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Parcel #: 040 - 1190 -80 -000 07/18/2006 08:46 AM
PAGE 1 OF 1
Alt. Parcel #: 4.28.19.846 040 - TOWN OF TROY
Current LX ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
CHRISM &SUZANNE MUELLER O - MUELLER, CHRIS M & SUZANNE
597 TOWER RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 597 TOWER RD
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 1.200 Plat: 2569- VALLEY VIEW HEIGHTS
SEC 4 T28N R1 9W LOT 7 VALLEY VIEW Block/Condo Bldg: LOT 07
HEIGHTS
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
04- 28N -19W
Notes: Parcel History:
Date Doc # Vol /Page Type
07/23/1997 971/04
2006 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.200 53,200 203,300 256,500 NO
Totals for 2006:
General Property 1.200 53,200 203,300 256,500
Woodland 0.000 0 0
Totals for 2005:
General Property 1.200 53,200 203,300 256,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 111
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total
0.00 0.00
0.00
• AS BUILT SANITARY SYSTEM REPORT
NER w ; r�/soly , TOWNSHIP ; s SEC. T N, R W
.0..ADDR SS , ST. CROIX TY, WISCONSIN.
l�uosoN � , •
;BDIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
• �a uSEC
PTIC TANK(S) /DOQ MFGR. CONCRETE STEEL
NO. of rings on cover er Depth (•• DRY WELL
ENCHES NO. of width length . area
; D no. of line 3 width lengt area
depth to top of pipe 36'
1GREGATE
tiRK RATE AREA REQUIRED 7 AREA AS BUILT y� _
sclaimer: The inspection of this system by St. Croix County does not imply complete
-mpliance.with State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no liability for
'stem operation. However, if failure is noted the County will make every effort to
wtermine cause of failure.
:EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
- INSEW&
DATED PLUMBER ON JOB
a
LICENSE NUMBER 33 y
j
f y
REPORT OF INSPECTION-- INDIVIDUAL SL74AGE DISPOSAL SYSTEM
Sanitary Permit
State Septic o
TOWNSHIP
St. Croix Couny
SRDTIC TA'?K
Size gallons. `umber of Compartments
Distance From: We 11 ft. 12% or greater slope #
Building z �. ft. Wetlands — f
r�
11ighwater _e— ft.
DISPOSAL SYSTEa 1Tile Field or Seepage Pit(s)
Distance From:•' jle tX.21 or greater slop fL
'� .'t y• ` Building (P& ft. Wetlands
F)WLD Xiphwate ' — _' ft s , ' . t a , . .
v Total length of lines 10 6 ft. N umber of lines � Length of
,y ach line 3 ft. Distance between lines ( 4 ft. Width of the
nch r. ft, Total absorption area sq. ft. Depth
of rock below the Z in. Depth of rock over tile in. Cover
over rock Depth of tile below grade _in. Slope of
trench in per 100 ft. Depth to Bedrock ft. Depth to
ground water — ft.
N
PITS
?lumber of pits diameter diameter ft. Depth below inlet
ft. Gravel a _y es no. Total absorption area
sq. ft.
Square feet of trench bottom area required
`'Square feet of see ge nit ar a required
/
Inspected ! Title:
Approved Date IJ 197,x.
Rejected Date 197_,
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State and County State Permit
.P . 7 Permit Application County Per #
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. O NER OF PROPERTY Mailing Address:
v I
Ae
B. CATION: A! r '/d ' %, Section , T R, E (or) W Lot# City
ubdivision Name, v nearest road, lake or landmark Blk# Village
tivD 5 Towns
C. TYPE • OCCUPANCY: Commercial *Industri *Other (specify) *Variance
Single family 4- Duplex No, of Bedrooms No. of Person
D. TYPE OF APPLIANC . Dishwasher YES NO Food Waste Grinder YES ! �O # of Bathrooms
Automatic Washer YES NO Other (specify)
E. SEPTIC TANK CAPACITY /,Qj2ro gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation / Addition Replacement _ Prefab Concrete
* Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) . Total Absorb Area sq. ft.
New Addition Replacement * Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches _
Seepage Bed: Length Widt Depth� Depth - No. of Lines ,
s r'
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land Distance from critical slope "
1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared
by the Certified S it T s r, / / / �
NAME C.S.T. # 6-5 __ and other information
obtained from (owner/builder). JJ//
Plumber's Signature J Mp MPRSW# = Phone # Yf' -O�a
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
fip
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a
Do Not Write in Space B elow FOR DEPARTMENT USE ONLY O
Date of Application 'v�/ Fee Paid: State /O, G' Cou Date -7 l
Permit Issue ded (date < Issuing Agent Name
Inspection Yes /LNo Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy)
� Revised Date 6/11/76
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Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y St. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar ,P�,rR�itNo.:
e Personal information you provice may be used for secondary purposes (Privacy Law, s 5.0,, (1)(m)]. J �Fyb3
MUeller, fins yeSuzanne ❑ City ❑ Vi4age 4 OWTlSn lp State Pl ID No.:
1l roo y t
CST BM Elev. - - / Insp. BM B Description: Elev.: M Diption: Parcel T
� � 648-- °1190 -80 -000
TANK INFORMATION ELEVATION DATA �d 8 -i9r SY
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic `5 nn Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic (off .Z NA Dt Bottom
Dosing NA Header/ Man. g 5 q5%
8- s
Aeration A Dist. Pipe 9S• sl
Hol Bot. System
PUMP / SIPHON INFORMATION Final Grade cll%
St
Manufacturer Demand
cover
0Q J r
Model Nu ber GPM D1►�✓�, vtr�uL e,. i'F_ dF G �S J , 't
TDH Lift Friction System TDH Ft ;� s,h �, 8 3 gQ(o
H ead
For ain Length Dist. To
SOIL ABSORPTION SYSTEM
DE430-AIRENW Width r Length f No Of rench PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS (og•1S Z es DIMENSION
SETBACK SYSTEM TO P / L BLDG WELL LAKE/ STREAM LEACHING M n ur r:
INFORMATION Type Of r r t CHAMBER Model N ber:
System: \/, $ -(- -r 30 D OR UNIT ' .-C
DISTRIBUTION SYSTEM
Header !Manifold tl Distribution Pipe(s) x �xHo�lespaclng Vent To Air Intake
Length Dia. ngth Dia. pace > ` jp r
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of TX[] x Seeded/ Sodded xx Mulched
Bed/ Trench Center Bed /Trench Edges Topsoil Yes ❑ No ❑ Yes ❑ No
COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: oaf/ f 57 Inspection #2:
Location: 597 597 Tower Road, Hudson, WI 54016 (SE 1/4 SE 1/4 4 T28N R19W) - 042819846 Valley View Heights -Lot 7
1.) Alt BM Description = N�/�
2.) Bldg sewer length = Z 3 r
- amount of cover = ?
Plan revision required? ❑ Yes 15J
Use other side for additional information. G /S w
SBD -6710 (R.3197) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
On n See reverse side for instructions for completing this application PO Box 7302
Personal information you provide may be used farsec,Qndary purposes Madison, WI 53707 -7302
Department of Commerce (Privacy Law, s. I5.(y4(if(m)] (Submit completed form to county if not
-. state owned.
Attach complete plans to the county copy only) fbpOeisyst6m, on paper not loss 14an 8 -1/2 x I 1 inches in size.
County State San' Permit Number 0,Chcckif revisigft us a tali State Plan 1. D. Num r
,.
I. Application Information - Please Print all Information `i _ Location:
Property Owner Name Vjj! 4 Property Location
si —1 Cj r -� �- SC 1/4
1/4, S T" ,N, R/ YE o W
Property Owner ss Mailing Address CH ss cj1 !,� � ft0 ' LotNumber Block Number
City, State Zip Code nC t I r ( Subdivision Name or CSM Number
II. Type of Building: (check one) ❑ city
❑ 1 or 2 Family Dwelling - No. of Bedrooms :_
❑ Village
❑ Public /Commercial (describe use):_ Tow
❑ State -Owned /
Nearest Road i-
/p.
Parcel Tax Number(s) _
III. T e of Permit: Che nl ox line A. Check box on line B if a licable - , t ° I . W.
A) 1. ❑ New 2. $Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
KNon pressurized In - ground It, w u' y ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
• • At -grad Pressurized In- ground C n FA< 1 S p t J N fry ❑ Aerobic Treatment Unit ❑ Single Pass 0 Drip
ciirculatin ❑ Other: the
V. Dispersal/Treatment Area Information: N-51 fJ W %T* F t t,T � u O d
1. Design Flow (gpd) 2. Disp Area 3. Dispersal 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
SO R- --- '_ �S Pte^^^ V17 GalsJda /s . it) (Min ✓inch) 9 Elevation clf�
VII. Tank Capacity in Total # of I Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete strutted
Tanks Tanks
s X000 0 ❑ ❑ ❑
Wi '�cSt
❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumbers Name Plumber's Sign (no MP/MPRS No. Business Phone Number
Plumbers Address (Street, City, State, Zip Cod
IX. County/Departt6ent Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps)
5tApproved ❑ Owner Given Initial Adverse Surcharge Fee) ro q /13[twc)
Determination low /"CC r
X. Conditions of Approval /Reasons for Disapproval: 2 l led i
O Orf 7e�} lG�jdXGt– S `e !�G �bt- �I ti.� +,•emu, o(� 'i �G✓ 11tiS
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Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567-P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number 3 - 7yq
Number of Bedrooms '
Design Flow - Peak (gpd)
Estimated Flow - Average (gpd)
Septic Tank Capacity (gal) i51SD
Soil Absorption Component Size (ft') - 1
Type of Wastewater Dom tic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) rt{ 3'7 7
Maximum Influent Particle Size (in) 1/8
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the septic tank and outlet filter shall be assessed at least
once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure
proper operation. The filter cartridge should not be removed unless provisions are made to
retain solids in the tank that may slough off the filter when removed from its enclosure. If the
Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
tank.
Manhole risers, access risers and covers should be inspected for water tightness and
soundness. Access openings used for service and assessment shall be sealed watertight upon
the completion of service. Any opening deemed unsound, defective, or subject to failure must
be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Component
Soil Absorption
onent p
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
2
Management Plan for a Septic Tank and Soil Absorption Component
Plantings of deep- rooted trees and shrubs directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
3
Y : Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3
Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code
A.C.E. Soil &Site Evaluations
Attach complete site plan on paper not less than 8'/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal ref ep:n BM), direction and _ St. Croix
percent slope, scale or dimensions, north arr �oc4atance to nearest road.
��/ / Parcel L 0- 1190 -80 -000 ID#4.28.19.846
APPLICANT INFORMATION - P print 1 infofMa"n.
, Revi wed By Date
Personal information you provide may be us fer Kbcond a rivacYtavJ & 15.04 (1) (m)). I- at
Property Owner ,; :- , Property Location
Chris &Suzanne Mueller - it a ovt. Lot SE 1/4 SE 1/4 S 4 T 28 N,R 19 W
Property Owner's Mailing Address i S f CROIx ' Lot # Block # Subd. Name or CSM#
597 Tower Road 7 Valley View Heights
City State `Zip,Cod6"hWQ tppr�er ❑ City E] Village ❑Town Nearest Road
Hudson WI � 4`' t 715- 386 - �'' Troy Tower
❑ New Construction Use: Rest N bedrooms 3 ❑Addition to existing building
❑ Replacement ❑ Public or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate 0 bed, gpd/ft .7 trench, gpd/ft
Absorption area required bed, ft 643 trench, ft Maximum design loading rate 0 bed, gpd/ft .7 trench, gpd/ft
Recommended infiltration surface elevation(s) 94.0'. ft (as referred to site plan benchmark)
Additional design / site considerations histall Bull run valve to allow future use of existing hydrolically failed system. Existing system elevation = 93.25'.
Parent material Glacial outwash Flood plain elevation, if applica ble na ft
S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system ® S El S [A U ❑ S El ®S ❑ U ❑ S ®U ❑ S ® U
SOIL DESCRIPTION REPORT
Boring# Horizon
Depth Dominant Color Mottles Structure GPD/ft
in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
1 1 0 -7 10yr3 /2 None sl 2fsbk mfr as 2f,lm - 0.5
2 7 -27 1Oyr4/4 None scl 2msbk mfr as Ifm - 0.4
Ground 3 27 -37 7.5yr4/6 None is lmsbk mvfr cw - - 0.7
elev -
99.68 ft 4 37 -54 7.5yr4/6 None s Osg ml gw - - 0.7
Depth to 5 54 -119 10yr6/4 None s Osg ml - - - 0.7
limiting
c
factor
>119" ro
Remarks:
2 1 0 -21 1Oyr2 /1 None sit 2fsbk mfr cs 2f,lm - 0.5
2 21 -30 1Oyr4/4 None sil 2msbk mfr cw lfin - 0.5
Ground 3 30 -38 7.5yr4/4 None scl 2msbk mfi cw - - 0.4
elev
98.87 ft 4 38 -54 7.5yr4/4 None A 2msbk mfr cw - - 0.5
Depth to 5 54 -88 A— 7.5yr4/6 None s Osg ml cs - - 0.7
limiting _
factor 6 88 -114 1Oyr6 /4 None s Osg ml - - 0.7
>114" `{, 1 4
Remarks: —
CST Name (Please Print) Sign re: Telephone No.
James K. Thompson 715- 248 -7767
Address A.C.E. Soil & Site Evaluations Date CST Number Ref #
340 Paulson Lake Lane, Osceola, 54020 7/22/00 3602 1269
PROPERTY OWNER. Chris & Suzanne Mueller SOIL DESCRIPTION REPORT 128s Page 2 of 3
PARCEL LDJ 040- 1190 - 80-000 ID#4.28.19.846 AC.E. Soil & Site Evaluations
Depth Dominant Color Mottles Structure nsistence Bounda ry Roots GPD"2
Horizon in Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Bed Trench
3 1 0 - 8 10yr3 /2 None sl 2fsbk mfr as 2f,lm - 0.5
2 8 - 14 1Oyr4/4 None A 2msbk mfr as ifm - 0.5
Ground
elev 3 14 -28 1Oyr4 /4 None sl 2msbk mvfr cw - - 0.5
98.34 ft 4 28 -49 7.5yr4/6 None s Osg ml gw - - 0.7
Depth to 5 49 -111 10yr6/4 None s Osg ml - - - 0.7
limiting
factor
Remarks: _
4 1 0 -9 10yr3 /2 None A 2fsbk mfr as 2f,1
27 9 -24 10yr4 /4 None scl 2msbk mfr 1 fm - 0.4
Ground
elev 3 24 -39 7.5yr4/6 None Is Imsbk cw - - 0.7
100.08 ft r5 I 39 -62 7.5yr4/6 None s Osg ml gw - - 0.7
Depth to 0yr6 /4 None s Osg ml - - - 0.7
limiting
factor
>120"
1 V�i5 1 ln6T► 6- c. v
Remarks: N -moo � �. t-t V4�t
o
Ground
elev
Depth to
limiting
factor
Remarks: _
Ground
elev
Depth to
limiting
factor
Remarks:
P� 3o{3
Scal / a VO
re5 � . �,�•�� ��d a er
-frees • D� ■ 5o;(Obsortm -�
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dc•i'Kwa 83
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Toy, SE . Croix Co., C,)i
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 C �� (z S -XO � N P. - 1 A
j residence located at:
Section V_, T N, R -f )(4, Town of
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: R o) U�� ��
Did flow back occur from absorption system?
Yes - `'`-� No (If no, skip next line)
Approximate volume or length of time: gallons minutes
Capacity: / UO O 5, Ia ";
Construction: Prefab Concrete �� Steel Other
Manufacturer: (If known):
Age of Tank (If known):
(Sig ature) (Name) Please print
(Title) (License Number)
-1 l oo
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).
o�
Name �1� �0����e���9� Signature ._ �� ` L;t�,�? ^�'� MP /MPRS � ��
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer l°B /'i_ 9 ��L C� MarJ.Ly
Mailing Address IO LI) P p &ad
r .
Property Address 1 >
(Verification required from Planning Department for new construction)
City/State J1 zj" /,Ik ,U If Parcel Identification Number 040-1/ -666
LEGAL DESCRIPTION
Property Location 5 t: - ' 1 / a, y 1 /., Sec. , T - N -R _W, 'Town of — rrD id
Subdivision , zuklii �� , Lot #
Certified Survey Map # . Volume , Page #
Warranty Deed # Volume ' Page # O 5L
Spec house ❑ yes ( no Lot lines identifiable O yes O no
SYSTEM MADTENANCE
Improper use and maintenanceof 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, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/31itli of sludge.
Uwe, the undersigned have read the above Mqugepts and agree to maintain the private sewage disposal system wrt6, dte standard:
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
expiration date.
SIGNATURE OF APPLICANT DATE
AWN R CERTIFICATION
j_(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 de ve, by v' a of a warranty deed recorded in Register of Deeds Office.
SIGNATURE 6F APPLICA _� 4d
DATE
• * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * *•
** Include with this applics n: 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
, I
DOCUMENT NO WARRANTY DEED � s >►��.c Rcatnvca ►nR wtcnnc:ac o^-^ '
' STATE BAR OF WI3CONSIN FOAM 2--1�
9'7
4886 -
vot 971ow 04
- - ��ICE
John d. Larson III and Judith K. Larson, REGI -
ST husband and wire as ,point tenants R
SEP 241992
�f conveys� t�a� r� ChV18 K. Mue1It'r And Sutaririe
(� %flle .Vs %usoarid and wife 1.00 A•
I
i' f
...... ... _... ... _N ,-•z C. I TITU INC',. -
_ P O. BOX 17268
ST. PAUL, MN 55117
the following described real estate in $t • CI'OiX County,
State of Wisconsin:
l
Tax Parcel No: . ............................
i
Lot 7, Valley View Heights in Town of Trcy, St. Croix County, I,
Wisconsin.
� II
jl is ;
This .- _ ........ . .... ------- homestead property. i
(is) (is not) I�
Exception to warranties: easements, restrictions and rights -of -way
of record, if any.
Dated t --- - ----- 1 - ------- day of . - -.._. August ' 19 92 I!
_.. .. ... ... -- ...... (SEAL) /G��� [/�-Lt ! " Gl /L`'otti. (SEAL) j
- -- - - - - -- hn - - - G Larson IIL_ _ -._... • ._. Judith K. La..rson 1
_ .... ..... ..... .I., --------- - - ...... . ..... ...(SEAL) (SERI.)
!�
AUTRUNTICATION ACHNOW LBDOI[BNT II
STATE OF it/ O'fld- I
sa
--- - - - - -- •-------------------------....- •- •---------------------- - - - - -• I
----County.
authenticated this day of 19- PP n before me / t�his4W7 of
....... ............... 19.4.92- the above named
.................................... -- ........................................
......................................................... ..............
........................................................... ............. - --- ------------------------------------------------------------ ---- - - ---- -- --
TITLE: MEMBER STATE BAR OF WISCONSIN I
(If not+ ---------- ------- --- -- --- •--- ---- -•-- --•- -- ------ - -•- i)
authorized by j 706 -06. Wis. StataJ - -•--- ---- --- ----•- ------ - ---•- ------ ------ --- -- - ••- i,
to me known to be the per-on 5- - who executed the
foregoing instrument ann 1'
THIS INSTRUMENT WAS DRAFTED BY DW TlETJE
........... I'i t na__OB� and. iarAFnplj" MnnEWrA
WUNTY
Attorney at Law
/i[rCllC..
I - --
. Notar Pub C_ nIsnin lon E" _ ' t' t
(Signatures may be authenticated or acknowledged. Both My
are not necessary.)
•Name of Persons **&tax in wa — so city should be typed or printed below their sismawres.
ii WARRANTY DEED STATE SAS OV WtSCONSIN Wisconsin Legal Blank Co.. Inc. I .
• FORM No. 2 — 1982 Mitwauk.,o. Wisconsin
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.gicacnita'
ST. CROIX COUNTY
».e , WISCONSIN M�
— —=- -`� ZONING OFFICE
ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016 -7710
(715) 386 -4680
SEPTIC INSPECTION / WATER TEST REQUEST FORM
T ease specify desired test(s) & remit appro e e
application. Outside water lines are often ed off, _Our
winter months, making access to the home neces Please ma
arrangements with this office to insure that a cftrB 6ggaipe
Water (VOC's) $185.00 11 S c G �0.00
J( Water (Nitrate & Bacteria) 45.00 11 Ni &Padteria
rete $ �5 0
a Zany
Owner: ue 1 1e - Reqested by: -5cime
Address: 6q7 Address:
&ds ak ZIP ZIP
Telephone NQ: () _333F6 -59 a Tpl phone N °: ( /S ) .3X(„
Property address ( Fire N & Stree 7 TouJCr /�cl
Location: - h' ;, Sec. , T N, R W, Town of
Realty firm: Lock Box Combo:_ Closing Date:
JLfo - 1 -- s 0 - 000 � 2-q I 'l `3 `V
TO BE COMPLETED BY PROPERTY OWNER
* PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM*
Water sample tap location: . 7�k,,, Sin- ?
Is the dwelling currently occupied? F It Yes 0 No
If vacant, date last occupied:
Age of septic system: /1�
Septic tank last pumped by: Date: to - 9f
Previous Owner's Name(s) : _ & hh hrs rn (97,
Have any of the following been observed?
❑Y gN Slow drainage from house.
❑Y JON Sewage Back -up into dwelling.
❑Y ,IAN Sewage discharge to ground surface or road ditch.
❑Y RN Foul odors.
Other comments relative to system operation: /bs�
I certify that the above information is complete and true to the
best of my knowledge.
OWNERS SIGNATURE: ` ' DATE: ;
1/94
f
OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION
I N
O
X
�U)ta
TO BE COMPLETED BY INSPECTION AGENCY
System design & /or permit on file? ❑Yes ❑No
Soil series per SCS Soil Survey: sheet #
Type of soil absorption system ❑Below grd ❑At -Grd ❑Mound
Approx. size 'X ❑Gravity ❑Dose ❑Pressurized
Ft. ❑Bed ❑Trench ❑Dry Well
Molding Tank ❑Outfall pipe
OBSERVED DEFICIENCIES ❑Other ❑Unknown
Septic tank
Setbacks: ❑House ❑Well ❑Prop. line ❑Other
Dose tank
Setbacks: ❑House ❑Well ❑Prop. line ❑Other
❑Locking cover ❑Warning label ❑Pump /Floats
❑Alarm ❑Elec. wiring
Soil Absorption System
Setbacks: ❑House ❑Well ❑Prop. line ❑Other
❑Ponding: ❑Discharge:
General comments
INSPECTORS SKETCH OF SYSTEM LOCATION
N
r
i
Inspector
Title
ST. CROIX COUNTY
., WISCONSIN
ZONING OFFICE
p N N p Nouni ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
- — ® Hudson, WI 54016 -7710
_ (715) 386 -4680
March 18, 1996
Chris & Suzanne Mueller
597 Tower Road
Hudson, WI 54016
Dear Mr. & Mrs. Mueller:
Enclosed please find the results of the water tests taken on your
property located at 597 Tower Road, Hudson, Wisconsin on February
26, 1996, and March 11, 1996.
Should you have any questions, please contact this office.
Sincerely,
Mary J. enkins
Assistant Zoning Administrator
Enclosures (2)
cc: File
i
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
.p
ST. CROIX COUNTY ZONING OFFICE: REPORT NO.! 13738/47 PAGE
ST.CROIX CTY GOV.CTR REPORT HATE: 3/14/96
1101 CARMICHAEL ROAD DATE RECEIVED: 3/12/96
HUDSON, WI 54016
ATTNS THOMAS C. NELSON
OWNER* Chris & Suzanne dueller
LOCATION: 597 Tower Road. Hudson
COLLECTORS M. Jenkins
DATE COLLECTED. 3 -11 -96
TIME COLLECTED: 324pm
SOURCE OF SAMPLES Kitchen tap
` NITRATE -NS 12 ppe
Above 10 ppm exceeds the recommended Public
Drinking Water Standard.
Nitrate- Nitrogen, mg /L
LABS TECHNICIANS Pam Gane
WI Approved Lab No. 19
Means "LESS THAN" Detectable Level approved by:
PROFESSIONAL LABORATORY SERVICES SINCE 1952
e
COMMERCIAL TESTING LABORATORY, II4C.'
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.'. 13008/03, PAGE
ST.CROIX CTY GOV.CTR REPORT DATE: 3 /01/96
1101 CARMICHAEL ROAD DATE F,'ECEIVEDS 2!27/96
HUDSON, WI 5404
ATTNS THOMAS C. NELSON
OWNER: Chris 6 Suzanne Mueller
LOCATION: 597 Tower Rd., Hudson
COLLECTORS M. JenPin5
DATE COLLECTED: 2 -26 -96
TIME GOLLECTEDS.. 3S450wa
SOURCE OF SAMPLE: Kilchen tap
DATE ANALYZED4'2 -27 -96
TIME ANALYZERS 2S00pm
COLIFORM,MFCC: 0 /100 ml
INTERPRETATIONS Bacterjologically SAFE
otiform Bacteria /100 mi
LAB TECHNICIANS Pam Gave
WI Approved Lab No. 19
{ Means "LESS THAN" Retectable Level Approved by!
1 PROFESSIONAL LABORATORY SERVICES SINCE 1952