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AS BUILT SANITARY SYSTEM REPORT
OWNER
L~+~~E`~z~x a
ADDRESS y-
SUBDIVISION / CSM9 LOT 9
SECTION_ f ,2 T.,7 4 N-R g 0 W, Town of ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
r ors
t:
e
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhnln r-nv( t
BENCHMARK: j & /Z s--
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity:_ lea
Setback from: Well__ House / Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle
Alarm Location
-:SOIL ABSORPTION SYSTEM
Width: Length Number of trenches 3
Distance & Direction to nearest prop. line:-
Setback from: well: G House Q 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 INSTALLATION: PLUMBER ON JOB:
LICENSE NUMBER: INSPECTOR:-
3/93 j t
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:,
LaboMnd Human Relations $T, CMIX
Safety and Buildings Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
F
P i oJgr's a ❑ City ❑ Village Town of: State Plan No.:
1)`6 ~ T `HARVIAEUX
CST BM Elev.: Insp. BM~E)lev.: BM Description: A Parcel Tax No.:
TANK INFORMATION ELEVATION DATA Z /96
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing -10 ~ 97,E 1
Aeration Bldg. Sewer
Holding St/off Inlet
TANK SETBACK INFORMATION St#t outlet 9 5
TANKTO P/L WELL BLDG. venttake ROAD Dt Inlet
Septic 5-0 ' 11 -4 NA Dt Bottom S
8 .3
Dosing NA Header. f
Aeration Dist. Pipe
v2-
Holding Bot. System
PUMP/ S"aN INFORMATION Final Grade
Manufacturer Demand
Model Number
TDH Li Friction Syste
Loss Flea
Forc ain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches ,_Pff No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMEN I
SYSTEM TO P / L BLDG WELL LAKE/STREAM L. acturer.
SETBACK C IAU:; Model Number:
INFORMATION Type 0 ri
System: Lrc,'c OR UNIT
DISTRIBUTION SYSTEM
Header /Aid Distribution Pipe(s) „ x Hole Size x Hole Spacin Intake
r r ,
Length 72 Dia Length !S-7 Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grad: tems Only
Depth Over Depth Over xx Depth Of xx Seeded / So x,Bed / Trench Center Bed7Trench Edges Topsoil ❑ Yes ❑ No No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOC ATTO23: HUDSON.12..29.20 , RE, SE s BRA14DON DRIVE
l
JQ~~? r- GY t ~J+~€ t l LP x~ ® `C/k (~+c L (yY7Cflz -!~=~t!,fg!
Plan revision required? es ❑ No ~y
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspe or's Signa ure Cert No.
r
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: ro,
43 Pz`)
Safety and Buildings Division
~•p..}j ; SANITARY PERMIT APPLICATION Bureau of Building Water Systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size-
• See reverse side for instructions for completing this application StateSaSanit~ary[TPee~rmpit Number
The information you provide may be used by other government agency programs hec k i't revisio~To previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Pro OwnerName Property Location
40
e.je4:~ iect 1/4 S 1S /2 T'Z~ rNrRaQ E(or)
Property Owner's Mailing Address Lot Number Block Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
57'f'// 66t 11'.cl-n d
II. TYPE F BUILDING: (check one) ❑ State Owned ❑ Cit~ Nearest Road
❑ VII age
Town of 1~c~aC c~a,J
E] Public 1 or 2 Family Dwelling - No. of bedrooms --5::7
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 6o'a 6 , / :!f >C - ?
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office-/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on IineA. Check box on line B, if applicable)
A) 1. N_New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank OnlyExisting System _________Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq_ ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
4S"65 00 P -0 Feet Feet
VII. TANK Caa
ns Total # of Prefab. Fiber- Exper.
in gallons Site
INFORMATION g Gallons Tanks Manufacturer's Name Concrete strutted Con- Steel glass Plastic App
New Existing
Tanks Tanks
Septic Tank or Holding Tank R ❑ 1:1 ❑ 1:1 1r:--1~
Lift Pump Tank /Siphon Chamber ❑ ❑ 1:1 1:1 1 u
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature ( o Stamps MPRSW No.: Business Phone Number:
` at y,1 A zt 1w a ~ ~1- e P- o lp
Plumber's Address (Street, City, State, Zi Code):
Jv~r
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater , ate I ue Issuing Agent Si nat a (No Stamps)
Approved Surcharge Fee)
❑ Owner Given Initial Ux
Adverse Determination
=F OF APPROVAL/ REASONS FOR DISAPPROVAL:
4 3
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Ruil, li ngs Div ii on, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) most be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years-
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815.
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 on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement- Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number- Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service- streams and lakes; pump or siphon
tanks,- distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve- pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
^ Safety and Buildings Division
ersystems
r~■■. HF! SANITARY PERMIT APPLICATION 201 EBureau shin ton Ave.
. Waashington AvIn accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 81/2 x 11 inches in size. 51. &,~o f X
• See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide may be used by other government agency programs ❑ Check if i evjdu/ -_P -lion
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
We14_TF 1/4, S 2 T g17 , N, R,24 E (or)o
Property Owner's Mailing Address Lot Number Block Number
1.9 a d s % PT3 Q 4f 1
City, State Zip Code Phone Number Subdivision Name or CSM Number
II. TYPE F B ILDI G: (check one) E] State Owned qty Nearest Road
p Village
Public 1 or 2 Family Dwellin - No- of bedrooms Town OF Nt~de~e.✓ yQ,ri o,cJ vIll. BUILDING USE: (If building type is public, check all that apply) Parcel Tax
Number(s)
d20-l3/~-
1 ❑ Apartment /Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. gNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
------System System Tank Only-- Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 J4 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq- ft.) (Gals/day/sq. ft.) (Min./inch) 4 Elevation
.tdo i / • Feet <r S- Feet
VII. TANK j Capacity
n gallons Total # Of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks manufacturer's Name Concrete Con- Steel glass Plastic App
New Existin strutted
Tanks Tanks
Septic Tank or Holding Tank e5 T---s-,r/ ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans-
Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP/ PRSW No.: Business Phone Number:
~3 3~~ -,3/07 t
A,4 Loll 2nkx Z'_ "
Plumber's Address (Street, City, State, Zip C de): s
l 10 '70 S__ ~
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sa tary Permit Fee (Includes Groundwater e Issued Iss in Agent Signat a (No Stamps)~-
Approved F] Owner Given Initial Surcharge Fee)
41J
Adverse Determination Date
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
j
INSTRUCTIONS
1: A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable-
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815.
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 on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smallerthan 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale orwith 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-1 15 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
o.v aQ avve'eu t=yS% S' 2 OW f~aT~' kfi .~~2 Add 4 set .
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log 17
Wisconsin Department of Industry, SOIL AND SITE EVALUATION
` Labor find Human Relations Page of
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
County
Attach complete site plan on paper not less than 81/2 x 11 Inches in size. Plan must
Include, but not limited to: vertical and horizontal reference point (BM), direction and,;:, ,
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # , "
wi.~TER TFST rD~DiT•D-~S • Sv~.v~/~ 11,'_8 "S'~o~J ,i~ r ~ . ~
APPLICANT INFORMATION -Please print all Information. 3 19',VSi • Reviewed Qate
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner V4- VAv15 ,O J-040 A) .SrfP /ftiD Property Location
1/4, t, T < 7 ' ,I f •Z`~, E (or (4
T~Ofl~S N/ ~LSEN Govt. Lot EVE 1 /4 Sr
Property Owner's Mailing Address Lot # Block# Subd. Name or C6%# j
N
9~7 111,11ARiDUE g i >y~fRTG~ty~
City State Zip Code Phone Number 7/Jr_ Nearest Road
Ftup.SD~ kll. 54dllo (3~~ > - 7Zz ❑ city OVillage El'-
WUA1,A61AJ P,P
L~ New Cdnstruction Use: L7 e-sidential / Number of bedrooms 2'q Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
NOT- Pme-0, lm4wAJ
Code derived daily flow &Od gpd 4-1-1,f Recommended design loading rate / bed, gpd/tt2 trench, gpd/ft2
Absorption area required _bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/fIR J~ trench, gpd/1`12
Recommended infiltration surface elevation(s) .S.P~12 NOTE &-/,0 9<,7 P4 3 ft (as referred to.slt kplan benchmark)
Additional design/site consi tions - ✓r 000
Parent material 5Cjr 7 Af/f Lip - & 1 u^4 s 3-°1357 1hs' Flood plain elevation, if applicable Lv~ ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system R's' ❑ U L`_'J S El U B unS El U [S ❑ U ❑ S (2.6- ❑ S
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/112
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
i~s6fP_ cs 3-F y ..s
Ground
-25 A0 IIA-4
elev.
aft. 35- A /o Yze f 2 ccv f• S
7's y s y : - 5
Depth to
limiting
factor
-7 Quin.
G OO Remarks:
Boring #
d-~ o Y? eI,l,.-f c S 3y' ; , s
2. 1O o 31j- 's,,,-fp- C10 z f y ; _ s
20 -10 /0 YX vlze'
Ground 7 y ' 7 /0 4m 4p- C
elev.
7-S Yle :W
Depth to
limiting
factor
?In. Remarks:
CST Name (Please Print) Signature Telephone No.
R ORER r -24038 i a r 71,5-- 3 ?Co -'R 185
Address Date CST Number
i tea C57-H 1-14 b? 2_
Private Sewage Cons tali s
aRa nimall Rd.
PROPERTY OWNER SOIL DESCRIPTION REPORT
_ Page of 41.
PARCEL I.D.N LD
Boring # Horizon Depth Dominant Color Mottles Structure ITrench
In. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots
Gr. Sz. Sh. Bed io 2-.-- 44.1y /o 9 NJ- /f 5 ilk-, 44, -?"k _C&-) z.f
elev. Ground =3 y ~~r /Q :5'11 S/✓/~ 11 C 4 / f S , to
j~-~gy-ft.-_ 7 /o t S /f silk- G6cJ ' • S
Depth to 7.S J S ~4,M AM-fk i ,
limiting
factor
O / Remarks:
Boring #
o-~ ,o y Z /fs -~,e cs 3 -f
Y
Ground
elev. 7 s /~s~ /yN~ie ; J
9G-eft.
Depth to -
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G D/fe
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
5 -2- t 313_ - / f's6,~ fe c'cv z-F
3 o I S~/ Z ski c 40 I f . S
Ground
3~
✓~fiP/frlf/L~~ s ~~s /YN Q s S
elev.
ft.
Depth to
limiting
G factor
Remarks:
Boring #
Ground
elev.
h. '
Depth to
limiting
factor
In.
Remarks:
SBDW-8330 (R. 08/95)
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ULBRICHT & ASSOCIATES CO.
655 O'Neil Road • Hudson, Wl 54016 Reg. Designers of Engineering Systems
715-386-8185 Private Sewage Consultants
Re: Sol] Test sites, and siting Your Home.
To Owners/ Developers, Please be aware:
All of the systems for lots #4,5,6,7,8 in Hartland
Subdivision (tested under winter conditions March 11th &
12th, 1996) will require very large TRENCH TYPE conventional
systems because of soil permiability restrictions.Conditions
across other parts of each lot can/ and may require entirely
different on-site treatment systems.
Also, as required by state codes, an equally large
replacement area has to be left intact UNDISTURBED with
proper set-back distances to the well, other structures,
etc. as deemed by code. Less space is required if the owner
were to install a mound type system (i.e. no replacement area
is required for mound type systems).
Please understand, that in the process or procedure of
selecting the actual homesite, if the owner will be using the
soil test areas as provided and recorded by the seller/developer,
the following is very critical: The installing plumber you
select, or a registered designer or engineer should meticulously
layout and plot the system as indicated from the soil report..
And an equally large replacement area should be plotted out.
Further information to be supplied by the owner is necessary
in order to determine the actual exact size of the system.
The final size of the system is dependent upontthe gals. of
wasteflow to be generated from the proposed size of the home.
The County Zoning Dept. must review the owners final house-
plans', only then can the installing plumber determine the
final size of the proposed system.
All of this has to be carefully addressed before a
builder and owner can safely choose one's precise homesite.
Often times the original soil test area, provided for
subdivision approval by the seller as required by County
Zoning Dept. ordinances, is not in an area prefered by the
eventual buyer, or perhaps the size of the buyers home may
require a 'larger test area. New or additional testing may
be required, since a septic system by law has to be laid out
exactly within the recorded spot tested; it cannot be shifted
out of the area recorded with the zoning dept.
Finally, it is our recommendation (and of most
consciencous installers) that when soil permiability on
a site is very slow (.5GPD/ft2 or lower) to install a
presurized, dosed mound-type system. It is the consensus
of most officals that mound systems will generally outlast
in-ground conventional system (average life 10-15 years).
This is a very important option to cautiously consider.
Remember, the two most important systems you will be depending
upon for many many years to come is your well and the quality
of your septic system.
CATED IN PART OF THE NI12 OF THE NEI14 OF THE SE114 0
JNTY, WISCONSIN, BEING LOT 4 OF CERTIFIED SURVEY MAP
JNTY REGISTER OF DEEDS OFFICE. PLAT CONTAINS 12.60
=0i
4B C. S. M. L
~ F a4/
h`L `✓0'". 67 PG. 1596
-4y
N89°04'17"E
402.86' 311.98'
z I
O
/001
LOT 4 W LOT 3
~o-``~~/ I 1.43 AC. 2.01 AC.
F 62,290 SQ. FT. N 87,700 SQ. FT.
LOT 5 3'a w
s.
1.67 AC.
N
N 72,619 SQ. FT 7
z w/
O m 6
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER 'DONAL-D T. 4- J4N I KE7 I.. • R A9\/1 EIA-X
MAILING ADDRESS 120' N - bWE7NS Sr 1419i 4302 S-1L-L\ATE(zj Mt'j %08'2
PROPERTY ADDRESS )(Y-Y, B?_A t,) bt4 Q?-WE ~ \l l,►' ot'l -owl. 6401 (o
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE "u-0Sbt44 4~S -5'4 c)i Io
PROPERTY LOCATION 1/4, SE 1/4, Section 12. , T 29 N-R Zb W
TOWN OF N•tkpSoN ST. CROIX COUNTY, WI
SUBDIVISION H Arf-TLP:: Nm J p ooiTjt>~ LOT NUMBER S
CERTIFIED SURVEY MAP I 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 expiration date.' 1
SIGNED:i
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
a
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 Do4AL-D a- TAN 11,4c, L_ 4 A K-V 1 CLk.:A
Location of property 1J E 1/4 Se 1/4, Section 12 , T 24 N-R 2 0 W
Township ST. TbSep+4 Mailingaddress 1202 N. OW-KS ST.
A-Pr 4 Ti 2 Mgt. s50
1
Address of site fl, 4NDp Ord VE .rj
406
subdivision name 4P T L1 A1n 4001 i 1 DAf Lot no. IF
Other homes on property? Yes ✓ No
Previous owner of property 'f>a- P•1 'L->EVEi-09HEtJ i
Total size of property 1. 0? ACREG
Total size of parcel Z50 SC2. F-F
Date parcel was created
Are all corners and lot lines identifiable? ✓ Yes No
Is this property being developed for (spec house) ? Yes t✓ 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. , 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 Ic Applican
4/Z2/gc. t
Date of Signature Date f Signature
I
WARRANTY DEED
Document Number 1REO$STER°S OF'F'ICE
S ST CRON CTY, w8
Reed for Record
Return Address APR 18 1996
11:00 A.
P180"'zr of t?asd3
Parcel I.D. Number
B & N Land Development, a Wisconsin Limited Liability Company, conveys and warrants to Donald T.
Harvieux and Jannine L. Harvieux, husband and wife, the following described real estate in St. Croix
County, State of Wisconsin:
Lot 8, Plat of Hartland in Town of Hudson, St. Croix County, Wisconsin.
TRAN~FER
This is not homestead property.
Exception to warranties: Easements, restrictions and rights-of-way of record, if any.
Dated this day of April, 1996.
B & N Land Development, a Wisconsin Limited Liability C any
(SEAL) (SEAL)
Dennis M. V6islad Thomas K. Nielsen
AUTHENTICATION
Signature(s) Dennis M. Bjornstad and Thomas K. Nielsen
authenticated this day of April, 1996.
Kristi gl
TITLE: MEMBER STATE BAR OF WISCONSIN
THIS INSTRUMENT WAS DRAFTED BY:
Attorney Kristina Ogland
Hudson, WI 54016