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HomeMy WebLinkAbout020-1066-90-000 'r ~ a o I o° o I I o I I N v ~ I A i I ti I ~ I c z LL 3 a I ~I Q I I M vt a) z y co = o Z y y a m 04 N H O C U oza m Z o o tAF-~ 4' v E c a N N M NW a ~ I Co v C C c c y O z D w z o I y c I L E > N = N m V 0 CD C - Y C o c c a E O z~> ~mmm al in rr o a. a 0a Cn a a ~ J U rn rn } Cl) O a W M a p N ~ ~ do E~ I co co y c Q. a a co p d Q } (n m N O o a E y C O n 3 (n N U 0. CL C a C) N :3 o C) HO a~ f v co C,2 o W C) CO C M y~ L w '=D y N C N H d N a C O N ca U 'Loo 11 E • o N S > o z C (n O C~ r+ C~ V t E d m C. #6 a ` a ~ • C m .V d a, E c rr~~ ~ o i`e ~ 3 v~c°~ ~1 A L C.2 0 Parcel 020-1066-90-000 12/09/2004 08:01 AM PAGE 1 OF 1 Alt. Parcel 24.29.19.257A 020 - TOWN OF HUDSON Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner " ROSIEJKA, DONALD C & DONNA K DONALD C & DONNA K ROSIEJKA 824 BADLANDS RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 824 BADLANDS RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.967 Plat: N/A-NOT AVAILABLE SEC 24 T29N R19W S 1/2 SW1/4 LOT 1 CERT Block/Condo Bldg: SURVEY MAP IN VOL II PAGE 450 ORD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 24-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1032/452 WD 07/23/1997 854/443 07/23/1997 730/530 2004 SUMMARY Bill Fair Market Value: Assessed with: 1356 310,600 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.967 58,900 181,400 240,300 NO Totals for 2004: General Property 3.967 58,900 181,400 240,300 Woodland 0.000 0 0 Totals for 2003: General Property 3.967 58,900 181,400 240,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 221 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 _ Form -3TC-106 AS BUILT SANITARY SYSTEH REPORT . i•}•OifNER►'•: u ~c-~-~ •e TOWNSHIP SEC. T _g&j-_'N-R H ADDRESS -ST, CROIX COUNTYi WISCONSIN •t...... r 37A 1 SUSDITIEICN L~~ • LOT • 1 LOT SIZE PLAN VIEW • ' •,4 Distances sad dimensions to neat requirements of•MHR 83' SHOW EVERYTHING WITHIN'100 FEET OF SYSTEM ••.+rr•. • • ,••.J t~ 1:94 tot ' . i. 1 7•t KL: 1. i.t . v 1D /YI- AGM 1 0*4 0: i • . :fir..: .::....t !a• :•I.t1o•.•.r • , gas; jet ' INDICATE NORTH ARROW DENCiQMMI Describe the vertical reference point used col me Q S / l~ Elevation of vertical reference points zB®~ " Proposed slope at sites SEPTIC TANKS Manufacturer: •~y*i c&JJZ9T Liquid Capacity: GG o mod" L '•'••'•NumbeE of rings used: _l Tank manhole cover elevation: • • Task Inlet Elevations Tank Outlet Elevations Number of feet from nearest Road: FronttOSideo Rear, feet • 1 • . • -From nearest-property line t • Front/O Side 0Rear, 0 1! el' '"T. -2 f) feet ii Umber of feet iron: veil uilding: _ (Include this information of-the above plot plan)( 2 reference dimensions to septic t.:.- SEE STi)' T PUMP CKAMER Manufacturers _ Liquid Capacitys ' Pump Models Pump/Siphon Manufacturers Pump-Size Elevation of inlets- Bottom of tank elevations Pump off switch elevations Gallons per cycles Alarm Manufacturers Alarm Switch Types -Number of fast from nearest property line f. Front, O Sida~ O Rear. O !t.__ 'Number of feat from wells Number of feet from buildings (Include dLotances,on plot plan). SOIL ABSORPTION -SYSTEM , , , , Bddr • Tranchs Width: Length .-Number 'of Lines:~2 ~ Area Built: Fill depth to tJ of pipet Humber of feet f oro nearest property line: Frpntg O Side. O aur.Olt., d Number of feet from walls ' N Mbar of feet from buildings fwd (Include di tancea on plot plan). SEEPAGE PIT t Sizes Number of pitas Diameters Liquid depth: Bottom of seepage pit elevations Area Built: " Noe either a drop box O or distribution box 0 been used on any of the above soil absorbtion sytems? (C~eck one). HOLDING TANK Manufacturers Capacity: Number Wirings useds•Elevation of bottom of tanks • Elevation of inlets Number of feet from•neareat property lines Front, O Sideg O Rear, Oft* Number of feet from wells Number of feet from buildings Number of feet from.neareat roads Alarm Manufacturers ' . fd Inspectors. Dated sl Plumber .on jobs / License Numbers 3184:soj • I 4 , DEPARTI0IENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING DIVISION LABOR & HUMAN RELATIONS P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION M DISON WI 3707 State Plan I.D. Number: SW ,Sw4,Sec. 24,T29-R19 'NVENTIONAL OEl ALTERATIVE Of assigned) 'Down of Hudson, Lo ~ - - -1 LJ Ho ing Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: gv Suzanne VanMele 8767 Spring View Woodbur MN 7//-3 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: PER PT. ELEV.: ST REF. PT. ELEV.': a ~d Name o Plumber: MP/MPRSW IN County: Sanitary Permit Number: Wm. Schumaker 6382 St. C 'x - 135533 SEPTIC TAN Sj " o 6(e cdacr= 0, 2,3' ' 3 P MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: T U WARNING LABEL LOCKING COVER ~j ! PROVIDED: PROVIDED: Co, -15- 1 /~1/~/d "X S2 11~ e Ca 6 ) 6vo /0 9, 0 o O YES ❑ NO ❑ YES NO BEDDING: VEND DIA.: MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH GO, p "N'T LL ALARM: FEET FROM LINE: /O~ AIRIN~ET~ }/Il ❑ YES NO L ❑ YES NO NEAREST—-* DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: PROVIDEDLABEL pROVIDED:OVER WARNING ❑ YES ❑ NO ❑ YES ❑ NO ❑ y I ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑ YES ❑ NO NEAREST -1111110- SOIL ABSORPTION SYSTEM. Check I moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolle I to a wir , construction shall cease until MAIN the soil is dry enough to continue CONVENTIONAL SYSTE : BED/TRENCH WIDTH: LEN NO.OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHES: M1?IAL: PIT DEPTH: DIMENSIONS S C9- GRAVEL DEPTH FILL DEPT DISTR. PIPE DISTR. PIPE DISTR. P MATJ=RIAL: O STR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH .INLET: ELEV/ D: ("(J1l 81MATT> I PI ES: FEET FROM LINE: , AIR INLET: / ELkllf BELOW PIPES: ABOVE CO 62ri - ldJC ifSTi►t O ??d9~ NEAREST_----* J~ ,O 7oZ~ MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: TRNO.OF ENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO /NEAREST 9 3 eta In in county file for audit. Sketch System on Reverse Side. SIGNATU 2TIL : " SBD-6710 (R. 06/88) SANITARY PERMIT APPLICATION TDILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ~j 8% x 11 inches in size. chkrev sion to pre ous appl!cation -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 4qA Z B t/4 t/4, S T 6L , N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE P ONE NUMBER SUBDIVISION NAME OR CSM NUMBER w e' 6_1V O! - C ,!S on II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ❑ VILLAGE 404(W QF: AX N MB U El Public ~1 or 2 Fam. Dwelling- # of bedrooms PARCEL III. BUILDING USE: (If building type is public, check all that apply) `01 57 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 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) , e ELEVATION 040. f - O ` Feet v 41. - Feet '4ds0 GDI fO VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret structed Con- Steel glass Plastic App Tanks Tanks Se tic Tank or Hoidin Tank Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsits sewage system show on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) PRSW No.: Business Phone Number: 44ll~a S' tiA ~3~ 3 1e? Plumber's Address (Street, City, State, Zip Code): gs- IX. COUNTYIDEPARTM T USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Surcharge Groundwater a e Issued Issuing gent Signature Fee) Approved ❑ Owner Given Initial A v rs D rmin ti 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 a,ll appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than .8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) 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 developaeot bra intended for resale by owner/contxactgr,("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 Z eA~2awAle 99 Location of Property .~GJ It, Section 91(T of N - R W 't'ownship Mai 1.Ing Address Subdivision Name G 3 52 Lot Number Prt-v iuus Owner of Property ,rutal. Size of Parcel -4m ,S duct., Parcel was Created c-7' go Are all. corners and lot lines identifiable? Yes No Is this property being developed for resale (epee house) ? Yes ,P<~_ No Volume and Page Humber it 4n:.recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION 0118 08 THE FOLLOWING. 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deada Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed deacriptioa"references to a Certified Survey Map, the the Certified Survey Nap shall also be required. PROPERTY 0 0 CERTIFICATION Y (we) cen ti 6y that a,PX statements an ttti+b foAx au tnue to the beat o 6 ay (O UX ) knowledge; that 1 (we) am lane) the avrutA A o6 At ptopeUg dwA bed in .tUA n 6 onma ,i.on donmo by v Atue o6 a wart~tanV deed 4&40A& -in .the OW C& C& o` the County gimteA 6 Deeds as Doeuwent go. 5' as ; and that (we) rmuenUy own the ptopoaed Ait¢ jo.a the 4s pad 4(Atem (an 1 (wt) have obUined an easement, to nun with the above dtaeAibed p+wpea ty, 60K the eonatAuct-ion o6 said gatem, and the 64w has been duty neeonded in the 066iee o6 the County Reg.i.6 , o6 Deeds, as Document No. ) . SIGNATUR OF F OWNER SIi'1ATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED -e'••~"'!-~+ DOCUMENT NO. tiS•'TAZ.E BAR OF WISCONSIN FORM 1 -19821 TNIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 452"1"57 VC, 854 PA,E 443 REGISTER'S OFFICE This Deed, made between JQhnsQn._and ST. CROIX CO., WI Thexesa.~l._.John?_~On.,__hus~iand•-And__wife_,_ as joint tenants Recd for Record u~ 101989 Grantor, of 10:45 A.M and----Suzanne- -M_..VanMele---------- i~ j Register of DeedsE` j , Grantee, Witnesseth, That the said Grantor, for a valuable consideration...... TO j, conveys to Grantee the following described real estate in __.St.__ Croix County, State of Wisconsin: j i ~I Tax Parcel"No: I! Part of.the South One-Half of Southwest Quarter (S2 of SW-4) of Section 24, Township 29 North, Range 19 West, St. Croix County, Wisconsin described as follows: Certified Survey Map filed August 23, 1977 in Vol. "2", Page 450, Doc. No. 342566 as corrected by Affidavit of Martin Halverson recorded in Vol. "724", Page 414, Doc. No. 406432. ME This is._not......... homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And------- Steven_•M. Johnson and Theresa M. Johnson - warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except i easements and protective covenants or restrictions of record, if any and will warrant and defend the same. Dated this Cl day of - - October - 19 89 I (SEAL) (SEAL) S EVEN M' JO}iNSO_• (SEAL) r-- EAL) !I * * THERESA M. JOHN ~I AUTHENTICATION ACKNOWLEDGMENT ii Signature(s) STATE OF WISCONSIN SS. S t . Croix County. authenticated this day of___________________________ Personally came before me this 1!...... day of. October , 1989.... the above named L Steven M. and Theresa M. Johnson. TITLE: MEMBER STATE BAR OF WISCONSIN aj ' 'J' (If not, authorized by § 706.06, Wis. StatsJ .'e~• ~ j v to me known to be the persons. ~,t ex4uted,,Uip foregoing instrument and acknoedghe/ s.. THIS INSTRUMENT WAS DRAFTED BY r--(, liexwood & Cari ' by Samuel R' Cari Qt,- tai-X- P_.Q_,__Box__229_,-_fudson, Wl 54016 r St Croix '+++I,,,, ' Nota.y Public .,,,,~,`4"!Ry, Wis. I (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration are not necessary.) ,I - date- ) 'Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. y r STC - 105 r I y r, SCP'1'1C TANK MAINTENANCE AGI(EEMUMT c St. CCoiX County o y r1 tiW PJ l? is / IsAR-E-tt -A:t l% I"=L - n ?-z ROUTE/ BOX NUMBT1':It Fire Number CITY/s1AIL' 1110;I1l-A(TY LOCATION: tiect iuu K lC W, I '1'uwu l) t_ St. Croix CuunLy, Subdivilsiuu <'S_/P_- fa?G Lot number tmpruper use and maltttenauce of your sel)tic. system cuuid re_`iult in it ti premature 'I it ilure to handle wastes. . Proper ma intenan.:u Coll- pumping ouL the SeptiC tank every three years or sootier., si;cs Of ii needed, by a iicensed s _tic tauk pum„Ler. What you put into Lhe SYStem can affect the fuuctiou of Lite 6L'pLiC tank as a treat- uit:iiL stale in LhG waste disposal system. St. Cruix County residents w~i+ be eligible Lu receivu a grunL fur it maximum of 60Z of the cost. of replacement of a fuilinb system, wit ich was lu uperaLion prior to July 1, 1978. St. Croix County .i(:cL:p'Led this program iu August ut 1980, with the requirement that Owner:. of all newsteuis al;ree to keep their systems properly w:A iutaiaed - - ^ The properly owner agrees to submit to St. Croix County 'Lulling a curtificatiun turns, signed by the owner and by a master plumber, journeyman plumber, restriCLed plumber or it licensed pumper veri- fying that (1) the ou- site wastewater disposal system'is in prupur 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 0 three year expiration. 0 i/WE, the undersigned, have read the above requirements and agree w, ru maintain the private sewage disposal system in accordance with M Lite standards set forth, herein, as set by the Wisconsin Depart- 'v 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. - S I C N E D-- t DAT E___ G~ / Jr p _ St. C.-oix County ZonIng'Office 1'.0.. fox 96, tlammo'jld, WI 54015 715-7 16-2239 or 715-425-8363 Sign, date and return to abuve address. r r ...o CERTI F I SURV E MAP y a I/S ilk SEC., 24 T ' slue 9 N-?n 1 w 44 ~i , r• QV EF? SHERNIN Sl?vlE IA ~F.3 SUVEyQ l~ .'I Ai E~aL~'UR1 N al N N HUDSON q W S C0NS1 N N n a S .000 57'00 E' 343.2 a W u ° a S~ 1r z w ' h 0 LA. ~ ~ 1.~~1 . ~ ~ r r~ ! .ray/ ,`1 n ' ' r ..i 4t r ROW, CD V) k _ lMrt¢ r .i.,. y1~ro I ~7 JULY 19, 1975 or: ..r . "0 coo Sri lz %s ' ~f Ir f.M'•, 1 i ols L L7 'i N' EX I ST o , 2 p! PE ~r. 1ND ' 2 24 s' SW CORNERS SEC. 7, 4 T 29 N H 19 W c E lot _ t T \ MAUI,UN, WI ba107 (ILHR 83.09(1) & Chapter 145) 3, f !lam S LOCATION: SECTIqN: TOWNSHIP/MW+*#e+PAA.=: T N LK. NO.: SUBDIVISION NAME: sc~1/ sw /T4 N/R19 E (or) W f><u05'o~ i c5.44 3f2 sGG I/a. z Viso COUNTY: NAME: MAILING . CWI x 5'vz-,+AWe l/-f~ "We4 876,7 6Ae;.o6- l/,~.v ~~y ~itoopl3u,Qy ~1.u" s,Sis s DATES OBSERVATIONS MADE DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TEST5_7 rLResidence New ❑Replace • I 1 4 ~T CQ l - - ~ RATING: S- Site suit" for system U- Site unsuitable for system 7C S 1M f R'r ~ ~ R. kjty ^ RAT ( V N N NAL: MOUND: IN-GROUN _SSUR D-PRE M_IN-FILL OLDING TANK: RECOMMENDED SYSTEMaoptional) EIS ❑U ©S ❑U 12 S ❑U ❑S ZU ❑S g] U C'GnJww;ropvAL -Tipf4k- 1 s w/ 'nw'17 a 01( 'DiS'1'Ut V ^F r dy If Percolation Tests are NOT required DESIGN RATE: i If any portion of the tested area is in the under s. ILHR 83.0915)Ib), indicate: C`/'fS S .r Floodplain, indicate Floodplain elevation:T- PROFILE DESCRIPTIONS IN 'pF~jftitlfrL f♦ . BORING TOTAL P H T R U D% ER INCH S CHARACTER O SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION gS RV TO BEDROCK IF OBSERVED SEE ABBRV. ON BACK.) p ' i .S, 1C'.a..)- V T'S., S' aa.SI, 1.o' TAa S Lp' Tw B- / d . S boy 2ri Teo 8 $ C S ! 9R , S S T.p~ ucp CS 3. 6-IL g3•~k.&1.$1 r.s li Q g 9 .9 u1: a• cs 4 k. U, -';t" ' 1 p ' i~ 6-K. k.) 41~ LS' 1AS •S(1 C,, S • T4~ uFat~ cs 7 S /00. fy. . S • 'Dr. 13.3 - SI T.S. G7' Bj- St , •.t3' K • Is ' qR. B' llo 7. `S 1 . S 34. C S t d~R 1 ' a VE it CS s• S > 90 io•vk.e~.sr 7 o' c s S B- PERCOLATION TESTS Av 1045e.V TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RAT MEMO- NUMBER INCHES AFTER SWELLING INTERVAL-MIN. 1 I o PER INCH -P 1 I P. P_ Z 3.8' w- z G P. , ! P• 1 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 percer of land slope. _ ~ SYSTEM ELEVATION u PpE PL T RE 41 mac. I I I 71 F-0 F. 'It Th- for a co, ~te I 1 i I T j f 1 , 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. NA print : TESTS WER COMPLETED Ma HOMESITE SEPTIC PLUMBING CO. pC O , ADDRESS- ROBE-1 ULBRIGHT CERTIFICATION NUMBER: PHONE NUMBER (optional), 7 M.P.R.S MINN. IM-,TALLER & DESIGNER LIC. W) nW" CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILMRSBO.6395 (R. 10/83) -OVER - J 1 Vmv-4 //~+P•il~. ScfJ ,5 ~c c ~R ~f ~Allr 4J'C<~- oc~✓~t/ 01~e~, 1 G° o ~f `!mac s~ ~7`,~ I I I d` I I I 33 `Ta~~ ~,~rJs I i I I I I a ~ x it r~ it -.~S` ~w i j l ~ I I' I I I I I I I RE F irk ~A T1006 t sEt ~ w' ~Ir. ~ 55 - • = 6ACe~leoE Pi RE RC S+-ffS pRo Post J ~v~~p1alr S~,f~EO o T 10 +o l l % So` G r/TG~- 5 icp~ I N i bhEt~ ~ ~FGprynE~+~O / tiu f~ 1 ~ 1 1 1 1 1 ! 11 ,1 ` 5 Y STe,% Elc a , r' 1 ► owi ~ ~ > t ~ J aQ4 Syrr&Al io !oeI 1 1 1 N I, ` -~,1 1 1 1 1 1 1 1 1 ~ 1 1 ~ y101s~.. ZyPz ~pp~~'~C S T 50 M Poo - ,Mg a' 4'WOO UC' No' W1N - (COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 ST. CROIX COUNTY GOVERNMENT REPORT NO.: 45331/01 PAGE 1 CENTER REPORT DATE! 7/23/93 1101 CARMtICHAEL ROAD MATE RECEIVED: 7/20/93 HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER: Suzanne Van Miele LOCATION: 824 Badlands Rd., Hudson COLLECTOR: M. Jenkins DATE COLLECTED: 7-19-93 TIME COLLECTED: 11:30am SOURCE OF SAMPLE: Outside faucet _ DATE ANALYZED:7-20-93 TIME ANALYZED:2:00pm COLIFORM,WCC: 0 /100 m: INTERPRETATION: BacieriologicaLLY SAFE NITRATE-N: 3 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIAN: Pam Gane WI Approved Lab No. 19 u r < Means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 O~ G`i0 GOB \C3 'zk 1.°~GO p~ JOb~O s~ • `.~51 yon • 1 O`t',,yGa ~<S a4 e~ ~ e" o0 vZ ~0 o ye 5e a~ ~ a o~' I a44 ,oe 4~ea Ga'y` 0 y5J f , GAS y'~' 'C.~ A fi 4~ti e~ S~ • r ~O t~'e yea t, e g:) • oo 0 ILI, ° eGe ,ire ~ti • O5,19 o o 'S• 0a,C-ee yK by e I, 00 e; ~o ~ree al A~~~~ ~ ~e~., 1 w ~ro~ • eG ya a°. Ge `S IISo O a,~ o ~p Asa IN * Q ti 01 K) 11 06 e ~a e" jj vw c r, ~k 4 4 0 p ~a e ; y4 e q eG • p o~ as``'p a-s'• , tee•. 'oa l iy~ 9 4 1 ace , ~c.`I 9 SG ~p , eat r • ^ ~1 ` a A " K,A o{` ~ti iD July 19 ~etie4 ~~c,~ a 0•' aK;*- o 4v~ 5~ ye~• ' 1993 °~e y°~•~ G G 5~ G~4 LoWr ~'S,~, • e e~K;"' G S yoa, •~~f r 1201 Y Real Es '3:cr- ° ` -i `Q~ ' `oe. Hudson a WI Ro d to e A yt` e y~e~ ee{' r°~4eoJ ~r yrs. 540,16 e1, a~'• 5 e e` ,0 On e ,LO a~ K~ o~ e An4 eGa{,~c. e 1 e7 Mete nspectio Sy ~ayG S at.O re e °a,~a~aG~-G,~,a~ ~po~o~ ~aac ti Jul 1Ocat n of the ti~e4~ yG 5 o`A e Sys °te 0 " fi~~ Y 19 19 ed at g2 septic 5 e4'° yoo o~ 9~ ~a~ e G`c` a~ 01\ G°~ as Sting• T 93' At 4 Badla syste1 5 ~e~ r~ 5ee~a~' ay ay -16~ we receive he O~' resul she same ts. RoaQ 4 ~e ~ ~~oa'4 6, N KO tiy0 4a gti° ae a At them b of thaIme a w the ack at test O q o~ K;*- Y t tlOninle Of ins from the labo ► *A- ~ ~eea e '~o no ern Was prober pectIon rat, O~ I oa G~y4, then involve ased upon ' The the sari t et' e a~ disc e Is theany exc a surfac nspect I ary Go ,~,p ae -g6 a p'o'oe a'~' dye o or guarrable by tssibiliting e Inspect . of t system• ntee t his in y of °r h, hemiCal n ~ Of I 1:1" every t It is e continue ectlon. Idden defe nalysi, s°ce may be depen Bears cosh Te.r nded thet r the f pct doo I in a!, escnot In S °y'~ 0*- should you hav nt upon proper m the pzso st mnhor Opera e SlnCerely' a any questions alntenance°°fethl fe of t please the system• hl arY J Contact this office. sslstant Z°nin j g Administrat°r P o i~ ~s d o~ S~ ¢ S~ \ ~l ~s s s°11~e~ Loci T ~p ° es g~ a ~ o r°k s per , \ oSe se~~d~d~,~r ~ ~10~ SU~~ ~ ,s ~ k \ O e~bk asks: - r~~'" ~O~~e ,ohs°rr7~ 9 ~ \s . ~To~s s~~ ~h sp ~1~'ec~°r m  --Mddm solo Cq/ ST. CROIX COUNTY WISCONSIN tX.' • - ZONING OFFICE ••aa~~c ST. CROIX COUNTY COURTHOUSE 911 FOURTH4TRE" HUDSON, W154016 1 yV~ (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. / ❑ Water (VOC's) / $185.00 ❑ Septic x//$25.00 ❑ Water (Nitrate & Bacteria) $35.00 (Visual inspection) Owner: SULU,n e_ It.n Me-. Ie- Requested by: : U sk /emu a, e.r a Address: yr d.. Address: uc ar , i City & State: AL`, d-sd r~ I city & St. Zip Code : ,Tyo / 6 Z i Code : S Telephone N4: ( ) Telephone N4: ( 3ff 6 - 3 z G 3 Property address (Fire N4 & Street) : gad ~~d ~4 in 5 u- d. Location: Sec., T_el N, R_W, Town of I-/u do,Ur St. Croix Co., WI. Tax ID N Parcel ID N4 House color: Realty f'rm:40wn Lock Box Combo: OF Water sample tap location: ' .i- `h, jL TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS l Pa25rn/ Is the dwelling currently occupied? Yes ❑ No /3 If vacant, date last occupied: Septic system installed by: 031L_L Year: /~10 Septic tank last serviced by: er Yr 5 'r v Date: Previous Owner's Name(s): Have any of the following been observed? p ❑Y Slow drainage from house. ❑Y N Sewage Back-up into dwelling. ❑Y Sewage discharge to ground surface, i,, 1 ,I taa'3 road ditch or body of water. ❑YN Slow drainage from the dwelling. `1~~ ❑Y XN Foul odors. Other comments relative to system operation: - I certify that the above information i comple and true to the best of my knowledge. ' OWNERS SIGNATURE : u~t DATE : 21L03 4/93 r OWNERS DRAWING OF HOUSE & SEPTII TEM LOCATION 4 N ~C GrPIJ v D/ZµIAJ ~FIX ~3ribLAw'p s `7 TO BE COMPLETED BY INS ECTION AGENCY System design &/or permit on file? XYes ❑No Soil series per SCS Soil Survey: sheet # Type of soil absorption system: ❑Below grd ❑At-Grd ❑Mound Approx. size 'X ❑Gravity ❑Dose ❑Pressurized Ft.: ❑Bed ❑Trench ❑Dry Well ❑Holding Tank ❑Outfall pipe OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank Setbacks: ❑House ❑Well ❑Prop. line ❑Other Dose tank Setbacks: ❑House ❑Well ❑Prop. line ❑Other ❑Locking cover ❑Warning label ❑Pump/Floats ❑Alarm ❑Elec. wiring Soil Absorption System Setbacks: ❑House ❑Well ❑Prop. line ❑Other ❑Ponding: ❑Discharge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION M Inspector Title A ~ Y ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE x; 1101 Carmichael Road • Hudson, WI 54016 1 - (715) 386-4680 July 19, 1993 Lowry Real Estate 1201 Mayer Road Hudson, WI 54016 An inspection of the septic system on the property of Suzanne Van Mele, located at 824 Badlands Road, Hudson, WI was conducted on July 19, 1993. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact this office. Sincerely, Mary Jenkins Assistant Zoning Administrator mij