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ST. CRO /X COUNTY GOVERNMENT CENTER
1 10 1 CARM/CHAEL ROAD, HUDSON, WI 54016 715386 FAX
PZPC0. SAINT CRO /X. WI. US W W W _CO _SAI MT _C ROX)AW -US
Wisoc%Wn Deporimient of Commerce PRIVATE SEWAGE SYSTEM county:
Safety and Buildings Division INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 384227
P rmit er ❑City ❑ Village Town of : State P an ID No.:
c�lmftt, Ho � 's N era me: Hudson Township
CST BM Elev.. Insp. BM Elev.: BM Description: Parce Tax No.:
d a / �� v c 020 - 1021 -70 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic c/ d Benchmark Y JO /
Ing Alt. BM ,�O w q
Aeration Bldg. Sewer F Se
O 9 9
Holdin Ht Inlet
TANK SETBACK INFORMATION Ht Outlet /o. S
TANKTO P/L WELL BLDG. Airi to ntake ROAD
Air I
Septic � y ' NA
p NA Header / Man.
Aeration — NA Dist. Pipe �. ( f( , e
Bot. System ( �S S
Holding . Z
PUMP/ SIPHON INFORMATION Final Grade
PFce cturer
emand over
Number G
Friction System TDH F
Loss ain Length Dia. .Tow
SOIL ABSORPTION SYSTEM , r
BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. liquid Depth
D IMENSIONS Z DIMENSION
LEAC ING Manua urer:
SETBACK SYSTEM TO P / L BLDG WELL [ LAKE/STREAM AMB
o Number:
INFORMATION Type Of
System: �� —� yS-i Y IT
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length —1L Dia._ Lengths 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 ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, j pfpp ection #1 J( / (o / 4 Inspection #2: /
Location: 932 LaBarge Road, Hudson, WI 54016 (NE 1/4 SW 1/4 14 T29N R19 - ' 4 wow 1.) Alt BM Description = �,�/ o Ul cm► - wc� s�c�� y) Iu��� - Z so 4o�.
`
2.) Bldg sewer length
- amount of cover = > ;y `' ' �"°'� L�or /`-q 6c do-e- �v
Amve 5 S /cl„, .^4 S iraG
z� e(" 4, �� � off' ��� l7 ,6.��
Plan revision required? C] Yes No
Use other side for additional infor ation. UH
SBD -6710 (R.3/97)
Date Inspectors Signature Cert No
0 Ver —'�
N
00
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G73978'
y..,k •. ' c s . Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
isconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not
state owned.)
Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x I I inches in size.
County State San Permit Number ❑ Check if revision to ation State Plan I. D. Number
' 3 842_2. ':�
I. Application Information - Please Print all Information r '° ocation:
Property Owner Name ` perty Location
L_ie4 R'ECEIV
1/4 1/4, S W IVN, R (or)o
Property Owner's Mailing A dress umber Block Number
c >>_
x
City, Sta Zip Code Pho eldtMber cotwTY ivision Name o CSM Numbe
ZONiNGOrFICE
II. Type of Building: (check one) J ❑City
I or 2 Family Dwelling - No. of Bedrooms : ❑ Village
❑ Public /Commercial (describe use):_ 0 Town of
❑ State - Owned
Nearest k oad
2 3 ' _ le�lnt.Yn ads Parcel Tax Numbers)
III. Type of Permit: (Chec only one box on line A. C heck box on line B if applicable) Q -- — D O
A) I. JS New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only , Existing System
$) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
Jff Non pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. oil Application 5. ercolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. 8.) (Min. /inch ) Elevation
VI . Tank Capacity in Total # of Manufacturer Prefab Site Steel: Fiber- Plastic
Information Gallons Gallons Tanks Con- Con-
glass
New Existing crete structed
Tanks Tanks
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑ ❑
x
VIII. Responsibi it to em
I, the undersigned, assume responsibility for installati n of the POWTS shown on the attached plans.
Plum be 's a rint) Plumber's Signa e s ps): MP RS No. Business Phone Number
C � `� .
Plu bee ddress (Street, City, S te, Zip Code)
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ZAgent Si na (No stamps)
Approved ❑ Owner Given Initial Adverse Sµrcharge Fee 6D
Determination t 1 2 I
X. Conditions of Approval /Reasons for Disapproval:
/� �1. -
S 4-• { SY .5 1 i �er °` � _ 6 d[x M.141 i1e1�� tll�nce `..IC.tAAR `.u,'
nn - tea. s ba -
SBD -6398 (R. 07A 0)
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Wisccr _sin Department of Commerce SOIL EVALUATION REPORT Page 1- of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
paper on
Attach complete site Ian a er not less than 8 1/2 x 11 inches in size. Plan must
a P P
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, anc[k=af distance to nearest road. — /O Z (- ) 0 '/ 0 0
Please printpH i eviewed by Date
Personal information you provide may be u farspeondary p poses (PfivpoXl , s. 15.04 (1) (m)). '� f
Property Owner r `,� , i +f� Property Location
J Pidg Qo vt. Lot NE 1/4 Sys 1/4 S 1 4 T 29 N R 19 EAor) W
Property Owner's Mailing Address # Block # Subd. Name or CSM#
337 Co. Rd. "E" {:-i -1 na csm vol.3- 745
City State Zip . � e,.:, Phone l City ❑ Village 0 Town Nearest Road
Houlton Hudson I LaBAr a Rd
New Construction Use: [R Residential /*irftZer 6 ion§ Code derived design flow rate �(� GPD
El Replacement E3 Public or commeraa{ = - 6 a exiibe:
Parent material outwa Gh Flood Plain elevation if applicable n ft•
General comments
and recommendations:
trenches spaced to code, 4.00' below grade
F Boring
Boring #
pit Ground surface elev. 99.80 ft. Depth to limiting factor +110 in. Soil Application 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
1 0 -13 10 2 2 dsh cs 2f .5 8
2 13 -32 10yr4/4 none sil M na
3 32-11C 7,5yr4/6 none ms Osq dl
i
Boring # F] Boring
2 U pit Ground surface elev. 99.70 ft. Depth to limiting factor +1 1 0 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft=
in. I Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2
1 L 2csbk dsh cs 2
2 13 -37 10 4/4 none 1f
3 7 -110 7.5yr4/6 none ms
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg /L ' Efflugnt #2 = BODJ30 mg/L a d TSS 5 30 mg/L
CST Name (Please Print) Signature `CST Number
Gary L. Steel 02298
Address � ,Zz_ e
ed Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 10 -24 -20 715 - 246 -6200
f
Property Owner Jim Pi dgeon Parcel ID # 010- Page 2 of 3
D 3 Boring # ❑ Boring
[ pit Ground surface elev. 99.80 ft. Depth to limiting factor +110 in.
Soil icetion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0 -13 10 2/2 none
2 13 -20 10 5 4 non
3 20 -38 10yr5/4 c2d 7.5 5/6 sil M
4 38 -11
Boring # E] Boring
❑
4 ® Pit Ground surface elev. 99.70 ft. Depth to limiting factor �1 1 !1 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 cs 2f .5 8
2 13 -36 10 9W 1f .�
3 36 -11 7.5 4 none
•g gZ.$'
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
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. 'Hf#1 'Eff#2
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = B013 30 mg/L and TSS < 30 mg/L
p rovider and emp loyer. If
The Department of Commerce is an equal opportunity y ou need assistance to access services or p y
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777.
SBD -6330 (R6=)
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Jim Pidgeon New Richmond, WI 54017
MPRSW - 3254 NE S14- T29N -R19W (715) 246 -6200
town of Hudson
lot #1 -csm
I , N ,' 1 =40 1
BM.= top of 1" pvc pipe @ el. 100.00'
Alt. BM.= top of 1" pvc pipe @ el. 100.30'
/3�
kG �
109 '
W
�0 Ak-
Gary L. Steel
10 -24 -2000
MAR. =29' 01 iTHU) 18:45 EDEN PRAIRIE E. R. TEL:612 828 9531 P. 002
;ent by: EDINA AEALTY HUDSON WISCONSIN 715 388 1502; 03/29/01 16:33; lafFax #932;Page 216
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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 (POWTS) 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-
10567-P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number 3 Fyiq zz T
Number of Bedrooms
Design Flow - Peak (gpd) s
Estimated Flow - Average (gpd) LTD
Septic Tank Capacity (gal) ttt70
Soil Absorption Component Size (W) - b�
Type of Wastewater Dorfiestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) tboo Z- M
Maximum Influent Particle Size (in) 1/8
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 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 tank and outlet filter shall be assessed at least
once every 3 years by inspection. Th shall be cleaned as necessary to ensur
p roper operat The filter cartridge!2� removed unless provisions are made to
retain solids in the tank that may slough off the filter when removed from its enclosure. If the
Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
tank.
Manhole risers, access risers and covers should be inspected for water tightness and
soundness. Access openings used for service and assessment shall be sealed watertight upon
the completion of service. Any opening deemed unsound, defective, or subject to failure must
be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
2
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1
ST CROIX COUNTY
SEPTIC "TANK MAINTENANCE AGREEMENT
. AND
• OWNERSHIP CERTIFICATION FORM
'OwnerBuyer
Mailing Address
Property Address 9 ,1.� Z: = - C
(Verification required from Planning Department for new construction)
City /State I L I z Parcel Identification Number /�?/ —Z42� D
LE GAL DESCRIPTION
Property Location ,yam t/., TO _ '/4, Sec. _Z_e/, T N -R,Z.�2 W, Town of �j
Subdivision , Lot #
Certified Survey Map # ` /��/%� , Volume /? , Page # ; 732
Warranty Deed # ��3 // , Volume l %2C , Page #
Spec house O yes % no Lot lines identifiable a yes O no
• SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenanc
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the systerr
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
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 pumping (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 trust be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date,
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
_ N
I (we) certify that all statements on this form are true to the best of my (our) knowledge.. I (we) am (are) the owner(s) of
the prop rry described above, by virtue of a warranty deed recorded in Register of Deeds Office. 44<L44� 6 /3/o/
SIGNATURE OF APPLICANT DATE
Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.'• ""
•
Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
N �
FILED 2
q �R 2 IM4+►
514471 JAMES p.
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VQ 1646w i 596 �-
M AFFIDAVIT KATHLEEN 46534 H
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
Document Number: 05 -25 -2001 2:30 CM
ZONING AFFIDAVIT
EXEMPT R
CERT COPY FEE:
COPY FEE:
Return Address:, F� `x.t ���' TRANSFER FEE:
33��3` 1 1 14v� O RECORDING FEE: 12.00
rrinrlEtt �d f✓7 /1
'5-34P,; PAGES: 2
Parcel I.D. Number: 020 - 1021 -70 -100
STATE OF WISCONSIN )
) ss
ST. CROIX COUNTY )
Your affiant, being duly sworn, states under oath that:
1. The parcels described on attached Exhibit "A" have been added together in Warranty Deed recorded in
Volume 1626, page 258, Doc. No.643811, County Register of Deeds Office, resulting in a single parcel:
(See Attached Exhibit "A ")
2. The addition of these parcels to create one parcel is a transfer exempt from Chapter 18 of the St. Croix
County Land Use Regulations pursuant to Section 18.05(a)(3).
3. The purpose of this affidavit is to notify the public of the addition and the resulting parcel.
Gerald A. Schmitt Aandy It. Jeuk
Subscribed and sworn to before me
this � �lay of May, 2001
Notary Public C(n�� C[Ycntl,lui
My commission p - M
This instrument drafted by: � M.
Attorney Kristina Ogland 6EWAM1N t
Estreen & Ogland
Hudson, WI 54016 `
OF W�S�
1646PAG1597
EXHIBIT "A"
That part ofNE' /4 S W' /4 Sec, 14- T29N -R19W described as follows: Lot 2 of Certified Survey Map
recorded in Vol. 10 of Certified Survey Maps, page 2739 as Doc. No. 514471.
Also, a part of SE /4 of SW '/4 and part of NE 1 /4 of SW '/4 of Section 14- T29N -R19W described as
follows: Commencing at the S '/4 corner; thence N00 °36'33 "W, along the north -south '/4 line of
Section 14, 490.15 feet to the point of beginning; thence continuing N00 °36'33 "W, along said north -
south 1 /4 line, 1193.25 feet; thence S89 °23'27 "W, 627.03 feet; thence S00 °36'33 "E, 1424.03 feet;
thence N69'1 1'06"E, 668.14 feet to the point of beginning.
VOL .1626PAC, 258
STATE BAR OF WISCONSIN FORM 2 -1999 69, $ g 1 Z
Document Number WARRANTY DEED KATHLEEN H. WALSH
RTGJSTER OF DEEDS
This Deed, made between Hallbeck Farms, LLC ST_ - CROIX Co., WI
RECEIVED FOR RECORD
0A -2E -2001 9:30 AM
Grantor, and Gerald A. Schmitt and Randy R. Jeukens, tenants in YARRARTY DEED
common EMFMPT I
CERT COPY FEE:
COPY FEE.
TRANZER FEE: 1110.00
Grantee. RECORDI46 FEE: 10.00
Grantor, for a valuable consideration, conveys to Grantee the PAGES. I
following described real estate in St. Croix
State of Wisconsin (if more space is needed, please attach addendum):
o ��
That part of NE 1 /4 SW 'h Sec. 14- T29N-R19W described as follows: Lot 2 Recording Area
of Cert ified Survey Map recorded in Vol. 10 of Certified Survey Maps, page N8f11e and Retum Address G�
2739 as Doc. No. 514471. aq f','
Also, a part of SE '/. of S W '/4 and part of NE '/4 of S W '/4 of Section 9. j -
X ga J ` ryr O9
14- T29N -RI 9W described as follows: Commencing at the S' /4 corner;
thence NOO ° 36'33 "W, along the north -south '/4 line of Section 14,490. 15
feet to the point of beginning; thence continuing N0036'33 "W, along said 020 - 1021.70 -100
north Y, SOO 36'33"E, 1 feet; thence N69 °1 1'06 "E .14 feet
1424.03 1$ , "W, 668 o the th ence nt of Parcel Identification Numbcr (PIN)
beginning. P This is not homestead ro e
P P nY•
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. 00 (is not)
Dated this ac - h — day of April
2001
H eck Farms,pc
• YIAQ lls.t� , rN�twS
AUTHENTICATION
Signature(s) ACKNOWLEDGMENT
STATE OF WISCONSIN )
f lL ) ss.
authenticated this day of County )
Personally carne before me this 07&p— day of
April 2001
Public
Hallbeck Farms, LLC the above named
TITLE: MEM to OT Wisconsin
NSIN
(If not, to me known to be the person(s) who executed the foregoing
authorized by ¢ 706.06, Wis. Stats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland ' A 4 ad& Aq. / w
Hudson, wl 54016 Notary Public, State of Wisconsin
(Signatures may be authenticated or acknowlcdged. Both a not necessary.) My Commission is permanent. (If notstate e xxpiiration date:
• Names of persons signing in any capacity must be I (— ty v ` )
typed or p tinted below their signature. bdo arfon Pmrassionajs company, Fn du ta<, �
WARRANTY DEED STATE BAR OF WISCONSIN 000
FORM No. 2 -1999
Parcel #: 020 - 1021 -70 -100 05/24/2005 11:05 AM
PAGE 1 OF 2
Alt. Parcel #: 14.29.19.99C 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
* SCHMITT, GERALD A
GERALD A SCHMITT JEUKENS RANDY R o�(O
JEUKENS RANDY R - U
HUDSON LABARGE
HUDSON WI 540101 6
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 932 LABARGE RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 23.610 Plat: N/A -NOT AVAILABLE
SEC 14 T29N R19W PT NE SW BEING LOT 2 OF Block/Condo Bldg:
CSM 10/2739 3.64 ACRES ALSO PT SE SW
DESC AS COM S1/4 COR; TH N 00 DEG W Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
490.15' TO POB; TH N 00 DEG W 1193.25'; 14- 29N -19W SE SW
THS89 DEG W627.03 ;THS00 DEG E
1424.03'; TH N 69 DEG E 668.14' TO POB
more
Notes: Parcel History:
Date Doc # Vol /Page Type
05/25/2001 646534 1646/596 AFF
04/26/2001 643811 1626/258 WD
07/23/1997 1181/629 QC
07/23/1997 1086/229 WD
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
Use Value Assessment
Valuations Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 20.610 3,100 0 3,100 NO
OTHER G7 3.000 54,000 454,000 508,000 NO
Totals for 2005:
General Property 23.610 57,100 454,000 511,100
Woodland 0.000 0 0
Totals for 2004:
General Property 23.610 57,100 454,000 511,100
Woodland 0.000 0 0
Lottery Credit Claim Count: 1 Certification Date: Batch #: 542
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
CIA
d �
ILED
NAR 2 8
514471 JAMES O•
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Parcel #: 020 - 1021 -60 -000 12/09/2004 08:37 AM
PAGE 1 OF 1
Alt. Parcel #: 14.29.19.99A 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
SPEER, DONALDA
DONALDA SPEER
948 LA BARGE RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description " 948 LA BARGE RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 28.860 Plat: N/A -NOT AVAILABLE
SEC 14 T29N R19W NE SW INCLUDES THE W Block/Condo Bldg:
264.67' OF LOT 1 CSM 3/74
'PT 10 CS f ESC Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
1086/229 NKA PT PLAT SWEET GRASS FARM 14- 29N -19W NE SW
Notes: Parcel History:
Date Doc # Vol /Page Type
08/08/2000 628820 8/8 PLAT
07/23/1997 1086/229 WD
07/23/1997 768/255
07/23/1997 689/402
2004 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 09/05/2000
Description Class Acres Land Improve Total State Reason
Totals for 2004:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Totals for 2003:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Lottery Credit: Claim Count 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
001 -WATER SPECIAL ASSESSMENT 0.00
Special Assessments Special Charges Delinquent Charges
Total
0.00 0.00 0.00
FORM — STC — 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ��„AL,�A r0��Q TOWNSHIP
SECTION T _,U N -R _ W
ADDRESS , Le ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT__LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
/ oPos -ra W E L
�s
_ 3 5 �.s'
ci: `t 0 0
CZZArV OUT
/996 COA Day)„E '
S� / ScN E,L 90 t"ffLuwr LInnE : ;
.CEf TAM< •Ro/'ofFQ
1%BNT - r7/gcK �u1Lt�SnIG
NE S/D .OiitaY:v6.1`ENEa
lc ,
-PL o AE
Pnvaol'Eo 1A .Z Z 1r INDICATE NORTH ARR
'410 -rcq4r t I
BENCHMARK: Elevation and description: _Z2 ey.= /Od.o0 ,`,(�,�� A OX7
Alternate benchmark O1 7,5A/ CE'
_d/oni�
SEPTIC TANK:Manufacturer: /�� Liquid Cap.
Rings used: L Manhole cover elev: 903 Final grade elev:
Tank inlet elev.:—% Tank outlet elev.: 95:33
No. of feet from nearest road:Front , Side �6 ,' Rear Ft.
PUMP CHAMBER
Manufacturer: Liquid-Capacity:
Pump P 1 . ' Pump /Siphon Manufact.: Pump size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: pum
P
off elev.:
_Gallons /cycle.
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front_, Side Rear
Distance from: Well Building
SOIL ABSORPTION SYSTEM
Bed:- Trench: seepage Pit : %' C l- /9 ,� ,,q
Width: Length Number of Lines: Area Built_
Exist. Grade Elev.
Proposed Final Grade Elev.
Fill depth to top of pipe:
No. feet from nearest prop. line:Front =, Side Ft.
No. feet from well: 132. _ NO. feet from building
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: "Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line: Front Side, Rear„_Ft.
No. feet from: Well
, nearest road
Alarm Manufacturer:
INSPECTOR:
� DATE:
PLUMBER ON JOB:,
LICENSE NUMBER: _d�/'U ��?OD
Wisconsin Department of Industry PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT St. Croix
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION NE, SW, Sec 14,T29– Rl9,LaBarge Rd. 149257
Permit Holder's Name: ❑ City ❑ Village [R Town of: State Plan ID No.:
Donalda Speer I Hudson S91 -41059
CST BM Elev.: Insp. B Elev.: BM ion: Parcel Tax No.:
.,,- eP 0201 021 60
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ��� r Benchmark
Dos'
Aeration Bldg. Sewer
Holding
Stl Inlet s�' ,&
TANK SETBACK INFORMATION St/ b Outlet
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic >/0 ,mil �- NA Dt Bottom
in NA Header/Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufa Demand 5�
Model Number GPM a 4 4=
TDH Lift Friction System DH Ft "L ,-P l
H ea
�S
Forcemain Length Did. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width a No. Of Tr nches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS A. a A DIMENSION
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK CHAMBER
INFORMATION Type O C c?11i & 7 / OR UNIT Moe Number:
System: j
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Leng ia. Spacing
SOIL COVER x Pressure Systems Only xx UpuPA At -Grade Systems Only
Depth Over Depth Over xx Depth Of Seeded/Sodded xx Mulched
Bed/Tr nch Center Bed / Trench Edges Topsoil ❑ Yes ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Plan revision required? ❑ Yes 2-ITO
Use other side for additional information.
SBD -6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
i t
5
SANITARY PERMIT APPLICATION
. o LHR In accord with ILHR 83.05, Wis. Adm. Code C OUNTY S /
T C�c'a 1 X
b Eons STATE SANITARY PERMIT #
–Attach complete plans (to the county copy only) for the system, on paper not less than �.�/�+� a�'7
8% x 11 inches in size. 1:1 Check If revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S9/ --
PROPERTY OWNER PROPERTY LOCATION
6 %, S T N, R E (or W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
4AZ
CITY, STATE V ZIP CODE PHONE NUMBER CSM NUMBER
21V6 1 (Ar)2,& -tj2r c5im Job• 1,01
11. TYPE OF BUILDING (Check One) El State Owned ❑ VILLAGE: NEAREST ROAD
S Public ❑ 1 or 2 Fam. Dwelling -# of bedrooms — RCE TAX NUMBER
III. BUILDING USE: (If building type is public, check all that apply) D c� U 1 O 1 6 O
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining
4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash
5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 Other: Specify !�l&-UA AA4iv
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. 0 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit ## — Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy
13 M Seepage Pit ! Pressure 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 14.LOADINGRATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) p ELEVATION
.S O 17 d t� 00 Feet 9a S,1 Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name C oncrete Con- Steel glace Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank t7
Lift Pump Tank/Siphon Chamber
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number:
JV A3
Plumber's Address (Street, City, State, Zip Code):
IX. CO TY /DEPARTMENT USE ONLY
❑ Disapproved I Sgpitary Permit Fee (Includes Groundwater a e Issued Issuing Agont Signature (No Sta
rcharge
, Approved Fee) proved ❑ Owner Given initial
Adverse Determination +
X. CONDITION OF A A� NS { DISAPPROVAL: _
SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS ,
1. A 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.
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. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning_ your- nnsite- sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608 -266 -3815.
To be complete and accurate this sanitary permit application must include:
G
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1 -7.
VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
VIII. 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.
IX. County /Department Use Only.
X. County /Department Use Only.
Complete plans and specifications not smaller than 8 1 /2 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; pump or siphon tanks; 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; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD -6398 (R.11/88)
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
'RIVATE SEWAGE PLAN APPROVAL Western Regional Office
2226 Rose Street
LaCrosse Wisconsin 54603
ZAPPA BROS. INC. Owner: DONALDA SPEER
715 6TH ST. N. 943 LABARGE
HUDSON WI 54016 HUDSON WI 54016
RE: Plan Number: S91 -41059 Date Approved: December 23, 1991
Gallons Per Day: 210 Date Received: December 20, 1991
Project Name: SPEER, DONALDA Location: NE,SW,14,29,19W
HORSE STABLE & RIDING ARENA
Town of HUDSON County: ST CROIX
The plumbing plans and specifications for this project have been reviewed for
compliance with applicable code requirements. This approval is based on Chapter
145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are
stamped 'conditionally approved'. This approval is contingent upon compliance with
any stipulations shown on the plans. All items that are noted must be corrected.
All permits required by the city, village, township or county shall be obtained
prior to construction. The licensed plumber responsible for this installation
shall keep one set of plans with the department's approval stamp at the
construction site. The installer shall notify the appropriate inspector when
inspections can be made.
This approval will expire two years from the date approved or if a sanitary
permit is obtained, it will expire the day the initial sanitary permit expires.
The Section of Private Sewage has reviewed these plans for private sewage system code
requirements only. These plans have not been reviewed for the code requirements
set forth in Section ILHR 82 for general plumbing or in Chapters 50 -64 of the
Wisconsin Administrative code.
This approval is for the following, components onl
PP .� p Y
- NEW CONVENTIONAL
Inquiries concerning this approval may be made by calling (608) 785 -9348.
Sincerely,
GERARD M. SWIM
Section of Private Sewage
Division of Safety and Buildings
PPP039 /0009ri/ 4
cc: DONALDA SPEER X Private Sewage Consultant
5111) 84a3(R.01/91)
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DEPARTMENT E Ni [XJSTRYI LAN RELATIONS IVISION OF LDINGS
SU- cow NCE w
DEPu , OF RE PORT ON SOIL BORINGS AN D SAFETY &BUILDINGS
I I
. �`DUS'rR'Y, DIVISION
LABOR AND PERCOLATION TESTS (115 MADISON WI 537 9 53707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/ LOT NO.:BLK NO.: SUBDIVISION NAME:
N� � /4SW 1 /a / /h N/R /9E (or aU - -
C UNTY: OWNER'S AILING ADDRESS:
USE DATES OBSERVATIONS MADE
Residence NO.BENMS. r
: COMMERCIAL DESCRIPTION: 4New ❑Replace ( I /� / A� 1 DESCRIPTION TEST �
RATING: S= Site suitable for system U= Site unsuitable for system
CON�(ENTI�AL: MOU D: ❑� IN -GROU� ❑A RE: S S Ia�LHt1 Z]U : T 1 OMMEN DD(optional) ' `�iL-
Per
ff DESIGN RATE: : � K W
If Per Tests are NOT re uired f If an portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: L� 5 1 Floodplain, indicate F elevation: �a
fl C PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH L4, ELEVATION _ ES IGHES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- t j S W.6`7 r4o pj c > 1 .5 /S " LTs I z n S L 7 8 4 MS 70 &.v1VS-K
C.rS l Fs "BPu 4 Ts''Bn / !
B- f .2< g`o •2� n/oN �'� •Z 6' Qe,,£e�CS�G� 3C' Iiati M5 S 60,u CS 440 -
B- 3 i 3 bb 9�&Ab Nora IF > /3. 'Bc. rs Zd"
B - 4 13,'0 9'6.17 &fom r -2 _2'8 LYS Z418 j C. 40'goi csia e
B- S ZS a > j Z 2 _&Z-Ts 2/ "BAjS, 7 '$RNMS S2g ,ea GS1:
B-
�� PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEV L- I NCH ES RATE MINUTES
NUMBER AFTER SWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 P R PER INCH
P _) Qrc.7o o.Jt` tl 7 `Z z > .4
P _ z " %.ao m6- 9% 3 > Z > 2 > 2 <3
P- `3's qa o a Z > Z
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
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 percen
of land slope.
SYSTEM ELEVA ION �`�•oy � �QK _ SP ►Kr� �� a 2
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INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
To be a complete and accurate soil test, your report must include.
1. Complete legal description;
2. The use section must clearly indicate vvhether this is a residence or commercial project;
3. MAXIMUM number of bedrooms or commercial use planned;
4. Is this a riew or replacement system;
5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheet may be used if desired;
8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent;
9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
tion, if appropriate;
10. if the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11. Sign the form and place your current address and your certification number;
12. Make legible- copies and --distribute as required. ALL-SOIL TESTS-.MUST-BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
il k
s
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st — Stone (over 10 ") BR — Bedrock
cob — Cobble (3 - 10") SS — Sandstone
gr — Gravel (under 3 ") LS — Limestone
"s - Sand HGW — High Groundwater
es - Coarse Sand Perc — Percolation Rate
rued s _. Medium Sand W Well
I's — Fine Sand Bldg --- Building
Is Loarny Sand > — Greater Than
x sl — Sandy Loam Less Than
t .._
Loam Bn - Brown
R S;I - Silt Loarn BI Black
si Silt Gy Gray
`cl -- Clay Loarn Y -- Yellov
scl — Sandy Clay Loarn R - Red
sicl — Silty Clay Loam rnot — Mottles
sc Sandy Clay w:' - with
sic — Silty Clay fff — few, fine, faint
c -- Clay cc — common, coarse
pt - -- Peat mm — Many, mediurn
in — Muck d — distinct
p prominent
HWL — High water level,
Six general soil textures surface water
for liquid waste disposal BM Bench Mark
VRP Vertical Reference Point
4
I
TO THE OWNER:
APPLICATION FOR SANITARY PERMIT
8TC -100
Thls application form is to be eompletod In full and signed by the ovnec(s) of
the property being developed Any lnadequa WI11 only result In delays of
tho petmit issuance. - Should t11ls development be intended tot resale by
co e P leted the ptopetty is and s submitted t s
to this office! with the
appropriate deed recording.
-------------------------
------------------------------------------------------
Owner of property r y. �2) —
Location of ptoparty 4 1/4 1/4, Section .-- .�1. — T -jk� -R .Z2- w
Townshlp - L C3 Fzr Cl
Mailing address
Address of site -Ie�ol -
Subdivision name
Lot number
Previous owner of property �'7 'O'-� (3►rars sr - 4 -� �S°VN L,., I - -
Total size of parcel
Date patcai was created
Ar all cotners and lot lines identifiable? - Yas �l o
Is this property being developed lot resale Cs pee house) ?__Yas
Yalu" _ a nd Page Number _ as recorded vlth the Register of Deeds.
r•----r-----•r--------------- ----r --------
r-----------------------r------r-----
INCLUDE WITH THIS APPLICATION THE FOLLOWING!
A WARRANTY DEED vhlch Includes a DOCUMENT NVMBRR, VOLUME AND PAGE NIM,RR, and
the SEAL of THE RROIBTBR Of DEEDS. In addition, a cettifled survey, 11
avallable, would be helpful so as to avoid delays of the reviewing process. tl
the deed description references to a Cestltled Survey Map, the Csttitled Sutve)
Nap shall also be tequlted.
--------------------------------------------------------- - --------------------
PROPERTY OWNER CERTIFICATION
I(Ve) cattily that all statements on this form ate true to the best of my tour
Rnovledgel that 1 Iva) am late) the ownerts) of the property described U
this intotmatlon totm, by virtue of a warranty deed recorded In the Office o
the County Register of Deeds as Document Ho. = and that I twe
presently own the proposed site for the sewage disposal system tot I (we) hav
obtained described to err tot th
easement to tun with the P yt
brained an , P
..--- ►... - .� -- -t "&'A r., -Fr.-_ a-A i fhm mama !. hmen Auly rmeerded In the Offie
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eE
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER /BUYER
ADDRESS: LLCabcm_( e_ QDQA FIRE NO:
LOCATION: ,Vey 1/4, 1/4, SEC. T N -R_Z, W,
TOWN OF: �ALAdbcc\ ST. CROIX COUNTY
SUBDIVISION: LOT NO.
Imp oper use and maintenance of your septic system could result
in f 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 septic tank pumper. What you
put into the system can affect the function of the septic tank as
a treatment stage in the waste disposal system:
St. Croix County residents may be eligible to receive a grant to
help with the cost of the 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 system properly
maintained.
The property owner agrees to submit to the St. Croix County
Zoning 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 (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of
sludge and scum. Certification from will be sent approximately
30 days prior to three year expiration.
I /WE, the undersigned have read the above requirements and agree
to maintain the private sewage disposal system•in accordance with
the standards set forth, herein, as set by the Wisconsin DNR.
Certification form must be completed and returned to the St.
Croix County Zoning Officer within 30 days of the three year
expiration date.
SIGNED:
I !
DATE:
r
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
INDUS T TR `Y, OF RE PORT ON SOIL BORINGS AN D SAFETY &BUILDINGS
INDUSY, DIVISION 76 LABOR A PERCOLATION TESTS (115 MADISON W 53707
HUMAN RELATIONS
(ILHR 83.0911) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/ OT NO.:BLK. NO.: SUBDIVISION NAME:
NLC � /��/a / /T29N /R /9E (or a;.� - -
C� UNTY: OWNER'S AILING ADDRESS:
ti' C*, I vl P"'
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILEDESCRIPTIONS: PE LA ION TESTS:
ky ResidenceNk 4New ❑Replace
Oft SOIL<- - P I a
RATING: S= Site suitable for system U= Site unsuitable for system
r ON( ❑ � . I � �� IN- GROUND Pa URE: Y I��L H J G Tfj�V� . RE C'/V i/ �f�JT f0 �J�(brtion WLL�
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: LA 5 Floodplain, indicate Fl elevation:
C1;�T PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH 64. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- i i �� 9gs.6`7 NO E > 19 .S -s /5 IL LTS 17. n S ; L. 7 -6 ' M S 76
��'BLLtS / Fs "Bov 4 - a'Ba NS
B- 114 .Z e�.z� NeKI � f�yB��nesv�>a 3c' is a,,, S BQNCS M GR
B- '� 1 i3 .ob 9 , 9 A6 None > /3. '8c crS 20`" S, C 7 7'84v A�S-f 3� gRNa -
B-4 10 1 •1.7 if otl C > /356. ZZ'8/.CTS 2�� "$ �S � 8QN M �0�$4�CS�EG(2
B <_ L S' 9% .0 Alp r4 > 24 21 "$ S ►L 7 - gZv /15 S 2 ., CS>;
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES
NUMBER jAt&tW AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD PE RIOD PER INCH
P_ i 9% 7t OoJE . Q) > `Z >Z
P _ z %.36 m6 19% .3o 3 > 7 Z >2 <
P_ 3 11 A& o >J'd O 3 > Z > Z >2
P-
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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-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM fLEVA ION _ S -P I KLr 10 6 R.
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INSTRUCTIONS FOR COMPLETING FORM 115 - S O - 6335
To be a complete and accurate soil test, voui repwt must in-clude.
'I, Complete legal description;
2. The use section must clearly indicate whethea this is a residence or c mme'rc ;ial Project;
3. MAXI1 i number of be drowns or corm use planne d;
4. Is this a nee , 1 of replacenle"T Wsteffl;
S, Complete the suitability rating boxes, A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL. CONDITIONS;
6. PLEASE use the abbreviations shown" here for vritir:g profile descriptions and completing the plot plan;
7, MAKE A LEGIBLE diagram accurately locating your test locatiom. Drawing to scare is preferred. A
separate sheet may be used if desired;
8. Make scare your benhr k and vertical elevation re= erence point. are clearly shown, and <rre permanent;
9. Complete all appropriate boxes as to dates, names, addresses, flood {Main data, percolation test exertap-
tion, if appropriate;
1C3, if tFte information {,e,e,h as flood plain, eflevation) does riot al ply, rflace Nk in the app) box;
11. Sign the loan and plane your current ad£.fress and your certification number;
12. Make legible copies and distribute as rOgUired. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL. AUTHORITY Y WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL. TESTERS
S oil Separates and Textures Other Symbols
st - Stone; (over 10 ") BR - Bedrock
rol) Cobble (3 - 10 ") `S - Sandstone
y, £srau`4'' {udder 3 "', LS - Limeston
° s Sand 1 1 G VV ...... High Grou,ndwater
rs coarse= Sand 'e rc - Pe.- colation Hate
rnco s
n ecii =sr sand VV We,II
is - Loarr�y sand > Greami TS
..._ S ;tl p t ,;,r„ ._ Le Thor
C ;'
scl - Sandy C.'.ay Loarn B Rt-d
sicl - Sit t Clay Loam mat N1ott le s
sc — SSanl Clay try% with
sir, Silty Clay tff - fern, fine, faint
* c Clay cc carrffli tC , coal -e
Pt __. Feat 1t7 ;ri Many, med n)
in -- My .ick d — distinct:
P --- proryline w,
HWL High water level,
Six lten,t�r r l s =ail textures surfac water
for Iigkj ;d rT1<',ste d sposa! BIVI - B-ench Mark
VRP Veitical Reference Point
TO THE OWNER:
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