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HomeMy WebLinkAbout020-1163-90-000 St. Croix County Zoning Monday, December 13, 2004 at 4:52:30 PM Detail Sanitary Information Page 1 oj1 Computer 020.1163.90-000 SublPlat: Edgewood Estates Section: 7 Parcel 07.29.19.960 Lot 30,31832 TNlRNG: T29N R19W Municipality: Hudson Township CSM: 114114: SW 114 NW 1/4 Owner: Nelson, Gerald 1075 Marty Drive Hudson, WI 54016 State Permit: 83795 Issued: 0711511986 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: 1010311986 POWTS Detail: Bed (seepage) Bedrooms: 3 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Harold Barger Yes Cudd, P paul Cudd plumber $0.00 Signed Off: Yes Maintenance Scheduled Pump Date Pumr>ed 1st Notification 2nd Notification 3rd Notification 7/1512005 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - s v Parcel 020-1163-90-000 12/13/2004 04:48 PM Alt. Parcel 7.29.19.960-962 PAGE 1 OF 1 Current ❑X 020 -TOWN OF HUDSON Creation Date Historical Date Ma # ST. CROIX COUNTY, WISCONSIN p Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner GERALD G & FAYE M NELSON NELSON, GERALD G & FAYE M 1075 MARTY DR HUDSON WI 54016 Districts: SC = School SP = Special Type Dist # Description Property Address(es): • =PrimarySC 2611 SCH D OF HUDSON ` 1075 MARTY DR SP 1700 WITC Legal Description: Acres: 1.053 Plat: 1929-EDGEWOOD ESTATES SEC 7 T29N R19W EDGEWOOD ESTATES LOTS 30, 31, & 32 Block/Condo Bldg: LOT 30 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-19W Notes: Parcel History. Date Doc # Vol/Page Type 07/23/1997 723/468 2004 SUMMARY Bill M Fair Market Value: 49029 Assessed with: 237,700 Valuations: Description Last Changed: 10/26/2001 Class Acres Land Im rove RESIDENTIAL G1 p Total State Reason 1.050 32,800 151,100 183,900 NO Totals for 2004: General Property 1.050 32,800 151,100 Woodland 0.000 0 183,900 0 Totals for 2003: General Property 1.050 32,800 Woodland 0.000 151,100 183,900 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 130 Specials: User Special Code 018-RECYCLING Category Amount SPECIAL ASSESSMENT 27.00 Total Special Assess 27 O Special Chargeess Delinquent Charges Form- S T C - 104 s _ AS BUILT SANITARY SYSTEM REPORT OWNER GEf4utJ la. /10-16d TOWNSHIP /,~wnso~l SEC. IZ T Z _N-R 20 W ADDRESS Q"T" 3 ST. CROIX COUNTY, WISCONSIN SUBDIVISION E3p~WW6 ' 'al' LOT 3Oi' t 3Z. LOT SIZE /lob X /51,&' PLAN VIEW _ Distances and dimensions to meet requirement`s-6f IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Eta„ s zS'.or ~ 4 -a N' u O f-d 4t-S 1 Sit, F%ft 3 INDICATEINORTH ARROW BENCHMARK: Describe the vertical reference point used u SLQ~+pE Elevation of vertical reference point: J00-00 Proposed. slope: at site: - SEPTIC TANK: Manufacturer: k2ESC'R Liquid Capacity: l~jp~G,,I~d*11 Number of rings used: ' Tank manhole cover elevation: Q Tank Inlet Elevation: Tank Outlet Elevation: 85.32 Number of feet from nearest Road: Front, Side, Rear, q 3,r , .a..... feet From.nearer-t property line Front,OSide Q Rear,Q Z'•'3'+ feet Number of feet from: well ~-b building: lIi-10" (Include this information of the above plot plan)( 2 reference` dimensions to sepr SEE REVERSE SIDE f 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 T Re ype: Number of feet from nearest property -line: Front, Side, O-Rear, Ft. 't Number of feet from well: Number of feet from building: (Include distances on 'plot plan). , SOIL ABSORPTION SYSTEM Bed: of Trench: Width: s q`..du Length: qdNumber of Lines: 4 Area Built: 9bQL Pill depth to top of pipe: Number of feet from nearest property line:. Front, Side, Rear f O O X Vt 1'' Number of feet from well: Number of feet from building: 21 ~-0" (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 0 or distribution box0 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, 0 Side, ORear, 0Ft.. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated /D - 3 - YZ Plumber on job:- 'License Number : /0/Z W -2 Z3 ' 3/84:m / DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. BOX 30969 PRIVATE SEWAGE SYSTEMS DIVISION M41DISON, WI 53707 BUREAU OF PLUMBING MCCONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (It assigned, NA OF PERMI ~LDER: ADDRESS OF PERMIT HOLDER. INSPECTION ATE. BENCH MARK Permanent reference pantl DESCRIBE IF DIFFERENT FROM31gNLemon St . N. , Hudson WI 54016 446 REF. PT. ELEV. SST REF PT ELEV SW NW, Section 7, T29N-R19W, Town of Hudson, Lots 30-31, Edgewood E t Name nt Plwnber. MP/MPRSW Nn.: Coumy: Sanitary Permit Number: Paul Cudd 2739 St. Croix SEPTIC TANK/HOLDING TANK: H3795 MANUFACTURER. , - , LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV WARNING LABEL LOCKING COVER PROVIDED BEDDING. VENT DIA.. VENTMATL.. HIGH WATER ~D PROVIDEYESD. ❑NO ❑YES ❑NO ALARM NUMBER OF ROAD: PROPERTY WELL BUILDING. VENT TO FRESH YES ❑NO /f FEET FROM LINE AIR INLET -A Al . I ❑YES ❑NO NEAREST Q~~ 17 I 'z DOSING CHAMBER: MANUFACTURER BEDDING LIQUID CAPACITY PUMP MODEL PUMP SIPHON MANUF ACTIIHEH WARNING LABEL LOCKING PROVIDED. PROVIDED OVER ❑YES ❑NO ❑YES ❑NO ❑YES GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. F-1 NO (DIFFERENCE BETWEEN NUMBER OF PHOPFHTY wFLL Bunowr, VENT To FRFSH PUMP ON AND OFF) FEET FROM LINE AIR INLET ❑YES E]NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENCITH DI nA1f TF H A1AT1 HIAI 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 NO OF / DISTR PIPE SPACING COVER THE NCF)yy ` MATER AL: INSIDE . DIA aPl(ti LIQUID DIMENSIONS 1W PIT DEPTH GRAVEL DEPTH FILL DEPTH It TH PIPF DISTR. PIPE DI ST PIPE MATERIAL N STH HFLOW PIPE ABOV COVER F I F V INLF I ELEV NU ~J UMBER OF PROPERTY WELL BUILDING VENT TO FHFSH ov 9 /pI P y FEET FROM LIN G AIR INLET NEAREST MOUND SYSTEM: ALI/ 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- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER Tex TURF PFHMANf NT MAHKF ITS OBSI HVA IION WIIIS U CEENPTTEHR OVER THE N(:H BED EDEPDGTEHS OVFH TRENCH. BED ❑YES SEFUF D ❑NO ❑YES ❑NO DEVT{1 OF TOPSOIL SOI)uFl) MULCIII D ❑YES ❑NO ❑YES DNO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEpTH HE LOW PIPI TRENCHES. FILL DEPTH AHOVF COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NPOISTH DISTH PIPE DISTAIHIIIION PIPE MATE HIAI & MAHKIN(, ELEVATION AND ELEV ELEV DIA ELEV. PIPES UTA DISTRIBUTION INFORMATION RULE SIZP HOLE SPACING DRILLED COHHeCII.v COVFR MATE HIAL VEIf TI(:AL LIFT COHRE SPON US TO APPROVE U PLMIS COMMENTS: PERMANENT MARKERS❑YES ❑NO ❑YES ❑NO OBSERVATION WELL NUMBER OF PROPERTY WELL BUILDING ❑ YES ❑ NO FEET FROM LINE ❑YES ❑NO NEAREST Sketch System on Reverse Side. Retain in county file for audit. G T RE TITLE DILHR SBD 6710 (R. 01/82) wmconsin R APPLICATION FOR SANITARY PERMIT . DIL H (PLB 67) St . Cro'X COUNTY a-~ -"..TRY,LRBOR6FlufngnPELRTIOnS UNIFORM SANITARY PERMIT # 13 Z IS -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPS TY OWNER MAILING ADDRESS Gerald G. Nelson 531 Lemon St. No., Hudson, WI 54016 PROPERTY LOCATION SW 1/4NW 1/4, S -7 , T29, N, R19 ktalli W. XamX= Hudson LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAROF: EST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER 30-31 Edgewood Estates Edgewood Dr. TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): THIS PERMIT IS FOR A: 1Z 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. EASeepage Bed ❑ 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 1 X Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: Wi ser oncrete Prod cts IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): WATER SUPPLY: Class 2 945 960 ® 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): S' atu MP/MPRSW No.: Phone Number: Paul R. Cudd MPRSW2739,(715)425-2049 Plumber's Address: Name of Designer: Rt. 5, Box 364,River Falls, WI 54022 Art Wegerer COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agen Fee: Date: ❑ Disapproved Approved ❑ Owner Given Initial Reason for ' pp al Adverse Determination Alternate course(s) of Action Available: DILHR-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 r 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.); 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. Anew permit will be needed if there is a change in, estimated wastewater, flow, (number of bedrooms, 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-tank(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 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 G'eru ~q`~ 9(- e%s Location of Property Section 7 , T d2 Lj N-R1Z W Township /`~Gld SO s'! Mailing, Address Sam/ ego"f, . GCQSO yr Gc// I'r S'/!~ .SS~U~~ Address of Site f q~q~ k/OOe / .®e V e Subdivision Name o~q~ fJO c~'~d~`os- . Lot Number -?0 ~ / - 3 Z Previous Owner of Property Total Size of Parcel A, D ~ cZC/"eS 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 7,22 and Page Number 416 S as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warrant Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION 1 (We) centi6y that att btatementa on this 6ohm cute true to the best ob my (ou&) knowtedge; that I (we) am (ane) the owneA(b) o6 the pnapehty de~scA bed in thi,6 injoamation 6onm, by viAtue o6 a wa4Aanty deed neconded in the 064 ce o6 the County Register o6 Deeds as Document No. e-10 Off` ; and that I (We) pneaentty own the pnopos ed.6 to bon the sewage dispoz a y-z-fe-m (on I (we) have obtained an eaaement, to nun with the above du c Abed pnopenty, bon the constnuc ttt on of .said dyatem, and the same had been duty neconded in the 046ice o4 the County Reg-isten of Deeds, as Document No. SIGNATURE OF OWNER IGNATGE OF CO-OWNER (IF APPLICABLE) TE SIGNED D E SIGNED + GRANTEE: Na +3. u Name Gerald 0 ~-irid Fa ' e M. Nelson .3cci~l Security Number d A. Social Security Number ? I 1,ull Address - New address if property transferred was residence Full Address 336 St. Croix Stroe t. Nortil S31 Y Street North Hudson, WI 3 I J 16 lhxlscn, WI .54016 -is grantor related to.&rantee? Relationship includes, ❑ Yes' No Name and address to which tax bills should be sent if not the same as above marriage, blood relative, partner, lessee-lessor, co-owner, parent corporation or joint owner. 3 r "If yes, explain how related Grantor is ❑ Individual ❑ Partnership ❑ Corporation Other Grantee is IndividualS ❑ Partnership' Corporation Other Telephone: Grantor( ) Telephone: Grantee( ) - PART I - PROPERTY,TRANSFERRED PART 11- PHYSICAL DESCRIPTION AND'INTENDED USE' Check proper box and enter name of municipality and county 1. Kirid of Property 2. Principal IntendedUse ❑ City ❑ Village Z] Town a)El Land Only a.0 Residential d. ❑ Agricultural County C, -Y ' ❑ New Construction b. ❑ Commercial e. ❑ Recreational Street address of property transferred. Include road name and /or fire number. ❑ Building Previously Used c. E1 Industrial `f. ❑ Other (Explain) Route 2 , Edgewooc.' Lr':.ve ❑ Solar Design Hudson , WT S401 I, ❑ Earth Sheltered Home 3. Land Area and Type Estimated Legal Description (Fill in complete legal description in space below or if metes Condominium a. Lot size . x ❑ and bounds description attach 3 copies of it as shown on the instrument of -b. Residential Units, if any b. 1 - 0 5 3 Total Acres • ❑ conveyance. If certified survey map number is used in description list town, ❑ One Family .1. Tillable Acres 'D range, section and acres.) Tax Parcel Number ❑ 2 and 3 units 2. W.T.L. Acres ❑ Lot No. Blk No. Section Town Range ❑ 4 or more units 3. F.C. Acres ❑ Pla[ Name c. Ft. of Water Frontage T>L•'GAL DBSCRIPTION :'0k'1"TAC;1.ED:--Tyesd lots are being sold as a combined parcel of at least one (1) ,-acre in total. area. mote restrictions prohibiting sale of individual lots until connected to nunicipal sanitary.sewer anti water facilities PART 111 - TRANSFER (One answer is mandatory for questions 14, 5a or' b' must be completed, questions 6,.7 & 8,as.apply) 1. M Sale 2. ❑ Gift 3. ❑ Exchange 4. ❑ Other transfer (Explain) 5. Ownership interest transferred. a. El Full b. ❑ Other (Explain) 6, 'Deed in satisfaction of land contract - What was the date of-the original land contract? 7 Amount of mortgage assumed by grantee? $ n0nt3 8. Does the grantor retain any of the following rights:❑ Life estate ❑ Easement PART IV - ENERGY is this property subject to the Rental Weath'erization Standards, ILHR 67? ❑ YES F&]' NO If NO, enter Exclusion Code from instructions N-7 NOTE: If YES attach the appropriate DILHR Transfer Authorization form (Cert. of Compliance, Stipulation or Waiver) to be recorded. PART V - COMPUTATION OF FEE OR STATEMENT OF EXEMPTION (See instructions) 1. Total value of REAL ESTATE transferred (purchase price, etc. rounded to next even;hundred). Include real estate Qxempt from local tax (Solar, wind, M&E etc.), but exclude personal property $ 15, 000 . 00 ' property 2. Value of personal property transferred but excluded from line 1 3. Value of property exempt from local property tax included on line'T $ 4. TRANSFER EXEMPTION NUMBFR if exempt for Reasons 1-13 (see instructions) Sec, 77.25. ( ) 45.00 5, Fee - thirty cents per one hundred dollars of value (line 1 times .001) Make check payable to Register of Deeds.... S PART VI - CERTIFICATION The transfer must be reported regardless of the grantor's state of residence. Information on this return will, be used to.administer Wisconsin Income and Fran- chise Tax Laws, Wisconsin Real Estate Transfer Laws and Wisconsin Rental Unit Energy Efficiency Laws.. We declare under penalty of law, that this return (Including any accompanying schedule) has been examined by us and to the best of our knowledge and belief it is true correct and complete. Signature of Grantor or Agent Date Print or Type Agent's Name SIGN HERE Signature of Grantee or Agent Date Print or Type Agent's Name If Signed By Agent Agent Address Phone Document No. Vol. (Reel) Page (Image) . Date Recorded Date and Kind of Conveyance- LEAVE 406058 723 468 1040/85 10/9/85 WD THIS Parcel Number 19 19 Code: Count Tax District Assm't Dist AREA L .'L BLANK I 11 Office 2 Field 3 Use 4 Reject A B C D E F T T Ratio' Consideration School District No. PE-500 (R. 7-85) WILLIAM J. GILBkkT Donald E. Haornstad, PreSidertti_,and W~11tam Cll • •AN to Too NUSNT ONE N•MeaNta EDGEWOOD ESTATES r^R . "is MAYS Stan MAN To VMS NeAetSi Yulks, To 11441 YALNe SHOWN. A RURAL 6UBOIVISION LOCATED IN THE SE 1/4 OF THE MEIN OF SECTION 121 T29N. P20N. AND IN THE SWV4 OF THE NWHM OF SeC 107 72106/ M1W, NE f.,04tN • t, n 6 TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN r 1~ NOSTH LINO OF THE %@-So r !YN , M eu r ! • Y MWT14 LINO Of THE Or-NW e,N' - _ as, 44. 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MIi, HI NI, I II h I I ,I1 ' ' ' .I •li "lA IL' tUMNtr)ANf i ,r t: "1 , :AI,MUN YIYI , H z C H a STC-105 r a SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County z • tti OWNER/BUYER ~L°/Ct/C/ C~.`3L~/E /F' fOh ROUTE/BOX NUMBER oct7 E ,LCc7~i~ Gclooc/ Fire Number CITY/STATE 17GeaS01l ~eQytS/!~ ZIP "5 ~ • PROPERTY LOCATION: SAI It, /1//I/ k, Sectio , T 29 N, R__ZI-W s Town of ,/G a/so/_7 St. Croix County, Subdivision'4 ~ e&/Ooa a7c,S Lot numbers Improper use and maintenance of your sep~ic 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 th 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 replacem:nt of a failing system, which was in operation prior to July 1, 978. St. Croix County accepted this program in August of 1980,I,with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to S Croix County Zoning a certification form, signed by the owner nd 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/ full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. y 0 I/WE, the undersigned, have read the abo a requirements and agree x to maintain the private sewage disposal ystem in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- 00 ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. DATE St. Croix County Zoning Office P.0. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. r N S S ~ N C W c cn w S co ~c 3 OI (D fD O CD e ..°,co cocuo~'<su ° 3 c co co - - < a "D C5y -oaooooA m c"D O O CD M CO (D 0 CD CD 0. ZA. ID m 0 < 3 (CD ? fD -w O S A 3 Q p o wO m m 00 0 CD > > O W co W O O M tp O C C l<Q 0 ° p 25- fn CA. O A~ y O-4 O Q CD j' CD 00 Z7 D < N ti p. Ja Q O .n. con~'~ 0Dc -~A ~ta w0 v--*Opo'g `m O fn O W p y O m U1 Vl o Al W Z CO) o< :E o cc IC p cn (D N m n (Op _Z CD - -1 3~ (n o N Q a ~1 a C :E CO) "a 30° hiM oN~ oa°mw w ° o M " W O a Ca 0) • , 3 a o -C, n y ~n ~7 a0 f y 0-0 C' Q1 W o c C Q Al p m o fn c - . . -1. v m may' Z. 0 p 7 c cQ ~ o CD A C (Q O . (D M n 3 m A Q° O O° Q o N 7% n o o p C -t ~ UJ ~ C Q O C Q ??W =o Q = 3 O cD O o ' ~ O Q O < 3 O II DEPARTMENT OF ~ SAFETY& BUILDINGS INDUSTRY, REPORT ON SOIL BORINGS AND RELATIONS PERCOLATION TESTS (115 DIVISION HUMAN D P.O. BOX 7969 (H63.09(1) & Chapter 145.045) MADISON, WI 53707 LOCATION: STOWNSHIP UNICIPALITY: LOT NO.:BLK. NO.. SUBDIVISION NAME: siu /N'~/ COUNT Y N/R N M E (o ~4v~sa,~, 30 31 - ~~se, n ~s Y: WNER'S UYER'S NAME: MAILING ADDRESS: 531 L 01~ S ~j7•• N O1L`~ lx GizAL~ c. IvE _ USE aoNJ 1-+kj , W ! SV61 6 NO. BEDRMS.: COMMER IAL DESCRIPTION: DATES OBSERVATIONS MADE Residence 3 PROFILED S TIONS: PER A ON TESTS: • ®New ❑Replace 6 _ zo - a6 -7-9-86 RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: IMOUND: IN-GROUNDPRESSUR_E: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) ~S ❑U ❑S ®U IBS ❑U ❑S [IS WU Zyx~ e~ve~arJ If Percolation Tests are NOT required DESIGN RATE: under s.H63.09(5)(b), indicate: If any portion of the tested area is in the lFloodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL PTH TO GROUNDWATER-1 NUMBER DEPTH ELEVATION fHESTS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH OBSERVED EST. IGEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B--A-- n-S, 1o3.Z~ Nrrw~ > J o's ' C!X8' Dh.Bbi SO Ts ; ►-6' i ►,h N ; N.- A 1=E^p S i SPOTS 3 S. B- 2 1D.Z IOZ. 3 tio~~ > 1D.2' ma: S~rsi17S; $'~~►s11; ah_sl;- y-S' Z3 - B-- q,C7' loo-a' 'N~i~v q. p' ones tc1i 17'S; 13n s, J; z,o' B- 10.0 ~I q • 3 1~o>v ; z, o ~1zUv, s j I ' Z. p' 8rl sil ; 5~_8rN Y,YI S w/ -tNt--hn -zevse s 1 si'o~s - B- 5 q.~' Qq-3' Imp ~ 7 9•g' N,3,'e1 si Ts; z.o, Zr si I 1.~' Bn s!; V. ~Y\ 1-n 4,9. g - - B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME NUMBER INGHEg AFTER SWELLING INTERVAL-MIN. DROP IN WATER LEVEL-INCHES RATE MINUTES PERIO 2 PER INCH B„ P- ~ S.(.11 N D 3 Q P R 01/16 t P R P- 3 S.5' )v0 10 Z'5//6 Z ti //6 } 1 to s, 9' P NO IC> 3 1ti, 31/ 3 3 go o.1 P---- ___VI T`t E~j D! 11T1 ► IN s. s r~E SuR F v IolAlG. '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- 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 )f land slope. percent SYSTEM ELEVATION a 6.6 6 ° SC~JETT - _ 11 2 07 30 - S .p F 1 S t s. lU S T O s - _ r 11(19 u F-+ - r S l_l~C p' E, ~t A [Z~p ( I t i t Y f O m o15 i _ - Lor he undersigned, hereb YTtify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin ministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. ME (print TESTS WERE COMPLETED ON: DRESS: ~(f-T y oX Z.'2 (o ~"~-8 ro . ~O~ CERTIFICATION NUMBER: PHONE NUMBER (optional): •[ltis ~oR. ZVO)II S-)6 715-~1ZS-p16 1M1'hlN-l- ~Z ~jUfVUSly, CSTSIGNATU E: S 8`y ~gU~f SOH ~ 1 C ST• 3W?I/ Td $E Lkm rRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. HR-SBD-6395 (R. 02/82) -OVER - 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; 1 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; plain clearly exemp- B^ Make sure your ropr'i to boxesvas to dates, reference point data, Percolation t s 9. Complete all aKpE tion, if appropriate; appropriate box; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the app oE 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 Other Symbols -Soil Separates and Textures st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone HGW - High Groundwater *s -Sand cs Coarse Sand Pere - Percolation Rare med s - Medium Sand W - Well fs - Fine Sand Bldg - Building Is - Loarny Sand ) - Greater Than *st - Sandy Loam < - Less Than *1 - Loam Bn - Brown *sil - Silt Loam BI - Black Gy - Gray si -Silt *cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - 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, surface water Six general soil textures 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. Own"r'S naPFrI'l*._ I;o. }36 3 .0 5 P -OT i'l:AN Show: ✓ ii Location of building served L'rJ41 Dosing dhamber Septic tank t-~ Vertical/horizontal reference point tEr Building sewer System elevation is _ 46.6 El' Effluent system Well t--A Replacement system area Property lines w/in 501 of system Distribution boxes Scale = 1 = 40 , or dimensioned Pump and controls: Nifr. & Model No. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Gal. per Min. Gal, per Cycle Place check mark in appropriate box, indicating item is shown on plot plan below: _ moo. Gb ~ Lo~ 30 1D~ ~AS'~ T moor 3~{ I I C ~'"~~1_~ob ii:'- T,fl-* TIE'S .0 I; 2 ~ j 1 z 1 H~Z P Q h 10 O F j EA Y-'CX ~t~o~ app= fir s ~i 14 A y~~vt T_ fj L- ;--1 401 OF O~S1S1~E?vlSJN I~lPFS D 2 (n 1) d v j i QI LoT Z) 4 ~ n~ 0 I I~ Lc, T 3 Z By the granting or approving of the above plan, or upon the event of a subsequent permit being issued,5-r,C^~_~x County and the County Zoning Administrator, does not assume or hold itself liable for any defects in plans or specifications, plan omission, examination oversight, construction, or any damage that may result in or of installation. r ig a ie License 6a~e Pev. F ~i E. i CROSS SECTIO?-j OF A BED S ~ST~I~I ~ ~I~IS`r1r - 2" O F A G G R E G AT C SOIL FALL Ni D15TR1BUTfok3 PIPL ~ ~ _ AT F P.OVE.p SyI ~THETIC f 7V1 R, y~y~ ~ \ ~ s ~ ' lh7 LRIAL OR 9" OF O O- - ji . OF, M4P,SH Hl~y !o ©F% -21Z., AGGREGA F- / Y ELEV. OF G'_~•t? FEET___ 1___F:~`tt'--flit}:i=~? 1- - °-7T1TJY, rJ= L- =Z. DISTRI13UTIOM PIPE TO BE AT LEAST INCHES BELOW ORI&WAL GR).DE AI,.1D AT LEASTZO WLHES BUT WO MORE TWf M 42 IMCHES B'-l_OW FIF.lAL C-RADE MAXIMUN DEPTH C)F 1=XCAVATIOU FROM ORIGIWAL GRF,DL Wil-L BE WCHES MINIMUM DEPTH OF EXCAVATIOM FROM ORIGIUAL GRADE 4JILt- BC _ -~Z INCHES 51 L-1J E - t. I G E u S C 1.1 u M S E R: 1~~~^~,l _7