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Wisconsin Departniontof Industry, PRIVATE SEWAGE SYSTEM County:
Labor-andH,uman Relations INSPECTION REPORT St. Croix
Safety and Bucldings Division
(ATTACH TO PERMIT) Lot 32 Sanitary Permit No.:
GENERAL INFORMATION SE% SEq Sec.18 T29-R19 Willow Rd. 149096
Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.:
Marshall Sinnett Hudson
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic I ~i .J.J Benchmark S~ O 160-0
Dosing
Aeration Bldg. Sewer
g7,
Holding St/ Ht Inlet , W7
TANK SETBACK INFORMATION St/ Ht Outlet 1
LOY 96- 1(f
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic / ~r ? 13 NA Dt Bottom
Dosing NA Header / Man. Dal q3
71
09 -F 3,
Aeration NA Dist. Pipe /o, 10,33 99.r- 7
Holding Bot. System gCK2
PUMP/ SIPHON INFORMATION Final Grade (.,S Q17,
Manufacturer Demand / J., (AI 991 S -V
Model Number GPM
TDH Lift Friction System TDH Ft
mead
Forcemain Length Dia. Dist. To well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length I No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ~v DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER i Model Number;
System:--7~j 517 /d G OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched
Bed /Trench Center Bed/ Trench Edges Topsoil E] Yes E] No [I Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.),$1,; I r1
. O I
D,
.31
~ r - ;9is
,x o
Plan revision required? ❑ Yes ❑ No -
Use other side for additional information. Ait
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER A`~Y,4c-ll Jl,tee ll- TOWNSHIP A140a0)11
SECTION T_L4_N-R___W
ADDRESS `1le LCl jltaaj ;62i PV ST. CROIX COUNTY, WISCONSIN
kl ~ em GtJ ~~sr'o l~
SUBDIVISION ieLOT 32 LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
♦ ~~iSt~Y~,y L~P
AS &C'C ~'rllm we U ~o
5~-P I,C- Ly,
d ~.eac k es 5x 50
~L to 5~~ ¢t'r- ~fa~,~va
L
216
E A
i q A
Lo L,k-,
INDICATE NORTH ARROW
Sf c tea, c~ exp.! /sec
BENCHMARK:Elevation and description: 1&ec,
Alternate benchmark
SEPTIC TANK:Manufacturer: IcJ 45 G P, Liquid cap. loco
Rings used: o Manhole cover elev: Final grade elev:
Tank inlet elev.: Tank outlet elev.:
No. of feet from nearest road:Front , Side ~c , Rear Ft.
From nearest prop. line:Front , Side X, Rear Ft. 63
No. of feet from: Well (P~/ , 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: -X Seepage Pit:
Width: J~ Length ~o Number of Lines: Z Area Built c;7~
Exist. Grade Elev. q~,a Proposed Final Grade Elev. 7~So
Fill depth to top of pipe:
No. feet from nearest prop. line:Front , Side , RearX Ft. /4o
No. feet from well:_ZL_No. feet from building Z~
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 : /0- PLUMBER ON JOB:
re
LICENSE NUMBER: /y1'/t'S 32Z~
6/90:cj
SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
STATE SANIT PE MIT
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ qyloqp
8% x 11 inches in size. -----k if revision to re ious 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
P~A v !i rl 5' %t SLI %t,S IS T Z4~N,R (Or W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CC i(~ Q
0 W 1 .'1 "2- 1 F I
CITY, STATE ZIP ODE PHONE Uly ER SUBDIVISION NAME OR CSM NUMBER
L
O/ Iu ;
CITY NEAREST ROAD
11. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE : w
❑ Public Ell or 2 Fam. Dwelling-# of bedrooms . NUMBER(b)
111. BUILDING USE: (If building type is public, check all that apply) L,
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
40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
50 Hotel/Motel 90 Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ® New 2. ❑ 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 220 In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 430 Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) (ti ELEVATION
7d/G' Feet q7 `O Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New Existing Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App.
Tanks Tanks strutted
Septic Tank or Holdin Tank d 7;
Lift Pump Tank/Si hon Chamber 2'
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumb is Name (Print): Plumber'A Signature: (No mps) MP/~SW-No.: Business Phone Number:
I~A
Plumbers Address (Street, Ci , State, Zip Code):
X6`7
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater a e ssue Issu'n Agent Signature (No Stamps)
/
Approved ❑ Owner Given Initial Surcharge Fee) - / ~l
Adverse Determination ca (Ij
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
APPLICATION FOR SANITARY PERMIT
S T C - 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 1" IAA-t'A't.~~ ~jDt r-~•~-l ~c~tfi"°
Location of Property 4, Section n , T 2 N - R l W
r
Township'
Mailing Address
Subdivision Name V"~itil•!?r~
Loc Number
Previous Owner of Property J G 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 No
Volume and Page Number as:recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION.ONA OF THE FOLLOWING:
k.
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.
PROPERTY OWNER CERTIFICATION
I (We) eeAti6y that att atatemente on thi,a 6onm ane .true to the but ob my (oun)
k.nowxedge; that I (we) am (are) the owner(s) o:6 the pnopeAty dec cA bed in th,i.a.
.in4o4mati.on {onm, by viAtue o6 a warranty deed recorded in the 066.ice of the
County RegiAeh o6 Deeda a.6 Document No. 3--,, ; and that I (we)
pnesent2y own the paopo.tic.r s4 to bon. the sewage poaa s yj f!-,► (on I (we) have
obtained an eabemen:i, :to nun wiUh the above daci i.bed pn.opeLty, jo)L the
eonetnuction o4 said bybtem, and the bame has been duty recorded in the O~6ice
of the County Regi6t. en o6 Deeds, as Document No. _ 1•
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
bOcuMENT No. STATE BAR OF WISCONSIN FORM i-'1982 THIS SPACE RESERVED FOR RECORDING DATA
WARRANTY DEED i 053347 I,
VOL 90o N ,E 6
A 3)
James P. Lutiger and REGISTER'S OFFICE
This Deed, made between I
~
.Sheila..S....Lutiger, husband..and wife as maritdl ST, CRDIX Co
property.with..rights of survivorship_ ReC~d for Record
, Grantor, 81991
and.... M4Tshall•F,--Sinnet-t-and -Roberta L
Sinnett, at 0:4 A.Mt
husband and wife as marital survivorship property
- , Grantee, V. Regittet
Witnesseth, That the said Grantor, for a valuable consideration......
.
RETURN TO j
j
conveys to Grantee the following described real estate in
I
j County, State of Wisconsin:
Tax Parcel No:
I
Lot 32, Willow Ridge 2nd Addition, Town of Hudson
I
~j
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I
U-Itug-
REE
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This .....is_ not.,.-......, homestead property.
(is) ~Ec
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And......James_.P....Lutiger_and _Sheila_.S. Lutiger.......-----•
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
easements, restrictions and right-of-way of record
and will warrant and defend the same.
Dated this day of June 1991.... II
...........a1i
J (SEAL) . (SEAL)
* mes P. Luger j
.
......................(SEAL) 4.... . --.................(SEAL)
* * Sheila S. Lutige
i
AUTHENTICATION ACKNOWLEDGMENT II
Signature(s) STATE OF WISCONSIN j,
ss.
St Croix
County.
authenticated this ........day of 19...... Personally came before me this ................day of
June.___, 19..91-. the above named
......h~~~a.......Lutiger_
*
TITLE: MEMBER STATE BAR OF WISCONSIN *~~e"""**~•*+ ~j
(I i1ot, •-••••-••-•...•--•-.--•...iw`..xJ,P.......
authorized by § Stats.) 11~77...................
706.06, Wis. .
to me known to bythe.l;rson ...5..'~4.. 4o executed the
foregoing instrument &O ~RNN" a thesame. !
•
THIS INSTRUMENT WAS DRAFTED BY . ■
Steven B. Goff, Attorney at Law ' " '
710 North Main Street, P. 0. Box 167 * . .
RI.yer..F.&a.~,S,...~"Iiscotlsin•-_• 4022-------------------- Notary Public • -e • County, Wis.
r. 6Nn state expiration !i
(Signatures may be authenticated or acknowledged. Both My Commis 'on is pfr I
are not necessary.) date: U~~~!!n.~'~..' 19'~k.3-.)
.Names of persons signing in any capacity should be typed or printed below their signatures,
I,
STATE BAR OF WISCONSIN
Wic_.. - Fon,T Z 7 IqQ, 1 +4mAr At., 14f1/11
Di', t r.f r - y
S T C 105 r
Y
H
SEPTIC TANK MAINTENANCE AGREEMENT o
SC. Croix County tz
• o
,-1
OWNER /BUY 1. R A (TlsbFA'1it~ r ` $°f~ 't ~~,.1+.L>t<-rr' -
/ROUTE/BOX NUMBER J?ire Number
'All I, L_
CITY/ST All, 1: -.,...__...----lIP~,
j
PROPERTY LOCATION S i c ti o 11 2 N. W
town of ~u►-~So,-1!____ , St. Croix County,
Subdivision VLJ ,L oAOW~ , Lot number 3ZImproper use andMaintenance of your Septic system could result in
its premature'lailure to handle wastes. Proper maintenance'con-
si5ts of pumping Out the Septic tank every. three years or sooner,
if needed, by a licensed se tic tank pumper. What you ptit into
the system can affect the function of Lhe septic ,:ank as a treat-
ment stage in the waste disposal system.
SC.-Croix County residents uia_ be eligible to receive a grant for.
a maximum of 607.. of the cost of replacement of a failing syst,em,.
which was in.operacion prior to :July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement Chat:
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 (it nec-
essary), the septic 'tank is less than 1/3 Lull of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration.
I/WL•', the undersigned, have read the above requirements and agree Ln
to maintain the private s"ewage disposal system in accordance with, ~
the standards set forth,'he'rcin, as set by the Wisconsin Depart.-
menC of Natural Resources. Cert•ifieation form must be completed
and returned to the St. Croix County Zoning Office within 30.days
of the three year expiration date.
SIGNED GL
U All, E Q (ol 04/9
St. C;*oix County Zoning'Office
P.0. ilox 9&,
llammo'r)d,' WI 51,015
715-7't6-2239 or 715-425-8363
Sign, date and return to above address.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DIVISION
INDUSTR'Y,. ' P.O. BOX 7969
ANQ LABOR
HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: AT OWNSHIP OT NO.:BLK. NO.: SUBDIVISIO AME:
/8 /b7N/RAE aQ ?z
UNTY: (3-MIT 6/BUYER'S NAME: MAILING ADDRESS
jifeo :
'T IN -S►NNEYT
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFI ED SCRIPTIONS: E ATI N TESTS:
Residence uNv oNew ❑Replace 6 z& 9 /
7 f Q~ OnN 'Sows
1:56d Y, or S? QxD2-_80kK.IJ#'Q&T &kt- EMME91-
RATING: S= Site suitable for system U= Site unsuitable for system
CO VENTIONAL: MOUND: IN-GRO P RE: SYSTEM-IN-FILLHO❑LDING T ANK: RECO1VIMENDED SYSTEM:(opti all
SS ❑ U ®S S❑U S OU S
(/_z v!O Ac
Y1
If Percolation Tests are NOT required DESIGN RATE: n If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: `LA% Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH2111r. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- ~3 ~s:1`3 IJonl - .3 ' Z ~g SC ,~,MS~G~ ,MS
B- Z .4Z 96.49 nIo >9A7-
B- TS3 „sc ~s"B s/St o' /hs~~le
O% p N6hjp > 1C).08 4"&L STS SaNIMj /'$R ~1S
B- A . 9 > 8. tS~Ts 6" NSL"e N 14 1- o Lz- "&Sas ri hap'& 544* W'9aN1hS 26"saNr-S
66 QN rrl
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER AFTERSW LLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P ROD
P_ .ao 146 ~s7o 3 >
P-z A.00 9C.S 1o ' 174 174
P-
P_ I-= E129kmaN T
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. U
SYSTEM ELEVATION
d
_.a _ 714 _ $E~G~~11l1~ _.T►1-N
oQ ~Go wed
3
E
P
_r CAt
E
LIEE
-r ~
I S' V3w3
776
E
nett _ . _ _ - - J
E
E
E ;
d..
I, the undersigned, hereby certify that the soil tests reported on this form were made by me i d with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED O
14A&(V N So ,4 N ~JC~w Z
AD RESS: CERTIF CATION NUMBER: PHONE N MBER(optional):
o. ~x 9 !->r~e,sau a 3454-ago
CST SI TURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
INSTRUCTIONS FOR COMPLETING FORM 115 - SRC - 6395
To be a complete and accurate soil fiesta, your report must include; I
1. Complete legal description;
2. The use section must clearly indicate whether this is a residence or commercial project;
3, MAXIMUM nun-ber of bedroorns or" commercial use planned;
4. Is this a new o€' ° --cen3ent system;
5, Complete th s " y raging boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTE-IS ARE RULED OUT BASED ON SOIL. CONDITIONS;
b. PLEASE use the abbreviations shovoi here for writing pro`ile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately lcscatirrg your , ~ locations. Drawing to scale is preferred. A
separate shetn may be used if desired;
S, Make sure your benchroar"k and Vertical elevation reference paint: are clearly shown, and are permanent;
9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exernp-
tion, if appropriate;
101 If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11. Sign the form anal place your current addr ess and your certification number,
12. Make legible copies and distribute as requited. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 GAYS OF COMPLETION.
ABBREVIATIONS FOR (3 ERTIFIE{ SOIL TESTERS
Seed Separates and Textures Other Symbols
st: Stone (over 10") BB - Bedrock
cob Cobble (3 - 10") SS Sandstone
yr" Ora; (under 3") L:: - Limestone
Wgh Orocandv,rater
Cc ___id _ Percolation Rate
rraed s Mr .tium Sanr1 - Well
fs Fine Said E31dct Build ing
is l_o~ my Sand > - C;n ater Fhan
sr
Loam 13 ~ - Jrt
cii S Br
` y
5r X12 G
~E. `r' Yellow
Sea -JI-WI R Bed
sic' Sil ; C; ~Loanh mot - l fottles
sc Sandy Clay ik~ with
sic; Silty Clay ffl few, fine, faint
c - Clay cc common, coarse
pt feat corn Many, medium
m - Muck d - distinct
p - prominent.
I-IWL High ww.'xr ' 1,1
Six general soil textures surfac:,,_ rr
for licauki waste disposal BM - Bench Marls
VRP Vertical Reference Point
y
TO THE OWNER:
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verification of this soil test it-, the field prior to permit issuance. A complete set of plans for the private
sewage system and a permit application must be submitted to the appropriate local authority in order to
obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction.
X1717 P 1~ -
JOB
TIMM EXCAVATING SHEET NO. I OF Z
Route 1 Box 192 _
WILSON, WISCONSIN 54027 CALCULATED BY Ew ( /.►4 DATE
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
SCALE
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PRODUCT 205-1 ~nc., Groton, Mess. 01471. To Order PHONE TOLL FREE 1-800.2256380
JOB
lnMM EXCAVATING SHEET NO. r~ OF Z
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY DATE
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
SCALE
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PRODUCT Inc.,Groton,Mass, 01471. T. Order PHONE TOLL FREE I-800-225-8380