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FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER~.zz TOWNSHIP
SECTION T'06/_N-R/~' W
ADDRESS S~,./~ G✓,' ST. CROIX COUNTY, WISCONSIN
SUBDIVISION ; lls' LOT LOT SIZE 2-IL
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
r #
INDICATE NORTH ARROW
BENCHMARK: Elevation and description: ,5cILx
Alternate benchmark/jrj,1~~
SEPTIC TANK: Manufacturer: 2~~`dCt,s? Liquid Cap. ZDr,,u
Rings used: [ Manhole cover elev: Final grade elev:
Tank inlet elev.: - Tank outlet elev.:
No. of feet from nearest road:Front X, Side , Rear Ft.
From nearest prop. line:Front Side , Rear Ft. / lJ
No. of feet from: Well ,ta'e - Building:_ 4j
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
w
r
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: Seepage Pit:
Width: 12 Length Number of Lines:_;Z_Area Built 461-2
Exist. Grade Elev. Proposed Final Grade Elev. ~9 s
Fill depth to top of pipe:
No. feet from nearest prop. line:Front , Side )Z, Rear Ft.
No. feet from well:d0 . feet from building4p
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: _Ci5l PLUMBER ON JOB: LICENSE NUMBER: cap
6/90:cj
4 o d 0 l0 SfFETY & BUILDING
SEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR
LABOR & HUMAN RELATIONS DIVISION
P.O. BOX 7909 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
MA, ION WI 53707 State Plan I.D. Number:
S1- , NE 4 ,Sec . 2 8 , T 2 9 - R 19 (If assigned)
Town of Hudson, Lat 5 El CONVENTIONAL ❑ ALTERATIVE
Aldro Lan u Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECT~I,O1N~D TE:
Bill Harwell 589 Co. Rd. UU Hudson WI k1`7^
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.:
02' p" ry ii
Name of Plu ber: MP/MPRSW No.: County: Sanitary Permit Number:
Wm. Schumaker 6382 St. Croix 148994
SEPTIC TANK/HOLDING TANK.
MANUFACTURER: LIQUID CAPACITY: 7TANK LET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVDED:
r1 `l Gt IOC' .1 r E S ❑ NO ❑ YES NO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
/ ( r ALARM: FEET FROM `1 / LINE i. ~O 7 AIR INLET:
❑ YES U-NO 1 4 ~ / 0- ❑ YES d NO NEAREST / 7 V /
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: MP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
17 PROVIDED: PROVDED:
E__1 YES El NO I j A L--- ] ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: IBUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF /7A11 ❑ YES ❑ NO NEAREST -0
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID
BED/TRENCH TRENCHES: MAT RIAL: PIT DEPTH:
DIMENSIONS q-
-GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DI TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOVE COVER: ELEV. INLET: EA V'. €f PIPES: FEET FROM LINE 5o AI INLE
,y/ t -2 7 NEAREST J ~V
MOUND SYSTEM:
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
meets the criteria for medium sand. ELEVATIONS MEASURED.
❑ YES ❑ NO
'
TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS,
SOIL COVER
❑ YES ❑ NO ❑ YES ❑ NO
DEPTH OVER TRENCH/ BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DSTIR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
PIPES: DA.:
ELEV.: ELEV.: DIA.: ELEV.: I
ELEVATION AND
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑ YES ❑ NO ❑ YES ❑ NO
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
COMMENT,Sr; FEET FROM LINE: I
E] YES E] NO -1 YES E] NO NEAREST ! r r n
CnkP-V 7,
97~ Y&
1
c/e . D
-7 Z_
/0,0 Retain in county file for audit.
Sketch System on
Reverse Side. SIGN. E: r TITL
Wes' i
SBD-6710 (R. 06/88)
E DILHR SANITARY PERMIT APPLICATION ~o~N
In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT #
f7QQ ER
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ SANITARY
8% X 11 inches in size. Check if revision {o previous 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
f
S. T ~,N,R i7 E(or W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
II. TYPE OF BUILDING: (Check one) ❑ State Owned VILTMLAGE d ` NEAREST 1~ f ~G
1
❑ Public L2S.11 or 2 Fam. Dwelling- # of bedrooms .3 PARCEL NU
III. BUILDING USE: (If building type is public, check all that apply) d 2 O 1/" .,;v ` 16
1 ❑ Apt/Condo V
Outdoor Recreational Facility
2 ❑ Assembly Hall 6 El Medical Facility/Nursing Home 10
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. LZ 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 [21 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
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) CELEVATION
Feet ! v Feet
ysD 'I'll" /_5_ 0 Z2
VII. TANK CAPACITY Site
in allons Total # of Manufacturer's Name Concrete Con- Steel Fiber- Plastic EAxppepr. Prefab. INFORMATION New istin Gallons Tanks structed
Tanks Tanks F-V
Se tic Tank or Holdin Tank
Lift Pump Tank/Siphon Chamber El E -1 1 L[ Fj
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
iness Phone Number:
Plumber's Name (Print): Plumber's Signature: (No Stamps) 9OMPRSW No.: 7(U-S
C
3 ~ a5~y
lumb is Address (Street, City, State, Zip Code):
IX. CO NTY/DEPARTME USE ONLY
Disapproved Sanitary Permit Fee (Includes Groundwater Dale ssue Issuing gent Signature (No S S)
Surcharge Fee)
Approved El Owner Given Initial ~ 8p a2 S.-.r_
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
APPLICATION FOR SANITARY PERMIT
STC - 100
This application form is to be completed in full and signed by the owner(s) of the 9
property being developed. Any inadequacies will only result in delays of the permit
tssuauce. Should this development be intended for resale by owner/contractQX,("spec
liuuse"), 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 ~l C -
Location of Property ~_8 . /G k. Section T -Q N R --~--t- w
Mai i 1 ing Address G( t _
Subdivision Namw 00 I ( S
Lot Number
PrL,vluua Owner of Property ( r(~ La I
'Coral. Size of Parcel 4-
-J
Dar a ll arcr:l was Created
Are all corners and lot lines identifiable? Yes No
1~ Lhis property being developed for resale (spec house) ? Yes No
Vulumes and Page Number 4a:recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION.ONE Of THE FOLLOWING.
1. Warranty Deed
2. Land Contract
3. Other rc,.ordings filed with the Register of Deeds Office
in addition, a c•:rtifiad survey. if available, would be helpful so as to avoid delays
of the reviewing process. If the dead description references to a Certified Survey
Map, the the Certified Survey Nap shall also be required.
PROPERTY OWNER CERTIFICATION
1 (we) c e4ti j y that art a tatemente on thiA JO AM au tut to the beat 01 09 (a uh )
knmtedge; that I (we) am (acne) the **wA(a) of the p4opeAt!! de cA bed in th-!A
i 60hit+ation 6u m, by vi4tue o6 a wakAanty A.eC*Aded in the 06(tce o6 the
County Reg" tea o j Dee& as Document No. ~Tq;f?cl ; and that I (M)
p.htebe.ndy own the pitopoaed sit¢ Jon the ♦ 89+e apoAal AV&tem ton I (we) have
obt .L`teal an eab emen t, to nun ati th the above deA cA bed pKOpen trl, bo'% the
cone thue,ti.on o6 aa.i.d aybtem, and the came has been. -utl ne@o4ded in the 066~.ee
~j 6 .t#~ e (',~cln t y Reg teh o 6 Deed , as Document No. / % )
i
SIi;NATUKE OF OWNER SIMIATURE OF CO--OWNER (IF APPLICABLE)
It A1 SIGNED DATE SIGNED
4
7 TNas erAes/ atasavaa P011 asoomNe DATA
• or,i umzwr NQ: 8 'ATE OF II1NfNId ;11h• 11fiM
~ h LANE! .1,:,
Vie 4A t OFFt,.. :
p ANSA Ofss Ovals
Atli, WN"C"ONsi . CO., w •
Reed for ReWd *0 11th
Contraot, by and between ...:Harry. J; Stewarts,~ as Pe)Ceonal day of J~.A,.D. 19 $6'
. R.eprestieata tive of the Estate of A1dro Larsen a k a John AL
;
. A1.4 9..LA)MA0..4A1AJ.9h9:AW.TR--M. -T9kDL.ULTQ%n.. At ("Vendor", James 0 on ell
whether one or-. more) and.... V"i . man.. . ("Purchaser", •whetheri me or arose). . i
V endor sells and agrees to convey to Purebaser, upon the prompt land tall, por` deputy
formano4 of this sontract by Purchaser, the following property, togsaw with the
rents, profits, fixtures and other appurtenant interests (all Galled the "Property'),
in St r„ Croix.................... . County, State of Wb0041413~s aaTURN TO
See legal Description on Addendum-
Tax Parcel No
3e6 _ q~73
SFl
S FAT
This I A AQ2 homestead property.
XMX (is not)
Purchaser agrees to purchase the Property and to pay to Vendor at , such,.place_ as, he shall ,rank„
the sum of ;..192 a500.00 In the following manner: (a) W..Q09..OQ
at the execution of this Contract;' and (b) the balance of ;JUJO.•QO together with interest from data
hereof on the balance outstanding from time to time at the rate of LOLU LU)........... per cent per annum
until paid In full, as follows:
See Payment Terms on Addendum
.
Provided, however, the entire outstanding balance shall be paid in full on or before the....... llth.......... day of
j1iT11: 19A.Q. ( the maturity date).
Following any default in payment, Interest shall accrue at the rate of ...IQ.... % per annum on the entire amount
in default (which shall Include, without limitation, delinquent interest and, upon acceleration or maturity, the entire
principal balance).
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonablY antici-
pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor,
Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of
taxes, assessments and insurance will be deposited into an escrow fund or trustee `account, but shall not bear interest
unless otherwise required by law.
Payments shall be applied first to interest on the unpaid balance at the rate specifled and then to prinelpul• Any
amount may be prepaid without prmium or fee upon principal at any time.
tba~x3suooc zo~s~cwiwMac~ '
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
j as unpaid principal) is less than the amount that said indebtedness would have been had the payments been
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:
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 felt purchase pries is paid.
Purchaser shall be entitled to take possassim of the Proper/ ea........ thfi-- smi.innaf x`......
sy •cra.. OUt oa.
O.A 4%,. wl9Rnxe114 w1won.in k* lkaek Oe. lne.
O►lit, tl 0pAr,E .1 t1 7Z I13 /
Purchaser 'promises to pay when die all taxes and assessments levied on the Property or upon Vendor's in;':xast
it it end to deliver to Vendor on demand receipts showing such payment.
Purchaser
Purchaser shall keep the improvements on the Property insured against lose or damage occasioned by fire, ex-
coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved
by Vendor, in the sum of 4... ..........n/A..., but Vendor shall not require coverage in an amount more
than tile balance owed under this Contract. •Purchaser•shall pity the insurance premiums when due. The policies shall
contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writin , the original
of all policies covering the Property shall be deposited with Vendor. Purchaser shall s
promptly glue notice of loss to
iw-nrutire companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall
ha applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be
r Mundrally feasible.
Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Propert.r
in rood tenantable condition and-repair, to k! the Property free from liens superior to the lien of this Contract, and
to comply with all laws, ordinances and regua Ions &Meeting the Property.
Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions
shall be fully performed at the times and In the manner above specified, Vendor will on demand, execute and deliver to
the urchsaer a 1hcm 1ivi simple, of the Property, free and clear of all liens and encumbrances, execpt
srsona~ R res n a
any tens or encumursnces eras Y e act or default of Purchaser, and except: easemenxs.*..$ratt ctive..
.r-oV -nameta..Qt.xecQrd,...iL..any.*...aAd..Zaniag..o.tdithence..xaquirementa-........................................
Purchaser agrees that time is ofthe essence and (a) in the event of a default in the payment of any principal or
interest which continues for a period of ...fiQ... days following the specified due date or (b) in the event of a default in
performance of any other obligation of Purchaser which continues for a period of AD.... days following written notice
thereof' by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract
shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby
Waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in
addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's
rit,htq, title and interest in the Property and recover the Property hack through strict foreclosure with any equity of
redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from
the date of default at the rate in effort on such date and other amounts due hereunder (in which event all amounts previously
raid by Purchaser shall be fortifeited as liquidated damaures for failure to fulfill this Contract and as rental for the
roperty if purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel
immediate and full payment of the entire outstanding halance, with interest thereon at the rate in effect on the date of
defnuit and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser
shall he liable for any deficiency; or (iii) Vendor may sue at law fer the entire unpaid purchase price or any portion
therr:pf; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet-title
action it' the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession
of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action
under (i). (ii) or (iv) above.Notwithstanding any oral or written statements or actions of Vendor, an election of any
of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses
including reasonable attorneys fees of Vendor incurred to enforceanv remedy hereunder (whether abated or not) to the
extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in-
curred, and shall be included in any judgment.
Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents
to the appointment of a receiver of the Property, lneludinR. homestead interest, to collect the rents, issues, and profits of
the Property during the pendency of such action, and such rents. issues, and profits when so collected shall be held and
applied as the court shall direct.
Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any
of Purchasers rights under this Contract or by option, long-term lease or in any other way) -vithout the prior written
consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest
conveyed is a Pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of
Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding
balance payable under this Contract shall become Immediately due and payable in full, at Vendor's option without notice.
Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of
this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser
makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to
the Mortgagee it Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on
this Contract.
Vendor may waive any default without waiving any other subsequent or prior default of Purchaser.
All terms of this Contract shall be binding upon and inure to the benefits of the heirs. legal representatives.
successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable
consideration joins herein to release homestead rights In the subject Property and agrees to join in the execution of the
deed to be made in fulfillment hereof.)
Dated this 11th
tits June 19..86...
(SEAL) ~V..
• tarry..J...Atewtart........................ (SEAL) AL
• . William C. Harwell - I J GIC
i
AUTHENTICATION ACKNOWLEDGIMENT"'•~',~.'~~ `y
Signature(s) r WISCONSIN
STATE OF-
So.
authenticated this s~~x...e1~RiB ...-.....--•---..-..Cou~tty.
day of. 19..... Personally came before me this ..110........ day of
• - - INA...•----... 19.M.. the above named
• . HarrX..:1e..Stewart-•and-•Wil @9!.G•...ufrv All
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not
authorized by if 706.06, Wis. Stats.)
to me known to be the person who executed the
foregoinp,)nstrnment and cknowledge the.:ame.
THIS INSTRUMENT WAS ORAFTEO BV
1oi_.•.. Mur1FaY.•._ NEYWOOD,_ C • . MURRAY... .
& SHE
RBURNE, P.0 BOX 229, )9v/d....,f WsO,0✓
J.......----
'Hudvon'---WI. 5r481fr.........-•••-....... Notary Public ....Ste Croix County, Wis.
(Signatures may be authenticated or acknowledged. MY Commission is ~ ~e •
are not necessary.) Both per anent. If no state expiration
date'1 1' r 19.. ~j
'Yam•. of persona siening in any expacity ,hpuld he typyl or nrlnt*d be! ♦IN-,..
.saw
'G
to
H
. a
ST C- 105 r'
a
M
SEPTIC TANK MAINTENANCE AGREEMENT ~0
St. Croix County z
d
/ a
/r
OWNER/BUYER
ROUTE/BOX NUMBER
~,Q_~C~- ~-"-ten
CITY/STATE
PROPERTY LOCATION: Sectionf-S_, T` ~N, R_J__~4_W,
Town of SCE , St. Croix County,
SubdivisionQ Lot number.
' I
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
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
H
three year expiration. H
I/WE, the undersigned,, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with H
the standards set forth, herein, as set by the Wisconsin Depart- 'b
ment 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.
SIGNED
D ATE St. Croix County Zoning Office
P.O. Box 98
Hammond, WI 54015
715-796-2235 or 715-425-8363
Sign, date and return to above address.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DIVISION
INDUSTRY, P.O. BOX 7969
LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707
HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145)
SECTION: TOWNSHIP/ LOTCNO.:BLK. NO.: SUBD~VISI*ON NS
fitt
LOCATI N]0/4
T24 N/Ri9 E (or 1~1 soN a C
1/ ,rZe /
COUNTY: O ER'S MAILIN ADDRESS: ,
DATES OBSERVATIONS MADE
USE PRO I E D R I NS: E AT ON TESTS:
NO. BEDRMS : COMMER IAL DESCR;PT ON:
Residence New ❑Replace Z~ 9i M1/~ Z? l /
u So,~s,
RATING: S= Site suitable for system U= Site unsuitable for system
al
)
O VENTIaAL. MOjl IN G~ ~ RE: S~EM-IN-FILLHOLDING TA K: REC MENDED SYSTEM: lopel&
SS UU 11(SyJI S ❑ U 0 S e6t4VjAj)6^lAt- Perc
olation Tests are NOT required DESIG UATE: If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: J Floodplain indicate Floodplain elevation:
u dSs
PROFILE DESCRIPTIONS
BORING TOTAL P H TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH= ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- F 9.08 99 . S-Z No > 9. U / L Z 4 *"6,e Sc 0 b S*#y ✓►is
B- Z 9.c6 9.s5 NWE > 9. o SG dak" N-S
B- 3 Q.00 $.0 I'lloug , 9,00 /4" L STS 11_80N SL If, "80jj S
B- . t g.49 mtj F. •od ' LsLIS zC8Q~►S ' nA Z " CS
B- ,97- / ? YZ l$'~ LTS l7n$4wSL 7Z.,84ilk► ARS
B-
PERCOLATION TESTS
C
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER hI481111111! S AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH
P_ r oa 9.s® 3 ~Z > z >
P_ Z. 7 ,2n 3 > > Z
P- a 14%.150 > 2 2 .4P- ,~,f
P_ I.,~v er ON AT @ 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 p ints and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. lld-) 0 0
SYSTEM ELEVATIO _ _ 45 77777777777T 7- ! I
C.- hii-- 60
- ZIO ~ ~ 3 I
i
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1 1 )
73
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AltiQ 3~ g Irk
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AuA
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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 of the tests are correct to the best of my knowledge and belief.
NAME (print : TESTS WERE COMPLETED ON:
4Ae J 3Q14 rj k>N saiV S u 'L M 12 9
A RESS:. CERTIFICATION NUMBER: PH NE NU ER (optional):
~•o . 1 L-16 _P4 S4o~ 34 ogb
CST S ATURE:
0 0"
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHRSBD-6395 (R. 10/83) - OVER -
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.COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227
ST. CROIX ZONING REPORT NO-1 08510/01 PAGE 1
ST. CROIX COUNTY REPORT DATES 7/29/91
COURTHO(a F m 2 7/25/91
HUDSON, WI 54016
ATTNS THOMAS Co NELSON
IJ 0
t
OWNERS Thomas aw 1 Vickie Berends
LOCATIONS 761 ALdro Lane, Hudson
I COLLECTOR: M. Jenkins
f`
SOLRCE OF SAMPLES Outside faucet
COLIFORMS 0 /100 ml
INTERPRETATIONS BacteriotogicaLLY SAFE
NITRATE-NS 4 ppm w
Above 10 ppm exceeds the recommended Public
Drinking Water Standard.
Coliform Bacteria/100 ml
Nitrate-Nitrogen, mg/L
LAB TECHNICIAN: Pam Sane
WI Approved Lab No. 19
P"t
o < Means "LESS THAN" Detectable Level, Approved byt
® PROFESSIONAL LABORATORY SERVICES SINCE 1952
_t
4ST. CROIX COUNTY ZONING OFFICE
911 4th Street
~i Xu Hudson, WI 54016
Telephone - (715)386-4680
F
~TheeSt. Croix Co. Zoning Office offers the service of septic and
water inspection to Lending Institution, Realty Firms, and
private individuals.
COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN BE
LOCATED.
Please provide the following information, enclose appropriate fee
made payable to ST. CROIX CO. ZONING, and mail, along with fo m
to the above address. Testing will be done as soon as possi e
after fee and form are received.
WATER TESTING-------------------------------- FEE:$ 25.00
(For nitrates and coliform bacteria)
WATER TESTING FEE:$175.00
(VOC'S)
SEPTIC.SYSTEM INSPECTION FEE:$ 25.00
PROPERTY OWNERS NAME: l Tl~rn R r NAB ~I /c
PROPERTY OWNERS ADDRESS : ?6 / rho L CITY : ~
Legal Descri tion 1/41 1/4, Sec. , T N-R W
Town of ~-f fA ,Lot No. , Subdivision 4~R ~4
FIRE NO. LOCK BOX NO.
Color of house,ja,~N_ Realty sign? Firm:
PLEASE 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.
Firm or individual requesting services. aYrti a
Telephone No. I. -7
REPORT TO BE SENT To :
CLOSING DATE: v
.A,NV~
Signature:
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
x_ ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
July 25, 1991
Doreen White
First Nat'l Bank/Hudson
307 2nd St.
Hudson, WI 54016
Dear Ms. White:
An inspection of the septic system on the property
of Thomas Shaw located at 761 Aldro Lane, Hudson, WI was
conducted on July 24, 1991. 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 back from the laboratory.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and
did not involve any excavating or chemical analysis.
Accordingly, there is the possibility of hidden defects in the
system not discoverable by this inspection. This does not in
any way warrant or guarantee the continued proper functioning or
operation of this system. It is recommended that the system
should be pumped once every three years. Therefore, the
prolonged life of this system may be dependent upon proper
maintenance of the system.
erely,
~ Rrrt.~
Mar J nkins
Assistant Zoning Administrator
cj