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HomeMy WebLinkAbout026-1098-30-001 .. 0 r, * ■g 2 _ § g ; ƒ ] E CDg � , 0 / _ § F f I E.Fi Q o E ƒ q p- ${ z e z . } / k $. 7� °\ Z , m > u : [ \ 7 e Z , Q 7 CO CD f .° ET -0 -0 31 r • z 0 0 0 § ° -0 = S § § '\ c. -o v �o 'v \ k \ 1= �2 � - / go z. ; e / i ZINO z rr B. o > > g 1 . ( . } cn C A \ co % co a , / k / ,,cn c — 7J } E # z o co CD \ / —J g l ® 2 o r 2 f � ƒ �n > § \ k * � {ID -n $ ® c ( \ 2 ` 1 E ET. 7 2 co .7 ƒ 2 I \ 5 ) ro \ _ o ® § § k 7 Parcel #: 026-1098-30-001 04/27/2005 04:36 PM PAGE 1OF1 Alt. Parcel#: 34.30.18.531B 026-TOWN OF RICHMOND 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 *KINNEY,TERRENCE M TERRENCE M KINNEY 1211 120TH ST NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description * 1211 120TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 3.560 Plat: N/A-NOT AVAILABLE SEC 34 T3ON R18W 3.56A SW SW LOT 1 OF Block/Condo Bldg: CSM 5/1400 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 31-30N-18W Notes: Parcel History: Date Doc# Vol/Page Type 09/24/1998 587638 1359/411 WD 07/23/1997 782/199 07/23/1997 684/287 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 20406 101,800 Valuations: Last Changed: 06/20/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.560 47,700 44,700 92,400 NO Totals for 2004: General Property 3.560 47,700 44,700 92,400 Woodland 0.000 0 0 Totals for 2003: General Property 3.560 47,700 44,700 92,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 523 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 / k 1 CVO 0 ro , e � : ' g 2 g • < - .. ' 0 _ § - � I Tr FF 1 E ƒ F, o E K £ ° coo l ( w B p- ƒ E B B ; % -o = Q e - , § E g £ £ . 7 I § P $ j 0 -0 cl A A / T1 / ) p 0 0 , 0 a 0 0. 6 = = g E § 1 5 e . Z ® A a ■ 0 / / £ / S. § , ■ ' q 3 - e e I , \ k 2 \ } I ( k k q § . � � E M. Z = I E 2 k \ o 0 0 § 1 ' § § ai o ƒ § § § � ' < z g ■ ■ ■ ■ * . . > g § = ) 7 g § o Q 0 0 2 g 7 ig § 1 / , / g K � I $ \ . o ƒ .. § 2 ( / g / / / / - m 09 2 E CD m Z c co 1 2 z 0 iii a& ` ! / z 0 8 o = 5 co ® 1 o ° - 1 xi 3 1 k k m I $ k ) k�kk CD )a _ ■ o - / a0) C%/ �o2o _,, E \\0 . o - ` E& ; $ /k/ VJ \kk I g q V .4 2 WG E ■ K ! b N 2 § \ @ ? m k E . 7 t Parcel #: 026-1098-30-001 04/27/2005 11:30 AM /i PAGE 1OF1 Alt. Parcel#: 34.30.18.531B 026-TOWN OF RICHMOND Current XI ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): *=Current Owner *KINNEY,TERRENCE M TERRENCE M KINNEY 1211 120TH ST NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description * 1211 120TH ST SC 3962 NEW R RICHMOND WILLOW 0/d k'u� — �� SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC (/L'- /g Y, old 1 q 7(1 1$s- s? Legal Description: Acres: 3.560 Plat: N/A-NOT AVAILABLE ./ mil. if 7 5 SEC 34 T3ON R18W 3.56A SW SW LOT 1 OF Block/Condo Bldg: 1 lAA CSM 5/1400 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 31-30N-18W Notes: Parcel History: Date Doc# Vol/Page Type 09/24/1998 587638 1359/411 WD 07/23/1997 782/199 07/23/1997 684/287 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 20406 101,800 Valuations: Last Changed: 06/20/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.560 47,700 44,700 92,400 NO Totals for 2004: General Property 3.560 47,700 44,700 92,400 Woodland 0.000 0 0 Totals for 2003: General Property 3.560 47,700 44,700 92,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 523 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 7 \. I (4'?) 3917740 1 i7 unplatted lands owned by others w i7 �. Hn0 w H \ O :a ° H N Z o Z m WEST LINE OF THE SW 1/4 - w NORTH 484 . 68 ' Nr----le j�a' CL TOWN ROAD w m cn NORTH 433 . 42 ro 0o cn IC N o � co IG * Iv 0 0o cam - rc ro z rt H 50 ' 0 t'1 NI-' HwI--' tr1 IW b O (D - to �C • N Z • to -7 S � in t=J Eli Q, N H n oo ,I� n to to - Irt to - t•'1 o - t~ Ol• J� U1 I(D Cn I = N C dl C I— I-- �' �� 01 Ip, t'i n Cl' to C) > o ( i >a H CD pp I 130 t" H ( J H C Co —I . N Eli= D-J ;a 0 fZ - Z Z '.t9 -�.• IA) to Z n (n 0t1icn aticn N 4 1"' IG (A El �' w cn 10 v) IO "'"�F - \ 1¢ id H o N W • :a v N Ito o m ttoo Z 13 Z H x _ - 10 � On (Cl H N pi 0 � w• I ° C z ¢' t- ) C 'Q to I(D to b 0- 50 ' two - la - H n1 IC 0 I F-, tTJ > Itr • C7 1-3 :a ro �C ° W o 1-3 Cl' En 0 tO • 1< Z 0 rt o 50 . 0(b' 422 .36 ' IA N O y SOUTH 4-?a_36_ H uZplatted lands .wned by Platter , In 0 x H Zn — ro tli 1-3 D x p 0 Z\ rn = '� C7 —I Z cn I y rn z '—' n 01 BEARINGS ARE REFERENCED TO THE WEST 0 cn H cn LINE OF THE SW 1/4 ASSUMED TO BEAR NORTH. H X n � rn til APPROVED to MAR 7 198 R .,\ 4 a,a�' cn rt O 1n cn ss: .� y •_•es ii i (D `t' 7• fi ? Z > 5'�$`" H (7 (D ✓- C \ k' °I Cw CP -e r- ; to cn 1-3 N n ° — Si. ‘C COUNTY •. rn - .4: �-�+ ' n H rN 0 c. COMP.cciiE-tSdvE• ?AP IS PLANNING ,._ ,, ._ .4- ?a z al tti .3 0 0 G n AND zo;r,Nr CraAdtr�i*J:f v ' y •',.+ _A Z Z W.Z r— J¢' rt fi (O In tir+ t}-c° ' ,.4.1. t;3 » H w r 1C G /'�%��� M ";k 4 z HI L t '�• sue+ rt G Co 1i z / >z G + : ,z? 1-3 k< < 0 fD K 11 !-' 1-' n (n z :U1'1 0 ,--,- Z o� 9C 1-3 J • Z ' O op O N t1 ti p Z I rTI H A z �\ sy ° ° �gJ L cn O n.ta n z r` Cn H 11 rn x O tzi ITI I� ,, .bi ` v ,a Ox z x 0• N II F`iEHp Y HZ CO ZN0 tt ° � MAR • 1b tiC - x , •A n I—' � R 7984 1TJ H Z Z H wo O ` ", totiu , y i y 1yc H Z . ) *ofic �, cn O cn C n U,z1-3 U O H-'z J Volume 5 Page 1400 t 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, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: r� Trench: Width: Length: 9i// Number of Lines: ,7 Area Built: // 7c Fill depth to top of pipe: ,? /, Number of feet from nearest property line: Front, O Side, Rear,O 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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: / Plumber on job: (4 ;c,, License Number: �S"� S' 3/84:mj • • Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER // Ak'r'ii4,r/5 Z-4' 37/F TOWNSHIP /C�fs>,°,',(2 SEC. , .' T ;7O N-R fg W ADDRESS 12Y ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT •t/t LOT SIZE Ai/ PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM • 1 Al tit�L //,9S= 9d& / ) / idos -/t. '5 - / ( INDICATE NORTH ARROW , BENCHMARK: Describe the vertical reference point used ,'/ ,A/ �rc Elevation of vertical reference point: /a/),(5 ' Proposed slope at site: AZ SEPTIC TANK: Manufacturer: /c,;,e6lJ;,,,,,,1 4;,,4 Liquid Capacity: /(7 7s,/. / ,l Number of rings used: / Tank manhole cover elevation: P‘19/ Tank Inlet Elevation: 9-5/1 Tank Outlet Elevation: 9 C S^ Number of feet from nearest Road: Front,O Side,O Rear, /‘,-:? feet From nearest property line : Front,O Side,Rear,O .8( feet Number of feet from: well g) ' , building: Jy' r (Include this information of the above plot plan)( 2 reference dimensions to septic tank) ..'- nnTinn,n n-nom+ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7949 BUREAU OF PLUMBING MAIrftrON,WI 53707 I CONVENTIONAL ❑ALTERNATIVE State Plan I.D.Number: Of assigned) ❑Holding Tank ❑In-Ground Pressure ❑Mound • NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: '3a FIanence HopFiivvs E.&t. Rt. 4, NewR-chmand, WI 54017 //y€7 ,Z,� BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF ELEV: SW SW, Section 34, T3ON-R 18W, Town o i Richmond . Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: _Cat PoweJ • 1563 St. CA.oix 88465 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL POOVIDG COVER PC.K0 �7 PROVIDED: PROVIDED: f,A 1I [C11.70 3y,o/ qJr /3 YES ONO OYES I'NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY I WELL: BUILDING: VENT TTOETRESH ri �( (,/ ALARM' FEET FROM Z ❑YES ENO l C I ❑YES , NO NEAREST > / DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. PROVIDED LABEL LRCKINGDOVER OYES ONO OYES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING: VVERN N`O FRESH (DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) OYES ONO NEAREST--- SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH. DIAMETER MATERIAL AND MARKING FORCE or excavation. (lf soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH: NO. DISTR.PIPE SPACING: COVER INSIDE DIA SPITS LIQUID I /\ /V y/ TREfVCHES.. d ) MAT IAL: PIT DEPTH. DIMENSIONS / T/ L l/!• GRAVEL DEPTH FILL DEPTH DISTR.PIP IDISTR.PIPE IDISTR.PIPE MATERIAL: NO DIST NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES. ABOVE COVER: ELgEV.INLET EGLE�V.END G, PIPES: FEET FROM LI©� 9 3 / AIR ININ=ET. � )I Z2 /��1I I /ol%� 27 2 / . NEAREST--x- V'1 / 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 LINO SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS OYES ONO ❑YES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED CENTER: EDGES: OYES ONO OYES ONO OYES ❑NO PRESSURIZED DISTRIBUTION S YSTEM: 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.: DIA..: ELEV.. . PIPES DIA.: ELEVATION AND • DISTRIBUTION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS OYES ONO OYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM OYES ONO OYES ONO NEAREST 1 �� q~ o. 5 ofS • \D P\ 7 �. 9_ i � 13- Sketch System on Retain in county file for audit. Reverse Side. i SIGNATURE. TITLE. DILHR SBD 6710(R.01/82) / ,,..„„e__ �' 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 concerting 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 owner's name and mailing address. Provide the legal description where the system is to be installed; II. 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 8'1 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 ever 2 years of steady negotiation and public debate. The groundwater bill Ground,Water .- i ecluded the creation of surcharges (fees) for a number of regulated practices which V'Jisconl in'S • can effect greun'water. The surcharge took effect on July 1, 1984. All of the water that buried �re asure . used in your building i s r eturned t� th e groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The hones ?Ilected through these surcharges are credited to the groundwater fund adminis- i.t a „4i terec by the Department of Natural Resources. These funds are used for monitoring ground- ater, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) Dt g SANITARY PERMIT APPLICATION COUNT 640.L In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# 77414 —Mach 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 I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ❑ NO PROPERTY OWNER PROPERTY LOCATION / /oreif%ct op/ / i 6:5--t, s5 /4 `� `4, s3 (/ T3ZN, R A -5(or)W PR ERTY OWNER'S MAILING ADDRESS !!// LOT f R BLOCK U BER SUB I E PR 14 TY • ���� /�� CITY,ST E ZIP CODE PHONE NUMBER CI // NEAREST ROAD,LAKE OR LANDMARK O2W u r o,J ' �YC7/ 7 ( TOWN F: Jic—L''iam ce E ii ' II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): ii�/ III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b.kReplacement 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.JConventional 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. El Seepage Trench c. El 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): c 3 jf' , 4;a.- I J7_5 // 2. / �� O Feet k Private ❑Joint ❑ Public CAPACITY VI. TANK Site in gallons Total #of Manufacturer's Name Prefab. Fiber- Plastic Exper. 1 Con- Steel INFORMATION New Existing Gallons Tanks Concrete glass App. Tanks Tanks n strutted Septic Tank or Holding Tank I. OQ 000 V !t �/' ❑ Lift Pump Tank/Siphon Chamber 0 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) 1MI191MPRSW No.: Business Phone Number: C I'4-'/v/r) Co----er 5 f 0 a..Q.w-��l�- / 5-63 ('?/ s)ZL/`-51.35- Plumber's Addresss( ,Ci State ip Code): v Name of De g r: 3 /l✓ E.i--' K re-1.®y- (�/ ( '� f / VIII. SOIL TEST INFORMATION Cer[tied SolJ Tester(CST)N e CST# C---”4-1('/r v7(CST) w e.c.Th j ( ."5"5"5-3) CST' ADDRESS,Sf�eet,City,Sta Zip Cole) / Phone Number: 3 IVew i�c h-.ter of w/ .��0/ 0 (e)l S) ZyG - 5%35 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) . Uf Approved ❑ Owner Given Initial Ili g, Surgharge Fee 7 `2 �{'j)..Adverse Determination (• 49Q/ S- -13 1" /�) U ��X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber • 1 • 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 1F/• ` ¢. e 171 O,If )Al .s — Es 7 . tc_ Location of Property SW .5/t/ 1, Section 3 y , T 3t N - R / K w Township l c 12/f) n G/ Mailing Address �_J - /1/ 1'0 /c 4 m a h l WI sL/ Al Subdivision Name • Lot Number / Previous Owner of Property Q(A/ 69 e_ r ^e) .-r-7- for q1. t/eei's Total Size of Parcel 7 e Date Parcel was Created --. 9 !' Are all corners and lot lines identifiable? L/ Yes No Is this property being developed for resale (spec house) ? No Volume F-7 and Page Number 7 as recorded with the Register of Deeds CO INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: Warranty Deed ..--- A g7 "� /0 ' 157 s � y 6 ( 2. Land Contract • 3. . Other recordings filed with the Register of Deeds Offige 3',/ 7.2 2 //o/ 5 0901-e- l '/o e j , ,w In addition certified surve f available, wo ld be helpful so as-to avoid delays of the reviewing pro ess. the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. • PROPERTY OWNER CERTIFICATION 1 (We) centiliy that a..te ata.tementa on .thL6 ionm ane time to the beat o, my (oun) fznow!edge; that 1 (we) am (are) the owner.(a) o i the pnopen ty deb cn b ed in th i,a .inbonmatLon Lonm, by vAi tue o6 a warranty deed neconded in the O66.ice o6 the County RegA ten o 5 Deed az Document No. ; and that I We) pneaentty own the pnapoaed d.c to OIL the aewage di,apoeat aybtem (on I (we.) have obtained an easement, to nun with the above deaeh.i.bed pnopenty, icon the conatnucti.on ea.id byatem, and the dame ha4 been duty neconded in the Obii.iee o� the County Reg.i.4te4 o6 Need, as Document No. ) . • SIGNATURE OF OWNER SIGNATURE OF CO-OWNER IF l'PLICABLE) DATE SIGNED DATE SIGNED r Y oryLivt,e4 t / et / / /moo /.444.,,xti',39 7340 cn cn I if CJ n ' unplatted lands owned by others w w 0H 1H-1 0 H H O_ N Z O O Utz WEST LINE OF THE SW 1/4 ® NORTH 484 . 68 ' (^)L^' Z CI, TOWN ROAD w V '- m w I NORTH 433 . 42 ' rc a: Cl) IS✓ H k IC1) Co i * w o 0o res Z rF (11 l0 O II-, H O c* 1•-' 50 ' o tr] N F H w F-, (n IA) IV H (D - U7 3C • N '.Z • LP --1 Irt t=] t=1 fl N 1--. 0 Oo .A C) tr1 (n - I rt •• Lc _ r a,- t a,. (n I() Cl) H = Ni C Cl C H I— ,- C1 IQ t'i C) A) 0yo 0 >I 1--, O = 1 HO r' - H C) tom) H C) Co —I Ni txi II-. 7:1 0 Z ',i'1 Z :rl Lo Iw (!1 Z C) Cl) C) tx7Cn G) tIiCn F_. -1-' I cntl7 ›, w cn lO Cn rJ • la 7t7 H .i. N \ '=J ■ 'TJ v N 1 w O 0 •p 10 d2. n 0 H H H H OO • IE - C) H La I: C) C Z H t1' 50 ' Cl) r �- ia. H I'd > Its d H Z Di P.) Cl) O ro • 1C Z OO 50 . O(b 422 . 36 ' io N tli O Fri C x SOUTH 472 . 36 ' Irt - m '� H lID I'lJ C) 'Ai t=1 Hn uzplatted lands owned by platter In 3 x cn M x c) cn off m rri O - 01-3 ZZ 1 t17 g z Z Cn l CnO p_ t� I z ; H � m tli y BEARINGS ARE REFERENCED TO THE WEST c HLINE OF THE SW 1/4 ASSUMED TO BEAR NORTH. H Cr) rr C) 1-' .m< I' O N C P -7 'lit1 nf iinztrg a • Z I-. RP. j. t4", H O -o`,• A 5 En �' O G) „"et, rr.•N;;:t f:"...1 Q$ U) H N n o - , 67 ra ... t O H Q. 0 it G C) s e 1.!....;:s1: Z Z 6 r„ - 4a H b' ii � o —I x 0 ® Z /c co m n ''1 HF1 C) 01 Zz1 �i o . Z 0) XC i . Z • O H '� .� Ni c) co N.) ttxjC) r— z • t C) op 0 ti = 7i 73 rn H Z tr °o w o GI C) td CnH ►-I m x0tri m II H o at ° • ( I� • ro t' C - ,F' N F--' fti I-I Z Z H 'I CD H Pd Z o w CD 1-C H (n O ` • Z 171 (1) cn to O tii t':] H CC) (n H 0 Z H •p • x C7 H O H 0 H Z Z - '� ;i€� ,� • :. , 3 Jr �)<: � x�: � ,, �, `. �a. . Q'at'.,? 4 r '�C• ws..rx� �.,, ....eA: Z� rea..�...z.,..R.3. .,.v Yom: ...�''r.,e�t�. r� pa- •c...+am14. ."t • SURVEYOR ' S CERTIFICATE I, Allen C . Nyhagen, a registered Land Surveyor, hereby certify that by the direction of Florence Hopkins, I have surveyed, described and mapped the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows : A parcel of land located in part of the SW 1/4 of the SW 1/4 of Section 34, T30N, R18W, Town of Richmond, St . Croix County, Wisconsin; further described as follows : Commencing at the SW corner of said Section 34 , said SW corner also being the point of beginning of this description; thence North, along the west line of said SW 1/4 , 484 . 68 feet; thence S87°57 ' 56"E, 324 .39 feet; thence South, 472 . 36 feet to the south line of said SW 1/4 ; thence S89°51 ' 29"W, along said south line of the SW 1/4 , 324 .19 feet to the point of beginning. Above described parcel is subject to an easement for C.T.H. "E" and an easement for a Town Road, and all other easements of record. That this Certified Survey Map is a correct representation of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236 .34 Wisconsin Revised Statutes, and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. • LLEN fT S-1407 s a!�} {S. 9_,J+ i it I4E[ 4 wl ft) • 1 us a t ' '• td r z W H H . Y STC - 105 r SEPTIC TANK MAINTENANCE AGREEMENT H 0 per~ St . Croix County z 1 d i a OWNER/BAR F/ore.hCe /74/A.) n..s '-- ES /4/7, rri ROUTE/BOX NUMBER E Y Ay, SY Fire Number• CITY/STATE ill euJ ,�/ cd A � Dnr) N. ZIP .5. 9P /7 PROPERTY LOCATION:5 4V 1, 5 k) 1, Section 3 / , T ,30 N , R le W, Town of jq/G /yam , n Gl , St . Croix County , Subdivision 4- 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 three year expiration. HH I/WE, the undersigned, have read the above requirements and agree m to maintain the private sewage disposal system in accordance with x H ' the standards set forth, herein, as set by the Wisconsin Depart- ro ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days 1[ of the three year expiration date . / p � i SIGNED /L�.�L_ �..:/s .,:r� 7 DATE / /3 '- g. r- 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 . • M1• � INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is 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 ON SOIL CONDITIONS; 6, 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 scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exernp- 'ion,if appropriate; 10. If the information (such as flood plain,elevation) does not apply, place N.A.in the appropriate box; 1 1. Sian 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 Storer (over 10") BR -- Bedrock cob Cobble (3- 10") SS —• Sandstone (it -- Gravel (under 3") LS -- Limestone — Sand HGW — High Groundwater r,s -- Coarse Sand Pere Perccflation Rate med s Medium Sand W Well Eine Sand Bldg Bu riding _._ Loamy Sand Greeter Than ;I -- Sandy Loam l -- Lest: Thar) I — Loam Bn --- Brown Sir t Loam BI Black Slot. try -- Gray Clay Loam Y _-. Ye ow sea --- Sandy Clay Loam R — Red sic:. Silty Ciay Loam mot -- Mottles sit Sandy Clay ni/ -.. with c -- Silty Cirry fff few, line, faint --- Clay cc -- t,omrnon coarse ya --- Peat min -- Many, medium ;�1�ack d -- distinct p — prominent HWL. -- High water level, • • Six general soil textures surface water • for liquid waste disposal BM — Bench Mark V RP --- Vertical Reference Point • TO THE OWNER: This soil test report is the first step in securing a sanitary permit,The county or the Department may request verification of this soil test in the field prior to permit issuance, A complete set of plans for the private • sewage system and a permit application roust he submitted to the appropriate local authority in order to • obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction, • v DEPARTMgNT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.09(1) &Chapter 145.045) LOCATION: SECTION: T7SHIPtro�y�„ LOS)d .:BLK�IyO. SUBD),VJ�ON NAME: 5 � 14%)a �3' /T3oN/R►'I(or)W `. I 1 m /'V k /IJ COUNTY: OWN R'S/BUYER'S NA E: e e{Te.. MAI ING ADDRESS: , t /: /re-,•/Ctc__c,, Ik I - I* t proil (4'I U/ USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION:- PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 '�NN1V/�////// ❑New eplace I — / �_,, U� / /3_8") O RATING:S=Site suitable for system U=Site unsuitable for system 9 ie (.J V r �Fj r CONVENTIONAL: MOW D: IN-GROUND-PRESSURE:SYST�NI- N- ILLH DING TANK:RECOMMENDED SYSTEM:(optional) l EIS ❑U /� ❑U ;_AS ❑U ❑S ❑S��U co ,c 7-,,,, DESIG RATE: If Percolation Tests are NOT req ire If any portion of the tested area is in the � under s.H63.09(5)(b),indicate:IV/� G/a53 Floodplain,indicate Floodplain elevation: r._.., — MOW DESCRIPTIONS BORING TOTAL ELEVATION jaPTH TO GROUNDWATER-IFS CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH P�Tht NUMBER DEHd;' OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) / " B- ► ; `.SJ one � 6 o -. , �! J I, B--2— c 2„ / on • / 1 U - .rl4/7'S� , ' _Z,LCns,/ 2,Z -30ens I -1 +a /- ;, .5 • .7 - ,"4 - .o 1 O-iS6ITSj .S- -2-,Yee,5' B- �r5 93� 3 f on � c)15 2.y - -. 79ns/ '7, 7-�l. '�t3n/S ' . y-7. - B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES DUM�jBER tk2tlE3= AFTER SO WELLING INT_E7RV�-MIN. PERIOD 1 P��2 PERIOD 3 PER INCH P- L 4.� h 0 7 0 / 2?f ,_7`/// _ P- j 3, 1' P-Ia 7 a jly I I Ya 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 701 0 , ii nse _ 1. sll. ...1. C I 4 1 � r!14c1 ( ? 4._. E Si 1 1, , __- 7 t w � , i 1 / ii i_ . . : , 1 . la_ _a _ai.._ ! T ---1 f t-1 4)----;$-C 4 1- 1.. .2 IL_ _ 1 . _ 3 77 c t t S 1 � , _ _ -+-'- ,PJ-t ;r . 3 I ; _ __ s 4 Lt./ F t i 'v I pf _ = F -. � - I ... — { ( _ 1 1 i , L } 1 _II_ i t ..._.i I III: __I _, .. _ _. _ 71 trJ -3-.-.-._._�'._... -. ..____ _.._. ....._......�_.,.....,. ,._....._.'s..._.._.j...__..__.__. .�_ _...._._...._._..._. __�..._.._._. 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): l \ TESTS WERE COMPLETED ON: Cn_}v,vv) �e� 0 / -' 1 3 —877 AD ES : 3 i CERTIFICATION NUMBER: PHONE NUMBER(optional): e*� ( ' rP OV W 1 �S S3 C 15' 7, i4-51 6- T � CST S NATURE: J DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. g` LHR-SBD-6395 (R.02/82) —OVER — _ • j�jorence it-crA,ir. & reey /1✓ewe r. w1 1 . • S w y 5 w %Y 5ec_3 -1:70 CV el g t....) ( " _ J27 K t goi 6 e et c--k In a 1 I,- 11/9-, / !n /N\1rt^e.e_. 12YeJ 5 t 2-e- 1-1.X 9 q ' -- //2-5 z `Jig 1-1c--19nK Pc-P ro0o7 u. ' / 1/ _ `1o ` 5c.,. /..e___ 04- 1 -- 13—i 7 ...L..— . oof.,,i, c.a/vt., - - r rh P 4-5 L*-d / s-6 3 I 1 iroL.3‘,,-D o+n I I 51 .- I it ' A O w r.1 i -I 4 a3 J1 1 I • " PAGE OF * (\mil • r1 4° Coro S S V � ' • ► V /, o V E. �� J y 7 e n---) Fresh Al, Inlets And Observation Pipe r,. Approved Vent Cap Minimum 12"Above T..,". flout Grad• i 20-42"Above Pipe _4"Cost Iron To Final Grade Vent Pipe Marsh Hoy Or Synthetic Covering win 2"Aggregate Over Pipe r-1 Distribution —Tee Pipe '—"I o 0 0 o o 6"Aggregate [o l Per .teii Pipe 8::cam Beneath Pipe ^_ _ 1 �o Coupling Terminating Al Bottom 01 System Prop())(1) c'1 gR rkC , 1 SOIL FILL • DISTRIBUTIOI•I PIPE APPROVED SiNTHETIC COVER MIl `4=31a1d11111•1* -'.0--'i ."---MATERI/PI- OR 9" OF STRAW 2"06moREGA1E —�' IIIII4) 4) .. OR MARSH HAy 90 to OF 12 -27a AGGREGATE 009 � �/ �. tLEV. OF 90 ,=14.:-,. %' ' :.:\�%%. 3. .3' N DISTRIBUTIOM PIPE TO BE AT LEAST aD IIJCHES BELOW ORIGIAIAL GRADE A1JU AT LEASTZO IMCI-IES BUT MO MORE THAI) H2 IAICHES BELOW FINIAL GRADE MAXIMUM DEPrH OF EXcAVATI' J FRom oRIt;WaI. GRADE WILL BE 40 INCHES MINIMUM 0Epns OF E$CA'/ATI®N oM O l(►MAL GRAPE WILL BE 2,1 INCHES SIG LIED' r - r LIC ELI SE AJUMBE R: /5‘..-3 DATE : /3 — " 7 110