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a Q o� 0 ° v3 I 0 o c» I CIA c c c 0 0 0 I (D fp U c C U y C I N E C N fn w - a ° o o d I en .y. O N I O I _y z z c a z a LL o LL o LL o Y -o0 1 cc ¢ I I M I I I y a , W E E E ° 0) c w am am I am I 1 o I o I o f c c I c I •+-. � � 7 y 7 y - 7 y - o d Z rn c c z c z c 0 1 E - o I N O O N N O N N •3 a y a I N o I y y C' 1 y a •� a� r a� t o a` o O O c m O z m Z I z m Z `' I z H Z I N E E Z I Z o m m c I c I — y = N E E E _ d N R �1 c p p .�'�. Y tO a .. Y I a cu L G G a` n E ° G O a.. a E I m 0 G a a c ° I c`i m o � _ U)U)W lomym o 1 U - •N Naaa 1 oaaa z �aaa z N y U) J U U 00 co 4 I N CO O I j 0 0 o 0) rn } � Z 2 N N z N N � V N � U U t O zoo � 1 E o E 1 U o o a ml ml a I ml c a I to O m . 6 N O LM _ � y O� d co o _°' ¢ } U) v °—' ¢ z rn co I :3 o m ¢ z co C ° E w N cn y H 100 y N I .., o co y c E y E I m y c I + ° o o E v� o v E (D c`r'o °o ?� o a = a ° o I Q) a N I c m m O c m y c °� I m c _ I N y �` c y~ •O Z a 'O I N y N w l CD o N t °: o o E :: ° E r c �c An • o 2 m o z N 2 2 m c o z In 2 H cn I (� c z z z g 0 I ^" I E E I E m CL AL a 1 a 1 a • at CL m .2 m m an d d d c r� R r A ciao ;Ovid ovici ,Ot�nCi 'COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 C:1jr kt� 715 - 962.3121 800 - 962 - 5227 f c ST. CROIX ZONING REPORT NO.. 20121/01 PAGE 1 ST. CROIX COUNTY REPORT DATE. 3/27/42 COURTHOUSE DATE RECEIVED: 3/25/92 HUDSON, WI 54016 ATTN. THOMAS C. NELStN! OWNER! BiIL Berend LOCATION. 589 Spurtine Circle, Hudson COLLECTOR. M, Jenkins DATE COLLECTED 3 -24-92 TIME COLLECTED. 11.00am SOURCE OF SAMPLE. Outside faucet DATE ANALYZED.3 -25-92 TIDE ANALYZED22.00pe COLIFORM4* 0 /100 mt INTERPRETATION. Bacteriologically SAFE NITRATE -N. 7 ppm Above 10 ppm exceeds the recommended Public Drinking Water Sta0ard. CoLiform Bacteria /100 ml Nitrate - Nitrogen, mg/L 1� f Cn 3 d, � C, � p44t � ' I tNG At ` 2� ' LAB TECHNICIAN. Pas Gam G� a' �► WI Approved Lab No. 19 t Means "LESS THAN" Detectable Level Approved by. ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 v , ST. CROIX COUNTY ZONING OFFICE ( St. Croix County Courthouse 911 4th Street Hudson, WI 54016 C - (715)386-4680 J Tele hone The St. Croix County Zoning Office offers the service of septic and water inspections to Lending institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can be located I � Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING-- - - - - -- ------------------ - -FEE: $ 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $175.00 (For VOC'S) SEPTIC SYSTEM INSPECTION---------- - - - - -- -FEE: $25.00 (Determines if system is properly functioning at time of inspection) �. Property owner's name Property owner's address Legal Description 1/4 of the 9 1/4 of Section , T ` N - Town of 4"In,) Lot Number Subdivision FIRE NUMBER � U LOCK BOX NUMBER Color of house Realty sign sign by house ?If so, list firm: �J PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: Telephone Number REPORT TO BE SENT TO: / ,0 ./kr. 22,..us..,,Z A7 W Closing da Signature A Lowl REAL ESTATE 1201 MAYER ROAD • HUDSON, WISCONSIN 54016 • (715) 386 -3363 or (612) 436 -2034 I I I_ CERAMIC FOYER LARGE PANTRY CATHEDRAL CEILING 3 CAR GARAGE LARGE MASTER BEDROOM WET BAR CENTRAL AIR INSULATED GARAGE BUILT IN MICROWAVE WHIRLPOOL TUB LARGE DECK AND PATIO j INTERCOM & STEREO THRUOUT WOODED LOT COZYHEAT FIREPLACE & WOODBOX & CHUTE AddP 5RA S urline Circle WALKOUT LOWER LEVEL C Hudson fi0 588 Qa ] MAIN FLOOR LAUNDRY 1i V4 SW T Hudson Ictv St. Croi Ex! Alum /Brick 1YF Bh 1986 1HIPropan e sme Split La sw SMFL TFf Tic yr 1&L Low Maintenance /High Efficiency 2.3 Acres $2363.55 This very large newer 3+ BR, 3 l C 0 Awax Rill Sys 3 Bak Sd1 Hudson Bath home on 2.3 Acres has end- LR M C B 14.5 X 16 MM8 fYJ BB PAR S St. Patri DR M C B 11 X 12 D wstr D . MI B.I. less features: Intercom, huge KA B 11 X 12 Reh R6 Mt private master suite, cathedral FR L CIR126 X - 14.5 WS 14 R JYJ 0 Avg HI$ ceilings, M.F. laundry, family MB M C C 12 X 27 1 C. Wtr M C. S m. Avg UW $67 mo. room w /cozyheat brick F.P. & R C B 11 X 10.5 11 Well IC' POSs Date Negoti�, woodchute storage, C /A, Ins. 3 BR L C B 11 X 11.5 F C. At 6sml Full walks ffldv� Ld Gar GW LY Dad yj ti car garage, whirlpool tub, wet- RWAMN Ldi UFFI M Y Pik -17E 7 --- -11 bar, ceramic, patio, deck & more. LOUD" W6 Lot 17, Northline Station- 3+ BR, 3 Bath, SEE IT!!!!!! home has intercom, private master suite, cathedral ceili ins. 3 car garage, wetbar, ceramic, whirlpool tub, pati(. SIB PRICE: $119,900.00 2.8 lict�t Sandee Lowry Ph 336 -3 "1 Lowry Real Estate 650 436 -2( DIRECTIONS: I -94 to Somerset exit- north to McCutcheon -then left. Q.01 VW Information is considered accurate but we accept no liability for error. Listing may be changed or withdrawn without notice. ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE r 911 FOURTH STREET • HUDSON, WI 54016 (715) 386 -4680 Mar. 24, 1992 Lowry Real Estate 1201 Mayer Road Hudson, WI 54016 Dear Ms. Lowry: An inspection of the septic system on the property of Bill Berend, located at 588 Spurline Circle, Hudson, WI was conducted on Mar. 24, 1992. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. erely, 6 l Mary J. Jenkins Assistant Zoning Administrator js T i c Form -STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP ���,���• SEC. TN - W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION Zld !. 4e, LOT / ? LOT SIZE a �� PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I l ed i i r c� e s 10 , ?s - IND CATE NORTH ARROW 0 BENCHMARK: Describe the vertical reference point u ed Elevation of vertical reference point: a Proposed slope at site: �_ PUMP CHAMBER 0 TM 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, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: 4L Length: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,O pt. Number of feet from well: sd 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: r DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDING: Ill LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING MADISON,NJI 53707 a 9CONVENTIONAL ❑ALTERNATIVE state Plan It D. Number: c , (II assigned) El Holding Tank ❑ In- Ground Pressure ❑ Mound NAME OF PERMIT HOLDER! J ADDRESS OF PERMIT HOLDER: INSPECTION DATE William Berends 653 6th Street N., Hudson, WI 54016 BENCH MARK WP nr nent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV. SE NE, Section 16, T29N —R19W, Town of Hudson,Lot #17,NorthLine Station El Name of Plumber: IMPIMPRSW No Cnunl y. Sanitary Permit Number: William Schumaker 6382 St. Croix 79165 SEPTIC TANK /HOLDING TANK: r,J MANUFACTUR 4 r z f QUID CAPACITY. T INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER 4 OVIDEDOVIDED V T� ✓r /�J l PR YES ONO DYES ONO BEDDING: VENT DIA.. 1 VENT MATT HIGH WATER NUMBER OF ROAD: PR OPERT WELL: 1 11111111, VENT TO FRESH ' / 1 1.X ALARM FEET FROM LINFjso '� AIR INLET. / /�( C� ...-.. r`l o il// ` /�� YES NO u� - rs -r� -i vy= NEAR7rST DO NG CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL JPUMP SIPHON MANUI ACIIIHEH WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO OYES ❑NO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF ' PROPERTY WELL BU17 VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) EYES ❑NO I NEAREST --► SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 11 N(,TH J DIAMF TE1t I IIATI HIAL 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 )ISTR PIPE SPACIN , COVER J INIH)l UTA 'PITS LIQUID BED /TRENCH /� THE NC HE / MAT HIAI_ PIT {/ DEPTH DIMENSIONS GRAVEL DEPTH - F ILL DEPTH DISTH PIP' kEV STH PIPE DISTR PIPE MATERIAL _71t NUMBER OF 'PROPERTY WELL. BUILDING: VENTTOFRESH BELOW PIPES ABOVE ER E INLF f END P LINE A ,7 )/ FEET FROM ✓ • �J4Z NEAREST-- -•--I► MOUNDS STEM: 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- DYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE I II HMANF NT MARK HS OBSERVATION WELLS _ ❑YES ❑NO DYES ONO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED 1111 OF TOPSOIL SDDUFD JEE UrD MULCHED CENTER EDGES ❑YES. E:1 NO I I:]YES 0 N DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: QED /TR ENCH WIOTH LENGTH TRENCHES: LATERAL SPACING I GHAVIL DEPTH BE LOW PIPE- FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATEHIAL NO DISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.'. ELEV. CIA ELEV. J PIPES DIA ' DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHECI LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ONO DY ES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NOM ;E",R OF PROPERTY WELL: BUILDING: FEET FROM LINE. DYES ONO DYES ON( NEARES Sketch System on Retain i unty file for audit. Reverse Side. SIG AT R TITLE. DILHR SBD 6710 (R. 01/82) V DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code J STATE SANITARY PERMIT # —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I . NUMBER 8'/2 x11 inches in size. A 74 —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION FOR VARIANCE ❑ YES X NO PROPERTY OWNER PROPERTY LOCATION ' 4 VO% , S T N,R If E(or PROPERTY OWNER'S MA LING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME sa✓ ! l `� CITY, STATE ZIP CODE PHONE NUMBER L3 CITY NEAREST ROAD, LAKE OR LANDMARK L O VIL II. TYPE OF BUILDING OR USE SERVED; Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. X 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 # la 9gjC�/ Date Issued '?/ r 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. 6N Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. X Seepage Bed b. ❑ Seepage Trench c. ❑ See a e 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): d �+ -5 .? 7 , Td Feet Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in gal lons Total # of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank Lift Pump Tank/Siphon Chamber Li VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system h2W on the attached plans. Plumbe Name (Print): Plumber's Signature: (No Stamps) MP PRSW No.: Busines Phone Number: ✓ Plumber's Address (Street, City, State, Zip Coe Name of Designer: •- F4 S'GJ'dk - r , r V III. SOIL TEST INFORMATION Certified Soil Tester (CST) Na a CST # ,+L r CST's AD S (Stp6et, City, Sta e, Zip Co e) Phone Number: jy2= A IX. COU NTYfDEPAR TMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) Approved ❑Owner Given Initial S u Fee Adverse Determination /ae = X. COMMENTS /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION , TO THE APPLICANT: 1. This sanitary permit is valid for two 2 YP Oears; Y 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- 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 every2 to 3 years; 6. If you have questions concerning your private sewage systen;, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608 - 266 -3815. 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 !I. 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 8Y2 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 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 Ground IIBIs,,: included the creation of surcharges (fees) for a number of regulated practices which Wisco ln' ." a can effect groundwater. The surcharge took effect on July 1, 1984 All of the water that buried T35t1te is used in your building is returned to the groundwater through your soil abforgtion o system or the disposal site, used by your holding tank puripef. a The monies c;aliecteo through these s�ircharges are credited to the groundwater fund adminis- ?rrec! by the Department of Natural Resources. These funds are used for monitoring grourij- f ate: gDur;- water contamination in�.estigations and establishment of standards Orcune +.�ater, s worth protecting. SAD -h398 (8.03186) I 0 f� it 10i o a 0 spa � �r t 03 f r ---------------------- L )EPARTMENT OF R EPORT ON SOIL BORINGS AND S AFETY & BUILDINGS "J USTR Y, DIVISION [) LIMA N RE(_ATIONS AND (UMA PERCOLATION TESTS (115 MADISON WI 370 • (1) & Chapter 145.046) _OCAT( !: SECTION: TOWNSHI Y: OT NO..BLK NO.: SUBDIVISION NAME: /T N /R /94(or ub Sa►v 1 M o *TN tIm t � r4T /Cgff_ COUNTY: OWN 'S U NAME: �. ';TC-k6l)t WILijIk'( `+ M Yp1Jfl &'14;tENI�S Ei 6711 •5T A16t - CI! / � v as G w �1 ' 4 1 6 ISE DATES OBSERVATIONS MADE C OMMERCIAL NO. BEDRMS,: 1 PROFILE l.. STS: Residence UNK N A t oNew ❑Replace MAecla I�j �gB Q +et14 /6 S DICS B OP Y, 6 4 C 6S J ©iLs. A A 1 /�.LO- 3ATING: S- Site suitable for system U- Site unsuitable for system - ONV N NAL: MOUND: IN- FILL OLD N TANK: RECOMMENDED SYSTEM• optional) Oki S ❑U DS DU �S DU DS L U DS ®U C-F If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the A / /( >nder s.H63.09(5)(b), i C.L/d 55 Ftoodplain, indicat Floodplain elevation: 1v A q.r PROFILE DESCRIPTIONS 30RING TOTAL ELEVATION DE PTH UNDW T£R- INCHES CHARACTER SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH VUMBER DEPTH q0, _.. OBSERVEP EST. HI TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 0 -04' ik WrS 0.6. a krVSL ? 4 - 3 4 -,36t ti cA B- I 96 C .B6 , d6r4 �' c. g•4 119 is rn r �, 1 W C S arE Mo'rT � 3 •ta - IJ 4 . L . ._.._. D - d•8 �L(, p.FS' /.$ � it NSL l$'� � t 'T'g�N S,�'Ceb B- 7 - 8. S 9 h loa f y 8 .S q o- 8.. •� S 0 -1.8 ll.'f'S 1.6-3.4 $em'S i -SL 3.6-9.4 C-r tN 5 B- 3 C1 S 97.2 910. � `}�S 4.4 4 C-S 4.8 -s /. ^ -CS 4-1.4 L' 0 /.4 -S 4•r 9 RrISI 7• - 3.e &t,4 B- 4 q.o gg.za nloNb - 7 4•o 3a-'5,a Cs b e S .o -t.o r" © - LLIS 7.Z- .e � St +� 4.► -� -o '5 R- B- �J �oA g7.7 i 46,149 } /D.o b.o -6.F3 S 6•e -ic•o S - M S . B- _. D PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IU*HeS AFTERSWELLING INTERVAL -MIN. PER INCH P_ Z 6.7" 14 -7.0S' p" / g 1 ' Z 7 . P - 3 ?G' NeAI " 97.50' P" LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori tntal and vertical elevation reference points and show thgir location on the plot plan. Show the surface elevati n at all borings and the direction and percent I land slope. I 1 _....._. -. -_ - _..._._...._ �• 1 iYSTEM ELEVATION q? • o r4S g � TYb{� Q�r4�t.�10 I iINTR� �t.A��fV' f� t � � IJouS� $ itnl'C" � � � 55rT Ortq 1 • �S , Fwq�y S I 67 71' u h (,7 cob us L J: t uw o AL ATe S.>rsT r A C /c A¢/ ivex ► ri^'es V u 4t 77 Oly s3 ; � � M Kenn e, i • s • s - °• a ST. CROIX COUNTY 1'n WISCONSIN ' r��z ZONING OFFICE t, y > �i 796 -2239 (HAMMOND) ? p, 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 May 28, 1986 Carolyn Haag Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Carolyn: Attached please find permit 469681, which was rescinded due to change in location of the system. Permit 44 79165 was issued for the system. Should you have any questions, please feel free to contact this office. Sincerely, /N � Mary J. Jenkins St. Croix County Zoning Office < w o.= E 5 d W M r + ; L N N CD ° c W v �' o f o Q C) .2 2 a > « o c E ,� n LU QI Q ° E`er c o- > O _� f o a " 2« c ">' ,' o y Tow ` "° c Z -12 E any =�`o ,; ° W i V E° ,%. M !: ; m= rn dm Cl. w� Eo ad > E E E a - ' O M r C i w O c Cl. o _ > ` W d 3 =° 'N ° ; •- obi of E E„ pC a N mEl E« . ,o y „ cr 2 t` Q. ° t; 0 O F Nm i v o,y C « > rm d oN o > -m d� d _N W J `o «° c oN a.0 cE "° �° .a c.S 3� w E dr �:° 0 m M •« C d .O > N W ~ d ~ O C • w. « Ip TD L " Q °i 5 u m = E .. rn c A m'Q o od mom wt d _ , a W z — w � z z Z U F— O O w zF- C) 0 —' O Z) t� > z W CC X U) U) a p Q z p Z N O v W O � U U Q = C� � O " Oo cr F- O � � m 0 LL t w Ir J w cr w —� co p o w m c� w Z v m 0 U) p F Q J DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDING; LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 , BUREAU OF PLUMBINC MADISON; WI 53707 • 2TCONVENTIONAL ❑ALTERNATIV r S1.1. Planl. D. Number. ► (if assigned) ❑ Holding Tank El In-Ground Pressure ❑ Mo d NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER INSPECTION DATE: William Berends 653 -6th St. N., Hudson, _ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. SE NE Section 16, T29N -R19W, Town of Hudson,Lot#17,Nort in tation I Name of Plumber. J MPIMPRSW No Cnr,nty. Sanitary Perron Number: William Schumaker 6382 St. Cr 69681 SEPTIC TANK /HOLDING TANK: MANUFACTURER. LIQUID CAPA TV. T .. TANK OUTLET ELEV WARNING LABEL LOCKING COVER PROVIDED. PROVIDED' F:1 YES ONO EYES ONO BEDDING: VENT DIA.: V MAIL IHIGHWATER INJUNA E CIF ROAD. PROPERTY WELL. BUILDING: VENT TO FRESH ALARM LINE AIR INLET. Eli' FRO M DYES ONO EYES ❑NO EA EST DOSING CHAMBER: MANUFACTURER BEDOI NG: LIQUID CAP/ ITV PUMP MOVL LI IPMP,SIPHON MANUE ACTUH EH WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YE ❑NO EYES - ONO OYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROSOPERATIONAL NUMBER OF PHOPEHTV J WFLL BUIL TO FRESH (DIFFERENCE BETWEE FEET FROM LINE INLET PUMP ON AND OFF) ❑ E ❑ NO NEAR EST' --1t► SOIL ABSORPTION SYS EM. Chec� ture at the ept f plowing or excavation. (If soil ca be rolled frtio c ease until FOR the soil is dry enough to ontInue. MAIN CONVENTIONAL SYST' M: -. WIDT N(i H F DISTH PIPE SPACING, COVEH INSIDE )IA =PITS LIQUID BED/TR'£NCH TH E Mn7EHIAL PIT _ DEPTH DIMENSIONS GRAVEL DEPTH FILL PTH UISTH PI UISTH P E DISTR. PIPE MATERIAL NO DISTH NUMBER OF JILINE PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES ABOV COVER EI EV. IN I ELEV U PIPES FEET FROM AIR INLET NEARES T - MOUND SYSTEM: Mound site plowed per ndicu r 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- meets the criteria for medium sand. TIONS MEASURED. ❑YES ONO SOIL COVER TEXTURE PEHn1ANI NT MAHKEHS OHSEH VATION WELLS DYES ONO EYES NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED 1 1111TH OF TOPSOIL SODDED JEf UFO MULCHED CENTER EDGES ❑YES. ONO ❑YES ONO ❑YES NO PRESSURIZED DISTRIBUTION SYSTEM: BEDfTRENCN WIDTH LENGTH TRENCHES LATEHAL SPACING GRAVEL DEPTH HELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE M NO DISTH UISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. DIA ELEV. PIPES DI A.'. ELEVATION AND' DI COVER INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT ELY VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES El NO 1:1 Y ES ❑NO COMMENTS: PERMANENT MARKERS: J OBSERVATION WELLS: NUMBER OF PROPERTY WELL, BUILDING: FEET FROM LINE- ❑ YES ❑ NO ❑ YES ❑ NO NEARES ---- Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. DILHR SBD 6710 (R. 01/82) wlsconsln -' APPLICATION FOR SANITARY PERMIT �O UNTY 67) UNIFORM SANITARY PERMIT # InDUSTRV, LRBOR 6 NUTRn RELFiT10n5 — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS PROPERTY LOCATION r - e rr *— �1/4,U/= 1/4, S G , T , N, R / (or) TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: X New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ® Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Qd Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: 4 Z4144 IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In- Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump /Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 9 0 15 X Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: MP /MPRSW No.: Phone Number: -Z2 (aZ3► S�'G Plumber's Address: Name of Designer: GG a 7A Yo l P COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved 01, ' / ] Q ��� p� ❑ Owner Given Initial 1 G Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR -SBD -6398 R. 5/82 DISTRIBUTION: Original to Count Owner Plumber l ) g C ty, One Co To; Bureau of Plumbing, lu Copy 9, INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 , To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. • APPLICATION FOR SANITARY PERMIT . ST C- 100 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 development*be intended for.resale by owner /con tractQX,( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -, Owner of Property Location of Property. , 4 Section T - 2 9 - N - R W Township Mailing Address • L, 11 Subdivision Name oto l� Lot Number Previous Owner of Property j Total Size of Parcel Date Parcel was Created Out C /0 U Are all corners and lot lines identifiable? Yes No Is this property being developed for resale ;spec house) ? Yes No Volume and Page Number as recorded with the 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 I (We) eeAti.6y that aU statements on :thiA 6oAm aAe t-tue to the but o6 my (ouA) knowledge; ghat 1 (we) am (anel the owneAk) o6 the pAopeAty desehi.bed in tw in6orrmat%on 1 6oAm, by viAtu.e o6 a wa4Aanty deed , Leco4ded in the 066ice o6 the County RegtAteA o6 Deeds as Document No. ; and that I (we) pAes oun the pnopo.ded sit b on the s ewage - du ey .6 tem (on 1 (we) have obtained an easement, to tun with the above dezctibed pnopenty, 6oA the comtnucti.or, 06 said system, and the same hats been d n' c Aded in the 066.iee 06 the Couoy Reg.vsteA o6 Deed6, as Document No. `3 -1 . DOCUMENT NO, I �j�j�j R'ARRANTY DEED VOL VCJV PA uf 47 iTAT6 OF WIICONBIN —FORM 0 THIS FMCS R[e[RVED FOR R[CORDINO DATA y , — - - -- Donald A. and Diane J. RMISTFRS OF FICE us . d ST. CROIX CO., W IS. , . aria va e . .................... ........... • - -• -• ................••. Rec'd. for Record this lot ........ - ..............•--.........._.... .....- •-- •- ..............._.... - - -_— grantor - - -S of ------- - ------ St. 4r0? ?? .. ...... .......... ........................County, Wisconsin, day of . UJX A. D. 19_Z7 hereby conveys and warrants t Y1S�.MdX1 .K. ............... •• - - -••- t $;30 A. , M. Berends, husband and . wife ....... ............................... . •---- •................ .-• .................. .. ••- .......................... ........ . ...................... .................. Rspistter of Deedr .........................................•-••--.....•--•-- .................grantee.S..... of St Croix .. County, Wisconsin for the sum of �1e Ibllar ($1.00) and ... Other Good and. Valua� P ............................ RETURN To w A t 141006 T01v FE DER& Q711 sideratiarl S A v l Iv c♦ k04 A ttnv. °•--------------------------------••-•••._...••-••......_........_......_.••-_..........•-•••-- -- ---•.................. . ...... �j oo E. G M E rrwa r t "TAE ET _ .........................................•--...---••-..........---•--•--.................. ..... ................ I T s,+r wr4TER. ,wow. SSO4;. 5t. i County, — the following tract of land in ......................... ro .._. Wisconsin: ...... .................... ••-- ......_ . lot 7 & 8, Block "l ", Matteson's Addition to the Village of North Hudson, except the W 235 feet thereof. TRANSFER S- -�- -1-�= - FEE In Witness Whereof, the said grantor..S.. ha - .se ; . hereunto set....... theax .. ........... hane ... a and seal ..... s this ....... ...... Oth ..... day of..._ ...... Jnnn ............................. . A. D., 19 .. 7... . .........................(SEAL) SIGNED AND SEALED IN PRESENCE OF Wald A. ij j rO stran Le .. ............................... ......................... ( SEAL) ..............................................•----•----............---------------- ••................ Dia. ' ...................................... ............................... ......................... (SEAL) ....................................................................... ............................... ........................................................... ......................... ...... (SEAL) M,�NNIJoT�4 te oftxens:s, ) i L�ASN.►urw�.�, -.� ,. 5 - - - " -- -- -- L -�- -- ...., �t,:.. Z 4 ?I. ,1,,. �F S lA. W E A- D-- 19 -77... Vi �I ' Y r S '1 C - 105 r y I H j ;;f•:PT LC 'PANIC MAINTENANCE AGREE '~ 0 Sc, Croix County -� 0 Y H l)IJNI ?I: /IfUI't'R i 1� i ru Number ICOU'I'I: /fiUX tJlfllfi):f. 3 5k? --- ---- - - - - -- ' ' S u c L ion '1 N , R � lJ 1' I: a l' I�. k'I' Y 1. U l; A'1') U N : ��_ . , N� _ a . � - � .__ Town of St. Croix County, Subdivision O�T�� ��fJ�,- ��.��!� Lot number_! I Improper usu . and maiutenancc of your supLic :system could res"LL in its premature failure to "handle wastes. Proper mainLuuance con - s1nLs of pumping Out the supeic tank every three years or sooner, it nuudud, by a l icen_.ud sc•I�L is t ink MPur. What you pnt into Lhc system Cate affuc:C the IernCLion of Lhu ::c•pl. tank as a treat- ment stage In Lie waste disposal system. St. Croix County residents be ul ilgibl to receive a grant f or a maximum of 6OZ of the cunt of replacement of a failing system, which Oil in operation prior to July 1, 197ti. Sc. Croix County accepted this program in August of 1080, with the requirement that owners of all now 5ystcnir; agree to keup Lhvir systems properly nw i.nta i noel . Thu property owner agrucs Lu submit to St. C:roLx County Zoning a curtificaLi norm, signed by the owner and by a master plumber, Journeyman plumber, restricted plumber or A licensed pumper veri- fying that (1) the err -Si Le wastewater disposal system Ls in proper opuratLng condition and (2) alter inspucL and pumping (if nuc- essary) , .the sepLic 'Laulc is less than 1/1 lull of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiratiun. o G I/WE, the undersigned, have read the above requirements and agree U , to maintain the private: sewage disposaL system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- v munt of Natural. Resources. Certi_li.catiun form must be tumpletud and returned Lo. the St. Croix County Zoning Otfice wi�riu 30 days of the three year explraLi.o" date. X' c S1CNEU - -- DATE - - -- St. Croix County Zoning 011 Lcu P . 0 . Box ;8 Hamm( nd, W1 54015 715 - /96 -2239 or 715- 425 -13363 Sign, date and return to above address. v N m x^'30 c m tow w � o o (D > o z ` it°`< 0 3 c`O`O o N n -0 j f N N a �+ N : n ° a p o ' w� w 6 w co 113 w p m a qr tO ( E n O CCD e o 3 a o ..�to su t p O C N O CCD O O p. t 7 7 w N A C C f0 O N D to tT G) � o C n w n 0 A w = a a tD 7 w = to N C o CD tD w to Z N i oycD m����RD p e a 3 U) vi - --A p tDctD p? o,. m was ��' �c w o o 7 = D� viva a C m o M tD oaw wN n m ID V °ao N o a — � N o c - = y vi a 1) p a �D O C? p� c m aoE N =,awo CL aa�a� M Qg6) p 5.: �� �w 3 % A C to 7 C o N 0 > mo 0a c � u S CL a cow �: -.� O a 3' c (D = p 0 ;.. :.; 3 a aw :3 0 3 a O QQ3 i DEPARTMENT REPORT ON SOIL BORINGS � & BU,LDINt INW)STAY, o p DIVISIC It !"tBOPt AND PERCOLATION N TESTS (11 ' � SON, W1 537( i P.O. BOX 713( HUM AN RI LATION5 (H63.09111 & Chapter 146.045) (Tri f ESN: i N : N �46iR�4WI.Y: OT NO.: : SUBDIVIS ME: - SL '/*j L�� /� / 7 zs N�R/ for AA &SciP4 1 ? � > CA 1'i ery Jl_ COUNTY: WNER' I LINU ADDRESS � S� t, / ST �E'd►X� lAM 1:�6ni�S. 6S 3 e7 5T N /'YIAdSON Wr USE DATES OBSERVATIONS MADE u4rResidenor U N MM 0 XNew ❑Replace. ( �r�T �/ 19 S 'StPr TE STS: SOILS 0010 AE,L 51l - jQILS - PIA J P,iLL6r RATING: Sm Site suitable for system U. Site unsuitable for system N i, M U I1 IN- GROUIV 11 (� -I -Fii_L OLDt G TANK: RECOMMENDED SYSTEM:(opti net) S U S U � $ QV ❑J U ❑$ U �oN�(e 'TIONAL ��� If Percolation Tests are NOT required DESIGN RATE: if any portion of the tested area is in the under s.11 Indicate: C L , 4 <,c a , Floodplain, indicate Floodplain elevation: A / D PROFILE DESCRIPTIONS BORING AL A NCHE C A A F IL t THICKNESS, COLOR, TEXTURE, AND DEPTI NUMBER .qt ELEVATION OBSER F OBSERVED RV BACK.) TO FOR K I OBS RV D iSEE ABS RV. ON B .) ? X 9.23 R/ Nt zQ 0 - 0.9 L L 0A'-zA eeN4Y SI V OR B- �3 a 8 ?.V- 4 s' Mec4 5 4f,R 4.6 -8 .'z ,v S 5 ;( , e �B- 2 $.00� 9a .6Z' No�t� '> Oa• Q- 0, BBL o. >� Y &'S'L a2 a /, o' CS 1 6 C6M 3,0 -E3,0' me S B- 8,30' 98.92' n(oN� yf3.3o' 6 - /'/, ' - 8LL A/ -1' QeN S d Y -5� -S,L 2 .1 - .F j G ' ,- a'- f�3.3' -•cal S F GP Fcoh 8- 4 g.00 q9,)I�� NoNr: y £3.00 o -i.o i e o R-4:' o IL 2. ? -q,i Csr p cQl 64 -a' 6L L /,O' -2.6' RN Y 15, 6t 1�[AYCs1Ge Col 13. ' 19,3a gq.16 No me } 8 , 3a . 4.7 -e.3 Mad 5 �'ae Cob B- PERCOLATION TESTS DEPT RATE MINUTES NUMBER IEUfIN{rB AFTE IN INT RVAL-Ml PERIOD 1 PERIOD 3 PER INCH P. 11 9' P- �0' 7.0 1 / 7' P r.... _ P• ELEVATt N AT P.0 t£ _ T • PER Ntimee 's QeK to To lAcehIT Bet l G 'LOT PLAN: Show locations of percolation tuts, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the ho !ontol and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and perce f land slope. SYSTEM ELEVATION 9►�,,00' t 1 Lll O� C1 . i 1 i , FL4�= / 6 6-00, n I I Ll ti PARK 35vSi EM A4 I t I... ! 40� & i AyTEk ' 6 4'1 ^ _ //✓i` ll �''ar �`""/c f el.S n �7f S to c,6r of - � 6i� Co,✓�t�,e�7-�o -� l�ZeaE � 356 l ��c• f � 3 5' ($' Ga l� rN C / � t o i� Aele Wisconsin Dep!*rtment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 63 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: Geisler, Brad I Hudson Township 020 - 1159 -65 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 16.29.19.908 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes n No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 588 Spurline Circle Hudson, WI 54016 (SE 1/4 NE 1/4 16 T29N R19W) North Line Station Lot 17 Parcel No: 16.29.19.908 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes [�] No j Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. County Sanitary Pohnit Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary pu n ST. CROIX COUNTY GOVERNMENT CENTER [Privacy [Pacy Law. S. 15.04(1)(m)] 1101 Carmichael Road Hudson, WI 54016 -7710 (715)3864680 Fax (715)3864686 Attach complete plans for the system on paper not less than 81 1 inches in size. County Sanitary Permit # ❑ Check if revision to pp _ it "'65 -.00o Application Information - Please Print all Information Location: Property Owner Name Jlii�l Z 3 2003 J' 1/4 141; 1 /4,Sec /6 6Crd—. G T 2Ct N. Of R 1 E (or roperty Owner's Mailing Address 5 T C;``' ^ Lot Number Block Number OF ity, State ode Phone Numer Subdivision Name or CSM Number II rp i ublictCommercial of Building: (check one) I�ity ❑ Village Town of or 2 Family Dwelling - No. of Bedrooms: (describe use):p it ❑ State-owned Nearest Road 11. Type of Permit: (Check only one box on line A. Check box on line B if applicable) %, f i' N •-<- Parce Tax Numbers) A) 1 1.0 Repair 1 2. ❑ Reconnection 3. ❑Non - plumbing .Rejuvenation � � . l �g Sanitation r �O r l I B) Permit Number Date Issued E3 State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) 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 . Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Min./inch) Elevation (9th q C( 3S 1. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks nth ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ II. Responsibility Statement 1, the undersigned, assume responsibility for repair/ reoonnenction /rejuvenaUonrnstallation of non- plumbing for the POWTS shown on the attached plans. A icense is not required for terralift repair or the installation of non- plumbing sanitation system. rs Name (print) Signature (no stamps): ARW df4t8" Qtf. Business Phone Number e c `111'n E3) "-� /s' - f36, 2136 s Address (Street, City, State,, Zip Code 1 01PI t_ S 11. County Use Only Disapproved Sanitary Permit Fee Date Issued rnt Signature No stamps) Approved Owner Given Initial Adverse Determination 1z_ 1S ZC0 I)( Conditions of Approval /Reasons for Disapproval: Ak 4-wt,Q j 'Dr' _ � o _ Q --- $a �c. Acv 7 " P c O 1a P �tcsN Clt X02 (eacf 12 "+ S �e rar U -r J Wisconsin Department of Commerce SOIL EVALUATION REPORT Page l of 2 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must inGude, but not limited to: vertical and horizontal reference point (BM), direction and parcel M pe Med elope, AaVo or diMensioris, north Annow, and to Anion a `rid di ncA to n aRW road. Please print all infonwilon. Ravimvd by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner _ _ Property Location El Brad Geis er R E C E I `/ E Q Govt. Lot Se 1/4 NE 1/4 S 16 T 29 N R 19 E() WW Property Ownees Mailing Address LBlock # StAd. Norm or GSkW 588 Spurline ircle , h City State Zip hone N m []MIlage JDTown Nearest Road Hudson WI 5401 r Y Spurline Circle EI New Construction UseEi Residential / Number of bedrooms 10 4 Code derived design flow rate 450 to 600 GPD BRaptacemant 0 Public or commercial- Describe: Parent material _ l .ness over glacial fill Flood Plain elevation I applicable w(a ft. General comments This evaluation is being conducted for the purpose of using the Terralift and recommendations: - Boring U 1 ��'� # 40 - 49 Q pit Ground surface elev. 99.35 _ ft. Depth to limiting factor _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 "Eff#2 1 0 -24 loyr2 /1 A 2msbk mfr cw 2f 5 .8 2 24 -40 10vr4/4 silcl 2msbk mfr cw if .4 .6. 3 40 -49 1 4/4 flf5yr5 /8 silcl lmsbk mfi ew - .2 .3 4 49 -120 7.5yr5/6 s Osg ml - - .7 1.2 ❑ 2 Boring # Boring pit Ground surface elev. _ ft. Depth to limiting factor in. Soil Application Rate Honzort Depth Dominant Redox Deserip w Texturs Structure Consistence. Boundary Roots GPDff in; Munsell Qu. Sz. Cont. Color Gr: Sz. Sh. - Eff#1 { 'Eif#2 Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 < 150 rrgL ' Effluent #2 = < 30 mg& and TSS < 30 mg& Nam CST Na (Please Pnrit) _ Signatwe CST Number Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, Wl 11/09/02 715 -246 -2454 i A s _ �e 51 O Qvi 21 "V t 0 1a 1 1 - T op of Veni P opp, 10 of M f Q�Z. 1 0 o�Me-n�olR COJ (L 9q QI gq,35 $I �bf I i� e �rc za zti 3 3 7 U 2 3 11 P 4 3 4 729932 K KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX Co., WI Document Number Document Title RECEIVED FOR RECORD 07/11/2003 11:35AN St. Croix County ZONING AFFIDAVIT EXEMPT # Affidavit of System Rejuvenation REC FEE 11. TRANS FEE: COPY FEE: CC FEE: Name — (Owner) Typed or printed PAGES: 1 being duly sworn, states, under oath, that: 1. He/she is the owner /part owner of the followin parcel of land located in St. Croix County, Wisconsin, recorded in Volume Page 2 U Document Number'JaZ;EL"t. Croix County Register of Deeds Office: Recordina Area Name and Return Address A parcel of land located in the V4 of the Nr ' /s of Section T 1 6_ N — R _ W, Town of 14, 1 -., , St. Croix County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or detailed legal description): 070 - )I S9 - G -- 600 Parcel Identification Number (PIN) As owner of the above described property, 1 acknowledge that the septic system serving this residence (Is, eow) undersized by current code standards. I understand that the issuance of a sanitary permit to allow the attempted rejuvenation of the septic system does not imply that the system meets current code sizing requirements, nor does it imply that the proposed procedure will be successful. 1 also acknowledge that I will make this. informaticn, avaiiable to airy futurs.pa&w interested in pruchaairg'this property. Dated this day f ucu Y . �• * w * i # U N ON ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ).ss. authenttcated this day of t Croix County. ) Personally came before me this day of — the above named TIT • to me known to be the person(s) who executed the foregoing I A instrument and acknowledge the same. N N O STRU J E W, Ag DRA _ E y G+seiwion Er�est,IYI. +k Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. If not, state expiration date: necessary.) Date: "THIS PAGE IS PART OF THIS LEGAL. DOCUMENT — DO NOT REMOVE" This information must be completed by submitter.• document title. name 6 return address. and P(N (if required). Other in*rmation such as the granting clauses, leagal description, etc. may be placed on this first page of the document or may be placed on sWAbnal pages of the document. Note: Use of this cover page adds one page to your document and $2.00 to the recomft fee. Wisconsin Statutes, 59.517. • DOCUMENT NO. • "N WARRANTY DEED ,++ s SPA1.9 IIr9[RV[O FOR, RECORWNO OAT• STATE BAR OF WISCONSIN FORM 2 -1882 VOL 947PAtiE 420 REGISTER'S OFFICE William F. Berends, a single person and Marna K. Lundgren, ST.CROIX CO., %M formerly Marna K. Berends, a married person i Reed fa Recwd .......... APR 2 81992 conveys and u: rrante to - Bradley L. Geisler and Tan ja R. O� 10 :50 A. M Geisl,er, husband and wife, as survivorship marital I. .- . .... proper "ty ..__ 0 l.� .. -. .. _..... ..._ _ .. -. too* d Des& .. .... .. .... .. ....... __- ......._. ...... -. ... wrTURN f0 r the following described real estate in ...... .... $- t".-X imix ... ...... .... ...--- Cour.t), State of Wisconsin: Tax Parcel No: . ..... ... ... .... .. .. .......... Lot 17, North Line Station II in the Town of Hudson, St. Croix County, Wisconsin. i 1 l J $_35 This is not homestead property for Marna K. Lundgren. 'Rttxx xx`C xxxxxxxxxxx kmxoEtmcdxpxc,xoot7C p0gx i* fXXX)C Excel+tian t warranties: Existing highways, easements and rights of way of record. PMCd tbi.: day of April 92 /J ISEA1.1 C U'. -G L Lc« -� f- j 4 c "� "� • William F. Be,rend r 1 Marna K. Lundgren AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ -. -. __ __- _ _ . .. .. . .. ...... .__ -. -_ STATE OF WISCONSIN _.. -- ... ... .. ... .. . ...._ -------- - ST. CROIX as. .. "- . -- "-"" ...- v ca .. County - authenucated this . -_._ day of - ---. . -_. 19- Personal! me before me this '� -)- dtr of April_- --- - .. 19 92_ the above named William - -- am F. Berends,- a single person and •" . -_ ----- - -- - -- - - - - -- - _- `Iarna .. K._Lund-ren, a married person TITLE- NTF.NfBER STATE BAR OF WISCONSIN Y ... (If not, authorized by 5 704;.06, Wis. Stag.) to we i m % t t +� (r5 a r.+t�1�► wi , t'Xco, {fed ffe lure ntn_ i t�'�il�k� gtjtc ti�k 'u�•� 7 S INSTRUMENT WAS DRAF?F.D PY - J � , � ✓Y /,,�- Attorney David J. Fstreen p 621 Second Street -- - --. -- ..." !r /,i;i �?i .!' ;sT .O. O' Hadson, WT. 54016- _-- ------- -- -- -_ -_ .- -._.._ _. _- Nnt :i%' Puhf ��'- St -s ;C , CRo 1 t� County. Wi'. lr (Sil; natures may h authenticated +r acknowled -ed, Both \T f nuui <;inn ice' nrrn:, r. n•..(Ti .a t, Aate ec ratiwr arc not necess: ry.) date: 19 1-