Loading...
HomeMy WebLinkAbout020-1097-14-000 . 0 vy / } o 4 0 ts m � $ � $ � � ƒ � ] . � ( � � . � a k � ? c LL \ \ ! n � in w I � § z & R § $ (L co q � . B z ® 2 ) k k D \ ƒ E { RD CY) \ & 5 § E ƒ .� k \ / E � . � o � < 2 z co \ E 0 k \ An o a ) E \ < _ ■ ■ Z $ 0 0 0 -� a a a CL j \ \ \ o ® _ E / j § j a)of o \ ) 2 < \ m u 2 / % § k / a E L $ m co o a \ § $.\ w @ ( — © ° o = a : t o 2 5 a CF o oi z a = , =\k\ \}§ k o z z a J 2 \ k I — _ EL " a u E ' § a § - 0 3IL & J l Parcel #: 020-1097-14-000 03/21/2006 04:50 PM PAGE 1 OF 1 Alt. Parcel#: 33.29.19.389J 020-TOWN OF HUDSON Current ST.CROIX COUNTY,WISCONSIN e nt � 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-RODE,WILLIAM A&JANET M WILLIAM A&JANET M RODE 662 GILBERT RD HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): •=Primary Type Dist# Description "662 GILBERT RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.376 Plat: N/A-NOT AVAILABLE SEC 33 T29N R1 9W SE NE LOT 3 OF CSM Block/Condo Bldg: 5/1483 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 856/168 07/23/1997 801/204 07/23/1997 791/336 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 92168 292,200 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.376 71,300 226,700 298,000 NO 05 Totals for 2005: General Property 2.376 71,300 226,700 298,000 Woodland 0.000 0 0 Totals for 2004: General Property 2.376 42,300 193,800 236,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 107 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 PUMP CHAMBER r 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,Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: tii Length: 7-5- Number of Lines: Z_ Area Built: 7-C6 ' r Fill depth to top of pipe: i L Number of feet from nearest property line: Front, O Side, 0 Rear,0 irt . 3- Number of feet from well: fD 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 or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: f� � 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, OFt. 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: �z 3/84:mj Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 6,rzy�A Zkj C. TOWNSHIP ;0�'�4" SEC. 3 T 2'S N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION �/'�C'' !,► LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IZHR 83 SHOW H W EVERYTHING WITHIN 100 FEET OF SYSTEM a� l� /UUO � �7 �ti v li - INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used �ao7r ` Lrnr Elevation of vertical reference point: /. Proposed slope at site: 7 _ SEPTIC TANK: Manufacturer: [1�.t7 ./O Liquid Capacity: /1$00 Number of rings used: ! Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,Q Rear, O ./go c�/ feet From nearest- property line - Front,0Side0Rear,0 feet Number of feet from: well / building: 7 Y (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE w..„,.DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS DIVISION LAROA&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING 0.0.BOX 7969 MADISON,WI 53707 SEA, NE'-,, S33,T29N-R19W )X ONVENTIONAL ❑ALTERNATIVE Stassigned) Number: of assigned) D N Town of Hudson ❑Holding Tank ❑In-Ground Pressure ❑Mound Lot 3 Kreye Minor NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Hudworth Inc. Route 1 Gilbert Road Hudson WI 5401 CST REF PT.ELE V BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELE V.: . .. Name of Plumber MP/MPRSW No_ County: Sanitary Permit Number: lRoger Timm 3224 St. Croix 99119 SEPTIC TANK/HOLDING TANK: MANUFACTURER ,� LIQUID CAPACITY. TANK INL T ELE V.'. TANK OUTLETLE V.'. R ING LABEL LOCKING COVER / 6)1"5 P IDED PROVIDED • $ YES ❑NO ❑YES NO BEDDING. VEN7 DIA.. JVINTMATL,. HIGH WATER NUMBER OF OAD. PROPERTY WELL. BUILDING. VE T FRESH ALARM LI AIR INLET FEET FROM ❑YES NO DYES ONO NEAREST / / � DOSING CHAMBER: MANUFACTURER IIEDDING i LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MA4FACTURE WARNING LABEL LOCKING OVIDED OVER PROVIDED: El YES ONO OYES ❑NO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. R OF PROPERTY WELL BUILDING VENT TO FRESH LINE AIR INLET (DIFFERENCE BETWEEN ROM PUMP ON AND OFF) ❑YES ❑NO ST 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 to continue.) MAIN CONVENTIONAL SYSTEM: WID L NO OF DISTR.PIPE SPACING COVER IN;IUaPITS LIOUIBED/TRENCH rREy�HES F MA IA PIT DEPTH DIMENSIONS Cd GRAVEL DEPTH FILL DEPTH UISTH.PIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO.OISTR. NUMBER OF PROPERTY WELL BUILDING VENT 70 FRESH BELOW PIPES ABOVE COVER ELE V.INLET ELE V.END' ` PIPES FEET FROM LINED /'83 ! ?.INLET g /10„23 Pod � 7 2I G� NEAREST O� / ` S /b MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO OIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ONO F-1 YES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED J.UIECHEDS CENTER. EDGES. ❑YES ❑NO ❑YES ❑NO ❑YE ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR UIST R.PIPE DISTRIBUTION PIPE MATERIAL.&MAHKIN(, ELEV.. ELEV,_ CIA. ELEV.. PIPES DIA: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY JCUVERNEATERII L VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO DYES El NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LI"E: DYES ENO DYES ❑NO NEAREST LI LJ Sketch System on tain in county file for audit. Reverse Side. SIGNATUR TITLE DILHR SBD 6710(R.01/62) �'`�� Zoning Administrator INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT'', APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system rotation, 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. Prcaerty 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 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'/:, 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. ------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 Ater.-� included the creation of surcharges (fees) for a number of regulated practices which Wisco 117`5 can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried TBSlire ° is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper, a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, t it's worth protecting. SBD-6398(R.03/86) SANITARY PERMIT APPLICATION COUNTY 10, 70D,-ILHR In accord with ILHR 83.05,Wis.Adm.Code l9l� E F - STAIESANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION i. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE r_1 YES ❑ NO PROPERTY OWNER / / PROPERTY LOCATION y� LGI}'Z v � '/o /U�.'/a, S � T�%, N, R � (or A W PROP TY WNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAM 49 1ke t _./ /11 i* CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE R LANDMARK 5Z TOWN OR t 6 1 VILLAGE II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. �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. gConventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tan k V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b. ee a e Trench c. ❑seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): 11 -7� v76z> r 2 Feet rivate ❑Joint ❑ Public VI. TANK CAPACITY Site Fiber- Exper. in allons Total of Prefab. ## INFORMATION New xisting Gallons Tanks Manufacturer's Name Plastic Concrete strr cted Steel glass App Tanks Tanks Septic Tank or Holding Tank '`' Lift Pump Tank/Siphon Chamber ❑ [I El 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'Signature:(No St mps) MP/MP Business Phone Number: 7/ 772 ,2! Plum is dress,(Street,City,Stat ip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST## CST's ADDRESS(Street,City,State,Zrp CO AA) - / / Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee I Groundwater ate issuing Agent Signature(No Stamps) rchar Fee Approved ❑ Owner Given Initial �..��8 Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber APPLICATION FOR SANITARY PERMIT ITC .. 100 This Applicatlof► faii it 66' dottpieted in full and signed by the owner(s) of the property being developed itetuaeies will only result iti delays of the permit Issuance. Skid t�►�� � �'bi intended for resale by 6ftdt/contractor, ("spec house')r the!! R 64"it Abos :#` be retained and completed Asti the property is sold ftd subiatti va,"iW4kCy ifti: .tb the appropriate deed i~ei d"thfng. ..f r .•.. .1.Y YY i � � � -i:k�iTi i� t ;,�1 � 1I.5 '� w r r Ii .�'°Y` r r r r r i. ice'�i�[ 1� dY fYY r .. r — r — — — — ,,, �yyy+may, ?,- Apr m,t d �.� W � ��1•� ���YaIV,. 1j`{l i •- Locstiofi of +s k, Section . .... 14-R�. W Fib mailing Address f ` Address of Stag Subdivision a Lot Number i R Previous Owner of Property NNd rA( ,JV ,e y. - Total Sise of Parcel: A Y Date Pare el wad Created Are all cornet and lot lines identifiable? x Yes No Is this property being developed for resale (spec house) ? X Yes No Volume �` and Page number as recorded with the Register of Deeds. IxCLUbE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the.Register o 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. it — — r r — — — — r — .I11 w V► — — — — — — — — — — — Rd1 Ty OWNER CERTIFICATION ? (wets 1 d al�,� tdter�enta an thia �onm cvice due to the befit o6 my (oun) knowledge; at I (we) dm (aAe) the ownen(e o6 the pnopenty dedchibed in thiA in6ovma ion bout by viout 06 d WdA anty deed neconded in the 06 ice o6 the County Reg,i6ta o4 Veedeab 'D0CWtnt No. 496?-400 ; and that I we) pneaentty own the pnopead aite. 661t the bewage u6pozat eya em (o)t 1 (we) have obtained an easement, to Un With the above deimibed pnopehty, bon the con6tnucti.on o6 aaid ayatemo and At same has been duly heco) ded in the 066ice o6 the County Reg.faten o6 Ueed6, db Voement No,'' p ✓ _,. :1 . i SIGNATURE Old DOWNER /► SIGNATURE OF CO-OWNER (IF APPLICABLE) .�....G..:WiYMi�.Wi•W w.�ir�..•.iaiiY.y'IY..L+Iw116YYwulYYY..a.n.�.� DATE SIGNED DATE SIGNED TY DEED THIS SPACE RESERVED FOR RECORDING DATA DOCUMENT'NO. WARRAN STATE BAR OF WISCONSIN FORM 2-1982 430309 _ REGISTERS OFFICE ST. CROIX CO., W IS. Kenneth J. Kreye and Karen A. Kreye, husband Reed. for Re=d this 18th ---------------- and__wife day of SSeep^tr—A.D. 19L, ..-------••--------------•------....---------------------•-----...------.............•---- ...................... ........ • .................. .. ..................... ..... r �_4 0� P. conveys and warrants to ...Hudworthl Inc. a Wisconsl.n ..COx pora tzon..................................................................................... .of s ......................................................................................_.......................... ......................_.._..____.....__..._...._._._...._._..._....._._._........_.._.........___._......_._-.... RETURN TO . the following described real estate in ............St Croix ....................................County, State of Wisconsin: Tax Parcel No- ------------------------------ i Lot 3 of Certified Survey Map filed October 16, 1984 at 8: 30 a.m. in Volume 5, Page 1483, as Document Number 397058 being part of the Southeast 1/4 of the Northeast 1/4 of Section 33 , Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin. This 1S riot------ homestead property. M (is not) Exception to warranties: easements, restrictions and rights of way of record, if any. Datedthis -•------•------•-•/'9....................... day of ............September•---------------------------------- 19.... .....................•--•-•--•----•--...._....-•--------•-••----.....(SEAL ......(SEAL) -------•-••---•---•-----•. •K. eth..,7-,-.. r eye- .....................................................................(SEAL) (SEAL) .Karen A. Krey AUTHENTICATION ACKNOWLEDGMENT Signature(s) ------------------------------------------------------------ STATE OF WISCONSIN {f ------------------------------------------------------------------------------- %a rc ------ [.. --------------County. authenticated this ........day of........................... 19------ Personally came before me this -----�8......day of Se tember-------------------- 19.8. .. the above named -----------------------------•-•------------------------------------------------ Kenneth J. Kreye_ and Karen A. Kreye •------------------------------------------------------------------------------ ------------------------------------------------------------------------------ jl TITLE: MEMBER STATE BAR OF WISCONSIN (If not- ----------------------- authorized by § 706.06, Wis. Stats.) to me known to be the ao>'Y'-s--------- who executed the j! foregoin sent• 1i `ekiio ledge the same. THIS INSTRUMENT WAS DRAFTED BY 1 __Joseph D. Boles / fiSQ -•. . a . . _ ------------- River Falls, -WI. 54.022 Notary Public _E` ..1s_`_:_=''.. -_.-.County, Wis. I (Signatures may be authenticated or acknowledged. Both My Commission 6 p)VVane t. :nbt,estate expiration are not necessary.) t! D date: *Names of persons signing in any capacity should be typed or printed below their signatures. ® STATE BAR OF WISCONSIN C&—-11. Its— nnnn ' H y ' a ST C - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT Ho St . Croix County z d a OWNER/BUYER 4IZA,19.4 ria .7;000 15A ROUTE/BOX NUMBER Z (eI if eA7— ®. Fire Number CITY/STATE u100�V,•N wig ZIP S1/0 i(0 PROPERTY LOCATION :5_14, Ale k, Section, T 7-'%_N , R__t% W, Town of A4DS ^J St . Croix County, Subdivision f°# � �/clp✓� 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 . 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 . yo 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- ro 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 . S I G N E D r1,f41-41 DATE -Z St . Croix County Zoning Office P . O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign , date and return to above address . } INSTRUCTIONS FOR COMPLETING FORM 115- SRD - 6395 To be a complete and accurate soil test,your report must induce: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 6. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown 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 sheet may be used if desired; B. Make sure your benchmark 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 exemp- tion, 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. Make legible copies and distribute as requireri. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Sail 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 Sand Pere Percolation Rate rued s - Medium Sand W - Well Fs - Fine Sand Bldg - Building Is - Loamy Sand > - Greater-Than sl Sandy Loam < - Less Than *I - Loam Bri -- Brovvn sit - Silt Loam BI - Black S - Silt G - Gray cl - Clay Loam Y - Yellow scl Sandy Clay Loam R - Red sic! - Silty Clay Loam mot - Mottles se - Sandy Clay W'If -- with sic - Silty Clay fff - fow, Tine, faint C _ Clay rc; common, coarse pt - Peat rnm - Marry, medium rn -- Muck d - distinct p - prominent HWL - High water level, Six general soil textures surface water for Iiquid waste 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 sot 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. i DEPA9i'RY, OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUS.RY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 3707 i HUMAN RELATIONS (H63.090)& Chapter 145.045) LOCATION: SECTION: TOWNSHIP MUNICIPALITY: LOT NO.:BLK.N .. SUBDIVISION NAME: �/ '/a /TAN/Rr�E ( ► ,L,,�,a.s COUNTY: WNER'S UYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL D CRIPTION: PROFILE DESCRIPTIONS: PER LATION TESTS: ®Residence '� ®New ❑Replace I 8� RATING:S=Site suitable for system U=Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) ®S ❑u ®S ❑u �S ❑u EIS ZU DS au o._ P1P145 o/y-A. L, ,zx» If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the / under s.H63.09(5)(b),indicate: �L'-, 5- G. 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- 6- S PERCOLATION TESTS �.� .� .�,,s�2i�r �,4rT,eE �o.src,�• 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- P- .. P-_ P_ 2.0' 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. INITIAL 99.2 SYSTEM ELEVATION REPLACEMENT 99.8' OT 31 AG�151i u 2.5 ' 4 . O' _ 34; I RON PIP 6 i SCALE I"= 0 - � 0 � I PI 10 7 i E o , I I , � � I I ti83: �SU EA� } j ITAB E R 27 @5 Q.F . ' � � VP - i i I t ; I i I x _ - i 1,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WERE COMPLETED ON: -q v .�c vv. .t.� v.�v�-, Y '7— � 5 — 15?-;2*— ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): .Ve¢0 CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. HR-SBD-6395 (R.02/82) —OVER — i ' t ` r < CERTIFIED SURVEY MAP KENNETH J. KREYE Part of the Southeast 1/4 of the Northeast 1/4 of Section 33, Township 29 North', Range 19 West, Town of Hudson, St. Croix County, Wisconsin. C.S.N. LOT i . VOL.4,PAGE 817 1 UN PLATTED LANDS a — so _ S89. 46'00"E 599.47'R(EAST 600.00'! 299.47 300.00' % b „ ro . �---tr 153-50 s82•a7 Os W 0 NO ACCESS LOTS TO C.T.N."N" o 1 ~ s N, SSG O lVS Nip ♦`� ••....u•••.•y �/ wojam ♦ .• y � ° - � O 1� I LAURENCE,. LOT Z I �' S rn W MURPHY ? °C • '" M N •r 2.376 ACRES '� a) S 1713 � s : 0; 103,500 SO.FT. I 2 CP %RIVER FALLS,,• , NET■ 2.177 ACRES I � '••, WISC.•••.• � 9a,B►7 so.Fr. i 9 o J , I �''• F�•LANO S •`� o 3 13 0 c n o O CI C DUPLEX C; tIO = z 589.46'00"E 300,00 OI a GARAGE N W oa W o t•I e e „ °o M ° I 49 � 01 4 h O GARAGE O =IM LOT 1 0° 3 ° 4.744 ACRES ° 208,634 SQ.FT I0 O O I z NET* 4.389 ACRES • 191, 171 SO.FT. LOT 3 O 2.376 ACRES 00 y O 103,500 SO.FT. 00 a 3 ; W, M V 0 p, 0OM F-l)- Y° - 3 b N O Laurence W. Murphy Registered Land Surveyor M �W 10 N O F- v oz 2 99.4 7' 300.00, N u o N W v --N89.48 00 W 599.47 R/WEST 600.00'1 --- {LNLPLarTEO LANDS W z SCALE IN FEET 1"+ 100' p - o0 8 ° O � °z W g 0 50' 100' 200' 300' z Z g 4a O OI y = N' O 1- 2 O • O M > C z Vol. Page z'm ALL BEARINGS REF. TO THE EAST LINE OF THE HE 114 Certified Survey H ; OF SEC.33, T29N, R19W, RECORDED AS NOO.00'00"E Maps y .Dated: 31 July. 1984 St. Croix County, Wisconsin a ; SHEET 1 OFY = t L TimmJOB 4�6 r AC SHEET NO. OF Z Excavating Co. i 6 CALCULATED BY ��` ��"`° R I, Box 192, Wilton. WI 6=7 CHECKED BY DATE 7 SCALE ... it I C � as 4 e i � s s �. . _..:. ...__ _. 4 ZK \, k max, k n� i .. ............ .. ...._ _. ... . _uu i'ivr_-NI mr G:don,Mau 0101 Timm JO6 -- SHEET NO. Z OF L Excavating Co. ' CALCULATED BY ' R 1, Box 192, Wilson, WI M7 - 7 CHEQKEO BY DATE SCALE j /b l*(n : ... ........... . f ':. ..... ......n...... ...!... ............. .......... ... ` ..4. ... G COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 I FAX - 715 - 962 - 4030 f STr CROIX ZONING REPORT NO.: 37581/01 PAGE i ST. CROIX COUNTY REPORT r1ATE; 3/03/93 COURTHOUSE DATE RECEIVED! 3/02/9; HUDSON, WI 54016 ATTN: THOMAS C. NEL50P! plvdm iz� OWNER: Willia Rode LOCATION: 662 Gilb Rd., Hudson .LECTOR: M. Jenkins DATE COLLECTED: 3-01-93 TIME COLLECTED: 2:30pm SOURCE OF SAMPLE: Outside faucet DATE ANALYZED:3-02-93 TIME ANALYZED:2:00pm COLIFORM: 0 /100 ml INTERPRETATION: Bacteriologically SAFE NITRATE-N: 3 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml. Nitrate-Nitrogen* mg/L 9 B N cc O o 01 p ry �. LAB TECHNICIAN: Pas Gane ' �o WI Approved Lab No. 19 t Means "LESS THAN" Detectable Level Approved by! ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse \� A� 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion gf this form i, essential a, that tag property can ba located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail , along with form to the above address. Testing will be done as soon as possible after fee and form are received., .. WATER TESTING-----------------------------FEE: $ 35.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: . $25.00 (Determines if system is properly functioning at ;time of inspection) �6:�nL�PROPERTY OWNER'S NAME: U � PROP. ADDRESS: 40/d 4 CITY J Legal Description 1/4 of the 1/4 of Section Z, T N-RI Town of Lot Number Subdi sion: lyn FIRE NUMBER LOCK t3O ER J Color of house Realty sign by house? If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: Telephone Number REPORT TO BE SENT TO: CLOSING DATE: Signature