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HomeMy WebLinkAbout020-1165-80-000 0 N p n N 0 0 N O E T n �w (D ( (D (D m m A- w i �F c (D m m ` ) 3 r 3 rr (n x z N z O W Cn - 1 j to z O Cfl z C- N z O N y 2 J N <C �Oy • = &3 Cr n O O N_ 3 C) 7 C i 7 < C W S 3 3 C (D O C N n n N Q f'." C X l CD n fD N N CD %A co C CD CD W CD U) O _ CL m 7 Z Z S z 00 -�-` C (7 W fD CD (D E CA O ET O CD Cn C M- N D N N O '^ Cs 3 N O O N 3 'O N C 0 p 00 m cn a cn u (A 3 m (n W (n m ° m G D D m a z D m a Ln C C fD C C_ co m c :. O O O O N 3 �, '� A C.' Cwt A I N N N (A Q0 CID n C O cD X z co (D p z CD CO () 0 r' CA CID CD CO `< O CU W 7 O (D ( D U1 O C V V C O W 0 CS T !Ai 0 Cn V 'a 'U c U ti • O O O 2 0 0 0 4� O O O Na Z o ���a cniT ���9 o ���o coM C N CAI o O !- N N N J CA (n N J ° r( 3 IC 0 G a !o T O G (ll J. 0 O CID M. ° (D (n < CD j(D , O y 7 IN W (-A, _ cn CD w 'a co a) 'O A N CD CD - (D ? 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CD H • (D (D y (n ( y CD (D C a (D 0 N N III C CD w (o O. fD O. n 3 CD E CD c6 m (6 N > > A z O N Q d G 0• W W m v z CL 1 3 3 ZX o - to o .. y y z .a D CD A y O Q CD a c a a o a (D z (D (� O y x fi Ar I I � I I II I � ti V I tv p I I i A O O w (D (D D Q V En 0 6s 0 O p r I O yb O CL O a y Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division Count INSPECTION REPORT St. 6roix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353213 Permit Holder's Name: ❑ City El Village Town of: State Plan ID No.: charfenber , Tim & Ann Town of Hudson �' CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: . S ,. 020 - 1165 -80 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic K I / gyp' Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. Air I ntake ROAD Q4 IQIQ4_ Air Septic NA Dosing NA Header/ Man. Aeratio NA Dist. Pipe Holding Bot. System 1 azo 1 0 PUMP / SIPHO FORMATION Final Grade , 5' Manufacture Demand St cover Model Number GPM TDH Lift L Ion SY TDH Ft For aIn Length Dia. H Dist.Towe / AM SOIL ABS PTION SYSTE 4b /a . S` B TRENCH width r Length No. f Trenches T No. Of Pits Inside Dia. Liquid Depth DIM EN S DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING M�a - nua rer �S`�tlJt INFORMATION Type O CHAMBER M oo+ d e Number: System: OR UNIT - C DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length 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 I ❑ Yes ❑ No. ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1( 0 /m/ 4q spection #2: --- Location: 941 Becky Circle, Hudson, WI (NE 1/4, SW 1/4, Section 17 T29N - R19W) - 17.29 _ .1.1 4 n 1.) Alt BM Description= 7 y � - 2.) Bldg sewer length��� - amount of covers _ (14A = 9`F C"q 3 Ge.c`� w- tw� `" - "1 e,y-( �o s�.tcc3`�' s y5 z 9q..Sa Plan revision required? . ❑ Yes IV , No _ S Use other side for additional information. 03a- O p 4 ) 1 SBD 6710 (R.3/97) � µ� Date Iry�pector'sSignature Cert No. �7µ� 'R°ClC+WQf�J ADDITIONAL COMMENTS AND SKETCH • . s SANITARY PERMIT NUMBER: A f Vi sc6hsin Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue I P O Box 7302 Department of Commerce In acco with ILHR 83.05, W IS. A r_ - � r , , , ,,. Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syste y per noli less co ty than 81/2 x 11 inches in size. �, l;i� / / o • See reverse side for instructions for completing this applic i 4 State- Spnitary Permit Number Z V Personal information you provide may be used for secondary purposes� � if revision to previous application IPrivacy Law, s. 15.04 (1) (m)]. ST CkOtX• d�� State an I.D. Number I. APPLICATION INFORMATION- PLEASE PRINT ALL Pro erty Owner N {� me c t . ^ Prope 6teti 1 M J- f-� N N J cha Nt Ua ..� T , N, R E (or W� Propert Owner's Mai ing Add sk b Block u T (, ) j Cit State f Zip e Phone Number S ivisi n N f or CSM N i %A 9 v)J I t, t v) (71S > 3�if� (.7S Ate. ''vktj » J , II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ !t age 0\10J00 Nearest Ro d Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Vtll Town OF 1_ 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) - �A 1 ❑ Apartment/ Condo Q — - Q 0 0 1 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 online B, if applicable) A) 1. ❑ New 2 Replacement 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 ❑ Mound 30 ❑ Specify Type 41 [ Tank 12 Seepage Trench �N� 1 fiftp�ar/ 22 ❑ In- G Pressure 42 C] Pit Privy 13 [1 Seepage Pit � round e� -/ 43 [] Vault Privy 14 E] System -In -Fill ©yDO E ,pN _ KOow- 'Prh' S¢C. wui� VI. ABSORPT SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade ( rrll Re uired (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min inch) �v.► leva le 0 V U S V 3 -W Feet T (v Feet Ca acit VII. TANK in allo s Total # of Prefab. Site Fiber- Exper- INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank (1 two ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ ❑ ❑ VIII. RESPONSIBILITY 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 Signature: (No Stamps) MP /MPRSWNo.; Business Phone Number: IL Plumbe ' Address ..yyss treet, Cit State, Zip Code): D C >Hw �S wpj0 4 1rc• � U1 IX. COUNTY / D ARTMENT USE ONLY ❑ Disapproved nitary Permit Fee (includes Groundwater ate I ssued Issuin Agent Signatu (No Stamps) ❑ S Pppproved Owner Given Initial Surcharge Fee) Adverse Determination✓ X. OND TIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber --Odom 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. F r, 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. 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. IL 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 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 81/2 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 mainstwater 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 ano 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. -s-Tr -,• ....�.d �40;4-a-Ln4 VIII// zacL z s T e • = ��Na phc��� So'. A- genr -� r ' I PK ' Q(46 M plfi 6N c1 mpt?l Top &� ,S, T ' w5veXOO apPWI N 99.8 0 W 4 , 1; TP4�441 t'f?j So' 4M S f?t)c. d S * )314n A� �c 10fi5 taa, A fpr4elk fit, y Q wp loo' feu► �p �' Ber- mpe. MOM LJ o a�, a� Sie;N pSJGrh�A G t o e � S gsfi k I' ) 73,ou C6 N l 0 4 � o C C v E T cW E c 6 - N c� +. (D ca N E Ev c r x 0) cn ui In 0 Z '0 0 Q c3 CL U g M o a cn at-� tin W _- s E N C x cti _�� rn = `�° rn COL 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 a -T,;eoNC X - 75 ►S ay a► 3 � Sao °sal Burl K � 3� INDICATE NORTH ARROW ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Property Address City /State U S ti J r c Legal Description: _ �� �� �� Lot Block Subdivision/CSM # I- J '/a W t /4, Sec. L, TAN -RJjW, Town of PIN # /7.2(, SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: uRip 5,XIS T arv( DN) I Tank manufacturer J � S - Rf\. J Size ST/PC ob 6 / Setback from: House a 1 Well S P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road intake Water Lme Meter location Alarm loca SOIL ABSORPTION SYSTEM: Type of system: N �' �' 3 '� Width Length Number of Trenches Setback from: House a 4 Well 5 3 P/L r 5' Vent to fresh air intake 5b ELEVATIONS Description of benchmark 1� ��� ^ S J bl N G Elevation Description of alternate benchmark Elevation Building Sewer ST/HT Inlet `, ST Outlet 3 PC Inlet PC Bottom Header/Manifold 3 " 5 V Top of ST/PC Manhole Cover Distribution Lines () I 3.3 �O Bottom of System () 9 a- O U Final Grade () " S () I Date of installation gPermit number 35 A 3 State plan number Plumber's signature Q Q- License number Do ' Date S / I S/ 0 0 Inspector Complete plot plan a i� Wiscon ;in Deparbnent 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 x 11 inches in size. Plan must County include, but not limited to. vertical and horizontal reference pant (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION - A o ation. 020 - 1165 - 80 - 000 Personal information you provide may be us ry purposei aw, s. 15.04 (1) (m)). a ev+ed By Date p Property Owner �'� r' Property Location Timothy & Ann Scharfenb U Govt. Lot NE 1/4 SW 1/4 S 17 T 29 N,R 19 W Property Owners Mailing Address 4 > -. — Lot # Block # Subd. Name or CSM# 941 Becky T Circle � 19 97 NA Parkview Estates Fourth Addition City S e-- Zi umber E] City Village ❑Town Nearest Road Hudson 0 G 86-6 Hudson Becky Circle ❑ New Construction Use: rooms 4 ❑Addition to existing building [7:] Pu ' ❑ Replacement describe Code Derived daily flow 600 gpd Recommended design loading rate .7 bed, gpolft .8 trench, gpd/ft Absorption area required 857 bed, ft 750 trench, 11 Maximum design loading rate .7 bed, gpd/ftz .8 trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations trenches using high capacity infiltrators. Install Bull nun valve to allow future use of existing hydrolically Parent material outwash s & gr. Flood plai n elevation, if aPPilicable NA ft S= Suitable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ®S ❑ u ❑ S❑ U X S❑ U M S❑ U ❑ S® U ❑ S® u SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure Consistence GPD/ft' Boring# Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz Boundary Roots Bed Trench 1 1 0 -13 12yr2 /1 None sl 2fcr mvfr cs 2f,lm 0.5 0.6 2 13 -32 10yr3/6 None fst Ifsbk dfi cs 2f,lm 0.4 0.5 Ground 3 32 -56 10yr4 /6 None s 0 sg dl cs If 0.7 I 0.8 elev 99.34' ft 4 56 -125 10yr6 /6 None s 0 sg dl - - 0.7 0.8 2 Depth to `6 limiting V _�l factor 04 >125' kv Remarks: 2 1 0 - 15 12yr2 /1 None sl 2 fcr mvfr cs 2f,lm 0.5 0.6 2 15 - 25 10yr3 /6 None fsl Ifsbk dfi cs 2tlm 0.4 0.5 Ground 3 25 -45 10yr4 /6 None s 0 sg dl cs if 0.7 0.8 elev 98.97'ft 4 45 -122 10yr6/6 None s 0 sg dl - - 0.7 0.8 Depth to limiting factor >122" Remarks: CST Name (Please Print) Sign re: Telephone No. James K. Thompson .;� 715- 248 -7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, WI 54020 7/25/99 3602 1078 PROPERTY OVVNER: Timothy, & Am Scharfenberg SOIL DESCRIPTION REPORT ems page 2 of 3 PARCEL LD# . o2o- 1165- s0-000 ' A.C.E. Soo 8c Site Evaluations Horizon Depth Dominant Color Mottles Texture Structure nsistence Boundary Roots GPDffl2 in. Munsell Qu. Sz. Conk Color Gr. Sz. Sh. Bed J. Trench 3 1 0 -13 12yr2 /1 None sl 2fcr mvfr cs 2f,lm 0.5 0.6 2 13 -36 10yr3/6 None fsl lfsbk dfi cs 2f,lm 0.4 ! 0.5 Ground elev 3 36 -58 10yr4 /6 None s 0 sg dl cs If 0.7 0.8 99.28' ft 4 58 -125 10yr6 /6 None s 0 Sg dl - - 0.7 0.8 Depth to limiting factor >125' Remarks: 4 1 0 -10 12yr2 /1 None sl 2 10 -35 10yr3 /6 None fsl Ground elev 3 35 -52 10yr4/6 None s 99.02' ft 4 52 -115 10yr6 /6 None s Depth to limiting factor Hand augered sal evaluation to determine suitability of reconnection of epsbng hydrollically failed soil absorption system. Loading rates not calculated due to inability to determine structure of sal. Horizons # 3 & 4 would have 0.7/0.8 loading rate Remarks: if a morphilogical soil evaluation were completed. Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: ' � , �. 3o•F 3 • //anc/ aayved So;/ eA/ e /ed " % a►� 7s N Own W: $ .4n n 9y1 8ech'y �o 97, '4"e w e'v E.s-&ks Qom✓ n E yySwiy 5cc . i7, 7 - 2fel, /f ed, Tn. o� fl�dsa4,, 56. Cro i w¢ LL i f fardfA o O� E /rtr = 9980 � i ey"6 :nq "I'J, ¢Xisfi� ■ 0_� 6. oz F' e s,. 84 - �7 ��/ ouELtt: 7.S ,ZO �•�3 ,Z �rtnc�tS a-4-3 X 7S Csyoaci4y eX: s�, /p X3G'so;/ absa�p�i S y yEe.,•,� • / Flees b o{�c y Chamber SAS SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Chamber Soil Absorption Systems Permit Number 11 — /8 - /9 - 9 -- 1 Date x " x " Gravity Distribution only 1 Pressure Distribution 3 ft Suitable Soil I Note 1: Bury depth as per manufacturer 18 in Chamber Height 2 8 ft Maximum Bury Depth 3 600 and Estimated Daily Peak Flow 0.80 gpd /ft Wastewater Infiltration Rate 750.0 ft Code SAS Size 40 % Down Sizing Credit 300.0 ft Reduction ( -) 450.0 ft Min. SAS Size 93700 ft Proposed SAS Elevation Soil Surface Acceptable Finished Grade EL 4 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 96.00 102.50 1 99.34 125 91.92 97.17 Yes 2 1 98.97 122 91.80 96.80 Yes 3 99.28 125 91.86 97.11 Yes 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Total height of chamber in inches. 3. Maximum bury depth as per manufacturer's recommendations. 4. Based on chosen system elevation, and chamber height. Top of chamber is equivalent to top of aggregate. The addition of fill for cover or the reduction of finished grade may be required to meet minimum or maximum code standards. M• 30 { 3 I /o ca-Ecd �p �j0 . S talc ' ♦ E /�daE: erg S I� Owner: 7'7," 4 Ain SaarAr c' 9,// 6ecA C., - GCF //&.dsoy; ,Cod' 97, �di env Es�6af+es s/ awl ►�•a; �'� �n use CL . 6.4.: To/i e jamfA o S.T. Anspcc e}r N bcaG -Darr+ ��i mi�ifiYb�eie �o� ncs�ence o/"S,'J: . AsSun+cd G1 t� =�cb•ct�: t fit, � sfi� ■ 0� oz • a Ve.. of it 0,1 fi i.v3 ,t 3Y IS CJ¢�/ oKECef :9y1� �C ,Z4rc�t.�tS l� A:rw Cap4 0 4' C,Y: s�E.•na /p X 3G'so ;� abso� Sy�ler►,. ,Pl Can�[G� u�,'� baCC ran ✓t.(t�K. , ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICA FORM OwnerBuyer_ Mailing Address Y L L r Property Address 1 �� (Verification required f m Planning Department for new construction) City/State / w/ Parcel Identification Number 0,20 1 co _ go - 0 oo LEGAL DESCRIPTION Property Location '/., SVy y,, Sec. T-Z� -Rj�_W, Town of ► VL6t.SUy) Subdivision _T�2� 4r Vl e(&) ��Ct�2� jl�t r�/1 (j�,j`r1 PY�� Lot # . Certified Survey Map # Volume , Page # Warranty Deed # -1 , Volume , Page # * 3 pq . - r Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM MAiN'rri,NANCE 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 n.:eded 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 wastewaterdisposal 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. Irwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 . days of the three year expira ' n date. SIGNATURE OF APPL ANT DATE 9 R CERTIFI - MON I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prope described above, by virtue of a warran corded in Register of Deeds Office. SIGNATURE OF APPLI DATE * * * * ** Any information that is mis- represented may result ' 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 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 t I� he Yy\ 4 A" S�h�P �i residence located at: �r _',, S ;, Sec. I -? , T N, R_j_2__jW, Town of obPSc"J , St. Croix County, Wisconsin. 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' 9 Did flow back occur from absorption system? Yes No� (if no, skip next line. -- Approximate volume r length of time: gallons minutes Capacity: --LO b U -p Construction: Prefab Concrete Steel Other Manufacturer ( if known) : Age of Tank (if known): �-J 1 r 0 (Si ature) 1 _ (Name) Please Print (Title) (License Number) 1) ) y ) I I (Dat ) 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 (except for inspection opening over outlet baffle). Name - LV1 r - ')AA"t- 4fit Signature MP /MPRS r �? V 1 46O pp PAGE 571 • EXISTING SEPTIC SYSTEM AFFIDAVIT F L 3385 KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI Name & Return Address RECEIVED FOR RECORD Tim and Ann Schar£enberg; 941 Becky Circle 11 -05 -1999 3:30 PM Hudson WI 54016 AFFIDAVIT EXERT # CERT COPY FEE: 1 COPY FEE: 2.00 7 .2 9.19.1014 TRANSFER FEE: Parcel I.D. Number RECORDING FEE: 10.00 PAGES: 1 020 - 1165 -80 -000 Computer Number The existing septic system that serves the dwelling is being replaced with a 4- bedroom soil absorption system. The existing 1000 - gallon septic tank is not being replaced. Therefore the septic tank must be inspected to determine that the tank is not leaking, baffles are in place, and the tank cover is covered or locked per code. The results of that inspection must be made available to this St. Croix County Zoning Office at the time the replacement permit is applied for. If the existing septic tank is found to be code compliant, the tank can remain and the tank will be undersized per Comm 83.055 (3)(g)(4)(b) requirements. Property Owner(s) Tim and Ann Scharfenberg Property Mailing Address: 941 Becky Circle Hudson, WI 54016 Property Legal Description: Lot # 97 CSM /Subdivision Parkview Estates 4 Addition Part of NE '4, SW 'K, Sec. 17 , T 29 N -R 19 W, Town of Hudson (wee a t ta0494)- Comments: The existing septic tank is sized for a three- bedroom dwelling. I, as the owner of the above - described property, hereby affirm that the septic system serving this dwelling meets the above referenced state private sewage system codes. I realize that in the event of a failure the septic tank will be replaced with a code compliant tank. I will make this information available to any future parties interested in purchasin this property. . Slit Signature: Notary Public Subscribed an °i!ti sworn to before me on this Date: ' ►, = r- �� 10N _ C t Official Signature: My commission expires: N33 Date: �� Q /o VL �423PArE238 6 State ar o Wisconsin Form I - t932 KAI HLEEH H. WALSH WARRANTY DLED REGISTER OF DEEDS ST. CROIX F�0., WI NO. -- DOC UMENT - - - -- — — " -- - - - -- — - RECEIVER FOR RECORD THIS DEED made between Jeffrey S. Anderson and 05-03 -1999 8:00 AN Edith A. Anderson husband and wife ' YARRANIY EXERPT D CERT GORY FEE: COPY FEE: Grauutr, TRANSFER FEE: 415.50 RECORDIN6 FEE: 10.00 and Timothy L. Schar.enberg and Aan E. Scharfenberg, PAGES: I husband and wife as survivorship mar�Fd: property I S ivs SPAC nE SERVED FOR R DATA _ Grantee. NAME AND nETURN ADDRESS: WITNESSFTII, That (lie said Gramor, for a valuable considelalion couveys to Grantee (lie lullowing described real estate in St. Croix /I County. State of Wisconsin: _ 02 _ 1165 - _ PAIK_R nDEtrTIFICA TION NUMBER Lot 97, Parkview Estates Fourth Addition in the Town of Hudson I This is honiestead property. (is) 6tlaorld Togellier with all and singular the hereditameuls and apputlenances thercunto belonging: And Grant - ir warrants that die title is good, indefeasible in fee simple a free and clear of encumbrances except easements, roadways and restrictions of record and will warrant and defendro same. Dated this 3C day of April (SEAL) (SEAL) • I Jeffrey-_ S._ Anderson , - -- (SEAL) !A F YI & ' (X_, /� _— (SEAL) • . Edith A. Anderson „ia rutN ............................ AUTIIENTICATION ACKNOWLEUI Jt►tEOq v ' .G. Signature(s) STATE OF WISCONSIN F— qz j St. Croix County.y> L/�yy ` audienticated this da) of 19 Personally came before me tlus -(� �';, day of April t9 49 Wrt a named Jeffrey S. Anderson and E3'itll A. • Anderson TITLE: MEMBER STATE BAR OF WISCONSIN (if not, audiorized by Section 706.06, Wisconsin Statutes) to me known to be the p:-rson s .. who executed (lie foregoing instrument and knqled e the � . THIS INSTRUMENT WAS DRAFTED BY r 1 Michael II: Forecki Attorney • Kathleen R. Videen 1 Eau Claire, Wisconsin Notary Public _ r olk County Wis. (Signatures Wray he suntemicated or zcknowledged. Both are not necessary) iy comnisskm is permarretit. (If trot, stale expiration dale: 11 • Names of persons signing in any capacity should he typed or printed below their signatures. June 24 _ .. .. igw200 F) r - _ ' M EAST - WE OUARTER SECTION LIPE- _ I I i t ESTATES I I THIRD 0 --- -I - - -- 81 82 I 83 - - - - - -- 84 I i I I I I i I I �V7 � I � 6 � 5 � ? � „ i ° 15' 14 "W 1 S79 4.3` 75 ' S ppt 236 1 II • ' 1 98 --�� 93 m' 1.494 ACRES %257 SO. FT. 97 1 1.373 ACRES � I � ea ement 1,198 ACRES b '� 94 59,754 SO. FT 52,166 SO. FT. N 1.153 ACRES 20I drivewa a ement 92 30,246 SQ FT. 1, 166 ACRES 50,742 S0. FT. � 1 1 ♦l NS2 °31� 15E ' ' N 14' 0 1 °4 0 r i 201.43 205.77 W ' Y > '° 207.10 �y 1 1 1 I 0 I , cr \ I 299 1 1.034 ACRES - , 1�1 45,062 SQ FT. ' 1.021 ACRES 1.019 ACRES 44,460 30. FT. 00 44, 383 30. FT. 2 - - - -- 24&00' I - - - -" -- - - - - -- 249.87 - - - -- z ---------------- t I — NST 14 E 495.87 NEW15 14 E - DRIVE 64 90 - 100 � ACRES i SQ. FT. � S89 1514 W 558.od 5 ?, 21to °e 1 75.00' - - - - -- 408.00 ------- - - - - -- - 750 -t,_ 300.00 ry 5 ` Op' t ^ 1 V X /�-"� t I 1 � .`V I o t 103 I �. 98 3 7 ACRES O I � % ' 95 SO. FT O tJ 1.498 ACRES co 1 65,257 SO. FT. A) �� 8 97 30000 3 99 Z® riveway ea oment/ 1.198 ACRES b'o 9 1.196 ACRES 52,166 SO. FT. cn ' ' 2 52,097 SO. FT. ; 1.153 O� - - - - w-5 50,246 O 102 0 ACRES 5 50. FT. S830 9122"E N82 °31' 15 "E N 1 °4 — 2 00.46 1 I 200 ; ; 205 8 300.00' 1 1 O 292 tt = t S - - - 9 °32'05 2 2 � I3 t 101 O t o 100 157 0 27'55" �� _ 157°27'55° 96 � :6 G 54 ACRES o 1 � j 1.036 ACRES - ' ' 1.034 ACRES b N 45 SO. FT. 45,140 SO. FT. 45,062 SO. FT. U! 1.021 A 1 ° O N , L I 44,460 S Q Sbo ONO , tN si b t O 300-00' - -- 1 � - - - -- 246.00'----- @��zc°� t � - - -- 246.00' - - - -- -- '15'14 "W 546.00' N89 "E 495.87 ROOKWOOD - - -s89 °15'14 "W 148 28 ---- - - - - -- �- - - - - -- 243.00' ------ - - - - -- 156.00' -- - - - - -- 15600' - - -- - -- 156001 I ---- 1417.04' - - -- I 3 ' 0 8 - 1- 107 IN 108 N o o 109 R R 110 111 � _m 697 SO. FT. ` O 1 1.071 ACRES M L074 ACRES 1.074 ACRES 1.074 ACRE 46,651 SO. FT. 6,795 SO, FT. 46,795 $O. FT. 46,795 SO. F t 3 3 0 E, N89 "E 243.00:' 1� o `o. - N U) cn N? X60 9 xb o t 0 156.00 156.00' 156.00' 0— S 89° 1514 W 468.00 0 Mscgnsin- Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ST CR IX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Permit Holder's Name: ❑ City ❑ Village ATown of: State Plan ID No.: HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: A9600198 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. Air I to ntake ROAD Dt Inlet Air Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Head Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON.17.29.19W, NW, SW, LOT 97, BECKY CIRCLE Plan revision required? ❑ Yes ❑ No T I Use other side for additional information. SBD -6710 (R 05/91) Date Inspector's Signature Cert. No . w • vis.'■'■r!'i SANITARY PERMIT APPLICATION S afety and Buildings Division Bureau of Building Water System: 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. C i o - \ `/ • See reverse side for instructions for completing this application State Sanitary Permit Number a(,e?3 46 The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property q' er Name ` Property Location e jt �T iA 1 -t U S 1/4, S l r( T. Z. N, R 11 E (or nW Propert ailing Address Lot Number Block Number City, State Zip Code Phone Number visio Name or CSM Num ( > II. TYPE OF BUILDING': (check one) ❑ State Owned E] Cit Nearest Road Village f Public r 2 Family Dwelling - No. of bedrooms _ Town OF N 1'� ba rJ >: L Ill. BUILDING USE: (If building type is public, check all that apply) arcel Tax Number(s) 1 ❑ Apartment/ Condo (-DZa -- 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 If 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 ❑ Replacement of 4. ❑ Reconnection of 5 �epair of an ______System __ ^_____ System ________ Tank Only______________ Existing System ______ ExlstingSystem B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Dis"ution Pressurized Distribution Experimental Other 11eepage Bed 21 ❑ Mound 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 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 (sq. ft.) (Gals/day /sq. ft.) (Min. nch) Elevation (oQQ I 81SI }� � q 1$ Feet #3. Feet VIVII. Ca acit TANK in Capacit Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks manufacturer's Name Concrete con Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank &00 /000 (, El 1:1 1:1 1:1 1:1 _" � Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. s Name: (Print) Signature: (No Stamps) M uslness Phone Number: m�� `c `a ) Address (Street, C it State, Zip Cogq): }dd d —� "� 6 IX. CIOUNTY / D EPARTMENT USE O ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate I ssued Issuing A nt Signature (No S WApproved surcharge Fee) ❑Owner Given Initial S'iyi� Adverse Determination QCJ lGl� CONDITIONS OF APPROVAL/ REASONS FOR DIS PPROVAL: U SBD -6398 (R. 05/94) DISTRIBUTION: Original to county, One copy To: Safety & Ruildings Division, Owner, Plumber INSTRUCTIONS r 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the I 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 -3815. 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. Ill. 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 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.); t 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 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) fora numberof regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. 1 10v o/= 50i15 . /�E� vUivq -Tio.� PI�oCESS �/ii9� T�R�P�Li�� Wisconsin Department of Industry, Z SOIL AND SITE EVALUATION / Labor an Human Rela Page of L d I a eat Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. 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 7' CPO/Y, percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 0 2. 0 - 1 165_ - J' 0 APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner % Property Location *� JEFF 60 t *(4, 14ti PeW,5�DA_ Govt. Lot /V!<l 1/4 60 1 /4,S /7 T 2y ,N,R E (or) Property Owner's Mailing Address Lot # I Block# I Subd. Name or CSM# LI/ /& 97 P�4�P� a,Ew Fsrgr�s . �3oD /r. city State Zip Code Phone Number 7/S Nearest Road w/. 5y 1& ( 30&) / /y/ ❑Ciy ❑Villa e o Q Town ❑ New Construction Use: 2 Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial -Describe: WA O,t? �i 6� ?✓ 13th ie'-15 Code derived daily flow (0 6V gpd Recommended design loading rate • 7 bed, gpde — trench, gpd /ft Absorption area required p 5 :7 bed, ft 7�� trench, ft Maximum design loading rate • 7 bed, gpd/ft trench, gpd/ft •Reeommmmm eadod infiltration surface elevation(s) E aU" / a • 7� ft (as referred to site plan benchmark) Additional design /site considerations dd Parent material 54: 5 SS 13 y ee,,4 ^e p7 Flood plain elevation, if applicable N�ll' ft S = Suitable for system Conventional , �MMound In -Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ag ❑ U L" S 1:1 U E S .❑ U [-S ❑ U 2M EJ U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/112 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench a /Z �o YR 2 /� /s / �t+r /� dsti 9 S z , -7 ; ,g Ground 3 / - /f7 Yle elev. 98• I z o S. • 7. g Depth to limiting factor Remarks: Boring # Ground elev. Th s test site ft. for a O Depth to limiting factor In. Remarks: CST Name (Please Print) Signature Telephone No. f�o,6t i /�jT 713 386 S /8S Address Date CST Number � �— r Private Sewage Consultants __ 655 O'Neil Rd. /f/O/CS Hudson, Wis. 54016 ----— CO, D �//9� I ' 57 / ,0 1 X 3 c v / T� • ,PAWN—! 0,� ti we' ll 0 / 3 0 i • s gy=p T� c / orw r i ar o � PEES u-��D or aF IX 36 , 3 y 3( 2 0 L- q o ,v 6 — 2 6 - j(,� SyST• , / x two r S� 5c ,4c of (' a, — y 7 STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER J t V - Z �- C— � '' Or' �\ "1 s 0 f l MAILIN ADDRESS C % CC_ ` PROPERTY ADDRESS 1 (location of septic system) Please obtain from the Planning Dept. CITY /STATE \� \ UV ^ k ' PROPERTY LOCATION �� 1/4, 1/4, Sectio T 2 N -R ) 5 W TOWN OF ` ST. CROIX COUNTY, WI SUBDIVISI � u', <<_� t c., , LOT NUMBER _C CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment 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 prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater lumber, journeyman lumber, restricted lumber or a licensed pumper verifying P J Ym P P P P fY g that 1 the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: a St. Croix County Zon Office h' g Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 I r S T C - 100 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. Should 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. ------------------------------------------------------------------- owner of property Location of property N Q 1/4 1/4, Section Z I T Z'f N -R !T — W Township 9 A SGi:1 Mailing address c %ir__1e_ Address of site C \`} �, ��� C �' L t - .,► Subdivision name K� ,., - ��� - {_Lot no. 91 Other homes on property? Yes No Previous owner of property CC,, j I Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? _Yes No Is this property being developed for (spec house) ? Yes _ Volume and Page Number ':�_Ic( as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. 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 recorded in the office of the County Register of Deeds as Document No. and that I (we) presently ( ) P Y own the proposed site for the sewage disposal system or I (we) obtained an easement, to run 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. S n to - LT, of<7pplicant Co- Applicant d6 / qr- Date of Signature Date of Signature . DOCUMENT NO, WARRANTY DEED 't, i SPA "c RE,ERlEI FOR RE,: RU1 •+ DArA • STATE BAR OF WISCONSIN FORM 2-1982 5213'73 - u }� s7. c ;oixco.,IM Ga.;y- .D.— Wiech.and Robyn M. Wiech,.. husband a:�d wife,....- �,� . a , _ - ----------- - OCT 3 1994 . -- - -- - a.0 conveys and warrants to . ._ jeffrey S_ .Anderson. and EdiLh.A _ `: Andersoc ., -- husband and. wife, . .. -__ . :grj ----------- .... ...-- . - - -.. ........ ..... ... - -- .. ...... . ...... . ... ..... . .... _ _ .- .. .. RETUPM TO a . ........... .. --- - -- ---------------- y l ti following described real estate in .... St. Croix - -- County, State of Wisconsin: , f Tax Parl-el No:----------------- -- ---- - - - - -- ►'; i Lot 97, Park View E:tutes Fourth Addition to the Town of Hudson, St. Croix °4 County, Wisconsin. r . 1 sl X . s This is . . ._... homestead property. , j. (is) Kom .." n to warranties: ti Excepo i• Easements, restrictions and rights -of -way of record, if any. c Dated this`.......__- ----- --. day o -- - - -- September _ _ -_. _ 19_ 4 D L!/i��'�'l (SEAL) X!`__n�- ..lv �c _(SEAL) J Gary D. Wiech Robyn M. Wiech __ - - - - -- _ ..... ----------- ... _(SEAL) _.---- -- -. -. (SEAL) ` - AUTHENTICATION ACKNOWLEDGMENT Gary D. Wiech Robyn M . STATE OF WISCONSIN Signature(s) , - Wiech ss. i --- ------------------ - County Se tember 94 t % ii authenticated this ._... -d( /any' of _- ___�? ............... 1 9 ---------- Personall came before me this - .....- ........day of 4 . ! 13 the above named ��u�� ----�' -- --- ------ ---•-- - iI l._. .. _ --- --- - -- --• --------------------------------------------------- --- ---- ------ -- -------- -- -- - -- -------- -- ?? i •..- Kristina Ogland ----------------------- - - -- - - - -- -- - - - - -- i TITLE: MEMBER STATE BAR OF WISCONSIN ---------- -------------- - ----------------- - - - - - ------ ---- -- - - - - - -- ---- -- ----- -- - - -- - _ -- - -- r, �I au not . .... .......... 0 6, . known -- - - - -•g ------ - g authorized by $ 706.06, Wis. Stats.) o me to be the peon - - - - - -- - - -- who executed the - ' `vr -oin instrument and acknowledge the same. l a I� l. $ i T~Kristina Ogland RAFTED BY ................. . ... ... a _ ! �p t. - -.. ... ....... .. .. - Attorney at Law County Wis. F ---------- -- --- ---•-- -------•--- ------ ------- -- ------ - -- ----------- Notary Public : (Signatures may be authenticated or acknowledged. Both 31c Commission is permanent. (If not, state expiration i �_ I are not necessary.) date ---- --------- -- -- -- 19 ------ _ -•) 'Names of persons signing in any capacity should be tyDe� or printed be3a� '�!3 `x'-•s rs �- Inc I _ Wsronsin Legal Blank Co.. - WARRANTY DEED STATE BAH Or 7Ci 'O- SIN MdWaukee. Ntsconsin FORH Na 2— + 03/16/99 TUE 10:03 FAX 715 386 4686 ST CRX CO ZONING [7j 002 ��•.�.� ST. CROIX COUNTY WISCONSIN ZONING OFFICE "" ST. CROIX COUNTY GOVERNMENT CENTER ,�. I10ftarmichaei Road --- ---- -- t►dsOn, WI 54016 -7710 ...rte (715A 336 -4680 SEPTIC INSPECTION / WATER TEST UE FORM JJ 1 P A 1 9Q 0 S7- CRax Please specify desired test(s) & remit apprQ) fd^t* fed: ith application. outside water lines are oft �rn.t FMf ' ring winter months, making access to the'home nec _ make arrangements with this office to insure that e art gained. ❑ Water (VOC's) �" ' Septic $$8:'Ot7 foo - °' Q Water (Nitrate & Bacteria) 454'00 ❑ Nitrate & Bacteria ,❑ Water (Lead Concentration) 21;00 retest $15.00 Owner: 7-eUi - .Dec, ni2da_Soon Requested by: LAaVrA rVS� Address: Address: OF arc/ 2 = 1 Prel 6rw ZIP 7L'lo I g n b p. ZIP / Telephone W: ( ) Telephone W: (�) ?��- X26 ?,c 1 2� Property address ( Fire M & Street) : q 4 11 &e(_11, 6 l -� Location: h, �;, Sec.__, T 771 N, R W, Town of_ _ 8 7 - 1 e gbj_r" � 10 � Lu-1- � I C Realty firm: 0C�1� Lock Box Combo: �(� I, Closing Date: N,LeG� e pf - off i✓LS (x �JV QS SD 0 �o5s i hte� T O BE PLETED BY PROPERTY OWNER * PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Water sample tap location: Is the dwelling currently occupied? es 0 No If vacant, date last occupied: Age of septic system: a Septic tank last pumpe by: ; D ate Previous Owner's Name(s): Have any of the following been observed? ❑Y ON Slow drainage from house. OY ON Sewage Back -up into dwelling. ❑Y ON Sewage discharge to ground surface or road ditch. OY 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: 1/94 a s� OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION I N �yive i reLesc ,?.L,.VV Owner: - tom Anti eV Y1 Requested by: Address: Her-k. Address: 01 ZIP Telephone N°: (�) Lt- jG?jq S � Telephone N °: ( ) ZIP Property address (Fire N° & Street) : Location• '., %, Sec. , T N, R W, Town of Realty firm: Lock Box Combo: Closing Date: TO DE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Water sample tap location: Is the dwelling currently occupied? Yes 0 No If vacant, date last occupied: Age of septic system: S• - - 6W4 LA-N WOO Septic tank last pumped by: Date: ow', lwla Previous Owner's Name(s) : _Rdoih 4 C7gvi,� 1,�2i� Have any of the following been observed? OY N Slow drainage from house. OY Sewage Back -up into dwelling. OY Sewage discharge to ground surface or road ditch. OY 1 Foul odors. Other comments relative to system operation: I certify that the above information is c mplete nd true to the best of my knowledge. OWNERS SIGNATURE:i DATE IK- 1/94 ST. CROIX COUNTY WISCONSIN ZONING OFFICE r ST. CROIX COUNTY GOVERNMENT CENTER rNN Nrr ■���� 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 March 23, 1999 Laura Foster Century 21 Premier Group 70619' St. South Hudson, WI 54016 RE: Septic evaluation Dear Ms. Foster: On March 18, 1999, I conducted a surface inspection of a septic system located at 941 Becky Circle per your request. The surface inspection revealed 30 inches of septic effluent ponded in the drainfield vent. On the inspection request form, it was reported that the septic system was re- conditioned in 1997 by Tri- County Sanitation. The septic system serving the property was installed on May 22, 1987, and was sized for a three bedroom house, a Weiser 1000 gallon septic tank discharges to a bed type drain field -18 feet by 36 feet. The system was inspected by staff from this office on May 22, 1987, and was installed as a code compliant system. The replacement area is located directly to the north of the existing drainfield. On March 18th, the sanitary system appeared to be functioning and was not discharging effluent to the surface. Effluent ponding in the drain field may suggest that the system is reaching its maturity, but is not a failing system per § 145.245 V 6 Ponding results when microscopic bacteria and sludge plug the soil pores. This process forms a clogging mat (bio -mat). This clogging mat decreases the soil's ability to dispose of the sewage effluent. Over time, this clogging mat becomes thicker, causing less and less liquid to percolate through the system. As this mat becomes progressively thicker it leads to failure of the system. To prolong the life of the SAS you may try to rejuvenate the system. When an existing SAS is rejuvenated there are no guarantees on how long the system will function, it's only a short term solution. Other efforts to prolong the life of the system could be as simple as fixing or replacing plumbing fixtures with water conserving fixtures, reducing shower time, washing dishes when the dish washer is full, avoid using a garbage disposal, using a wash machine with a suds saver feature, etc. 1 i The inspection of this sewage disposal system was based on a surface inspection of said system, and did not involve any excavation or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discovered 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 or when the solids get to be 1/3 depth of the septic tank. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact this office. Sincerely, e oz� t a"r Rod Eslinger Assistant Zoning Administrator = z 0 c v' z K m m O 00 :u OD C=) r O m x -v cn c m m C/) U) n 00 r 4111 �.. m � � o0 O r0 -� r M � D � C7 � Z = D n Mac O m ° rn O N Cn 1 Z 0 Z O 0 C � z D c D A - n z z c M r 0 v) C� � ° n m - (n z C Z Z . 7V Wq o oQ Z O CD m _ Z CL °< i io: mom O o 3 m d m c° a 70 IT1 ? f N O ' D m� y: 00 m m 3 m _d N �" am 3 J m A to m ; f ; N N d m �aN 'Tl <s < o p c O ° m < � m s -� 3 3 3 < d m N ° o �^ d mm° `° 103 O =. Q ' _ m " v N 3 FV Z o p- ? c� - mN y �•< .* _ D A < om H' °o Z d < ad � N � N o . m c < ago o D m M o N m m - � 0 CA m - c 3�d sa W - - < m o' o d 3 0 d ° 00 D V N f N N N 3 0 ° m rn ....... �... ... v.. 201 E. Washington Ave. In accord with ILHR 83 -05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 a Attach complete plans (to the courity copy only) for the system, on paper not less County than 8112 x 11 inches in size. �. C c O ^ \ 9 See reverse side for instructions for completing this application State Sanitary Permit Number a6 - 86 the information you provide may be used by other government agency programs ❑ Check if revision to previous application Privacy Law, s. 15.04 (1) (m)1. State Plan I.D. Number !. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Iroperty er Name 1 ` Property Location 1 it �- c+. � KI V SW 114,S I T.Zq ,N, R /9 E(or W IropWty Own ailing A dress Lot Number Block Number =ity, State Zip Code Phone Number visio Name or CSM Num 1 . TYPE OF BUILDING: (check one) ❑ State Owned O ityy Nearest Road Village Public r 2 Family Dwelling - No. of bedrooms Town OF v.�So t., r✓� k� C.�.h 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 []Apartment/ Condo v — I j 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. Q New 2. ❑ Replacement 3. Q Replacement of 4_ ❑ Reconnection of 5. epair of an ______System ________ S�rstem ______ _______ 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 DiS)~44Pution Pressurized Distribution Experimental Other 11N6eepage Bed 21 ❑ Mound. 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14,0 System -In -Fill VI. ABSORPTION SYSTEM INFORMATION- 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 15. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Mi.n.hnch) Elevation (00 1 75 Feet 9 R feet VII. Capacit TANK in gallo s Total # of Prefab. Site Fiber Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- - Steel glass Plastic App New Existin strutted Tanks Tanks septic Tank or Holding Tank ,G ❑ ❑ ❑ ❑ ❑ -oft Pump Tank /Siphon Chamber ❑ 1 ❑ I ❑ I ❑ 1 ❑ ❑ All. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. s Name: (Print) Signature: (No Stamps) M uslneess Number: C7 f ZB& `e`a `dress (Street, Ott, State, Zip C00401: IX. COUNTY / DEPARTMENT USE ONLY Q Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing A Tit Signature (No S Surcharge Fee) / A Given Initial pproved ❑Owner � Adverse Determination Xe\ CONDITIONS OF PPROVAL / RE SONS FOR D15�►PPROVA� / � S80 -6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety R Buildings Division, Owner, Plumber 11 �u,t Date CST Number ., i we' ll O ly 41 A epk V s e? Ti 0 I I � PR�s u-ti� y Z i �h y 0 0 T- O I � i �Q z 36- , 3y � 3(p i ' i o O�'�iv,Fi•�GD 0,v -za -1G syST' U,P.4i�✓ff��v 14 d# pq 0 u - r s, � 5 e - .4Le : / " z p ' f /�y. o�-of a — �.4 TZoA) o� so ; /s .9 1P 7 r 7 xisrr� G— , ,rVt1W1+ r110W AIP v/;+ 72�/PA L /F7 Wisconsin Department of Industry SOIL AND SITE EVALUATION Page / of Z Labor and Human Relations Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 81/2 x 11 Inches in size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and s 7 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 02 0 APPLICANT INFORMATION - Please print all Information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location d 1C F f= r �� + /�i(1 p�/PS�� Govt. Lot AIW . 114 5W 1/4,S /7 T 2 y ,N,R // E (or) Property Owner's Mailing Address Lot # I Block# Subd. Name or CSM# !, /A ��r/ 134G,eY ci;Pc /E 97 p411�e blew �JVPlr. City State Zip Code Phone Number 7/� Nearest Road El ❑ulna e o own / c & y ❑ New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: L-y byh S O ji*AI y 3 13t'D I S - Code derived dally flow &O a gpd Recommended design loading rate _ '7 bed, gpd/ft gpd/ft Absorption area required 9 5 7 bed, ft 7� trench, ft 2 Maximum design loading rate • 7 bed, gpd/ trench, 913d/(t EXtsTraCr C PmeemeAded infiltration surface elevation(s) / o% • �8 m ft (as referred to site plan benchmark) Additional design /site considerations Parent material SL S S$ 13 Uft ^e P7 Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In -Giro, unndd Pressure AT -Grade System In Fill Holding Tank U = Unsuitable for system 0'' ❑ U &s ❑ U LAS .❑ U ❑ U [�❑ U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/it2 In. Munsell ou. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench / /z /o YR 2 l /a IIR 2 / — /s /�.r d �s i -7 .8 Ground 3 /0 3 /S , .8 elev. ;g. i ft. — . Depth to limiting factor Remarks: Boring # rN Ground elev. Th S test st e --- ft. for a c Dnven tR 17 W Depth to limiting factor tn. Remarks: CST Name (Please Print) Signature Telephone No. flo,6 i i�L,7� 7 /.S 3,96 S I SS Address Date CST Number Private Sewage Consultants __ 655 O'Neil Rd. 410 455 S y5 7`Ei'9 / 5 /ilJ Hudson, Wis. 54016 �— eoD�" efe l a 114 �`o� /S � i o- /k A �SF� X3 y O/ KIIJ t=/e C Zlvvt`7c� 5�'2� Fal2 R-�+- 2r u T D / ST. CROIX COUNTY WISCONSIN ZONING OFFICE N r r ■ ST. CROIX COUNTY GOVERNMENT CENTER " " ■" 1101 Carmichael Road Hudson, WI 54016 -7710 - - (715) 386 -4680 �r March 23, 1999 Laura Foster Century 21 Premier Group 706 19 St. South Hudson, WI 54016 RE: Septic evaluation Dear Ms. Foster: On March 18, 1999, I conducted a surface inspection of a septic system located at 941 Becky Circle per your request. The surface inspection revealed 30 inches of septic effluent ponded in the drainfield vent. On the inspection request form, it was reported that the septic system was re- conditioned in 1997 by Tri- County Sanitation. The septic system serving the property was installed on May 22, 1987, and was sized for a three bedroom house, a Weiser 1000 gallon septic tank discharges to a bed type drain field -18 feet by 36 feet. The system was inspected by staff from this office on May 22, 1987, and was installed as a code compliant system. The replacement area is located directly to the north of the existing drainfield. On March 18th, the sanitary system appeared to be functioning and was not discharging effluent to the surface. Effluent ponding in the drain field may suggest that the system is reaching its maturity, but is not a failing system per § 145.245 Wisconsin Administration Code. 4; F # -4 - Ponding results when microscopic bacteria and sludge plug the soil pores. This process forms a clogging mat (bio -mat). This clogging mat decreases the soil's ability to dispose of the sewage effluent. Over time, this clogging mat becomes thicker, causing less and less liquid to percolate through the system. As this mat becomes progressively thicker it leads to failure of the system. To prolong the life of the SAS you may try to rejuvenate the system. When an existing SAS is rejuvenated there are no guarantees on how long the system will function, it's only a short term solution. Other efforts to prolong the life of the system could be as simple as fixing or replacing plumbing fixtures with water conserving fixtures, reducing shower time, washing dishes when the dish washer is full, avoid using a garbage disposal, using a wash machine with a suds saver feature, etc. The Y sewage inspection of this disposal system was based on a surface inspection of said system, p g p and did not involve any excavation or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discovered 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 or when the solids get is tank. Therefore the prolonged life of this system may beto be 1/3 depth of the septa ank p g Y Y dependent upon proper maintenance of the system. Should you have any questions, please contact this office. Sincerely, e 0 r ) 6 ";7� Rod Eslinger Assistant Zoning Administrator � w r x Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT TO SEC. T C9 N -R W OWNER - �i ��� r- T �li � o i> � 7 � / 9 � ADDRESS �� #/ ,Bob' 2 4=01 2 ST. CROIX COUNTY, WISCONSIN yo L eo SUBDIVISION Rat Pjj&j[s.j_ LOT / 7 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM VicW�lort #l7 E. i l w k )k I � . INDICATE NORTH ARROW it BENCHMARK: Describe the vertical reference point used a SGcJ, Ca /.jai' Elevation of vertical reference point: /00.0 Proposed slope at site: SEPTIC TANK: Manufacturer: GtJ21 ,o ¢Y" Liquid Capacity: /coo q /. Number of rings used: 2 Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: s Number of feet from nearest Road: Front,O Side, Rear, 71 feet i From nearest property line Front 1 0 Side,© Rear, O feet i r r Number of feet from: well gZ , building: .20 s,F eve ►�uror No,, 5d- (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE I - � PUMP CHAMBER rr�� 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: (D K Ue.v Trench: Width: Len the Number of Lines Area Built: & Sy -7 T Fill depth to top of pipe: `/ Z �� s Number of feet from nearest property line: Front, N Side, (/ Rear, O �'t. Number of feet from well: fo O N Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: kA Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: o Dated: Plumber on job: License Number: ✓ "! _ ✓ 3/84:mj r - DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O,. BOX 7969 BUREAU OF PLUMBING MADISON, Vial 53707 ,, NW,, SE,, Ip� , S17,T29N -R19W CONVENTIONAL ❑ALTERNATIVE Slate Plan I.D. Number: Town of Hudson E] Holding Tank El In Pressure ❑ Mound Lot 97, Park View Estates IV NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Sam Miller Route 1 , Box 282 , Hudson, WI 54016 `� ;OU -aa- g? BENCH MA (Permanent ,fe,rencq pointI DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. Name of Plumber y MP /MPRSW No.: County: Sanitary Permit Number: Douglas Strohbeen i 5932 St. Croix 92497 SEPTIC TANK /HOLDING TANK: MANUFACTURER I LIOUtO CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV.. W AR ING LABEL LOCKING COVER - O IDED: PROVIDED: Y z _ � YES FIND DYES ONO REDOING: VENT DI0..: VENT TL.: HIGH WA NUMBER OF ROAD' PROPERTY W BUILDING: VENT TO FRESH S FEET FR ALARM: LINE t : AIR INLET O , _; DYES NO J, ❑YES O NEAREST DOSING C AMBER: If MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL: PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO F] YES ❑NO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERAT IONAL: NUMBER OF PROPERTY WELL BUILDING. V NT TO FRESH , (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES 1 NO 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 DISTR. PIPE SPACING: COV INSIDE DIA. SPITS. UOUID BED /TRENCH THE (C FJE$t f I MATER ;AL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR, PIPE DISTR. PIPE MATERIAL NO. DISTR. NUMBER OF PROPERTY WELL BUIL V DING. NT TO FRESH BELOW P PES ABOVE COVER. ELE ELE ND:, PIPE LINE I VENT +liC LE 1 NEAREST I IW $Jti It 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. ❑YES NO SOIL COVER I TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ONO ❑YES 1:1 NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER: EDGES: DYES ED NO 1:1 YES ❑NO DYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. BED /TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.: ELEV.: DIA.'. ELEV.: PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PEARNSCAL LIFT CORRESPONDS TO APPROVED ❑YES El NO ❑YES 1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES El NO El YES 1 NC NEAREST ` I Sketch System on in county file for audit. Reverse Side. SIGNATU TITLE. ` � Zoning Administrator DILHR SBD 6710 (R. 01/82) SANITARY PERMIT APPLICATION COUNTY = IMLHFi In accord with ILHR 83.05 Wis. Adm. Code ST� NITARYPERMIT# �a 'v 9 -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES R NO PROPERTY OWNER PROPERTY LOCATION .So 1 , a ( ) % S E %4, S / T o? , N, R E (or PROPER / OWNER'S MAILING , ADZ � Z ` LOT NUMBER BLOCK UMBER oU`BDIVISION 4 E _ t� S IL CITY, STATE ZIP CODE PHONE NUMBER CITY ,V NEAREST ROAD, LAKE OR LANDMARK 4&j.50 A I �f o ! 7rs 3c ;0 VILLAGE: �f_k I^ 1 V4— 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 # 2,3 or 4, if applicable) 1. a. X 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. 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. X Seepage Bed b. ❑ seepage Trench c. ❑ seepage 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): c - 7 �. ( -T �l 4, 4g �T r /� Feet ®Private ❑Joint ❑Public VI. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank l0001 e_ r Lift Pump Tank/Siphon Chamber I ❑ __H_ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: 00W lgs S 10046 MA- 9' ,Z f7 3 3 3 Plumber's Address (Street, City, State, Zip Code): 1, Name of Designer: Al &- A Ie- A P A W1 �'�o1 p 6&,f VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # - D w Y . GIB r ► 0"0 GY g CST's ADDRESS (Street, City, State, Zip Code) Phone Number: a.. 6 � t4J-r l - r9 9 l IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) ® Approved ED Owner Given Initial �1 S charge Fee L� 7 P /�ZAy� Adverse Determination �UfJ_ Ucl as,v� �" _�` ``�� Yl i !�h -t 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 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; 3. 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 syster,,, 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. I. Property owners narie and maiii.ig a0ress. Provide the legal description w! the system is to be installed; II. Type of building o)r use served: If public rr, 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, III. 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 83� 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 rr,ore commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady rregotlation and public debate. The groundwater b it Gr our;d ater included the creation of surcharges ('ees) for a number of regulated practices which Wiscort in'S can effect groundwater. The surcharg_, took effect on July 1, 1984. All of the water that buried fleaSLire a is used in. your building is returned tc the groundwater through your soil absorpt� n o system or the disposal site used by your holding tank pumper. 0 T �e ;nomes collected through these �jrcharges are credited to the groundwater fund adminis- iereti by :he :department of Natural Resource:,. These funds are used for r ;onito6ng ground- t 4vater, groundwater contamination it :estigations and establishment of standards Groundwater, it's worth protecting. SBD -6398 (R.03/86) f 'f APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by owner(s) of the property being developed. Any inadequacies will only result in delays of the permit Issuance. Should 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. Owner of Property ■ Location of Property /k � ,, y R + , Section T _. N - W s . Township j Mailing Address QZ flies t . �or Zg2 Subdivision Name ��r Lot Number , Previous Owner of Property � ��a.1 UjC, Total Size of Parcel ___,(oZ �ca�✓ _� Date Parcel was Created — Are all corners and lot lines identifiable? , X Yes No Is this property being developed for resale (spec house) ? ,U Yes No Volume Page Number Z as recorded with the Register of Deeds 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 the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. -------------------------------------------- PROPERTV OWNER CERTIFICATION I (We) eVLU6y that aU 6tatement6 on thin 6ohm ane true to the beet o6 my (oual knowledge; that I (we) am (an.e) the ownen(e) o6 the pnopeAty de cAi.bed in .th.iA in6oAmati.on 6oAm, by vitu.e o6 a warAanty deed neconded in the 066ice o6 the County Reg•caten o6 Veeda as Document No.: ::Z: 2_ y and that I (we) ' pneA&Wy Mn the pnopoaed e.ite 6oh the s ewage po — lea. eye.tem (oK 1 (we) have obtained an easement, to hun with the above deaenibed pnopeaty, bon the conetauction o6 eai.d eyetem, and the same has been duly tecoAded in the 06 jive o6 the County RegiAta& o6 Deeds, as Voeument No. SIGNATURE OF OWNER SIGNATURE OF CO -OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED i PAR K V1 r - W ESTATES FOURTH ADDITION I A ;. ` AL -9jr:j M51CN LCCATE6. !N E %- Z *`V41411 WW�SEV� SECTICN 17, T294, R19 , 'tOO N : CF. RMSCN., ST CROX CAUNTY, W1SCOWN C33tTl7ICAT% Or Tov* TvrAstmzn STATS Or - XISCCNS . ST. CSOIr COCy:x ) Ss. } I, Beverly A. the daly elected, qualif &&and acting Town Treasurer file Tawas o Hudson, do r spoe apaefal certify that in seeordataee 4 rda in lay ot Lh n u th• are no unpaid laces ez rase l ssraents ra of : ' on any Land incle'" !A the P141 of Park Vierw sattttas Fourth Addition. S y • Beverly . Yjohnsow rown Treasurer M TOWN BOARD R.SOLUTION ltZWLVX:D, that the Plat of Pack View Estates )Fourth Addition in the Town of ` Hudson, Carrel E. Wart and Hove A, Wert, owners, is hereby approved by the i Town 9a� :d. • /' j _r r, / Data own rman _ r �. / f' D tgned own l.natrman� R F a "orabv tevtliy that the for• oin COPY ado pted by the Town 4 g is a cu of :. resolution ado 1 Board of the Town of Hudsc n. Dits own Clerk OWNIASt CiMTIF :CATS OF DEDICATION As Owners, we htireby certify that we caused the land described on thl Plat to be 4 aurveyal, dl.-Aded, mapped and daddieated as ro ?re+ented on this Plat. V,4 alto certify ' tbat t is Flat is required by S. 236.10 or S. 230.12 to be submitted to the following for f approval or objection: Dopartmeat t.f Development 1 ltaoartment of Industry, Labor and Human Aelatiots, Town of Hudson. City of Hudson and St. Croix County, W ;TN=SS the hand and real of said owners thls _ ' day of �! 1 • /fro ' In .sence of: I ' it r� tr r1 , Beverly A. Wart 1 • I ' STATE OF WISCONSIN I ST. CROIX COUN - f Y Personally came before me this " day of /�,r r • •• the above nam••i Darrel E. Wert rnd Beverly A. Wert, to me Anown to be the persons who executed the foresoinx instrument sad acknowledged the same. Notary Public �-�' ,0 -- „z, , Wisconsin My commission expires �s� Mary iRtsch, Notary Public CERTIFICATE OF TOWN CLERK- i STATL OF WISCONSIN) CROIX COUNTY ) 1. Alta ;brne, being the duly appointed, qualified and acting Town Clerk of the 'Town of :'.t•dson, do hereby e if that copie of this flat worts forwarded no required by .t. 236.12 on theday of . 1984, and that within the 2Q•day limit set Fy s. 236: i2 (3) (no objects na to the plat have been (lied) (all ah)- c:inns to 'ho ; Iat have boon me). Date }tit Horne, Town Clerk JAMES ES E. RUSCH SURVEYING & MAPPING HUDSON WISCONSIN TM3 iNSYRLW.hT CRAFTED St 7 ` .y -+= c, e-•�,,,,z, X1 1 SURYMCMIS CLRTMCATE:, 1. Amies- S.'nook. Roglaterod Wtseoneia Laud Sazveyov, hsiesby certify to the bee% Of lag profeeeioaal knowledge, uaderstaod3img sad belief: That I haws sarvey". divi4ed mead mapped Park View Estates ;Fourth Addition, hoc"" is tbi NZIA at the 5Y! 114 and the N 4 of the SEI 14 of 3ettioo 1', , TZ9 It 19M, Tow of Hudson. St. Croix County. WLwcensin: That I have naedo ouch survoy, land division sad plat by the dim*csion of Darrel E. Wort aw4Devsrty A. wart. ewaors 03 said lsarl, described as foLlows: Cosnreaaeing at the EIA come: of said Section 17; tiease S3962w "W (asewned bon.riW rel reaced to the um"numded EAST :i• EST 1/ 4 Section. Ilao s3: Section 1T. bsae6st asommod 309 (recorded as SW Z 146'"N on that CertiM -hod Surrey Map recordad taYa4nans 1,. Pa, 194). 1332.90 alaig said E AST -WZ3T Igo Section tiseaosi0"Oi 227.T'S tothe point of beginning. thence N3l52 "As' 412.00t; thence.. NO"Oi WC 2.12.00 to the Seutlorly right- of-way Use of Greea Bill Lana; theaea UST" 64.00 along said right-of-way lase: thence W04e30" W 251,00 !harts 57V2b 1 92"41. 194.35 thence S2VIS - W 236.76 -, thence N7VS7 14Z. 17 theate 5E9"15'et4s'W 356,W-, thence N006 104.00t.; thence SWIS 3NY.04 drones 2 4 .sjr30 "S 1M,W; %homoo Si9`15 66.01 than" 50s06 316,,;6'7': th, 33y"IS�14'!W LS1.00e:.theacr N0'37t51"1f 54.13 tbeaca 339'22 l41.W; thence t,0 204.43 thence N4W15 158.00 thence 30 thence !Y39'1SsY 'L 1Sd.QO 'henna.Soatheestarly 66.23 al the, the, aza of a.3M00* radive curve onesse Nortaerstsrly whoop chord beareS•%'SOt50"E "66�I ;themaw NW15 "t 57.0!'T sltsaco 3omdheaatozly_13b.Set along tie ars of a 317.00 curve eoeeave Northeasterly vboee ehov4 bears SZ4 03 "1: 135.51 thence AW23 143. 14 threes 1t7136s30"L me. thence N99"15014 "E 243.08 theaee±_9r06t3r"it 105.00 thence ;f33 W30 259. 16 %house Southeasterly 94.14 aloe= the arc of a 217.00 rsstbwr oeoeays liasthssatorlx �rlisre ahord'bett :e S73"03 1b "2: 96.35'; thence Is6!! W140s 920.041 thence' Nsrtbeastorly 91.21 along the are�`.of a- 300.fn9' radius cuvvm40062'ro ffbvtlewlastasly weose chord bears NW32 th mvo North- v►eaterlp 91;4 the are of a 309.00 radius curve concave Northoset,erl ,y whose chordl9atrA ;93'3 T 91.09': thaasa NO 150.00+; thence NW15 478.09; tkanve Ni906 634.56 to tbs point of beginning. That small plot is a correct repmemaldation of all the wderler bouodsates of the land set. red sad the subdivision thereof arcade, and Tier I have folly arsgiied with the provisions of Chaptor 536 of tho lff lseonsin stateoss. the Subdivision aid ZanisAa Regulatlmna of St. CroiX County, She .'own ul if ,dose SubdiAslan Ordinance. and the City of Hudson. Sabdivistan and inatz:ing Or4i- nance„ is sarraying. oridiag w A mn.pping the same. Dated this - 1 L 6 day of l edW . 198.3 R wised t of April, 1964, XMM s S. R use h�- L 421 #srossd Street 1iYt Hudson,, Wisconsin 54016 CCnYXTT T21EAMMEA CERTIFICATE BTA7It' Or WISCOMMM � ST.- CROIX COUNTT ) 2. hioa'•1 Soso Livermore, being duty elnctea, qualified and aeuing Tr,msurer of St. Croix Caunty, do hereby certify that the recovds in my office sho+r m unredeemed tax salts sod oo unpaid taxes er spacial asseoemebts as of 4 J�' df affee#es the lands included in the Plat of Park View Estates Fourth Addtivon. Date unty Treasurer 1 - I 70N2NG CO21F.tIT'.CE2; 1traOLUTION This plat is hereby approved by the St. Croix County Comprehnnsive Perks, Puftoing sod Zoning Commint e. m Y y Date Admlaistrator li osifir's ,f , ;%fill al.'JMl .k •�. , K..,,., • #' rimy i i 2`Y - _. #�' ` Y r ; F F Y z ST C- 105 r • a . H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a H OWNER /BUYER �a �Jj ��i✓ ROUTE /BOX NUMBE � gY LS)� Fire Number CITY/ STATE `� F- L41,Z Z I Si PROPERTY LOCAT ION: lk�el Sectio T a IN , R Town of 144^01 St. Croix County, Subdivision Lot numbe Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper What you put into I[ the system can affect the function of the 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 prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is 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. Ho E I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ro ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE _ St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715- 796 -2239 or 715 -425 -8363 Sign, date and return to above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS - INDUSTRY,' CC DIVISION HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: OWNSHIP /4AUU G4- PActFF : LOT NO.: BLK. NO.: SU DIVISION NAME: COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: s i - . J 4cc Gf�cS . S d! USE DATES OBSERVATIONS MADE NO BED RMS : COMMER IAL DESCRIPTION: I PROFILE DESCRIPTIONS: ER CATION TESTS i/ : Residence New ❑Replace ! �Q '7 L/ / �7 RATING: S= Site suitable for system U= Site unsuitable for system (� S AQ r ONVENTIONAL: MOUND: IN- GROUND- PRESSURE: SYSTEM -IN- FILLHOLDING TANK: RECOMMENDED$ /� YSTEM:(optional ,xS D U �SDU ®S DU OSIU DS ®U C� If Percolation Tests are NOT re uired DESIGN RATE: Q If any portion of the tested area is in the under s.H63.09(5)(b), indicate: A F i Floodplain elevation: /r9 PROF( E DESCRIPTIONS BORING TOTALr DEPTH TO GROUNDWATER CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER D �-E7 ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- /r S r 1 4 ' 2 _5 . /S� AZ �n S � y Q eA 1 B- eZ- /0 /. y ' oice > 7 J /, 0 8 l S / /• If N 4 , S / �/. 7 On /lei e j s B- 3 ,s' /o s' l.3 Bls/ / s/ .P M6 s B- LC 101-7' (.loin > 7. S' o d S� /r t. S/ . 6 g'M 'j 4(iel S B- 7 ' 0 /, 3' &4 e- o2, .� �e s / / At a� BA Me` B- PERCOLATION TESTS TEST DEPTH/ WATER IN HOLE TEST TIME DROP IN WATER LEVEL- INCHES RATE MINUTES NUMBER 'w 9 AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PE RIOD - 9 — PER INCH P- .S f C P- o 3 P -_ 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 ELEVATION Z 6-ew 3 4 _ T -' 9 `I �. f. y lop- IN _ g F 3 CE _ . 4 - � fop r f 3 f i 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: jo JP,4-A &I e 6- 0 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): O 1. o `s . Sao/ _ l 15'=316-rW CST �C SG AT�URE: � ...— �— DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) —OVER — F INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6395 To be a complete and accurate soil test, your report nor =st include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3, i'V1AXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; b. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be raved if desired; B. Mal« SW e your benchmark and vertical elevation reference point are clearly shown, and are permanent; R. Crmplete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- ticm if appropriate; 101 If the information (such as flood plain, elevation) does not apply, place N,A, in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribrue as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates acid Textures Other Symbols s — Stone iover 10 ") BR — Bedrock cola - Cobble; ('3 - 10 ") SS — Sandstone qv -- Gravel (under 3 ") LS — Limestone X's Sand HGW — High Groundknrater c's — Coarse Send Perc — Percolation flare nied s -_ Medium Sand W — t %r +rill k Fine Sand Bldg — Builcling Is — Loarny Sand Greater Than sl -- Sandy Loam < — Less Thar `; — Loam Bn — Brov,n X sil .- Silt Loam Bl — Black. s -- Sill. Gy — Tait �C3 _.. :lay Loans Y .... yeIiov sc,` Sandy Clay Loam R — Red sic 'l — Silty Clay Loam mot -" Mottles v - Sandy Clay w,' - with c " , c�ll , z_y ay fl, _ I r (.vv, fare.= $f!,rat Cray tnc ...- coanMor+, crra :e pi float nim Many, n r.f3irar? m - rriuck d -- distir p — prominent HVVL — High water level, Six general soil textures surface water for liquid waste disposal CAM -- Bench Mark V RP - Vertical Reference Poinar, TO THE OWNER: h , sc test repurl is he Bast st<ap ir± securing a sa;Jttary permit. The county of The Depastrnent may request o I „" sod *..t,?i in the r'.,I(I pi of 'u p'''rm[t. 75a..f `!.'F;£, A t'C)E pl,,,t.. ;Iel of {7lril ":':y'r- the private :cl ° iys: :_< rocl is o„nn;t s }al(L:z3i: „usl3 ,)t:, o the t, FBI pt I<k3.': IoE ;?' in Or(jt ?'" 1 "C3 s, r,}`3i(i t t t'Cit', I4ie Si" "t ,.8rg' (. ",t r3 1't 7"i be C)fi..c= ? :t?d , a.0 tie ),2 ;cI p; ?t) t+J 73L ;i 3Ct ('?f .t) + ",If "UChON, DEPARTMENT OF REPORT A ON SOIL BORINGS AND SAFETY & BUILDING:. INDUSTRY, 1�� r7V D�VVRR VV DIVISION' LABOR ANO PERCOLATION TESTS ( 115 ) 1 P. O. B 7965 °R HUMAN RELATIONS 1 MADISON, WI 53707 IH63.090) 6 Chapter 146.045) L OWNSHIP/ p�lrNPAWIFY; O NO. LK NQ: $U DIVISION NAME: COUNTY: WN S7. r' C 4u GtJ�f, 0 E DATES OBSERVATIONS MADE rp PROFILE DESCRI R RCOLATION TESTS: esidence , New ❑Replace I Y Y d - J O 6_O .t0 r• S Y i17I^ �` Q RATING: S- Site sui table fo r system U - Site unsuitable for system v �. ONVEN Q � . M� �, a � 1 �^ ' - a -IN U L Q S G TANK: RECOM(NENDf�� EM:(optional Ix Ste, S ®$ (� U E Percolation Tests are NOT required DES GN RATE: If any portion of the tested aresils in the der c,H63.09(5)(b), indicate: Floodplain, indicate Floodplain,elevation: /v PR FI E DESCRIPTIONS BORING TOT AL0 T R N ATER HA ACTER SOIL IT THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DE ELEVATION B V EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 3 S o /.x a g 7. l• 8 / . , se S B- S_ 171 0 o �,� �' 7� S' 8 /s / �, f B ,� M� LB- PERCOLATION TESTS TEST DEPTHI WATER IN HOLE TEST TIME DROP IN WA TER LEVEL-INCHES LEVEL-INCHES RATE MINUTES NUMBER "i6i+Eg AFTERSWELLING INTERVAL -MIN. PER INCH P- .S' AID P- o Z 6 G P ' No L� P P- P- PLOT PLAN: Show locations of percolation testes 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 how their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 7- �e 6-e t? Air -- _ i / e i 10 1 TN _ - - -- re; t f{ to r P,1 - __ _ - Ue. -`CQ/ f1i` �eQu�tci`t I, the undersigned, hereby certify that the soil tests ireported on this form war made by me in accord with th procedures and methods specified In the Wisconsin Administrative Code, and that the data recorded and �he location of the tests aro,lcorrect to the best of my knowledge and belief. NAME print : TESTS RE COMPLETED ON: � t ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optionall: / is=3 1 0f V1 CST GN UREt I ' . DISTRIBUTION: Original and one copy to Local AuKhority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) ( OVER — Zoe �r,� CIS 0 A l IAO V► -4 1 d Y O � N s VA ! . I f i ! I � I. j ( 1 1 ! �d1 j f J I i q. 4 I 2 ! ~ �! 3 7 � ! �N Q.. v ai't. re a � t•= -(d Q a i t o \e b t c d - PA S m 0 v r rz d _ ° v �. d cA ul a a- da a a d s o o ti 3 �- y"� d16 �x -o A I lic ob N N March 23, 1999 Laura Foster Century 21 Premier Group 706 19' St. South Hudson, WI 54016 RE: Septic evaluation Dear Ms. Foster: On March 18, 1999, I conducted a surface inspection of a septic system located at 941 Becky Circle per your request. The surface inspection revealed 30 inches of septic effluent ponded in the drainfield vent. On the inspection request form, it was reported that the septic system was re- conditioned in 1997 by Tri- County Sanitation. The septic system serving the property was installed on May 22, 1987, and was sized for a three bedroom house, a Weiser 1000 gallon septic tank discharges to a bed type drain field -18 feet by et T stem was inspected b staff from this office on May 22 1987 36 fe he s Y > and was installed as a Y p Y code compliant system. The replacement area is located directly to the north of the existing drainfield. On March 18th, the sanitary system appeared to be functioning and was not discharging effluent to the surface. Effluent ponding in the drain field may suggest that the system is reaching its maturity, but is not a failing system per § 145.245 Wisconsin Administration Code. Ponding results when microscopic bacteria and sludge plug the soil pores. This process forms a clogging mat (bio -mat). This clogging mat decreases the soil's ability to dispose of the sewage effluent. Over time, this clogging mat becomes thicker, causing less and less liquid to percolate through the system. As this mat becomes progressively thicker it leads to failure of the system. To prolong the life of the SAS you may try to rejuvenate the system. When an existing SAS is rejuvenated there are no guarantees on how long the system will function, it's only a short term solution. Other efforts to prolong the life of the system could be as simple as fixing or replacing plumbing fixtures with water conserving fixtures, reducing shower time, washing dishes when the dish washer is full, avoid using a garbage disposal, using a wash machine with a suds saver feature, etc. 4 The inspection of this sewage disposal system was based on a surface inspection of said system, and did not involve any excavation or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discovered 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 or when the solids get to be 1/3 depth of the septic tank. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact this office. Sincerely, Rod Eslinger Assistant Zoning Administrator i �I