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Home My WebLink About236-1975-18-000 o w o 3-0 n d col N O CD C q ~ Q z PO O N N O ~p = •G j~7 ICI N m N n C 1 O m n D O A o = O o rn ° c O a Z N N CL a CD C) CD _ W G N CLco oo O O o o C [ R r m a~ on 00 co o r, ca A- = N 3 Fr C \ ::I (D (3 G7 I N A N rt n W Cf) I rt H td d 0~0~0~ _ U, x ! u, y m vi vi cn `i wr co I-T3 Vvv `D N CD U, (D v -P- H -1 O Ct y0 QD z b ON z 3_ N o n a H a N N r (D t~ :z zco z Q 00 7k,- (D CD 0, o) CD N ~yN~ -0 C: 00 m (a N 1- CD CD O N rd m -4 N F'i \O = p A Z .O. m Z o ~ld a a F! y x (D W m to CO G n m N c 3 a Z 0 0 3 ° pq I H ~ Li CD A N A ~ N I ~ Q O 7 d N 7 3 d C"C X CD =t CDL N n N C CL N O z a n CL p (n K p N S 2, K C = 4 (D fl. `G ICI 1 UO) 0 A 0 CD O p fi (D 7 A N O = 4 O O _ N N c0 O o tv O) M j O a V I ~ 'II W (D ~ V ti OO 69 0 ° i iv Al O Parcel 236-1975-18-000 01i26i2007 03:01 PM PAGE 1 OF 1 Alt. Parcel 236 - CITY OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - MATHY CONST CO INC MATHY CONST CO INC PO BOX 189 ONALASKA WI 54650 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 2700 HANLEY RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 56.668 Plat: N/A-NOT AVAILABLE AS DESCRIBED ANNEXATION DOC 587748 Block/Condo Bldg: 1360/041-044 EXC CSM 18/4670 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 32-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2006 SUMMARY Bill Fair Market Value: Assessed with: 190997 832,500 Valuations: Last Changed: 12/20/2006 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 56.668 850,000 0 850,000 NO 05 Totals for 2006: General Property 56.668 850,000 0 850,0000 Woodland 0.000 0 Totals for 2005: General Property 56.668 583,300 0 583,3000 Woodland 0.000 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges 00 Delinquent Charges 00 Total 0.00 Parcel 020-1094-00-000 01/26/2007 02:55 PM PAGE 1 OF 1 Alt. Parcel 32.29.19.381A 020 - TOWN OF HUDSON ST. CROIX COUNTY, WISCONSIN Current X 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 - MATHY CONST CO INC MATHY CONST CO INC ANNEXED Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 0028-ANNEXED 1360/041 9/98 SEC 32 T29N R19W PT SE SW INC PT LOT 1 Block/Condo Bldg: CSM 4/1043 EXC PT ANNEXED 1360/041 1998 & EXC AS DESC IN 1528/93 & 1528/95 Tract(s): (Sec-Twn-Rn9 40 1/4 160 1/4) ANNEXED 1575/72 32-29N-19W SE SW Notes: Parcel History: Date Doc # Vol/Page Type 07/20/2000 626724 1528/095 QC 07/20/2000 626723 1528/093 QC 09/25/1998 587748 1360/041 AX 07/23/1997 1194/466 mW D ore 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/18/2001 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: 0 0 General Property 0.000 0 0 Woodland 0.000 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges 00 Delinquent Charges 00 Total 0.00 VOL f t}Pac[044 EXHIBIT "A„ LEGAL DESCRIPTION OF PROPERTY TO BE ANNEXED BY CITY OF HUDSON A parcel of land located in the NE of the SW 'A the SE V, of the SW and the SW of the SW of Section 32, To nos ip North, Range est, o n of Hudson, St. Croix County, Wisconsin, described as follows: Beginning at the S '4 corner of said Section 32; thence N 02° 02' 08" E 577.34' along the East line of said S thence N 38° 13' 52" W 1207.91'; thence S 51° 46' 08" W 45.00'; thence N 38° 13' 52" W 55.60'; thence Northwesterly 590.26' along a 1295.00' radius curve concave Southwesterly whose chord bears N 51° 17' 20" W 585.17' to the West line of the NE 1/4 of the SW of said Section 32; thence S 01° 47' 02" W 547.36'; thence N 88° 07' 47" W 820.90' along the North line of said SW of the SW `/t; thence S 01° 32' 04" W 1314.88' to the South line of said SW thence S 88° 02' 09" E 2127.29' along the South line of said SW of Section 32 to the point of beginning, containing 64.022 acres of land more or less. f . I I 1 0 1 I W ! I fl C17 r~' I ~~Oa~11 I ~ g i ri ¢ SSl~! i lr ` W • , r Icf I ~ ~ r t Yip • ~i I I N \ ~;Es 1 ! I :P'r I C ! i i Lkir - I...... _.CiGTSfi.G-.~i_.~..~,n..•...,.~+~.:-....- - ~y„~...~aFi.:~•..~. . r Y r I N C f ~ v } I ~ J • ~ ~ 1• ~ ~ ~N IY'► 1~ W , I• i s cm ` f knit I € - T 1 r I . I b ..-.--_-_-.-Z moil - 1 } 11 5 ! u111 \:111111 LL11111~i1Nit11L t t:3t;:3 itticf ltttrMt.t, n . s W f i ~ ~ ~ ~ ~ leuu\:ulsuuu:stslluus _ ~ W ~ ~ r K.ros ~ ff r; t ! 8 r wuuatu:uuawluuu\ I ~ ~ ~ ~ I: Cli.~l;t~iti?tit:Llt'ftltl xa.... ~a n _ ~ .,n.rnuwuraxa.t.,,,• ylaavwa••rlswrru•r I \:uluu\::uu\u\wluu,l ~ I f~'l _ S . 1 s 1 \,:,fit I Ii;\ :L s.'C:. tttltyiC ~ • i ~ ~ t i ~ - \nuuoa\al I III!lIt111ilUSIl:.IinPlr~ I • rr i l - f1 t , 16 r t 1• k• i I E~ - n`~ Parcel 020-1093-10-000 01/26/2007 12:27 PAGE 1 OF 1 F 1 Alt. Parcel 32.29.19.377A 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 - WEST LAKE, BUILDERS INC BUILDERS INC WEST LAKE Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC egal Description: l Acres: 36.000 Plat: N/A-NOT AVAILABLE SEC 32 T29N R19W E NW XC E 3.5 RDS OF Block/Condo Bldg: CJ S 20 RDS & EXC S W 660 FT & EXC P377B AS DESC IN 755/291 ALSO THA__T PART Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) OF SE NW AS DESC IN 766/200 & EXC CSM 32-29N-19W SOR Notes:/'` S. b ~cf Parcel History: Date Doc # Vol/Page Type wb q~6 ` 2,9Z (I V) 07/23/1997 1221/064 WD 07/23/1997 1202/026 TI 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/10/1998 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 020-1093-10-000 01/26/2007 12:18 PM PAGE 1 OF 1 Alt. Parcel 32.29.19.377A 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 - WEST LAKE, BUILDERS INC BUILDERS INC WEST LAKE Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 36.000 Plat: N/A-NOT AVAILABLE SEC 32 T29N R19W SE NW EXC E 3.5 RIDS OF Block/Condo Bldg: S 20 RIDS & EXC S 66 FT OF W 660 FT & EXC P377B AS DESC IN 755/291 ALSO THAT PART Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) OF SE NW AS DESC IN 766/200 & EXC CSM 32-29N-19W 11/3232 NKA WINDSOR HGTS Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1221/064 WD 07/23/1997 1202/026 TI 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/10/1998 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT or- y~ _ p OWNER TOWNSHIP SEC. N-R W i ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION! LOT LOT SIZE PLAN VIEW W)) ~~0'2oz l9~ 3 Distances and dimensions to meet requirements of H 63 lqq~ kr e4,-94 40 MAA,` y SHOW EVERYTHING WITHIN 100 FEf?,I OF SYSTEM (lq7 - 6 5~ T ` ~i 7k," 4 j INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ?1e Elevation of vertical reference point: Proposed slope at site: 37e' SEPTIC TANK: Manufacturer:/ Liquid Capacity: k- Number of rings used: ! T Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,0 Side 0 Rear, o feet From nearest property line Front, 0Side, 0Rear, O feet Number of feet from: well b~ building: -IJ61 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) 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, 0Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Number of Lines: Area Built: Width: ,1A) Length: Fill depth to top of pipe: C~ Number of feet from nearest property line: Front, 5 Side, Rear, O Ft Number of feet from well: J 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: U 4~ CJ Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. Box Tess PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING CONVENTIONAL ❑ALTERNATIVE State PlanLD Numbers ❑ Holding Tank ❑ In-Ground Pressure ass;gneal ❑ Mound NAME OF PERMIT HOLDER: DRSS OF PERMIT HOLDE RAlvin Ellingstad NSPECTION DATE R. R. 3, Box 354, Hudson, WI g BENCH MnreterenoESC~JAD.E OM PLAN - V NE SW, Section 32, T29N-R19W, Town of Hudson REF. PT.BLEV. GsTREF PT ELEv Name of Plurn ber. MP/MPRSW No.. County. Sanitary Permit Number. Tom Wang 3231 St. Croix 54957 SEPTIC TANK/HOLDING TANK: MANUFACTURER .!7 LIQUj C~g1jpA ITV. TANK INLET ELEV.: TANK OUTLET ELE V.. WARNING LABEL LOCKING COVER I - J V PROVIDED. PROVIDED. BEDDING: VENT DIA. ❑ YES ❑ NO ❑YES ❑ NO VENT MATL. HIGH WATER NUMBER I'! ROAD: P LIROPNEERTY WELL. BUIL ALARM DING: NT TO FRESH ❑YES ❑NO FEET FROM JAVILR INLET ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACT=RERB LIQUI D CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER S ❑NO PROVIDED PROVIDED GALLONS PER CYCLE: PUMP ANOCONTROLS OPERgnoNAL ❑YES ❑NO ❑YES ❑NO (DIFFERENCE BETWEEN NUMBER OF PROPERTY WELL BUILDING IVENTTOFRESH ON AND OFF) FEET FROM LINE AIR INLET PUMP ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing Nc, nt ulgMErER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF DISTR PIPE sPpclNC; covEH w TR 1ES. t / Mq IAL, / INSIDE DIA. =PITS LIQUID DIMENSIONS lU a~l/° ~L . PIT DEPTH GRAVEL DEP H FILL DEPTH DISTR. PIPE DISTR. PIPE ISTR. PIPE MATERIAL. NO. DI BELOW PIPES ABOVE COVER E V IN ~T EI,E~Y.ND J" f NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH ! s~ PIPE FEET FROM LI" AIgyT ? ~ ~ I ``//C~ 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- ❑YES ❑ NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS. OBSERVATION WELLS DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED ❑YES ❑NO ❑YES ❑NO CENTER EDGES. DEPTH OF TOPSOIL SODDED SEEDED MULCHED ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE TRENCHES FILL DEPTH ABOVE COVER. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV ELEV CIA ELEV PIPES Dla. DISTR IBUI ION INFORMATION HOLE slrE HOLE SPACING TRILLED -CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED PLANS COMMENTS: ❑ YES ❑ NO ❑ YES 1:1 NO PERMANENT MARKERS: OBSERVATION WELLS: PROPERTY IWELL: BUILDING: NUMBER OF LINE M ' ~ FEET FRO ❑YES ❑NO ❑YES ❑NO NEAREST c: Sketch System on Reverse Side. "Retain in county file for audit. l z 17E~TITLEDILHR SBD 6710 (R. 01/82) ~ wlsconsln APPLICATION FOR SANITARY PERMIT IIAL-t~ COUNTY '.~EPRRTTEnT OF 1111111(~~ (PLB 67) UNIFORM SANITARY PERMIT # 1 -0 11111111111'III10USTRY, LRBOq 6 HUmgn RELRTIOnS _ s9S -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 PROP~RTY OWNER MAILING ADDRESS ,&'3 ' 3~ lr Sc' n s PROPERTY LOCATION CITY: / ~1/41/4, s 3 , T(2y N, R 9 E (or W T Lam' ~d .1 SGtiI~ LOT NUMBER BLOCK NUMBER SUBDIVISION NAME EST ROAD LAK OR A MARK STATE PLAN I.D. NUMBER _ ~Q K TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. FZJ 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: M j d V N 0 , C, 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): prw U ~1?a 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): , Signatur MP/MPRSW No.: Phone Number: Plumber's Address: Na Designer- COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved j~ fj /111 Y24 ~1_ _ ❑ Owner Given Initial -I-LJC l0 Lf/~e a 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 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. Form - S T C 100 Owner of Property AJV m E El l i ya atad Ala Irve] I ~M-- 1 xggtxd Location of Property N.E. Z S,W. ~4, Section 32 T2, N R 19-W Township Hudsox Mailing Address Rcut• 3. Box 354, 01Nei7_ Roast Hudson WiscoxisSr 54016 Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel Was Created Are all corners identifiable? Yes No Include with this application one of the following: .Certified Survey Map .Deed .Land Contract, or .Other Legal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. ; and that 1 (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No.2y2Z3 /2 ) SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED V S T C - 105 r r 9 y SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County d A OWNER/BUYER A.'.vi;- E. Elliggstad ROUTE/BOX NUMBER Ro"Ite 3, Box 354, O'Neil Road -Fire Number 218 CITY/STATE Huasr>.x Viiscolsl Z [P 5 ~ PROPERTY LOCATION: N.E. ~4, - Section 32_' t- 20____N, R-1'7_-__-._W , I Town of Hudson St . Croix County, Subdivision Lot number I Improper use dnd 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. Ho F. I/WE, the undersigned, have read the above requirements and agree Cn to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ~d 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 St. Croix County Zoning Office P.O. Box 96 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, , DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 ,HUMAN RELATIONS \ 1 MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: OWNS MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: ly j5 /431 '3 ~ /T;~~j N/R~/ E c) SLl f, OUNTY: OW R'S/BUYER' NAME: M AI LI,(VG ADDR SS: ' 0; x C 5 & Scar USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: r++~~.~ PROFILE•DESC IPTIONS: PERCOLATI N TESTS: Residence ❑New Latfeplace y~ c RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑U ❑U 91 ❑U Z U ❑XU CJ/?J d-rx b ~ [under Per:s.H:63.09( aon Tests are NOT required DESIGN RATE: I If an L any portion of the tested area is in the 5)(b) , indicate: C) /C 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 IFF OBSERVED (SEE ABBRV. ON BACK.) B Z.d6 60 6 OCR X66) A _n 1 -760 4n ~ 5 B- a DE? N.!~ ~~kac~ std s 5.sb ~o~ C's B- B- 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 PE IOD 2 PERIOD 3 PER INCH P- P- 51) iB P- J J 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. SYSTEM ELEVATION ra -Z to I" -f- 140 1 e P3 .r- ~v { P9 3 ~ r Yt , rvv ' S r~ ~ rn y~f i PIC fill 3 I 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): A J~ TESTS WER COMPLETED ON: 7 ADDRESS: CERTIFICA ON MBER: PHONE UM ER(optional Leo 1 a IV~ 19 CST S TUBE: V { and ac"'' f,a= T In t& i, a _ =r F f:)u vw~ ~ Vrtf JtG` -.tee r. 3 5n -s arc x_ fi ?y r x IS <dz `~enC3 L r {d, tits e,s[F i3 i. s ON ,JG3a.()r, eEe1t)r Pz_ E S ue d. a`._ E in „ down An Mt r+~ , desnApQ ,=t h it and vi 4 of 01 ,E500 r{ ;",-?a,L i Q., p snwvp~ and viii, , .,1S.c`; _°ra= r wo aw-nowdate =)63m d to S?` , narros, nuh-mm, Rod POW d war, , cc £ .t ra W F , .o- i t e,.o" K :-p u irul r . I it ° t jai pka t`, p sion1 do-v r in; mdc _ Stay ,T A i. tlon ng3hMe i.{ CON& 0, 17) Gov, wool Y S Lmow, G , Coo 5- So u1i Pon P" a , pKombpol ,,tea 0 son, .ac4 .i - are ; A q s. E4 e, ; Saw, fol t <can) , so~ Coy air- twit t ' pi ummir! €trt sa" t .ti Na bh n. xv owt , k '=h n F._, „ npt _au a may rt°,ue"i i .,t. ~ OR "I K M F E v r ~k vnn~ncp it t'"j on t1 t`i,i3„ i o g t:n'sif t ,o nwp 9t, t k. I r 331 fly ~ T e U e CGS A tv l Y6 e c1 _ reT. E Ito. O '&l b 3~0 L? e~( ~o 3g4 New ocf) c Cl l j (t l'~ S ei P 3 3 Ti~ L~ e a k, J Fai ~J f SANITARY PERMIT County . ra GROUNDWATER SURCHARGE rrx-Rift V,uwrcw".w,n"r Pub-ow o sanitary- Permit No. On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com- monly 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 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. Ground Wer Signature of Issuing A ant: Groundw Wisco sin's ater Fee: D e: Q .t s_ buiied tree ilura 4LHA $80-7289 (N. 05184) C° BE GIPOINNTNI OFG N MA7CM LINE - SHEET 2 SOUTH LINE ^ .47", CF SE I14 MATCH LINE-SHEET 2 319 01 _ mm 10• 476 49 . 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