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N co E N O N ley i _ 0 O Mfr co a w O O N al a) "T O 0 a LO I 0 U) U) U) n c 0 0 0 o a a a a ~ c o N = o o N cn J U -0 rn rn y 0 0 0 o ° m_ o o = d rn 7 m o •o m y s> (D IV w d Q !~l O c N N N m c co c c E M co O 0 0) 3: O Ocn (n . Q a a) O O W O 7o - N m m~ E E N tti co c o O 00 0) C) N ~ O Lr) 71 p L N E E 7 U C'j U • .M O S C/) O s~i f O :C . . ~t C N d 7 d w • a c, (D c S r~ t A ) L IL 0 0) 00 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP U Qf 0 SECTION T r N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN I~.S0A., 4v/S SUBDIVISION LOT O PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 000 'd a elo C ~,:•vD W To~ of 7o3,02 yJ,a° z To~ 0/: ~T 70y03 I Top ©f mac. 763 t-1 7, ►Q _ 700, So 7dr 6 F % 26 ' GD,vc~IPtTF /3iP'OGE ~i%',o 20 lJ X97- /aw ES T /~oi,c,) T- 6P Z o 13 ~ST~A~ LiS ~!•~p ~/ooh p~ ~I~UTio 7D/. 0 INDICATE NORTH ARROW ~Ot7 d~ CO vLs~E T~ / P%i,v 6- BENCHMARK:Elevation and description: 70d-.6-0 ' Alternate benchmark S C TANK:Manufacturer: Liquid Cap. Rings used. Manhole cover elev: F' grade elev: Tank inlet elev.: Tank et elev.: No. of feet from neare roa ont , Side , Rear Ft. From nearest line:Front Side Rear Ft. No. of t from: Well , Building: clude this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE ORIGINAL PUMP CHAMBER Manufacturer: Liqui apacity: Pump Model: Pump/Siphon ufact.: Pump Size 0 -06 tom of tank elevation Elevation of inlet: Pump on elev.: Pum off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from earest prop. line: Front_, Side, Rear_Ft. Distance f om: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepa it: Width• Length mber of Lines: Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to to f pipe: No. feet fr nearest prop. line: Front , Side , Rear Ft. No. fe from well: No. feet from building HOLDING TANK Manuf acturer : ~d S~' W S S y JG G Capacity: 200 O v No. of rings used: Elevation of bottom tank: 0 " Elevation of inlet: 696 . ) No. feet from nearest prop. line:Front Side Rear ~ t. No. feet from: Well 0 , building Z 2 , nearest road Z Alarm Manufacturer: INSPECTOR. DATE• PLUMBER ON JOB : PD'f-EP T Z W/F / CA LICENSE NUMBER : 3 3 PAP S 6/90 : cj 441,,) U- HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 64016 ROBERT ULBRIGHT NI6. MPSTER PLUMBER LIC. NO, 3307 M.P.R.S. r.srNp~ iP~" I_GP & DESIGNER LIC, NO. 00663 19190 ,1A LOCATION: HUDSON 18.19.29.159A,SE,NE, TROUT BROOK RD. Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Hufhan Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX • (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 171426 Pepfnk Holder's Na e: ❑ City ❑ Village)] Town o : State Plan ID No.: HLOFF I AN VOC-TR HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 020103780100 TANK INFORMATION ELEVATION DATA A9200190 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark '7pp . So Dosing Aeration n Bldg. Sewer Holding i oskin 2-ovo St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding & SOf Ipp -f Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand J Z.P Model Number GPM o Ile1 t S7 70 , o TDH Lift I Loss Friction ye em TDH Ft Z .SL 7aJ• Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. f T en es PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L ELL LAKE /STREAM LEACHING Ma a r SETBACK INFORMATION TypeO CHAMBER o clN Num e System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. ZP 4 L9- SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of ;Ve / S xx Mulched Bed / Trnch Center Bed / Trench Edges Topsoil No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Plan revision required? ❑ Yes ❑ No Use other side for additional information. g yZ Z `f S SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r. III SANITARY PERMIT APPLICATION TDILHR In accord with ILHR 83.05, Wis. Adm. Code COS C STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 8% x 11 inches in size. c ec i (rev,ion revious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S Z 3 PROPERTY OWNER PROPERTY LOCATION I DE SEA) jCA) SF % AF %a, S I8 T N, R E (or (o PROP IVY ERTY OWNER'S U MAILING ADDS fSSo e EJ LOT # & ~ . BLOCK # CITY, STATE 4V/5, Zvi 01 PHONE NUM/ No3 SUw I~NAOMECOR CS 0 UMBER C a, f~s0~ ST (l/ Yi ~ S-0 /Tv~G J II. TYPE OF BUILDING: Check one CITY : , / „lp-r® NEAREST ROAD ( ) State Owned / a VILLAGE : tTCJ /v y~ov~ ❑ Public K 1 or 2 Fam. Dwelling- # of bedrooms - AR EL AX Nu ' /~f~ III. BUILDING USE: (If building type is public, check all that apply) 4.2-c l ? 24, d' 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. E1 New 2. ~ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.E1 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 K 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 n REQUIRED (sq. ft.) P,RIO~PO ED (sq. ft.) (Gals/,d/ay/sq. ft.) (Min./inch) ELEVATION /6" Al-4 < eV, 4 14114- Feet Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete strutted glass App. Tanks Tanks ,,X4.C. .tX . Saniffin Holdin Tank Lift Pump Tank/Si hon Chamber, ~ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: j~o awe r ?,!l6~i~~T 33 a -7 des- Me-d'<~S Plumber's Address (Street, City, State, Zip Code): Co 5 S O '.v G i2v t!Yv Aire~ S G IX. COUNTY/DEPARTMENT USE ONLY p Disapproved S itary Permit Fee (includes Groundwater fffa e Issued Issuing Ag t Signa ~TbtaM)40L, Approved ❑ Owner Given Initial ^arge Fee) Adv rse Determination pS Q 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 z. 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 rene wal 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 rnains,'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 usE!d for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) RJR 83.08(2) S91-Q2593 PROJECT INDEX: SHEET Owner UOE- vENSt ti -715- 3 P4? "-6y 3 Address fl-/p T,PovT /,SPOOK ;2a , h/~OSo,~ cc~iS. SS~a~Co o~ Site Location 5~- 704v W h10oSo.u 577-. e eo lr Co v T'Y Project Description ,4 -'X1'57'1)6- / /3 DiPM . Y,!~:-4,e R Du•cJ,9 /HO n i C h A s R FAW-1AN&- NOW Cv N PI(A,.YT 5EPTiC- SyST6h I1,4s f36-a"i OQD ,-06,0 Oy zo►~iaG- at~pT op 51', Ckoix LoUvey 7-0 1e&?11fcz5- f• TIA4- ( ,R O pe 12 -r y I'S R U r=12 - I oc. k 8 D ? IlJ IA4- 27.e S l' 5,3 A rec) `DMR F1000WA U0 TL/per dF sySrE M 0th. `tt,ati ,4 hotel is 6- 7-•tA-)k I'S ptJeM f'rA a IJa7 , ~CTiTi prJ MO ~i ~ , ci1Ti on3 A- PPRo0nL_ I'S PeOU;A6D `1' k iS AJ0 0 knI'C I e- ,~Cc s s ~O -t~C P OoPe2 T'/, OCtV IOAA3 T"/ D W o E l_ C- 4,v o v L y >~GGt X ' S ha,q e- R''/ 4 /^V S S/' A,3 6-- ~i110tt) Ac K'oS y Foor aRId 6-tE, . ~etS"'1 T 46 T le A CTI N 6- Page 1. Plot Plan & SYSTEM Plan View PuM PEP, C Tt?1 - Cp0wTy Page 2. Cross Section of ~,qn'~i TATI'ON> ~+45 µ~L O ~ Cr T•t,c~/c , S `.I.E. ~ ~C A.K r'.V ~-p wC P RO P OSc TO S ..PviCE `ta- ~01D/a 7AAJ 1< I A-y ( ' 'A.~ i A- 3„ PLUMBER : Su L T I' o A-~ h O S E ~w i S lq ~t f y I;OIAESITE SEPTIC PLUMBING CO. C~ t C k L )A I ULtr- 655Q'NF~~ R~ ~iU~SON, WIS. 54016 ROBERT ULBRIGHT _ 'r Ko u c t< P?f CV144 E- /A) I-a 7 1 wV S. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MINN. INSTALLER & DESIGNER LIC. NO. 006W 4 CL,0 S S Date: 11yo00,K ,',v,4 Te- 7b Tf ~ 150 Signature : [*)s e:- Wi 11 Zt S Fog 5-6-P 10v ' i 1 ` h0 l-,01,2-16- T-.tA.7/< T ti II ~ O o , c ~ -Q 71. r 0 N cri ONS p R ~ ~S ~ q p/ OP a ok y ® b y n 14 o NOFN 1 c 0 o ' °0 11 Lo 0 r r►~r0 t~r ° m a o~ p m~ C, mm C- 1: 0 1 i "z~z ~ / v N z ?5 ~a~~E a' ~b ~ Z -4 N N N Z S 91.425 9 3 ~o nG ~ " r r' C rn L zy ~r O o rNt ~ ~ ~ x W Lf rl o rn Fo 3 0 < m ~a s N=~ Ar ° o -P Hr~ ° 11 `ice O ~ ~ ~ ~ ✓ z -i Q s o M 's O) IT G 9~0 ~ c n o m 70 ~ N o o y d X ~ °p ~ ~Qe z ~O _ Nc x M~a 30 p o b o x O o ow Vo \ 0 r~ 7C LO Z A 70 t L~ UO r r C- C) cop mo Zp N y -n m1v Z A -4 0 A0-`4 vz n L G~ o Z3- rC o u1, o zop Co nri0o N -1 -I ° o n p p -i o L ;K in cM a on LZ fb \ p r 0 C am 00 v tA 3 x p 3, A ° z y - A ° t v N 'C a r1 70 1v rJ a f~ ° A D S. LL to in -n * r jD r- ;a re 0 fn :0 05-4 A ° oo fns 0 In v i~ JO 3ovd, ° rn o d 4 o -t ~ m 3 L e o 70 "A U. Q f SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations December 30, 1991 201 East Washington Avenue P.O. Box 7969 Madison, WI 53707 HOMESITE SEPTIC Owner: JOE JENSEN 655 O'NEIL ROAD 948 TROUT BROOK ROAD HUDSON WI 54016 HUDSON WI 54016 RE: Plan Number S91-02593 Project Name: JENSEN, JOE County: ST CROIX Location: SE,NE,18,29,19W Date Received: 09/26/91 HUDSON Date of Request: 10/02/91 On October 2, 1991 we sent you a letter regarding your submittal for the above-mentioned project, stating that this office could not process your submittal until we received the requested additional information. It also mentioned that plans submitted to this office which require additional information will be held 90 business days for the receipt of the information, and if after 90 business days a response had not been received, your submittal would be returned. The purpose of this letter is to inform you that 60 of the allotted 90 business days have gone by and we have not received the requested additional information for the submittal. if we do not receive a response from you within 30 business days from the date of this letter, your submittal will be returned. If you have any questions concerning this matter, please contact this office. Sincerely, Ano. Addis Plan Entry Unit (608) 267-5119 qy! 9 cc: JOE JENSEN L OY JANSKY s~ f OUNTY: ST CROIX (0034n) - rv ~ r. P/ ti SLID 6423 1 N. 01/91) SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Bog 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations February 27, 1992 JOE JENSEN 948 TROUT BROOK ROAD HUDSON WI 54016 Petition No. S91-02593-P Dear Fir. Jensen: Re: Joe Jensen - Residence Private Sewage System SE,NE-,18,29,19W Town of Hudson, St. Croix County, W1 Your petition for a variance to section ILHR 83.18 (7)(a), Wisconsin Administrative Code, has been reviewed. The petition has been approved. The rule being petitioned requires that holding tanks shall be so located to an ail-weather access road or drive so that the pumper may drive pumping equipment to within 10 feet of the servicing manhole. The variance requested was to allow a holding tank to he installed 150 feet from a service road. All of the data and statements submitted on behalf of the petitioner were considered. This variance is specific to the subject petition and cannot be used for any additional modifications. Sincerely, 8 9 Richard Meyer, Arch test 0 C' Director, Office of Division oz Codes and Application s, T (608) 266-3080 m `N RM:1270:WPP3~ cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator - St. Croix County Robert Ulbrich t, Plumber, Homesite Septic Plumbing Company SOD 6928 (R. 01/91) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 1 Madison, Wisconsin 53707 HOMESITE SEPTIC Owner: JOE JENSEN 655 O'NEIL ROAD 948 TROUT BROOK ROAD HUDSON WI 54016 HUDSON WI 54016 I" RE: Plan Number: 591-02593 Date Approved: March 3, 1992 Gallons Per Day: 300 Date Received: February 10, 1992 Project Name: JENSEN, JOE Location: SE,NE,18,29,19W Town of HUDSON County: ST CROIX The plumbing plans and specifications for this project have bienbreviewedCfor compliance with applicable code requirements. This approval 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approvedl. This approval is contingent upon compliance with any stipulations shown on the plans. All items that r county shamust be ll be obtainedd. All permits required by the city, village, township or Y prior to construction. The licensed plumber responsible for this installation shall keep one plans with when construction site. inspections can be made. This approval will expire twoyears thefrom initialapproved dayhthedate sanitaryfpermitiexpires. permit is obtained, it will expire 1 The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have been for the set forth in Section ILHR 82 for general plumbing or Wisconsin Administrative code. This approval is for the following components only: I - NEW PETITION - NEW HOLDING TANK i ii I) 1 1 SBD 6423,B. 01411 ~ SAFE'Py & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations HOMESITE SEPTIC Page 2 NOTE: Inquiries concerning this approval may be made by calling (608) 266-8230. Sincerely, ~L ~ K N ETH STIEMKE Section of Private Sewage Division of Safety and Buildings PPP016/0009n/ 1 cc: JOE JENSEN UW-SSWMP Plumbing Consultant Private Sewage Consultant County - -Owner -Plumber -Environmental Health i i 5140 6443 ik. III fHli i SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations February 27, 1992 JOE JENSEN 948 TROUT BROOK ROAD HUDSON WI 54016 Petition No. S91-02593-P Dear Mr. Jensen: Re: Joe Jensen - Residence Private Sewage System SE,NE,18,29,19W Town of Hudson, St. Croix County, WI Your petition for a variance to section ILHR 83.18 (7)(a), Wisconsin Administrative Code, has been reviewed. The petition has been approved. The rule being petitioned requires that holding tanks shall be so located to an all-weather access road or drive so that the pumper may drive pumping equipment to within 10 feet of the servicing manhole. The variance requested was to allow a holding tank to be installed 150 feet from a service road. All of the data and statements submitted'on behalf of the petitioner were considered. This variance is specific to the subject petition and cannot be used for any additional modifications. Sincerely, Richard Meyer, Archl4ct Director, Office of Division Codes and Application (608) 266-3080 RM:1270:WPP3 cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator - St. Croix County Robert Ulbrich t, Plumber, Homesite Septic Plumbing Company t `{IID 1W28,R. 01/91, SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 1) UGC P ADDRESS : q/ y k Ttoc.: f- a"'C'r~ k FIRE NO: -Y LOCATION: E 1/4, ~G 1/4, SEC. I=T N-R~W _ TOWN OF: W! Soo ST. • CROIX COUNTY `P s SUBDIVISION: LOT NO. Z 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 to help with the cost of the 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 the St. Croix County Zoning a certification form, signed by the owner and by a master 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. Certification from will be sent approximately 30 days prior to three year expiration. 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 form must be completed and returned to the St. Croix County Zoning officer within 30 days of the three year expiration date. SIGNED: 1. ' DATE: St. Croix County Zoning office 911 4th St. - Hudson, WI 54016 • • I ' i S T Y ~ OO This application form is to be completed in full and signed by the owncr(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property Location of propertySEl/4 A)' 1/4, Section, TaqN-RAY.W .Township 6-f aul~o" Hailing address L -0t.cf cee_aol Address of site __La Y71,-co A~ subdivision name Lot no. Other homes on property? yes,_ X___No Previous owner of property Total size of parcel Date parcel was created A uc, Are all corners and lot lines id ntifi ble? _ Yes No Is thin property being developed for (spec house)? Yes 4HO Volume/ and Page Number as recorded. with the Register of Deed • 114CLUDE WITH THIS APPLICATION THE FOLLOWING: A WARIUUITY DEED which includes a DOCUMENT NUILDER, VOLUME AND PAGE HUMBER It THE, SELL Or THE 112GISTill 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 referencess to a certified survey Map, the certified survey Nap shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of ny (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty steed recorded IrL the office of the County Register of Deeds as Document No. -2 f 5_3 7 S , 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 reco; ed in t~ ice of County Register of deeds as Document No. j oL'~licant Co-applicant f gnature Date of Signature GHERTY AND GHERTY, S.C. ATTORNEYS AT LAW THE CONSTITUTION BUILDING TERRENCE M. GHERTY* 328 VINE STREET LAWRENCE P. GHERTY MARK J. GHERTY* P.O. BOX 190 (1913.1980) SUSAN SCHLEIF GHERTY HUDSON, WISCONSIN 54016-0190 x715.386-2332 *ALSO LICENSED TO PRACTICE IN '4 6-7730 THE STATE OF MINNESOTA y F Xt 7 5- 6.7626 .s December 17, 1991 . °r Mr. Tom Nelson St. Croix County Zoning Administrator 824 Fourth Street Hudson WI 54016 RE: SW of SE 1/4 of NE 1/4 of sec. 18, Town of Hudson Dear Mr. Nelson: I met with Joe Jensen on December 16, 1991. I was presented with your Notice of Violation dated August 7, 1989. It is my understanding that as a result of that Notice, Mr. Jensen took immediate action by contacting Bob Ulbricht of Homesite Septic and began preparation for the installation of a holding tank. I have also had an opportunity to speak with Rita Horne. Ms. Horne informs me that the Town of Hudson gave approval to the system. It is my understanding that Mr. Jensen also made application with the County and, according to Mr. Lepak of the Department of Natural Resources he received approval from DNR, which was subsequently withdrawn. In speaking with Mr. Lepak he informs me that he is waiting further action by yourself regarding information from the Township. He further informed me that you had informed him that the Towhship had not yet provided you with this information. I have spoken with both Rita Horne and Bev Johnson of the Town of Hudson and have been informed that they have not received any inquiries from either you or your office. It is my understanding that other land owners in the Willow River Flood plane have received approval and constructed new sanitation systems. As I informed Mr. Lepak we do not endorse the plan of placing piping underneath the Willow River. We are merely asking to run a disposal hose, on a per job basis, across the bridge for the purpose of pumping out the holding tank. I am requesting immediate action on this file. v Mr. Tom Nelson December 17, 1991 Page Two It is my initial thought that an action for an Order to Show Cause may be in order in light of the fact that the two year statute of limitations has run on your Notice of Violation and Mr. Jensen is entitled to the installation of the holding tank. I will look forward to hearing from you. Sincerely, GHERTY AND GHER Y, S.C. Mar "J. rty MJG/ds cc: Joe Jensen Mr. Rita Horne - SAFETY & BUILDINGS UF REPORT ON SOIL BORINGS AND DIVISION C P.O. BOX 7969 rNDUSTRY, LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RELATIONS (ILHR 83.090) & Chapter 145) L CAT E 10 TOWNSHIP/ OT NO.: LK NO.: SUBDIVISI NAME: 1/ NE 1/ 47 /T29 N/R/9 E 0) W Hups I____D_R_ff SS: COUNTY: M A I L I G AD Sf L~PDl'~( JDE S~~SC 9118 -rPou7- Roeook- . HL7vSaa cv~$ USE 3 DATES OBSERVATIONS MADE 'PROFILE DESCI COLATION TESTS] IERCI NO. BEDRMS : COM AL OE CRI TION: Residence ❑New Replace RATING: S- Site suitable for system U= Site unsuitable for system • ICEIS ON VENTINGROUND-PRESSURE: SYSTEM-IN-FLL ODING TANK: RECOMMENDED SYSTEM:(optional) I as©u os[Z as©u as❑u If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the 70~ under s. ILHR 83.09(5)lb), indicate: /V, A ' Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS SG S BORING TOTAL P H T ROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED HET TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) -6 c'o41.' S~ G y2 B-/ y362 36, D T v c s w B- B- B- B- B- PERCOLATION TESTS TEST DEPTH , WATER IN HOLE TEST TIME DO 1 WATER V L-1 H S RATER INCH NUTES f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P RIOD 1 PERT P- P- P- P- P- P- rLOT 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. f ti~,v ' /1' /7~ LOS G oc- 10 r } 1 ~ N Lr" R Lt t : f_._. - 4 fi - - I , t_ __I 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: :Qi,,4ESITE SEPTIC PLUMBING CO. Se-AT ' l3 y v Qn _H DS0 WIS. 5 016_ ebb ADDRESS: ROBERT ULBRIGHT CERTIFICATI N NUMBER: PHONE NUMBER (optional): ER LIC. NO. 3307 M.P.R.S. -119, IiAAqTFR 1 yF2 -6'ies UU6M IMSTALLER & DESIGNER LIC. d CsT SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. 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