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HomeMy WebLinkAbout020-1269-20-000 \ ° \ \ § 0 \ � � \ � � A � § � $ � � ) � � G � z 2 7 � q � < � « § Cl) « z B z f 0 « 2 § / k a ■ /q � • ■ - k 7 4) z / / � , m I ƒ f \ j § _ § 2 ) $ < z = _ 2 z C t t 2 7 / i ■ E 4 2 & $ # \ n : \ U) 2 ca \_ \ } Cl) � I \ 2 2 � 7 m k 2 a a § A CL $ -1 0 = k k 2 � � » ° » z g f \ § ° ) � 0 k A 2 0 U) \ ° o = i « - - k N c ( \ \ ) \ ) 0 / k § \ ; % 2 6 § 1 � + • $ & f k � 1 n a - f § \ } � \ / \ z / i ) ) « $ ( I CL E ) c k - , . (in $ J a 2 � 0 3 J Parcel #: 020-1269-20-000 12/07/2004 12:23 PM PAGE 1 OF 1 Alt. Parcel M 21.29.19.1326 020-TOWN OF HUDSON Current ❑ ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): *=Current Owner * MAGADANZ,JOHN L&BRENDA J JOHN L&BRENDA J MAGADANZ � 839 HARBOR VIEW RD HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *839 HARBOR VIEW RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.063 Plat: 2137-JACOBS LANDING THIRD ADDITION SEC 21 T29N R19W PT NW NW&SW NW Block/Condo Bldg: LOT 33 2.063AC LOT 33 JACOBS LANDING THIRD ADDITION N/K/A LOT 33 OF CSM 8/2370 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 21-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 906/353 07/23/1997 906/353 07/23/1997 872/45 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 2554 229,100 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.063 30,300 146,900 177,200 NO Totals for 2004: General Property 2.063 30,300 146,900 177,200 Woodland 0.000 0 0 Totals for 2003: General Property 2.063 30,300 146,900 177,200 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 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER .1n fiI,'jIPir TOWNSHIP "�jo-,,_,,- SEC.3_ T °2� N-R 9 W ADDRESS.$ay±,2,a Z ST. CROIX COUNTY, WISCONSIN SUBDIVISIONS bS /.Qh LOT LOT SIZE �' 4(n�rS PLAN VIEW Distances and dimensions to meet requirements of II HR 83 /326 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ✓CL- w �� c7dX32 Ito o jf//, 3 s Lo INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point usedZp , N5'f S(J tea/ Ait#33 Elevation of vertical reference point: 19.C1) _-S" Proposed slope at site: SEPTIC TANK: Manufacturer: I��ac �( Liquid Capacity: goo Number of rings used: / Tank manhole cover elevation: Tank Inlet Elevation:_�51 5q Tank Outlet Elevation: .S Number of feet from nearest Road.: Front,O Side, Rear, O ISO feet From nearest property line . ' Front 10 Side,p Rear,O F feet Number of feet from: well building: (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE i 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:(�r,�✓ss.X jam- '� r Trench: Width: /g Lenth: 3 6 Number of Lines:�_ Area Built k�8 Fill depth to top of pipe: '-/ z Number of feet from nearest property line: Front, O Side, O Rear,0 Pt .//S Number of feet from well: //,D i Number of feet from building: �D (Include distances on plot plan). SEEPAGE PIT y� Size: ��'I 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 �j Manufacturer: A Capacity: - T 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: Plumber on job: Dated: D License Number: 3/84:mj j 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 S 4,. 41, ee. 33 ,T29-R19 (ifesigned) Number: Town of Hudson Lot ,43 El CONVENTIONAL El ALTERATIVE Harbor View Road � Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Sam Miller tox 282 Hudson WI 54016o�� BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELE .: / /' e of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Dou Strohbeen 5432 St . ix - 1 SEPTIC TANK/HOLDING TAN MANUFACTURER: LIQUID CAPACITY: TANK LEV.: TAMMUTLEITLEV.: WARNING LABEL LOCKING COVER PRO IDED: PROVIDED: J` /O2,,S/ /Do?,__151 - YES ❑NO ❑YES NNO BEDDING: V5 4T DIA.: VFdGFMATL.: HIGH WATER UMBER OF ROAD: PROPERTY WELL: BUILDING: VENT RESH G,(� ALARM: FEET FROM LINE: , I AIR INLE :1 ❑YES NO ❑YES NO NEAREST---* DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES [__1 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 E:1 YES E]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. CONVENTIONALSYSTE BED/TRENCH WIDTH: LE NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID TRENCHES: M�IAL PIT DEPTH: DIMENSIONS ` G , /t / GRAVEL DEPTH I FILL DEPTH DISTR.PIPE I DISTR.PIPE DI R. i AT R NO. I TR. NUMBER OF PROPERTY BUILDING: VENT TO FRESH BELOW PIP S: ABOVE COVER: ELEV.INLET: ELEV.END: �.� PIPES: LINE: / AIR INLET: i� ri � � _ FEET FROM � �57/, '1 <• NEAREST---- MOUND SYSTE 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 I 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 I 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 COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on tain in county file for audit. Reverse Side. SIGN URE: TITLE: SBD-6710(R.06/88) ] Y>7 4 Ez DI LHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05,Wis.Adm.Code COUNTY .�._,..e, 57`. C2- i STATE SANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than V 1:1 � 8%x 11 inches in size. c ec I revis on t4revlous 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 Sf�/�% • ��di'' w%a W '/a, S 33 TZcJ, N, R l E(o PROPERTY OWNER'S MAILING ADDRESS LOT# 3 3 BLOCK# Z-.2 Z- CITY,ST TE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Asa„ & y% 90 z7G9 7'at:obs LO—A 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned VILLAGE: ,C ON W: M❑ Public 1 or 2 Fam.Dwellin g 3 of bedrooms u�SOh arbor V tzw � 111. BUILDING USE: (If building type is public,check all that apply) 3 1 ® Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑Replacement 3. ❑ Replacement of 4. ❑ 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 ® 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) c3ELEVATION 6.7 Z G 3 ��Z.3�0 Feet 7 9•S76 Feet VII. TANK CAPACITY Site in allons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete structed glass App. Tanks I Tanks Septic Tank or Holdin Tank �.r S G/ LJ 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): lumber's Signature:(No Stamps) MP,//Mi�PRSW No.: Business Phone Number: STrol &4L //�.��� ZyG 3Z7 Plumb Address(Street,City,State,Zip Code. IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee(Includes Groundwater Date Issued ssuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) // 9 Adverse Determination !`V C 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 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: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. I1. 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 111-LLF,� Location of property S GrJ 1/4 /Uw 1/4, Section Township /VcS®� Mailing address ,fox -o Z Z �/4 5ah GIJI_ S5/D/- Address of site Ld-r b O c V;a•cd K-� H t ASovk- 4-)Z S114 Subdivision name 5a-r-obs La-y, ',w2 Lot number # �3 Previous owner of property Total size of parcel 5 Date parcel was created - z z - 88' Are all corners and lot lines identifiable? /1" Yes No Is this property being developed for resale (spec house)? Y Yes No Volume ©s`and Page Number `��Z as recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PACE 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 1(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. ; 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. 41,36-Y17 ) . Signature of Owner Signature of Co-Owner (If Applicable) I (' ) Co — '�?"� Date of Signature Date of Signature noc.t_mi-Fjl No WARRANTY DEED ))1.11 SPA,L na.))r.o 0410 .1...,041,n,, u..A STATE: IIAR OF WISCONSIN FIRM 2-1982 43;4117 �Ljj r REGISTER' S OFFICE 11i°t ST. CROIX CO., WI ., Virginia M. Manson, a single woman Recd for Record LIAR 121468 « 8:00 A M rou�r>: :nnl n.lratil. to Sam E. Miller, a single mail /y ftgkw of 0006 the fall...r1a1 dr.,'rlhe.) real eState in St. Crulx l•.tl.a�, State of \\luonsiti: Tax farce) No: ... .. .... ............... West half (W',) of Lite Southwest 12uarter (SW%j III Suction Twenty-one (26, Township 'twenty-nine (29) North, Range Nlneteen (19) West, St. Croix County, Wisconsin except that j)art South of Lite I.ublic highway and except hots S, 6, 7, and 8 of Certified Survey Map n Vol. 6, Page 1747, Doc. No. 419479. That part of the West Half (W%) of Lite Northwest Quarter (NW'L) of Section Twenty-one (21), Township Twenty-nine (29) North, Range Nineteen (19) West, St. Croix County, Wisconsin lyLll', South of Lite right of way of the Chicago, St. Paul, Mlnneapolh, and Omaha Railway Company. '[RANSI-=h� 0 $~ E£F This is not hlnulStrml prnperty. #ctk 114 Ilot) I:fuel••""' I.. `arranlie": easem•_nts of record and pro$-ective covenants and restrictions of record, if any. holed thus dad ..! . l!►fifi V.lrglnla M. Hanson (tiE:\L► ISEA1.1 AUTHENTICATION ACKNOW LEDUMENT Signature(e) . ..... STATE OF WISCONSIN ss. authenlicaled thin .. . dal of 10 I'rra.)nall�' ca tile hrfnre mr this 50 day of >a. 'L L 19 88 the :hove named Virginia M. Ilanson TITLE: MEMBER STATE. HAIL OF WISCONSIN (1f Tint. authorized by S 7116.11G, Wilt. %tats.) In tiu• L11n11n to he Ihr perron tchn rsrrulcd lhr fur+•I:Iliu• Artiment aat) ai0KI,(I •Icd¢r the ams. T•• s INSTRUMENT WAS DRArTCO nV V. l.ois•A. Murray, .heywpod,. Cari b Murray P.O.' Box 229, Iludsl)nA Wl, . 54016 ;,1,,.' Ilnr,• FK ' t Pt' ❑ 4y f' )f i. I'mnll c. Wk. (Siennturen male' he nuthenticalcd Ilr nrkw-Mrdged. Milli %I, I'..•uvi`rv,,i M y,MVII,1•I�.I if III11. State c•n• radio., are tint necessary.) dal••. •Name.of Mrw,n% eisnine in a1.r rara.iir •1....,'.I 1.. n,..•.� , �.,r..l 1 • .. •b.., r. . WARRANTT DI:LD sTA'r P. nAR OF AISI'M:•W N..•.,,.•,, 1.:w1 1•fa L_ I STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER :5LfTZ L /-F1� ROUTE/BOX NUMBER`' SOX Z$ Z FIRE NO. CITY/STATE}�9/-50s1! &T_ ZIP S-VOI ' PROPERTY LOCATION: s w l/4 &Lt�l/4, Section —, T_M? N, R /9(� Town of AzC4Lo�4 , St. Croix County, Subdivision e_oios La. ZIASi , 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. DATE 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 r DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, C HUMAN RELATIONS DIVISION • LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 (ILHR 83.09(1)&Chapter 145) LOCATION: SECTIOW-_ TO,�{NSHIP/M"I!'IF0llI—.y: T NO.:BLK-ND.: S}►8DIVISI N NAME: w �/ NW'/ 33 /1Z� N/R19�(o W Nu4so 33 Jdco LaNA►NQ COUNTY: MAILING AD S : 5-CeO'), 7SAtl M, 4Ee T eoc,T &00o4_ INW40N W1 USE DATES OBSERVATIONS MADE A I Q p _M* 14 Residence K Nevv ❑Replace I /9%;9 Sobs 600k, PG St's Soft: - nCz - $ve C jq4*kT RATING:S-Site suitable for system U• (Site unsuitable for system c /1 O i �� . MWS ou IN ZS Elu gS ou [IJG�u Cic'&jYkNT oAJALEM:(o�ti MA ii Z If Percolation Tests are NOT required DES//I��GN RATE: If any portion of the tested area is in the under s.ILHR 83.09(5)(b),indicate: C�Ll11SS f Floodplain,indicate Floodplain elevation: NA PROFILE DESCRIPTIONS BORING AL ELEVATION P H T IZiF R UN WATER-INCHES HARA T R O SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER DEPTH --OBSERVED TO BEDROCK IF OBSERVED SEE ABBRV.ON BACK.) B- 9.9Z /07.62 I�o�ILf > 9.QZ 6"$�c.-t's �''$i N L 26 >QajcSf6.l� B- 2 9.5� /oS. I �o>U� > 9 .5EA fSu-7-5 A/0"do-- L 4i1Z&IRewC_"SjGe SC"&of AS JV 4 B- J 1 i� p �( q FS'OILp� "ZeRAaQ'VCS- c i~t7 RN •CIS �07•OC N L > I.4Z 14"R& QN CSt4ft SC),doN r4 v El- dr ` 3 t 7'B��TS S"' $aN L 27' tR.� CsdC,� �G Q,a.v v++ 9.17 U I•�/ 9.1� Is"R&&V Csi4lt 4or BQrJ 04S-C<&4 p C `p .ZS east4 rn5 17"Q+�Be,�C.S�IG� 3c''81N rw� B- li ��- PERCOLATION TESTS TEST DEPTH , WATER IN HOLE TEST TIME D 1 A V H RATE MINUTES NUMBER ItS AFTERSWELLING INTERVAL-MIN. PER INCH PERIOD P. � •I IO7 0 �� � 1 P. s.3o 107,%0 3 '>*k > >� <� P. 3. c90 3 > > > � < P- P' �1.E ►�1 t V i1Q c— P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. ascribe what are the hori- zontal and vertical elevation referen6e points and show their location on the plot plan. Show the surface elevation at all borings anc the direction and percent of land slope. SYSTEM ELEVATION. �tsa r_—T--T ��. i ,—fi- - -- I _ f.. -- A -- - -- _ '--- � �, X I I 31 - i 14 -'ro(� OFD Aid, _ �- - - -----; - o 4{.� .._ ,aa I ►-Q� i r L _ C"ZI ,. I—! -1- 1, 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. NAM (print): D TESTS WERE COMPLETED ON: oK SUn, -- U1 av� AD . CERTIFICATION NUMBER: PHONE NUMBER(optional): SEAN 4' Nu n, 1 - �a CST SI TURE: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. L�nn HR-cgnA.ia,,in tnra-t► r I Wit M � CD ` 2 r W cA r - �c � — —per —'-•o 1• � N � S x (J. •F\ 01 o a� vk ° V i N ` ' M T 3 J o M 0 o N s 4. 0 wl d -•f"+.'x:-. .. .,,.....•. _. r:, •,.,r ill *'..._ Q all- E _J .Mt f+l+4•. . J J a ( a t 5 Id o • �> •. t j .� d. N •I c9 t vi IV . . n\ ST. CROIX COUNTY ,.' WISCONSIN ZONING OFFICE ST.CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 1 (715)386-4680 May 21, 1990 RE: Certificate of Compliance FROM: St. Croix County Zoning Lot 33 of Jacobs Landing SW 1/4, NW 1/4 , Sec. 33 , T29N-R19W, Town of Hudson St. Croix County, Wisconsin St. Croix Co. Zoning Department personnel inspected the installation of the septic system which is to serve the dwelling located at the above described property. The inspection was conducted on May 21, 1990 and revealed that the system was designed and installed in accordance with all local and state requirements. Should you have any questions, feel free to contact this office. cj D