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HomeMy WebLinkAbout030-1069-50-000 0 to O 3 'n n C tD co~ 3 A- CD C) 3 (D d A :i U) - I Z ° 0 w `C • 3 o m C. o CD N S. m z c7 N v N O CD N O) IV CD. 7 O_ O fD ? C, C.fl O O C N 'i N O U' 3 g y O N N Q0 I'' (D N N a CD CD N W O V co 3 rn D CD F~ N N o CL N co 00 C y 0 co 3 Q z 0 0 0 o' ~ o o ~ 3 lv~ 0 g fn fn CD w (D o Im a O C/) S?o c N cc, CL 0 N N z Zco Z o o II v o D m N !1 X •O N lr c w a a 3 z CD (6 O A Z Cif t r ~ M CL G N w M o Cl w CL - z 3 r O ;o I H ~ w ~ CD w d I ~ O~ o02) D 3 ' 'o 31 -gz-3 n tOir y o O p N C N C OD O. @ N O C >>w0 _-m D ? ~ 7 N N to 3 5i CD CD O. C Q ti N (D N A r-R CD @ D) p X 01 7c C.)) m x Q O S C CD A 1.M su°'~ CD aQm m D ?0 uo N .N. N j O O O I p O A ~ b O 1i O ti O CL h, Parcel 030-1069-50-000 02/18/2005 04:19 PM PAGE 1OF1 Alt. Parcel 26.30.19.252D 030 - TOWN OF SAINT JOSEPH Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner KILGRIFF, STEPHEN P & JANE M STEPHEN P & JANE M KILGRIFF 1775 LEXINGTON AVE S #7 LILYDALE MN 55118-3629 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 26 T30N R19W PRT OF GL 3 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 26-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 07/2311997 7pp4~-4~_/32 ~ 2004 SUMMARY Bill Fair Market Value: Assessed with: 5309 48,300 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 0 47,500 47,500 NO Totals for 2004: General Property 0.000 0 47,500 47,500 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 38,300 38,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount 040-OTHER ASSM'T SPECIAL ASSESSMENT 320.58 Special Assessments Special Charges Delinquent Charges Total 320.58 0.00 0.00 4 i Parcel 030-1069-20-000 02/18/2005 04:19 PM PAGE 1 OF 1 Alt. Parcel 26.30.19.252A 030 - TOWN OF SAINT JOSEPH 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 * BASS LAKE ASSN, %JANE M KILGRIFF, TREAS %JANE M KILGRIFF, TREAS BASS LAKE ASSN 1775 LEXINGTON AVE S #7 LILYDALE MN 55118-3629 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 25.850 Plat: N/A-NOT AVAILABLE SEC 26 T30N R19W GL 3 EXC E 10 RDS N OF Block/Condo Bldg: S 4 RDS (ADD'L HIST 744/321,939/310, 939/313) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1134/147 PR 07/23/1997 1087/589 PR 07/23/1997 1087/587 QC 07/23/1997 991/234 QC 2004 SUMMARY Bill M Fair Market Value: Assessed with: 5307 956,300 Valuations: Last Changed: 09/07/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 25.850 940,800 0 940,800 NO Totals for 2004: General Property 25.850 940,800 0 940,800 Woodland 0.000 0 0 Totals for 2003: General Property 25.850 730,800 0 730,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount 040-OTHER ASSM'T SPECIAL ASSESSMENT 796.40 Special Assessments Special Charges Delinquent Charges Total 796.40 0.00 0.00 Parcel 030-1069-30-000 02/18/2005 04:19 PM PAGE 1 OF 1 Alt. Parcel 26.30.19.252B 030 - TOWN OF SAINT JOSEPH 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 %JANE M KILGRIFF, TREAS BASS LAKE ASSN BASS LAKE ASSN, %JANE M KILGRIFF, TREAS 1775 LEXINGTON AVE S #7 LILYDALE MN 55118-3629 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 0.570 Plat: N/A-NOT AVAILABLE SEC 26 T30N R1 9W SE NE PT G.L. 3 E 10 Block/Condo Bldg: RDS EXC S 4 RDS & EXC AS DESC IN V 822 P 248 ASSESSED WITH 240C Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 26-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1087/589 PR 07/23/1997 1087/587 QC 07/23/1997 991/235 QC 07/23/1997 822/248 2004 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/25/1992 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 030-1069-40-000 02/18/2005 04:19 PM PAGE 1 OF 1 Alt. Parcel 26.30.19.252C 030 - TOWN OF SAINT JOSEPH Current XJ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner %JANE M KILGRIFF, TREAS BASS LAKE ASSN * BASS LAKE ASSN, %JANE M KILGRIFF, TREAS 1775 LEXINGTON AVE S #7 LILYDALE MN 55118-3629 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 26 T30N R1 9W PRT OF GL 3 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1087/589 PR 07/23/1997 1087/587 QC 2004 SUMMARY Bill M Fair Market Value: Assessed with: 5308 26,200 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 0 25,800 25,800 NO Totals for 2004: General Property 0.000 0 25,800 25,800 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 18,500 18,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount 040-OTHER ASSM'T SPECIAL ASSESSMENT 21.84 Special Assessments Special Charges Delinquent Charges Total 21.84 0.00 0.00 0 0 r°. o c co c 1495 - - - 150th Ave. o a 14 - - - O ,469 464 i • • • • ,483 478 m ffi • 1477 474 • ffi 1 1477 1473 172 O r i 470 / co J~ • N +aee • j 23 14% 1482 • 24 I West Shoi • i s j Bass 1428 43rd Ave a i ' r~r 1410 • I (D .C r* • m • 141 1414 •D 407 Terri r • njL ,a ,1 12 co m i 1 0th i 1375 r;~ Lake CO I 1366 13Q3 4 ~ ` • ~ • • 1371 I 1357 1372 • • X378 1362 -9 136, 26 TJ' Tr 1398 1 1363 1377 • 1'x'1 ~ ~ • ~ • • 25 0 ' •1 1339 ' 0A03 133rd Ave. i z 32nd 1393 A io • Iz r. jz 1304 1306 1312 0 1307, • 1310 -N • 1303 to 1283 CU g 1298 3011 `V R ,294 • 273 /Q 21 1285 I.V e~ L . 1281 1286 • ,280• 12 . i 1261 ,270 ,276 , ca i J 35 A 1260 ,249 36 .c • I t 1226 C Fu r 1 co i c 1 k ,224 III 9 m 1215 y 1218 • • • ^ a~^o MMcu 11 ~ p*a W ~ ~ ~ O . ~ I C ~i 1207 ` • A~J I E C) ! - j cc River ! Z A ry Dam I ~ Lake , Form-STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SL•/Jl SEC.- T N-R 199 W ADDRESS e;2;2 ;~j 45,7-)j rj&,Q ;~l ST. CROIX COUNTY, WISCONSIN C SUBDIVISION LOT LOT SIZE PLAN VIEW v~ 036- l 0tg/ v -Z . Z~ZD Distances and dimensions to meet requirements of ILHR 83 A-AS 41 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM U IL en, 66 y INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /00.0 Proposed slope at site: SEPTIC TANK: Manufacturer ~S /)rte Liquid Capacity: j 0% ^A Number of rings used: Tank manhole cover elevation: ~L Tank Inlet Elevation: Tank Outlet Elevation: 971, Z 7 Number of feet from nearest Road: Front 10 Side,O Rear, 'ook feet From nearest property line Front,O Side,O Rear , feet Number of feet from: well 7 , building: 7 -rte ' (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE (e '13 91 PUMP CHAMBER c~ Q Z Manufacturer: Liquid Capacity: --g 2 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: J~ Length: Number of Lines: Area Built: Z Fill depth to top of pipe: 219 Number of feet from nearest property line: Front, n Side, O Rear, Number of feet from well: 2 Number of feet from building: ~''Zy^ (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, 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: ~t License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 - BUREAU OF PLUMBING MADISON, WI 53707 p~ UCONVENTIONAL ❑ALTERNATIVE State PlanLD.Numben (lf assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: IN PECTION DATE'. B non E. Sta nz 2270 Rivewood P2a.ce, St. IEau2, MN 5570 - er BENCH MARK (Permanent reference pomU DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: JCSTREI,PT. ELEV.. 7-0014 47 NE SE, Section 26, T30N-R19W,- Town of St. Joseph Name of Plumber: MP/MPRSW No. Cnumy. Sanitary Permit Number: Cat Poweu 1563 St. Croix 79207 SEPTIC TANK/HOLDING TANK: MANUFACTURER' LIQUID CAPACITY. TANK IN[ FT ELEV.. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED'. I~ Y YES LINO ❑YES NO BEDDING: VENT DIA.: VENT MATT HIGH WATER NUM BEROF ROAD PROPERTY B UILDINGVEN TO FRESH FEET FROM LINEv~<AIR INLET❑YES NO S LINO NEAREST FFLL F / j- "3 DOSING CH MBER: MANUFACTURER 7INGUOUID CAPACITY Pl1MP MOUEIMPISIPHN MANUF ACTUREH WARNING LABEL LOCKING COVER PROVIDEDPROVIDEDYES LINO PU ❑YES LINO ❑YES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL - NUMBER OF PHOPEHTY WELL BUILDING (VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) ❑YES NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing - JDIAMF TER 111ATI RIAE 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 NO. OF UISTH PIPE SPACIN(l COVER iNSll]E f)IA -PITS LIQUID A IT DEPTH. DIMENSIONS TRENCHES M 1i4E H I A L I"I P .F 4VlL UEI'TII FILL DEPTH DDISTH PIPE DISTR PIPE MATERIAL NO DIS H NUMBER OF aT7 WE ' LL BUILDINGVENT TO FRESH BELOW PIpESf ABOVE C~OVEH EE V INLF T ELEV ENU PIPE AIR IN~ET: 7~(b!'~, FEET F R O M NEAREST t > > 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 LI NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE JPIHIIANI NT 11AHKIHS OBSERVATION WELLS _ ❑YES LINO ❑YES LINO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BEU DEPTH OE TOP1111L SOIIDF I) SEEDED MULCHED CENTER EDGES ❑YE " NO ❑YES LINO ❑YES LINO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO.OF LATERAL SPACIN(JAVEL DEPT HCI PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: F DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE ANI OL ATERIAL O DISTR jD! STHPIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVELEVCIAELEVPEDA.' ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHRECT LV COVER MAT HIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES NO ❑YES NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS' NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE' ❑YES LINO ❑YES LINO NEAREST Sketch System on Retain in county file for audit. Reverse Side. ]TITLE DILHR SBD 6710 (R. 01/82) DAL R SANITARY PERMIT APPLICATION COU In accord with ILHR 83.05, Wis. Adm. Code • STAT~NITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 4? (5/ 8% X 11 inches in size. STATE PLAN I.D. NUMBER -See reverse side for instructions for completing this application. 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PETITION PROPERTY OWNER FOR VARIANCE ❑ YES ❑ NO PROPERTY LOCATION PRO TY OWN S MAILING ADDRESS TSo , N, R &(or LOT NU BER BLOCK MBER SUBDIVISI N NAME CITY, STATE ZIP CODE PHONE NUMBER CITY VILLAGE NEAREST ROAD, LAKE OR LANDMARK Ar"r II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family_ -3 OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check 2,3 or 4, if applicable) 1 a ❑ New b ~156WJI stem ment c.0 Replacement of d. ❑ Reconnection of e. Repair System System Septic tic Tank Onl ❑ of an p Y 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. In-Fill Tank Y ❑ Mound f. 11 IGP V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. M 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): VI. TANK CAPACITY Feet ❑ Private Joint ❑ Public INFORMATION in al Ions Total of Prefab. Site New xisting Gallons Tanks Manufacturer's Name Con- Steel Fiber- plastic A p. Ex er. Tanks Tanks Concrete structed glass App. Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the 'vate sewage system shown on the attached plans. Plu tier's Name (Print): Plu is Si nature o St ps) MP/MPRSW No.: Business Phone Number: lu ber's Addre s (Street ity, State, Zip Code): - Name of Designer: k/ n6/ -7 VIII. SOIL TEST INFORMATION Ce fied oil Tester (CST) Name F CST # C ADDRE ( treet, 'ty, state, Zip Code), Phone Number: 7 q;iz Z I X. CO TY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Su charge Fee Adverse Determination 7 00 2~ X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal.any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage. systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your privat- sewage syste<<~, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's narne and mailing address. Provide the legal description where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 111. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section-of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act =:10 was signed into law. This legislation is more j. commonly known as the groundwater protection law. Thin change in statutes was the . Groundwater - result of over 2 years of steady negol bii+s: del,ate. Th groundwater bill iatlon and p included the creation of surcharges (lees) for a number of regulated practices wh~cES V`iseQrj$tn's can effect groundwater. The surcharge took effect an July 1, 1984- All of the water that buried free ire is used in your building is returned to the groundwater through yrl-ur . oi! absorpti ~r4; system or the disposal s te.used by y.-)ur holding tank pumper. >urr1arg4 s re k_ edited t6 g ,ur:c`w~ rxc` c;r he r onics .ollected through these lereC! by the epartrr;ent of Natural F.-~source These fu t s a ,-e t aec a or {or ` ~tJ , !!rate; grroundwater contamination in`_es1.'gat?Et is and .tit ~14~:; 1€c r,t u it's worth protecting. SBD-6398 (8.03/86), APPLICATION FOR SANITARY PERMIT ST 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/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 o Z\5 Location of Property ~14, Section ,2jT_3;:) N-RW Township Mailing Address j1Z Address of Site Subdivision Name y`C Lot Number L Previous Owner of Property Lw~ Total Size of Parcel Date Parcel was Created 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 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) centiby that att dzatements on thib batim atce glue to the best ab my (auto) knowledge; that I (we) am (ake) the owneA (d) o6 the pno pen ty dei n ibed in thi.6 .inbotcmation bosun, by vi tue ab a wa4Aanty deed ttecothded in the Obb,ice ab the , and that I (We) pttedenty County Reg us eA ob Deeddad Document Na. J.~ own the ptopoded site ban the dewage d~ jood d y~stem• (on I (we) have obtained an easement, to nun with the above dens ctr ibed ptcopen ty, bats the con6tAuct i.on ab said dydtem, and the dame had been duty tecokded in the Obb.ice ab the County Reg.usteA ob Veedd, ab Document No. 40 . SSIGNAI'M OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H z cn H a STC - 105 r" r a H SEPTIC TANK MAINTENANCE AGREEMENT H . o St. Croix County z d a OWNER/BUYER ~ C ROUTE/BOX NUMBERZ,7a ~Lk2-42a Fire Number CITY/STATE /~I z 4 Z IP S le PROPERTY LOCATION: k, Section, T_?4 N, R-W, T / Town of 4-A t , St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior-to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 0 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. SIGNED /cd DATE "nx- 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. , NI AUS TMOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRYRY, , GG DIVISION tABO R AN BOX HUMAN REDLA'rmfs PERCOLATION TESTS (11J) MADISON W 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/M4LW+efPALITY: LOT O.:BLK. O.: SUBDIVIS N NAME: Al,r '/4s-'/a 112, NJR (or , . COUNTY: OWNER'S/BUYER 'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE W NO. BEDRMS.: COMMERCI L DESCRIPTION: PROFILE DESCRIPTIONS: PER OLATION TESTS: Residence ❑New Replace -3 -A RATING: S= Site suitable for system U= Site unsuitable for system Co , CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYST M-IN-FILLHOLDI G TA K: RECOMMENDED SYSTEM: (optional) ®S ❑U ~S ❑U S ❑u ❑S EZU [Is U If Percolation Tests are NOT required DESIGN -RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: / Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS JULY A~r BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH R% ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 92 10 A266f } _ B- 7 - B- 8 B- 9 978 B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 44eli_= AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERT D 3 PER INCH P- i - P- / I P- < mu/x 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 23 7 - E E € € € i , ~ V _ _ e x . ` x 8© ~ u x ' ' E E 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. NAM (pri TESTS WERE COMPLETED ON: ,Jr 2"R 414 Z A CERTIFICATION NUMBER: PHONE NUMBER (optional): CST GNATU E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - INSTRUCTIONS FOR C- -T"'-3 FORM 115 - SB - 6335 To be a complete and accurate soil test, your r~ inclUde: 1. omn , fl description; 2. Tt- lust clearly :1 is is a residence p 3. M,` f ci use planned; 4, C IQ, 6 of plan; ? ferred, A rmanent; 9. A exe€np- ti 10, o ;riate box; 11.i _ 12. Make I, T _ED WITH THE LOCAL "EVIAT"' ce"F OIL TESTERS r GIs 1 ~s r; si y - B - - l mot . m w may r- & _ r7s.! 4m. ~7D /~dE.~aluoA / /1'.L~" y S.C ~~5~~~~ T.~®Nl l5 ~9~✓ /~7© ~SE'.i.CE ,all - - 8C f1~.r°~°Sw /~"~3 l sa f v i t77 AS5 ,c~o~ b ~y 44 l~_ PAGE OF CroSS Seejton O~ A Ze0 Syster" -q-17a ed44'ti),v~o Fresh Air Inlets And Observation Pipe S-570 ~-~--Approved Vent Cap Minimum 12" Above Final Grade F 20- 42" Above Pipe _ 4" Cast Iron To Final Grade Vent Pipe Marsh May Or Synthetic Covering min. 2" Aggregate Over Pipe Oletrlbullon pipe o 0 0 0 Tae - Beaeaoch Pip Plpee a Perforated PIPa Below Be Cooping Terminating At Bottom Of System I I Prt,Posen ~'tr,kl 19ro c1{ SOIL FILL DISTRIBUTIOU PIPE APPROVED S4WNETIC COVER c` ~-N1AT~RI~t OR 9, OF STRAW OF/~6GIAIE OR MARSH NAy AGGREGATE 4,L V. E FFEET, DISTRIBUTIOAI PIPE TO BE AT LEA5T _ INCHES BELOW ORIGINAL GRADE AM) AT LEAST20 INCHES BUT AIO MORE THAN 42 IMCHES BELOW FINAL GRADE MAXIMUM DEPTH OF EXCAVAT100 FROM 0KI&W AL 6RgoE WILL BE 65~ INCHES PUFAMUM AEfrh OF FAWATIow FROM Oiki(AMIN " GROE WILL BE INCHES j SIGNED: I LICEMSE NUMBER: DATE: _L2.: g~ IC