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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 - PELZEL, ROGER J & SHEILA M ROGER J & SHEILA M PELZEL 298 EDGEWOOD DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 298 EDGEWOOD DR SC 2611 SCH D OF HUDSON SP 1700 WITC i Legal Description: Acres: 1.058 Plat: 1929-EDGEWOOD ESTATES SEC 12 T29N R20W EDGEWOOD ESTATES LOTS Block/Condo Bldg: LOT 21 21, 22, & 23 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 12-29N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 886/444 07/23/1997 733/510 07/23/1997 726/557 2005 SUMMARY Bill M Fair Market Value: Assessed with: 92808 227,700 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.058 47,400 184,800 232,200 NO 05 Totals for 2005: General Property 1.058 47,400 184,800 232,200 Woodland 0.000 0 0 Totals for 2004: General Property 1.058 33,000 138,700 171,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 136 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 , s Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER'- TOWNSHIPy SEC. T N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN r a5r SUBDIVISION G;.,• LOT LOT SIZE r PLAN VIEW Distances and dimensions to meet requirements of 11HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ f. ' to ~t I o r 4 ' r_ F r INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used'"" - fv.; Elevation of vertical reference point: Ll Proposed slope at site- SEPTIC TANK: Manufacturer: / Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest- Road: Front,O Side Al Rear, O feet From nearest pr®pert}r line- Fr Number of feet from: well building:' (Include this information of the above plot plan)( 2 reference dimensions to septi SEE REVERSE SIDE i s r 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: i 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: Length: Number of Lines: Area Built: Fill depth to top of pipe: ~c Number of feet from nearest property line: Front, O Side, O Rear,© Ft.Z4 ' Number of feet from well; Number of feet from building: C;~: (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, OFt. Number of feet from well: Number of feet from building: Number of.feet from nearest road: Alarm Manufacturer: Inspector`: f tied: Plumber on job: License Number: ti DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, #1, 53707 MCONVENTIONAL ❑ALTERNATIVE State Plan{. D. Number: as Holding Tank El In-Ground Pressure El Mound 11 t signed) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE B & H Developmi 836 St. Croix Street, N. Hudson, WI e"t.- BE NftMARK Flrnanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: SW NW, Section l7, T29N-R19W, Town of Hudson, Lot#21,Edgewood Est. Name of Plumber. MP/MPRSW No.: County: Sanitary Permit Number: William Schumaker 6382 St. Croix 74964 SEPTIC TANK/HOLDING TANK: i I L MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: - J TANK OUTLET ELEV.: ARNING LABEL LOCKING COVER / P PROVIDED: PROVIDED YES ❑NO ❑YES JZI NO BEDDING: VENT DIA.: VENT MATL: HIGH WATER UMBER OF ROAD: ROPERTY WELL: fUILDING: 1:1 TO RESH ALARM,~` FEET FROM - LINEJVENWT AIR INLE ❑YES NO C ❑YES r NO NEAREST *'-7 DOSING CHAMBER: MANUFACTURER: BEDDING: IL1051DCAPACITY. PUMP MODEL. PUMP/SIPHON MA ACTURER. WARNING LABEL LOCKING COVER f PROVIDED: PROVIDED: ❑YES ❑NO j f ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: NO CONTROLS OPERATIONA nR OF PROPERTY I J WELL BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN ET FROM wE AIR INLET: PUMP ON AND OFF) 7E]YES ❑ ARC SOIL ABSORPTION SYSTEM. Check the soil moistureat the depth of plowing _1 NGTH: lu,AMETER 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 'NIDTH. LENGTH. JNO.01` DISTR. PIPE SPACING: ?~S INSIDE DIA.: #PITS. LIQUID TRENCHES. ~T _ DEPTH: DIMENSIONS l.2 _ GRAVEL DEPTH - ILL DEPTH DISTR PIPE DSTRPE DISTR. PIPE MATERIALNUMBER OF PROPERTWELLBUILDINGVENTTO FRES BELOW PIPE. ABOVE CO; ER EL VLETE`E EPID FEET FROM LINE: glj#JINLET; IV//_ 1r , ~,rFt 12 NEAREST:.4 J (e► i,,tf h/f „_Jl 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: OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED PTH OF TOPSOIL: ISO DDED. ISEEDED: IMULCHED: CENTER. EDGES DE . ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BEDlTRENCH WIDTH: LENGTH NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. D{STR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.: ELEV.. DIA.. ELEV.: PIPES: DIA.: ELEVATION AND : DISTRFBUTION INFORK"TION HOLE SIZE HOLE SPACING DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: :[5Ett ER QFERTY WELL: BUILDING: FROM ❑YES ❑ NO ❑YES ❑ NO EST Y 6(v „ C& 4 An 41 1 Sketch System on Retai ''n county Reverse Side. file for audit . SIGNATURE: ~ ,,r TITLE DILHR SBD 6710 (R. 01/82)° Wisconsin APPLICATION FOR SANITARY PERMIT Ci .LLDILHR COUNTY (PLB 67) DEPRRT TEf"1T OF UNIF ~/f~ SANITARY PERMIT # IrIDUSTR LRBOR 6 MUTRI I RELRTIons / V/ -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 '7Tc ra A. PR PERTY LOCATION 11 9 d CITY: - 1/4'vg1/4, S 7 , TA f, N, R ~j E (or) AWN E: LOT NUMBER [BLOCK NUMBER ISVBQIVISION NAME AREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER l ✓~F f _ TYPE OF BUILDING OR USE SERVED or 2 Family Number of Bedrooms: 3 EJ Public (Specify): THIS PERMIT IS FOR A: X New System ❑ Tank Replacement ❑ Repair L] Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification 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 Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity ,X 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 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): REQUIR/~ED (Square Feet): PROPOSED (Square Feet): 9r~ !i,'6 //,A_ 0 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signatu P MPRSW No.: Phone Number: 'FA C4 ej Plumber's Address: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signatu a of Issuing Agent: Fee: Date: -1 Disapproved 4~ I J - % S ❑ Owner Given Initial / ~ Q 6" p 14 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. i • 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 44 1eV-r- k0 OYY e (A t Location of Property X14 ^jO It, Section 1~ T N _ R W ~ - a Township d-~'o C) Ma i i ing Address Subdivision Name C,{j,~y(~ Lot Number Previous Owner of Property 'T'otal Size of Parcel /T c 2 - Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for sa (spec house) ? Yes No Volume to 8 17- 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) ee4ti6y that aU .1-tatement6 on thiA boAm aAe tAue to the but o6 my (ouA) knowledge; that I (we) am (an.e) the owneh (4) o6 the pupen.ty de,6c4ibed in .th,%h in6vo mat%on boAm, by viAtue o6 a wa4Aanty deed AeeoAded in the 066ice o6 the County Regis-teA o6 Deeda as Document No. _ ~4,-)b ; and that I (we) pn.esentty own the proposed .6 to 6o4 the bewage dizpoSat ayatem (oA I (we) have obtained an easement, to Aun with the above de cAibed pnopWy, 6oA the const4ucti.on o6 aaid d ys.tem, and the same has been duty AecoAded in -the 046ice o6 the County Regis-teA o6 Deede, as Document No. SIGNATURE OF WNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED R DATE SIGNED ~I ' H 9 STC - 105 r' r SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z _ d OWNER/BUYER- -4- j ~4U~~O ROUTE/BOX NUMBERX Fire Number CITY/STATE ZIP LA` \ , oleo PROPERTY LOCATION: 5GJ ;4, NLJtJ!4, Section T-)7_N, R Iq W Town of Npr+-'V1St. Croix County, SubdivisionFc1CQ j~dtS 1- 5 , Lot number - a3. I 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. 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. 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. r m -4 3 ~ ~ rtfm~ ~m~~o~ 7 ~---s~ rn w ~p O 0 = cO cO o p =r 'o m m o z Ila CD * 'a c m N o* o^~ g~ Aim moN~N~ qr C'D A O (Op (D C A 3 a o r► cfl (D too 0, ID w r• `c w c c c % owwCo o~= o~ooCDo CD > CD 0) < CD CCn: con (D to D W A A O G1 N O A p O (D (aD O * C Om = =r m-0 0 w Z D waf~ Z SD0CD M m 3CDMM CL D1 n o a M A U) R1 oc~ °~*omo ~vo a'?cw QND mvisoao°' CL ac0*(D C m o v; w~o-a ,D c o CL a CD ~N n o m(D 0 5m-.- Z a~ A to S~. o _o o - m N IN w o c CD v, 0 w G) ao N c' o.w o m w m- ocno ac m C. CL a=V1 Q~n crso3 : g c 3 c o N A y o FD_ o C oQ a m -Im c o CL ° =ow a =cNcoe m ~a3 ELM v03 ,a < w < w W ° ° z ® . O ~O e IPJu~ DV. iz R 01- REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS Ir~srr~y, DIVISION ' - LIABOR PERCOLATION TESTS (115) MADISON WI 3707 HUMAN RELATIONS (H63.090) & Chapter 145.045) {Ctr;i+ilC~r; SEC I N. TOWNS HIP/"UkRtFfi~Y: OT NU.:BLK.NO.: SUBDIVISION NAME s '-1 /T i§ZN/R S9 (or 14 t.6St.) AI L,-6 i(,0UNTY: OWWNER'S _ MA D : I`' '~T-C.-QX OPM N1 NC g3C ST ~koix =Ti TW USE DATES OBSERVATIONS MADE r~,-B[ DRIVIS, : COM RCIAL S R TON: OFILEDESCRIPTI_ NS: EFICOLATION TESTS: Residence _ WNew C', Replace 9 ©CT / N ~ SOIL & PAC 49 -SOILS RATING: S- Site suitable for system U= Site unsuitable for system L OKIAM IA FQ7N~V:-ENTIZ) L: MD T N-GROUND ~U :SYSTEM-IN-FILL OLDNUEENDED SYSTEM: L ptional) s ._o s mu o s ®u o s ~uZ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under g.1-163.09(5)1b), indicate: I ~uQS~j Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION R UN AT R-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, g yj,OJPV V TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- ► 143 /~i.g4' No~/ ~ 8LL s -o.fA 15 R AL Sc tC,l2 i•a-4.3'cst6e4c0h Z N -0•5'gL L O.S -2.3' BRN S L IvGr; f ~ Cal, 7.3 =3 7 'St vv B- //511 C,R4'cob 3.7:4.3 ~,S X43-s U sr w~'G>< ~.0 9.9;•.S,.Gaclc~ b 3 91~ St I ZU'. az.-5 " 9LL TS ~.o=i.s g~ti L I,':- B l2Or 4 I4oNe > o- Z.8'G 'z.5' 6eN ~c wStr csle R C66 Cow, 7.W-/U C; A, r~a S B. IZS' ~~9.~1, L > /25'' p-3 0~ 8~ L S 3.0 43"StCL~ GR 4.3-8•s Sl w B- /00 5 L B- -T PERCOLATION TESTS TES DEPTH WATER IN HOLE TEST TIME DROP WATER LEVEL-INCHES RATE MINUTES NUMBER 00ftM AFTER SWELLING INTERVAL-MIN. PEfa PER INCH P. A10-ML /'0 78 2/4 P - P - A ION oy- 62,65 h - P• _ PLOT PLAN: Show locations of r0 1 ~Z percolation t s, aoll borings and the dime sions of suitable soil areas. Indicate scale or stances. Describe wfi are the hori 7ontal and v tical elevation reference points and show their location on the plot plan. Show the surface elevation at all b rings and the directi n and percent of land slop . _ - - SYST ION 9 3. oo' 3 3' 3 I APPLOXIMATE L0CJvT1bN _0T wi..~ 1ryn.rfAri.~o y it. IOTIA; I z0 Lor, / 1. W. Z: ROA N 27 'J& 11 1~ . . hN/.wM ri11K I r 99 B3 I V i °a P-1 3~- TN P43 g,, CALE 3su Sy TES i 8-S rtl'' / ~3~ \ i RE LALErA, Z l l c--r--? t 3 . , i i i pU>rW p°~ 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 date recorded and the location of the tests are correct to the best of my knowledge and belief. NAME print : TESTS WERE COMPLETED ON: /'141k QCTOtl<e~ /S /9f3S ADDR CERTIFICATION NUMBER: PHONE NUMBER (opt ionall: 407 S&Co"& _~Yr. /lumow Wt Soo/G RS1 8414 ~oiNu CST S~IG~'ATURE: DISTRIBUTION: Original and one copy in Local Authority, Props: -?wner >)i Soil Testes. ca' C cE rJ i~~ / J 16 } ~ rG c h yJ T- r i i