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Form - S T C - 104
,, AS BUILT SANITARY SYSTEM REPORT
J:,�,.
OWNER c`U �/1,. �H /. <c-7;,,z,, TOWNSHIP �sz-<i SEC. . T -,- l N-R_/C,.,W
ADDRESS ST. CROIX COUNTY, WISCONSIN
br
SUBDIVISION LOT LOT SIZE �_�-a
PLAN VIEW
Distances and dimensions to meet requirements of IAR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
`7—G
N
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used z`-,mac �� ��6--
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: �"`
Liquid Capacity: c).,
Number of rings used: �5 Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,O Side, Rear, O p feet
From nearest" property line Front,0 Side 10 Rear,0 feet
Number of feet from: well ,',6-' , building: ___ .2_5,1
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: l�,�lic�T gN c„ y,T Liquid Capacity:
Pump Model: ,.� Pump/Siphon Manufacturer: !)y ' Pum p
Size
Elevation of inlet: j Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: /h ��f�� s'vsT�<,Alarm Switch Type: ,r/ `22 c,
Number of feet from nearest property line: Front, O Side, Q Rear,p Ft.e-fe
Number of feet from well: r
Number of feet from building: 3_ '
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: 16, Length: Number of Lines: Z Area Built: H2O
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, O Rear,0It
Number of feet from well:
Number of feet from building: 41�
(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 Q" or distribution box 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, Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector•
Dated: % Plumber on job:
License Number: 2G �
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING
P.O.BOX 7969
MADISON,WI 53707
NFi, SE! ,S23,T29N-R19W ❑CONVENTIONAL ❑ALTERNATIVE StfassPlann I.D.Number:
Town of Hudson [11 Holding Tank ❑In-Ground Pressure Mound 8708187
Lot 17 Fox VaUe
NAME OF PERMIT HOLDER: ��n�tt.1/��s, ,,.{.�. ADDRESS OF PERMIT HOLDER: (�� INSPECTION DATE:
Cudd �ro.6. Con.6t +uct�(,on 322 Nohth Cudd Avenue, Rivet F IC ST REF PT ELEV
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.:
Name of Plumber MP/MPRSW No.: County', Sanitary Permit Number:
Glittiam Schumaketc I6382 St. Cnoix 112715
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY'. TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED
DYES 1:1 NO DYES ❑NO
BEDDING. VENT DIA.. VENT MAT L'. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: JBUILDING.(VENT TO FRESH
ALARM FEET FROM LINE AIR INLET
❑YES ONO El YES ONO NEAREST
DOSING CHAMBER:
MANUFACTURER JBIEDDING LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES ❑NO ❑YES ❑NO DYES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING JVENTTOFRESH E
LINE AIR INLET
(DIFFERENCE BETWEEN FEET FROM
PUMP ON AND OFF) ❑YES NO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIALAND MARKING
or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH'. LENGTH NO.OF rR.PIPE SPACING COVER INSIDE III,' xPITS LIQUID
BED/TRENCH TRENCHES MATERIAL: PIT DEPTH
DIMENSIONS 7
GRAVEL DEPTH FILL DEPTH IDISTR.PIPF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPE RTV WELL BUILDING. VENT TO FRESH
BELOW PIPES ABOVE COVER ELEV INLET ELEV.END'. PIPES FEET FROM LINE AIR INLET
NEAREST-►
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
DYES ❑NO
SOIL COVER TE XTURE PERMANENT MARKERS OHSEHVATION WE ILLS
1:1 ❑NO ❑YES F-1 NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL IS ODDED SEEDED M
CENTER EDGES.
DYES FIND 1:1 YES 1:1 NO 1:1 YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH JILENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MNO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL.&MARKING
ELE VELEV.. DIA.. ELEV.. PIPES DIA:
ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY ERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYES 1:1 NO El YES ❑NO
COMMENTS: - PERMANENT MARKERS: JOBSERVATION WELLS'. NUMBER OF PROPERTY WELL: BUILDING.
FEET FROM LINE
❑YES 1:1 NO DYES ❑NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. TITLE
DILHR SBD 6710(R.01/82) Zoning Admin"ttraton
SANITARY PERMIT APPLICATION COUNTY ST T DILHR In accord with ILHR 83.05,Wis.Adm.Code `/l
kl'e
STATE SANITARY PERMIT#/
—Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER
8%x 11 inches in size. 7
—See reverse side for instructions for completing this application. PETITION
f. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES V NO
PROPERTY OWNER PROPERTY LOCATION
�f `o y�� ,o _'/4$<''/4, S 3 T q N, R /9� E (or
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
3a is �./<` 1 -- <e
CITY,STATE ZIP CODE TONE NUMBER ❑ VILLAGE
CITY NEAREST ROAD,LAKE OR LANDMARK
G� D �—
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family J? OR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable)
1. a. 1 New b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.El 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.i&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.Z 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): /-A--
J 2 rf o� �X 7y,'7 Feet 9Private El Joint ❑ Public
VI. TANK CAPACITY Site
in gallons Total ##of Prefab. Fiber- Exper.
INFORMATION Manufacturer's Name Con- Steel Plastic
New xisting Gallons Tanks Concrete glass App. I,
Tanks Tanks structed
Septic Tank or Holding Tank I/ ❑
Lift Pump Tank/Siphon Chamber 9_0411 / ❑ ❑
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) MPRSW No.: Business Phone Number:
Plumber's Address(Street,City,State,Zip Code): N e of Designer•
VIII. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST##
C s ADDRESS(Street,City,State,Zip Code) PhoM Number:
?' << ( ? alG'
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved S nitary Permit Fee Groundwater ate Issuing Agent Signature(No Stam )A .`Approved Owner Given Initial Surcharge Fee
C
Adverse Determination V. i��
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'/2 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 Aftr
included the creation of surcharges (fees) for a number of regulated practices which Wisco in'S
a
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reds ro.'
is used in your building is returned to the groundwater through your soil absorption u
system or the disposal site used by your holding tank pumper.
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)
^ ~� Wisconsin vv�sconsin []ep@rtm9OtCf Industry, Labor and Human Relations
SAFETY m BUILDINGS DIVISION
PRIVATE SEWAGE PLAN APPROVAL
OF
Office of Division Codes and Application
201 East Washington Avenue
P.O.CD Box 7969
Madison, Wisconsin 53707
WE & ASSOCIATES Owner: CUDD BROTHERS CONSTRUCTION
P.O. BOX 74 322 NORTH CUDD AVENUE
RIVER FALLS WI 54022 RIVER FALLS WI 54022
RE: Plan Number: 87-08187-S Date Approved: November 23, 1087
Gallons Per Day: 450 Date Received: November 30, 1987
Project Name: CUDD BROTHERS CONSTRUCTION Location: NE,SE,28,29, 19W - LOT 17
Town of HUDSON County: ST CROIX
The plumbing plans and specifications for this project have been reviewed for �
compliance with applicable code requirements. This approval is based on Chapter
�
145, Wisconsin St he Wisconsin Administrative Code. The plans are
stamped 'conditionally approved' . This approval is contingent upon compliance with
any stipulations s own on the plans. All items that are noted must be corrected.
All permits require by the city, village, township or county shall be obtained
prior to construction. The licensed plumber responsible for this installation
shall keep one net of plans with the department's approval stamp at the
construction mite. The installer shall notify the appropriate inspector when
inspections can be made.
This approval will expire two yearn from the date approved or if a sanitary
permit in obtained, it will expire the day the initial sanitary permit expires.
The Section of Private Sewage has reviewed these plans for private sewage system code
requirements only. 'These plans have not been reviewed for the code requirements
net forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the
Wisconsin Administrative node.
This approval is for the following components only:
- NEW MOUND
this approval may be made by calling (608) 266-2889.
� ��
PETER E. PA�
Section Of vate Sewage
Di�ioi�n mf' Gaf�t� and Buildings
� PPP013/0009n/ 4
�
co: CUDD BROTHERS CONSTRUCTION
___Private Sewage Consultant ___County ___UW-SSWMP ___Plumbing Consultant
�
_-_Owner Plumber --Environmental Health
SBD-6423(R.10/87)
� __-
�
Pa ge 1 of 5
MOUND SYSTEM
FOR
A 3 BEDROOM RESIDENCE
MeR
LOCATED IN THE N )/y& THE SE"/ OF SECTION Z-3 , T nN, R 19 W.,
TOWN OF �-`cvOSow 5T• 0-�O1x COUNTY, WISCONSIN .
(L-oT 1-1 or 7)+ ej_hT OF F-oX VptLLEf )
INDEX
PAGE 1 of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW-CROSS SECTION
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
5'
CuDL� arzw-Tl{QZS- G4QS7TZQcT?0N
SOW �Q� �zZ N C,v�Q AV ErvvL
pfd
�o
�c Q• �taG� PREPARED BYs�� �� !
WM�RER, WEBS? A:TD _E ASSOCIATES ARTHUR L.
WEGRE
G� BOX 74 421 N. i4AIN ST RT Q D-915 Pa • S
O ELLSWORTH.
RIVETS FALLS, WISCONSIN 54022 It" - wrS.
t o°
I G
'�g�eaQ3aaa�
you . it, l9cyl
Job
PLOT PLkN
• PAGE Z �= __�_
Scale 1"=SOI
416V 3)
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0
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Q 16 DIZ i H
I.Q D
� pEP1vR"�'fWKtpa�
ACES
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I Co+�PN'CT � I
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_ 3 ��1
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8M'tl 6Z' ---- `�•
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a
NOTES �d S
1. Elevations shown are existing ground elevations unless otherwise noted.
2 . Install cast iron pipe 31 onto undisturbed soil both sides of each tank.
3. Install permanent markers at end of each lateral. ( Y required)
4. Install 4" observation pipe with approved cap. ( - required)
5 . Septic tank to be lbo0 gallon capacity as manufactured by
6. Bench Mark- Elevation
spi'*► _�t �oofl'a,, �'�x3" w�,� �'T'P±r,; ,tip Lr�rN -
- ,
3M 41 9,x'
7 5)uE-7—T SvRFACE wATE�z Pn\S.3t, -'C PRE\)GJvT P(.k3z) r, AT Upt}tLL StAE.
Plan View Of Mound Using A Bed For The Absorption Area
OF
•u .
Perforated Pipe Detall'
End View
�erlor�tec j
\PVC r:pe
�e
.v .o^ i -•ol-s LoccIec Or' Bcttorr.,
y
Ore Ecuoll, Saecea
I
-O�ST&t t_ PEr:MA1vEtiT H/i�K7�
' qT BUD of EAC.14 LRTcRAL
P S
PVC l�
Mon,}oIC Flpe ~�ti
1 /Lcst "Ole SnouiG E3e_�
Nett Tc c.nd Gat:
End Gap Distribution Ptoe L oyout P l�.Z S -qT .
ti _ s G o 1 N
Rev le ���as x z, 6 t►�.
p /j t�►'� Y Z-6 1N
a
N
;,IONS Hole Diameter 1� inch
A _N � i_a ;.eral � inch(es)
Manifold Z inches
• rl
•''� NGE Force Main Z Inches
a
WOO . � E
5p -tF ---
5EE' G��RE
i N\)c2t �`�V h�%a N �= �r'tTc�..a i S' �,L�1 •?A s-r
?Lp�C t Sr �L� t3 � F � CATER OF Mf)A-3► �Ub \,c>1 5�CCE�-D1�,G t-;aUES f�T
Z�Ik �N� �Va -S. '-►\ST RULE 'TO S` NGXT To
PUMP CHAMBER CRO55 SECTION AND 5PECIFICATIOUS E S OF 6
VEKIT GAP
4"C-I. VENT PIPS WEATHER PROOF APPROVED LOCKING
JUNCTIER BOX MANHOLE COVER L4 -T-H
25' FROM DOOR,
WINDOW OR FRESH 12 MIU.
A;,--I ILITAKE I _
GRAD F I 4"MIM.
15"MIN.
COIJDUIT ` ______
18"MIN. \\
>tioIMLET
0 APPROV
ED JOINT5
APPROVED JOINT A 0 \NG I WIC.=• PIPE
W C.T. PIPE 8 I A EXTENDING 3'
LARM
EXTENDING 3' � NG� i i I ONTO SOLID SOIL
ONTO SOLID SOIL
>�tN'�N� oti
c r
O�P pp,P� I
ELEV.q t Tl FT. S�� G PUMPS , F
D
g 0.00
I CONCRETE BLOCK
�
Nt�v•3 of
RISER EXIT PERMITTED ONLY IF TALIK MANUFACTURER HAS SUCH APPROVAL L3�L1liVG
SPEC.IFICATIOUS
':rEf'FrC-E
DOSE CWeRE E PRONCr5.UMBER OF DOSES: 3'9 PER DA-4
TANKS MANUFACTURER:
TANK SIZE : SO GALLONS Do5rz. VOLUME
ALARM MANUFACTURER: S.S. E�-�G'�D SYST�►;-1 S
INCLUDING BACKFLOW: 130-� GALLONS
MODEL HUMBER: \'0 \ `� w CAPACITIES: A= � 5 INCHES OR L40''k GALLONS
�- INCHES OR - GALLOAIS
SWITCH TYPE: �ER' , �'� B
PUMP MANUFACTURER: F•E. .5 . Ci0• C=
-6 /IZ INCHES OR 31 .3 CALLOUS
MODEL NUMBER: SS
D=�ILI INCHES OR 3ALLONS
SWITCH TYPE: ♦'I , ' NOTE: PUMP AND ALARM ARE TO BE
7 ILED ON SEPARATE CIRCUIT-5
GP
MINIMUM DISCHARGE RATE -1-144_ M
VERTICAL DIFFERENCE BP-TWE E N PUMP OFF AN D DI ST
RIBUTIO N PIPE
FEET
4- MI►.11MUM NETWORK SUPPLY PRESSURE . . .
2.5 FEET
01S F
ZI 2.
.T.S FEET OF FORCE MAIN Z•33 YO�FRICTIOU FACTOR_. FEET
TOTAL DyAIAMIC. HEAD — N'-) FEET
DEPTH
INTERA]AL DIMEMSIONS OF TANK: LENGTH ;WIDTH _;LIQUID
BoTTa r--I �2� = 3. I y x Z. �r,.3 _• z;; � Z 0. O S_ _J ��;�/i�.
r
SUDID- tAl NI ®V3H IVIOI G OF
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CD I L O
CD '�tN000 (D NOOOCDvN
s=iz3=i i i l v u l.Ae v_..vs
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.
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Owner of Property
co
Location of Property � Section _ )Ll T, N-R fq ii
Township
Mailing Address
--- c i e, .l(c
Address of 81 t (.� .a
Subdivision Dame _ � !i J d/e
. Lot Number
�Previopa Owner of Property S ✓U Lt 1—!cti.q� a d
" Total Size of Parcel i/�cre S
Date Parcel was Created 9S"�
Are all corners and lot lines identifiable? Yes 'No
Is this property being developed for resale (spec house) ? ! yes No
Volume 71Y and Page Number
—I A6- as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and page nun mber, 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 he required.
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PROPERTY OWNER CERTIFICATION
1 (We) centi.6y that att etatementa on thin onm ane true to the beat o6 my (ou,%)
knowledge; that I (we) am (ah.e) the owneA(e g o6 the pnopenty dew chd.bed in t UA
in6oAnktUon 6onm, by viAtue o6 a waAAanty deed he onded in the 06 ice o6 the
Count
Re94Aten o6 Deeda ab Document No. 3 Q/ ; and that I (We) puAentty
own a pnopoeed 6 to bon the sewage di pd4aZ.6 on T
ead ement, to nun with the above dee cA i bed y ( (we) have obtained an
eya.tem, and the same has been due necoided in the�06on the eona,tCouniy eg AteA
Deede, 44 Document No. y ) . 66.Cce o6 the County Reg.Lete : a6
SIGNATURE Old OWNER SIGNATURE OF CO- ER (IF APPLICARLB)
DATE SIGNED DATE SIGNED
GUGUMENTNU. otntca
,�. WARRANTY DEED
..:) 't
431214 ML 794PKE126 iwisms OFFICE
ST. CROIX Me WIS.
This Deed,made between The First National Bank of Reed. for Re=d III* 19th
g»cly,nn A wi gnnn,si n Ranking Corporation-
Grantor, 9:40 A
and Cudd Brothers Construction Xb0 Inc.
I
Grantee,
Witn@Sseth That the said Grantor f r a valuable consideration
Eight Uhousand and 00/Yg0�s --�—'°°-- RETURN TO DLP
conveys to Grantee the following described real estate in St. Croix The First National Bank
Cou ate of Wisconsin: 307 Second Street
d 6
Lot 18 Plat of Fox Valley in the Town of Hudson,
oix 5ounty, Wisconsin. Tax Parcel No,
DIANSPW
$ O
S
This IS NOT homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And The First National Bank of Hudson
warrants that the title is good,indefeasible in fee simple and free and clear ofencumbrances except
easements, right of ways, and restrictions of record.
and will warrant and defend the same.
Dated this 16th day of October 19.,87,..
f
(SEAL) of
. • Kenn A. Heiser President
(SEAL) (SEA')
• Susan K Gilbert, Cashier__
AUTHENTICATION ACKNOWLEDGMENT
Signatures) STATE OF WISCONSIN
ss.
St. Croix County.
authenticated this day of ,19 Personally came before me this 16th day of
October ,19 8 7 the above named
Kenneth A Heiser, President and
Susan K Gilbert, Cashier
TITLE:MEMBER STATE BAR OF WISCONSIN'
(If not, M-ly M. )"1;161 me known to be the pers9n s who excuted the
authorized by§706.06,Wis.Slats.) NOTr',R7 PU1384 'ng instrument and ack wiedge the same,
THIS INSTRUMENT WAS DRAFTED BY State Of titi`i.3conS( d
The First National Bank of Hudson
Mar Finn
Notary Pub f1c St. Croix County,Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state ex iration
are not necessary.) My Car.::, s:an X:' Iuly
date:
Names of persons signing In any capacity should be typed or printed below their signatures. NF 3573
WARRANTY DEED STATE BAR OF WISCONSIN Nelco Forms,P.Q.Box 1020,Breen Bay,W.l tMJM7<om
FORM No.1-1982
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STC - 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT o
St . Croix County
x
ty
OWNER/BUYER
1 1 -1 10.1 Q Fire Number___.
ROUTE/BOX NUMBER 6ga' �� �� n�
CITY/STATE
RrUe�- �a�lS (,eJFSG ZIP
PROPERTY LOCATION: 149 _14+ Section , T Cl N, R /g_ W•
Town of #�C ��G'` , St . Croix Coun
Subdivision ; L 0-1 eat , Lot number
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
if needed, by a licensed septic tank um er . 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 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 iifper
operating condition and (2) after inspection and pumping
nec-
essary) , the septic 'tank is less than 1/3 full30fdsludge andtscum.
Certification form will be sent approximately y
three year expiration. C
E
I/WE, the undersigned , have read the above requirements and agree
to maintain the private sewage disposal system in accordance with r+
the standards set forth, herein, as set by the Wisconsin Depart-
b
ment of Natural Resources . Certification form must be completed
and returned to the St . Croix County Zoning Of k4;e wi� 30 days
of the three year expiration date .
SIGNED
' DATE
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 .
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON WI 537907 9 53707
HUMAN RELATIONS
(ILHR 83.0911)& Chapter 145)
LOCATION: SECTION:T p p N MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME:
NEt4 SE �/ Z3 1 Z9N/R 1!E (or) 1J{l��sb1L7 — Pt Tor- 1�-ou UhL�Y
COUNTY: W UYER'S NAME: MAILING ADDRESS: 3ZZ ►`1 • G�1pp" I�CJE -
sT.c,�w14 U1IM F-ALL-s w l SoZZ-
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
XResidence N , , New ❑Replace N O -9 _Q � I D _�_S�
G Q`Aj'rLf ON- S lT� l o_l S-9-7D W-f -TaM 1Ue1.SW f'
RATING:S=Site suitable for system U=Site unsuitable for system LL-MOY '"XfrA JS IX)C
CONVENTIONAL: MOUND: IN_-GROUND•PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional)
❑S mu 0S ❑u ❑S Ou ❑S Yu ❑S ,�u -
If Percolation Tests are NOT required DESIGN RATE: I If any y portion of the tested area is in the ►� ` p
under s. ILHR 83.09(5)(b),indicate: N •N. Floodplain,indicate Floodplain elevation: 'V•�
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-11ft E S CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH
NUMBER DEPTH OW ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
0.-7 '�1r�G5r$n )ITso.6'_BhSJ_1_L�.l'R ►,Sl�o
B- Z.7' ao No�
6- ' FE NoTC -Z. ) sBR T
`t 8>7 c l
O•7'Dlt6yf3hSiI_ ; 1.3'Bhsi.� i 1.1Z t)Gl _S6 _Sl
B- Z. 3,y q1.S' tJor�l C vn bTL. Z.> o.3 '�-!'$n c.1 C LS 13 R RT 3•V
I ( l.�o►vE � 3+�jI o.7' D1LGcsi`3ns1l Ts;o.a' insl_�-i_o•B�.Bn_S/_� o._z_'
B- 3 3.8 \ob,0 ah Scl 1.3 'L S $ '� So°10 2tl'Zk CLST3 2.S'�
o. 9 ' DkGy$h SO� Ts; 1.3'-13nSi 1 ; 0.8 �h SO 0.314k?h
B- 3.$' M-9 lvc�.lL rnoTC Z.9 ' Ck • o,S� _S tLslpw C",En
Ar a
� _4 a' zGy_LanS ) 7S; 0.8'B�SiI ; 1.D'�nSl; a• Z' __
B-S Z•8� 9$-Gf tJOi�JE Nora Z.Z ne,l C
a•z` otzGyanSiI Ts;o-9 'E?hsi1;_l•o!_
B- 3•`? al�• ►J�ri1C V►�dl'C� Z,S 1 8>n C1 (S-9' LS [ J_--_V NkA4 C LS 33 R k 3•> `�
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERT PER INCH e—•
P_ ► tJO+�!� 3 0 1 1 I 3 0 qn•-)
P_ z is J-_\o>v ICI. i 3� 1 3�a , 3�s' z z cr)
P-P-
P-
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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. IE�L_ 1 QQ•, $OT'TOh OF 13eb PtGe_ S$ Stvs`t1 t ro S i l
SYSTEM ELEVATION (+ ►tip �'o� sl�D�
7 ;
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WILL
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): 'RIC 1R-T-ft UI L. LAJ J�__C L TESTS WERE COMPLETED ON:10 --Lo— 8-1
ADDRESS: ZCskZ-M y �� ZZ (� CERTIFICATION NUMBER: PHONE NUMBER(optional):
cc_LSwOR kuL SVu Sib �1S-4ZS-olb
CST SIGNA
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395(R. 10/83) —OVER —
iNSTRUCTIONS FOR COMPLETING FORM 115 SBD 6395
To b awcuiwe' s601 t xszl' your iep-Ort n"%' Wlck'd'
VU,
2� --',h'e use sxciz1or" (Aea"I",
C
I rI )0 £.s A S I E IS SCH'TiABLE ROR A HiM D N'G TANK ON41-'v ff ALL
1 HER Ri'JLE'D CWT BASED ON SOC L CONDI-I IONS:
7' a.. 6ri10r� m lFL le€e or muo �sc "" p")n
d, A
-AAKE-, A LE--(jIB!—F' accuratf4y k)c�"'Ucq y o r te S
may S;;id 'd rioso'e j,
V: �'
k 30d Vi�r fl
t;,`d �"eJj -- 'ef��re n ce no c
w'��aru k�aijv .k
piaw'
z:011' app:npt
i", p, In' as JoA )!ain, elevation'; no- NA,
i�� 0 nd "vaur
�he fo�rr, '�d
12, make co, ics Iid dr- i-ed A L L SO I L 1'E'SIFS !"',11 U'�"r ---F F L ED IT H '1 H E
p, "i�'Duu� z�s � � -
LOCAL A�J 1"i"10 RITY`4","ITH I N' 3 DAYS OF COMPL.1.710N.
A',,,,3, BR EVI AT IONS FOR CERTIFIED SOIL, TESTERS
ors °3epaumes and Textures Symbols
("',nder 3,",
Hiqh GMUM"Ov""'AU",
a"V WE, 1
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TO THE OWNER:
This soil test report is the first step in securing a sanitary permit. The county` or the Depas-o`Wnt r-Mly r0(jUeSt
veritication of this soil test in the field prior to permit issuance. A complete s;�t of plans for the private
sewage system and a permit applicallon must b.e sr bmitied ta the appropriate !-Dcal authority in order to
obtain a permir.Th-sanitary permit rnusi be obtained and poslfNJ (Drior to the start of any construction.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
DIV tSION
INDUSTRY, P.O. BOX 7969
LABOR AND PERCOLATION TESTS (115) MADISON,WI 53707
HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145)
LOCATION:r SECTION: p WN MUNICIPALITY: LOT NO. BLK.NO.: SUBDIVISION NAME:
N��/ sC �/ Z_J T Z�N/R 9E (pr,,.._
COUNTY: WN UYER'S NAME: MAILING ADDRESS: __3_Z tJ . ('�lJpp /kUE
ST C.�IV Gvpp 18\_t _t S �s ,vc ------ —-Z C--ft Lt�S �tI L s 0-,"Z-
- --
DATES OBSERVATIONS MADE
USE --------- -- --
NO.BEDRMS : COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
esidence New Replace
[��R -- -----------
CAU1J� ON- S!T'E 10-)S-8-7 BY TdM IU�S'lYv 6'
RATING:S=Site suitable for system U=Site unsuitable for system ___
_
CONVENTIONAL: MOUND: IN-GROUNaPRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional)
s ®u MS ❑U ❑S MUD❑S MU I ES ZU - Q�ROC�
t_ DESIGN RATE: If any portion of the tested area is in the
If Percolation Tests are NOT required ��A
under s. ILHR 83.09(5)(b),indicate: •�+ Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-!!jet!iS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IW, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV ON BACK.)
o.� '15tcGY Bri LTs;o.�.Bh s_I I_x_1,_1_. RBh s_�_o.------_--
B Z•� i a6.o` i�lOiJ� rno z. t �8nc,1
o bh-G'/CanSi1 TS, 1.3'Bnsl I 1-.1 'iZBhDOSE . S/
B Z 3•yI c11•S� ��C YylbTLa Z_`1 0.3 �lgh G� C LS J3 R. Ft 3-Y
r o•7' b1,GYe)\sl_Ils;0,8'_ >7Sj 1_ .-0_$�3nSI
B 3 3.81 \ob OI 1JOruE 7 3•�1 Can sc-1 \•3 'L S �R So°10 Rack CLS BR 1� _Z
o. 9 ' DhGy$hSj) TS; \.3 ' 'en Si1 ; o•S'ShSI; 0.3 'LlaA
1 qg,q' )UC�►l_ ynoTCa Z.91 C11 . o.S' LS t C t-s�r� Rr 3 a,
_B- �{ 3.� o. a' 'Ck 6y Lan si 1 73; o-8'8n si I ; )•r)'�n s I; 6• z'_
B-S z.g' 9$•S' �b� E rv,�T� z..Z n c1 C I_S$ _ Z g'
D1LGy&nsit Ts;o•9 'SrtSil; 1-o'3nsl; 0.3 �
' M D70 Z.S,
B 6 3_�t , 1 rJ�rvC ��r c1 ;o-� LS tZ�-srLy w ESL R hT
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 PERT D 3 PER INCH t�-
P_ I tJL�sz- 3 ci 1 ) I 3 0
P_ Z 18 1-2s o�E
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. e Z3�TTOX'! OF I3er> �'�C7� S8 t9_1)1_T1 ft(6o S }
SYSTEM ELEVATION 16',Ki
i16Y-31 ' �M�11#J - 1F C. LOO-0100
PJ t.RT).J _
Tay' +'"Z- LS--, 9q S'0IJ 1'lec3°Ili 00Z
VJ ,/ L Pej-H
'BE I�T LAST_SD
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tis1T't L-bCl T qSb' w.e-Zz0 S-
,� d >3 - fl� � `vim Cote r12 o F `n-) T N
e s>z o� ss Q I_ CJ1rA`/,.
83 W P3
tiov5c en'}1 Sy �3n
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me irran:md-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:
C=, --R
ADDRESS: 2JaJ 4 r�jty( ZZ (� CERTIFICATION NUMBER: PHONE NUMBERIoptional):
►ei ! sVo1) S'?b 11S-4ZS-o16�
--.--- -- CST SIG/N�AT;E:
y�
DIS-1 RIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) —OVER —
ST. CROIX COUNTY
ik WISCONSIN
f ZONING OFFICE
796-2239 (HAMMOND)
425-8363 (RIVER FALLS)
HAMMOND, WI 54015
October 26, 1987
Division of Safety and Buildings
Bureau of Plumbing
P . 0. Box 7969
Madison, WI 53707
Dear Sir :
An on site investigation for Cudd Brothers Construction property
located in the NE 1/4 of the SE 1/4 of Section 23, T29N-R19W,
Town of Hudson, revealed suitable soils at a depth of 2 .1 feet,
below which bedrock was noted .
This site should be suitable for a mound system.
Should you have any questions regarding this subject, please feel
free to contact this office .
Sincerely,
01y" 0.
� /l ftLe7,I�C
Thomas C. Nelson
Zoning Administrator
rc
I