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020-1121-80-000
~ C w 0 i C m ~ ~~ G ~ T ~ ~ ~ ~ ~ ~ ~ C ~ ~ ~ ~ ~ I 3 " I ~ .. v ~+ ;.. I r: :+ 0 fn ~ I ~~ Z v m o O A W o c I 2 7 Z °' ~~ _ ~ O~ = = v N ~ ~• ~~ (D 7 3 fD A ~ O fD w O ~ a Q ~ N ~ '~' O. ~ p n N C ~~ d o N N' ~ j ~ ~ C A ~~ ~ N ~ ~ . O j ~ W ~ ~ ~ ~~ ~ ~ ' [ l ~ N I ~ ~ O O p 7 ~ ~ D N ~ ~ I 7 V! m ~~+ H ~ ~ O ~ ! ~1 0 I m cn z r N A N ~ a Q I ~' m~ Gl a~ i `D ~ ~ !mil m cn D a ~ co ~, ` a f ~ m c° _ _ ~ ( m ~_° _ nri O W ~ O ~ O ~ i ~ ? ~ I O CO C + N N ON (D ~ y N~? N w l'~i r ~ 3 ~ ' z 0 0 0 O O O K o ~ ° ' _ °' rn m v ~ c 3 ~viNN I o ~ NviN ~ _ `~ ~ ~~ v v o; I Q~ ~ v v ~ ~ y ~ ~ ~ ~ ~ ~ ~ ~ ~ A ~ d ' I I ~ _ ~ I ` -' ~' I 3 ° ~ 3 m ~ iv ~ tD ~° lD a o ~ ;• w ~ ;~• I o I y o D~ o O I :" ~ I D o ~ ~ ~ a ~ ° O ~ c ~ C W ? m ~ ~ ~ !mil ~ ~ I D m I ti '~'~ a7 m m ~ ~ ~ m ~ v, ~ ~ I C " I -+ N ~ ~ N. a I ~,, ro v a I ~ a ~ ~ ~ I ~ ~ ~ ~ 3 ~ ~ D I ~ u ~ ~ "'~ N i ~, ~ , ~ ~ ~, I ~~ a I a F~z3 I 3 I I I cn -~ ~ oo ~ W 'o ! ~ ~ afD I ~ n~ 3 ~z a ° ° ~ I o " o " cn ~ I I N y ~ ~ Z N ~_ A ~ W pj W I ~ I I Q I o -~ D I ~ ~ ~ ~ I . o o_ o d~ ~ m ~ I o m v = ~ i I z a I ~~ z a o _. ~ o N N F (p N I ~ 41 'O ~ y ~ ~ 3 I I N X sA' W ~ ~ , ., .~ ~ a `D b I I ~ 3 a " ~ A I - N I I ~ 0 ° i ~ „ I I ti I `~ I ~ ~ ~ I o ~ I a~ ~ ~ v ~ ~ O i O Id ti ~' ~~ ~~~~ 13y-93 ST. CROIX COUNTY WISCONSIN - ZONING OFFICE / ST. CROIX COUNTY COURTHOUSE /~/ ~Q~~:~eJ ~ HUDSON, W15d016 (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 ^ Septic $25.00 1~ Water (Nitrate & Bacteria) $35.00 (Visual inspection) Owner: ~ +- ~n~ ~ U r0•'t1 Requested by: ~M c~ L.~_5~(C~ti- Address : ~ 14 ~ ~ ~ ~JE Address : ~(~ " ~ rLE N City & State: So,~ hJl City & St. ~os~n l~I , Zip Code: `IaIG, Zip Code:~"~Oi~ Telephone N°: (7lS) _~SC~ -51`i8 Telephone N°: (7l~) 384 -S /`14 Property address (Fire N4 & Street) : ~ 3 ~14T7'Z~,Y ~ ~N ~ Location: ;, ;, Sec.~_, T~N, R l W, Town of UDSo~ St. Croix Co. , WI . Tax 3D N4 U,'11~-/lit '~O Parcel ID N4 3 ~~ House color: r pAf'- Realty firm: Lock ox Co o: `~~(o~ Water samrle tar location: `~ 2~-N r Ct'2 AC = ~Ikc.~C~, i TO BE COMPLETED BY iPROPERTY OWNER PROVIDE A SKETCH 'OF HOUSE & .SEPTIC. SYSTEM dN REVERSE_ OF THIS FORM Is the dwel-ling currently occupied? ^ Yes. 0 No If vacant, date last occupied: _ _ Septic system installed_by: Year': Septic tank last serviced by: Da Previous Owner's Name (s) : '~® _ `°-. ` "e ~. ~° Have any of the following been observed? r. ~' ~? ~ ^Y ^N Slow drainage from house. ~ ~ ^Y ^N Sewage Back-up into dwelling. (-~.., ~~~~'~; ~ ,~-';. ^Y ^N Sewage discharge to ground surface-; ~; `'' ~' , ~,~-, road ditch or body of water. ,yr,o A_, :- ~ ~ ~ ~ ` `' ~' ' " '' ~~ ~ ^Y ^N Slow drainage from the dwelling. ^Y ^N F l d '.~ ~'~. N• ?~ ,,~ 'fir, " ~ f . ou o ors . ~, ,~ , ,~ 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: 4 z~z ~~~~~ J OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION t -- ~~ TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ^Yes ^No Soil series per SCS Soil Survey: sheet # Type of soil absorption system: ^Below grd OAt-Grd ^Mound Approx. size_ 'X ^Gravty ^Dose ^Pressurized Ft.2 ^Bed_ ^Trench ^Dry-We11 ____ ^Holding Tank ^Outfall pipe OBSERVED DEFICIENCIES ^Other ^Unknown Septic tank _. _ _ Setbacks.: ^House_. ^Well ^Prop. line -_ ^Other Dose tank Setbacks: OHouse :~.^Well ~ : ^P-rop:. 'line : ^Other ^Locking cover ^Warning label ^Puinp/Floats ` ^Alarm ^Elec. wiring Soil Absorption System - -- - - Setbacks:__^House. _~WWell ^Prop. line OOther ^Pondng: ^Discharge: General comments: f C~IMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 ( Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 ~' FAX - 715 - 962 - 4030 ,' ST. CROIX COUNTY .GOVERNMENT CENTER 1101 CARMICHAEL ROAD FNDSRN, WI X4016 ATTN: THOMAS C. NELSQN Qi~~~~ REPORT NO.: ~2?..07/01 PAGE i REPORT DATE: 11/08/93 DATE RECEIVED: 11/04/93 OWNfE;1 Chuck t~ f~im Lagerstrom LOCATION: 3h3 I~ratttey Lane, Hudson COLLECTOfi: M..ienk i ns DATE COLLECTED: 1i-03-93 TIME COLLECTED: i1:i5am SOURCE ~ SAf#'LE: Outsid+° faucet DATE ANALYZED:11-04-93 TIME ANALYZED:2:OOpm COLIFORM,MFCC: 0 /100 mt INTERPRETATION: Bacteriologically SAFE NITRATE-N: 2 ppm Above 10 ~+pm exceeds the recommended Public Drinki»g Water Standard. ~: Coliform Bacteria/100 ml Nitrate-Nitrogen, eg/L ~-~ LAB TECF~lICIAiY: Pam Gave f'~-- ~-~ WL Approved Lab No. 15' Means °'LEraS THAN" Detectable Level Approved by: PROFESSIONAL LABORATORY SERVICES SINCE 1952 * C AS BUILT SANITARY SYSTEM REPORT OWNER 5 6 41 47 !l t (71, TOWNSHIP N c/ S t a^ SEC . 7 T2e/N-Rf qW ADDRESS T t 0,41 5 ,, K Re,' ST. CROIX COUNTY, WISCONS IN . U(/ 6/4e;1 vc . 1 /- 14 _. SUBDIVISION F U7/() / / � LOT S LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 __ _ SHOW_EVERYTHING. WITHIN 100 FEET OF SYSTEM - r - , f ♦ - 1- ...........- i j r e , 1---A ,4" il 1 5 [ le - „ r r ti Y 1 I _ -1 r , - f 1 - -+ a -r Indicate Vo th Tor - — _ E : = SCAL , BENCHMARK: (Permanent reference Point) Describe : - 7'" A-°5 '' vily pc,,Aroa Gi'J 3 Elevation of vertical reference point : 3. 5 Slope at site : 70 SEPTIC TANK: Manufacturer : W; .^4 � ^ Liquid Capacity : `006) c G Number of rings on cover : 1 Tank manhole cover elevation: Tank Inlet Elevation: 10, iG Tank Outlet Elevation : J /L 9. it-- PUMP CHAMBER Manufacturer : Number of gallons Number of gal . pump set for a cycle gallons ; total capacity of distribution lines gallon : size of pump _head; gallon per minute ; horsepower ; brand name of pump and model number , Type of warning device HOLDING TANK: Manufacturlr Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE : - Number of pits feet diameter feet liquid depth seepage pit inlet pipe-elevation bottom of seepage pit elevation feet . SEEPAGE BED SIZE: number of lines ' width / . length tile depth 3C SEEPAGE TRENCH: width length PERCOLATION RATE : AREA REQUIRED c' / h AREA AS BUILT C 1- INSPECTOR DATED PLUMBER ON JOB . 7 LICENSE NUMBER c i 5 Z Le, t- 6 E7 /(‘ e‘ ‘), 'n In tI u c' 4'e 0 Lf/; 5 L (i n S /A R 5 c (. --1- //— I / a. I i i_ ' - r " • . , lq Hout. se r_ 6-0 JPlf 7 ' 7sI 1 „ori dt.ai, $ ef1 it 0 To 4 ir I I l 1 p 3 j G -y , g I 1 1 1I 1 I II L. 1 l Vnv F DEPART ENT OF INDUSTRY, LABORi HUMAN RELATIONS P.O. BO'X 7969 MADl10SON, WI 53707 INSPECTION REPORT FOR PRIVATE SEWAGE SYSTEMS ^ CONVENTIONAL ^ ALTERNATIVE ^ Holding Tank ^ In-Ground Pressure ^ Mound SAFETY & BUILDINGS DIVISION BUREAU OF PLUMBING State Plan I.D. Number: III assigned) NAME OF PERMIT HOLDER: AODR ESS OF PERMIT HOLDER: INSPECTION DATE S ~ ~ ~ / c ~ G ~n ~' BENCH MARK (Permanent re erence point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. EL .. CST REF. PT. ELEV.: Name of Plumber. MP/MPRSW Na. Counry: ermrt N mber Sanitary u /n/ / / > F SEPTIC TANK/HOLDING TANK: MANUF ACTUR ER: LIOUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV. WARNING LABEL J PROVIDED: ~ LOCKING COVER PROVIDED: ~ ~~~ ~ , (~%.s~ YES ^NO ^YES ^NO BEDDING: VENT DIA.. VENT MATL: NIGH WAT R NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH n /_ ALARM. FEET FROM LINE ~} ~ ~ AIR INLET. ^YES ^NO ~ 1, 1 ^YES O NEAREST v DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUF ACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ^YES ^NO ^YES ^NO ^YES ^NO GALLONS PER CY CLE: PUMP ANO CONTROLS OPERATION AL: NUMBER OF 'ROPERT V WELL. BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE. AIR INLET: PUMP ON AND OFF) ^YES ^NO NEAREST-~ SOIL ABSORPTION SYSTEM. Check the soil moistu re at the depth of plowing _ __ EN:,rH DiAMerER MATERIAL AND MAR KING or excavation. (lf soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL S YSTEM: WIDTH. LENGTH NO. OF DISTR. PIPE SPACING. COVER INSIDE DIA.. SPITS. LIQUID BED/TRENCH DIMENSIONS ~ ~ ~ ~ TRENCHES: I MAT ER~~~~ ~ PIT DEPTH: GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVE _. ELEV. INLET ELEV. END. PIPESx LINE: ~J~ OM I ~ AIR INLET: ~~ ~1(ST~ ~/ ~~ NEAREST __ 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. ^YES ^NO SOIL COVER. TEXTURE PERMANENT MARKERS. OBSERVATION WELLS. ^YES ^NO ^YES ^NO DEPTH OVER TRENCH'BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED. MULCHED. CENTER EDGES. ^YES ^NO ^YES ^NO ^YES ^NO PRESSURIZED DIS TRIBUTION SYSTEM: WIDTH: LENGTH. BED/TRENCH DIMENSIONS 'MANIFOLD PUMP 3LE V.. ELEV. ELEVATION AND DISTRIBUTION INFORMATION ioLE SIZE HOLE SPACI COMMENTS: PERMANEN~ OF LATERAL SPACING. GRAVEL NCHES: 1NIFOLD (DISTR PIPE (MANIFOLD MATERIAL'. IPIPESI A. ELEV. PLANS: ^YES ^NO ___ ^YES MARKERS: OBSERVATION WELLS: PROPERTY NUMBER OF LINE: FEET FROM YES ^NO ^YES ^NO NEAREST ^ NI Bul Sketch System on Retain in county file for audit. Reverse Side. SI NATU ~~ TITLE. DILHR SBD 6710 IR. 01/82) /~~/Lt`:11r / _ ~ - REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM 3' `J U Sanitary Permit � ` State Septic NAME M /77 /477/LietiF,e TOWNSHIP /'Y (,)SQil) St . Croix County LOCATION SE Se Section '? Lot # 6 Subdivision Efg6L'f R/,b cE SEPTIC TANK Size , : gallons Number of compartments Distance from: Well Building 12% slope / Highwater PUMPING CHAMBER Size gallons Pump Manufacturer Model Number • HOLDING TANK Size gallons Number of Compartments ' Pumper Alarm System _ Distance from: Well Building 12% slope Highwater ABSORPTION SITE Bed /g-->(, 3? Trench Distance from: Well gJw Building 6 /7 12% slope Highwater • ABSORPTION SITE DIMENSIONS Width of trench /? ft Required area 45 ft . Length of each' line 3.5 ft Depth of rock below tile / in. itr Number of lines Depth of rock over tile in . gTotal length of lines //d,!)J ft Depth of tile below grade in . 141 D stance between lines 10 ft Slope of trench Z in. per 100 ft . Total absortption area 69 fli ft Type of Cover : PIT DIMENSIONS Number of pits Gravel around pits yes no Outside diameter ft Depth below inlet ft Total absorption area ft V Area required ft INSPECTED BY TITLE APPROVED DATE 198NA REJECTED DATE 198 REASON FOR REJECTION • s.. PLB 67 ,,.,ii., ' \' State and County State Permit # Permit Application County Permi # -N' - ' ��( ��:,�d.,�� " for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY ,;- 4'�' Mailing Address: c J I L 4 °'1t �� ( (( r r l i^ /3 f-4 47 k A wl I-I a f 5 o n W 1 5 J 1 U I'6 B. LOCATION: c 1/4 5 I-= 1/4, Section 7 , T ;21N, R J CIE (or) 0 Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village il^ Township ucL,S c�l 4 C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family t/ Duplex No. of Bedrooms 1 No. of Persons D. SEPTIC TANK CAPACITY / C d 0 Total gallons No. of tanks I HOLDING TANK CAPACI Y Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement _ Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 7 Total Absorb Area C/ _sq.ft. New i/' _Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width D pth Tile depth (top) No.of Trenches Seepage Bed: Length Sj Width / If' Depth, 1-6 '' Tile depth (top) 3 6• No.of Lines Seepage Pit: Insic diameter Liquid Depth No.of Seepage Pits Percent slope of land! 1 Distance from critical slope WATER SUPPLY: Private LJ Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the CeAtified Soil Test r, t/ NAME f-" �1 /7 5 G �j {`+5�c/'�'� t�'�j C.S.T. # '1 S^ 1 l and other information obtained from _.5' w r /Yt 1 1/e. / (owner/builder). Plumber's Signature eQ .�.�,L��-. 11'�(.rs � MP/MPRSW# /� 1� —4 2 Phone # � Plumber's Address �� A w' ': t c- 4 ,,- it '4 1.-4't s PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20.Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. to Not Write in Space Belgw - FOR COUNTY AND STATE DEPARTMENT E ONLY (y/ :te of Application �/ G' ,,r./ Fees Paid: State / o-zt County / 0--e..../ Date - -D mit Issued/ d (date) 1/— 9-�� Issuing Agent Name �r �l •ction Yes No State Valid# Date Rec'd unty (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 e (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 Ell 115 Rev.9/78 ---,/ REPORT ON SOIL BORINGS AND PERCOLATION TESTS Z • , ) =,3 I I t WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES o N • P.O. BOX 309,MADISON,WISCONSIN 53701 CY) rn Gm LOCATION:- '/4 // '/4,Section 7 - /'E=,T 7 N,R/ It+(or) ►I -ownship or Municipality ��'i-v SQ/ :.1'�' `F'Lot No. , Block No. , L-,16- r•cI Gj'- County 5 ' C' o r'le, r,t"-' -_- \ � Subdivision Name d Owner's/Buyers Nam/ I°e:' ^: L-_'1 I/'''t /'^I'd-ev- Mailing Address: , '!4f,fr... . /166 al cr,„,, (4 , Y®/ TYPE OF OCCUPANCY: Residence x No.of Bedrooms -3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM 7,/_f OTHER DATES OBSERVATIONS MADE: SOIL BORINGS // if/" PERCOLATION TESTS /�j/�` ( SOIL MAP SHEET 7 7 NAME OF SOIL MAP UNIT Pc, � /"e"r7 2/ yra#-i PERCOLATION TESTS ��/� !6/1,‘ TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MINTIN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- / Co wee_ Sov lit-/A. nZ `( A/0 /0 /`/ / L-- y� 3 P- q _ See_ Ja a e_ d /;4 02`l /flo , lb P- 3 30" Se e_ L c- .. -f.1 a'1 //a Jo Y 3/4. 2 /' 3 P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED/ HIGHEST IF OBSERVED IN INCHES B- / 76,r /Vera 4e- > ?ice ' /0 4 tj' /3"JI/f Ol3' -"•$` ,F /-6,, I/2",(c•: e- 15 fG*, B- 3e(w _Wog_Woge- 7 cry r' O„rs, /if" 1,-/ �2.. .S, '6t, y(" .z.`4 e—,Sf ... .-. B- 3 f'f" Jt,low42- 7 RY'` ,Getrt.S /©., Cs/ - 6- /ir,Cs4(4rr.Sd" Zile IS B- / V 7 r ,A oi4 e: 7 py" 9" .20" . k'f u2 o" I.-1.- S/).S... 4 it le_ I c B- gY A/0,t4 7 aYR 6.•7-S, /o' S/-4-6r, 6," /c tz Is .A- 6,, B- PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy C/ j / (je)'�'' .Indicate scale or distances. Give horizon /tal and vertical reference points. Indicate slope. / / S..e,.` -046 weA /�d 0 ScA/<- — J�l-sl�i'u�`'e5 ,c �icda`c4t /� `! A Top '(Lfp.' � Se s /ill Sr 1{e ct-_ Past © Pe,.-4s ill �eI c -q,�(,� 4 1 i ru- aoj + fa re lepn.4,-- 4 07. R_- /vo' f /- a-, PG45 4/, s ( Viz. = 7s"' i -il 33 r , = 701.s-- J`{ < ' N e a' ' PrAl>" fz°eli EL = 70' ,T So 5,O ✓t'apt. S.E, , O _ rE 0�' , �- 0 S©©Ysl 9r� C//P'xYo' 'r' `o /i-b.-1 g,-y 54,4'4._- iU/SiAAG c 0 0 03 sI ( ,_F ee_ Asf- 1 \\I fro/4J ' t CorAtev- I,the undersigend,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 location of test holes are correct to the best of my knowledge and belief. jj Name (print) n2tiIr.c , rYtrr"S)/e/%di'3'ea, Certification No. Cll.- /spy Address ///b igr e ( / az , /1itih-04, CeJs.3, W/4 Name of installer if known CST Signature Copy A—Local Authority ~,. ' 11 ~~ U ]i ~! ~,r..~ ~ n ,+- 1 ~ ~G~ f~ .... 3... ~. ~- x,..,.,~ ° r~ '~ .~ G ~,1 ,, ." R r `~~ c o~ r ~~ ~'.' ~~ ~1 l ~~ U ~ ,``, ~ ~ riL ~ C ~ ~ 5 .'.; S ~, n "~. .f yy ,- , ~, ,,~, -> 4 ;'~ ~:~ ..~ " ~~~ ~ r ~~~~ ~~~~~ S n ~`~~~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division ' INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Bur er, James & Elizabeth Hudson Townshi CST BM Elev: Insp. BM Elev: BM Descdption: ^ . D d 0 7~dz- CuZc.rr~ ~ TANK INFORMATION v p - TYPE MANUFACTURER CAPACITY Septic _~ 15-h ~n 6 ~d Dosing /~ ~ r/(/ Aeration `~ DC / ~- I ~ {(~- J Holding t '~ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Se tic , ~~/ ~( Dos ng Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Num r - TDH Lift 'on Loss System Head TDH Ft For ain Length ia. Dist. to weu SOIL ABSORPTION SYSTEM -I'~ o~~ ~ ~ - //1 ELEVATION DATA county: St. Croix Sanitary Permit No: 420444 0 State Plan ID No: Parcel Tax No: 020-1121-80-000 STATION BS HI FS ELEV. Benchmark 3.y< < ~3 ~ Da ~~ Alt. BM Bldg. Sewer f SUHt Inlet S t Outlet Val J~~ ~~ ~~ X90 X17• S-l Dt Bottom ~' ~ Header/Man.'b 6 /t'~ , ~, (, Dist. Pipe ~ n Q` ` -~l Bot. System ~~''~°'vl ~ ~ ~- Fin rade rJ- St Cover _- -S 3~ r d- U t'~ C r~'l d.~ ~s~x- nw _ l ~ _ _ . BED/TRENCH DIMENSIONS Width / Length f ,/~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ~ ~• S SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM EACHING Manufactur 2 JJ ~ • INFORMATION CHAMBE t30 Type Of ;~ tem: ~ ^~t ~ / ~,j/ ' T f Model Number: // ++ DISTRIBUTION SYSTEM / Z SFC~ 'g- '~ ~ ,.,f L~t~,,r, ~,i. Header/Manifold Length Dia Distribution Length ~ Dia Spacing x Hole Size x Hole Spacing Ve it Intake SOIL COVER , x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 3 • ~ ~ BedlTrench Edges Topsoil I,] Yes ~ No ~! Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / l 0 '~ Location: 363 Krattley Lane Hudson, WI 54016 (SW 1/4 SE 1/4 7 T29N R19W) Eagle Ridg~ L t 06 PaCcel No: 07.29.19.535 1.) Alt BM Description = ST"'C0~/ -~ Paul, lit'` s'~i~/ / ~ a-~QQ /~~e~~ 2.) Bldg sewer length = ~'~ ys-utf¢~ ~" ~~ ~~i U ~:~tiu~"'~x- -amount of cover = ~ , s js-~, t ~..~~?~ ,tom ~~y ~~a~- , Plan revision Required? ' e~' Yes i " No Use other side for additional Information. ~,_/_~! ~_ ~ (/ 2~ ~ _ _ _ ~'~Yt~-~~ I (/ ~ I ~ _. _--- I, ~, Date Insepctor's 'gnature Cert. No. SBD-6710 (R.3/97) Safety k buildings Division ` Sanitary Permit Application 201 W. Washington Ave. aa ~ Ig~+~ns~h In accord with Comm 83.21 Wis. Adm. Code PO Box 7302 Madison, WI 53707-7302 Department o1 Commsroe Personal information you provide may be used for secondary purposes (Submit completed form to county if not ~, ~ ~, 0 Z [Privacy Lew, s. 15.04(1)(nr)] .3 0 state ownt:d. Attach com (ate lane to the count co onl for the a stem on a er not less than 8 -I/2 x 11 inches in size. County - ~ ~~ ~Rol>c State Sanitary P it Number O Check if revision to previous application ._ _ State Phn I. D. Numbier rJ I. A ilea/ion Information -Please Print all Information Locatlott: P yOwnerName ~ ,) 2 ~ ~ g Properlyl_ocalion n y~~ S Z• l~r2 ~*' - SEP 2 4 00 (~l l/4S £ I/4,S ~ 'f~ 9 N R YG or W Property Owner's Mailing Address . Lol Number Block Number ~p ~,(~ ~~~~ ST C!?OIXCOUrJT`r' ~~ City, S1 ate uub~~~ ~~ Zip C e S~'QI~ PI N Subdivision Nnne or CSM Nu bu ~A ~~ ~~~ II Type of Building: (check one) ~ ~~(~~c~1V ~~(/~utiJ t?~ I or 2 Family Dwelling - No. of Bedrooms: /` O PublidCommercial (describe use): -~-~ -~cL --~-~ o vi i e g ti}'I'uwrr of ~ u ~ f U __ _ _ _- _ -_ . _ O State-owned Ili Type of Permit: (Check only one box o A. Check box on li if applicable) Nearest Road ~J l - A) I. O New System iS•,Replacement 3. ^ Replacetnertt of 4. O Addition to Parcel Tax Number(s) ~ S stem _ 't'ank Oniy ) Existing System ~ a ~' ~ a ~ "- (~ B) D A Sanity Permit was reviousl issued ____ _ __ Permit Number Dale issued IV. Type of IPOWT System: (Check all that apply) 3 r ' ~ ~ SW ` ~( I~.Non-pressurized In-ground ^ Mound ^ San Filte ^ Constntct ed elland • O Pressurized In-ground O I lolding'I'ank O Single Pass ^ brip line ~~jj O At- rade ~N ' ' 2 ~ g . l O Aerobic 1 realment Unit O Recirculating O Other. 1 ~' 3 vk-' / Z. ~ `had V Dia ersal/Treatment Area In[ormaliott: 1. Design Flow (gpd) / / 2. DispersalArea Required ~ 3. Dispersal Area Proposed 4. Soil Application Rate (Gals /da /s Il ) 5. Percolation Rate /i Mi h 6. System ev lion 7. Final Gnde l~ ~ ~ ~ U U ~ ` ~y 1 . y q. . 4 s ( n. nc ) -~` i0 Elevation ~S.Z~gs~ VI Tank Information Capacity in Gallons Total Gallons q of 'T'anks Manufacturer ~ j ~.y Prefab Cvn- Site Con- Steel Fiber- glass Plastic New Existing ~~ crate strocled '1' k ~~ ert s Tanks 1~ ---- --- ----- ----- - ~ _--------- ~ --^ ~_ ^ D a _._- o---- ---o--- " o ^ D VII Responsib lily Statement I the undersi ned assume res onsibilit for installation of the POW'I'S shown on the attactted plans. _ _ ___ Plumber' Name (print) Plumber's- o atatrrps): • MP/MPRS No. - nuslness Phone Number ~-~~-~ o~~~~~ ~ -~% ~~gU~ ~lJ'`~( ~a~1~ ~ ~ Plumber's Address (Street, City, late, Zip Code) _~_- ----- ~-~ ~--- -- --- -- o~~ o ~w 3s ~, ~~,~ ~~'~ ~ v VIII County/Department se Only Approved ^ Disapproved O Owner Given Initial Adverse Sanitary PermH Fee (Includes Groundwater ~ Surcharge Fee) ~~ s Date Issued d~y~ ~ mg t Signature tamps) Determination . . ~ (~iv1-+-~. 1X. Conditions of Approval /Reasons for Disapprovalt ~ U s~~w. - Sys-~~~ as Spew n , r l ( Ircch -h-e~--r~~G,.~-s ~~vrn I P. 2 --> ~S .(e l i„uGi c `Gl~i ~S ~ ~ ^ ~y ~L2~'t -~ ~(J~t~ ~-'a"-~ir2 Ci~Givr, ro~-~. ~~21/tLT `iI~'l. ~ 055 r f~~- -fit ~ o~~xCa v~-F~on~a ~s't2w -~~-. CUn-~l i'"t~n 5a i't Z (7 . -(a q9 " -i~-o,~ Ltt ~ ~ C~nd ~~Sysf~- Pr~i~-~,~,~ ~~~~~j~PyB.~,~- ~ -nouns Mgt ~1~. ^, v~x.r v lwe,~.r_ .. ~~~.c~rn.~w- `~`~'~, z/ 7Cl~uc_ i rr S,~Le C~Ge a ~ C !~> u~nl1~ ~[-~L ~~~uc.~-~- ~^- ~. /~'l-~na~ SjsS~Pi~''~s .PAL-~ `~C .~c 0 "~ l~-l-C!/~'Gfi~t. ~ ~1~- • . . ,, ., ,..._ 1 ti . r 6 / _S t'/V A. .. -../�! ��/ a /d � (�. C. aJil fil... 1 S. Tiumle '✓ F er s _ l 1--0n- g kn i\ /_VAA4L _J n ou./r1.�.� 1er'' . it. lk `i i ), PZOT L.."11) v --- ID .44 ql..-- .'xfst"5 Sp�,ice y'pPok'fi 1 n T�tr .)$ <---- ���I �uN Vb)YP 'I U'i/7 ---cig ti ^ r--13o sk$2)( w)�L P-I Ub r H--r 3.)' )0O64b\ SL?"tI( Dwell BC}JCL yv`pel( • �� oP�)c 14of _57914-1C- Tb)sik / 3 eetik n, rY)PNWulp I-v- iO.() tr J Top'o'C DRA Afi sf coodt►2 klO {, L\i . H O I. Sy I 1:11-4-'1"4---" i :\ \ (7, ji ---k(10 ry 0 le-r1 e-)..'° S- u) ‘1.3)_. edwd4 ;, O C -I �\ / V Y Y C C C .-U II^^ c ' -.L _ T E - C) 75� o ° d� C flU N Ed (NialI co - o (n H 11 7( N0 0 _ N7 i 3 a) (a d : c ti E a) U O ► �.! > co Np 7 - «_ O -0 (!) U ai W -.. . __ \ '5 3 2.-) 1)E '-u a a) C -0Na_ -OUJl r roQa) cco , C 0 ems_C _C p L >-• NsC m � COO -( I aaa _ LLO = cn aw O Cn C�wV�V y a. • • • • s , _ I-'' I A, 6 / hot /r/ f and ._5 d J e a u fide. . ' • ' oi Ecf _ _ -P- I it n 1 Le / ./v1� 1$ 4. t rKv R�g ,n __ ./1�. .Ml- J m. t hu.o�.e.5 ter t A i < D 5kC V\ Ay_ L/e_ense . 4-- ,_ 2(aciT_C)_Y __ _ _ 1 \ ,1 ,, _ . . . . ____ - L o __ ' ' / N f i q‘'° 0.16/.r.4:: V tPAO;vd I ) El ' v -s- 4 371/1)/ B 3 �x,,s- ,,n, ib', ys'eM 3xGa.5U ikter ag �$ f--- yule �u Vn)Vf J/ 1O� �, r---1 ' - 1 u`)�� P-I ut) r,H--t A 00101 t (36UcL YnaeI( Of.,,)( .1.111 TU ), OfSe'ffIC '-rbk► 3 geikvo+t,N, N"pM1i))a Iw- )Dl)•0 Igo TooTov'ok Qizc.i` Al-' S Co'''v-tg J I-lotkire Lv , M 01 Sy n Iw i 1716/144/ e 11 I fi l://vj-: .3i)) In ! III L °' jj 1 III[fflIIP C I, -ill 1 c� "` l D O Cr)� cd C i ;A = � � Irl Nc o Ln_ dddaA ro • ro CCO a) ,coX In CD D. ® fv r --- "high i 44 Q) E � (d N E E -p C L X t7 Cil � . IHiL111J i. - OJ I ail iIil W O W 12 a (_ UO c:,- (U U J imio- -C U L >' a) -C C _ 0) .0 °Vp,. a • is • • • , Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Courrty Attach canplete site plan on paper not less than 8'/: x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference pant (BM), direction and Parcel I.D. percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Please print all information. evieuued ~ Personal iMOnnatbn you provide m A' m~acy .•~.~~ ~ e Zi _ .SIN ~ ~ - 1577 page 1 of 4 A.C.E. Sal & Site Evaluations St. Crooc 020-1121-80-0 Date s. 15.04 hl (m))~ t'~/7/1~3. ~ 7 ~ ~/ Property Location Govt. Lot SW 1 M S E 1 /4 S 7 T 29 N R 19 W Lot # Block # Subd. Name or CSM# 6 Eagle Ridge City J village ~ Town Nearest Road Hudson ~ `~""T7'S=`38'6=T' Hudson Krattley Lane Property Owner James E. & Elizabeth A. Burge Property Owner's Mailing Address 363 Krattley Lane City ~ New Construction Use: Residential /Number of bedrooms _ 3 _ Code derived design flow rate 450 GPD ~{ Replacement Public or commercial -Describe: Parent material Glacial outwash FI n ion, ' applicable na General commerrts ~ ~3 and reconxnendations: Install three trenches a1y94'FO' using 30 leach chambers. ~~~ r! _ ~ r Boring # ~ Boring s/ >96" i n. Soil Application Rate ~ Pit Ground Surface elev. 98.20 ft• Depth to limiting factor Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP *Eff#1 D/ft= *Eff#2 1 0-11 10yr3/2 none sil 2fcr mvfr cs 2f,1m 0.5 0.8 2 11-28 7.5yr4/4 none sic/ 2fsbk mfr cw lfmc 0.4 0.6 3 28-38 7.5yr4/6 none Ifs 2msbk mvfr cw 1im 0.5 0.9 4 38-96 10yr5/6 none Is,fs,s 2msbk/0 sg mvfr/ml - - 0.5 0.9 ?3.0 2_ ~ ~~ C 6 r FI#4 consists of an unsorted mixture of 1 msbk 10yr4/4 Is, 2msbk 10yr5/ and do not s. Bout between textures are d 6 fs ~ 0 g 1s Oyr 5/ interfere with pemtiability between textures. Loading rate retfects most restrictive permiability encountered. Boring # ~ Bonng _f Pit Ground Surface elev. 95.21 ft. Depth to limiting factor >86~~ in• Sal Application Rate Horizon Depth Dominant Caor Retlox Description Texture Structure Consistence Boundary Roots GP 'Eff#1 Dltt2 'Eff#2 1 0-9 10yr3/2 none sil 2fcr mvfr cs 2f,1m 0.5 0.8 2 9-16 10yr4/2 none sil 2fsbk mvir cw 1 imc 0.5 0.8 3 6-26 7.5yr4/4 none gr. sl 2msbk mfr aw 1fm 0.5 0.9 4 26- 7.5yr4/6 none gr. Is 0 sg ml cw - 0.7 1.2 5 30-85 10yr5/6 none Ifs,fs,s 2msbk/0 sg mvfr/ml - - 0.5 0.9 ct3.o_ 2 •~`/ S,de Io ur/ts il(!~ /`;~- r-.sl oks- Ii;IkS consists of an unsorted mixture Of 1 msbk 1 4/4 Is, 2msbk 10yr5/6 fs & 0 sg 10yr 5/6 Boundries between textures are diffuse and do not interfere with permiability t res. Loading rate relfects most restrictive permiability encountered. * Effluent #1 = BOD ~ 30 <_ 220 mg/L ark T >30 < 150 L t #2 = BOD < 30 mg/L and TSS <~0 mg/L CST Name (Please Print) 'nature: _- -`' CST Number James K. Thompson ~---__. 3602 Address A.C.E. Sal 8~ Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake lane, Osceaa. WI 0 8/23/02 __ 715-248-7767 i i property Owner '}ames E. & Elizabeth A. Burger p~ Ip # 020-1121-80-000 Page 2 of 4 Boring # ~ Boring _J Pit Ground Surface elev. 97.47 ft. Depth to limiting factor >95" in. ~ Application Rate Hori De th Daninant Color Redox Descri tion Texture Structure Consistence Boundary Roots ' zon p p 'Eff#1 *Eff#2 1 0-6 10yr3/2 none sit 2fcr mvfr cs 2f 0.5 0.8 2 6-14 7.5yr4/4 none sicl 2fsbk mvfr aw 1 f 0.4 0.6 3 14-25 7.5yr4/6 none gr. Is 0 sg ml cw 1f 0.5 0.9 4 25-95 10yr5/6 none Is,fs,s 2msbk/0 sg mvfr/ml - - 0.5 0.9 off= l 3. / ~ ~~ ~, H#4 consists of an unsorted mbdure of 1 msbk 10yr4/4 Is, 2msbk 10yr5/6 fs & 0 sg 10yr 5J6 s. Boundries t~etwaen textures are diffuse and do not interfere with permiability t textures. Loading rate relfects most restrictive permiabildy encrourrtered. ^ Boring # J 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 'Eff#1 *Eff#2 Borng # ~ ~~ _j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots `Eff#1 *Eff#2 "Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mglL " Effluent #2 = BODS <30 mg/L and TSS <30 mglL 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 deparhment at 608-266-3151 or TTY 608-264-8777. SOIL AND SITE EVALUATION 1577 Page 3 of a PROPERTY OWNER: lames E. & Elizabeth A. Burger PARCEL I.D.# 020-I 121-80-000 A.C.E. Soil & Site Evaluations REPORT MEMO F~dsting septic tank must be inspected to verify capacity & structural stability. Effluent filter must be added downstream of septic tank outlet. Install bull-run valve after effluent filter to allow future use of hydrollically failed system. /• ~~~~~y t~ K i-1a-/Jho% Cock-/'. flstu mcal elegy: ~ ~oo.~.' ES-E,~.+-ta~Eed2le~a~S.r.o~i~= 9rss~; Gad. a-E s, r. ou.~/c~ = 99. /0" ,~e~~ /S77 ^ Soi / olZSer~a-~,o., P; ~ ~ F/eda,~;o~ Jude a_{ p~e~ovsed trn ate0. 095.57.' CXiS~'~~ /8 X 3(0" 50"'/ e ~u~ = 9Ss0' P~.~o~~ ~~ . ~ Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number a Number of Bedrooms 3 Design Flow -Peak (gpd) y S ~ Estimated Flow -Average (gpd) 3~~~ Septic Tank Capacity ( al) 1 uul~ Soil Absorption Component Size (ft2) U~ Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) ~ S 0 Maximum Influent Particle Size (in) - 8 1/8 Maximum BOD5 (mg/L) a p 220 Maximum TSS (mg/L) U 150 Table 3: Maintenance Schedule /-~-~ Septic Tank Inspect and/or service once eve 3 years . Outlet Filter Inspect once a year and clean at le once every 3 years Soil Absorption Component Inspect once every 3 years ~'' Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the ' ~ ~ Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers,~access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 " - ' ` Management Plan fora Septic Tank and Soil Absorption Component i Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. When system fails, we will replace with another system at owner's expense. Alternate area must be left undisturbed. St Croix County Zoning Office 386-4680 Boumeester & Sons Excavating 386-9020 Tri-County Sanitation 386-2130 3 ,. , ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEP`PIC TANK This is to certify that I have inspected the septic tank presently serving ~^ e , tie _ J pie j 1~ ~ ~~ ~ ,,hx,~l, ~ari •Gi~ _ residence located at: s(,J ~, S~ Sec. ~_, T a ~ N, R~~, W, Town of ~J1~b1'~N St. Croix County, Wisconsin. Upon inspection, I certify that I leave found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced ~ 1~ U a Did flow back occur from .absorption system? Yes_ No^~ (if no, skip next line. - Approximate volume or length of ti e• gallons -- minutes Capacity: _ duu Construction: Prefab Concrete Steel Other Manufacturer (if known) : lN'e~tcr Age of Tank (if known) :. F~9 b (Signat e) - - - ~l ~ lll~~.l~~-~~ (Name) PleaseQ Print iY1 b, ~ ;-e.~ ~ I ~ w l~ ~- lam: S ltd c~-f ~ _ a ~~ 1 ~~ (T1tle) (License Number) ~a3® (Date) Form 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: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83,-Wis. Adm. Code (except for inspection opening over outlet b~affl-{e~) . Name `-' ' ~ V U~,~~,~.1~ g ignature °'MP/MPRS ~a v ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ~' , OwnerBuyer -~-~ p ~ S ~ ~- ~ ~ 12 a ~' ~-~, Qu (~ ~-Pn Mailing Address 3 ~ ~ X ~ b` I i ~-e; ~, lip Property Address ~w (Verification required from Planning Department for construction) ~~CI.S"s1 l~)~~- Ci /State i ~ ~ ~ ~ (~ ~ ~ ~ a) " ty 1 u~ C ~~ y Parcel Identification Number LEGAL DESCRIPTION Property Location S ~ %,, S ~ ~/,, Sec. ~ . T a ~ N-R~ ~ W, Town of ~ ~.Sv ~_ Subdivision __ ~ a~ I~ ~~ -~;~t Lot # Certified Survey Map # ~~ .Volume ~ ,Page # Warranty Deed # ~~ 3 ~ ~~ ~ Volume 0 ~ 1 ,Page # ~ ~ Spec house ^ yes i~ no Lot lines identifiable ~ yes [~a no n .- SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintentnce consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of tho septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeymanplumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewsterdispoal system ~ is P~ ~m~B condition and/or (2) aRer inspection and pumping (if necessary), the septic tank is less than 1/3>kill of sludge. Uwe, the undersigned have read the abovenquuratoants and agree to maintain the private sewage disposal syeteta wtth:'the stao~dards set forth, hereiq as set by the Department of ~Oornmerce and the Department 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 Zoning OtBce within 30 days of the three year expiration date. SION TURK OF APPLICANT DATE _O_WN1~R CERTL~CATION ' I (we) certify that all statements on this. form are true to the best of my (our) knowledge. I (we) am (are) the owner(B) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. F' ,a , 0~ SI(3 TURB OF APPL ANT DATE ****** Any information that is mis-represontedmay result in the sanitary permit being revoked by the Zoning Depsrtrnent. **•*** ** Inclade with tbia application: a stamped wacrsnty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the wamtnty deed 'J. 1983P 32~f 69 1 054 KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX CO., kI St. Croix County Occupancy Ai~davit ~S b Name - (Own r) Typed or printed being duly sworn ,states, under oath, that: 1. He/she is the owner/part owner of the following pazcel of land located in St. Croix County, Wisconsin, recorded in Volume -1 p67 Page 3a l Doctunent Number $~/3 705 St. Croix County Register of Deeds Office: A pazcel of land located in the '/. of the '/. of Section T N - R W, Town of ~m N , St. Croix County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or deta' ed~gal description): S~ t^~,tac~te RECEIVED FOR RECORD 09-19-2002 4:30 P?l AFFIDAVIT EXE?PT # REC FEE: 13.00 TRANS FEE: COPY FEE: CERT COPY FEE: PAGES: 2 Na a and Return dress 363 _K~4-Ft'~l ~Qsd.t we s~o~G Sao-~ra~-sue ~ owner of the above described property, I acknowledge that the septic system serving this residence is sized for a _ bedroom home, or a design flow of d. The design flow is calculated by a suming 150 gpd for 2 individuals per bedroom. There are currently ~ occupants living in this residence; ~ occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modified to accomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. Da d this ,~~ day of ~~Oo'Z , '~ M~.S • AUTHENTICATION Signature(s) authenitcated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 71.06, Wis. Stats.) / THIS INSTRUMENT WAS DRAFTED BY ~S`` _ 1 %_ ~~ r- (Signatures may be authenticated or acknowledged. B~p.are n~t necessary.) .>J, ~' "THIS PAGE IS PART OF ACKNOWLEDGMENT STATE OF WISCONSIN ) )ss. St. Croix County. ) Personally came before me this ~..._ day ofSCr~ CO the above named Ja. wi.es ~ _ 13ll h9eY' to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. iV / J's. LEGAL DOCUMENT- DO NOT REMOVE" This Jnformation must be completed by submitfer. document title. name d rstum address. and ~ (rf required). Otherlntormatlon such as the granting dauses, leagal description, etc. maybe placed on this Brst page of the document or may be placed on additional pages oI the document. Nole: Use of this Dover page adds one page to your document and 52.00 to the recording lee. t~sconsln Statutes, 59.517. 1 ~ Notary Public, State of Wisconsin 0. My Commissio is ermanent. If not, state expiration date: Date: ~---- ~1 1.983P » .~ . ~ _'-~+ "', ti t~`~ l n` r ,. .~ c ~:} OOCUMEt~T NO. 51.3'705 325 STATE HAR OF WISCONSI:1 FORS( 1-19tf fNie ~r~ee Rc[eRVCO row Rieowo,Ne oar WARRANTY DEED :---=- -_== - _--_-_----- .. -. __ _ ~~ 10~7~~,E~21_ _... -- ;~ krG~STF~,nS . _ ~- ~-- - _ ,t FF~CiE :~ This Deed, made b~tweao ~~ ~• (',RQy( .................... ?, -..Charles...R... Lagerstrom and..Kim..M....Lagers.krocn, it P=~',f`=r P._ y ~; ..... husbaitid. and. wi Fe, ........... bIAR .. . ......................... . ., ;~ ............................ 3 ................................................ ....., Grantor. ! 994 F: and .... lames...E..-..Burgez..and..~l.iz.abekh .A...HurQer,..•-. '~ ~t 1:,x,5 p•• l .......husband. and .wi.fe,...as survivarsh.ip aazi.t,ax..... ~ V ~' ~~ M j' .........property ........................................ .......... ... ... ........ ~~ YY ~sar~tae,.:a Witnesseth, That the said Grantor, for a valuable eoeuideration...... j! S1..0.0. and..ether...vaiuabie...cons.i~aera.ton ~ __ __ ~j conveys to Grantee the following described real estate in ......St.. .G,X'Q,~.}(_-.... (f R[TVRN io ~ "--'_ :_ _._- _ -_ __ ~i County, State of Wisconsi~i: iI !~ ~ i Taz Parcel No :................... Lot 6, Eagle Ridge in the Town of Hudson and that part of Lot 7, in said Eagle Ridge, described as follows: Beginning at the Northeast corner of said Lot 6, being the point of intersection of the common bolsndary lire between said Lots 6 and 7 with the South- easterly right of way line of Krattley Lane; thence North 56°02'30" East along said right of way line, 60 feet to the Northeast corner of said Lot 7; thence South 33°57'30" East along the Northeasterly line of said Lot 7,173 feet; thence South 00°38'02" West 105.68 feet to the Northeasterly line of said Lot 6; thence North 33°57'30" West along said Northeasterly tine of said Lot 6, 260 feet to the point of Beginning. :-., . .................. This 16 ...., homestead property. '-~~ (is) (is not) r :.~ Together with all and singular the hereditaments and sppertenancea tF.ereunto belonging; And.....Cnarles_.R.._and, Kim..,~I,..Lagerstrom .. . ......................... warrants that the title is good, indefeasible In fee simple and free and clear of~encumbrancea except recorded covenants, restrictions, sad easements of record, if any and will warrant and defend the same.,, I Dated this ................ C ~'.. day of ..............!~lareh ......................................... 19.9...... ........Ct~a.~.... ~..~° ~~t.r+•~., SEAL) ~ fir!-v... ~.:. . .. .... .. ......(SEAL) ............ ... • .....Charles...A....Lagel;strala.......... • ._Rim.M....Laq.ers.trola .................... 'I i! i; I~ ~, :~ !i ~~ ~~ 1' ~~ .........................................•-• ........................(SEAL) AQTSHNTICATION 1 Signature(s) ............................................ authenticated Wia ........day of»............ ....................................................................• 19..... .................. ..................................... (SEAL) ACBNOWLBDOMSNT SATE OF WISCONSIN ,S_.. CRVIX ......County. ~ ........... ..~~ ~cyae before me thin ~.~.~...day of • •-••••••••••••-•••. 199.Q... the above named .._ Cb;3tr~.es...I~....~as~zs.~xom...ans~ ................ OOCt1ME1dT No. STATE DAR OF W[SCONSI:f PORK 1-198s 5~.3'7OJ WARRANTY DEED .:1~1~ ; ~~ ,E 321 . Thls Deed, made batween ..__ ........................ ................. ?~ Charles.. R... Lagerstrom and..icim..M. La~gexskzom., II ;; husbalid. and. wife, _.... .................. ............... i ................................. ...... .. ............. .., Grantor, ~) ana ..James:.i;....8ur.gez...and. ~l.izabeth A... Surgs>r,...... '~ '~ ......husband. and .wi.fs,.. as suz'viva>:sni.p ~axit.aJ...... ' property... _ ... .... .. i '~ ......... _., Cr~ntee, ~ TNI( (IAC[ 11[[111V(D /OA 11[COIIDINO DATA i ' ~: Witnesseth, That the said Grantor, for a valuable eomsideration ..... ~ I. ~ $1..00. and..atht:r...v.aiuabie. cons.l:aeration ...._ .. .... '~ -- .. - : . , it n[TV1/N ip conveys to Grantee the following described real estate in .....~.t. 'C 1.o,1X.... County, State o[ Wisconsi,i: ii Tas Parcel No :................................... Lot 6, Eagle Ridge in the Town of Hudson and that part of Lot 7, in said Eagle Ridge, described as follows: Beginning at the Northeast corner of said Lot 6, being the point of ; intersection of the common boundary lire between said Lots 6 and 7 with the South- ; easterly right of way line of Krattley Lane; thence North 56°02'30" East along said right ' of way line, 60 feet to the Northeast corner of said Lot 7; thence South 33°57'30" East ; along the Northeasterly line of said Lot 7, 173 feet; thence South 00°38'02" West 105.68 feet to the Northeasterly line of said Lot 6; thence North 33°57'30" West along '~ said Northeasterly line of said Lot 6, 260 feet to the point of Beginning. ,~ . ~.: ~. , ~~bl • ~ 3~0` -„SD This is ..........., homestead proprrty. ! • •t' .(is) (is not) ..•J Together with all and singular the hereditamenta and spp.:rtenances thereunto belonging; Anil ...-Charles.- R._---and.-him_~1-.-..Lagerstrom warrants that the title is Q~od, indofeasible in fce simple and frer and clnur of ancun-hran~er except recorded covenaltts, restrictions, and easements of record, if any .t S and will warrant and defend the same. i Dated this .................._...........%~~...~.. day of .......... ...Nareh._ ..................................., 19.94.... ~j • ' ......-~`~+~--(~----~ ..... .... SEAL) .. _`~.Gnv...~.:.....i.~~~.......(SEAL) • .....Chan.es...R....Lage>;s.tram-.•--..... ' ---Kim.M.....Lagers.trom ..................... ..........................................................•---......(SEAL) -- - ...... -- -............-.................--•----..........(SEAL) ~I c - - .................... _................ AIITHBNTICATION t ACHNOWLBDCiM13NT Signature(s) !i ........................................... STATE OF WISCONSIN ., ,~ • --• ............ .............•--County. 'I authenticated this ........day of ........................... 19....._ Perso ' y c e before me this ~.n.~__.day of I~ ..--~-.C.`.. .~r'..~.._........, 199.Q... the above named 7 p~V- u' Ste, •s°~ ~ / ., 2 °-- ~ ~ 12 Y ; ~ ~ ~ I I / ~' tiSSO 1.09 AC 51 0°- ~ 1.98 ACRES 87 °24~35~~ ~. ~ ~S 2, S° qty O~ 2~`~ g92° ~. 3 ° X99' ~ \,~°Z~ ~ 242° ~Y o - ~~~ ,ham ~ "'~ ~ 6~- ~ 93,L'+~ 3g 2s3~3 s Qi~, °~ _ `~u'' 0 00 73 °2030" M4) o OO O 6 ° ~`~~ - %y TS o ~~ O ~,~~'(~ 60 00 90° 1.49 ACRES 9 8 4 C °t7 ' ° 8 40 ~ M O ~ g0 ~ - 36, M /O 6 29, 0 OZ 3 ~\~ X02. ~L 56 '~ ~ 92 3 0 5 23 ~y • o 3° y6° ~ 2 ~ h / ~ v' N ~ ~ 8 o m s, ~~, rn u°-- ° y mss- °3j. 103°5 i 0a `y y~ 2.32 ACRES ~ Q 2.23 ACRES ~ 2 `~° ° Q ~ `ra, ri ~°ty- "s ~~, ~~ O ~ O 4 ~a, N ~~ ti ?~ ry 2.70 ACRES ~~ S 89°04~50~~W 281.43~40~~ ~ - 146° 5~~ 40 201.43 - 80.00 2 2 8 o, ty oNi y v ~~ Ns N 5 s-,- ~` ~ 2.44 ACRES ~ iA .~~ ~ ~~~ O O ~ N ~~ Z NOTE- 2 ~X30~(RON APE ~~ ~`~ 43 2.29 ~ ~^~ X8.98 ~ (73. (8~ 904 137.94 .. 92.93 ' ' 201.42 ~ 151.5 i S 89.0450°W 2(54,(T . LANDS eft Cer a~~~~ ~~