HomeMy WebLinkAbout020-1015-50-400Wisconsin 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
Helm ren, Rich Hudson Townshi
CST M Elev: Insp. BM Elev: BM pescription:
TANK INFORMATION ELEVATI N DATA
County: St. Cr01X
Sanitary Permit No:
404923 0
State Plan ID No:
Parcel Tax No
020-1015-50-400
:i: C..
TYPE MANUFACTURER CAPACITY
Septic ~,~ ~-" ~!~-~T
~k ~ ~~ l~
Dosing _
~..,v
C
Aeration P~
Holding
TANK SETBACK INFORMATION
TANK TO C,. P/L
~C"l.l. V1~ELL
/ '~ BLDG. Vent to Air Intake
b ~~. ~. ROAD
~
Septic ~ II ``', /J~~ r
4UV
~ ~~' / w
~
''~ +/
7 ~ ~rJ
Dosing
Aeration
,:
Holding
PUMP/SIPHON INFORMATION
Manufacturer Demand
__._"-- GPM
Model Numb
TDH Lift Friction s System Head TDH Ft
Forcemain ngth Dia. Dist. to well
SOIL ABSORPTION SYS
BEDITRENCH Width ~:~ Len h ~' No. Of Trenc~t e9
DIMENSIONS ~~ '~
SETBACK SYSTEM TO "'IIIGGG ~~"' P/L ~ ¢LD
INFORMATION Type Qf S~ys~te)mp:/ ~ ~ }-~ ~ - j /
r11STRIRIITION SYSTEM '~lj /~ f~
STATION
~2 c. BS HI FS ELEV.
Benchmark ~/
Alt. BM 11 LL
L <i, 6 - `lsr
~ ~
~,y y `
,~
~dg. Sewe[f~~ ~~ f~`h
z,v~~r--~
~, ~
o ~ .
St/Ht Inlet /~~",, _
Ht Outlet
/a. ~~
Dtln J
Dt Bot ,~
Header/Man., ~ jY1V-t'r
~~ (J' 9.~ ~. ~~ rct
ot. Sy tem -- ~ `~
Final Grade
tD r~
~ ~/ '
St over
DIMENSIONS No. Of Pits Inside Dia.
~ /' -
~E/STREAM LEACHING ManNfac u
CHAMBER OR ..-Ll~~
_~ ~ ~ UNIT
'~V
Header/ i~ Id ~,, Distributio 1, , ~) b~ ' ~ , L~ ~ x Hole Size x Hole Spacing Vent to Air Intak~
Pipe(s) {, '' ~ ;~ (J ~ft _~ j~ /~
Lengt Dia ~ Length Dia Spacing ~
SOIL COVER ., o.-e~~~~ro c.,~rom~ nni.. YY Mnnnrl nr At-Grade Systems Only
Depth Over jJ Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center ~ I ~ BedlTrench Edges ~ Topsoil Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ ~~~/~ Inspection #2:_ / /
Location: 1016 Arctic Trail Hammond, WI 54 1i5/ (NE 1/4 SE 1/4 12 T29N R19W) NA Lot 4 Parcel No: 12.29.19.690
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1.) Alt BM Description = ~'~~`'~.~ ~`-' ~~
2.) Bldg sewer length = ~~ (S~'1 ~ . -~- G f..~L' ~ ~i~~.C'-f;-L~ ~ ,~k..
-amount of cover = J~ I ~ `t ~~h ' ~/ `„ti.~~ ..~, -~z~r~~
q ~
Use otherls de for add tional in Yes No
..formation. ~ ~~ _~ ~ ~ ~' ~ l ~C~ ?'~uG~C l~ ___ ~~( G7~1/t!t. _ _ _ ~~~ S~~i`'~ _ `~"
Date Insepctor's ignature Cert. No. ~
SBD-6710 (R.3l97)
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~. 1-Z-0l-OZ 715-425-0165 220254 pZ.~~[
CST Signature Date Telephone ITo. CST PIo.
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Safety and Buildings Division C~tY ~~
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201 W. Washington Ave., P.O. Box 7162 `
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I~CO~~,n Madison, WI 53707 - 7162 Site Address
De artment of Commerce hLts<- Zzs O /lo /~R.L'T~tt- TQ.~4t v
Sanitary Permit Applicatiu~ ,- Samtary Permit ~~~
In accord with Comm 83.21, Wis. Adm. Code, personal information provide ^ ~~k if Revision
ma be used for seco ses Privac Law sIS. m
,
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I. Application Information -Please Print All Information • ~ State Plan I.D. Number
---~
Property is e _ ,,
`r, I' (Number l
D D ~~Oll
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Property~\\Owner's /, /~Q/~ ~
`~~tsilf .!'
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~ perry Lo(c~ation ~7 /
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City, State Zip Code ~, "`~ ay ~ Lot Number Block Number
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II. Type of Building (check all that apply)
^City
~
~~1 or 2 Family Dwelling -Number of Bedrooms
^Village
^ Public/Commercial -Describe Use
Township SON
^ State Owned Nearest Road
III. Type of Permit: (Check only one box on line A (n bering scheme for internal use). Complete line B if applicable)
A' 1 ^ New 2~Replacement System 3 ^ Replacement of 6 ^ Addition to For County use •-
stem Tank Onl Exis ' S stem
B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued
,t
IV. Type of Permit: (Check all that apply)(aumbering scheme is for internal use) a~ Cljq~ i'/`S ~fi•y Cst p L' a ~ .P~
44~ Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter 50 ^ Constructed ryetland
22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line ~],~ ~t 3 ~ ~~ p~P~rp
"~
45 ^ At-Glade 46 ^ Aerobic Treatment U ' 49 ^ ulating 30 ^ Other
ri (~
V. eatment Area Informat ion: t_
Design Fiow (gpd) Dispersal Area Dispersal o A canon Percolation Rate stem 1?lev on
~
~ Final Grade
~
Required Propo ~,'~ (~] te(G s./Days/Sq.Ft.) (Min./Inch) LJ6 , ~
j Elevation jD~,~
~~~~ s ~~ , ~ rt N
~1 9~
75 ' ~q'G 1
x .
. ;
s
VI. Tank Info Capacity in .Total Number Manufacturer Prefab Steel Fiber plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Talcs Tanks
Septic or Holding Tank x _ ~ p ~/+
C..!'
Dosing Chamlm
VII. Responsibility Statement- I, the tmdersigned, assmme responsibility for POWTS shown on the attached plans.
~~~~er's Name (Print) ,/ ~ Pl r' Signature nNumb~ejr~ f Bustin/ess PhoneQN~u(~mber
Plumber's
ress (Street, City, Sta ,Zip Code)
A
dd
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VIII. Coun /De artment Use
Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
^ Owner Given Initial Adverse . Surcharge Fee) _
~
Determination ZZ S. .Z8
IR. Conditions oP ApprovaUReasoas for tsapproval
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~ _ ~ ~ "A/tac6 ~St)rp County on17) far the system on papee not leas than 8112 a 11 inches to ~u
SBD-6398 (R. 05!01) ~ (~~~ct~rtw- ~--~---~ t~~•~.gAa7u~'tT~M s.ep'~ZC.~a.t,~.~~~~ ~ °'°~¢'
PLOT PLATT
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~. 1-Z~-OZ 715-425-0165 220254 pZ.~~
CST Signature Date Telephone ITo. CST PTo. Job PTO. '
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ~ of 3
Division of Safety and Buildings
' ~ ~ in accordance with Comm 85,..11~s:-Adm. Code _
+ (`n nh.
Attach complete site plan on paper not less than 8 1/2 x 11 in in Size. Plan must. vvy ~~ 5~' L'j~ `X ~
include, but not limited to: vertical and horizontal reference -'nt (BM), d'rection and
percent slope, scale or dimensions, north arrow, and loca 'ort,2nd dista tp barest road.
!,
, Parcel LD.
O ZQ - 1 D LS - S Q - ~ 00
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Please prinf all inform iAn
~ ~ .Reviewed by Date
i~ ~
Personal information you provide may be used for secondary u es (Privacy Law, s. 15.04 (1) (m)). '
i
Pro
perty O
w
ner
_ t ~~rrty Locatjq~ ; '~
p
l
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`~~C~ "^"U SUE ~ ~~-~ G ~Z.- C ~ ~ ~1/4 SE 1/4 S ` Z T ~-~ N R l~ E (or W
Property Owner's Mailing Address ~ of # Block Subd. Name or CSM#
P-o...sox ~l~Z ~ _ Csr~ Vo~.l~, l~5 3q~19
City State Zip Code Phone Number
l~
vp s
~
- ^ Village ~ Town Nearest Road ~ ~
~
c
ore
v 1 S x.016 c
1 LS) ~ ~lq -3 ~ S I t`~bSO ~v ~-Rc.~.c +n~ ~
^ Mew Construction Use: [~ Residential / Number of bedrooms) Code derived design flow rate _ _ U S~ GPD
Replacement ^ Public or commercial -Describe:
Parent material _ G l.Pr@.LI'~. ~ ~ ~ ~'31~ Flood Plain elevation if applicable ~ ~ ft,
General comments
and recommendations: 3 C-LSJ-~S ~ ~e.L~1 3i X SO ~ LONG ~1 ~ g V-v Ct-~ OF 1-~-'16~~ Ci}~~(~e,!`1"~
S ~ ~ L~-._11 ~ ~~1 ` _ `~`P-v Ls e.~~''I ~3~~ 1~ E2 c.L~,~. .
Q ~~~ C~ ~t.l.S Tp a~ fti ~X~ ~ u„t `39' ~ DLL . ~'se~~T~ CN 1~ 3)
a Boring # ®Boring ~ ~
Pit Ground surface elev. ~ R_ Ilanfh }n limitinn f~Hnr 7 ~ ~ S ,n
y ~~~~
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate
GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
o-l S lob ti 31 Z - s t I Z.~S Irk ~„1`ft-- - 1 ~ . S . ~
Z 1s-3b ~~ ~~ ~1~ - si I Z.~sh ~~~ - -~ • s •U
3 ~ 39 ~.SY23Ly _ ~, S ~ Sg h1U`~ - - .-1 ~. '2..
3q-S 2 ~•S~Ia'Z31~ -- S ~ 6~- O Sq rn ~ - - ,`I ~. Z
S S 2 Z S ZS `{ 6L fit'(, - S D S 9 Yv) ~ - ~ 1 l. 2
a Boring # ®Boring
pit Ground surface elev. ~ ~ ~ • Z ft. Depth to limiting factor ~ 7- S in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff:1 I 'Eff#2
1 0-~Z l~`tuZ 31Z.. - ~ St 1 Z~sbt~ t-v~`~r 1~ - S - $
Z 1.'Z._i9 10 K2 3~` - S) 1 Zwi Sbk ~ W-S~t- - - _ S . 43
Lf ~=1S '1,S~-12~1~ S O g5 Wl ~ -7 1. 2
9G. ~
-•••~~••• • - .~.~s - .... _ ~.. ~~~~,~ anu 1 JJ rov _~ ion rngi~ - ~muen>; ~~ = tsws < 30 mg/L and T55 < 30 mg/L
CST Name (Please Print) ignatur CST Number
Arthur L. tdegerer ~ ~ ~' ~ ~ ~ 22254
Address (~ e g e r e r S o i l Testing &, Design S e r V i C e Date Evaluation Conducted Telephone Number
t121 i1. I~iain St. River Falls, [•TI 54022 ~ ~ Zq_pZ 715-t-25-0165
a
Property Owner l~S~l-~'~(G IZ~~ Parcel ID # ~, Z ~ ' l ~ ~ S - S ~' ~(ud
Boring # ®Boring
^ pit Ground surface elev. ~ ~' O ft. Deoth to limittnn factor 7 -l s ~.,
Page Z- of 3
Horizon
Depth
Dominant Color
Redox Description
Texture
Structure
Consistence
Boundary
Roots Soil Application Rate
GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
Z o -1.0
1 O 36 l.a `~ 2 3L
10'-1 R 31 '-~
~ S t (
S) l Z `Fs b-~c
Z~ S(v rn '~ r
h? `FIB -
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- . s
- S - s
• g
3 36~ ~.sy2~l _ S US -~ I - .~ ~.~
f 9 , ~'~ (ye .b, z
Boririg # ®Boring
Pit Ground surface elev. qq- ~ ft. Depth to limitinn fartnr ? ~ S
Horizon
Depth
Dominant Color
Redox Description
Texture
Structure
Consistence
Boundary
Roots Soil Application Rate
GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
I o-9 1 ~ ~ tz ~l - s i I z:`Fs b ~ vn`F-r ~ l `F . s . ~,
Z 9 -Z.I l0Y 2 3~(, - S) ~ Zt~Yj S~{-c ln'~Y- ~ - , S _ ~'i
3 ZI -Z -7. S y 2. 31 - l S ~ g9 ~"i l - 7 ~ - Z
y Zt./ tS ~•S ~~vtr - S c~ sg vYt I - .7 t_~
.r~-- `1PI'v-~'
-y ~(
^Boring # ^Boring
^ Pit Ground surface elev. ft. Depth to limiting factor in.
Horizon
Depth
Dominant Color
Redox Description
Texture
Structure
Consistence
Boundary
Roots Soil Application Rate
GPDlft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
• Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BODs < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
580.8330 (RN00)
Y
' PLOT PLAr1
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CST Signature
Page 3 of 3
~~D1~-ASS= .101(, t~CTiC TR.f~1~
./ i^-?--tZ-L _ t_5 ? ! Q 0 ~ 1v ~ OF S'-IS~S~ .
----
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1-Z°l-OZ 715-425-0165 220254 OZ-l~
Date Telephone I.1o. CST Tdo. Job PdO.
`~e a System• Management Plan
' Pu s~uanC to Comm 83.54, Nis.Adm. Code
• The septic tanKsh~fTe maintained by an individual certified to service septic tanks unCer s. 281.48, Scats. Tne pntents of the
septic tank shah be disposed of in ac~,irdance with NR 113, W is. Adm. Code. sting gndition of the septk tonic and
outlet fitter sFialt be assessed at least once ever/ 3 years by inspec:lon. T patio. film s~ ~a;l be c:eared as necessar to
ensure proper ooeraticm. The filter cer~idge should not be removed unless provis;ons are R'~ e o reta,n solids in the tank that
Wray slough off the fBter when removed from its enc'.csure. If the fitter is equipped wiU1 an a - „ ,the fitters.
the alarm is ac5vated pntinuousty. Intermittent filter alarms ma utdicete su a Bows or an im `~ be serviced if
sePSc tank snap have tts gntents removed when the volume of slu a and sr..rm in the tank exce~~ pntinuous ~artn' Tne ~-
the tank if the pntents of the tank are not removed at the time of a trlenniat assessment. maintenance pew ~ shaU~dvise
' the'owner of when the next service needs to be performed to maintain less than maximum scum and skrdge aazrrmulatkan in
_ the tank The addit{on of bialogtca! or ~emicat additives to enhance septic hannk Perfomtance is gener.By not required.
However, d sum Products are used they shaft be approved for septic tank use by the Deparbnent of Commerce, Safely and
Eur'iding's Division.
umo Tank
The pump (dosing) tank shag be ms at least ery 3 years. Aft switctses, alarms, and pumps shag be tested to
!mil proper operation. If an eft9uent fifer' sect the tank ft shag be inspected and serviced as gecessary.
At- rode Component an ressure Distribution S stem ~
Ho.trees.or shru oul be plaate or allowe to grow on the componea antings may
e made around the perimeter and the component shall be seeded and ched as necessary
t prevent erosion and to provide some protection from frost ration. Traffic (other
the or vegetative maiatenanc.e) oa the component is not wad. Cold weather install-
ations equire the component to be heavily mulched spat protection.
Influent qua ty into the at-grade system ma of ezcee3 22Omg/L BODS, ISO mg/L TSS and
30 mg/L FOG. In ent flow may not ezce the maximum design flaw specified in the permit
for this installat
The pressure distnbuticn system is ed Hdth a ftuslvng potrrt at the end of once biterd, and ft is repmmemded that eac't
Iaterd be flushed of aprtcnulat oGds a once eve 18 months. When a
gmpared to the infiai en the system ed to detemune g orifice test is pe<forsmed H shook! be
~~ to main dtstr~butian within the disp 99m9 has oc~nred and if orifice cteaning is
Observ oa pipes vi thin the dispersal cell sh be'checked for effluent ponding.
Poa ng levels should be reported to the owner an ny levels above 4 inches considered
as impending hydraulic failure requiring addition m rre frequent monitoring is
accordance with•Comm 83.52 (2), .
General ~~
Th s.sy§tem shall be operated i-n accordance with Comm '82-84 Wis.Adm~.Code and shall be
maintained in accordance with it!s component manual SBD 10570-P•(H.6/99)~and.Iocal and
state roles pertaining to system maintenance and maintenance reporting.,
No one should ever enter a septic or Pump tank since dangerous gases m.^y be present that putd cease death. Septicand - r
PAP tank abandonment shag be in acprdance wr~h Comm 83.33, Wis. Adm. Code when the tanks ate no ku~ger used as
POVYTS gmponents. .
Septic or ' ~ .
Pip tank manhole risers. ac: ass risers and Avers should be inspected for wafer tightness and soundness. Acxess
ePenings used for seance and assessment shag be seated watertight upon the pmpletion of service. •Any opening deemed
unsound, defective, or subject to failure must be
be saaaed by ~ effet'tive reP~ced. t-xposed ac.,.ess opertings greater than 8-inches in ~ameter shaft
locking device to prevent acadenta! or unauthor¢sd entry into a t<n!c or pmponerrt.
anav plan
•~ ~rdc orarry of its components bepme defective the tank ar pmponent sirup be repaired ar repfeCSd to keep the •
PfOPe!'oAer?tlng condition. _ ..
if the-dosir~ tank pump, PAP carttrats, alarm or related+-- - . - •
~~ d or replaced with a pm neat of the same orbecames defecffire the defective component shall be •
Po equal Performance. _
. If -th~ a grade compoaeat-fa3.ls to accept ~rastewatnr•or bsR3ns~,o`disc ergo^wastevater~to
the giound surface, it may be necessary to install as aerobic pre-treatment unit ar
.replace the component. Additional site and soil•evalnations may seed to be doae.aad ~`
addizioaal pleas may'aeed to be prepared-and approved by the Department of Coamerce,•
Safety and Buildings Division. -
_ _ _ _ ~ _
Questions•about~the operation~or maintenance of•this system should~be directed to:
>.
-• The CouatyfZoaing Office at _-Zls- Z~-3-. 6'?~'7 1~1.~ •: ~~-l~/Ji~l(3~'~-'~16,
The ,system installer at __ 1 ~.S _ Z,s- ~Q S~ : - hJf~,J _ ;
The tank manufacturer at ~• _3ZS_ S ` t
.The effluent :filter'maaufacturer at ~0~ - Z21. S-?~[2. Zri~~rt, i~ ~Lo~
. -
Own uycr
Mailing Address
Propcxty Addressv /L~l'
ST CRO[X COUNTY
SBPTiC TANK MAINTCNAN(.' AGRLeMeNT
AND
OWN~RS({[P C~RT[F[CAT[ON FORM
(vuifcatioa rcquic+cd from Plaaaiog Dgpubmcat for
~~ ~ ~4h~ ~011~~
coastxudioa)
C~ity/StaLc .~bl~ ( r ~ Panxl Idwtification Number %J~ ~ S'-- ~ ~~
Z.~AIi A~~'TI'ON
Propuiy Loc~tioa/~ %, ~ /ti Soc.
T~N R ~ W, Towa of ~,~'~~
Sabdivision Lot #~
«t Stuvey 11rLap # ~ ~ ~ % ~ volume _ 1 P c # .3~~
-~._.., ~
Warranty Deed ~ Volame pie # M
Spot b,~ase ^ yes ~ no .
Lot tiaes idwtifiablc ($yes ~. no
~~~'~~WA~TG~
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i~~bw7~ynrmpZmmbq 6y8reo~raczaad{ry: a
or=Feocasod tit(Y~~,eoaa~Ge:rastca~eratspsbcm
is ~a{uoperopr~g,oa:ad/oc(2) a&r~ C¢.~it kssdua 1l3~arll ofl~ludg+G,
.~ ~~rc.a~ddre
~ ~~~ ~ ~ ~ ~ad~ooe b ~o.tbo pcirite sego dispos;i sym0eott~, Qre ttmdatds
_~' mcmtaf~eooemdtSeDof'fiSt:~ofWisoaosia~. d~fiba
days•aftbe ~dstG m°~bec~oa~idodsaRtnbaaaodtoffieSGQoa.Coum~r?,aaia~O~,oe~m30
SIGNA pF ~~ d I'~3/d
DATE
~Wl'~ ~C~R1~CA.~ON
Y ~~~ flat all statRxacats oa Otis fooa anc ttac to the best of mY (onzj lmwwkdgc„ I (wc) aat (are) the owact(s) of
~ abo~rr, by vicdsc of a
dood inootdod is ~gistrx of Daods Offices
SI(~Nlt. t)F ~~ ~
DATE
ssssss ~, ~~~ that is mis-rtod a~ay moult is tt,o:wituy limit bcictg t+cvolc~cd by tltc Zoaiag Depattmaat- •sss.•
ss Iadadc ~dth thts appticatioa: a sCawpod wac=xaty flood fi~omt tha ~~. of Doods offioc
a oc~y of the axtifiod cucvoY ~ if t~cfa+caac is aiadc in the watraaty dcod
MG W ^IMOaapry~
t)OCUMENT NO.
356~~'76
von 5~'3 FaaE 55
Aoy Hopkins and Edna Hopkins, his wife,
conve s and warrants to ~ M
~IieLtwrrn, htasband and wife ire -tenants. -
STATE 8AR OF •19CtON9IN-F91W 1
MAIIMNTII OEfD
fNlS 3-AC[ NESEMEn FOI1 lIECWlOil16 OAf~
REGISTERS OFFtGE
ST. CROIX CO., WIS.
Rsc'd for Record !Iris ? h
doy of A~ ____A. D. i 479
of 9 s SO A. ~,. PA.
TO
the following described rcai estate in St• Croix County, j
State of Wisconsin: ~
A parcel of ].and located ixl Section 12, T29N, R19W, in the
Town of Kuc3son, St. Croix Ootnty, more fully described as: Tax Ke No.
Commend.ng at the SE corner of said Section 12; t2lenoe S 89° 5 $' t(, 46 2 y ~
feet; theme N 264 feet; thence W 66 feet tD the POIl~ OF B~tIlVG sa maxiaed by a steel
survey post; thence W 516 feet to a steel post; tfietloe N 1046.05 feet tC a steel stake;
thESloe N 1321 feet to a steel stake an the North line of the N~ SF}j of said section;
thence E 286 feet to a oatteritec~-in treated post; thence S1325 feet to a o~lted-in
treated host; f3ienae E 231 feet to a e~nentec~-in poBts thence S 1046.05 feet to the P'QII~tt ~
OF BEGII+~TG, Zbgether with a norr-exclusive easeme;lt far an access mad and for installati
of utilities, all utility lines to be loc~~tc3 as to not interfere with the use of said
area as a mad, over and across a strip of land 66 feet in width Lying North of the team
road, the E line of said easat~it being described as follows: Cauoencing at the SS corner
of said Section 12, thence S89 5$'W; 462.00 .fleet; thence N 110.59 feet mare CE'les3 to the
oPSlter of the east-west 1ts~t Arad and the PCII~ t]F BEGII~IIBING; thence N 1199.56 feet more
or less tic the Southerly botaldazy of that parcel of land recorded. in Vlol. 566, Page 442, ~
Doc. 345433, Register of Deeds office for St. Croix Canty, Wisconsin.
Zllis cieEJd is givhn in performance of a land contract between the above parties, dated
Sept. 2$, 197$, and reeoanded an Oct. 4, 1978, 3n Vbl. 582, Page 254, Doc. 3521.
Buyer is not to force the building of any fence on perimeter of the
~:coperty. Any fencing desired by the buyer to be his responsibility. ~
This ~ not homestead property. TR.AN$~
(is) (is not) d+~ ono
Exception to warranties: ,1
The grantee is not to subdivide the above parcel for a period of five
years without the consent of the grantors. ~
Dyed this 10th day of AAxiI , 19~.
(SEAL)
(SEAL).
AtITNENTICATIOlt ACKNOrr~E06MEliT
Signatures authenticated this 1Qth gay of STATE OF WISCONSIN
~ County.
Pecsonaliy came before ale. this dale ofE
,;
'~ the above aaaied
_ ` ?TILE: 1MEIiBER STATE BAR OF WISCONSIN
(lf not,
authorized by 3 706.06, Wis. Stets.),
This iastn~medt was drafted by -- ,
_ ~,
HEYWOOD AND CARL. by JC~I D. HCYWCXn to me known to be the peraoa _, who ezeetttsd the fore-
1~udsQSt itiseo[tSin 54016 going instrument and acknowledged the same.
(Signatures may be authenticated or acknowledged. Both ~'
ate cot necessary.} _ Notary Public County, ilia.
6fv Commiaaion is aersueaet_ !If eat. stela estairatioa
N
l
1
~~
FILED 2
6 nrn_~
`r..~~
~~r t ~+ LVVV - 3
KATHLEEN H. WALSH
Re9isterofDeeds CERTIFIED SUR~/EY MAP
~.~~,~
ti ~ ^CATED IN PART ^F THE NE1/4 ^F THE SE1/4 AND IN
°' PART OF THE SE1/4 OF THE SE1/4 ^F SECTI^N 12, T29N,
R19W, T^WN ^F HUDSON, ST, CROIX COUNTY, WISCONSIN,
OWNERS MATCH LINE OF w~S~,
RICHARD & SUSAN HJELMGREN SEE SHEET 2 '~~ Oy
P.O. BOX 1112 ~P DOUGLAS J. ~~
HUDSON, WI 54016 y Z
Q ~ ~ I *. ZAHLER
~7 i I ra l~ l S-2145 ~ W Z 3
89157'29" a I~ I~ I~ I HUDSON, ~ o a,
r I Inn ~ I WIS. S U N
~~ ~~~ Vi ~; ~ N N
~""~ tt11nnII11 ~, I p p~
nn~ I o _ CO Ol ~l ul !oo l ~~ CWj O Z
IJI ~ cro ~ I~I~I I~ WW0_'
v I
O l O l rJ l M 66' W Vi vl OI LJI ~I ~\
~; ~~~~ w LOT4 $ Q{~~~'Q~ ~~~ ~ ;o
-~I ~ I ~I rn 6.114 ACRES Op al I a w
o~ ~ a I ['~ I O iv 266,319 SO. FT. °00 ~ °al ~~ ~
~i wi0°i o ~ to ~~a
O W Q cn
~ i [15 i~° i z o N89°38'11 "E m w
I ~~ I 231.22
I ° I LJI g , ----------
t~n,i d I ~I z
~° I 0 i ~ i HOUSE &
~~ I~ I r GARAGE o, 0° I
I I ~ ~I I
U[~il] i ~ I OO I ~ ~ HE ® EXI TING ~ i ~ i (!(o~ j ~ i ~J I
/; (~ i o l I ~ SEPTIC DRIVF ~ ~ I° I r"~ I
~J I QI ~~ ~I
Q ~ APPROVED 66, N ~~ ~~ ~; QI Lw1
(01., ; ST. CROIX COUNTY ~ ~° i 0 i ~ i o i ~ I
lar~ning Zoning and Parks Committee ~ i ~ i ~ I ~ i ~ I
SEP 14 200a ~ ~I OI a; ~I ~~
~ nil nil ~I I I
~ ~ 78°3444458.13' o~ °v~i V~ OI ~i ~I
~If not recorded within 30 days of • 227.72' ~ 320,24, •- QI °~~ ~I QI
~~ approval date approval shall be S7 , 298.76 pl ~TIN~ q a ~ a
/t ~ \nuil and void 8 44" RI
OQi / \ • E 526.48 ~ ~
d ~ • • LOT2 ----------
~~ ~ ~„ \ ~ 3.643 ACRES ~
n 158,681 SO. FT.
~ o~~ 1~~~ ~ Should Lot 2 access from the
~~ - -- / existing access for Lot 3,the `r~ O
/ ~~/ / ~ access would be required to ~ o o ~ I
~ ~ /~, / I be upgraded to County road N O ~I QI
p / Standards. ~ ~I ~I w t1J~1
?ROPgSED ° I° i~ i~ I~ I
/ \\'~~/ 233.97' S84°1 7"E 518.77' DRIVF Q~i ~i 0°
/ ~~ \~° I 284.80 OC i ~ i ~] ~nnn I o ~ ~
H O p UI O ~I
/ ~~ I • UI I~IC~ IM If~I
w / ~~o ~I I ~I CSI V-~I ~I
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c~5 I ~I ~I ~I no
b 314" REBAR FOUND ~ LOT 1 N Q, CSI ~I Q, CSI
~ O 3.643 ACRES a l ~ I
~ ~ S86°52'06"W, 7.85' ~ 158,707 SO. FT. a; °~
FROM SET CORNER. PROPOSED 3 33
m ~ ~ I DRIVE
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• f AS BUILT SANITARY SYSTEM REPORT
I
~ "-~R ~ , TOWNSHIP~~i~~,~) SEC. / z- T~ N, R~W .
.0. ADDRESS ~ff~,,q~j, z , ST. CROIX COUNTY, WISCONSIN. .
_~3DIVISION LOT LOT SIZE ~~yl,~,NF~ -
PLAN VIEW
Distances ~ dimensions to meet requirements of H62.20
. lz
~~
..~s'~
i,~.
~`~~~1
'TIC TANK(S) ~. MFGR. ~: /,~/. G'' . CONCRETE
NO. of rings on cover Depth DRY WELL.
3NCHES N0. of width length .area
=~ no. of lines Z width Z ~ lengthy Z ~ area ~ a~"'
depth to to of pipe /~'
uREGATE f 8" ~/S~-~. ~ "' ~us h~Cf'-'
~.K RATE ~~ ~ AREA REQUIRED ~~~; ~' AREA AS BUILT ~~iG'~'
sciaimer: The. inspection of this system by St. Croix County does not imply complete
_~pliance with State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no liability for
item operation. However, if failure is noted the County will make every effort to
ermine cause of failure.
r--
f y
R€PDRT OP INSPECTION INDIVIDUAL SFUlAGL SySTFM
-,
Saru.~ary Penm~,~ ~~
S~a~e S~p.t~.c ~~~~
,, ~1 , . / -
NAMF / Ztic'--~~~.Cu~ ~'~ ,~,i~?t,~~;~ '~i`awneh~.p ~~2~~.~1~'~z% S~. Cno~.x County
;/ _
~,
CFPTT(' TANK ..
S.ize~„ ga.2.e.on~ .
Bu~..2d~.ng ~- c fix.
ii.i.ghwa~en ~ ~~.
DISPOSAL SyST~M
D.id~anee Prom: We.~.~ ~ ~~.
- Bu.i.2d~.ng~b~.
H.Lghwa~er "-' ~~.
PIPLD DIMPNSIONS:
GJ~.d~h a ~ ~nench l ~~ ~~.
Length a~ each .~~.ne~'~, ~~.
Number. a~ ~~.ne~s_
~'a~a.C 2eng~h a ~
D.Le~anee be~.veen
Tv~a.~ abb on6~,i.an
-- Rec~u.ined area _
PTT DIMPNSIONS:
i
`;y
2.ine~s~~~.
.2~.ne~5 ~~.
area ~ ~. ~~2
1~~~ ~~2
12~ an gnea~en 6.2ape `~ ~~
Gle~.2and~s
12~ an gnea~en ~.~ape
~~.
~~.
We~.band~s Pz.
D ep~h a ~ na ef~ b e.2aw ~~..2e / ~~.n .
Depth a~ naefz oven ~~..~e ~ ~.n.
Depth a~ ~~..~e be.2aw gnade~~tin.
S2ape ab ~neneh ~~ ~.n pen 100 ~~.
D e p~h ~a 6 edna cfz ~ ~~.
l
Depth ~o gnoundwa~en ~ - S~.
Type o~ Caven: Papers n Straw
Numb en o~ p~,~.b •, Grave.2 around p~.~~s ye.a_
Out~s~,de d.~ame~en `b~. Depth be.~aw ~.n.~e~ S~.
To~a.~ ab~sanb~.i.a ea ~J ~~2.
Area requ~.ned ~~2
i
~ /~; .,
INSPPCTPD BY K~L~~~ `/~~~ f,I/c"~+, TITLE ~) !".. -
APPROVPD ~ ~ ,DATP ~~"'/`'~~' 191.
RPJECTPD ~ ,DATP 197
I
Numb en o~ Compan.tmen~d ~
na
z
A
m
r
EH 115
_ WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF'HEALTH,BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON,WISCONSI N 53701
�
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: A/ -.'/4, 5 E'/4,Section j2-,T.?N, R /7 E (o�rr) W,Township or Municipality // I''c/-C l'
Lot No. Block No. 4 /�j� ����r A County 3/ ("0' t r
ubdivision ame
Owner's Name: /I/ e. 4 G i'"� ' P •1,7 r� ,
,,o
Mailing Address: $ 3 7 i L"�/"// , ui. _.. , / a!% ""^• - -rye
TYPE OF OCCUPANCY: Residence /"'� No. of Bedrooms .3 Other
EFFLUENT DISPOSAL SYSTEM: NEW G----- ADDITION - REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS_ _" - .7 cr PERCOLATION TESTS 3 -a2 ' 7y
/ �-SOIL MAP SHEET 5 - ,3X G� SOIL TYPE ay..oattlj ci '- s`d 17- try e efe"/Ale
PERCOLATION TESTS
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
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P— See / r,.. iv 1 3 6' 6' 6 ' $'_
-z 3 k / /11v 3 6 6 , 3 -
rr-
r
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBERM INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
/B. J1/0 lie '4'-- r 5 /(? .5, / 5 �- 5
2 7 ' ' 772. J '= 7 $ ,' "5/7 .5".'= $
3 7 2, ' ' 22... 7::: f i /E .— S / 5' 5"'._ usB-
5 7 _ ` ' 7 72 7 - r- � iU " < / , s's - s
B
4 7. _ 7 72. 7- 7-5 ii s ; / ,.5 >
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable areas ndicate numb of square feet of" tion area
needed for building type and occupancy. g / �—` /j s •i'+ +end. ate scale ,,0
or distances. Give horizontal and vertical reference points. Indicate slope.
1 17.2 Y'D 5i/ , . ''4414 tk. . '
_ — . \ Ai ra" '47
9 Q� } 1 r.9 --"--)
•
Ar
A
U
9 t
. _
_
1 - _
,e' _ _ ._
� y' Irk I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures
and methods specified in the Wisconsin Administrative Code,and that the data recorded and location of test holes are correct
to the best of my knowledge and belief.Name (print) /f r "a 1/1/ ry J`
� � g /17 /4 '( Certification No. /1/
Address 4' U) • 'P Lt./ 4/ `• A ,,,-t A s, ti V' 'S
Name of installer if known / ��
CST Signature �c`�� 1,1,1-0' AJr7"` ;
CO
PY A— LOCAL AUTHORITY
eP
riii)vii,i,
State and CountyState Permit # " f Permit Application County Permit #_'t,r,—�(' for Private Domestic Sewage Systems
County ?/ i. "��`
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
47/C-, X 9' ,I n ) -e, l Jh F r t. .-N._ 5 f/ '-`- f h°i i'Pi .i 'Sin
B. LOCATION: NE- 1/4 j '/1, Section /)" , T, 7 N, R /7 E (or) W Lot# _ City
Subdivision Name, nearest road, lake or landmark Blk# Village
nG //cl •'/l d, S Township ,1 q6ye,, `,
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family // Duplex No. of Bedrooms -3 No. of Persons 3
D. SEPTIC TANK CAPACITY /t --L* Total gallons No. of tanks C—+vZ-
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel L_ Fiberglass Other (specify)
New Installation L— Replacement _
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate , Cs Total Absorb Area G 2- V sq.ft.
New G Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed ' Length 'z Width /- Depth C / Tile depth (top) A-('' No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land ,g % Distance from critical slope
WATER SUPPLY: Private 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 CertifiedJ Soil Tester,
NAME /j ,c 4 n / ,/ 1/j/ HAi1 rC t ri S C.S.T. # / y / 73 and other information
obtained from (owner/builder).
Plumber's Signature �c-, l e,-, .-rl f, � ��'L MP/MPRSW# C ! Phone # 1-"E` _� �/,7_ /
Plumber's Address L/i C ,, e 71.-
+` , ( '1 ' L
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.
-2 9 e?'',.,..., ,-, i -
•
iv e iv
2`
-- ra ,
fj
v
•
4/1
V
Do Not Write in Space, Below ,- FOR COUNTY AND STATE DEPARTMENT USE ONLY.
Date of Application ) : - / Fees Paid: State ( i - �('' ( Date PP � � / � ;� C ' County � ,.� e-77
Permit Issued/Rejected (date) r` - -,1! . / 9 Issuing Agent Name \—:<.;:1`%j' / '_%e„ C' 2�
Inspection Yes K No State Valid# Date Rec'd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy)
Revised Date 7/1/78