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HomeMy WebLinkAbout020-1270-20-000 4 ~ I a•°i °o o° -0 0 0 h N O vi C; C; v> 0 ova ao M c C L L o ~ .3 y •3 y c c y O a) w a a fn (n c N C a) Q L W L 0 r+ C C h a) Ci O O +O„ ~ U N N V N a) h CD O CL co o m C N` C N V _O U C m N C a .V O O. 3 O a 3 W z m orn z a) oa, LL CO O N C p 0 N c O` C - O C W - a0 - O N Q ~ Y a Q Y a I Z E rn Z o Z a m N N V- In O O O Z c v G' r ~ w w d 2 to F- 0 Z 0 Z c E '2 E O CO M N N_ 3 O N N N N O- N N i ~ • A~1 0 a N s o s o •(a O (a Q O O ° o N Q Z co z M N N Z N N Z N O C f6 a7 ~ N (6 .O C1 y O) O) (c m m c E O O O O c i O O 0 0 m J a M w c c c c N a~ a> c a~ a> c d O a~ N o a~ a) o .14 a O d a s a a s a L L (6 L L N N N N o o o o 3 CL U) U M U) U 0 0 0 0 z z a _ o N !I c> o N N VJ J U O O m Z M Y Z M = O O M E co O C N O CL N 0 N ) N N N Q Z N Q r. Z..f? (a N d R 0 O O O 0 N C O O O O O C O y C y E N O M 0 C 0 E N (O M y ON P co a) C N C as 0 a 0 0 0) a) C N C N tl a 0 0 w r E E O' a C •O N N E CL •E a a p N N V y" o~ of ~ f0 c a E a) 2 c °D v (h n c a) E m 2 c v co P O n N r.. O N N c t C7 n N N t C7 75 C-4 C (D O M O N O E O N U O N O E O N N U • 7, N O o N 2 O z Z~ Z Y (A Z N Z Z Y (n v ik n 44) a • a m y v - a~ E ~r-ww o ~ 1 O U a o O in (i J ST. CROIX COUNTY WISCONSIN ZONING OFFICE ! r N a r s ■ r,r,i ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-771.0 (715) 386-4680 Fax (715) 386-4686 July 24, 2000 Linda Besk Edina Realty 200 Chestnut Stillwater, MN 55082 RE: Septic Evaluation for Nate & Lisa Lindsay property located at 846 Dorsey Lane, Hudson, St. Croix County, Wisconsin Dear Ms. Besk: Our records indicate that the bed-type system that is being utilized on the above referenced property was installed by Douglas Strohbeen in 1993. The bed-type system consists of three (3) laterals and is 18' x 36' and it is sized for a (3) three bedroom structure. The system was installed as code compliant. On July 21, 2000, 1 conducted a visual septic inspection on the Nate and Lisa Linsday property at 846 Dorsey Lane, Hudson, Wisconsin. At the time of the inspection, the sanitary systems appeared to functioning properly. There was no vent cover on the vest/inspection pipe. I did not observe any water ponded in the vent pipe of the bed-type systems. I would recommend that a vent cap be installed on the vent pipe of the system. This will allow the trenches to stay aerobic. You can purchase the vent cap at any plumbing supply store. Ponding results when microscopic bacteria and sludge plug the soil pores forming clogging mat. This closing mat decreases the soil's ability to dispose of the sewage effluent. Over time, this clogging mat becomes thicker, causing less and less liquid to percolate through the system. As this mat becomes progressively thicker it leads to failure of the system. To prolong the life of the system is as simple as fixing or replacing plumbing fixtures with water conserving fixtures, reducing shower time, washing dishes when the dish washer is full, avoid using a garbage disposal, using a wash machine with a suds saver feature, etc. The inspection of this sewage disposal system was based on a surface inspection of said system, and did not involve any excavation of chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by the 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. Should you have any questions, please contact me at (715) 386-4680. Sincerely, K&~ 1&0"' Kevin Grabau Zoning Technician U?-v. 121 0 - Zo-oUV~ 21.261.1 1. 122 JUL.,=18'00(TUE) 14:41 EDINA STILLWATER TEL:430 7575 P.001 VD 10 . CROIX COUNTY ISCONSIN ONING OFFICE C.. ST. CR 1X COUNTY COURTHOUSE 911 FOU TH STREET • HUDSON. W! 54076 ' - (715) 306-4680 SEPTIC INSPECTION / WATER 'T'EST REQUEST FORM Specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. / Oro D t7ater (VOC's) $185.00 `Septic $25.00 Nater (Nitrate & Bacteria) 5,.00 Visual inspection) Owner:AfAte- 4 L;so- i Requested by: L( ney_-K Address : (4 (a hars Address: 2co mme City & State: City & St.;_fdt~i v. MAI Zip CoC! L:: Zip Code : _ ~aS 4vv Telephone N4: (2jE) -A q - Telephone No: W) > Property address (Fire NO & Street) : ~DrSC~VLa.I/I Location: fit,-}; , Sec.,a~, T N, RW, TdWn of St. Croix Co., WI. Tax YD N° Parcel TO W House color: Ranlty farm; C-l~~ytT Lock Box Combo: Water sample tap location: ,TO_ M.: COMPj~~~.'h'D BY PROPERTY dTi~NER *PROVIDE A SKETCH of ROUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Is the dwelling currently occupied? Yes 0 No \ If vacant, date last occupied: Septic system installed by: y~ax; _ -septic tank last servicad by: / oUt Date: -47124 -7,410 rc(, Previous Owners Name (s) : Have any of the following been observed? OY C)N slow drainage from house. OY ON Sewage Back-up into dwelling. OY ON Sewage discharge to ground surface, road ditch or body of water. 0Y ON Slow drainage from the,dwelling. CIY ON Foul. odors. Other comments relative to system operation: I cer; he above information s etas and true to the bes e. o TLRS SIGNATURE: DATE 461 i^ CO OOFF~G - too yz~ L o) 1 OWNERS DRAWING OF HOU,SE._..&_._.$EPTIC SYSTEM LOCATION t N - T de C , 7 ;f ~In W TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? j9Yes ONo soil series per SCS Soil Survey: sheet # Type of soil absort~tion system: Below grd 0At-Grd ❑Mound Approx. size 'X OGravity ❑Dose ❑Pressurized Ft.z wed OTrench ❑Dry Well ❑Holding Tank ❑Outfall pipe OBSERVED DEFICIENCIES 00therpi OUnknow Septic tank Setbacks: OHouse a.( OWell OProp. line O er Dose OLocking cov abel OPump/Floats OElec . wiring Setbac use OWel 0 er_ t Soil Absorption System Setbacks: ❑House ~z5 ❑Well OProp. line_1o 00ther ❑Ponding: ❑Discharge: General comments: INSPECTORS SKETCH OF SS LOCAT O Y TEM 6 vw fie- rlbve~oQ d~ t~ Nil ~ A- elk Inspector Title VA- low d ~u~`~dZ i 6 ST. CROIX COUNTY WISCONSIN - ZONING OFFICE Irrrrrrrr ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. 0 Water (VOC's) $200.00 ❑ Septic $125.00 Q Water (Nitrate & Bacteria) $55.00 ❑ Nitrate & Bacteria 13 Water (Lead Concentration) $21.00 retest $15.00 Owner: Requested by: Address: Address: ZIP ZIP Telephone W:( ) Telephone W:( ) Property address (Fire If & Street) : Location: Sec. , TN, R W, Town of Realty firm: Lock Box Combo: Closing Date: TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Water sample tap location: Is the dwelling currently occupied? ❑ Yes ❑ No If vacant, date last occupied: Age of septic system: Septic tank last pumped by: Date: Previous Owner's Name(s): Have any of the following been observed? OY ON Slow drainage from house. ❑Y ON Sewage Back-up into dwelling. OY ON Sewage discharge to ground surface or road ditch. OY ON 'Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: DATE: 1/94 Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Scam ►/h; Ilc.,✓ TOWNSHIP A111c61, SEC. Z / T ADDRESS ~oXZ~z_ ST. CROIX COUNTY, WISCONSIN ~4.~S9n W= SS~DIi SUBDIVISION T~cob S &'orl A2 LOT LOT SIZE z Q y~ mrS PLAN VIEW 6 133 y Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r~ra5m Co - d~ - S c,. c a a'x so' 1 ~ ❑a 3 ►03' i / d L %A T log ox N k (Q (off / i 1rI'' r I ~ ~ ~ sox / \3e L yb' INDICATE NORTH ARROW B NCHMZRKDve ribe the vertical reference point used I iil2o•. E evat tical ref erence point: t(00.00' Proposed slope at site: S-2-E- ~ S.E„ TIC TANK: Manufacturer: Wm1s¢v Liquid Capacity: ~Opo N Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road.: Front,Q Side,(D Rear, O j feet .From nearest property line Front, 0Side ,0Rear, 0 w5 feet Number of feet from: well _ t- building: I% (Include this information of the above plcVlan)( 2 reference dimensions to septic tank) a. SEE REVERSE SIDE J PUMP CHAMBER v~ Manufacturer:/V/T Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: W Len the 3 6 Number of Lines: 3 Area Built: G4 8 Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side" 0 Rear,0 Vt.I S" i Number of feet from well: 3 Number of feet from building: y Z~ (Include distances on plot plan). SEEPAGE PIT Size: Z14- Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: d/ Capacity: Number of rings used: Elevation of bottom of tank:1 Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from.nearest road: Alarm Manufacturer: Inspector: ~ j Dated: Plumber on Job: License Number: 1"( I 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 SW, , , NW 4 ,Sec . 21, T 29 -Rl9 Sf assigned) Number: Town of Hudson Lot CONVENTIONAL El ALTERATIVE In-Ground Pressure ❑ Mound D -rQo-,-r Rd _ g Tank 1:1 "NAME-OF PERMIT HOLDE 'ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Box 282 Hudson WI 54016 4: 7 - BE R Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.. CST REF. PT. .:9e Z • ~ e Name of Plumber: MP/MPRSW No. County: Sanitary Permit Number: St. jqg:4x 135525 SEPTIC ANK/ 9,6 - .3, a MANUFACTURER: LIQUID CAPACITY: TANK INLE TANK OUTLET ELEV.: WARNING LABEL LOCKING COVI~Q , PROVIDED: PROVIDED: F,-f,~O ties ev a/. 78 /0/, - 1P ES ❑ NO ❑ YES N BEDDING: V.EDLLDIA.: MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH C v. r, ALARM: FEET FROM LINE: AIR IN T: ❑ YES Z NO _ V ❑ YES NO N ~ CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑ YES ❑ NO NEAREST 10' 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 SYSTE " 5 t- o-F_S E: e BED/TRENCH WIDTH: L NO. OF DISTR. PIPE SPACING: CO R INSIDE DIA.: # PITS: LIQUID TRENCHES. / MATERIAL: DEPTH: DIMENSIONS 3~p (p a-,- GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PI E DISTR. PIPE MATERIAL: O. I TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE OVER: ELEV. INLE;: ELEV. END: r~ p PI FEET FROM LINE: f AIR INLET: 01 2 10,VC NEAREST - LJ, 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 ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ 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. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: 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: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST lJ ,I,p a ft4c~ X 'it iv /tl~ ✓c~T +a~, Cr~tr4 rrzJ~g " j c~/ c 1, ,7 , ~1~a~ , ~c,~'EzF ~ /03. ~ , Sketch System on a 'n in county file for audit. Reverse Side. SIGNAT E: TITLE: / SBD-6710 (R. 06/88) / DILH Mill SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code CouNTY STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than El 8% x 11 inches in size. c ec M' s on to 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 lmr S4?,)t/48W Y4, S Z T , N, R / E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # OZ / CITY, ST E ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER D/ G 7G ,Taco b s Ld M rt II. TYPE OF BUILDING: (Check one) 1:1 State Owned ❑ VILLLLAGE NEAREST ROAD _QA ❑ Public CSI 1 or 2 Fam. Dwelling-# of bedrooms 3 PARCEL TAX NUMB R ) III. BUILDING USE: (If building type is public, check all that apply) I 3 1 ❑ Apt/Condo 20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 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. 5fl New 2. ❑ Replacement 3.E1 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 El Specify Type 41 El Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 430 Vault Privy 14 ❑ System-ln-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 ey REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION G I S G 4~ O.7 Z G 3 100-2-0 Feet /0'1-70 Feet VII. TANK CAPACITY Site in allons 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 000 / we Lift Pump Tank/Siphon 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's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: p0u ~S 4 l`14alr6e~~l 00 //114 .~3-2 X97 3~ 3 Plumber's Add esa (Street, City, Stat , Zip Code): f1 F ~Ow ZIG47?at j 7 f,G/7 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuin gent Signature (No Stamps) Approved ❑ Owner Given Initial / Surcharge Fee) Adve 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. 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. 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 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) 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/conttectot,(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 -<-g-A1_ //&r_- Location of property ,<,--~1/1 &/4, Section e T Z~ ~-R,~f Township Mailing address _Pox4b, 2-8-01- f-~u ~sar~ GCT~ Sy0 Address of site Subdivision name Sac of r f-&A'o ; n ~ Lot number Previous owner of property M. ~~r15o✓1 Total slse of parcel 2 -0~&- y4cs15 Date parcel was created 3^22- ~ Ate all corners and lot lines identifiable? At so No is this property being developed tot resale (spec house)? as 0 Volume 0QS and Page Number 4/& as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUMB AND PAGE NUMBER, and the SEAL OF THE REGISTER 00 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 Certified survey map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(Ve) certify that all statements on this form are true to the best of my (out) knowledge; that f (we) am (are) 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. 4~~55//,3 ; and that I (we) Presently own the proposed site for the sewage disposal system (at I (we) have obtained an easement, to tun with the above described property, tot the consttuctlon of said system, and the same has been duly recorded in the Office of the County Register o Deeds, as Document No. `!3 Som.//3 Signature of Owner Signature of Co-Owner (If Applicable) /19 ^ q o Fa-t-901- ate of Signature Date of Signature I L nocul`Ir,il NO WARRANTY DEED 1•••s spa I. ntstnvtll Ina o4•n STATE IIAR OF WISCONSIN FORM 2-1992 43041.7 n~ REGISTER'S OFFICE t" ~W I~'.L W ST. CROIX CO., WI Virglnla M. Hanson. a single woman ReC'd for Record MAR ~ 2149 « 8:00 ~J - ADM 1'0I11%1'~. :m.l ~••►r:u•1. In Sam E. Miller, a single mall (qgI.hrJ of Ooici o' n:un n the foll..lrlnc dr%ei ibed real estate in St. Cru l x ~'.•ur.t). Slate inorb7i11: Tag Parcel No:... West Half (W',) of the SouthweSL Quarter (SWII,) 1•I Sectlun 't'wenty-one (21). Township 'twenty-nine (29) North, Ranfge Nineteen (19) West, St. Croix County, Wisconsin except that ilart South of the public hlglfway and except Lots 5. 6, 7, and 8 of Certified Survey Map n Vol. 6, Page 1747, Doc. No. 419479. That part of the West Half (W!q) of Life Northwest Quarter (NW'&) of Section Twenty-one (21), Township Twenty-nine (29) North. Range Nineteen (19) West. St. Croix County, Wisconsin lying South of the right of way of the Chicago, St. Paul, Mlnneapolic. and (hnaha Hallway Company. -['KANSF•Eh~ 0 FEF This is not lln►II111end prcipert;• Link fix licit) F:aev1•'inu l.. Nnrranlie': easements of record and protective covenants and restrictions of record, if any. 14114d this d:y of I( L" 1!0 88 I.-; F. A 1.1 Virglnla M. Hanson AUTHENTICATION ACKNOWLEDUMENT Signature(s) STATE: OF WISCONSIN 1 ! ss. 1 l (fount}'. authenticated this day of 19 Per-unallb' ranee before nip this Ni 41. y of .r• 111 88 the a1111f'e nann'41 Virginia M. Hanson TITLE: MEMBER STATE BAR OF W1S1•ntitilX (If nol. authorized by 1 7116•96, Wis. Slat.a.) In n1e Ln•.an In br thr pcr;on Icl.o ecrruled lhr fcirecoin • Iiu nt : iitj ni'kl,olrle•Igr the s:11•le. T•1 i INSTRUMENT WAS QRArTro RY l.ois•A. Murray, .I'eywtwtl,• Carl b Murray P.O.# Dox 229. Iludspn. WI 54616 `:,d11• felt iv #~4 l Counlc. Wk. (Siennturen lil:q• be nuthenlirnled or Both •~••~I11:II,rI,►,I If not. Male e•:e rali...► are not necesanry.) •H.men of perw.••m Planing in nor #61.4.:1, •1....,•.1 1« 1„• • • • . 0-4 1 .1.. r. WARRANTT 01:►D STA'1F. nAR OF 1:11:1'11%' •V F#I•IM 114 t-- 1.-. N•... ..a.,, 1.*41 1'1:.• • Pee i S T C - 10 5 r, o SEPTIC TANK MAINTENANCE AGREEMENT ~ St. Croix County r w OWNER/BUYER,,, w 0 ROUTE/BOX NUMBER Fire Number o CITY/STATE ZIP Sy.P~.h m PROPERTY LOCATION: -w 34',,4~4/k, Section, T_,,ar N, R r S? Town ofAZ4:e~_ St. Croix County, Subdivision-T Lot number~zz 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 a ect the .unction o the-septic tank as a treat- ment stage in the waste disposal system. St. Croix County residents may be eligible to recieve a grant for a maximum of 60% of the cost.of replacement of a failing system, whiTcTi wwas 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 agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and •(2)•after inspection and pumping (if nec- essary), the septic-.tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H I/WE, the undersigned have read the above requirements and agree o to maintain the private sewage disposal system in accordance with 5 the standards set forth, herein, as set by the Wisconsin Depart- x 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. SIGNEt~~(d -mJ DATE - z- _e St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 HUMAN RELATIONS N WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: TOWNSHIP OT NO.: BLK- NO.: S BDIVISION NAME: SN V4 NWY4 z1 /Tz9 N/Ri,9 E (or I,+^SoN A / ~/llCO$S~vdl COUNTY: OWNER'S MAILING A R 'OJT C %~0) X 'Sd M M I LL 11L IQ USE DATES OBSERVATIONS MADE NO. UUMMLHUIAL DESCRIPTION: S: JVResidence ORe lace uN~ - New p g:Z'• JuNc 6 /99a 'Sosc.S 7%, ~dQZT- RATING: S- Site suitable for system U- Site unsuitable for system ~ Z It- O I& S E JU • MESCIL , OU IN- G GgO S OU BIJ EA I EI S E-T-NECO MMENDE D STICEM: A`ion&.4 F11Perc,. olationTests are NOT required N RATE: If any portion of the tested area is in the r IL HR 83.09(5)(b), indicate: AS _ / Floodplain, indicate Floodplain elevation: ~f + r id cc PROFILE DESCRIPTIONS BORING TOTAL ELEVATION PTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DF_PTHiS OBSERVE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B I q o0 0s-21 14041C >9.00 sas 2~1"&hj MS Z7 8eN MS44&C kc41% 4o' k MK.S B- q.0$ /03.79 oN~c > 96$ 33~&~YS /6" a GsEG+R 3?~QaN MS 23"BaNcst6t B- 3 9-T5 03.1 tJo Is >4•z1~ /z" ~cTS zf"g~t,C ~2t eQ.4C_'4,( Gtt 66 ,eQjM5- 9.41 /vl.zS Mwvr- >9.41 'z *kLLTS A'*EeNL /T Be,-cS161e 49*&mr'1S B' > •S$ g'~ QttTS ~ 4N1. /1 r$IQ.,,GS~41Q ~3r$~•.r rhS B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER R GMS AFTER SWELLING INTERVAL-MIN. PER INCH P s s~ ~s70 }Z >2 3 P- Od NONt! /03.20 < P- P- E WEVITr I A< P_ PLOT PLAN: Show local ons of percolation tests, I borm t imensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevat n reference points andA their I pn the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. P- I SYSTEM ELE AT_ION I /UO.zO _4 4 i ._.4.. ' I T r - _ 1 - , i I r - - f • r. t.. _ - - - - ;Ao - r_ - peoftilry _ I - -I 'Si 'U ElLa.ATIcv►= ~oo.oo. 1, the undersigned, hereb 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: 14141111110 SON J0 Nsoti Sc►,Qy~y JNG //VC. ~ w r 6 /1140 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 4o Sr uaso►,j We i 4ci1 6 3414 386- 4086 CST SIG TORE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHRSBD-6395 (R, 10/83) - OVER - lOb I o ~ v 313' / Arta ~ X / 10 lam ~ ~ Via= 91 lov, r r I u.E 'I P-1 i p 30~~(3-I F w tih o Ko,SgL o~ a S' n 6avtyQ, t gar I ~ - Of i s 4 ce~~J o d 111~~ ~ ~ P 7 I~ 1• vo - O 0 0 r S o r o T ~ 46 a'+ w f s ~ ! I ~ ~ I cl i < I i I I I I m I ~ z I i ° rn I j j ~ i I o W ! I I W 1 rte- I I I i I I I ~ i o I I I m I I Q i i ► C I I = p I ~J o I 1 I n C ~ 1 I I r -V I I I L4 j "0 l I i ~ ~ I m ! I 1 ' CA C/) m I z f tp I -0 O ~ 4~ it 1 X 9-, -I oo o ° o A C.) F; < n M -f z -n °c _ -v °o xm r~ m ~ z m z off? ~s' ~ It T P r' + 41, W 1 P 50* ek, a~n rol\ 1 ~ " GEti a 962 - 52 S~' 15--g62 2 1° 00 t tot Z gpt~ey ~~oe { cru`e't G~"G~ st q Ob 04 M'• Lei 5 '`fie d• d S~ ~ 4 iii"°` ~Z {1 tee to cc~~'" ~io-(o Ga ale 41~ . has ~ 40 G ~a • ~9 by Gab Z Q~ ~9 2 5 SiNG~ to \ Joe\. t`~'`~~ab ~ S~~JiGE EQENDENT. z $ ONO" Si~NPG~P 04 O ~ Ov bgp,`, 8 r s; i M A . t ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse J# All, 911 4th Street ` Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, 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 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. / V WATER TESTING--------------I ----------'--FEE: 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $175.00 (For VOC'S) / SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 V (Determines if system is properly functioning at time of inspection) Property owner's name- Property own9i- 's address i0oYSey COP'. Legal Description S141 1/4 of the Nl_l/4 of Section ~T,?? N-R Q ih Town of d,d Lot Number .Subdivision Name Waco s -F FIRE NUMBER 7 LOCK BOX NUMBER . Color of house Realty sign by house?,4j If so, list 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 t~st 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: Telephone Number - REPORT TO BE SENT TO: Closing dat a Signature r N r: ST. CROIX COUNTY WISCONSIN y ' . ZONING OFFICE ST. CROIX COUNTY COURTHOUSE ` V 911 FOURTH STREET * HUDSON, W154016 IN MAILA (715) 386-4680 May 14, 1991 Jim Dahlby Edina Realty 700 2nd St. Hudson, WI 54016 Dear Mr. Dahlby: An inspection of the septic system on the property of Mr. Miller, located at 846 Dorsey Dr., Hudson, WI was conducted on May 14, 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. S'n rely, P Mar ins Assistant Zoning Administrator cj JUL.-17'00(MON) 13:19 EDINA STILLWATER TEL:430 7575 P. 001 CROIX COUNTY LISCONSIN ONING OFFICE Y C< ST. CR IX COUNTY COURTHOUSE aM 911 FOU TH STREET • HUDSON, W154016 _ (715) 386-4680 SEPTIC INSPrCTION / WATER TEST REQUEST FORM Specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary- Please make arrangements with this office to insure a time when entry can be gained. ; oa 0 Water (VOC's) $185.00 Septic$25-00 Water (Nitrate & Bacteria) *9 00 (Visual inspection) Owner: 11f ~1-t %(4 ~ 1~ JC!Eje.% ie. I- ~1 g. L ~1 V1 Requested by. Address: Address: 200 w~'E City & State: ( City & St. ! 11LIVIii- v Zip Coc•..: s(!Q16p Zip Code: SS-aQ_-g,- Telephone N°. (265) %/-63 / Telephone N°: ( ) C~~ ~7$~ Property address (Fire Na & Street) : C/6 _bDV' e- •LezP1 Location.: k, k, Sec. jjR:.L, T _c MN, R W n of .s o St. Croix Co-, WI_ Tax YD N9 P eel ID 2 20 pp ff ► 133 n Rouse color:/~ Rezlty firm: LLlIOV~} Lack X Combo: 14-, A) .b Water sample tap location TO Di: COMPLETED BY PRQPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Is the dwelling currently occupied? e<Yes O No If vacant, date last occupied: Septic system installed by: 'Z Yjaar: Septic tank last serviced by:_ 'F72-- 0 .7. / U6U'TV Date: _ Previous Owner's Name(s): Have any of the following been observed? OY ON Slow drainage from house. OY ON Sewage Back-up into dwelling- OY ON Sewage di.=charge to ground surface, road ditch or body of water. OY ON Slow drainage from the.dwell.ing. [~Y ON Foul odors. Other comments relative to system operation- I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: DATE:- 1/119 C_9~ avz- 7a-V3 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE _ 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. ❑ Water (VOC's) $185.00 ASeptic $25.00 Water (Nitrate & Bacteria) $35.00 (Visual inspection) Owner: e7 S ~U Requested by: - ~kKi) l Address: ',~r . Address: Q© H T-_ KJ City & State: ob6qts city & St. «7~ Zi Code: Zip Code. Telephone N°: ( ) Telephone N°: ( o~3~ Property address (Fire N2 & Street) Location: P&c 4jq Sec. GP T_ N, RAW, Town of ,J St. Croix Co., WI. Tax ID N2 Parcel ID N4 U House color: Realty firm: Or ti Lock Box Como C/( 2,-~ Y-- Water sample tap location: I Teh6,3 Se TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF TH c R b Is the dwelling currently occupied? ❑ IKs ❑ No If vacant, date last. occupie • Mo Septic system installed by: ,may/ Year: Septic tank last serviced by:- 4~IA Date.:-A,)/,4 Previous Owner's Name(s): Have any o the following been observed? ❑Y U Slow drainage from house. ❑Y PN'-- Sewage Back-up into dwelling. t Q~~ ❑Y QA>% Sewage discharge to ground surface, road ditch or body of water.-., e ❑Y If Slow drainage from the dwelling. ❑Y OW Foul odors. =A~Z7/4- co ents relative to stem o e ation: r~4 f M /,J/q y P cG , I certify that the above informatio is comp a and true to the best of my knowledge. OWNERS SIGNATURE: DATE: o21 J~ OAJ /J 7-0 -\r OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION 4 IN TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes ❑No sheet # Soil series per SCS Soil Survey: Type of soil absorption system: ❑Below grd ❑At-Grd OMound Approx. size.. 'X OGravity ODose ❑Pressurized Ft. Z ❑Bed . OTrench ODry' Well ❑Holding Tank ❑Outfall pipe OBSERVED DEFICIENCIES ❑Other OUnknown Septic tank Setbacks: OHouse. OWell ❑Prop. line OOther Dose tank Setbacks: OHouse ❑Well OProp..'line _ ❑Other ❑Locking cover OWarning label OPump/Floats" OAlarm ❑Elec. wiring Soil Absorption System Setbacks:_OHouse_ OWell OProp. line OOther ❑Ponding: ODischarge: General comments: INSPECTORS SKETCH OF'SYSTEM LOCATION N Inspector Title