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HomeMy WebLinkAbout020-1069-00-000 4 o a-0i°o, ~°o o O~ 03 6 a d N 0 0 h ° N m - N Cc c M O y y m c r m N U N O O C aL M~ fn CL C ~ v m~ rp m p C m 0 (D w 3 N tl co p0 O c ~ LL CD 0 Op N a) o.: a ° a 3 boa) L_ m 0 V) a~i > m 3 a1 E N O p O 'D Z c 'v E V Z° C m a) c y CO N U. C Op1 L CL LL c m 0 3 O M d 0 y O y L x cC C 7 a) C - 0 3 Q Ra7r 3 E Q mv° 3 Cl) m v v a~ a1 Z N N 0) w E E u~ O O W v o o v a Z ~ m a1 a1 rn d a co a m ~ N N H CO O Z a c c O fA H N a1 Z c E c E D 01 2 M N N N CL 7 7 N CD y ~ N i C •~V d L_ a L L ~ Z co z Z H Z ~ O N i z m m E m E N ~ fI1 C O m N G 0 = 0 r O O C Cl) A2 oaCL ~w p'caIL o .N Z > p Q- F- 33 aZ o v 0 0 0 c 0 0 0 Z •N Lo CL aa yaaa v C~ 0) 0) CD o ° CO) f/~ J V ON O31 0)i } 0 OOi 001 } Y M 7 0 co o N O O = M N y O - N O 0 -0 aD aD E Q O O .7 'O y 0 0 7 N a) m y (1) N O 9 m N O a) m Q (n c00 41 Q Q O O C y O C H O E 04 (0 Cl) O O O 3 co N U d O O 0) (IJ O N~ - CO 2 O' m -O N N O co 4 y o a1 a O n` c` c fl- = 4) C O Q> y O to N Z M N 1- C N 00 ~ p N O m N O O N O N O N E L) ' • O L O N 2 fn N Z c F- E 0 Z S cd (n €a €a1 d a ask a Lai, U(L • a m 2 a1 m e m . y c ~`I~.1 E c c r-: _1 A 0CL2 Ovv ONV Parcel 020-1069-00-000 05/13/2005 11:59 AM PAGE IOF 1 Alt. Parcel 24.29.19.260G 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 * FITZENBERGER, JERALD J & SUSAN M JERALD J & SUSAN M FITZENBERGER 861 RED OAK DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 861 RED OAK DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.320 Plat: N/A-NOT AVAILABLE SEC 24 T29N R19W SW SE LOT 1 OF CERT Block/Condo Bldg: SURVEY MAP IN VOL III PAGE 616 ORD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 24-29N-19W Notes: Parcel History: Date Doc # Vol/Page, Type 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.320 62,300 185,500 247,800 NO Totals for 2005: General Property 5.320 62,300 185,500 247,800 Woodland 0.000 0 0 Totals for 2004: General Property 5.320 62,300 185,500 247,800 0 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 120 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 34959 Fl~4 fo o~ 19,78 CROIX PQ/ SURVEYORSCOUNTYRFCORTD010* PART of the SW 1/4 of the SE 1/4 , of Section 24, T R 19 W, Town of Hudson, St. Croix County, Wisconsin 2 CERTIFIED SURVEY MAP \ RICHARD BUCK i g. 3 n 0,2: 00 S 79°04- E N 88' S9 £ b1.2o' 66 9~ 82. b~ . s~ U f` ~D. O O O ~ VoL . 48,a 19 C~ PC,. 311 0 a L o -r i 0 ~ W d , 5.32 AcP1rs 0 0 z J o a o al 'P tl OL Q c O M 0 o 0 ' JAM ES L. Z Z h-41 MURPHY o Q o< S- 1 0 4 2 % CP RIVER FALLS, .O / ? -4 k ~J. MSC. <t,~ SCALE: 1 - 100' ~~J LAND►u~1`~~\\~ VOL. $00 0 PG . S 4to 9oe N PO g~ N 90°00,00"w 41$.00 O NOFZT H So8.81 C.S.M. VOL. I, PC.. 233 rod N00'4205'& - N89015,300"E a Indicates 1" diam. iron pipe found. 158.37• 859.03 (M0M) S 1/4• Cost. SEG. 24- 29 - 19 DATk.D: 24 MAY 1978 DESCRIPTION: That certain parcel of land located in the SW 1/4 of the SE 1/4 of Section 249 T 29 N, R 19 W, Town of Hudson, St. Croix County, Wisconsin, more fully described as follows; Commencing at the South 1/4 corner of said Section 24; thence go N 010 421 05" E 158.37 feet; thence N 890 531 00" E 859.03 feet; thence N 000 00' 00" E a distance of 508.81 feet to the POINT OF BEGINNING of the-parcel to be herein described; thence N.000 00' 00" E 522.00 feet; thence N 880 59' 00" E 82.66 feet; thence N 770 02' 00" E 344.10 feet; thence S 000 00' 00" E 600.67 feet; thence N 900 00' 00" W 418.00 feet to the POINT OF BEGINNING, the above described parcel containing 502 acres, more or 41- less, together with an easement for ingress and egress over a 66 feet wide strip of land lying adjacent at right angle to the above describe parcel's North boundary line and extending Westerly and Northerly from the above described parcel to an existing Town Road as follows; Beginning at the Northwest corner of the above described parcel thence N 790 041 W 67.20•feet; thence 1 N 470 16, 40" W 118.39 feet; thence N 270 581 30" W 196.16 feet to the centerline of a Town Road. Certified Survey Maps St. Croix County, Wis. James L. Murphy (See raverse) FORM - STC - 10 AS BUILT SANITARY SYSTEM REPORT TOWNSHIP OWNER ,t f ✓._L SECTION_,2_~Y_T_.,~N_R19 W ADDRESS ST. CROIX COUNTY, WISCONSIN I I SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM .QQ r "e c 1 1.~ 37 1 T -3 j' S' _-_-,15' 9A T, f(,,1m ~ •>,9 L 9 ~GO N N INDICATE NORTH ARROW BENCHMARK: Elevation and description: lLb e4 "oe Alternate benchmark 011 SEPTIC TANK : Manuf acturer : i' -,Ns_ ~,g GG P ~°~i quid Cap._ ,Poo Rings used:-)-Manhole cover elev: ,5, Final grade elev: 9S.S~ Tank inlet elev.: 'T, Tank outlet elev.: 2 7,.S Z No. of feet from nearest road:Front , Side , Rear Ft. From nearest prop. line:Front Side Rear Ft. No. of feet from: Well 7 , Building:-- (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE j .G.y ferry 9 ~,-n PUMP CHAMBER ty: Manufacturer: <Man 7 Pump Model: ump/SipPump Size Elevation of inlet: ion Pump on elev.: Pu off ycle: arm: Man.: SLocation Al Distance f nearest prop. line: Front, ideRear Ft. Dista a from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench:-Seepage Pit: 4 Width: Length D Number of Lines: Area Built J Exist. Grade Elev. C Proposed Final Grade Elev.- Fill ~depth to top o pipe._ 7 / y No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from well: 1D g No. feet from building HOLDING TANK Manufacturer: apacity: No. of rings use Elevation bottom tank: _ Elevation of inlet: No. feet from nearest pro line: t , Side , Rear Ft. No. feet from: Well , building , earest road Alarm Manufacturer, INSPECTOR: DATE: PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION AIS N LVI 5 707 wc„ ~4i ec.24,T29-R19 SIatssgned).Number: Town of Hudson CONVENTIONAL ❑ ALTERATIVE 80th Ave. ❑ HoldingTank ❑ In-Ground Pressure ❑ Mound A- ZM(J(7 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTI N . C Jerald Fitzenber er 1 Rd. Oak, Hudson, W1 9/-:) BENCH MARK (Permanent reference point) -DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. EL V.: CST REF. PT. ELEV. - Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Henry Nechville 325 St. Croix 1297-17 SEPTIC TANK/ d 1, y Gv~z r . Y `1' MANUFACTURER: LID CAPACITY: TANK INLET ELEV.- TANK OUTLETELEV.: WARNING LABEL LOCKNG COVER PR VIDED: PROVIDED: 9 7, AG 7 Sao YES ❑ NO ❑ YES NO BEDDING: VENT DIA.: VEN MATL.: HIGH WATER ,NUMBER OF ROAD: PROPERTY WEL : BUILDING: VENT TO F ESH r;- /I C o. ALARM: FEET FROM LINE: AIR INLET: ❑ YES NO Cu. ❑YES NO NEAREST - /o? /~P 14 MANUFACTURER: BEDDING: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATI NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑ YES ❑ NO IX-ARUT SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: METER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue,) CONVENTIONAL SYSTE i _ q I, / BED/TRENCH WIDTH: LENGTH: NO.OF DISTR. PIPE SPACING: COVER INSIDE DIA. # PITS: LIQUID 5 G / TRENCH ES: a / MATERIAL PIT DEPTH: DIMENSIONS L. d GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. - I TR. NUMBER OF PROPERTY WEL : BUILDING: VENT TO FRESH BELOW PIES: ABOVE COVER: ELEV. INLET: ELEV. E PIPES: FEET FROM LINE: AIR INLET: r X12,93 Z•8! i' LASTNI-D07) NEAREST--► 7Jt / 7o 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 S OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACIN GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATER I O. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION PPROVED PLANS ❑ YES ❑ NO ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: 4~~ LINE: FEET FROM ❑ YES ❑ NO ❑ YES ❑ NO NEARESTT X11 'V k Le 0-f C d. CI, ~ yam. ~ ? v V C~~C~'~ C14 ` 4F . LURE: Sketch System on tain in county file for audit. Reverse Side. TITLE: SBD-6710 (R. 06/88) A aLHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code couN °........~...e. 'zA CuLt4 STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than / c~ P`73 7 8% x 11 inches in size. ❑ Check if revision to 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 7`xr° S W % SZ7 Y4, S g!y T~ N, R E (o W T # PROPERTY OWNER'S MA P0, W_ 04L A- A /r I NG ADDRESS LO # BLOCK CITY, TATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 38C - f '7 -5 lU,` s Cl NEAREST ROAD II. TYPE OF BUILD71,or Check one) ❑ State Owned OWN AGE gQ A O Public 2 Fam. Dwelling- # of bedrooms TAX • U ER() _ t+ , III. BUILDING USE: (If building type is public, check all that apply) V 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check on 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 ~,8eepage 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. SYST EV. 7. 5INAL GRADE LE AT O , COE A.-OL Pa IF 0 REQUIRED (sq. ft.) PROPO ED (sq. ft. (Gals/day/sq. ft.) Min./inch) ts, 01 Feet C Beet Vll. TANK CAPA TY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New lExising Gallons Tanks Manufacturer's Name Concrete stru Con- Steel glass Plastic App Tanks Tanks - t - A Septic Tank or Hoidin Tank GO 10,119mLn 19Do Cf. r Tr I Lift Pump Tank/Si hon Chamber OVA Fj, VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Stree , ity, State, Zip Code): IX. C LINTY/DEPARTME T USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing A nt Sig re (No S p ,~XA/pprovecl ❑ Owner Given Initial Surcharge Fee) D D rmin ti Advers 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 R INSTRUCTIONS • r 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 licehse~ pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code adn Tnf trator or the State of Wisconsin, Safety & Buildings Division, 608-266-.3815.- To be complete and accurate this sertitary.permit application must include: 'u s 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 perfo&4nce curve; pump model apd pump manufacturer; D) cros ection of the soil absorption system if . ` required by the county; E) soil test data on a 115 form; and-F) all nformation. - GROUNDWATIER 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 hese_suNtharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6396 (R.11/88) APPLICATION FOR SANITARY PERMIT 9TC- 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 ownst/contractot,(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 g A- 0 Location of property -1/4 .l/4, Section iP T N"R W Township Melling address Address of site &'6 Subdivision name Lot number Previous owner of property Total size of parcel -s•-~.~1~ Dots parcel was created Are all cornets and lot lines identifiable? ___Yes 0 ? Yes No Is this property being developed for resale (spec house) Volume 6 4 and Page Number 4-3 was 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 Ceitified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION itYe1 cattily that all statements on this form are true to the best of my (our) knowledge; that I (we) am (ate) the owner(s) of the property described in this Information form, by virtue of a warranty dead recorded in the Office of the County Register of Deeds as Document No. 3 9 7 / 19 8 ; and that I (Wel presently own the proposed site for the sewage disposal system tot I (we) have obtained an easement, to run with the above described property, for the construction of sold system, and the same has been duly recorded in the Office of he County Re9Istax of Deeds, as Document No. 1• Aff"MT74--a-Owner Signature of Co-Owner (If ApplicablA Date of signature Date of Signature r ♦ ~ YY~ fx ~qtM 4 f`~ t.¢ S~ 1C= wA 4 C R i. Z^ ' > sr 4' yam, .yes •far~IIIMA~I ti T yrt x t r40"thmest along c a ~ r - r its*V L yf + ~~'1 _ L" r 1. OW boobbumoft sad apparweapm id cis* a dS aiia>li soft a i k Of tvco 'd y l ! . 0710 'toot day at WtT-. ,f (SEAL) r`,AVMEs H.SCHM . . ESEwY.f - GERAhDINE V. SCHAVB r a*,arll~.>Ilrs><aa!>Eax : wa:>NOwbas~►~~''~t~. ~ , S H 5cha and - STATE OF WISCONSIN li dire Y. NL camtar - S ptcr 19, 84 Personally camn before 90 -h' zt s....._....»._. ;J $E8 STATE BAR OF WISCONSIN _ aathariud by $ 7%-06. A Stats.) to me known to he the Person WIM tilts a foregoing instrument and &*noslaiP OA Y111S t144TRUMENT WAS OFA0 T7Fr FY - h~ H. CAR I & RURRrZY #yy 1 R. ('are .Y►I 5:1016 M P.Q y Public ' Bp)E•S~9r commission is permanent-(If v^.014 630 (Signatures may he -ithenticated or acknowledKed. Roth y l~ s a' ' are not necea.+an.). date: - • ~ t wt ' printed Winn dwor afteAWrar «~Ar of Taes9><i W'A1Ai ila: .A7 9~ia ~r,u:d •e %V" , Md or ~ ter;; Y STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ^ a A.---- ~ 7 ROUTE/BOX NUMBER FIRE NO. CITY/STATE ZIP PROPERTY LOCATION: S (V 1/4 S 47 1/4, Section . ;2 T N, R / W) Town of St. Croix County, Subdivision , Lot No. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after` inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, 1 herein, as set by the Wisconsin Department 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 St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address 1 b AN U INDI*STRY, -DIVISION `L,AW1#t AND PERCOLATION TESTS (115) MADISON, OI 53707 .-NOMAN RELATIONS ' (ILHR 83.0911) & Chapter 145) LOCATION: SEC ION: TOWNSHIP/+TY: LOT NO.:BLK. NO.: SUBDIVISION NAME: sw 5E % /Tz7 N/R17 E (o r) W U DSO N COUNTY: OWNER'S 1114" 'S NAME: MAILING ADDRESS: 51.4WIX 3FERRy (=I,+2E,3SL=R&,e P_ ''ED 6AI< , WVPSo0 5¢OlCi USE -Q, 75 DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: R FI DESCRIPTIONS: 1PERCOL A ION TESTS: Residence 3 N, A- , ❑ New Replace filOt~ Z9r I ~(OrJ <2 / - Jy~~ ScS 59 BuRK~AROT RATING: S= Site suitable for system U= Site unsuitable for system Q _ ~TI❑~ . MOUND: x ~ IN-GROUND-PRESSURE: SYSTEM-IN-FI LL HOLDING TANK: RECOMMENDED SYSTEM: (optional) w 1IROP "I ® S U U S U C,90064T%'o-jAL - TI2C-NCAk S wa 1- 3E 4~~STin.~ Ca= -bOc- To uEJeY aR a i c TS. _ STRA7"AS If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: C/+S'S Floodplain, indicate Floodplain elevation: wlviE',e TEST eo,v0v1-.S • suuu ' 33°F PROFILE DESCRIPTIONS 2N 'DCC(H6L FT FRoST. BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHFST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) Dr RIk. 1.,-s .33'Do%B.A.I~ SY-a„. I. B- ~,O Q(~.(o8 > e, O 51, 2.0' 0R. C11 6-R y 0, T.}N VERY CS w 4,#,,- - iSOt ,'JED 5' QOCKET6G 10VC&VS~O.)S OF T.tv f. 5 BB- 2 ~Or I7.76' fe 0 75 ' 3(k. Digs . , Ts, r'. 7S' t' 6,0- 01tfAjoic , ) . S- of oR. SI W G,e z,o o oce C5 L. Pf~ G2 w/ 4d<,- . 31 O ' Tea VCS pu_ Gt . B- ' *A! Iri- A- S. • S8' &T . G 7 .f 7S' Slk- T: B-3 eO 14-o(o kr > e-0 TAN ~S 1. T*JW cs Ge UERy cS B- PERCOLATION TESTS W (U6Ry CS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PE IOD2 P OQ3 PER INCH P_ / , 0 Z Y 'I c•tY < Z 3 P_ L 2,00' P- P_ P_ P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the ho 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 per of land slope. upPER TREA,L(.~ IZ'~8~ ~04) E(.SYSTEM ELEVATION T ~EN~-~- - Z v I ` i 5Et=~. DoT L ~u~ f~s~ , , E . E 1 , . 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods sp Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: HOMESITE SEPTIC PLUMBING CO. lie? ADDRESS: ICERTIFICAJION NUMBER: P ROBERT ULBRIGHT L CS TSIGNAT RE: MINN. INSTALLER & DESIGNER LIC. NO. 00663 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - hL0 r ST1atr wE// 1$' 3 '13 ~ 0 2aoM ueeT. REF, Pr, 45 _ Top of eoucstiZ StAf.S Hi'DO~f of ourLer OF 19 1~ EKI'S7-IA3b- SEPTIC 2\ Soy 31N Wis., J _ ~ ~,y, v~NT Ex,srav(~ SYSTEM - 98 - r - of ovfRF~~o''n''S x 6 ~ ~ tic O s , rt i- ARDwd0 Fo e EST' L,+ ApS 6. 6$ / 96 a~ Sc/4/E: 30 yam- e. o c It s B4 elt'lME /J dko/49d S w e~ X Pete S "rE- orSO me~`SC S / rt ~~{red ra\\ j~C P N 09S HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 3 g ♦ ROBERT ULBRIGHT ~s2 5'PZ VIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. ~ir1N. INGTALLER & DESIGNER LIC. NO. 00663 Z f ' r AS BUILT SANITARY SYSTEM REPORT j ` ~°f I 3ckQve , TOWNSHIP wp~j SEC. 2' T,2'~7 N. R~W •s. ADDRESS e I , ST. CROIX COUNTY, WISCONSIN. ?DIVISIONrer~. LOT-fl LOT SIZE PLAN VIEW -Distances b dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM _ 83' X N- 1 1 I ( / { 3 -5' _ ;"TIC TANK(S) 16lld GR. S Indicate No4th Annaw / '5 r ~ CONCRETE X STEEL S cat e jj),-~an(Q ckS „ N0. rings on cover a Depth DRY WELL, . -'-NCHES NO. of - width length area no. of lines width length 26" area qy~ depth to top of pipe a</" , ;:ZEGATE / / • u: RATE e la-1_1 / AREA REQUIRED 1~5 AREA AS BUILT If _ ~iaimer: The inspection of this system by St. Croix County does not imply complete ,-pliance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for ;tem operation. However, if failure is noted the County will make eve ` o ::ermine cause of failure. 'aASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYS ECTO DATED 7 " o rI LU: iBER ON JOB z _ LICENSE NUMBER 7-7 P Y-Y 33 I P~ z `REPORT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM San.itany Pe.nm.ix~ State Sep.t.ic / /D NAME rown,6h.ip St. Cno.ix County Location Section SEPTIC TANK Size Jgr~ gattond. Number o6 Compantmentz I Distance Fnom: Wett tJ~~c ~ it. 12% on greaten b.tope~ it Bu.itd.ingZ_6t. Wettands 6.t. H.ighwaxen - it. DISPOSAL SYSTEM . Distance Fnom: Wet it. 12% on greaten zZope` - it. Bu.itd.ing 3 it. W ez.2ands Ft. • H.ighwaten - it. FIELD DIMENSIONS: Width as tnench it. Depth ab rack be.tow t ite_Zg_in. Length o6 each Zine_~it. Depth a6 rack oven tiZe .i li Number o6 tin e.6 3 Depth as tiZe beZow gnadein. Toxat .length o6 Zinesilw_ it. SZope a6 .trench in pen 100 it. Distance between tines `i t. Depth to bedrock Total abdonbtion area ~t2 Depth to groundwater Coven: Pa e on Straw area it 2 Type o6 p -Requ.ined PIT DIMENSIONS: Number o6 pits Gnavet around p.it~5 yed no Outside d.iameten 6 Depth below inlet it. 2 rz Total abdanbt.i an a it Area nequ~ d it2 rn T I T L 2 INSPECTED BY 19 7~. APPROVED DATE 2/0 7 1 1 f k, REJECTS DATE 197. L~ 2 0 3~ ER 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 J MADISON, WISCONSIN 53701 / REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION:S-4/1",x1 Section-^f , T-NN, R1,9 0 (or)(Pownship or Municipality ~zo" Lot No. Block No. C,[~i 7~ -s~crdeY County S~~ ~~d~ty SC Subdivision Name Owner's Name: 2'/ Mailing Address: )y TYPE OF OCCUPANCY: Residence x No. of Bedrooms `3 Other EFFLUENT DISPOSAL SYSTEM: NEW X -ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS --12-3 - 7/ PERCOLATION TESTS SOIL MAP SHEET s-f SOIL TYPE ig)l D2- ~i6-04 'Jt- -,-Oh! 'Q 6?dx 140e PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 7gY 0,/, A10 3 AID ~L- -3 3N 3 3!1, I P 3 See- 6cr 40 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES Y? NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B- x B-3 A6 1.2 Ire t< 30 B_ , . C, r « S X, Sd l,-. g.OL 64 ad 4, - PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square eet of suitable areas. Indicate n f square feet of absorption area needed for building type and occupancy.-? dou S'L X /yba f?~ ~~9 Indicate s9le or distances. Give horizontal and vertical reference points. Indicate slope. SYS 4, qF- e, '01 i c S h w f 4 Q` k o u r ,C l IN p~ r Q. ' ? ~1- IA 40- /Q lot 0 0 r e 6 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 location of test holes are correct to the best of my knowledge and belief. -Q Name (print) Certification No. S= ZiZ Z Address S~ Name of installer if known ef~:~ 17 CST Signatur COPY A -LOCAL AUTHORITY j- + . , ~ . - ~ ~ t ~ S 1 ` 1 . _ ~ • - . z ~t ~ Q _ _ _ ~ _ _ _a I r. State Permit PL8 67 State and County Permit Application County Permi # O~ 0 for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address/: sc-kaye- I'Je f~LLc-~S o B. LOCATION: S E '/e, Section Taf N, R (or) Q Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village C e- f. r •oho-r4 La, k Township N _4pl'l ? C. TYPE OF OCCUPANCY: *Commercial Industrial Other (specify) Variance i Single family _ ( Duplex No. of Bedrooms 3 -No. of Persons D. SEPTIC TANK CAPACITY AWO Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation X' Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New )e Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top)No. of Trenches Seepage Bed: _-)'(_Length - -5 V/0 Width 1a ' Depth 410 ~z Tile depth (top► No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land O G?o Distance from critical slope WATER SUPPLY: Private ® Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME eve v► is C.S.T. # 5-5-/-'J y and other information obtained from (own /builder). f p Plumber's Signature ti tA,-M /MPRSW# >`l(l)("C C' 33 Phone #3~(,.,- / -}0 Plumber's Address 1C i4XC, i _S 1- I F 1 t C % PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. N© sue, r tJlsi~.~.c s e~5 r4,1 Z4.4 4 i aaI` OL- / L o 3 E u . m 4 C -'I SQ'5.> 90, W,. #I (,.wth { 16 5 5 ,l i s Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application r - 167 Fees P ' State o County67-1-; t'C7 Date / Permit Issued (date) - ent Name - / - Inspection ' sNo Stat Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78