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040-1025-10-000
C, I CD N y a Oq N I a) N Qr O ° C O N rn y d CL a) O N' O CD `- O c Ua � a) O_7 (D a) c 10 > 'Q X !0 CL N 3 O E ` N N a N c .. C .. p cC O Z > C Z M V C L f m o LL 0 a) LL O H O m c 3 v y a o v o L a E Q y = Q oC� d � I I CL 3 v y I ° Ix iir z I rn w E E Z r o I _ o I o 0 Z € v -o ao m m m m ? N a m a m > f0 0 Z a c m z a P o cr y �' a) O >N d O d N N O O CL O y o • �! O a) N O N (I � a :` O a � O O ' z° = z ° zmz :! c I N y , ° y w :: x LA m E 0 LO LA m oaf w o a ,°,, (D 3 G O a` a o v a` a ai E CL E `n) 000 a (0000 a N •►� 4i eaaa ocean. a o a 7 o N 0 0 00 co CD o v o ° E oo O rn = o U m •- c d m y c �p7� rn (D y y LA y 3 QI A U) f0 ° d Q } (n Op N C Q C C E 1V p O O O LL O O U 0) O) N O - —to U `Q N O 0 C C f0 l4 G N pp a 0 C m y O �17 m aO U) a) C C w '� p )° ~ y N V Z (X, a) C a) O O O •= 3i �, > > L N o o(6 0) o Z Q r- o Z 1- O da € a M L: a � I 0 m U RECEIVED ST. CROIX COUNTY ZONING OFFICE JAN 2 8 2010 CERTIFICATION STATEMENT sr. CROIX COUNTY FOR UTILIZATION OF EXISTING SEPTIC TA ING & ZONING OFFICE This is to certify that I have inspected the existing septic and/or dose tank presently serving the following, residence: - Z (Street address) i 7 '- I z located at: ', ' 1 14, Section _ , Town Range - W, Town of r~ o , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service S ewl � I ' p �, b��- Did flow back occur from absorption system? Yes No T X (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacit I Construction: Prefab Concrete X_ Steel Other Manufacturer (if known): (j)r Spr- C'on(,- Age of Tank (if known): Pe umber (if known) �.DPrin�i� ©1 7 recdrd (Licensed Plumber Signature) (Print Name) (Title) (License Number)` /MPRS (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 Wiscopsin,Department of Commerce County: Safety'and Aiding Division PRIVATE SEWAGE SYSTEM St. Croix (0,; INSPECTION INSPECTION REPORT Sanitary Permit No: 515181 0 GENERAL INFORMATION _J %lp (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: U.S. Bank National Association I Troy, Town of 040- 1025 -10 -000 CST BM Elev: Insp. Eley: BM Description OA Sectionfrown /RangelMap No: L 06.28.19.83E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER WAXI CAPACITY STATION BS HI FS ELE1(. Septic � — • 1 1 / T Benchmark Ik 7 , /bZ iti r'� �i S G . s ' Alt. BM k 3 • �Z . Aeration n � � Bldg. Sewer o � .5 Holding St/Ht Inlet / TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL b BLDG. Air Intake ROAD 04dnlet- (,J 5 sew.. S eptic �'1 - 7 - 8 I tp (Q Dt Bottom , Q J ' / q • v G i / Header /Man. 1 . . S/� O J I g 2_ 6 O _ �F Aeration $� Dist. Pipe 9 7-a 9 '73 -'Z 7 Holding Bot. System � e/ inal Grade Z' Q PUMP /SIPHON INFORMATION 1i 1 3- Le /o Manufacturer Dem and St Cover S • ( /L Model Number D • � 9 ' � T TDH Lift Friction Loss System Head Ft T Q O ' 73 . Forcemain Length Dia. Dist. to Well 92 Z <Ok— Q SOIL ABSORPTION SYSTEM W 'T' SS T Z • AD BED /TRENCH Width / Length IN o. Of Trenches PIT PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 yy E� Tee _-- SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacture= i INFORMATION L f CHAMBER OR ` Typ P f System'. " C o , UNIT Model Number: DISTRIBUTION SYSTEM t V Header /Manifokt // Distribution x Hole Size x Hole Spacing Vent t A I take 1 Pipe(s) �� r Length Dia Length Dia Spacing �' �• „� I�r �D r� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only �� e Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Z Bed/Trench Edges 1 TYes ❑ No L j-�s No i COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 376 Tower Rd. Hudsgn, WI 54016 (SW 1/4 NE 1/4 6 T28N R1 9W) metes & bounds Lot Parcel No: 06.28.19.83F 1.) Alt BM Description = Ga c� 2.) Bldg sewer length = - amount of cover = Plan revision Required?[] o I� � T Use other side for additional information. _. —_ Date Insepctor's Si nature Cert. No. SBD -6710 (R.3/97) 0017 marceml.gOV Safety and Buildings Division COY 201 W. Washington Ave., P.O_ Box 7162 s a sco n s i n Madison, Wl 53707 -7162 Sanitary Permit Number 06 be filled in by Co.) Department Of ComnfCTCC 5 / Sanitary Permit Application State Transaction Number a In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission ofthis form to the oa a 4•' unit is required prior to obtaining a sanitary permit. Note: Application forms for woe WTS aze Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide tray �ced:fer�eeead�y" 7'w� purposes in accordance with the Privacy Law, s. 15.04(1 xm), Slats_ � 4 L Application Information — Please Print All Inf tion 4 RE C E IVED .S a 0 Property Owner's Name Parcel # 0CT 2 7 2009 D � 10--tpa Property ') Owwner's Mailing Address j� LANNING OFFICE Property Location / 6 To w k1 \ RO G, ZONING Govt Lot P &ZONING City, State Zip Code Phone Number r/s, Section ky �d/V y N; R E circle oneA W ` � V� °� O � II. Type of Building (check all that apply) T A or 2 Family Dwelling —Number of Be ooms Subdivision Name Block # ❑ Public /Commercial — Describe Use ❑ City of ❑ State Owned — Describe Use I ! ` CSM Number ❑ Village of / �iK�L� «t+G`1.. �- X T( j � � O ! Y III. Type of Permit: (Checitonly one box on line A. Complete line B if applicable) A ❑ New System XReplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New last Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) t L X Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At- Crrade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24m' of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application te(gpdsf) Dispersal Area Required Dispersal Area Pr sed (sf) System Elevation 60 ff , F57 ) �` " - , VL Tank Info Capacity in Total # of Manufacturer y Gallons Gallons Units a � ° o '°„ � New Tanks Existing Tanks � /� m d p asll.l U Fn y w C7 W Septic or37alsenk �( J) / / Dosing Chamber / ` 1 VIL Responsibility Statement- I , the undersigned, yxMne responsibuity for installation of the PATS shown on the attached plans. Plumber's Name (Print Pl s Signature MP /MPRS Number Business Phone Nuummb 71r .1 (!/U Plumber's Address (Str eet 1 i(y State, Zip Code) 7 1I d Coun /De artment Use Onl Permit Fee Date Issued Issuing Signature Approved ❑ ed $ 475, ❑ ven Real rfor Denial �� Z DL Condi ' easons for Disapproval 3� I .�. v G �. �.� ��-: ,moo/.. r 1. Septic tank, effluent filter and' dispersal cell must all be services / maintained r Wn — C6 ,r LJ:5 - AJ G)s 3 �'1 A �j � L. , as per management plan provided by plumber. ✓ 2. All setback requirements must be maintained Attach to complete plans for the system and submit to the County only on paper not less than 81/1 it 11 inches in size SBD -6398 (R. 02/09) Valid thru 02/11 Plot Plana _ Page 3 of l Property Owner %t1 UKAAtS 'T I nA oTit x !� s Safi .1 s I = 40 ft Legal Description s w '/LA a,= rt �� /, s c� , (except where noted) Tz$si, T-,- igw . Off- I-M T. Mo, cps = Backhoe pit w�� �o� �►a . b � �AN� ��f `. North V.7DOD5 ( N) 3x46` , (RENC , � ES M .�Q a. 1 -k $ebT-mo^e Swett we Site Location: �p� ;_�C]c0 PY Plot Plan = Page 3 of y Property Owner 7f1UKVlt 'TIVXOTttY 3icyc;,: sue, SaN Z -AsUJ 1 " = 40 ft Legal Description s w t/Li o t= � � �3 � `1 ` s i ; (except where noted) 72$k), r{ ►gvj . T , or- 71--04 S T. CRui)c QA,0TY. = Backhoe pat was corJ su1. North - 72 A �R�s �„7DOD S (N) 3xNb� �{RgNC ^E � n a�CtNc vPJ� �. E 4C a W SW-- Tt rs�- dot e�a�so Et_ Qx �o 9 -0 Et -�pso� ptlT - � 0 Th'�K co�tE2 'CiM * 7- J Q`' r � y BEbRaa� � we4,x�uc y Site Location: X RPM f V 0 Wisconsin Department of SOIL EVALUATION REPORT Page 1 o f 3 Division of Safety and Buildings in accordance with Comm 85, VYs. Adm. Code County ST. CROIX 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 pares I. 04 - 1025 - 10 - 000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Wicirmation. Revie by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). �d Z7 Property Owner y/ E roperty Location TIMOTHY J. & KERI J. THURMES (Buyer: J� �i) Govt. Lot ""- SW 114 NE 1/4 S 6 T 28 N R 19 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name CSM# 376 Tower Road OCT 2 t °7 2009 -- -- -- City State Zip Code Phone Number s� vow E ity ❑ Hudson, F Yllage ■Town Nearest Road WI 54014 ( P),ANW & ZONING Tower Road New Construction Used Residential / Number of bedrooms 4 Code derived design flow rate 6 00 GPD 0 Replacement ❑ Public or commercial - Describe: Parent material sandy outwash Flood Plain elevation if applicable General comments 1 - g Conventional in-ground trenches -- 0.7 loading and reco��ndptons: f �/ ��V// ' "" ' " � 5 �''^"'' � � 5 fie°""- t n�-a �j a .�•�.5 E Boring # ❑ Boring spit Ground surface elev. 100.00 ft. Depth to limiting factor 100 in. Sal Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I 'Eff#2 1 0 -3 7.5YR2.5/1 1 3fabk mvfr cw 3vf-m 0.6 0.8 2 3 -15 7.5YR2.5/1 - I 2f -msbk mvfr cs 2vf-co 0.6 0.8 3 15 -19 7.5YR3/2 - sil 2f -msbk mfr cs 2vf-co 0.6 0.8 4 19 -36 7.5YR3/4 — sicl 2fabk mft as 2vf-m 0.4 0.6 5 36 -38 7.5YR3/4 — Is Osg dl aw lvf-m 0.7 1.6 6 38 -100 7.5YR4/4 — s Osg ml -- -- 0.7 1.6 Some gr; few cobs. 2 Boring # Borin 97.50 89 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -9 7.5YR2.5/1 - 1 3fabk mvfr cs 3vf-m 0.6 0.8 2 9 -21 7.5YR3/4 - is Osg ml cs 2vf -co 0.7 1.6 3 21 -89 7.5YR4/4 -- s Osg dl -- __ 0.7 1.6 S ome gr; cobs UD ft ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 rrg& ' Effluent #2 = BOD < 30 ng/L and TSS < 30 mg/L CST Name (Please Print) — — ature CST Number Ma Jo Hu rt Hollister's Soil Testing & Design) i 224832 Address Date EWUation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 10-22-09 (715) 426 - 1775 t Property Owner THURMES, Tim (Buyer: Swenson) Parcel ID # 040 - 1025 - 10 - 000 Page 2 of 3 3 Bo Boring nes # Pit Ground surface elev. 94.30 96 ft. Depth to limiting factor M. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 1 0 -6 7.5YR2.5/1 -- I 3fabk &gr mvfr cs 3vf-m 0.6 0.8 2 6 -13 1 7.5YR2.5/1 -- 1 2fabk&gr mvfr I as 2vf-co 0.6 0.8 3 13 -21 7.5YR3/4 -- is Osg dl cs 2vf-co 0.7 1.6 4 21 -96 7.5YR4/4 -_ s Osg ml -- 2vf -f 0.7 1.6 Some gr; few cobs. l� tl ❑ Bonng # � Boring Z 97.70 Pit Ground surface elev. ft. Depth to limiting factor 80 in. — SW — AWication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 04 7.5YR2.5/1 -- I 3fgr mvfr cs 3vf-m 0.6 0.8 2 4 -12 I 2f &abk mvfr as 2vf-co 0.6 0.8 3 12 -17 7.5YR3/2 -- is Osg dl cs 2vf-co 0.7 1.6 4 17 -80 7.5YR4/4 -- s Osg ml -- 2vf -f 0.7 1.6 some gr; few cobs. I � F-1 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mglt- and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. M- 8330Test (It07/00) Plot Plan for Site and Soil .Evaluation Page 3 of 3 Property Owner >HLMS t�.M ©t+►yc € k Sw n av - J - A-->a J 1 �� — 40 ft. Legal Description sw /y o TIC /44, S6 , (except where noted) tZ$N, jQW r far TM,4 ST, cxo%x co B = Backhoe pat wkSC s a = 1 -�AMr, Pc4 North Et, qy'� �SftN� vF� DBZ A04 G -9'�So EL 47. 70 � oU°� 6RO�*►aD 5v.R.ki� S� 3 I LO .�-�aK �ve.R g� #� 2 %�oZ -T�• !� J J P. � 4- r � y BEORaoM c� we4.wc Site Location: yi` !ZP �4 > - rOOSP, - FLOA D v Title Sheet for New Septic System Residential Application Conventional Septic System Owner's Name TiMOTfi y 9' K ER 11'h u wv��s (5UU- : ,-1AsaJ Address 37,�q To w EP, FD. g o so ,,. wT g Legal Description sw 'ly oF- THE N c'/4 s G. -rZSW, r? MIA) Township County ST• e - zOI x Subdivision Lot Number - Parcel LO. Number 690- 1 o 2-5 - 1 0 - 00 0 P /�t'►n Number; a., P Page 1. . � ........... ..........................Title Sheet Page 2 ......... ............................... Plan View Page 3 ......... ............................... Plot Plan s Page 4a b, e .. ............................... Maintenance Plan DesFg :. License Number 1 Date Phone Number L 42Jo - Signature Ain, tAv Design Information: In- Ground Component Manual SBD- 10705 -P/N. 0 1/0 11 Page of 'X 'q � ' I o � lb M, jv ? wA a o ' V TvspEeruvj ,emirs � ,� a�►'Lt}tvna� n.,,..ecar� �c�►�. ,� awe �� w1R.11i�a.G►t�s { a Mw: $ i3�t oonA sus n - b ©0 qCd /orals PER CI 410 _ 7 104d M 7 /5/ ti 20 C/SA g6 u�3 + 7 S OR - k44 W � yy uvn-s 7a > USED y � ,V �Z F 1 L7�` �� snZ i 13utJ WA 1 5 iu i�EfZ b HOLE eme- Z5TE ti t —2 II POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner ?I Fk�Mt35 TIMOTIt S tic Tank Capacity /25 al r3 NA Permit # J Septic Tank Manufacturer W l E5 ❑ NA Effluent Filter Manufacturer f 1 o k, ❑ NA DESIGN PARAMETERS Effluent Filter Model .� ❑ NA Number of Bedrooms 100 d/bedroom ❑ NA s Pump Tank Capacity al A9 NA Number of Commercial Units NA Tank Manufacturer NA Estimated flow (average)* 41 g al/day Manufacturer 91 NA Design flow (peak), estimated x 1.5* &60 g al/day Model 'o NA Soil Application Rate U. '`J ga l/day Pretreatment Unit N R C3 NA Influent/Effluent Quality (NAtZ) Monthly Average ** ❑ Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) < 30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODO < 220 mg/L [I Disinfection C3 Other: Total Suspended Solids (TSS) Manufacturer: Model: <_ 250 L Dispersal Cell(s) Pretreated Effluent Quality ❑ Monthly Average * ** Ff In- ground (gravity) ❑ In-ground (pressurized) Biochemical Oxygen Demand (BOD < 30 mg/L ❑ At -grade ❑ Mound Total Suspended Solids (TSS) < 30 mg/L ❑ Drip-line ❑ Other: Fecal Coliform (geometric mean) <10 cfu/100m1 ❑ Leaching Chamber Manufacturer Maximum Effluent Particle Size 1/8 inch diameter Model Laying Length/Chamber ' *Wastewater Flow Verification and Calculations: Soil Application Rate . gpd/ft Area Req. ft (Other than bedroom based) N A Infiltrative Surface/Chamber- ESIA Ratin 20 Minimum Number of Chambers ❑ Aggregate Design Flow/Loading Rate= fe min ** Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ** *Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA ❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.a1.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ❑ "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis — ASAE Publications 5 -77 and "Design Manual — Onsite Wastewater Treatment and Disposal Systems ". EPA 625/1 -80 -012 October 1980 ❑ SBD — 10570 —P (R.6/99) "At -Grade Component Manual Using Pressure Distribution" ❑ SBD — 10567 —P (R.6/99) "In Ground Absorption Component Manual" SBD — 10705 —P (N.01 101) "In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD — 10628 —P (N.6/99) "Recirculating Sand Filter System Component Manual" ❑ SBD — 10656 —P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572 —P (R.6/99) "Mound Component Manual" SBD - 10691 P (N.01 101) "Mound Component Manual" Version 2.0 ❑ SBD - 10595 —P (R.6/99) "Single Pass Sand Filter Component Manual" ❑ SBD - 10657 P (8.6/99) "Drip -line Effluent Disposal Component Manual" ❑ SBD - 10573 —P (R 6/99) "Pressure Distribution Component Manual" ❑ SBD - 10706 —P (N.01101) "Pressure Distribution Component Manual" Version 2.0 ❑ Drip -line Effluent Dispersal Component Manual for Multi -flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequenc Inspect condition of tank(s) At least once every ❑ months 3 Z s Maximum 3 P ump out contents of tank(s) When combined sludge and scum equals one -third 1/3) of tank volume Ins ect dispersal cells At least once every ❑ months 3 Ej- s Maximum 3 Clean effluent filter At least once eve ❑ months 0 year(s Inspect um controls &alarm At least once eve ❑ months ❑ s ®: NA Flush laterals and pressure test At least once eve C] months [3 e s — NA Valves At least once every ❑ months ❑ year(s) Or NA Other: At least once every ❑ months ❑ ye s NA Page_Y�of START UP For new construction, prior to use of the POWTS check treatment tank(s) 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. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water- saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized Toilet tissue is the only paper that should be discharged into the system Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. p Valves Valves shall be operated in the following manner: ❑ Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. INPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Septic Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) 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 NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. ❑ Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of any filters. Any service needs or repairs shall be promptly taken care of. - Ground Gravity Component Dispersal Cells The insp ection pe on shall include recording the levels of ndin if in the observation Po g, any n tubes and a visual inspection for any eviden of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page .0f� START UP For new construction, prior to use of the POWTS check treatment tank(s) 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. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimiz Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. p Valves Valves shall be operated in the following manner: Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. INFECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). (Septic Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) 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 NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. ❑ Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of any filters. Any service needs or repairs shall be promptly taken care of - Ground Gravity Component tY mpo Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75 %.of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page_!�A_of� p Mound, At- Grade, In -Ground Pressure on for any The inspection shall include recording the levels of ponding, if any in the observation tubes apdy inspecti evidence of surface seepage or discharge. Any discharge to the ground surface must b rom tl rted to the regulatory authority. Ponding greater than 75 of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an open at the of of each l ateral with multiple laterals should be a laterals should be flushed at least once every three (3) Yom u longevity f the system. ensure that equal distribution of effluent is occurring to promote the MP ORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code- - All piping to tanks and pits shall b 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, gravcl or other 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 replacement 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 b protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed strucdtre, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil 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. [3 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. ay be reconstructed in place following removal of the biomat at the infiltrative C3 Mound and at-grade soil absorption systems m surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> IC PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND /OR INSUFFICIENT SEPT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMS DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR R POSSIBLE. ADDITIONAL CO MMENTS POWTS INSTALLER POWTS MAINTAINER Name IDeANis +WW +"rT Name D . tS +l Phone Phone _ �� LOCAL REGULATORY AUTHORITY SEPTAGE SE VICING OPERATOR (Pumper) A en t e1Z0iX ZU�I��° Name TA/ -C'o u,u 1 X 3tA' i T* 1r' 0r/ g e 5 Phone X715 3 ' A13 Phone - 5l C K:XWPDATAW"0WT3 OWNWS MANUALdoc PagekLof2L £1133HS:3113 991ve - SZ2 -008 800Z 'Ndf n321 aooz kuvnNVr :3.Lva 09L49 Nn 'NOON N3alvH *OUMH Sn 9LL£M idnNdW 0LLd3S Z \ 1MS:1.8 NMVNO o :31va ON A38 j = 4 £:3lVOS \ 31b'130 bIMSINVO 831113 v) � p _J Q Q Q J W W O 0 U) I I F Q I— W W : W C)f 0 _1(~ U� W Z WQ U p U NN J r. l w W W i' N N Q LL a H Q d U N ° Y W O w J J / ° Q 1 W N W J NIW „8l W C) zo (/ ) ¢w = V J J a w w z o I Hg N N JUN JO_'t0 - uZ Z� UJ(nJ N EE :R < < 1 — 0 3�W ~mow o aQN of LA C) u d N L Q �� up ln5- Uo57I(? ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTff ICATION FORM Owner /Buyer R S e v\ S a !/, �J • 0 v�c�(/ �SSo�� a.�i c�✓\ Mailing Address "W t✓ LC Property Address S ",-A- f (Verification required from Planning & Zoning Department for new construction.) City /State 1 t^ � S d,,-, "'J A, Parcel Identification Number _ LEGAL DESCRIPTION p v Property Location' /s�, 1 /4, Sec. T �o N RW, Town of �`�o i Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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. Uwe, 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 Planning & Zoning Department within 30 days of the three year expiration date. 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of edrooms /6 oCi GNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) I hill{ 1{Ill IIIEI lull III{I IIIEI illl IIIIEI II {{ IIII * 9 0 1 4 5 5 1 SHERIFF'S 901 455 Document Number DEED BETH PABST REGISTER OF DEEDS Drafted by: Duncan C. Delhey ST. CROIX CO., WI RECEIVED FOR RECORD Return to: Gray & Associates, L.L.P. 08/05/2009 11:00AM Attorneys at Law SHERIFFS DEED 600 North Broadway EXEMPT s 14 Suite 300 c � REC FEE: 11.00 Milwaukee, WI 53202 CC FEE: 3.00 PAGES: 1 040- 1025 -10 -000 Parcel Identification Number RE: U.S. Bank NA v. Timothy J. Thurmes and Keri J. Thurmes, , Case No. 08- CV-664 Pursuant to a judgment of foreclosure entered in this matter, the subject premises was sold at auction to the highest and best bidder, U.S. Bank National Association, as Trustee, on behalf of the holders of the Credit Suisse First Boston Mortgage Securities Corp. CSMC Trust 2006 -CF3, CS Mortgage Pass- Through Certificates, Series 2006 -CF3. Therefore, the sheriff does hereby grant and convey unto said successful bidder, all of the following described land, located in the County of ST. CROIX, State of Wisconsin, to wit: A parcel of land located in the South % of Northeast ' /. of Section 6, Township 28 North, Range 19 West, described as follows: From the Northeast comer of said Section 6 go South 89° 03' West along the North line of Section 6 a distance of 1340.7 feet; thence South 0° 45' East a distance of 2684.1 feet to the centerline of the Town Road, the point of beginning for the parcel to be conveyed herein; thence South 89° 15' West along the centerline of said road a distance of 200.00 feet; thence North 0° 45' West a distance of 375.0 feet; thence North 89° 15' East along a line parallel to centerline of said Road a distance of 200.00 feet; thence South 0 45' a distance of 375.0 feet to the point of beginning. Said land being in the Town of Troy, County of St. Croix, State of Wisconsin. 14" It n. Y#Jk - '(Strike he inappropriate title) STATE OF WISCONSIN ) )ss COUNTY OF ST. CROIX ) n N Personally came before me this day of , 2009, the above -named boJ76 6 • A0151n,64 , personally known to me as the officer d b bove, and who executed this document as the sheriff or on behalf of the sheriff of this county. Notary Public ST. CROIX County, Wisconsin t n My commission expires: 1 of 1 CdMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 -3121 800 -962 -5227 FAX - 715 - 962 - 4030 w ST. CROIX ZONING REPORT NO.: 42656/01 PAGE i ST. CROIX COUNTY REPORT DATE: 6/10/93 COURTHOUSE HATE RECEIVED: 6/04/93 HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER: Mike Nelson LOCATION: 376 Tower Rd., Hudson COLLECTOR: M. Jenkins DATE COLLECTED: 6 -02 -93 TIME COLLECTED: 2:30pm SOURCE OF SAMPLE: Kitchen faucet DATE ANALYZED:6 -04 -93 TIRE ANALYZED :2 :00pm COLIFORM: 0 /100 ml INTERPRETATION: Bacteriologically SAFE NITRATE --N: 4 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. CoLiform Bacteria /100 ml Nitrate - Nitrogen, mg /L 1� 1 2 REC NE0 t , JUN 14 1993 cA ST CROIX COUNTY LAB TECHNICIAN: Pam Gane < 1 ZONINGOFFICE �. \NDFVEA/DfHj 9 1 r WI Approved Lab No. 19 Y V < Means "LESS THAN" Detectable Level Approved by: OO PROFESSIONAL LABORATORY SERVICES SINCE 1952 I RECEIVED ST. CROIX COUNTY ' � - N WISCONSIN ,� I MAY 2 4 '1993 � '.: ��,;� ~•• � ZONING OFFICE M" f ST CRO!X w ST. CROIX COUNTY COURTHOUSE .a COUNTY ZONINGOFFICE 11 FOURTH STREET • HUDSON, WI 54016 (715) 386 -4680 a, SEPTIC INSPECTION / WATER TEST REQUEST FORM 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 a time when entry can be g ined. ❑ ater (VOC's) $185.00 ❑Septic $25.00 ater (Nitrate & Bacteria) $35.00 (V sual inspection) Owner: Requested by: Addres 7`o Z4GP Address City & State: City & St. , Zip Code: M Code: Telephone N ( _)t�J� - �'�`,• u Telephone N (LZ� Property address ( Fire N' & Street) - 7 - [g Location: , ;, Sec. (P , T N, R W, Town of St. Croix Co., WI. Tax ID N Parcel ID House color: dealt _ CN y firm: ��� tf-✓ Lock Box Combo: Water sample t loca ion: TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Is the dwelling currently occupied? 0 Yes No If vacant, date last occupied :-!5__ — .Q6 -- 93 Septic system installed by: Year: Septic tank last serviced by: Date: ' Previous Owner's Names) : je 424 Have any of the following been observed? OY Slow drainage from house. ❑Y Sewage Back -up into dwelling. OY TAI Sewage discharge to ground surface, road ditch or body of water. OY _dN Slow drainage from the dwelling. OY Q� Foul odors. l Other comments relati )6e to system operation: I certify that the above information is complete and true to the best of my knowledge. , OWNERS SIGNATURE: DATE ` � 4/93 L - - Id ST. CROIX COUNTY r r WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 1 (715) 386 -4680 June 3, 1993 Mary Nasvik Edina Realty 700 - 2nd St. Hudson, WI 54016 Dear Ms. Nasvik: An inspection of the septic system on the property of Mike Nelson located at 376 Tower Rd. , Hudson, WI was conducted on June 2, 1993. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon 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. Should you have any questions, please contact this office. Sincerely, t Mary Jenkins Assistant Zoning Administrator cj OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION N �zlt X 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 ❑Below grd OAt -Grd OMound Approx. size ' X OGravity ❑Dose ❑Pressurized Ft.' OBed OTrench ODry Well Molding Tank OOutfall pipe OBSERVED DEFICIENCIES ❑Other OUnknown Septic tank Setbacks: ❑House OWell OProp. line ❑Other Dose tank Setbacks: ❑House OWell OProp. line ❑Other ❑Locking cover ❑Warning label ❑Pump /Floats ❑Alarm ❑Elec. wiring Soil Absorption System Setbacks: ❑House ❑Well OProp. line 00ther OPonding: ❑Discharge: General comments INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title -76 -Qd OKo /o- �. z - 3 ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54,016 Telephone - (715)386 -468 The St. Croix County Zoning Office t o ffers the s F f se ptic and water inspections to Lending I and private individuals. rn,entAtion of t his form is essential no that th�nrQDarty can be_ 1s�.dtS� • Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING--------------------- - - - - -- -FEE: $ 25.00 _- (For nitrates and coliform bacteria) FEE: $175.00 WATER TESTING (For VOC'S) --"" FEE: $25.00 S' 0 0 SEPTIC SYSTEM INSPECTION--- - ------ (Determines if system is properly functioning at t -me of inspection) 1,( Property owner's name M �'F inspection) ; ,b "� R e Property owner's address (0 8 c.A3 e e P of Legal Description 5 1A, o the X 1 /4 of Section Town of Lot Number Subdivision Name 1 ER Realty sign b house? a If so, list firm: Color of house Y 9 Y �'� -�-- PLEA8S INCLUDE, IF AT ALL POSSIBLE, A MAP, .e,COPY OF PLAT H K ^ WITH ATION §qOWN, A COPY OF THE LISTING SHEET. tin ofv esidential a sample that is fresh. Zf Tell g s the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual re uesting services: XD,L.��� A=4 Telephone Number - 2 REPORT TO BE SENT TO: �^ 2 _ u d i Clos ng date Signature Ile A ST. CROIX COUNTY '1 WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386 -4680 Aug. 10, 1990 Septhen Dunlap 1409 Coulee Rd., Box 285 Hudson, WI 54016 Dear Mr. Dunlap: On Aug. 9, 1990 we received a application for a septic inspection to be done. When I went to the property to do the inspection, I was told the inspection had already been done by another company. Therefore, I am return- ing your check in the amount of $25.00. If we can be of service to you in the future, please let us know. Sincerely, fJ James K. Thompson Assistant Zoning Administrator cj COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 -962 -3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.: 13627/01 PAGE i ST. CROIX COUNTY REPORT DATE. 11/12/91 COURTHOUSE DATE RECEIVED: 11/11/91 HUDSON, WI 54016 ATTN: THOMAS C. NELSON fR: Croixland Properties LOCATION: 376 Tower Rd., Hudson COLLECTOR: M. Jenkins SOURCE OF SAMPLE: Kitchen Faucet, Repeat COLIFORM: 0 /100 mt INTERPRETATION: Bacteriologically SAFE NITRATE -N: 4 ppm Above 10 ppm exceeds the recommended PubLic Drinking Water Standard. CoLiform Bacteria /100 ml Nitrate- Nitrogen, mg/L i j LAB TECHNICIAN: Pam Gane I WI Approved Lab No. 19 k- i i O �.ND [ V[Np 'N, � { Means "LESS THAN" Detectable Level Approved by: �� ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 11/12/91 16:05 $715 962 4030 COMM. TEST LAB S.C. CO CRTHOUSE Q 002 COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 426 Colfax, Wisconsin 54730 715.982 800. - 5227 I Q i ST. CROIX ZONINs REPORT X1.2 13627/01 ST. CROIX COUNrr PAGE 1 MATHOUSE ITT DATE! 11/12!91 DATE REC1:IVEDi 11 /ii /9i HUDSON, WI 54016 ATTN: THOMAS C. NEl.,, j I � OWNER: CroixLend Properties'; LOCATION; 376 'Toeer Rd.t Hudson i COLLECTOR.* M. Jolikins SOURCE OF SAMPLE+ Kitchen faucsf Reseal COLIFORM; 0 1100 ml i 1N1"MV - *' Batter i o Log ica L ly SAFE NI TRATE -N; 4 ppm AbOV* 10 Ppm exceeds the recomended Public Drinking !dater Standard. CaLiform Bacteria /100 el Nitrate - Nitrogen, mg/L,_ i LAB TECHNICIAN: Pam Gane WI APProved Lab No. 19 i i ��.woiPe� i V H � O Means "LESS 'THAN" Detectable Level Approved by: PROFESSIONAL LABORATORY SERVICES SINCE 1952 I OM�MERCIAL TESTING LABORATORY, INC. 4 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.: 13300/01 PAGE 1 ST, CROIX COUNTY REPORT DATE: 11/04/91 COURTHOUSE DATE RECEIVED: 10/31/91 HUDSON, WI 54016 ATTN: THOMAS C. NELSON I OWNER: Croixland Properties LOCATION: 376 Tower Rd., Hudson COLLECTOR: M. Jenkins I SCE OF SAMPLE. Kitchen faucet COLIFORM: 5 /100 of. INTERPRETATION: Bacteriologically UNSAFE NITRATE -N: 2 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria /100 ml Nitrate - Nitrogen, mg/L J LAB TECHNICIAM Pam Gane WI Approved Lab No. 19 V < Means "LESS THAN" Detectable Level Approved by: �► ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY ZONING OFFICE 824 4TH STREET HUDSON, Wl 54016 TELE'PHO;NE - (7 15) 386 -4680 The St. Croix County Zoning Office offers the service of septic; and water inspections. to Lending Institutions, Realty Firms, and private individuals. MP ompietion of this form is essent. a.l so that the property can be located. Please provi_(je the foliowi-n infor•mati.on, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will he done as soon as possible after fee and foram are received. WATER TESTING-------------- - - - - -- -FEE: 525.00 ( For nitrates and col:iform bacteria — (W ATER TES'T'ING FEE: \ (For VOC'S) SEPTI C, SYSTEM INSPECTION ---------- FEE: $25.00 X (Determines if system is properly functioning at time of i.nspect�.ion) Property Owner's Name Ll< o C311AA, PIca 1P G- %V \� Property Owner's Address 3 v, `� Z\ w S- I.,e;al. Descri.T -ti.on 1/4 of the 1_/4 of Section , T N / F;_ Town of Lot Number Subdivision Name FIRE NUMBER LOCK BOX NUMBER S - FYaw�� Color of house Realty; Sig n by House? @� If so, list f irm : Q'S PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i.e, COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTINIG: Many times water lines are turned off, or sill conks are turned off, makin access to the home necessary. If this i.s the case, please make proper arra.rigements with this office to ensure time when entry may be gained. Firm or individual requesting services: C_,\ -_\\ maw \Ce Telephone Number —38to- 3942 REPORT TO BE SENT TO: G�\� ►rte \\ �vy��Y t�to ��• \ �.1cr�� ix +�1. Closin Date II f � ' ^ A MEMBER OF THE SEARS FINANCIAL NETWORK DON SUIZOWATEY 1262ND STREET REALTY, INC. - sus 7151 8 BUS. (715) 386-8600 FAX (715) 386 -6741 730 376 TOWER ROAD {, A016 ,s .>Y p f PRICE: $109,000 — - --- ------ I_:ARGF; FAMILY HOUSE, NICELY DECOR,'ATF I) . AND PRIVATE BACK YARD. Y DIRECTIONS DIMENSIONS FEATURES Sot' TH ON F 'I'C) LR: 3 0 TOTAL SQ. FT: 2798 ti ;ER R0 DR: 8.1.0 N 10.10 HEAT: GAS F/A - IC,R'\1 T;I•:F'T GO KIT: 10.2 Y %2 AIR: N/A 3 39p. 1990 1/4 'TILE MBR: J -6. 1 1 12).11 TAXES: — 9 BR: 10.10 N 14.7 LOT: 1.89 FINANCING BR: 8.6 X 9.10 SIDING: CEDAR BR: 10.2 1 6 ,9 HEAT COSTS: 100.YR FH OR ANY FR: 14.8 X 22.8 APPLIANCES: RANGE C'ON I: [ I ON XL BATHS: DISHWASHER AND OVEN SCHOOL: HUDSON PRESENTED BY: GARAGE: 3 YEAR BUILT: 1988 DON SUKOWATEY • BROKER COLDWELL BANKER OFFICE: ( 715) 386 -3.942 Ir)formaticn i s I_� accurate but we METRO: (612) 436 -5515 accopt- r).o 1ia.b:i _ity for error. Listing mn. HOME: (715 386 -6790 hr' chaYi,yeci o r with out. notice. An Independently Owned and Operated Member of Coldwell Banker Residential Affiliates, Inc. r _ ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE r> . 911 FOURTH STREET • HUDSON, WI 54016 (715) 386 -4680 i r , r Oct. 30, 1991 Don Sukowatey Coldwell Banker 126 2nd St. Hudson, WI 54016 Dear Mr. Sukowatey: An inspection of the septic system on the property of Croixland, located at 376 Tower Rd., Hudson, WI, was conducted on Oct. 30, 1991. A water sample was also obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon 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. Si erely, P Ma Jenkins Assistant Zoning Administrator cj Note: The home is not presently occupied. Form - STC - 104 MOP AW AS BUILT SANITARY SYSTEM REPORT OWNER i Ez, TOWNSHIP SEC. T R�N-R��W ADDRESS 1P A Ril 3 -f0',ey A ST. CROIX COUNTY, WISCONSIN ua soN Wise— SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I.1LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ay' ,�• 'C /S L,I/V t- Aj E-A,CE No S c A,E' West Dry t vE w�Y Scac-'4 PRvPek-tY41NC INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used /" -1'9QA3 Elevation of vertical reference point: /00 ' Proposed slope at site: SEPTIC TANK: Manufacturer: (.J/d S'a Liquid Capacity: 60 aAI, Number of rings used: / Tank manhole cover elevation: M 022 J. Tank Inlet Elevation /a' Tank Outlet Elevation: �F6. q7 Number of feet from nearest Road: Front, Side,Rear, 0 /3c� feet From nearest property line Front,0 Side, Rear,O Slo feet Number of feet from: well 8o building: /S (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER a. Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: ���+++ Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: 919. 00 Trench: Width: (VIP Length: 35 Number of Lines:_ Area Built: 410'sy,P+, Fill depth to top of pipe: �, /7 7 Number of feet from nearest property line: Front, O Side, (Z)1ear,O Pt . Jr' b Number of feet from well: /g N-11 Number of feet from building: S3 (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one) . HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: ! fi Plumber on job: r License Number: ��/,E'/ZJ' .S�. C► �> 3/84:mj Parcel #: 040-1025-10-000 05/07/2014 02:10 PM PAGE 1 OF 1 Alt. Parcel#: 06.28.19.83F 040-TOWN OF TROY Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-SWENSON, JASON P&JANELL A JASON P&JANELL A SWENSON 376 TOWER RD HUDSON WI 54016 Property Address(es): *= Primary *376 TOWER RD Districts: SC=School SP=Special Type Dist# Description SC 2611 SCH DIST OF HUDSON SP 1700 WITC Notes: Legal Description: Acres: 1.720 SEC 6 T28N R19W PT S1/2 OF NE1/4 COM NE COR OF SEC 6;TH S 89'W 134Q.ZET:TH Parcel History: S 2684.1 FT TO POB;TH S89'W 200 FT'TH Date Doc# Vol/Page Type N 375 FT;TH N89'E 200 FT;TH S 375 FT / ( / 11/04/2009 906411 WD TO POB Cl/ V� 1 08/05/2009 901455 SD 1� 05/07/2003 720513 2234/33 WD 07/01/1993 501625 1019/192 WD more Plat: *=Primary Tract: (S-T-R 40%.160%,) Block/Condo Bldg: *N/A-NOT AVAILABLE 06-28N-19W 2014 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/12/2010 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.720 52,200 219,700 271,900 NO Totals for 2014: General Property 1.720 52,200 219,700 271,900 Woodland 0.000 0 0 Totals for 2013: General Property 1.720 52,200 219,700 271,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 310 Specials: User Special Code Category Amount I I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 XN CONVENTIONAL 1:1 ALTERNATIVE State Plan l.D.Number: ❑Holding Tank El In-Ground Pressure ❑Mound (If assigned)1 YX J NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTI61,rDArE: Tom Abel 166A Rt. 3, Tower Rd, Hudson, WI Al— g?l —z F BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT ELEV.. SE NE, Section 6, T28N—R19W, Town of Troy Name of Plumber. MP/MPRSW No County Sanitary Permit Number: Gary Zappa 3300 St. Croix 79204 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER • //�� C PROVI DED. PROVIDED. OYES ONO OYES kNO BEDDING VENT DIA.. VENT MATL HIGH WATER NUMBER©F ROAD'. PROPERTY WELL. BUILDING: VENT TO FRESH ALARM FEE,I,FROM LINE c2 C AIR INLET. E:1 YES NO \ ❑YES NO NEAREST ! �� U 8 U �/ DOSING CHAMBER: MANUFACTURER. BEDDING'. LIQUID CAPACITY PUMP M11111 1111MP,SIPHON MANUF ACTEIREH WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES NO ❑YES ONO I OYES FIND GALLONS PER CYCLE: 77ND CONTROLS OPERATIONAL E VN OPERTV WELL BUILDING JVENTTOFRESH (DIFFERENCE BETWEEN F" F flM E AIR INLET PUMP ON AND OFF) OYES ❑rM#jIlN(,TH EA 3? SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing IAMFTEH 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: WIDTH. LENGTH NO OF IDISTH PIPE SPACINIi COVER =IINSIIIE DIA zPITS LIQUID BED/TRENCH TRENCLAEES Mac RIAL DEPTH. DIMENSIONS 3 3 Ct; U 3 GRAVEL DEPTH FILL DEPT UISTH PIPE DISTR PIPE DISTR.PIPE MATERIAL NO DI,. R NUMBER OF WELL. BUILDING. VENT TO FRESH BE PIPE, A V VEH ELE V.f Fi E� 1����-2_� IPIPE NEARE.�A'OM IPROPERTY NEE AIR INLET: �p/V�►' FEET FROM ? MOUND SYSTEM: J Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PEHMANf N1 MARKERS OBSERVATION WELLS _ El ES ❑N _❑YES ONO DEPTH OVER TRENCH BED DEPTH OVER TRENCH AEU 1011`111 OE T1/P$DIL �SQDUEI S UFD MULCHED CENTER EDGES f` f Y'S YES NO DYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO.OF LATERAL ACING (] V DEPTH BE LOW PIPE- FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. DIMENSIONS j MANIFOLD PUMP MANIFOLD TR.PIPE MANIFOLD MATERIAL K-0-1 DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV.' DIA. ELEV. PIPES DIA.'. ELEVATION AND DISTDISTRIBUTION R DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORHECI LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED (� PLANS DYES El NO I OYES 1:1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER PROPERTY WELL: BUIG: FEET FROLI LDIN NE. OYES ❑NO ❑YE N /VO/ I Sketch System on Retain in county file for audit. Reverse Side. SIGNATURES.�� ./ qr_:�' TITLE. DILHR SBD 6710 (R.01/82) INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city,village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report,the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system,circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis.Adm. Code will be applicable. 10. A new permit will be needed if there is a change in,estimated wastewater flow, (number of bedrooms,etc.), location of the system, depth of the system,type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan,drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances,distances between beds if appropriate,tank locations,effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a ne w permit.Private sewage systems must be properly maintained.Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years.If you have questions concerning your system,contact your local code administrator or the Bureau of Plumbing,DILHR,State of Wisconsin. wlsconsln APPLICATION FOR SANITARY PERMIT ` / t OUNTY DILHR (PLB67) ��oevRRTmenT OF UNIFORM SANITARY/PERMIT# InOUSTRV,LRBOR&HUMRn RELRT1OnS 9 —Attach complete plans in accord with s. H 63.05,Wis.Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. r/ —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILI//NG ADDRESS _ 6� PROPERTY LOCATION- £irr: {-F� f1/4 -1/4, S , T , N, R E (or W Tow N OA'F:: .D LOT NUMBER IBLOCKNUMBER SUBDIVISION NAME NEAREST ROAD/LAKE O LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED I� It)r� 1 or 2 Family Number of Bedrooms: Public (Specify): THIS PERMIT IS FOR A: 9 New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. 54 Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total *of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): JIl ^ ® Private El Joint El Public 3 OA I,the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: /MPRSW No.7 Phone Number: CIA I r'� o ( S►3 Plumber's ddress: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved �� //Q�/ ❑ pproved Owner Given Initial A Adverse Determination Reason for Disapproval: Alternate course(s)of Action Available: DILHR-SBD-6398 (R.5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing,Owner,Plumber APPLICATION FOR SANITARY PERMIT 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 ,L � C Location of Property —X ;�-6 �4, Section T QcP N - R �_ W Township Mailing Address Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes - No Volume 1, and Page Number 16.1 as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTV OWNER CERTIFICATION I (We) ce4ti6y that aU statements on thi6 6o�cm cute tAue to the but of my (ouA) hnowtedge; that I (we) am (are) the owneA(s) o6 the ptopen ty descAibed in this in4onmation Sonm, by vi tue o6 a waAAanty XW-We d in the 066ice o6 .the County Regiz teA o4 Deeds as Document No. ; and that 1 (we) p4u entt y own the proposed 6 to bon the a ewag e poi at system (oA I (we) have obtained an easement, to tun with the above described pnopeAty, jon the co"tnuc ion o6 said system, and the came has been dut )L carded in the 0 6 6ice o4 the County Regi6tea o6 Deeds, ass Document No. ) . r".z y S SIGNATURE F° WNER SIGNATURE W6-OW (IF APPLICABLE) �!';`7' DATE SIGNED DATE SIGNED G' k' 3 r, i4 Ne •, r'!"��IlM���f1h'S*N.�L M �r��.�ir �Kiwi+�k wlya�a.yilp� l r " r YS 3 � N " • m H ` 9 ST C - 105 r <a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d 9 OWNER/BUYER ' O I3 AAr� H / to ROUTE/BOX NUMBER �T 3 / C, Fire Number CITY/STATE P)UL so,I'_ ZIP Syy�b PROPERTY LOCATION:5_!�_k, k, Section & T 1A N , R_Lj W, Town of St . Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment 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 systems properly maintained. The property owner agrees to submit to St . Croix County Zoning% a certification form, signed by the owner and by a master plumber, journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank. is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration . Ho E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SIGNED DATE St . Croix County Zoning Office P.0. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. OVE2 GOB To lvo Ark PAopaTY Z-z E /_L sLop Si5VSO,ti AZA14' S AL . 6 P9- as /,/,Z OT E C'r E—/oY3OGiaL .1'--PTsc TAn,K Tom /Y/3cL yo 1VE�vEVSTBM Is '�s" To wN ar- TtLo y /3pF AT ST_ Cnazx Co. &QSE DF TeLEPNavE PUE kL- * 7S&-7N/v I/-/A /'Arco ELV. =loaoo Top oc&.E �j�pOS£/] t�� �rSSDENU: P/ZOPDS-.® EAST PO.PEATY L.SNE SD GA&A6E i WEST PA&PERTY L2rvE J�E'PnopoSEO I.✓tlt /Vb TCA) r //76POSE0 O/aV FNAY SoLrrj4 PfwpERTY LINE �--GXrS1Z�G /�ITCFd SOS,. TESTSivb �y APPnovED vcAn- CAP //I�alrnu�P1 I fir/MOVE �'Z6ivEQ 5,A G.i,on l t Ct ivs a* Q DA-rE I 4AXztnum of 112'' Aaov,E /OE �-- To ATAAL Vn,ao►'c �i0nr1J �i�AY 6/t SI'MNETSC, Ccv�zN(, _ l/1N, 2" AGGAAGATE 60E IL /'1PE 1�S�E o 0 0 0 0 vAT=o,v AE o //scmL O -m PFD 6 A�Grl��pT� Tea /.3�0►,, M �?. F- 9—.Lev, �� 0 E � COU�L2Nb TE�=,,,p?Ytil� AT l3bT7r n OF .SY17�m • INSTRUCTIONS FOR COMPLETING FORM 116 S D - 6396 s� be a c rnplete and accurate sail test,your report must include; 1. Complete legal description; 2. The use section roast clearly indicate whether this is a residence or commercial project; 3, MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; S. Corrtplete the suitability rating boxes.A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; B. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagrarn accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; Lt. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Cornpl€ate all appropriate boxes as to dates, names,addresses, flood plain data, percolation test,exernp- ti in, it appropr late; 10, If the inforrnation (such as flood plain, elevatior;)does not apply, place N.A. in the appropriate box; 1 1. Sign the form and place your current address and your certification number; 12= iNlake legible, copies and dis-tribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY s,I,tITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR (;ERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols s _ Stone "C)air 10"; BR -- Bedrock COO -- Cobble (3- 10") SS — Sandstone gr --- Caravel (under 3") LS - Limestone �-s — Sand HGW — High Groundwater c"; Cozmesaf)dl Perc Pt cwati€rnRata r ed s — Medium 'S.md bN 9s Fine Sand Bldg - BUiidiV1g is _._ Loamy Sand ; Greater Than Is! - Sandy Lo,'im — Less Than -- Loam Bn - F3rcro,,s sil Silt Loam Ell Black si — Silt Gy — Garay ci clay sc l - S n dy ' L.=:,;a a R -.,. Boni sicl — Silty Clay Loath mot — Mottles sc - Saiady Clay wf - with sic - Silty Clay fIt few, line,faint 'c Clay cc cornmon, coarse- pi Pr =.t warn - Many, mediurn rn -- Muck d distinct p prominent HWL High water level, Six general soil textaares surface water for liquid waste disposal Bill — Bench Maroc VRP - Vertical Reference Point TO THE OWNER., This soil test report is the first r,tep in securing a sanitary permit.The county car the Department may request veii{ic,36ors of this sod test wl the field p!'loi to p�=snit issuance. A £.mrlr)lete set of plans for the private FV'VaOe Wsacrr'a and a p..,`"3l it �rE—d�llCatt�);)- r;3rivT be Sa;.ItrTiitt£.'-{t t{1 th{' e31)pl'i){7r(aLrrt (<'3C;al authority 3t"1 order to C fl,'.xa£1 i . .,.r€ne>. The sanilaat y pt'rrTIi t n€ust tie 0 bte ain� d anti pt)stOn o)I i 0 r t0 tale Start Of any e.,ta Pl 41;l"Uction. .l I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS IItlDU,ST4iY, DIVISION CAbOR AND LATIONS PERCOLATION TESTS (115) MADISON WI 7969 (H63.090)&Chapter 145.045) LO ATION: SECTION: TOWNS IP/MUNIetpAk! Y: LOT NO.:BLK.NO.: SUBDIVISIONNAME: 5� 1/ 1/ /T 2' N/R I E (o W T?Po _ COUNTY: O S 6NAME: �O L �A �T a t A vll 4, 46L, 031 // . # Pf 4V1 - a/ K �i//� . y USE DATES OBSERVATIONS MADE NO,BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence J �, * , New ❑Replace 1�t& 3-- y w ��r 3o V RATING:S=Site suitable for system U=Site unsuitable for system 5 "0� � S/ V CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) QS ❑U OS ❑U OS ❑U ❑S ©U 11 KU I 6*vociThIv41 /F'X,3C0 ` (3QIL . If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: el-4-S S Z I Floodplain,indicate Floodplain elevation: (rte PROFILE DESCRPPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DrE�PTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- /•� / OZ, 70 - 75 ' �,r' �"• S, �•O� a• S �i!1S !/.¢�, CS ' Tea / � 33 7 o 8-� io. ADO ' T�.J ep 5 . ,r. / , - , B,u . s , . s s , s 'Ta.v v,�.y CS B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P RI PER INCH P- / � • ` Z P_ w Ae 1*4v P- Z .� L P_ 7/ 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 00 770770,"o g �' 0 _ _ W _ — - I _ Reu" I ( F _ al"A Ills f esi Siie APPR VtD, �I tN . I ii � I 94 �_ 1 ; j,- m : r r 1L� ' e ,vim . I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative 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, HOMESITE SEPTIC PLUMBING CO. J04,0- 3 _ /I v `� ADDRESS: CERTIFICATION NUMBER`. UMBER(optional): ROBERT ULBRICHT WIS.MASTER PLUMBER LIC.NO.3307 MARI Z� Z PAP; MINN.INSTALLER&DESIGNER 11C.NO,00663 CST-SIGNATURE. DISTRIBUTION:Original and one co to Local Authority,Property Owner and Soil Tester. 9 copy Y, p Y DILHR-SBD-6395 (R.02/82) OVER — —_ _� CA ` C w sa�-co'N �om p° ,�°-vC" g O 3 �0 O CD ° r- 3 0 CD co o c c 3 3 m c m= N v m cD o o ► a w o wo � A' ,CD i 0 -om avi M I ° < � R r=Zoo o m Aa c IS O ° G to 3 S c � C C w O N w? 30Qo Q � 0 0 w ° � ° nm ' . p . ;OW. m� cv �O �< m N Q D(cc N Q D --CD CL �' m � S � a � ' ai C CA W M -i c Z m m »to � (D Co A N o co m D m �•• (DA 3 � CA ° n v, c m ° m O ? O V Q ca CD =r — A > a m �' ? ato °i N _ -Y -% CL C o * CD C m v .0 m O 5 w m _ � M c ( O a �D ic O Q _ CD Q M m \ ., O m 'O CD � cQ 3 cn 0 w Q `—' w n 0 tCA C = a N p m w cD w — CD A O Q QQp �a o m > �N Cr :3 ' MVip < mA CD n 3 m A O n Q ° oco a oN C l m Q cow a � m a c c cD _. o ..� 3 ° � 0 -.. 3 m CD O , p, 3 «r m v, 3' a o ry N �► _ (� r ° O `w I