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Home My WebLink About020-1102-40-130 o c ° c p 0 my to to a o o qb cc of E y z Q) L) C N III Lo - E O. O N y i' E'€ v y c y Q c 3 -`c as 0 Z E N = v LO L :2 CD 8 Lo "C O 'Z > L y x'k O w O> V y E zn' _ y E o p aE ~w as 0- Cc a o a~ z ~v E .-Co v z o2p c a) c y w2 (6 (a O. (6 y C LA. 0 ID 2 S 0 mw ~Y c:S O N rnL - y w N Q F o o 3 Q w C fn 4= I V M lD z E z E z = O w O a. O E O Z M O (D 0 IL m d m 0 co 0 O 0 2 a c c 2U) o d z Q c z M c ~ c Cy D III N (D N O. cc a (L) Q) I y y N N G O c c O 0 0 o N Q o( Q . t- I m z z F- Z o y z N rn c c I d O N y~ E o R E Y a°' n c co y y N a) H d V a) C O U) cca -0 cca a o E o to t4 t/~ (A Z M > U) fn co rE ~ ~+J r r o ° 3 3 a o a z •N 0aaa aaa CL N J V 3 rn rn d y 0) 0) !mil c > c } o ~l y N O E = N N ''G c' Z 0 0 - -O C O O ~ E v d 7 O J 2) co 0) V 6'1 III co y J d Q (n W d Q Z cn Q } ~,i i ~ 7 a0. . N 7 .0+ _ U O to U) r- c co y c N E O~ M M O W y C ° L d °iLO o o co O O ai o O m c n y -0 a c a rn° N ~ m E E f0 co of o o O c W ° O 0) y U L 2 W y d z C N 0 0 oi w U) (D •O O_ r O Z C' 2 co 0 Z R € a € a V a AIL ~a~ • a d .2 m m c Q E M c c c S o ttww o : 1 0 3 a 10 IL 0 U) u a Parcel 020-1102-40-130 02/10/2005 09:22 AM PAGE 1 OF 1 Alt. Parcel M 34.29.19.408B30 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 * ANDERSON, CRAIG L & JERRENE L CRAIG L & JERRENE L ANDERSON 672 EDIE LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 672 EDIE LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.055 Plat: N/A-NOT AVAILABLE SEC 34 T29N R19W 2.055 AC PT SW NW LOT 3 Block/Condo Bldg: CSM 8/2117 ALSO OUTLOT 1 CHERRY HILL ADD'N(SEE NOTE ON PLAT MAP) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 34-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1236/432 WD 07/23/1997 997/562 WD 07/23/1997 931/32 07/23/1997 927/458 2004 SUMMARY Bill Fair Market Value: Assessed with: 48440 281,000 Valuations: Last Changed: 04/29/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.055 40,400 177,000 217,400 NO Totals for 2004: General Property 2.055 40,400 177,000 217,400 Woodland 0.000 0 0 Totals for 2003: General Property 2.055 40,400 177,000 217,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 138 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 t Y, STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ':To H /V Ff 4 r11 / e- -7-0,,y ADDRESS o 7 Z eED /E L ,~f JV~`' _ SUBDIVISION / CSM# LffE~°2~ !~//C L LOT # SECTION el T Z `J N-R W Town of A/ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Z?L,Lt /Lrl~/ cJ/alu 7S --*-I /Oar' G41. c5WTgArt 7 To Gr4 L WEed7i rk - - - - - - - - ~ - of - ~ - it , ~ oJSE g•~ G'4 ft A6E r III L JF LL- INDICATE NORTH ARROW i Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: lDf o~ / CoT oN Io7 z/,4 cgn ALTERNATE BM : S;// EPTIC TANIT/> PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: S Foz_ Liquid Capacity: //000 L. i Setback from: Well House l3 Other - Pump: Manufacturer Model# Sized----- Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: S Length 7S Number of trenches Distance & Direction to nearest prop. line: 70 c.rJCSTT I-oTL,AVE Setback from: well: House- Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: ~t< LICENSE NUMBER: /✓F'7 Q J INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labot and Human Relations INSPECTION REPORT ST. CROIX • Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284156 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: HAMILTON, JOHN HUDSON CST BM Elev.: / Insp. BM Elev.: BM Description: Parcel Tax No.: v5ar)'a /G C u. TANK INFORMATION ELEVATION DATA AQAnnAnQ G TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 5 ` q Benchmark, o' Dosing Aeration Bldg. Sewer Ing St/,I;'( Inlet S. 8 cb2 5.~ TANK SETBACK INFORMATION St/ Outlet ~ 5.75 3f« oa.1s' TANK TO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake v-Al Septic >ZSo r J?} NA Dt Bottom Dosing NA Header / Man. Aeration A Dist. Pipe Ing Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 106,9 e Cr,4' - ir' /dl/. G`S Model Number -_.GPM 6. ~Si /o/. 3s' TDH Lift Lfiction System TDH Ft /v/, 35~ Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length i No. Of Tr nches Of Pits Inside Dia. Liquid Depth DIMENSIONS 7S DIMENSIONS EACHI anu SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM L - INFORMATION Type O(/ , C BER Moe Number: System: eyt S R UNIT DISTRIBUTION SYSTEM Header adavOgiglt- „ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length 3-3 Dia- Length 2 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade ems On y Depth Over Depth Over „ xx Depth Of xx Seeded/ Sodded xx Mulched y~~ To soil F] Yes No C] Yes El No Bed/ Trench Center 2O -_3& Bed /Trench Edges p~ p COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON.34.29.19W, SW, SW, /LOT 3 J6,.4pa a,, , ,old Plan revision required? ❑ Yes B<O > Q Use other side for additional information. /O 1-:2-F SBD-6710 (R 05/91) Date Inspector's Signat re Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' e e ~ _ ma 30' r ..t■i~■es BSafety and ureau of Butilding Water Division ~.■...r■r. SANITARY PERMIT APPLICATION 201 E. Washington Ave- In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53✓707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County < ' Cr- 0 than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Pyit ; tuber The information you provide may be used by other government agency programs ❑ Check if rev 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 F111BUILDING AM LTO IV s'uJ 1 /4 /VUJ 1 /4, 5 T ~ N , R E wner's Mailing Address Lot Number Block Number Zip Code Phone Number Subdivision Name or CSMNytuber F BUILDING: (check one) State Owned ❑ City Nearest Road blic 1 or 2 Famil Dwellin - No. of bedrooms S n :r USE: (If building type is public, check all that apply) Parcel Tax Number(s) partment /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 only one box on line A. Check box on line B, if applicable) A) 1. Z New 2. ❑ Replacement 3. ❑ Replacement of 4. E] Reconnection of 5. ❑ Repair of an -----System System Tank OnlyExisting 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 9<-•5 Elevation 7 S Q /Sm~ /SOO 9 yro 9a- Feet !oa - gXPeet VII. TANK Capacity gallons Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank ~~SO Z Gt~,QrSE2. ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber El El E1 1:1 ❑ El 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 Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: " L 'tom /1~t~'' 3 Z_ Plumber's Address (Street, City, State, Zip Code): O N V ~15_0-, 9 < Q IX. COUNTY / DEPARTMENT USE ONLY El Disapproved Sanitary Permit Fee (includes Groundwater ate slue Issuing Ag nt Signature (No S ) Surcharge Fee) Approved E3 Owner Given Initial f r 2_410,1' Adverse Determination 0 TX. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05114) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 5 y 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 8 112 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; replacernent 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. BONN IfAM'i- Tor( C S/VI v$ ~G Z r -7 Z E 0 I L 'o} N E L o7" it 3 scr C/ N ITIVIC jtf 03 t'o t IIq J v5 c 14 v j o ~ a' 4,J FI~ t h~. ~ 1oup~ Lo7 ~ Z L°~ 3 I tAl r 4 r rq 1 v 6`' O $ }I -Alt t r z *lob m I I i S Z7 i ~ tl ~ b f 1 i t I r ~ I i 1 r m t , z 'Ti I > Q i 0 Ir ~ i ~ _D 1 ~ I ~ i f r\ I O ~ L4 i Z to. i ~ I m g o o ~o 7 o ~A o 0 ~o Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor arxf Human Relations Aivision o#4 safety 8< Buildings in accord with ILHR 83.05, V1G~ ~4cJrr1, Code r COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size 46Cdh;fnust incfude, but not limited to vertical and horizontal reference point (BM), direction and %p s# slope, scale or ARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION" EiWED BY DATE PROPERTY OWNEP:r?iQPERTYlACAT10N A CJ N ~~1 a/ GQaPT.. LOT' SC3 f 4 N'o,j'iA ,S 34 T '7_9 N,R E (or) W PROPERTY OWNER': MAILING ADDRESS L BLOCK #U AME OR # An ~A-4c M Y +P4 z117 C , STATE ZIP CODE PHONE NUMBER ❑CITY ❑VI LAGE OWN NEAREST RO D [ ] New Construction Use [Al Residential / Number of bedrooms [ ] Addition to existing building jg Replacement ( ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate o, 4 bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2_0,~Ltrench, gpd/ft2 Recommended infiltration surface elevation(s)-FREA1C14E", ft (as referred to site plan benchmark) Additional design/ site considerations LowFS - 94,06 A6 9E S-r- 98-00 Parent material Flood plain elevation, if applicable ft L S = Suitable for system CO VENTIONAL MOUND IN-GROUND PRESSURE ABRADE SYSTEM IN FILL HOLDING T K U=Unsuitable for system s ❑ U WS ❑ U S ❑ U ®S ❑ U ErS ❑ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BajxJary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmr& 2iF ' is, 7-21 7.-SYR4 3 - S~ 6.4 n Ground IS Z/_S/ I6`14 4 - ~ (3 ,m r ~ w p7 C)~ elev. _ /aZ30 It. ~c 1 0 /Woe 4 4 - S 0'7 Depth to C &RO limiting fqctor 11417 Remarks: Boring # H 0-7 fbYk3 Z l n, abK r►~T,r CS Zit o.4 d S -1 -Is Ye 4- !9:5 Ground elev. g3 g•~b /L)`/►24 4 S r ,v, -7 R C)S,14fL Depth to limiting factor Remarks: CST Name:-Please Print N l fA$4Cy O N ,Is (),j Phone:/ AdRo Address: t l~ Signature: ~O Date: 7L 9 CST Number: . 34 'PROPERTY OWNER SOIL DESCRIPTION REPORT Page? of PAFMEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. ft. Depth to limiting factor Remarks: Boring # 3 g, FS'-J 4 i~~ R 5> L 1 m s~I~ w v.`3 y 8z 4 -41 7.SY 3 S L m w Ground elev. 1- 68 16°/,e 9 4 r - ,7.$ Depth to limtrg ►VOT o 'Nis 8o12~N End O YSTEA fact Remarks: Boring # r E3 Ground Zv-41 >0'/e 4/3 5 ,r r r, l ,7 elev. ,O4ft. Depth to limiting fc~tor. Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) I 0k F, w~ LCA~j zN0 n ~ a ~ ' O . 7v C b c , Sri a. X apt J_ rn O a~ 3 I i I i 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 T.04/V ff,4 Iyl i L T o 1k/ Location of property5 W 1/4 111LJ 1/4, Section N-R Z? W Township tL y S o N Mailing address 47Z- E D I E L A kl E Address of site 7 Z / L fa Nt subdivision name _C i4 \F (?_SLY N 1 L L Lot no. 3 Other homes on property? Yes No Previous owner of property ry/ ed~ J t.,~ Total size of property Z - S~S Total size of parcel Z Ss~ L- Date parcel was created 3 - Z z - y3 Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house)? Yew No volume 9'9' and Page Number SG 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. _~4~f/O Z 77 , 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. 77 S' ature of Applicant o-Applicant - a 1b Date of ignature Date A Si nature I STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERBUYER SeD tf /V 1V,4z)11 /,L 7-0 N MAILING ADDRESS 6p 7 Z E-0 l E L 14 n/E PROPERTY ADDRESS 6- ) 2- ED l E L e 1''F (location of septic system) Please obtain from the Planning Dept. CITY/STATE 14 c> 1) S- Yd /Al PROPERTY LOCATION S LO 1/4, v 1/4, Section Y' , T N-Rl ' W1 TOWN OF 44 J 0 C en , ST. CROIX COUNTY, WI SUBDIVISION C #L (?-A `1` LOT NUMBER -3 CERTIFIED SURVEY MAP' 4y - VOLUME , PAGE 2117, LOT NUMBER 3 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 must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: A'rr~ DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 OGiJhicNT NO ~N~a sv>,~c ~=,r.zv2a •t•9 R€~_a~a~rac D4TA r WAM;AN"'i CAE . 2 Ozo /lOZ ~/a X30 41,54 VOL U? S 3. C S, E,.. ML17 nr, _a..sjp~e peg . - - - MAR 2 ? l~~~v . . ~:3 conve- s and warrant3 to jgjtn P Ha~?'j lt,on, Jr. a Id v Ckie..~.,... HndltQc:,. bt3,}y~ ci. Cx~..Y~ife a>a`viycx: ?i.ip • R~_ru.RN TO . - the fol!o;v na ~es_ri`~1 real estate in St. _Cmix County, - State o! Wis.on.41n: Tax Pa c, A No- - Pe°°t of the S'?j 1/4 of NW 1/4 of Section 34, Tbwis!2Lp 29 North, Fta. 19 West, I St, Croix County, Wiscon_~in described as follows : Lnt 3 of Cep:-t1 fiPd SuTVey PW filed June 27, 1989 In Vol. 118", Pad 2117, Doc. No. 4492109. ALSO Outlot "1", Plat of a,_ x°r•y 11111.1 in the 7bn i of H ei 6, St:, Cv., ,V, Wiscon-M.n. This is--not homastezd property. (is) (is not) Except'+o^ to warranties; ems.ej-_rlcs, restelcti[jris acid rights cf• :may of' mcord, i ary s3 Dated thsg r - day of .......Marc' - is. 93 - ..--..(SEAL) (SE AL) w Sem E. Full, -----(SEAL,) ADTHXXTIC ATIO AClK N -C, 's4I E1;Z. V NN i Sam F. l~ llp; STA u f?F ~ I3+ n y <x as. guess=.~,,.=-:(s) f this .......d y oi.------------ 0'93- Ped+, .,,21y c. .1-'i - tlo'5 .-ti+A of - - - TAL- a. _ _ . (If nk -i - - r to, to s AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SECTION-2-!~__T N-R IF ADDRESS Rex Z S 2-- ST. CROIX COUNTY, WISCONSIN k.. J./s e9 ro Ala :5-d IV SUBDIVISION C4 le/C. z f~ -LOT 7W' LOT SIZE s~• PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Scale- ply„~ 10 ~ ~ gyp" - \ ~ - 32" 3o zs' A )0 '90 i Wo i r\ ~s INDICATE NORTH ARROW i BENCHMARK: Elevation and description:' lot 1 N'C I = (CO 00 Alternate benchmark SEPTIC TANK:Manufacturer: UJei5ar Liquid Cap. 1'000 Rings used: 2. Manhole cover elev: Final grade elev: .~3 1t ~ p PUMP CHAMBER Manufacturer:,k/Z Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front-, Side-, Rear-Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: ten oP1'/,'n,*40' Trench : Seepage Pit: " Width: ~y• Length Number of Lines: , Area Built-/" ~ Exist. Grade Elev. Proposed Final Grade Elev.° Fill depth to top of pipe: y~ No. feet from nearest prop. line:Front-,X-, Side \ Rear Ft.FSS No. feet from well: f Z No. feet from building___30 HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR: DATE PLUMBER ON JOB: U22 ,r A A A n 0-7 T~ ~nNt HU G~ 34.29.19.408B30 SW NW, EDDIE LANE, LOT "VG irSl~epartmen o'fin ustry, PRIVAf E SWAGE SYSTEM <:S Coun Labor an(; Human Relations INSPECTION REPORT ST. CROIX 'safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 171511 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: KILLER. SAM HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 020-1102-40-130 u TANK INFORMATION ELEVATION DATA A9200277 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 4 Benchmark 7" /00 Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet 101, TANK SETBACK INFORMATION St/Ht Outlets loa.35 Vent TANK TO P/ L WELL BLDG. Airito ntake ROAD Dt Inlet Septic 70/ :5 NA Dt Bottom Dosing NA Header / Man. I I, ~ cl Aeration NA Dist. Pipe Holding Bot. System ID,13 0 "1.` PUMP/ SIPHON INFORMATION Final Grade. 1 ' Manufacturer Demand , a fps< Model Number GPM TDH Lift Friction System TDH Ft Head Forcemain Length Dia. Dist.Towell SOIL ABSORPTION SYSTEM BED/TRENCH width Length0 No. Of enches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS f DIMENSIONS LEACHING SETBACK Manufacturer: SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION TypeO , o-,cT r t , / OR UNIT CHAMBER Model Number: System : 6 $ 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 if xx Depth Of xx Seeded /Sodded xx Mulched Bed/ Trench Center ' Bed /Trench Edges J/, - Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) i is Plan revision required? ❑ Yes I.3 No j _ 'i` Use other side for additional information. 5 h 4 ' [Ad SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: • r i f r' DILHR SANITARY PERMIT APPLICATION couNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANIT Y PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ Ch~Ck t# reLislo evious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 54I~/4 c.v'/4, S ToZ , N, R /9 E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK Z L 3 CITY, T TE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER = O (10 3 -2 7 k C lea-►-r f~%l/ II. TYPE OF BUILDING: (Check one) CITY r NEAREST ROAD ❑ State Owned ❑ VILLAGE .M TOWN OF: ❑ Public X 1 or 2 Fam. Dwelling-# of bedrooms 2- PA EL X NUMBER ) III. BUILDING USE: (If building type is public, check all that apply) / D 1 ❑ Apt/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 only one in line A. Check line B if applicable) A) 1.0 New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - 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 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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) ELEVATION `05 O 10110 6.42-9 1 (,o cJ $ 00 Feet D 1.30 Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank boo Wz " s -f-✓ R . F1 F1 I - - El 1 1:1 0__ El Lift Pump Tank/Si hon Chamber u 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 Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: S • k p~ IV^ 3233 Plumber's ,Address (Street, City, State, Zip Code): 2, Z s w P, 4 o ~I S IX. C UNTY/DEPARTMENT USE ONLY a e issued fusisuingAg nT8 ignatu No Sta p [D '7 ❑ Disapproved San' ry Permit Fee (Includes Groundwater Approved El Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' 1. A.sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renearal 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 (S'30 6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumpen 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 coce acirr inistrator or the State of Wisconsin, Safety & 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 Fan-i / Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacemen° econnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallors, 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 curly if ranks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with apprc>pni to 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% x 11 inches must be submitted to t`"n 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 rnains!Nater 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 absorrtion system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE e 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) Q.lJ~~ 1„~~~~. on worst (ofi1~hE-~I = loo.oe~ ~ V B o✓'6- 'S C Z3 k t~ O G.. 1 j J d oaf s ~T. srt.13etto C-1 = 900 W ~ H w so~~ (ot I;.to., (l o I- ofi Z gat 3 , Hou s aaxs'o yX3L k~ C ~ (S 45 R \ \ S"X Z 100,o0 r ~L ItV N ~r ~Y ilJort'l~ le-t l;Ha, `f~4•T4~~e Sc41~- _ DEPAR,TM-ENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY,* _ DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 3707 HUIVIAN•RELATIONS ^ ~j'~ DISON, WI 53707 (ILHR 83.0911) & Chapter 145) c~1&k1tY--V7t.LS, LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.JVO.: SUBDIVISION N ME: w 1/ N d14 A /T29 N/R/4E (or►W 1/c_xb A) Y 2~~? COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: ~JTC~R.61X JAM Ilc.a.EQ USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: IPROFILE DESCRIPTIONS: TEES S: LN New Replace l `,JLy z4 199Z 79 RATING: S= Site suitable for system U= Site unsuitable for system '51L 447 MKY ro_M~ENTIO0NAL: IMPU D: IN-GROUND Pa URE: SYSTEM-IN-FILLHOLDIN A K: RECr~tq MENDED SYSTEM:(optio I) LL'~2r SS UU T~~]/II SS ❑u VS U ES XU ESJXU V A J?'JouaL ED I N RATE: If Percolation Tests are NOT required DES I If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: LA S ~ Floodplain, indicate Floodplain elevation: .1 1 PROFILE DESCRIPTIONS BORING- TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) e- ,33 e2.S-1 > 7,33 "'8~SL 39"►BR.a/hS29" Ba,4CZf4O. s- Z 7.33 62.11 ntlk > 7.33 '7"& rr5 0"A ..SL d4'8JWftS44 A. i3" r5 19"8RN54 24" QABA- n1 S e- ~3 l03 .~3 3 NONE > 8.83 V' 8a,v 418awt S B-4 g.47 /63x? Nolnlh' > 8.67 W'eesc-s ?.cc5" $aNs~is~Q~$aN~ss.~8a> s R e- i8 t4a > 6,63 i3'eu.-* tt''8+t"6,CZZ_P '8"As Sc"394#4S,E4►R, 13- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER OIN61,40 AFTER SWELLING INTERVAL-MIN. PERIOD 1 PE RIOD 2 PER PER INCH 4 P_ ) z.o Z.Z 16 73 P- -4 'S .9a 63,96 Ito /A 'A 8 A.6 idt b 62.7-6 16 P- P_ L Ai N wr 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 a evatiqp_pf_all borings and the direction and percent of land slope. _ 1i SYSTEM ELEVATION 919.06 - P-3 ba_ A , mA L, Q p_z Q i p E _ E 3 E E N f3 3 Wrr' { 1 INSTP'-CTIONS FOR ETING FORM 115 - S - 61335 To Iae a c QM )l I e sail test., y report must iiic hjde: 1. Comply tp leual de; 2. The use section rtaust clearly indicate Is is ;ice ar, Cory IoIem; 3. MAXIMUM numb,, ~ hdiOorras arc 4. Is this a nevi, c>r syste€~~; E. Complete the su boxes. A F' SU FOR A HOLDING TANK ONLY IF ALL 0TFIFR S% JLE OUT _ CAN : "NDi 3; 6. PLEASE use the a!- s sh£. -itiriq ofile descrit. _r is and cz~m = the plat plan; MA 'F A LE 1 ' . r y your tesi locations, CJrawiny to sca ~(prred. A i. r your Iar ad ) on reference poin, ~ clearly shown, an ~ l- lent; 9. all app iat.e boxes a to iarnes, addresse,., i yin data, percola° art xutrt3 , 1C1. It tr' -t;c' (Such as flood plain, (3'. . ~!O~') C~t3e5 t1Ot <3 . lll.A. ,he al i1iop e dax; 11, Siy€ dace your curt ~t 1 your c+ rt, 12. M c pies and distribute as ALL SOIL T;-STS ' FILED WITH THE LDCA ;TYWITHIN30 D Pd_b_I ;5. ABBREVIATIONS _,--RTIFIFI SOIL TESTERS Sail Separates and Textures Other Symbols St - Stone (over 10") SR B, ock cols Cobble (3 - 10") SS - ~e yr Gl'aVel (under 3") LS L ° . z ale "s Sand I UAN [A ~ d - cs G wl~a e sand p rc - P - ~r rned Medium Sand ft - Fsna, Sand I E Le :my Sand ~ 't;l -'y Loan . . 13 I Rl ^y ..f' » - rtat'? VV sic - Silty Clay fff' - fr e, faint ~y iy pt I narra p ~t. ei, Ievel, tzi lace vuater BiN1 - 13;r h Mark VRP - Vertical Refe;ren€;e Point S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER S~ /~A"Ale-r ADDRESS 20 y- FIRE NUMBER CITY/STATE ~/aASo~ GvT ZIP S`w/JC PROPERTY LOCATION :SU--11/4,1/4, SECTION Taq N-R TOWN OF Wo/-COrl , St. Croix County, SUBDIVISION r~l✓!~,/ , 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 a 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 must be completed and returned to the St. Croix Co. Zoning Officer within 30 days of the three year expiration date. SIGNEtN A±lz 2XIL DATE: 7- St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 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 ~Stti o, Location of property 5 u/ 1/4 /Y 4-1 1/4, Section, TAN-R-LCL& Township f/k A e e ti Mailing address Zol Z~ L 14&A".' t'yz 3 yo/6 Address of site Ed; a- IaN~- Subdivision name CAr,,LL4 Lot no.-3' Other homes on property? yes u No Previous owner of property J st Am+- Ro-^ k a~ lfu ~ s o y Total size of parcel 2-t)Q S AL. Date parcel was created zo - 9z- Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? u Yes No Volume 931 and Page Number 3 2- 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 & 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.--Y780&? , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above descr_ihed nrnnari-v_ fnr I1Of .111.11 .IJ I 1II WARRANTY DEED MIS 31•ACV. RC5EI.VF_U 'OR RECORDING DATA STATE BAR OF WlS(lONSIN FORM 2-1982 L n d ~~y / I ` }VS Zj Z First National Bank of Hudson_ a United 9 J 3 -%4-, States Bankinp, Corporation . -.1 z . l G L a sin le conveys and warrants to PersQ.n...... oo~ Al - - RETURN TO the following described real estate in County, - - . . State of Wisconsin: Tax Parcel No: Lots 4, 12, 13, 14, 15, 16, and 17, Plat of Cherry Hill in the Town of Hudson, St. Croix County, Wisconsin. Part of the SWI~ of NW'4 of Section 34, Township 29 North, Range 19 West, St. Croix County, Wisconsin described as follows: Lots 2 and 3 of Certified Survey Map filed June 27, 1989 in Vol. "8", Page 2117, Doc. No. 449209. li Outlots 1 and 2, Plat of Cherry Hill in the Town of Hudson, St. Croix County, Wisconsin. J This ....15„.170 homestead property. I~ (is) (is not) Exception to warranties: easements, restrictions and rights-of-way ~ of record, if any. Dated this :'f? day of Jan ,uary....... is9 . F' s Natio B k of Hudson, by) I (SEAL) (SEAL) ~ II lop VIC-6- (SEAL) (SEAL) of 0. Goa= ► the t: a _ ln~t~l!1!l!~!. *by 1.1m . . 'm* and earrtn c.> ►y ar tliQ do4i11~ # i 't - boo :"t,rl .t.' awce ow b" i'1I'H NTICATION I ACKNOWLEDGMENT Signatur s . cZ STATE OF WISCONSIN I I rr STATE .:a...:.... i I . St .---Croix authent ----dav of o lllt tl1 "in --County. , l_, ~ n ~ I ~S < ii 'i! I z _ I !i ~jl ifl O {1 ~ n z ~i~ ~i -ty i( Y l~ C7 m j,, jJ ~ I!I ~ i I o h (i~ ~ii ~ lil Q Ii I z i{ ~ i rry o m il~ i. If~ ( 1 a~r~ n I rn N D ( i i p i hI i , O 1 I;' ~fl C7 ~ 1 w i -a i i 41. +II l rrt i i y ^~s~ i ' i (10 1 cy -a ' ~i r,,, rri 4. P!, x o 0 z M xO J = m r a m -a 1~ ~ m ~ n I 1A 1A