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11/14/2000 12:42 17154256864 WEGERER SOIL TESTING PAGE 01
WEGERER'SOIL TESTING and DESIGN SERVICE
SOIL TESTING - SEWER SYSTEM DESIGN
ATTN: - DATE I _1 O
CC:
SUBJECT: A l
THE FOLLOWING ITEMS ARE -F~~- F;P^ _ES:>
NO. OF DESCRIPTION
COPIES
b✓ [ Al
SENT TO YOU FOR THE FOLLOWING REASONS:
✓FOR YOUR USE FOR REVIEW-AND COMMENT ~ INFORMATION DESIRED
S*z(,j_s n a~vt~t, w Gov liu E -
WEGERER SOIL TESTING
AND
DESIGN SERVICE
pnzrl,
P.O.BOX 74 421 N_MAIN S.T. RIVER FALLS,WI 54022 PHONE 715-425-0165
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11114/2000 11:55 17154256864 WEGERER SOIL TESTING PAGE 01
FILED
OCT 9 1997 r
)AM 01 CONIGM
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430993
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CERTIFIED SURVEY MAP
LOCATED IN THE NE 1/4 OF THE NW 1/4 OF SECTION 36,T2,9N,RI7W,TOWN OF
HAMMOND, ST. CROIX COUNTY, WI QWNEpeY; Lori LEON• AUD951LL
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OCT 08~ ASH kT 1 OF 2 .
er- 11113
S[, C1:0rx LIMY THIS IN9TRUMENr OROFTEp EY
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OCT 9 1987.
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CE R T I FI ED SURVEY MAP
LOCATED IN THE NE 1/4 OF THE NW 1/4 OF SECTION 36, T29N, R 17W, TOWN OF
HAMMOND, ST. CROIX COUNTY, WI OWNEDBY: LOT:2 LEONA RUDESILL
tal R T' 2
OSCEOLA, WI 54020.
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JAMES !'d.! Z
Ow Ial I WEBER
W I S-1804
I ' SPRING VALLEY
WIS.
64-Z NW CORNER OF SECTION 36, I
T29N,R17W.(000NTY SURV- f d'
EY0R'S MONUMENT FOUND). +sj/~~~~~•~~.w~~+g''~~~`O`~
SCALE I" = t00' ya~sf48 u
68620;0%
JAMES M. WEBER S- 1804
O' S0' 100' 200' DATED A"~ •Z4. ~~8' 1 .
OCT 081 ' SHEET I OF2.
87- 253 ST. CRW OOtM THIS INSTRUMENT DRAFTED BY
.0%%P .a;HE1*W PAJNit< P1A1~Ni
.ND zotao VOLUME PAGE 1897
"m OOMJAft7lsi
c.
1
DESCRIPTION
A parcel of land socated in-he NE-4 of the NW41 of Section 36, T29N, R17W, Town
of Hammond, St.Croix County, Wisconsin, more fully described as follows:
Beginning at the Nl- corner of See-Lion 36, T29N, R17W:
Thence SOo2112811E along the North-South Quarter Section Line a distance of 4.29.001;
Thence WEST 693.001;
Thence N400213511L along the easterly line of the Certified Survey Map recorded in
Volume 6 of Certified Surveys, Page 1630'a distance of 430.061 to a point on the
North line of the NW4 of said Section 36;
Thence LAST along said line a distance of 380.001;
Thence SOo2112811E 350.001;
Thence S850 07' 0311E, 117-491;
Thence 1,I002112811W 360.001 to a point on the North line of the NWT of said Section 36;
Thence EAST along said line a distance of 163.001 to the point of beginning.
Contains 5.71 acres subject to C.T.H. "Jn right-of-way over the northerly
portion as shown. Also subject to any and all easements, right-of-ways or conveyances
of record.
SURVEYOR'S CERTIFICATE
I, James M. Weber, registered land surveyor, hereby certify: That in full
compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and
the provisions of the St.Croix County Subdivision Ordinance I have surveyed and
mapped the above described parcel of land and that such plat correctly represents
all exterior boundaries and the subdivision of the lands surveyed.
Dated this Z`N day of 11987.
James M. Weber S-1804
Wegerer, Weber and Assoc.
River Falls, WI
SURVEYOR'S NOTE
There are conflicting title elements in the description for the parcel recorded in
Volume 416, Page 507. The description calls distances of 3501 and 3601 to the North
line of the creek. The distances as recorded place the line on the South line of the
creek. For the purpose of this survey, and by direction of the owner of Lot 2 as shown
on this' survey, the description is interpreted most in favor of the owners of the
parcel recorded in Volume 416, Page 507.
agq,$t~iN~'$pll~ek
JAMES M.'
WEBER
S - 1804
SPRING VALLEY
WIS.
VOLUME 7 PAGE.!: 1897 ~'~i~j "*....,..,..•r ry~o°~
t? v
SHEET 2 OF 2
87-263 THIS INSTRUMENT DRAFTED BY
AS BUILT SANITARY SYSTEM REPORT
-
OWNER a y L - TOWNSHIP C'7 ~4 ~a y k
SECTION T-A-7 N-R--0 W
ADDRESS bS-`& / il'i4 ST. CROIX COUNTY, WISCONSIN
SUBDIVISION
LOT LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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..,.n.,+x ,w+wx.vsw .saw•.,,.•ua+attm.+ir.,~r+aw+w•.?««+r.,±;..wea..~.vwr:r-
- INDICATE NORTH ARROW
BENCHMARK: Elevation and description: to rJ o+ 4c r,.J-, rte
Alternate benchmark
SEPTIC TANK:Manufacturer: 1 t S! Aes r,*fteLiquid cap.
Rings used:-OManhole cover elev:J~M Final grade elev:
Tank inlet elev.: Tank outlet elev.: ,
No. of feet from nearest road : Front 1 t
Side Rear Ft.
1
From nearest prop. line:Front Side Rear Ft.
No. of feet from: Well I=% , Building:
(Include this information in the above plot plan)
(2 reference dimensions to septic tank) -
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model' Pump/Siphon Manufact.: Pump Size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.: Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front, Side_, Rear_Ft.
Distance from: Well Building
SOIL ABSORPTION SYSTEM
Bed: Trench: LOOOOO* Seepage Pit:
'"r Number of Lines:~Area Built
Width:~Length
Exist. Grade Elev. S l 2- Proposed Final Grade Elev. 7,41
Fill depth to top of pipe:
line:Front , Side_je0,00*Rear Ft.
No. feet from nearest prop.
Ste) ► No. feet from building
No. feet from well:
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line:Front , Side , Rear Ft.
No. feet from: Well building , nearest road
Alarm Manufacturer:
INSPECTOR:
PLUMBER ON JOB: G t-4
1
DATE'
01
LICENSE NUMBER:
6/90:cj
'I,
LOCATION: HAMMOND 36.29.17.552D,NE,NW, CO. RD.J
WiscWsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT
` Safety and Buildings Division ST. CROIX
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 17143
Permit Holder's Name: ❑ City ❑ Village)] Town of: State Plan ID No.:
LEE DAVID & MICHELLE HAMMOND
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
018107950000
TANK INFORMATION ELEVATION DATA A9200198
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark Z ,25 /p' ,ld
C
Aeration Bldg. Sewer
Holding St/ ,W Inlet
TANK SETBACK INFORMATION St/ 1-Outlet S qv, / 83~
TANKTO P/L WELL BLDG. Ventto ROAD Inlet
Air Intake
Septic NA &Lila om
Dosing— NA Header / Man.
Aeration NA Dist. Pipe tSl_
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Ma rer Demand
97
rrr C / • g0
Model Number GPM
TDH Lift Friction System Ft
Loss Forcemain Length Dia. Fi Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS S .21 DI
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manu urer:
SETBACK CHAMBER
INFORMATION TypeO c r / Mo a Num e
System: P nC ?1). > 11 OR UNIT
DISTRIBUTION SYSTEM
Header/ / rl Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length ~ Dia. Length _]Z2 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
N N
Bed / Trench Center Bed/ Trench Edges -/V I Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) ~-~~Gf n = S 77-7. IV 7
2 .25, 5ln' y3/
/
Plan revision required? ❑ Yes 2.60
Use other side for additional information. 4Date SBD-6710 (R 05/91) Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH - w
SANITARY PERMIT NUMBER:
SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COU
4 bLLHR -
„v
i,a.~ a,aana„rs Y STATE ANITA MIT#
-Attach complete plans (to the county copy only) for the system, on paper not less than
8% x 11 inches in size. ❑ Check if rev si~to pr application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER / PROPERTY LOCATION
0c4 V d l e_ e_ N/,67-Y. S 34 T Q 1, N, R 17E ((or) W
PROPS OWNER() 'S ; MAILING GADDRESSS LOT # BLOCK # 9- t 19110 El
CITY ~j STAT~j ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
~J4 ~Lr 4, ,h
II. TYPE OF BUILDING: eck one CITY NEAREST ROA
❑ State Owned { O VILLAGE : Yoh, AV v ol
❑ Public 1 or 2 Fam. Dwelling-# of bedrooms PARCEL AX NUM ER( )
III. BUILDING USE: (If building type is public, check all that apply) ~e j 1 q s G a Q
1 ❑ Apt/Condo V ( i
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 in line A. Check line B if applicable)
A) 1. ❑ New 2. [A 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 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ® 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 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
/1 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
Ll 5_v 1/25-- 1)25-- , q0 C1 I 7.Feet / Feet
VII. TANK CAPACITY Prefab. Site Fiber- Exper.
in allons Total # of Manufacturer's Name Con- Steel Plastic
INFORMATION New istin Gallons Tanks Concrete structed glass App.
Tanks nks
Se tic Tank or Holdin Tank U YV) t w tis C ry
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber Signature: (N mps) nPRSW No.: Business Phone Number:
Toe
Plumber's Address (Str , City, State, Zip Code)
3'D4 n✓~ FloU R. NVoodt.~ (lc ~✓'s S'°~~~
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved S nitary Permit Fee (Includes Groundwater ate ssue j suing Agent Sign)
/~0 Surcharge Fee) s _.2
- ' 9 Approved ❑ Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS -
1
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.
Ill. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in 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 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 fif 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'h 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; repla~.ement system
areas; and the location of the building served; B) hcrizontai 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)
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92
A
0
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 p3tmlt Issuance. -Should thls development be Intended for resale by
ownst/contractot,(spee 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.
Ownet of property Dri C/ i•0/ 2 r- - -
Location of property N_ 1/4 N lu-,~.1/t, Section 3 G _ T q__P-R_.. _V
Township j"A" 6A. 01
Rolling address
Address of site - 1~ l?
subdivision name
Lot number , M 1 - -
Previous owner of property
Total size of parcel 3 5 D 1'-2
Data parcel was created
Ate all cornets and lot lines Identifiable? as o
to this property being developed foe resale (spec house)T_.Yes o
Volume and Page Number as recorded with the Register of Deeds.
"ft - - -
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A VARRANTY DENO which Includes a DOCUMNHT NUMBRR, VOLUMQ AND PAGIR NVMB[R, and
the StAL OF TH9 REGISTER 07 DEEDS. In addition, a certified survey, it
available, would be helpful so as to avoid delays of the reviewing process. it
the deed description references to a Cestifled Survey Nap, the Cettifled Survey
Map shall also be required.
PROPERTY OWNER CERTIFICATION
t(We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (ate) the owner(s) of the property described in
this Information form, by virtue of a watrsnt egjtteo G{~rded In the Office of
the County Register of Deeds as Document No. i ; and that I (We)
Presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, tot the
construction o sold system, and the same has bee£, u1. ter rded In the Office
of t WCounty egl r o heeds, as Document No.
s.
signature of Owner el a of Co-Owner (if Applicable)
Date of Signature Date of Signature
~ t\
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER_ 04.
ADDRESS: f 0 6_0 1U1Y 1314 "I, FIRE NO:~
LOCATION: N e- 1/4, /V/k/ 1/4, SEC.~T a7 N-R.-,-r? W,
TOWN OF : 116 m olu lid ST. CROIX COUNTY
SUBDIVISION: LOT NO.
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 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 to
help with the cost of the 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 agfees, to submit to the St. Croix County
Zoning 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 (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of
sludge and scum. Certification, from will be sent approximately
30 days prior to three year expiration.
I/WE, the undersigned have read the above requirements and agree
to maintain the private sewage disposal system-in accordance with
the standards set forth, herein, as set by the Wisconsin DNR.
Certification form must be completed and returned to the St.
Croix County Zoning Officer within 30 days of the three year
expiration date.
SIGNED:
DATE :
St. Croix County Zoning Office
911 4th St. "
Hudson, WI 54016
i Ca"!Tta t r Yi.r E~t~O, r
TVM 7,11.
~i,t/auulMs t4 _
7~ i • s
- • LAB - S"T.. -~'ril
avu" TO
.•tke follovhhd deoaibed real estate in Cr0 X County, ~
State of Wisconsin:
Fast of the northeast Quarter (HU) of ~r `
Tax Key No.
n t Quarter JIWJ) of"56ation 36-29-17
erilled as follws: Il enciwg oe>E M line of said wY
Amo
tt writ Quarto 1.1wif . feet of NZ corner thereof
thence M on said M list 137 feed thence S parallel with B line „
of said Iiorthwest Quarter (NM}) 350 feet; thence southeasterly Ou
1t rl, bank of Creek to point 360 feet South of Place of
A Deginningi thence Tbrth 360 feet to Place of Beginning. y
4e
' (yW
This 18 homestead property. )
` t (is) (ROW) x
zxceytion to warranties:
~ ~ . 19 Qfl__ . '
- -
n 'Gated this day of ~ - - ,
Z,4-L(SEAL)
FinaLL
(SEAL) (Sl yi
-
ACKNOWLEDGMENT 3
$ AUTMENTICATIO14
R Signatures authenticated this day of STATE OF WISCONSIN (ss. ~ rt
19 County.
k P rso all} came before r.,e, this i0i J
s
the above named
chG,►-Ccs
TITLE: MEMBER STATE BAR OF WISCONSIN ~ . E!J
!!t
asthodxed by S 706.06, Wis. Stats.)
l This Umbussat was drafted by
5 taiald J. Fast in, me known to be ,hv persons who executed Al fOfe-
~ ' dffi @ parkr BOX 546 t 5icument and a 9k owl 'fed the same.
`,~7ytAvin iriiSL•Anrtin 54002
.4<. me -
stray be authenticated or acknowledged. 3&Ij - County Wis.
Notary P;tLl~cC
not necessary.) A- t not, state !xPfirst
##1i-aawl-Mi is prmanent. ( l ~ t-
f
REPT131 HAMMOND ST. CROIX COUNTY ZONING PAGE 2
06/09/92 12:05 REQUESTS FOR INSPECTION WORK SHEETS FOR: 6/ 9/92 AREA: JT
Activity: A9200198 6/ 9/92 Type: CONVSEPT Status: PENDING Constr:
Address: HAMMOND 36.29.17.552D,NE,NW, CO. RD.J Use.
•
Parcel: 018-1079-50-000 Occ:
Description: 171433
Applicant: LEE, DAVID & MICHELLE Phone:
Owner: LEE, DAVID & MICHELLE Phone:
Contractor: STANG, JOE Phone: 698-2266
Inspection Request Information.....
Requestor: JOE STANG Phone:
Req Time: 14:06 Comments: Time Exp
Items requested to be Inspected... Action Comments
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION