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HomeMy WebLinkAbout020-1183-10-000 E ] § » _) � / k ( Ll k� / fC CL 2 § E S ¢ m §£ / \C % k ) & ! 2 c )/ j3 @t \ /\ [ » ® CD ® z b CD $ ! " ° § CD § z a ■ .. f § z - 2 0 ® « ■ § � / ] $ 7 k 2 2 k m Cl) . f $ ® ` f G _ » § o 0 k k )_ § w 6 z = f R E ^ \ CL M / � § k a m k CD ! c cn co U) § $ } E z i ) K k k E (z / 2 2 2 { . .oft, § a = _ 2 j v � ] \ co z f f 2 § D k \ . / % \ 4 7 e 2 / \ § 7 ƒ ) / m ) CO o o o \ � « § 2 = o o o = _ f • e # a o R 0 2 / ® � I ` % a E CD a - § § ) CO 0 z / k ) \ CL $ r k a i ƒ 0 a \ 0 2 L Parcel #: 020-1183-10-000 01/07/2005 01:05 PM PAGE 1 OF 1 Alt.Parcel#: 20.29.19.1151 020-TOWN OF HUDSON Current Al ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): *=Current Owner KURT F&TAMMY M ZACHARIAS "ZACHARIAS, KURT F&TAMMY M 487 FOX CIR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *487 FOX CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.510 Plat: 2328-PINEGROVE HEIGHTS 1ST ADDITION SEC 20 T29N R1 9W NE SE LOT 11 PINEGROVE Block/Condo Bldg: LOT 11 HEIGHTS 1ST ADDITION TOWN HUDSON Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1167/396 WD 07/23/1997 999/156 WD 07/23/1997 807/331 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 49191 228,700 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.510 25,100 151,800 176,900 NO Totals for 2004: General Property 1.510 25,100 151,800 176,900 Woodland 0.000 0 0 Totals for 2003: General Property 1.510 25,100 151,800 176,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 216 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 - ST C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ¢i��� ,� fj, j,<j TOWNSHIP ���,� SEC. _20 TR_-,:� N-R /2 W ADDRESS 37.59 Qra.P,,j&w- ST. CROIX COUNTY, WISCONSIN SUBDIVISIONJOU"_ S. LOT f l LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•I.HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM o INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: � _ Proposed slope at site: SEPTIC TANK: Manufacturer: _ 1 S Liquid Capacity: Number of rings used: _ (� Tank manhole cover elevation: Tank Inlet Elevation: 7 Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side Rear, O feet From nearest property line Front,O Side,O Rear feet Number of feet from: well �Q building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE. _SIDE ti PUMP CHAMBER Manufacturer: iquid Capacity: Pump Model: P Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switc levation: Gallons per cycle: Alarm Man acturer: Alarm Switch Type: Numb of feet from nearest property line: Front, O Side, O Rear,O Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM / Bed: Trench: y/ Width: Length:_ Number of Lines: 2 Area Built:-sod'Cr Fill depth to top of pipe: 2 Number of feet from nearest property line: Front, O Side, O Rear, Ft .5-8 Number of feet from well: ip Z 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Z �c� Plumber on fob: C License Number: 3/84:mj SERCO Laboratories 1931 West County Road C2. St.Paul. Minnesota 55113 Phone(612)636-7173 FAX(612)636-7178 LABORATORY ANALYSIS REPORT NO: 30300 PAGE 1 02/02/93 St. Croix County Zoning DATE COLLECTED: 01/27/93 911 4th Street DATE RECEIVED: 01/28/93 Hudson, WI 54016 COLLECTED BY : CLIENT DELIVERED BY : C SAMPLE TYPE ER Attn: Mary J. Jenkins • �ti SERCO SAMPLE NO: 7533 SAMPLE DESCRIPTION: WOOD ANALYSIS: 8 ---------------------------------------- -------- Bromodichloromethane, ug/L <0.2 Bromoform, ug/L <0. 5 Bromomethane, ug/L (Methyl bromide) <1. 0 Carbon tetrachloride, ug/L <0.2 Chlorobenzene, ug/L <1. 0 Chloroethane, ug/L (Ethyl chloride) <0.4 2-Chloroethylvinyl ether, ug/L <0.4 Chloroform, ug/L <0.5 Chloromethane, ug/L (Methyl chloride) <0. 6 Dibromochloromethane, ug/L <0.4 (Chlorodibromomethane) 1,2-Dichlorobenzene, ug/L <1. 0 (o-Dichlorobenzene) 1,3-Dichlorobenzene, ug/L - <1.0 (m-Dichlorobenzene) 1,4-Dichlorobenzene, ug/L <1. 0 (p-Dichlorobenzene) Dichlorodifluoromethane, ug/L (Freon 12) <0. 5 1, 1-Dichloroethane, ug/L <0. 1 1,2-Dichloroethane, ug/L <0. 2 (Ethylene dichloride) 1, 1-Dichloroethene, ug/L <0.2 trans-1,2-Dichloroethene, ug/L <0. 1 1,2-Dichloropropane, ug/L <0. 1 cis-1, 3-Dichloropropene, ug/L <1. 5 trans-1, 3-Dichloropropene, ug/L <0.9 < means "not detected at this level" . 1 mg = 1000 ug. ff MEMBER cai 7 SERCO Laboratories 1931 West County Road C2. St.Paul. Minnesota 55113 Phone(612)636-7173 FAX(612)636-7178 LABORATORY ANALYSIS REPORT NO: 30300 PAGE 2 02/02/93 SERCO SAMPLE NO: 7533 SAMPLE DESCRIPTION: WOOD ANALYSIS: ---------------------------------------- -------- Methylene chloride, ug/L <5.0 (Dichloromethane) 1, 1,2,2-Tetrachloroethane, ug/L <0.2 Tetrachloroethene, ug/L <1.5 1, 1, 1-Trichloroethane, ug/L <5.0 1,1,2-Trichloroethane, ug/L <0. 1 Trichlorofluoromethane, ug/L (Freon 11) <0.7 Vinyl chloride, ug/L <1.0 Benzene, ug/L <1.0 Ethylbenzene, ug/L <1. 0 Toluene, ug/L <1.0 Trichloroethene, ug/L <0.4 Total Xylene, ug/L <1.0 2 a/5 This sample's analytical results are below the U.S. EPA's SDWA Maximum Contaminant level of 1/30/91 for those requested compounds which are also on the SDWA MCL list. < means "not detected at this level" . 1 mg = 1000 ug. , , MEMBER Irm 71 SERCO Laboratories 1931 West County Road C2. St.Paul. Minnesota 55113 Phone(612)636-7173 FAX(612)636-7178 LABORATORY ANALYSIS REPORT NO: 30300 PAGE 3 02/02/93 All analyses were performed using EPA or other accepted methodologies. Samples that may be of an environmentally hazardous nature will be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, Diane J. erson Project Manager < means "not detected at this level" . 1 mg = 1000 ug. P MEMBER COMMERCIAL TESTING LABORATORY, INC. ' 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 1 800 - 962 - 5227 FAX - 715 - 962 - 4030 ,t ST. CROIX ZONING REPORT NO.S 36189/01 RAGE 1 ST. CROIX COUNTY REPORT DATES 1/29/53 COURTHOUSE DATE RECEIVED: 1/28/93 HUDSON, WI 54016 ATTNS THOMAS C. NELSON OWNERS Tim h Marian Wood LOCATIONS 487 Fox Circte, Hudson COLLECTORS M. Jenkins DATE COLLECTEDS 1-27-93 TIME COLLECTEDS 2230pm i SOURCE OF SAMPLES Kitchen.faur-et DATE ANALYZED21-28-93 TIME ANALYZED22204pm COLIFORMS 0 /100 mt INTERPRETATIONS Bacteriologically SAFE NITRATE-NS 3 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L a 1S�,1t LAB TECHNICIANS Pam Gane [ ti DF,,NDFCFNDENr (F 0 WI Approved Lab No. 19 s t Z a C Means "LESS THAN" Detectable Level Approved by! PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse R; 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 ewe St. Croix County Zoning Office offers the service of septic `, land water inspections to Lending Institutions, Realty Firms, and ^ , V private individuals. Completion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING------------------ --------FEE: $ 35.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 X (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 X (Determines if system is properly functioning at . time of inspection) PROPERTY OWNER'S NAME:- I Im MARtpj,N L0000 PROP. ADDRESS: L4Br1 FOX Ct2Ct-E CITY Ot� Legal Description 1/4 of the 1/4 of Section , T 2 N-R l Town of F} k650N Lot Number Subdivision: P#N EGrL006 Ts FIRE NUMBER '-IP�rI LOCK BOX NUMBER C3- C:- R ©2U-//9 3 Color of house F3QowN, Realty sign by house? If so, list firm• CFN-R-LQ y -al P2 EMI E Q, &7(ZOO P. [+LA JSQr J - SEN1N y ©15014 PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: C - Zi P�zEMl�2��2oJP Telephone Number 3B(Q -(52-01 REPORT TO BE SENT TO: SEIVN-t LSO" CE N'R-L-�► Z i E�rZO yp `IOU i 9 n+ ST-50 CLOSING DATE: �a lq3 Signature ST. CROIX COUNTY ?� WISCONSIN ZONING OFFICE ST.CROIX COUNTY COURTHOUSE _ 911 FOURTH STREET • HUDSON,WI 54016 (715) 386-4680 January 27, 1993 Jenny Olson Century 21 Premier Group 706 - 19th St. S Hudson, WI 54016 �I Dear Ms. Olson: An inspection of the septic system on the property of Tim & Marian Wood, located at 487 Fox Circle,Hudson, WI was conducted on Jan. 27, 1993 . At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact his office. Si cerely, Mary J. Jenkins Assistant Zoning Administrator cj III DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS P.O.BO& ti'UMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION .O.BOX , W9 BUREAU OF PLUMBING MADISON,WI 53707 NE' ,SE4,S20,T29N—R19W 17CONVENTIONAL ❑ALTERNATIVE State Plan I.D.Number. Town of Hudson 1lf assigned) ❑Holding Tank ❑ In-Ground Pressure ❑Mound Lassie Lane NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER'. INSPEC1`101 DATE'. Timothy Wood 3759 Orchard Avenue North, Hudson, WI 54 16 �a_ a^O r 1 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN- REF.PT.ELEV.: COST REF.PT.ELEV.. Name of Plumber. MP/MPRSW No Cnunly Samtary Permit Number: Gary L. Steel 3254 St. Croix 106074 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIOUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. DYES ❑NO DYES ❑NO BEDDING: VENT DIA.: VENT MATT HIGH WATER NUMBER OF ROAD. PROPERTY WELL. BUILDING. JVENT TO FRESH IALARM FEET FROM LINE AIR INLET: ❑YES ONO DY ES ONO NEAREST DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL PUMP:SIPHON MANIA ACll 4iEH WARNING LABEL LOCK INGCOVER PROVIDED. PROVIDED ❑YES ONO D YES ❑NO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF >PHOPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST--�0 SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth ofplowin9 FORGE I[ (,TI{ rnnMETEI+ IMATI HIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRI=NCH ', WIDTH LENGTH NO OF UISTH PIPE SPACING, COVER NSIUE DIA -PITS LIQUID THEN!L / 1 M HIAL' IT DEPTH: DIMENStONS 11 L ` / GRAVEL DEPTH FILL DEPTH I(E)I!S TH PIPE DISTH PIPE DISTH.PIPE MATERIAL NO ( TH N'.UMBER OF PROPERTY WELL BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER EV INLI! ELEV.ENU PIPES FEET FROM LINE. AIR INLET: NEARErST. 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 ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE IP11111111NI NT MAHKE HS OBSERVATION WELLS _ 1 1:1 YES ONO OYES 1:1 NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED UFPTH OF TOPSOIL SOOOFO SEE UFU MULCHED CENTER EDGES ❑YES. NO ❑YES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO OF LATEHAL SPACING OHAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. DtMENS1ONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATEHIAL NO DISTH DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING PIPES.. . ELEVATION AND ELE V ELEV. DIA ELEV CIA DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING JDRiLLED CORRECTLY COVER MATEHIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO _ DYES ❑NO COMMENTS: ]PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE. G� ❑YES NO ❑YES Lf NRA I NE E T V ►�°� L .q �,o I Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. DILHR SBD 6710 (R.01/82) Zoning Administrator SANITARY PERMIT APPLICATION COUNTY L a1LHR In accord with ILHR 83.05,Wis.Adm.Code St. Croix �°°�^•^�^�- STATE SANITARY PERMIT# /6)&v y —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 rPSCi NO PROPERTY OWNER PROPERTY LOCATION Timothy Wood NE '/4SE '/4, S20 T 2 , N, Rlg fkor)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER IBLOCKNUMBER SUBDIVISION NAME 3759 Orchard Ave. N. 11 n/a Pine Grove Hts. CITY,STATE ZIP CODE PHONE NUMBER CITY : NEAREST ROAD,LAKE OR LANDMARK Hudson, Wi. 54016 n/a [ED: VILLAGE: udson��1 Lassie Lane II. TYPE OF BUILDING OR USE SERVED: [mac Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): III. 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. ®Conventional 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. ❑ seepage Bed b.El 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): 1 495 500 99.85 Feet Private ❑Joint ❑ Public CAPACITY VI. TANK in allons Total #of Prefab. Site Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank x 1000 1 Weeks Concrete 1 El El Lift Pump Tank/Siphon Chamber, --- ❑ I ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's ' nature:(No St ps) MPRSW No.: Business Phone Number: Gary L. Steel 3254 _ Plumber's Address(Street,City,State,Zip Cod : Name of Designer: 988 N. Shore Dr. , New Richmond, Wi. 54017 VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# Gary L. Steel CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 988 N. Shore Dr. New Richmond, Wi. 54017 715 46-6200 IX. COUNTY/DEPARTMENT USE ONLY ❑ DisapprovedSanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stam s) Approved ❑ Owner Given Initial �,\ Charge Fee Adverse Determination 4 ,W �`' X. COMMENTS/REASONS FOR DISAPPROVAL: 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 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; 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% 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 EitBi included the creation of surcharges (fees) for a number of regulated practices which disco can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure is used in your building is returned to the groundwater through your soil absorption e system or the disposal site used by your holding tank pumper. 0 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 \LOO(� Location of Property Wt. , Section -Z-0 , T 2°1 N-R -i W Township 14 l0 S o*4 Mailing Address _ 51 S q 004-H AwL o A\11E (2ogtp _4, DAB NlN �54zz Address of Site S Q!.A Subdivision Baste PI UiE (,mo .-- . Lot Number I Previous Amer of Property ekC- 49VZ10 Sj°fp�n.r Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? _ Yes _X_ No Volume _ $01 and Page Number ^'7 8 �7 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and'IPaRe 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION i PO I Cott i6y that a t 3tatementr5 oil tlu�s JOAM cvee hue to tke begs t o m hncwtedge; that i (we) am (ane) tJ�e owneA( o6 the phopenty de�smibed6.inythiA I .in6olma.tion 6o", by viAtue 06 a waAAanty deed neeonded in the 066-ice o6 the Coll n.tyy Re-giAten o6 Veed�sah Voeument No. 4(o3o'18 ; and that I (We) pneeenL£y CRUn tl�e p�topvaed d i to bon the Sewage diA CIA 4yh em (oh. I (we) have obtained an ecuememt, to stun with the above de c&�bed pnopWy, bon the eon tAucLi.on o6 aaid e ye.tem, and the came ha.e been duty hecohded .tn the 066.tee o6 the County RegiAten. o6 Deed&, a& Ooement No. 6301 I . SIGNATURE Oh ER SIGNATURE OF CO-OWNER (IF APPLICABLE DATE SIGNED DATE SIGNED T�DEE • BOOK R��f 4 �Q" ►' GISTERS 01-1-111-L . Ci o:X C0.0 Wis, ' or Record this 11th {T r "T5 C � T C i , j. IST ( a Anril A.D. 1988 9:00 N& conveys and warrants to 12 T14 0111T FY t `OOD and James O'Connell i �;i.IC-td T. 1100-D husband and wife .Q pie RETURN TO the following described rest estate in t • O r'O 1 County, y State of Wisconsin: Lot 11 , Pinegrove }-ieights 1?irst h.ddiidon in Tax Parcel No: the Down of Hudson located in the 1Jorthea5t ,darter of the southeast .tivarter of ;ection 20, Township forth, itange 19 West. L�NLO This i n U t homestead property. (is) (is not) Exception to Warranties: easements, restrictions and rights-of-way of record, if any Dated this 1st day of + cAZ C�h , 19 . (SEAL) +%I .. ;�; �C. SEAL i;iciiard G. :;tout .'--Janet P. stout . I 'SEAL) (SEAL) i.aud ii. ..;tout by iiCtiard U. ou , Ower or Ltty AUTHENTICATION ACKNOWLEDGMENT w . ...Slgnaturs(s) STATE OF WISCONSIN Ss. County. authenticated this day of < ,19 _ Personally came before me this of 19 the above named �- VT TITLE:MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person who executed the authorized by§706.06,Wis.State.) foregoing Instrument and ackn ledge t e same. THIS INSTRUMENT WAS DRAFTED BY �^ Tr a t O,U t ~ '1 ti-t.-•fir---- Notary Public~ . ,� County,Wis. (Signatures may be authenticated or acknowledged. Both My Commissl�s permanent. (If not, state ex iration are not necessary.) date: CEJ.RB Notary ' "7 'Names of persona signing in any capacity should be typed or printed below their signatures. NTF 2280 WARRANTY DEED STATE BAR OF WISCONSIN Nelco Forma,P.O.Box 1075,Green Ba W154305-1075 Form No.2—1982 Y. H N ' H a STC - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT Ho St . Croix County z d a OWNER/BUYER ��MO" 1—T WoOf� ROUTE/BOX NUMBER 315q Oa-CA4A2p .AYt. W Fire Number CITY/STATE %e,1t4&,o 4 M%-i 'LIP S5-42-Z PROPERTY LOCATION :_Nf, 14, ;4, Section Zp , T 79 _N , R 19 W, Town of 1'ivA DS,0*4 , St . Croix County , Subdivision P C,W\(e 4TS , Lot number—k Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper . What you put into I` the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping ( if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration . H 0 E I/WE, the undersigned , have read the above requirements and agree z to maintain the private sewage disposal system in accordance with x the standards set forth , herein, as set by the Wisconsin Depart- v ment of Natural Resources . Certification form must be completed and returned to the St . Croix County 'Zoning Office within 30 d s of the three year expiration date . SICNED l v DATE `-I St . Croix County Zoning Office P. O . Box 98 Hammond , WI 54015 715-796-2239 or 715-425-8363 Sign , date and return to above address . 4 ` DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY; C DIVISION BOX 76 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.090)& Chapter 145.045) LOCATION: SECTION: TOWNSHIP/�¢ X: LOT NO.:BLK.NO.: SUBDIVISION NAME: NE �/4SE/ 20 /19 NlR9xf (.,)W Hudson 1 11 n/a I Pine Grove Hts. COUNTY: UYER'S NAME: MAILING ADDRESS: St. Croix Timothy Wood 3759 Orchard Ave. N. , Hudson, Wi. 54016 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: 1 I PROFILE DES RIPTIONS: PERCOLATION TESTS: ®Residence 3 n/a New ❑Replace 4-1-88 4-1-88 RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) ®S_oU �S ❑U IS ❑ I I [:IS � [:IS CCU I ccx�ventional If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: n/a Floodplain,indicate Floodplain elevation: n/a PROFILE DESCRIPTIONS page 58 PIA BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER IDEPTHIft EEEA ION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 1 6.91 36 no ne >6.91 .83bl.1. 1.33bn.sil. .50bn.s.l. 4.25bn.c.s.&gr. B_ 2 7.00 103.36 none >7.00 1.25bl.1. .83bn.sil. .75bn.s.1. 4.17bn.c.s.&gr. B_ 3 7.01 102.98 none >7.01 .92bl.1. 1.42bn.sil. .50bn.s.1. 4.17bn.c.s.&gr. B_ 4 6.84 102.14 none >6.84 1.00bl.1. 1.67bn.sil. 4.17bn.c.s.&gr. B- 5 6.83 102.42 none >6.83 .83bl.1. 1.25bn.sil. .83bn.s.1_. 3.92bn.c.s.& r. B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER,LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P_1 none 3 6 6 6 <3 P-2 3.50 none 3 44 4 4 1 P-11 3.12 nnnp 3 3 1 3 3 1 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 99.85 i € _I J", i x I 7 i t _. _.�__ � _ _ � __ _ �,.. .k. _ �. �. ; _ _ __ _ t � � _ �`� � I _t_ � _.� N S , i [ E 7 1 Z 3 I I,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: Gary L. Steel 4-1-88 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 988 N. shore Dr. New Richmond Wi. 54017 2298 715-;46-6200 CST SIGN E: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) OVER — - :I 919L �� �- ' N INSTRUCTIONS FOR COMPLETING FORM 115- SBD - 6395 To be a complete and accurate soil test,your, report must include; 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement systerrr; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDi T IONS; E. PLEASE use the abbreviations shown here for writing Profile descriptions and completing the plot Ilan; 7. MAKE A LEGIBLE diagram accurately locatit=g your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sere your benchmark and vertical elevation reference point are cleanly shown,and are permanent; 9_ Complex e all appropriate boxes as to dates, names,addresses, flood Main data, percolation test exernp- tion, if appropr late; 10. if the information (such as flood plain,elevation)does riot apply, place N.A. in the appropriate box; 11. Sign the Porn)and place your current address and your certification nunihur; 12. Mace lertibie copies and distribute as required. ALL SOIL TESTS MUST BE FILED VV`iTH THE LOCAL Asa I' @ORITY WITHIN 30 WAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and TextUres Other Symbols st — Slone (over 10") BR — Bedrock cols - Cubble j3- 10"} SS — Sandstone gr — Gravel (under 3") LS - Limestone S - Sand HGVV — High Groundwate,' - Co.lise Sand Perc -- Percolation Rate MI"'diUn! S Wd VV t:keIi is _ Fine Swul Bldg — BuiId J n Is Loarny Sand > Greater Tnan sl Sandy Loam < — Less Than Loarn Bra - Bro,r.r " ii Silt Loarn BI Black — Silt Gy — Gray cl Clay Loam Y Yellow scl — Sandy Clay Loam R — Red sicl — "Silty Clay Loarn rnot - Mottles sc Sandy Clay vv/ - with sic — Silty Clay fff' -- few, line, faint C;l:.a.y <;c; — cornrnc?r.,c;ctarsr o - f'cvrt MI-1 — Mary, rnedium rr uck I Q — distinct I-) prorn.ment HWL - High eva'ter level, Six vne'ral soil textures surface water to! liquid waste disposal BM _- Bench Mark VRP - Vertical Reference Point a Y n TO THE OWNER: Thrr soil �sl repow is the first step in securing a sanitary permit. The cor!nty or th e Departr lent may request yr t i ica tlon or th.s soil test in ttte ficld prior to permit issuance_ A corrmplete set of plan, for the private system, and a permit application must be submitted to the appropriate local arrth(-Iriis n orc r;r to obl n « rse rrr t. Ti e sanitary permil must. be oWatkse ri and jwsted l�6or t( ttE�r star t c f any t s �rstraction. Timothy Wood NE-SE% S20-T29N-R19W Hudson, township i Le r-rr9-.r7Xs 13 w l T• .L. 1-�. t2. 83 ,10 O�aoo�'��� 3 VO �[p 3 1 �-3- GZ7- l03 X36 -7 aP ".x- 85 l2vcr< stir Gary L. Steel 988 N. shore Dr. New Richinond, Wi. 54017 MPRSW 3 54 X