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HomeMy WebLinkAbout020-1043-30-100 0 "0 0 on ? 0 3 r► P.1. !D D n ~D O it m m Cn ''S, = Vl Z O 41 IID C CO N • Cy ° N K O d N Q H c Co 0 I N co c~ a 0 ~Dy m N o` w -0 a O O 00 m 7 m =r C1 7 7 ? O -I w 00 O Sp p O ~1 3 CA yr ul ` O o !V ~1 C N ~ v v> ~ ID ~ v a7'' I (D a i C~ w ° _0 CD m r_ CL I N N 3 O c O C) W Q z co 00 r n r N ° can cm G7 ° Q N m ! .o -0 TTc O O C Z O 0 V-1 F7 Q I N N =i Q N vi CA ? O< N D I o o C, 1:3 N b o H N N 07 S° G _0 O W I rn rn a °1 CD Cn N H O I = 7 O o F' y z z N Z.- I o Q z mD o Z ~ O~ O D a ° E w d Er "WA CD O 4 CD cn (D `i ~t Z I c m cn - p. yHy I w 'm t C I a C. Z 3_ A Z A d w o A z o ~I H H Cn I ~ 0 o ~ E I ao M m CD Co I °O rr Z co to rn `L CD , rt w co " 0 0 CL > a F m r• I o ~ 0 3 : c 3 rt I o o a I 0 N a I t I a I y I 6q A I N I ~ I o O I a A o b ~ I CD a v I O CD a Parcel 020-1043-30-100 08/25/2006 10:54 AM PAGE 1 OF 1 Alt. Parcel 19.29.19.174G 020 - TOWN OF HUDSON Current XJ 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 - PERSICO, JOHN V & JOANN TR JOHN V & JOANN TR PERSICO 350 WILLOW LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 350 WILLOW LA SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.700 Plat: N/A-NOT AVAILABLE SEC 19 T29N R19W PT NE NW BEING LOT 2 Block/Condo Bldg: CSM 6/1604 ALSO COM S1/4 COR SEC 19 N 4058.48FT TO SE COR LOT 2;TH N 88'W Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 330FT TO POB;TH N 88 DEG W 166.22FT; TH 19-29N-19W N 60'E 47.12FT; TH N 21'E 101.52FT TH N 30.96FT;TH S 88'E 86.92FT; TH S 150FT more Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1191/356 QC 07/23/1997 1077/137 WD 07/23/1997 763/08 07/23/1997 726/105 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.700 166,500 265,900 432,400 NO Totals for 2006: General Property 1.700 166,500 265,900 432,4000 Woodland 0.000 0 Totals for 2005: General Property 1.700 166,500 265,900 432,4000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 208 Specials: User Special Code Category Amount Special Assessments Special Charges 00 Delinquent Charges 00 Total 0.00 Parcel 020-1043-20-000 08/25/2006 10:54 AM PAGE 1 OF 1 Alt. Parcel 19.29.19.174E 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): O = Current Owner, C = Current Co-Owner O - STRANDQUIST, JAMES R-ET AL JAMES R-ET AL STRANDQUIST 351 WILLOW LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 351 WILLOW LA SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE SEC 19 T29N R19W NE NW S 8 RIDS OF E 20 Block/Condo Bldg: RDS Tract(s): (Sec-Twn-Rng 401/4 1601/4) 19-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 53,000 114,900 167,900 NO Totals for 2006: General Property 1.000 53,000 114,900 167,900 Woodland 0.000 0 0 Totals for 2005: General Property 1.000 53,000 114,900 167,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 122 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ?1 57 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT IL fj(N 4lf1 As/ TOWNSHIP 1~U~~a~td SEC. T -R 0 WNER ` / W ST. CROIX COUNTY, WISCONSIN ADDRESS ~j~~oLc1 11V SUBDIVISION 403t ' Al LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of 11HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i 7 L O.J 6-- Z o ,ter H n v 90 1 1 ~ ~ ryl i 1 i p fJ npsED ;'.c~i 7-y/ 4xv 1260 4W k' n,, pp ~.Icl ~Po~ I'd IC ~ _ LS C'ausTiF0CTlo,v •voi Y,5-7- INDICATE NORTH ARROW of St-? Ti'G CeV,#44-7'10- AOv-15 '"PA -fps . Sys'Aie Se -,K- BENCHMARK: Describe the vertical reference point used 9,01 v17 L?y 1,0// Tej7z ~ 1 Elevation of vertical reference point: /'0 Proposed slope at site: °ZYa SEPTIC TANK: Manufacturer: ~E~s~d Liquid Capacity: zr' • 7 r Number of rings used: A 16y"- Tank manhole cover elevation: Tank Inlet _Elevation: T x'•53 Tank Outlet Elevation: 7U . 36 Number of feet from :nearest Road.: Front,@ Side,O Rear, O ZDO feet ~ S / feet -From nearest? property- line'- .~ront,OSide,ORear,0 toeiI NOT 10 S4 1/tP J ffboSE ,vaT 0ptCTFD ye- 1. /PVV is-y~s Number of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufactu Liquid Capacit Pump Model: ump/Siphon acturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elev on: Ga er cycle: Alarm Manufa rer: Alarm Switch Typ . Numbe 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: Trench: •2 Width: 5 Len fh: ' > 7 Number of Lines: -Z Area Built: Fill depth to top of pipe: Less 3 do - Number of feet from nearest property line: Front, 0 Side, O Rear,0 rt !0 Number of feet from well: !yVj .&o7- Number of feet from building: TOE ~tioT /fviC7~ J%j (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom o age pit elevation: Area Built: Has ei r a drop box O or distribution box 0 been used on any of above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings use Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Fron , O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: / Inspector L Dated: 2`QC Plumber on job: License Number: It 3 O'NEIL RD., HUDSON,~WI5pI6 ROBERT ULBRICHT WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MINN. INSTALLER & DESIGNER LIC. NO. 006W 3/84mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING P.O. BOX 7969 MAbISON, WI 53707 I.D. Number: CONVENTIONAL ❑ ALTERNATIVE State Plan (if assigned) 14 ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound r INSPEC ION DATE: [Name E OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: John Persico 635 Kinnicknie, Hudson, WI 54016 . CH MARK IPermanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF PT. ELEV : SW NE Section 19, T29N-R19W, Town of Hudson sanitary Permit Number: of Plumber: MNo.. C-,I, Robert Ulbricht 3307 St. Croix 74993 SEPTIC TANK/HOLDING TANK: I/ MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER /'~u~l F G PR VED: PROVIDED. YES _90 YES ❑NO ❑YES ❑NO NUMBER OF ROAD PROPERT WELL BUILDINGH AIR I.LET BEDDING: VENT MATT HIGH WATER LINE/? JVENTTOFR ALARM FEET FROM oC/~ YES ❑NO ❑YES ❑NO NEAREST_ _ D S NG CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP,SIPHONMANUFACTOREH WARNING LABEL LOCKING OVER PROVIDED PROVDED. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING ENT TO FRESH AIR INLET GALLONS PER CYCLE: LINE / IV (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) ❑YES ❑NO _ NEAREST `,I H UTAMF T111 MArE HIAL AND MARKING SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: uoulD IDTH LENGTH THE NCy!4S UISTR PIP[ SPACI N(, COVE HIA INSIDE )ln -PITS DEPTH- BED/TRENCH PIT DIMENSIONS NUMBER OF PROPERTY WELL BUILDINP VENT TO FRESH GRP.VEL DEI'TII FILL DEPTH DISTIL PIPE DISTH PIPE DISTR P F MATERIAL PNOP TH LINE AI L L eELOwPIPES ABOV~covER 11 11 INLF I ELEV END I~ j~ FEET FROM O'~I ((JLL• ~j ILLL !!p_/v` NEAREST 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 PFHMANF NT MARK EiIS OH$EHVATION WELLS SOIL COVER I TEXTURE ❑YES ❑NO ❑YES ❑NO SEEDED ES OVFH THENCH BED DEPTH OF TOPSOIL SODOfO CENTER TRENCH BED DEP DGTE H MULCHED DEPTH OVER ❑YES. ❑NO ❑YES ❑ NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH ABOVE covEH WIOTH. LENGTH NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATEHIAL P PESISTH DISAT R. PIPE DISTRIBUTION PIPE MATEHIAL & MARKING E LEV_ ELEV. DIA. ELEV. ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING CHILLED COHH ECT LV COVER MATERIAL PLANS ❑YES ❑NO _ ❑YES ❑No PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING. COMMENTS: FEET FROM LINE ❑YES ❑NO ❑YES ❑NO _ NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIG E,~►'%.GL' TITLE: ~77 /~~e~- DILHR SBD 6710 (R. 01/82) wisconsin APPLICATION FOR SANITARY PERMIT r X . DILHR (PCB COUNTY UNIFORM SANITARY PERMIT # - - inDUSTTT OF ~ 9 9 0 OrlS IrlOUSTRV, LR BOQ 6 MUTRrI RELFiTl 17 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS A# ,V j f, 3 5 , ti v/~ ev%S. Sf~pl PROPERTY L CATION G __Ul I Y:- 1 /4 1 /4, S T I`f, N, R E (or W T ln_ o LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, 6AKE ARK ;TATS LAD. NUMBER 2,- CS 9ftl -30-10 TYPE OF BUILDING OR USE SERVED 1C.,1011111110, 11 1 1 or 2 Family Number of Bedrooms: Public (Specify): THIS PERMIT IS FOR A: New System El Tank Replacement ❑ Repair r Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed Seepage Trench ❑ Seepage Pit ❑ Holdiny Tank ❑ 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 Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: ELKS e-vv 6-.e` et_ ok ~fs- e4~ 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'nch): REQUIRED (Square Feet): PROPOSED (Square Feet): G/i,~}SS &60 Private El Joint El Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: rPP/MPRSW No.: Phone Number: (7lS ~j~ HOMESITE SEPTIC PCC. S307 Plumber's Address: ROBWRT ULBRICHT Name of Designer: WIS, MASTER PLUMBER LIC, NO, 3307 MARI 0- COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ❑ Owner Given Initial 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 N INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 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 including a 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. HOMESITE SEPTIC PLU6,dING CO. RT. 3 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRICHT WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. haNN. INSTALLER & DESIGNER LIC. NO. 00663 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 Q Location of Property S~ ~ 14, Section T_Zf N-R W Township 12 " P5~6' Mailing Address iP 3 _9_ `C_/~411V%Ck_t'yi_P - 41V P Address of Site (01*116 rv GN Subdivision Name 7 Lot Number 2-- Previous Owner of property Total Size of parcel 41- 7- Date Parcel was Created Are all corners and lot lines identifiable?~ Yes No Is this property being developed for resale (spec house) ? Yes y 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 (We) ceAtiby that aU 6tatement6 on thi,6 4ohm au ttue to the best ob iMw (ouA) h.nowtedge; that I (we) am WOW the ownen(.s) o6 the ptopeAty descAibed in this in6o, mati.on 6ohm, by vixtue o6 a wajvcanty deed Aecoltded in the O jice ob the County Reg.usten ob Deeds ass Document No. ~ Kf g_3 ; and that4(We) pnesentty own the phoposed .bite bon the .6ewage duspoz .6y.6'em (on - (we) have obtained an easement, to nun with the above descAibed pxopenty, 6o& the con.6tAucti.on o4 said .system, and the same has been duty %econded in the 046iee o6 the County Reg.usten o6 Deeds, as Document No. 1. SIGNATUI& OF OWNER I TURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED 199 I _ . cx~ 1 'S:1111 i saaeJ4 Iiews - I c ( U O1 2 O v 10o'£L£ M11£ 1STo00N f 3NIl 831HVnb HIAOS - HIUON • U Cl 10 'OST 18h'850 MlIE£ISToOON peo,i IOOunoZa ainan3 ITS'£9 16h'98 100'Z£T 18h'9Z6£ Jo} 3uamasea aptn 199 z 1 IZT'ZZZ 166_'h9 Li o MuE£151o00N N % M LU Z cD S O• N i:: I` .7 IS O v_i IX-r + i b w M . L I J V J (n ^7 D~ 41 411 00 014 W w -1 4; M 10 r-- + I + 1 _ 4- 4- co a! w co O W 1 7 In 06 h ~ O O' C!' O co co t O U I 3 O w w .G N .S N I ~f O M1 N OS In J O La. J O M _j* ..7' Cl Q I y N In z I Cl 'r - IOO'Z£T cn N 100'OST Mn££ISToO0N co II 1 Io ON rn 5 W ~ O Ot Z .T M ~ 1 N -__M1~9t~~o oos 1 _ 3uZZi6h9ZOS_ _o- 00 C> +1 1h9"6Tt N CD It6'8ZT v O,OrZS NMu9t9iZoOUN s~I U y Pwj \ 11 W \0 1 .1 I,.. I`"!~ \c-' 3119 t I t Z OO S r 1` ISO ~ K I V z c7 \A t•- 3 a h z rv r W O O © \ s.\\ C1 l W D. • Z O . z w Q 0 lW G~. L~ o ti z w .1 `mil rn W w a la. n, Z U. O Y ¢ w\ \ ` CJ .i a i " 0- ¢ j c t b ~O ` 3 178 10 K MM - f 1 J H tY r-1 J J s Al 1 W M N O m / W J = yI .S m Z K W Z / O 2 r- C N J O H K O cr. C) m x 00 C) s o w IH w z Q N o w a s x Z ,60 M ; cu e W • 61 / / ti~~' vCOi A w q O O 4 CI H 7 > ~.1 o 0 41 w co C, w co .-y I Z o ' / N16 2 ~.k~t In a CZ) Q t > O 2 6 41 0 CD o m r 1 i~21 c x`90 1► ,bs d 08 41 T. * a. O o } a w o ~~l Q6F o W v eu L(. \3' \ J Ln I 641E W 4 = L co ~ ,jai- ~ ~\e j • \ 3~\\~ rte'- w e W L^ s 0~ ~s 2~0 20 a ` Q cQ1 0 -j 6 5 r- i LU . r Q LU a In o d o 1n Y C a`t o I- LL rv p x x x w ;>swns~ I H • z - ,.~n~.EStTE $EPT1C PLUr~,~lNis';;G• y 3 3'PlEIL ZD., HWSON: Wis. 54016 Y ROBERT ULBRICHT r ST C- 105 r ^PLUMBER UC. NO, '3307 M.P.R.S. y 'ASTER &DESIGNER LIC. N0.00653 y SEPTIC TANK MAINTENANCE AGREEMENT o z St. Croix County e 9 #N A S > 4~-tri OWNER/~ ROUTE/BOX NUMBER 63 Fire Number .CITY/STATEZIP C Sct-) 14, Section 9 T z/ N R W, PROPERTY LOCATION: , Town of St. Croix County, O~ Subdivision I~ 2 Lot number voe. 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 pdt 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 H three year expiration. ° z I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with b the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed Z and returned to the St. Croix County Zoning Office within 30 days C of the three year expiration date. SIGNE pp DATE St. Croix County Zoning Office P.O. Box 98? Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address ,r . James Sargent , . l\ w- < ask:. INN Q)-a -E r IL O O p t V O C 0- l0 O 0) p H p O c O C ~w L. N V i 0 O C cm O 0 3 c V M N Z C L i, U) 0.0 ul octl~0.0 ~3E~ cd v m C ~:d b O C p) 7= 7 O M O N 0ww ~ N U)) m C O 00 a) _ c10 CL 0 E W m3 - 3 rnws v IL V/ ed000 m~a }Q O L O L j 0 CD E U) 0 (D -0 a 4) L- H Q ~i FL. t ~ - 3 t) c Q c o O O O N d c p Z - e0 c. t c C) d y CO N m r%.. ° Cc C (M C 3.2 -o2oa LM-- iR a) 7 Q 0 p 0 > V .0 cm N C 7 0 v to N C Q m a Go of t4 c Lv or- c a~ O. N C ~ N ' O d r i t cd C c°~-0 OE5°, 3,E C o C 3= o r cL t c c cvj (M p '0 E V co OC C O r " i O C 0 N N L m a w V C v0~o~c0 po3a~ m 0) Z - O co cm ) C p% O O C p < o 0 3 0 N p p i 0- 0) N C a N O C C Z 0 0 a E .p i 0 A N C O i i y C p N m c O Ec.) ai v:3iL-.:~ 3 = r N ac C = N J O REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DEPARTMENT OF DIVISION INDUSTRY, P.O. BOX 7969 LABOR WAND PERCOLATION TESTS (115) MADISON, WI 53707 IJUMAN RELATIONS (H63.090) & Chapter 145.045) TOWNSHIP MFHidtCtPX~1'ITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: LOCATION: SECTION: ~1 ' 'I46 '4 A), H/R/ " (or) W MAILING ADDRESS: COUNTY: OWNE 'S BUYE 'S NAME: DATES OBSERVATIONS MADE USE PROFILE DESCRIPTIONS: PER OIrA ION TESTS: NO. BEDRMS.: COMMERCI . L DESCRIPTION: New ❑Replace /~t~J Residence RATING: S= Site suitable for system U= Site unsuitable for system ED SYSTEM:(optional) f_W CONVENTIONAL: MOCas UND: IN-GROU ~ RE: SYSTEM-IN-FILLHOLING TANK: RECOMM ❑u Y S UU 0 D SS O DESIGN RATE: If any portion of the tested area is in the If Percolation Tests are NOT required t Floodplain, indicate Floodplain elevation: under s.H63.09(5)(b), indicate: 8 1 A 1,4 L C~PROFILE DESCRIPTIONS Al&_ BORING TOE / DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, T XTURE, AND DEPTH NUMBER 01gmm, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ~U 5 5 0® B-Z ~SB IVE >0 7 7 ~7S 75 B- 3 /7 100&' No } 7 i g~.S,~. ~ . 6' - s.d 5,_0 4~22 B- L. B_ PERCOLATION TESTS DROP IN WATER LEVEL-INCHES RATE MINUTES PERIOD PER INCH TEST DEPTH, WATER IN HOLE TEST TIME PERIOD 2 NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIODt P- P- P- 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. 8 f7 SYSTEM ELEVATION E 3110 lb ell" ~H E A rib 3 i E i E i E j n TA' E - - Q I E I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures a~ a ds specit' a Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. TESTS WERE COMPLETED ON: NAME (print): C7 cP7 ION NUMBER: PHONE NUMBER (optional): CERTIFICAT ADDRESS: 7 ZZq -Z d_ 6L4LJ 16 a i WJ CST SIGN T DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. D I LH R-SB D-6395 (R. 02/82) -OVER - INSTRUCTIONS FOR CC' L TING FORM 115 - SBD - 6395 L: comple- - sail test- vn eport must include: I . Corrl I 1, The t v this ~ e or cor x rr ercial project; , P'A) 3 ercial use p r.ed; u ~ OL, t SITE IS SUIT' FC ING T ' ALL IT BASED GPI qr E i I era for writ . Id car = plot plan; > cating y r tic iwinsg to preferreri. A c ' ph- I~. n bQ%; 12 I , joi E I THE P r d x T'. f' = the Department may • ~ ~ J ~ I So.oo~ C.1.~ S~~-~ ~ _ tea 1. a 1- a ~ { ~ o q I S~TIG I O ~ _T)2AItJF~6.~~ M Nl N1 _ i~ ~ W6-w i Z'L ~A rL, . ~ So.oo' r ~ 4L 30 t5 a 4 gy R \o I -.rr--r I r / GG. 7,eEiV Gli ~ \r V S 'witaE- X 66, ' 4401 ' ~ Fr- ~Piti2T Z' Q O i e 5 v S 7cx-i 41eE4 111 %l6J f/Qp .u //ouSF v J cc f ~ojbbS~~ LAE// v 7FS7- yzezF . S p • Z-07- G1;v4 HOMESITE SEPTIC PLU{c,61NG CO. RT. 3 O'NEIL RD.: HUDSON: WIS. 54016 ROBERT ULBRICHT VVIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. , N.INrd. INSTALL f? & DESIGNER LIC. NO. 006.53 v Fresh Air Inlets And Observation Pipe h Approved Vent Cap Minimum 12" Above F i n a l Grade F°~~5 l•~°~9/~E- - /00.0 F7-- f r'-)k ' 4" Cast Iron (2~ ')Above Pipe Vent Pipe -to Final Grade Marsh Hay Or Synthetic Covering Miggregate e OvL7e Distribution Tee ,p Pipe ~ 0 0 0 VESegate o Perforated Pipe Below BePipe Coupling Terminating At Bottom Of System ~j T ~Co - 1 , r , z ~ M vim, m T CC) 0) CD cn a rrn D c m a MtiS S cn m o m 2 v' N ON C) `rv0 6~ fe jai W z T < A c r T r1 vn G 9~1? ° r c' 3) p, M rt a 3 rt o o D y`S90 `S4~ `p 54' II d 06, I m t`?~~ i~ o O o r-'r coy I m X51 i•. ~ M 1 ~ co U) W li; M N O M i 1 -s o N G7 c c z 'T cdi ~t~~ O~ m. m T D i M :M. CA CD M I (A En M C) 41 M rn C3 C> 3 --4 N_ F N co X O T m o . 20 ► z o r (.n z c - ao m cn a 3 / 3 z m z z U) w r m W O N - r W C" gec~d= r r~ ~o m y o -o -v m _ art m T " m z o T D M T c m z to f- m o z o -n •a z a ~o 'SOa✓~ \ rr c ° T c o cn O~ O M zo c v m T N F\'rf~ ` C o m z = rr C, 676.08' 0 ~°od`~s S00°21116"E -n m N00 21116"W ,S~ lpl, a o z 666.56' y ?1~4,~i S?~ 128.911 ^N' 119.64' i+ 00 z w cn N ?3~RV `O-S$060- 16"W---_p. 50264922"E V F co N 9 7 00 O WO F F F F m 7 _ t0 m NO 01 I 11 z co NO0°1513311W 150.00' N to 0 132.00' 41 13C z 1 a o W N O I r T cFi+ cn cwn o r - w O F CO OO O in .0 N I C C/) N V QO y t+ I m O 00 LM rn co U) (ft ~0 O w rt z 1 H cn O ~ O F N ®A Id T -h -n m I+I+ ;i ~AO ^ j~ A 1 W rt co :0 1rt ( - o rM (n N A n m Or. Ie+ a ~ \1 m .?y Q O C) z . n m o®. y m c ` CA) z % ipP~f.,,a•.;>a:4~~~~ - -0°15'33"W ° W NQ 64.99' i'- 222.12' 66' wide easement for A~ town road 3926.481 132.00' 86.491 63. 11 future 223.00' N00°15'33"W 4058.481 150.'(;' o P c r NORTH - SOUTH QUARTER LINE I N001 ~311W 313.00' 3 P O ~ r1 z ? 'o 0 ~al►+ z z to CD small tracts 66'~~•