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HomeMy WebLinkAbout020-1211-10-000 c h „ 03 64 ti C 00 4 0 w ~ I c b 0 a~ I 0 H ~ ti m I N ~ a I a ° rn mL N c ca c m a~ o o c z LL o o2 3 a t co Q z w " rn z o z IL m o `0zv' c ~ a I N co N O C ( N N a ~i 2 y o •1V a ri) r - ' O O z m z N z ~V1 Q y QO N ~ j O' a0• N O co U) C0 co ~"N rr L a ° o 3 ° a tv a in R °v a a a N a LO o y 0) 0) vN J V co co z j N N - 0 2 ty E CL O M m N Q7 O E 4) Q fn Q ~Y O O ° y ~O O N 9 ~ V C O d j 04 a r- V o ff ° n U) 0 d o s., E co N E R rn 04 C', N ? C r N f0 7 O N O E t6 U O 2 ~ O Z z~~ (A O 34 E a IL CL ca rr ~0 Cd c~ ' m = o m 3r 'o Parcel 020-1211-10-000 03/21/2006 08:11 AM PAGE 1 OF 1 Alt. Parcel 16.29.19.1212 020 - TOWN OF HUDSON Current Xj 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 - LOFGREN, DAVID J JR & DANA M DAVID J JR & DANA M LOFGREN 985 FERN RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 985 FERN RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.730 Plat: 2282-PARK WAY ADDITION SEC 16 T29N R1 9W NW NE LOT 10 PARK WAY Block/Condo Bldg: LOT 10 ADDITION Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 01/05/1999 595037 1392/538 WD 07/23/1997 1097/416 WD 07/23/1997 873/506 2005 SUMMARY Bill Fair Market Value: Assessed with: 93034 224,700 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.730 52,900 176,300 229,200 NO 05 Totals for 2005: General Property 2.730 52,900 176,300 229,200 Woodland 0.000 0 0 Totals for 2004: General Property 2.730 36,300 131,300 167,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 131 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 ST. CROIX COUNTY WISCONSIN ZONING OFFICE r r n v n u n n i w,■.6 ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 September 26, 1994 Kernon Bast I Edina Realty 700 Second Street Hudson, WI 54016 RE: Water Test and VOC Water Test inspection for Residence Located at: (Butch & Brenda Ferkovich) 985 Fern Lane, Hudson WI 54016 Dear Mr. Bast: Enclosed is the original test results from Commercial Testing Laboratory, Inc. for water inspection and the test results from SERCO Laboratories for VOC inspection of the above property. If you have any questions with regard to said report, please do not hesitate in contacting me. Sincerely, IMarytnkins Assistant Zoning Administrator St. Croix County, Wisconsin js Enclosure cc: Pat Collins I I C [e I ~C.OMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 I I ST. CROIX COUNTY ZONING OFFICE REPORT NO.: 70551101 PAGE 1 ST.CROIX CTY GOV.CTR REPORT DATE: 9/21/94 1101 CARMICHAEL ROAD DATE RECEIVED: 9/15/94 HUDSON, WI 54016 ATTN: THOMAS Co NELSON All Butch h Brenda Ferkovich , g qr LOCATION: 985 Fern Lane, Hudson SLR 2 1994 COLLECTOR: M, Jenkins DATE GAL.LECTED: 9-i4-94 TIME COLLECTED: 11:00am ~r..« SOURCE OF SAWLE: Outside faucet DATE ANALYZED:9-15-94 TIME ANALYZED:2:00pm COLIFORM,MFCC: 0 /100 mt INTERPRETATION: Bacteriologically SAFE NITRATE-N: ! 1 ppm Above 10 ppm exceeds the recommended Public Drinking Water- Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIAN: Pam Gane WI Approved Lab No. 19 .OF.\NDFCENpEhrG y0 V ! deans "LESS THAN" Detectable Level Approved by: S~ PROFESSIONAL LABORATORY SERVICES SINCE 1952 SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 46613 PAGE 1 of 3 09/23/94 St. Croix County Zoning DATE COLLECTED: 09/14/94 1101 Carmichael DATE RECEIVED: 09/15/94 Hudson, WI 54016 COLLECTED BY : CLIENT DELIVERED BY : CLIENT SAMPLE TYPE DRINKING WATER Attn: Mary J. Jenkins CLIENT'S ID: Ferkovi SERCO SAMPLE NO: 140734 SAMPLE DESCRIPTION: Ferkovi E ANALYSIS: Benzene, ug/L 0 Bromobenzene, ug/L <0. 2 Bromochloromethane, ug/L <0.4 a,\ Bromodichloromethane, ug/L <0.2 Bromoform, ug/L <0.5 Bromomethane, ug/L (Methyl bromide) <1.0 n-Butylbenzene, ug/L <0.3 sec-Butylbenzene, ug/L <0.4 tert-Butylbenzene, ug/L <0.5 Carbon tetrachloride, ug/L <0.2 Chlorobenzene, ug/L <1.0 Chloroethane, ug/L (Ethyl chloride) <0.4 Chloroform, ug/L <0.5 Chloromethane, ug/L (Methyl chloride) <0.6 2-Chlorotoluene, ug/L (o-Chlorotoluene) <0.2 4-Chlorotoluene, ug/L (p-Chlorotoluene) <0.2 Dibromochloromethane, ug/L <0.4 1,2-Dibromo-3-chloropropane, ug/L <1.2 1,2-Dibromoethane, ug/L <0.2 (Ethylene dibromide) Dibromomethane, ug/L <0.2 1,2-Dichlorobenzene, ug/L <1.0 (o-Dichlorobenzene)` 1,3-Dichlorobenzene, ug/L <1.0 ~r (m-Dichlorobenzene) l < means "not detected at this level". 1 mg = 1000 ug. t' GS v. . CM 7 SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 46613 PAGE 2 of 3 09/23/94 SERCO SAMPLE NO: 140734 SAMPLE DESCRIPTION: Ferkovi ANALYSIS: 1,4-Dichlorobenzene, ug/L <1.0 (p-Dichlorobenzene) Dichlorodifluoromethane, ug/L (Freon 12) <2.0 1,1-Dichloroethane, ug/L <0.1 1,2-Dichloroethane, ug/L <0.2 (Ethylene dichloride) 1,1-Dichloroethene, ug/L <0.2 cis-1,2-Dichloroethene, ug/L <0.1 trans-1,2-Dichloroethene, ug/L <0.1 1,2-Dichloropropane, ug/L <0.1 1,3-Dichloropropane, ug/L <0.2 2,2-Dichloropropane, ug/L <0.2 1,1-Dichloropropene, ug/L <0.2 cis-1,3-Dichloropropene, ug/L <1.5 trans-1,3-Dichloropropene, ug/L <0.9 Ethylbenzene, uq/L <1.0 Hexachlorobutadi.ene, ug/L <0.3 Isopropylbenzene, ug/L, (Cumene) <1.0 4-Isopropyltoluene, ug/L <0.5 (p-Isopropyltoluene) Methylene chloride, ug/L <5.0 (Dichloromethane) Naphthalene, ug/L <1.0 n-Propylbenzene, ug/L <0.4 Styrene, ug/L <1.0 1,1,2,2-Tetrachloroethane, ug/L <0.2 1,1,1,2-Tetrachloroethane, ug/L <0.1 Tetrachloroethene, ug/L <0.2 Toluene, ug/L <1.0 1,2,3-Trichlorobenzene, ug/L <0.2 1,2,4-Trichlorobenzene, ug/L <0.2 1,1,1-Trichloroethane, ug/L <5.0 < means "not detected at this level". 1 mg = 1000 ug. r Arm, i 7 SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 46613 PAGE 3 of 3 09/23/94 SERCO SAMPLE NO: 140734 SAMPLE DESCRIPTION: Ferkovi ANALYSIS: 1,1,2-Trichloroethane, ug/L <0.1 Trichloroethene, ug/L <0.4 Trichlorofluoromethane, ug/L (Freon 11) <0.7 1,2,3-Trichloropropane, ug/L <0.2 1,2,4-Trimethylbenzene, ug/L <1.0 1,3,5-Trimethylbenzene, ug/L <1.0 (Mesitylene) Vinyl chloride, ug/L <1.0 Total Xylene, ug/L <1.0 This sample's analytical results a-~rat below the U.S. EPA's SWDA Maximum Contaminant level of 1/3oar, 1 for those requested compounds which are also on the SWDA MCL list. The analytical results in this report pertain only to the items tested. All analyses were performed using EPA or state approved methodologies. Samples that may be of an environmentally hazardous nature may 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, Carol A. uehn Project Manager < means "not detected at this level". 1 mg = 1000 ug. 1 ~r ' j ST. CROIX COUNTY WISCONSIN ZONING OFFICE A N N N p g g p■ _ xrrr` ST. CROIX COUNTY GOVERNMENT CENTER _ 1101 Carmichael Road y - Hudson, WI 54016-7710 (715) 386-4680 September 21, 1994 Kernon Bast Edina Realty 700 Second Street Hudson, WI 54016 RE: Septic Inspection for Residence located at 985 Fern Court, Hudson, Wisconsin Dear Mr. Bast: An inspection of the septic system on the property of Butch and Brenda Ferkovich located at 985 Fern Court, Hudson, Wisconsin, was conducted on September 14, 1994. 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. Also, water samples were taken. Once we receive the results we will forward the same on to you. Should you have any questions in the meantime, please do not hesitate in contacting this office. Sf~ perely,,,~ r ,vim-<.- • Mary J. Jenkins Assistant Zoning Administrator js J Puo)) Py ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road - - Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM V Pi-ease Pi-ease specify desired test(s) & remit appropriate fee with 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. Water (VOC's) $185.00 Septic $50.00 ater (Nitrate & Bacteria) 45.00 0 Nitrate & Bacteria retest $15.00 Owner: Requested by: Address: eP e16&,QT"' Address : / 4 EA-A7' J,Q ~ S© ZIP~ZIP C Telephone N4: ( ) Telephone N4: ( ) Property address (Fi a If & St ) Location;, Sec. , T N, R W, Town of AOSo Realt fim. Y 'o"--rc~~4 Lock Box Combo:, Closing Date: "',--?U - TO BE COMPLETED BY PROPERTY OWNER PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: &~f1/m_E707- -74fo Is the dwelling currently occupied? Yes 0 No If vacant, date last occu ied: Age of septic system:- Yf S Septic tank last pumped by: Date: ~1r9" Previous Owner's Name(s): A)e4,6 Have any of the following been observed? OY PN Slow drainage from house. OY fW Sewage Back-up into dwelling. OY P11 Sewage discharge to ground surface or road ditch. OY Cam` Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. i OWNERS SIGNATURE~~7 DATE: 9 1/94 w'": OWNERS DPtWtN~/F HOUSE & SEPTIC SYSTEM LOCATION D ~~ct TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system: ❑Below grd ❑At-Grd OMound Approx. size 'X ❑Gravity ❑Dose OPressurized Ft.' OBed OTrench ❑Dry Well Molding Tank ❑Outfall pipe OBSERVED DEFICIENCIES ❑Other OUnknown Septic tank Setbacks: ❑HouseOWell ❑Prop. line ❑Other Dose tank Setbacks; House OWell ❑Prop. line ❑Other OLock' g cover ❑Warning lab OPump/Floats OAla m OElec. wi soil Absorption System Setbacks: ❑HouseOWe11 ✓ ❑Prop. line ✓ 00ther OPonding: AllyXnl ODischarge: Ge e al comments: 0 d INSPECTORS SKETCH OF SYSTEM LOCATION N 15-4 \ l~ Inspect Title Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Sn TOWNSHIP I'/ A SEC. J<o T N-R / W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISIO"r LOT 0 LOT SIZE 2 «S PLAN VIEW Distances and dimensions to meet requirements of I•ZUR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM a- wQ s ad 1 Z III err' /r~ r`r I' r , l I I I I INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 2 /off $ w c,~n-ev Ltls~~" Elevation of vertical reference point: SZ Proposed slope at site: S SEPTIC TANK: Manufacturer: /,t/at ~,a✓ Liquid Capacity: 00 y Number of rings used: t--_ Tank manhole cover elevation: Ov~N Tank Inlet Elevation: _Z,. 0 Tank Outlet Elevation: Z-&-z Number of feet from nearest Road.: Front 10 Side, Rear, O SS feet From nearest property line ' Front,0Side10Rear,® f ~b feet Number of feet froi*: well 4!6- 1/building: /6 / (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: ~f 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, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ($H,j.r,,s}-1Trench: Width: J8 Length: 3 ~o Number of Lines:- Area Built:.4rz4tS~7""" Fill depth to top of pipe: 3 (o 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). 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 rings used: Elevation of bottom of tank: A ~J Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: i"A0 Dated: Plumber on job: License Number : Z- 3/84:mj r h PUMP CHAMBER Manufacturer: 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, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ~aHrla~`E Trench: Width: 8 Length: 3 jo Number of Lines:.._-~_ Area Built: > Fill depth to top of pipe: 36, Number of feet from nearest property line: Front, O Side, O Rear,/VN Ft. Number of feet from well: 90 vv Number of feet from building: (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 box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: /y 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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: I Plumber on job: ~ License Number: 114 -1 Z 3/84:mj SANITARY PERMIT APPLICATION M ILHR In accord with ILHR 83.05, Wis. Adm. Code cou TY ' STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than / j ~Q 2 8% x 11 inches in size. ❑chec if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION j et Ny / ,1/(V% N C'/a, S r c T 2 1, N, R cIIR(or) PROPERTY OWNER'S MAILING ADDRESS LOT # a BLOCK # ~`P ~.r P)"0 t IC r, ) l CITY, STATE ZIP CODE PHONE NUMBER Q SUBDIVISION NAME ORaCSM NUMBER 1-4 U~rio~1 1(3 8` a 4 It P,; /l~ wo II. TYPE OF BUILDING: Check one CITY NEAREST ROAD VILLAGE s , ( ) ❑ State Owned ~j ❑ Q =N 14 ❑ Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms ° PARCEL TAX NUMBER( S) Ill. BUILDING USE: (If building type is public, check all that apply) Q a a - l a - 1 ❑ Apt/Condo 2- ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 50 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. EYNeW 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 LJ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION C r % ~ 6 Q , .7 3 Feet / 0 . Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 0 ~aJ ) w p 7 f t F1 I r7_ 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 Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: cc v~>R5 3 Plumber's Address (Street, City, S te, Zip Code): a //,Ow ~ / 017 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved C3 Owner Given Initial ) Q Surcharge Fee) / Adve rse D rmination J X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: v 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. Vill. 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) DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS 'LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 . BUREAU OF PLUMBING MADISON, WI 53707 NW4.M,,SeC.16,T29=R19 ❑CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number lf assigned) Town of Hudson Lot 10 El Holding Tank El In-Ground Pressure El Mound I est. NAME OF PER IT HOLDER: JADDRESS OF PERMIT HOLDER INSPECTION DATE. BENCH MARK (Permanent reference point Box 282 Hudson WI 54016 ) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.-. '*Q tj Name of Plum MP/MPRSW No County Sanitary Permit Number: oug las trohbeen 5432 St. Croix 135402 SEPTIC TANK/HOLDING TANK: MANUF AWC,LS R: LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL JLOCKING COVER PROVIDED. PROVIDED: iog ~~J ~0& ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA. VENT MATI J HIGH WATER NUMBER OF ROAD: J PROPERTY WELL. BUILDING: VENT TO FRESH ALARM LINE y AIR INLET ❑YES ONO ❑YES ~NO NEA_RESTOM _ ~SS /Ob ~0 5 ~O DOSING CHAMBER: MANUFACTURER. BEDDING. ILIOUIDCAPACITY PUMP MODE L P : SIPHON MANUI ACTLIFiER WARNING LABEL JLOCKING COVER PROVIDED. PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AONDCONTR TIO L NUMBER OF PROPERTY WELL JBUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) NEAREST 30 SOIL ABSORPTION SYSTEM.CheckthesoilmoistureattAMFTEH JIIATFHIALAN DMAHKING or excavation. (If soil can be rolled into a wire, constructi II FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO.OE ISTH PIPC SPACIN(. COVER INSIOL DIA apITS LIQUID J( I TRENCH S MnIAL' PIT DEPTH'. / DIMENSIONS 3 6 GRAVEL DEPTH FILL DEPTH UISI R. PIPE UISTH PIPE DISTR. PIPE MATERIAL NO D11 1H NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER El FV INLf I ELEV. ENU PIPES LINE AIR INLET. FEET FROM 5~ UIof3~ D r~i l 3 NEAREST_--~► d / Q D -2 J_Z 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- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER rexruRE PFI+MnNENT MAHKERS oesERVnnoNWE LLs ❑NO DEPTH OVER TRENCH BED ❑YES ❑YES ❑NO TOPSOIL ["')DUFI1 ❑ JEEUED MULCHED IDEPTHOVIII TRENCH BED DEPTH OF YES. ❑ YES ❑NO EDGES CENTER ❑YES ❑NO ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO OF LATE HAL SPACING GRAVEL DEPTH HE LOW PIPE FILL DEPTH ABOVE COVER TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL JNO DISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. DIA. ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING L'H ILLED CORRECI Lv JCOVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE. ❑ YES ❑ NO ❑YES ❑ NO NEAREST I` Sketch System on Ep E~(O _ ~At Retain in county file for audit. Reverse Side. T SIG ATU TITLE DILHR SBD 6710 (R. 01/82) / 'L 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 .S4r-n, A; let::: Location of property A~V 1/41/4, Section 1 , T zy N-R-Zf P Township 8, 'L L MIN Mailing address Sk41r-Z::2 ccd'~o r. ~A) ~ C-V o 1 So Address of site UJO,4, Subdivision name Lot number V - Previous owner of property , W,&._cLd-4~ 2.a. Total size of parcel 1A ~t- Date parcel was created b'*' Are all corners and lot lines identifiable? X as No Is this property being developed for resale (spec house)?~Y _Yes No Volume 80(o and Page Number 6-99 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 beat of my (out) knowledge; that I (we) am (ate) 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. j 3 s-R V ; 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. 43 s-R V:V ) . Signature of Owner Signature of Co-Owner (If Applicable) / r- k- jj Date of Signature Date of Signature St'A!'i YY., r 7 7 pry`=iv • ~ .11.4 .MpM.M M N... . NM _Y, 1.Y ................w:. n..... sd woeraM. a ..j■a.Z...1n11~as..a..aio6Lt..p ' M "MS I► D •M......M.M.. W.W.N...«..qW »....»..•MNMUb»•»..u»... t .MM..... ..•..•N......... »..N•..... ..W..•.w.WW......... .rw»: •...M. ..•.•..N.......N»•»i.».»...•.»«...«»».«.«».».«•.».««««.»..... A.}yAM h . a.N....r.....•.MY^M/..N.•M.M.M•.w.................. a... his dnww ttMl eftu in ».•.BZ..»4'>r1pSi. M~M~t n", Tu Ptlt+wl Not *Qrastor of tM Nostbwt Qumer of Section 169 Tonasbip' 29 Ilosl , ISt, =t. `Croix OMty, Nlacoasia QCRPT Lots 1 thre"A isduslvs , ' VVY 1w..€ UW July 239' 1964. M Vol. "S", pqp 1447. Doc., 1o.1, %"4 sct to~tMi~Dscllasmtioa of Protectivs Cownsats dated February 15, 1l6S;' oifiss ,Of dw MBistss of Dssds as Fsbsussy 16, 1985 im vol. 7060' pop 139, 46at to mom-mclus"s safe l!mOf ree:ord for use of the 66 loot road 11e41 C.ol; S od the aboMS aesticssd Cartifisd Sus"Y Map. ,,pa1►Je t'to tW "Wtitios Feaw Arssmsat bettrsen tM State of Yiscoesio p~ of ai. Msourca sad VGDUW Ism datsd September 15, 19799 recorded ` tsd er 28, i!7!" 1a' •ol. "60109 psp 6399 Doc. 00. 360128 for the saimtemseme of, bet""" o'N k of as k of Ssctios 1-29-19 sad IV k of a k of 1,21-11.` i~n w f,A, This to warnuout tld! .F r~. » . dY of . I~... . • •~~~~~'1fIfRI~ ~osa+R.illai.ns.lAk=.. .........OICAL) l.. (8S/1L) . ~..f.: Fs • YOM . AWWZXXVICATIOx wosxowLllaaUilxs Wa) WATa Or wrscoxsm ~ tld~ ........e.t of It...... r.nonnly e.m bKoro s>e this ..aof of + »AA as o6NO MOW ~~..lsrnshcdn..Ysslsr..Y...lua.aod...». r TI?LiI MOM STATS BAN OF WpXC..........».. tsi iRl A..R1A l1..~lIfi~.A~1F~#~.1~IIdi~4J •i.,,• TCONSlTN ~ ►s*i 'ni ie:"wi:: sew:a . . r y t~eso w ! r" nng to be tM pe so j.........iMMN ba fM . r r~+ THIS ff"" IJMon WAS ORA j y, x..... ~•be mthswtk"W or oek $L.. CI'A1x .........Ceontr , ( wovleatiwl. Roth NMy eteG•y ~m i'miwsiuhlicml is Q►h >p Lil r:pirs b11 aRt.: I., wMbmm .e. qw M Ofttw. h vq .w,..lgr *..y be 11M1 nr Nrl.#_l! IrM~ llrh vi mtulw. r~ A*l! Ott sTATS IIAA M w txcMgM a t y MOIII/ 1Iw R.. IMf YlMwlllw / nM.4 Cw Iw. _ STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ice/cam ROUTE/BOX NUMBER '~o)C FIRE NO. CITY/STATE stud Lf) ZIP PROPERTY LOCATION: 11AV114 IVA5 1/4, Section , T _a7 N, R J Town of 4& 1,- x , St. Croix County, Subdivision flrk A&U , 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. S I GNED a DATE_ r. 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 ~RTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS JSTRY, DIVISION P.O. BOX 76 .BOR WLY-- PERCOLATION TESTS (115) ___"DISON WI 3707 OMAN RELATIONS (ILHR 83.090) & Chapter 145) SECTION: TOWNSHIPIMVffF=&lZCI*Y: OT NO.: BLK. NO.: SU DIVISION NAME: LOCATION: NW'/ NC i6 /Tz9 N/V E (o /lCASoN o- W!!. ILIN AD R S COUNTY: r~, r 8P, do< 'lea >7 ST Coolx S~lM M r LL E R Pm USE DATES OBSERVATIONS MADE NO. BEOR : COMMERCIAL DESCRIPTION: PROFILE DESC Nb: PERCOLATION q INO)l QT Residence ~4 1.9New ❑Replace /VOA 14 9 ~S /r So1LS K A&t SrK _ B^xCZ- u~,c reA RATING: S- Site suitable for system U- Site unsuitable for system ~I ~ _ t'~A 40T )k O ST❑U IONAL: Mu` t S OU IN GW S OU MYSTEMIS -IOU L ElsG T : RECOOMMENDTIO.J4L SYSTEM: (optional) If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09115)(b), indicate: CLel55 Floodplain, indicate Floodplain elevation: NCB PROFILE DESCRIPTIONS BORING TOTAL DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH-0 ELEVATION OBSERVED I EST. HIGHEST- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ~s'BcSL~ /618e""SL S^BeNGS IZ"lRe"CS*Gtk B- 9,Z~' /~g,33 oNat ? 9.Z1 Zo BQ~Cs'C&A 3>~'$a~► ►~5 B- ~,7~ /07,40 N > ffi,7~ 8""$csL~ 14'">gQNSt 13'94,MS&O 70"I,>QN M5 B- 3 .9Z /V9.~Z t~lC~n►ir 7 •9Z LSI $tz,~ s aa'$eNGS1GR-13 Qa•~'t1S (fa 10 B- .9Z /01.1+ No't41 L > .9Z 9, -,L C"" etiSL. 2~" ef,Nc7 QN ✓~S ►MS B- //1,16 7' DL.SL.7s O, ge r"G Z9, 81211CSt&e 79`80,N B- r+ C~ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER L V N H RATE MINUTES NUMBER S AFTERSWELLING INTERVAL-MIN. PERIOD I PER INCH P_ 1 q.?d ts6we /04•-Cb 3 > Z > < P_ SO I404f /cli.4a 3 y 2 >Z >Z 4 3 P- 6 fJ oN /11.76 3 >z >Z P- P- O AM RL 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. pos. ~o g 4 t ~ i N i I~ i 6 ~ 414T)W L IC~0 .1_1._._ 7 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: 144p-ov .~pNNSoN eUSU4'jUQ\16y1N4L /S Mai AD RESS: CERTIFICATI N NUMBER: PHONE NUMBER (optional): ? Nudsot, Wi . Soar U1 3~6-4ox~ CST SIG URE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR•SBD-6395 (R. 10/83) - OVER - - ~ M NN v~ - Q g C C/ \ ap r ~ -w Sul - ,AIN T3. j 4s d . ~ l1 p` yc - , b iP f e ~ M~ b■ ~0LA U pd p P U t4 a b \I t yh . o m A ~ I~ P o m ~ ~ X04 0 a V 0 (3 S l~ 1•• O ` ° P P to s i o iS7 • y, 1v 1J rI ^ A 7 00 ~ N P e ~ rJ p 5 ~.P P E b n P fx ~ ~ P 'S' f G o 1>41 f P P P P I 3 or • ~ ~ I 1 r t , .r -d o rR t` k-n , ; ,tr