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HomeMy WebLinkAbout030-1024-90-000 \ t c 9 0 ] £ � \ o — f ; # Co K § ) � 2 7 � ] « c W C § G $ ± k \ E CD �3 U. O bo ) - - = x20 k E .9 2 f 2 \ \ E § \ % § . z > � 2 _ § $ (L m § • � _ � } � N ° ~ \ 7 a) -� J3 ) § . » Q zmz " © § 2 c E : ) « E 2 N. CL E k k k , £ a - § f \ a 0 o a = $ ƒ m \ ) k k k \ E = 5 a a a � � E [ A � ) \ m \ \ ƒ 0 � co 0 2 § _ > 0 E ' 3 ° j Q) CL / ) 4 ƒ / m � � E \ � / � k o = E » _ } 2 / D / S CL E@ . E § c $ - Q) 22RR � / ) , E � . 2 § j 2 S $ \ r ƒ % $ \ S « ƒ / 0 z $ z / \ 2 « L { § ) - k a f ƒ J � 0 & C) . , . Parcel #: 030-1024-90-000 04/07/2005 09:07 AM PAGE 1 OF 1 Alt. Parcel#: 06.29.19.102A 030-TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): '=Current Owner `ANDERSON,JAMES F III&LAURA JAMES F III &LAURA ANDERSON LEIS J&L,ANDERSON J&S LEIS J&L,ANDERSON J&S 1102 GOLDEN OAKS DR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description 1102 GOLDEN OAKS DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.050 Plat: N/A-NOT AVAILABLE SEC 6 T29N R19W SE SW LOT 28 AS SHOWN ON Block/Condo Bldg: CSM 1/88 Tract(s): (Sec-Twn-Rng 40 114 160 1/4) 06-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 11/17/2003 746847 2458/085 WD 08/23/2001 654591 1704/541 WD 04/03/2001 641877 1612/56 WD 07/23/1997 806/378 more 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 4923 405,700 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.050 130,000 269,100 399,100 NO Totals for 2004: General Property 5.050 130,000 269,100 399,100 Woodland 0.000 0 0 Totals for 2003: General Property 5.050 76,000 182,200 258,200 Woodland 0.000 0 0 i Lottery Credit: Claim Count: 1 Certification Date: Batch#: 313 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan).SA4T-- � S HtRDkR 9 q , �ie q3 •-1 S-DM �N� -1 SOIL ABSORPTION SYSTEM Q 3 99 - 9Y 3 UO �qQ Bed: ✓ Trench: 10,33 SaOom Width: Length: Number of Lines:— Area Built: 0 Cpl Fill depth to top of pipe: Number of feet from nearest property line: Froont, O Side, ® Rear,0 Ft .� Number of feet from well: �I� Number of feet from building: J ( � i (Include distances on plot plan). i� 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 O Side, O Rear, Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: it Inspector: c� Dated: 311 -7 0 Plumber on job: tv-r' License Number: -R5 O 37 lP3 3/84:mj Form - SS `Tj�C/- 104 AS BUILT SANITARY SYSTEM REPORT l g Pi OWNER L�j(ZRU� a \1M �� TOWNSHIP St .��JS��1�� SEC. To�J N-R�W ADDRESS Rt g0>( �pc� ST. CROIX COUNTY, WISCONSIN SUBDIVISION Nouk, '1 K3c)\ LOT LOT SIZE r PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 0 I y 1��.tiR�or� Horyl F_ a — '�?' o J li 0 OVI \0 x BtD INDICATE NORTH ARROW i BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: �3. "- S Proposed slope at site: 10 SEPTIC TANK: Manufacturer: W�� k 5 Liquid Capacity: �OV 1 Number of rings used: )�a'' Tank manhole cover 'elevation: 9 9. S Tank Inlet Elevation: 25. 07 Tank Outlet Elevation: 3q. 7a Number of feet from nearest Road: Front,O Side,O Rear, tv) 33 feet From nearest property line Front,OSide,0 Rear, feet Number of feet from: well TD , building: I (Include this information of the above plot plan)( 2 reference dimensions to septic tank) A SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 ,�; SEA, SW% XT* , S6,T29N—R19W ' CONVENTIONAL ❑ALTERNATIVE IS,,,,P Town of St. Joseph lanVD,Numb- ❑ 9 Holdin Tank ❑In-Ground Pressure ❑Mound Lot 28 Trout Brook Hills NAME OF PERMIT HOLDER I JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Larry & Kimber Heinemann Route 1, Box 62, Hudson, WI 54016 3-I'l-I?$ I'm 43 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumbe,-. MP/MPRSW No.: County im.wy Permit Number: Richard Hopkins 1059 St. Croix 102804 SEPTIC TANK/HOLDING TANK: MANUFACTURER. ILIQUID�CAPACITY TANK INLET ELEV.. TANK OUTLET ELEV_ WARNING FPFI ING COVER 0D PROVIDEIDED, �1 , �YEYES RNO BEDDING: VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WG VENT TO FRESH ALARM LINE ❑YES O ❑YES �NO NEARESTM �65 �/,DOSING CHAMBER: �? V MANUFACTURER BEDDING. LIQUID CAPACITY JNDPC..TR UMP ODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. YES NO DYES ONO ❑YES ONO GALLONS PER CYCLE: PUO LS OPERATIONA L. NUMBER OF PROPERTY WELL BUILDING VENT A LO FRESH (DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) ❑YES ❑NO 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 to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO.OF DISTR PIPE SPACING jNOD IN SIDE DIA =PITS LIQUIU BED/TRENCH �� .#� TRENCHES. �� AL• PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTH.PIPF DISTR.PIPE DISTR.PIPE MATERIAL. TR. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BEL W PIPES ABOVE COVER ELEV.INLET ELEV.END' FEET FROM LIN,EI AIR INLET If_ — � ' Or / NEAREST `►0 qD _L" 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. ❑YES NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ONO 1:1 YES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. ❑YES ❑NO DYES ❑NO ❑YES ❑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&MAHKINIi ELEV.. ELEV.. DIA.. ELEV.' PIPES D A ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ONO 1:1 YES ❑NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM uNE. q3 1 5 [1)YES E:1 NO DYES 1:1 NO NEAREST 0 il�j 7,a 5-" 05 .2 .(OLI Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE 'I —, Zoning Administrator DILHR SBD 6710(R.01/82) 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 prermit issuing authority. A new permit may Pe,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 uestions have ou concerning y q g your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-381:3. To be complete and accurate this sanitary permit application must include: I. Property owners name and mailing address. Provide the legal description where the system is to be installed; I!. 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; Ili. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repai r; 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. ------ ----------------------------------------------------------------------------------------------------------------------------------------------------- i 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 y miter—' included the creation of surcharges (fees) for a number of regulated practices which discofrt`S ° can effect groundwater. The surcharge took effect on July 1, 1984 All of the water that buried r Asure 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. 0 The monies collected through these surcharges are credited to the groundwater fund adm!nis- ° tered by the Department of Natural Resources. These funds are used for monitoring ground- f jh atf>r, g,our,dwz!er contamination investigations and est<%blishmEmt of standards Groundwater, *.'s ti;;orti, protecting. �3t3-,398(R.03/66) r SANITARY PERMIT APPLICATION COUNTY U ®ILNR In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8Y x 11 inches in size. —See reverse side for instructions for completing this application. PETITION I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO PR PERTY OWNER f� PROPERTY LOCATION R 7 � R MA N C 1/4J W %, S (,0 T)9, N, R W PRQeFRTY OWkE&MAILING A15DRESS LOT NUgBER BLOCK NUMBER PNI DIVISI N AME 1L. C7 vx , I Y,JITE ' .1 ZI C DE PHONE NUMBER CITY AR $T ROAD LAKE OR NDMARK Q W VILLAGE : b d�TOWN OF7 II. TYPE OF BUILDING OR USE SERVED: L/ Number of Bedrooms if 1 or 2 Family L OR ❑ Public(Specify): C rQV< '( ONA &d. III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. XNew 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. XConventional 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.XSeepage Bed b. ❑seepage Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: I� (Min es per inch): REQUIR D(Square Feet): PROPO ED S uare Feet): 3a) o $� ' Feet ®'Private ❑Joint El Public VI. TANK CAPACITY Site in 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 QL� Lift Pump Tank/Siphon Chamber El 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's Signature: No Stamps) MP/MPRSW No.: Business Phone Number: �5 38(�J 90)0 Plu a 's Ad ess S reef,City, tale Zip Code: Na of Dqq��igner, , e taa b 1 C,h V VIII. SOIL TEST INFORMATION Certifie f�it Tester( T)Name CST#� `O 9c1R.rZT c� CST's AD PRESS(Street,City,State ip C d ) Phone Number: 3 at IC, J �J ' S, syo /s IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Issuing Agent Signature(No Stamps) JR Approved El Owner Given Initial n S charge Fee ,Q' Adverse Determination r Vate ��4" X. COMMENTS/REASONS FOR DISAPPROVAL: `Plan 0WNJ,j bj he poy SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber • t, 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 Larry and Kimber Heinemann Location of Property SE' SW , Section 6 , T 29 N-R 19 Ej4 Township St . Joseph Mailing Address Route 1 , Box 62 Hudson , WI 54016 Address of Site Subdivision Name Trout Brook Hills Lot Number 28 Previous Owner of Property `7 ��r�.,G„ L Ni CCU Total Size of Parcel '�.����" Acro,_s Date Parcel was Created ha�(� Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes �_ No Volume 1 and Page Number 88 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. PROPERTY OWNER CERTIFICATION 1 (eve) cehti.6y that a t statement6 on th.L6 6onm ake tAue to the best 06 my (oun) hnowtedge; that I (we) am (aAe) the cwnenk ) o6 the ptopenty de ut bed in thin .in6oAmation 6onm, by viAtue 06 a waAAant deed %ecotded in the 066.ice o6 the County Register o6 Deects ass Document No. • and h (U that I ( e) pne6 en,tey own the proposed zite bon the .sewage di,6po�s 6y�s ems (on 1 (we) have obtained an easement, to nun with the above dea ch i.bed pnopehty, bon the con.6tnuc ti.on o6 s of d .6y&tem, and the Game ha.6 been duty %ecotded in the 066.iee o6 the County Reg-c,6teA o6 Deed&, as Document No. SIGNATURE OWNE n. SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED REGISTERS Of"CE CUM Ni N�,), R�7AN1 1 {/i�M THIS SPACK AtSILKV&D F0111 rwcCOMInu aATA i} f STATE BAR O)'' WISCONSIN FORM 2---iM0 ► 4�U4'79S 119PAGE 53 ST. CROIX Co., WI& Rec'd. for Retard this 30th day of August A.D. 19 85 , 'I I ... ..---••----.. . . ... _. ..............._ __ j Thc,nas E, N icc,tini and Joyce I. Niccum at 1.35 P ........• .._. .._...-- �i - - James O'Connell ✓y conveys and warrants to ................................................... 1f� .I.as>:y.. R...._H.ezzlelaanu.,a.nd...Ki.mb_e.r_..L...._He-i.n.ema.t>,n.,_._._._._ I ..h u.aba.nd...an.d._.w_if.e,__.aB..j ain.t..ten.an.t s-............................. I deputy ------------------ - . - . ---...--------- ---- ...----------•- •--------- __ y _ ...... ....... ....••......-•-•-- I r & M Larry Hein r ............ ........ ......................... RETURN TO ..................... ..... .__.------ ------.... Route 1 Box 62 a ►r' - ------- - . ----_-- - _ Hudson,Wf..54016 the following described real estate in ...........SA;_CZpix...................County, 'I State of Wisconsin i' Tax Parcel No: ........................ li Parcel of land located at SEI of SW} of Sec . 6 T29N, R19W in the Town of St . Joseph described as Lot 28 as shown in a Certified Survey Map filed and recorded on March 12 , 1975, �i in the office of the Register of Deeds in St . Croix County, Wisconsin , Volume 1 , page 88, Document #325978 . I' TS r FEE �j II i! This ...__. iS-Ilo_t__..__.. homestead property. 0s) (ix ml")K Exception to warranties: Existing highways , easements and rights-of-way of record . j` Dated this ------. p + ----------------------- day of - ----1--6vS'/---•-•---------- -- 18 $5 i' -- •------------------(SEAL) ----- !V ------ ---•--.(SEAL) !i. Thomas E. Niccum .---- --- ------------------------------------------ ................. -.. ...` . ... j' ------ --------------•-•---- --- ---(SEAL) .._.(SEAL) I -•.................. .....---.................. 4 ...Jo ce- L� Niccum it AUTHENTICATION ACBNOWLEDGMBNT j� Signature(s) ............................................................ STATE OF WISCONSIN as. ......................... -•--•••-•-------•----••---------------------•--•-•---• ...........S.t,_._.Cr cLix._....County. authenticated this _....... of........................... 19...... Personally came before me this . 3d�........day of .................••-•-----•--....---•--....---............----............._..._ ..................... 19 85. the above named _ THOMAS E. NICCUM and JOYCE L. NICCUM . f TITLE: MEMBER STATE BAR OF WISCONSIN •--••--•-••- ----------------------------•-• ---------.._ ....................... (If not, . . .-•........................ -•-•---•---------•---- authorized by § 706.06, Wis. State.) •i,uu�u,, to me known to be the person S___... _ who executed the �,,,,, P. _RF� foregoing instrument and acknowledge the same. �•. THIS INSTRUMENT WAS DRAFTHDij Es Daua.d_.,I...__lstr_ee A r• r-.�a~, .,•'�i'ep+ •wa•.,.11.......,•.I��t , ^ ..................v n iATq� � --S1 : )--;_rr- - - �a n(St L a Notary Public County, tMCommssio s P erma nt f not state expira tion ig (Signatures may be authenticated o are not necessary.) d+ 9 date• - i 1 ) 00 t •Names of persons signing in any capacity should be typ&bV%Vn%ted below their signatures. KGMNIsrCarywy® STATE BAR OF WISCONSIN n s„••,� s� FORT[ No. a— 1882 Stock Ho. 1300M2 x! ,y° ' �v a �xv rr >1 7 t,. tyr' ffG�'d .I✓ t: •yy •'c� r:�r, '� hl'.�.. a" r _ t �. t 1319.26' N89040'50"W 3 343.44 ' 65877" ►- 2dl LOT 28 T 1,7 5. O� t M 5,05 ACRES it N S E:E/4 OF 6 t^ SETt 6 Yk LOT 29 x . F fA N ST C - 105 r C_ SEPTIC 'TANK MAINTENANCE AGREIIMEN•T o St . Croix County y OWNER/BUYER Larry & Kimber Heinemann ROUTE/BOX NUMBER Rt . 1 Box 62 Fire Number CITY/S1'A1'E Hudson , WI _ZIP 54016 _ PROPERTY LOCATION : SE ; , SW 16 , Section_6 , T 29 N .: K__L9_EY , Town c;f St . Joseph St . Croix County , Subdivision Trout Brook Hills Lot number 2�--. Lnhroper use and maintenance of your septic: system could result in Its premature failure to handle wastes . Proper maintenance cull- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank Lu►Ler. Wliat you put into the system can affect the function of the svIltic tank as a treat- ment stage in the waste disposal system . St . Croix . County residents, may- be eligible to receivu a ,brunt for. a maximum of 60% of the cost' .of replacement' of a faiIin`KF.,System, which was in. operation prior. to July 1 , - 197$ . ,, St . Cruix'I- County uccepted this prugram in Au};ubt of 1980 , with` the- requircrticat. that owners of all nc.w s stems a ree to kec > th ' , • g ', �I 4`!r -systems., properly �w maintained . The property owner agrees to submit to 5t . Croix County, Zoning a certification form, signed by the owner and by a master`';plumber , journeyman plumber , restricted plumber or', a licensed puucper veri- fying that (1 ) the on-site wastewater disposal system iS ,rin 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 . .j O I/WE , the undersigned , have read the above requirements and. agree N to maintain the private sewage, disposal system in accordance with H the- standards set forth , herein , as set by the Wisconsin Depart u1ent- of Natural Resources . Certification form must be completed and returned 'to the St . Croix County Zo�lii �` Offl<rpe within ;30 days of the three year expiration date . k r SICNEU s DATE St . Cl>oix C:,unty Zoning Office P . O . I-ox 98 Hammond , WI 54015 71.5-7� 6-2239 or 715-425-8363 Sign ,' date and return to above address . A A DUPARTMENTOF REPORT ON SOIL BORINGS AND SAFETY Rt BUILDINGS UIV151C)N INDUSTRY' PERCOLATION TESTS (115) n 130x 7969 LABOR AND ,p MADISON,WI 53707 HUMAN RELATIONS (H63.090) & Chapter 145,045) �/OL / �• �p L CATION:-� OTv' 1'UWNSIIIV'MdtlfdtC?fltt'f't LOT NO.;IiLK.NU.. SUN[IIVIS1pN NAM I. SE 1/4 1/4 G /T'.I N/R 17E (or)W 154 . 3 os N--- COUNTY: BUYER'S NAME: MAILING ADDRESS: S Y. x L !Xl MRE � (Yo x w2- DATES DOBSERVATIONS i MAs D•E Sf�oiG USE - --"-- PROFILE I T�STS: NO.BFDRMS.: COmM—€I IALDESCRIPTION: r U 5 19L) • 13 Cos IResidence NoT' /V• — New ❑Replace Q J C,-3 S477A e5 SuB s r�PArhS . S RATING: S Site suitable for system UID Site unsuitable for system ___ CONVEN 06igAL: MOUND: IN-GROUN5:M SOT€: S4STEM7NFII.L llOLDING'rAN-K:�R COMMENDED SYSTEM:(optional) ,' S ❑U z S ❑U ©S ❑U I B S EU�I 0 S ©U I�oNuF.y� If Percolation Tests are NOT required DEES/IGN RATE: If any portion of the tested area is in the I under s.1-163.09(5)(b),indicate: C. L/� s s Floodplain,indicate Floorlplain elevation: PROFILE DESCRIPTIONS P7- PTH T GR UNDWATER-11 CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH LEVATION OBSERVED S IGM EST TO BEDROCK IF OBSERVED (SEE AB. ON BACK.) • T .ti . ,7 3XoO > 7. s o,�, si 3s• ' T,,Ao �E,� cs 3, �o' 2¢- ' 7- t5. /.O ' �, o fG'oy > 1 7S 7 --�N v cs G�' . ft.7.5 .0/- R'j . 704,1, AV-7'0-*A B- B-� 1.2 ,S y Zo - > X02• °• V Cl `°' B- _ sale-YrAcs- EIf(!/}ReA;S PERCOLATION TESTS TEST DEPTH WATER IN HOL TEST TIME DROP IN WAl'EFi LEVEL-INCHES RATE MINUTES R PER INCH NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P RI D1 PERIOD �'. P- P. i P. 0.0 ,� L P- P- P- PLOT PLAN: Show locations of perco ion tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation referent poi s and show their Location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. •F•-�•• S y SM Ta L f E �� SYSTEM EL EVATI /•��Tl'o,�r � /;� = 9a • O = E RAc ' /Pi Ts ,5 i N o. Lo T �-i a /lfi'('j /9 "Ac,c .S,•7-eS �a �t S;TE AReR iylp , Regt i ALT��PRT►o,J y j � , �s '�"' (sHnvrN� cff °f 9. �a ,EV 13 TN -top So ;� co T- Z8) '� � I1./�y�1.J�l: hr '1�.� .,{rl1✓)1Cil ':.C::`Jt.11i ?1jJ�L' (De A.) vL�, oQVr•o�S So. �o J T- C f i'.)E F WIN c_ �i' powE�C /gtD �oX. i S UERT• pe F. S� ' -r"P c°, "7�c. B4� 5z; '9 rN. w• (FlEv• - /00.0 . 1, the undersigned, hereby certify that the soil tests reported on this form were mnde 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: ` _ QG-• 13 - ( 4 $ S In" Irl CFPTIL:hI tIA^.iliPlli i�'.t_ — ADDRESS: + CERTIFICATION NU BER: PHONE NUMBER(optional): R1. 3 O'NEIL RD..HUDSON .'.I:�. :r.Uil� ROBERT IILDRICil1 .SS''(9. ?i15.MAS10 PLU lh. !!. ;.+ in,r ...,. CST SIGNATURE: Mild N. IN31ALLLR&RAPIER i!c.till.I:I;t�G3 DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DIL14R-SBD-6395 (R.02/82) -OVER - P. �. L. 6 7 �P L. OT A r, �, I 0 S SECT 10 f\l L _� A I �. 'N A M E rI_lv: ! N rn M E � L o A5 6 0 CAT I 0 __ I-1 r �. I� I C E N S�E - ., . tjolt fits Stie pRep W 111 Re u tale, 4 cc ?, .. 0� SU!JAy1Nq 07 4 44 p J Oft . 1"AN K i Svtcm 'Is 13 �� Q s �. -F4FAC9, thAN Spy t S •l/ s', /� • 0 pa 6 3 ti � O°1 x� PVC n�a Lof d{ Vey Vlfat ,f /Q ►' :� 5 E,,j s Hi Powe - PIA fir C� p: �S L o� V. =lov UA1' A W f FRESH AIR INLETS AND OBSERVATION PIDE „ k CROSS STCTION .� Approved Vent Cap "Minimum 12 Above KI Nh f GkAJ& Final Gai ____..>._ a M AI< ' . 4„ Cast Iron Above Pipe Vent Pipe t 1 To Final Grath----- E Marsh Hay Or Synthetic Cover--i.ng 4. Min. 2" Aggreg :11 c, ,. Over Pipe `� '��/ ___ ._._ ,-� Tr'`►' of ��� rs� s Distributi Tee Pipe _.._._.__-._ .. Aggregate lD Perforated Pipe Below �a a Beneath Pipe G Coupling Terminating At r Bottom of System