HomeMy WebLinkAbout030-2001-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
515172 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)).
Permit Holder's Name: City Village X Township Parcel Tax No:
Suhsen, Karl St. Joseph, Town of 030 - 2001 -40 -000
CST BM Elev: Insp. BM Elev: BM Description: .` Sectionrrown /Range /Map No:
G J I 33.30.19.361i
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER ►.1 CAPACITY STATION BS HI FS ELEV.
Septic �Z Benchmark 2 ,
n Alt. BM
1'o ks ft, SZ
rH, ation Bldg. Sewer
din g SUHt Inlet ' A "A*
TANK SETBACK INFORMATION St/Ht Outlet Z. R5•�it1
TANK TO 4. j (I_ WELL n BLpG. Vent to Air Intake ROAD Dt Inlet
Septic - / .7C Z/ / Dt Bottom
Dosing � Header /Man.
9, l`b
Aeration Dist. Pipe + .
Holding Bot. System /O, )s 47Z- if l'
1
Final Grade
PUMP /SIPHON INFORMATION 3 .5 9 ' I 6
Manufacturer GP nand St�Coier �, I -Z Model Number ((rte• , TJ
TDH Lift Friction Loss System Head DH Ft
Forcemain Lengt Dist. to well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length INo. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS (0 I P
SETBACK SYSTEM TO P/L BLDG ( WELL LAKE /STREAM LEACHING Manufacturer /
INFORMATION CHAMBER OR
Type Of System: ` � 8� /�� UNIT Model Number:�
U2 �� a O 1 r (1/
DISTRIBUTION SYSTEM
Header /Manifol jr Distribution x Hole Size x Hole Spacing rient 0&r Intake
Pipes)
Lengt Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center renc
Bed/Th Edges Topsoil
� 0 Yes [] No Yes No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 1277 Arrowwood Trail Hudson, WI 54016 (NW 1/4 NW 1/4 33 T30N R1 9W) metes & b unds Lot Parcel No: 33:30.19.361i
1.) Alt BM Description=
F; kvc,.,, A%"4 Q o Q 5 b l
2.) Bldg sewer length =
f
- amount of cover
Plan revision Required? Yes to
Use other side for additional information. !
SBD -6710 (R.3/97) Date Insepctor' Signatu Cert. No.
I
commerce.wl.gov Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 St. Croix
t i sco n s n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce IS
tate Trans ton Number
Sanitary Permit Application �jr,
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate ental 1`T'
unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for secondary
purpo in accordance with the Privacy Law, s. 15.04 1 m , Stats.
I. Application Information , 7 lease Print All Information 1277 Arrowood Trail
Property Owner's Name R Par c 1#
Karl & Christina Suhsen Y 03T00��0
Property Owner's Mailing Address OCT 19 2009 Property Location \
28847 Isle Ave. L
FiUI% Y Govt. Lot
City, State Zip Code Bt&_ ONING NW v <,NW' /4, Section 33
Northfield, MN 55057 (circle one)
H. Type of Building (check all that apply) Lot # T 30N; R 19 W
® 1 or 2 Family Dwelling - Number of Bed ms 4 �? �� Subdivision Name
Block #
❑ Public /Commercial - Describe Use 1 S Nr `, City of
E ] State Owned - Describe Use CSM Number ❑ Village of
, q Ab+-re,116 dqdiiLl ®Town of St. Joseph
III. Type of Permit: (Checldonly one box on line A. Complete line B if applicable)
A. New System Replacement Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain)
System
B. Permit Permit Revision F of R Permit Transfer to List Previous Permit Number and Date Issued
Renewal Before Plumber New Owner /
Expiration
IV. Type of POWTS Sy stem/Component/Device: Check all that appl
Non - Pressurized In- Ground Pressurized In- Ground F1 At -Grade 0 Mound > 24 in. of suitable soil 0 Mound < 24 in. of suitable soil
❑ Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) ^�
,% , 4�
V. Dispersal/Treatment Area Information: eZh ' AM_ I t
Design Flow gpd) Design Soil Ap [cation Rate(gpdsf) Dispersal Area Requ red (sf) Dispersal Are a posed (sf) System Elev n
600 .5 1200 ,� 1223.2 92.5
VL Tank Info Capacity in Total # of Manufacturer
«:
Gallons Gallons Units
New Tanks Existing Tanks ::' y
�leKCd a U w C7 a
Septic or Holding Tank 1250 1250 1 ieser
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) PI bet's Si 1 MP/MPRS Number Business Phone Number
Travis Butterfield 652879 (715) 634 -8176
Plumber's Address (Street, City, State, Zip Code) 3
14346 W State Road 77 Ha ard, WI 54843
VIII. County /De artment Use Onl
.Approved Permit Fee Date Is ued Issuing nt Signatu
eason o
$ 7jr. °D /6
Ow
rven R zo 67
IX. Conditions of p�proval/Reasons for Disapproval ,
SYSTEM OWNER: 3, � V,6 i5 A61� i Ge�►Iec
1 Septic tank, effluent filter and
dispersal cell must all be serviced I maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained 4 G0�2
as per appl icable , p plans for the system and submit to t1k County only on paper not less than 8 1/2 x 11 inches in size
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Karl & Chistina Suhsen Property Owners Name
1277 Arrowood Trail Property Address
30200140000 Tax Parcel Number
S7 �2rOA County
NW /NW Legal Description
33 Section
30 Town
19W Range
Page Index
1 Property Information
2 Data Entry
3 Plot Plan
4 Drainfield Cross - Section
:�- Maintenance Plan
6 Contingency Plan
Travis Butterfield Plumber's Name
Plumber's Signature
652879 Plumber's License Number
(715) 634 -8176 Plumber's Phone Number
/ 0- 13 -0c( Date
Not an endorsement, written or implied for the following companies and products; DeVotto Concrete, Wieser Concrete Products
Inc., Skaw PreCast Co., Huffcutt Concrete Inc., Zabel Environmental Technology, ITT Industries(Goulds), The Pentair Pump
Group(Myers), Infiltrator Systems, ADS Products, Polylok Inc., Orenco Systems Inc., Sim/Tech Filter Inc., Sta -Rite Industries,
Page / of b
Conventional Soil Absorption SBD- 10567 -P (R6199) Component Manual Used
4 Number of Bedrooms
2 Percent Slope ( %)
114 Depth to Soil Limiting Factor (in.)
0.5 In Situ soil application rate
400 Estimated Wastewater Flow (gpd)
600 Design Wastewater Flow (gpd)
1 Number of System Elevations
92.5 Proposed System Elevation #1
Proposed System Elevation #2
Proposed System Elevation #3
Original Grade #1
97.5 Finished Grade #1
Original Grade #2
Finished Grade #2
Original Grade #3
Finished Grade #3
Infiltrator Quick 4 Standard Chamber Type
12 Height of Chamber (in.) 9,0 sq.ft. per chamber
4 Rows of Chambers 5.8 sq.ft. per pair of end caps
3 Distance Between Cells (ft.)
63 Proposed Number of Chambers Used
1200.0 Minimum Distribution Cell Area Required ( sq.ft.)
122ag, Distribution Cell Area Proposed ( sq.ft.)
Wieser 1250 1 ISeptic'Tank
Orenco Biotube 8" jEffluent Filter
Surface Depth to System
Soil Boring Grade Limiting Lowest Highest Elevation
Number Elevation (ft.) Factor (in.) Elevation Elevation Acceptable
1 98.69 117 91.9 97.7 TRUE
2 95.71 94 90.9 94.7 TRUE
3 98.51 114 92.0 97.5 TRUE
4 3.0 -1.0 FALSE
5 1 3.0 -1.01 FALSE
Page of P
Crass Section of a Three Cell Ingroimd Componmt
Using Leaching Chambers
Finished Grade
Original Grade
1 y11d owVdwP%w Top of Chamber 1.00
/ System Elevation
Finished Grade 97.5
Slope 2% C Finished Grade
Feet
Original Grade
93.50 Top of Chamber i' X Original Grade
Top of Chamber 1.00
92.50 System Elevation �= ;,:,.y r r System Elevation
=t p4w b be comus d and eked wMh app�dvedlmMel't�Y fflK t60 paliOOLt ll/G
Diagrams Not To Scale
0 o cap a o o
t
bservation ! Vent Pipes to be located 1/6 the length of the distrution cell measured from the end of the cells
IL-
Page of
Karl & Chistina Suhsen
1277 Arrowood Trail
3.02E +10
Number of Bedrooms 4 Septic Tank 1250 Wieser
Estimated Flow (average) gallons / day 400 Effluent Filter orenco bio -tube
Design Flow (peak), (Estimated x 1.5) gal/day 600 Pump Tank
Soil Application Rate gaVday/ft Pump Type
Influent / Effluent Quality Monthly Average
Fats, Oil & Grease FOG 30 mg /L
Biochemical Oxygen Demand (BOD.) 220 mg /L
Total Suspended Solids (TSS) 150 mg /L
!!NOTE!! Servicing frequency of 12 months or less requires the
Maintenance Schedule Management Plan be recorded with the Register of Deeds.
Sery ice Event Service Frequency
Inspect condition of tank(s) At least once every 3 Year
Pump out contents of tanks When combined stud a and scum = 1/3 of tank volume
Inspect dispersal cell(s) At least once every 3 Year
Clean effluent filter At least once every 1 Year
Inspect pump, pump controls & alarm lAt least once every
Maintenance Instructions
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses
or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer, Septage Servicing
Operator. Tank inspection must include a visual inspection of the tank(s) to identify any missing or broken
hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for
any backup or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to
check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground
surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals 1/3 or more of the tank
volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and
disposed of in accordance with ch. NR 113, Wisconsin Administrative Code.
A service report shall be provided to the St. Croix County Zoning Department within 30 days of any
service event.
Start-Up and Operation
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting
products or other chemicals that may impede the treatment process and / or damage the dispersal
cell(s). If high concentrations are detected have the contents of the tank removed by a licensed
Septage Service Operator.
System start -up shall not occur when soil conditions are frozen at the infiltrative surface.
Page f of b
Do not drive or park vehicles over tanks and dispersal cells.
Reduction or elimination of the following from the wastewater stream may improve the performance and
prolong the life of the POWTS: antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers,
dental floss, diapers, disinfectants, fat, foundation drain (sump pump) water, gasoline, grease, oil, painting
products, pesticides, sanitary napkins, tampons, and water softener brine.
Abandonment
When the POWTS fails and / or is permanently taken out of service the following steps shall be taken to
insure that the system is properly and safely abandoned in compliance with Wisconsin Administrative Code
Comm. 83.33;
- All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
- The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing
Operator.
- After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void
space filled with soil, gravel or another inert solid material.
Continuencv Plan
If the POWTS fails and cannot be repaired the following measurers have been, or must be taken to provide
a code compliant replacement system: (Check One)
rV-0 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a
suil and site evaluation shall be performed to locate a suitable replacement area. If no replacement area is
available a holding tank may be installed to replace the failed POWTS.
A suitable replacement area has been evaluated and may be utilized for the location of a replacement
51 absorption system. The replacement area should be protected from disturbance and compaction and
should not be infringed upon by required setbacks from existing and proposed structures, lot lines and wells.
Failure to protect the replacements area will result in the need for a new soil and site evaluation to establish
a suitable replacement area. Replacement systems must comply with the rules in effect at that time.
A suitable replacement area is not available due to setback and /or soil limitations. A holding tank may be
I`;talled to replace the failed POWTS.
MARNINGII
Septic, pump and other treatment tanks may contain lethal gasses and /or insufficient oxygen. Do not enter
a septic, pump or other treatment tank under any circumstances. Death may result. Rescue of a person
from the interior of a tank may be difficult or impossible.
POWTS Installer Septic Pumper
Name ITravis Butterfield IName IScott Poppe
Phone # (715) 634 -8176 jPhone # (715) 634 -1450
POWTS Maintainer Local Regulatory Authority
Name IButterfield Inc. Agency ST; Z-7; o
Phone # (715) 634 -8176 Phone # '7iS 386 -y68D
Page of 7
J
. u
2187
Wisconsin Department ofCommercf , OIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings 00 in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.
Please print all R���E 03 - 200 0 - 000
Revie By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). /d Zd 6
Property Owner 01, 7M9 Property Location
Karl & Christina Suhsen r Govt. Lot NW 1/4 NW4 $ 33 T 30 NR 19 W
Property Owner's Mailing Address PLAM,.1', t,14iNG OFFICE Lot # Block # Subd. Name or CSM#
28847 Isle Ave. Na Na
City State Zip Code Phone Number J City J Village vJ Town Nearest Road
Northfield MN 1 55057 1 (952) 652 -3044 St.Joseph 1277 Arrowood Trail
J New Construction Use: 01 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
01 Replacement J Public or commercial - Describe:
Parent material Glacial Outwash Flood plain elevation, if applicable Na
General comments
and recommendations: Soil suitable for conventional POWTS with 0.5 gpd /sq/ft/ loading ratre. Recommended system elev. _
92.50'. Existing dispersal cell elev. = 94.00'.
Boring # J Boring
N Pit Ground Surface elev. 98.69 ft. Depth to limiting factor >117 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft=
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 - Eff#2
1 0 -7 1Oyr3/2 none sil 2fgr ds cs 2vf,fm 0.6 0.8
2 7 -16 1 Oyr4 /4 none sil 2fsbk mfr gw 2fm,1 c 0.6 0.8
3 16 -26 7.5yr4/4 none scl 2fsbk mfr gw 1fmc 0.4 0.6
4 26 -40 1Oyr4/4 none 1 sl 2msbk mfr cw 1fmc 0.6 1.0
5 40 -82 1Oyr4/4 none „Ifs Osg dl gw 1vf,f 0.5 1.0
6 82 -117 1 Oyr5 /4 none gr s Osg dl - - 0.5 1.0
Horizon #6 contains 1/8" - 1/2" bands of 7.5yr4/6 Is. Loading rate of horizon adjusted to compensate for reduced permeability associated with
banding.
Boring # - I Boring
M" Pit Ground Surface elev. 95.71 ft. Depth to limiting factor >94 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -9 1Oyr3/2 none sil 2fgr ds cs 2vf,fl 0.6 0.8
2 9 -24 1Oyr4/4 none sil 2fsbk ds gw 2fm,1c 0.6 0.8
3 24 -46 1 Oyr5 /4 none sil 2fsbk dsh cw 1 vf,fm 0.6 0.8
4 46 -61 1Oyr4/6 none Is/Ifs mix Osg dl cw - 0.5 1.0
5 61 -94 1 Oyr5 /6 none f1 gr s Osg dl - - 0.5 1.0
Horizon #5 contains 1/8" - 1/2" bands of 7. Is. Gb5cling rate of horizon adjusted to compensate for reduced permeability associated with
banding.
Effluent #1 = BOD? 30 < 220 mg /L a d TSS >30 -)1!50 mg /L ' Effluent #2 = BOD < W mg /L and TSS < 30 mg/L
CST Name (Please Print) Signat e: CST Number
James K. Thompson VO L , 3602
Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceola, WI 54020 9/30/2009 715- 248 -7767
Property Owner Karl & Christina Suhsen Parcel ID # 030 - 2001 -40 -000 Page 2 of 3
3] Boring # J Boring
001 Pit Ground Surface elev. 98.51 ft. Depth to limiting factor >114" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0 -4 10yr3/2 none sil 2fgr ds cs 2vf,fm 0.6 0.8
2 4 -21 10yr4/4 none sil 2fsbk mfr gw 1fmc 0.6 0.8
3 21 -34 10yr4/4 none sl 2msbk mfr gw 1vf,fm 0.6 1.0
4 34 -61 10yr4/4 none Ifs Osg ml cw 1vf,f 0.5 1.0
5 61 -114 10yr4/4 none gr s Osg dl gw - 0.7 1.6
fl
❑ Boring # J Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2
F-1 Boring # I Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2
Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD S.30 mg /L and TSS <30 mg /L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777.
SBD -8330 (R,07 /00) A.C.E. Soil & Site Evaluations
/1w/�yhr�J%� Sec. 33, T. 3orl•
,6eiT 7.03 Q cre.S
lfuumed e/eif = A .00'
0 fain E /e� = 99.33'
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VOL .2�.i;��- X04 .:,A : i... F.'.'E: H. ,J ._
REGISTER OF DEEDS
T. CROIX CO., WI
AMENDED RECEIVED FOR RECORD
SHERIFF'S
Document Number DEED v'-22 -20 0 12:15 PM
Drafted by: Terry R. Gray SHEAUFS DEED
EXEMfAT N
CERT COPY FEE:
Return to COPY - --
Edina Realty Title Co. TRANSFER'FEE: 317.10
400 South 2 Street P AGES: RECORDING FEE: 22.00
Suite, 115
Hudson, WI 54016
030 - 2001 -40
Pn.rrel T" 'tic ' if,
Nnt+�►,rr
s•
RE: Residential Funding Corporation v.
"!'tae -nin J. L.urr.
Case No. 99 -CV -35
Pursuant to a judgment of foreclosure entered in this matter, the subject premises was sold at auction to the highest and
best bidder, Karl W. Suhen and Christina L. Suhsen. Therefore, the sheriff does hereby grant and convey unto said
successful bidder, all of the following described land, located in the County of St. Croix, State of Wisconsin, to wit:
t
SHERIFF
(Strike the inappropriate title)
STATE OF WISCONSIN )
COUNTY OF ST. CROM
Personally came before me this 1'7 day of Q.e, C .r 1999, the above -named
personally known to me as the officer described above, and who executed this document as the
sheriff or on behalf of the sheriff of this county.
REBECCA J. PHANEUF , N Public
NOTARY PUBLIC St. Joix County, Wisconsin
STATE OF WISCONSIN
My commission expires: Ur'
poi_ . 1491 F ,: 405 FI LED
E� 14 1999
CLERK OF COURT
ST. CROix COUNTY
A tract of land in the NW:: of N51'.`. of Sec. 33, T30N. R19W. Town of St_ Joseph,
St. Croix County. Wisconsin, more fully described as follows:
BEGINNING at a point that is 617.32 feet South and 623.91 feet East of the
northwest corner of said Sec. 33; thence N 47 °58' E a distance of 98.47 feet;
thence N 64 °2S'E a distance of 82.30 feet; thence S 73 1 31' E a distance of
82.30 feet; thence S 50 °37' E a distance 110.10 feet (to a reference point j
referred to hereafter as Point 'A '); thence S 00 °07' E a distance of 168.55
fret; thence East a distance of 113.SO feet; thence S00 0 07' E a distance of
523.70 feet; thence S 89 °25' W a distance of 459.00 feet to the center of a
66 foot road; thence with said centerline N3 °11' E a distance of 544.30 feet;
thence with said centerline northwesterly around a curve concave westerly
-whose chord bears N 14 °013' W a distance e.` 150.50 feet; thence, leaving said
centerline, due east a distance of 37.86 feet to POINT OF BEGINNING.
TOGETHER WITH a non - exclusive easement for travel over and through a strip of land
24 feet in width immediately adjacent to and abutting the north line of
the above described parcel. the south line of said easement being that
portion of the description above running from the Point of Beginning to
said Point "A" at the end of the 110.10 fcot line.
ALSO TOGETHER WITH ANQ SU8JECT TO-a non - exclusive easement for travel over and
through a strip of land 24 feet in width described as follows: BEGINNING I
at said Point "A "; thence S00 0 07' E 144.55 feet; thence East 113.50 feet; thence
- S 00 °07' - E 24 feet• thence West 137.50 feet; thence .400 0 07' W to the north
line of the first parcel described above.. being also the south line of' the ease- i
ment described above; thence S 50 0 37' E to said Point "A ". the POINT OF
BEGINNING.
ALSO TOGETHER WITH AND SUBJECT TO a non - exclusive 66-foot wide road eiseMent
running from the NW corner of the first easement described above southerly to
County Trunk Highway "E ". which easement is the southerly portion of the
land described in a warranty deed from Werts to Sables dated July 31.1972.
recorded August 10, 1972, in Yol. 487, 9 a e 543, Doc_ No. 311747, in the office
p
of the Register of Deeds for St. Croix County, Wisconsin. and which easement
includes the westerly 33 feet of the first parcel described above.
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Parcel #: 030 - 2001 -40 -000 05/26/2006 09:15 AM
PAGE 1 OF 2
Alt. Parcel M 33.30.19.3611 030 - TOWN OF SAINT JOSEPH
Current -X-1 ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner
0 - SUHSEN, KARL W
KARL W SUHSEN C - SUHSEN CHRISTINA L
SUHSEN CHRISTINA L
1277 ARROWOOD TR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1277 ARROWOOD TR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 7.030 Plat: N/A -NOT AVAILABLE
SEC 33 T30N R19W NW NW COM 617.32 FT S & Block/Condo Bldg:
623.91 FT E OF NW COR SEC 33, N 47DEG E
98.47 FT, TH N 64DEG E 82.3 FT, S 73DEG Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
E 82.3 FT, S 50 DEG E 110.1 FT S 168.55 33- 30N -19W
FT TH E 113.5 FT, S 523.7 FT, W 459 FT
TO CL 66 FT RD, N 3 DEG E ON CL 544.3
more
Notes: Parcel History:
Date Doc # Vol /Page Type
02/22/2000 618669 1491/404 SD
2006 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 09/07/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 7.030 108,800 41,000 149,800 NO
Totals for 2006:
General Property 7.030 108,800 41,000 149,800
Woodland 0.000 0 0
Totals for 2005:
General Property 7.030 108,800 41,000 149,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 10/14/2005 Batch M 05 -33
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel #: 030 = 2001 -40 -000 05/26/2006 09:15 AM
PAGE 2 OF 2
Legal Description: cont.
FT, NWLY ON CURVE CHORD BEARING N 14 DEG W 150.5 FT, TH E 37.86 FT TO POB PVT
RDWY MAINT AGREEMENT 880/362
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS r DIVISION
. BOX 7969 PRIVATE SEWAGE SYSTEMS _))-j;� OF PLUMBING
11111111- v�ll. 53707 s
CONVENTIONAL 1:1 ALTERNATIVE State Plan l.D. Number:
Of assigned)
❑ Holding Tank ❑ In- Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
L
BENCK MARK (Permanent reference point) DESCRIBE IF DIFFERENT FRIQM PLAN: REF. PT. ELEV.: C
33 s 7 ��
More of Plumber: S P /MPRSW No.: County: / / ^/ Sanitary Permit Number:
tie 0 6� 1 4� V r
SEPTIC TANK /HOLDING TANK:
MANUF ACTU R LIQUID CAPA ITV: TANK NLET EL V.: TANK OUTLET ELEV. WARNING LABEL LOCKING C ER
�/� ! ^ P O DED: PROVI D:
'75 k>�. -3 1 . ,G 7 ( /,('/( YES ❑NO NO
BEDDING: J VENTDIA.: VENT MATL. HIGH WATER ROAD: PROPERTY WELL: BUILDING: �VEN O FRESH
�r ALARM j �� A �./� LIN AIR INLET:
ES ONO 'UNO "' UV / �Cl
DOSING CHAMBER:
MANUFACTURER J UE�ING S LIQUID CAPACITY PUMP MODEL. PUMP /SIPHON MANUFACTURER'. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED'.
ONO DYES ONO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL . PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN uNE AIR INLET.
PUMP ON AND OFF) DYES ❑NO
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
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
'°""* WIDTH- LENGTH. J NOOF DISTR. PIPE SPACING. COVER AINSIDE DIA.. It PITS. LIQUID
® ^ TRENCHES. I MALI �tlp"' DEPTH:
GRAVE L DE N TH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. OI PROPERTY WELL: BUIL2G: VENT TO FRESH
BELOW PIPES ABOVE COVER. E, �� T ELEV. END �� PIPE z LI / AIET:�
w ( /,/ 7
7 �`�
MOUND SYSTEM: "7.37 IS D
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
❑YES NO
SOIL COVER. TEXTURE. PERMANENT MARKERS: OBSERVATION WE ILLS
❑YES ❑NO DYES ❑NO
DEPTH OVER TRENCH'BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL. SODDED SEEDED. MULCHED:
CENTER EDGES.
❑YES El NO DYES ❑NO DYES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
•'` WIDTH. LENGTH. NO, OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER.
'. TRENCHES:
+ MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL. I N O. PIPES DISTR, D ID:STR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV_: ELEV. DIA. ELEV. : A.:
"HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES El NO ❑YES 13 NO
COMMENTS^. PERMANENT MARKERS: OBSERVATION WELLS: PROPERTY WELL: BUILDING:
LINE:
L1 YES El NO ❑YES El NO
17.
Coo -A .�
C�
Sketch System on a1 o ty file for audit.
Reverse Side.
SIGN TITLE:
i
DILHR SBD 6710 (R. 01/82) / /
AS BUILT SANITARY SYSTEM REPORT �----
OWNER /y, L G h TOWNSHIP T _ 3 o5 e, SETN.
C�1 -RT
u i
ADDRESS 7 U t ST. CROIX COUNTY, WISCON
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
THING WITHIN 100 FEET OF SYSTEM
r�
X
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r
Ify
,f
I di a e o th A ro
SC J,
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point: Slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity: �/0-V' p
Number of rings on cover : Tank manhole cover elevation: 0
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set for a cycle gallons; total capacity of
distribution lines gallon: size of pump head;
gallon per minute horsepower brand name of pump
and model number ;
Type of warning d evice
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
Type of warning device
SEEPAGE PIT SIZE: - Number ot pits feet diameter
feet liquid d4pth seepage pit inlet pe- elevation
bottom of seepage pit ( evation feet.
SEEPAGE BED SIZE: number of lines wi th length T), the depth
SEEPAGE TRENCH: width length
PERCOLATION RATE AR A REQUIRED AREA AS BUILT
7 g INSPECTOR
DATED �`r PLUMBER ON JOB
LICENSE N
• ,.
-�
D
<�a �
1
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' PLB State and County State Permit #
Permit Application County Perm t #
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
q -51 'r �r
B. LOCATION: W '/4 '/4, Section T�� N, E (or) Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: *Commercial * Industrial *Other (specify) Variance
,
Single family y Duplex No. of Bedrooms 3; No. of Persons
D. SEPTIC TANK CAPACITY ±22 Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured -in -Place Steel ��� Fiberglass Other (specify)
New Installation L� Replacement
Lift Pump Tank or Siphon Cha Total gallons Prefab concrete Poured -in -Place Other (Specify)
E. EFFLUEN_ T�DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No. of Linea) Ft. Width Septh Tile depth (top of Trenches
Seepage Bed: Length S.1 Width�_ Depth —,�__ _ Tile depth (top No. of Line
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
0
Percent slope of land ! 4 / Distance from critical slope
WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than p owner:
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared
by the Cs4 Pied Soil Tester,
�
NAME _ qr� L —5 /
, e L C.S.T. # and other information
obtained from G (owner /builder). d
Plumber's Signature �44�6P /MPRSW# __ Z J_ Phone # �L_ S � /
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
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Do Not Write in Space ' Be ow - FOR COUNTY AND STATE DEPARTMENT E ONLY
Date of Application i� Fees Paid: Stat County e ` 7"
Permit Issue c4Rsa.. d (date) � Ynt& Issuing Agent Name
Inspection YeskNo State Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary cgpy) Revised Date 7/1/78
KH 115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
' DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
_ P.O. BOX 309
MADISON, WISCONSIN 53701
"� R ORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: Ji�'/4, & /4, Secti n3 -5, N, R O Wor) W, Township or wicipaliiy '- • O s A
Lot No. Block No. County X 1 , a �x
Subdivision Name
Owner's Name:
Mailing Address: D
TYPE OF OCCUPANCY: Residence �^ No. of Bedrooms 3 Other
EFFLUENT DISPOSAL SYSTEM: NEW �— ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS s ��a,c/ 979 ,p PERCOLATION TESTS S0` 60 , AFZ
SOIL MAP SHEET 7°Z SOILTYPE 6602 L/f' /G l�—C�IJil7yli/9
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN /IN
5C
Wo
Z a„
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVVE
i ,
z T 5G /.�' C is s; .c , a ,�e • q
/i / ��f' it " �C3 . S. e1 e.7 i
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable areas. Indi nuber of sq ar fee of absorption area
needed for building type and occupancy. �i�s��sEd• a r/ 3 m R A� Indicate scale
or distances. Give horizontal and vertical refe nce points. Indicate slope.
2Z AA, _P
C`
t IN
I
11
/
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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 location of test holes are correct
to the best of my knowledge and belief.
Name (print) (0,45. X ertification No.
Address
Name of installer if known
CST Signature -en;�L Z.�
COPY A —LOCAL AUTHORITY
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C 7 8 � °
A• v
I -
ST. CROIX COUNTY RECEIVED
SEPTIC TANK MAINTENANCE AGREEMENT
AND NOV 0 3 2009
OWNERSHIP CERTIFICATION FORM
Ji viWii vv✓rvi
Owner /Buyer VC �� � � i q J ems_ PLANNING & ZONING OFFIC,_
Mailing Address ; ,,,6- % A + , 7 - -r3te- A IoAI) 5 56 5`7
op
Property Address 1 2 77 A`('pwpa (4 ,
(Verification required from Planning & Zoning Department for new construction.)
City /State Parcel Identification Number 030 - ZM t - YO - OCO
LEGAL DESCRIPTION
Property Location A)k) '/4 , AhJ '/4 , Sec. 33 , T 30 N R / W, Town of
Subdivision Plat: , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # J $ (0(07 (before 2007)Volume , Page #
Spec house yes .a no Lot lines identifiable! yes i i no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
ess t an u ? ge.
I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am /are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Num er of bedrooms
1
G n ct
SIGNATURE OF APPLICANTS) DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
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