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Parcel 11.30.19.636C 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner O - ENGELS, KAREN M KAREN M ENGELS 704 68TH ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 11 T30N R19W 5A IN SW NW & ALSO IN Block/Condo Bldg: SE NE OF SEC 10 AS DESC IN VOL 481/147 ASSESS WITH P617E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 11-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 08/26/2005 804595 2875/339 QC 07/23/1997 1142/339 07/23/1997 715/389 07/23/1997 481/147 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 032-2037-80-000 Valuations: Last Changed: Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 030-2019-90-000 01/25/2007 11:55 AM PAGE 1 OF 1 Parcel 1.29.20.42660 0 030 - TOWN OF SAINT JOSEPH ST. CROIX COUNTY, WISCONSIN "It urrent X reation Date Historical D Map # Sales Area Application # Permit # Permit Type 00 0 c o T x Addres Owner(s): 0 = Current Owner, C = Current Co-Owner N a 0- SIME, SHERWIN G& ALICE M N S ERWIN & ALICE M SIME 2 3 CEDAR DR W DSON ~I 54016 0 c tricts: SC = SCI$ool SP = Special Property Address(es): Primary T pe Dist Description " 233 CEDAR DR W S 2611 HUDSON S 17001 WITC z o a ~ ~ c m E LL 2 U P CU L gal Description. ¢ 'D Acres: 1.930 Plat: N/A-NOT AVAILABLE S C 1 T29N'R20W rah 2 LOT 2 CSM 5/1433 Block/Condo Bldg: A M'T INS 30-2?-) 4i 0(426J) & Tract(s): (Sec-Twn-Rn 0 0-2(~20~~(4261Z~ E I 9 401/4 1601/4) 0 01 v E L z a m o M N tes:.. I o Parcel History: c z C Date Doc # Vol/Page Type w * 0 Z o C z H E .a .a ~ cri N 1,D) D Bill It Fair Market Value: Assessed with: •►"~w a L 1696 947,800 (~1 co jDs6ription 06 SUI'Ifl Mee~` luatiOtllS: z° m z z Last Changed: 07/09/2004 r- Class C Acres Land Improve Total State Reason &ENTIAL M Gj 11.930 535,900 286,400 822,300 NO °C' c CL 4 -r to y d U L O d N in 0 a U (D Cn U) U) O H H - E I a ~ z i Qtalsfor120.060 0 0 Wiwi t0 - General Property 1.930 535,900 286,400 822,300 N Woodland 0.000 0 0 lf) ~ in cNi o OR ) ° z ,v otals for 205a ~ oeral Pr ertp 1.930 535,900 286,400 822,300 Wo - landg a9.000 0 0 L 'fl N d .m 61 00 6 d ~ }to : H Claim Count: Certification Date: Batch 211 - b 1 o ` 1 v c co r D `o wt~J $ °S}1'e~al' CQce H z Category Amount C) 0 Co Cn N C O d N C. CV) Lb E 0 O cA 1 co O z 2 I- cn co M E d CL d E d c Special Assessments Special Charges Delinquent Charges `1v c o 'o Total 0.00 0.00 0.00 A V a2 0 inv ZOMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 C:C: 16io(p 1 ;a CROIX COUNTY REPORT GATE: 12/19/91. MURTHOUSE L+ATF RECEIVFD: 12/17/91 'TGON. W1. 54011. o52- 0 ~ 1- -2J -60b fiichaF ~ Mann. OCATION: 704-68th St.r Somerset ;_"OLLECTOR: M. ,Jenk i ns =OURCE OF SAMPLE: Kitchen faucet (JLIFORi{2 0 /100 mi. INTERPRETATIONS Bacteriologically SAFE <1 NITRATE-N; C 1 ppm above 10 ppm exceeds the recommended Public Drinking Water Standard. Conform Bacteria/100 ml Nitrate-Nitrogen, mg/L I LAB TECHNICIAN. Pam Gane WI Approved Lab No. 19 OF.WDEPEND EHr V Means "LE 3, THAN" De~effabf,e Level Approved by. m PROFESSIONAL LABORATORY SERVICES SINCE 1952 r ST. CROIX COUNTY ZONING OFFICE 11 St. Croix County Courthouse 911 4th Street Y5) 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. Testinq will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25.00 a S'- D n (For nitrates and coliform bacteria) WATER TESTING FEE: $127.00 (For VOC' S ) aj1-- on SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at time of inspection) ~~C% '►1L~.i'1 c.^►^. (a(4.7-.3~2cf) Property owner's name ~ &ryl r % 0Z V1 Y) Property owner's address `7, o 4 $ 5~ - c-~6 Legal Description 1/4 of the 1/4 of Section T_3QN-R 15tO Town of Lot Number Subdivision Name FIRE NUMBER LOCK BOX NUMBER Color of house Realty sign by house? If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY 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 requesting services: ILt_Z_ { Telephone Number 3~5(n SS 3(~'~~ S r•`/A 5-CN~ ~ LU l ~ Sz-[ O ~ ~ REPORT TO BE SENT TO :i)6Y, XQ/V) Closing date 12 - 2D - Signature ST. CROIX COUNTY C WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE T 911 FOURTH STREET • HUDSON, WI 54016 715 386-4680 Dec. 16, 1991 Doreen White First National Bank/Hudson 307 2nd St. Hudson, WI 54016 Dear Ms. White: An inspection of the septic system on the property of Richard Mann Jr., located at 704 68th St., Somerset, WI, was conducted on Dec. 16, 1991. At the same time 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. Sin erely, Ma~-J.4&J n/kips Assistant Zoning Administrator cj COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 ' i'.....' 4µ.m bT. CkOix COUNT REPORT UAI'E: 11/27.,COURTHOUSE Ito;c Er.F I VET,; 2 HUDSON, WI _ o2o-1112 -C~'-C~71 zj Cart lk Anna t i se ''yrat .,00 10 C ar,good, Hudson l t .lank i ns 1JRGE OF SAMPLE. Kitchen fauc _IFORMI 0 /100 m( 'NTERPRETATION: ',6ove u'e C LAD iEGHNICIANS Pam cane 0 OZ C) ~i WI Approved Lab No. 19 .Ot.NDEDENOpH 1(, O p uj > J p .e f ',i~,_ u_~ -;t^.•'.f:: _ W Cci ' ~c7 tt? s._c..J'.: ,:,ij~1'iiU'e'iJ a PROFESSIONAL LABORATORY SERVICES SINCE 1952 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 Countv 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 (For nitrates and coliform bacteria) WATER TESTING FEE: $127.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 f (Determines if system is properly functioning at time of inspection) O 'n t~( Property owner's name J ~N nJA LISC- N Property owner's address 101(-) 5i ~/Z Q Ll-)66-10 f-I U/~56(\j L--) I O(4~ 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? If 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. Firm or individual requesting services: T° ` , t. Telephone Number -t st ~u ~sO ^I t~ of Nzi rl cnn 307 REPORT TO BE SENT TO: , Closing da e Signature l ST. CROIX COUNTY WISCONSIN -'`'}pry`~;f ZONING OFFICE ST. CROIX COUNTY COURTHOUSE i2l IV 911 FOURTH STREET • HUDSON, WI 54016 715 386-4680 Nov. 26, 1991 Peg Starke First National Bank/Hudson 307 2nd St. Hudson, WI 54016 Dear Ms. Starke: An inspection of the septic system on the property of Carl & Annalise Dyrbye, located at 1010 Starwood, Hudson, WI, was conducted on Nov. 25, 1991. At the same time a water sample was also obtained for testing. The results of that testing 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. n erely, Ma --~.4'Jenkins Assistant Zoning Administrator cj I 5,4104' RP - 5 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 1W 11141VN TOWNSHIP sd'`'~ ='f'SE SEC. T 30 N-R I W ADDRESS Ai.'r-e ST. CROIX COUNTY, WISCONSIN R s SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IL11R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 EXIST/'may ' W&I 33 O Sa l HA~,`~a ~ x.55 ~ , ~y ~rSZ ~ r ~ r j3ED ~3oTro~t ~ jS 9y 50 ~ Sys „ Ro cK Z57 /-ICE s,l>^I o.~- } ZfytD~i r INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 7-zF"= yyj a~ Elevation of vertical reference point: /d 0• i Proposed slope at site: IOzro SEPTIC TANK: Manufacturer: M Liquid Capacity: Number of rings used: 91Me Tank manhole cover elevation: Tank Inlet Elevation: 9'' / Tank Outlet Elevation: Number of feet from nearest Road: Front,© Side,o Rear, O 2 feet From nearest property line Front,©Side,0Rear, 0 feet i Number of feet from: well 33 building: FT-- (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacture r• Liquid Capacity: Pump Model: ump/Siphon Manufacturer: Pump Size Elevation of inlet: m of tank elevation: Pump off switch elevatio Ga ns per cycle: Alarm Manufac er: Alarm Switch-Type: Numb 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: y Trench: r 1 _3 Width: ~2 fT Length: 1 Number of Lines: Z- Area Built: Fill depth to top of pipe: 3 „ Number of feet from nearest property line: Front, Side, O Rear,0 I''t -`~s ' Number of feet from well: (c / rT . Number of feet from building: 3 9 , (Include distances on plot plan). SEEPAGE PIT i 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 ain -of the above soil absorbtion sytems? (Check one). HOLDING TANK Manu urer: Ca y: Number of rings u levation of bottom of tank: Elevation of inl Numb@L-6 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: HOMESITE SEPTIC PLUMBING CO. f Inspector: RT.:3 O'NEIL RD.: HUDSON: WIS. 54016 ROBERT UtBRICHT 7 S WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. Dated: Plumber on job: MINN INSTAI I FR P DFSiGNFR LIG NQ QOS63 License Number: 3/84:mj ??EPARTMEta 9 F , . USTRY; INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMH,'l RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P J. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53701 kRCONVENTIONAL ❑ALTERNATIVE state P 1D N.-be,. - (If ass,9„~I Holding Tank El In-Ground Pressure ❑ Mound d NAME OF PERMIT HOLDER (ADDRESS OF PERMIT HOLDER. I;NSPEC; ION DA rE Mr. & Mrs. Richard Mann R. R. 1, Hwy. 12, Hudson, WI 54016 9-0,)340 MARK (Pe rrnanent reference point) DESCRIBE IF DIFFERENT FROM PLAN .REF PT. ELEV.. CST REF PT. ELFV I SW NW, Section 11, T30N-R19W, Town of Somerset, Lot #12 i Name of Plurn her'. I I IMP!MPRSW No. C~u,iy ISantay Pe,m~i Number. Robert Ulbricht j 3307 St. Croix ( 69597 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAP ACITV. TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL JLOCKING CO ER f _1 C PROVIDED: FIR OV,IIDD~ `~'c/~j`- I O C / / J 54° ZIYES ❑NO -YY1=S ❑NO BEDDING: JVVENT MATL HIGH WATER NUMBER OF ROADJPR OPERTV JWELLJBUILDINGVENT TO FRESH ! JALARM. !FEET FROM LINE AIR INLET. ❑YES O / ❑YE 110 NEAREST f ?,0Z- DOSING CHAMBER: MANUFACTURER 71NG L IQUID CAPACITY PUMP MODEL PUMP;SIPHON MANUFACTURER WARNING LABEL JLOCKING COVER PROVDEDPROVIDED. ES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY JIVE LL BUILDING VENT TO FRESH 1(DIFFERENCE BETWEEN _ FEET FROM LINE AIR INLET PUMP ON AND OFF) CJ YES ~NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER IMATIHIAL 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. PIPE SPACING COVER INSIDE CIA 1 PITS LIQUID BED/TRENCH TRENCHES MA 1AL PIT DEPTH DIMENSIONS 1Z GRAVEL DEPTH FILL DEPTH [E) H. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. ISTR ) NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BE LOW PIPES ABOVE COVER. EL IN LE ELEV. END PIPE ~LINF. AIEL INLET_ qq I FEET FROM - J 2- NEAREST-s " 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 SOIL COVER TEXTURE PE MANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH:BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL'. NO DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.' ELEV.. DIA. ELEV.. PIPES. DIA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL I VERTICAL LIFT CORRESPONDS TO APPROVED I I PLANS. ❑YES ❑NO I ❑YES ❑NO ILDING: COMMENTS: IPERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY JW FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: - j TIT DILHR SBD 6710 (R. 01/82) Wisconsin APPLICATION FOR SANITARY PERMIT COUNTY D1 LHR (PLB 67) UNIFORM SANITARY PERMIT # N OEPQRTm EnT of InOCJ5TRV,LRBOR 6 HumRn RELRTIOnS I -Attach complete plans in accord with s. H63.05, 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 O NER MAILING ADDRESS lv. Ais.2ea AAP 11A,1N Flo PT ht~vi . /Z HODSo,J 4011f, PROPERTY LOCATION tiITY. C D ~EQS E 1 iFhtZAt'E : J SW 1/4 Alw1/4, S T30 N, R I E (or W TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, 4LAKE ' ""moon l< STATE .PLAN I.D. NUMBER 12- TYPE OF BUILDING OR USE SERVED LXJ 1 or 2 Family Number of Bedrooms. 3 ❑ Public (Specify): THIS PERMIT IS rOR A: N 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 00 Lift Pump Tank/Siphon Chamber Holding Tank capacity , Manufacturer: (,l} & S QAV i'GGI/`~~~ L7 40 i-S IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound essure f a Site Steel Fiberglass Plastic Gallo anks onstructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUI ED (Square Feet): PROPOSE (Square Feirt): 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: akP/MPRSW No.: Phone Number: p~ p HOMESITE SEPTIC PLUMBING CO. ~(~!'L, lj_._._ 33D (715) 3Q6" 610 Plumber's Address: ROBERT ULBRICHT Name of Designer: e-NEIL RD., HUDSON: WIS. 54016 - MS. MASTER PLUMBER LIC. NO. 3307 M.P.H. COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved Owner Given Initial ~_/10 45, 1 rApproved 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 • s INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 ` jP 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. a ` 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/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 Al Location of Property J h~ 14, Section T 3O N - R W Township 5,*,, 1 E~ Mailing Address P- G(J/ S Subdivision Name Jy?~-IS Lot Number Previous Owner of Property Total Size of Parcel S- Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes ~ No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed pj'u P1,UM61NG CO. Ndg-NEIL RD- MUOSOS WI&, 54016 2. Land Contract qt. ~ONE11T UL590 1 .S aQB~ QN0.330, MP.R PLUM t W15 tiiGkR SIC. N0.00663 MASTER 3.- Other recordings filed with the Register of Deeds Offi*lN.1N31AL~~a~ 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. PROPERTV OWNER CERTIFICATION I (We) eeAti.6y that att etatement6 on thi.6 6o4m ate tn.u.e to the but o6 my (out) knowCe.dge; that I (we) am (cute) the owneh16) o6 the ptopenty debeh.ibed in thi6 .in6onmat.ion 6onm, by viA tue o6 a watn.anty deed %eco4ded in the 06 6.iee o6 the County Reg.ie.teA o6 Deed6 a.6 Document No. 4031,r 5 ; and that I (we) p4e6entty own the p.4opoded .6 to bon the sewage di4po-A-07-zyAtem (on 1 (we) have obtained an ea6ement, to nun with the above desni.bed pnopehty, bo& the con6tn.uction o6 da.id dyetem, and the aame had been duty % on.ded in the 066.iee o6 the County Regi6ten. o6 Deed6, a6 Document No, "Y03 /9~ ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DA A SIGN H , y ST C- 105 r 9 H e SEPTIC TANK MAINTENANCE AGREEMENT HOMESITESEPTICPLUMBINGCO. RT. 3 O'NEIL RD., HUDSON, WIS. 54016 0 St. Croix County ROBERT ULBRIGHT qIS. MASTER PLUMBER LIC. N0. 3307 M.P.R.S. z MINN. INSTALLER & DESIGNER LIC. NO. 00663 9 OWNER/BUYER Alf ROUTE/BOX NUMBER Fire Number CITY/STATE uDso") C-0 /-S S I PROPERTY LOCATION: 4, N 4i Section T 3o N, R W, Town of SOMAL St. Croix County, Csi`t 1~0 . L_ Subdivision G Lot number-,~'_. 3GS~~s p. Y7 -1(~' V 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 i 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- '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. SIGNED ~ ~GL DATE 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. o P x ~ x m p c r; cn cn iv oc o m v,wmCD ? ~w~mc~c -.~3 o~ r. CD m 4 (a g o o m an co a 3 u~i h i p w w 5 =1 3 cco(COD 0 ~ .2 0 FD' =r D a. _ Lo :E -0 C CO CD W cn 3 = ilu~ m m m ate? r w 'v ~ m cn m n =r N r3 a o-° m m 'Co o m co C o_ o > > s w c° cc o o C- c C _ o c o c 3 o n o z =r C ww 00' 5 wm o( c- <N p•?co Qp mum, o>c m~ O Q oo -w o ° cow°mmof O 2- mCD mac = wo C N m ?NCD C,CD 1:1) T. Z D cn ~ w N~ ~ co Q Z tic'm :3~m m~mm~ma a o. amo 3~ CD o o m ..~'?°cwo w a r: =r > m m N =ro.co N 'O vi w a o c o m C m c 3 ° Co m 3 a Cn CD Lo L•• ..m w 3vw 2 0 0 co c .:C~p 3 N Ly w o a m 1 0 O m CA c c CL O o. w w m= m N m o. CL o ap Q~ * nS(n' N ~co w m CD 3 n m 0 cc ~ co a o N. CD 1 N O Q o m o co c -I m e D m d m 0 a S C =r w 0 t~^ B As gc::3 m0 3 "1m ai, a3' o co o w o. o < 3 v Co z 0 ~o y p DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFEZY & BUILDINGS IN D JS R Y, DIVISION LABOR AND PERCOLATION TESTS (115) P B°X 3707 HUMAN ;RELATIONS MADIS°N, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION SECTIQN TOWNSHIPir'TUTSF~ L LOl NO..BLK.NO.. SUBDIVISION NAME: _'0w 14 _'~4 _ l1 _lT 3D N/R 19 E nor So~aE~SE% ' ~v ~b x. 08 fi s V ygl 1 y 7 /~'p COUNTY: OErO S/BUYER'S NAME: MAILING, ADDRESS: 5 7/4o i X ' ~,PS . /+~~,r/~✓ AFT / ~y0 Y- i2- YUPIoI'), USE DATES OBSERVATIONS MADE -ONS: P R Ol_ATION TESTS: NO. BEDR i COMMERCIAL DESCRIPT-TON PR Flt_E DESCRIPTI W~Residence 3 New ❑Replace X ~-r RATING: S= Site suitable for system U= Site unsuitable for system 1 G ~:ONVEN IION"L. MOUND: IN-GROUNDFF2E~SUf L SYSTFM-IN-FIII_IJOLDIfJGTAU-1H COMMENDEDSYSFEM:(opuonal) r E S ❑U FS ❑U [ZS 0U I ~ S _ t1~ S U Nif?t. riDEc~h/ EF~16F v A.-n D- D I1 Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)Rt) indicate: GG/~. ~S Floodplain indicate Floodplaw elevation: PROFILE DESCRIPTIONS rN 1jRGlh fL• BORINGS TOTAL. DEPTf1 TO GROUNDWATEP CHARACTER OF SOIL WITH THICKNESS, COLOR TEXTURE, AND DEPTH NUMBER DEPFf4 ELEVATION -OBSERVED ESI. HIGHEST - TO BEDROCK IF OBSERVED (SEE ABBRV.ON-PACK B > N - o /~~P . ~ B- Z / S /0 0.0 1 /kr- S s,oo,- S ' ✓ 1 /i "w 0C Boyps DAP • /s . 6o3~a w IB-~ ;9~ 9~.~y~- d{. j~'W;DedANns G~ of oP. ~autse ~s. C / ~3 6~ S fs, ;Z.6 .Qv .--4x~uo F T3 P , B 3 ( /S X G.3 R~tHDS Qom. ~S. Q-s-------- 1 - - <p vie Sr O.P. S . PERCOLATION TESTS FESI DEP Fh1 WA I ER IN FIOLF TES F T IME DROI IN WA I IR I_C VI t INCI IFS RATE MIND-1 ES NUMBER I'r' AI 1 ER S'%EI LING INTERVAL-MIN. LriirtD i MOO 2 i'ER10D 3 - PER INCH 30 2- P- P. z Z -1-~Q - PLOT PLAN: Shovv 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 and slope. 44 SYSTEM ELEVATION (DL O u l+ NoR ~G~ Lo r - ~ S s c A e- P - yo ` IUD gm , ~5 ® z IS a 3 si 6 nl r ~~5 0_ 9y `/yS 03, a, y , 0 of sly = tk - w 3 e • K Slif,E~EU dUT I, the undersigns d, herehy certify that the soil tests reported on this ow) were made by mr, in accord with the procedures and methods s{x:cified in the ''"I Conlin Administrative Code, and that the data recorded and the location of the tests are correct to the hest of my knowledge and belief. •NAME (print) ~TE_ TS WERE COMPLETE/D~ON iIC PLUtiil31NG CO. y -/`~Q S PDDRE fTIf ICAI ION NUMBER PF~ f U E R (o pli Rudf l utBr2lt,H1 ,f~ -01. y~L_ f 6 (D / I is Q(1 LM N- i ' - -L- ~11NP; Ifa3TALlE-it tt DESIGNER UC. NU. 00663 CST SIGNATUR - DISTRIBUTION: Or:gin;J .r:id one coley to LCXttrl Authority, Property Owner and Soil Tester. DILHR-S13D-6395 (R. 02/82) -OVER - ,f?,Pp yc f- -1 S~~JE.t <Sr j S . ~s \o Q~t~i~`0 ~ ALA. \ 31 O .13s 'S 70 /-A- ~j 0 /00 D Pys ~~Pv cc) 3 v L SEE I^\ V 0 pRp~o s~~ lod > SD Fresh Air Inlets And Observation Pipe V l~ Approved Vent Cap Minimum 12 Above / F i n a l Grade N,AXItio~ o F 4" Cast Iron ~(L Above Pipe - Vent Pipe -io Final Grade Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution -Tee Pipe _ o 0000, TIAI SOIL TFST , Aggregate 0 Perforated Pipe Below Beneath Pipe - f~~v~ fIDU ~y. S 0 Coupling Terminating At Bottom Of System ' o tom, O y W Y a~ m R, n y N 1 d C c~, Cl j c y t T Z _ Q \ ni uJ Q Z ~ o L-a fi O~~ U c~ ~n G G h d ~ d