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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 w ST. CROIX COUNTY GOVERNMENT REPORT NO.: 53336/01 WAGE 1 CENTER REPORT DATE** 11/30/93 1101 CARMICHAEL ROAD DATE RECEIVED** 11/24/93 HUDSON, WI 54016 ATTIC!** THOMAS C. NELSON OWNER. Ron Lockwood LOCATION** 3022 Highview Rd., Hudson COLLECTOR: M. Jenkins DATE COLLECTED: 11 -23 -93 THE COLLECTED** 2 **30pm SOURCE OF SAMPLE** Outside faucet DATE ANALYZED**11 -24 -93 TIME ANALYZED **12 **00pm COLIFORM,MFCCi 0 /100 m! INTERPRETATION** 9acterio',.ogicalty SAFE NITRATE -N** 1 ppm Above 14 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria /100 ml 1 Nitrate- Nitrogen, mg /L O (9 C� LAB TECHNICIAN. Pam Gane" ' A DEPEN— WI Approved Lab No, 19 O A A t Means "LESS THAN" Detectable Leve! Approved by, d PROFESSIONAL LABORATORY SERVICES SINCE 1952 �., ST. C OIX CO I` WISCONSIN ZONING OFFICE i` ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 -_ - (715) 386 -4680 I SEPTIC INSPEC�U T / WATER 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 X Water (Nitrate & Bacteria) $35.00 (Visual inspection) Owner: Ken L— o ,,Kwo odl Requested by: +rI iG� �� &Il k Addres 322. Address: (. od City & State: City & St. o'1 wL Z ip Code: 5 y0 / ( Zip Code: Telephone N ( mot S ) 3 43(o - 7 7 y - 7 Telephone N ( 3-,:;r6 Property address (Fire W & Street) : 3 Z - 2- � ""eMJ 6A • Location: ;, h, Sec. 0`7 , T ZE N, R 11 W, Town of 4 oh St. Croix Co., WI. Tax ID W o zo - -,i - 7o- Parcel ID N la O 1I - 70- House color: Realty firm: Lock Box Combo: ,. /e? �,4 Water sample tap location: nv +Sid S2 TO BE COMPLETED BY PROPERTY OWNER * PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Is the dwelling currently occupied? ❑ Yes 0 No If vacant, date last occupied: Septic system installed by: Year: Septic tank last serviced by: Date: Previous Owner's Name(s): Have any of the following been observed? ❑Y ON Slow drainage from house. ❑Y ON Sewage Back -up into dwelling. ❑Y ON Sewage discharge to ground surface, road ditch or body of water. ❑Y ON Slow drainage from the dwelling. ❑Y ON 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: DATE: 1 I k OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION t IN TO BE COMPLETED BY INSPECTION AGENCY System design & /or permit on file? ❑Yes ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system OBelow grd ❑At -Grd Mound Approx. size 'X ❑Gravity []Dose ❑Pressurized Ft. ❑Bed ❑Trench ODry Well ❑Holding Tank OOutfall pipe OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank Setbacks: OHouse ❑Well OProp. line OOther Dose tank Setbacks: OHouse ❑Well ❑Prop. line OOther ❑Locking cover ❑Warning label OPump /Floats " ❑Alarm ❑Elec. wiring Soil Absorption System Setbacks: OHouse OWell ❑Prop. line OOther ❑Ponding: ❑Discharge: General comments INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title (A - 0 n 0 o o O 3� o G I c .. � A C(D 7 3 3 f7 3 M CD M CD cn y C z O W -1 z O� N !V • 3m N o W 0 o N o A o I actoP 0 k -' CAD m. r i• U) CD y N Z N co V O -, OO O N C 3 7 p V CD 7 co G D. m O _ O o O O cn N ON , <D m N m N D O A� O CD O N N Qo N H W O �i c c Cy m cn�D a cn [D eo a= (D (O CD W CL W W O. s N N N c O. c O H L ? O I f0 O O N CD CD co E co OD a co D co CD CO) O C 3 • OZ 000 0000 _o o �_ v m n Q N N N O s Cl) co N w a cn N !* n v G C I c 3Q -0 0 G !+ -4 CD rA +' X I CD A O G N 0. (D y Z a O 5 � (D N O p c z =� D o = m o n n :3 O n o N v CD m Co <D CD N N C C CD W a d Ei Z m m (6 m N c c a A Q 0 cn --I �+ W 0 W (D Sc m c c z " Z C C co N N Z I o I f a 1 D CL 3 �• m a CD o �' mpo z a an d Z a O 3 o y O 7 a O 5 C m I I 7 b N o- v I I CD, o CD °A I ( � o o b (D CD I o c 0 e A o � o v' ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner /il �' K �1 i 0 /�c /t/,A 37-7—r RCC Property Address 3 ?-�— lI EGA Orr � � City /State 6LP st C IS Legal P al Descri tion: 40 �' ST 3 y' S r x Lot Block Subdivision/CSM # 1 /4 ,dZW /4, Sec. �, T4N -R4W, Town of J f - z/1 D �✓ DTN # SEPTIC TANK -- DOSE CHANT" MMATION ` otZ Ex�'STi�lr• S.T.. = lc�i6'S � - y ,� N � Ew Tank manufacturer f1IPOMS / e g Well 7 - 5,0 P/L Pump manufacturer 1 S �� ' t / Alarm location iNSrPE .� a � S (HOLDING TANKS ONLY) x 1� Setbacks: Service road Vei U ne Meter location Alarm location �u SOIL ABSORPTION SYSTEM ut ! w OEIP A DU'VP _ Tenches Type of system: Width ' �✓ Setback from: House q2 ` _ We IDo F _ ..%;sn air intake 7v rre"e �lG!> ELEVATIONS Tod 1vS1"C7'1-e v c, — 160 •� Description of benchmark r P F l6lv.CST &0'00l7 S ` ��r'+' ' w 'F / � Elevation �'� • s Description of alternate benchmark TZZ9 D �- 7S d S ty C T ,v /< Elevation X12 0 5 : T• � 4 4 .3CQ ,vim w .' � �. �� Building Sewer ST/HT Inlet q • 7 L ST Outlet 5 ' S PC Inlet PC Bottom g� • 20 Header/Manifold ` ' Top of ST/PV"Manhole Cover Top lj' ,, L5 t� off Distribution Lines ( ) 7 ( ) ( ) Bottom of System ( ) ( ) Final Grade (} ' � () ( ) 21,v � �A' M Go.vf ar.�., �Gr�� /mil d u.� �� = ! • VS ss z .s'si Date of installation q /1� 14 Permit number 3�3�z 7 State plan number T � 30 5 Plumber's signature License number Z-I(e" S Date / / Inspector T 0 S yNN 4ti TA � Complete plot plan � NOTICE Please provide the following: • 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 � T NG7 14oLYS <��� A�& INDICATE NORTH ARROW g _ - � --- too , C�L V W� d C y - - - — Po - As rep ° F c s. r. - -- ��� / o c APE ZIS� O x•01 P po o s ED S' O 3 S P 544j. P,eee-,,fs r 0 � �s z : �-� of - -- -- - - - • - I2 , v L o Cvt's T STS/ ` � 3 T °TEL of New 11900 101 0 iele �fl�� ill do ai tie •r-yP'r� �'w [33 I I I AS /3 Y � ' 9a. _" � � I S�' ww y s s s �Fx;srives i x y / 7 ' / -- IAJ _ TO BLS , ¢j�4 , �Lb -v�U •� Pt-fi/u 30 . 4R i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division 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)]. 353127 Permit Holder's Name: ❑ City ❑ Village ® Town of: State Plan ID No.: MCNAMEE Mark & Ji I HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 4 44 4z 020 - 1170 -10 -000 TANK INFORMATION Z ELEV TION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic „ rS, / 00 0, Benchmark Z Z r Dosing t e- U� v eration Bldg. Sewer Hol �/ Ht Inlet TANK SETBACK INFORMATION 01 Ht Out et TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet QQ Air Intake Septic 4 / '7n / NA Dt Bottom d Dosing 75-0'4' / NA Header / Man. - 1 W 11 7 Aeration Dist. Pipe Holdi Bot. System 3: N 9 Z PUMP/ SIPHON INFORMATION w P�` Final Grade Manufacturer � �.•� Demand Model Number 9 U GPM TDH Lift 2 Friction ` Z SystemZ� 5 TDH �jFt �Vt , Z (� e'- (j Forcemain Length �D I Dia. H `� Dist. To Well Z ° �� 1 5, r/ SOIL ABSORPTION SYSTEM / TRENCH Width Lengt�, No Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth SYSTEM TO P / L BLDG WELL LAKE / STREAM ING Manuf er: SETBACK INFORMATION Type Of j `- CHAMB el Number: System:l -� >�w O IT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake cr Length % J Dia. Length �d � Dia. � Spacing � � V 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.) HUDSO 7. 2 9, SW,NW 322 HIGHV ROAD - EDGEWOOD EST - LOT 73, 74, 75 1 � 3 - el 414 �kS�a!(r4 t h w ew 'S V Kew S4 Inck 4 Av-e Z riSlrs " plr Slv%krl i0� /S (t © Aeta st ksed 9s�� T'av B/r'I l,�oa.�ir .- !r"51 o 7 0� -6.4' u&r4eo( (o ovraf ldee k, s Plan revision required? ❑ Yes ❑ No Use other side for additional information. L;F SBD -6710 (R.3/97) Da Inspector's ature Cert No I r ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: u _ ._r .. . x .. € i # € # i a 3 2 � E 4 P w e 1 f € £ F { w d,�... N , vem „. _ `7 i 4 _ e s 77 e e 4 e £ g 3 ..t a # i € B e W.. . e m e d ................. e _... ...,,..�.<... e . „ ..... �.� x.., ...,.e_ e _ . ., e _ .� € g s $ �""".. e., �.... gae_. j ..$wee 4 � Y 03 f # I t t ( i # # � F c 1 s- �..e., r - ®vae -„..«. «... r t P g a f k { E ., ,»«...,., -.. .. -...., ,.,e... a .,.,.mom ............ .«. -...", .....:_ -„, .,. m..m ... . »... ,.,. .,.,...,_,,,, ...... ,,..,.a.. >..... ...,,.,,,,«., w. ..m ...,.... ...... ,... -m.— ., .,. .., ..,.., ,.a....m... ......,.„,.....d...... e .m �. +.»a..w.. t Safety and Buildings Division • Vi sconsin SANITARY PERMIT APPLICATION 201 W. Washington Avenue In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, o a 8 9 c9, ty sT �iPo� than 81/2 x 11 inches in size. `� "; • See reverse side for instructions for completing this applicati Sta °5arlitary Permit Number Personal information you provide may be used for secondary purposes ❑ Ch9cli if` evision to previous application [Privacy Law, s. 15.04 (1) (m)]. _ ` f i ? ate s � N I. APPLICATION INFORMATION - PLEASE PRINT ALL I MA Prope Owner. Name I G 1 � 'f 1 /�,!NoIl '' aE 1/4 R l / E (or)© Property Owner's Mai ing Address /�'j/ n n • J B�ck Number 3 Z z r'Cr V .. City, St to Zip Code Phone Nu Subdivision Name or CSM Number vVSo 4>/ • c?rs) 77.0`y eo 6-m-w 000 6'rane s k 1 . TYPE F B IL G: (check one) ❑ State Owned ❑ ❑ villa !t ge Ne est Road !� U1�4,7 Public 1 or 2 Family Dwelling - No. of bedrooms wn of Rup,So,J III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) oz 0. 1170 • /0 • &Zrc 1 ❑ Apartment/ Condo 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: (Chet only one box on line A. Check box on line B, if applicable) A) 1. [] New 2. gteplacement 3, ❑ Replacement of 4. ❑ Reconnection of 5, ❑ 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) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 24round 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System- In- Fill rj IL YSO' VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 1 7. Final Grade Required (sq. ft.) Proposed q. ft.) (Gals/day /sq. ft.) (Min. /inch) r,.Zr ys Elevation C Q dZ2 .J �• �— Feet 1 J P Feet Capacity VII. TANK in Ca g allons Total # of Site Fiber- INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel g lass Plastic App New Exist in structed Tanks Tanks I /tf jP v5S7Z92,4- eptic Tank r u,.l�, 1.50 1 Ufa 1- 1 5 0 2.. S T ❑ ❑ ❑ ❑ ❑ Lift Pump Tank 1 07M ( ❑ ❑ ❑ ❑ ❑ VIII. RE ONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) I Plumber's Se : (No Stamps) � PRSW No: Business Phone Number: 1 2 o B ? , 4 �� r icy � 26 3 �S - 7/1 • M Plumber's Address (Street, City, State, Zip Code): 5 ti &rl L S �f dl IX. COUNTY / DEPARTMENT USE ONLY [R/Ap proved E] Disapproved Sanitary Permit Fee (Includes Groundwater ate I ssued Is 76 r,4 Agent Sign ture (No Stamps) [R Surcharge Fee) pp ❑Owner Given Initial 2 ou� 6D �f��$ /99 Adverse Determination Jam' X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS ' 1. A sanitary perrmt i 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 administrator or the State of. Wisconsin, Safety and Buildings Division, 608- 266 -3151. " xl 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 fine 8 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 manufacturer'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 must sign 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 most 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 k 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 oria,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. • Safety and Buildings PO BOX 7162 MADISON WI 53707 -7162 TDD #: (608) 264 -8777 *iseonsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary September 14, 1999 CUST ID No.226375 POWTS INSPECTOR J ZONING OFFICE ROBERT W ULBRICHT ST CROIX COUNTY SPIA 655 O'NEIL RD - 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 I w., RE: CONDITIONAL APPROV �'' �� APPROVAL EXPIRES: 09/14/20 1 RECEIVE0 Identification Numbers 1 Transaction ID No. 245516 Site ID No. 180474 SITE: .. S - CRUX `' t Please refer to both identification numbers, Site ID: 180474 cX)ISNrY / above, in all correspondence with the agency. ST CROIX County, Town of HLTD96N ZoN INGOFFfCE 1 SW1 /4, NW1 /4, S7, T29N, R19W ti Lot: 73 -74 - 75, Subdivision: EDGEt`17`}A II Facility: MARK & JILL MCNAMEE 322 HIGH VIEW RD, HUDSON 54016 FOR: Object Type: POWT System Regulated Object ID No.: 490351 MOUND / DWELLING 600 GPD The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • The existing septic tank must be inspected for structural soundness, size and baffles, and mist be brought into conformance with the requirements of chapter Comm 83, Wis. Adm. Code. If it does not comply, a state - approved septic tank shall be installed. • A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. �Iy, DATE RECEIVED 09/07/1999 GI-� -- FEE REQUIRED $ 190.00 c. FEE RECEIVED $ 190.00 JAMES B QUINLAN , POWTS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (608)266 -3937, JQUINLAN@COMMERCE.STATE.WI.US WSMART code: 7633 cc: MARK MCNAMEE Safety and Buildings A PO BOX 7162 MADISON WI 53707 -7162 TDD #: (608) 264 -8777 iseonsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary September 14, 1999 CUST ID No.226375 ATTN: POWTS INSPECTOR ZONING OFFICE ROBERT W ULBRICHT ST CROIX COUNTY SPIA 655 O'NEIL RD 1101 CAR - MICHAEL RD HUDSON WI 54016 HUDSON WI 54016 RE: CONDITIONAL APPROVAL Identification Numbers APPROVAL EXPIRES: 09/14/2001 Transaction ID No. 245516 Site ID No. 180474 SITE• Please refer to both identification numbers, Site ID: 180474 above, in all correspondence with the agency. ST CROIX County, Town of HUDSON SW 1/4, NW 1/4, S7, T29N, R19W Lot: 73 -74 - 75, Subdivision: EDGEWOOD ESTATES III Facility: MARK & JILL MCNAMEE 322 HIGH VIEW RD, HUDSON 54016 FOR: Object Type: POWT System Regulated Object ID No.: 490351 MOUND / DWELLING 600 GPD The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner. as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • The existing septic tank must be inspected for structural soundness, size and baffles, and must be brought into conformance with the requirements of chapter Comm 83, Wis. Adm. Code. If it does not comply. a state - approved septic tank shall be installed. • A copy of the approved plans, specifications and this letter sliall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of cons tructiorv'installation /operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sing ely, DATE RECEIVED 09/07/1999 PA -� FEE REQUIRED S 190.00 FEE RECEIVED S 190.00 JAMES B QUINLAN , POWTS PLAN REVIEWER BALANCE DUE S 0.00 p Integrated Services (608)266 -3937 , ,r JQUNNLAN @COMMERCE. STATE. WI. US WiSMART code: 7633 cc: MARK MCNAMEE G�� U BRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, Wi 5401 neg. Designers of Engineering Systems 715- 386 -8185 Private Sewage Consultants RECEIVED SEP 7 1999 PROJECT INDEX SAFETY b BLOGS. DIV DIHIR Plan I.D. # Date Aug. 29, 1999 Owner Mark & Jill Mc Namee Phone 715 - 377 -0690 Address 322 High View Rd. Hudson, Wis. 54016 PIN 020 - 1170 -10 -000 Legal Description Lots 73,74, &754 Edgewood Estates PhaseIII. SW1 /4, NW1 /4, Sec. 7, T29N,R19W. Town of Hudson County St. Croix C.S.T. James Thompson CST3602 Installer Local Authority/ Supervision St. Croix County Zoning Dept. PROJECT DESCRIPTION A replacement system, for a home recently sold (previomse owners: Mark & Phyllis Giovanelli) as a 4 bedroom home. Estimated daily wasteflow: 600 gals. The existing failing system (over- saturated, in mottled seasonally saturated soils) was only sized for 3 bedrooms or 450 gal /day wasteflow. The failing 18 drainfield shall be abandoned. the existing 1000 gal. precast septic tank (code compliant) shall be re -used, and an additional new 750 gal/ precast septic tank shall be added in series (Midwestern Precast Inc. Menomonie, Wis.). The final tank will be provided with a Zabel filter, and an approved above ground locking manhole cover for maintainence ease. Soils per the CST are permiable (.5/.6 GPD /ft2) but seasonally satnrated at 39 A long narrow mound system using 12" sand fill is proposed. 7 i { `�araaiunna�mpni ii S ILDINGS ���� �C,' Ci oNs► j i ROBERT I Pg.l PLOT PLAN VIEWS R _ ULBIU Nuum w Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS �+4 Pg . 3 PIPE LATERAL LAYOUT ��4rnrnuCuu� Pg.4 DOSING CIIAMBrR CROSS SECTION Pg.5 PUMP PERFORMANCE SPECS I 'ilils i design desi for installation is based en landsc r_o i llation etc. ltirely on measurements, elevations, 4,0 '1110 �' ) .and soil suitability provided by CSTM accuracy of Ills specs, as reported, shall remain the sole responsibility of the CS'IM. Any use cf this POWTS design ty any licensed plumber, or any related unlicensed parties or persons (excavaters, laborers) shall not be construed as an assumption of responsibility by the designer for the workmanship, construction, placement, substitution or selection of any components not specified, or any assumptions by the plumt•er that any unspecified components are stat e or the effects of poor judgement approved oved PP or p roper , er , P If working under adverse damaging weather conditions (wet /frozen soils) by any such parties or persons. i i r�M� aiaA�� ���� � �� ���� I y U1L /n h I 0 �tLL EXIST /,V6 - - I C►S� S y 1?'�s Top of c s. T. ' g a- v io G TO fit: �/s� �? : � Pose pop o Nf w 7So E ,-,fS T C 0si 'S G o Loe 7 �1f11- %Co. 6S � of �---- 2. • � PUG ` ,vEw / F ,y1li v I toil oa 83 S ff�ltJ,U ' A 13 y VW yt 13EP t i� IAJ LP TO ,BLS �1�4tiGbv�U .� I \y r- ��JJ � 30 S , [ CROSS SEGT1 O M oo ,) wi r Qe D OED of A5 JQ DISTRi(3�1T 00 G , T k iG k a E5 9 pip �N Cr O To s ysrEM PSOiL IEV�IT'io,� 0"i F op " T o E h !� • f. k R A T#o oil Plow EL ToPSoi % SIopE FORCE" uN FORM (° Mho t_ t MUAT1o" 0" DE R REP F r. — E L E V A D 0 , 0 5 -" ,, j2•�S /.3� F IM V F -Rr O F Z IA rERA(s � Top p o f R o c k C f ' .3. 3 0 Z " 93. 1 �� �•5� T op °F I A r ER AIS � FT PLAN VIEW of M DU,'J D -- Wirt} BED FORE MA A (Q FT, I - - -- -- - - - -- I (3 8� Fr Fr Fr W ----- - --- -- - -- - - - -! 1 FT W r -tom � Z � ` g F T _ Bev of PVC. tAppEp To 11�� 013 5ERVATIOAJ A 99�EghrE P+pes PERM�N EuT M hR kERS RE(QUiRED BASAL- /tReA - 'D ( vhS r E'Flato SOIL- 1 0 - f0rIQATI0E C hpAC 07 5 4. Fr PRopo5Ep f)ASA1 Mve = B ( A + z FT. A P� . 3 o 5 Di5TRif3uTioA,3 PIPE OU-TwoRK LA - C2 ti- tfcvaleK P R ° `' ° T� MA a�IJ _ p Fr \ R 2-.5 Fr X � FORCE M INcNEs Ai,J S Fr. Z y of PVc iucHE5 Q VRRi'A(3LE TOTAL VOID ValUrtE u Z GAIS ST ^,,3 H olE D,' AMETE'R LhTt =pAL Fopce MA Iti1 Z I �c 4P OF FOIE5 P; PE 2-/ I.tJUERT E LEVATt0►,) oF. LATEgAk S 12. 9s' Pi pE 'DET^% I-- up. CAP p E R Fo R A f • Re"ovE All DRjIt f3URR5 \ y HoIES InCATEd o,v BoTToM E SPACEo , Dis TRH BuT1o" 'DISC.h E RATE r-OR JaA�ch LATERAL- PEP, C)Ti s GA �MiJv TOTAL V 'D►5CH^R &ta' RATE r 1JET wOR K � GAL/ � a •�' M I* 0 1 , M V " � t�D . PUMP CHAMBER CROSS SECTION AMD SPECIFICATIONS - - - _ psi E f of S /1 _— • - VEIJT CAP , I C.I. V[4JT PIPE t WEATHER PROOF APPROVED LOCKING JOUCTION BOX MANHOLE COVER -- ?-5' FROM DOOR, li /w,ftNl.)&- IA13EI WfUDOW OR FRESH 12 "MIU. AIR INTAKE � ' fLe U GRADE I 4 MIA1. z I 93, o 1/00 i/ COIJDUIT ---- = =i = == s 1, 11, +n ev \ �1 U 11, - - - -- IMLE T PROVIDE I - - - -- J__.._^►- - - - -- - - - -- -- AIRTIGHT SEAL I II I I APPROVED JOINT A INS K I I APPROVED JOINTS w /C.T. FIPE I �►A I I I I (. W /C.I. PIPE CXTE►JD11,)G 3' _ _ 30� O I I I ALARM EXTEUDING 3' e 0`QT0 SOLID SOIL / � I II ONTO SOLID SOIL g! / � 0 C, y F LI- V- FL __� 2 ii i PUMP OFF u-sE ✓ Ow M r io d BLOCK 51fVP f�DY�iN G RISER EXIT PERMITTED OFJI_9 IF TAUR MANUFACTURER HAS SUCH APPROVAL SEPTIC E 5PCC.IFICATIOKJS DOSE /� TANKS MANUFACTURER' PER DA � / 11 0t)ES'7KAAf ^El S T- W MBER OF DOSESDA-4 TA1DK 517.E / : O/ Z o GALLOMS DOSE VOLUME` /D 3 ALAR MANUFACTURER; . 1 1 1 7 1 1 1-Z- am , - C ' INCLUDING BACKFLOW: /O / GALLONS MODEL KIUMBER: - b' V' L CAPACITIES: A= /& INCHES OR 7 / � GALLONS SWITCH TYPE: T SL(l� / l� Z -SD 8 = INCHES OR GALLONS PUMP MANUFACTURER. /�I r_ /'7 1 INCHES OR 3/Q GALLOAIS MODEL DUMBER. ME d -40 ee yyyy- -- - D= 9& INCHES OR Z�Q GALLONS SWITCH TYPE: 2 yX/7C/� C 4 17 MOTE: PUMP AND ALARM ARE TO BE MIAIIMUM DISCHARGE RATE SO G�M \ INSTALLED OM SEPARATE CIRCUITS VERTICAL DIFFERE BETWEEN PUMP OFF AUD DISTRIBUTION PIPE.. "5; FEET fiAok !9PEc-5 + MI NETWORK SUPPLY PRESSURE . . , , , , , , , 2 . 5 FEET EA C (A— ~ r O 7 f �J� tGL 4- .SO FEET OF FORCE MAIN X !' (? F YpFT.FRICTION FACTOR.. FEET -tgoA S `� TOTAL 09IJAMIC. HEAD = FEET `T �, )1JTER►JAL. DIME."SIONS OF TAUK: LENGTH / ;WIDTH y , ;LIQUID DEPTH �© r; ME40 Series mvem 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 to �j 30 H 1L 8 H 25 Z H t� W 20 - 6 15 Q O 4 O 40 2 5 0 0 0 10 20 30 40 50 60 70 60 90 100 CAPACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code A.C.E. soil & Site Evaluations Attach complete site plan on paper not less than 8'/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dirrtemsions, north arrow, and location and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION - pi t'►t M 11 o ation. 020 - 1170 -10 -000 _m. R B Date 2 � Personal information you provide may be used C � purposes( vp ' w, s. 15.04 (1) (m)). ` OL Property Owner r - Property Location Mark & Phyllis Giovanelli ;~ Govt. Lot SW 1/4 NW 1/4 S 7 T 29 N,R 19 W Property Owner's Mailing Address j ' Lot # Block # Subd. Name or CSM# 6 View Road I 73,74,75 Edgewood Estates Phase I1 322 Hi City Stie Zip C� oder - + El City Village ZTown Nearest Road Hudson W� 54(1/N X381 -349 Hudson Harshman Dr. ❑ New Construction Use: rooms 4 ❑Addition to existing building ® Replacement Use: `o�oo scribe Code Derived daily flow 600 gpd Recommended design loading rate .5 bed, gpolfF .6 trench, gpd/ft' Basal area required 1200 bed, ft 1000 trench, ft Maximum design loading rate .5 bed, gpdfft .6 trench, gpdff Recommended infiltration surface elevation(s) At -grd.: 92.5', rand.: 93.5' ft (as referred to site plan benchmark) Additional design / site considerations Existing 1,000 gallon septic tank capacity must be upgraded to a total capacity of 1,200 gallons. t Parent material Glaci al till. Flood lain elevation, if a icable NA ft ble for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank itable for system ❑ S ®u Z S ❑ U ❑ S ®U ®S ❑ U El S ®U L] S ® u SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring# Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Bed Trench 1 1 0 -24 10yr3/2 None A 2fcr mvfr cs 2f 0.5 0.6 2 24 -31 10yr5/4 None sil 2msbk mvfr cs - 0.5 0.6 Ground 3 31 -48 7.5yr4/6 None sicl 2fsbk mfr cw - 0.4 0.5 elev 92.46' ft 4 48 -61 10yr4/3 fl d7.5yr4/4 sil 2msbk mfr cW - 0.5 0.6 Depth to 5 61 -91 7.5yr4/4 f2f7.5yr4/6 A 0 m mfi - - 0.3 0.4 limiting factor 48" Remarks: 2 1 0 - 22 10yr Non _ sl 2fcr mvfr cs 2f 0.5 0.6 2 22 -30 10yr5/4 None sil 2msbk mvfr cs - 0.5 0.6 Ground 3 30 -42 7.5yr4/6 None sicl 2fsbk mfr ew - 0.4 0.5 elev 91.71' ft 4 42 -64 10yr4/3 f2d7.5yr4/4 sit 2msbk mfr cw - 0.5 0.6 Depth to 5 64 -98 7.5yr4/4 None sl 0 m mfi - - 0.3 0.4 limiting factor 42' Remarks: CST Name (Please Print) Sig ture: Telephone No. James K. Thompson _ 715- 248 -7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, 54020 8/11/99 3602 1090 MWPERrY MOM Mwk & PW]is Giovanni SOIL DESCRIPTION REPORT toso page 2 of 3 PARCEL LDJ 020-1170-10 -000 A.C.E. Soil & Site Evaluations Horizon Depth Dominant Color Mottles Texture Structure nsistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0 -18 10yr3/2 None sl 2fcr mvfr cs 2f 0.5 0.6 2 18 -29 10yr5/4 None sil 2msbk mvfr cs - 0.5 0.6 Ground elev 3 29 -39 7.5yr4/6 None sicl 2fsbk mfr cw - 0.4 0.5 93.63'ft 4 39 -88 10yr4 /4 m2d7.5yr4/6 A Icsbk mfr cw - 0.2 0.3 Depth to 5 64 -98 10yr4 /4 m2d7.5yr4/6 Sil 0 m mfr - - NP 0.2 limiting __. _ factor 39" Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: 5cave : = sto o tip Wl 0 �o O ur Lr' � s w EJCiSE:n h�cdw? C Js, ss�oi6 �o gone k Moore: lop DCS.T. e�16 /•&S - 7 3, 7q, 9 7S of E c(�ecJct& C ro p °� ej` ev O., E5 "S Muse j.�� SWy y r)WYyi E /tvsE 6D Sec-, 7, - 7 7 Zg Y, tg T . off' r 4 1 00 .0, i q �, �, ' �. ■ C i , � � 1 ' ,I� 9sso' i '. =s� "; A9/4/?' i 1 1 1 9 � , t 93.y/ 9.7r�f� g 1 pl (W. 5 y6j.," e%".- = 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 / j /• le ' 10 & -F residence located at: ! SW 1/4 Sec. / , T N, R IT W, Town- of 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 Did flow back occur from absorption system? Yes No if no ski r ti P Y ( , p next line) Approximate volume or length of time: gallons minutes Capacity: / e�vv D`A�z Construction: Prefab Concrete K Steel Other Manuf,acurer ( if known) : Age of Tank (if known): (Signature) (Name) Please Print 43 - 25' (Title) (License 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 -83, Wis. Adm. Code (eiteept -Eex- fle). Name _1 2 d13E 2 � ClF� ( S` Z2- Ct,3 s signature MPRS i 5/88 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 377 ©6 FO Owner /Buyer M" � j A4,646: Mailing Address .3 'I.. �" ��' � � F�tl � y��a+ -t. ,S 4v Property Address J 4 " ' (Verification required from Planning Department for new construction) City /State Parcel Identification Number cq Z' ©'. jf 70 • jd • d LEGAL DESCRIPTION Property Location 'A. '/4, Sec. , T N -R W, Town of Subdivision 4:5,0 &tyyk 2'Sr - 1'44'rz _ Lot 73' � 7S Certified Survey Map # , Volume /�// , Page # Warranty Deed # (0 d g 3 �' , Volume /7 , Page # 2-7 Spec house ❑ yes t Kno Lot lines identifiable es ❑ 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 can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix 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 comp!eted and rcturncd to the St. Croix County Zoning Office within 30 days of ee year expit date. — - / ,- U � , o '� /` S SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) im (are) the owner(s) of the property described above, by vi a of a warranty deed recorded in Register of Deeds Office. SI O AP L CA T DATE * * * * ** Any information that is mis represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed o' Vol. 1452PAGE 270 6091382 STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH Dmument Number WARRANTY DFFD REGISTER OF DEEDS ST. CROIX CO. WI This Deed, made between Mark J. Giovanelli and Phyllis A. RECEIVED FOR RECORD Giovanelli, husband and wife, 08 -27 -1999 9:15 AM WARRANTY DEED Grantor, conveys and warrants to EXEMPT N Mark G. McNamee and Jill M. McNamee husband and wife CERT COY FEE: COY FEE: TRANSFER FEE: 546.00 RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin Recording Area (The "Property "): Name and Return Address 020- 1170 -10 Parcel Identification Number (PIN) This is homestead property. Lots 73, 74 and 75, Edgewood Estates II in the Town of Hudson, St. Croix County, Wisconsin. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this ) %A- day of August, 1999. * * i va I * * Phyl1j0A. Giovanelli AUTHENTICATION ACKNOWLEDGMENT Signature(s) and Phyllis A. STATE OF %0t§6@ffM J6WA Giovanelli, husband and wife, ) ss. ra o r1 County ) authenti aced is - day of August, 1999. Personally came before me this 9 0 day of snite 1999, the above named Mark_ J. (,i rwanPl 1 i to me known to be the * Kristi Ogland person(s) who executed the foregoing instrument and acknowledge the same. TITLE: MEMBER STATE BAR OF WISCONSIN � (If trot, authorized by § 706.06, Wis. Stats.) Notary Public, State of T090hqin1hWA THIS INSTRUMENT WAS DRAFTED BY My Commission is permanent. (If not, state expiration date: Attorney Kristina Ogland 3 DD ) Hudson, WI 54016 91MOM MORELAND MY = EKPIRFO (Signatures may be authenticated or acknowledged. Both are not '" —dU necessary.) *Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 -1998 INFORMATION PROFFSSIONALS COMPANY FOND OU LAC, WI 800 -855 -2021 J I • a I = N � I I � I I I r . • I • wl I 3.Tf.10.30 N I I ff w I w w w I wl w I � I I I ,9 9 • I acT ~ 3.Tf.SZ.To N I I I o f I M I o • .N•Oaf I .10'.ra. 1 90 N w I I I .ZO'Z6T I 3.Tf.SZ.TO N I �. I � w co s ee l it i L N / / 1 09 . 1021 110TI.9ir �/ • � Is d OU M31A 1401H / arm - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP ,mow f .S'�+.�% SEC. T "�,-j` -R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION �.,� r i : ���.� j% % LOT ?s - 7 -1 - 7 _5' LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•I.HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I INDICATE NORTH ARROW ` 1 BENCHMARK: Describe the vertical reference point used I Elevation of vertical reference point: lOG"c Proposed slope at site: SEPTIC TANK: Manufacturer: �J,,�..� -- Liquid Capacity: • Number of rings used: �` Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: L i Number of feet from nearest Road: Front,O Side is Rear, O `j� feet From nearest ro ert line Front Side Rear S P P Y �O �� � O feet C Number of feet �rom: well - S e , building: (Include this information of the above plot plan)( 2 reference dimensions to septic ta. SEE REVERSE SIDE PUMP CHAFER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: ? y Len$th: 1 `17 . Number of Lines: Area Built: /,2 — Fill depth to top of pipe: y Number of feet from nearest property line: Front, Q Side, O Rear,0 Ft. - .; 7:z ` Number of feet from well: Number of feet from building: v (Include distances on plot plan). 'AGE PIT ize: Number of pits: Diameter: iquid depth: Bottom of seepage pit elevation: Area Built: s either a drop box O or distribution box O been used on any of the above soil bsorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: - Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: I 3/84:mj DEPAf;,MENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 g� sate I.D. Number: Plan I SW�,I�W %,S7,T29N,R19W PCONVENTIONAL ED Slats Plan I ) Town of Hudson El Holding Tank El In Ground Pressure ❑ Mound Lots 73- 74 -75, Edgewood Estates NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: n B & H Development 613 1st North Hudson, WI 54016 ��� �'/ �/- 3o BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: 7ST REF. PT. ELEV.: Name of Plumber: MP /MPRSW No.: County: Sanitary Permit Number: P illiam Schumaker 6382 St. Croix 88478 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TAN NLET EL TANK OUTLET ELEV.: WARNING LA L LOCKING COVER PROVIDED: PROVIDED: f } N / a ES ONO ❑YES NO BEDDING: VE VENT MAIL: HIGH WATER NUMBER O ROAD: PROPERTY WELL: BUILDING: IVENT'TO FRESH ALARM: FEET FROM LINE DI .: : I AIR INLET. OYES NO OYES O NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO 1 DYES ONO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. IVENTTIIFRE511 (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 LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO. OF D SPACING. C INSIUE DIA. ar PITS LI BED /TRENCH ^ ' TRENCHES: M ERIAL: PIT EPTH DIMENSIONS 1 L GRAVEL DEPTH FILL DEPTH OISTR PIPF DISTR. PIPE DISTR. PIPE MATERIAL: NO. DI NUMBER OF PROPERTY WELL: BUILDING. V NT TO FRESH BELO PIPE$ ABO VER E V INLE E V E PIPES j FEET FROM LIN�J /� /r ` /L+♦ ArIg�ILET. 1 �a NEAREST --► // L ♦ \ w� / / / 1r Y � 7 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- meets the criteria for medium sand. TIONS MEASURED. ' 1:1 YES ONO OIL COVER TEXTURE PERMANENT MARKERS J OBSE11VATION WELLS YES NO YES 1:1 NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL SODDED SEEDEO MULCHED CENTER. EDGES: DYES ONO ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED /TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.'. ELEV.: DIA.. ELEV.'. PIPES DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES El NO OYE 1:1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION W S. NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES ❑NO ❑Y EL ❑NO NEAREST `v L l� Sketch System on ~ Retain in county file for audit Reverse Side. 1Y U TITLE ' j It DILHR SBD 6710 (R. 01182) Zoning Administrator � .,w � �.� "'�" ~ ,- Thomas C. Nelson SANITARY PERMIT APPLICATION COUNTY ILHR f In accord with ILHR 83.05, Wis. Adm. Code •� '�'°•�^^°r^� STATE SANITA Y PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8%z x 11 inches in size. -See reverse side for instructions for completing this application. PETITION ��jj 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES LJ NO PROPERTY OWNER PROPERTY LOCATION '/a & ,S 7 T f ,N,R E(o PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME 1 B T .c/ 73 -7Y -7r — CITY, STATE ZIP CODE PHONE NUMBER CITY NEAR ST ROAD, LAKE OR LANDMARK VILLAGE TOWN OIF� 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public (Specify): III. PURPOSE OF APPLICATION (Check only one in ##1. Check ## 2 or 4, if applicable) 1. a. 0 New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit ## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2) 1. a. 8.1 Conventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ® Seepage Bed b. ❑ seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): z 3y, :3 2 . r .25/X I:2,$' �yX y Feet �sJ Private ❑ Joint ❑Public VI. TANK CAPACITY # Prefab Site Ions Total of . Fiber- Manufacturer's Name Con- Steel Plastic Exper. INFORMATION N in aI New xisting Gallons Tanks Concrete glass App. Septic Tank or Holding Tank Tanks Tanks structed Lift Pump Tank/Siphon Chamber ❑ ❑ I Li VII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the private sewage system sho " on the attached plans. Plumber's Name (Print):. Plumber's Signature: (No Stamps) WMPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): Name of Designer: / &4 4' y VIII. SOIL TEST INFORMATI Certified Soil Tester (CST) Name CST ## '.f/ -'r CST's ADDRESS (Street, City, State, Zip Code) Phone Number: r 7 ' 8� IX. COUNTY /DEPARTMENT USE ONLY ❑ DisapprovedSanitary Permit Fee Groundwater Date R641Go uing Agent Signature (No Stamps) © Approved ❑Owner Given Initial � S ` charge Fee Adverse Determination 16c) oa "'"' j S oa - �7 0— /UJ_aO rh, c.. X. COMMENTS /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber I INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT- APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 1 All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include !. Property owner's name and mailing address. Provide the legal description where the system, is to be installed: 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 111. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1 -6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County /Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8' /z 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; dosing or pumping chambers; 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. - - - - -- --------------------------------------- - - - - -- ---------------------------•------------------------ ---- - - -- -- ------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is r .ore ? commonly known as the groundwater protection law. This change in statutes was the result of ove ~ °2 years of steady negotiation and public debate. The groundwater biii Grou.sd rater included the creation of surcharges (lees) for a number of regulated practices which Wisco in S , can effec? groundwater. The surchara took effect on July 1, 1984. All of the waiter tha bar ? Ed re SLIr8 g used in your building is returned t(- the groundwat..r .through your soil absarpiJon o system or the disposal site used by your holding tank pumper. a -he monies cDllected through these s „rcharges ae edited to the groun,;wat s '_ nd admmis fare by the Department of Natural Hasource.� :. Thew. ft,nds are used for r,ion „'U ,: g,our :d- T kvatf -r, g dwater contamination irwest igations ano ;it4lli•'S?rnE' ^t of standa"ti :- GroundwatF' is word protecting. 4.3D t -7 I 4 2y �yF !3 � I p� N c al l -� �" hLy D[PARTCR?-ENT o f REPORT ON SOIL BORINGS AND S A FETY & BUILDINGS DIVISION P.O. BOX 7969 1_40H ANC! PERCOLATION TESTS 11 5) MADISON, WI 53707 HUMAN RELATIONS (1-163.090) & Chapter 145.046► LO I NSHI UNICIPALITY: NO.. : SU D lVIS1514 NAME: Svc 1/ N ' `o� M�R II QIo U4 13 74 -1 S tA4&LJ00& f~ 7L COUNTY: N U AM _ b Co►vs3 i3 7 "S� �-w 14u a r s4016 US DATES OWE MADE LATION Residence U-IK C --� 10 grNaw 0Replace 1 01/. tT /9Y l • 1 S /�gC TESTS sags f6o K A 6E - 49 Son zaC2 - SAN1144ro .1 ` ju.)AC - r RATING: S- Site suitable for system U- Sit* unsuitable for system q Q - ONV TI IV�. MOU IN 0S ❑U EIS 4_L QS � u RE m DEDS I) (L�t LQ7Jf1Y1 r�� ,! WN If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the unde s.H63.09(51(b), indicate: , C,, -KtS5 * 3 Floodplain, indicate Floodplain elevation: �t Fr PROFILE DESCRIPTIONS c B NUMBER DEPI•H -. ELEVATION B V R A I CH TO BEDROCK IF OBSERVED SEE ABBRV.ON BACK E, AND DEPTH e- So ` ? � 0 5a f $LLrs vf1em S I L 9' &S46 k 1 0 / 91.5 Re w -� {i 54 10 ° &Lt.TS SC 9k4SII. W Cab B- 1 9.4 z 97.70 doq > 9.47 2 " s•s' B. 3 9 4 � 9C•V3 6 �. 191.47- /5�6LL 3 Rp$ dy!S,II t6 +�M3 i#GI►e B- 4 9.33 s.SZ ,33 Iro< �3S YS,L /0 9*0 Msf< Zo'$IevAm C,R. 9 9 3 � E B - 9.33 94 :2% > 9 .33 +7 . 9LLTS 54" 8RN YS, L CI "Re$bi v 40. P_ B- PERCOLATION TESTS TEST pEPTH WATER IN HOLE TEST TIME A MINUTES NUM BER I S I AFTER SWELLING INTERVAL -MIN. PER INCH P_ S •52 97.2 4 4 / Y4 74,0 P. z 4.78 s 9% 1 ' 4 / ' P_ pp o r 95.70 so 1' 3 P Ar or s @� P PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or ibe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the s urface elevation a rection and percent of land slope. P,R'IM'IRr - 91.7 A last' -1 A') A-4 SYSTEM ELEVATION AL - 90 0o v��' ti; �`�, �,�► sl i g,q r G A �. r y. : t S cAL tL 4 Z " c j 1,-40, $M► - 1 � i ttoN Pt Pr, P � gAWtok 3` O�rl aR II 9Z \ /` zf' ii CtiRou h �� t . �\ 9• zI ` � � t92'&rwfiW IRONS 10Q D Co t "X 9 � Fo+t T�g L6 �� N � U � �OD the undersigned, hereby �rtify that A'soiTTests reported on this form wen made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME print . 1 TESTS WERE COMPL TED ON: /-IAo(ey Jo 14N -.0fv 1Jf�/EM$ /s 11V6 DRESS: ` /' CERTIFICATION NUMBER: PHONE NUMBER(oprionall: A DD R ESS: S6<o,•ll� err 4wi Wt S A OIC 3484 3Ts6-4oFsv CST S NATU �3 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. nil im-sRD -6395 (R. 071821 OVER «a v S T C 1Q r y SEPTIC: TANK 14AINTENA l ounty CE ACRLEMEN'1 0 St, Croix y OWNER /BUYER e;s ROUTE /BOX NUMBER _Fire Number CITY/STATE Avd j6N L PROPERTY LOCATION: it, =�. Section _, 'r R _/9 W, Town of / 0 St. Croix County, Subdivision� Lot number7.. Improper use•and maintenance of your septic system could result in I its premature failure to handle wastes. Prup maintenanCe con- sists of pumping out the aeptie tank every three years or sooner, if needed by a licensed s!ptie tank jLuner. What you puc into the system can affect the function o"f t'ne septic tank as a treat - ment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation p ;icy:-= �u •+;�•�y , fit, .Cr.o x County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep t systems properly " maintained. 'rhe property owner agrees to submit to St. Croix County Zoning a certification form, aigned by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pup►per veri- fying that (1) the on -site wastewater disposal system Vs in proper operating condition and (2) after inspection and pumping; (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 I /WE, the undersigned, have read the above requirements and agree (A to maintain the private, sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin, Depart - �o ment of Natural.Reaources. Certification form must be completed and returned to! the St. Croix County Zoning Offkre within 30 days of the three year expiration date. SICNED V' DATE St. Croix' County Zoning Office P.O. Box 98 Hammond, WI 54015 715 -796 -2239 or 715« -45 -8363 Sign, date and return to above address. s+ r' � `' tier rwtM � eraaauttlt reltaa d ub ., o ��•. R i 'r OFMCE r y X 00N TZrDi • n %e4L for Ron 11th MR 4 • ;�•,•. �sw 1I�f tltlrrryM"�Ilrll��• � z „ ` ,iii`: , arm Mll�b Ill wiralrsitts arw�tr �IIC3 i 1 A of aoe�sls�i� � �MMt�IgJIA� :7e` Iff "M X111 that, Part s '!!Ir"'SZk i0f. edit of 8actioA `13. To fter ft ..« ...�..........�...:... T29Mr �e 'l �ybrYp of state 'ht'li �igAorl�tYr:"t3�'�Y: � tba Sg4h 32 rcdr ! r aid' f: y pl fit' M►uAm#_ lYip4 tithi4tlY and '>A) y, rr t A and iiXO a 10ltA ` t 'w of the �u r`p� `�tiRRD 12•Zle�►EOe, . tlf M of ae•� � �i ltslly . driaribrd' " '�420mi SCAM at he iii r` O! raid SaottoA 121 ••' �p "M 1 t 333.81 t!**% to the Ely right- oat -+aiy Of . .j • i.'l.�• 34• ►'` .14 637.11 ltwist.alo�+q said sly right -of-wy Of S. ?.g, •,3S..'. 1�,Rr ;O! the � deeded t� Arthur t. , Mirr�itt asird Mary - AM' NiA001fre', as r to Vol. M pa'" IS, Coo. No. )2S1i3 iwr tlltsry0 tioo of the 4t. t�ro)!x amity Asgisar of Oirrisdsr being =NunE C`dll"WMI 1001�E11Dt 1« ttnre ' • e ») 4�s a�at te►we�„� r rNril�wi Mtr> 'w► tw b rid ic'V al mrftAO�ll . M e 11 ...... Y tM 1Wbrrtltt� lttelulrlrt t�! � .r.. t. ..��.. t �• at aaesties at this Gntarrlrti � p) for batdvw of 10-M a .......: t lh�r 0" 1012""t from 4140% w,,,yy (.� 1 � ,��, .•. t .f ,�11rYN....�Y.a.... N.M ", of Per MI minial urst imntr cf .$10,000.00 each. plus aci: sad ant llit Ott (W btefate the first and sewind affil vwmaries of t21is ContraCtr and tML )milt bil tw es pltlss 40=% Qd ihtfte tr cn or before the third airiniwMairy of this Contract-, Stye attartred 11L17FUN foie protvisilnns f(W ftlee►rre + ate ilgppll t �`. F tIMMto. EstiMt®d PARI MAW TaMW fOr 19840 1'ssyabL* in 1�5�� hll closing; Purchaser shell ser s thus pay the entire 1984 and d Provided. havrem, the caber ewtatandintt bale atoll be pill)) is ton obi tit � 1tds't,tiity .... ................. W7.... ( for aalawitr date). = • F•vllowind any default to payment, interest thrtl aetrue at the tali of ... per annust eft SINN estate Mount in delbolt twhwk shall include. witboat limitation. delinquent latetest and. upon aa'crlerateon or maturity, thr entire prrncrp ( hale"re /• p Purchaser. M ""a to par WMannual teaas, special suseaaatente. fire and required insures" premiums when due, and furnish copies Of M0111pta Oft VendcaC's i tbw r ec k NeSt - °i Pnta abatl be applied erst to isteteet on t he s apart bWaso at the >reitaM eptjlilltrd sad t; liir'Rti principal. Any g.w r �atow t my be prepaW without prMiutn or fee up" princtpal at asy' iipla % F I} 3 to the e+ea►t of any prepat - most, this contract ah" Not tea t"411 "it it `�11 �� Alftneet to 1oa� ' - a. the .enpaid balance of principal, and intetert land in curl! rate srMraft iii if" tthdl'l'tYll ;"-*hall lee trestw: as .. -ihnrd principal) is Ices then the amount that acid` Indrbtadraaalt IMAM I**# beds I Nayla+tnta beast t.ude as fr.t specified al.ove: provided that monthly paYwonts OW be 4114111110! Is the event iif 0 464 -Of any P ,.! ,n•urar,rr or rondentnution, the ru ndemned premina briny thetftftPrr rf1ti11d1at1 tNraftree►>r !'ur. h.se ltatrJ tt`..t 1 is siatisflsd with the ime as obo)Illt by'tiN► title tit4044i'aaiw bd to Purtberet !hr ra..n•'t,&twn etrept* Within six (6) wri ths h:i•cafter, Vendor atoll ro ord 3 c't, rtified ccM .t tjee: ej, %itt► c rtif of William F. Marty, and 1'rltlmtar. Of inheritaWc tax l iens in *it. - w.tr•r r,f the• E,:tat t ref wi l l iron r. Marty, U.) the mtislfaction of Ptla c+iasc►r's attorney. r v r �•. r r, r.•. • p4 rr, til r tot rr t.t.r i , h r.r 1� llt.v rv It r Ill td v rdr NI, hl" fr.,rt, tt t r t �. r,l .r .t.• r }• tr ... ti ,• pa I. Ili Iilr a I'll' 1 "� Ih ! f 1t N (er yi , , " l. } ft. e' . hl .... _.._ r., •".+ *"" Y Ir d _w. die `. r •r. y t+tot.brit.hstaAdiriq thit at�wraid��• to varA for mleaw oU. .i c►! . ' 3 e �fsll br' : slioh odditioral t, aqw aer"" not the"tol� ft - Liao it rwitipliad by =1,500.00 din waftr this Cwtpvotr ,. ,t t ti `x -,�, �s,• r "a lor"oi ft 'prrOVlrsio is tue Coatr"t tihiob probi S: L id Prow ty _ to t" OXOWtF trot is lor+9oiuq P�►iaioaa. _ � � � � �;; t ,'qtr , + .��� s •.� t � P {, R .. y d ,° ��>�a.�11 ;�. f p� ,� f 1 tR x �u rr. sl' �"•'.1 ,F' �.�� i�,cs�.f� ? 4� t • S �'r ,, d+ , a s� _'^ 3 >y �,,, F Mr.� Ek'� 1; :3* a r a'i j . •! ,sax,. � .. �. ' t",� } ,� . ,..,w .w•.ry_. ,. +�If+.'MZ"1�lr. _ .mow. rte•. - t .,wr++••..• ...nlAµ. �:••r•1.2M•M .,+r.•.wr..w�y . 77 , � '� "� T •) sz fah x` d f 8 V r, F : ,t r � ,aa• �� � � � X y a 4 i� ��!, Itl i �� 'J•, PN � � t � T • :i < 'r�s »� "' � �� � rte; t q i A j -- - w rte ." ~ Mat te drfisa�IrMSS �w w�9�rr�W iiA a Yeliyt'i t wl ohs MaarlriMSlali r- M�fIN, irlsewMw �wilwi � ba M MMrlll�lrt ar , " ii rlritit foommos Mrt M mmu aw airs► wrra M as■MrMtsli is f ;:rrf�asas� �� fisarrrtiwpMdsriatlriMat �. " "1►wirrytassdlrR is aalM Iirare�isss piu wMM bilwwt adnr rrwsrrtawiM fi, pddaMt "�ait/1M►M�alr Iiaar�ursMw��Wr�wi��rr�� ►�rwlsr�/ r >brrd. wR i6s llsrlrty. fias aMi slw r lives sndiw. rwlrt ate► s fr ar C ,rdas�el/t: eagaen,,,._.ts_raseryations a rrsr�e MM S IR lisw # of dnasssra cad in core at dit* in do 1 sash ailri ' � 1�f � a� t�' aOMaan�r. R at lrrewa�r. i � i *el #tYaM�'aa w, tl� eN/net atarwM.+i�*f�d dr a Mw(Mut f+ f► i4Meinsari�r rfrrdsrMfiWlai.tis 1 loll " atrfasMiMwd 1MrMra t.fid�i thi aMd'vaMdrrsilsii �.. _ .lrw�s . , � at }e. �t t�s �iw d i►�■ilie Ili wltMC itiuis�r. ■Mlw +1itrMl af i�si lri irwa ft�ar mtiMc i a�ri� ,� ` tyle`r wftY i ssiMn wbidr �► M ww Mr /rid bfr •iMir ar aaweii rt w nler rlw�wii rW M eilsrW f*a wit at Iw. ae ry flr�lYww . - . I�nrllrt ar i! 6a of Impm bod bm dos at w On who aw m& dalrak slnl�srrs► wII�SM /IiaeipY aii lalrwR st do wns so dbbomd oft LMwart Ir fs+t�r �I► YlwMdsr, wwtllsr awssd ar MsR a# �s ` " city! . aides taJi�r dMS rs iMSMnrd. astii Y ass d jrw awi �s it tirnla Usn drsummosam rtar *MiMs do ! of aMy aew d lerad�sr4a d tW Caae:aet. lrr�r , •- piIMiIw of a no*w d w . hwhAnd hsmsasd laRwwt. to airct do ww. boom and d a a a40% rd wren now. boom "f prfia wlna ft mead rWl M whi rl►rd J .'+IrN iret _ AN %me of Wo fas after 04 M bhmftg upon wd bw to the baedia of the win. Mssl rrllrslrselsplj� <' ;dwovwd %oft M M r. fu sa m eww d w P/rpasy w spars d Vander far • vubm" ft ralrs hsrasMr•i r� f j f wryset wap.y aai apru to jaia is do aseww d w dud so #o Dmad& 2 _._, n�wt February, .ls 81 MAU DAVID W. MEN)" • HENRY gT MAW A= Impagnmimiff i' 840"ma""Ie"Iddo 2nd dqd STATE OF WISOONSIN February . d w shave awed _ David N land Henry L Peraoa�ib► tiny before aw this . 1p the abwo easrrri to aw known to be w pareoa _ whoaauatsd TMY.E: UMUR STAY'S "S OF WISCOMN i owwwat cad mkomMdged theaasie. F ' AKK ` This foram ms w dra kdd by Nary Publie My CaaeseiMaira is ourmsoWL llf %sk STEPHEN J . DUNLAP Hudson, Wi' c. in W aw be oudaawgd err,admawl Opt &a aA mot The nu d wiel�eseea is apioslsl. " •Nanw of psnoln aisri� is Nv aepedty should be typed or printed bdais Bair dpntuna. µ � ;f eooK 769 PAGM9 2 4 WGISM OFACE ST, CRO 00., Wis. i f ,, d 00y Of Feb. eb., . A.D. i yB7 rat 8:3 A 7 A F FI D A V I T �, ��C. d eput STATE OF WISCONSIN) SS ST. CROIX COUNTY ) I, Harvey G. Johnson, Registered Wisconsin Land Surveyor, hereby depose and say: That I have surveyed Edgewood Estates II, located in the SW 1/4 of the NW 1/4 of Section 7, T29N, R 19W, Town of Hudson, St. Croix County, Wisconsin; That there is a proposed on -site liquid waste disposal system intended for, and a percolation test completed on Lot 75 of said plat; That said system is intended to serve a home intended to be built on Lot 73 of said plat; And that I make this affidavit to inform all future purchasers of said Lots 73 -74 -75 of the possible existence of said system. Subscribed and sworn to before me this 17th day of February, 1987 N 'a"A4S State of Wisconsin Iv19,1� Mm1 s s r7 on ; Epirws ----- County Clerk ;'this 0nstr4men£'dr0,ft ®fl t y: "It,ar ve��. G : <J oh4isbn� .. 1 e " APPLICATION FOR SANITARY PERMIT STC - 100 i • i This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Shuuld this development be intended for resale by owner /contractor,( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording., - - - - - - - - - - - - - - - - / - - - - - - - - - - - - - - - - - - - - - - - - - - (honer of Property CI�T��l�tn f Locat of Property �, Section �_ , T N - R_ W Tuwnsl►ip /� �ceA/ Mail ! Lag Address Subdivision Name "tt Lot Number ! Previous Owner of Property Tutal Size of Parcel Z&-a DJLe Parcel was Created Are all corners and lot lines identifiable? f Yes No is this property being developed for resale (spec house) ? >_ Yes No Volume as recorded with the Re PagQ Number �/,YS inter of Deeds 8 INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING 1. Warranty Deed 2. Land Contract . 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of Lite reviewing process. If the deed description references to a Certified Survey Mal), the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1 (we) ceAti.6 y .twit aZE etatemente on thiA 6onm ane true to the but o 6 my (oun ) k►iuwtedge; that 1 (we) am (one) the ownen.(a) o6 the pa.openty deaCAi.bed in .thiz .ik,6o4matiun 6onm, by viAtue o6 a waManty deed necakded in the 066-i.ee 06 Vie Cuunt y Regi4ten u6 Deede ad Document No. 9 ?/c D ; and that I (we) pn ee e ttZy own the . pnopoa ed a.c to bon the sewage poa ata ya tem (an I (we) have obtained an easement, to nun with the above d"c ibed pnopen ty, bon the eonAtAucti.on o6 said system, and .the Game has been duty neeonded in the 066.ice u6 the County Reg•ieteA o6 Deede, ae Document No. 39 2 Q_ ) - SI�i:Nn'IURE OF OWN' SIGNATURE OF CO -OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED