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Parc I #: 020-1027-80-000 07/1012006 11:32 AM
PAGE 1 OF 1
Alt. Par rel#: 16.29.19.123B 020-TOWN OF HUDSON
Curre t EX-1 ST. CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
00 0
Tax Adi Iress: Owner(s): O=Current Owner, C=Current Co-Owner
O-KRAUSE, MARK E
MARK KRAUSE
598 M UTCHEON RD
HUDS N WI 54016
District : SC=School SP=Special Property Address(es): *=Primary
Type Dist# Description *598 MCCUTCHEON RD
SC 2611 SCH D OF HUDSON
SP 700 WITC
Legal escription: Acres: 2.515 Plat: N/A-NOT AVAILABLE
SEC 16 T29N R19W NE NE LOT 1 CSM 3/851 Block/Condo Bldg:
REPLACED BY CSM 4/997 REPLACED BY CSM
7/1882 Tract(s): (Sec-Twn-Rng 401/4 1601/4)
16-29N-19W
Notes: Parcel History:
Date Doc# Vol/Page Type
01/07/2005 784502 2827/223 QC
01/07/2005 784498 2728/219 QC
07/23/1997 1117/237 WD
07/23/1997 925/527
more
2006 SUMMARY Bill#: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Descril ition Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.515 71,100 189,900 261,000 NO
Total I for 2006:
General Property 2.515 71,100 189,900 261,000
Woodland 0.000 0 0
Totali for 2005:
General Property 2.515 71,100 189,900 261,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 202
Spec als:
User S ecial Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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, Rear,
p Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: ,$' ' Length: Number of Lines:—_,2 _
Area Built:
Fill depth to top of pipe: �6 "
Number of feet from nearest property line: Front
OSide, O Rear,OFt .—/0'
Number of feet from well:
v
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 0 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.
O
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:
3/84:mj
Form - S T C - 104
�► "° AS BUILT SANITARY SYSTEM REPORT
OWNER Teter Heilmann TOWNSHIP Hudson SEC. 16 T 29 N-R 19 W
ADDRESS 205 Country Road TT ST. CROIX COUNTY, WISCONSIN
Roberts, WI 54023
SUBDIVISION N/A LOT 1 LOT SIZE N/A
PLAN VIEW
Distances and dimensions to meet requirements of I•T.HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
10-d IV
1
1
l�
w
1\
M
r
e IX sf'
A
i I
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: 14,x; ✓ Liquid Capacity:
Ntmber of rings used: / Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front 10 Side 0 Rear, O feet
From nearest- property line - Front 10 Side,O Rear,0 l/a ` feet
Nimber of feet from: well �, building:
(InclILde this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
fRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
DEPARTMENT of iR7ATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING
LABOR&HUM 5370
P.O.&Oy"", T 9N-R19W CONVENTIONAL ❑ALTERNATIVE Sfassiganl.D.Number.
"MA['r.4f > (If assigned)
.1 of Hudso ❑Holding Tank El In-Ground Pressure Mound
igcCutcheon Road
NAME OF PERMIT HOLDER JADDRESS OF PERMIT HOLDER INSPECTION DATE:
Peter Heilmana 205 County Road TT Apt. 5, Roberts, WI 4023 4—a(p
BENCH MARK(Permanent re erence point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV.:
Name of Plumber: MP/MPRSW No.. County Sanitary Permit Number:
pack A. Bowma 5875 St. Croix 99096
SEPTIC TAN K/HOLD ING TANK:
MANUFACTURER. LIQUID CAPACITY TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
�f� PROVIDED: PROVIDED:
!VL/�
Rn 1 O ( G8 1�rJ YES ❑NO ❑YES LY1N0
BEDDING: NT DIA.: VENT MATL. HIGH WATER NUMBIr"'R ROAD: PROPERTY W BUILDING: VENT TO FRESH
^ �— ALARM: LINE: AIR INLET:
❑YES_S]NO FEET FROM
4 1,��.J� ❑YES �NO NEAREST � �U
DOSING CHAMBER:
MANUFACTURER. B DDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED PROVIDED:
YES ONO YE ❑NO OYES ONO
GALLONS PER CYC_E: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROP TV WE BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET.
PUMP ON AND OFF ❑YES ONO NEAREST
SOIL ABSORPTION YSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER ERIAL ND MARKING
or excavation. (If soi can be rolled into a wire,construction shall cease until FORCE
MAIN
the soil is dry enough o continue.)
CONVENTIONAL SV STEM:
IDTH: LENGTH. NO.OF DISTR.PIPE SPACING. COVER DIA.-. #PITSLIQUID
#3EDfTREI0 TRENCHES MATERIAL: DEPTH:
# �NSI*N$
GRAVEL DEPTH F LL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: nDR UMBER CIF PRO PERTY WELL: BUILDING. VENT TO FRESH
BELOW PIPES F L D CTHER. ELEV.INLE7 ELEV END. LINE: AIR INLET195 q51 t FROM
�- o �0 0 51 +
MOUND SYSTEM:
Mound site plo ed 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.
YE ❑NO
SOIL COVER ITEXTUF E PERMANENT MARKERS OBSERVATION WELLS
❑YES ONO ❑YES El NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED. SEEDED. MULCHED.
CENTER. EDGES.
El YES ONO I OYES ONO OYES 1:1 NO
PRESSURIZED DISTRIBUTION SYSTEM:
DTH_ LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER:
e; e'`1CGCH TRENCHES:
NIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING:
g E EV.: ELEV.: DIA.. ELEV. PIPES:
,I.�i 1lATIflN ANU
°�BTIBUTI CIN H LE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED
INFCiRMAT#ON
PLANS:
❑YES ❑NO OYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: 7BUILDING:
FEET FROM
LINE:
3 3 S ❑YES ❑NO ❑YES ❑NO NEAREST
a
4.1
J /
"1
Sketch System on / Retain in county file for audit.
Reverse Side.
I TITLE:
Zoning Administrator
DILHR SBD 6710 (R 01/82)
INFORMATION & INSTRUCTIONS FOIL'COMPLETING A SANITARY
APPLICATION
MhT
ti
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 airy 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 wastewaterAow (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 4
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 tahk replacement, reconnection or
repair;
IV. Type of system: check all appropriate boxes depending on system type. Check experimental only,if project
is in conjunction with University of Wisconsin; -
V. Absorption system information: Provide all information requested in ##1-6;
VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if.
tanks received experimental product approval from DILHR;
VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County/Department Use Only;
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 8� x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; dosing or pumping chambers; distribution boxes: soil absorption systems, replacement
system areas; and the location e° the building served B) horizontal and vertical elevatior reference points;
C) complete specifications for Pumps and controls; dose volume; elevation differences friction loss; pump
performance curve, pump model and pump manufacturer; Di cross section of the soil absorption system if
required by the courty, E) soil test data on a 115 form.
On A1iiiV
result o,
'` fifer
i.;
Tn nc >
SANITARY PERMIT APPLICATION COUNTY
ow
In accord with ILHR 83.05,Wis.Adm.Code St. Croix
D STI�jE�A��Y PERMIT#
r C7/'
complete laps(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER
,z 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 Lbw NO
PROPERTY OWNER PROPERTY LOCATION
Peter Heil nn NE '/a NE '/a,S 16 T 29 , N, R 193)W
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
205 County Road TT Apt # 5 1 N/A N/A
CITY,STATE ZIP CODE 1PHONENUMBER CITY NEAREST ROAD,LAKE OR LANDMARK
VILLAGE: Hudson Mc utc eon Road
Roberts WI 54023 715 749-3779
II. TYPE OF BUIL ING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify):
Ill. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable)
1. a. n Nevy b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an
Syst am System Septic Tank Only an Existing System Existing System
2. ❑ A Sanit iry Permit was previously issued. Permit## Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The Sy tem is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYS EM: (Check only one in#1 and only one in#2)
1. a. Con entional b. ❑Alternative C. ❑ Experimental
2. a. ❑System- b. ❑ Holding C.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fi.I Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a.X See a e Bed b. ❑Seepage Trench c. ❑Seepage-Pit
2. PERCOLATI RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes pe inch): REQUIRED(Square Feet): PROPOSED(Square Feet):
17/ 5s s ��O Feet 2Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Se tic Tank or Holdin 3 Tank /aoc, K
Lift Pump Tank/Si h i Chamber ❑
VII. RESPONSIB LITY STATEMENT
I,the undersigned assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Pri t): Plumber's S' ature:(No mps) MP/MPRSW No.: Business Phone Number:
Jack A. Bo n � 5875 715 235-3650
Plumber's Address( treet,City,State,Zip Co Name of Designer:
2819 Knapp S reet Men onie, WI 54751
VIII. SOIL TEST 1 IFORMATION
Certified Soil Tester ST)Name CST#
2538
Jack A. Bowmin
CST's ADDRESS(Str et,City,State,Zip Code) Phone Number:-
2819 Knapp Street Menomonie, WI 54751 715 235-3650
IX. COUNTYIDEI 1ARTM ENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
S rcharge Fee
Approved ❑ wner Given Initial ( *�� w l s,o U a '1 I_ � OI +
Adverse Determination (�l of "Cy I
X COMMENTS/1REASONS FOR DISAPPROVAL:
rj
SBD-6398(formerly P -67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber
APPLICATION FOR SANITARY PERMIT
ST 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 s bmitted to this office with the appropriate deed recording.
Owner of Property peter J & Debra M Heilmann
Location of Property NE ;x NE 4, Section 1_ 6 , T 29 N - R 19 W
Township Town of Hudson
Mailing Ad ress 205 County Road TT
Roberts WV 54023
Subdivision Name
Lot Numbe
Previous Owner of Property Gordon L & LaVonne Bradley
Total Size of Parcel An
Date Parcel was Created &-Dlbh,-L � J& �9�7
Are all corners and lot lines identifiable? ,/ Yes No
Is this property being developed for resale (spec house) ? Yes ,.- No
Volume 3 and Page Number 851 as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
3. • Other recordings filed with the Register of Deeds Office
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 the Certified Survey Map shall also be required.
PROPERTV OWNER CERTIFICATION
I (We) a '6y that aU 6.ta.tement6 on thiA 6onm ane true to the best 06 my (oun)
knowtedg ; that I (we) am (ane) the owneA(s) o4 the pnopeh ty du cA bed in this
irn6onm 'on 6onm, by viktue o6 a wahAa the 066ice 06 the
County R giAten o6 Deeds as Document 1 a d that I (we)
pneaa own the pnopoaed bite bon th tem (on 1 (we) have
obtained an eu ement, to nun with the above de6ex bed pnopenty, bon the
comtuction o6 said system, and the same has been duty neeonded in the 066ice
o e County Reg"—t-en o6 Deeds, a6 Document No. 1 .
SIGNATORE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SI GNED DATE SIGNED
o ,Meru HO. STATE BAs OF WHOWNSIN 7031K 1-3sM *"�+rrw awran. snags i
WAFAAKff
01M A37
NO 8 Cho
- -- ---
Gordon L. Bradley and' _. W,
'Zwd n ..... .. ........... ... . ........ ►
LaV nne ra ear, ..-uaband and wife twa fW to A �
.................Peter . He ilsann and De Lisa H. fle ilaaan. husband 1:00 ! .>
(irattoe, r
.......... ......................... .........t...................
and we as survivorship marital Property, ''
.. ..... .
.. ... ................................................
.......... ................••......, Gsantea,
1 Witnesseth, That the said Grantor, for a valuable consideration..--.. F
.•. --•- - ............ .. --••........ ---
- --------------fit-. -Croix asrua«ro ,
cone s to Grantee the following described real estate in ... ................. ............
Count , State of Wisconsin
Pari of the Northeast Quarter of the the Northeast
Quarter of Section 16, Township 29 North, Range 19 West, a;
Tax Pared No::...-..._-_...... J,.
described as Lot 1 of a Certified Survey Map filed in '
the office of the Register of Deeds for St. Croix County, Wisconsin
In
Volume 7, Page 1882, as Document Number 430173, on September 15, 1957.
Tog they with a non-exclusive easement for ingress and egress over a 66' vide st
of land shown on said Certified Survey Map as 'Townhall drive".
Sub ect to easements, covenants and restrictions of record, including an
easement granted to Ruth L. Katner, of which grantees are aware.
4 sS
• � � r�F
'
Ft xr
x {'
is not homestead property.
Together with all and singular the hereditaments and appurtenances thersuato belonging: s
And.....Gordon L. Bradle and 4yonne Bradley ;
.....--•--...... ..Y........... ........... ---- . .-Y _._ .. - ._.q......,>
warm its that the title is good, indefeasible in fee simple and free and clear of encumbrances swept '
!9 9
and w 11 warrant and defend the same. 4
Dated this .....................e�...... ......... day of . . .... September . 1187.._:
f
.. . ... .... .. ... .. ............................
r: ......... ..... ...... ---......_......... ...... (SEAL)
• ...... ........................................... •
Gordon L. Bradley................
1 - - •--
........ .............................................. ............(SEAL) d- - .........................(u")
LaVonne Bradley
...... ........................................................ .. ..... ... •-- ._.. ...... .... ............._--•-•---
AUTH1elgTICATION ACKNOWLEDOKNNT
S (s) ....Gar.69A.le--1.1r4-a y..a!d.-•-•---•-•-• STATE OF WISCONSIN
LaV nne Bradley !,
............................................................_...�
....................... ............_.County w
au ticated day 'beg 1s 87 Pill came before at County.
. ...... fL / .=� ........ ........................................... 1s_..... fire alws a iflr
suel,,R: Cari..._.. ._:...._ .......3 .
TI s I[jSDER STATE BAR OF WISCONSIN .... .._
Y �E
( Nick•..... ......................-•-...--•----•-....... ...._. E 3
by; 706.06,Wis. State.) to me known to be the person ............w1o''asap
foregoing instrument and aeitnowledge the name.
MIS IT46MUMENT WAS ORAMED BY
D, CART 6 MURRAY ......-_. ........ .............
................ rPry
Notary : ... --•- -•-- .............
-... ..�..°-
. tom be autbenticated or acknowledged.Beth My Commission is permanent (If tot, sonar
� •) date: ,
yisalee hb-my mpeeft sibmild-Im used at eriaU4 b.— their.rsJ t�craw.
. �.
arasa awt err .-Usk c
a.t-.ups
FILED
SEP161987
to -Anp a cowdu
cam. of News"4
CERTIFIED SURVEY MAP
ocated in the NE 1 /4 of the NE 1 /4 of Section 16 , T29N, R 19W , Town udson ,
R . Croix. County , Wisconsin, Being Lots 1 & 2 of that Certified Survey
Map recorded in Volume 4, Page 997 .
Owned by: Gordon Bradley
Rt 5, ivlcCutcheon Road
I�Pr ROVED Hiadsori, 'JWisconsin 54016
NE CORNER
SECTION IB
\ \ T29N, R19W
PARKS I'LANN#V ���{yN \0
H
ZON NG COMMITTH q`11 �
�O
z y b \ 63b•/s ,
FW (V 9, 1,
y rf O O 'BO ��
Ww ti 12'UTILI'TY \
W ? EASEMENT
0z < LOT 2 M
1-2 id J� \
-I 128, 788 SO. FT.
W >Iq F2 .95 1AF.) q \ \
U W"
y 't Li
W° v al 0 '�'�' w
V I z N89 034'01"W PREVIO S LOT LINE , ` i
W
za "1 37.38' L 0 T 1
v - a1 109, 350 50. FT.
z='a al01 w F 2.515 .AC. ) W a
~O WI I {O i(V I s I S
CD 0 z= ul- o Cert if ed m Surve Map I m N °J ��
z
0 v of 3 Pie-51 o �I
POINT OF BEGINNING o z l
- - - 205.00• _399.00 33' 33'� - -
N 89° 54 01 W
604.00
" _MC_ CUTCHEON— ROAD
NORTHLINE STATION 3T VOL. 5 PG.6
h
GALE ')N FEET 1" n 150' --„�
LEGEND n 3
E 1 /4 C OR.
0 ' 75 150' 300'
SECTION CORNER MONUMENT N
O I"X 24" ROUND IRON PIPE WEIGHING Oj
1.68.LBS./LIN. FT. SET. Z
I" ROUND IRON PIPE FOUND
L Radius Central Arc Chord Chord Tangents
Nc Angle Length Length. Bearing
1
185 . 001 65°26' 12" 2l 1 .28' 199 . 99' S32`55155"E' S65*39101"E S0012149' E
NOTE: Proposed roadway centered on section line 33' east of Lot 1 .
A 33' easement will be granted from Katner to Bradley adjacent,
ca st of'' and parallel with said section line , also, a 33' easement
will be granted from Bradley to Katner adjacent, west of, and
parallel with said section line .
Cne;4 h s m ap is a realignment of lot lines. No b lots have been created. St. Croix
o my Zoning approval is not required ,
pe St. Croix County Zoning Ordinance HARVEY Q,
18.02 (4)(b)3 ---,� JOHNI N
HO
Vol. 7 Page 1882 ''�N�111N!M� 487.1275
SA. 11
from-
' H
- z
H
a
ST C - 105 r
a
y
SEPTIC TANK MAINTENANCE AGREEMENT o
St . Croix County z
t7
a
OWNER/ UYER GT9k- "OLPA00
ROUTE/ BOX NUMBER P,015 (' S Fire Number
CITY/S ATE l,Oc�Fk f ZIP 5`�OZ3
PROPER Y LOCATION : 1J� �, t�E _14, Section_, T Z4 N , R 141 W,
Town of tA Vo'tpOo-f , St . Croix County ,
Subdivision
OqVUNE !%"W4 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 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 . C oix . 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
ownerE of all new systems agree to keep their systems properly
maint ined .
The p operty owner agrees to submit to St . Croix County Zoning a
certi ication form, signed by the owner and by a master plumber ,
journ yman plumber , restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
opera ling condition and (2) after inspection and pumping (if nec-
essar ) , the septic 'tank is less than 1/3 full of sludge and scum.
Certi ication form will be sent approximately 30 days prior to
three year expiration . y
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I/WE, the undersigned , have read the above requirements and agree
to ma ntain the private sewage disposal system in accordance with H
the s andards set forth, herein , as set by the Wisconsin Depart- b
ment tf Natural Resources . Certification form must be completed
and r turned to the St . Croix County Zoni Office within 30 days
of th three year expiration date .
S I G N E
DATE
St . Croix County Zoning Office
P .O . 3ox 98-
Hammo d, WI 54015
715-7 )6-2239 or 715-425-8363
Sign, date and return to above address .
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INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 •
To be a complete and accurate sail test:,your report rust include:
1. Complete legal description;
2. The use section must clearly indicate whether this is a residence or commercial project;
3, MAXIMUM nu€nber of bedroorns or comma€=,rcial use planned;
4. Is this a new or replecenaent syst:ena;
5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLD NG TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED CAN SOIL CONDITIONS;
6. PLEASE use the abbreviations shower here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheer may be used if desired;
8. Make sure your b€fnchna ark and vertical elevation reference point are clearly shown,and are permanent;
9. Complete all appropriate boxes as to dates, names,addresses,flood plain data,percolation test:exerp-
tiott,if appropriate;
10. if the information (such as flood plain,elevation)does not apply, place N.A.in-the appropriate box;
11. Sign the form and place your current address and your certification number;
12. Matte legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION,
ABBREVIATIONS FOR CERTIFIED SOIL. TESTERS
Soil Separates and Textures Other Symbols
st — Stone (over 10") BR Bedrock
cob — Cobble (3- 10") SS — Sandstone
gr - Gravel (under 3") LS — Limestone
"s __ Sand HGW High Groundwater
cs Coarse Salad Perc Percolation Rate
reed s - Medium Sand W Well
I's F nE Salad Blelcl — Buildin€I
is .._- Loamy Sand > - Greater Than
sl — Sandy Loarn ` Less Than
'l Loam rasa — Brown
Isil — Silt Loarn BI Black
s€ Silt Gy _... Gray
Xcl — Clay Loam Y — Yellow
scl — Sandy Cray Loarn R -- Red
sicl Silty Clay Loam mot — Mottles
sc - sandy Clay tn:` - with
sic - Silty Clay fff few,fine,faint
*c — Clay cc — common, coarse
p.t ..... Peat rm .... Many,medium
n) — Muck d — distinct:
p -.. prominent.
HWL High water level,
Six general sail textrares � surface water
for liquid vvaste disposal BM — Bench Mark
VRP Vertical Reference Point
TO THE OWNER:
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private
sewage system and a permit application must be submitted to the appropriate local authority in order to
obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction.
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, DIVISION
LABOR AN
R`Ep PERCOLATION TESTS (115) MADISON WI 3707
HCIMAN LATIO S
(ILHR 83.0911)& Chapter 145)
LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME:
NE �4 NE 1/4 16 /T 29 N/R 19r)W Hudson 1 N/A N/A
COUNTY: O NER'S BUYER'S NAME: MAILING ADDRESS:
St. Croix Peter Heilmann 205 County Road TT Apt # 5 Roberts WI
USE DATES OBSERVATIONS MADE
140.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER 0LATION TESTS:
®Residence 3 N/A New ❑Replace I August 1, 1987 August 2, 1987
RATING:S=Site suitable for system U=Site unsuitable for system
CONVENTIONAL: U ND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDINGTANK: RECOMMENDED SYSTEM:(optional)
®S ❑U IMI S ❑U ®S DU ®S ❑U 0S ®U
If Percolation Tests are OT required DESIGN RATE: If any portion of the tested area is in the
under s. ILHR 83.09(5)(b),indicate: Floodplain,indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- 1 80 V7.5 None ) 80 4" BL ts, 8" BN sil,68" BN sand & gravel
B- 2 1 75 97.8 1 None ) 75 6" BL ts, 9" BN sil, 60" BN sand & Gravel
B_ 3 72 93.0 None ) 72 8" BL ts, 10" BN sil, 54" BN sand & gravel
B- 4 75 12.5 None ) 75 8" BL ts, 12" BN sil 55" BN sand & gravel
B- 5 75 None ) 75 6" BL ts, 10" BN sil, 59" BN sand & Gravel
IB- 6 1 75 97.4 None ) 75 4" BL ts, 11" BN sil, 60" BN sand & Gravel
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
P_ 1 30 None 10 6-2 6 6 Class 1
P- 30 None 10 7 6�4 6 Perc
P- 6 30 None 10 6 54 5 Rate
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. - G--�7 -/ Sf�
SYSTEM ELEVATION
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I,the undersigned, hereb 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:
Jack A. Bowen n d/b/a BOWMAN PLUMBING August 2, 1987
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
2819 Knapp S reet Menomonie W 1 54751 2538 1715-235-3650
CST SIGNA R
DISTRIBUTION: Origin I and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395(R. 10 83) —OVER —
Bowman's plumbing
Jack Bowman - Proprietor
_ilmann Master Plumber No. 5875
.,ounty Road T
_oberts, WI 540D 2819 Knapp Street
Menomonie, WI '
St. Croix County 34
Town of Hudson
715 235-46 �
; jack A. Bowman CST��4�52538
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