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Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER _ IVlelvld' I " 1 1 ~ E11 1)4 TOWNSHIP {)hl SEC. c~ ~p T N-R 9 W
rI 1
ADDRESS 9,,~k I ' 1~laG~W~ ST. CROIX COUNTY, WISCONSIN
SIZE
LOT
LOT
SUBDIVISION
b ZZo - 1 l (c, 3 6 -aoo
PLAN VIEW
Distances and dimensions to meet requirements of I•IHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
'I
IaxSa aeb
a~0 O
~IPPUUUI-
3a
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-t
Af
I IN ICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used -Fop . 0'1 Tje b ~OU e pf f)
Elevation of vertical reference point: 100. 0 Proposed slope at site: I~'
SEPTIC TANK: Manufacturer: Liquid Capacity: jUOO 9t
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation: 95.
Number of feet from nearest Road: Front ,0 Side Rear, 0 a' feet
.From nearest property line Front, 0Side,QRear,O 8s / feet
Number of feet from: well, building: S_
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER 1
Manufacturer: Liquid Capacity:
" tpump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft.
dumber of feet from well:
Number of feet from building:
(Include distances on plot plan). 3k4 -5o7 qt Ax>,z- a 8$•07
I~ oo ENQ ~y~~ ~ 8~-~►
SOIL ABSORPTION SYSTEM Ib.S 7
Bed: Trench:
Width: ~d Length: a Number of Lines: a Area Built: a y
Fill depth to top of pipe: y
Number of feet from nearest property line: Front, O Side, O Rear,O Pt.D_
Number of feet from well: i ~3 S
Number of feet from building:
(Include distances on plot plan).
I
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of ri s used: Elevation of bottom of tank:
Elevation of Inlet:
Number of feet from nearest property line.: Front, O Side, O Rear, OFt.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated,;,; o U 0 Plumber on job:
License Number: U7
3/84:mj
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
1fV QISOItV 1 ; g07 ' State Plan I.D. Number:
vy
4 9 j ec . 26 T29-R19 ❑ CONVENTIONAL ❑ ALTERATIVE (If assigned)
Town of Hudson Lo td
Hi h Meadows Rd. Holding Tank ❑ in-Ground Pressure ❑ Mound
NA OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: IN`SPPECTIO DATE:
eal & Mike Filla 784 Meadow Dr. Hudson TRI 54016 Qa 16130
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.:
I.v' lIJJ.C~'
Name of Plumber: MP/MPRSW No., County: Sanitary Permit Number:
Jim Boumeester 3404 St. Croix 135421
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: T;: WARNING LABEL LOCKING COVER
ra PROVIDED: PROVIDED:
)e e- ,5 96• ~Q I q=`5. / YES NO O
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WEL - . BUILDING: VENT TO FRESH
❑ YES NQ ~ 4 It C ALARM: FEET FROM LINE: AIR INLET: ~
NEAREST 75 z3.
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: MP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF PU ❑ YES ❑ NO NEAREST 1110-
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIALAND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID
BED/TRENCH
i TRENCHES: MRIAL: PIT DEPTH:
DIMENSIONS 1
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: N ISTR. NUMBER OF PROPERTY WE BUILDING: VENT TO FRESH
BELOW PIPES: ABO VER: ELEV. INLET, ELEV. END. PIPES: FEET FROM LINE: / AIR INLET-
G"I . / , y G' J ~ R IC_ NEAREST 00- 77 /
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:
NO
❑ YES ❑ NO ❑ YES ❑ NO El YES ❑
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
BED/TRENCH
TRENCHES:
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:
A ❑ YES ❑ NO ❑ YES ❑ NO NEAREST
I C/
xae~ta in county file for audit.
Sketch System on
Reverse Side. SIGNATU TITLE:
SBD-6710 (R. 06/88)
Eli ~ILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
e....,..,
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than s / 1
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.
PROPER OWN R . PROPERTY LOCATION Q.
~ t/4 t/4, S a T.17, N, R 19 E (or)
PROP OWNER'S MAILING ADDRESS LOT # BLOCK # '
iv
C , STATE ZIP CODE PHO gBER SUBDIVISION NAME O CSM BER
HqbSQ&.0lS<_. 1SVolc
r_j CITY : NEARES R gQAD
II. TYPE OF BUILDING: Check one)
( ❑ State Owned ❑ VILLAGE
sN N~ 1 0
❑ Public W1 or 2 Fam. Dwelling-# of bedrooms 3 PARE TA NUMBER (S) 0 /00_`1 /__~.X
(O
111. BUILDING USE: (If building type is public, check all that apply) a • ! . 77.1
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 only one in line A. Check line B if applicable)
A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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
110 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
SCE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
/W~ '"/7 > o Feet 0 0. oc Feet
Vll. TANK CAPACITY Site
in allons 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 x)00 e
Lift Pump Tank/Si hon Chamber
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number:
Q 0 32~_%)O
_T I & '3q
Plumber's ( treet, City, State, ZR od ) ,
'1 s 6h s l
S 0l
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Approved ❑ Owner Given Initial / - Surcharge Fee) / --2 5"?
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 8 Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
II. Type of building being served.'Check only one-and complete of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 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 development be intended for resale by
owner/contractor,(spec house), then a second form should be retained and
completed when the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property
Location of property 1/4 S 1/4, Section T~ N-Rj J_Y
Township
Mailing address
Address of site
Subdivision name
Lot number
Previous owner of property
Total size of parcel 7
Date parcel was created .~-~--r•-~-~ /
Are all corners and lot lines identifiable? _Yes No
Is this property being developed for resale (spec house)? Yes X No
Volume and 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, and
the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if
available, would be helpful so as to avoid delays of the reviewing process. If
the deed description references to a Certified Survey Map, the Certified Survey
Map shall also be required.
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (out)
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. ; and that I (We)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
of the County Register of Deeds, as Document No.
Signature of owner Signature of Co-Owner (If Applicable)
~-20 a
Date of Signature Date of Signature
. . _ -
DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
1 STATE OF WISCONSIN FORM 2-1982
861 PAGE 621 i.
! - - REGISTERS OFFICE
i ._-___Robert-_E. _-Greenhalgh and Corinne K. Greenhalgh, ST. CROIX CO', WI
Recd for Record
a§ his_ wife and' in her own right
i -
10:50 A
~I conveys and warrants to Neal _M._.Filla•_and__Michael__P________________+
] la,._sit le~gexsons_,_a~ joint`-tenants 'WRe91 erof
DeecEga',.:
j RETURN TO
~i
~ - -
I~ the following described real estate in St.........C.........roix .....................County,
I State of Wisconsin:
Tax Parcel No:
Lot 7 in the Plat of High Meadows, a subdivision located in Sec. 26-T29N-R19W,
Town of Hudson.
FE
I' TR
!
,
j This ________ls__nOt_______. homestead property.
OX (is not)
Exception to warranties: Existing highways, easements and rights of way of record.
Dated this day of January................................
19 90....
_ J
(SEAL) . (SEAL)
• _Robert-_E. --reen- -lgh-_---
Z
----------•-----------------(SEAL) K 1.i.~RX~i1!l.(SEAL)
* .Cozz.nnn__K...GxeQnhalgh.._._.__...
AUTHENTICATION ACKNOWLEDGMENT
Signature (a) STATE OF WISCONSIN
St. Croix County.
authenticated this ________day of__________________________ 19 Personally came before fore ma e this ---fQ4~:_day of
Januar --am
I
._..1'----------------------- 19_---- the above named
Robert E. Greenhalgh and Corinne K !I
- -
Greenhal h husband and wife
TITLE: MEMBER STATE BAR OF WISCONSIN
1t
(If not, . - - E,p'
authorized by § 706.06, Wis. Stats.) /i s
r',z ~I`,-o me known to be the person who executed the
regoing instrument and ackn edge the same.
THIS INSTRUMENT WAS DRAFTED BY Attorney David•_J= Estreen f= 11_.~~
621_ Second _ St . Hudson, W 'Notary Public St. Croix , Wis.
:
(Signatures may be authenticated or ackno My Commission is permanent. (If not, state expiration
are not necessary.) y/j _ Y.
date: -----------------•-------I 199:__._) 'I
*Names of Persons signing in any capacity should be typed or printed below their signatures. ill BAR 6TATFORM No. 2 ISi 82 SIN Stock No. 1$002
L
S T C - 105 r
r ;
SEPTIC TANK MAINTENANCE AC ItEEMEN'T
' o
St. Croix County z
a
9
OWNER/BUYER
ROUTE/BOX NUMBER F7 ` t{ f7,~~iti i'i-f Fire Number
CITY/STATE'ZIP J O / ;
PROPERTY LOCATION: 14 Section c2 T il, R W,
Town of4Ltd50AJ St Croix County, .
Subdivision Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes.. Proper maintenance Cu-n~,
silts of `pumping out,the septic tank every three years or s.opae:r
if needed, by a licensed septic tank .Lm.L~L What you put into
the system can affect the function of thu sv•ptic tank as a treat-
ment `stage in the, waste disposal system.
St. Croix county residents may be.eli'gible`tu receive a grant for,
a maximum of 60% of the cost of replacement of ;a failing system
which was in operation prior to July 1, 1978. St ;Cro., X County
accepted this hrugram 'in ;August of .198U,, with- the roduiroinent tIlat
owners of all new s_ystens, agree to' keeli their systems prop-
maintained, «
The property owner agrees to submit to 5t. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper`ve.ri-
fying that (1) ;the, on-,,site wastewater disposal system is in-proper
ooeratin,g condition and (2) after inspection and pc1111pin;; (lf nee-
essary), t.he,s'eptic tank is less than 1/3 tull.bf sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. o
0
I/WE, the undersi'gned$ have read the above requirements and agree ti
to maintain the-private sewage disposal system in accordance with x
the-standards-set `forth, herein, as set by the Wisconsin Depart- i
ment-of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Off:Lge Within-30 ;days
of the three' year expiration date.
SICNED`
DATE
St. Ctloix C.Junty Zoning Office
P..0. 1•ox 98
Hammoud, WI 54015
715-7S~6-2231 or 715-425-8363
Sign, date and return to above address.
-GLiA)7-fk TEST
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDIJST(~Y, DIVISION
N P.O. BOX 7969
LABOR A(vD PERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELATIONS
s~ (1163.090) & Chapter 145.045)
LOCATION: SECTION: TOWNS111PfMt-1l,+IE:HiAt-fI•Y: LOT N0.:13i K. NO.: SUBDIVISION NAME:
N,r 1/a '4 Z6 /T.27 N/R /9'E (or,
COUNTY: 0VV1'I:` 6 BUYER'S NAME: MAILING ADDRESS:
S~• /j/O~ U nr,~
-5 Cto/ e'vo t n/ y/7 ~j'J o v,PD E" his sf%s~
USE DATES OBSERVATIONS MADE
NO. REDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRITPTIONS: ~E1 AT ON TEST
PResidence 13 x(/,14--- - AlNew ❑Replace DAC'. /3
RATING: S= Site suitable for system U_= Site unsuitable for system J ~S 13 eA'
,
CONNENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
s ❑u a s out au a sou ❑ 1 91U (eVP )71,OV4 47-"r
If Percolation Tests are NOT required DESIGN RATE: r_ I If any portion of the tested area is in the /Ir~
under s.H63.09(5)(b), indicate: e161 S It Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS IA-) '0ZCi Mo-Q-
BORING TOTAL DEPTH TO GROUNDWATER. CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
r ' Dw. Q,u . S 33 ' N . S w/ , Co 7 N tom. 13 .
B l /fib 90,74 3 7,e . QN. cs 7.0 r,/A) d CS
B- Z ~l S l Sri-- ' use 15 ' r,,A.' -A19,;v. s 7. ,4,v v.rRf -W .
9 o r qz Al ' 9 o s z. s • -dy,.. t rs y, ;~I' ?4N vE~ s• B-~ I
B/ 1.2 ,w-- 7/~ 5 . 7S'nFg~~SI /.1s'/IN. S ,
C'A
B-
. aVlffrr,_ elz-alTl,,Av of- )0,etcs PERCOLATION TESTS
TEST l GPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER AFTER SWELLING - INTERVAL-MIN. p€fgiOD 7 PE IOD 2 PERIOD PER INCH
P 1- G 10'i7"- j '941vtv i ti O~e„~ a ` 3
P- AiNV7t5 CS
P-
P_ r
&':E i 7Z 6 3_ w1i7F D.P :v>ro /v is .2 < f
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. 13D 7dAi /sn_~ `
SYSTEM ELEVATION 'o ' ,Q,¢
SyEE~ fE.v~'E ,~OSf f ! I- i ~ ~i~t -
I i \ 631
2-~ e
eltw. Top °a P. 60
/rT• I I ~ ~ X11,, I PZ `T { ~ j
x)j I i j - -
f3 r---- 60 [3 f I I I
w N
1 76
fA)
AREA o' This
~~#estsiteAPPRdVEpI
cQn~! rational septic system.
1
f ,QD LOT-. I ` L
E~S~~fE~r 7; /.OQ _
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief,
NAME (print : ROTV(E$ TESTS WERE COMPLETED, N:
R1. 3 O'NEIL RD., HUDSON, WIS. 54016 e_ C , f y ^ / (r'
--ROBERI-ULBRLCHT^
ADDRESS: CERTIFICATION NUMBER. PHONE NUMBER (optional):
WIS. INSTALLER & DESIGNER LIC. NO. 00663 S dL %pl 3?6
MINN.
CST SIGNATU E:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner end Soil Tester.
Ulf IIFI SBD-6395 (R. 02/82) OVEH -
I_ A N
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OCATION.I _ O.S.. LICENSE:.f= 3VOL
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PT . 0 I CI A'_P
FcNce Post' 83 60~ Qy lv~ pc~s !
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ba -a r, N 75
L 45 Str~
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~uf ~ F~C2 N • 6A<t-6 We r
/iNe -4 SG X Pc RC ` >
f K1~e A
o loo V
_ ~Al
35
14. r(e Rd N,
N'. h Me~Oews ~aAn
, FRES11 AI1: INLETS AND OBSERVATION PI.BE
CROSS SECTION
Approved Vent Cap
Minimum 12" Above < rwf~)
_Final GLaijS'
A" Cast Iron
Above ~Pipe l
To Final Grade Vent Pipe
Marsh Hay Or Synthetic Covcri.ng
Min. 2" Ayg,~ec~I'al
Over Pipe T '.1
Distribution Tee
Pipe 7 _
8qI Aggregate ~o Perforated Pipe ee loc:,
V f ern ~~Q~ Beneath Pipe Coupling Terminating
. Bottom of System
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. B0_` 7969 I. BUREAU OF PLUMBING
MADISON, WI 53707
'f ryy~,
CONVENTIONAL ❑ALTERNATIVE rl, Pla nl.D.NuE] Holding Tank El In-Ground Pressure El Mound assigned)
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Carolyn Stark 417 Monroe St., N. Hudson, WI
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.:
NE SE, Section 26, T29N-R19W, Town of Hudson,Lot#7, High Meadows
Name of Plumber: MP/MPRSW No. County Sanitary Permit Number:
Richard Hopkins 1059 St. Croix 69614
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
OYES ONO OYES ONO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: 1PINE ROPERTY WELL: BUILDING: VENT TO FRESH
ALARM FEET FROM: AIR INLET:
DYES ONO OYES ONO NEAREST
DOSING CHAMBER:
MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
OYES ONO OYES ONO OYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL. BUILDING: JVENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET'
PUMP ON AND OFF) DYES ONO NEAREST
TH DIAMETER MATERIAL AND MARKING
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of lowin
or excavation. (If soil can be rolled into a wire, constructions all cease until FORCE
-1 I
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
I L
J ENGTH: NO.OF DISTR. PIPE SPACING COVER JINSIDE DIA. PITS LIQUID
BED/TRENCH WIDTH:
TRENCHES: MATERIAL: PIT DEPTH:
DIMENSIONS
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: V NT TO FRESH
BELOW PIPES. ABOVE COVER. J ELEV. INLET. ELEV. END. PIPES: FEET FROM LINE: AIR INLET:
NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
OYES ONO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION N WELLS. O NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED OYES O NO
CENTER JEDGES. DEPTH OF TOPSOIL. SODDED. SEEDED: MULCHED:
.
OYES ONO OYES ONO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH: LENGTH. NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER:
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. JDISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. -
ELEVATION ELEV.: DIA.. ELEV.: PIPES: DIA.:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY ER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS:
OYES ONO COV DYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
D YES ❑ NO ❑ YES D NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE: TITLE:
DILHR SBD 6710 (R. 01/82)
E wlsconsln APPLICATION FOR SANITARY PERMIT
•
DILHR (PLB67) 1/ COUNTY
UNIFORM SANITARY PERMIT In0USTRV,LR80R 6NUTgn RELRTIOnS j/
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OW ER MAILING ADDRESS
C,a KO N Y 1'7 N o poIz S~` Norc~'1, -Nu oU '
PROPERTY L C ION CITY: C p
_ViLLAGE:
f-1 /45 1/4, S c~ , Ta9, N, R $ E (or) owN ~
LOT NUMBER 113LO K NUMBER JSUBDIVISION NAM INEAREST ROAD, LAKE OR LANDMARK STATE PL I.D. NUMBER
I R 14
TYPE OF BUILDING OR USE SERVED Al t
1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): \j e NI I om P, f ~ d
THIS PERMIT IS FOR A:
New System ❑ Tank Replacement El Repair
El Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System El Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
Seepage Bed ❑ Seepage Trench U Seepage Pit ❑ Holding Tank
~F_ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Con ete Constructed
Septic Tank Capacity U U 0
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
8 GI J Gp e Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the ttached plans.
Na of Plumber (Prin)): Sig ure: RSW No.: Phone Number:
P umber's dress: Name Desig er: t
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date:
❑ Disapproved
/ 0 d~ / ❑ Owner Given Initial
y up ll7 OPS Approved Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
f
r
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.);
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
~ w
APPLICATION FOR SANITARY PERMIT
SIt,C - 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
then a second form should be retained and completed when the property is
house"),
old and submitted to this office with the appropriate deed recordinb
s g•
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property C0.rolu n 'b ~Aor ~ ~obbivlS
Location of Property NG Section T N - R l9
Township ~aC~S~L
d ~ r3
Mailing Address 4r- A
F-1 u ~s b e lye.
r
division Name i ► o teGAQLvS
~ h
Sub
+i.
Lot Number
Previous Owner of Property ~QL'Jtt (20rj'^n2 0V e-4e0 a''
1
Total Size. of Parcel a a(P.3 ~G'/^ES
Date Parcel was Created Tu yt e R19
Are all corners and lot lines identifiable? ✓ Yes No
Is this property r developed for resale (spec house) ? Yes ✓ No
-
being
Volume and Page Number as recorded with tile Rugister of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
3. Other recordingd filed with the Register of Deeds Office
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 the Certified Survey Map shall also be required.
- - - - - - - - - - -
RTy OWNER CERTIFICATION
E
rROr
1 (We) ceA-t 6y that a Z ataiemem a on rius 1104J11 cvLe true to the but, oD my io 6)
knowledge; 'hat I (we) am (ane-) the otgnen (s) o6 the pnope) ty deseh.i.bed in tU,6
.in6on,rnation i6orcm, by viAtue o6 a wa/vLanty deed aecolcded in the 066ice o6 tAe
County Regti6te/L o6 Deeds a6 Document No. ~ and that I (we)
pneaen.Uy oun .the pupo.6ed zite bon the scu.,Ja3e c.apos system (on 1 (we) have
obtained an eabemen.t, to nun w•lth the above dac&Zbed pnope/Lty, 6oiL the
eomtaucti.or, o6 said system, and the scone leas been duty lceeonded in the 066.ice
o6 the Coun4 y Regiz te/L o6 Deed6, a.a DoewnuLt No. ) .
NATURE (F OWNER SIGNATUI:L OF CO-OWNER (IF APPLICABLE)
SIG /
of _i o ~ ~ 0(1~.~ -
DATE SIGNED DATE SIGNED
DoCUME54T NO. STATE BAR OF WTSCONrtN FORM 1 -1982 T1IIr. 9PA(F_ REbLRVF.O FOR RECORDING DATA
WARRANTY DEED
o
X019
This Deed, made betweenRobert.-E.GTeenl>:a-1gh-and
orinue..K.__Gr_ee.uha.jgh......
- - -
. Grantor,
and._.Caralyn_.D,_-Stark-and-.Catherine__E..--Dobbins-,-. a.s. _ j of at..
tenants
- , Grantee,
Witnesseth, That the said Grantor, for a valuable consideration--.___
- - -
RETURN TO
" conveys to Grantee the following described real estate in _-.St_-.Croix-.-_.._____
County, State of Wisconsin:
Lot 7, High Meadows "Addition •to the Town of Hudson. -
Tax Parcel No-
4~
I
I ~
.1 I
'
This is-Rat........... homestead property.
64 at)
Together with all and singular the hereditamenLs and appurtenances th nto beloroir. ;
And.R_Gbgrtr_.E,__Gr-eenha].gh_and,._-Corinne__K__Greenhalg i------------------------------
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
easements, covenants and restrictions of record, if any,
i,
ii
and will warrant and defend the same.
Dated this day of---------- DL elttb.er------ - 19.84_._.
. I
(SEAL) -------------"----•---------------------------•-----------------•--(SEAL)
ROBERT E. GREENHALGH
------------(SEAL) -----(SEAL)
Ct~INE K GH
" - RR_ _
*
AUTHENTICATION ACKNOWLEDGMENT
Signature (s) STATE OF WISCONSIN
ss.
St, --Cr-oix•..._••--._--------County.
authenticated this day of...... 19 Personally came before me this day of
Darzambeex-------------- 19$1---- the above named
•
•-•-•--Ro art.- _ G eenhalgh _an~
* Corrine K. reen algi
TITLE: MEMBER STATE BAR OF WISCONSIN
u not_ to me known to be the person$----------- who executed the
(If authorized by § 706.06, Wis. Stats.)
i
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAF'1"ED BY
HEYWOOD
CARI & MURRAY
by Samuel R. Cari -
P-;O-.--Box- 229-i--Hudson-j.-tdis-:-----5.441-6----- t y, W
(Signatures may be authenticated or acknowledged. Both My Co misston is permanent. (if not, state ex ration
are not necessary.) date: Co Public anon - rolx........ opi a .
, 19
I
-Names of persons signing in any capacity should be typed or printed below tbeir riignatures. j
«
t?J.sir, ..n )Lc"I_, lr.~'t R[tiCt;v, 11 i*! n Leal Blank Co. Inc.
WB43: Amendment; To Contract Of Sale Wisconsin Legal Blank Co., Ins.
Approved by the Wisconsin Department of Regulation and Licensing Milwaukee, Wis.
5-1-82 a
d
AMENDMENT TO CONTRACT OF SALE ;
1 It is hereb mutually agreed that the offer dated P"e m l e r..... 6.. • • • • • • • • • • • 1
2 and accepted Ca- ...60 • j19gY, between the undersigned for the sale and
3 purchase of the real estate at..f •~°G1u7 •
4 ...................................................................3. is hereby amended as follows:
5 (X) Closing date is changed fromTeQ~.W.\•2A-r.~....(• .I. g~........... to 4 .t .l • .
6 ( ) Purchase price is changed from $ to $ .
~O Occupancy of,the property is rrhanged, fromClP• ~-1. n.q. • Pta h, rr,i• ~1 L e i .
8 ( ) Occupancy charge is changed from $ per day to $ per day.
9 ( ) Buyer is aware there are contemplated special assessments in the estimated amount of $ for the
10 installation of.. and agrees to pay for same.
11 ( ) Seller agrees to pay $ to Buyer at closing for 0#4templated special assessments
12 for the installation of
13 ( ) Seller shall provide title insurance per contract printed provisions in the amount of purchase price and Buyer agrees to pay the difference
14 in cost between the title policy and extension of the existing abstracts.
;
15 ( ) The financing contingency is changed as follows: loan amount from $ to $
16 interest rate from to due date from , years to. . , y4m; monthly p&yme%K from
17 to ; and .
18 ( ) The following item(s) of personal property are excluded from sale:... , ,
19 . .
20 ( ) The following item(s) of personal property are included in sale: • • • • • • • • • • • • • • • • • • •
21 ........k.. .
22 { )'Buyer and/or Seller waive the following contingencies: • • • : • • • • • •
23 qdl~
24 .
25 err... ,v..s ~1v,isStgtj... r..... f°.,P.hS•.k0e, •!4.f'?.... q <,,7 ~W.
26 aid krx?. ~pT.r+ Q fe- V- ....~^e .lv 4 as o ~.s...
274Q.!1 A .
28
29 All other terns of said contract shall remain unchanged and in full force and effect as though fully set forth at length inthis amendment: THIS
30 IS A LEGALLY BINDING AMENDMENT TO SAID CONTRACT.
31 Dated: CO? I`a
32 . .
33 (Buyer) Seller)
3 . (Buyer)........... • (Sellesf)..
35.
36 THIS AMENDMENT SHOULD BE ATTACHED 10 THE OFFER TO PURCHASE.
II° 88
I~•
ST. CROIX COUNTY ABSTRACT COMPANY
HUDSON, WISCONSIN
CONTINUATION OF ABSTRACT NO. 16,074
From the 6th day of November 19 79 at 8: 00 o'clock in the --A-M,
of the land described as:
Lot 7, High Meadows in the Town of Hudson.
89
Glenn A. Waxon and Vycella M. Land Contract.
Waxon, his wife and in her own Con. $
, 1979.
behalf, Dated N Novov. . 233,
Ack. Nov. 23, 1979.
Rec. Nov. 26, 1979.
-to- In "605", page 64, #361397.
Robert E. and Corinne K.
Greenhalgh, husband and
wife as joint tenants.
Lot 7 in the Plat of High Meadows, a subdivision located in Section 26-29-19,
s Town of Hudson.
Also a non-exclusive easement to use as an access road the private road show
a on the Plat of High Meadows and the road extending Easterly therefrom to Kinney
Road, which is the town highway running along the Easterly line of the Southeast
1/4 of Section 26-29-19.
^ Recites: Subject to protective covenants of record, utility easements of re ord,
i if any, and an easement for walkway and maintenance vehicles as shown on said pla .
This is not homestead property.
Except Protective Covenants of record, utility easements of record, if any,
i and an easement for walkway and maintenance vehicles as shown on said plat.
.r
90
Glenn A. Waxon and Vycella Warranty Deed.
Con. Valuable.
Waxon, his wife and in her Dated March 31, 1983.
own behalf, Ack. March 31, 1983.
Rec. April 1, 1983.
-to- In "662", page 84, #383624.
Robert E. Greenhalgh and Corinne
K. Greenhalgh, husband and wife as
joint tenants.
1
Lots 7 and 11 in the Plat of High Meadows, a sub-division located in Section
26-•29-29, Town of Hudson.
Also a non-exclusive easement to use as an access road the private road
shown on the Plat of High Meadows and the road extending Easterly therefrom to
Kinney Road, which is the town highway running along the Easterly line of the SE'/4
of Section 26-29-19.
`s Recites: Subject to protective covenants of record, utility easements of re ord,
if any, and an easement for walkway and maintenance vehicles as shown on said pla .
This deed is given in performance of two land contracts between the parties oth
dated November 23, 1979 and recorded in the Office of the Register of Deeds for S .
Croix County, Wisconsin on November 26, 1979, in Volume 605, Pages 64-65, (No. 89) as
Document 36.1397 and pages 1b6=6"T,- as ocumen .
This is homestead property.
($17.00 Transfer Fee).
ST. CROIX COUNTY ABSTRACT COMPANY
CONTINUATION OF ABSTRACT
1 4
c. I
Ln
S T C - 105 r
y
SEP'T'IC TANK MAINTENANCE A(:ItI,'LMEN'I' ~ o
St. Croix County
d
11
OWNER/BUYER %S*Mr1 L.0► er~n~ . 10661ns m
ROUTE/BOX NUMBER ~A' z~/_'p /Q Fire Number 1 58
CITY/ STATE =W0jd*,0r WT~S~COn6tY~ __L 1P ~+~Q~lp
PROPERTY LOCATION: Section_ 1_'2_,x, R I9 W,
~,dSOy~ St. Croix County,
Town of
Subdivision-pt; h Rlaul ua , Lot number 7
- )
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank Lumber. What you put into
the system can affect the function Of the sul~tic tank as a treat-
ment stage in the waste diSpL)Sal system.
St. Croix County residents may be eligible to receive a grant 1,or.
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1080, with the requirement that
owners of all new s stews agree to keel, tht-ir systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner ind by a master plumber,
journeyman plumber, restricted plumber or a licensed 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 sludge and scum.
Certification furor will be sent approximately 30 days prior to
three year expiration. Ho
ZZ
I/WE, the undersigned, have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with x
H
the-standards set forth, herein, as set by the Wisconsin Depart- 'a
went of Natural Resources. Certification corm must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED
DATE
St. Ctioix C.,unty Zoning Office
P.O. 1• o x 98
Hammord, WI 54015
715-7S6-2239 or 715-425-8363
Sign, date and return to above address.
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A
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
IN~JSTRY, . DIVISION
1 c P.O. BOX 7969
LABOR HUMAN RE AND LATLpN¢ PERCOLATION TESTS (115) MADISON, WI 53707
s _ (H63.090) & Chapter 145.045)
1 ?
LOCATION: SECTION: 1-OWNSHIP +@+ TY: LOTNO.:BLK.NO.:SUBDIVISION NAME:
NE 1/ 1/ zce /PIN/R IE (o f/ut~s~►-~ r~ h~i' ~vE~vaws
COUNTY: ("V1!tWfo BUYER'S NAME: MAILING ADDRESS: s~. ~o UD
pis sf%
.s (,4 CA, O L Al sT.rr~k %17 M axloPo E
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: 1-T ~C FILE DESCRIPT ONS: 1PERCOLATION TEST
Residence 3 New ❑Replace • I3 ~Dn • I t_
RATING: S= Site suitable for system U= Site unsuitable for system
57c.:570 CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
ES ❑U EIS ❑U IS ❑U ❑S NU DS 21U (0VI/Vv1, 490,4 /Lxs'z
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: CGASS -T- I Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS I'V LZec i tito>Z /c1.
BORING TOTAL DEPTH TO GROUNDWATER. CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
' > N . 33 ' u . S w/ . , . !0 7 N . k
B- L /s 3 4~e . s RA). JlAtcj Cs 7. o ' r.4AJ d CS
. ~•o,~/3N. s/ /.25* •,oy-ey, Si, ?.s,P' k;X. e~ Ra.
B- Z /l. 5 / ~Z err S use. (S ; TAB , s 7.17 .,ti #&e e"s G~
B-3 a •.S r 9y ' 9YJ`" > 43 'Pd- [3u. 7'
0
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.S0, 6e- (::!F/Z- (14TIOKIX OF Pis PERCOLATION TESTS
TEST PrPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
P L „ w,s*rEA D 410tO /.v a 3
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PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. nD 17dAi
SYSTEM ELEVATION 7" 0 =_tC3.4_ct/__W ~!Ts
}
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): HUMESIIE SEPIIC PLUMBING CO. TESTS WERE COMPLETED N:
RT. 3 O'NEIL RD., HUDSON, WIS. 54016
ROBERT I II RRICHT
ADDRESS: WIS. MASTER PLUMBER UC. NO. 3307 MARI CERTIFICATION NUMBER. PHONE NUMBER (optional):
MINN. INSTALLER & DESIGNER LIC. NO. 00663 J. =6 L yFL_
CST SIGNATU E:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
h
ti
INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6395
To be a complete and accurate soil test, your report Must include;
1. Complete legal description;
2. Ttfe use section rh t clearly indicate whether this is a residence or commercial project;
3, MAXIMUM numL of bedrooms or commercial use planned;
4. Is this a new or r nent system;
5. Complete the suit.-`.i rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTIF RULED OUT BASED ON SOIL CONDITIONS;
0. PLEASE use t# ins shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLf_ diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheet may ta, r=sed,if desired;
8. Make, sure your benchmark and vertical elevation reference point are clearly shown, and are permanent;
9. Complete all appro,niate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
tion, if appropr
10. If the informati- , as flood plain, elevation) does not 2 afaly, place N.A. i )priate box;
11. Sign the form an i place your current address and your cert 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 - Sconce (over, 10") BR - Bedrock
cob - Cobble (3 - 10") SS - Sandstone
gr - Gravel (under 3") LS - Limestone
s - Sand HGW High Grou11d4
cs. - Coarse Sand Perc f'nrcolationG<t:
rned s Medium Sand W - U'I
fs - Fine Sand Bldg - ?dir
Is Loamy Sand > - G ater Than
~s# - Sandy Loam < Leis Than
"l - Loam Bra - Brovvn
#sII - Silt Loarn BI - Black
Si - Silt Gy Gray
.cl - Clay Loam Y Yellow
scl - Sandy Clay Loam R Red
si-cl - Silty Clay Loam mot - Mottles
sc 7dy Clay Vii" with
sic - Clay fff few, fir,:
c cc _ comma
pi - # mm - Many,
m - Muck is d - distinct
P - promine
HVVL High v,_
Six genfer-r I'r~'xtures r surfar
for liquid isposal ' BM - Bench N/
VRP Vertic "Ice Point
TO THE OWNER:
This soil test report is th,, _ •r
ire county or the D q--, ~ y rccJuest
verifi ation of this sc A com~jlete set of ;e private
sir and a p app' > local , order- to
The
HOME MARKETING CONCEPTS
i M
TWO BUILDING SITES
Thes two lovely lots in High Meadows Addition in Hudson
Township have Rolling hills, nice view, south facing
slopes and easy access to the freeway. Lot 7 is priced
at $12,000 and Lot 11 is $11,000.
HOMESITE SEPTIC PIUiNG CO.
' RT. 3 O'NEIL RD., HUDSON; YAS
o RWAT UL8"T
+ WIS. MASTER PLUMBER liC. NQ $307 MAR.&
MINN. IN31ALLER i DEStt}NES I tC NO, 00663
7T S8~_ ~l 66'
E 37-156*
N 81• 42' S 89. 37'22"E 300 Or
o
J1 W
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F A
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a 437-
w Z 1 275 p0 T ' 12 63 _ _ _300 13' ' - 1
# I.\i`~.. - 943-54' MENnn
600 ,N -
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B L. ` 67 PLOT AN(► 10SS SECTI~~ICI
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N A M.E *CP'P'0) N S_ KNAME Irv
DENSE-
'LOCATION ~ ~nf
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35
170'
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r 'fkor►e fed loo-o'
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FRESIi AIR I: IL I'S AND OBSERVATION PIPE
C I-110
So-SECTION
Approved Vent Cap
Minimum 12" Above-:
b Final Grac~____.__..
I II
leAX.
4" Cast Iron
Above Pipe Vent Pipe
To Final Grades--
Marsh Hay Or Synthetic Covering
Min. 2" Agg.re%l1
Over Pipe
Tee
Distribution It
Pipe
-_lo
Aggregate Perforated Pipe Below
' Beneath Pipe 4 -Coupling Terminating At
(~J
~~LIt1.M___l>~$ Bot.t_om of System