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020-1059-70-100
$+ 2 $ f j 2 . § g c . 0 k } % � ■ { � ® E � to ¢ 0 / z 2 . ] 0) 0 CL $ . \jc . o � » � c § z` z / CD R § $ IL M § I z k ) $ k E 2 2 A f r . � \ / a � 9� \ §� a § ' q Q z z .. z 3 % I ts % tm § e $ % \�$ 2 / 2 0 0 8 0 2 0 0 Z k / \ /\\ E m z 3 3 -� k] a a a � E k \ § �\ CO k ƒ � § 5 = § \ § \ E § CO - 7 �co (D � 2 J : c . . / 16 2 E § E �¥ 4 v© o= o G . [ j § 4 0 \ / \ (� § § o U') « - c 3 = c % o)§- g . s e 3 a =/ - \ § } CO j o z \ z ) \ � ■ � 2 E 4) E 2 ; c a § k 2 a 0 2 o j2 _qLI ST. CROIX COUNTY << WISCONSIN ZONING OFFICE " " " " " ST. CROIX COUNTY GOVERNMENT CENTER in 1101 Carmichael Road j - — Hudson, WI 54016 -7710 i s (715) 386 -4680 July 5, 1994 Ms. Nancy Johnson DZ (r l S - - 7o - AJ6 Century 21 706 19th Street 22 C �. 2Z�o 3 Hudson, Wisconsin 54016 RE: Water Inspection for Dave and Pam Pearson Address: 834 Kelly Road, Hudson, Wisconsin Ms. Dear M Johnson: J Enclosed is the original test results from Commercial Testing Laboratory, Inc. for a water inspection of the above property. If you have any questions with regard to said report, please let me know. Since ely, o-L.- J es Thompson Assistant Zoning Administrator mz Enclosure r COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 800 - 962 - 5227 FAX - 715 - 962 4030 3T. CROIX COUNTY ZONING OFFICE REPORT NO.: 64976/01 PAGE 1 ST,CROIX CTY GOV.CTR REPORT DATE. 6/27/94 1101 CARMICHAEL ROAD RATE RECEIVED: 6/23/94 HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER: Dave & Pam Pearson LOCATION: 834 Kelley Rd„ Hudson COLLECTOR** Jim Thompson DATE COLLECTED! 6 -21 -94 TIME COLLECTED: 8 :45am SOURCE OF SAMPLE:` 'Kitchen faucet- (Filtered) r NITRATE -N: t 1 ppm Above 14 ppm exceeds the recommended Public Drinking Water Standard. Nitrate - Nitrogen, mg /L Post -it" Fax Note 671 Date pages 70 From Co. /Dept. Co. Phone # Phone # Q�J Fax # S Fax # LAB TECHNICIAN: Pam Gaue WI Approved Lab No. 19 RESU t,ro, FAXID ON: PHONE'," ON:.�Z CALLLR: o < Means "LESS THAN" Detectable Level Approved by: 6 S 0 PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY WISCONSIN — - - -- '� ZONING OFFICE � � trrrrrrrr ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. ❑ Water (VOC's) $185.00 ❑ Septic $50.00 ❑ Water (Nitrate & Bacteria) 45.00 Nitrate & Bacteria retest_X_$15 0 Owner• L op 4 Requested by: Address: Address: ZIP / 0141 ZIP Telephone W:( ) Telephone W:( ) X ,3 wo -(! a � � Property address (Fire W & Street) Location: ,, ;, Sec. , T N, R W, Town of d��✓ aA Realty firm: CSI-. a I Lock Box Combo:_ Closing Date: S�� V 0 V-(�( TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Water sample tap location: ��eo fjay� Is the dwelling currently occupied? XYes ❑ No If vacant, date last occupied: Age of septic system: ---- Septic tank last pumped by: Date: Previous Owner's Name(s): Have any of the following been observed? ❑Y ON Slow drainage from house. ❑Y ON Sewage Back -up into dwelling. ❑Y ON Sewage discharge to ground surface or road ditch. ❑Y ON Foul odors. Other comments relative to system operation: I certify that the above information 's complete and true to the best of my knowledge. OWNERS SIGNATURE: ATE: 1/94 41 (ql 47 9 UtA& - >I r OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION 1 N 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 ❑At -Grd ❑Mound Approx. size • X OGravity ❑Dose ❑Pressurized Ft.Z ❑Bed ❑Trench ❑Dry Well Molding Tank ❑Outfall pipe OBSERVED DEFICIENCIES ❑Other OUnknown Septic tank Setbacks: ❑House OWell OProp. line ❑Other Dose tank Setbacks: []House OWell ❑Prop. line ❑Other ❑Locking cover OWarning label ❑Pump /Floats OAlarm OElec. wiring Soil Absorption System Setbacks: ❑House OWell OProp. line ❑Other OPonding: ❑Discharge: General comments INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title 4 - a ,�►� ST. CROIX COUNTY WISCONSIN -- ZONING OFFICE I HI x IN a ,,,,,� ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road w _ — Hudson, WI 54016 -7710 (715) 386 -4680 i 1 Z,'3 June 15, 1994 Ms. Nanci Johnson Century 21 706 19th Street South Hudson, Wisconsin 54016 RE: Water results for David and Pamela Pearson Address: 834 Kelly Road, Hudson, Wisconsin 54016 Dear Ms. Johnson: Enclosed is the original water test results from Commercial Testing Laboratory, Inc. for a water inspection of the above property. If you have any questions with regard to said report, please let me know. incerely, 7 . , Ja�Thompson Assistant Zoning Administrator Enclosure js o COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 -3121 800 -962- 5227 FAX - 715 - 962 - 4030 f i ST. CROIX COUNTY ZONING OFFICE. REPORT NO.. 64017/01 PAGE i ST.CROIX CTY GOV.CTR REPORT HATE. 6/13/94 1101 CARMICHAEL ROAD DATE RECEIVED! 6/09/94 HUM, WI 54016 ATTN** THOMAS Co NELSON 094NER4 David 6 Pamela Pearson LOCATION'. 834 Kell Rd., Hudson i COLLECTOR** Jim Thompson DATE COLLECTED** 6 -07 -S4 T IME COLLECTED** 11200am SOURCE OF SAMPLE** Kitchen faucef DATE ANALYZED**6 -09 -94 TIME ANAL YZED'42**OOpm COLIFORM,MFCC: 0 /100 ml INTEF,'P%TATION** Bacter i o log ica l iy SAFE NITRATE -N** I ppm Above 10 ppm exceeds the recommended Public��2 3 Drinki Water Standard. w CoLiform Bacteria /100 ml ,+citrate - Nitrogen, m9 /L O� o� s � a RESULTS: FAX'D ON: PHONEO ON: �.13►5� LAB TECHNICIAN: Pam bane CALLER: ya. \NOEOENpfNr WI Approved Lab No. 19 J� 4 0 s Means "LESS THAN" Detectable Level Approved by! 0 PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY WISCONSIN - -- - - -_ ZONING OFFICE M' p N N p p p p _ _ `••,� ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road �- Hudson, WI 54016 -7710 _ — (715) 386 -4680 June 15, 1994 Nanci Johnson Century 21 - Premier Group 706 19th Street South Hudson, WI 54016 RE: Septic Inspection for Residence located at 834 Kelly Road, Hudson, Wisconsin Dear Ms. Johnson: An inspection of the septic system of the David & Pamela Pearson property located at 834 Kelly Road, Hudson, Wisconsin was conducted on June 7, 1994. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not -- involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Also, water samples were taken. Once we receive the results, we will forward the same on to you. Should you have any questions, please do not hesitate in contacting this office. Also, I enclosed a copy of the As Built Sanitary System report. S1 cerely, James Thompson p n Assistant Zoning Administrator Enclosure js 0 D ST. CROIX COUNTY WISCONSIN — - - -- `� ZONING OFFICE r r r N N r r r■ " "' ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. 0 Water (VOC's) $185.00 kI Septic $50.00 XX Water (Nitrate & Bacteria) 45.00 ❑ Nitrate & Bacteria Pja&o() re test $15.00 Owner: L 'i Requested b : Address: Address: - l� ZIP ( 70 ZIP 5w i& Telephone W: ( ) 3$b - / s Telephone N ( '715 ) , 3 Property ad ess (Fire N° & Street) : 03q Location: ;, ;, Sec. ZZ T N, R F fj W, Town of Realty f irm: Lock Box Combo: Closing Date: - TO BE COMPLETED BY PROPERTY OWNER 7t PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Water sample tap location: 1 Is the dwelling currently occupied? X Yes ❑ No If vacant, date last occupied: Age of septic system: 5 Septic tank last pumped by. - - Date: --- - Previous Owner's Name(s): n 00 e Have any of the following been observed? ❑Y 9N Slow drainage from house. ❑Y ' oN Sewage Back -up into dwelling. ❑Y IM4 Sewage discharge to ground surface or road ditch. ❑Y )RN Foul odors. Other comments relative to system operation: Y I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: CQ�_�� DATE: 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION I N --------------- -� — - -- - TO BE COMPLETED BY INSPECTION AGENCY System design & /or permit on file? @'Kes ONo P'" Soil series per SCS Soil Survey: sheet # Ty of soil absorp s stem "! ❑At -Grd ❑Mound va p v Approx. size /2-'X r y ❑Dose OPressurized Ft.z We ❑Trench ❑Dry Well ❑Holding Tank ❑Outfall pipe OBSERVED DEFICIENCIES 00 her OUnknown Septic tank Setbacks: ❑House oc ❑Well Prop. lin Other Dose tank Setba House OWell ❑Prop. line ❑Other ❑Locki g OWarning label ❑Pump /Floats ❑Alarm ❑Elec. wiring Soil Absorption System Setbacks: OHouseWell�Prop. line Other ❑Ponding: ODischar General comments INSPECTORS SKETCH OF SYSTEM LOCATI N a U / Inspec i Title Form- S T C - 104 AS BUILT SANITA SYSTEK REP ORT OWNER J/,0 TOWNSHIP SEC. Tc2U N -R 9 W _j / 6/'O�j ADDRESS rL.�� �_ ST. CROIX COUNTY, WISCONSIN Jv SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r i ti W r � INDICATE NORTH LOW BENCHMARK: Describe the vertical reference oint used a X +.J P �,� � 1 0� 0p N Amt � o Elevation of vertical reference point: /�,Q Proposed slope at site: SEPTIC TANK: Manufacturer: �. �j5 Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,n Side 0 Rear, O feet From nearest property line Front .0 Side, Rear, 0 4 2,0 feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM �- Bed: Trench Width: $� Length: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,O Pt. Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: r a drop box or distribution box been used on any of the above soil Has either p o 0 absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation nf bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of fe(!t from building: _ Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3 /84:mj l DEPARTMENT OF INDUSTRY, SAFETY & BUILDING INSPECTION REPORT FOR LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 5370 N2 NI T+ , , SF. , 22 , 29 , 19W Stassgned) Town o P Number: Hudson CONVENTIONAL El ALTERATIVE ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound AV C? 0063 1 NAME PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION E: Route 2 Box 107 St. Croix Falls,W — 5_ rQ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: GST REF. PT. ELEV.: Name of Plumber: MP /MPRSW No.: County: Sanitary Permit Number: alvin Powers 1563 St. Croix 128624 S EPTIC TANK /HOLDING TANK: ! MANUFACTURER: LIOUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT )IA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY I WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: El YE ❑ NO ❑ YES ❑ NO NEAREST--► DOSING CHAMBER: MANUFACTURER: I BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP /SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO I 1 ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑ YES ❑ NO NEAREST —♦ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: I MATERIAL AND MARKING: or excavation. (if soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED /TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET: NEAREST MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH /BED I DEPTH OVER TRENCH /BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED /TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: I GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV: ELEV: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST —* 0 Y_ i_ Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: SBD -6710 (R. 06/88) Zoning Administrator Thomas C. Nelson SANITARY PERMIT APPLICATION L � iLHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY . .�.„_..e,_ MEM STATE SANITA Y PET # –Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 8 X 11 inches in size. eck If revis on to pr lour application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROP TY OWNER PROPERTY LOCATION aww &W-sig'al A % '' /a,S ,N,R or PROP RTY OWNER'S MAILING ADDRESS, LOT # BLOCK # Ad 7 N Cl STATE ZIP CODE PHONE NUMBER SUBDIVISION AME OR CSM NUMBER 11. TYPE OF BUILDING (Check one) ❑ State Owned VILLAGE : NEAR T ROAD =W RF: "a l ❑ Public ®1 or 2 Fam. Dwelling — # of bedrooms PARCEL TAX BER() Ill. BUILDING USE: If building a is public, check all that apply) o (a ( !/ tYP P _ 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /C Wa 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line 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 # — 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 0 Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 1 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTE V. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) 7'– – ELEVATION /101 O T d? " pcS% Feet VII. TANK CAPACITY Site In gallons Total ## of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App strutted Tanks I Tanks Septic Tank or Holdina Tank E�E I I Lift Pump Tank/Siphon Chamber LE Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans.. ;(Prlp): P lu is i natu N to MP /MPRSW No.: Business Phone Number: Plumber's ame 9 P um Add ( treat, City, tats, Zip e): IX. COUNTY /DEPARTMENT USE ON Y Disapproved anitary P rmit Fee (inclu c Fee) w ater Date Issued Isaui ent Signature (No Stamps) Approved ❑ Owner Given initial Adverse Dete n o�v� X. CONDITIONS OF APPROVAL/REASONS FO SAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber APPLICATION FOR SANITARY PERMIT STC -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 D a &2 k d P'.'" Location of property N 1/4 S E 1/4, Section a Q , T _ N -R_ W Township �. SQ v- Mailing address "—" a &,k 1 a Address of site cxls0n� Subdivision name Lot number N �7 ,_.—Q Previous owner of property arm Total size of parcel �/ r Date parcel was created Are all corners and lot lines identifiable? ,_ Yes No Is this property being developed for resale (spec house)? Yes �_ N0 Volume k17 and Page Number mil 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. _3�'� 9, ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. ). e Q, Signature of Owner Signature of Co -Owner (If Applicable) Date of Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 11 -1982 THIS SPACE acRFaveo FOR RECORDIN(7 DATA LAND CONTRACT • Individual and Corporate 4 97 (TO USED FOR ALL TRANSACTIONS WHERE OVER REGISTERS OFFICE $26,000 00 IS FINANCED AND IN OTHER NON - CONSUMER ACT TRANSACTIONS) - _ ST. CROIX CO., WI Farm Credit Bank of St. Paul f k/a . Reed for Record Contract by and between ----------------------------------------------------- - - - - -- ra Bank of P The Federal Land Saint Paul - - - -- ------- - -- - -- -------- - - --- -- ("Vendor ", : earson__and at 11:30 A M whether one or more) and ----- __C�__NI P -- - - - - ------- - - - - -- . Pamela__ --- and ... xis__as... alary-1.vox 1p C� mar1 t; a. l __grope.rty___ ________ _________ ( "Purchaser ", whether one or more). � �RegislerofDeeds Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- formance of this contract by Purchaser, the following property, together with the It � 1 d other appurtenant interests (all called the "Property "), ___ __ rents, pr : C� -- - in------------ - - - - -- - - - - -- ----------------------------------- - - - - -- Co unty, State of Wisconsin RETURN TO AZ& - 2 - A parcel of land located in the NE of the SE4 ��`��_5`a� - -- _. and in the NW of the SE-,! of Section 22- 29 -190 'w Town of Hudson, more full described as follows = Tax Parcel No. - __.____ . -- - - - - -- Commencing at the East 1X corner of said Section 22; thence SO'14'57 "E along the East line of the SE4 a distance of 6W. 95 feet to the Point of Beginning; thence continuing SO'14' "E along said line a distance of 687.10 feet to the Southeast corner of the NE4 of the SE-. of said Section 22; thence N89'57'16 "W along the South line of said NE'- of SE!, and extending along the South line of the NW4 o the SE-, a distance of 1333. feet; thence N0'15 "W 687.10 feet; thence S89'57'16 " E 1334 .05 feet to the Point of Beginning. Containing 21.04 acres of land, subject to Kelly Road right -of -way over the Easterly 33 feet thereof. This _.... not ---------- homestead property. (is) (is not) Hw 35, River Falls, WI --- Purchaser grees to urchase the Property and to pay to Vendor at __ ..y___ _______ ___ _______ ___________ __ __ ______ __________ 2� 000 00 ____ _______ ___ n g a) $_� 00 - - - ---- - - - -- i the followin manner: __ - 200 the sum of $ } at the execution of this Contract; and (b) the balance of $ --------- HOO_. 0 ----- together with interPCt from ,l.,t.o hereof on the balance out.atanding from time to time at the rate of-.-.__._-y.'--Z-S--------------- per cent per annum until paid in full, as follows: Commencing Saptam r 1 , 1988 and on the _ice day of each and every month thereafter, equal monthly installments of principal and interest in the amount of $185.36. Provjdo, however, the enti e3outs the aur date). all be paid in full on or before the_____ ____ 31St __- day of Foll any default in payment, interest shall accrue at the rate of . 12.__._ % per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any time a'f�eir_ -there- mayrbe-rty- prepayrent vf-pri'mipai- withmd permissiorr af- Vendor In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long ated as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall a re b en as unpaid principal) is less than the amount that said indebtedness would have been had the monthly paym made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except none Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. Purchaser shall be entitled to take possession of the Property on ____ ______ ____July 19.88. -. *Cross Out One. STATE. BAR OF WISCONSIN Wisconsin Leeal Blank Co. Inc. LAND CONTRACT— Individual and FORM No. I1 - 1982 Milwaukee, Wis. Corporate 1 BOOK 817 tvt 44 . Purchaser p r 'promises to pay when due all taxes and assessments levied on the Property or upon Vendo's intcae,t in it and to deliver to Vendor on demand receipts showing such payment. Purchaser shall keep the improvements on the Property insured against loss or damage occasiomd by fire, ex- tended coverage perils and such other l lt)re a ards as Vendor may require, without co- insurance, through insurers apl,ru�cd by Vendor, in the sum of $__.__-__.____. __ /____ ----------------------- , but Vendor shall not require coverage in in amount more than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. Tt,e policies shall contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall he applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be ecunumically feasible. Purchaser covenants not to commit waste nor allow waste to be committed oil the Property, to keel) the I'rul:c: in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditiun:> shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except: --_-___"-"______ ___ ___ _______ __ _______ ____.__.. --- - -- ---- - - -- ---- - ---- - ----- -- - --- --- -- -- ------- ---- ---- -- - - -- ----------------- ---- ---- ------- ----- ---- - - - - -- - ---- - - - - -- ------ - -• - -- ---------------- --- - - -• - -- - -- -- ----- ----- --- -- _ _ _ . Purchaser agrees that time is of the,�e�sence and (a) in ills event of a default in the payment of any principal or interest which continues for a period of --- ._.._.._ days following the specified due date 5 t• (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of _.__.- �• days following written notice thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser', rights, title and interest in the Property and recover the Property back through strict foreclosure with any ecplity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest the"eou l•ivni the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously paid by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem) ; or (h) Vendor may sue for specific performance of this Contract to compel iunn,ediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract asacloud on title in a quiet -title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issue, or profits during the pcudency of :lrly action under (i), (ii) or (iv) above.Notwithstanding any oral or written statements or actions of Vendor, an clectiou of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whether abated or nut) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as iu- curred, and shall be included in any judgment. Upon the commencement or during the pendency of tiny action of foreclosure of this C retract, Purchaser consent: to the appointment of a receiver of the Property, including hometead iutcrest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any, of Purchaser's rights under this Contract or by option, long -term lease or in any other way) without the prior written consent of Vendor unless either th outstanding halance payable nder this Coitr�et is first tlid in full or tbite in terest conveyed is a pledge or assignment of Purchaser's interest under tyiis Contract solely it s secure y for an intle tednrss or Purchaser. In the event of any such transfer, sale or convey once without Vendor's written consent, the entire uutstatlldinr; balance payable under this Contract shall become immediatelydue and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under an, mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes the Mortgageeaif t he t due and all so by P Purchaser shall a ny such payments directly h ll beo» side considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) _ - July - - - -- -- - - - - -- -------------- - - - - -- 19 $$. Dated this - � -- ------ ---- - -- - -- day of _.. -• - -- _ The Far Credit Bapk of St. Paul, ---------------- (SEAL) 4 tint - (SEAL) David M. Pearson Thomas Hass,, - Director_of._ACquireci Prop. -------------------- - - - - -- - - -------- - ---------- - - - - -- - - - l (SEAL) - (SEAL) ._P_amela.A .--- Pe_ar_sa>a --------------------- - - - - - - ._ _.. . -- AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN Signature(s) -----•---------------------------------•---- authenticated this -------- day of .......... ................. 19 ------ Personally came before me the :,. '•_ ._..day o J U1 _V__ ......................... _, 19•_88. the above named ----- - - - - - -- --- -- ----- ---- ---- --- --- - - -- - -- ------ ---- -- --- - ----- --- ---- - - - --• •-- - - - - - -- ---------------- .TThomas__�.__Hass, "Director "_of__Acq,_ -Pro_ " - - - - -- -- - - - - -- - - - -•- TITLE: MEMBER STATE BAR OF WISCONSIN --- David --- M_. • __ Peax'�Qxl_ . -a_11C1__.P (If not, -- •-- -- ---- ------ -- - - -- ---------------------------------- --- P_ ear_ so_ n------------------------------------------------------------ A , authorized by § 706.06, Wis. State.) to me known to be the person ------ - - - - -- who executed tb�� re oing instrum nt an • cknowie a tine same. THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland Lundeen lie *Alit -e. -J� F -e A 'rneY --- at LAW '� cousin - - - - -- - •- --- -- -- -- - -- - --- Notary Public ------f � ---- --- ------- ---- - - -- -- -- County, Wis. --- ---- - -" --" " ---------------------- My Commislpn is pgr�nanent. (If not, state exp' tion une i (Signatures may be authenticated or acknowledged. Both J are not necessary.) date- ------------------------------------------ ---- - -- --- ---------- ---- --- ----- - -- - -- , ...•rHOnx ul¢nuut in un cwnicity uhould be I%I . ... I.l'mCei) twl,,w their uixlll u . STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER < Jc, U 'l r2a rSo r` ROUTE /BOX NUMBER O -] FIRE N0. CITY /STATE S'� . C,-0 'jZD,LIS kQJ ZIP PROPERTY LOCATION: NE 1/4 S 1/4, Section T _N, R --L2— w, Town of �C1�L�o , St. Croix County, Subdivision N),,. , Lot No.. Improper use and maintenance of your septic system could result in its premature failbre to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a 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 $3000 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 verifying 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. Certification form will be sent approximately 30 days prior to three year expiration. 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 Department 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. a.� S I GNED �O,J QV1,,"J � DATE St. Croix County Zoning Office St. Croix County Courthouse 911 9th Street Hudson, WI 54016 (715) 386 -4680 Sign, Date, and Return to above address UE +AR 1NI NT OF REP _ON S OIL B O RI NG S AND SAFETY & BUILDINGS N _ DIV IStO INDUSTRY, `— P.O. BOX 7969 LABOF AND P ERCOLATION TESTS (115) MADISON, WI 53707 IHJMAN RELATIONS (ILHR 83.09(1) &Chapter 145► LOCATION SECTION: WNSHI UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME �� sE=� /� zZ /Tz�N Rt9E(or 1��D — _— COUNTY: OWNER'S UYER' AME: MAILING ADDRESS: 2T z B ox t u t � 5'"f • C�v lX A V 1 1�LS'PS RSC1ty �T. _-LZZ L W1 S V o 2 - — - -- DATES OBSERVATIONS M ADE USE PROFILE DESCRIPTIONS: PER OLATION TESTS rfi�tt NO. BEDRMS.: COMMERCIAL DESCRIPTION: r g Xpesidence 3 � `P\ KNew ❑Replace i R ATING : S= Site suitable for system U= Site unsuitable for system _ �ONVENTIOIVAL: MOUND: IN - GRNN - FILL HOLDING TANK OMMENDED SYSTEM:loptional) r js U - -xS au S ❑u oS �u = S;i ,,oe> <�s 6� - -- If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area 'sin the , under s. ILHR 83.09(5)(b), indi Floodplain, indicate Floodpla elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWAT CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH pW. ELEVATION OBSERVED EST. HIGHEST TO BED IF OBSERVED (SEE ABBRV. ON BACK B- _S' 0 11• S 1v�Jf � S' 3.4 8 h vn e S G'> $n S1 ) Ts; 9 S s 0.6' G7 tins; 173; o•� `t $tilsi ); 1•c� t3til Gh ts� g_ 3 �.y' ojq_p' Noun 7 6 y' �c•t' n s s;1 7 S � y ►1 s l• I : 1 a' a>1 G►. l s; B y b - St tDl - 3' �o>vt= 7 (, - s' u•I' n s o - 6' G-1 C3 i t Ts; o•�' Lf $n Sit } i•2'Bn Gtils; B- 5 •6' o� tvo�►� > 6• U . Z' ��, s B- PERCOLATION TESTS EP DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES INCHES AFTERSWELLING INTERVAL -MIN. PERIOD t PERT D2 PERIOD PER INCH P _ 4� c s 13 - 3. ' D v S L_U E 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 "im LTL'�1 Oxj 1� Z "ttiloofl S'T'AIR -(Z ..k L trYN -_ Z moo' 143 F� I »T PRO PN'1tT'/1 81�j H 2 - I_► N - J �L . °t9 • S ' ckl 7t OF -6 Y- _ wQofl eAi2►.�LsR POST R�?V'cC JcHes OF'Ti't� Sl CO5t.ff)Z Ot= 'Mlt jy - I"R�.tct♦FTS \ \�o U� t- tN , .ix �� B , S >S NovSE )N) W-Z RT LO C� - 110 S1L ETON �i L_ �_ ' r'.� a kie t3T L Sb'FRliyl ivy T LoT LINE \�' `mss DRAIN ILt_fl. � s 3 00 '� so u•, � -- _ -- _ ____ __ _ _ x 3' C 1'• lii U ` SCr\LE X So' sec, zt 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 Adininistralive Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. .NAME (pant): TESTS WERE COMPLETED ON: ADDRESS: �2t�v`t eksx ZZ :CERTIFICATION NUMBER PHONE NUMBFRIopuonall S7 6 - )1 S_ - - - -- - -- -- CST SIGNATUR DISTRIBUTION: Ori9inai and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R, 10'83) — OVER — [ Al Xq SA TT NN r1 c� 1 PAGE OF FracA Air 11119116 And Obcarvallon Pips , S ( 04 �/l O ( Approved Vent Cop 1'� (�-Ji Mlnlmwn 12 Above Final Grade 20- 42" Above Pipe _ 4" Coq Iron To Final Grod. Vent Pipe Mor.A Moy Or SyntAetk Covering i Min 2" Aggregate Distribution over Pipe PIP@ Too 6" Aggregate eneath a Perforated Pipe Below Pip@ o — Coupling Terminating At Bottom Of Sy.tem SOIL FILL OISTRIBU rIOF.} PIPE APPROVED S4MPETIC COVER — —MATI:KIAI- OR 9" OF STRAW 2" OF AGGR ELATE --�� OR MARSH HAy r (o OF 12 -Z /Z AGGREGATE t LEV. of FEET �' 7/ DIS PIPE TO BE AT LEkST _ IUCHES BELOW ORIGIUAL GRADE AIJL AT LEASTZO IUCHES BUT MO MORE THAI) 4Z IIJCHES BELOW FINAL GP,ADE MAXIMUM ®EQTH OF EXCAVATIm1.9 FRoM oWvvu War. WILL BE IAI CHES PU NIMUM M" O EXCAVATION! MOM. 01KI4 r WILL Ma e IN SIGAIED: LICEUSE DUMBER: DATE: — -1?: ,e J 110 w ST. CROIX COUNTY ZONING DEPARTMENT,' ;:,' AS BUILT SANITARY REPORT ' RrcE IVED' � — P I e C3 2 N ::, M.r� , lss.) r Owner 4- �N SAN Rp N 0 ! ST CROIX Addres _ 83 1 1� ti n a r> {�: COUNTY ` ^� City /State N Vn s 0 ►., y i s c S� {'� ��, ZONINGOFF" S� Legal Description: Lot Block Subdivision/CSM # 14 T ' /a S f , Sec. , T I N -R W, Town of IA ko c)N PIN # i SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer U) A-t S Size ST/PC aU� / Setback from: ]fie (S Well Z �/L 7 Pump manufacturer Model —� Alarm location -- ----- (HOLDING TANKS ONLY) Setbacks: Service Vent to fresh air ' ater the Meter to on Alarm location SOIL ABSORPTION SYSTEM Type of system: T�w�,ty4ur Width 3 Length so Number of Trenches �. Setback from: Well -'>/ 0 ' 3 ' P/L > I W; Vent to fresh air intake > 5 V Pule 60 ELEVATIONS Description of benchmar � A sx Q or. �a 1 ri A, d t Elevation 1 U b Description of alternate benchmark Elevation Building Sewer ST/HT Inlet -�4 ST Outlet �(p 3a PC Inlet --- PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines (I�) �} 3 y 1 () Lei ( ) WRs � 1.13 Bottom of System O 4 (L) • a ( ) Final Grade ( ) I ) . 4 5 ( ) Date of installation Permit number �� g a 3 a State plan number Plumber's signature �aww License number a;, Date 3 A / f 1 Inspector -V-,CA s `" Complete plot plan • r � 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 To` B AP-t4 o a' 0 INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Y= Count Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purpos [Privacy Law, s.15.04 (1)(m)j. 315923 � � N & SANDRA HUDSON Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 10Q r�ZJ 6_1A, 020- 1059 -85 -200 TANK INFORMATION LEVATION DAT A98 312 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic W e;-- c9C-) Benc 2r , 3.1 143.9' /bed Dosing Aeration Bldg. Sewer `�, Holding At Inlet TANK SETBACK INFORMATION St Outlet -?.67 TANK TO P / L WELL BLDG. Ai to ROAD Dt Inlet I ntake Septic �� 906 NA Dt Bottom Dosing Header/ Man. Aeration NA Dist. Pipe /0 `7A • Co Holding Bot. System T O 9' PUMP/ SIPHON INFORMATION Final Grade / Manufacturer nd � , f ��' Model Number De GPM TDH Li Friction System DH Ft Forcemain H ead Dist. To Well SOIL AB PTION SYSTEM BED/%TRENCkV Width Length No. Of Trenches PIT No. Of Pits In uid epth DIMEN c�1" DIMENSION SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEA NG Manufacturer: SETBACK CH MBER INFORMATION Type Zy� -7 t v OR U Mod er: Sys �w DISTRIBUTION SYSTEM Header / Ma ifold tj Distribution Pipe(s q l j x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length •9TH >7 Spacing ���0 e 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 ED] ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 22.29.19.227D,NE,SE 834 KELLY ROAD ,� Plan revis on �Q (!� VNo - Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert N . SANITARY PERMIT APPLICATION 201 ashnilgtonAve sion 14siconsin In d with ILHR accord Wis. Adm. Code P.O. Box 7969 Department of Commerce 83 05, Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 vi x 11 inches in size. / • See reverse side for instructions for completing this application State Sanitary Permit Number The information ou provide may be used b other overnmenta a gency programs Check if revision to previous application P Y Y Y 9 9 Y P 9 ❑ P PP [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION PLEASE PRINT ALL INF RMATI N Property Owner Na P operty Lolation r 1 /4 1/4, S T 0� , N, R (or� Prop_grt O ner's ailing dr / [J Lot Number Block Number city l � .,.., Zip C ode Phone Number Subdivision Name or CSM Number M �,S� j ( ) 111. TYPE OF B ILDING: (check one) ❑ State Owned Ity. Nearest Ro Vil age Public 1 or 2 Family Dwelling - No. of bedrooms own OF P / 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo - _ -� O ova a°+ • l 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 on line B, if applicable) A) 1.ew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of S. ❑ Repair of an ystem System __ _________ __Tank Only______________ Existing System ------- --------- - ---------- -- B) 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 WSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 1 fd 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. 7. Final Grade I Requ'red (sc -ft Proposgd(s ft.) (Gals/d /sq. ft.) (Min ' ch) Elevation 4v 5.� y Feet T Feet Capacit VII. I NFORMATION in gallons Total # of . Manufacturer's Name Prefab. Con- Steel Fiber Plastic Exper. New Existin Gallons Tanks Concrete strutted glass App. Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. P lums b i e r's N Print) Plumber's Signature: (No Stamp) I MP/MPRSWNo.; Business Phone Number: / �1Db?� Plumber's Address {Stre t, City, State, Zip Codea: IX. GOUNT Y / DEPARTMENT USE ONLY ❑ Disapproved Sani ry Permit Fee (includes Groundwater ate Issue Issuing gent Signature (No amps A roved Surcharge Fee) pp ❑ Owner Given Initial � C� Q� /e 7,� s_ Adverse Determination Ov X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SB13-6W (R.111a) DISTRIBUTION: Original to County. One copy To: Safety 6 Bungs Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be Y complete and accurate this sanitary permit application must include: p 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. 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 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. + Safety and Buildings 15837 USH 63 j HAYWARD WI 54843 -8107 A SCOT Isi ■ Tommy G. Thompson, Govemor Departmen of Commerce William J. McCoshen, Secretary July 08, 1998 CUST ID No.222904 JAMES W BOUMEESTER 1070 HWY 35 N HUDSON WI 54016 RE: CONDITIONAL APPROVAL mb APPROVAL EXPIRES: 07/08/2000 IdeitiBcatinNuers,.., Transaction ID No. 112946 Site ID No. 13736 SITE: Please rfei . btb tleat%fietlt ztutn�, Site ID: 13736 above, in a1l witli the;gericy. ST CROIX County, Town of HUDSON NEIA, SE1 /4, S22, T29N, R19W JOHN & SANDRA BEGIN FOR: Description: NON - PRESSURIZED IN- GROUND FOR HORSE STABLE Object Type: POWT System Regulated Object ID No.: 29052 This approval is for a privately owned and used horse stable with a clothes washer, 1 floor drain and 3 family members using the facility for a total of 365 gpd. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: P.0 C on n 1. This plan action is subject to designer comments on the plan. APP 2. This approval does not include plans for the general plumbing systems or sewer piping leading to the septic /holding tank that may be required for this project. See section COMM 82.20, Wis. Adm. Code, to DEPARTMEI determine if plan submittal and approval is required. DIVt iY OF SA 3. The gravelless system components must be installed in accordance with the manufacturer's printed instructions, the plan approval, and ch. COMM 83 system sizing criteria. If there is a conflict between SEE CORF the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. 4. The system elevation shall be 3' above the limiting factor. 5. The system shall consist of 2 trenches each containing 8 High Capacity Sidewinders. 6. The replacement area shall not be disturbed per COMM 83.09(1)(c). A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. JAMES W BOUMEESTER Page 2 7/8/98 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 06/25/1998 FEE REQUIRED $ 110.00 PATRICIA SHANDORF , POWT LAN REVIEWER FEE RECEIVED $ 110.00 Integrated Services BALANCE DUE S 0.00 (715)634 -7810 , M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE. STATE. WI. US COMMERCIAL SEPTIC SYSTEM DESIGN BEGIN HORSE STABLE (Private use only) TRANSACTION# 112946 Review Date: June 29, 1998 Plan Reviewer: Pat Shandorf PROPERTY LOCATION: PROPERTY OWNER: NE1 /4 SE1 /4, SEC. 22, John & Sandra Begin T.29N., R.19W., Tn of 834 Kelly Road Hudson, St. Croix County, Hudson, WI 54016 WI. AE INDEX TABLE ✓ �D PAGE 1 OF 4 TITLE SHEET S ? 4 1998 PAGE 2 OF 4 WORKSHEET 6'4 PAGE 3 OF 4 PLOT PLAN PAGE 4 OF 4 SYSTEM CROSS SECTION ATTACHMENTS SOIL REPORT W.T.S. - tionally )OVER 4ESP M E PREPARED BY: D Jim Boumeester NDENCE 1070 H wy 35 Hudson, WI 54016 (715) 386 -9020 SIGNATURE: Certification #222904 DATE • / g WORKSHEET JOB DESCRIPTION: Private Horse Stable. Conventional septic system design for Begin family horse stable. This facility will not be open to the public but must obtain state level approvals because it is not a one or two family residence. The stable will contain one restroom with lavatory and toilet, 1 clothes washing machine, and 1 floor drain. ABSORPTION AREA SIZING UTILIZING HIGH CAPACITY INFILTRATOR CHAMBERS: 1. Existing grade elevation 95.96' at B -5 2. Depth to limiting factor 94" (elev. = 88.13') 3. System Elev.= 88.13 + 3.0' = 91.13' at chamber /soil interface. 4. Absorption area required: 437.50 sq.ft. Clothes washer: 300gal /.8gpd = 375.00 Floor drain: 50gal /.8gpd = 62.50 437.50 (437.50)(31.8 sq.ft per unit) = 13.75 units proposed: 2 trenches = 445.2 sq.ft. (267.0 actual) Trench length (B) 44.50' Trench width (A) 3' SEPTIC TANK CAPACITY: (1 clothes washer)(300gpd) = 300 Gpd (1 floor drain) (50 gpd) - 50 Gpd 350 Gpd + 750 gal. min. capacity minimum tank capacity = 1,100 gal. Tank Manufacturer & Capacity: 1,200 gal. Weeks Concrete I pro ostd Kars< 3 0 { . P propose.d 1,20074. SEza To edyc o f bo oty, �,-t ta-Q fry m ede . 1✓Le� = /,V. (Z., aGL Co.n . 93 10C1 �/ '� ��� T - 303 Si E /'P 'GCiien�a�rrE.s h.a r. bury l�d. �. eM(-uenf &ne- /Y(.� er �YCee.d� o F 3/9/ z h /i ecaGr wiz �:'Lt� a-ir g -5 z wnt,r.' ��hn4 �- . l3��1►, 8 � y �aaal C aA o►-� g_3 g_y 176 Ste. 2 T, zgtr� S� _ Cro n c c o � � r , �o a -S used 4= estab, Ca K. "v 6 A w cr W � p� o Wisconsin Department of Industry SOIL AND SITE EVALUATION 3 'Lflbor and Human Relations Page of 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 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # O O / ,f �1 d • /O d2p "' �dS1`' • � Zoo 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 tr r p Property Location G 6T}> > SA0 Q �t�7' JJ Govt. Lot 1/4 1/4 S Z >✓ T y7 N,R E o W D� l� N S c Property Ow Mailing Address Lot # Block# Subd. Name or CSM# '3 q y .0 P • i8 44W-5 City State Zip Code Phone Number Nearest Nearest Road �fUj>,so�tJ �/• Sys /lO (?15 )3 ' - ❑ City ❑ village Town �CLLS/ A0 . 93 Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement [9'<ublic or commercial - Describe: • S�,071 G .sysr- fiA h4&46' RE�e�y.�,,e•,aDeL:; S72iA-� 6-- t,� Code derived daily now ySo gpd Recommended design loading rate ` —bed, gpd /tt ' — trench, gpd/ft Absorption area required _ y � bed, ft trench, fit Maximum design loading rate • ? bed, gpd /ft ' 8 trench, gpd/i1 Recommended Infiltration surface elevation(s) ' it (as referred to site plan benchmark) Additional design /site considerations 2fsE E.v,s• o.� .f' /ate ^ L.� 9,� B -s Parent material Ines - S OL7 Flood plain elevation, if applicable ft S = Suitable for system �Conve tional Mound In -Group ressure AT-Gr a System In Fill Holding Tank U = Unsuitable for system LrJ s❑ U ❑ s ❑ U Las El 3 ❑ S U E - b U O s SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /it2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Z /• /0 Z - 5 /mot S cf — ' Ground �e ' ft. ,% 1 6 , Depth to Ilmiting factor '7 a (2 -d-- Remarks: Boring # Z y X /o YO CS /7a z • 3 Z- .5 Ground 1' r--- S G�s C S -- • 1 • 0 f� -J & ft. S /D V,O S Depth to limiting factor Eg- ln. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number 13 q tjibricht 8 Associates Private Sewage Consultants / 665 O'Neil Rd. I N 07— /f 1& fe s Iz- / L!1 l Hudson, Wis. 54016 r lei-Ila 4 06 /eeT7 A, PROPERTY OWNER r SOIL DESCRIPTION REPORT Page L of ,3 PARCEL I.D.A �� if 4 -es Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots --.,, • in. Munsell. Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench `3 y Ground 3 Z • Y /0 Y te Y ` S/ L /7Y he lw / • Q S . 1. . • 3 elev. .— Depth to S - �1 1 0 r 5 S 0 S limiting factor ' Vin. �� Remarks: Boring # / �P .3/ - SL 2 z y/ SL 2 She "" Ground S 7 • d elev. Depth to limiting factor lig– in, 7 Remarks: Horizon Depth Dominant Color Mottles Structure t Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # / • / S /D / ,S L 1 -fShe � �/ S 1 f . S •� /D YX � z �e 7i . C S S .G d Ground D a • �7 elev. Depth to , limiting factor ri/ In. Remarks: Boring # 1 ter.. Ground elev. tt. Depth to limiting factor In. Remarks: SBDW -8330 (R. 08/95) I t 1, qo ttO Ft o 30 RS E BAN P( Ts '77o1 , eke 130 2- O /o or 3 141 tou /d f3 ICU � r1�G 0 _._._ -�� • � SD -- - • Sys 7- 40.0 /f D QS o� Al — / 00 �S� A cray A LL 1}Ibticht & Ags ecCOnsultants 655 0 1 1 49} Rd. 5406 W�dgon, Wls- 2- T �--tv . fik,! S Fka, 3 r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer .� Y r 1 Mailing Address Property Address (Verification required trorn Planning Department for new construction) / v j v - /'a59 -- 85 - 4,06 City /State dO � Parcel identification Number tO4t) - /,Q,5Z -7 -ice© LEGAL DESCRIPTION Property L.acati � Y4. C ls, Sec. T N -R . jW, Town of ,6L� .5 0� Subdivision Lot # _. . Certified Survey Map # ,TM 3 _ � Volume 10 . Page # Warranty Deed # - -5 - 1 ( ? s :T6 - c) Volume /9 9- . Page # C) Spec hous ❑ yes no Lot lines identifiable J yes ❑. no STEM .�AfARMNANCE Improper use and maiateaaaoeof your septic systemcould raurlt in its k". ; I fru+e.�rue do handle waste;. ProPermaintenanx consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect die frmctioa of the septic tank a treatment stage in fire waste disposal_sysbem, The PwPcrty owner agrees to submit to St. Croix Zoning Department a certification, form signed by the owner. and by a p l Phmd)c4 restnctedptmnberor a hcensedpampervaiffying that (l) the on -site w uwaterdi gxnd system is in proper operating condition and/or (Z) after inspection and pumping necessary), the septictank is less than W to of sludge. Uwe, the umderdgaed have read the above requirements and agree to maintain the private sew-age disposal sy%tea with the standard: set forth, herein, as set by the Department of Commerce and the Department of Natural Rase stating that your septic Resources. State of Wisconsin.. Cec6ificatioa system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 of the three year expiration date. LOA SIGNATURE OF APPLICANT' DATE OWNER CERTII�IC -TION I (we) eat fy that all statements on this form are true to the best of my (our) lcmowledge. I (we) am (are) the owner(s) of Im propertydescn abo by virtue of a warranty deed recorded in Register of Deeds Office. • ^ ATURE OF APPU DATE « « « « «« Any information that is ma represented may resvlt is the sanitary permit being revoked by the Zoning Deparamait. «« 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 FILED 3 AN 2 7199 9 512332 Z i J f • O �b wr x Bearings are referenced to the fi O rn ►+ rn — r ►+ N I t" 1 0 o X = a , _ I (p east line of the SE} of Section IL Or rt °° x IlQ 22, assumed to bear S00 ° 14'57 "E. F1 ( CU n 1 (D °o H r I O 01 co w a ao m o a n 0 1 0 c . T I In � J Ate— LAND" ��. >✓ (L .• > O ' "" �.�2I I EIS � n - - - -- - - - -- U� `� (t rt m w o N d -S) F h ° N rt = i N 00 ° 15 46 "W 687.10' rt P. to IV ° ° .. � z 0 0 � T , to t7J ° N O CD I••h O rt (D � -4 En V:—j °F o ° to cn A� ° Co ° r ° s ^' C) O a a C � O OD '� 0 ' � n OD I G� ✓ t.0 1•rl • !-• • 111 w b 10 ••r O F -' x o z O I r - rt C - ) N o_ x a 1 � v O W v 12> (D �TJ O I -'_ . • �. w i (D m - W 01 00 3 - h = to In O C7 o CD �N If rh 0 to �* w a o+ a m ir W a W I G rt C CD w w M- -3 W n .P I � (D < a CD Ch I(/: rrt pp o Cr s E� 0 U1 tzj A� n N O s i Fh —) N00 ° 14'51 "W D~ rt x N• I r� 400.00' { O I w Co O I I w N W R ' �. .L !0 M c m O rc Co cn r.G t4AE I` CD o y T fn —{ V o V z 1 0 0 1 Q r z o CD N 1U �= ° m' ZM N o oar xA .. ��...... ...W..... ... m ................. l0 w I p �ij o f pW 0 i .,c:8t'S C� z `" o , ❑ 4 I 287.10' I fir ;, 1 y� a '•� S00 14 57 E — — — — 1001*57 E I� ui 400.00' 287.10' w 0) v Cn S00 14!17"E —JU—U' w 640.95' °� V C/) 1327.94' — — — — — — — East line of the SE} H rt KELLY ROAD �; ° rr c'� -- - - -- — N x a. VOLUME 10 PAGE 2727 0 O i