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HomeMy WebLinkAbout020-1231-40-000 � \ 0 7 ƒ \ § § � o _ o ® ƒ / \ \ 2 c I / \ o ! / 2% b c 0 C 2fo g V)00 §�-0 2m § 1 1 , cc 00\ 0 ? z §a z \ /\k 0 < > < 7 � Cl) n a - z ' z � � t § � q / \ IL c IL m 0 z k ] 2 \ C: \ $ k E { \ \ © 2 tm CL j j / j A ) m g o § , $ _ G Q $ z ca z z) z j ® .. .. z k Cl I 2 £ G £ e e ■ . � g = � G - / 0 � c © C k 0) / k 3 § o a ± ƒ \ & o a 2 0 a n 7 ■ ■ | 2 § Ee = Em 0 \ a § § £ § § § � , � 2 k0 B ƒ _ � c CO ■ u 2 2 k % ƒ / \ .� § { ƒ § §I D § § -0 § \D E > 2 \ G j m \ 2 \ § % $ / 7 ® \ 9 c I c E ° - - E § S J o LO / CV 0; ) k � / G � k7 \ � -� 2 6 m ] D [ § ; \ 2 / / R g ) f � 3 o } / § 2 Cl) 0 ) / Z / m � � 2 } k . n % ) . IL � " a » E CL k ( k ( k k c u ■ o ■ u o ■ u - , , Parcel #: 020-1231-40-000 02/08/2005 09:01 AM PAGE 1 OF 1 Alt. Parcel#: 29.29.19.1241 020-TOWN OF HUDSON Current X', ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): "=Current Owner GERARD B&MICHELLE M UCHYTIL "UCHYTIL, GERARD B&MICHELLE M 494 COUNTRY VIEW RD HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description 494 COUNTRY VIEW RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.750 Plat: 2421-ROSSING'S COUNTRY VIEW SEC 29 T29N R19W LOT 13 ROSSING'S Block/Condo Bldg: LOT 13 COUNTRY VIEW ADDITION Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 857/359 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 49281 272,400 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.750 33,800 176,900 210,700 NO Totals for 2004: General Property 2.750 33,800 176,900 210,700 Woodland 0.000 0 0 Totals for 2003: General Property 2.750 33,800 176,900 210,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 112 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 S¢,yV A,avtl TOWNSHIP SEC. z 9 T !E-'1N-RZZ0 ADDRESS r�n1� ZSfj� ST. CROIX COUNTY, WISCONSIN SUBDIVISION gP6�5 -tT Viu.) LOT j LOT SIZE 2- ���(•ct/j PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 4t- � 3 C)(S'f,tm -1. -- Maltt c JJ a�. I� o b 0 l2 z 72 Z$ir Z �.s'xzrl' s' w — lA t. vt >-z4 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used i Elevation of vertical reference point: .90 = 1660 Proposed slope at site: • SEPTIC TANK: Manufacturer: Szy Liquid Capacity: Number of rings used: Tank manhole cover elevation: 70 30 Tank Inlet Elevation: 9•Sy Tank Outlet Elevation: 9.gS 77 ��.OS Number of feet from nearest Road: Front, Side0Rear, O ego feet From nearest property line : , Front,OSide,/7�Rear,0 / 2 Z feet Number of feet from: well ? 2,� , building: ZS/ (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE Pump CHAMBER Manufacturer: 14 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 o» plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: �. Width: / -� Length: 3 Number of Lines: Area Built: ASS Fill depth to top of pirr: Z-/ i Number of feet from nearest property line: Front, O Side, Rear, O Ft Number of feet from well: Number of feat from building: `f. (Include distances oil plot plan). _ a — �� ]� jc�, X. SEEPAGE PIT ��as 9a ya Size: A 4 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: L Inspector: Dated: f\\ Plumber on job: License Number: �`/ l r a 3/84:mj SAFETY&BUILDING ,tMENT OF INDUSTRY, INSPECTION REPORT FOR DIVISION LABOR&HUMAN RELATIONS ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION P Q BOS 7969 State Plan I.D.Number: MADISON,WI 53707 (If assigned) Sf,,,,ft 4f S29,T29N-R19W Ed CONVENTIONAL ❑ ALTERATIVE Town of Hudson Idin Tank ❑ In-Ground Pressure ❑ Mound g INSPEfff���TION DATE: NA E OF PERMIT HOLDE . ADDRESS OF PERMIT HOLDER: _ O / - Q Box 282, Hudson, WI 54016 0 Sam Miller REF.PT.ELEV.: CST REF.PT.ELEV. BENCH MARK(P rm�.annent reference point)DESCRIBE IF DIFFERENT FROM PLAN: 9 ill - N e�rk� County: Sanitary Permit Number: MP/MPRSW No.: 119497 Name of Plumber: 5432 St. Croix. Doug Strohbeen SEPTIC TANK/HOLDING TANK: PROVIDED: PROVIDED: LIQUID CAPACITY: TANK INLETELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVE MANUFACTURER: [[,�� O O 11-o5 /AYES ❑NO YES .�NO If, c„) 03& HIGH WATER NUMBER OF ROAD: , PROPERTY WELL: BUILDING: AER N OH BEDDING: VENT DIA1 VENT � 3 M LINE: �� /`)� ALARM: �,( FEET FROM v ❑YES 0 I ❑YES LJ NO NEAREST DOSING CHAMBER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: EONSBEDDING: LIQUID CAPACITY: PUMP L: PUMP/SIPHON MANUFACTUR ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PROPERTY WELL: BUILDING: VENT TO FRESH CYCLE: PUMP A CO TR O RATIONAL: NUMBER OF LINE:FEET FROM ETWEEN y ❑NO OFF) t Of IOWin FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: SOIL ABSORPTION SYSTEM. Check the soil moisture a he P P g A or excavation. (If soil can be rolled into a wire,construe on shall ease until the soil is dry enough to continue.) CONVENTIONAL SYSTEM: INSIDE DIA.: #PITS: DEPTH / DEPT WIDTH: LENGTH: NO.OF DISTR.PIP�SPACING: MATERIAL pl� BEDITRENCH TRENCH S: DIMENSIONS PROPERTY WELL: BUILDING: VENT TO FRESH LINE: / AIR INLET/ GRAVEL DEPTH FILL D PTH DISTR.PIPE DISTR.PIPE DISTR.PIP MATERIAL: NO EDISTR. FEET FROM �S Q BELOW PIPES: ABOV COVER: ELEV.,IN E : E�EV END: ��. NEA REST O MO D SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM ON REVERSE SIDE. SHOW slope and furrows thrown unslope: mound systems to make certain that it ELEVATIONS MEASURED. ❑YES E-1 NO meets the criteria for medium sand. PERMANENT MARKERS: OBSERVATION WELLS; SOIL COVER TEXTURE: ❑YES ❑N( DYES ❑NO MUL DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: CHED: DYES ❑NO ED YE CENTER: EDGES: ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH ABOVE COVER BE WIDTH: LENGTH: TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE:NU.UF DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: No ES: DIATR.PIPE DISTRIBUTION PIPE MA ELEV.: ELEV.: DIA.: ELEV.: ELEVATION AND VERTICAL LIFT CORP DISTRIBUTION COVER MATERIAL: APPROVED PLANS HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: ❑YE INFORMATION ❑YES ❑NO PROPERTY PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF LINE: FEET FROM COMMENTS: ❑YES El ❑YES ❑NO NEAREST 0 X1 _ �/ � 9 T 13.a Retain in county file for a Sketch System on NATURE: TReverse Side. SBD-6710(R.06/88) DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm.Code Noma STATE SANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than /1 c?-//�F 7 ❑ Check if revision to previous application 8r4 x 11 inches in size. p —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 -s r.- cr Sw '/a '/4,S Z T2 , N, R /� E(or PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# g 4E e CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER h`a m n f cJ Sy0/!a 3 G Z /1 e 2 4n II. TYPE OF BUILDING: (Check one) ❑State Owned ❑ VILLAGE: �� NEA`RErROAD'1`tN R n ❑ Public �1 or 2 Fam.Dwelling-#of bedrooms 3 PARCEL TAX NUMBER(b) v/ d� Ill. BUILDING USE: (If building type is public,check all that apply) O Z _ ' Z .3 1 ❑ Apt/Condo 77 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 Bit applicable) A) 1. ® New 2. El Replacement 3. El Replacement of 4. El 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 0 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 Oo 6 1S (q ? 41w—.`o`r 90• Z Feet 9�e 2 Feet VII. TANK CAPACITY Site in a llons Total #of Prefab. Fiber- Expp. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT 1,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): PI ber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: Doc,j •.,, M P f V Z 7 3 7— 3 3 Plumbe 's Address(Street,City,State,Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(includes Groundwater Ta e ss ue ing Agent Signature(No Samp�' Surcharge Fee) Approved ❑ Owner Given Initial !V� _ ��Adv rse etermination ( CJIJ " 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. 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) ,t " APPLICATION FOR SANITARY PERMIT STC - 100 I 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 2 W 1/4 �1/4, Section Z , T N-R Township Mailing address .,e-,Y' zV Z / - Address of site EoN Subdivision Lot number /3 Previous owner of property fr�s7` OL°�.SS'�ng Total size of parcel Date parcel was created ��— 7 — $ 7 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes No Volume 79 7 and Page Number - 77 as recorded with the Register of Deeds. ------------------------------------7------------------------------------------ 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 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. 1� Z z S6k ; 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 County Xr of Deeds, as Document No. ' rl Signature of Owner Signature of Co-Owner (If Applicable) �0rr2-^ F.Z Date of Signature Date of Signature DOCUMENT NO. 9 pA�t 49 STATE BAR OF WISCONSIN FORM 11-1982 THIS SPACE RESERVED FOR RECORDINO DATA _ . LAND CONTRACT REG' TER'S Ur►=10E IMhHuI and(.at ..... •'�3e 1 _E�((� ITO BE USED FOR ALI. TRANSACTIONS WHERE OVER T AIe230 1-%0110 IS FINANCED AND IN OTHER NON-CONSUMER S1. Ckf:ix CO., W1 At•T TRANSACTIONS) Rec,1 t(,I p:acord Contract, b1 and between .......... Noveat��.�.Z, °AT a sin le woman pf 1:25 P M RukX..Ra leY.s.............&......... ........................................................... ................................................................................................ ("Vendor", whether one or more) and_Sala.R....NA11RX............................................. Register of Deadls o0 ......................................................................--- .................................. .......................................................... ("Purchaser", whether one or more) Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- formance of this contract b1 Purchaser,the following property,together with the rents,profits,Sutures and other appurtenant interests (all called the"Property"), ie......SC.a..(rxQl)f............................................ County, State of Wisconsin: RETURN TO West one-half of Northeast Quarter (iJ!OO&) except the east 8 rods, and the Northwest Quarter of Southeast Quarter (NASW, except Tax Parcel No. .............................. the south 6 rods, all in Section 29, T29N, 19W. "" TRANS $7 FEE This .. -.. . -is..noIt homestead property. b19� (ia not) Purchaser agrees to purchase the Propert• and to 208 8th St., Hudson, WI 256 150 OOp s Pap to Vendor at ............................................................. the sum of=........•.......:......................................... in the following manner: (a) =. Q,000..QQ...--------..............-•-- at the execution of this Contract; and (b) the balance of a ..................together with interest from date hereof on the balance outstanding from time to time at the rate of.nine...(9X1l....................... per cent per annum until paid in full, as follows: Interest to January 11, 1988 shall be limited to $1,320.29. $80,000.00 plus interest on the unpaid balance on January 11, 1988. $50,000.00 plus interest on the unpaid balance on January 11, 1989. $50,000.00 plus interest on the unpaid balance on January 11, 1990. $56,150.00 plus interest on the unpaid balance on January 11, 1991. The above payments shall be made in addition to any payments made for the conveyance of lots until the total price is paid in full. All payments shall be by 2 checks, one to each Vendor for � of the full amount. A �ot .�,%l�ase Aguem�nt h adlso been shi t�d oI� .tt}i date 11th day of rove e , owever, a en Ire ou s an Ing ba ance e e pat In u on or before the........... . ........ ....,L=Uary--_------------_.., 19.31.. ( the maturity date). Following any default in payment, interest shall accrue at the rate of 14.......% per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless exeused by Venderr agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated awNusl"melt,apeeiol wwuFrmeTAP,#ire mW required insuraees premiums when due.To the extent received by Vendor, vendor-agrees te-uppiy payuwnts-to-boas abligatious when due.--Such amounts received by the Vendor for payment of Lases6 ass6maments and insurance will be deposited into as escrow fund or trustee account, but shall not bear interest unless otherwise required by law.Any amount may be prepaid on principal at any time. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Ariy- -amount may be prepaid without premium or fee upon principal at any time after........ . ...................1 19........ (OR) Hem saeµ-be no prepayment of principal without permission of Vendor. "A" � In :he event of any prepayment, this contract shall nut be treated as in default with respect to payment so long as the unpaid balance of principal,and interest (and in such case accruing interest from month to month shall he treated j as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premisep being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: Purchaser agrees to pay the cost of future title evidenct. If title evidence is in the form of an abstract, it shall be retained by Verdor until th•r full purchase price is paid. Purchaser shall beentitled to take pos session of the Property on the date hereof 10 •f ror. (Pi; (IU. I LAND CONTRACT—Indiv4dual and .ST\T,' 1(.\R W' WIRCONMN R'Lr.•.'n L.v.1 IG.nk Cu- Inr Corporate PORt1 Vn. II•—IvE1 )L n•w R,e. L STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER S4 ROUTE/BOX NUMBER ,6°�X 'Z8� FIRE NO. CITY/STATE z4"_;r ZIP PROPERTY LOCATION: S 4U 1/4 *,6_ _1/4, Section , T2f1 N, R �? Town of All-S64 , St. Croix County, Subdivision /Y d_� , Lot No. �3 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 MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGN DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 u (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AN -LABOR TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION:./ SECTION: TOWNSHIP;""'�.RS.'�'�E;T LOT NO.:Bl. NO.: SUBDIVISION NA E: Sw '/av�/ /�2 Wei(o s /3 — �P�ss.�,�c r � �.�y COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: * elrollk o6 .J w l�o`f CY USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: S:DES RIPTION R ATION TESTS: Residence , New ❑Replace I /,a-v2 of- pO RATING:S=Site suitable for system U=Site unsuitable for system r 8��. �' CONVENTIONAL: MOUND: IN-GROUNDPRESSURE: S STEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) �2ex j-L� ®S ❑U ©S ❑U ZS ❑U ❑S ®U ❑S DU v � /8',c 44, 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: /v A Floodplain,indicate Floodplain elevation: P F! E DESCRIPTIONS BORINGI TOTALS DEPTH TO GROUNDWATER- W44C-9 CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTHW, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- j d r y , ' 0 7 dHI`0' s 7 0151, 1,2 Sr B' 2 70" 7 7, 0 r O je15 B- 7 YXIsl . Bn s/ /S t s e-� 1.0' 7 7 /s/ - 20-114 IVA stk /s S' s B- PERCOLATION TESTS TEST DEPTH/ WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 41944 AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- y..S' o 3 E 6 P- oa& G 6 ` 3 P- 3 6 G 3 P-. P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all.borings and the direction and percent of land slope. SYSTEM ELEVATION 9a LCa/e tN i ire I 3 - E i i ' //` _. 04- e i P�___ .. I j i p r lei Ti- __ _ .i � A 1,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with a pr ced res 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 k wle ge a d belief. 416 rt*-, SI-x.,4 +BZ to M9-'M44,',. 4140-4' l A A AQ,Q1w ,akt4a. r NAME(print►: TESTS WERE COMPLETED ON: /�//ev�e,4, ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): // r, e. So.✓ 4y,'-s' �-,V xc 1-5-f 2 171.r--3X- CST S TUBE: �-- twa. r DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. �DILHR-SBD-6395 (R.02/82) —OVER — SQL, /�/.�/y ✓SOSSi�n S �oec h /�/ �i L ct/ f 1-3 Sys 7¢'W = q� 2 4 a¢- °'c J o yf/ P3� n c J r u 0 /pg zd �►� l f/ow Ste. Gxra�u i ,?q�,3•G� ��rry� N i a �1pt A/o Se• 2 vi, e P � c N r ' P P a tr P P p• P Ell IF -d Pb P � X` �, •-D w 0 � r r w •� . s • o of .