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HomeMy WebLinkAbout020-1183-70-000 a o II e 0. 0 M � I I 0 � II C i .o I � I I � I fl Z C = N LL O Q 3 � V N E w a m N F Z C 0 O z c N Z ZE US P c a � hhww N CL m y 4) N •W46 d L O y Q Q N z m z N y w = « m Lo L 0 > iI � a - O` y d N \.11l v d H FN- = V CL U) •P%4 � aaa CL_ a 0 � v) l,j � rr� M W N N C7 0 O N N N _ cli O O = N a N N 0 m y tT N r LO l0 p d Q } to Q U) _ Y! V1 O O O O y C O O C 'O V d = N a O �G+ � N N C C V a 0 0 0 0 l Y+ M U 0, VOl _N lV N N N N v C 00 O) d' N N O 7 N N - 6 01 FB4 I 6 N 'y0 = ^ r0+ 7 E E C L • N O = O O O y O O U O N = (n O Z 2 O = E I CL 3 # a L a • e4 CL m .2 m r- 0 CL 2. ; oU) (3 a a: 41' A i � � l COMMERCIAL TESTING LABORATORY, INC.. ` 514 Wain Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 ST. CROIX ZONING REPORT NO.: 33658/01 PAGE i ST. CROIX COUNTY REPORT DATE: 12/11/92 COURTHOUSE DATF RECEIVED: 12/09/92 HUDSON, WI 54016 ATTNS THOMAS C. NELSON OWNERS Paut 6 Christina Mc Ginnis LOCATIONS 492 Lassie Circle, Hudson COLLECTOR: M. Jenkins DATE COLLECTED; 12-07-92 TIME COLLECTED*# 2*#15pm SOURCE OF SAMPLES Kitchen faucet DATE ANALYZED:12-09-92 TIME ANALYZED:2S00pm COLIFORM: 0 /100 mt INTERPRETATIONS Bacteriologicatly SAFE NITRATE-N: 5 ppm Above 10 ppm exceeds the recommended Public D►i nk i ng dater Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L 9 10 IF sf 'y �o LAB TECHNICIAN. Pam Gane O,NOEGFNpENr � C� `; WI Approved Lab Not 19 S _l Z A Means "LESS THAN" Detectible Level Approved by'. PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 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. V Completion 2, this form I& essential = that ±JjM proyerty g IM 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 functio ing at time of inspection) _ PROPERTY OWNER'S NAME: PROP. ADDRESS: CITY '''' Legal Description 1/4 of the 1/4 of Sectio , T - R Town of Lot Number Subdivvision: rim NUMBER LOCK WX NUMBERD� l l9 3--7Q ` JS-77 Color of house Realty sign by house?-W—.&.-,If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A ,i.e,COPY OF PLAT HOOK, WITH LOCATION SKONNO 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 - 3 REPORT TO BE SENT TO: CLOSING DATE: Signature L@W REAL ESTATE V ! 1201 MAYER ROAD • HUDSON_ W SCONciN 5401E•17151386.3383 or(612)438.2034 „ 0 3 LARGE LIVING ROOM FORMAL DINING AREAr''"' OAK MOLDING & CABINETS GE GAS RANGE & DISHWASHER CENTRAL AIR 6 PANEL DOORS �. 8X16 SHED BLACKTOP DRIVE •. EXTENSIVE PERENNIAL f•_ :. %:; NATURAL GAS HEAT & HOTWATER 9 FRUIT TREES RASPBERRIES Adds* 492 Lassie Circle Delightful Decor/Lush Landscaping c5ai Hudson Fje 492 low l Discover this newer professionally �" u SW TVAO Hudson ICtvSt.Croix decorated and landscaped home on Exl Cedar Y( Bk 1987 Hl Nat. Gas Split SMFL Tif TO1 Yt 191_ 1.2 Acres. 3 BR, 2 BA, F.P. , C/A 1.2 Acres 1000 2000 $2222.99 all appliances, 6 panel doors, 2X6 L C ox Rm Site 2 Bat hs Sch Hudson construction, energy efficient, LR M C D 15. 10X14 MB 88 PARS St. Patri DR M C 111.3Xll Dww I iq Dy. MI Bil. natural gas, walkout, deck, gardens KO M C I 10.7X8.4 Rak R80 MI and more. A MUST SEE ! ! ! ! ! ! f_R L C I 14.5X22. I Yj W$ Iq R ri 10 Avg HIS MB M C 1 13.5X 12.8 jrq C. Wti INI C. Sm. Avg UW S1MTmo. BR C 114.8X10.7 Wei jyj &VIC Pou Date Neg. BA C 11.6X12.6 13 F C. At 8sM1Full/walk( mm�Ld L V 12X10 Gil I A GDO IYI 064 [f) t j Ric RMIA ldr UFFI Y N N NOW Lot 17 Pine Grove Heights Rio.8 lJiUf Sandee Lowry 81386-33� PRICE: $114,900.00 I/ Lowry Real Estate W 650 8436-20' DIRECTIONS: I-94 to Carmichael exit- left over the freeway to UU- take right- go 1 mile- take left on Jacobs to Dorwin Rd. Left to Maud Circle - left to Lassie Lane - �Tlze 4Wir - n�rr�f*,mo w Information is considered accurate but we accept no liability for error. Listing may be changed or withdrawn without notice. ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST.CROIX COUNTY COURTHOUSE ryr. 911 FOURTH STREET • HUDSON,WI 54016 R 715 386-4680 6 0 December 7, 1992 Sandy Lowry Lowry Real Estate 1201 Mayer Rd. Hudson, WI 54016 Dear Ms. Lowry: An inspection of the septic system on the property of Paul & Christine McGinnis, located at 492 Lassie Circle, Hudson, WI was conducted on Dec. 7, 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 back 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. Should you have any questions, please contact his office. 8'ncerely, Mary J. Jenkins Assistant Zoning Administrator cj Parcel #: 020-1183-70-000 01/07/2005 04:29 PM PAGE 1 OF 1 Alt.Parcel#: 20.29.19.1157 020-TOWN OF HUDSON Current OX ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): *=Current Owner *VONASEK,SCOTT M& PAMELA J SCOTT M&PAMELA J VONASEK 492 LASSIE CIR HUDSON WI 54016 Districts: SC= School SP=Special Property Address(es): *=Primary Type Dist# Description *492 LASSIE CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.200 Plat: 2328-PINEGROVE HEIGHTS 1ST ADDITION SEC 20 T29N R19W NE SE LOT 17 PINEGROVE Block/Condo Bldg: LOT 17 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 1135/344 WD 07/23/1997 989/278 WD 07/23/1997 830/303 07/23/1997 801/245 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 49197 203,600 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.200 22,000 135,500 157,500 NO Totals for 2004: General Property 1.200 22,000 135,500 157,500 Woodland 0.000 0 0 Totals for 2003: General Property 1.200 22,000 135,500 157,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 202 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 PUMP CHAMBER nufacturer: Liquid Capacity: Pump Mo Pump/Siphon Manufacturer: P ize Elevation of in Bottom of tank eleva Pump off switch elevatio Gall per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from neares 0,00,property 1 he. Front, O Side, O Rear, Ft. er of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: _ X Trench: Width: ��� Length: 3 Number of Lines Area Built:_. If Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,(Ft . � Number of feet from well: Y� __. Number of feet from building: (Include distances on plot plan). SEEPAGE PIT ze: Number of pits: Diameter: Liqui depth: Bottom of seepage pit elevation: Area Buil Has either a drop bo or distribution box O been used on any the above soil absorbtion sytems? (Check e). HOLDING TANK Manufacturer: Cap ity: Number of rings used: Eleva n of bottom of tank: Elevation of inlet: Number of feet from near property line: Fr , O Side, O Rear, 0Ft. ber of feet from well: umber of feet from building: Number of feet from nearest road: larm Manufacturer: Inspector: Dated: 16,3 ^�� Plumber on job: �( ��,�_ r;KVj;_i License Number: Qj i 3/84:m3 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER (?tc ffA,, o STOUrTOWNSHIP 11q, 56F1\/ SEC. _ T VN-R W ADDRESS ST. CROIX COUNTY, WISCONSIN �uosa�r SUBDIVISION &M& CRO(JG LOT /7 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Aldo, 10, L T r(0( i s /fig�G P INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used sTEroL Elevation of vertical reference point: Aa0.P© Proposed slope at site: SEPTIC TANK: Manufacturer: WA66E( fr, Liquid Capacity: fl'aao Number of rings used: Tank manhole cover elevation: If. , 7� AM= A6 l j9?—,,-2,6— Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front, Side,O Rear, O l 20 feet From nearest- property line 'o..' feet �{® feet Number of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE OEPAF3TMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS ON I LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMB DIVISING P.O.BOX 79'69 MADISON,WI 53707 NE4,SE4,S20,T29N-R19W )0 CONVENTIONAL ❑ALTERNATIVE (H,,Plan 1,D.Number: Town of Hudson ❑Holding Tank El l In-Ground Pressure El Mound Lot 17 Pine Grove Heights NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Richard Stout Route 2, Hudson, WI 54016 lo,30^ 3v BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: JCSTREI.PT.ELEV.. Name of Plumber JMPIMPRSW No.: County: Sanitary Permit Number: onavin Schmitt 3205 St. Croix 1 102778 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER 1000 �� �©�/ PRQVYES ❑NO PR❑IYES NO BEDDING. VENT DIA.r VENT MATL.. HIGH WATER NUMBER OF ROAD: PR ERT WELL- BUILDING.IVINFRESH �(/ ALARM. FEET FROM /7o LINE. O N , /� AIR INLET ❑YES NO C ❑YES O NEAREST / DOSING CH MBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/$IPHONMANUFACTLIRER WARNINGLABEL hBUILDING COVER PROVIDED. D: ❑YES ONO DYES ONO S ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OP NA NUMBER OF PR OPERTV WELL VENT TO FRESH (DIFFE RENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) 1:1 YES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check thesoil moistureat the depth of plowing 1 LENGTH JDIAMI 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: _T WIDTH- LENGTH NO.OF DISTR.PIPE SPACING COVER JINSIDE DIA SPITS LIQUID BED/TRENCH / ' TRENCHES � ' M RIALI PIT DEPTH DIMENSIONS C GRAVEL DEPTH FILL DEPTH DISTR.PIPF DISTR.PIPE DISTR.PIPE MATERIA NO.11 NUMBER OF PROPERTY WELL BUI DI G V NT TO FRESH BELOW PIPES T ABOVE r�R. ELEV INLET ELEV.EqND. ^ PIPES FEET FROM LINEQ AIR ET 7 NEAREST--► b O 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. ❑YES 1:1 NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO YES NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. ❑YES ❑NO DYES 1:1 NO OYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. ND.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MAHKING ELEV. ELEV.. DIA.. ELEV.. PIPE DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS VRTICAL LIFT CORRESPONDS TO APPROVED OYES ONO OYES 1:1 NO COMMENTS: PERMANENT MARKERS JOBSERVATIO WELLS. NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE 1 DYES. : NO : YES ENO NEAREST t � _ 77 qjq Sketch System on Retain in county file for audit. Reverse Side. SIGNATU ) ,: TITLE. Zoning Administrator DILHR SBD 6710(R?01/82) INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually ever y 2 to 3 ears, 6. If you have questions concerning your private; sewage syster:i, 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: 1. Property owner's narne and mailing address. Provid(I the legal description where the system is to be installed; 11. 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; Ill. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII: Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'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 Gro undy8�a' — included the creation of surcharges (`ees) for a number of regulated practices which Wisco WS can effect groundwater. The surcharge took effect on July 1, 1984 All of the water that buried re Sure is w:..ed in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural R?sources. These funds are used for monitoring ground- t v;,ater, groundwater contaminatio i investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(8.03/86) SANITARY PERMIT APPLICATION COUNTY: In accord with ILHR 83.05,Wis.Adm.Code IST STATE SANITARY PERMIT# oayy -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. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES X NO PROPERTY OWNER _ PROPERTY LOCATION � ^a j F1/a5E '/a, S TZ , N, R E (or PROPFfhfY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME +- i — 1121-'r-5 CITY,STATE ZIP CODE PHONE NUMBER E I CITY NEAREST ROAD,LAKE OR LANDMARK O VILLAGE: 11. 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. X New b.❑ Replacement c. ❑Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill 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 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Feet ❑Private ❑Joint ❑ Public CAPACITY VI. TANK Prefab. Site Fiber- Exper. in allons Total ##of Manufacturer's Name Con- Steel Plastic App. INFORMATION New xisting Gallons Tanks Concrete structed glass Tanks Tanks Septic Tank or Holding Tank lox L'C ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on he attached plans. Plumber's Name(Print): PlumbV Signature:(No St ps P/MP SW No-) Business Phone Number:/ um er s Address(Street,City,Sta e,Zip Code): Name of Designer: �T VIII. SOIL TES FORMATION Certified Soil Tester(CST)Name CST# v S EL CST's ADDRESS(Street,City,State,Zip Code) Phone Number: N, S IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved anitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) N7Approved ❑ Owner Given Initial rchharrge Fee Adverse Determination /,;lC)-no QS.CC) /0-X99-e?' Ai-M X. COMMENTS/REASONS FOR DISAPPROVAL: P/oh APP& ,ted by ?f►btoc-o C,/L4 I.Svh SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber t N ' H ' a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z 0 _ a H OWNER/BUYER ElG p 12 y S/L?u / ROUTE/BOX NUMBER�/2 / I Fire Number .CITY/STATE Aaz)S&A GVr ZIP �y©�G PROPERTY LOCATION:�14, �L ' , Section C , T -N , R_L,W, Town of St . Croix County , Subdivision 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 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-eite wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 I/WE, the undersigned , have read the above requirements and agree y to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- 'v ment of Natural Resources . Certification form must be completed Nn returned to the St . Croix County Zoning Offkpe within 30 days the three year expiration date. SIGNED i'� "LA�.�-� (�► 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. 1 sill 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 p property is i P P Y sold and submitted to this office with the appropriate deed recording. Owner of Property R l c& r�/� 7o LW Location of Property &• 1% AltF h;, Section , T -;Z 9 N-R c' W Township t? D 5a V Mailing Address R l r I Address of Site Subdivision Name ire S - &�'n Lot Number 7 Previous Amer of Property Total Size of Parcel 7 Y A- _/7�=_ Date Parcel was Created /Q-%?, Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? �_ Yes No Volume L5 and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION H T E 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 1 (We) centi.6y that a t statements on thin onm ahe true to the best 06 my (our) know.tedge; that I (we) am (are) the owner(s f o6 the pnopenty des ch ibed in thin .i.n6onmation 6o4m, by viAtue 06 a waAAanty deed neconded in the 066ice 06 the County Reg.iAten o6 Deeds as Document No. ; and that I (we) pneaentty own the proposed bite bon the sewage d Apas , s yst (on I (we) have obtained an easement, to nun with the above deacA bed pnopehty, bon the constnucti.on o6 said system, and the same has been duty keeakded to the 066ice o6 the County Reg.csten o6 Veede, ae Voeument No. —1L=3 ) . SIGNATURE O OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) /'C7 /5= 7 DATE SIGNED DATE SIGNED i I, DOCUMENT NO. ;"STATE BAR OF WISCONSIN FORM 1—1988 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED .� "`T 'i 604 . 15 AGE REOISTERS OFFICE This pe , ma?e betwe George J. H. Gies and ST. CROIX CO., yVt$, e ........ Jean Dorwin G es, iis wife .• ------------------------------------- ........... Recd Record Mdih - -- ----- - Grantor, day of�A.M 19`86' and_ _-_Ricb.?rr _0,--Shout-and-JanetP� Stoutx_ husband ;I 9:30 A. IL anc(_wife--as__joint -tenants- as to a-70% interest, and 0%-•i;nt� est______ .............. •-_ ..................+ Grantees Witnesseth, That the said Grantor, for a valuable consideration__.•__ !j ----- _ conveys to Grantee the following described real estate in __$1r_.__Croix_-____-_-_ -_ i RETURN TO County, State of Wisconsin: j i All that part of the NE4 of the NE-14 lying Southerly of the railroad right of way; The SSE-14 i of the NEB; Taa Parcel No: .......... •--•-----•.............. The NEk of the SE14; All in Section 20, T29N, R19W; SUBJECT TO all existing highways, platted roads and easements of record. EXCEPTED FROM THIS DEED are all parcels of land previously conveyed in part performance of the land contract referred to below by deeds of record. This deed is given in final performance of the land contract originally made by George J. H. Gies and Jean Dorwin Gies, his wife, as ve s and Robert L. VerDugt and Betty Jane VerDugt as purchasers, the purchaser s interest in said contract having been assigned to Richard 0. Stout, Janet P. Stout and Maud H. Stout. The original land contract was recorded in the office of the Register of Deeds for St. Croix County, Wisconsin August 18, 1975 in Volume 52X, Page 271, Document #328700. The assignment was recorded in the same office on September 30, 1982 in Volume 652, Page 447, Document #380015. • 1�g11Vy►.7� This ----------i5__1z91r------- homestead property. PRE A to lV, ( (is not) a Together with all and singular the hereditaments and appurtenances thereunto belonging; FEE And-----------GeorgeJ•�_H, Gies_•and-_Jean_Dorwin--Gies_,__his_-wife,--__-•_- warrants that the title is ................. ........ good, indefeasible in fee simple and free and clear of encumbrances except easements and protective covenants or restrictions of record, if any; conveyances, liens or interest created by the act or default, if any, of the grantees, and will warrant and defend the same. 1st August 86 Datedthis --------------- ------- •-------- day of --------- -------•---- --------------------•--- ------- 119......... ------(SEAL) " � 1' /•�'` .................(SEAL) Geor g e J ie s ------------------ ---------- -- �-----------•----------•-- (SEAL) ........ - (SEAL) , " ------ ------------------------------------ - s` Jean Dorwin Gies AUTHENTICATION ACKNOWLEDGMENT Signature J. h. Gies and Jean Signature(s) ------------------------------------------------------------ STATE OF WISCONSIN Dorwin Gies, his wife as. ---------------------------------•--------------------•------------------------- ,/_ y authent --------------County. August 19 86 Personall came before me this . i ated this __�,lJ�ay of...______... ............... ...............day of j. ...... ..........................................1 19-------- the above named " ohn D. He "'cod ----•------------------------------------------•-------------- TITLE: MEMBER STATE BAR OF WISCONSIN •---------•-----••-----•------ (If not- ----------------•------------------------------------ authorized by § 706.06, P«'is. Stats.) to me known to be the person ............ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Heywood,__Ca --- Murray_-&-_ Sherburne P. 0. Box 229, Hudson, WI 54016 "-------•---------------------------------•----------------- .................. Joh-n-D.--Heywacid-------------------------------------------•-------•-- Notary Public ------------------------------- ------_County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration are not necessary.) pds date: -_.. + 19- ) *Names of persona signing in any capacity should be typed or printvO below their signatures. , � � » ^ . ^ INSTRUCTIONS FOR COMPLETING FORM 115 - SBD 8395 � ~ To hnu complete and accurate soil test,your report Must include: I Comp|ete. legal description; %� The use section must clearly indicate whether this is residence nroommornia| project; 2. MAXIMUM number of bedrooms or commercial use planned; 4. |s this a new o, replacement system; 5. Complete the suitability mdnn boxes. ASiTE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL ` OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; G. PLEASE use the abbreviations shown ho,=for writing profile descriptions and completing the plot plan; 7, MAKE A LEGIBLE diagram mooureoe|y locating Your test locations. Drawing to ooa|r is p,efwnnd. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation ,cfomnve point are clearly shown,and are permanent; 8. Cump!:/o all appropriate boxes as to dates, nam*o.addresses,flood plain data, percolation test oxemp- zion. ifappropriate; 70� If the information (such as flood plain,elevation)does riot apply, place N.A.in the appropriate box; 11. Sign the form and place your Current 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 OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10'') BR — Bedrock rnb — Cobble (3' 1O^) SS — Sandstone y, — Gravel (under 3^) LS — Limestone °s — Sand HGVV — High Groundwater os — Coat se Po,c — Percolation Rate medn — Medium Sand VV — Well fn — Fine Sand Bldg — Building Is — LoamvSand > — Greater Than °d — Sandy Loam / — Less Than °| — Loam Bn — B,nvvo °oi| — Silt Loam 8| — Black d — Silt Gy — Gray °u| — C|ayLoam Y — Yo|!nw so| — Sandy Clay Loam R — Red oin| — Silty Clay Loam mot — Mottles sc — Sandy Clay w/ — with ( ' oic — Si|tvC|my fV — few' fine'faint � ~n — (]my cc — common, coarse ' p/ — pea' mm — Many, medium m — Munk d — distinct p — prominent ` HVVL — High water level, ° Six general soil textures surface water for liquid waste disposal BM — Bench Mark VRp — ye,do*| Reference Point _ TO THE OWNER: This soil test report is the first step in securing a sanitiry permit. The county or the Department may request verifioadon of this soil test in the field prior to pe,mi/ issuance. /\ complete set of plans for the private � se�ugc sysl*m and u permit application must be oubmittod to the app.np,iazu local authority in order to � oumin a pernnit� The sanitary permit must beobroin,d and posted nrior�o the u�o,� of oono�,uchon � , T R OF SAFETY B I INbUST R Y,* REPORT ON SOIL BORINGS AND DIVISION `LAB(`)R AND P.O. BOX 7969 ` AB4�AN RELATIONS PERCOLATION TESTS (115) MADISON,WI 53707 R (H63.090)&Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ ymNUUMY: LOT NO.:BLK.NO.: SUBDIVISION NAME: NE 1/ySE1/ 20 /T'29 N/R19 Vor)W Hudson 117 n/a Pine Grove Htgs. COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: St. Croix Richard Stout R.R.#2, Box 340, Hudson, Wi. 54016 USE DATES OBSERVATIONS MADE NO,BEDRMS.: COMMER IAL DESCRIPTION: PROFILE DESCRIPT ONS: ER AT O TESTS: FO Residence 3 n/a New ❑Replace 110-1-87 10-1-87 RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYST M:(optional) [as ❑U � ❑U �OUP ❑S EN ❑S �]U conventional If Percolation Tests are NOT required DESIGN RATE: I 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 decimal ' PROFILE DESCRIPTIONS Page 58 BRC2 BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTHM. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- 1 7.25 106.44 none >7.25 1.33bl.l. 1.42bn.sil. 4.50bn.c.s.&gr. B- 2 7.17 106.53 none >7.17 .75bl.1. 1.00bn.sil. 5.42bn.c.s.&9r. B- 3 7.34 105.81 none >7.34 1.00bl.l. 1.42bn.sil. 4.92bn.c.s.&gr. B 4 7.75 104.72 none >7.75 2.08bl.1. 1.67bn.sil. .50bn.s.1. 3.50bn.c.s.&gr. B- 5 7.26 104.84 none >7.26 1.67bl.1. 1.67bn.sil. 3.92bn.c.s.&gr. B- decimal' PERCOLATION TESTS TEST WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTER SWELLING INTERVAL-MIN. PE IOD t P RIOD 2 P PER INCH P_ 3.63 none <3 P_ 2 3.72 none 3 6 6 6 <3 P_ 3 3.00 none 3 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 102.81 { t 1 f L IF_ bj 1 i E • a 2.� i • , � � _. __ z _-_. _.mom �ttE E L _..... _. .. .�.,....,._ g. i -� I .__._ ..».....�_.A..............- t 7 ? ( { ! t G a - ..a a. . 3_._. _ ._.L.__ _ I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WERE COMPLETED ON: Gary L. Steel 10-1-87 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 988 N. Shore Dr. New Richmond, Wi. 54017 2298 715- 6-6200 CST SIGN DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — 1 ' - 1i } IE I ' ll ' r II, I � -- , TJ, III i I II I � t w ZA irA F-,o'jW. ,PTV I T,E M R. 0 N nt I V,V M