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020-1125-70-000
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CROIX COUNTY „ WISCONSIN — _ ZONING OFFICE a r r r r r r r■ M ■.6 ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 2 - 1. / z:-- �" 0 February 22, 1995 Ms. Sue Schaeffer 357 Miller Road Hudson, Wisconsin 54016 RE: Water Inspection Results for Residence located at 357 Miller Road, Hudson, Wisconsin Dear Ms. Schaeffer: Enclosed is the original test results from Commercial Testing Laboratory, Inc. for water inspection of the above property. If you have any questions with regard to said report, please let me know. Sincerely, Mar JI. Jenkins Y Assistant Zoning Administrator St. Croix County, Wisconsin mz Enclosure COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 800 - 962 - 5227 FAX- 715 - 962 -4030 C ST. CROIX COUNTY ZONING OFFICE REPORT NO.. 79466/01 PAGE 1 ST.CROIX CTY GOV.CTR REPORT DATE. 2/17/95 1101 CARMICHAEL ROAD DATE RECEIVED: 2/14/95 HUDSON, WI 54016 ATTN. THOMAS C. NELSON OWNER. Mark Schaeffer LOCATION. 357 MiiLer Rd., Hudson COLLECTOR. M. Jenkins DATE COLLECTED. 2 -13 -95 TIME COLLECTED. 20'30pm SOURCE OF SAMPLE. Kitchen faucet MATE ANALYZED.2 -14 -95 TIME ANALYZED.2:00pm COLIFORM,MFCC. 0 /100 m + INTERPRETATION. Bacteriolosical.Ly SAFE NITRATE -Nl; 3 ppm Above 10 ppm exceeds the recommended PubLi Drinking Water Standard, CoLiform Bacteria /100 ml, Nitrate Nitrogen m9 /L LAD TECHNICIAN. Pam Game WI Approved Lab No. 19 I EVE F .AND NOE O Nr v �9a J O O �d SA < Means "LESS THAN" Detectable Level Approved by. 0 PROFESSIONAL LABORATORY SERVICES SINCE 1952 7 �'►.�. ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road — a - Hudson, WI 54016 -7710 (715) 386 -4680 February 13, 1995 Ms. Sue Schaeffer 357 Miller Road Hudson, Wisconsin 54016 RE: Septic Inspection for Mark and Sue Schaeffer Address: 357 Miller Road, Hudson, Wisconsin Dear Ms. Schaeffer: An inspection of the septic system for your residence located at 357 Miller Road, Hudson, Wisconsin, was conducted today, February 13, 1995. 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. Also, water samples were taken. Once we receive the results we will forward the same on to you. Should you have any questions in the meantime, please do not hesitate in contacting this office. Sincerely, 4 Mary Jenkins Assistant Zoning Administrator mz ST. CROIX COUNTY .. WISCONSIN }_ ZONING OFFICE t r MINN IN QOIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 i . ; (715) 386 -4680 0 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please 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 that entry can be gained. ❑ Water (VOC's) $185.00 Septic $50.00 'Water (Nitrate & Bacteria) 45.00 ❑ Nitrate & Bacteria retest $15.00 Owner: Requested by : �Q� Address: _5 Address: - d �_ ZIP `�� [- l-�-t .�_ of s t, j-. Z I P -� �o Telephone W: ( �. � _�a �s Telephone N (7jr�_) l0� "75 Property address ( Fire N° & Street) : S s '7 rye j // er N c l . Location: ;, ;, Sec. , T N, R W, Town of F�i:r� ova Realty firm: Lock Box Combo: C L 1 yA Closing Date: 1 f ` j TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Water sample tap location: L 41bk, ;01 0 Is the dwelling currently occupied — ? Yes ❑ No If vacant, date last occupied: Age of septic system: H 9 P Y , l �i r5 . J Septic tank last pumped by: . -C Date: Previous Owner's Name(s): Have any of the following been observed? ❑Y N Slow drainage from house. ❑Y Sewage Back -up into dwelling. ❑Y Sewage discharge to ground surface or road ditch. ❑Y qV Foul odors. Other comments relative to system operation: ---- I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: rl � DATE : 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION I N " / a O`r � TO BE COMPLETED BY INSPECTION AGENgY� System design & /or permit on file? ❑Yes ONo ��yy Soil series per SCS Soil Survey: sheet # Type of soil absorption system 03telow grd ❑At - Grd ❑Mound Approx. size 'X [dravity ❑Dose OPressurized Ft. OBed OTrench ODry Well ❑Holding Tank OOutfall pipe OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank Setbacks: ❑House Owe 11 ✓ ❑Prop. line ✓ OOther Dose tank etbacks: use []Well OPr ine OOther ❑Locking cover ❑Warnin el ❑Pump /Floats ❑Alarm OEle . Soil Absorption System Setbacks: ❑House ✓ ❑Well ✓ OProp. line '� []Other OPonding: G'�i ❑Discharge: ( jr General comments INSPECTORS SKETCH OF SYSTEM LOCATION N !s� I ` Inspector_ Title i a ST. CROIX COUNTY ZONING DEPARTMENT • AS BUILT SANITARY REPORT Owner JO ffA) Property Address 35 7 City /State a, 61 -1-1 ST CRO,x COUNTY Legal Description: ZON1NOOFF,G� Lot Block Subdiv3'sion/CSM # 7 4 406 - '/a ' /a, Sec. , T )- N -R�W, Town of � VPSOn.) PIN # X {" 70 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION to wES/ Tank manufacturer ��ES � Size ST/F* Setback from: House >* I Well SO P2 ? dos Pump manufacturer N+ Model — Alarm location &4= (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location aW SySTE / -, e26 I3 EI9 SOIL ABSORPTION SYSTEM �j :ppi ITPA"P, , 3 x 93 , Type of system: TQe"NG(AE� Width ✓� X Length �/ Number of Trenches Z Setback from: House _3�g! Well SS' P/L 2 9 Vent to fresh air intake 6vFST ELEVATIONS Description of benchmark ?Ol OF 1P �/ NA) 1 O / I De N A , Elevation Description of alternate benchmark TaP Of A07 7 1-1 1 1" e•7- Elevation /D /• l 0 vvtit s T( EX r'STi t, &-- Buildine Sewer N ST/HT Inlet Nl+ ST Outlet PC ! PC Bottom --- Header/Manifold Top of ST/PC Manhole Cover Distribution Lines 0 1 7 5. 1 5 O S , D O Bottom of System () 3 ' 9 () 1 3 . 7 ( e ( ) PO R 10 - d � - Final Grade ( ) ( ) ( ) Q Iq 1/ - 101 353Jy� Date of installation / / Permit number State plan number yZl�3�S DUE•JL- I Plumber's signature License number Date Inspector n ky /�U 6,R1+ S /f I Complete plot plan NOTICE: : Please provide the following: g • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW INDICATE NORTH ARROW P� 0 �P Ulbricht 6 Associates private sewage Consultants 655 O'Neil Rd• 54016 Hudson, VWis. 0 �x �S 1 A.)C9 -- TP v s. b 7 , r SE PTIG ® E'''' PV v I I I I w PLC Q s . y 1 � � IM i t � M� i In _ o I �c M �i� m i9d�3 ov a ICI I i I I I `. I sr /sT 0 -fu - 4 UJ— 2 343 ' I 0 o rr y& bP - - - -- -- L� 0 0, D ORIGIN Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y: Safety and Buildings Division Count INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 353142 Permit Holder's Name: ❑ City ❑ Village Q Town of: State Plan ID No.: Town of Hudson Insp. BM Elev.: M Description: Parcel Tax No.: If19. ' 7 ( 40 JD. a' d+ co" 020-1125-70-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic x,1 pip Benchmark Dosing` Alt. BM Aeration Bldg. Sewer I Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Air Intake r 3 ti 1.1 Q � NA Dosing NA Header/ Man. ,L ( 7r , 10 Aeration NA Dist. Pipe q, cis Holding Bot. System It' E to. :;A q4. m P S IPHON INF Final Grade 6 9 acturer D m cover �� Model Number GPM X j ?• `(o 5j5-, 3 $" TDH Lift Fricti ystem TDH Ft Jug- Force Length Dia. Dist. To e SOIL Aj SYSTEM �'� s = e ig.�l TRENCH Width t Lenq No. Tenches PIT No. Of Pits Inside Dia. Liquid Depth DIM 1 I DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING INFORMATION TypeO p r CHAMBER ode] Num r System: eZL 10 SS OR UNIT i DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length � Dia. Length Spacing 7� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 1 11 / Iq Inspection #2: Location: 357 Miller Road, Hudson, WI (NW1 /4, SEl/4, Section 7 T29N -R19W) - 7.29.19.573 19 00 44 464 00 01 9.4v4ot mAZJ 4o 41 A, Plan revision required? ❑ Yes 'Q No S Use other side for additional information. /l SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: , 4 � # F P i i em j i I 4 8 ' 0 3 v { e i E F a i i v e r I v m E a E ^^ s m i } r � t E � ( S E i 1 me _ ..a..�. a e.e C # _ y .... _,.... .......� ..... ,. . . e.,,. . ., n. .�.�.. �... ,,,. ...... ._ .... s _. ...... ..w ..... _ .b ... ,.,„. J � E � � m pj i } t 9 S � 3 i 3 a� 3 v 3 m n 3 g e e Lw a E E AA sconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 7302 De artment of Commerce accord with fLHR 83.05, Wis. Adm. Code P Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 12 x 11 inches in size. S Cle0l' • See reverse side for instructions for completing this application State Sanit P Nu Personal information you provide may be used for secondary purposes ❑ ur Check if revision to a rhvT6us application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION N Prop y IT� Owner Name L ,+� , ` / S �� �v l< N Pr o pe rt y a pe �e 1/a ation S T Z f o �Mfx� 7 LAlz�G / I N , R E (or) Property Owner's Mailing A Lot Number Block Number 3S ltfI 1 «2 D Cit , tVeSD.J �/' Zip Vol (ho e Number" 7 Subdivision�lamg�� II. TYPE F IL ING: (check one) ❑ State Owned 0 L it y Nearest Road Public _ or 2 Family Dwelling - No. of bedrooms F v ow a n OF �n`SaJ III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 4 1 ❑ Apartment/ Condo V .-.?- - 112 5' - 70 -AfT. 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. replacement 3_ E] Replacement of 4 E] . Reconnection of 5 C] Repair of an System System Tank Only Existing System Existing System ----------------------------------------------------------------------------------------------- B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) 2AjFft7 +7ZW,'S "S /ALw�.vf��7� "S Non- Pressurized Distribution g - Distribution Experimental Other 11 ❑ Seepage Bed + a 21 E] Mound 30 E] Specify Type 41 ❑ Holding Tank 12 (Seepage Trench SQ 22 ❑ In- Ground Pressure y �j Sc>CGitf .40ILaG� 42 ❑ Pit Privy 13 E] Seepage Pit G�(a - 2-,? Sffil�s' 3 O 43 ❑ Vault Privy 14 ❑ System -In -Fill s/ VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft_) (Min. /' Elevation ,�// 7o 1 5 . S g- 3O Feet Feet TANK Capacit VII. I NFORMATION in gallo Total # of Manufacturer's Name Prefab. Con Steel Fiber- Exper. Gallons Tanks Concrete glass Plastic App New Existin structed Tanks Tanks Septic Tank or ��"� v�v �>�s� ❑ ❑ ❑ ❑ ❑ Li er LL4 3 dU1 5fAlt ED ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STAT MENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) PI tuber's Sign ture: (No Stam s) /MPRSW No.: Business Phone Number 2v ITT 4 3- 5 71s 3 Plumber's Address (Street, f ity, State, Zip Code �� &55 0 w r l 5 5 0/ IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Iss Agent Signature (No Stamps) [A roved Surcharge fee) Approved ❑Owner Given Initial a,�C C _t1 --III .� Adverse Determination JJ � L.A X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: FI•o p(aiK— W ki}a �_C. SBD 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS -' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code adpninistrator or the Stateof Wisconsin, Safety and Buildings Division, 608 -266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufactdrer's name, indicate prefab or site constructed. and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement: Installing plumber is to fill. in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber mustsign application form. IX. County/ Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the:county; -E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ep 3� ,4 T Nw a 7 AT �f S S7f�lU,r1 Alit W i I' • a S YS 95,3 0 ed. x I � I '�• � (o I I I I I o T y 61 (1 > r o I I i B EV j GD.dN L�?ZsT� to tc vt f � I T . � _I �v� • /Sol- 3 T3 *,� O wrc siq 7 ;c s � V lcht �' Agao^$alta ^ta � / 0/ . /0 $ewao e Co p�1va�Ne11 R 5 4016 NU O d w� 2;)' on U 101AI, 2- I I/M 3. 15 5 Sy.-� TAM C /fo S$ SEC O ZlS IA.) ( INi L 7�•9 T - o�'S' � ��✓1 C�! j�r4 C�'r � ' ���1���i -v��� •' �-J pl��L , . 3 , x � , ,, �a.v G-- .. p 101V 2 ' p M 3 Z -- B �i,� 9S3 O. Wisconssn Department of Commerce SOIL AND SITE EVALUATION Division of�Safety and Buildings Page I of 3 Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and S C r U f V percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # DZ 4 ' 10--5 7 G APPLICANT INFORMATION - Please print all i►liemma?", R iewe by Date Personal information you provide may be used for secondary pu*'s' gse)WiivAcy Lak,t;. 15.04 (1) (m)). D Property Owner ! ' Property Location Z ' LT e. S I� 0 I 1 C. V�e_ Govt .k t A11V 1/4 1/4,S T Z� N,R E (or) W Property Owner's Mailing Address Lot. -- Block# Subd. Name or CSM# City State Zip Code ' Phone Numt.4r ' . El City El Village tZ Town Nearest Road C� El New Construction Use: Residential / Nu �r f ��ljo mt `' Addition to existing building V Replacement] Public or commercial Code derived daily flow SQ gpd Recommended design loading rate Ll bed, gpd /ft 1 trench, gpd /ft Absorption area required 10 -5 bed, ft U trench, ft 2 Maximum design loading rate _ _.Y _ bed, gpd /ft S trench, gpd /ft t Recommended infiltration surface elevation(s) 9 1,5 0 — °I 5 - a ft (as referred + i to site plan benchmark) Additional design /site considerations ��p. D e w teM Cr rGU_I Ty 1� t? 6 1 n t � 1 r'J U( k C C S n Parent material clS 0i r p } i, lr A C h sc. n Flood plain elevation, if applicable N ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system M S ❑ U EW S ❑ U &S ❑ U Ys ❑ U ❑ S IFJ U ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1._ I 0- 1u r3 3 CS "1 1 -19 IV r y/ S, I Z 6 k Mfr C S I F S Ground 3 16 -32 to \ 1 c , y q -- S 1 1 I r1 s6 rn F I C- 5 elev. 9ft. r / ��.-� S /' 7 /� : �3 Depth to J 6 6 - 1 . r 5 y _ V dS m ' limiting f c or S 7 in. 9 Remarks: Boring # 6 -10 10 r 3 f3 — 5 1 I z-ms6k r C S �Z ,S Z r a -43 I v r y — Si I z r�t ab �l ��1 r �' S 1 (= , .S , (� S r — S I m s k rr) r a s S 4P Ground Ll 5 -7 7. S r ? / -I S S M' C S 7 -� elev. ft. S -9 > - 7, s r 5 _ s Depth to limiting 501 factor '7 q Din. Remarks: CST Name (Please Print) Signature Telephone No. Address f�� 2 (2 Date CST Number PROPERTY OWNER u eS � 0. 4 C h e �K SOIL DESCRIPTION REPORT � o ' Page PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 D - !v vr 3 — St 6K 2 103 5 `– yy Stl 2ns6k m r LS IF ,s Ground ,3 _q � Q r 4//& 1 �S � r,sbk m V r elev. "159ft. q l5b m s 61C rn y r CS _ , 7 5 Depth to 50 - 7,5 r 5/ - (, Ds M I e S — , 7 ' � . $ / QQ limiting l0 (cb 1 7.5y 5 1 ( , — v $ 7•� t r in. ' Remarks: Boring # 13 Ground elev. ft. , I Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # E3 Ground elev. ft. Depth to limiting factor in. Remarks: Boring # 13 Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) [KV1 �Y 0[51 1432 120' STREET, NEW RICHMOND, WISCONSIN 715- 246 -2454 Tom Nelson Certified Soil Tester 227387 - -- Registered Sanitarian SR00713 ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** t ot m 2d2 1 SI ��x C'� ��� &2 99. al Q3 q�,,5q "ols\ t (v� (aS I 3 bc�t-oo� V—e s I C1 4E LT Ble.sKJcheck SCALE I"= 30 1 Tom Nelson BM2 lop o� Iron p�Pe 100 I �-� Tod o� c1eGn �� P%� i a.boue gr &At elev I01 110 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify tha I have inspected the septic tank presently serving the - So &AJ PIE Sl- T�1L residence located at: Al 1/4, 54 1/4, Sec. T x N, R // W, Town - of I�v�Sa� Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly.� Last time serviced S l '�/ Did flow back occur from absorption system? Yes No (if no, skip �`- next line) Approximate volume or length of time: �� gallons minutes Capacity: lev Construction: Prefab Concrete Steel Other Manufacurer ( if known) : /,E',s' 4:x Age of Tank (if known): (Signature) (Name) Please Print / N; l -L / e 3 - J S 27 -013 - ) S (Title) Number) (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR -$3, Wis. Adm. Code (except for inspection opening over outlet baffle). Name � ZL 431 s wool `Xing Mn Si gnature — P /MPRS 5/88 .ST CROIX COUNTY SEPTIC 'TANK MAINTENANCE AGREEMENT AND n OWNERSIIIP CERTIFICATION FORM j? r— Owncr /I3ttycr ' Mailing Address 3 Y7 lq/l<t�X IeP �f��rG�� �� xzl& <,- Properly Address _ (Verification required front Planning Department for new construction) City /State Parcel Identification Number taw 7 O LEGAL DESCRIP'T'ION Property Location 0 ' /a, 50' '/,, Sec. 7 , T 2 4 N -R �� W, Town of V� Subdivision �� /����J , Lot # y � Certified Survey Map # , Volume , Page # Warranty Deed # Volume X Page �i 2 7 g # Spec house Oyes no Lot lines identifiable tB yes C1 no SYSTEM MAINTENANCE 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 cart affect file function of the septic tank as a treatment stage in flue waste disposal system. 3lie property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a ttaster 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, asset by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification slating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expir lion date. St NANATU 0,- APPiacANT DATE OWNER C 1 (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 file prop rty described, 9 ribed abo e, by vi tue of a warranty deed recorded in Register of Deeds Office. 9 SK;NAIU . Oh APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** include with tills ap lication: a stain red wawa p ► my deed from the Register of Deeds office R copy of the certified survey map if reference is made in the warrrnly deed ORIGINAL Pltx w �i( VOL V ?A t t WARRAWY DEED . 56y2 Document Number RECIS`fE�" ST. CRQI)(* Co.. WI b; 1Qr RIcdr►1 Return Address QEC 1 1997 10:45 ` q h► d C�.d� Parcel LD, Number: 020 - 1125 -70 Nate R. prsch and Wendy D. Pigorsch, husband and wife conveys and warrants to John B. Bl esirateheek and L z e J. Bleskateheek, husband and wife the following described real estate in St. Croix County, Mate of Wisconsin: Lot 44, eagle Ridge in the Town of Hudson, St. Croix County, Wis. onsin. This is homestead property. Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 2 - day of November, 1997. SEAL _ (SEAL) (SEAL) DatR. Pigocsch Wendy Pigorsc TRANSFER AU'IiHENTICATION � y� °9 FEE Signature(s) Nate R Pigorsch and Wendy D. Pigorsch, husband and wife, authenticated this day of November, 1997. ;aw c-- Kristin O g land TITLE: MEMBER STATE BAR OF WISCONSIN THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristin Ogland Hudson, WI 54016 I O N 5 ------- __ - - -- ° m 144 °353 CA \ �- C tr �Z 4D m \ , m ' 0)_ OD \ i� n W ,� \ ) m ,Q \ \ OD ____ - - -- w 'r,G rn $ \ D o ° o e $ S'� 1 Q6 °44' t S ° � N e cn M 9 0� o c l I' 00 ' 4, — OD 5830„ N o� OD r*ii m p w 0 Dcn c m co c o- o'O %% o_ le Fs Wo 2/38° D ep, 09 A 0 . 0 48 30" m O !y u► cn ,p er cn o O O \ S O o 0 0 ?' 0 0 �' c N / 19 /U te a' ° O ff, 131 ° 1I'10� �'° N c` L 2 ° O O 0 � 6c` o (}1 80 ° 55 O5'' 11 7. °50' cJ � , s a 00 - o� °, O �o m O o O w to v a' X \Gi 0 �, to -+-' 0 �w Oi � ` �S Ste,° n l \ m 4. o O Q m 00 99 N O� /�� ° C J1 _ OD S i % ti' m O yW ti c0 � C� 0 � m co N O CII �%v 't' Qtico — 2 ON w o m � �. 01 14, ° o > N �` AS BUILT SANITARY SYSTEM REPORT OWN:3R / TOWNSHIP 14 U - ; U SEC . T N -R W ADDRESS r, u/ ������ /0 ST. CROIX COUNTY, WISCONSIN. SUBDIVISION Fa LOT / ¢ LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I di at N r h rr w LIE H BENCHMARK: (Permanent reference Point) Describe f � `'� / 'fw 1" / Ger/ Elevation of vertical reference point: � /,/,/ Slope at site: SEPTIC TANK: Manufacturer: 5r Liquid Capacity: [ U ":) o v Number of rings on cover : 2-- Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: / Number of gallons Number of gal. pump set for a cycle /� 4 gallons; Total capacity of distribution lines N4 gallon: size of pump ;V head; gallon per minute A /1 1 4 ; horsepower ;brand name of pump and model number ; Type of warning device /V HOLDING TANK: Manufacturer Number of gallons zV Elevation of manhole cov Type of warning device SEEPAGE PIT SIZE; Number of pits feet diameter feet liquid depth V4 seepage pit inlet pipe- elevation bottom of seepage pit elevation_ /J feet. r - SEE — EPOE BED SIZE: number of lines width length /tile depth SEEPAGE TRENCH: width / length N PERCOLATION RATE AREA REQUIRED G AREA AS BUILT INSPECTOR DATED PLUMBER O JOB LICENSE NUMBER /(/l "- 3 Z 64 rl S s io o . , � f g � i► 1 I ✓o 1 1 f j � 1 1 1 , � 1 1 s-r � L ` T l _ l DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOP.& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969q BUREAU OF PLUMBING MADItON, WI 53707 fMCONVENTIONAL ❑ALTERNATIVE I State Plan I.E. Number: [If assigned) /❑ Holding Tank El In-Ground Pressure ❑ Mound �V N E OF PERMIT HOLDER J AIDDRESS OF PERMIT HOLDER: INSP CTION DATE: Sam Miller Trout Brook Rd., Hudson, WI 8 3 0l o'a0 NZ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELM: SW SE, Sec. 7, T29N — R19W, Lot 44 Eagle Ridge,Town of Hudso Name of Plumber: MP /MPRSW No County: Sanitary Permit Number: Douglas Strohbeen 5432 St. Croix 38472 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET EL V. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER 9 PROVIDED: PROVIDED: kb O / [ `. LP WYES ❑NO DYES 0 N BEDDING: VENT DIA.: VENT MATL HIGH WATER NUMBER OF ROAD: PR OPEPTV WELL BUILDING VENT TO FRESH G� ^ ALARM: FEET FROM /D r� LINE: T / / A AIR I41ET:�_ '9 YES ❑NO [ /�/ ❑YES ❑NO NE [/ �! ( 7 � S `/ ,J DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ON I OYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. JVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORGE LENGTH oIAMErER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) �� L � CONVENTIONAL SYSTEM: ` Z J WIDTH: LENGTH J NO,OF DISTR. PIPE SPACING. COVE INSIDE DIA.. #PITS. LIQUID +raiLX:N.F TRENCH Elf PIT DEPTH: 11W fad S. J GRAVEL DEPTH FILL DEPTH OISTH. PIPF DISTR PIPE DISTR. PIPE MATERIAL. N0. DISTR NUMBER OF PROPERTY t WELL r BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER EMI E V N PIPES LINE / AIR INLET NEAREST : n FEET FROM 5'� iJ lam ---► O� 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- OYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES 0 N DYES ONO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL. SODDED SEEDED. MULCHED. CENTER. EDGES. DYES ❑NO I OYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: ` WIDTH: LENGTH. LATERAL SPACING. GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: for; N� MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. I D ISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. -._ ELEV.: ELEV.. CIA.. ELEV.: PIPES: DIA.: °fUVA. AN OtSTRfBIfTfflN HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED �RMs I'' PLANS: DYES ONO ❑YES E1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER ��,", PROPERTY WELL: BUILDING: FEET FROM LINE: i, DYES El NO OYES ONO NEAREST Sketch System on Retain in county file f audit. Reverse Side. SI NA U TITLE . i DILHR SBD 6710 (R. 01/82) DEPARTMENT OF A PPLICATION SAFETY &BUILDINGS INDUSTRY FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN i t ATIONS (PLB 67) MADISON, WI 53707 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 or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of- the soil test report or the owner's copy must be included. Property Owner: // Ma illp Addre : I S a A4 Property Location: & I Ni Township: County: S /a 5 E 7: iT . %NrR / Lot Number: Blk No.: Sub e: Near Road, Lake or Landmark: State Plan I.D. Number: 9'' i✓ + �"' or Na �B � � � /` P Q �� � L O !f C (lf assigned) TYPE OF BUILDING Number of ❑Public F Variance El Other (specify) Bedrooms: 3 O , 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE AS PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK /SIPHON CHAMBER Vj MANUFACTURER: t EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA ,..,,,,��� (Minutes per inch): PROPOSED (Square feet): [Kew F-1 Replacement ❑ Experimental Lld'Seepage Bed ❑ Seepage Pit '7 ❑ Alternative (specify) ❑ Seepage Trench Water Su Owner's Name as Listed on Soil Test Report (If other than present owner): Lrd'Private ED Joint El Public ,e A-1 C I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber 4 Signature: MP /MPRSW No.: Phone Number: Plumb is Address: Na m of Designer: COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: Sanitary Permit Number: ��j APPROVED �y . O �� 3 DISAPPROVED Reason for Disapproval: Alternate course(s) of Action Available: 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 DI LHR -SBD- 6398 (8.07/81) i 1 Forw - 5 `l' C loo 44 Owner of Property � ` Location of Pro erty 4 Sectio�i _,'f`�N RW Township Mailing Address Z Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel Was Created Are all corners identifiable? _Yes No Include with this application one of the following .Certified Survey Map X .Deed .Land Contract, or .Other Legal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed reco ed in the Office of the County Register of Deeds as Document No. ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. ). SIGNATURE OF OWN SIGNATURE OF CO-OWNER (IF APPLICABLE) 6-S- 8 - 3 DATE SIGNED DATE SIGNED DEPARTMENT OF REPORT ON SOIL BORINGS A �, I / TY & BUILDINGS INVUSTRA, , DIVISION 'LABOR'AND . PERCOLATION TESTS (115 M R FCE��E M SON WI 53707 HUMAN RELATIONS (H63.09(1) &Chapter 145.045) � ' �QY 3 LOCATION: SECTION: TOWNSHIP / foN LOT N . NO.: N . G � / 11 T � ? N /R /? 1(or COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: 5 f T awl a�6 USE DATES OR E NO. BEDRMS.: COMMERCIAL DESCRIPTION: PRO ICED CRIP S: R CATION TESTS: Residence - 3 J LKNew El Replace Q RATING: S= Site su itable for system U= Sit unsuitable for system # Y G p y j f CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) L�1 S [:]U [_I S ❑� ® S ❑U IEIS ©U EIS ®U 4f trc10V,9"1; Bed /UX.?6' If Percolation Tests are NOT required DESIGN RAT I If any portion of the tested area is in the `/ under s.H63.09(5)(b), indicate: N Floodplain, ind icate Floodplain elevation: 11 PR FI DESCRIPTIONS BORING TOTALr TH TO GR UNDWATER - G"688— CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH r!�OO ELE VATION BSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) `7, 6 /00,/ o '?. G " , ?ell A 7X4 1 . rAA s/ S4 i ,9 s B- Z '7.�" /00, 0' 6 g / a. q B 1 , (7t., 2. o 6 B F s V le / oo.3' Velm e_ 7 � �' ` // A hy & / �'7 010, 2. Y& s .l B-S /.,r /ol)rl, AlQAle �r �' ♦1G 1 1 .3 ,1. •a ( .3• e- 5 B PERCOLATION TESTS TEST DEPTHO WATER IN HOLE TESTTIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER ID16iiE AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P _ / ' O O IS S X_ P- A n 3' 3 3 P- 3 q,.3' Ato Z S P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELE"TIO. `l�". �I W/u'� t � � � r i f I E � �� T _-� � �• �c I T t N /00 _.;___ IL z I 1 f � I �t 7--_ • ' I'1 r 04' >r: _ . � ? �.. ' � E ,�wq��1�► € ✓ '; it _.. _ .. /W t.�'� �/_ �_7� _...��!�...' �'!_4�' � I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: g's O {'S . C r s { r ._ = 41- .� ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): /rl CST ATURE: -. • c inal and one copy to Local Authority, Property Owner and Soil Tester. 2) — OVER — 4 l INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 5395 To ,tQ a ce;tnpalete a4d aCQUrAte soil test, your report most inclkufe.: 1. Cor Ieplal description; The use sartjc» n)usii. clearly indicate vE;e±lreA,tl > is ?Jesidenee or cornmercial project; 3, MAXIMUM number of bedrooms or cornmctciai use planned; 4. Is this a nev%s or reral acement system: r. a. Co ap?lete the suitahilil- y boxes. A SITE IS SUITABLE FOR A Ht�LDIkJC� [ A ft ONLY IF ALL OTHER SYSTEf>IS Al3E RULED 00 BAGED ON' - RAL CONDITIONS; b. PLEASE' use the abE-reviations shoskra here foY profile descriptions and compieting the plot p�Ian; 7. MAKE A LEGIBLE diagram accurately locating your test locations. DraAring to scale is prefeiked. A � s past Theta shay b;'.tusd i1 desired; £3, Mate sure your benchmark and ire €ti al elevation reference point are clearly shown, and are permanent; 9. Go .laiet? all boxy °s as to dates, names, addresses, flood plain data, p ercolation - test exernp- ticn,, if appropriate; ' i €.). If t.3 €: o €; €mot ; €fa tm, - h as flood plain, elevation) does not apply, p_lacr; N,A n tI r. approprir , ite box; 11. Sir P the form and place your current address and your certification number, 12, IVW (., legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED 4 VVITH THE - I_O 'AL AtJTIAIORI'I Y WiTIiIN 30 GAYS OF CQMPLETION, BBR IIATIONS FOR CERTIFIED SOIL TESTERS ear: Se same anc3 Textures Other Symbols St _... sty t ,� iover 10 ") BR Bedrnck t €: f,c,t,lfl<, f3 - 10") SS _ Sandstone Jr -. Gravel (,und *e'i :3") LS Limestom s — Sand HGVV High Giom,dv atet os ._ t 3a n-e S >!)'I rte, t e3(atio ? Rine nr — a ,roan_a t3 tad — t'u,r`i Fine Sand [3dcia B uioric3 is - Loamy Sand �, -._ Gseater Th<tr3 si — , Loinn < — s_.,,s L, ,wl - [_("am Bn — B ov n " �„ - t L_oar 131 - Mae, 'y - t,itay Loam? Y - ' k, Hrt iay Loam mot ._. rvl _. . �. SSxyenl : >otl textures itfa(`E: :aiEri" lol Iirlsri' f,jastFdispkos Bkl P,:> I1, � ti °JHF Vt rt cal r . ir:repc, 'c irrt• .rt, :; it . I TO THF OVINER: . Ttr S r ; t ,rvt 3`£'. p7t'7 t5 apt. i[rC >t M ., ,a ;?[I ?1 €r a tSarllta r }eE "miL. The county t„ trle ra t r e q u es t E fa. tnlent may request of f;." 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