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HomeMy WebLinkAbout020-1167-30-000 N 0 s \ J O - d f 3 O rt O A Q IODD *%A (n _ Z O J = N O~ iV N N O D. CO NO °C O) CD O N CD C) j m , .►y CL 0 CO P 0 Q 3 a• O 0 O 0 ~ J "S 1 CA O f0 J7 C fD 0 (D P. 7 A O A7 3 co O O 3 ur n -w O Q w C O 0) C l~ C CD D U) CL rn co < 3 O rn_ Q i N co cc Q o r In U) 00 OD a: cn 0 c C;) 0) c rr a ty 0 v 0 01 h1• o 0 0 0 We =r =5 Icr 'a voo CD d v rn 42 CD CD li < Q N O O z 00 z O C') O D a "A CD N Q c COD N w ~ Q a 3 z m (6 N c .n v O A 2 3 a 0 0 N CND 0 CD o CL N z 3 m 0 + y z A C4 s a_ . Q 'm f ors v T W 0 z a y 0 y 0 Q W e FD O 0a o- I _S ~ j A rn• cn I I ti I = o 0 a CD L Parcel 020-1167-30-000 02/04/2005 08:51 AM PAGE 1 OF 1 Alt. Parcel 29.29.19.1034 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): Current Owner DANIEL G & KAREN A SCHOLZ SCHOLZ, DANIEL G & KAREN A 469 COUNTRY VIEW RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 469 COUNTRY VIEW RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.840 Plat: 0211-COUNTRY VIEW SEC 29 T29N R19W W1/2-SE1/4 LOT 3 - PLAT Block/Condo Bldg: LOT 3 OF COUNTRY VIEW Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 745/189 07/23/1997 745/188 07/23/1997 687/386 2004 SUMMARY Bill Fair Market Value: Assessed with: 49074 316,200 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.840 34,200 210,400 244,600 NO Totals for 2004: General Property 2.840 34,200 210,400 244,600 Woodland 0.000 0 0 Totals for 2003: General Property 2.840 34,200 210,400 244,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 310 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 0 O N ~ M M W M C• 0 moo 6 ~1 In N 5 N N 121,493 SO. FT. I Na 2.79 ACRES 108, 125 SQ. FT: I 2.48 ACRES 94,412 SQ.FT.) EXCLUDING 2,17 ACRES Y EASEMENT i O N87° 46' 58" E 415.99' W47" 47„ 47'54.5" E 0 cu 0 h CD - 20 3,1W . m 18" W. p Z w Co 00 W = v ,p 4 C3 N c N W 11 0, 123 SQ. FT. f'_ W W t; > - era F- I 2;53 ACRES 0 in .0 Z00 o - z Q $ 415.99' Ell 1 W 8a5,51" E 436 21 N N o 3 p = 1.1° 45' 21" I o Oo R = 203,00' CS= SO80 05'42.5" E 00 0 0 m io C= 41.58' 8 0 o a) L= 41.65' tO(D NN CV N 123,858 SQ. FT. TB=N2°t3'02"W 2ND TB=N13°58'23"W NN 2,84 ACRES 66' 110, 131 SQ. FT.) EXCLUDING SO. 87,660 FT. 33' 33' 2.53 ACRES ) EASEMENT 2.0! ACRRE ES , 415.99' _ 420:2.5' - - 0- - 66' WIDE EASEMENT FOR N87°46 58 E 14 415.9 M .10 3 TOWN ROAD m M FUTURE .41' - N 87° 46' 58" E 4 3~= (D 166.01' - - 1 582.00' 317. 40' - - - NT 340.40' 53' 250' W DRAINAGE n m n RETENTION AREA o 1 G i - Co a. M to N ti 144,533 SQ. FT. N N o N 3.32 ACRES O N OWNERS OF LOTS 182 ' iQ. F T. ; 0 SHALL BE RESPONSIBLE 130,806 SQ. FT.) EXCLUDING ES FOR MAINTAINING 3,00 ACRES ) EASEMENT VEGETATIVE COVER ON•;• DRAINAGE. RETENTION AREA. ; 582.00' I S-870 46 58'~ W 13 1.72 R/W VARIABLE INTERSTA TE HI GHWAY 94 REFERENCE LINE 1- 94 _ >'E sin that na owner,.Possessvr, user, aicensee, nor other person .ar ingress or egress with 1rzerstxte dighway 94. Access wi11 be is shown an the Plat; it being expressly intended that this restriction 130' To R/W the Public benefit accor.ding to section 236,283, Wisconsin Statutes, Fo rm - S T C - 104 AS BUILT SANITARY SYSTEM REPORT / c 1 40, pr OWNER TOWNSHIP ~lu f~s ► SEC. T N-R ADDRESS ST. CROIX COUNTY, WISCONSIN cfSo LJ I SUBDIVISION/'64ny/V ~J LOT 3 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM SYafia ~N ~ 111, l ~ t . ~ ;p t~.m. = Joo•b . u~ r i Ve w a u ~I t goo ~ 'y o ~ 90' o f/ zo INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used v foolge r o Elevation of vertical reference point: . ® Proposed slope at site: SEPTIC TANK: Manufacturer: (,{o- cy- Liquid Capacity: Number of rings used: Z_ Tank manhole cover elevation: f~, g p Tank Inlet Elevation: Z, Q Tank Outlet Elevation: Z SO Number of feet from nearest Road: Front,0 Side,p Rear, O Z t7 feet From nearest property line Front, 0Side Rear, 0 y feet Number of feet from: well building: Jy F✓ow, ~tc~Na✓ 1 Z~ ~r4;~~ttb ~iar< S~ 1 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER y 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, Side, Rear O O , Ft. x Ndmber of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed : ',,/~fAj`jftfc,,,c,I Trench i Width: 1131 Lenith: Number of Lines: Area Built: Fill depth to top of pipe: Q Number of feet from nearest property line: Front, O Side, Rear,O Ft.to Number of feet from well: Zoo Number of feet from building: 7 (7 ' (Include distances on lot 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 0 been used on any of the above soil absorbtion sytems? (Check one). HOLDING. TANK J'. 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: Z License Number: 3/84:mj 1 DEP.ARTMEftT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 LCCONVENTIONAL ❑ALTERNATIVE State Plan 1. D. Number: ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (If assigned ) a _ NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPE ION D TE Sam Miller Rt. 1, Box 282, Hudson, WZ 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFF FROM PLAN. FiF. PT LEV.: CST REF. PT. ELEV.. SW SE, Section 29, T29N-R19 7 ,Town of Hudson, Lot#3, Country View Name of Plumber: JMPIMPRSW No. County. Sanitary Permit Number. Doug Strohbeen 5432 St. Croix 79160 SEPTIC TANK/HOLDING TANK: 4.jEe LIQUID CAP CI V. , ITANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER j PIDED: PROVIDED. e- Is z- fi-7 • YES ❑NO ❑YES ❑NO BEDDING: VENT DIA. VENT MATT HIGH WATER V BER OF ROADPOPERTWELLBUILDINGVENT TO FRESH r FROM LINEAIR INLETYES ❑NO REST DOSING CHAMBER: MANUFACTURER. JBEDDING. LIQUID CAPACITY PUMP MODEL PU MP; SIPHON Mn NUF M:T UHEH WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUAND CONTROLS OPERATIONAL NUMBER OF PHUPERTV WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM uNE AIR INLET. PUMP ON AND OFF) ❑YES ❑NO NEAREST 00 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing UTAMFTEH 11ATEHIA1ANDMAHKING 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 ILENGTH TOE OF S ID11TH PIPE .SVncIN6 C'ovEH INSIDE Dln 31Irs LIQUID PIT DEPTH. DIMENSIONS R"', FI LF I'T I+ FILL DEPTH J'E:111 TH PIPE UISTH PIPE OISTR PIPE MATERIAL NO DISTH NUMBER OF PHOPE RTY WELL BUILDING. VENT TO FRESH BELOW PIPES ABOVEC VER .IN LfT ELE V.ENU PIPE' LINE~~ / AIR INL T: y FEET FROM 10 ` ©11 I p~ NEAREST ®0 D 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 ❑ meets the criteria for medium sand. TIONS MEASURED. NO SOIL COVER TEXTURE 111111,111111 NT MARKFHS 11111SIFIVATION WELLS _ ❑YES ❑NO YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH HEU DEPTH OF TOPSOIL SO OI)FO [E111111 MULCHED CENTER EDGES ❑YES. ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIOTH LENGTH TR EOOCHES LATERAL SPACING IGHAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE JMANIFOLD MATEHIAL NO DISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. CIA. ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHECT LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO _ ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE ❑YES ❑NO ❑YES ❑NO NEAREST I Sketch System on Retain in county file for audit. Reverse Side. SI NAT E TITLE DILHR SBD 6710 (R. 01/82) wisconson , APPLICATION FOR SANITARY PERMIT (PLB 67) COUNTY ~"DILHR OEVraaT of UNIFORM SANITARY PERMIT # ~ OIOI STRY,Ln LRBOR 6 MUTRn RELRTIOnS 17 /W/ D --Aitach 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 PROPERTY OWNER MAILIN ADDRESS PROPERTY LOCATION *FPW. -A14,5x,1/4, S J,47 , %2F, N, R E (or W T: WNOF LOT NUMBER JBLOCKNUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D NUMBER w TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: 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. eK - Seepaye Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holdiny 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 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 3 C_ /-5J "4 g 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): Signat re: MP/MPRSW No.: Phone Number: Plumber Address: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved /j~~ {y ❑ Owner Given Initial f ✓ v ~I Approved Adverse Determination Reas for i p o I: 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 , 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. A new 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. 1 z N H a ST C- 105 r r . a H SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County z d a H OWNER/BUYER C-zQr~{ bb~ rQ ROUTE/BOX NUMBER N Fire Number 1-7 CITY/STATE N~dS~ k LA) r- ZIPSya(~ PROPERTY LOCATION: 5W ~4, j L' 14, Section, T P-9 N, R 19 W Town of I-It'Loy. , St. Croix County, Subdivision L'OL'kf`e/ i Vi cw 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, 1 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. '-3 0 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- It 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 RIC6VED St. Croix County Zoning Office c~ JUG 5 1987 P.O. Box 98ZO;~1NG Hammond, WI 54015 OFFICE 715-796-2239 or 715-425-8363 Sign, date and return to above address. 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 6 Q ' K Location of Property S w 14 Section , T al N-R / 9 W Township d-5 p h Hailing Address _ele' / l~l--A 5 0 Address of Site J/ 6 r ~ 7 Subdivision Name , f ..r; REP Lot Number / ;>r EI fcn; 5 1987 b Previous Owner of Property on _At 11mr, --t 'J„If Total Size of Parcel Z . 3 C_ 4-d OFFICE Date Parcel was Created Are all corners and lot lines identifiable?l Yes No Is this property being developed for resale (spec house) ? Yes 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) cen.ti6y that att Atatement6 on this 6onm ahe true to the best 06 my (oun) hnowtedge; that I (we) am ( cute) the owneA (,s) 06 the pnopeAty de,6ch i,bed in thiA .in6o4mation 6oAm, by vi ttue 06 a waAAanty deed neconded in the 066.ice 06 the County Reg.i.6ten o6 Deeds" Document No. I y~; and that I (We) peedentty own the pnopo6ed date bon the 6ewage diApo4 6y4 em (on I (we) have obtained an easement, to nun with the above de4cA bed pnopeAty, bon the eon6tnuetion o6 said eydtem, and the Game has been dut neconded in the 066ice o6 the County Registen o6 Deedb, as Document No. S q SIGNATUR OV OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED 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 Location of Property. Section T~N - R Township u_ Mailing Address- Z Subdivision Name LC 4 11~ LJ V il Lot Number Previous Owner of Property -V Total Size of Parcel" /~q y •e Date Parcel was Created 77 Are all corners and lot lines identifiable? Yes _ No . Is this property being developed for resale (spec house) ? Yes No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3.• 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 Hap, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) eeAt i.6 y that a.Pt 6 to temen A on th i b 6onm an.e tAue to the best o6 my (oun ) knowledge; that I (we) am (ace) the ownen(s) o6 the pnopeaty de cAi.bed in #hi6 in6o4ma ti on 6onm, by viA tue o6 a waua.n ty deed uconded in the 06 6ice o6 the County Reg.ia.teh o6 Deedb ad Document No. • ® Z-- ; and that I (we) pnebenttty own the pnopoeed 4ite bon the Sewage pod eydtem (on I (we) have obtained an easement, to nun with the above dedenibed pnopenty, bon the eon.6t ucti,on o6 eaid.6ptem, and the eame hab been duly hecoAded in the 066ice o6 the County Reg,ib.teA o6 Deed6, a.6 Document No. 32 - pry 7-- SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) Sr, , `AV DATE SIGNED DATE SIGNED H H a ST C- 105 r r - a H SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County z d a OWNER/BUYER CJ-,~~I~y ii ROUTE/BOX NUMBER 02,? * j Q ~ g'Z Fire Number CITY/ STATE-#-& ZIP PROPERTY LOCATION:, Section, T7,~PN, R-Zf 1 Town of keX6k1 , St. Croix County, Subdivision ,,-fe (1 1' _ ud , 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. ti 0 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- 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. SIGNE JL 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. I c • x m ~ x ~ . m Q o N O fD `C O O N a Sr S w' E to C Do c C w `G 3 0 N a ~0 CD ~~oNNg°~ CL 0 m :E CD o x - w w .4, 0 0,0. CD CWO A3a p~o`0 0 CD r > j cc on w O C w O O 'o< `c w S C `G Q 7 0 w r ~mwwv,~ Cl) - (D Oc. C=D O ~ p a ~ N 0'°DZvv D :1, CID C: CD N O D c w? tC N O (~D N 0 0 COL N (p 7? ¢Qj O 10 C N 61 : fell Ul (D W CD :E N Z D U) A (0 v Z S w .N. A SI) =3 m a 0' O O V Ol A CDSO a D CD ° w ~ o o M 0 CL CD cn C. co N V ac A CD C m j. m 3 'D --y v CL ~ ~l 5V D Cl) m CAA O W N n -CD w =l Qw --o o . to D O = CD n N_ ID G) n.o* cnQ'?x00o m w a s 0. a O C ao (D Q' „ASV,' l< CC =r CD A m O M 0 co 0 c L~tO 0 FA, " c 0.0 CL C % 0 -r-% (D --4 CCD C cD V Oi =r ID -0 c CL a S' a (D o o 3 Y N N a O< ® coo z 0 -DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS 1 / MADISON, WI 53707 • (H63.09(1) & Chapter 145.045) rAOU A I N: E ON: TOWNSHIP OT NO.: BLK. NO,: SUBDIVISION NAME: 10 ' of ''I /S'/ /T n N/R/71(or 3 NTY: WNER'S BU ER'S NAME; MAILING ADDRESS: USE • DATES OBSERVATIONS MADE NO BEDRMS: COMM R A D S f31PTION: PROF[ NS: A N TESTS ~Tl~~~ ew F[ LE DESC WResidence N k DRep:1:-ace] -3 lu I 1,4 Sd"I M~ B~ G Z RATING: S- Site suitable for system U- Site unsuitable for system , s e ~ Ze r O NVjNTIONAL: MOU ND: N-GRCIUN6 SSURE: STEM-I -FILL OLDING TANK: RECOMMENDED SYSTEM:(optional) ]CIU 19S ❑U C1U ®U EIS RIU c If Percolation Tests are NOT required DESIGN RATE: `Dn , - [Floodplain, any portion of the tested area is in the under s.H63.09(5) (b), indicate: indicate Floodplain elevation: PROFI E DESCRIPTIONS BORING TOTAL. PTH TO GR UNDWATER-4W64+EB CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, ANO DEPTH NUMBER DEPTH4;,h ELEVATION OBSERVED EST. I HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 8, o' /I I ' ~lo,~~ > , 3' s .2. 3 BalS, y y ge-S B-3-91 o' Clf B- PERCOLATION TESTS TEST DEPTH , WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER !kWY"E9^ AFTERSWELLING INTERVAL-MIN. I R D PERIOD PER INCH P_ ~d 3 L i P- 2 ' 41-0 Al P ' 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- 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 - T_ A ?e, I 01 T 'T TN I _ A'i Y-42 I I I f / k of T /~-AIL 1, 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: /D -,2 0 - -r ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST S ATURE.- r DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. IILHR-SBD-6395 (R. 02/82) -OVER - ' ~ ,L) ✓I .b d a opt I r ~ I. 1 ~ ! ~ I p 1 on la o r~ , i (70 n i y CO o 9- Q P 0 1 r n ~ ~ ~ ~S 0 to ~ c V LA (N LV r o si s ~c'~ ~fi1 P I kA% P I p I . a j S. n / (/1tA o v ~ ~ ~ -~k' 4 Z _ I n -C ♦ F1. -G ~ a 0 i `N CdZ I S T C - 105 i 9,... + SEPTIC TANK MAINTENANCE AGREEM N St. Croix County RECEIVEO y7 MAR 12 X987 OWNER/BUYER 0.V SGk© I --z- ZONING OFFICE ROUTE/BOX NUMBER re D CITY/STATE (,LCl Sc~Y~ Z I PROPERTY LOCATION: U/ 14, Section, T~~N, R W, Town of St. Croix County, SubdivisionCo j Lot number 3 • I I Improper use and maintenance of your septic system could result in I 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 H three year expiration. o E z I/WE, the undersigned, have read the above requirements and agree cn x to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- 'd 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 4 G Sc'~ - DATE 3- S7 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. • IMP APPLICATION FOR SANITARY PERMIT S T C - 100 -7- 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 _,2acn 5r, Q Z Location of Property 5 4154_14, Section T 2 1 N-R W Township 9 0 Hailing Address Address of Site Q~~ I Subdivision Name r U'( g- Lot Number 3 Previous Owner of Property sq Total Size of Parcel 2. 9 y ii Date Parcel was Created z] I~ Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes_ No Volume and Page Number / F9- 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) cotti.6y that att Statement6 on thi,6 604m ah.e true to the best 06 my (OUA) hnow.tedge; that I (we) am (ate) the owner (a) 06 the pnopenty dens chibed in th.i,a .in6onmati.on 6onm, by v.ihtue o6 a waAAanty deed Aecokded in the 066ice o6 the County Reg c step o6 Veed~s ass Oocumen t No. .0 and that I (We) phe~s en tty own the proposed bite bon the .sewage div pops .dyes em (on I (we) have obtained an easement, to hun with the above desc,% bed pupeAty, 6o)t the constnucti•on 06 said system, and the name has been dut tecokded in the 066.ice 06 the County Reg•i.e.ten o6 Ueeda, as Document No. SIGNATURE Op OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 0 jrT DATE SIGNED DATE SIGNED