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020-1041-20-000
.C c a~i °o I ~ °o, I 0 03 °60'* 0 °n ~n a O O Cl) c rn N ~ I I chy .oc ~ I I I I Q I I ~L w I I I I aNi N 0 0 0 v I I Z z c c C U. c p ii o o E ¢ v `m I E ¢ I I I O M f0 M > N CL > W rn z ~ E ~ E Yg ~ v rnCCID4 Z a m € m I o I O z V c v ~ ~ y :3 o 0 v d z to I- ~ c c z c c N v I v rn I ` N N 7 N a 7 CL :1 ID (D a' c a u) r a r t O o C c O Z m z Z H Z I Z N V O t ( O N O O R O ►y. 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Provide 2 dimensions to center of septic tank manhole cover. 1 IIENCFII•fARR• To/" MOST Pw b- 0--j 40ga-// - /00. O ALTERNATE BM: ~.//5 T/~u G- C~•e'T~~i~y iu ODE ~r~p /~~t aT co.~D~T t c v SEPTIC TANK / FPMv ER / TION GpU.vT~ Manufacturer: &y4L=st.e Liquid Capacity: /evo Tl r<eA) Setback from: Well 3Y' House Z7 Other Pump: Manufacturer 4/4' Model# IV* Size /U - Float seperation /V, Gallons/cycle: Alarm Location yi- :SOIL ABSORPTION SYSTEM 3 Width: Jr" L`ength Number of trenches \ Distance & Direction to nearest ProP• line: 30 c z- l . Setback from: well: , House 6S , Other ELEVATIONS Building Sewer ? ST Inlet: ST outlet PC inlet PC bottom Pump Off Header/Manifold POT' P),~AJ Bottom of system Existing Grade 97' O Final grade O DATE OF INSTALLATION: /0 - y_ f-3 PLUMBER ON JOB: /00436 P 7- 211-13 --f i~rA 7- 141"-S, 330-7 LICENSE NUMBER. INSPECTOR: T~ r p ~0Aj 3/93:jt ~ls 6c)Spycs ►~sT~~r 10 3 - 7,C~,uc ~ SP~cS ire 414.5 H-eD 31y " rr5'y eell~-ATE 7W546D HMO" yy,~~G., rte` ~,eo rE G ~ y Ty vf- • Tle eNC-h. IS T Ft~t~o~~ l3 y T 12t~NC,(,~„ G „ 46tr3; 134 APIA /,vLt T - ?o sy 5-~-~ n \ /.vLET TO Pl S77ei,8t9 T%O•v 11 U410C ~D.~E C,15 T do X 1~G • /2, ' /to y 9G . y O ~ E Li E G~~ ~ ~y w cif f~~ SEA Ut~T ~ L~L~ S• f/~' ~'7 aaE Li.v~ CO~b ems. s its v~-s S Ys 7e , T'R E.v c to- LE v.+ T/ o v S 7iP G~/' F/N~t l T°P - P/?X rv p ' ld/~05- SYSreAl COlJ'ER #e iPcR 1/E.lT E,up DE~7ln(, END 2-, 5 3,0 r3 q~. o ~y-Y4~y 3~ oi3- YS 3,0 qy. 3 113. 4/5 r a l 1 3 I ~ I IWAR5 I G~R~tG-E I I I - IeE' W56 AP ~x,sT%~ U- II9" w i~sEn 1 NEI' 6k /~oR `S S~pTic T~~k well 3~l d ve ovr o~ y' ,vew D (AA.IK " VIA r3o 1 I 1 s- I I pis7- 1 V I Y I rl Z I I .-I ~ I N S ~ r ~Mo/~d t\~ 1 r, I I I t V~ 13 ~GLV.VEC7fj~ I i j ( I ( I $3 I B S t I, G~ 1 I PI I • pt" U(3r6 G u~ d1.,,~ I h, I u. l I I I i I - a; CAP I v t_ I a ~ I i "'I i I 1~ M I ~ ~ I b~ l I 1tA ~QQ I ~ N i I k l I ~ I. ~ vS od SJ I I U% ,41 6_ UPS 5ySTF.N L- -p - I I m ¢ us ~'.Dv S cc co I w m ~o _ i . I ~M = 7apMosT yo,'NT ~~lv~ ) ELtyhdo~ _ /oC>.d i 15 LaUATIoNS 8' 9l~. Z y , 7. 2-6 ' sy57TtM SC,9l..E L = 20 B f7, 06 3 f3, ~Y .5 Ts 1ti 5 ~s► //cv 3 7 e yE's C,4 5',c 3q' .r Ls~nFfartb~ust~y9. 29. 19.17R&ATE SEWAGE SYSTEM County: Labor A Human Relations INSPECTION REPORT Safety and Buildings Division "W GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar r it Permit Holder's Name: ❑ City Village R Town o : State Plan o.: CST BM Elev.: Insp. BM Elev.: , BM Description: X Parcel Tax No.: Ie •c6~- TANK INFORMATION ELEVATION DATA A9300270 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3 9 / 60 Dosin Aeration Bldg. Sewer r Holding St/Ht Inlet (,t4, TANK SETBACK INFORMATION St/ Outlet Vent TANKTO P/L WELL BLDG. Airito ntake ROAD Dt Inlet Ar Septic 35/' rP(o / NA Dt Bottom YTA Dosi NA Headed_4Gaw.- g' 915.31 Aeration A Dist. Pipe g p~~ S",L ID 5~ Holding , Bot. System 9• 77 9.3 9~D ~ PUMP/ SIPHON INFORMATION Final Grade s, 60 97 52 Man ea- Demand Model Number GPM TDH Lift Friction ys m TDH Ft H Forcemain Length Dia. Dist. wen SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length / No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S W DIME N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA Manufacturer: SETBACK INFORMATION Type O vn,f q/ CHAMBER Num er. System .,-&-,e- OR U DISTRIBUTION SYSTEM Headepo#*m-*felt!' , / . Distribution Pipe(s) „ x x Hole Spacing Vent To Air Intake Length Dia. Length 36 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At- a Systems ly Depth Over ~1., Depth Over xx Dep xx Seeded/ Sodded Mulched Bed /Trench Center l2d '-18 Bed /Trench Edges ~;)a ^ Topsoil ❑ Yes ❑ No ❑ Yes No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 19.29.19.172H i ell Plan revision required? ❑ Yes D-iqo, / Use other side for additional information. & d Y SBD-6710 (R 05/91) Date Inspector's Signat re Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code -.d,.,,.,.~.....,..,, 5'7'• Cie K STATE SA~IT 17 M T # -Attach complete plans (to the county copy only) for the system, on paper not less than /j`/'jj f[e7~ 8% x 11 inches in size. El Check if vis on previous 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 P/u $ )f jE10Cit77b,' efOA4 Vtr l.S©.✓ NW Y. Aelf- Y., S /fl T 2f, N, R 1 E (or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 2~ 2.4 SIT-. CITY, STATE ZIP CODE PHO E NUMBER SUBDIVISION NAME OR CSM NUMBER DSO ~~S SY6~~o 3 , OG0 CITY NEAREST ROAD 11. TYPE OF BUILDING' /(Check one ) State Owned Ell O VILLAGE . ❑ Public or 2 Fam. Dwellin g-#of bedrooms- ill. BUILDING USE: (If building type is public, check all that apply) Q ZQ ~~Yt~~- 20 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 ne in line A. Check 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 # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ SWpage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure i 43 ❑ Vault Privy 14 ❑ System-In-Fill 3 3JO 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.) PRSO, DOSED (sq. ft.) (Ga/day/sq. ft.) (Min inch) 0 ELEVATION ~!Q tD Feet ' O Feet 3 • CAPACITY VII. TANK Site in allons Total of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank ___f6mo F1 1 71 El Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu tier's Signature: (No Stamps) MFfMPRSW No.: Business Phone Number: Rowr vil ic4 r 3367 7/S 3P40 Plumber's Address (Street, City, State Zip Code): IX. LINTY/DEPARTMENT USE ONLY c /0' ❑ Disapproved Sam ryPermit Fee (includes Groundwater a e ssu Issuing Age t Signa ~ pproved ❑ Owner Given Initial Surcharge Fee) l0 Advers 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 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 T ansfer/Renewal Form (SRED 6399) to be submitted.to the county prior=lto installation. 5. On: ite sewage systems must be properly maintained. The tank(s) must be pun`ped Ly a licensed pumper wheriever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code aclminrstra.to~ 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 insta4led. 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 per(rit 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 requests-:1 in ##1-7. VII. Tank ii-ifor(nat on. Fill in the capacity of every -sew and/or exit i-° ` o +st the total cLL-;E •c iurnl;er of tanks and ;s.anufacturer's name. Indiude pfefab or rite construct-d anc tank material. r c:yu, ,ate for all septic pz!(np/siphon and holding tanks fo~ this system. Check a.; wr -Y,~:n al approval only if tanks received experinlevi'a.l product approval from D:1 '-M. Vill. Resp--!~ ib(iity statement. installing plum!)er is to fill in name, he ense n-.imber with appropri;4ie prefix (e.g. MP, etc.), address and phoney number. Plumue, must sign app'ic: loon form. IX. County/t1epartment Use Only. X. County/Department Use Only. Ccc- -1'( to plans and specifications not smaller than 81/ > t 1 inches must be submit~ed to the county. The plains } :;st include the fn _°ing; Al plot plan, :awn to =;c: s r c:nmplpte 1i(nerdons, iocation of hQlri r r 'vrrk( i. SG e,i,- to s` t7r oth` r treatrnr nf-tanks' bt.: EJJ+" } Vt'' 4V8ltS; we to %--s .sinter service; strearyis pumT siphon tanks, di-l,,ihution ocs-s LS+`+ ,ti(It systeirs replacement system areas; and ille ~ocaflon of h,' bullring serve-:,, ,3) !lorizo^tr -,ali n reference do(rt;: C) complete specifications for pumps and controls; Jose ),oturm:; d;fferences; frict on loss; pump performance curve; pump model and pump manufacturer; D) crc•_s section of the soil absorption system if, required by the county; E) soil test,data on a 115 tbim; and F) all sizing information. K* - - - - - - - - - - - - - - - - - - - - - - GR0UNMATER~URCHARGE 1993 Wisconsin tact 419'included thg creation of surcharges (tees) for Zt nun-„ac-.r c. regulated prac' c-~s `Vhic~ can effect groundwat+ F The n.. ])nlG~ c0e^tad through these G~O.iti; water contamination in e , iq7 :!tions ant] estab:ish(,ent of St•6.r,ti,3rdS SBD-6398 (R.11/88) t Wisconsin De ,WrR*nt or Industry, SOIL AND SITE EVALUATION REPORT Papa/ ~ of 3 labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code S/*T~ /I~l~,P SS 3o Z GtJiY1OGJ L.v. /fvvfc 'o S"yoi G COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not lirnited to vertical and horizontal reference point (BM), drection and % of slope, scale or PARCEL I.D. IF dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER ,771 U$ i~~L act j is n~ C/o PROPERTY LOCATION d,~ ~//E/So.v GOVT. LOT *AJ 1/4 Nr 114,S 1 T 2-f N,R 1 E (or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK8 SUBO. NAME OR CSM # 2i 9 1,►e S r', CITY, STATE ZIP CODE PHONE NUMBER OCITY OVILLAGE OWN NEAREST ROAD h~,PS ,J ~vss . ~YoiG (~<s) 3AG -q~0 ~fvr~sa,~ f [ New Construction Use [ Residential / Number of bedrooms 3 [ ] Addition ID eAs*Q building [vrReplacementt ( I Public or commercial describe Code derived daily lbw y%O gpd Recommended desist loading Tale 7 bed. 909 -<f trentch, gp W Absorption area required bed, 112 1,63 trench, ft2 Maximum design badtng rate • 7 bed, gp02 ` -9 trench, WW Reoonrnended infiltration surface elevation(s) R (as referred b site plan WOmark) Additionaldesign / she oortsideratiorts Parent material SCS 57 a ,S - ae-'7 S A~ A/. Fbod pain elevation, ti applicable 'vim R u= u f~ s o r° o u ca u"` ~eiDav ms's a u o ING TANK SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Strucbme Consislience Baffifty Roots GPD in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. Bed tench 0-6 io ye z t S 2 ,w, 6j,' 4ri Ilr"4 S 3,44 , ~L I- .6-12- to VX !s I 'f 9X IM V7W s /uf , 7 Ground 10-36 7, 5 w y elev. fL Cr 6' SYNC Depth ID Cz .0 fifamitictorng y~ Remarks: Boring # jaY,e 2/ N ;3, /5- -),r /D ye 316, /s 0, , ,e f~ w v~ . -7 Ground elev. 132__ 3l0 75 y,P '1" s . '00 fL _ - D" to C ~ - G3 S `,e y S rector - Remarks: T Name:-Please Print ~Po l&e-,e7 - *G 13,C/C4 T, Phone. 71s 3P6 ~l 8 S ress: 5 S O i'L tea - /-/o Ps-o,3 Cv SYaG f - J a J73 CsT~y 1 YPz signature: 7Z + uee-, Date: CST Number: No Tt /'s r, S / S r CA4 G•Es i,v Cop - w,~ Ip /,4,v7- soy/5 s,~ ~~~~Eo us>=v 0 13o)( 2 11,L& w/ dZu4o~ /p ' PROPEMOWNM SOIL DESCRIPTION REPORT pap 2a 3 PAfMIA# . Structure GPI Borkg orizon Color Monies Depth Munsell (au. SL Cont. Color Texture Cir. Sz. Sh. Oorrsislenoe Bourffiry Roots Bed To-ch e5 00 /3, y- zs /o Yle 314 /s f~ of 2 S f 1,7 00 crowd 13Z zs -16 7, s y y - elev. It 3~ -SP S Y~ c S - - 7 Depth io Grr~Ung ~ Ll . . Remarks: Boring # E3 FF- Grout elev. I~ Depth a taclor Remarks: Boring # Ground elev. it Dept b ba" kiCbr Remarks: Boring # Ground elev. R Depth lo fiaa~r' 9. bdtor Remarks: OWN 007n/D ^cx%," F , ~o' - ~ 3 of 3 ~0 T3~~R~15 ~ GAR~tG-E i sr%.) 6- Oke ~~s r' ib o o A 9 w ~~sEn 21 NEI' /3OR5 S-CPr1c r AA< r l[JE~~ ' well aumar: p 95 -7 S 9 o 3 33 °N Fitliv G- sysr,C.A4 93.9.6 ' r i 33' ~~l = TdPA4o5r l o,',v r oA~, 6PE!/. ELtv~tr~o~ _ /oo.d C LaUATIoNS - Sv~dESTEv s/S~-~~ ~7.z ' o CMIFA-) (3 3 r 7, 0 6 vA7-/0 s 93. p 'Ts 1ti s fi~ 3 7 iPE.v C f -5 K ~l .r ~oliv S Dt roc rtD !.V ZrC4) T' P~ . i of Z ~ I 3 I ~0 l3>`~~~JS I G~R~tG-E I I I I i ,fc•ws 1 A7A','SrIA) 6 - Pe,- clsr- iboo~ li, / E s, n 21 NEI' b k /30R ~s SEp rI c T•t,~k well ovr[ET : 95. 5 o.~- wEll 5b o 3-0 I OrsTRrBvr~oa ,Bi - -I /30 Y, ~I I I a I 'r I I~ Kct ~ I ,c b ( o I I , I I I I ~ 13 IV' I r l I' I I ill j ~av-vEC7fp I , j I I I I 13 3 ~ h~~ Dol I I ~ I I ~ I r v I MI I I I I loo ~ M I ~ ~ I ovl I I I M ~Q~ ~ I I I ml ~ I:` v~ ~ I I I or. 13W=~ /EVE} 1'i'GN 2- S/ - I I c°m w 93.9.6 05 Z c o OV 33 1 c~. GU ~/~04J L.v , a~ ~E!/. EL t V4 r/o Aj / oa . d ELEVATIONS B I 2 y , ~y G! 7 ~ 2 p 20, v Z CteCAJGGi) sysTEM B3 I/.ARoA.J s 93, p S.C,9=LE~/}cKl~oE •Ts Itis,~A// 3 7~rE~v~ yE's ~I f Approved Vent Cop Minimum 12' Above Final Grade 970 4' Cost Iron o d Above Pipe - • Vint flpo' '}e Final Grade Synthelic covering Min. 2' Aggregate Over Pipe Distribution - T•• Plpe 0 0 0 0 0 e Aggregate 0 Perfbraled Pipe Below Beneath Pipe o -Coupling T•cmtimollnq At Bottom 01 S.rstew y3• o ' • Fresh Air Inlets And Observation Pipe Approvod Vent Cap 7,ec j t 14 /J Minimum 12' Above . Final Grade I~ r 9 7.0 3~0 ' Above Pipe _ 4' Cost Iron 1o Final Grade vent Qipe a: Synthetic Covering $ ci i Min. 2' Aggregate ~z p m § QL Over Pipe Al Distribution -Too Pipe 0 0 0 0 0 as 61 A a=~w~ Be Aggrhegate LUU) Pipe o -Coupling Pipe Below ° ¢ cr s STf o Coupling Terminating At ca w ¢ ,c Bottom Of System b N a~ f3.o UPI Fresh Air Inlets And Observation Pipe Approved Vent Cop Minimum 12 Above Final Grade fr~~/Sff~v 7 _ 4' Cost Iron Above Pipe Vent Plot Ito Final Grade Synthetic Covering Min. 2' Aggregate Over Pipe Distribution - Tee Pipe 0 0 0 0 0 Aggregate 0 Perforated Pipe Below Beneath pip: in Torminelin At Sy5 7E.41 ~ Bottom Of System ' 93. o Y~ r • S & N LAND SURVEYING • HUDSON , WISCONSIN 54016 (715) 386-2007 Nome First National Bank 'Address 307 Second Street ' Hudson, WI 54016 Description A parcel of land located in the NWT of the NE4 of Section 19, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; discribed in Volume 376, Page 324 and Volume 411, Page 481 in the St. Croix County Register of Deeds. Small Tracts 18600 354r 05,,E S860.35 ' 135.00' (R. S8700271 90:00' 45.001 E, 450')-- . Shed ' N N Garage 4J I t` i M j to =us ,J ! 6 U W i t_ I r` _ > j 3 ^ In +I s cr 'r N .n s I M .~-r ND 011 1 y i o O a I _ s O ,1+ 1 „I o Areas 30,662 SQ. FT. o W ;j r~ Z r 0.7 Acres to Lr) C2 V1. Co n s V m _ ac tri H S N ON t-' ~O " W i, 4- /q~ 02 8. LEGEND s6ol4.111 • 3/411 Iron Pipe Found j8 8 .a Y+. • 111 Iron Pipe Found f♦ 211 Iron Pipe Found sd; TS W Corner of the NW} of O 111 x 241' Iron Pipe Set 14P the NE} of Section 19 ;tote of Wisconsin :ounty of St. Croix ) at. SCALE OF' MAP - 1 INCH = 40 Feet ' A~l_fln C. Nvhageil , registered Wisconsin Land Surveyor,do hereby certify that n Septeinbeer Z 19 87 , t surveyed the above described and mapped property according to tie official records and that the accompanying mop is a correctly dimensioned representation to scale of the boundorles,thol II buildings and improvements lie wholly within the boundary lines, and that no encroachments by adjoining owners appear rom sold survey. ~~3g~9C':lbf;~~, e Map No. 8 7 - 3 7 ALLEN C- `roNn 9 FW13 . " hlYNfti^EN 1~I' ~ auA6W By _ C i-1407 r flurnon, f LUIS. dot ""»..w..,r~•` -14 t S T C 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYEP /US "CA-rIM) ADDRESS(-`Z CC.J/ doeJ IAA)'E FIRE NUMBER CITY/STATE fi4 rJ ZIP alb PROPERTY LOCATION:AJ k1 1/41/4, SECTION, T~N-R__/__J_W TOWN OF , St. Croix County, SUBDIVISION , 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. SIGNED: DATE : 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 1a 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 $ ® CGA-i"'f otl Location of- property1/4 111E 1/4, Section 117 , T 1 N-R_LjW Township Mailing address X0V 2A ;)-6 ra 01 Address of site Subdivision name Lot no. other homes on property? yes-__No Previous owner of property Total size of parcel Date parcel-was created Are all corners and lot lines identifiable? =Yes No Is this property being developed for (spec house)? Yes 2 No Volume 77~and Page Number °Z 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 i the office of the County Register of Deeds as Document No. ~F ('03 e , 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 County Register of deeds as Document No. signature of applicant Co-applicant 7el'9_3 Date of Signature Do&te o Signature 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 - 3Ca-2- Gu%l/oGu Lw ffvOfo-v residence located at: itJ4J 1/4, 1/41 Sec. 7(~ T 2-7 N, R 17 W, Town of ~y DSo Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. q 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) : 4)OC. 6:- 7 Age of Tank (if known): ! / (Signature) (Name) Please Print ti-tP~S 3307 (Title) (License Number) -3o-y3 (Date) Form to be completed by licensed plumber (x.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 ` oRerT lbR e C44 7-Signature %4UZ14,4,SP-/MPRS 330 5/88 i • 1 DOCUMENT NO. STATE BAR OF WISCONSIN FORM 6-1981 T"ia SPACE RESERVED FOR RccoROiNO DATA PERSONAL REPRESENTATIVE'S DEED 43is30 . jgJPa 242 REGISTER'S OFFICE ST. CROIX CO., WI J Crawle Recd for Record ............X. ._:....Xt Oct. 30, 1987 as Personal Representative of the estate cf 10:40 A M uiola. L...Burke..__.....----••----.......................................................... (..Decedent"), Rp1910r of Deeds for a valuable consideration conveys, without warraity, to i--'•' #ert_ J.• Erchran.and•Berri_-A...Fc?~an~..husband_and wfe ..sutviwrship_mairtal.p ppertYr.......................................... ~ Grantees RETURN TO CYO1X the following described real estate In SL-----•---------------•----•-----• County, fatS of Wisconsin (hereinafter called the "Property") : Part of Northwest Quarter of Northeast Quarter of Section 19, Township 29 North, Range 19 West described as follows: Clo mencing at Southwest corner of said hwest Quarter Of Tax Parcel No: Northeast Quarter; thence N10131W on quarter section line of Section 19, 451 feet, more or less, to fence line; thence S87°27'E on said fence line 450 feet to place of beginning; thence S6°21'E 234.5 .feet; thence N58014'W 132.1 feet; thence N1013'W 167.5 feet; thence S87°27'E 90 feet to place of beginning. T MER WITS easerent for access road Southeasterly from above Parcel to Town road. Part of Northwest Quarter of Northeast Quarter of Section 19, Township 29 North, Range 19 West described as follows: Omamlencing at Southwest corner of said Northwest nuarter of Northeast Quarter; thence N1013'W on quarter section line 451 feet, more cr less to fence line; thence S87°27'E on said fence line 450 feet ofplace oi land bconVeYed eginning; thence to S87°27'E on fence line 45 feet; thence S6021'E to boundary parco J• Sherman Peterson and wife in "361", page 215; thence N58014'W to a point S6021'E of place of beginning; thence N 6o21"W to place of beginning. 5 F Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which the Decedent had immediately prior to Decedent's death, and sill of the estate and interest in the Property which the Personal Representative has since acquired. (~~~/y}, Dated this 26th------------------------------- day of (A-- 18.$~ I ~,.ej... (SEAL) (SEAL) Ii Mar J. Crawle Personal Representative Personal Representative I! AUTHENTICATION ACKNOWLEDGMENT i Signature(s) STATE OF WISCONSIN St. Croix County. authenticated this day of 19 ersonally came before me this day of L _tS..•_-•-_-_----•----_._, 19..87_. the above named Matt'- J. _ C - -rawleY_... II TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by j 706.06, Wis. Stats.) to me•kn wti•t6 114161 son who executed the foregbiag instrument died' acknowledge the same. dol~ TNI S INSTRUMENT WAS DRAFTED BV Robert F. Wall .....R1E-,'FU9W'1--WA~r-&--HAF.I+'--------------------•------- - L , 522 Second Street ~ I S re~.......... i NoigB~ .540-16 Wis. Hudson-;•-M-- 5441Cr (Signatures may be authenticated or acknowledged. Both My",, pg•tsdos.•t3Lifermanent. (If not, state expiration are not necessary.) date: S .Names of person signing in any capacity should be typed or printed below their signatures. STATF. BAR Or WISCONSIN Wisconsin Legal Blank ro. Inc. FORM No. 5 - 1982 Milwaukee. Wis. Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER / r TOWNSHIP C~ SEC. T ,-:2LN-R~W ADDRESSU)III}W ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~t1 U i f 1 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 10a Of ex/ ad T Elevation of vertical reference point: /4Z~ L., Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: 94 . s a a Tank Inlet Elevation: Tank Outlet Elevation: 1~t 3 ~ Number of feet from nearest Road: Front SideoRear, feet From nearest-property line Front 10 Side 10 Rear, 0 feet Number of feet from: well 4 , building:_ (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE f PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear Ft. Number of feet from well: Number of feet from building: Uncluda._distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ` Trench: Width: Length: ~ Number of Lines:~ Area Built: Fill depth to top of pipe: 9P c / Number of feet from nearest property line: Front, Side, Rear,O O Pt Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom tank: Elevation of inlet:' Number of feet from nearest property line: Front, O Side, 0. Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: frr Q Inspector: Dated: I J rg Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION `P.O. BO~Y%7969 BUREAU OF PLUMBING MADISON, WI 53707 ePled) Number: El CONVENTIONAL OALTERNATIVE (lf Statassigned) n ❑ Holding Tank D In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Viola L. Burke Willow Lane, R. R. 5, Hudson, Wi 3-15-gs 1 + 3a BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: NW NE, Section 19, T29N-R19W, Town of Hudson Name of Plumber: MP/MPRSW No. County: Sanitary Permit Number: Richard Hopkins 1959 St. Croix 58945 SEPTIC TANK/HOLDING TANK: WARNING LABEL LOCKING COVER MANUFACTURER. LIQUID CAPACITY: TANK INL T ff-LEV. TANK O LET ELEIJ. / PROVIDED: PROVIDED: g(O' Sy `~G.Sz YES ONO ❑Y NO BEDDING: VENT CIA.: VENT MATL.. HIGH WATE NUMBER OF ROAD: PROPERTY WELL: LZ7, INGVENT TO FRESH ALARM FEET FROM 11\1 . AIR INLET: ES ONO DYES NO NEAREST j("f D SING CHAMBER: MANUFACTURER'. BEDDING: ]LIQUID CAPACITY . PUMP MODEL. PUMP/SIPHON MA U CTLIRE WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO ES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: N VMR F PROPERTY WELLBUILDINGVEN(DIFFERENCE BETWEEN F R M LINE AIR INLET: PUMP ON AND OFF) DYES ONO N S SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing JLENGTH JUIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH. LENGTH. NO. OF DISTR. PIPE SPACING. COVER INSIDE DIA.. #PITS: LIQUID BED/TRENCH Q TRENCHES M IAL: PI DEPTH: DIMENSIONS I iJ I nEAf DEPTH FILL DEPTH DISTRPIPE DISTR. PIPE DISTR. PIPE MATERIALNO. DI UMBROPERTY WELL: BUILDING: VENT TO FRESH GRAVEL BELOW PIPESABOVE COVERELEVINLEELEVENDPIPES INE AIR N ET//HL EET I I 1, EST-i V MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE SHOW ELEVA- meets the criteria for medium sand. TIONS MEASUREEN DYES NO SOIL COVER TEXTURE PERMANENT KERS: OBSERVATION WELLS l'I F z JYE 'fiyp" DYES ONO DEPTH OVER TRENCH/BED I / y DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: DDED. S~.ED D. MULCHED: CENTER. EDGES fFj DYES' EDL"I DYES O NO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO. OF LATERAL SP ING: jGfAVEL DEPT BE OW PI FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: DIMENSIONS r MANIFOLD PUMP MANIFOLD DISTR. PIP MAN FOLD M TERIAL: NO. ISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.: ELE V.. DIA. ELE V.. ) PIP S: DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED DYES ONO I PLANS DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: 2 ~ FEET FROM LINE: J V DYES NO DYES ONO INEAREST 0(. / ~OJ n ~ 7 u ~sf 0I~I 5.13 qq`~ Sketch System on Retain in county file f1,Faudit. Reverse Side. SIGNATU TITLE: t DILHR SBD 6710 (R. 01/82) rf w'S`°r,s." APPLICATION FOR SANITARY PERMIT DILHR Sfi' C? X COUNTY (PLB 67) OEPRRTTErIT ' OF UNIFORM SANITARY PERMIT # InOUSTRY, LRBOR 6 HURKirl RELRT.r s _'X 9 _A15 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OV~NER MAILI G A DRESS 16 A L - ItA K~k I otj L I N E. R. PROPERTY LOCATION CITY: 1VW1/401/4, S / T~ , N, R~ VILLAGE: (Dr) W TOWN OF: JSGN LOT NUMBER JBLOCK NUMBER ISUBDIIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER Nook No►J Ne ow LANE TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): N ( 0 THIS PERMIT IS FOR A: ❑ New System K Tank Replacement ❑ Repair X Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued - El An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity 1000 Lift Pump Tank/Siphon Chamber Holding Tank capacity manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): a 60 d ~p Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber nnt): Sig ure: &WMPRSW No.: Phone Number: Plumber' ddress: Na of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved &J=~ d' j to ❑ Owner Given Initial ,Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: I DILHR-SBO-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. 1 APPLICATION FOR SANITARY PERMIT 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/contractgz,("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 ~I e LA t~R/1.~✓ Location of Property .14 Section l 9 T N - R W Township Mailing Address jR Subdivision Name Lot Number Previous Owner of Property LZ 14 4'11 Zf Cdr ~ ~Cls. ( Y4eA Total Size of Parcel Zi2D Date Parcel was Created S~sf~rY '~/.V.rr ~D 7 `J Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number IG / as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) eeAti. y ghat aU atatementa on .this 6onm ane t ue to the but o6 my (ouh) know.bedge; Aa-t 1 (we) am (anel the owneh (a) o6 the pnopenty deacAi.bed in thi.6 injonmation &4m, by vi tue o~ a wahnan.ty deed neeonded in the 066ice o6 the County Regi4'tea o6 Deeda ad Document No. /'77-7 ; and that I (we) pnesentey oun the ptopoaed .mite ion the aewage poaa ayatem (on I (we) have obtained an e" emeo t, to nun with the above da cA bed pn.opeh ty, bon the eon.6t&ucti.or o6 amid .ay~s.tem, and the same has been duty neeonded in the 066ice o6 the County Regi6 ten. o6 Deeds, as Document No. 18'x[ 777 ) . SIGNATURE OF O ER SIGNATURE OF CO-OWNER (IF APPLICABLE) ~j77iv 11 DATE SIGNED DAICE SIGNED DOCUMENT NO. WARRANTY DEED STATE OF WISCONSIN-FORM 9 THIS SPACE RESERVED FOR RECORDDIG DATA &W k THIS INDENTURE, Made by Vallie D. Cutsforth and REGISTERS OFFICE -Juanita b.__CuLslorth,_hi _~rif8, - ST. CROIX CO., WIS. - - - - - Recd for Record this-21- _ •st Fnt , nb~r grantor _A. D. 19 County, Wisconsin, hereby conveys and warrants day of` S to- Choster P Burke and Viola L. Burk©1 husband _ and 8t3_.~'?__----_'-5 M. wife as joint tenants. - Reglst~r f)aeeds grantee RETURN TO i of County, Wisconsin, for the sum of -Twenty Thousand Five Hundred and nor100 the follow- -in8tract of land in St CTOiX County, State of Wisconsin; II Two parcels of land located in the Northwest Quarter (NWJ) of the Northeast Quarter (NEI) of Section 19, Township 29 North, Range 19 West, further described as follows: i. j - - - 1. From the Southwest corner of said Northwest Quarter of the Northeast t T Quarter of said Section 19 go North 1° 13' West along the quarter line 3``F a distance of 451 feet, more or less, to a fence line; thence South $70 27' East a distance of 450.0 feet along said fence line to point of beginning for parcel to be conveyed herein; thence South 6° 21' East a distance of 234.50 feet, thence North 580 14' West a distance of 132.10 feet, thence North 10 13' Westta distance of 167.50 feet, thence South 870 27' East a distance of 90.0 feet to point of beginning; together with an easement for an access road southeasterly from the above described parcel to the town road as now opened and travelled, until such time as the area subject to said easement is dedicated and accepted by the Town of Hudson ~kdu1~ ~I as a public street or highway. -ALSO- 2. Commencing at the Southwest corner of said Northwest Quarter of the Northeast Quartor; thence North 1° 13' Wust along the quarter line a distance of 451 feet more or less to a fence line; thence South 87° 27' East a distance of 450 feet aloe; said fence line to the POINT OF BEGINNING of this description; thence South 870 27' East along the line of the last j r. mentioned fence a distance of 45 feet; thence South 6° 21' East to boundary of the parcel of land conveyed by Edward J. Christoph and wife to J. Sherman I' Peterson and wife, by deed recorded in the office of the Register of Deeds for said county in Volume 361, page 215; thence North 580 14' West, to a point which is South 6° 21' East from th° POINT OF BEGINNING; thence I North 6° 21' West to the point of beginning. , N III IN WITNESS WIiEREOF, the said grantor 3ha _Ytl-. bereunto set . t he i r- hand _S_- and seal _s - this 2nd _ Ir , day of _ SehAilzr , A. D., 19 65 SIGNED AND SEALED IN PRESENCE OF (SEAL) VALLIE D~CUT FORTH _ r ~tc:~• i l`l (SEAL) _JUANITA E. CUTSFORTH 1 ~ (SEAL) DONNA hi. OLSTAD (SEAL) i STATE OF WISCONSIN, St_. Croix ss. h --County. N - Personally came brfore me, this 2nd -day of _ September A. D., 1965 k the above named ___Y_al_li~U.__.CutsfortlL_and-Jstanita_E_ Cutsfth, his_9f1f~.__--__ to me known to be the person 0 who executed th or►ing instrumen nd acknowledged t e. HEYffOOD cry wOTAf;Y f 5 JOHN D. y J SEAL.. ` i Notary Public St. Croix County, Wis. This instrument drafted by HEYWOOn AND HAYE.S _ Attorneys ` My Commission Qb78 jt(Is) Permanent. Hudson, Wisconsin. (Section 51.61 (1) of the Wisconsin Statutes provides that all Instruments to be recorded shall have plainly printed or typewritten thereon the names of the grantors, I matem. witnesses and notary). WARRANTY DEED-STATE OF WISCONSIN, FORM D&b 417 1 PA-CE 16 e. C. MILLER CO., MILWAUKEE r. 'L H r STC - 105 r SEPTIC TANK MAINTENANCE A(;kE)EMENT o St. Croix County - a y OWNER/== ROUTE/BOX NUMBER _ Fire Number CITY/STATE Ld/~.Srw~ ~ _ZIP X PROPERTY LOCATION: 14, ~14, Section-j1_1 T R_M_W, Town of A'0f/ _ St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to haudle wastes. Pruper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank punc1)er. What you put into the system can affect the function of tl,e .,e;)tic tank as a treac- u.enc stage in the waste disposal sys-_z. St_ Croix Cuunty r,=siden:s wa to receive a grant for a maximum of 607: of the cost of sep`=~ctlt of a failing system, which was in operation prior co':_1v_ 1, 1978. Sc. Croix County accepted this program in Augu_* _f: with the requiremunt that owners of _ail new systems agree t e r systems properly tuain Ea ined. The property owner agrees to su'_-..i: Croix County Zoning a ctrcification form, sigL cd i,y __:-i by a master plumber, journeyman plumber, resc.icLed ;r a licensed pumper veri- fying that (1) cite on-site wasc=waz 'ispusal system is in proper operating condition and (2) after ins,:,-_ztion and pumping (if nec- essary), the septic -tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 0 G I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the. standards set forth, ;he.rein, as set by the Wisconsin Depart- to ment•of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 d ys of the three year expiration date. ~$o 409 SIGNED ' DATE , 4J-St. Ciloix County Zoning Office P..O. Fox 98 `Hammond,WI 54015,1 '39 .fit' ''5 r 2 G r i a, =715-7c~6-2239, or--J15 425 8363 Sign, date and'returni toaabov'e address n-~ r D ti MM x A 0 00n. 3 r? w o co QO C Cc: -01 ~ Z n D N a m m p? 6 'am w ('YD OR 0 w C N w' co CD (wA ? 0 -0 M I=D . a I , r M =r 0 :r 10 tG o 3 a c A O c° co > > Fr- co w o 20- 3. w r 0_ 0 ~ c p: vi 5ZQ c~c O wwcn co W •w► - M 130 c I a 7 N _y ODD C~ D 0' 0 :N (COD ' N _a °e ccoy=r °R, (Q way 0,wa =w CL .03 !,a 'c~a~vN, Z N cn) Z CD -i ~ D c aN cD 3 m CD ??0 CD 0 CD CD 06 N c m o M cu CM L ,Y ? c c ° Qy -•o > > w w:r CL co a ~ C vi w d p ~ cD . c m CD 0 Co (D :r ~ S M CO c 00 (D co w n c a0 y o coot :cm~win .;l w a ~D~oO(a ~ G) ao f ch c c am o M 9D w -o,ccyo o. a j.0 (A +n(00 o~cDO g ao 0 oto a c M ID i= CL cow ~w~o Mca ~cm= o X03 03 oo °Qs (D 0 s} f° o 0 ° DEP,~RTMEN,T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ID'~USTRY, DIVISION L R;RRNEDLATIONS PERCOLATION TESTS (115) MADISOP.O. BOX 76 N WI 3707 'HUMAN (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOwul-SOn HIP/UNICIPALITY: LOT NO.: BLK. NO.: SUB (VISION NAME: N' W 1/400/4 I /TA/R 11 o W //O//,P-- COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: ,5+,cr0i L_ T(A K w Lane- SE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DES RIPTIONS: IPERCULA Residence ❑New Replace 8?3 RATING: S= Site suitable for system U= Site unsuitable for system C NVENTIO❑NAL: M 9tjN D: EJU IN-GRO N ❑S RE: rEIS Y TEM-IN-FILLHO~LDING TANK: RECOMMENDED SYSTEM: (opt' o 1) M S If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: toll Q PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIIGHEETT TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK non _ t f Cob 1 .'3 `BI 6I,31 19451,1 B-a 715' q bb, _ c Gq a' .6t) _S 1Af ~~•~OJ~ LS j40 'T6n 5l~ _'4. 0' h l y.of n 5 B_ > cob, B- B- B- PERCOLATION TESTS TEST DEP WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBE ES AFTERSWELLING INTERVAL-MIN. PERIOD( PERIOD2 PERIOD 3 PERINCH l0 5 P_ r 4/.0-1 A)ytl P- 3~ Np 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. qy 0 / SYSTEM ELEVATION ancl, V~4 r- E 1 I t Y. xl, _4_4 z ~i - f 3 , i g ` role ~ 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 COMPLE ED ON: ADD ESS: CERT FICATIO NUMBER: PHONE NUMBER (optional): ~,3 6a 33 cS , _ q 1 CST SI ~ . DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - .r A~ INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include; 1. Complete legal description; 2. The use section must clearly indicate whether tois is a residence or commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 0. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if alp, iiite; 10. If tale info ~i (such as flood plain, elevation) does riot apply, place N.A. in the appropriate box; 1 1 . Sign the fc ace your current address and your certification number; 12. Make legibi copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10'") BR - Bedrock cob - Cobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone *s - Sand HGW - High Groundwater cs Coarse Sand Pere - Percolation Rate med s - Medium Sand W - Well Is - Fine Sand Bldg - Building Is - Loamy Sand Greater Than ' sl - Sandy Loam < Less Than ~l - Loam Bn - "n sil - Silt Loarn BI si - Silt Gy G ' cl - Cl y Loam Y Yellow scl - r 't Clay Loam r R - R -1 sicl - Clay Loam l mot - M,=itio~ sc - S ;dy Clay sic - 'y Clay fff 1 tine, faint Y cc ~ .7mon, hoarse Pt - ITIM - " iy, mediurri l m d - :1stinc p- prominent HWL High wa' evel, r' _`'XtUYec ,Ur' S e disposal BrV1 Benc V RP Vert,cc ace Point r t i si TO THE OWNER: T'. lil'c ;t is the first step it) securing a sari ai y ~i i-. The county orthe Department may r :lufst v ti., . _ ris sail rest in the field prior to pf m n ^omplete set of plans for ` e sew, system alication must be sr'ropriate loo obtain a permi t -nus to the start of r l_ P' 67 PLOT Nc} (^,a~;c~ 'T I I~f - NPI AME N V,QI s y L 0C AT ill T Gll" 9e Lit 18X30 ovoa ° ~ kc Ue CoNVeN~'i ao~~' `I i I 63 { P3 > i (18x~3~~ ~ ' ^ 1 I ~ f o~ O law LAND FRESH AIR INLETS AND OBSERVATION PIPE CROSS SECTION I Approved Vent Cap Minimum 12" Above N,j e ~ a G itp'It Final 1 ' 9 8 . E3 i j I 4" Cast Iron Above Pipe Vent -'ripe To Final. Grade---- Marsh Hay Or Synthetic Covering Min. 2" Aggreg-`e ~ Over Pipe 1V Distribution It E-- -Tee Pipe r~ Aggregate Perforated Pipe Below U Beneath Pipe 4- Coupling Terminating At 9 G Bottom of System r Parcel 020-1041-20-000 08/25i2006 11:25 AM PAGE 1 OF 1 Alt. Parcel 19.29.19.172H 020 - TOWN OF HUDSON ST. CROIX COUNTY, WISCONSIN Current IX! Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - PARDUHN, RICHARD F,&P F MARCINIAK RICHARD F,&P F MARCINIAK PARDUHN 362 WILLOW LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 362 WILLOW LA SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.710 Plat: N/A-NOT AVAILABLE SEC 19 T29N R19W PT NW NE FROM SW COR GO Block/Condo Bldg: NLY 451' TO FENCE, ELY 450' POB; S6DEG E 234.5', N58DEG W 132.1', NLY 167.5', E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 90' TO POB & USING ABOVE POB TH E 45', 19-29N-19W S6DEG E TO LAND CONV. TO J S PETERSON IN 361/215, N 58 DEG W TO PT S 6 DEG E FROM more Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1042/458 WD 07123/1997 795/242 07/23/1997 786/385 07/23/1997 711/618 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/30/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.710 37,600 123,100 160,700 NO 05 Totals for 2006: General Property 0.710 37,600 123,100 160,700 Woodland 0.000 0 0 Totals for 2005: General Property 0.710 37,600 120,600 158,2000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 114 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 020-1041-20-000 08i28i2007 04:33 PM PAGE 10F1 020 - TOWN OF HUDSON Alt. Parcel 19.29.19.172H Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - PARDUHN, RICHARD F,&P F MARCINIAK RICHARD F,&P F MARCINIAK PARDUHN 362 WILLOW LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 362 WILLOW LA SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.710 Plat: N/A-NOT AVAILABLE SEC 19 T29N R1 9W PT NW NE FROM SW COR GO Block/Condo Bldg: NLY 451' TO FENCE, ELY 450' POB; S6DEG E 234.5', N58DEG W 132.1', NLY 167.5', E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 90' TO POB & USING ABOVE POB TH E 45', 19-29N-19W S6DEG E TO LAND CONV. TO J S PETERSON IN 361/215, N 58 DEG W TO PT S 6 DEG E FROM more... Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1042/458 WD 07/23/1997 795/242 07/23/1997 786/385 07/23/1997 711/618 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/30/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.710 37,600 123,100 160,700 NO Totals for 2007: General Property 0.710 37,600 123,100 160,700 Woodland 0.000 0 0 Totals for 2006: General Property 0.710 37,600 123,100 160,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 114 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00