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HomeMy WebLinkAbout020-1166-40-000 n rn Of c3 0 d r 2 w I y o c eD n I ~ Q ~sv 0 2 co N Z ° w 2 N `C ~1 • m a' o o r m -4 ° ro° i" Sr~l d a a N V , NCO O c ro CD CD CD A o 0 3 y y a CD C p C o v cn CD D a N p n' (D C N 4 W 0 c CD 3 ° rn d CD O O CD to m ( cD co C'. ft cr o 3 M M O 000 o cn ai cn ° w v v ° m two H rn < FD* m V N d o 3 su y (o m CL m N N Z rr ` zco z < 0 O D o d :3 CD N CD N N N C CAD N W d d 3 7 Z CD N I ~ v, o AZT 0 a A Z O W Ill V CL Z 3 A I ° fn z I CD ~ A I CD O C S : C o a CD N co I x rn fi N e rl n A < CD I I a I I w I N O I a I A O b W o 0 ti W ti a) p co~ o m c Z~~ `D-c M A) CD 3 n O Z W= O m O C cXl • N 7 v (D CL N 0 1~1 cl) C.0 O" tD Z ro n N V ' 0 N Q ; O O C/) CO b n O, O O ? N O C7) O A W O K f3B N W O O r7 !1 r,- 23 O. Cn C W ~p cC a CD n (D 0 3 ° co o°`o ° O W CD O v v ~1 0 io CO = n r co p ((DD CO rn 00 N 3 a l~l rt 0 rt z 000_ "AM• j11 00 = cn rn Oy 00 =4 x at CY 0- 0 CD CD O N •a CD v n 0 3 d m H VS a N _ o y F-3 D CD O < O a~ j X Z .d\ fD N C 00 C: CD CD I C H Z w N a N O N t 3 3 5 Ul 'rt 10 Z N fQ Z U] p ~O p Z m w d o 7y 3 Azo 01) C~ G) b :vl (D rt D) ° 0 rt W Ill N V CD O D Z F~• gJ 0 X G (D 0 co F-h I z a CL > a Q o o - 3 m c z d p CD N I I d y I '-q O CD f O s N 0 n 3 j °o• t I < N N A M 0 O O OO 00 L b ti _ Y Parcel 020-1166-40-000 10/10/2005 12:36 PM PAGE 1 OF 1 Alt. Parcel 17.29.19.1024 020 - TOWN OF HUDSON ST. CROIX COUNTY, WISCONSIN Current X' 11 Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner PATRICK & MELISSA MCDEVITT O - MCDEVITT, PATRICK & MELISSA a 443 BROOKWOOD DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 443 BROOKWOOD DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.210 Plat: 2284-PARK VIEW ESTATES 4TH ADD SEC 17 T29N R19W PARK VIEW ESTATES 4TH Block/Condo Bldg: LOT 107 ADD LOT 107 1.21 AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-19W i Notes: Parcel History: Date Doc # Vol/Page Type 12/15/1997 569916 1282/541 WD 07/23/1997 1163/199 TI 07/23/1997 752/52 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/0612003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.210 26,800 262,500 289,300 NO Totals for 2005: General Property 1.210 26,800 262,500 289,300 Woodland 0.000 0 0 Totals for 2004: General Property 1.210 26,800 262,500 289,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 136 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form -STC - 104 A- AS BUILT SANITARY SYSTEM REPORT ! ~y kacj-., OWNER T / TOWNSHIP Od', SEC. T ZIN-R_.Z5 W ADDRESS ST. CROIX COUNTY, WISCONSIN OT SUBDIVISION V1, . LOT SIZE f 'C! G'r P PLAN VIEW Distances and dimensions to meet requirements of 11HR83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i i Z XSo ~N i ► 00 R 4,Oe /1 '0 , Iq INDICAT ORTHW BENCHMARK: Describe the vertical reference point used 01 tA.-) C p~ Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: aB 00 Number of rings used: Tank manhole cover elevation: r Tank Inlet Elevation: Tank Outlet Elevation: tl. Number of feet from nearest. Road.: Front, Side, Rear, 0_ feet = ~ From 'nearest~ property line Front,OSide,ORear, tVS _ feet Number of feet from: well ° building: aDIcrw S x(,XzL (Include this information of t e above plot plan)( 2 reference dimensions to septic tank ) SEE REVERSE SIDE PUMP CHAMBER F a Manufacturer: Liquid Capacity: . Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: CLL~7a - Trench Width: l ° Lenth:^ Z Number of Lines: Area Built: Fill depth to top of pipe: 4f Z e~ Number of feet from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: (p C~ (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: / Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number : ` )0 1 3/84:mj i 139PARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.13OX9969 BUREAU OF PLUMBING MADISON, WI 53707 MCONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number E] Holding Tank El In-Ground Pressure F-1 Mound (if assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTI N DAT Sam Miller Rt. 1, Box 282, Hudson, WI 54016 /s BENCH MARK (Permanent reference poiml DESCRIBE IF DIFFERENT FROM PLAN. RE . PT. ELEV.: CST REF. PT. ELEV.- NE SW, Section 17, T29N-R19W, Town of Hudson,Lot#107,Parkview Est.IV Name of Plumber: IMP/MPRSW No Cnumy Sanitary Permit Number: Douglas Strohbeen 5432 St. Croix 83777 SEPTIC TANK/HOLDING TANK: S MANUFACTURER . LIQUID CAPACI Y.+ TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER I`'/~,~ _ _ „ PROVIDED. PROVIDED: A~9I~// l O , / YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.. VENT MATT HIGH WATER NUMBER OF ROAD: PROPERT17 WELL. JBUILDING: VENT TO FRESH JI ALARM FEET FROM LINES 7L AIR INLET YES ❑NO ❑YES ❑NO NEAREST_ G/ ~j~ ✓ DOSING CHAMBER: MANUFACTURER BEDDING- JIQUIDCAPACtTY PUMP MODEL J PU MP;SIPHON MANLIF ACTIIHEH WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOPEEITY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET' PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing UInME TER MATE RIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until LFORCE the soil is dry enough to continue.) AIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH jL11GT. 111,111 WITH PIP sPACIN(i cov CHF~f EH -INSIDE Dln sPlrs ILIQUID ~7 TH N tv PIT DEPTH. DIMENSIONS L / ' \ V 1,,, V L L U E I'T I~ FILL DEPTH UISTH. PIPE UISTR PIPE DISTR.PIPE MATERIAL NO CISTH NUMBER OF PROPERTY WELL. BUILDING. VENTTO FRESH BELOW PIPES_ ABO COVER ELEV. INLE I EL V,('E NUJ I PIPES LINE ] AIR INLETFEET . i t/'_-L,___CV NEARESTO-► GG~ MOUND SYSTEM: d,d 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 TEXTURE JIHMAIIINI MALiKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED DEPTH OE TOPSOIL IS11111111 SEEDEC MULCHED CENTER EDGES ❑YES. ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIOTH. LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES'. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE JMNO UISTH ID ISTR. PIPE UISTHIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. CIA. ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHRECTLY COVER MATERIAL VERTICAL LIE T CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO NTS : PERMANENT MARKERS OBSERVATION WELLS : : NUMBER OF PROPERTY WELL. BUILDING FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATUR TITLE ^ DILHR SBD 6710 (R. 01/82) IIE SANITARY PERMIT APPLICATION cou DILHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PEFIMIT F,3 2 -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PETITION FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER PROPERTY LOCATION s ljl;lldl^ ff %5S /7 TZ1/,N,R Q(or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME ~r 2 4 L .0-- 942 y D Park &w E a-f4. CITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK u/ 16VQ11v 716 )M -7-7e VILLAGE: 4156n 131.ooG woocKF Lli V!i II. TYPE OF BUILDING OR USE SERVED: ' aaQ" O7l~lP'~~ Number of Bedrootns if 1 or 2 Family OR Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. X New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. E1 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._Z Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- "ding c. E1 Pit Privy d. ❑ Vault Privy e. E1 Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Seepage Bed b. ❑ seepage Trench c. ❑ 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): S 20 S ;?T S 2 pi 31-1 960- 'Z" Feet ® Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank /ZOO di S~✓ ❑ ❑ ❑ ❑ Lift Pump Tank/Si hon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: ~a,e.n tc, / P_S-.q 715' 2q7-3233 1 3;1 Plumb s Address (Street, City, State, Zip Code): Name of Designer: IZ 2 New o/ .`,~a, -:~Doh*A Vlll. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST ,D c- in CA; to c r .-.,c /579 9 CST's ADDRESS (Street, City, State, p Code) Phone Number: 7/ S g~ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuin Agent Signature (No Stamps) Approved ❑ Owner Given Initial / 49 ~ Surc -charge Fee 10/ -.7 74d ~ I ~[yJ(~ Adverse Determination 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 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 necessa>y,`usually:every-2 t,~I3 years; 6. If you have questions concerning your private sewage systeF;,, contact your local code administrator or thu 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; if. 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'/z x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. - GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Groundwater - included the creation of surcharges (fees) for a number of regulated practices which Wiscor#sin's can effect groundwater. The surcharge took effect on July 1, 1984. Ali of the water that buried treasure r is used in your building is returned t= the groundwater through your soil absorption o system or the disposal site used by y)ur holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural R=sources. These funds are used for monitoring ground- t \vater, groundwater contamination investigations and establishment of standards. Groundwate., it's worth protecting. SBD-6398 (R.03/86) Form - S T C 100 Owner of Property- Location of Property~~ sW ~ Sectionl 7 T Z N R ~ / -~--q~:/ Town ahiP Gt S©rr Mailing Address 0/ R" V :;,,r Subdivision Name 19a`,e Lot Number -90"/Oz- Previous Owner of Property E Lc1c✓* Total Size of Parcel J-O/ /f ~~✓s Date Parcel Was Created /?7a y 1ex, l f 8'~ Are all corners identifiable? Yes No Include with this a lication one of the followin : .Certified Survey Map- .Deed .Land Contract, or .Other laegal Document which describes the property PROPERTY OWNER CERTIFICATION I I Me) certify that all statements on this form are true to the best of my (our) . knowledge; that 1 (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. if 35/S"Z presently own the proposed site for the sewage disposal syste; and that I (we) m (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the some has been duly recorded in the Office of the County Register of Deeds, as Document No. 42--Y-f-1- SIGNATURE OF OWNER SIGNATURE OF CO-0W ER (IF APPLICABLE) lei, DATE SIGNED DATE SIGNED H z cn H r ST C- 105 r" SEPTIC TANK MAINTENANCE AGREEMENT ~o St. Croix County z . r7 9 OWNER/BUYER.5a /YI ///i~~d✓ ROUTE/BOX NUMBER Uox 2, Vv Z, Fire Number CITY/STATE Gtf .Sdr ~ ZIP,5,~~016 W PROPERTY LOCATION:A/E k, SLc.) 14, Section/7 T_1N, R_/'7 Town of /yao16011 St. Croix County, Subdivision~L ~.,GtJ E /G 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, I if needed, by a licensed septic tank pumper. What you put into !I 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. 00 z I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- ►o 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. n S I G N E J DATE / St. Croix County Zoning Office P.O. Box 98. Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. o ~ m N . v ~ vi w ~ ~ w ~c c N~ O N " C (D O (D n n (D j 0 Go o ~3 v w w o c o 3 `G IA i ? C' (0 O 3 C (p (p o p IC ' C ? (D 'o d (D (D 0 pN i'JD 0 = (D N CD _ a A emD - a n w p (p O (D w a o ~'cm aN i~ (D (D t°o3a o~oMM(ODD " r >>g. ~0wo~ w 3 co: l< C- =r c W c O .4- 0 C`G a-m a0 O Q1 y 2. O a t~D 0 CD w00 M ~ mod N> :9- COCD S. c- o C) ° w° _ o wow °~CD a ° p Q°w O 0 CD F~ 14 (now5D v, Z D m CD CD z CL N o 3 m m a 1 ~ 3. we Iwo-oso iT1 a o c f m F V ca Ch o CD° a vNww C m (D '0 CL =r :3 CD CD CD 0 C,L (a o tio2=: b =i o =3 CD -03 CL 03 F (D c aa~i o m (D S- Q d CD U) Q U) ° Q3.*?cn. 6-1 S.- l< CC -7 CD (a :3 a OA m o ca a ° y (n O e° W a c w c 0 c 0 V.~ sa a~ _3 0 m o 0 0 am o0 S* CL o < € 0 0 2 p TNIENT-0F REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LAB° N REANDLATIONS PERCOLATION TESTS (115) MADISOP.O. BOX 76 HUMA N WI 53707 (H63.090) & Chapter 145.045) • LOCATION: SECTION: OWNSHIP LOT NO.:BLK. NO.: SUBDIVISION NAME: 'fa w'/a 17 /x.29 N/R/9 COUNTY: OWNER'S/BUYER'S/NAME: MAILING A~RESSr ~ y ` r/' Ckv -x S x v to ~~ffn0 fOUol C $ t 5~011e USE DATES OBSERVATIONS MADE [XLResidence NO. BEDRMS.: COMMERCIAL DESIPTION: y~ PROFILE DESCRIPTI NS: PER OLATION TEJ'am' New El Replace s~~•ir er ~ RATING: S= Site suitable for system U= Site unsuitable for system rMsou ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optio al) Im S❑ U XS OU ❑ S LR U ❑ S ®U t_A'. . 7If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the "(.,1,4 under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: P Oil E DESCRIPTIONS BORING TOTALI ELEVATION DEPTH TO GROUNDWATER-3-W911{$ CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH.bPd OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- f or 00,5` gtlOAe .0- 9 t~` 8/s W. 5- 3,.2 An g S ~S B- e2 . C1 0 01 A4,ae - cC) ` . 661s/ 23 3 gn S /4 S B-3 3` ~Glo.u~ .v ` /o S . qgm -r/ .2, An a SA 1%ed5 B- lf aS ` /03. Y ,t l0,~c j /3 B;i >z S 4 /,;K S 1. g Bh 3.0 A- at -S B- PERCOLATION TESTS TEST DEPTH# WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER %+GU" AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIO PER INCH P- I .3 o P- Z o .L 162 L P- O ; G P__ I ::T 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 9(a oZ' r t D cf~ 6 E f F a_ 3 Nsd b~o-sG~ N 47 _ - ' _ 8cwex g.~ C 31:_ ~t 0-~s 7~c5t/3~ A-L E I t - _ . t pr- L L . L 4- Al- 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): ~t y[ TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): ///(0 44Yeel Ale. w-f, sVOr4 44E 9 7/.s=_7 - CST TUBE: c DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. D I LH R-SB D-6395 (R. 02/82) -OVER - rm 1 test, YO _f r. 5 T, v I AL THE ?le a b . J a at .~I o fi„ p P 6N ► p~ Irl I ~I i (!J i~ . > ` 0 T -S- f.~ y ~ %Z IZS S a m WI I e_r PC r K V; a w '*10-7 t LAG end A B• rn" i 5 t k cl. VcrT, d- H 0 f; 2 R a. F ?m', v,-r at t h S w lot Ga r ✓l a-tr v /l to P O~ c~ Z" /oI p; ~P ~ to n ~ s `r c~ a. 3/V A A o )a- A'5 5iA mQ_d Eiv.- Iob"0' d (Bo,ro-s Bo--K hod.) O TO-fc 5 C-rast Sad am = q~.2~) s 61a- blc- Ara,q W o c c _ 1~' Natd: srr~a// L~7 r4ro ~ /3 Z r°ma;nTq;h ~e✓fi,`ca/ ,~a.,o7"~f u:r~ Sy s~-Q.m EIV = 9~-z 4 r~~hts d d /00 P { p 3 ~ s i~ j a Hou s !L (oa~a5e av'x 4~" Z~x2y' 0 p/ ° 30~ 1 1 ~ l~3 ~ 27 ' D/ ~ xd / 1 i ~`o SDw~~ ~ol ~~'1~. I 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 U k © G k Location of Property -L _ LAJ , Section , T,9 N-R W Township Cdc Q ! . V, Hailing Address ( 3 Q Address of Site Cat k. S c~ t..►) " r Subdivision Name Pa I. K V ► a.- w 1Y- ` A Lot Number Previous Owner of Property a W dA Total Size of Parcel /,0 3 H c¢ 5 Date Parcel was Created 1 )I 2- ' 1 r Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes X No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) ce U6y that att statements on this 6osm ase true to the best o6 m hnowtedge; that I (we) am (cute) the owneA(s) o6 the psopesty de~schibedinythis ouA) in 6onmat i.on 6o4m, by v chtue o6 a wa"anty deed seconded in the 0 6 6ice o6 the County RegiAteA o6 Veed6 as Document No. S/ G~'z b ; and that 1 (We) pse,dentfy own the psopos ed site bon the sewage digs pos s ys em (os I (we) have obtained an easement, to nun with the above descnibed psopehty, bon the constsucti.on o6 said system, and the same has been du.Cy seconded in the 066.ice o6 the County Reg.csteA 06 Deeds , ocument No. /6 2 90 1. Cwt' c.Az l_ e~ ZJD &J SI 0 SIGNATURE OF CO- LICABLE) OWNER (IF APP3 /;/_2 DATE SIGNED DATE SIGNED 1 H a STC - 105 r r • a H r SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County 0 d a OWNER/BUYER G' ROUTE/BOX NUMBER Fire Number CITY/STATE ff 5~•~, ZIP 5A211a - I PROPERTY LOCATION: Section 7 T N, R~ W Town of 14a(L" V4 St. Croix County, Subdivisionia,/ K U;suJ, Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- I 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 to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- v ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zonin ffice within 30 days of the three-s-- expiration date. SIGNED =i < N DATE- S t . Cro\ijti~r Cou t9' Zonin$ Of fice P.O. Box Hammond, W:14 ~jt)15' 715-796-2235 ~.1A7--T15-425-8363 Sign, date and return to above address.