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HomeMy WebLinkAbout030-2069-95-000 l r r ST. CROIX COUNTY �> WISCONSIN yl r, N use. ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 5, M9 WPIPq1111 911 FOURTH STREET • HUDSON,WI 54016 Owl (715) 386-4680 Sept. 24 , 1991 Peg Starke First National Bank/Hudson 307 2nd St. Hudson, WI 54016 Dear Ms. Stark: An inspection of the septic system on the property of Nolan & Marilynn Jones located at 1292 27th St. , Hudson, WI was conducted on Sept. 23 , 1991 . 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. Sincerely, Ma J J4enk s CY Ass t nt Zoning Administrator cj ST. CROIX COUNTY ZONING OFFICE St . Croix County Courthouse �0 911 4th Street r, Hudson, WI 54016 Telephone - ( 715 ) 386-4680 The St . Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals . Completion of this form is essential so that the property can be located . Please provide the following information, enclose appropriate fee made payable to St . Croix County Zoning Office, and mail, along with form to the above address . Testing will be done as soon as possible after fee and form are received . WATER TESTING----------------------------FEE: $ 25. 00 /I (For nitrates and coliform bacteria) WATER TESTING FEE: $127 . 00 (For VOC' S ) x SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at time of inspection) Property owner 's name WHAM L —"bN S +- t-, 2. [LY/V/V J. JO/\(ES Property owner ' s address jag °1 °7� T1+ S� Legal Descri tion 1/4 of the 1/4 of Section a _, T N-R Town of S s Lot Number Subdivision Name FIRE NUMBER LOCK BOX NUMBER Color of house Realty sign by house? OXD If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i .e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted . WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home , necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained . Firm or individual requesting services :T,// L( &%K= Telephone Number `l(� — 3 � SS 1 REPORT TO BE EN TO: PCt: S17-1-e Ke FAQ :�-O^l 2.� 40/).30ti Closing da - ( - Signature COFAMERCIAL TESTING LABORATORY, INC. 514 eAain Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.: 11411/01 PAGE 1 ST. CROIX COMITY REPORT DATE: 9/26/91 COWTHOUSE DATE RECEIVED: 9/24/91 HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER: Nolan & Marilyn Jones 3� 0, Z0, 6o/I LOCATION: 1 udson COLLECTOR: M. Jenkins SOURCE OF SAMPLE: Kitchen faucet COLIFORM: 0 /100 ml INTERPRETATION: Bacteriologically SAFE NITRATE-N: { 1 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 mt Nitrate-Nitrogen, mg/L LAB TECHNICIAN: Pam Gane WI Approved Lab No. 19 J i �.\NDEVENOFNr � < Means "LESS THAN" Detectable Level Approved by: I ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 y y Cp a o a ~ y 0 © s H CL o ~ N C L i y U .3 o L U N O V7 N O> ~ N T N C y o ,J a a -a N a) N a) a) o Z 3 C C 7 m E o LL C O C O _ f0 c E 4 0. U I _O M d CL a) LU O N Z O N O d E p z y c > d m co (0 10 F Z c 0 O Z ? u o N - ~ O n Z C tq F- r Ca : rn v co 1~.]~1V1 N O N (n N C a L O c O co V O Q zl-Z o N w c N E o' is 0 - d .6 G w C O O tVl. Nl y O O O G U N co Q IL E M N N N co N~ E w O \O N N a O v v Z O O a a a a c (mil N O O 1}~~ t% U rn rn o `l S z ..O N a O C) p O N O O 6 Q a. O 04 C) N w N a) O O a) Q Q N 7 04 U) r) Q O 3 N N C © O O C O O ON O O O O O j a) N 0 r \ 6 0 0 0 <p t O O- O- 'Ly N N N N v Q Zo O 0 Z C E E N V' co N co O . NO t L O r O N 04 0 ~ co N H aa) nr (6 cl -1 c: O ~ N E E U • y' O M U) O N O N om= C/) O ~ _ E N ~ d y a EL L: a CL A v a m 0 (n 0 4 FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 11'011A/ ~S TOWNSHIP_ S7 ~JbS~`~~f"'_ SECTION 9Ce T N,~~-//R 2-' W ADDRESS I)-I~Z a 7'I~ S T ST. CROIX COUNTY, WISCONSIN HuDSO,- cc~i .S~ld/ L SUBDIVISION N//I LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i INDICATE NORTH ARROW 7-0P OF RE file nENCItxARK:Elevation and description:_5W, "e-"A _ lEV~rio i s "eO.0 Alternate benchmark TOP 0rc4Xr0Sf-V S;Pr'c. 'r4fe c-ocJce o_v SEPTIC TANK:bianufacturer: Z/v.t'vocv.✓ Liquid cap. to f0 75' Z ,s Rings used:ly Manhole cover elev:=Final grade elev: Tank inlet elev.: 9z - ~oS Tank outl ~a, 3Z et elev.: No. of feet from nearest road:Front>/C) Side , Rear Ft. From nearest prop. line:Front , Sidpoo , Rear Ft. Na. -10 No. of feet from, Well ~ 75 , Building: 2 ~ (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE op PUMP CHAMBER Manufacturer: L uid capacity: Pump Model:_Pump/Siphon anufact.: Pump Size Elevation of inlet: ttom of tank elevation Pump on elev.: Pum off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from earest prop. line: Front_,, Side_, Rear-Ft. Distance fr m: Well Building 2 6~-vf S SOIL ABSORPTION SYSTEM Bed: Trench: x Seepage Pit: CPS Width: 5 Length 70 Number of Lines: Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: -~D 20 No. feet from nearest prop. line:Front , Side Rear Ft. No. feet from well: No. feet from building y60 HOLDING TANK Manufacturer: acity: No. of rings used: Elevatio of bottom tank: Elevation of inlet: No. feet from near t prop. line:Front , Side , Rear Ft. No. feet fro Well building nearest road Alarm M ufacturer: / INSPECTOR:, PLUMBER ON JOB ADS DATE: LICENSE NUMBER: 110MESITE SEPTIC PLUMBING CO. 6 /9 0 : c j Eby O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT S. MASTER PLUMBER LIC. N0.3307 M.P.R.S. t17,TALLER & LESIGt4ER LIC. N0. 00663 z 1 y PLO 1 P LA J 3 ARK' I JJ I ~7Cti'1'r~ ~Tr0s~' A,4 6 I e S S~ R ° ~ u/ ~dovE fP6uaD ~ 3 ~o~,t';vim covk 49 y E/~u= y5.S1' F QIV~' o ' a `~~5.6~ 6ySTEH = ~y 10 •lo M ' / ` Of g5 , . I+ S,uGtT T° ~ ~ , / ~ PI' ~lv• I8 ' . \ oY PIS' T4. 2,71-q( ~ iS'TR e$ o ri oa ER re~NC~ PVC ~i pt' 0 • ppFaeps Fi RST' 6tPVC- T'y4yl~ - ~ou•.~D ,t~,~ ~v~,~ c r~1Z RCN I<a o w~v C EST! F/1: D F.o TS ~/V /A- ~~p r - Q p Rod`s C PP'CCA.ST, t 4orE- • k ~~v o~p = 53 ` Fou,u o - w ' GA-/LvLM`t0 //O/vyE - /1790 ~1JS• Sct/~ ; = 2 O If Fo HOMESITE SEPTIC PLUMBING CO. 655 OWEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT - `JIS. MASTER PLUMBER LIC. NO. 3307 MLP.R.S. .gel. INSTALLER & DESIGNER LIC. NO. 00W #k 1(,LA+--- 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 MADISON WI 53707 State Plan I.D. Number: NWk, NE - i Sec . 36 , T30-R2O CONVENTIONAL El ALTERATIVE (If assigned) Town of St. Joseph 2 ❑ Hol Ing Tank El In-Ground Pressure El Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Nolan L Jones 127th S Hudson. WI 090 = BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. P1. E T REF. PT. ELEV.: X yes. , o Name of Plumber: MP/MP SW No.: County: Sanitary Permit Number: R r Ulbricht 3307 S Croix SEPTIC TANK/ MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK O LEV.: WARNING LABEL LOCKING COVER ~ PROVIDED: PRO IDED: (.(,r,Kn O (D ' 3 / YES NO YES ❑ NO BEDDING: VENT DIA.: VENT MATE: HIGH WATER NUMBER OF ROAD: PROPERT WEL BUILDI G: VENT TO FRESH 4 ALARM: FEET FROM LINE: / AIR INLET: ❑ YES E] NO *1 ❑ YES NO NEAREST-111" > l~ "'95' a7 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: PUMP AND CONTROLS OPERA NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN OM LINE: AIR INLET: PUMP ON AND OFF ❑ YES ❑ NO NEARES SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIXIII R: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, qin r c,tion shall cease until MAIN the soil is dry enough to continue.) c ~I• , CONVENTIONAL SYSTEM BED/TRENCH WIDTH: L NO. OF DI STIR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS s 45070 c? GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. nPIPE MATER AL' NO. I TR. NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH 40 , BELOW PIPES: ABOVE COVER: ELEV LET: . EN`: /-Cf{ Sr• PIPES: FEET FROM LINE: / AIR INLET:, 7v ~J v hD C UnF C~✓Ci NEAREST ~ 710D_'--q4 ~ MOUND SYSTE OIC4'C'0'~ kcae_ Mound site plowed 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/ D 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: NO. OF LATERAL SPACI GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MAT AL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIA VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF LI 2PERTY WELL: BUILDING: FEET FROM ❑ YES ❑ NO ❑ YES ❑ NO NEAREST "Lx't,G'v c/~ /a •'~'~/!~E C O~C%/\ 4 nc1~C~lCtu r+ .end Gw c+~ 1..6~e o r ~P~`"'~ t crvc ~d/4 (A-) 00 t 9 Koh, 09 7 i I Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: SBD-6710 (R. 06/88) :71 DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY K STATE SANI R PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 8% x 11 inches in size. 4 k irZ into7previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. iV , A PROPERTY OWNER PROPERTY LOCATION A104.4A L , ~D~VE S N&;'/a Pi_: '/a, s 36 T20, N, R 20 E (or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK# l7-yZ :r) :5r CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 4u p.SO..a &ns . 5*6/4, ~-y 6 0166 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State owned ❑ VILLAGE : 5- f. Uwa P 2- -7 +tii $ T ❑ Public IX 1 or 2 Fam. Dwelling-# of bedrooms PAR L TAX U ll[/ III. BUILDING USE: (If building type is public, check all that apply) L-3&' ~ Q 2,0 1 El 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. K 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) E*a, 7~e Env CJk S r 1( (o C,- Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 p Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit 2 Pressure ~s 43 ❑ Vault Privy 14 ❑ System-In-Fill ~~~iii 2 DU1rZSi21lS1D 72eA..) S 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//~ay/sq. ft.) (Min./inch) 64/, 8 ELEVATION YJ Al f5 CQ6Q • `erg A Z Feet Feet VII. TANK CAPACITY Site INFORMATION in allons Total #of Manufacturer's Prefab. Fiber- Exper. New istin Gallons Tanks Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank N v Lift Pump Tank/Si hon Chamber 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 Signa re: (No Stamps) lMft/MPRSW No.: Business Phone Number: 2o8€Rr 21_Bpick'T P0 330? '7157 -PlJ05 Plumber's Address (Street, City, State, Zip Code): 6 SS 0'N~- ~ ffvDSO ~v is. syo~ Co IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued issuing Agent Signat No Stam 4ipproved I El Owner Given initial surcharge Fee) A v D rmi i n 0 7 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a 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; (Jose 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 9TC-100 This application form is to be eonplatod In full and signed by the owner(s) of the property being developed. Any Inadequacies will only result In delays of the parmIt Issuance. -Should this development be intended tot resale by owner/contractot,(spec house), thon a second torn should be retained and completed when the property Is sold and submitted to this office with the appropriate deed recording. a-------------- a------ Ovnet of property N~ L~,~ ~d ~7CS Location of property 1/4 ~ 1/4, Section 30 T 3=r-R=Y s Tovnshlp TO Matting address f~vDSo,~ Lv/'S , S yQ/ w - Address of site _ 41% •ubdivlslon name ' Lot number previous owner of property ~Eu✓~yNE IJ~RR~/ Total size of parcel _ .2. Date parcel wee created Are all corners and lot lines ldsntitlablst ~,_Yes 0 Is this property being developed for resale ('spec house)T,__Ya8 ..o VDItllM o 7l,+end Page Humber as recorded vlth the Register of Deeds - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - r w - INCLUDE - - - - - - - - - - - - - - - - - - - - - - - - - - WITH THIS APPLICATION THE FOLLOwINC1 A VAARAHTY DIND which Includes a DOCUMSHT NUMBIR, VOLUMQ AHD PAOR HUMs[R, and the DR&L OF Tels RRaISTER OF DRRDS. In addltlon, a eettlfled survey, it available, would be helpful so as to avoid delays of the reviewing process. it the deed deactiptlon references to a Csitlfled survey Map, the Csttlfled Survey Map shall also be tequired. PROPERTY OWNER CERTIFICATION i(Ve) cectlfy that all statements on this form are true to the best of my (out) Rnovledgel that I (we) am (ate) the owner(s) of the property described In this Intot atlon form, by virtue of a Warranty dead recorded In the Office of the County Register of Deeds as Document ma. _3_S7117- presently own the proposed site for the sewage disposal system j(atdit(v~)[ have obtained an 0onament, to run with the above deacribed property, [or she construction of ssld system, and the same has been duly recorded In the o[[Iee o[ the oynty Register o[ Deeds, as Document No. signature of Own c 8lgnatuta of Co-owner (lt Applicable) Dete at elgnatuce Date of signature STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/Bd-YM D L A Al L , oN E S ROUTE/BOX NUMBER I Z 4a-7 4h FIRE NO. / 29 CITY/STATE zip yFI/~ PROPERTY LOCATION : 4) 1/4 1/4, Section 3 , T v N, R W, Town of s- J o's 1E St. Croix County, Subdivision , Lot No. Improper use and maintenance of your septic system could result in its premature failfire 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, 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. i I L SIGNED DATE 9 g e> 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 I 1- 2 1 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the 'V 0 L14A.J J U'uE- S residence located at: !V(V 1/4, 1/4, Sec. Re_, T ~0 N, R 20 W, Town of 54' To Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced N G~ Did flow back occur from absorption system? Yes No (if no, skip next line) Approximate volume or length of time: ~ns minutes capacity: K Construction: Prefab Concrete Steel Other Manufacurer (if known) : 5r12C ' OF 7-4'v1<~ ? x Age of Tank (if known) : 1006) - I L-Y4 f r~ ; 0 R -t-1) , ~ ) (Signature) (Name) Please Print 119) BPS 336 7 , ,"--!C 3 3 6 -7 (Title) (License Number) (Date) - Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name ROOF-e T 70hR (C 4 Signature MP7CMPRS 33Q 5/88 - ; k ~~tt ti5'~Y ~ ~ ti '4 ~ ~ ~ I~~ i ''z Y~_t ~ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION 4:4BOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N W1 3707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/MtPNtet1i`%tt1T4: OT NO. BLK. NO.: SUBDIVISION NAME: OW 1/ A!5'114 3CP /T3 o N/R 2-0 E (o Ms r' ~ osEP ~i`-- COUNTY: MAILING ADDRESS: 5~-. C,P04 IVOZAA) J"D,vES ~i9z 21-rr^ 577 Igo L) LTo,-3 W S , S4o~'Z USE DATES OBSERVATIONS MADE PROFILE DESCRIPTIONS: PERCOLATION TESTS: NO. B2EDRMS.: COMMERCIAL DESCRIPTION: Residence J Ni ff'. ❑New Replace N~V J / f'O RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: ~Eols YSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:(optional) ®s ou ©s ©u ®s au ou as ou 51o E $ E1CCtcSS;LnF- tn cuRu oN Cv.v Td v 2 . 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: G L/1 S S Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. E T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 76 83. 9Y' v ` ~O S . . w / L I (p BbKK 15- PA-- 8 a . 1S 2 1 " 'Q N . • e o v'e k-e_ B- Z /DZ P4, 27 > /O 2 /s IS loos-e 2r/ a~9 S If B. 1~6e o 1. ~P Sg cc- 35 //Q y- r,,. s 38" Rr. by 3 lD ~N / PP_"' (""-'T- oR-9Y. H Ot S y yo o~ 6-y o r ~y- A. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DR I WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD PER INCH - < Z P-7- 3,o' S Is/ 2/4 i& P-3 3. z' 2- 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 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. i Crt`f' T RE u - y ~d LdCV I-le EAv e-Gt- 00 Z0 • SYSTEM ELEVATION. S 15 s t/, oiQ5 o, - TH Ir I L'i if 'e, I- V r j I rt #r V , A 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): TESTS WERE COMPLETED ON: HOMESITE SEPTIC PLUMBING CO. 4/610V S 1 `l 855 O'NE11 Rn„hIjDSON. WI$., 54016 _ ADDRESS: ROBERT ULBRIGHT CERTIFICATION NUMBER: PHONE NUMBER (optional): ,.VM. MASTER PLUMBER LIC. NO. 3307 MR.R.S. 2 q d Z 3(F6 `INN. INSTALLER & U€SIGNE LI , NO, OOb63 CST SIGN,ATTU~RE~ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - 2--7 s T- . l well E~i51~a~ 0 To 'R E RE 24 , -FOR coD~- cow I i•Ra c2 : I-_. P - ' 3 $~aRM F~~ST/vim p,~~ •c►!•Sr I ~ IfoMt; ~ S~T/G 7>t,~it 30~ 5 ~itAbE ool 30 i • - B~4CKh~E ~f rs ~ ~ X = /~iC~C TESTS 27 I n' vtRr. /O7' is ~PP,yRE,u S~ ~ OF f I , 1 I TDP OF c o-v r~.cf Fiti, w 6- - ;7 7 c 7o P.tTia - DaoR 5~~46 Ar S.o coQasl2 83 t ' X11 f\ f . CPO 1 Zs 85 I II III H014ESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT `ST ay~L '.M. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. :INN. INSTALLER & DESIGNER LIC. NO. 00663 P l- O -r P L A AJ .j N, Fresh Air Inlets And Observation Pipe -Approved Vent Cap .P ' Minimum 12" Above Final Grade SIDE' 4" Cast Iron ' 2- " Above Pipe - t Vent 'Pipe' ` -io Final Grade Synthetic Covering min. 2" Aggregate Over Pipe Distribution Tee pipe Flo 0 0 0 0 , CQ Aggregate 0 Pertbrated Pipe Below Beneath Pipe V 0 Coupling Terminating At son Bottom Of S.ys,tem if S S TE ~ ZQ~ v Fresh Air Inlets And Observation Pipe h ~yJ Approved Vent Cap Minimum 12" Above Final Grade 1 _ 4" Cast Iron 2$ Above Pipe Vent Pipe 'to Final Grade Synthetic Covering i1 Min. 2" Aggregate Over Pipe Distribution 5c4, 2--721y Tee I.i Pipe 0 0 0 0 o F. Aggregate j (0 o Perforated Pipe Below Beneath Pipe 0 Coupling Terminating At 1 Bottom Of System 2--7 +4, S T-. 0 To 13 R~• 2tSED -Foe coDaF- com pi o ce : I- I I 3 $~aRrt 4PPyhP, l7ly `°no,(,p• ( Gl" 30 SSv,'4EO ~P~ RE u r ,q tpE~1- of v t R r. P~ F P7' /s S'ySTt~ 1 i ToP of co,c,GtHf P.triv- D5ol2 stAB 5 . w • coea~2 A r M ; B3 sySTCM~ 6(&-VAT i•ofJ = /d 0, D 414, - 8q. So cif et-Ev " I co (po 8 ox . i 1 ~f 1 ' ZI s US 1 PJ ~ y HO?4ESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT `sr 41 2-jKe2 '-VIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. 'INN. INSTALLER & DESIGNER LIC. NO. 00663 PLC)-r ILL AJ N014 V TO A-) 6-s f{a~vE Parcel 030-2069-95-000 12/05/2006 11:31 AM PAGE 1 OF 1 Alt. Parcel 36.30.20.611 D 030 - TOWN OF SAINT JOSEPH Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - HOEL, PATRICK L & KRISTIN E PATRICK L & KRISTIN E HOEL 1292 27TH AVE HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1292 27TH AVE SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.280 Plat: N/A-NOT AVAILABLE SEC 36 T30N R20W NW NE COM N 1/4 COR, E Block/Condo Bldg: 1247.3 FT TO CL TN RD, S 66 FT, W 570 FT, S 231 FT TO POB: S 231 FT, E 383.59 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) FT TO CL RD TH NELY ON CL TO PT E OF POB 36-30N-20W TH W TO POB Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1180/429 WD 2006 SUMMARY Bill Fair Market Value: Assessed with: 170059 256,600 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.280 77,400 145,200 222,600 NO Totals for 2006: General Property 2.280 77,400 145,200 222,600 Woodland 0.000 0 0 Totals for 2005: General Property 2.280 77,400 145,200 222,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 124 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROIX CO W I SCO ZONING C~ , NMr0 p,M. NOUN~ ST.CROIX000NTY RNMLI ER 1101 Car ei F~oad,: ^ . _ Hudson, 16=7`710 (715) 468x, ' SEPTIC INSPECTION / WATER TEST REQUEST FORK"""'.."'. Please 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 that entry can be gained. J ❑ Water (VOC's) $185.00 A Septic $50.00 Water (Nitrate & Bacteria) 45.00 0 Nitrate & Bacteria retest $15.00 N ~ \ ov~5 So ~r e.s Owner.: F,\c~ 6w.~\c~ C~~\~~~ z",, J Requested bo.~\ Address:. ` a q Address: ~.su.JicN~s• ZIP S,-t S. ZIP Telephone N°: ( ) Telephone N4: (11L) 2~25~ `3944 i Property address (Fire N° & Street) : - q 7,q-_A2M. Location: Sec. -3(p T _N, R -W, Town of Sk- Realty irm: Co\a.u~~~ Lock Box Combo Closing Date: 030 - 2069- qs -ppp TO BE COMPLETED BY PROPERTY OWNER 360. 30. 20. L) PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: Is the dwelling currently occupied? ❑ Yes No If vacant, date last occupied: 10-9k Age of septic system: Septic tank last pumped by: Date: Previous Owner's Name(s): Have any of the following been observed? OY ON Slow drainage from house. OY ON Sewage Back-up into dwelling. ❑Y ON Sewage discharge to ground surface or road ditch. OY ❑N Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: D 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION IN TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? []Yes ❑No Soil series per SCS Soil Survey: sheet # Type of soil absorption system: OBelow grd OAt-Grd OMound Approx. size 'X []Gravity []Dose []Pressurized Ft.Z []Bed OTrench []Dry Well []Holding Tank ❑Outfall pipe OBSERVED DEFICIENCIES []Other []Unknown Septic tank Setbacks: []House []Well OProp. line []Other Dose tank Setbacks: OHouse []Well OProp. line OOther OLocking cover []Warning label []Pump/Floats []Alarm []Elec. wiring Soil Absorption System Setbacks: []House []Well ❑Prop. line OOther OPonding: []Discharge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title I~ r•1ra•,-'-- 1 ~-yam wt•.... ~ _ i ST. QROIX CO. / ~ N~;..^,~.. +:•4lS,54 i°'i Aye t,{e. .i ..A,. t ISC , O ZONING ICF,,• A- u F1NM~ftfI'gER r' i, M S7. CROIX COUNTY 1101 Gar C el F}gad; Hudson, -5 16-77f0 i~`:?, (715) .9 46 SEPTIC INSPECTION / WATER TEST REQUEST I'OR1l~ey`t n (Please specify desired test(s) & remit appropriate f c~ ~ application. Outside water lines are often turned o MR winter months, making access to the home necessary. P e arrangements with this office to insure that entry can gai`i,e, i - ❑ Water (VOC's) $185.00 septic 0.0a; rr^% r xcoFF~cE Water (Nitrate 6 $acteria) 45.00 0 Nitrate & t er` retest Re ested bye \t TS^3 . \~L`\ Owner:S' c~\c~ .,~\\{ua\C~v ~~~v~rtu.~ 17 c Address: ;09~- AnNe" Ovt Address: ka- ;L ~ S. ZIP iS~ P"Is wS- ZIP S~,Ic,, w~ Telephone N°: ( ) Telephone N°: (A)25~"39c(-A- 4v~-- Property address (Fire W& Street Jq ° Location: Sec.3(p T N, R _w, Town of Sk- Realty Lock Box Combo:'~j Closing Dater TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF TH.-IS FORMS Water sample tap location: is the dwelling currently occupied? 0 Yes No If vacant., date last occupied: - Ib-~ Age of septic system: Septic tank last pumped by: Date' Previous Owner's Name(s): Have any of the following been observed? OY ON Slow drainage from house. OY ON Sewage Back-up into dwelling. OY 00 Sewage discharge to ground surface or road ditch. OY ON Foul odors. Other comments relative to system operation:- I certify that the above information is complete and true to tle hest of my knowledge. ~-4y~ OWNERS SIGNATURE: t?r BAN / RIr BY: 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? OYes ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system: OBelow grd OAt-Grd OMound Approx. size 'X OGravity ODose OPressurized Ft.= OBed OTrench ODry Well Molding Tank 00utfall pipe OBSERVED DEFICIENCIES OOther OUnknown Septic tank Setbacks: ❑House OWell OProp, line OOther Dose tank Setbacks: OHouse OWell OProp. line 00ther Mocking cover OWarning label ❑Pump/Floats OAlarm ❑Elec. wiring Soil Absorption System Setbacks: OHouse ❑Well OProp. line OOther ❑Ponding: ODischarge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N i Inspector Title ST. CROIX COUNTY WISCONSIN ZONING OFFICE ~uuruu ~ rn~6 ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road - - Hudson, WI 54016-7710 (715) 386-4680 May 21, 1996 Don Sukowatey Caldwell Banker 126 Second Street Hudson, WI 54016 Dear Don: On May 20, 1996, an inspection of the septic system on the property located at 1292 27th Avenue, Hudson, Wisconsin, was done. A water sample was also collected and forwarded to the lab for testing. When the results are received, you will be notified. At the time of the inspection, the sanitary system appeared to be functioning properly, however, it was indicated on the application that the residence has been vacant for some time. Therefore, should the system be failing, it most likely would not be evident at this time. The inspection done on May 20, 1996 was based on a surface inspection of the 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 this system. It is recommended that the system 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 me at the above number. Sincerely, Ma Jenkins Assistant Zoning Administrator cc: File T. CROIX COUNTY WISCONSIN ZONING OFFICE r r N w ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 _ (715) 386-4680 May 29, 1995 Mr. Dan Sukowate Y 126 Second Street Hudson WI 54016 RE: Water Results for Residence Located at 1292 27th Avenue, Hudson, Wisconsin 54016 Dear Ms. Sukowatey: Enclosed is the original test results from Commercial Testing Laboratory, Inc. for water inspection of the above property. If you have any questions regarding these results, please do not hesitate in contacting our office. Sincerely, Mary J nkins Assistant Zoning Administrator bjp Enclosure O D HID RCIALTESTING 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 ZONING OFFICE REPORT NO,: 17724/0; FAGS j ST.CROIX CTY GOV.CTR REPORT DATE: 5/24/96 1101 CARMICHAEL ROAD DATE f.ECEIVED: 5/21/96 HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER: Coldwell Rank.eORelocation LOCATION: 1292-27th A,ve., Hudsoi+ 01, COLLECTOR: M. Jenkin_ Rr~IvO DATE COLLECTED: 5-20-96 C TIME COLLECTED: 2:OOpm co K'k:°i` 2 9 1996 ro f4 f SOURCE OF SAWLE: Kitchen faucet ST CROX. COUNTY ZONINGOFFiCE Co HATE ANALYZED;5-21-96 f TIME ANALYZED; 2;00pm COLIFORM,MFCC; 0 /100 m( I INTERPRETATION; Bacteriologically SAFE NITRATE-N: < 0,5 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Conform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIAN: Pam Gave WI Approved Lab No. 19 RESULTS: FAX'D ON: sl b.yl 9m PHONED ON: _ ~l v/ 9co CALLER: li < Means "LESS THAN" Detectable Level Approved by: PROFESSIONAL LABORATORY SERVICES SINCE 1952