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HomeMy WebLinkAbout161-1053-30-000 \ o 0 j / \ & o 7 k E ? . 00 { c ¢ E00 ! !$ \ \ % L ƒ 77 [ m $gQ ® fk\ � Q) ) k §]5 U. ƒe] , � } }f( � J § ES � .. o C) \ z � , ■ � � n § ) a co § � \ z :!t 2 \ co 7 [ 4)- ƒ f ) $ } ) k ) \ / Q0 ^ # E 2 ' 3 12 a ƒ 7 CL m \ f ' 4 § a a \ k \ k n \ 0 ' ° a \ \ § z -� k ¥ a a a R ¥ k \ L) \ \ o L i $ 7 { Q) ° / § . % ° E 2 C D V � (D a ■ \ # » m = I § LO \ j z \ ) § § { % ® ° : 5 3 - c a / ƒ \ [ / \ \ \ \ k / \ / � , _ E a Q / A a o z f z / \ $ % { CL � . — _ % : " a » E ' k a § k J 2 2 3 & v . , , r 4 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT Q OWNER Co_t� N U(if K TOWNSHIP Q SEC. T N-R�� 1I ^� MO AK U► SON ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION IV nr LOT 4 3 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Al 3 BEDROOM 1 omc, ay , o ' 9a — © 3a — — — 3� i QQ w �- - - — - - G3 -- - -- - - - - 3► ao ly i i INDICATE NORTH,, RROW BENCHMARK: Describe the vertical reference point used Elevation of verticA reference point: 100-6 _ Proposed slope at site: SEPTIC TANK: Manufacturer: L.��,� � Liquid Capacity: I060 qA Number of rings used: �_ Tank manhole cover elevation: 9 9, Tank Inlet Elevation: WI$ Tank Outlet Elevation: Number of feet from nearest Road: Front,0 SideO Rear, O 1 3 feet From nearest property line Front,0 Side,O Rear,© _ feet Number of feet from: well 51 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,© Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). Sk6t 5-`73 HcADrK: 970f – 97-09 100,00 SOIL ABSORPTION SYSTEM f o 5-13 EW 00 u Bed: ✓ Trench: 9-1 8-4om Bea Width:_ J Len$th:- Sa Number of Lines:_ Area Built: Fill depth to top of pipe: Ut r Number of feet from nearest property line: Front, 1 O Side, ® Rear,0 Ft .� Number of feet from well: Number of feet from building: a�, (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: JL 1 g Plumber on job: (3LVy License Number: 5 0 3,7 3/84:mj L DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 NE4,NE4,S24,T29N—R20W ZYCONVENTIONAL ❑ALTERNATIVE I State Plan l.D,Number : Town of Hudson ❑Holding Tank f-1 In-Ground Pressure ❑Mound (If assigned) Lot 3 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Scott W. Snyder 1551 Namekagon Avenue, Hudson, WI 54016 'N11.,0A b_ U 3 120 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber: MP/MPRSW No County Sanitary Permit Number. Richard Hopkins 1059 St. Croix 106071 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER (� _ a PR VIDED PROVIDED. (?1?'0 P,c, 3 `-1 (o7 YES ❑NO DYES O BEDDING. VENT DIA.: VENT MATT WATER NUMBER CIF ROAD. PROPERTY WELL. BUILDING. VENT TO FRESH A LAHM LIN (AIR INLETFEET FROM❑YES NO 11111311 ❑YES NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING'. LIQUID CAPACI7V PUMP MODEL 111IM1,111111IN MnNUI ACTIIH EH WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ❑NO ❑NO 1:1 YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF 'PHr HTV L BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM L'N AIR INLET. PUMP ON AND OFF) ❑YES ❑NO NEAREST---} SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing It f N(;Tfi JHIAMFTEI Ti I L AND MA NG or excavation. (If soil can be rolled into a wire,construction shall cease until FORGE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH IND,OF DISTH PIPE SPACINII COVER <1NSI1)E Dln SPITS LIOUID BED/TRENCH TRNCHES nTEHIAL: PIT DEPTH DIMENSIONS (p "�' GRAVEL DEPTH FILL DEPTH UISTH PIPE DISTR.PIPE MATERIAL NO DIS NUMBER OF `PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES ABOVE OVER T ELEV END PIP LINE AIR INLET: + j'E)1!S1'V',1'NL"F' a� 9 �� `� .. NEARES°"—. �a a ago MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER TEXTURE 1111111ANINT MAHKIHS OBSERVATION WE ILLS DYES 1:1 NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVFFI TRENCH BED 11111'111111 TOPSOIL Sf)1)OFD SEED1 MULCHED CENTER EDGES ❑YES. 1:1 NO 1:1 YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES: LATEHAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTH DISTR PIPE DISTRIBUTION PIPE MATERIAL&MARK ING ELEV.. ELEV. CIA. ELEV. PIPES CIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHECT LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ❑NO F-1 YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF t PROPERTY WELL: BUILDING: FEET FROM LINE: I �2 L1 YES L1 NO DYES 1:1 No NEAREST 9s Sketch System on Retain in county file for audit. Reverse Side. NATUR TITLE Zoning Administrator DILHR SBD 6710(R.01/82) SANITARY PERMIT APPLICATION COUNTY ZUILHR ° In accord with ILHR 83.05,Wis.Adm. Code STATE SANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION (� 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES LJ^ NO PROPERT OWNE PROPERTY LOCATION -1 G U S '/a '/a, S y Tol Q, N, R O E (Cr)( PROPERTY WNER'S AILING ADDR SS LOT N MBER BLOCK NUMBER SU�I�IVJSI NIEq,1OM/1NOp SbAI 11 55 ITY,S ATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE O LANDM K u \ ( .WVILLAGE: 0 II. TYPE OF BUILDING OR USE SERVED: - VV Number of Bedrooms if 1 or 2 Family^? OR ❑ Public(Specify): COfUVe III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. �New b.El Replacement c. ❑ Replacement of d. El Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a.4conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a.X Seepage Bed b. ❑seepage Trench c. ❑Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(_Square Feet): PROPOSE Square Feet): / �j J Feet ulPrivate ❑Joint ❑ Public VI. TANK CAPACITY in allons Total #of Prefab. Site Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New xisting Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holding Tank too v 1 Wet El Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber' Name(Print): Plu is Signature:(N Stamps) MP/MPRSW No.: Business Phone Number: ;�, 1 � w S9 lr5 Plumr's Address(Street,C ,S te,Zip Code: Na of D signer: A 0 VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name. CST# e N.l , ChP, .. , ' P N) CST's ADDRESS(Street,,City,S te,Zip Code) l Pho a Number: vl JS w SC. 'J`fL r 1, r MG-57V IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial '/ v Sur arge Fee Adverse Determination T " ' X. COMMENTS/REASONS FOR DISAPPROVAL: J C:L I, G4*rc)iaerj b i�) "7�6M co 0. SBD-6398(formerly Plb-67)(R.03186) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; Ill. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground iiir included the creation of surcharges (fees) for a number of regulated practices which WiSCOr it 'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried rlda: , '. is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) I APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owners) 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 1/4 ��� 1/4, Section o2� , T -?-9 N-R -20 Township Mailing address ��St /�AM r K A AV6- Address of site � 1 i�C YZ Si I�E Re , /YG 1�a J9gV� Subdivision name K,+-s r Lot number 1-47 7- 3 Previous owner of property /- AIDI Z E o Total size of parcel -1 Date parcel was created `n C�.�,� C( e Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes X No Volume and Page Number l0 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. Y 7 ; 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 C my Regis of�De�edns, as Document No. !f l � A) � -CJ' Signatu f Owne Signature of Co-Owner (If Applicable) �- 7 � Date of Signature Date of Signature ,•'� DOCUMENT NO. WARRANTY DEED I' THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 41f; l BOOT 75I I I, RESISTERS OFFICE l! R.Rlore.S..T..•.AndersQn,.-_a--single..person. ST. CRG a CO, WIS. ---•• ... Re+c'd. for c:^�rd this 10th C l 6 ...-----------------.............•--------•----•---••---•----••---•-•---••------••--- I Sept � I ........... .................. . ....................................................._._..._...._....__........ ii conveys and warrants to -_.SCOtt--W... Snyder_.and . 1' 3:45 P J' � GQlleen•.A...-O'Connell husband and wife I AdN a_ _• uryvorsYli-p-•marital..-propertt�,-- i 1 ... f RETURN TO ---------------------------------------------------------I--------------------- -------------------------------------------- the following described real estate in St. Croix County, ! I I _..... State of Wisconsin: �I Tax Parcel No: .............................. I� Part of Outlot 71, Assessor' s Plat of the Village of North Hudson, St. Croix County, Wisconsin, described as follows: Lot 3, Certified Survey Map, dated May 19, 1981, recorded I! June 3, 1981, in Vol. 4 , page 1066 , as Doc . No. 371250, except Ij the Northerly 15 feet thereof. I I !i li II I t i r t ! This ___15_.r?Q.t•________- homestead property. (is) (is not) t Exception to warranties: I: Subject to easements, reservations and restrictions of record. II ! I i Dated this ..---•--....o°.i7. ......-----•............. day of ------- AUK �t------ ....-----•- -•--------•--------- r 19..86.., i i I' -- -•••...............•-----.(SEAL) ----- - ------------------------------------------•------------------•- * --AQ�Q�ES-•�'-_+-- ,�1N]�ERSON---...._....---•-- !I (SEAL) ------- ------- - ----------- ---------- ---------.....(SEAL) �! I -- ---- -- - - jj " --•---------------------•----' - .................. AUTHENTICATION ACKNOWLEDGMENT II I Signature(s) ............................................................ STATE OF WISCONSIN ---------------- ss. ! -------•---•---------------------•---------------------.....--- 5t. Croix ..................................... County. authenticated this --------day of........................... 19...... Personally came before me this ....... day of August ,i ............. 19._8_ _6 the above.named ii ------••--------•------•..........••-••-....•---•............................•.. l�flloxes_..T..._.1�ns�ezar�...--•--------••--------------- TITLE: MEMBER STATE BAR OF WISCONSIN ' ----------------------------------------------------- (If not, . .................................................p •` ' authorized by § 706.06. Wis. Stats.) to me known to be the person ....,:.0.' w cu¢,g,�l the.=, foregoing instrument and acknow3et�gf< THIS INSTRUMENT WAS DRAFTED BY ryr' �C 1 i'1� IYl .CluJ11�: ....----- .......-•-•••--•-•--•-_---- �! 1iudon,_ Wisconsin Notary Public c ---- w,*,, t?c:ae(l r :^a-., i .,+.. >.,(t; '�1•..� f',,r, i°;I,,.I 1 ;.. n:.at{rr r„t, 'WA..',�e,, ,e f.r,r:-_ r:ro got necessary.) ) jat.e: ..-—------- . - `--.�f`.`_.>_._ i ....... 19! ...... •?7ame;� of y-(nons siyrnin[, in any capacity shunld I,e tynoe,I or I.:ir1t.:d 1,1-- ti.�ir STATE BAR OF tx I ,„11 Stock No. 13002 L ily) JLS �� N_7I ! Trcts`D7Sk �lar�7V .� pT`77/nom'/1 -� A„�1/OOv N3�•� rn ,b JV7d S aOSS3SSd 3+U ate /L 1071r10 dO 3A//7 1S3M 3//1 O ~' Frt, O a Ion N �= ,£b'£OZ -is (D N W rrtt L_�7 En 91'ZOS bZ ,6Z-0'S (p O rft v (D 0 5 0 rt In n H (D (D " O=Sd 030td0�3s) b p - w z z h + - m G "C rt w O O O rt ae :f rt O rt G rit v .�J• NOo 3 rt rt (z � � x0 wF NG • oa qq ►-•- t- a rn -1 Os X y C (D _ F F ' (D� U1 A.r tC D A > N C w r• (D o (fit CL FO-' N p O (D ma or No �� Oz o w 2 cD , N P* (D � � N �! En of�n a O 0 m p w 2 ' R G 4 fOt, rr�tr N £ rt rt fl ey4 om m ^; Z2 Ih �NW N• � (n \y 3 0 F& 0 _ w r„ po m ` ¢ N ou Fl M 5 I'j Ut Z WZ l' Off_ S � 2 rt 0 w G O O 2A� N � N m m m CD C ►o-' n ~ N rt a b Lp rO In rm m O F_ rt y O ' . rt W o irt o r ,00'SIZ 3 „£S ,ZI of 'N ! a � W �+ � 6 rpt 'J In ee. m .00 ool . .00vol M' ? D rt En N" r ti o1. _ CD F- ss• 9e F �2s8 a b (D C N• cn ter . o�,.?s � �s• °'- m 0 � n4 ( rt ca - 4► m IP- r• H- rt O H' A y 1 fK O (D (D rrt1 4ti y N N_ y rt d ]" LAI a mx 34.04.�- w a° ww a � � C rat Z A ti , ` ? - ti O� (D , z G 3y o► .9• N i lit Ld CIX rn o 3 � ?TT, q w. I 2 �u rn Z �• _n air^ b q u Q �N 1 1 1 © % CD �ov_ � ! 1 ' moo Z • Q w w w r � s r __ I I l 1 �l�� �' r � '��� �� �a`�� ��l�� ������� U) � � ' S I C - 105 r` � � � SCyTIC TANK MAINTENANCE AGREEMENT o � Sc , Croix County � Iz) *^ -o 0WNF8 BUYE S ff / ` yi�c Number � R0DT2/BUX NUMBER C I�Y ST�IU _ |_____% [P__-Ci �h~° Sccci� u I N � YK09Ck'yY �0CA'[l0N : �, , ` , AIL N , Town uf _-__, St ' Croix County , Lot L 7 / � ~ Improper use and maiureouucc of your scytic ,yxtem could c cS,1t in its ycemucoze iuilure to handle wastes . Proper maiuccouu,c cux- aiuts of pUmp1ng ouc the septic Lank every chrue years or sooner , if needed , by u licensed y-�1)�i�� c� lu� l�e� , What you put into the system Can mf,/—u-c-c--L110 \'uuc ti ou Of c |/e Septic tank a." u treu c- | meuc stage Lit t|'c wuucm di,poaal ayacc/x . St . Croix County residents v`�� he eligible to receive u xcuoc Iu r u muuimum of 607 o| the cost of ceylucuu=ut u[ u falling System, wb--cb---, u in Operation prior- to July 1 , 1978 . St . Croix County Of l98w vi�|` cb� c�quiccmcu� cuuc uccepccd this pcogcam in uuGxat " , owners of all new s sL£�� u6cec to keep their systems properly muiocuiucd . The property owner agrees to submit to St ' Croix County Zoning a cuzciLicuciuu ivcm, a1Gxcd by chc owner and by u muScer y1umhL-c , journeyman plumber , restricted plumber or u licensed yumpec vcri- �r , r�o tying that (1) che oil-*iLe- wastewater disposal eyucem is in proper upecuciug condition and ( 2 ) after inspection and pumping ( i[ uec- eauury) , the scyc i, 'tank less ` k � 1 chuu L/ l full of sludge uuJ acum. certification form will be sent approximately jO days prior to ~� three year cup1cacLuu ' o � � I/WE , the undersigned , havc read tile uhuvu requirements and agree to maiutuiv the private oewxAo Jioyoso| syuce-m in accordance with m;� ~n che standards uec fuzcb , krrUin , as a"c by tile Wisconsin Depart- ment of Natural Kus"ucccs . Cccciiioatiou | u/m must be completed and cecucucd to tile Sc ' Croix Cn^ucy %"uinG office within 30 days of tbe Lbrce y::c euplra Liuu dacc ' � SlCNE0 D ATE ________ St . Croix Cuuucy %oulug 8l' |ice P . O . 8uu 98 � Uammcud , Wl 54015 . 715-796-2239 or 715-425-8363 . Sign , date- and return co uhuvL address . K u ` DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, DIVISION . LABOR AND HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WOI 7969 11,163.090)& Chapter 145.045) G •fCT-I0—N.T /MUNICIPALITY: NO,:BLK.NO.: SLIBDIVISION NAME: G �r t 11 1iJOT 3 m � COUNTY: HW`N£w& BUYER' NAME: #ILING C rf A DR S: I" i e A/JCo ��/ M e op U E DATES OBSERVATIONS MADE P NO.BEDRMS,: COMM DESCRIPTION: -PROFILE-6�C ISTION-S: N TESTS: Residence �Naw ❑Replace RATING:S-Site suitable for system U-Site unsuitable for system S7 ONVENTI NAL: MOUND: jI(+1-GFiOIJNC FiESSUR S E -N•FIL.L OLOING TANK:RECOMMENDED SYSTEM:(optional) E$ ❑U O$ ❑U ®$ ❑U ios2u ❑$ ®u Co If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)lb),indicate: /V Floodplain,indicate Floodplain elevation: PR FI E DESCRIPTIONS BORING TOTAL4 ELEVATION—DEPTH T R UNDWATER-4NeA IES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH4 OBSERVED IT TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) & / ?a' /do,3' o e 7 7•S' .S"6I S o /s s' 2. S ,--- B- 17.,s'' /o u.o' R. S s 7 VI S a . q 8.q _r t S Y�16//_(. /. 6 0 In /s, /.S r/S' /,3 8., S' B- PERCOLATION TESTS TEST DEPTH( WATER IN HOLE TEST TIME DROP IN WATER LFVEL-INCHES RATE MINUTES NUMBER iN(;LIii6 AFTER SWELLING INTERVAL MIN. --- ,egg- PER INCH • 3 6 c _ _ 3 P. .1 v 3 6 11- 3 P- l < r- 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• wntal 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 �,fs e,/ -- ' Q A __ -- I ��� z g. 1l�t Ar I 9.1�sa-�r1 RM��•�,, __gyp._ � � � � � • 's_ _>, —• __. .l --- ���- .. ti o e_1 - !'� - '�- - i I t IT i - '• Sum 0, .j' ar,.f , . ��-— --- , !L 1,the undersigned,hereby cgrtify 1hat'the soil tact[rape riadan.thii form ri@fe.M09�y ma in accord with the procedures and"thods specified in the Wisconsin Administrative Code,and th4t the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAM E(print): TESTS WERE COMPLETED ON: f &/40:'(";U -,4 y A ADDRESS: CERTIFICATION NUMBER. PHONE NUMBER(optional): /�! e Ale, 7 CST S TURF: - • • _ je DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. I DILHR-SBD$396(R.02182) -OVER- 1 __ 0 P. B. L. ) 7 PLOTA 11 R 0 S S -) ECI PL U M P I- N A M E NAM E A)ftft( Lit)L A, ION) _K11V S L I C E N S E 7jl.t-.. 1.)ATE V_ , kl P Will T PLO A' V A-Z B.M. Is A HURN R4 R. 1A (OKWF, PIi I otj Top 0� a, Goe-q S martk lot I'l?10- well ol pl- Uj 134 qS1 w ws 'ON Sri i C. 4- -J- 9A I El FRESH AIR INLETS AND OBSERVI rION PIDE C IOSS SECTION R Approved Vent Cap NO. YO" Minimum 12" Above PIMA) Gitrj Final Gr M A)< 4" Cast Iron Above Pipe V.ent..Pipe To Final Grade- Marsh Hay Or Synthetic Covering Min. 2" A Over Pipe Distributl-24,..F Tee Pipe Aggregate Per-forated Pipe Below Beneath Pipe Coupi.ing Terminating At Bottom of System BO&M Parcel #: 161-1053-30-000 02/17/2006 11:43 AM PAGE 1 OF 1 Alt. Parcel#: 13.29.20.511 F 161 -VILLAGE OF NORTH HUDSON Current LX', 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 SCOTT W, &C O'CONNELL SNYDER O-SNYDER, SCOTT W, &C O'CONNELL 1209 RIVERSIDE DR N HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description * 1209 RIVERSIDE DR N SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 1066-CSM 04/1066 PT OL 71 LOT 3 OF CSM V 4/1066 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-29N-20W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 753/318 07/23/1997 746/526 07/23/1997 694/149 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 108266 284,100 Valuations: Last Changed: 05/20/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 76,400 201,600 278,000 NO Totals for 2005: General Property 0.000 76,400 201,600 278,000 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 47,700 131,300 179,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 214 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00