HomeMy WebLinkAbout042-1087-80-000
n Cl) O 3 -0 n
o a) v
B
CD M a A •
1 lot
X ~ O
co 0 D Z O A C7 `C ~1 •
(7 p~ m O (O fD N N 1~/l
N O? W
N N O
CO C
W W O 23 Q y c
N CO 7 O (A O
O
O 7 v
O CO W O O
0 , 7 (0 m < 7 D o
0 0 7 O
N ~0 O O ~1
N (n
P O c ;l
C cn ~ D co a
(cn CD C~ O. n
D 7 (n CO
C
* 1 Z
O OW W O
O
N CO CO (0 co ;a 0 r- U)
CD _
O~ (n O C
Q
CD
o O O O < •
CD Cn Z rye
~ 3 N N y o (D
o v v N
< 07
O7 (D ° d •yp W QO
_ ° - 19 0
(D CD N C
7 3 07 7
7 m N
z
N
Z Z O
D m O
N O 7 7
3 !r
o
(D (D C
CD 7
C N CND
w D a
Q E
z -1 V)
O E3 A Z n
n 7 A Z O
v a O 3
M --j W
W N
Cfl
CD CD - CL , N Z
, 3 (n x
O WCC
N Z A G
CD
W
C- E; 2 D
CD 7 p Q
CD
(D CD T
7 N 0 y C
CD 7 Q Z Q
N CD O
CD CD
N
(/1 7
C71 n
x
00 Z
U1 C) O
X ~ 1
W C•
Z
S (D O
(D
O N N
F:v (D O
O
n A
V
O
(D Chi
~ N
(fl O ti V
O
O y
O L
Parcel 042-1087-80-000 10/05/2005 07:46 AM
PAGE 1 OF 1
Alt. Parcel 31.29.18.487A 042 - TOWN OF WARREN
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - KRITTA, ALLAN C & ANN C
ALLAN C & ANN C KRITTA
946 CTY RD N
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 946 CTY RD N
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 24.000 Plat: N/A-NOT AVAILABLE
SEC 31 T29N R18W 34.70 A SE SW EXC PT S Block/Condo Bldg:
OF HWY. & EXCEPT P487C
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
31-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 757/377
07/23/1997 699/428
2005 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 07/20/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 25,000 47,700 72,700 NO
AGRICULTURAL G4 12.000 1,700 0 1,700 NO
AGRICULTURAL FOREST G5M 10.000 15,000 0 15,000 NO
Totals for 2005:
General Property 24.000 41,700 47,700 89,400
Woodland 0.000 0 0
Totals for 2004:
General Property 24.000 41,700 47,700 89,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 208
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 042-1087-90-200 10/05/2005 07:47 AM
PAGE 1 OF 1
Alt. Parcel 31.29.18.487D 042 - TOWN OF WARREN
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
O - KRITTA, ALLAN C & ANN C
ALLAN C & ANN C KRITTA
946 CTY RD N
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 7.690 Plat: N/A-NOT AVAILABLE
SEC 31 T29N R18W E1/2 SW 1/4 7.69ACRES Block/Condo Bldg:
COM S1/4 COR SEC 31 S 88 DEG W 1311.59'
TO W LINE E1/2 SE SW N 608.52'- POB, N Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
737.59'N 89 DEG E 487.03'S 56 DEG E 31-29N-18W
225.09'S 33 DEG W 499.26'S 61 DEG W
394.26'S 71 DEG W 45.71' -POB
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 794/411
2005 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 07/14/2003
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 7.690 1,100 0 1,100 NO
Totals for 2005:
General Property 7.690 1,100 0 1,100
Woodland 0.000 0 0
Totals for 2004:
General Property 7.690 1,100 0 1,100
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
WARREN T• 29N-R.
SEE PAGE 43
-%r[ 111 ty c7a->.eE i HRE Us q c/a/e~.ce P ' siT se W F Cje~a Id C 00/a' y
A N~f~.i/s ~4'
U /i!'.~,fed FO///ts, 7..3.69 9O ~G 7739 v 9 v 65
y .~f. o C C n ~.v • ~Toh~
CA -z' Inc Sn° T s • V Q~ l n Dam 2756 Mcke/sc
r P q (T mes ~S v N 3 C C~ 0 V N
ze /ous R / 5 ~v M h-y l~ 0 25 q1 Q G. ` ° Y Q/
cr es _ ~ ~A\ 4 n~/7 •
Lo~/s N bar/
W PeF nk , s Q. ich s 041 S eo noh.-i Wes
V S
fC7,-/
/'an wC ~ /`7a y 32a
Z
R 4v~ NPc w " za~n /ao /`9i's. Dan eda~,c,E
a
/`7a/one sa ~-~x
W /soV~o 4-s-s~v~~~.67 Oem..~ sog9s • ~W~ s
M chQe/T F.nk °oN ~A 0 ~ ~ s ~ r esf ~
l . h sm W4 i ar V ~ ~ ao
• ~Te f f -
~~~/ennEFanc,s ~c ¢/d F, Redinon f D o/fy • l_eha.~t s ® F P-de/-.c,E• RNK
wa~ ShQ.on Her,>/k >/--~n~.eas
i3e/.a zs_ /s r 1077-.o.~ F led~:ch AhY/iarr~ 60
80 y O ~j Kenne t/7 !3a ' VU Ws. f Ma y
C nom: ° d dd Ne,ink
/49.36 L¢if,bJc /GO C1n-/ Bo • •
Nff /o
S Bo a
° ° s Ra6e~f f -z~o~¢/d C/e/'a./d. ¢./y77s, Ken~e ti,
N f yor,s SPiQ.i'on /Pcts~n U S R FQCm,
~ Fiede~, c.E p
° Lu ///e E~/a/- We/ss S"c Snc.
~ • ^ RC.,o vi 9_~. Me// • /513-
Ol\lll ~ v r~V Hen- /60 /5/ 9a /S/89 Zoo /'a /bo /~O
0
- • _sn~nac ~s a • • s s~.+_ Lao .D. V • G✓a./ten
,2-66 C.~ennQ ~ BUf/tsl
/Vechv Y/
Gi/-/ a9cou t C C % m y z 6 o C o~ v ~ 78. ¢ l/a i/s~
cSf Cr-o/x V¢//e v
3 ~ Jt v /68.a J ~ Nech vy/e z,a
zaz f y ~ ~d~~ d0
C E~ ene
~ d v ~ C KH a 0% Gco/ c f/~'.f2r f v o/a Fne
3 9 y sch~/f<
Leo D
a~
Cami//e C ~ C //es ` ~o ~ C C ° mo ~ ~ i B/mm E~, / ~ TePe
2 v v o 41 ~ d d /`7cKF~,~/<z y h p *i e/yn
0 f/o/den h p 0 Lever/ 0 E sue / n6 s¢ /-2e//er z<so Fiad tl
1~ ~ •w~ ~ /60 ~ o~ ~ Famai(//(// q /9~ z s~; M~eii-. ~s79s soh
V T [~'f • • RS 24
12
/ea ~ BOY E. • T ~ h 3. h,.o-,
k TI CC! eta/ 5 a~ @ REN_r GVC Ally 97 N ~ O C
/6 0 E
^ ~ ~w /6 0 .Q de ° H a 43 ~ ° v °
,5' <9z t\ clone 6, .8N 6 < p 3• • B b Ohv.A- /O B. zS /4933
W 9//an 6 / e ~a/e/- W~ I ~ C9
z
d ertf /Aq
04, ob
_ S¢nrlra 0
/6 z.9/ C7R/'d ne/' y V
1716r/ ht v✓/f ad v v Newe// ¢ am • NO v
W 15. 9-- ~ j ~ o~°vC B w~
h Ci y sn+1 l C ' f'ech~man Ud Od V
f Eve/ F.A- /9Z 4s (~v /s67s t/am7,n C ~.n ~I ~T
YN,%buc 3o-B • BOTH
``ll~ /j'fh •AVE. 1108E R I S. TT ~O n ~O F
Lnvid e Coro/= ha/ho y weCo h ti N H v v Z / 11 7 H-
Coua/' is ashen-n ~v ^1 N 0 N U ° ¢hcz n f R~/h /i~
~Q,etu cTW ci n d 3' d `C , C.y G r /oa o'Con.,e//
y 0 2 3 y` y 0 M///C/' o O Con4z 4z.i39 Don ~ ,.e ■ vdi; ~ wC =C1V Q4, ~041~ i3/o /60
~L, - flnde.- n Bp ~~v o~ ti 9 f4¢rk
d J e h Darce / os aes r- _ ae~ o H
/9gderson /o O/av~~/au O'Cor/n
z 1 65 c a,y G
7 o s/ :fen e
0
h h ~'pti ~ .~K~S 1 ~ F U/ate s Ea / E eor f flau,Fenes
I~ I ~j ~ C 3 ¢o z ~ i V a cS n,-/h PecF.~man ~ LBOn
is Leon¢ndE ~e I / z s ~ N• ~i/cvI¢ /GO Mari/
a o Buc,Q a Q no F7r71'e/son De/o-
x.5.9 ~2 ,2 YGa7 ~i. y, R 4/.3.3 ^ \ 4B'
3. ss o o a La 9/,°ff E Fio a rd E Dcr/s CR da/ h l Coe /s'Y C~
,aboid K e tl 999s C'/a ra ~ !N s/ y
a/~ o ~ s~ 94 /o/ ~ ~r ~e.s.Fa~ w E t r~~,,s e ~3e
c~ w/e s
/szoe
~7a rne.s /60 0`cN /Go
• DR B- ` 39 /37 / 257 l \ ~ r
C TN CA ° Q\~\
16o R be f,g be/-f E 1 Ja,~e~ .q > l Lc.Ci//e G ti •uy'po
y~ e d 5a,/ y.8 FJes,~au, • %ES.Ea~ 9 • n Na.~san • ° v° 0~ \
~.C • ,Pob't do A75 et x • 0 • t C
} n y~ ~i ° Ma./-k Mer-- • • < L oo f zz7 ~N
C m ° we// Ua mas ~¢r~^'••x Dan is t~¢n. v
j Len- n m o ¢na rnan/ 'B/oc
N V v f~, /„arr 9 foyerly Foyart ~ n/e/son Ne/- ,a ~ ~ Sam- /at3
° 3 Q/~ a3o Co- /S966p S /S6 ]2 375 3~n BFy~~ ¢ •3➢d6
o a/9ss,2~.c,F or a~ Pte, /s. rnc. SEE PAGE 17 t51 f Cro
r
Dependable Hybrids
From Dependable People
- t~ryl CAB
C• Gv5
Richard H. Kamm
o •
. ,■■o•M•„Tor„Ewoa~I Roberts, Wisconsin
CALL: 749-3332
sxw
Form-STC- 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP ; SEC. ~ Z T r . N-R 3 W
ADDRESS tom' r-',' /1/ ST. CROIX COUNTY, WISCONSIN
SUBDIVISION, LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I1HR, 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
C7 /✓r, L,e v;~A ry ,
1
c7 I-
?
U
i
c' .
~ Ile ~
1
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity:
Number of rings used: Tank manhole cover elevation:
Tan Inlet Elevation: ,(,~'Tank Outlet Elevation: zz
Number of feet from nearest Road: Front,O Side,U Rear, O /f C feet
From nearest property line Front, Side, Rear, O O f feet
Number of feet from: well , building:`
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, Ft. _
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench: Gam'
Width: Lenith: Number of Lines ,2 Area Built
Fill depth to top of pipe:
Number of feet from nearest property line: Front, Side, O Rear, Ft
Number of feet from well:
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 0 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: Plumber on job: Ji,~ll'' f~~1
License Number:
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISOfq, WI 53707
CONVENTIONAL ❑ ALTERNATIVE I are Plan eLD Number
ur ass~ g nd(
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER ADORESS OF PERMIT HOLDER. INSPECTION DATE.
Virgil Cernohous RR~~3, Cty Trk "FF", Hudson, WI 54016 - Y-fd //a-,.,_,
BENCH MARK (Permanent reference poi)t) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF PT. ELEV.
SE SW, Section 31, T29N-Rl8W, Town of Warren
Name 0 Plumber. IMP,MPRSVI N,, C<i.~n TV S~~ni, ; por rnit Number.
Henry Nechville 3258 St. Croix 74970
SEPTIC TANK/HOLDING TANK: I
MANUFACTURER LIQUID CAPACITY
/ TTANK INLET FLE V. TANK OUTLET ELEV JWARNING LABEL LOCKING COVER
PROV ED PROVIDED
_ YES NO ❑YES /<NO
BEDDING. VENT DIA. VENT M.1T1 HIGH WATER NUMBER OF ROAD PROPERTY WELL JBUILDING NT TO FRESH 00
nLARM FEET FROM LINE ev JAVIER INLET
❑YES NO ❑YES L O NEAREST
7 3
DOSING CHAMBER:
(MANUFACTURER BEDDING LIOUID (:APA(:I r1Y PUMP Mf)DE I PU^.TN .;IP~I(;N MnNUI Ar:TUFiE R WARNING LABEL LOCKING COVER
PROVIDED PROVIDED.
❑YES ❑NO ❑YES ❑NO L_IYES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERAT IONAL NUMBE O PROP WELL BUILDIN(, VENT TO FRESH
(DIFFERENCE BETWEEN FEET O L ` I AIR INLET
PUMP ON AND OFF) ❑YES ❑NO _ NEAR ST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing N T DInr.TF T F I: 4TAT1 HIAI AND MAHKIN(I
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 DTH LENGTH NO OF uISTR PIPL ; v INS, ~EI+ VIOL aIn =PITS LIQUID THL tirIls -RIAL PIT DEPTH
DIMENSIONS ,
GHAVELDEPTR FILL DEPTH DISTR PIPE DISTH PIPE DISTR-PIPE MATERIAL NO DI R NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
BELOW PIPES ABOVE ~C OVER El v INI [ ELF1i C PIP S FEET FROM LINE.? 4 I AIR INLgET
'mot /d/ C OI ~Z~ NEAREST J 3Z 5~
MOUND SYSTEM: J~
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 TEXTUHL Pi HMANI NT VARKFRS OBSERVAT10%Av ILS
El YES ❑NO 1:1 YES ❑NO
DEPTH OVER TRENCH BED DEPTH OVI R TRENCH BL D DF PTH DF T()PSf 11L St)D )F I) SE f UE1) JMULCHED
CENTER EDGES
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH NO OF LAIERALSPACIN(; RAVEL DEPIHHELOWPIPI FILL DEPTHAROVECOVER
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR PIPE IMANI FOLD MATE HIAE NO UISTH (:ISTH. PIPF UISTRIHUTI ON PIPE MATE RIAL&MARKING
ELFV. ELEV DIA ELEV PIPES UTA
ELEVATION AND
DISTRIBUTION
INFORMATION TTOLFSIZF HOLESPACING DRILLFDCORHECTLY COVFR MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PL nn~s
❑YES ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS
ROPEERTY WELL
F . BUILDING.
1T-NUMBER OF P LI N
01 ❑ - EET FROM YES ❑NO ❑YES NO (NEAREST-
42,' `L
Sketch System on Rmy file for audit.
Reverse Side.
$YCNAT URE ~•J,-- f~ TITLE
Je p_ J
DILHR S B D 6710 (R. 01/82) ~ ~ G/
wiscons,n APPLICATION FOR SANITARY PERMIT
(COUNTY
oERRRTR1EnT O❑ (PLB 67) UNIFO/~RM SANITARY PERMIT #
~ In0USTRV, LRBUR 6 HUfr1Rn RELRTIonS / C)
-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
PROPER 017Y LOCATION CITY:
A.
61- 1/4,-'01/4, S T d N, R ~ /
E (O W 'OWN OF>
LOT N~11/IB R JBLOCK NUMBER jSUBDVI ION NAME AREST ROAD, LAKE OR LANDMARK STATE P AN I.D. NUMBER
~yvJ
A
TYPE OF BUILDING OR USE SERVED
Lk~i or 2 Family Number of Bedrooms:. ❑ Public (Specify): '
THIS PERMIT IS FOR A:
L>s+`I 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
❑l 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` It ! /r
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
manufacturer: t / T 77-T
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
1 Total # of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity 1
Lift Pump/Siphon Chamber
Manufacturer: a
F
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet)::
F
" o ,~4 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- MP XLg No.: Phone Number:
t
r @.. ! t • C....
Plumber's A dress: Name of Designer:
s r s~'
COUNTY/ DEPARTMENT USE ONLY
Signatur of Issuing Agent: Fee: Date:
Disapproved
`f y
2 ~ d , y Approved Owner Given Initial
'(1 J ` 0 S 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
l
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 permaneht and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
APPLICATION FOR SANITARY PERMIT
STC - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequaoies 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 ,'r n
Location of Property S iv ;4, Section 3 I , T 9L N - R W
Township L=t~ ~yv e-rf
Mailing Address" L.~a 7j
°s 13
Subdivision Name ~a N
Lot Number '
Previous Owner of Property S &.JQ It . C e r n c ~U cc S
Total Size of Pere-e-1 Aq r~ x 67 t4~vs Sty vvL-- .
Date R-rca1 was Created /l
~x '"`fiel y Uh)y'
Are all corners and lot lines identifiable? Yes No (h, Al
at z►^ v ~re~~ J
Is this property being Yee No
G'I Ile~.e.-1 op e~ ~5~ahi; yhe~Q ~a.v~~-z
Volume and Page Number l)e /I<, 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) ee ti6y that att statements on -thiA 6onm cute txue to the but o6 my (ouh)
knowledge; that I (we) am (ane) a ,owne~(s) o6 the pnopen.ty desc4i.bed in .thi4
in6onma.ti.on 6onm, by vi tue o6 a , "`deed neeonded in the 066ice o6 the
County Reg-i.d.ten o6 Deeds a6 Document No. ~ ~7- ; and that I (we)
ptuentty own the proposed site bon the sewage pos sy6-tem (on I (we) have
obtained an easement, to nun with the above deaeh,i.bed pnopenty, bon the
cons.tnucti.on o6 6aid system, and the same has been duty neeonded in the 066ice
o6 the County Reg.cs.ten o6 Deeds, as Document No. ) .
S GNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
11) - 2L 0-1-s7'
DATE SIGNED DATE SIGNED
IL
H
L
rj
a
ST C- 105 r'
r
• a
y
SEPTIC TANK MAINTENANCE AGREEMENT H
St. Croix County z
d
a
=OWNER>UYER T CeV,1LC ~L~JrC 5
ROUTE/BOX NUMBER Rt 3 Utx Fire Number ~d
CITY/STATE H,4-,f 5 ,,i l.i,t 'LIP g-/o/ 6
PROPERTY LOCATION: 4, 5 Section, T o7- ' N, R I W,
Town of Loa b- #-e_kl St. Croix County,
Subdivision ~'~t✓v►2 Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. 'A
0
E
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- ~a
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 c
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.
v o
r m
x
3 0
C m N w O (D N 0
N _ o aCD CD 3 .off = w w~ w
0o a, Q p C O, cA w
i0 N
(O C
Z S 0 O O '(SD -0 'COD 2-:3
c^ C (D N (D p N 5~.
o ao~ w o m w' oo
` w 0," N A Rr
. :3 -to
c0 CD o I
n 0 ca to G'
M :3 1=
0 CD C O D93
o
woo ~~c C:N
-
o _
3°c 3oao
z - 2 Q~ f
o o .moo ac~D 3
C=D
w
'00,~-v )C':'
CCD c
c NDcv
<CD
CD Cn 0, COD
p C S O a w p '
o m C t!1
w Z D
u, m (D
m m f3- D
m w c(DACD CD~mm?a a D
o ao o 3 ~cn(a -I
MCI. a .....0.c w
a'cn CD mvi ~a~
a o f y m
va C(ID) w N j M
' ? 0 ~
m CD cs o ao Cn
m o w Qw = Co >
WW " -;3 L o . o
o c c co 3 (n
% :3 (D-+3v a~
0.3 0. uc,0 0 cr.ow0 o m
M
w (D CL 0.
mr (a
0•~ '<co w m~ 3 a' en
v, O c0 7 p to c) CD '
O C -1 N C
0 ca
0 o ca
d -0
O O a S C (D p 0
3
C O
,,r # (~D co o o ~ o
i
REPORT 0 SOIL BORINGS AND SAFETY & BUILDINGS
DEPARTMENT OF DIVISION
INDUSTRY, PERCOLATION TESTS (115) P.O. BOX 7969
LABORPAND MADISON, WI 53707
UVMAN AELATIONS (H63.09(1) & Chapter 145.045)
TOWNSHIP/ 'T LOT NO.: BLK. NO.: SUBDIVISION NAME:
T _3 / /T N/R/F I &64P.- e ~;ro.l-
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS:
5f, Cry,` i'r l l! ,uru ~P a3 ' r,i, lei s , -S- Yai C
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
ResidenceQ~New ❑Replace / _I;
s . / 4-74,' gX a2-
RATING: S= Site suitable for system U= Site unsuitable for system Syr <jr a Si4lJ/ C~/•
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL I HOLDING TANf]R~ECIM ME N ED SYSTEM:(optional)
ZS ❑U ®S ❑U ®S ❑U EIS ®U ❑S DU o..~ PiRe-.I
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the j
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: /y 14
PROFILE DESCRIPTIONS
(.e BORING TOTAL' DEPTH TO GROUNDWATER-R+e"= CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH_pT ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) t
B
d r . ~ :lc,~ ~ 7 /1 r of s ` B/ / n l / aZ G'rr S ! B IS, .S• ® j e IS
B 7 ~r Oki / l3 l / 3. y en / "le /
,1 Z
B- 9,0_'
• s
V . G~ ei 7 , / s &i
B ~t Q r 1, U 1L- Q` a rQ
l / /1' A A
Off
B-
PERCOLATION TESTS
TEST DEPTH* WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER }?d6+}ES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PERINCH
P- /0 3 - ~
P- X c o 3 02 '/z /Y-
P- 4Jo Vv ~7_ Z S
P- o
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 percent
of land slope.
SYSTEM ELEVATION ZeGewd
I
g. M. 113
tee
q p
4 s~
1 0
lit
P.ye
e..
I p
vcA-
/ 0p>pi07
Bs- ale 1.
S s5 e /ov. T N
P Aare s 644 A a)
_ -
o , 3
1,441a 0. e4
r '
S `i cif I l -8 z to All W.
p pe_ Set . PeeRe~~~, e.s
I, th,q ign> her;Q certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
' Ad48% s~*tive e, a~i at 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:
D CERTIFICATION NUMBER: PHONE NUMBER (optional):
lAllov, eve . u W ~'s . sY~fL 7/~~ y~'%
ti CST URE:
TION: Original and one copy to Local Authority, Property Owner and Soil Tester.
6395 (R. 02/82) - OVER -
R.
' 639,,S,
tF, Y~J", !,L e1 <~r } .r o as a _iu
F iii:, A ,fib H _ EEm
E.1.. ,,""f i riod €~tta 31,.3 ' ; 1€~ € Yfi z ion t2I: ± .
,r E
~nrea ' ,l'r7i ul a3 x.,.,„ 2i.,
Er~°',s,,4=,1
s ..•~'t ~L~'^ ~ ;>.i
Hi
16
-v
r
F4 c
- 11.
,
S,. a~.. o1 _r tE
r i a r
v
E "6. t
Q