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AS BUILT SANITARY SYSTEM REPORT
4~
N, RW
uR , TOWNSHIP .h..'.►~s~ : SEC. T
ADDRESS , ST. CROIX COUNTY, WISCONSIN.
DIVISION LOT LOT SIZE
PLAN VIEW
-Distances b dimensions to meet requirements of H62.20 -
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
I
100,
r
I i I i ( i ~ I I
' i
F_V
Ft ' I t
LE
;'TIC TANK(S)MFGR. ~ CONCRETE STEEL Inds cafe Nanth Annaw
NO. of rings on cover S ea ~e 1
Dep h DRY WELL
..NCHES NO. of width length area
no. of lines width_~_ length / area
3 depth to top of pipe
3REGATE
.i.: RATE AREA REQUIRED, ` AREA AS BUILT
,claimer: The inspection of this system by St.,Croix County does not imply complete
~Dliance with State Administrative Codes. Thera are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no 1i ~yffor
:tem operation. However, if failure is noted tle County will make ery effort to
-::ermine cause of failure.
'ASES AND OILS SHOULD NOT BE DISPOSED THROUGH tHIS SYST
Wy '
`INSP OR L
DATED AC PLUIMIfER ONJOB
L'ICENSE NUtMER
.
REPORT OF ITiSPECTI011--I:1DIVIDUAL SEWAGE DISPOSM, SYSTEM
Sanitary Permit'
• • S ate Septic .5'5°
. ,
To_
1•TI1SHIP
• t. Croix, County
SEPTIC TA711: S ,s 3
Size
.~ze gallons. 'lumber of Compartments ,
Distance From: Well ft. 12% or greater slope r ft
Building ft. Wetlands f
Iii.ph~aater ft.
DISPOSAL SYSTE:1 Tile Field or Seepage Pit(s)
Distance From: dell. ~o ft, 12%.or greater slope* - ft
Building; ft. Wetlands " - f;.
FIELD Highwater •---'ft.'
Total length of lines ft. Number of lines ~ Length of
each line -/,"/ft. Distance between lines ft. Width of the
trench 7t. Total absorption area g 8 sq. ft. Depth
of rock below file in. Dp-pth of rock over tile in.. Cover
aver. rock,, ~ e Depth of tile below grade 6 in. Slope of
trench in per 100 ft. Depth to Bedrock ----ft. Depth to
Pround water £t.
PITS
Number of nits Outside d m er ft. Depth below inlet
ft. Gravel around pit:,<:_`yes' no. Total absorption area
-sq. ft.
.Square feet of seepage'tre c bottom area required
%Square feet of s4epag>. pit air required
Inspected
.
ti ~•`l 'Title
Approve Date v 197
Rejected Date 197
6
EH 1.15
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
• P.O. BOX 309
MADISON, WISCONSIN 53701
RPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATIONa:~_tLY4 /4, Sectiom_L, T=IN, R S9*(or) W, Township or Municipality/
Lot No. , Block No. County` 1
Sub ivision Name
Owner's Name:
Mailing Address: Ax, a 1-C
/
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW J ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS - z - 7 i PERCOLATION TESTS '~Z- Z 79
~,1 ~
SOIL MAP SHEET I SOIL TYPE
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
Z_
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
RA
-;2 2
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area
needed for building type and occupancy. 6/ 74X!""J isaiol0J Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in d with the pro s
and methods specified in the Wisconsin Administrative Code, and that the data recorded and loc r correct
to the best of my knowledge and belief.
e__0 I
Name (print) Certificati o.
74-
Address
Name of installer if known
CST Signatur
COPY A -LOCAL AUTHORITY
State and County State Permit # 10S P7-0 LB6 Permit Application County Per
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER jOF PROPERTY(~~ f Mailing Address:
/ O rn q5 " < <l l O Vl I K 5o m -r r S zt (~Jc S G
B. LOCATION: 5co '/q J W Sec ' n -3y T,7L N, R If (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance
Single family y Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste GrinderYES__~CNO # of Bathrooms-
Automatic Washer kYES NO Other (specify)
E. SEPTIC TANK CAPACITY J, .S Total gallons No. of tanks
*Holding tank capacit Total gallons No. of tanks y
New Installation Addition Meplacement _ Prefab Concrete
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) i 2)1_21)_/ _Total Absorb Area 0 sq. ft.
NewX Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length Width 1,2.- Depth 416 Tile Depth ,2 No. of Lines -2.
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land &r Distance from critical slope
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil Tester, r/
NAME 424 AA4 C.S.T. # gD and other information
obtained from (owner/builder).
Plumber's Signature MP/ PRSW# 7/ 1- ' Phone #'~y`
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well). 5C 1. 1111- rl
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Do Not Write in SpaV#71-9 FOR DEPARTMENT USE ONLY Date of Application Fees JP 'd: State v Co Date /
Permit Issued (d te) Issuing Agent Nam
Inspection Ye7ecopy Valid# Date Recd
1. county (w) 3. ow ner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy4. plumber (canary copy)
Revised Date 6/1 /76
w
AS BUILT SANITARY SYSTEM REPORT
OWNER 1.~ r a t ~C r TOWNSHIP
SECTION T_N-R W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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INDICATE NORTH ARROW
BENCHMARK: Elevation and description:
s✓ :i -c z~ r ^'u
Alternate benchmark , G... ~.~,s, / / rtJ
SEPTIC TANK: Manufacturer: Vr.y.~ Liquid Cap.
Rings used:-4-Manhole cover elev: /e/,))Final grade elev:
Tank inlet elev.: r./',"/ Tank outlet elev.: 9 X.?
No. of feet from nearest road:Front Side , Rear Ft._.~
From nearest prop. line:Front Side, Rear Ft. ~o d
No. of feet from: Well 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
e
SOIL ABSORPTION SYSTEM
Bed: Trench: Seepage Pit:
Width: Length Number of Lines: Area Built li
Exist. Grade Elev. Proposed Final Grade Elev.-2/- !-r-
Fill depth to top of pipe:/
No. feet from nearest prop. line:Front Side , Rear Ft.joY(l
No. feet from wellNo. feet from building / y
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:
DATE: 7 z `Y Z PLUMBER ON JOB:
LICENSE NUMBER: /
6/90:Cj
IQC orT~~,I bN: OMMF~R~ ET 34.31.19.450C SW SW ~ County:
Labor and Human Relations ustry, PRIVATE StWAGE SYSTEM
` S*fety and Buildings Division INSPECTION REPORT ST. CROIX
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION 171502
Permit Holder's Name: ❑ City ❑ Village [}Town o : State Plan ID No.:
HATCH, BRUCE R & LORRAINE SOMERSET
CST BM Elev.: Insp- BM Elev.: B Des ~ption: Parcel Tax No.:
~t.e.i C, 032-1096-60-000
TANK INFORMATION ELEVA ION DATA A9200269 7
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Do ng
Aeration Bldg. Sewer
Holding St/Ht Inlet 8•l '
TANK SETBACK INFORMATION St/ Ht Outlet
Vent
TANK TO P / L WELL BLDG. Air Ito ntake ROAD Dt Inlet
Air
Septic NA Dt Bottom
Dosing--- NA Header/ NWA%-
Aeration NA Dist. Pipe S~ , ~T
Holding Bot. System C-PUMP / SIPHON INFORMATION Final Grade
urer Demand 4 °/Z) e 7 e st3~ '
162i 160, Model Number GPM
TDH Lift Friction System Ft
mead
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 42 DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING manufacturer:
SETBACK
INFORMATION Type Of ~(Y-i CHAMBER / Mode Number:
System: 7U u! 11- Q OR UNIT
DISTRIBUTION SYSTEM
HeaderiAma 140'd Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length _62-L Dia. Length 'E2 Dia- Spacing P
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over ,e xx Depth Of xx Seeded/ Sodded xx Mulched
Bed/ Trench Center o2a r Bed /Trench Edges -30 Topsoil E] Yes No -1 Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
D Z
Plan revision required? ❑ Yes 2-1 o
Use other side for additional information. 17 . SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH +
SANITARY PERMIT NUMBER: °
fl LHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
STATE SANIT Y PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than Z
8'f x 11 inches in size. c ec i revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROP TY OWNER N PROPERTY LOCATION J
I- 4 C e / ~ 4vcx 5L.3 % 543 S -3/ T3/, N, R 19 _F) W
PROPERTY OWNER'S MAILIN9 ADDRESS LOT # / BLOCK #
5011 077 A u C. /V
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
-SO"rter•s~~ I~~ S~Do~ 5 w IA-
[3 TYPE OF BUILDING: (Check one) 1:1 State Owned ❑ VILLAGE : s NEAREST ROAD
a tT a r 5 e
El Public tK1 or 2 Fam. Dwelling-# of bedrooms-3 ELTAx NUMBERO
III. BUILDING USE: (If building type is public, check all that apply) d 3 o g6 -6 O 7 S~
1 ❑ Apt/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 130 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ❑ New 2. n Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 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
1140 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
CQ REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ~r C ELEVATION
4150 /0 - D -S~o . a~ G C/q,,Sff /v Feet 16 Feet
Vll. TANK CAPACITY Site
in gallons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New xistin Gallons Tanks Concrete structed glass App'
Tanks Tanks
Septic Tank or Holdin Tank drop wQ
Lift Pump Tank/Si hon Chamber El El
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's Sign Lro Stamps) WMPRSW No.: Business Phone Number:
Plumber's Address (Street, City State, Zip Code):
/7(-9 to A non (sJ r Syo/>
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui Ager~Sign ure (No Stamps)
Approved Surcharge Fee) UU
❑ Owner Given Initial 'f\ / H _-7 -lic
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 '
J
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 t4is. sanitary-permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed:
11. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. 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 fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% X 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
..,required by the count)4~_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;surfrharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
i
SBD-6398 (R.11/88)
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/contcactoc,(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 Q t-(A<-e- 4`'+ch
Location of property ':~;(V 1/4 S101/4, Section -3V
Township S c7m z r-S t
Mailing address O 10 r +y-2
~o,.r e r S l~J T 5 D Q.,S
Address of site
Subdivision name A) Z A
Lot number ~
Previous owner of property
Total size of parcel
Data parcel was created
Ace all corners and lot lines identifiable? an No
is this property being developed for resale (spec house)? Yes 0
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 (out)
knowledge; that I (we) am (ate) 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 t (We)
system (or I (we) have
presently own the proposed site for the sewage disposala
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
01 the County Register of Deeds, as Document No.
319tune of owner Signature of Co-Owner (If Applicable)
~a
13 - C
Date of Signature Date of Signature
e.
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i M AW WMW'N Ms t A .
` l1osA1Nl=o~► for ACKNOWL
q~s a~M1 t his K BTATS Ot wwwx=
q'~i1[Si:R lYtAfi6 WlR O! RIfUON!!!N
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113 12
354973 ~ ~Y>
~ n
REE ON PROPERTY CORNER, SURVEY MAP (COS
ET PIPE 5.00 CERTIFIED
WAY ON NORTH °';•y~~lr
ROPERTY LINE SW 1/4-SWI/4 -SEC. 34~ T31,N R19W c, Lj
UNQ~P,~.~EO. ~ANOS. N ~
°_31'-.25" W 295.00'
Q~.• `,PNoS. S 89 BEARINGS RECORDED ALONG
` 290.00
5.00 a THE EAST LINE OF C.S.M.,
co VOL. I , PAGE 84
r` m CO
( S01°-07'-20" E)
';'0 oM
p0
,
0\11
O
O
E-? LEGEND
EXISTING
o HOUSE o - 1" IRON PIPE FOUND
o v
L~J m M o--- I" X 24" IRON PIPE SET.
N 3 WT. 1.68 LBS./LIN. FT.
00 O
F -
APPROVAL OF THIS MINOR SU8DIVISIOt
M• '
o DOES NOT MrAN APP..CVAI FOf
w N 01 BUILDING Z ~ i ~ OR SEPTIC :,Y,, itM-
vo~ o r-: W LOT 1 °
BAs, REFER TO H62
cv r~ 4.4 ACRES .t0.
z
pP. o
°SNP "
SAN°5' APPROVED
o OCT 2 5 1978
' COMPdBHENSIV' PArtKS PLANNING
AND ZONING COMMITTEE
h IDo 9~\ EXISTING DRIVEWAY
OF .p p AND RAILROAD CROSSING
POBEIGNIT NNING of 0 % \N
9s
M
N 89°-31'-25" E 'Z'
0)
F
295.00' R/W
I-
1 _ I -
CENTERLINE OF WISCONSIN CENTRAL \ \
RAILWAY CO.'B, MINNEAPOLIS, ST. PAUL \
AND STE. MARIE RAILWAY RAILWAY CO.
100 75 50 25 0 100 - TOWN ROAD
`~~NtOtth►k~
SCALE IN FEET y~iDlvS~^~j~rz
THIS INSTRUMENT WAS DRAFTED BY GCS. GENE C.
• SHAFFER
78 - 73 S• 1325
HUDSON
WIS.
Q'
0ed Next Page)
VOL. I PAGE 1Ct,~p 1yp ~ (Continued
CERTIFIED SURVEY I~IAPS~dottat~e°''
_ ST. CROIX CO., ',1I.
1
;ti
112
ST. CROIX COUNTY ABSTRACT COMPANY
HUDSON, WISCONSIN
CONTINUATION OF ABSTRACT NO. 16 , X11
From the 7th day of Auwust , 1974 at 10:00 o'clock in the ---A--s--M.
of the land described as:
Part of SWy of SW' of Section 34-31-19 described
as follows: Lot 1 of Certified Survey Map filed
February 8, 1979 in Vol. 113111 page 764(No.113).
TOGETHER WITH a 66 foot private easement as
shown on said Certified Survey Map.
113
Certified Survey Map.
Document No. 3973•
(See Next Page)
R,a
y Sv
IV
ST. CROIX COUNTY ABSTRACT COMPANY
• ; CONTINUATION OF ABSTRACT
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STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER EY` U1CR
so y
ROUTE/BOX NUMBER 6 tA\AM A 0 Q_ FIRE NO.
CITY/STATE Se Pn-e.riia .1 l~ ZIP 5-yo o~?S
PROPERTY LOCATION: 51/4 5 1/4, Section T.YZ_N, R l?_W,
Town of St. Croix County,
Subdivision n1/ , 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 for a MAXIMUM of
$3000 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 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 form will be sent approximately 30 days prior to
t
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,
heiein, as set by the Wisconsin Department of Natural Resources. Certification
form must be completed and returned to the St.Croix County Zoning Office within
30 days of the three year expiration date.
SIGN
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
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
-INDUSTRY, _ DIVISION
P.O. BOX 76
LABOR AND PERCOLATION TESTS (115) MADISO
N WI 53707
HUMAN RELATIONS
(ILHR 83.090) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
sw 54)'/a 3 /T31 N/11/7 11110I W ~5 oeyt.erS e f rv ~ 3 t+
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
51- C r D , x Iru .SUS ~d ' e SO M rz et wis y o a s
USE DAT OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: IPERCOLATION TESTS:
/ JDo,.? f A
Residence !/A ❑New Replace M
RATING: S= Site suitable for system U= Site unsuitable for system
rgs ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional)
❑u s ❑u s au DS u a s u 0" 041Y14 !G A C
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the ~ O
under s. ILHR 83.09(5)(b), indicate: C''X5 s Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
• o-/,o /oyR a S/J /0 3o ioyR s 6 3J
B- / 96.0 NO~n e g 0 -58 S s
l
4 15 -5 8' VR 34
Ot- .)/oyR S~y J.s #'1,35 -so
B-~ 9 97,3 NOON o- o io o- 75l' s
40 /DyR 513 5/~ !l-a0 /V IV P, qy /S j V., 030-410 OR 1,1 5
B-3 8 ~5, S rvv~~ > g 40 S6 /oyR S 56-89 7.,S' YR Y S/
YR Y19 s 3-~a 7.SYA y 4 s/ DA-se
D-3 75
B- y Se 100,.3' Q
>1 S
6#6 -7 6 s
B-,-5
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD 3 PER INCH
P-
P
P-
P_ 2j ! K cf,
Pp_
PLOT PLAN: Show locations of percolation tests, soil borings and the dimen ns o sui ble s it eas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their locatio 96 of plan. ow t e rface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION . S /
o
. s
I
;tot
3
s
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I, 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
Administrative Code, and that the data recorded and the location oft a tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
or of S3 -v)344S/,3!S
5t/a/ 7 CST NAj~URE~:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
D I LH R-SBD-6395 (8. 10/83) - OVER -
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Appror'ad Vanl Cop
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final Grad.
20. 42' ADora Plpr -4, call iron
To final Grado V.nl Pip.
Lor.n Nor Or STnlMlk Co ulnd
min 2' Apar.aolo
Or.r Plp$
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Plpa o 0 0 - Tao
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B►noalA PIP$ o PW0,014d PIP. 6.1a.
o -"CO,gllna T.rminallnp Al
Hallam 01 s"lorri
SOIL FILL.
0I5TRIBUT10f.I PIPE
APPROVED S4)JjNETIC COVCR
2'OF AGGREGATE r /IATERIAI- OR 9" OF STRAW
- _ OR MARSH HAy
'"Yr Ie,OF1t-21/T
AGGREGATE
ELEV. OF 15 EE
3 3
F- (o -
bISTRIFjJTIO1J PIPE TO HE AT LEAST IKJCHES BELOW ORIGIQAL GRADE
AIJU AT LEAST LO WCHE-1 BUT KIO MORE THAI) 92 IIJCNES OELOW FIIJAL GftADE
MAXIMUM DWH OF F-X(AVAT*1b0 rKOM OWWAL 60\K WILL BE INCHES
nt'"AUM 0£Pni of EACAVATIco r'POM C~161h411IL GRADE WILL BE a~ INCHES
51 G fJ C o: c.~~A. .
LICEki5C QUMBER:
DATE: 10~~7 f °Z
REPT131 SOMERSET ST. CROIX COUNTY ZONING PAGE 1
07/21/92 12:52 REQUESTS FOR INSPECTION WORK SHEETS FOR: 7/22/92 AREA: JT
Activity: A9200269 7/22/92 Type: CONVSEPT Status: PENDING Constr:
Address: SOMERSET 34.31.19.450C,SW,SW,
Parcel: 032-1096-60-000 Occ: Use:
Description: 171502
Applicant: HATCH, BRUCE R & LORRAINE Phone:
Owner: HATCH, BRUCE R & LORRAINE Phone:
Contractor: POWERS, CALVIN Phone:
Inspection Request Information.....
Requestor: CAL POWERS Phone:
Req Time: 09:07 Comments:
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION
I
r
r ~
COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227
F ST. CROIX ZONING REPORT NO.: 25938/01 PAGE 1
ST. MIX COMITY REPORT DATE: 7/17/92
COLIRTHOUSE DATE RECEIVEDt 7/15/92
KJDSON, WI 54016
ATTN: THOMAS C. NELSON
OWNERI Bruce 6 LorraineM.Watch
LOCATIONS 50 - rset, WI
COLLECTORS M. Jenkins
DATE COLLECTEDS 7-14-92
TIME COLLECTED! 2S00pm
SOURCE OF SAMPL.ESKitchen faucet
DATE ANALYZEDS7-15-92
TIME ANALYZEDS2S00pm
COLIFORKS 0 /100 ml
INTERPRETATIONS BacteriologicallY SAFE
NITRATE-NS < 1 ppm
Above 10 ppm exceeds the recommended Public
Drinking Water Standard.
Coliform Bacteria/100 ml
Nitrate-Nitrogen, mg/L
LAB TECHNICIANS Pam Gane "
WI Approved Lab No. 19 Y
< Means "LESS THAN" Detectable Level Approved by:
~d S+i
yt~
PROFESSIONAL LABORATORY SERVICES SINCE 1952
NOEKN
q ST. CROIX COUNTY ZONING OFFICE
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
Telephone - (715)386-4680
he St. Croix County Zoning Office offers the service of so'ptic
and water inspections to Lending Institutions, Realty Firms, and
private individuals.
Completion 2f this form I& essential = that #~g property gm Im
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: $ 35.00 35.00
(For nitrates and coliform bacteria)
WATER TESTING FEE: $185.00
(For VOC'S)
SEPTIC SYSTEM INSPECTION FEE:. $25.00 25.00
(Determines if system is properly functioning at.-time of
inspection)
PROPERTY OWNER'S NAME: Bruce R. Hatch and Lorraine M. Hatch
PROP. ADDRESS: 504 - 180th Av., Somerset, WI CITY
Legal Description 1/4 of the SW 1/4 of Section 34 T 31 N- 19
Town of Lot Number 1 Subdivision: CSM Fi 1 ed 2 -_7--/Vo
CSM pg 764
FIRE NUMBER 504 LOCK D" NUMBER , doc~~3540 2 _101& _6~ nu
Color of house Realty sign by house? NO If so, list firm:
Lorraine Hatch is home during the day (2477-5277) Call and she will be there
PLEASE INCLUDE', IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOK,
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER .TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual requesting services: Bank of Somerset- Arlene Reardon
Telephone Number 247-3348
REPORT TO BE SENT TO: Bank of Somerset, ATTN: Arlene Reardon, PO Box 220
Somerset WI 54025
CLOSING DATE: Jul 23 992
Signature Left"I 7o/
141
ST. CROIX COUNTY
r . {{WISCONSIN
ZONING OFFICE
rA`Y'x ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
July 15, 1992
Arlene Reardon;'
Bank of Somerse~''
P.O. Box 220
Somerset, WI 54025
Dear Ms. Reardon:
An inspection of the septic system on the property of Bruce &
Lorraine Hatch, located at 504 180th Ave., Somerset, WI was
conducted on July 14, 1992. At the same time a water sample was
obtained for testing. The results of that testing will be sent to
you as soon as we receive them from the laboratory.
At the time of inspection, the sanitary system appeared to be
failing. Violation has been issued with orders to replace the
system.
Si erely, . O
s'0 f t
Mary J,/ Jenkins
Assistant Zoning Administrator
cj