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Home My WebLink About020-1122-10-000 St. Croix County Planning and Zonin Monday, April 04, 2005 at 11:41:27 AM Detail Sanitary Information n page I oft Computer 020-1122-10-000 Sub/Plat: Eagle Ridge Section: 011 Parcel 07.29.19.538 Lot: 9 TNIRNG: T29N R19W Municipality: Hudson, Town of CSM: 114114: SE 114 SE 114 Owner: Burton, Rodney G. 369 Kraftley Lane Hudson, WI 54016 State Permit: 88404 Issued: 10/13/1986 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: 1212211986 POWTS Detail: Bed - Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Tom Nelson Yes Sykora, John P. III Original permit issued to Lyle Myers, then $0.00 Signed Off: Yes transferred 12118186 to Sykora to install. Installed a 1200 gal. Weeks tank to 12'x 52' bed (still 3 BR size dispersal area) Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 612212005 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Parcel 020-1122-10-000 02/22/2005 12:42 PM PAGE 1 OF 1 a Alt. Parcel 07.29.19.538 020 - 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): * = Current Owner MASON & MART L RATLIFF ` RATLIFF, MASON & MARI L 369 KRATTLEY LA HUDSON WI 54016 - Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 369 KRATTLEY LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: .490 Plat: 1925-EAGLE RIDGE SEC 07 T29N-R1 9W EAGLE RIDGE LOT 9 Block/Condo Bldg: LOT 9 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 11/30/1998 592544 1381/160 WD 07/23/1997 7781317 07/23/1997 756/412 2004 SUMMARY Bill Fair Market Value: Assessed with: 48626 229,600 Valuations: L t Changed: 04/29/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.490 33,400 144,200 177,600 NO Totals for 2004: General Property 1.490 33,400 144,200 177,600 Woodland 0.000 0 0 Totals for 2003: General Property 1.490 33,400 144,200 177,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 108 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 CdMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 4mak FAX - 715 - 962 - 4030 ST. CROIX ZONING REPORT NO,* 41279/01 PAGE 1 ST. CROIX COUNTY REPORT DATE; 5/18/93 COURTHOUSE DATE RECEIVED* 5/13/93 .HUDSON, WI 54016 ATTNS THOMAS C. NELSON OWNERS Edwin & Joanne Schmidt LOCATION: 369 Krattley Lane, Hudson COLLECTORS H. Jenkins DATE COLLECTED: 5-12-93 TIME COLLECTED: 10S30am SOURCE OF SAMPLES Kitchen faucet DATE ANALYZEDS5-13-93 _ TIME ANALYZEDS2S00pm COLIFORMS 0 /100 of INTERPRETATIONS Bacteriologically SAFE NITRATE-NS 3 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 mL Nitrate-Nitrogen, mg/L ~C~ co 4 ~9 ti~H o ~F w 09PINOEro LAB TECHNICIANS Pam Gane S WI Approved Lab No. 19 d < Means "LESS THAN" Detectable Level Approved PROFESSIONAL LABORATORY SERVICES SINCE 1952 19 11 ST. CROIX COUNTY ;rk. AFC WISCONSIN yy•e~t~ IY59 ZONING OFFICE M Jib .r x S , /,yy'~ N ST. CROIX COUNTY COURTHOUSE rt SON ~~uy+ FOURTH STREET • HUDSON, WI 54016 W (715) 386-4680 SEPTIC INSPECTION / 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 3 this office to insure a time when entry can be gained. Ala ❑ Water (VOC's) $185.00 11 Septic $25.00 It Water (Nitrate & Bacteria) $35.00 (visuall inspection) All, Owner: Esawn. ja- . ,414 Requested by: 4 Address: 3A A.. 6-q 414 . ,L Address: 402 t V ew - City & State:_- , City & St. )CkrL&0 l.- Zip Code:. 6YO16 Zip Code: 476 Telephone N4: 06- Telephone N4: Q-6-) 34 6;6-Y-3 / 57/ Property address (Fire N2 & Street) : 3 ~l Gt41 P, e/ Location: 07.a.9.,17,Q7,, Sec. OZ, TAN, W, wn of AA/c& N St. Croix Co., WI. Tax ID N4ojo -ua.t /p Parcel ID N4 07,ay , /g ,5 House color: /~rn Realty firm:/A/ Lock Box Combo: Water sample tap location: TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Is the dwelling currently occupied? tA/Yes 0 No If vacant, date last occupied: Septic system installed by: ,,,,fah c,r ~,,s Year: / 2?2 Septic tank last serviced by: T',.,; -CGV„ fi, _Su~lf~ f%da Date* .So~,.,s - /QQd Previous Owner's Name(s): Have any of the following been observed? ❑Y RN Slow drainage from house. ' ❑Y NR Sewage Back-up into dwelling. ❑Y M Sewage discharge to ground surface, road ditch or body of water. ❑Y W4 Slow drainage from the dwelling. ❑Y INN Foul odors. Other comments /relative to system operation: t/e do Smf Q" Odoe onP gds a 9eeff k.-14114E 4ro G-,,ov4 .7 L/ V I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: L ✓L~,~ __JJ~~ DATE t 1 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION IN l✓e f~ Task Qna~ n 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: ❑Below grd OAt-Grd ❑Mound Approx. size 'X OGravity ❑Dose OPressurized Ft.2 ❑Bed OTrench ❑Dry Well Molding Tank OOutfall pipe OBSERVED DEFICIENCIES 00ther OUnknown Septic tank Setbacks: ❑House OWell ❑Prop. line 00ther Dose tank Setbacks: ❑House OWell OProp. line 00ther OLocking cover OWarning label ❑Pump/Floats OAlarm OElec. wiring Soil Absorption System Setbacks: OHouse OWell ❑Prop. line 00ther OPonding: ODischarge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N • Inspector Title w ST. CROIX COUNTY w WISCONSIN i p rh i ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, W154016 - - (715) 386-4680 May 12, 1993 Metropolitan Federal 1920 Crest View Dr. Hudson, WI 54016 To Whom It May Concern: An inspection of the septic system on the property of Edwin Schmidt, located at 369 Krattley Lane, Hudson, WI was conducted on May 11, 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 we 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, there 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 every 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 his office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator cj ~ y..-►a ti Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT ER L{ fTOWNSHIP SEC . T C -R R ADD S~x ST. CROIX COUNTY, WISCONSIN AL SUBDIVISION J CG J LOT LOT SIZE S. -,~r- PLAN VIEW Distances and dimensions to meet requirements of ILH,R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM let C4d tte ~~iJJJ f t A 12,11 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ~ = r G Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: C C Number of rings used: j Tank manhole cover elevation: C; S,LL Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side Rear, O 73 feet From nearest property line Front 10 Side 0Rear, 0 75 feet y' Number of feet from: well 27, building: g (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 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: 1 Z Length: Z Number of Lines: Z Area Built: Z.~ Fill depth to top of pipe: Number of feet from nearest property line: Front O Side, ®.Rear,O Ft. Number of feet from well: ~Q Number of feet from building: Z 5 (Include distances on plot plan). SEEPAGE PIT I V / 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 / V/ 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: a T elSn L! Dated: / Z lZZ/gl~ Plumber on job: P 5~ Z~- License Number: 32 l Z 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS I,.ABOR & HUMAN RELATIONS • BOX PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI WI 53707 BUREAU OF PLUMBING ❑CONVENTIONAL DALTERNATIVE State Plan l.D. Number: (lf msignedl ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: RODNEY BURTON RT. it 4 BOX 58A NEW RICMIOND 1 (/.W8 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: SEX4 SEk SEC. 7 T29N R19W HUDSON EAGLE RIDGE LOT 9 Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: JOHN SYKORA 3212 ST. CROIX 80c, 11216 4 SEPTIC TANK/HOLDING TANK: MANUFACTURER: ` LIQUID tOUIO CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: IWARNINGLABEL LOCKING COVER ~ FlIqMIDED: PROVIDED: BEDDING: YES ONO DYES O VENT DI VENT MATL F H WA R NUMBER OF ROAD: ` r PR~O~P"ERTY/ WELL: BUILDING: V NTT FRE H RM. FEET FROM S ~,1 L r J AIR INLET: DYES ONO DYES ONO NEAREST J r DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY'. PUMP MODEL: PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER _ PROVIDED: PROVIDED: DYES ONO DYES ONO OYES ONO GALLONS PER CYCLE: PUMP AND ONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING V N TO FRE (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 to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LEENGTT~H NO.OF DISTR. Pp E ACING C VER INSIDE CIA *PITS LIQUID DIMENSIONS ) TRENCHES M RIAL' PIT DEPTH R L EP H FILL DEPTH OIS/TR. PI/PF" DISTR. PIPE DISC. PIPE `MRIAL: N R. PROPERTY WELL: a G: V NT TO FRESH ELOW PIPES ABOVF~Oy,~R: ELEV. INLETELEVENP NUMBER OF "(j J 7 FEET FROM LINK AtR INLET: ! MOUND SYSTEM: 7 NEAREST - 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- DYES ONO meets the criteria for medium sand. TIONS MEASURED. IL OVER TEXTURE PERMANENT MARKE S. OBSERVATION WELLS DEPTH OVER TRENCH/BED OYES ONO OYES ONO CENTER: EDGES OVER TR NCH/BED DEPTH OF TOPSOIL'. SODDED. SEEDED. MULCHED. EDGES'. DYES ONO DYES ONO DYES NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: WO. -OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS ELEVMAN.:IFOLD E PUM LEV.: MANIFOLD DISTR. PIPE MANIFOLD MATERIAL'. NO. DISTR. DISTR. PIPE UIST HIBU T ION PIPE MATERIAL & MARKING DIA.. ELEV.: PIPES. DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COV ER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. D COMMENT aS: ERMANENT MAR YES ONO DYES O NO OBSERVATION WELLS: TFEUE MBER OF PROPERTY WELL: BUILDING: FR OM LINE: DYES ONO EAREST 1~/z G C Sketch System on Reverse Side. 1/( etain in coun file for audi SI E: TI LE DILHR SBD 6710 (R. 01/82) g- ~ a vd N m 1 N d0 ~ d (O ' 1 ~ d ~ t 1 N_ a a u oa Q9 r~ m- SANITARY PERMIT .,os TRANSFER/RENEWAL - COUNTY ' (PLB 67-T) UNIFORM PERM/IT # 1100 PERMIT RENEWAL DATE: PERMIT TRANSFER DATE: T Q .r e7~~ ORIGINAL PERMIT ISSUANCE DATE: STATE PLAN I.D. NUMBER: PRO E'F y- PERTY LOCATION: VILL LOT UMBER: N•Rl7 E (or W BLOCK NUMBER: LIii'lVISIONN • SL N E' NEAR T R AD, LAKE OR LAN MARK: PREVIOUS SANITARY PERMIT HOLDER (IF CHANGED: NAME: SANITARY PERMIT TRANSFERRED TO: SIGNATURE: NAME: ADDRESS: PHONE NUMBER: PHONE NUMBER: ADDRESS: the undersigned, hereby assume responsibility for installation of the private sewage property, system that has previous) been a MBER'S SIGNAT E; Y approved for this P OUS PLUM ER'S AME (IF CHANGED): ~U ER'S ADD ESS:, PR OUS PL ER'S AD ESS: P/MPRSW NUMBER: 3 PHONE N MBER: s is MP/MPRSW NUMBE T Jr6 -l~1PH/I~~ONE NUMBER: 3N TURE OF ING ENT: DATE APPROVED: DISTRIBUTION: Original - Count NR-SBD-6399 IR. 5/82) COPY - Bureau of Plumbing Copy -Owner COPY - Plumber o W c colpico 9 ~ . m ° z m rn 0 m 31 00 aloft N r-- Mo 0 covi x < cn ~ n oro ~ m ~ :Cow m C7 p co rC K 0 O tin Z c D = r n G7 m o C-1 % --I ~ 0 N En z D o Cl) ,n 0 v, --I ~ co m 7 ~ Z z < 0 W Z m o a C7 aloft 5--1 can n z 0 ezv 72 m C 30 :D m ds mom a ~o ^'ci ov Dm Z = c a m a z > D 3 = f on = m _ C.i ~a ° m S J cp S m C m CO, . _ 3' r- m o f a ~ O 3< .J C Q _ p1 fD ~z CD Q `°a 3O m rn Jm ~ do 73m~ VN D3 cv~ H ~aaJO3 m o o 3.~, f~ C C N ~,Q ~D J » as O 07 O• w 6< al 0 C y S- 1 7< G c g 0! 3 3 3 < m•p m ~.Q n d. ma ° 0 v 3 n o~n~ 3 o z to m r H' y m D m H `~'i m G y~ O' m N S ~ ~H m o ~ m f m 00 0 3 < m 3 D co C < Da ' Go S N w. 3 m a C • m m - S2- DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR 211eH(JMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION • PtO: BOX 79,69 BUREAU OF PLUMBING MADISON, WI 53707 X EONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: ❑ Holding Tank El In-Ground Pressure ❑ Mound (lf assigned) NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Rod Burton Rt. 4 New Richmond WI 54017 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: SE SE Section 7 T29N-R19W Town of Hudson Lot#9 Eagle Ridge Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Lyle J. Myers 6219 St. Croix 88404 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: IWARNI G LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WA J I NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM FEET FROM LINE: AIR INLET: ❑YES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: - PUMP MODEL: PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING: VENT (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) ❑YES ❑ O EAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ENGTH DIAMETER IM, TERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FOR the soil is dry enough to continue.) MAI CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: INO.OF DISTR. PIPE SP IN : C V NSIUE DIA *PITS LIQUID TRENCHES: T IAL: P DEPTH-. DIMENSIONS UffA__V L PTH FILL DEPTH U TR. PIPE DI R. PIPE DISTR. PIP MA L. O. DISTR. BER OF PROPERTY WELL: BUILDING: V NT TO FRESH BELOW PIPES: ABOVE COVER LEY. INLET ELEM. END: PI Es: MET FROM LINE. AIR INLET. r\N rd NEAREST MOUND SYSTEM: Mound site plowed per ndi la to slop a he texture the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown ups pe: u system to make certain that it ON REVERSE SIDE. SHOW ELEVA- s the cr ' ria for medium sand. TIONS MEASURED. ❑YES N IL OVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS 'i Z I ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH DV" TRENCH/BED TH OF TOPSOIL. __jS6DDED SEEDED. MULCHED. CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD MVP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.: EULE.: DIA.: ELEV. PIPES. DI A.: ' DISTRIBUTION INFORMATION HOLE SIZE HOLESPACING: ORILLEDCORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: ❑YE ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARK OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST i i~ fw~ Sketch System on Retain in county file for audit. Reverse Side. GNATURE: ITI'lLE. DILHR SBD 6710 (R. 01/82) r ~.s fta wrsconsln APPLICATION FOR SANITARY PERMIT D ILHR (pig 7 COUNTY Z -.OEPRRTmEnT OF 6 UNIFOR SANITARY PERMIT # - InDUSTRV, LRBOR 6 HUMRn RELRTIOnS -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PR RTY OWNER MAILING ADDRESS ~GzcJ , S /7 P O ERTY LOCATION CITY: r '1164!5)14,S VILLAGE: N, R E (or OWN OF D O~ J LOT NUMBER BLOCK NUMBER UBDIVISION NAME AR T ROAD, AKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 Xor 2 Family Number of Bedrooms: Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. L Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank fff❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity dC'J L G~3 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: A> -I IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): / Z Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Na of Plumber (Print): Signature: _ MP MPRSW No.: Phone Number:. Pfu er's Address: Name of esig r: C iS S< A 71 It _j COUNTY/DEPARTMENT USE ONLY Signa ur of Issuing Agent: Fee: Date: El Disapproved ~oC`7 ~ ,~1 i ❑ Owner Given Initial n Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County; One Copy To; Bureau of Plumbing, Owner, Plumber „~z r a . . i a ' INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 R To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan includinga plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. cj h y~ Soh ~ ~ s a n f.( t*-~cU e~y --7 9 (LL21 rE ct O L t 1 J. S 1 ~ sz- ~•Q _ oW F C)l t o 0 rn ,J f o ~ 757 I ~S 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 p Q/ Location of Property Section , T~N-R W Township S O ~U t.~J ilia Mailing Address D k ' Address of Site Subdivision Name LG <Lot Number I Previous Owner of Property Total Size of parcel Zi Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number 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 I (We) eexU& that alt btatemenU on thi,6 6onm ane true to the but o6 my (oun) knowledge; that I (we) am (ake) the owner(.d) o6 the pnopenty denscAi.bed in thi6 .in6o4mafii,on 6onm, by vi tue o6 a wwaant deed neeonded in the 066ice o6 the County Re9i,6ten o6 Deeda as Document No. 64 ; and that I (We) ptuentby own the pnopobed .6 to bon the sewage diZpob . yb 'em (on I (we) have obtained an easement, to nun with the above d6cAi.bed pnopmty, bon the eonatnucti.on o6 4aid eyetem, and the .name has been duty tecokded in the 046ice o6 the County Reg.ia.teA o6 Veede, as Voeument No. L~till.~~ SIGNATURE 0 OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) E SIGNED DATE SIGNED IjERMOTT AGENCY • GALLERY OF HOMES 600 Third Street Twin City Toll Free 436-5755 • Phone 386-5151' HUDSON, WISCONSIN 54016 EAGLE RIDGE A ounty, Wisconsin Rural Subdivision Located in the SE % of Section 7, T29N, R19W, Town of Hudson, St. Croix C ~,~~~.I~ 1 u►►>cvx , M.K ..r rr wn.n..w 29 28 1 27 30 { 34 33 ..«.2... ~ w r. 1: • q i 35 rW»R• U"• .wa 19 a 11 1UYi M% W 1 21 22 23 24 2D 11 ~ 36. o / W .t • 37 38 15 17 fal..n. y f 1 y ~ O` 46 I' l WW-ft -W 39 E „s i j 4e ~i 14 11 40 41 45 i + / +0 cs. •JA '149w / ~J w.6K y 1 1 .rr ~ h 1 w 50 44 12 O , ? y 42 43 51 ' s 11 w 11r 52 ♦~4♦. ♦ s Y Y •w~ 10 6 4 r. 3 5 7 1 ....an W ' AIM= H - 'Z N 9 r . r STC-105 N H 0 SEPTIC TANK MAINTENANCE AGREEMENT v St. Croix County ~ 0 v~ Q OWNBR/BUYER Fire Number Ok ROUTS/BOX NUMBER ZIP .CITY/STATE 't~ SC-1% Section+ T .2LN , R _j3_W , PROPERTY LOCATION ' _9 St. Croix County, Town of 17 a • Q £ , Lot number. Subdivision £ e of Your septic system could result in Improper use and maintenanc es. Proper maintenance con- its premature failure to handle ass every three years or sooner, silts of pumping out the 8ep tank um er. What yo k u as pdt a Into at- tic tan if needed, by a licensed septic tank the system can affect the fun°systf the em. sep ment stage in the waste disposal residents ma1►,be eligible to receive a grant for St. Croim of of the cost of replacement of a failing 1, 1978. St. Croix County a ch m of 6t0% of prior to July which was in op cast of 1980, with the requirome=iythat to keep their systems p p accepted this program in August owners of all new svs s agree maintained. Zoning a Croix County The property owner agrees to submit to St. a master plumber, igned by the owner and by um er veri- certification form, srestricted plumber or a licenseempispin proper journeyman plumber, osal sys if nec- fying that (1) the on-site wastewater action and pumping ion and (2) after insP full of sludge and scum. operating condit essary)• the septie'tank is less than 1/3 30 days prior to 0 Certification form will be sent approximately E three year expiration. x uirements and agree the undersigned, have read the abovetem in accordance with I/W8, disposal sys to maintain the private sewage as set by the Wisconsin Depart- the standards set forth, herein, of Natural Resources. Certification form muetwithinm30e ment days and returned tearhexpirationxdatenty Zoning Offir of the three y SIGNED DATE St. Croix County Zoning Office P.O. Box 98, 54015 Hammond, 715-796-2239 or 715-425-8363 Sign,tdate and return to above address. mmm„~ ujacona, SANITARY PERMIT Coon j ~i 'LHR OUNDWATER SURCHARGE PermltNo. La"imn LJ a, GR Sanuary his more tion is com On May 4,1984,1983, Wisconsin Act 410 was signed was the result of over change in statutelegisla monly known as the groundwater protection law. This bill included 2 years of steady negotiation and public d awhich caneeffect groundwater.rTheion of surcharges (fees) for a number of regulate practices surcharge took effect on July 1, 1984. All of the water that is used in your building is returned the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund aou wate dminis- tered by the Department of Natural These Resources. establishment of standards. Groundwater, water, , groundwater contamination investigations and it's worth protecting. Ground" Wisco Groundwater Fee: Date: 3 buried k' IaYZI buried ng Sign re of Issui Agent ~f DILHR SBD-7289 (N. 05184) ern ON SOIL BORINGS AND SAFETY & BUILDINGS DEPARTMENT OF DIVISION EP.O. BOX 7969 GNb WAND PERCOLATION TESTS (115) MADISON, WI 53707 LABO~i ;AND HUMAN RELATIONS (1-163.090) & Chapter 145.045) OWNSHI UNICIPALITY: OT NO.: BLK. NO.: SUBDIVISION NAME: LOC 910 A ON: SECTION: `N/R ~E to /4 _ ~Y]ER'S NAME: A LIN111 l G ADDRESS: c 0~ III COUNTY: OWNE 1 r DATES OBSERVATIONS MAD A TESTS: USE P~PF/~ NS: NO,BEDRMS.: COMME~AI,~ CRIPTION: New ❑Replace N Residence c nal) RATING: S= Site suitable for system U= Site uns itable for system ONV ZONAL: MOUND: IN-GROU NO-PRESSURIE: SSTEM-IN-F L OLLDING TA : REC M NDED SYSTEM:(op S Q~ U S ❑U S El S , y C S DESIGN ATE: If any portion of the tested area is in the u Percolation Tests are NOT required Floodplain, indicate Floodplain elevation: under s.H63.09(51(b), indicate; N g , PROFILE DESCRIPTIONS , - ro PQ BORING TOTAL D H TO GR UNDWATER-INCHES TO BEDROCK IF OBSERVED (SEE ABBRVS O COLOR, AND DEPTH I NUMBER DEPTH IN, ELEVATION OBSERVED ES EST /I 1 11 aI si S/ a 'Bn SI / a gN Fill > ozf / y~ N 6 N B- Z & N B-3 l05~ `IL $ 1Va~J !o~ aeN VagM sal , Nb~J~ ? o B- B- qws/ St/ as .s, M 134 B- All O~ > Q~ A( 1011 11,11 11 ililli ! ? 78'ERCO }0/r s1!7 ~La~ / 33r y C.z. B' 78 QO ~b RA E MINUTES DROP IN WATER LEVEL-INCHES PER INCH TEST TIME PERIO 2 TEST DEPTH, WATER IN HOLE P NUMBER INCkIES AFTERSWELLING INTERVAL-MIN. PER U1 < P- P- P=?~ all boingseand the'd rection and percent PLOT PLAN: Show locations of percolation tests, soil bhe ~9i cado h on ~thenplotsplan UShow the s dace ellevatio a scale zontal and vertical elevation reference points and show of land slope. iW SYSTEM ELEVATE - IF ~_g a i..... i )1l I C _ E dits-C ! i -r- rv.. L~ • E € i ' hereby certify that the soil tests reported on this form were made by mee accordrlmuth ~ thoC Wisconsin I, the undersigned, tive Code, and that the data recorded and the location of the test c r~c 7 best p ~ @rG /~_1~O Administrative TESTS eERE COMPLETED ON: ME (print : "41 G I ! is CER IFICATION NUMBER: PHONE NUMBERIoptional ; R SS : . CO ° co F2377 ` CS SIGNATU L pr\9in° 13-0ON. o21s2i___ T% 60 63gy tR• Local Authority, Property Own - OVER - a.r INSTRUCTIONS FOR COMPLETING FORM 115 - SBQ - 6395 4 • To be.a coicplete and acmgrate soil test, your report must include: a 1. Complete legal description; y 2. The use section must clearly indicdte whetlter this is`a'esidence or cornmerciat~farojeet; 3. MAXIMUM number of bedrooms or commercial.use planned; 4. Is this a new or replacement cyst@m - 5.-.CompletO the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING T NK ON`. e ~-IF ALL OTHER SYSTEMS ARE RULED OUT BASEL? ON SOIL CONDITIONS, A 6. RLEASEruse 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 referred. A separate sheet may be used if desired; Make sure your benchmark aridyertical- elevation referencepoint'-are ch~axly shown, and are pe'rinanent; a' 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- Lion, 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 required. ALL SOIL TESTS MUST BE FILED WITH THE LOCACAUTHORITY WITHIN 30 DAYS'OF COMPLETION, • . B FIBA NT.1C} STOR QERTIFIEO SOIL TESTERS Soil Separates and Textures ` Other Symbols st Stork (over 10") BR - Bedrock cob Cobble 4- 10") 4. t SS - Sandstone gt - Gravel (under 3") `ae • ` ; LS - Limestone *s - Sand HGW - High {groundwater ~ cs Coarse Sand • Pere Percolation 4ate meal s - Medium Sand W - Wel1r fs - Fine Sand Bldg -Building , . Is - Loamy Sand "sl Sandy Loam - Gr"ester Than . ' _ - • ~ - Loam - Less Than Silt Loam n Brown t *1 B BI Black i 1 si -Silt - - . *cI -Clay Loam Gy -Gray Y Yellow scl - Sandy Clay Loam R _ Fed sicl - Silty Clay Loam ; . mof Mottles` sc - Sandy Clay t w% with - sic - Silty Clay fff - few, fine, faint ~c -Clay cc - common, coarse pt Peat mm - Mari' m - Muck Y, rtditm d -distinct ti p - pramirtent` t: HWL - High water Ievilll"r j ` Six general soil textures surface Water i ( liquid Lasfe disposal .d BM -Bench Mark VRP Vertir4 Reference Point t R! .tom ~ t •L i~,} TO THE OMER: This soil test report is the first step in securing a sanitary / verification of this sail test in the field prior to perm l issuance. Ac complete sett of plans r forr the priva se / sewage system and a permit application must be, submitted to the appropriate local authority in order to obtain a perrnit. Thesanitary permit must be obtained and posted prior to the start of arty construction. 90 o'S ti9.