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HomeMy WebLinkAbout040-1041-95-000 n ca O n~ O 3 'v 0 d _ 1 0 sr :E IM 0 '0 n I z z F z O D (n x y z o D o o W CO =r CD m CCD :3 CD N CD N A Q O ' y (OT .Oy.. OD - N rn CD m m 5' wo C: 7 m m m 'j O m~ O ^ N N 3 3 a; y _ \ 1 O m C O N CD A p N C COD f0 t0 A 0, O W O 3 a a 0 _ fD 3 O O O D fD O 7 N > > > y O O. C) 0 L7 z D m a z U? v D n z l e~ (D (D D to G - (D CO A 0 a C -p m W O v m m G7 'II N c c O O C C O. 00 0 0 0 3 0 - m l 3 O A a m CD W 0 f _ CL O N N a O 00 O O O c m m 0 0 c co) 0 r, 0 C CL l c y 3 a 000 000 ° "IVA ~ I c~_ 'o 0 0 0 1 0 o_ 'i o O ° ° m 3 3 N ~ 41 ''',I N N O D m D m m m m o m c m p c C: or~ CD a 3 3 0 3 CD m cn (Q -1 co 0 CL a ? `z o (n co co v oo m a co CL A z °o °0 3 A m y Z y ;u CD m a f w w v I I ~ my a Q N to o. c a CL c CD N) mm 3 7 N N N C W 7 0 m z a y z CD 0 a ° CD CD O N m = m~ ao o I dN° I a w a~ o w I ~ N I I ~ ti I I O O O CD ffl 0 69 0 A O O CD O a O L O ti Wiscqnsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515051 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Augustin, Lance Troy, Town of 040-1041-95-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: (1/\ , 09.28.19.139D1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t Benchmark Q"tmlr Alt. B ~1~. C.A~~-• / S Aeration t Bldg. Sewer Holding St/Ht Inlet , %J S t Outlet TANK SETBACK INFORMATION _jZ. , 1 Z. 9 S 5 Vent to Air Intake ROAD Dt Inlet ~Z 93 . SS TANK TO 41~L WELL BLDG. a'6 Septic Dt Bottom ~ Z ~ Header/Man. LL JZ.B`7 yZ.78 t 7 Aeration Dist. Pipe 1 Z. 8? X12 Z. ?S le 01 Holding Bot. System J3. T1 PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand Sts;pver iti ~L J' GPM Model Number J 6 F t TDH Lift Friction Loss Syste5Head3>f Forcemain Length Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 LOU Z Teo t ~y SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: 7W, INFORMATION CHAMBER OR RA' Typ Of System: i (*i ZQ UNIT Model Number: 6o*.Je a DISTRIBUTION SYSTEM sCA NW6+4 Header/Manifoy Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) \ Length a D Dia L~ Length ` Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded r Mulched Bed/Trench Center BedfTrench Edges Topsoil Yes Aj No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 404 N. Glover Rd. Hudson, WI 54016 (SE 114 SW 114 9 T28R19W) NA Lot 1 Parcel No: 09.28.19.139D1 1.) Alt BM Description lefewe_ of 2.) Bldg sewer length = / , L f - amount of cover = x 1 0*1• 1, l Plan revision Required? E° Yes No her side for additional information. % Use ot Date Insign re Cert. No. !YS SBD 6710 (R.3197) commercemi.gov Safety and Buildings Division county 201 W. Washington Ave., P.O. Box 7162 ~Yc Cy/j (C sco n in Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Comm ame 5/ 5 a51 Sanitary Permit Application State Trannsa 'on Number in accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental A// unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Projerpdrr (iliif~ than mailing ad~ss) submitted to the Department of Commerce. Personal information you provide may be used f ondary 1 purposes in accordance with the Privacy Law, s. 15.04(1 (m Stats. %JTG 1. Application Information - Please Print All I ormat n Property Owner's Name t / Parcel # u ~ PR 2 2009 D l -rope y Ow/neees-Mailing Addres , y IlG Property Location 10" 43 ~ 5( Jj A) Y er I?d, Govt. Lot C J City, State Zip Code one Number y~~ y., Section le on s ~f S 4 11. Type of Building (check all that apply) Lot # T N; R J,a(circ E W / Subdivision Name 2!14 or 2 Family Dwelling - Number of Bedroom lQ~ Block # ❑ Public/Commercial - Describe Use ❑ City of . ❑ Village of CSM Number ❑ State Owned -Describe Use f.Jl~V l0 C~VW MI~ ~p ZZZ. Town of ~4- B 111. Type of Permit: (Check only ne box on line A. Complete line B if applicable) ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) A. ❑ New System Waplacement System B. C1 Permit Renewal ❑ Permit Revision ❑ Change of Plumber List Previous Permit Number and Date Issued ❑ Permit Transfer to New Before Expiration Owner IV. T e of POWTS System/Component/Device: (Check all that apply) S r XNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: f / Design FloIgpd) Design Soil Ap lication Rate( sf) Dispersal Area Required y Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in otai # of Manufacturer Gallons Gallons Units U B New Tanks Existing Tanks ; n 0 w tj in y ti i:: C7 w Septic or Holding Tank t b / ~1 ( f r Dosing Chamber VII. Responsibility Statement- 1, the undersigned, ass me responsibility for installation of the POW 17S show the attached plans. Plumbe 's Name (Print) Plu Signature M P umber Business Phone Number P umber's dd__ s (Stre'et',Cily, tate, Zip. Code) - , up jLy VIII. Count /De artment Use Only Issuing nt SiWnatu K 1, pproved ❑ rsapprov Per,(miit Fee Date Issued A " J ❑n R. aaso tfecDenial $ I 75. yJ IX. Conditions of Approval/Reasons for Disapproval 1 . b~30,6 Kas b38'6.A 'er~t., 3l,lad ` 3 32x20- (~~C7 if - .5 Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 111 inches in size X51 s~ SBD-6398 (R. 01/07) Valid thru 01/09 VL,Ul YLH d a a e of ` Scale 1' =39 ' nb rn&<,, t re v~C~~ ~ 6 Q - • t for ~ l R1ti1►~1 O I.\SlT) G o D~-'pr1 N 1=1~„O D.3 V L~-g /rr 1 o s \%-M ~j 0 N ~_,A i S *3 ° T t~ D tD rirb s'` ~ l cn o o 0 O_ V 1111:...+___ rLUr rLe~a "ace o - ' Scale 1'=3C) ')Ab Lim f U3 a K) ~}~aU'C a ~neeS L~w~.t o ~X\S'~NG / G ~R 13p1 ~ ~ y O 4 4A Ste EY. \STt ~ G Copp 6t~t az °C ~ ~ GNP r `3oT 'ro S "E G - b~zly C- d 6 Qm.1w 2= o f b o ICL GKCEIVED SOIL EVALUATION REPORT Page of 3 ,V~iision sconsin of Safety and Department of Bui ings omme3rL`~' ` NOV 1 i%aonrdenceth Comm 85, Wis. Adm. Code Attach complete site pla on paper not less than 8 1/2 x 1 inches in size. Plan must County S~- ~A 1 x include, but not limited t : ve*pl Xrjgpiq%pjTqferen a point (BM), direction and Parcel I.D. percent slope, scale or imensiq@N%1g1®RpgL;and to lion and distance to nearest road. C) -M\ -0„s _ O(~ Please print all information. Revi Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). f cW Property Owner Property Location W L Mi CL • & S L 1/4 SW 1/4 S q T Z~ N R ~ g E (orf"VV Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# gT" OF L01- OF L-10 N . (SLJJV F-i)Z Zb prD - - Cswi 11\J vo X.1 t 2., z Z City State Zip Code Phone Number ❑City ❑ Village k] Town Nearest Road >J©RTA S0 kv1 S ~0) ('CIS) 3~~ X13 Z jZp~( G <o VIZ R1~ ❑ New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate GPD ® Replacement ❑ Public or commercial - Describe: Parent material 6 LP) C.11'r-l. ~tJ T f'~ 7 ki A Flood Plain elevation if applicable General comments and recommendations: O S +L-~2L. `1 i 7:2 (20 U eT,> Boring # ❑ Boring pit Ground surface elev. q. S ft. Depth to limiting factor L Z~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh• 'Eff#1 'Eff#2 Z- q -U I o H lZ 3l6 - s 1 1 cs (o h YV) r- c w - 3 $-S S ~.5~ ~!y `S o s rn I C►v - . -2 . Z SS-1Zo I Oy 2 V/L S o Sg n1 - Z L a Boring # ❑ Boring Q pit Ground surface elev. I ft. Depth to limiting factor 7 y in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o -1U ►o~~z3Lz - si i -Z~sb k C.w Z \A , S cw - ,S Z )0 3s )1 D LlZ-A - s~► 2*nsb YnA~ 3 s so ~s~~~cy s t eSb , +r cw _ 6 ' Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODs < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) SS'anature O CST Number Arthur L Wegerer oC t 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number. 421 hT. Hain St. River Falls, 141 54022 q-a-01 715-425-0165 i Property Owner F 1j G Us 1 Parcel ID # U (40 -1 b q) - q S - U Page Z. of Fa-1 Boring # ❑ Boring ® Pit Ground surface elev. ft. Depth to limiting factor 7 1 Z in. SoH Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft2 In. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 / 0-)1 104 r- 3 l z 6 k 1'Yl`Fh- c Zug' • s Z 1 1-~ I' 1 04Q 311, s j Zwt 4 blz hi 0-W ~ S 8 3 2-137- VA S o S9 M - L-Z F-L-/ I Q Boring # ❑ Boring Pit Ground surface elev. `~y• ft. Depth to limiting factor > < < 9 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 / D-13 1~~-tlZ 31 Z. - sr I Z`FSbl2 ►m ew Z •S - 8 z ~-~9 ~oyr~-3~b S ' I Zf~ sbk ln~... cw - .s . 8 3 y9-61, 7svtz 3~~ - I s o s ►11 I cw fib-~t9 talQ--Y/6 - S U s n1 - •1 Z F-1 Boring # ❑ Pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BODa < 30 mg/L and TSS < 30 m ' _ g/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. SBD.8330 (R.6/00) Property Owner Flu G US -1 Parcel ID # O L40 -1 UV ' -t S -()0(:) Page Z- of 5 Boring # ❑ Boring ® pit Ground surface elev. C~ q ft. Depth to limiting factor 7 I -In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 -Eff#2 / O -1 1 1011 1'2-3/Z S t( 2 `(1$ b k ~►1`Fh C~ Zug Z 11- 6 Z1 0`~ 12 3 LC S 1 Z wt S h k. Vwl ``~'1- CkJ - -S - 8 3 t- i3z o~ 1Z~16 - s O s - L. "Z F-L-/1 Boring # ❑ Boring Pit Ground surface elev. D, ft. Depth to limiting factor 1 1 9 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 -Eff#2 3 31 Z - - i I z` _S b k Vln ew Z • S - 8 Z-~L9 Joy~.3~b _ s ' I Zw1 sbk~h c1AJ - •s 8 3 q9-66 7,Sj2319, 1 s O S W1 Cw -'1 Z bb-~1q f0sfLVLb - s U s rvl - . -1 Z F-1 Boring # ❑ pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 'Eff#2 Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L - Effluent #2 = 130k < 30 mg/L and TSS < 30 mg/L ` The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD18330 (R.6/00) Wisconsin Department of Commerce SOIL EVALUATION REPORT y Division of Safety and Buildings Page of 3 in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County S~' e I.01 x include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 0 ` I O -M\ -CIS-O0p Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner ,p Property Location L fV)\) L~Z r'v V g~ S(- 1/4 S~t11/4 S q T Z N R LVII Property Owner's Mailing Address E (or lr Lot # Block # SuEN- ame or CSM# or- L~- QI Ci I-10 4 N. G COV ElZ. K.0 P - w j \~p l t 1 z -z Z tY State Zip Code Phone Number ❑ City ❑ Village kD Town Nearest Road >N)°1?T? ) 1>Soi)J Lv1 S~0)6 (-I IS) 3~(~_613Z 1 TZ•0`-( 6 Lp V ~Z T21~ ❑ New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate L~ S GPD ® Replacement ❑ Public or commercial - Describe: Parent material 6 P1 Cl R'l. C U 1' Flood Plain elevation if applicable IJ, . General comments ft Et> and recommendations: 5 C`_~ L 3 X 13 0' L yv j~j OF pr K ► )n(j M F3 or- co U eiZ 01~:~ 94.5 ' Boring # ❑ Boring ® pit Ground surface elev. C~ q. rJ ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Sal ApGPD/ft plication Rate z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I o -q t o ~t Q 3!z - L 2 6 k C W Z v~ . s . 8 Z C1 -q I H(Z3lb - sl I~~btz mV - cw - y 3 Ss?.S~riz~ly \S o s +n I ck, S S 1Zo / 07 2 Z Boring # - ❑ Boring ® pit Ground surface elev.) Z~ ft, Depth to limiting factor 7 ~q4 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 'In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 D -1p to~~31Z - si I ~~Qsb k ~'F~- cw Z )o-3s 1r)y 216 - s I Zsb cw - as-so I'sLi"ty 5Tj-kk-1k4 a, ' Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L . . CST Name (please Print) S' nature CST Number : Arthur L :.We- gerer O 3-t:1 6 . 220254 !Lh~_ - - - Address W e g e r e r So i 1 Testing & n e sign S e r v i c e Date Evaluation conducted Telephone Number, 421 N. Bain St. River Falls, WI 54022 715-425-0165 PLOT PLAIT Page 3 of 3 Scale 1' = 39 ' t for S ~IPIw•l 0 EFX,WDtjG y " o --~D Ttv-r13J ~=1 i 4 o ~ ~q 9 goo o o O 6 Prt az Q O j °U 1 Z4~~ ~ v r ',0 oT SC~I.E ivC L' MN)%Z~S 715-425-0165 220254 03- y ~ CST Signature Date Telephone No. CST No. Job NO. ~CA~ Q v II o II A . CL i d o v L. a) N W W c 4- 40- .M O a~ 10 n II a Q ~ III ~I , o II o s c w c U- O r1. . system Management Plan Pu suant to Comm 83.54, His.Adm. Code Sectic"Tank The septic tank shalfbe maintained by an individual certified to service septic tanks under s. M A8, ctme b ,.,,,,,r,,.,, „..L _ SGt9iie- t 5:i'o'~i b@ w.~kyvP or Ina wrdatits wl`h _ - - . w. W3 ma u1 U is - r-- - with NR 913, Wis. Adm. Cade. The operating condition of the septic bA and o ensm utlet p~ be ~7he 1t Est once ever/ 3 years by inspewion_ Tne outlet finer shall be deaned as necessary to ma midge should not be removed unless provisions are made to retain sofids in the tank thct y s3ough off the filter when removed Arms ~ e•.,4„...u,~ , th_ . the al^t;ri is ac fed continuously. UM v -11; ec mat an a+atr;t, the SitErSttetl be StnriCa if septic Mark 3W have its lttten rat filter alarms may khficate surge flows or an imlteruting bus alarm. The coatenti rernaved the lank. ~ ~e Chave t5 of ~e tank ate edwhen the vokime of sludge and w= in the tank exceeds M the Wd voluine of • removed at the tune the Ma mter t~E' %fte" now m _ vi pf a tr~ennt'af aSS ' " enL m rnt Mtnr p e..K...^..^»..°..~ a+: our we a+savrCe reeds 10 be pedomied to rnaktin less than ma arrmrt SCtnt and 04a 2CMMUdgan in ale tadL Odftm Of ~ [ ion logical or Chemical a=m to w ft= ge;ft tank pees is gehereellr not required. However. F such Wodtft am used they shag be approved for se* tank use the 0 by apartment of Commerce, safety and Purno Tank 'sits Pup (daft) tank shaft be irispec;ed at least mice every 3 years. Ali switches, aim=, and pMM shall be tedl d to Proper operat~n• ~n ~n„~,,.,,,,.,p~ ~ _ : N iii as Nf.1{ YJW!!rl Lie ranKi 8natt be tnspacted and serviced as necesmy- . ,At- rade Component and Pressure Distribution System o.trees.or a ru a a on e p ante or allowed to grow on the component: P acting- be made arefnnrt the _~..8y ~Qr Y@r..mmuzs and the component shall be seeded and'mulched as-necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the component is not allowed. Cold weather install- ations require the component to be heavily mulched -f r frnet nrnts..t4.._. Influent quality into the at-grade system may not exceed 220mg/L BODS, 150 mg/L TSS and 30 "A FOG, Influent flow may not exceed the maaimnm design flow specified in e,~ for this installation. the r n---;« The pressure . n sysle'n 4 provided with a flushing pokit at the end of eadi lateral. and a is hm~~~ lateral be *n W of a m,. wn„ds i once every 18 maifhs. When a Vessm leg mquW b =Mtda eq~ f w8liki kistelled the d1spersal to deternwx if once clogft has o~ gori6~ be is call. 9 . 0?+_ersatio;. YPes within the dispersal cell shall be'checked for effluent ponding. Pondang levels should be reported to the owner and any levels above k inches considered' as an impending hydraulic failure requiring additional, mote frequent monitoring in accordance with•Comm 83.52 (2). n!=Tcco,rdanr_P l be operated in accordance with Comm'82-84 Wis.Adm.Code and shall be with iteJ component manual SBD 105'!0-p•(8.6%99)-and -local and state rules pertaining to system maintenance and maintenance reporting.. NO 0110 4hMM QvW enter a soplic or pump tank since PUM abandgnm wo gases may be present that could use desii+< cep and ' - P01Af T5 COINU 83.33, Wis. Adm. Code when the Wft are no lunges used as 5 pan-'r-Q. Ueed for Service aw nses, risers and cower Should be : t;d 4wtess and srxamess. Access ~ shall be sealed wa Any operfq deened ttriMmd. dry, Or =APd to More must be of sarvka. be decided by an eve kioldag devke to Prevent acddmW or uneutafted s than "chain dameber shall entry into a tstdc or swunortent frthesepicwa n.anyafits =Mxnerft . • - won. ° defedve ttie tank orcamponert shd be mpidred or reeldCSd 10 12" the ` tf thte dostng tank; cMp=p m n -3k*1,, 2WM deft-we to ddecdva cor*cast *A orrSP.k=W a sa=oregWpwbmmgcL be the at-grade co`aipoaent-fails to accept'srastwat- __T c 3ina o disc rge waatew atei -replace -to ce the ompon comport,snt. it J necessary to lnatail as aerobic pie-treatment treatment unit or Additional site and &oil•evaluations may need to be done. and ` additional pl"s May-need to be prepared and apfroved by the Department of Comore*,- Safety and Buildings' Division. _ Questioaa ibout 'the operation-or maintenance of-this 8-7-3t x should-be direcetd to: The Cooaty/zoning office at -,-t lS _ 2rT3_ 6-7q-7 ` The system installer at 1 LS- UZS-- c1LSa , tit.3bQ ' _ The tank manufacturer at $pp- 3ZS_&4IS& _V%31 lam The effluent filter' manufacturer at &pQ ZZ,1. $7qZ Z!Mt V ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to cer . fy that I have inspected the septic tank presently serving the residence located at: S"E 1/a, 3k.) 1/4, Section , Town N, Range y W, Town of , St. Croix County Wisconsin. Upon - 7h id inspection, 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 service o 9 Did flow back occur from absorption system? Yes No ~c. (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: lbbl) Construction: Prefab Concrete k Steel Other Manufacturer (if known): Age of Tank (if known): (Licensed Plumber Signa e) (Print Name) (Title) (License Number) M /MPR (Dat Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) V1• Vl\V1L\\✓V V1\11 SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner uyer Q l1 C '46mdl~e Mailing Address 7 lover Property Address s '~tt e A P i e f2 (Verification required from Planning & Zoning Department for new construction.) 1 a City/State ~ An1'1 kt , Parcel Identification Number 4~W ,Q LEGAL DESCRIPTION r1 / ~ W, Town of Property Location '/4 , Sec. T N R / 1 Subdivision , Lot g 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe 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 bedrooms SIGNATUME 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) Unplatted land oa by R. Schultz ~y~\ O air c'oo ~ CERTIFIED SURVEY MAP 0 52 ,b0°' Go. 2 RICHARD SCHULTZ APPROVED , 9G~1p?>.. Nub. \ 4 ST ROI?; C^UNTY COMPe=i-,ENSW2 PARKS PLANNING AND ZONING COMMITTEE MAR 3 1976 oa a, \ A zP.CZ Al- F T" ;!S MINOR SUF.~DlVISION D - iv , i EAN r-' PPR.OVAL FOR SEPFICr ns g~\o~ Y5 M. RIA.F, R ; H 2.20 Q4R a. 976 Unplatted land owned by R. Schultz ` w cP o_ ~ 3~0 oFJ ~ZS dig ~I 3pt ~O$ Nom, Bearings based on ,~.Idoo South line of Section 9 assumed being due .~O Z East/West. 42 VI>. 1 5 orn~a~_ '3 ~~8• ~ 9 d 3 • o Indicates 24" long iron pipe stake weighing 1.13 #/ft. being" p 1" in diameter. a, 7p cNi► N 59026t34"E 344.65' V01.809 .u~~~~~apumrunhu~,~~~ Page 330 jib At e l r b i` o -T- I lbij JIM "10 P. o.B- OvF F S -1/4 Corner of S Sec.9-28-19 </neS c. 9 460T Part of the SW 1/4 of the SE 1/4 and the SE 1/4 of the 28•/9 SW 1/4 of Section 9, Townshl-p 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin 1 p e 222 Unplatted land Vol. ag owned by Others. 3 Certified Survey Maps, St. Croix County, Wisconsin (See reverse) 1 it tiI ' II G. II Ti..ss e~ACC RESCAYEO FOR RECORClNG DATA It oa.~Tc, fiAR O€ ~'iYISi;Oiv$iiv FvTT.Ivi I-i$fS~ii II WARRANTY DEED _ s',; 1~~~~ ~s~ __~I~ F2EGISTER'S O iCE I) I~-~~ ~ i cr rc~~w ..a ~ 1 ~h 11s5 D~Qd Wade between. R°~'~ fOC h~CO,-u it BOBf'P !f. EDMONDSON AND I~ li ' sAi►~a -c. EZ ~i~soN. sussaiin .ice ~I JUL 2 1993 II - _ Grantor, I gt 8:00 A M {I Lance 8. Augustin._ancf__~iane_L.__.August.in and.-- h husband--and- wife Reglater of Deeds I I Grantee, t; {I Ii Witnesseth, That the said Grantor, for a valuable consideration...... II TEN DOLLARS and other good and valuable consideratIon Ii ----..ST. CROI-------------- { conveys to Grantee the following described real estate in I Rerv Rn Tn County, SwLft of Wisconsin: - I) Tax Parcel No: I PORT OF THE SE 1/4 OF THE SW 1/4 AND PART OF THE SW 1/4 OF THE SE 1/4 OF SECTION II 9, TOWNSHIP 28 NORTH, RANGE 19 WEST, ST.CROIX COUNTY, WISCONSIN, DESCRIBED AS II ii FOLLOWS: LOT 1 OF CERTIFIED SURVEY MAP FILED MARCH 11, 19?b IN VOLUME 1, PAGE 222, AS CORRECTED BY DOCUMENT NUMBER 438812 RECORDED IN VOLUME 809, PAGE 330, ST, CROIX COUNTY, WISCONSIN. i! I. ~j aub~ect to restrictions of record, conditions, reservations and easements, II zoning ordinances, if any, and general taxes and assessments, not yet due and ~I payable. i~ I ~I II 1'kA "'FE~ {I ii ~ 1i II FEE ii it I ~I I i 1 This homestead property. !I (is,, (is not,) ! II {I g. g~urtonancea thereunto be.on t To ether with all ar_d singular the hereditaments and a ging; ~I And...-__ROBERT H. EDMONDSON-AND SARAH G. EFMO:.DSON warrants that the title is good, indefeasible in fee wimple and free and clear of encumbrances except iII i and will warrant and defe.id the same. II D: ted this .......llth day of . ----.--..-M~.v 19__.93 II I (SEAL) - (SEAL) ROBERT H. EDMONDSON ~I •--------------------------..(SEAL) V~ t?s'`-'-----(SEAL) SARAH G. EDMONDSON Ij - - 1 u I{ * 11 1 II AUTHENTICATION AC$NOWLEDOMENT li 1 Signature(s) STATE OF W251&QAJT3iM Minne to i sa. r. ____TeJashirgiiar,____________County. authenticated this -______-da of___________________________ 19_-___. Personaily came before me this _........-llt i i y ^ a $hy of Maw ia___. t~ the above named it li li Robert H' Edmondson and.------------------_-... it TITLE: MEMBER STATE BAR OF WISCONSIN a. an G. Edmondson (If not. ii 1; authorized by § 706.06, Wis. Stats.) - - - to me known to be the person w o executed the foregoing instrument and acknowledge t same. ~i THIS INSTRUMENT WAS DRAFTED eY I; r~ Notary tic ...Washington--- County, VKWX MN (Signatarer. may be authenticated or acknowledged. Both My Com ,(~siion- is permanent- (If not, state expiration are not necessary) date: t'/r/A+-. 1 _ _ - - - - `--v - - --MARTFf1C-A. iZl ~€t- - a Name`s of T..•raona alumna in shy caoactty sh<.!d he tyt` d or srinted bel..w- their ai.n,.tnr... ~ r:e-xav ~usttc wl,,:tiEyorA ~ RTATFF WASHINGTON LINTY WARAATIT4 77Ftp DAR OP w19C0*.*u!^T ~L!=con T 1,+8k TCO9 I FORTT No. t - 1982 MY ~oMaat99! ,~lL~A q~ 9 7 ~.•ww $UMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800.962 - 5227 ST. CROIX ZONING REPORT NO.: 19719/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 3/18/92 COURTHOUSE DATE RECEIVED: 3/17!97 HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER: Bob & Kathy I_uty LOCATION: 404 N. Glover Rd., Hudson COLLECTOR: M# Jenkins DATE COLLECTED: 3-16-92 TIME COLLECTED: 3:00pm SOURCE OF SAMPLE: Kitchen faucet DATE ANALYZED:3-17-92 TIME ANALYZED:2:00pm COLIFORM: 0/100ml INTERPRETATION: Bacteriologically SAFE NITRATE-N: 3 ppm Above 10 ppm exceeds the recommended Public Drinking Bacteria/100 ml _ Water Standard. + Nitrate-Nitrogen, mg/L LAB TECHNICIAN: Pam Gane ~.\N06P,pQ.N, WI Approved Lab No. 19 v < Means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 g5,57 3/3/92 OFFICE ST• CROIX COUNTY ZONING ~.J County Courthouse ~U ✓ St, Cr911 4th Street U 54016 Hudson, WI (715)386-4680 Telephone 715)386 4680 ervice of septic 1<1 Office offers the sRealty Firms ► and County Zoning Institutions, The St, Croix to Lending and water inspections ro ert an be private individuals. tial so that t e is esse et on of this form i appropriate r m enclose and mail, c atga' inf ormation► Off ice, as the following County Zoning will be done provide., to St. Croix Testing please - a abthe above address. received. fee made p with Y for m to f ee and f orm are along 00 X soon as possible -FEE: $ 25 - WATER TESTING--"-- and_ coliform bacteria) FEE: $175.00 (For nitrates TESTING $25'00 WATER time of (For VOC'S) h IC SYSTEM INSPEC SIO is properly functioning a ~v SEPT if system (Determines Bob & Kath Lut R inspections name WI ertY wner ZY N-' f ' o prop 404 N Glover Road - 4uofnSection T_- owner's addr the ~T ess 4 of 1SubdivisiO~ a/~~{ 9s Property tion -L D Lot Numbers-~- ~ ~ Legal Descrip list firm. Town Of. Tro LOCK gOitsiq by house?~If so, FIRE NUMBER 404 Rea Y Color of house ,COPY OF PLAT BOOK, 21 Bert elsen-Gudd POSSIBLE, A Mpp'i. e EET Centur LISTING SH IF AT ALL COPY OF THE If PLEASE INCLUDE SHOWN, AND A that is fresh. WITH LOCATION a sample the water line requires tial water for some timehOUrs before. Tes,,,. the L. ng vaca of vaca n nt► and has been 5O for several , the home iurged by running the water or sill must be p turned of f ► if test can be conducted. lineS are times water to the home necessary • this TESTING: Many access er arrangements WINTER turned off, making cocks are please make Probe gained- the case, when entry may this is office to ensure time - individual requesting services: - n, Firm hone Number Telep TO BE SENT TO: REPORT ING SAP. Closing date'kPLEP'SE 'f0 TAt Signature OF WATER 'T'EST AS THE E CALL WTTR DATE & TIME -I;FLEiS T"ANK YOU THE JENNY OLSON ST. CROIX COUNTY ' N We WISCONSIN ZONING OFFICE S Y',• j 'Ftix ST. CROIX COUNTY COURTHOUSE ' 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Mar. 16, 1992 Jenny Olson Century 21 706 19th St. Hudson, WI 54016 Dear Ms. Olson: An inspection of the septic system on the property of Robert & Kathy Luty, located at 404 Glover Rd., Hudson, WI was conducted on March 16, 1992. 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 warrantor 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. in erely, .;9 TY. w^` ~ r• Mary J. Jenkins" Assistant Zoning Administrator cj I