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030-2009-90-001
o y 0 o 3 o G d cn E - 0 Z ti 2 0 -t� 6 I cn K Z —1 w Z ° ;o � A ° w O • 7' y N O C N y N . O . N ( O CD a m m m a 3 co ° D o` o N ~ to co �' rn° A a Z_ y Ch o ff,, ^ _� CD C7 m m M m co o n ` 1 a a> > c N n S o y =r CO CO \ D j x, o co o a >' 7 N x !, 0) Q a o Lnn ° w o°oo m n o o n o 7 y (n to y (P I m A W I O m to CD cl, `•7 v v D a d l 9 T< D (D a v co Lo N d �. CD (a m (A a �. O V7 y n f W lD j W CD W CD 3 ° ° o — Lv ° n� a rn rn n V O O CL o C c (D l o � rn rn m CA ° 0 0 o c o 0 o a n r N C/) y N N co co (n 3 . a C ; j p z a 000 �I Z 000 c! • o Z <�A a o Z o ', <, aQ m Co cn c o I v CO) co to 0 o D o. o m v v v rn l No o ' CD o °' c°r, CA V co lu fu N v 3 d N m 3 o Z Z Z co Z O n T ' n D n �1 m O v O l►1 CD o m I 10 CD CD cD �. y CD y CD CD a) C � CD C CD CD <� n a w a d 3 ty 7 d 3 7 Z Z j C6 N (n A a 0 a �' 0 0 W � W 0 w a a a Z I o 3 3 » cn y y Z < 'CD I CD A CD <(n 0 a CD O j Cn 0 a C -r'o a C O CD _ G I 3 CU (,D a 0 G S y O_ >. T CD 7 w^ O T O d N CD 0) C N y C (D S in .y. Z 6 CD 7 j Z d O O O N L y N O CD `< y fpe 0 3 C� O O a -p rl y O ffl S p<i N n I Cm C cr CD O O A fD 3 C y fU y CODS CD (D a CD fD fU y CD (D <� CD QOaa O 3amx � a mNO� 3`yCD Cb CD a) CD =r a w U) Q o a 'b (D CD w cis O rs> O O ° N o o � ,, Wisconsin Deparynent of Gommerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 420481 0 GENERAL INFORMATION 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: Rose, Chuck I St. Joseph Township 030 - 2009 -90 -001 CST BM Elev: Insp. BM Elev: BM Description: D / Sjrnrn.,j- TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark gmgyl Dosing Alt. BM J^ Aeration Bldg_ Sewer n 1_ U�lv �z✓ roC�O 0 9 �� Holding SUHHtt Inlet ,(�,(� � �j /s CT- / /•�� qo, 63 TANK SETBACK INFORMATION St/Ht outlet d TANK TO P/L WELL BLDG. Vent to it Intake ROAD Dt Inlet �- - Septic Z Dt B t ✓ .�� Dosing Header/Man. Aeration - - Dist. Pipes ` I 2 �d Z) Holding Bot. System Final Grade PUMP /SIPHON INFORMATION , 90 , V Manufacturer Demand St Cover GPM Model Nu er Nw TDH Lift ion Loss System Head TD Forcem6in Length Dist. to Well SOIL ABSORPTION SYS BED /TRENCH Width / } Length No. Of Trenches PIT DIMENSION No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/ LDG WELL LAKE /STREAM EACHING Manu t er: INFORMATION CHAMBER OR r Ty Of System: 35` / ,/` UNIT ode[ Number: l7 DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) f Lengt Dia Length Dia Sp�cing Y:L SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only 3 O'Yt Depth Over & AIV Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ] Yes No �] Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / D 7 , Inspection #2: Location: 656 Beatrice Circle Hudson, WI 54016 (SW 1/4 SE 1/4 34 T30N R19W) NA Lot 1 77((�����((77 Parcel No: 34.30.18.386C 1.) Alt BM Description = ST' C00 � 2.) Bldg sewer length = "j SVf' I - amount of cover = Plan revision Required. Yes 61 /O Gi Use other side for additional information. i _ ! Date Insepctor's Sign. ru Cert. No. SBD -6710 (R.3/97) Safety & Buildings Division Washington Ave. Sanitary Permit Application 201 W. PO Box 7302 `Wi sconsin In accord with Comm 83.21, Wis. Adm. Code Madison, WI 53707 -7302 Department of commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not /D-14 .4 Z [Privacy Law, s. 15.04(1)(m)] t!0 /S3 state owned. Attach complete plans to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County State Sanita Permit ber ❑ Check if revision to previous application State Plan 1. D. Number � n 0� ALA I. Application Information - Please Print all Information Location: (cS Yak 'cam Ci✓ . Proo Owner Name Property Location l' ` 1 /4S£ 1 /4,S� 7 T30,N, 9E or W Property Owner's Mailing Address Number Block Number S ( J� )Aa`) C , 1 R (A � FRE VED City, State Zip Code Phone Su division Na me or CSM Numb 3 /3 03 kA Ifb>4 Ut SW ( 2002 SM �o II Type of Building: (check one) ❑ ity lb 1 or 2 Family Dwelling — No. of Bedrooms: G x! 77 C�" �OIX COUNTY ❑ illage S D ZONING OFFICE own of ❑ Public /Commercial (describe use): S ❑ State -owned U S III Type of Permit: (Check only one c o ine A. Check box on line B if applicable) Nearest Roa 1&)� ce L rtc� A) I 1. ❑ New System 5Weplacement ❑ Replacement of 4. ❑ Addition to Parcel Tax Number") System Tank Only Existing Syst 030 a 06T ` O - 0 0 f B) Permit Number Date Issued ❑ A Sanitary Permit was revto Issued IV. Type of POWT System: (Check all that apply) ,3 - 1 WENGIrS 3" SI (3 CAA knb�.oJ = lNon- pressurized In- ground ❑Mound ❑ Sand Filter ❑ Constructed We and ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevatio 7. Final Grad / Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation U p 00 1 a 1 � . S ?GIo 90 0(D .� VI Tank Capacity in Total # of Njan Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing A 166 )�I crete structed Tanks Tanks A ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VII Responsibility Statement I, the undersigned, assume res on ibility for installation of the POWTS shown on the attached plans. / lumber's Name (print) I`Aiffi r's S (no MP/MPRS No. Business Phone Number �ic a ��- k/fd.✓ 9 G� 2 - 2 -S'8f� ( 7� 36(. 3P Z3 Plumber's Address (Street, City, State, Zip Code) VIII County/Department Use Only - ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Agent Signatu (No stamps) GYApproved ❑ Owner Given Initial Adverse Surcharge Fee) / _ Determination S l 11S Q ? IX. di jg�f Approval s_ for D jppror� IV hl nS / �cae d on. e,,4tvl. slzd�fr - m Csr � 1&,A4 9/ syf ioU "-�ih CosL�ul�' 9d. D � 1C / - � / �� � tE � ttc ¢.2, � J �,/ Q • y / , 9' �� 1 ( / 3 ) Z /� . /� S � / ! � _ / ` . — ,y l , / GtAhi `�p 3'S i�3"iT'�'/z°r'' �� ^�� !-'� (X�/� /D � L32-L .r y • ^, - T Lf�.���hA !/ate �Q.Q -. • a-,. bf3, (t.3 l • cti�`tk �� � � o�-e R,�k -� saN InS L BeafiR►ce C'. R C) � c1 c. n) o n p d &P CI {�10 aX- = P I B • M PK K MOP-, o§ S�b�� Toe o3 puoK eil y g��Ruo►�, 1Jon.� a�' ia��5e� Sir j L ,/ tv o l 3 I�uN�l 3 SOS C� to 3b•� o_ -- '— -- -- -- - 0 E c ch N EEvc z x v, r� L U � ° o C 0 v .�. o om�~ inv op 6s(, BeA�,��ce C "�RC)� Lac ►vo �p a ( -- 6 eoo� P I 9• M P►i 1; �14v =►ou.p £L ��� v9 eil y Is 0 ia'' 4 ' �3 Ir�N�l�es 3 °I.� NOT 16 4 - I �ro•�o Y. -- ... EEv� t x o, V- W U N N M Q N 22 C O C ��■ / � i D CY) O 0 F- QQ (n C1 N j' c. N C N d O U ui 0 L N >( CL L \ 4 - A C� r � U L? C _� . �. 0 ) 75 CIL M U a • • • • 1568 Wisconsin Department of Commerce SOIL EVALUATION REPORT page I of 4 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code AC.E. Sal & 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 pant (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 030 - 2009 -90 -001 Please p . � aevg > R B D ate ` -!� �r 1. k Personal inrortnaWn you provide may used lot e may Law, . 15.04 (1) (m)). Property Owner Property Location Chuck & Joyce Rose e; JliZ Govt. Lot SW 1/4 SE 1/4 S 34 T 30 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 65 Beatrice Circle 1 1 CSM Vol. 5, Pg. 1415 City State ip Phonetiiumt r ° ° _J City _I Village �j Town Nearest Road Hudson WI 54016 715 - 549 - 6588 St.Joseph I Beatrice Circle I New Construction Use: 0 Residential / Number of bedrooms 4 _ Code derived design flow rate 600 _GPD Replacement I Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable _ na General comments and recommendations: Install 3 trenches using 39 leaching chambers at system elev. = 86.90'. �S�%c1�rto/ y/. Q DAD 6�/iue�.J .B/ 0 z ❑ Boring # - Boring 1 Pit Grand Surface elev. 91.1 ft. Depth to limiting factor >9r in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft *Eff#1 *Eff#2 1 0 -13 1Oyr3/2 none sit 2fcr mvfr cs 2fm 0.5 0.8 2 13 -21 1Oyr5/4 none sit 2%bk mvfr cs 2fm,1c 0.5 0.8 3 21 -32 1Oyr4/4 none fsl 2msbk ds cw 2f,1m 0.5 0.9 4 32 1Oyr5/4 none fs Osg dl cw 1fm 7 1.2 5 49-54 1Oyr4/6 none fs Osg ml cw 1f 0.7 1.2 6 54 -97 10yr6/4 n trat s &g Osg ml - - 0.7 1.2 H #6 contain approx 15% cos & gravel. F-1 Boring # Boring tI Pit Ground Surface elev. 89.90 ft. Depth to limiting factor > in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft *Eff#1 I *Eff#2 1 0-6 1Oyr3/2 none sit 2fcr mvfr cs 2fm,lc 0.5 0.8 2 6 -13 1Oyr4/3 none sit 2fsbk mvfr cs 2fm,lc 0.5 0.8 3 13 -20 1Oyr5/4 none sit 2msbk mvfr cw 2f,1m 0.5 0.8 4 20 -31 7.5yr4/6 none gr. sl 2msbk mfr aw 1 f 0.5. 0.9 5 31-44 7.5yr4/6 none gr.Is Osg ml gw 1f 0.7 1.2 6 44 -84 1 Oyr6 /4 none trat fs&s Osg ml - - 0.9 H #'s 4 & 5 contain approx. 10% gravel. H#6 contains 14' -1" bands of 10yr4 /4 Om Ifs at 4" - 8" intervals. Loading ir reduced to relfect restricted y f labs horizon associated with banding. * Effluent #1 = BOD > 30 < 220 mg/L and TSS > < 150 mg/L * #2 = BOD < 30 mg/L and TSS <30 mg/L 5 CST Name (Please Print) Sign CST Number James K. Thompson _ s.— 3602 Address A.C.E. Sal & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson lake Lane, Osceola, WI 20 7/9/02 715- 248 -7767 I property owner Chuck & Joyce Rose Parcel ID # 030 - 2009 -90 -001 Page 2 of 4 3] Boring # J Boring &I Pit Ground Surface elev. 92.47 ft. Depth to limiting factor > 105" in. Sail Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0 -13 na none fill na na na 2fm,1c na na 2 13 -17 10yr3/2 none sil 2fsbk mvfr cs 2fmc 0.5 0.8 3 17 -32 10yr4/4 none Sil 2fsbk mvfr cw 2f,lmc 0.5 0.8 4 32-45 10yr5/4 none sil 2msbk mfr aw Ifmc 0.5 0.8 5 45-65 10yr4/4 none sil 2msbk mvfr gw 1fm 0.5 0.8 6 65 -105 10yr4/6 none %I 2msbk mfr - - 0.5 0.9 H #1 consists of an unsorted mbdur of s & sil fill. H#6 contains 1/47- 1" bands of 10yr4/4 0m Ifs at 4" - 8" intervals. Loading rate reduced to relfect restricted permiability of horizon associated with banding. ❑ Boring # On g Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 F Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 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. SOIL AND SITE EVALUATION 1568 Page 3 of 4 PROPERTY OWNER: Chuck &Joyce Rose PARCEL I.D.# 030 - 2009 -90 -001 A.C.E. Soil & Site Evaluations REPORT MEMO Verify size and condition of e)asting septic tank. Install effluent filter at septic tank outlet or downstream of tank outlet. Install bull -run valve to allow future use of hydrollically failed system. i ■ So��l Q ✓c�1 'on l 0,'� ♦ Ele ✓a -6'04 ,455LL&ttd ele' . To,4 oC dcor sill. E/. _ /0 /. 09 66 cve !/ 0 CXiSb � O open yard I �_EXlSEln /2��aP. SepE,"c.�mf EsE. Elev!a�o��Je{z = Sy. 9o. EX /S E�'n ( � soil al,'s / arsa /ce// G�odeaf S,T. = 97.73;' Qf 1 8X fib. 5y Ste n+ Q!. = &6.86 (o S6 A ✓anE , 7 . 5.'o 7 I �� Rtp l 0. cemcnf SYS6cm Xreq LIJ o�cic 82 Cot - qo,D Slic Iz3 �9 P yon � Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In -Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567 -P (R.6/99). Table 1: System Desi Specifications Sanitary Permit Number / Number of Bedrooms Design Flow - Peak (gpd) (, U Estimated Flow - Average (gpd) you Septic Tank Capacity (gal) I aIw Soil Absorption Component Size (ft a ou Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) v U Maximum Influent Particle Size (in) I 1/8 Maximum BOD, (m /L) 220 Maximum TSS (mg /L) S 1, 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and t least on4 evey 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component I filter is equipped ed with an alarm the filter shall be serviced if the alarm is activated continuously. q Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service u needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or Impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption Component r Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. When system fails, we will replace with another system at owner's expense. Alternate area must be left undisturbed. St Croix County Zoning Office 386 -4680 Tri- County Sanitation 386 -2130 3 w .. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM, Owner/Buyer Mailing Address Property Addresst (Verification required from Planning Department for new construction) S g City/State �� �kh f Parcel Identification Number LEGAL DESCRIPTION Proper Location S 'h, S £ 'h, Sec. 3y . T 3 0 N - 1 W, Town of p � v� {� 1 �� # "Subdivision C 5 � Lot " °' ' r `� t Certified Survey Map # 3 �� : Volume ___ Page # 41 1 S W , arranty Deed # $3 boy, , Volume S� Page # Spec house O yes ano Lot lines identifiable 13 yes O no S Y STEM MAiNTENAN E Improper use and maintenanceof your septic system could result in it premature failure to handle wastes, Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 lull of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to- the St. Croix County Zoning Office within 30 days a ar ration date. SIGNATURE Of APPLICANT DATE QWNER CERTIFICATION V we) certify that all statements on this form are hue to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro .;de bed e, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE ' *• * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ***$** •• Include with this application: a stamped warranty deed from the Register of Deeds office •a copy of the certified survey map if reference is made in the warranty deed ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXIS'T'ING SEPTIC TA14K This is to certify that I have inspected the septic tank presently serving toe C �v ���c� �oS-t residence located at: SW 5 Sec. 3y T 3 N, R 4 W, Town of S Svx�� St. Croix County, Wisconsin. Upon inspection, I certify that I have „found the tank and baffles to be in good conditio , and it appears to be functioning prop roperly. Last time serviced Did flow back ocbur from absorption system? Yes_ No line. m (if no, skip next — Approximate volume it length of time: - gallons minutes Capacity: ( a Oft b fibu K . Construction: Prefab Concrete Steel Other Manufacturer (if known): W Age of Tank (if known):. I Z atu ) (Name) Please Print //���� re (Title) (License Number) v (Da e) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113;Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis.'Adm. Code (except for inspection opening over outlet baffle). / Name Si gnature gnature MP /MPRS DOCUMENT NO. WARRANTY DEED THIS s.,::c RESERVED FOR RECORDING DST. STATE BAR OF WISCONSIN FORM 2 -1982 4832E4 VOL 950P1r'E 15 i STEVEN W. HENNING and NORMA J. HENNING, REGISTER'S OFFICE Grantors - ST. CROIX CO., bNi 4 Reed fw Recor MAY 121992 conve}, and warrants to CHARLES T. ROSE. and . JOYCE . 8. ROSE, husband and wife as survivorship.marLtal prc;ert.y,. _. at 1:20 P. M Grantees,. _ Re�tster of Deeds ... . -. .. -.. ..... - -.. .. .. T-;1 LO the following described re:,l estate in . St. Croix.. ._County, State of Wisconsin: Tax Parcel No: .............................. A parcel of land located in part of the SW of the SE's of Section 34, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin; being part of Lot 4 of Certified Survey Map recorded in Volume 7, Page 1989 at the St. Croix County Register of Deeds Office; further described as follows: Commencing at the Sk corner of said Section 34; thence ;:00 "E, along the north -south 4 line of said Section 34, 585.25 feet to the point of beginning; thence continuing N00 "E, along said north - south % line, 307.99 feet; thence N88 "E, 431.52 feet; thence S00 "W, 321.90 feet to the north line of Lot 1 of Certified Survey Map recorded o 415 at said office; thence N89 27'37 "W, along - s - a - n north line, 431.34 feet to the point of beginning. Above described parcel contains 3.11 Acres (135,847 Sq. Ft. ) and is to be deeded to an adjoining owner. TOGETHER WITH and SUBJECT TO reservations, restrictions, easements and rights -of -way of record, if any. r , This iS nOt t:o!ncac,u! 0) (is not) F:xv,iainn tI, %.arr;:rtie May 92 STEVEN W. HENNING NOR%Lk J. HENNING AUTHENTICATION ACKNOWLEDGMENT Sieuanln';) STATE OF WIS('(rN.�IN ' – _ _ ST. CROIX l'Ilunt }. authenticated this iac of._ }'ct• I'na'!Y r:uuc h••fI'ro we t1;.'S �J dad n' May 1.1 92 the :11_ve n:uno t Steven W. Hennin; and N %*La.0.,•l(Nithig 'CITLF:: NIFMBER ST:1l'F: BAR (1F \I'IS( (rN�iN I !i rot. V auihl rizc� b' ;iII;.IHi, l�:>. >htt .l _' ! • J ed llu_ : C" Attornev Barrv C. Lundeen - �, • 7� ' MUDGE, PORTER & LCNDE.EN, S.C. i ST �tE;��•`: 110 Second Street..- Hudson, Vf 5 rO16 t I I St. Croix t.t!?` ;. tc; mne he a.ltl'r ^'Hated I aAn tc!. i • .i 1; ' }T t r • -'_ I ` not, .talc " \WARRANTY Of r. f:111! BAR OF CiI C(. %a\ •' ' I F1L ED MAY ..• 0930 3 1984 '� 'A;An o' tv of b ""d" Ga►x SOUTH 1/4 CORNER UNPLATTED L!AN�S SECTION 34, T30N, R19 W, - - - -- 8Q O T b COUNTY MONUMENT WEST LINE SEI /4 00 -'V < 3g" I N 00 E S `��' rn 585.25' A owi S• 39' `pO,E r 0 z cA A �� —� NISQ .o Om_ 33 O IQ `� 3 ,p. � f 6+0 3c 0 LA rtl u+ 2 s rn I OO.pO„ I TO v� O C" '0 OD w o \ z Do 4 , m cn C n Z I W �wW HOMO 00 G O m u'� �• O r I 0 _ Z M O ~ I QD D I m 00. 0 C) Z ®1 Q rn -f mo rn ° te a "m N D �����'z °�' o f x O Z I N o _ (n � x � '° 0' N o � � c �D 2 �p o°—' o. In p ° i+� `� ow ° { I :_4 Q rn W A 0� O NN O G) N N n nI' c -4 z 0 I M o '� "� r" m o m A N OD O G) m In . D Z $ y 1a N Z 9 O rr I r' v -4 Z ° a N Olz z w °x a-4 ►O,, O . VS 0� O rn C N N r �S 0 0 0D V7 z o gdeCY30 o r Z © i c 0 N M (n J Z r m CDC\ \ 1 N -U N D an , , .. cn O CD _ N (D • M ~ 2 = Z X1.40,, ( �,,.. 'i o o 0 o N ,P r M N N$ C) Z O N gr° � N N — o ch �;, n m f�l M �. Z `+ m .Z + P w .I� :0 w I o m •� rn G, U , o O _ ja W V r. A O N �' w O O C '4 A N 0 m o z< ��- '� o �' g w -1 °. I c Z b W N W N - O Z m w N Ir (n to - i �z� \ 3 - 3�„ n1` O :' 01 Q O O CO l0 N I N �1+ N-A m� D � \\ ;0 m _ \ �i Q n O ' O ` Z t A O O O O A A 4 z A A c rn n W r'1 N tr (D - N N N tD (0 Op r 0 ° 0 O 4, _ \ \ �D I W la O A O N N 01 01 OW Z x IS O 'tn Z • P U ° O_ tWD_ 0~i 8 O O `0- = Q C \ \ \ '�° �� 1 0 Z W M p- Iz cA cA (A cA w cA N In cA cA In cA cA 0 < m O tT W x 8 A N W o v (J N N N x m W o o t to r 0i to w 0 0 0 Oo O O 0 \ � t�. SOD Z D , o , o A , o , ' - _ OD p I '_ -. O A W W W W W W W _ v N ,- m � • O I W O O OD A N 0 0 0 O. O O x $ I O OO O , 0 0 0 m - z ^' 198q I rn °° °° a °? 0 N z D O — a �m� 0 JAN 1 G O W N' o O p -4 v w cn o w p o $ O ° O ° G) r x $? Z ST. CROIX C'JU = O O '� N Z COMPREHENSIVE PARKS I I.A:. -0, m O O 20 -1 m AND ZOt�lN3 COM +li til BEARING ARE ASSUMED AS N O 0% N L N N w 'D OD c m n M N 00 20 E ALONG THE WEST JI (D r o N O OD N M O m o A M M t+1 LINE OF THE SE 1/4, SEC. 34 (0 N W A 0 0°i to t" A N = (,7 m N -1 I W - - O - .I n O z - Volume 5 Pave lhl5 rn Parcel #: 030 - 2009 -90 -001 02/15/2006 03:16 PM PAGE 1 OF 2 Alt. Parcel #: 34.30.19.386C 030 - TOWN OF SAINT JOSEPH Current [XI 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 CHARLES & JOYCE ROSE O - ROSE, CHARLES & JOYCE 656 BEATRICE CIR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description " 656 BEATRICE CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 7.250 Plat: N/A -NOT AVAILABLE SEC 34 T30N R19W SW SE LOT 1 OF CSM Block/Condo Bldg: 5/1415 ALSO A PAR- CEL DESC AS BEING PT OF LOT 4 CSM 7/1989 DESC AS COMM S1/4 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) COR SEC 34; TH N 0 DEG E 585.25' TO POB; 34- 30N -19W TH CONT N 0 DEG E 307.99'; TH N 88 DEG E 431.52'; TH S 0 DEG W 321.90'TO N LN more... Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 950/157 07/23/1997 737/609 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 84161 419,400 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 7.250 144,200 237,200 381,400 NO Totals for 2005: General Property 7.250 144,200 237,200 381,400 Woodland 0.000 0 0 Totals for 2004: General Property 7.250 144,200 237,200 381,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 123 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT Form - ST C- 104 OWNER 5� �} Sy4C TOWNSHIP . c "z _ SEC.3� T N -R _L I Z t ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION Dorf o LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM o � � FA O i 18 xq(p B CD 3 ( i IV - INDICATE NORTH ARROW i 11 BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: V P SEPTIC TANK: Manufacturer: _ We e- ��..' Liquid Capacity: WO �1 Number of rings used: Tank manhole cover elevation: V Tank Inlet Elevation: Tank Outlet Elevation: �1��• Number of feet from nearest Road: Front,o Side,o Rear, i t feet From nearest property line Front 1 0 Side 1 0 Rear,o c CL feet Number of feet from: well k building: t. J (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: c (Include distances on plot plan). 9,ao H eaoe ; lw)- a5 - 14',I.a 100 O b SOIL ABSORPTION SYSTEM _ N D , 10O O(4- Bed: Trench: Width: I Length: Number of Lines Built: 0 Fill depth to top of pipe: �c1 Number of feet from nearest property line: Front, O Side, Rear,0 Ft. p �+ Number of feet from well: Number of feet from building: l I (Include distances on plot plan). SEEPAGE PIT its: Diameter: Number of Size: p 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: Plumber on job: Dated: �_. 3__��_ /`' ,. License Number: 3/84:mj I� c. L EPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY &BUILDINGS ON I LABOR &HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMB DIVIS P.O. BOX 7969 MADISON, WI 53707 SW'jSM,S34,T30N —R19W ERCONVENTIONAL El ALTERNATIVE I staTe Planl.D.N (If assgned) Town of St. Joseph El Holding Tank ❑ In- Ground Pressure ❑ Mound Lot 1 Don Norell, Private Road NAME OF PERMIT HOLDER'. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Charles & Joyce Rose 652 Green Mill —Daily Road, Hudson, WI i4016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: I CSTREF. PT. ELEV.. Name of Plumber MP /MPRSW No.: County: Sanitary Permit Number: Richard Hopkins I 1059 St. C roix 112654 SEPTIC TANK /HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED DYES ONO [:]YES ❑NO BEDDING. VENT CIA .: VENT MATL. HIGH WATER NUMBER OF ROAD'. PROPERTY WELL. BUILDING Iv,N, TO FRESH ALARM. FEET FROM LINE. AIR INLET ❑YES ONO ❑YES ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING'. I LIQUIDCAPACITY PUMP MODEL PUMP /SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO ❑YES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPER7V WELL BUILDING J VENTTO FRESH LINE AIR INLET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) DYES El NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth Of plowing LENGTH I DIAMETER MATERIAL AND MARKING or excavation, (lf soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) L MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH NO OF DISTR. PIPE SPACING COVER INSIDE DIA aPITS LIQUID BED /TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH I DISTR PIPF DISTR PIPE DISTR. PIPE MATERIAL'. NO. DISTR. NUMBER OF PR OPE RTV WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE COVER ELEV INLET ELEV. END. PIPES FEET FROM LINE AIR INLET 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- meets the criteria for medium sand. TIONS MEASURED. DYES ❑NO OIL COVER TEXTURE PERMANENT MAHKFRS OBSERVATION WE LLS ❑ YES 1:1 NO ❑YES ❑NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. DYES El NO ❑YES ONO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER BED /TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTR DISTR. PIPE DISTHIBU T ION PIPE MATERIAL & MARKING ELEVATION AND ELE V. ELEV.'. DIA, ELEV.. PIPES 1 111A . DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS CAL LIFT CORRESPONDS TO APPROVED ❑YES ONO DYES ONO COMMENTS: PERMANENT MARKERS: J OBSERVATIO WELLS. NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE ❑YES NO ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE Zoning Administrator DILHR SBD 6710 (R. 01/82) I 1 --�L SANITARY PERMIT IT APPLICATION COUNTY In accord with ILHR 33.05, Wis. Adm. Code STATE SANITARY PERMIT# ZI Q &5 — Attach complete plans (b iM county copy only) for the system, n paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. —See reverse side for instructions for completing this applicatio . PETITION 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATIO FOR VARIANCE ❑ YES $Z NO PROPERTY OWNE F ROPERTY LOCATION '/a ' /4, S 3 T�Q, N, R 1 E (or PROPER Y OWNER'S ING ADD SS OT, Nu ER SUBDIIVISION W E Gr_ 1 �A o �` I BLOCKNUMBER I-1 CIT , S ATE -1r ZIP CODE ONE NU BER CITY AREST AD, L E OR LANDMARK 76 W .� h VILLAGE: �d e II. TYPE OF BUILDING OR USE SERVED: (� Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): CON Ve 011170 !J III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2, 3 or 4, if applicable) 1. a. New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an ystem System Septic Tan Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit ## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. Xconventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Seepage Bed b. ❑ Seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORFITION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSE (S are Feet): p� 9 9, 1 Feet Private ❑Joint [ Public VI. TANK CAPACITY Site in aa ons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank -QQ s Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plu er's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: T' c: ^ I J r 10 71 e' - 9Q0 . PI OU r's Address ( treet, C ,State, Zip Code): Na a Qf D signer: � U Vlll. SOIL TEST INFORMATION Cer ' ' d it Tester (CST) Name CS =# CST's ADDRESS (Street, City, State, ip Co ) Phone Number: IX. COUNTY /DEPARTMENT USE ONLY �( ❑ Disapproved S itary Permit Fee Groundwater ate Is ing Agent Signature (No Stamps) ,—,Approved ❑ Owner Given Initial � 1 rchar e reee� �+ X Adverse Determination ' v �e �w X. COMMENTS /REASONS FOR DISAPPROVAL: I OL I, 04f(wiJ bL� `-V� N-44 0 SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SMATAl',Y tERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608 -266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1 -6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; , VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; , X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE I On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes.was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground tel included the creation of surcharges (fees) for a number of regulated practices which Wisco can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried T+B2i5 e is used in your building is returned to the groundwater through your soil absorption o 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- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD -6398 (R.03/86) 4 . APPLICATION FOR SANITARY PERMIT S C - 100. This application form is to be completed in full and signed by the owner(s) of the- property being developed. Any inadequaciea 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 deed recording. 1 Owner of Property Location of Property _� -' S , Section 3'� , T a N -R /y' Township Hailing Address Address of Site .;rte Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created Iq 8 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec' house) ? Yes _�_ No Volume and Page Number as recorded with.the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: 1 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 CERTIFICATIO 1 (we) CeAt16Y that aU dtateme,ntd on this okm' ane tkue to the but 06 my (oun) hnowfledge; that I (we) am (ane) the ownen(.6) 06 the pnope�cty dedcAi-bed in thiA in6onmation 6onm, by vt4tue o6 a waAAanty deed tended to the 066.ice o6 the County Regi6ten o6 Veedh ad Document No. / /2 Z 5 and that I (W p nedentty own the pnopod ed d-c to bon the d ewage di spoil d yb em (on I (we) have obtained an e" ement, to nun with the above des ex bed pnopeh ty, bon the condtnuc ti.on o6 aa.id d yd tem, and the dame had been duty aeconded in the 0 6 5.tce o6 the County Reg.i.a.teA o6 Veedd, az Doament No g11 Z J ' V. SIGNX O r .. OWNER G SIGNATURE OF CO -OWNER (IF APPLICABLE) DATE SI D DATE SIGNED DOCUMEN NO. • WARRANTY DEED • "I's sl.c: acs¢aveo '_ — 1- 11oirve — 1. STATE BAR OF WISCONSIN FORM 2 -1982 . I J7PAGS D " REG15TERS OFFICE Donald Norell ST. CROIX CO., WIS. Recd. for Record this 28th _.. _ - ay Of April A.D. 19 86 _. .. 10:30 A and :jnts tuj _ Charles T. Rose . and Joyce - B . - r Ros.e,- husband--and _ wife,_ as_.survi-vo-rshiD.. .._ma,eital...pr.operty ------------- .. . ..... . r.E,uary TO GWIN & GWIN P.O. Box 106 Hudson, WI 54016 the followin, described real estate in _.St._-_Cr.oix ... _._Conr:ty, - - of Wisconsin: Tax Parcel No:.............................. Part of the SW; of the SE4 of Section 34, Township 30 North, Range 19 West, Town of St. Joseph described as follows: Lot 1 of a Certified Survey Map dated June 21, 1982 and recorded May 3, 1984 in Vol. 5 of Certified Survey Maps at page 1415 in the office of the Register of Deeds for St. Croix County, Wisconsin. TOGETHER WITH AND SUBJECT TO protective covenants of record and use of the private .road for ingress and egress as shwon on said Certified Survey Map. `. "; iv` , This is not homestead property'. (is) (is not.) Exception to warranties: Dated this day of 19.. 8 (SEAL) .. (SEAL) -- - ..D.onald ... E.. No-re 11 .. ...(SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature (s) ----- ..... STATE OF WISCONSIN SS. r •--•---- ------ - - - ... ---- -- - - } before this day f . --- - -County. authentica3 this / <= "�ay�f Personally �{ J 19. -�� ersonay came eore me s ...............y Part of the SW4 of the SE; of Section 34, Township 30 North, Range 19 West, Town of St. Joseph described as follows: T,ot ] of a Certified Survey Map dated June 21, 1982 and recorded May 3, 1984 in Vol. 5 of Certified Survey Maps at page 1415 in the office of the Register of Deeds for St. Croix County, Wisconsin. TOGETHER WITH AND SUBJECT TO protective covenants of record and use of the private road for ingress and egress as shwon on said Certified Survey Map. 0 This _----- -_..-- is not _ homestead propert }'. (is) (is not) Fxception to warranties: 86 llated this .._ _.. - - l.. __.- day of (SEAL,) (SEAL) I -_ . Donald_ E.Norel l ---- - - - - --- - -- _.(SEAL) __. (SEAT.) x .. AUTHENTICATION ACKNOWLEDGMENT Signatures) - - - - -- - -- -- -- -- STATE OF WIS(ONSIN ss. -- -- --- -- - ----- - -- --- -- --- - -- --------- - -- -- ---- --- -•-- - - - -- ------ - - - Count ` %4_ authentica thi y f � /._ 19__� Personally dune before me this . -. -. .day of day - .- -.- - -- 19 -- ... . the above named L - ---------------------- - --- - u H' Gwin ------------------- - - - - -- - - -- - - - -- N lA - -- - - - TITLE: MEMBER STATE BAR OF WISCONSIN (If not, --------------- ------------ --- --- -- ----- -- - --- - - -- -- authorized by § 706.06, Wis. Stats.) to me known to be the person ____ -. - who executed the foregoing instrument and ackrnowlalge the same. - THIS INSTRUMENT WAS DRAFTED BY - -- _ - N/A Attar..--- Iiugh_.H._._ Gwin_ 430 2nd St., P.O. Box 106, Hudson, WI * - __ _ _.__ - - - - -- - -. - - ---------------------- ---- --- -- ------ ---- ------ - --- --- ------ - 5-40-16- Notary _ Public _. _ _ County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: _ _ ------- -, 19- --- -....) 'Names of Persons signing in any capacity should be ty ped or printed 1".1o" their sian:,turr'. WARRANTY DEED STATE BAR OF WISCONSIN N'is °an in Legal RI:u 1' Co. In' FORM No. 2— 1982 >I�: �.- ,,,�.. <•,:. \bi 3; ��i V . ? E D �• 93 , AY 3 1884 c.r O f D13d, P. O ly,�i, SOUTH 1/4 CORNER UNPLATTED LANDS A lj WI SECTION 34, T30N, R19 W, - - - -- - - -- 90° T � COUNTY MONUMENT WEST LINE SEI /4 2S 04�3g. r- N 00 E gs 2 >. 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'-q.89; 5 Z • 585 ''b/ L ES aul- So alln 1.e em. -9uOTs H I IOZ - IZZ H eouauq. !uoTjdTaosap sTUq. So 2uTuuT ,9aq So quTod aHq. osTs sT .zauxoo t/ L S PT ss ' uoTq-aaS ;o Jauaoa V t S au!. 4-s RuTOUammo0 �� :sMOTTo; es pagTaosep • o uxO ' `H O� I •zauq.sn,T �uTsuoosTM '1��uno0 xTo.zO �S udaeor �S � Z M 6 L 2i 'tC uOT1.09S So t/ L gS auq_ So t/ L MS auq. So q-asd uT pagvOOT pumT So Taoisd y a a T u :sMOTTo; ss pagT.zosap sT paddsm pub p a�Sat►.zn s o.zsd u�e � So T P 1S.xspunoq aOT.zal.xa auk gxtj!� !dlgq 1SaeanS PaT ;Tgaao sTUq. Aq paluaseadea sT uoTlqM • OaO Buo a a�San.zns a� TT DI pT Q o uOTq.OGaTp � aossd usT auk. paddsm pus pagT.zos p p � I C p a .ql. Aq ;suq. A;Tjsao Aga•zau 'aoAanznS puul peael.8T991 s 4 ue9suAH • o uaTTV `I gSV0I3ISHS0 SHOISAIMS , STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER C4,2) 6�� ROUTE /BOX NUMBER h Z FIRE NO. CITY /STATE ZIP ' 5 7 /t3 / 4 PROPERTY LOCATION: V1 1 /4 S 1/4, Section 3 , TN, R / 9 W, Town of , St. Croix County, Subdivision 0__ dnn � , Lot No. 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 SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED p DATE 014 r d St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 (715) 796 -2239 or (715) 425 -8363 Sign, Date, and Return to above address LABOR AND PERCOLATION TESTS 115) P.O. BOX 7969 HUMAN RELATIONS •- � MADISON, WI 53707 k (H63.0911) & Chapter 145.0451` p Qc 5EV 1 /i V4 3 ' /T 3o N /R I / L (0 TO t' 1 / NO.: BUC. Nt7: S'UJV 1 ni�� FCC L COUNTY: - . WNE AM •7 MAILI !' ADDRESS: 64 . 060 ~I'De o�PE�L • lv / /a.w 1 VIP. soA) was. USE • DATES OBSERVATIONS MADE ON .B p IL CO T ,pt Now Replace [Pb Residence U 9�i J. d RATING: S - Site suitable for system Un Site unsuitable for system 5 74 , 5: g `^ •�54vp S11b rTi 4m,:; , i ONVEN NAL: 1 GFaOU 'Y$' •FILL OLDING TANK: RECOMENDED SYSTEM:Iopeional) ®S ou US ou W4 !ILL oU as ®U ❑S ©U C f RECOMMENDED avrlAl - & P �oj SoOrr If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s,H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: i' PROFILE DESCRIPTIONS BORING TOTAL H T N WATER - INCHES CHA ACTER O SOIL IT THICKNESS. COLOR. TEXTUAL AND DEPTH NUMBER DEPTH IN. ELEVATION O BSERVED HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) X3,4 Yr�A# -Gr, s;%, S s%1 / . ,�, y . 4f. . w // /3N. SG o tdesr f 30 9 . B. Z �[P 0 . ZA ) 9G "/�v L, /�.,G� Qar. L, // "Ll� AJ, SLR 1G ~ �! Zs.0 •s. P&4 B. 3 9.S �oa .�0 , �L 7" &-V PI 3/" 0 &..f %L� y" GHQ- 04 . S•L j•O . .J n B. y S3' g7 > �� yps�►. Ste, �1��tj• sl ,� „ Ai/x. 1W 73A). S s o d &4A 7k4 ,v. SAV 13 ” A; -6,y Si- , i 7 ~ / 6A. f" S4. Lf -9 . s 4.L' B_ Sv�ci E /caAnovf OF RE f PERCOLATION TESTS TEST DEPTH WATER IN HOLE I TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER "44465 FTER SWELLING INTERVAL•MIN. PER INCH P. P -. P- , t7 •, / 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 .'evation at all boring; and the direction and percent of land slope, & MA1 Or- BCD Sb •91,L l h - EO ri_ a N' /,fit 1" 1/40r 1Z.4L. 4rEi ZAke SYSTEM ELEVATION Po RT et&yftTroN of `/9. f $ cr. _ s �- - , 94 1r4i B,l1,.4ir"A ►1_ T_�?, i i '... c i i _ ` i hbuyE .4!u� Ar A 1 sic f ow - `rl `ll Sp- F_ LAMA 4 j I i isf Tom" �� _ d F P� L 1 1 7 1 1 r 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods sped fied in the Wiscuinin k` Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. , ,AME print ' 3 TESTS WERE COMPLETED ON:.. '.� •.. 9� ADDRESS: HOPI�. S T1: TESTING . C O. . C�R�IFICATION NUMBER: PHONE NUMBER(opt�o 11: fir• -�-• w� CST SIGNATURE; � UDSOA�1 WIS. 5 1 )ISTRiBUT10N: 0. i9inai anrt one copy to Local Authority. Propei ty Owner and Soil Tester. `0 SS SECTIC 1\1 B.L. 67 P L OT I [5 O' P. J E C ID L U _K s E 0 0 )W 1NAME CkAs �Af-t- Po 5 Q NAM �i L 0 C T N S I C E N ' I --- 7_.. #J4 F A �.. - - -_ - -.. A PLO &4�oe, 80m Pits 3e0poorn Nom f , of ROA 1 st r ip( Se 39 �t rgo rv% 94.. Nutt to 8004 MZ100-0 0 Notx - 0 A a� A Cq. A Lots, - rkqz Wt I I S pee ir.46q V_ 6 - 64M (Wt from sqrflc VP1 x 1 Mott: W ' is �h 6P 60fl �rt(um 9 1� P + g4 tj -t el A P, .08 Top 3YI �o ................... . ........... . FRESH AIR INLETS AND OBSERVATION PIKE cnoSs SECTION Approved Vent Cap 103, Y Minimum 12" Above j, Final CjrAb e_ N t 4" Cast Iron Above Pip Vent Pipe To Final Grade Marsh Hay Or Synthetic Covering Min. .2" Aggrog o I Over Pipe I I Q Distribut i Tee Pipe Aggregate Per•forated Pipe Below V49 i3encath Pipe e —Coupling Terminating At Bottom of System