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Home My WebLink About014-1038-20-100 St. Croix County Planning and Zoning Monday, February 05, 2007 at 1:50.08 PM Page 1 ojl Detail Sanitary Information Computer 014.1038.20.100 SublPlat: >35 acres Section: 18 Parcel 18.31.15.274B Lot: 1 TNIRNG: T31 N R15W Municipality: Forest, Town of CSM: Vol. 11 Pg. 3186 114114: NW 114 NE 114 - Owner: Fouks, Stanley 2659 220th Ave. Deer Park, WI 54007 State Permit: 88412 Issued: 1012011986 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: 11107/1986 POWTS Detail: Bed - Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes py Issuer/inspector As Built Plumber Other Requirements Additional Notes Money Harold Barber Yes Smith, Gale This house is south of an existing house (shown $0.00 on 1979 plat book) on original 40 acre parcel Tom Nelson Signed Off: Yes belongs to Stan Fouks; fire #2661 is shown on the CSM, which is the "exsting house" and the new house, constructed in 1986, is 700' south of 220th Ave. Checked deeds, in 1997 the lot was transferred to Bruce. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 10120/2006 - - - - - - - - - - - - - - - - - - - - - - - 10-4 8- R4-6e FQUKS, STANLEY, JR. NW NE, Section 18 R*,4'7(v(~/ T31N-R15W - d~s~p Deer Park, WI 54007 Town of Forest Ifu ~~IEE I 2~ „ail! San.Permit#88412 10-20-86 G. Smith ' ,er1n~ Conventional, New INSTALLED 11-7-86 k ; la: o I~l,,sre , 6 i4 ,it ~';i', St. Croix County Planning and Zoning Monday, February 05, 2007 at 8:37:35 AM Detail Sanitary Information Page I of I Computer 014-1038-20-100 Sub/Plat: >35 acres Section: 18 Parcel 18.31.15.2748 Lot: I TNIRNG: T31N R15W Municipality: Forest, Town of CSM: Vol. 11 Pg. 3186 114114: NW 114 NE 114 - - ner: Fouks, Stanley 2659 220th Ave. Deer Park, WI 54007 - State Permit: 88412 Issued: 10/2011986 POWTS Dispersal: Non-Pressurized In-ground Permit: Ne County Permit: 0 Installed: 1110711986 POWTS Detail: Bad- Seepage Bedrooms:! 31 ~'-wl Fund: POWTS Pretreatment: NA V Notes Issuer/inspector As Built Plumber Other Requirements Additional Notes Money Owed Harold Barba Yes Smith, Gale data from notecard - an epsting house (shown on $0.00 Tom Nelson Signed Off: No 1979 plat book) on original 40 acre parcel belongs to Stan Fouks; the fire #2661 is shown on the CSM, which is the "new house" constructed in 1986. Checked deeds, 1997 the lot was transferred to Bruce. Maintenance Scheduled Pumo Date Pumped 1 st Notification 2nd Notification 3rd Notification 10/2012006 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - r Parcel 014-1038-20-100 02/05/2007 08:18 AM PAGE 1 OF 1 Alt. Parcel 18.31.15.2748 014 - TOWN OF FOREST 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 - FOUKS, BRUCE J & BECKY L BRUCE J & BECKY L FOUKS 2659 220TH AVE DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 2659 220TH AVE SC 1127 CLEAR LAKE SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.820 Plat: N/A-NOT AVAILABLE SEC 18 T31 N RI 5W PT NW NE BEING LOT 1 Block/Condo Bldg: CSM 11/3186 1.82AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-31 N-1 5W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1217/442 / 1 w WD 2006 SUMMARY Bill Fair Market Value: Assessed with: 160607 99,300 Valuations: Last Changed: 10/18/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.820 12,000 82,800 94,800 NO Totals for 2006: General Property 1.820 12,000 82,800 94,800 Woodland 0.000 0 Totals for 2005: General Property 1.820 12,000 82,800 94,800 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 113 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charg00 Total 0.00 U U v ads 1996 552675 ST. CROIX COUNTY RVEYOR'S RECORD CERTIFIED SURVEY MAP Located in Part of the Northwest Quarter of the Northeast Quarter of Section 18, Township 31 North, Range 15 West, Town of Forest, St. Croix County, Wisconsin. BEARINGS ARE REFERENCED TO THE NORTH LINE OF THE Prepared for and at the request Of: NE 1/4 OF SECTION 18 TOWNSHIP 31 N., RANGE 15 W. OWNER: WHICH IS ASSUMED TO BEAR S89'40'36"E Stanley S. Fouks 2661 220th Avenue Deer County Section Corner Monument Park, WI 54007 ~ Drafted by. Ty R. Dodge of Record • Set 1" x 24" Iron Pipe. weighing ^ - ~ li minimum of 1.13 pounds per linear foot. b UNPLATTED LANDS _ S 89'40'36" E 2668.07'------- NORTH LINE OF THE NE 1/4 AND ' ~S89*41V36* CENTERLINE 220TH AVE. ' 24376' E 262.58' 216173 - , 33.00'- 2 Ay i NORTH 1 /4 CORNER, I i N 9'40'36" W 255.69' SEC ONASTT CORNER, NORTHE SECTION 18 18 (ALUMINUM CAP MONUMENT') (FOUND 1/ /2" ROD) o LOT 1 O .100' BUILDING N SETBACK LINE N 2 J rn M W M ~ CV UNPLAT ANDS r ` - w R a) rn of W/$C0 N UNPLATTED LANDS N DOUGLAS J. 4-ENTERLINE DRIVEWAY HOUSE N co ZAHLER 2t "-2 APPROVED WELL F SEPTIC q v s S 0 9" W 223.99' o NOV 7 A7 EXISTING FENCE 3.5, n SMEbi ST. CROIX COUWY Comprehensive 1pli1 / Zoning anti TOTAL AREA: ~p Parks ComrWttft 1.82 Acres 79,505 Sq. Ft reordsii AREA EXCL!! = R. O. W. : UNPLATTED LANDS If within not record4 dSf 30 d&Ysc 1.63 Acres 70, 70,904 Sq. Ft approval dAte approval shelt'se ll nuts R vnitf FILED NO TH !0V 2 7' 1996 t 3 KATHLEEN H. WALS14 ANEW Reglstef of Deeds % Croix Co., WI 100 ° VV 100 JOB #96152 IV, Prepared by. GRAPHIC SCALE A & E LAND SURVEYING SCALE IN FEET: 1 inch - 100 feet Phone No. (715) 246-4319 P.O. Box 325 NOTE: The parcel shown on this mop is subject to State, County and Township 109 East 3rd Street New Richmond, WI 54017 laws, rules and regulations ( i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel, contact the St. Croix County Sheet 1 of 2 Zoning Office and the appropriate Town Board for advice. ' AMEW VOL. 11 Pap 3186 1 Fo rm - S T C - 104 ICN/~ 194 AS BUILT SANITARY SYSTEM REPORT CAA, R ~e F S TOWNSHIP FQ)Q SEC. T N-R W f ADDRESS GQf'~ ST. CROIX COUNTY, WISCONSIN De, R P4R K lv i SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ORtve w~+y l 4~~ v& a ~ S c P ~'>c t,,l N K 0 ?00' \q1~ 73 ~ Sao B.M, goo ' 6hRA~e INDICATE NORTH ARROW QpT fD 1vl 0A' S/ d IAA BENCHMARK: Describe the vertical reference point used d CORAi 9! O G G,+A4A g < Elevation of vertical reference point: ~D D Proposed slope at site: 7 Oj2 SEPTIC TANK: Manufacturer: 1.y 'e,, R $ Liquid Capacity: /000 Number of rings used: p Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,N Side,0 Rear, O 70 Q feet From nearest property line Front ,(;Z~Side,ORear,0 240(9 feet Number of feet from: well Jy , building: /0 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE P CHAMBER Manufa rer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bott f tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Ala witch Type: Number of feet om nearest property line: Front, ide, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench. X Width: Length: le )O Number of Lines: Area Built: sod Fill depth to top of pipe: n Number of feet from nearest property line: Front, Side, O Rear,0 Pt. Number of feet from well. . 3 6 Y Number of feet from building: 9 7 (Include distances on plot plan). SEEPA PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or dist ution box O been ed on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capac Number of rings used: Elevation of-bottom tank: Elevation of inlet: Number of feet f nearest property line: Front, O Side, Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number : Im 10 K"~ 9 d 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION ` P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 LONVENTIONAL ❑ALTERNATIVE State Planl.D.Number: ❑ Holding Tank ❑ In-Ground Pressure El Mound (If aasigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Stanley Fouks, Jr. Rt. 1, Deer Park, WI 54007 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: _AE F. PT. ELEV.: CST REF. PT. ELEV.: NW NE, Section 18, T31N-R15W, Town of Forest Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Gale Smith 5690 St. Croix 88412 SEPTIC TANK/HOLDING TANK: MANUFACTURER: ILIOUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER /y PROVIDED: PROVIDED: m v ~ OYES ❑NO DYES I~GO BEDDING: IVENT DI VENT MA~.: HAIGtRMA NUMBER OF R AD: PROPERTY WELL: BUILDING: VENT TO FRESH FEET FROM LIN : AIR 1 L FST: DYES 1N DYES ~NO NEAREST O fv') DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER: WARNING LABEL CKING COVER ON _D: v OVIDED: DYES ❑NO ❑NO DYES ❑NO GALLONS PER CYCLE: MP AN CONTROLS OPERATIONAL: NUMBER OF OPE WELL BUILDING V NT TO FRESH (DIFFERENCE BETWEEN FEET FROM INE AIR INLET: PUMP ON AND OFF) vu DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONA YSTEM: BED/TRENCH' WIDTH , LENGT JNOF DISTR. PIPE SPACING: COVE INSIDE DIA. *PITS LIQUID TREN ES: RIAL: PIT DEPTH. DIMENSIONS GRAVEL ILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISM. NUMBER OF I PROPERTY WELL: BUILDING: V NT TO FRESH ~ir LINE: BELOW PIP gBOyE 2V~R: ~EV. INLET Ew. e. : 2, 2_ I PIPE FEET FR INLET oft L + NEAREST--► ~D / r 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- DYES ❑NO meets the criteria for medium sand. TIONS MEASURED. 1 OVER TEXTURE PERMANENT MARKERS JOBSERVATION WELLS DYES ❑NO DYES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED imULCHED. CENTER: EDGES. DYES ❑NO DYES ❑NO DYES ❑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 ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES. DIA.: 'DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. DYES ❑NO DYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY IWEC-L7: BUILDING: FEET FROM LINE: DYES ❑No DYES ❑NO NEAREST I r - Sketch System on _-Main in county file for audit. Reverse Side. ~f SI TITLE. DILHR SBD 6710 (R. 01/82) Wisconsin APPLICATION FOR SANITARY PERMIT D1LHR COUNTY - OEPggTR,EnTOF (PLB 67) - Ir10U5TRY.LRBOR&HUMRnRELRT10r15 UNIFORM X~SANITARY ~PERMIT # -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING A/hD~DRESS PROPERTY LOCATION U Old k 1/4 tit- 1/4, S T N R 0(Or) W TOWN OF: 3I. "OWN OF: X10 e•S LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER .2 .2,o t1l AP A Vie TYPE OF BUILDING OR USE SERVED 1q_ it 1 or 2 Family Number of Bedrooms: - ❑ Public (Specify): THIS PERMIT IS FOR A: X New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed X Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total *of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity 0Op X Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: e IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Gallons Tanks onstructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: EEE PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 00 .S' Q X Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: _ MP PRSW No.: Phone Number: Plumber's Address: Name of Designer: 7" GA a u.0.0 d oJ4 G COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved JD o7a El Owner Given Initial J!1 Approved Adverse Determination Reason or Di pr l: Alternate course(s) of Action Available: )ILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether,this is in a city, village or town 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.) ; 1(`L 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrodms, etc:), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tgpk(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. APPLICATION FOR SANITARY PERMIT S T C - 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 J-W Location of Property 114 _AL 4 3, Section / f , T N - R 1 W Township _ repr-- f" Mailing Address R -D e A R P A R fi-5"y ~a 7 Subdivision Name Lot Number Previous Owner of Property 10,4 7~-,e Z.L / Total Size of Parcel A C` Date Parcel was Created Are all corners and lot lines identifiable? Yes_ No Is this property being developed for resale (spec house) ? Yes_ No Volume 4l 0/ and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 1. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTV OWNER CERTIFICATION I (We) cex;ti jy that allstatemenfi6 on Chia 6onm a&e tAu.e to the beat of my (oun) knowledge; that I (we) am (one) the ownen.(s) of the pnopenty dacAi.bed in this .in6onmat.ion JoAm, by vi tue o6 a wavcanty deed neconded in the 0jjice of the County Regis ten of Deed6 as Document No.o ; and that I (we) pnesentty own the puposed .6ito bon the aewagedZspooAEF6ybtem (on I (we) have obtained an e"ement, to nun with the above dachibed property, ~o& the conztnuc Lion o j said .6 ys tem, and the .game has been duty t eco tded in the 0 j j ice of the County Regizten of Deeds, aA Document No. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED ' H ' z rn H _ a STC - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z d a OWNER/BUYER SANLe~r F44`P ROUTE/BOX NUMBER- ` Fire Number .CITY/STATE deg p P,4R/f i ZIP 7 PROPERTY LOCATION:'y Section, T?_N, R /J- 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 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. H 0 • E I/WE, the undersigned, have read the above requirements and agree czn to maintain the private sewage disposal system in accordance with x 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 Offkrte within 30 days of the three year expiration date. SIGNED DATE l d l U 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. i I ~ ~e,~ N I ~ ~w p~ ~ ~ ~ 7 Uincx3rWan SANITARY PERMIT cou DILHR •°~~„u„~,,,,, GROUNDWATER SURCHARGE Senitery Permit No. On may 4,1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com- monly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. Ground Signet re of Issuing A _ ent: Grogeter Fee: ts~ n n WISCO DILHR SOD 728 (N, 84 =ZU ; buried t. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, ° DIVISION P.O. BOX 76 H UMAN RED LATIONS PERCOLATION TESTS (115) MADISON WI 53707 HUMAN (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNS HIP/A41T: LOT NO.:BLK. NO.: SUBDIVISION NAME: It N/R "or) W _ o - Wz COUNTY: OWNER'S MAI AILING ADDRESS: USE DATES OBSERVATION MADE NO.BEDRMS,: COMMERCIAL DESCRIPTION: (PROFILED C TIONS: 1PERCOLATION TESTS: p / 10~ Residence ;7 - DO New ❑ Replace I M V e2 RATING: S= Site suitable for system U= Site unsuitable for system C! O 7 CONVENTIONAL: MOUND: IN-GROUNDPRESSURE:SSTEM-IN-FILLHOLDINGTANK:RECOMMENDEDSYSTEM:(optional) ®S ❑U ®S ❑U ®S ❑U ®S ❑U ®S ❑U ~D~iyCNJ~%~N~G If Percolation Tests are NOT required DESIGN RATE: iFloodplain, If any portion of the tested area is in the under s.H63.09(5)(b), indicate: ;2o hi indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST- I HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-~ 1 X7,2 17 YZ 'o"aN 1 .5-A Se. !9.2 4 A ed 1.0 rfse, *,7 pied x B- 3 r 7, a J~ 1 "sw, 44- r, g S O N L eal B- 41 r B- > / [ / o ed B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERT 2 P R PER INCH P- P- 2 ~Q o 3/' 6 P- P-- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- contal 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 B - S w e _ j l ! I ! Y O D Otr= i r _ - T ! t ; 1 3 I 4- Gr v aJ o fio vie 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: 6~ Le- S D--i -d',01 ADDRESS: CERTIFICATION UMBER: PHONE NUMBER (optional): fi G e O CST SIGNATURE: G~ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) OVER - a 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; S- 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 exemp- tion, if appropriate; 10, If the information (Such as flood plaid, elevation) does not 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 Sail Separates and Textures Other,Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone *s - Sand HGW - High Groundwater cs - Coarse Sand Perc - Percolation Rate % med s - Medium Sand- W - Well Is Fine Sand Bldg Building Is - Loamy Sand > - Greater Than sl - Sandy Loam < - Less Than *1 - Loam Bn - Brown *sil - Silt Loam BI - Black si - Silt Gy - Gray *cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay wl - with sic - Silty Clay fff few, fine, faint *c Clay cc - common, coarse pt Peat mm Many, medium { m - Muck d - distinct p - ;prominent HWL - High water level, Six general 'soil textures surface: water for liquid waste disposal BM - Bench Mark VRP - 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 must be 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. Smith Plumbing & Heating PHONE (715) 265-4838 GLENWOOD CITY, WISCONSIN 54013 _S"1`A N o v ~o tf Ir S' .TA A(lu v NF See !Z t 2i R /j-4/, St C, o ix G'~, An aSed BR Ho M p4 Wfe FCPo a G /'o 0o G~ Se ptl ~ 7`A~vK tx d Am Joe L4 K- jpolre-vt- Qo l`tp m o <~iiv~ 8 '7220 1 .0I v ~,,,(o Pe a XiSt7 d° d Remo Ise E;ARA~e I o v e lq td P ~F' S lSteny f o ' S` y s ?'t' M s, ste-M F~e~99f13'' A/ 1"Velvt roP Sd ~L s.yNtH et/G pwpl n 0 0 0 floe k ~ C ll A P 06 t~ b a ~ o pR.4 w y St. Croix County Planning and Zoning Friday, July 13,2007at8:32:16AM Detail Sanitary Information Page 1 of] Computer 014-1038-20-000 Sub/Plat: >35 acres Section: 18 Parcel 18.31.15.274A Lot: TN/RNG: T31N R15W Municipality: Forest, Town of CSM: 1/4114: NW 1/4 NE 1/4 Owner: Fouks, Stanley 2661 220th Ave. Deer Park, WI 54007 State Permit: 88412 Issued: 10/20/1986 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: 11/07/1986 POWTS Detail: Bed- Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Recuirements Additional Notes Money Owed Harold Barber Yes Smith, Gale Stan Fouks purchased 80 acre parcel from Mrs. $0.00 Tom Nelson Signed Off: Yes Lester Larson with house at #2659 and then built this house at #2661 to east. Created lot 1 of CSM 11/3186 in 1996 to separate the 2 houses. See Bruce Fouks' 2007 replacement permit. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 11/7/1989 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Parcel 014-1038-20-000 07/12/2007 05:12 PM PAGE 1 OF 1 Alt. Parcel 18.31.15.274A 014 - TOWN OF FOREST 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 STANLEY S FOUKS O - FOUKS, STANLEY S 2661 220TH AVE DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description 2661 220TH AVE SC 1127 CLEAR LAKE SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 38.180 Plat: N/A-NOT AVAILABLE SEC 18 T31N R1 5W NW NE EXC CSM 11/3186 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-31 N-1 5W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 891/432 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 10/18/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 35.180 4,500 0 4,500 NO UNDEVELOPED G5 1.000 100 0 100 NO OTHER G7 2.000 10,000 148,300 158,300 NO Totals for 2007: General Property 38.180 14,600 148,300 162,900 Woodland 0.000 0 0 Totals for 2006: General Property 38.180 14,600 148,300 162,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 212 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 St. Croix County Planning and Zoning Thursday, April 05,2007 at 11:41:08 AM Detail Sanitary Information Page I of 1 Computer 014-1038-20-100 Sub/Plat: >35 acres Section: 18 Parcel 18.31.15.274B Lot: 1 TNIRNG: T31N R15W Municipality: Forest, Town of CSM: Vol. 11 Pg. 3186 114114: NW 114 NE 114 Owner: Fouks, Stanley 2659 220th Ave. Deer Park, WI 54007 State Permit: 88412 Issued: 10/2011986 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: 11/0711986 POWTS Detail: Bed- Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed Harold Barber Yes Smith, Gale This house is south of an existing house (shown $0.00 Tom Nelson Signed Off: Yes on 1979 plat book) on original 40 acre parcel belongs to Stan Fouks; fire #2661 is shown on the CSM, which is the "existing house" and the new house, constructed in 1986, is 700' south of 220th Ave. Checked deeds, in 1997 the lot was transferred to Bruce. Found Byron Bird's 1986 soil report showing existing 3 BR house 200' south of road. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 1012012006 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - r DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS P.O. BOX 7969 VvMAN RELATIONS (115) H63.09(1) & Chapter 145.045) MADISON, WI 53707 LOCATION: SECTION: / /R/ ( ) TOWNSHI /MUNICIPALOT NNO.:BLK. NO.: SUBDIVIS~I_ON NAME: D !1 -e COU TY- OWNER'S/BUYER'S NAME: MAILING ADDRESS: -5-a I ^J 1k 5 A-e r IC'r GcJiS` 60z USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFI E DESCRIPTIONS: 1PERCOLATION TESTS: [E*esidence 02 XNew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOU D: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) (1S DU S DU 11~S DU ❑S U ❑S U 5 If Percolation Tests are NOT required DESIGN RATE: [Ficodplain, n y portion of the tested area is in the under s.H63.09(5)(b), indicate: indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- ~2c~- 511._ 'r B- - OwG B- / 0" §&U-6 0-.;1e ~,G B- ti1L 4 ~/,1 6' 1917 C a 2 -7 A62" Cl /;PERCOLATION TESTS r TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD2 PER1003 PER INCH ee P-It- ec P- P- a G P P- P- LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- )ntal 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 f land slope. >YSTEM ELEVATION 93 41 '14:0, ~eal I - T~r C7, tr~tC C /M 6~L' ' ,~e3 p i -4~ 1 /o •1 64 59 4 , i 71- 1, L the undersigned, hereby certify that the soil tests repo d thit''?orm were y me in accord with the procedures and methods specified in the Wis nsin Iministrative Code, and that the data recorded and the loca tes t to the best of my knowledge and belief. AME (print : - TESTS WERE COMPLETED ON: DDRESS. CERTIFICATION NUMBER: PHONE NUMBER (option-al) zg)l c c ® 3 4/ 7 0" /✓t'~26 0, CST SI NATURE. -ir STRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. LHR-SBD-6395 (R. 02/82) - OVER - e INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6335 ` 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; 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 exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does not 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. ABBREVATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures ~tf~her Symbols st - Stone (over 10") BR - Bedrock cob Cobble (3, 10") SS - Sandstone gr - Gravel (under 3'") LS - Limestone *s - Sand HGW - High Groundwater cs - Coarse Sand Perc - Percolation Rate med s - Medium Sand W - Well fs - Fine Sand Bldg - Building Is - Loamy Sand > Greater Than *sl Sanely Loam ( - Less Than *1 - Loam Bn - Brown *sil - Silt Loam BI Black si - Silt Gy - Gray *cl - Clay Loam Y - Yellow scl Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles r sc Sandy Clay wI - with,. sic - Silty Clay fff - fewfine, faint Ic Clay cc common, coarse pt Peat corn - Many, rnedium m - Muck d - distinct p - prominent HWL - High water level, Six general soil textures surface water for liquid waste disposal BM - Bench Mark VRP - Vertical Reference goint Y r TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county orthe Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private ,age system and a permit application must be submitted to the appropriate local authority in order to c: a permit. The sanitary permit must be obtained and posted prior to the start of'any construction. St. Croix County Planning and Zoning Thursday, April O5, 2007 at 11:44.-55 AM Detail Sanitary Information. Page I ojt Computer 014-1038-20-M Sub/Plat: >35 acres Section: 18 Parcel 18.31.15.274A Lot: TNIRNG: T31N R15W Municipality: Forest, Town of CSM: 114114: NW 114 NE 114 Owner: Fouks, Stanley 2661 220th Ave. Deer Park, WI 54007 - State Permit: Issued: 01101/1972 POWTS Dispersal: Non-Pressurized In-ground Permit: Replacement County Permit: 0 Installed: 01/0111972 POWTS Detail: NA Bedrooms: 0 WI Fund: POWTS Pretreatment: NA Notes Issuer/inspector As Built Plumber Other Reguirements Additional Notes Money Owed Not determined NA Unknown no permit on record for this older farmhouse - Not determined Signed Off: No $0.00 existing since 1972 plat book, house on 60 acres owned by Mrs. Lester Larson Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 611/2006 11111975 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -