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020-1053-55-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552310 0 GENERAL INFORMATION (ATTACH TO PERMIT) 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: Richardson, James L. Hudson, Town of 020-1053-55-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: U 20.29.19.197J TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 6,-75 0' 75 IM P ' Alt. BM~ t C . S. I Aeration I Bldg. Sewer r 49 • SpZ , (,3 Holding St/Ht Inlet 1 7- 72-6.3 TANK SETBACK INFORMATION St/Ht Outlet S. 3S 72-4 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic O~ 76 / Z7 / 75 Dt Bottom Dosing O Header/Man. 7.73 11. 67- Aeration Dist. Pipe t A . OZ. o1~` Holding Bot. System /0.7:5 96,6 I PUMP/SIPHON INFORMATION Final Grade (o.171 lit. Manufacturer GPM nd St Cover, r.t L...-. Go Model Nu TDH Li Friction Loss Syst Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM D DITRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pit ` Inside Dial Liquid Dept -3 3z I j7e-.,~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:- / INFORMATION Type Of System: CHAMBER OR ~r1+r-T t! ~ ~7 ~n A J~ UNIT Model Number: ~ DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole 9iig x Hole acing Vent to Air Intake \ Pipe(s) \ Length 1 Dia N, 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 Topsoil Yes ® No Yes ❑ ]N, COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 823 Dorwin Rd. Hudson, WI 54016 (SE 1/4 SE 1/4 20 T29N R1 9W) NA Lot 1 Parcel No: 20.29.19.197J 1.) Alt BM Description = / r -I L., 66 0-el EZ Goo w f ✓CXeU.)S 2.) Bldg sewer length = 2,7 - amount of cover 3 of rn~ole.. a Plan revision Required? ❑ Yes ~No G ' ~J7 Use other side for additional information. 1 Date Insep is Sig ure Cert. No. SBD-6710 (R.3/97) JJJ ~ Q ~ a t4o;n wi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St. Croix 1 n Madison, WI 53 707-7 1 62 Sanitary Permit Number (to be filled in by Co.) f co roe 55 2_31 0 NJ - o Permit Application State Transact' n Number Adm. Code, submission of this form to the appropriate governmental Project Address (if different an mailing address) \unis s requ ed ing a sanitary permit. Note: Application forms for state-owned POWTS are )W is ed to ent of Commerce. Personal information you provide may be used for secondary Same gZ sin ac with the Privac Law, s. 15.04 1 m , Stats. 1. A nforma ' Please Print All Information Property er's Name Parcel # James L. Richardson _ 020-1053-55-000 Property Owner's Mailing Address Property Location -7 823 Dorwin Road t 9 Govt. Lot City, State Zip ode Phone Number SE SE'/<, Section 20 Sbraerset, WI. !'~lJ x /v I e- 540ifT (circle one) Ill T/y~e.tlf Building (check all that apply) Lot # T 291 N; R 19 W lldor 2 Family Dwelling - Number of Bedrooms'' 557 1 Subdivision Name /~~_e' Block # CSM Vol. 6, Pg. 1525 ❑ Public/Commercial - Describe Use Pe 5'6 in Na ❑ City of ❑ State ed - Describe Use CSM Number ❑ ill e of / " w 01-0001 032-56 Vown of Hudson III. Type of P mit: (Check o illy one box on line A. Complete line B if applicable) A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Compon plain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Informat' n: fi ator "Q4 Plus" Standard chambers &.4endca s, of Lok PL-525 effluent f esign Flow (gp Design Soil Applicatio st) DisRr al Area Required (s Dupers a Propose s System Elev~ton / Ngpd 0.50 gpd/sq. ft. sq. ft. 34 . sq. ft. 170 Z~ 89.50' / ~J VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o New Tanks Existing Tanks A. 2 o`.. U v~ 2 2 on P. CD a, Septic or Holding Tank - 750- 1 Wieser Concrete X Dosing Chamber VII. Responsibility Statement- I, the u ersigned, ass a responsibility f ' s 'on of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe s Sign MP/MPRS Number Business Phone Number James K. Thompson MPRS 30021 (715 248-7767 Plumber's Address (Street, City, State, Zip Cod 340 Paulson Lake Lane, Osceola, WI 54020 VIII. Coun epartment Use Only Approved 11 Permit Fee Date ssued Issuing gent Sign e $ ❑n Reason for nial `]I / ✓ 3 ~j IX. Conditions of Approval/Reasons for Disapproval 99 SYSTEM OWNER: 3~ NO rz T beef aO r" -s O 1. $eptic tank, effluent fifter be A e / /I n dispersal cell must all be services !maintained 4r ~ a+~ /'~'>✓[,e`j50 1D~~~ as per management plan provided by plumber. 2. AN se(back requirements must be maintained as per code / ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 8 12 x 11 inches in size SBD-6398 (R 02/09) Valid thm 02/11 Conventional POWTS Index & Tilte Sheet Project Name: James L. Richardson Conventional POWTS - Accessory Structure Owners Name: James L. Richardson Owner's adress: 823 Dorwin Road, Hudson, WI 54016 Site address: Same Project Location: Subdivision: Lot 1, CSM Vol. 6, Pg. 1525 Legal Description: SE1/4 SE1/4, Sec. 20, T.29N., R. 19W., Town of Hudson, St. Croix Co., WI. Parcel ID 020-1053-55-000 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 Septic Tank Cross Section Page 8 Parcel map Page 9 Septic Tank Maintenance Agreement Page 10 Waranty Deed Attachments: Soil Evaluaiton Report by James Thompson, 03/01/2012 Mater Service: James K. Thom son, De 't. of Comm. Credential #30021 Si/ Date: Page 1 Of 10 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01) ■ ,~i/eda/ua~an ~a~ Ja 'Qn E.~~ tinq le Sca/e~ / = s/0 X6 So..~~.s L .~c~rdscr,,or~= 8.23 f/udsv~, ~i suo~c " " Gsm doP. G,~ /s1s O SEYfI ~ Src moo, 7044 5~. Gro;Y Co., ~J/ pc'/. Oho - /053- ss--crC Q~ctcremw-t6 u~il I be m-6 O'- ~XCCt ~t~• 9S,0 9g's' ~(opos[ L4 odd5pAr&Jc'_&I 3S« (~rrdou~~ y'S!O ©Ke C~) ti~,.cl, :,t 2. E33 x G,a,4 6crS. Sys e r3 .60 be = B9so' dk\ 40 5 ySm 1AreA wC, ; ■ a2 ~ ~ ` fro sed u? e csC~ Cease roc 2- 1 ~iv2wa ~ 1~'w~~ Qoac~ 40 ;e{~~ n~i /✓~dr • Tpo Z' fjssa.-ed e,Ittl = /40.60.. P5. z/r~ • ki/ e daA,,a.6e,-) /a ♦ E.ri~z~ir+q 2/cJa-&on 923 der Win ss~0/G f/udSd,;, cJ/ SEY' Scc .20 7-2~A, W. / j C)., T. O ~ ycWlSo n 5~. Gro ~ Co., ~.J/ ~ Oho - /053- SS-off -~>2aEe ~ ~ t f Comm. 83 Sc~K ¢XC_LCCL1. 9SV' 94's' ~(opasc of ol~Sp~rs.Jc etl. 3S~c~ oKe At 2.83X ~ ~ C1,a..a 6.~5• S ys~e,,, elur I ~ b ~ be = 89so' h w,ky~r~;,~ ~ 5 ySfxm Are4 wL° i ■ + i 1 B 2 ` ~~oPosed u? e cK:- Cenerc~x u i~~ s.r w/ ~o/ Lo.K R >iV2W a ~-lu~ ~ Qoad ~cua C,y ,~r7C~i Gar Tjo o f' y -jrj jjs 4 e~~'~vo~ Ass a,~e~/ e, It r/ ~ 14Y2 r~ P5. z io RICHARDSON DISPERSAL CELL & SEPTIC TANK SIZING CALCULATIONS JOB DESCRIPTION: Rest room located within accessory structure located on private residential property. Structure is for the private use of owner. System to be oversized to maximize efficiencies of installation and extend system life expectancy. DISPERSAL CELL SIZING CALCULATIONS: 1. Estimated Daily flow = 40.00 Gpd design flow j 2. Infiltrative capacity of native soil = 0.5 gpd/sq. ft. 3. Absorption area required: s . ft. 4. Absorption area as proposed: sq_ft. (8 chambers total) D~ Infiltrator "Quick 4" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4" end cap (pair) = 5.89 sq.ft, EISA Number of trenches: I @ 8 chambers per trench Trench width: 2.83' Trench length: 34.00' Trench spacing: 0.00' on center Total system area w/ 6' trench spacing: 2.83'x 34.00' SEPTIC TANK CAPACITY CALCULATIONS: 1. Design wastewater flow = 4>9~Q~ L 2. Minimum required capacity: 1 Gallons ~J' 2$ (40.00) + (11.61 x 3* x 0.54) + (46.77 x 0.54) = 25.26 *(Requires a maximum 3 year maintenance cycle) 40.00 gpd / 75 &9d = 0.54 gpd person equivalency 3. Proposed Septic Tank Capacity & Manufacturer: 261 gallon Weeks Concrete 4. PolyLok PL-1525 effluent filter to be installed at septic tank outlet. Pg. 3 of 10 Soft Absorodon System Cross Section 94.25 ft .4' Schedule 40._ ► Final Grade PVC Vent Pipe 90.50 With Vent Cap ft Leaching ~T 89.50 Chamber ft System Elevation Soli Absondlon System Plan View _3~0 ft 2.83 ft l Leaching Trench 1 Vent Or Observation Pipe Chambers 4' Dia. Header i_eachina Chamber Specifications Manufacturer And Model Infiltrator "Quick-4" Plus Standard EISA Rating 20.00 sq ft per chamber Soil Application Rate 0.50 gpd/s4 ft 0 gpd Design Flow; 0.50 Soil Application Rate 20.00 EISA = 4.00 Chambers rows of 8.00 chambers each. 4 10 Page of 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. Contingency 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. Pg. 5 of 10 • • J: T Filters PL-525 EFFLUENT FILTER (COMMERCIAL) 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 the largest commercial filters in its extension handle 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,; f the market can make that claim! Accepts 4° & 6„ SCHD. 40 Pipe PL-525 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before 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 R` 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# 6,015,488 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 tank. Make sure all solids fall 4 or 6 outlet pipe. If the 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. i W/v e w aA/~ON Ael;c> h1old'I'l ~ANAC aNk1w, ~v u3~d1 A~ ~n ON 1,5 !2 ~ 8 k 3y _ X40 5,~ IYb~ ~ ~cAl~ i z~ WEEKS GGMCP1`Ir- RAY L WEEKS 1832 215th St. New RichMord, 54017 IL AQ A, (.0 .N J,4`u iT Cr3~ts4~1C gbalav" Cat I)A CERTIFIED SURVEY MAP yW Located in the SE 1/4 of the SE 1/4 of Section 20, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin Surveyed for: Larry Hanson Rt. #Z, New Richmond WI 54017LEGEND SCALE IN FEET 1 = 200 0 100 200 400 6O0 &COUNTY SECTION CORNER MONUMENT • I " PIPE FOUND PINEGROVE HEIGHTS m I X 24" IRON PIPE WEIGHING E 1/4 1.68 LBS / LIN. FT. CORNER C. S.M. VOL. 5 PAGE 1210 N 89'12'18"E 1337.51 oD 465.00' 420.00' 422.85" "ff 29.Gd m o 6 6 LOT 1 LOT 3 LOT 4 m co o W 176644 sq. ft. W 314491 sq. ft. (7.22 318069 sq. ft. (7.30 A z cn (4.06 acres)including Cn acres) including R/W acres) including R/W N ° N IZ Z O1 R/W co 300631 sq. ft. (6.90 304074 sq, ft; (6.98 m 10 0 166156 sq. ft. (3.81 m acres) excluding R /W acre s) excluding R /W 0 s O g acres)exbluding R/W N z z z p om ~Ln .io ~.io ~v ~o 29,27 465.00 M A LTI ? IO N 89'3 0 '54"E 494.27' N W W N N ~ M ~ to N '0 m g LOT 2 to o N ro o Rl Iv 192223 sq. ft. (4.41 X X m - 0 W acres) including R/W W N - 165572 sq ft (3.80 rn i® o acres) excluding R /W o N 16 6 I POINT OF BEGINNING 465.00' 420.00' 424.08' 493.85' _ JACOBS LANE _ 33 _ 420,00 _ _ 424.13' _ m S 89030'54"W 1337.9B _ m Pn DESCRIPTION A parcel of land located in the SE 1/4 of the SE 1/4 of Section 20, . ` m' z T29N, R19W, Town of Hudson, St. Croix County, Wisconsin, m described as follows: Commencing at the SE corner of said Section 0 cn C) 20; thence NO°47'57"W (assumed bearing referenced to the East line m 0) of said SE 1/4) (previously recorded as bearing N0058'43"W) 565.76' i ul along said line to the point of beginning; thence S89°30'54"W N ~1 J (previously recorded as bearing S890 04153"W) along the centerline ° of Jacobs Lane 1337.981; thence NO045'50"W (previously recorded as bearing N0°52'50"W) along the West line of said SE 1/4 of the SE 1/4; thence N89°12'18"E 1337.51' (previously recorded as bearing N89°01'32"E 1337.53') along the North line of said SE 1/4 of the ,~~alvrrrcaa i;~Wmox OMY rvtr+*~h'1.1 `;)WY4 41MM113r-JWOJ? AjtAOO:) )f](1010 IS SZST 02Ed 9 'TOA AOUdV paooaa jo sIu-euanoo pu'e suoz40t.14sa.z 's4uauzas'ea TT-e o4 goaCgns ~upq osj-e pu-e °d-eLu p@uo-e44,a oip uo umoTis su Aem M61a N 6Z 1 OZ jo 4u~lj~ plCoU umo L oq o; paCgns $utaq puu ° ssaj ao a.zoLu ° (S;Daz)e N01133S 9686' Z2) 4aaj @-Tunbs LZiv `T00 `T 23utut-equoo :$uiuut2aq jo 4utod aq4 o4 :6/T -70 a 10 aut s-e -E-es 'Juo e aoua ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/~ C-mes Z Mailing Address Property Address (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number ©~D /U53 -SS-~ LEGAL DESCRIPTION Property Location 56-'/4 , 5 ~I'/4 , Sec. ;7_0 , T ,2 `_N R~W, Town of Subdivision Plat: Lot # Certified Survey Map # Volume CP , Page # Warranty Deed # V(6UZ (before 2007)Volume ? 77 , Page # /.Z3 Spec house ❑ no Lot lines identifiable es ❑~ie 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. Nu ber of bedrooms T O A I M4T(S) 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) P q 0-00 I-46-n i i - 12" rr ie, pr+c• waasnvsra ioe :ctaRnin4 nw STATE B_kR Q-F- V UICO `S WARRANTY VMD 9` ~ i~~S1 C1L^IA. ' - . 1'~~~Mtt L. ~ _ I~~>•!i_Y1 - ~ - This Deed, mr, b tv a . Tsh I' and Laurie S _ ST. "M CM, W lhu-hand and wife- as. surv~voreh3~--mgr3,ca2 r~ra~r~ re}? R$~: for Rd~CY~ - - Granter, ? ' ftl$7.~ P rand---dame* L _ RiChaZdato- S eriaan - - = Grantee. ofr t i ` it71eSSeth That the said Grantor for P. valuable eonaiderattoa 1 - z - - - = - = .:o a ct., a -gnat ,.~wEl..n SL&N Coursty, State of •SPirconein _ Fart of Southeast rzrteY Of Southeast- Quarter mf sectiVn 20. l! i Townehip 29 '-Torth, Range 19 West: descr be a as f6330c,:sc T&x Par,_ri No z Lot 1 Lf C rt :r d SM rVe f i'~ed May 24 1985 in Vol. "6" E CSM_ Page 2525. z. t ; This _ homestead property. ( ) pF **0 ~i Toget'.zer wit:l all and singµlar' the hereditaments and appurtenance.9 thcreunto L belonging, ii -And._._gxznrors_. Thr►.•, ..._.Eazan xa,. ( tvarran7tu that the title is good, in:lefeasihle zn'£ee simple and free nnel olear of encombrancea except _i easements, covenants and restrictions of record, i£ anyy at-id will warrant and defend the same. 4 Elated this day of - JulY.. lo_.._. ___(SEAL) (SPAL) John P Evans (f _ } -a9 (SEAL) r . - (SEAT.) f' ft Laurie S mans it AUTXXEZ+T ICATI0I~7 ACKNOZ71 bBDGRllBNT _ L STATE 01- 7 WISCONSIN 1 }f. Signature (y) ___o__.__._ t _ _____tt 4LQf.x . --------County. authenticated this duy Of__.____ 29______ Personally came hefore me this of - - r -------'~l?l.X_..._........ the Yiii..Fi7 Y15sni$ u Jahn -P. Evans -and ~T TITLE M-EMBER STATE BAD, Or WiS•C4~N45vq 1#~. - (It. Tut, tZ_--' . rnt, cite<1 the ~r _ aric-rro\vledge t17.': same. ' THOS INSTRUMENT WAS MR= P7fiT'i. By - to r_1 U ~r L*% f~ LG ~ 111-Z 6 ~ C ? HE` WOOD and CART - ~ s ~ - l;y Samuel R Car: ' / f l i jii; / % Lr r• S c St Croy P £I: $lox 22L} 3i data3•- 1 __54C77E~ , a v p htii Ccu r Z31f. a.kt.=.c ie.d iv.3 with `T t r+>-zzn.t: ss~,~ i rc-n. in. ni_ i Ff nn?_ .tip , I.it (Signatures may be avitnenticate.t or nre not ner-essarv_1- z-.«..+~ `i ~3 ~l z Lc...,.. •27amea or s..•n Q,str.:nc m - r. e•.. . •N - c.. ~Z'V VI lO zir W:ICIiRANT7 ZJL£Z7 - - a-~ , .VY! C 2276 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix 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. 020-10 -55-000 Please print all information. Reviewe Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(l) (m)). Property Owner Property Location James L. Richardson Govt. Lot SE 1/4 E 1/4 20 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 823 Dorwin Rd 1 Vol. 6, Pg. 1525 City State Zip Code Phone Number J City J Village a Town Nearest Road Hudson WI 54016 Hudson Dorwin ej New Construction Use: J Residential / Number of bedrooms 0 Code derived design flow rate 26 GPD J Replacement I 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 with 0.7 gpd/sq.ft./day loading rate. Recommended trench elevations to be 89.50'. Boring # J Boring ✓ Pit Ground Surface elev. 94.46 ft. Depth to limiting factor > 102" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/2 none sil 2fgr mvfr cs 2fmc 0.6 0.8 2 10-28 10yr4/4 none sil 2fsbk mfr cs lfmc 0.6 0.8 3 28-34 10yr4/4 none Is Osg ml cw 2vf1fm 0.7 1.6 4 34-102 10yr4/6 none s Osg dl - - 0.5 1.0 11 Horizon #4 contains 1" - 3" irregular, wavy, discontinuous bands o 10yr4/4 fs spaced at 12" - 30". Horizon loading rate reduced to relfect permiability restriction associated with textural changes. Fil Boring # J Boring j Pit Ground Surface elev. 94.06 ft. Depth to limiting factor >96" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/2 none sil 2fgr mvfr cs 2fmc 0.6 0.8 2 10-25 10yr4/4 none sil 2fsbk mfr cs 1 fmc 0.6 0.8 3 25-30 10yr4/4 none Is Osg ml cw 2vf1 fm 0.7 1.6 4 30-96 10yr4/6 none s Osg dl - - 0.7 1.6 1( rl QI * Effluent #1 = BOD5> 30 < 220 mg/L a d TSS >30 < 50 mg/L Effluent #2 = BOD5 <30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signa re: CST Number James K. Thompson ptirr <-7-747e 5--- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 3/1/2012 715-248-7767 Property Owner James L. Richardson Parcel ID # 020-1053-55-000 Page 2 of 3 3 ] Boring # Boring ' Pit Ground Surface elev. 94.14 ft. Depth to limiting factor >98" in. F Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-14 10yr3/2 none sil 2fgr mvfr cs 2fmc 0.6 0.8 2 14-43 10yr4/4 none sil 2fsbk mfr CS 1fmc 0.6 0.8 3 43-48 10yr4/4 none Is Osg ml cw 2vf1fm 0.7 1.6 4 48-98 10yr4/6 L none s Osg dl - - 0.5 1.0 ,5 t Horizon #4 contains 1" - 2" irreg r, wavy, discontinuous bands of 10yr4/4 fs spaced at 12" - 22". Horizon loading rate reduced to relfect per iability restriction associated with textural changes. ❑ 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 P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <30 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 & Site Evaluations Sa.,e,5 L. ex A, -rdWn 8,23 dbrc Jio U'OCJ ~m daP G,/~. /S1S SEY~Ksfl5ec .20 72-0,0 7/ 41 " 5E. GroCo.,cJ~ roe/. # 0~ - /053- SS-ct;~ Yto~e A I ( Cam.6 3 S4,6&a f QC~ktrervw-tS u~il I 64 mE.;6 Oy- Qxce~dcd. 9S 9~s ~ moo, s ys~ Are4 + ■ ' i B 2 e.le~ 3 /cYJ. cn,. i VIERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.' 02550/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 3/14/90 COURTHOUSE DATE RECEIVED' 9 90 HUDSON, WI 54016 ATTNS THOMAS Co NELSON C~ OWNER*, John 6 Laurie Evans 0,/o LOCATIONS 823 Dorwin Rd., Hudson COLLECTORS M. Jenkins, St. Croix Zoning SOURCE OF SAMPLES Kitchen faucet COLIFORMS 0 /100 el INTERPRETATION: Bacteriologically SAFE NITRATE-NS 3 ppe Under 10 ppm is safe for human consumption. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIANS Pam Gane WI Approved Lab No. 19 ~.\NDEVFNOFNl u < Means "LESS THAN" Detectable Level Approved by! ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 u, YCY X"Ir !f + ` ca, /gyp ~ ST. CROIX COUNTY ZONING OFFICE ~h % St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning office offers the service of septic i and water inspections to Lending Institutions, Realty Firms, and private individuals. CRjeti on of this form is essential so that the vroperty can be located. Please provide the following information enclose appropriate fee made payable to St. Croix County Zoning office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25.00 (For nitrates and coliform bacteria)FEE: $175.00 WATER TESTING (For VOWS) FEE: $25.00 SEPTIC SYSTEM INSPECTION---------------- (Determines if system is properly functioning at t me of inspection) E v C,.z~ s Property owner's name doh rN an 6 Lei e- oF~ -fo-ce~~ to vuL „j,, C* Cc.1~) Property owner's address g~3 ~orwir~ 1'c~od zkj- cry ?a uu. Legal Description 1/4 of the 1/4 of Section , T N-R Town of Lot Number Subdivision Name FIRE NUMBER LOCK BOX NUMER Color of house C&Ag6r~ ~(-,Realty sign by house?„ If so, list firm: l., For s 0e- b'A O wc~ex PLRASR 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. phew y o a rr•L i~o-~t-r -rha~ ks . Firm or individual requesting services: L0.J-A'i e- -vans A 1- Telephone Number ~n REPORT TO BE SENT TO: 16hn ctncl (a1 c F. if 'wiry f d z -544 A I to Closing date W(krch Al iggb - Signature t--Z&AA&AJ S a p N 0 'o 0 c ; 3 3 m a A o C: O (n .--l j z O 01 2 2 N O • ~O O N 3 v m y y N c CL Z n N O 0 0 ' ►.y c co S 7 ? P cr p N m ' o r, CL w 3 L O Cil O 3 ~ N W co a O O p m N CL D ° w W 3 c°~n co c l V ° w o Z co CD 0 r ca C C N C rn (_n Q I ~ 3 v < z ~-3 (n ca co > o' N C rn N ~ tNn N Z Zooz O CD 0 D O a = \r l~l m N ((D v c t~l c to N w m a Z 3 CD (6' -1 to ° a o A Z c A CL P o. ° fA -I N "a RI co O CL Z 3 a 00 Sri co 3 m w Z I w CD I -ay y CD < ~ 3 a am n y 3 ra v c N O :3 0 a 3aRU v N I omt~° a Ty "in y m 0 O a oo 0 m CD ~(D ° =C) (n y CD 0 o v CD Yr a vv 0 V ° 7 p O N o H I ti o a °O i_ ti I Parcel 020-1053-55-000 02/0212005 07:54 AM PAGE 1 OF 1 Alt. Parcel 20.29.19.197J 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): * = Current Owner * RICHARDSON, JAMES L JAMES L RICHARDSON 823 DORWIN RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 823 DORWIN RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 4.060 Plat: N/A-NOT AVAILABLE SEC 20 T29N T19W PART OF SE SE LOT 1 OF Block/Condo Bldg: C.S.M. 6/1525 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 877/123 07/23/1997 768/623 07/23/1997 725/616 2004 SUMMARY Bill M Fair Market Value: Assessed with: 48024 243,800 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.060 52,400 136,200 188,600 NO Totals for 2004: General Property 4.060 52,400 136,200 188,600 Woodland 0.000 0 0 Totals for 2003: General Property 4.060 52,400 136,200 188,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 120 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 001-WATER SPECIAL ASSESSMENT 0.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 Form - S T C - 104 R s VFW AS BUILT SANITARY SYSTEM REPORT • OWNER Bj~ TOWNSHIP r SEC. T~N-R19 W ADDRESS ST. CROIX COUNTY, WISCONSIN C SM (_f fSa-S _ SUBDIVISION - LOT LOT SIZE ~31~aY~w►v PLAN VIEW 0 Z0-~OS"3_ 5.~~~311 J ~Z Distances and dimensions to meet requirements of ILHRR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I. L 1_ 1 ' ,J3/7 i r-s 011 W~~1 INDICATE NORTH ARROW BENCHMARK: Describe the vertical referenc oint used L. Elevation of vertical reference point: Proposed slope at site: ` SEPTIC TANK: Manufacturer: ~-2Z414*quid Capacity: 1/,4hil CS Number of rings used: Tank manhole cover elevation: 4~77 Tank Inlet Elevation: Tank Outlet Elevation: feet from nearest Road: Front,O Side,® Rear, O feet F nearest property line Front AN Side 10 Rear, 0 feet Number of feet from: well, ~i building:_ ! ,~c='_lsMiftude this information; of, e,'abov above plot plan) ( 2 reference dimensions to septic tank) ` SEE REVERSE SIDE Win. +x r moo. K w _ PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: -1~ Length:_.{'~ Number of Lines: _2 Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Rear,0 Ft.,94/ Number of feet from well: 3 Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of.feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj Y 4 +DEPAFiTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN' RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISONsWI 53707 • XCONVENTIONAL DALTERNATIVE State Plan I.D. Number. • ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound Ill assigned) NAME OF PERMIT HOLDER: ADDRE OF PERMIT HOLDER: r IN 3FF.CiION ;VE rNjM A ermanent eference pomt) DESCRIBE IF DIFFERENT FROM PLANREF. PT. ELEV.CST REF. PTELEV Name I Plum ime/MPRSIV No.. County Sanitary Permit Number: SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIOUID CAPACITY: TANK INLET ELEV,: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER IPROV DED: PROVIDED: 0 k, 6~1 f I YES ONO OYES ' NO BEDDING: VENT DIA.. VENT MATL.: JHIGH WATER NUMBER DF DAD: PROPERTY WELL: BUILDING. I VENT TO FRESH A M FEET FROM LINE 1l AIRIIjNLET OYES O OYES ONO NEAREST % .1J1' DOSING CH MBER: MANUFACTURER. BEDDING: JLIOUID CAPACITY. PUMP MODEL UMP/SIPHON MANUFACTUR EH. 1 WARNING LABIJN0 LOCKING COVER PROVIDED: PROVIDED: ,_rl' OYES ONO OYES OYES NO GALLONS PER CYCLE: PUMP AND CONT L PERA ZONAL: NUMBER OF PROPERTY JWELL BUILDING I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) OYES ONO NEAREST I SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENII+I+ JDIAMETER MATERIAL AND MARKING 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: WIDTH: LENGTH: NO. OF ToST R.PIE SPACING: COVER JINSIUE DIABED/TRENCH TRENCHES KtRT ER IA L' PIT H DIMENSIONS ~2GRAVEL DEPTH FILL DEPTH DISTRPIPE DISTRPIPE DIS. PIPE M ERIAL: NO. DIS NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIP S ABOV I Z~ I , i E CD,VER. ELEV. INLET ~eV END: ,.,.-.I PIPES. 1 FEET FROM LINE^ _ Ali I E ! ^ / / C~ NEAR EST__11►i C MOUND SYSTEM: 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- O meets the criteria for medium sand. TIONS MEASURED. YES NO SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS OYES ONO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED. SEEDED: MULCHED: CENTER: EDGES. OYES ONO OYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE IM ANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.. ELEV.. DIA.. ELEV. PIPES: DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: OYES ONO DYES ONO COMMENTS' PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY JWELL: BUILDING: / FEET FROM LINE: 7 ❑ YES 1:1 NO ❑ YES ❑ NO NEAREST Q Orl _ CO)~ G Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82) Ali- unsconsv, APPLICATION FOR SANITARY PERMIT . jAa__COUNTY (PLB 67) UNIFORM SANITARY PERMIT # DILHR DEPRRTrTEr1T OF / IrIOUSTRV, LfiBOR6 MUTR1-I LiELiiT10n5 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PWPERTY OWNER MAILING ADDRESS j ~ 2-t] Y l , A QY1 eJ W CdJ ! D~ c , . O 9 PROPERTY L CATION C-FfY: vu I Or;F; ,5 - 1/4SL1/4, S p , TN, R I 'I @ (or) W TOWN OF:~~c T ~ninnnnFx~ LOT NUMBER BLOCK NUMBER is BDIVISION NAME NEAREST ROAuLrcicE v.. a STATE PLAN I.D. NUMB l if f N vve T TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): THIS PERMIT IS FOR A: , X New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench U Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity /000 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total Of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 1X6 0 L - 17f (/S Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installati the private sewage system shown on the attached plans. rA) Name of Plumber (Prinil: r Si a r /MPRSW No.: Phone Number: C )~5 6 (Ir lye 2/3 a L I 1Z ;~4_ r _ 3 1 PI ber's Address: Al Name of Designer: V (.`1 f s O Wt G 'Y 0 / COUNTY/DEPARTMENT USE ONLY Signature f Issuing Agent: Fee: Date: ❑ Disapproved ~j1 / Q f7j ? Q~' ❑ Owner Given Initial 0 S Q J"'QV Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber s INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install, the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. i 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 S. F-- It 5 SectionO , T N - R W Township -au d5a Mailing Address U Subdivision Name rt r due- Lot Number Previous Owner of Property i 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 ^G No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed _ 2. Land Contract-- 3.• Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTV OWNER CERTIFICATION 1 (We) eenti6y that att 6tatementa on thin bonm cute true to the but o6 my (oun) knowledge; that I (we) am ( cute) the owner (s) o6 the pnopen ty deb uLi..bed in thiA injonmati.on 4o4m, by v-cJttue o6 a warranty deed neeonded in the 066ice ob the County RegiAten o6 Deedb ad Document No. ~o2_o :Z -3 ; and that I (we) pneaenti?y own the pnopobed 6 to bon the sewage dispoaaZey.6tem (on I (we) have obtained an ea.eement, to nun with the above de6cki.bed pnopenty, bon the tem;~ d the Game had been duty neeonded in the O j 6ice eo ns tn.u.c t i.on ..4 z aid b yd o the County )leg i e t o U,~e ae Document No,,. ) . en may.......... . C /74 SIGNATU F 0 ER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATA SIGNE DATE SIGNED r-~ z to H ST C- 105 r • r 9 H SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z t7 9 OWNER/BUYER - ch J -A ROUTE/BOX NUMBER Fire Number CITY/STATE a:) in yj I S C~ ZIP C) PROPERTY LOCATION: _k,~'k, Section, T N, R W, Town of ud_C, 0St. Croix County, Subdivision ioirl&~Pouc_-14P Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into it 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 o E I/WE, the undersigned, have read the above requirements and agree En to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- Fv ment of Natural Resources. Certification form must be comp eted and returned to the St. Croix County Zoning Of.f3ce within] 0 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. 4 i 717PAGE34-- • 7 -7, DOCUMENT NO. I STATE BAR OF WISCONSIN FORM 11-1982 THIS SPA(:& RESERVED FOR RECORDING DATA ' LAND CONTRACT Individual and Corporate ' I (TO BE USED FOR ALL TRANSACTIONS WHERE OVER 9~ 1 $25,000 IS FINANCED AND IN OTHER NON-CONSUMER ACT TRANSACTIONS) - c; G15TERS OPlFICE ~ Robert J. Magdanz, owner of an undivided 1/2 interest Carla J ST` CX W'j 11t~IS„ C9nn1 act by and between l R 31st "Magdanz, Andrew J. Magdanz, and. Mark R_. Magdanz,- _owners of a ac d. + undivif'ecT TTStfi interest each: all as tenants in colr(mpp„dor", July A.C. 19_$5 - whether one or more) and------•----------------------------------------------------------- 11:00 A M. Larry F. Hanson, a single_manx_________________ ("Purchaser", whether one or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- t3a~tilNr of oeod• formance of this contract by Purchaser, the following property, together with the - ` rents, profits, fixtures and other appurtenant interests (all called the'"`Property"), - St. Croix Count State of Wisconsin: in Yf RETURN TO j I The West 1/2 of the SW's of Section 21, except that part _ South of public highway and all that part of the SEk of - - - the SEk of Section 20, lying North of the public ~I highway; all in Township 29 North of Range 19 West. Tax Parcel No- And That part of the W 1/2 of the NWk of Section 21, Township 29 North of Range 19 West, j except the right of way of the Chicago, St. Paul, Minneapolis & Omaha Railway Company across the above described premises, together with all the privileges, hereditaments and appurtenances thereunto belonging, or in any way appertaining, lying South of the right of way of the Chicago, St. Paul, Minneapolis & Omaha Railway Company. i i I I I i This is not homestead property. (is) (is not) Purchaser agrees to purchase the Property and to pay to Vendor at such place easonabl... irected the sum of 23Q., Q. Q:00 in the following manner : Xat*------------------------------------------------ ~iKsn~tQnxs~cf~i~£~21q>t~n~xxv~x(~kx4hx~~slSC~xxxxxxxxxxxxxxxxxxxxtaa~hlx~Ital~Fud~~rsra~~xotlltxlxbe~c j iq xG[ga;at)Kec~4 [K34x0eMffi~x~ffig Sx oc~cLFt~E&xx3 X(XXXxxxxxxxxxxxxxxxxxxxx xa=)PNMt NEX i% ttlj~4x~4x~aHxlcA+:totDWa~[ : i r See Addendum attached. i i i IACxmbW;xbo mexe4xlisgcxxbtntxwXxbmftgxbutanm)arbxtDtXmxptUILXSMRKZ]Olc txObx@c --xxxxxxxxxxxxxxxxxxxxAxxXXI(Aitxx kkwxk Following any default in payment, interest shall accrue at the rate of JO % per annum on the entire amount I in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). 1414~G~R14R3t71~4~klF8FicKlt§Cl1C4RYc1l9CR4iC7341$1414fft}x~4}~}E~k'111Q~4lEX~§C j lx~xtx~x~caci g~~~c#5t#x~>~e ~3FS9~a Vxa~c3~x~~c~sxtoxa~lxxoaxne~xa~x~asex~xbtaaaex~}»mc>~amcxS:adoxaaan~scxesx~exdc~xa~5excluex6ax~naoe»~cxl5c tasaesxas+ei~l>:oa~ aol?i>$ata[xi~ICmibeat~a~IhoxaQx:esaxacvc~m¢nYaarx~adxe<xtiG~~a~kt~a~oic~taeaoaci~[6c uxDes~c~~eecpoimeat~cbaw. ~ i Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any time after December _ 3---- lg 85 (8 t13E~scx~ag~CilecxRixpO~e~xRt~fs>dodxas>~Pa~4teaadxrs' In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been j made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom.' Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: (See Addendum attached). i Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. closin ~ Purchaser shall be entitle to take possession of the Property on... -Cross Out One. KC.MIIIerCompry STATE AR' OF WISCONSIN - Stock No. 13011 FORM No. 11-Y98f FILLED MA .2419 o+93 r V COW= CERTIFIED SURVEIL MAP Located in the SE 1/4 of the SE 1/4 of Section 20, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin Surveyed for: Larry Hanson Rt. #2, New Richmond WI 54017~ECEND SCALE IN FEET 111= 200 o too 200 4O0 ~ &COUNTY SECTION CORNER MONUMENT 1 " PIPE FOUND PINE_GRWE_ HEIGHTS I X 24" IRON PIPE WEIGHING E V4 1.68 LBS / LIN. FT. CORNER C. S.M. VOL. 5 PAM 1210 N 9'12'18"E 1337.51 465.00' 420. 00' f 422.85' 29.66 6 6 LOT 1 )c LOT 3 LOT 4 rn W 176644 sq. ft. 314491 sq. ft. (7.22 318069 sq. ft:. (7.30 ti ut (4.06 acres)including M acres) including R/W acres) including R/W o g I a rn, R /W cv 300631 sq. ft. (6.90 304074 sq. ft. (6.98 n Am 16 ° 166156 sq. ft. (3.81 m acres) excluding R/W acre s) excluding R/W O A " 01 acres)excluding R /W z N I z 'P, oR w ~01 o o " 29.27' 465.00• •J o m A ~-J 0 t z N s m IO N 89'30'54"6 494.27' ro N ro to !-0 ID LOT 2 too %o _ g 1-4 192223 sq. ft. (4.41 'A o acres) including R/W w ra 165572 sq ft (3.80 I~ o acres) excluding R /W o N 6 _ POINT OF BEGINNING ~ 465 420.00 42.4.08' 493.85 JACOBS LAME 33' _ 420.00 424.13' 0 i 5t"W X337.98_ DESCRIPTION c A parcel of land located in the SE 1/4 of the SE 1/4 of Section 20, . ' T29N, R19W, Town of Hudson, St. Croix County, Wisconsin, m described as follows: Commencing at the SE corner of said Section Ln C 20; thence NO 047157"W (assumed bearing referenced to the East line 1R M (previously recorded as bearing NOo58'43"W) 565.76' of said SE 1/4) along said line to the point of beginning; thence S89030154"W -J (previously recorded as bearing S89 04153"W) along the centerline 4 of Jacobs Lane 1337.981; thence NO04515011W (previously recorded as a bearing N0052'50"W) along the West line of said SE 1/4 of the SE 1/4;~ X thence N89012'18"E: 1337.51' (previously recorded as bearing N89001132"E 133753') along the North line of said SE 1/4 of the SE 1/4; thence SO 47'57"E 752.22' along said East line of the SE 1/4 SE CORNER to the point of beginning; coait:adning 1, 001,427 square feet (22.9896 SECTION acres), more or less, and being subject to the Town Road right of 20 way as shown on the attached map, and also being subject to all T 29 N,RMW easements, restrictions and covenants of records' APPROVED Vol. 6 Page 1525 MAY 17 1985 3T. CROIX COUNTY CoMpolif.WSIV'E PARKS ►LAN:4fiN® A~ip tGttll~dis f~dl,M1TF@t LO) m N v m vi w~? w ~c c ^'3 O 7 cD ~ ~ ^G O 7 N 0~aw 'QSor C--IrW:~ cn > ; O CDa00cn°g p O _ CL 0 n w cp CD O a N A R ca ?~-..O ~co e o 3 d O 0 0O om CD W O w O 0 C 7 7 cp t w p L c Q0 O S.3 O a 0 mm CID-, v5 c1D 7 CD N O p0. D 1w T. < cn O c0 Q O v mr- O CD _Dc g~ O n- w p n Oa O 0 cD '0 7? p W? N C m u',-~~' `~ww`D~y Z D 0 (D =r 0 ca 0 to 0 =r CD ? a D a 0 ' , ~D m M ch y D N~a - wEo~ ° $ m w a^: =,r ^'?c w ~ -y a v; ?aco w (w acn¢cD~ C 1~ o w _ cD u, w w ~m 3c am. .5 (D =r ► ° ~ m fD N CD v, n t o °L co go .n+ - tG D p Colo w ~c CD ca 0 A aai0w Ocrawo m w aFL aw cn ao N o f acv; Qt CD 3 w n FD'0c oy~0((AD o a o d C~ w M D --1 c1 $ q f~; O a w r. n R` c m o a =r c o v vxx : ir' o 0 --3 t w a a m o, x... a o < 3 T CD ? »<>< ' 0 2 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, cc DIVISION LABORMD BOX HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.090) & Chapter 145.045) ITY: LOT NO.: BLK. O.: SUBDIVISION NAME: LOCATION: SECTION: TOWNSHIP/ FNjGADDR /PgN/R(or 'r A) COUNTY: OWNER'S /BUYER'S ME: MESS:USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFI E DESCRIPTIONS: PERCOLATION TESTS: Residence jNew ❑Replace 13 044 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTE (optional) XS ou OS au s ❑u ❑ s ®u EIS ®u If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(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 17x1, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- y B - - T V4'1-9 7 63 y ~ e5 "I &ZI 41,1r B- PERCOLATION TESTS r TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 1= 4156 AFTERSWELLING INTERVAL-MIN. PERIO 1 PERIOD PERIOD PER INCH P- t 1 P- N p_ 3 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 r of land slope. SYSTEM ELEVATION -j - TT 1 I 1~ esI_ 1 E E _ -4- _T TN 4 ( r _0 i i I , i 3 __E___ the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin dministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. AME rint : TESTS ERE COMPLETED ON: Wa26ces< - 4Z _1~ D SS. CERTIFICATION NUMBER: PHONE NUMBER (optional): s CS NATURE i - U TRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. HR-SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6395 _ a To be a complete and accurate soil test, your report must include; 1. Complete leggy' d :ion; 2. The use section rn clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes, A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. INTAKE A L-GIBLE diagram accurately locatiig your test locations. Drawing to scale is preferred. A separate - - r---y be used if desired; S, Make Burr rr I enchmark and vertical elevation reference point are clearly shown, and are permanent; 0. Compl, apl ropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tic te; 10 1 (..jch as flood plain, elevation) does not apply, place N,A, in the , e box; 11. plvrce your current address and your certification number; 12. )le copies and distribute as required. ALL SOIL TESTS MUST BE FII WITH THE LC-AL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols Stone (over 10") BR - Bedrock - Cobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone *s - Sand HC - High DUHdvvater cs Co d r c - P- << _ion Rate reed s - N'.~. Ad W, 'I fs Fin B Built I Is - Loarny Sand > - C rThan sl Sandy Loarn < Le! , Than 'I - Loarn Bn - bi own Silt Loarn BI Black - Silt Gy Gray ~cl Clay Loam Y - Yellow scl - Sandy Clay Loarn R Red sicl - Silty Clay Loam mot - Mottles se - Sandy May vv/ with sic - Silty Clay fff few, "r, Clay cc C()rnr or Peat rnm - Man- m m - Muck d - distil- p - promir., HWL - High L. ,,el, Six general soil u srn for liquid wast::..i BM - Bench VRP Vertic, 1r P TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or th t may request v-, "'m of this soil test if) the field prior to (permit issuance. A c:-- r of `r)r thy, private system and a permit application must be s!rbrnitted to the app rr =lo_y lr=r to i errrtit. The sanhary permit must be obtain=ed and post ,tartof t co DI D1 i C. 4•''r y C nSn~ W, t,0 T) f n e qnv ~ ~jG.7S PAGE OF ~E yy Scy Cro Se IL) n or , isle 0 Fresh Air Inlets And Observation Pips Approved Veal Cap Minimum 12" Above Final Grod. 20- 42" Above Pips - 4" Cost Iron To Final Grads Vent Pips Marsh Hoy Or SyMnatlc Covsrinq win 2" Aggregate Ovar Pips Dlsfrlbulion - Tee 1 -1 pipe -0 0 0 0 6" Aggregate a Perfora Beneath Pips Utl Pips Below o _ Coupling Terminating At Bottom Of system Prp~o5e1~ tlnkl 9rH~1{ , ~~tJn~ ton SOIL FILL DISTRIBUT101`.1 PIPE APPROVED S4~IITHETIG COVER, ° MATERtI^t OR 9" OF STRAW 2u OF A& EGA?E OR MARSH HAy (o' OF -2'/2 AGGREGATE tLEV. of / FEET-.,. ~r F-- DISTRIR-UTIOU PIPE TO BE AT LEAST IUCHES BELOW ORIGIUAL GRADE AIJU AT LEAST20 WCHES BUT AIO MORE THAL1 '42 INCHES BELOW FILIAL GRADE MAXIMUM ®EPrH of EXCAVATiobj FRoM AiGINAtr &KAK WILL BE 9S) I"CHES IAII411MUM 9F-f" of EACAVATIOW W^ 01K►GAbgL 6RAPE WILL BE 3 INCHES SIGHED: LICCUSE AJUMBER: 1.5-63 ZZ J DATE: 110 1 SL_ yy S~yy z0T 5A/ 19~cW~Nu~sun 122 X Ste rl c.-7'4n /~--I- C. P / C7 W Q r Cal v/H -pcryL.. ems Q r M P~s'S~3 NO L,6 ! i✓/ lit `?S r 33~E-3v j,99.0 coo /ov a 3 1 4 ST. CROI X COUNTY , 3 1 WI S C 0 N S I N ZONING OFFICE _ 796-2239 (HAMMOND) - 425-8363 (RIVER FALLS) HAMMOND, WI 54015 August 27, 1985 Larry Hanson R. R. 2 New Richmond, WI 54017 Dear Mr. Hanson: The sanitary permit for the property located in the SEA of the SEk of Section 20, T29N-R19W, Town of Hudson, Lot#1, Pinegrove Heights is being issued to your plumber, Mr. Cal Powers, Jr., after the copy of the recorded.'. land contract was provided. As the developer, however, it is your responsibility,at the time of transfer of this property, to have the new owner complete the enclosed forms, STC-100 and STC-105, and furnish a copy of their recorded deed for Lot X61, in order to update the files of this office. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Thomas C. Nelson Assistant Zoning Administrator mj Enclosures: STC-100 STC-105 r