Loading...
HomeMy WebLinkAbout040-1017-70-100 r r~ a N01 3- o a1 CD (D 3 3 co m n U) z 0 0 O co 7'I O O • 3 Vr O N FV `pG IV 0.0 CO CO Q. z O N Ln CD -i 00 R a m 0 CL 0 0 °O OD o ` cn co C Z, 'a 5 p O° 'rt lr O H c cn CO C7 CD CP O D CD D `D a . c~, (D cQ y Co a 0 o c O O 3 0 ! w o o CL 0) O m r 0) 0 00 CCOO C N o c rn am C 3 Q • of v_ m m m d _ _0 ~ o .0 = v, co CA `s o y at c v v o 0 lu y _ N D) C1 m a N Q 7 I aD z O 7 0 ~i 0 ; > 7 t~ 0 CAD CD CD CD (n C N N C W ~p CN a a 7 O O ~ z N =i ur C CL a W Z N A ao CD CD z c ;o m co w z CD W 3 a 00 0 0' 3 D0' c CD o a ur CL I ~ c y i CD ai O C a ti I 0 I ~ 0 CD o0 0 I o ~ ~ w b O Parcel 040-1017-70-100 10/27/2004 03:26 PM PAGE 1 OF 1 Alt. Parcel 4.28.19.61 M 040 - TOWN OF TROY Current ❑ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): Current Owner THOMAS E JR & SHERYL L TESMAR * TESMAR, THOMAS E JR & SHERYL L 595 TOWER RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 595 TOWER RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.580 Plat: N/A-NOT AVAILABLE SEC 4 T28N R19W NE SE 2.58AC LOT 1 CSM Block/Condo Bldg: VOL 6/1628 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 04-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 987/630 WD 07/23/1997 845/09 07/23/1997 743/389 2004 SUMMARY Bill Fair Market Value: Assessed with: 206,400 Valuations: Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.580 54,500 162,500 217,000 NO Totals for 2004: General Property 2.580 54,500 162,500 217,000 Woodland 0.000 0 0 All 2.580 54,500 162,500 217,000 Totals for 2003: General Property 2.580 48,400 150,200 198,600 Woodland 0.000 0 0 Total 2.580 48,400 150,200 198,600 Lottery Credit: Claim Count: 1 Certification Date: Batch 120 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 • J to `S Icn ~ ~ ~UBL-IC - - - / .99.0£6 M.00 00.00 S 8 .99•S0t .00.95 .00.O Of dp• H ~o•a I as 1%.zs V 3N N ~ I Z I ~ g o o g I / < n n ~ / 00 P j / .99.582 .00.562 .01 •btL 11.00 A0.00 f ~ lL 9b9 M.00.00.00 S .u wz / 1 .of.fl.nl M I r 1 0 F w I 1--) 1 N D Z C7 N 'n ~ N -i (A kA N OC r ti : Aft I ZOZ C _ ~ $ 1n 1 Z ~ ZO rO •Z a 9 O I -n --'1 V=In W? • •11.00..,; f N j d_ rrl 'T C) f~l a C) C) a awNls to rx to of 1 :z Z-+ 1D tD W V 1n 1n "I D y g i In O Y O 0°700 O ~O tD ~xrn --4 c L 1 WWV V 2LO Ln LO to o v I : ~ ~ N •--1 .n a u b 1 C) O r N(n0(D N.-•VOW f+lx to ln(D 1D O(7) wNa zP Ww ;"CD O c~ z C71 O O T OD N A Ir -1 O r) I n M O S V.-o-- NOwmm x C o_ 0600.100.00 s 1 :r 0-1-n t .09•oot A Z C = < C7 N .r A«....... Z N rD rn .01.0.401# 1 x 1NilaLO vaQN'm z1~-1 p co ~Drn 01 I Vooooa ----rvw D w ZN 00 -'NN00 ITNm x N ••4 1 ( G70 D v 41 1 1 ~ m 4• } 1 - I Le) zzLA zzlnZzz rn= D o9•sot /°i•re 1 I C)) LO 0000 oD a0.-.-mCO V Do CO 1 Z D W 1D V 1n O N 1D N W MM r A.00.10.00 f 11 i N rn Ln ••O rn 1 NO W ANNCn Z I "(n IT N 12 V 12 10 V(n n t O N n to 0 U1 W e.00.f0.00' f I j - \ OmNO NNV VO • .06,014 1 I 1 I r toOto001!1000 't0 r4 1 I O ` An a a i i s Jj 1 1 rnrnrnrnrnS >fa Es Si •`r •4 1 I 1 1 000'NN•-•0 N D1'7 1 1DN 112 -t ZR1 1 I X. W Nn(nONW r? o 1 1 V ON.--n N 0009 V R1> 1 D 1 I ' N N N N A. O r 1 A (n0 A to Am C0 ' 3 7 a a i 7 a 3 7 4tj 1 I •A J~ 1 1 1n 2 (n z m --4 4ti, Js 1 OD N O 170 D Z ' •~•30"'0. 11 N O O Cn m G7 - rn .LL.'♦S2 3.8~.60.I0 S 1 3.,O4.IP0.10 S oma o cziZ 1 ,.SO'98d ~m O N O O I C 1 Ol + O n o O z Z l7 000 0 s HWY 35 'o ol 2 0 ; 0 W N O X. 8 ~ _ 2r 4 m > !4 L COMMERCIAL TESTING LABORATORY, INC. 51!4. Ma.n,,Street, P.O. Box 526 Colfax, Wisconsin 54730 7'15-962-3121 F, 800 - 962 - 5227 FAX - 715 962 - 4030 9:. ST. CROIX ZONING REPORT NO.: 32427/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 11/16/92 COURTHOUSE DATE RECEIVED# 11/13/92 HUDSON, WI 54016 ATTNI THOMAS C. NELSON t 4-z- gerrt / s OWNER. Frank 6 Sue Gii.liland LOCATION: 595 Tower Rd., Hudson COLLEC1ORt M. Jenkins DATE COLLECTED*# 11-11-92 TIME COLLECTED*# 11.15am SOURCE OF SAMPLE1 Kitchen faucet DATE ANALYZED:11-13-92 TIME ANALYZED111WOam COLIFORM*# 0 /100 mt INTERPRETATION' Bacferiotogically SAFE NITRATE-N: 6 ppm Above 10 ppm exceeds the recommended public Drinking Water Standard. Coliform Bacteria/100 ml. a 9 Nitrate-Nitrogen, mg/L .4 co ~c7~' O m Ea tS~ v LAB TECHNICIAN: Pam Gane OF.,"0EVEIp~fHf s, WI Approved Lab No. 19 P V > Means "LESS THAN" Detectable Level Approved byl 0 PROFESSIONAL LABORATORY SERVICES SINCE 1952 R ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 1~`6 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. oft WATER TESTING----------------------------FEE: $ X (For nitrates and coliform bacteria) WATER TESTING FEE: , (For VOC'S) SEPTIC SYSTEM INSPECTION---------- ----FEE: $25.00 (Determines if system is properly functioning at time of inspection) i Property owner's name Property owner's addressL ShS Tr hd Legal Description ~11t 1/4 of the S C 1/4 of Section 1ff T o~rZ3 N-R Town of Lot Number - Subdivision Name/ ---7 FIRE NUMBER S J~ LOCK BOX NUMn,ER Color of house ~j k0u) Realty sign by house?___~(__If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OFITHE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been s'o for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: luny 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 ma, 'be gained. Firm or individual requesting services: a77cJ Telephone Number 8 3~ REPORT TO BE SENT TO: c~ o 0 'f Closing date Z Signature - - "A Family Tradition Since 1955 Hudson Office 700 Second Street r Hudson, WI 54016 Office (715) 386.8236 Metro (612) 436-7072 FAX (715) 3864502 >----h PRICE: ° 119,900 # WDROOMS: 3 # BATHS: 2 MB wr n BB M TERMS: Ro s AI;lTFSS: 595 Tower Road CITY: Hudson ZIP: 54016 W',21EY: St Croix LT SZ: 2.58 Acres LIST: O1 SCrICOLS/ R": E.P. Rock MID: Hudson IUC41: Hudson PAR: Sr Pat's LFCAL: NE, SE Sec 4-28-19 CSM Vol 6 PE 1628 STYLF: Soft Contemporary FXTERI01Z: Redwood YEAR BUILT: 1986 WES: $ 2203.02 YR: 19 91 SQ FT VAIN LEVEL: 860 TOTAL FIN FT: 1430 ROOM DIMENSIONS L W. F FC?LJII 1F111 / MISC LR: 13.5 X 19.5 M B C .REFRIC: C. um: DR: 9 X 11 M V OVEN : X C. SWR: 11 X 11 M V RADIGF.: X WELL: X FR: DWS11R: X SF_'''LIC: X MB: 11.5 X 15.5 U C C ~D I S P DEC: :BR2: 8.5 X 13.5 U B C WS: X Rented PATIO: X 8 X 21 BR3: 10.5 X 11.5 M B C A/C: X hASM1': 1'u 11 1314: CAR: 22 X 24 CEO: X FP.PLC: POSS 1 !,TE: Flo V , 1 HEAT: Propane FA Burkhardt 550 r NSP 37 mo Newer 2 story soft contemporary home on very private and wooded acreage. Just one mile south of I-94. Vaulted ceilings, eat-in kitchen, lrg living/dining area, glass doors to patio and deck area. Second floor deck off master suite. Basement: poured walls, bath R.I. Maintenance free exterior fascia and soffec. Cat/dog chain link kennel attached to garage. Beautiful and private country setting. AM a fFinanT.rcCOiPe-YJohnson P11# 549-6130 LISTFT': F11 lit - [a MUp S!b/C 2.8 Brkr: Edina Realty # 260 PHONE 715- 386-8236 612- 436-7072 LOCATED IN THE NE 1/4 OFTHE SE 1/4 OF SECTION 4,T28N, R19W,7OW-N OF TROY ST.CROIX COUNTY' WISCONSIN. OWNED BY: FRANCIS MARSON ' RT. 3 HWY. 35 SOUTH 1 1 HUDSON, WI 5,4016 *SEL 2 OF 2 FOR KkF IIvF0::N1fTI01c • E 1/4 CORNER O.PSECTION 4,T28N, 19W. I COUNTY SURVEY MONUMENT FOUND). LEGEND Oa SET 1"x24"IRON PIPE WEIGHING 1.13LBS PER LINEAL FOOT. e: I " IRON PIPE FOUND. 2"IRON PIPE FOUND. R: "RECORDED AS r~ M•: MEASURED. M i TOWED ~ to - WLU X v) 4'1 h a W r- m _ .ter N Q 1L DQ~ r- O lY I ) W u U W I W 2 z W u 1 I I ( W VI W "o 'z ix x ( 33• , 33 I t~F-• . v ,n ,n0 LL o Z a`- W V O 1 O v W W N M r•~ I , , ~ ~ ~ o D cn ~ M lei I ~I `.1• N W- W W Z- „ VI 't • ~tl I I Z'\ a W 4 n j I I 66~ WIDE PUBLIC STREETS ; m - ~v (UNIMPROVED) zw z `L o - o ox w ( ~I- WZaaO I R= S85030-00--E 36Z.35'(M=36I.8I.ToFD.LP.) SECTION LINE ] u w I ISBS°00`33 66.31 ,.E 356.82' K4 BASED ON PLAT Fwwcr ' 66.20' .99 Ir .224.31. o a z W U0• z W O 0 Q Z. W E o J. N S rn o LA Q SCALE I.• 100 cr L O I I W 0 50, Ioo 200 W ? 0 2.58 ACRES ,o oo 1112;209 SO.FT.) z,n oN t`C~3t~:;ttadflp.e! O• - fn 0 Z LLJ- Q. F-: 1!I (SP EG M. 1'3 J• 1- EBER CL • ' Q . o 1804 Z • I _i: „ G VALLEY 1 t 2 7 7. O 0 77. 40' ZN8956'00"W 354.40 O; 4 R= 360.70' 4) S U R I N ' I t7il9B4 o. Z• 3 In on: 't->Vf_, JAMES M. WEBER S- 1804 1~ : LLJ• ,n on ° WEGERER,WEBERANO ASSOC. O DATED n1oV. 0 1y~5 ~1'• 11''i~t"e• ~~i 1~,,. z i•,\I •11.•i.. •.i r Q; SE CORNER OF SECTION 4,T28N, • R19 W. (COUNTY SUNS 'EY MONU• Q. MENT FOUND.) i Z' Form - S T C - 104 R ~ • AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP ' SEC. T d' N-RIB ADDRESS' ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i f i l -to 3 y W6 w 77, [SOX j t s s t I . !t INDICATE NQRTH ARROW i e BENCHMARK: Describe the vertical reference point used ~J}: s Elevation of vertical reference point: Proposed slope at site: e r• SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: e Number of feet from nearest Road: Front,O Side ,O Rear, feet From nearest property line : Front 10 Side 10Rear,O I 1' Q feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) ovv nncionoc nr-- PUMP CHAMBER • Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle`: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM / Bed: Trench: Width: Lenjth: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, Pt.~ Number of feet from well: 01 Number of feet from building:,g (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit-e vation: 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, OFt. 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: 0-{ 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. B0~ 7969 MADISON, WI 53707 BUREAU OF PLUMBING r `t TCONVENTIONAL ❑ALTE RNATIVE State Plan 1. D. Number: ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (If assigned) NAME OF PERMIT HOLDER' ADDRESS OF PERMIT HOLDER: INSPECTION DA E: FITZGERALD, JOHN A. Rt. 2, Box 311 Hudson, WI 54016 r ,6 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. T. ELEV.: CST REF. PT. ELEV NE SE, Section 4, T28N-R19W, Town of Troy Name of Plumber MP/MPRSW No.. County Sanitary Permit Number: Richard Hopkins 1059 St. Croix 79205 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET EL V.. WARNING LABEL LOCKING COVER ~r7'1 ~.eay,G}r I►~ /~/~7'~ PROVI E PROVIDED: ES S ❑NO ❑YES N Y M]~T ENT I A.VENT MAT GH WATER NUMBER OF ROAD PROPERTY WELLBUILDING JE T -rO FRESH ALARM FEET FROM LINE AIR INLET❑YES NO N_EAREST_ _ i? r DOSING CHA BER: MANUFACTURER. ]Zj] LIOUID CAPACITY POMP MODEL PUMP; SIPHON MANUF AL TUNEH WARNING LABEL LOCKING COVER PROVIDED. ROVD❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: P UMP AND CONTROLS OPERATIONA L NUMBER OF PROPERTY WELL BUILDING VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM NE I AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST 10. SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing T I+ DIAMETER %IATFRIAL 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 JDISTR PIP SPACING COV INSIDE DIA =PITS LIQUID THE NC~IES MAEHIAL ' PIT DEPTH'. DIMENSIONS S~ ~ S (1 ~ ~ - ',RAVLLDLPTII :ABIWOVER LLDEPTH DIST Ii. PIPF DI H PIP DISTR. PIPE MATERIAL NO DIS T NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH BELOW PIPES / ~r E j F~rIF I EL :~r PIPE LI AIR INLET/l(~II ! 7.- FEET FROM S NEAREST- MOUND SYSTEM: I 6 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 PIHh1ANINT MAHKFRS OBSEHVATTON WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED DEPTH )F TOPSOIL SODDF1) SEE DF1) MU CENTER EDGES LCHED ❑YES. ❑NO ❑YES ONO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: W 770 -OF LATE HAL SPACING (iHAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED/TRENCH IDTH ENG TH TRENCHES . DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO UISTN DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV. ELEV. DIA. ELEV. PIPES DIA: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING GRILLED COH Hf.CT LY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF 4PROPERTY WELLBUILDINGFEET FROM INE ❑YES ❑NO ❑YES N0 `1. _ NEAREST 70 4'D z 441 Sketch System on Re in county Ile for audit. Reverse Side. SI RE TITLE. DILHR SBD 6710 (R. 01/82) w'S`°nsw.1 APPLICATION FOR SANITARY PERMIT .DILH (PLB 67) f ~-=rT-COUNTY ~ OEPggTTEnT OF inousrgv,LRBOg6wumqnqELRTIOns UNIFO SANIpp/TAy+ARY 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 PROPER. WNER MAIU-NQ ADDRESS r PROPERTY LOCATION CITY: Nr_1/45C 1/4, S L , T ; N, R E (or)(W V AGE: }Q LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEA OAD, L E O LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 71 1 or 2 Family Number of Bedrooms: ❑ Public (Specify). 17) - -0 .1-1 1 THIS PERMIT IS FOR A: a 'r ll N 4, 01 1 New System ❑ Tan Replacement ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy C ❑ Alternate System ❑ Reconnection ❑ Petition for Modification J IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed } Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity i Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel 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: J Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Na f Plu ber (Prin Sign re: MP/MPRSW No.: Phone Number ,to k! rPlTr's Address: . Na T D signer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved Z ❑ Owner Given Initial Approved Reason for Disapproval: -d d ^ *y Adverse Determination 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 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. APPLICATION FOR SANITARY PERMIT S' 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/contractgV,("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 ~7 iJ /7 • l8110,eCx 141 7~ Location of Property Section 7 T 4~r N - It W Township ~v 7 Mailing Address /f T 1-3 eo-SOAJ Subdivision Name IV14 Lot Number Previous Owner of Property A _/~~fC Total Size of Parcel Date Parcel was Created 1914 o2 Zf 7 ~ Are all corners and lot lines identifiable? c Yes No Is this property being developed for resale (spec house) ? Yes _ No Volume and Page Number -?Lf as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE Or THE FOLLOWING: 1,:-~ arranty lleed 2. Land Contract 3. Other recordingd 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) eeAti.6y that a.U statemen t6 on ,thin 601un ane tAUe to -the but a 6 - y ( CU ; ) knowledge; .ghat I (we) am (cmel the oi~gm (s) o6 the pnopehty de CAibed in thiA in6o1unati,on;601cm, by viAtue o6 a wcma)t.ty deed /Lccoaded in t1te 066ice 06 the County Reg-i 6 -teA o6 Deeds a,6 Do cwnen t No. ~11 A''I and that I (we) pAuemUy oun bLe phopobed .6 to bon the. buuage c cusp bybtem (on I (we) have obtained an errs lent, to kun with the above dcsuLi.bed pnopvi-ty, bon. the corls,tlLucti.or, 06 .da.id system, and the same has been du,ei necoAded in the 066ice o6 the C nay Registeh o6 Deed6, ae DgcwnerLt No, SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED . E I/4 COFN•ER -OF SECTION 4,T2ON; ; 6 .R!9W. ( COUNTY SURVEY MONUMENT FOUND). LEGEND ,C-SET I"424"IRON PIPE WEIGHING 1.13LBS PER LINEALFOOT. • I " IRON PIPE FOUND. 2"IRON PIPE FOUND. AS Fir 'RECORD ED MEASURED. A pe) _ f W Iy0 T ev - O CD N N LL T 1 O O ' ' A W W ~ W i W W = u W U 1 1 i•..•' lu 33' 33' f \ G~ • ' v p . Lu W LL to _ LL a ~:l_ Y:r~ O M W U W r o M. N 0 W W O M y N 2 1-• Q 1 _ -1 1 I 2\ a W~ tJ 1 ✓ 1 66' WIDE PUBLIC STREET auW in X Au a - V (UNIMPROVED) 2W 2 k m on 1 O2 SOW J I R S 85°30'00" W O O E 362.35'(M=361. CD 81'7pFD. LP SECTION LINE -I S85400'33 "E 66.3! ' 66 20 356.82 4.99- BASED ON, PLAT 4! > 224.31' 1- to o 47 Q 2 WON E o Q W T 0: o En S 2' C' Q^ SCALE I 100 u~ 3 L0T I M o P. 0, 50' 100 200 V W W = 0 2.5 CRES ~m 0, Q ° 112.20 0. FT.) &n 2.V W . c `tieE. rest?pi C) a: Q Z N y P W 2 2 7 7. 0 0 ' 7~ ao' ZN89056'00"W 354.40 _ ~e-t~/y~``~.._..~•''`~~y~` R= 360.70' ! S - o. aR o z. I ` .n: Q: mm O _~Orw.a.t~~•4~cQ~_. ry 1.F;D r - • JAMES M. WEBER S- 1804 q _ W n~n~°O WEGERER,WESERANDASSOC. F' i1 ' i ce`, DATED NOV. 0. \405 J, SE CORNER OF SECTION 4,T28N, a, R19W. (COUNTY SURVEY IWONU- Z, ~MENT FOUND.) D. SHEET I OF 2. L S 71 THIS INSTRUMENT CRAFTEDBY J~~.~~+JeI~w cn STC - 105 r y SEPTIC TANK MA1NTLNANCL AGRELMENT H St. Croix County o d OWNER/BUYER eCfS► 7.2 m ROUTE/BOX NUMBER ~r2 doX Fire Number CITY/ STATE 11oDidd c,1J ~j/Q/~ ZIP PROPERTY LOCATION: Section_,$/ , T RW, Town of_~i~CJ , St . Croix County, Subdivision- Lot number .l Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance cun- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed se} tic tank LimLer. What you put into the system can affect the function of Lhu SvIltic tank as a treat- ment stage in the waste disposal system. St. Croix County residents mater be eligible to receive a grant for a maximum of 60% of the cost of replacemunt of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this prugram in August of 1980, witlk the requirement that owners of all new systems agree to keel, their systems properly maintained.-- The prupUrty owner agrees to submit to St. Cruix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or it 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. 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- i went 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. SICKED 'LL DATE - /-~z - 196 St. Croix County Zoning Office P.O. Uox 98 Hammond, WI 54015 715-7S:6-2239 or 715-425-8363 Sign, date and-return to`-above address. . m • m v, v ~ viw-,? (D d fD O A A CD O M 0 ~ 3 v ~ c =r -4 O c c O' l< 3 c m p c 5 FD a CD (OM o 4 O=CDCn to a p A w 0 = CCD n (D O CAD x w P. - co ?cc n A 3 a O .A• ° D CD w ? C =joo S C ~ c-r- go N A 0 o a cr 0 w 0 w CD o ~o ac, CD co amc< CD U) Q CD cn 0 0, cn 0 A 1 A A O e tp - '0 o O a O 'a w o w o -_"a~~ w O co CD m oCD Cn CD N w 6 ~ N Z a w !A o C=D Go aCD O w CAD C?D ?`°a D -=d CD 0 CD e a ; O r► Cc N 3' ..i ~ -a~i~og"' fT1 cl. CD FA w vi w a c =r a Co ~ CA =r 0 * CD CL M ~IC 7 NN CD CA O• Et c r cS N n O CL CD CD ..w O Cn O A. C. O - O m CD n N N CL w m3 f aiccc* wow cD -mcawo IT1 , . CD CO M O O O c . CD CD , co n % a O A N 0 =1 00 a c a w m -A N c C a C W A ~a a~ _3 O 00 o y w a CD :1 o a 3 4 3 l y w CD Cn o < r o O h C%EPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, , DIVISION LABOR'AND- PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN BELATIONS \ / ~ MADISON, WI 53707 (H63.0911) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: T~~N/R RE (o -two - - ~~hos~ c, s. COUNTY: WNER' BUYER'S NAME: MAILING ADDRESS: sr, C.Rp\u ~►~.~s 1~ R~SOtJ 2T 's l\wY 3S S, 1~~~Sot~, Lv I 54%dl~ USE DATES OBSERVATIONS MADE NO.BEDRMS.: 1COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER OLATION TESTS: Residence N . )4%. ®New ❑Replace q-11-Gs q-z6-g5 RATING: S= Site suitable for system U= Site unsuitable for system '7 CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) S ❑U ❑ S ~V CXIS ❑U ❑ S ZU ❑ S ~U Z 1'Q6~Ckf~s- ~ftC.Fl S I x BSI Ln~G If Percolation Tests are NOT required DESIGN gRATE: If any portion of the tested area is in the 7-Q under s.H63.09(5)(b), indicate: ) v / e I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-I"@OES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH W, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) S.~' 1Nti,i_1E Wt o? o ~b~GyBn_sil S, 1 J'G~l3~sj~ ; z•S~Bn IS_!ti1D _8n B- - \ Z'-va I.Z z, tse sl Lf4+-c ms • Z. y' Rf3L ~•G \o-z' " V40-t o•~'D\LGy13nsill~; 1.8'GIrB+lsi1 _)•)'Bnls;3.3,R7B 3 S IlL/• S ' t( _ > 5. `3 ' 0•-7' WrLGS• 8h S1 1_TS J o•-' GY-En S1 1 3• b'$►1 GH IS i - B 1•y'~~h SLIGHTL DO.IS~ GHS ~ 6.0' ►\S.o' tt 6.0' 0.-) L~~cGY St I '17'J; I-3'G`1 y0 *RRn_-_G►- S L_ B- 5 6•I' \\\•S' +t ? 6. 1' o.E~' ).g' Bnsil '21'cT80s1');1•y'RT~hsl F it "'T 3.b" 0.8' YBn S) 3•_S'VeZL/D94% RBnc•S1 B- 0' \ \1 •S' > 3.g'R134C slab WLDwS-e B- S 1bIo.3' 1JOtvE > 6.5 D•~'D1~6y t3 51) TS ' 1-y'`1 S1 3.8~Snsl 6 , ~n ~S~ PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P_ \ 7~,(. 1~ 1 1/% I/8 9 P_ z 36 N C, t o \~s/ 1 6 -7/S -218 ~ I P- 3 16 111(3 \0 1 5A8 \ S/a 1 Sig ~ P P- 1J L 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. 1FJL-Rte tZ~S'LAC~YI pi~cGE ~`(Z2L Ukvl d \oz Q 901.6 SYSTEM ELEVATION - Ec ho!~m Rovl.,p 11.a y I 1oG,p' orJ SF, ~-c r., Z 1EL. r-, i C w'~tv ~`l~c H S r I t'' dv~ G~ ~w " i : ~ ry 8V0 i i I ~ I i 110 ea 0 r ( 1 N - _ ' W -(ao~'ZC B~ S7 B(- j 3 .u.~~J~ 4 LSD 3 1^ to RIO I -WO N , . i CJ\ x`17 i o -I 9 .7 1 i S LC 114= loo' SI_F 1c 14 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: Z`T1 vZ . w EG OZI _24-as ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 'ZT 1 o L6' W14L-i I S41) I S--)6 ~S_LP_S-of 6({ CST SIGNATU L- DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ~PCG~ O Z DILHR-SBD-6395 (R. 02/82) - OVER - • ICTION -'FOR MPLET° J) FORM 115 - S BD - 7 To he a rn r accu st, your rep etude: ether this is or Corny s 3, l ` X11 > rcial u jn`Jr'- TANK ONIV IF ALL t plan; 7. IC: -.!y she in data, , --AT- mL;ERTIFIEDSOII - L G C d ar n. DEP4RTMENT.OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR RANV ELATIONS 1 PERCOLATION TESTS (115) P.O. BOX 7969 HUI1IIPfN~iE / MADISON, WI 53707 { (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSH UNICIPALITY: LOT =]SUBDIVISION NAME: ti/~~/ z1 /T?-8 N/R !9'E c ► - Pu~e~ c_s» . COUNTY: OWNER'S UYER'S NAME: MAILING ADDRESS: e tw t~ ~►~s 3 N w 3S s. E-~voso;~ C-v t s V o r b USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: ~FTesidence 3 N - A\ - ~Tlew ❑ Replace I RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ES❑u ❑S®v 'S❑u oS®v ❑SLou 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: k3 • A\ . l Floodplain, indicate Floodplain elevation: ~ • A PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO NG6 '68 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH I#.: ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 9 ~•3' ~o~.o'- ►~ot-~E >_6.3' o.~'UkBr~LTs-]1-3'Bnsl;-3_'8_~ 1S rneS~~ 10 6•~ r 1oo.s' tl > 6.~' 0.7' li '1•-j '$nst _aA hlec~ S -`?'3' ~O`1•S' tii 7 7 3~ ©•6'b`rtGy!► Si~7S_10 6'_`7b~h51 'ZnS-~ ;-1,q B- LZ Z, tJp.~ ~ 6' d 6' D'cc_ Gy 8h;S i I 'Q' 13,A C *11 B- z.a' S'Z.S' LT ~Y\ es B- B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D 3 PER INCH P- P- P- P-_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION • Gam, ~ d) I t ? r I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): ~cZZ~ (-I,S[.JOiZ`7~1 ~Uf SVC)jj S 6 l$_ CST SIGNATURJlp: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. Q F DILHR-SBD-6395 (R. 02/82) - OVER - L -')R COMPLETING FORM 115 - SBD - To st, your report must include: 1. 2, r this is a residence pr-,ect; 3. Nis use planned; 4. 5 cs Y ! ALL. s pla E -tg=VI " ER r €r O OIL i I s HWL P a J a. P. .6. L. 6 7' P L CST A PROJECT ' 1L ' _ NAME AME IV[ N T N 1..C E 1\1 S E PLO 1_ MAP t 4 b 1 tI - ~w 30 7T . r ~ . 19 I r FRESH AIR, ~INLETS 4AND OBSERVATION PIPE CROSS/ SECTION Approved Vent Cap Minimum 12" Above Final CradQ q 4" Cast Iron Above Pips" Vent Pipe To Final Grada-- Marsh Hay Or Synthetic Coverirng Min. 2" Aggrcgla l Over Pipe ` ' Distribution Tee Pipe - g . Aggregate Perforated Pipe Below Beneath Pipe Coupling Terminating At BoLLom of System