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HomeMy WebLinkAbout030-1095-50-001 e r~ 0 CO) O C-u 0 d O C w O m 7 CD C CD N . C U) z n iV O 0 N O CT co N W (D 0 3 (D fD COT O L W F~ ~Yl \ CL tb z 0 N N> ^~""S lA\ CD (0 N ro F"f 1 C- = 0 O 0 ' O CD 0 O CT 3 N d O T O y y ~ 7 O n+. O I o d ~ w ° C D d m cQ m 4 CD - I N O_ W O -P, 3 -4 CD O N W m N OD (o co r- co Cp 0 N° C ~i+ vvva "ad• N 3 o w 0 < > z ~ ~ Cn cn cn ~ o D O. m m p A _p O CD N A CA G) -0 N a = (D - cc Z y 0) O1 N W z I z z co Z 0 D a CD 0 O o m CDCD 0 N N N CD CD C O W a 2L 7 z Co > -I N a c A z 0 v O 0 Z W aov moN `D > z o ! a z w z I " I n ~ N Q I C/) 'o x Cn F3 c a a z o ~ E 0 0• n N 0 0 E; CD ai e N I a C_ CL co i A 0 q O m N O _0 Vn N 0 O Q I to a O 69 O m a,} } O 0- Parcel 030-1095-50-001 02/25/2005 10:38 AM PAGE 1 OF 1 Alt. Parcel 32.30.19.345E 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 * BURTON, RONALD & SARA JO RONALD & SARA JO BURTON 417 OLD E EAST HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 417 OLD E EAST SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.680 Plat: N/A-NOT AVAILABLE SEC 32 T30N R19W NW 1/4 LOT 1 CSM 6/1639 Block/Condo Bldg: 3.68ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 32-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1058/334 QC 07/23/1997 695/185 2004 SUMMARY Bill Fair Market Value: Assessed with: 5594 231,100 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.680 83,800 143,600 227,400 NO Totals for 2004: General Property 3.680 83,800 143,600 227,400 Woodland 0.000 0 0 Totals for 2003: General Property 3.680 49,200 115,200 164,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 303 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 030-1095-50-002 02/25/2005 10:38 AM PAGE 1 OF 1 Alt. Parcel 32.30.19.345G 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 * BURTON, RONALD & SARA JO RONALD & SARA JO BURTON 417 OLD E EAST HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 32 T30N R19W NW NW THAT PART OF LOT Block/Condo Bldg: 1 CSM 6/1661 ASSESS WITH P3441 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 32-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 853/317 07/23/1997 749/43 2004 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 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 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 030-1094-95-002 02/25/2005 10:36 AM PAGE 10F1 Alt. Parcel 32.30.19.3441 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 BURTON, RONALD & SARA JO RONALD & SARA JO BURTON 417 OLD E EAST HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.330 Plat: N/A-NOT AVAILABLE SEC 32 T30N R19W NE NW 3.33 ACRES THAT Block/Condo Bldg: PART OF LOT 1 CSM 6/1661 ASSESS WITH P345G Tract(s): (Sec-Twn-Rng 401/4 1601/4) 32-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 853/317 07/23/1997 749/43 2004 SUMMARY Bill Fair Market Value: Assessed with: 5588 54,500 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.330 53,600 0 53,600 NO Totals for 2004: General Property 3.330 53,600 0 53,600 Woodland 0.000 0 0 Totals for 2003: General Property 3.330 31,500 0 31,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 030-1095-10-000 02/25/2005 10:39 AM PAGE 1 OF 1 Alt. Parcel 32.30.19.345A 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 " RONALD & SARA JO BURTON BURTON, RONALD & SARA JO 417 OLD E EAST HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 32 T30N R19W NW NW EXC P345B AS IN Block/Condo Bldg: 409/325 & EXC P345C & EXC P345D & EXC CSM 2/318 & EXC P345F & EXC CSM 6/1661 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) ALSO A PARCEL DESC AS COMM NW COR SEC 32-30N-19W 32, TH N 89 DEG E 703.56'; TH S 01 DEG E 186.18'TO R/O/W C T H E; TH S 73 DEG E more... Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 933/43 07/23/1997 873/388 07/23/1997 667/27 2004 SUMMARY Bill Fair Market Value: Assessed with: 5589 32,600 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 32,100 0 32,100 NO Totals for 2004: General Property 5.000 32,100 0 32,100 Woodland 0.000 0 0 Totals for 2003: General Property 5.000 18,900 0 18,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - S T C - 104 s AS BUILT SANITARY SYSTEM REPORT OWNER V _6u--lixoty TOWNSHIP J~K VV t SEC. T30 N-RI/F WU ADDRESS `Ci. ST. CROIX COUNTY, WISCONSIN .00 SUBDIVISION LOT LOT SIZE s.IS ~ PLAN VIEW c yf r Distances and dimensions to meet requirements of I1I1R 83 0 U 0 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I~,Zq No S C' 1C r? y ~U Sm Q ~0S O J f 3n~~Tr Pt, op 9L3 4- a l~s ys' AxopoS&fo InL INDICATE NOR ARROW BENCHMARK: Describe the vertical reference point used 7,b OF -c ~ox Elevation of vertical reference point: 160,Q0 Proposed slope at site: SEPTIC TANK: Manufacturer: 0); Ser -~F Liquid Capacity: 1000 qa L Number of rings used: Tank manhole cover elevation: /tea Tank Inlet Elevation: Tank Outlet Elevation:S o?S' Number of feet from nearest Road: Front 10 Side, Rear, O J11 feet .From nearest property line Front 10 Side 10 Rear, 78' feet Number of feet from: well e0 , building: /S' (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Nolle 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, 0 Side, O Rear, Ft. _ Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: G~.rzs I~- Width: Lenith:Number of Lines:_ Area Built: Fill depth to top of pipe: ya Number of feet from nearest property line: Front, O Side, O Rear, Ft. ~ Number of feet from well: ~"'S Number of feet from building: (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 O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Il Manufacturer: ,~llc~~rP 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 e6 Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O,: 66X 7969" BUREAU OF PLUMBING `MADISON, WI 53707 XXI CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number Holding Tank El In-Ground Pressure ❑ Mound (If assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION A E: Ronald L. Burton 633 6th St. N., Hudson, WI 54016 /7-,2-SOP/ )-,30 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: NW14 of the NE% of Section 32, T30N-R19W, Town of St. Joseph, Lot#1(CS } Name of Plumber: MP/MPRSW No.. County: Sanitary Permit Number Gary Zappa 3300 St. Croix 75052 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIOUID CAPACITY: TANK INLET ELEV. . TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER ' PROVIDED: PROVIDED: 1 oc~v V ~iS•2 IYES ONO OYES YNO BEDDING: VENT DIA.: VENT MATL: HIGH WATER NUMBER OF ROAD: PROPERTY WELL' BUILDING: 1VENTTO FRESH ALARM FEET FROM q LINE: / AIR INLET: 4111. R OYES NO ( OYES O NEAREST G. 6. b S DOSING CHAMBER: " MANUFACTURER: BEDDING: LIQUID CAPHS MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OYES ONO OYES ONO DYES ONO GALLONS PER CYCLE: T S PERA ZONAL NUMBER OF PROPERTY W V ELL ILDING ENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIRI"LET PUMP ON AND OFF) O NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ILFN,,TH 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: JLENGTH - INO. OF DISTR. PIPE SPACING. COVER INSIDE CIA #PITS LIQUID 1 TRENCHES. M IAL DEPTH. : PiT DIMENSIONS GRAVEL DEH FILL DEPTH DISTR PIPE DNO~ER NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPPE_S: a.( ABOVE COVER. ELE MST ELEV,. y v~ PIPES' FEET FROM LI"E' AI NLET: G_ 7 7 I NEAREST- ► Z S MOUND SYSTEM: t 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- meets the criteria for medium sand. TIONS MEASURED. OYES ONO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS. DYES ONO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED: MULCHED: CENTER: EDGES. DYES ONO OYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: 'jT0. -OF BED/TRENCH WIDTH. LENGTH. TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES. DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLESPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES ONO OYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: OYES ONO OYES ONO NEAREST Z4 Sketch System on Re in county file for audit. Reverse Side. S 12 TOR 75 ITLE: DILHR SBD 6710 (R. 01/82) 77 w'S`°nein APPLICATION FOR SANITARY PERMIT . OIL lw~ R ! n ` °~~I OUNTY - OEPRRTr7 [(P L B 67 ) in°usTRV,LRBOR&HUMRnRELRTIOns UNIFORM SANITARY PERMIT # Attach 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 MAILING ADDRESS PROPERTY LOCATION Orv - ~e Q 6 IVW1/4 t , ST.N, R E r;or W TOWN OF: LOT NUMBER OCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE R LANDMARK STATE PLAN I.D. NUMBER MT. S J, TYPE OF BUILDING OR USE SERVED 0.?o 1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specif Y): THIS PERMIT IS FOR A: N 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. 54 Seepage Bed ❑ Seepage Trench U 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 OD Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: N IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass 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: Nv""l: /Lt=quo AlE2 9 N5 66 ®Private El Joint El Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: idle/MPRSW No.: Phone Number: Plumber' Address: OU ( ,s 13 6.~ Name of Designer: o .z.r. S 6 Go COUNTY/DEPARTMENT USE ONLY Signature of Issui.ngoAgent: Fee: Date: ❑ Disapproved 11-4- ~d ❑ Owner Given Initial A Approved Adverse Determination Rval: Alternate course(s) of Action Available: DILHR-SBO-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 t 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 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 Q'ai au" 1 (Kr Location of Property I1L W, Section T -'~>O N - R W Township Q e, Mailing Address SIN 2 Subdivision Name Lot Number Q N L Previous Owner of Property Total Size of Parcel 34 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 6 S- 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 Map, the the Certified Survey Map shall also be required. PROPERTy OWNER CERTIFICATION I (We) eeAti6y that aU htatement.6 on this 6onm ate true to the best o6 my (out) know.eedge; that 1 (we) am (ate) the owneA(,s) o6 the ptopenty dew c i.bed in this in6o4mation Sonm, by vi ttue o6 a wa~vcanty deed tee d in the 066ice o~ the County Regiztet of Deeds as Document No. `'1 )13; and that I (we) pnesentty own the phoposed site bon the .sewage poloe system (on I (we) have obtained an easement, to nun with the above de cubed ptopeAty, Jot the eon,stAuction o~ said system, and the same hays been duty teeonded in the O~6ice ob the County Regiztet of Deeds, ass Document No. ) . SIGNATURE OF OWNER SIGNATURE OF CO WNER (IF APPLICABLE) DATE SIGNED DATE SIGNED S00058'26"1835.21' 763.15' .[72.06' v w N w N ko w 6S, w rn, ct, O C) m CD A- 6.O F-O f - p >w >k.0 O n ~ n to -i O t1i En t1i En C) In KD In ?0 ()o 8 `~Q• 1 19 , ro ro o H \ `Ow S6' X z C' C o n \ 00 0 3 z r ~1~ £ 1,01' i~ 0 C:) Fa % o 'T1 C~0 00 y Iu 00 t1i ~ In Iry- t3j 1-3 10 co / c„ In w to z 1. F-• tij n ~ i co n C o H\ G7 CD H HO p H A n r~ ° z z n cn II 0 in 1 N '7~' I J W ;e-Ur N N t7 100 N 4 t7i O 1 W x o to -cz r N - 740.46' ~ o ALL BEARINGS ARE REFERENCED TO THE EAST LINE OF 'rHE NW 1/4 ASSUMED TO S00024'39"W BEAR S00024'39'W. O w 0 O m 0 cOn :;o -i z z > 1-< tlj -m O M l0 H d 00 q C) U1 c/') I triwc)rzl~ O n ro C Ln 3: co II II II II II II C F-{F- I'- NH z0~o < O H In rT-l F' z z z NNW zX z- or Z Hzy 03 W O F-• w ,P w P. < c m rn w mN- oo u,~ o m roN xn z cn 1710 z010 O O O F-• • • ,P H trl ' o = Qr H O 'TJ O F-' .P •P W J Z -D .P CJ 0 6"" MkDN -JN - 1-3 H [Hr] w q In ~o t7j wNtn o ~ to ~X ~l n co 00 00 t'j O H C) Hz x° o x o~ H bd H T7 FC t% ro t7i 00 \ ro .0. t~ ~ N x 1-3 t7i to n C rn O,j' C~ G) Z H n 2: c cn A• ro n 1. ~7 O O z ~ F-• yid X W n G') :a 'w L O H N O t1 t~ I H z . cn H STC-105 r r H SEPTIC TANK MAINTENANCE AGREEMENT Ho St. Croix County z OWNER BUYS U O1J G r~jo ROUTE/BOX NUMBER v~ Fire Number CITY[STATE ZIP ~40 1 PROPERTY LOCATION: _NW ;4, __J4, Section 3 T N, R i~ W, Town of -si-.-joc , 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 is 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 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- ro ment of Natural Resources. Certification form must be completed and returned to the St. Croix County,6Pnin Off, a w' in days of the three year expiration date. SIGN 1 ~j f DATE St. Croix County Zoning Office P.O. Box 98k Hammond, WI 54015 715+-796-2239 or 715-425-8363 Sign, date and return to above address. T r ~ m w =r O (/i W W C C N D V (D O 7C A A CD 0 0 N D O O ~J , O K) o a a3 vc° D=i w w o m 0 5 (D O a (D fD p ? y~ =0 3 1 113 N D O O (D O O "N" C m a 0 A p) 0 W COD S 3 A (D O ,C m wo w 5 i- ° ' o v, a~ R~ =r ID A 3 0. O A-. O CD (D w 0 CD =r 0 3° c c c w' 3'oZ= c~ Qm 5* EL A ca so w La. 0 Op- CD n < m c Q~' c o Qo M CDv,c N IC A CO, O O 0 O_ n' w C ~o c = O CCD'- - CD 0 E; cn N C Z cNVo, cno,~°'o 0 D CD w 0 a?-io' Z CA. 0 3 CD (D -.a 0 >5! (D ° fO A 7 > W O a c W° CL ~ Quo o`n=r a a cc N ? O a C A:E CD C m 3 CD (a 0 l f0 N M 0 m-% C N' T i ain v w Q » m CD -1 C') C l (a6~ CCDD - cQ~uoCA 0 0 aof CAcc0.0o m w aw OL ao ca ° °O~ Q a Zvi o N c %cc° aC 3 & n m A C O 0 cn A cD 0 7 ao oco a c C ~CD c CD a aC a ~c cw .BOA ~S 3 0~ 0°3 Cr,~ v 0 a~ nm O 3 C CD v7 0 z ~'10 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS iN©USTRY, DIVISION '-ABOR AN BOX ~U AN RE°ATIONS PERCOLATION TESTS (115) MADISO w 53969 (H63.09(1) & Chapter 145.045) , 707 LOCATION: SE-CT-ION: TOWNSHIP/ LOT NO.:BLK. NO. SUBDIVISION NAME- /VV 1/4X 4 32 /T30N/R111(or) .77: ✓osE~s~ / ~~RT, sua~~y ~aa COUNTY: 6KFWER~S BUYERS NAME: MAILING ADDRESS: sr C'~oiX ~d N .0a lPTd Al 1.633 6Tiy ST 1Y iy~jvsoir/ 40 .S~¢d )SE DATES OBSERVATIONS MADE W Residence BEDRMS.: COMMERCIAL DESCRIPTIOr~t 7RUME DESCRIPTIONS : PERCOLATION TESTS: y~Residence 3 N/A VyNew ❑Replace, SATING: S- Site suitable for system Um Site unsuitable for system ll /1 CONVENTIONAL: MOUND: JITANK: RECOMMENDED SYSTEM: (optiong, , ZS ❑U ❑S ~U 9S ❑U ❑S ®U ❑S ®U COavfv7-1e.vA-e oEb /2x84, If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.1-163.09(5)(b), indicate: CLASS 2 Floodplain, indicate Floodplain elevation: 402 PROFILE DESCRIPTIONS )TJ~. 42 BORING TOTAL -DEPTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B l /08 /0 2. A10NE 7 /0 8 12 ' • 30 - r a. an A W / 2 /05. O ONE' 7 / • /02 B- 3 132 /06,0 V0AIE > /32 /Z, ; 3oB-n o W ced- B- 132 /O¢. NONE 7/32 90~ •~o Ern cep B- 5 /0 8 99.2 A/oNE 71618 Ala ~ 19-5-2 - B- 6 /20 /d3.3 /V4, NE 7/20 469 0,4~*7 30, ,E,i-> 4 4 ' B- 7 9 6 MO. '7 Nang 96 /z, 36 44, alz 61-k !!e dt PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PER INCH P- P- P- L .P .O 2 7" P-. P- P- LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- intal 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 f land slope. ;YSTEM ELEVATION q 7.00 RZrE,p AN,arE SeAI E 9►0' T 06. &14, leo .4 e 41S.6 ,dey .17 03, y~. 7"4, PF 6LE c' 7F1 9T L 1 96' S .I ~l ` ; 97 I s` _ I~•eP o _ 9.9 ilk, IN the undersigned, hereby certify that the soil tests reported on t is 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. LAME (print : TESTS WERE COMPLETED ON: rAl " i z iN ea. I 71.f4 yAzT ✓ G 4,,B - O >DDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): E. ~L~rI Sr. R/v ,cL LY'/ S4oP2 ss=s88 7if ¢zs~~6X/ CSCSIGNATURE 914-11t . 'L ✓08 /VO , S 98 ASTRtCWTION: Original anti nne copv to Local Authority, Prope„y Owner and Soil Tester. •;L14,'- -'D_ji395 -OVER - INSTRUCTIONS FOR COMPLETING FORM 115 SBD - 6395 To.,be afolnplete and accurate soil test, your report must include: % 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; ~f 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all, appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- Lion, if appropriate;..: ,..1,0.. if thpJnformatiQn-(suchas_flood plain,al-evatiort)-cloes-npt:apply.-place N.A.•in-th"ppropriatebox;4--.q - 11. Sign the form and place your current address and your certification number; . 12. Make legible, copies and distribute as required. ALL SOIL,'TESTS MUST BE FILED WITH THE LOCAL,AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone *s Sand` HGW - High Groundwater' cs Coarse Sand Perc - Percolation Rate med s - Medium Sand W Well fs - Fine Sand Bldg - Building Is Loamv Sand Greater Than *sl - Sandy Loam < - Less Than *1 - Loam Bn - Brown *sil - Silt Loam BI - Black si - Silt Gy - Gray *cl - Clay Loam _ Y Yellow scl - Sandy Clay Loam R - Red sic[ - Silty Clay Loarn mot - Mottles 5r. - Sandy Clay w/ - with sic - Silty Clay fff few, fine, faint *c - Clay cc .Y common, coarse pt. Peat , mm - Many, medium m Muck d - distinct p - prominent} HWL - High water level, * Six general soil textures surface water for liquid waste disposal BM - Berrch Mark VRP Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. Pi /-s G7 . PLOT p,vo C/zo,rs CC 611 IS 7oP of E&c, Gvc~oSURE d. M arv. = /00, 00 Q / /Zoj"Ec r to y~LIRTOh! U ro ~,/EsT j 4--/vo/tTN 1°/wArRTY n0N .U PL`TY ES 7- L=NE .ST- JoSEPN /ow.,vrAap .S J. C/toik Co. ~ FEn/c£ `x•10 paS ~ SLopE yo' aQ Lim ALT. 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