Loading...
HomeMy WebLinkAbout030-1069-10-002 n~4 O 3 y o d to _ < W m v v o c C: I CD ~ m 3 A l 1 A: ;s o co =i 0) (1 to b O A El N ° m o o A tom- m o ? m rn O ` 1 W ro O N W S N Ctt N a 7 O c j O O n 7 O S U7 O (D O +n O r. lk CD 3 N N v ::3 ON O v t~ O o O O TJ O r ~ m `_n ~ m a w O _ a O ~o .fin 3 t~- 1- o rn D R o0 N m (ND ? ~I (o r._ ti m ((OD n r N CD CC) co ~Z I a n ° IT A m T h • O O O r- ~ -w _ N Z Is N N N cn O D m c( D O O f~l i(9 M M o 0 y V O n " = N n Z 01 (D cf] !V C-, rti b z C/D ' N z co z 0 CD o D Co ~ a 7 -o o Cn E • Q - Q m M 7 A CD (O N w Cl) c-D ~ cS c~ w Z C Z CD O A Z 7 O_ N W O W rn O , Z a a 3 O N O 3 ~ N ~ W W N O (D N T iD 3 O O O ^ - N 3 ,D 7 I T C G? O 'z a CD ~ i m o I~ -4n CO =3 A W CL CO D ? m m o- C ~ A N N O - S n N (D O N ~ fD A I A N kn Ci O ~I n ~ 1}7 C) ICi_ ti Code Enforcement Tracking Sheet Origination Date: 09/22/2000 Violation 00-v-41 Owner Name: Daniel Orf Project Name: Filling and Grading Property Address: 780 132nd Avenue Mailing 780 132nd Avenue Hudson, WI 54016 Address: Hudson, Wl 54016 Municipality: St. Joseph, Town of Computer 030-1069-10-002 Parcel 26.30.19.251 G Zoned: Ag-residential Overlay: Shoreland Codes section in 17.29(2)(a) question: Ordinance Subject: General, Shoreland, Floodplain Zoning - Ch. 17 1 HISTORY OF CORRESPONDENCE: Letter of Inquiry Notification Final Notification Citation Letter/Corporation Counsel Citation Issued: Forwarded to Corporation Counsel: Compliance Date: 10/10/2000 Staff Signature: Findings of Resolution: COMMEOCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 C:ROIX COUNTY REPORT DATE: 1/27/92 _ :OLIRTHOUSE DATE RECEIVED! 1/23/92 DSON, WI 4^,a, Ll 9 l _ICATIONS 784-132nd Ave, Hudson 3LLECTORI M. Jenkins .TE COLLECTED: 1-22-92 MME COLLECTED. 3'00pm WRCE OF SAMPLE: 1; i ,=TE A,11ALYZED:1-213... 4TERPRETATIONI Bacterlh! 7 pp,,. Above 10 12 RE~~vEO Cn ~N 2 $ 1992 sj ~ADti ; w V (1r .:,ifrxt,t.f42 f dpi pia CAON F IGE ' / Z~1NG0 r,t V OFANDEDENpE,yf / !9P WI Approved Lab No. 19 9 1 5~ V D 01 Means "LESS THAN" Defectable Level Approved b, 'b,, PROFESSIONAL LABORATORY SERVICES SINCE 1952 Av-J G~ ST. CROIX COUNTY ZONING OFFICE ✓ v 911 4th Street Hudson, WI 54016 V Telephone - (715)386-4680 The St. Croix Co. Zoning office offers the service of septic and water inspection to Lending Institution, 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 CO. ZONING, 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:$175.00 (VOC'S) a (77 SEPTIC SYSTEM INSPECTION FEE:$ 25.00 PROPERTY OWNERS NAME: 1 0 v` 4 3 ~~CITY : i r PROPERTY OWNERS ADDRESS: j Legal Description 1/4, .1/4, Sec. T . 4N-Rt W, Town of <7. 't Lot. No . Subdivision FIRE NO. LOCK BOX`N~. Color of house Realty sign?,,,/,- 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: 7 Telephone No. '7/-'i REPORT TO BE SENT TO: " . ' tvt ;r~ ' ~:'t Z S - ~..r CLOSING DATE: Signature: -I 1~5'86Zt - -Muco,9[o00S 1 C) -Ztl tom) m O to to 0 (3 4- 10 CY) UJ t- e. co r K.u• - U s ,A Z 4- t.1 co ti 1~1 ii> W 4 Y.. 7 7 r i O U L ~ `y i~ v ~ _ to N y - - rah lr; i ° a r c Q/ p 7 E LU n N O L LL-1 O c. w u LL C > - - c7 n sjag4o iq pauno h8£I •6d .S .IoA 'W•S.0 n LLLI Ovou 31VAIHd I ~ w o L7 x c ( I L>J - = IZS'SL£ Mu£O19Io00S IZh'£Z J n ' U Ih6'86£ N _ I cn o O O In O-l N" toO N CJ co • 1 ' W W 3C S - N I _ O+ N V \ O 10 cx Ot - N to Ln. 1" 0 0 9.031 ° 0 0 cr cc 04515811E 2~1 I co 51`' 233.35 k ~ ~ ~ Z Z t G > I I n n 0 o c I w I O I \ c c 10 v ~ rn_ c 1 rr m~ S I N .2 _ X N I. N I I CO C2 __j -0 OD +I• .~•._J 3 CO I • ~ N c I-I I ( `/\l 1 to w O v r \ F7 O 1!1 M O O C~ 00 1) C~ -,3 5t :3c pc I• co 1 I Q W N N to N' r'"~• • ' 1 v v t7 u7 I t-- • Qi o CD +1 +I N z I: Q ao M o N O - > 1 L r~i rr I O O co co 1 W tti + 0 0 1. 'o W N t0 2 M M • 1 W 1 O S 1 • J J I' I¢ A A A A n 3 co N I N N W - J z >>c I~ IU c a aO U J ^ .W-. I U C-1 I Ot .Mi • 1 co C) al O to o+ J v +1 +I Z cn N I Ol 01 S lV O co c 1 Z A , ^ ~ a U U Lr) t,..l O I O I c0 1- Lf; C) to ~ ~ i t0 d .Ci ` 'K N N N I~ co N j •N N +1 +I _ Z I + 3119o, C> C" > o ZQ90N CL co co N E u, /l y Z N 1 I Te , 20 pE~ o i y N > O J~ N N > C I 1 O 7 O J N U \ c v v) W r ~ L ° 1 Lij t_ i I > v 1 N Q Q \ 199 I - to v to cC C,~ . I t. os 1~~ J C9 I 1 L7 ° n E ~~~y i 1 O (U 2 C I' I o .x 3n£019io00N 1 u_ ~ yea 9 o; Pamnsse 9Z not oaS 3o 13S a44 1 1 4' J, •N n O W . 30 autl sea aye o4 pa3uaJa4au aue s6utueag I LLJ C> O O 3 co J A ti O c0 N ST. CROIX COUNTY WISCONSIN dw~ ZONING OFFICE ST. CROIX COUNTY COURTHOUSE %zf 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Jan. 23, 1992 Bill Lawson 1917 Co. Rd. I Somerset, WI 54025 Dear Mr. Lawson: An inspection of the septic system on the property of Dan & Julie Orf, located at 780 132ne Ave., Hudson, WI was conducted on Jan. 22, 1992. 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. S' c rely, Mar a. enki s Assistant Zoning Administrator cj Parcel 030-1069-10-002 02/15/2005 01:23 PM PAGE 1 OF 1 Alt. Parcel 26.30.19.251G 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner DANIEL T ORF ` ORF, DANIEL T 780 132ND AVE HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 780 132ND AVE SC 3962 NEW RICHMOND SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 2.250 Plat: N/A-NOT AVAILABLE SEC 26 T30N R19W NE SE 2.23 ACRES PART Block/Condo Bldg: OF G.L.2 THAT PART OF LOT 1 CSM 5/1384 KNOWN AS LOT 2 CSM 7/1980 EZ-IE-1324/412 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 26-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/26/2000 625304 1521/366 QC 07/23/1997 1153/594 WD 07/23/1997 1081/400 LC 07/23/1997 1081/390 WD 2004 SUMMARY Bill Fair Market Value: Assessed with: 5306 376,200 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.250 250,600 119,500 370,100 NO Totals for 2004: General Property 2.250 250,600 119,500 370,100 Woodland 0.000 0 0 Totals for 2003: General Property 2.250 164,000 93,800 257,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount 040-OTHER ASSM'T SPECIAL ASSESSMENT 593.66 Special Assessments Special Charges Delinquent Charges Total 593.66 0.00 0.00 d sr FEB c: ST CRo'X COON cr SURVEYOR'S TY o RECORD .0 Nt5 0 D Bq S. Z Z 09(2), ~ .qkF 3 ea oof), n C Z Z Z 0 rV co 00 00 v n r m j< N N f'l p r1j 00 OJ -n i Z hV -4 r Z n - N N O V I(7 O m m :c J Z frl 4~ 1 I~ -I r~ Ip pp, IN a w d w,/ I ~ Z N _a 3 ~ N N D °OV CD --4 co N M N Z I to m -4 Z m o I o D z o°v Ippp w N Z d r/~ D ~ /i C!1 D n m O V D n I I I I ~I~I M Z o 0 II II Z C co N m m / ON Us w C) C) ru £ 90 Uaoc) I p N m 0 N O C z m r m Z m m m ° mm < co (n m 0 N m 70 m 3 N \ Z % z N m 3c ~ r ~ o N r- 1298,58' 1298.58' A S00°16'45'E S00°16'45'E `v om ~ n EAST LINE OF THE SEI/4 OF SECTION 26 m n Zm zzzz N X m mp m -T1 O TI name %no Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ✓ C~t't_ ~ ,J)111W4 TOWNSHIP jSEC. T N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN 6Z 3 SUBDIVISION J LOT I C LOT SIZE PLAN VIEW vY ASS Distances and dimensions to meet requirements of ILHR, 83 - cj(7V `6 0 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM V -1000 OL SAP 61 n 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: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side o Rear, Q feet - From nearest property line Front,0 Side,0 Rear, O 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, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: ✓ Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, O 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 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, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector~x`~ L~JKK~, r~ ~~`-t~ Plumber on job: Dated: License Number: 3/84:mj DEPAR-MENIIT;7F INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS *'.O. BOX 794) . PRIVATE SEWAGE SYSTEMS DIVISION M.9C4SON, W1 53707 BUREAU OF PLUMBING U CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: (If assigned) E] Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Amdahl, *t je-1-ye e 1560 Amundson Lane, Stittwaten, MN 55082 Q BENCH MARK (Permanent reference d pomt) DESCRIBE IF DIFFERENT FROM PLAN. REF. PL ELEV.'. CST REF. PL ELEV NE SE, Section 26, T30N-R19W, Town o6 St. Jo6eph Name of Plumber: MP/MPRSW No.. Count y Sanitary Permit Number. Cat PoweAz 1563 St. C)Loix 49501 SEPTIC TANK/HOLDIN TANK: MANUFACTURER. y , LIOUI CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOC G. O , - J ~'1 O DED PRO D YES ❑NO ❑YES NO BEDDING. VENT DI VENT MATL HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. VENT TO FRESH ALARM FEET FROM LI AIR INLET. ❑YES ❑ND ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIOUID CAPACITY PUMP MODEL PUM IPH N MANUFACTURER WARNING LABEL LOCKING COVER / l PRO ICED I PR,V~°ED D~~Jc~lo YES ❑NO Goa J YES ❑NO DYES [:]NO GALLONS PER CYCLE: PUMPANDCONTROL OP ATIONAL NUMBER OF PH OPERTV WELL BUILDING VENT TO FRESR (DIFFERENCE BETWEEN FEET FROM LINE 7 I AIR INLET' PUMP ON AND OFF) Y ❑NO NEAREST L Z_ SOIL ABSORPTION SYSTEM. Check the soil moistureat t e e th of to ing LFNOTH DIAMETER MATERIAL AND MARK NG or excavation. (If soil can be rolled into a wire, construction shall ce until FO CE the soil is dry enough to continue.) MA 7 CONVENTIONAL SYSTEM: WIDTH. LENGTH NO. OF DISTR. PIPE SPACING COVER BED/TRENCH NsiDE CIA &Plrs LIQUID DIMENSIONS TREyES MAT RIAL: PIT DEPTH GRAVEL DEP H FILL DEPTH DISTR. PIPE DISTR PIPE DISTR. PIPE MATERIAL NO. DI' PROPERTY WELL. BUILDING. VENT TO FRESH BELQ yPIPE~ A vE COVER E Ev INL r ELEV END NUMBER OF a 4 j ~j~ S✓ END PIPES PES FEET FROM LINE. AIR INLET: l/.f~ ( l C~ 2„- NEAREST lt f ~JS MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑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: BED/TRENCH WIDTH LENGTH NO OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO DISTR DISTR. PIPE DISTRIBUTION PIPE MATEHIAL & MARKING . . PIPES DIA.. ELEVATION AND ELEV ELEV CIA ELEV DISTRIBUI ION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPHOVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: =O MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY JWELL. BUILDING. FEET FROM LINE: YES ❑NO ❑YES ❑NO NEAREST (I 4C I- lYA f i E 1 Sketch System on R~ in county file for audit. Reverse Side. c SIGNATURE + DI LHR SBD 6710 (R. 01 /82) TITLE. ~-t wlsconsln APPLICATION FOR SANITARY PERMIT - CQUNTY (PLB 67) UNIFORM SANITARY PERMIT # DILHR OEPRRTTT1EnT OF ~"1 O / - InOUSTRV,LRBOR 6HUTRn RELRTIOnS -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPFr TY OWNER MAILING ADDRESS ( ;2 1/2 PROPERTY LOCATION ~LIY VILLAGE: t/` 1/45 0 1/4, ire R (Dr 'vV rawly OF: r 1 LOT N BER BLOCK UMBER SUBDI /IS N NAME NEARS ROAD, LA OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED /w • a3D-- 0 ' U 1 or 2 Family Number of Bedrooms: Public (Specify): THIS PERMIT IS FOR A: ❑ Repair ❑ New System Tank Replacement El Privy Replacement Soil Absorption System ❑ Revision ❑ Petition for Modification Alternate System ❑ Reconnection IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed El Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure El Vault Privy ❑ Pit Privy issued ❑ Existing, For Which A Previous Permit Is On File, Permit # ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity X Manufacturer: 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): PROPOSED (Square Feet): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Se: MP/MPRSW No.: Phone Number: Narwie'~of Plumber (Pp(r}t): Uelv i Name~f Designer: f u er's Addre s / / COUNTY/ DEPARTMENT USE ONLY ee: D~t e : Disapproved Signature of Issuing Agent: Owner Given Initial (J v 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 vvawi supply; 6. PRINT the name of the master plamhei ~)I mt3ster pllirnber 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 - 1.00 This i1pplica1,1on form is to he completed in full! ;ind signed by the owner(s) of the !)roperty being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owns -/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 Property Section T N - R W `I'owrnship M;ii inyr Address iSZ2 Subdivision Name ,441 Lot Number previous Owner of Property Z2,4i 'total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No is this property being developed for resale (spec house) ? Yes ~ No VOltlme and Page. Number as recorded with the Register oi- Deed,- INCLUDE WITH Ti-11S APPL,ICA` 10N ONE OF THE FOLLOWING: 1. Warraiit_y 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 "lap, the the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION T (W) eeh-ti (y that aXX ~tate-ment6 on this KoAm aAe tAue to the beAt o ~ my (OwA ) fznowtedge; that I (we) am (aAe_) the owneA(A) o~) the pAopvLty de-Ani_bed in this f'.ki{on.mation ~oAm, by viJ t_ue- oo a wahhanty deed ,Lecogded in the- O{O ice oA -tile County Regt"SteA o(~ Deeds a,~ Document No. 3~j/ 3 % and that I (we) own the pAopo6ed bite. {oA the- dewage. di.6poAaX Ay,~tem (oA I (we) have obtained an ememen.t, to nun with ,the above dmeA%be.d pnopeA.ty, AoA the- cove,5-tAuct.on o{ 6ai.d byAtem, and ,the tame hab been duty 'Le,o-o',tded in the- 0A0,(-'C'C of the County iZe.giAfieA o Deed, a Document No. S ATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) . 7 DATE SIGNET) DATE SIGNI?D H S T C - 105 r r-j SEPTIC TANK MAINTENANCE AGREEMEN'T' 0 St. Croix County z 0 OWNER/BUYER ffl~'k~r~'~ - rn J, ROUTE/BOX NUMBER Fire Number - CITY /STATE Z 11'---- - PROPERTY LOCATION: Section_,)Z, T N, R_,/___W, Town of St. Croix County, Subdivision- 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 um)er. 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 eligibly recvu a g raiit I~~r a maximum of 60% of the cost of replacement of a tailing 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 stems 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. 0 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- o meat of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date.--7 S I G N Eyl t v~ 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. Model 3870 Submersible Effl tr gg g gg` 140 William East Sa1us Rupresuntativu I :10 3621 Gull IAvunuu hp Eau Clalru, Wiscondn 64701 Phonu: 715-632-1177 yJ. IUU SA 3 0 LL O W 80 t 1y~,ti u rS m F✓ f, > ~Yj0 7 p 0 60 N. a w~f ffu5 ,IU 1 WPMU3, V, H.P. 2U WPO3, Y, H.P. I f U 20 40 60 f5U UU 120 Capacity • Gallons Per Minute WI. No Volta Phan. Amps HPM 6o110s (ID#.) 0 hl a WIU111(. WI MUlIIt IIL bq t ( r t~~~. { ^ ' V, r l I p WI'U.r121 WI'MUA 1:l VVI'l I(1', I I L. I 1 III u I - 1 WI I lU 1:11 1:+U u U 1 r r - ^ - Wf'I IU`)321. .'1113~2SU S 4 { WI'1IUr 171 "JO 14, 90 WI I I013. 1k 20612SU 4 i . . r "..4 ! WI'I1013,11 .IUD .lq 21 Ill Wi'IIID 12t. .'SO 14, 1 1 L 9460 - WI9 "01": .4'U6/230 64 I' I WI I I I0341: 41,0 :12 i 1 r WI III 12t 139- - 1 l T . - Will e t)3A 001230 9 ? 7 WiltIf I1~31L 08/230 . SV, 92._ ul i ._t WI III I1,; i.11 hill 4ti 'A L (,11 I1:AI Ju)WAI U ,NIUI GI I( r r r 1ANt 4 VVI l I lull l Nt J I ICI S f i PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS -Vent Cap Weather Proof Junction Box Approved Locking Manhole Cover 12" Min , 4" C.I. Vent Pipe Final 4" Min Grade ' / Conduit 18" Min " .1 18 Min , Inlet iii Approved ' Approved Joint w/ A Joints w/ ' C.I. Pipe C.I. Pipe Extending Extending_ 3' Onto , Alarm 3' Onto Solid On B Solid Ground Ground C Off Pump Concrete Block D SPECIFICATIONS TANK PUMP r Manufacturer ;Manufacturer: Tank Material: Model Number Tank Size: G!!/> Gallons Switch Type Total Dynamic Head: FT CAPACITIES Pump Discharge Rate: ? GPM Total Daily Effluent - Gallons A ~or Gallons Number of Doses: Per Day B = " or d. Gallons Dose Volume:_ j Y' %~tJdac„r Gallons C or Zo Gallons Notes: 1. See pump curve for D = , or Gallons additional performance Total Tank information. Capacity Required = ~jo Gallons 2. Pump and alarm are to be installed on separate circuits ALARM as per R 16.19 WAC. Manufacturer SIGNED Model Number: /J,/ jl LICENSE NUMBER : ' Switch Type DATE: - ~l-~~ PAGE OF r c) L C I u r l G C Fresh Ali lolet► And Obcervallon Pipe Q Approved Vent Cup Minimum 12" AOOre Final Gr°de 20- J Pipe _ 4° Cast Iron To e Vent Pipe Marsh Nay of Syring wigole - OPipe 0 0 Tee bPer B° Perforated Pipe Below o Co,tpling Tenninoling At 80110m Of Syalem SOIL FIL-L- DISTRIBLITIOF_1 PIPE APPROVED StINTHETIC COVER ° 'MATF-RIAI- OR 9" OF STRAW 2"oFhG GRE4AlI. OR MARSH HAy L V. 'V, f nt O P %2 /p A(, R r GAT F- DISTRIF~UTIOIJ PIPE Tp BF_ AT LEAS-T,2 IIJCHES BELOW ORIGIIJAL GRADE AIJI) AT LEASTZO IIJCHES BUT IJO MORE THAI) '12- IfJCHES BELOW FINAL GRADE /MAXIMUM DEP-N OF F-XCaVATII0iJ FXOM OkI&WAL Ftf K WILL BE .~2 "I/ . INCHES MiMMUM OFFrh OF E'ACAVATIOW FKOM C4Kf(,IMAL. .3949E WILL BE _~lJ INCHES r i r SIG"ED: LICEIJSE Q UMBI- R: I r~r rr .CIE ; A4_1 ~,L id?s "Al I~ I I ! ! i Fl I ! u j 4 1 - r~ i ' Laff ~ C I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDU.~"RY, DIVISION N rBOR AND PERCOLATION TESTS (1151 P.O. BOX 7969 HUMAN RELATIONS \ / MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION:T T NSHIP/MUNICIPALITY: LOT NO.: BILK. NO.: SION NAME: l- or~ i CQUNT WNER'S/BUYERS NAME: 1 MAILING /A ADDRESS: USE > i~~, j ~ `l ~,v NO, BEDRMS.: COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE PROFILE DESCRIPTIONS: IPERCOL,7zN TESTS: Residence ❑New Replace i j RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYST M-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) (1S ❑U 2s ❑U S ❑U ❑S U ❑S ®U If Percolation Tests are NOT requireq DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: e f L~ f Floodplain, indicate Floodplain elevation: jr PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH-{N, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) a B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIO__1 PERIO 2 PE 1 03 PER I' CH P- j y' P P-2 P- P- P-_ PLOT PLAN: Show location 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 of land slope" , percent .1, SYSTEM ELE NG e v , p. E ...r_ y i1 y. 7- ILI irr - - - 0 a ; 1 `.5 © JCBi~~ F J~ 1, 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. NAIL (printTESTS WERE COMPLETED ON: ES CERTIFICATION NUMBER: PHONE NUMBER (optional): C SI TU E- DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. C HR BD-'3391`i (R. 02/82) r 'n ON F. toi vvr de4t.1 Ept.6: et r: rr, ?i~':-€~r;g i:?1-c'. ¢b(~„ 5C ,.c~_i 1, ~.+,7 >1f s Sx3u C,.,:- . n=.,.u >4 ti 3.}S n Fi ,I s .i L, C ::".3 et t i -cc VOW' e", ...E , v - r , E ty r r FT ;t3f t t? F~ S :rj tESri"~. ip s ~d (F i S J J n t^{ 3 Ott t 6 a i f S` s 1, c. -'frL t_ i. n t,t; E' ;tt", E i. E. ,ta 81, Ea E f4' to I