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HomeMy WebLinkAbout161-1022-50-000 (2) @ � e _ ¥ : C ts\ 0 ts ? % \ . % \ � § � ; § � � §k � §ƒ � a , § � § } 7 a � ) ƒ � \/ \ ƒ� � k 73j � § � «_ L CD « \ E ) { 8 k n § § a m E 0 z k \ / 22 � e a z m e — § 2 @ � \ § D -� DA ) % } / 7 } t § % _ \ E � § 3 § � c0E , o cc 2 k ) § § j C \ \ \ ~cc e e a. / 3 0 -"Na k � a a a 2L U) \ ) / } . z = ) r 2 § 2 § co a § ' 9 2 # » n c ) E 2 7 t ; S J \ \ / © a 8 § ^ ® / § § 5 E / 2 \ j \ § $ 0 \ o m } a . - a 5 ; o z / 2 \ § CL — , _ " a » I E ' k a § &J a 0 2 0 , , Parcel #: 161-1022-50-000 06/27/2006 10:56 AM PAGE 1 OF 1 Alt. Parcel#: 13.29.20.415B.416.417A 161 -VILLAGE OF NORTH HUDSON Current !X] ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-PIOTROWSKI, EDWARD M&BARBARA J EDWARD M&BARBARA J PIOTROWSKI 3766 BRIGHTON WAY N ARDEN HILLS MN 55112 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description "547 GALAHAD RD N SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 02/35-LAKESIDE ADDN 1910 N 10'LOT 3 BLK 6, LOT 4 BLK 6&S 20' Block/Condo Bldg: LOT 5 BLK 6 LAKE-SIDE ADD VIL NH INCLUDES PARCEL 161-1021-20(P383B) Tract(s): (Sec-Twn-Rng 40 1/4 1601/4) 13-29N-20W Notes: Parcel History: Date Doc# Vol/Page Type 07/30/1999 607759 1445/427 WD 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/19/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 319,900 183,200 503,100 NO Totals for 2006: General Property 0.000 319,900 183,200 503,100 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 319,900 183,200 503,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 161-1021-20-000 06/27/2006 10:56 AM PAGE 1 OF 1 Alt. Parcel#: 13.29.20.383B.384B 161 -VILLAGE OF NORTH HUDSON Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-PIOTROWSKI, EDWARD M&BARBARA J EDWARD M&BARBARA J PIOTROWSKI 3766 BRIGHTON WAY N ARDEN HILLS MN 55112 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description "547 GALAHAD RD N SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 02/35-LAKESIDE ADDN 1910 N 10'OF LOT 1 N 10'LOT 2, N 10'LOT 3, Block/Condo Bldg: S 70'LOT 4, S 70'LOT 5&S 70'LOT 6 ALL IN BLK 1 ALSO PRT VAC LAKE ST Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) BETWEEN BLKS 1 &6 LAKE-SIDE ADD VIL NH 13-29N-20W ASSESSED W/161-1022-50(P415B) Notes: Parcel History: Date Doc# Vol/Page Type 07/30/1999 607759 1445/427 WD 2006 SUMMARY Bill#: Fair Market Value: , Assessed with: 0 Valuations: Last Changed: 05/04/1994 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Lenth: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft . Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one) . HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: lJ Plumber on job: License Number: �.f IJEIP G) ID 3/84:mj Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER SEC.�A/-/L - F Iy SEC. T Z�1 N-R Zd W ADDRESS -5"//7 k' ST. CROIX COUNTY WISCONSIN /ate A4 � N, � AA40 SOLI i b✓/. SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM -7 OLo7 e C��oSS e%etN PReaPeGet2� Le.�� N�K/ /200 o O //O 'fo FjC:"STe� P120.7'F c? ; o CX' 7:)r/ Ex/59in)C S/I P7,c 7i+e.1K C)A�AC� f?Fr oc.+c/<M F-►T �KeS1eJL /! Q \� tfxeS9iJC� /.300 [ems//sJ e �0 /VD SCA CE INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: V4C4C eS6e_ Liquid Capacity: I.20o e?A//oJS Number of rings used: C91- Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,rk,,:'—�Side0Rear, O ,2(oS/ feet From nearest property line Front,0 Side,(DRear,O 12- ' feet Number of feet from: well '70' , building: 40) (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX+9969 BUREAU OF PLUMBING MADISON,WI 53707 ZS CONVENTIONAL SE%,S14 T29N—R20W ZSCONVENTIONAL ❑ALTERNATIVE State Plan I.D.Number: (If assigned) Village of North Hudson ❑Holding Tank ❑In-Ground Pressure ❑Mound Galahad Road NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: nn Roger Dahl , 547 Galahad Road North, Hudson, WI 540 .6 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number Gary Zappa I3300 St. Croix 1 92545 SEPTIC TANK/HOLDING TANK: MANUFACTURER: L TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LAB L LOCKING COVER PROVIDED: PROVIDED'. DYES ENO DYES OTNO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING:(VENT LE FRESH ALARM: LINE: AIR INLET. FEET FROM DYES ONO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO DYES ❑NO DYES ONO FR GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. VERN TO T FRESH (DIFFERENCE BETWEEN FEET FROM uNE PUMP ON AND OFF) DYES El NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH O 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: BED/TRENCH WIDTH: LENGTH: TRENCHES DISTR.PIPE SPACING MATERIAL: INSIDE CIA St PITS LIQUID PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTR.PIPF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES. ABOVE COVER: ELEV.INLET.ELEV.END. PIPES. FEET FROM LINE AIR INLET: NEAREST---► 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. ❑YES NO SOIL COVER ITEXTURE: PERMANENT MARKERS JOBSERVATION WELLS 1:1 YES ONO ❑YES NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL- SODDED SEEDED MULCHED CENTER: EDGES. ❑YES ❑NO 1-1 YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.'. ELEV.. CIA. ELEV.: PIPES ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL: PLAN SCAL LIFT CORRESPONDS TO APPROVED ❑YES El NO El YES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY W . FEET FROM LINE: DYES 1:1 NO ❑YES NO NEAREST I V ul Sketch lystern on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. Zoning Administrator DILHR SBD 6710(R.01/82) i INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 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: 1. Property owners name and mailing address. Provide the legal description where the system is to be 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 all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/ x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ------------------------------------------------------------------------------•---------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into 'aw. 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 Ground ater included the creation of surcharges (fees) for a number o! regulated practices which Wisco iF; e can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried rea. ure is used in your building is returned tc. the groundwater through your soil absorption o , system or the disposal site used by your holding tank pumper. 0 The monies collected through these surcharges are credi:ed to the groundwater fund adminis- tered, by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, i''s worth protecting. SANITARY PERMIT APPLICATION COUNTY DILHR In accord with ILHR 83.05,Wis. Adm. Code J/ • (2 ST4SANITARY - # Ps —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 1:1 YES N NO PROPERTY OWNER PROPERTY LOCATION e %_(`t %, S T 2y, N, R 90 E (or)W F�ROPUKTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME s- A, i-A r✓ CITY,STATE Z CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR L NDMARK D..i 6 K- yob I® VILLAGE: el �v Q TOWN 11. TYPE OF BUILDING OR USE SERVED: y Number of Bedrooms if 1 or 2 Family / OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in P. Check#2,3 or 4,if applicable) 1. a. ❑ New b. ❑ Replacement c. Z 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. ❑ 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 El Joint El Public CAPACITY VI. TANK Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed a Septic Tank or Holding Tank A o Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) #hP/MPRSW No.: Business Phone Number: �-fU � /�n 6 - .5 Plumber' Address(SilthO,City,State,Zip Code): Name of Designer: S a.I l✓ t III. SOIL TEST INFORMATION Certified Soil Tester(CST)Name f CST# CST's ADDRE (Street,City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) ®Approved ❑ Owner Given Initial S rcharge Fee /c��► ��,//� Adverse Determination �""' �� ���'" � `!'��Lw'lh� . X. CO M NTS/RE ONS FOR DIS PPROVVA,}- � P/Qh Kip 1 t & ! SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property �o 7� r_f �Qn7 .41X,Awci .+<� T� 1_ca✓/ti / J_W" 7 r ev i Location of Property , Section /` , T N-R G W Township /Y'- Mailing Address Address of Site Subdivision Name a<`' Lot Number %.9 -- > Previous Owner of Property Total Size of Parcel ' /mays Date Parcel was Created —5 �L s 7° sT1'` `lx Are all corners and lot lines identifiable? Yes No Is this pr_perty being developed for resale (spec house) ? Yes /` No Volume L_ and Page Number Z as recorded with the Register of Deeds. 9T N- j-2 V INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) eeAti.by that aU .statements on this bonm ane tAue to the be-6t ob my (oun) knowledge; that I (we) am (ate) the owneA(.$) o6 the pnopeh ty dejs cA ibed in thi s .inbannation bonm, by vi tue ob a waAAanty deed teco&ded in the Obb.Lce ob the County Regcaten ob Deeds as Document No. 7 ; and that I (we) pmsentty own the proposed .site bon the .sewage d.i.spo.s .aystem (on I (we) have obtained an easement, to nun with the above danibed ptopehty, bon the eonstnuction o6 said system, and the tame has been duty keconded in the Obb.ice ob the County Reg.<,aten ob Veeds, as Document No.,, �) . SIGNATURE OIt OWNER SIGNATURE CO-OWNER (IF APPLICABLE) DATE SIGNED DAT SIGNED kulul ..u. ... 262581 94to fnbrnturr, made, by Ella M. Linder grantor , of St. Croix County, Wisconsin, hereby conveys and warrants to Roger J. Bahl and Ploy S. Dahl.# husband and wife as point tenants grantee , of county, Wisconsin, for the sum of One dollar and other od and valuable consideration go era the following tract of land in St. Croix County, State of Wisconsin: 1 .. 4 . N 10 feet of Lots 1, 2s & 3; S 70 feet of Lots 4, 5s & 6; all in Block 010. S 20 feet of Lot 5; All of Lot 4; N 10 fsetotqLo ..all• In Bloc And part of Vacated Lake Street between Blgcks "1" and 116" as described in the Caption. All in Lakeside Addition to the village of I , North Hudson. '�61STERS 0FP1 '.I ST. CFtpIX CO.. WIS. Recd for Record thi s_2-nd__ y y day of...&gugt -AD.19_60 at_i9=45-------A►M. Re st r Deeds S n >,1 Q f Q . t In witness 04erraf,The said grantor ha s hereunto set her hand and seal this 29th day of July - ✓1. ,� SIGNED AND SEALED IN PRESENCE OF R11a 1ft. Lindsr Robert L. Bauer SD.1L) (SL'.�1 L ( Rub �auer 0 .. a .. >. A tate of Isitoransin, ..t Si. Croix County oil ,,, t1111t11//t/ Per?gna'ty,eame efore me, this 29th day of July .g�D;:�tg•�d•'''�:; tk* aboe named Ella M. Linder I ito ine, wn to be ie;erson who executed the foregoing instrument and acknozvled.(ed the same. _ `.� :. %­t Robert L. Bauer Notary Fublio, St. Croix County, TPis. My commission expires JWz 7 , .q. D. 1943 *Typewrite Name undir each Signature I-ooK 370 FACE137 Orlando G. Holvay phone Registered 724 St. Croix Street DU6-3922 Urtnd Surw or Hudson, Wisconsin Hudson, St. Croix County. Wisconsin Due to numerous surveys of our property. along Galahad Road in the village of North Hudson, Wisconsin. none of "oh agree, we the sundersigned owners. Donnie Hollerude and Roger Dahl, stipulate and agree that V's prop*rty line . between our respective properties in Lakeside Addition, to the village of Borth Hudson shall be as follows, to Witt CoinmWing at a I-Ont 844.37 feet South of the East 4- corner of Section 14 T 29 N. R 20 N, the aeotion line ti tla.: b: ..,.a iy} -w r lwsdiiai bein � ' t�nr:` o�da' tbi?Mcitht� ; r thence Westerly at right angles ,tro the East line of said Gov. Lot 1 in said � Section 14, and running to Fake St. Croix fresh the Bast line of acid (k)v. Trot 1. Dated this � day of ,.,�.2.961 Witness 2aa�i".9 " 4 State of Wisconsin St. Croix County, Wisconsin On this day of 1961, before roe the undersigned, a Notary Public, within and for said o and State, personally appeared the above -_; named Grantors and Grantees, known to the to be the persons described herein and who',oxeouted the foregoing instruluent cad acknowledged the awe. Notary a, St. Croix County, Win. h#Y Commission a wires JAMES I GREE • Notary Public -St.Croix Co., Wis. My Commission Empire%Sept.13,1964 '��1--� � n .c,'%"_ � f� /�.`- ,f GJ F �r ! 'cam ! !c_�� G .�.•-���( Abstraot of Title and .. . .,, P L'-A- T _. To:. Desoriptions as in Dead !Book..2 98 page 235 _. ..:� xs R %p Ja C.�irld O o � 1 ti x O z HUDC50N � ~K.a► s.• t. a p T r t �-s 1 sheet 1. r,�°� it N . z N ' H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT p St . Croix County z d _ a OWNER/BUYER ROUTS/BOX NUMBERS -147 '3�' Fire Number .CITY/STATE f���f��Gi� CE/�S"c ZIP PROPERTY LOCATION: 14, It, Section , T N , R W, Town of �� y`' s°' St . Croix County, Subdivision 7D, Lot number/54 /D - Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper. What you pdt into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 0 • E I/WE, the undersigned , have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x fr 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 Offkre 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. INDUS TMENT,°� REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION AND P.O. BOX 7969 LABOR LABOR RELATIONS PERCOLATION TESTS (115) - MADISON,WI 53707 HUMAN (1-163.090T&Chapter 145.045) LOCATION:5 1 N: TOWNSHIP/MUNICIPALITY:' OT NO.:BLK.NO.: SUBDIVISION NAME: S� '/ /4 TZ4 N/Rzc>.#(or V/LL44 46 ­�So t4 COUNTY: WNE IYSWS NAM-- M f N ADDR S : '/ STCkoI> G,� .�ANL. 547 6ALA1-IAts �� NL1,So4f 1 Soo/ & USE DATES OBSERVATIONS MADE NO.B DR : COMMERCIAL DESCRI PTION: _ DESCRIPTION A N ESTS: Residence uj, C�New Replace 14k IL 2a, MSS / SOILS d< 241- 57 SOILS- Nsg- RATING:S=Site suitable for system U=Site unsuitable for system OQENTr,_,,,AL: MOU�E Q _Dm rlYST S-1Q UL O�LDINGTANK:RECOMMENDED SYSTEM:(optional) If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.Ff63.09W(b),indicate: Floodplain,indicate Floodplain elevation: _ PROFILE DESCRIPTIONS BORING TOTAL H TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTHM ELEVATION OBSERVED EST.HIG E TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- '7,'90 n7780 > 7,SO i6'&,jS*&9GAC6,M 3Z"&,qSL 4e"8RgM*6S*41lz Co b Co 0-%. B- B- B B- e- PERCOLATION TESTS TEST DEPTH ' WATER IN HOLE TEST TIME D I WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERT D2 PERIOD 3 PER INCH P- P c SE'S s O nrE /S ✓M Lf So L C 1 10 / d l 4 Td- {ire � P- P. LASS l EtRG 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 lapd slope. SYSTEM ELEVATION j , x F , ' i s x j _ rXI, , tN ✓ � Sy 4 >z m + 7 Ir A OLCr° EUVA-ftotN �DUst ALL 20. &eMcN t *Vb F",4 S P6 LC CON C_eaTe . � I , , 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. NAM pri t : TESTS WERE COMPLETED ON: 1 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 40-7 S�u,>vq S-r gua�>.l Wi 3474 3�S6�4o�0 CST SI TURE: , DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82)' OVER — L DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS DIVISION INDUSTRY, P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON,WI 53707 HUMAN RELATIONS (H63.09(1r&Chapter 145.045) LOCATION: `Z 0 TOWNS HIP/MUNIC,I/PALITY: OT O.:BLK.NO.: SgU�►BDIVISIONNAME: �� ., '� I 1'L°`�' N/Rz tor) YI Ur14 A� /Y COUNTY: OWNE NAME: I LING AD <rCPo !< IL-)Al 347 L,ALa,1nR �t, f�(4�DsQw ` 016 '— DATES OBSERVATIONS MADE USE -- TROFI LE DESCRIPTIONS:IFERCOLATIDN TESTS: NO.B DRVT COM11TlrIRZ`T�CS IPTION: _ Residence C-U�� - �JNew Replace AP�IL 2t, IS117 SoiI-S aIt�' 42' - s7 SOILS- RATING:S=Site suitable for system U-Site unsuitable for system ONVE�N I�VAL INGR6l1ND -I -FILL NG TAECOMMENDED SY5TEM:loptional) IMOU19D: ZS ❑U ❑S U ZS 01 If Perco lation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(511b),indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL J2gEjjjjQgRgU ND ATER-INCHES CHARACT R OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEP?H AP. ELEVATION OBSERVED TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) II B` � ], ^ n� J M5� K 9 C.ab c0 V/, . B- B- B. l B_ PERCOLATION TESTS DEPTH WATER IN HOLE TEST TIME DROP IN A R LEVEL-INCHES RAT INUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN, ----PER! PER INCH P. P- P&L JES S NOT h6fvE !S /MtL . 'SCIL C io df T&' Pkint &AdLe P- PLOT PLAN: Show locations of percolation tests, soli borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- -nntal 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 + e►,,i us N Cc.EVn7ronl /0o-ocy D /�=2-6 l�tNCI��AR� - Cti�Nt l? . d ' TL 1166_ *b 1A •C)Uy 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, NAM Ip/rintT�--- ~� --��- —•__..__TESTS WERE EOMTLETED-ON: /.��t�'J .•,`-�.1ifl�``°aL�A,� R�xu ,uQJEYin/C, �N�-. I°tC't� Z$ �qh7 ADDRESS: / CERTIFICATION NUMBER: PHONE NUMBER(opt ionel): =— -- CS1'SIG TUBE. .J DISTRIBUTION:Otigrnal and one ropy to Local Authority,Pinker Iv Owner and Soil Tester. vU DILHR•SRO-6395 (R.02/62) -OVER -- DFPARTMLNT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS DIVISIQN INDUSTRY, P.O.Box 7869 LABOR AND PERCOLATION TESTS (115) MADISON,WI 53707 HUMAN RFI ATIONS (1,163.090T&Chapter 145.045) LOCATI ON:T pp T'O/WNSHIP/MUNICIPALITY: OT N0.• LK.NO.: S AB�DI�VIS NAMF �� l'1� iz.r N/RZ 't(0, YILLt�La C'v N6 COUNTY: VVVF4 NA S-1 IQ P,A�lt- A7 GllL�llrAe e tNt�1�SoN F S40/� DATES OBSERVATIONS MADE USE NOS CO M 1 TIO �t Residence — Awl. 2a, M Sons &13< -so IL.S" RATING:S-Site suitable for system U-Site unsuitable for system ONVEN I MOU D: IN•GROUN3 FILL OLDING TANK:RECOMMENDED SYSTEM:loptional) r os �u zs ❑u_ os u ,®s ❑u os ou 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: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL H R UND ATER INCHES C ARACTER OF SOIL WI H THI K SS, OLOR,TEXTURi ,AND DEPTH NUMBER DEPTH M. ELEVATION gQ SE VED TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) B- I O 7-7,3, > 7.SU io�BeaSrtL,R��Co,�. 32"$�e�►SC. 4®�&q Mt(_ StGf, B- B- B- B- PERCOLATION TESTS DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHFS RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIO I —P-MOD 2 PERI PER INCH P• P- E G JCS 5 6,16 THIS !M 'L So C td ! dl Tzr n�Q d P. P- PLOT PLAN: Show• - . ��,......,.._.. t of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori. :•.ontal 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 I "� I GYiS �nlG, M S-/S ti 'Z! ?' I �j >rt~AhPOCr L-Lr V lor,J /UO Cx�' SAL[ p 20� �tr.IGtlr't,Y1f2� - Cv�'�ICR Q�' fLd�St7(�Lt C.ON�.r;�.TL'r 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: lL. Z'g /C/87 rte J� ) ►�I Su Qvr:Y� ADD S: CERTIFICATION NUMBER: PHONE NUMBERIopoonal): T P)s DISTRIBUTION:Otigmal and one copy io Local Authority,P101101Y Owner and Soil Testei. 1311-HR•S130-63115 (8 09182) OVER 1,,i zO P-f — 0/0 fL op' -0 /vFw /100 �— AAL 70 r'rasr /°noncn-rY 12.,,E GAL, SE,PTSc 7ANk, Arvo sgLA)i4a /U3 op ExsrzNb /eoo _� n �v O kY CT CAL.SEEPTIC TA UK T//O To wEST� /s, //�� yy�� Ps�p�27r LT.,,E id /COGF2 /J/JJyL LxssrsNG SEPTIC- 71 r_xuTrN6 Gino bEb �F/'L/�CE/ylEN'>' ExrlTZrvC � � 13oo CAL DAnvGLS LEXUrrNv WELL /1i0 .fCjoL E .SocfTN I°AOPrn..TY L=NE /vOT /ZcqUX/ZEO TA-)4 12LPLACE'12'7�,-vT APPROVED VENT CAP t-#,XIM JM 12" ABOVE FINAL GRADE 4" CAST IRON VENT PIPE hA AY IM IM OF 42" ABOVE PIPE TO FINAL GRADE SIGNED: MARSH HAY OR SYNTHETIC COVERING LICENSE: MINIMJM 2"AGGREGATE � GATE: OYER PIPE DISTRIBUTION PIPE *- TEE SOIL TESTING BY: ELEVATION BED 6" AGGREGATE • BOTTOM PER SOIL,, BENEATH PIPE PERFORATED PIPE BELOW TEST IS '`-- • COUPLING TERMINATING FT. AT BOTTOM OF SYSTEM