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HomeMy WebLinkAbout020-1250-20-000 N O (D 0 0 6n, M O� bq O t3 @ 00 C O C c y '0 C .0 ro N t+ N m N O O d 2 c = c c _ c _ _ _ O y U O y N N � m� U N U c y 0 X N C 0 o C C a a 3 � M y 3 � M y rO III C p � C O O ro.O a) y O N'0 0 y -O y N -O N - .t.. N E c oL E o h U w 0) i y N ro y ` N N .� E T — E :,,8 = U w M a0 Er O y O y U - U C co U- U C co ro N Iro O C O C Y y C C Y y y ro O) N C VJ ro aw C N +-+ N +-+ o m0 0 �'E o ro0 co u?'E Z y — y Z w — y T t N N — T o — — f0 — f6 U. ro 0 r o n ro T. o a I p) a rn � ro ro LL o p � o m 3L o o �o N 3L 0 a)a� '� rn ro 10 �ar'� rn Q 'y ro ma w Q 'y ro ro� w M N Z Lu 0) E O E o Z (v H Z C m c c 0 0 E C7 p c m O 2 c U V d O y O r Z Z c E v E v v CI)l M a) �' y c U)•� O d Q) = 0 t O li *.� c 0 0 �ca O Q O N Q - w Z 00 Z o p N C p y Z y y Z N ro (6 ro ro C E O O N O O N C N N ❑ ❑ ❑ ❑ J y O • `. N N CF CL C0 N MA r D N O C a D 0 ° O IL E N � o O O M F H H 2 (n U) N d N Z o Z o • @ 000 o N ' ro ro Q) fA U = o2 rn Z Z U O c0 0 (0 °o °o E N (\ = E y 9 m y 2S Q � � n N C7r Q CS. N In a 6 Q ff Z ro Q > ! Z (r, (o _ O {0 ❑ ❑ � @ of a C O OI'i N C N C N j N O O y 3 N O O N N LO O I LO N C C C a 0) O D N M C C C U d 0) C) 0 l 1 L O F- N (n (6 N C KOtl N_ y N N In U) C m N O .0+ C 7 N M C m N N .w0. 7 N M 4.) N O _ !fl 'O Z M N ) -0 (D 'O Z '� N N = 0 y ro p ro O m U O y CU p ro O 0 U • y'7„' O N = O N = H Z V1 Z N 2 F- Z U1 O �.+ .. E a a L: a r t A C) a O N 0 Parcel #: 020-1250-20-000 12/17/2004 08:14 AM PAGE 1 OF 1 ` Alt. Parcel#: 21.29.19.1252 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 STEVEN &GINA WILLIAMSON WILLIAMSON, STEVEN&GINA 511 JACOBS LADDER CIR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description "511 JACOBS LADDER CIR SC 2611 SCH D OF HUDSON SP 1700 W ITC Legal Description: Acres: 2.297 Plat: 2135-JACOBS LANDING 2ND ADDITION SEC 21 T29N R19W NW1/4 OF SW1/4&SW1/4 Block/Condo Bldg: LOT 30 OF NW1/4 LOT 30 JACOBS LANDING SECOND ADDITION Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-29N-19W I Notes: Parcel History: Date Doc# Vol/Page Type 07/09/2003 729330 2306/431 WD 839/261 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 49292 252,500 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.297 31,500 163,800 195,300 NO Totals for 2004: General Property 2.297 31,500 163,800 195,300 Woodland 0.000 0 0 Totals for 2003: General Property 2.297 31,500 163,800 195,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 211 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 - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER '�_e,- TOWNSHIP SEC. T �Lq N-R 19 ADDRESS C��X # Z ST. CROIX COUNTY, WISCONSIN ,,lee <xS SUBDIVISION LOT 3o LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of 11HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM :J° ladu5� q xso" w c 9acobs dot 3� A.4 y' ySTd ►� E v. = /OS 8 C 't 0 /90 has INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used I lot p;f,_ S.E. IOT Co r ­r Elevation of vertical reference point: \DO.O' Proposed slope at site: SEPTIC TANK: Manufacturer Wt,; s �,� Liquid Capacity: 12- SO ! � Number of rings used: u Tank manhole cover elevation: //Z• Sd Tank Inlet Elevation: ///.DD Tank Outlet Elevation: //0. 70' Number of feet from nearest Road: Front,Side Rear, O / SS feet From nearest property line Front,0 Side 0 Rear,0 feet Number of feet from: well 7 S , building: Z 2' -- 3S"71ro", s.Ex.".rc; Nom s� (Include this information of the above plot plan)( 2 reference dimensions to septic tank) __ SF.F. REVERSE STnF. PUMP CHAMBER Manufacturer: y 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, OSide, ORear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Cevkam-f,'p A*- Trench: Width: Length: S Y Number of Lines: 3 Area Built:97Z s7� Fill depth to top of pipe: 5/D i Number of feet from nearest property line: Front, O Side, ® Rear,0Pt . 'YD Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: 11A Number of pits: Diameter: y Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box been used on any of the above soil absorbt.ion 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: Plumber on job: o��Jtra/14a 4 �- v. License Number: 4 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING * LAA*)OiR&HUMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: NA-,SGI 14-,S21,T29N-R19W ® CONVENTIONAL ❑ ALTERATIVE (Ifassigned) Town a6 Hudson ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound �-WAMEE5PvPE441111&0&RLa ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Sam Mitten Route 1 Box 282 Hudson W1 54016 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: Doug StAohbeen 5472 St. Cuix 119391 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER �!c�® � g �(� + 0( 1'�1 PROVIDED PROVIDED: •J �r j"� � YES ❑NO DYES 5ZNO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LI,NE� AIR INLET: ❑YES NO Cz ❑YES �KNO NEAREST----* 1�/ DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: P PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: I MATERIAL 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/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID P? TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO. STR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: PIP S: FEET FROM LINE: t� AIR INLET: t` 10 �I "% &-I�.� NEAREST� �� � � to 8/p J- MOUND 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 El 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: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. 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 I ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: I I Lf ❑YES ❑NO ❑YES ❑NO NEAREST—� i Sketch System on v 1 Retain in county file for audit. Reverse Side. SIGNATUR TITLE: Zany y Adm iwust�caton SBD-6710(R.06/88) SANITARY PERMIT APPLICATION COU 31LHR In accord with ILHR 83.05,Wis.Adm.Code f' 0 1 STAT SANITARY PERM T## -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 [9 NO PROPERTY OWNER PROPERTY LOCATION S�W_ /d/ G) 1/45W%, S , N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER IBLOCKNUMBER SUBDIVISION NAME 0e_f 41 f fgd,rI ZT ;—:- 3 0 SuCofva a» CITY,STATE ZIP CODE PHONE NUMBER 7n CITY NEAREST ROAD,LAKFdR LAND ARK W TOWN OF: VILLAGE: Q��l,v et�l �dmSQL u o L '4�D v 3 Z7c II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) j 1. a. 0 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.X 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. 9 Seepage Bed b. ❑Seepage Trench c. ❑ See a e 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): �S Feet ®Private ❑Joint -1 Public VI. TANK CAPACITY Site in gallons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank 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's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: tf 4 Plumbe 's Address(Street,City,State,Zip Code): / , Name of Designer: i� 3 1v4-u.1 P� -'c.A A, a -, �I P__11i / 7 c� 5 7✓0 +5 VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# CST's ADDRESS(Street,City,State,Zip Code) Phone Number: ///` L .0-- ! o Gam,' - a 7i S � IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved itary Permit Fee Groundwater ate I ng Agent Signature(No St:�,& Sy ha�rgLe Fee Approved ❑ Owner Given Initial ,� �l�Q1�^CDO Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: 'lar I lah eqWCW-ed SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber i 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 $@r included the creation of surcharges (fees) for a number of regulated practices which Wisco ill's a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried re3&U & 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 purrper. 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- 1 water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) l.� 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 5Sc th /�1� /e,� Location of Property � j GtJ , Section °1 , T�9_N-R t W Township Mailing Address ,e-ye a Address of Site L14 ge Subdivision Name Lot Number _gyp Previous Owner of property Total Size of Parcel Z - z L7-7 er S' . Date Parcel Was Created A', , Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume S� and Page Number 6 `,--- 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1 (we) eenti.6y that att statements on this 604m a e, thue to the best o6 my (oun) know.tedge; that I (we) am (ah.e) the owner(s) o6 the pnopen ty des eh i.bed in this in6o4mafiion 604m, by vi tue o6 a waAAanty deed teemded in the 066ice o6 the County Reg.r step o6 Veeds as Voeument No. 5 7 ; and that I (we) peed en tty own the proposed site 6oh the 6ewage df spos s ys em (on I (we) have obtained an easement, to nun with the above de cx bed pnopenty, bon the eonstAucti.on o6 said system, and the same has been duty teemded in the 066ice o6 the County RegiAten o6 Heeds, as Voe ment No. _4e 3 S y/Z ) . SIGNATURE OIL OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED i rNl. f�ACt R[f[RftO IOR R[fORO1N0 OAIA OMUMEP41 NO. WARRANTY DEED •1 ' 1"417 STATE BAR OF WISCONSIN FORM 4—i2-112-1111811 3., 9 RcvISRR,S OFFICE .• • ' a Red for K19W Virzftle.11c Hanson, a single woman... . ........ ........... . . ........ .... ......I.. ....... ... . ... . ... . ... .. ............. ...... ...... . ... � �� ...... . ...... ............. ... ..... .. . . ........ . ..... .. .... ........ .. .... . .... . .. . .. ...... ..................... � 8. 0o� A�M eonYeyR and warrants to S.am..E. Miller•..a..single man... � I ........... � C .. .... .... .. . ...................... 1000-1h�hln e>Oasi .. .. ... . ...........I....I......... . ..%. .. .. . ... ..... .. . .. ......... . . .. .. . . ........ .. . - .. ............... .... R[TURN TO the following described real estate in ......St...Crolx ..County, ................ State of Wisconsin: TaiParcel No:.............................. West Half (W�) of the Southwest Quarter (SW)t) of Section Twenty-one (21), Township Twenty-nine (29) North, Range Nineteen (19) West, St. Croix County, Wisconsin except that part South of the public highway and except Lots S, 6, 7, and 8 of Certified Survey Hap in Vol. 6, Page 1747, Doc4 No. 419479. That part of the West Half (W31) of the Northwest Quarter (NVh) of Section Twenty-one (21), Township Twenty-nine (29) North, Range Nineteen (19) West, St. Croix County, Wisconsin lying South of the right of way of the Chicago, St. Paul, Minneapolis and Omaha Railway Company. • SE'EK� 0 EEE This . is not.. ....... homestead property. thk (is not) F.xrelltion Uo warranties: easements of record and protective covenants and restrictions of record, if any. 4r }� . )9.88 . Dated this � 1 .... ... .. _. ... day of �C. .1' ' ........... . . .. . .(SEAL) --!/..(SEAL) . .............. ......... .......... ................... . . ... • .Virginia.M...Hanson .... ... .. . .. .. ... . ....... ... .... ....... . . .... . . .(SEAL) .(SEAL) • . . ... ..... . . AUTHENTICATION ACKNOWLEDGMENT Signatures) •..... STATE OF WISCONSIN ..................................................,•„ ................................................................................ c... ........S \.r.4 y County. ts. authenticated this .......day of........................... 19...... Personally came before me this .. . .......day of ................9 19.88... the above named ................................................................................ Vir inia M. H neon • ......... .......... ..................................................... TITLE: MEMBER STATE BAR OF WISCONSIN (If not.............................:............................... ..... .. I................ ... ................... ... ....... . . . .. .. . authorized by 0 708.06. Wb. Slate.) to me known to he the pttr IS on ....... .... who executed the foregoin trument and acknowledge the same. Ta1S INSTRUMENT WAS DRAFTED BY Yt •'. (t4):!!.A,..�Wr,xaXA..Neywood, Cari b Murrax ( ` P..Q....liox..229x..HudhkQAa..}�I ....,�t4016.................. tiotn•. ulti(c p �'•�y'. County. Wi. (Signatures may be authenticated or acknowledged. Both M. Co Imi.ajnfl I��ICr�ld4lcnt.(If not, stole expiration are not necessary.) date: .t. .T.. .... ............ . 19FI A *Kama of oeesons Idtaint in any capacity should be tyue•1.,r print.d Iw•low•their rfRnnl,:re.. WARMAN” DEED STATR BAR OF WISCONSIN 1AVId FORM Na e— IV42 Nd�..•w�, wh• i Y STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County II OWNER/BUYER ROUTE/BOX NUMBER" l�o� ' z� �, FIRE NO. CITY/STATE Ye, b,Sa y ZIP '.5-510 /C- PROPERTY LOCATION: �? Jl/4 SG/ 1/4, Section —D / , TAN, R /� �w� Town of 1�L��Sdu , St. Croix County, Subdivision 5 14 L-A Lot No. Zd 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. SIGNE 1 r Q DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS IND RY, DIVISION UST c LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.09(1)& Chapter 145.045) LOCATION: SECTION: OWN HIP A4irlAFW4PAC1T'1': LOT NO.:BLK.NO.: SUBDIVISION NAME: W �/w�� 01 /V? H/R/�'6( 1 ftud�sVA. 30 COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIA DESCRIPTION: PROFILE DESCRIPTIONS:1PERCOLATION TESTS: Residence z /, KNew ❑Replace /0 /d_,7;? y y /`� y s°c- s�o Br C 2- �� d r�,�w ply /o.�,�•r RATING:S=Site suitable fors stem U=Site unsuitable for stem rxs ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional)❑U �S ❑U f&S ❑U ❑S EAU ❑S ®U Cw�ud / ,Se� Z'z3`' If Percolation Tests are NOT required DESIGN RATE: I If any y portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: IVA PR FILE DESCRIPTIONS BORINGI TOTAL/ DEPTH TO GROUNDWATER CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH.IW. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- �i ` //pr�` dti �' r 6 B/s/ • 9 gH.�/ i s V. s B- ?'' 7.S /d 7 r dii[ ' 7 7 s` /s . h s� �i t Ah !s . S B- Y ..r' w 6.7' A4A e- 7 j, (o AQ / On / . 3 8A S 7 Aft r S B- S` l�6�?' Qoe_ 7 7. r' , 7 h / , 3A r /s 4'6 Al s B- PERCOLATION TESTS TEST DEPTH# WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 14ftMI" AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD PERI PER PER INCH P- .O r o L- 6 ` 3 P y r o Z 6 3 P_ d • A& Z 6 ro P-- `P- P- PLOT PLAN: Show to tions of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical ele tion 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 A ?o "= ` ��_ . _ - - ¢G� F -' r YL Lear , i t_,..(.,,,.. _...,....,,,# ............. �/-- Y -`'',,._ €-.,... e.........�. ... _ .�.� _ •.. �lC O� ,e'L.74+{jam—�-_®� --i 7 \i 71� a . - Ix, I _. e 7L I ?$ f �/d t: SMAN C�cfi /fi-o.[ $/ To MArk' d:•u lea.-f-�° Q�i//� AeQf're Aq uvts. 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: Q•1 tyct�� r `, / &-r4a //7 —(!fJ ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): svav /S9 fit CST URE: � c DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — 1 INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test,your report must inCIUde: i1 1. Complete legal description; 2. The use section must clearly indicate whether this is aresidenee or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitahility rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6.r RLEASE use the abbrevia t ions shown here for writing profile descriptions and completing the plot plan; 7. ;MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be useet'if desired; S. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. if the information (such as flood plain,elevation) does not apply, plane N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL. AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS i Snil Separates and Textures Other Symbols st — Stone (over" 10") BR -- Bedrock o1) Cobble (3- 10") SS — Sandstone gr -- Gravel (under 3") LS - Limestone s — Sand HGW — High Groundwater w- Coarse Sand Pere - Percolation Rate coed s — Mediun-t Sand W Well fs Fins Sand Bldg -- Building Is — Loarny Sand > Greater Than 'sl Sandy Loam { _.- Less Than 'I Loam Bn -- Brovvil *0 - Silt Loam BI - Black s€ — Silt: try Gray "cl - Clay Loans Y Yellow sc, — Samly Clay Loam R —. Red sicl - Silty Clay Loam mot Mottles" sc Sandy Clay vv/ -- wit I) sic — Silty Clay fff f0w,fine, fain+: . C Clay cc -. common, coarse , pt float rrrm - Many, MCAM111 m Muck d - distinct 1) — prominent HVVL — High watm,level, Six general sail textures surface Uvat-,r for liquid waste disposal BM — Bench Mark VRP ...... Vertical Rcferencce Posit" TO THE OWNER: This soil Brest report is the first step in securing a sanitary perrnit. The county m the IDepartr7 er", may request verification of this sail test in the field prior to oszrrriii issuance. A complete set of plans fw the private s a��U systt,,rn and a perrrn t application must tae srrtsm;Tted to the appropriate io<,al authority it) order to �t�tr in 4 faerrrsit:The sanitary,pin'rnit mast: be and poster! I>1 for to the start at ar3y rrtsts uctirarr. 5�0,"Tk, tot b 40- 114 -Y.4 At S.W. !OT eorn,4.i e I.,to C. a w Q- 4 74 L I FY 40 aZ qa CK—Lis'- 30 20 70 81 zo IQ4-1 iL ------- sr- y %5 al�- to A. C� y cn W �C- 0 d vi /- 9 -7 ST. CROIX COUNTY ..r �.� WISCONSIN ZONING OFFICE r r r r r ■,■, ST. CROIX COUNTY GOVERNMENT CENTER ,.2 ,.• M 1101 Carmichael Road ` =----_ Hudson, WI 54016-7710 ��. 0%`' (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM i' Please specify desired test(s) & remit appropriate fee with p � t application. Outside water lines are often turned off during `! winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. V VOC Water 's 185. 00 ( ) $ ❑ Septic $50. 00 Water (Nitrate & Bacteria) 45. 00 ❑ Nitrate & Bacteria 'vy'ate (Lead Concentration) 21 . 00 retest $15.00 Owner: C` \ ei�kt*lRequest by: ( ��k aJ Address: 't t S ;(address: "lc S oO Sep" ZIP - v UV ZIP (1=j Telephone N4: ( lr Telephone N°: Properly address (Fire W F. S�reet) : `t �kCQt3S Location: Sec.. Z( , Tag N, R W, Town of t) Realty firm: Lock Box Combo: Closing Date: r0?0-125,0- 249-000 TO BE COMPLETED BY PROPERTY OWNER 21.29. 1? *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* /ZS,Z Water sample tap location: Is the dwelling currently occupied? 0 Yes 0 No If vacant, date last occupied: Age of septic system: Septic tank last pumped by: Date: Previous Owner's Name(s) : Have any of the following been observed? O� a r� ❑Y ON Slow drainage from house. ❑Y ON Sewage Back-up into dwelling. CO pp �EO ❑Y ON Sewage discharge to ground surface or d Al 0161❑Y [IN Foul odors. 3NN � 3 Other comments relative to system operation: S-T�CPO .- I certify that the above informatiyn is compl a and rgZTCq ,e- best of my knowledge. OWNERS SIGNATURE: �I DAT:-- 1 /94 "F OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION 1N { TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes., ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system: OBelow grd OAt-Grd OMound Approx. size ' X ' OGravity ODOSe ❑Pressurized Ft• 2 OBed OTrench ❑Dry Well Molding Tank OOutfall pipe OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank Setbacks: OHouse OWell OProp. line ❑Other Dose tank Setbacks: OHouse ❑Well. ❑Prop. line ❑other OLocking cover OWarning label OPump/Floats OAlarm ❑Elec. wiring Soil Absorption System Setbacks: OHouse ❑Well ❑Prop. line ❑Other ©Ponding: ODischarge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION Inspector Title 9 -7 ST. CROIX COUNTY WISCONSIN ----=� ZONING OFFICE ItNlrNrrr lilts ST.CROIX COUNTY GOVERNMENT CENTER >,. 1101 Carmichael Road x_=_ Hudson. WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. Water (VOC's) $185. 00 ❑ Septic $50. 00 Water (Nitrate & Bacteria) 45.00 0 Nitrate & Bacteria I] Water (Lead Concentration) 21 .00 retest $15. 00 Owner: 1t1'MLC.U_! -"tacnAjRequest by: ( :; 1k � aJ Address: '�l S ;f�ddress: -tt s �O Sow ZIP - v U� ZIP ((0 Telephone W: (��- _ Telephone W: ('7 LS-) - ��R 4"1,4Lc,% coLZ-7? -7 O Properly address (Fire W & Street) : S (l �o ak t_r_mpS Location: ;, Sec. Z( , T Z L) N, R W, Town of Realty firm: Lock Box Combo: Closing Date: -��irv� -1O►.�c= . © wK5q_C%LS 1 TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Water sample tap location: Is the dwelling currently occupied? 0 Yes 0 No If vacant, date last occupied: Age of septic system: Septic tank last pumped by: Date: Previous Owner's Name(s) : Have an of the follow ? r1 Y following been observed. ❑Y ON Slow drainage from house. J i g OY ON Back-up Sewage w g p into dwelling. � pp O OY ON Sewage discharge to ground surface or d d Ak OY ON Foul odors. 9s1 JA NB 3 19 Other comments relative to system operation: S1 cRqx GpFFt I certify that the above information is comp le and r �T �t best of my knowledge. 1 `�-- OWNERS SIGNATURE: I DATE: 1 /94 } OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION 1N TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes , 0No Soil series per SCS Soil Survey: sheet #_ Type of soil absorption system: ❑Below rd Approx. size ' X ❑Gravity ❑At-Grd ❑Mound ^' Ft. 2 Y ❑Dose OPressurized DBed OTrench ❑Dry Well OBSERVED DEFICIENCIES Molding Tank 00utfall pipe Septic tank -❑Other ❑Unknown Setbacks: ❑House OWell OProp, line Dose tank ❑Other Setbacks: ❑House OWell. ❑Prop, line ❑Other ❑Locking cover ❑Warning label_ ❑Pump/Floats OAlarm ❑Elec. wiring­ Soil Soil Absorption System Setbacks: OHouse OWell ❑Prop, line ❑Other DPonding: ❑Discharge: General comments: N INSPECTORS SKETCH OF SYSTEM LOCATION Inspector Title -OMWERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 j 800-962-5227 FAX-715-962-4030 ST. CROIX COUNTY ZONING OFFICE REPORT NO.'# 32906/01 PAGE 1 ST.CROIX CTY GOV.CTR REPORT DATE: 1/21/97 1101 CARMICHAEL ROAD DATE RECEIVED! 1/17/97 HUDSON, WI 54016 ATTN'# THOMAS C. NELSON I� OWNER'# Janice Ira Hendon LOCATION: 511 Jacob's ;_adder Circle. Hudson COLLECTOR: M. Jenkins DATE COLLECTED: 1-15-97 TIME COLLECTED'# 2'#00pm SOURCE OF SAWLE'# DATE ANALYZED'#1-17-97 TIME ANALYZED'#12'#00pm COLIFORM#MFCC'# 0 /100 ml INTERPRETATION: Bacteriologically WE NITRATE-N: 3.7 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard, Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/i LAB TECHNICIAN'# Pam Pane WI Approved Lab No. 19 t Means "LESS THAN" I+etectahLe Level Approved by'. PROFESSIONAL LABORATORY SERVICES SINCE 1952 t ' ST. CROIX COUNTY �..� WISCONSIN ti ZONING OFFICE r r r r N r r r■ ,,,,,,` ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road ;. Hudson, WI 54016-7710 (715) 386-4680 January 23 , 1997 Janice & Ira Hendon 511 Jacobs Ladder Circle Hudson, WI 54016 RE: Water Test Results Dear Mr. and Mrs. Hendon: Enclosed please find the results of the water test taken on your property located at 511 Jacobs Ladder Circle, Hudson, Wisconsin on January 15, 1997 . Should you have any questions, please contact this office. Sii7cerely, J ' .+ ;:' Mary J. Jenkins Assistant Zoning Administrator dl Enclosures (1)