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020-1005-90-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 19 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: Zuliani, Walter& Kim Hudson, Town of 020-1005-90-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: •3Y � � jK�j'h ��S Ob�'V• i 08.29.19.15A1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS EL ZAP 5 Septic S Benchmark �1 ems. 2 ZOD 37 /oS G I7.3 Y g Alt BM Zb I bld . X/0- s s 00, Aeration Bld er l -kl0 ` D � 6 3 Holding TANK SETBACK INFORMATION St/Ht outlet n . ^' _ ' a�ct� 9Z 0� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Z& Dt Bottom Dosing • Header/Man. , Aeration Dist. Pipe Holding Bot.System AL- PUMP/SIPHON INFORMATION Final Grade V"J Manufacturer GPM Demand S %t�1J� r Model Number If rG�o TDH Lift Friction Lo Syste Head TDH Ft Forcemain Length Dia. Dist.t ell SOIL ABSORPTION SYSTEM Q' BED/TRENCH Width Length No.Of Trenc es i , PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS /��6/ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil / Yes 0 No � Yes � No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / f� l Inspection#2: / / Location: 1032 Deer Run Rd.Hudson,WI 54 S 1/4 11//4 NNW 1/, 4�8�T29N 19W) Deer RjunjEstates Lot 1 �, arcel/No: 0/8..29..1�9..15A1 1.)Alt BM Description 2.)Bldg sewer length= Q{�l� /{N , v 7Z ' t/" L- W binds Gl�- -amount of cover =� ytsi� �-- UfQ'A �VXXX 10 , `lam � ` Plan revision Required? ❑ Yes V No Use other side for additional information. SBD-6710(R.3/97) Date Insepctor's Signatufe D„ / _ /tp-<4 ip,(�'7ryd� N O a) ° N 03 °(n Q ° ~ y O C c O C O C a) � as. a R of _ p O'O(n O 0 0 a) N — 7 N a> �.O U c p.— a E c V i .. :3) - N 0 0 C r V) O C - ti O .-Y d.- > 'O O L 7 i ? EL :°.ao c a� o �y � 2•; p y N a .y cw v,ao p W,.- a>� O)6 N 0---a p m ail Q. a O.f0 fT C O 3 V w N Y tl) 7 C@ y c.- p c C.O cL 2 cc y a) M O y i6 E w a) > p O O E N O= N 7 y:O N N OU1 a) _O N a3 (D_ v 3 0 0 w m d p w V 0 3 N 2 7 += O O m E O z 'O 5 L C N c C C L z O)d 7 a7 Y'p c O E Z'N N O 7 N C c LL c Vl C C .,,, O N O V O LL c c CM ca - V c U'O N 0 3 0 3 'o c V 0,00 O -O O Q I-° a@ia a° ccc mc)icn � Q U -0 o D+ v o v v a>i y i>> 3 E E z ! w_ o _ o v E z € v ' O) am am ao F-• U) o z v ° C c c r w m N N Z o Q c o c E N 7 N v CY N •' w N • d a L O O O 2 Q O O O Q z m z z m z NCWD N d y Z, _ ' mNil +Cpl t�i1 E c ►� W ° ° G .. 'Y c 0 is .. = IL LO v Co I, y 0 a) y O .� C a a I L C O a L > o H H H a`0i c H Imo- I-- FL aUi y 3 3 3 a LL N 3 3 3 a z •� _ 2aaa = aaa CL v C0 o a 7 O to C O C e- O O N J U O N z RO' N z O �, O "O O z O O z � N 7 0 O N = w [L co m CO a A (n •p d Q A (n as S �j 00 y 1`p cif I�yl! C O oa 0 V 4L L.y i c ns a o ; (D ?0: 75 9) N ° ,o O C O O N E E O Ln 0-4•►mil ' o 0 2 ! N z a d N z w z 2 (n v y CL � a � a � •� � a � cam tw• a a� . m d c t A ciao !, oaici 0 (nu CD N p (a p cn o (D v 0 Q � I c U)y° 4) �v ca " N �i rn a�i c 4) E.8 w �N.0.0 d cc' aE cc Q4 Naxi o vc'a c c rn Y a mac`) c a cY a - E 3:'S �i 0.0 in a c �Q N C cD LO C O O A a C4 0 N ca .O € L C N N O y N N � C t C Z C ir, j M N C Z C C N LL c "x > y� m °3 `°?� cE 0 d O - O C Q'G E _ N _ oZf t E 3 Q c �� 3 Q H 'cLi vo n :� C CD z N E E o v °) 3 am am c U I I o z a c N v O N O O O 7 Q a. CA CO) N O z° m z z° m z N c ^` c d J ` w 0 4)- ` O v CL O O 0 I' � 'eaa E oca > o IN- H Imo- al m ~ ~ ►N- E 0 0 0 y 0 0 0 a H •N 2 a a a a (L a Z a d In J w U Ix W) } N N N 7 a � N N O) N :3 O } CO p rn N o p E N N y M c, p O O � � O N N Q O O 7 N Cl) f� C a CO (O N m N C 4f Q A (n f6 L E H c O C O DO N lC) O rn o m c a c°1i a °o 0 o ' c r \ c N N N C O V p o ai c ; o ao o \ m ° Z O c coo u) co co N d - 00 m N O N N C U O V N CO n a 0 2 !. N v o z !2 a `1 to 0 N o z 2 2 H O � I I • o d .� `D a c m e A ) a !II O N V O u) V County Sanitary Permit Application ST.CROIX COUNTY WISCONSIN Gp A4 In accord with Chapert 12 St.Croix County Sanitary Ordinance PLANNING&ZONING DEPARTMENT Personal information you provide may be used for secondary purposes ST.CROIX COUNTY GOVERNMENT CENTER t�G♦� [Privacy Law.S.15.04(1)(m)j 1101 Carmichael Road ,L*,. Hudson,WI 54016-7710 (715)386-4680 Fax(715)386-4686 mplete plans for the system on paper not less than 8-1/2 x 11 inches in size. ita 0P #�} Che o revious application Ic� VI I. Application In ton;?Case Print all Information Location: Property Owner NOW j , 4 A(4`1/4, 7 / �O 10!� Ste- 1/4 Sec G-. v/ (It Al ., `ST CF?OI �J N, R E(or Property Owner's Mailing Address wivi I Y OEV — Lot Number Block Number - City,State Zip Code None Numer Subdivision Name or CSM Numbe -17 r� �– s �G �z �y6 'KF2-3 �� V � to JGZ II�Typ�f Building: (check one) am i amity ❑Village own of LRii or 2 Family Dwelling-No.of Bedrooms: ❑ Public/Commercial(describe use): J a^ ❑ State-owned Nearest Road 11.Type of Permit: (Check only o e A. Check box on line B if applicable) -� Parcel Tax Number(s) l A) JUD Repair 12. Reconnection .❑Non-plumbing 4.❑Rejuvenation Sanitation Permit umber Date I sued p e� B) Y State Sanitary Permi4 reviousi � :-,1? (6 y-� 1 j IV.Type of POWT System: (Check all that apply) Ll'7 l 41S ST JW Non-pressurized In- round_ ❑ Mound? 24 in.suitable soil E3 Mound s 24 in.suitable soil ❑ Mound A+0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At-grade ❑ Aerobic T atment Unit ❑ Recirculating V. Dispersal/Treatment Area Information: 77777777-1 7-717 1.Design Flow(gpd) 2.Dispersal Area 3. Dispersal Area 4.Soil Appli,6ation Rate 5. Percolation Rate 6.System Elevation 7.Final Grade Required Proposed (Gals./day/sq.ft.) (Min./inch) Elevation VI. Tank information Capaicty in Gallons Total #of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks 2—o4� ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Vil. Responsibility Statement I,the undersigned,assume responsibility for repair/reconnenction/rejuvenation/instailation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non-plumbing sanitation system. Pub/erp Isjrarrle(print)- Plumb i n turg�(n 2(/2S No. Business Phone Number Plumber', dre�,s�Beet,City,State,Zip Code) / 5,r/�lG Gj I Z 3�j�j — /U v VIII. Couun use Only C�cGG w•f— T Disapproved Sanitary Permit Fee Date Issued I wing Ag t Signatur No stamps) Approved Owner Given Initial Adverse Determination IX.C09diti pfOA rov�al/Reasons for Disapproval: 11.YSelptticc tank,effluent filter and C111 J dispersal cell must t serviced/maintained r�� `� �i � �y,�f�S '� as per management plan provided by plumber, r J 2.All setback requirements must be maintained j��� ,,j KVA- � as per applicable code/ordinances. G� r f 1 c' �' 5,9,l pVQ/ua�iG/J PrG Deer Kun Koad '7�`'Ekis�n_g c�;�e�cxe/•ne � ��--� ���v� L'uL-de-Sam -�- Eyi56�y/u)ovd*,7,a4ek pnce ® EXrs ���lcda�ron c�� N s cat:/= �/o' ,Zu/Al,, /06 5 wn v iJ,S.8, T, 2917y,P/9 uJ,Tn. tea Vi IY aktdad GrOZY 3' b� Se✓¢r� SlopRS � o, 0 Ex;s��� ro6amil"!!s \ Seder.e Seri de�oe /. 20" S/q°�s Ana , QerK.�M.rK: oFS,d;r�- datair►tined ��ar7�o 0 Plu�. F/eu:'-47.35/' St Uer1 '4 J,4 414,6111-1 t"re'7 7{! ,sa/Ca. kea✓i 1 y uxoded open y ���5�.��D �• �� �PProx./ocaEo� of a�vs&' eay.y ey -_ vent A94 - lr - -� 89.7►s J -6z _ -- ,r{ o bcar,'ly waded Road 3 P.O.�.T.s.d;spers../cells. � I e, �J S O anaals as 4 a aalnbai s4noueal:) 'cede Pvo-d ssaooy `. 4 OOT => sInOuealo 1 Z S£'Z8 WWOO aas .? .: y SWId aye jo lulod uogoa . ut pp W 544 somas umW }e paaln J 1ttoU 1 anaaTg asoid io}doomlui slaMas RUW.3 imonooma alBAUd 6ulppq jol se awes uoqoa4wd Iswj 1 '(:))(TT)0£°Z8 wWO: SmPTmg siamas 6ulppq aoj CIAJ JI= / se awes uogellelsuw anomato= s ``,T2tS�1 S 144d lq:)eq:pS 1 o r?� SJGMGS uIew ao4dooaowl 84SAI.ad f .�I ( - p911 Aliaog4ne :)Ilgnd a Aq Palloa4uoo A(lamp m 6uinaas 4ou pue s6u i°pl° q aaow ao Z aannas paunno AI@4enlad a sueaW .pauuaa .PI. q Z ao s6ul ln S1MOd auo �(q panaas 4 smalnaa juawpeda P 6ui ae6a.l 6uipuad a6uego apo� P su61sep mainaa pinogs saijuno:) 1 Maina.l juawiledep a.linba.l .la6uol ou siames ulew ao4daoaalui ajeApd aajaweip pui j, Z-OZ'ZS algel wwo:) 'ZOOZ 'T AInf ..':...... saomeS uisw ao;daoaa;u j o4enlad •o m ❑ ❑ ❑ m m _ m � � m c m a ° c c N E E m E L m w Z (7 Z Z U c o N 3 o c m n ° C u7 m U C O m O O C d N O m 2k C i N W � f_' Z U U O m o m 7E O N ,0 N C C L O Z J Z LU m m° w N H 5 c ° c c Z N a m m c - —° o m T m c Z o f ° ° CL g ro N m r ° rr, m � 2a > m ° mm N °' W m ° to • m N T L m 5 Q D> C E E > w E a 3 m L 3 m N ° E tab N -N U m a ° ° —0o Z o o r c a m = C o Q ui c >am- c °� 3 � U ` U .Lm. x CIS 03 N c N N m c C .. O OL COD 4 w w E E c -° m € U U W m s a) w L H° 'm L~ m w U m m _N° m cn aC a CL O co N > N m m o O O O m m O L N � LL o a N - U Q E - 414 = - m m 0 C k O c°'- O M ca m 0 m O �W m =E E N m > Z" m m m W �- amm 8Lm °. E .tm. °; o c W W z jjjj:Zoj L z z o a W Pp U cD � Z v z � F- o D U) LL � o w �- co O N z o � oO Z �0 Z w V .�' CD z U a W OD D o o J LL o c- J It WSW 0 co N 0 0 ` L —� w }LL oco _.. %T- W W L.. O 0 w o -� D w w m z z rte, 0 o V r< NA s ,ex�w�w;�ba�NdltaitQgs tp�t County Sanitary Permit Application ST.CROIX COUNTY WISCONSIN Gp In ac with Chapert 12 St.Croix County Sanitary Ordinance PLANNING&ZONING DEPARTMENT O o i ation you provide may be used for secondary purposes ST.CROIX COUNTY GOVERNMENT CENTER b � � � [Privacy Law.S. 15.04(1)(m)] 1101 Carmichael Road �� $QV Hudson,WI 54016-7710 (715)386-4680 Fax(715)386-4686 Attach complete plans for the system on paper not less than 8-1/2 x 11 inches in size. County Sanitary Permit#/ ❑ Check if revision to'previous application 1. Application Information-Please Print all Info tion Location: Property Owner Name C # a � 1/ 4,Sec D Lea! l.Z Iw Q ' c 21 ! R E(or(W Property Owner's Mailing Address Lo;jo!��J Block Number cad - City,State Zip Code Phone Numer bdivision Name or CSM Number u.�SO/V ��/ II Typ f Building: (check one) n amity ❑Village own of 1 or 2 Family Dwelling-No.of Bedroom � J- e 1 ) ❑ Public/Commercial(describe use): ❑ State-owned Nearest Road 11.Type of Permit: (Check only one box on line A. Che box on line B if applicable) �' Parcel Tax Number(s) 1.❑ Repair 2.9 Reconnection 3.❑Non-plu ing 4.❑Rejuvenation A) old-boos- go, Sanitation B) ermit Number Date Issued State Sanitary Permit was previously issued IV.Typ POWT System: (Check all that apply) Non-pressurized In-ground ❑ Mound? 24 Xsle ❑ o `- 1 ❑ Mound A+0 ❑ Sand Filter ❑ Constructed ❑ at ❑❑ Pressurized In-ground ❑ Holding Tank ❑ Si ass '( ❑❑ At-grade ❑ Aerobic Trea ❑ Recirculating V.Dispersal/Treatment Area Information: 1.Design Flow(gpd) 2.Dispersal Area 3.Dispersal Area .Soil Application a 5.Percolation Rate 6.System Ele ation 7.Final Grade Required Proposed Gals./day/sq.ft.) (Min./inch) Elevation �0 20D Z 13 4 S 3 89. VI. Tank Information Capaicty in Gallons Total # f Manufacturer refab Site Con- Steel Fiber- Plastic New Existing Gallons t ks G Crete structed glass Tanks Tanks ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VII.Responsibility Statement 1,the undersigned,assume responsibility for repair/r onnenction/rejuvenation/installation of non-plumbing for the OWTS shown on the attached plans. A license is not required for terralift repair or the inst lion of non-plumbing anitation system. Plu is Name(print) Plumber's ignature(no sta ps): MP/MPRS No usiness Phone Number Ft F c�iv� 7y4-3- 2 Plumber's Address(Street,City,S ate,Zip de) Vlll.Coupa Use Only JDi Sanitary Permit Fee Dat Issu 3 d Issuing nt Signat er Given ial er Deter on Approved se l0 2Z,6t ur (N mps IX.Conditions of Approval/Reasons for Disapproval: L /� 1F(,PTEMPWNER: 3 aezw Ot4T / t�Jr ��` f. SepW tank,effluent filter and � ) dispersal pen,must all be services/maintained � ! I` r a per;nanegement plan provide y plumber. ' , ) 1 2. 0 r�fenta must mautained ,\/✓ Mpiir>tppYdllQOtMotdittlnncM, J , i 1 • 'tom - � `+ 1 �y : Lb la I kAl , i �✓ , i I I � `� r r i r • ,. ^_y i ,✓ I I 4 I I i I ; I I I 11 011 ... ...-....... _ ........,._... ._ .... .......... 1 I , .: ....... .......... If ItA it ' 1 fi I ' A� , 7J~Knn kn 'x!'s -a-E"xis~~/ ~IM~Qrc~tc-E pace ov, S u. ,l 1-1, S. 8, T, 2917Y P W, 74-. /l ✓i IY armed of .~udsan, a6. croik Gy Z4 b Seder? Slimes ~ a 'I" a1 ~'rfu:a:~ c~ l~s ~6cdreo.,~ k Sede~.e +P~s• c%aee r~ 1/~A~ s ,Iq Y S/qe3 ,Z"_d ~ 1'►4ar~= ~8e6~trn~scl;r~. C'apae; ~3frKL~ec.~t/ °~`'~f i Pa~E:o slur ed a)tV =ice. X' li~~Ee~r-~:«~usf-be fE. Q. Tpof'S,T. C/tanau~ ~ da airru.,ed~0~ %or 2io = . r1cbl 47.351' 5tUe11 igSEd of.►G,J Pill 114l4ion 5 des dlsf►u'sa/ ca..9'. k ✓i 1 y u~aod pd open y."d eal,l i.Jcode•d 9fok. Y 4,apr4x. p0.u1.Ts, cl;~trSalCe1/. Vent -94 - .p ~ 81~ Sid `62--- / - tm,,,7y wooded Ti'ou~ ~r~ N Road '`~PPraX /ayocct a; P/OPOSw node. 6t,:s ..~q ru / f?O.cc~.TS. d;spQrS./eel/s. ~n ce.l! ales = 86.c0(J•r oC ~ S P9. 3 a3 r Wisc.'bnsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479485 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: Zuliani, Walter Hudson, Town of 020-1005-90-000 CST BM Elev: , Insp. BM Elev: BM Description: Section/Town/Range/Map No: -7- 3 .3 1 Ltt S7 D Vd• - 08.29.19.15A1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTU ER CAPACITY STATION BS HI FS ELEV. Septic Bench rk 165 ee- 0-6q, Dosing C j Z I-0) U Alt. B J W`~ Z -ter S) ~~•63 Z~ 9~• Aeration f~ Bldg. Sewer Holding SttHt Inlet TANK S€TBACK INFORMATION St/Ht Outlet • `1 Ct z-~ `f TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > ~ 45t 2t0 r Dt Bottom T Header/Man. . Z b • , l21 } SD f ~j 5 / b -1 Aeration Dist. Pipe Holding Bot. System f PUMP/SIPHON INFORMATION Final Grade S 3 Manufacturer Demand St Cover GPM Model umber '4' Z r S',OS 2• Sgt N TDH LFriction Loss System Head TD Ft 2 S• 3 Z. Z7-1 Force in en th DDist. to well g 0 sp .13t SOIL ABSORPTI TEM NC Width ngth t No. Of Trenehhes--e 1I1~ a PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM S 2r 3)® 62'SD , 1 SETBACK SYSTEM TO P/L `T BLDG WELL LAKE/STREAM LEACHING Manufactur r: t INFORMATION CHAMBER OR T,n ~tYe~,f Type System: UNIT Model N ber. / t 12 DISTRIBUTION SYSTEM ' Header/Manifold Distribution x Hole Size Ix Hole Spacing Vant to Air Intake L„nC Length Dia PipeLen it Dia acing CJ SOIL COVER x Pressure Systems only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of odded xx Mulched Bed/Trench Center Bed/Trench Edges ITopsoil xx Seeded/S R Yes No r~-j Yes n No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection Inspection #2:--fi-~~ Location: 1032 Deer Run Rd. Hudson, WI 54016 (SW 1/4 NW 1/4 8 T29N R19W) De es Lot 1 Parcel No: 08.29.19.1 Al 1.) Alt BM Description = N'IA- fry (O ' 2.) Bldg sewer length 'J -amount of cover= i , /1D ST; 2 4dld2adL r a~~(°JZ~ `~!►~Qo Est l D ' - ow~. - - - - Plan revision Required? ~ Yes No i Use other side for additional information. L__ - - - SBD p,Q Date Insepctor's Signature Cert. No. 6 10 (R.3/9 L-T J t ^"""'i q i ~ s47 a-~ (IL. -Low r r Safety and Buildings Division County ` 201 W. Washington Ave., P.O. Box 7162 • ' o.) Iseonsin Madison, WI S 19 &iia y it Number (to be filled igy -C I r Ll De artment of Commerce (fig 266 3131 5/ Sanitary Permit App w ¢ k 4e. Number omm 83.21, Wis. Adm. Codation yo provide In accord with C may be used fm secondary purposes Privacy Law, s s (if different than mailing address) CRX S 1. Application Information- Please Print All Information (,NING <R/ Property Owner's Name Parcel # Block # 6blkller ZUj1,&,n ~ ID Property Owner's Mailing Address Property Locatio 029- z , q L(l W 1034 ~ O --IQL'/., Afaf%, Section City, State Zip Code Phone Number i cl) rs,4/ ,L ( T N; R-/-4E II. /Type of Building (check all that apply) I or 2 Family Dwelling - Number of Bedrooms ` S S Subdivision Name CSM Number 7 j ❑ Public/Commercial - Describe Use V-0/ ❑ State Owned - Describe Use ❑City_❑Village Township of 71 III. Type of Permit: (Check only one box on line A. Complet line B if applicable) ep ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System A. ❑ New System lacement System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner -2- 3 -7 3l s g Z V IV. Type of POWTS System: Check all that apply) 1 -3 -4 dft `§144on -Pressurized in-Ground ❑ Mound >24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In round ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line ❑ Gtavel-less Pipe ❑ Other Lain V. Die rsal/I•reatment Area Inf rmation: Design Flow (gpd) Design Soil A plication Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area o sf) System Elevation 3 6~ .I WOO I; I ~gU 8S'so V1. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tank- Tanks Septic or Holding Tank Ad -Z, AD I M) S Dosing Chamber w VII. Responsibility Statement- 1, the undersigned, assume responsibility for Installati n of the POWTS shown on the attached plans. Plumber's Na rint) Plumber's ' atu MP/MPRS Number Business Phone Number 0 d 7/,J -3606 -9646 Plumber's Address (Street, City, ~t`~ ate, Zip Cod / A) ZYA) 6~~WA) aZ J-~/Qje~ V1I County/Department Use Only Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater gate ssued Iss g Agent S' natu N ) 4, Surcharge Fee) ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval 1 optic tank, effluent fitter and dispersal cell must all be serviced /maintained 1 GQ4 as per management plan provided by plumber. pad 3~t~lw 2. All setback requirements must be maintained as per applicable code/ordinances. Attach c o m p l e t e place (to the C o u n t y only) f o r the system on paper not l es s than 8112 a l l inches in sine SBD-6398 (R. 01/03) 67, , d e UJ .n~, . .a P/;'! . d ec.. kuA) uu gay. Ac* . 3 - TtieN c~►S 3-x ~LaS 41 A~+ B.~~k V,,1ve pipt'~kv 3 e New a rxprf4 L ,v ~o l vv vlSib►N ~I 1 4, A. It o . C~,1 d~ Sic A t ear-. kuA) 3 - T~ceN c~►s 3x 8i•as lee log i ~ Pipe ' rat) 9'I 31 e New o rkf,rf aLbSA~ w A RAW. 4sbim5 10 jib) WY)/ Ck~ dq SAC Aj a b l~¢Yv c n . 8 1939 Wisconsin Department of CM4SOIt: E UA ION REPORT page 1 of 3 Division of Safely and Buildiigs A.C.E. Soil & Site Evaluations i~ d w 9"r iWis. Code Attach complete site plan on paper U 8' 11 inches in size. 11PIan ;?must~Y St Grob( include, W not limited to: vertical and n and percent slope, scale or drnemsions, north a a t near road. Parcel I.D. 0-1005-90-0 Phase print all informs n. R Pao= kdamahm you provide maybe used for seoorday pucpoees (Privacy Lao, s.15.04 (1) (m)). a Property Owner Property Location Walter L & IGm T. Zukani Govt. Lot SW 1/4 NW 1/4 S 8 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1032 Deer Run Road 1 CSM Vol. 4, Pg. 1022 City State Zip Code Phone Number City _J Village M Town Nearest Road Hudson WI 54016 (715) 386-3641 Hudson 1032 Deer Run Road I New Construction Use: 0 Residential / Number of bedrooms 4 Cade derived design flow rate 600 GPD N Replacement ] Public or cornrr>ercial -Describe: Parent rr Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install conventional POWTS using three trenches with combined E.I.S.A = 1,200 . It at elev. 85.50'. ❑ Baring # Boring A 108" in. Sod PR Ground Surface elev. 90.95 ft. Depth to knifing factor > Application Rate Horizon Depth Dominant Color Redox Description Texture St ucture ConsWence Mindary Roots GPD/ff= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfW1 'Eff#2 1 0-6 10yr4/3 none sit 2fcr ds cs 2fmc 0.6 0.8 2 6-22 1Oyr5/4 none sil lfsbk ds cs 2fm,1c 0.4 0.6 3 22-39 1Oyr4/4 none sil 2msbk mfr cw Urn 0.4 0.6 4 39-108 7.5yr4/6 none gr Is 0 sg ml - - 0.5 0.7 /D/, o H#4 contains approx. 30% coarse fragments and several stratified layers of 7.5yr416 Osg gr Is & 10yr5/6 Osg gr s too numerous to differentiate. Loading rate of horizon adjusted to reflect reduced permeability of horizon due to textural changes. a BofM # ~i Boxing 401 Pit Ground Surface elev. 88.75 ft. Depth to meting fwW >93" in. Sod Application Rate Horizon Depth Dominant Color Redox Descryion Texture Structure Consistence Boundary Roots GPD/fF in_ Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-10 1Oyr4/3 none sit 2fcr ds cs 2fmc 0.6 0.8 2 10-16 1Oyr5/4 none sit lfsbk ds cs 2fmc 0.4 0.6 3 16-28 1 Oyr4/4 none sd 2msbk mfr cw 2fm,1 c 0.4 0.6 4 28-93 7.5yr4/6 none gr Is 0 sg ml - 1fm 0.5 0.7 H#4 1s approx 30% coarse fragments and stratified layers of 7.5yr4/6 Osg gr Is & 10yr5/6 Osg gr s too nuns to differentiate. Loading rate of horizon - toWlect reduced permiability of horizon due to textural oranges. ' Effluent #1 = BOD s> 30 < 220 mg/L and T S >30 < 1 mg/L -Wlf cent 02 = BOD <30 mg/L and TSS <,0 mg/L CST Name (Please Prim) ignature: ° " CST Number James K Thompson 3602 Address A.C.E. Sol & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 7/152005 715-248-7767 • property owner Walter L & IGm T. Zuliani Parcel ID # 020-1005-90-000 Page 2 of 3 3]Boft F # e ~ Ground Surface elev. 88.52 ft. Depth to limiting factor >97" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Con t. Color Gr. Sz. Sh. 'EMI 'EtF#2 1 0-6 10yr4/3 none sil 2fcrr ds cs An,1 c 0.6 0.8 2 6-25 10yr5/4 none Sil 1fsbk ds CS 2fmc 0.4 0.6 3 25-45 10yr4/4 none sit 2msbk mfr cw 2fm,1c 0.4 0.6 4 45-97 7.5yr4/6 none gr Is 0 Sg ml - - 0.5 0.7 H#4 contaim approx. 30% coarse fragmerrts and several stratified layers of 7.5yr4/6 Oag gr Is 810y W 0sg gr s too rnnrrerous to differen iate. Loading rate of horizon adjusted to reflect reduced permiability of horizon due to textural changes. Bordg #9 F-I Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate H=w Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cord, cola Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # Bodng Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Awcation Rate Horizon Depth Dominant Color Redox Description Texture Structure Cmsisthruce Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Efihrent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5<30 mglL 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 608-2648777. . ~ $~~%e✓alua~~~JP~~ ~2,r Rkn Load • ~--c-'ki's~~g c~,•~e k~ce/,-ne C,u.(.-de- SaL pace ♦ Ex~s sa~~ Jcda~ton scale: / = 4/0, ko,- zmq 5 tag W S. 8, T, 24/1 ~ ~ / 9 oJ., T . kQ.n Ji tY wkr~acl of ~kdso~ ar;. croiX ~i t` b 5¢d¢rQ S/g0es oR 0 6-X S'ui'ng rcC ai✓;,v 4xt(j 444drov-1 edLrt U ell 4mce Ilef4;~ s/gPL3 ~M t e uGrK.~! ►'►'~arl~= oFSia~i✓7~. ►~;#is kc6urt% 1 r P&4;0 Assurmtd e)t,v. =/cn cn, lip i^usfbe Ib, Q. Tipo{S.T. C/tgnouf deE.1Pn,.,ed /0~/~r t5o Pltu~. E(tv: = 97.3f1" ~jl UL~{ i/J.J~y!/q lion OF~►GcJ S d; SpLrSa/ ca* k e4 Ji l y tad Ad mpen yafd eao:ly u)Caded ca,.+ou. 4PPrmc./ocQ6o., of - vent . ♦94 n 8$7~ J -a /{car,'!y t,koded O Ti'ou~ ,BroAC~ 0 Aoprer. */Yo at o~ ~roPpsed 8 ~1trEc = Ex,'s~•~g dlsp~~so~ / Road ~ P Pn ~ cep( e.la . - 86.co lot 0 P~ 3 a3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND O"ERSHIP CERTIFICATION FORM Owner/Buyer _ I u! I AA-11 Mailing Address f aAL &2N RQAJ Property Address nao-A 9,)/y 8,4& "SM W) S~o l6 (Verification required from Planning Department for new construction) City/State 1~~~,cb S 6-/) (A-) Parcel Identification Number 6,?6 - /D D s_- 1D -006 LEGAL DESCRIPTION Jfy-R_Z W, Town of Property Location "L*)f 1/4,10 Sec. . Ta "Subdivision Lot # Certified Survey Map # Volume Page # Warranty Deed # , ~48 ?a~_ . Volume Page # .5-19 . Spec house ❑ yes k no Lot lines identifiable O yes O no ,SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes, Proper maintenance 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 the septic tank as a treatment stage in the waste disposal system. The property awner agrees,to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restrietedplumber or licensed pumper verifying that (1) the on-site wastewaterdispoW system is in proper operating condition and/or (2) aftor inspection and pumping (if necessary), the septic tank is feu than 113 fall of sludge. Uwe, the undersigned 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 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 Office within 30 days of the three year expiration date. Lac 71 SIGNATURE OF APPLICANT DA'L'E ;r MME CERTIFICATION i '•ti -P(we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the propi*.described aabov~e~ by~ virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. Include with this application: a stamped warranty deed from the Register of Deeds office -a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity / wo t ) ( U gal ❑ NA Permit # 5/ Septic Tank Manufacturer ? e e ❑ NA -7 VP DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 7 ❑ NA Effluent Filter Model Q - U b ❑ NA Number of Public Facility Units j~NA Pump Tank Capacity / gal RNA Estimated flow (average) 3 / .J gal/day Pump Tank Manufacturer a NA Design flow (peak), (Estimated x 1.5) GOD gal/day Pump Manufacturer ~ NA Soil Application Rate 0 gal/day/ftz Pump Model NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) <30 m /L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) <220 mg/ ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 1 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODS) <30 mg/L 0 In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) <30 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) :004 cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ya in di . ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: Q-3 ear(s) s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 13 year(s) Clean effluent filter At least once every: [I month(s) [I NA 9+ year(s) Inspect pump, pump controls & alarm At least once every: , ❑ month(s) ❑ NA @ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA 8 year(s) other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ 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 identify 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 on the ground surface. 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 (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance 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 <12 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 any service event. Page 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 concentrations 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 pump 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 may 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 over, 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; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; 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 taken 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 replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should 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. A h site h s n een evaluate identify a sui lacement are pon failure of the POWTS a soil and site " e ation m t be erform o loca a sui a replace tar no re me s available a ho me be in lied as a resort to replace t e failed PO TS. ® 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/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name y„~FQ Name Phone S - Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name D 2 iJ Name S. Rb 1 X Co M N N Phone ~ I ~s ° I ~a E I Phone 3$ ~ - y 0 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. C'ROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEP'T'IC TANK This tti11s11 to certify that I have inspected the septic tank presently serving the L- d- I~)1v-, T Zu, liesN') residence located at: Sec. T a IN, R ) i W, Town of ~1/~bS6 ~J, St. Croix County, Wisconsin. Upon inspection, I certify that I Have found the tank and baffles to be in good conditi n, nd it appears to be functioning properly. Last time serviced log Did flow back occur from absorption system? Yes_ H01,41 (if no, skip next line. Approximate volume or length of time: _ gallons minutes Capacity: t~_~~ Construction: Prefab Concr j~ Steel Other Manufacturer (if known): Age of Tank (if known) : 2ro - Q r RMA M+fJ~6 (Sig re) (Name) Please Print T t3 D 4 V (Title) (License Number) l`3 11 (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 baffle). r Name _S) _Bb U m-e-e S Signature MP/MPRS - _ ~l bk4 - - Parcel 020-1005-90-000 09/19/2005 07:57 AM PAGE 1 OF 1 Alt. Parcel 08.29.19.15A1 020 - TOWN OF HUDSON Current X1 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner O - ZULIANI, WALTER L & KIM T OCHS - WALTER L & KIM T OCHS - ZULIANI 1032 DEER RUN RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1032 DEER RUN RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.460 Plat: N/A-NOT AVAILABLE SEC 08 T29N R19W SW NW LOT 1 C.S.M. VOL Block/Condo Bldg: IV P1022 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1114/518 WD 07/23/1997 925/534 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.460 37,900 199,800 237,700 NO Totals for 2005: General Property 3.460 37,900 199,800 237,700 Woodland 0.000 0 0 Totals for 2004: General Property 3.460 37,900 199,800 237,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 144 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 5 iC pt.y~ State Bar of Wisconsin Form 2 - 1982 WARRANTY DEED DOCUMENT NO. VpL,PI REGISTERS O~C(~c R ST. CROIX Ca., V!'! Recd fc; Record _JQ5egh_,Jichie_and_U1awn_S,Richie, husband-:_ MAR 2 0 1995 -and-wife., - at 11:00 A. r conv ys and wants to W8 te~'r L•-Zuliani and Kim T. 71 • Oc IS-Zu Yani, hus and to e, Register cfDec~!a TNIS SPACE RESERVED FOq RfCORnING nATA NAME ANU NETUNN AUONES the following described real estate in St. Croix County, Mate of Wisconsin: 020-1005-90 ~I (Parcel Identification Number) Part of the SWl/4 of NW1/4 of Section 8 Township 29 North Range 19 West St. Croix County, Wisconsin, described as follows: Lot 1 of Certified Survey Map filed December 18, 1980, in Vol. "4", Page 1022, Doc. No. 368417. R ~ s~H o, t ~ r This is homestead property. (is) r ) Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this 17 day of March 19_95_. ` (SEAL) (SEAL) Jose A. Ric ie . (SEAL) (SEAL) • Dawn S. Richie AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN SL St. Croix County. authenticated this day of , 19_-_ Personally came before me this 17 day of ~LlaLCh , 19_95. the above named _Joseph A, R~chie-a-r Dawn huS_l .and. _4dfea_ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, _ authorized by §706.06, Wis. Stats.) to me known ' who executed the fore . g in. THIS INSTRUMENT WAS DRAFTED BY Kris ting 0gland_ an 'Qeir Attorney at Law _ Nota P ie County, Wis. f (Signatures may be authenticated or acknowledged. Both are not My commission is permancnl. If not, state expiration date: w • ' FORM NO. 985•A y ' H. y.MIlsiCanpeny~ hq~m nC bobtar of D004 3684:7 CERTIFIED SURVEY MAP LEGEND TTED LANDS UNP~-A _5 o45'W 248.00' ~ SECTION S CORNER 84 ~~01~~~0 ER o 1"x24" IRON PIPE NW CORN o WEIGHING 1.68#/LINEAL SECTION 8 FOOT, SET. o~ T29N, R19W tD- 1" PIPE SET FENCE y co ti N v co SCALE IN FEET co r-rz f , N 1oD ..I 66' TRUE 0' 100' 200' w 4 VII--I c,, 2.41 ACRES I~ I I BEARING m I10 UNPLATTED LANDS 126.55' N 89°14'W ) 202o J J 8r 3n o der c 90° 138053'78~ ~6'o IC 5 o co n/g ' qv z -PRIVATE s°ss DrN~ °A 13405010311 3~~'83 0n V ~D -`1 P S890 141E 66o~G -i 2 m -7.> 126. 55' m 616, 1 >009, s \ m "'po SW- NW I , v) 3011 1 t o m r I I o N D 110 Ilcn'~ 6 ' 17 2.18 ACRES c IN 0 1 1 113043'1 9"~` 4 z 40031161r 00 u, x IN 3.46 ACRES 0o j ` 295 009141 4 o 3' Iw 295°09'41"' cc V 1 33'1 3 N\ 1 1 \ 1 . t IC 1 , R=80' z it 6 ' 0 165037'20 l., D a~ S a~ 1 6 a ~3 Z X84 0~ c D 1 \ a~ o ' 99, -I r o 10 0) m \ \ v~ 1 `\0 y 2.98 ACRES N Z N O 1.0 00 'r1 APPROVED v) Z \4 \33 57.46 1820401 w g \ Ln 6 19 0 00)0 3-on r~ °c 7 3 d d r CD 3 3 N W a N Q I~ cil CL N Z n m v fD O O ID U) CD P CO 5 CD a) n C) m ' o` D ° O 3 H ` ° °o o c p d W cn g D eo a O CD y W 3 o N O cn w v N (D rn c°~n a C (D co 0 r. cn m N N a N .O. a. h• I = I 3 ~ o OOOo 'j<~o ' 3(- C.0 : m m w Ui A .Z~1 Of A O to H rn m y N B m c ~ I a ~ N y I Z C W Z O ? a g o w v N C C C M. CD W cx a 3 5 _ Z ? co co a p 2 v a Q s cn N O caM gN) a Z i O Z CO H Z CD I p c Q c3CD O. 6 m m o I ~ m v c ~CL ao a m f_. N ~CL z B. N m ID, a ~ A I 7 Q ` co a A a CD j C e Q N N - O m cz O A O (D Op ~p ' A (A O ti O L ti FORM NO. 985•A n r N.yYMiI~NConprry~ r Co FILED DEC x81980 -0 AQU cowft V~ bobtar of 36841 CERTIFIED SURVEY MAP &2 C000 LEGEND UNPLATTED LANDS , SECTION CORNER S84045'W~ ~ p 1"x24" IRON PIPE v, NW CORNER WEIGHING 1.68#/LINEAL , BO`''G, 00 SECTION 8 FOOT, SET. ~ T29N, R1 9W - 1" PIPE SET FENCE co ^7 N v co IDlz SCALE IN FEET I ZIr I 4 N Q1 Iv9- Ih 6 ' BEARING 0' 100' 200' y 2.41 ACRES 0 m IIO ;o I I UNPLATTED LANDS o `J c IO ~I-I I j 126.55' O ~~Z J N890141W 2020181031, ~"11~°°, I Q V) 90 138053' ` 7 8 IC pdeD o~ \ 6'07, 1., ie o, .o St Sh a 134 ::g of3 ° 0' 03" N I D r~ v 3 14 I - ~,r'I tNO S89°14'E 3`1 '~~r1 . , G6°~ I- i 2 126.55' r SW- NW - m 1301, C'o I 1o I~ 1-i IC ►W ( 3 6 2.18 ACRES I~ I,00 Im'~ 113°43' 19'?. 174003' 16" Ln 1 1 1 4 '-o 3.46 ACRES NP ' 295oO9'41 _ ~ 33' 1 3' 2950091411' , 1 ~p 00~ 1 1 Ztoo 7 0 Ic: z it O R=8(I~+,/ "'C7 1 1 \ ' © 165°37'20" S -1 A o kp - 78 O~c m I m p Io o i` 6G c ~ o 9.1 IZ ✓ 9~ m S)' En Ut -n 2.98 ACRES N \ ~4 Z N O 0 \ ° co W APPROVED .9= N z \ 2 \\33' 57.46' 182040' 0 \L. \ \ n i. r1•t A lAAN "gr Parcel 020-1005-90-000 01/19/2005 03:32 PM PAGE 1 OF 1 Alt. Parcel M 08.29.19.15A1 020 - TOWN OF HUDSON Current X; ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * ZULIANI, WALTER L & KIM T OCHS - WALTER L & KIM T OCHS - ZULIANI 1032 DEER RUN RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1032 DEER RUN RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.460 Plat: N/A-NOT AVAILABLE SEC 08 T29N R19W SW NW LOT 1 C.S.M. VOL Block/Condo Bldg: IV P1022 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1114/518 WD 07/23/1997 925/534 2004 SUMMARY Bill Fair Market Value: Assessed with: 47622 307,300 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.460 37,900 199,800 237,700 NO Totals for 2004: General Property 3.460 37,900 199,800 237,700 Woodland 0.000 0 0 Totals for 2003: General Property 3.460 37,900 199,800 237,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 144 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 001-WATER SPECIAL ASSESSMENT 0.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 s AS BUILT SANITARY SYSTEM REPORT OWNER ::J-640 di l n stm. J r TOWNSHIP 14 46`t SEC. T,-%-R 2 ST. CROIX COUNTY, WISCONSIN. ADDRESS SUBDIVISION® Lc.n LOT LOT SIZE PLAN VIEW D 26 -96,00/ 0/0. ISM Distances and dimensions to meet requirements of H63 EUTHING WITHIN 100 FEET OF SYSTEM i e'l e _ I k 6 q-Lnt j a1 11 U r Z / J a e o crow , - ~'4 - S CAL peso BENCHMARK: (Permanent reference Point) Describe: -yz ('6 S Elevation of vertical reference point: /GM~ Slope at site: Cv Td SEPTIC TANK: Manufacturer: l,J t eSC/ s Liquid Capacity: Number of rings on cover : Tan manhole cover elevation: Tank Inlet Elevation: 1 2 Tank Outlet Elevation: j( Z ,0( PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cycle gallons; total capacity o distribution lines gallon: size o pump head; gallon per minute horsepower brand name of pump and model number Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: um er o pits feet diameter feet liquid dept seepage pit in et pipe-elevation % ~ ~ ~ f ~ ~ . _ ~ ~ _ - ~ 4 Z ~~~,2 J U~. ~ - ~ ~0~.~ - ~ r; ~ DEPARTMENT OF INDUSTRY, • INSPECTION REPORT FOR 'SAFETY & BUILDINGS LABOR & HUMAN RELATIONS h DIVISION P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS ~Io" UU BUREAU OF PLUMBING MADISON, WI 53707 CONVENTIONAL OALTERNATIVE State Plan I.D. Number: El H ding Tank El In-Ground Pressure ❑ Mound (If assigned) NA OF PE MIT HOLD R ADDRESS OF PERMIT HOLDER: INSPECTI N DATE: 4; Z_ CH MARK (Permanent reference point D SCRIBE IF DIFFEREN ROM PLAN: LtJ REF. PT. ELEV.: CST REF. PT. ELEV.. 1 a 4 ) vo Name of PI ber: MP/MPRSW No.: Coun Sanitary Permit Number: ' 3aay A y~37 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV. WARNING LABEL LOCKING COV PPROVIDE 0 ta4"~3 I Z-0o ~c?1 101,6 YES ONO ❑ NO BEDDING: VENT DIA.: VENT MAIL.: HIGH WATER NUMBER OF ROAD:: PROPERTY WELL: BUILDING: IVESH M FEET FR YES ONO C f ALDYE A INEARESTOM_-~ ✓U LINE: 751 /00 AIR IN DOSING CHAMBER: UID CAPACITY PMP OD PUMP/SIPHON MNUFACTURERWARNING LABEL LOCKING COVER LIQ MANUFACTURER . 7INGS PROVIDED: PROVIDED: ONO OYES ONO OYES ONO GALLONS PER CYCLE: P A DC NT LS PERATIONAL: NUMBER OF PROPERTY WELL BUILDING JV(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) U YES ❑Nn INEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing fH DIAMETER MATERIAL AND MARKING FORCE or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH. LENGTH- NO7OF DISTR. PIPE SPACING. COVER INSIDE DIA #PITS. LIQUID BED/TRENCH C TREN HES` MATERIAL: PIT DEPTH DIMENSIONS is 4(1 GRAVEL DEPTH FILL DEPTH OISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. 1 NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV. INLET ELEV. END. PIPES. LINE AIR INLET: 90,71 ~ 2'/ C FEET FROMf Z 7 97,0 NEAREST J 1 - - MOUND SYSTEM: Mound site plowed perpendicular to slope Check the to °ure ohe fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: m 1d sys ms to .11 ke certain that it ON REVERSE SIDE. SHOW ELEVA- mee s the iteria for riedium sand. TIONS MEASURED. OYES ONO J SOIL COVER. TEXTURE. - i• PERMANENT MARKERS: OBSERVATION WELLS. I OYES ONO DYES ONO DEPTH OVER TRENCITBED DEPTH OVER TRENCH/BED DEPTHPF OPSOIL: Is ODDED SEEDED: MULCHED: CENTER EDGES ; f OYES ONO OYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH NO. OF TERAL SPACIN JGF~AVEL~ DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES ; DIMENSIONS YIANIFOLD PUMP MANIFOLD F I TR pip Er MANIFOLD TER IAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. e LEV.: ELEV. DIA. EL V. r r' PIPES. DIA.: ELEVATION AND { DISTRIBUTION INFORMATION IDLE SIZE HOLE SPACING DRILLED CORR,CTL COVER MATERIAL PLARNSCAL LIFT CORRESPONDS TO APPROVED 'S ONO' _ OYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION ELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: OYES NO OYES ONO NEAREST---~ ~uv CA 103. 1 f, r) 10 0 5-G4 ~A.S n s f k,e It crl_~ C-e-•- &-<-f4j i,J~u2~-~` t.~•, y t o S Lj Sketch System on _,,,.e......._,._-.Retal In county file for audit. Reverse Side. NATURE- TITLE: e/~% DILHR SBD 6710 (R. 01/82) r DE=RAFTi\IIENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: _ Mailin Address: Property Loca ion: Crumb U orDwriship: County: ~ (A) '/a ~O/aS rvY /T t' t NCR 1 ~ *40v) X -j l !l /,ie. Lot Number: IBIkNo.: lSubclivysionName: - Nearest Road, Lake or Landmark: State Plan I.D. Number: +C (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: tE 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): IgNew ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit ,2p ❑ Alternative (specify) ❑ Seepage Trench Water Supply: ~J Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name oT&e4,4-t4,' bar: Signa MP/MPRSW No : Phone Number: r 23 Z (71:!5) YOZ Plumber's 9kAfress: Name of Designer: Z COUNTY/DEPARTMENT USE ONLY Sig a re of Issuing Agen Fee: A Date: APPROVED Sanitary Permit Number: 3 DISAPPROVED 40 3 F Llr~llr.A Z-01 (~f. I led son for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (N.03/81) 'DIEPARTR/IENT OF \ 1 FETY & BUILDINGS r~ INDUSTRY, REPORT ON SOIL BORINGS P.O. BODIVISION X 7969 LABOR AND HUMAN RELATIONS PERCOLATION TESTS ( ) FEe 26 DISON, W1 53707 19 10# 82 LOCATION:' SECTION: TOWNSHIP/MUNICIPALITY: LO LK. BDIVIS AME: 1/ 1/ 8 /T79 N/R/9 E (or) W ~fvpSoN COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: 54 CROI #A./ 11, CA vIJ E Sew 0/O &eal e o LCl %S • ' ~A'~ USE DATES OBSERVATIONS MADE NO. BEDRMS : ICOMME RC IA L DESCRIPTION: DESCRIPTIONS: PERCOLATION TESTS: FD V-L- - Residence New ❑Replace Z3 ~y~ RATING: S= Site suitable for system U= Site unsuitable for system y'v / CORISTOIONAL: U M®S DU I, 1ZS a~RE:S❑STS I©ULH~SGDU SYSTEM Aewlmrl If Percolation Tests are NOT required DESIGN RATE: S STEM E If any portion of the lot is in the -ry, under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: 1)G PROFILE DESCRIPTIONS Se'S Q,Uj,14j4-- BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WIT ICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.141 HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 9', 1,71' N S;L , /e2 " 67r•QiJ, SL W% B- 1 1 0^r"~, y 'luN l1Ef SiL /Q".• fti i+A Qle S;4 GS N OW-AV eawP - S4- B- Ft. f " AA), &Y' 4, 21 " Lf 6"j. S;L, 9 9~ Z 9a ArAV rdW s~ r;710,90 . a4 s /0 M' 1 ~-f3v ' Gy. I- „ L 5 G , 22 B 5Y " RxA_ (9tJ . eom &-e- 5 L °Ic P- «.,,;L O )L4 ~,3 Ff q 7"L/•aN."Gy~ L~ y°G . 1-, .25"/-1/•13/a.5iLq Ole- N Si- S S % -,L SL 25' - ~1T0. 7 F~ a 9"`'~ l3nt. '6y. L g /.3,v /,qA/ Sl4 36 B ,i o ~fltr~-&c.. d 8S S' N (Of > B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 ----7978 OD 3 PERINCH P- a P- Z 671 to P i {y . P- 3 2 P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show) the surface elevation at all borings and the direction and percent of land slop. f 7 J / • f!. ~j0 b ~'M !b'~~ cYwOUX t X~R'TLy y 3 fr SYSTEM ELEVATION yl'c~c ~P,`fRF.GeE ,ao~.u7~ . ;S flv t a~D ALL = EK E l ~ MAV*VAIy ; 4 CA Sr x- mil= r to ca~ FZ~M T r ~ ~ d_ ..ice - - - ~ ~ ~ . %~on) ~ ~ houlu~ ~ ~ ~ I= r I PRopcsE D I ~ _L d? E oA-) i 4'r. "Aig" a z _ti / 6v 5 57 GL~U/t T~d,v o ~ r a . r s • 1 C~ _ c ~ dXS' 1 ~ CIO, Vi V p~ N r=- F o c; it