HomeMy WebLinkAbout030-1096-60-000
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sTC 104 AS BUILT SANITARY SYSTE ORT
CID'
OWNER GeU~ _
g TkoK S o
ADDRESS IDS 3 R0 ►n.n I ~ ~ 5 ~ i,,
UTA. 7 hi ~rl 5• ~ of " ./\`+I 8:. f ~
I
SUBDIVISION / CSM# LOT #
I
SECTION 3-~ T 30 N-R__Lg TW, Town of S~ ~S~bA"
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
3 1)?vgu0
rnf
op71 p se o
9V~ 1 (~4N ~
vA),qje
~~7a
Sysf
3 Ir~►.Q s V
S~ SO o o ~
ye d yid' F--
FOAn INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: ~Idgdr_ Q~ 60t7 '51b)Aj3 R f SW CoK.Nex OT' ►1pThe ~C= ODA)
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: u5ed Old -rANr- Liquid Capacity (7d~ A
Setback from: Well OVeK SO House_ Is Other
Pump: Manufacturer ' Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length U Number of trenches 3
Distance & Direction to nearest prop. line: y V I
Setback from: well: OVkf- 15 House 7a Other 7 -1
rKUtifi tNd f9b,4 tkD -1
~c.HT zNb
9-)-45 91.41 9a.sc~ 9.39 11.88 ELEVATIONS 9Tay
Building Sewer ST Inlet; 9S,07 ST outlet ~V
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system 11.50 ( jo-qO
Existing Grad g3Pinal grade SAS
DATE OF INSTALLATION:
PLUMBER ON JOB: C,w►~-43
LICENSE NUMBER: V O Y
INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI
THORSON, GEORGE X
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
l . 66 /Gl) - C~ S r~c~ a tlc t: l cam-,--,
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ,s~;~,, GLJ;rse r Ccyc dCb Benchmark 3, 07 QQ, 6D
Dosi n
Aeration Bldg. Sewer
Holding _ St/ Inlet Dla,:: - c(
TANK SETBACK INFORMATION St/f Outlet
Vent
TANKTO P/L WELL BLDG, AirIto ntake ROAD Dt Inlet
Air
Septic ~ _o, ~ - NA Dt Bottom 'I
Dosing NA Headers
tI
Aeration NA Dist. Pipe
Holding Bot. System, ✓
PUMP/ SIPHON INFORMATION Final Grade
Manu ac Demand
Model Number GP 9,;/ 77
TDH Lift Lricti
TDH Ft c T, g, 3Z CJSI ~S,
ead
Forcema! Length Dia. Dist. To well r
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length renches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 5d DIM N I N
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEAC anufadurer:
SETBACK
INFORMATION TypeO / CHA R
System: i rv ^ /Sc a, Std' / OR UNIT Mo e
DISTRIBUTION SYSTEM
Header / d „ Distribution Pipe(s)/ n ! Pr~✓ x Hole Size x Hole Spacing Vent To Air Intake
Length _;~v Dia. Length /7 Dia. Spaci4
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys s Only 1
- 11. Depth Over Depth Over xx Depth Of xx Seeded/ Sodde xx Mulch
Bed/Tr nchCenter Bed /Trench Edges TE] Yes E] No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons resent, etc. n h,~ S
LOCATION:,,St. Joseph.32.30 19W NE, , Lot 1 Rolling Hill Tail
~
Plan revision required? ❑ Yes 0--'No
Use other side for additional information. 02 Lad In 91
___1 1~evilll
SBD-6710 (R 05/91) Date Inspector's Signatu a Cert No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
-5 4/
/5 03 9! ~s~
r~ J
11,671
II
SANITARY PERMIT APPLICATION
r~•~~~7■1 COUNTY
In accord with ILHR 83.05, Wis. Adm. Code S1. cr-4r
STATE SAI~IT~ PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than °C)11 9
8% x 11 inches in size. ❑ Check if revision to vious 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
Gqzt R ¢ J6N %5E %,S~ol, T3U,N,R 9 E(or)W
PROPERTY OWNE MAI ING ADDRESS LOT # BLOCK #
a5 ~1~~1~ IR I N
CIJY ~~oM Vl SC ZIP COD
~ O E PHON MBER SUBDIVISION NA E CSM N~USMBER A n• tc) IL TYPE OF BUILDING: Check one CITY ~j NEAREST
( ) El State Owned ❑ VILLAGE S' ' a f ~ o,14 ) N l
❑ Public ER1 or 2 Fam. Dwelling-# of bedrooms _ PARCEL TAX NUMBER( S)
Ill. BUILDING USE: (If building type is public, check all that apply) o3O _ / ® 9(a -(~7
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 120 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. ❑ 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 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
C-~//`` REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/ ay/sq. ft.) (Min./inch) 9 Jti V ATION
S V It Tsb J 0 ( Feet Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallbns Tanks Manufacturer's N~pge C ete Con- Steel glass Plastic App
Tanks Tanks I / structed
Septic Tank or Holding Tank
Lift Pump Tank/Si hon Chamber
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 Sta s) MP/MPRSW No.: Business Phone Number:
S►ti, &.AM.ee~ ea a I s ML-
Plumber's Address (Str t, CityState, Zip C
vot
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater rffa e ssue Issuing Age t Si ature (N amps)
Approved El Owner Given Initial Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROV
Eo~,~2~z _a~
r
SBf}6398(R.08/93) 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 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 & 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 in 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 in ##1-7.
VII. Tank information. Fill in the capacity of every new and/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% 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, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
PLOTA )0, S5,,...
• . f~ n m ninye.~t Pfi{
M L ~eoRc ~,~~sul~ CE N S
N A
0 C AT 10
1_ n..~.
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R ~ p lvti
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rptl p d 00
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POO)
38
5
EX50 WoDP Stb1NA A~ SE Cunl~rf~
e $a y'/d sl~~. o~ ~Id~•.~ JJ~ l~ ~ oo. o
~v01-" TAIL p
SUS rtn u
T
-
- t ~Z411 A.ll: ~t.'LrS AND ODSE[~VA'f1Qt7
C1103S SECTION
Approved Vent Coi,
fog
ptinim,lm 12" nl,ovc f,
al.
lI ~ ,
`la1` rhpk q" ca
Vei)t
Above PiPc
ro Final Grader--' i
iia'-sil Hay 01 SynLhcti_c Coveri,lcJ ~
Over 1'iPc
- - Tee j
Dis tribe, or~ tJ Y+ - I
i Tr~v>rG~ Pipe l
gl ~o Aggregate -Ve3:-Lor.z C
Mip g~OU I)encath PiPc
Bottom. 0
LOW 9 a ° . .
Wisoonsin Depar'"nt of Industry, SOIL AND SITE EVALUATION REPORT P 3
' :bor arA Human Relations _ Of
nnsi6c If Safety & Buiktings in accord with II-HR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY GATE
PRO/P 74,0,eS4 PROPERTY LOCATION 1 r
GOVT. LOT VC v6e 1/4,S 32-T30
N,R j 9 E (or) ~S
PROPERTY OWNER':S MAILING ADDRESS LOT # LOCK # SUED. NAME OR CSM #
12-53 Rat1i;v6r i t5 tR
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE OWN NEAREST ROAD -
t160 Lt-a a 601- Syd ,?z-- (7/5) Syy- 6 o s, -70s'G7- k- rJ
[ ] New Construction Use [ y' Residential / Number of bedrooms 3 [ J Addition to existing building
(j Replacement [ J Public or commercial describe
Code derived daily flow 4!'~29 gpd 7 Recommended design loading rate S bed gpd/ft2 trench, gpd1ft2
Absorption area required bed, ft2 -%P3 trench, ft2 Maximum design loath rate bed, -
n9 9Pdm2 trench, 9pd/ft2
Recommended infiltration surface elevation(s) 5-A24- p S • 3 ft (as referred to site Ian benchmark)
Additional design / site considerations Z[ S E ~C Q w 0 4 ox 't'S T
Parent material ✓5"CS i. 4 , - hvTi &0 qw-AAI~ Flood plain elevation, if applicable IV4-- ft
S = Suitable for system CON -ff'ONAL MOUNn IN~GR PRESSURE AT-GRA SYSTEM IN FILL HOLDING TANK
U = Unsuitable for system s [FS ~ U C Is f u C•t'S [73 U as- 0 U ge-0 I I
❑ S Chi} -
f%I/a~T~►iit~S /~1 SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Ebjncl3y Roots GPD/ftin. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed iench
1 0-13 1.5 YR 3/i [ f; S6K A% try t' R. S 2-f N
AJ V3
A• b 3-lp /0 he coh sr/ ~f ~v-FL a.s Z+ u N
Ground ~Z{" y•yp /o yt' y 3 fi~ z s,dK ~w+~i• R S • S: •G
elev.
ft. -7S y,e y - -0E1.s . v s d ,2 - - ;
I
Depth to !
limiting
factor
Remarks:
Boring # 74 ,S6t- /W f R
Z - - /y ItOW yl3 S•/ / f 6-At 4-A -fl?
s l v f y S
Ground /72 f '.Z /D ~Q y~3 S Z 4- died AVrF/ • -S ~G f S
elev. ft. 1*22 7•S • S S d~
Depth to
limiting
fact„ 0% r% I
E UKTUINI~-L
Remarks:
_
CST Name:-Please Print j?G j3Ee r u C 3 e j C k T Phone: 714"- 3 P6
Address: Co5'5 O 'A-le/1 ~GQ • l f vDf O.J 3. _5-yW 6 5--j -f J/P 2__
Signature. Date: CST Number:
NOTE
,q v C e v T -70 ..4
co~~ cal 417-
MA y /;?,I-
,,pE ~i it- ~/rt/vF off' Di 's TX1evT1oA✓
~~y .
PROPERTY OWNER Gtd ' --T'~ oR.s°nJ SOIL DESCRIPTION REPORT Page Z of
PARCEL I.D. # i 7
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. BWrerxh
3 0-/7 7.,S' 3~z c0,gM Tfv Si • 4" v i• 2 S 7,77 P
N N b .1-
.
10 / 6 CS A s y 3 2--F.
Ground B ' 32- S yR y/ f S~ n~ R Aq of R cS • y . S
rev. ft. a ~_y~ ,.S yR Y y y~P'' s o, s d,Q a.C• _ b'
Depth to l.viX
limiting
factor i'2d +tJ a2 Gov -7*A-7 d l~~'T5 0 5~
I J
Remarks: ZIS~ ,PS/cy+~- ~4~10iv (T if'~T~ o~ . S (v 6,C' s"YSf•._
Boring #
0
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground r -x...
elev. i .
ft.
Depth to
limiting
factor
Remarks:
con onnnio nCinn%
y ,r
~yD ~ ~ ~ • o wF/~
C S~PTiC ovTLE-T 'N 3 f3EaiP
sy sy •
y3
SEPTCc SYS .
1 Qi`1
ue•rr 2____,. o Pool
w/ l •C4 • EFfwe~T 1 ~
sy slem 1 a3
Ec~u• gi.s~
38`
so _ , L3 2
~ I ~.v ~r~•o~S
C3 ~ ~y yo
3 6C ALE,: k"= 30
' ~ ~~«r of A~•rs
Sv &6E'STE"D --pEA1 C&IFIeVATioaS /3/'9 z /3o7To y EDGE o~
C 64- -T lz a Ai a,, woOD Sipl vG- 47 -
?'11 i•O Tip EN G~ ° , F/EU.f rxay ' /00 • o
low ~~,v~ • yo '
2 3
ti pit J~ a
373543 ~ 3Ep Ep ~
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Bcc CD
s*l ar o; K ,
N 1/4 COR. CERTIFIED SURVEY MAP Ts g
sects 32 NW 1/4- SE 1/4 -SEC. 32, T30N,R19 W
I \ C. S.M. VOL 3 , PAGE 856
33'
33' S 8 °-37'-57"E 652.06' EX/STING FENCE
1 23.42 628.64' I 30'+
I
I I 900 3a '
Z 1
_0 1 I
o Z !A
w O O
Z O - -
o
LOT /
-1 ~ o N
I
m Iv 274,767 SQ. FT. (6.308 ACRES) TOTAL a , Z
Iv
J ( m 264,242 SQ. FT. (6.066 ACRES) EXC. R/W o D
p O-
.A m
3 P 0 IN IO
0
0 0 1D
~I I O 10
Z I1. - IN
• I I
"WEST LINE OF THE
0 SE 1/4 SEC. 32
I D
0 ; '900
i e4' .O I
N 88°- 37'-57" W 653. 2 G'
2:T26.58' 626.68'
N
APPROVED
N (
Z T _ I _sURVFry MAP
I
O oO` CERL IFIEDPAGE "5-' -
2 SEP 16 1981
w ~ I
I d,;' 2 3\1Gt4ia 4tP.irifTSS£ I
m
I
33' 33'1
LEGEND
OWNER
GERALD JOHNSON
I
- - FOU1v0 I" X ''4" IRON, p it RT
\ HUDSON, W1.
1 COUNTY MONUMENT BERNSTIEN CAP
S I/4 COR
CO. MON. LINE NOT TO SCALE
SEC. 32
THE -WEST LINE OF THE SE 1/4 OF SECTION 32 r146
IS ASSUMED TO BEAR N. 10 36' 15" E.
ALLEN C. ;
VOL. PAGE11 no NYHACEN
CERTIFIED SURVEY MAPS n S-1487 1 3:
ST. CROIX COUNTY, WI. HUDSON, {
WIS. fi IQ-
0
THIS INSTRUMENT WAS DRAFTED B.R. <41 su
J08 NO. 81-31 y '7'•y1 V
SCALE: ONE INCH EQUALS ONE HUNDRED FEET
100' 50' 0 100' 200' - 300'
SL-,1V1YCZS Cr, T Il'ICA'i:.
I, Allen C. ;yh--en, a registered Land Surveyor, Iioreby certify that by
the direction of Gerald Joluison, I have surveyed, described and mapped
tale land parcel ,;;Thich is represented by this Certified Survey I,ap that
the exterior boundary of the land parcel surveyed and Napped is
described as follo,.Ts:
4 part of the y„ 1 /4 of file SE 1 /4 of Section 32, T 30 IT, R 19 W, Torn
Of St. Joseph, St. Croix- County, Wisconsin, further described as follows:
Corizlencing 3t the S 1 /4 corner of said Sec. 32; thence 2~ 010-36'-15" TL'
along, the 1+'est line of the SL 1"/4 of said Sec. 32, 2218.42 feet to the
point of begirlning; thence continuing V 01 °-36'-15" 421.00 feet;
thence S 830-37'-57" 652.06 feet; thence S 010-261-29" V1, 421.00 feet;
thence II 380-371-57" ;653.26 feet to the point of beLinhing. Above
described parcel is subject to a Toi-m road caUcment along the westerly side.
That this Cep°tified aurvey iiab is a correct representation of the exterior
boundesy surveyed and described;
that I have fully co::;plicd ,-rich the current provisions of Chapter 236.34
'~risconsin Revised Statu -ce, and t'_,le Land Subdivision Ordinanco of -,he
County of St. Croix in urveyiriLr and r.o.nping, sane;
Certified this dZo --Vt,_day Of 10,01 , I-.t 11.udcon, i.,i sconsin.
S gn e d ' CI.SL.~ M. 17 P
O F
Allen C . Il~rhuren, t, IBS 1407 f `
1d land Surveying ~ ALIEN
udsorl, i . 5Z C1 o T NYHAGEN c
'I S. 40T P
ri-, r HUDSON,
C 11TIFICA 3 or _1J fo.,I OF can. Jos,. 1
Wis. f ~
o ,
I do 11^.cPrebZ ce.:..if '.T that L this Certified r _ N erv o ~
aurZe a Su
1•: p has been roy the ~'o;rn of St. JO se3?il. E.59t!::~`~~3
This d^y 0- 1X31
7T .
oTvil i Clerri of St. Jo: c p h
Vol. 4 Page 1109
1
~J i
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that II have inspected the septic tank presently
serving the /d70r A) residence located at
Sec. :U T 3'6) N, R_Z"" 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
functioning properly.
Last time serviced
Did flow back occur from absorption system? Yes No (if no, skip
next line)
Approximate volume or length of time: gallons minutes
Capacity: /
Construction: Prefab Concrete Steel Other
Manufacurer (if known) : SQ ~Z,
Age of Tank (if known):
d'rnrf,'
(Si nature) (Name) Please Print
(Title) (License Number)
~PC_ l~l ~4~y
(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 ~~A_(~~ ~;',ltr~-lp~ r~Signature Yul' MP MPRS~~
5/88
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
MAILING ADDRESS ~•c,~\.~~cti
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION hl c,~ 1/4, 1/4, Sectionx V - 0 , T _30 N-R 19 W
TOWN OF '~r ~Sc-► ` ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP 373 S :5 , VOLUME? , PAGEE~OT NUMBER 1
610 9 )
Pk9c_-~
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 ex iration date.
SIGNED:
DATE: lc~- 7
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.
of property _
Location of property KW 1/4 sC 1/4, Section 3
T 3a N-R 19 W
Township
hailing address j-7•
v
Address of site )Z53
Subdivision name
Lot no.
Other homes on property? yes No
Previous owner of property
Total size of parcel 30
a. Acz,rS
Date parcel was created
Are all corners and lot lines identifiable?
Yes No
Is this property being developed for (spec house)? Yes xNo
volume and Page Number 1109 as recorded with the Register
of Deeds.
INCLUDE 14ITII THIS APPLICATION THE FOLLOWING: -
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
(we) certify that all statements on this form are true to the
be s t Of my (our) knowledge that I (we) am (are) the owner(s) of
t`1e property described in this information form, by virtue of a
'warranty deed recorded in the office of the Count
Feeds as Document No.~g~loa5 Y Register of
o n the , and that I (we) presently
proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described
the construction of said system, and the same has been duly
o
recorded in the office of county Register of deeds as Document
o
Signa ure a icant~t\
Co-applicant
9Y q- 7 -
Date 9y
of Signature
Date of signature
i
` DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
STATE BAR OA~F?? WISCONSIN FORM 2 -1982
3840 V0L ~U FACE
REGISTERS OFFICE
ST. CR'OIX CO., W16.
GERALD.A._-_ -OHNSON___and..LINDA-_D_._._JOHNSON,--------------_-- Rec'd. for Record tMs 19th
.husband.-and--wife--as-_.j_oa.nt--tenantsr------------------------------ day of April A.D. 1983
.Grantors -
conveys and warrants to ___GEORGE.-A--_-THORSON__and_._CONN_IE_.R_. cat 12:15 P M.
-THORSON.,-_-husband __and_.-wlfe___as-_j_oint.__tenants...........
.Grante_es-o------------
hr oRop4f Do
-
RETURN TO Hugh H. Gwln
P.O. Box 106, Hudson, WI
54016
the following described real estate in _4._.. rO1X........... County,
State of Wisconsin:
A parcel of land in the Northwest Quarter of the Tax Parcel No_
Southeast Quarter (NW; of SE;) of Section 32,
Township 30 North, Range 19 West, Town nof St. Joseph, St. Croix County,
Wisconsin, containing 6.308 acres, mor& or less, and more particularly
described as follows:
Lot 1 of a Certified Survey Map, recorded September 25, 1981 in Volume
4, Certified Survey Maps, at page 1109, as Document No. 373543 in the
Office of the Register of Deeds for St. Croix County, Wisconsin.
Subject to zoning ordinances, recorded easements for public utilities,
road easements and restrictions of record.
THIS DEED GIVEN IN SATISFACTION OF THAT CERTAIN LAND CONTRACT BETWEEN
THE ABOVE NAMED PARTIES DATED OCTOBER 3, 1981 AND RECORDED OCTOBER 6,
1981 IN VOL. 636, PAGE 339, DOCUMENT NO. 373778 IN THE OFFICE OF THE
REGISTER OF DEEDS FOR ST. CROIX COUNTY, WISCONSIN.
r j`A.EYS
$ O-D
This ___1S not homestead property. L
(is) (is not) F.uL
Xx XXXXX OMPM
Dated this ----------------------15th---------------- day of `a'Pril 198-3----
r
---------(SEAL) - -----.-(SEAL)
* Gerald A. Jd'hnson
- - (SEAL) Z'ru'CIG- -(SEAL)
~
* * Linda D. Johnson
- -
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONTSIN I
St. Croix Ss.
----------------------County.
authenticated this day of--------------------------- 19 Personally came before me this _ 1--th--__-day of
Apr i 19._ 8 3_ the above named
Gerald A. Johnson and Linda D.
.7oh~isonl husband-- and
TITLE: MEMBER STATE BAR OF WISCONSIN _
(i
(-If -
J uthorized n-96.06, Wis. Stats.) to me k to per who executed the
t O fore, i nst 1e an 4nowledge the same.
:THIS 1WSTF_UMEN-f WAS DRAFTED BY
Htk'Y1_~
* g-h H-. _Gw -wi n
HuA n_., WI_ 54016 Notary Public St_.-Cro_ix-------------County, Wis.
c C My Commission is permanent. XXXX~~FXXXXANIX
(Signatures tIWV_be authenticated or acknowledged. Both
are not necessary.) date: - - - - - ------------------------------------P 19--------•)
-
*Names of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. hw
FORM No. 2-1982 i);: .rnkec. \Vis.
Parcel 030-1096-60-000 02/24/2005 07:48 AM
PAGE 1 OF 1
Alt. Parcel 32.30.19.353B 030 - TOWN OF SAINT JOSEPH
Current j X' ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): Current Owner
* THORSON, GEORGE A & CONNIE R
GEORGE A & CONNIE R THORSON
1253 ROLLING HILLS TR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1253 ROLLING HILLS TR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 6.308 Plat: N/A-NOT AVAILABLE
SEC 32 T30N R19W NW SE LOT 1 OF CSM Block/Condo Bldg:
4/1109
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
32-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
2004 SUMMARY Bill Fair Market Value: Assessed with:
5622 268,300
Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 6.310 105,700 158,300 264,000 NO
Totals for 2004:
General Property 6.310 105,700 158,300 264,000
Woodland 0.000 0 0
Totals for 2003:
General Property 6.310 62,000 126,300 188,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 301
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER 6 -,r % T l c<' ~ ^h TOWNSHIP ~ t ;,L7 h SEC . l 2T 3a-R l -l W
ADDRESS-/ w 5, 5 r ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION `L0T LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
I di at N r h rr w
I
BENCHMARK: (Permanent reference Point) Describes
Elevation of vertical reference point: G' CJU Slope at situ.
SEPTIC TANK: Manufacturer: Liquid Capacity: GOD
Number of rings on cover Tank manhole cover elevation: 06,.2
Tank Inlet Elevation: 3 Tank Outlet Elevation: Q3. 7')
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set for a cycle (VA gallons; Total capacity of
distribution lines A14 gallon: size of pump JV4- head;
gallon per minute IV horsepower A11A ;brand name of pump
and model number /V ;
Type. of warning device x/14
HOLDING TANK: Manufacturer AlA Number of gallons
Elevation of manhole cover ;
Type of warning device
SEEPAGE PIT SIZE; ~V 4 Number of pits feet diameter N
feet liquid depth /V11 seepage pit inlet pipe-elevation
bottom of seepage pit elevation • /V feet.
SEEPAGE BED SIZE: number of lines width $ length 3 O tile depth
3
SEEPAGE TRENCH: width length /VI
PERCOLATION RATE AREA REQUIRED G AREA AS BUILT `f
r. INSPECTOR
DATED PLUMBER ON JOB .z
LICENSE NUMBER
1
t
14 7, 01
T~ -
i
I V
0
g
S ~~rT«
• l~ G
a~
r
oaf !h
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MAD,ISON, WI 53707
EM CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number:
(If assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Geonge Thomsen 1008 Wisconsin St.,Hudson, WI IP-1;7-g3 -~:pO m
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELE
NW SE, Section 32,T30N-R19W, Getotid Jvhnzon Ptop.Twnoi
-3 It.
Name of Plumber: MP/MPRSW No. County • Sanitary Permit Number:
Dougtas Stnohbeen 5432 St. C'toix 43647
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
P "IDED: PROVIDED:.
YES ❑NO ❑/Y,ES ❑NO
BEDDING: IV T DIAl..1 VENT MA L. HIGH WAT YES ER ❑ JNEARESTOM NUMBER OF ROAD: JL RPERT WELLBUILDING: VENT TO FRESH
A LARMINFt ` AIR INLET:
( ❑NO JZ' f IV
❑YES ❑NO
DOSING CHAMBER:
MANUFACTURER. BEDDING: LIOUID CAPACITY. PUMP MODEL. PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PRO)f IDED: PROVIDED:
❑YES ❑NO YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMB@R OFPROPERTY f WELL BUILDING: IVERN N OTRESH
(DIFFERENCE BETWEEN FEET FROM LINE
PUMP ON AND OFF) ❑YES ❑NO NEAREST'
IAMETER MATERIAL AND MARKING
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing u
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
MAIN
the soil is dry enough to continue.) JLEN~,TH
CONVENTIONAL SYSTEM:
WIDTH: _ LE GTH: NO. OF DISTR. PIPE SPACING: COVE [NIIIJ DIA.: #PITS: ILIOUID I~ I J . BED/TRENCH 'I ` t THE NCHES. P MA
IqL~!` PIT DEPTH:
DIMENSIONS
GRAVEL DEPTH FILL DE IT JDISTR. PIPE DISTR. PIPE DISTR.eIPE„ MATEFMA t.. M. b ISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW P)PES,. ABOVE COVER. ELEV. INLET ELEV. END PIPES FEET FROM LINE AIR INLET:
y; = JiL.L NEAREST
l g Z
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to m c rtaini at it REVE% DE. SHOW ELEVA-
meets the criteria for , diu sand. T'IONS ME ED.
❑YES ❑NO
SOIL COVER TEXTURE PERMANENT ARKERS: JOBSERVATION WELLS
❑ ES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH/BED rEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. CODED SEEDED. MULCHED.
CENTER. DGES.
❑YES / N S ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO. OF LATERAL SPACNG: GRAVEL DEPTH LOW P FILL DEPTH ABOVE COVER:
BED/TRENCH TRENCHES:
DIMENSIONS j
MANIFOLD PUMP. MANIFOLD DISTR. PIPE IMANIFOLD,.MATERIPX NO. DISTR. ID:
PE DISTRIBUTION PIPE MATERIAL & MARKINGELEVELEV.DIA.ELEV.: PIPESELEVATION AND
DISTRIBUTION OVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY PLANS
❑YES LINO ❑YES ❑NO
UMBER OF PROPERTY WELL: BUILDING:
COMMENTS: ]PERMANENT MARKERS: OBSERVATION WELLS: JNE
EET FROM LINE:
EST
❑ YES ❑ NO ❑ YES ❑ NO AR
L
r ~ t 1
I
Sketch System on _ R I In county file for audit.
Reverse Side.
S TITLE:
DILHR SBD 6710 (R. 01/82)
01-
DEPARTMENT OF ta"Mal 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'/Z x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be
included.
Property Owner: Mailing A ress:
C-00,-j(' n
ho~5Ph 16D~ W,4, 5t, aQsa4 Wes ~~G(G
Property Location: Ok".VALige-m Township: / C C
ounty:
A) W/a 5 lu 3 1,T30 NCR I I Wbr) J~ ~oSC /1 J c CPa (A
Lot Number: Blk No.: Subdivision Name: j Neares/t R d, Lake or Landmark: State Plan I.D. Number: -
Gl'/'O1f .~a~~5on /)e P,, Hr (If assigned)
TYPE OF BUILDING
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms
0211,11 or 2 Family *State Approval Required.
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: W1 c S C'
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ®~New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit
3 ❑ Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
Private ❑ Joint ❑ Public
1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. •
Name of Plumber: Signs re: MP/MPRSW No.: Phone Number:
DaCf y/~15~,- e, ~~ccn MP- F I V o1-7r-3.Z 33
Plumber' Address:
Name of Designer: /~tcA
COUNTY/DEPARTMENT USE ONLY
Signs ure of Issuing Agent: e: Date: APPROVED Sanitary Permit Number:
O D'ofp ❑ DISAPPROVED
IFfeason for Disapproval:
Alternate counsels) 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
D I LH R-SB D-6398 (8.07/81)
Form - S 'r C 100
1t
Owner of Property Vim, Q_ ~c~~2
,Location of Property iNw Section ? T ';O N R I q 1W
Township_ _
Mailing Address
Subdivision Name_
Lot Number
Previous Owner of PropertyIJ`
Total Size of Parcel C.03 AcktcS
Date Parcel Was Created G'-yes- Are all corners identifiable? No 0
Include with this application one of the following:
.Certified Survey Map
.Dead L-~
.Land Contract, or
.Other Vagal Document which describes the property
PROPERTY OWNER CERTIFICATION
1 (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 & warranty dead recorded* the Office of the
County Register of Deeds as Document No. -3- 41 n; and that I (we)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an essement, to run with the above described property, for the
construction of aid system, and th some has been duly recorded in the Office
of the County Register of Deeds Document No.
ZONATURE OF OW SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIG D DATE SIGNED
i
DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
i
STATE BAR OF WISCONSIN FORM 2 -1982
38.1
VOL FACE
REGISTERS OFFICE
ST. CROIX CO., W16.
GERALD-_A.__.JOHNSON.._and. -LINDA-.D_.-..JOHNSON-------------- Rec'd. for Record this 19th
.husband --and--wife--as__j_oi-nt--tena-ntsr---------- da of April
Gra.nto.rs,------------------------------------------------------------ ~A.D. 1983
conveys and warrants to _._GEORGE_.A_...THOR:ON__and___C_0NN_IE___R.. At 12:15 P M.
.THORSON.,.--husband _and-_-wif e-as.- j_oint___tenants....-_--...
Grantees-,----------------
Rp4fr of Do
- -
RETURN TO Hugh H. Gwen
. P.O. Box 106, Hudson, WI
- • 54016
- - - - - - - the following described real estate in _t..._.CrQ1X ..............._.____County
State of Wisconsin:
A parcel of land in the Northwest Quarter of the Tax Parcel No:
Southeast Quarter (NW; of SE;) of Section 32,
Township 30 North, Range 19 West, Town of St. Joseph, St. Croix County,
Wisconsin, containing 6.308 acres, more or less, and more particularly
described as follows:
Lot 1 of a Certified Survey Map, recorded September 25, 1981 in Volume
4, Certified Survey Maps, at page 1109, as Document No. 373543 in the
Office of the Register of Deeds for St. Croix County, Wisconsin.
Subject to zoning ordinances, recorded easements for public utilities,
road easements and restrictions of record.
THIS DEED GIVEN IN SATISFACTION OF THAT CERTAIN LAND CONTRACT BETWEEN
THE ABOVE NAMED PARTIES DATED OCTOBER 3, 1981 AND RECORDED OCTOBER 6,
1981 IN VOL. 636, PAGE 339, DOCUMENT NO. 373778 IN THE OFFICE OF THE
REGISTER OF DEEDS FOR ST. CROIX COUNTY, WISCONSIN.
T FJLN S"
This ri
(is) (is s not) homestead property. FEE
XX XXXXXX1X4PXI9X
i
Dated this - - - - - - - - - - - 15th day of - - - - April----------------------- 1x83
-
(SEAL)
-
-----------------------------(SEAL)
4
* Gerald A. Johnson
-
(SEAL) =r Cam: t 4 !__l__-- (SEAL)
* * Linda D. Johnson
AUTHENTICATION ACKNOWLEDGMENT
Signature s) nl STATE OF WISCONSIN 1
St. Croix County ss.
authenticated this day of 19...... Personally came before me this _ 15th--_--day of
Apr i_l_ - 8 3. the above named
Gerald A. Johnson and Linda D.
Johnson-,-- !uaband_ and_Wif-e----------------
TITLE: MEMBER STATE BAR OF WISCONSIN
tl • V
J uthorized by. §+106.06, Wis. Stats.) to me k to per n __S________ who executed the
r : OT A S Y foregoin nst ie an c4nowledge the same.
:THIS IW„STF_UMENY- WAS DRAFTED BY
Huh-- _allni_1. attorney
h H Gwin
HUGS4I_ -•WI- ~401-- - -
Notary Public St_.---Cro-iX-------- ---County, Wis.
(Signatules Itt yc_be authenticated or acknowledged. Both My Commission is permanent. (xXxxxxrxxxxxxxxx
are not necessary.) date: - - - - - 19--
- )
-Names of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, lur
FORM No. 2- 1982 wis.
cj~
2 3`3543
N 1/4 C0R. CERTIFIED SURVEY MAP TgTr g
CO. MON.
SEC. 32 NW 114-SE 1/4 -SEC. 32, T30N,R19 W
I \ C. S.M. VOL 3 , PAGE 856
33' 4.4't 8+
133' S 8V-37'-57"E 652.06' EX/STING FENCE
I l 23.42 628.64' 1 301+
I
6~-
I ' 900 3a '
i 9 •
1
z I I
I O 1 I
o z N
w O O
01
a I _ o LOT /
m I N 274,767 SQ. FT. (6.308 ACRES) TOTAL la ' Z
IT
I m 264,242 SQ. FT. (6.066 ACRES) EXC. R/W N co r-
0 D
N C I -1
J I P O N Im
0 1 00 Ir
p I _
I O Iz
I ~
I. 1 IN
z O Iv
I
-WEST LINE OF THE
I n SE 1/4 SEC. 32
1 ° g 900
11 IN1 I a~ - og, I
09 - N 88°-37-57 W 653. 26' `'6 I
I
Z26.58' 626.68'
N
N I MAP APPROVED
I
LOT SURVEY
I Z CERT1 pIED 4
1
o PAGE 5~ I
o I V0L-2- SEP 16 1081
dti 2.OAC?<, ct33i' mmT B I
I m
I
I
(33 33
N LEGEND
i OWNER
GERALD JOHNSON
• FOUND I" X 24" IRON PIPE RT.
- HUDSON, WI.
\ COUNTY MONUMENT BERNSTIEN CAP
S 1/4 CDR
CO. MON.LINE NOT TO SCALE
SEC. 32
THE -WEST LINE OF THE SE I/4 OF SECTION 32 C 00
IS ASSUMED TO BEAR N. 10 36' 15" E.('.~~~~
p ALLEN C.
VOL. 4 PAGE 1 1 (1q sf' NYHAGEN
CERTIFIED SURVEY MAPS S'1407 1
ST. CROIX COUNTY, WI. HUDSON,
apts. rf Q-
THIS INSTRUMEN T WAS DRAFTED B. R. PALMER
lC~ 0 s u JOB NO. 81-31
SCALE; ONE INCH EQUALS ONE HUNDRED FEET 7/
100' 50' 0
100' 200' 300' J
. r
I
i
I
i
I
60TT 92ud 7 •ToA
udO~0 • 10 V,za'[o u'101
• W
• Leo L ` o s IU,T
r c T S .
01 Li _r o U1:0' via s~ OAO.a.CiCi~ UOOO eU d:-T
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21,T7
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h
r LDINGS
MDUS T OF REPORT ON SOIL BORINGS AND SAFETY & B DI VISION
LARD' TRY? RYD PERCOLATION TESTS (115 P.O. BOX 7969
LA~Oii AND 1
HUMAN RE-L.ATIONS / MADISON, WI 53707
(H63.09(1) & Chapter 145.045)
LOCATION: ' SECTION: TOWNSHIP/ LOT NO.:BLK. NO.: S DI V1 10 D1aME
NW /aSE/ 3a- /T3o H/R/yI (o - 7, ~ee C~ac Zi.
COUNTY: OWNER'S BUYER'S NAME: MAI I G ADDRESS: aF e/ W E.fs7
S i ~T Eo G .-fo,r~ /cJ G(J~°s . 51, ~u~+s o v UJ.S. rvl-11.6
USE DATES OBS RVATIONS MADE
NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: PRO ILE DESCRIPTIONS: 1PERCOLATION TESTS:
19IResidence j~ XNew ❑Replace
Soy/'f,4R O XA e--f- On Cz / / O
RATING: S= Site suitable for system U= Site unsuitable for system 04. ~ Q c _ 4'.'1"6 G Cl!^ jC
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
MS ❑U MS ❑U C -S ❑u ❑ S aU El S Z U CoV d.e.~*Awg / ,z 'x36-0
If Percolation Tests are NOT required DESIGN RATS: I If any portion of the tested area is in the 141,14
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PR FI E DESCRIPTIONS
e~
BORING TOTAL DEPTH TO GROUNDWATER',. +M CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTHr4 ELEVATION OBSERVED EST. HIGHEST- TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
9,0' O ol-t e > s. 0
B- oZ .S' /O.S S 7 S' 'Ph /s . J `6 S~ r 2x. 04 MVd s
B- 3 9,S ' OS . '60 oih 4-1 B .s 1' A wed s
AV
TESTS
TEST DEPTH$ WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER '~.-r AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
P- 5r 0' AAO oZ 6 --'3
P_ o' o dZ 6 6 3
P- .7' v ( L -3
P-_
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 6 6 ew
I E
` I fletf
AB,1. S' S, C, Te'/e~K l~essAl L6t. _t!!~~'_o!
h
~_R i
$-3 BSs
O PZr
~7)
- -
%
7-0
7 4,
_/1 eetv.e.
I C
I;' I F
E
.am _._A
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
1~~u,u: s r 4, a s--/o - OV3
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
/S`9 7/1 3( J~
e e u Oro ffs. d 16
CST ATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
r
s r
JCTION- -1 CO- LETING FORM 115 - SRC - 6395
To be a cc ,t accurate sail teSt, your report MUSS include:
1. Comp :ion;
2. The use ly it t11 is a ice or cotom ~.)}ect;
3, "AX C~^' ` . i ~,or I~
re, syste,,:;;
nq ka~ i SUITA ;-E FOR A HOLDING TANK ONLY IF ALL
O-i LEC, SOIL CONDITIONS;
0. ah: ting profile descriptions and compl plot plan;
i.__GIBLE d s accur (j your test locations. I' raing to s ,err-ri. A
may be desit'd,
sn yaur benchnwi k and vetti reference point are n t;
all . i ; opriate boxes as to da names, addresses, flood
fl-I plain}, ek-~vation) does riot appi° r'' e box:
e current address arc: yon certification
12'hle ie as requires. ALL SOIL TEf TH THE
L ,Ul HOF JY WITH 'A 0 DAYS OF COMPLETION,
ABBREVI_`_ FOR CERTIFIES SOIL TESTERS
~cl i s.s...,,= Other S~-~mbcsls
i BB
SS
LS L
Is
- Bri
B1
C, y -
-r Clay ~Lt
ay
r. _ d
p -
H VV L -
~a1 Bari
VRP
TO THEOIN
I
L
• ao/, q e Tk 6!-Sol
Prye/ff 1 c1 ~hh 3,a,, r~~~
of Line
Leo tl
8M 15 f6, Vorf,
Nw~
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rile 4r6c(M,,4 Ef. 00"
+ fu Dottf c,e&;6kAof
PCAC5 6Fe f 6 ff"I'7
LIP ~T
az i
~w
1 / ( C ~yya fi GC /f .J f b
~ M~ef ~/tF~ r~a~l~7 /'°~u/rte Nlth~`S
L
b
~ N
L
Cyr nh ~hs~~
67
Al rG~ g 5 vy ~~~rt~
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rh
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MQry
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r o v~
~ acv ~
~r 4vn bc air r/+l+ j0' GoSf /1/~~ y°
~h f~e~l~tary / h "r Gk Tod/V.~
I
COMWIERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227
i
I
ST. CROIX ZONING REPORT NO.! 14367/01 PAGE 1
ST. CROIX COWTY REPORT DATES 11/27/91
COURTHOUSE DATE RECEIVED** 11/26/91
HUDSON, WI 54016
ATTNS THOMAS C. NELSON
2 2v ~q ~3S-3
OWNERS Corgerson
LOCATIONS 1253 Rotting Hills Trail, Hudson
COLLECTORS ii. Jenkins
SOURCE OF SAMPLES Kitchen faucet
COLIFORMS 0 /100 ml
INTERPRETATIONS Bacteriologically SAFE
NITRATE-NS 2 ppm
Above 10 ppm exceeds the recommended Public
Drinking Water Standard.
Coliform Bacteria/100 ml
Nitrate-Nitrogen, mg/L
9
O
LAB TECHNICIANS Pam Gone IN
WI Approved Lab No. 19 $
O G
o - N
oF.\NOEVENpEN
0 t Means "LESS THAN" Detectable Level Approved byi
4A
® PROFESSIONAL LABORATORY SERVICES SINCE 1952
Pat J\ rr~i Asa-a(
ST. CROIX COUNTY ZONING OFFICE
St. Croix County Courthouse
C,~ 911 4th Street
Hudson, WI 54016
Telephone - (715)386-4680
The St. Croix County Zoning office offers the service of septic
and water inspections to Lending Institutions, Realty Firms, and
private individuals.
Completion of this form is essential so that the property can be
located.
Please provide the following information, enclose appropriate
fee made payable to St. Croix County Zoning Office, and mail,
along with form to the above address. Testing will be done as
soon as possible after fee and form are received.
WATER TESTING----------------------------FEE: $ 25.00
(For nitrates and coliform bacteria)
WATER TESTING FEE: $127.00
(For VOC'S)
SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00
(Determines if system is properly functioning at ime of
inspection) ~
Property owner's name6 L /I:Q7L~f5LC ~
Property owner's address j ass P-ft Ulky---3 H I LLIS 1"LLL
Legal Description l1 V1 1/4 of the SE 1/4 of Section a;t , T O N-R
Town of Lot Number Subdivision Name
FIRE NUMBER LOCK BOX NUMBER
Color of house Realty sign by house? If so, list firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOK,
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual requesting services:
Telephone Number 1s ; l`-a =~S t 19` tna_ -Sn t O
udSOri
REPORT TO BE T TO : 207 211;r „ HIJAIGni W! 54016
Closing dat b-C
Signature
ST. CROIX COUNTY
~v
r ,
WISCONSIN
~ z l. i7S 1 f ?five
z 'rL~a ZONING OFFICE
a ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
Nov. 26, 1991
Peg Starke
First National Bank/Hudson
307 2nd St.
Hudson, WI 54016
Dear Ms. Starke:
An inspection of the septic system on the property of George
Thorson, located at 1253 Rolling Hills Trail, Hudson, WI, was
conducted on Nov. 25, 1991. At the same time a water sample was
also obtained for testing. The results of that testing will be
sent to you as soon as we receive them back from the laboratory.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and
did not involve any excavating or chemical analysis.
Accordingly, there is the possibility of hidden defects in the
system not discoverable by this inspection. This does not in
any way warrant or guarantee the continued proper functioning or
operation of this system. It is recommended that the system
should be pumped once every three years. Therefore, the
prolonged life of this system may be dependent upon proper
maintenance of the system.
n erely,
I«
Mar J. Jenkins
Assistant Zoning Administrator
cj