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HomeMy WebLinkAbout020-1188-40-000 / 0 2 $ f \ Q § ( � R � k � * � � § � 2 � % } � 2 ) 3 \ � \ J � n � a Lu z 2 { z' K k \ / \ a 2 § k z k K J ) z E _ \ / \ © 8 § f § O = k / k j ) § \ « E I ' 2 co c % \ a g } m \ t o a ) U) , $ _CD § \ § \ ) - k o a a a CL O = _ j v m § § ƒ a § § 6 2 S § to \ E r a : 2 n 2 2 c ) 0 a J » m R ■ _ : » 2 2 E ' ® o ) E LO k } / 3: : § § k { \ $ / § E . \ @/ 2 5 § a S ■ a D k 2 5 - § k } ' J C. z / k k ) \ � e � ) k k a f k J 2 o v Parcel #: 020-1188-40-000 03/23/2006 01:41 PM PAGE 1 OF 1 Alt. Parcel#: 28.29.19.1181 020-TOWN OF HUDSON Current E 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-CAREY, MICHAEL F&KIMBERLY D MICHAEL F&KIMBERLY D CAREY 790 HARLAR CIR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description `790 HARLAR CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.049 Plat: 0153-CEDAR HILLS ESTATES III SEC 28 T29N R1 9W NE 114 LOT 53 CEDAR Block/Condo Bldg: LOT 53 HILLS ESTATES III 2.049ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 28-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/28/2004 770046 2625/613 WD 07/23/1997 824/185 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 93003 260,800 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.049 70,100 195,900 266,000 NO 05 Totals for 2005: General Property 2.049 70,100 195,900 266,000 Woodland 0.000 0 0 Totals for 2004: General Property 2.049 40,700 154,500 195,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 118 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 i Special Assessments Special Charg es Delinquent q Charges Total 27.00 0.00 0.00 Form - STC - 10 AS BUILT SANITARY SYSTEM REPORT OWNER ^ C TOWNSHIP SEC. T, -R ADDRESS ��Q .3 ifJ iBs� ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITH 100 FEET OF SYSTEM i 1 I I a ' mVS� INDI ATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ,�� Elevation of vertical reference point: _ Proposed slope at site: SEPTIC TANK: Manufacturer: squid Capacity: / Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Utz? Number, of feet from nearest Road: Front,O Side,W Rear. ' feet From nearest property lin Front,O Side, Re J feet Number of feet from: well , building: Ledimensions(Include this information of the bove plot plan) ( to septic tank) AFx7FAQF ER :turer: 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,p Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: a ' Width: .J Length: Number of Lines:_ Area Built: T Fill depth to top of pipe: 4� Number of feet from nearest property line: Front, Side, O Rear,®Ft . Number of feet from well: Z �I- 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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Z Plumber on job: License Number: 3/84:mj OEPArt'fMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING �ABOR&HUMAN RELATIONS DIVISION P.O.BOX 7799n6�9�T 8 �T7 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION �v`r 4's9 J y,M,T29N—Rl9T State f assigned) I.D.Number: TOWCI Of Hudson � CONVENTIONAL ❑ ALTERATIVE .' I Tank ❑ In-Ground Pressure ❑ Mound Lot 53 Cedar Hills ,��t��� NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION D E: Steven Walter 1303 River Ridge Road, Hudson, 141 5401.6 S BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV: CST REF.PT.ELEV: Name of Plumber. MP/MPRSW No. County: y - Sanitar Permit Number: Gary L. Steel 3254 St. CrQ'' ° 11422 SEPTIC TANK/HOLDING TANK: " a` MANUFACTURER: LIQUID CA CITY ;7gNK INLET ELE .: TANK OUTLET ELEV.: WARNING LAW LOCKING COVER PROVIDED.' PROVDED: ES ❑NO ❑YES V NO BEDDING: VENT DIA.: VENT MATL.: HIGH WAT R NUMBER OF PROPERTY WE L• BU DING: VENT RESH ALARM: FEET FROM t / LO AIR INLET: ❑YES VNO C ❑YES ❑NO NEAREST­41" / V DOSING AMBER: `. MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: w LABEL LOCKING COVER P PROVDED: ❑YES ❑NO Ellir ❑NO ❑YES ❑NO GALLONS PER CYCLE: - PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY:j WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF El 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.) CONVENTIONAL SYSTEM: BE WIDTy' LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID S �� TRE�HES MATERIAL: PIT DEPTH: DIMENSIONS U RAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROP TY W BUILDING: VENT TO FRESH OW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: PIPES: LI AIR °� FEET FROM o /� �- 2 NEAREST� A .. 'MOUND SYSTEM: x. M#pund site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: 00 mound systems to make certain that it ON REVERSE SIDE. SHOW E-1 YES ❑NO} meets the criteria for medium sand. ELEVATIONS MEASURED. !+ SOIL ER 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: BAD/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: CiAMM'SIONS ' MANIFOLD PUMP MANIFOLD gfBTR.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 PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: I `�-� Q❑YES tl NO ❑YES ❑NO NEAREST----1111" J � O ' Sketch System one ounty file for audit. Reverse Side. SIGNA TITLE: SBD-6710(R.06/88) " Zoning Administrator FZ7Qq1 LHR SAN ITARY PERMIT APPLICATION COUNTY ,.e,....,w.,..,w In accord with ILHR 83.05,Wis.Adm.Code St. Croix STATE SANITARY PERMIT# -Attach complete plans(to the county copy only)for the system,on paper not less than ❑ //9' 41 8%X 11 inches in size. Check if revision to previou 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 Steven Walter SW %6 NE '/a,S 28 T 29 , N, R 19 4x-(or)W PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# 1303 River Ridge Rd. 53 1 n/a CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Hudson Wi. 54016 715 386-6039 Cedar Hills Estates III 1. TYPE OF BUILDING: (Check one CITY NEAREST ROAD I ❑State Owned ❑ VILLAGE Hudson I Harlar Circle ❑ Public 01 or 2 Fam.Dwelling—#of bedrooms 3 A ELTAX N ER c �/� III. BUILDING USE: (If building type is public,check all that apply) 1181 oa0— a a i~ _►_.O 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. El Replacement 3. El 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 93 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 450 495 500 1.2 1/3 92.0 Feet 95.3 Feet VII. TANK CAPACITY Site #of Prefab. Fiber- Exp in allons Total . INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App. Tanks Tanks structed Septic Tank or Holdin Tank X 1000 1 Weeks C P. Lift Pump Tank/Siphon Chamber — ---- — VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsit sewage system shown on the attached plans. Plumber's Name(Print): Plumb r' Signature: Sta s) PRSW No.: Business Phone Number: Ga L. Steel r!3254 715 246-6200 Plumber's Address(Street,City,State,Zip de): 988 N. shore Dr. , New Richmond., WiQ 54017 IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee(includes Groundwater ate Issued-- uing Agent Signat�No S mps) f/� Surcharge Fee) ��^ Approved ❑ Owner Given Initial q I '-T� Adverse Determinatio 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. Il. Type of building being served. Check only one and complete##of bedrooms if 1 or 2 Family Dwelling. Ill. 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) t. . 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 Location of Property 5W �4 W<-, '4, Section 2� T Tol N - R (9 W Township 6A O 510" Mailing Address I X0'7 V�j\1 E%It--- 1C) 4-6JSO` + Subdivision Name CAc—,-O An- 4k L&,5 Lot Number Previous Owner of Property &4, �VfwC, py,= Y . Total Size of Parcel Date Parcel was Created q-2(o -cbdb Are all corners and lot lines identifiable? Yes No I s t his property being developed for resale (spec house) ? Yes No Volume and Page Number � as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty De 2. Land Contract 3. Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTy OWNER CERTIFICATION I (We) een ti 4 y that att .6 to temen 6 oh th.%.s 4onm ahe tAue to the best o f my (oun) hnowtedge; that 1 (we) am (an.e) the owneA(s) o4 the ptopeJtty descgi.bed in thd,6 in4onmation 4onm, by vi&tue o4 a womanty deed Aeeonded in the 044ice o� the Coun-tu Regateh oA Deeds as Document No. -j41_q 44. ; and that 1 (we.) pn.esentty own the phopobed site. bon the sewage cGisp�Aa. Aystem (on 1 (we) have obtained an ea6eme.nt, to nun with the above dmcAibe.d pnopenty, 4on the con6.thucti.on o4 said system, and .the same. has been duty ne.eonded in the 046ice oA .the County RegizteA o4 Deed6, as Document No. 441 9 44 ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE. SIGNED DATE SICNED L.�All mss. 4 /\YLCI\� LI,Nt Of NE s ME 41 16"E 520.61 . 310 ' !84.00' ���((( N 02 04'47-E \ 93498 SQ. FT. .ge `�9 - (2. 146 AC.) Zg 2 00 Or, 206-59 ebb ( d4• •� 20 � N 12 �jO O 52 f J N 5 4 �O, n `� �►. 88 30 SQ.FT.�' 89262 SQ. FT.\ + (2.049 AC.) w (2 042 AC.)— r 2rO� $00049'04"E 53 269.97 ' O) /�1te 4s 1 100 s �1 89262 SQ. FT, o (2.049 AC.) m C>_W • sq o to DRAINAGE G EASEMENT i 00 i Od U) 116.04' - X01 .35`_�— 116.5 S6' - ►6s �6 N ��90 di, 18739' N, ii 4S E Z I 417.39' 15, 127.50* _22 23 1 _24_ I � I I I to CEDAR HILLS ESTATES VOL_ 5 PAGE 38- 0 All linear measurements 'Lave been made to the st hundredth of a foot. All angular measurements ee made to the nearest six seconds and have been ted to the values shown. durve Data T Central Arc Curve Radius Angle Leng 6 Blk 884.00' Z6 38144" 411 . 7 Blk 950.00' 24 06'28" 399. i �i DOCUMI f NT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1= .. � 441944 eoQ� REGISTER'S OFFICE Cedar Hills Develo went Inc. a Wisconsin cor oration ' CROIX Co., W1 P........�. ._. . ,......... ••E.................. Reed for Record ............................................ -----•----•--•-•-•--•-.•--•........................................••............ OCT 31988 Violexxe.........-"....... at 12:50 P M conveys and warrants to --Steven H. Walter and rTrOi'I�t F. Walter, �G. husband."and.-Wifa-_aa..sulcx�ixarahig_.aaxi.xa�..gxapar_ty.............. •"...........................................................................................•--................. RptMrr�prilN`x I .... ............•.....-•---.....•••-•-........... ..........•-----•--•-----------•-.... .................. 77E _ -- ----- ---- --------------..............------•---... ..... ...._._...... /30.3 , the following described real estate in ......S.t.•..CxjDjx.........., ••.".County, ON aso: ......................•-- .... Lot 53, Cedar Hills Estates III in the Town of Hudson TR NSFER FEE _._ is not This - ----------- - ------ homestead • property. ft (is not) Exception to warranties: easements, protective covenants and restrictions of record, if any Dated this ..........•.......6.G. `......-""-- day of ...... . • CEDAR HILLS DEVEL MENT INC. !/\J --..-""_.-".""-."""."..--•--.."--"-------- •--.-•----(SEAL) . BY Dean--11-: arson President•------------- (SEAL) •..................•-----..._........................----------•-. ' ATT --- -ESTED--- B•-- Y: .............................. .....................--•-"...........................................(SEAL) . _. ..............(SEAL) Wil�lQ/ifsin C:""IiarWe21";�"�"S�ecrefaiy .................................................................. (�"�. ►s'YL. f.• .FQ/QK1L�1:................._.__....... AUTHENTICATION ACKNOWLEDGMENT signature(a) ............................................................ _ STATE OF WISCONSIN authenticated this•.................................... •- -....._....... ....St.. .u(i-x_...............County, �• .day of.......................•_.. 18,,,_.. Personally came before me this C�G day of ......... ....Sl.Plomb£x..................... 183x... the above named ....... ........................ .................... . ... Oadar.._Hi.l.la._Devalcipmaai;, ..Inc....b. .Y..ileau .� .. ...._.- Laraan..aad_.Wi7.7.i�tm..C..Har�tall..".Preaid Bt: an !I T'IT'LE: uii:MBEj&s* Akita BAA t) W'i UUNSIN Haaratazy.._a�..aha��a..named._cargarati.on,. hq�; (If not, ............................................................b 706 i knaFtn__ta..ka..Lha._gars+ana..t�#�et..eacecuted��. 1"� ; authorized by $ ?08.08, Wis. Statlt.) .;• `; foregoing instrument and acknowI • '• a^` WAS DRAFTED BY •��w r THIS INSTRUMENT This corpaati hag no: rwd'..�' Lois A. Murray, HEYWOOD, CART & MURRAY - -/' ..... •P.O. •Box9�..Hucfsoii ... - - jl�................. ;+.ti,, xtb iff ......................................................_ ... Notary Public ._ St.. -Croix.........'.-A:Coun y My Commission is (Signatures may be authenticated or ..;,;:nowledged. Both permanent.(If not;;atfB Ir Ions'+ are not necessary.) ,�. ,ti,�¢ ,,4 •, w R III date: ..................... �4 ,1 A1� —*Names of)Penn signing in any eapaeacy should be typed or Printed below their signatures. WARRANTIr DEED STATE BAR 08 WISCONSIN �..-.:.•� wJrco,mzn al Blank Cu. Inc," 1!'OAII[ NO. g-- lYBE �`'1 lliiiwal�ka � H (A c Y � 306- &o347 y SEPTIC TANK MAINTENANCE AGREEMENT St . Croix County C) Y OWNER/BUYER �EYFjN l\,.,At---M11-- m ROUTE/BOX NUMBER_ X303 lLtY�ry �?-t�u� (Lp Fire Number J .CITY/STATE IAos-o n, WI ZIP 5401(6 PROPERTY LOCATION : Nom , Section 2� T 29 N, R I9 W, Town of_ 4(A050" St . Croix County , Subdivision (ft-,DNT, IAWLA-5 Lot number Improper use ifnd maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a lic_e_nsed se tic tank pumper. What you put into the system can affect th_e function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix County residents may be eligible to receive a grant for a maximum of 60% 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 veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic tank is les.s than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 0 I/WE, the undersigned , have read the above requirements and agree Cn Cn to maintain the private sewage disposal system in accordance with x the standards set forth, herein , as set by the Wisconsin Depart- ro ment 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 . SIGNED �,� DATE l St . Croix County Zoning Office P. O. Box 227 Hammond , WI 54015 715-796-2239 Sign , date and return to above address . i DEPARTNfCNT 01t REPORT ON SOIL BORINGS AND SAFETY&BUILD6,, S INDUSTRY, LASoR AND P PERCOLATION IVISION , ON TESTS (115 P.O.P.°.BOX F1U 44 RELATIpN$ ` , MADISON,WI 53707 1H63.0911)&Chapter 145.045) A TOWNSHIP/fslUteffaf'dMti�Y: OTNO. f110: SUBO S NAME: Sw V/ Y . z MY N/R/y E I.)W �f U jos"� • ` 53 f1�i//S r COUNTY: B M AILING ADOR 17/30 3 AGSr� E -��•� �il�- fLONw OReplace "d DATES OBSERVATIONS MADE MM S PTI N ';.. Residence 3 !� D yt ••�f'�P RATING:S-Site suitable for system U•Site unsuitable for system ONVENTI NAL: M UND: 1 M-IN-FILL OLDING ANK:RECOMMENDED SYSTEM:loptionall '« �$ ❑U �S ❑U S ❑U ❑ Co NV S U ❑S C�]U �F rcy� ;> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the coder s.H63.09151(bl,indicate: r��s S .. � Floodplain,indicate Floodplein elevation: PROFILE DESCRIPTIONS iv O€Guff L Ff BORING TOTAL NUMBER DEPTH IN, ELEVATION J-2QUI ID A •1 CH 'CHARACTER OF SOIL WITH_THICKN SS,COLOR. EXTURE,AND DEPTH !;�{ TO BEDROCK IF OBSERVED SEE ASBRV.ON BACK.) B- / �, 0 93. 36 3, /0 w.. s: , IS' ;newt e-441 4,v B_L 7,0 90./z' 7�0 .3, s c r -7"0 aOPC g- 3 8, r f,S 30' �o > o ' 1.91 e' 7.11 • 0 •7s•B ea s- 9"b " 99,i �, 0 ' s ' i3lk•S(� 1.0 'Ra S! t Grs 'Tint. &A& 06 w/ Fie B- 7 > �,Q ,S l IE'• S� S rJ. S 7i 0 T�� V GS psi '� 1+' is PERCOLATION TESTS EST DEPTH WATER IN HOLE TEST TIME WA LEVEL-INCHES RAE IN NUMBER INCHES AFTER SWELLIN INTERVAL-MIN, fie P s PER INCH /3 � P•Z P- 3 l,. P- ; P_ ' ' y P PLOT PLAN: Show locations of percolation tests, soil borings and the dirrtensions of suitable soil areas. Indicate scab or distances.Desoribe what ate the ho-, k zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings end the direction and psrogM of land slope. , SYSTEM ELEVATION 1 I I ti_ 1 �.... I - I .�.. .•� t i. , � T R -- fN obf . r • I I LL I to t • 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 Wiswnsin r: 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 O l'f c S&TIC PLUMBING CO. ADDRESS ROBERT ULBRIGHT CERTIFICATION NUMBER: PHONE NUMBERIoptiorlai): " MASTER PLUMBER UC.NO.3307 M.P.R.S. 'L TI/ — "'i INSTALLER&DESIGNER UC.NO.00663 CST SI NA U E: Tester. �� P4/�� se Ai t : 1 " 30 ;,colft 5cPriC PLUMBING CO. 6.ii O'NEIL RD.,HUDSON,WLS•G64S0� z�pl ROBERT ULBRIGHT MP.R.S• ,VIS.MASTER PLUMBER LIC•NO.3307 `O.t. 3 ;•1:NN.INSTALLER&DESIGNER LIC.N0'oM 5 ec( . 31 186 CtDAR WAS 'C. ,� Io tee � UN 2 f s 3 9 , +Q y f 15 40 1 AV sr fr. Wc�� Fir 7 f 4erk' i .s' PV Steven Walter SW4NE4 S28 T29 R19W Hudson, township i &t�u /r z:4, i2. eJ S 1000 0 �1 s0-P � S ti, Gary L. Steel 988 N. Shore Dr. `t New Richmond, Wi. 54017 MPRSW 3254 i �I-i&,8y