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HomeMy WebLinkAbout040-1071-90-000 County: 7information t of Commerce PRIVATE SEWAGE SYSTEM St. Cr oix vision INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 515077 0 GENORMATION State Plan ID No: Persoou 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: Bellinger, Robert I Troy, Town of 040 - 1071 -90 -000 CST BM Elev: Insp. BM Elev: BM Descn on: 'L Section/Town /Range /Map No: / . U ! ya f6 Ted - ���c -'+ 18.28.19.274F TANK INFORMATION VATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic r Benchmark 2. �l 1 ij90 v r Holding � 'i) L� Z Alt. BM r V: Bldg. Sewer SUHt Inlet lJ e TANK SETBACK INFORMATION Outlet S 2 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD ret ., s 97. Septic 0D/ / zs / tom S g�' l !y G t" an. • S V - / J 5. 0 rHolding Bo n Dist. SI Y (7 t. S m ►.3. l 85 PUMP /SIPHON INFORMATION Final Grade Ul g 31 1 7 L Manufacturer Demand St Cover r 3� GPM /oo• 5 h ✓J Model Number TDH Lift Friction Loss m Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length fi No. Of Tre ches PIT D 32 IMENS S No, Of Pits Inside Dia. Liquid Depth DIMENSIONS QNds � 6� J6 SETBACK SYSTEM TO P/L BLD WE LAKE /STREAM ACHING Man r INFORMATION AMBER OR / 7y�( Ty p Of System: UNIT Model Number: DIS IBUTION SYSTEM A4, C �►V4W--- / i S�yyO go o t�� ade anifold Distribution / 1, x Hole Size x Hole Spacing r�/ take 4 S - // Pipe(s) �' R Od / Length ' Dia Length by 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 T Mulched Bed/Trench Center / -'/, Bed/Trench Edges Topsoil 0 Yes a No � Yes E No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /� Inspection #2: Location: 353 Cty. Rd. F Hudson, WI 54016 (SW 1/4 NE 1/4 18 T28N R19W) NA Lot 1 `f'Jl � Parcel No: 18.28.19.274F � 1.) Alt BM Description = D f 1\ h� want P-CI( �Qw,,_ 2.) Bldg sewer length = '&o sfi - amount of cover = Plan revision Required? 0 Yes Y<No Use other side for additional information. SBD - 6710 (R.3/97) Date Insepctor's Sign ture Cert. No. commercemi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St. Croix i sco n s i n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce p A I 5/ 5 o 7 Sanitary Permit Application State Transacti Number - N a In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary Same // . C purp oses in accordance with the Privacy Law, s. 15.04 1 m , Stats. L� T L Application Information — Pleas t All Information Property Owner's Name Parcel # 040 - 1071 -90 -000 Robert W. & Janet L. Bellinger Prop! y Owner's Mailing Address Property Location , / 3-WCo. Rd. F . `�` ST CROIX COUNTY Govt. Lot �� City, State Zip Code Rq"0l11i"&0N SW - /,, %, Section 18 Hudson, WI 54016 (715) 386 -4193 (circle one) II. Type of Building (check all that apply) /�' Lot # T 28 N; R 19 W 0 1 or 2 Family Dwelling —Number of Bedrootr 3 I Subdivision Name `_ L 1 7D CSM ❑ Public /Commercial — Describe Use IgCQ.G�11� ck # Na A ❑ City of ❑ State Owned — Describe Use CSM Number ❑ Village of .Z t+ &+4 4 l . 4, Pg. 1122 ® Town of Troy III. Type of Permit: (Check only on ox on line A. Complete line B if applicable) A. ❑ New System Replacement Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) System i B. ❑ Permit Permit Revision ❑ Change of ❑ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner .I Expiration IV. Type of POWTS System/Component/Device: Check all that apply) t ® Non -Press ized In- Ground LJ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank Other Dispersal Component (explain) El Pretreatment Device (explain)I IpetY�96 V. Dispersal/Treatment Area Information: Design Flow (gpd) / I Design Soil Ap ication Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Propose (sf) System Elevation 450.00 f" ! 0.70 642.86 sq. ft. 651.60 sq. ft. 89.75 VI. Tank Info Capacity in Total # of Manufacturer W A o Gallons Gallons Units L U New Tanks Existing Tanks { ^��� a� O Septic or Holding Tank 1 00 1000 1 Wieser Concrete ® ❑ Dosing Chamber VII. Responsibility Statement- I, the un ersigned, ass a responsibility NE' a la n of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb s Sign MP/MPRS Number Business Phone Number James K. Thompson s ---- 30021 1 (715) 248 - 7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceola, WI 54020 - 5413 VII Coun /De artment Use Onl ,KA pproved d Permit Fee Date ssued Issui gent Sign ZZ _ Owner ik a or Denial $ 75 , a, r / lJ. 0 IX. Conditt"*AffmWeasons for Disapproval V I. Septic tank,. effluent filter and dispersal cell must all be services / maintained as per management plan provided by plumber. 2. AN stback requirements must be maintained as Go* i .. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 EXG -Q.dQ u'on � /t�ui�C oC,•s pGrs / CLl/ U o V 3s3 Co. /ivy. F 411 A, E /;nt s a--e evea,41.- /1Kds�n /60 "e'ro'" 5,v 5 er7 area. Sec. ie T18a. /9c�•, Tn.oF'7 o s/o /o 7/- 90 - cab Pro posed oL;s pi+'sa/Ce /l. Tuz (2� Xx 6 ' e i' {,c /us�� one / ' W E�ie�n 1,te�J�• P _ •��'/ �/�_ S KA SyovC� �?ii�t'. Tq✓e/� � 8� � i� �� ' i� � - _ - - - 97. 0 e e% cukItt =91.s(,Z' i �lZd n /Op.OfJ' DiVUS:cn i' �i fiSloe Va /uC , 5 070 1 11 EY,S�i17J , 9 .??o E,�' iS fin� �',' /t5 ttt�ivPScsifac� EICt! _ /�J. 3e. 3 bedrobw, Cone�L�e e lee e 91.2.5 S sew s dam �P 4� PC COPY r cl; s�oorsa / cam!/ �—Ia ac 1 Ae/ %7,yP oroP U V 35 c-. f/wy, - fl o if u 1 4 /o E 1;4 Ore of�ca u 04 S-1W14 •e— Aa,j /Gb',erCem SyrSf ¢M Q,/'2Q. Lai/ CSM ✓a /. �i� //22, SWfy/I l' 5f. e-rolr Cm u�l. . _ P s.cd a(;spe/sa1Ce /% Tcvo(2> �dc% o 4 /0 /0 7/- 90 c6o IH,G a&- lea c-A CA+a ,o.c>• fru,c.1. f f4.s,T,y 3o,9s/ of .'� — d3 ' - 9sC o ne Etisfi:� I,C�YJ '��� 71' 6� 95`D� S 97. 0, s�iC t +t' rn✓erL 8/ �i -� ��/ e 1Prl = /oD. a0' Vnluc ' r/s 9 /BX�G d.�aersa/ �/ /, .�$GF;' /r�rafi'vPSurfctc� EIeY = /GV- 38. 3 bcdro�r„ trConcO��e G!!t!` c 9,t.2S z^d - [oc�P� - sue E�is�inq star 9 449 e- 9r'4v dam �P c• ' Q y i 2161 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction percent slope, scale or dimensions, north arrow, and location and distance t Parcel I.D. Please print all information. 040 - 1071 -90 -000 Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04(l) (m)). Property Owner RECEIVEE J P,operty Location Robert W. & Janet L. Bellinger Govt. Lot SW 1/4 NE 1/4 S 18 T 28 N R 19 W Property Owner's Mailing Address 12 2009 1 Lot *Block # Subd. Name or C M# 35 Co. Rd. F CSM Vol. 4, Pg. 1122 City State Zip Code Phone Number J City J Village e Town Nearest Road WI 54016 ST Ct�otxcouN Hudson pt,�j}*)"Q*11 ®f3 O FICE Troy Co. Rd. F J New Construction Use: y_f Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 0 Replacement J Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for conventional POWTS using gravity distribution. Soil application rate = 0.7 Recommended system elevation = 89.75'. Boring # I Boring e Pit Ground Surface elev. 94.63 ft. Depth to limiting factor > 991, 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 1 0 -23 1Oyr2/1 none sil fill 2mpl dsh cs 2fmc Na Na 2 23 -38 1 Oyr3 /6 none sl 1 mpl dsh cw 1 fmc 0.4 0.6 3 38 -44 1 Oyr5 /4 none sil 2fsbk mfr cw 1 fm 0.6 0.8 4 44 -55 7.5yr4/4 none gr Is Osg ml cw 1fm 0.7 1.6 5 55 -72 7.5yr4/6 none gr Is Osg dl gw - 0.7 1.6 6 72 -99 1 Oyr5 /4 none gr s Osg dl - - 0.7 1.6 $S.y it Boring # J Boring 0 Pit Ground Surface elev. 94.35 ft. Depth to limiting factor >97 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDR in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 1Oyr2/1 none sit 2fsbk dsh as 3fmc 0.6 0.8 2 12 -18 1Oyr3/2 none sil 2fsbk dsh cw 2fmc 0.6 0.8 3 18 -33 1Oyr4/6 none sit 2msbk mfr =cw2fm,1c 0.6 0.8 4 33 -37 7.5yr4/6 none gr Is Osg dl cw 1fm 0.7 1.6 5 37 -97 1Oyr5/6 none gr s Osg dl - 1vf 0.7 1.6 �, tt * Effluent #1 = BOD 30 < 220 mg /L a TSS >30 < 1 0 mg /L *Effluent #2 = BOD <30 mg /Land TSS < 30 mg /L CST Name (Please Print) Signatur . CST Number James K. Thompson 5-- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 6/9/2009 715- 248 -7767 Property Owner Robert W. & Janet L. Bellinger Parcel ID # 040 - 1071 -90 -000 Page 2 of 3 a Boring # - Boring V Pit Ground Surface elev. 94.38 ft. Depth to limiting factor >96" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 1Oyr2/1 none sil 2fsbk dsh as 2fmc 0.6 0.8 2 12 -24 1Oyr3/2 none sil 2fsbk dsh cw 2fmc 0.6 0.8 3 24 -45 1Oyr4/6 none sil 2msbk mfr cw 1 f 0.6 0.8 4 45-50 7.5yr4/6 none gr Is Osg dl cw 1vf 0.7 1.6 5 50 -96 1Oyr5/6 none gr s Osg dl - - 0.7 1.6 ,7 �I 7i F-1 Boring # J Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 F-1 Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QP 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD S30 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. SBD -8330 (R.07 /00) A.C.E. Soil & Site Evaluatbns � Sa % ed4tuct�io,� / o,� EXC2 d!! u / on t c "I&C ic d, s /oG ✓,Se / cG!/ A �j(/:s �Y y,-adC Q IW. I � 43a a L4 t(o 4 1! /o l :hes a.- e �•- /tc�dsan Sy5te -1 a-rCA- �o�i vo/ / /�z, swyy1) S T 28lt., le 717. ldc% �`05�- 90 - ce 7 o tsA c� 1 a3 95C 7 S �ea ri,✓er g! f � — - - 97.0' r�q Ass k rnea! fi d elcp: /0D.38. 3 6edro8w, keS�'dtnCG Sts� 4 i'49G dr 'vQ �' 3 W-3 C Soil Absorption System Cross Section ft 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap go, ft Leaching --0,. 75' Chamber ♦_ 8 � ft v System Elevation 2. 0.3 ft lo.� Soil Absorption System Plan View G6.0 ft x.83 ft { IIIIIAIIIIIIIII i 2 " ft Leaching Trench 1 Vent Or Observation Pipe Chambers 4" Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model "Qu;Ce `f EISA Rating W.0 sq ft per chamber Soil Application Rate Q. gpd /sq ft o,Q gpd Design Flow T O.7 Soil Application Rate T W.y EISA = 3.Z /O Chambers 2 rows of /G chambers each. Page Conventional Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10705 -P (N.01 /01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be <_ 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October - March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248 -7767 or the St Croix County Zoning Department at (715) 386 -4680. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /der Mailing Address 353 Co. h! c( F" Property Address La (Verification required from Planning & Zoning Department for new construction.) City /State CJ/ sf�o� Parcel Identification Number 0510 - /07 /- 90 -otZ LEGAL DESCRIPTION Property Location 5rJ 1 /a , /9,5' , Sec. / , T �28 N R /9 W, Town of �T Subdivision e.5`r1 , Lot # � . Certified Survey Map # Volume , Page # Warranty Deed # 7 7 7 , Volume Page # Spec house Lot lines identifiable yes 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. 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. r Nber of drooms SIGNATU 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. 08105) l I ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the /e 6A,'-6 cc.). 42 n /-. residence located at: 5 0 '/4, 4,5 ' /4, Section 18 Town ZB N, Range 1,9 W, Town of 0 , 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 service Did flow back occur from absorption system? Yes No P- (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: .p a0. Construction: Prefab Concrete �' Steel Other Manufacturer (if known): t,�iesc� Cm.�cre Atr Tank (if known): GIo71,63 =oZG icensed Plumber Signature) (Print Name) (Title) (License Number),kf?�MPRS 9 ,ua9 ate) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) I L ST. CROIX COUNTY CERTIFIED SURVEY MAP LOCATED IN THE SW 1 /4 —NE 1/4, SEC. 18, T. 28 N., R. 19 W., 4TH P. M. IVIgPLATTZp I.ANpS 4WtCQ $Y QWI_ S 88 51' 30" W 695.68' Ic 900 NA • 0 b IZ I m LOT / 1 6.339 ACRES INC. R/W 276,126. 84 SO. FT. rr Iv 6.207 ACRES EXC. R/W 270,376.92 SO. FT. I� p 'b ? ° R 0 O N.88 °51' 30 "E ° 0 0 m y 82.63' • m 1 g (EAST) N. 89° 33' 13" E. 384.45' N ' ( RECORDED AS EAST, 385.0 FEET) A ax L a a yr1?�9Z1rEld _LAND c R/W CURVE= .04 M R= 202.88' Q� cif A=32-48 ? \\ L= 116.14' qe p `� C o N. 7 3 51' 30" E. Gpn -- -- - - - - -- S - SEE OE TAIL FrtED 33.00' 21.82' LINE - o�s ,•� NOV •� 1981 � �' �`�� p�30 �. f �) S-89 44'30 "E. �\ rn � R cmft G- . jt(J. -1 - LINE /h LEGE7y0 78T M O 1" X 24" IRON PIPE SET w rn WEIGHING 1.68 LBS. / LIN. FT. �f �� • IRON PIPE FOUND APPROVED E CURVE; R= 169.88' AUG 2 0 A = 32 °48'00" L= 97. 25' e, C N "wan = N. 3 51'30" E. ST. CRO,X :.. Y yGQ,�spo* 95.93' COlG1PRE71ENSlVE PARKS PLANNING �� II�p'�0 AND ZONING COMMITTEE Irk ALL C. NYHAGIEN OETA /L SCALE: I INCH = 100 FEET 8 N ii HUDSON, j s y 100' 75 5d 0 100' Vy1S �� .�i ro • C, N at SU Z ci m SIGNED CA�� DATED ! 0 ' 80 ALLEN C. NYHA`3F_NRUS 1407 JOB NQ 80 -16 Volume 4 Page 1222 � this instrument wos drafted by ken hodkiewiez. PAGE I OF 2 • DOCUMENT NO. II II r.nn erw...e FZSeaVen IOR „ZCORn:.= WARRANTY DEED !� STATE BAR OF WISCONSIN FORM 2-1982 i 507144 REGISTER'S OFFICE II Si: CROIX C WI Robert B. Wasmund and Barbara J. Wasmund, husband IL Reed fwlte ad ?n4Z_ W }f.�.__ ate._ �Ljl'PIzmXsl}ip. marital_. Property --- ----- - ----- OCT 21993 � I ----- -- -- -- -------- -- -- ----- --- ---- - - -- -- at 1: P. M 1 1 7! coltveya and warrants to - .Bober-_ W_. ___ -._ �e�jk#)gfx�.. ..rife,._D.$. mari.tal___.__ ------- •- •- •-------------- - - - --- ----- -•--------- .-- •--- • - - - -- - - - -- 1 "" ,W14 6 12 of Deeds -------------------------------------------------- ---------••------------------- •--------- - - - -•- ------- - - - - -- .. ........................................ _ ..... _..................... .._.__...................... .............. RE5 URN TO 1 . . ... -------------------------- ------------------------------------------------------------- - -�� the following described real estate in .... ........................County, State of Wisconsin: ' I Tax Parcel No: ------------------------------ I A parcel of land located in the Southwest Quarter of the i Northeast Quarter of Section 18, Township 28 North, Range 19 West, described as: II Lot 1 of the Certified Survey Map recorded in the Office of the Register of Deeds for St. Croix County in Volume 4 C.S.M., Page .IltL, as yacumenc Num'ver 574295. II Together with a non- exclusive easement to use as an access road and for the installation of utilities, the utility lines to be so located as not to interfere with the use of the roadway: 1. The 66 £t. wide private road shown on Page 2 of said map as running in a general ( .. East -West direction. The 66 ft. wide private road running in a general North -South direction West of Ef I and parallel to an extension of the Eas line of said Lot from the South line of II i said Lot 1 to the Town Road. �I The Grantees to share the cost of maintaining said private roads, as long as they II remain private, with the other owners ha-.i_ng easements to use such private roads. Subject to all utility easements of record and to the 30 ft. driveway easement shown on said Certified Survey Map running from unplatted lairds to the above mentioned East - West private road. Subject also to the covenants recorded in the Office of the Register of Deeds for St. Croix County, Wisconsin in Volume 460, Page 135, as Document Number 299996. This ---- is (is) ____ (is __ not) ___ ___ homestead property. Exception to warranties: ' e Datedthis ........ .......•• ........ ........ day of ................ October --------- .----------------- - (SEAL) R .. ...MUND, .by APA.4 (SEAL) - • x�e: phan..J.� ._PDlver..A l)tts�rney t ----------------------------------------- (SEAL) (SEAL) I! ' .......... .-------------------------------------- t BARBARA_._. - SMUND AUTHENTICATION ACKNOWLEDGMENT Signature (a) ----------------------------- -------- ---------------------- STATE OF WISCONSIN as. 1) -. .. ------------°° St. Croix -- --- - -- --- -- • --- ---- -------------- County. authenticated this -------- day of_ ____ __ _____ ____________ ___ 1-9 ------ Personally came before me UA4 --- .------- day of Dc- ¢beg__________ I9_ �_._ the above named !I I - -------- ---- -- �--- °-- ---- ---- ---- --- - ---.-_ -- - -- - - -- - --- __ -- - - - - --- - - -_ --- ---- Stephaci.__ x�.__ L2unlaia ._as__>?Qylsix__Qf__A.ttQxneY ' _ -- fax__RQbart:__ll-__Wasmiand -- - and- - Baxbaxa. - - TITLE: MEMBER STATE. BAR OF WISCONSIN _-__S dasmund- -------------------- _------ ------------ (If not, ----------- - -- § 406.06. Wis. Stats.) - •--- -- ---------- -- --- -- - - °-- -- � -----•---- ------ -•----- --- -•------- •-- --- authorized by -- . to wn to be the a s_- .__ -__._ _who executed the I fg inst ru an ekno ed a the sa THfS (NSTRtJ N.'ENT WAS DRAFFED BY VC VJ L'� ------ _ ____ _•__ .__._._. _.._. ., ..._ _ ........ __ ___ __ ___ li STEPHEN- J..:_. DUNLAP . , ^ :'$ � ? .12� ` I u-- -- --- -- -- fir 1� Hudson. <... - ` V - - v V St. C.., i - Wi consin Notary Public .... .... ............_.... -_ _.. ou�riyy,sAWS. (Signatureb may be authenticated or acknowledged. Both M.v Commission is permanea�t. (I= not -s *.. e I I are not necessary.) date* -No 2 4 ) •Names of pe-rsone efgolag 1. spy —p—fty ahoutd be typed or printed below their aig—tur • � � ,,� `�� 1I WARRANTY DEED STATE DAR OF WISCONSIN W.scons- ! .Qal Blank Co.. Inc FORM No. 2 — 1992 Milwaukee, wiscons,n e s COMMERCIAL TESTING LABORATORY, INC. 51& Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 ST. CROIX COUNTY GOVERNMENT REPORT NO.! 49559/01 PAGE 1 CENTER REPORT DATE: 9/27/93 1101 CARMICHAEL ROAD DATE RECEIVED! 9/23/93 HUDSON, WI 54016 ATTN! THOMAS C. NELSON OWNER! Barbara Wasmund LOCATION: 353 Co. Rd. F, Hudson COLLECTOR! Jim Thompson DATE COLLECTED! 9 -22 -93 TIME COLLECTED! 11130am SOURCE OF SAMPLE! Outside tap DATE ANALYZEDI9 -23 -93 TIM1E ANAL.YZEW2140pm COLIFORM MCC! 0 /100 ml INTERPRETATION! Bacteriologically SAFE NITRATE -N! 7 ppm Above 10 ppe exceeds the recommended Public Drinking Water Standard. 12 ) Coliform Bacteria /100 at Nitrate-Nitrogen, mg/L Z'' Ef LAB TECHNICIAN! Pam Gane ! Of . \NOEGENp WI Approved Lab No. 19 Means "LESS THAN °.Detectable Level Approved by! 7 r PROFESSIONAL LABORATORY SERVICES SINCE 1952 09!16/93 12:58 1715 381 4400 S.C. CO CRTMUSE 2001 5 OSt -It' ',rand fax tansmittai memo 767# # of w3�e f l �° F`°°' PhondS ST. CROIX COUNTY .. T-- WISCO Dept n �„ ZONING OFFICE Fax �- - CROIX COUNTY COURTHOUSE HuqsON, W1 54016 M (715) 386 -4680 SEPTIC nvSPECTIOId / ASTER TEST REQ FORM specify desired test(s) & renit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary- Please make arrangements with of five to insure a tie whet, entry can be gained. Water (VOC's) $185.00 0 Septic $25.00 Water (Nitrate & Bacteria) $05 -.00 (Visual inspection) . > Owner • W S Requested by: D e Address : 3 3 C.�1 R F Address a f ,aa qty & State: U�sa city & St. -- �,_. -- ��1 e Ld AV Zip Code: _� D _ Zip cede: I' �e` 5 . Telephone t1 ( 386 31 l Telephone �0 C�� t worm Sao go-a Property address (Fire W & Street) Location: S�-? �, ;bE_ +. Sec - S -_ , `f N R�- 3 W, Tawas cif ]E: � _______. ,� St. Croix Co. WT. Tax 3D 1'1' b i - Parcel ID 5 IFO ) l � Housa color: _ - ajj Realty firm; Lock Box combo L s Water sample tap locati_an: _F_2o ►.> 1 6 F o u Lk - J VJlti1DDuJS TO BE COEP BY. PRO FERTY OWNBR [PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FARM* Is the dwelling currently occupied? Yes ❑ No if vacant, date last - occupied: Year : 3 Sep - tic system. installed by. ZAP�c� 205 _ -—^ -,— Septic tank lest serviced by: C L t tJA Date: Previous owner's Name(s): do tj Have any of the following be observed? QY IN Slow drain from house. GY Sewage Back - up into dwelling- DY T Sewage discharge to ground' surface, read ditch or body of water, DY IAN Slow drainage from the dwelling_ IlY $N Foul odors - other comments relative to system operation: - - - I certify that the above information is complete and true to the best of lay knowledge. DATF OS SIQ+TA` A (;3 '16,"93 12: $715 381 4400 S.C. 0 CRTHI)USE 12002 OWNERS DRAWING OF HOUSE & sEPTIC SySqrEM LOCATION N TANK �3Ac�. aF H oks E ll�� TO BE COY—PLETED BY !NSPEC AG System design &/or permit on fil-t OYes UNo _Soil series per SCS Sail Survey:__ sheet y p � of soil abscl-Ttion sys F L��wcjd EiAt--Grd ❑Nound .A-pp.cox- size- y DDose OPressu-rized Ft. renc-1i LID-ry -Well Molding Tank UOutfall pipe OBSERVED DEFICIYNCLES 110ther Dunknown agtgt tank Sethacks., nHouse.nL�/ell up-rop. I ine C 'GOther Dose tank ClProp.. 'l ine cki rig vt-_r Owarnlrncj label OPUMP/L-Ioats OEleu. wixj_ncj Soil syqte�� Set-back-s: _UHouse Dwell 6KOProp. line DOther Dpaading: ) e col=ent-s: P(_,. , General IIVSP�!CTORS SKETUR OP SYSTM LOCATION cr 10/05/93 13:58 $715 381 4400 S.C. CO CRTHOUSE Q001 I COWRCIAL TESTING LABORATORY, INC. - l 54 Main Street, P.O. Box 526 post -It brand fax transmittal memo 7671 *of pages it Colfax, Wisconsin 54730 To b From 715 962 3121 co. 800 - 962 5227 Phone # FAX 715 962 - 4030 Dept. 6 Fax # Fax # b ST. CROIX COUNTY MVERNMENT REPORT NO #S 49559/01 PAGE 1 CENTER REPORT DATES 9/27/93 1101 CARMICHAEL ROAD DATE RECEIVED*# 9/23/93 HUDSON, WI 54016 ATTN; THOMAS C. NELSON OWNERS Barbara Wasmund LOCATIONS 353 Co. Rd. F, Hudson COLLECTORS Jim Thompson DATE COLLECTED*# 9 -22-93 TINE COLLECTED*# 11530am SOtktCE OF SAMPLES Outside tap DATE ANALYZEDS9 -23 -93 TIME ANALYZEDS2 COLIFORM,MFCCS 0 /100 m! INTERPRETATIONS Bacteriologically SAFE NITRATE -NS 7 ppm Above 10 ppe exceeds the recommended Public Drinking mater Standard# I Coliform Bacteria /100 ml Nitrate- Nitrogen, mg/L :h(, gi14 CID / _ 1 19 LAB TECHNICIANS Pam Gaue -- �,NOo.MO` "' WI Approved Lab No. 19 t Means "LESS THAN" Detectable Level Approved by' 7 PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROW 'COUNTY WISCONSIN PLANNING & DEVELOPMENT PLANNING SOLID WASTE REAL PROPERTY ZONING 715 - 386 -4674 715 - 386 -4623 715 -386 -4677 715- 386 -4680 September 22, 1993 Barb Wassmund 353 Cty Rd F Hudson, WI 54016 An inspection of the septic system on the property located at 353 Cty Rd F, Hudson, was conducted on September 21, 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, James Thompson Assistant Zoning Administrator mij ST. CROIX COUNTY GOVERNMENT CENTER • 1 101 CARMICHAEL ROAD • HUDSON, WI 54016 10/08/93 11:08 $ COUNTY CLERK [a 001 ace ACTIVITY REPORT* TRANSMISSION OK TX /RX NO. 0013 CONNECTION TEL 61p9207069 CONNECTION ID START TIME 10/06 11:07 USAGE TIME 00'46 PAGES 1 RESULT OK post -lt"' breind fax transmittal memo 7671 # of Peges' From . - Peet- Phone P �, V� L ri.7 � 1 V � Fax* Fax M r t . _. „ -...AG & DEVELOPMENT PLANNING SOLID WASTE REAL PROPERTY ZONING 715 -386 -4674 715.386.4623 715- 386.4677 715.386.4684 September 22, 1993 Barb Wassmund 353 Cty Rd F Hudson, WI 54016 An inspection of the septic system on the property located at 353 Cty Rd F, Hudson, was conducted on September 21, 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 u pon p maintenance of the system. P P y P P Y Should you have any questions, please contact this office. 10/11/93 09:36 $ COUNTY CLERK IM001 eea ACTIVITY REPORT TRANSMISSION OK TX /RX NO. 0079 CONNECTION TEL 93861075 CONNECTION ID START TIME 10 /11 09:36 USAGE TIME 00'41 PAGES 1 RESULT OK t Post -it" brand fax transmittal memo 7671 F - 1 pm s ► / COM_ MMIAL TESTING LABORATORY, INC. w Fro 514 Main Street, P.O. Box 526 Co. cb Colfax, Wisconsin 54730 715 -962 -3121 Dept. Phone - i 800 - 962 -'5227 Fax ,Y (P ^ I D ?5 fax # 1 - y 00 1 FAX - 715 - 962 - 4030 I i 5T" CROTX COUNTY GOVERNMENT REPORT NO,: 49559/01 PAGE 1 CENTER REPORT BATE; 9127/93 1101 CARNICHAEL ROAD DATE RECEIVED: 9/23/93 HUDSON, WI 54416 ATTN THOMAS C, NELSON OWNER: Barbara Wasmund I LOCATION: 353 Co. Rd. F, Hudson COLLECTOR: Jim Thompson DATE COLI,.ECTED 1 9 -93 TIME COLLECTED: 11:30am I i SOURCE OF SAMPLES Outside tap DATE ANALYZ£D:9 -2343 TIME ANALYZED COLIFORMPWCC! 0 /100 m I I INTERPRETATIQN; Sacteriolo9icattY SAFE. 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Parcel #: 18.28.19.274F 040 - TOWN OF TROY Current X! ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - BELLINGER, ROBERT W & JANET L ROBERT W & JANET L BELLINGER 353 CTY RD F HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 353 CTY RD F SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 6.339 Plat: N/A -NOT AVAILABLE SEC 18 T28N R19W 6.39A SW NE LOT 1 OF Block/Condo Bldg: CSM V 4/1122 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 18- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1041/158 WD 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 158269 369,500 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 6.339 79,000 258,100 337,100 NO Totals for 2006: General Property 6.339 79,000 258,100 337,100 Woodland 0.000 0 0 Totals for 2005: General Property 6.339 79,000 258,100 337,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 313 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Ile AS BUILT SANITARY SYSTEM REPORT OWNER A IV P TOWNSHIP SEC . Zf W -RlfJ ADDRESS / d _ ST. CROIX COUNTY, W� NSL � f 0S SUBDIVISION LOT PIA LOT S ZE PLAN VIEW Distances and dinsions to meet requirements of H63 THING WITHIN 100 FEET OF SYSTEM L k . s 3C „ 3 4,, a I di a e o th Arrow ' }— SC L, F BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site : 22/6 SEPTIC TANK: Manufacturer: f, /�,;r_ Liquid Capacity: Lpt�t� Number of rings on cover : / Ta�nc manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cycle gallons; total capacity of distribution lines gallon: size of pump head; gallon per minute horsepower brand name of pump and model number ; Type of warning device HOLDING.TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: Number of pits feet diameter feet liquid dipth seepage pit in et pipe- elevation bottom of seepage pit elevation feet. ,/ SEEPAGE BED SIZE: number of lines �� width leizgth the depth �Ly SEEPAGE TRENCH: width length PERCOLATION RATE —��_ REA REQUIRE AREA AS INSPECTOR DATED PLUMBER ON JOB____________ LICENSE NUMBF:R__U d -- --- -_ - -_. DEPARTMENT 0 INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 a BUREAU OF PLUMBING MADISON(, WI 53707 CKCONVENTIONAL ❑ALTERNATIVE state lanI.D.Number: pl ED Tank 1:1 In-Ground Pressure El Mound waipned) NAM F PERMIT HOLDER: _ 7Al2DRESS OF PERMIT HOLDER: INSPE — � d /lo BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. S - P iq T Name of Plumber: MP /MPRSW No.: County: n;tary mit N rumber: T-am I A. 1 14 Ll SEPTIC TANK/ LDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: FINING L ID LOCKING COVER � / q PROVIDED: PROVED: /�•� l7 / DYES ONO ❑YES ONO BEDDING: VENT DIA.: VENT MATL.: HIGH NUMBER OF ROAD: ROPE ELL: [ 7, 5 UILDING: V NTT FRESH ALARM: 1300 RI Jt� � AIR INLET: FEET FROM DYES Q O OYES ONO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: IL IQUID CAPACITY U 1000 E : !SIPHON M ACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES 1:1 NO ]YES ONO ❑YES ONO. GALLONS PER CYCLE: PUM 7:ES 1 NAL: UM R PERTY W LL BUILDING: V N (DIFFERENCE BETWEEN i EE FR M NE: AIR INLET: PUMP ON AND OFF) �' ❑NO N RE SOIL ABSORPTION SYSTEM/Chq4 SYSTEM/Ch th it moi8 re at the depth of plowing L GTH AMETEK MATERIAL AND MARKING or excavation. (if soil can ed in a wire, construction shall cease until F CE the soil is dry enough to continue.) IN CONVENTIONAL SYSTEM: WIDTH H: '. LENG STA. PIPE SPACING: J INSIDE IA *PITS. LIQUID BED /TRENCH TRENCHES AL: PIT DEPTH DIMENSIONS G G V L 59"P FILL DEPTH UI H. I F DIS R. PIPE IS 1 A IAL: NO. R. MBE OF WELL: BUILDING: V NT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET ELEV. END. PI LINE: I AID 141_E7: p FEET FROM ( VV LL II 7 q L l �� NEAREST MOUND SYSTEM: 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- 1 YES ❑NO meets the criteria for medium sand. TIONS MEASURED. OIL COVER TEXTURE PERMANENT MARKE S: OBSERVATION WELLS ❑YES 1 NO DYES ONO DEPTH OVER TRENCH /BED DEPTH OVERTRENCH/BED DEPTH OF TOPSOIL SODDED. SEEDED: MULCHED CENTER: EDGES: El YES FIND ❑YES ONO ❑YES F-1 NO PRESSURIZED DISTRIBUTION SYSTEM: BED /TRENCH WIDTH LENGTH: TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE CO DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MAN( OLD MA ERIAL: NO. DISTR DIS R. 1 ISTHIBUIION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV_ DIA. ELEV. PIPES DT: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING HILLEU COHRECILY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS Y ONO OYES ONO COMMENTS: ERMA N A OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: b DYES 1 -11 NO OYES DNO NEAREST oo.�j(� &.y(o 9398 1 gs. 3 9 � Sketch System on , Rpof ain in county file for audit. Reverse Side. SIGNAT 1 L DILHR SBD 6710 (R. 01/82) DEPARTMENT OF APPLICATION SAFETY &BUILDINGS INDUSTRY; FOR SANITARY DIVISION LABOR4NIvp PERMIT P.O. BOX 7969 HUMAN' RELATIONS (PLB 67 MADISON, WI 5 7 ISO 3 07 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H -63, Wis. Adm. Code, must be shown. An index page, ore i ach page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be sown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: e U)A5A vNP ky sy 01 6 Property Location: City, Village or Tow�hIp County: % W % #1 %S d /T N/R E (or Tjp6y �. Lot Number: Blk No:: Subdivision Narne 1 1 earest Road, Lake or Landmark: State Plan I.D. Number: 353 (If assigned) A TYPE OF BUILDING 1 � Number of ❑ Public ❑ Variance ❑ Other (specify)* Bedrooms: 1 or 2 Family * State Approval Required. ��J-- TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLASS N REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INST L ON MENT (Specify) SEPTIC TANK CAPACITY /'015V HOLDING TANK CAPACITY NA LIFT PUMP TANK /SIPHON CHAMBER JVh MANUFACTURER: & L E ,0,VCjP .e_ �yJA /�E✓V oLt GU/ - EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPO ED (Square feet): EA New ❑ Replacement ❑ Experimental A Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signs e: MP /MPRSW No Phone Number: Plumber's Address: & F f I Name of Designer: 72-2 COUNTY /DEPARTMENT USE ONLY Sig a re of Issuin Agent Fee: 00 Date: IN APPROVED Sanitary Permit Number: I El DISAPPROVED Reason for Disapproval: y Alternate course(s) of Action Available: l Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67. -T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White- County, Canary- Bureau of Plumbing, Pink - Owner, Goldenrod - Plumber DILHR -SBD -6398 (R.07/81) DEPARTMENT-OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.09(1) & Chapter 145.045) j GU I'/ 1/ S� TIO %T 7d H /e �� r (or T OWNSH IP /M�I�� ALITY: I LOT . NO.:BLK. NO.: SUBDIVISION NAME: COUNTY: 3o,6 S 1LV ,+ SIN /aA1,0L N � A C ES FLC � // v®,SO�J 4)I�,S .S_% O- USE /J I/ .7 DATES OBSERVATIONS MADE NO. BEDRMS.: ICOMMERCIAL DESCRIPTION: PR9FILE DESCRIPTIONS: R ATION TESTS: Residence 2 New ❑Replace �/ /��, �7 1QpZ NQa, /7 ! yff RATING: S= Site suitable for system U= Site unsuitable fors stem O / , /♦ // c! s s ,74 r ONVENTIONALM OUND: IN- GROUND - PRESSURE: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) 4F ( 3s ❑ ®S ❑ U ® S ❑ � EIS ®� EIS ©� Ao.)U£.uTiDNaL &P �/5 s a Fr. If Percolation Tests are NOT required DESIGN RATE: /W If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicat Fl elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- yf, to 2 > //D -- IfAt .- 3a , 0 S w r y f 7" 'Er /SA,vD 7" D,KBa. SL `�" (3N. L Zp "O L � 2( s2e -Ra SiL I B- Z �L� ��o. G o - r �,.. ss"fa f ;. o,� rrol s ftoM 5s "�o i ° 5 - „ - 8,) CS 0itU,,w s-e ftt f,&A s,'t_T QAuD 4)As A o r w i T'. V o o¢-491— B- 1 " S q / �j� > /.�- ccuQ o / %S .o B- 3 /� /lP/�G /� 1I� �I �� ,L, 9"/�,v, G� 9„ p2. L, / L R �a " 'ev L's' w G- - 13.J C S ,S A93 A93 9� oa ` — /Q� �� �k aa. L, 6 „ & L /y B - „ Ali. SL/ /Cv " , S w na GR " d - �EQG 3)E /N �BE r PERCOLATION TESTS TEST DEPTH WATER IN E TESTTIME DROP IN WATER LEVEL- INCHES RATE MINUTES NUMBER INCHES AFTERS LING INTERVAL -MIN. PERIOD 1 PERT 9Q 2 PERIOD PER INCH P_ 1 3 . Y A ' Z ' �- P- P- P -_ - � ?4:� . < _3 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. 13 077-0-Al O A 16- 0 SA441— L%.'- `-*_'r4C7Ly f, Q fr. &'4, — l3o'PE o 9 Q Ft. , ; � . ► FT haw- �i icy o�,vy- SYSTEM ELEVATION ' - P 3 7 V I i r _. _ l A r b� __ _ _ �._____ ___ _ __ � o M _._... -_.. ylaP� 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 WE ��OM �ET� OZ: -STING CM ADDRESS: 111 014ES I TE CERTIFICATION NUMBER: PH NE NUMBER (optional): RT. 1, O'NEIL ROAD S3 -- O.Z /- / � 3& - HUDSON, WIS. 5401 CST SIGNAT RE: / Iced— DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. /" �IOTr if- NL'l- I, E/} 15 J PA APDC -1 0 DILHR-SBD-6395 (R. 02/82) — OVER — RDD��� F�(� w ill N�� L 9AiN Cow foo 20, SCIW -k To 131,01 ¢ LiAW_ - 1 INSTRUCTIONS FOR COMPLETING FORM 115 - SC® - 6395 To b e a complete and accurate soil test, your report rrIust include: 1. Cornplete legal description; 2. This use section must clearly inclicate whether this is a residence or commercial project; 3, MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacernent system; S. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the Blot purr; y. MAKE A LEGIBLE diagram accurately locating your test locations. Diawing to scale is preferred. A separate sheet may he used if desire(]; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 6, Complete all appropriate boxes as to dates, names, addresses, Blood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 1 1 . Sign the form and place your current address anJ your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED `VITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Slo ne (over 10 ") BR — Bedrock cols Cobble (3 - 10 ") SS — Sandstone gr -- Gravel (under 3 ") LS Limestor - r s Sand HGVV — High Gror.m dvvatcr cs Coarse Sand Pere Peicolatlon Rate med s Medians Sand W _. k'Nell fs Fine Sand Bldg -- Building Is — Loarny Sand > -- Cheater Than sl Sandy Loam < _ Less Than I — Loarn Bn _.- Brown sil Silt Loarn Rl - Black si — Silt G — Gray c — Clay Loam Y Yell ow scl Sandy Clay Loam R — Red sIcl Silty Clay Loarn mot — Mottles sc — .Sandy Clay w,' __, Vritl> sic -- Silty Clay fff fevv, 'ine, faint C; _.. Clay CC ..... -. cc;ra cS?Ierr> f7 frs£x tit Feat arras - Nr.any, rr'rf.rliwn =, El Urk is _ _ distinct p — pr0Irrrr=t('nt HNiL High lvatei ievel, Six cgrenerad sail textures surface t'vdt.r.r for liquid kivaste disposal RM _.. Ben =;n 11!?<ark VRP Vertical Retwerace Pour* TO THE OWNER: This soil test repor, is the first step in srtctarir-,cg a san=:ttary permit. The county or tyre Department may rerluest vc ifica# ion of this soil test in the field prior io po rni! issuance. A €:ompleie set of plans for the pnliatr rva'Ie system and a pei rml application must be r,Ub t.itt €;d 'n the wal authority in ordel to oblami a perrytit. The sianitaiy permit nILW. be obtained a' posted fsri<ar to 'n start of any c01150'uctiorr. i PL 8 7 N y 1 6 PLor anJ CRO � SECTIO PIAN50- z �R7E /tPPPS�� 3 r p ` _ — &,er.2 ' - •. i 5TAkE� O uT � racl VCR S&L 'FES �. 11m -9 SE of 51EIc rt gG � PRop°sp,, M OP E 1^ / /3oI3 tv� VP M 115 y �� �M s �,�� �Qoy ?d 1 6 9 NED jr- Fresh Air Inlets And Observation Pipe ��- Approved Vent Cap Minimum 12" Above f Final Grade � D Above Pipe 4 Cast Iron - To Final Grade Vent Pipe Marsh Hay Or Synthetic Covering Min. 2 Aggregate Over Pipe Distribution Tee Pipe 0 0 0 0 0 �y "Aggregate a,, Perforated Pipe Below Beneath Pipe 0 Coupling Terminating At Bottom Of System Pon DLBRICK MOMESITE TESTING CO. DT. 3, O'NEIL ROAD lUDSON, MIS. 54016 TR�y 70NSI W ObJ�S 3 `_ .. • pi " [ Die T Rv 3s 7 ti R e n 4 , 98 1 � T. CROIX COUNTY CERTIFIED SURVEY MAP ICATED IN THE SW 1 /4 —NE 1/4, SEC. 18, T. 28 N., R. 19'W., 4TH P. M. 8 z w m t0 O R4 S z > 0 0 0 c^y to 0 � m � g� 3 0 U) m 1 SIGNED t..tJA , P, ��-..�►.. -.- DATED 0 3 8a U V -s -4 z C - y 0 0 ALLEN C. NYHAG RLS 1407 "• v m REVISED 11/02/81 = SETBACK LINES ^a�04,'°'...' toot +;� . 4 0,x► I ; nI SONI0 �!. UV�cTN?5 o N D - - - - - - -- -- - --- - m 3 „ZO ,Z£ 068 'S 8t>38 Ln �! „d„ 'H'1'0 _ �� - Ol Q3Wf1SSbl SI 81 '03S d0 3N1'1-b /I S-N O z b /1 -3N 3Hl AD 3NI3 H1(10S 3Hl �i (Hif10S) �, 0 w . ,01'ZSZ P ,60'981 3NI M /2i s © .; o APPROVED Z °♦ o_ - /o t , m AUG 2 0 1981 _ _ fG i �• Q a `, N —00 �� ,Lct, °� �O, d' ' u' I $ SP. CROIX COUNTY ' O ` D COMPREHENSIVE PARKS PLANNING ' m 1 0 2 - 01 1a (V p c0 cD y to W I Z fp 1 I 1 I I I 1 I I A N p< C I m OD D pd ` * J W -" O- rn m n O� 1 -I v Ir.. 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