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HomeMy WebLinkAbout030-2067-70-000 t ` n O 3 y c 0 CO) O c U * d r1 2. 3 -I Z o w_ N z -04, o Z cWi) w • ~ o w n a s o d ~ 0 0D ° ` w° i„ = e. 3 Z m~ w N 3 0 o y ° m N Q Z ° No p ^ N No m CD o01 \ 1 co :3 OI -4 ::z CD (D CD y N N O 7 O 4 ^ O a o m y m o CD~ o o C 7 y Q' N CD C N y C .Z_1, O CD a U> D CD U) m !D CD a cfl y N a CD C` CD N fp Cfl N W c a a OOo A D n) 3 p O O CD -w N W N to 0 CO) CA CA N CD CO a li' 3 !7 c m !r • 000N 000', Y Cl) ° o Z -0 * * a 1 ::E I I Z Orq = N v, cn D F3 C) = N N Cl) 0 J. N < cr O CL CCD O A = CD (DD 7 0 0 = y O l~w~ 7 03 CD - 3 d < 7 77 C2_ N M D a z (3) O D a v ~ v ° cr • m 0 CD N N N CD = C CD v = N V = N a m a 3 CD o N = Cn (a A Z CD O W G rrt O N j ° a C A Z o C z n O (D ro w rNz W~ rt r(D~~ W M a `D °z _0 CL rt H d 0 3 0°r. fv -Lt O o H I--'\ 00 y an Z A C ;d CD rt 4? O Ca b CS ~D- CD D (D \ N ° ' O CD ° Q CD CD it o, n H ° cr 7c~ 3 ~ 77 CD N CL a~ w c m c (D CD _Zo m N rn CD o rt 1 o o y voi 00 ~ o CD r oi x E a m ON c O ,arn. 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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 - WEINGARTNER, GERARD J GERARD J WEINGARTNER 198 RIVERVIEW ACRES RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 198 RIVERVIEW ACRS RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.560 Plat: N/A-NOT AVAILABLE SEC 35 T30N R20W PT GL 4 PARCEL AS DESC Block/Condo Bldg: IN 593/13 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 35-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 06/28/2004 767155 2604/385 WD 11/21/2000 634111 1561/408 WD 07/23/1997 769/41 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.560 93,400 185,100 278,500 NO Totals for 2006: General Property 1.560 93,400 185,100 278,500 Woodland 0.000 0 0 Totals for 2005: General Property 1.560 93,400 185,100 278,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 130 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 it I n N O v n ~.y (D ID Q C .r v CD 3 3 U) -1 z o eo C cn w O • n ° w co ° co ° cn w c_ 3 c a w W D w Z c-- N N 0 N N CD N C ro @ 3 CD CD - > (D Q) :3 o O CD a) UT m CD a 0 -4 C, (D 1 m 7 N o o OOy 3 O 3 N 7 O > CD. 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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 GERARD J WEINGARTNER O - WEINGARTNER, GERARD J 198 RIVERVIEW ACRES RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 198 RIVERVIEW ACRS RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.560 Plat: N/A-NOT AVAILABLE SEC 35 T30N R20W PT GL 4 PARCEL AS DESC Block/Condo Bldg: IN 593/13 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 35-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 06/28/2004 767155 2604/385 WD 11/21/2000 634111 1561/408 WD 07/23/1997 69 41 ' Ok Amy, nr7 2005 SUMMARY Bill Fair Market Value: Assessed with: 84673 306,200 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.560 93,400 185,100 278,500 NO Totals for 2005: General Property 1.560 93,400 185,100 278,500 Woodland 0.000 0 0 Totals for 2004: General Property 1.560 93,400 185,100 278,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 130 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 inmrMIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 962- 5227 FAX-715-962-4030 ST. CROIX ZONING REPORT NO.: 39084/01 PAGE. 1 ST. CROIX COUNTY REPORT DATE: 4/06/93 COURTHOUSE DATE RECEIVED; 4/02/93 HUDSON, WI 54016 ATTN: THOMAS C. NELSON f~ OWNERe Donald Martin LOCATION. 198 Riverview Acres Rd., Hudson COLLECTOR* M. Jenkins DATE COLLECTED: 3-31-93 TIME COLLECTED: 2I45pm SOURCE OF SAMPLEt Outside faucet DATE ANALYZEDS4-02-93 TIME ANALYZED:121404pa COLIFORMS 0 /100 ml INTERPRETATION: Bacteriologically SAFE NITRATE-NI 2 ppm. Above 10 ppm exceeds the recommended Public Drinking Water Standard. Cotiform Bacteria/100 ml Nitrate-Nitrogen, mg/L 9 10 f LAB TECHNICIAN: Pam Gane NOEVENOE Y W1 Approved Lab No. 19 £ o ~ Means "LESS THAN" Detectable Level Approved by+ o PROFESSIONAL LABORATORY SERVICES SINCE 1952 x3-13 0 . REEEBVEO TO 2 3 ST. CROIX COUNTY ZONING OFFICE co y.. U ~CY_~ a J 4, St. Croix County Courthouse 911 4th Street ZONI,{ 1CG ~ Hudson, WI 54016 9 45 Telephone - (715)386-4680 e St. Croix County Zoning Office offers the service of septic I nd water inspections to Lending Institutions, Realty Firms, and rivate individuals. Completion of this form is essential so that the property can be located. S1 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. 0 WATER TESTING----------------------------FEE: $ 35.00 V/ (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at time of inspection) PROPERTY OWNER'S NAME : Q &ALQ Q_ 6j,4 T/ PROP. ADDRESS:-/,?f &L-1-V/ e'Iu Ae_,* 55~ 9 CCITY u m jo a Legal Description SC-1/4 of the C 1/4 of Section Taco N-R.X6W Town of 5 T ToSePH Tut P._ Lot Number / 5 Subdivision: i CAES FIRE NUMBER /2F LOCK BOX NUMBER Color of house 13P24 w,t( Realty sign by house? UQ If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A NAP,i.e,COPY OF PLAT BOOR, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the 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:_ .,AIA- 1) C, Telephone Number "545 -60 JL4 REPORT TO BE SENT TO : °->1 D ¢E~ VC CLOSING DAT Signature L_ 4 0 ° C) °o 0°En 0369 v v ep m (D d o ° x C`3 c a O U ~ C C ti U) Na °r V~ H > m y c m ti U a Y O U c , M C (D C N a) E CL N I v tl a) m 0 0 td V , UM) O ° a V E° ca°o o V \N cc O O N N U nO ax~u3° .2 y U) w 4? C m c z° co Z° 3 3 O 0) 0) LL c a LL. c T o rnz m \ V o w~ o 0v00z; ~ Q w `o E Q I- fn0 M O y I CL Z E I E CD ~ E E N ° y O Y O of J j Z :P- a M m 0 a co d m a a O z Z C C O o~ ~ E N I c N d Z ~ c c N H S c ~ I c ~ I N a~ ° N ~ O N ~ O U) a U) ° O C t0 00 CD • ~ N O O CD O Z O V O N d 1? 0 !E E O z m z (D Z m Z p ° o ;s 4i z Z 0 N aci ° ui d 12>m R 10 m o m 2 CL o o Q fi e a CL n O °00 a ~ t w > L 3 U) U) N EI = rn N v) :3 a U) a z • vaaa l a aaa CL ° Q 7 o CO) O v n' r- a) 3: CD (D 0) CO CO O v1 J U rn rn Z rn rn z :z W "Ww ) O M O N\ G O O N Q O O O CO E N N N 0 :3 - C) co 3 O O 0 7 O M N N m U) C a) co U) O 4. fn u, O a U) N a N N W N (~i a m Q) cii ° 'a d Q uJ m t: ID U) 0 V N C N C IV O C OD E LO 0) cn LO 9 a) z C) 0 o^ o F- CD c o (D c c v CL OO C) 0 o V N N N N O (^O O N Q c m Cc r M O oO OC C E- 2 4r O N y y C a Z O Z ..0+ 7 N M N No C°> > 'o o f c M ti~ Z c m u fn o M fri o o o v, m° o co o ur o o m U o M !n Z n Z 2 m H a co o Z cn a (D a a • cl a m 2 m~ ~ m y r rr`~1V , E c ° c ° ~1 A 0a~ O3aci On ci Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT L _ F OWNER ,rz^ TOWNSHIP SEC. c.Y TN-Rl % =W ADDRESS IY2 ; ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT f LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM a C:.}~~~xl ~ ~GGGLLLFAAAI (Y C \ ..Z f ~-~,z cru-• a LiL 1 ~v. { ~ss ~d'~ ;.1 ~ ~ c~ j•''-fir . ~ or) INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation:-tA&, pa-"'Tank Outlet Elevation: Number of feet from nearest Road: Front,OSiGe,k,~-) R r, O j feet .From nearest property line Front,0 Side,&ear, O feet Number of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SF.F. RF.VF.RSF. STM s i _f 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, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: L/ Trench: - Width: ( Length: % Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, &ICear, 0 Ft. Number of feet from well:1 ~ 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 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, O Ft. 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: s- 3/84:mj ,a. Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNERd t2 TOWNSHIP f _ SEC. T N-RC~C1~ ADDRESS /r ST. CROIX COUNTY, WISCONSIN SUBDIVISION / LOT f j LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i E~ .X C ^ iE7nc~(i i_ INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ,-2 Elevation of vertical reference point: /,!~?C>~f? Proposed slope at site: j SEPTIC TANK: Manufacturer: L p r l'd~1. /L, _Liquid Capacity: ?&)~2 Y ; Number of rings used: Tank manhole cover elevation: age X;F .66 Tank Inlet Elevation:t-,t~.,V5'Tank Outlet Elevation: Number of feet from nearest Road: Front 10 Site, Rear, 0 j % feet From nearest property line Front,O Side, ear, O feet Number of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE D LABOR EPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS P.O. BOX & HUMAN RELATIONS P PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX "69. BUREAU OF PLUMBING MP.DISON, WI 53707 )W CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number- Holding Tank ❑ In-Ground Pressure ❑ Mound (lf assigned) IM tlrj 7M NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION D ATE: Donald & Carrie Johnson Rt. 2 Box 114, Hudson WI 54016 ,Z -X BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: SE SE Section 35, T30N-R20W Town of St. Joseph. Lot #15 Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: I Henry N 32 8 Co 88432 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER ROAD: PROPERTY WELL: BUILDING: IVENT TO FRESH ALARM. FEET FRLINE: AIR INLET. ❑YES ❑NO ❑YES ❑NO NDOSI NG CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL IIIUILIIIN6: JVENTTOFRESH (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 FORCE LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF DISTR PIPE SPACING COVER JINSIDE CIA TI -TS LIQUID / ^ TRENCHES. MATERIAL: PDEPTH: DIMENSIONS O` GRAVEL DEPTH FILL DEPTH IDISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL NO. DISTR. F PROPERTY WELL. BUILDING: VENT TO JFREIH BELOW PIPES. ABOVE COV ER. ELEV. INLET ELEV. END: PIPES. LINE: AIR 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 ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS NO ❑YES ❑ ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER =TRENCH/BEDDEPTH OF TOPSOIL. SODDED TUIII MULCHED CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: - WO. -OF BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENC DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL'. NO. OISTR DISTR. ELEVATION AND PIPE DISTHIBU TION PIPE MATERIAL & MARKING ELEV.: ELEV.. CIA.. ELEV.: PIPES DIA. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. ❑YES ❑N ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBS RVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES ❑ NO ❑YES ❑ NO NEAREST S o v 3~) 0 Sketch System on CJ Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. DILHR SBD 6710 (R. 01/82) SANITARY PERMIT APPLICATION COUNTY , CILHR In accord with ILHR 83.05, Wis. Adm. Code STAS MITARY PERMIT # --"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. I -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER PROPERTY LOCATION o Tl ks©,'d SA: %-5-- S 3S' T3p, N, R p E (or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISI N NAME /V7-2 Aox 44" 4 CITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK p S- ,0 -2 _ O ILLAGE : ~~C a A/ U 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR Eblic (Specify): III. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. ❑ New b. eplacement c. ❑ 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. E4' onventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTIOI LSYSTEM INFORMATION: (Check one) 1. a. ee a e Bed b. ❑ See a e Trench c. ❑ Seepage 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): g20 Feet Private ❑Joint ❑Public VI. TANK CAPACITY in gallons Total # of Manufacturer's Name Prefab. Site Con- Steel Fiber- Plastic App. INFORMATION New xisting Gallons Tanks Concrete structed glass Appp. Tanks Tanks Se tic Tank or Holding Tank E?p 000 8D0 - ❑ ❑ ❑ ❑ Lift Pump Tank/Si hon Chamber N - VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumb~~eJJ's Name (Print): Plumber's Signature: (No Stamps) PRSW Business Phone Number: lum er Address (Street, ity, Stat Zip o Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST CST's ADDRESS (Street, C' y, State, Zi ode) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa tary Permit Fee Groundwater Date Issuing Agent Signature (No Sta ) Approved ❑ Owner Given Initial j~ p Surcharge Fee Adverse Determination 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 1 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 yo.ir pr'vat , sekA,age syste ri, contact your kcal code administra'or 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 name 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; III. 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 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 bill Groundwater included the creation of surcharges (fees} for a number of regulated practices which Wiscorisin's can effect groundwater. The surcharge took effect on July 1, 1984 All of the water that buried trea~re is used iri your building is returned te, the groundwater through your soil absorption system or the disposal site used by iyc)ur holding tank pumper. The monies collected througi these :surcharges are credited to the groundwater fund adminis- tered by the Department of Natural P ~asources. These funds are used for rnonitoring ground- v-'ater, groundwater contarro'sn ation ir: estigations and establishment of standards. Groundwater, ~41 it's worth protecting. SBD-6398 (R.03/86) ' w 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 QaZ,0,,4r"_j Location of Property Section 3 , TN-R_2_'0_ W Township :~L_ Mailing Address Address of Site SCE Subdivision Name Lot Number /6, Previous Owner of property ~1`'T'1L~JJL[~X Total Size of Parcel j 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 a,-q as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warrant 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) cvLti.sy that att .dtatementd on this Sotm cute ttcue to the but o6 my (ouA) knowledge; that I (we) am (ane) the ownen(.s) oS the pnopehty dedcAi.bed in thi.d insoAmaiion Sown, by v.chtue o6 a wa &anty deed neconded in, the 066ice o6 the County Register o6 Deeddad Document No. _3 6~J^O ; and that I (We) pne~sev►tCy own the ptopobed s to Son the sewage dispod d ystem (on I (we) have obtained an easement, to nun with the above ducnibed phopehty, Soh the condtnucti,on o6 said .dybtem, and the .dame had been duty neconded in the OK6ice o6 the County Reg-(.bteA o6 Deeds, ad Document No. SIGN TURE 0 OWNER SIGNATURE OF CO-0 R (IF APPLICABLE) 19 el ~2 0-0 t DATE SIGNED DATE SIGNED C) cn o co o a w n d o G CD M ID 0 5 v n a st c m m ID CD \ 1 Y to Q n o m 0 o ° ooD o o w o rn o o En °w t • :r 41 =r co CD N tD W y O CD 4D O N O N N a tD Z L m ` th N p z a p M O I -Z CD V I s;> v vo ' y co 3 0 m o 0) O *ft a O O O) N j ~ 0) J tS -0 CD 0 m CD CD -q (0 0 C 10 co cn 3 ° f?o 0 0 o CA 0 CA X v cn D A a co D m a? CD cC) CD y a j (C CD N Q O m CO <D c r3 3 O U o a v O N w i N ° z CD co to Co C N v m a N r co Co o 0) 0.) f co cc ° Q FJ o O O O O O O CD 0 to cn Vs = cn to cn o' L_M,f I ? m v v C l 3 o v O g A 2 fD HI N A M. U! O ("D m 7 d G N 0 N N CD cn l o m O m o 3 C) Z A o D m o° D 0 o O o O a o O a o N m D ° C> 0 O m y m tw • x 'a rn m v CD v /S&-0 (D N C N N l m a a CD - I V1 c c A .n. CL a P C) I a,~ I a`~° 0 w cwi °z 0 0 ° N N ~ y Z A C D CD 0 W a O d D o D 0 c)- CD c c 0- ;K- 0 3 o cn,fD a O O o' w (D p a 62. O T S~ T aCD Zp -l< N a 8 0 C 0 o F z a 00 z CL a= o o.rn 0 1 0CD 00Ox.va o-o ti o ov -4 fD a M (D CD N 00CO m 3 v co o OD o °O ° co -o I CD m ~Coco a 3 C<D 3 a) C D 0 v ' a g Ica n c S Co S CD (D Z, En 0 CD CD 0 c~O~' w o 'D :3 o Cb cq 0 GD O fD X A • 0 b A rn < o o v CL CD I CD 0. Croix County Final Property Rep° Print Report 2005 Pro ?e_ Repot ~Jt_ CCO1X Chu - Data Updated: 12/15/2°05 4:00:00 AM Generated: 12/15/2005 4.31.56 PM PARCEL COMPUTER NUMBER: 030-2067-70"000 35.30.20.609M * & dark red =delinquent) Click nnual record. PARCEL MAP NUMBER: _ on the year to select the a 2001 2005 Billing information 2002 2003 GERALD ] WEINGARTNE Proper Description Name / Attn: 198 RIVERVIEW ACRES RD 030 0 -TOWN OF SAINT JOSEPH Address: Municipality: 767155 Document Number: HUDSON, WI 54016 V2604, P385 City, State, Zip: Volume & Page: USA Public Land Survey: SECTION 35 T30N R20W Country: Ownership Quarter: GERALD J WEINGARTNER QQ / Tract: Primary Owner: NOT AVAILABLE 198 RIVERVIEW ACRES RD ' Plat: SEC 35 T30N R20W PT GL 4 PARCEL Address: Description: State, Zip: HUDSON WI 54016 AS DESC IN 593/ 13 City, USA 1.56 ACRES Country: Total Acres: Site Address: 198 RIVERVIEW ACRS RD Secondary owner: other 306,200 Assessed Value Fair Market Value: 0.9095 7/9/2004 Valuation Date roved Total Assessment Ratio: 0.013935538 Land Imp Value Net Assess. Val. Rate: Assessment Type Acres Value Value District: 2611-SCH D OF HUDSON 1.56 93,400 185,100 278,500 School G1 - RESIDENTIAL 1.56 93,400 185,100 278,500 Tax Detail Totals Balance Tax Installment Dates Tax paid Due Amount Category Amounts Period Date Due 1,g67.49 3,881.05 1 1/31/2006 1867.42 Real Estate Tax Due 73.04 7/31/2006 Lottery credit 0.00 3,808.01 2 Total Taxes 31808.01 3,808.01 Net Property Tax 0.00 0.00 0.00 Tax Payment History Special Assessments Receipt Number 0.00 0.00 Amount Special Charges 0.00 0,00 Date Paid Total Payments > 0.00 Delinquent Charges 0.00 0.00 0.00 Specials Private Forest Crop 0.00 0.00 0.00 0.00 0.00 Amount Woodland Tax Law 0.00 0.00 0.00 Category Managed Forest Lands 0.00 NONE 0.00 Penalties 0.00 0.00 Interest Totals 3,808.01 0.00 3,808.01 e'70- / e/LRportal/total_process.asp?IDV alue=030-2067-70-000&ne... 12/15/2005 http://72.21.230.178/webslt 40 ArcIMS Viewer Page 1 of 1 t XSE 1# IA-SW 1.4 ~ ~ 11 -VCL 5 P C M7 V64 ~Q V St J0 y 35 35 VOL 7P 5i SW SW 1/4 XOWR EM LOT f ys vs s E tn. yp Vol CM VO L 72 PC M& http://72.21.230.178/websiteALRPortal/ARCIMS/MapFrame.asp?PIN= 12/15/2005 z • H a r STC - 105 r a H H SEPTIC TANK MAINTENANCE AGREEMENT o z St. Croix County d a OWNER/BUYER H/0 36,4-) ~j0 t c,L Fire Number v~°Z ~oZ ROUTE/BOX NUMBER ~ Z I P o5`~©~ ~o .CITY/STATE U 5L 3%, Section , T N, R W, PROPERTY LOCATION:__:SLL~4. Town of 9 St. Croix County, Subdivision Lot number 1J~ 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 ptit 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 dispo"sal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to H three year expiration. E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with r~ 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 DATE !I~ / ~b 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. Mir O C3 F rn M = i~ V) _ Zi dt. u~~ D rnrIn o x N J o D _ o 00 0 p v ©['1 1U N ~ O WN t3l.•r~ J it ~1 t Z D+ Y G Z C y~° J D= h a. m \ . V orr ' 0 m O0° D -1 t4 > .BOO--}~ k der I N --t _ . coy ^ > LA ~ - • , ~ C ~ D fV s4! N ► it lj• ~ ~O _ ~ r \ SOS ~ - ~ o: 4ft 3 *t LA o u i ~ G tf+ ~ , _ R v C DEPARTMENT OF* REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATIUN: SECTION: TOWNSHIP Y: OT NO.:BLK. NO.: S BDIVISION NAME: <s, 1/ 1/4 35 /T3o N/R io sEPtf- '(/2. 011e w 11 ~x ; COUNTY: OWNER' NAME: AILING ADDRESS: STGipO/X ~o,.~ C .Q~'~E To Hz'50Z T. ( k ~ vek Pit! w Acres H u DS owl w i S Syos USE DATES OBSERVATIONS MADE NO. BEDRMS.: C MER IAL DESCRIPTION: PROFI E DE IPTIONS: R OLATION TESTS: (Residence ❑New Replace I QC~' .Z s~ t7s QC~;' 3Q Gs a RATING: S= Site suitable for system U= Site unsuitable for system rZS ONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-F11 LLHOLDINGTANK]RECOMMENDEDSYSTEM: (optional) ©U I ❑S E]U 7~ DU DS (DU DS ❑U EIS s fs Too e- If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the l under s.H63.09(5)(b), indicate: C1,4I-S r Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS -N .SJE~ i HI1 Fr. BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-IN- CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) - oc S B- l d • S' 90071 > G'.P7' 3. a.' S~~ s G Oje- Q w k fA-t,,- Ph y 5'1 T lvl' o1: Qa • S/ 6 7 .u • 6-A' - 9. / 7 ' 13x . B- 2- 102 .12. s w . d c-P, ' -~l ~ yt' Af:13,,,,. s/~ 2.o8'Qa. S , /•~'3 43• I B /2.0 , /03. 60 > /2. D ' .4,4V D of I94 s./ .P• o'M C S 3 Yes 2. k snvR~7~v 5; / ~ f/E~v; ~y ~o rya) ~ B E' sc 47- tMe o v s o TS B- r - f&ec ezepT'TiauS /'f PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER lN2MfS AFTERSWELLING INTERVAL-MIN. P RI D t PERT D2 P R PER INCH P- 7 .7 i. v e P_ , & 61 / P- 2- AV- /0 2 . Z A_ I P- • V P_ 3 /O 2 ea 1404 O v .S '6 ' P_ 1 67le0op- 'PIV /N~p /N /E f' o(/ N V •T ES• 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. p 7TO /K D f J Z s SYSTEM ELEVATION X p'pE Fvv~vp #r N.w. /ar co.PN re . Elev. _ /o o. o - FA.ei4, 1s~v~eES All 5 No./oT / E ~igc.FyoE 93 6 /3 oRES y i NOTES sySTfh /}IPef 4vi// Ar4)VIAV-ex7E~vrive- /3t~//poZriuG 5; i7*E 4/7,-x+7-1on1.# it. .8 r D~f fEIIE/ ~~C C ESS rbP' Sei/- tN ~E D/oS; t~lVf rAoR e7-_-P r• +wr Sffro'~e ty -l o 3 ► 5i7e- 7V 4eopeA17- P _ A c evsS' SyYTEAf n I Zy ~ v 58 To C>-.PovNp w,~7E.(~ ~/E~/" pv.,~ I To RE (_7;VEx r c oT%wE 2- WEsT ~ dF flovsE'. 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are cofrect to the best of my knowledge and belief. NAME (print : TESTS WERE COMPLETED ON: HOMESITE SEPTIC PLUbIdING CO. G~, 3 RT. O'NEIL RD. c ~;anlfi ADDRESS: ROBERT ULBRICHT CERTIFICATION /UMBER: PHONE NUMB R(opbtional)< WIS. MASTER PLUMBER LIC, NO, 3301 M.P.R.S. ✓ S yZ- a CST SIGNATUR : RIBUTION: Original and one copy to Local Authority, Pro erty Owner and Soil Tester. -SBD-6395 (R. 02182) - OVER - G.. 46, ~l X0 18 yst~n , 901~ ~_aoQ 9S ~ ©f s"-a j AS BUILT SANITARY SYSTEM REPORT ,.SCR , TOWNSHIP j. AD RESS S' SEC. ST. CROIX OU„Tye WISCONSIN ' SDJC _.^i sZVISZON~LGG~ •---'~tt~'-~____, LOT LOT SIZE . Distances & dimensions to meet requirements of H62.20 _ SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM { j ! t ~ i! l ~ { ~ l i { i 1 i 7-4 ~L- _ 1-4 ! - r TI C TANK (S) MFGR . l CONCRETE STEEL I nd i"ca e No,,Lt h A coin NO. of rings on cover _ Depth Scale rf • ~:~.CHES N0. of width - DRY WELL no. of lines T length area_ aidth= length - area ~:ZEGATE 3 depth -to top of pipe • K RATE A REQUIRED AREA AS BUILT ;claimer: The inspection of this system by St. Croix County does not im 1 t•?liance with State Administrative Codes. There are other areas p y complete inspect at this point of construction. St. that it is not possible Croix operation. However, if failure is noted theCoCoun ass untyywillumakeneverybeffortto 'rmine cause of failure. tU f :BASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. • `INSPECTOR DATED PLU;•iBER ON JOB LICENSE NUMBER 4 REP'01RT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM Sanitary Permit State Septic00 NAME Fownah.ip A Lle-o~ St. CAoix County Locatiara ~ _ se= ec-t.ion - SEPTIC TANK i Size M1000 gattonz. Numb en o ompaAtments Distance Fnom. Wet it. 12% on greaten ztope Bu.itd.ing__ZAit. wettands S . DISPOSAL SYSTEM N.%ghwaten it. Distance Fnom: Wett AO it. 12% on greaten Mope it. Bu.itd.ing 27 it. wettanda ~---F.t. H ighwaten it. FIELD DIMENSIONS: L Width of trench p it. Depth os rock below tite / kn.- Length o6 each tine it. Depth o6 rock oven t.ite. ~ in. Number o5 tines ~ Depth ob t.ite below grade,3(r .in. Totat .length of tines it. Stope o6 trench in pen 100 it. l Distance between tines (0__Jt. Depth to bedrock gz. Totat absorbt.ion area 6t2 Depth to groundwater it. Requiked area ~t2 Type of Cover: Papers r Straw PIT DIMENSIONS: Number of pits GAavet around pitzs yes no Outs ide diamete a Depth below inlet it. 00~ Total ab6arbt" a e it2, z Area neq Ae it2 rn INSPECTED BY TITLE 09 /4/- APPROVED DATE 197. REJECTED DATE 197 0 t 10. ~e State and County State Permit # v~ Z6 .67 PLB -t: Permit Application County Per i # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: r B. OCATION: 10 Ya s4_'/4, Section ~'r TUN, R_AQE (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village p Township .5% C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family X Duplex No. of Bedrooms -3 No. of Persons_ I D. SEPTIC TANK CAPACITY .=6 Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation X Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: -X_Length 31(= Width iz Depth-56" Tile depth (top)_ ~ No. of Lines -3 Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land goQ Distance from critical slope 45' WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME rdl-11!,/1 Lz? hFA C.S.T. # J I and other information obtained from (ownerAY11111111kder). _ Plumber's Signature m P/MPRSW 3201 Phone # Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. N ` iti SL~;PL- P a Atc, us~ p_ J000,7 13 6 a Do Not Write in Space ~Beelo~-w / ' FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application _y~~.3j ~ Fees Paid: State f, % C unty C~ D e 7 Permit Issued/ ( ate) Issuing Agent Name Inspection. Yes No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, W1 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES` Gr" ' DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 . REP WT ON SOIL BORINGS AND PERCOLATION T TS LOCATION: ~Y4, SectioJ-Y-, TN, R ..R.... (or) W, Township or Municipality, Lot No. Block No. County Subdivision Name Owner's Name: ! Mailing Address: ~a~ L~tJ~ TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS _ 12-- 5 PERCOLATION TESTS Z---j SOIL MAP SHEET hl SOIL TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN 0 P-3 jv~ SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B- B_ eLj / PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. ndi to number of square feet of absorption area needed for building type and occupancy. 1 25-J z7kl a "r 0011 sxf --e" Indicate scale or distances. Give reference point. Indicate slope. 1~ _ L ~ I 7 C ON A 3 L ~_j 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 location of test less are correct to the best of my knowledge and belief. Name (print) Si9nature i Certification No. Name of installer if known Copy A - Property Owner