HomeMy WebLinkAbout020-1177-40-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
578998
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:
Anderson, David & Lisa Hudson, Town of 020-1177-40-000
CST BM Elev: Insp. BM Elev: BM Description: 1 Section/Town/Range/Map No:
;D , 28.29.19.1114
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark IL t
Alt. BM L ,
) 2
L j FE m _ Bldg. Sewers • J
Holding StA*Inlet D tOJ
- S•$ a5~l5
p
TANK SETBACK INFORMATION StlM~tOutlet • 7
TANK TO P WELL BLDG. Vent to Air Intake XROADJ I~rmtet-
Septic aLBQ#QM-- Bader an. .25
Aeration 1 Dist. Pipe ,(p jq..
~ •5 9'x.5 k. ~
Iding Bot. System 'Q . t 3.
Final r t Q3.ro
PUMP/SIPHON INFORMATION
Q +2
Manufacturer Dema St Cover I.
Model umber Li . G +
TDH Lift Friction Loss Syste Bad T Ft
Forcemain Length Dist. to Well
SOIL ABSORPTION SYSTEM -4- S t
BED/TRENCH Width Length / 'QI,,/l Jl No. Of Trenches A PIT DIMEN NS No. Of Pit Inside Dia. Liquid Dept
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: A~1 ~j~/
INFORMATION CHAMBER OR ! f v '
T Of UNIT Model Number: !7/rf
DISTRIBUTION SYSTEM l►~ / ,(u
Header/M fo I / Distribution x Hole Size x Hole Spacing/ Vent to Air Intake
Pipe(s)
Lengt Dia HE 1,Length__ Dia Spacing 07V ~m ~
SOIL OVER x Pressure Systems Only xx Mound Or At-G de Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil es ® No 2rYes 0 No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / /
+
Location: 783 Aldro Ci Hudson, WI 54016 (NE 1/4 NE 1/4 28 T29N R19W) Cedar Hills Estates Lot 14 Parcel No: 28.29.19.1114
1.) Alt BM Description= r a ~ C(Ati- aA'A SO 1646 .1 J 0 ~f
2.) Bldg sewer length= 6-j'r,1NV
- amount of cover
~~~b ITV ac~Q
Plan revision Required? 0 Yes /No
Use other side for additional information.
ate nsepctor's Signature Cert. No.
SBD-6710 (R.3/97)
1-7
OF sS,
a
m
IND
,1 ~7 c IN
N ~
G ~
vti 4tir `n~
M +y. q e4. Industry Services Division 6 -e i JX
h ` p y JJ 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.)
B: SIR, P.O. Box 7162
PAI Madison, WI 53707-7162 'I 1~ Q Q
S~
Sanitary Permit Applicati State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the ape ~o1~g~Q~ental unit Nrf
is required prior to obtaining a sanitary permit. Note: Application forms for state-o=~V'I(~l a¢d, ri itted to
the Department of Safety and Professional Services. Personal information you prQ de a be used for secondary Project Address (if different than /mailing address)
u oses in accordance with the Privacy Law, s. 15.04(1 (m), Slats. J 1 C~l COUNTY
~~orII(•~ A n
1. Application Information - Please Print All Information r 1 'LOPMcNT
Property Owner's Name 4- il 1,15c,- Parcel #
Dav 1 CtN d 02-o -1 1?7- `tv oo6
Property Owner's Mailing Address Property Location
-793 Q ! tJA, o e, ~ Govt. Lot
City State Zip Code Phone Number /ti £ I/4, /V ;F`/<, Section L B
,
circle one)
1 uC[csd f'/iV~ S~O~~ TZ9 N ; R/4Eo&
H. Type of Building (check all that apply) Lot #
[J 1 or 2 Family Dwelling - Number of Bedrooms / Subdivision Name
Block # ~115zj..
❑ Public/Commercial - Describe Use
❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of
G cjd
1 a l~ ✓ C ~ Ca ® Town of (A /
III. Type of Permit: (Check only ne box online A. Complete line B if applicable) Q rti, x'
A. ❑ New System (Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. T e of POWTS System/Component/Device: (Check all that apply)
DR - Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain
i e-
V. Dispersal/Treatment/Area Information: J s ' X Lv® T o't~ K'Gk v.r
Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Area Proposed System Elevation
(00 0 Rate(gpdsf) B 7 8.~ ~ 9® C7 ! .
VI. Tank Info Capacity in
Gallons Total # of -C
Manufacturer U N N
Gallons Units L c " C Y F
New Tanks Existing Tanks * c c.. U v V cn r- 0 C.
A4 r
e or Holding Tank v /000 13 LO L jx e 14-, c . -lr t ❑ ❑ ❑ ❑
Dosing Chamber ❑ ❑ ❑ ❑ ❑
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
mber's Name (Pr'nt) Plumber's Signature MP/l It Number Business Phone Number
P umber's Address (Street, City, State, Zip Code)
Pte. A-y c 1A, J_ Y
VIII. oun /De artment Use Only
Approved isapproved Permit Fee Date Issued Issuing Agent Sigriatu
❑ Owne ive on or Denial
IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER:
1. Septic tank, effluent filter and
dispersal cell must b seryiMA /Maintained
as per management plan provided by plumber.
v€2.3 d d Z. 0 _/d 70 ,7r-_ to 2/ All tback requirements must be maintained
code/ordinances.
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size
SBD-6398 (R03/14)
n
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: ff
Owner's Name: Q V i 4 Q~ fzSo
Owner's Address: 783 al d o d;A
/--/U C-JS0 N, L&P SYo /I,
Legal Description: N om- Z q 2 9 /V r R. I w
Township: JJ,,t ~l sfAl
County: S - eA- o r, /X
Subdivision Name: 601- /s ~j- Ile
Lot Number: Iq
Parcel ID Number: v7 6 -t C-1 -7 - Yv - Go o
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross-Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber. 4a e- > u c w A- A,5 License Number: 2 L Z ~7~
Date: Phone Number ?1r-~9i-J ~8$
Signatur
Designed pursu t to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
bit-
OF
1
L
Q
11 `cl
n
nL ~ S
IND
c~ M
'-....o0ooo4 ~v
W /
N f
O ~
w
^ ~
A
Soil Absorption System Cross Section
/DG. v ft ~j
9g. ft
4" Schedule 40 Final Grade
PVC Vent Pipe ft
With Vent Cap
Leaching ~j f t
Chamber v J System Elevation
3 ft ft ft
Soil Absorption System Plan View
ft
ft
ft Leaching Trench 1
Chambers
4" Dia.
Trench 2 Header
Vent Or Observation Pipe
Trench 3
Leaching Chamber Specifications
Manufacturer And Model ( -A ; c-K ~!s
EISA Rating 2", O sq ft per chamber Soil Application Rate 7 gpd/sq ft
Loop gpd Design Flow = ' 7 Soil Application Rate 2-°' v EISA = s Chambers
3 rows of / S chambers each.
I
Page of
J
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner ~a v N f~3d Septic Tank Capacity / 3 Z 0 gal ❑ NA
Permit # Septic Tank Manufacturer (,v£r ks - c~~f kw ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ANA
Number of Public Facility Units -45'qA Pump Tank Capacity gal ANA
Estimated flow (average) 6,00 gal/day Pump Tank Manufacturer -0-NA
Design flow (peak), (Estimated x 1.5) 900 gal/day Pump Manufacturer ~A
Soil Application Rate -7gal/day/ft2 Pump Model ZI-NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit 9-11A
Fats, Oil & Grease (FOG) _<30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD5) <_220 mg/L 2 A_ ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) <_150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODS) <_30 mg/L Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) :530 mg/L .i-PdA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) <_10' cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Ya in dia. ~_CI:NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent.
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
3 year(s)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
/ -E1-year(s)
At least once every: ❑ month(s) ❑ NA
Clean effluent filter l • t5-year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ~A
❑ year(s)
gyp,
Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s)
Other: At least once every: ❑ month(s) r -]'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.
GMW (4/01)
START UP AND OPERATION Page of
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.
The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/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 INSTAL ER POWTS MAINTAINER
Name a, - k'n.,f ✓jr Y; e_ Name
Phone '713--- L1 g / - S388 Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name a - /1 a- , - A, Name ~7F, eA-0,` t
Phone 71 D" -'7 Phone 71j-_ 3171 - qt
ga
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. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Dct u , -d Q 'L'ejf4Sa,11
Mailing Address4l'783 6?1d.L o
Property Address a 6ovc
' /I (Verification required from Planning & Zoning Department for new construction.)
City/State N..dr0,, Parcel Identification Number G 2-0 - a -7--~ -(YO -d G p
LEGAL DESCRIPTION
Property Location "Z 14,14--Z Sec. Z-& , T N R / j W, Town of /~/u c%.✓
Subdivision Plat: fy 1rs
Lot #
Certified Survey Map # , Volume Page #
Warranty Deed # (before 2007)Volume Page #
Spec house yesy-no Lot lines identifiable ~-Yes . no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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. Owner maintenance
responsibilities are specified in §Comm. 83.52(l) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pwnping (if necessary), the septic tank is
less than 1/3 full 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 Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this nn are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a warr qty deed recorded in Register of Deeds Office.
Number of bedrooms
SIGNATURE OF APPLICANT(S)
DATE
***.any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. `
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REN 08/05)
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) 7g.3 q / dA 6 e, t. c h located
at: ~J 1/4, NC 1/4, Section 2Y' , Town Z 9 N, Range_Ll__W,
Town of /ju d,s4'A--1 , St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of Comm. 84.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service
Did flow back occur from absorption system? Yes No
(if no, skip next line.)
Approximate volume or length of time: 2, o U gallons 2- v minutes
Tank Capacity: / o o -1
Xan st ruction: Prefab Concrete Steel Other
ufacturer (if known):
Age of Tank (if known): u N z 9
Permit number (if known)
Y(cenle22 Plumber Signature) (P Ant N me)
q1) to z z Z B7
(Title) (License Number) /MPR
Z y
(Date)
Form to be completed by licensed plumber (Dept of Commerce Chapter 5
and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin
Administrative Code)
Rev. 9/2008
Installation and Maintenance Instructions
Installation
Step 1 Dry fit the filter case onto the outlet pipe going to the drain field. Ensure it is centered directly under the
access opening. (if outlet pipe is already in a fixed position, additional pipe may need to be added)
Step 2 If utilizing the additional single side support and the two bottom supports: While the case
is still dry fit to the outlet pipe, measure aPd cut 1"schedule 40 pvc pipe to the length needed to extend from the
hubs that are pre-molded into,the case to the side wall and the inside floor of tank. solvent weld pipe into the
hubs that are pre-molded onto the case.
Step 3 Solvent weld the case to the outlet pipe. Insert the filter cartridge into the case pressing down on the
cartridge until it locks into place at the bottom of case.
Step 4 if utilizing a vertical read switch: Insert switch into the hole pre-molded into the top of the filter. Press
straight down until it locks into place
Maintenance
1) Remove the access lid of the tank. Note: To ensure undesirable solids do not exit the tank and into the
drain field, the tank should be pumped out until the level of effluent is below the outlet level of the tank.
2) To remove the filter cartridge from the filter case, pull up firmly on the handle of the cartridge dislodging
it from the case. (if utilizing a vertical read switch, removal of switch is optional)
3) Using an ordinary garden hose, rinse the filter cartridge ensuring all visible septage material is removed.
4) Place the filter cartridge back into the filter case pressing down on the cartridge until it locks into place.
5) Place the access lid back onto the tank ensuring it is secure.
Lifetime filter has a lifetime limited warranty:
Lifetime filter LLC warrants the filter will be free of manufacturing and workmanship defects during normal use for the period of
time the original purchaser owns the product. Lifetime filter will provide a replacement filter in the event that the original filter was
not damaged during the installation or maintenance process. Damage to this product caused by accident, misuse or abuse will not
be covered under this warranty. Improper care or malfunctions resulting from product not being installed, operated or maintained
properly will void this warranty. Lifetime filter assumes no responsibility for labor charges, removal charges, installation or other
incidental or consequential costs.
Contact: mike@lifetimefilterllc.com Phone: 502-724-2231
STATE BAR OF WISCONSIN FORM I - 1998 6•_ext5* `xS 1
KATHL.L"EN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
ST,. CROIX CO., WI
Document Number VOL PAGE 46 RECEIVED FOR RECORD
This Deed, made between Gary A Quist and Kendra F. 05-15-2001 5:00 AM
Quist , husband and wife WARRANTY DEED
EXEMPT #
Grantor, PERT COPY FEE:
COPY FEE:
and David R. Anderson and Lisa M_ Anderson husband and TRANSFER FEE: 590.40
wife RECORDING FEE: 10.00
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate in St. Croix County, State of Wisconsin
(the "Property"): Recording Area
Name and Return Address
Da ' d R. Anderson (G `}f
Lis M. Anderson
783 ldro Circle LOS
Huds n, WI 54016
gAr,cr 3.La a 3
020-1177-40-000
` Parcel Identification Number (PIN)
This i s homestead property.
Is~ ~is no
Lot 14, Cedar Hills Estates in the Town of Hudson, St. Croix n y, isconsin.
Together will all appurtenant rights, title and interests.
NONE
Grantor warrants that the title to the Property is good, indefeasable in simple fee and free and clear of encumbrances except
Dated this g7-'(A7_ day of Agril 2001
(SEAL) (SEAL)
Gary A Quist Kendra F_ Qui t
(SEAL) (SEAL)
*
AUTHENTICATION ACKNOWLEDGEMENT
Signature(s)
State Of Wisconsin,
f Ss.
St. Croix County.
authenticated this day of Personally came before me this Q-/ " day of
April 2001 , the above named
Gary A Quist and Kendra F. Quist,
husband and wife
*
TITLE: MEMBER STATE~Btis~i0-1 C to
(If not, ~r11ff~G~~`"''' me known to be the person who executed the foregoing
authorized by §706.06, WipT F WOS trument and ac wledge the same.
gT
THIS INSTRUMENT WAS DRAFTED BY
Coldwell Banker Burnet 01-04213
1301 Coulee Road
Notary Public, Stat of Wisconsin
Hudson w1 54016 My commission is PC nt. (If not, state expirat o ate:
( Signatures may be authenticated or acknowledged. Both are )
not necessary.)
Names of persons signing in any ca acit must bet ed or printed below their signature.
5 AT AR OF WISCONSIN co.,lnc.
WARRANTY DEED FORM No. 1 - 1998 Milwaukee, Wis.
~1 t
33' 33' w z f
ALDRO CIRCLE
g 00• 11W
i .
0
lz ?
+
33' 33'
~e1 W +fl
4 S1.1,
13 14
Ou LOING SETBACK LlM%
r r
*all
A.
SO" • • M
O
TihANGLE IS &
#lrli 0
MT• Gw- 1t
p
E
RE EVY
. .
JUN 18
Wis. Dept. of Safety and Professional Services SOIL EVALUATIM14REPCRTITY Page l of
Division of Safety and Buildings : QMMUNITY DEVELOPMENT
in accordance with SPS 385, Wis. Adm. Code
County ~ ;~/A
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. G LO ( -YO O b O
Please print all information. Revi ed by Date ¢ c
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 6 p f J
Property Owner Property Location
DA~f £ti~ ~tJ Govt. Lot /V £ 1/4`l/ 6 1/4 Z T ,~v 9 N R 7 E (or) W
Property Owner's Mailing Addres'sJ Lot # Block # Subd. Rana or CSM#
Ci State Zip Code Phone Number ❑ 7_11A ❑ Village [8Town Nearest Road
❑ New Construction Use: Q Residential / Number of bedrooms Code derived design flow rate GPD
[replacement ❑ Public or commercial - Describe:
Parent material Flood Plain elevation if applicable ft.
General comments
and recommendations:
Borin El Boring
Boring # RI Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate
z
Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2
.3
;L /d 7 16 e- Y13 6xC Z_
3T- iQy,c~iy Oc5' r►~ Grw -j Z
6 y2 *Y/ s 1 _ 7
of 1 7
Boring # Boring
pit Ground surface ele . ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 ff#2
17-ag Vim as Ef . Z_ , 3
57-
1~r d
e c,
>1
* ent #1 = BOD 5 > 30 < 220 mg/L an >3 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Nam (PI ase Print) nature . CST Number
tc G C7 (A .JIV s ~~L.. 2 Z L~ 7?.
Address Date Evaluation Conducted Telephone Number
~ o r G~ u le, t t, , ~ - - / /3` ?r ` Y q/ 'J38$
SBD-8330 (RI 1/11)
Page of 3
Property Owner Parcel ID #
❑ Boring >119
Boring # ~V W f• Depth to limiting factor in
Pit Ground surface elev. Soil A lication Rate
0
ruc Horizon Depth Dominant Color Redox Description Texture GStSz tSh onsistence oundary Roots ff#1 GPDIf ff#2
in. Munsell Qu. Sz. Cont. Color y - J
149 _ZJr
3 .f~9 l~t?,LY/.~ s/ ~✓~'~$hx ~yyt✓T'~• G~w /V~ , `y~ ~ ~r
t►
❑ Boring
❑ Boring # f. Depth to limiting factor in Soil Application Rate
❑ Pit Ground surface elev.
Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots ff#1 GPD/f2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
F-I Boring # Boring Ground surface elev. f. Depth to limiting factor in.
Pit Soil Application Rate
❑
Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots ff#1 ff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
Effluent #1 = BOO s > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD e < 30 mg/L and TSS < 30 mg/L an equal opportunity service provider and The Dept. of Safe
and Professional Services
access services or need material in ansalte ate format, contact he department at 608-266-3151 11 or TTY through Relay.
SBD4330 (RI 1/1 1)
tA (4 4- Co
*J o S " N CI
2
a ~
M
O
h ~a
I
~ v
I
1
a°
I
_I
ry o ~ C, I
M p to I
a N
0. c
C
NO
qb
N I
h
N
.o I
d ! I
C
C
O
I
O I
«0
o Z c
C
`6 I
LL CO
I
I
M
v (D
z w I
E
0) z o
v o
z d
rn
co H z o m
_o
o z I
°
d Z a o
fQ F- r rn y z
E I
'2
v M
y _ N d
L_7~1/1 C fO0 ~
y C
(D O
a ~ ~ I
Q z m z
N E z
uJ E > N
~ I
CL Y Y ` y C
f6 O 0 0 CL E -
w
o I
it
'N ~aaa
IL
orN n
0 'a J U= CO CO
M
z
M
2 ~ N O O
U O O _ O E N I
a) a N
m C
~ 'O
N N m N ~
Q 'C d Q UJ N I
C _ N N
n
O O Y!
O ~ 3 f0 U O N n N co
\ r O 0- C N N
v w f~ ~ C _ S N O ~ ~ n N I
C', E
O N N H ~ Z
o) w c D I
o N m E U
co 2 2 rn 0 Z y I- 'L U
etf
r
v : E
E a~
I
a
a
L: a
CL v
`I co, c IL 0 U) 0
0 0
~ Ol
0
M ~
~ D
~ I
N ~1 f0
p I C I
i
m
a>
Q)
m c
(D
Ul N
N
C Z w
LL c
~ o
v
Q o
i
3 co C O
ZN 1/! E L N
E O Of 0
LLl 11
Z a+ O a N N
Z d N N
E
a) LU
N~ Z a m 3 E y
0 0 0
(n V1
'2 a)
O Z V c .r f0
o y y 0J 0C
C
N FZ- 'i a~ L a~ c
cioo-co
° o arn0
y f6
J\w N 01 = d O N o
4) Z5 ca -ig C
V~
y O D3Z`°m
y y L 4: d
• 2) Co N E C
4) M 0 CL
3 0 U f0
' O C
O O O a
Z co z
N y
w
W r
a Y
U) d ~ N t0
(0 E
`m G o a D
:3 tj
EL ch
_ 3 3 3
• ~aaa
o
CL ~ I
0
j y
7 Q y
rn Q
V) J V = rn Z
M (D O O_ N N_ N_
F\) Q M_ O ~ Q O O O O O O O
N N N N N N N
O m C a N ('7 N
^ y O V
M
U) U)
v C O y C
IV cd p t C O C N w m m M m to to
O O 3 N C W U a 0 0 0 0 0 0 0 0
r Q - O O• C -Q N N N N N N N N
y y £ 0 4 sf e= O` h f7
O C N O C 7 N M N
cli
m O L
• O N= 2N 0 O Z y H~ ~ fn
O
r
41
v a`, m € a
is 00.
E "e ! c
~1 A ciao 0 viti
PUMP CHAMBER e
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: % Z- Length:?- Number of Lines: Area Built: Fill depth to top of pipe: Yd'
Number of feet from nearest property line: Front, O Side, gRear'017t. l~
Number of feet from well: Q 7
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector: /
Dated: n Plumber on job:
License Number : ~2--
3/84:mj
i
Form - STC - 104
AS BIV LT SANITARY SYSTEM REPORT
OWNER efei~,i,~Z ,&OWNSHIP 3 0 SEC. -Z T ~N-R_(r W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION ,/~,`~/s• LOT 1,V LOT SIZE tx-c4,~_;
PLAN VIEW
Distances and dimensions to meet requirements of I1HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
rd ~ td
/,7 I
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used < r-~- c-g ~f l {
~za
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: v Liquid Capacity:
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation: -
Number of feet from nearest Road: Front IQ Side,@ Rear, O feet
From nearest property line Front,0 Side /TN
Rear, O y feet
Number of feet from: well building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADIStM, VI 53707
NEk,NEk, Section 28,T29N-R19WE:1 CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: (If Town of Hudson ❑ Holding Tank El In-Ground Pressure El Mound
Cedar Hills Est. Lot 14'
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
William Harwell IPPute 1 Box 1910, Hudson WI 54016 o~ - 8 -7
BENCH MARK (Permanent reference point) RISE IF IFF RENT F OM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.:
~-uName of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
illiam Schumaker 6382 St. Croix 92492
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
r'c~ Pl V ED: PROVIDED.
93-53 _ , .3/ IYES ONO OYES NO
BEDDING: J I VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM. LINE: AIR INLET:
OYES o FEET FROM
L I OYES NO NEAREST
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
OYES ONO OYES ONO OYES ONO
GALLONS PER CYCLE: MP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET.
PUMP ON AND OFF) PU OYES ONO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH: LENGTH: NO. OF DISTR. PIPE SRACING: COVER JINSIDE DIA SPITS. UOUID
DBED/TRENCH IMENSIONS I `a- 5 ~ TRENCHES: / M RIAL: PIT DEPTH
GRAVEL DEPTH FILL DEPTH 105 PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTRNUMBER OF PROPERTY WELLBUILDINGV NT TO FRESH
BELOW PIPESABOV/ErCOVEtNT ELEV. NDPIPE UNE
FEET FR ~i tf i NEARESTO-~ / ~O G
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
O meets the criteria for medium sand. TIONS MEASURED.
YES NO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
OYES NO OYES ONO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED MULCHED
CENTER: EDGES:
OYES ONO OYES ONO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE JMANIFOLD MATERIAL- NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEV.: ELEV.: DIA.. ELEV.. PIPES DIA..
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
OYES NO OYES NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
OYES ONO OYES ONO Na
v
`mil} V
R•9 -7
Sketch System on n S Retain in county file for audit.
Reverse Side.
SIGNATURE: TITLE
DILHR SBD 6710 (R. 01/82) Zoning Administrator
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
APPLICATION
TO THE APPLICANT:
1. This sanitary permit is valid for two (2) years;
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable;
3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed
if there is a change in your building plans, system location, estimated wastewater flow (number of bed- ` i
rooms, etc.), depth of system, or type of system;
4. Changes' in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be-
submitted to the county prior to installation;
5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years;
6. If you have questions concerning your private sewage system, contact your local code administrator or the
State of Wisconsin, Bureau of Plumbing, 608-266-381.5.
To be complete and accurate this sanitary permit application must include:
i. Property owners name and mailing address. Provide the legal description where the system is to be
installed:
II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat
restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;
III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or
repair;
IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project
is in conjunction with University of Wisconsin;
V. Absorption system information: Provide all information requested in ##1-6;
VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if
tanks received experimental product approval from DILHR;
VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County/Department Use Only;
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 8%z x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water Mains/water service;
streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement
system areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form.
GROUNDWATER SURCHARGE
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more
commonly known as the groundwater protection law. This change in statutes was the
result of over 2 years of steady negotiation and public debate. The groundwater bill Groundwater
included the creation of surcharges (tees) for a number of regulated practices which Wisconsin's
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried treasure
is used in your building is returned to the groundwater through your soil absorption {o
system or the disposal site used by your holding tank pumper.
The monies collected through these surcharges are credited to the groundwater fund adminis-
terec: by the Department of Natural Resources. These funds are used for monitoring ground
\'vater, grouli9w ler :ontamination investigations and establishment of standa-ds. Gro:rndNn%at_!;
s worth protecting.
~E30-6398 (R.03/86)
SANITARY PERMIT APPLICATION COUNTY
I-S17. 61
UILHFI In accord with ILHR 83.05, Wis. Adm. Code
STAT~ S NITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER
8% x 11 inches in size.
-See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES r,%,L, NO
PROPERTY OWNER PROPERTY LOCATION
6 all +''/a '/4, S T ;Zorj, N, R E (or
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME 14 - -0 CITY CI S ATE ZIP CODE PHONE NUMBER 0 VILLAGE : NEAREST ROAD,
LAKE OR LANDMARK
lie
r 40
i
11. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public (Specify):
111. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable)
1. a. K New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2)
1. a. ,.,Conventional b. ❑ Alternative C. ❑ Experimental
2. a. ❑ System- b. ❑ Holding C. ❑ Pit Privy d. ❑ Vault Privy e. E1 Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. ASee a e Bed b. ❑ seepage Trench c. ❑ seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
4:~'e'-f- 1!::15-- ~ e 40 Feet [Private ❑ Joint 1:1 Public
VI. TANK CAPACITY Site
in allons Total # of Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete structed glass App
Tanks Tanks
Septic Tank or Holding Tank X_ I
Lift Pump Tank/Si hon Chamber ❑ ❑
VII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) M / PRSW No.: Business Phone Number:
A, .6 C_ 46 Or-3
Plumber's Address (Street, City, State, Zip Code): Name of Designer:
K r
Vlll. SOIL TEST INFORMATION
Certified Soil Tester (CST) Name CST #
.,r
ST's ADD S ( et, City, State, Zip Code) Phone Number:
:5 7`
ti
IX. COUNTY/DEPARTMENT USE ONLY
spry ❑ ODisapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps)
LL~J Approved ❑ wner Given Initial ` S rcharge Fee]
Adverse Determination 4" to ~ o ' - C
X. COMMENTS/REASONS FOR DISAPPROVAL:
i
SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber
APPLICATION FOR SANITARY PERMIT
S T C - LOO
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies; will only result in delays of the permit
issuance. Should this devetoPment b intended for resale by owner /con tractQ spec
house"), then a second form should be retained and ccmpleted when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property
Location of Property Section 6Z T =-,O N - R W
Township
Mailing Address ld~a,~!---P=~L~'
Subdivision Name
Lot Number ~ -
Previous Owner of Property
Total Size of Parcel ~-c~ tr•er-____ _ _
Bate Parcel was Created
Are, i0l oorners anii lot linos idetntAfiab.l-'? Yes No
Is this property being developed for resale (spec house) 7 Yes No
Volume 'and Page Number r-5 as recorded with ~~'t~he~Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
3. Other recordings filed with the Register of Deeds Office
In addition, a certified survey, if available, would be helpful so as to avoid delays
of the reviewing process. If the deed description references to a Certified Survey
Map, the the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
1 (we) ceAti.6 y that att s tateme:nt4 on .thi d Jo4m ane tn.ue to the beat o j my ( sun )
kn.owl'.edge; that 1 (we) am (ane) the owneh (6) o6 the ptopeAty des cAibed in #h.i.d
inbo4mat on 604m, by v A tu:e 06 a wauanty deed neconded in the O j 6ice o A the
County Regi4lteA o j Deeds " Document No. e- .and that I (we)
ph_ezentty own the p4opoaed 6i te. bon the sewage c1a.a~to~aP -6yz.tem (o4 I twe) have
obtained an ea.6ement, to &an with the above desciibed pkopeAty, jon. the
condtnaeti.on o6 baid bybtem, aad the earne has been daty h.kcon.ded in the 0j6ice
o6 the County Reg.us.ten of Deeds, ab Document No. -//3/ )
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
Z/-
DATE SIGNED BATE: SIGNED
AL. j qj PACE ?yam - ; y j-
. c'A" UMENT No: STATE BAR OF WISCONSIN FI~M 11-1982 TNIS SPACE RESERVED FOR RECORDING DATA
' LAND CONTRACT
y ~~~yL Individual •nd Corporate t~' R~'05TUS OFF.r"
j J ITO IIE USED Ft)R ALI. TRANSACTIONS WHERE OVER
;i i2fi,000 13 FINANACT TRANSACTIONS) NON-CONSUMER ST. CROIX Co., Wis.
Recd. for Record this 11th
Contract, by and between Harry J . Stewart as Personal day Of Juun~_q~p. g 86
Representative of the Estate of Aldro Larsen a/k/a John of 11:45 A ~y1.
._Aldro_Larsen__afkfa__John_Aldro Myren_Larsen,* ("Vendor", James 0 Connell
whether one or• more) and_..William C. Harwell
~~IM't d D..an~~
*single man „
......................n.___..._...............__......._.. (Purchaser ,whether one or more).
Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- deputy
formance of this contract by Purchaser, the following property, together with the
rents, profits, fixtures and other appurtenant interests (all called the "Property"),
St. Croix__________________ County, State of Wisconsin: RETURN TO
in..........••-•--._._._...
See legal Description on Addendum
Tax Parcel No........--•-----•r
3~~ _ q.~73 y.
SANS
FT
This ......is••not.._..•_--- homestead property.
(is not )
Purchaser agrees to purchase the Property and to pay to Vendor at -Such lace as he shall name
the sum of ;__192.x500.00•____________ in the following manner: (a) 59.,QQQ.1QQ.._.._.._......
at the execution of this Contract; and (b) the balance of $ -131. 5Q0-~QQ•_-•._•_._......., together with interest from date
hereof on the balance outstanding from time to time at the rate of ..............keA._!`I.4!)........... per cent per annum
until paid in full, as follows :
See Payment Terms on Addendum
Provided, however, the entire outstanding balance shall be paid in full on or before the.._..._ 11th day of
...._..._June 19...4.0.. ( the maturity date).
Following any default in payment, interest shall accrue at the rate of ___10....% per annum on the entire amount
in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire
principal balance
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici-
pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor,
Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of
taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
unless otherwise required by law,
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any
amount way be prepaid without premium or fee upon principal at any time.lG9tik l~ xxxxxxxx]t~c]tx c gx2c2Cx7g7~
tkacx: ~:a,;,~x aa~mc ~pxAxe¢atxa4'xirmit~i pmtx~it~suooi~ox x>!fx~erxbaait
In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long
as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated
as unpaid principal) is less than the amount that said indebtedness would have been had the WRIgt*ij&payments been
made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds
of insurance. or condemnation, the condemned premises being thereafter excluded herefrom.
Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser
for examination except:
Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall
be retained by Vendor until the full purchase price is paid.
Purchaser shall be entitled to take possession of the Property on.._._..t-h?v dente__hgXPPX____________________lax - .
.Cross Out One.
LAND CONTRACT-Individual and STATE BAR OF WISCONSIN Wisconsin L al Hlank Co, Ine.
r!n.nw.wt_ Fnui,,t v. !nnn _e!.ce::•:-!
Wh L C4 1) 117
Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's in;':r~at
in it sand to deliver to Vendor on demand receipts showing such payment.
i -'Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, ex-
Irr:lt•d coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved
by Vendor, in the sum of .nla but Vendor shall not require coverage in an amount more
than the balance owed under this Contract. Purchaser shall pay the insurance: premiums when due. The policies shall
contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original
of all Policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to
in::11ralire companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall
It- aplilied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be
:nutnirslly feasible.
Purchaser covenants not to commit waste nor allow waste to he committed on the Property, to keep the Propert;-
in vood tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and
to comply with all laws, ordinances and regulations affecting the Property.
Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions
shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to
the 'urchoser a 8ti~l7[1lLD~ Fed in ,tee simple, of the Property, free and clear of all liens and encumbrances, except
ersona7 Re res in
a iv s
any sons or encum ances crea ed ~y the act or default of Purchaser, and except:.... easements,,-protective..
...covenants..af..recard,Af._any,..and..zaning..a.rdinanue.-requi rements..
Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or
interest which continues for a period of ---60... days following the specified due date or (b) in the event of a default in
performance of any other obligation of Purchaser which continues for a period of A0.._. days following written notice
thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract
shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby
waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in
addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's
rielits, title and interest in the Property and recover the Property hack through strict foreclosure with any equity of
redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from
the date of default at the rate in effort on such date and other amounts due hereunder (in which event all amounts previously
paid by Purchaser shall be forefeited as liquidated dama_es for failure to fulfill this Contract and as rental for the
Property if Purchaser fails to redeem) ; or (ii) Vendor may sue for specific performance of this Contract to compel
immediate and full payment of the entire outstanding; balance, with interest thereon at the rate in effect on the date of
default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser
shall he liable for any deficiency; or (iii) Vendor may site at law for the entire unpaid purchase price or any portion
therrvif: or (iv) Vendor may declare this Contract at An end and remove this Contract as a cloud on title in a quiet-title
action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession
of the Property and have A receiver appointed to collect any rents, issues or profits during the pendency of any action
under (i), (ii) or (iv) above.Notwithstanding any oral or written statements or actions of Vendor, an election of any
of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses
including reasonable attorneys fees of Vendor incurred to enforce tiny remedy hereunder (whether abated or not) to the
extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in-
curred, and shall be included in any judgment.
Upon the commencement or during the pendency- of any action of foreclosure of this Contract, Purchaser consents
to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of
the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and
applied As the court shall direct.
Purchaser shail not transfer, sell or convey any legal or equitable interest in the Property (b•; assignment of any
of Purchaser's rights under t%tis Contract or by option, long-term lease or in any other way) -rithout the prior written
consent of Vendor unless either the outstanding balance payable under this Contract is first pitid in full or the interest
conveyed is a pledge or assignment of Purchaser's interest under this Contract solely As security for an indebtedness of
Purchaser. In the event of tiny such transfer, sale or conveyance without Vendor's written consent, the entire outstanding
balance payable under this Contract shall become immediately dlle and payable in full, at Vendor's option without notice.
Vendor shall make all payments when due tinder any mortgage outstanding against the Property on the date of
this Contract (except for tiny mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser
makes timely payment of the amounts then due tinder this Contract. Purchaser may make any such payments directly to
the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on
this Contract.
Vendor may waive any default without waiving any other subsequent or prior default of Purchaser.
All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives,
successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable
consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the
deed to be made in fulfillment hereof.)
Dated this .......11th day of June
, 19..86...
e -4-l
. .................................................---.........(SEAL)
' --Harry.J....Stewart---•--••---•••------••--
..............................(SEAL) ✓~(J~ L.. '.f!' !!r -
William C. Harwell c Q
AUTHENTICATION ACKNOW LED GKENT'~,'~~.'- C t
Signature(s) STATE OF WISCONSIN ~~''a * C•
ss.
St.
•-•C........roix ....................County.
authenticated this ........day of. 19...... Personally came before me this _Llth...... day of
June 19.86._ the above named
Harr J
•.•-_••___y__•• .__Stewart__and__William. C,__Harwell
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not .
authorized by § 706.06, Wis. Stats.)
to me known to be the person s........_. who executed the
foreM.... 'nstrument and acknowledge the. same.
THIS INSTRUMENT WAS DRAFTED BY Lois A••••................ •
u_. raY.~._ HEYWOOD, CARL, MURRAY
& SHERBURNE, P.O. BOX 229, ~V~,d.....__.._.. ~~R O/✓
Hu=9svn; WI 54Ulfr Notary Public St,..Croix..._.......
County. Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is per anent. If no state expiration
III- ' tire not necessary.)
date:t _g 19..
'.s
Il Names of persons sisninir in any capacity should be typed or printed be! - slanatri;ra.,
a
I
i
,1 JVM O E ~ H',.~/
- ~ su',. sr
di/w AMO ~rls
aaih 1 s.r ;1q .n ~ 4 ° CQ
its ysJi or /wI✓7 l/rI/ • _
✓i,
v/
-arcs • ~
r - °
ski /,/..,v s% u \ A Vc~
n,
-3 M
...r~,.. Ord _7- •~.I ~ ,
DEPARTMENT OF REPORT ON SOIL RINGS AND SAFETY & BUILDLNGS
DIVISION
INDUSTRY, PERCOLATION TESTS (115) MADISOP.O. BOX N, WI 53709
LABOR AND 7
HUMAN RELATIONS (H63.090M Chapter 145.045)
OCA ION: i~RtWTNER'S ACTION: UNICIPALITY: OT NO.:BLK. NO.: UBDIVi}S11ON N ME:
N F_ / N/R o for 14V hsoq 4 ES'rAT&S
COUNTY: U S AM : ]MAIL11mu DDRESS:
~l ~4d/ V
S-I-CP-olx /AIL I11:, ~oP1~rN k, ter -C-C LA f: USE DATES OBSERVATIONS MADE TS: PROFILE DESCRIPTIONS- IFERCULATION TrESTS:
NO.6 )RMS : CO M A D R PT10 : ❑Replace /
Residence ` ~NV New APkIL. 6 /9-ro'? 4PRIL-7
JJ~ts QK ACt 06 so Ls 'bAtlDTa
RATING: Sm Site suitable for system U- Site unsuitable for system
TA
ONN NT N L: MOUND: I'-GROUND-PRESSURE: FI L ffjG
NK: RECOMMENDED SYSTEM:(optional'nis ou a s Zu s ou Us ❑u ,®v CeN VL' 4T►OrVAL l$fh
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the WA
under s.H63.09151(b), indicate: C~dss Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
t i
BORING TOTAL P H R U ATER•INCH S HARACTER O SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTFIJR, ELEVATION p^^gIISE V D TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 5.4-Z 100.eA ,VO t. > $.QZ /Q'r8LLTSis" eN1. 4o tr &N MS 33'tita M S-46-m
B- Z 8.z-,~ /oo-94 No NC 8.Zs I-ZIt. TS ~BRwL 41*kr19o,4 / K 14"BtR.1 S*Gk
B- &,)'7 /0/•44 NON t > 8.17 12"Al.LTS /6"&,4st 70" &,4S'(&e -PSA^u
B- 8.2S /0/.0o NO Iq 8 Z< 171F' L-rS /o"LSQN L 7oh 4Q4 'MS 2" 81 wenS4 G, IQ
B- a,17 /DI-11 I40 tr ~ e, / It.Ak-dSC Se&&v /4s legear St6*-
B-
PERCOLATION TESTS
ISSI DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES A MINUTES
NUMBER I AFTERS ELLININTERVAL-MIN. PER INCH
P- 3,1--b o 3 12 2 4 Z
P_ Z 7 10OA7 3 > 2 > 2 < 'z
p- '.e 3.5 flasl ~OO.SG 3 > < 2
P. A-r a k<-
P_
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
yontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 97,00 6 r '
'Sm L6c-a-r- ►a fv qLt.`,~
C* kFoe-e-s-C
°V~ g-S ' R N'~~ C 1
7 e0N PI , Ate 3,• sZ
►s •8 Z u p
Forma _ _ , _ _ _ .
CenntR 49' .~1 ~3 `.~CAId
AC_
i
J ,
4t _ L_
10
%J
_ qtT 14 nloTE Plee+osc E~cv L oti c o~R
4li L1~NCttMAQk ' / 1RoN P„Pr L° -raP d7 ILOCV. of /4+U.IP $ASfMEV.
LC~7- t` O Rt~J L R LOT 3 /Q 3. 3~
1, the undersigned, hereby certify that t e gists ~Ft.dhis form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data r and the location of the tests are correct to the best of my knowledge and belief.
l1
NAM print : TESTS WERE COMPLETED ON:
/44QVtY N!SILOSI IL ie%C4 "trea( yl . AP*IL ? /97r7
ADDRESS: C RTIOCATION NUMBER: PHONE NUMBERIoptionall:
4 Q7 Z c ce jj S-► Ulu r j 3484 3~ -4a~sCi
CST SI TURE:
DISTRIBUTION: 01igi it and one copy to Local Authority, Property Owner and Soil Tester.
fall HA-SRD•6395 M. X7/87! OVER
I~
y..
~/LL~cP1.C . 7`r are Ua oa,~..~
l ol`
SGo p3
3
(65$'x`
L G
l~
rl
e
a
t~
V
s '743 87
. 'Y
LAND CONTRACT ADDENDUM
Legal Description
The NJ of the NJ of the SEJ"of Section 28-29-19, except the South
100 feet of the East 565 feet thereof, and except a parcel of land
located in the NEi of the SEI of Section 28, T29N, R19W, Town of
Hudson, St. Croix County, Wisconsin, described as follows:
Commencing at the Ej Corner of said Section 28; thence S8903714611W
(assumed bearing referenced to the monumented East-West I Section
line of said Section 28, bearing assumed S89°311 4611W) 23.78' along
said East-West line to the point of beginning; thence continuing
S8903714611W 1301.48' along said line to the West line of said NEI
of the SEJ; thence S 000314411W 661.63' along said West line;
thence N8903414811E 761.971; thence N 000511211W 100.001; thence
N8903414811E 535.401; thence N 003013811E 560.56' along the Westerly
right-of-way line of U.S. Highway 1112" to the point of beginning.
NEI of Section 28-29-19, except that parcel described as Lot 1 of
a C.S.M. recorded in Vol. 3 of C.S.M.'s, page 862 as Doc. No.
359579 and except that parcel described in Vol. 583, page 527 as
conveyed to the State of Wisconsin.
Payment Terms
$35,000.00 on June 11, 1987 and $35,000.00 on each
anniversary date of this Contract thereafter; provided, however,
that if the unpaid principal balance on the Contract is greater
than $85,000.00 on July 1, 1988, Purchaser shall make monthly
payments of $3,500.00 commencing on July 1, 1988 and on the first
day of each month thereafter. Also provided that on the first day
of the fourth month following Purchaser's death or permanent
disability, monthly payments of $3,500.00 shall commence hereunder
and shall be paid-on the first day of each month thereafter.
Vendor shall release Lots of not more than 31 acres in size at any
time during the Contract upon payment by Purchaser to Vendor of
$5,500.00 per Lot. Each $5,500.00 payment and each $3,500.00
monthly payment shall'be applied to reduce the next $35,000.00
required annual payment. Also provided that for each $5,500.00
paid by Purchaser in total monthly payments, Vendor shall release
one additional Lot of not more than 31 acres, upon request of
Purchaser. Purchaser shall pay the cost of drafting Partial
Releases.
Vendor shall convey to Purchaser one parcel of land around farm
buildings upon recording of C.S.M. without further payment.
Parcel not to exceed 6 acres.
. r
ST C- 105
H
SEPTIC TANK MAINTENANCE AGREEMENT Q,,.
St. Croix County
H
l~ia Y~~-~l -
OWNER/ BUYER
ROU'T'E/BOX NUMBER fiL! Fire Number_
CITY/STATE zip
PROPERTY LUCATION:,/~ 14, 14, Sectlunar-T dL~N, 1tW,
St. Croix County,
Town of
Subdivision Lot number r
Improper use and maintenance of your septic: system could result in
its premature"failure to handle wastes. Proper maintenance con-
sists of pumping Out the septic tank every three years or sooner,
if needed, by a licensed septic tank put~er. What you put into
the system can affect the function of the septic tank as a treat
ment stage in the waste disposal system.
St.-Croix County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained. The property owner agrees to submit to St. Croix County zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-bite wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
H
three year expiration. o
I/WE, the undersigned, have read the above requirements and agree cn
to maintain the private sewage disposal system in accordance with H
the standards set forth, herein, as set by the Wisconsin Depart-
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
S I C N E D •~~G~ ,its
DATE ~7e
St. Croix County Zoning 'Office
P.O. ,►o x 96.
Hammo')ld, WI 54015
715-7 16-2239 or 715-425-8363
Sign, date and return to above address.
1JYV
FF, r~.' t fl~
/JY+'sY ul r~p ~ *AS
r ~ ve ~ 0
r ai) `C dos w:e `t
ftm-fta
•[/c/. P,,r+'q tern may/ rnte~"'(f--_'>`__- ~p
61,7
t-Lvl 3-7
• `tir. ~ ~ ~.f...; X11 j
~ by ti.5'
M nCJ
h'/ ~i.l „//J.v n A 1. 2.
ai
mar//..,.N ' r .>L
~ I. MI 1Y..p~ .
1/osp/w/ 14
I MENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION
INDUSTRY, .O. BOX 7969
LABOR AND PERCOLATION TESTS (115) PMADISON, WI 7969
HUMAN REhATIONS
(H63.09(1 T & Chapter 145.045)
LOCATION: E ON: p o Q UNICIPALITY: OT NO.: BLK- NO.: SUBDIVISION NAME:
NE 4 4 -4 L8 T-z- N/R~ 1 ~(or1.W /~V A$c~nf CElt,t4lC~ll(-i S7ATr
COUNTY: WNER'S U ER'S AME: MA LINta ADD bl
S. C~t~lx IJI~Ls~E oP~'":: ~ I~`T 1 ~ov 1C/~ /~r,~5~ W ~4
USE DATES OBSERVATIONS MADE
NO, BEDRMS.: COMM R IA DESCRIPTION: PROFILE DESC PERCOLATION TES
Residence w ❑ Replace A,PR l t_ ~910 PRI L 7
t, NiC
RATING: S- Site suitable for system U- Site unsuitable for system
OUN : S ST -I -FILL OLDING TANK: RECOMMENDED SYSTEM:(optional)
-GR
ONV NTI NAL: MOUND: ouN
U EI S S Ou US ❑U rEIS WV LANAA1T10N„l_ &a
u
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s,H63.09(5) (b{, indicate: CL"4s5 Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
t i
BORING TOTAL P H T R UND ATER-INCH S CHARACTER OF SOIL WITH THICKNESS, COLOR. TEXTURE, AND DEPTH
NUMBER DEPTHzK ELEVATION OBSERV D JIGH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
I
B- J Y5.9Z /00,`6 do' !Vp L > $.4Z A'18tCTSis"S4wL g0~LT$+NMS !3`19ttJMSrt6"
B. Z Q 25 ~~0 9q NON L a-Ti-C.Tr it' ~Ao.,L 4"z`zTEQN • K 14`iQ / 5*lG-vr
B- 3 8.1~ /o/•q4 NON L > e 17 1C&,4,;t 70"9e,4S46e -PS.6ak'"
B- 6 zS / o/, oo 1 8 2<- 0* L-rs 1o~~8eN L 70° QR,d MS 2"&NMS4 6,12
B- a.)-? /o/a, Q•! /rat", T tf,4RaN5c 53°L,$Rv m /else,r st&*-
B-
c PERCOLATION TESTS
~T
DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RA MINUTES
NUMBER I AFTERSWELLING INTERVAL-MIN. P -PE-13100 2 PERIOD 3 PER INCH
p- kn o ? > 2 y ? < 2
P. f < 1z
.A /00 17
P- 3.5 fJo ~oo.s6 r > < 2 -
P A-r Gk,
P-
P-
. _ r .._-_..~.-_.-1
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
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 larid slope.
SYSTEM ELEVATION
r<F~~ 5LOT~ g-3
10 N
vc:l
RN
?''IRON IPiPt i ALA 37. s2!
FovN'D . - - - -139'-- ~ ~ • g- s~i
t H
CeN'TLR 49' SCALE
CAF ! 1 3S~ ►It) / %40
\
10
L_oT- 14 ,goTE: N600Sth CLCVKT cwk
41; $FNC,AMAek IkoN P.ts(' LL"' TaP dC rpIOCK of /44LF &ftt/nCjVT
1, the undersigned, hereby certify that t e s ests•,6ep6rted on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data r c and the location of the tests are correct to the best of my knowledge and belief.
I t l owl ~PL _
( NAME print TESTS WERE COMPLETED ON:
ADDRESS: CERTIFICATION NUMBER: IPHONE, NUMBER (optional):
40-7 i r `a J + i 1 (J b stint { r> Q ~4$'~ 3R( - 4 o%-6
CST SI TURE:
DISTRIBUTION: Original and one copy to Local Author uy, Property Owner and Soil Tester.
C)II HR 9RD-6395 If;. (12/82) OVER
I
I
iJrV
it -JVI■• •p
"11YW9 ~ Y/hr'
'1 T p='~~P _ .Ih
POW G C sae s. a ' `c'r y~ o
1/IIM h~ J'
■ • N a, .
i
-IV
I6 r z. Z}
Of
kwav
nn
's arcs •
c~
r/i✓i.ii~y ~ ~ ran
1
,.IV
•l1 ~ 1
SAFETY & BUILDINGS
DEPARTMENT Y, OF REPORT ON SOIL BORINGS AND olvlstoN
INDUSTRY, P.O. BOX 7989
LABOR AND PERCOLATION TESTS (115) MADISON, W1 53707
HUMAN RELATIONS (1-163.090M Chapter 145.045) '
.1
LOCATION: ~ 1 E N:T y p ~y / UNICIPALITY: OT NO.: BLK. NO.: SUBDIVISION NAME:
NC 1/4 : ZS 1 ZS N/R I ~(or n Uv Ac~p~ 4 ~LAR~II(t ~STATSS
COUNTY: WNER'S /UY 'S AME: AILING AD S :c~ O,
`~iCRplx IJfI ~E•1 :OPM: i RT / DOt~ /7/b /JCI~S~ ►V
USE DATES OBSERVATIONS MADE -IT NO, DRMS.: COMM R A DE RtPTION:
Residence - New ❑Replace 4,tlL& 1ChaI PRIL 7 1qT
N k!-
»rL - l (yOK 4.t tjtl .O
RATING: S- Site suitable for system U- Site unsuitable for system
r ONN NTI NAL MOUND: IN-GROUNa PRESSURE: S ST -1 -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
S CCU 0 S Z11 S DU LAS L~U D S ,ill ~dN vE►~~toN~►t. 610a
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the ~t
under s.H63.09151(b), indicate: C L_wss Floodplain, indicate Floodplain elevation: H
t PROFILE DESCRIPTIONS
i
BORING TOTAL UEPIIJ T R UNDWATER•INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, E TURE, AND DEPTH
NUMBER DEPTH SR, ELEVATION OBSERVED ~y 4IG H TO BEDROCK IF OBSERVED (SEE ABBRVV..~ON BACK.)
B-
%92 e64, ^ / V > O.9Z /9"8/_LTS /S„pRN L ~O~LT~ttN r I.a ~~~DR►I S~ ~`f1t
B- 8.25 /oa•94 1-40 t > g.2s a'TuT ~1 ~9*4 6~~,~~$pN ~^'IS 1/'t°$a.~ S~Cate.
B- 3 8.1-7 4A- NON L > ~ .17 ~2"IS~cr~ /d~$IeNSL 70"BINS#6re ~Si ba+;cs
B- S2S /~/•po Lv 8 2~ 0"$tL.TS/0"9PNL 76"' a-44 MS. Y'$QNf'►'IS4G,R
B- E3. 1-7 /DI.L`1 tt t > e- / /i 8t-I T'- I6"8RNS4- _Se&&,q /Ns legeo 'Stele
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RA MINUTES
NUMBER I AFTERSWELLING INTERVAL-MIN. Pr;n 00 2 PERIOD PER INCH
P_ 3Id> Iqoi, t 3 ~2 ~2 < 2
P. Z 3. Ss~ 3 > 2 > Z < 2
P• 3 5 tdo 3 Z > < 2
A-r a Rc
P-
Pp
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
xontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 9-7,00 _ t
sc- ,
o„~` ~,b .
opt k'~ lr B-S P~
R N
7''1 ~oN P>: Alf 3Y S~
Fa~N~ - - -139'-- < .e^ TH
Cer.atLR 49'44M16
I oT- 14 I-tl!AdoSltt ELevrCSION c
L Not E o~R
~ 1 i, , L at
QL i $a<NCtaMaoRk - IRoN Plot. 1~•. ' -nop- dF' $~Oc.K of /49jY ~AS£MER>
Q C~tt/ATIOn) - 10c).cyG
1, the undersigned, hereby certify that t Xq, stsrted on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data r nd the location of the tests are correct to the best of my knowledge and belief,
I "itoli_P.4,
NAME (print) TES,T/~S WERE COMPLETED7ON:
~~AQr/43 ~O~NcI~JScNuC'lE i'I ~~lL /-'tPPtL 7 ~9~51
ADDRESS: f CERTIFICATION NUMBER: PHONE NUMBER(optionall:
4'67 "ti.F:y17y La~u a ~t 401L '!>AT4otsG
CST SI E:
STRIBUTION: of illinal and onie copy to I-ocatl Amhoi ity, Propel ty Owner and Soil Tester.
DI
17.11ILHR•SRO-639S (R, (1218)1 OVF:II
,
ST9 CROIX COUNTY AA I
PLANNING ZONING
December 05, 2012
David & Lisa Anderson
783 Aldro Circle
Hudson, WI 54016
Re: Sanitary Violation on property located at 783 Aldro Circle, Town of Hudson
Parcel 28.29.19.1114, Computer 020-1177-40-000
Code Administrauon
715-386-4680 Dear Mr. & Mrs. Anderson:
Land Information&- The St. Croix County Planning and Zoning Department is the "governmental unit for
Planning
715-386-4674 the regulation of private sewage systems" in St. Croix County pursuant to Section
145.20(1) (a) Wis. Statutes. Section 145.20(2) (f) of Wis. Statutes states that the
Real Propewty governmental unit shall investigate violations of the private sewage system
715-386-4677 ordinance and shall issue orders to abate the violations.
Recycling This Department received a complaint alleging that you have um ed se tic
715-386-4675 y p p p
wastewater onto the ground surface on multiple occasions. This is a violation under
St. Croix County Code of Ordinances, Chapter 12 Sanitary Ordinance, subchapter
12.1(F)(4)(e) and considered a human health hazard as defined in Wisconsin
Administrative Code SPS 381.01(128) and Section 254.01(2) Wis. Statutes.
If this department receives photo documentation of any future illegal pumping a
citation will be issued.
A licensed plumber can help you determine any potential causes of the failing
system and what options are available to meet the needs of your family and yet
comply with all State and Local ordinances.
If you have any questions feel free to contact me at 715-386-4680.
Respectfully,
Ryan Ya rington
Zoning Technician
ST. CRO/X COUNTY GOVERNMENT CENTER
1 101 CARM/CHAEL ROAD, HUDSON, W/ 54016 715386.4686 FAx
PZCaCO.SA/NT-CRO/X. WI US
WWW.CO.SAINT-CROIX WI US