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LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02
REAL ESTATE TOWN OF HUDSON
COMPUTER NUMBER 020-1154-10-000 Parcel Number 23.29.19.849A
OWNER NAME: First JEFFREY & DEBORAH Last SCHUTTS
PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment
837 BRADLEY DR
SECTION 23 TOWN 29N RANGE 19W '/4160 1/440
Line Description Line Description
TOTAL ACREAGE 2.920 PLAT LOT BLK
01 SEC 23 T29N R19W 15
02 PLAT OF FOX VALLEY 16
03 LOT 21 EXC PARCEL 849B 17
04 18
05 19
06 20
07 21
08 22
09 23
10 24
11 25
12 26
13 27
14 28
F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit
Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC. T~~N a
k- ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION &X LOT LOT SIZE .
PLAN VIEW
S'am'
Distances and dimensions to meet requirements of ILHR; 83 cn f
44
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
1 l' \
40
4
z- L
INDICATE N RTH ARROW
BENCHMARK: Describe the vertical reference point used 70
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity: 1420e:Q 14z
Number of rings used:- Tank manhole cover elevation: I
Tank Inlet Elevation: Tank Outlet Elevation:
n ,
J-
Number of feet from nearest Road: Front Side,Q Rear, 0 feet
.From nearest property line Front,0 Side, Rear, O feet
Number of feet from: well , building: / ~C
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
4 `
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: Trench:T
Width: Length: '7-5- / Number of Lines:_ Area Built:
Fill depth to top of pipe: _.e"" tr
Number of feet from nearest property line: Front, Side, O Rear,1rt.
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:
a
License Number:
3/84:mj
DEPARTMENT CF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. POX 3969 BUREAU OF PLUMBING
MADISON, WI 53707
XCONVENTIONAL ❑ALTERNATIVE State Plan ID- Number
(If assigned)
E] Holding Tank [:1 In-Ground Pressure ❑ Mound
A
NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER'. INSPECTION DATE
Je6Sch.ut;bs 902 GiAatLd, Hud5an, W1 54016
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF, PT. ELEV..
SE SE, Section 23, T29N-R19W, Town a6 Huctsan,LUt#21, Fax Va,Uey
Na- of Plumber MP/MPRSW No. Coumy Sanitary Per- Number_
Lyte Myeu 6279 St. C"Loix 69656
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING C ER
P ) ( f~ _ PROVIDED'. PROVIDED-
~ 0 lf~) YES ❑ NO ,❑YESV ❑ NO
BEDDING. VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY JWB
UILDINGJVENT TO FRESH
ALARMFEET FROM LINE AIR INLET❑YES LINO ❑YES LINO NEAREST , DOSING CHAMBER:
MANUFACTURER 7INGLIOUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDEDPROVIDEDYES LINO ❑YES LINO ❑YES LINO
GALLONS PER CYCLE: D CONTROLS OPERATIONAL . NUMBER OF PR OPERTV WELL / BUILDING I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) PUMP AN❑YES LINO NEAREST 3111.
4
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENC,T IHAMFTER 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. 1 PITS LIQUID
BED/TRENCH TRENCHES MATEHIAL PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL. DEPTH IDISTH PIPE DISTR PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH
BE LOW PIPES ABOVE COVER ELEV INLET ELEV. END. PIPES r LINE- AIR INLET.
FEET FROM 7
I' NEAREST
-s
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-
❑YES NO meets the criteria for medium sand. TIONS MEASURED.
LI
SOIL COVER TEXTURE JPERMANENT MARKERS OBSERVATION WELLS
❑YES LINO ❑YES LINO
DEPTH OVER TRENCH BED ID EPTH OVER TRENCH. =OF TOPSOIL SODDED JSEEDED MULCHED
CENTER EDGES
❑YES LINO ❑YES LINO ❑YES LINO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH. NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES.
DIMENSIONS
MANIFOI D PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL IN O DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV. ELEV.. CIA ELEV.. PIPES DIA.:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES LINO ❑YES LINO
COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING'.
FEET FROM LINE
❑YES LINO ❑YES LINO NEAP
V,
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATUFjFr"TITLE.
DILHR SBD6710 (R. 01/82)
E: in APPLICATION FOR SANITARY PERMIT COUNTY
ILHR f
mEnT (PLB 67) UNIFORM SANITARY PERMIT #
V, LRBOR 6 HUMRn RELRTtonS 4
-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
PROPERTY R MAILING AQVRESS
PROPERTY LOCATION
4'. V 1/4, s,-,?3, Tl, N ( E (oryfi TOWN OF: ~A cS d
LOT NUMBER BLOC ' N MBER SUBD VISION N ME NEAJiEST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED n~lo _ fs-y ~Q OQ
1 or 2 Family Number of Bedrooms. Public (Specify): C~
THIS PERMIT IS FOR A:
0
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.
❑ Seepage Bed Seepage Trench ❑ Seepage Pit ❑ Holding 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: ; t-
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):
X Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signature: P MPRSW No.: Phone Number:
s i ~'z 7~ s
0 J Z G ( 5TH" 3:.
Plumbe 's Address: Name of esigne
t, I,/ Liz" C, ie C:
COUNTY/ DEPARTMENT USE ONLY
Sign atur of Issuing Agent: Fee: AA Date: ❑ Disapproved
t G"~ ❑ Owner Given Initial
Approved Adverse Determination
n 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
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 ail 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.
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 ~ GI F L L%
Location of Property St ~4 5 14, Section , T ZL`1 N-R~q _ W
Township H CO IS 0 n,
A_DK_ SS O
iT4E7
Address o4--&i-te P A 0 S % H 0 U 54
Subdivision Name R
Lot Number
Previous Owner of Property N 0 R M At') C. F R A rO K CZ LA PLA AJTC
Total Size of Parcel ~ 8 AC Pf S
Date Parcel was Created F5LI
Are all corners and lot lines identifiable? V Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume 6(? 6 and Page Number 09 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) ceAti.6y that aU statements on this 6otm cute tAue to the best o6 my (out)
knowledge; that I (we) am (orte) the owner(s) o6 the pttopeAty desu ibed in this
in6otcmati,on 6otum, by viAtue o6 a watrAanty deed ttecottded in the 064ice o6 the
County Register oA Deeds as Document No. 39(,1- and that I (We) ptcesentfy
own the pttopos ed site 6otL the sewage dis po~tem (otL I (we) have obtained an
easement, to stun with the above described pupnty, 6otL the consttc.uction ob said
system, and the same has been duty tecotLded in the 044ice o6 the County Registers o6
Deeds, as Document No. ) .
SI A URE OF 0 ER SIGNATURE OF CO-OWNER (IF APPLICABLE)
C1 1 / S
DATE SIGNED DATE SIGNED
N
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STC - 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
c7
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OWNER/BUYER F FE C `s J 'C. H O I I
ROUTE/BOX NUMBER R T I L,Ab (_A )\J Q" k o Fire Number
CITY/STATE ~1~~`~C~~ 1~y~•Z ZIP S4-c" I
PROPERTY LOCATION: S 4, Section T -CA N, R 1'h W,
Town of { L~) 0K) St. Croix County,
Subdivision ~y(_,(_(, Lot number 2)
I
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
0
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with H
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 Office within 30 days
of the three year expiration date.
SIGNED
DATE lII
r
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.
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY,' DIVISION
P.O. BOX LABOR AND PERCOLATION TESTS (115) MADISON WI 3707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
L CATION: SECTION: 46 TOWNSHIP/ Y: LOT NO.:BLK. N SUB (VISION NAME:
/a 1/a /Ta9 N/R E (or 41 tvn
C UNTY: OWNER' / UYER' NA E: MAILING ADDRESS: AA~ W
DATES OBSERVATIONS MADE
USE -
NO.BEDRMS.: COMMERCIAL DESCRIPTION: IPROT7W~~~~
10
NJRsidence 3 A129 XNew ❑Replace Cj RATING: S= Site suitable for system U= Site unsuitable for system
~C&N ENTIO❑NAL-. MOMS: ❑U IN-G®NDPSSURE: SYSTEM-IN-FILLHO❑LDING NK: RECOMMENDED SYSTEM: (optional)
~J
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: A Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B 9j C1 1-1: CJ > 7 00311 a fln 5, L. 6, gn (y) ed s33 ,5d'c r
B 7 78 akbnsi Iq n . , Dq ,mec/; ' j1W i7 5{
B43 H 5 `1 0 ns~ sfL, v,FC~ S QnSId
By 91 Ll Ds1'`I 5~, &ns /O s30
B 7~ 50 Z~Mt, '>9 vu 04
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P IOD 1 PERI 2 PERT D 3 PER INCH
P- 3 .3v f " l I
P, 39 aool~~
Pz3
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-
z )ntal 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
cf land slope.
SYSTEM ELEVATION C3 I
L,i
I►~-.3 r-i5_I] ~3 a Q ~~la .cZC~Cx.~Q ~ ~Q
$rn- A
13
&P4 tN
q ' -(00,
e
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 (prm ' r (TESTS WF~RE CO~/IPLETED ON: II
ADDRESS: CERTIFICA ION NUMBER: PHONE NUMBER (optional):
-5'~:302
C SI NATU .
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
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Field Material Order
ORDERED BY
JOB NAME (1~4 JOB NO.
DATE DATE NEEDED WHSE. MATERIAL ORDER NO.
Quantity Description Item
3
5
6
7
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12
13
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FORM NO. 54
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Field Material Order
ORDERED BY
JOB NAME JOB NO.
DATE DATE NEEDED WHSE. MATERIAL ORDER NO.
Quantity Description Item
1
2
3
4
5
6
7
8
9
10
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FORM NO. 54
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Field Material Order
ORDERED BY
JOB NAME JOB NO. `
DATE DATE NEEDED WHSE. MATERIAL ORDER NO.
Quantity Description Item
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2
3
4
5
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8
9
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FORM NO. 54