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HomeMy WebLinkAbout020-1167-60-000 • o co) O! 3 m "a 0 o d = 0 3 A A . 0 a • 1 r* s N (=A O O W a N oo f _ o H co CYl (D M E-L 0'. Z, loo a- c -4 o n CD ° ° o cn CD w o ti o N y b is F j . N CL d (D (n W < o CD d m li c_ s 3 N O_ * _ O c (D N C n CD p co p O co D A Q co (n C CA W 3 Q C fl O w• 0 01 0 o CO) cocnLn v ? Q 0 o 0 1 Q 0 7 CD 0 3 d li ~ CL N Z y z ou o =n CD 0 0 D a 7 o m m CD C c CD m :3 I c m CND m a w a 3 -1 N (D (6 Z i p Z m O w c s ;1 a n' n ACS o W N (D CD a N Z 3 cn A G " m co y z w ~ I 0 04) OS > CD m m cD m a) 3 a CO a (D c.) n CO p m ~ om z a CD O c p 0 --1 o ;-r CD CD V,, (D a 0 0 C) 0 O i O 0 7 7 :E ~j co a odo U) r fD = C - CD fJ [S Rj O 2. -p cz Z O ~fD nomC7. LQ y A O N E O <jaCL O CD 0) CD N cn -0 a)-a'a -0 OM OC v o b e (CD oa 44. 6s 0 o Q I Parcel 020-1167-60-000 02/04/2005 08:50 AM PAGE 1 OF 1 Alt. Parcel M 29.29.19.1037 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 NOACK, DAVID W & LINDA C DAVID W & LINDA C NOACK 717 COUNTRY VIEW CIR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 717 COUNTRY VIEW CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.790 Plat: 0211-COUNTRY VIEW SEC 29 T29N R19W W1/2-SE1/4 LOT 6 - PLAT Block/Condo Bldg: LOT 6 OF COUNTRY VIEW EXC THAT PART DESC IN 803/ 538 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 975/284 07/2311997 803/538 07/23/1997 772/517 07/23/1997 745/188 2004 SUMMARY Bill Fair Market Value: Assessed with: 49077 245,200 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.790 34,000 155,700 189,700 NO Totals for 2004: General Property 2.790 34,000 155,700 189,700 Woodland 0.000 0 0 Totals for 2003: General Property 2.790 34,000 155,700 189,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 302 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 COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Coffax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.. 30261/01 PAGE ST. CROIX COUNTY REPORT DATE. 10/06/92 COURTHOUSE DATE RECEIVED! 10/02/92 HUDSON, WI 54016 ATTN. THOMAS C. NELSON gg~ OWNER: Rick & Sheri Hall LOCATION. 717 Country View Circle, Hudson COLLECTOR: M. Jenkins DATE COLLECTED. 9-30-92 TIME COLLECTED. 320pm SOURCE OF SAMPLE. Ouiside faucet DATE ANALYZED.10-03-92 TIME ANALYZED.210OPm COLIFORM. 0 /100 ml INTERPRETATION. Bacteriologically SAFE NITRATE-N. 2 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Con form Bacteria/100 ml Nitrate-Nitrogen, mg/L 9 ~ 70 O N tD 2 C, O C- n1 LAB TECHNICIAN. Pam Gana f~l WI Approved Lab No. 19 C Means "LESS THAN" Detectable Level Approved by. ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse ~ bLll 01~-4 ' 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. Completion o 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, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING-------------------- -FEE: $ 35.003 S (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) SEPTIC SYSTEM INSPECTION FEE: $25.00 X -ZS (Determines if system is properly functioning at.time of inspection) PROPERTY OWNER'S NAME : PROP. ADDRESS: _'7l-2 CC) y y/ (w> C/~ CITY_ IVU,~>S A) Legal Description 1/4 of the 1/4 of Section Town of h~ Lot Number T N-R Subdivision: Coytir-R U~~w FIRE NUMBER LOCK BOX NUMBER L3 .12 026-116 , 1637 Color of house c3TZOwn> Realty sign b house? by YFajf so, list fi m: C-zI PAM 1r= iZ a"~~ ~v PLEASE INCLUDE, IF AT ALL 3SSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A,';.bPY OF THE LISTING SHEET., Testing of residential water requires a sample that is fresh. If the home is vacant, and l:a been so for some time, the water line must be purged by running tie 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 gained. Firm or individual requesting services:_ J/nom /z!/ - - G-Z! Telephone Number )-7 REPORT TO BE SENT TO. Ji n~ A/ n>>pU 7p g h eao CLOSING DATE: Signature ,k ' JJG.lV v 1 LJ O ;~V - 12 39 13~ S 4 - - Z9° 2 a V~ I e2 y\a33 CQ~ 1232 459.08 12'30 ito• °►b~lal~ 1231 h~ M 9 .~~te '3 N 1237 NW - SE 114 - 21 1235 I 7 o1229 a9 ql°~Iay ~Q q?V~l~ 1~ 39T.50~ CD 8 \ 93, n 9 of) JJ~ U C! z°~ 339 \ N 1236 a\ 1 2 LOT I 0 LOT O 7, PG. 1956 - C. S. 430.75' - - 415.67' 522' z' 339 B - - - - 33 9 0 _ - - 5 6 1036 s, 340 D 1037 _ VOL. 5 2 R 150 0 1035 4 415.99' 2 . 340 E 340 C 340 A 22 438.61' 3 SW l/4 - SE l/4 1034 1. 7 cli .78' 1038 340 B 420.25_ Ito cD 1033 .1032 1014.97 200.1 200.16 201.22 I w r k 4 y ST. CROIX COUNTY ty ~ WISCONSIN ~f ZONING OFFICE M" 'off ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 _ (715) 386-4680 October, 1, 1992 Jim Henry 706 19th Street South Hudson, WI 54016 Dear Mr. Henry: An inspection of the septic system on the property of Rick & Sheri Hall, located at 717 Country View Cir., Hudson, WI was conducted on Sept. 30, 1992. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. J~erely,f U v Mary J. Jenkins Assistant Zoning Administrator 7s C ~6 Rs ST. CROIX COUNTY WISCONSIN _ ZONING OFFICE 6 Y x N n N 11 n M ....d ST. CROIX COUNTY GOVERNMENT CENTER - 1101 Carmichael Road = Hudson, WI 54016-7710 _ - (715) 386-4680 All, ~ V- - msfc.~ July 19, 1995 02o- 11(a?- `~~--OvD Mr. Doug Torgerson D, `2 1 L*) 3 7 Century 21 r , 706 19th Street w 1 .~rt/ V Q,G~J Hudson, WI 54016 / RE: Water Test Results for C. Krueger Address: 717 Country View Circle, Hudson, WI Dear Mr. Torgerson: Enclosed please find the water test results for C. Krueger located at 717 Country View Circle, Hudson, WI. If you have any questions or if we can be of further assistance, please do not hesitate in contacting our office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator db Enclosure COMMERCIAL TESTING LABORATORY, INC. X14 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 8 FAX - 715 - 962 - 4030 ST. CROIX COUNTY ZONING OFFICE REPORT NO.: 87985/01,:, 1 ST.CROIX CTY GOV.CTR REPORT DATE: 7/17/95=i~q -a 0. 1101 CARMICHAEL ROAD DATE RECEIVED* 7/11/95 tiv HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER: C. Krueger LOCATION; 717 Country View Circle, Hudson COLLECTOR: M. Jenkins DATE COLLECTED: 7-10-95 TIME COLLECTED*. 2.00am SOURCE OF SAMPLE: Outside faucet i DATE ANALYZED17-11-95 TIME ANALYZEDJ2+00pm COLIFORM,MFCC: 0 /100 mL INTERPRETATION. Bacteriologically SAFE NITRATE-N: 4.0 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml. Nitrate-Nitrogen, mg/L LAB TECHNICIAN: Pam Gane WI Approved Lab No. 19 oF.\NDEVEN" T, J` SO O A z f Means "LESS THAN" Detectable Level Approved by: PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY WISCONSIN ZONING OFFICE aauuuusu■ rrr~6 ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 July 12, 1995 Mr. Doug Torgerson Century 21 706 19th Street South Hudson, Wisconsin 54016 RE: Septic Inspection for C. Krueger Address: 717 Country View Circle, Hudson, Wisconsin Dear Mr. Torgerson: An inspection of the septic system for C. Krueger located at 717 Country View Circle, Hudson, Wisconsin, was conducted on July 10, 1995. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Also, water samples were taken. Once we receive the results we will forward the same on to you. Should you have any questions in the meantime, please do not hesitate in contacting this office. Sincerely, Mary Jenkins Assistant Zoning Administrator mz • ST. CROIX COUNTY WISCONSIN 1Yxuau4ar - ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road ' Hudson, WI 540 1 6-771 0 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM ~C~ V lease specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. ❑ Water (VOC's) $185.00 Septic $50.00 X Water (Nitrate & Bacteria) 45.00 0 Nitrate & Bacteria retest $15.00 Owner: Kk'OEC'E Requested by: We 'OleRe- IFIP ~u) Address: -11-7 60,09M gTW i5) Address: 1, ITAO-1 Telephone NQ: ,r ZIP~y~f~ Telephone N°: (74C) ]W 247 Property address (Fire N2 & Street) ~Vl eLg-) Q Location• Sec. , T _N, R W, own of_-- Realty firm: -lap. Lock Box Combo: Closing Date: 1 `,TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM*\ Water sample tap location: /tor- Is the dwelling currently occupied? Yes 0 No If vacant, date last occupied: Age of septic system: Septic tank last pumped by, Date: X193 Previous Owner's Name(s)- Have any of the following been observed? ❑Y 1IN Slow drainage from house. ❑Y 1XN Sewage Back-up into dwelling. ❑Y XN Sewage discharge to ground surface or road ditch. ❑Y ON Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: DATE: 1/94 r ' OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION 0 Q~ TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system: below grd _❑At-Grd ❑Mound Approx. size 'X ©Gravity ❑Dose ❑Pressurized Ft.z ❑Bed OTrench ❑Dry Well OHolding Tank 00utfall pipe OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank Setbacks: ❑House &X OWell L/ ❑Prop. line ❑Other Dose tank Setbacks: OHousoOl/ OWell ❑Prop. line 00ther ❑Locking cover OWarning label ❑Pump/Floats ❑Alarm OElec. wiring Soil Absorption System Setbacks: ❑House ❑Well ✓ ❑Prop. line OOthery OPonding: ❑Discharge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N Q 4:-- Inspector Title CERTIFIED SURVEY MAP LOCATED IN PART OF THE SW 1/4 OF THE SE 1/4 AND PART OF THE NW 1/4 OF THE SE 1/4 ALL IN SECTION 29, T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. CENTER SECTION 29 2" IRON PIPE N89°06'51"E 522.00' SOUTH LINE NW1/4 - SE1/4 9006' S1"E 111,1 133,732 sq.ft. ,n p 01 o c i sr 3.07 acres 4-'_ LOT 3-1o o rn~ ~V •o i zW ~o v N `Lobo h ~ ~ ~ ° -cc ry °D in C1 a LOT 2 LOT 4 LO L ~I a C3 UWl l v to O I d a to -1 W FI 90,930 sq.ft. 132,481 sq.ft. It o 9I m a U_ Cn Hi x 2.09 acres 3.04 acres ° W = H L41 :D CD Z (7 Z 1-1 0 _j _p I to f) C *I 438.61' mi m Ai a o 56 20`4 S87°46' 58"W Vol 3 En z LOT 1 CA. v' 88,832 sq.ft. C 66' 0 1 1-a L'o 2.04 acres A` ° c c m° o N SCALE IN FEET N 2 66' ROAD - - ' 100 0 200 DEDICATED TO - THE PUBLIC. 587046' 58"W OWNER tO 23.00' SAM MILLER 8 - TROUT BROOK ROAD unplatted-lands owned-by-platter HUDSON, WI. 54016 (D N ~i LEGEND N N ~6T I 0 111 IRON PIPE FOUND. awl"/ 00 1" x 24" IRON PIPE O z C WEIGHING 1.68 LBS/ LIN.FT. S 1/4 CORNER SET. SECTION 29 COUNTY MONUMENT 'li CURVE rqG0 LOT CENTRAL RADIUS CURVE CHORD CHORD `S Rio NO. NO. ANGLE LENGTH LENGTH LENGTH BEARING `f*.~ ALLEN C. ~s NYHAGEN s 1-2 1 22021'13" 929.13' 362.49' 360.20' N73057'12.511E 3-4 1 27°48'34" 137.00' 66.50' 65.84' N16007'1911W UDSO ! 4-5 310°01'31" 80.00' 432.88' 67.59' N44047'09.5"E HUDSON, ~ WIS. 1 87033'40" 122.26 110.701 N66026 14611W I v <q ~ 2 82033'39" 115.28' 105.56' N18036'53.511E 3 52050'59" 73.79' 71.20' N86019112.5"E 6® 4 46°08'26" 64.42' 62.70' S03°16'18"E ~WiaU~ Z C, 4-5 cul-de-sac 40054147" 57.13' 55.92' S46°47'54.5"E 5-6 32048'48" 203.00' 116.26' 114.68' S18037'2611E 4 15023'06" 54.51' 54.35' S27020'1711E \ road 17025'42" 61.75' 61.51' S10055'5311E _ p~ X11 7-8 27°14'38" 863.13' 410.41' 406.56' S74°09'39"W 00 THIS INSTRUMENT DRAFTED BY DOUGLAS ZAHLER JOB NO. 84-12 ncnp~ 3v0 C ~1 O C T n -5, 4t O d M 0 Z O O N O 01 d V7 W _ C • Q 3 1:1,6 N to N "i O 3 CD P OD 0) C-D N o- m N O 0 ~ is Vt ..t ` 1 O D ~ O CD A CD CD -4 ° n c :3 m0 3 N N n! O Q =i m C D fl v> y O cc O W < ~ a ~ ~ m Irv o ~ = 0 ~ ~ ~ it t\i m r co) N rn~ rn 3 M a N oz O o 3 g w g D r Q p m 3 cn CL °o c~ Z y N z ca z 0 O v p D a z • ID ~ ID CD n 3 \ O c O A Z m in a a ~ a I A Z O O co W CD m c 3 I z ~ L a z Cpl y z A W (D =r Q N ~ ~ I T Q N C o z~ o U) a V A f IT, W S o u r c A m N e 00 a? c Q 1 CD V 69 O A ~n O * ~ V O O O y Parcel 020-1167-60-000 02/07/2005 08:16 AM PAGE 1 OF 1 Alt. Parcel 29.29.19.1037 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 * NOACK, DAVID W & LINDA C DAVID W & LINDA C NOACK 717 COUNTRY VIEW CIR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 717 COUNTRY VIEW CIR SC 2611 SCH D OF HUDSON SP 1700 WITC at: 0211-COUNTRY VIEW Legal Description: Acres: 2.790 VI SEC 29 T29N R19W W1/2-SE1/4 LOT 6 - PLAT o ck/Condo Bldg: LOT 6 OF COUNTRY VIEW EXC THAT PART DESC IN 803/ 538 Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) I y 29-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 975/284 Q 07/23/1997 803/538 07/23/1997 772/517 07/23/1997 745/188 2004 SUMMARY Bill M Fair Market Value: Assessed with: 49077 245,200 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.790 34,000 155,700 189,700 NO Totals for 2004: General Property 2.790 34,000 155,700 189,700 Woodland 0.000 0 0 Totals for 2003: General Property 2.790 34,000 155,700 189,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 302 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 ` 5~~Yf%i r► g f $b Form ---...S T C - 104 • ~9 At rAS BUILT SANITARY SYSTEM REPORT ~J- CA OWNER TOWNSHIP /t u d-Sc'E SEC. J-..' T I N-R ADDRESS ,,ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE 2- L 0" 7 C % r' n PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ID i pf ~r r. P~ INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 6, s1 ~r Elevation of vertical reference point: f DO • d Proposed slope at site: N~ SEPTIC TANK: Manufacturer: CWe,i ,5 d Liquid Capacity: D ~ D f - Number of rings used: Tank manhole cover elevation: 0 Tank Inlet Elevation: 3.r/a Tank Outlet Elevation: J Number of feet from nearest Road: Front,( Side, Rear, O©d feet ,.From nearest property line Front 10Side ,0Rear, 0 l feet Number of feet from: well building: a (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE R 9 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 Bed: Trench: Width: 111 Len the / Number of Lines: 3 Area Built: ~o T' Fill depth to top of pipe: 'le)' Number of feet from nearest property line: Front, O Side, O Rear, Ft.Za Number of feet from well: ~S Number of feet from building: "f -3 / (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 Q 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, 0 Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: (zL~ Inspector: Dated: Plumber on job: 2 License Number: 19 J 3/84:mj i DEPARTMFNT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LAI.OR & IfUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. V30X MADISO SON,7WI 969 969 53707 BUREAU OF PLUMBING MA UCONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: Ilt assigned) El Holding Tank 1:1 In-Ground Pressure El Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Sam Miller Rt. 1, Box 282, Hudson, WI 54016 /2-27Z1'Ill, BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: icST REF. PT. ELEV.: SW SE, Section 29, T29N-R19W, Town of Hudson, Lot 4G ~11~~i Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Doug Strohbeen 5432 St. Croix 88398 SEPTIC TANK/HOLDING TANK: . 0,` MANUFACTURER: E LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED f (1 lO ~'~G/ J YES ❑NO ❑YES ❑NO BEDDING: ]VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING: VENT TO FRESH t JALARM FEET FROM .4 A LINE / LAIR LET. YES ❑NO ❑YES ❑NO NEAREST O`er i~~(L' II DOSING CHAMBER: MANUFACTURER: 7IN-G L IQUID CAPACITYPUMP MODELPUMP/SIPHON MANUFACTURERWARNING LABEL LOCKING COVER PROVIDED: PROVIDED ES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONA L: NUMBER OF PROPERTY WELL IBUI LDING. 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 LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: INDOF JDISTR. PIPE SPFjCING COVER NSIDE DIA *PITS ILIQUI TRENCIi'" S: h ~ {,IT DEPTH. DIMENSIONS Q_/~J GRAVEL DEPTH FILL DEPTH OT R. PIP' DISTR. PIPE DISTR PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES/ ABOVE COVER VNL ET ELE END IPES FEET LINEAIR INLETC•!Or' S (Jl~ r~ NEAREST O-► O rJ / MOUND SYSTEM: y 6 Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑ YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS. JOBSERVATION WELLS DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED ❑YES ❑NO ❑YES ❑ NO CENTER DGES. DEPTH OF TOPSOIL. SODDED. SEEDED MULCHED : E ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.. ELEV.: CIA.. ELEV.: PIPES DIA.. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: JOBSERVATION 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. SIG TITLE DILHR SBD 6710 (R. 01/82) - OUNTY ~ SANITARY PERMIT APPLICATION B f~,LHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # .....p~.,.o~ -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION -PLEASE PRINT ALL INFORM TION. FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER PROPERTY LOCATION L• "Aj ' kA4 '/a, S Z T~ , N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT UM ER BLOCK NUMBER SUBDIVISION NAME ile V* 1 B92 2, g, oT) 46Z CITY, U ATE ZIP CODE PHO E NUMB NEAREST RO D, LAK OR LANDMARK .M f, a 1:3 VILLAGE II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR El Public (Specify): -~0ji- 7- 111. PURPOSE OF APPLICATION: (Check only one in #1. Check # 213 or 4, if applicable) tv rrn-y- 1. a. )c New b. ❑ Replacement c. E1 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. ❑ See a e 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): (P V Feet Private ❑ Joint ❑ Public CAPACITY VI. TANK Site in gallons Total # of 's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xistin Gallons Tanks Manufacturer Concrete stCon glass App. Tanks Tanks Septic Tank or Holding Tank ' Z)- ❑ ❑ ❑ ❑ 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: Plumber' Address (Street, City, State, Zip Code): Name of Designer: It & ~-t- R1 /5 /1 M U17 VIII. SOIL TEST INFORMATION Cer ' d Soil Tester (CS Np me CST # enrJ ` `1 re's 740 0 /7 e rso /1 C M's ADDRESS (Street, City, State, Zip o e) /j Phone Number: ~I efiQ cc v e l ive _ A48'61). S410 ! 6 ~/S .38'6 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuin Agent Signature (No Stamps) XApproved ❑ Owner Given Initial /00 Surcharge Fee Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: i 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 PERM 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 necessary, usually every 21o 3 years; 6. If you t-ve Ji-wsi,inn-, colcerning your private sewage syste contaF_t your ic-icai code administrator or the ~tat~ of ~lisr~n~in, Bureau of Plumbing, 608-266-3815. To be complete and arc;_ ute this sanitary permit application must include. I. Property owner's name and mailing address. Provide the !-,gai description where the system is to be installed; ll. Type of building or use served: if public is checked, indicate type of use (i.e. 10 unit apartmen'., 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; 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 a// 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'h 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 holden 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 hill Groundwater included the creation of surcharges (fees) for a number of regulated practices which Wisconsin's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried f reasure A is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- 1t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. 3BD-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 Location of Property ~it Section T_CA~_N-R. Township Mailing Address Address of Site ,far w/ L Zr~yr ,Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel J. Date Parcel was Created a4zz Are all corners and lot lines identifiable?_ Yes No Is this property being developed for resale (spec house) Yes No Volume1 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) ceAti.by that a t .statements on this bonm ane true to the best ob my (ouh) knowledge; that 1 (we) am (are) the owner (.s) o6 the pnopen ty dens cnibed in this inbonmation bonm, by viAtue ob a way anty deed neconded in the Obbice ob the County Reg.usten o6 Deeds as Document No. a 7 __Z; and that I (we) ptuentty own the proposed site bon the sewage diZ po.s .aye (on I (we) have obtained an easement, to nun with the above de6cA bed pnopenty, bon the construction ob said .system, and the same has been duty keemded in the Obbice ob the County Regi6ten ob Deeds, as Document No.~ 3c 7 ) , SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) -DATE SIGNED DATE SIGNED H z r Cn y STC - 105 r r a y SEPTIC TANK MAINTENANCE AGREEMENT Ho St. Croix County z d a H OWNER/BUYER ~~j,yy~ r Aw c~ ROUTE/BOX NUMBERn Fire Number .CITY/STATE MUJ-SpL7 ZIP s~l~~fo PROPERTY LOCATION:, Section, TN, R1Z2j Town of~ d,.? , St. Croix County, Subdivision V1',Ccf1 7- , 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 pdt 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 Zoning Offkge within 30 days of the three year expiration date. SIGNE G+ 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. DEPARTMENT OF ~EY & BUILDINGS REPORT ON SOIL BORINGS AND INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MAD SO WI (H63.09(1) & Chapter 145.045) LMNTION- ON TOWNSHIP/ : OT NO.: BLK. NO.: 5 (VISION WA-ME-e, S. K. I_,'yv 114gY /TAY N/Rn1(o sQ~, C~ 1L A/ A JUNTY: OWNER'S BUYER'S NAME: MAILIN ADDRESS: r USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: R FI DE IPTIONS: PERCOLATION TESTS: Residence w, /A New ❑Replace r Oyu p ~2 - fy S'v: MAP Bic 1)2- a 7 O ` RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: ['9"S' N-GOUNDPRESSURE: SYSTEM-1 -FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ®S CJU ❑ S ®.U ❑U ❑ S 14U ❑ S OU Gacv~ ~ /~'xsa-' If Percolation Tests are NOT required DESIGN RATE: If any portion the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: A PROF I E DESCRIPTIONS BORING TOTAL ELEVATION DEPTH T GROUNDWATER-O#e"'3 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHS OBSERVED EST. IGHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 1,60 -.4vo AZe- -7 Cob, l~ B-~ ~w' .9~ oke 7 ,vl► •~I3IsI/C9B~s/, .30o IS + B-3 w S^'``~'' AiOde- 7 .0' /roB s/ Z3 daf 11 XZ L, s tv- eol B- I r0f ~C.7 r Aloae- r~ I • 5 •41 V S 3.V 04 =F 4eo~ 3,0 4t s • d 5/,-/, 7 S j"ah .j -cob , 7 E r B- PERCOLATION TESTS EST DEPTHr WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER tW-Wk.$, AFTER SWELLING INTERVAL-MIN, p Rl D I PERIOD P R PER INCH P- 3 P" 2 L 3 P- L 3 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 C 7 -T . _ 1 l ~IH~.>4 t P ' \ CAI " ) 1 , Pit - j pies b0 Ild t 27 X10p, 4- --__L_ _.1--- __i i__ _-.l _1 ,__./~'tp•~~~~t1 _/±~~~f~`so/I_ ~P f~i t;_ _u_jrt-%'?t*..s I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print : TESTS WERE COMPLETED ON: ( rte ~4-s - ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optiont /l r~ t s Yo ,S-? y 7iS- 8 CST ATURE: J DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ' DILHR-SBD-6395 (R. 02/82) - OVER -