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Parcel #: 020-1016-08-0~0 01/12/2005 10:06 AM
PAGE 1 OF 1
Alt. Parcel #: 12.29.19.71 F-30 020 -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
*LUEDKE, WILLIAM D
WILLIAM D LUEDKE
1010 MOONBEAM RD
HUDSON WI 54016
Districts: SC =School SP =Special Property Address(es): * =Primary
Type Dist # Description * 1010 MOONBEAM RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 3.003 Plat: 1223-CSM 15/4040 020/01
SEC 12 T29N R19W PT SW SE BEING PT CSM Block/Condo Bldg: LOT 8
4
5/1
17 LOT 4 & NKA CSM 15/4040 LOT 8
3.003AC Tract(s): (Sec-Twn-Rng 401/4 1601/4)
12-29N-19W SW SE
Notes: Parcel History:
Date Doc # Vol/Page Type
05/14/2004 762598 2571 /578 W D
03/29/2001 641575 1609/450 W D
03/29/2001 641572 1609/429 QC
01 /07/2000 616680 1482/549 QC
more...
2004 SUMMARY Bill #: Fair Market Value: Assessed with:
47689 222,500
Valuations: Last Changed: 06/05/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.003 54,000 118,100 172,100 NO
Totals for 2004:
General Property 3.003 54,000 118,100 172,100
Woodland 0.000 0 0
Totals for 2003:
General Property 3.003 54,000 118,100 172,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
018-RECYCLING SPECIA L ASSESSM ENT 27.00
001-WATER SPECIAL ASSESSM ENT 0.00
Special Assessments Special Charges Delinquent Charges
Total 27.00 0.00 0.00
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JOB NO.00-148 DATE: 01/09/2001 REVISED 02/26!01
Z
BEARINGS ARE REFERENCED TO THE SOUTH
LINE OFTHE SE1/4 OF SECTION 12, ASSUMED
TO BEAR ~Q°~'1N
~- FILED
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide maybe used for secondary purposes [Privacy L'aw, s.15.J4 (1)(m)].
Permit Holder's Name:
Frerichs, Chad City Village X Township
Hudson Townshi
CST BM Elev: Insp. BM Elev: BM Description:
TANK IN FORMATION
TYPE MANUFACTURER CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic
Dosing
Aeratior
Holding
PUMP/SIPHON INFORMATION
Manufacturer Demand
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
ELEVATION DATA
county: St. Croix
Sanitary Permit No:
73
State Plan ID No:
Parcel Tax No:
020-1016-08-000
Sectionlrown/Range/Map No:
12.29.19.71 F30
STATION BS HI FS ELEV.
Benchmark
Alt. BM
Bldg. Sewer
St/Ht Inlet
SUHt Outlet
Dt Inlet
Dt Bottom
Header/Man.
Dist. Pipe
eot. System
Final Grade
St Cover
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
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 i !_, No
JI Yes No
~yOMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /_
Location: 1010 Moonbeam Rd. Hudson, WI 54016 (SW 1/4 SE 1/4 12 T29N R19W) NA Lot 8 Parcel No: 12.29.19.71F30
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
q __ _~ - ~-----
----- -
Plan revision Re uired~ Yes ~ '! No
Use other side for additional information. ,' L _ ___
SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No.
County Sanitary Permit Application sT. caolx couNnr wlscoNSIN
!n accord with 15.04 St. Croix C„^tAtty S?Hilary Ordinance ZONING OFFICE
Personal infornation you provide may be Used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER
,, _ . ~
'
° [Privacy Law. S. 15.04(1)(m)J 1101 Carmichael Road
~-~~
~ Hudson, Wt 54016-7710
(715)386-4680 Fax (715)386-4686
Attach complete plans for the system on paper not less Ulan 8-1/2 x 11 inches in size.
County Sanitary Permit # ^ Check if revision to previous application
1. Application Information -Please Print all Information f ~~" Location:
Property Owner Name I ..` " ~ ~ l..) 1 /4 ~ 1 /4
Sec ~ ' ~ ~i
,
J ~
'( -e C i L s T N, R (q E (or)
Prop
Owners
il
r
t
y
M
a
in
g A
dd
ress Lot Number Block Number
e
_
Q ~\~/
r^~
`
\
_
`
''
y
~
r~ 1
City, State Zip Code ~ ~~ ~ Subdivision Name or CSM Number
II Type of Building: (check one) ~ amity ^ Village Town of
l~l 1 or 2 Family Dwelling - No. of Bedrooms:
/
\ 1
^
PublidCommercial (describe u8e): GZ~ Q.~~,~J~y,~ ~
h n ~
^ State-owned Nearest Road
tl. Type of Permit: (Check only one box on line A. Check box on line B if applicable) ll
~ ~ pCu -~.
Parcel Tax Number(s)
~
F~
1.^ Repair 2. ^ Reconnection 3.^Non-plumbing Rejuvenation
A)
'
~
~~
Sanitation 1 CJZU ° ~(j~G-v - C~GC7
B) Permit Number
State Sanitary Permit was previously issued ~ ~ ~~ ~ ~' Date Issued
~ Z b
IV. Type of POWT System: (Check all that apply)
'~ Non-pressurized Irrground ^ Mound ^ Sand Filter ^ Constructed Wetland
^ Pressurized In~round ^ Holding Tank ^ Single Pass ^ Drip Line
^ At-grade ^ Aerobic Treatment Unit ^ Recirculating Other
. Dispersal/Treatment Area Information: /3 -
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. oil Ap lication Rate 5. Percolation Rate 6. System Elevation 7. Final Grade
Requil!redr
~~ b `T ~ Proposed (Gals./day/sq.ft.)C~¢ (Min.lnch) G ~,.. Elevation
to ~~ ~~ Jyt~~ -l ~ ~ 7 5
i. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic
New Existing Gallons Tanks Concrete strutted glass
Tanks Tanks
~ rt. / O /c2~J~ I -~ ~~ ^ ^ ^ ^
^ ^ ^
11. Responsibility Statement
i, U-e undersigned, assume responsibility for repair/reconnenctioNrejuvenationrnstallation of non-plumbing for the POWTS shown on the attached plans. A
icer-se is not required for terralift repair or the installation of non-plumbing sanitation system.
s Name (print)
~n- ~Mof ~ s Signature (no stamps):
~v, ~Q 77~ iv4PMAPRIsNo.
NoT R>~ll~ Business Phone Number
~'~5-3 6'Z/3d
Phi s Address (Street, City, State, Zip Code)
/G 2cf - '~ ~' ~)
11. County Use Only
Disapproved Sanitary Permit Fee
~
/ ~
te Issued t o tamps)
1 ing Ag
Approved Owner Given Initial Adverse ~.~
/ ~ ~
Deternination
IX. Conditions of ApprovallReasons for Disapproval:
'
o',~
SYSTEM QWNinI-~ .~~.~~d 1'1" ~~.e- ~J/"~~ `~
d ~~- ~
l
f
ter an
i
v
1 Septic tank, effluent
dispersal cell must all bE S~ iced /maintained ~~ y~~~,y` ~~ D~,,;~
as per management plan provided by plumber
2. All setback requirements must be maintained G!~ ~ //I'J S~ ~~ ~ '~~
~
~~
~z~
~GC
.~`-2
O~LLn-Lp~/ ~L~-I' ~=~
as era plicabie code/ordinances. ~ ~ .22Gt~ - Yc ~
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.~ 2566P 357 ~E'18~~
KATHLEEN H. MALSH
REGISTER OF DEEDS
ST. GROIR CO.. NI
Document Number Document Title RECEIVED FOR RECORD
05/06/2004 01:00PM
St. Croix County AFFIDAVIT
EXElIpT # 8
Affidavit of System Rejuvenation eEC FEE: 11. ~
,qM,s F~~~.«~ TRANS FEE:
nom'"` ) -~ COPY FEE: 2. ~
S CC FEE:
Name - Owner) Typed or printed PAGES: 1
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 ~_ Page ~ST~ Document
Number C.3~14 t. Croix County Register of Deeds Office: Recordin Area
Name and Return Address
A pazcel of land located i eSw '/, of the $~'/, of Section /2 _
T~ N - R ~ W own of N ~ ~,~ , St. Croix 1~2~ ~ /~ ,~ ~ .~ ~ r ~ Lh S
County, Wisconsin, being duly described as follows (include lot no. and Z~ a~ gV ~, ~ ~ ~ Cvr p,~ {~d~
subdivision/CSM or detailed legal description): I
G~ ~ f s - ~~ ~ d Parcel Identification Number (PIN)
~-e.~ ~ w _ ^ o0 3
As owner of the above described property, I acknowledge that the septic system serving this residence f~ s n )undersized by current code
standards. I understand that the issuance of a sanitary permit to allow the attempted rejuvenation of the septic system does not imply that the
system meets current code sizing requirements, nor does it imply that the proposed procedure will be successful. I also acknowledge that I will
make this information available to any future parties interested in pruchasing this property.
Dated this ~/ day of ~ ~~_.
* ~ ~~
~.,
AUTHENTICATION
Signature(s)
authenitcated this day of
TITLE: MEMBER STATE BAR OF WISCONSIN
(if not,
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
(Signatures may be authenticated or acknowledged. Both are not
necessary.)
ACKNOWLEDGMENT
STATE OF WISCONSIN )
)ss.
St. Croix County. )
Personally came before me this ~ day of "~
'LOi"t the above named
tac\e\a ~r r•~z~~c,~s
to me known to be the person(s) who executed the foregoing
instrument and acknowledge the same.
i ""
_ 44 ~
~ i
~• ti
* ~._ _ •._
My
"THIS PAGE IS PART OF THIS LEGAL DOCUM
This information must be completed by submitter. document title. name & return address. ~~{
granting Causes, leagal description, etc. maybe placed on this first page of the document or
document. Note: Use of this cover page adds one page to your document and 52.00 to the n
>~~~- .
If r>~t, state expiration date:
Other information such as the
additional pages of the
;onsin Statutes, 59.517.
STATE BAR OF WISCONSIN FORM 1 - 1998 6.-4 1. 575
WARRANTY DEED ' Kfl TH~.EEH H. WALSH
REGISTER OF DEEDS
Document Number S T_ ':RQ I X CO. ~ W I
-V:,..16~~9Q~~,r 4
RECEIVED FOR RECOkD
This Deed, made between MARK J • HAMPTON ___.._ n3-2g-2001 1:30 RM
- -- - - --- " -- ~_ iiRRkRNTY DEED
--- - ---- -- _ __ Grantor. EX~I«F'T Y
__ CEP.T COPY FEE:
and CHAD A. FRERICHS and ANNA M. FREFtICHS, - _- _- rppY .Ec.
'; husband and wife TkRNSFER FEE: 126.00
_ _.._. _.._ _. _._ -- S:EC.~kDIuG FEE: 10.00
_ ,. _ _. ___ RRGFSe. 1
_ _ __ _ _-._ ._ Grantee.
Grantor. for a valuable consideration, conveys to Grantee [he following
described real estate in St. Cr01X _ County, State of Wisconsin
_.
,. „a:.; r
(the "Praperry ): ,.;,,;. .._
Name and Return Address
Lot 8 of Certified Survey Map filed February 28, 2001, ~„/«~ ,(~~o,~ , ,(, ~i~,,~
in Vol. 15 of Certified Survey Maps page 4040, as ; CfOD cS O~il.~~~W
Document No. 639453, located in part of the SW-1/4 of thei
SW-1/4 Sec 12,T29N, R19W, Town of Hudson, St. Croix S-+®'yj~ t.c.~~ •s~~~~'
County, Wisconsin. ~~~ 3~6 J S..SI
020-1016-00-003
Parcel Identifcation Number (PIN)
This i.s nOt homestead property.
(Is) (is not)
Together wRh all appurtenant rights, [isle and interests.
Grantor warrants that the title to [he Property Is good, indefeasible in fee simple and free and clear of encumbrances except - none.
Dated this _____SX~ day oC March 2001
{SEAL) (SEAL)
MARK TON -
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature (s)
authenticated this da of ,
DIANE M. BARRON
State of Wisconsin
T[TLE: MEMBER STATE BAR OF WISCONSIN
(lf not.
authorized by X706.06, Wis. Stets.)
State of Wisconsin,
ss.
St. Croix County.
Personally came before me this _ day of
March 2001 .the above named
Mark J. Hampton
me known to be the person w}to executed the foregoing
instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BV /~ ~--~- ~ -- -- -
Attorney Barry C. Lundeen _ _ __1~1s.~~`-~ --
MUDGE , PORTER,~LUL ~ ~ •-~ Notary ublic. State of Wisconsin
110 Second Street, Hudson, WI 54016 My commission Is permanent. (If not, ~sta~te expiration dace:
(Signatures may be authenticated or acknowledged. Both are not __,___ .- -~? 6}-~=~0~'-'- ')
necessary)
_ _
_.
__
' 'Names of persons signing in any capacity must be typed or printed below their slgnantre.
STATH BAR OF WISCONSW Wisconsin Leget 81enk Co., tr,c.
WARRANTY DEED FORM No. 1 - 1998 Milwaukee. Wis.
/*
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
Vifda(x~nsir,'~+epartment of Commeroe
Safety and t ~:ildings Division
,.
GENERAL INFORMATION
Personal information you provice may Ge used for secondary purposes [Privacy Law_ s.15.04 { 1)(m))
rmij H Ider' am ^ City ^ Village ^ own of:
~rerlc~is, G~~'ac~ Hudson Township
CST BM Elev.: Insp. BM Elev.: B Description:
l v ~~o s ~
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic
r Q p O
Dosing
Aerat'
olding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. vent to
Air Intake ROAD
Septic > S' 3 ~' ~~,5' NA
_- ~ _ NA
Ae 'on \
Holding
PUMP /SIPHON INFORMATION
Ma cturer ~ ----- --~- errand
Model Number. ""
TDH~ tft~ Friction stem TDH F
Forcemain Length Dia. ois .
SOIL ABSORPTION SYSTEM
BED / NCH Width ~ Len th No. Of Trenches PIT No.Of Pits Inside Oia. Liquid Depth
1 N 1 S Z DIM I
SYSTEM TO
P/ L
BLDG
WELL
LAKE /STREAM L Mau ufer:
.~
SETBACK
INFORMATION TypeO ~~rr__
System: t.a>h.J /
(~ r t/
i' I ,Sr
~
, ~Dd ~ HAM R
O Mo/ Num er:
S,. r ~
r11CTRIRI ITIAAI CVCTFM
Header! Mani old Distribution Pipe(s) ~ ~ x Hole Size x Hole Spacing Vent To Air Intake
r!
Length r Dia. ~ Length ~~Dia. Spacing ~ ` ~ ?sO'
SOIL COVER x Pressure Svstems 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 ^ No ^ Yes ^ No
/ COMMENTS: (Include code discrepancies, persons present, etc.) (~ (3 6(
Location: 1022 Moonbeam Avenue, Hudson, WI 54016 (SW 1/4 SE 1/412 T 9N R19W) -12291971 F30 -
Lot 8 B{ ~~~ \\` I /
1.) Alt BM Description = ~P ~~.. Y~J V4~sc~ 'ta,r.~c ~ iticc~e.- a ~o,.,
2.) Bldg sewer length =3K' ~~ ~~~/ lP,~ ~ W
-amount of cover = S ~' L G `c~ 5 ~~~ ~~ mss.
~ ~ do (~ c l ~ a ~`r..
Plan revision required. ^ Yes No ~-
Use other side for additional infor ation. (~ ~ ~
SBD-6710'(R.3/97) Da Inspedor'sS nature Cert. NO.
ELEVATION DATA
Count
~t. Croix
Sanita~83964 0.:
State Plan ID No.:
Parcel Tax No.:
020-1016-08-000
STATION BS HI FS ELEV.
Benchmark O ~ l6 d Up
Alt. BM ~ d . Z~-
Bldg. Sewer ~ . Z ~ lOZ • 2 O
t Ht Inlet ~. (~ ~ /, 3
St Ht Outlet d , ~~'
ne
Header /Man. ~' ~ 3 ,
Dist. Pipe R 9- y~
a
Bot. System L id . sy
~o -SG
Final Grade ~ ,~" l0 , SSA
f ;,
_ _ _,
~f,sN
to~~
~~
~~ _
30
ra.s~
~i/~
~o~~
6' U
,^~ rr; q /~
tt1~.N r~ c c C /']D~..N.ci1A
A of -tfi~ ~7~ ~ /5
', r
Sanita Permit A lication
I'3' PP
Wis. Adm. Code
In accord with Comm 83.21 Safety & Buildings Division
201 W. Washington Ave.
PO Box 7302
WI 53707
7302
M
di
, -
son,
a
ra,r,N, t,.,,~. ~ E~ ,n,,,,~,,,,,~~,, Personal information you provide may be used for secondary purposes (Submit completed form to county if not
[Privacy Law, s. 15.04(1)(m)] state owned.)
Attach tom lete lans to the count co onl for the s stem, on a er not less than 8-1/2 x 11 inches in size.
Cou ~ l_~1=-C' / State Sanitary ~ nit umber 0 Check if revision to previous application
~O State Plan I. D. Number
I. A lication Information -Please Print all Information Location:
Property Owner ame
1 Property Location
' ~ ~I /4 .S /~ 1 /4, S ~ T D'~, (or W
Property Owner's Mailing Address
\ Lot Number .Block umber
S
~~
City, State Zip ode Phone Number Subdivision Name or CSM Num
II Type of Building: (check one)
~ () City
~ Village
1 or 2 Family Dwelling -No. of Bedrooms:~
D Public/Commercial (describe use):
,!~ Tow,n o
~
/~
D State-owned C~.(/"~" 1 .
[
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road ~,~~'D--vim.
A) 1. ~hlew System 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to Parce~llTaxNumber(s
~
~ O '- ~ ~ -
S stem Tank Onl Existin S stem J
g) Permit Number
7
Q Date Issued
^ A Sanitary Permit was previously issued . ~ -
o
IV. Type of POWT System: (Check all that apply) ~c- --((JD
Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland
Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line
bic Tr nt Uni ^ Recir ating ^ ther: ,
f J
^ At-grade e
~
~
~.
V Dis ersal/Treatment A a In ormation: - G
1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application .Percolation Rate 6. System Elevation 7. Final Grade
~~~ Re
quired Prop
ose~d (Gals./day/sq. nft..
~ (Min./inch) C/ 7 Elevatioap
/
lJ ~ /
IGIJ ~ '~°~
~ ! / ' 7
VI Tank Capacity in Total # of anufacturer Prefab Site Steel Fiber- lastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing Crete strutted
Tanks Tanks
^ ^ ^ ^ ^
VII Responsibility Statement
I, the undersi ned, assume res onsibility for installation of the POWTS show the attached tans.
Plumber's Name (print) Plumber's nature o slam ) P RS No. Business Phone Number
P umber's Address (S
tre
et, Ciry, State, ~p~~ode)
~
/
VIII County/Department Use Only
^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Sign tore (No stamps)
Approved ^ Owner Given Initial Adverse Sur e Fee)
M Z 20~ ~
Determination
IX. Conditions of Approv I /Reasons for Disapproval: ,l~SZ~[~. vin(,t,tarcSe ,~,,.
` `oe>~~^^-~
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• ,
z- Wisco~sinDepartmentofCommerce • SOIL EVALUATION REPORT
Page e
l of~
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code minty S ~ ~ . /
0
t
i
Pl r
' y
an mus
ze.
Attach complete site plan on paper not less than 8 1/2 x 11 inches in s
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.
Please print all information. Re wed by Date
Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)).
` Property Owner
~~~ ~~ ~ ~ Property Lo~c*ation
Govt. Lot .,). ~ 1/4 ,S~/4 S ~ 2,T
Z,~ N R
~ E (or) W
Property Owner's Mailing Address
~
: Lot #
8 Block # Subd. Name or SM#
4~•
~ h
.
22 e w
Code Phone Number
Ci State Zip ^ City ^ Villannge Town Barest Roa d
, (
ti~. 0~ ~ S4' b~ ) 4.8t56~t 1~1dun vQl.~M
New Construction Use: Residential / Number of bedrooms Code derived design flow rate 4 GPD
^ Replacement ^ Public or commeraal Describe:
Parent material ~0 ~ ~ S ~ ~ ~ d ~ ~ ~ ~'S l Flood Plain elevation if applicable fl•
General comments
and recommendations:
Boring
Boring # Ground surface elev. ' d ~ ft~ Depth to limiting factor ~ din
Pit Soil lication Rate
i
ti
D
R
d Texture Structure Consistence Boundary Roots GP D/fF
Horizon Depth
in. Dominant Color
Munsell on
escr
p
ox
e
Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2
~
~ o-~o
~o • 2 (o ~'3z
r
~ ~ Stl bk
~''~ `~ 1 C W
~ 2
'~' , S
~
. ~ ~
+ Fp?
^
2 Boring # ~ Boring 11 ~ 7 3
~' pit Ground surface elev. r6 ft. Depth to limiting factor/ / Z' in• Soil lication Rate
th
D i
t C
l
D tion
Redox Descri Texture Structure Consistence Boundary Roots GPD/fF
Horizon ep
in. or
nan
o
om
Munsell p
Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
a• 9 e it 3 t z 6 k M fir C>~ ~ • S •`~
b S i~ ~ ~ ~ ~` ~.W
•
-
roo
.~
" Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < isu mgn_ - tmuen~ trc - ova _ o~ ~~y,~ a„~ ~..~ . ~~ ~~~~-
CST~ilaraQ. Please Print) Signature CST Number
~ ~ ~s ~ 41 s o -~ ~-~- 2 7 3 ~ ~
Address Date Evaluation Conducted Telephone Number
,~ 3 ~ l2~ ~ S~ ~~,~5 ~i~i rtzs ~c~ CJ ( 2 ~ t (- O! 2 G - ~-~~ `~
, .
. .`
~ ~
Property Owner ~~~ ~ _ Parcel ID # Page Z' of
Boring # ^ Boring f~ ~
~~ r U-b ft
f
l
d
De
th to limitin
factor ~ in
.
sur
ace e
ev.
^ Pit Groun p
g .
Soil
lication Rate
Horizon .Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2
t6 • .5 ~' S' co ~ ~ r C . 'C . 8'
. S"G /I'~3. S
Boring # ^ Boring
^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *Eff#2
Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
^ Pit Soil A lication Rate
H
ri th
D Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft?
zon
o ep
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 =GODS < 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.
SBD-8330 (R.6/00)
i , :.~-
Wisconsin Department of Commerce
Division of Safety and Buildings
SOIL, EVALUATION REPORT
Page ~ of 3
in accordance with Comm 85, Wis. Adm. t;oae
t
Pl
Courtly S - ~ ~ 0
an mus
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.
but not limited to: vertical and horizontal reference point (BM), direction and
indude p~ I.p,
,
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print allj~orm~atfo~~ j ~.-
Reviewed by Date
Personal information you provide may be used for secondary purposes"(Privacy I:~w, s. 15.04 (1) (m)).
Prop-,e/rt~y Own1e'r ~ ( ,` ~, ~ ^!+
1 r IQ~2.r~ rt~~'1 ~'V (l l~`-'~ ~.~~ ) roperty Locetion
govt. Lot g(~ 1/4 S4. 1/4 S ~ ~ T ~~ N R 1 -D*~r) W
Property Owner's Mailing Address ;~1 Block # StR~d. Na or CS~
~~
City State Zip Phon~ k- ,;
Nry
~
z~
`' C'lty ^ Vllage Town -Nearest Road -
Oh k
,
ll~
'(
I~SO n '~.~ E S 0 ~ p
New Construction Use: ~ Residential r3m15e `»f-be~ingc•Kn~. ~ Code derived design flow rate ~ S ~ GPD
'
1 )
//
^ Replacement ^ Public or cart - srcx~b '
Parent material 0 w ~ Flood Plain elevation if applicable tt.
General comments
and recommendations:
a Ong # ~ Boring p
pit Ground surface elev. I ~ 1.7~ft. Depth to limiting factor ~ / 2 in• Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/(g
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
I ~-1b
16 - D to t'3 2
I b f n a
~'1 A S-)
S l' ~Msbk
~~'1Sbi~ m r
r
~''1-~ C~
C~,c,J 2
1
O ~,S r !o r1 1 I r~ sbk r
r'l1T ~ - -
Boring q
Z- Borng # ~ pi( Ground surface elev. I ~a 7 3 ft. Depth to limiting factor? ~ Z in. Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft=
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
~ ~- to r3 Z u
2 q- o ~ ~ u c~ ~
Effluent #1 = BOD > 30 < 220 mg/L and T55 >30 < 1 btl mg/r. ~mue~ m .rte - .~.,., _ ......,y,~ ....... -- _ -- .--,z -
CST Number9
T Name (Please Print) Si re ~~ ~~~~ 2,2? J
~~ i) M S Date Evaluation Conducted Telephone Number
(~3 ~2 1 a o ~ ~ S-~ ~k~ ~(c~i MaK(Y t,.~f' Z-~ 1- d J 2~f G • 1 ~~~
property Owner ~ G M n ~'D h Parcel ID #
Page ~ of
0 ring # ^ Boring ~a o , 8 8 }~~ .
'~ Pit Ground surface elev. ft. Depth to limiting factor ~n• Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Strtxxure Consistence Boundary Roots GPD/flt
in. Munsell Qu. Sz Cont. Caor Gr. Sz Sh. 'Eff#1 'Eff#2
i c~-!a t®~ rp nG s11 a.r, k r~~r eta ~~
2 i o -~{~ -7,S ~ s n S 11 2 r, 6~c Fr CI.J 1
3 - -- ~~ r n r^ 31. - ~ aYts~u m~t -
a Boring # ^ Boring
^ pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate
Horizon Depth Dominant Caor Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring # ^ Boring
^ Pit Ground surface elev. ft. Depth to limiting factor in.
Sal lication Rate
Horizon De
th Dominant Caor Redox Description Texture Structure Consistence Boundary Roots GP D/F(`
p
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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 (8.6/00)
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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: Svstem Design Specifications
Sanitary Permit Number !o
Number of Bedrooms 3
Design Flow -Peak (gpd)
Estimated Flow -Average (gpd) o~
Septic Tank Capacity (gal) ~
Soil Absorption Component Size (ft2) ~ 3 Z
Type of Wastewater Do stic
Table 2: Soil Absorption Component -Limits of Reliable Operation
~,'
~ ~'
Septic Tank Component Soil Absor tion Component
Design Flow -Peak (gpd) rs>~O - as i
Maximum Influent Particle Size (in) 1/8
Maximum BOD5 (mg/L) 220
Maximum TSS (mg/L) 150
~~-eh~
Tab le 3: Maintenance Schedule
Septic Tank Inspect and/or service once every 3 years
Outlet Filter Inspect once a year and clean at least 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 and outlet filter shall be assessed at least
once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure
r~roper operation. The filter cartridge should not be removed unless provisions are ma e o
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 enfer a septic or ofher treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere wifhin the septic or ofher
freatment of holding tank may contain lefhal gases, and rescue of a
person from the interior of the tank maybe difficulf 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
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION, FORM
OwnerBuyer GN~-v % 64~,J14- ~lL~~~ ~s • -
Mailing Address
~ ~
vV 1+-•
K~ • M~• Ss~~o
Property Address
(Verification required from Planning Department for new construction)
City/State 1~~~~ • ~--~ ~ • Parcel Identification Ntunber D o?o IO/~ ' ~~ - c'O3
i.FGAL DESCRIPTION
Pro a Location ~ ~ '/., 5/ ~'/,, Sec. 107 . T~N-R~W, Town of _~~~''^
P rtY
~bdivision ,Lot # ~•
Certified Survey Map # ~ ~ ~ y_S 3 ,Volume ~ ~ .Page # yU _•
. _ ~ ~s~
Warranty Deed # ~ ~~S 7J , Volume l w0 Page # _
Spec house D yes ~ no
Lot lines identifiable ~ yes O no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintcnance
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 owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeyman plumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requiremtnts 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
da s of the three ar expiration date.
o~ /~ / ~ ~
S TUBE O APPLICANT DATE
t~~l\L'Jl~ ViJl\l ii'iV~ai J.Va~
''v ~'(we) certify that aii statements on this form are true to the best of rtiy (our) knowledge. I (we) arXt (are) the owner(s) o
the proptlrty.described above, by virtue of a warranty deed recorded in Register of Deeds Office.
~~ .F / /
"` ~?.
SIGNATURE OP ' PI.YCANT DATE
*+**** Any information that is mi8-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
a
~~ `c°i Indicate management strategy by checking (/) tfie appropriate box:
~a '
Q.mc za Management Strategies
t l Temporary stabilization of disturbed areas.
Note: It is recommended that disturbed areas and sail piles left inactive for extended periods of time be stabilized
by seeding (between April ist and September 15th), or by other cover, such as tarping or mulching.
L l Permanent stabilization of site by re-vegetation or other means as soon as possible (lawn establishment).
Indicate re-vegetation method: Seed I ! Sod L I Other C_ I ~ or.~lU ~
Expected date of permanent re-vegetation: ~~ ~ 01
Re-vegetation responsibility of: Builder l-1 Owner/Buyer l~ '
Is temporary seeding or mulching planned if site is not seeded by Sept. 15 or sodded by Nov. 15? Yes C1 No {{~
~I L-) Use of downspout and/or sump pump outlet extensions.
Note: It is recommended that flow from downspouts and sump pump outlets be routed through plastic drainage
pipe to stable areas such as established sod or pavement.
Jz7 ^ Trapping sediment during dewatering operations.
Note: Sediment-laden discharge water from pumping operations should be ponded behind a sediment barrier until
most of the sediment settles out.
~J Proper disposal of building material waste so that,pollutants and debris are not carried off-site by wind or water.
j~] Maintenance of erosion control practices.
• Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to
half the barrier's height.
• Breaks and gaps in sediment fences and barriers will be repaired immediately. Decomposing straw bales will be
replaced (typical bale life is three months).
i
• All sediment that moves off-site due to construction activity will be cleaned up before the end of the same workday.
• All sediment that moves off-site due to storm events will be cleaned up before the end of the next workday.
• Access drives will be maintained throughout construction.
• All installed erosion control practices will be maintaineu until the disturbed areas they protect are stabilized.
For more assistance on plan preparation, refer to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code,
the DNR Wisconsin Construction Site Best Management Handbook, and UW-Extension publication Erosion Control for
Home Builders.
The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available
through State of Wisconsin Document Sales, 608/266-3558.
Erosion Contro/for Home Bui/dens (GWO001) can be ordered through Extension Publications, 608/262-3346 or
Department of Commerce, 608/267-4405.
i .
-o
EROSION CONTROL PLAN CHECKLIST
~.
~~a 4~ ;Check (/) appropriate boxes below, and complete the site diagram with necessary information.
4 Q~
voF =o Site Characteristics .
~7 North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways.
~7 ~l Location of existing drainageways, streams, rivers, lakes, wetlands or wells.
f1~1 ^ Location of storm sewer inlets.
lEd Location of existing and proposed buildings and pa~~ed areas.
The disturbed area on the lot.
Approximate gradient and direction of slopes before grading operations.
Approximate gradient and direction of slopes after final grading operations.
T' Cl Overland runoff (sheet flow) coming onto the site from adjacent areas.
Erosion Control Practices
^ l~f Location of temporary soil storage piles.
Note: Soil storage piles should be placed behind a sediment fence, a 10 foot wide vegetative strip, or should be
covered with a tarp or more than 25 feet from any downslope road or drainageway.
i
Location of access drive(s). '
Note: Access drive should have 2 to 3 inch aggregate stone laid at least 7 feet wide and 6 inches thick.
Drives should extend from the roadway 50 feet or to the house foundation (whichever is less).
^ h~ Location of sediment controls (filter fabric fence, straw bale fence or 10-foot wide vegetative strips) that will pre-
' vent eroded soil from leaving the site.
Cfl f 7 Location of sediment barriers around on-site storm sewer inlets.
f J ~ Location of diversions.
Note: Although not specifically required by code, it is recommended that concentrated flow (drainageways) be
diverted (re-directed) around disturbed areas. Overland runoff (sheet flow) from adjacent areas greater than
10,000 sq. ft. should also be diverted'around disturbed areas.
LrJ L:I Location of practices that will be applied to control erosion on steep slopes (greater than 12% grade).
Note: Such practices include maintaining existing vegetation, placement of additional sediment fences, diversions,
and re-vegetation by sodding or by seeding with use of erosion control mats.
I l 1~4 Location of practices that will control erosion in areas of concentrated runoff flow.
Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through use of
such practices as in-channel fabric or straw bale barriers, erosion control mats, staked sod,' and rock rip-rap.
When used, a given in-channel barrier should not receive drainage from more than two acres of unpaved
area, or one acre of paved area. In-channel practices should not be installed in perennial streams (streams
with year-round flow.).
^ ~ Location of other planned practices not already noted.
..
STATE BAR OF WISCONSIN FORM 1 - 1998 [6,41575
WARRANTY DEED Y.A i HLEEN H. WALSH
• REfiISTER OF DEEDS
Document Number ST. CkOIX CO., WI
~a~ 16(}94AG£'}~ P,ECEIVED FOR RECORD
This Deed, made between MARK J . HAMPTON _ to-` _
-- "3 241 1:30 PN
WNRRRNTY DEED
--- - --- _ r Grantor EY.EtIF'T 9
CHAD A• FRERICHS_ and ANNA M. FR_ERICHS CEF.T COPY fEE:
and ' .--- nBEt' ~E~.
husband and wife ~ TFIANSfER FEE: 126.00
- - _` -- -- RECCRO?R"u fEE: 10.00
_ ___ .. _ __ RAGFSa 1
_ ___ ____ _ ._ Grantee. '
Grantor, for a valuable consideration, conveys [o Grantee the following
described real estate in St. CrO1X_ __ County, State of Wisconsin
(the "Property"): ur.q .re:,
' Name andReturn Address
Lot of Certified Survey Map filed February 28, 2001, ~7,f`~~~~ ~i~a~.
ol. 15 of Certified Survey Maps pa e 4 as C•l~
Docume~ nt No. 639453, located in part of the SW-1/4 of the; ~f~~ ~~~/~-
- 4 ~c IZ 29N, 19W, Town of Hudson, St. Croix S~'!~~ te.~~ ~~~~
County, Wisconsin. ~GT"?~ 3~6 ~ S.~
020-1016-00-003
Parcel Idenli8cation Number (PIN)
This is not homestead property.
(is) (Is no[}
Together with all appurtenant rights, title and interests.
Grantor warrants that the Title to the Property is good, indefeasible in fee simple and (ree and clear of encumbrances except - none.
Dated this ~ day of March
(SEAL)
(SEAL)
AUTHENTICATION
Signature(s) ______
authenticated this ~_ da of
r...a++....++~..w
DIANE M. BARRON
_ State of Wisconsin
TITLE: MEMBER STATE BAR OF WISCONSIN
(lf not,
authorized by §706.06, Wis. Stets.)
2001
(SEAL)
MARK TON
(SEAL)
ACKNOWLEDGMENT
State of Wisconsin,
ss.
St. Croix County. y~ ~
Personally came before me this _ -day of
March -, 2001 ,the above named
Mark J. Hampton
_-- to
me known to be the person wfto executed the foregoing ,
instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BV ___ .. .__ _
Attorney Barry C. Lundeen _
MUDGE , PORTER, LU ~ '-C'- Notary ublic, State of Wisconsin
110 Second Street, Hudson, WI 54016 My commission Is permanent. (]f not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not ____ _~7-~e~o~.)
necessary)
' Names of persoru signing m any capagty must tx typed or printed below rhelr signature
STATE BAR OF WISCONSIN Wisconsin Lege1 Blank Co., Inc.
WARRANTY DEED FORM Nn. 1 - 1998 Milwaukee, Wis.
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THIS INSTRUMENT DRAFTED BY: WILLIAM KANE JOB N0. 00-148 DATE: O1I09/2001 REVISED 02/26/01
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BEARINGS ARE REFERENCED TO THE SOUTH
LINE OF THE SE1/4 OF SECTION 12, ASSUMED
TO BEAR Sea°F°'^~°W
FILED
FEti 2 8 2001
kAiltlfFNN.WALSH
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Voi.75 Page 4040