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020-1125-30-000 (2)
St. Croix County Planning and Zoning Tuesday, February 14, 1006 at 5:07:30 PM Detail Sanitary Information Page 1 of Computer 0: 020-1125-30-000 Sub/Plat: Eagle Ridge Section: 7 Parcel 0: 07.29.19.569 Lot: 40 TN/RNG: T29N R19W Municipality: Hudson, Town of CSM: 114 114: NW 114 SE 1/4 Owner: Steele, JoEllen & Michael 356 Miller Road Hudson, WI 54016 State Permit: 49429 Issued: 03/13/1984 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: 04/24/1984 POWTS Detail: Bad- Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspect As Built Plumber Other Requirements Additional Notes Money Owed Harold Barber Yes Strohbeen, Douglas file this w/replacement permit $0.00 Harold Barber Signed Off: No Owner: Steele, J lien & Michael 356 Miller Road Hudson, WI 54016 State Penn 399674 Issued: 01/232002 POWTS Dispersal: Non -Pressurized In -ground Permit: Replacement County Penn Installed: 0125/2002 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plum Other Requirements Additional Notes Money Owed Not determined NA Boumeester, Jim $0.00 Kevin Grabau Signed Off: Yes Maintenance Scheduled Pump Date Pumped 1 st Notification 2nd Notification 3rd Notification 125/2005 04/012005 424/2006 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). arnit Holder's Name: �•Q,elP I Ja Ej1,e-,�7 -41 r q City Village X Township age "s R Hudson Township ST SM Elev: Insp. BM Elev: BM Description: a I ICFD.D' ANK INFIhRUATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic 1 Dosing Aeration Holding TANK SFTRACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic > t t¢0 I L r Dosing Aeration Holding PUMPISIPHON INFORMATION Loss SOIL ABSORPTION SYSTEM (� D BED/TRENCH jWidthi Length DIMENSIONS 1 462-Sbl �• INFORMATION Tv oe Of Well P/L JBILUG WILL , STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer ' SVH1 Inlet 7-1 St/HIOutlet �Z q pnr 1 C� Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System q2 Z2 Final Grade 1 St Cover B fv I q-Ci 2,1 otT nluFNSIONS INa. Of Pits llnside Dia. ILiquid Depth 'KE/STREAM LEACHING IManu( cty ej r CHAMBER OR I1'1'+r�•r UNIT IMod911Number: Header/Mari fold Distribution Pipe(s) x Hole Size x Hole Spacing Vent to Air Intake �' 3 t I Length Dia L SPacr^9 Depth Over Depth Over xx Depth of xz Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Ves No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #U/_Z5 L Inspection #2:_ T--=— Location: 462 McCutcheon Lane Hudson, WI 54016 (NE 1/4 SW 11417 T29N R19W) Park View Estates Addn. VI Lo Parcel No: t17.29.19.1.) Alt BM Description = ^/l/4 r Nk DII 32.)Bldgsewerlength� - amount of cover Plan revision Required? a Yes o Use other side for additional infonmatf& Date Insepctors Signature SBD-8710 (R.3/97) Safety A Buildings Division Vjfseqnsln Sanitary Permit Application 201 W. Wapp Box 7302 In sceord with Comm 53.21. Wis. Adm. Code Madison, WI 53707-7302 Dopertment of Commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not [Privacy Law, a. 15.04(1Xm)) state owned. Attach complete plans to the county copy only) for the system, on paper not lea than 8-1/2 x I I inches in size. County State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number 3°19b�� r� r< vu• L I. Application Information - Please Print all Information Location: Property Owner Name Property Location e 1/4 5t I/4 S 7 T N R/ yE or Property Owner's Mailing Address Lot Number Block Number (Xet� Ciry. S le Z p Code Phone Number Subdivision Name or CSM Number -�� 7vr • 9 Za e k e II Type of Building: (cheek one) o city O I or 2 Family Dwelling - No. Bedrooms:-3—_ ❑ Village of !� TOwn o O PublidCormtercid (describe use):_ \ � � /fu /5 / 7 O State-owned l d l�J K ` III Type of Permil: (Check only one box on line A. Ch• Nearest RoanecA) r�yo I. ❑ New System 2. Replacement 3. ❑ r Parcel iax Numb«Ss) 0 7, Z9,em Ta Gb2 D - au �D - B) Pe O V' Date Issued ❑ A Sanitary Permit was previously issued I Type of POWT System: (Check all that apply) r leii L LV. Non-prenurized In -ground ❑ Mound Sand Filter ❑ Constructed Wetland Pressurized In -ground ❑ liolding'fank ❑ Single Pass ❑ Drip Line ❑ At -grad 4 Aerobi ' re ingot lJnil ci ulaling ❑ Other: V DispersaVIreatment Area Information: Ors a 1. Design Flow (gpd) 2. DispenalAres 3, Dispersal Area 4. it A plicstion 5. Percoleti Rate 6. System Elevation 7. Final Cade $O Required Sao Proposed Rate (Gday/sq.ft.) I (Min./irlevation k t) 9� �S E. )s G - `'&f VI Tank Capacity in Total N of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete slrucled Tanks Tanks 000 Jic �" ° ° ° ° bps iN L.'%K ( - V o4) VII Responsibility Statement 1 the undersigned, assume responsibility for installation of the POWTS shown on the attached plaits. Plumber's PI s t) Slgn (no stamp : MP/MPRS No. Buslrres i Phones Number V& LAk�e- r Plumber's Address (S City. State, Zip CodV o �Ozed .lo aU' Vill CountyADeparinient Use Only Approved ° Disapproved D Owner Given Initial Adverse Sanitary Pamil Fee (Includes Groundwater S Fee) sp Date Issued Issuin Agent Signore (No stamps)) Determination ��• AN.23 ?ft IX. Conditions of Approval /Rsasons for Disapproval: k 4va'�is s T -ic0 s. 5�e i r �e. Li s , as� w �t,�e,•�s ate� ,,,.,,1,:s� a.eQ�e.�f• ���f s a,Q.Q��? . �w�t+:.er0 i+ �fec,r�tabzt s.�— tUQw take � !� ntww�— C�.o.-���o�tlei�• S�� t� •{•i Lla' oo btu �a�+u,�-r=�.uai�( � /, ���,vq �•�R.t�,. •{o {adz ..�•ri �t'�C.Q � u.� �t VJ�-r-^n..v. �1�-• a a- yv�, I823PAIf ?_? 669303 r.tl i hLELN H. WALSH REGISTER OF DEEDS :-iT. CROIX CO.. WI RECEIVED FOR RECORD St. Croix County Occupancy Affidavit 1Gtt'fGt- AV06 .10C-11£+J 4_Dl� Name - (Owner) Typed or printed being duly sworn , states, under oath, that: I. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume 11q 1 Page 4POV_ Document Number5`}t252St. Croix County Register of Deeds Office: A parcel of land located in the Nary. of thetW"A of Section , T:241_ N - R )"it W, Town of i•11t bSMPJ , St. Croix County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or detailed legal description): Le-t- *- y.0 oc' 6^w-4- 21,4E 01-25-2002 9:30 AM ZONING AFFIDAVIT EXEMPT M CERT COPY FEE: .:DPY FEE: 2.00 TRANSFER FEE: RECORDING FEE: 11.00 PAGES: 1 To v=ixev\ P 5'tee-ie ,35(v Mrllev k1I n2-0 — I17-5-150 ^ DoO is As owner of the above described property. I knowledge that the septic system serving this residence is sized for a 3 bedroom home, or a design flow of gpd. The design flow is calculated by assuming 150 gpd for 2 individuals per bedroom. There are currently occupants living in this residence: Ai occupants are permitted based On the design flow. Therefore the septic system serving this residence is code compliant. However. I understand that If there are intentions to exceed the number of permitted occupants, the system will need to be modified to accomodate any increased wastewater flows and/or contaminant loads 1 also acknowledge that 1 will make this information available to any future parties interested in purchasing this property. Dated this vC.J y of .Ja yLyary AUTHENTICATION Signatures) autheniteated tMa day of ACKNOWLEDGMENT STATE OF WISCONSIN ) )ss. SL Croix County. Personally came before me this a day of dd^ v cZ OC A.. the ab� nae�e, P. eefet TITLEMEMBER STATE BAR OF WISCONSIN. 1 •'� to me known to be the persons) who exewmth d e foregoing (II not, y.►••, .1, ! 7instrument and acknowledge the same. authorized by § 706.05. WIa. Sta THIS INST RUMENT WAS¢RA'P�Aey ^� To Z l 1 GV%, P 5te4l!y ra 4 Q- Q rc Notary Public. Stale of Wisconsin (Signatures may be authenticated or acknov.4sdg�e.r Both are not My Commission is Permtrmnt. Isrgl, sole expiration data: Date: _ nsosssary.) 'THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE** This in/ormafron must be completed by submater locum rnr this, name A rel m addrsa5, and EM (if re4utmd)_ Other mformaaon such as the granting clauses, feagaf descnPbon, etc. may be Placed on this first Page of dw document or may be Placed Orr addltionel pages of 'heording lee documoht. Not*: Use of this cover page adds one Page to your document and ,f2. 00 f the me WJsconsin Srefufos. 59.57 7. SIDEWINDER" Chamber High Capacity Model Side Vi �� 75' — End view t c > � 7 a SL/ 34. -o Product Features • Lightweight units offer easy assembly and installation. • Fully -lowered sidewall provides maximum infiltration. • Open chamber bottom allows additional infiltrative area. • High -density PolyTuff polyethylene construction guarantees strength and durability. High Capacity Sidewinder Chamber Specifications Size (WxLxH) 34'x75'x16' Storage 115 gal.l15.3 W Weight 32 lbs. 7r'4 a DVICX' r% f s A 3' r- v`' o .ri d_ I t i i �., ra V t` i (A 3 to I� �f SIDEWINDER Chamber High Capacity Model Side Vi 75' - End View 3, 76 Gl s :! r a n 34' 4.� Product Features • Lightweight units offer easy assembly and installation. • Fully -louvered sidewall provides maximum infiltration. • Open chamber bottom allows additional infiltrative area. • High -density PolyTuff" polyethylene construction guarantees strength and durability. High Capacity Sidewinder Chamber Specifications Size (W x L x H) 340 x 751 x 160 Storage 115 gal./15.3 f 3 Weight 32 Ibs. �n 00- CDC � ~ I V` i i � 1 ' I JRN-23-2002 10:52 RM R.C.E. Soll i Sic• Eual. 713 240 7764 P.02 R'b Pic tie o9j, /�Jen SEelek�. M wfl//ir *V.0 /old . Jt . Gw•,c G.,�.J/. 4 of Jcm6,.Ac"lw- Ir %/Ili.40.' F i•St/ I _J Ain � bl ���Shc si.ar�ba, sYl�wl. pur(-j)trvs tAls-a/ �O .in�i�ford //v b'sw.c� g. 3&Cj JAN-23-2002 10:32 AM A.C.E. Soil & Sitw Eval. 713 248 7764 P.01 .1. C.L. Soil $ Site LaalU40*0M JaPIWAK 77eoll"On Plumbing Inspector Beene *4819 Cer• Soil Teeter llceme #3aO2 Fax Transmission To: Fax #: 7/S— 3 P6 ' S1lo YG From: JimThomoso ] a >~ Sniff & Site Eya_itlatiOnB _ Fax #: r71 s»4a - 7764 U-Paeea includine cover sheet_ If this repurl is incomplete or illegible, please contact Jim Thompson at telephone #(715) 248 — 7767. pd Plej /6I Z113iy 1488 Wisconsin Department of Commerce SOIL EVALUATION REPORT Pape t of 3 Division of Safety and Buildings in accordance with Comm 85, Ws. Adm. Code A C.E. Sol & Sas Evaluations Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St cmb( include, but not limited tor vertical and horizontal relerence point (BM), direction and p I.O. — percent a", scale a dimemsias, north arrow, grid location and distance to nearest road 020-1125-30-000, iDM 7.29.19.569 Please pArrt all lnformaidon. - - -Dde — Personal ftiriubon you provide men be used for secondary wposes (Pmacy Law. s. 15.04 (1) (m)). Property Owner Properly Location Jo Elan Steele Govt. Lot NW_1/4 SE 19 S 7 T 29 N R 19 IN property Owners Mailft Addfsas Lot / 81ckf Said. Name or CSW 356 Miller Road _ 40 Plat Of Eagle Ridge City State Zip Code Phone Number City ViNege © Town Nearest Road Hudson WI 54018 715-386 Hudson Miller Road J New Construction Use: 16 Residential / Numbar Rr Code derived design flow rate 600 GPD yf Replacement J Pudic or co mrercial IZIGLTIFTow Parent material Glacial outwash aD a inns Flood plain elevation. if applicable na General co orients ST CROIX and recomrTIendations: Install high capacity infiltrators a = 92.25hWlQiivaNe to allow future use hydraulically failed system. Additional tank capacity and eftlu r reeddr' OFFICE � J Boring 9� Boring# d Pd Grrwrxl Surface elev. 97.06 Wrrrrlrg factor > 110' in. Sot Apptieation Rate Horizon Depth Dominant Color Redox Description I Ted" shchre Cdsistence Boundary Rods 1 0-12 10yr3/3 none slfll lmsbk mfr cs 2f 0.0 0.0 2 12-23 10yr5/4 none sd - - 1 thin pl mv(r gs 1f 0.2 0.3 3 23-80 1Oyr4/4 none as 2msbk mfr cw 0.5 0.8 4 50-67 1Oyr5/4 none -- sfs,lfe 0sg,2msbk ml,mfr gb 0.5 0.9 4k 42.-- `q.q>� 5 67-110 10yr5/4 none strat s Osg ml 0.5 0.9 l� an unaorW miland Ong a,2m" fs, $ ns 1r5. Loading rate reflects most restrictive sal condition encountered. 3t.'ty� 1 I1ng x Cob r:mmA RrnriarnAnv itd.91 tt. rloJh In lirnifim ixlm->W-._In. Shc AooNratan Rate Horizon DqM Cda Redox Description Tmdue SWchxe Consistence Boundary Rods GPD/ft' 'Efhr1 'Eff#2 1 0-12 1OyrJr'3 none - none 81 si gr. is gr. s Ifs shish s 2fsbk 2fsbk Ogg Osg 2msbk Osg mfr mvfr ml ml ml ml cs gs aw aw aw 21 0.5 I 0.2 - 0.7 - 0.7 - 0.5 - 0.7 0.9 0.3 1.2 1.2 0.9 1.2 2 12-24 1Oyr5/4 3 24-28 7.5yr4/8 none 4 28-44 1OyrW4 none 5 4448 1Oyr8118 10yr5/6 none 8 48-98 node Efnuent *1 = BOD ? 30 < 220 mg/L and TSS 30 < 150 mg/L • E = BOO 5 < 30 mg/L and TSS <_D mWL CST Name (Plow Print) S uns CST Number James K. Thompson 3602 Address A. C.E. Sri & SNe Evaluation a vaMarian ConducMd TdWhow Number 340 Paul lake Lane. Osceola. Wl 1020101 715-248-7767 Property Owner 3o Elm Steele' pay p # 020-1125-30-000. IDS 7.29.19.569 Page 2 of 3 80nng # • Ground Surface ebv. " 97 � Pit .55 fL NO to limiting factor > 101" in. SolAWkation Ho zon Deo Dominant Cola Redar Description Tathse SVdcWm Consistence Boundary Rods GPDM'Ei(#2 1 2 3 0-9 10yr3/3 9-21 10yr514 2130 10yr414 none b 1fsbk mvfr mvfr cs 21 gs 11 ew - grr - 0.7 1.2 none - Is i fsbk 0.7 1.2 none sl 2msbk mfr 0.5 0.9 0.7 .2 0.7 1.2 4 30-71 10yr5/4 none s 099 ml 5 71-101 1OrS14 none strat. s on MI 8 5 contali 1' bands of 7.5yr4/4 0 sg is at 10' -1B" irMervels. An Jir9 does not radios inflltrallon 10 a degree that would reW" rod+cson of 100*9 rate. ❑ Boring # Boring Pit Ground Surface elev. R Dep1h to limitirg factor in. Sod gym RW Horizon DeW Danarant Color Redox Des "on Tddure Stnwiae Consistence Boundary Rode 'Eff#1 'EIf#2 ❑Bonng # • �9 t0 limiting(aster In. ® Pp Ground Surface elev. ff. Depth Sol Appicatim Rate Horizon Depm Dominant Cola Redox Description Teen Sbuch a Consaterm Bourdery Root GPOMF •Eff#1 'Eff#2 Effluent #1 = BOO s> 30 < 220 mcA and TSS >30 < 150 mgrL ' Effluent 02 = BODs < 30 mg1L and TSS <�0 mg1L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format. iolem contact the deeartment at 608-266-3151 or TTY 608-264-9777. We+•'` 1W 7 � /1�X51 �,S�i/ az&raEi spom. Sr 5+e,,., a Isµ = 91. 78' /-- welf O 1 a/n L 1 /'[SidtKeL av ,��� �' Ro�secl rcp ICicemaiE ..� �_So:l abao�060., SySE�In ,� Facr(�tlenc�es�/ /0 0 ■ So, / o.6 u a &cr) /J-6 E(c ✓a Eon ICl/c:/:gyp'✓ irli R c a, Tc Me', SEee /e '-Vio. 3 S6 M;//! l- Qd. , /oE /0,, p,6 f Coe Ev/e A-#e, A,ciscn, .St • GO i,( 4 , Cj /. r, J . 3o(3 Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In -Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on rile at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In -Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number 99 bfi Number of Bedrooms Design Flow - Peak (gpd) 45� Estimated Flow - Average (gpd) av Septic Tank Capacity (gal) U u D Soil Absorption Component Size (ft') Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absor tion Component Design Flow - Peak (gpd) p Maximum Influent Particle Size (in) 1/8 Maximum BODS (m /L) U 220 Maximum TSS (mg/L) S U 150 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once eve 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se k and outlet filter shall be assessed at least once every 3 years by inspection. T utlet fil r shall be cleaned as necessaryto Qnsijrp proper operation. The filter cartridge s ou not be removed unless provisions are made to e am so i s m the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being In full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the Interior of the tank may be difficult or Impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual Inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. K Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. When system fails, we will replace with another system at owner's expense. Alternate area must be left undisturbed. St Croix County Zoning Office 386-4680 Boumeester & Sons Excavating 386-9020 Tri-County Sanitation 386-2130 3 Owner/Buyer Mailing Address Property Address ST Clt01X COUNTY SMITIC 'TANK MAINTENANCE A(HU --MUN l' AND OWNERSHIP CERTIFICATION FORM 00. „% (Verification required front Planning Department for new construction) /- City/S(ate _ u'5bA) Z1J1 Parcel Identification Number C'+jo -// Z5 -.30 c.<)c, Property Localion/'u _ %., `r y,, See. _L. '1' N R ?W, Town of 4yilcll5t:ti Subdivision Certified Survey Map # Volume Page N Lot 0 () Warranty Deed # `) S� % .�` c� Volume ��%� , page 0 �. Spec house O yes,( no Lot lines identifiable ❑ yes O no SYSIM MAINTENANCE ImpraM um and maintenance of your septic system could result in its ptemature failure to handle wastes. Proper maintenance conah><s 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 Ruwdon of the septic tank as a treatment stage in We waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a muster plumber. Journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal we 'Sin Proper optxating condition andlor (2)' r ItslsQection and pumping (ir necessary), the septic tank Is lea Um 1/3.iM11 of sludge. Uwe, the undersigned l tj.' j "i fined have read the boy ` and agree to maintain the private sewage disposal s standards sat forth, heroin, a set by the Depattraent " and the Department of Natural Resources, State of WWIsoomeim Qerdficatbo stating that yom septic syatem Iw been nuintajned must be completed and returned to the St. Croix County Zoning Office within 30 1810NAMnW0'F xp ondate. APPLICANT DATE t. . I (we) c tifj that sU statements on*EXP are true to the beat of my (our) knowledge. I (we) sm (are) the owrter(s) of �°- � abo y rttle of aNprasly deed recorded in Register of Deeds Office. / I �- / I lDI O�2 81 OF APPLICANT •'' �'` ` DATE •'•••• Any information that is mil -re Pro!!�J,�ggwll In the gsmltgry permit being revoked by the Zoning Department. •••••• •• Include with this application: a stomped. ' nrped•Vangaq deed from the Register of Deeds office a copy of dw certified survey map if reference is made In the wrnranty deed Title St. Croix County Occupancy Affidavit M tC*l*6-L- Arib ::11D CIL6,13 4 tF Name — (Owner) Typed or printed being duly sworn , states, under oath, that: 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume I M I Page lD Document NumberSw257-St. Croix County Register of Deeds OfTce: A parcel of land located in the MVIr'/. of the6_ %. of Section T _2cL N - R 14k W, Town of A% hSWJ , St. Croix County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or detailed legal description): �,.,+ * L'O of ESL& QlO(i6 Address p 2_0 — )12 5 — '�D — eco Parcel Identification Number (PIN) As owner of the above described property, I knowledge that the septic system serving this residence is sized for a 3 bedroom home, or a design flow of �gpd. The design flow is calculated by assuming 150 gpd for 2 individuals per bedroom. There are currently _ occupants living in this residence; -- occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modified to accomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I Will make this information available to any future parties interested in purchasing this property. Dated this day of AUTHENTICATION Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY r e ACKNOWLEDGMENT STATE OF WISCONSIN ) �s. Croix County. ) Personally came before me this day of the above named to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. If not, state expiration dale: necessary.) Date: "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" This irNamation must be completed by submitter document titlename d return address and PI (d required). Other information such as the granting clauses, lesgal description, etcmay be placed on this first page of the document or may be placed on additional pages of (he document. hMC Use of this cover page adds one page to your document and $2.00 to the recordinc fee. Wisconsin Statutes, 59.517. ST. CROIX COUNTY ?.LINING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTTNG SEPTIC TANK This is to certify that I have inspected the septic tank. presently serving t.he JoL%%eal Sfeeip residence located at: , '..) & kt Sec. "L_, T_,A1y_N, R_L!Y W, Town of _,gLs-_AL__--_- - , St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condi ion and it appears to be functioning properly. Last time serviced U Did flow back occur from absorption system? Yes--_ tJo-�< (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel _ Other _ Manufacturer (if known): �(�(►� __ _ _ .__ _ _ Age of Tank (if known) : (Sig ture) MKS (Title) 11 0a (Date (Name) Please Print 4jc-.�90 (License Number) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wincunsin 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, ifije_e� Signature _ MP/MPRS QQy __ A RURAL SUWYMM LOCATED IN THE SE A OF 5EUI lum A it! KALE 0 es PC4N EC es Iv im 4 rmmm-- -- --- REGISTERED LAND SURVEYM DATE THIS SOT" Off of f TEm8E&19.m37 ��.l nmpmwv TWIN Romm " ma Auvc• A-mv VAGAUD ftN't vmt 1A 4k, .e* `14 Ja W-11 V SCVMW TIES gOTH bAy Cir OCTOBOV" I .o�R_T!Ejkl). 1;mY.r.TuYj1;.j. I .111M.. iVOLUME I PAGE 176 2 It 4 1 .... 40 WPS S93 ' 3 I.$$ ACR95 2 to &61 ACRES 0, SOS a go, ATTED. slur I lft-� virt ,�Mwk; 47 50 i -1 w k k 4 'b\ 2.70 ACME& r• TQ. Form -STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER :541W /f �G� TOWNSHIP / ieg / Sp/7 SEC. % T �N-R /cI W ADDRESS, l .8QY Z 25 Z_ ST. CROIX COUNTY, WISCONSIN l &4t 5Q4 11!Vy 5- - --- r i D•J_- 1AT -4�Llh yes 1.823PA;E 27 St. Croix County Occupancy Affidavit iM tC,t*6.L- mil, Jo ElL6+a cj�e� Name — (Owner) Typed or printed being duly sworn, states, under oath, that: JAM CT• V 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume 1191 Page iTfi Document NumberSt. Croix County Register of Deeds Office: 669303 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 01-25-2002 9:30 AM ZONING AFFIDAVIT EXEMPT CERT COPY FEE: COPY FEE: 2.00 TRANSFER FEE: RECORDING FEE: 11.00 PAGES: 1 Name and Return Address A parcel of land located in the Nld'14 of the6_'/. of Section Jp Etle P 51 eAe T� N - R �9 _ W, Town of A%ub5 10 St. Croix �� M't� eF k3, County, Wisconsin, being duly described as follows (include lot no. and sayl 54V I subdivision/CSM or detailed legal description): `,..+ * Lb nF Elq-,L& P'l t46, 2,0 — 112 5 — 7�D " 000 (PIN) As owner of the above described property, I knowledge that the septic system serving this residence is sized for a 3 bedroom home, or a design flow of wgpd. The design flow is calculated by assuming 150 gpd for 2 individuals per bedroom. There are currently _ occupants living in this residence; AQ occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modified to accomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. Dated this ohs y ✓tl(a�I 2 _. A _ i • AUTHENTICATION Signature(s) authenitcated this day of * ACKNOWLEDGMENT STATE OF WISCONSIN ) )ss. t. Croix County. ) Personally came before me this °� day of Jam^ ` Q°"T a oa 31- the above named Jo e(le-A P. S'leeie TITLE: MEMBER STATE BAR OF WISCONSIN,'% (If not to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stag.)" •+ti �r - _ instrument and acknowledge the same. THIS INSTRUMENT W" [)RA Ray L" �. SoF,)lgw� p- <T— a e 02 F 1�1.cc' • , Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledgAd.i Both are not My Commission is permanent. If not, state expiration date: necessary.) Date: 1- a - -;Z00 3 "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" This infomlation must be completed by submitter document title. name 6 return address. and PIN (if required). Other information such as the granting clauses, leagal description, etc. may be placed on this first page of the document or may be placed on additional pages of the document. Note. use of this cover pegs adds one page to your document and $2 00 to the recording fee. Wisconsin Statutes. 59.517. kLncluue Enit3 1111ULW4L4u1& UL Luc aVvvc Pav1. LCLCLCttCC uLAtcOaavOa w acts•.-.. •eo..s SEE REVERSE SIDE PUMP CHAMBER NA Manufacturer: Pump Model: Elevation of inlet: Liquid Capacity: Pump/Siphon Manufacturer: Pump Size Pump off switch elevation: Alarm Manufacturer: Bottom of tank elevation: Gallons per cycle: 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 ABSORBTION SYSTEM Bed: �� 3 �_ Trench: i Width: �� Length: 3 Number of Lines: -'7) Area Built: 4-L Fill depth to top of pipe: q Z Number of feet from nearest property line: Front, O Side, O Rear,® Ft. 3l0 Number of feet from well: O < Number of feet from building: Li S ' (Include distances on plot plan). SEEPAGE PIT /Y A Size: Liquid depth: Area Built: Number of pits: Diameter: Bottom of seepage pit elevation: Has either a drop box O or distribution box O been used on any of the above soil absorbtioq sytems? (Check one). HOLDING TANK NA Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of.feet from building: Number of feet from nearest road: Alarm !!.anufacturer: Dated: Ll --C� Ll - ? �/ 3/84:mj Inspector: _ Plumber onjob: 3 License Number: 110 C MA¢)K INDUSTRY, Y,OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION L,A13OR-AND P.O. BOX 796 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 6307 (H63.09(1) & Chapter 145.045) ;. RATING: So site s - ' I for system U- Site smaoit ible for system Se, D4 .Q Arc o Q_ s Fill- MQ S• OU IN ®S aU ❑ SYSTEM®� LrOS ®1TANK: RECOMMENDED AMENDED SYSTEM: (optional) 'X 6 1 )] If Percolation Tears we NOT rettuired DESIGN RATE: If any Portion of the tasted area is in the under s.H63.091611b), Indicate: MIA Floodplain, indicate Floodplain elevation: PRpFIV DESCRIPTIONS BORING NUNS ELEVATION R BS V D ATER-iei@H!� A T L N H TO BEDROCK IF OBSERVED (SEE ABBRV ON BACK.) B_ / 7119 1 /0.j: /'r oAKe- 7 %.�' / .3 & / , 6 ffn S . 3 6ti IS ar 1 S B•3/ . s' e / , o s / s: 7 s B' 7 2,S" .3r OA[L 7 �•4 • . is Aft 6 • .S/ . S .aZ S B. '7,S' oS, o L '%�' . (v B/S.'/ .S / .3 d s w 3.6`Li /X, PERCOLATION TESTS TEST NUMBER p P Hr s oomell . 1N HOLE AFTEHSWELLIN TEST TIME INTERVAL -MIN. W RATE MINUTES PER INCH PFRInn tPERIU03 • o .s Of// / s P. z c s .2,'14f a 3 P. .sT . A10 L P_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate sale or distances. Describe what are the horl zonal and vertical elevation reference' points and show their location on the plot plan. Show the surface elevation stall borings and the direction and psrarlI of land slope. SYSTEM ELEVATION to gay I I I I 1 �ofi ICdr,Iieio .. Ste :yi is L I 1, the undersigned. hereby arNfy that the soil Mats reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the date recorded and the location of the tests are correct to the best of my knowledge and belief. 1 OISTRISUTION: Original and one copy to Lncal Authority. Property Owner and Soil Tester. DEPARTMENT OF IN DIISTF#Y; . LABOR AND HUMAN RELATIONS REPORT ON SOIL BORINGS AND PERCOLATION TESTS (115) (H63.0911) & Chapter 145.045) Ai y iE NO. B : C �AesidenEx New El Replace A1V AiAP A DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS P.O. BOX 7969 MADIrON; WI 53707 ICI CONVENTIONAL El ALTERNATIVE ❑ Holding Tank ❑ In -Ground Pressure ❑ Mound r.>m1iIIIIII111111111 1 SAFETY & BUILDINGS DIVISION BUREAU OF PLUMBING Scale PIin 1 D. N.mW, DI It NAME OF PERMIT HOLDER 4DDRE55 OF PERMIT MOLDER INSPECTI`O,Nj1AT Sam Miller R. R. 1, Box 282, Hudson, WI 54016 BENCH MARK IP.,.vm reluerme pomp DESCRIBE IF DIFFERENT FROM PLAN REF PT EL V. ST REF PT ELEV NW SE, Sec. 7, T29N-R19W, Town of Hudson, Lot #40, Eagle Ridge Alt W- 4.m. nl Pwmnn MPIMPRSW N. C.,Y PH—, Numbs Douglas Strohbeen 5432 St. Croix 49429 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY TANKINLETELEV A KO TLET ELEV ARNING L4 L PROVIDED LOCKING COVER PROVIDED r a VES ❑NO ❑YES ❑NO BEDDING VE VENT MAIL HIGH WAT R NUMBER OF ROAD ROPERT % WELL BUILDING FRE H AIR LLEEVENT T n ALARM FEET FROM YES ONO v' ❑VES O NEAREST DOSING CHAMBER: u.waer n'RFw I RF nnING LIOU ID CAPACI Tv IPUMP MODEL IPLJMP SIPHON MANUI AC T ()HE II WARNING LABEL LOC K INGCOVER ❑YES ONO ❑YES ❑NO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING Y NT TO FRE H IDIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES FIND NEAREST SOIL ABSORPTION SYSTEM. Check the soil moistureat the depth of plowing LFNGTH DIAME TEH MATERIAL AND MARKING or excavation. Ilf soil can be rolled into a wire, construction shall cease until FORCE the soil Is dry enough to continue.) MAIN GUNV tN I IUNAL SYSTEM; cm: WIDTH LENGTH NO OF DISTR PIPE $PACINL V INSIUE DIA PITS LIQUID DEPTH BED/TRENCH //�� 3 RENCHE / MA PIT DIMENSIONS . AV L D PTH V FILL DEPTH UI TH PIPF `J DISTR PIPE DISTR PIP MA RIAL NO DISTR W UMBE DF ROPE Tv WELL tlUILOING VENT TO FRESH Al INLET BE LOW PI4`$.� tlUVE VER ELEV 'jl'1 ELFTL,EN PIPE FEET FROM LWE • 2 /� /�11JI 5 F •E�11; F NEAREST muuNu a T a I cm: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ONO ICENTER Sketch System on Reverse Side. SIGNATURE DILHR SBD 6710 IR. 01/82) I DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 1R. 02/82) — OVER — Retain in county file for audit. ❑ YES u INSTRUCTIONS FOR COMPLETING FORM 115 - SBD 6395 To be a complete andhd[e Soil test, your report must include: 4 �] ` 1 . Complete legal description; .2; The use section must clearly indicate whether this is a residence of commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new of replacement system; 5. Complete the suitabiltty rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; P. PLEASE a.e ih<, %, )UIEAPI t .l;i ; ",. II 11•:I e f'or cal IUng pr'lillr: dt•scnptlons and comnll•tinq the plrlt plan; ?. MAKE A I I tll;tgrtrn arr:wat:;IY locatitrl yO;r test loc;n;rnrs. D;uvv;ng to scull: 1. I,,, 'card. A. sepa i'e sl;l•et may he cn.atl It rlt'siletl; 1)" hill .,I'll '. ,1 l�l� "'-:.I; I',: I �i' 1'1 I(:I' �1,1�1 t •111' iil i; ii,, ;.I1\1_11, •111(i III IttI 1111 I n; )l I riy o IIWA J tIl II.'t 0S nil11 l1( I(1, , ,i ��I I��,i'�II rl,l �I. II-D I,I 11 o?) {rl `inn• , q,I Ir,)I]•..;t r� 'll. � _. I .. u'11 ;. i �..I I'3111. P F!'•I tlOn) dJ :S nrt! (IUniy. ..' 1'J Ii. I" � I I.�,I I; �I!��A ti--c fc•• m and Id,,rr• yt -c iinrnt irldlev. ind ywji certlflr,itun(i nurnt). _ arni distnbute :;s req.nrett. ALL SOIL IFSCS '.1UST BE FILLD l:lTll 17HE AFFRFVIATInNS FOR CERTIFIED SOIL TESTERS ? _ Spit ti�:p uht•<.:11d IcKtulrs .Uth l`r Synlbnl. , . b ; 1 ;!1 0 Cry L.1x.. „„•I ......, \ ."3.te LbTtU•V� ^i .l TO THE OWNER: . Irl;rn' „:ne III>t :.I •!1 n .�.rlrnu. .1 ran'taly Ilcrm t h.• cmmty n 'h� D�•I1:, rt mn nl rn.r� �.. nrn,.,t i�l "rl:"� I S., ,. i . f �1.41:H T♦� ::'r" �, �! �'.L; 'I t 5 AIM M ] LLiR EALLE R?DBE L o� i' L 94 flous4L- �gxSD B.m. 5 4,kiL u&,t - - µbv,-L 1Ldc ?o, +h` S.u/. LoA ConQ1 1)0, O� A Lo-f P;Re-_ pi-DMP:Qd_� 1 0 0 %-(L 01\` SL,'A o,,blJ. A( a S (jk SAM M I.LLa- EA�LIE QI 6) Lt)-r S.�STEM L01-z 10\t% ✓eAt / �51lau1(A%/ 3o31, So1�il F,�C- y,7a.e* IL o xY`Gt3�- Kq 0 00�,c�Q 1000 6a1. STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER cam' NQ Sir ROUTE/BOX NUMBER Fire Number CITY/STATES Se-� ►. �) �� ZIP PROPERTY LOCATION:& W 1S _k, Section % , T Z'j N, R/0' W, Town of St. Croix County, Subdivision Z' Lot number . Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 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 Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Offkre within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. 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/contractgr,("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 Sc Location of Pro(plertyNW k ? E_�, Section �T Z L N - R �1 W Township b[ to Z� f, c, PZ k*jgeft Mailing Address Z k* Subdivision Name Lot Number (1 Previous Owner of Property L, „ /a R. e-k- QW.Cr'___ H ,, ! ; -/ Total Size of Parcel Date Parcel was Created�- Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes )_ No Volume 7 and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office In addition. a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) ceh.ti.6y that att wtatemen.t,6 on th.i.b 6o4m ane true to the bewt o6 my (ouA) knowtedge; that I (we) am (aAe) the owneA(w) o6 the pnopen,ty de6CAibed in this i.n6o4mati,on SoAm, by vihtue o6 a waAAnnty deed Aeconded in the 066i.ce o6 the County RegiAteA oS Deed6 a6 Document No. c� _ y ; and that I (we) pnebentty own the p4opo6ed ai to Son the 6ewage dupow bywtem (oA I (we) have obtained an m ement, to nun with the above dewcAib ed pnopenty, bon. the con6thucti.on o6 6a.id 6y6tem, and the bame ha6 been duty Aeco)Lded in the 066i.ce o6 the County Regi.bteK o6 Deed6, a& Document No. 3.7 ) . SIGNATURE OF OWNER DATE SIGNED SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED