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Parcel 042-1016-70-100 06/21/2005 04:22 PM
PAGE 10F1
Alt. Parcel 7.29.18.100B 042 - TOWN OF WARREN
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
* KATNER, GERALD N & PAMELA T
GERALD N & PAMELA T KATNER
975 107TH AVE
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 975 107TH AVE
SC 2422 ST CROIX CENTRAL g1p'~
SP 1700 WITC
Legal Description: Acres: 9.280 Plat: N/A-NOT AVAILABLE
SEC 7 T29N R18W PT OF SE NE FORMERLY LOT Block/Condo Bldg:
1 CSM 6/1696 N/K/A LOT 4 CSM 9/2457 9.28
ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4)
07-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997
07/23/1997 750/ 64
2005 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 08/28/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.280 46,300 178,100 224,400 NO
AGRICULTURAL G4 5.000 300 0 300 NO
Totals for 2005:
General Property 9.280 46,600 178,100 224,700
Woodland 0.000 0 0
Totals for 2004:
General Property 9.280 46,600 178,100 224,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 126
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC. T a~N-R /JP W
ADDRESS fp~,f~vt ST. CROIX COUNTY, WISCONSIN
ws S "449-X.3
SUBDIVISION - LOT LOT SIZE Q~tiew
PLAN VIEW
Distances and dimensions to meet requirements of I•IHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
I
S.T.
1
a3N ~ oti~F~e-~- 1~83
a
_ do
63 i
INDICATE NORTH ARRO
BENCHMARK: Describe the vertical reference point used_ -77_~~~,-~~ 2*
Elevation of vertical reference point: /gyp p Proposed slope at site:
SEPTIC TANK: Manufacturer: "ek Liquid Capacity: /app
Number of rings used: .3 KZ Tank manhole cover elevation: app,
Tank Inlet Elevation: 93_/2 Tank Outlet Elevation: 93.3D
Number of feet from nearest Road: Front,O Side,O Rear, > ~o feet
From nearest property line Front,O Side 0 Rear, O feet
Cve/l ~"R
Number of feet from: well building: 3p
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
RRR RF.VFRRR STnF.
o
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, Q Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: t1/ Trench:
Width: /.2 Length: Number of Lines: Z Area Built: ~6•
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, O Rear, 0 It
Number of feet from well: > ,2®p
Number of feet from building: >,2&0
(Include distances on plot plan). h/«~Prr py, yc/ r
SEEPAGE PIT
117. Y6
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, 0 Rear, Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector: Dated: 9 - Plumber on job:
License Number: 3z-~9
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 749 BUREAU OF PLUMBING
MADISON, WI 53767
CONVENTIONAL ❑ALTERNATIVE Stare Plan I.D. Number
11 assignwfl
❑ Holding Tank ❑ In-Ground Pressure El Mound (
A &d t12 Q 16 2 J?
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE
Getcaf-d Ka net 100th Avenue, Robe s, GUT 54023 7 40
?6 3,"'SQ
BENCH MARK (Permanent reference poun) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.. CST HEf PT. E LE V
SE NE, Section 7, T29N-R18W, Town aj GUanhen
Narm of Plumber. JMPIMPRSW No.. County Sann i,v Permn Number:
Dave Fogerty 3289 St. ctoiX 83833
SEPTIC TANK/HOLDING TANK:
MANUFACTURER LIQUID CAPACITY TANK INLET ELEV. TANK OUTLET ELEV WARNING LABEL LOCKING COVER
PROVIDED PROVIDED
YES ❑NO ❑YES ❑NO
BEDDING V . VENT MATL. JHIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING VENT i0 FRESH
h ALARM FEET FROM ~q LINE AIH IN}LET
YES 0 ❑YES ❑NO NEAREST UO'` tJ CJ
9 NO
DOSING CHAMBER: _
M ANI)F AC T UR EH BEDDING LIQUID CAPACITY PUMPMODEL JPUMP. SIPHON MANUF ACTUHEH WARNING LABEL LOCKING COVER
PROVIDED PROVIDED
❑YES ❑NO ❑YES LINO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHtll'E l+lv 11'11 LI Hl)IF. DING IVE NT TO Flit SH
(DIFFERENCE BETWEEN FEET FROM LINE 11HINFET
PUMP ON AND OFF) ❑YES ❑NO NEAREST- 0
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of lowin LENGTH rnnntf TE H nlnn I+InI nND a1AHKIN(.
or excavation. (If soil can be rolled into a wire, construction shall ceapse until FORCE MAIN J 1
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM: _
WIDTH LE N(iTH JNOISTR OF UPIPE SVACYNG COVER JIOIA ~Pllti l.IOIIID
BED/TRENCH THEVWjES / eIALd PIT )
DIMENSIONS
` p(, (P
(,HAVEL OEPT1/ FILL DEPTH UISIH I'I I't UISTR PIPE DISTR. PIPE MATERIAL N( STN NUMBER OF PHOPEHTY WELL HDILDIN(VENT To f Hf till
ft' LOW P FEES AH()OVEH f V INI F I ELEV END A ,
~ P s FEET FROM ' LINE a ~'~7~ _ AIR INL[ T
NEAREST-►
1
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-
❑ meets the criteria for medium sand. TIONS MEASURED.
YES ❑NO
PF HM nNf N1 M1Anftkf 1+5 ORtiI HVAlI11N Wl l l ti -
SOIL COVER TE X TORE
❑YES ❑NO _ ❑YES LINO
DEPTH OVER THE NCH HE 1) JDIPTII OVER 111ENCH BE-[) DEPTH OF TOPSOIL St)HOf 1) SEE O(O Mlllllf O
CENiEH EDGES
❑YES ❑NO ❑YES ❑NO ❑YES NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LF N(ITH TRENCHES LAT EHAL SPACING T NAVEL Of PTH fit LOW 191'1-- f IF I UFPIH AHOVI COVE H
DIMENSIONS
M
PUMP MANY OLO DISTR. PIPE MANY OLU MATERIAL NO I11SIfi EI h7nlf ltl Al 74 n1nItK INI.ELEVELEV CIA ELELEVATION AND EV PIPF S DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING U HILLED COHHf CI 1 Y C)VEH MATERIAL VE HII('At I IF T COHH1 SP()NI)s 10 APPII()VIIF
vF nn~s
❑YES ❑NO ❑YES LINO
COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS. NUMBER OF FETUPERTV WELL BUILDING
FEET FROM LINE
❑YES ❑NO ❑YES ❑NO NEAREST
Sketch System on
Retain in county file for audit.
Reverse Side.
su Aru TITLE
DILHR SBD 6710 (R. 01/82)
w,scons,n APPLICATION FOR SANITARY PERMIT _
COUNTY
DILHR (PLB 67)
■o - TRV. R80 UNIFORM SANITARY PERMIT
inDU #
InDUSTRV,LRHOR 6NUTR1"1RELRTI°n5
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8%x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
PROPERTY LOCATION
RQ.E
]',O=W,
- 1/4 1/4, S -7 , T:~ , N, RE (or)6~
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE 6R-t-A1qDVA1tK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED Q - /D/ 7,
14' 1 or 2 Family Number of Bedrooms: ~ ❑I~Public (Specify):
THIS PERMIT IS FOR A:
E' 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.
El~ 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 Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity i" Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: 771 e 4 1
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
Xy'jr " ~Private ❑ Joint ❑ Public
1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
e of Plumber (Print): ture` MP/MPRSW No.: Phone Number:
Per's Address: Name of Des~er:
- r
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
9~~ Q„/~T~ ❑ Owner Given Initial
/ O O Approved Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.) ;
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
APPLICATION FOR SANITARY PERMIT
S T C - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractgz,("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 rw ! E ' "r-
Location of Property / ;4, Section :ZT jRj_ N - R _1 W
Township rr
Mailing Address P
1,5c cro?
Subdivision Name E ~ .S (,tfUj=-t
Lot Number `
Previous Owner of Property
Total Size of Parcel a6f eS -
Date Parcel was Created 11W,
Are all corners and lot lines identifiable?- Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume 9.5'0 and Page Number.z~ X 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
1 (we) cettijy that a t statement6 on this jotm cute true to the but of my (out)
knowledge; that 1 (we) am ( ate ) the ownet.(s ) o j the ptopetty des ch i.bed in this
in6onmati..on Jotm, by vi tue o6 a waAAanty deed tecotded in the 0j6-i..ce o¢ the
County Reg-i,6tet o6 Deeds as Document No. ; and that I (we)
ptesentty own the proposed site Got the sewapos system (ot I (we) have
obtained an easement, to tun with the above desclubed ptopetty, Got the
construction o~ said system, and the same has been duty tecotded in the 066ice
o6 the County Regiz tet o6 Deeds, as Document No.
~y 7
oln
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
a~ 8'6 7~~~ ~'1P
DATE SIGNED DATE SIGNED
I
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9
ST C- 105 r"
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9
SEPTIC TANK MAINTENANCE AGREEMENT ►y-+
0
St. Croix County z
OWNER/BUYER
6~ra~l
hn
ROUTE/BOX NUMBER Fire Number
CITY/STATE GCS- ZIP
PROPERTY LOCATION:.5'F, -.14, N% 14, Section, T o9 L? N, R _W,
Town of k1a rrej~j -,St. Croix County,
Subdivision Lot number-_.
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed-septic tank pumper. What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix.County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. H
0
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- 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. Q
SIGNED
DATE d '
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.
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•
IDUS TJVIE,NT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INNDUSTRY: DIVISION
LA9OR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS \ / MADISON, WI 53707
(H63.09(1) & Chapter 145.045)
LOCATION: SEC ION: TOWNSHIP/ OT NO.: BLK. NO.: SUBDIVISION NAME:
s , / /T,7 N/R /Y E (o - -
100UNTY: OWN NAME. MA D .
e7
USE DATES OBSERVATIONS MADE
NO..BEDRMS.: COMMERCIAL DESCRIPTIO P
ROFILE NS: PERCOLATION TEMI
OResidence 3 QNew ❑Replace
zzf 7//o
RATING: S- Site suitable for system Ua Site unsuitable for system
ONVI-cNTIONAL: IMOUND: (Q11 IN-GROUINQD•P(RREES~S~URE: SYST1E~`M-IN-FILLH(OL~DING TANK: RECOMMENDED SYSTEM: (optional)
QJ t ~~J ~U CJJ L"JV CJJ ~U LlQS 1:1~ '
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS _
BORING TOTAL P H TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTUR , AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED ES IGHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- fd! e-
'141 p, 5
es e4
B- C /0 0 > ' S '91Z _1V ' ' A ' Cs
B- S Od 9L ' i t/ ' e- S
B_
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD I PERIOD 2 P PER INCH
P- 2 p
P-
P-
P__
P- - G p Z Z z
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 f7, r
7 I
_ _
A I ~ ,
( i
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/
'9 rjA
_ cs . So~i/i - _~~_..i_ r'v_... _ s_ ~txt. _r►-rude
1
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. ~~..1~J~F4Ir ~4
2K _Ile_
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 (prinfl. ` TESTS WERE COMPLETED ON:
o o 7 0
ADDRE S,-~ CERT FICA ION NUMBER: PHONE NUMBER optional):
CST SIGNATURE:
z; L 1 '0
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02182) - OVER -
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