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Parcel #: 020-1056-80-120 02/16/2007 04:32 PM
PAGE 1 OF 1
Alt. Parcel#: 21.29.19.212D 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
O-CORCORAN,JAY K&KIMBERLY M
JAY K& KIMBERLY M CORCORAN
566 CTY RD UU
HUDSON WI 54016
Districts: SC =School SP=Special Property Address(es): '=Primary
Type Dist# Description `566 CTY RD UU
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 2.947 Plat: 1768-CSM 06/1768
SEC 21 T29N R19W LOT 3 CSM 6/1768 EXC TO Block/Condo Bldg: LOT 3
CTY HWY PROJ 1312/584
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-29N-19W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/15/1998 583041 1340/348 WD
04/07/1998 576670 1312/583 WD
07/23/1997 872/326
07/23/1997 794/327
2007 SUMMARY Bill#: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.313 76,300 230,900 307,200 NO
COUNTY X3 0.187 0 0 0 NO
Totals for 2007:
General Property 2.313 76,300 230,900 307,200
Woodland 0.000 0 0
Totals for 2006:
General Property 2.313 76,300 230,900 307,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 215
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
V '
D` 42'.227
CERTIFIED SURVEY MAP
NLocated in the SW 1/4 of the SE 1/4 of Section 21 , T29N, R 19W , Town
of Hudson, St. Croix County, Wisconsin
Owner and Subdivider: N
Verlyn & Catherine Benoy UNPL,ATTED_}.ANOS- -
Rt. 1 Meadow Drive S 00'51'49"E =
Hudson, Wi. 54016 EAST LINE OF THE
SWI/4- SEI/4 479.26• 3 ' ,33'
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SECTION COR. MONUMENT a: ~o yea QOa O Z ao�Jl
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I" IRON PIPE FOUND �O �' n ti�N C4 t0
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2" IRON PIPE FOUND �• F 2W; °DZ3 W I J
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O N 24' ROUND IRON PIPE WEIGHING ti W a
1.68LBS . /LI N. FT. SET ~ N'
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150 !00 50 0 ISO 800 450
O, 50. o w �Lj1RStEN —
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8CALH'IN FEET •Fip.08' '0 W
Bearings referenced to the South line of the o� N 3 ? ----
SE1/4 of Section 21, assumed S890 23151"E. o o
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4645.72' 550.00'
N 00'51 '27"W 33
583.01' I
Volue2e 6 Pa.L;e 1763
i
s
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: /�� Length:_�� Number of Lines:_ Area Built: r
r,
Fill depth to top of pipe: 4/O
Number of feet from nearest property line: Front, O Side, O Rear, IS _
Number of feet from well: 2'O
Number of feet from building: 28
(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 near, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
dl
D a ted: Plumber on job:
License Number:
3/84:mj
w
Form - STC - 104
I
AS BUILT SANITARY SYSTEM REPORT
OWNER �d Hst H TOWNSHIP fftr �o t� SEC. Z T 2-9 N-R/`1
p
ADDRESS H c.�c7 Sa vt ST. CROIX COUNTY, WISCONSIN
SUBDIVISION s f n g LOT Az� 3 LOT SIZE -'2- 2 14/e✓ S
PLAN VIEW
Distances and dimensions to meet requirements of IL. HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
e
1NS
i
i
d 2-4Y -1 I�
d
�o Hoas�
f {
d
3
a ;
/yo
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used � �,�c� E„ EWfa��
Elevation of vertical reference point: loo •o / Proposed slope at site:
SEPTIC TANK: Manufacturer: t�1cziS Liquid Capacity:
q i ,
Number of rings used: � Tank manhole cover elevation•
Tank Inlet Elevation: Ts ko
S, (� an Outlet Elevation:
i
Number of feet from nearest Road: Front,O Side,U Rear, O feet
®
O O — /
From nearest property line Front, Side, Rear, feet
Number of feet from: well (o !5' building: al d- u)CcN
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.Q.BOX 7969 BUREAU OF PLUMBING
I
MADISON,WI 53707
SW%,SE!4,,S21,T29N-R19W CONVENTIONAL El ALTERNATIVE State Plan l.D.Number:
Town of Hudson ❑Holding Tank ❑ In-Ground Pressure E]Mound (if assigned)
Lot 3 County Trunk "UU"
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Ken Stein Route 1, Hudson, WI 54016 ib -q-c;7 1:•3`
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.:
I I R ou PIPE, - To UN ON -oT* 4-- AME S C 5r 10C o 10 (). 0
Name of Plumber: - MP/MPRSW No County Sanitary Permit Number:
Douglas Strohbeen 5432 St. Croix 99061
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: Eqs*NK OUTLET ELEV.: WARNING LABEL LOCKING COVER
r� PROVIDED: PROVIDED'. rrGG
�jSelr 1 QQ� 5 10 ONO ❑YES I�sINO
BEDDING: VENT DIA. I VENT MATL.. HIGH WATER NUMBER C,F '.ROAD: 1PROPERTY, WELL: BUILDING. VENTTO FRESH
/��I' ALARM G� LI AIR INLET:
DYES NO `T �� EYES NO NEAREST I � '
DOSING CHAMBER:
MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL. JPUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES LINO ❑YES ON OYES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER.OF PROPERTY WELL. BUILDING.IVENTTOFRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET:
PUMP ON AND OFF) ❑YES 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 FORGE
MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH- LENGTH. N .PIPE SPAC ING. COVER JINSIDE DIA.-. #PITS. LIQUID BED/TRENCH / � TMATERIAL' PIT DEPTH:
GRAVEL DEPTH FILL DEPTH DISTR.PIPE DTR.PIPE R.PIPE MATERIAL: NO DISTR NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES AB+COVER. ELEV INLE f ELEV.END FEET FROM LINE: AIR INLET►1 ''{ 90 0 .30 30 3 �e��. �3 INEARE S T 7 5 90 0?
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
OYES ONO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
DYES ❑NO ❑YES ONO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SO DDED SEEDED: MULCHED.
CENTER. EDGES.
El YES ❑NO DYES ED NO OYES El NO
PRESSURIZED DISTRIBUTION SYSTEM:
` ey WIDTH: LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER:
BEf►/TEistCC TRENCHES:
MANIFOLD PUMP MANIFOLD DISTR,PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING.
ELE V.. ELEV.: DIA.-.
ELEV. PIPES. DIA.:
.L=LE'�ATIOIV ANSI
Ii1I�RT,Q1�1 HOLE SIZE HOLE SPACING. DRILLED CORRECTLY: COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED
IF{IPIw I PLANS:
EYES ❑NO DYES NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUM13i LRNE ERTV WELL: BUILDING:
FEET FROM
DYES El NO OYES LJN INSAREST _ilwi
0O
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. TITLE:
Zoning Administrator
DILHR SBD 6710 (R.01/82) �'
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
APPLICATION s s
°
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 revis4pns 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;
Il. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat
restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;
III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or
repair;
IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project
is in conjunction with University of Wisconsin;
V. Absorption system information: Provide all information requested in ##1-6;
VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if
tanks received experimental product approval from DILHR;
VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name If
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County/Department Use Only;
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 8Y2 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.
-----------------------------------------------------=a----------------------------------------------------------------------—--------------------------
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 ator
included the creation of surcharges (fees) for a number of regulated practices which Wisco i'1'
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried resure` °
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 purnper.
_ I o
The monies collected through these surcharges are credited to the groundwater fund adminis-
tered by the Department of Natural Resources. These funds are used for monitoring ground- t
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
SBD-6398(R.03/86)
DILHR SANITARY PERMIT APPLICATION COUNTY/►�/
In accord with ILHR 83.05,Wis.Adm.Code
.o�.:.y,��......�.
STAAE SANITARpY PERMIT#
L190&–Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER
6%x 11 inches in size.
–See reverse side for instructions for completing this application. PETITION (��
1. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. FOR VARIANCE El YES Lail NO
PROPERTY OWNER PROPERTY LOCATION
K@-n st C-01 f1 50/4 SE '/4, Sa / Ta�J, N, R !(o W
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
CITY,STATE ZIP CODE PHONE NUMBER 113 CITY NEAREST ROAD,LADE OR LANDMARK
4d VILLAGE: �' / /C 4e ze
11. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family — OR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable)
1. a.X New b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit# Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in##1 and only one in#2)
1. a. X Conventional b. ❑Alternative C. ❑ Experimental
2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. X seepage Bed b. ❑seepage Trench c. ❑ See a e Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): i rVI
Z t!O 1Ssq.� . �p�� S' �T. 93` Feet Private El Joint ❑ Public
VI. TANK CAPACITY Site
in a allons Total #of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank 000
Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number:
d? "!21,e1 5fflg r6e(, )'ih- 5'?-') 2�I --323 ?i
Plumber' Address(Street,City,State, ip Code): Name of Designer:
,l/(4 w r G � ^o 16/
VIII. SOIL TEST INFORMATION
Ce ified Soil Tester(CYST)Name CST# 3 Cf
99 -J
CST's ADDRESS(Street,City,State,Zip Code) Phone Number:
01 -f" k o (,� s 7(S ) 3r(o o Ff0
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved S nitary Permit Fee Groundwater ate Issuin Agent Signature(No Stamps)
Approved ❑ Owner Given Initial rcchaarrgee*FFee
Adverse Determination
X. C)MMENTS/REASO S FOR DISAPPgOVAL:
SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber
APPLICATION FOR SANITARY PERMIT
STC - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor, ("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
Owner of Property _�Zvi i V1
Location of Property 5 c.j �6 _ , Section a- , T �j N-R�
Township g
Nailing Address R
Address of Site � 2- � C_, , c� U
_� c�cFsc3� i S7�40
Subdivision Name _ r1l .7tL 5 6
Lot Number
Previous Owner of Property Vd✓ I V V% JE_ cw, o y
7�
Total Size of Parcel 0 , J /¢e-
`5
Date Parcel was Created
Are all corners and lot lines identifiable? < Yea No
Is this property being developed for resale (spec house) ? Yes x No
Volume -7 and Page Number `f-S_.S as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and page number, and the
Seal of the Register of Deeds. In addition, a certified survey, if available, would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
i
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
I (We( ceAti.6y that att Atatement6 on th,i6 okm Me true to the but 06 my (our)
hnowtedge; that 1 (we) am (are) the ownen(bf 06 the pnopenty duc i.bed in this
.in6okmati..on 6onm, by viAtue 06 a waAAanty deed heeonded in the 066.iee 06 the
Count RegiA ten o6 Dee&ae Document No. � � ; and that I (We) pneden,tCy
own the phoposed 6 to bon the .sewage di,6pob .6y6 em (on I (we) have obtained an
easement, to nun with the above d6chi,bed pnopeAty, bon the eondtnucti.on o6 said
eye,tem, and the dame hae been duty keeotded in the 066.iee o6 the County Regi6te,% o6
Veede, as Doewnent No. Zo y Z � )
SIGNATURE Olt OWNER SIGNATURE OF CO-066R (IF APPLICABLE)
L�12
DATE SIGNED DATE SIGNED
fls
w DOCUMENT NO. STATE BAR OF WISCONSIN FORM 5-1982 THIS SPACE RESERVED FOR RECORDING DATA
PERSONAL REPRESENTATIVE'S DEED
410
AV 02)P 1 r ,
Harry J. Stewart .,. UFeiCE
...... --------••-----------•--------------•-------------•----------
' iIX CO WI&
--------------------------------------------------- as Personal Representative of the estate of ; �..:� R:" ; �nc�rt i4Us 31st
John Aldro M ren La se a/k/a John Aldro Larsen
.....�•--•--••-..•--•dro -y•-rse -- .D�... .. ... March A.D. 19 86
a�k�a Aldro Larsen
4�
T�
------------------------------•----------.----------•---------------------------
(..Decedent"), --°
for a valuable consideration conveys, without warranty, to ._Verlyn E. Benoy
j _ and Catherine A. Benov. as husband and wife as marital rlwimrr R
................................... ---••-----•••--......_......._........-••-•.------
! property with right-of survivorship _
i .. .,. -
i ---------•--....----••-------••................•--.....--- Grantee
L TO '
the following described real estate in ...St........................................roix County,
State of Wisconsin (hereinafter called the"Property")
West Half of the South East Quarter of Section 21,
Township 29, Range 19 Tax Parcel No: ..............................
L
i
I
!
I
I
Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which
the Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the
Personal Representative has since acquired.
Dated this -------Uth................................. day of -----------MAKC-1h............................................... 19Ah...
--------------------•--------•---------------•----------------------(SEAL) ....)AN
�tiUV Cw� (SEAL)
' • HarY.. •... X.eWsI- ----------------..._,` :.:� ,
--------------------------------------------------------------- -N
Personal Representative Personal Representative
y,`:• •� x` V J
AUTHENTICATION ACBNOWLEDG]d TO
J 44,
Signature(s) ............................................................ STATE OF WISCONSIN
--------•............................................•----.....-•----•--•---•-- ._..S"..CzalX................County.
authenticated this ........day of........................... 19------ Personally came before me this .....Ath...day of
MAX.0............................. 19-2.6... the above named
-------------------------•------•-------- H S e as Perso Re esentative
---.ail•X..��.---.1z..I1�a��,s..............•--.F)?if__.._.P.r_...._....
'---------------------------•--••----•-----...----• o]C._l:he_.es>sae..4f__.?oh>j.Ald ro-Myren••Lasen,
TITLE: MEMBER STATE BAR OF WISCONSIN .-a/k/a.John__Aldro Larse- n /k/a Aldro
• -s..a
(If not- -------------------- - Larsen
authorized by § 706.06, Wis. Stats.) to me k own to be the person ------------- who executed the
foreg ins�t and ack wledge the same.
THIS INSTRUMENT WAS DRAFTED BY w
.t_....
Lois A. Murray of HEYWOOD, CARI & MURRAY ---- - ---- --•- -
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Z.CL. -Sox--229.,.-Human,.-IiIL.-5AGLfi................... Notary Public ..St.__Croix...................... Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. If not, st to expiration
are not necessary.) date:
7" p
........................
19.51.0
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*Names of persons signing In any capacity should be typed or printed below their signatures.
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SEPTIC TANK MAINTENANCE AGREEMENT Ho
St . Croix County z
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OWNER/BUYER ����
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ROUTE/BOX NUMBER Fire Number
CITY/STATE -" n �,1 Z I P ' e�
PROPERTY LOCATION :SO14, S 7 14, Section T1_N , R W,
Town of 11,A S p ✓1 , St . Croix County,
Subdivision&,�t S Lot number 3
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 up_mper . What you put into
the system can affect the function of the septic tank as a treat-
,.
ment stage in the waste disposal system.
St . Croix. County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1 , 1978 . St . . Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained .
The property owner agrees to submit to St . Croix County Zoning a
certification form, signed by the owner and by a master plumber ,
,journeyman plumber , restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is 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/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
H
the standards set forth , herein , as set by the Wisconsin Depart- by
ment of Natural Resources . Certification form must be completed
and returned to the St . Croix County Zoning Office 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 715-425-83'63
Sign, date and return to above address .
l
CERTIFIED SURVEY MAP
Located in the SW 1/4 of the SE 1/4 of Section 21, T29N, )R 19W, Town
of Hudson, St. Croix County. Wisconsin
Owner and Subdivider:
Verlyh be Catherine Benoy
Rt. 1 Meadow Drive d 00•x!14901E
Hudson, Wi. 54016 Sri N+=[D14TN[ •
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LEGEND �� �. ,.
SECTION CON. 001111.0""T �' • EMI
I" IRON PIPE FOUND 00 1
�b•
2416011 tPt FOUND w
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Ik E,?ROUND IRON PI►[ 9 9 1 011 111 0 Itl M` �► I t>t
I.NLS[./LIN. FT. SET
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Bearings referenced to the South line of the
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SEli4 of Section 21, assumed S89 o 23 r 51 11 E.
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DEPARTMENT OF REPORT ON SOIL. BORINGS AND SAFETY&BUILDINGS
INDUSTRY, DIVISION
LABOR A:AID PERCOLATION TESTS (115) MADISON wl 63
HL-1,1AN'Ri LATiONS (H63.090)&Chapter 145.045)
y� UNICIPALITY:
Sw 11�E i� 21 NCR19 4(or U1�SoN 3 MtT� > . Ids
COUNTY: 18UYER'S NAME:
5 - C��ix �c`. y 1 MCA 4,0W hRI E X i
DATES OSSERVATIOli6MANE -s
USE 11FERCO
NUL BEDRMS.: OMMERCIAL DESCRIPTION]WResidence UN K- ErNew OReplaos L QGT Z7 ! (,kT Z /W
SOILS A6E 5$ 'SptLS
RATING:S-She$uitable for sysM- U-we wNYNNIie for aystsm BxCti
rQ—NVENTI_QNAL: MOUND: - K: E QMM ENDED SYSTEM
o 0 S m ❑d U'S-OUT❑S
If Percolation Tests are NOT reWlrsd rESIGN RATE: If any portion of the tested ores is In the
under s.H83.09(5)(b),indicate: N A C L/(SS. Floodpiain,Indicate Floodpiain elevation:
c�T PROFILE DESCRIPTIONS
BORING ,AN DEPTH
NUMBER DX& ELEVATION K F VE EE A BRV.ON BACK.)
B- >X5.33 X3 49 B cs 6k +'cots t T Ms t4t
6 �,�3 97� No
13~ lt.' / RNS,L 13' gerd%_
B- 7 7•72- 97.7c' Nc tti > 7.4Z o"UN MstGt'VCAk
24"QLLTS 14" RNStt. "'$RN S L 4416Qt 4&zrt S {Z
B- $ g•�s3 9�.�� No L� >4•t�3 i6"8ar�cS#4rlt ;s9"$�iM3
Z�gg«TS 1Z'8hN iL 5 t'" t �.►
.B- q og TW.14 ot Nli > T•O'K i�•'�T$af�Ms`f , 0''SarcG M 5►t61e; CA CON
.33 $7eLerl I & f
1c. x Cr gRN MS 1O~S"S*6 k
B-
oE��r PERCOLATION TESTS
DEPTH
iNL TEST
iNCiES AFTER SELIN IN VA IN. PERIOD PIFRI002 rz W12
P
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INCH
4.24 Nova f 9779 >ZW
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PLOT PLAN: Show locations of.peroolation tests, soil borings and the dimensions of suitable soil areas. indicate Coale or distances.Describe what are the hors•
aontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borlop and the direction and percent
of lend slope.
SYSTEM ELEVATION 9 3 so" 84T la SYSTL M S
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1,the undersigned,hereby certify that the soil tests reported on this form were rnade 6y me n at o��N the b o�csd�es,r�d rtroffiaM 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.
NA ME(print): TESTS WEAE CWFLETKO ON.
144NEY Cx. - Z7 19YK
�6 °ER,'F34g�NUMBER: PHONE NU BERloptionall:ADDRESS:
A� S eC O N t, ST 14U Q'SC N Soo
3&6- oho
s aTURE:
DiSTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
PILHR,50,-6395 M 0?/871 -OVER -
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