HomeMy WebLinkAbout020-1188-70-000
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AS BUILT SANITARY SYSTEM REPORT
OWNER /?Z'll lac v TOWNSHIP ,
SECTION T N-R W
ADDRESS 4&,1--jif ST. CROIX COUNTY, WISCONSIN
SUBDIVISION C e-cLQt^ f~S' LOTS`C LOT SIZE -!2-.-'- a CVer"
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 'f ore-',
V'
5a'
'0 0
IN ICATE NORTH ARROW
BENCHMARK: Elevation and description:
Alternate benchmark
SEPTIC TANK: Manufacturer: & crazy-- s-T Liquid Cap. lr2G7dr,'
Rings used:-~Manhole cover elev: Final grade elev:
Tank inlet elev.: Tank outlet elev.:
No. of feet from nearest road:Front A, Side , Rear Ft.
From nearest prop. line:Front , SideA" , Rear Ft. ZIF-
No. of feet from: Well Building: 4 °
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
r
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,dO_Number of Lines:, L-Area Built
Exist. Grade Elev. Proposed Final Grade Elev.
Fill depth to top of pipe:
No. feet from nearest prop. line:Front, Side, Rear Ft.,,~r
No. feet from well: ,40-0-,,1- feet from building
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:.~ ~iC~m•E~~ir~/
DATE : PLUMBER ON JOB:-
LICENSE NUMBER: J/l,~2 b ~~2
6/90:cj
I
LOCATION: HUDSON 28.29.19.1184,NE,NE,28, CO. RD. UU
Wiswn'sin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Lipbor and Human Relations INSPECTION REPORT
`Safety ar4guildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
149289
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
CEDAR HILLS DEV INC Lo"E- ~o HUDSON
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
'Id
as mlt4~a, 02011887000
TANK INFORMATION ELEVATION DATA A9200130 o
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 0,(07, Je,
D 051-n ''6,v
Aeration Bldg. Sewer
Holding St/ I K Inlet p
TANK SETBACK INFORMATION St/}ft Outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
Dosin NA Header/jfti
Aeration NA Dist. Pipe Z 0/ 1
Holding Bot. System 1~ 67 8' g
PUMP/ SIPHON INFORMATION Final Grade
Manufac Demand
a.,, 6 12Z
Model Number GPM
TDH Lift Friction Syste TDH Ft
Head
Forcemain Length Dia. Dist. To
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Leng No. Of Trenches PIT No. O Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING M facturer:
SETBACK
Model Num
INFORMATION Type CHAMBER
System: 070, OR UNIT
DISTRIBUTION SYSTEM
HeademPftd .Koi M Distribution Pipe(s) •i / x Hole Size x Hole Spacing Vent To Air Intake
Length _i Dia. Length ~ Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched
Bed/Tr nchCenter Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Q 6,).W c~1 0 - 0.~ ccl &SW~
0'r
Plan revision required? ❑ Yes
Use other side for additional information. ~f
uv
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH ,
SANITARY PERMIT NUMBER: r
y
DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUN
STATE 77V ERMIT
r;u
ach complete plans (to the county copy only) for the system, on paper not less than
-Att
8% x 11 inches in size. ❑ Check if revision to (7 7
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
K, t'/4,S Ta'j,N,R If E(or
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
G~
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
r-- 4, G
_0 CITY
11. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE : NEAREST ROAD
ea Izeyt CL LG
❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms AR AX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) 7d
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 120 Service Station/Car Wash
5 ❑ Hotel/Motel 90 Office/Factory 1130 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. 0 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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) a d ELEVATION
qG D Ff~ 0 i ~,g 2 Ff' Feet s Feet
VII. TANK CAPACITY Site
In gallons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank add yr! 77
Lift Pump Tank/Si hon Chamber. VIII. RESPONSIBILITY STATEMENT
[,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:
Plumber's Address (Street, City, State, Zip Code):
SY
16 e
IX. CO JUJN USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing ent Sig ture (No tamp
Approved ❑ Owner Given Initial Surcharge Fee) ~z ,
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. -A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the time of 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, n3connection, 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, lumber of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, purnp/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/ water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points,
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
- - - - - - - - - - - - - - - - - - - - - -
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11188)
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 / /i~~ k- ..ell
Location of property, 1/4 ,e/4~7 1/4, Section TAN-R /9 W
Township:
Mailing address e~-e ]r,ly
Address of site Z"
u
Subdivision name r.Q„QdX. rh Lot no.
r
Other homes on property? yes No
Previous owner of property
Total size of parcel 2 f r~ ~Y •e
Date parcel was created
Are all corners and lot lines identifiable? k Yes No
Is this property being developed for (spec house)? Yes No
Volume land Page Number as recorded. with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available; ;would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I(we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of
the property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. y/9 ~Z P , 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
r'
Date of Signature Date of Signature
ascoROlNa DATA
qjPA • ,r. i;uMENT NO: STATE BAR OF 'W .11CON91N F 11-198A T srAC~ sssRVm FOR
LAND CONTRACT
: e~~pC 1 t
IadiT~ and Cor"rste PIMMS OFF z
,.~r.~+{~~J1 ~ITO BR USED FOR ALL TRANSACTIONS WKKRZ OVER
0=0,000 18 FINANCRD AND IN OTHRR NON-0ONSUM31I ST• C Co., WLS.
ACT TRANSACTIONS)
Reed for R""d 111is 11 th
and between arry,. J ! tewartx. as Personal day of _Lune
Contract, ne 0. 19 86•
by
Representative,of the Estate of Aldro Larsen a1k,(a,John pf 11!45 A
a a o BgD..41.k1 ..•IQ •("Vendor", James 0 onnell
whether one or-. more)
*single- man...... .........("Purchaser",-whether one or•more). ~
Vendor sells
and _ agrees to convey, to Purchaser, upon the prompt and full per- deputy
formance of this contract by Purchaser, the following property, together with the
rents, profits, fixtures and other appurtenant interests (all called the "Property"),
...............Croix..................................... County, state of Wisconsin: RcTURN TO
in.. S
See legal Description on Addendum
Tax Parcel No
3~b - ? 3 .
FEE
This ......19..11RI:.......... homestead property.
304 (is not)
Purchaser agrees to purchase the Property and to pay to Vendor at .such place as.. h..._shall~name.....
the sum of In the following manner: (a) $...60.,uQ9-09
at the execution of this Contract; and (b) the balance of $.114,599.09 together with interest from date
hereof on the balance outstanding from time to time at the rate of Lart.-!r100.......... per cent per annum
until paid in full, as follows:
See'Payment Terms on Addendum
Provided, however, the entire outstanding balance shall be paid in full on or before the........ 11th.......... day of
June 199.Q. ( the maturity date).
Following any default in ps ment, interest shall accrue at the rate of ...14.... % 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 reasonably 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 these obligations when due. Such amounts received by the Vendor for payment of
taxes, assessments and insurance will be deposited into an escrow fund 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 then to principal. Any
amount may be prepaid without premium or fee upon principal at any time.lwtil#G?iXJiJtJi
tl~oDt7t:'~~ixlflmtp~[N1Ci~iL1~[1~1~XRiI~iClit~i~i~N~~~
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 kkpayments 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 herefrom.
Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser
for examination except:
Purchaser agrees to pay the cat of future title evidence. If title evidence is In the form of an abstract, it shall
be retained by Vendor until the full purchase price is paid.
Purchaser shall be entitled to take possession of the Properlyon....... 1ihitAAXNAM99 XXX
.cross Out One.
my AV WIRC( WAN wifeaenla Leos! Blank Co. like.
Purchaser promises to pay when due ail taxes and assessments levied on the Property or upon Vendor's in,•ar_-st
in it and 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 fire, ex-
kmded coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved
by Vendor, in the sum of $ .n/8.......................... but Vendor shall not require coverage in an amount more
than the balance owed under this Contract. Purchaser shall pay the insurance premiums When due. The policies shall
cuntaiu 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
in::nrunce companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall
he applied to restoration or repair of the Property damaged,. provided the Vendor deems the restoration or repair to be
,wmicalh' feasible.
Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Propert-
in good 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 and regulations 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 urcheser a I4t1kre d in If simple, of the Property, free and clear of all liens and encumbrances, except
ersonal Re res n iv~ 1°
any fens or encum antes crea y he act or default of Purchaser, and except: easemetUa+- gxntectixe..
..cov m=ta..af..xecard,...if..any-,..and..zany,ng..axdlnance..requlxemente.
Purchaser agrees that time is ofthe essence and (a) in the event of a default in the payment of any principal or
interest which continues for a period of ---6XI... 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 ..160.... 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
waive,..), 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
ri>;hts, title and interest in the Property and recover the Property hack 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 due hereunder (in which event all amounts previously
pail by Purchaser shall be forefeited as liquidated damages 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
immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of
defnuit and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser
shill be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion
th~~rrof: or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet-title
action 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
under 0), (ii) or (iv) obove.Notwithstnnding 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 enforce any 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-
curred, 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 beield 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 paid 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 convey nnee 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 pal"ents when due under any mortgage outstanding against the Property on the date of
this Contract (except for any mortgage granted by Purchaser) or 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 execution of the
deed to be made in fulAllment hereof.)
Dated this 11th June
. y
(SEAL) ~1.~!V......._.~-: T1`/. S~4AL)
• ..Harry.. J....S.tewart...
(SEAL)
a @EALL
William C. Harwell
• -J
AUTHENTICATION
ACKNOWL]yDQA[BNT',,'1~.'•..,
Sirnature(s) STATHi_OF-WFSCONSIN ~''•,`,~a e, N. .
r
authenticated this Us. ....Qi1~QU ...................County.
.day of.. 19...... Personally came before me this - l lth......day of
June 19.$x!.. the above named
Harr J Stewart and Wi i m C ell
TITLE: MEMBER STATE BAR OF WISCONSIN
• • • t .
(If not
authorized b
Y ~ 706.06, Wis. State.)
to me known to be the person g.......... who executed the
foregoin nstrument and cknowledge the. same.
THIS INSTRUMENT WAS DRAFTED BY ~~/~,(,JJ ^ /J
Loisg..A•..Murray HEYWOOD .
s.. HURRAY D~ S
& SHERBURNE,
P.O. BOX 224,. ,D.......~....,................... ~
Huldson.... WI... r4-01fir Notary Public. St. Croix County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is pe-ri anent. If no state expiration
are not necessary.)
cr. dates :1 f:._~.......... 19_.~)
Mtamee of versons signing in any capacity sh
ouid be tyRed or printed be! . signatures.
L
I
SEPTIC TANK MAINTENANCE AGREEMENT ro
St. Croix County
OWNER/ BUYER lc~ /l stir w~ 0
0
ROUTE /BOX NUMBE Fire Number p
tj
CITY/STATE ZIP 6L J ~CJ
`S d r~
-
PROPERTY LOCATION : S e ction T R W.
Town of St. Croix County,
Subdivision Cep lls Lot number S~
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Prover maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed' s'e tic tank um er. What you p
can a ect the function o. t e'septic.tank as a treat-
the system
ment-stage in the waste disposal system.
St. Croix County residents may be eligible to recieve a grant for
a maximum of 607. of the cost.o£ replacement of a failing system,
whi.c 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 sys"t'ems agree to keep their system properly
maintained.
e ro ert owner agrees to. submit to St.. Croix County Zoning a
ce p P Y and by a mater plumber,
jcoerurntifi cateyman i plumber, s restricted by th lumber owner or..a lcensed pumper veri-
fying 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 days andtscum.
Certification form will be sent approximately 30 three Year'exPiration. y
the undersigned have read the above requirements and agree 0
N
to maintain the private sewage disposal system in accordance with
the standards set forth, herein, as.set by the Wisconsin Depart- ::r
w
be completed ►d
ment of Natural Resources. Certification form must
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED , "f ti , 'CL" rr ,~~s•---------
DATE
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
386-4680
Sign, date and return to the above address.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
P.O. BOX 76
LABOR AND PERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: ITOWNSHF/ ~R4LI~-Y: LOT 0.: BLK. NO.: FSCDIVISIONN)4ME:
'/a '/a Tz9 N/R/9 E (or) W 442 LLs
C UNTY: OWN R'S/BUYE NAME: MAILING ADDRESS: s46 t,6
I't USE DATES OBSERVATIONS MADE
NO.I BAEDRMS.: COMMERCIAL DESCRIPTION: PROFI L S RIPTIONS: PER 0 ATIpN TESTS:
Residence vLN>~ New ❑Replace ?/2-7 92 3 Z/ /`L
-SOILS y' V t~ OILS ~UrZ~~Q~bT
RATING: S= Site suitable for system U= Site u(n~suitable for system ~~p CONVENTION?L: MOU s. ~u IN Gr' J PCIU RE: SY EM-INaFILLHOaLDING TANK: RE~QQj m
- - ~o4(- / `z\x14 v
S
If Percolation Tests are NOT required DE~GN RATE: L ~ If any portion of the tested area is in the N
under s. ILHR 83.09(5)(b), indicate: b.l~~JS Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ft ELEVATION OBSERVED EST. HIGHEST lu BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- ~ 1 ( `7 /A0 ~ tf ~ s ~ OnOLJf*.~ ~ 7/'~el~.l ~ FSd'/ C7Q,J I ~s~41C
B- Z I'S 9-4 9217 oNL- > 191 /'Z_"$Q,jSL $ek~, A'St4k
B- goo 43.24 4oNIgf y D.Dr-) zz'$t_SLT-:~ 2o"$a,0SL -7b BeN
B- Q 9.%3 46.68 n(omtr %3 ~OJBuTS W $RN 94" $RN m-si l
e p.o 46.9 /~0~1~ /O.Ob ~6n$csc.7'S j'1&" &jzu .1 mS
B_
PERCOLATION TESTS
ES
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D
P_ qo 04b 3 >2 >Z < 3
P- z b 04 it z.'6 o > Z > z >2 <3
P- s. o rJoNll 93.16 3 > >Z >
P-
P- ATI u T
LP_
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 a all borings and the direction and percent
of land slope.
SYSTEM ELEVATION
nx61M+t~~1~n.oo J ES 4LS N
Nom
_T6+ 61F 8L-6C-V- 07 pfzP~&'& A W"-L. T~~Q U 1 ~i tYN &
Corr I h' -a4c A fEd T-3
S
Q fum P $ ,fib
J
q
I, the undersigned, hereby certify that the soil tests reported on this form were mad y 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 co ect to the best of my knowledge and belief.
NAM (print): TESTS WERE COMPLET D 0
12 9-
'42 Sa~ Joy, so~5~ 3 -
ADDRE S: CERTI CATIO NUMBER: PHONE N LAMB ER(optional):
~ a~ ~I S O I z
CST SI ATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR_SBD-6395 (R. 10/83) - OVER -
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 this is a residence or commercial project;
3. MAXIMUM number of bedrooms or comrrrercial 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 014SOIL 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;
9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
tion, if appropriate;
10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11. Sign the form and place your current address and your certification number;
12. Make legible 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 - Sant) HGW High Groundwater
cs' - Coarse Sand Perc - Percolatioq Rate
tried s - Medium Sand W Well
fs - Fine, Sand Bldg Building
1s Loamy Sand > - Greater Than
Asl Sandy Loam Less Than
Loath Bn Brown
sil Silt Loam BI Black
si - Silt: Gy - Gray
`cl Clay. Loam Y - YeIIovv
<cl. - Sandy Clay Loarn R -l=ied
sic! - Silty Clay Loam mot Mottles
sC - Sandy Clay vV - with,
sit: - Silty Clay fff - few, fine, faint:
`c - Clay cc = common, coarse ;
pt Peat mm - Many, medium
in Muck d - distinct
` p prominent
HWL High water level,
Six general sitil textures surface water
for liquid waste disposal Bib1 Banch Mark
VRP Vertical Reference Point
I
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.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DIVISION
INDUSTRY,
P.O. BOX 76
•L4BORI-AND PERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELATIONS
(ILHR 83.09(7) & Chapter 145)
LOCATION: SECTION: /R19 E (or)W TOWNSH /U~SQ~ LOTfVO.:BL~KrO.: S` J.I~&A4t N N11 i
T29 N ~J((~~ U W
C UNTY: OWN R'S BUYE NAME: MAILING ADDRESS:
"j"C~17. ~~us NvG~oPr► ~l 12iC "uu." C~IU~Sa>'.► t
USE DATES OBSERVATIONS MADE
A I N TESTS:
NO. BEDRMS.: COMMERCIAL DESCRIPTION: IPRO-FILE/DE RIP IONS: R
Residence ~NV_ ,New ❑Replace 3 DDZ7 9~ 3
-SOIL-, ~ 4 bD ~O1LS oU~2.Kl-lA~d'f"
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MC±U S. ❑U IN GZS P❑U RE: SY EM-INEFILLHOEI S TANK: RES,QM1v o~
If Percolation Tests are NOT required DES GN 1 C RATE: If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: ~)..Ioss I Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
VATION
NUMBER DEPTH n. ELE OBSERVED ES . HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- . 5 9 440 0 > S /Fsn$~sc rS , 9 "~eN L Tso" $aN AS14 P_
B 2 -4 92.7- oNe > .9Z a' &Z.---s IZ"8e►~S ~s3° $e>J ~s>~4~
y D.D6 zz'$LSLTS2a"9010SL -r~' 6aNntS~tC.~-
B- (0.00 43.24 t4oj -f
B- 9.%3 46.08 room %3 /D'gu-rS 14" $aN C. 94" $RN A Si,(,a
B-'5 p.o 96.99 /~ofJe- 10,00 1e9LSLTS STS"'ga~,Sc. g6,.gaU +~tS~~r2
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RAT ES
NUMBER AFTERSWELLING INTERVAL-MIN. P RI D PERIOD2 PERIOD3 PER INCH
P_ 1 40 A_041ae b >2 >Z >Z <
P_ z a o 1-T6 > > Z >Z <3
P- 5. o a 3 > >Z
P-
P- A71 to -T c~
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 elevationmall borings and the direction and percent
of land slope. {{vv~~
SYSTEM ELEVATION ~6"~ ~a _
- -
Noce ~nx~1M414k lda..o6) tS 4
'foew Loc.k.F _ f . -
~ P
Aga. W I~~ ~~4 ~ _ ~ ~YN ~ i _ o ► ~
.
A
_
I _
~,~c,►a~hd~iC-'~~P,1C~ IN t ~ ~
4
t E ~ E
f
.
t(EF
{
I, the undersigned, hereby certify that the soil tests reported on this form were mad y 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 cc act to the best of my knowledge and belief.
NAM (printTESTS WERE COMPLET D O
>Qk Sow Joy >uS~ 3 Z9
ADDRE S: CERTI CATIO NUMBER: PHONE N BER(optional):
N a~ S a J 3U Fsb
CST SI ATURE:
III
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) -OVER -
INSTRUCTIONS FOR. COMPLETING FORM 115 - SBD - 6395
To t)e a cornpie:'te and accurate, soil test, Vot.1i report must incl(a(;e:
I. Complete Iegal descri[Aion,
2. The use sect:ioii ra)c{St Clearly indicate whether this is a residence ot" commercial pi'oje: t;
3. MAXIMUM rirtnlber of bedrooms or commercial use planned;
4. is this a nevi or rel)lac rnent system;
5, Complete the, sfiitability 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 shov,11) here for writing profile descriptions :anti cc)rnoleting the plot plan;
i. iv1AKE A LI-__-GIBL1:~ diagram JC(Affately loeutir'=.y your test lo{',at:ions. Dr,,.ving to scait9 is pieterre:ci. A
sel:>arate suer-et may be used if desired;
8, Make sure your benchniat'k and vertical elevation n4eience point are clearly shown, an, err(; perrnan=lest;
z
'.Iaoc1 plain data, percolation rest exernIp-
9. Complete all apps opriate boxes as to dates, names, addresses, c
tion, if appropriate;
10. If Ino =nio-mation s`Such a flood plain, (elevation) does not apply, place N.A. in e... ;i3rr> rit;te. aax;
11, Si(P the forn) and place your current address and your certification ri> niber;
12. Make legible copies and distribt.ite as required. ALL SOIL TESTS %4""IST BE FILED t":"I-tld THE
LOCAL AUTHORITY WITHIN :36 DAYS OF COMPE...ETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st: St.;nfe lover 10") BR Bedrock
r~tl t. Gobbie r • Cent Jtar:..
LS Liine:stoc
yi' i !`v£'i (Under 3")
, I"IGV High C,Y~~Ii t( ~vcitf.^r
o ,
Perc t .'.:'coiatio a Rute
rY3+;(I a ir.(il Jan(: r.;
du S'!1 1,iiri(j
Less Y i ,'Egli Than
SiI` t:; y are rnclt - mottles
Sandi
Sic - Silty Clay `ff few, fine, faint
x c
Clay cc camrnor,coarse
p; - P(sat i)lrn - Many, mecliw-
rn - Mt.rek d distinct:
p prorninent.
;
;i .erxt iI Surface t,
vase a ,rt>s,, Bl1 - ~3 r;ct?.' . .
VRP `Jter-tidal ,t
TO THE OWNER:
This soil test reponi is the first step in securing a sanitary permit. The county of the Department may request
verification of this soil test in the f}eld ;}rior to permit issuance. A co,,1101 tr,'e 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 he obtained and posted prior to the start of any construction.
~~:~f w~ l rf Y a~Ta-i yij A~,~~~
fl
8
t
Gb
c a'
v0 .v
a k s -e
t
13
Fled
a
REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1
06/02/92 14:19 REQUESTS FOR INSPECTION WORK SHEETS FOR: 6/ 2/92 AREA: JT
'`J ActCivity: A9200130 6/ 2/92 Type: CONVSEPT Status: PENDING Constr:
Address: HUDSON 28.29.19.1184,NE,NE,28, CO. RD. UU
Parcel: 020-1188-70-000 Occ: Use:
Description: 149289
Applicant: CEDAR HILLS DEV INC Phone:
Owner: CEDAR HILLS DEV INC Phone:
Contractor: SCHUMACHER WILLIAM C. Phone: 386-3121
Inspection Request Information.....
Requestor: BILL SCHUMAKER Phone:
Req Time: 13:06 Comments:
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION
i
i
I'
RT ON SOIL BORINGS AND SAFETY & BUILDINGS
IPARTMENT OF PO DIVISION
VDUSTRY, 1 P.O. BOX 7969
.ABOR AND PERCOLATION TESTS (115) MADISON, WI 53707
.IUMAN RELATIONS (ILHR 83.09(1) & Chapter 145)
/ L0.: BLK_NO.: S` ~.I~~A NTI,
OT f1 ~j
ANX "/a SECTION: TOWNSHIP
fff
/T-P N/R/9 E (or) W v~Sor~ 5(~ ! 1
MAILI: L,
~ t
ADDRESS
R'S/BUYE NAME: T-
UNTY: OA
5 "t C IX ~r2 /Lt5 GLof M c
DATES OBSERV TIONS MADE
JSE PROFIL S RIPTIONS: ER ATI N TESTS:
NO. BEDRMS.: COMMERCIAL DESCRIPTION: New Replace 3 Z7 9~ 3 z /
Residence LA N V_
_
DU~R-K 1-~ P.S'T
14-S K 6 bD SOILS
RATING: S= Site suitable for system U= Site unsuitable for system
ONVENTIONAL: MOUND: IN-GROUND-P URE: SYEM-IN❑-FILLHOLDING TANK: RES,QMMENDED'OSYST ~AL Woattonal) 0e
CAS ❑U 14JS EA ZS U S U ~S
TD fN-~_
RAIf any portion of the tested area is in the JIf Percolation Tests are NOT required ~~t•NT
under s. ILHR 83.09(5)(b), indicate: ` Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
C
BORING TOTAL LEVATION DEPTH TO GROUNDWATER INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPT
NUMBER DEPTH r E OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- q . S q 44o o 7 s /FSn ~-TS 9 ~~~e~, L Fso" 8QN (hs14 P_
12." &1-.--rs 11 $ QNS L 13" $ ¢ u Alst&k
B- L 94 oN~ > $9Z
s_ 3 /p,0a 43.24 n~o > 8~w~'hS~tG+e-
B- Q 13 96.o8 14 01Nkir ~ /D~$L.L_TS 14"$AN L. 94" $~N ►tiiS,FG~
B- p.o T6,.gaU wrS4 L l2.
B-
PERCOLATION TESTS
DROP IN WATER LEVEL-INCHES RATE MINUTES
FP- DEPTH WATER IN HOLE TEST TIME PER INCH
R AFTER SW11Q. A ELLING INTERVAL?IN. PERIOD 1 ; E~RIOD 2 ` I Am .40 ~ >
9 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 a)all borings and the direction and percent
of land slope. iDJ
SYSTEM ELEVATION
r l 3E ~ ~
~ t
E ,
;S 4Cs5 O'
01F $u5cv- aV Qo Paste oUS e _ _ I
m
LtTNLf,
IN
y
14"-~0~.
33 0
,
,
G
3
s
I, the undersigned, hereby certify that the soil tests reported on this form were mad y 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 co ect to the best of my knowledge and belief.
TESTS WERE COMPLET DO
NAMES (print): ? q
ADDRE~S: 1 CERTI CATIIIO NUMBER: PiJONE N BER(optional):
C- A
IQ~
CSTSI ATURE: 7~OG~
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
1
1 IFTRUCTIONS FOR COMPLETING FORM 115 - SID - 39
To be, a cr arid accurate soil t t, vour report must include,
I , Cornp ~ option;
2, The use iust clea,iy ; to whotherthis is sidence or commfn rc;ial pr=o)ec:t;
3. MAX lMU . of bedroorns of c€ammerc al . vaned;
4. Is this o "mment system;
b. Complete t' ty rating boxes, A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SY RE RULED OUT BASED ON L CONDITIONS;
6. PLEASE L if €bhreviat_ions shown here for vvi-itiny ofile descriptions =rd completing the plot plan;
7. MAKE A i A LE diagram ac(;c[rately locating your test locations. C to scale is preferred. A
separate she. may be used if desire, ;
8. Make sure your benchmark and vi elevati~)n reference point ar( rown, arid are permanent;
9. Complete all appiopriat:e boxes as dates, names, addresses, lloo, ` percolation test exemp-
tion, if appropriate;
10. If the information (such as flood plain, elevation) does riot apply, pla „ >1'013riate box;
11. Sign the form and plane your current address and your certification n i
12. Make legible copies and distribute as req€.aire(t ALL SOIL TESTS E FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Sel 3 rid Textures Other Symbols
st - S i e (over 10") BR Bedrock
cob - Cobble, i3 • 10") SS - Sandstone
gr Gravel {under 3") [S Liffrestone
Sand Il~ Higf Ground- atr,r
c;s Coarse Saud r - P rcolaiion Rate
reeds Medium Sand {fit Well
is F ICI(;
is lj -nyr Sand
r
Loam F;
si Clay Loam (Trot - s
c Santry C!f y Sl•j
sic; Sil Clay fff- fine, faint
cc r.)n, coarse
pt mediurn
n M d in€;t:
p rninent
H ks",,f L -High w
Sax gr. zxturas surfa -
p«r is :lasposa l BiIM Bench Ili
VRP Veitica Pont
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 he obtained and posted prior to the start of any construction.