HomeMy WebLinkAbout020-1172-40-000 c
0
tt
Co
0
a)
0
Z
LL cu E o
0
cc
0
co
IL m
.0
0 z
0) z
c
U) z
'2
ce)
N
CL
(D
a) c
I_D U) CD 0
c "0
o a) <
Z ca z
0
cc
W
(D
:2 (D CD
q)
CL -14 c LO
O m CD
CD co .0 CD IL .5 E
E =3
co U) U) U)
r.- CD .2
L-0 '0'
CD
Z
0 0 0
IL (L CL
IL
U) a) m
-i
0 U) 0 co co
co co z 0
Cj
0
to CD
a. C,r.- 'a E
G7 CO N C
ri) CD .0) Q)
'a 75
< 05
co
(4 W
0
i r 8 E
i ID (D 0) 0
O
0 "C, 0 a- CD C5
0 0 r-
C, oi m 0)
40. ro- Z Z
Qi LO (D
X CD
E E
M 04
C14
C:,
U)
O t
at cc
EL L: IL
CL
E
cu
0
Y Parcel #: 020-1172-40-000 08/28/2006 04:44 PM
PAGE 1 OF 1
Alt.Parcel#: 17.29.19.1077 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): O=Current Owner, C=Current Co-Owner
LAUREN N WAXER O-WAXER, LAUREN N
918 RIDGE PASS
HUDSON WI 54016
Districts: SC=School SP=Special Property Address(es): "=Primary
Type Dist# Description *918 RIDGE PASS
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 1.085 Plat: 2627-WILLOW RIDGE EAST
SEC 17 T29N R19W LOT 78 WILLOW RIDGE Block/Condo Bldg: LOT 78
EAST
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
17-29N-19W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 796/501
2006 SUMMARY Bill#: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.085 55,200 200,800 256,000 NO
Totals for 2006:
General Property 1.085 55,200 200,800 256,000
Woodland 0.000 0 0
Totals for 2005:
General Property 1.085 55,200 200,800 256,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 114
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Form - S T C - 104
i
AS BUILT SANITARY SYSTVM REPORT
OWNER TOWNSVIP SEC. T o2 CJ N-R W
ADDRESS 3 $ cG' ST. CROIX COUNTY, WISCONSIN
SUBDIVISION lJ;llo •` 22 LOT �� LOT SIZE 2 -t 5'
PLAN VIEW
Distances and dimensions to meet requirements of I•ZHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Cly
y�
t C G�Gs.
.s
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used -e
Elevation of vertical reference point: ZQ 67- Proposed slope at site: -11?Z:
SEPTIC TANK: Manufacturer: "'/Icl- Liquid Capacity: /6ay
Number of rings used: 0 Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,@ Side,@ Rear, O /.3G ` feet
From nearest property line Front,0 Side,@ Rear,0'-' e, 8 feet
Number of feet from: well 4t'�'K25 , building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liquid Capacity.
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear,0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: X Trench:
Width: /SF- Len the ?G Number of Lines: 3 Area Built:
Fill depth to top of pipe: '5'
Number of feet from nearest property line: Front, O Side, ® Rear,0 Ft .�S
Number of feet from well:
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: Plumber on job:
License Number: AO�y r-2-
3/84:m'
J
-.
s
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
SW' ,SW,14,S19,T28N-R19W CONVENTIONAL ❑ALTERNATIVE State Plan I.D.Number
Town of Hudson ❑Holding Tank El In-Ground Pressure El Mound Ilf
Lot 78 Willow Ride East
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION D TE:
Lauren Waxer Route 3 South Cove Road, Hudson, WI 5 016 7- 3t.CX?
BENCH MARK(Pe(manent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: 77v..
Name of Plumber: MP/MPRSW No.: County Sanitary Permit Number:
William Schumaker I6382 St. Croix 112658
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACIT TANK INLET ELEV.. TUTLETELEV.: WARNING LABEL LOCKING COVER
c PROVIDED PROVIDED
0� . 9 ( YES ❑NO ❑YES ®NO
BEDDING: VENT DIA.. VENT MATL.: HIGH WATE NUMBER ROAD: PROPERTY WELL. BUILDING. VENT TO FRESH
AIR INLET
ALARM FEET FR LINE:�� f —^
DYES NO ' ❑YES 1-1 NO N 11
DOSI NG CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES ON OYES ONO DYES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBEROF PROPERTY WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) 1:1 YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH D'AM'TEH IMATI.IAI .11 A MARKING
or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH: LENGTH NO.OF DISTR.PIPE SPACING COVER IN';IUE DIA =PITS LIOU lD
BED/TRENCH
TR ENCHES
I + M ERIAL PIT DEPT('
DIMENSIONS
GRAVEL DEPTH FILL D H 1111TI PIPF DISTR.PIPE DISTR.PIPE MATERIAL. NO.DI R. NUMBER OF PR OPERTV WELL. BUILDING VENT TO FRESH
BELOW PIPE tl ABOVE COVER Eh E/V INLET ELEV.END' PIPES FEET FROM LINE AIR JNLF.T
0 Fr 7(do 9 , _I 2 NEAREST--► 55 ,IrO f �vdl (/pQ
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-
meets the criteria for medium sand. TIONS MEASURED.
OYES ONO
OIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS
DYES El NO ❑YES ❑NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES
1:1 YES 0 N ❑YES ONO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MAHKING
ELEV.'. ELEV.. CIA.. ELEV.'. PIPES DIA..
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYES 0 N 1:1 YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE.
C 2�
El YES ❑N(O�! DYES ONO NEAREST
L s
Sketch System on In in county file for audit.
Reverse Side.
SIGN TITLE
DI LHR SBD 6710(R.01/82)
j �- - Zoning Administrator i
SANITARY PERMIT APPLICATION COIN n �y
L FERN In accord with ILHR 83.05,Wis.Adm.Code `-ARv`
����,�,,,�,,,�,,,� STATE SANITARY PERMIT#
1d&
—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 NO
PROPERTY OWNER PROPERTY LOCATION
C 4)o- Gl '/a '/4, S T,2Q , N, R q E (or)W
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDI`VISION NAME
F_ f f 3T
CITY,STATE ZIP CODE PHONE NUMBER ❑ VILLAGE: NEAREST ROAD,LAKE R LANDMARK
.✓ �✓i -S - A.✓
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify):
111. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable)
1. a. � New b.❑ Replacement c. ❑ Replacement of d.❑ 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. gConventional 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. ViSee a e Bed b. ❑seepage Trench c. ❑ Seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): v
/S- �/� �� Feet �Private ❑Joint ❑ Public
VI. TANK CAPACITY Site Fiber- Exper.
in allons Total ##of Prefab.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Plastic
Concrete strructed Steel glass ti App
Tanks I Tanks
Septic Tank or Holding Tank ���d ❑
Lift Pump Tank/Siphon Chamber ❑ ❑
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system sho n on the attached plans.
Plumber's Name(Print): Plumber's Signature:(No Stamps) P MPRSW No.: Business Phone Number:
` .`a l" u a e 2 l 2 l
Plumber's Address(Street,City,State,Zip Code): Name of Designer:
ol
r G �/
VIII. SOI TEST INFORMATION
Certified Soil Tester(CST)Name CST##
k: i 3
Phone Number:
CST's ADDRESS(Street,City,State,Zip Code)
, Q 7`
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sa itary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
rVi LLN Approved ❑ Owner Given Initial 1_20,c)6 S ;oharge Fee �� � ]
Adverse Determination /
X. COMMENTS/REASONS FOR DISAPPROVAL:
?!av� C4Vr3d.QC, bts C ,
SBD-6398(formerly Plb-67)(R.03/86) 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 muskbe 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:
1. 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;
III. 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'h 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 ground-Water bill Ground t faB�
included the creation of surcharges (fees) for a number of regulated practices which Wisco Ih"S
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried
is used in your building is returned to the groundwater through your soil absorption
system or the disposal site used by your holding tank pumper.
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)
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 -f P 2
Location of Property SUJ _� W 1%, Section I . T N - R
Township — g S O Y� _
V/ Mac i I.ifsg Address 3 �l,e ,��• /4 4M
Subdivision Name p W &C �� S _
Lot Number
V PrOviouS Owner of Property 0-A
/'i'otal Size of Parcel
�/ Dace Parcel was Created
_ _a identifiable?( Yaws No
Are all corners and lot line
Is this property being developed for resale (spec house) ? Yes No
L/Volume af.G and Page Numbers as:recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION -ONE OF THE FOLLOWING.
1. Warranty Deed
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. It the deed description references to a Certified Survey
Map, the the Certified Survey Nap shall also be required.
PROPEM OMER CWIFICATION
T (we) eenti y that a.tC statexexU on tILiA JOU ant tAUe to the beet 06 IV (oun)
knowledge; that 1 (we) am (axe) the **wA(A) o,6 the ptope4 dt cAibed in thiA
.i.nSonma.ti.on 6o4m, by v.iAtue o6 a rrucwt x4 deed 4440Ade4 in the 064ce 06 the
County Reg-i0e& o6 Veeda aA Voeument No. c,� : and t 1 (wtl
phebenLly own the ph.opoaed Ait¢ `on the ♦�t�p1 Aptem lox 1 (we) have
obtained an eaaement, to nun Willi the above dfehibed paopen.ty, ban the
corwtnucti.on o6 aaid ayetem, and the aaawe has been duty neeo4ed in the 066icre
o6 the County Regiateh. o6 Deeds, ae Vocvoent No.
SIGNATURE OF OWNER SIGNATURE OF CO—OWNER (IF APPLICABLE)
DATE SIGNED I)ATB SIGNED
DOCUMENT No. STATE BAR OF WISCONSIN FORM 1-4982 TH,. SPACE RESERVED FOR RECORDING D/,TA
WARRANTY DEED
432134-___ i. o. 796rky501 REGISTER'S OFFICE
ST. CROIX-CO., W{
This Deed, made between ...$•__&.H.•_Deyelg�mentt_•In ..-..-
-- Wisconsin Car RAC'd for Record I'
_ _--- -- oration- ---------- -
Nov. 13, 1987
-- ---- -- ------------ - -- ---------------------- Grantor, 10:55 AM
arid.__---Lauren-N._Waxer,- _ single--woman-- ---------------------------------_
------
�IIKOi DNd�
---- ---- ---•--------------------------•----------------------------------------------- , Grantee,
Witnesseth, That the said Grantor, for a valuable consideration______
------------------------------------------ ----
RETUR O
conveys to Grantee the following described real estate in __________________________ _.....
County, State of Wisconsin:
Lot 78, Plat of Willow Ridge East in the Town of Hudson Tax Parcel No- -----------------------------------
St. Croix County, Wisconsin.
ACT—*
This -----is n_of___........ homestead property.
OiX) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And _
B• & H. Development, I-Inc
-------_---------------
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
easements, covenants and restrictions of record, if any
and will warrant and defend the same.
eleventh November
Dated Dated this ----- - •----------------• ------- ......-•-- day of ----•---------- -------
--------------------•--_---•-••--------------------------------------(SEAL) •--.10,164 '!72'.e.. .(SEAL)
* * William C. Harwell, Secretary
r' c
------------ ---------(SEAL) =rte- �'' Ice-
* (SEAL)
* Donald E. Bjores ad, President
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) ------------------------------------------------------------- STATE OF WISCONSIN
ss.
..............•-•-•-------- .................................................... Croix
St•--------------------------- County. 11th
authenticated this -..-----day of--------------------------- 19------ Per onally came before me ..--------------day of
November
----- 19-------- the above named
-- --- William C. Harwell
-
.............................Donald E. 13jornst°ui.
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not- ------------------------_--- -------------- --------------- ---------------------------------------- ------------i;c ....------
authorized by § 706.06, Wis. Stats.) to me known to be the person S______._ �; fl the
10...x.... gptto
fore oing instrument and acknowledge;thee samto.. ,
THIS INSTRUMENT WAS DRAFTED BY :J.I ••'✓i
.8
Donald E. Bjornstad, President of = �+
...........I._....--•--......._ .......................••----...... +►eft
s
-----• I► Laura L. He ernan _
Corporation ...........•-•- •--••-..,.-•ro...._,.�, 4
st. Croix
---......._ ................................................................ Notary Public ....,..._.. _......---•---=:-`�•��y Wig:
(Signatures may be authenticated or acknowledged. Bath My Commission is permanent. (i$.`iY4• t;.. rwil n
are not necessary.) date: ...•Septe►aber.................
.��''�,'3k 1 )
*Names of persons signing in any capacity should he typed or printed below their signatures.
WARRANTY DEEM STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc.
FORM No. I—1982 niilwwikK, Wis.
y
STC - 105 r
SEPTIC 'TANK MA t N'fENANCL: AUItEEME.NT
c
St . Cruix Cuunty
a
Y
rl
tt ' urEtt Ctvt2eh (� 01
1o)IJ''E/ BOX NLIMB it /Z _C'C�c!2 -12 c� - ---1 ite NumhL r
z1
t'Iti;l1I:it'1'Y L.UCATIUN : ,,) �—l4 , �� Jr. , Sect iuu � � , C_a N IZ /
W
T own of-- &,S C—) -_ ' St . Croix Cuunty ,
Subdiv i1si.uu �� Illw 124 L �4Sf[ ut t►un►ber
1
improper use attd nlaintenatice of yuur sel)Lic system cuuld result in
iL s premature "I adore to hatadle wastes . Proper maintunatiee con-
sL,its of puniping out the septic tack every three years or suoner. ,
it needed , by a licensed Sei)t is tank putnpc,r . What you put into
the :;ystent earl of fect the fuiieLlt)11 of Lhu sapLic tank as a treat -
utt,-ltt Stage ill Like waste disposal system .
`•l Cruix County residents ut?y. be eligible Lo reevivu a granL for
it maximum of 6UZ of the cost of replacement of a falling system ,
which -was ill operaLiun prior to July 1 , 1978 . St . Croix County
'ICCUII'Led this program ilk August of 1980, with the requirement that
0w[10rti of all uew agree to keep their systems properly,
muinta iii ed . - ._.- ---
The property uwaer agrees Lu submit to St . Croix Cuunty Zonit►b a
ccrLifi.catiun turm, sighed by the owner and by a master plumber ,
journeyman plumber , restricted plumber or a licensed pumper veri-
fyijig that ( i ) Ll►e ou-Site: wastewater disposal system' is in ;proper
operating condition and (2 ) after inspection and pumping ( if nec -
essary) , the Septic tank is less than 1/3 full of Sludge: and scum.
Certification furm will be Sent approximately 30 days prior to
three year expiration . 0
0
f /WE, the undersigned , have read the above requirements and agree C
ro maintain the private sewage disposal systeul in accordance: with
Lhe standards seL forth, herein, as set by ti►e Wisconsin Depart- R►
utent of Natural Resources . Certification form must be completed
and returned to the St . Croix County 'Zoning Oifijce within 30 days
of ti►e three year expiration date .
S I C N E if
St . C .'oix county Zoning 'Office
P . O. . 00x %,
llammc►jtd , WI 51,015
715-7 16-22.39 or 715-425-8363
Sign , date and return to above address .
r�mT J�hG� I�Q� aG
l6%
d, a
k
" � r00,�
DEPARTMENT OF REPORT ON SOIL BORINGS AND `""` ,f ETY&BUILDINGS
�NDU"STRY, DIVISION
P.O. BOX 7969
LA'ffTFrKP4D ' PERCOLATION TESTS (115) MADISON W1 53707
HUMAN RELATIONS
IH63.0911F&Chapter 145.045)
LO 0 •5 UNICIPALITY: OT NO.: LK NO.: SUBDIVISION NAME:
51� 1/4 Q1/ Q /T29 11X9 6(o /, u n N ?A — WILLOW IeIDC,r EF►S�-
COUNTY: WNE AM A S:
S-Ceolk LAL)kEKJ VA R �7 3 S CoVC ��C1�cSary
USE DATES OBSERVATIONS MADE
DRMS.: COMMERCIAL R PTIO le)y,fir{
Residence Uly -- �G1JNew
;OR place /`�L,, 3 �� Al0 1 /9�7
ris 444: �� &bj >gcAV.14 Attr
RATING:S-Site suitable for system Us Site unsuitable for system
V L: MOUND: IN ILL OLDING A K:RECOMMENDED SYSTEM:(optio all
RIJI sou X$ 1 s ou s au ❑s ca /6NNL�
If Percolation Tests are NOT required DESIGN RATE: I `V If any portion of the tested area is in the w�
under s.H63.09(5)1b1,indicate: C,L'4►4 s S Floodplain,indicate Floodplain elevation: A
LCD PROFILE DESCRIPTIONS
BORING AL j UP ATE -INCHES O OIL WITH COLOR,TEXTURE,AND DEPTH
NUMBER DEPTH ELEVATION B ERVED TO BEDROCK IF OBSERVED SEE ABBRV.ON BACK)
B- 8-se 101.9"1 > a.s% /'' s /0'laNL /Z''tRNSL o~'Cr rdRN C-M s
B- "S% 91.97- > $.S8 /3'AtLTS /3"IS(WL 9"ereqSL 6t"/r+&RN C-All S
B- 3 '1.9Z 99.09 A > 1.91 /Z"1&t.LTS 'Lo"Ite L ?S"' Lrl&# C--All
B- .02� 7.93 '4 C > B.ov //"&kL_r S -7 44N L !4"&R,4-4 "LT$kro 04 �S
B- /0-00
B-
�� PERCOLATION TESTS
TEST EPTH WATER IN HOLE TEST TIME S AT MINUT S
NUMBER AFTERS ELLIN INTERVAL-MW. PER INCH
P. 3.33 N>= 3 Z. 2 <
P- _x ,12 o%� 0./-L 3 'Z <3
P- 3 31-7 9.6 3 Z G
P VA'TIt,04 AM-
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-
rontal 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 96'00
LLA It T,o'.Q -OO I I i
4
('#
Ldr 77
tN
r
ScJoPtc- z-3 �► �
I
I NIlaaR,Y
g-Z
the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures an methods specified in the Wisconsin
:A:1-T
ninistrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
TESTS WERE COMPLETED ON:
• -�oNN rJ�l kUScH S(jQVEY1N6 /HC- NaV / I%I&
CERTIFICATION NUMBER: PHONE NUMBER(optional):
:t4le;4 86-40 ,0
CST SIGN RE:
and one cooy to!_oval Authority.Prol -tty Owner and Soil Tester.
.09/82) -OVER