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HomeMy WebLinkAbout020-1059-30-000 C) � R 0 7m � A � 0 � ■ & ® A 77 . E § E % { [ . a z *6 § @ _ , LL k �\ :X3:5 ( J3] § ( Cl) t 2 � z B \ § � C14 § $ p k z :t 2 \ _ . � 0 U) k 7 ƒ E { . \ 7 :3 n \ ( ) § a % D o \ { 3 ) z e § - z 0 \ ~ _ ■ ■ CL « $ . _ & k 2 I \ §) 3 � ) $ ! � a a a « -� 0 m < \ E a 'OM § £ m o \ i i E/ m k / \_ ] \ # ƒ 7 c . u k § I ƒ I § ) / E Q 2 k 8 k \ \ 1 § Cl) 'Co', E \ § I \ / / a 7 § / K k ) % /A. 4. - o § } } f c z / k ) ) aka � IL . cl. : k % f k \ ) 2 � 3 k � • Parcel #: 020-1059-30-000 12/20/2004 03:29 PM PAGE 1 OF 1 Alt.Parcel#: 22.29.19.225C.225H 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 AMY E ALWIN *ALWIN,AMY E 640A BADLANDS RD HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *640 BADLANDS RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.410 Plat: N/A-NOT AVAILABLE SEC 22 T29N R1 9W W 1 00'OF S 207'OF E Block/Condo Bldg: 1/2 SE SW EXC PT TO TN FOR RD&INC PARC COM SW 1/4 TH N 90'W 655.00FT;TH N 00' Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) E 207.OFT TO POB;TH N 00'E 732.98FT;TH 22-29N-19W S 89'E 307.OFT;TH SWLY TO A PT 288.00FT N 90'E OF POB;TH WILY TO POB more Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 926/613 07/23/1997 827/505 07/23/1997 426/554 05/16/1997 559492 1232/387 QC more 2004 SUMMARY Bill M Fair Market Value: Assessed with: 48084 230,200 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.410 60,500 117,600 178,100 NO Totals for 2004: General Property 5.410 60,500 117,600 178,100 Woodland 0.000 0 0 Totals for 2003: General Property 5.410 60,500 117,600 178,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 001-WATER SPECIAL ASSESSMENT 0.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 1 J�V 574 Form - S T C - 104 e AS BUILT SANITARY SYSTEM REPORT 4 ' 212- OWNER li(,(/ TOWNSHIP 1109:�r0AI SEC. T 24 N-R W �J S `� i7•l//7S ADDRESS ST. CROIX COUNTY, WISCONSIN /7y)Psoly eAx SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM , I INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 4 /-of Elevation of vertical reference point: 16,0' 0 / Proposed slope at site: D ✓��d f,U >ES'E� /da"� � • SEPTIC TANK: Manufacturer:/CoyC t-& Liquid Capacity: Number of rings used: / Tank manhole cover elevation: Ty ' ¢� .-'-% Tank Inlet Elevation: / G' Tank Outlet Elevation: ✓ Number V feet from nearest Road: Front,(D Side,O Rear, O feet From nearest property line Front,O Side,O Rear,O I.0 E/r -V0T" ORIiI'&O .4v DArr , Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic. SEE REVERSE SIDE • PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufactu Pump Size Elevation of inlet: Bot of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from n rest property line: Front, O Side, O Rear, Ft. umber of feet from well: Number of feet from building: (Inc ude distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trenc yF;,uGl�e s �� Width: Length: ✓ Number of Lines: 2, Area Built:R Fill depth to top of pipe: 1jfZ iA4 J41 — g Z 17 ,� e Number of feet from nearest property .line: Front, O Side, 0 Rear,0 Ft .0 Number of feet from well: &E/I tie r Pe //&Q �-�p/ Number of feet from building: 'Z (Include distances on plot plan). SEEPAGE PIT ' I Size: Number of pits: ameter: I Liquid depth: Bottom seepage pit elevation: Area Built: i Has either a drop b or distribution box O been used on any of the above soil absorbtion s ms? (Check one) . HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom tank: Elevation of inlet: Number of feet from nearest propert ine: Front, O Side, O Rear, 0Ft. Number of f t from well: Number o eet from building: Number f feet from nearest road: Alarm Ma acturer: Inspector Dated: Plumber on job: License Number: HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD.,HUDSON,WIS.54016 ROBERT ULBRIGHT `JVIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. 3/84:mj MINN.INSTALLER&DESIGNER LIC.NO.00663 i �1 TL Lt. h `� A VI W oC ¢ 4,.CA.o W V, OD J C4--, 1 I I L L °ai H• b� t a z � � � w 3 2 0 � r . Q w Q ac � � u t Zbh = cc G4 Z c/j U JJ m3 o cr S2 z w � zz , 00 SP axrmo U) co fi! �9 CL 0 d �0wzxwQ M p ►- w + i z Vi w'u a w � � f hqC DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&,HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION 11 P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 p�T SE%,SGI%,S22,T29N-R19W XXCONVENTIONAL El ALTERNATIVE State Plan l.D.Number. Town o� Hudson [1)Holding Tank El In-Ground Pressure El Mound III assigned) BadZancts Road NAME OF PERMIT HOLDER: ADDRESS.OF PERMIT HOLDER: INSPECTION ATE: David 9 Amy Attain 654 Badlands Road, Hudson, W1 54016 H— gg IC)30 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: RobW uZbxicht 3307 St. ctoix 119379 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIOUID CAPACITY TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. '•. ��/ 9 tO�j �5+�� DYES ❑NO DYES ❑NO BEDDING. VENT DIA.. VENT MAIL. 1111611 WATER NUMBER ROAD: PROPERTY WELL: BUILDING. NT TO FRESH ALARM. FEET FRO (") — LINE' r IVE A1 R INLET: ❑YES ❑NO ❑YES ❑NO N ! ,[r� DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY JPUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO ❑YES ❑NO I ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPE TY WEL 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 LENGTH IDIAMETq YTIfITNOMARKING 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 JNO.OF DISTR PIPE SPACING. COVER INSIDE CIA. UPITS LIQUID BED/TRENCH TREN HES I 4 MATERIAL PIT DEPTH: DIMENSIONS " GRAVEL DEPTH FILL DEPTH I'l"ET1 SH.PIPF UIS7R.PIPE DISTR.PIPE MATERIAL: NO.DIST UMBER OF PROPERTY WELL BUILDING V NT TO FRESH BELOW PIPES ABOVEC OVER NLET EL V END PIPE : LINE. AIR INLET I! .I. o .41 , �� � � NEARESTM f3 c�0 (p-F- 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 0 N meets the criteria for medium sand. TIONS MEASURED. SOIL COVER ITCXTURE PERMANENT MARKERS OBSERVATION WELLS 1:1 YES 1:1 NO ❑YES 1:1 NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH;BED DEPTH OF TOPSOIL SODDED ISE E DED MULCHED CENTER EDGES ❑YES ❑NO ❑YES ❑NO DYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: IND DISTR. ID ISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEVATION AND ELEV. CIA. ELEV.. PIPES. DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YE COVER ONO DYES 1:1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE` /) 0 ❑YES ❑NO ❑YES El NO INEAREST 7 0.03 �3 Sketch System on a �— q I "�' Retain in county file for audit. Reverse Side. I ,fffGNATIVRE: TITLE. Zav►,i.ng Adm�.vu.3tc.atan DILHR SBD 6710(R.01/82) DILHR SANITARY PERMIT APPLICATION cy'7e.or- ILH In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PE IT# —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 tN NO PROPERTY OWNER PROPERTY LOCATION POW S 414 Z �lGv/,t✓ 1:6.- % j"Im4, S 21 T� , N, R l9 E(or PRQPFEtTY OWNE�MAILING D��S � n LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,STAAT /� !/ //J���/,��f�� ZZIP ODE /7PkH?O/N�E NUMBER CITY r NEAREST ROAD, d /t`VAPSO v 4ws 5` 0,116 3A& f'170 7O VILLAGE: ('�,+ �iV /JO-4 4T//OS II. TYPE OF BUILDING OR USE SERVED: 3 ­W&, • Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. �q 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. axConventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound I. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) Z G/tiE •' S� S'� 1. a. ❑ Seepage Bed b.&ee a e Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): `R/EQUIRED(Square Feet): PROPOSED(Square Feet): P / 77 "o a F' ' Feet rivate ❑Joint ❑ Public VI. TANK CAPACITY Site in alls Total #of Prefab. Fiber- Exper. on INFORMATION New xis Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks I Tanks strutted Septic Tank or Holding Tank Lift Pump Tank/Siphon Chamber El ❑ ❑ I LJ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. PI u ber's Name(Print): Plum er's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: �. 2-fl0j Chi7- 3367 3RC,-R/J5 Plumber's Address(Street,City,State,Zip Code): . Name of Designer:vp C VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name HOMESITE bEF I IU FLUMBING - CST# 655 O'NEIL RD.,HUDSON,WIS.54016 .4 Y�.Z CST's ADDRESS(Street,City,State,Zip Code) Phone Number: WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. LIC.NO.00663 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issui Agent Signature(No Stam ) urcharge Fee ✓}J, Approved ❑ Owner Given Initial I`�0 a� - / / ? Adverse Determination C {�7 X. CO MENTS/REASONS FOR DISAPPROVAL: c SBD-6398 former) Plb-67 R.03/86 DISTRIBUTION: Original to County,One Co To:Bureau of Plumbing,Owner,Plumber (formerly )( ) 9 tY. PY 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; P Y YP Y 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 it 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 ate[ included the creation of surcharges (fees) for a number of regulated practices which WisCO 0 can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried T iii t43 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. a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) 'j 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 P^/I) Location of property 1/4 S4) 1/4, Section 2-2— , T ZL N-R_�LW Township _ TT �/�Sd'✓ K Mailing address (pJr,f-" ave;,f �5 A_ Address of site Subdivision name Lot number Previous owner of property Total size of parcel l _ Date parcel was created l�70 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes No Volume G? and Page Number J as recorded with the Register of Deeds. --------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. --------------------------------------------------------------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. IN 3.z/f-- ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained asement, to run with the above described property, for the construe :,. nd the same has been duly recorded in the Office of , current No. ) . 40 wl"11`11'1`1 Sign re of Owner u of Co-Own (If Applicable) .�o f Signature Date Signature L THIS SPACE RESERVED FOR RECORDING DATA DOCI-IMENT NO. 11 STATE BAR OF WISCONSIN FORAT. 1-1982 i ^I II _-WARRANTY DEED I� 443214 e�oK R27 her 0 P ' I REGISTI� S OFFICE ST. CROIX co., W1 This Deed made between Donald------Alw--- ------------a sngle• ••..__ R @C'd for Record ' man - - - - -------------------------- --------------- ----------------- --- ------ ------ -------- N iV 17 1988 --, Grantor, at 4:00 P. M j! and--David--D-,-_Alw n_and--Amy C,__Alwin,__husband_and_wife ----- _as---survivorahi.p_marital--prpperty-------------------------------------------- II Register of Deeds' ` -- Grantee, I Witnesseth, That the said Graptor, f-o- r a valuable consideration-.__•_ I RETURN TO conveys to Grantee the following described real estate in ----- ------------- County, State of Wisconsin: 1 I!- t1 ------- ------ ----- Tax Parcel No: ----------------------------------- iI The west 100 feet of the south 207 feet of the Vi of SE14 of SW4 it of Section 22, Township 29 North, Range 19 West. II �i I I� SFER FEE- This __.._is-_not----------- homestead property. ( (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And-grantor,__Donald__L.__Alwin _ __ _ ____ _______ _ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except .p i easements, protective covenatns and restrictions of record if an and will warrant and defend the same. Dated this -- --�-- ------------ ---- day of ----- November --------------------•---------------------- , 19 88 -------------------------------------------------------------- ------(SEAL) -alGt,L- `, ...(SEAL) ,: onald L. Alwin --------- ------------------------------------------•--- ---------(SEAL) ---------------------------------------•- ---_-------------------(SEAL) AUTHENTICATION ACKNOWLEDGMENT jI Signature(s) __Donal>3-_L—ALwiti___________________________ STATE OF WISCONSIN i j I ss -- ---County. i authentic/t�d is // November - 19 88 Personally came before me this ________________day of J_IY_ day of__._ . _ - 1?Z /s--- � -�J ___ _______ ___ ____ ___ __ ____ ______ _' 19-------- the above named Jahn__ __-Heywood-------------------------------- -------------- ------------- �I TITLE: MEMBER STATE BAR OF WISCONSIN ------------------------------------------------------- ------------------------ (If not- ------------------------------------------ authorized by § 706.06, Wis. Stats.) to me known to be the person ------------ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY John D. Heywood, Heywood, Cari & Murray -------------------------------------------------------------------------------- P.O. Box 229, Hudson ,WI 54016 i Notary Public ------•-_---------- ---------------------County Wis. (Signatures may be authenticated or. acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 1—1982 Milwnnk— wir. r - W T STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St . Croix County `.: "i OWNER/BUYER L, is.;'N• . .r a ROUTE/BOX NUMBER 6,) Fire Number r ' CITY/STATE_.,.,A-- ZIP PROPERTY LOCATION : k, 14, Section , T N, R Town of , St . Croix County, Subdivision , Lot number Improper use and maintenance of your septic system could result In - ;x its premature failure to handle wastes. Proper maintenance coq- sists 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 treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximpm 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. 3, The property owner agrees to submit to St . Croix County Zoning $ ` certification form, signed by the owner and by a ma8ter 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. y 0 I/WE, the undersigned, have read the above requirements and­agres N '' to maintain the private sewage disposal system in accordance with - the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources . Certification form must be completed and returned to the St . Croix Coup,r y77/ /*ht 30 days of the three year expiration .;'' SIGNED DATE � . • 3, ,mac'".�' ,i ;. L 1 3i St . Croix County Zoning Of f icy` P.O. Box 98 . ; Hammond , WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address . of `INDUS TRIENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, DIVISION P.O.BOX 7969 LABOR AJND PERCOLATION TESTS (115) MADISON W1 53707 HUMAN RELATIONS (H63.09(1)&Chapter 145.045) ' TOWNSHIP/�rTY: [OT NO.:BLK.NO.: SUBDIVISION NAME: 5E '/ �/ 2-2- Ajf N/R/f E iokV H U,010--1 COUNTY: OWNER'S/BUYER'S NAME: MA 11-10 ADDR S: 54- Clot X -S)O&l 4 L4U/i✓ /D 27 410-✓k0-e- USE 3Ftn— 5 1 DATES OBSERVATIONS MADE TESTS:B DR : C A R PTION: PR Residence Z f New ❑Replace RATING:S-Site suitable for system U-Site unsuitable for system ONVEN N L: MOUND: IN-GROUN :S S EM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM: EIS ou ,�s au s ❑u a s ®u a s au ���-� s w D� 80 x A9 I'SM I &U i otit If Percolation Tests are NOT required ]DESIGN RATE:,r I If any portion of the tested area is in the under s.1-163.0915)(b),indicate: C//t SS 1" Floodplain,indicate Floodplain elevation: I F-) HDiti-W� t=)CCEP41bA Fble r-pPl/EL7, PROFILE DESCRIPTIONS 0 BORING TOTAL DEPTH TO GROUIS DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIG HE TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) 5 ' B,v./S 2.i-2 e '3 liY-a:y. sl . 3' ,e.a4. x4 r"4 e- 7, 0 / z, 4 2 ,(1 Is 1.17' U-14 T40 sl . � t ,s 13e.B"), s .2.3,-xiw Zs sr.PT y o Sat -07 ,�, B-3 %D ���8 9 o aR f ' zs �a. Is p, S ' T�� �S (w CS r- r/�j of B- 9s /0.7 0 ' !"'0 7 �,S B,t« O lil9 M GEC lo.� B uD of ct+f 1 . Rr kPPILOX Up 'go 2./ ' . s Q ,uc B-5 3P o e-Gy rot5 c s , PERCOLATION TESTS /ou Cf s-�,A+, TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. P RI D t P R D2 PERIOD PER INCH P- / ` ? . P- P- Z 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 �y0 — c�T s�v °� D6WAI. 0 , -fo a. fT ._ - OF Topsoil ©rte __sysf;� A�t?e,q�_ -M IV-sea 4 P pe,-R.S 1 c 9 - - ;,0 tN _.... for a Pnkion�l' ...its ,„fQ .- off " - � 1,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): HOMESITE SEPTIC PLUMBING CO. TESTS WERE COMPLETED ON: 655 O'NEIL RD.,HUDSON,WIS.54016 A P FD—:--1_ .70 ( , ADDRESS: CERTIFICATION NUMBER: PHONE NUMBERloptional): WIS.MASTER PLUMBER LIC.N0.3307 M.P.R.S. Zy? Z-- S MINN.2N8:f*LtER&DESIGNER LIC.NO.OM CST SIGNAT E: j DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. Na ; Lod-- Lim+. ry^ O 2 0 "F 1 � v ,4 , L 6 OMESITE SEPTIC PLUMBING CO. r O'NEIL RD.,HUDSON,WIS.54016 L uf� tU � ROBERT ULBRIGHT C s r NIS.N ASTER PLUMBER LIC.NO.3307 M.P.R.S. ^ANN.INSTALLER&DESIGNER LIC.NO.00663 2 i I � ` oS �Rb �D P 4„ 0 r I 3 �o► 000*� -- — — — — r— — — — 301 -fo fPe0t0cT-;0 !� INr�rMUM S 4sT .-07- 6-%.v-4- r �7 3 r 30 • - G s S ���� \G • - . Yk -39 o� a PLor A : 1 li C -f rE s 01 ) UP uE Yo R s s Cc7 /pf Lo,pti� C(&UArIOA = /0010 w4- 4eefso E s /00 -,-l-o 7 �`�/� DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS DIVISION INDUSTRY, PERCOLATION TESTS 115 P.O. BOX 7969 LABOR AND ( ) ' HUMAN RELATIONS MADISON,WI 53707 (1-163.090)&Chapter 145.045) A N: 1 OWNS OT NO.:BLK.NO.: SUBDIVISION NAME: S E '/4 1)� y� /T ZI N/R'If E I r)w 1, D 10 CO ST NTG�o l / OWNER�' C.a7/A/J• MAILING ADDRESS I USE DATES OBSERVATIONS MADE NO.B : COMMERCIAL DESCRIPTION: y' PROFILE DESCRIPTIONS: ERCOLATION Residence XNew ❑Replace S�_ _ 1 RATING:S-Site suitable for system U-Site unsuitable for system fONVENTIONAL: MOUND: IN-GROUN STEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) a s ou ❑s ou *o s ou a s au EIS 0 s 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: ��fj S S �— Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING AL DEPTH R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIG HES TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- >f 40" I O h n 'IBS B- PERCOLATION TESTS DEPTH. WATER IN HOLE TEST TIME DROP WATER LEVEL-INCHES RATPER INCHES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p I D t P I P- P- P- 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 V tN Thi i i IS ts et sip �dPOYE� . _fora gonventional septic sys#erY'i. -l_ 1,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the test&are correct to the best of my knowledge and belief. NAME print : HOMESITE SEPTIC PLUMBING CO. TESTS WERE COMPLETED ON: fop? 655 aNEIL RD.,HUDSON,WIS.54016 3 l G v ADDRESS: ROBEW UMIGIV CER FICAT Ohl NUMBER: IPHONE NUMB Rloptionall: WIS.MASTER PLUMBER LIC.NO.=7 M.P•R.S. MINN.INS!AttEmn a DeSIGNER WC.NO QM CST SIGNATURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. Rio /oi.Av HOMESITE SEPTIC PLUMBING CO. -P 655 O'NEIL RD.,HUDSON,WIS.54016 ROBERT ULBRIGHT y; WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. IINN.INSTALLER&DESIGNER LIC.NO.00663 0 3 S?,4 IZ 0� Y � poop � O , IMP 3 ��M 13 141f, 'm UST o� Ab k4k,. Fo"e 4V41Ai DO'" A ol 61r � a: ss ii v J v�eT I PlWtAs r y �L06' nor �- - - - -- -- - - »�i — rr ��011A pp;d 0 � °-v- --- --------- - --- ---- !t. • i' 3 W � ?epwltcMEUT RQ� 30 C 20, x !r s " ) �• S3 as - 34 ' w + " N. `,'MITE SEPTIC PLUMBING CO. GJJ O'NEIL RD.,HUDSON,WIS.54016 ROBERT ULBRIGHT "S.MASTER PLUMBER LIC.NO.3W7 M.p.R,S. "`J, INSTALLER 8 DESIGNER LIC.N0. 1r,(� t� J w vFresh Air Inlets And Observation Pipe � h 00 Approved Vent Cap Minimum 12" Above Final Grade �iuilh/FD 4" Cast Iron Above Pipe Vent !Pipe' -To Final Grade Mersfi--Hcy-@r Synthetic Covering Min. 2" Aggregate Over Pipe Distribution xi-j- Tee Pipe --'' 0 0 0 0 0 " Aggregate O Perforated Pipe Below Beneath Pipe 0 Coupling Terminating At Bottom Of System