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HomeMy WebLinkAbout020-1177-50-000 w 0 h y a 0 w C n N O ~ O N O c h; o N U 3 U ~ C "C (0 O O O N r ~ L m .3 I o C Z N Y a c U. c U x a J N 3 ~ v o Z N Z 0 p Z '0 Q1 w a co 00 CA N H Z I O Z :!t c d' fn ? r Q1 y C G_ O yi N O 1~1~1V1 N :1J N N • ~i d U) _ O N Q O O Z m z m ~ m N N E ~o ~ = I w N .Lo r C. d Y N d i O m m Ln 4 P o > ~ ~ ~ U -I V) • Naaa CL Z *Z; m g I s 7 0 N O N N N to J U 2 rn rn M LO O N M O O O 2 _ N N n - Q E 4-) O O N 3 ~ CL Z:: ~ CD ~ _ N N d' 'may co O O m N C LO a (0 co V) (n 0) 0 0 O y C C O O O O N N C 12 w .rte-- O C m 0 N N = V N L. r O 2N co n -O „y O' N N C V N M N (n co co ,wl Ir)1 -O ~ - L U I • ~~n' O N= 2 0 N to € a EL CL • C~ G Z V Q w C d E i C C A 0 a~ O w 0 s Y a AS BUILT SANITARY SYSTEM REPORT OWNER ll ~~'J" we- Ll TOWNSHIP 1rlG oC~~~ SECTION -T 2 N-R l L W ADDRESS ~~`~,,t/ ~ST. CROIX COUNTY, WISCONSIN SUBDIVISION Ce. d-o.y M-115- LOT LOT SIZE 2 a ~r~ 3 PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r V s~ Q5 INDICATE NORTH ARROW I BENCHMARK: Elevation and description: .S'a 9, -C eL S /z-~ Alternate benchmark SEPTIC TANK: Manufacturer: ibli o~a1.S~- Liquid Cap. 1,2e e Rings used:_4-Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front Y_, Side , Rear Ft. Idd From nearest prop. line:Front , Side„, Rear-gL_Ft. ;?O" No. of feet from: Well Building: ~n (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front_, Side_, Rear_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Length 7.~ Number of Lines:--,L-Area Built 7f Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side, Rear Ft.,~~ No. feet from well: No. feet from building 7'f HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR: 77-7 DATE: PLUMBER ON JOB: Z'/.` LICENSE NUMBER: e~/® ~3~-- 6/90:cj LOCATION: HUDSON 28.29.19.1115,NE,NE, ALDRO CIRCLE, LOT 15 wiscor%soo Department of Industry, PRIVATE SEWAGE SYSTEM County: (aboi and Human Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 171436 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: CEDAR HILLS DEV INC HUDSON CST BM Elev.: Insp. BM Elev.: 7ja-y-XLf Description: Parcel Tax No.: (06,' ~do- / 4 ~1 020117750000 TANK INFORMATION ELEVATION DATA A9200201 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark de, Dosing Aeration Bldg. Sewer Holding St/Ht Inlet y X TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 701 601 /0/ NA Dt Bottom gY , Dosing NA Header / Man. 94 Aeration NA Dist. Pipe g, OV qL & Holding Bot. System d PUMP/ SIPHON INFORMATION Final Grade Rg,N Manufacturer Demand Model Number GPM I Loss Friction System TDH Ft TDH Lift Forcemain Length Dia. Dist. To Well Fi SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of enches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS a DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER of 7W7- 6~1 : RD / V A OR UNIT Model Num er: INFORMATION SYysptem DISTRIBUTION SYSTEM Header/ Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over v xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) = ~1 t , I Plan revision required? ❑ Yes ❑ No ; Use other side for additional information. 7/ F(a I SBD-6710 (R 05/91) Date --.,nature Cert. No. ADDITIONAL COMMENTS AND SKETCH f , SANITARY PERMIT NUMBER: i ~ILR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUN STATE SANITARY PE IT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ G -71 8% x 11 inches in size. Check if revision t 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 r ll.' Gil %a Z ' ;V /a, S T p25;, N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # &-,-4- r~ CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER alb - C , '11,r II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD El State Owned VILLAGE : RCEL TAX NU R() Cam' eL~' ❑ Public IIM't or 2 Fam. Dwelling-# of bedrooms PAR=N OF: Ill. BUILDING USE: (If building type is public, check all that apply) Q,~~, lt'7? ~Q 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. 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION On~a QOW I" D 04W. G 76Feet /C.. ~eet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisti-ng Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank tk f Jj fcj 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): Plumber's Signature: (No Stamps) MPRSW No.: Business Phone Number: 0- FF 41tewl I , 1," F e f Plumber's Address (Street, City, State, Zip Code): Jln G -r e L7 G- d.!r ` S YCJ '16 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuin Agent S' ture (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) Q Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: ;BD-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 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.1ISJorm; and all,sizmg~nformation. . GROUNDWAtER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect grpundwater. The monies collected through these surcharges are used for. monitoring groundwater; ground- water contamination investigations and establishment of stanaaids. .1 SBD-6398 (R.11/88) APPLICATION FOR SANITARY PERMIT STC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property L<J.`//, ~a c✓~l Location of property -Vt' 1/4 1/4, Section T~4_N-R-ZZ_W Township ~ d Mailing address 5G Lc, :.4- .Zy 4,, 5- J-1 011,6 Address of site Subdivision name Lot number Previous owner of property _ L-Cli~ Qu o Aay.s d--~ Total size of parcel c Date parcel was created ,jC~ PG i Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)?-4-Yes _No Volume and Page Number LPfv as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. /7 91 . ; and that I (We) presently own the proposed site for the sewage isposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. Signature of Owner Signature ot~Co-Owner (If Appli'cable) Date of Signature Date of Signature s rIea Maoeamsu oATA 0f.4UMENT NO. WAT OF *19CON811d 1 *401 twu w,►es aaaawq ' LAND COW AA . DV ostr wears oust .11194WIMNAMIRD AMD IN MISS wCT TPANanoTIQUO) ~T. CROIX Co., WIS. Recd for Record" 11th Contract, b and between HarrX.1r, Stewarta- as, Pe)Ceonal day of J~_A.O. 19 86' Representatie.of,the Estate of Aldro Larsen aWe Jotw at' ..~l l X~..kAXBltlk.l9/-JA.:I4~lA~.~~.dX4. ("Vendor", James onnell ; whether one or-.more) and.... UIM.R. As...401.€1i: ...sin.rle man ("Purchaser",-whether me•os.more). Vendor sells and agrees to convey to Parehaaer, upon tM prompt and fall per- deputy formance of " eantrast by Parchaw, tM follow* propaetre teen With tM rents, profits fixtures and other appurtenant intawte (all a W tM "Propm'tl►" -r- . " in At s.. Croix County, State of Wieooniiq: awes" TO See legal Description on Addendum Tax Parcel No . 386. s FEE This 10-RSit.......... homestead property. *4 (is not) Purchaser agrees to purchase the Property and to pay to Vendor at - Such--place- as- he Shall name-. the sum of ;..1R9ANQA9 In the following manner: (a) 4Q.~)?Oq aQQ at the execution of this Contract;' and (b) the balance of s r?QQ.aQQ topther with interest from date hereof on the balance outstanding from time to time at the rate of tQA--(1QX)........... Par sat per Mauro- until paid in full, as follows: t, See Payment Terms on Addendum Provided, however, the entire outstanding balance shall be paid in full on or before the....... l l th day of .)Ill'IP......................... 19...40. ( the maturity date). Following any default in payment, interest shall accrue at the rate of Q.... % per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance)., Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonaay antici- pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to thus obligations when due. Sack amounts received by the Vendor for payment of taxes, ameaments and insurance will be deposited into an escrow land or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and than W priadps►. Any amount may be prepaid without premium or fee upon principal at any time. { In the event of any prepayment, this contract shall not be treated as in default with respect, to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the WRjAftP&Ym*nts been made as first specified above; provided that monthly payments shall be continued In the event of credit of any proceeds of insurance. or condemnation, the condemned premises being thereafter excluded here(rom. Purchaser states that Purchaser Is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: i Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the fell purchase pries is paid' a....... ....thllAil-t8..h8X8f?f Purchaser shall be entitled to take possession of the Propesft en... S4 •cro" out on.. ..m imp wrear+n;t9E4l1 nVbromla I.iRI Oloak Go lee, llys. if f f Purchaser promises to pay when due all tales arnd armaments levied on the Pro rty or upon Vendor's in"zmst ir, it knit to deliver to Vendor on demand receipts showing such payment. Purchaser shall keep the improvements on the Property Insured against loss or, damage occasioned by Are, ex- let'de•d coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved by Vendor, in the sum of $ .............n/.a........................., but Vendor shall not require coverage In an amount more than the balance owed under this Contract. Purchaser shall pity the insurance, premiums when due. The policies shall contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to insurance companies and Vendor. nless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be :nutnicaUy feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Propert;• in ttoud tenantable condition and repair to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances wash regulions affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to` the urchaser a pp d simple, of the Property, free and clear of all liens and encumbrances, except any teal °or encum~rancie°l y act or default of Purchaser, and except: ....eaSeWenX,4_.FXAt9XtiXE.. -c0-V*JU Wt n -.o.£.xecntd,-.i.f..anx,..and..xnning..ardi nance..requi rementa. . Purchaser agrees that time is of•the essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of ...6Q... days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of AD.... days following written notice thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts duehereunder (inwhich event ailamounts previously ppIitl by Purchaser shall be fordfeited as liquidated damuues for failure to fulfill this Contract and as rental for the Property if Purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel itnniedinte and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of def.w;t and other amounts due hereunder, in which event the Property shall be auctioned at judicial stile and Purchaser snail he liable for any deficiency; or (iii) Vendor may sue at law fer the entire unpaid purchase price or any jtortion th(•rr:if; or (iv) Vendor may declare this Contract at an end and remove this Contract as &cloud on title in a quiet-title artjon if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action tinder (i). (ii) or (iv) above.Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to erforceany remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curved, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, Issues, and profits of the Property during the pendency of such action, and such rents. issues, and profits when so collected shall be bold and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any cf Purchaser's rights under this Contract or by option, long-term lease or in any other way) -without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first puid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any ortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser)mor under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs. legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the executi n of the deed to be made in fulfillment hereof.) Dated this .......11th. day of June 19._86... (SEAL) • Atarry..J....S.tewart........................ . . (SEAL) ir,21...C1...~~ 0~61e 'K Q- . ..............rte r A • . William C. Harwell s'~= :o AUTHENTICATION A C K N 0 W L E D G UZNT",',''>; 0' Siltflsture(s) STATE.OF-WISCONSIN auth 6ta....QmQ U ...................County. enticetend this ........day of.. 19...... Personally cams before me this .1111k...... day of .,.09 19-$6.. the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not. authorized by ~ g06.08,Wis.-Stets.) to me known to be the person @........... who executed the forego ~np,(nstrnment an A_S cknowledge the- same. THIS INSTRUMENT. WAS ORAFT[O By !/`!(/I`"~_ e HEYW HURRAY JoPI ..A.. MltrnaY... .44D CA & SHERBURNE, P.O. BOX 229 > • ,o....1.~...., .W,0~f2s00%-, Hudson•-WI-- 501tr • Notary Public ....Ste. Croix County. Wis. (Signature's may be authenticated or acknowledged. Both My Commission is per anent. If no state expiration are not necessary.) ~''A 19.. date:) of:.' r b~.----•...-... /0 '~iam.a of persons slanl4a In any e110ae{ty should be tylhd or t~.lntad b.! danat,irs.. G N • a r ST C- 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z 0 a H OWNER/BUYER ei /Xrcc~t ~~l-•~1~ ~i~ ~r ROUTE/BOX NUMBER -e-a f~d a44- Fire Number CITY/STATE ZIP •,-~/"T PROPERTY LOCATION:X/4~ 14, Section -a r Taf N, R _W, Town St. Croix County, Subdivision r_-ee5&,y- Z)6 S' Lot number ~s Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into I` the system can affect the function of the septic tank as a treat- ment 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 o'f all new systems agree to keep their systems properly maintained. 'A The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, •j`a,urneyman plumber, restricted plumber or a licensed pumper veri- f'ying that (1) the on-.site wastewater disposal system is in proper operating condition and (2) after inspection 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. Ho F I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- 'b ment of. Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 7.15-796-2239 or 715-425-8363 Sign, date and return to above address. I N DU DEPA6TMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DURY; DIVISION LABOR'AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHI / LOT O.: BLK. NO.: SUBDIVISION NAM N 4t4t I/a z~s /T79 N/1119 E (or) W ~►fls~>v I EbA ~~tS C :NTY: OWN 'S BUYER'S NAME: MAILING ADDRESS: ~ CP-0 JIx LL A' vJ F-LL USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFI D S RIPTIONS: PER OLA ION ESTS: ,Residence / f PrNew ❑Replace S 1 qZ 9~ RATING: S= Site suitable for system U= Site' nssuuitable or sy tem n I LS Jul i, CONTIO❑NAL: OS ou IN-GROUbJD-PRESS YSTEM-IN❑-FILLHO ELDJJVGT~K:REMM ENDED SYSTEM: (optio E1 URE:S ,J ~~~JJJ 60kjV&-rjM0iJAL n~~A 5~S If Percolation Tests are NOT required DESI RATE: R~ C ~ If any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate: (Floodplain, indicate Floodplain elevation: ' Y PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH AM ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- J osb 99.43 ILALL-rS 191$at,L ;,"temthS MS%6 P. B- Z 93S' 9~.gS N6 tj . > ~ i3"BLL~S I~'$~eut FF~"$e~► ms 's ~2 B- 3 9.67 9'k.'t*Z 1aI~, > 9.67 rIhLTS 14"W#A '29n$elJA1S S-1"8ewA.St4*_ BA 9.97 9r . Z d > 9.9Z fi~°BLL7S IL"gati M5 6Ts""8ak NS- Ge. B- 9.0% 9g.%7- t~Idnl r~ 7 9.0 L Z7 y 8R..) Ms +(4 P, 6- ~ PERCOLATION TESTS TEST DEPTy WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERS ELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH 7~ 2- > >2 < p- AAS N©N~ o P- 4_4-o5 Nat4a o > Z >'Z P_ .61 r"~ f-: 6 G P- P- - L4 1870 AT u~ P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION. D L14 rn a~2~- 1 d~' dF x ~ E-) tL\e_ AID _ E Lo-r: C E, E f$ .j 1 3 E N ) ~a qZZZ 'p a6- 3 ....E ~ E d r J I { t 3 I, the undersigned, hereby cer t~y tRat the-.Wl tests reported o this form we g.madeTy me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the loc6fi 1n of t~l teimlare correct to the best of my knowledge and belief. NAME print) TESTS WERE CO ON: NAME print): 3614 S6ti 36NUSOro LE s~RV~Y~N j~ ADDRESU CERTIFICATE NU BER: P~{ONE,NU~IBE~oOptional►: lJ JJ?? .c~V~7~~UO Ou[/ 'ddT~~~UU CST SI RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - P. INSTRUCTIONS F,-~ COMPLETING F '7M 11 - SB - 6395 To be a compl> d accurate s s your repot't taus: 1. Complete If °ion; 2. The use sectiol' cfea3ly dhetherthis a rE,asid=~rrca or comrtaerr;ial projeet~ 3. MAXIMUM nur= f bedrooms rnme.rcit.i nned; 4. Is this a new ear r,~ ' taent system; S. Complete the it . rating boxes. A SITE IS S011"ABLE FOR A HOLDING TAN ONLY IF ALL OTHER SY._. ;E RULED OUT BASE[ CAN SL711 CONDITIONS; 6. PLEASE u, avi<.T=:ons sh£ . mere for vtritin i~~scriptions and completing the plot plan; 7. MAKE A f, ream & aly locating yo -at:ions. Drawing to scale is preferred. A separate sh.:et d if d' 6. Mae sere your L park and ~t.i{:en rr.=feren u e clearly shown, and are marlent; 9. Complete all appr q . iate boxes names, addresses, flood plain data, percola.G r ~ ,t exemp- tion, if appropriate; 1C}. If the information €.b a flo elevation) does =lot apply, lal., a the apps opriate box; 11. Sign the lor£n and 'rre your c ldress and your certification r, 12. Make legible: c ~.FI dis it as requited, ALL. SOIL TFS`S =T BE FILED WITH THE LOCAL A1JTFfOEr''; WITHIN 'IS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED OIL TESTERS Sail Separates and Textures Other Symbols st: - Stolle (over, 10"i BR - Bedrock cot) - Cobble (3 - 10") SS - Sandstone gr Gravel (under 3") L Limetstor S Saar l 4 High Gr- c,s `parse' Sa,ld f'e~rcol<ation R~ n-rr d k ~~c.itam canespv'nI£ f :e Sand E3!dkj Building Is a `sand G .F dy Loam scl R Rod sic] mot les se - S< dy Clay zNl/ sic; S. y Clay fff - faint `c C` , cc Coal",-,(, pt fo nam me:diurrs t - V C I, d - 6 stinct. P prominent HWIL High ;s:{ ter level, Six g€er Ktm?~ sur~Iace water for lieu ;d E - Bench Mark V ei tic al Re "ererrc e Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. G/t•~ sic .2 st' Ot~ !9 1~ o Fi~e~'a~tJ vim' r ~s SCPU ' n. 02 ,v4 Grp REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1 07/3/92 08:42 REQUESTS FOR INSPECTION WORK SHEETS FOR: 7/31/92 AREA: MJ Activity: A9200201 7/31/92 Type: CONVSEPT Status: PENDING Constr: Address: HUDSON 28.29.19.1115,NE,NE, ALDRO CIRCLE, LOT 15 Parcel: 020-1177-50-000 Occ: Use: Description: 171436 Applicant: WILLIAM HARWELL Phone: Owner: CEDAR HILLS DEV INC Phone: Contractor: SCHUMACHER WILLIAM C. Phone: 386-3121 Inspection Request Information..... Requestor: WM. SCHUMAKER Phone: Req Time: 16:07 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION