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Home My WebLink About030-2088-20-000 ato 0cn �w o G r_ d f d E T `i1 C 3 � � O a� O A CD C _O c. . O N W O (n r! • �� 3 3 3 c 3 3 0=r is o -. CD Z CD V` 'a -1 --I a) O N ° cu TJ 0 � 3 m w O .. c c o o m Co a 7 K 3 3 N p S S T C i >> m O o o CD ' A N O (n N 7 7 O CA O N O (�1 O N 7 N n j O C CJ C � O a m ° `° 4 `z a N (y N C 3 O OOi �7 r. o Ul Sr - - Z N N !_ O N W W O it o o= a n r 0) m CD O ON d N A A C •" a . C O en a !V C O O O - : ' O n" 3 N N C = 3 N N N CD D O O S CD A m v O N CD m m v O CD _ m O �7 •� m L1 (D CA iZ O m m z Q d N w N N CD m 3 m - _ - CL � F) Z 3 o D o o D o O o o ' o 0 Z O CCD CD • CD C CD C r*A FT P W O. N N d a 3 V v 3 � CD CD CQ -� N O o I p 2 m CA D o n 7 3 A Z O A C1 CL O O C O A W (D cD (D < Cl , 0. Z 0 3 0 3 " ;a o " o m co A CD A N CD rn (n - 0 - 0 (D X an d CD 7 0- CD m C Q C CL Cl) N .3 OT O . N C) (p G 7 O N O T `z y o O 'C1 CD CD N C - O N 7 C 3 n�oom Z a - m Z a o� o_ 3 o o =E o CD "' (o Co CD CD r: a CD C L (D M O COD -01 CJD -0 _. (n •• �3(nmco ma m a CD cn r m 3 (7" S N 3 N C) co � o 0 p CL ( o m C > > N m 3 C CD m tT N � Q (n = m O M N fD 'O N +• d (D N cn O p O V CL m O (o m (n O � Q O O Efl 0 Efl (J I w.l O CD O 0 0 CL O O' Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ` s INSPECTION REPORT Sanitary Permit No: 405139 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: Humphrey, Gary St. Joseph Township 030 - 2088 -20 -000 CST BM Elev: Insp. BM Elev:� IBM De ription: f TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark � Z o 2.3 Dosing + � J` n� � ,7 , „ � Alt. BM u-7- Aeration 1 �� Bldg. Se er v 7a P d l�if i/ , , -3a 93- o Holding St/H In_�I ,t, _ , r— r/' S t Outlet TANK SETBACK INFORMATION c S� 1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Se p�� '�/ � � � � Dt Bottom Dosing Header /Man. a. Aeration Dist. Pipe To Holding Bot. Sys m�8 Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St M / Y Model Nu ber TDH Lift tion Loss System Head TDH Ft Force a' Length is Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length f No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L jt3LDG iWELL LAKE /STREAM AC NG an er: INFORMATION Typ Of System: HA MB R OR UNIT Model Number: DISTRIBUTION SYSTEM a d4k4 pS 6 —F ,, 1 maser ✓. s v � Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake I Pipe(s) f `—! Length Dia Length ��- 4- Dia acing / 0 ( _ 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 �tY� Bed/Trench Center Bed/Trench Edges Topsoil Yes E] No 0 Yes E No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:_/ 3l / b Inspection #2: Location: 661 Walsh Road Hudson, WI 54016 (SW 1/4 SE 1/4 34 T30N R19W) Deerfield Lot 2 Parcel No: 37.30.19.742 rv ) Alt 11 BM Description = (L�tj ( CA,51n'� L'g'61ag sewer length = 6L 11 4Zr C t v Ytf J 1N /CXXCU'Mwt �p'�k' �Ob - amount of cover = ( r ,w► t� Plan revision Required? WYes []No Use other side for additional information. k /' Date Insepctor's Sign ure Cert. No. SBD -6710 (R.3/97) T. R IX S C O COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner MAR K � � �'� 0� 6r0 I V ,5' yl - 5 1- 72- Address G SY A p. City /State 14UPSo Gv/. SyD /(r RECEIVED Legal Description: JUL 3 1 2002 Lot 2_ Block Subdivision/C -18M '/4 9& '/4 E, Sec. �, T36N -R4W, Town of S • '"d S N • Z. • l0 •0W SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION �,)W /NG' M1Dl0g5r "A.,. W • > / da Tank manufacturer G Size ST/PC j y� Setback from: House �'� Well P/ I, Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM ` 115 ' Type of system: ?Ipg'N � Width 3 Length Number of Trenches 3 Setback from: House Well P/L Vent to fresh air intake > • 50 ' ELEVATIONS -ro p tip A10, J/W,4 ,e ©ook 'll - �'A-s r S %O� Description of benchmark 5 1 Elevation Description of alternate benchmark 70,0 Dr We Il 44Sj'`� Elevation Building Sewer ST/HT Inlet ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover sez- P/ o r P1. 4,v r r/t Distribution Lines () () ( ) Bottom of System ( ) ( ) ( ) Final Grade ( ) ( ) ( ) �c� 30- Date of installation / / Permit number / 3 State plan number Plumber's signature License number 11(43,7 s g Date Inspector P�� QU;N ✓ Complete plot plan O RIGINA L � l t NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of -the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. , PLAN- VIEW INDICATE NORTH ARROW ivc CL D vim. aZ�� In °�� `► �VV `KI o ^� 1 S R j ACC `s` h G T c� L y � - 0 �Y , y m 70 �: ao 0 0 r, a O r�r I I ts r i • I I II 1� ` ' I I I Z�. c1 vo 1 °) vJ Z 1 ► Nlz� rn '� I I I I • to I Qo I _ '6I I I y O � I w R� p aG o �a 3 ?e t � Safety and Buildings Division County `/�� y ons 201 W. Washin ton A ve., .O. B 7162 ST l k A ox �sein Madison, W1 '53707 - 7162 Site Address Department of Commerce v $.3I 3 4 &/ 1V1 ' I9 1- V *A P ��yvs Sanitary Permit Application Sanitary Permit N umber In accord with Comm 83.21, Wis. Adm. Code, personal information you provid O S/3 9 ma be used for secondary purposes Prlvac ❑Check if Revision I. Application Information - Please Print All lnforma Ion State Plan I.D. Number /U/,f Property Owner Name �J UN U 3 2002 Parcel Number 3 0 . 2 0 S _ (T41 �` Y"I' X c Op p " Property Owner's Mailing Address C /, j� /j� L LZON ROIX Property Location �� I�(/j�liS // !'�� ING OFFICE 54() u S9 'A• S 53 T3L N. R /y am City, State 1 ) Zip Code Phone Number C/ Lot Number Z Block Number �' ��SDN ICJ I. S7 0/� 3 �rp � fQIO � Sabdiv�io��e •E$hffihtmbEr II. Type of Building (check all that apply) ocity - !' V I or 2 Family Dwelling - Number of Bedrooms []Village ❑ Public /Commercial - Describe Use / ownship 5T • S O S ❑ State Owned 7 1 X106 dAe 7-41%4- earest Road ~ N 16 cka /mod r�ac4._ ,�. w/f GS//- f, M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 ❑ New 2 Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use system Tank Only Existing System B. 01 eck if Sanitary Permit Previously Issued Permit Number Date Issued ji; i ao9 0 li - /f ?y IV. Type of Permit: (Check all that apply)(numberingssheme is for internal ,�-- 44XNon - Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wedand eA 22 ❑ Pressurized In- Ground 41 ❑ Bolding Tank 48 ❑ Single Pass 51 ❑ Drip Line '� t 3� O. Tr Z 1 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other C� V. Dis ersal /Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposer �� Rate(Gals. /Days /Sq.Ft.) (Min./Inch) s_ Elevation hers 12� ' VI. Tank Info Capacity in Total Number armfac r Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass t New Existing M Tanks Tanks Septic or Holding Tanis I � O /2� _ O *e4 vv V /r'c t Dosing Chamber VII. Responsibility Statement- I, the tmderslgned, assume respoasibWty for tnstalla Hon of the POWT3 Aown on the attached plans. Plumber's Name,(Print) Plumber's Signature /MPRS Number Business Phone Number- R. . I�bR�t c Z2-4r 37 S 71s -30 S Plumber's Address (Street, City, State, Zip Code) 4 P SS 6 N.e, L P >fvPso,j Zvi. �S'yoi Count /De artment Use Onl Approved Disapproved' Sanitary Permit Fee (includes Groundwater Date Issued I mg ent Signature (No Stamps) Surchar a Fee) ❑ Owner Given Initial Adverse. * Determination IX. Conditions 2 of ApprovaURea;ons or isappro 1 -� S 4, AD TT mil- 9 Wefto a Co m only for atem� pap; "r of I tLae 1/1 SBD -6308 (R. 05101) A epa ment rt of Industry PRIVATE SEWAGE SYSTEM Count Human Relations y ST CRO 3ulldings Division INSPECTION REPORT IX GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryPermiTNo.: Permit H I r' rry� MIE.I W , BRUCE A . ❑City ❑ Village f_1 Town of: State Plan D No.. CST BM Elev.: Insp. BM Elev.: 8M Description: 7 � Parcel Tax No.: TANK INFORMATION ELEVATION DATA -7 � - �? TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septi SO •O/r.�.SZvr�,1 � <�a.st �? J�� Benchmark Dosing Aeration Bldg. Sewer Holdin St/ Inlet (� of 53 TANK SETBACK INFORMATION St /yf Outlet 27' TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake _._ Septic ' NA Dt Bottom P ?SQ �c?S /3 r Dosing Header4-ttan— 4, Aeration Dist. Pipe __ ^? (" Holding Bot. System i L 97,0 PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand Lp 0 4 S',T. Model Number PM TDH Lift Fricti e Sysn DH Ft Forcemain Length Dia. H Dist. To wn SOIL ABSORPTION SYSTE (1) _ BED / TRENCH Width Length i No. Of Trenches IT No. Of Pits Inside Dia. Liquid Depth — DIMENSIONS fe DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING a'cturer: INFORMATION Type 0 k.r J - AMBER Mo Number: System: +--r" — 1 4) X 5 0 OR UNIT DISTRIBUTION SYSTEM Header, i ' / 0 Distributi6n Pipe(s) ,? ! x Hole Size x Hole Spacing Vent To Air Intake I Length lL Dia. / Length � Dia Spacing l� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Syste Depth Over i Depth Over xx Depth Of x Seeded i Sodded xx Mulche fled /IcwwdiCenter -5 Bed /1t6aGi>'Edges3o�— � Topsoil ❑Y es [] No ❑Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) 4L ( LOCATION: St. Joseph.34.30.19W, SW, SE, Lo t 2, Walsh Roa Plan revision required? ❑ No L ?I o Use other side for additional in ormation. 9 / SBD -6 ?10 (R 05,91) Date Inspector's Signature Cert. No. f�rTE'cF— - -- G3 i ;S� VISMIUU r ION: UrllQnnl and onn carry to Lacril /Wlhorlly, P:npnrty (Uwnnr rind Sall" -- - - -- ,e i►itiut.snu -asr�� ul, to�o3► _ .ij I Ij ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently v M serving the ��/ R/��- residence located at: 5 � 1/4, 56 1/4, Sec. 3 Y , T N, R /Q W, Town of T O Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No-! no, skip ,. next line) Approximate volume or length of time: gallons minutes r. d - Capacity: ! � J Construction: Prefab Concrete Steel Other Manufacurer (if known) : /�?�f>�I.Q s 7XRV PAC +S - q S Age of Tank (if known): l (Signature) (Name) Please Print (Title) (License Numb (Date) Form to be ompleted by licensed plumber (x.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 I`�•� 1 �^~ Signature Z Z'(�375 5/88 ' I . j -BI-11 A-I ' & ASSOCIATES CO. 655 O'Neil I- load - Hudson, WI 54016 Reg..Ves► of Fnglneerin Systems 715 -386 - 8165 Private S esw qs Consultants PROJECT INDEX 3��.� PLAN I D # N -- �� //��'�,p �J �/ BATE OWNER &,4 y 110 ,9� 6 nn / - PHONE 41 ' 3d ADURT SS (�� P LE DESCRIPTION P/ /1/ D 30. 2 0 2 0 Got # 2 X0- -�� p - Sw, �e S� . 3 y 7_30 N, R TOWN OF -ST 3'OSO 5 ' zo /K_ COUNTY LOCAL AUTIIORITY/ SUPERVISION S 44 C �� •V /�V (�--. PROJECT DESCRIP'T'ION. O . � y 50i 15 Ai' rA, G0,4- D1416- _ Phi C s T s VM o &P, �- 7 SY S 7�_e,_. X"� I�R, AA THIS POWT SYSTEM SHALL C t�. lbricl�t & Ass°ctales INCORPORATE PER COMM. '� W� p sewage O0 "8gltants 85 5 p 83.44(2)C A PROPER ZABEL O R 'Nell Rd• 54016 FILTER MODEL # � Hudson W1s �p,� s :# Pg.l INFILTRATOR SIZING WORKSHEET Pg.2 SYSTEM PLOT PLAN Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pg.4 if n of if of P9.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS P9.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG•7 (OPTIONAL) PUMP PERFORMANCE SPECS. The attached plans and specifications are based on "In- Ground Absorption Component Manual For Private Onsite Wastewater Treatment Systems." (Version 2.0) SBD- 1075- P(NO1 /01. I � o � y N A y �, D w THIS POINT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL co� �O FILTER MODEL # • < �� °O og. O� • -kN 0 � �� . � I I I I , l ` Vi '• o III � I � � �� - ll � i ll � ► � I y I 3 o 11 `� Z R1 l l I ° ►, t �I � � 1 c �XN l l ' 1 � � I I jl ii .o Z c CIA � o . 4 p Z'' �' • �� — W r I I yam` � c m y 1 �j oOro T 6AP tp v.v r c ,,vs r/o v / 1 0 � ff l - - - - - tj -�-2- 1 yam. x �► 7"iP�.t) C� 2 C/;'o J c TioA-) 5Q, F7 Tv T j L /p -fit. s L-7 r ia,v w I ff . 13 s ysTZEM THIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)C A PROPER ZABEL FILTER MODEL # 1 4. p i 1' o �t AP ,eon e4 O C-e 011 G o �J 11 0 P- � U 1 1 2, RIA1. g?. 0 G' o 575 SL- c ion 0 � T � OL 3 1, / s Q, FT Tv T i L f u4, s i 0 7' %ld .v a v iNSP�c T /ov �/ iff QED n i Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings In accordance with Comm 85, Wit. Adm. Code county St, Croix Attach complete site plan on paper not less than 81/2 x 11 Inch in size. Plan must Include, but not iirrilted to: vertical and horizontal reference point (BM), direction and Parcel I.D. p 3 0 • 2 0i x' • Z b percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please Print all information. Da l Personal information you provide maybe used for secondary purposes (Privacy Law, s. 13.04 (1) (m)). ' / f/ Property Owner Property Location Deanna & Gary Humphrey Govt. Lot SW 1/4 SE 114 S 34 T 30 N R 19 E (or) Property OwnVo Mailing Address Lot # Block # Subd, Name or CSM# 661 Walsh Road 2 Deerfield City State Zip Code Phone Number ©village own Nearest Road Hudson WI 1 54016 ( 7j 5 -549 -5418 Walsh RD New Construction Use(n Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD E] Replacement Public or commercial - Describe: Parent material T xii'Sover gl acial till Flood Plain elevation if applicable hi a ft. General comments This system is being installed for the purpose of replacing a system that is currently ponded. As the home owners and recommendations: are selling the house, one of the conditions of the sale is that the system be replaced. This system is not backing Into the residence or seeping to the grounds surface, At the time of this tort I verism the soils in thta alg system am am suitable for a blow grade system and iiesigrr. FT] Boring # E] Boring El Pit Ground surface elev. 94.53 ft. Depth to limiting factor >98 in. SoH Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 10yr2 /2 1 2msbk mfr cw 2f .5 .8 2 12 -29 1 4/4 sil 2msbk mfr cw if .5 .8 3 29-46 7.5yr4/4 sl 2msbk mfr cw - .5 .9 4 46 -6 7.5vr5/6 is 2 cw - 7 1.2 5 j 1 7.5yr4/4 - sl 0m mvfi - - 3 .5 2 Boring # Boring 94.75 98 0 pit Ground surface elev. ft. Depth to limiting factor In. Sop Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munseii Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0 -12 10yr3/3 1 2msbk mfr cw 2f .5 1 8 2 12-40 7.5w4/4 - sil 2msbk mfr cw if .5 .8 3 40-98 7.5yr4/4 sl qm mvfr - - .3 .5 " Effluent #1 = BOD > 30 1220 mg/. and TSS >30 1 150 mg/L " Effluent #2 a 8 < 30 mg/L and TSS 5 30 mglL C~gj,me (Please print) Signature o CST Number I ha M) w S e d n -& 227387 Address Date Evaluation Conducted Telephone Number 0 � S � r, ��, e � r-,a r.j t 43 5/22/02 246 -2454 �30•�o�8'z Property owner Humphrey Parcel ID # age Of 3 Boring 3 � # El Pit Ground surface elev. _ 91.35 ft. Depth to limiting factor 98 in. Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDRF In. Munsell Qu, Sz. Cont. Color Or. Sz. Sh. 'Eff#1 "Eff#2 1 0 -12 10yr3/3 - 1 2msbk mfr cw 2f ..5 .8 2 12 -29 7.5w4/4 sit 2msbk mfr cw if .5 .8 3 2 -50 7.5yr4/4 - sl 2msbk mfr cw - 5 .9 4 54- 7.5yr4/4 - is 2msbk mvfr cw - .7 1.2 5 58 -60 7.5yr4/4 - sl Om mvfi cw - 3 .5 6 60-98 7.5yr5/6 - Is 2msbk mvfr - - .7 1.2 r47-- ��',6 y Z /I -7 10 . 2 y F-1 Boring # On g Pit Ground surface elev. ft. Depth to limiting factor in. Sod cation Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPDAY In. Munsell Qu. Sz. Cont. Colo Or. Sz. Sh. 'EfI#1 'Eff#2 I10 S , ❑ Ong # Boring H pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Ram Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P In. Munsell Qu. Sz. Cont. Collor Or. Sz. Sh. 'Eff#1 'Etf#2 ' Effluent #1 = SOD, > 30 < 220 mg/L and TSS >30 150 mg/L ` Effluent #2 = SOD, < 30 mgA. and TSS < 30 mg1L 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. SBD43M4* QL07 /00) �N cx n Y1 C0. Q f (3M 1�s� �� 5►c�►t�� C4Rr1e2 OP w , Lei �4�53 q � g� y � R� a3 g 5 ____ - -- 1 ank OIJ Pp (^ 0, c- ► a 5 y Q he�s� 4 io-ri koLJ, Ie4- a�nc� h ow, w c- N� ,�3 v y�Rs : M�ic'� S'1' CRUIX COUNTY � SEPTIC 'TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer Mailing Address & (Y Ze-M 45 !mot A� Property Address — (Verification required from Planning Department for new construction) City /State 030 . 2 0 . 89• LO • t?Da... Y Parcel Identification Number LEGAL DESCRIPTION Property Location 50 '/, 15j, '/, Sec.' 1 T 30 N - I / , R W, Town of Subdivision :DE rl , Lot # Z Certified Survey Map # , Volume , Page # Warranty Deed # 3 _70 Volume 1 Y 70 Page # 3 Spec house E) es no P Y � Lot lines identifiable 0 yes O no SYSTE MAINTENANCE 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. The property owner agrees to submit to St. Croix 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 wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 1 /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 of the thtee ear expiration date. S AT E AP LIC NI' DATE OWNER' CERTIFICATION I (we) certify that all statements on this fo are true to the best of my (our) knowledge. I (we) Am (are) the owner(s) of the property de cr bed above, b vir a wa my deed recorded in Register of Deeds Office. / Y O ' � I AT E P LIC T 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 IPOWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa / of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner 7TV Septic Tank Capacity ZI ZOD al ❑ NA Permit # �- Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ,s�'Z_ ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model �()� ❑ NA Number of Public Facility Units i' ❑ NA Pump T pacity 1/& j;45.1tJ a l ❑ NA Estimated flow (average) al /day Pump Tan Manufacturer r A Design flow (peak), (Estimated x 1.5) um al /da Pump Manufac Soil Application Rate ,L.fNv77rAI , 3 gal /day /ftz Pump o el Standard Influent /Effluent Quality Monthly average' Pretreatment Unit lal A Fats, Oil & Grease (FOG) :530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Disper I Cells) 79oEJ:_VCi44e-_T ❑ NA Biochemical Oxygen Demand (BOD :530 mg /L � Grc und (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) Inspect condition of tank(s) At least once every: 3 (Maximum 3 yea;) ❑ NA earls) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y o c volume ❑ NA ❑ rponth(s) Maximum 3 ears) ❑ NA Inspect dispersal cell(s) At least once every: , iY y ears) (Maximum Clean effluent filter At least once every: ❑ ear(s) ❑ NA ❑ month(s) UHIA Inspect pump, pump controls & alarm At least once every: ❑ year(s) Flush laterals and pressure test At least once every: ❑ ye ar) )(s) 044-4 S ❑ month(s) Other: /� ,� l � �� r1,�G At least once every: ��arls) �- ❑ NA Other: / r(d COY /� -� ❑ NA 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 Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections 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 back up or ponding of effluent on the ground surface. *The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation i es and to ch-de fnr anv o 9 o e uent on the around sur fara 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 one -third (Y 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 chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. L Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) 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(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cellls) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. 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; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; 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 chapter Comm 83.33, Wisconsin Administrative Code: • 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. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replaceme system: "A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should Ibe protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement 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. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > 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. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name 6 ker Name Phone s 3�(0 S Ph one SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. p ` voi. 1470FAGE386 613769 STATE BAR OF WISCONSIN FORM 2 -1998 KATHLEEN H. WALSH Docummi Number WARRANTY DFFT) REGISTER OF DEEDS ST. CROIX CO., W1 This Decd, made between John J. Mondloeh and Theresa A RECEIVED FOR RECORD Pease, husband and wife, Grantor, conveys and 11-12 -1999 1:50 PM warrants to Gary L, llumphrey and Deanna L Httmnhrev husband and WARRANTY DEED wife. EXEMPT N CERT COPY FEE; COPY FEE: TRANSFER FEE; 609.00 RECORDING FEE: 10.00 Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property "): Recordin Area Name and P.M. Edina Realty Title 400 South 2nd Street Suite #115 Hudson, Wl 54016 030 - 208&20 -000 Parcel Identification Number (PIN) This is _ homestead property. C L,t, Plat of D e,field in the Town of St. Joseph, St. Croix County, Wisconsin. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this ( cf'- day of November, 1999. I h n * * Theresa A. Pease AUTHENTICATION Signature(s) John J. Mondloch and Theresa A. Pease husband and wife, ACKNOWLEDGMENT authenticated this day of November, 1999. STATE OF WISCONSIN ) )SS. County ) A Kristina Ogland Personally came before me this _ day of TITLE: MEMBER STATE BAR OF WISCONSIN 1999, the above named (If not, authorized by § 706.06, Wis. StatsJ to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson, WI 54016 Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not ) necessary.) 'Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FOAM No. t • IM INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 80065r12021 LOT 3 - LOT 12 —+ m 1 = 130,679 So. Fl 130. S7t) SO. FT. N M � I 3.00 ACRES 3.00 ACRES _ I 33' 33' � I I I g "WI/ -- 411.42 — SWI/ 398.34' -- N89 °27'37 "W WALSH _ — N89 °27'37" W 1287.34' — 464.34' -_ 398.34' -- 66.00 N8 t I z W W W p LOT 2 W o2 U. w N LOT 3 u — — -- — 131,207 SO. FT. ; ~ �oI M O 3. 01 ACRES W acv O QO N lV > N 0 CERTIFIED ` 33.01'- 1 -33 .00' S89.27'37"E 398 . St' S8S' 2T' 37" E N9.9C 888 33" W 431-52 \ �r NOTE LOT 1 AND OUTLOT 1 AF UNDER THE SAME OWNEP w +t r LOT SMALL TRACT N la♦ , st2 -so. FT G M 3.32 ACRES a Z e 449.90 N89 3T" � I SI /4 c 01lNER o1= WCTION 34 LOT I CERTIFIED SURVEY MAP IN V01 - -- -- — - - - - - I — — — -- — E •. Safety and Buildings Division County NI fi 201 W. Washington Ave., P.O. Box 7162 5� seons►n Madison, WI '53707 - 7162 Site Address 4/h / A �D Department of Commerce 7 — 3 t —o7__ j5J� (ee % Sanitary Permit Application Sanitary Permit Number y 5 13 y� In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Check if Revision may be used for secondary purposes Privac Law. 05.04(1)(m I. Application Information - Please Print Al�formatiot S -a:lae I. umber N i Property Owner's Name - °° -- Parcel Number � MA R K AX t- /1/0 A-' 7 -&O c, �l� Q h ,•. 0 30. 2 2, • �D Property Owner's Mailing Address Property Location cod l whiff - RP - 1 � I .sw %s8 til.S311 Tao N R I f � City. State Zip Code Phone 1lpfnpCr , ,; Lot Number Z Block Number yD��v Subdivision Name @51W No ber syy .�y� Z PIaex, ez� II. Type of Building (check all that apply) , / �(-5:? � ^� [)City Y1 or 2 Family Dwelling - Number of Bedrooms �+ OVillage ❑ Public /Commercial - Describe Use _"10 A-A S 0 1 1, 7& 7—&V &ownship 5 T • ❑ State Owned f / � d e , / D %��i �.e1T Nearest Road �ieD.w �� N,4 I N it J/'T Ill. Type of Permit: (Check only one box online A (numbering scheme for internal use). Complete line B if applicable) A. 1 11 New 2 Replacement System 3 ❑ Replacement of 6 (111 Addition to r�� use S stem Tank Only Existin System 13. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme Is for Internal use) 3 io r Qom/ 44 Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tahk 48 ❑ Single Pass 51 ❑ Drip Line �S /�` e 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other 3 1 • f �� V. Dispersal/Treat ent Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.FI.) (Min./Inch) 5 &E- Elevation 01 fT 13 3 � • 7 ✓ �- ,Dior �r .4 VI. Tank Into Capacity in Total Number Manufacturer Prefab Site Steel Fiber PlaStic Gallons Gallons of Tanks Concrete Constructed Glass t New Existing Tanks Tanks / A." Septic or holding Tank Y AQV IAbd I Sig S Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume regmnsibdity for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature - MP/MPRS Number Business Phone Number. 'R •.2 L G F- f C ( 2- 2 4 3 5 7/S • 38� • S Plumber's Address (Street, City. State, Zip Code) Ce S S O .vet �D • ll� s' o .� 41/. ye i . County /De artment Use Onl Approved ❑Disapproved ' Sanitary Permit Fee (includes Groundwater Date Issued Issui at Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse S . -7 1 ' Determination V Conditions of Approval/Reasons for Disapproval p _ 3T rv� /0 �?a r� 0. gpd /� Cf�� D SyS► /�� ttP� O Attach empyte plans (to the Co only) for a g0em on paper than $112 x 11 hwhes e SBD -6308 (R 05101) ORI GIN A L 1 _ vc � Ott � v c C 1 11 T wZ= E Z l q r D 171 mw o . W� N 1 13 AK. Tbl' R o � � 1 I • t � • 1 I I -� C � � � w l i I I� I I N �► nl u� 'yl 115 I I kA I II OC 4 Z I t I Ij w a 3 y N w ) `` V) y co RI "\ e, l> ► w Z �cl a oG 3 3 _4 O �0 O ao � o 'h b w iP�ui o vS oG V, ' ,PezAi A o /Peq : �gk &Ap � y iMsconsin Department of Commerce SOIL EVALUATION REPORT ? iivislon of Safety and Buildings Page of `� In accordance with Comm 85, Wis. Adm. Code 3' -z_ js � Attach cornplele life plan on paper not less than 8 1/ x 11 I� County include, but not limited lo: vertical and horizontal Defer nce poiiri and percent s t slope, se or dimensions, north snow, and calion and distance to nearest oad. Parcel I.D. 03d . 20 88 . 2Q • COQ Please print all 1" 0 atloM y 2�pZ jf3e by Date Personal Inlormatiar You provide maybe used for secorrdar purposes Privacy Lew, s. 15.04 (f) Property Owner 1 G 3 �?ARk / nEr,/ �c ZONING OF f Ir "edY cation !,/ l � /J 't'!,� �t/1� 7 G/111�N Govl. Lvl SW 114 1/4 S' T30 N R /� 4_r ( W Properly Owner's Mailing Address ✓ Lot # Block # Subd. Name or CSM# Clly Stale Zip Code Phone Number ,yv�so•v lei sy o,� (��s,syy. sy7z ° sT. S Fj New Construction Use' 1yl Residential / Number of bedrooms J� Code derived design flow rate GPD Replacement ❑ Public or commercial - Describe: Parent material �jf S S (y s�q 1 f�,/ Flood Plain elevation if applicable General comments �J n and recommendations: dU f "�� ti 1'/PE/f- ! nn J / 1 3 Z - 13 © Boring # [] Boring K PII Ground surface elev. it. Depth to Nmiling factor in. Soil Application Rate ant Color Redox Desc Horizon beplh Dominription Texture Structure Consistence Boundary Roots GPD /fl in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EI( #1 Eft#2 2 I/• ! �a 3I 5/4- /�s h " fi,' cs z • z . 3 3 z �. S 2 S/L 2 c5; / • 5 - 1 I S he A, of V c — S S. 7 io Z-5 Imo► 2. Boring # L1 goring '7 Pit Ground surface elev. fl. % Depth to Ilmiling factor LO in. licallon Horizon Depth Dominant Color Redox Description Texture Structure Consislence Boundary Roots Soft A GPM(' Role In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Elf #1 'Ett#2 / °• / �� /�° y/3 /l M,4ra,¢ S� G f / e 4 f,e w Z Z • 3 3 z •� •sYR ` s ip zfsh _ - _ � �i' 4s - S • � S �z. Effluent #t = ROD > 30 < 22 g/L and TSS >30 < 150 mg/L • Effluent 02 = BOb < 30 mg/L and TSS 30 mgn- CS1 Name (Please Print) Signature TZ &P 7 7! /t.' < � 2 21x 3 7 S Address Dale Evaluation Conducted Telephone Number Ulbricht Associate s • �Z 7�5 • ��p ' �/� S Private Sewage Consuitants 1355 O'Neil Rd. Hudson, Wis. 54016 a , 4 4- or ORI GINAL Lo 7" P Owner 0 30 • Z DgU 0 • V � y parcel lb p _ Page of Boring 0 U Boring Pit Ground surface elev. / / fl. Depth to limiting factor �� /d in. Soil Application Rate I lorizon Depth Dominanl Color Redox bescriplion Texture Structure Consistence Boundary Roots GPD /fl' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. '{ ff #1 TIM • 2v /D M C5- z . Z A /D .51 2 .w, ,6k f i" C . S - 7. 5 _--- -- 5L / /Vj,, f C 1v - • G o • io S D A r-� IUD Boring i/ tlJtt Boring ; t _I pit Ground surface elev. ft depth to limiting factor In. Soil A II ca fi on Rate Horizon Depth bominanl Color Redox bescriplion Texture Slroclure Consistence Boundary Roofs GPO /fl In. Munsell Ou. Sz. Cont. Color Gr. Si. Sh. 'E8 #1 Etf#2 i r k k Boring # Boring pit Ground surface elev. fl. Depth to limiting factor In. plIcMallow Horizon Depth Dominant Color Redox Description Texture Slruclure Consistence Boundary Roots Solt ApGPD /It' Rafe In. sell Qu. Sz. Conf. Color Gr. Sz. Sh. •Eft #1 'EIV2 Effluent #1 = BOb > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent 02 - BOD < 30 mg/L and TSS < 30 mg/L The Department of Connnierce is an e qu a l n r q pporivnity service provider end employer. If you need assistance to access services or need material in an alternate format, please contact the department at 609-266-3151 or 1TY 608 -264 -8777. SAb.Rt70 (R 6llN/r r k k n . I r i � D \, 1► n z o G o �t�A k' 0 kA `C( o 1 �� ► I I I i t � `n 4 I I � I � I • ► ! I II I lJ� W c 3 d Vo 0 % r SF. CROIX COUNTY N r 5 u WISCON NNNNrr _� T �� IN ....� ONING OFFICE "rNcp C, 1 COUNTY GOVERNMENT CENTER 1101 Carmichael Road - ? / Hudson, WI 54016 -7710 SEPTIC (715) 386 -4680 'r TIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit application. Outside water appropriate fee winter months, making lines are often turned off durin arrangements with this office to ins rem th ecessar e Y- Please make at entry can be gained. ew, ater (VOC's) te r (Nitrate & $ Bacteria) Septic $50.00Q� b Water (Lead Concentration) -45'00 °' p Nitrate & Bacteria 2100 retest (--Owner: CS6� — $15.00 Address: SCE INl `ck< Requested by: R te- Address : pp ZIP Telephone NQ. - �tQ -� (�s7 a ti ! - F{o cs � t- �, ,- Telephone ZIP Sha � N ( 3 ' ) _3 Property address ' � Location:__ # (Fire NQ Street) : k, S.C. 3Y , Gc7 .w Realty firm: T �' N, R _Lq_ w, Town of _ Lock Box C om b o: �1 L o4- a r �(C a Closing Date: 2088 TO BE COMPLETED BY PROPERTY OWN V / �yZi *PROVIDE A SKETCH OF HOUSE &SEPTIC ER SYSTEM ON REVERSE OF THIS FORM* Water sample to location; Is the dwelling If vacant, currently occupied? date last occupied: � es 0 No `Macc_G Vr Age of septic system: uv��r -�� 5c � s�- Septic tank last �� tnc -c Previous Own • s p Nam C vy C cr t Have any ❑ � the following N Slow been observed? DY drainage from house. S e g ewa oY Back -up into dwelling. oY /Sewage discharge to ground surface of QN Foul odors. road ditch. Other comments relative to system operation: I certify that the best of above information my knowledge, is complete and true to the OWNERS SIGNATURE; 1 /94 ATE: I_ ,L-�T OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATI T Q QCD aoca TO BE COMPLETED BY INSPECTION AGENCY System des & /or permit.on file? OYes ONo Soil series per SCS Soil Surveys sheet # Type of soil absorption system ❑Below grd []At -Grd Mound Approx. size 'X ❑Gravity DDose OPressurized Ft. OBed- OTrench ❑Dry Well _ OHolding -Tank OOutfall pipe. OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank , Setbacks: OHouse ❑Well ❑Prop. line ❑Other Dose tank Setbacks: OHouse ❑Well ❑Prop. line 00ther OLocking cover ' :' �OWarning label ❑Pump /Floats OAlarm _OElec. wiring Soil Absorption System Setbacks: OHouse OWell ❑Prop. line OOther DPonding ODischarge: General comments INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title ST. CROIX COUNTY �-> WISCONSIN ZONING OFFICE " " "■ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386 -4680 September 23, 1998 Bruce and Susan Mickelson 661 Walsh Road Hudson, WI 54016 RE: Septic Inspection located at 661 Walsh Road, Town of St. Joseph, St. Croix County, y � Dear Mr. and Mrs. Mickelson: On September 23,1998, an inspection of the septic system on your property located in the SW' /a of the SEY4 in Section 34, T30N -R19W, Lot 2 of Deerfield, Town of St. Joseph, St. Croix Coun Wisconsin, was conducted. A water sample was also collected on this date, and the results will b sent to you when they are received in our office. At the time of the inspection, the sanitary system appeared to be functionin pro rl The inspection of this sewage disposal system was based on a surface inspection of said syst and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in this system not discovered by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions regarding this, please contact our office at (715) 386 - 4680. Sincerely, Mary J. Jenkins Assistant Zoning Administrator Enclosures cc: Kim Kolashinski - Edina Realty ST. CROIX COUNTY WISCONSIN ZONING OFFICE r r r r r r r r i ST. CROIX COUNTY GOVERNMENT CENTER "' "� 1101 Carmichael Road Hudson, WI 54016 -7710 "" --- (715) 386 -4680 September 23, 1998 Bruce and Susan Mickelson 661 Walsh Road Hudson, WI 54016 RE: Septic Inspection located at 661 Walsh Road, Town of St. Joseph, St. Croix County, Wisconsin Dear Mr. and Mrs. Mickelson: On September 23,1998, an inspection of the septic system on your property located in the SWA of the SE% in Section 34, T30N -R19W, Lot 2 of Deerfield, Town of St. Joseph, St. Croix County, Wisconsin, was conducted. A water sample was also collected on this date, and the results will be sent to you when they are received in our office. At the time of the inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based on a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in this system not discovered by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions regarding this, please contact our office at (715) 3864680. Sincerely, oLt Mary J. Jenkins Assistant Zoning Administrator Enclosures cc: Kim Kolashinski - Edina Realty I COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 800- 962 -5227 FAX - 715- 962 -4030 ST, CROIX COUNTY ZONING OFFICE REPORT NO.. 73462/01 PAGE 1. ST.C.ROIX CTY GOV.CTR REPORT DATE. 9/28/98 1101 CARMICHAEL ROAD DATE RECEIVED: 9/4/96 HUDSON, WI 54016 ATTN. JIM THOMPSON OWNER: Bruce & Susan MickeLson LOCATION: 661 WaLsh Rd., Hudson COLLECTOR: M# Jenkins DATE COLLECTED. 9 -23-96 TIME COLLECTED. 11.00am SOURCE OF SAMPIE. Outside faucet DATE ANALYZED4*9 -24 -98 TIME ANALYZED. 2 4 400pm COLIFORM,MFCC. 0 /100 mL INTERPRETATION. BacteriologicaLLy SAFE NITRATE -N. ( 041 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria /100 ml Nitrate- Nitrogen, mg /L LAB TECHNICIAN: Pam Gane WI Approved Lab No. 19 ( Means "LESS THAN" Detectable Level Approved by. I ST. CROIX COUNTY WISCONSIN ZONING OFFICE N, N ; Nampo ST. CROIX COUNTY GOVERNMENT CENTER NN.N6 1101 Carmichael Road Hudson, WI 54016 -7710 ' -�-- (715) 386 -4680 September 29, 1998 Bruce and Susan Mickelson 2600 Starflower Lane Wausau, WI 54401 RE: Water Test Results for Bruce and Susan Mickelson located at 661 Walsh Road, Town of St. Joseph, St. Croix County, Wisconsin Dear Mr. and Mrs. Mickelson: Enclosed are the original water test results from Commercial Testing Laboratory for a water sample that was taken at the above referenced property. If you have any questions regarding this, please call our office at (715) 386 -4680. Sincerely, May J. Assistant Zoning Administrator Enclosure cc: Kim Kolashinski - Edina Realty STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 4py-G -e- ( IGl�cca�_Sy✓f� ADDRESS SUBDIVISION / / CSM# �OL°�Y �/LGt_ LOT SECTION 37 T3_N -R W, Town o f ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I INDICATE NORTH ARROW Provide setback and elevation information on reverse of this f orm. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons /cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS ' w Building Sewer ST Inlet. ST outlet g PC inlet PC bottom Pump Off Header /Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt �s bui Tfi 5 VA to o- 0 �. x Wisconsin Department of Industry PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and�63uildings Division f (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION Permit Hold is Nam ❑ City E] Village Town of: State Plan D No.: MICHAR OI� , BRUCE A. CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: AQAnn] 14 TANK INFORMATION ELEVATION DATA 7 S,'50 j? TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septi Benchmark K �?O 4 Dosing �L , A4 • /d �Aeration Bldg. Sewer /da, Holdin St/ Inlet 0 /,53 r TANK SETBACK INFORMATION St /0 Outlet TANKTO P/L WELL BLDG. Air to I ntake ROAD Dt Inlet ir Septic }So / >c�S' /� ,� NA Dt Bottom Dosing NA Header Aeration Dist. Pipe Holding ot. System p�/ r g 7, PUMP/ SIPHON INFORMATION Final Grade o� S,7, Manufacturer Demand ,1, ,2, 7" G /d ' 2- Model Number - PM TDH Lift Fricti Sys DH Ft H Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM (I BED/TRENCH Width Length / No. Of Trenches IT No. Of Pits Inside Dia. Li uid Depth DIMENSIONS DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING- acturer: SETBACK AMBER INFORMATION Type Of Y I Model Number: System: f�e-o, � d �SC1 OR UNIT DISTRIBUTION SYSTEM Header /AAer!i 0 Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake � Length Dia - Length Dia. Spacing Mound SOIL COVER x Pressure Systems Only xx M ou Or At -Grade S y ste Depth Over Depth Over xx Depth Of x Seeded / Sodded xx Mulche ii �/y 1 / 1 Bed /UQ&,64Center 3 "a Bed /Tzowc! }Edges 3a— d Topsoil E] Yes [] No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.)4S LO St., / Joseph.34.30.19W, SW, SE, Lot 2,, als RRoac�., C,:.�n�hi'? � , �_ CI mot,, -a �/�S Z � k!' Q'Q�- -sue ✓. ��((!! 19 � '-.-ate c` �--� (� c— L/Q-e' ..�; "' �. Plan revision required? p^ '0 No Q _ Use other side for addition in ormation. /I �� Q L // SBD -6710 (R 05/91) Date Inspector's Signature Cert. No. DI L HR S ANITARY PERMIT APPLICATION D M v In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. R check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 'o•.r- .t A 0_4� LTG Y. e — e /a, S T,9d, N, R E r ov PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # O dR !ti~/i/t �Lt 8^e ry x/ CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING (Check one CITY : NEAREST ROAD ) ❑ Sta Owned O VILLAGE ; s T.7s QXg ❑ Public ®1 or 2 Fam. Dwelling -# of bedrooms PARCEL I AX NUM 111. BUILDING USE: (If building type is public, check all that apply) as 6 —24 yr — a O 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. K New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit ## — Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) A ELEVATION �Sd ' 11 1 )6 4 1d6of •y.3 p_ % / Feet l4wrCd Feet VII. TANK CAPACITY Site INFORMATION in s ons Total # of Prefab. Fiber- Exper. New istin Gallons Tanks Manufacturer's Name Concret Con- Steel glace Plastic App Tanks Tanks structed Septic Tank or Holding Tank Lift Pump Tank/Siphon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system show on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) P PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): Q ?A c zlew IX. C UNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Pe ee (Includes Groundwater Date Issue Issuing Ag nt Sign re (No S)srn ps) Surcharge Fee) Approved ❑Owner Given Initial Adverse Determination + X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A 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. 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. Onsite sewage systems must be properly maintained. The septic tanks must be pumped b 9 Y P P Y P O P P Y a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 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 and parcel tax number(s) of where the system is to be installed. t . II. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vlll. 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. IX. County /Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 832 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; pump or siphon tanks; 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; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD -6398 (8.11/88) °--� SANITARY PERMIT APPLICATION 01 COUNTY , In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than i � El Check 8% x 11 inches in size. U Check if revision to previous application —See reverse side for Instructions for co mpleting this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION "` - ' /ate t /4, S ' - 15c , N, R j E (orrw PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE' ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER CITY NEAREST ROAD II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE X WN :S7`'7df -# vl ❑ Public ❑ 1 or 2 Fam. Dwelling of bedrooms .Y— P u ( 111. BUILDING USE: (If building type is public, check all that apply) t.y j _. p 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdbor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ RestaurantlBar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. El Reconnection of 5. El Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit ## — Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -in -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ASSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED ( sq. ft.) (Gals /day /sq. ft.) (Min. /inch) 9 � ELEVATION l o w Feet �'^' r Ll� Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION in Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Est structed Tanks I Tanks Septic Tank or Holding Tank 11 Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) 'MP PRSW No.: Business Phone Nu ..`� � !� � �_ ;,� �✓ 3L - 3/../( Plumber's Address (Street, City, State, Zip Code): IX. COUNTY /DEPARTMENT USE ONLY r ^' I L Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agont Sign ure (No mps) . Approved [:3 Owner Given Initial �.� R� Surcharge Fee) / Adverse D r in tion X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS '. 1. A sanitary permit is valid for two, (Z) years... 2 sanitacl(.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. 4. Changes in ownership or plumber requires a. Sanitary Permit Transfer /Renewal Form (SBD 6399) to be. submitted to the count prior to installation. YP S 5. Onsite sewage systems must be properly maintained septic tank(s) must be pumped by a licensed,, pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your ons4p sewage systerrl,, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 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 and parcel tax number(* of where the system is to be installed. J r II. Type of building being served. Cheek only one and complete ## of bedrooms if 1 or 2 Family Dwelling, .. III. Building use. If building type is Public, check all appropriate boxes that apply. IV.: Type of permit. Check only one in line A.,Complete line B jf permit is for tank replacement, reconnection, or repair. V. Type of system. Check• appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate. prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VNI. Responsibility statement. installing plumbeils to fill in* license numberwith appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. 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 of 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-,pump or siphon tanks; distrtbutionboxes; soil absorption systems; replacement-s f ystem 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; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect, groundwater. The monies col lected ,through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. • SBD -6398 (R.11/88) D�LHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code CO . Q. -o E STATE SANITARY PE MIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ e09' ©f 8% X 11 inches In size. Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION G, r .S"!� %aS/C %a, S T.? 4, N, R ZIE E (or)dc PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) El State Owned ❑ VIL : NEAREST ROAD ❑ Public X1 1 or 2 Fam. Dwelling -# of bedrooms 3 A x PH u BE III. BUILDING USE: (If building type is public, check all that apply) 03 0 .70 ff (J 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # — Da te Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 14. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) ELEVATION l / 7 , 1 510 I Z2 5 115 � � Feet 1 ,0L4,, Feet VII. TANK CAPACITY Site INFORMATION in oallons Total # of Manufacturer's Name Con- Steel Prefab. Fiber- Exper. New xistin Gallons Tanks C oncrete glace Plastic App Tanks Tanks structed Septic Tank or Holdina Tank a s, -ex",!/ Ej F] F1 I R T L Lift Pump Tank/Siphon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) / PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): IX. C NTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date ssue Issuing gent S' lure ( St PS) Approved ❑ Surcharge Fee) Owner Given Initial // s A dverse Determination X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A 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. 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. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a Licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 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 and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vlll. 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. IX. County/Department Use Only. X. County/Department Use Only. 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; pump or siphon tanks; 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; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD -6398 (R.11/88) �5 a A V�e e FROM EDINA REALTY HUDSON WISCONSIN OFFICE 05.17,1994 10:30 N0,11 P. 2 • PLAT OF ' U tkK r 1 tLU LOCATED IN ThIE NWI /4 OF TILE SEI /4 AND IN PART OF TIIE' Swl /4 OF TIIE SCl/4 , ALL IN SECTION ER FIED S R Vi ,,• ' or TOWN OF ST. JOSEPII, ST, CROIX COUNTY, WISCONSIN; INCtvDING PART OF LOTS 2, 3 AND 4 DD CUMENT�NUMBER MAP RECORDE IN VOLUME T PAGE 1009 AT THE ST. CROIX COUNTY REGISTER OF OEL "OS OFFICE'. E CARVE OATH . • N 1 WN IW ' Ird U!, WIN I.WM IL IM 9t r«ly v� uss a to anln' N i l ,�.�.1 A. I 1„ Maw wNYn 11'w1aW N,.w NI.In' NI'11•M1 NI11•In ' � 1.. IM'w M•NYr' {II•N.II.W Now W,w MNI'IW ' .wINIM • � � .11 III.w lrww N{YI•NY i N.I' KIM .it • 1 MI.w 1 1WNII I{YI'IIY Ir.M' IN.w w.l • / • { 'i ' • � 1 r..w IW1r NI•N•II.W •. II.Nr II..M .1 !� • i ' i • • .' ,1.1 : N•.w ' wN'w 1N'N'1aW MI.Nr N..Iw• NYII•IM {Nhhllr • :11 1.1 W.w IYNYr YI•h•N. IN. Iw.n1.Y I/11•w. � � , .. .W tirl1. .Iw•.i w'« � M.N N..0 ° lA± 6110 0m)f n a 56 tj • a ::.� yar•a ...w r uu.{w•r •...r .r _ e• ! 4 I `} , M�M • • � M ' §OLD Ece .. l ' l. ln lril LC " SOLD $29 LOT 8rr. I 11 ,2i �" - -l�. LOT 6 LOT. 7 •' H 1.M M.11 • ��JJjj�1 � ' v %soLA Y I Y ' l .T� LOT 9 LOT N5 4 t • \ . i �::i./i n. / 1 \ LOT b ' : i I :.� y •• 7 _� •1��..•,1 �1i;`•• , 150LD�1 .g / / r.��JlBl:� y�_ I _w• � 'I QI f/ � �� • 11 II. .•I.w'� M.w• '0� � Y MI .. •, Yj .t 619,900 $19,900+ $22,900 +�I {{ I ! B LOT 4 LOT I1 S\ LOT 14 � I LEOCHO . mn p; _ i nC • w M•Ml MI. MNr � � 1 ; .,,.., - "1.1..1. -. - ""'' �•;�,� is ?:i l.. % $19,900' + $19,900 $22,9 LOT 3 E�. LOT 12 NO 11 N N • IA 4 •r , 1 ' 'r.:! {:: "Iw �• .u. •rn q 1 �.:: :uli'1. ; • ..r ww J .. ' -�• •GE ✓: wln ..n r N ' E ..._.........._...__..._.-� L _ ..... ».•. f�• � _ :.. _ _I t _' _' N . 3�_..• .. •— WI11E11 �.� i•u•a . --_ • • It " 1 ^•—. 4 1 NN•33 Jr'M EIS. a!' . I � `IIC� N. d q ICI 130LD { soibl ` JI • ` ' 1 � /N Lot, • ��,lOd � [ €9IlF.IE4 ] M9? !h yD4une r, ?!44. ina n,r wr a r7Y US m: K. VD21I 3� $vatL Id@SI ® « ..N ... > lo �No— NN•a7'St'M 1�1 arN .i. o wr, 1 ?I ! EE^T.IEIE4 . MY ! ItM YI YQtVMl 2. ;60E till 99S• b9• }$1911 ...• ..1..•1.1 u�l., r y.aau Nar •• . PARTMENT OF RE PORT ON SOIL BORINGS AN D SAFETY &BUILDINGS ,NDUSTRY DIVISION LABOR ANL4 PERCOLATION TESTS (115 P.O. BOX 7969 HUMJ,N RELATIONS MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: p � TOWNSHIP /�ALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: SW 1 /4 SE 14 34 /T30 N /Rl94(or) W St. Joseph 6 n/a n/a COUNTY: OWNER'S � AME: MAILING ADDR SS: c C' St. Croix Steven & Norma Henning 665 Walsh Rd., Hudson, Wi. 54016 V/Z USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE ES RIPTIO S: P R OLATION TESTS: (Residence 3 n/a fie`" R 110 -29 - 91 n/a RATING: S= Site suitable for system U= Site unsuitable for system r ONVENTIONAL: MO IN- GROUND - PRESSURE: SYSTEM- IN- FILLHOLDING T RECOMMENDED SYSTEM:(optional? ❑U 4 S ❑U Q S ❑u ❑ S �U ❑ S conventional If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate: class 2 Floodplain, indicate F l o odplain elevation: na/ decimal' PROFILE DESCRIPTIONS p age 42 OMB BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DE ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B -1 6.92 101.10 none >6.92 .42bl.1. 2.17bn.sil. 4.33bn.l.s. B - 2 7.08 101.10 none >7.08 .83bl.1. 2.50bn.sil. .75bn.s.1. 3.00bn, l.s. B 3 7.33 100.25 none >7.33 .75bl.1. 2.00bn.sil. 4.50bn.l.s. 4 7.16 99.50 none >7.16 .83bl.1. 2.83bn.sil. 3.50bn.s.1. B- B _5 6.50 99.90 none >6.50 .75bl.1. 2.00bn.sil. 1.25bn.s.l. 2,50bn.s.l. 6- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD2 P R PER INCH P- P- P- P a 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 97.10 E E E E e �70 i's- J__P� pm _ n _ �. t r - - - . E E IN E eo 3 I per '(P . 3 t ' - - E I the undersigned hereby certify that the soil tests r bPt d on this �� invade b {r� n accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and t qtpn oWe te.Rs ar t t th best of my knowledge and belief. p NAME (print): G'� v F- ,' TESTS WERE COMPLETED ON: Gary L. Steel �`� I 10 -29 -91 ADDRESS: r CERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. Ave., New Richmond, Wi 2298 715g46-6200 CST S DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R, 10/83) — OVER — � INSTRUCTIONS FOR COMPLETING FORM 115 SBD'6395 � � To bom complete and accurate soil test, Yom repwi-t must imdude� 7, Complete lugai description; 7, The use section mistclnxdy indicate xvhmho/ this isa nakhncmnrmommmmia| pn;ect 3, N1AX|k8UKD numberofbedix monroommorcia| use planned; 4. \otkis o nem u, ,opiac*mertnymem, 5, Complete the Suitability rating boxes, /\SITE 1S SUITABLE FOR AHOLD|NG TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; G, PLEASE use the ahb,oviariuns shown here profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately )ooatinV Your test \ooahon», DmwinV to scale is prefe/md. A separate sheet may be used irdad/md; 8. Make aury your bonchn'ork and vertical alevabon rufomnoe point are r|emdy shown, and ate permanent; G� Complete all appropriate boxes as todazns plain gota percolation test oxamp' don,ifappropriate; 10� if the information (such as flood plain, elevation) doao riot apply, place N.A.in tile epprupriate box; 11. Sign -thofoon and place your curmntuddiesSand your certification nunobev; 12� Make !ogih|o copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL ALJTHOR|TYVV|THiN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates anti Textures- Ot Symbols st — Sion (over 1[y') BR — Bedmr cob — Cobble (3 10^) SC — Sandstone g, — Gravel (under 3~) LS — Limestone °x — 8vnd HG'Al — High Gmumbmmter cu — Cuare3a^d Pe,c — Perco Rata tried s — Medium &nd VV — Well N — Fine Sund Bldg — Building is — Loomy3and Than °r| — Sandy Loam ( — Less Than Loam B^ — Bnn vn °ui| — Silt Loam 8| — Black Gy — Gray °d — Clay Loam Y — YeUmm a3 — Sandy Ciay Loam R — Red sic! — Si|r/ Clay Loam mol — Mottles uu — San"'VC|ay sic — SihyC|ay fff — few, fine, faint ' ~C — {]ay cc — romnmn / rx — Re, mm — Many, medium � in — %8uck d — distinct ` i / P — pnnnnero ` HVVL — Highvvaler level, Six~~Am| nni| textonm `- su,fauov*arer for|iqu�d��m dim�oo i BM — Bench Mark VRP — Vet ica| R�emnc* Point ' , " ` / ` ~ ' � TO THE OWNER: � This soil test report is the first step in securing a sanitary permit. The county or the Department may request / vohfioad"o of this uvi| test in the field prior to permit issuance. /\complete set of plans for the private sewage system and o permit application must be submitted to the appropriate local authority in order to � obtain a permit. The sanitary permit must ba obtained and posted prior tothe start ofany construction. � � I - FROM EOINA REALTY HUDSON WISCONSIN OFFICE 05,17.1994 10131 N0,11 P. 3 INUU UtIlA T or REPO ON SO BORI NGS ANN) s, ►f kT y w 11UL INUUCriY, UIVISIUr LU solt 11E PERCOLATION TESTST(115) r.a. BOX 3 HUMAN Il[LA'fIUN, ivinutsuN,wt aa'ro KIM & Chopter 1451 MCA�1 tSNi r,rlC110N" - _ - , - - r' s�ilitfiiGl I'f� fd7Cn1 : 1 tuu�FJs'iili in,�r tI�n�li'v; u o.; fC�'Jt Nil" SW V4 SI3 14 34 jT30 N/ Rl9x hi1l w St. Jo seph ��n /a'� 11 - U 1v: QVIN €r VS /kl`(51;eux A 1JAILING ADulles . St. Croix Steven & Norma llefillillp, 1 605 Walsh ltd., lludsot Wi. 54015 US _ DATES OOSMATIONS MADE Gl't> l '`: F coNlfdEfiCl)Ct Gl SC1iIpTrr3N: — pn r LE "tSI entpTIt3N .. pEpCt3L7iTIaN7 8?IT?;- k3nesiaoucts aiVow ❑noploee L 3 1 n/a 1 , 10 -29 -91 n/a ItiA TIVECNTif7SlAt— lmuuyu syslom I(J (i IYiCtt Ultt 1: YST& bi- r j UMNiGNUEU SY5 { ia lvlil nr111unail . oU , S ❑U S O U J ❑ S v J0S mll I� 4zQuyelltiol t nt i It Parcolnllon Tests ma NOT raflulrod U €sii3NTiAl E o it any portion of live tested #too is In lire' umMr s, 11.11[1 01.00ffitfbi, lodlcain: _,� -- Clf►ElA 2 J� Fl Ind Flo odpl a fn otevntlon: tin/ r f'nUr•ILE UESCIIIPTIONS pu8e IL decilnal + ! %ill ' "ui.iilirJc - 1VAI. — j _'Ii v�'' t - iniEHM Lr1AiiT�%1 €�I�c3fi Wit 11' sill %KFIEs § ci-tCFiti - 'i i=R iilii€; FNii liiF i ii NuMULft UEI.11 EL! VA't10N _ � E �c r� � 1 0 i3El)Ti 08511nVEU (SEE A0911V ON uncle T 13 -1 6.92 101.10 (Tone >6.92 .42bl.1. 2.171in.sil. 4.331n.l.s. 0 - 2 7.00 IU i.10 none >7.00 .83bl.1. 2.50bn.sil. .75bn.s.l. 3.00bn. l.s. (3 3 7.33 100.25 (Tolle >7.33 .75bl.1. 2.001)n.sil. 4.501)n.1.8. 0 4 7.16 99.50 none >7.16 .03bl.1. 2.03bn.sil. 3.50br1.s.1. h 6.50 99.90 none >6.50 .75bl.1. 2.00bn.sil. 1.25bn.s.1. 2.SUbn.o.�. [1• I'EnCULATION TESTS emu'll( — wir111N1101 - 'IES! "IIMk PiN AI" V' •NI,IIS 1 '1 t . NUNiUCII I NCITES _AF MISW E LLINt3 INTERVAL•Mlm �>: H �f )11r j (j',L_ g � PIn INCI I F' p - h• s e l;rT rcI> e r• P. PLOT PLAN: Snow locatlonr of parcolntion tests, soil borings and tho (ltmansloris of suitable soil areas. Indicate stole or distances. Describe what ore 11 :e ho :1011191 mid vartical elevation raforonM points and show their location on ilia plot plea. Show ilia surface elevation at nil borings and Ills dlreetlou and pefca or land slope. SYSTEM ELEVATION 97.10 it 'U � ,� I r I's ie P Pei 9 00 ti j r C t, the uadonlenad, hereby cordfy [lint the toil Icsb rerrorled on this ferns wall made by me in accord with tiro procedures and methods specillorl hs the wi -114101, Administrative Code, and Ihot the data recorded and Ilia location of Itio tests ore correct to I119 best of my knowledge end belief.' % T f1l11iAirnli' - T 'T Ei1 CtM�'[E79IjON: {•.� Gary L. Steel 10 -29 - 91 I l... ET'rIF1CATIUN NUfv113C►h I'IIpNE it NU mill 1554 2001h. Ave. Nei; Richmond, SJi. 54017 2'290 715 16 - 620Ut + 'i U E. _ 3? f 1 DISTf11UU T ION: Oi ilthrnl rind one copy to Local Authority, Property Ownar mid Soll 1 �t DILI 111- Snumus {n, iolo.1) _ y f : + 1 •it1 DOCUMENT NO. WARRANTY DEED THIS SPACE nEstnvED rOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 � STEVEN W. HENNING and NORMA J. HENNING, husband and . � xxIuuwuLwum nwnnw�e wn*/x�� *��"��`^��^�^~Y State of Wisconsin: Lot 2, Plat of Deerfield in the Town of St. Joseph, St, Croix County, Wisconsin. � ^ || � T0Q8IBDD WITH and SUBJECT TO reservations, restrictions, easements and rights-of-way of record, if any. � This ............ ;!A.A!lt ..... homestead property. (is) (is not) � ' Exception to worcooNen' DobJ this ..- ............... .--'---..' day vf....................... May ---.----. ,18 ---.---------'----------(8D&L) .� ��v (SEAL) ------'--'------'-'-'----- ~ W , 11 N ------------------..-----.(GEAL) ....... .......... U ---C30AL> * �6mm a --.-'----�_� .J��_//�� _.__ AUTHENTICATION Signature(s) ............................................................ STATE OF WISCON&N% ---------------'--------------------''--'' St. Croix authenticated this ----dar o�------.------, 1B--- Personally ommm before me ' t6 of .......... /k'?-z........................... 19 .'-2�' the above named * ------------.---'---------- -----.-'-'-'-------'-----'----------------' -_-'��=,=^^ ° "="^^^" and TITLE: &YEMBERSTATE BAR OF WISCONSIN ' ''----------- -------'-----'-------' ` "(If ---------'---------'-'---' -.--'-----'----'--'--'--~'--'-------''-------' mntnnr�ndbng7VG�6 ��.8tn�.) -. --' '-'--'''--------------------------------- to me known to be the peronns�........... who executed the ` foregoing instrument and acknowledge the same THIS INSTRUMENT WAS UnAprcoo, � /\��oro� Barry C Lundeen - ��' ~� ^ ntu �6*nN�utm� acknowledged. ]� ' Commission (Signatures ,�mm� � � n ��.�� y mm is permanent. (If mot, state expiration Eire not '' date: -/A/- --_.------------------,1�'��»-,� |! *Names "x Persons ,w"*m In an cap"cit xbo"u be *»~ or I.,/"^^^rI"vr ,^,/,"ig""m"~. � '- '------ � | |' WARRAIWT DIPIN) s^m STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER g �-u . -e A M MAILING ADDRESS /?_9 �wa a`k e t �� i /�tteLQ�✓ PROPERTY ADDRESS �� t /,),& 1,5 �! (location of septic system) Please obtain from the Planning Dept. t CITY /STATE ��vf �...� l� z PROPERTY LOCATION S-V 1/4, 1/4, Section, T N -R W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER 2, CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER 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 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 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 system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater 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. 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 DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year a SIGNE r <� DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, (spec house) , then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property iVr-e e Jr/I,'C�i a e � ssd Location of property EAJ 1/ , Section T _�& N - R W Township o 4%��,� Mailing address e/P Awd7 Zkna; A 62 Ark-- l AA Address of site Subdivision name 0 Cl /-,`c Lot no. _ Other homes on property? Yes No Previous owner of property .S a - 2. ,6 v AAA y Total size of property ,?..,� a c r<s Total size of parcel au,oa r Date parcel was created le Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes A__ No Volume �f and Page Number 5 as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. 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. 5/6 77a , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run 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. Signature of Applicant Co-AppliCaht 61 11 /� L1 Date of Signature Date of ignature DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA li IiSTATE BAR OF WISCONSIN FORM 2 -1982 516'772 _ STEVEN W. HENNING and NORMA J. HENNING, husband and wife, G • -- --- - - - - -- ----- _----- •------- .. .................... ... , Reled*,rRwxra rantors -� .-- ----- •• - - - - -. .................................................. ... --- - -....---- ••- •-- •--- •••- •• - -• -• MAY 1 8 1994 - -- -- - -- - - - - - -- - - - -- - ------ • - - - -- ._ -------------- - - - - -• ...... .. - -- •• -• 10:30 A. conveys and warrants to ..BRUCE A. MICHAELSON and SUSAN K. V MZCHAEhSON,- .�iusband . and - wife__as_ marital ----- p.rogP_rty.,_..Orantees .................................... ►e>t - - - -- ------------------------- - ---- - - - - -- --------------------- •--------- - - - - -- -- - - - - -- ------------------ - - - - -- ------- ----- - - - - -- - — ..------------------------------------ . ............ ......................... ................................. _.. RETURN TO .......................__._..________-.--__--_-._---____-.___-_.-_.___...-__...-._ __.._._____.......__....._..._. .....................__._..____-_________....___.____._____.____ ___..__- __- __........... ._ -___. �. the following described real estate in ......... ......fit -,.- Croix............... County, -- - - - -- �i State of Wisconsin: Tax Parcel No: ........... ................... I' Ij ii it li I Lot 2, Plat of Deerfield in the Town of St. Joseph, St. Croix County, Wisconsin. I� li I , i I! TOGETHER WITH and SUBJECT TO reservations, restrictions, easements and rights —of —way of record, if any. i 1 This __._._ -_._ is -------- homestead property. (is) (is not) Exception to warranties: I Dated this / •-- -- - - - --- day of .._.. May - -- -•---- ----- -- - --- --- 19- _ 94._. -- ---- --- ••--- . - - -- -. (SEAL) Y ... -- .... - -- -• •- - - - - -• -- ....(SEAL) -------------•--- - ----------------------------------------- - - - - -- * ._.._�TEY_EN__W. -•)I NN --------- - - - - -- --- _-- •-- -• - - - - -- ---------------------------- (SEAL) -- ___v.k ....... (SEAL) * * NORMA J. NNING AUTHENTICATION ACKNO MENT Signature(s) STATE OF WISCON� --------------------------------•-•---------•------------------ •---------- - - - - -- St, Croix t .................. -County. authenticated this -------- day of- _____---- --- ------ ---- - -- 19...... Personally came before me this •_ -------------- day of ---------- MaY-........................... 19- --94• the above named ...... .... ...... * - - - - -• ••• _ Hennin -- and --------- ------ • • •- -• - ••. TITLE: MEMBER STATE BAR OF WISCONSIN Norma J. Henning --------------------------------- -- - - -- --- - - - - -- "(If not, .................................... authorized by § 706.06, Wis. Stats.) to me known to be the persons ........... who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Barry C. Lundeen .------------------------ - - - - -- -- - - - - -- MUDGE, PORTER & LUNDl;);I�� * . -• - -- - - -- - -, i ... ........... ...... .......... .. ......................... treetHudson WI 54016 Notary Public .._._. x St. Croi ._. County, Wis. (Signatures may be authenticated or acknowledged. Both My Commissio is permanent. (If not, state expiration II are not necessary.) date: -__ 9s' I *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc.