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ST. CROIX COUNTY ZONING OFFICE
911 4th Street
Hudson, WI 54016
Telephone - (715)386-4680
The St. Croix Co. Zoning Office offers the service of septic and
water inspection to Lending Institution, Realty Firms , and
private individuals.
COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN BE
LOCATED.
Please provide the following information, enclose appropriate fee
made payable to ST. CROIX CO. ZONING, and mail, along with form
to the above address. Testing will be done as soon as possible
after fee and form are received.
WATER TESTING--------------------------------FEE:$ 25.00
(For nitrates and coliform bacteria) - 4 -
WATER TESTING--------------------------------FEE:$175.00
(VOC'S)
SEPTIC SYSTEM INSPECTION------------ - --------FEE:$ 25.00 X
PROPERTY OWNERS NAME: `71 vM4 5 G{n Cwaf li Ale"/.e loss
PROPERTY OWNERS ADDRESS:_ /2 La /rc�I CITY:
Legal Description SV✓ 1/4 , SE l/4, Sec. 3 , T 30 N-R /9 W,
Town of $d.�/ou�� /,�rL6t. No901�9N9.�! Subdivis ion +-7 FIRE NO. A ZkL� A �°��` D� ✓
Color of house )3 rywn Realty sign? Firm:
PLEASE INCLUDE, IF AT ?LLL POSSIBLE, A MAP, i.e. , COPY OF PLAT
BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
� Cindividua�eq esting services: s
Telephone--Noo - - _ p
REPORT TO BE SENT TO: f/ faH
/
CLOSING DATE:
Signature:
ST. CROIX COUNTY
'�,,�,. WISCONSIN
ZONING OFFICE
F� ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON,WI 54016
(715) 386-4680
Mar. 4 , 1992
Thomas Nettleton
1214 Co. Rd. I
Hudson, WI 54016
Dear Mr. Nettleton:
An inspection of the septic system on the property of Thomas
Nettleton, located at 1214 Co. Rd. I, Hudson, WI was conducted on
Mar. 4, 1992.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and
did not involve any excavating or chemical analysis .
Accordingly, there is the possibility of hidden defects in the
system not discoverable by this inspection. This does not in
any way warrant or guarantee the continued proper functioning or
operation of this system. It is recommended that the system
should be pumped once every three years . Therefore, the
prolonged life of this system may be dependent upon proper
maintenance of the system.
erely, ,
Mai-j—J Jenkins
Assistant Zoning Administrator
cj
vn� 1494PacE 148
EX19TTNG SEPTIC 4E:*3- 2
evemF>tir AFFIDAVIT KATHLEEN H. WALSH
Document Number REGISTER OF DEEDS
ST. CRDIX CO., WI
Name & Return Address RECEIVED FOR RECORD
Thomas H and Gwen R Nettleton 03-06-2000 10:45 AM
1214 C-T_ I
AFFIDAVIT
Hudson WI 540 EXEMPT R
CERT COPY FEE:
COPY FEE-
030-2009-90-007 �a 3 n .-1 9 _3 R 6 I TRANSFER FEE:
Computer I .D. Number Parcel I .D. Number PAGES:iN6 FEE: 10.00
PAGES: 1
The existing septic system which serves the dwelling being added on to must be verified by
an acceptable soil report or be inspected by a licensed soil tester for compliance with
high groundwater and/or bedrock separation requirements as set forth in s. Comm Chapter
83.10 (2) WI. Adm_ Code. The results of that inspection must be made available to this
office. I£ the existing septic system meets these minimum requirements, and is properly
functioning, an addition may be added to the dwelling without updating that system. This
addition must not, however, encroach upon the required septic system setbacks as set forth
in s. COMM 83.10 (1) .
property owner(s) Thomag H and Gwen R
property Mailing Address: w
Property Legal Description: Lot # 1 _CSM/Subdivision
SW —EL2/.. 36c. 44 Q_N-R�2w. Town of Josegh
Coamnents: The existing septic system was sized and installed for a four bedroom dwelling.
The building remodeling project will involve adding a bedroom in the lower level of the
structure, and as such may result in septic system to be undersized for the structure being
served. �
erty, hereby affirm that the septic system te private sewage system codes. 1
I, as the owner of the above described prop
serving this dwelling meets the above referenced sta
realize that this addition may cause the existing septic system to become undersized for a
dwelling of the resulting size, and I will make this information available to any future
parties interested in purchasing this property.
4
__� �� Notary Public Subscribed and
Signed: c sworn to before me on this date:
_ O
Date z 3 -G °o H
..... "V/,S,j Mjr commission expires.
Zoning Depil�ctment ��-
Approval:.�llllxu
Date: 3-b- O-D
y�b� S.V
Thomas H.Nettleton
• 1214 County Road I
• Hudson,WI 54016
March 6,2000
St.Croix County
Zoning Department
1011 Carmichael Road
Hudson,WI 54016
Dear Sir or Madam:
I am writing to clarify the room usage in the basement finishing project we hope to complete which
adds three rooms now and one room in the future.
Our intention is to have the following rooms:
s
I One(1)Bedroom(w/an egress window and closet)
. Qge,(1)Exercise Room
1,( ),Family Room
4
06t(I),,Game Room(Future-This is not part of the current project.)
We,,e rntact me on 715-549-5246(H)or 651-768-1512(W)if you have any questions or concerns.
7
Sincerely,
Thomas H.Nettleton z u
Homeowner `(
i
II
t
fU
EXISTING SEPTIC
SYSTEM AFFIDAVIT
Document Number
Name & Return Address
Thomas H. and Gwen R. Nettleton
1214 CTH I
Hudson WI 54016
030-2009-90-007 34 ,30 , 19 ,386I
Computer I .D. Number Parcel I .D. Number
The existing septic system which serves the dwelling being added on to must be verified by
an acceptable soil report or be inspected by a licensed soil tester for compliance with
high groundwater and/or bedrock separation requirements as set forth in s. COMM Chapter
83.10 (2) WI. Adm. Code. The results of that inspection must be made available to this
office. If the existing septic system meets these minimum requirements, and is properly
functioning, an addition may be added to the dwelling without, updating that system. This
addition must not, however, encroach upon the required septic system setbacks as set forth
in s. COMM 83.10 (1) .
Property Owner(s) Thomas H and Gwen R Nettleton
Property Mailing Address: 1214 CTH I
Hudson WI 54016
Property Legal Description: Lot # 1 CSM/Subdivision CSM 7/1989
SW V4 —%, Sec._ 4 , T_�N-R 19 W, Town of St Joseph
Comments: The existing septic system was sized and installed for a four bedroom dwelling.
The building remodeling project will involve adding a bedroom in the lower level of the
structure, and as such may result in septic system to be undersized for the structure being
served.
I, as the owner of the above described property, hereby affirm that the septic system
serving this dwelling meets the above referenced state private sewage system codes. I
realize that this addition may cause the existing septic system to become undersized for a
dwelling of the resulting size, and I will make this information available to any future
parties interested in purchasing this property.
Signed: Notary Public Subscribed and
sworn to before me on this date:
Date: 3 -G - oa �n,,,.A,4, /,� , ae)0 0
Zoning Dep txaent �.P.• •.S�j My commission expires:
Approval:, - _ A- c •' D01-- ,
Date•
us
SNP, "'.
t�
• tjPRS 3224 WI
t MrCA 696 MN roe
' SHEET NO. OF 2
Timm
CALCULATED BY DATE
•M V//��
• Excavatin • CHECKED BY DATE
R I, Box 192, Wilson, WI W27 SCALE
715-396-5443
ROGER TIMM 715-772-3214 .....
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CALCULATED BY ' DATE
Excavating Co. CHECKED BY DATE
R I, Box 192, Wilson, WI 54027 SCALE
ROGER tiMM 716-772-3214 , { I I
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PROPERTY OWNER SOIL DESCRIPTION REPORT Page of
PARCEL I.D.#
Boren # Horizon Depth Dominant Color Mottles Structure 2
g Texture Consistence Boundary Roots
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed ,Trench
Ground
elev.
ft
Depth to
limiting
factor
in. '
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. 35 5
Remarks:
Horizon Depth Dominant Col Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell, u. Cont.Color Gr.Sz.Sh. Bed ,Trench
Boring#
...........................
...........................
...........................
Ground
elev. 2q
ft.
Depth to
limiting
factor
in. Remarks:
Boring#
E3
Ground
elev.
ft.
Depth to
Limiting
factor
in. Remarks:
SBD-8330(R.07/96)
Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include,but not limited to: vertical and horizontal reference point(BM),direction and
percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.#
APPLICANT INFORMATION - Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)).
Property Owner Property Location
Govt.Lot 1/4 1/4,S T N,R E(or)W
Property Owner's Mailing Address Lot# Block# Subd.Name or CSM#
City State Zip Code Phone Number ❑ City ❑ Village ❑ Town Nearest Road
❑ New Construction Use: ❑Residential/Number of bedrooms Addition to existing building
❑ Replacement ❑Public or commercial-Describe:
Code derived daily flow gpd Recommended design loading rate bed,gpd/ft2 trench,gpd/ft2
Absorption area required bed,ft2 trench,ft2 Maximum design loading rate bed,gpd/ft2 trench,gpd/ft2
Recommended infiltration surface elevation(s) ft(as referred to site plan benchmark)
Additional design/site considerations
Parent material Flood plain elevation,if applicable ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system ❑ S ❑ U ❑S ❑ U ❑S ❑ U ❑ S ❑ U ❑ S ❑ U [Is ❑ U
SOIL DESCRIPTION REPORT
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench
Ground
elev.
ft.
Depth to
limiting
factor
in. '
Remarks:
Boring#
Li
Ground
elev.
Depth to
limiting
factor
in. Remarks:
CST Name Please Print Signature Telephone No.
Address
Date CST Number
{� SANITARY PERMIT APPLICATION COUNTY
U DILHR In accord with ILHR 83.05,Wis.Adm. Code
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..
—See reverse side for instructions for completing this application. PETITION
I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO
PROPERTY OWNER PROPERTY LOCATION
'/4, S ' T : , N, R IF, (or tW
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBERf SUBDIVISION NAME
CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK
E:1 VILLAGE :
s
II. TYPE OF BUILDING OR USE SERVED:
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. l 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.'91 Conventional b. ❑Alternative C. ❑ Experimental
2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. ❑ seepage Bed b.,R]Seepage Trench c. See pa 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):
Private ❑.,Joint El Public
Feet
VI. TANK CAPACITY Site
in aa ons Total #of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- LE glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank r " �' ' El L1
Lift Pump Tank/Si hon 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 Stajmps) MP/MPRSW No.: Business Phone Number:
Plumbers Address(Street,City,State,Zip Code): Name of Designer:
VIII. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name r CST#
CST's AODR S(Street,City,State,Zip Code) Phone Number:
( i
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
Approved I F-1 owner Given Initial Surcharge Fee
Adverse Determination `
X. COMMENTS/REASONS FOR DISAPPROVAL: v
SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County, 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 sartary permit may be renewed Lcf the expiration date, and at the time of renewal any new
critet;a i ' e- Wit nsir: Administrative Code will be applicable;
3 All rr i;., �� Ihi.-, p„rmit must be app ,•. d by the permit s .iin authority. A ,c_w per ;il! r;'lay be needed
;f tilt -- r mange ire your building plans, systern location es' ;,;,ifed vvaste',',dte `lo✓v (nur-iber of bed-
os sys`F rn_ or type of system:
4. Changue, O,�-rship cr -I:ember requires a Sanitary Permit Transfer/Renewal Form (SEC 5399) to be
su :r ,4; . e . ty prior io installation,
5. Private systems must be properly maintained. The septic tank(s) should be pum„cri by a licensed
Pumper °,vf j,-, :e( essacy. usually every 2 to 3 y:-ars,
6 It you h ,ve questions conc_�(ning your private sewage system, your local c(_ide itfn inistrator or the
State of 'dVisconsin, 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
nstall2d;
i! Type of I,:wilding or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat
restaurart, fc: Fill in number of bedrooms if building is a one or two family dwe!linq.
ill Purpose: of application: Check only one in ##1. Complete #2 if permit is for tank rep!ac:1o1Y. reconnection or
repa,r
V Typ: c=f system: ct ,..,k ail appropriate boxes depending on system type- Check experiment-ii only if project
s in (.Orlp.mction with University of Wisconsin;
i! . ri _v_t�_ur, info, Oion: Provide all information requested n #1-6;
',�rrnatior r.!I ipacity of every new and/or existing tank, list the tot,; r �, to t o irl=;tailed.
nrbc r of `anks ar-�3 r a �r , cturer's name. Indicate prefab or site constructed and ;a,r�i. ralz: i;:a; Complete
a.r er and homing tanks for this systeir.. Check, ap�nava! only if
Dk c.�;vec product appr;r✓a; Born DILHR.
s; ,oC: qty st. `,” stalling plumber is to fill in name, license number with z.,ppiopr,atj prefix (e.g.
P.1P. etc ), address and pho,ic number. Plrrrober must sign application form. Fill in designer �,ame if
applicable,
V!1!. Soil test information: Certified soil tester's name, certification number, address, ano, phone number.
!X. 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 V/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 serves; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; frict"on 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 A tater
included the creation of surcharges (fees) for a number of regulated practices which Wiscorr in'S a
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that burred reasure'
is used in your building is returned to the groundwater though your soil absorption o
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)
.,RTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
.,4DUSTRY, DIVISION
LABOR ANL PERCOLATION TESTS (115) MADISON W 53707
HUMQIV RELATIONS CC
(H63.09111&Chapter 145.045) d'
LOCATION: SECTION: TOWNSHIP/�Y: LOT N BLK.NO.: SUBDIVISION NAME:
SW 'IfE 1/4 34 �T30 M� t9 J(or►W St. Joseph *� n/a Henning
COUNTY: OWNER'S ME: MAILING ADDRESS:
St. Croix Steve Henning R.R.#2, Box 328A, Hudson, Wi. 54016
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS:1PERCOLATION TESTS:
®Residence 3 n/a ®New ❑Replace I 11-10- 87 11-10-87
RATING:S=Site suitable for system U=Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional)
S ❑U ®S ❑U IS ❑U ❑S BU ❑S E U conventional
If Percolation Tests are NOT re uired DESIGN RATE:
Q If any portion of the tested area is in the
under s.H63.09(5)(b),indicate: n/a lFloodplain,indicate Floodplain elevation: na/
deciaml' PROFILE DESCRIPTIONS Page 42 ONC2
BORINGI TOTA DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH
NUMBER IDEPTH LEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B-1 6.92 100.24 none >6.92 .75bl.1. 2.17bn.sil. 1.00bn.cob.gr. 3.00bnn.c.s. gr.
B-2 6.75 99.93 none >6.75 .50bl.1. 2.83bn.sil. .42bn.s.1. 3.00bn.m.s.
B-3 6.93 99.77 none >6.93 .42bl.1. 1.67bn.sil. .92bn.cob.gr. 3.92bn.c.s.&
B 4 6.83 99.83 none >6.83 1.00bl.l. 1.00bn.s.l. 4.83bn.c.s&gr.
B-5 6.75 99.54 none >6.75 .42bl.1. 1.00bn.sil. 1.83bn.s.1. 3.50bn.c.s.&gr.
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER155 3 PER INCH
P- 1 .3.5C none 3 6 6 6 <3
P.2 3.79 none 3 31, 3 3 1
P-3 3.73 none 3 3-2 3-4 31 1
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori•
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 96.04
I 7
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_ol►m, too � °alb• �,� /�' ;�- - I
� 3 '
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I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME(print): TESTS WERE COMPLETED ON:
Gary L. Steel 11-10-87
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
0988 N. Shore Dr. New Richmond Wi. 54017 229e, 15-246-6200
CST SIGN RE:
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —