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HomeMy WebLinkAbout020-1151-40-000 a C7 v1 c 3 O m F CD a A+ • T c M fD d _ 3 0 0 N 0 ° W C C CD N • N p p C co 3 N IV H cn a A a a y 3 o cn M N) c C N N N y _ CO CL 00 O a' O N R ~ CD CD o N C) 3 N O ~~1 U) (DD v Cf w cn C D m a CD (n a j v W ° CD 3 j O N W C] cn x Cx ` CD co co v o r co a rn W rn c (A 0 00 OD (D FIJ rt (D peril r•t " y O 0 0 (v rt H o 3 N N N w N v v 00 cr 0' M V7 O CD CD A CD N O CCDD Z W 4`. (D CAD tQ Ill D r r FJ- d E rn C N c ~m (D m H N a rr gj y D a o w r NJ O 1 =r h44' trrJ ~ CD d \ q CD •O cn N ~O V cn :3 c CD N N FW w a U7 OD CD O N E A Z O Q F! rt "0 4 su n o (n -i w ~ N co d I~ W N CL z K :E~ (D 3 m m n °o cn rt (n H rt 3 m m o a 0 z • N (D rt tV N ( CA (D H* 1.0 d © < FD' ~ NE-r a M O N v n rt ~:s 3 - o v; o a O CD x CD y fD 7 a CL j o' n 0 N w v a0 ~ VN I °c N°o 7 CA M j b A (D oO r o ° ` Parcel 020-1151-40-000 06/13/2006 04:03 PM PAGE 1 OF 1 Alt. Parcel 29.29.19.822 020 - TOWN OF HUDSON Current X; ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - BAUER, THEODORE J & SALLY A THEODORE J & SALLY A BAUER 727 GLENNA DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 727 GLENNA DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.095 Plat: 2356-PRESIDENTIAL ESTATES SEC 29 T29N R19W PRESIDENTIAL ESTATES Block/Condo Bldg: LOT 13 LOT 13 Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 29-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 869/186 07/23/1997 748/10 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.095 46,500 208,600 255,100 NO Totals for 2006: General Property 1.095 46,500 208,600 255,100 Woodland 0.000 0 0 Totals for 2005: General Property 1.095 46,500 208,600 255,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 117 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ~ c! lgdS 61~ (Ile <¢pcdQ~ Va.~Ue ~P,U,sor ~~~7~ 2y ors ('A,^Qeil I 1 3. o ~~~cv~ Lr ~ `~wc~ Cerra ~a C i~ a/~ S ~ ~ U~`C~5 U ~a~5 7'royvo~ ~ ~ (3 5 I `~D 10 ~o- va r~oki e Yao o - e f ~ -/a - qc) ` COMM 01AL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.i 03516/01 PAGE 1 ST. CROIX COUNTY REPORT DATE! 4/05/90 COURTHOUSE DATE RECEIVEDt 4/03/90 HUDSON# WI 54016 ATTNS THOMAS C. NELSON -/~s/-ya-cam 020 (WR: Kenneth & Catheri Kummet LOCATIONS 727 Glenna Drive, Hu n COLLECTORS M. Jenkins SOURCE OF SAMPLE: Kitchen faucet COLIFORMS 0 /100 ml INTERPRETATION. Bacteriologically SAFE NITRATE-NS 2 ppm Under 10 ppm is safe for human consumption. Cotiform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIAN. Pam Gane WI Approved Lab No. 19 OF.WDEVENDEN p V y 6 4AG < Means "LESS THAN" Detectable Level Approved by', ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 J, 1. r no - CIF _..t `Y ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street/ Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. cmnletion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning office, and mail, alonq with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $175.00 (For vOCPS) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at time of ins) Propertypowner's name ~C.Q Palk r-1- - jr (CiUzuetc he . Property owner's address /a / &e1zw.,- xO)~C D7l 510~~ Legal Descr pt on 1/4 of the 1/4 of Section , T N-R Town of Lot Number Subdivision Name a ~L= BOX NUMBER Color of house Re lty sign by house? If so, list firm: ~7~ by PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, .e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the % test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be ga ned. p Gt~ OG~ Firm or individual re uestinc, er ices: Telephone Number REPORT TO BE SENT TO . closing dat 1W191 6) Signature 46 26;& 1 9 a _ LIME FALLS - - - - - 12 t 7 GFq POND MIf,~1VIEW ti 8 9 d LA. =F m 10 r - - a LR. a I 1gID_ I LA.d PARK LA. a MC CUTCHEON NORTH I a QQ~ R°s t3 R 3 I e r; Q ~~e• HUDSON I 1 eE' ' GREEN LA 16 NATCIIERY 15 m 1 I R E PASS c a w A ~p V~u I VA I Q ROS rE X DR ci 7' ~ W 24 19 z c 1- - - - - I w 0 20 L Cit. E w~ 21 22 r - I = $ Gov~c j 1 UU I I'~ 1 ~ JACO88 LAR x 1 BADLANDS 1 LA. ALD CR I ° 0 °z a I = oRU 310 25 HUD ON 3 0- o i D c 29 >r § I o ° z ALOa~ 27 W ca BRAKKE M FROM E LEN Z 12 r STAGE ~ BAKER \ 1 -j BAN TARA DR. 4TH V 4 6 31 I i ROAD 35 1 I z 32 s ~e o a e„ 34 Z r a w .p Z ~ c TROY al Badlands Road CS-7 Carmichael Road fA Baker Lane D2 Daily Road B4 Fern Road E5 Casperson Drive B2 Deer Haven Road p; B4 Harbor Vie Baker Road ES Cedar Lane Frontage Road D2-3 Hershman D 03 Deer Run - Fo rm - S T C - 104 AS BUILT SANITARY SYSTEM REPORT w OWNER 4- TOWNSHIP L74 i/_cc~ SEC.QA~ T d / N-R' ADDRESS y( ST. CROIX COUNTY, WISCONSIN SUBDIVISION Sfe4 el,ffl-~ e-- f c~0T LOT SIZE G a✓S PLAN VIEW Distances and dimensions to meet requirements of 11HR 83 SHOW EVERYTHING WITHIN 100`FEET OF SYSTEM t (o S HoKSa ©o 4ft 5tccAtL/y~~ zo I /O-t P ' C.~ ~ w Lor H av- N I _ INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point. DQ / Proposed slope at site: 'S-_. z.'c._ SEPTIC TANK: Manufacturer: a tdr Liquid Capacity: , 1'2 Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: S Tank Outlet Elevation: Number of feet from nearest- Road.: Front, Side,Q Rear, O feet -From nearest-property -ty line Front,oSide,~Rear,O 7S / feet .,W Number of feet from: well 4F ! , building: ap' 2 I ' -?e64' N E Go! v1¢ti a't a.. 5r- (Include this information of the above plot plan)( 2 reference dimensions to septic tank) L SEE REVERSE SIDE s PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Trench: Bed: r.. Width: I CK Length: C"! Number of Lines: Area Built: Fill depth to top of pipe: i .~os Number of feet from nearest property line: Front, O Side, ( Rear,O ht Number of feet from well: 9 D Number of feet from building: (Include distances on plot plan). 0 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: o~ f Dated: Plumber on job: License Number : 3/84:mj J DEP. RTMEN"f OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS P.O. BOX 7969 DIVISION MADISON, WI 53707 BUREAU OF PLUMBING ®tONVENTIONAL ❑ALTERNATIVE St ate Plan I D.Numher El Holding Tank ❑ In-Ground Pressure ❑ Mound Lassigne,) NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE Kenneth Kummet 903 Colonial Drive, Hudson, WI 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST HEE PT. ELEV SW SE, Section 29, T19N-R19W, Townof Hudson, Lot#13, Presidential Est N.,-of Pluintrer' MP/MPRSW No. CounlY' SanaarV Permit Number: Doug Strohbeen 5432 St. Croix 83821 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY TANK INLET ELEV. TANK OUTLET ELEV WARNING LABEL LOCKING COVER PROVIDED PROVIDED REDOING ((~J °YES ❑NO ❑YES ❑NO VENT DIA. VENT MATL HIGH WATER 7r ALARM NUMB R OF ROAD: Pq OPERTY WELL BUILDING VEt+il TO FHFSH FEET FROM LINE IAITI INLET YES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING LIOUIU CAPACITY PUMP MODEL 1PUMP. SIPHON MANUF ACTUHEH VIAH N I NG LABEL LOCKING COVER PROVIDED PROVIDED YES ❑NO ❑YES ONO ❑YES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PliO1'f HTY WELL BUR DING VENT TO THE SII (DIFFERENCE BETWEEN FEET FROM LINE AIR INLFT PUMP ON AND OFF) ❑YES NO NEAREST 0. SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing -111111 IIIIA111 I III MAN HIA1 nNn MnHKIP,, 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 UISTR PIPE SPACING COVER NSIUI I)IA THE IES M T =VIIti DIMENSIONS & ✓ PIT nlri'liu) GRAVEL DEPifi FILL EPT/I Ills PIPE DISTH PIPE DISTR. PIPE MATERIAL NO DISiq NUER OF ABOVE COVER f I F INI I I EL III LOW PIPES EV END M13 PH pPEHTY WELL HDILDI N(i VENi iU F Rf till / PIPES FEET FROM :LI"EE, /n/ nHl INLf r NEAREST- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑ YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER ITT X TUHE PF HMANI NT MARK IRS UIi51 HVAIIfIN WI 115 DEPTH OVFH THE NCI( HFU DE VTIf OVFH TRENCH RE 1) UEViH OF TOPSOIL f U ❑YES ❑NO _ ❑YES _ LINO CFNTFH EDGES SFF UFU Ml1L f:llf U r ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING IiHA VEL Uf PT11 HI (UW PIP! R L UFPI11 ABOVE COVE H DIMENSIONS TRENCHES MANIFOLD PUMP MANIF _OLD UIST R. PIPE MAN IF OLO MATERIAL NO I)IS111 I)ISTH PIPF I11Slltlfil/IIlIN PII'f f\1AIf RIAI &NIAHKINI, ELEVATION AND ELEV ELEV DIA ELEV. PIPES DIA DISTRIBUTION INFORMATION POLESIZF /IOEE SPACING L`I:ILLEU CORRF CILY COVFH MATERIAL VERII(:AI I Il T COHHF $P(IN US TD AVVI111V1 U PI nni5 ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. ER OF PROPERTY WELL BUILDING FROM LINE ❑YES ❑NO ❑YES ❑NO EST FN Sketc h System on Reverse Side. Retain in county file for audit. SIG ATURE TITLE DILHR SBD 6710 (R. 01/82) DILHR SANITARY PERMIT APPLICATION Cou TY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach tomPlete plans (to the county copy only) for the system, on not less thapaper srA, E PLAN I.D. tDNUMBER `8%.x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER PROPERTY LOCATION Lk a /4 S Z T , N, R E (o W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME .y- CITY, TATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK ?~s VILLAGE : Ie Q Dr, I/4L. 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family- 3 OR ❑ Public (Specify): 111. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. ~ New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2) 1. a. Conventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding C. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. 9 seepage Bed b. ❑ Seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATE ,SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): <3 v (0 . 7 Feet Private: ❑ Joint ❑ Public VI. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank Zo U-76- q,/ ❑ ❑ ❑ ❑ ❑ 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 Signatur : (No Stamps) MP/MPRSW No.: Business Phone Number: A - 1644 a Plumb is Address (Street, City, State, Zip Code): Name of Designer: Q. tt, a L VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # ~JD yy T CST's ADDRESS (Street C~4e. , Zip Code) Phone Number: /O - ~Sa~ Gv S D/6 715 3 PG- 5,9 3 IX. COUNTY/DEPARTMENT USE ONLY X ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surgharg~ee g Adverse Determination Q 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 oe.pumped by-a licensed. pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage syster,i, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description where the system ?s t: be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; Ill. 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; Vl. 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 applicabe; - 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'/2 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 l~ result of over 2 years of steady negotiation and public debate. The groundwater bill tjround ate included the creation of surcharges (fees) for a number of regulated practices which Wiscor Sin's can effect groundwater. The surcharge took effect on duly 1, 1984 All of the water that buried reasure is used in,your building is returned to the groundwater through your soil absorption o 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- _ 1\ water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (R.03/86) 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 W YVI Location of PropertySection. , T_,g ? N-R W Township Mailing Address m Address of Site ~14- -4 4 Q c~1 OC Va Subdivision Name /J Lot Number- Previous Owner of Property„ Total Size of parcel f A e- ay--T ' Date Parcel was Created - 7 - uL/ Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume _-1) and Page Number 14~ 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) ee4tti6y that att statements on thin 6oh-m ahe thue to the but o6 my (ouh) knowtedge; that I (we) am (oAe) the ownen(z) o6 the pupenty descA bed in this in6o,tmati,on 6o4m, by viAtue o6 a waAAanty deed tecoAded in the 066.cce o6 the County Register o6 Deed6as Document No. ; and that I (We) paesent2y own the pupobed site bon the sewage digs os aye em (on I (we) have obtained an easement, to nun with the above described pnopenty, bon the eonstnucti.on o6 said system, and the same has been duty teco&ded in the 046ice o6 the County Register ob Deede , ab Document No. V -7 g~ i 5SZATURE OIL OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DAT IGNE DATE SIGNED L • H z N H • a STC-,105 r ' a SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z d OWNER/BUYER [ a A ii 9~14 H cn ROUTE/BOX NUMBER Q'9 Kp~n~~ _Fire Number .CITY/STATE_,4,~, ,,r7" kllrT ZIP~~ff PROPERTY LOCATION t45 14, Section , TC9'7 N, R_~ 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 pit 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 I/WE, the undersigned, have read the above requirements and agree z 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 Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 98= Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to abovd address. y DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IN1pUSTRY, 1 P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RELATIONS 3.09(1) & Chapter 145.045) OWNS I /MU ICIPALITY: OTNO.:BL . SI)BDIVI ON AM~E:: ATI ~ ~ SECTION: N/R i~lor ~i~'c+~ S kJ /S /a 2 / 11 SO Al L C Y: , OWNER'S BUYER'S AMA: AILING ADDRESS: ''O~ ) ~,I (1Q S !n DATES BSERVIATIONS MADE USE PROF ESCRI TIONS: PER AT N TESTS: NO. BEDRMS : COMMER I D CRIPTION: r~,JNew Replace ~~Q gC 7 /O Residence J~ RATING: S= Site suitable for system U= Site unsuitable for system C VENTIONAI MOUND: IN-GRROjUND PRESSURE: S(YSTEM-1 -FI LHOLQDING TAU K: RECOMMENDS SYSTEM:~ppjignal) ❑U rvi S ❑U ST l.-J S S CDf~//PW/rDai4 QU DESIGN RATE: If any portion of the tested area is in the if Percolation Tests are NOT required ` _'sc under s.H63.09(5)(b), indicate: ` Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS IT-R -ACTER BER DEPTHJiI, D OPTH BSERVEDOUND EST.EHI I HESTS TO BEDROCK IOF S5 L WITH (SEEICK B SS ON BACK jEXTURE, AND DEPTH COL BORING ELEVATION r EE ~ 1 j , ~QS , S 0 e ; r / .7 QN s t B- t 7S 97 5' 1len-e > 'Oh ~I, 'l3 cs r 7 6- S,' r .L 7 /Q S 9''/ • 4'7 B~ GS' B- 2- ,8i5/ . ' 8H s O9 7 'jS t S' z s -p, S y2 e~ B-.3 9,92` fI 1.7-1 .7S3~, a33' 6.Zs'B7cs 67 0/T/ NL'Bn s ff~ i . S6h -s"019 s 0/7'R 7~ B- V 7, 0` >t~ >749 o1 C *1 78r, Csrlp"i . S'u'fi s, /.17 !1n ~S 7'' j B- PERCOLATION TESTS DEPTH WATER IN HOLE TEST TIME DROPIN W TER LEVEL INCHES RATE MINUTES • TEST NUMBER INCHES AFTERS LLING "INTERVAL-MIN. PERIOD? P 8I00 PhHIULJ PERINCH 3 P- 3 ` P_ /g a 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- 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_ 91,9~ i A T '0W lot i/c L _~J 0 E E `s f 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. ot): TESTS WE EC PL6ED ON: /V_ , NAME (p ADDR S: , CERTI ATI NNUMMBER: HON NUM BER(optiorsl.): S Cpl C5 d 3~/y 7J S S° j'7 O L4 CST SIG RE: DISTRIBUTION: Original and one copy to Local Authority, Property Odtrner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - v INSTRUCTIONS OR COMPLETING FORM 115 - S BD - 6395 To be a complete and accurate soil test, your report nl st 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 n I -.-'NG TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIC' _ 6. PL -,SSE use the abbreviat' ns shown here for writing profile descriptic I completing the plot plan; 7. lk' 8~ 1\ LEGIBLE r accurately locating your test locations. D i scale is preferred. A a sheet may be desired; 8. IV e sure your 1 nc ind vertical elevation referenre '-ti-re clearl , 1 9. C Mete all a > ~r op ermanent; l r € , .z 3 boxes as to dates, names, adc re: od plain c' s st exe )propriate; p 10, - formation H. r~ flood plain, elevation) dons n: : apply, plaef 10' A. in the , 11. -Sii he form and pl< ate box; Yo 'current address and your tror° nr . 12. Make legible copies and distrit r as required. TEE 5 -'--T BE FIL,J WITH THE LOCAL AUTHORITY WITF.I DAYS OF COMPLE. ON c A REVIATONS FOR CERTIFIED SOIL TESTERS °parates and Textures Other` Symbols - re (over 16") BR - P cob - C 1 (3 - 10") SS _ - gr - ' under 3") LS - L *s - S id HGVV - cs C, ~e ",and need s - l' 'ed' Sand fs F - Is - I y ;and - han sl _ Loam \ *1 _ L B-1 #sil - S Loam £ _ si - S - G y #cl - C ~c m y I v scl - r"z Loam R sicl - S Loam t - sc S: C'ay sic - S, Clay f *c - Ccc - s p t mr - M m - M d - d p WL Vii," el t`?xtures r e lisposal BM _ VRP - -nce Point TO THE C' :-I.: This soil test report is the vt step in securinc i permit. The Count- . D- , y ;c St verification of this soil f in the field prior p~,-Jt issuance. A coin ' sev system an a p plication must b ibmitted to the apr c' err~7 i it permit must be obtained and pasted prior r w w "a r N r t` 3~~ P r w A, P-~- ~ ~ L o\° r N m o P (lb ~ a IT1 r7l ~ P k S h ~ ( 0 Ix, l w0 o~ ~ I I I I Cow Ire / I ~ x,~ ,1 0 i i { { s U - - P r N • e ~ S I I i I I I ~o ^ I II II ~U+ -f II ( i I ` l1U P I N Q li ~I ~ II I h ~ 'A ~ II II II li ° \ I I I( P I I ~ I I R .{7 i~ I I I I Y I I P I r I( I ~ I ~ II II ~ II I ~ II I I I ( II j ~I II II I( ~ I ~ I I I I I I .,r I~ C n Q I i S N 'I ~a P r P ~ ks O r A 4 l P I~ m ° p s P p p w T A RL N v; ~ f~ a 8 i L-A m~ f H x H s~ \ r 9 SEP TIC TANK MAINTENANCE AGREEMENT St. Croix County aR SPC z STC - 105 (NNum y OWNER/BUYER l~ n jCc,-/'h M ROUTE/BOX NUMBERFire .CITY/STATE6~_, G✓~ ZIP PROPERTY LOCATION: ;jk. ~..G. Section, T N R lC W Town of y , St. Croix County, ~".J Subdivision ,Cf`eI,f60 l . of number_z__~_. Improper use and maintenance of your septic system could result in V Its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you pdt into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. a ~ St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the coat 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 1 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 I/WE, the undersigned, have read the above requirements and agree £ z 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 Offkre within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 98, Hammond, WI 54015 715-796-2239 or 715-425-8363 Si n, date and return to above address. APPLICATION FOR SANITARY PERMIT r~'` MAR S T C - 100: Il;~ This application form is to be completed in full and signed by the own of the property being developed. Any inadequacies will only result in delays of 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 Q W%1 VK rl~_, /m Location of Property !5 LXJ 1% jC_ _1%, Section , T N-R W r _Z2 Township u-k ` dV%, Mailing Address , 5 m3 r Address of Site Subdivision Name Prd-- s t' Lot Number 3 Previous Owner of Property,,,, Total Size of Parcel `T ~6 d~ ~C2 Date Parcel was Created R Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes Volume /and Page Number / - as recorded with the Register of Deeds. ~draML INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warrantq 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) cent ti6 y that ate .statements on this 6o%m ahe tAue to the but o6 my (om) hnowtedge; that I (we) am (ahe) the owneA (b) o6 the pnopexty deJs car ibed inthiz .in6o4mation 6oAm, by viAtue o6 a waAAanty deed keconded in the O66.ice o6 the County Reg~teA o6 Veed~s as Vocument No. ; and that I (We) pheaentty own the pnopoaed z to bon the bewage dtspoA aya em (on I (we) have obtained an eaaement, to nun with the above deg cAi.bed pnopehty, Got the cowatAuetion o6 said byatem, and the same ha.a been duC neconded in the O66.ice o6 the County RegiateA o6 Deeds, a,a Document No . `f / 5/ 7 ) . r 0.4 SIGNATURE OIL OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED