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020-1158-30-000
e o -0 o I 'a Cl o O ° ° 03 I N y N I N I 00 0.' o o w r 3 (D m °o N t c O 0 w-CD I I c Q n a Fu c v c « O c°c~ w c E € ° F' Q) L) CL O y L O aNi 3 z m I Z 00.0 Z N I U. cc ~.~r) LL o o aEi I a m3 c c 3 ° a O c~ E ¢ ~ 3 M I a M I I z E E v 0 € v € v z rn a co a m N H fn i I O c c O Z :!t r > - aoi z :!t Q o I U) H °c' a> C o o I O N O N Cl) (D M D .1 a N CL V o o o a) 4) Z3 CD • ~ 2 R (D c O c C c O C C 0 Q z z z z N a z l 3 a~+ y I N E R E N d_ aRi o~ y s a~i E CL CL 0 M. -j An N coca cca O) ~N U) cn U) •N N a a s 0 m m m y a o D I C N 2 (D (O y S I~ N oo 00 0) CD U) -i o ~l n r r tt- T N N T (D CO ;D- w O E (D 0 0 CD CD m c m c a CD co o _d Q in co ii _d Q 05 co U ayi C U w c CD ° o o v E ° Q M rn m a£ c y c a p co o°i F- c c co c c y c 4) F I .U) a~ ~ CC) C of vOi r o Z t N v E v Z t C14 C) M m o o m co o y o • O N m fn co O z-= H fn N O 2 N z .t (n O ~ I I Y, €CL €a L: IL L: r~• to C. d d y C 0 y C r A 0 a 2 O a U O y v i _410MMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 5227 ST. CROIX ZONING REPORT NO.S 03184!01 PAGE 1 ST. CROIX COINTY REPORT DATE: 3/29/91 COURTHOUSE DATE RECEIVED! 3/28/91 HUDSON, WI 54416 ATTNS THOMAS C. NELSON j OWNERS Chet 6 Jerilyn Sachseneaier LOCATIONS , udson COLLECTOR: M. Jenkins SMCE OF SAMPLES Kitchen faucet COLIFORMS 0 /100 ml INTERPRETATIONS Bacteriologically SAFE NITRATE-NS 2 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogenr mg/L LAB TECHNICIANS Pam Gane WI Approved Lab No. 19 0*AV40EPEN,) N . T♦, ,rv ye0 ~ D Z` < Means "LESS THAN" Detectable Level Approved by: b yn' QD PROFESSIONAL LABORATORY SERVICES SINCE 1952 _ ~~f ttt l//lll/// AV~" ~A -q I ST. CROIX COUNTY ZONING OFFICE rt t 911 4th Street Hudson, WI 54016 ~ 4 'q'6 4t Telephone - (715)386-4680 ~ ~The St. Croix Co. Zoning Office offers the service of septic and water inspection to Lending Institution, Realty Firms, and private individuals. COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN BE LOCATED. Please provide the following information, enclose appropriate fee made payable to ST. CROIX CO. ZONING, 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 (For nitrates and coliform bacteria) WATER TESTING-------------------------------- FEE:$175.00 (VOC'S) SEPTIC SYSTEM INSPECTION FEE:$ 25.00>_ PROPERTY OWNERS NAME: CAtj d PROPERTY OWNERS ADDRESS:$OS L-~-~! a6ITY: 1`Ilcf, Legal Description 1/41 1/4, Sec. , T N-R W, Town of Lot No. Subdivision FIRE NO. g © s LOCK BOX NO. Color of house„ _Realty sign?~_Firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i.e., COPY 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 No. REPORT TO BE SENT TO: CLOSING DAT 9 Signature: q1 Neu ,Z C) ~6a-cc ` ST. CROIX COUNTY WISCONSIN ZONING OFFICE , , - ST. CROIX COUNTY COURTHOUSE . 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 _~FYJ Mar. 27, 1991 Knutson Mortgage 12941 Ridgedale Dr. Minnetonka, MN 55343 To Whom It May Concern: An inspection of the septic system on the property of Chet & Jerilyn Sachsenmaire, located at 805 Kelly Rd., Hudson, WI was conducted on March 27, 1991. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. i cerely, M en ns Assistant Zoning Administrator cj Parcel 020-1158-30-000 06i07/2006 08:11 PAGE 1 OF 1 F 1 Alt. Parcel 23.29.19.890 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - SACHSENMAIER, CHET W CHET W SACHSENMAIER 805 KELLY RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 805 KELLY RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.020 Plat: 1903-DEL'S WESTVIEW ADDITION SEC 23 T29N R1 9W DELS WESTVIEW ADD LOT 3 Block/Condo Bldg: LOT 03 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 23-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1040/216 QC 07/23/1997 750/585 07/23/1997 691/254 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.020 85,100 175,700 260,800 NO Totals for 2006: General Property 2.020 85,100 175,700 260,800 Woodland 0.000 0 0 Totals for 2005: General Property 2.020 85,100 175,700 260,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 216 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ~C Form - S T C - 104 l * AS BUILT SANITARY SYSTEM REPORT Ok_ TOWNSHIP -fZ! 0 4~ rtJ SEC. T ~N-R 9 ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION zz S 1~~CzJ LOT 31q LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•L14R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM \90. - 10~11R6 'Al off ICE cc ,OCT MOO G AZ Y ti INDICATE NORTH ARROWS ALL 4 f r ~ yr. ~ c i- • _ J , ~ ~ ~v ~ ~ ~ ~ 1 ' , ~ - ~ ~ - . C) , L ~ ' S 7 / ` ~ ' 1. I/ EPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS ABOR & HUMAN RE.4ATIONS PRIVATE SEWAGE SYSTEMS DIVISION .O. BOX 7961, BUREAU OF PLUMBING ADISON, WI 53707 OCONVENTIONAL OALTERNATIVE State Pl. I.D. Numlxl 111 asngnMl O Holding Tank ❑ In-Ground Pressure O Mound TRANSFER NAME OF PERMIT HOLDER. DDRESS OF PERMIT HOLDER. INSPECTION DATE Chet Sachsemaier A579 Sloan, X62, St. Paul, MN 55101 ,oZq'gP ,,2, 3O BENCHMARK IPermanenl reference pomp DESCRIBE IF DIFFERENT FROM PLAN Ef. PT. ELEV.: CST HEF PT ELEV SW SW, Section 23, T29N-R19W, Town of Hudson, Lot#3, Del's Westvieq Number Na.-nl Ploudrer. MP/MPRSW No.. County Addn. SannarY P,.,-.t Lyle Myers 6219 St. Croix 83773-T EPTIC TANK/HOLDING TANK: MANUFACTURER 2', IO CAPACITY TANK INLET LEY. TANK OU7lET ELEV WARNING LAB L LOCKING COVEN p / O PR VI ED PROVIDED C111) I G' E ~~r lJ YES ~NO ❑YES X -NO BEDDING VENT DIA VENT TTL. HIGH WNUMBER OF ROAD: PROPERTY WELL BUILDING IIENT TO FRESH AIR TOT INLE J ALARM FEET FROM / LI" OYES ONO ❑YES ❑NO NEAREST (O t~V d DOSING CHAMBER: MANUFACTURE" BF DOING ILIOUID CAPACITY PUMP MODEL PUMP. SIPHON MA Nut AC TIME H WARNING LABEL LOCKINGCOVER ROVIOED PROVIDED OYES ONO OYES ONO ❑YES EINO GALLONS PER CYCLE: 17NO CONTROLS OPERATIONAL NUMBER OF V111F Iv JiVt LI lit lll OlNi; VENT TO I11151t (DIFFERENCE BETWEEN FEET FROM INE AIR INl I1 PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I F N61H 11AM1 1( It Vn I1 HI.11 ANI1 M1tA1tk IN1. Or excavation. III soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH NO Off UISTH PIPE SPACING COVEN J7 1 INSIDE 1)IA spits LH)UIU BED/TRENCH THEN[HFS N EHIAU PIT OFPTH DIMENSIONS (iHAV LUF T" 'ILL UEPTII 1115I14 VIP! UISTH PIPE DISTR.PIP. MA RtAL NO U TR NUMBER OF HOPE" 1Y WEL 1. HUILOING VENT I"I I4111H I", LOW PIPE AB V OVEH 11V INIII ELEV ENO PIPES LIN Alit INLET Jr•d g SJ 'z ~ J / FEET FROM NEAREST-► U~ MOUND SYSTEM: d Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it . ON REVERSE SIDE. SHOW ELEVA- meets the criter' for medium sand. TIONS MEASURED. ❑YES ONO _ OIL COVER TFXTUHF VFHMANINIMA14KII15 11111M IIVA WIN III I I OYES ❑NO DYES LINO Df PTHOVFH TRt NCII HfO DEVTIIOVFH IHENCH BED I)E Vlll/f I( Srl _ ISFI UIU - M11 It(.F111) Cf NTEN I J EDGES ❑YES DNO OYES E)NO ❑YES DNO PRESSURIZED DISTRIBUTION SYSTEM: _ WIDTH LF NL, 111 NO. OF LATERAL SPACING GHAVLL UEPTII HI LOW YIPI 1 II L OF PIH AHUVI COV1 H BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIf111U DIS1 PI E ]MAN7 )LOMA E111AL NO 1,ISI14 I151Ft PI' Illti 114111UIIIINNI't r0AIt HIA11LMAIIk1N(. ELEVATION AND EL PIPES UTA DISTRIBUTION ELEV ELEV DIA INFORMATION HOLE Sllf RULE SPACING 014ILlEU1;011111 l y COVEN MAiF"IAL VI HIIIfAI 1 U 1 I:rIHHf SPItN Uti IU AVVI/nVl U PLANS ❑YE ONO DYES DNO J BUILOING COMMENTS' PERMANEN ARKER OBSER ATION WELLS NUMBER OF PROPERTY WELL FEET FROM LINE ~G ❑YES ❑NO OYES ONO NEAREST 0T 1 r _ ~7 COLA) kAj - q,g Sketch System on Ret in ' county file for audit. Reverse Side. SIGNA TUNE ~ TITLE DILHR SOD 6710 (R. 01/82) F/ SANITARY PERMIT ®IL:HR TRANSFER/RENEWAL COUNTY UNIFORM PERMIT # . ' (PLB 67-T) ~r ERMIT RENEWAL DATE: PERMIT TRANSFER DATE: ORIGINAL PERMIT ISSUANCE DATE: STATE PLAN I.D. NUMBER: PROPERTY LOCATION: ~-A SW Y. S'(•V a S CITY: 3 ,Ta9 N,R / E (or W PILLAGE: LOT NUMBER: BLOCK NUMBER: SUBDIVISION NAME: O 3 NEAREST ROAD, LAKE OR LANDMARK: f o d PREVIOUS SANITARY PERMIT HOLDER (IF CHANGED): SANITARY PERMIT TRANSFERRED TO: NAME: SIGNATURE: NAME: PHONE NUMBER: ADDRESS: PHONE NUMBER: ADDRESS: 1, the undersigned, hereby assume responsibility for installation of the private sewage system that has previously been approved for this property PLUMB S SIG TURE: PREVIOUS PLUMBER'S NAME (IF CHANGED): P BE ADDRESS: / `-'rr al 'land ry PREVIOUS LUMBER'S ADDRESS: MP/MPRSW NUMB R: PHONE NUMBER: MP/MPRS NUMBER: PHONE ~h ONE NUM E NUMBER: : ~0'y3-'jJ Q SIGNATURE OF ISSUING AGENT: DA~TiE APPROViED: DISTRIBUTION: Original - County Q D~ Copy - Bureau of Plumbing DILHR-SBD-6399 R. 5 2) Copy - Owner Copy -Plumber c 446 hit 4 / 6?S .3 f3 ~,o /for" P-3 6o X83 P_2 14 ~t /0 0 L3 d-~;- u e4 3 I~y WON WHOA £z zz iz oz 61 81 Li 91 Si 4i Ei Zi ii of ' 6 8 L 9 S E ' Z i inalI uoi;dpagoa Ai;usno 'ON U30HO -lvlu3.LVW '35HM 03033N 3140 3"a ON BOf 3WWN ®Of AS 03zi30a0 aaplo MA018M RNA d lea-~ ~J~NI(U[l7d 5,3~,(~ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY., _ DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069 HUMAN RELATIONS t (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: IPIWNIVA BLK. NO.: SUBDIVISION NAME: '1 "f cr1 ~/a a3 /T6?eJ N/R / E (o TWNS cc,C~d tom. wu-tuo,w COUNTY: OWNER'S/BUYER' NAME: MAILING ADDRESS: A2,11-1 A A P" USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFI DES RIPTIONS: PER O ATI TESTS: L!fResidence -3 l/7 L_ ew ❑Replace I RATING: S= Site suitable for system U= Site unsuitable for system o CONVE TIOEINAL: MOUND: ❑~N-GROUND-P E: SYSaTEM-IN-FI LL HOLDING TANK: RECCO~MMENDED SYSTEM: (optional) If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 7Dh9nsiI G/a B.~ SL, /7 Bn s, 30" n mQ. s 17< B- ?(c > 7~ ox Q,A,iij 1013 nsi. i n 6n -s a~ Y 6n rn e s C' , /tar y~~ TS 116,7s,/, 166,-,sZ :5 319 6A me s 16 B- B- >~Ca /i D,r(3a5 Cf CIS /ydnfst Y13A me. s U i4 B:5 6 , > 7 !o 01C B n s; I, ► w 4 n 5l.l UI (Q s, i~+9 A m s n 5.1, to 1.15 111 S n 5/ .30 Y n rn e $ B- 4 61.1 i PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 P IOD 2 P O PER INCH P rQ P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION T4.60 rc -A 13 E/0'. C3 P -3 Q 33 B~rL1 8. /o i76 P-I INSTRUC.: - ; FOR COMPLETING FORM 115- SBD e a €Pca,, t twci ate soil test, €~ur r >~nrt i €sY it ~ 1. Compl e esc.ription; w12 , use .i ~~us arl set irate whs Q-t# ~esirie €:r. gar (~ryinlercial pro" ct; 3- MAXIMUl _.;sbes If ' roams ar comrnerctal use planned; 4, Is this a ne r reg#a€:ement system; `J p»\ Cosrsple e u \NIR rating boxes, A SITE IS St~ITABLE 1=` RWMLDIN TANK C3111FY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL C': 3ITIONS; 6. PLEASE use the al:3breviatians shown here for writing pro.- ;criptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test lc: tion~ Drawing to scale is preferred, A 1 e3~etfiif c €~~14{; \I 8. Make; sure your benchmark and vertical elevation reference paint are clearly shovers, and are permanent; M Complete all appropriate= boxes as to dates, names, addresses, flood plain data, percolation test exenip- Xon, if anptopriate; WA 10. If the infonna°,'r,;,~- (such as flood plain, elevation) does riot apply, place N.A. in the appropriate box; 11. Sign the fc Mace yescsr €.urrent address and your certification number; 12. Make legible ies and distribute as required. ALL SOIL. TESTS MUST BE FILED WITH THE z ~srn n8 16l&A1 %oo NT\a ° % , i1z~>"F6( VPLETION. ab9l~ n~ Y r~ a~n~ r1 .farVv bI ,ramp ro P ~ ~ w A;Bg RkTP~~AiS FOR CERTIFPI~ IL TESL ~ •rP 2 9m nc°.~Y pb `t:~~F1` ►r ryQ P 1i✓t~~~v ~e aVj f L`. Nay F AE ,c t ~ s~ei~1 ~~e ry~ ~ 6 $u Symbols P0_ Ct 1. t ,.mac \ z ^ro ray off, _ 'P 9 I~zn9x4 p 131303i dry k ell n a le' (3 - 10") 5 - San€:istone'~-~Q gr Gravel (under 3") LS - Limestone '°s Sand HGW High Groundwater cs - Coarse Sand Perc - Percolati&\Rate mecl s Medium Sand W - Well I's Fine Sand BIdcl Building, Is - Loamy Sand > - Greater'rli'An sl - Sandy Loam < Less Than "I - Loam Bn - Brawn *sil Silt Loam BI Black si - Silt ' Gy Gray 'cl Clay Loam Y - Yellow scl Sandy Clay Loans R Fred sicl- Silty Clay Loam rnot - Mottles sc Sandy Clay vv% with sic - Silty Clay fff few, fine, faint *c Clay cc common, coarse pt - Peat min Many, medium m - Much d - distinct p prominent HWL - High water, level, Six general sail textures surface water -for liquid waste disposal BM Bench Mai k 11RP Vertical Reference Point w Y C Ct M c Y Y h- > E $ I c CY) CC 00 H 5 ~ I E 3E E N 0 W u c o w~ 052 zi N C31 F, -2 9 : N o A A a 2, M ~ wYa _ pp M T L y Y ~Z ~ N r Y ~ ~ ~ C ~i~ Z o » a'Q > a z E N~ Y« p W V E g w u Y ;v i.` .E.-I a: H vi _ . o ~ Nt, ~ yEi -w .5 ~ M r w O C Q « > «ate O T w r _ M Y N o, C a Yg~ = YE ; C~ H 28 t Mw ~ of o« W F.... A! c W J Z 5~E«c eI ;v W V n u ~Y ~N T 0 r r~ r c iE m~ v o >Y UJ W = Z w D U Z Z 0 LL ~ U) 0 O Z Z U U) ° o j > > LL cr x o to I-- m o <Z a: w 0 to N O O LULJ o o~ w U Q U Q t Z O U cr Vol J O~ t c U- % W J U) m ° CW ~ U) > X a: LL 1 2 OD C= to ao cc w O ~j a: cr M p W co w Z CL Z ao U ° J ~ m 0 0- P.- Q = _ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. 90X,7969 BUREAU OF PLUMBING ,MADISON, WI 53707 KXCONVENTIONAL ❑ALTERNATIVE State PlanLD.Number: III essignLrd) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE Chet Sachsenmaier 1579 Sloan #2, St. Paul., MN 55101 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.- SW SW, Section 23, T29N-R19W, Town of Hudson,Lot#3,De1's Westview Add. Name of Plumber MP/MFR-SW Nn.. County. Sanitary Permit Number: Terry Miland 6142 St. Croix 83773 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LCAPACITY. TANK INLET ELEV. JTANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROVIDED: PROVID E D. BEDDING: V : FVENTMATL HIGH WATER ❑YES ❑NO ❑YES ❑NO ALARM NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH FEET FROM LINE AIR INLET ❑YES ❑NO ❑YES ❑No NEAREST DOSING CHAMBER: MANUFACTURER. BEDDING- JLIQUIII CAPACITY PUMP MODEL JPLIMP,SIPHON MANUE ACTLIREH WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PH OPEHTY WELL BUILDING JVENT TO FRESH (DIFFERENCE BETWEEN FEET FROM NE AIR INLET' PUMP ON AND OFF) ❑YES ❑NO NEAREST- -]77 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ' f ME MATI HIAE AND MARK NG or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO 01 DISTH PIPE SPACING COVER INSIUE UTA SPITS LIQUID TRENCHES MATERIAL: :pIT DEPTH. DIMENSIONS GH '~'FL DFPTII FILL DEPTH JDISTH PIPE UISTH PIPE DISTR PIPE MATERIAL NO OISiIt NUMBER OF =PHO WELL. BUILDINGVENT TO FRESH BELOWPIPES ABOVECOVER EEVINLIT ELEVENU PIPES FEET FROM AIR INLET. NEAREST MOUND SYSTEM: 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- ❑ YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE JPI HMANI NT IIA14KIHS oesERVATION WELLS _ ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH RED DFPTI/ OF TOPSOIL S(IOOFO SMULCHED CENTER EDGES ❑YES. [:]NO ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATEHAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTH DISTH. PIPE DISTHIBUT ION PIPE MATERIAL & MARKING ELEV. ELEV. DIA ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DHILLED COHHECTL Y COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. Tr~F' UM BER OF PROPERTY WELL: BUILDING: EET FROM LINE❑YES ❑NO ❑YES ❑NO EAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE DILHR SBD 6710 (R. 01/82) DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # 3 ,7- -Attach cdmplete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ No PROPERTY OWNER PROPERTY LOCATION GJ'/4 ,5WY3 T , N, E (or W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER SUBDIVISION NAME CITY, TA~TTf ZIP CODE PHONE NUMBER CITY NEEAA EST ROAD, LAKE OR LANDMARK M TOWN OF: ,"hSeS VILLAGE : A.1 /AU~ //!l/S/ ..S/d lob 77 _363 O ilssCL~ 7 0~4 II. TYPE OF BUILDING OR USE SERVED: zc., -to Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): 111. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. ® New b. ❑ Replacement c. E1 Replacement of d. ❑ Reconnection of e. E1 Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2) 1. a. E Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b. 19 Seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 9s o0 9 .SD Feet ® Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total of 's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks Manufacturer Concrete stCon glass App. Tanks Tanks L Septic Tank or Holdin Tank DDo OOO oizigr AzZ 0- ❑ ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MPH 4PFWWNo.: Business Phone Number: Plumber's Address (Stre t, City, State, Zip Code): Name of Designer: 3% VIII. SOIL TE T INFORMATION Certified Tester (CST) Name CST # CST's ADDRESS (Street, City, State, Zip Code) Phone Number: 17 yer IX. COUNTY/DEPARTME USE ONLY j8r F-1 Disapproved Sanitary Permit Fee Groundwater Date Issuing Pgent Signature (No Stamps) Approved ❑ Owner Given Initial Q~ S Wharge Fee Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION y TO THE APPLICANT: , 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, -usually every 2, to 3 yE,ars; 6. If you have q!iestions concerning your privat sewage systenn, contact your local code admir,istrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description where the system s to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 882 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawr 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Grountvv ater included the creation of surcharges (tees) for a number of regulated practices which Wisco;izin`s can effect groundwater. The surcharce took effect on July 1, 1984. All of the water that buried reasll,re is used in your building is returned tc the groundwater through your soil absorption o system or the dis;:)osal sit6used by your holding tank pumper. The monies c.olle;,teo thrc;ugh thc-:se surcharges are crecited to the groundwater `,:nd adminis- tered by the Department of Natural Resources. These funds are used for roonitor r-g ground-- ~f ,A,ater, groundwater contaminatio,} in,estigations and establishment of standa,ds Orcundvvater, ".'s worth protecting. BD-6398 (R.03/86) ' a . APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property Location of Property 14, Section T~N-R W Township Mailing Address Address of Site U LIC/Za 21 pa0L Subdivision Name &W, E; Lot Number Previous Owner of Property b2t rT Z. L E' 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 _ and Page Number _3D as recorded with the Register of Deeds. op c 141 S INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) ce&ti6 y that att ~6ta temevi t6 on this 6onm ate true to the best o6 my (ouA) knowledge; that I (we) am (ate) the owner(,) o6 the pnopehty densn bed in this rr r.' a ,..i,' TWO MAfa MSSSW*W POR i~wa No_ ,-aTATS BAIL OF WISCONSIN FORM 11-fM LAND CONTRACT L Iaal+Maa1 sad CorPer"o ITO ER USED FOR ALL TMANSACT10N8 1V1[iR9 OYBR eri,MO 18 TINANCZD AND IN OTHER NON-CONSUMM ACT T19ANSACTIONBo 69.i X 25'4 RrCOM ST. CMM (0.8 WW- andl . Rg ft zbetween Reed is R.oo~a w%b., W saoert) and._--4FT --FI_:...21Fi$...... "v~~. a of 5S~ , i' .huae o.e ( . .("fir whether one or more). , vabdor rile and agren to convey to Purchaser, upon the prompt and full per- forwasee of We contract by Purchaser, the following property, together with the ~ IMMIts. and o~hor appurtenant intwests (aA called the "Property"), k ps t. ..Croix County, slate or wlseomdR: acTOaa To v I Lot 3, Dell's Westview Addition, of Certified ~1,.• Survey flap recorded in Vol. 2 of CSM, page , 347, all in Section 23, T29N, R19W. Tax Pared No..................... f J~r~C-1+~' r'f s~.T.i . r* u is not This homestead property. (is) (is not) V wheresoever designat®d - Purchaser agrees to purchase the Property and to pay to Vendor at . 2 500.00. - ; ..i- ; 12 SQO 00-- in the following manner: (a) the seen of;---•--..r.--• ----t-•-••---••----•-----• L at the execution of this Contract; and (b) the balance of ; 1Q r QQ•Q •-4~- together with wer"t 11'808 *ft hereof on the balance outstanding from time to time at the rate of-.... 9.l4P YA0...(1. $1........ per cant per as("i until paid in fu% as follows: principal and interest at the rate of $217.43 per ,J*ontU*. commencing the 22nd day of July, 1984 and continuing on the 22nd day O each month thereafter for a period of five (5) years, at which time all .r9 , principal and accrued interest shall be paid in full. Provided, however, the entire outstanding balance shall he paid in full on or before the........ 2.211d•••••••• dal! at ----.--..June 19.29_ ( the maturity date). Following any default in payment, interest shall accrue at the rate of per annum on the entire ssla(!nt in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance pDlg0l0ibftK002221l~ ----aCN10B1kim--1 Purchaser, >mtMK agrees to pay >>lmt~M ' i >I!!~ annual taxes, special assessments. fire and required insurance premiums when due. TpC1blC ~IU~Qll~11711O~7g1~117p!!lKlC1~Q'~l9llU~ilf~ltllK~141C7dI19t7~1te1~X94IQ1l~ft+lClPJl~1~1[~C~7C~)!Ill~G1f~~ ' 7~t!!!!!E)P!!~*IC~C~~P~OIQ>Q719C9QlCI~IG7~)QIC~11EfR;aClFIiPJ~C , Payments shall be applied first to interest on the unpaid balance at the rate specified and then to prineipaaL Amy ° amount may be prepaid without premium or fee upon principal at any time after.. C.1Q.iXXg_..-_ssX)P=s~Al tlrlRlsI *K==939ff 3c*v tn6wkMOibolcOC ; s la the event of any prepayment, this contract shall not be tre.ited a: in default with respect to payment se as the unpaid balance of principal, and interest (and in ,uci. ' a<e accruint[ interest from month to month hl eitied at. unpaid principal) is less than the amount that said indebtedi,ess wou'd Lave been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the- event of credit of any preeeeds of insurance or condemnation, the condemned premises being thereafter excluded here(rom. _ Purchaser states that Purcha=er is satisfied with the till: ^s shown by the title evidence submitted to Purebaeer i' for examination except, NONE e lr'It ~p V!~daee w on ira W t"M iselfteftents w • R l'u+ehasar W" k ~ showing suet psyant• an ty or the Vresses"a. tGod" b V eosst~ Paella aaL such o PPftP~ty insured against loss or a s 1 tha no of y regaure, wathout ~~ilAwraR~tVander , 41 Owed under ' ""db Standard of 08 the WU "P.Mint~the ~Pro~s~~yPWeh"W I but Vendor PaY t insurance require nse s ^ < nsdor. ~n fiesures" ogre" - "Pa" MW othe a applied to r -0 Purwiw and esiW with Vendor. Purchaser s In J. k s eeenoa ka ft fe"Sia rsPafr of the prspsky- vendor otherwise aa;geewe Wr sift, Provided the Vender ,laps Pthe os+ehassr covenants not to eoasaed< k good ka N cone Was ADM W r a ttoo L repair to hese to 0- 40 to beo mitted on the - to su shall M an~ *V000 that to case the atsetias the props y Perior to tbo AWtV the at th°Dsytitn will ea , in fee WE** .1 the ss and dose abaU~_-~ Mai Mt "Oft- party, arse and clear of ~ any H~ all us" a" or "combraft" created by tlw t~8_~.-.strictions a r "t of Pnrc! wa U • , and except rights-of- - ' egress that time is of -#`31 E the essence and - ntereat eoatlnoes for a riod of (s) in the event of a default in the PsymeM pe ---3 Q,.- days follow i et any of say Other obligation mg the s ~or pecif.rd due date or (b) in the i, nsdor (delivered Peraonall'of Purchaser which continues fora event of a deSamdt in ( r beonae immediately die •sO y or mailed by certified mail!. then tl a riotd O ou - 3.Odaya foUowi and Vendor shall Payable in full, at Vendor's option and were notice ithout tetan ward u tser OddNiii to >ttose also have the following rights and remedies ( Purchase provided by law or in (subject to any limitations t." t . talk and interest is the Pro equity and : G) Vendor may, at his option, terminate this Contract Dtiom to be conditioneu upon re, recover the Pro rtprovaded! g full p 1w) is, the date of default at the rate m effect na such date and othe tRYmen he Pt of the back through sng balm celosi u re ~ xh s s s por~ehaser fails to the'e4nirl by P rehaser shall be forefeited as liquidated damagesrforofa lureethoe fulfill rth awCo tract and U s hwmediate ~ w tart uP [ redsete); or (ii) Vendor may sue for specific p Ierform ev~aooAj, default tireontatar►din b ance of this oad with interest thereon at CeatinieR~ aed elm snrounts due hereunder. alance, the rate in effect on WWI ereof; 1Ia6~e for say ts du deficiency; Vendor th eevent the Property shall be auctioned the da th action it or the eIVV~or may declare this may sue at law for the entire un laid lud~cial sale a»d.pt} z . Of the P gnatabk interest ec Purchaser at an end and remove this Contract ass clouds on title In a quie"I e sad have a receiver ap baser is insignificant; and /v) Vendor may have Purchaser a ~ or a ny - pot•t,en under (i), (ii) or (IV) hs~m~ to collect any rents, issues or profits during the Joe en fautn ~itorego;ng remedtns~y~l• on! wit tending an oral or a ritten statements or actions of Vendor, nt reasonable attorne Y he binding u Pendency o ; ' son of the pun Vendor if and when pursued in litigation and all costs d~ od ant "tent not prohibited by Ys fees of Vendor incurred to enforce any remedy hereunde (whether &be ` ) .pnssss curved, and shall be inltaded in any judgment. title evidence shall be added to principal and s °r the to the Upaq the OO m or during the Paid by Purchaser,; as ja•„- ,a ; to sPPeta~t a eet t of the Property of any ae;ion of foreclosure of this the aPPlied as t dPandeney of such . a uding homestead interes t, to collect theorenta"nss h rt sha ll irect, action', and such rents, issues, and profits w of purchbas er~sh lumot transfer, sell or convey an 1 ~ so collected shall rr any egal or t of a3W, r „ o consent of f Par a Vendor iunless s n m~ Contract or by option, long-term lease equitable in any other Property b the outstanding balance payable under this Contract is first ) (Y ars~gmmea of aly*#'. ittewn Porch In or assign paid in full anent of purchaser's lute,-eat under this Contract sole! • Y) without the p+ior event of er wtee" i' balance PaYabk under this Contract ontract such shall 3 as security for an transfer, sale or conveyance without Vendor's written consent~_ Vendor shall make all become pavm imimediatelydue and Payable in full , at Vendor's otpi~~without- ~ of this Co"tract Is for any ag ts e when due under am• mortga~ out t makes timely payment of the created b Pnrc standing against the Pr ~ 4 ~ under thereb the Nort if Vendor fails to do amounts then due under thisasCo nt act. Pu chaser may n ajce any auch~y on the of aser ;nside this Contract. so and all secured Y.paProvided Pna+ch payments so made by Purchaser shall be considered -ments dlrectl ski. Vendor ma Vendor o PsYmenlr ~ ie • terms of waive any default without waiving any other subsequent or successors and ass this Contract shall be binding upon and inure to the benefits of the heirs, rep deed to be made ~ ~ ~e ; to tale♦ (If not an owner of the Property the spouse of Vl; ~sn M%.nt h.se ".fh 12 In the subject Property and agrees to join thdor rose' a rdtt , of Dated this . in the eseeotisn the day of June (SEAL) • Del)rer ...L-.. BreeF ~ tel. a.. , . , ~ ; z ley (S)CAT,) Chet W. _ • Sachsenmai.er. - • (SEAL) (SEAL), . AUTRANTICATION ACHNOWL Signature(s) I3DtiURNT STATE OF WlSr - OASIN authenticated this day St• Croix ss. S of.. . 19.._.. ('aunt, Fers•)r;;i;)_ came hi fore me` this .•i June day of a Delbert L , 19. 8 4 . the abuvaarued ' TITLE: MEMBER E.reezley. an STATE BAR OF NIFf W• Sachs O~'cl?~ enma i e r (If not, - authorized by a ;O~.Or. R'is. Rats.) a STC - 105 r r a • H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a OWNER/BUYER ROUTE/BOX NUMBER Fire Number .CITY/STATE f~1~~~5p,~1 /~)1 ZIP PROPERTY LOCATION:, Section, T~_N, R AW Town of ~At_ )/V' , St. Croix County, Subdivision ld'--t;I iV,ei J 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 pdt 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. H 0 I/WE, the undersigned, have read the above requirements and agree Cn to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- a ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date./' SIGNEDL Li.~: , DATE - i_3 - St. Croix County Zoning Office P.O. Box 98f Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. 4 C N r = 1p p 1p (N W~~ N? C C CV ~ O O ro ~ < p O N 0 ro a 3 A O O ro O_ Z c =r~ _O C o W W N K W C (a (Q c 10 0 O S ro '0 p ro m O A '113_N ~a N ro w ro Uf N 1 N o a p n N O CD 0 CO ~ oro cow '00 =w r :3 Cc C 30c •<C c-°•' N ? c o c ~ !a ~ W lv !A "fro w ~mc ° ~Di < ~ a• o o w o o D w o C1 y e cp 0 cu . --x w p roCOD - o F m Q (o X =any (Nn C U1 -1 aCD o 3'ro ro Q. N 3• > D (D - rn o:1 co D M~ a ~n -0 ~o m Q ~ -7 c w rov, mw a a to Cl) c Imo vaccnmwfD~ C m r CD 00 OL CD s /3~7 CL (a N 0 (gyp Q O N p - ~t0 D d CD -Cs CQ n N N ^^A 3 CL CL o f N C C C* Y/ ( CL _ao.CD N R1 A) w~ a(D 0 CL l O 0 W n y. a- a N 0 0 c ro (D 3 m n CD 0 C a O N O ro O e n O CO -I CD -i (D C ro [o La 2 f - Fad 0 _"ro003 W CD o 3 CD a ° CD 0 o T.;:2F N; R~ ~dS O .v Owner,' 6 name Zbwtl Show the following on the plot plan. Provide additional information as necessary: 'Location of building served ❑ System elevation ❑ Location of septic, pump, and holding tanks ❑ Vertical reference point--identified ❑ Building sewer ❑ Horizontal reference point-- Soil absorption system identified ❑ Replacement system area ❑ Well and water service lines ❑ Distribution/drop boxes ❑ Property lines within 50' of system ❑ Pump and controls: Manufacturer Model # Vertical lift Friction loss T.D.H. Force main diam. Vol.-dist. pipe Gal. per min. Gal. pex dose Dimensioned or scale of ~o f ~J 7`- llelrx /000 6'4 L PP_ O pas C V 1---,~ I ~IouSl' O-PP opas CO SO S W E L L gym/ { 'r I r ` / , i j ~ I \ a ~ Io d 0 z I ~ 'Qa l ~ ~ I o T 'LL of o n ~o. r 3 a Roo,M ry B rUt /o 0 ,41 7 - hlp S~ r~~ t z 1VV/. /Q /k- ~ STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS G A SUBDIVISION / CSM# ~l G S We~J 1/ ~l W LOT # SECTION j~)✓ T22N-R_2q W, Town of ~(l S d ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING ITHIN 100 FEET OF SYSTEM f ells © 8,~~ Ted EX;S INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. T _ f BENCHMARK: 5~ ~DD ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: lt7)(4YX144o Liquid Capacity: D Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length ~ Number of trenches Distance & Direction to nearest prop. line: ZA-)65-~ Setback from: well: /'m House Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLAT N• p PLUMBER ON JOB: LICENSE NUMBER: 3 3 t INSPECTOR: ~J 3/93:jt Wisconsin bepartment of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary,PygnX14.: ,p{P~~errrsonal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. SCeft"ka& , CHET Ek ftkgllage ❑ Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description7i Parcel ir2Blo_:1158-30-000 _-7- `5/ QJ~v~✓' qtr... - . lJ TANK INFORMATION ELEVATION DATA A9700313 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ~p 03_/J Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header/Man. 6' J?_ S;,2' g4.1017 ' Aeration NA Dist. Pipe ' 1 Holding Bot. System ~Z PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift L ction System TDH Ft Force rnai< Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH widt Len th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION Type O CHAMBER Mode Number: System: >/f) r ' l(70~ UV OR UNIT DISTRIBUTION SYSTEM Healer /Manifold Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center ` Bed /Trench Edges ,2 i Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 23.29.19.890,SW,SW 805 KELLY RD LOT 3 Plan revision required? ❑ Yes [g,"No Use other side for additional information. /sy SBD-6710 (R.3/97) Date Insp or's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION COUNTY V'~Lr■■'t In accord with ILHR 83.05, Wis. Adm. Code SrL . Cry STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than a 0 7 ttG~/) 8% x 11 inches in size. ❑ Check if revisionto/previousapplication -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBS 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. a Q- 115T-:36 PROPER WNER PROPERTY LOCATION Q 5W'/. TA.;, a, S T o~ , N, R E (o W PROPERTY,(OW E'S MAI I GAPPRESL~, LOT # BLOCK # CITY, ST TE l t• Z DE, PHONE NU~~ SUBDIVISION NAME O M SMBER4jeS, A ~Aj II. TYPE OF BUILDING: (Check one) 1:1 State Owned O VI AGE : ~G~ NEA T R 4 kd OWN OF: ❑ Public ®1 or 2 Fam. Dwelling- # of bedrooms RARER L TAXI UM ER() p III. BUILDING USE: (If building type is public, check all that apply) 6-16 2 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 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 in line A. Check line B if applicable) A) 1. ❑ New 2. K Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 121 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12'M Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTE ELEV. _ 7. FINAL GRADE 95~~ 1 Ir , 46 REQ IREDQ(sq. ft.) PROPOSE (sq. ft.) (Gals/day/sq. ft.) NJ nch) -'3 Bk .Ob Feet %d. Feet VII. TANK CAPACITY Site in al Ions Total of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank Bb 1Z Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown o ached plans. Plumber's Name (Print): Plu ignat ire: (No S ) M R o Business Phone Number: TX0101ro Plumber's Ad r (Street, Ci Sta Zip de) Dty 5W IX. COUNTY/ EPARTME USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing ent Sig re (No S ps Surcharge Fee) Approved ❑ Owner Given Initial Adverse Determination C/ X. CONDITIONS OF APPROVAL/RE S NS FO DISAPPROV SBD-6398(R.08/93) 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 the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety &Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. C mplete 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 in #1-7. VII. Tank information. Fill in the capacity of every new and/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% 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) '~he•F ~a~~ Zehrhaiel^ f dell D 3 l 1 v ~ ~r Q~ ~~5~ 6b b c~ bM fiopDomk~Ae 903.1 ~r l ~i 9~~ tren~~cS x r ~a ~e I X` a6 • &3 &f Lot pleC TrA ~ormej l~ ~.h~~`j )ood Wisconsin Department of Industry, SOIL AND SITE EVALUATION Page / of 3 Labor and 'Human Relations Division of Safety and Buildings in accordance with~s.• ILHR 83.09, Wis. County Attach complete site plan on paper not less than 8 1/,2 x 11 inches in size. PI st 5S • ael X Include, but not limited to: vertical and horizon4rrence t (Blk direct) percent slope, scale or dimensions, north arrocatioto ne oadParcel I.D. # Lj) oZo - 30 APPLICANT INFORMATION - Pleas t af1'•►~ioim ti ~ ed by Date Personal information you provide may be used or securposes (KV44~ , s. 15.04 m . Prope Owner / / ZONING&*1CE Location C;r T -!5,,/Gam/ 26AI t'JA V. Lot SW 1/4 54) 1/4,S 23 T 2 9 N,R 9 E (o& Props! Owner s Mailing Address z of # Block# Subd. Name or CS M# YIDS" RIP . Ci State Zip Code Phone Number// agg Nearest Road X PSQ~ Wl syQ~~o ( 71.5) 3d 4 's F-1 City C' O lNe Town ~ El.Ly Ap Construction Use: Residential / Number of bedrooms - Addition to existing building iracement ❑ Public or commercial - Describe: VP)- APEIOM 141 e,0,0 ~ ,wv H T Code derived daily flow gpd C 7r S Recommended design loading rate AM bed, gpd/ft2 • s trench, gpd/f12 Absorption area required~bed, ft trench, ft2 Maximum design loading rate bed, gpd/ft2 ~trench, gpd/ft2 Recommended infiltration surface elevation(s) S-'e 3 ft (as referred to site plan benchmark) Additional design/site considerations VS&' <OA16- WO,,44/ -i Ftie-Al'S 41>/ t? 6X PIS Parent material SGT ~/fP D .S/tv0~ O IJTw~f Flood plain elevation, if applicable it I Con ntional MoIn-FS d Pressure I,AAT, G de System ,iinn,Fillll Holding Tank S = Suitable for system U = Unsuitable for system S❑ U 2's ❑ U ❑ U L ~"S ❑ U ❑ S ~ U El S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 0-// /O Ye Z/ 2- S/L 2 f S A"-fX S 3 -t . S . 6O . s . Ground 3 SY,2 51-- 2 f 5k g! • le /6 7. 7 SO 16 L• f / S Depth to limiting factor `l J~/--jn. Remarks: Boring # 0 R 2/L .S/G 2~X S 3f .S . ~o 401 Z • 3 sk Le e 5; 6, S y z -PA 3 15- 7. 5L Ground 7. li GL elev. Depth to limiting factor 7 ~in. Remarks: CST Name (Please Print) Signature Telephone No. ;eOA3E~ ?1GAXIA 7-- 7/S • 396. 8/dR5 Address Date CST Numbecrc r~ ' `l C'.ST~ Z 1 ds" Uibricht a Associates 15 Privets 8awapa Consultants an OPINION FW- SOIL DESCRIPTION REPORT PROPERTY OWNER Page 2- of PARCEL I.D.# 02o iiS~ 3 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G~pjft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 0-17 io YR 2/2- _ siL{s ,k; h„ fe cs 3-F- . z 3 2- 7• is SCi~ 2-fsh,e •~1,c,e ~s ~-f s' Ground j ~Q J 2-FS4 /C elev. 1 Gin 7.5 Depth to limiting factor 7 in. Remarks: Boring # Ground elev. n. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure PD/ in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Boring # a Ground elev. n. Depth to limiting ; factor m. Remarks: Boring # Ground elev. n. Depth to limiting factor m. Remarks: SBDW-8330 (R. 08/95) IMPORTANT 1`inTF mn nT.TATL'DO c- SECTION 23 p UN_PLATTED LANDS OWNED BY OTHERS O AD-LANDS ROAD °o 85004'II° W - a S87°4549 263.07' N 88° 39 11 ° W 308.21' 57.84' 210.90' 52.17' _ z ~rM>0 A OD D c v w -4 ZWN-4 m O qW o u OA om z O ? O W NZPD M N pO -I I N N N(O 0DOD-1 . "D O N D~ 400 D -n O n N b o M m 0 rn * tn? ~ O pb= o z 0 7-1 z N z 33' 33' La rn z M 616' D2 N .4° m o N 89° 43'51 E 0N;40'' m U) D Q w . m . 7- l N 418.15' o':........... W~ oW o m i r - Z rn N OD v 1 v O~ < N A m N_ _N DA W O p 0A N p0 M0 o (n N -n I Z O 210.00' 418.47' Oo 628.47' N ` NO W 01 I I c MP ' IT Z W A N O O co 0 O -i m o O to cn m LO ir, r z m ° 1N z rn 628.86 . 10 7- m m N N I< 10 I-'1 NN N rn rn Ns. OD 0 OD OD 0 ;0 -N LA no O m vl p v o m cn p m cn o o D O 0 N (0 . 629.30' o ao' ~ I to! W cn A ° o C7 rr~ Ln T 0--4 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St C-Mil County C6,fj '_~36r~ OWNER/BUYER MAILING ADDRESS 0 V PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE Pa S bl, 01'. 5Vw PROPERTY LOCATION 1/4, 1/4, Section ~_q , T_2L/ N-R W TOWN OF 4~J5 U~I ST. CROIX COUNTY, WI SUBDIVISION C)'P dS Wk_S~ Ott&_) , LOT NUMBER _ CERTIFIEDSURVEY MAP 9 VOLUME PAGE , LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 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 system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. 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 DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expirati d e. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 8TC- 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/ contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with, the appropriate deed recording. Owner of property a;c E' M t Location of pro ertyE 1/4S 1/4, Section,T~ N-R W Township SD ~ Mailing address o 11 Address of site A. Subdivision name l S 04'ems Lot no. Other homes on property? Yes'_No Previous owner of property Total size of property Total size of parcel cab Date parcel was created Are all corners and lot lines identifiable? e~'--_Yes No Is this property being developed for (spec house)? Yes C No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. SD b ~S-" ~ and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of Applicant Co-Applicant V 11V Date o S anature natP nf cimnAti„-r~ ~ I . , .t - z -.ac a s .+•.'»3.-'# : . TF z. _ x•..1:.3.:,. :#:..'7aG2 7R'.. -•.i.6~t.. a. „T, k 'rtr ~ llf+ ~ V • ~ ssL DOCUMENT NO. STATE BAIL OF WISCONSIN FORM 5-198E THIS s►wcc eceewvm FOR eccoemNa DATA QUIT CLAIM DEED 506952 VOL 1040PW2JR - n~CiS7ir.R'~ Cr wC Jerilyn N. Sachsenmaier ~T CRa ord t7 y=e ; . -----------------t-o OCT 8 1993 quit-claims _ - at 10:11}5, - ATA - - ' . v ' ►or°°°°" the following described real estate is A_. County, _ State of Wisconsin: eeTVew To tt9l u~ ~ mar ~Q1w~e w Tax Parcel No: _9Z O --•«3S-' ~O I A p wcel of land located in part of the Smdwest Quarter of the Soudamst Quarter (SIB SA) -of Section 23, Tbwnship 29 north, Range 19 West, St. Croix acxnty, Wisconsin, described as follows: U* 3, Dell's Westview Addition to the Ttm of Hudson. i 11173 t f W= AID SUEL7B .T TO existing mortgage an said pc perty, and to any other ens~oents, aoro~ernants, i rvatians or z~trictions of record, if dry, but this small not be deemed to extend any such other reeoeded wanes beyond the tPxla established by law therefor. This homestead property. Dated this '.1------------------------ - day of Cc60ber-.. , 19.-.. 93 ..........(SEAL) (SEAL) ' Jerilyn N. Sachsem aier - (SEAL) --------...---.............-...............--..-........(SEAL) ` AUTHENTICATION ACKNOWLEDGMENT Siguatire(s) Jeril N. STATE OF WISCONSIN sa t authent d OCbO1Jr County. 19-93- Personally came before we this ................day of 19 the above named ` C Win TITLE: MEMBER STATE BAR OF WISCONSIN (If authorized by 1706.06. Wis. State.) to me known to be the person who executed the I foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY t