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HomeMy WebLinkAbout020-11102-00-00 i rr_~ nv,o3~n C v1 3 <D n 1p C • 7! m 3 o o o o II No • a a iv *4 a~ ~ n m N s~ p~~ ~ =3~CD n rv a o 3 °o c' m o co o A~ Q cn a o 0 0 C y o to ~ o- p co (n D C) n t'.) H D m y N 4 o W , c CD W rb c~ 3 O F N a (D rt CD z ' Q rt 0 H H~ 0 z co 00~ c N O c H. rn rn o 3 00 i H Z z = y CD o Z r ((D v a j N d i a 0 zco z Q i D m o I a O ~r r H H Z CD m • :3 CD (n 0. ON 'a C OIQ ~ z~ I c m y hit F~ xV-' N z CD p Z CL ° j m w a A 3 0 0 Fl- CD w ooh m z a 3 ~ ~ o of z I A C,3 m N N a j o 0 CD 3 v c 0 o a m ~ I n N 5 N zi A j N A N N CD N I a ~ C NO CAD 0 Q O O 69 0 v i Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. T ckLN-R W ADDRESS C 4 U t ; ila ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM C 31. a~ Q t i I t4i INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Gj' Elevation of vertical reference point: Ai. .a Proposed slope at site:, 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,0 Rear if feet .From nearest property line Front 10 Side 20 Rear,0 feet Number of feet from: well 5~I , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE i 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: V Trench: v Width: Length: Number of Lines: Area Built: W Fill depth to top of pipe: 1 x(98 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). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O 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: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7869 BUREAU OF PLUMBING MgPISON, WI 53707 CICONVENTIONAL DALTERNATIVE State Plan I.D. Number (lf assigned) O Holding Tank El In-Ground Pressure O Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Don Lindstrom 429 Cty Trunk N, Hudson, WI 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: NE NW, Section 34, T29N-R19W, Town of Hudson Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Richard Hopkins I1059 St. Croix 88421 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER ' A^ PROVIDED: PROVIDED 100 0 97.11 9~ t1 8 WYES ONO DYES 5NO BUILDING: VENT TO FRESH BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: : 0 / ALARM: LINE AIR INLET: DYES NO FEET FROM ~ ` 0 1 ~-1 DYES NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: - I DYES ONO DYES ❑No DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONA L: NUMBER OF PROP ERTV WELL BUILDING- VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES 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: WIDTH: LENGTH. NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA. #PITS LIQUID BED/TRENCH q TRENCHES: M ERIAL PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL. BUILDING : V NT TO FRESH BELOW PIPES . f I % ELEV INLET . ELEV. ENDQQ C~ PIPES FEET FROM LINEq- QO AIR/IAN Ef &f Ii ~3•sV 2 7 2 NEAREST --10'~S f 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- D meets the criteria for medium sand. TIONS MEASURED. YES ONO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ONO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED MULCHED CENTER: EDGES: DYES ONO DYES 1:1 NO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRNO. LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.: ELEV.. DIA.'. ELEV.. PIPES DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. r _ FEET FROM LINE DYES ONO DYES ONO NEAREST .~.L1~ , q 5 Q: C Sketch System on } Re county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82) DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code -5t STATE SANITARY PERMIT # 99 X/ z -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8Y2 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 . PROPERTY LOCATION now b 14 0 NF_ % RUN,, S 9 TQ , N, R 17 E (or)Q. PROP T OWNE ' MAW A RE$S C LOT NUMBER BLOCK NUMBER SUBDIVISION NAME 1 RAW ZIP K Q CODE PHONE NUMBER O CITY NEAREST 11 ) LAK OR LAN MARK CITY, S ATE C , t f` I-] VILLAGE : C C4 squ, II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public (Specify): CUN ON III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. ❑ New b. N Replacement c. ❑ Replacement of d. ❑ Reconnection of e. E1 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. ~ Conventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. E1 IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. X Seepage Bed b. ❑ Seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Min 43 utes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): (9115 0 Feet 7QPrivate ❑ Joint ❑ Public CAPACITY VI. TANK Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tank* Tanks structed Septic Tank or Holding Tank ❑ ❑ ❑ Lift Pump Tank/Si hon 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 er's Signature• (No Stamps) & P/MPRSW No. Business Phone Number: G S ~ I I - lo (71<-)-3-,T,6 PI ber's Address (Stye , late, Zip Code): Na of Designer: w A,y , % v VIII. SOIL TEST INFORMATION Certified Soi Tester( ST) Na CST # CST's ADDRESS (Stre t, ity, St4e Zip Code) Phone Number: DV Vh l )T (71's ) k Sow ~y~ 3 ,IL IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) X Approved ❑ Owner Given Initial Surcharge Fee (~~,~rr 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 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; ll. 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 a// 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'/2 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.Water included the creation of surcharges (fees) for a number of regulated practices which Wiscomin's ~ can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that. buried reasure is used in your building is returned to the groundwater through your soil absorption r: ~v system or the disposal site used by your holding tank pumper. ILI, 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- !Mwi#tFQMMMMM~ water, groundwaier contamination investigations and establishment of standards. Groundwat-, J_ ..a il's worth protecting. S90-6398 (8.03!86) • APPLICATION FOR SANITARY PERMIT S11C- 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/contractqr,(" 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 0 a 4 dli~ a_-~,,,i •,o- Location of Property' N Section 3T N - R W Township Mailing Address Box ? c? Subdivision Name VON Lot Number Previous Owner of Property Total Size of Parcel S Date Parcel was Created 26. 1977 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes _ No Volume o2 and Page Number .173. as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIEICATION- I (We) eeAtisy that att atatemenxa on this 4ohm aAe tAue to the best o6 my (ouA) knowledge; Aat I (we) am (ate,) the owner (s) o6 the pupa ty du ibed in this .insonmati.on &Am, by viAtue o~ a wwLAanty deed Aeeotded in the 066.iee o6 the County RegizteA o4 Deeds as Document No. and that T (we) pAesentty oun the proposed zite 60h the sewage posat system (oA I (we) have obtained an easement, to tun with the above descAi.bed pnopeA-ty, Got the constthucti.or, o~ said system, and the same has been duley tecotded in the 04~ice o6 the CounX y Regiztet o6 Deeds, as Document No. 3,H ) . SIGNATURE OF OWNER SIGNATURE OF -OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED CERTIFIED SURVEY MAP N 1/4 CORNER SCALE SECTION 34_-,--o IN FEET T29N,R19W 3 p i[ 200 10050 O 100 20d UNPLATTED LANDS o co NE - N W Cn 89o PQINT OI n: Z S 1317 834 BEGI NINz w 3: 0 Z: 66.0 150.71' 347.65' 496.71 256.66' o 9 ~ w J; li o 0S' 0`o J TRUE. BEARING w w Z W W O OQ: O f, pOiw J, cr W p p ti. w f:7." 15.12 ACRES INCLUDING ROAD W ? o 0 14.20 ACRES EXCLUDING ROAD o H cn: U)IW to Q.Z: F.. 2 ai C J: Q: Oi fiousE I CENTERLINE o a: J: ~ DRIVEWAY N 89- 44'20" 20 W Z: 3 ad 1316.98' NORTH RIGHT OF 6. 0 1250.98' ,`WAY LINE 9o. L ?K COUNTY TRUNK HIGHWAY "N" - -r - _N 0° 07 IE SOUTH LINE OF THE NE If4 OF I S o. 08, W I 1 33.00 I HE NW 1/4 OF SECTION 34 I 27 76'- - UNPLATTED LANDS DESCRI11T I ON A parcel of land located in the Nlil/4 of the NWI/4 of Section .34, T21)N, R101v, Town of Iludson, St. Croix County, Wisconsin, described as follows: Commencing at the N1/4 corner of-said Section 34; thence S0*08'ld (true bearing) 818.571 along the East line of said NW1/4 to the point of beginning; thence S0°08'W 500.00' along said East line of the N1V'I/4; thence N89058'11 1316.98' along the South line of said N1:1/1 of tile. NiVI/4; thence NI1°0711i 5011.00' along the hest l i iie of' said N111/4 ()I' the N'w 1 /•1 ; thence S8905811: 1317.13' to the point o f beg.ilming. Stfl)ject: to an casellient across the South 331, more or less, for County 'i. runk I1 i ldiway "Nov. I certify that. the above description ally map are currect and that I have fully compl iCd With the provisions of Sec. 236.34 of they Wisconsin Statutes and Section 5.4.2 of the St. Croix County Zoning Ordinance. Hate: Al)C.11 11., 1977 0~j%f CJeN,.~p~a - r--- f - •.....!J Francis 11. Ollden S-382 Job !~o. 77-??7 Ogden Engineering Co. ' c'..'•`,!S'~. 123 E. lilnl Street River Falls, Wi. 54022 11NI:R AND Terlyn Schmidt SlIBiflkA 1)1:!): R. R. !r• I =Y Y.:• Iludsun, 1 i :;cons i n 5101o I hereby certify that this snap has been approt•ed by the Towle Board. hate `OTI:: Proposed roadway easement to he covered in a separate document. 51 Verlyn V. Schmidt and.Carol Warranty Deed. L. Schmidt, his wife, Con. Valuable. Dated May 26, 1977. -to- Ack. May 26, 1977. Rec. May 27, 1977. Donald A. Lindstrom and Diane In "554", page 556, #340371. J. Lindstrom, husband and wife as joint tenants. A parcel of land located in NE4 of NW4 of Section 34-29-19, as shown in the Certified Survey Map dated Apr. 11, 1977, and recorded May 19, 1977, in the Office of the Register of Deeds for St. Croix County, in Vol. "2" of Certified Survey Maps, page 373, Doc. No. 340140 (No . 50). Reserving to the grantors V~sement to use the w 66 feet of said parcel as an access/T ad)and for/~4h 3 stallation of utilities from County Trunk High-~s& klWr to-land-,owngdty the grantors N of the land conveyed to the gran~ees'~by..his ihktrume t. The grantees further agree that if required J* ,town o ] `ounty u`tW;ies in connection with development of PhQ.g~antors bland, t e will join in a dedication of a public road on "d" -er__said "66._foot.- eD it being understood, tiering,, radi g and constructing however, that all e ens s ,I fpnll improvements of sai ea's ent~ asa°'prirate qa r as a public road will be paid by the X44 ors: The'benefitsT d urdens of this agreement shall run kith the lanc Arid shall be inding upon the grantees and their successors 'Yn tide as inners of the, and hereby conveyed and on the grantors aria their suc6,essorS i.t~ tale as owners of the land lying Nly of that conve ed('by''this._deed.~N'-, Recites: Existing ighwayt~andlity/•easements of record. This is not homestead"property.$60.00 Transfer Fee). Donald A. Lindstrom and Diane Mortga e. J. Lindstrom, husband and wife, Con. V7, 800. and each in their own separate Dated May 13, 1977. right, Ack. May 13, 1977. Rec. Ma20, 1977 @ 2:55 PM. -to- In 554'., page 268, #3+0168. Tri County Savings and Loan Association, a corporation. Parcel #2: A parcel of land located in NE4 of NW4 of section 34-29-19, Town of Hudson described as follows: Commencing at the N4 corner of said Section 34; thence S00081W (true bearing) 818.571 along the E line of said NW4 to the point of beginning thence S00081W 500.001 along said E line of NW4; thence N8905~1W 1316.981 along the S line of said NE4 of NWu; thence N00071E 500.001 along the W'line of said NE4 of NW4; thence S89°581E 1317.13' to the point of beginning. (continued next page). € F 11TU 41 a ~ ♦fC~f s • o i - 01 A Qr."Ok Y'g0V[D Y[Y SIN unono uuu I it • DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, ' DIVISION LABOR AND RELATIONS PERCOLATION TESTS P.O. BOX 7969 HUMAN Rlr (115) MADISON, WI 53707 (H63.090) & Chapter 145.045) j LOCATION: SECTION: p OWNSH UNICIPALITY: LOT :BLK. O.: SUBDIVIS NAME: PPQ /N/ /T2/ N/Q „/71(or sb CQ NTY• , OWNER'S l3U ER'S NAME: MAILING ADDRESS: ~~~So~ Troft -1 At GO C~x USE DATES OBSERVATIONS MADE NO.~DRMS.: COMMERCIAL SCRIPTION: PROFILE S IONS: PS TS esidence ~Newn / NI RATING: S= Site suitable for system U= Site unsuitable for system ttt777b !J (p NS []AL: MOUND: ❑U IN-GRS P❑U RE: SQSTEM-1 X 7V L HOLDING TANK: RECOMMENDED I) eN $Pti-n If Percolation Tests are NOT required DESIGN RAE: If an p ,A y portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVE (SEE BBRV. ON BACK,) B l !6 7 0.(j b 017L® >1.i ?.~7 s, • L s ft's .3 rr w 8 691ItY4 2S/hlllb &s L-te,e Z ` Sr s AF ` , S, . s 8' s 9r 15"8,,.5 2.33 B- S 1 10, 10 a J Z ` / f10~'/iC 2,~ s B & 5~ • S~Bn t 5 9r~ 4 t V 5.5~L' GS f wf f 3o~%S <y-, B- Glei )a - lya'F"91 0 t"ce 5 /4yc .17C5 w envy`Y S B- B- PERCOLATION TESTS TEST DEPTH •WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INC ES RATE MINUTES NUMBER AFTE S ELLING INTERVAL-MIN. PERIOD 7 PERIOD 2 PERIOD PER INCH 3 P_ 6 ,A 3 P- 3 A ZS I *_V 3 6 P P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 1 7 j F~ 4 Bpi P~ _ Fe~" o/'pG Wi/~L~ j1'IG&'RPst' I OS /c _ ~ ( S l~Lt t /o fgC,k ho a 630x .b Gl_ , JI A-a$- meh~s ' 1'U 6k 4 u 7- 1 . , .ru E ' E E ~ E 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. 'I NAME (printl: TESTS WE E OMPLETED ON: ADDRESS: CERTIFIC ION NUMBER: PHONE NUMBER (optional): Sf k G~; S ©b 3 71S 4911 CS SIG T DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. D I LHR-SBD-6395 (R. 02/82) - OVER - L INSTRUCTIONS FOR _ APL.ETIN FORM 115 - SBD - 6395 f T- 1-iq a c-replete and accurate soil test, y r report must include: 1. I A A-scription, 2. 7-' c i must clearly indicate wh )r this is commercial project; 3. M r `KIMUM number of bedroo 1 use pla 1 4. Is this a n ar' r Eer 5. Co = S ITABL A HOLDING TANK ONLY IF ALL, O'Cl. O iSOIL C IS; 6, PI I I triting profi s -1 completing the 1 7, M LEGIBLE c iag y sea is pre"!r S. u by _ r n, ai 9. _ D: to r. rcol it „ p_ a(. ti, 10, If the inforn >n (such as flood plain, E ration) does >t A. in the appropriate box; 1 1 . Sign t' e ' a cI place your current F-' -id your -i t r; 12. Make le v pies and distribute _s =d. ALL SC BE FILED WITH THE L.OC~ ' CITY WITHIN SO CAA' OF COMPLETION. _ `EVL- a®~, -)R CERTIFIED SOIL, TF ® Sri - anc' E err lots sr 16 1 3- 1011) - ~l (under 3") 31 sl - L 31 cl - i _oarn Y scl C sicl 1 ' si _ lay Si I ures fl L't X TO TH. is V, a- STC - 105 r H SEPTIC 'L'ANK MAINTLNANCL AGIU.' 'MENT H 0 St. Croix County v OWNER/BUYER D6rAl- } ek , / N d ~-Tv b m ROUTE/BOX NUMBERp e 1 '80 x/)y Fire Number 4/J2 CITY/SPATE SDI _Zil'_ PROPERTY LUCATIUN: %d, N / lL, Section ~y 1' Z il, it -W, town of.Sp~~ St. Croix County, Subdivision _ 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 Lmper. What you put into the system can affect the function of the svl)tic tank as a treat- ment stage in the waste disposal system. St. Croix County residents mcL 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, L978. 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 0 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- a went of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED , DATE r St. Ciloix C,)unty Zoning Office P.O. I-ox 98 Hammond, WI 54015 715-7~ 6-2239 or 715-425-8363 Sign, date and return to above address. -F? ~B. L. 6---... P L CST. A 0 S,' SECTION s Ar P tN ~A M E 1 NAME R W, OP ~ ~~s 0 CAT 10 N our, C _E N S E =f 1.~ _ _ E 0 D PLO T Nd A P k k T-~z t ' 6 -4) :t{. l 0-0/c~ died CAI Cff s Y' ' I V4R; r pd 4(TOT) 10 ,t Eti1;: R Cty TR F : FRESH AIR INLETS-AND OBSERVATION PIVE CROSS SECTION Approved Vent Cap k minimum 12" Above Final ra~ _ Y 4" Casa Iron Above Pip Vent Pipe To Final Grade-- 47 4 Marsh Hay Or Synthetic Covering Min. 2" Aggregr~1 Over Pipe Distribution (I A I Tee Pipe E ~l Aggregate ~D Perforated Pipe Below Beneath Pipe 4 Coupling Terminating At Bo - L om of System Parcel 020-1102-00-000 05/22/2006 09:29 AM PAGE 1 OF 1 Alt. Parcel 34.29.19.406B 020 - TOWN OF HUDSON Current L ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - LINDSTROM, DOUGLAS A & VERONICA M DOUGLAS A & VERONICA M LINDSTROM 636 CTY RD N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 636 CTY RD N SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 8.050 Plat: N/A-NOT AVAILABLE SEC 34 T29N R19W NE NW LOT 1 CSM 2/373 Block/Condo Bldg: NIA LOT 1 CSM 7/1971 EXC PT TO COUNTY FOR RD EZ-1-1218/085 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 34-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1075/425 LC 07/23/1997 1004/447 WD 07/23/1997 847/307 07/23/1997 554/556 more 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 8.050 105,300 138,600 243,900 NO Totals for 2006: General Property 8.050 105,300 138,600 243,900 Woodland 0.000 0 0 Totals for 2005: General Property 8.050 105,300 138,600 243,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 134 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00