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AS MR1,T SANITARY SYSTEM REPORT
OWN FR
TOWNSHIP
Al)Dlll:`;S
ST. C.ROI X COUNTY, W t SCONS IN .
r
S I 1 111) V I S ION 1.UT LOT
i
PLAN VIEW
D.isiances and dimensions to meet requir.ement:3 of IA63
UW_ EVERYTHING W ITHIN 100 F 1;ET OF SY STEM
I I
f h
Z
Ir di •n e oy Arrow �
BENCHMARK: (Permanent reference Point) UescrL he :'
E :levatiun of ver.ti.cal reference point. SLope at site:
i --
SEI 1'TC TANK: Manufacturer: S_ lAquid Capacity:__�UC�CI
Jce'S '
Wimber of rings on cover. Tan�c'rtr�tnhole cover e�levatic n
Tank Inlet Elevat _g�� 'lank Outlet Elevation:
PUMP CHAMBER
Marirafactur_er: Number of v,al - ions
IJi.arnher of gal . pump set or a cyc'1 e gallon ; ; i.o�a'C capacit - " — y o
di tr.ibut Imes ka11on: si of pump head;
}, l l on per minute ; horsepower of pump
rand model. number. -
`I'ype of warning Tje T - Ce
1101MIN(, 'TANK: Manufacturer Number of ga.11ons___- —
E'le'vation of manhole cover
Type of warning device
`)E,E'PAGF. [),IT SIZE: - Nuill1i of pi is I"eet Ti.arnc� ter
1'cel, I -i(uid dept i seepage pit inlet i pe -- elevation
bol tom of seepage 1)11. eI -evat 1011 feet.
`-;! {I' PA( I:: BED SIZE: i'lumber. of I i ne s width LE �� th t i t e depth
NCII: wilt I) f_enl;i - --
PE:RCOI.ATION RATIO S -- _1�firn r:rgti r ,D 7�itU- A P., A A 1 TJ T T
LNSPE CTOR
DAT1- :D PLUMBPI.R ON
I. rC,I;NSI NUMBER 3 ZZcy
DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS
LAP6R & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number :
Tank In- Ground Pressure ❑ Mound (lf assigned)
NAME PERMIT H LDER� ADDRESS OF PERMIT HOL ER:
INSPECTION DATE:
i
BENCH MARK (Per anent reference point) DESCRIBE 1 DIFFERENT FROM PLAN: R F. T ELEV.: CST REF. PT. ELEV.:
/ IUi.y 5 1 lop s0
Name of PI ben i ,. MP /MPRSW No County: Sanitary Permi Number:
�3 &4_41
SEPTIC TANK /HOLDING TANK: — 7.1 7 7, 3 9
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
®YES ONO ❑YE
BEDDING: VENT pIA.: VENT MATL: HIGH AT �`�*'. ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM. LINE AIR INLET:
YES ❑NO ❑Y Sr� ,.J'1
D SING CHAMBE R:
MANUFACTURER BEDDIN LIQUID CAPACITY PUMP MODEL. J PUMP/SIPHON MANUFACTURER. n LABEL LOCKING COVER
D: PROVIDEO:
ONO ONO ❑YES ONO
GALLON C rE T. P UMP AND CONTROLS OPERATIONAL: P V WELL BUILDING. J VENT TO FRESH
(DIFFE N E AIR INLE PUMP AN OF DYES ONO
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing NGT I MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
I WIDTH ENGTH NO. OF DISTR_PIPE SPACING- COV R INSIDE DIA. #PITSLL^ THE ES MAT RIAL: DEPTH:
'., .n ,. ..� ,. �
RAVEL DEPTH FILL DEPTH PIPE PIPE DISTR. PIPE MATERIAL: NO. DI ,PROPERTY WELL BUILDING VENT TO FRESH
BELOW PIP 5 ABOVE COVER. E L i ND PIPES. 'LINE: AIR INLET:
f �� ----
MOUND SYSTEM:
Mound site plowed per endic ar to lope
Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown u lope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
DYES ❑N
I
SOIL COVER TEXTURE PERMANENT MARKERS: __]OBSCRVATtON WELLS
�1 � j ( ( � OYES 1:1 NO El YES ONO
DEPTH OVER TRENCHBED PTH O R TR NCH18 DEPTH OF TOPSOIL. SODDED SE EDED MULCHED:
CENTER JI GES.
❑YES ONO DYES ONO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGT N . OFf I XATERALSPACING . GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER.
T EN E :
y
MANIFOLD PUMP I L11 DISTR PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING.
ELEV.: ELEV_ DI ELEV. PIPES: DIA.:
HOLE SIZE HOLES C ILL D C RRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED
G:
PLANS.
p ❑ ES ONO OYES FIND
COMMENTS. PERMAN TMARKERS: OBSERVATION WELLS: PROPERTY WELL: BUILDING:
L: LINE:
DYES ❑ NO ❑YES ❑ NO
r �1 y,g4
r f�5 q l .9s
; Z
9 2-
.. ; -- Le vM r j;,
J
=� 9 2 tl 3
Sketch System on �� Re ain in county file for audit.
Reverse Side.
SIGNATUR � - TITLE
DILHR SBD 6710 (R. 01/82) ~
r 1
DEPARTMENT OF D APPLICATION S AFETY & BUILDINGS
INDUSTRY FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be
included.
Property Owner: / Mailing Address:
Property Location: it laqQi Town i • _ County:
'/a d%S iT ZW N/R 7 /d /eI!
Lot Number: B Subdivision Name: Nearest Road, Lake r Landmark: State Plan I.D. Number:
(If assigned)
TYPE OF BUILDING �
Number of
❑ Public ❑ Variance ❑ Other (specify)* Bedrooms:
Rt 1 or 2 Family * State Approval Required.
TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY J " A )
HOLDING TANK CAPACITY
LIFT PUMP TANK /SIPHON C AMBER
MANUFACTURER: V It ,e
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ® New El Replacement El Experimental ❑ Seepage Bed El Seepage Pit
2 14� 7 e, 0 ❑ Alternative (specify) Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Na f Plumber. Signaturer; MP MPRSW No.: Phone Number:
3ZZ (7/�► 3�� �� 6
Plu b Addres P Name of Designer:
COUNTY /DEPARTMENT USE ONLY
SignaSurgpof Issuing Agent: Fee
Date: ,( �i !) Sa�ni Permit Number:
C�(1 cJ U O or ❑ DISAPPROVED
Reason for Disapproval:
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer. Form (67 -T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White - County, Canary- Bureau of Plumbing, Pink - Owner, Goldenrod - Plumber
DILHR -SBD -6398 (N.03/81)
DEPARTMENT OF REPORT ON SOIL BORINGS AND r INGS
LABOR TAND c �. MAY c1U 1PO• B 969
HUMAN RELATIONS PERCOLATION TESTS (11J) jOa pVF DjI, 707
LOCATION: SECTION: OWNSHIP O.: OT NO.:BLK_ N IVISI ME: ,�
J '/ / / N /R !1(0 7; --- —
COUNTY: OWNER'S BUY R'S NAME: MAILING ADDRESS: / �Z
Cry X 'Ut 0 d x sS .
USE 15ATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION] ROFILE DESCRIPTIONS PERCOLATION TEST9:
F)i Residence 3 //� New ❑Replace
RATING: S= Site suitable for system U= Site unsuitable for system s 0 it'j ,x, 0
r ONV I ENTIONAL: MOUND: IN- GROUND•PRESSURE: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
NS ❑U ❑ S ,CCU XS ❑U I EIS IKU I EIS XU CO344 v 44AY7 'o
If Percolation Tests are NOT required DESIGN ATE: ELEV. If any portion of the lot is in the
under s.H63.09(5)(b), indicate: I Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED EST. GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 3 ! 9 '7' 7 6" Arl 8 1 n a 2 Y
B- ��" ?' k 7 6 `` 8 1( !3 tr / " B C / 45 Aq b
Ci 19,7/s
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN.
RVAL -MIN. P RIOD 1 PEIOD 2 PERIOD 3 PER INCH
P_ Yry -
P- if 0
P- I I I I
P.
PLAN VIEW: 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 slop.
SYSTEM ELEVATION ` 7A,
1
) AVyr tLL
1 "C4
_._.
G o; F xx�.f
f
e-
..... a!�', rw7rrt r/,fl p • . A /fir
�a
..._
t O rc ON
E
- 4101 as
1
4
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin
Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): ` TESTS WERE COMPLETED ON:
.Ao4u�_( 0 et 1 3a - *.t
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional):
CST ATURE: a
I �
DISTRIBUTION: Original -Local Authority, 2nd page - Bureau of Plumbing, 3rd page - Property Owner, 4th page -Soil Tester.
DILHR -SBD -6395 (N. 03/81) ' ,
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EXISTING SEPTIC C OP ,,
SYSTEM AFFIDAVIT
Document Number
Name & Return Address
Michael and Evonne Ganz
565 Cty. Rd. U
Hudson WI 54016
042 - 1001 -20 -100 01.28.19.7C
Computer I.D. Number Parcel I.D. Number
The existing septic system that serves the dwelling being rebuilt must be
verified by an acceptable soil report or be inspected by a licensed soil tester
for compliance with high groundwater and /or bedrock separation requirements as
set forth in s. COMM Chapter 83.10 (2) WI. Adm. Code. The results of that
inspection must be made available to this office. If the existing septic system
meets these minimum requirements, and is properly functioning, the residence
may be rebuilt without updating that system. This new dwelling must not,
however, encroach upon the required horizontal setbacks as set forth in
Wis. Admin. Code Comm 83.43 -1.
Property Owner(s) Michael & Evonne Ganz
Property Mailing Address: 565 County Rd. U
Hudson WI 54016
(11/3097) Property Legal Description: Lot # 1 CSM /Subdivision CSM #543292
Sec. 01 T 28 N -R 19 W. Town of Troy
comments: The existing septic system, installed in 1991, was sized for a
three(3) bedroom dwelling.
The building reconstruction project will involve construction of three (3)
bedrooms, plus a potential 4 bedroom in the lower level. A study and Bonus
room are planned, but will not qualify as bedrooms. The end result of the
project will be four - bedroom structure. Currently there are five (5) occupants
of this dwelling. The potential 4th bedroom may, in future, result in the
septic system to be undersized for the structure being served. When the
addition of a bedroom exceeds the designed wastewater flow to a septic system,
an affidavit must be recorded the deed as a disclosure to future property
owners. Since the septic system was installed as code - compliant on 03 -06 -91
and certification provided that it is functioning properly, the requirement for
the system to be inspected by a soil tester will be waived.
I, as the owner of the above described property, hereby affirm that the septic
system serving this dwelling meets the above referenced state private sewage
system codes. I realize that this remodeling project may cause the existing
septic system to become undersized for the dwelling being served, and I will
make this information available to any future parties interested in purchasing
this property.
Signed: Notary Public Subscribed and
a C/ sworn to before me on
Date: J (/ this date:
Zoning D artme , My commission expires:
Approv
Date: 312 �/ 1
* Q4 NQ
:gar c-r uY ua; eua uarrei 1 Lunn iio- YCa-culrb P.1
MAR 24,2004 08:14 NatureScapes Landscape 17153865394 Page 1
:3T. C:ROIX COUNTY YON.ING OFF10E
CERTIFICATION STM'EMI;NT
POP T)TTT,T7,A'I'l0N OF AN rXISTING SlsPTIC: TANK
This is to certify that I have :in::pccted the septic: Lank preserit.ly sere uy
residence located at_: SW %,
Sec. I T Z N, R �� W, 'town of _ TI?ov - St _ Croix
County, Wisconsin. Upon inspection. I certify 1t / hat I havc; found rhr tank anct
bafflers to br.. in good condition, and it appears to be funrt:ioning properly.
Last time serviced � � - (9 l{ LOT /.._ -C-5 -4 '5�r aZg2- VO1 1/
AA Oho - /ooi- ZQ -boa / vi. Zf. 19. 7L
Did Clow back occur from abnorption system? Yes_ No_X (ii no, nkip next:
1 itir,_ .
Approximate vc.Ouffr, or length of time_ gallons mir:ut..es
Capacity: /g49,(7
Construction; Prefab Concrete SI.eel Other
Manufacturer (if. known)
Ayr of Tank (if known) : n
Oa r r - c // .0, n/( _
(Name) Please Print -
(Tit.lc) (Licenr3P Number) -
Form to be c:c:cnp.le4ed by licens . plumber (s. 145.06, Wisc:c va;ics qr
iicen ed di.;E•mer (Nlt 3.1'3 Wisconsin Adm.i.niutrative Code)
Plumbr;:r (applying for sanix_ary permit) Certification:
In accept:i nq t•ha ahc:,vc, st atcment reyardirny ctx i t,t. i ng t;cwpt: tank condition, I
certify t.hat. t.l,r t.ank, t.c, I.ho best of my knowledge, w.i l.). conform to' the
requirement: of 7LHR 83, Wirr_ Adm. Code (except for intgxtc:tion opening over
out.Iet baffle) .
Namc :; ignature
MN /M�l' s
GENERAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR01
REAL ESTATE TOWN OF TROY
COMPUTER NUMBER 040 - 1001 -20 -100 Parcel Number 01.28.19.7C
Claimed 1 Date Re- certified / / Relate Number:
OWNER NAME: First MICHAEL L & EVONNE L Last GANZ
CO -OWNER
Mailing Address 565 CTY RD U
City HUDSON State WI Zip 54016 - C
Type Vol Page Doc # Rec.Date Type Vol Page Doc # Rec.Date
HISTORY WD 1179/300 07/23/1997 /
PROPERTY ADDRESS:
Hse # 1/2 PD -- Street Name- Type SD Apartment Post Office Z 1
565 CTY RD U
School District: 2611 - SCH D OF HUDSON
Special District: (1) 1700 - (2) - (3) -
W ITC
Plat Code: Last Changed on: 07/01/1996 Book Number: 1
SECTION 1 TOWN 28N RANGE 19W '/4160 '/440 Map Number: 00 - Sales Area:
Parcel Control 0 TAXABLE
Number of Units:
ZONING: Permit Number: Type:
Bank Numbers:
F4 -Prev, 175 -Next, F6- Legal, F7- Value, F8- History, F10 -Exit, F12 -More
G� Cp
O o i600 9s' �1;2 oG
s FILED , 7 41 0/ 2
MAY p 6 1996
SLI �� eeft
CERTIFM SURVEY MAP
Located in part of the SWJ of the NWJ and part of the NW} of
the NWJ, All in Section 1, T28N, R19W, Town of Troy, St. Croix
County, Wisconsin.
NW Corner of
Section 1
r.
N
I O �
r• N 0
o O
r
N URP L4 i i EC
L
d t
50.21' �- - ° 03'13 " r V7
a o�
C� r _ Septic 419 4 69.61 1.
40
= o M— 0
0 4J
(—� c O c m i
21 N Pole s 5
V� d ' N Shed �' a
.o
•� 3 w House
0 ® Well
0
33' 50' Pole 10
Silo's Q Silo Sh ed o,
o
z
N88 °58'49 "E S88 °42'49 "W Shed O Barn
45.00'00 o
0
H
' Y
pp U
Va r . 45' ma y •`
� � UI
LOT 1
L
U
7.53 Acres Inc. R/W �I
327,970 Sq. Ft. ,,
7.23 Acres Exc. R/W M v
315,117 Sq. Ft. IT
M C-)
°� Lt 11
M y
C\J1 `^ LEGEND z ' — I
K)i <1 .
Aluminum County Section Monument Found J 0
O 1" x 24" Iron Pipe set, weighing 1.681 a
-+ lbs per linear foot. JI c
ji ,^� yr-0 Existing Fencel i ne C •a
. y� setback line x '- , ROVED �
AL LEN 0 6
t_E�l G
� I 65' 45 N a NYN P,
J1 _ (` 2 .aOIX COUNTY
Fit! "3`
7 oning and
., ti ✓�,� f < .�,�:. arlCS Committee
N82 ° 07'28 "E
45.30' �4� A ,�.
yf'a
-got recorded
N82. 28 "E 429.0 .11,n 30 days of
r-T ac►oroval date
33' 33' C[��C ± � 0 ov8i Shad be
Charles., .
'_" V �t p 772 C.T.H. "N"
Hudson, WI 54016
M
N Scale in Feet Note: Lot created under
A Corner of o o, Farmland Consolidation.
Section 1 v> l
0 50 100 200
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of - 2—
r Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
s COUNTY
Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or P Eli .. #
dimensioned, north arrow, and location and distance to nearest road. °. 4{ o
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION W.fEWEDBY DA
et a t
PROPERTY OWNER: PROPERTY LOCATION C .e►
\'(�`T V cyv ►-jE cz �m Z f N3 1/4 N0 U4 [ T tiq
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NA C lap 0Fr
S L s e-our ` v` 1 e Sri v l 1
CITY, STATE ZIP CODE PHONE NUMBER []CITY OVILLAGE MOWN N C�
Cot(, C) VS) LtZS_ 6b8S Two v "
[ ] New Construction Use [5Cj Residential /Number of bedrooms 3 [ ] AddifiQn to existing building
j Replacement [ ] Public or oommercia! describe
ex-t s�t-rN �
lode derived daily flow LIS o gpd Recommended design loading rate bed, gpddt = 6 french, gpdd/ftt 2
Absorption area required bed, ft S trench, ft Maximum design loading rate - bed, gpd/ft trench, gpd/ft
Recommended infiltration surface elevation(s) t"f M IV G Z - • 5 ' ft (as referred to site plan benchmark)
Additional design / site considerations Z. e'x_ t SZ7N G L-t_I - S 'y_ - 16 , (_ W G .
Parent material SMwi er/T t)y %2 S � T t L L Rood plain elevation, if applicable Iv. R - It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for syste m S❑ U ®S ❑ U PS ❑ U 10 S ❑ U ❑ S ®U ❑ S [@U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bottr>dary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Twit h
Z l4 31 10
Ground 3 7• ,S ` p- 31Y — S, � _s m U -�v C S _ •; 4
� s
elev.
c u- - — z
Depth to t 1 `S `f- Y
limiting
factor „
796
Remarks:
Boring #
Ground NJ N 1 N C Uri1 YV C
elev.
It. L ow t P
Depth to , OQ k I � G
limiting S CJtLC&j W S
factor
Remarks:
CS T Name.---Please Print Arthur L. We erer one 715- 425 -0165
egerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022
Signature: _/J Date: CST Number:
aC C16 -3z.S 1 L. S_� (o M00576
PLOT PLAN Page Z of Z
SCALE 1 "= ilp '
? �s i- iR4 uN -
i
le
�- �lS'Pw 6 �y"Ctf'S
S S•
L:; ly�lu SE PrAA6 ► SELL. ftlZE ? 100' ENV
C3 F 'Ma►v tttz ,
i
B — CZ-. LUX-O CN - wz O
96.3
715 42.5 -0165 1400576
CST Signature Date Signed Telephone No. CST #
` Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page l of �_
Labor and Human Relations
Qivision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
y Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and %of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. o - 100 ZA- 1 0 0
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
\-t+ `f V arum GP Z 80 f .1:0f N 1.J 1/4 M►O 1 /4,S I T Z S ,N,R ' .q E (01@
PROPERTY OWNER SS UNG ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
S (,S --�'^+ ' U ° 1 C .M V0V. 1\ 30 ql
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE @TOWN NEAREST ROAD
1�1vDSot.,, i-vl 5 LCot�, 0151 yZS_ 6b8S
[) New Construction Use [XJ Residential / Number of bedrooms 3 [ I Addtkn to existing buildiN
j JJ `� R � dail f I Public or commercial describe
l�0oe ` ed l fl e-r-I M" a
ily Q gpd Recommended design loading rate - bed, gPKW = 6 trench, gPdlft
Absorption area required - bed, ft -1 S O trench, 9 Maximum design loading rate - bed, gpcW • �- trench, 9pd/ft
Recommended infiltration surface elevation(s) M= tj G O1 Z. S ' ft (as referred to site plan benchmark)
Additional design/ site considerations Z. k_ TtZ vc,F+ S- L-_fvc^.� S ')6 LWC,
Parent material SED1 V je JT 00e2 S � T t L. Rood plain elevation, if applicable fv. ft
S = Suitable for system DONVQMONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM W FILL HOLDING TANK
U= Unsuitable for system Q S C1 ®S ❑ U WS ❑ U S O U [IS ®U ❑ S W U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Cor>SistiBnCe Boundary Roots GPD /ft
m
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed r nch
v t
10`t( Z Z Z Std Z�S'F1�
Z ► 4 I
Ground 3 7. S Y R 3/y S' Zt `S \ C s b'r` Tv, V c S _ • S - 6
elev.
a. - z It
Depth to
knifing
rq
Remarks:
Boring #
13- v\ i S 1t
Ground I lv kJ 1 N e T1 vJ t N Coll
elev.
ft
Depth to
limiting S \ G W S
factor
Remarks:
T Name.- Please Print Phone_
Arthur L. We erer 715 -425 -0165
egerer Soil Testing & Desi Se rvice -P.O. Box 74 River Falls,WI 54022
Signatures aC . r:
�'L 6 _ 3 Y. S Date: S `� b CST Number
a M00576
PLOT PLAN Page Z of •�
SCALE 1 "= 1 413 '
i
i
a
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II
S. S.
E�ccsY�+vG �y-pv s E � ��.,L t'�►�z -� � � o�" �r�T��a.��l
OF 'MU9v C -te3 ,
8h' t'Z. L" , p' o 1bvo of
96 -32-5
�u ( 715 ) 425- 1400576
CST Signature Date Signed Telephone No. CST #
IL
�--�►..� ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
I N p "u I NN ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road i
Hudson, WI 54016 -7710
.. (715) 386 -4680
SEPTIC INSPECTION / WATER TEST REQUEST FORM
Please specify desired test(s) & remit appropriate fee with
application. Outside water lines are often turned off during
winter months, making access to the home necessary. Please make
arrangements with this office to insure that entry can be gained.
P Water (VOC's) $185.00 Septic $50.00
f Water (Nitrate & Bacteria) 45.00 ❑ Nitrate & Bacteria
, l retest $15.00
Owner : f?� ' C F Requested by : vs'
Address: - 7 a Address: 1 _
ZIP ' - -
ZIP
Telephone °: (:ZW - � ?�� TJY3 Telephone : Z
s
Property address (Fire N Q & Street) :
Location:' „��'„ Sec. T,�B_N, R_14 __W, Town of paq
Lock Box Combo: Closing Date:
Q 0 0 X04 uG I �i2�',�arso o t3 !
Mo.
) BE COMPLETED BY PROPERTY OWNER
7t PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM*
Water sample tap location: b t hp C) k-\
Is the dwelling currently occupied? 0 Yes No
If vacant, date last occupie 1
Age of septic system: c��w o
Septic tank last pumped by: 'di_ Date:
Previous Owner's Name(s): ev% hLckyLd 16 s,
Have any of the following been observed?
❑Y Slow drainage from house.
❑Y Sewage Back -up into dwelling.
❑Y M Sewage discharge to ground surface or road ditch.
❑Y k Foul odors.
Other comments relative to system operation: own eh k.5 ho fi
rve,d (Vt hnufig
I certify that the above information is complete and true to the
best of my knowledge.
OWNERS SIGNATURE: � C .>ti Ag j& DATE:
1/94 V�
i
r
OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION
TO BE COMPLETED BY INSPECTION AGENCY
System'design & /or permit on file? ❑Yes ONo
Soil series per SCS Soil Survey: sheet #
Type of soil absorption system OBelow grd ❑At -Grd Mound
Approx. size 'X I OGravity ❑Dose OPressurized
�. Ft.Z OBed OTrench ❑Dry Well
Molding Tank ❑Outfall pipe
OBSERVED DEFICIENCIES ❑Other OUnknown
,
Setbacks: ❑House OWell OProp. line OOther
Dose tank
Setbacks: OHouse OWell OProp. line OOther
OLocking cover ❑Warning label OPump /Floats '
OAlarm ❑Elec. wiring
Soil Absorption System
Setbacks: OHouse ❑Well OProp. line ❑Other
OPonding: bDischarge:
General comments
INSPECTORS'SXtTCH OF SYSTEM LOCATION
N
Inspector
Title
l
CERTIFIED SURVEY MAP
Located in part of the SW} of the NW} and part of the NWJ of
the NW}, All in Section 1, T28N, R19W, Town of Troy, St. Croix
County, Wisconsin.
NW Corner of--� AT
Section 1 W _ jv
N I W
I O
�r��
o — LJ IIEC r
v w'
50.21' 0 6 °03113 11W 469.61' c
I—a
Septic 419.40' �
C JI
• _ rnav
e to \ cmm
I c Pol
N N $ h @(� m -P w
C,) l 3 w �. 1 House
° o
o N ®Well c
33' 50' P o l e w
' Silo's( Silo Shed
i .F Q z
S88 042149 1?W Shed 0 Barn
N - 0 0 � 0
45.00'
i O
X
00 u
Var. 45' W
• W
o c
LOT 1 UI
X
RW
A Inc. /
7.53 Acres
i 327,970 Sq. Ft. JI
7.23•-Acres Exc. R/W M o
o, 315,117 Sq. Ft.
w
en L.
M o —1 -o
71 v, LEGEND z 1 <1 C
Aluminum County Section Monument Found R.
o 1 x 24" Iron Pipe . set, weighing 1.68 a
.. _ lbs per linear foot.
.)� -* --r Existing Fencel i ne
...
° •••.••••• 100' Roadway setback line r
`I ti
SI
(nl 65' 45'
UI
I
N82 ° 07'28 "E '
N8 2 °07'28 "� 429.04'
NIE"�Y OWNER I
33 33 C.�_ -- ' Charles Garbe
W V 1 PLtJ i '772 C.T.H. "N"
�- - Hudson, WI 54016
� M
M
n
C14 Scale in Feet
` y
0 50 100 200
a
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'azis DoT mYUUiuzuu 'spueTIaM ' suoTIsTnbaa pus saTna 'sMST dTigsumoL
pue A:Iunoa 'a:le:IS o:l goaCgns st OeTd) dem siq:t uO UAOus Taoaed gaeg
- awes Buiddem pup BuKAaeans ur_xtoa0 - :IS to d:Iuno0 agl to aousu -r
uozszATpgnS pueZ aqg pus sa:lngE:lS uisuooST m agg to b£'9£Z aaldegO
to suotstnoad quaaano agI gaits paiTdmon ATTnI aneq I -4egg !pagiaosap
pus paAanans Aaspunoq aotaaaxa agg to aTsos o� uoi
Ioaaaoo a sz deW AaeanS paili:IaaO stg-4 aeq:l AJTI as osTe 'I
•paoaaa to sluamasea TTe
pue ( unu ) AeMgBTH X =S AqunoO aol deM- to -lg6Ta og :139Cgns st Taoaed
. (' g3 - bS
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941 01 199l T9'69V 'Mu£TiEO098N aouagl :1093 8V TOL 'Mu8£ifiEOTON aouagI
=aaal fi0'6ZV 'auTT gIaou pies BuOTe 'Su8ZeL0OZ8N aouagj .aatllO speaQ
JO a9:18T69g A:IunoO xioaO 'IS agl Ie LSfi aBsd I T amnTOA ui papa
1 Caa10090 aq:l to auTT q agg o: Baal 61 'deA- to - :lgBia pTes
BuOT'e 'HuTT<OTOS aouagI =unu ARAgBTH ](unay dqunoO t o Arm- 1 0 -:145ia
ATaa:lssa aqa oq - 4aal 00*sv 'Su6:P,89088N 9au943 :3983 TT'69Z 'auTT
asaM piss 6uOTe 'SuTTiLTOTOS ButnuzIuoo eouaq:l
a gg 0 1 zaaJ LZ' SZ6 'uOT1 pees 3 1, /TMN O RI to au I saM agg B IIOTe
`$uTTaLTOTOS aauagl 'Tiiozpoes piers to aauaoo MN aqq ae S SA
:sAoTTOI se pagzaosap aagaanl !uTsuoosTM '.ClunoO xioaO
'IS IAoay to uMOy 'M61H 'HSU 'T uot139S UT TTe '1 /TMN awl to P /TMN agg
to lard pue 1, /TMN aql to V /TMS agg to aced uT paleaoT pueT to Taoaed V
:sAolloI se pagiaosap ST
paddem pue padatuns ToaaQd poet agg to Axepunoq aozaa -4xa aiq:l gEq:t !dew
AaAanS paTjTlaaO sTgl Aq paauesaadea si gotgM Taoaed pueT agj pagtaosap
r pus paddsum 'paXanans aneg I 'agaEf) 9aTaei6 to uo agg Aq -Ieqg
A;Tlaao Agaaaq 'aoAaeanS pusZ uTsuoosTM paaalsi6aa 'ua6eg�CN uaTTK ' T
I
7 - -
ST. CROIX COUNTY
WISCONSIN
- -- - ZONING OFFICE
ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016 -7710
M 9 6 (715) 386 -4680
Doug Torgerson
Century 21 Prem. Group
Hudson, WI 54016
Dear Mr. Torgerson:
On April 24, 1996, an inspection was made of the septic system on
the property located in part of the SW,- of the NW, & part of the
NW,, of the NW,, Section 1, T28N -R18W, Town of Troy, St. Croix
County, Wisconsin. The property is owned by Charles Garbe, and
the mailing address is 565 C. T. H. "U ", Hudson, Wisconsin. A
water sample was also collected, and the results are enclosed.
At the time of the inspection, the sanitary system appeared to be
functioning properly, with no visible signs of failure. In
researching the records, however, no information regarding the
installation was found as far back as 1982. It was indicated on
the application that the system is approximately ten years old.
It was noted at the time of inspection that another system exists
on the property, but is not in use at the present time. Due to the
fact that no records exist, it is not known whether that system was
properly abandoned.
The inspection of the system was based on a surface inspection of
the system, and did not involve any excavating or chemical
analysis. Accordingly, there is the possibility of hidden defects
in the system not discoverable by this inspection. This letter
does not in any way warrant or guarantee the continued proper
functioning or operation of this system. It is recommended that
the system 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, please contact this office.
Sincerely, yy
Mary J. Jenkins
Assistant Zoning Administrator
Enclosure
cry
t :
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 140.4 16290/01 PAGE 1
ST.CROIX CTY GOV.CTR REPORT DATE: 4/30/96
1101 CARMICHAEL ROAD DATE RECEIVED: 4/26/96
HUDSON, WI 54016
ATTNS THOMAS C. NELSON
I
i
OWNER, Charte5 Garbe
LOCATIONS 565 C.T.H. U, Hudson
COLLECTOR** M. Jenkins
DATE COLLECTED' 4 -24 -96
TIME COLLECTED' 24'00pm
SOURCE OF SAMPLES Kitchen tap
DATE ANALYZED:4 -26-96
TIME ANAL.YZED:12i00pm
COLIFORM,MFCCS 0 /100 ml.
INTERP'R'ETATION+ BacterioLogicaLly SAFE
NITRATE -NS 13 ppm
Above 10 ppm exceeds the recommended Public
Drinking Water Standard.
CoLiform Bacteria /100 mL
Nitrate - Nitrogen, mg/L
RECEIVED
LAB TECHNICIANS Pam Gane 5T CRUX
COUNTY
WI ps
WI Approved Lab No, 19 ZONINGOFFICE
< Means "LESS THAN" DetectabLe Level Approved by:
PROFESSIONAL LABORATORY SERVICES SINCE 1952
LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02
REAL ESTATE TOWN OF TROY
COMPUTER NUMBER 040 - 1001 -20 -100 Parcel Number 01.28.19.7C
OWNER NAME: First MICHAEL L & EVONNE L Last GANZ
PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment
565 CTY RD U
SECTION 1 TOWN 28N RANGE 19W 1 /160 1 /440
Line Description Line Description
TOTAL ACREAGE 7.530 PLAT LOT BLK
01 SEC 1 T28N R19W 15
02 PT W1/2 N W 1 /4 16
03 BEING LOT 1 CSM 11/3097 17
04 7.53 AC 18
05 19
06 20
07 21
08 22
09 23
10 24
11 25
12 26
13 27
14 28
F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit
GENERAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR01
REAL ESTATE TOWN OF TROY
COMPUTER NUMBER 040 - 1001 -20 -100 Parcel Number 01.28.19.7C
Claimed 1 Date Re- certified / / Relate Number:
OWNER NAME: First MICHAEL L & EVONNE L Last GANZ
CO -OWNER
Mailing Address 565 CTY RD U
City HUDSON State WI Zip 54016 -
Type Vol Page Doc # Rec.Date Type Vol Page Doc # Rec.Date
HISTORY WD 1179/300 07/23/1997 /
PROPERTY ADDRESS:
Hse # 1/2 PD -- Street Name- Type SD Apartment Post Office
565 CTY RD U
School District: 2611 - SCH D OF HUDSON
Special District: (1) 1700 - (2) - (3) -
W ITC
Plat Code: Last Changed on: 07/01/1996 Book Number: 1
SECTION 1 TOWN 28N RANGE 19W '/4160 1 /440 Map Number: 00 - Sales Area:
Parcel Control 0 TAXABLE
Number of Units:
ZONING: Permit Number: Type:
Bank Numbers:
F4 -Prev, F5 -Next, F6- Legal, F7- Value, F8- History, F10 -Exit, F12 -More