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020-1176-90-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561100 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Madigan, Daniel Hudson, Town of 020-1176-90-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /A--, 8 CST- 28.29.19.1110 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic W,1.Qs _ / Benchmark Z.ZS 162•2 14:16 M-'na _j - Alt. BM 41 /Q' , _44 1 Aeration) f Bldg. Sewer i 4 St/Ht Inlet Outlet TANK SETBACK INFORMATION St/Ht q . Z TANK TO P/j WELL BLDG. Vent to Air Intake ROAD D11 Mf ~ z• O I w-- Z To Lh 7 Septic 415 -5v 3b Dt Bottom 7 ZOO 004- Dosing / Header/Man. 7. I Z O y iaa l a z 9'0 . G 7D . Aeration Dist. Pipe '7, g Holding Bot. System a' 'r b 10 g 6k PUMP/SIPHON INFORMATION Final Grade 1T•, 1 3. g 4/+ Manufacturer De and St Cq~~ 1•/ / Model Number GPM (J 9'7• o TDH Lift riction Loss Syste Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trench" PIT DIMENSIONS No. Of Pits Inside Di Liqui Depth DIMENSIONS 9j\ Z /aw SETBACK SYSTEM TO VV P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: 6k/ f 7- j 1 1 ' IQ~ IT Mo4l Nu mber: fff DISTRIBUTION SYSTEM 2z -LZ : 4 Header/Manifold 1 Distribution x Hole Size x Hole Spacing Vent to Air Intal~a Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only C Depth Over 47 Depth Over xx Depth of Seeded/Sodded xx Mulched / ✓ B Bed/Trench Center Bed/Trench Edg Topsoil ` xx Yes g] No es ~ No Y COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 762 Aldro Lane Hudson, WI 54016 (SE 1/4 NE 1/4 28 T29N R1 9W) Cedar Hills Estates Lot 10 Parcel No: 28.29.19.1110 1.) Alt BM Description = ` ~4 COJ'' CLa: L.. S. l oG~ 8 2.) Bldg sewer length A1.6(- - amount of cover OrOJ Plan revision Required? ~ Yes No Use other side for additional information. L J o. Date Insepctors Si Cert. N SBD-6710 (R.3/97) PLOT PLAN PROJECT Dan Madiaan ADDRESS 762 Aldro Lane Hudson Wi 54016 NE 1,/4 SE 1/4S 28 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/11/13 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/280 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 66 BENCHMARK V.R.P. Walkout Slab ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 89.3/89.9 5' below qrade Aldro Lane All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. Vent Well >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 12" 50 Existing 4 4 Long Grade at System Elevation Bedroom House 34' Scale is 1" = 40' BM.* unless otherwise noted 30' 0' T alve (if ossibl 15' Vent btu S ' Huffc t 280 ST 80 25 0 45' 8% Slope 70' 60' B-3 B-1 2-3' X 90' Cells with >3'spacing 45' 96.5' 80' Property Line B-2 94.5' County - Safety and Buildings Division 20'1 W. Washington Ave., P.O. Box 7162 - Sanitary Permit Nuinber (to he filled in by Co.) u Madison, ' a e 53707-7162 W! 4z 57(,o . ~ - State "f'rar►saction Number 04 it Application 12 f In accordance with SPS 3$3. t1 m. Code, submission of this ibrnr to the appropriate go~runental uin is required prior to obtaining a sanitary permit. Note: Application thrums for state-owned P01~ TS are sf~R d to project Ati mess (il' di$erent $r marl' g eddress) the Department of Safety and Professional Servies. Person infbrmation you provide may be used for sle;xAi y j / _purposes in accordance with the Privacy Law, s. 15.04(1 (m , btafs- -I. Application Information Please Print All Information Property Owner' tune - - Paw e /1 Property Owner's Mailing Address - - - - - - property Location - - ch)VI. LOT state Zi C ode t P Phone Number , Section - _ - j- V 11 T of Building (check all that aPutY) N; 1Z Lot - I or 2 Family Dwelling - Number of Bedrooms Subdivision Name $1oc / 0 Public/Commercial - Describe Use l_I City of C7 State Owned-Describe Use CSM Number Village of <4 own of 11I. Type of Permit: (Check o ly one box n line A. Complete line B if applicable) ❑ New System lacement System l] Treatment/Hold ng Tank- Replacement Oni}' L~ Other Modification to F_.xisling System (explain) - ❑ Permit Renewal ❑ Permit Revision ❑ Changeof Plumber 01e1-red'1'rtursfertoPlew tListl1revious Permit Number amid Date Issued - - Before Expiration Owner IiV Type of P0lW'TS S steret/Com ouexet/Device: ~Checlt all that a 1 - on-Pressurized In-Ground U Pressurized In-Ground ❑ At-Grade ❑ Motmd > 24 in. ofsuitablo soil ❑ Mound <'L4 in, of suitable soil G [J Holding Tank ❑ Other Dispersal Component (explain) - /--r retr eatruent Device Dient Area Information: De Flow (gpd) DesiSoil Application Rate(gpdsf) Dispersal Area Required (I~ispc,r: a1 Area Proposed (sf) System I levat on - F191. 7, V1. Tank Info Capacity in total # of. Manufacturer Gallons Gallons Units New Tanks I L•xistumgTanks - Uv P o rI °a ~.V C~ I n. v`r w C7 w Saptic or Holding Tank Dosing Chamber '1I. Responsibility Statement- I, the undersigned, assume r o bility fur installation of the PO'1V1'S shown on the attached plans. ,In bet' Name (Print) Plumber's Si e - - - " ~ MP/MFRS Nuinber 7 $usiness Phone N~,utuberC/ Plumber's Address (treet, City, State, Zip Code) V III. Couti /De rartment Use onl pproved D PelTnuit Fee DIssuing eat Signature ~ 11110wne veu lZ.eason for Denial "476 _ ;;9 IX. Cond ill5arOW easous for Disapproval 1. Septic tank, effluent filter and dispersal cell must all be services / mai6talned as per management plan provided by plumber. 2.- AM i's k r4gmfferr►ents turret- be rnairttairs~i# n per o0de / t1r01nitiGO&. - Attach to cuouplete plumb rum the system aad sabtuif to the County unly oat paper ant less than 8 112 x 11 inches id si Ze - SUIT-6398 (R_ I I/I l) PLOT PLAN PROJECT Dan Madiaan ADDRESS 762 Aldro Lane Hudson Wi 54016 NE 1/4 SE 1/4S 28 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/11/13 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/280 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Walkout Slab ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 89.3/89.9 5' below qrade Aldro Lane All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. L-Grade Well >6„ Quick4 Standard of Cover eaching Chamber ith 20.0 ft2 of Area .6ft^2/pair of end caps 50 Existing 4 4 Lonat System Elevation Bedroom House 34 Scale is 1" = 40' BM.* unless otherwise noted 30' 0' T Valve (if possible) 15' Vent Nu S 80' Huffcutt 280 ST 250' 45' 8% Slope 70' 60' B-3 B-1 2-3' X 90' Cells with >3'spacing 45' 96.5' 80' Property Line B-2 94.5' Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 6/11/13 Owner:Dan Madigan Location: NE1 /4 SE1 /4 S28 T29 N R19W 762 Aldro Lane Hudson System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet 8. St.Croix Count 'lization of Existing Septic Tank Fork Signature License nu r #226900 PLOT PLAN PROJECT Dan Madiaan ADDRESS 762 Aldro Lane Hudson Wi 54016 NE 1,/4 SE 1/4S 28 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/11/13 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK 1000/280 LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Walkout Slab ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 89.3/89.9 5' below qrade Aldro Lane All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. Vent Well ALo Quick4 Standard Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 50 2" Existing 4Grade at System Elevation Bedroom House 34„ Scale is 1" = 40' BM.* unless otherwise noted 30' 0' T Valve (if possible) 15' Vent 61A S 80' eCAA_ Huffcutt 280 ST 250' 45' 8% Slope 70' 60' B-3 B-1 2-3' X 90' Cells with >3'spacing 45' 96.5' 80' Property Line B-2 94.5' Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 5.6ft^2 pair of end plates Finish grade elevation Typical Installation 95.0' Vent Grade Vent 3, 4" 3' ./30/34 Septic Tank 5' Long 1 91 5' S' Long 1 Grade at System Elevation 3691 Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tubeNent At end of cell A B 22 chambers per cell System elevations: A-89.9' B 89.3' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity ❑ NA Permit # Septic l ank Manufactui er ~ v NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms NA Effluent Filter Model NA Number of Public Facility Units XA Pump Tank Capacity NA Estimated flow (averagej_ alJda Pump Tank Manufacturer - NA Design flow (peak), (Estimated x 1.5) dal/da Pump Manufacturer - NA Soil Application Rate gal/day/ft2 Pump Model - NA Standard Influent/Effluent Quality Monthly average` Pretreatment Unit` - NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids {TSS) <150 mg/L ❑ Disinfection El Other: Pretreated Effluent Qualily Monthly average Dispersa Cell(s) - ❑ NA Biochemical Oxygen Demand (BOD$) <30 mg/L X1jn-Gro and (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) <30 mg/L >f~NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) x104 cfu/100m1 ❑ Drip-Line _ ❑ Other: Maximum Effluent Particlu Size in dia. - ❑ NA Other: 0 NA I-vi NA 0 NA *Values typical for domestic ivastewater and septlc tank effluent. Other: - 0 A MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s), At least once every: ~ 'S) (Maximum 3 years) El NA ear s Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA Inspect dispersal cell(s) At least once every:_ month ,s) t-Year s; (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ~months s) - _ year(s; _ ❑ NA Inspect pump, pump controls & alarm At least once every: 0 ear N s) NA Y Flush laterals and pressurE' test At least once every: - ❑ month(s) Other: ❑ year(s) I At least once every: ❑ monthf s) - Other: ❑ year(s) NA NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; "Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identity any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent an :he ground stirface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (X) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordanc, with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of ant, service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high --oncentrations are detected have the contents of the tank(s) removed by a sEptage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages Gump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and mGy result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump, controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park aver, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; der tal floss; diapers; disinfectants; fat; foundation drain (sump pump) water; frAt and vegetable peelings; gasoline; grease; herbicides; meat scrap: ; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be takim to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. + "The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator, • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material, CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant rep7-The ent system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. replacement area should be protected from disturbance and compaction and sholrld not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacemem area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/ON, INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DhATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE, ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Sj~ ` Name Phone Phone J Y ;1-- SEPTAGE SERVICING OPERATO PUMPER LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. Div FILTER CARTRIDGE INSTRUCTIONS Instial Istiion gr zFp % Dry kit tiler 11111x1!• case oft the end of thri alltl,kt owe to ensure it fr. centered under the accesas opening, if nut, then either Insert tfiuru 1 or tank through the outlet or eol~rent weld (glue) bddiilonaF p ik kr'ta the pipe. pigs Itrrku tile outlet 6 E P a Whlle the case is AM dry fitted otl the !nutlet phie, rnmaisure tim imreytr4 of 46-inch pipe needed to bra cc, the niter to tine tank tend we" if utilPeing the aptioral suppllamorital stele support, If side support ntathud. fs nut utifk ed, proceed to step fate. 5. .p: x Fin. installations tltifixing the aptianal EsupplentitntEal sidu support: solvent weld the %-ihch piper onto the filter ravie. If rifler support hlethdd is trot utlliscrd, ilroreed to step fam- solvent weld the filter case ohte the nutiat pipe,. Xhb„rt the miter cartridge into the case, prmmslft l down until the filter lue:ke into the buttutr+ of v e:~ the rasa- a if a Viis switch iei utlfi.zed_ insert intu Gem Clockwise 90". setter and fuck by turning r 9k , ;;f~ Vie' Maintenance 1. 1'he etnuent niter should be aaaanad livery tione the suptic tank fS serviced. 2, apeh the outlet access opening to inspect the tank turd lHlitrr, L S. puretp the septic tunic outnplvltclyr !necking sUrp to rumalia the Siudso 1byel as the button, at the ureic and n»t just the scum and effiumnt. ,u e_ once an, elauanttavel has bean towered beiaW thu invert of the f outlet pipe, firmly pull up on the filter boodle to dieiodgo the cartridge ironl the case. s 5. Slide the rarirldw up and o u: of the cage her cleaning. Y G. it a Vets switch r unnectrEd to all alartrt is prosent, the S"Itt,h ' should he ramoved by tur•riing r%quritordockMse 90m and cleaaud a Y r' with water only. 7. while hulling the cartridge ern its Ride (large that surf ice iaclrig It down) aver the a!ccour, uplnnhtg, rin4n oft the cattridUa with wakne Ai aniy, makikig sure all amptago. material is dosed back, Into Chet traalc. ` a, ir• VHS eswitah Is utilizers, replu,as by losarting iota filter and , turning ciackwisa 91r. t. 9. Ylrsart thes fitter cartridge bark into the cat*, llressbtg dawrt mrtif " , a.. Ole filter locks into the hottum of the caESo. fit, `n;r. m iteplace and secure this fit t emm ufls ping an the tank. KrL-••:rc-.,•:•'~lc ;ai,~#Ei',Srd •1.-4i'Y ~frat'(Jr :N:,i!,%61 W~Wf4lIG,i~a~1t'Hllllplsi♦~.ictfkrit ~ ~>~i~,~iQi [~r~~-~5i£3:~~ Fez ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer I/j~ Mailing Address _fcy-'V' Property Address (Verification required from Planning & Zoning Department for new construction.) p City/State Parcel Identification Nturi per - / d O~7V LEGAL DESCRIP rYON Property Location/ r/4 , Sec. Z , Tc N R ~W, Town of ~I r Subdivision Lot Certified Surve=y Map # - - Volume _ , Page # ' Warranty Deed # Volume Page Spec house yes ao Lot liner dentifiabl yes o SYSTEM MAIZ!ITENANC:E AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its pre=nature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, ii-)needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste, disposal system. Owner maintenance responsibilities are specified in §Comm. $3.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zord;ig Department a certification forin, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licewed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the w dersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein., as set by the Department of Commerce and the Departrrront of Natural Resources, State of Wisconsin. Certification stating that ;your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that :all statements on this form are ~Die to the best of my/our knowledge. Uwe andare the owner(s) of the property described above, by virtue of a warranty dee ecorded in Register of Dews Office. Nu er of bedroo ms e ///1-3 2 - - -f OF ~PLIICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being rsvoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08105) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK ,rli.is is to certify that I have inspected the septic tank. presently s(~rving the) 1~ ~1 ~-Q~ _ residence located iii': 1 Section T.. 0? N, R ^W, ~Cown 17 Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Ialst time serviced: D - -A~ I)i.d flow back occur from absorption system? Yes No (If.no, skip next line) Approximate volume or length of time: gallons minutes capacity: ~C7UC~ construction: Prefab Concrete Steel _ other 14:_,nufacturer- : (If known) : 3 13u~, known : Incie of T (.f ) e ( nature) (Name) Please print of ]e) (License Number) [•'orm to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: 1ti accepting the above statement regarding existing septic tank condition, I certify that the tank to the be of my knowledge will conform to the requirements of ILHR 83, W' . Adm. Code (except for inspection opening ver outlet baffle) Signature MP/MPRS Name U 2068P 627 STATE BAR OF WISCONSIN FORM 2- 1999 7 m 9 S 8 Document Number WARRANTY DEED KATHLEEN H. YALSH REGISTER OF DEEDS ST. CROIX CO., MI This Deed made between John D. Baker, Jr. and Cindy M. RECEIVED FOR RECORD Baker, husband and wife, 12/05/2002 08:20A1i EXERT i Grantor, and Daniel D. Madigan and Kimberly K. Madigan, husband and wife, REC FEE: 11.00 TRANS FEE: 778.50 COPY FEE: CERT COPY FEE: Grantee. PAGES : 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Lot 10, Cedar Hills Estates in the Town of Hudson, St. Croix County, Recording Area Wisconsin. Name and Return Address ~ U U n O5 3735! 020-1176-90-000 Parcel Identification Number (PIN) This is homestead property. (is) 10[00 Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Metro Legal Services li EDIRET 373512 A Dated this day of November 2002 321631 WD 146248 * * John . Baker, Jr, + * Cin M. Ba er AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. St. Croix County ) authenticated this day of Cynth Van Ausdall 'f^ • Personally came before me this day of Notary Public ~November 2002 the above named State of Wi$conSrhhn D. Baker, Jr. and Cindy M. Baker, husband and wife, * TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY + 'OLA t Attorney Kristina Ogland Nota ublic, St of Wisconsin Hudson, WI 54016 My Commissions ' ermanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) /-2" b ~ G ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals company, Fond du Lac, WI STATE BAR OF WISCONSIN &"55-2021 WARRANTY DEED FORM No.2 - 1999 RUSCH SURVEY'`IN% in H!lDSO N, 'IAt`I CONSIN roftfolEft it .4NM#@ 0Y ►LATTERS 497 .i ncilLo- 1AM03_ Hut o 10 w 12 Z A 0 40' X 40" ssmrat for bum stop ` --00, 00' 7.50' y 1 .3• _b ALDRa g.ANE _ . 1 ow s 172. 1• d ~ ham. o r f Wisconsin Department of Commerce SOIL EVALUAEPORT Page of Divisiom of Safety and Buildings ~1 in with Comm 85, Wis. m. Code L oun tY Attach complete site plan on pa t x 11 inches in size. Plan'mjtl .013 " v~ n , include, but not limited to: v I PntalWJA00hce point (BM), dir?tion and Parcel I.D. percent slope, scale or dims, no nd location and distanca'fo,0pp6 st road. 2~ Z&-9U Please print all information. ~ CoU,yry eview t Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). G' w~l w (ell l Property Property Location C cL yt/ j Govt. Lot " 1/4.5;1/4 S 7,g T 2 N R Z2 E (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ VII wn Near t Road 1 ~ oe ( ) ~ lQ .tPi ❑ New Construction Use• Residential / Number of bedrooms Cod derived deesii n'fllow rate Q GPD Replacement ❑ Public or ercial - Describe: - __J' -f Par Gener ent material - d~__ Flood Plain glevatfign if applicable / T7 and recoru ndretions: A0 System Type System EIG Boring # Boring ~i'3 F71 it Ground surface elev. < l%~ ft. Depth to limiting factor ~ r ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence LBou ndary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef f#1 •Eff#2 - v s m Boring # ~p1 Boring ® Pit Ground surface elev! -3 ft. Depth to limiting factor in. Soil ii cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color / Gr. Sz. Sh. 'Eff#1 'Eff#2 I Effluent #1 = BOD > 30 < 220 mg& and TSS >30 1150 mg& ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatu CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 6 715-246-4516 Property Owner _ Parcel ID # Page of Boring L-S] ;Q # El Boring Pit Ground surface elev. J~_ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 A? o a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon 'Depth Dominant Cola Redox Description. Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I J Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/_ ' Effluent #2 = BODS < 30 mg/_ and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6/00) ji Property Owner _ Parcel ID # M Page of ❑ Boring E Boring # /j7 Pit Ground surface elev. ft. Depth to limiting fador L L in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 A, !r tr o.Le a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate. Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDfff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BODS 130 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SB48330 (8.6/00) Soil Test Plot Pla Projec#, Name Dan Madigan Sha Bird Address 762 Aldro Lane Hudson Wi 54016 C M #226900 Lot 10 Subdivision Cedar Hills Estates Date e6110113 NE 1/4 SE 1/4S 28 T 29 N/R19 W Township Hudson Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Walkout slab System Elevation89.3/89.9 5' below grade *HRpSame as Benchmark Aldro Lane Scale is 1" = 40' Well unless otherwise noted 50' Existing 4 Bedroom House 30' 60' T 15 Vent Oki 151* - 50' 4B-1 8% Slope 760' B-3 45' 96.5' 80' Property Line B-2 94.5' • 1 ti 'D Co ry c o ° N ti 0 6°9 0! N ~ c N 0. 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I i I ~ I ~ I I m I C Z N LL c o v v u Q a Cl) N c N Z y f0 y LLJ r+ O O) Z L ~ L a m E 00 (N N h fn =O p N y C C7 O C M.0 O O Z c c U 3 V O N c O Y E w o~ 2 ~ _ p m N m m N M O N Q V c 0 w y O g o co •N a L 3 a O M N N c -O O O m L N N O Z m z o Z o 0 r m N w W m £ Lo m H d O CL Y °ooa .o E U FN- H H E v 0 0 0 a •N 3aaa a O N o U) fn J V 7 C)000)00 Z M f+') 0 co ° c N r-• 0 O O O O J O O E N N N O m a a y (D 0) o w7 t° H y c O c U O d j N a O M V a o 0 o N c u) N V o ° 0 0 f0 p N N N fn O O H y N~ t0 N~- 0 -S C = ci +~o z ^ ° = N i-4 O N> m y E L CN C14 U =E ~ d • at a L: 0. CL £ v 'c c ~w v J 1 r Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~f Rll~ l~~~vz/l TOWNSHIP. SEC. T N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN T SUBDIVISION Lea-r^- Gr(, `l~s LOT LOT SIZE -t-az,,z~-rte PLAN VIEW Distances and dimensions to meet requirements of IZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM J K k INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ,jG+- Elevation of vertical reference point: /04 k e- Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: /"2 o Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,Q Side 0 Rear, Oz' 'g feet .From nearest property line ` Front,0Side,ORear,Ofeet Number of feet from: well---5-,? building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE r 4 ~PUMP CHAMBER r Manufacturer: 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, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: Width: f,2 Length: Number of Lines: ;2- Area Built: lS' Fill depth to top of pipe: ,egg Number of feet from nearest property line: Front, O Side, 6 Rear,0 Vt. Number of feet from well: fi Number of feet from building: Z,S (Include distances on plot plan). SEEPAGE PIT Size: 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: Capacity: Number of rings used: Elevation of bottom of tank: 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: Dated: Plumber on job: ~ License Number: 3/84:mj ' DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS •LABOR"& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O: BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 SE4,NE4,S28,T29N-R19W KNCONVENTIONAL DALTERNATIVE State P9^nIiD. Number: Town of Hudson El Holding Tank El In-Ground Pressure D Mound Cedar Hills Est. Lot 10 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: William Harwell Route 1, Box 1910, Hudson, WI 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: /MPRSW No.: County: Sanitary Permit Number: illiam Schumaker MP 6382 St. Croix 92493 SEPTIC TANK/HOLDING TANK: MANUFACTURER: ILIOUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER a PR VIDED: PROVIDED: j ~000 / 7'J ~ l / YES ONO DYES O BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER F ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH JALARM: / LINE AIR INLET FEET FR . / s j / 3 5 DYES NO I DYES ONO INEARESOT-M DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO DYES ONO OYES ONO GALLONS PER CYCLE: MP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) 7u DYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH: DAND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH jN1,OF DISTR. PIPE SPACINGCOVER JINSIDE DIA#PI75 LIQUID BED/TRENCH ~7 TRNCHES: / MAT IAL PIT DEPTH DIMENSIONS \ 2 !a GRAVEL DEPTH FILL DEPTH JDISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL. BUILDING: V NT TO FRESH BELOW PIPES. ABOVE COVER ELEV. INLET ELEV. END: PIPES: LINE / AI INLET: ~pl t11~2 ~2.~5 ~2$3 ~ 2`) L NFEET I EARESTO--► (og ~t)0~ ~S ~St MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ONO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED MU LCHED CENTER: EDGES. DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.: ELEV.: DIA. ELEV.. PIPES DIA.. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED DYES ONO I PLANS DYES ONO COMMENTS: . PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: DYES ONO OYES ONO NEAREST 12 2( 20 If 11 0 Sketch System on 1✓, `~!etain in county file for audit. Reverse Side. RE. TITLE DILHR SBD 6710 (R. 01/82) SIGNATU Zoning Administrator SANITARY PERMIT APPLICATION COUNTY (~19ILHR In accord with ILHR 83.05, Wis. Adm. Code "STATE SANITARY PERMIT # RY -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ® NO PROPERTY OWNER PROPERTY LOCATION rl A-0 j----ay '/4 ,p1= , S T , N, R / E (or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME on /D ~ ::S~ CITY, STATE eO PHONE NUMBER TY NEAREST ROAD, LAKE OR LANDMARK 1- C9 TOWN F-1 VILLAGE : oL~ s 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family ORE] Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. PC New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. I~LConventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. See a e Bed b. ❑ Seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Feet Private El Joint ❑ Public VI. TANK CAPACITY Site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank L,JiQ~ ---El i 1:1 0 Lift Pump Tank/Si hon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) P/ PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code : Name of Designer: d✓ 6 ` VIII. SOIL TEST INFORMATION Certified Soil Tester (CS ) Na a CST # CST's A SS (S t, City, State, Zip Code) Phone Number: v 8 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial S0//ac) ©0 q-13-S7 S charge Fee Adverse Determination Cr-, c. X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION - TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/2 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public de:)ate. The groundwater bill GroundWater included the creation of surcharges (fees) for a number of regulated practices which Wisconsin's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried ~reasure is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- ,e e , by the Department of Natural Resource~5_ These fun's are used for monitoring ground f wa e; , groundwater contamination investigations an(-' establishmer: t of standa,ds. iroundwate!, = it's wor} protecting. 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/contractQv,("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 f //'1111 a 1 &/arI., S Location of Property 14 Wjl~7 Section 8~ , T ;?f N - R W Township f Mailing Address e,__ Subdivision Name Lot Number Previous Owner of Property d nr„ A Qels Total Size of Parcel ~,ti--- Date Parcel was Created / Are all corners and lot lines identifiable? Yes No Is Lhis property being developed for resale (spec house) ? Yes No Volume ',217V and Page Number efS-'X- as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 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 1 (We) centi jy that a.?,e btatement6 on thi.6 jonm ane tnue.'to the befit of my (ouh.) k.nowtedge; that I (we) am (ane) the ownenl.a) of the pnopenty de6cA bed in thin in6onmation 104m, by viAtue of a wannanty deed tecokded in the 06jice of the County Reg-cz ten of Dee6 ad Document No. 411p 1797 ; and that I (we) pne6?,nt.ey own the pnopozed .6 to bon the aewage-~poaa6ystem (an I (we) have obtaAned an e;a6ement, to nun with the above ducA bed p)Lopenty, jon the conbto.ucti.on o6 6acd 4y6tem, and the Game has been duty neconded in the 0jj ce of thek County Regi6ten of Deeda, as Document No. Lr/~~ I SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) L-' L2 f,9 fl"7 DATE SIGNED DATE SIGNED &VO j qj PAS - ; y S- TN15 SPACE RESERVED FOR RECORDING DATA ~c~cuMENT NO STATE BAR OF WISCONSIN FIM 11-1982?yam t LAND CONTRACT .d Individual and Corporate K"OJTERS r" t ~IY.i + ~ITO BE USED FOR ALI, TRANSACTIONS WHERE OVER OFFI_, =26,000 13 FINANAACT TRANSACTIONS) NON-CONSUMER ST. CROIX Co., Wis. Recd. for Record this 11 th Contract, by and between ...Harry J.___Stewart~ as Personal day of Jun a ~A*p, 19 86 Representative of the Estate of Aldro Larsen a/k/a John Of 11:45 A M. _ Aldru Larsen a/kfa__John•Aldro__Myren Larsen, fi* ("Vendor", James nes O'Connell whether one or-.more) and.... illiam C Harwell • 1"Me of o *single man ("Purchaser", whether one or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- deputy formance of this contract by Purchaser, the following property, together with the rents, profits, fixtures and other appurtenant interests (all called the "Property"), St. ---Croix - In County, State of Wisconsin: RETURN TO See legal Description on Addendum Tax Parcel No ,38b Q~7-3 r NSM FEE This 113..not........._ homestead property. 4" (is not) uch Purchaser agrees to purchase the Property and to pay to Vendor at ..s.. _...._..lace as he shall name the sum of $__192., 500.00_._.•__....... in the following manner: (a) 5Q_,QQn_.QQ...................... at the execution of this Contract; and (b) the balance of $.AR.,500.EOQ•................. together with interest from date hereof on the balance outstanding from time to time at the rate of te.U..LIQ7)_.......... 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-------- 11th day of june .......................1 19__.4.0._ ( the maturity date). Following any default in payment, interest shall accrue at the rate of % 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 specified and then to principal. Any iG4tiXXxX7c}cxXX~CXxX~CgXXXx~gl~ amount may be prepaid without premium or fee upon principal at any time. t>Rene:~:~.;~~amcpc~rx7axo¢atxod'xi~i>xcip~ix>Rat~~IC~mimeioxx~fxVeax6a~fk • 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 as unpaid principal) is less than the amount that said indebtedness would have been had the jQRikt*kkpayments 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 full purchase price is paid. Purchaser shall be entitled to take possession of the Property on....... ishe__da1e__tlerepx.................... lax *Cross Out One. LAND CONTRACT-Individual and STATE. BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. Purchaser promises to I fit) ? / pay when due all taxes and assessments levied on the Property or upon Vendor's in:'. rust in it and to deliver to Vendor on demand receipts showing such payment. Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, cx- W'r,lvd coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved by Vendor, in the sum of a........... .n/.a but Vendor shall not require coverage in nn amount more than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall rrrntain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of lose to in::nrarlce companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be ::winiral)y feasible. Purchaser covenants not to commit waste nor allow waste to he committed on the Property, to keep the Prope:-1 - in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting 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 specifieds Vendor will on demand execute and deliver to the 'urchoser a _1&3 [9tx~ e d in ifee simple, of the Property, free and clear of all liens and encumbrances, except '.ersona'1 Re~resen aetiv any lens or encum ances created gy she act or default of Purchaser, and except: easements,..p rotecti e.. . zoven=ta..af ..re-card,..if ..any,..and..zani.ng..a.rd inanna..raquizements. Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of ---6LO... 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 A0---- days following written notice thereof be 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 wnives), 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 rieht!:, 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 pail by d'urchascr shall be forcfeited as liquidated darilt res for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem) ; or (ii) Vendor may sue for specific performance of this Contract to compel ioinwdinte and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the (late of defattlt and other amounts clue 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 for the entire unpaid purchase price or any portion tlwrrif: or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet-title acti on if 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 enforce any remedy hereunder (whether abated or not) to the extent not prohibited by la,.v 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, including 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 (b;; assignment of any cf Pnrchaser's rights under t% is 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 pitid 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 tnv 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 tinder 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 tinder this Contract. Purchaser may make any such payments directly to the Mortgagee if 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 he 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 day of .................June 19..86... -l ....................(SEAL) • ..Harry...J....Stewart......................... / ............................(SEAL) ~ 4.. . "...ut. L)(- _ Q J • William C. Harwell - L' AUTHENTICATION ACK1g0WLEDG MENT~%,'~r:'; Signature(s) STATE OF WISCONSIN ''•,~~(f ..r- . as. St. -•--•--•--C•••••-•-roix County. authenticated this ........day of........................... 19...... Personal) came before me this -110day of une 19.86._ the above named Harr J Stewart and William C Harwell ITLF.: MEMBER STATE. BAR OF WISCONSIN . (if not . authorized by ~ 706.06, Wis. Stats.) to me known to be the person P who executed the foregoin nstrumenttaand acknowledge the. same. THIS INSTRUMENT WAS DRAFTED BY ~~~~111 Lois . --A...Murray, HEY1,l00I), CARL HURRAY 'O f2so^.,) & SHERBURNE, P.O. BOX 229, ..PP-.•% u sun-;"ittl-.. 54Ulfr Notary Public .-t-••C-•------roix....................... County. Wis. (Signatures may be authenticated or acknowledged. Both My Commission is per anent. If no state expiration are not necessary.) date':, i 19..~) _ - 'cr. I~ \Names of rensons signing in any capacity should be typed or I+rinted b~! - signatures ML 74:3wo. 87 a LAND CONTRACT ADDENDUM Legal Description The N1 of the N1 of the SEI"of Section 28-29-19, except the South 100 feet of the East 565 feet thereof, and except a parcel of land located in the NEI of the SEI of Section 28, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin, described as follows: Commencing at the Ej Corner of said Section 28; thence S8903714611W (assumed bearing referenced to the monumented East-West I Section line of said Section 28, bearing assumed S8903t'46"W) 23.78' along said East-West line to the point of beginning; thence continuing S8903714611W 1301.48' along said line to the West line of said NEI of the SEI; thence S 000314411W 661.63' along said West line; thence N8903414811E 761.971; thence N 000511211W 100.001; thence N8903414811E 535.401; thence N 003013811E 560.56' along the Westerly right-of-way line of U.S. Highway 1112" to the point of beginning. NEI of Section 28-29-19, except that parcel described as Lot 1 of a C.S.M. recorded in Vol. 3 of C.S.M.'s, page 862 as Doc. No. 359579 and except that parcel described in Vol. 583, page 527 as conveyed to the State of Wisconsin. Payment Terms $35,000.00 on June 11, 1987 and $35,000.00 on each anniversary date of this Contract thereafter; provided, however, that if the unpaid principal balance on the Contract is greater than $85,000.00 on July 1, 1988, Purchaser shall make monthly payments of $3,500.00 commencing on July 1, 1988 and on the first day of each month thereafter. Also provided that on the first day of the fourth month following Purchaser's death or permanent disability, monthly payments of $3,500.00 shall commence hereunder and shall be paid-on the first day of each month thereafter. Vendor shall release Lots of not more than 31 acres in size at any time during the Contract upon payment by Purchaser to Vendor of $5,500.00 per Lot. Each $5,500.00 payment and each $3,500.00 monthly payment shall'be applied to reduce the next $35,000.00 required annual payment. Also provided that for each $5,500.00 paid by Purchaser in total monthly payments, Vendor shall release one additional Lot of not more than 3j acres, upon request of Purchaser. Purchaser shall pay the cost of drafting Partial Releases. Vendor shall convey to Purchaser one parcel of land around farm buildings upon recording of C.S.M. without further payment. Parcel not to exceed 6 acres. r STC - 105 r ' H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County G 0 H OWNER/BUYER s,i/----- - rn ROUTE/BOX NUMBER ~T Fire Number Y41_ C I T Y / ST AT l: ZIP 1 PROPERTY LOCA'TION:,~ t4, Suction Ta._~N• R0 _W, Town of~ St Croix County, Subdivision C Lot number 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 ~un1er. What you put into the system can affect the function of the septic tank as a treat- meat stage in the waste disposal system. St.-Croix County residents n►u-y be eligible to receive a grain for it 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 septictank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H z I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with M the standards vet forth, herein, as set by the Wisconsin Depart 'n 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 vGJ~~~ DATE St. C:-oix County Zoning 'Office P.O. ,Iox 95• Hammo',pd, WI 54015 715-716-2239 or 715-425-8363 Sign, date and return to above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION E /.BOR AND PERCOLATION TESTS (115) MADISONP,°., Box 3707 HUMAN RELATIONS WI 53707 (H63,090T& Chapter 145.045) LOCATION.. ECTI N: 1W/75-b:5,oAj OWNSHIP MUNICIPALITY`. OT NO.: BLK. NO.: SUBDIVIS O NAME: S j-& 5 C t/4 c 14 ~ 9 N/R/9 0(o D CCDAl2 fl t-LS CsrK tbs. 11 COUNTY: 01NNE 'S AM : MAILING ADDRESS: ';TCRoto CE~,~ rL!S J~~b~n~eNi 'gpk 19io //wU .soH / S40/L~ USE DATES OBSERVATIONS MADE NO.DRMS.: COMM R A DE CRI q~ S [J~R. sidence UN 1< Replace I At I L -7 / ~ a7 : ApelL a RATING: S= Site suitable for system U= Site unsuitable for system OUND: W FC STC]UTC7S U l. I t' I 15CL IN-G_ S DU ISYS S IDuL E~G TANK:JRECOMMENDED NVfrNTorvAt.M:( i JEM If Percolation Tests are NOT required DESIGN RATE: j If any portion of the tested area is in the under s.H63.09(5)(b), indicate: C~~~ I I Floodplain, indicate Floodplain elevation: A/A c -r PROFILE DESCRIPTIONS BORING TOTAL DEL H T R UND ATE -INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHt* ELEVATION OBSERV D HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) EST. HIG B- 9 2S /pp ~ o > 9, 2 e&(-LTS 6'' CwL/x 97"L.T'$ef4M s -PlS k `I /,Z~- ~4'9LLT✓ /S~ L I te,4 Y4 9. t'J~ NAd t 61t B- q (A I-r 94 -4 /4 '5 B- 3 'j.92 94 ,13 NoNe ' .9z 33~~l Stems /2- &*'4 S 6ecT$RN B-4 9./7 9~T .ZZ > 9. lOr $~L- q3"L-r$QN'S~tCa>c S7"LT8 ,v MS B- S 97 V4 1\10 q { > 9.06 AS Icea ~f- C T PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP I ATE LEVEL-INCHES RA MINUTES NUMBER I~1£S AFTER SWELLING INTERVAL-MIN. PERIOD 1 -PLO- 100 INCH P. i 1 E 100•I I 3 y Z <3 P- 2 S.9' z_ 97,42 3 > 2 > ? < P- nJ 9va'd 1 3 > 2 > Z < P- 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- rontal 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. SYSTEM ELEVATION 4 Z.oc~ I RON PIA A-r L CNc11, Lo'r j U Z"11614 APL AT N%A ratNE' l.e-r 11 64r 9-4 i Sao ~ P 3 • ~ / ' ALTE~NaT> ; 9 n/oT'E : Noascta Tub' tN Lt? 45 r-~YSrEM ~,p.Z ' Cj~. gcpclc C4tJ4't f4NALr/ 1;-7 00"'nc ~tTf_ L6cocrION oq n Pt c t ~ r r r ~ c . P- I Bar~lC> 1 4 t c = I I R O N AT 'S9 COP.N f:-je ©C La-r / d ELL font = /UO 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified to the Wisconsin Administrative Code, and that the data recorded and the location of the tests are cofrect to the best of my knowledge and belief, NAME 4(int) : TESTS W PRE COMPLETED ON: kQ1' _\10R4n4'SC1N >`V~cf1 c~t~J~`//tVC, ~NC _ P~►L 8 Ise-7 ADDRES : ' r CERTIFICATION NUMBELPHONENUMBER(optional): CST 5VNATURE: DISTRIBUTION: Oi rtmal and one ropy to Local Authority, Prolmi ty Owner and Soil Tester. DIL.HR-SRD-6395 (R. 02182) OVER - iVWr nfYie~. nn os: T a:: a ~ : lP saci./o/ o~i6~ea! a9w i N sdt rf as// WSW arlo ov,~/ /ai /o.vxv~rz vr..pg. b 107/ ww' ✓A h e~ ,-.N • r /V011W~o~ / • Q ~n . /&vn nn P.rwV[r v o si vv eio..n YY WV cox[ ab -/971 aw t~ • t/0/ yy ~K N 6 rr ro QOM ~ r [.rlsp~ay°~~ ~O j aB Pjv • w A J DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INQUST, R Y,, DIVISION L ~60R AND, P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (H63.09(1P& Chapter 145.045) LC~' •ClTIO : TOWNSHIP MUNICIPALITY: OT NO.: BLK. NO.: SUBDIVIS 0 AME: C- / / LLS Es-I-A re3 w i uDSa^/ CfDAQ s T~ 9 N/R/9►(o / ER: COUNTY: OWNER' 'S AM 1AILING AD ST CPQ t> CE kA P arcs JE rrA/s C N i >~r 1910 Nt,1~SdN 1 S4ol 1 G USE DATES OBSERVATIONS MADE _ NO.BEDRMS.: COMMERCIAL DESCRIPTION: PF19FILE On 6 I.VfResidence UN,", New ❑Replace L -7 /IT7 PoiL (3 /91 ~tLS K AbC `jolts ~V r41COTtQ RATING: S- Site suitable for system U- Site unsuitable for system TA 19K: ECOMMENDED SYSTEM: (a tonal) 0NENTI~IA MOUND: IN- GR° ND : S S IN-FILL OLDV-1 NTayvAl CL rov S❑U 1 ❑ S WUM S ❑U S ❑U ❑ CONVtr If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: L J Floodplain, indicate Floodplain elevation: A ' J G -T PROFILE DESCRIPTIONS AND DEPTH THICKNESS, COLOR, TEXTURE, OF O. BORING TOTAL P H R UND ATER-INCH S CHARACTER S IL WITH NUMBER DEPTH to* ELEVATION OBSERV D HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 9.25 3v o > 9.2 S'"'8~L•rs 6'~>YArvC 1st 97~LT$ed M S -F'b B- 2 ~ C IR L LT:. 1< t -i L W' eat 14S K &,Y r>l~ 16t 2 S 97.zZ 64" LT13aN MS B- 3 ~.9z 94 •~3 Aforvtr > Q.9Z 33'°&.v--T-1.2 8 ~ S Cz'tT$eN Al s B. 4 9.17 9 ,zZ Pjo > 9, / Sc.cTs g3"LT>~QNS'~r!Ak 'S7~C-r&,4 MlS B- ~ y`l.~rd t ~ 9.0~ /a'$eNd:,~• 9Fs"C-r$RN fhS dGte. B• b C T PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER i4MfteS AFTERS WELLING INTERVAL-MIN. PERIOD -PERIOD PER INCH P. 1 t 1 f /U0.1 ? 3 y Z > 7 <3 P- z,9 Z 97,9 Z 3 2 > ? < P- N .o I 3 Z > Z 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- rontal 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, i~ SYSTEM ELEVATION 4 z oy 1(16)4 PI A& A-r 146 Cap Nc-* Lo-T 10 Z"Ikosi APi, A-r NW COINEli LoT I 64r 9-4 / A cr6Qnlat><; 9 1 40TE : Now. c b TAP t N L a,,= IQ qS 5vs rEM ' 1 c $ E1-44AN tbN ScaLt# ~T Laca-ria, o*1 0.4 Ptf tr t (~i?`~~Z ; gintc tJ Iti14P.K = R AT -S9 COPNCA 6T LCI-r 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. NAM tint : TESTS W RE COMPLETED ON: k~m U 1e z~tI uk Ji lItq& /NC- ~~►E /98 7 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): qo~ SE~o>v Q u~~rv W) ~54ot~ 3 mc- 4ao CST 5qNATURE:: DISTRIBUTION: Oiijimol and one rol(y to Local Autlioiity, Prop(nly Owner and SUIT 1-ester. DILHR-SBD-6395 IR. 02/821 OVER - I e v Yr! . ~ 9%fr? a ~ ~ ~s sau/off i'VI/fJ07~ N sue, r ~ w/ O La c h' o~ N ~SZ S ~txUL %Vwuigr ~dfii ~A~xn . ,7T~sx-o/y ~'SR OR ilAe• o q// eG Sli' rron :f nn vw n Ice/ /,Vowy ae.JFi s.e L a8 sy 7i/ JaU Y~y • • h, j/ '/L ' uo / .N S n Orp[Q~ i o~U,N ~r uvspJny'a'. ~ si t 6 ari rr 9°j~ ~ y I)EPAFrTMENT OF REPORT ON SOIL BORINGS AND SAFETY St BUILDINGS INDUSTRY, DIVISION LABOR AND, PERCOLATION TESTS (115) MADISON w 637707 HUMAN RELATIONS . (H63.09(1 T & Chapter 145.045) LOCATION: ' SECTION: OWNSHIP MUNICIPALITY: OT NO.: BLK- NO.: SUBDIVIS O NA E: sc / 9N/R~9 (o w r uasaN ~o ecDae :T~►ro COUNTY: OWNER' 'S NAME: MIMI ADDRESS: 6.4 19/0 -S4o S-r'C PO I> 0-10W USE DATES OBSERVATIONS MADE IND. BE DRMS.: 1COMMEACIAL DE RIPTIO NS' ROResidence Ur~►l< ..g1New ❑Replace #00elL M7. /apQ/t $ /9,9 SOILS K '44C 6~ Soup 1~ q 18 - 3, 4<o-r64 RATING: S= Site suitable for system U- Site_unsuitable for system ONV N 1 NAL: MOUND: IN-G - S N-FILL OLDING TANK: RECOMMENDED SYSTEM:(°~tonal) 1S ❑U ~ ' S ❑U S ❑U ❑S CONVLN?1orv+4l i~lpL If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)Ib), indicate: ~Cjs5 ,Floodplain, indicate Floodplain elevation: d A PROFILE DESCRIPTIONS C -f BORING TOTAL P T GROUP D ATE -INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH t9F. ELEVATION OBSERVED H TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- x.25 /0-0 3v l3 9.2'~ t 'B~tTS 6"~$RtvL~s~ 97*L-rtt J M5 'yak LL V rs" RNL I!° 8e.1 MS /S wr-6 f 6i B- 2 2 S q']•~Z- 64" ~~$RN MS B- 3 l'i,TZ 94,13 Alorvt > e.9Z II'BLS -M 1.2 'aitN S 64.T$t14 AS B- 4 91-7 9x ,zZ- I~lO L > 9. / ,o~ $~z-rs q3"'[T>~teNs`FG>c S7"L-r rl M B- f 97.(, 5 Ut > 9.0G ~o"$eN j~ qfi"C-r~QN AS <,So- B- c L PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP 1 WATER LEVEL-INCHES RATE TEMINU S NUMBER lhMdMtES AFTERSWELLING INTERVAL-MIN, PERIOD P ER jQt4 E rno.r r 3 y? > Z P. P. 2 5.97 C 97,4z 3 > 2 > ? < P_ r4 -6 1 3 Z > z < P- R<- . 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- .ontal 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. SYSTEM ELEVATION. 4 2. oy r v , R°" PI ~ A-r- r4 L Cok Nr_& Lo-T j O 2•"1IPeN A;'L A_r t4W CO' NEtf,' I - - - - - Cp,- I _ - Sao, 64 A~ ~wla 9 ^10TE Foam r'D Tap tp L c 4 I O SCAL> SnTi:M pC gedck E~tJ4-traN L 41 g S s~' t=ok ljoju -115 40 f = 3C r€ Ldca-rtar,, oN I AT 'S9 Cpk N t4k of . tom @ ? S9 _ EL€4ATIOM /00; r I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures, and methods specifier], to 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. NAM riot : TESTS W RE COMPLETED ON: NnrSoN 1~ys.ci~Sc,~JEy/ryC ~NG _P~r( 8 /9~7 CERTIFICAT ON NUMBER: PHONE NUMBER (optional): gcsr SE~aw a ~-T /~uD'~1J/V W i 54oi~ LITCST E: DISTRIBUTION: Oumm at and one coPy to Local Authority. Property Owner and Soil Tester. DILHR-SBD-6395 (R. 021I4?I - OVER I J os*: ~ ~ sf scree./o/ O a . _ ®uirfioa4 a9va`J gJaB' eLJdC~C~ IR 1 V N sac ~ ~ 4 sxur: ofy Si. I+x ve.:..yg• 6, ~1 07/ d Od" C fa•LY• I~Dn o, nn ' ad? n ~ a4i✓ s'! it/ coLl 7O J • • .iat7 10, Jfy //o r,2,N uvspJay'~ ~0 si JvgJVg fu o q~. ;v~j 6 ~I 1 ZZA~ ~ v a lye 0 Ila 3'~rov