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Home My WebLink About020-1085-00-400 i c d f 0 N 0 o D F c . ' d CCIO) `D• 0', 3 ;~f ID II '0 CD CD m ) z 0 S Z O cn N O "~S CD O O_ I~ ~p d .n D O C Co N ~G» O a N d In N 00 0 cp N (D o- N O rn c~ 0 W ~o cn I.c,- cr ~ o c° o ~ a) co o o- 3 co ~c c~ j Q 3 w vZ 0 0 cn 1 ~3c R7 O O O 7 C%1 '7 f7l A C7 O O p d (D N N 0 O C nl I~ C O .3 c LL CD D m° cn 1D a L-3p N N Q < 0 N Cn D. ° CD m Ic < ~ D N O O O v F ~C1 N 0) C7 N C~ O _N _O F a O O O C7 CD (o co w O 00 00 O y 00 00 (D 0 0 C a 0 (n O O O O O O p 0 C: S (1 N N o N y N 0 Z CS O 0 cn - D 3 CD CD <D N C? Q iQ , 0 0 0 0 y CD CD N• LD. a am 0 N N 0 N C z ~ ' cn CD O N :74 Z ~ o 0 D co 0 Z co O O a 7 D CD 0 0. =s o' (n -b 10 m -D (D (n , CD N ~1 » (D m N ~ Z7 -p N !!`iil c CD CD W C1 CD N a 0 ~ a w o 1 to h o AZ (D a s O CL A Z O co G ~ W (D p 3 O. Z 3 0 3 Cz C N CD 71 Z _C < CJ (D A * N n CD O O O CD (D O S D Ct) CD D C (D co G C 7 N O CD O N G T CT l~A O N a y Vl ' n z = S C)- CO 7 0 C? C Fn• ~ f2 O Q) Cn CD -I 0 CD O i 7 m a CCDD ° s 3 =1 - !r C) < aF CD ~0 m Cn CD ~o m N (D ,4 =r w 'a 3 (D O O. V w N x'00 S: CD " CD pNj ,n.. 0 0 N "O CD (D O N O N a, C A (ll 7 7 N d .O-n "O O O' 0 7 V O O, (D O N C) CL O. G < d r~ O f O p p' CO O CD cn O N 0 001 N O CD = J A N a o n o N EP a W o m ((DD N S CD o a M o l O7c CD N ti 0@ CD CD n 0 0 S' n @.J c m o A c ~~IO r o o w N o is ti CERTIFIED SURVEY MAP LOCATED IN PART OF THE SW 1/4 OF THE SE 1/4 AND PART OF THE NW 1/4 OF THE SE 1/4 ALL IN SECTION 29, T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. CENTER SECTION 29 2" IRON PIPE N89°06'51"E 522.00' SOUTH LINE NW1/4 - SE1/4 N89o06'S1"E 133,732 sq.ft. p 3 ,rr 3.07 acres D LOT 3 3 C N iO- ai N f11 0 0 W (77 w°j~ o 00 b i a oo u 0~ o W co ..I Ln ANN ~~ti • O rh 01 I I. o U„ v . -,LOT 2 LOT 4 = Ca 1:41 r+ 90,930 sq.ft. to H W 2.09 acres 132,481 sq.ft. OOH Q 0 wi ox ~ 3.04 acres U) zsi ~i p P4i ~ r'1 1 _pi J a; 438.61' H m 'all 2 i x v 14% Ai a o S63 2p~0 S87°46' 5811W ¢j UU)i z o N. 3 6 to vlaA) I a, z LOT 1 N 88,832 sq.ft.`\D w 661 o g 2.04 acres ~A N o . w m ° o a SCALE IN FEET N 2 - N 66' ROAD 100 0 200 DEDICATED TO THE PUBLIC. 1 7 S87°46'58"W OWNER 23.00' SAM MILLER 8 TROUT BROOK ROAD 11npl211ed-lands owned by-platter HUDSON, WI. 54016 N N LEGEND 0o v • 1" IRON PIPE FOUND. z 1" x 24" IRON PIPE WEIGHING 1.68 LBS/ LIN.FT. S 1/4 CORNER SET. SECTION 29 COUNTY MONUMENT s ~~~dQ@!@4QFd~jy* C IV CURVE LOT CENTRAL RADIUS CURVE CHORD CHORD NO. NO. ANGLE LENGTH LENGTH LENGTH BEARING ALLEN C, B 1-2 1 22°21113" 929.13' 362.49' 360.20' N73°57112.5"E NYHAG EN I 3-4 1 27°48134" 137.00' 66.50' 65.84' N1600711911W 5-1407 011 4-5 310°01' 31" 80.00' 432.88' 67.59' N44°47' 09.511E HUQSON, 1 87°33140" 122.26' 110.70' N66°2614611W WIS. 2 82°33139" 115.281 105.56' N18°36153.5"E 3 5205015911 73.791 71.201 N86°19112.5"E 4 46°0812611 64.421 62.70' S0301611811E Ofir:8~ 0~gJ . 4-5 cul-de-sac 40°5414711 57.131 55.921 S46°47154.511E V t 5-6 32°4814811 203.001 116.261 114.681 S18°3712611E 4 1502310611 54.511 54.351 S27°2011711E road 17°2514211 61.751 61.511 S10°5515311E 7-8 27°1413811 863.131 410.41' 406.561 S74°0913911W ' S THIS INSTRUMENT DRAFTED BY DOUGLAS ZAHLER JOB NO. 84-12 Q , O D p l N N I W O M M C 5 (\i 0) In N N N 121, 493 SQ. FT. to (D NN 108, 125 SO FT 2.79 ACRES 2.48 ACRES 94,412 SQ.FT.) EXCLUDING 2.17 ACRES ) EASEMENT I ` O N87° 46' 5811 E Dc~ L0 415.9 9 i4' 47 O 47 54.5" E o a ff. '0. 0 cD 20`31'IW tif 10 181 W ° z W rn 00 ~I t0 N ``G (i w to J ~ I N w tiw0 w 110,123 SQ. FT. 4 - - In =0 2,53 ACRES r O in L C) "r, r, ~ Z o o - O O 0 z Q z 1 O 415.99 W) 1 QI 0 0 35, 51„E 436,21 0 N82 O = 11° 45' 21 ( ro 0 R = 203,00 OM o 0 CB= S08005' 42.511 E o o m In co 3 C= 4 1. 58' 0 0 ( D 0) N N L= 41. 6 5' c0 (0 N N 123,858 SQ. FT. TB=N2013'0211W 2ND TB=N13°58123"W NN 2.84 ACRES 7 66' 110, 131 SQ. FT.) EXCLUDING 87,660 SQ. FT. 33' 33' 2.53 ACRES ) EASEMENT 2,01 ACRES 415'99 - - 420:25' - OJ 66 WIDE EASEMENT FOR ~M N 87 ° 46 58'1 E M ~j 415.99' ro TOWN ROAD co -m 0 0 FUTURE N 87° 46 58 E 4 3, 41' M 317. 40 - 166.01' - - 582.00' ' - - 4T 340.40' X 531 250' w DRAINAGE r i o RETENTION AREA 0 2 >n m IT In m c\j r- f 144, 533 SQ. FT. N N 0 N 3.32 ACRES O N OWNERS OF LOTS 18 2 ;Q. FT. 0 SHALL BE RESPONSIBLE 130,806 SQ. FT.) EXCLUDING ES ; FOR MAINTAINING ,3,00 ACRES )EASEMENT VEGETATIVE COVER ON DRAINAGE RETENTION AREA. 582.00' 1311.72 S 87° 46~ 58W R/W VARIABLE INTERSTATE HIGHWAY 94 REFERENCE LINE 1-94 7E s in L~1a:: oc owner, ~"`Y'eS5 or regress w.--,! diCet".a i9 ~.@ 1auy i4. Ac:ess Wlxl Jk 130' TO R/W is shorn} on the Piat; :t bezng expressly -m ended chat this restrictton the ?uh y benefit accar^Ji;) 1, 0 X31`.793, Wisconsin S*..a~:utes, .r Parcel 020-1085-00-400 02/04/2005 07:46 AM PAGE 1 OF 1 Alt. Parcel 29.29.19.340E 020 - TOWN OF HUDSON 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 THOMAS R & CYNTHIA BRINSKO " BRINSKO, THOMAS R & CYNTHIA 715 COUNTRY VIEW CIR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 715 COUNTRY VIEW CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.040 Plat: N/A-NOT AVAILABLE SEC 29 T29N R19W W1/2 SE1/4 LOT 4 OF Block/Condo Bldg: C.S.M. 511500 AS DESC IN 718/133 Tract(s): (Sec-Twn-Rng 401/4 1601/4) % 29-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1156/356 WD 07/23/1997 718/133 2004 SUMMARY Bill M Fair Market Value: Assessed with: 48311 302,000 Valuations: Last Changed: 06/06/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.040 35,200 198,400 233,600 NO Totals for 2004: General Property 3.040 35,200 198,400 233,600 Woodland 0.000 0 0 Totals for 2003: General Property 3.040 35,200 198,400 233,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 211 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 4 Fora - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Sct /i'~~aE..r TOWNSHIP 1411 a.z SEC. n - TN-R-W ADDRESS 4G / Z ST. CROIX COUNTY, WISCONSIN #a7_5 -a h tv SUBDIVISIONej° yi LOT LOT SIZE _ L, 3 a-✓ PLAN VIEW Distances and dimensions to meet requirements of IL$R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM fop' ~or~h Lo~ ~N?-._...__~_____._.__.-----a► O 7= ~Y I !oa/ofC• i z/rz y i INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used /'2o-'to, d„ /Vu) Elevation of vertical reference point: z2 Proposed slope at site: /Z /j SEPTIC TANK: Manufacturer: ` Liquid Capacity: Number of rings used:_ Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: -C% S Number of feet from nearest Road: Front,O Side Rear, O feet -From nearest propert^ line Front,O Side, Rear,lO /✓0 feet Number of feet from: well $ building: 7 sr 5,t~... c} (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 4 PUMP CHAMBER / V ~ Liquid Capacity: Manufacturer: 1 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 fe#t•-from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: 6N. U¢Lf6aa / Trench: ~3 Width: Length : 52~ Number of Lines : Area Built: Fill depth to top of pipe: ~O Number of feet from nearest property line: Front, O Side, O Rear, Ft./O 1 ' Number of feet from well: J10 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: Elevation of bottom of tank: Number of rings used: j Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. I Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: / Plumber on job: Dated: s License Number: 3/84:mj 'F REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION -LATIONS PERCOLATION TESTS (115) MADISOP.O. BOX N, WI 7969 (H63.09(1) & Chapter 145.045) LOCATIOlJ: SECTION: TOWNSHIP/au~ua LOT N0.:BLK. NO.: SUBDIVISION NAME: /U? N/R/9d (o COUNTY: OWNER'S/BUYER'S NAME: MA AI [ 8~i / r~ 1 r LING ADDRESS: USE NO. B3 EDRM7~F~/vAL DESCRIPTION: DATES OBSERVATIONS MADE PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence New ❑Replace ~2S _f7u SCE r M P 9.x 2 - RATING: S= Site suitable for system U= Site unsuitable for system d~} _6 L &*re_ lpX CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-1 -FILL HOLDING TANK: RECOMMENDED/ SYSTEM-(optional) ❑U ❑S CCU 9S ❑U ❑S 19U ❑S 90 If Percolation Tests are NOT required DESIGN RATE: F' any portion the tested area is the / under s.H63.09(5)(b), indicate: L Floodplain, indicate Floodplain elevation: ~ R PR FI E DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-FPd2tifg 'CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH+Wd, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) . B eZ "d I •O~le If rs B- -3 9"44 f-;? An zb16 - B u s[ s 3. v B s 4 er o B, s . 13- - I d " 31, 1761 S -f .1 ~ •iro6 y, 7 41 S ^ B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 41 AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P 3 P L 3 P-o3 „2 L 3 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 I 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 lo~ Re O j. S ► P10 a TN F oPI Caf• S - y(3 O Peo,es 7,10S'. t BeWd„, -C•~ rey Fa "'re'yG' I-7A' `?t pep e % lea~~ 5, ,00?0., to 0, I, the unde hereby certify a soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrati nd tha` 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): I s S~Y~ Y 7Is-3 CST ATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ;I HR-SBD-6395 (R. 02/82) - OVER - rf ~n i; f t i-{ C£r ..,5 - dirt' ,t .df d 176t s r-4 s b i; i s . e r . c r j „r h1 T c C_ F3 r 3 9 y E ~ z~ f [ s s~ E ~f ~r A£ _ rrvr i'i" <,ti 4 i ' r , .'C;MGs~ 4. a C i <r e ti£.f5 £c~4£ st` aY a~ a5t~t, =jJ=` r I ` Form -STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. T N-R W ADDRESS /~1 X Z V Z ST. CROIX COUNTY, WISCONSIN SUBDIVISIONe,,,f;,r LA.) LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILH.R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r I I I I I ~ I ~ ' I I I V 7I J, !3 iio o to Now 5 Ce;,,, leaiafC I t~YZN INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ~n! d't- /✓u tn,~ r; r Elevation of vertical reference point: Proposed slope at site:/2 SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: ~2 Tank manhole cover elevation: FAG Tank Inlet Elevation: `d Tank Outlet Elevation: ' v S Number of feet from nearest Road: Front 10 Side, Rear, O /416, feet From nearest property line Front,OSide,nRear,O feet Number of feet from: well Co `C building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE { PUMP CHAMBER f, 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: Cok u 4-d,, fI.OYca ` Trench: Width: W Lenith: SZ _ Number of Lines: 3 Area Built:_ Z,3 Fill depth to top of pipe: ~d Number of feet from nearest property lire: Front, O Side, O Rear , Ft./d Number of feet from well: Jto Number of feet from building: 5-,S- (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 : rtl'e)l Plumber on job: License Number : 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P, O.* BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING ` MCONVENTIONAL ❑ A LTE R NAT I V E ware Plan LD. Number: ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound assigned) NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE Sam Mi2Pen RR#1, Bax 282, Huct5an, GJI J ~i BENCH MARK (Permanent reference Point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV. CST REF. PT. ELEV SOU SE, See.29, T29N-R19W, Town o4 Hudson,LGt#4, SeAiin ptc.apenty CSM Nam, of Plumber MP/MPRSW No. 'County. Sanitary Permit Number: Daugtaz Sttohbeen 5432 St. CtLoix S$9ab SEPTIC TANK/HOLDING TANK: MANUFACTURER' LIQUID CAPACITY. TANK INLET ELE V.. TANK OUTLET ELE V.. WARNING LABEL LOCKING COVER >\ti PROVIDED'. ED0V IDED. BEDDING J F. ❑NO ❑YES ❑NO VENT DIA.: VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING. VTO FRESH JENT ALARM. FEET FROM LINE r AIR INLET.:, YES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING'. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKIECOVER PROVIDED. PROVIYES ❑NO ❑YES ❑NO ❑GALLONS PER CYCLE: UMPAND L NUMBER OF PROPERTY WELL BUILDIN(DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENr; TH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH. LENGTH. NO. OF DISTR. PIP SP CING. COVER BED/TRENCH r INSIDE DIA Plrs LIQUID DIMENSIONS rRENC+gs IILArfl1n f , PIT DEPTH t l l GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR. PIPE DISTR.J~WE MATERIAL. NO DISTR. NUMBER OF BELOW PIPES ABOVE COVER ELEV INLET ELEV. END. PROPERTY WELL BUILDING. VENT TO FRESH PIPES:? LINE: FEET FROM ~ AIR/Iy(_ET, NEAREST-► f t! MOUND SYSTEM: f 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 DEPTH OVER TRENCH BED - ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH: BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED. CENTER EDGES ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PINE MATERIAL & MARKING ELEVATION AND ELEV. ELEV DIA Elev. PIPES DIn: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURFr: TITLE DII_HR SBD 6710 (R. 01/82) wlSCOnsIn APPLICATION FOR SANITARY PERMIT ~DILH R COUNTY ~M oERRRTmEnr of (PLB 67) - InOUSTRV,LRBOR&HUMRnRELRTI / UNIFORM SANITARY PERMIT # / -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER M ILING ADDRESS PROPERTY LOCATION CITY: Su`1/4.5 =1/4, S 2- , TZ% N, R/ R (Dr kcc/sc, • A LOT NUMBER BLOCK NUMBER SUBDIVISIbN NAME TF' T=. EAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER k Cl • f TYPE OF BUILDING OR USE SERVED M 1 or 2 Family Number of Bedrooms: ❑ Public (Specify: THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Replacement Soil Absorption System El Repair ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Ly Seepaye Bed ❑ Seepage Trench System In-Fill ❑ Seepage Pit El Holding Tank ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. issued Total # of Prefab. Site Septic Tank Capacity Gallons Tanks Concrete Constructed Steel Fiberglass Plastic -J Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: i -s IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Gallons Ta_ Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump/Siphon Chamber y Manufacturer: PERCOLATION RATE ABSORPTION AREA (Minutes per inch): REQUIRED (Square Feet : ABSORPTION AREA WATER SUPPLY: PROPOSED (Square Feet): c l S`'"~ ❑ 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): Signature: Q~ d MP/MPRSW No.: Phone Number: let ✓V t J `~~""(G Plum is Address: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ~~~C~/ ~ ❑ Disapproved 4J ❑ Owner Given Initial Reason for Disapproval: - Approved Adverse Determination 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. Wisconsin APPLICATION FOR SANITARY PERMIT COUNTY I(PLB 67) oOUSTImLR ov UNIFORM SANITARY PERMIT # - InOUSTRV,LgBOR6NUTgn RELRTIOns -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 M I IN4ADDRESS PROPERTY LOCATION I"tt~!/s0 H 441114S61/4, S Z'~ , Tzf, N, R / t (or W TOWN OF LOT NUMBER BLOCK NUMBER SUBDIVISION NAM NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER $K1 F' H Re . SIB'' 1 914 v Z. w► ; S. h TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): THIS PERMIT IS FOR A: X 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. 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 DO Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure ~J~ Total #of Prefab. Site Plastic Gallons Tanks Concrete Constructed Steel Fiberglass 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): ❑ Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: MP/MPRSW No.: Phone Number: l~- 7 f s~ Y jr l )7 ~j Plumbgiss Address: Name of Designer: z~~ rY e'v :v , 1i t i i l ~j , y D rt t COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: /4 ❑ Disapproved C, tj ^L ~'l-, j V, ❑ Owner Given Initial JJ Approve 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. l" u ' ~ In 00 r U d VIC ell -P 6\ 00 a ~ ~ so i M (y s -C ! C c i 1 I I ► Pw ~ v o w It, 11 F t4 o r 0 N • ~ i I I ( I J i I 1 ~ as ~ I I I C T.~ 00 S;U4 ~ i L ~ S L j Y d'~'t3 to jDp l 3r 41 2~. O SAMt Mil.l.~t~ I` o.,s.. For~►~r g..~t:+, ~~.Q.~.trty ~.s.M. B.ItI. ~ s IA Q.. . ~ pp Yart. i/eriL. As~. p 'vim 2y i•/ ~o i h?" i! f 7% IV, W !0r L• rr~~r' o A w`Y TAP A ~7' P., C- S S tt rh L d F I Y= /P o CI, ao~C-5 C84,c KL-ta W-) S ►,r,c o.11 4 Cq, b% 4L Yw~t• a~~T~r~~ 4~~%»~~w~S 00 AI 7 I o i IATj 9. vfc~' 14 38~---~ 3r zd SAM MILLER, dN3~. hoawt...r gs,rt:H, TtoQ~l~~l ~ . 1~~ . //o r 4 X ~!L 1.et # y to Wi•Ba 1S ~l ZX S Z. (.~1a11 --SS.. ~.1 B./L~ s t~1a- Yar~:1F/ari L. ~s~. P." ~~1/~. w,,,Y zy ~C Zy i h e /f ti,. IV, W , /ot Gs r."40- o /1 P f ~4 l J oT P e.. EL -6 sI /V E. lovv -1 C. -,CV- fa 6 Yw~. a""pT~,. ~ Q14 i/aw►s k,/ S Ll IrAL r . qv C, z (Cy LJ .to r a E }x// fi .d { ~Gw 6~t~e ~t~ y jjq S 1 A)e sp r~ ~ 2Gl~x Z •1 w . ~1 ,r N LAJ i ~ z, 1 1IR i I ~ i Lr, - W \i i L 0 7 Form - S T C 100 Owner of Property Location of Property 5l~t/ ~4 SF SectioL,2-; T Z? N R Tow11ahip doh Mailing Address Subdivision Naule24, ,way-- aQrl~•N 4.0 ~~/~j/ C',•S m Lot Number Val, Vp 14z- ~ Previous Owner of Property f5Y-ii R.-/ A. Total Size of Parcel Z 7 f~GQ~ 3 Date Parcel Was Created Are all corners identifiable? Yes No Include with this application one of the foilowing: .Certified Survey Map .Deed . and Contract, or .Othe - cuu(ent which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. 313 O 7 Z ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. 130 7 Z ) SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED L H y S T C - 105 r r H SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County d y OWNER/BUYER S ROUTE/BOX NUMBER Z Fire Number CI'CY/S'I'A`I'E /OV -4 PROPERTY LUCA` IoN:_S_4/ii„ Secti.c,n 2-1 T_zZ N, R/4?~ Town of St. Croix County, SubdivLsionAdl-, -f e/ yGS~' Lot number T I Improper user 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 uhrae years or sooner, if needed, by a licensed s_eRyte tank lump r. 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 ply 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 L, 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 (i) 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 OWE, 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 meat 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. U ATE-1 _ - - - - 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. i' r O o O 3 r° qt e J. p. of o o C p c co r+ U cv.c 0 L U O= C C 01 O O N O L Rf L U O q o O U L- O C O C U i O N U y E O O C 0 O N 'C. 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