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020-1028-50-000
'o C> z- 0 \ k > c 0 21 c 0 -2 cn 0 z 0 m U E .0 M LLJ z 4j k 0 z V a c,4 ca LLJ IL U) .0 0 z c 0 W z z 72 2 E CY) ) (D c .2 0Q, 0 (D < z co z c 0 2 2 t CO m 12 211 0 .4-- (o E -'a'd 0 0 F- 0 Z m 't YL '6 z 0 0 0 m 0 0 cn 10 00 00 0 0) a) z '0 N C14 CD 7a 5l 2 R 0 cl - 0 0 'n v E (D c m 9 0 0) CD L) C) LO LO c / ) ) CL 00 0 a CN co Q> m o 04 (D 0 c a) . :E -6 z 7 (on 0 a) '0 a) 0.4 0 C14 E �c m a) N (D o co 0 z 10 C'n L CL IL cl E CL Z 2 0 m o U) o o 0 CL €?arc I #: 020-1028-50-000 02/16/2006 08:24 AM PAGE 1 OF 1 Alt. Par el#: 16.29.19.126C 020-TOWN OF HUDSON Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner KURT L&JULIE A SCHMIDT O-SCHMIDT, KURT L&JULIE A 590 SP RLINE CIR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *590 SPURLINE CIR SC 26111 SCH D OF HUDSON SP 700 WITC Legal D scription: Acres: 2.010 Plat: N/A-NOT AVAILABLE SEC 16 T29N R19W SE NE LOT 3 CSM 4/958 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 06/04/2002 680765 1903/571 WD 07/23/1997 1039/328 WD 07/23/1997 789/469 07/23/1997 780/01 more 2005 UMMARY Bill#: Fair Market Value: Assessed with: 91583 282,300 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDE TIAL G1 2.010 69,000 218,900 287,900 NO 05 Totals for 2005: General Property 2.010 69,000 218,900 287,900 Woodland 0.000 0 0 Totals for 2004: General Property 2.010 48,000 163,000 211,000 Woodland 0.000 0 0 Lotterl Credit: Claim Count: 1 Certification Date: Batch#: 138 Specials: User Sp 3clal Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 e OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION t IN TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system: w grd ❑At-Grd ❑Mound Approx. size 4' X,�r Ee: ity ODose OPressurized Ft.2 d OTrench ODry Well Molding Tank OOutfall pipe OBSERVED DEFICIENCIES ❑Other OUnknown Septic tank P�GOSLocking etbacks: OHouse OWell-e❑prop. linei�e❑Other ank etbacks: OHouse� OWell ❑Prop, line ❑Other cover ❑Warning label ❑Pump/Floats OAlarm ❑Elec. wiring _Soil Absorption System Setbacks: Hous*❑Well -DProp. line OOther OPonding: Q, ❑Discharge: General comments: J INSPECTORS SKETCH OF SYSTEM LOCATION 0 r l Inspector Title � ` c ,. ST. CROIX COUNTY 3 WISCONSIN ZONING OFFICE ST.CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 (715)386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Specify desired test(s) & remit appropriate fee with application. outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. Water (VOC's) $185. 00 L$ Septic $25.00 I Water (Nitrate & Bacteria) $35.00 (Visual inspection) Owner: Jeff & Pam Larson Requested by: Jim Henry - Edina Realty Ad ress:590 Spurline Circle Address: 700 2nd Street Ci y & State: Hudson, Wi . 5,4016 City & St. Hudson, Wi . ,54016 Zip Code: Zip Code: Te ephone N4: ( 715) 386-7602 Telephone N4: (715 ) 386-8236 Property address (Fire NO & Street) : 590 Spurline Circle Location: SE „ NE ;, , Sec. 16 , T 29 N, R 19 W, Town of Hudson St Croix Co. , WI. Tax ID N4 Parcel ID N4 ZTU7� House color: Brown Realty firm: Edina Lock Box Combo: JDH Water sample tap location: your choice TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE 0 IS FORM>t Is the dwelling currently occupied? XY Yes ❑ No qg I --k- If vacant, date last occupied: Se tic system installed by: Boumester Const. Year: Se otic tank last serviced by {- t- �• n Date: X99 Pr vious Owner's Name(s) : n a Have any of the following been observed? OY `ON Slow drainage from house. �' � OY E1 Sewage Back-up into dwelling. OY $fN Sewage discharge to ground surface, road ditch or body of water. OY 1N Slow drainage from the dwelling. 0Y JqN Foul odors. y l k✓, Kr� Y other comments relative to system operation: I certify that the above information i complete an `tue to best of my knowledge. OWNERS SIGNATURE: I 4/ 3 August 18, 1993 Jim Henry Edina Realty 700 2nd Street Hudson, WI 54016 Deai Mr. Henry: An inspection of the septic system on the property of Jeff and Pam Lar on, located at 590 Spurline Circle, Hudson, was conducted on August 18, 1993 . At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as ue receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, the 2:e is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once eve y three years . Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact this office. Sincerely, James Thompson Assistant Zoning Administrator mij COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3 21 l 800 - 962 - 5 27 FAX - 715 - 9 32 - 4030 ST, CROI COUNTY GOVERNMENT REPORT NO.* 47211/01 PAGE 1 CENTER REPORT DATE* 8/24/93 1101 CAR MICHAEL ROAD DATE RECEIVEW 8/19/93 HUDSON, 111 54016 ATTN* TH C. NELSON OWNER* Jeff 6 Pam Larson LOCATION* 590 Spurline Circle Hudson, WI COLLECTOR* Jim Thompson DATE COLLECTEDB-18-93 TIME COLLECTED4*00 SOURCE OF SAMPLE* kitchen faucet DATE ANALYZED*$-19-93 TIME ANALYZED*2*00 COLIFORM,MFCC* 0 /100 ml INTERPRETATION* Bacteriologicatty SAFE NITRATE-N* 8 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform acteria/100 ml. Nitrate-N trogen, mg/L RdIVED AUG 2 6 1993 N ST CROiX COUNTY w LAB TECHNICIAN* Pam Gane qc- ZONING OFFICE oFANOEVEIypEH WI Approved Lab No. 14 4 Cy { Means "LESS THAN" Detectable LeveL Approved by* PROFESSIONAL LABORATORY SERVICES SINCE 1952 4 ERCO Laboratories 1931 West county Road 2. St.Paul. Minnesota 55113 Phone(612)636-7173 FAX(612)636-7178 LABORATORY ANALYSIS REPORT NO: 33067 PAGE 1 of 3 08/31/93 St. Cr ix County Zoning DATE COLLECTED: 08/18/93 1101 Carmichael DATE RECEIVED: 08/19/93 Hudson, WI 54016 COLLECTED BY : CLIENT DELIVERED BY : CLIENT SAMPLE TYPE DRINKING WATER Attn: Mary J. Jenkins CLIENT'S ID: J Larson SERCO SAMPLE NO: 104673 SAMPLE DESCRIPTION: J Larson ANALYSIS: ----------------------------------- -------- Benzen <1. 0 ug/L <0. 2 Bromob nzene, ug/L Bromoc loromethane, ug/L <0.4 Bromod chloromethane, ug/L <0.2 Bromof rm, ug/L <0. 5 Bromom thane, ug/L (Methyl bromide) <1. 0 n-Buty benzene, ug/L <0. 3 sec-Bu ylbenzene, ug/L <0.4 tert-B tylbenzene, ug/L <0.5 Carbon tetrachloride, ug/L <0. 2 Chloro enzene, ug/L <1. 0 Chloro thane, ug/L (Ethyl chloride) <0.4 Chloroform, ug/L <0. 5 Chloro ethane, ug/L (Methyl chloride) <0. 6 2-Chlo otoluene, ug/L (o-Chlorotoluene) <0. 2 4-Chlo otoluene, ug/L (p-Chlorotoluene) <0.2 Dibrom chloromethane, ug/L <0. 4 1, 2-Di romo-3-chloropropane, ug/L <1. 2 1,2-Di romoethane, ug/L <0.2 ( Ethylene dibromide) Dibrom methane, ug/L <0. 2 1, 2-Di hlorobenzene, ug/L <1. 0 ( -Dichlorobenzene) 1, 3-Di hlorobenzene, ug/L <1. 0 ( -Dichlorobenzene) < means "not detected at this level" . 1 mg = 1000 ug. , Arm 7 ERCO Laboratories 1931 West County Road 2. St.Paul. Minnesota 55113 Phone(612)636-7173 FAX(612)636-7178 LABORATORY ANALYSIS REPORT NO: 33067 PAGE 2 of 3 08/31/93 SERCO SAMPLE NO: 104673 SAMPLE DESCRIPTION: J Larson ANALYSI : ------- -------------------------------- -------- 1,4-Dic lorobenzene, ug/L <1. 0 (p Dichlorobenzene) Dichlor difluoromethane, ug/L (Freon 12) <0. 5 1, 1-Dic loroethane, ug/L <0. 1 1,2-Dic loroethane, ug/L <0.2 (Ethylene dichloride) 1, 1-Dic loroethene, ug/L <0. 2 cis-1,2 Dichloroethene, ug/L <0. 1 trans-1,2-Dichloroethene, ug/L <0. 1 1,2-Dic loropropane, ug/L <0. 1 1, 3-Dic loropropane, ug/L <0. 2 2, 2-Dic loropropane, ug/L <0.2 1, 1-Dic loropropene, ug/L <0.2 cis-1,3 Dichloropropene, ug/L <1. 5 trans-1 3-Dichloropropene, ug/L <0. 9 Ethylbe zene, ug/L <1. 0 Hexachl robutadiene, ug/L <0. 3 Isoprop lbenzene, ug/L, (Cumene) <1. 0 4-Isopr pyltoluene, ug/L <0. 5 (p Isopropyltoluene) Methyle e chloride, ug/L <5. 0 (D'chloromethane) Naphtha ene, ug/L <0. 2 n-Propy benzene, ug/L <0.4 Styrene ug/L <1. 0 1,1,2,2 Tetrachloroethane, ug/L <0.2 1, 1, 1,2 Tetrachloroethane, ug/L <0. 1 Tetrach oroethene, ug/L <0. 2 Toluene ug/L <1. 0 1,2, 3-T ichlorobenzene, ug/L <0. 2 1, 2,4-T ichlorobenzene, ug/L <0. 2 1, 1, 1-T ichloroethane, ug/L <5. 0 < means "not detected at this level" . 1 mg = 1000 ug. ("(DE,11-1�` ERCO Laboratories 1931 West County Roac C2. St.Paul. Minnesota 55113 Phone(612)636-7173 FAX(612)636-7178 LABORATORY ANALYSIS REPORT NO: 33067 PAGE 3 of 3 08/31/93 SERCO SAMPLE NO: 104673 SAMPLE DESCRIPTION: J Larson ANALYSIS: ------ --------------------------------- -------- 1, 1,2- richloroethane, ug/L <0. 1 Trichl roethene, ug/L <0.4 Trichl rofluoromethane, ug/L (Freon 11) <0. 7 1,2, 3- richloropropane, ug/L <0. 2 1,2,4- rimethylbenzene, ug/L <0.2 1,3,5- rimethylbenzene, ug/L <0. 3 ( esitylene) Vinyl chloride, ug/L <1. 0 Total ylene, ug/L <1. 0 3 W&I--93 This sample's analytical results are aT-,- not below the U.S. EPA's SDWA Maximum Contaminant level of /30/91 for those requested compolLnds which are also on the SDWA MCL list. The analytical results in this report pertain only to the items tested. All analyses were performed using EPA or state approved methodologies. Samples that may be of an environmentally hazardous nature may be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, Diane J. Anderson Project Manager < means "not detected at this level" . 1 mg = 1000 u g• Parcel M 020-1028-50-000 02/15/2006 11:41 AM PAGE 1 OF 1 Alt. Par el'#: 16.29.19.126C 020-TOWN OF HUDSON Curren X ST. CROIX COUNTY,WISCONSIN Creatiori Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Add Tess: Owner(s): O=Current Owner, C=Current Co-Owner O-SCHMIDT, KURT L&JULIE A KURT L&JULIE A SCHMIDT 590 SP RLINE CIR HUDSON WI 54016 Districts: SC= School SP=Special Property Address(es): *=Primary Type Dist# Description *590 SPURLINE CIR SC e 611 SCH D OF HUDSON SP 1700 WITC Legal D scription: Acres: 2.010 Plat: N/A-NOT AVAILABLE SEC 16 T29N R19W SE NE LOT 3 CSM 4/958 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 06/04/2002 680765 1903/571 WD 07/23/1997 1039/328 WD 07/23/1997 789/469 07/23/1997 780/01 more 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 91583 282,300 Valuations: Last Changed: 10/25/2005 Descrir tion Class Acres Land Improve Total State Reason RESID NTIAL G1 2.010 69,000 218,900 287,900 NO 05 Totals for 2005: General Property 2.010 69,000 218,900 287,900 Woodland 0.000 0 0 Totals for 2004: General Property 2.010 48,000 163,000 211,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 138 Spec als: User S 3ecial Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 " m IL�D JUN 30 1980 homw of 6066 36 888 Oak '° afy- CERTIFIED SURVEY MAP z NORTH--� SCALE iN FEET ASSUMED NORTH REFERENCED TO 0 300 600 THE E. LINE OF THE NE 1/4 BEARFN6 (1°=300') I ASSUMED N 00 12' 49" W ' -- — E I/4 CORNER LEGEND "CORNER SECTION 16 -� COUNTY MONUMENT,BERNTSEN CAP u T29N, R19W N 0°12 49 W 1287.50 0 3/4" X 24" STEEL BAR WEIGHING 1.502 LBS./ 3 - NE 1/4 �� LINEAL FOOT SET UNPLATTEO LANDS DESCRIPPION tn °m z N O°05'59°E tiF A parcel of land located in the SW-,' of the NE-1 and th BEGINNING 3oe 342.14' SE1 of the NE1 of Section 16 T2 9N, R19W Town of 4 4 9 f I o" 4 \�^° 82,E F Hudson, St. Croix County, Wisconsin, described as to O follows: Commencning at the E4 corner of said Sectic ipV 7 4.008 ACRES e 16; thence N 0012'49" W (assumed bearing referenced t the East line of said NE4, bearing assumed N 0012-49" f I Sry 0005'59"wo o�o�� 1287.50' to the Southerly right-of-way line of McCutc o I o.00' o - °�App Road; thence N 89 954'ol" W 194.35' along said Souther 10 ® ° m t th line o e point of beginning; thence continuing N0005'59"E N 89054'01" W 2429.04' along said Southerly line to t 0 50.00' i I V6�I, tiF a �� West line of said IQ thence S 0021'38" E 219.00' - m ♦ ab �o�� 2, along said West line; thence S 89054'Ol" E 400.00' ; thence N 0021'38" W 219.00' to said Southerly line; °U0 90 W h w I M 2.01 ACRES thence S 89054'01" E 66.00' along said Southerly ling. F .F, 0 136"15"o ip thence S 0021'38" E 438.o6, ; thence S 89 054101" E 20C .ym a3��° �9a thence N 0021'38" W 438.00' to said Southerly line; 3 I s � 0 thence S 89054'01" E 1036.04' along said Southerly li I 0o thence S 46°20'59" W 149.601 ; thence S 43039'01" E W I sm1 311.021 ; thence N 46020'59"' E 208.93' ; thence North- easterly 149.33' along a 185.00' rad us curve concave Z I Northwesterly whose chord bears N 23 13129" E 145.31' In I o; thence N 0005'59" E 50.00' to said Southerly line; oil ='z �i thence S 89054'01" E 66.00' along said Southerly ling o1 thence S 0005'59" W 50.00' ; thence Southwesterly 202. a along a 251.00' radius curve concave Northwesterly 3 W 3 13 SW- NE y o U. W; whose chord bears S 23013'29" W 197.15' ; thence zzMU7 Zfl .x o 0 " Wilt �i S 46020'S9" W 57,of ; ;thence S 43039'01!' E 389.31' ; z m a c 0 x11 I - thence Northeasterly 150.94' along a 2814.93' radius i FBI ;; curve concave Northwesterly whose chord bears N 430 W N o °o �'I 47125' E 150.92' ;\thence 0005'59" E 342.14' to the Z; c U)0 011 F point of beginning`\,, Wzo 0 0 III a M c l o (thence N42 015'15"E 135.82' Subject to all easements of record, and subject to ,a m Cr G 12' utility easement across the existing and proposed F X W ° 0 °_ I roadway frontage running parallel therewith. Fa- w ; W i ( N O°2 '38"W 438.00' a N N N I �° w Containing 10.038 acres more or less. c z It M M 1 0 2j3T ill 2 11's� 0 0 > =m v N N 1 Ne�Z11 2n ACRES �°2�N I, James E. Rusch, registered Wisconsin Land Surveyor. z z I 1980°21'3 "E 438.00'3?° y do hereby certify that I have surveyed and tf)apped the O F o 8 o 1 - PRO OSEO above described property; that such plat is a true an Z a W °a, �, X19 13 CV —= —Tu Rt°-A� correct representation cf the exterior boundaries of t'co N ry J -land surveyed; and that I have fully complied with th �z < v M 1 I "` °�W provisions of Chapter 236.34 of the Wisconsin Statute 1 I '� ° o q and the Town of Hudson Subdivision'Ordinance, and the Z - I ACRES Om ° St. Croix County Subdivision Ordinance. to the best of I g . H my professional knowledge, understanding and belief. ryD Q° I"IRON PIPE ,°� FOUND !M, Ids o 2038"E �— ames E Rusch S-1376 rd� t�G�ry$��!,*iy 1661 W. LINE NE I/4 Stevens Engineers, Inc. - 1 1 1409 Coulee Road-Box 321 } JAMES E. I I UNPLATTEO LANDS Hudson, Wis. 54o16 RUSCH R 1 -------- -- S-1376 River Fags, s 1 fi Wis. Volume 4 Page 958 �� < ,w A ySS ''+F � 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, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). ncPOe� 5W - 1.o1 AND 41. 95 81.95 too. SOIL ABSORPTION SYSTEM -To i.oi — I- 9.4I g�Iba� (3cc� Bed: ench: Width: Length: Number of Lines: Area Built Fill depth to top of pipe: 7 �1 i Number of feet from nearest property line: Front,, 0 Side, 0 /7%Rear, Ft . _ Number of feet from well: Number of feet from building: +�r (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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: D2� - i I I Plumber on job: B() rfyu b�� License Number: 3/84:mj r Form - S T C - 104..)) AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP L u S i)�� SEC. TN-R- Ll nW ADDRESS ' � �� ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distanzes and dimensions to meet requirements of II- HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM den y. Y, 3 B f-'D ROO ry �a Ho(Y\ ---a N INDICATE NORTJ ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: 100J Proposed slope at site: SEPTIC ANK: Manufacturer: ��, k 5 Liquid Capacity• I a U Num er of rings used: Tank manhole cover elevation: Tant Inlet Elevation: 9 3.4 Tank Outlet Elevation: 93• g Num er of feet from nearest Road: Front,®Side 0 Rear, O feet Irom nearest property line Front,OSide,k,/yRear,0 IS feet Num er of feet from: well 41 )►U building: (Tnt-ltidc ttis information of the above plot plan) ( 2 reference dimensions to sept c tank) SEE REVERSE STDE r I DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION MA 611810W,P BOX 7969 BUREAU OF PLUMBING �YE''W 1 5370 SE4, NE4, S1 ,T29N—R19W UCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number : (lf assigned) Town of Hudson ❑Holding Tank ❑ In-Ground Pressure ❑Mound Lot 3 North! ne Station II N 71 A-i AME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Jeff Larson Route 3, Box 277, Hudson, WI 54016 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: Richard Hopk ns 1059 St. Croix 99109 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV,. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PRrO�IVIDED: PROVIDED: , ACES ONO DYES --9N0 BEDDING: V NT DIA.: VENT MAT L: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH CiZ ALARM FEET FROM ^ LINE AIR INLET: ❑YES O 'ES O NEAREST' 1 O�P o()TXU 14 DOSING CHAMBER: MANUFACTURER. 9 iDUING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER 1 :1 PROVIDED: PROVIDED: YES ❑NO ❑YES ONO OYES ❑NO GALLONS PER CYC E: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (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 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 I o continue.) MAIN CONVENTIONAL SY TEM: W DTH: ILENGTH. ENO.OF DISTR.PIPE SPACING. COVER INSIDE DIA.. ,*PITS LIQUID B / E +" e� ENCHES. r MATERIAL: DEPTH DEPTH DIMENSIONS is va -- GRAVEL DEPTH FI L DEPTH IDISTR.,PIP1 DISTR.PIPE DISTR.PIPE MATERIAL: NjEtI, UMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES. A OVE COVER. ELEV. NLET.ELEV.END: PI 'LINE AIR INLET: q��(p ��,R a"1��1 NEARES°"�--�.. 5v Ua+� 43 43t MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thr wn upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- OYEE ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER ITEXTURI PERMANENT MARKERS OBSERVATION WELLS DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED.OYES ONO DYES MULCHED: ❑NO CENTER. EDGES. DYES E1 NO DYES 1-1 NO OYES E:1 NO PRESSURIZED DISTRIBUTION SYSTEM: WI TH. LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BE■L�11T ED/TRENCH TRENCHES: Mi NIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. EL V.: ELEV: DIA.-. ELEV.: PIPES: DIA.: ELI=�f�,7'F �I�1I� '. 1IBTRII�UTION H LE SIZE HOLE SPACING- DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATIpN PLANS: OYES FIND DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS NUMBER OF L NE:ERTV WELL: BUILDING: DYES 1:1 NO OYES 1-1 NO NEA1I:ST '' Sketch System on Retain in county file for audit. Reverse Side. G TUBE: TITLE: d13ifnb� Administrator DILHR SBD 6710 IR. 1/82) C„ 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; 11. 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; 111. 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'/z 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. • s -------------------------------------------------------------------------------•----------------------------------------------------------------------------- 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 dater included the creation of surcharges (tees) for a number of regulated practices which Wiscor sfn'S a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasuft is used in your building is returned il� the groundwater through your soil absorption u , system or the disposal site used by your holding tank pumper. a The monies collected through these surcharges are crecited 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 es,ablishment of standards. Groundwater, it's worth protecting. 5BD-%398 'RM186) r � DIL R SANITARY PERMIT APPLICATION co T C In accord with ILHR 83.05,Wis.Adm. Code STAT ## SpANITARY PERMI -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 iri size. -See reverse side for instructions for completing this application. PETITION I. APPLICANT IN ORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE El YES R NO PROPERTY OW ER JJ PROPERTY LOCATION L A e 5GIN %a '/a, S 1 T , N, R I q E (orQ PRO ELY O ER' A NG ADDRESS LOT NUMBER BL CK UMBER S DIVI I N ME 3 3 a i CRT ,S ATE ZIP CODE PHONE NUMBER ❑LJ CITY VILLAGE: N REST AD,LA .OR L D RK k o Sc. k So j K C aA II. TYPE OF BUILDING OR USE SERVED: "- &&J — Sal Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify):Co ' W III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. 1X 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 Exis ing 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. XConv ntional b. ❑Alternative c. ❑ Experimental 2. a. ❑Syst m- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP I n-Fi 1 Tank V. ABSORPTION YYTEM INFORMATION: (Check one) 1. a. XSeep tge Bed b. ❑Seepage Trench C. ❑Seepage Pit 2. PERCOLATIOI RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Mies per'nch): REQUIRED quare Feet): PROPOSED(S uare Feet): I Q Feet X Private -]Joint ❑ Public VI. TANK CAPACITY Site in gallons Total ##of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper. INFORMATION New xistin anuact N Gallons Tanks Concrete stCon- glass App. Tanks Tanks Septic Tank or Holdina Tank 0 t} Lift Pump Tank/Siphon Chamber I ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber' Name(Print: Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number:kof&S I ,_ I os 9 -1 Plumber's dress(St eet,Cit fate, Code): Name o3A94 signer: C r�o X17 o n► VIII. SOIL TEST INFORMATION Cert'fi d S ester T)Nam6t W CST CST's ADDRESS(St Vlo City,State,Zi Code) Phoneee Number: 3 x 31 Q--w 9j k mtj Nd W'i s c. 5100 15 � —D03 IX. COUNTY/DEP RTMENT USE ONLY ❑ Di 5appro ved IV,itary Permit Fee Groundwater ate Issuin Agent Signature(No Stamps) ®Approved ❑ O ner Given Initial S arge Fee ( A verse Determination ', • C�tJ —�� GYt� X. C MMENTS/RE ASONS FOR DISAPPROVAL: �--- SBD-6398(formerly Plb- 7)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber t i APPLICATION FOR SANITARY PERMIT S T C This application form is to be completed in full and signed by the owner(s) of the property bei g 'developed. Any inadequacies will- only result in delays of the permit issuance. S ould 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 sub itted to this office with the appropriate deed recording. Owner of Property Location of Property 1-J E k, Section kkQ , TQ�N-R—t c�— W Township Mailing g S2+_ 75 BnY a > try Address of Me 1 4 K Subdivision tame �o��� 1►ir�f-� < lte Lot Number Previous Owner of Property Total Size of Parcel 311" X 111� /t Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (!pec .house) ? Yes No Volume and Page Number as recorded with .the Register of .Deeds. F INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Telzister 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 be required. PROPERTY OWNER CERTIFICATION 1 (We) ceh ti 4y that att &tatements on thi4 6onm ape 't&ue to the b-U t 0-my (OUA)1--'----..-- K knowledge; at I (we) am (ape) the owneA(z) o6 the pnopeAty ducAi•bed in thin in6oAmati,•on le nm, by viAtue o6 a waA awty deed neconded in the 066ice o6 the County Reg.i.& n o6 'Deeds as Document No, y 9 , and that I (We) pnedentey own the pup zed 6 to 6on the d euag e d i z poa d yb em• (on I (we) have obtained ned an easement, to un with, the above descA bed pnopehty, bon the constnucti.on o6 &aid system, and tame has been duty neconded in the 066ice o6 the County Reg.izten o6 Deed&, as Vocument No. -el.?96 5$ V. QLTR—Qa,� , �Ai MQOptW OP DWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED xo OR i QQC4 x ` .ri y r S follyflm TO 7M T'kK NO WO Y N 3 C `�'�`"► 40 Mg4 vo avlo a L5E\1,4 06 N r- V, g ,�{ : ' `�' � '�,�„�•nine��� �a..��n, ��tia. w;.�,,tt�,,�,3 �� c+ �' � t�Rat A x =y - 'f �1 h +,am. so M Alt TY t�iMO � � r # t _ „ sTATE'OF WWOCNiM!► t x" 5t: taotx P��r�w�►r r A of aelr�irrttfy�tl1 "� fl r r .................................................................... 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S6 ............................................................................................................................. P6 ...................I.......................................................................................................... 16 ............................:16 0198 S3NFT NI 031V-LS SN0I1VJLN3S3Xd3U GNV S91INV-"VA#t 01 SN011d30X9 Z6 Umoux E)UOU U011!pUO3 2ullsIX3 Auu jo U01130noo Jo U01juni1u *.uud;).t 2upinbatiopio pno3 io Ama2u JU3UJWOA0(q) 16 •A1-'ado-'d aql loollu Alluilojew astAuaqlo jo sjumssassu jumads ui jinsO.1 AUM q3111M JUMOAoidwi micind panowuloo jo pauuuld(L,) 06 :Auv jo o2p3l"Aoul jo aoijou ou suq'jalloS juqj joAn* o" 68 8 1 sjuaswdw pup sluunum jolloS (•suoijulntm spuullom of jaja-d :uoijnu3) 88 .. ... .. ................................................................................................................. LB . ...... ..................•......... .jad su 'weld pool; u ui polnol sou si A1-'ado-'d aqj ley iaAng of sjuasaldal puU Sjuu.UWA.1ollOS 98 UmouxE)UOU ,.........................*............................I........................... .......................................... S8 . . . ....I...................................................................... pauoz si Apacloid aqj juqj JOAn 01 SjuasoidainliaS V8 .t�............. TPT4U9PTSaJ - -1 . '-'atlas pue iaAng Aq guilym uj paaift aq Am se aould pue atui iaqlo'q,3ns A Yo 19 • 61 . ........ £8 *—... ... . ..... . ..... .. .... ... .... ... .. . ajojz)q jo uo. .......................I69puourL.13T.H..MaN..'.*.9AV..S @.TMO.UN..q4n.0 S..T 0.Z ze ..................-1.......................... jo a5W6 atp ju jo aaftilvotu s,.iaAng jo aoUjo aLp ju pasol3 aq ol st uotpusmil siql is 13 NAG UPA "e-T-4SUT;DU ......... ................. 'J0OJDqj fUOA1l;)pluuosjad Aq jo. .........I........................................................ 08 .................. )e joAng ol passaippu sl!ew 6L . ....... . . .................. IVA (� 0 m,p!vd.)jd 34,ujsod'p3qsodap si j3jjo pa)doonjo Adoo u 1pun nAnu uodn',Iuipuiq aLuo.),,)q)ou lleqs j!'pajdain si jajjo sitliji 8L err... ..,.� .. .�...,..�... ��,.,.� 5-1-8.2 VACANT LAND OFFER TO PURCHASE 1 ...... ..... New Richmond.. . ...... ,Wisconsin. ................................................... 19 . . . . 2 The unde signed Buyer, ....... ... ......69 0 .. 3 hereby offers to purchase the property known as Lot 3 Nor t h l i ij2 S t a t ion I I 4 in the . . . . .T wn. . . . . . . . of . . . . . . Hudson . . . . .County of . . .St. Croix ,Wisconsin, 5 more particularly described as: ....see above.............................................................................. 6 ............ .............................................................................................................. 7 ............ .............................................................................................................. 8 ............ .............................................................................................................. 10 at the price of. @Jer . 414 , ..- �..�uk ,t ...4 -=��,�+-x.. `O.<. ......... ............................ 11 Dollars($—//,. .4A.,&•... ..) and on the terms and conditions as follows: 12 Earnest money c f$...5-M,.?m.........tendered herewith.Additivnafie 13 . . .------ ----:-7------------77 -l:0 fie paid win-.:--:----nays o—raccepTance oT—otTei or o—n—.—......... 14 ------ ----------------------------------- ;and the balance in cash at closing tn+ashereaPterserfarth. . . ....... .... ...... ..... .. ... ..... ......... .. 15 If this offe is the result of a co-brokerage,then all money paid herewith shall be held in the selling broker's trust account until the acceptance of 16 this offer and sh all be transmitted to the listing broker upon such acceptance. 17 Additiona earnest money payments shall be made to the listing broker and held in the listing broker's trust account or NIA......... 18 ............. ............................................................................................................... 19 TIME IS OFT E ESSENCE AS TO:ADDITIONAL EARNEST MONEY PAYMENT,LEGAL POSSESSION,OCCUPANCY,AND 20 DATE OF CLOSING. (Strike those not applicable.) 21 THE BUYER'S OBLIGATION TO CONCLUDE THIS TRANSACTION IS CONDITIONED UPON THE CONSUMMATION OF THE 22 FOLLOWING 23 (If this offer is st bject to financing,percolation test,specific zoning or use,approval of recorded building and use restrictions and covenants,or any 24 other contingen y,it must be stated here. If none, so state.) 25 1. This offer is not contingent on the sale of any other property. 26 .2.. .T. s,offer-is.not..contingent.on...inancing. ... ..... . ..... ... .... ... .... ..... ... ... ..... ..... ..... ... 27 3. This offer is contingent on the subject property meeting the present 28 , st ndards 'to*'o}6ta ri a permit f' the ristalYationof 'a' c'1as's''tf' se tic system. 'Tie percoYat on 'tes.t''sh'a1'1**be''taken'*at'�UYtl2' 29 , 30 ...., ex en.se.by-Ci-66rt fiecT'soiY"tes't'er: .Th6e report.sfiaYl:'be'"corlpletec�' 31 .........pr'or to closingg In the event the subject property faiis--said test, 32 tfi's 'offer 'sliaYl�be.clecl'ared..riuYl..arid..voc�.;..with..earriest..moriey..be.ing.;:: 33 .. ... re urnec� to..$iJ��It�. .. .... .. ..... ........... .. .. ........ .......................... 34 ..,4.. Bit ER.is..aware..of..buiIdinq..anc� use..coven ants of record: .P. 35 ...5 .....�.. W 44..0, , .f�0( 7:k-.=............................ 36 ................ $.04.Mi ..(. .....tl1� ....t..0.158:1..<e�k...l(.� `Yq.irtif�F,' :.e .;(* 5.,/q0.7.......... 37 ............. .............................................................................................................. 38 ............. .......................... ................................................................................. 39 ............. .............................................................................................................. 40 ............. ........................................................... 41 ............. ............................................................`.................................................. 42 ............. .............................................................................................................. 43 ............. .............................................................................................................. 44 ............. .............................................................................................................. 45 ............. .............................................................................................................. 46 .......... .............................................................. ............................................. 47 48 ............. .............................................................................................................. 49 50 51 ....... .... .................................................................................................:............ 52 Buyer agrees thal unless otherwise specified,Buyer will pay all costs of securing any financing to the extent permitted by law,and to perform all acts 53 necessary to ex dite such financing. 54 ADDITIONAL ITEMS INCLUDED IN SALE: ..NQnQ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 55 56 .............. .............................................................................................................. 57 ITEMS NOT I CLUDED IN SALE: N/A.................................................................................... 58 59 60 Seller shall,upon payment of the purchase price,convey the property by warranty deed,or other conveyance provided herein,free and clear of all 61 _ liens and encumbrances,excepting:municipal and zoning ordinances,recorded easements for public utilities located adjacent to side and rear lot 62 lines, recorded building and use restrictions and covenants, general taxes levied in the year of closing and ............................... 63 ...........io....................................................... ..... ............................................... 64 Legal pos ssn of property shall be delivered to Buyer on date of closing. 65 It is understood the property is now=q*ittr.,...vacarnt....•...•........... .................... ..................... 66 under{uraf written-lease);vMdrtetms mt---............................................... I......................... ..... 67 ............. ........... 68 Occupancy of . . PrQ?n],$PA . . . . . . . . . . . . . shall be given to Buyer on ,,_, ,,,,,,,,,,,,,,,,,, 69 If Seller is permitted to occupy property after closing, Seller shall prepay occupancy charge of$ ....N/A,,,,,,,,,,,,,,,,,,,,, 70 payable as follows:............................................................................................................. 71 In addition, the sum of$ . . .NSA. . . . . . . . . . . . . shall be withheld from the purchase price to be escrowed with ................ 72 73 to guarantee deli ery of occupancy to Buyer AND FOR NO OTHER PURPOSE,which sum upon Seller's failure to deliver occupancy shall be 74 paid to Buyer as liquidated damages or returned to Seller if occupancy is delivered to Buyer on the agreed date. (� 75 All earnes money paid shall be applied toward payment of the purchase price if this offer is accepted on or before ..f P.(,,1.�....... 76 ••.•.......... ........... 19 . 8.7. . ; otherwise, to be returned to the undersigned Buyer no later than ...!)f. ................... 77 19 .87. . and th s offer shall become null and void. • Ooid IrtO NM. pats•Ott0°„�•f r .it0 :a* ,. `. s r`,w°. rd•t� s sM ,.J S �J °”, 1 4 a. O (�//j�� ',.•./"ice f°•°1".t•. • , i i _ `�i.i , 's• �e r '\! .s .�t N r to t ._.ig.}i�_..... . . t _.%„(..� -ti t,sod ..�,,.•.-.,_c_.«.;:.,t..o ,.cn..--.�.s Iz V G 34 t t4r-SPUR r,r s cn� .N Sood IP ITT � � © �� > o �"'• � ;� -off O r t ��`` .t �.•' Z �� .',°fir N•� . A � E ♦ \ l• , fit. �� � ♦ • . 9y� ,. / �: � w � o ,� ,� 11 - a 'a - ;:Yi•o.°Q?Yew �� � s - i;2 ^� ._ 3; Z' :o CFA' •p � � �,� o �.i y' i Ail i T C• ° ! i C^ I• � � tt,• i r-���:F kPr ' {� :g�,s`�"�'�s=� �� 's EI�- +� pq '` •.�: •+ _ s Tr I�I(��.rs t. 8 e t• �3 j R S C 4 s C r s °'�i —_� •1 t L , N + Y STC - 105 r. r SEPTIC 'TANK MA f N't'LNANCE AGIM-I'MEN'1' St . Croix County v OWNER/BUYER m ROUTE/BOX NUMBER �, ye; a.�7? Fire Number- CI Y/STATE ktUQ�QCI , W� ZIP Q((a PR( PERTY LOCATION :_5r-- 4 , n(E'-E , Section 1' m it�� Town of 14u._:Qr� �f=a.S' t4xr , St . Croi.x County , Subdivision Lot number Improper use and maintenance of your suptic system could result in its premature failure to handle wastes . Proper .maintenance cull si is of pumping out the septic tank every three years or sooner , if needed , by a licensed suhtic tank LmLee . What you Tut into the system can affect the function of the supLic tank as a treat- ' meat stage in the waste disposal system . . St : Croix . County residents maw be eligible to receivu a grant fur. a inaxill1t.1111 of 60% of the cost of ment' of a failinl; system, y w ---- hich was in operation prior- to July 1 , L9.78 St . Cruix< County acce1)te'd this 'program in AuEiust of -1980, with the requirement tout -owners of all new systems al;rce to keep, thuir, systems properly --- -- 4 u►a inta i n e d . The property owner agrees to 'submit to 5t . Croix County 7ouing a ' certification form, signed by the owner and by a master plumher , journeyman plumber , restricted plumber or a licensed : pumper veri- fying that (1) the on-,Site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to , three year expiration. •� 0 I/W ' the undersigned , have read the above requirements and agree N to iiaintain the private sewage disposal system- in accordance with x the standards set forth , herein , as set by the Wisconsin"Depart- w men • of Natural Resources . Certification form must be completed _; and returned to the St . Croix County _Zoning Office within 30 days of he three year expiration date . S I C N E ll DATE St . Ciloix C,)unty Zoning Office F. 0 f-ox 98 Ham for d , WI 54015 715 -7S:6-2239 or 715-425-8363 Sig ; date and return to above address . DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION BOX 76 LABOR AND PERCOLATION TESTS (115) MAD►SON W153707 HUMA N R'ELAT10 S HUMAN (H63.090)& Chapter 145.045) LOCATION: SECTION: TO NSHIP/M NICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: s ' �/,E'/4 / N/R E (or 1' , COUNTY: O NER'S B YER'S NAME: MAILIN ADDRESS: S Al USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCI LDESCRIPTION: RO S:1PERCOLATION STS: Residence 1ZNe. ❑Replace y/y`/ ;— c'le _1Z_ RATING:S=Site suite le for system U=Site unsuitable for system ,' +T,11 it CONVENTI NAL: M UND: IN-GROUND-PRESSURE: SYSTEM-I -FILLrEMS ING A K:RECOMMENDED SYSTEM:(optional) C�JS ❑U S ❑U �S��U ❑S ®U If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the / under s.H63.09(5)(b),i ndicate: (Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS 5 BORING TOTAL� —DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER DEPTH 1�1. E EVATION OBSERVED EST.NICHES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- ? - s 7 3 / _? B- - B- •1/ 7 / / - B- PERCOLATION TESTS TEST DEPTH ATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES W NUMBER INGU" FTERSWELLING INTERVAL-MIN. PERIOD PERIOD 2 PERIOD PER INCH P- i -O 3� 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 eley3tion 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 / l� Kim' Lo U I ` t IN I I ! i 1 i 1 I I I i ! ,� =j 1,the undersigned, her by certify that the soil tes ep r d on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,a d that the data recorded and the cation of the tests are correct to the best of my knowledge and belief. NAME(pri 1: )� TESTS WERE COMPLETED ON: AWE ADD S: /, CERTIFICATION M ER: PHONE NUMBER(optional): CST S E: y DIS?RIBUfION:Or nal and crow Io !-non! P, .il. ity•! : `N,n•• .rr.i ';nil I�.: ' . _ �:� : 5 E C T Pe. . 6 T PLOT AN .. I 0SS EC T L U M f� {: NAME _ -- ivnME � � y � oCA i o N -L I E NJ E =f�= _ leg 1�------- - P . o _t_ M A P a' T, mr-cutc pop �d a10' Tod uQli �Cb . Bs icoo,A) A i r 00 StAiJA eA : CRS 'rhAN 5a' Nd h W-El 1 'i s m u�S� o D644 iw '1 0I't � P �d FRESH AIR INLETS AND OBSERVATION PIPE CI:OSS SECTION Approver.? Vent Cap Minimum 12" Above / Final Gr FAI�Q` �K� e ac7�_____._�. IL Vol rn AY , 4" Casa Iron Above Pipe� Vent- Pipe To Final Gradcr- __ Marsh Ilay Or Synthetic Covering Min. 2" Aggreg' l r, _ Over Pipe _V `V. t- Distribuio� M _��i Tee Pipe _.__ .._.. Aggregate p Perforated Pipe Below ! ' �3encath Pipe CoupT i.ng Terminating At y Bottom of System 8�?OM ----- _----