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Parcel #: 020-1264-10-000 02/08/2005 09:03 AM
PAGE 1 OF 1
Alt. Parcel#: 29.29.19.1282A 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
*
GEORGE W&JERRI L TURNER TURNER, GEORGE W&JERRI L
496 COUNTRY VIEW RD
HUDSON WI 54016
Districts: SC=School SP=Special Property Address(es): '=Primary
Type Dist# Description *496 COUNTRY VIEW RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.760 Plat: N/A-NOT AVAILABLE
SEC 29 T29N R1 9W 2.76 ACRES PT NW NE, SW Block/Condo Bldg:
NE&NW SE LOT 14 ROSSING'S COUNTRY VIEW
FIRST ADDITION Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
29-29N-19W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 853/102
07/23/1997 797/49
2004 SUMMARY Bill#: Fair Market Value: Assessed with:
49322 262,400
Valuations: Last Changed: 04/29/2002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.760 33,800 169,200 203,000 NO
Totals for 2004:
General Property 2.760 33,800 169,200 203,000
Woodland 0.000 0 0
Totals for 2003:
General Property 2.760 33,800 169,200 203,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 315
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
M �
Form - ST C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP d Sala SEC. T Z9 N-R W
ADDRESS # Z_� ST. CROIX COUNTY, WISCONSIN
62:r --5-
SUBDIVISION 'u 6.&t/I :,t GC/LOT / LOT SIZE Z 3s ZLd e's
1s5 AdJ, 0 20-- (J-&V-16 , �2gzA-
PLAN VIEW
Distances and dimensions to meet requirements of II,HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
oSSiKy �o .,�rtr �� u ; cw Lir-:11 IN
ysf�w, E I V. :-- %•3a,
Sca (� `ly -= log
A4
JAI
t
q w
o \
� J
. K
0
T
IN
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used Topa�T��I.A�� 7� : S_�Je 1-ttc-C par-
Elevation of vertical reference point: 1.SO _ JW-0 Proposed slope at site: (0- W.o�
SEPTIC TANK: Manufacturer: j.,)e.,5 e V/ Liquid Capacity:
r i
Number of rings used: Tank manhole cover elevation:
cl
Tank Inlet Elevation: <16-Tank Outlet Elevation:
Number of feet from nearest Road: Front,Q Side, to("Rear, O 1� feet
From nearest property line Front,0 Side,P Rear,O gal feet
Number of feet from: well 72- , building: 1 � �
(Include this information of the above plot plan) ( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
1
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 neare.<lt 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: �,g„��{, ,o„�f Trench:
Width: �� / Length: s�6 Number of Lines: Area Built: S
Fill depth to top of pipe: q2
Number of feet from nearest property line: Front, O Side, O Rear,Mitt .90
Number of feet from well:
i
Number of feet from building: 3o
(Include distances on plot plan).'?-H' l•8`I R =`�1.9�� 72,H. I)•Sy $�.g
i
SEEPAGE PIT
° ` boom / Z•8� _ 8-i l
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: y`z/� 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:
7�7License Number: ^=� �
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING
LABOR&HUMAN RELATIONS DIVISION
P.O.SOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION
MADISON,�7�+, 2 9, 2 9, 19W State WI 53707
SW N r� State Plan I.D.Number:Town of Hudson CONVENTIONAL ALTERATIVE assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PE MIT HOLDER: ADDRESS OF PERMIT HOLDER: INS ECTION DATE:
Sam Miller Box 282 Hudson _ >
E CH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FRO PLAN: REF.PT.ELEV.: CST REF.PT.ELE .:
Name I Plumb MP/MPRSW No.: County: Sanitary Permit Number:
oug Strohbee 5432 St . Croix 128597
SEPTIC TANK/HOLDING TANK:
MANUFACT RER: .. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
//�tt G� //� PROV ED PROVIDED:
0 J /a< t� L2rYES ❑NO ❑YES NO
BEDDING: VENT A.: VENT MAT HIGH WATER NUMBER OF AD: PROPERT WELL: BUILDING: VENT TO FRESH
11 ALARM: FEET FROM LINE' / AIR INLET:
❑YES NO ❑YES ❑NO NEAREST 10 '/ 6 7 -
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIP MAN F CTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO ❑YES ❑NO I ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPER IONAL: . U AB OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN JEEJIFR LINE: AIR INLET:
PUMP ON AND OFF ❑YES EA EST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plolving CE LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire,construction shall ceas until
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM: t
BED/TRENCH WIDTz LENGTH: NO.OF DISTR.PIPE SPACING: CO ER INSIDE DIA.: #PITS: LIQUID
TRENC S: M ERIAL- ) PIT ,/°''� .✓' DEPTH,,,,,.
DIMENSIONS d/
GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DI QTR.PIPE MATERIAL: NO.DI NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELO PIP S: AB COVER: ELEV.INLET: ELEV.E PIP LINE: AIR INLET:
!� ,. q / %c; FEET FROM / 0
U (0 1 NEAREST-o �1 1� J `� 6
MO ND 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 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: I GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
DIMENSIONS TRENCHES:
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. I 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 Retain in county file for audit.
Reverse Side. MIGATURE: ` TITLE:
(X. ,, . Zoning Administrato
SBD-6710(R.06/88) .
r
oma s . e s on
{-- SANITARY PERMIT APPLICATION
l�OILN� In accord with ILHR 83.05,Wis.Adm.Code COUNTY
STATE SANITARY PERMIT#
–Attach complete plans(to the county copy only)for the system,on paper not less than ❑ os/
8%x 11 inches in size. cn k if revisi to previous application
—See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER
I. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
cam%&F %,S z Tz , N, R /9' E(or
PROPERTY�OWNER'S MAILING ADDRESS LOT# / BLOCK#A
CITY, ATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
S 3� Z e 7�r
II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ,
( ) State Owned ❑ VILLAGE� I' p
e 1coc,"t.-V ✓I&k.) M1
❑ Public �1 or 2 Fam. Dwelling–#of bedrooms PAR L TAX NU BER( )
III. BUILDING USE: (If building type is public,check all that apply)
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.El 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 91 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 14. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) ELEVATION
/$D (,1,5 , - !o`f$ -.1 7'f' 1 O-1 Z- G _:;� SS-756 Feet 9 • Feet
VII. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
Manufacturer's Name Concrete Con- Steel glass Plastic App
INFORMATION N w istin Gallons Tanks
Tanks Tanks structed
Se tic Tank or Holdina Tank bD0 G[!Q i 54 fr l
Lift Pump Tank/Siphon Chamber
VIII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name(Print): Plumber's Signature:( Stamps) MP/MPRSW No.: Business Phone Number:
o S re �� NP-5 z— `7
Plumbeft Address(Street,City,State,Zip Code):
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Safttary ermit Fee(includes Groundwater Date Issue iss ' g gent Signature(No Stamps)
;4 pproved ❑ Owner Given initial C'�l c surcharge Fee)
Adverse Del min tin ' CJy
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:
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.
11. Type of building being served. Check only one and complete##of bedrooms if 1 or 2 Family Dwelling.
111. 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.
n
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(8.11/88)
^ APPLICATION FOR SANITARY PERMIT
S T C - 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 S'2w�,'//si
Location of property Sw 1/4 NE_1/4, Section o2! , T a ? N-R-Z&P
Township A14cZsnd
Mailing /address 9cX 01" Z9' ..
Z
C d c Se h C. X -,5-960/fie
Address of site Z0.5s,k log+.+ iii r.�w /4u1soti lrv= s/a�C
Subdivision name_ Q�1�,-�iv
Lot number
Previous owner of property gnrr c sl E. 12bs.5 hA
Total size of parcel Ae- r- S
Date parcel was created $"l
Are all corners and lot lines identifiable? _ C Yes No
Is this property being developed for resale (spec house)?_ a Yes No
Volume and Page Number 441 as recorded with the Register of Deeds.
-------------------------------------------------------------------------------
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and
the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if
available, would be helpful so as to avoid delays of the reviewing process. If
the deed description references to a Certified Survey Map, the Certified Survey
Map shall also be required.
-------------------------------------------------------------------------------
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described in
this information form, by virtue of a warranty deed recorded in the Office of
the County Register of Deeds as Document No. 4'5 Z Z -,"0• ; and that I (We)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
of the County Re i ter of Deeds, as Document No.
Signature of Owner Signature of Co-Owner (If Applicable)
_1-13 j ` 7
Date of Signature Date of Signature
L
f.7 /?Alt 9
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 11-198s „(a f►ACt R[tiRV[D rOR R[COROINO DATA
_ LAND CONTRACT REG, TER'S C*FICE
Individual and Cerporate
�3� �0 ITO IF USED FOR ALI. TRANSACTIONS WHERE. OVER
J�j +�anoo IS FINANCED AND IN OTHER NON-CONSUMER ST. CKf�iX CO., W
ACT TRANSACTIONSI r 1 1r II p:icord
Rc,t:
Novenbt�(`..l.L 1987
--- -
COrit1RCt, by and between . 1RXXlr&t..�....RR$X. !)S.and............. 1225 P M
RukY-..Ra �NY.a.a single woman ................................. at
........................................ ("Vendor",
whether one or more) and. 54M.E.-A4.111.9. .............................................. Register of Doods
...... .......................................
.•....................„_........._.................... ("Purchaser", whether one or more).
Vendor sells and agrees to convey to Purchaser, upon the prompt and full per-
formance of this contract by Purchaser,the following property,together with the
rents,profits,fixtures and other appurtenant interests (all called the"Property"),
in......,St.a....QKPIX............................................ County, State of Wisconsin: RLTURN To
West one-half of Northeast Quarter (ViNVO
except the east 8 rods, and the Northwest
Quarter of Southeast Quarter (NW%SEtt), except Tax Parcel No. ..................................
the south 6 rods, all in Section 29, T29N, 19W.
I RMPPOM
FEE
This ._ ... . .is._not._ _. homestead property.
(is not
208 8th St., Hudson, WI
Purchaser agrees to purchase the Property and to pay to Vendor at ................ ..........................
256 150.00 ......... in the following manner: (a) 0Q* -QQ.............................
the sum of$........+...................................... .
at the execution of this Contract; and (b) the balance of $23Fs.150.Q0..................together with interest from date
hereof on the balance outstanding from time to time at the rate of.nine..19Y.l ....,,W ........... 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 ;i of the full amount.
A LLot .RRe1 ass Ag eem nt h so been s,�t1 d o t}q�l date-. 11th
Prov►deed,�iowever, }1e en ire outslan mg balance Wdff—�e pai� in Cuff on or before the...................... ... day of
.....Jjmuary...................... 19..91.. ( the maturity date).
Following any default in payment, interest shall accrue at the rate of 19.......% per annum on the entire amount
in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire
principal balance).
paleheserr uniess excused by Vender:egrees to lay monthly to Vendor amounte sufficient to pay reasonably antici-
pated aa*wum taxes,rpeeW asVessmentsr fife-and fe"t"ed-nsaranee premiums when due.To the extent received by Vendor,
Vendor-agfeea.ta.mpp4.V pa>:a+eata to these aWittatious when due.--Such amounts received by the Vendor for payment of
taxesr aFS`saments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
u„)ees-otherwise fegoifed 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. AfFy-
-amount. may be prepaid without premium or fee upon principal at any time after 19....... (OR)
„ n
there mat', he no prepayment of principal without permission of Vendor."P 's-
In :re event of any prepayment, this contract shall not 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 be treated
as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been -
.nade 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 premises being thereafter excluded herefrom.
Purchaser states that Purchaser is sutisfied with the title as shown by the title evidence submitted to Purchaser
for examination except:
Purchaser a:rrees to pas the cost of future title evidence. If title evidence is in the form of an abstract, it shall
be retained by Verdor until tI, full purchase price is paid.
Purchaser shall be entitled to take po p
ssession of the Proerty on t11e date h(�reof 14
�(rtr94 (1'J: I,"
ST%1I It,\It OF wIS111]�IN 1y�•• n L•ral Nlank Cn. Ins
LAND COti TRACT—Indies dual and F0 ,1 \.:. 11--198. �1i`'"'"•`• R:e.
Corporate
J
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER ;U✓'
ROUTE/BOX NUMBER 13ox*2s6 Z FIRE NO.
CITY/STATE_4Jr,_c�tau w ZIP
PROPERTY LOCATION: 54v 1/4 ,vim 1/9, Section TAN, R /9 W
Town of TW.Soh , St. Croix County,
Subdivision ifwnfty V;a v , Lot No. 1'q .
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
$3000 of the cost of replacement of a failing system, which was in operation
prior to July 1, 1978. St. Croix County accepted this program in August of
1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their
systems properly maintained.
The property owner agrees to submit to St. Croix County Zoning a certification
form, signed by the owner and by a master plumber, journeyman plumber,
restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and (2) after
inspection and pumping (if necessary), the septic tank is less than 1/3 full of
sludge and scum. Certification form will be sent approximately 30 days prior to
three year expiration.
I/WE, the undersigned, have read the above requirements and agree to maintain
the private sewage disposal system in accordance with the standards set forth,
herein, as set by the Wisconsin Department of Natural Resources. Certification
form must be completed and returned to the St.Croix County Zoning Office within
30 days of the three year expiration date.
SIGN
DATE —
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016 r
(715) 386-4680
Sign, Date, and Return to above address
riDUSTRY 14_(. O� ����>� I ON IL KING6 All) a,�w►:I�a.BUtLDtNGS
DtvtsIcm
HUMA N RELATIONS AND PERCQLATON TESTS (115) MADISON,HUMAN
(HO3.09(1)&Chapter 145.045)
� 1 W . : T O. NO.: U I/T2 OU 5v NCR ° t ,N Sa
COUNTY: OWNEI
DAM OBSBRVATI"MADE
70 Rafdence t4u K ....-- {r aw OReplecs IULy Z4 /9T9 . wAt.y CULATION TIN
*1
RATING:$-Site suitable for system Ui$its unsuitable 6 le for system
ICOAVE S QV M s.av IN V t. u s �L �tp1IJG ffTE? ,111�$N Tt0�14t� (
If Percolation Tats are NOT required DESIGN RATE: If any portion of the tested area is in the
under s,H83.09f51(bi,indicate CL/d�S Floodplain,indicate Floodpisin elevation: N
�- PROFILE DESCRIPTIONS
BORE
Nth hi A •i H SOIL C X ,A DEPTH
A
TO 8 R CK IF OBSERVED SEE ABBRV.ON BACK.)
B' v.z9 NoN� >�.OFs i ° L-,L-r S9" ,�SL )-6 MStalL
/3'gtt>L.TS WAI$ r.ISL
B- �. x.75 4z. ?9
B- D 67 9q .r9 r >
4G4'
B- 4 4. Z 97.0 > 9.4 Z
K > 9.42 7,. SLSI.-TS 7h$ s+` 4a°Bau�sl
B-
L�- PERCOLATION TESTS
TEST D PTH . WATERWELOOL INTERVAL-MIN. PER INCH
ESTTIME IN. LEVEL-INCHES
Z.GQ IJON4L 90.30 3 -> �• -> .4
P. e- 16 40 97.40 > 'Z <
.70 0 QO 3 > >2 �►
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-
wntsl 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 I"slope.
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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.
NAME print TESTS WERE COMPLETED ON:
,ADDRESS:4k � Or i _._.._._let3cu f\jL.Y IAK, - CERTIFICATION s' 110
UMBER: PHONE NUMBER(optional):
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