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Home My WebLink About020-1053-10-000 0 y O 3 •v 0 d °c f c n ° r- m d ° 3 3_ �' -- < 0. C 'A 7 O- IV I•r \� N O x j < (D (O O N N Q z {U f0 0 =r CD co W O a a 0 0 C: N CD A ',, v 0 '+ CO N C C"� C N 7 DTI O 3 N ° C) ° o p I y C N '� t►1 to z D (D cc 0 a C � m W Z, c= O o co I N � _ " CS. ° co cD o ', 0 r to c � N a O O O � � 0) 3 N y N 0 n v v U 00 ° m Q t"n d m - ° N 3 d c C I (D N N °z O A O Z Z N D m ° O O > N N S S Rte{ rn o t @ y N ro ° F x CD �r CD CO -i fn 7 (D I •• W f o C z O A '� O m m N "00 A W S11 m co a 3 w Q m fU N A L Q Z 3 , O a -0f0 N 0 I r; (D fi O n O 4 D Q CD I � a 2 I I o I a N I ° o b A 0 ti O p m A �. 0 6q O f O O p o CD i I - P Parcel #: 008 - 1000 -90 -000 09/28/2009 08:53 AM PAGE 1 OF 1 Alt. Parcel #: 01.28.16.4C 008 - TOWN OF EAU GALLE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - THOMPSON, TROY M & AMBER R TROY M & AMBER R THOMPSON 560 270TH ST WOODVILLE WI 54028 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description 560 270TH ST SC 0231 BALDWIN - WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 1.190 Plat: N/A -NOT AVAILABLE SEC 1 T28N R16W 1.19A IN SE NE COM E1/4 Block/Condo Bldg: COR SEC 1, TH N 403.8' TO POB; W 204.72' N 254.26', TH E 204.72'S 253.76' TO POB Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 01- 28N -16W Notes: Parcel History: Date Doc # Vol /Page Type 11/05/1998 590953 1374/319 WD 07/23/1997 905/265 07/23/1997 902/85 07/23/1997 775/156 2009 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/07/2008 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.190 19,700 211,600 231,300 NO Totals for 2009: General Property 1.190 19,700 211,600 231,300 Woodland 0.000 0 0 Totals for 2008: General Property 1.190 19,700 211,600 231,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 513 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 COMMERCIAL TESTING LABORATORY, INC. ' 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 .715- 962 -3121 800 -962- 5227 FAX - 715 - 962 - 4030 ST. CROIX COUNTY GOVERNMENT REPORT NO.'# 44060/01 PAGE i CENTER REPORT DATE'# 7 /01/93 1101 CARMICHAEL ROAD DATE RECEIVED! 6/29/93 HUDSON, WI 54016 ATTN'# THOMAS C, NELSON OWNER; Ron Rorvick LOCATION: 472 Jacobs Lane, Hudson COLLECTOR'# M. Jenkins PATE COLLECTED: 6 -28 -93 TIME COLLECTED'# 1020am SOURCE OF SAMPLE'# Outside faucet DATE ANALYZED'#6 -29 -93 TIME ANALYZED '#'?.'#OOpm COLIFORM'# 0 /100 ml INTERPRETATION'# Bacteriologically SAFE NITRATE -N'# 4 ppm Above 10 ppm exceeds the recommended Public Drinking Water- Standard. Coliform Bacteria /100 mL F r , Nitrate - Nitrogen, mg /L LAB TECHNICIAN! Pam Gane 9,. O ,. \NDEVEq�E t WI Approved Lab No. 19 O Means "LESS THAN" Detectable LeveL Approved by! PROFESSIONAL LABORATORY SERVICES SINCE 1952 I - �a 9� ST. CROIX COUNTY WISCONSIN ZONING OFFICE - - . � ,�..,... • : •., " .. a;� ' s•' ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET •HUDSON, WI 54016 - (715) 386 -4680 •w SEPTIC INSPECTION / WATER TEST REQUEST FORM b b�Specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. r s IW O,* P-2v 4AI/ 0 Water (VOC's) $185.00 )(Septic $25.00 Water (Nitrate & Bacteria) $35.00 (Visual inspection) Owner: �iUN 15U(Z Requested by: , JENNiFE2 C)U50 Address: 411_ SACC6s LANE Address: SENT uy_u - 21 - IOU Icith 5i Su City & State: rbAD r; I W City & St. }fjsply� VJ; ,54011x: Zip Code: hUCj h: Telephone N°: (Q16) : : t 3Clda Telephone N °: (r715) 36& - f32Gr7 Property address (Fire N° & Street) tg7 JE Location: ` ;, SE ;, Sec. _ , T ,Lq N, R IcL W, Town of p5t� St. Croix Co., WI. Tax ID N Parcel ID N2 l�/7L House color: t4 Realty firm: Awu gs4 Lock Box Combo: �10� ` Water sample to� �o at , ,$,, on Weli -s l l-t 5�3�� Zoo I= T bCC TO COMPLETED BY PROPERTY OWNER * PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Is the dwelling currently occupied? P( Yes ❑ No If vacant, date last occupied: Septic system installed by: Ke 'Re rZ Y ear: 1 ? - s - e y Septic tank last serviced by:� Date: S ,_ I WZ Previous Owner's Name(s): Have any o the following been observed? ❑Y Pff Slow drainage from house. o O ❑Y 29 Sewage Back -up into dwelling. ^ �� - �gg� w ❑Y MIT discharge to ground surface, road ditch or body of water. N22 � ❑Y Mid Slow drainage from the dwelling.. G ❑Y 611" Foul odors. Other comments relative to system operation: J J W )060 S 4 'MLCTAA k TiM it if �MX'Z,5 ��uL c G2 /�Avt f�L 7U 151n r- V L'ry C Z/tsT Tl�rc n< FE�' Z.!r&o�� "o -iv . I certify that the above information c mp ete and true to the 4,11 r best of my knowledge. OWNERS SIGNATURE: DATE: OVE(Z _. .. ,......_,..T.•.- R. ».;, �..«+ c4. . ».tiwrr..rw+t'�'tsP "'r"" w OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION 1L N4 yl - A,�00 nq TO BE COMPLETED BY INSPECTION AGENCY System design & /or permit on file? ❑Yes ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system ❑Below grd OAt -Grd ❑Mound Approx. size 'X OGravity ❑Dose ❑Pressurized �- Ft. ❑Bed_ ❑Trench ❑Dry_Well Molding Tank OOutfall -pipe OBSERVED DEFICIENCIES ❑Other OUnknown Septic tank -._ .Setbacks: OHouse ❑Well ❑Prop. line ❑Other Dose tank Setbacks: OHouse ❑Well 0Pr6p.line ❑Other OLocking cover OWarning label OPump /Floats ❑Alarm ❑Elec. wiring Soil Absorption System - Setbacks:-OHouse OWell OProp.-line ❑Other OPonding: ❑Discharge: General comments INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title y ST. CROIX COUNTY WISCONSIN • ZONING OFFICE ^. a. ST. CROIX COUNTY COURTHOUSE 1101 Carmichael Road Hudson, WI 54016 (715) 386 -4680 June 29, 1993 Jenny Olson Century 21 706 - 19th St. South Hudson, WI 54016 Dear Ms. Olson: An inspection of the septic system on the property of Ron Rorvick, located at 472 Jacobs Lane, Hudson, WI was conducted on June 28, 1993. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact this office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator mij �I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y: Safety and Buildings Division Count INSPECTION REPORT V GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryPermi 34455 8 Personal information you provice may be used for secondary purposes [Privacy La I s.15.04 (1)(m)). Permit Holder's Name: ❑ Cit p Villa e Town of: State Plan ID No.: LYON, KEITH - HUDSON CST BM Elev.:- Insp. BM Elev.: BM D<scription: Parcel Ta6 N00 _1053 -10 -000 crp . � — Ar 9 L TANK INFORMATION ELEVATION DATA )_d .zq. t9. t 20 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic arvz) Benchmark }3 G✓ I l�• � Dosing Aeration Bldg. Sewer [ Holding 4W–lnlet p' t" Z , /( TANK SET16ACK INFORMATION /fit Outlet Q, /o 1!• (0 3,, TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic �� p�� y( �j NA Dt Bottom Dosing NA Header/Man. # �+►- -� Aeration NA Dist. Pipe �/� �3.F0 • a 3� v , 5'. 3 ? Holding Bot. System OY4 E S. z o 6 PUMP/ SIPHON INFORMATION Final Grade X1.30' Manufacturer Demand 5 4p, S3L 2 ! Model Number GPM TDH Lift Friction S stem TDH Ft Forcemain I L gth Dia. Dist. To well SOIL ABSORPTION SYSTEM Width Length No. O ff renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -3 DIMENSION Manufact�r � r: ' SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING ZK� <, — INFORMATION Type O CHAMBER Mo Number: lJ�" System: > l °'° > f 6-0 , ;),Zoo — OR UNIT o = av DISTRIBUTION SYSTEM a ie Header /Manifold u Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length I Dia - Length "_ Dia. Spacing �D _ > Z� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over h u Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center p2b 4 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 20.29.19.197E,SW,SE 472 JACOBS LANE ��/ Ian revision required? ❑ Yes J$ No 1 Use other side for additional information. 0:V I 9 SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. t ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I a . F E _i 3 R � e E E : f r � a x 8 i a { € d a s 3 i $ � s i i , Vim°" t G a s a _.... d.. i E i a e t t r + b a r 3 s ,mm <, ».. v.,.,,... ,.,eae "� „e E �,...,.. ,P� i .. _ e f 4 s , I � 5 s e i i E 3 gg i 3 B t Safety and Buildings Division Vi scons i n SANITARY PERMIT APPLICATION 201 W. Washington Avenue In r i m. P O Box 7302 Department of Commerce acco d w ith ILHR 83.05, Wis. Ad Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County r than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sa itary Permit Personal information you provide may be used for secondary purposes C] Check if revision to previous application IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name Propert Location 41/4 1/4, S a Q T pZ , N, R/ W Pro pert Owner's Mailing AdAr ss Lot Number Block Number 7 a City Sta Zip Code Phone Number Subdivision Name or CSM Number tkA Z7 o (7/37 6- °I �1 II. TYPE OF BUILDING: ILDING: (check one) ❑ State Owned it� Neares Road o Public 1 or 2 Family Dwelling - No. of bedrooms Town OF W a / III BUILDING USE (If building type is public, check allthatapply) Parcel T cZumber(s) , 3 — / 1 ❑ Apartment/ Condo 6ao — / 4 �- - 0 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. VReplacement 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 ❑ Holding Tank 12 flSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill C 9 _ 3 VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/da q. ft.) (Min. /inch) T- / -657.5 Elevation 22 - feet Feet Cap acit y VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks epticT QQ� ❑ ❑ ❑ 11 El Lift Pump Tank /Siphon Chamberl I I I ❑ I ❑ I ❑ I ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite s eXage system shown on the attached plans. Plum is a e: (Print) Plumber' ignatu . ( o Sta s) PRSW No.: Business Phone Number: Plumbe ';,pddress,($tree C' y, Sta Zip # 76/ �O6 c IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit fee (includes eFee) G �t /�i�u Issuin Agen Signature (No Stamps) �� Surcharge Fee) []Approved ❑ Owner Given Initial Adverse Determination , ..P� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: / SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tanks) must be pumped by a licensed pumper whenever, necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 - 3151: To be complete and accurate this sanitary permit application must include: 1. 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 apprppriate 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 mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information_ ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. 304 ■ Sol 1 CSe�o�ar P. t A Elem on 6 -i Stele : = �� ■ , 90.36' IOCO &.3 � - 384' yz a ,38s�Y,Z i� 4e/4 n� drYca ctris6;n Sep��l�o.,+ICs - �o be ct ba.�don td a S tur code EXis,v'n 3 bcdr6om � , VU - Lane ° R. 19 7 . off' SE . CroiX ea. cJ /, 30-z ��cobs Lane- F i Wisc6nsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 " Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code A.C.E. Soil &Site Evaluations Attach complete site plan on paper not less than 8 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and I and distance to nearest road. parcel I.D.# APPLICANT INFORMATION - p/ e q r 020 - 1053 -40-0 }E/. , lion. Personal information you provide may be us r� dary pu ses (Pries, s. 15.04 (1) (m)). R Ddt¢ / Property Owner ��^ "� �' Property Location Keith & Victoria L on U Govt. Lot SW 1/4 SE 1/4 S 20 T 29 N,R 19 W Property Owner's Mailing Address _ ( '' t Lot # Block # Subd. Name or CSM# 472 Jacobs Lane (.0 City Sta ` 0 Code iber 1 ❑ City ❑ Village ❑Town Nearest Road Hudson W e 1$ l8 Hudson ❑ New Construction Use: idi► Brooms 3 [:]Addition to existing building ❑ Replacement ❑ Publ, ascribe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ft •8 trench, gpd/ft Absorption area required 643 bed, ft 562 trench, ft Maximum design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft Recommended infiltration surface elevation(s) 85.5 upper trench 84.0' lowgr ft (as referred to site plan benchmark) Additional design / site considerations Install trenches using high capacity infiltrators. Parent material outwash s & gr. Flood plai n elevation, if applicable NA ft S= Suitable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system N S❑ U ❑ S❑ U ® S❑ U ® S❑ U ❑ S ®U ❑ S E U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDfft2 Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -9 10yr2 /1 None sil 2fcr mvfr cs 2f 0.5 0.6 2 9 -16 10yr3 /4 None sil 2msbk mvfr cs 2f 0.5 0.6 Ground 3 I6 -38 10 r4/4 None sil 2msbk mfr if 0.5 0.6 Iv y � ee 89.02' ft 4 38 -43 IOyr4 /6 None A 2msbk mfr as - 0.5 0.6 Depth to 5 43 -97 10yr5 /6 None s & gr. 0 sg ml - - 0.7 0.8 limiting factor >97• Remarks: 2 1 0 -8 10yr2 /1 None sl 2fcr mvfr cs 2f 0.5 0.6 2 8 -24 10yr3 /4 None sil 2msbk mvfr cs 2f 0.5 0.6 Ground 3 24 -36 10yr4 /4 None sl 2msbk mfr gw If 0.5 0.6 elev 89.18' ft 4 36 -94 10yr5/6 None s & gr. 0 sg i ml - - 0.7 0.8 Depth to limiting t factor >94" Remarks: CST Name (Please Print) Signature: 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 540 6/16/99 3602 1048 Y . PROPEWY OWNER Keith & v ictoria L SOIL DESCRIPTION REPORT Boas Page 2 _ of 3 PARCEL LD.J 020 - 1053 40-0 A.C.E. Soil & Site Evaluations Depth Dominant Color Mottles Structure GP D" Horizon in. Munsell Qu. Sz. es, Color Texture Gr. Sz. Sh. nsistence Boundary Roots Bed � Trench 3 F0 -9 10yr2 /1 None sil 2fcr mvfr cs 2f 0.5 0.6 1 2 9 -19 10yr3 /4 None sil 2msbk mvfr es 2f 0.5 0.6 Ground elev 3 19 -36 10yr4 /4 None sil 2msbk mfr gw if 0.5 0.6 90.46' ft 4 36 -42 10yr416 None A 2msbk mfr as - 0.5 0.6 Depth to 5 42 -110 10yr5 /6 None s & gr. 0 sg ml - - 0.7 0.8 limiting factor >110" Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: _ Ground elev Depth to limiting factor I Remarks: 3o e 3 ■ Soi ( C�,,geNaba►� P: t • CjaAd cn N 19; s �O9c , � B-3 :trtc I Fnc. •�rtc r..,,e Z ' 3 .Y, 3� e� o, "q u� a sun d ry�tics O' 4C_Y/s6;h s1ep�c -f�„Ks -to be O r9 ba. cn/ ct .idon � a S �' c EXis16inc 0 0 3 bcdr-oom W G • I'tSio�sn ,yon , V7Z cods Lane. L,o ca qy j : Sc<J /t'SE /t; ScC. zo T..Z9�t , 4,116 Af R. (9 W., %N . of /& dSo,•�, SE . Go1X eo. cJ /. 302 �l aco6S Lane. 3o /11 lb�n wuwk /� tT�i1 . fps s u Piles oo• �� ■ 50. ( Obsallo bo►� A E I4A&o» 13-1 Stele: l'= vo, ■ 89. A A 90.36 R, g, B-3 09' ■A .EitL line. kr.cc 1:•� i O eXiS�n� dr � cl(S Q c�1C�sE;n Scp�c,�w►K5 -fobs a ba.�don td A s pu Cad¢ EXi:S,Ei'n� OD 3 broom .v • ,, � � �eSidence y J,2 �co6s La ° k. wLll Psi sw%d 5c k#, Sze. zo, T. .Z9 , Y , 4,116 A R. I f ti., N . off' Adsc► -,, SE . CroiX ea., cot. 301 � , acc" I- ne- A JUL 12 '99 13:25 CEDARLEAF�AGENCY _.,._ .. _ ....; •3412• r... j �Il i , i I , 1 � i i 1 I,. ' I 1 ___._... .. _.. .....__ _ ._ .. .. -_ ... .. I ' ' I I ' i fi'sL; i` Est 1 , _ r , I � : I i I I _ ' .. k , •_ ....L__ � ��__._._....... l .. ' ... - - _. __...._ i 1 . - -_... _ .._ _ . � I i I , I �X • I I I � � .'.. ..I � I Cd own i 00 ` i , L. I i _........_._ _.L -.._. _ _ .... .... , , r , �w , I / i ` : _ I I is i I I ; , I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ow, -r/Buy k I -I � VI GjC� Ly0tJ Mai ng Ac d - , , ;s �� J Gtr LA E 1 N " !N( Prol -11ty A ..'I.i .:r;ss (Verific rtion required from Planning Department for new construction) City State .l „V �'u I Parcel Identification Number 020 - 10 0 - 10" �0 LEO A D IE; +I. RIPTIOI 3 Prod Itty Lcic r',on JVV r /4, ' /e, Sec. W , T 4-0 N -R__LVJ, Town of Sub ivisiot /A - , Lot # Cer ified 4� 3 t` ey Map f. , Volume , Page # Wit ranty ) d # 15 a 2 y z . Volume 10 2 � , Page it Z 7 Spey house I ;yes ff ne Lot lines identifiable Cages ❑ no SY! TEM : ! j;: , I = NAI 4CE Impi aj ),;, i use and ma: atenanceof your sepias system could result in its premature failure to handle wastes. Proper n:: i ttenance cons &; of pt air. Il. i i.g out the s ptic tank every three years or sooner, if needed by a licensed pumper. What you put into t system can Toct the f iu:.tion of the septic tank as a treatment stage in the waste disposal system. The ,pi ol: orty owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owne ; nd by a mass rplumb i:lt , , , urneyman p lumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterctisp : ;., t system is in groper o l x i ~,..ing conditic n and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full sludge. I/w +; the and sr. ; ij tied have re; A the above requirements and agree to maintain the private sewage disposal system witi tl;. c;andards set f -tai, hers nir s set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin- C, t fication state ;that yi. ° ; -ptic systerr has been maintained must be completed and returned to the St. Croix County Zoning; Offic(. , #hin 34 days A' the d ri ; LICAI xpirat date. SIGI AT; C , ; IT DATE ONN S t :'1!, a . TIFICA� "ION _ I (w:;) .:; Qtify that A statements on this form are true to the best of my (our) knowledge. I (we) am (are) the ,or(s) of the t 'o' ic, ;i: i.bed above, by virtue of a warranty deed recorded in Register of Deeds Office. t,t 1 ' :2 / - � , U. SIG. A.TURI., PPLICAI IT DATE * **, * Any if ii: ,mation tha is mis- representedmay result in the sanitary permit being revoked by the Zoning Dcpartm{ * * * *" * I e, ude v.:1 1i :Iiis applies tion: 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 DOCUMENT NO. W ARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 502828 FEd R'S OFFICE IX CO., WI RONALD L. RORVICK, a /k /a RONALD RORVICK AND JEAN orRecOrd 0 RORVICK, a JEAN RORVICK, HUSBAND AND WIFE ---- - - - - -- ------------- ------- •-------------------- - - - - -- ---------------------------------------------------•-- 6 1993 � r,2 *05.� P M conveys and warrants to .... KEITH -_R -- LYON and -- VICTORIA - LYON , � ..... HUSBAND _ - AND... WIFE .......................................... ) 1ieglster>cfDeeds •----•------------------------•---•------•-•----------------...----••-•------•----- •-------- ._._......_.......... ....................... .......................................................................................... RETURN TO .. ....... . .................................... .................. ......................... ......................... ..... .................................. ............................... ............................... ...__..—..........__ _"__ ...,. _ ........ _ .. _�_ . _ . — _ . � . 111111 . 11 the following described real estate in ....... Croix ....... ................County, State of Wisconsin: Tax Parcel No:. 020 -1053 40 _ (LEGAL DESCRIPTION ATTACHED). 020 -1053 10 do This . ........ is .... ........... homestead property. (is) (is not) Exception to warranties: Dated this JULY -------------- - - - - -- ---- - - - - -- --------------- - - - - -- 19.93 •. - -• -- ...ru --------- •--- •-- - - - - -- day of ......... JULY - (SEAL) -- --- •------------ - - - - -- (SEAL) ------ •----------------- ---- - - - - -- ............................... • ..RONALD_ L....RQRVICK. -- - ••-- - -- ....... (SEAL) - - - -- v- = 14, AN ............... VICK AUTHENTICATION ACKNOWLEDGMENT Signature(s) -- 1►_':1 L-p - - - - - _ L /' Q - V 1 G_J� -_ STATE OF WISCONSIN I ---------------------------- - - - - -- ss. -------------------------------- - - - - -- Ci't71 --- --- •---- •-- •- •- - -•- ------- - - -- -- County. ut a is d thi o --- - - - - -- - ------ , 19V Personally came before me this - -i;.Qn JJ-- _day of - -•• . .... .............. . . .. ..... ... . - ---- ----- ....... ......c..id.i.�l-- -- - - - - -- - -------------- 191- -- the above named ----- - - - - -- - -- - -TAY" 4=ic4 C �.ld�fr -------------- - - - - -- ---- - - - - -- ------------------------------- - - - - -- ------------------------------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not- --- - - - - -- ---------------------------------------- - - - - -- authorized by § 706.06, Wis. Stats.) to me known to be the person ____________ who executed the iI foregoi g instrument an ackno 1 ge the same. THIS INSTRUMENT WAS DRAFTED BY fi - JenniferA Olson . TERESA__STROMEN -- BAIER, GHERTY & GHERTY, S.C. S- otaryPlORjjje * - -- ----------------------------------------------------- ------Q -� Wisconsin 32$__Y.�HR_.S�RRR HUA QH ,..1� ._..54016..._..... - Notary Public .. .... 'St --- Crc7! ________________ County Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration II are not necessary.) date: II *Names of persons signing in any capacity should be typed or panted below their signatures. _. - ........ ...... . .. . - -_ _ ®® STATE BAR OF WISCONSIN a �n�f HGMiIIerComperyfMl FORM No. 2— 1982 Stock No. 13002 - 1 1123PAGE 528 Part of the SW 1/4 of the SE 1/4 of Section 20 -29 -19 described as follows: Commencing on E line of said SW 1/4 of SE 1/4 at intersection of centerline of original location of State Trunk Highway "12 ", being 558.2 feet N of S line of said SW 1/4 of SE 1/4 thence N on said E line 245 feet; thence W parallel with centerline of original State Trunk Highway "12 ", 201 feet; thence S parallel with E line of said SW 1/4 of SE 1/4 245 feet to centerline of original State Trunk Highway "12 ", thence E on said centerline 201 feet to place of beginning, EXCEPT part used for highway purposes. Part of SW 1/4 of SE 1/4 of Section 20 - 29 - 19 described as follows: Commencing on E line of said SW 1/4 of SE 1/4 at intersection of centerline of original location of State Trunk Highway "12 ", being 558.2 feet N of S line of said SW 1/4 of SE 1/4; thence N on said E line 245 feet; thence W parallel with centerline of original State Trunk Highway "12 ", 201 feet to Place of Beginning; thence W 101 feet parallel with said centerline 101 feet; thence S parallel with E line of SW 1/4 of SE 1/4 245 feet to centerline of original State Trunk Highway "12 "; thence E on said centerline 101 feet; thence N 245 feet to Place of Beginning. Part of SW 1/4 of SE 1/4 of Section 20 -29 -19 described as follows: Commencing at a point on the E line of said SW 1/4 of SE 1/4 803.2 feet N of S line of said Section 20; thence S89 302 feet; thence N00 °27'W parallel with said E line to N line of parcel conveyed to Sam E. Miller in Volume "532 ", Page 513; thence N86 along said N line to E line of said SW 1/4 of SE 1/4; thence; thence S00 along said E line 195 feet to POINT OF BEGINNING. ---- ---- - - -- -- Txr� �tcK---------------------- -.A cab. e. c ..... W- t --- M1 1DG�..�....-- - - - - -- - - - -- ------------------------------------------------------------------ TITLE: MEMBER STATE BAR OF WISCONSIN (If not- ---------------------------------- -------------------- - - - - -- ----------------------------------------------------------------- authorized by § 706.06, Wis. Stats.) to me known to be the person ............ who executed the foregoi g instrument an ackno 1 ge the same. THIS INSTRUMENT WAS DRAFTED BY JennfiererA. Olson TERESA STROMEN BAIER GHERTY & GHERTY S.C. NotaryNblic . ........... -------- - - - - -- ---- - - - - -- ------ - - - - -- $fate- of Wisconskl 32$..Y. ..S RI 54 - - - - -- Notary Public ------ -St - - - O?< ---------- County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: ------- �/-- .----- / ............... 19__! -. / -•) Names of persons signing in any capacity should be typed or printed below their signatures. I GMNIarCompay,M' STAT B OF M No. 2 W IS CON SIN Stock No. 13002 _ I � tC � rn Cp - �• J 1 0 D D _ 1 -� N �< v) 1 (A �J 32 141'9.57 y 207 20 1 W N 2 o I: ,CD a) (3) O (! V O CD 417.42' N N Ct> N �p I 464-68' m = m I DORW /N 20 : 169.2 35 7 300 1 366.0 I N O y 1 300.00 n 70 to cn �- ro — L g ro r OD 1 - In , D 356.07' 358:56' 110 1 I< (= h w O w .... b Irn Q N 10 O w ` r h I C I (Ti Ito N Os I W 1 215.61' w D — 749.92 ' - = I('nTi 00 O. O r 4 86.13 1� CO I N � 1 11 14 r ro r co 1 ap O o co I p •I TO t 293.00' I LOT 1 I • N - IG) , ' V w I N1 i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit 3445555 8 Personal information you provice may be used for secondary purposes [Privacy La s.15.04 (1)(m)). Permit Y Holder's KEITH E] C'tW Town of: State Plan ID No.: CST BM Elev... Insp. BM Elev.: BM Description: Parcel Ta6 h:_ 1053 -10 -000 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 TANKTO P/L WELL BLDG_ Ventto ROAD Dt Inlet Air Intake 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 I Lift Friction System TDH Ft Forcemain Length Dia. Fi 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 CHAMBER Moe 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 I Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 20.29.19.197E,SW,SE 472 JACOBS LANE t Plan revision required? ❑ Yes ❑ No Use other side for additional information. cRn -r71n IR aio71 Date Inspector's Signature Cert. No. Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue 14 scons i n In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanit ry Permit Number 3 s.s8' Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Proy O n r Name Propert Location pert 441/4 3/" 1/4, S a Q T N, R W Propert y Owner's Mailing A r ss Lot Number Block Number 7 7 ivision Name or CSM Number City Sta Zlp Code Phone Number Subd Gc c �-'` t5' O (Asl 399- ZO II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ It Neares Road C] v age Public 1 or 2 Family Dwelling - No. of bedrooms Town OF / 111. BUILDING USE (If building type is public, check all that apply) Parcel T c Number(s) , 3 O / 1 ❑ Apartment/ Condo ciao - / o 5_ - o` o 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility � 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. VReplacement 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 [:]Holding Tank 12 flSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill _ 3 VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Pro osed (sq. ft.) (Gals/da q. ft.) (Min. /inch) T- / _957 r/ Elevation so - feet — Feet Capacit VII. TANK in gallons Total # of r Prefab. Site Fiber - Exper. INFORMATION g Gallons Tanks Manufacturer Name Concrete con steel glass Plastic App New Existin structed Tanks Tanks epticT ❑ 11 1:1 1 1:1 1:1 ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite seAage system shown on the attached plans. Plum is a e: (Print Plumber' ignatu . ( o Sta s) PRSW No.: UZ ess Phone Number: 6 4 0 Plumbe ';,pddress,($tree C y, Sta Zip �� t J _ , U N 6 X06 IX. COUNTY / DEPARTMENT USE ONLY JIV ❑ Disapproved S nitary Permit Fee (Includes Groundwater ate Issued Issuin Age Signature (No Stamps) 0 0 ❑Approved ❑Owner Given initial 5 Surchargefee) 7��L Adverse Determination o r X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPR=4" n � �, /* t� c.nn ennn rn rn-r DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division. Owner, Plumber ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM PEI H Vi wa u :� k L o� o ��8 y y Mai ng Acd ; s 4� JAb Lam Fs 141V,5 N,11V( 54-ol Prol -rty AI(,x;;;s "f72- jhco e7 LMf RV P90141 W1 W* (Verific ttion required from Planning Department for new construction) City State .0,_0 , W i Parcel Identification Number 020 " 10 � �D � J �j "' LE! AL D I i;;4 : RIPTIO N Prod -,rty bx; .ion 5W ' /<, �'J� /<, Sec. , T 20 N -R_Lq-W, Town of Sub ivisiou.. , . ' , Lot # �_ _• Cer ilred ,E.,u ri ey Map # . Volume , Page # Wa ranty :l ti� d # 15 0 Z Z � Volume D 2 . Page # z 7 SpcV House (: yes [�' nc Lot lines identifiable 03 ❑ no M1 E ; ;0 j 1, I NTENAIYCE impi al u use and ma ntenanceof your septiw system could result in its premature failure to handle wastes. Proper n:: j :: ttenance cons u of pt ni l::i ig out the s sptic tank every three years or sooner, if needed by a licensed pumper. What you plut into 3 ; ; system can Tect the f Kj:; - tion of the septic tank as a treatment stage in the waste disposal system. The ; rjl: erty owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owns < nd by a mao r plumb !;r oinneyman p lumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disp : ;, A t system is in iroper o [x r.::: ing conditic n and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full :[sludge. I/we the un&r.;il_ tied have re; A the above requirements and agree to maintain the private sewage disposal system with t1} .:andards set .f :th, herrit , s set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. C. .j iftcation state - that yo u - ;; :ptic systetr has been maintained must be completed and returned to the St. Croix County Zoning; Officf: ;thin N days Of e� uca ;, ie expirat on date. �p _ / S __1 SIGI A.TURF C.Vi LICAI IT DATE OV SER ( '? 1 :;, =CAO TON I (w::) gI:: ttify that al' statements on this form are true to the best of my (our) knowledge. I (we) am (are) the jar(s) of the 1 ae1c:;4" i.bed above, by virtue of a warranty deed recorded in Register of Deeds Office. SIG. A.TURI � )1 PPLICAUT DATE Any ir.ifi: tmation tha is mis- represented may result in the sanitary permit being revoked by the Zoning Departm{ r* I elude w t It ;Iris 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