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HomeMy WebLinkAbout030-1072-50-000 n C/) O 3 v o d CD a W _0 CD CD O Cn -I z 0 ~ 0 ~ . o w co ID m N V 3 m o ° O r- CD o N (DD N O n C, CD W m o o O 3 w -4 0 0 y C v 0 N CA fD O. D fl N fl 1 0 W M. -u m C: CD 33 C: C) O (\1 r '0 (D 03 41 "Oftd CD O ' O CD CD OD co D n D r C/) C ~1 Uf cn cn ~3D N :2 !i O O O o "WA z o C- T N In t/~ cn o W D A - ~ y •p ~ N M = CD 0 (O CD N c CD cn ;L CD w a r! N z co O o D a '=o o. E ~ - H ID N C C(D N N O N C CD CD w N a 7 EL 3 -4 (40 z (D p O A z n z O A v a 0 G) rn w co 0 CL z 0 r o ° 3 cn CD y z < CD N ~ 6 N > N Q N vi D T X N - o N Z CL (D " a Cp D y a ~ N Z S CD a 00 00 03 m ~ o v w ~ CD 3• CD I y o 7 N CD = o .a o = CD O A la CD hp O H1 O N O (D O ZJ 0 Cl- 02/18/2005 04:45 PM Parcel 030-1072-50-000 PAGE 1 OF 1 Alt. Parcel 26.30.19.254E 030 - TOWN OF SAINT JOSEPH ST. CROIX COUNTY, WISCONSIN Current X Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner * STILES, THOMAS W & LORI J THOMAS W & LORI J STILES 717 TERRIER LN SOMERSET WI 54025 ' =Primary Districts: SC = School SP = Special Property Address(es): Type Dist # Description 717 TERRIER LA SC 5432 SCH D OF SOMERSET SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 4.470 Plat: N/A-NOT AVAILABLE SEC 26 T30N R19W PT GL 5 LOT B OF CSM Block/Condo Bldg: 2/553 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/01/2004 767620 2298/66 0 6 WD 07/23/1997 925/246 7/23/1997 07/2311997 924/197 more... 2004 SUMMARY Bill M Fair Market Value: Assessed with: 5340 511,200 Last Changed: 07/08/2004 Valuations: Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.470 293,700 209,200 502,900 NO Totals for 2004: General Property 4.470 293,700 209,200 502,900 Woodland 0.000 0 0 Totals for 2003: General Property 4.470 193,000 169,600 362,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: Category Amount User Special Code 706.08 040-OTHER ASSM'T SPECIAL ASSESSMENT Special Assessments Special Charges Delinquent Charges 00 Total 706.08 0.00 COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 I:ROlk LUN11`i. 'T. CROIX COUNT'i nr-i>OeiT siAiF: COURTHOUSE DATE RECEIVFit'i HUDSON. WI 34016 LD 2- b, ._OCATION. 717 c , .'OLLECTOR* M4 Jeri SOURCE OF SAMPLE. COLIFORM. 0 INTERPRETATION. Bacter i o log - d u o NITRATE-N. . 1 ppm Above 10 ppm exceeds tt«> Co l i f orm Bacteria/140 OF,~NDEPENoe, V 1, O A VZ( D PROFESSIONAL LABORATORY SERVICES SINCE 1952 -ZO ERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 962 - 3121 800 -962 - 5227 cz:w t.hu3x zuiv:. CROIX C" f REPORT DATE 1. 11/08/- JRTHOUSE IK#TE CUVED: SON, WI 54016 v OWNER. Bill Williamson LOCATION** 717 Terrier Lane, Some;- COLLECTORS M# Jenkins SOURCE OF SAMPLE: flitch=+ COLIFORMS 80 /100 INTERPRETATION; Bacter;r NITRATE-NS C 1 P.% Above I" , ry Coliform Bacteria/P .OF.\NDEDENp0. O V F 1 ~.7 ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 "COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 . CROIX ZONING REPORT NO,* 12887/01 PAGE 1 CROIX COUNTY REPORT TIATE; 10/25/91 GURTHOUSE DATE RECEIVED** 10/23/91 `JDSON, WI 54016 r Bill Williamson ar Lane, Somerset >OURCE OF SAMPLE*# Outside faucet .01LIFOR4i 36 /100 of NTERPRETATION. Bacteriologically UNSAFE. < 1 ppm 9 Above 10 ppm exceeds the recommended Public Drinking Water Standard, Nitrate-Nitrogen, Ong/L L.Ai~ "iELHNIGIAN ram Gar,& WI Approved Lab No. 19 2~G~9 C0" 7 ~ 41 OF.\NDEPENOp~ L O` ~P u s z { deans "LESS THAN" Detectable Level Approved 1- PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY ZONING OFFICE r` St. Croix County Courthouse 911 4th Street j Hudson, WI 54016 0, 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 'Go Lhe above address. Testing ~,~ill be done ,s soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25.00 $25.00 _ (For nitrates and coliform bacteria) WATER TESTING FEE: $127.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 $25.00 (Determines if system is properly functioning at time of inspection) Property owner's name Bill Williamson Property owner's address 717 Terrier Lane Somerset WI Legal Description 1/4 of the 1/4 of Section, T N-R Town of Lot Number Subdivision Name FIRE NUMBER LOCK BOX NUMBER Color of house Realty sign by house?L.IIf so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. I'LZ k' t~1 Firm or individual requesting services:~~ U)Ld~ Telephone Number 1~ 3 REPORT TO BE SENT TO: Closing date ( ( Signature _c > i ST. CROIX COUNTY ~T ) WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 44 LT Y 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Oct. 23, 1991 Peg Starke First Nat'l Bank/Hudson 307 2nd St. Hudson, WI 54016 Dear Ms. Starke: An inspection of the septic system on the property Bill Willianson located at 717 Terrier Lane, Somerset, WI, was conducted on Oct. 22, 1991. At the time of the inspection, a water sample was obtained for testing. The results of that test will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. i cerely, Ma J. r enkins Assistant Zoning Administrator cj 11/1/91 MARY - THERE IS A SAND FILTER IN THE BASEMENT. THERE IS A SEPARATE TAP IN THE KITCHEN WITH CARBON FILTER FOR BETTER TASTING DRINKING WATER. ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 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. WATER TESTING----------------------------FEE: $ 25.00 RETEST $15.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $175.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at time of inspection) Property owner's name Bill Williamson Property owner's address 717 Terrier Lane - Somerset, WI Legal Description 1/4 of the 1/4 of Section 26 , T 30NN-R 19W Town of St Joseph Lot Number Govt 5 Subdivision Name FIRE NUMBER LOCK BOX NUMBER AU Color of house Realty sign by house? NO If so, list firm: MARY HAS ALREADY BEEN THERE. THIS IS A RE-TEST. PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual re uesting services: Jenny Olson Telephone Number 386 207 REPORT TO BE SENT TO: envy son Century 21 er e sen- u Closing date NEED ASAP. 706 19th r-)L_re_et7b Signature Hudson, 54016 OCT. 011- ll~f Form - S T C - 104 j AS BUILT SANITARY SYSTEM REPORT q OWNER TOWNSHIP 5_1' SE/'~~ SEC. 2-6 T 30 N-R W 6t~ ADDRESS /TWt- ST. CROIX COUNTY, WISCONSIN C 5/" 3L0,Ae l f SUBDIVISION Uo% z-- b.5S-3 LOT 1 LOT SIZE S PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM solliv S Ev~tf1O ~r G q J ~a oQ` o 3" 11, )_0 Awl ww z~ r~ / ~ l iPF'ti.ti%vS . ~ 5 ~lol~ K INDICATE NORTH ARROW PL,. SoiI TtST- : Tap BENCHMARK: Describe the vertical reference point used s~ '4~0~1r- Soo LO t` Li J~ i Elevation of vertical reference point: /0v Proposed slope at site: SEPTIC TANK: Manufacturer: ~_EKf Liquid Capacity: Number of rings used: ~~NE Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: r Number of feet from nearest Road: Front,@ Side, Rear, O dU~"~ Zd0 feet So, From nearest property line Front, 0Side ,©Rear, 0 5 feet wE11 N07" 1A),S¢fj1Ev To Number of feet from: well D4-7-e' , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE v PUMP CHAMBER Manufacturer: Liquid Capacit Pump Model: mp/Siphon Manuf urer: Pump Size Elevation of inlet: ttom of tank elevation: Pump off switch elevation: lons per cycle: Alarm Manufacturer: Alarm Swit T pe: Number of feet f m 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: . R Width: Length: S Number of Lines: Z Area Built: Fill depth to top of pipe: y0 /441- So , Number of feet from nearest property line: Front, O Side, O Rear, O Ft .S Number of feet from well : CAF// tinT /N S7`~~/gyp J/~? , Number of feet from building: 3 6 (Include distances on plot plan). SEEPAGE PIT Size: Number ts: iameter: Liquid depth: Bot of seepage pit elevate Area Built: Has either a p box O or distribution box O been used on any of the above soil absorb "on sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings u E e ion of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, ide, O Rear,(~ FFt Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector Dated: If F1 Plumber on job: License Numi)er : HDMFSITE SEPTIC PLUMBING CO. RT. 3 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRICHT WIS. MASTER PLUMBER LIC. NO. 3307 MARS MINN. INSTALLER & DESIGNER L►C. NO. 00663 3/84:mj DEPARTMENT OF INDUSTRY LABOR & HUMAN RELATION Po. Box 79S INSPECTION REPORT FOR MADISON, WI 53707 PRIVATE SEWAGE SYSTEMS SAFETY F CONVENTIONAL BUREAU O, NAME OF PERMIT HOLDER ❑ Holding Tank DALTERNATIVE ❑ In-Ground Pressure slate Pla" LD. Nu,nb,.,, El Mound ' Bill Williamson ADDRESS OF PERMIT HOLDER BENCH MARK IPermanem reference poem) DESCRIBE IF DIFFERENT I-ROM 86 PL Grenada Ln. N • , Oakdale INSPECTION DATE: MN 55109 a NE NW, Section 26, T30N-R19W ~Q ~ rS =J~~ Name of Plumhe,. , Town of St. Joseph, Lot "B" REF. PT. ELEV.: CST REF P7 ELEV Robert Ulbricht MP/MPR$W " 3307 ° Co-ty SEPTIC TANK/HOLDING St • CYO 1X Sanitary Permit Npe, TANK: 64877''- NUFACTURER. 1 ? LIQUID CAPACITY: w J TANK INLET ELEV. TANK OUTLET ELEV WARNING LABEL BEDDING . : VENT DIA.: PROVIDED: LOCKING COVER VENT MATL. - PROVIDED HIGH WATER U ) DYES ONO DYES NO ALARM NUMBER OF ROAD DYES ONO FEET FROM PROPERTY WELL DYES NO NEAREST j' LINE, BUILDING vENrroFRESH DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPgC17 V PUMP MODEL PUMP/SIPHON MAN,LI FIRER GALLONS PER CYCLE YES NO WARNING LABEL ` PROVIDED: LOCKING COVER (DIFFERENCE BETWEEN PUMP AND CONTROLSOPERATIONAL PROVIDED PUMP ON AND OFF) NU BER OF PROPERTY DYES ONO DYES ONO SOIL ABSORPTION SYSTEM. Check the soil moisture at the ONO PE/ET FROM NE WELL BUILDING VENT To FRESH DYES : I AIR INLET Or excavation. (If soil can be rolled into a depth of plowing NENCTH EAREST DIAMETER MATERI L AN D M the soil is dry enough to continue.) were, construction shall cease until FORCE Aq RKING CONVENTIONAL SYSTEM: MAIN BED/TRENCH WIDTH LENGTH DIMENSIONS D H No of [57TR PIPE CINC; CoVER 0 TRENCHES GRAVEL DEPTH titATERIAL:, F L L DE INSIDE CIA -PITS BELOW PIPES IPTH DISTR. PIPE DIS PIT DEPTH LIQUID ABOVE COVER ELAV INLET TR. PIPE DISTq plpE MATERIAL / DEPTH ELEV END..U No DI 'TR NUMBER OF PROPERTY J.~~, PIPES WELL. FEET FROM LINE: BUILDING: VENT TO FRESH MOUND SYSTEM: NEAR ESAIR INLE Mound site plowed perpendicular to slope and furrows thrown upslope: Check the texture of the fill material for mound systems to make certain that it PROVIDE A DIAGRAM OFS LESTEM VA- DYES ONO meets the criteria for medium sand. ON REVERSE SIDE. SHOW EEVA SOIL COVER TEXTURE - TIONS MEASURED. PERMANENT MARKERS. OBSERVATION WELLS CENTER DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED EDGES DEPTH of TopsolL N ❑ YES SODDED YE ONO EDED r PRESSURIZED DISTRIBUTION MULCHED SYSTEM: DYE ❑ BED/TRENCH WIDTH YES ❑Np DYES ONO LENGTH. NO. OF DIMENSIONS TRENCHES LATERAL SPACING GRAVEL DEP H BELOW PIPF FILL DEPTH ABOVE COVER MANIFOLD PUMP ELEVATION AND ELEV ELEV DMIAANIFOLD DISTR PIPE ELEV. MANIFOL g7ERIAL. NO. DISTR DISTRIBUTION PIPES DISTR PIPE DISTRIBUTION PIPE MATERIAL & MARKING INFORMATION HOLE slzE HOLE sPgclNC DRILLED CORRECTLY D A COVER MATERIAL. ❑ YES VERTICAL LIFT CORRESPONDS TO APPROVED COMMENTS: PERMANENT MARKERS: D NO PLANS. OBSERVATION WELLS DYES ONO .'I j OYES NO NUMBER OF PROPERTY WELL BUILDING ❑ YES ❑ NO FEET FROM LINE: NEAREST n I v ch System on se Side. Retain in county file for audit. SIGNATURE. - BD 6710 (R. 01/82) TITLE wlSCOnsIn APPLICATION FOR SANITARY PERMIT ©ILHR 5~~/~ COUNTY (PLB 67) ~ oERRRT menT oc UNIFORM SANITARY PERMIT # InOUSTR4, LRBOR 6NUMRn RELRTIOnS -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PR PERTY OWNER MAILING ADDRESS ~Y/ PROPERTY LOCATION CITY: AMA /4 N01 14, S , T 3~ N, R q / E (o() W To\ oF: h LOT NUMBER BLS` NUMBER ISUBDIVISION LAME ~i NSD, LAKE O RK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 'JJyVt J 7!/,`j 7j / 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. K 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: k /yQU 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: j PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): /REQUIRED (Square Feet): PROPOSED (Square Feet): (p 1-XSL 6.2 ye 'X ~ Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Pr04ESITE SEPTIC PLUMBING CO. Signature: M94MPRSW No.: Phone Number: RT. 3 O'NEIL RD., HUDSON, WIS 540 330 ~ (7 S) r~~~f Plumber's Address: ROHERT UL RICHT Name of Designer: WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MINN INSITA-11-EIR & DESIGNER 06. No. 00663 COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: Disapproved ~t Gj/r~LU j~ r' ❑ Owner Given Initial I ~I d Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: 'LHR-SBD 6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber l INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 4 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. 'AgA . HOMESITE SEPTIC PLUMBING CO. RT. 3 O'NEIL RD.: HUDSON: WIS. 54016 ROBERT ULBRICHT WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. NnC!N. IN9TALlER i DESIGNER LIC. NO 04t 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 Location of Propert Section 2 , T30 N - R ~ W Township Mailing Address 34 ,9 6;-Oe UvfPA //0, Subdivision Name AW L . ~s(3 (/c/f,L Lot Number Previous Owner of Property Z Total Size of Parcel Date Parcel was Created 1- - / h 7Z Are all corners and lot lines identifiable?_ Yes No Is this property being developed for resale (spec house) ? Yes No Volume CO and Page Number 33 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) een ti6y that aU .6 to tementa on .th i a 6onm aice t.u.e to the best o6 my (oun ) knowte.dge; that I (we) am (ane) the owneA (a) o6 the pnope/c ty des c 4 i.bed in .this in6o4mati,on 6oAm, by viAtue o6 a waAAanty deed neeonded in the 066ice o6 the County Reg.iz teK o6 Deeda as Document No. 3 FS F,? ; and that I (we) peesentty own the ptoposed 4ite bon the sewage di4po,6ZT-zystem (on 1 (we) have obtained an easement, to nun with the above descAibed pupenty, bon the eons.tAueti,on o6 said system, and the same has been duty tecoAded in the 066.tee o6 the County Reg.i,6ten o6 Deeds, as Document No. ) Z z~g SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED .-t H Z Cn HOMESITE SEPTIC PLUMBING CO. RT. aO'NEIL RD., HUDSON, WIS. 54016 S T C - 105 r • ROBERT ULBRICHT r WIS. MASTER PLUMBER LIC. NO. 3307 M.RR.S. 9 MINN. INSTALLER &DESIGNER LIC. NO. 00663 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z 0 H OWNERi' t+7 ROUTE/BOX NUMBER Fire Number CITY/STATE `LIP PROPERTY LOCATION: '4, Section T30 N, RW, Town of St. Croix County, csM ~ YG 7G ~ Subdivision UoP. Z $S3 Lot number I 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. H 0 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- v 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. S I G N E D DATE :2- S"- per' St. Croix County Zoning Office P.O. Box 9£- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. 0 Z O > O C cn hu oc CD O O O= O E C 3 3.► U ca tr._ p ff O= C e N O F- O O) c 0-0 4 O a) o U i N C O O = U m v N yLtO. C'~~ w cC7 O N 7 N a ;g: 0 -0 o cNVV c a~ M c M C3 c -:t -2 10 o c _ D_ C oN o °w U co i N N N N C CI IW 0 CD CL m 0 0 -C $ (D E o~ W C c a ca 30,3:0= ~N C C U •L N O (D U) 2i .S L- -Zt r Q 't N N E U O p O L 0- N • Z 0 ~ H ~ cc - " Co li V) Z N a? o N N F' co • 0 c M aw C O 0 3 t7 _ ti. 3 0 O CD M O a c `U z O D U cC " U O; j 0I¢ c0 = O (D N cc c m a n , a`o co O N C O C O` O N c0 O N ` Q L . CU M N cu c o O E 0 v)Z.s c O O W O O O C C t ` .r o cu o 0 C C co 0)0) CD 0 y N p U E U Y O t C D w = L Of O U Co N. C CL RT y U _ ► , fV a) 0 0 0- 00 M i U ) IC3 0•~~ 3 W N 3 N N 3 0 M O C O Q n 0 `t C o N O c a N L 0 a pl 40 rn0) E c Lt c z c`o c`v o :3 o~ y cvt c a c o w C N U U Oy 3 N C O N C N N `O N O E (V vi N ca H 0 cu m m W ~ _J O ~ / f ~~/~iit~lfo,~ S~e~ ~~•G L o f cs,~ 3 y~ a~ 2- r. ss~ p i" L B ~ 7 PLOT and i.RO5J S6CrJON PLANS I ek0?05£o ,Ell o~ t l t `3 0.~~ X7'0 o ZOX73 r ~3 • tp zD LTf,pN~f Tf ' • Ih ~ .x 33 i ' r S 6IVrD i L CE,t/S~ 7 Fresh Air Inlets And Observation Pipe solL. TE5r03y (3y HOMESITE TES-l' :NG Approved Vent Cap RT. 3, c'Z~i jI RCS. _ HUDSON, WIS. 41016 Minimum 12" Above Final Grade i /11 ,t-X/',11 v,A y2- " Above Pipe 4" Cast Iron i o Final Grade Vent Pipe Marsh Hay Or Synthetic Covering min. 2" Aggregate Over Pipe Distribution 0 0 0 T e e V/f T/O 'V Pipe 700- ~e' 5611 Aggregate o Perforated Pipe Below Beneath Pipe o Coupling Terminating At Bottom Of System EPARTMENTOF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, DIVISION N H IUMA AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS \ / MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TWNS4-PA-LL Y: LOT NO.: BLK. NO.: SUBDIVISION NAME: rv6 '/a '/a 16 /T JO N/R /9 E (o JV " 7`j !3 s. rt. 3Y 6 76 r/ UUP. 2- h~ r, COUNTY: OWNER'Sft"ty_SR'S NAME: MAILING ADDRESS: S`/ CcD i p 3 i Gv i fO r'h Alf o 3 ~l Z G.P~,v t ZV, Ar 04 o USE ]7N0.BED7RNC] 7MMER_CIALDESCWHUN: DATES OBSERVATIONS MADE Residence PROFIILE DESCRIPTIIONS: PERCOLATION TESTS: New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system s-0,6_5- 7Ao,,hl-4s CCOf!N:VE N TIONAL: MOUND: IN-GRUNDPHOLDING ZTA K: RECOMMENDED SYSTEM:(optonal) S ❑u Rs ❑U )s LIu EA ®u ❑s r~~~~L If Percolation Tests are NOT required DESIGN RATE: C'Gy/S S If any portion of the tested area is in the under s.1463.09(5)(b), indicate: ::Z7__ Floodplain, indicate Floodplain elevation: Z/ PROFILE DESCRIPTIONS iN (D9_ci,4,t/_ `F'! , BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-IN. CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B r•~ ~~C~'O r rr.G~' rJ• d!!ri o' %'fU 0~1~9 Q'/9V. A Al S~ > 5e' 12,E ate. o /fr .0.0~N • 33 T,fv B- Z 9 L I!0 9 0 P~FRf eS AA- am XOA Ay ?-2- 7, r D~ Qv• OhM r o M //V f /d/ L y r l 0 ' 67 ~Ir . IUD d•1~ S / .v, a71 ff, t 744- ~ B- Sule PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN" Fr? AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH S .r P- P- S 95 / z > 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 percentJ of land slope. I r~r SYSTEM ELEVATION `t U, l ~X ~ Tio - ~_o I 5 ~ • k f ~ ! r I'a y s 9 ryG T ~ ~ • ~ fad , ay1 a ti 0~ /3 ~Er, o z Z _a _ 3 ? [ - r (1 f'f. • Y • f ~00, 0 73' 731 ' r 51 r N 15 /o Coy F ~ur~r $coPQs ~L9Q - 4 ~ zor 96 • .5 Gt1 10- c a~',~~R . ~ 'e--~ ~'h`o~E- f ~ L - o(o - ~ - _ , = ,6~i9C~fj~r3€ ~i `~i' , - 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: HOMESITE SEPTIC PLUMBING CO. 14Ae / / - / C opS ADDRESS: ROBERT CERTIFICATION NUMBER: PHONE NUMBER (optional): ULBRICHT f O l y~ 3A0 - R/,,)O -5- MINN. INSTALLER & DESIGNER LlC. N0.00663 CST NATURE: I LTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. -SBD-6395 (R. 02/82) - OVER - E t and accura~ p tit 3, x.aD:s0 t.3e: i2i ';11,i °a~Ir;. a Ctt t`; tai t£`e y i`FJE a*' t ~")i E_ .i co ttt y ) t t ' V C attta : c) t s. 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