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HomeMy WebLinkAbout020-1210-80-000 ~ 'v o I ~ 0 3 o I M d o 0 n O I O N N U ~ I I I ~ I E o 'a N ~ I O a Z °c 7 m E LL cp p f4 Q 7 I P Z yj ~ a) W a) Z = ~ I Z P d d ca Z a m I c I c C9 ~ I o Z !t c m Z o o to F- 4' (D Z c 'o CO N N rn c to ~ a~ c 0 o4) Q Q z m z o N o ~ ~ Z ~ i0 ~ O N a ai c c d ~v N D N O v G G a n - o N N y o w co ° cn z I CY) CD fA U rn rn Z I a~ ~ P P O N O) N N N '}3 d Q ~ (n N _ LL. N N ^I r"+ O O O y C 0' c JE N t0 o rn w cn u ~ o C O NT 7 C N O. O O Z Z O ~ v~ as € a #t a a • ea a m c v c I r~ o R 3 o ~1 A c) a2 0 v~U Parcel 020-1210-80-000 03/21/2006 08:02 AM PAGE 1 OF 1 Alt. Parcel 16.29.19.1210 020 - TOWN OF HUDSON Current -1 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner 0 - MCDONALD, DANIEL S & PAULA J DANIEL S & PAULA J MCDONALD 996 FERN RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 996 FERN RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.370 Plat: 2282-PARK WAY ADDITION SEC 16 T29N R1 9W NW NE LOT 8 PARK WAY Block/Condo Bldg: LOT 8 ADDITION Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 842/33 2005 SUMMARY Bill Fair Market Value: Assessed with: 93032 293,800 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.370 51,500 248,100 299,600 NO 05 Totals for 2005: General Property 2.370 51,500 248,100 299,6000 Woodland 0.000 0 Totals for 2004: General Property 2.370 35,400 180,700 216,1000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 112 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges 00 Delinquent Charges 00 Total 27.00 J H s N " -0 vj~ 0'a 1 C I h -yo) W p IIfN..~; P ~ ~ 9 41 a P_ P ; 3 p 1 n -t -d J .'1 P G~ p ~ H 3 • c s p s s., O P -0 P QD ...I P CQMPERCIAL TESTING LABORATORY, INC. 51414ain Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 .3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.: 16635/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 1/15/92 COLIRTHOUSE DATE RECEIVED: 1/14/92 HUDSON, WI 54016 ATTN2 THOMAS C. NELSON OWNER, Daniel 6 Paula McDonald LOCATIONS 996 Fern Rd., Hudson COLLECTORS Ml. Jenkins DATE COLLECTED; 1-13-92 TIME COLLECTEDS 21#15pm SOURCE OF SAMPLE# Kitchen faucet DATE ANALYZED! 1-14.92 TIME ANALYZED! 2.00pe COLIFORM : 0 /100 m l INTERPRETATIONS Bacteriologically SAFE NITRATE-NS ( 1 ppm Above 10 ppm exceeds the recommended Public Dr i Pik i ng Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L 1 8 un oaz~n 'Q > r r j e r.Z3 LAB TECHNICIANS Pam Gane „pE0fN0 WI Approved Lab No. 19 4 < Means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 q-z 1 ST. CROIX COUNTY ZONING OFFICE 911 4th Street Hudson, WI 54016 J Telephone - (715)386-4680 e St. Croix Co. Zoning office offers the service of septic and water inspection to Lending Institution, Realty Firms, and private individuals. COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN E LOCATED. Please provide the following information, enclose appropriate fee made payable to ST. CROIX CO. ZONING, 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 V (For nitrates and coliform bacteria) / WATER TESTING FEE:$175.00 i/ (VOC'S) FEE:$ 25.00 SEPTIC SYSTEM INSPECTION PROPERTY OWNERS NAME : •V•r 1~ S fi L ` 'U 1ft.L G(SOY~ PROPERTY OWNERS ADDRESS : _ i _ o Fern CITY: Legal Description 1/4, . 1/4, Sec. Tc_N-R 14 W, k/VV111~- Town ofTW i la c4c, , Lot: No. , subdivision Add-i) m FIRE NO. llc(0 LOCK BO N Color of house ~„~cpkf Realty sign? Firm: 'F to PLEASE INCLUDE, IF AT ALL POS IBLE, 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: jL-)inje~ c - t.Paula-,'- Telephone No. - 1() REPORT TO BE SENT TO: I Ct1c~ C6 L"- EGr n t2~4 \ S~~ . cam- S~ 01MOW R 3 k- t C- A'e vo 5 5 ( A N~cSV. ~rl ~c ~56Y~ 0.~ ~~rYma CLOSING DATE: oar (Y) Signature: • S a N LAND SURVEYING 41 HUDSON , WISCONSIN 54016 (715) 366-2007 Name First Federal of La Crosse `f Address 201 South Second St. Hudson, WI 54016 Description Lot 8, Parkway Addition in the Town of Hudson, St. Croix County, Wisconsin. McDonald, Daniel and Paula PLAT DRAWING N This is not a complete Land Survey W E S N89059' 1011E 461.00' 0 N O r o O i.-. ~ O N b %a9e hose LP '4 0 1f0 O o 28 ~s F 'so Utyllif` 1 easement ~~a_- Rosa ~p J Fero is R= 419.76' C= 225.96' hti' The location of improvements on this drawing are approximate.and.are based on a visual inspection of the premises. The lot dimensions are taken from recorded plats and deeds of county records. This drawing is for informational purposes only and should NOT be used as a comal`;e Land Survey First Federal of La Crosse has agreed to waive the minimum standards of AE-5 Map No. 89-01-141 Drawn By B.B. 5/18/89 1"= 60' Scale = SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 20182 PAGE 1 01/23/92 Commercial Testing Laboratory DATE COLLECTED: 01/13/92 514 Main St. Box 526 DATE RECEIVED: 01/17/92 Colfax, WI 54730 COLLECTED BY : CLIENT DELIVERED BY : CLIENT SAMPLE TYPE WATER Attn: Pamela Gane St. Croy Zoning 911 4th St. Hudson, WI 54016 SERCO SAMPLE NO: 4792 SAMPLE DESCRIPTION: McDonald 1262 ANALYSIS: Bromodichloromethane, ug/L <0.2 Bromoform, ug/L <0.5 BHromomethane, ug/L (Methyl bromide) <1.0 Carbon tetrachloride, ug/L v0.2 Chlorobenzene, ug/L <1.0 Chloroethane, ug/L (Ethyl chloride) <0.4 2-Chloroethylvinyl ether, ug/L <0.4 Chloroform, ug/L <0.5 Chloromethane, ug/L (Methyl chloride) <0.6 Dibromochloromethane, ug/L <:0.4 1,2-Dichlorobenzene, ug/L <1.0 (o-Dichlorobenzene) 1,3-Dichlorobenzene, ug/L <1.0 (m-Dichlorobenzene) 1,4-Dichlorobenzene, ug/L <1.0 (p-Dichlorobenzene) 1,1-Dichloroethane, ug/L -.0.1 1,2-Dichloroethane, ug/L <0.2 (Ethylene dichloride) 1,1-Dichloroethane, ug/L <0.2 trans-1,2-Dichloroethene, ug/L <0.1 1,2-Dichloropropane, ug/L <::0.1 cis-193-Dichloropropene, ug/L <1.5 trans-1,3-Dichloropropene, ug/L <0.9 Methylene chloride, ug/L <5.0 (Dichloromethane) < means "not detected at this level". 1 mg = 1000 ug. 7 J SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 20182 PAGE 2 01/23/92 SERCG SAMPLE NO: 4752 SAMPLE DESCRIPTION: McDonald 1262 ANALYSIS: 1,1,2,2-Tetrachloroethane, ug/L <0.2 1,1,1-Trichloroethane, ug/L <5.0 1,1,2-Trichloroethane, ug/L <0.1 Trichloroethene, ug/L <0.4 Trichlorofluoromethane, ug/L (Freon 11) <0.7 Vinyl chloride, ug/L ;1.0 Tetrachloroethane, ug/L <1.5 Benzene, ug/L <1.0 Ethyibenzene, ug/L <1.0 Toluene, ug/L <1.0 This sample's analytical results arey ZZ ^ SDWA Maximum Contaminant level of ,0/91fo~ those w regeested ERA's compounds which are also on the SDWA MCL list. All analyses were performed using EPA or other accepted methodologies. Samples that may be of an environmentally hazardous nature will be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, 9 tp Diane J. Anderson Project Manager < means "not detected at this level". 1 mg = 1000 ug. rt Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP 11k Ae i SEC. )(5,_ T-)? N-R ADDRESS 9a k,*Z kz ST. CROIX COUNTY, WISCONSIN N Soy, b0 f 5 ~(d f SUBDIVISION LOT -ry. LOT SIZE 2"l S PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM S la l~ /o sys+~„~l= 9y.~a 'i5' s i lot ?E S5- G T No sc fie h i i~ ,Q i i INDICATE NORTH A ROW BENCHMARK: Describe the vertical reference point used NAX-Lu, CJar F.g,_.,_ fo*"Nfelekrx-' Elevation of vertical reference point: Proposed slope at site: so S.L. SEPTIC TANK: Manufacturer: QJc,'_sW Liquid Capacity: Number of rings used: Z Tank manhole cover elevation: 39 Tank Inlet Elevation: 6.09 Tank Outlet Elevation: tel. 7Z Number of feet from nearest Road: Front,O Side, Rear, O feet i From nearest property line Front 10 Side QRear, 0 75- feet Number of feet from: well .170 building: 3`/ (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: v' Liquid Capacity: - Pump 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, © Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed : Trench:-' Width: Lenith: G Number of Lines: Area Built i Fill depth to top of pipe: ~f z Number of feet from nearest property line: Front, O Side, O RearFt do S Number of feet from well: g o Number of feet from building: J! (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: , Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box0 been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings 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: Plumber on job License Number: /*I 3 3/84:mj DEPARTWNT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & i%ABOR &•HUMAN RELATIONS D P.O. aOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLIC MADISON, WI 53707 State Plan I.D. Number: MA,-, NEE 4, S16, T29N-R19W ® CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Hudson ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound E F ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Sam Miller Route 1, Box 282, Hudson, WI 54016 - 1 - A0 d BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. P V.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Doug Strohbeen 5432 St. Croix 119437 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST--- DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: JPUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: E:1 YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) 1 ❑ YES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: 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 SYSTEM: BED/TRENCH WIDTH: LENGTH: N0. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET: NEAREST 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 JDEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: E] ❑ YES E] NO YES ❑ NO ❑ YES E] NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: DIMENSIONS TRENCHES: 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 / L__1 YES ❑ NO ❑ YES ❑ NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: i E] YES ❑ NO El YES ❑ NO NEAREST N. 1123 0, Ib Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: Toning Administrator SBD-6710 (R. 06/88) J:C,:~ 2 ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY A= ali 5 7- STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 19 ~3 y 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 %4 F %4, S J(a Ta j , N, R /gyp E (Oro PROPERTY OWNER'S MAILING ADDRESS L T # BLOCK # of d * / QmXZ-8- S CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER O / G bc/a Ad,74,0-~- II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD State Owned ❑ VILLAGE : 4~500 J'I P-Lt ❑ Public JAX]i or 2 Fam. Dwelling-# of bedrooms R ELT NUMB ) Z f O 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo L_ 0 20 Z O 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. P New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.E1 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # _ Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ SpecityType 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 q0 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min /inch) ELEVATION s 7 3 / . / Feet c,+ / f. 7 / Feet VII. 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 000 ; 's a-.-, 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: U A -.S+r- 4D 4L 4- f-, i~~ .2=&2, Do - J (2 )2 ) a 2- 33 Plum 's Address (Street, City, State, Zip Code): 1~ (Z # 1 ' k v" CJT- 5_'fd 1 -7 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa i ry Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) JR Approved Owner Given Initial Surchar s aa Fee) 1- r, r Adverse Determination 7 _l 1 y~~ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS nitary permit is valid for two (2) years. sanitary permit may be renewed before the expiration date, and at the time of renewal any new is in the Wisconsin Administrative Code will be applicable. ;5. 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 -<2 Location of property /e!C!l 1/4 1/4, Section /(,,2 AN-Rf~~ Township ~ so 1 Mailing address A.A*/ 6ox 2 8Z Address of site ark ( sy~. ~i c~d ; r o ti Subdivision name ' la ft k ujQA4 Lot number Previous owner of property W,s►a-v V~ Total size of parcel z . L S i4 c¢V 4 Date parcel was created N y - 19 V Are all corners and lot lines identifiable? Y Yes jV-No Is this property being developed for resale (spec house)?Yes No Volume and Page Number Q? l 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. ---------------------------------------------------------7--------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. y3 ; 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 f Deeds, as Document No. X3.5`8 yfL e- Signature of Owne- 223 r Signature of Co-Owner (If Applicable) 4--&-,b q Date of Signature Date of Signature 0.t j .pr M. 1. • F+d ~ Si Y, o 6W I - .A x r Ws. r:• c 8 i.Y e ~ t fff i. A lie STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 5arh /l>.~~~ ROUTE/BOX NUMBER / ~oX ZBZ.. FIRE NO. CITY/STATE~zc_G/S o .-r Gu A"' ZIP PROPERTY LOCATION: &tt/1/9 AliE~_ 1/4, Section L,, T2N, R 14 _ZV Town of , St. Croix County, Subdivision &4~_ UJR y , 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, 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. SIGN IT) DATE _ U St. Croix County Zoning Office St. Croix County Courthouse 911 9th Street Hudson, WI 59016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION LAXR R.Na P.O. BOX 7969 HUMANANREDLATIONS PERCOLATION TESTS (115) MADISON, WI 53707 HUMA (H63.09(1) & Chapter 145.045) LOCATI W / SECTION TOWNSHIP/ OT (VO.: BLK^NO.: SUB,pI`VIS)O J] 1 (/D T H/R/ 71S(► ate,, 4 lam/~& COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: SO -Ctbf 6 • ~t IZ9c~f / tc9O/~ Al. .S USE DATES OBSERVATIONS MADE [KResidence NO. BEDRMS.: COMMERCIAL DE CRIPTIOPROFI E DESCRIPTIONNS: PER ATION TESTS: New ❑Replace I /o A _L~/- d f~ fat % M~~ RATING: S= Site suitable for system U= Site unsuitable for system I PI SYSTEM-IN- ILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: $ ❑U RS ❑U ~ S ❑U ❑ S 1KU ❑ S .®U 0d V 0A, 13 1 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: ;v114- Floodplain, indicate Floodplain elevation: IAIA P FI DESCRIPTIONS BORING TOTAL/ DEPTH TO GROUNDWATER#AQ++ES• CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.. ON BACK.) B- • r /00. ye B- 3 F,6' /60 , /Llwe- 7 8,(j r I S/ 101- !//T at__5 7. 5-' 77. 7 7Fr &_x I's to "IT .I _g: 0 An 5 1 If s psi &x4 7,0n A&u B- PERCOLATION TESTS TEST DEPTH/ WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER i44le a'ES AFTER SWELLING INTERVAL-MIN. PERIOD I PERIOD 2 P R PER INCH P- , 3 0 2 6 6 P_ y 2_ P- r. 0 s Z _3 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 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. / SYSTEM ELEVATION 96.1 5 -4c.# /e / `t = Yo ` t J. J_ I- A - - A ;-A _Io-...car. _o N : E ~(f ty.K~sk, i ~ A~ rSu.F~ -a{ ~ ~ v~ 0 • t ' _ I WW__ .l'G1'~O 7986 Cf. € € ~ i t f i 4 17 _ _ € y~/~ o f~ ' SM R-!~ Cwt AI'1~-,k >P3 To M,a A-*7A U ~¢•rF-cad Oe~~ X e_Q& 5.d Ma.. fs l,"th~ ndersigned, 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 46u-I" i ze tr1l,~ i 0 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): Q o S /S-,q 7/s CS URE: DISTRIBUTION: Original and one copy to Local'Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - 1 1 . INSTRUCTIONS FOR COMPLETING; FORM 115 - BD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIML number of bedrooms or commercial use planned; 4. Is thi= replacement system; 5. Comp!k_, -ie suitabflity rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; l 1 . Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION, a ABBREVIATIONS FOR CERTIFIED SOIL TESTERS S rtes and Textures Other Symbols 'over 10") BR - Bedrock (3 - 10") SS - Sandstone tel (under 3") LS - Limestone S - Sand HGW - High Groundwater (.-,s Coarse Sand Pere Percolation Rate med s - Medium Sand W Well fs Fine, Sand Bldg - Buildinc) Is Loarny Sand > - Greater Than sl - Sandy Loam < - I Than 'I Loam Bn - l ,-,.r `sil Silt Loam BI - L'_ k si Silt Gy - Gr.ryr cl Clay Loam Y Yee'-)w ssci Sandy Clay Loam R sicl - Silty Clay Loatin mot. se, - Sanely Clay wl - sic = Silty Clay fff - f fine, fa Y c - Clay cc r in, { . pt: Peat mm n rd;u m - Muck d - 1e,:, p - ninent HWL - Nigh wa,~ r 1=. Six general soil textures surface t for liquid waste disposal - Bench M Vertical F f ce, Point TO THE OWNER: tfi ~ >~port is re , urinct a sanitary permit. The county r !may request to ~-m;' rt3~, A - for the private i. >t l in ordar to hernu` r y to 1 uctic5n. i ' n c by G4- ° cT" o41ZI a 0- QC S ~ d~~ st4 -ems ~ 1 4-- W E- V N \ 0 3 ns,~ t s -AL to ~N _ a M ~ QP M \ ,r N ~ -o - r Vl -~G_.._. ~N ..._.J - Zk- M o p 'n x o J~ a Vi J `N r +o o ~