Loading...
HomeMy WebLinkAbout020-1113-80-000 � S 0 cn O I I � m n 0 = a o v xt r `° w CD 3 K Q o W c!) ! 2 — o �. a Q 0 G N� a N N !r Sll N O v p _ W j a S"+ y N N 3 O O N N N n. X Sa O 1 W O O O t^, (D (D (D N W O cn CD 0 NJ Cn 6 3 �_ �_ �, o p -r N C 0 �y d (y O D a cn H SD w m 2 N Cti _ C 3 W C 3 o v N N j CO O p W (fl U1 "%%A W ; co co 0 r cn y o o C cn O C U) 0 OOO (� O Q O 0 QO Z7 (D lr _ t9 tT CD 3 - d n c CD N o A p z' Z Z �y ry D O N O N �3 �- N � N • C (� r4 �{ n� m v — � CA n O A z n (n I I I J A A Z 3 p a O .. W � r N Q Z 0 a Z 0 M (D A W N n N N W Q CD CD p O O N G d z G O_ CD OZ N C O a 0 7 O 3 v '0 Z O N O b N q O zz ro 1 - COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 -3121 800 - 962 - 5227 M j ST. CROIX ZONING REPORT NO.S 04135./01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 4/20/90 COURTHOUSE DATE RECEIVED: 4/17/90 HUDSON, WI 54016 ATTN: THOMAS C. NELSON 102 0 OWNER: Earl Johnson LOCATION: 1015 Hwy 35, Hudson COLLECTOR: M. Jenkins SOURCE OF SAMPLE: Kitchen faucet COLIFORM: 1 /100 mL INTERPRETATIONS Bacteriologically SAFE NITRATE -N: < 1 ppm Under 10 ppm is safe for human consumption. Coliform Bacteria /100 ml Nitrate- Nitrogen, mg/L LAB TECHNICIAN: Pam Gane WI Approved Lab No. 19 � DEPENp ti y E u 1 t Means "LESS THAN" Detectable Level Approved by# s ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 w _ L qq ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386 -4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Comm eta on of this form i is gsliential so that the vrooerty can be mo d• Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. / WATER TESTING--------------------- - - - - -- -FEE: $ 25.00 c � (For nitrates and coliform bacteria) FEE: $175.00 WATER TESTING SEPTIC ( $25.00 v/ (Determines if system is properly functioning at t me Of inspection) 7 Property owner's name — 2- a e � l� o( � � e (�► - Property owner's address 1Dt H t-0-9 V 5 Legal Descript on fLV 1/4 of the 5 F /4 of Section /_ , T N -R_2p To 1j,qW Hu Lot Number Subdivision Name FIRS MMER Dl Color of house Realty sign by house? If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COFY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: Telephone Number - REPORT TO BE SENT TO: a vL Dl W Closing date Signature � • K ' ST. CROIX COUNTY WISCONSIN ; i'. ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET 0 HUDSON, WI 54016 (715) 386 -4680 April 18, 1990 Earl Johnson 1015 Hwy 35 Hudson, WI 54016 Dear Mr. Johnson: An inspection of the septic system of Earl Johnson, located at the SW 1/4 of the SE 1/4 of Section 12, T29N -R20W, Town of Hudson 1015 Hwy P 35 was in on April 17, 1990. At the same time I also obtained a water sample and submitted it to the laboratory 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 the 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 is totally dependent upon proper maintenance of the system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, ? xk v - ted .� Mary J. Jenk ns Assistant Zoning Administrator cj I n _C F bn . o b I � 3 m 3r � ,►�' 3 CO Z ! 1 O N C1 C N O O 3 a J N C to o° p 0 3 N o o c ° ,, • 3 0 m � m o -; ► a g p o " w p' G m 3 I � cD ` •• N -•, O e•+ 'm y �m o o o. N D a cn c GO O ` °� cp• �' 1 �l 1 a) Q CD N Cl) ; w o co T OD C z Q K c O N ON O C CC 0 0 f � 1v °' rn I� Cl) _3 N o d o c N Z I o O (D y A ru in I CL Q CD N a S n 0i tU n j o' 3 Z 0 i a Z y (D I m co I w p Q. Q. T -` m R I „ c Z 3 D a y o C a i � C I I I � o D I m - ti m S 1 0 Z c , O m O a 2 m 0 I I I n cl) o \ ■ - o = k� §\ m a B a # ' 71 �J $ \ "D , . � . � \ ° \ j � e g= z z z \§ «\ I q $ O \ \ \ \ ( § : \ \ (0 ' 2 k $ ) \' � ' N) G s \ 3 ] ® < / � \ / § \ 2 G I \ \ K / \ ° £F \a E � g �° \ / / ¥ ¢ / < \ 3 } / \ \ � \ § k m \ e \ \ E \ ° ` CL A § $ V 10 T » \ � \ j j j » \ 2 0 \ R } o v » \ / � \� \ �gd ° \ « o ; E © . E i CL 0 z � / g \ ( / \ / �• CD / { \ \ / o \ \ y ) e \ o , \ \ § �;: m - ■ _ k \ ¥ § % � § \ § G ƒ k < / $ o r : z { � 7 � ~ §_ t / \ � G § 2 2 0 \ z $ < 0 F � \ � � \ _ � \ A � ƒ � \ � � 2 0 \ ƒ \ e 0 z \ 0 i \ / 0 ' © � ° � ` � � S � ■ [ k J ■ � T 7! M %b A � k 0 7 fƒ 0 °§ E r§ 8 CL 0 m / § § c U \ K C \ & , � , \ , . � k k \ § (a $ CO @ \ & § 8 8 2 Q m 0 % 9 ■ ° ` E E a k ƒ � g 'A / / / ( CL k 2 2 ¥ co _ 9 %� / « §! � / ` k k § / CO 2 ƒ 2 0 . CL ■ f _ z 0 0 0 \ ;- \: � a cn Rs 0 / 0 CD e \ : [ & , ® z >t0 \ { 7§ W&A- � \ ' ° 2 % / 2 \ ° i f 0 CL § / z E @ R � 2 d 7 § z 2 � � . -0 CL CD . � \ � z � 8 c z ( . / z . � � 7 � k � ) t $ � . 2 a < k \ _o �$ k� �4 x 5��TiG �r�K ST. CROIX COUNTY ZONING D MENT WlfT � U•�t� AS BUILT SANITARY Owner S O �v �• t} SGt/��/Sp,y Rf Cf1V G�l,� Property Address 101-5 3 S ED /> - S iNrq-c T City /State v.OS O-✓ Gu S O 1 f99,8'/ � Sr 71fl�� Legal Description: S �oarr �� Lot Block Subdiv'sion/CSM # f i � /� Seca 7- , T Z7 N -R - 7 -a W, of 9V p # 020 ///3 d SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC / Setback from: House Well P/L 35 Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fr air intake Water Line Meter location Alarm location ` SOIL ABSORPTION SYSTEM x 62- Lengt 1 r Type of system: ��G�l Width 3 Leng Number of Trenches 3 Setback from: House ZO' Well 7 PAL Vent to fresh air intake > 50' Ov 5/- la &" T.r ELEVATIONS d ` 13 0 1 - T0,, �e Of ffdl9SE 5iJJi "�(� Description of benchmark 4-T .5e- Elevation Description of alternate benchmark —W o f A /vet tl > �v Y" c -� Elevatio � � -r-A�ui ocD .5'y57'• ff 2-6 Building Sewer ST/HT Inlet ST Outlet 9y PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover V3/ / Distribution Lines( ) ! • 6 7 () 4 i- 2 • 6 3 ( ) ' Bottom of System () () ( ) r RR1r•�t !� 6 � t " Final Grade () ( ) Date of installation / / Permit number State plan number �21�375 pU`. Plumber's signature License number Date Inspector jP0P & 1'51 1 ' Uibricht & Associate$ Complete plot plan Private Sewage consultants 865 O'Neil Rd. Hudson, Wis. 54018 r 1 NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. i • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW I r P INDICATE NORTH ARROW � O � n � y , \m O c � t v1 N p 2's V4 l ZI _x4- 2 - __ -- 1, 3 XGi 3 �n a Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y- Safety and Buildings Division Count ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary fIrR19yY Personal information you provice may be used for secondary purposes [Privacy Lair, s.15.04 (1)(m)). .i L b6l1LL S WPINE*N N$M EjjftkbWI ❑ Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: SM Description: Parcel T �' - 1113 -80 - 000 I TANK INFORMATION ELE ATION DATA A9800502 TYPE ��MANUFACTURER CAPACITY STATION BS HI FS ELEV. Se �Vl cif+ Ben k (015 �0.1.fo I �C7 Dosing A n Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Air to i ntake ROAD Dt Inlet ir eptic qa �� 1v NA Dt Bottom . Dosing A n a�6 ?.-n qa , trcw a Aer tion NA Dist. Pipe °Ts Cf • 20 67 ',o f 9 Holding Bot. System 0 (p2 11 - co C7/.& j PUMP/ SIPHON INFORMATION Final Grade ? Og GjS S Manufacturer De d Si, W1l s 3 ' Model Number GPM \J.,,I TDH Ift Friction S TDH Ft '55 c N - t Force main Dia. Dist. To Well SOIL ABSORPTION SYSTEM No. Of Pits Inside Dia. L Depth BE TREN idth f Length�r No. Of enches PIT 4 P DIM 3 w .2 r DIMENSION SETBACK SYSTEM TO P/ L I BLDG WELL LAKE/STREAM LEACHING Or INFORMATION I Type O CHAMBER Mo el N r: Syste �`'l OR UNIT DISTRIBUTION SYSTEM Header / Ma fold �r Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length DTI Dia. Length .BTd Spacing #� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed / Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 12.29.20.459G,SW,NE 1015 HIGHWAY 35 V R41 4X All; lyt S7 V (o(� Plan revision required. Yes ® No Use other side for additional information. (� (q 1 9& / SBD -6710 (R.3/97) Date Inspecto sSig'nature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I I, I ` a Vi SANITARY PERMIT APPLICATION 2 w shn sion sconsin In accord with ILHR 83•.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County S GrPp/ J� than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N I Nl/f - Property Owner Name Property Lop tion So NTH-- SW�N�SDN SGv 1/4 / t/kj /4, S / T 2y , N, R 20 E (or� Property Owner's Mailing Address 2 � Lot Number Block Number City, State V Sb� /,./ 7 Zip Code Phone Number Subdivision Name or CSM Number N o , f f D KJ SY�/ t ( ) refs ar•� /,3 0v.� DS _T 11. I NG: (check one) ❑ State Owned 3 It i1Ul�SD.� Nearest Roa Public 1 or 2 Famil Dwellin - No_ of bedrooms V own o f �/ 111. BUILDING USE (If building type is public, check all that apply) b��`. Parcel Tax Number(s) ­ 1 El Apartment/ Condo a 0. 4 5 C / CT o Z o 1113 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2 replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ______System ________ System Tank Only g S ____ __�____________________ Existing ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Numb Date Issued V. TYPE OF SYSTEM: (Check only one) /fr<&_ ejW -/ � /. ��. -P�• r-�i. / LT '� 5° Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 OS epage Trench 22 ❑ In- Ground Pressure Zg 42 ❑ Pit Privy 13 ❑ Seepage Pit 3 �,vGLfCS 3 y- 5 Dc 43 E] Vault Privy 14 0 System -In -Fill S J VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rat 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /i l ElevatI n 7� �f -72 7 - S Feet (v Feet VII. TANK Capacity er. In gallons Total # of site Fi r- Ex per- o s Name Prefab. be plastic p INFORMATION Manufacturer' con I Stee x' in Gallons Tanks concrete glass App. New E lst st ed Tanks Tanks /(!dT' ,�-- epti� nk /fin ��D ❑ ❑ ❑ ❑ ❑ 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. Plumbers Name: (Print) Plumber's Signature: (No Stamps) W No.: Business Phone Number: �oB T 2(LB�iC�1.>T '2_Z3 7[S 38G'&8S Plumber's Address (Street� City, State, Zip Cod e L : (05S b ,v1Z /2U - IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuin Agent (No Stamps) ( 0 () 10 // N Approved []Owner Given Initial Surcharge Fee) O � Adverse Determination � X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 MA 1/96) 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 (S3D -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 licem-ed pumper whenever necessary, usually every 2 to 3 years. 6. If you have quesiicns concerning your onsite sewage system, contact your local code administrator or the State o 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 n:. of where the system is to be installed. 11. 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. V11. 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. LN Q C C G ti u w z w tz a N \\ i r a IN n; j� Q ©o e-A Iff q� o r V S S T EM y 9/, CVO SS SE CTIolO �OF TI'E A:mss ht S pssocla ulta�ta ��bs � S GOas Go Iff K 1 fRCA) y 3 s. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the �y' ,yeSS' residence located at: S 1/4, N Oe 1/4, Sec L . !Z T N, R ZO W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. / Last time serviced Did flow back occur from absorption system? Yes�Z Na (if no, skip U xt line) Approximate volume or length of time: gallons 0 minutes Capacity: :'t:r� Construction: Prefab Concrete Steel Other Manufacurer (if known) : Age of Tank (if known): `W — E e ri My r) CA•J (Signature) ,/ (Name) Please Print r� `-' L') a e - d l✓yGt -ito, T-7 ` co -4 � ! � a►^�i �Gy/ zj 4 �,;j (Title) (License Number) (Date) Form to he completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR -83, Wis. Adm. Code (except for inspection opening over outlet baffle) . Name 1��� Signature /�� ri°iP /MPRS 2 ? 5/88 Wisconsin Department of Industry SOIL AND SITE EVALUATION 3 -Labor "and Human Relations Page of . DMston of safety and Buildings in accordance with s. iLHR 83.09, Wis. i County Attach complete site plan on paper not less than 8 112 x 11 inches 1p4sZe an trust r Include, but not limited to: vertical and horizontal reference point Arectlon slo scale or dimensions north arrow, location p ercent sl V so .:+ , a nd ocat on a ` dtqtbnce t,, ;arc ��d. el I.D. # N,��,f� �/ ti � �- SLu��vso,yl, E pZ o i /13 �O APPLICANT INFORMATION - Please print all lr#errnat 6 ' ` � Rjviewed by Date Personal information you provide may be used for secondary purposes (t'rivagy Law, s. iq.1Mq *W. /� Property Owner ty �, , Z F=vt. Wcation 1�i�v /!7 //U i.Q.s7 \. Lot S &` 1/4 NC i /4,S 11., T 2? N,R Z, 0 E (o W Property Owner's Mailing Address BI # Subd. Name or CSM# /d1 3 S S a ,8 v.vfs' city State Zip Code Phone Number Nearest Road f{!l17s 4)/ 10 16 1 ( 71 3' )�d 6 •7aY ❑ city ❑ Village Town // Y . 3-5 ❑ New Construction Use: residential / Number of bedrooms Addition to existing building [Replacement l��• El Public or commercial - Describe: /V /,Q % IV 0 7 poAl A t Code derived daily flow / ✓ gpd Recommended design loading rate bed, gpd/t? trench, gpd/i1 Absorption area require bed, tt 2 _ trench, tt 2 Maximum design loading rate z 6k , bed, gpd /ft trench, gpd /ft Recommended Infiltration surface elevation(s) 3 it (as referred to site � plan benchmark) Additional design /site considerations 4 %4 A POG� ZryT G f1 "7a� / r �.5 Parent material Flood plain elevation, If applicable ? If S = Suitable for system Conventional Mound ,� � in- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S ❑ U ❑ S Irl U El ❑ U ❑ S 1:1 U ❑ S ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 In. Munseli PU. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench / o •1 i oy� 313 a s 20 PP, 3 io / L5 we a S Ground 3' D 1 5, � elev. �, 8 �7. LLft. ID Sf _ - Depth to limiting factor Remarks: Boring # A2 2 L S /,H, IJ4 Ground S 4 • ? • O elev. W 1 ` S 1! S Q S ld (16 r ° s� �fsk 4 .� .s Depth to /OY, S/ S /C s �G — . 's t limiting factor i, E1Q3 Sys/ • /S /,U GO!'�F G'Q.t�� / /�.y/ .SQi�f ' ►n. Remarks: CST Name (Please Print) Signature Telephone No. o Btie r 24(166 71S•3 ?G • 1(5> s Address -' a)p CST Number ry ` :2Z-0? Privets Sewage Consultants WS O'Neil Rd. Hudson, Wis. 54016 ,jss -q 4-,9 �osSi �S� - ' � Ol>7`1195FT - y sysT ZT,& 3 9� • S�a � � ,cr 7� -��es PROPERTY OWNER SOIL DESCRIPTION REPORT page Z of � 3 PARCEL 1.01 0 1 0 . / • d 0 Boren # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots f y - m In. Munsell Qu. Sz. COT. Color Gr. Sz. Sh. Bed , Trench . . _ Z �• 35 io 31 LS / 6-.'W ,A' cs Ground ��� 2 s Iry / � S • co elev. e* <.&It. - S Depth to limiting factor 7 � in Remarks: Boring # z Ground elev. n. Depth to — - limiting factor In. ^— Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /fe In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # — , x' ; Ground elev. ft. Depth to limiting factor In. .. Remarks: Boring # Ground elev. ft. Depth to limiting factor In' Remarks: SBDW -8330 (R. 08/95) IMPORTANT NOTE TO OWNERS & INSTALLER: All the finer textured soils (loams,silts, etc.) can & will be easily smeared Or compacted even.by a backhoe bucket during trench construction. When this occurs premature failure will result. As per ILHR 83.13 U( ), the installer MUST be very careful to properly hand rake to sidewalls & bottoms to re- expose all of the soils natural structure. Minn. even recommends that scarifying devices be mounted on the sides of the bucket. Only in this way can treatment & absorption be mast enhanced for normal longer system life. 9 /!; Oe T/0 I 007-- r ti Z r J e li lt to po _ I W g; h sT [..©T' 41, at tA 'i o � r 4 (i I w g 0 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _ - e'y Mailing Address �D� 5 � • 3 S v� S a''J �S • `s y °l G Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number 2- D O LEGAL DESCRIPTION Property Location S w '/4, P ig- '/,, Sec. 2 " , T N -R 20 W, Town of /1Y T� ' �DU��s C(i� Subdivision N�/f' s , Lot # Certified Survey Map # /i( , Volume , Page # r j Warranty Deed # y , Volume ` S , Page # Spec house ❑ yes K(no Lot lines identifiable PQ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year xpiration date. SIGNA#RE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNA OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed VIL State Bar of Wiscoram Fern+ ! - 1982 WARRAIMY [WED DOCUMENT NO. p<<ICE "I'111SDEED, nladebetweell David P. Langnes= and Tina r�Q�X Co.: wI M. Wock Langness. husband and wife —T. , r aoo�d SEP 21 1 9% f Tranlur, 7' 30 € I and Sonja H. Swanson trig R of Ooede l T r 115 SPACE RES FOR RECORDING ,;A Grantee, NAME AND RETURN ADDRESS W111 NESSETH, That the said Gr]tltor, for a valuable cunsaktation Title One Premier Group, Inc. 706 19th St. So. conveys to Grantee the following described real estate in St. Croix Hudson WI 54016 County. State of Wisconsin: r Part of the SW 1/4 of the SE 1/4 of Section 12, Township 29 North, Range 20 West, St. Croix Countv, Wisconsin 020 - 1113 -80 -00 described as follows: Commencing on the S1: c ~ner of pARMiDENTIFICATION WRASER - said SW 1/4 of SE 1/4; thence North on West line of said SW 1/4 of SE 1/4 507,3 feet; thence N 30 degrees 48' East on Easterly line of Y k.A State Trunk Highway "35 ", 175.0 feet to place of beginning; thence N 30 degrees w. * 48' East on said Easterly line 150.0 feet; thence S 59 degrees 12' East 175.0 feet; thence S 30 degrees 48' West 150.0 feet; tierce N 59 degrees 12' West 175.0 feet to ai� place of beginning. TRAN FER s 23 FEE This is homestead property. (is) (i zati) T • Together with all and singular the hereditanaents and appurtenances thereunto belonging: And Grantor warrants :hat the title is good, indefeasible in fee si. •nle and free air] clear or encufnb,ances except Easements, roadways, and restrictiors of record. I and will warrant al.d defend the same. Dared this div of September .19 98 '1 I ' - -- -- - - -- - -- — (SEAL) v — - - - - - -- SEAL) 4 (SLALI • Tina M. Wock Langres_• -X V x AUTHENTICATION ON J Signature(s) STATE OF WISCONSIN S. St. Croix County. •tthenticated this day of 19 Personally came before me this r day of Septem'�er 19 the abos_ named i David A. Langness and Tina M. Wo ^k *s Langness, husband and wife . 1ITLE: MLMBLR SI 47L' BAR 01: WISCONSIN � (if not, * who cxcc::ced the authorized by Section 706,06, Wisconsin Statutes) t- Inc m known W be the person *c. forefoing instrument and ack� owledge the same. tt, THIS INSTRUMENT WAS DRAFTED BY } t V\ JK • `� , Sa o J Michael H. Forecki, Attorney . Kathleen R. videen ", 1t Eau Clai• Wisconsin Notary Public Polk Cou. ,; Wis. g ryj (Signatures may be authenticated or acknowledged. Roth are riot rx<r..xa.•1, M commission Is perntallent. (if t.ol, stale expiraltotl r.,t�: • Names of persons signing in any caparly should be typed ur prioled below them June 24 %Tc? 00 1. t I : Y w .T3 4 Y A