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ST. CROIX COUNTY
r ,1
WISCONSIN
ZONING OFFICE
�: INxpllNru■ - r���6
ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
— -- Hudson, WI 54016-7710
/ .
(715) 386-4680
Z.e-rs
May 22, 1995
Dale and Patricia Johnson
354 Edgewood Drive
Hudson, Wisconsin 54016
RE: Water Inspection Results for Residence located at
354 Edgewood Drive, Town of Hudson, St. Croix County
Dear Mr. and Mrs. Johnson:
Enclosed is the original test results from Commercial Testing
Laboratory, Inc. for water inspection of the above property. If
you have any questions with regard to said report, please let me
know.
Sincerely,
Mary J. Jenkins
Assistant Zoning Administrator
St. Croix County, Wisconsin
mz
Enclosure
-.
Ij COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715 - 962 - 3121
800 - 962 - 5227
FAX - 715 - 962 - 4030
ST. CROIX COUNTY ZONING OFFICE REPORT NO.: 84224/01 PAGE 1
ST.CROIX CTY GOV.CTR REPORT DATE: 5/17/95
1101 CARMICHAEL ROAD DATE RECEIVED'# 5/11/95
HUDSON, WI 54016
ATTN: THOMAS C. NELSON
OWNER## Patricia E. Johnson
LOCATION: 354 Edgewood Dr., Hudson
COLLECTOR: M. Jenkins 8
DATE COLLECTED: 5-10-95 9
TIME COLLECTED: 11:15am
SOURCE OF SAMPLES Outside faucet
DATE ANALYZED45-11-95 .a c �y� `h)
TIME ANALYZED:2:OOpm a all
COLIFLIRM,MFCC: 0 /100 m(
INTERPRETATION« Bocteriologicaliy SAFE
NITRATE-N: < 1 ppm
Above 10 ppm exceeds the recommended Public
Drinking WAter Standard.
Coliform Bacteria/100 ml
Nitrate-Nitrogen, mg/L
LAB TECHNICIAN: Pam Gane
WI Approved Lab No. 19 (cSl,(L�-S:
FAX'D ON: 5(11 )cK
PHOI�I=D ON:
CALLED:
,.\NOFVEryQE
O Nr
O
V
:= A < Means "LESS THAN" Detectable Level Approved by:
d� !+
OO
PROFESSIONAL LABORATORY SERVICES SINCE 1952
1 r�C)s
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
N I N o a u r n■ ST. CROIX COUNTY GOVERNMENT CENTER
�,;,• 1101 Carmichael Road
--_= ---- Hudson, WI 54016-7710
(715) 386-4680
May 10, 1995
Dale and Patricia Johnson
354 Edgewood Drive
Hudson, Wisconsin 54016
RE: Septic Inspection for Property Located at
354 Edgewood Drive, Town of Hudson, St. Croix County
Dear Mr. and Mrs. Johnson:
An inspection of the septic system for the Patricia Johnson
property located at 354 Edgewood Drive, Hudson, Wisconsin, was
conducted today, May 10, 1995.
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.
Also, water samples were taken. Once we receive the results we
will forward the same on to you. Should you have any questions in
the meantime, please do not hesitate in contacting this office.
Sincerely,
Mary Jenkins
Assistant Zoning Administrator
mz
12 $ CLERK, 01 2 003 iGfSi
41
W
PATRICIA E. JOHNSON DALE W. JOHNSON &
PATRICIA E. JOHNSON
354 EDGEWOOD DRIVE 354 EDGEWOOD DRIVE
HUDSON 54016 HUDSON 54016
715 549-6058 715 549-5263
354 EDGEWOOD DRIVE, TOWN OF HUDSON,WI
PLATTED IN — 7 29N 19 HUDSON
(EDGEWOOD ESTATES III — LOTS 105, 106 & 107)
WESTERN WI NONE 5-15-95
REAL ESTATE CO.
1 �;> —CALL-549-6058 FOR ACCESS.
N
EXTERIOR—CORNER BY FRONT DOOR/BAY WINDOWS.
X
NEW CONSTRUCTION 1988 .
PRIOR OWNERS
HILORY=& NANCY COLE 1Q
X Rf1 D
X tlAY 2 1995
X �°o
E
5-1-95
y..s>�.–�. _<–.–.r....•,>;�.. t.._-t-,> ._-,---,c:•c--M•i w......__...,. _.__ ..sR. __ _:�– >•<=yet-___—._ �-�r.: _ k..
_c
i
X
3s�
�tQr,2U✓60(� �(" Je
t -
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/ arm
05/17/95 WED 16:44 FAX 1 715 962 4030 COMM. TEST LAB 001
COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715 - 962 - 3121 All.
800 - 962 - 5227
FAX - 715 - 962 - 4030
ST. CROIX COUNTY ZONINS OFFICE REPORT NO,: 84224/01 PAGE i
ST-CROIX CTY WV.CTR REPORT DATE: 5/17/95
1101 CARMIOLM L ROAD DATE RECEIU®: 5/11/95
HUDSON, WI 54016
ATTN: THOMAS C. NELSON
III
OWNER: Patricia E, Johnson
LOCATIONS 354 Edgemood Dr., Hudson
COLLECTOR*' M. Jenkins
DATE COLLECTED: 5' 10-95
TIME COLLECTED: 11:15am
SOURCE OF SAMPLE*# Outside faucet
DATE ANALYZED:5•-11--95
THE ANALYZED12:00pm
COLIFORM,MFCC! 0 /144 ml
INTERPRETATIONS Bacteriol.ogicatly SAFE
NITRATE-N: { 1 ppm
Above 14 ppe exceeds the recommended Public
Drinking dater Standard+
Collform Bacteria/100 at
Nitrate-Nitrogen, mg/L
LAB TECHNICIAN: Pam Gate
WI Approved Lab No. 19 RESULTS:
FAX'O ON: slivgs
PHONED ON.
CALLER.
ju
< Means "LESS THAN" Detectable Level roared b :
.,� APP Y
PROFESSIONAL LABORATORY SERVICES SINCE 1952
Parcel #: 020-1171-30-000 12120/2004 11:16 AM
PAGE 1 OF 1
Alt.Parcel M 7.29.19.1068 020-TOWN OF HUDSON
Current 1X ST. CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
00 0
Tax Address: Owner(s): *= Current Owner
*
RICKY H&JANICE P KRAUSE KRAUSE, RICKY H &JANICE P
354 EDGEWOOD DR
HUDSON WI 54016
Districts: SC=School SP=Special Property Address(es): *=Primary
Type Dist# Description '354 EDGEWOOD DR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.230 Plat: 1932-EDGEWOOD ESTATES III
SEC 7 T29N R1 9W LOTS 105, 106&107 Block/Condo Bldg: LOT 105
EDGEWOOD ESTATES III
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
07-29N-19W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 1125/07 WD
07/23/1997 990/117 WD
07/23/1997 776/371
2004 SUMMARY Bill#: Fair Market Value: Assessed with:
49109 268,600
Valuations: Last Changed: 10/29/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.230 30,000 177,800 207,800 NO
Totals for 2004:
General Property 1.230 30,000 177,800 207,800
Woodland 0.000 0 0
Totals for 2003:
General Property 1.230 30,000 177,800 207,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 137
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
l
PUMP CHAMBER
Manufacturer: 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, O Side, O Rear,0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: 2 Length: Number of Lines:. Area Built: 2 4 S
Fill depth to top of pipe: X�y �1
Number of feet from nearest property line: Front, O Side, ® Rear,0 it .�
Number of feet from well: 4 O
Number of feet from building: '
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one) .
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: /'x �► Plumber on job:
License Number:
3/84:mj
t
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER krenbareQ i G/,e_ TOWNSHIP 's-�Sra / SEC. T W 4?N-R W
ADDRESS 5e.i ST. CROIX COUNTY, WISCONSIN
SUBDIVISION T .%'' :' LOT SIZE i L
PLAN VIEW
Distances and dimensions to meet requirements of IIHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
,3s
r
/C INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: /Bp , o s Proposed slope at site: z/.7
SEPTIC TANK: Manufacturer: ( ,.. Liquid Capacity: /G'eQ
Number of rings used: 6— Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front Side, Rear, O ' feet
From nearest property line Front 10 Side,0 Rear,O C ' feet
Number of feet from: well o 0S �building: �.
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730 stj
715 - 962 - 3121
800 - 962 - 5227
FAX - 715 - 962 - 4030
ST. CROIX ZONING REPORT NO.: 34140/011 PAGE 1
ST. CROIX COUNTY REPORT DATE.' 12/22/92
COURTHOUSE DATE RECEIVED: 12/18/92
HUDSON, WI 54016
ATTN.' THOMAS C. NELSON
OWNER.' Lo)Est,
LOCATION.' III, Hudson
COLLECTOR.. M. Jenkins
DATE COLLECTED: 12-16-92
� TIME COLLECTED: 24#30pm
fm
SOURCE OF SAMPLE.' Outside faucet
DATE ANALYZED:12-18-92
TIME ANALYZE D.'I1.'OOam
COLIFORM.' 0 /100 mi
INTERPffETATION; Bacteriologically SAFE .
NITRATE-N.' < 1 ppm
Above 10 ppm exceeds the recommended Public
Drinking Water Standard.
9 10
Coliform Bacteria/100 ml
Nitrate—Nitrogen, mg/L
P
CM
to
ti�oy�t
IL
LAB TECHNICIAN.' Pam Gabe
.1DEYfNOE
WI Approved Lab No. 19
d yA i Means "LESS THAN" Detectable Level Approved by:
® PROFESSIONAL LABORATORY SERVICES SINCE 1952
ti
ST. CROIX COUNTY ZONING OFFICE
1 St. Croix County Courthouse
r��UU 911 4th Street
Hudson, WI 54016
Telephone - (715)386-4680
he St. Croix County g Zonin Office offers the service of septic
and water inspections to Lending Institutions, Realty Firms, and
private individuals.
Completion gf this form la essential aa that _thg rrooperty can be
located.
Please provide the following information, enclose appropriate
fee made payable to St. Croix County Zoning Office, and mail ,
along with form to the above address. Testing will be done as
soon as possible after fee and form are received.,
WATER TESTING----------------------------FEE:X $ 35.00
(For nitrates and coliform bacteria)
WATER TESTING FEE: $1$5.00
(For VOC'S)
SEPTIC SYSTEM INSPECTION-----------------FEE: X $25.00
(Determines if system is properly functioning at .-time of
inspection) u � IdR�1' IC Ca�'�.
PROPERTY OWNER'S NAME:
PROP. ADDRESS:3 S4 EQGcwooJ EST, a CITY QK/ 7ow&xAFCP
Legal Description 1/4 of the 1/4 of Section , T�_N-R
Town of Fk a#J Lot Number �oz Subdivision: WoaY! M 4r" JI
b
FIRE NUMBER LOCK BOX NUMBER ���'��'����r
Color of housej)K S-64W Realty sign by house?�fff� If so, list firm:
t R-+ttL Fro sAr ✓
--s42N GT
PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOK,
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER .TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual requesting services..dM 1(lraL.5CA.1 '?ur#Ve f (?erAt ry
Telephone Number 3k`-`t0(.o
REPORT TO BE SENT TO. - (J,er"V,1 _t LLrAJc f ca&-k.
QM a- l St fL,,dsc�1 W sSFi fC
CLOSING DATE:
signature
r
ST. CROIX COUNTY
WISCONSIN
SCO IN S
».. =;fir-
�•= ^` '_ � ZONING OFFICE
r
� ST.CROIX COUNTY COURTHOUSE
y" 911 FOURTH STREET • HUDSON,W154016
(715)386.4680
December 17, 1992
Tom Nielsen
Burnet Realty
219 - 2nd St.
Hudson, WI 54016
I
Dear Mr. Nielsen:
An inspection of the septic system on the property of Hilory R.
Cole, located at 354 Edgewood Est. III, Hudson, WI was conducted on
Dec. 16, 1992. At the same time a water sample was obtained for
testing. The results of that testing will be sent to you as soon
as we receive them back from the laboratory.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and did
not involve any excavating or chemical analysis. Accordingly,
there is the possibility of hidden defects in the system not
discoverable by this inspection. This does not in any way warrant
or guarantee the continued proper functioning or operation of this
system. It is recommended that the system should be pumped once
every three years. Therefore, the prolonged life of this system
may be dependent upon proper maintenance of the system.
Should you have any questions, please contact his office.
S' cerely,
Mary J. Jenkins
Assistant Zoning Administrator
cj
r
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS
DIVISION
Pl.p;BOX 7369 BUREAU OF PLUMBING
MADISON',WI 53707
SE,,NW4,S7,T29N-R19W RRCONVENTIONAL ❑ALTERNATIVE Ste a Plan l.D.Number:
Town of Hudson El Holding Tank El In-Ground Pressure ❑Mound (If assigned)
Lot 106 Edgewood Estate
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECT( A E:
Hilory R. Cole Route 2, Hudson, WI 54016 (9- 13- $'7 I ..3C)
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:
William Schumaker 6382 St. Croix 92566
SEPTIC TANK/HOLDING TANK:-
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LA 8L LOCKING COVER
! / PROVIDED: PROVIDED
`C�✓ Cz ❑YES ❑NO E Y ES ONO
BEDDING: ENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: 1BU I LED—ING-. VENT TO FRESH
ALARM. FEET FROM LINE: AIR INLET
DYES ONO ❑YES ONO NEAREST
DOSING CHAMBER:
MANUFACTURER. BEDDING: LIQUID CAPACITY. PUMP MODEL: PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVO PROVIDED:
DYES ONO ❑YES ONO ❑YES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING.IVENTTOFFIESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) OYES ONO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing I LENGTH DIAMETER MATERIAL AND 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. IND.OF DISTR.PIPE SPACING COVER =SIDE DIA. #PITS LIQUID
BED/TRENCH TRENCHES MATERIAL: DEPTH'.
DIMENSIONS
GRAVEL DEPTH FILL DEPTH UISTR,PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY 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 OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
❑YES ONO meets the criteria for medium sand. TIONS MEASURED.
OIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS
❑YES ❑NO OYES ❑NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/=F TOPSOIL SODDED SEEDED MULCHED
CENTER. EDGES.
1:1 YES 0 N 1-1 YES ONO ❑YES 1:1 NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING JORAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD PPlPES NO.DISTR. J.:STR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING
ELEV.: ELEV., DIA.: ELEV.. DA.:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY ERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYES 1:1 NO OYES 1-1 NO
COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL
BUILDING:
FEET FROM LINE:
/v"11 1
1:1 YES 1:1 NO ' OYES ONO 1NEAftESj
V
Lfor `��Sketch System on
Reverse Side.
SIGNATURE: TO LE.
DILHR SBD 6710(R.01/82) Zoning Administrator
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 rmay 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 m ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6394)-to be n
submitted to the county prior to installation;
5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licenseb=',.� }
pumper wheneverr necestiaty usudily every 2 tb 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:
f
I. Property owners name and mailing address. Pro%4We the legal description where the system is to be
installed;
It. 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;
lll. 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'Y2 x 11 inches must be submitted to the county. The
plans must include the following:-A) plot plan, drawn to scale or with complete dimensiops, 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: it [
included the creation of surcharges (fees) for a number of regulated practices which Wisco in`S
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried to S.
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- f
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
SBD-6398(R.03/86)
IL HR SANITARY PERMIT APPLICATION COUNTY �1
In accord with ILHR 83.05,Wis.Adm.Code [i
STATE SANITARY PERMIT##
–Attach complete plans(to the county copy only)for the system,on paper not less than STATE�PILAN I.D.NU BER
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 1150 NO
PROPERTY OWNER PROPERTY LOCATION
*L IQ X dr 1/4,(/ 1%, S Ta , N, R E (or
PROPERTY OWN R'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
42 j C', &) " lila .d EsT
CITY,STATE ZIP CODE PHONE NUMBER CITY NEA EST ROAD,LAKE OR LANDMARK
0! O VILLAGE :
�
11. TYPE OF BUILDING OR USE SERVED: / 'X� O oZO —
Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify):
III. PURPOSE
��OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable)
1. a. KNew 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. Mconventional b. ❑Alternative C. ❑ Experimental
2. a. ❑System- b. ❑ Holding C.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tan k
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. 91 Seepage Bed b. ❑seepage Trench c. ❑ seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet):
o`7 '�, P �,, -6– ���{• l a Feet Private ❑Joint ❑ 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 I Tanks structed
Septic Tank or Holdina Tank 65 QQ A ❑ ❑
Lift Pump Tank/Siphon Chamber ❑ ❑
VII. RESPONSIBILITY STATEMENT
1,the undersigned,assume responsibility for installation of the private sewage system howy on the attached plans.
Plumber's Name(Print): Plumber's Signature:(No Stamps) P PRSW No.: Business Phone Number:
�'a M c u a 3 / '2 t
Plumber's Address(Street,City,State,Zip Code): Name of Des' er:
c
Vlll. SOIL TEST INFORMATION
Certified Soil Tester T)Name CST##
G T
CST's AWRESS reet,City,State,Zip Code) Phone Number:
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved S nitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps)
S r a
Approved ❑ char Fee
Owner Given Initial ,�` g
Adverse Determination j Vu
X. COMMENTS/R ASONS FOR DISAPPROVAL:
SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber
1
q1 .
Ile
� Y/1
• IIS'T Y. OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS DIVISION
INI)11;'iiI2Y, DIVISION
i.Ali P.O.PERCOLATION TESTS (115) MADISON,W 537707
Hl1MA N R[13FL ATIONS C
(1-163.090)& Chapter 145.045)
1n .ATIt7N N ECfIFN: TO ;;ill MUNICIPALITY: OTNO.:BLK.NO.: SUBDIV E:
W!/
PWN T2q N/RM (nl) /Ulsr-n/ iAs ro7 - E e h Es-T 77r
l:Ot1N 1 Y i' 7HUYEN`S N71ME: MA AD S:
aC .. __ .. _ °.LLyS�O�PM�;NT_�A1C� _ 9/6 'STC-o- <f AlorZTN U So I 'S4016
SE DATES OBSERVATIONS MADE
Nt7.F1EI>f1MS : CONIMI' A NESCRIpl'fopl: -- _----
- Resid
PROFILE DESCRIPTIONS: PERCOLATION TESTE-1
en.:a I WNew ❑Replace
---_--...- -- U_ti _—J---= _ 14Aki ljj /4 1 x7 MaRc l 8
50-�s>�oalG �1C,¢ 4� 'So/LS -b2- - llmeky� s� EWCTI'
RAf►N(3:S-Site suitable for system U-Site unsuitable for system '�t[1 'SArJTt 4 I NVFN INAL' MOUND:�F' zs-GROUND❑� SQ I' OLD NU TANK:RECOMMENDED SYSTE' :(optional)
S U S L �O 1 A L *b
It Petentrilion Tests are NOT-eyuired DESIGN RATE: II any portion of the tested aiee is in the
umfer s.H63.0i)1511h1,iptlicate" C4A%S Z Floodplain,indicate Floodplaln elevation: NA
Ilu tr. PROFILE DESCRIPTIONS
BORING TOTAL P
-- 0--GROUP DWATE -INCHES HA ATER 6 OIL WITH TEXTURE,AND DEPTH NMBER DEI'rHN. ELEVATION OO BS E R _D TO BEDROCK IF'OBSERVED(SEE ABB BACK.)
r'
B- /oz.79 oNe >8.�7 "efa.'rs 9'"$eniGYsn 79 &t4 Mbv6R l .clb4kk` A
B- Z �rr&L /6'g4,�G,Y S n 30'Rr,Bafr M`� 5,1611 qs"[T
II 33 /11.93 o z 7 /1.33' S+6►t rt< °� 40" cNFs
3 7 //1•`� --tialgi > 7 S"BLi.TS IZ" tJSIL 25''Lr$��!S►:
B- - 7.7 ioq�Bo_ �Nz.__ > 7 7 S tTBeNF�MS'.�6>I<"
B- -::3— q Z 107.1 g Nof.►� ?9,9Z s"$i.r+s 1�"8e,46Y S�C it"'62N 3t L
C •M cSR
B- -
�� . FI PERCOLATION TESTS
1 nj. UEP i 11 WATER IN 1101 F TEST TIME V H S RATE NIWHF.Ii lfiio %S AF:TEIiSWE1.11NG INTERVAL-MIN. MINUTES I.
_ $-i. ... - T--PFRt _ PER INCH
1.0- 30 2
!I1o.94 30
la __
LOT PLAN: Show Igcations of percolation tests, soil borings and the dimepsions of suitabia soil areas. Indicate scale or distances.pesedbe what are Ow hors-
nntol and vertical ehmation reference points aM show th location on the plot plan. Show the surface elevation-at all bori a dirbetion and percent
I land slope.. PRIMaRy '
YSTEM ELEVATION o .i v
a
V SP►K(a' 'Jlyl �
Ci.!LYAT 14 W. Z/-4.3f,�
W%IA�R`�_ r I a
� �6 ,, d• it-� , ��3. 't I � ,_ :� ��
io Lat,Ew�D 1 ', No-t '4 So-1. 107,1:lk
aPNC y J °` �tEcdM Np►s a�t��stzJnlra
I, the ulularsigned, hereby cattily lhni the soil t@sjs\r*po#IePbn this form were atnale by runt in accord with the procedures aK1 snathods specified in the Wisconsin
Adm-nistrative Code,and that the data recorded and the ton of the testi are correct to the best of my knowledge and belief.
NAME.llpinl : `` TESTS W RE COMPL OON:
14AQJE'/ AanwSON QJSc►J �x�P.J6Y rnlC. l+�1 C _ / Ake-14 /6 /9TS
AnI1RESS: - , �CERTIFICA ION NUMBER: PHONE NUMBER(o0 a1):
J!ST S AT E-
x VW I
,cal 111111fl!ION lhgpn,ll.uul nnr-.gry to I nrdl Auihmily,N111 11y Owner mid Sari Teaei,
NIL nv rII
in
>
S T C 1 r-
r
• y ,
SEPTIC TANK MAINTENA C8 A4KEEMEN'r
St, Croix ounty
y
UWNEk/BUYEK �/����� / le C"
kOUTE/BOX NUMBEK ZZ 2 Fire Number
CITY/STATE _&w�Z/,t•o .z 141 211, "�i' ✓%%
PkUrEkTY LOCATION : k. �;, Section ? r 2-1J N . K (,�iW
Town of //La.0�ry .17 . St . Croix County .
Subdivision Lrc✓yG woad Lot number /404
Improper use, and maintenance of your septic hystein could result in I
its premature failure to handle wastes . Proper maintenance eull-
slrta ut pumping out the aeptie tank every Lh,r..'t: years or suutier , I
Lt nuuddd . by a licensed suptie tank Eu�ur . WiIat you put late
the system can offdet the functionon?• t�►.e a-t,pttc tank as a trv.,t -
aunt seise in the waste disposal system. .
St . Croix County residents !!tU be eligible to receive u grant for
d a-sx.lmum of 60% of the cost of replacement of a falling system,
which was in operation pritl St. Croix County
dccdptud this program in August, of 1980, with the rmy'uirduldt►t th.tt
owners of all new systems agree to keep their systems properly
maintained. -
The prupurty- owner agrees to submit to St . Croix Cuuttty Zoning a
certlficution form, signed by cite owner and by a master plumber .
journeyman plumber, restricted plumber or a licensed pumper veri -
fying that (1) the on-sito wastewater disposal system i.s in proper
uperating condition and (2) after inspection and pumpittb ( it nec-
essary) , the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approxinately 30 duys ,prior to
three year expiration.
0
I/WE, the undersigned, have read the above requirements and agree H
to maintain the private sewage disposal system in accordance with
the standards not forth, herein, asset by the Wisconsin Depart- v
.. ae'nt of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Offits within 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 .
' it ,
i 2t
APPLICATION FOR SANITARY PURMIT
sTC - 100
This application form is to be completed in full and signed by the owner(s) of the
property buing developed. Any inadequacies will only result in delays of the permit
iathueuce. Should this development be intended for resale by owner/contractor, ("spec
(rouse"). then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording..
- - - - - - - - - - .' .. .t • .. r.r - r r s - r - - - - - - - r - - - -- - - - - - -
Owner of Property Y G
Lucut ion of Property ..Nli! k. section ^,,,� , T 2 f N - R /f _ W
Tuwuship 11t,o/ja 'q
Nriling Address
Subdivision Name
Lot Number
Previous Owner of Property
Total Size of Parcel
oate Parcel was Created
Are all corners and lot lines identifiable? � Yes No
15 Lhis property being developed for resale (apse house) ? _ you X _ No
vulume _Z7 and Page Number '• as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. ' Yarranty Ds .
1. Land Contract
!. Other recordings filed with the Register of Deeds Office
lu addltion, -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 the Certified Survey Map shall also be required.
PROPERTV OWNER CERTIFICATION
► (we) eVLU6y tjLat aU atatemente on th. 6ww ant t ue to the beet 06 MY (uuh)
k►euwtv.dge; that 1 (we) any (ane) the owner.(A l o6 the ptopen ty +de c&Lb" in thin
e1e6uaniatiun 60a,e, by viAtue 06 a wahnanty deed atedaded to the-064" 06 tke
County Reg"ten o6 Deeds as Document No. � O o and tjh 1 (we)
pneee.ow own the,pnapoeed &Ue 6on the aswag po�eyete'^ (ox 1
(we) iuwe
ub.tai.►►ed an easement, to nun with the above deac;Ubed ptopeaty, box the
Cupb•tltucti.on o6 chid 6ptenl, and the dame has been duty ueonded in the 066.iee
u6 tjie Courtly RegiAten 06 Deeds, ab DOCUmeat No,
S1CNn't'U OF OWNER SICKATURE OF CO-OWNER (IF APPLICABLE)
1�
t►ATE S1 NL•'D • DATE SICNI U
425775 ►y�y -
I !8PAOE 551
REGSTERS OFFICE
ST. CROIX CO., WI&
Rec'd. for Record ft 18th
day of May A.D. 19J7
AFFIDAVIT 41:45 P
STATE OF WISCONSIN ) M �
SS
ST . CROIX COUNTY )
I, Harvey G. Johnson, Registered Wisconsin Land Surveyor, hereby
depose and say:
That I have surveyed and platted Edgewood Estates III, located in the
SE /4 of the NW 1/4 and the SW 1/4 of the NW 1/4 of Section 7, TZ9N,
R 19W , Town of Hudson, St. Croix County, Wisconsin;
That there is a proposed on-site liquid waste disposal system
intended for, and a percolation test completed on Lot 106 of said
plat;
That said system is intended to serve a home intended to be built
on Lot 105 of said plat;
And that I make this affidavit to inform all future purchasers of
said Los 105, 106, and 107 of the possible existence of said
system.
S10scribe'd orn to before me
",Ahis-,q/,,Yr day of May, 1987
r /r
O ary,.Puhlic, State of Wisconsin
M* rn: `iori expires /; , ,�. f
1�
�V
This int` ument drafted by:
Harv)q G. Johnson
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA
WARRANTY DEED
, ' 425009 E
_ PAG __ GISTERS OFFIC
r --
+"' ST. CROIX CO., Wis.
Thi De d, made between ------------------•---•--•-----•---------•-------••--_.... R�c'd. R 28th
a & De a eoord fhis
v 0 � nc'.-•-•------------------------------------------•---•--------.
..-----------------------•--•-...._...-•------•- y An_ri_.L.�A.D. 1987
a of _
Gr4 tor, p :30
, ,o..._:.... Code and ,
and.............. ......:_......... Nand Ce Cole, huS�anc�[ and wl e
...... ----• .............................. .�
as,-sury I (or � max i,tal ro ...
-----------------------------------•-•--------------.......------ .....---.....--------.......-----•------•----- .f
-•--------------•-............-•----.............-----•----•-• Grantee, !
.... y
Witnesseth, That the said Grantor, for a valuable consideration..._..
......._.GrtorS
St. Gro3 x-------•- — U
conveys to Grantee the following described real estate in RETURN To
/1t/Za
County, State of Wisconsin: �p76��
Tax Parcel No
Lots 105., 106 107 W iewood • --------------------------•--......
r g Ea`E�te�'-'����iiz-.�the .
of'Hudson' Ste CrOiX County, Wisconsin.
FEE
This ...�1a.11At,......._._.._ homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And._.. xall .Kt..----------•............................. ...............................
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
easementsr re$txtC4Qns and r�(Pubp-of^way of record, if any. .
and will warrant and defend the same.
Dated this 27th '----- day of .._.._.. x �• 87
-•--•.......................•-••--.....--•--•_., 19.........
& H Develorpent, Inc.
..(SEAL) � •� JLy
�...r .............(SEAL)
* * ............= d..slgxnstaa
.-•------------------------------------------------------------------(SEAL) .d1� _........ .._.. (SEAL)
* --•...................................•...._............__........ * ...._._.Waa,��,s1IC1.I lel.�. :........._..
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) _.--------�nad-�, QrnStad(________________ STATE OF WISL�'ONSIN
W�7, C-q Ha wjj .
-- ------------ --------•-------------------------•----------- ss.
27th ----•--------------------------•----..County.
authenti ated this -___..._day of---•_W''I----------, 19-87- Personally came before me this . .__..day of
_.... --
.t �� --•-•--•---------------------•----•----_.., 19._...... the above named
* ��st�114 Og d ----------•-----------------------------------------•------ ----------------
-------------------- ---------------------------------...---_..
TITLE: MEMBER STATE BAR OF WISCONSIN -"" "--""'"_-'"- --__..._
------------------------------•------•----------...--------._...-----------•----
(If not- ------------------•------•---••----•........_..------......• p
authorizedb --------------------------------------------------------------•--•--------------
y § 706.06, Wis. Stats.) to me known to be the erson _........_._ who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Kr�st, M Ogja'nd LUndeen ......................................................•---.._..------•-•---...--
torriey..dt haw..........................• *
-------------•----....---•---------•-•-••---•-........
-------------------•---_...__.................- -•---•......._...---•-_..... Notary Public ............................ County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration
are not necessary.)
date: -----••-------•---••-•----•----•-------•-••.............. 19..--•--•.)
•Namea of persons signing in any capacity should be typed or printed below• their signatures.
w—TIA-Tv n,-rn ST1TF F11R or wyI:r vcfv ..