R. NUMBER OF PR OPERTV WELL BUILDING V NT TO FHESH BELOW PIPES. ABOVE COVER ELLEEV/.INLEpT ELGEtV.END. o, PIPES LINE q AIR I T-} ./ 3 IIa.S D I 3 2 2 / Z— NEAREST— MOUND 3 L 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 ONO SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WE ILL ❑YES ONO ❑YES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDEU MULCHED CENTER EDGES. OYES 1:1 NO 1:1 YES ONO 1:1 YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR [STR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV. ELEV.. DIA. ELEV.. PIPES A: EL EVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO 1:1 YES ONO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS'. NUMBER OF PROPERTY WELL'. BUILDING. FEET FROM LINE DYES El NO OYES 1:1 NO NEAREST Sketch System on R tain in county file for audit. Reverse Side. SIGNATURE. TITLE DILHR SBD 6710(R.01/82) Zoning Administrator INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1 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 fwmit issuing authority. A new-permitrgay be needed if there is a Change in yo'ur building plans, system Ideation, 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 6359) to be submitted to the county prior to installation; 5. Private sewage systems must be-properly maintainedaThe septic'tank(s) should be pumped by a-licensed_ pumper whenever necessary, usually every 2 to 3 years; 6. if you have questions concerning your private sewage! system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. - To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be r installed; ll. 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 a//septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from Dll_HR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g.. . MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'h x 11 inches must be submitted to the county. The plans must include the following- A) plot plan;-drawn.to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;- streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump"model and pump manufacturer; D) cross section of•the soil absorption system if required by the county; E) soil test data on a 115 form` GROUNDWATER SURCHARGE On May 4, 1984, 1983,Wisconsin Act 410 was signed into law. This legislation is more - commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public,debate: The groundwater bill included the creation of surcharges (fees) for a number of regulated practices which Ground 2itei• can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that Wine in`� is used in your building is returned to the groundwater through your soil absorption buried reasttre system or the disposal site used by your holding tank pumper. ° The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- . ...... ... water, groundwater contamination investigations and establishment of standards. Groundwater, t it's worth protecting. SBD-6398(R.03/86) SANITARY PERMIT APPLICATION COUNTY DILHRIn accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# —. � �.�. /c)a y9i —Attach colSiplete 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. FFOR TION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. VARI ANCE ❑YES NO PROPERTY OWNER PROPERTY LOCATION G ,ff'/4 F '/4, S Q T , N, R E(or PROPER Y OWNER'S MAILING ADDRESS OT NUMBER BLOCK NUMBER SUBDIVISION NAME s CITY,STATE ZIP CODE -0 CITY NEAREST ROAD,LAKE OR LANDMARK VILLAGE: AM II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. � 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. 1�Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. rA Seepage Bed b. ❑Seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): 9(!r 53 Feet Private El Joint El Public VI. TANK CAPACITY Prefab. Site Fiber- Exper. in al Ions Total #of Manufacturer's Name Concrete Con- Steel glass Plastic App INFORMATION New xisting Gallons Tanks structed Tanks Tanks Septic Tank or Holding Tank ❑ ❑ 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): Plu r'-s Signature:(No Stamps) PRSW No.: Business Phone Number: Plumber's Address(Street,City,State,Zip Co e): Name of Designer: i VIII. SOIL TEST INFORMATION CST# Certified Soil Tester(CST)Name CST's ADDRESS(Street,City,State,Zip Code) Phone Number: e ILE Do, Maw ! IX. COUNTY/DEPARTMENT USE ONLY Issuing Agent Signature(No Stamps) ❑ Disapproved nitary Permit Fee Groundwater ate g g g t� rcharge Fee Approved ❑ Owner Given Initial I ao.� 4 t"',� ja_vA j— 7 Adverse Determination d� X. COMM /RE ASO� DISAPPROVAL: P l aK an �Or 41 A ln+n K lJo A---, 'q6398(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 �& S-c&tu r r- Location of Property ��_k c �c, Section _ !, T...,�;�N-R W Township AM 56,& Mailing Address 1?ri '768/E= !rge7 T Z40f' Sy®2 s" Address of Site �T 5 Subdivision Base /Ata7 Cr AQ V,6i:- j Lot Number Previous Amer of Property kte_10"o STC1ts l Total Size of Parcel 7 Date Parcel was Created Oc.T. L98- 7 Are all corners and lot lines identifiable? x Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number ''= as recorded with the Register of Deeds.. INCLUDE WITH THIS APPLICATION 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 IWO cutti.6y that att statementh on thi akm ahe thue to the best o6 my (ouh) hnrwtedge; that I (we) am (ane) Vie owneh(b 1 o6 the pnopeAty dens C i.bed in .th.i a .in601mation 60nm, by v.ihtue o6 a warranty deed neconded in the 066ice o6 the County RegihteA o6 Deectsah Document No. �r������s and that I (We) pnesentty avn Use pnopoaed Aite bon the sewage di6po-sat byst (on I (we) have obtained an easement, to nun with the above deAcA.Zbed pnopeJrty, 6o& the eonathuc ion o6 ea.i.d eystvn, and the name hae been duty neconded in the 066.ice o6 the County Reg.iisteA o6 Ueede, ae Voemeent No. SI TURE 01 OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 194PArit F103 REGISTERS OFFICE R c hard n- Rtnuti janpt p Stout and ST. CROIX CO., Wt& Maud T4. 9 t nu t Redd. for Record this 21st day of Oct. A.D. 19j7 An- conveys and warrants to John Schmitt 11:00 behew of RETURN TO the following described real estate in 6t. Croix County, State of Wisconsin: Tax Parcel No: Lot 15 , Plat of Pinegrove Heights First Addition, Town of Hudson AF O This i S riot homestead property. (is) (is not) Exception to Warranties: Dated this day of October 19 87 • i (SEAL) —(SEAL) Janet P. Stout Richard 0. Stout (SEAL) ti k) . Maud H. Stout by Richard 0. Stout, P.O.A AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN SS. St. Croix County. authenticated this day of ' 19 Personally came before me this 20th day of October -11987 the above named Richard 0. Stout, Janet P. Stout and Maud H. Stout by Richard 0. Stout, P. 0. A. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person who executed the authorized by§706.06,Wis.Stats.) foregoing insItaupent and ac ed the same. THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout Notary Public St. Croix County,Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: Jan. 1 ' 19 _89 'Names of persons signing In any capacity should be typed or printed below their signatures. NTF 2280 STATE BAR OF WISCONSIN WARRANTY DEED Nelco Forms,P.O.Box 1075,Green Bay,WI 54305-1075 Form fdn 2 198 H ' z En y 9 r ST C - 105 r" 9 • „ y SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d 9 y OWNER/BUYER �N ffN//TT ROUTE/BOX NUMBER /?j', Db)c 229. 'A Fire Number CITY/STATE �0/�/E?Q� ,� G01** !r ZIP 'yd2 s PROPERTY LOCATION:-6, Section, TJF ..N , R _W, Town of ��►a�'p/�/ St . Croix County , Subdivision �y� Lot 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 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 , 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 y three year expiration. E z I/WE, the undersigned , have read the above requirements and agree x to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- 'b 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 DATE 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 . ^ ^ ^ INSTRUCTIONS FOR COMPLETING FORM 115- SBD - 6395 To be complete and accurate soil test,your report must include: 1, Complete legal description; 2� The use section must clearly indicate whether this is residence n,00mmonia| project; 3. MAXIMUM number nf bedrooms o, commercial use planned; 4. b this a new or replacement system; 5. Complete the Suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED 0N SOIL CONDITIONS; O, PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to ooa|n is preferred. A separate sheet may be used if desired; 8 Make sure your benchmark and vertical elevation, mfe,ono* point are clearly shown,and are permanent; S. Cnmn|*n all appropriate boxes as to dates, names,addresses,flood plain data, percolation test exnmp' don' ifupproprime; lU. If the information (such as flood plain,elevation)du+s not apply, place N./\.in the appropriate box; 11. Sign the form and place your ou,m,u address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS 0FCOMPLETION. ABBRE\/|/\T|(]yJ8 FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 1O'') BR — Bedrock cob — Cobble (3 70^) 38 — Sandstone O, — Gravel (undor, 3^) LS — Limestone °o — Sand HGVV — High Groundwater co — Cuurxo Sand P,,c — Percolation Rate medo — Medium Sand VV — Well fs — Fine Sand Bldg — Building Is — LunmySmnd > — Greater Than °d — Sandy Loam / — Less Than °! — Loam Bn — Brown °,i| — Silt Lnom B| — Black si — Silt Gy — G,ay °c| — C|ayLoom Y — Yo||uw sd — Sandy Clay Loam R — Rod nid — Silty Clay Loam mot — Mottles ao — Sandy Clay vv/ — with ' mio — Si|tvCiav fff — fnvv. finc.foint ~c — Clay cc — romnmn,coarse pt — Peat mm — Many' medium m — K4uck d — distinot v — promincnt ` HVVL — High water level, ° Six general soil vexmm, surface water for liquid waste disposal 8K4 — Bench k8ndk VRP — Vertical Reference Point TO THE OWNER: � This soil Lost report is the first stop in securing a sanitary perr-nit. The County or the Department rnay request vo,Kioadon of this soil test in the fidd Ario, to pert-nit, ioounnCe. A complete set of plans for the private swaee svoem and c vorm(t application must be submitted to Iha appropriate local awhoritv in order to ,obtain a permit The sanitary marmi, mu­t baobzo|ned and Posted prior to the start of any construction, r J� INDUS DEPARMEW OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUS DIVISION LABOR AND PERCOLATION TESTS (115) MADISON W, 53707 HUMAN RELATIONS (H63.09(1)&Chapter 145.045) � 4 r LOCATION: ,,// SEC ION: TOWNSHIP/ LOT NO.:BLK.NO.: SUBDIVISION NAME: NE '1 S�/4 20 /T 29 N/R 19f (or)W Hudson 115 n/a Pine Grove Ht s. COUNTY: OWNER'S NAME: MAILING ADDRESS: St. Croix Richard Stout R.R.#2 Box 340 Hudson Wi . 54016 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILED CRIPTIONS: 0 ATION TESTS: ®Residence 3 n/a ©New ❑Replace 10-2-87 10-2-87 RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) CAS ❑U @I S ❑U ®S ❑U ❑S EU ❑S IE conventional If Percolation Tests are NOT required DESIGN RATE: (If any portion of the tested area is in the under s.H63.09(5)(b),indicate: n/a Floodplain,indicate Floodplain elevation: n/a PROFILE DESCRIPTIONS page 58 'RRC2 BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 1 7.08 99.10 none >7.08 .83bl.1. .25bn.l.s. 6.00bn.c.s.&gr. B_ 2 7.00 99.10 none >7.00 .75bn.s.l. 6.25bn.c.s.&gr. B_ 3 6.83 98.53 none >6.83 1.00bn.s.l. .33bn.sil. 5.50bn.c.s.&gr. B_ 4 6.58 97.00 none >6.58 1.08bl.1. 1.00bn.sil. 4.50bn.c.s.&gr. B- 5 6.67 97.05 none >6.67 .92bl.1. 1.50bn.sil. 4.25 bn.c.s.&gr. B- decimal' PERCOLATION TESTS TEST WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER DEPTH AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH P_ 1 3.57 none 3 6 6 6 <3 p- 2 3.57 none 3 6 6 6 <3 P_ 3 3.00 none 3 6 6 <3 P-- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 95.53 1 © 5� — , ? i _ - t_f ( � gFi ` r ' i 1 ( i i � � � '� �r"r � �� � � p _ _ t3 TN 71j. 1T 1 j . w -- _--_ I 0 VAV 1,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WERE COMPLETED ON: Gary L. Steel 10-2-87 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 988 N. Shore Dr. New Richmond, Wi. 54017 2298 171 246-6200 CST SIGN E: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. 0ILHR-SBD-6395 (R.02/82) —OVER — i iIi ii� i I � ii � l . _ � i a Il i � iI1iIJ ' � ; iii 11 � � + i4 ' II1 3 fI41 :J � i ail � i � li . � � � it 1 , . ' ' r Ii I i1I r � 'ire } I � i i ' � 1 , , I ' '� 1 r , � I � � ' � iT ,_ � _ II: ' � h � i 1111 i � I T i II ail li ' i � i ii Ii , it i � I i 1 i i 1I I� Ji I II III ' i MEN MEN MOEN MEN lk JOL SIZE mmomm mmMMM gg