HomeMy WebLinkAbout040-1003-20-000 Wisconsin Department of Commerce
Safety and Buildings Division Count PRIVATE SEWAGE SYSTEM $t. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitay&g76No.:
Person information you provice may be used for secondary purposes [Privacy Law, j (1)(m)].
Permit Holder's Name: ❑ Cit y ❑ l ane Tow f: State Plan ID No.:
McElwain, Melbern ray �wns`$�p
CST BM Elev_ Insp. BM Elev.: BM Description: Parcel 6401003 -20 -000
(5D . ID 1 /J a : n 4-ree, = C S !M
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic (���� � Benchmar *i
Alt. bAL—
QQ,iil� L ) ea-L In ( ;Z�
Aeration Bldg. Sewer , / ID
Holding St /Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet S q4 5
Ven TANK TO P/ L WELL BLDG. Ai Intake ROAD Dt Inlet
Septic ? 5D >6b r 3 NA Dt Bottom
Z >tvp �. gD -,,�p NA Header /Man. ( 0 1q.23 /
Aeration i ve j
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufact Demand t cover
Model Number GPM DT- o jj 19 -�
TDfi Lift L oss ion TDH Ft
ead
Forc In Length Dia. Dist. Towel
SOIL ABSORPTION SYSTEM O) C ,0 ,, f> - e n.,fi, _
BENCH width Length N Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIM I N 3 a• S 3 DIME ION
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK `
( � th
INFORMATION Type O CHAMBER ^ Moe Num er:
System: v . I T 1 (CID ? c50 OR UNIT t _C C- I
DISTRIBUTION SYSTEM
Header / Manifold a Distribution Pipe(s) x H le Size x Hole Spacing Vent To Air Intake
Length Dia. Spacing r��
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed/Tr nch Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: F� /4// Inspection #2: — f -- t
Location: 568 County Road U, Hudson, Wl 54016 E1 /2 NEIA 22 T28N R19W) - 02 81917B -Lot
1.) Alt BM Description = DT d�� E >'0'P �%u- S A&T ai ;�
2.) Bldg sewer length= 2, va 5 �S
.S
- amount of c q
Plan revision required?� ❑ Yes No
Use other side for additional information. 02- (S o I ( Z
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
4 ,
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Sanitary Permit Appli at' » LUUU Safety & Buildings Division
In accord with Comm 83.21, Wis. :'� Madison, WI 5 Code 1 ST CR X _ ! 201 W. Washington Ave.
See reverse side for instructions for complete ga#iis applicati ilUN �, I 15 Box 7302
Personal information you provide may be used fot"SecohatyZl9L� 3707 -7302
Dapd0niant of t antlneree [Privacy Law, s.15.04(i)(m)] ' (Subrpi`t completed form to county if not
ti- state owned
Attach complete plans to the county copy only) for the s sterri on a et-not less than $ -,I at:1,1 inches in size.
County . State Sanitary Permit Number U Check if revision to previous app ielmi - State Plan I, D. Number
O<x
I. Apglication Information - Please Print all Information Location:
Property Owner Nartte Property Location
er Pv zze,..i /
Proporty Owners Mailing Addrefs Lot Number Block Number
City, State Zip Code Phone Number S Name or CSM Number
� Sys /6 II. Type of Building: (check one) or 2 Family Dwelling - No. of Bedrooms ge
0 Public/Commercial (describe use):_ of
❑ State -Owned /rl7
Ne est Road
u �/L
Parcel Tax r($)Q 000
III. T Yoe of Permit: Check only one box on line A. Check box on line B if applicable)
A) 1. 0 New 2. eplacemcnt 3. ❑ Replacement of 4. 5. 6. 0 Addition to
System System Tank Only Existing System
B) Permit Number Date Issued
D A Sanitary Permit was p reviously issued
IV. Type of POWT System: (Check all that apply)
on- pressurized In -ground D Mound D Sand Filter ❑ Constructed Wetland
0 Pressurized In -ground D Holding Tank 0 Single Pass O Drip Line
O At-grade D Aerobic Treatment Unit ❑ Recircularin ❑ Other:
V. Dispersal/Treatment Area Information: J a r s
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5, Percolation Rate te
ysm Ek ton 7. Final Grade
Required Proposed Rata (Ga ,ldayl ) (Min,/inch) 9a J92 , levadon
3
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete strutted
Tanks Tanks
Y00 1,9001X00 4,
D ❑ D ❑ ❑
VIII. Responsibility Statement
I the undersigned, assume responsibility for installation of the POWTS shown on the attached laps. __7 Plumber's Name (print) Plumber' ature (nos ): ATP/MPRS No.
Business Phone Num 1-7
LL�j _') I �Xj 4 �_
Plumber's Address (Street, City, State, Zi e) r _
IX. County /Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui ont Si nature o stamps)
Approved ❑ Owner Given Initial Adverse Surcharge Fee ' O
Determination 2- 2 - 0 D
X. Conditions of Ap roval /Reason for Disapproval: / 0e q/a %h �
A'L4: A PQ �v�td/ S OP/ , s4t,�+ -k 1`4�Ct`k <r S �t Go r✓t �IU�dCac iv. S
a44Y N.o'- 6e > 670 Ae4w 00-If' h •✓/ If-el l e.
}� VGCotKnt "� . r.s �.r l /Cr Q. hi tr«• r `v Ae s ` o k P
t� P.ss�6
� T
PLOT PLAN
PROJECT Melbem Mcelwain ADDRESS 568 Ctv Rd U Hudson Wi 54016
E 1/4 NE 1/4S 2 /T' N/R 19 W TOWN Troy COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/23/00 BEDROOM 3
CONVENTIONAL )00( IN- UND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000/800 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .9 ABSORPTION AREA 500 # of chambers 30
BENCHMARK V.R.P. Top of Nail in Tree ASSUME ELEVATION 100' Filt r Za el A -100
❑ BOREHOLE O WELL - H. R. P Same as Benchmark
SYSTEM ELEVATION 92.7/92.0/91.3
Alt. BM Base of Shed Siding @ 94.9'
: 2L Sidewinder High
Well Capacity Leaching
Chamber
60'
3 4 Grade at System Elevation
Existing 3
B edroom
H ouse
25'
25'
25' 3 -3' X 63' Trenches with >3' Spacing
B -2 as 5
T Vents ( '/ a -
8%
20' Alt.
0 , (4G 4N
45' Gq AL
0
Old System has failed B -3 0' >,
Vent 0' 609 Shed 4
o
30'
10'
15'
VentsS B to b' - P -� "-" s
Oe I-, ra.It
Property Line 130'
r
0
Wisconsin Department of Commerce SOIL EVALUATION REPORT Pam of Division of Safety and Buildings
In accordance with Gomm 85, Wis, Adm. Code
Courtly
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 Pte( I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q 3 O
Please print ell information. Re Date
Personal intomm"on you provide may be used for secondary purposes (Privaoy Law, s. 16.04 (1) (m)). Oo
Property Owner _ Property Location t, Jl /�
Govt. Lot i!�(/��1l4 S p2 T p� b N R/ E (06
Property Owners ailing Address Lot # Block # Subd. Name or CSW
City State _ Zip Code Phone Number ❑ City ❑ Village Town Nearest Road
u l ( 'S o G�a�
❑ New Construction UseFResidentiel /Number of bedrooms. Code derived design flow rate GPD
f@e epleoemant / ❑ ublic or dal - Describe:
(
Parent material �- Flood Plain elevation if applicable
General commerg
and recommendations: S � s4 e rw -e- l J cztW,ti
i
3
M Boring # ❑Boring / b .
Pit Ground surface elev. Depth to limiting factor �== in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP
In. Munsel Qu. Sz. Cont. Color Gr, Sz. Sh. "001 *EN#2
Cs 5
. Z
dl
qy
Bori a # ° Boring
❑ Pit Ground surface elev � R. Depth to limiting factor G.S-2 ._ In. ESoll A pp l iceition Rag
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Root GPDA
in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff #1 * Eff#2
D
-A6 d 3 /z
3
q Z. 0
" Effluent #1 = BOD > 30 220 mg/L and TSS >30 5 150 mg/L " Effluent #2 = SOD 130 mg/L and TSS 5 30 mg/L
CST Name (Please Print) lure CST Number
i
Address , Date Evaluation Conducted Telephone Number
�6 ?� /� etj �/ Sy01 7 ` Y- y.�
Property Owner — _ Parcel ID # Page - -of
Boring # Boring
D 4�j
pit Ground surface elev. /6 ft, Depth to Ilmifing factor ���_ in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/M
In. Munsell Qu. Sz, Cont. Color Gin Sz. Sh. *Eff#1 *EW
Ac -
a
Z. ?z. 9
6 to 57. `v
a Boring # ° Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Appl ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMF
In. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. *Eff#1 *Eff#2
Boring # ❑ Boling
❑ Pit Ground surface elev. _..",__..+ ft, Depth to limiting factor In,
Soil icetion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD
In. Munseti Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#i *Eff#2
Effluent #1 = BOD > 30:5 220 rng1L and TSS >30 < 150 mg/4 " Effluent #2 = BOO, 1 30 mg/L and TSS 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or 17Y 608- 264 -8777.
SBD -8330 (R.6N0)
I
Soil Test Plot Plan
Project Name Melbern Mcelwain Sha d
Address 658 Cty Rd U
Hudson Wi 54016 W1269
Lot 1 Subdivision --- - - -- Date 7/23/00
E 1/2 NE 1/4S 2 T 28 N/R 1 9 W Township Troy
❑ Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Nail in Tree
System Elevation 92.7/92.0/91..3 *HRp Same as Benchmark
It. BM Base of Shed Siding @ 94.9'
Well
,\ IV
60'
E xisting 3
B edroom
H ouse
25' \l
25' 1
25' 0
B -2
T
80
20' Slo Alt.
45' �
0
Old System has failed B -3 0'
Vent 30' , Shed i~
�jc o
B.M.
1'
1'
25' B -
5'
Property Line 130'
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
serving the P G residence located at:
r1
/' ; , Section ..c T�N, /-,/-", W, Town of
Upon inspection, I certify that I have found
the tan} and baffles to be in good condition, and it appears to be
functioning properly.
Last time serviced: ��✓ ���(�
Did flow back occur rom absorption system?
Yes No (If no, skip next line)
Approximate volume or length of time: gallons minutes
vapacity:�'�Q /0 - // �
Construction: Prefab Concrete Steel Other
Manufacturer: (If known) :2zvt�jiLaR -v'
Age of Tank (If known); a-'tv
(S' �aatture) (Name) Please print
(Title) le) (License Number)
- -2
Date
Form to be completed by licensed plumber (s.145.06, Wisconsin
Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative
Code)
- -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the best of my knowledge will
conform to the requirements of ILHR 83, Wis. Adm. Code (except for
inspection opening over outlet baffle).
Name Signature MP /MPRS
ST CROIX COUNTY
SEPTIC WANK MA'IN'TMgANCE AGREEMENT`
AND
OWNERSHIP CERTIFICATION FORME
Owner/Buyer
Mailing Address 6c �� /C ll� Lv✓ ��1 �� (�
Property Address �cu� -ems
(Verification required from Planning Department for now construction)
City/State Parcel Identification Number ®yam / ®e.3 —, &' 006
LEGAL DESCRIPTION
Property Location � 4— y K, Sec. . 7 f W' Town of r
Subdivision Lot #
Certitled Survey Map # 7y Volume _ Page it / 3
Warranty Deed # 3 `V 7 Volume _ Page # �J
Spec house C) yes O no Lot lines identifiable O yes O no
SYSTEM MAIMNANCE
Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance
consl* 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 f4metion 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, 3ourwYman plumber, restrictedplumber 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.
Itwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as act by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system W be= maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the ear a dam,
rGNA 77401LICANT -DATE
OWNER CER, TIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the pr de rd ba e, by virtue of a warranty deed recorded in Register of Deeds Office.
C3 F XPALICA DATE
Any information that is mis- r+epresentedmay 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
• A
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1 - 19ft THIS nAca NCSCMV :D FOR RccORDINO —
WARRAWY DEED
438474 BOOK 814 r`Vi 65 ^ _� REGISTER'S OFFICE
,/t� ST. CROIX CO., WI
This Deed, made between --.---- ................. ....__- ......................
Reed for Record
........5.teAhe.n. _ 8..._. I3e. C RMan.And.-- layxlet.t - -.L S t.ne_r.- - - - - --
_.... Beckman.,.- .husban- d..and..wife . aa.jaint_.tenants__... .11IN is 19N
---- ••----- I -------------- -- -- -- --- - ---- -- Grantor,
and.. Me- lbern._ J.--- McElwain _and ... Kathryn..R...._McElwain of 1:30 PM
...... husband . and_ w - if�e ..as...surutvorship...mari.tal ........
....Pro ^ty....... - - - - -- -• .. ............ .. . . . .. ..... .• -- --......... . ........... 0 C
-- -• • ................ ................... Grantee, ti obwof DO*&
witnesseth, That the said Grantor, for a valuable consideration.... ......
_..Stephen. ._S Beckman - and_ _Lyne.tte.A.__Lis tner_.Beckman
conveys to Grantee the following described real estate in . ----- $t_,_..1~r0 - - - - --
R[TURN TO
County, State of Wisconsin:
Tax Parcel No: ...................................
Part of the E 3 � of the NEk of Section 2, Township 28 Nor Ch,
Range 19 West, Town of Troy, St. Croix County, Wisconsin .
described as follows: Certified Survey Map, recorded June 5, 1975,
in Vol. 1, Page 132, as Doc. No. 327422.
.TR jNS
l FEE
This -- _iZ -- ------ ---- ------ homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And... .... St_ ephen _.S.._..Beckman.and._Lynette M_ ..Listner. .Beckman .._ ..... ........... .......
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
easements, restrictions and rights -of -way of record, if any.
and will warrant and defend the same.
Dated this ..r lath. day of ........ ......June --------- -- -- ---------------------- 1988.....
------- EAL) �.1 �Cl<Cli- 2464IA
Stephen S. Beckman ynette M, Lister Beckman
- - - -- -- - - - - - - -- ....... _...._. - -. ----
...... _-- - -- - - -- - - - -- - - -- (SEAL) ... _(SEAL)
' ------ ---- •-- -- - -- ---- - - -- -- -- -- - - - --- -- -- - - --- - ---_ - - - - -- '
AUTHENTICATION AG=NOWLEDGMENT
Signature(s) __ZteP_ ea- .S_..BeOkman- ,- _--- ___..__ STATE OF WISCONSIN
Lynette M. Listner Beckman e8 ,
-- -•--- ------ •- •------y - •------ - ---- -County.
authenticated this ..1 of ....... Jurle- •- - - - -- 198$- Personalty came before me this ._ -- ......day of
>,g ,e « -�,� r ----•--- ----••--- ....... .............1 19 ........ the above named
... --------
-- ------- -- -•---- ------ ----------------- ...
•... :. Kra sti.na-- Ogland- .Lundeen - - -- - -- - - - - - --
T ITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorised by § 906.06, Wis. State.) to me known to be the person ------------ who exocuted the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Kristina Ogland Lundeen -- -- - - -
Attorney at Law - - -- _ --
- -- --- ----- -- - ------- --- ---------- -- --- - -- --- --- -- da
otav Public .. - _County Wis.
(Signatures may be authenticated or acknowledged. Both n is permanent. (If not, state. exn;ration
are not necessary.
19 )
*Names of Demons signing in any capacity shou!d he typed — printed hcl,w thrir sjgj.:r r,..
WARRANTY DEED STATE BAR OF WISCON.;I-N tC =gy m ir. I Blank C,,. Inc,
FORM No. I — 19f ". )t i:.�ankye, wis.
1
327422
CERTIFIED SURVEY MAP
Part of the E 1/2 of the NE 1/4 of Section 2, Township 28 North,
Range 19 West, Town of Troy, St. Croix Co ty, Wisconsin
Dale Affolter
w
327422
° PO e
,o ov
0
1
?3 33 !� �► O
FILED
A �
°
h gD 1v yo eo'°v' � Z ,�p° CO dUN b 1975 71 it 2 64.61. ' �' AMES 01 CONNELL
1S) Register of Deeds
11 $t, Croix County,
W isconsin
O
a0 �
,C�iv& •54%.2 T,ZBN R! ?W
I �
S�
1 i
h
l
�1 33
�/ 90'iiobd i cf+ r0. �
2 V. 6Z' .�
0 Indicates iron pipe state weighing a
1.3 # /ft and 24" long. l o t
a�
2
Description: � � COR"«'� srs�• 2 - 28 -!?
That oertain parowl of land or tract of real estate located in
the E 1/2 of the NE 1/4 of Section 2, Township 28 North, Range
19 West, Town of Troy, St. Croix County, Wisconsin, more fully
described as follows: Commencing at the E 1/4 corner of said
Section 2, thence go N 00 00 00" E along the East line of said
Section 2 (assumed bearing) a distance of 898.96 feet to the
Point of Beginning of the parcel to be herein described: thence
continue N 00 008 00" E a distance of 638.38 Feet; thence
N 90 00' 00" W a distance of 526,30 feet; thence S 00 00' 00" E
a distance of 190.18 fee; thence N 90 00 00" E a distance of
254.66 feet- thence S 00 00 00" E a distance of 448.20 feet;
thence N 90 00 00" E a distance of 271.62 feet to the Point of
Beginning, the above described parcel containing 5.09 acres, more
or less, including the Easterly 33 fbet thereof presently used
for Town Road purposes.
Certification:
I, James L. Murphy, Registered Land Surveyor, do hereby certify
that by direction of the Owner, Dale Affolter, I have surveyed
and divided the lands shown hereon and that the map and description
shown hereon are a true and correct representation and description
of the lands as divided; and that I have complied with all the
provisions of Chapter 236.34 of the Wis. Statutes in surveying,
dividing, mapping and describing said lands.
Dated: 31 May 1975 '0�� \������►1i ►nrn n ,,�����
Ja L. AftfMy ••
egIst red L p ur
FALLS
Vol. i Page 132 , was
'
Cert i ire Su r ey ps c.
W � �•
St. Croix County, is. �,,, U``' '`�� ��.•
L • U
Vol. 1 ale 132 '���u�uiunuiinat�`" ,
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0t 1 .24/98 MON 12:42 FAX 715 386 1686 ST CRX CO ZONING g Z002
1
i ns& ST. CROIX COUNTY
all
.__`. =� WISCONSIN
+����" ZONING OFFICE
M a y" II - ST CROIX 0OU" GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016 -7710
SEPTIC rNS PECTIO (715) 386 -4680
/ WATER TEST REQUEST rORM
Please specify desired
applicatio test s
Out w ater lines are O appropriate fee with
winter months g access turned off during
, making to the home necessar
arrangements with this office to insure tha
t en Y- Please make
rY can be gained.
O Water (voCis)
Water (Nitrate & $185.00 septic
tr Water (Lead Concentration) $50.00
oncentration) 2100 0 Nitrate & Bacteria
Owner: .
T retest
�
;address ;ZY f1 [W
V 1 Requested by: I � p US I Olrl
Address: :2 &p, L�YIrIV
:Celeph �� CCth�li I�riv2f
ZTP 5 , . . L ('. . ZIP
Telephone NQ. �2' 09
L'roperty address (o
L'�ocation; (Fire F� & Streets 51oS 60 In F �� y��" 2`300
,P`F � F' i- i
he E /2 0 thel elf vo i . i
ealty firm• � X 32 - ,Seclh0x-1 2 , IT� rvvVY15hip
Lock Box Combo:
. Pe , ftn CnCtf —, Closing Date: S
C�y�- l ooms — z U - ooa 02 . 28 . 14, 17
.t3
PROVIDE A SKETCH OF g COMPLETED BY PROPERTY OgR
HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM*
Ater sample tap location:
a the dwelling currentl
F y occupied? YeS
vacant, date last p No
is of septic .sy
occupi : /A
stem: '�►
!ptic tank last pumped by:
ious Owner's Name(s): 6
n Date:
rl
I �'e an
f the
OY following been observed? g e Slow drains
OY Sewa from house,
e
❑Y Sewage dischar g ento dwelling.
UY Foul odors, ground surface of
road ditch.
O ler comments relative to s
ystem operation:
I E'rtify that the above informati
b� It: of m on y knowledge. is complete and true to the
OWNERS SIGNATURE: /P
I l
DATE:
sr
18
.— > c9
08!24/98 MON 12:43 FAX 715 386 4686 ST CR% CO ZONING 11 003
S ig cartt S o f
OWNERS WING -OF HOUSE & SEPTIC SYSTEM LOCATION =:Y
' l a /•
A
/yo us P Gavad f�
y TO BE COMPLETED BY INSPECTION AGENCY
System de ig n� & /or permit som file? Oyes, []No Soil seri p er,SCS Soil .Survey: sheet =;
t i
TyDe of soil absorption=:system 08elow grd OAt -Grd ❑Mound ='s l
Approx. size `X OGravity ' ❑Dose OPressurized
Ft.z 08ed- ❑Trench ❑Dry Well -
❑Holdingi -Tank OOutfall pipe:•'
OBSERVED DEFICIENCIES ❑Other OUnknown
Septic tank
Setbacks: Mouse ,0 ❑Prop: line ❑Other
Dose tank
Setbacks: ❑House Dwell DPirop. line 00ther
❑ ckin c ,.. Y..,
Mocking over � _... DWarnang• label ❑Pump /Floats
QAlarm = r; ; C3E -ea. .wiring
Soil Absorption + System
Setbacks: ❑House ❑Well ❑Prop..line Oother
OPondng ❑Discharge•
General comments-
..
INSPECTORS SKETCH OF SYSTEM LOCATION
N
' n /
Inspector
Title
iJ
I
i
08,:24/98 MON 12:05 FAX 1800 924 4548 FREEDOM MORT -TITLE ONE 191002
08/24/98 XON 12 :42 FAX 715 386 4686 ST CRI Co ZONING 002
COUNT Y
som �9 \t WISCONSIN
urr �¢ ! I ZONING OFFICE
T `NKa� l �1)t COUMY GOVERNMEWr CENT
! N ` 1101 C&M6% W Road
QuHy GOFg C@ f Hudson. WI 54016 -7710
(715) 386 -4580
SEPTIC IZTSPECTIO
T REQUEST FOVX
Please specify desired t
application. outside water & remit appropriate
"inter months lines are often fee with
arrangements with king access to the home tur Off during
this office to insure that c ent nece
make
=Y can be gained.
D Water (VOC,$)
1) Water (Nitrate 6 Bacteria) 51 X Septic
11 Plater (Lead Concentration,) Z 45.00
1 p 0 Nitrat � Bacteria
o
Owner retest _$15.0
� r h
Address: 1 n Requested by: 6
Address: a to 5• 5 eedQ171 .4Hr► .wYln V
Telephon W. (.Y1;L) _ ZZP (� L.C. 44f I�►'IV�i U
1 Telephone
Property address
L'ocation :,p¢ 0F'th�, E :2 Or f str eetl • GOV F=
�qd u �l°J3- 2$l0
th�iNE / N, d oI , i, P9 ; 32 ,Sech0 r) 2 n • —
fealty firm
' Lock Box Combo " lo
R�lhance� closing Date:
To
PROVIDE A SKETC OF $ °O pLBTE Y RO ERTY O —
HOUSE SEJ?Txc SySTE1x oN
titer sample to lot XVERSE OF THIS F0AM*
the dwelling ion;
vacant, date last ocee aiedu
l e of p1ed� Yes
se N /A No
ptic .system; z .�
!Ptic tank last pumped by:
'evious OWnerOS Name (s) ;
Date: 99 mrne
J ve an f the fol lowin g DY
OY Slow drainage from hous o Sewage Back - up into dwelling,
Dy Sewage discharg to ground surface o'r road ditch.
Foul odors.
0 t er comffients relative to SYstem operat
I ertify that the abo
b, t of m ve y knowledge. information is complete and true to the
OWI Z93 SjCMT�:
1 / I DATE:
• 08/24/98 MON 12:05 FAX 1800 324 4548 FREEDOM MORT -TITLE ONE IM003
08 /E4/98 MON 12 =43 FAX 715 386 4688 ST CRa CO ZONIN & 03
&6 Of thel Koug&
OWNERS :DRAWING OF HOUSE SEPTIC SYSTEM LO CAT Y OIi y° -,
iN
TO HE COMPLETED BY INSPECTION AGENCY
System deli n fi/. r permit ^aon *file? OYes, nNo ,
Sod 1 seri p er "SCS Soil,.Surveyc sheet -
..
Tvne of soil absorptient DBelow gr d OAt -6rd @found ='��
Approx. size 'X 13Gravity ODose OPressurized
- --
M. Med• OTrench ODry, Well
+OHoldi Tank UOutfall p i;
n4�• P O,,
-
OBr;r;R_v"SD DEFICIENMES OOther - Ounknown
Septic � anl� <<; = "= - - .... _. ��.�;,• - . - _ . • .
Setbacks: Mouse , OProp. line ❑Other
Dose tank
Setbacks:ORovse Dwell OP =op. line OOther
DLocking cavqr < .� , � Y; pwa rnin glabel - :, �p /Floats
mi , ' • ::; ArRee'. miring
Soil Absorption System
setbacks: OHouse dwell OProp. -line OOther
OPondiiiq : -- 7 = - ODischarge :
General continents
INSPECTORS SRSTCS OF SYSTEM LOCATION
Inspector
Title
v
0,8•/,24/98 MON 12:04 FAX 1800 324 4548 FREEDOM MORT -TITLE ONE 0{001
FirstPlus Freedom
• 2363 S. Foothill Drive
Salt Lake City, Utah 84109
Phone: (801)493 -2776
( m R Fax: (801)493 -2860
Walt ryl4 " {; � €1,1!1 .
T : — t o Fax: 64686
o S S .C County Zoning 715 38
From: Lynne Hansen Date: 08/24/98
Re: Septic Tank Inspection Cert. papas: 3
CC:
❑ Urgent ❑ For Review 13 Please Conwrie d ❑ Phase Reply ❑ Please Rws yde
• ,,f11 r',p'' • 14d 111 (I'11 q;Y,,NI • • • • • • •
,r, r
not sure if this is enough information to order the Septic Cert. and if you need the
-I, ,{ , lit I•, r !�V'�h i+;, rfb�i'h'" 1'l� {,,�, ,,'Ur• ; II
! " + {' E { + you can complete it or if you could bill the mortgage company, Could you please
{ ` l i }14 { il' n { € €�'i!jl {Ur q {VI}�` €,,,+; ,; ,. �i r•q rr,
tr(8bl)493 -2776 to clarify the above information for me at your earliest convenience,
O
you for your help in this matter.
l
Lynne
I
+t . . . . . . . . . . . . . . . . . . . . . . .
„,I,r r ,,,,.� �,IiA,r.y..r,rrz,., lr�'; + +1. +,�.,�
FAX
ST. CROIX COUNTY ZONING OFFICE
1101 Carmichael Road
Hudson, WI 54016
(715) 386 -4680
DATE: q
TO: Fax Number: Q () 4 ` 1 J — 2-9�, o
Name: y1
FROM: Fax Number. 386 -4686
Name: `� Q
Number of Pages Including Cover Sheep
IF COMPLETE AND LEGIBLE INFORMATION IS NOT RECEIVED, PLEASE
CONTACT:
NAME: �awn��
TELEPHONE NUMBER: _ _ b lis)
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
r r x N x x ST. CROIX COUNTY GOVERNMENT CENTER
Nou d 1101 Carmichael Road
Hudson, WI 54016 -7710
(715) 386 -4680
September 3, 1998
Attn: Lynne
First Plus Freedom
2362 S. Foothill Dr.
Salt Lake City, Utah 84109
RE: Septic Inspection, Mc Elwain property
Dear Lynne:
On September 3, 1998, an inspection of the septic system on the
Melbern & Kathryn Mc Elwain property 568 C. T. H. "U ", Hudson,
Wisconsin, was conducted.
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 the system not
discoverable 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. It was
noted that the inspection vent on the septic tank is approximately
6 ft. from the edge of a turnaround that is part of the driveway.
Care should be taken not to travel over the tank.
Should you have any questions, please contact this office.
Sincerely,
Mary � Jenkins
Assistant Zoning Administrator
c: File
1