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HomeMy WebLinkAbout040-1179-40-000 r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No. 506168 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: Tilson, James M. & Joce Bour Troy, Town of 040 - 1179 -40 -000 CST BM Elev: In BM Description: Section/Town /Range /Map No: /m - o .23k / 24.28.20.711 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS Hi FS ELEV. Benchmark Dosing Alt. BM Aeration yt �Q/ Bldg. ewer -` Holding &I—It Inlet EY S t Outlet TANK SETBACK INFORMATION 'Of -t_w 1 lit2- TANK TO P/L WEL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 5 > � � C�t Dt Bottom � Dosing eader an. ` 19 27 O� Aeration Dist. Pipe 2- g `l Holding Bot. System .0 Final ad E PUMP /SIPHON INFORMATION iw .S -kp", Manufacturer Demand 9i nA , -i S -h 2. 3 • Model Number TDH Lift Friction Los Sys ead TDH Ft Force main L Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width 3 t Length No. Of Trenche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth 0 —7 DIMENSIONS (( / /�� SETBACK SYSTEM TO P/L BLD WELL LAKE /STREAM L !AM!B :G Ma factr: INFORMATION CH CJ Type System: ^ l Z r ` t Model Number: 91 SYSTEM Z Vhh anifol�i Distribution x Hole Size x Hole Spacing Rent Air,(ntak6^Sh Pipes) //-� 4 61 / / ! _&-t C/ Dia Le ngth�V Dia Spacing 6 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only //!� ` �^ Depth Over L Depth Over xx Depth of xx Seeded /Sodded xx Mulched 71N Bed /Trench Center �f / Bed /Trench Edges Topsoil Yes No Yes COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /� /� Inspection #2: Location: 247 Cove Roa d Hudson, WI 54016 (SW 1/4 NW 1/4 24 T28N R20W) St. Croix Cove Lot 54 Parcel No: 24.28.20.711 S/3 /ID' 1.) Alt BM Description / 2.) Bldg sewer length - amount of cover Plan revision Required? `, Yes tr"" Use other side for additional Information. L� — - - -- Date Insepctor's Sign ture Cert. No SBD -6710 (R.3/97) cc'mmerce.wl.gov Safety and Buildings Division Co unty 1mgto 11 201 W. Washington n Ave., P.O. Box 7162 St Croix t ( IDew sco ns i n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) ament of Commert:e 5 b tG I to <9 Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental AM 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 econdary Same G otJe. purpo in accordance with the Privacy Law, a. 15.0 1 m , Stats. Z 1 f 7 L A . Application Information — Please P t All Informs on RECEIVE % It Property Owner's Name Parcel # 040 -1179- 40-000 James M & Jocelyn Tilson Bour Property Owner's Mailing Address MAY 0 Property Location 247 Cove Rd Iot (,-711 city, stars Zip Cod on SW'�a,NW Y., section 24 Hudson Wl 54016 (circle one) K Type of Building (check all that apply) Lot # T 28 N; R 20 W ®1 or 2 Family Dwelling - Number of Bedro oms 4 ) 1 Subdivision Name `/ 54 StCroix CoveSub#3;V582,P458 # ❑ Public /Commercial - Describe Use El City of ❑ State Owned - Describe Use CSM Number ❑ Village of ®Town of Troy IIL Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' New System Replacement Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) System filter canister aged B. El Permit El Permit Revision Change of ❑ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner Expirati on I / IV. a of POWTS System/Component/Device: Check all that a 1 a Non- Pressurized In- Ground Pressurized In- Ground LJ At -Grade LJ Mound > 24 in. of suitable soil LJ Mound < 24 in. of suitable soil ❑ Holding Tank 1 Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatm Area Information: Design Flow bpd I Design Soil Application Rate(gpdsf) I Dispersal Area Required (d) Dispersal Arpa Proposed (s0 System Elevation 600 V/ 0 0-7 858 ✓ 900 •/ g 7.5 9"d, s VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units U New Tanks Existing Tanks Z✓ / U l` Y� IC _ ` i r� v� Go Septic or Holding Tank 1200 1200 1 Wieser C.6ficrete Dosing Chamber VIL Responsibility Statement - I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum Signature MP /MPRS Number Business Phone Number Darrell Hubbell 221073 715 3(Y7 -1630 Plumber's Addreas (Street, City, State, Zip Code) N6490 U S H 63 Beldemrille W154003 VUL -Coun /De artment Use Onl Approved isapp� Permit Fee Date Issued Issu' ent S' e IT Owner Denial $07J DL ConditiOMORNMEWeasons for Disapproval 31 �f •p �� I3 Ise . c„ (p e c�D � 1. Septic tank, effluent fitter and J Y dispersal cell must all be services / maintained as per management plan provided by plumber. /1 (� J S 2. AN attar )Wk taquirernents must be maintained 7 ��` �` ���• �' J Attach to complete plans for the system and submit to the County only on pa r not less than 8 1/2:11 inches in size � C�/ ✓ems.. II i�15Aec�-wJ c�d-- 14 r G rH� >fentk; lt>v; !!!tl6Y" isa 06 Plot Plan for Site and Soil Evaluation Page 3 of Y, Property Owner iAMP-S hX j jCcr,- , 1 " =4oft Legal Description i -cTs (except where noted Wiz,P��s 5�:;�i�s ,�� ►��► /i;, �, 4. T& M, mow. = Packhoe pat tcw , cF 7�ZcV Sz CR0m elci "► w tS& cn,�� ,North 9 � 'gM�d- 1zJDP sVe�p �100.00' t F- �x�5� � 0.q a a• °4 0� J W O UL J � �' A O S �J h�Ld� q 1 Sate ca on: Kr. ,x I• Plot Plan for Site and Soil Evaluation Page 3 of y► Property Owner .sA mzs ti� c���n► ► ►�L �.�, C 1 .99 = 4a ft Legal Description i 5��- .�:�x.r,.���:� 3. (except where noted 2 — Backhoe pit ` North �;� � � '� st-1 z 1�ssv- ►'t`vA I o a , oa E 2 0 0 ° ?. (Al a � �wao S ce'.r t 6 h ' Sate L cation: .E1 V X RECEIVED Wisconsin, Department of Co meroe S L EVALUATION REP Page I of 3 Division of Safety and Buildin s t , �(t7 Wi MAY I �e with C m 85, s. Adm. Code unty ST. CROIX Attach complete site plan 0 paper not le pp.� /t?13ry11 in es in size. Plan must include, but not limited to: v ical �� Ifeld1'reterence poin (BM), direction and Parcel I.D. 040 - 1179 - 40 -000 percent slope, scale or dime sions, north arro d distance to nearest road. Please print all information. Revie by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ✓�/3 d 7 Property Owner Property Location JAMES M. & JOCELYN TILSEN BOUR Govt. Lot "'SlAl1 /4 N Vj 1 /4 S � T 28 N R 20 E Property Owner's Mailing Address ;j!![:]Village ck # Subd. Name or CS 247 Cove Road -- St. Croix Cove Sub #3; V582, P458 City State Zip Code Phone Number Town Nearest Road Hudson, WI 1 54016 ( 715 ) 381 -7348 Cove Road New Construction Llse[D Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD 0 Replacement Public or commercial - Describe: Parent material sand outwash Flood Plain elevation if applicable General comments Conventional In- ground trenches -- 0.7 loading rate and recommendations: F7]Boring # 11 Boring Q Pit Ground surface elev. 95.67 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDflf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -7 I0YR2 /1 A 2fsbk mvfr as 3vf -co 0.6 1.0 2 7 -22 10YR2 /2 Is lmsbk mvfr cw 2vf -co 0.7 1.6 3 22 -45 7.5YR3/3 cos Osg ml cw 2vf -m 0.7 1.6 4 45 -100 7.5YR3/3 cos Osg dl -- -- 0.7 1.6 Horizons 2 - 4 have some gr. ❑ 2 Boring # ❑ Boring 87.97 85 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application 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 *Eff#2 1 0 -5 10YR2 /1 A 2fsbk mvfr as 3vf -co 0.6 1.0 2 5 -12 10YR2 /2 is Ifsbk mvfr cs 2vf -co 0.7 1.6 3 12 -42 7.5YR3/3 cos Osg ml cam' 2vf -co 0.7 1.6 4 42-85 10YR3/4 cos Osg dl -- -- 0.7 1.6 Horizons 2 -4 have some gr; Horizon 4 has pockets Of 10YR5 /4 COS &gr. 5 al * Effluent #1 = BOD > 30 220 mg/L and T S >30 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) r Si ure CST Number Mary Jo Hollister Hollister's Soil Testing & Design) 224832 Address Date valuation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 04-18-07 (715) 426 - 1775 Property Owner BOUR, James Parcel ID # 040 - 1179 -40 -000 Page 2 of 3 Boring [- 3 Boring # a Pit Ground surface elev. 87.97 ft. Depth to limiting factor 90 in. Soil Application 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 *Eff#2 1 0 -3 10YR2 /1 -- I 2fsbk mvfr as 3vf-co 0.6 0.8 2 3 -16 IOYR2 /2 sl 2fgr&sbk mvfr as 2vf -co 0.6 1.0 3 16 -28 7.5YR3/3 -- cos Osg ml as 2vf -co 0.7 1.6 4 28-70 7.5YR3/4 -- cos Osg ml cs 2vf -m 0.7 1.6 5 70 -82 10YR5 /3 __ s Osg dl cs -- 0.7 1.6 6 82 -90 10YR5 /4 -- s Osg dl -- -- 0.7 1.6 r -1 Horizons 2 -4 have some gr. F] 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil Application 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 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 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. SB13- 8330Te t(R07 /00) Plot Plan for Site and Soil Evaluation Page 3 of 3 Property Owner .suss ,%,� TccmUA -nLSEA - 60L& - , I"= 40ft. Legal Description �� ,s4, ,sr. �� ► X,r� slcFS 3, (except where noted) Wt t : = Backhoe pit - h...:.l OF North � t t � cc�ti'� E s► OC t t"S" Ex` SctN6 �tZ,�� �Or` �, oR`� u oet � dD 49 oQ la w—, ^g R�ooN� ti OFa�� p8 op � e 1G, � �v�oc►�D� d Site L cation: s(. X Z`f y Public, P ierce Co., Wis. G. L. Ga y l o �,, 2n �nf commission . f ,57 Croix C Su bdivisior? —Z i i i 04 as p. Unplq±±Sd Land _ — _ � O � fVA' a _ -- - ROAD d OV E -_ _ E 350. oo 1so.00 52 5ai/ b0r -In9 -;Peari )7o/es r� 0 0 0+ h 9 s B 9' z r- ts, 44 I• S o �^ N ° 5 4 5 5 _ �. Q„ N 2.70o- o p 3. 43 a. o � o j� O m Z 0 53 0 Y ` •Ar' ° 1, �aQ•o© rt�►•6 Title Sheet for New Septic System ResA*nffW/ AAaAbRbon Conventional Septic S)SAS ► Owner's Name A A � :10 Address 7-4 Cow - -Zo*n Legal Descr' don :- s : fiz s g iP' , 2-4, �t'z�nl, RzDw Township _r opt County _ t; cXD%X Subdivision -, ezolX rcvE;� Lot Number �2i Parcel LD. Number o4o- Irp - o©O Plan b�umber. • G. ' "• rifle 91pew • -`� , 4� � P •• Paige 2... ............... ..................Plan VMwv ......... ...........................Plot Plan P AVe 4 . ............... ....................Maintenance Plan ........... •..... ( • � •� � �� t gne r�'�1 _hb S K Ucarme bier 1859 -ov 7 aria Otis 4L1 -t9 -0'7 Pbon& Numbe ( ► 7'7.57 Signature: lO&Vn lnfnrmation: In- Ground Component Manjml SBD- 10705- P(N.OI /01) Page s - StQMAT1 .4 ieMr�. 906 a _ t�L Sa+r•� 1 r*L x. driver 7e�w�rerr.� 1rr�w�liri�l►�. ��J « - 11� ~'raw A . . ►j • f �u` u'� . W 6 a � 15o apr teach -boo �a tot.), BE etc 2 OT y POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION SPECIFICATIONS Owner A- BDur� Septic Tank Capacity gal ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer E3 NA Number of Bedrooms 100gpd/becUoom , 0 C3 NA Pump T Filter Model ❑ NA Number of Commercial Units NA Pump Tank Capacity A Estimated flow (average)* 1) pV day PUMP Tank Manufacturer 189 NA flow Pump Man ANA Desi gn (peak), estimated x 1.5* gavday Pump Model IffNA Soil Application Rate gaV Y fr Pretreatment Unit 5rNA Influent/Effluent Quality -0) M onthly Average** ❑ Send/Gravel Fiber ❑ Peat Fiber Fats. Oil & >r1e�� EfB00�) 5 30 mg/L ❑ M Aeration a ��d Biochemical Oxygen 5 220 mg1L E3 Total Suspended Solids (TSS) < 250 mg/L Manufacturer: Model: Dispersal Cell(s) Pretreated Effluent Quality E3 Monthly Average * ** gr E3 grormd (gravity) In -ground (pressnuzzed) Biochemical Oxygen Demand (BODs) 5 30 mg/L tj At grade ❑ Mound Total Suspended Solids (TSS) 5 30 mg/L ❑ Drip-line ❑ Other: Fecal Coliform (geometric mean) <I Wcf i1100m1 ❑ Leaching Abe' Manufkam Maximum Effluent Particle Sire i 1 inch diameter Model Approval Stipulation *Wastewater Flow Verification on and calculations: Soil Application Rate Area Req. - (Other than bedroom based) Absorption Area Credit per unit fe Minimum Number of Chambers Nk ❑ Aggregate Design FlowltAading R ate= fe min ss 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 pretreabed wastewater. and approval letters. DESIGN CRITERIA ❑ " rsconsin At Soil Absorption System, Siting, Design & Construction Manual" (Converse et.81.1990 ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and EJ. Tyler. Pubikatioi 1522 ❑ `Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Abp Trenches and Beds". RJ. Otis - ASAE Publications 5-77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems". EPA 62511 -80-012 October 1980 ❑ SBD - 10570 -P (1-6199) "At -Grade Component Manual Using Pressure Distribution" 'SBD - 10567 P (8.6199) "111 Ground Absorption Component Manual" ❑ SBD - 10705 -P (N.01101) "In Ground Soil Absorption Component Mannar Version 2.0 ❑ SBD - 10628 -P (7.6199) "Recirculating Sand Fiber System Component Manual" ❑ SBD - 10656P (1.6(99) "Split Bed Recumlatmg Sand Filter System Component Mannar ❑ SBD - 10572 -P (8.6199) "Mound Component Manual" ❑ SBD - 10691P (N.01101) "Mound Component Manual" Version 2.0 ❑ SBD - 10595 -P (8.6199) "Single Pass Sand Filter Component Mannar ❑ SBD - 10657P (8.6199) " Drip -Tine Effluent Disposal Component Mannar' ❑ SBD - 10573 - P (R 6199) "Pressure Distribution Component Manual" ❑ SBD - 10706 -P (14.01101) "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 Frequency Inspect condition o months tank(s) At least once every ❑ s ) um 3 yrs.) of tank volume Pump out contents of tanks) When combined sludge and scorn equals nine- third (1/3) inspect dispersal cell(s) At least once every ❑ months ._ year(s) (Maximum 3 yrs.) Clean effluent filter At least once every lZinonths. gRyear(s) Inspect Pump. pwnP controls & alarm At least once every ❑ months ❑ year(s) 9MA Flush laterals and pressure test At least once every ❑ months ❑ yea(s) A Valves At least once every ❑ months ❑ year(s) XNA every months ❑ s NA i At least once ery ❑ year(s) Other: Page of 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 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 opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS 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 be 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, gravel 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 be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, 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. ❑ 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. X ' 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. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name DAgPQL- #tU E Name LL- Phone (715) HZ1b-5Vb'7 I Phone - g SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name vJ' ARMF 5 05EPTIC. ,5'a RV*E Agency X T CR t Phone 1(S �,1 Z 5 - 1 O Phone IC- %WPDXI*A1E111POIVTS OWNER'S MANUAL.doc Page of 7q— VOL 1146PAGc- 4(:9 �I nOCOM NO S DATE BAR OF WISCONSIN FORNI, 1 - 1 WARRANTY DEE"' This Deed, made between Paul R. Hilgemann and Rene E. Ritchie ST. CROIX CO., VVI n /k /a Rene B. Hilgemann, hissband and wife, R, 'clfor Record ! OCT n 10 9 V+ � V i J ./ V 7t 11:00 A.M Granter, and 'ames M. Bour and Jocelyn Ti.lsen, husband and wife, as survivorship marital t erof ed - €tegistZr of peecJet property - - rualvrw 7ci �y� �. Grantee, Witnesseth, That the astd Grantor, for a Valuabte conslrieration conveys to Goranteatha ioiiowing U.zcnbv 6rani —ib in Sc. r """ ° >• SLaLc — e !, i pt r1- Wisconsin Tax Farces( No: 040-1179-40 Lot 54, St. Croix Cove Subdivision #3, in the Town of Troy, St. Croix C,unty, tJiscc.:ei�t. f I I y This is homestand property. 1 Together with all and singular the hereditaments and appurtenances thereunto belonging; And Paul Il. Hlgemann and Rene E, Ritchie warrants that the title le good., indefeasible in fee simple and free and clear of encumbrances axcep+ municipal and zoning o rdinanc es, recorded easements public utilities serving the property, recorded building and use rest icti:ons and covenants, and general taxes and will warrant and defend the eame, levied in the year of closing and subsequent years. t s 15th dayof Septemb -r, 1995 Qc��� itXaY �s I (3FAL) (SEAL) . Paul R. Hilgemann , n /k /a �_ 1 Rene E . H� g�mann [I! ..._ (SEAL) (SEAL) f AUTHENTICATION / ACKNOWLEDGEMENT S'gnatvre(s) of STATE OF WISCONSIN ss. — _Ma rathon County. { I Personally came before me thin 15 th dayof c+uthonticatod it nay of S e _7 ternber r9 ) - the above named _ Pau R. Hi.1ge a nt R ane E. Ritch n /k /a R eene P . Hi -lgemann TITLE: MEMBER STATE RAR OF WISCONSIN to me known to be Chn person (s) who exacutacA'f1�,�A ame. aulh–ired by a 708.00, WIS. sate.7 instru acknow18dg0 4he s THIS iN:RRUMENT WAa DRAFTED BY Bonni Neitze1 J. B u s hne ll Nielsen attorney At Law Notary Public Marathon — °- --- My hot, elate er;pb. (Signatures may `,e a0hmueotrld a aeknoreesdged. Bath ere not neeeasary.l 2 /2 3/ 97 t 9 _ .) r rn•vi - - • N — of rcrmru .Inning in spy wrsoty shauM be typed ar minted halo.• Ihelr aiF.tst eras. _ -- y� nrC �inii VP,Yi. Y:VN:•�iV Iva rtlr�A /ILI' J IW- 1RRAMY DP13T7 To-- r-NO. i ieca ST CROIX COUNTY • SEPTIC TANK MAINMANCE AGREEMENT • ' AND OWNERSHIl' CERTIFICATION FORM Owner/Buyer "L Mailing Address P Address (Verification required from Planning Department for new construction) CitylState Parcel Identification Number y LI 0- 1 171 -- L1 -0 0 0 ��'t^di DF.5CRIPTIOIy Property Location '/a, Sec. T Z `d N -R Z W, Town of , — .. v 2 Lot # _. C- Subdivision GJI,!! 3 Gerd survey bbp # _ _, Volume Page # - - �f p ag e WwTmty Deed # S SS 7� , Volume aS — Spec house ❑ yes 19 no Lot lines identifiable X yes ❑ no �yr'1'R.M MA1i11tTI�,,NANCE a.,rocr i could result in its Premahue faille" to lnndte wastes. Proper t � � and Hof yam' �+P& if taxdod b3► a licensed What you part into &0 "am O f pig out the se pw tank every► three years of sooner, can affect the function of the septic tank as a treatment stage in the waste difiPoad system. The property asvner agrees to submit to st. Croix Zoning Deptp *a w ifutatim f=4 s by the ovam and by a � , n pl t pi or a lie�ed 8*a (i) *e o n site vumw vawdia and syMm is is proper �tuIIg condition and/or (2) after isspacion and pig the tea tank is less than 1/3 frill of dodge - ro m ildsk se sy�n with the; standards have wad the above agree UrResources, Stale of Wiacomm Catfficatiom set forth, brsein, as set by the D ►t of C and the Dwatbold of ti Office within 30 fa that ng your septic sysem has been maintained must be, completed and zetunWA to the St. Croix County Zoning of tie throe year out elate. ATE " PUCANT 'iRICA_MN I (we) ceaft that all statemaenis on this form ap true to the beat of MY (our Im wledg . I (we) am (are) the owneu(s) of g d 'bed by virtue of a warranty deed c+e riled m Rcguster OF APPLICANT DATE eat. * * * * ** + + * * *w Any information that is vm- represented may result is the sanitary pmt &wg revoked by dw Zoning Depam •s include with this applieattou: a stamped warranty deed from the Register of made in the waaaaty deed a copy of the certified army y map if ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK T is to certify that I have inspected the septic tank presently serving the a m eS d - To C e `yn 7',' L S on 136)u residence located at: 5w 1 /4, //w 1 /4, Section 2 1 / ; Town 2�? N, Range 90 W, Town of Tki) y , 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 S — 0 7 Did flow back occur from absorption system? Yes No X (if no, skip next line.) P -evjvv5L Y I'j1 �)'ed Approximate volume or length of time: gallons minutes Capacity: / �2 00 Construction: Prefab Concrete X Steel Other Manufacturer (if known): Age of Tank (if known): y 2' DARR15LL l< f (Licensed Plumber Signature) (Print Name) Ca 4 1IV 5 aA 1073 (Title) (License Number) MP/MPRS s -3 -a7 (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) COMUERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 -962 -3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.i 22580/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 5 /18/92 COURTHOUSE DATE RECEIVED: 5/14/92 HUDSON, WI 54016 ATTN; THOMAS C. NELSON OWNER: Richard Peterson ;. LOCATION: 247 Cove Court, Hudson COLLECTOR: M. Jenkins DATE COLLECTED2 5 -12 -92 TIME COLLECTED. 2:30pm SOURCE OF SAMPLE: Outside faucet DATE ANALYZED:5-14 -92 TIME ANALYZED:200pm COLIFORM2 0 /100 ml INTERPRETATION: Bacteriologically SAFE NITRATE- -NS 4 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. a Coliform Bacteria /100 ml Nitrate - Nitrogen, mg /L LAB TECHNICIAN: Pam Gana � \NDEDFNp o po WI Approved Lab No, 19 V 4A ( Means "LESS THAN" Detectable Level Approved by. ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 5/6/92 Mary - As per conversation today, please schedule this testing for Monday, May 11th. 6 & to( Thank you. g ST. CROIX COUNTY ZONING OFFICE' " St. Croix County Courthouse 911 4th Street Hudson, WI 54016 kp Telephone (715)386 -4680 r ��The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can be located 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: $ 35.00 35.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) SEPTIC SYSTEM INSPECTION--------- - - - - -- --FEE: $25.00 25.00 (Determines if system is properly functioning at,time of inspection) PROPERTY OWNER'S NAME: Richard Peterson PROP. ADDRESS: 247 Cove Court CITY Hudson Legal Description 1/4 of the 1/4 of Section , T N - R = Town of Troy Lot Number 54 Subdivision -, : St Croix Cove #3 F O N O IRE NUMBER 247 LOCK BOX NUMBER MSN —1 l _7�- �o-660 Color of house Cedar Realty sign by house? Yes If so, list firm: I Century 21 Bertelsen -Cudd PLEASE INCLUDE, IF AT ALL POSSIBLE, A NAP,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 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 requesting services: Jenny Olson Telephone Number 38608207 REPORT TO BE SENT TO: Jenny Olson/ Century 21 706 19th Street S - Hudson, W CLOSING D E 5/29/92 % - %B lT WE NEED THE REPORTS ASAP Signature j _ _ Q'rm C. 21 BERTELSEN -CUDD • , ; %Y:sconsin 5 - 1 0'6 J r tip) jF , ]ji S- K-499R St Croix Cove L# _ Ad�r Cou Lovely 3 bedrm home on over Ci Hudsoi Fire # Dist 01 3 wooded private acres in St. 1 /. '/. Sec Twsp Tr oy C St Croix Croix Cove w/ St. Croix Beach Ext Yr Bit 19ZO JHOil I Sty leSpl it rights. Spacious home w/ Lot Sae SMFL TFF Tax Yr 1.991 newer carpet & ceramic. Wrap 85 2010 ! $3,128 .30 around deck. Extra garage. L C I D jApprox Rm Sae 2 # Baths \V Sch Hudson Nature trail w/ lots of LR 21 9 ( MB pQBB RI PAR S wildlife. DR 14x1O.4 Dwshr Disp. Mig Bal. _ Kit 12. M13.6 lip Refri ( R &0 Mtg T e FR — 2 x12.6 I WS R 0 Av Ht $ MB [ C 14.6x10:111 C. Wtr C. Swr. Avg Util S 71/no BR 1 C — 11x9.4 Well M Septic Poss Date Ne o BR 1 C — 10.2xlO.2 Frplcs ) C. Air Bsmt Full 21x12.6 JAGar 2 GDO Deck ( Patio Rec Rm(1q Ldr I UFFI ( )Y ( )IJ () UKN Legal,rDisdosve Lot 54 St Ccdx 0mm S1 V1 Beech rifts & boat moar1M for St Ccoix River(St Ccadx 0am Assn) Private wooded Lot. FXtTA 12x18 gee. Nair doesn't ° tile wock. `� Arrein S B!C Lister j son !Ph 386 -2554 PRIC $129,900.00 GirCentury_21 Bertelsen —Cudd # 230 'Ph 386 -82 Directions: Co. Rd F S to N. Cove Rd, follow all the way back to end. Little road called Cove Court. #247. Information is considered accurate but we accept no liability fcr error. Listing may to changed or wit ;drawn without notice. ::.d'— C�ccc. of CFr.;_:y �l :eal Es:z:e C :: r. ,. `cam. re::l L:o•_. - c C ^,'••. _ . ._' E?. CHCFF '.CE;Si�C'EFE'�CE \?L�'C'''•�' `• 'c��'•=.• - cam• yy,� •n 'I• 0o ee �`. • 10 1 0��; � .. p Y 2 Iml b �{•� � °I •° .. `a' v � 1 � 0. `1 c ` ,; a 1• e c n I it- e In op df drl ILS fA S .. '�► '•� 4 . 'r O r • 4• c 4 °•OyC rf• ,::t, fI`•'�ekMtt�Sti� Bertelsen -Cudd Hudson • River Falls • Baldwin 70619th Street South Hudson, Wisconsin 54016 (715) 386 -8207 (612) 436 -8433 ADDITIONAL INFORMATION PROPERTY: 247 COVE COURT HUDSON, WI PRIVATE 3+ ACRE WOODED LOT BEACH RIGHTS AND BOAT MOORING FOR ST. CROIX RIVER (ST. CROIX COVE ASSOCIATION) NATURE TRAIL WITH LOTS OF WILDLIFE NEWER CARPET — MAIN FLOOR NEWER CERAMIC TILE — MAIN FLOOR WRAP— AROUND DECK EXTRA GARAGE — 12' X 18' NEW SHINGLES — 1989 INCLUDED: POOL TABLE FIREWOOD WOODSTOVE WINDOW TREATMENTS DISHWASHER REFRIGERATOR RANGE NOT INCLUDED: j WASHER AND DRYER RIDING LAWN TRACTOR (WILL SELL SEPARATELY WATER SOFTENER DOES NOT WORK Each Office Is Independently Owned And Operated ST. CROIX COUNTY � k WISCONSIN J ZONING OFFICE ST. CROIX COUNTY COURTHOUSE r 911 FOURTH STREET * HUDSON, WI 54016 (715) 386 -4680 i May 12, 1992 jenny Olson (Century 21 706 - 19th St. Hudson, WI 54016 Dear Ms. Olson: An inspection of the septic system on the property of Richard Peterson, located at 247 Cove Court, Hudson, WI was conducted on May 12, 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 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. Sinc rely, r � , 1 , MaryrJ. rfkin Assistan Zoning Administrator c7 I COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 -3121 800 -962- 5227 FAX - 715 - 962 - 4030 ST. CROIX COUNTY GOVERNMENT REPORT NO.'# 44061/01 PAGE i CENTER REPORT DATE'# 7/01/93 1101 CARMICHAEL ROAD DATE RECEIVED: 6/29/93 HUDSON WI 54016 ATTN'# THOMAS C. NELSON OWNER; Paul Hitgemann 6 Rene Ritchie LOCATION: 247 Cove Rd., Hudson COLLECTOR: M. Jenkins DATE COLLECTED: 6 -28 -93 TIME COLLECTED: 2 '#45pm SOURCE OF SAMPLE'# Outside faucet DATE ANALYZED:6 -29 -93 TIME ANALYZED '#2 '#00pm COLIFORM'# 0 /100 ml INTERPRETATION'# BacteriologicaLLy SAFE NITRATE -N'# 3 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. 4 . I Coliform Bacteria /100 mL 12 Nitrate - Nitrogen, mg /L o C; Of L � LAB TECHNICIAN: Pam Gane OF . \NDEVEN, o WI Approved Lab No. 19 D C Means "LESS THAN" Detectable LeveL Approved by: 0 PROFESSIONAL LABORATORY SERVICES SINCE 1952 . ' ST. CROIX COUNTY WISCONSIN ZONING OFFICE Y • r .Y• r• . . /!0 CROIX COUNT CO�tIRTHOUSE T • HUDSON, WI 54016 (715) 386 -4680 r 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 gained. ❑ Water (VOC's) $185.00 [-Septic $25.00 Water (Nitrate & Bacteria) $35.00 (Visual inspection) Owner: _F.4,',_ %�i�c;c q�y�(:' i jt iN1rL „ , c Requested by: ��u•�l J¢ /cG i �nr✓ � �«N� Address: 247 Cov6 go Address: 7 go City & State: /�ns•eAl , 6,-'l City & St. flvo ti , Zip Code: Zip Code: 55 Telephone N°: ( 7i5 Telephone N°: 69S Property address (Fire N° & Street) : 24`7 Cove kr Location: ;, ;, Sec., N, R Town of 7nor St. Croix Co., WI. Tax 3D 4 cX1 0 - 11`74= rcel ID N 7f fi 40 ��li • House color: Z6&; Realty firm: A)r- Lock Box Combo: AIaAl— Water sample tap location: 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: Septic system installed by: ? Year: Septic tank last serviced by: Date: rrt,4Y I W2 Previous Owner's Name(s): Have any of the following been observed? �1 1 t ❑Y B� Slow drainage from house. ❑Y EXI Sewage Back -up into dwelling.. O ❑Y Ed1 Sewage discharge to ground surface, road ditch or body of water. ❑Y Eft Slow drainage from the dwelling. rn `` 221993 w ❑Y IAN Foul odors. SCPO N o\” Other comments relative to system operation: C9 \NGo I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: A DATE: C l �jSC n� �� .�LCQf . �� � � 47.3 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION t qV I N Ov i TO BE COMPLETED BY INSPECTION AGENCY System design & /or permit on file? ❑Yes ❑No Soil series per SCS Soil Survey: sheet # Type of soil absorption system ❑Below grd ❑At -Grd OMound Approx. size 'X OGravity ODose ❑Pressurized Ft.Z ❑Bed OTrench ❑Dry Well Molding Tank 00utfall pipe OBSERVED DEFICIENCIES 00ther ❑Unknown Septic tank Setbacks: ❑House OWell ❑Prop. line 00ther Dose tank Setbacks: OHouse OWell OProp.'line 00ther Mocking cover OWarning label OPump /Floats OAlarm OElec. wiring Soil Absorption System Setbacks: OHouse OWell ❑Prop. line 00ther ❑Ponding: ODischarge: General comments INSPECTORS SKETCH OF'SYSTEM LOCATION N Inspector Title i �. ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 1101. Carmichael Road • Hudson, WI 54016 (715) 386 -4680 June 29, 1993 Paul Hilgemann & Renee Ritchie 247 Cove Road Hudson, WI 54016 Dear Mr. Hilgemann & Ms. Ritchie, An inspection of the septic system on the property located at 247 Cove Road, Hudson, WI was conducted on June 28, 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, Mary J. Jenkins Assistant Zoning Administrator mij i