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N O N I I o m I I a ti 0 0 A to m (D A ti EA O EA O O O O D- O d I � I DEPARTMENT OF REPORT ON SOIL BORINGS AND � UE IV INDUSTRY, \_A ISION , 1 LABf1l:.� �� " O 53707 HUMAN RELATIONS PERCOLATION TESTS (115) ) HUMAN ` (H � 63.090) & Chapter 145.045) ,� �� ILOCATION: SECTION — UWNSHIP %A+ItTfCtCl1'RtYT^t'� LOT NO.I�LK. NO.: DIVISI CJ(\LtM11 M sw s '/ /Y,�� (COUNTY OWL /BUYER•S NAME. r MAILING ADDRESS: / .,, or,/f ,�'d, CI _ v l USE DAI ES OBSERVn NHCL)RM >.: ( COMMER / Ot CNI PEION :I 1201ILLDC SCRIPTI I t�0� NT[STS: ��.Residence - - -� O. � -- - - _— ` - -- rL - � L - -- --- 1 _,�New � �Rt: lac � (P RATING: S= Site suitable for system U° Site unsuitable for system �< G U S l U CONVENTIONnI -: MOUND IN- GROUNDPRI- "LJI!F SYSTEM IN I- I l II LUING TANK IiIL:UMNILNDLD SYSf ENl:loplionall �1 S C] U7D S ❑u [ �]S Chu _���75 kju_l ES Chu c0A,1 0a, -' lit Pwculauon Igists drt NOI lee uirud DESIGN 11 AT F I t II aoy porous of Ih0 W�Wd uea io III the undti s H63 0�151(b) Indicate - -- L luudhl iin_ iucJudte 1 luurlhl iin lwuuun: LLLLLL PROFILE DESCRIPTIONS - - - -- - BORING T(JIYtt i Prl1 TO (;HOUNOVVATEW ;, CIIAHACTEII OF SOIL Wl - ffl THICKNESS, COLOR, TEXTURE, AND DEPTH NUMB // ER DEPTI -I+Pr LLEVAHON OBS[fIVED L T. I IIGH SL TU HLDROC IF OBoLIiV lSILE ABBI- ON BACK- _ - s- '� S' �� �' � 1���� -_- - -� , s ' ._1�.� s 1. �• 6 �.� /.s �- � �s s- PERCOLATION TESTS TEST DEPTHS WATER IN HOLE TEST TIME DROP IN WATER LEVEL- INC RATE MINUTES NUMBER 1 +i4l4;_S AFTE R SWELLING INTERVAL MIN. _R) .__- P- P P r 'LOT PLAN: Shuw lucaoons of puiculation tests, soil bmmgg and the cliinunsions of suitable suit area;- lmdlcAto scale or distances. Describe what are the horn ontal and vertical elevation reference points and show their location tin the plot plan. Shuw the surldcu elevation at all borings and the direction and percent �f land slope. SYSTEM ELEVATION � Z 6 d ,( I o P er 3 � 9 � N t t iclEi'G ( Ur r ! r i t t h� q �`rl• I ± I I- s. 1, the understgnud, hareby certify that thu soil tests reported on this 10111) were made by rue in accord with the ptuceduius anti methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of Lite tests are correct to the best of my knowledge and belief. NAME (print) TESTS WERE COMPLETED ON: ADDRESS CEHFIE ICAHON NUMBEH: PHONE NUMBER(optional): CSI SI6NAI URL-: J 71STRIBLI I ION: Ur rymal an% une Copy to Local Authority, Property Owoer and Soil Tastur- �11_HR -SBU -639:1 (R. U2/82) OVER 1 _ p XOMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 -3121 800 - 962 - 8378 (WI) 4:ck 800 - 962 - 5227 gio @ A ST. CROIX ZONING REPORT NO.: 32124/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 8/03/89 COURTHOUSE DATE RECEIVEW 8/01/89 HUDSONr WI 54016 ATTN: THOMAS C. NELSON Lrb i OWNER# Rosemary Olson LOCATION: 349 MiLLer Road, Hudson, WI d COLLECTORS Mary Jenkins - St. Croix County Courthouse f SOURCE OF SAMPLES Outside Faucet COLIFOW 0 /100 ml INTERPRETATION: Bacteriologically SAFE NITRATE -NS ( 1 ppm I ' t Under 10 ppm is safe for human consumption. COLIFORM + NITRATE x LAB TECHNICIANS Pam Gane WI Approved Lab No. 19 7 �Zy L pp V 1 *° (Means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 r ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386 -4680 mow„ August 1, 1989 Rosemary OLson 349 Miller Road Hudson, WI 54016 Dear Ms. Olson An inspection of the septic system on the Rosemary Olson property located in the Town of Hudson was conducted. At the time of the 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 is totally dependent upon proper maintenance of the system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator TCN:sa q ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 1 9 911 4th Street Hudson, WI 54016 ,d �� J Telephone - (715)386 -4680 The t. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Co mpletion of this form is essential so that the property can be located Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING--------- ---- -- ---- -- - - ----- FEE: $ 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $175.00 (For VOC'S) ,:...SEPTIC SYSTEM INSPECTION----- ----- - - - - -- -FEE: $25.00 (Determines if system is properly functioning at time of inspection) Property owner's name Property owner's address �/Y %�— Legal Description 1/4 of the 1/4 of Section , T_ -R Town of ,�'" � Lot Number __ Subdivision Nam � FIRE NUMB / LOCK BOX NUMBER Color of house Realty sign by house ?7If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual re uestin g services: Telephone Numbers �� o REPORT TO BE SENT TO: 2 oG - i 9 vim- wi 16 Closing date Signature .a I EAGLE ;�;�t•�a� A RURAL SU_ BDIVISIOtV iLOCATED IN THESE 1/4 OF SECTION .7, , . 1 �•ri�"i`>t`. - 5�1.� ?„ 'j. r ii �.�i.� � is yy, r t y.. iu • i a . t • F :$. SCALE too 00 se N FRA rJ ,o� 3 ; ° : a °9• E � � {t S M2 �? FR ANC I S H . OGDE fr S-882 REVISED THIS 20TH DAY of OCTOWV975 m �' °� 0 o ° Io• lC REGISTERED LAND SURVEYOR .� E DATE THIS 30TH DAY OF SEP •n M4r cti ,a !� ed e °� , .0 3 . tiQ 3uA`�� TEM 8EN,1973 �. ' cP' a °a. �'►. ti ,W h d° o 37 , �; , c }, a� 4P 38 N � � D' e4•ss'sdc 4f2bS •P ab �' s q W C�'► At NO 2 �'� ° 1nod 117.5 '�S•4.?S s� °s,`FT� M � 46 RO 7; IN Pu'E 3 �1j 0 � s I 1.89 ACRES .4. ~s. 39 . 47 1.95 ACRES / / 215 2 Al 1 .59 ACRES 4. 41 ' 40 Al c .e av, co 1.45 ACRES W 153 ACRES 1.02 ACRES ! i Yn N i p •� 191.73' / �Ot ^ 9 • 9ry r 33.15` Iz ITS 6.73 ' 243y' •A 1 . , ♦ O O TEMPORARY TURN ,� ' NNE r' 4 „_ � � 1 9 '� • TZ+�� ° 101'402) AROUND TO 09 AUTO, ,e 2 9Si 4• �/ �° s� MATICLY VACATED UPON STREET MiMSIM 308.12. ,o 26 % f 44 4b• 5 0 >v , sirs`:" . 7 �ff.� M ,II.�O,pp � 1 4y. e5y d • r' r t"' ♦ JJ, ��3 *: t 0 �� r .�,''1N� �0 G I.75 ACRES 83•57io 1.80ACRr � / 1b 4M plc 42 N 43 �. 2.08 ACRES 1.78 ACRES V ♦O 1 Q 1.98 ACRES ' 326.36' 0� u rC o ' 185.su 333.00 9 0• 180.76' d ' 166.50' 168. ii3��• 5 2 s 84 30•W I 059.36 r t �J. e� r I a A 0 0 0 1 V. 1.70 ACRES N `Ip a 401* , �! i i VOLUME 1. aZ�oz�� Oi e S Yy 1 2 1 3, I (1 ,? O L nj! 8.34x. i o , S 83.3540 W 330.21 R ., .-•� {� 1 rh / J KRPTfY• rsa V ~ N 83.35` E 3301" ¢lip 4 Nq. 210.21` <} - 120.00' �i, y ad + !'p��• Jv 2.70 ACRES a, r i t pp OR 0 .�14: a, �> v • . n • q y18 2 M 1.85 ACRES ' m R 2.11 ACRES •N ds 2.13 ACRES r to M 293.16' 36521 d o$ 1 133.59 >8• 134.18' 158.98 \ 173.;5' y 1 Ibeyp• S 89 "W 81/4 CORNER F SECTION 7, . UNPLATTED. LP WhAVANNING Parcel #: 020- 1125 -50 -000 03/31/2005 03:50 PM PAGE 1 OF 1 Alt. Parcel #: 07.29.19.571 020 - 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): * = Current Owner * JEROME M & DENISE M ELLING ELLING, JEROME M & DENISE M 349 MILLER RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 349 MILLER RD SC 2611 SCH D OF HUDSON SP 1700 WITC i Legal Description: Acres: 2.080 Plat: 1925 -EAGLE RIDGE SEC 07 T29N R19W EAGLE RIDGE LOT 42 Block/Condo Bldg: LOT 42 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 07- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1006/245 WD 07/23/1997 850/440 07/23/1997 836/503 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 48661 259,600 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.080 40,500 160,300 200,800 NO Totals for 2004: General Property 2.080 40,500 160,300 200,800 Woodland 0.000 0 0 Totals for 2003: General Property 2.080 40,500 160,300 200,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 110 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 i AS BUILT SANITARY SYSTEM REPORT C � c� U OWNER J o 01 / � J "4 / 1/ J r ° TOWNSHIP l� u �S ®t� SEC. 7 T,2% -R / W ADDRESS (r au ST. CROIX COUNTY, WISCONSIN. SUBDIVISION a / re Z U � � P � l ( LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 I SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM _. I I I r I f E::H Indi ate N r h rr w BENCHMARK: (Permanent reference Point) Describe: A f'�GrNfn Elevation of vertical reference point: Slope at site: C �p SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings on cover Tarik manhole cover elevation: =1-22 Tank Inlet Elevation: C. G' Tank Outlet Elevation: G, '¢-! PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cycle /l14 gallons; Total capacity of distribution lines 1V,4 gallon: size of pump /f/A head; gallon per minute '4 ; horsepower IV ;brand name of pump and model number A ; Type of warning device HOLDING TANK: Manufacturer I A 1 4 Number of gallons A Elevation of manhole cov A Type of warning device _"ev/1' , / SEEPAGE PIT SIZE; i l/ A Number of pits /V 4 feet diameter !v4 feet liquid depth '41 seepage pit inlet pipe - elevation /V bottom of seepage pit elevation feet. 01 SEEPAGE BED SIZE: number of lines width 1-2' length SZ the depth SEEPAGE TRENCH: width // length PERCOLATLON RA'r$ ? AREA REQUIRED 41 / AREA AS BUILT INSPECTOR DATED PLUMBER O - JOB LICENSE NUMBER 2— i ' Ste! J 5 p .. �/ O Q r ly o � 1 7 � 7 a , ?L �l DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR A HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX -7969 BUREAU OF PLUMBING MADISON, WI 53707 • ER CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: I (11 assigned) ❑ Holding Tank ❑ In- Ground Pressure El Mound NAME OF PERMIT HOLDER: J ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Sam Miller Trout Brook Road, Hudson, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF, PT. ELEV.. SW SE,Sec. 7,Lot 42, EagleRidge, Town of Hudson Name of Plumber MP No County Sanitary Permit Number: Douglas Strohbeen I 5432 St. Croix 38488 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING C ER PR V ED: PROVID u .... -.`��% �'l / YES ❑NO 0 El NO BEDDING: VENT DIA.'. VENT MATL: I J HIGH WATER I NUI — V BE OF ROAD: PROPERTY WELL: BUILDING: J AIR VENTTO FRESH ALARM: PIN INLET. FEET FROM DYES ❑NO I ❑YES ❑NO NEAREST 2 DOSING CHAMBER: MANUFACTURER: [ 71 LIQUID CAPACITY. PUMP MODE L. PUMP /SIPHON MANUFACTURER. WARNING LABEL J ILOCKING COVER PROVIDED: PROVDED: ONO ❑Y ES ❑NO ❑ YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE' AIR INLET. PUMP ON AND OFF) OYES ❑NO 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: J ILENGTH NO. OF DISTR. PIPE SPACING. COVER ' INSIDE DIA.. #PITS: LIQUID �'IE�F.NCH rF TRENCHES MATT PIT= - - -- -- - DEPTH: GRAVEL DEPTH FI D TH O'S V. P F DISTR PIPE DISTR, PIPE M RIAL: NO. DISTR NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH PE Yf R. BELOW PIS. ABOVE C. ELF INLET ELEV ,-SN E D / f PIPES. FEE FROM LINE: / AIR INLET: 6 C_, � � _ ( IuAR�sT --- -� (I 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- OYES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER I TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ONO ❑YES El NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH/BED =OF TOPSOIL. SODDED SEEDED MULCHED: CENTER. EDGES: ❑YES El NO 1:1 YES ONO 1 YES El NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: E#fTIFi TRENCHES: �►MMEN�ION6 , _' !i MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO. DISTR. I D ISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. F. ELEV.. ELEV,. DIA.. ELEV. PIPES: DIA.: EVAT4 AN OI RIBUTIpN HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED Ttow PLANS. ❑YES ❑NO El YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF LINE. ERTY WELL: BUILDING: FEET FR(. (; r L ❑ YES ❑ NO El YES ❑ NO I NEARE1T 9 L 41 . r Sketch System on i Retain in county file for audit. Reverse Side. fIGNATURIE� TITL�"` DILHR SBD 6710 (R. 01/82) -- DEPARTMENT O F AP PLICATION SAFETY &BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. Box 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: a '01 -/Z oh I/vis S1 61 G Property Location: Qao hr@9•er Township: �Coynty: r (/✓' /4 r J' /aS 7 �T q NCR I I It Hu d ' I p Lot umber: Blk No.: - Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: �~ [C / e Kr a f ��• L r a C' ( assigned) TYPE OF BUILDING Number of ❑ Public ❑ Variance ❑ Other (specify)* Bedrooms: P 1110, or 2 Family * State Approval Required. TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE AS PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK /SIPHON CHAMBER A/ /V MANUFACTURER: A �, EFFLUENT DISPOSAL SYSTEM I c PERCOLATION RATE ABSORPTION AREA �...,,,,� �/► (Minutes per inch): PROPOSED (Square feet): A N ew ❑ Replacement ❑ Experimental LkSeepage Bed ❑ Seepage Pit �. ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Na r�n � s Listed on Soii Test Report ((f other than present owner): L!T Private ❑ Joint ❑ Public /�"/ 'T I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Nap of Plumb r. Sign ure: MP /MPRSW No.: Phone Number: Ow Ida S �fPo�i6('c1 � A4 55 ( ;)+7 -- 3z3 Plumber's Address: Name of Designer: /leW RAG a 7 W1 s �gINA r 6(f S f eP4 been COUNTY /DEPARTMENT USE ONLY Signat re of Issuing Aggnt: F p. Date: D APPROVED Sani ary Permit Number: (�� �'' — ❑DISAPPROVED Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White - County, Canary- Bureau of Plumbing, Pink - Owner, Goldenrod - Plumber DILHR -SBD -6398 (R.07/81) Form - S T C 100 Owner of Property " )yL'AL Location of P ope ty s� k, Section T -z ( N R W Township Mailing Address �2- 2- ' v 4 Subdivision Name Tt - 4 Lot Number �-� 9 Previous Owner of Property , Total Size of Parcel z C Date Parcel Was Created Are all corners identifiable? _Yes No Include with this application one of the followin : g .Certified Survey Map .Deed ' .Land Contract, or .Other I;egal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed re in the Office of the County Register of Deeds as Document No. W 7 ; and that 1 (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. ). � At' SIGNATURE OF OWNER SIGNATURE OF CO -OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED DEPARTMENT OF REPORT ON SOIL BORINGS AND BUILDINGS INDUSTRY,, IVISION ILABBOR RELATIONS PERCOLATION TESTS (115 �\f X 7969 HIJIMAN O 53707 (1-163.090) & Chapter 145.045) LOOCA SECTION: / OW / / LO NO.:BLK. NO.' DIVISI J ' � � / N /R( 0 for /TLL COUNTY: OW ER'S BUYER'S NAME: MAILING ADDRESS: d o Q USE DATES 0BSERVA N V NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFI E DE CR PTI N TESTS: .Residence 3 ,New ❑Replace /�� �/ '- RATING: S= Site suitable for system U- Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -I N- LL H LDING TANK: RECOMMENDED SYSTEM: (optional) m ❑U ©S DU ®S ❑U ❑ S ©U ❑ S ZU Cotzo4,. , / 4.� ',K Soz If Percolation Tests are NOT required DESIGN RAT If any portion of the tested area is in the under s.H63.09(5) (bl, indicate: ( Floodplain, indicat Floodplain elevation: � PROFILE DESCRIPTIONS BORING TOTALf ELEVATION DEPTH TO GROUNDWATER-IPA A CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ASBRV. ON BACK.) B / B- 7 . �' d�c� 7 '7, S" .S An /s 4- O CS .> ItIg B `f �' , a v,tt� 7 , .�' a S / �9 OV o,�v �.S" off, s /, 9 /s t NA C-5 B- PERCOLATION TESTS TEST DEPTHO' WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER Wf G++E-S AFTERSWELLING INTERVAL -MIN. PER IOD 1 PERIOD 2 PER PER INCH P_ / ., 2 6 G L 3 P_ 2 Y. 3' l) d2 6 6 G L 3 P- 3 A10 2 6 L 3 P P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori• zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 9y, 8 Ze (eu d op I 1 ! .._ LZ ,� � � - ., � e I 3 � I € # I 63� _. S __.. 37 ip L r jj a 3 I, the undersigned, hereby ce t y that the soil tests reported on this Corm were made by me IS ticcord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): v2 . GC sa CST S I� R E: ITION: Original and one copy to Local Authority, Property Owner and Soil Tester. ID -6395 (R. 02/82) — OVER — ,a t I R b II I I! �� i I � ` a I C vs— tl o �. �. � ( - v► c c o i 6 Lof 471- �' ¢ y 5 /V1 5�,c�� V�tr �'e � d I q He G0 -1fer ,L A f UM ti I v Q p c e$ 1rh I= f- s' 6 70, 5 �o� � A/ �= L j 000 . N_ ° z7" Ae �c P3 it .. L �- C 6' AA /�' a �► y g/ �� � to �Nlntcn or4n y � 7 1 i .1 � � �� i ,` � �� ,.. . , �. _, .. 4 _. ,. +. .. ... wl .. .. "M^ `} ����. f f. 3 �y � � .,i i .�.: - _ t, �, ii 4 ��' �s r Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count � T . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitaliniby.: Personal information you provice may be used for secondary purposes [Privacy , s.15.04 (1)(m)]. Permit Holder's Name: I nn�CC� n�y illage Town of: State Plan ID No.: LLING, JEROM HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel &M2 TANK INFORMATION ELEVATION DATA A9800191 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length FDia. i Dist. To well SOIL ABSORPTION SYSTEM BED / TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION I I SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer. INFORMATION Typeof CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/ Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 07.29.19.571,SE,SW 349 MILLER ROAD I Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Division Vi scons i n SANITARY PERMIT APPLICATION 201 W. Washington Avenue I n accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size."" • See reverse side for instructions for completing this application State sanitary Permit Number Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Property Owner Name Property Location _Jer // t /a t /a, S T Z c', N, R` 9 E (or) Property Owner's Mailing Address Lot Number Block Number s:; 7 Z City, State Zip Code Phone Number Subdivision Name or CSM Number II. BUILDING: (check one) ❑ State Owned o ! t Nearest Road Village Public 1 or 2 Family Dwelling - No. of bedrooms ! own OF III BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo Zc� 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B if applicable) / le-ai,''et, �W New Replacement Replacement of Reconnection of Repair of an 4. 5 A) 1. E] 2.❑ p 3.❑ p ❑ System Tank Only______________ Existing5ystem _____ � Existing Syrstem B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 1 LiSeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) c� Elevation /S�• Feet Feet Capacit VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete con- Steel glass Plastic App New Existin strutted Tanksl Tanks e tic ingTank ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersign assum esponsibility for' allation of the.Qnsite sewage system shown on the attached plans. Print) : (No Stamps) Business Phone Number: / Plumber's Address (Stye t, City, State, Zip Code): J IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agen Signa re (No Stamps) )(Ap proved urcharge fee) - � CA. pp [ Given Initial � tSl� O � . f v � Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber T Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings i.� Page �_ of Bureau of Integrated Services ccc9r pe with s. ILHR 83.09, Wis. Adm. Code ;1 Attach complete site plan on pap na4Xess thy $1/ 1 t inch irk glze. Plan must County �'; 1 include, but not limited to: vertic I -anc� horizontaf `refer "ence point�M),�direction and S C rQ �C percent slope, scale or dimensio ; north pjrpV, and location and dIs Ice to nearest road. parcel I.D. # ST S o APPLICANT INFORMATION P /easer, info ion, evi d Date Personal information you provide may be,usedfor 94QI dgi b s iva� w, S. 15.04 (1) (m)). ti 8 Q Property Owner Property Location Govt. Lot $ E 1/4 Lift /4,S 7 T oZ ,N,R E (o K h Property Owner's Mailing Address Lot # Block# Subd. Name or CSM # A A ,3 1 9 ryl �Ic r R& . y a L a e R. City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road ttV W11 S ND ► (1 ) 3 W. 14 y d YY1: r ❑ New Construction Use: residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 00 gpd Recommended design loading rate bed, gpd/ft2 _-' trench, gpd/ft Absorption area required bed, ft ` trench, ft Maximum design loading rate bed, gpd/0 trench, gpd/ft -Re e t infiltration surface elevation(s) 95.02 ft (as referred to site plan benchmark) Additional design /site considerations Parent material Q t or- a 6 y " {' W c, Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ®S ❑ U 12S ❑ U 5 S ❑ U S❑ U ❑ S 'z] U ❑ S RU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Uj f o -3 f o`1R 3 /� -k 3.13 ID IR 9 /3 S a>M bif_ V-"1F,,. Ground 3 3 - 1 D`1 P. SGL I A r m bk_ eA Ct-- elev. lii Lft. y �.ay `7, Sy tz` ►1�, S L a m ,5 b k IV, .5 Depth to ay • 7, `1(Z`I� "°'� f� - 5 tv11- �,W 1J J7 limiting 3b-3y 7. S y Qy 6L ' S , b factor -fir / Remarks: q Y fh Boring # Ground elev. ft. Depth to limiting factor in. Remarks: CST Name (Please Print) Signature Telephone No. Address 'f� Date (� CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER — Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Ground elev. ft. Depth to limiting , factor in. Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor ' Remarks: Boring # Ground elev. ft. Depth to limiting factor in. 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CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving r the �� �,�1,��, residence located at: /, 66,;t_ Sec. J7 T Z� N, R 1 �� — W, Town of t^..) - , N St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes/ No (if no, skip next line. Approximate volume or length of time: _zdo gallons minutes Capacity: (SCI Construction: Prefab Concrete X Steel Other Manufacturer (if known) : Age of nk (if known) : — 0 �/11 �1" (S' ture) (� (Name) Plea Print J' Go ".Dr i t� a, �¢� %DHSS (Title) (License Number) ":; -2a- -9 _ (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary y permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code :(except f inspection opening over outlet baffle). Name � 1 Signature . � MP /MPRS i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address _ Property Address (Wrification required from Planning Department for new construction) City/State (, >' {��-, �/ Parcel Identification Number LEGAL DESCRIPTXON Property Location, _ 5 � VA, Sec. 7 . T-- N -R i - W, Town of Z, .s Subdivision Lot # Certified Survey Map # Volume Page # Warranty Deed # y 9 �' Volume `'Q"d Page # 2 y< Spec house 0 yes [A no Lot lines identifiable yes 0, 110 SYSTEM:MAUffENANCE Lnp.rqper= adma kt=nceofymsepticrjg=cotddrewhia its - consists of pumping oat the septic tam]c every thrx y p� amto handlewast�es. Proper can affocttha frmctioa of 8e if mododby s licensedpamper What you, pat into the system tank as.: stage in fire Rrastodisposat_"Stem. The ProPerty owns agrees to submit to St Croix Zo *g Departmeat a certification fozm. signed by the owner and by a P 7oumc pkmcr >perV=4*that(1) ffi s is is prmpar operating condition and/or (2) after inspection and pcmrpmg.Crf necessary), the septic-tank less.d= W fill of sludge. Vwr. &c undcrsigned have read the above requirements and at= to maintain the Private sewage disposal system with the standards set forth. h=in. - as set by the Department of Commerce and the Department of Natural wLwonsitL- stating that Y= Septic system has been maintained must be completed and tetmmed to the S � Stu County Zo� ce within days of the 9= year expiration date. SM �APP�Ll�� -.3 / 0� DATE OWNER CERTI! FICAITON I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (art) the owner(s) of the property described above, by virtue of a warranty deed r cordcd in Register of Deeds Office. GNATURE, APPUCANT DATE « « « « «« Any information that is mis Y Zoning -rued may result in the snaitary permit being revoked b the Department""" «« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 0 { Order 111088816 DOCUMENT NO. ' WARRAM" �{ THIS srscc Rcscnvco yoR R[GOrroM6 n• *• I STATE BAR OF WISCONSIN FORM 8 ---19� 4 2? i__ T � --- - --r- -- hXISTSR'S 0F> `r ST. am OOL VA t R.ngez- .T... Kopp- - and - Mary. A....Xopp,- - $s-- h1s... ....... _. Rec'dforR9ty d - 3 .... - - - -- .......... ... - -- - .........- •----- .- ..._...... I Y 1993 .; t� - - -•. ------ _-- - - - -.. -------- - - - -- V conveys and warrants to ..-Aer Ojos --- M.. - . - 11 1 ing ._and._A�piae._.._... , M..._811in husband.- and._xi-fe _as. } g,- R�Arr®t ,f maxitaL prapertr- .......................... ...... .............------- •-- ........ ............ .. ..................... . .. ......... .... . . ................. ..... .......... .... -................... t --•---------•-----_•-•---•-•-----• .................... •---- ....---- ------------ - - - - -- .................................... .._......._.- ................._ ....................... _.... _.............. RCTURN TO ......... .............................. _............ _........ ,........................... — --- — --------- . ... I� ....-.- ........ ........ .....- ............. . .................. .... -... ............................. ............. the following described real estate in ..... ....-- Sz..XroiZ---- - - - - --- .County. State of Wisconsin: Tax Pared No: ..QZQ- 1,25 -M5-9 - I Lot 42, Eagle Ridge in the Town of Hudson I 1 { F i This .......... .......... ... homestead property. (is) (l!I)ts o Exception to warranties: Existinf highways, easements and rights of way of record { Dated this ............... 2nd.......................... day of - - - -- ----- -------- July ...... ......... ........ 19.9. I T_ S • ........... ................................................... --- • __R roger T...Kopp- -- ...._ - - - - -- . �l.N CA 4, . ................ ---- - - - - -- ---------------------- - --- - -- ---(SEAL) ... ... s '1 Y I A. Ko - Mary - • - ----...... p. P ...................:..i,..•.., }� a (I 1 r , v Iris } AUTHRNTICATION ACBN0WLEDGM*J;V� -P44 0.4)'''4 •tip, J •.... �� { 9' stares STATE OF VK�9i- MI Greene ss. •. �. a 4 t . °• - - - - authenticated this - --- ----day oL_... ............ 19.._... Personally tame before me this _.2nd ...... .day of { --___—. hLly-- .- ----_---- -__- -. 19.92--- the above named •-------- - - - - -- -- B T,..Ko p_.and_ -Ma =. A• -ICs e ---------------------------------------•-•----- ------ --- •--------------- - - - - -- _ uis hand_. and -- wife------ - - -. -- -_------------- - - - -- TITLE: MEMBER STATE BAR OF WISCONSIN __- ---_-----.-°-•-•--....-._--•_-•-°.• .......... ...................... --- •------- ----•- - - -• - aathorised Dy f 406.06, Wis Stata) is me known to be the person 3-.-- -- -- -- who executed the forte instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY At ----------•----•-- �21_. 2nd._ ------ .ritsr9' Public .--- ---- - -- ------- -- County. 1� �6. (Signatures may be authenticated or ackaou Cno ledged. Both my mysission is w f "noK'sta "e expiration are not necessary.) drt-: ------- WTAgfVjKtCV*Tf F -- 19._. ...... ) • _ � �_ - - -- - ; - - -- �,r, -= `i;'_'k Off= _ _ _— __ _ _ -- -- . ` s - Zatow of pmeas dsniai is any eaT»dty ebou3d be tyDed or printed blow their siw: to es. WARRANTY DEED STrt TB BA$ OF Wi_`COKSTV Wia. in Les.l 131un4 C.. Irtr POaM Pis. 2 — Ir+i !Id ♦u ke.:- w ».