HomeMy WebLinkAbout020-1028-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No
(ATTACH TO PERMIT) 538768 0
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Schiavone, Ted J. & Judith I Hudson, Town of 020 - 1028 -80 -000
CST BM Elev: Insp. BM El BM Description: Section/Town /Range /Map No:
GS 16.29.19.1278
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER j CAPACITY STATION BS HI FS ELEV.
Septic L it , Benchmark
e G��t�".� i. /cx�J tP
Dosing Alt. B
Z. 5 Go 1,S 99 .a
Aeration � LZL Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet I
TANK TO A P /[ WELL BLDG. Vent to Air Int ke ROAD 6 , s` . Q
Septic /ab / q.
Dosing 7 67 Z •S Header /Man.
35
Aeration Dist. Pipe
Holding Bot. System l 475. 4 1
PUMP /SIPHON INFORMATION Final Grade O
_7 4 73.
Manufacturer Demand St Cove Jar G
GPM
Model Nu L' 4 , 7 Q `
TD Lift Friction Loss Syst ad DH Ft /' Q J � at /� 7 5.7 /�,
V d/ Is.
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width / length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 -2 TI
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer c ,
INFORMATION CHAMBER OR " :17A — C 14,
Type Of System: � /t 3 � 7S f� UNIT Model Ny��; a el
DISTRIBUTION SYSTEM A-i 1 / /(
Header /Manifold if Distribution I x Hole Size I x Hole Spacing Vent to Air IIntake /(
Pipe's)
Length C Dia Length ` pia 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 L/ Z Bed/Trench Edges \ Topsoil \ 's E] No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ! ! Inspection #2:
Location: 998 McDonald Lanp Hudson, WI 4016 (NE 1/4 NW 1/4 16 T29N R19W) NA Lot 1 0 ` 7_9 Parcel No: 16.29.19.127B
1.) Alt BM Description
2.) Bldg sewer length =
- amount of cover =
i
Plan revision Required? � Yes No
Use other side for additional informati �p_�( _ _
SBD -6710 (R.3/97) Date Insepctor's ignatur Cert. No
c ou nt y : ! No: St. Croix
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Sanitary :
Safety and Building Division INSPECTION REPORT 538768 0
GENERAL INFORMATION
(ATTACH TO PERMIT) State Pla
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Parcel T Permit Holder's Name: city Village X Township
02 Hudson, Town of 0 -1 028 -80 -000 Schiavone, Ted J. &Judith Section/ge /Map No.
CST BM Elev: Insp. BM Elev: BM Description: 16.29.19.127 B
TANK INFORMATION ELEVATION DATA STATION BS HI FS ELEV.
TYPE MANUFACTURER CAPACITY
Benchmark
Septic
Alt. BM
Dosing
Bldg. Sewer
Aeration
St/Ht Inlet
Holding
St/Ht Outlet
TANK SETBACK INFORMATION
WELL Vent to Air Intake ROAD Dt Inlet
TANK TO P/L BLDG.
Dt Bottom
Septic
Header /Man.
Dosing
Dist. Pipe
Aeration
Bot. System
Holding
Final Grade
PUMPISIPHON INFORMATION Demand St Cover
Manufacturer GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
Len th No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
BEDITRENCH Width 9
DIMENSIONS
LAKE /STREAM LEACHING Manufacturer:
SETBACK SYSTEM TO P/L BLDG WELL CHAMBER OR
INFORMATION Type Of System: UNIT Model Number:
DISTRIBUTION SYSTEM x Hole Size x Hole Spacing Vent to Air Intake
Header /Manifold Distribution
Pipe(s)
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only ed
Depth Over xx Depth of xx !!ff=
[Be pth Over Topsoil Yes - ] No
dlirench C enter Bedlh Over Edges
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection Parcel No No : 16.29.19.1276
Location: 998 McDonald Lane Hudson, WI 54016 (NE 1/4 NW 1/4 16 T29N R19W) NA Lot 1
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? ® Yes [] No
Use other side for additional information. Date Insepctors Signature Cert. No
SBD -6710 (R.3/97)
an
e afty d Buildings Division County
commerce.wi.gov S St. Croix
201 W. Washington Ave., P.O. Box 7162
' Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.)
t IRconsi n
State Transaction Number /�—
Sanitary Permit Application
ission of this form to the ap p overnmental Project Address (if different than mailin address)
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, subm POWTS are
' �G��
unit is required prior to obtaining a san itary Permit. Note: Application forms fo t sed secondary Same
submitted to the Department of Commerce. Personal information you pro
p urposes in accordance with the Privac Law, s. 15.04 1 m , Slats.
I. A lication Information - Ple se Print All Information Parcel #
Property Owner's Name ( 020- 1028 -80 -000 IZ7 1) MAY Ted J. & Judith A. Schiavone Property Location
Property Owner's Mailing Address ST. cRw CUUNTY
PLANNING &ZONING OFFICE Govt. Lot
998 McDonald Lane NE ' /,, NW ' /,, Section 26
Zip Code Phone Number (circle one)
City, State T 29 N; R 19 E or W
Hudson, WI. 54016 715 - 38 - 226
PP y) Lot #
II. Type of Building (check all that a 1 l Subdivision Name
❑ 1 or 2 Family Dwelling - Number of Bedrooms 3 CSM
Block #
El Public /Commercial - Describe Use
1,u. Na ❑ City of
CSM Number
El vii a of
❑ State Owned- Describe Use Vol. 2 Pg. 400 WTown of Hudson
2 A li5 w / 4- CGS
I11. Type of Permit: (Check onl o e box on line A. Complete line B if applicable) El other Modification to Existing System (explain)
A. El New System Replacement System El Treatment/Holding Tank Replacement Only
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New ', r
Owner
Before Expiration
IV. T of POWTS S stem/Com onent/Device: Check all that appl
Non - Pressurized In- Ground ❑Pressurized In- Ground ❑ At -Grade ❑ Mound > Mound < 24 in. of suitable soil
24 in. of suitable soil ❑
❑ Pretreatment Device (explain)
❑ Holding Tank ❑Other Dispersal Component (explain) L -52 effluent filter
-4 standard
Dis ersal Area Propo d (sf) System Elevation
V. Dis ersal/Treatment Area Inform or" " dard chambers & 2 . endc s, Wieser Concrete f ter c r
Desi Soil Application Rate dsf) Dispersal Area Required (s 651 60 sq. ft. 89.50'
Design Flow (gpd) gn PP 642.786 sq. ft.
450 gpd 0.70 gpd/sq. ft.
Capacity n Total # of Manufacturer
VI. Tank Info "
Gallons Units w [
Gallons t', ;, ; Cd
New Tanks Existing Tanks 0. U Q Cn �` a
Wieser Concrete X
Septic or Holding ank N 00 1,000 1
T
Dosing Chamber Na Na Na Na
anon of the POWTS
VII. Responsibility Statement I, the un ersigned, ass me responsibility t s MPN PR Numbe ached Business Phone Number
Plumber's Name (Print) Plumb s Sign MPRS 30021 (715) 248 -7767
James K. Thompson
Plumber's Address (Street, City, State, Zip Code
340 Paulson Lake Lane, Osceola, WI 54020
VIII oun /Department Use Onlv Permit Fee Date Issued Issuing Age ignature
pproved tsa
❑ Owner ' Reason for Dent /
IX. Conditions o proval/Reasons for Disappro al
SYSTEl f
1. Se* uant filter and
di .04 must all be aoNi es t maintained
a �teinent plan provided by plumber.
2. Allner�s mtts< be maintained
o p e e p ans o'r the system and submit to the County only on paper not less then 8 1/2x 11 inches in size
SBD -6398 (R. 02/09) Valid thru 02/11
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Conventional POWTS Index & Tilte Sheet
Project Name: Schivaone 3 bedroom Replacement C onventio nal POWTS
Owners Name: Ted J. & Judith A. Schiavone
Owner's adress: 998 McDonald Lane, Hudson, WI 54016
Site address: Same
Project Location:
Subdivision: Lot 1, CSM Vol. 2, Pg. 40
Legal Description: NE1 /4 NW1 /4, Sec. 26, T.29N., R. 19W., Town of Hudson, St. Croix Co., WI.
Parcel ID #: 020 - 1028 -80 -000
Page 1 Index and Title Sheet
Page 2 Site Plan
Page 3 Dispersal Cell Sizing Calcualtions
Page 4 System Cross Section
Page 5 System Management Plan
Page 6 Filter Specifications
Page 7 Filter Tank Cross Section
Page 8 Parcel map
Page 9 Septic Tank Maintenance Agreement
Page 10 Certification for Utilization of existing septic tank
Page 11 Waranty Deed
Attachments: Soil Evaluaiton Report
Mater Pl er Restricte Service: James f Comm. Credential #30021
Thom son, De 't. o
Signature: G �---- Date: 2
Page 1 Of 11
Design pursuant to In- Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD- 10705 -P (N.01 101)
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DISPERSAL CELL SIZING CALCULATIONS
1. (3 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 450.00 Gyd design now
2. Infiltrative capacity of native soil = 0.7 gpd/sq. ft.
3. Absorption area required: 642.86 sq. ft.
4. Absorption area as proposed: 651.60 soft (32 chambers total)
Infiltrator "Quick 4" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4" end cap (pair) = 5.80 sq.ft, EISA
642.86 sq. ft. — (2 pair endcaps)(5.80) = 631.26 sq. ft.
631.26 sq. ft. /20.00 = 31.57 chambers required 2 16 chambers per trench
Number of trenches:
Trench width: 2.83'
Trench length: 66.00'
Trench spacing: 9.00' on center
Total system area w/ 6' trench spacing: 12.00'x 66.00'
Pg. 3 of 11
1
Soil Absorption System Cross Section
y3.ce
9V 36 ' ft
Final Grade
4° Schedule 40
PVC Vent Pipe
With Vent Cap �_ 9o.50 ft
Leaching --►
Chamber 8�. SO ft
System Elevation
.2-83 ft 6
Soil Absorption System Plan View
(,4,ZV ft
2.93 ft
i
(p.00 ft Leaching Trench 1
Vent Or Observation Pipe Chambers
4" Dia.
Trench 2 Header
Leaching Chamber Specifications
Manufacturer And Model '��ra- Q ry
EISA Rating sq ft per chamber Soil Application Rate 0•70 gpd /sq ft
4So•CI) gpd Design Flow T 0.70 Soil Application Rate + 20.67 EISA = ,32. eO Chambers
2 rows of __L!�_ chambers each.
Page of
f�. 'off'//
Conventional Septic System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained
in accordance with component manual SBD- 10705 -P (N.01 /01). All local and/or state rules pertaining to system
maintenance and maintenance reporting shall be complied with.
Septic Tank
Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with
bottom of tank to be <_ 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be
assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in
the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR
113, Wis, Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are
not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be
needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank
that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be
serviced if the alarm is activated. Septic tank manholes 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 individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank
abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS
component. The addition of.biological or chemical additives to enhance septic tank performance is generally not required. If
such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings
Division.
Soil Absorption Cell
Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should
be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for
vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface
within and above the system and will promote frost penetration during cold weather months. Cold weather installations
(October- March) dictate that the system be heavily mulched for frost protection.
Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not
exceed maximum design flow specified in the permit for the installation.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the
owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring.
Effluent flow shall be alternated between dispersal cells on a two- year /1 -year schedule by use of diversion valve.
Effluent to be diverted from new dispersal cell to old cell at 4 year anniversary of new system installation. Old cell to be
utilized for a 1 year period. Afterwards, effluent dispersal to be alternated between cells on schedule to allow use of new cell
for two years and old cell for 1 year.
Contineencv Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil
absorption cell to bring the system into proper operating condition.
Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715)
248 -7767 or the St Croix County Zoning Department at (715) 386 -4680.
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S t, Filters
i
PL -525 EFFLUENT FILTER ( OMML`R *JA10
Polylok, Inc is pleased to add its
new commercial filter to its existing
line of quality effluent filters.The
PL-525 is rated for over 10,000 GPD Alarm
(gallons per day) making it one of accessibility- ---- -- Accepts PVC
extension handle
the largest commercial filters in its
class. It has 525 linear feet of 1/16"
filtration slots. Like the Polylok
PL -122, the new Polylok PL -525 has
an automatic shut off ball installed 525 linear feet
with every filter. When the filter is of 1/16
removed for cleaning, the ball will filtration slots Rated for over
float up and temporarily shut off 10 ,000 GPD
the system so the effluent won't
leave the tank. No other filter on
the market can make that claim! Accepts 4° & 6" n
SCHD. 40 Pipe 7
PL -525 Maintenance:
�U
„`olt
The PL -525 Effluent Filter should
operate efficiently for several years `2
under normal conditions before tK
requiring cleaning. It is recom-
mended that the filter be cleaned
every time the tank is pumped or ;
at least every three years. If the
installed filter contains an optional
alarm, the owner will be notified
by an alarm when the filter needs '
servicing. Servicing should be Gas deflector
done by a certified septic tank Automatic shut -off
pumper or installer. �� ball when filter
is removed
1. Locate the outlet of the U.S. Patent No# 6,015
septic tank. 5,871,640
2. Remove tank cover and pump
tank if necessary. PL -525 Installation 1. Locate the outlet of the
3. Do not use plumbing when septic tank.
filter is removed. Ideal for residential and com- 2. Remove the tank cover and
4. Pull PL -525 out of the housing. mercial waste flows up to pump tank if necessary.
5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the
4" or 6" outlet pipe. If the
tank. Make sure all solids fall
filter is not centered under the
back into septic tank. access opening use a Polylok
6. Insert the filter cartridge back Extend & Lok or piece of pipe
into the housing making sure to center filter.
the filter is properly aligned and 4. Insert the PL-525 filter into
completely inserted. its housing.
7. Replace septic tank cover. 5. Replace the septic tank cover.
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FILTER CANISTER DETAIL SCALE:3 /4" REV N0. DATE:
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N MIERER coRCAETE
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m DRAWN BY:SWT
Z SEPTIC MANUAL W3716 US HWY10. MAIDEN ROCK, WI 54750 DATE: JANUARY 2008
J \° REV. JAN. 2008 800 - 325 -8456 FILE: SHEET 13
p 7WH
l 1
1X 977 APPROVAL OF THIS MINOR SUBDIVISION
DOES NOT MEAN APPROVAL fOR SEPTIC
N 1/4 CORNER
NW CORNE SECTION 16
PLATTED
..SECTION 16 268.13 TZ9N R19W
UN
PLATTED R19W S 89° It' 04" E LAND„ N as °Iloa'
- - --8
165.00' v. 33.00'I I
APPRdi 440.137'E 00 NORTH LINE OF NW 1/4 ^�
6', 0 6 6 1
JUN 15 1977 ° 61, °'
POINT OF 33' 33' I
sr. CROW C OUNTY LO: BEGINNING
C =1T9N S WM Tt e r z : o
Z Q� J : 0 0 I V7:
100' 0 100' X o:
z'
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U- Cr
OWiCR H:� d 3 O I
CLARENCE 0. ROTHE F':- O I p w o
R. R. #2
HUDSON, WISCONSIN 54016 a : 0 1.01 ACRES O Z z I
O H- N I F-:
z N O
SURVEYED FOR z L9 (n � I O I < :
:
DARREL ROTHE — I— 0
635 ORANGE STREET
Z:
Ln PRESCOTT, WISCONSIN 54021 v :D: w TRU E
SURVEYED BY N E N W 3 Z BEARING
OGDEN ENGII�IEERING CO. _
123 E. ELM STREET �i9°
RIVER FALLS, WISCONSIN 54022 _ I
M X
LEGEND °h 0, O I
I LLJ
COUNTY SECTION CORNER 165.00' � 01, N1ONUMENT, FOUND, BEMNTSEN CAP I
0 1 "X24" IRON PIPE WEIGHING 1.68 # / N 89 0 1 1'04'W
LINEAL FOOT, SET. 6 6' 1
UNPLATTED LANDS I
- --X — K EXISTING FENCE LINE 33 3 3' I
DESCRIPTION
A parcel of land located in the NE1 /4 of the NW1 /4 of Section 16, T29N, R19W,
Town of Hudson, St. Croix County, Wisconsin described as follows: commencing
at the N1 /4 corner of said Section 16; thence N89 ° 11 1 04 "W (true bearing) 33.00'
along the North line of said NW1 /4 to the point of beginning; thence SO °04'58 "E
266.00' along the West right -of -way line of an existing town road; thence
N89 0 11 1 04 11 W 165.00 thence NO ° 04'58 "W 266.00'; thence S89 °11'04 "E 165.00' to
the point of beginning.
I certify that the above description and map are correct and that I have fully
_ .. r n_ - mac 7 n .-.t +I- — hi4.- . -.-. —, q— Q+o+ 4 ariA
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner u ,.1 s tK A. S e- Anne
Mailing Address C o
Property Address
(Verification required from Planning & Zoning Department for new construction.)
City /State
Parcel Identification Number
LEGAL DESCRIPTION
Property Location Y4 , I�� /4 ,Sec. ��, T �N R_
W, Town of ,�cc.ra�Sor�
Subdivision Plat: X2 _, Lot # �.
Certified Survey Map # 3 y1 , Volume , Page #
Warranty Deed # 1 5 c 12 9� (before 2007)Volume #
Spec house 11 yes n®' o Lot lines identifiable El yes U10 o
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & 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
wastewater disposal 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 Planning &
Zoning Department within 30 days of the three year expiration date.
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.
Number of bedrooms
lat IN
GNAT OF APPLICANT(S) 4 DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 09/07)
ST, CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) M �,��,., �,/� located
at: ' /4, "2Gc)' /4, Section Z(, , Town 2-�? Range W,
Town of sue„- -, , St, Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of Comm. 84.25, and it (they)
appear(s) to be functioning properly,
Most recent date of inspection or service Oc &&4 -
T
Did flow back occur from absorption system? Yes No
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity: 116&�91
Construction: Prefab Concrete Steel Other
ivlanufacmrer (if known): uJ eSel con c,� .
Tank (if known):
Permit timber (if known)
_ icensed Plumber Sig ature) (Print Name)
z� P f9PP *,3
,T le) (License Number) W /MPRS
A
(Dat
Form to be completed bylicensed plumber (Dept of Commerce Chapter 5
�I!1d s, 145,06 Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin
.Administrative Code)
• ii STATE BAR WISCASIN —1982 �' S929S7 `Z
WARRANTY DEED I KATHLEEN H. idALSH
DOCUMENT NO.
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
Neil A. Abrahamson and Janice C Abrahamson, r 12-03 -1996 2:25 PM
as his wife and in her own right
WARRANTY- DEED -
EXEIIPT 0 17
CERT COPY FEE:
conveys and warrants to Ted hi Avon rid i tdi h A COPY FEE:
Schiavone, h tabnnci and wi f , as surcri vnrchi n TRANSFER FEE:
ari -tal- 12-rnpevty. i�.. REC ORDING FEE: 22.00
PAGES:
I
l
THIS SPACE RESERV FOR REC ORDING DATA
NAME AND RETURN
the following described real estate in - :;t _ rroi x County, 11 ff ``77
State of Wisconsin: f
l
020 - 1028 -80 -000
EI PARCEL IDENTIFICATION NUMBER j
�I
I:
(See Attached Exhibit A)
This deed is in complete satisfaction of that certain Land Contract between
the parties hereto dated September 24, 1993 and recorded September 24, 1993
in Vol. 1036, page 433 as Doc. No. 506076.
This is not homestead property.
(tr)X (is not)
Exception to warranties: Existing highways, easements and rights of way of record.
November
Dated this
day of A.D., 19
I
(SEAL) (SEAL)
" • Neil A. Abrahamson
(SEAL) �4w�c��f'�. (SEAL)
i ■ Janice C. Abrahamson
i
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of eXAV",FLORIDA
} ss.
Et County JJJ_
authenticated this day of 19 Personally came before me this J day of
Novemhpr , 19��, the above named
Neil A. Abrahamson anti Janice
Abrahamson, husband and wi
TITLE: MEMBER STATE BAR OF WISCONSIN
(if not,
authorized by §706.06, Wis. Stats.) to me known to be the persor8 who executed the foregoing
instrument and acknowledge the sa e.
THIS INSTRUMENT WAS DRAFTED BY
Attorne J tre n �/�� iQT -
304 Loci, , H tdson, W1 54016 Notary Public, L '= 64 Countpg FL
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (if not, state expiration date:
necessary.) 19 O )
�...
_ •r_ l�W =IMI&SIDAI /.S:C 67400➢ . .
• Names of persons signing in any capacity should by typed or printed below their signatures. = DfPIRES:
on OctobM 26, 2001
STATE BAR OF WISCON51 i` A•'. ,4 ,. Bded 7iltU Notwy PtONc Old. sin teGal Star* Co.. Inc.
WARRANTY DEED Form No. 2 — 1982 Milwaukee. Wis-
�. /( '��-
VOL 1383PAcE?36
EXHIBIT A
Part of NE1 /4NW1/4, Sec. 16- T29N -R 19W described as follows: Lot 1 of Certified Survey '
Map filed June 21, 1977 in Vol. 2, page 400 as Doc. No. 340973.
AND
Part ofNEi /4NW1 /4, Sec. 16- T29N -R19W described as follows: Commencing at the North 1/4
corner of Sec. 16; thence North 89 degrees 02 minutes 13 seconds West, 198 feet along the North
line of said NW1 /4 to the point of beginning; thence continuing North 89 degrees 02 minutes 13
seconds West, 155.04 feet along said North line; thence South 00 degrees 57 minutes 54 seconds
West, 453.12 feet; thence South 89 degrees 02 minutes 13 seconds East, 327.36 feet to the West
right -of -way line of a town road; thence North 00 degrees 02 minutes 22 seconds East, 197.18
feet along said right -of -way; thence North 89 degrees 02 minutes 13 seconds West, 165.12 feet
along the South line of Certified Survey Map recorded in Vol. 2, page 400; thence North 00
degrees 03 minutes 53 seconds East, 266 feet along the West line of said Certified Survey Map to
the point of beginning.
c
i
PAID
2244
Wisconsin Department of Commerce SOIL EVALUATION Page 1 of 3
Division Of Safety and Buildings in accordance with Corn , Wis. Adm. Code A.C.E. Soil &Site Evaluations
Attach complete site plan on paper not less than 8%: x 11 inch Plan st County
include, but not limited to: vertical and horizontal referen irection d St. Croix
percent slope, scale or dimensions, north arrow, istance to nea t road. lReed
Please print in aon. ,�
0 -102 -80 -
n 000
y Da te
Personal information you provide may be u r secondary pu pjva%y4 s. 15.04 (1 m)).
Property Owner GO Location
Ted J. & Judith A Schiavone VJ \XNG Govt. Lot NE 1/4 NW 1 S 26 T 29 N R 19 W
Property Owner's Mailing Address N N\ Lot # Block # Subd. Nam or CSM#
998 McDonald Lane Pte' 1 1 CSM Vol. 2, Pg. 400
City State Zip Code Phone Number J City _j Village a Town Nearest Road
Hudson I WI 1 54016 1 715 - 386 -1226 1 Hudson I McDonald Lane
J New Construction Use: yJ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Nf Replacement _f Public or commercial - Describe:
Parent material Glacial Outwash Flood plain elevation, if applicable Na
General comments
and recommendations: Site suitable for conventional POWTS dispersal cell wit 0.7 d /sq.ft. /day loading rate.
Boring # -j Boring
0 Pit Ground Surface elev. 92.18 ft. Depth to limiting actor > in.
9 Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 `Eff#2
1 0 -9 10yr3/2 none sit 2fcr mvfr cs 2f 0.6 0.8
2 9 -18 10yr4/4 none sl 2msbk mfr cs 1 vf,f 0.6 1.0
3 18 -23 7.5yr4/6 none Is 0 sg ml cw lvf 0.7 1.6
4 23 -40 10yr4/6 none s 0 sg ml gw - 0.7 1.6
5 40 -108 10yr5/6 none s 0 s� ml - - 0.7 1.6
1 Soil observation 85" - 108" completed use � ofhand auger.
All
Boring # J Boring
101 Pit Ground Surface elev. 94.91 ft. Depth to limiting factor >126" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I "Eff#1 *Eff#2
1 0 -12 10yr3/2 none sit 2fcr mvfr cs 2vf,f 0.6 0.8
2 12 -25 10yr5/4 none sit 1fsbk mvfr cs lvf,f 0.4 0.6
3 25 -32 7.5yr4/6 none Is 0 sg ml cw 1vf,f 0.7 1.6
4 32 -42 10yr4/6 none s 0 sg ml gw - 0.7 1.6
5 42 -126 10yr5/6 !' none s 0 sg dl - - 0.7 1.6
t (0�
So' rvation 90" - 126" completed by use of hand auger.
* Effluent #1 = BOD? 30 < 220 mg /L nd TSS >30 < 1 0 mg /L " Effluent #2 = BO
D <30 mg /L and TSS < 30 mg /L
CST Name (Please Print) Signature: CST Number
James K. Thompson 3602
Address A.C.E. Soil & Site Evaluations V Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceola, WI 54020 5/3/2011 715 - 248 -7767
Property Owner Ted J. & Judith A Schiavone Parcel ID # 020 - 1028 -80 -000 Page 2 of 3
F3 ] Boring # I Boring
�J/ Pit Ground Surface elev. 92.45 ft. Depth to limiting factor >116" in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Pp
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 - 10yr3/2 none sil 2fcr mvfr cs 2f 0.6 0.8
2 9 -22 10yr5/4 none sicl 2fsbk mvfr cs 1f 0.4 0.6
3 22 -27 7.5yr4/6 none Is 0 sg ml cw if 0.7 1.6
4 27-45 7.5yr4/6 none s 0 sg ml gw 1 of 0.7 1.6
5 45 -116 10yr4/6 e N s 0 sg dl
3b
Y
rvation 92" -116" completed by use of hand auger.
❑ Boring # J Boring
_f Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots I GP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
F -1 Boring # - Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD s mg /L and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777.
SBD -8330 (R.07 /00) A.C.E. Soil ✓A Site Evaluations
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