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020-1031-00-000
N 0 O 3 ci 3 0 a . E» O r V 0 0 G! O 'O N '3 w N O O N C ~ ~ N O _ N N N 0 o C= LL O V N V m M N U 0)-oo 32 L) 0 m 0 co N w o m aai"cNC CL.0 C N N 0 •C a) y Z`+ O O U E 7 0 N h!, O O. O L V N w fV N 3 N N > c •c a ) 3 0 3a ° aY Z `nc Z C c ca '6 LL Q y~_0 c~ U. 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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - MILLER, THOMAS J THOMAS J MILLER 491 MCCUTCHEON RD HUDSON WI 54016 = Districts: SC -School SP -Special Property Address(es): Primary Type Dist # Description " 491 MCCUTCHEON RD SC 2611 SCH DIST OF HUDSON SP 1700 WITC Legal Description: Acres: 2.500 Plat: 1254-CSM 05-1254 020-83 SEC 17 T29N R19W SE NE LOT 1 OF CSM Block/Condo Bldg: LOT 01 5/1254 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-19W SE NE Notes: Parcel History: Date Doc # Vol/Page Type 11/29/2001 663514 1775/530 QC 07/23/1997 738/315 07/23/1997 672/242 2012 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/17/2012 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.500 46,600 163,300 209,900 NO 10 Totals for 2012: General Property 2.500 46,600 163,300 209,900 Woodland 0.000 0 0 Totals for 2011: General Property 2.500 79,700 165,500 245,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 205 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 n cn O 3 v A C7 r~ 0 Z 0 N O N _ ~ l~l• O O M o O C v N rvl C (D Z 0 ° to in w O O ? o 0 -i n O Q (D 3 W CD CL o w D o c cn Z D a ems. co D y a ~ ' C N W 0 Q = O p c p 4 -4 0 m m o o co co ' j n r to co to rn rn a'; N T ° a m~ O O O o 0 r3 . . . a > Oro j (T 1 O e~ U7 CI O i rn f° r. _ 3 m N ~ ~ • 7 I A ""~~11 N O a ~N fD C N fV CD A 2 cD j' CL 'I N v W v m ° i c z z m to A 00 O 01 N fD OD. U L• c, 3 a co co - ° oz o M -f° 4! fD G 2 fD N 3 A N 6 N m O S (D fp N N I N tip 1 N i V O N ti O b O ~ c^ O d0 2 ti ~uq N b I ~ ~ N 'i i "RECENED STC - 104_ ..SEC f t 1997 AS BUILT SANITARY SYSTEM RE~RT COUCROIX NTY ZONING+OFFICE ` OWNER t ADDRESS EGG It 4''4d*`~ A N w S yor C" ffU~s SUBDIVISION / CSM# LOT # SECTION, l7 T ! Q N-R jC ( W, own of 110PAV.-~ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM CVO TES ~x~sTiN G- _Imoz? S' 1-7 C rte- -mle 74r GK'S . Ise - 111;f- INDICATE NORTH ARROW Provide setback and elevation information on reverse of this-form. Provide 2 dimensions to center of septic tank manhole cover. 96 6"-6- ef 7- 4tfA"4L BENCHMARK: 1~ y' r7 8 ALTERNATE BM: '7`b d~ C(J~ CttS/ NCj SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION Manufacturer: ev Liquid Capacity: 10~~ Setback from: Well 73 House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location -:SOIL ABSORPTION SYSTEM Width: 5 Length Number of trenches Z Distance & Direction to nearest prop. line: > S 4 C c~S T' . Setback from: well: 52- House (~O D Other ELEVATIONS r 2 z ''i/3y Building Sewer ST Inlet; ST outlet PC inlet l PC bottom / Pump Off Header/Manifold Bottom of system Urt /v~'S Existing Grade Final grade d& r-~s S~ 3 o r DATE OF INSTALLATION: 4; a c PLUMBER ON JOB: IZa 6~_= R,T- ZitfRRR (C-( IAJJ cam. OF LICENSE NUMBER: P I~-.S 33 O / D~6n /,~Q/~JC INSPECTOR:- 7E b S 3/93:jt I :m ~ a a o ~ p0, o c 1~ a 1 ~ ~ ooh O, o T 1 ~ oil r~ 03 M 1 o y, 6p 0 0 of O IZ 'T 0 G ttvl -n y ,Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety add Buildings Division ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryPgrSiti - Personal information you provice may be used for secondary purposes (Privacy La S.15.04 (1)(m)]. age Town of: State Plan ID No.: Permit Holder's Name: ❑ C.i~ V4 MILLER, THOMAS & KIM H&9,CST BM Elev.: Insp. BM Elev.: BM, Description: Parcel Talc Na._1031-00-000 00f 44 TANK INFORMATION ELEVATION DATA A9700499 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I e5 ~r siir • (~D,~ Benchmark 2 - 31 Dosing 2.5,' '79.7 8~ Aeration Bldg. Sewer 2,aus~'i~► Holding St/Ht Inlet Stin TANK SETBACK INFORMATION IQ* outlet x.573 Y~~ TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing w NA Header / Man. 1,.44 00% ~a os1f. k n.13 112 E42 I- Aeration ion NA Dist. Pipe z lr za ,,,1 ef/.08r 4yl.ao Holding Bot. System l2.Z5 qb. p (o PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Coves' 3Model Number GPM T~ 1 QL TDH Lift Lrictio System TDH Ft GzjForcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED RENCH Width c Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth S- OW I J DIMENSIONS DIMEN SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manuf urer: INFORMATION Type O CHAM81<R ~ o el Num'er: System:~onve_"Jf a t OR UNIT DISTRIBUTION SYSTEM -Try , -7e,, ey Header / Manifold Distribution Pipe(sj x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound r At-Grade Systems Only Depth Over Depth Over ept f xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges T it ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 17.29.19.143A,SE,NE 491 MCCUTCHEON ROAD -ZctbC` kkcW IV1Sf2(~ec b M YY~Wne,rj eh 7/96 y ! h S l lcv, rC Cowl McV44 ✓21PvMovi 1T. R~l~ f3 vie a ~C, lo-*5c c~Is poser .l J 3.) St j sewn is s efloaak C, tox s l rpe F'i via a -L - `l-7 Plan revision required? ❑ Yes 1"l No Use other side for additional information. 1'L 3 q 7 R j 7 3 Date Inspector's Si nature ert. No. SBD-6710 (R.3/97) Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. $T. c1f orK • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION N Property O ner Name 1 y, Property Location s /t'( r llE~ SF 1/4 "El/4, S T Llf , N, R ! FE (Or(O Propert y w er's Mailing ACddresCj t _ p i,_0 ^ Lot Number ( Block Number Cit , States o I Zi Code PhonC ti gr_ Subdivision arrf~CSM Number Of • 5 V D 5404 Ce c 7t t~i2 c s 3 V - I II. TYPE OF BUIL ING: (check one) ❑ State Owned ❑ City I V Nearest Road E] Public 1 or 2 Family Dwelling - No. of bedrooms / El own of M G (5u III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 17• aZ. 1 11,3A ~ 2 O ~J~~I - O00 O 1 ❑ Apartment / Condo 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 ly one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. ~eplacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System _System Tank Only Existing System Existing System 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 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 [~5 epage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 4 Z -r1ee s s ✓ ` 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 6. Zf . Lf' 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade ''ll Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) C Elevation 7S 5(4-3 &.50 Feet F V. LS Feet VII. TANK' Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Con- Fiber- plastic Exper. New Existing Gallons Tanks Concrete strutted Steel glass App. Tanks Tanks Septic Tank or Holding Tank ~O /Lsoo ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 1:1 1:1 1:1 El El 1:1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signatu e: (No Stamps) /MPRSW No.: Business Phone Number: ?0 8 aF-T- u LB iii cwt 33 0^7 7/S • 3A; Plumber's Address (Street, City, State, Zip Code): Gt~J IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit ee (Includes Groundwater Date Issue Issuing A en ignature (No Stamps) 0 1 Approved ❑ Owner Given Initial uO ~*D Surcharge fee) Adverse Determination X.. ONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: Tom. SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Ruil, ings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815: To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system- Check appropriate box depending on system type. VI- Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX- County/ Department Use Only. - X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service- streams and lakes; pump or siphon tanks,- distribution boxes,- soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; Q complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance,.urve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; 1.) soil test data on a 115 form,- and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater- The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ST. 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 the ~0M /~IilG SE residence locat.;d at: 1/9, P6 1/91 Sec. !7 , T)L- N R W. Town of Upon Inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be s,v~•~-~~ functioning properly. / C ~ M41~ Last time serviced Did flow back occur from absorption system? / Yes No (if no, skip Approximate volume or length of time: next line) gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacurer (if known) : Age of Tank (if known : 0 rs &2 / Wz, 43 n /"cam (Signature) (Name) Please Print (Title) Mto)e) ~3 O~ (License Number) (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 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 for inspection opening over outlet baffle). Name RD6zr-T" 41hxt. Signature l`vk fitP7`'MPRS 3 ~ 5/88 O (N 4A r LA 6 m A ,.i o kA Sir C 0i r Cf O ~ ~ 06 ' S cr, • Fresh Air "Inlets And Observation Pipe .HIGH TRENCH Approved Vent Cap Minimum 12"Above ~y. ZS- Final Grade FINISHED GRADE 2y Above Pipe F nal Grade Pipe' 'to Fi Synthetic Covlegalel iMin. 2" AggrOver Pipe Distribution Tee Pipe , 0 0 0 AggregaPerfbrated Pipe Below Beneath PipCoupling Terminating At Bottom Of System SYSTEM ELEVATION ~d7 S PER PLUMBING PRODUCT APPROVAL CODES, ALL ABOVE-GROUND PVC PIPING (FROM TANKS b SYSTEM AREAS) MUST BE SCHAO PVC MEETING ASTM D1785 OR 02665 STANDARDS. LOWER TRENCH Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12" Above Final Grade FINISHED GRADE ~ AL_- n: _ _ 4" Wisconsin Department of Industry, S E EVALUATION Labor and-Human Relations ` 6456 Page of Division of Safety.and Buildings QOfrC)aWi&•R 83.09, Wis. Attach complete site plan on paper not less than 8 1 2 1 1 cha'is Aan mu' -a County Include, but not limited to: vertical and horizontal r ei:,ft ce point (BM), direction and a-- ST 44401X percent slope, scale or dimensions, north arrow, a toCatiorcdit~ary~e "?rest oa Parcel I.D. # vzo^ 3 APPLICANT INFORMATION - Please pry infg,YePFICE Reviewed by Date Personal information you-provide may be used for secondary p g(Privacy Law, s; 15. Prope Owner arty Location 1 10/41f S ? GC!/~ f Govt. Lot SF_ 1/4 /Ug1/4,S /7 T 2.7 N,R E(or W Property Owners Mailing Address Lot # Block# Subd. Name or CSM# V f / loe Cu f--,4 • ! 1C.5,,qj3,?.2-7?3 141/y p '2S4 City State Zip Code Phone Number L' V S©j .~,~0 ~(O ty Nearest Road I, H l (115)3P6. 164 Ci Y UI e ~ Town loG 1:W4 ~O.tJ ❑ New Construction Use: esidential / Number of bedrooms 3 Addition to existing building (a-Replacement ❑ Public or commercial - Describe: Code derived daily flow 7J d gpd / Recommended design loading rate bed, gpd/fe trench, gpd/ft2 17 Absorption area required _Lbed, ft2 trench, ft2 Maximum design loading rate bed, gpd/fl2 trench, gpd/ft2 Recommended infiltration surface elevation(s) sue- p41 - 3 ft (as referred to site plan benchmark) Additional design/site considerations PXSVI60S ?ES T 6' LD 16 ' (f~/fj f S 6!~ S!/, f 4lfx,' 0 10 ~4~J Parent material S O yr v~f Flood plain elevation, if applicable 'y ff- It S = Suitable for system Conve tional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system Er-s"' ❑ U Eg- u ❑ U ~ u [r.4-9~0 u ❑ s SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots i- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 01q lOYA 3(3 SL If 8'L a.S -f .q ; .S V. Y -f- she ~ / - a S • S Ground 3 / d Slc I[ S - • L~ elev. qy 1--ft. Depth to limiting factor In. 77 Remarks: Boring # I a -5 10Y4 313 - SL I 'f R J_Sk ~t.S -/-f • 4 ; • S Z 2- - I?•S YAP VZ, S O Sef- cS - • ; •~3 k-576 '/0Vje5/'62 -57 0 Ground elev. • fin. , Depth to limiting factor f 4g-In. Remarks: CST Name (Please Print) R O s Ei~!r L n r Signature Telephone No. ~J vr1 r '715- 38 6 • 8 / 8.5 Address Date CST Number Wtuicht & Associates 2- S - CSTAI 2-IL4 8 L Rivals swag e.. ~n,_u nJ PROPERTY OWNER SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D.ff 62-0-1031. 6 0O O C-) i Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench 3 • q /o YR 3 3 S Q a2s t"- QS C f ((:.S W. ~a Ls' lh, s es •g Ground S D .8 V/P S31 Z/ elev. N. Depth to limiting factor 7 n. ' Remarks: Boring # Ground elev. n. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Boring Ground elev. n. Depth to limiting factor in. Remarks: Boring # Ground elev. n. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) W w I Z104 ~ I I 1 m to _ - "1 w S fx (kS o ~ w ~L 1. of ! f/ i iG/t-T~o.~ o Soi/ 1fn T4cEA-)T Ta 19=o~P pe-TUU1AJATfot~) P20cLt=:SS U/,4 -rE"P.2 At, (FT` Wisconsin Department of Industry, SOIL AND SITE EVALUATION / 7 Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than S 1/2 x 11 inches in size. Plan must County S T CiP~/ Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 6.2.0- 00000 APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner , k1 Property Location AM'+s' ? /L( Govt. Lot $E 1/4 NF1/4,S 11 T 2-~ N,R 9 E (orOWProperty Owner's Mailing Address Lot # Block If Subd. Name or CSM# y9/ Re ev {-46-6'u Til . ~ if 302-7f _3 fol. 5' Pg City State Zip Code Phone Number Nearest Road U~SO~ 5ybl~ ( ) ❑ City ❑ Village~ Town 0 /f1G t vf4E-OAI El New Construction Use: esidential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate .7 bed, gpd/ft2 g trench, gpdht2 Absorption area required ed, ft2 5(3 trench, ft 2 Maximum design loading rate .7 bed, gpd/ft2]-trench, gpd/ft2 EXISTfA.XJ- Recommended Infiltration surface elevation(s) 13. So ft (as referred to site plan benchmark) Additional design/site consi tions Parent material :5C5 SS `D Aik-D T,A Flood plain elevation, If applicable N~~ ft S = Suitable for system ~Conventional ,Mown In-,Ground Pressure ,AT,-Grad System in Fill Holding Tank U = Unsuitable for system I~ S El U I=J 5 El U Ir s U I~ 5 t❑ U 91 U El S SOIL DESCRIPTION REPORT Borin # Horizon Depth Dominant Color Mottles Structure GPD/ft2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench n-q ~o yR 2/~- - 51 c 9~e aos~ ,'V: '5- 2 -17110M A~ he dA a s . -z' 3 Ground J? /0 , / T j ,8 elev. Depth to limiting factor , 7C[in. 6- Remarks: 4`1(577A) (r- S!/ST• /S Boring # 13 n D-I al b I Ground elev. ft. , for Depth to SLOW 11c; em, limiting factor in. Remarks: CST Name (Please Print) Signature Telephone No. R019ER07- 7i-5= 3gG g~~5 (1317) Ulbricht & Associates Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 MC COTC~aot3 I D IT" CFFI, U&xl7: iti aRAi~v f i e~D - Z o -fG sysT/cv. _ X3.5-0 y" c.z. UE.u r t3~ I'btJND ~ , SCALi= U,-f 45- L2 I ] Q T p lc 50~ l 4,v ctz fR- ~ Afo" or- o x Z z iv tv TiP . f3E'9( ? s~ pTic S O z 13 / /t'Ri, /G/f T/off o S"oi/S ~t~ T~Q cE,~7- 7- ~,r isr/N6 S`sT,l P,5-TUU1^JA'T1o,J p2oct=s-5 --E-P_P_ AL(FT- . Wisconsin Department of Industry, SOIL AND SITE EVALUATION / 7 - Labor and Human Relations Page / of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1 /2 x 11 Inches in size. Plan must County S T CiPo/ Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # azo- /63/- 00000 APPLICANT INFORMATION - Please print all Information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner I / Property Location 710,",+ S /C / /kl /f Govt. Lot 5E 1/4 MF114,S 17 T Z-y N,R 9 E (or W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# y?/ Mc Po /066-o,-~ T'd - cs y 302-7Y3 PI City State Zip Code Phone Number Nearest Road UDSp~ et)/ 5ybl& ( ) El City El Village .V d Town /~L Cv f ~►Eoi1/ El New Construction Use: esidential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow !!F gpd Recommended design loading rate ' 7 bed, gpd/ft2 8 trench, gpd/ft2 Absorption area required 3 bed, ft2 563 trench, ft2 Maximum design loading rate ' 7 bed, gp N/ - ::trench, gpd/tt2 C -)(l S tf AX- Recommended Infiltration surface elevation(s) q3. 50 ft (as referred to site plan benchmark) Additional design/site consi tions Parent material SC S SS 'DAc VO T-'y--- Flood plain elevation, if applicable It S = Suitable for system Conventional ,M, oo In-Ground_ Pressure AST,-Grad System In Fill Holding Tank U = Unsuitable for system P S ❑ U U 5 ❑ U IBS U L❑ U 0-5 U El S SOIL DESCRIPTION REPORT Boring Al Horizon Depth Dominant Color Mottles Structure GPD/ft2 In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench /0 Y/? _77Te- d5X 2- -i 10Y? s// /~sh& a s . z' 3 Ground 3 /O ~P s 0~ j / . 7: 16 elev. 9 ~j~Q! ft. Depth to limiting factor 7G~in. Remarks: &P-5771V G-- SS/5T. /S Gv (41 DE" ~d•~++~J ~,v T- Soy/~' Boring # Ground elev. ft. Depth to limiting factor in. Remarks: CST Name (Please Print) Signature Telephone No. on - - - - - -7. /G - • - ~ t,Y , ~f 71 s -7 . -1 ti _ ir, ^r 2- of) ~~/~~}'Tlov o ~ X8.0 Ulbricht & Associates Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 Mc COTCG aoI3 I[D sysT ~icv. = y3.s-o , y" c .r• f/E.v T L3~ fb U.) 5CALe , l t~ - ZO rs 1 ~ I P co v c~.c f-e. 4 PRo.v i g°~ i /,Ayo0 T- 6/"-' r4' AF 3o x Al 4j -rip. 0 T• /~U• /00.0 ' i.5 i3 / ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT A FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the MIT Vf-r residence located at: c ``1/4,~~ 1/4, Sec. T ZEN, R_~~ Town of I IS Q0_1 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 servicedbL G.%, ( cl q Did flow back occur from absorption system? Yes-)LNo (if no, skip next line) Approximate volume or length of time: (v 00 gallons minutes Capacity: )Ooo Construction: Prefab Concrete Steel Other Manufacurer (if known) Age of Tank (if known): -e )J 0Vj (s~ gnatu e) (Name) Please Pri t (Title) (License Number) (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 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 for inspection opening over outlet baff`j / Name 2Signature `gyp RP/MPRS 5/88 • y . M STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 14.1 rr, N- M I-e/ . MAILING ADDRESS 4c 1 M C C_%,.t ON t a..► 7k PROPERTY ADDRESS S l_ . (location of septic system) Please obtain from the Planning Dept. CITY/STATE 1A ~&s o % U -k PROPERTY LOCATION s~ 1/4, JN G_ 1/4, Section - T 2 ct N-R 1r W TOWN OF 1A b n,,t ST. CROIX COUNTY, WI SUBDIVISION It- LOT NUMBER CERTIFIEDSURVEY MAP , VOLUME , PAGE LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment 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 system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained ~ust leted and returned to the St. Croix County Zoning Officer within 30 days of the tar expiration date.. SIGNED: DATE: ~v 4;2 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 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 Location of property1/4, Section /-L,T_Z_gf N-R_L _W Township _ A A boy Mailing address / YY) CG,,J ch",j , Address of site StM"JL__ Subdivision name ~c. t IL U. t w E S~c.~ e 5 Lot no. / Other homes on property? Yes J~ No Previous owner of property SSG.-~ C_he.4.A. Total size of property Total size of parcel Date parcel was created `a - &3 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes \ _ 4._No Volume _y - and Page Number 12S+ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. 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 Certified Survey Map shall also be required. 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 recorded in the office of the County Register of Deeds as Document No. 411aot3 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run 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. 141I_6q3 Signature Applicant Co-Applicant Date of Signature Date of Signature t~tt01 i K DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1--1992 *NU vAca acscavco FOR atconoiNO DATA WARRANTY DEED cL~ -,-JMFAGE3 } I REGISTERS OFFICE Thi Deed made between ---Cassandra L. Schave, a single pe?son, ST. CROIX CO., WIS. Recd. for Record this 30th Grantor, ! day of April A,D. 19 80 and ._.._..'i`hi iTas J::...M;ilY_er...an __I~im: L' Miller, 3:30 P husband and w fe as survlvorshi marital F.....)?......Y.! Grantee, or of DOW$ Witnesse Th t the said Grantor, for s valuable comideration_-__-- Gran or . NLTURN ?O;I conveys to Grantee the following described real estate in j County, State of Wisconsin: i Part of the Southeast Quarter (SE4) of the Tax Parcel No : Northeast Quarter (NE4) of Section 17-29-19, more particularly described as follows: 'I Lot 1 of Certified Survey Map filed February 22, 1983 in Certified Survey Maps, Volume "5", Page1254 in the Office of I~ the St. Croix County Regisier of Deeds. i +t A SFRI FED] This ..._....ls homestead property. (is) (is not) Together with _all an singular the hereditaments and appurtenances thereunto belonging; Garanlor And tle is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights of way of record, if any. and will warrant and defend the same. Dated this 0th--••--•---•----......-•----._.. day of ..........April.............................................. , 19__8.6.. ----------•----------•----------------•------------------•-----•----(SEAL) ------6, L~I!j94-C_._.(SEAL) Cassandra L. Schave (SEAL). -----.(SEAL) i~ i AUTHENTICATION ACKNOWLEDGMENT Signature(s) Cassandra L. Schave STATE OF WISCONSIN ss. ---------------------------------County. authenticated this _ 3-__day of... April , 19 86 Personally came before me this ................day of L 2 I . - - , ce-I -K fie'-r- ~ _19 the above named -r--------- t;-TY-~('~zz CCU<- TITLE: MEMBER STATE BAR OF WISCONSIN (If not- authorized by $ 706.06, Wis. Stats.) to me known to be the person who executed the #793 gyp .il CERTIFIED SURVEY MAP' FILED LOCATED IN Cal/ FEB 2219$3 SE 1/4 - NE 1/4 SECTION 17, T29N, R 19W JAMM O' CON ELL TOWN OF HUDSON, ST. CROIX COUNTY t' spidw crab swidh~ I WYrIm~ ~ PARK- V I E 1~I1_ E STA T E S I 9 75 -SECOND ADDITION - 76 I ' I PARK VIEW ESTATES - - I I - N 000630"w 311.01 ' I I SECOND ADDITION _ _ I I - - 16 19 81.01' 230.00' 44 1 00 ~a6 I 33' 33' ,3' 1 EASTERLY LINE OF SUDIVISION 66' cn w z o w 1 0 c ~ 2 0 1 = z m m 1 r = o I z 0 n 0 in 0 2.502 ACRES o n 0 iC ' R1 (109004 SQ. FT.) c I z ; , ; ' O ~-I z w m co i2 I m :mm D mm 0 I,fri I ' G C m o (J) 0 (D :m ;fr1 r) N. r m N 'Z 1 z -~O x = m Iz CL ' t ,(A J C/) m 1 m D ' -0 I Cn m N Z N0006'30"W 311.01 i ~m < 40 rn m M N I W PARK , Co _ ~ - - 1m I in w LANE_ r- - w 0 o CL __j 'D <o 0 0 ' ~rn O 40 m= Z o 1 2 ° < ' cn W r APPROVED ~ 'n C, 2.502 ACRES m m iO , 1J 1981 o (109004 SQ.FT.) v, ° IUD I ; 'D o r~0 N APPROXIMATE D I 5~. CROIX C07U~TY w HOUSE LOCATION m O COMPREHENSIVE PARKS PLANNING V Z AND ZONING COMMirrEt I i E 1/4 CORNER 1 SECTION 17, POINT OF BEGINNING 1 NE CORNER T29N,R19W \o ISO- WESTERLY RIGHT-OF-WAY LINE 1 1 SECTION 17, NO°06 971.58 ~o~~~ 06'30"E 311.01 I /`fir 1 T29N,R19W WiscorIn Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor andHumaei Relations INSPECTION REPORT St. Croix rSafety aQd Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268501 Permit Holder's Name: ❑ City ❑ Village El Town o : State Plan ID No.: MILLER, THOMAS J. & KIM L. HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9600208 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 oss Ff Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Mode 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 17.29.18W, SE, NE, MCCUTCHEON S ~t~wi 1= probe, Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • 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. Cp • See reverse side for instructions for completing this application State Sanitary Permit Number 12(00 so~ The information you provide maybe used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location C l I r-1/4 W-114, S/-7 T Z 01 r N, R ICI E (or(2b Property Owner's Mailin Address Lot Number Block Number ~-r c Z d. 1 ~ C-5 Al City, State Zip Code Phone Number Subdivision Name or CSM Number ( ) Z 1/0'. 57 70-Z y- II. TYPE OF BUILDING: (check one) ❑ State Owned !.yy Nearest Road ❑ Village H } LI1 Co 1~~ Public 1 2 Family Dwelling - No. of bedrooms Town OF 14 %A.460jj 111. BUILDIN : (If building type is public, check all that apply) Parcel Tax Number(s) 1❑ Apartment/ Condo o Z O- l U 31- a0 0 O 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) A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5, Repair of an System System Tank Only Existing System Existing System 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 11 Seepage 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 ~SU 1 6. Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation L} 3 13 • 5,14eet , 0 Feet VII. TANK Ca in gallo city Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank CC~ ILM! j ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibilit for i s a lation of the onsite sewage system shown on the attached plans. "Nom lgw4momoopqu~ e: (Print) `~,~{rrc~1 No Stamps) usiness Phone Number: W~o C X36.2 ) 3C sAddress (Street, ity, State, I Code): S1~ ~)A- IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issuing Ag nt Si ature (No m s) A roved Surcharge Fee) pp ❑ Owner Given Initial i ' 4~ 710 Adverse Determination X. CONDITIONS OF APPROVAL /REASONS FOR DIS PPROVAL: jP - 0;1-4 r% SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS s 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed- II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use_ If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR- VIII Responsibility statement. Installing plumber is to fill in narne, license number with appropriate prefix (e.g. MP, .etc.),`: address and phone number. Plumber must sign application form. IX- County/ Department Use Only- X- County/ Department Use Only- Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls-, dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE - 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. rr L J e, tj AS BUILT SANITARY SYSTEM REPORT OWNER 5 P 117 TOWNSHIP I a ~yo`? SEC. [ 7 T,?yN-R1j W 'ADDRESS ~/'~~+f ST. CROIX COUNTY, WISCONSIN. V44, Pj. LOT SIZE PO Pk Vf?k" e LOT 1 SUBDIVISION PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM - I di at N r h rr w Gorn~~ BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: I oo, C),-f ~ Slope at site:; 3 SEPTIC TANK: Manufacturer: t'l/ Liquid Capacity: Q Number of rings on cover ; Z Tank manhole cover elevation: 0iaa Tank Inlet Elevation , 2Z- Tank Outlet Elevation: 'IT7 PUMP CHAMBER Manufacturer: Numb'er of gallons Number of gal. pump set for a cycle IV4 gallons; Total capacity of distribution lines All~ gallon: size of pump head; gallon per minute horsepower IV A ;brand name of pump and model number Type of warning device IV 4 HOLDING TANK: Manufacturer A Number of gallons //4- Elevation of manhole cover ; 'Type of warning device A .y of pits 11,14 SEEPAGE RIT SIZE; /VA Number feet diameter feet liquid depth j/ ,~j seepage pit inlet pipe-elevation IV I) bottom of seepage pit elevation ,,41A- feet. SEEPAGE BED SIZE: number of lines width 2 length 2G -tile depth SEEPAGE TRENCH: width IV 4 lenfgth / PERCOLATION RATE `7 AREA REQUIRED AREA AS BUILT INSPECTOR DATED PLUMBER ON JOB LICENSE NUMBER__ C r~T~C~QI ~v~o~ G vH^~h a~ It p r L N i DEPAXIT&NT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUI LDINGS DIVISION BOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O. BOX 7969 MADISON, W 1.0707 len D. Number: UCONVENTIONAL DALTERNATIVE Sttne ate; Plan L El Holding Tank D In-Ground Pressure O Mound INSP C 1 DAT L E~ON f: NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: " o~/{ U Sam Miller RR~~S, TroutBrook Rd., Hudson ` REF. .ELEV.: CST REF. PT. ELEV.. BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN; SE% NE%, Section 17, T29N-R19W, Hudson Township 9Sr•,c5 ('-O~ nitary Permit Number: MP County: Name of Plumber. 3 7 9 6 5432 St. Croix Dou las Strohbeen : NK INLET ELEV.: TANK OUTLET ELEV.: WARNING LA LOCKING COVER SEPTIC TANK/HOLDING TANK: : PROVIDED PROVIDED : MANUFACTURER: LIQUID CAPACITY TA YES ONO DYES NO ROPERTV WELL: ~ BUILDING: VE TO FRE H LE DDING: VENT DIA.: VENT MATL.: HIGH : NUMBER OF ROAD: LINE: G AIR INLET' C nLnRM FEET FROM { 07- YES ONO DYES NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP ML: PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVID ED: ODE DYES ONO DYES ONO DYES ONO. PUM AN C NT L OPERATIONAL: NUMBER OF ~IRNE ERTV WELL. BUILDING: AIR I LETR H GALLONS PER CYCLE: FEET FROM (DIFFERENCE BETWEEN DYES ONO NEAREST PUMP ON AND OFF) LENfiTH: OI AMETER MATERIAL AND MARKING SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing =FORCEE or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) WIDTH LE NO. *PITS LIQUID CONVENTIONAL SYSTEM: NGTH: DISTR. PIPE SPACING: MA J w TREN / C DIMENSIONS GRAVEL DEPTH FILL a~ DE TH UI TS S/PIPE (p WELL: BUILDING: BELOW PIPES DISR. PIPE NO. DIST3iEi PIPES: aS~ r : ABOVCQ ER : EL V. NLF~ ELEV. END n~ n MOUND SYSTEM: wed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM Mound site plo and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. PERMANENT MARKERS: OBSERVATION WELLS. DYES NO OIL COVER TEXTURE: DYES ONO OYES ONO DEPTH OVER =TRENCH/BEDDEPTH OVER T RENCH/BED DEPTH OF TOPSOILSODDED. SEEDED: MULCHEDCENTER: : DYES NO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: LATERAL SPACING fiHAVEL DEPTH BELOW PIPE 1 L E TH AB V CO E WIDTH. LENGTH. NO.OF BED/TRENCH TRENCH DIMENSIONS !/o MANIFOLD PUM MANIFOLD DISTR. PIPE MANI OLD MA EHIAL: PIPESISTR. DDISA I DISTRIBUTION PIPE MATERIAL & MARKING ELEV. ELEV... DIA. ELEV.- ELEVATION AND DISTRIBUTION COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING NILLEU CORRECT LV PLANS ❑Y ONO OYES ONO NUMBER OF PROPERTY WELL: BVI: COMMENTS:ERMAN N M OBSERVATION WELLS: FEET FROM LINE DYES L.JNO DYES F NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE I L DILHR SBD 6710 (R. 01/82) DEPARTMENT OF APPLICATION 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 asspecified 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. Pro arty Owner: Mailing Address: Property Location: 6iEy, *hr~• O-M Township: County: t/a /V- q 1`11 17 /T~ N,R It(or) t,1 G S G p o ( X Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: C u c e it (If assigned) TYPE OF BUILDING o 00 0--6te Number of El Public* ❑ Variance.* E:1 Other (specify)*. 0020 O Bedrooms: 521^1 or 2 Family *State Approval Required. r r S /Z 3 If-1 f TOTAL NUMBER PREFAB POURED-IN NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE STEEL FIBERGLASS INSTALLATION MENT (Specify) r SEPTIC TANK CAPACITY V~ HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: W[0 EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): LJ New ❑ Replacement ❑ Experimental L Seepage Bed ❑ Seepage Pit 3 E:1 Alternative (specify) El Seepage Trench Water Supply: . Owner's Name as Listed on Soil Test Report (If other than present owner): Private 1:1 Joint ❑Public n~ h I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber. Signature: MP/MPRSW No.: Phone Number: pok /oS Jrt^044(eh MP-4'f3 (•`T- .~3 Plumber's Add ss: Name of Designer: 7 yZ~w 00 or K q /a s S o{ 6 c c 7 COUNTY/DEPARTMENT USE ONLY Si nat re of Issuing Agen Fee: Date: 0-6PROVED Sanitary Permit Number: L~ + D ❑ DISAPPROVED q46 Reason for Disapproval: 0 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$398 (R.07/81) All Ilee UA Ide a • a~ f,- t CGceneA toil' (L Ay 3s4 ld 13 Aeg 57 9 c~ f~~ pr 70r fir H awl SG .3~, 4- n t 17- a P~ J _V o Ar v " 4r G 4Z4 ~ J .a r S` f t ' v a lj~ s _ ~ no r. P ~ F h. o- s Form - S T C 100 Owner of Property ,Location o'f Prop rty J - SectionTa~N R~W Township Mailing Address Subdivision Name Lot Number Iy✓tJ~✓` Previous Owner of Property Total Size of Parcel WrC~1,'-p Date Parcel Was Created Are all corners identifiable? Yes No Include with this application one of the following: .Certified Survey Map Dead Land Contract, or .Other Legal 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 1 (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. ; 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. L SIGNATURE Of OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) A' 1 - )y 1 v- DATE SIGNED DATE SIGNED bit- - R Nam., Solt- TEST poNf3 Irpe. .EH11 Rev. 9178 pv 1'LQVS4e OP C.00A/'ry A&I/ftX/ REPORT ON SOIL BORINGS AND PERCOLATION TESTS pF (,.S.AA. ^1,, jicovgC } WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES Qj.-ANS Q1C/ST Ar P.O. BOX 309, MADISON, WISCONSIN 53701 T"~S T LOCATION; E'/4, Secc~tion /7 ,T~N,R ! f W W, Town hip MHRiQiPWi;41 LJ -54k 0 or -P I_- IV Lot No. , Black 'Nt r EAT I F 1 M0 S u R-✓& County T" -JjU Subdivision Name - _t V Owner's/Buyers Name: f3r_Pf A- >v IGNIN6 Mailing Address: - Z use N (.j k - f Co OFFICE zl~y TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM DATES OBSERVATIONS MADE: SOIL BORINGS 40/44 Z_& I PERCOLATION TESTS SOIL MAP SHEET g8 NAME OF SOIL MAP UNIT `✓A K0?A PERCOLATION TESTS TEST HOURS WATER IN TESTTIME DROP IN WATER LEVEL, INCHES RATE NUM- DEPTH CHARACTER SOIL SINCE HOLE HOLE AFTE INTERVAL MIN/IN BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 3 P 43 SeE - Le t YZ 01\111C P- Z P- 0/1W 1 P- P- P- SOIL BORING TESTS TEST - TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- 8¢ on►E f3 ¢ 81- L Om Sz / Si 6, a. 6, B- L 194 Alomc > 9 6 L Ts [ t I iI .v~ L wrrN S.. 7tb S 9L. 44,w B-,j 'F NE 7 hl A 7 i nl w~ •t T•~Q 1.0~ •TS Rd B-f 04 B-.4- 4 ONe > 8¢ 7's /3 6~Med 46jc+7; $46A tZj/M.d 'a. B- a 4- o e ->.64 ~ TS 7 ; 5".5,4'r; 00,4 A d S c-&, ~ • g~ f S ~z PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of.suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy Indicate scale or distances. Give horizontal and vertical ref^ erence points ndicate slope. VIS corw _ a yi ~ o m € I I i1~1 1 M'~ Al , ¢:E I ~i I G 3 ~ lk!Pi -ro r- O&F~4-- ---f 4-11 S o. e, -~r _ OD T- 44I__ O. 1 1, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures an methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Certification No. = 5 / G Z~ yZA-tifte installer if known Local Authority CST Signatur No: WB-2A OFFER TO PURCHASE-With Acceptance VACANT LAND - e Wisconsin Legal, Blank Company T 'Approved by. Wisconsin Real Estate Examining Board 1 Milwaukee, Wisconsin II j Hudson Wisconsin, Maxch 28 19:84 OFFER ` The undersigned Buyer, Sails E Miller hereby offersp purchase the property known as Se'e Below (Street Address) _ in the TE>wXl of H1148t3n County of St.. Croix , Wisconsin, more particularly ` DESCRIPTION described as P'aark. View Estates second addition located- in the- N4*f si tt i€ n h 29N. Range 10W. Town of Hudson. St. C.' x Calun. Wily- consin,, consisting of Lots No. 8, 5 7: 52: 689 50, 9 & 44 addition Lat 37 having a frontage of about feet, with a depth of about feet, at the price and f on the terms and conditions a follows: PRICE Price of(all lots) Sayr enty-.Light Thousand ar dd no6lQQ dollars` Earnest Money in cash NIrm i€ n t3r~ad! alrrit nc rtf loo dal"liars ($Q~. W j Tendered -herewith TERMS Additional Down Payment in cash ) I to be paid upon acceptance of offer (or on ) and the balance in cash at closing or as hereafter set forth. CONTINGENT THE BUYER'S OBLIGATION TO CONCLUDE THIS TRANSACTION IS CONDITIONED UPON CONDITIONS THE FOLLOWING: (if this offer is subject to financing or the sale ~of~other property iitt mustt be so stated here. ~IIf none so state.) f 1. 't''t+A Af'-fay tel. subject, +0 W~323l mt of ather ~!>t'iDj4'}~llt~` 3t- 1st MORTGAGE 2.. Rgirch. !a 9112W pe-ritea'q"t ~ I 2nd MORTGAGE h&uaa IL d; thalIhm r` LAND CONTRACT _ SALE OF OTC ' PROPERTY" y .1991p 0 MORTGAGEE'S ` CONSENT TO ' SALE OF , MORTGAGED 6. So* zwayerae iA" -10 n3 ' clam- PROPERTY SUBJECT TO > REZONING +Uic re *W d SUBJECT TO INSPECTION SUBJECT To APPROVAL BY = FHA IF CONTINGENT UPON CON- STRUC nON AGREEMENT SO STATE ADDITIONAL SPECIAL CONDITIONS Buyer agrees that, unless otherwise specified, he vrtll pay al I costs of securing any financing to the extent permitted by law, d BUYER PAYS and to perform all acts necessary to expedite such financin COST OF rY 9• FINANCING Included in the purchase price are: t 1.~T3d-0~.~r f EXTRAS INCLUDED (also) ADJUSTMENTS (Except): General taxes for the year of closing shall be prorated at the date of closing inclusive of said date on the basis of the . TAXES general taxes for the preceding year. If property has not been previously assessed, tax proration shall be on the basis of $ Seller will Pa` -198 taIxo n estimated annual tax.: SPECIAL Special assessments, if any, for work on site actually commenced prior to date of this offer, shall be paid by Seller. ASSESSMENT* Special assessments, if any, for work on site actually commenced after date of this offer, shall be paid by Buyer. CAUTION (Caution: - If area assessmets are involved, make special agreement.) Area Special Conditions: Assessments CONVEYANCE THE SELLER SHALL, UPON PAYMENT OF THE PURCHASE PRICE, CONVEY THE'PROPERTY BY GOOD AND SUFFICIENT Strike those not necessary WARRANTY DEED, OR OTHER CONVEYANCE PROVIDED HEREIN, FREE AND CLEAR OF ALL LIENS AND ENCUMBERANCES, and asde EXCEPTING: Municipal and Zoning Ordinances and Recorded Easements for Public Utilities; Recorded Building Restrictions; and r case may be Rights of tenants Existing Mortgages - - Future Special Assessments EVIDENCE OF The Seller shall furnish and deliver to the Buyer for examination at least fifteen (IS) days prior to the date set for closing, TITLE Sellers choice of either: 1. A complete abstract of title made by on abstract company, extended to within twenty (20) days of the closing, said abstract to ABSTRACT show the Seller's title to be marketable and in the condition called for by this agreement. The Buyer shall notify the Seller in writing of any valid objection to the title within ten (10) days after the receipt of said abstract and the Seller shall then have a reasonable time, but not exceeding sixty (60) days, within which to rectify the title (or furnish a title policy as hereinafter pro- vided) and in such case the time of closing shall be accordingly extended; or 2. An owner's policy of title insurance in the amount of $ , naming the Buyer as the assured, as his interest may OWNER'S appear, written by a responsible title insurance company licensed by the State of Wisconsin, which policy shall guarantee the POLICY Seller's title to be in the condition called for by this agreement. A commitment by such a title company, agreeing to issue such a title policy upon the recording of the proper documents as agreed herein, shall be deemed sufficient performance. 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I I SECOND ADDITION 81.01' 230.00' I 44 - - 06. EASTERLY LINE OF SUDIVISION 336633' N w Z O w I O x o 1 x m m ' O x II I x w r z w ,3 Z ID -1 cn { o I' m r1l x o x 10 . n 1 0 . 7C ' x 0 2.502 ACRES o x w in I m ' ,n r o x no ,C ; p ,rn (109004 SQ.FT.) .1 c 0.-4 1 x , w I m r z o < (n :0 1 m : O Z OD ?1 m co I m , rn rn (0 - m w p , i ' ~rn N .p r m N 'Z Z i ' m o 0 Iz ~ 1 .L m Z m ril CL -I m 1 m c ~D ' -p ~ (A m I m 1 ~ m N Z N0°06'30"W 311.01' 10 0 1 - - - - -'(n G) :X p rn lm < ~N I W PARK m m LANE_ O n w 1~ -4 t -4 In:- 1 0 o o y r------ ~D o <o 0 0 1 ~-n :-u O ",1 O I p m x z 1 ~:U 2 APPROVED w I cn ~ w ~'v I ~ 0 2.502 ACRES m 0 'p (109004 SQ.FT.) w0 I> to 'D C 1 JUL 15 1981 ° N APPROXIMATE 1 , m O ST. CROIX COUNTY y H,QUSE LOCATION 10 I COMP Zot INE PARKS PLANNING + y 1 'Z ANO D ZONING COMMITTEE + ( ' i \40 E I/4 CORNER POINT OF BEGINNING I NE CORNER TS2EC9NTI,ORN1917W , WESTERLY RIGHT OF-WAY LINE o I SECTION 17, ~a 1 00 T 29 N, R 19W aZO NO°06'30"1N 971,58 dab t S 0o06'30"E 311,01 1 45"30"W w 2 5 2. >T n~i N 0o - - - I EAST LINE OF NEI/4 DAI LY ROAD w 1 1 I LEGEND NORTH I 61s' I SECTION CORNER MONUM' BEARINGS REFERENCED TO THE EAST LINE OF THAT 133' 133' i 2"IRON PIPE FOUND CERTIFIED SURVEY RECORDED IN V.1,R 184, ASSUMED NO`O6'3d'W ["IRON PIPE FOUND } SCALE IN FEET I 100' IO 1"X24"IRON PIPE WE IGHII 1.68 LBS./LIN. FT. 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