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HomeMy WebLinkAbout020-1099-40-025 n co O 3-0 n o f c 11 o M 7! M m o ^ \ 1 r: ~ Q co 3 -1 z v z o v = W O ~l 0 !L O O N O tD (D C W N • ? 3 C N a jV m cc z CD O C N O CA (D CD 0 f, CO CD Su cn (A cc O O c CD 0 o ro n a D b y Q O N N CM O O O 0 n cn x cn D o. r3j Q G (a (D N a N c CD G (D G z 3 O rt m `D O N• b z CO CO a W V' ~ H co co c N o c Q 7y y N Ste.` C~ -0 T m 7 p; lNrl 00 Q m v z d o _ o En n to N H A o a a c0 cl d H Z o Q 00 x E D a l 00 - - F-3 F-3 6 N O N m Cn CD I C: CD N 01 o ON q rt, W m a ~o L7 ° 3 7 PO CD -4 cn Z co O' ((Di o o p z o m M A.C, rt 0 O W O CL A Czo Fl- fir} Z W G ! ti~ W W W Q rt a 3 a MZ D w $ rr co C8 3 m Z cD w ~ I Wa ~v a a O C p OZ d F d v y fi I m y I ~ I ~ o a W N O ti °o ~ a A 0 ti CD a o N CO 0 t b ti r Parcel 020-1099-40-025 03/21/2006 01:07 PM PAGE 1OF1 Alt. Parcel 33.29.19.400A-10 020 - 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 - WILLIAMS, BRONWEN K BRONWEN K WILLIAMS C - GALLION DEREK A GALLION DEREK A 631 PINE TREE RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 631 PINE TREE RD SC 2611 SCH D OF HUDSON SP 1700 WITC I Legal Description: Acres: 5.370 Plat: 4509-CSM 17-4509 020-03 SEC 33 T29N R19W PT NW SE CSM 17-4509 Block/Condo Bldg: LOT 05 LOT 5 (5.37 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-29N-19W NW SE Notes: Parcel History: Date Doc # Vol/Page Type 08/04/2003 733713 2346/592 WD 05/14/2003 721433 2241/183 QC 05/02/2003 719915 17/4509 CSM 05/02/2003 719914 2228/401 WD more... 2005 SUMMARY Bill Fair Market Value: Assessed with: 92178 360,600 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.370 88,500 279,300 367,800 NO 05 Totals for 2005: General Property 5.370 88,500 279,300 367,800 Woodland 0.000 0 0 Totals for 2004: n ral Ge e Property 5.370 46,900 211,900 258,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 104 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 Parcel 020-1099-40-025 03/21/2006 01:09 PM PAGE 1 OF 1 Alt. Parcel 33.29.19.400A-10 020 - 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 BRONWEN K WILLIAMS O - WILLIAMS, BRONWEN K DEREK A C - GALLION DEREK A GALLION 631 PINE TREE RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 631 PINE TREE RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.370 Plat: 4509-CSM 17-4509 020-03 SEC 33 T29N R19W PT NW SE CSM 17-4509 Block/Condo Bldg: LOT 05 LOT 5 (5.37 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-29N-19W NW SE Notes: Parcel History: Date Doc # Vol/Page Type 08/04/2003 733713 2346/592 WD 05/14/2003 721433 2241/183 QC 05/02/2003 719915 17/4509 CSM 05/02/2003 719914 2228/401 WD more... 2005 SUMMARY Bill Fair Market Value: Assessed with: 92178 360,600 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.370 88,500 279,300 367,800 NO 05 Totals for 2005: General Property 5.370 88,500 279,300 367,800 Woodland 0.000 0 0 Totals for 2004: General Property 5.370 46,900 211,900 258,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 104 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 . i LLxF X i' 353930 CERTIFIED SURVEY MAP F I L E D NORTH p C 3 1g18 CID Y DEC 14 1975 N COU,~ty JAA1f.S O' CONAtLNL CR~vX PARRS PLAaING Oh "crctx w t cowryOoed, SCALE ~M ypHZ N►N0 GpM~►N 200 100 0 200 ~~3ow~s~o~a M1NOK ~ FOPS 0= I"X 24" IRON PIPE WEIGHING `pF},4P«OVA 1.13 LBS. / LINEAL FOOT... AQ??,0' tA01 t1`s~k Syjj c sisl pOS •=IRON PIPE FOUND_ gV11.SD~NG SASS Off, Nb2.2 RFFSR 10 S 89050b0" E 1230.IG' o0 -90o , 717.60' 1 512.56' I 5 0%00y 66' 1 no I RESERVED FOR 1 13 FUTURE STREET w I 1b Loin 0- m N It 1 ~0 501° LOT I ~ ~J z LOT 2 ci II 10.037 ACRES I 4.297 ACRES M O l 80 ' ,n w 1wU-) ~ppp0 -0 S81°00'15E 426.12' 0 o I-0 0 6G 50(3.12, SGQo2 yg5 g\g6 w -U-) 0 1'0 O G_ 1c' 02 E o Y 1,r 6ta r> M c~ii 85 I ~ (b 0 co ~O O IO.o a N loo -i~ cL O i co pN p GG' ROAD cu EASEMENT r 1 85' 1 ~rn `Lp o J ^ co 10 co O~ ~ N89°5000W LOT 3 W LOT 4 120.00' 7;745 ACRES 0 7.874 ACRES 13793' O 1 0 1 ~89°SQ00"E z 0 55.86 0 0 RESERVED FOR N i FUTURE STREET °~p v I 0 0., 1 w 7500 Aso q6 731.74' S02.G6` o N88°5G'0O'E S880 5600"W 1234.40' N -O o O O 1l- z N 1 ` S CORNER SECTION 33-29-19 ^ Volume 3 Page 749 +,(~J - 60Sh abed W 10A ' Ion S133HS o zJtOo:L 133HS VIVO 03060038 ( ) o m 00636 Nnod ■ Z E003/0E/10 :31d0 l0-bbZ9 'ON 80f o ~ O oz 3414 N061 6313Wd10 301S1n0 „L 0Nn0j ® o - : li3JNISSI3J VNViElB O -i cn J8 (13J-JVUCI iN3WnaiSNl SIHI 1003 6V3NII 63d S81 99-L 0NIHO13M '3dld ° co z -r > ` N081 ONOI „8L A8 6313WVIO 301SNI „l 13S O R; O D G M n 83Na00 N01103S co = m CC N01103S JO 63N600 A1Nn00 X1060 '1S WnNiWnlV 0Nn0j ® o p Z 1/t HinoSi' ------t~-MM---------~a--n----n----~- QN3031 ---A m I Q~~OcJCJ~~~~~ iJO 'u' V LIU O 0 C O p----- (,l6'08Z1 M~61,99.68S) N m ,-b6 C9Z1 M ,Zl,6S.68S fJ b0~1 I ~ ' S'AOV813s 3l8V0llddV NO H0V08ON3 HOIHM JO 3N0N '9 iOl NO SONI01in8 AHOSS300V (.0019Z 3,£Z.0N) _ z CINV 3Sn0H ONIISIX3 NV SI 3U3Hi - O :310N .80 l8Z 3„00,9Z.00N__ O I Z O 0 o~ 0 O N C5 (3„ L£.68S) N 00'L L M„ti 4,L£.68N o 9 rri w rn m (.00'Z6l 3,CZ.0N) .~..m..- OCYN--~ to NJ co rn v 91 m _N (.001L 3,L£.68S) I o, 'OS L L9'L56) ,60'L l 3„C9,Z£.68S v S360V 66'LZ (,t6'£6t 3,£Z.0N) - i 9 .CT M 3„ LZ,9Z.00N z i (,00'9Z 3 L£.68S) I~ o ' ,8Z'SZ 3„6C,8Z.68S N (,99'Z0S M„ 00,9S.88S) (.tct£L M„00,9S.98S) ~ _ - - - , _ m j Z709 3„LZ,60.68N ---i 8£'L£L M„9Z,60.68S , (,00'9L 13„OO,Ot.OON) 1 `~I i~\ w N ,5l'SLl 3„Zb,9Z.00N ~v n S , (,98'69 L 3„00,09.685),69'99) 3„ 1£,££.68S<' 00 .8117'6L9 IN ii IM 0 AVM3A18(3 'NM H , OZ O i 31360N00 l3nb'60 JNIISIX3 I o r\3 N3,2 i i 0NI1SIX3 30 3NI1831 1 , V i.wr. m t o 0 0 U, li Z ~cn p ~ ~ i C„ Cv C, 00 co I O cn CJ A) 1" I N o Opp imv O c.~ t 4 S t• N L" 0N1031n8 ,4~^>' k o c., ( 1(4 00 o w 0NIISIX3 . !b -4 C% m P jut M I 00 c I0 00 I + ~O~ p~OQ'~- ov i/~ 0 1 z 2 ~ 6 w I t= 1 A ❑M vt ~ L0 ~ i ~ lg Z~ 9 ~S6I98 6L%1 i ~6Z~y I ' 00'08 -o~,@919 ❑ )C 39 ❑~Jl M ~ ICJ ❑M6_5 a Q b:& ❑ 6 ❑ £C N0U33S I i ('13 'OS L86'661) S360V 6911 JO 3NII 1/t g lm LN3W3SV3 OV08 0NIanl0X3 V38V Hinos-H18ON ('1J '0S 8£6'££Z) S360V L£'S N0I133S I 1N3W3SV3 O`d08 0NIam:)NI V38V O 6 NdO3 6 103 910179IM'N0S(3nH Mtlg IM'NOSanH ~I OVOd 33HI 3Nid LE9 aNV 9C, AVMH9IH (PO 9t9 00Z 0 00Z NV0VII8iVd NV0uoriHOlMO `:JOJ Q3Jdd3Jd ,OOZ = „l 133J NI 3~V0S NISNOOSIM 9tov91M'N0SanH )uNnOO XIOHO '1S 'NOSO(]H 40 NMOI `1S3M 133H1S 301N3 036Z Z : S39Vd 6t 30NV& '141HON 6Z dIHSNM01 'S6 N01 103S '8P6 ONI ONV]Mns GNVI NR S :33d Ad00 3Jdd 'Z 3Nn70A dVAI AgAdnS 0314111-130 40 t 107 GNd l~V3H 'W SVWOHl 00'ET :33d 034 dVW AmnS 03IjI.Lm '6tl-3SVd'E3Wn70AdvyvA3A&nS031411113040E107 :JO,,3A8ns Qti003 303H d `d W 43.4 n S a 3 U !1 4 3 3 O3AI032i i1d0p' q.BO800Z'I IM '03 XI083 is uuj S033a do 83IS I938 A MYA -H 60Sh 39Vd LL 10A 8dV 1 ~~a~3 j Form - S T C - 104 r. AS BUILT SANITARY SYSTEM REPORT OWNER t_ RM(A Atj TOWNSHIP S~Jy SEC. T N-R 3 ADDRESS _ 3 Btl ~I ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM lkdoom a''Pvc 01500) 130 10 '1 . ~ o V) W INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: 1 ~..Proposed slope at site: _a~.. SEPTIC TANK: Manufacturer: Liquid Capacity: S~U 4~1 Number of r~;.ngs used: Tank manhole cover elevation: i Tank',Inlet 1:1evation:_ Tank Outlet Elevation: Numb(r of Poet from nearest Road: Front, feet O Side, Rear, O 8V From :iearest property line Front,0Side,0Rear,4 feet Numb(r of feet from: well _ building: A_`'LAp_t6 come (Include this information of Khe above plot plan)( 2 reference dimensions to septic tank) L;rE REVERSE SIDE 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: Ft . , , Number of feet from nearest property line: Front, 0 Side`, ORear, 0 Number of feet from well: Number of feet from building (Include distances on plot plan). SOIL ABSORBTION SYSTEM Bed: Trench: ! 3 +Rtoc eS ! Length: Number of Lines: Area Built: i0o Width:., Fill depth to top of piper Number of feet from nearest property line: Front, :O Side, O Rear, 0Ft Number of feet from well: I ~V Number of feet. fron. building: 'i tf' (Include uistances on hiot plduj 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 syt.ems? '(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, Q Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUOMAN RELATIONS SAFETY & BUILDINGS P.O. Box 7960 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 63707 BUREAU OF PLUMBING OCONVENTIONAL ❑ALTERNATIVE State Planl.D.Number: ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (IE•algnedl .ti NAME OF PERMIT HOLDER. ADDRESS Of PERMIT HOLDER Patrick Reagen & Ruth Lunde Rt. 3, Box 343, Hudson, WI NtSPEC~T ION GATE: BENCH MARK (Permanent reference pomtl DESCRIBE IF DIFFERENT FROM PLAN 5401 6 P INSPECT tyD NW SE, Section 33, T29N-R19W, Town of Hudson, Lot #3 REF. PT, ELEV.: CST REF PT ELEV Name of Plumber MPIMPRSW No Cnunty Richard Hopkins 1059 Sanitary Perm,t Number St. Croix SEPTIC TANK/HOLDING TANK: 79218 MANUFACTURER LIQUID CAPACITY TANK INLET ELEV. TANK OUTLET E EV WARNING LABEL 97 ~F ~J PRO? DE O. LOCKING COVER / ! l PROVIDED: BEDDING. VENTDIA. VENT MAT( HIGH WA eH YES ❑NO ❑YES YNp Fl ALARM NUMBER OF ROAD. PROPER 7y WELL BUILDING. VENT TO FRESH YES ❑NO ti ❑YES FEET FROM (7~ LINE AIR INLET. NO NEAREST (r/Vl DOSING CHAMBER: MANUFACTURER BEDDING LIOUIO CAPACITY PUMP MomI PLIMP;SIPHON MANUI AC I WIEH WARNING LABEL LOCKING COVER YES ❑NO NAL PROVIDED PROV IDIE.D ❑ ❑NO GALLONS PER CYCLE: PUMP ANDCOnIrgoLSOPERAno ❑YES ❑NO ❑YES (DIFFERENCE BETWEEN NUMBER OF PHOPE HTV WELL BUILDING VENT TO FRESH PUMP ON AND OFF) FEET FROM LINE AIR INLET SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing❑NO NEAREST nA4f TFH AtA1F HI AI AND MAHKINK the or excavation,enough soil can be rolled into a wire, construction shall cease unti=MA N" I nough to continue.) CONVEN TIONAL SYSTEM: BED/TRENCH WIDTH LEf~G TH NO OF UISTH PIPE SPAC.IN(, COVEN DIMENSIONS THENG441S MAT HIAL: INSII)L l)In -PITS LIQUID IT DEPTH HAV L EPTH FILL D TH UI IPF U TH PIPE DISTR. PIPE MATERIAL BELOW PIPES ABOVE HER FAST ;I N) H NUMBER OF PROPERTY WELL BUILDI ` U LE VE NG VENT TO FRESH d FEET FROM LINE AIR INLET --s r S MOUND SYSTEM: NEAREST Mound site plowed perpenaicul r t slo e and furrows thrown upslope: U 41C the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES ❑ NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER rexn)RE Pf HMANF NI MAHKf HS OBSEHVAII0N WE LLS DEPTH OVE RTRENC14 BED DEPTH OVf H TRENCH HE I) ❑YES ❑NO ❑YES ❑NO CENTER EDGES Uf Vhf OF tOPSOtL SODDf 1) SF F Of O MULCHED PRESSURIZED SYSTEM: ❑YES ❑NO ❑YES ONO ❑YES ❑NO DISTRIBUTION BED/TRENCH WIDTH LENGTH NO OF LATEHAL SPACING (HAVEL DEPTH HE LOW PIPF TRENCHES FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIF OLU MATERIAL N) ELEV ELEV UISTH UISTH PIPE IIIST HIHLII - ELEVATION AND . OIA ELEV. PIPES )tA ELEVATION PIPF MATENIA L. & MARKING DISTRIBUTION' INFORMATION" HOLE SIZE HOLE SPACING F7iILLEUC0RHEC1Ly ICC`VER MATERIAL - VERTICAL. LIFT CORRESPON US TO APPgOVED PLANS COMMENTS: ❑YES ❑NO ' ❑YES PERMANENT MAgKER&. OBSERVATION WELLS. ❑NO ~ r NUMBER OF PROPERTY WELL. BUILDING. ❑YES ❑NO FEET FROM uNE ~j , ❑YES s~` NO , _ NEAREST s/ - J. 1. Sketch System on Reverse Side. Re ain in county file for audit. SIGNAT DILHR SBD 6710 (R. 01/82) TITLE Wisconsin APPLICATION FOR SANITARY PERMIT ILHR ' ~ (PLB 67) COUNTY OEPRRTfnEnT OF UNIFORM SANITARY PERMIT # InOUSTgV,LRBOR 6MUTRn RELRTIOnS -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROP TY P NE M I G DDRE S t ~~th v Id e, . N 4 SU f PROPERTY LOCATION CITY: W1/45 1/4, S , Tc N. R E (or)4V WN OF• LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN. D. NUMBER TYPE OF BUILDING OR USE SERVED LY 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): pp THIS PERMIT IS FOR A: X 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. ❑ Seepage Bed U Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity 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 Gallons Tanks Concrete Constructed Steel Eberglass Plastic Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): WATER SUPPLY: Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. ,pp Na a of Plumber (Print): Signatu MP/MPRSW No.: Phone Number: ~eha t,J diN6 • /osq. -71 S-) ZV4-s ~z Plumber's Ad ess: 1001- Na of D signj er: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ~ ❑ Disapproved ~/~y 9 ❑ Owner Given Initial Approved Adverse Determination 6y" Z54!~~Amg * Reason for Disapproval: 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. ' APPLICATION FOR SANITARY PERMIT S T C - 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/contractQ-1:,("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 PC4reck L It eagQn ItGf F ~irh4 Location of Property LUI ;4 SF_ IL, Section 3Y , T d? N - R / 9 W Township l~ U /So Y~ Mailing Address ' , /SOX 3 X13 W C, e h 6V Ise s yo / d Subdivision Name Lot Number 3 Previous Owner of Property Ply (A) euYev d N Total Size of Parcel Lmt 3 = 7. 74 5' a~~es + Lmfs y - 0~9,9'S3actE s Date Parcel was Created &lr- Q7~ Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes ✓ No Volume 3 and Page Number y 9 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 Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) CeAt16 y that aU 6ta tement6 on .thin 604m ane tAue to the befit o6 my (om ) knowledge; Aat I (we) am (ane,) the owrleh (6) o6 the pnopeh ty de.6n bed in this .tn6o4mati.on j6oAm, by vilitue ob a wa4Aari-ty deed AeeoAded in the 066ice o6 .the County Regiz ten o6 Deeds as Document No. 9116 ~ 3 7 ; and that I (we) pnesentey oun the phopo6ed .6 to bon the. 6ewage dn-po,5bystem (on I (we) have obtained an ea6 eme.nt, to nun With the above du c4.ibed pupen ty, bon the corvstauctior, o6 said .6y.6tem, and the same has been duty Aeconded in the 066ice o6 the County RegizteA o6 Deed6, a6 Document No. ) SIGNATURE OF OWNEk SIGNATURE; OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED 61 35393 ~ ; CERTIFIED SURVEY MAP F I L E D NORTH Dt~ 1g7 DEC 14 197 N CO NN1NC' , s OQOaX S F~ l't-"FS Rvpbl.r of Gnd .4 [pt PREtkt- cG `po 411EE 1k SCALE J~ ° N X9 wbc 200 100 0 200 tO? 0= I"X 24 IRON PIPE WEIGHING rJ~"j~411~pF?~GVj` 1.13 LBS. / LINEAL FOOT... O, M`'* 1' StYj~G 5-( 1,l OES c O'k • = IRON PIPE FOUND_ vloll p ~b2 gyp. CE>: LR . S 69°5000'E 1230.16• Do, : 717.60 1 512.56' 00 t c i 1 501 - 665' RESERVED FOR r 6, 1 13 FUTURE STREET w 1 Ilj oti i lQln o-. later OQ 1 b 0 50 ° LOT 1 z" LOT 2 " 10.037 ACRES 4.297 ACRES 1 8p• vi 0000 S81000.15.. 426.t2' 0 °O I7R o QYt Uv 50G./2. LO 0 ib rn SGAo 2 SG} 56 w s o 1 a q° ZO 2 ° Z N •1 G n BS 1 0 (D 0 13 0 CD 0 1°000 p0 N 1 rO o 3 Cb• ° i O" O tr GG'ROAD m IvI 3h 0~. rt, EASEMENT r"• 85' I 'Om °O P ry0 * •o r to h °O c I rq .7~ ~ -p N89°5°°. Y' 2 LOT 3 w LOT 4 120,00 "co13793' 7.745 ACRES o 7.874 ACRES ° ~89°5000 E 0 55.86 oRESERVED FOR ~i• b a~oa FUTURE STREET °i• w 4 a 731.74 502.GG' °o. - _75.00 • 8168°56.OO~E S B805G•0O'w 1234.40 -Q rte c1 n S CORNER SECTION 11311page 7119• Continued 1leyt Page) 33-29-19 Vol ume H Y STC'.165 r r - H st wric TANK MAINTENANCE ACRLEP-111:NT H a _ St. Croix :County t4 v :Y OWNER/BUYE'R a-FNtClc ~ea aH i- IGfA fi. 6A ~ ROUTE/ BOX NUMBER Rf 3 fox __3`/~~_ Fire Number -41 PROPERTY LOCATION: _NW_~4, SE '-y, Sect lun T N It W Town of Isan 7wSkle-St Croix County, Subdivision Lot number -3 Improper use and maintenance of your septic system could resu1C in its 'premature failure to handle wastes. PeupCr ntaintUnalWO Coll- sists of pump-iup, Out tite sul,tic tank every <tltree years or :;oouer, it' needed, by a licensed Se>t c tank rum,c-. What you tut into Lite sytitem cait it flectlth0 function of the c,Llptic tank its 'a LreaC- nteut state in Lite waste disposal _SySteut. St. Croix County residents etar 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, 1.978. St. Cruix County accepted this 1) rogram in August of 1980, wi It the re(Iuirement that uwiiers of all new stUms agree to keep their systems properly uiuintained. The property owner agrees LO submit to St. Croix Cuctttty l.r)tlint; a certification to°rm, sii;ued by Lite Owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper ver:i- fying-that (1) the oil- site wastewater disposal system is in proper operating condition and '(2) after inspecLion and pumping; (if rice essary), tile, sepLie 'tack is less than 1/3 full of sludge and scum. Certification formwill be sent approximately 30 days prior to three year expiration, o I/WE, the undersigned, havt- 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 Lite Wisconsin Depart i ment of Natural Resources. Certification form must be umpleted and returned to.the St. Croix County Zoning Office within 30 days of the three year expiration date. SICNED fAJ L DATE St. Croix County Zoning Office P.O. Box SS Hamm ltd , W 1 54015 r 715-196-2239 or 715-425-8363 Sign, date and return to above address. v r s s C N N -a U) :r WO N (D to~ ~ pO:03 D :3 N a3 ~3 0 0 Sr ( o a °co c~www~~ c o 0 3 co U3 O o o p a CD cD o °cmv, cDgo~'cng~ v. m o o p o w o w o 00 n*cD CD ~maN? ~w a m $r c~ " ? O O ' (D OD P A 3 Q 0 C .1 ~O W 92 7 > > wo_o c- c=v, Z~ c~ Q5 ~ w_w 1m w w v_, C, o O -Cs ~ CD J~. (D c A. Ncoin CC* pD~Qomj R cn ow A = w A p $ cc w o m o O 2 w A O a Q w Am o~~ Nm-% 0 Z a (~m cn w c ?w=-i o 6 . m a S A a O a CD A 3 (D N cD (A 0 0= cu o.a sr ch cD coNoa aco~ N 'O acA~cD C m =coo uww~~ m 3c= o~a0~w? o w o Q a' S oQ ° o N o = c° a 1 w° Or c~ o N w a cQ~cf~' m co c aw o m=w m 'ocDwo ao " aa~ a ~O Qa r« Noc ~ccw~3 r m 0 c° G) t° n C o CD O r CA CL 0 a:) ~ a c 0 w Er C A A o ° r cm= o a cD a N a o o co 0 oz IN DUt T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS NDUSTRYY, , c DIVISION LABOR AND " PERCOLATION TESTS (115) MADISOP.O. BOX 76 N WI 53707 HUMAI)J RELATIONS (H63.090) & Chapter 145.045) LOCATION: • SECTION: TOWNSHIP/ LOT NO.: BLK. NO.: SUBDIVISION NAME: &W 1/ 1/ 33 /T L9 H/RI E (o )W HVPSoAv 3 SAl Jf3 o 11o/ 3 .7V' COUNTY: OWNER'S/BtiYC-R'S NAME: MAILING ADDRESS: Sf. 4V / /3 I~DI✓ wEfTtiPry,~AJ % C'~I f',VSo v, rkv(p USE DATES OBSERVATIONS MADE NO. BEDRMS,: COMMERCIAL DESCRIPTION: - (PSREOF~IL/ ErDESCRRIPTIONS: PER O ATION TESTS: Nesidence New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system r ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-Fl LLHOLDING TANK: RECOMMENDED SYSTEM: (optional) QS ❑U ®S ❑U DS ❑u ❑S M ❑S ©u 7;f'Ve4es --ove-7"° If Percolation Tests are NOT required DESIGN RATE: lFloodplain, If any portion of the tested area is in the under s.H63.09(5)(b), indicate: ~a'Q indicate Floodplain elevation: 7T OAAC-5 PROFILE DESCRIPTIONS j BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BA K.) f .0 V S ,3 , S . 33 RA, - B-2-19. 9~.7~ 9 / GR 1.33 ' h!X• a f S1 ' T4AJ ANA ~►^~P• S, ) //fo ' si °Wj- S/~ . ?I 'So - -GAP. sL ~ 7. a•' B-3 . ~ 9 ~e~ Ito- 9 a aN. o,~a,,► ~..s-. ~ CQt .~j ,.as !K o y- sl ~r Qa• sl, .S8 ~N. ' gyp. p' A &P. o . 5Ail , . P ' ~BANOED 77lt°415 d F S/ s wry st po~p.rs . •s' oRy, *Ar B- , JCI B-,5' 10-S 71. 36 S a f o,p. sJ *_*L oe. ;4.4. S. 5 ' v , cs PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PE OD 2 PERIOD 3 PER INCH M P_ P_ P- Y D io /lp P-_ P_ 1 2- -5 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- O 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 ~oTtor~ of T+eeNC.P..~s ' 3 T~ r" W ~T 4l r P 3 t 30 .SD o s o~ N B ''7 %JI '06 41 sF A 9s I _ T ' a - - h h , So, t_oT1Nt' _ t ~ f J_ j 6,601, 1101-,'e5 jOS40e 144AJ C) 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: HOMESITE SEPTIC PLUMBING CO. s r ADDRESS: ROBERT ULBRICHfi CERTIFICATION NUMBER: PHONE NUMBER (optional): WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R•S , j - D 1- VIP Z 31N MINN. INSTAL CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 , t To use a complete and accurate soil test, your report must incluc:le: 1 . Complete legal description; 2. The use section must clearly indicate whether tbis is or..cornmercial project; 1 M (IMUM numk of ' edroorns i commercial use pla i 4. Is anew or r_. sy_. 6. Cc the __ii r L S1 1 SUITA _F :)R A HOLDING TANK ONLY IF Al L. OTI-. SYSTEW I SOI FIONS; 6. PL u e r. i he "ng profil ptions and ~ R 7. i "SALE t' I to sl' e sure: _ to d are pe c . )mplete names, t colation test ex r -a_ tion, i 10. If the irrror ac } riate box„ 11. Sign the form ai i - ai ' yc i . 12. Make legible cop c i ate iir f ALL _ FILED WITH THE LOCAL AUTHORITY WITHIN 0 DAY ! F COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS cf s f RR c S l"} L cs med s - 1 fs 131 Is - I cl sI #l L sit - Si y - C y Loarrr _ - "_oam sic ay, pt rig _ P HWL. "ires Ab. _ al 13 St n rit a -m n f s a T - . _67- PLOT.. SS S FCJ 10 1\1 ..A M E 11fx o IA16 'N M E t NAME Z L O C AT 10 N_ ' I C E N S E :lt- ~ 9111 P L 0 T Nd A_P 0 Noble e z vas i,6Att0 Ito ~M Pa 2 al S t ~ y ~ t Q3 5et: WP& 1x 03 PVC Pi Pe. U4zv, (00 .0 i ~ s r: i I 1 i - 0 Y S F4 who "1 10 xN 'VROtj SWI. FRESH AIR INLETS AND OBSERVATION PI-QE CROSS SECTION Approved Vent Cap Minimum 12" Above Final (iraSl~ Y - I hl p' yy~ 4" Cast Iron Above Pipe`' Vent Pipe Sj To Final Grad Marsh Hay Or Synthetic Covering l Min. 2" Aggregf~0_e ° Over Pipe - Distributio~n~ iI Tee Pipe Aggregate Perforated Pipe Below __Beneath Pipe 4 Coupling Terminating At Botto System m of i - 5393 •61 3 i CERTIFIED SURVEY MAP FILED NORTH D- a, -___DEC 14 197 C0U' 't ~ .NN,No JMeS o' CpNneu S. coo x rs f~ Reo4f.r •I Deeds co1~ RENCONG Gp►iJUS1Ff se. Croix wry GO SCALE wbc«,a r 9 I 200 100 0 200 - ~3D1V~5;G'1 Spy: S Fp?. 0= I"X 24" IRON PIPE WEIGHING 0 jZ~'"'~'1~ FF?^ClIq r_ 1.13 LBS. /'UNEAL FOOT... rIDOts ~;pS r OZ =IRON PIPE FOUND... g 105b~.'tG• . S 89°5000'E 1230.1C~o'oe , 717.GO' 1 512.56' , o0 i 1 50►0 66' o~y 1 RESERVED FOR 13 FUTURE STREET w I Ib oti 1 i la%n 07 1 r~ I o- 0 50 iNN LOT I °N LOT 2 N I I ti ` 10.037 ACRES 4.297 ACRES 0 I '0 0 I _ m 8p. in b f I w ~w Q00 S81000. Q 15 4 0 ao E 26.12' v1 50G.12. 1, 00 to 0 10M 0 SGQo 20 ~G} 6 0~ 56 w 0 I Q = Z 0 I'n GQ02 n N 'i85'1 N o CD 13 o Ts I ioo a~ ^ S" N Ib O ~ ~/L f 1 10 0 a GG' ROAO 140 Iy •s'- PCb 4, EASEMENT ti ~co °O O --T-- o 85 1 'Om• -'L 1 i,~j ^h ^7 ' i I, o 00 1 ~ S N89°5000 W LOT 3 W LOT 4 X13 900 7.745 ACRES .0 7.674 ACRES I i ~ ~89°5000•E 0 0 5 o RESERVED FOR ~e v oc FUTURE S74EET °/o w 4 , b a~ 731.74 502.GG' 75_00 N88°SG00E S88°5GOO,W 1234.40 0 o n 0 L Z M S CORNER SECTION (Continued Next I' 33-29-19 Volume 11311, page 7119. Con 1