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Parcel 020-1174-30-050 08/11/2006 12:30 PM
PAGE 1 OF 1
Alt. Parcel 17.29.19.1094A 020 - TOWN OF HUDSON
Current I 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 - CONOVER, GARRETT & DEBORAH
GARRETT & DEBORAH CONOVER
931 RIDGE PASS
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 931 RIDGE PASS
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 1.797 Plat: 4147-CSM 15/4147 020/01
SEC 17 T29N R19W LOT 95 WILLOW RIDGE Block/Condo Bldg: LOT 95
EAST NKA LOT 95 CSM 15/4147 1.797AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
17-29N-19W SE SW
Notes: Parcel History:
Date Doc # Vol/Page Type
02/08/2002 670679 1833/58 EZ-U
07/23/1997 755/472
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.797 72,100 496,600 568,700 NO
Totals for 2006:
General Property 1.797 72,100 496,600 568,700
Woodland 0.000 0 0
Totals for 2005:
General Property 1.797 72,100 496,600 568,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 11/16/2004 Batch 580
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
i
Form -STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC._ T N- RW
ADDRESS ST. CROIX COUNTY, WISCONSIN
9` 1641.
SUBDIVISION T LOT4 LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I•IHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
tled
IkSq
3
~ ~rw..4~7 Tl
74!
Blil ~
~c
/29V
_Z2 '
A, V
YL (lfrs~7~'Y'f INDICATE NORTH ARROW
„
/ `
cJe f
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: ~jo~_ , Proposed slope at site: ,
SEPTIC TANK: Manufacturer: ~~Liquid Capacity:
Number of rings used: 0 _ Tank manhole cover elevation:
ray,
Tank Inlet 5E/Y, 7 Tank Outlet Elevation:
Y
Number of feet from nearest Road:
Front,O Side,0 Rear, feet
..From nearest property line Front, 0Side,aear1O ? S-D feet
Number of feet from: well ~Sa building: 1
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SRR. RRVRRRV eTnV
~ r
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, Q Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: 1/ Trench:
Width: / Lenith: S,z Number of Lines:, _ Area Built: 9~3w
J/
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, (2~Rear,0 pt;?
i
Number of feet from well:
l
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:
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
Dated: Plumber on job:
-211
License Number:
3/84:mj
t r
DEPAR`rMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR & HVMAN RELATIONS DIVISION
P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
MADISON, WI 53707 State Plan I.D. Number
I 4jM,&-,S20,T29N-R19W CONVENTIONAL ❑ ALTERATIVE (If assigned)
Town of Hudson ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION 'DATE:
Garrett Conover 935 Ride Pass, Hudson, WI 54016- J- /Z dy\
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Avid B. Fogerty 3289 St. Croix 119495
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: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑ YES ❑ NO ~ I ~ ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: MP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF PU ❑ YES ❑ NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIALAND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO. 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: Na 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 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 SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑ YES ❑ NO ❑ YES ❑ NO
MBER OF PROPERTY WELL: BUILDING:
PERMANENT MARKERS: OBSERVATION WELLS: iAREST-
COMMENTS: ET FROM LINE:
❑ YES ❑ NO ❑ YES ❑ NO
X,
-f o
u G
Sketch System on t` Retain in county file for audit.
Reverse Side. [7NATURE: TITLE:
Zoning Administrator
SBD-6710 (R. 06/88)
I
2 SANITARY PERMIT APPLICATION
u ff'LNR In accord with ILHR 83.05, Wis. Adm. Code COUNTY _
°..,.~..,..o. f lip
STATE SANITARY PE IT
-Attach complete plans (to the county copy only) for the system, on paper not less than 9
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
t/a S ZT~ :!fB:L N, R ' E (o
PROPERTY OWNER'S MAILI DDRESS LOT # OCK #
J r RLdi~
CITY, STATE ZIP CODE ` PHONE NUMBER SUBDIVISIO NAME OR CSM NUMBER
4991&4 -5-1 LUAU!? Ej PE OF BUILDI ING: (Check One) ❑ State Owned ❑ CILL GE NEAREST ROAD y
II. TY
❑ Public IN L~J 1 or 2 Fam. Dwelling--# of bedrooms - PARCEL TAX NUMBER( )
111. BUILDING USE: (If building type is public, check all that apply)
7 a
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. R New 2. ❑ Replacement 3. ❑ Replacement of 411 Reconnection of 5.0 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 300 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
4740 ? 3 7 ~70• 4 Feet .O /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 Ze O / CPC
Lift Pump Tank/Si hon Chamber . T_ Fj F1 I El L1
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) 17 /MPRSW No.: Business Phone Number:
(5 e .2- 7 3~
P umber's Add ass (Street, City, tats, Zip Code):
G
1 UN /DEPA MENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued I uing Agent Signature (No Stam )
Surcharge Fee)
Approved ❑ Owner Given Initial C^+ v~ r~ "Q~ %~h
l~ J C
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
r r
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 tanks must be PumP, ed bY a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. It 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)
r
" 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 G&ta-6-rr S, Dc96GIAN • ev,Jc~J15 rL-
Location of property 1/9 1/4, Section , T N-R W
Township in -r 9 S PLAT y F ~ r'.~ zz 0G r: EAS7-
2eq~ K1
C~ailpig nadd'rress~_ 9 ~S' R G~ PA ~ lilt 015e w1s• s'Y~'/~
Address of site - 93 PA S S f u 0 so,)
Subdivision name Uj-r C' "L: R- -Z D - 'Ca s r
Lot number 9S
Previous owner of property _ ( t A) Pl ems- l) gy IL M QQWA
Total size of parcel 1, ,SS A e rZ 6 S
Date parcel was created 3A e
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house)? Yes ~No
Volume 7_5'.'5' and Page Number `0*? 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. ~%J ~t;w/• ; 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. 4 7Ly/
Signature of Owner Signature of Co-Owner (If Applicable)
A
Date of Signature Date of Signature
THIS SPACE RESERVED FOR REC.I,R0'NV I-
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982
I WARRANTY DEED
I.
4' It r`)~l fAGE ~,y) E,5I5TIMS OFFICE
This Deed, made between __.....D_.&._H_ Development, Inc. r, CRC~1X 0;3., WM
re:_1
rhlS
-6 B d IJilliam, 'ar`• s
by Don: ornstad _
- Oct. A.D-----------------------------------•----------------------- - - - , A.D. 19 86
Grantor,
1?_: tD
cs
and--------• G arT~tt--and l~eboraYl_.Conovcr,-- liu.>k~anc~--~~rid -w i_--c-
ro ert
as--surlvorship._?-----i al__prpp y
Blwht~r d D•
r Grantee,
Witnesseth, That the said Grantor, for a valuable consideration.-
.f _ RETURN TO
Grantors
St Croix-----------
conveys to Grantee the following described real estate in
County, State of Wisconsin:
~I
Tax Parcel No-
Lot 95, Plat of Willow Ridge East in the Town
of Hudson, St. Croix County, Wisconsin.
i ~k~1 lid J~ y
FE11
This ._1S..nOt.............. homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto be1011gi1rg;
And Grantors-----------------------•-------------------
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
easements, restricti ons and rights-of-way of record, if any.
and will warrant and defend the same.
, 19g'
Se tember
25th---_----------------------- day of P -
Dated this _
- B & H Development, Inc., by:
-
_ (SEAL)
-•----..(SEAL)
Donald Bjornstad
(SEAL) •7 , iL.1. = =C:t/......-•---(SEAL)
c
William Harwell
AUTHENTICATION ACKNOWLEDGMENT j
• STATE OF WISCONSIN
Signature(s) T1a1C1_.BaQL71S ad . SS.
i
------County.
~iy1] 1am.H3C'feLe11.
I
I authenticated this --2-5..day of------ September-., 19.86._ Personally came before me this ----------------day of
19...._.__ the above named
t _9 7.axld. ur?ftet?.........................
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
to me knov,n to be the person who executed the j
authorized by § 706.06, Wis. Stats.)
I foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Kristina Ogland Lundeen
Attorney at Law
Notary Public County, Wis.
(Signatures may be authenticated or acknowledged. Both Rly Commission is permanent. ([f not, state expiration ~I
are not necessary.) date- 19•-----•-•)
L *Names of persons signing in any capacity should be typed or printed below their signatures.
STATE B 1TI (W wlsCONSIN lt'i=nm .in TA-M Monk Co. Inc.
WARRANTY DEED FOIL\1 No. Mik aukee, Wis.
I - 193'{
es
8 7
• James E. Rusch,
registered Wisconsin Plat
Land of Willow Ridge East.
ei~1
Surveyor, Dated June 13, 1986.
Revised Aug. 10, 1986•
-to- Rec. Aug. 27, 1986.
In Vol. "5" of Plats, 4
The Public. Page 34, Doc. No. 416296.
certify I, James E. Rusch, registered
to the best Wisconsin Land S I r
belief: of my professional knowledge urveyor, hereby
That I have surve ed understanding and f A.
located in the SW, of SW`,Ythe divided and mapped WILLOW RIDGE EAST,
17, and the NE; of NWi of Section ~20f a1l ~in nTSW` of SE; of Section
St. Croix County, Wisconsin; that I have made such survey, Town of Hudso
and plat by direction of B & I
described as follows: H Development, Inc land land n
Commencing at the S owner of said land
thence S89°09'27"W : corner of said Section 17; '
(assumed bearing referenced to the south line
SW4 of Section 17, assumed S89°09'27"W) 54.25' alon t of
the SWi of Section 17 to the oint• of be g he south line of .
thencefN89°46'37"W 91.56';,thence S76034g11"Wng, thence S2°03'36"E 46. 61; I;
250.00t; thence N0°40'37"E 90.00' 113.62'; thence N83°50'2 "W
'13 E 179.58'; thence S88°00'37"W 257.75'; thence
SO 49 thence 589°10'47"W
thence S85°26'37"W 321.70'• 66.00; thenceNO°49'13"W 210.0 ,
325.10thence N86° thence N13°29'29 W 92.6l'; thence S85°27'0 "W
N51°06'03"E 50.00'. 43'30"W 540.17'; thence N38°54'33"W
thence northeasterly 70.30' 369.44thenc
radius curve concav7` to the southeast whose chordibearshN5arc of 317 00'
70.15'; thence N26* 113711W 4
89°09'27"E 2600.37. 66.00'thence N19°54'16"W 315-84';
E
90.00'• ° 1; thence SO 58'59"E 331.19' thence 5890
01thence
° thence SO 58'59"E 397.56'; nce S89 '01"W
S2 03 36"E 173 04, ' thence N86°21'40"W
. t' the point of.beginnin 281'18 thence
feet (44.946 acres) g, containing 1957851 squar
restrictions and covenants or
less; and being subject to all easements,
recor
d.
That such plat,is a correct representation of all theadexterior
ries of the land surveyed and
ounda sion thereof
That I have full the subdiv
of the State of Wi me.
Y''complied.with the•.proivisions of Chapter 236
sconsin Statutes, and
own of Hudson and St, t.he'subdivision regulations of
the same. Croix county-,in' surveying, dividin he
g and mapping
ORPORATE OWNER'S CERTIFICATE It
ugust 8, 1986. OF DEDICATION - Dated & Acknowledged
B. & H. Development Inc., under and b nc•, a corporation duly organized and
s owner, Y virtue of the laws of the State of Wisconsin,
does hereby certif
escribed on this plat to beysurveld corporation caused the land
s represented on this Yed divided, mapped and dedicated
B. & H. Plat.
Development, Inc., does further certify tht this plat
is required by S.236.10 or s.236.12 to be submitted totheafollowing
for approval or objections:
Department of Development,
Department of Industry, Labor and
Human Relations, i
St. Croix County Comprehensive Parks,
Planning & Zoning Committee,
Town of Hudson,
/s/ Donald E. City of Hudson.
Bjornstad - President and William C. Harwell
Secretary.
i
(Continued on following pages)
s
u
STC - 105
i
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER (!SA a a G- 7 S Go n; e ve (L
ROUTE/BOX NUMBER R_r-oG& P,4 S FIRE NO. 3
CITY/STATE_ //u,0 S a:11 (;Us , ZIP S'/(J/6
PROPERTY LOCATION: 1/4 1/4, Section , T N, R W,
Town of 9a Q S 10 A) St. Croix County,
Subdivision Cv Zz~~~ P-L06c< 64sTLot No. 9S .
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 m.-t e ~ ~nc1. a~✓
DATE 02 /cs
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
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
P.O. BOX 76
LABOR AND' PERCOLATION TESTS (115) MADISO
N WI 53707
HUMAN RELATIONS (H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/"""""^ PA- t LOT NO.: BLK. NO.: SUBDIVISION NAME:
20 /T N/ E (o 5,
COUNTY- OWNER'S BUYER'S NAME: AILING ADDRESS:
USE DATES OBSERVATIONS MADE
^^LL NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
17GResidence ~ ~lew ❑ Replace. ✓C 7 S
if JF
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUNDPRESSUR_E: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
CAS ❑U CAS ❑U GAS ❑U [Z -S ❑U FiS ❑U
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: Z, Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- f i c z z' des w 6 z s
B- 2
B- s^ 7 s, s'
B_
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIUU 3 PER INCH
P-
P_ J %s
P_
S3 sj J
P__
P- 2 1 ' 6 S s"
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 'PA 0'
I
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r
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print : TESTS WERE COMPLETED ON:
DAVE S=RV ING
ADDRESS: uCensed Perk Tesi CERTIFIC TI N NUMBER: PHONE NUMBER (optional):
32 Plumber
IGN
r-ST
ggee
ROBE Phones 749-3656 54Q23
TION: Original and one copy to Local Authority, Property Owner and Soil Tester.
- D-6395 (R. 02/8
- _ 2) OVER
1-_
INSTRUCTIONS FOR COMPLETING FORM 115 - SRC - 6395
To be a cornplete 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. MAXIMUM number of bedroom commercial use planned;
4. Is this a new or replacement sys`
5. Complete the suitability rating' A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED O T BASED ON SOIL CONDITIONS;
6. PLEASE use the abb `ons sho or writing profile descriptions and completing the plot plan;
7 f AKµ. A LEGIF^ ' -i accura ly locating your test locations. Drawing to scale is preferred. A
'iect may bt, ~a.• f desired;
8. ur benchm : k and vertical elevation reference point are t :,own, and are permanent;
R l appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
~cprlate;
1C ~n (such as tID(' plain, elevation) does not apply, place N.A. in the e box;
11 td place your ;-rent address and your certification number;
i" copies and ~ as required. ALL SOIL TESTS MUST ICE FILED WITH THE
L HORITY WITI- w6 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Se,- Textures Other Symbols
Stol-~ "over 1tt„) BR - Bedrock
Cobble i3 - SS - Sandstone
Gravel I LS - Limestone
Sand HGW - E h Groundwater
Coarse SanLi Pr,rc - P~° -'--ion Rate
Medium Send -
Fine Sand - ding
Is my Sand Greater Than
sl - `y Loam < - L Than
Bn - C
si Sill t,y -
Clay Loam }
(".y Loam? R - Red
Loam tnot - Mottles
y Clay tvl - vVitlI
sic - Silty Clay fff - ft w, fine t
c - `J cc: - corer.
P1 Inrn Many r,
nE - d - drstit
p - 1)
HW L - H' >vel,
as, di.: BM - E
VRP V Point.
AE OWNER:
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