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HomeMy WebLinkAbout020-1158-40-000 o fn O 3 y ° d r1 m f 7 3 r"~ A IDO 3 C/) o o=i uNi o o w m a w o • CD 3 o ro m w a 0 3 O a CD C) ro o A+ cn _ A y a r (D b O co cci CD 0, a 3 a 0) co CA 00 CD OD co Cl) 0 c fT 17 ~ V' w rn rn 3 N" cyl O O O A JC3 m 3 v v m CZl] g Q m d m _ m m N l~V` cy~ a 00 00 O N Z co Z O rt Z D En CD 0 O a 00 o =r G r-~ 0 m CD ON 1~0 W (D Imo- :E: N CCD m cn H rt I C. N 'O a 3 (D f ~'7 Sa Z CD ~ p Z A W O. d A Z 2 F'• r O (D C, 0 (n ~ N I-11 (D ~ < (ND W a °•3 AZ 3 cD f z I w CD ~ I CL D. C I D=i c I o a CD N H V N O q O= bq N ~ A ~v ~ V O O 0 Q ti To Date Time 0 M WHILE YOU 77 WERE OUT of Phone Area Code Number Extension TELEPHONED ELEAE L CALLED TO SEE YOU GAIN WANTS TO SEE YOURETURNED YOM Sage Operat AMPAD ® EFFICIENCY® REORDER X23-000 I 06/07/2006 08:11 AM Parcel 020-1158-40-000 PAGE 1 OF 1 020 - TOWN OF HUDSON Alt. Parcel 23.29.19.891 ST. CROIX COUNTY, WISCONSIN Current EX-1 Application # Permit # Permit Type Creation Date Historical Date Map # Sales Area 00 0 Owner(s): O = Current Owner, C = Current Co-Owner Tax Address: O - VAN DEN MEERENDONK, PAUL P & DEBORAH A PAUL P & DEBORAH A VAN DEN MEERENDONK 809 KELLY RD HUDSON WI 54016 * =Primary Districts: SC = School SP = Special Property Address(es): Type Dist # Description * 809 KELLY RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.680 Plat: 1903-DEL'S WESTVIEW ADDITION SEC 23 T29N R1 9W DELS WESTVIEW ADD LOT 4 Block/Condo Bldg: LOT 04 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 23-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1051/318 WD 07/23/1997 904/60 07/23/1997 744/564 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Last Changed: 10/25/2005 Valuations: Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.680 91,700 243,900 335,600 NO 0 Totals for 2006: General Property 3.680 91,7000 243,900 335,600 Woodland 0.000 Totals for 2005: General Property 3.680 91,700 243,900 335,600 Woodland 0.000 0 0 Lottery Credit: Batch 126 Claim Count: 1 Certification Date: Specials: Category Amount User Special Code Special Assessments Special Charges Delinquent Charges 00 0.00 0.00 Total Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT • t SEC. T Z~ N-R15 W OWNER 1YL'-~~ - TOWNSHIP ADDRESS O ST. CROIX COUNTY, WISCONSIN SUBDIVISION (4~ / ei_1 4 LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IZHR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f S /V 40, C / 2 oo 5 ~ : C ' -7,Z Cal- INDICATE NORTH ARROW e, (te. -Ale, k-?ez BENCHMARK: Describe the vertical reference point used yA2 1!~)/ ef7 Elevation of vertical reference point: Proposed slope at site: CO 7 SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front ,O Side Rear, /r f? feet From nearest property line Front 10Side ,/0 Rear,0 feet Number of feet from: well y , building: 4 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE A PUMP CHAMBER • Manufacturer: Liquid capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: L Trench: -21 Width: ~J Len the 7Z.. Number of Lines: Z Area Built: 6460 Fill depth to top of pipe: Number of feet from nearest property line: Front, Side, O Rear, Pt.1/5 Number of feet from well: 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 boxtQ( %10- or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: /1M 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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: r~ilg' C~- License Number : LL 3/84:mj g3 ST. CROIX COUNTY! WISCONSIN ZONING OFFICE COUNTY COURTHOUSE " r ~.S fi ro~ 1•, CROIX 9d WI 54016 1°~•URTH STREET • HUDSON, v~. ra`ty (715) 386-4680 'FUN, A REQUEST FORM SEPTIC INSPECTION & remit appropriate fee with application. Specify desired test(s) winter months, outside water lines are often tu. Please make arrangements with making access to the home necessary. can be gained. this office to insure a time when entry 0 12 Septic $25.00 ❑ Water (VOC's) $185.0 $35.00 (Visual inspection) ® Water (Nitrate & Bacteria) Requested by: T;m nahlby Owner: Jeff & Joan Kidd Address: Address: 809 Kell Rd Wi • City & St. Hud ' r"'' City & State: Hudson Zip Code: 54016 Zip Code: 54016 phone Telephone N4: (715) 3 8 6- Tele N°: ( 715) 386-6797 address (Fire N4 & Street) : 809 Kell Road L- - Property SW SW Sec. 23 , T 29 N► R12_W, Town of Location: St. Croix Co.-, WI Tax ID N4Parcel ID N° I • ~Zp--J f ~~L~G~1~ ~ ` Lock 130 om o• JIM House color•Brown Realty firm: Edina sample tap location: TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Is the dwelling currently occupied? Yes ❑ No If vacant, date last occupied: rh ear. Septic system installed by: Ur, Kro Wry Septic tank last serviced by: ~'ckness lUmh'^ Date:O~T_(,jqa, l Previous Owner's Name (s) : f Have any of the following been observed? ~rw ❑y Oil' Slow drainage from house. ❑y GN` Sewage Back-up into dwelling. ❑y (3N- Sewage discharge to ground surface, road ditch or body of water. k ❑y gN Slow drainage from the dwelling. ❑Y Foul odors. a ga W as Other comments relative to system °peratio S /NCC I \ S4-4 Na,h'a Y-N l~tg I certify that the above information is compl to and true to the knowledge. DATE: 1O q best of my OWNERS SIGNATURE: 4/93 OWNERS DRAWING OF HOUSE & S "TIC SYSTEM LOCATION y [IN r 1 TO BE COMPLETED BY INSPE ION AGENCY System design &/or permit on file? Wes ONo soil series per SCS Soil Survey: sheet # Type of soil absorption system: [Below grd OAt-Grd OMound Approx. size 'X 06f ~-a-v it Ft.= y OD se OPressurized OBed enc!g2 - ry Well ❑Holding Tank 00utfall pipe OBSERVED DEFICIENCIES 00ther OUnknown _Septic tank Setbacks: OHouse~OWe11~OProp, liner 00ther Dose tank Setbacks: OHouse OWell OProp. line 00ther n A-Blocking cover OWarning label OPump/Floats OAlarm OElec. wiring Soil Absorption Syste Setbacks: OHousel~Well OProp. line OOthe OPondin r g yODischarge:_ General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N p ~I`✓2 Spector ST. CROIX COUNTY WISCQNSW PLANNING & DEVELOPMENT PLANNING SOLID WASTE REAL PROPERTY ZONING 715-386-4674 715-386-4623 715-386-4677 715-386-4680 October 19, 1993 Jim Dahlby 700 2nd St. Hudson, WI 54016 Dear Mr. Dahlby: An inspection of the septic system serving the home of Jeff and Joan Kidd, located at 809 Kelly Rd. in Hudson, was conducted on Oct. 13, 1993. This inspection was based upon a surface inspection of said system and did not involve any excavating or chemical analysis. Accordingly there may be hidden defects in the system not discoverable by this inspection. A water sample was also taken at the same time. We will forward the results to you as soon as we receive them from the lab. Most septic systems consist of a septic tank which traps the solids and greases from the sewage stream and then allows the remaining liquid to seep into a subsurface drainage area. Once the liquid reaches this point it seeps away by percolating through the soil surrounding the system. Failure is caused by the soil surrounding the system becoming plugged with microscopic bacteria and sludge, among other things, which form a clogging mat. As time goes on, this clogging mat becomes progressively thicker, allowing less and less liquid to drain away from the system. When this clogging becomes severe enough, liquid sewage is trapped in the drainage area, a condition known as ponding, and results in backup of sewage into the structure or the discharge of sewage to the ground surface. At the time of inspection, this system appeared to be functioning, but not at full capacity. I noted that there was sewage effluent ponded within the upper trench drainfield area. the lower trench was dry. Because a systems failure is a progressive process, I cannot predict how long this system will continue to properly dispose of sewage effluent nor how soon the system will reach complete failure. With proper care, this system could conceivably last for several years. However, I cannot guarantee or warrant that this system will function properly in the future. In an effort to prolong the system's life, I recommend that steps be taken to minimize the wastewater flow from the house which enters the system. For example, repair any leaking water fixtures and/or replace them with water conserving fixtures, reduce time spent in the shower, wash clothes and dishes only when there is a ST. CROIX COUNTY GOVERNMENT CENTER • 1 101 CARMICHAEL ROAD 0 HUDSON, WI 54016 full load, use a washing machine with a suds saver feature, etc. I would also recommend that you have the septic tank pumped at a minimum of once every three years. Should have any questions or concerns that I can clarify, I can be reached at this office between 8:00 am.- 5:00 pm., Monday - Friday. Sincer ly, es K. Thompson G Assistant Zoning Administrator cc: file r COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 FAX - 715 962 - 4030 ST. CROIX COUNTY GOVERNMENT REPORT NO.Y 50885/01 PAGE 1 CENTER REPORT MATEY 10/18/93 1101 CARMICHAEL ROAD DATE RECEIVED! 10/14/93 HUDSON, WI 54016 ATTNY THOMAS C, NELSON OWNER! Jeff ak Joan Kidd LOCATION2 909 Kelley Rd., Hudson COLLECTOR! Jim Thompson DATE COLLECTED! 10-13-93 TIME COLLECTED! 9Y15am SMF- OF SAMPLE' Kitchen faucet DATE ANALYZEDY10-14-93 TIME ANALYZED4'24400pm COLIFORM,WCCY 0 /100 ml. INTERP'RETATION1 Bacteriolog;icatty SAFE NITRATE-NY 3 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L Cb 1z f~ 'r 6~ LAB TECHNICIANS Pam Gane v OFnNOEVENOpNr~ S r WI Approved Lab No. 19 17 O P zg yA < Means "LESS THAN" Detectable I.evel Approved by'* ' I PROFESSIONAL LABORATORY SERVICES SINCE 1952 _I 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 ~ XXCONVENTIONAL ❑ALTERNATIVE State Plan l.D, Number: (If assigned) Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: James Dailey Rt. 1, Hudson, WI 54016 ~ BENCH MARK Wermanem reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. SW SW, Section 23, T29N-R19W, Town of Hudson, Lot#4, Del's Wesview Add. Name of Plumber IMP/MPRSW No. Samtary P- NumberRoger Timm 3224 T7; Croix 83771 SEPTIC TANK/HOLDING TANK: _ NI G LABEL LOCKING COVER MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV TANK OUTLET ELEV WAR ,,f P V ED PROVIDED' 0 0 ~ J~-~ YES ❑NO -]YES O BEDDING. lV/ VENT DIA.. VENT MATT HIGH WATER NUMBEROF ROAD: ROPE 4,y WELL. BUILDING: jVENVTO F ESH ALARM LIN AIR INLET. FEET FROM L/ ❑YES %0 ❑YES NO NEAREST 2 DOSING CHAMBER: MANUFACTURER BEDDING'. LIQUID CAPACITY PUMP MODEL PU; SI PHON MANDE ACIOREH WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ❑NO YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPER ONAL NUMBER OF PROPERTY WELL BUILDING I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO` NEAR SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth/,6f Oowing FORCE IIANIFTEH MATERIAL ANDMAHKING or excavation. (If soil can be rolled into a wire, construction sh cXase until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH LE,raC,~H NO OF U STR PIPE SPAC C EH INSIDE DIA -PITS LIQUID BED/TRENCH t{ J- TRENCHES Ask-HIAL PIT DEPTH. ~ DIMENSIONS ~el y GR.4 `dEL GCPT11 FILL DEPTH UISTH PEPI UISTR PIPE ISTR. PIPE MATERI NO UISTH NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER ELEV. INLF 1 ELEV. ENU PIPES FEET FROM LINE J AIR INLET: G 7, ~7 NEAREST- 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 SOIL COVER TEXTURE PCHNIANf NT MAHKEHS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BEU DEPTH OF TOPSOIL 75DF1) ISEE CFO MULCHED CENTER EDGES ❑YES. ❑NO ❑YES ❑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 UISTH UISTH. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV.' DIA. ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT LY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE 0~ ❑YES ❑NO ❑YES ❑NNEAREST- .-7 ~1 Co/ - - k° v(a~ d i Sketch System on Retain in county file for audit. Reverse Side. SIGNA TITLE DILHR SBD 6710 (R. 01/82) SANITARY PERMIT APPLICATION X 0 I, ' ©tLHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANNIITtA~i~'"R_Y-P~ELRMMIT# .._~.a~. S3 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 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER PROP RTY LOC TION ~j 'a S /a, S _;2 3T 05, N, R (or)~J OT NU ER BLOCK NUMBER SUBDIVISION NAME L PRO TY O NER'S MAILING A ~ESS `-l. ZIP COQ PCITY NEAREST ROAD, LA R LANDMARK J Q CITY, STAT 4t/~ D/~J R VC II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 ORE] Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. M New b. E1 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. E:1 System- b. ❑ Holding C.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a.,196ee a e Bed b. ❑ See a e 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): Q 6<0 Tb/" !~-,o Feet APrivate ❑Joint ❑Public VI. TANK CAPACITY Prefab. Site Fiber- Exper. in gallons Total # of Manufacturer's Name Concrete Con- Steel glass Plastic App INFORMATION New xisting Gallons Tanks structed Tanks Tanks Zoo ❑ ❑ ❑ ❑ ❑ Septic Tank or Holding Tank /l~C ❑ ❑ ❑ ❑ ❑ ❑ 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): Plu is Signature: (No St mps) MP/AG, BBAI No.: Business Phone Number: Plumber' Ad ress (Str et, Ci , State, Zip Code): Name of Designer: aZ 4 15m-7 Z4 VIII. SOIL TEST INFORMATION Certified Soil T ster (CST) Name CST # n CST's ADDRESS (Street, City, State, Zip Code) - Phone Number: IX. COUNTY/DEPARTMENT USE ONLY Issuin Agent Si nature (No Stamps) ❑ Disapproved Sanitary Permit Fee Groundwater ate g Approved El Owner Given Initial Surchar a Fee 2.1 Adverse Determination (f 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 INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT ' APPLICATION , TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 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%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. 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 Wiscorisin's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried f teas:ire is used in your building is returned to the groundwater through your soil absorption 1 system or the disposal site used by your holding tank pumper. The monies collecte~ thrDugt thtye surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- v,rater, groundwater contamination investigations and establishment of standards. Groundwater?, _Y it's worth protecting. SBD-6398 (8.03/86) APPLICATION FOR SANITARY PERMIT S T C 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 .cS Location of PropertyG~ Section 3 , T___.;MN-R W Township Mailing Address Address of Site t//tom ,~D• Subdivision Name Lie /3' /4/z *r J/, 4-ul Lot Number Previous Owner of Property J64gzt-x- lc Total Size of Parcel Date Parcel was Created - 8 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume- and Page Number S as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and pane 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) ceAti6y that aU ~6tatement6 on this Sonm ane tAue to the beast o6 my (oun) knowledge; that I (we) am (aAe) the owneA(b) o6 the ptopehty de.6cAibed in thvs insonmati,on Sown, by vi tue o6 a wa4Aanty deed fceco,%ded in the 066ice o6 the County Reg.usten o S Deers as Document No. and that I (We) pnez entty own the pnopo.s ed site San the sewage d4A pos ~5 y~ em (on I (we) have obtained an easement, to nun with the above de scA bed pnope~ty, So,% the con6tiru on o6 ~6aid system, and the .same has been duty neconded in the 04jice o6 the Cou y Reg-usten os Deed6, as Doc ent No. SIGNATV~E OF OWNER Q SIGNAT OF CO-nR~~IIF PLICABLE) /U DATE SIGNED DATE SIGNED • H ' 7. V] ' H a STC - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County z d a .9~rgt5 OWNER/BUYER ROUTEIBOX NUMBER Fire Number ,CITY/STATE ZIP PROPERTY LOCATION:_ t0 k, Sid k, Section 13 , T 92 N, R W, Town of Q~~ , St. Croix County, Subdivision pe/S [Nl~✓i,rv✓ , 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. H I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Off' a within days of the three year expiration date. SIGNED DATE St. `Croix County Zoning Office P.O. Box 98s Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. ;o ~c' N L 0 c a) -0 a~ o•°- C c~ 3 o a) o > 0 E c ~c _0 ° o (n c 3 C.0 a U) C7 § .0 W O w'a 0 -0 c`u32 'a Ec 0 L- y ~ c C~ ~ ~ o t- Q (D ;~N o°o 2 cti~ c as moo.. V W c° U° CL Y 4)L c° ° °3~v cn co a N ~cc~-° 0(n cv :3 - - = 'a Co °L -C ca c - CC W W C U O 3 w 0 ° `gym L U O cc >1 cn M 0- cc 0- L c p N 0 3 3°v«oO n stern r~R p U U cC U 0 o 0.0 0) cn w .0 in UCL s"~fti OTC Q L p - cn c C O T O O co L _O N a) r. c 3 c -0 o c _ C 'O E >O rnZ cn , : o E C L `O 3: CD C O m O p w O O d a) L 4) 0 C- N C i p r ~ U co C $ M M ~Y 3 a c ^ rn c a) a-' o co o0~ o $ 3 m w.. 3 0 U) a) c 0- a) O a CD a o 0 '0 ° L- mc It) " I.- , - cis cC cC O O O •Q i fl i O a co c (D U U pY D a) 3 C O O C Co to m U) cn 0 E N U) cn F- CD m rL.. ~ 3 « fA ~ Q cA p DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 76 LABOR AND - PERCOLATION TESTS (115) MADISO N WI 3707 HUMAN RFLATIONS (H63.09(1) & Chapter 145.045) LOCATI N: SECTION: TOWN SHIP/MU*fC-H'A4:tTY: 0.:BLK. NO.: SUBDIVISION NAME: 5tv 1/ 1/ 2-3 /T)-1 N/R/ E (o Al fJvDSov OT LLB'/s W$7X&'A0 4APi71*,' COUNTY: OWNER'S BHYtWS NAME: MAILING ADDRESS: 5> r,Pol)( T4Ars- .1,4V,4Aj50 Zl9iG w. zyg, 5-7yx AwwxA-l Cal "'tv'rm"t Zvi r. s3, G USE DATES OBSERVATIONS MADE ,,-yy(( NO. BEDRMS.: COMMERCIAL DESCRIPTION: RRIP IONS: 1PERCOLATION TESTS: L4IResidence /f/ New ❑Replace /O yJ! M141 - RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: rEis YSTEM-IN-FILOLDING TANK: RECOMMENDED SYSTEM:(optional).D Af '5 O O FO ©s ❑u Cis ❑u s ❑u RuL H❑s ©u . w.4o-s -oA.7~ . 'Y'o qW,%4fj, 1"1-401111 A05 .IDJa If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the I under s.H63.09(5)(b), indicate: e' 14517 Floodplain, indicate Floodplain elevation: No S~'~ J! Jl3!lRI~'f14R.07- PROFILE DESCRIPTIONS BORING T DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED ES IGHE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) av-ty si, /-•7' 81J s: , 143 3 B- / 9• D1.7o ~!U- y 9'. s/ X. G v 66avePS 8U • Is ~ 71,u . lw-4- S r B-Z v X00• ~l fir- 8~- yf( S. ,e33N s~/ ~G.e- , 7' .4i~4U.4 N,9 6 .r ti1X. B-3 0 99~ 7~- 'f' -4y. S►l 1O' 30. S-/,/ o- 'V s f/ O /.S' Bv- CS , d ,tip X. of •2,-4' -S 4 'L I S B- ,•l) ~s-' aN jov~le s~ ~I - y/O•D S' 84 j/ s%/, gr- 7f+-~o '33'8"'-6y P/ . S'B.~ 1~ . 67' B~,• s/ is' Teti a~•P S. S.l,vp B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 P RI D 2 PERIOD PER INCH P_ . Z' L P- we 0,0 P- Z- / P- P_ 'Doe4i eno . PLOT PLAN: Show locations of percolation tests, soil borings and the, dimensions of suitable soil areas. Indicate scale or distances. Describe what are the horn 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. 3,077OA4 o f Z TiE'~s 9 ?'uw A ;.e r ' f .K ~G SYSTEM ELEVATION 1 E 5 J V, ~~~Q _ _.~E E , 19, 7-1 APPRC Gt Sete Stem -,r h15 -Septic SY I for ~ ponvent1ona I 1 _ I dE R T'. ?1=F Pr. , is To f of_ PA auE . , . i t?ED ~ l ~fl ~ ~ /40~4~ i f S725,VF r/it-T~.(_---P.Po I, 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): HOMESITE SEPTIC PLUMBING CO. TESTS WERE COMPLETED E>(& ON: / (Q WI S. 54016 HUDSON ADDRESS: RABERT ULBRICHT CERTIFICATION NUMBER: PHONE NUMB (optional): WIS. MASTER PLUMBER LIC. N0.3301 M.P.R.B. 1 7 ?.I, 3 CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Ownar and Soil Tester. DILHR-&1313-6395 (R. 02/82) - OVER - / JOB T~9 Ine S A ~ROHL & TIMM EXCAVATING / OF L i SHEET NO. - 310 Arch Street tiGf r~" iy eKK DATE' HUDSON, WIS. 54016 CALCULATED BY (715) 386-8664 DATE CHECKED BY SCALE • Prve~~ a r-e prnP&Y, 3 { tfevtl ins~ec ic~r~ t4 ~3ax _~l _ 1 [4s~ G v, L ~n e J PRODUU 204-1 Inc., Craton, Mass. 01471. JOB /9nLc?S /t 6[LW~f ROHL & TIMM EXCAVATING 310 Arch Street SHEET NO. of HUDSON, WIS. 54016 CALCULATED BY DATE_ (O F~ (715) 386-8664 yy~~ 5"cam CHECKED BY DATE_,'`P~S 32z/ SCALE 1 _ all PRODUCT 204-1 Inc., Groton, M- 01471. i