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HomeMy WebLinkAbout020-1149-20-000 I 0 ° °m' o d `r1 0 * _~3 CD a # v 3 d m 3 A: Z sv 0 W v vii O CD N s w o • co 3 K) I C: CD o o CD n m a CO CL d O_ _ N Un fn O Q~ WAN a ~W NO D 0~ p Q Q (D °p O O O C CD CD (D o p n m p a~ -I A N 3 O O p 7 N A C) C N = 0 y O (D r cn D (D a m fl of d Z 3 _ c - , ~ o p CD lot N N O O N O ~y O O 0- j 7 O p 41 - co O O 0 r- (n (D 00 co cn c en O C o fi d (n o rn r~v_ °o wccnc(n ~n c vooo 0 O ~ ~ N V1 cam- _ fD a N O pn < ai N z d. 7 m a, z CD N o z co z CL :3 , ) O COD N N . r CC d o m (D n i i. m --j cn _ O v' O A 0 7 A 00 Q N I"rl ~ 4 Q ~z Z Vj (~l N W rm m -0 Q CD z i 0 3 " ~ ~ ~ (o I ° m co rv p ~ c I L w CL cs I m c ~ I z a o_ CD I I I ~ I fi A ti ti I o 0 a A ~ b @ o 69 o ti W a O (D O L y Parcel 020-1149-20-000 02/23/2006 09:01 AM PAGE 1 OF 1 Alt. Parcel 33.29.19.800 020 - 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): O = Current Owner, C = Current Co-Owner O - ASMUS, ROBERT & RAMONA ROBERT & RAMONA ASMUS 614 COUNTRYSIDE LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 614 COUNTRYSIDE LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.480 Plat: 0215-COUNTRYSIDE VILLAGE SEC 33 T29N R19W COUNTRYSIDE VILLAGE LOT Block/Condo Bldg: LOT 14 14 ALSO PT LOT 13 BEG AT LOT COR COMMON TO LOTS 12,13 14 TH S 61 DEG E 35 FT TH S Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 22DEG E 158.58' TH N 29DEG W 187.17' TO 33-29N-19W POB Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 697/366 2005 SUMMARY Bill Fair Market Value: Assessed with: 92668 267,900 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.480 80,900 192,300 273,200 NO 05 Totals for 2005: General Property 3.480 80,900 192,300 273,200 Woodland 0.000 0 0 Totals for 2004: General Property 3.480 37,400 144,800 182,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 310 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 r- a► Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 3o12 TOWNSHIP SEC. 2 T N-R / W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION(- -,;r/iy_Tj0 LOT LOT SIZE ~ZLL ACS PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM C/ nC'r L mOSEV WE'LL r J r 0 b ✓Eri DO J -ROPF/Z7 / -;r1E To WEST i'a ~L PE /IT X /Enl" S7-ACI< ^-,o INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used / S,'Z0r/ /Lon oi_/ao, ,1 n /~/LASn/ r:~w _O r Elevation of vertical reference point:' Proposed slope at site: SEPTIC TANK: Manufacturer: L..."r-,c_r Liquid Capacity: ~tf`Gb Number of rings used: C Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: n. Number of feet from nearest Road: Front,O Side,(9 Rear, feet From nearest property line Front,©Side, ®Rear, ® 0yefl 1:'! p feet Number of feet from: well building: 'ar (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, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Y~ Trench Width: L~ Length: 13 j' Number of Lines: , Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Rear, O Ft Number of feet from well: O1it2 /00 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: 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:- G7Ja- Dated: Plumber on 'job: License Number: 3/84:mj DEPFtRTMEN-i OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MF,DISON, WI 53707 %1 CONVENTIONAL ❑ALTERNATIVE State Planl.D.Number (lf assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTI N ATE: Bab ksmws 485 C~mmvwn, Lake Etma, MN f ~ ~x✓ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. SB SB Section 33, T29N-R1961, Town a6 Hud~an, Lat#14, CountAy/side V" Narne of Plumber- MP/MPRSW No. County Sanitary Permit Number Galty Zappa 3300 S Ctcaix 58865 SEPTIC TANK/HOLDING TANK: MANUFACTUREq: LIQUID CAPACITY. TANK INLET ELE V.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER ~ 7/ /yam / ~r-~ PROVIDED PROVIDED l;T,_.. ` I I V YES ENO EYES ENO BEDDING: NT DIA.: VENT MATL HIGH WATER NUMBER OF ROAD. ` PROPERTY WELL BUILDING. VENT TO FRESH ~i ALARM FEET FROM Y LINE AIR INLET YES ENO 4 DYES ENO NEAREST Y. &I DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER Pq OVIDED: PROVIDED: EYES ENO EYES ENO DYES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) EYES ENO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH 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. PIPE SPACING. COVER INSIDE DIA. =PITS LIQUID BED/TRENCH L/ TRENCH ) M TEHIAL. DIMENSIONS % m 15 ~ ,I PIT DEPTH GRAVEL DEPTH FILL DEPTH DISTH. PIPF DISTR PIPE ' DISTR. PIPE MATERIAL. NO TR NUMBER OF PROPERTY , WELL. BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER ELEV. INLET ELEV. END PIP LINE. AIR IN LET. a FEET FROM ez qq, NEAREST -r f'5 S / r 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. EYES ENO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS EYES ENO DYES ENO DEPTH OVER TRENCH'BED DEPTH OVER THENCH;BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. EYES ENO EYES ENO EYES ENO 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 MATEHIAL & MARKING ELEV.. ELEV.. DIA.. ELEV. PIPES. DIA.'. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS EYES ENO EYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE OYES ENO OYES ENO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNAT RE. TITLE. -y < DILHR SBD 6710 (R. 01/82) f`:%r " 4 u,Ilsmnsln APPLICATION FOR SANITARY PERMIT DILHR ~-COUNTY 'L-~ OEPRaTmEnT OF (PLB 67) UNIFORM SANITARY PERMIT # i~ InOUSTFIV, LRBOR 6 HU-Fln RELPrrl X~J -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 PR PERTY OWNER M91LING ADDRESS 0/3 4S.yvf' ylfS- el ME~'o y 1.4 /.~i a . PROPERTY LOCATION ~ 77-:: V~ SS_ 1/45 1/4, s33 , T YN, R /9 E (or) TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAM NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED Uau _ j/(,/ _'-~70-_6)0 Q 1 or 2 Family Number of Bedrooms. Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System L1 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 U 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 /OT'v Lift Pump Tank/Siphon Chamber IVA Holding Tank capacity Manufacturer: ZVELEdE4 C (n~ d S Q~7 IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): /REQUIRED (Square Feet): 6'.2' PROPOS D (Square Feet): / 15 6 iy ~ X `lt l 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 *W/MPRSW No.: Phone Number: 33oo (715 J, FS'C P umber's Address: Name of Designer: ~w 3 S NoA tf IIvP;o,, 'Z/* I COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved t 19 ! N t ❑ Owner Given Initial Jr Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. 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 G Location of Property-4 5, Section, T N - R W Township .kl Mailing Address _ N'~ 4E MlQ Subdivision Name ~0U.y7~►J'S~o~t t Lot Number 141 Previous Owner of Property ~!'ailCr f 09'1"4 Total Size of Parcel 3• 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 613 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) eeAt 6 y that ' statement/s on .th i6 Bohm atc.e tAue to the best o6 my ( outs ) knowledge; that I (we) am (are) the owner.(,) ob the pnopehty daceibed in this in6on.matiJon 6onm, by viAtue o6 a wawtllanty deed neconded in the 066ice o6 the County Registeh o6 Deeds ass Document No. ` '7f ,2 A/ ; and that I (we) p.,L"entty own the pnopo6ed bite bon the 6ewage po,5at 6y6tem (on I (we) have obtained an easement, to nun with the above de~scA bed pnopetcty, bon the con,s;Outcti.on o6 said system, and the same has been duly neconded in the 06bice ob the County Registe& o6 Deeds, " Document No. ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H G cn H ' y ST C- 105 r ti SEPTIC TANK MAINTENANCE AGREEMENT - 0 St. Croix County z d OWNER/BUYER L~t)it',,' 7 A&'j _ ROUTE/BOX NUMBER Fire Number CITY/STATE 117 • l_wt1 6c/ Z IP PROPERTY LOCATION: 5 S 1~%4, Section 3J_, 'I L'l N, R /Y'__W, Town of T7~~QSy~Z~ St. Croix County, SubdIvisIonCc)ilA,, %ry S/Of 44AAGi Lot number . 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 punier. 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 maw 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. o F 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- w 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. GG~ f SIGNED ~4,/ 4f_~! ~.c DATE St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 i Sign, date and return to above address.