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O `z C c C N d ti i N V m a ° m N C CL 7 ro N iC LL C C X 3 0 aa� 3 Cl) v I � Z y _rn Z C Z 1� N W d CO H Z co c a c C7 v o z c o o c E d M N N C f N C N N •� a y C U) L_ 0 O Z m Z o N - Z E � '0 N w e � 3 _O C r m v a O c i O 0 a a� g bap Co Lo a U N o •�'i w 0 0 0 0 Z �v v �v a _ N 3 y fn J V N } =� , J C O 0 O O = N C rn E y c O O C '7 =3 C) CO � n ~ CO N 2 c o y c m CD 4 " O € O y U Z • r' ~ N ti 7 m p O c p U Z O O 2 O v 0 H L U1 a # a a • ee a d .� m e 10 CL 2 0 c c 3 .` r _ Wisconsin Depart`.oent of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515135 0 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: Obermueller, James & Susan Hudson, Town of 020 - 1142 -90 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: �VD • d i�o. � 17.29.19.738 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark D g ft �7"Y co" - Z Z6 Al / ko,� Aeration W Bldg. ewer 1571 /, Holding St/Ht Inlet Ok- St/Ht Outlet �, IS q � TANK SETBACK INFORMATION (o I (� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Inle r ( �• I Septic -n (� /V i Header /Man. '] -)Zq Aeration Dist , O�f ttS 5• �� } Holding Bot. S Final Grade PUMP /SIPHON INFORMATIO Manufacturer Demand St Cover �1 GPM •C OD• Model Number TDH Lift Friction S istem Head TDH Ft Forcemain Le Dia. Dist. to Well SOIL ABSORPTION SYSTEM C BED /TRENCH Width ► Length No. Of Trenches PIT DIME NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1; 3 SETBACK SYSTEM TO P/ BLD WELL LAKE /STREAM ACHING Manufactur INFORMATION HAMBER O Typ f Syste ) V r O l.f" UNI Model Number: Q RIBUTION SYSTEM 79 Header/ anifold s ributr / x Hole Size x Hole Spacing Vent to it Intake ,Q, j i Pipe(s) Lengt Di __ a Length Dia Spacing SOIL COVER x Pressur Systems Only xx Mound Or At - Grade Systems Only I K C j/m-d Depth Over 1 j./ Depth Over xx Depth of xx Seeded /Sodded xx Mul6fied Bed/Trench Center / _ Bed/Trench Edges Topsoil I F1 Yes B No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: /__IL/� Inspection #2: ! / Location: 981 Sherman Lane Hudson, WI 54016 (NE 1/4 NE 1/4 17 T29N R1 9W) Park View Estates II Lot 45 Parcel No: 17.29.19.738 1.) Alt BM Description= MANI,hAes- C WA, 2.) Bldg sewer length - amount of cover = Plan revision Required? FA Yes o c Use other side for additional information. o9 SBD -6710 (R.3/97) Date Insepctor's Si nature Cent. No. �G� Einq ��ade eIPI/; 'miGFSZ a� 1 144 I z �z /77 /rn g 6 u< Ch-,-/floe r�f�dso•; f,J /. 6*016 nd �, ot S(5, 2 — ,4r1c +. >�o 1qsrk ckJ Esz4 le 5cc, 17 7."- z9/1,A."/9u�, 'T. o�I,icco(,SO� S�.GroT,f- Co ,4r Ya -90 -coo zy. sv" Pr0�5e(7 �iS�iSC�I �'t l�' - 7 (3) �ye.tcliZS n i¢ $�.rs�G � 'L�/CrX�..rnF' /tia- fi✓ C.�tt! = �- Slab ' 4Spka /� �Pivaway� N•rc%'�q f 0 a f l Z$ /o tl�rof ` �i z' V$ i c � ^l /- o� t J: eSC! Cone- ; GM qW *6 r- e oat/cj a (e[/: = 9(0.!0 3.1 (� bif / i �� � -- - - - - -- •o �_EXls�i' /d:r36 "a':�,oer,�/ce/% = /�iz►,F✓c S�.rF.cce a %�1= 9J,75." ��e id "�rc osedd�Sf�ibu io �/ A- 82 � 9G. Sb I • ,q uccnrc a/ c l evy = ioo ca ' r — commerce .Wl.gov Safety and Buildings Division County 4Zi 201 W. Washington Ave., P.O. Box 7162 St. Croix �q o s n Ma dison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Dent Commerce P A 1 / Sanitary Permit ApplicatioP Nate Transacti Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary _ p urposes in accordance with the PrivE Law, s. 15.04 1 �j I m , Stats. Same / " hu oKa 0%. L. I. Application Information — Please t All Information Property Owner's Name Parcel # 020 - 1142 -90 -000 James E. & Susan J. Obertnueller RE CEIVED Property Owner's Mailing Address Property Location 7 3g 981 Sherman Lane J S'EP 0 3 2009 Gait. Lot City, State Zip Code Phone N �`( NE' /.,NE %a, Section 17 Hudson, WI 54016 S �E (circle one) PLAN I II. Type of Building (check all that apply) Lot # T 29 N; R 19 W ®1 or 2 Family Dwelling — Number of Bedroo s 4 Subdivision Name na 45 Park View Estates 2 Addition ock # ❑ Public /Commercial — Describe Use BT Na City of ❑ State Owned — Describe Use / CSM Number ❑ Village of 3 Q'b� � G� r.✓ I A 7 +4 I4 Na ®Town of Hudson III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. List Previous Permit Number and Date Issued New System Replaceme Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) Sy stem ❑P ermit ❑Permit Revision Change of Permit Transfer to � Renewal Before Plumber New Owner _ J f ya � Expiration L7 7 IV Type of POWTS System/Component/Device: Check all that appl ® Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank H Other Dispersal Component sin) ❑ Pretreatment Device (explain)Hoot H-600 V. Dispersal/Treatment Area Informati : el.Q " ° / cha 641J W.O f JAr end x ss &=4 = *57 30A Design Flow (gpd) Design Soil Application ispersal Area Required (sf) Disftrsal Area Propose (sf) I System Elevation 600.00 sq. ft. J 0.70 gpd/sf ,� 857.15 sq. ft. ✓ 857.40 sq. ft. 94.75' VI. Tank Info Capacity in Total # of Manufacturer o Gallons Gallons Units o' U p� w W W W a N New Tanks Existing Tanks u ai O H F Septic or Holding Tank 261,.,E �,� 1000 1261 2 Weeks/Wieser Dosing Chamber A_5;L r VII. Responsibility Statement- 1, the unde signed, ass me responsibility for i ation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb s Sign MP/MPRS Number Business Phone Number James K. Thompson 30021 (715 ) 248 -7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceola, Wl 54020 -5413 VIII. County/Department Use Onl > I Permit Fee Date Issue C� Issuin ent Sign e ner� enial $ y1 OL Condit3"4 easons for Disapproval t. Septic tank, effluent filter and dispersal cell must all be services/ maintained as per management plan provided by plumber. 2. All selback requirements must be maintained as p Opplk;able code / gdnWrAL Attach to complete plans for the system and submit to the County only on paper not less than 8112 x 11 inches in size SBD -6398 (R 01/07) Valid thm 01/09 • /pC1t�e�i0r'o/4. S� ♦ 66 i ��de elect • 50;/ ¢�/a.�ua� ton Pig �k R ¢P '2177 G� 98 /S�ei � [anc. /,Fu.dSOn u� /. S'y0 /b 4et 15, % -"Add. bo 1 4,) EsEu 4eYy e - .4 Scc. /7 7. 1,A , 9c- -rx dso,? 6e.Gro7xCo., f c 1. �"` O.? - o - i1 y-2 - YO -cGb I .zy.sa' pro c�spe,-y,l '74rec (3) i - /eaclics az daEo 3'� �8'� 4 �n���iec L cfia.+r�s i Cona - -, � Slab i I gSPka /�d /ivawwyL/4rK•'n� _. a t I t (� 1 J u)a/ '�� �/6 �ao•h N�. LC SYSE AIeQ o� i �E,YisEihy cJ:tsCfCone ;ub9.PSc,4 6•c1!E2o Outlrt e14 = 96.63" / • ti t 9 F 9761 , / /i l . �/ -- - - • o EXi's �i' Sn l / ai66 K Suw e/rlf = 93,75." / �u�1�,r` �• 6A R 94. A ssA Hz- t c lei; _ /00. oo.' 2177 Wisconsin Department of Commercu"''--- SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8%: County x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. . 020 - 1142 -90 -000 Please print all information. Revi d By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). h/ G Property Owner Property Location James E. & Susan Obermueller RECEIVED Govt. Lot NE 114 N /4 S 17 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 981 Sherman Lane SEP 0 3 2009 45 Park View Estates 2Nd Addition City State Zip Code Phone Number J City J Village tJ Town Nearest Road Hudson WI At 4 zc(ROM GKI4654 Hudson Sherman Lane I New Construction Use: 0 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ✓_f Replacement _J Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for replacement conventional POWTS using 0.7 gpd /sq.ft. loading rate. Recommended system elevation = 94.75'. Boring # I Boring Pit Ground Surface elev. 99.39 ft. > 102° in. Sol Application Rate Depth to limiting factor pp Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/itz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -19 1Oyr3/2 &4/4 none sl fill na na aw 2vf,f na na 2 19 -32 1 Oyr5 /4 none sl 1 msbk dsh gw 1 vf,f 0.4 0.7 3 32 -37 7.5yr4/6 none Is Osg dl cw 1vf 0.7 1.6 4 37 -68 1Oyr5/6 none s 0 sg dl gs - 0.7 1.6 5 68 -102 1Oyr5/4 none s 0 sg dl - - 0.7 1.6 �5 2 Boring # Boring 1/ Pit Ground Surface elev. 99.16 ft. Depth to limiting factor > in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD / in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 1 0 -9 1 Oyr3 /2 none sil 2fsbk mvfr aw 2f,1 me 0.6 0.8 2 9 -26 1Oyr4/4 none sil 2fsbk ds gw lfmc 0.6 0.8 3 26 -31 7.5yr4/4 none gr sl 2msbk dsh cw 1 vf,f 0.6 1.0 4 31 -36 7.5yr4/6 none gr Is 0 sg dl cw - 0.7 1.6 5 36 -65 1 Oyr5 /6 none s 0 sg cil gs - 0.7 1.6 6 65 -109 1 Oyr5 /4 none s 0 sg dl - - 0.7 1.6 mt * Effluent #1 = BOD? 30 < 220 mg/L knd TSS >30 -)150 mg /L * Effluent #2 = BOD <30 mg /L and TSS < 30 mg/L CST Name (Please Print) Signa re: CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluation Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 8/18/2009 715 - 248 -7767 Property Owner James E. & Susan Obermueller Parcel ID # 020 - 1142 -90 -000 Page 2 of 3 37 Boring # - Boring iel Pit Ground Surface elev. 100.06 ft. Depth to limiting factor >125" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -13 10yr3/2 none sil 2fsbk mvfr aw 2f,1mc 0.6 0.8 2 13 -20 10yr4/4 none sil 2fsbk ds gw 1fmc 0.6 0.8 3 20 -25 7.5yr4/4 none gr sl 2msbk dsh cw 1 vf,f 0.6 1.0 4 25-31 7.5yr4/6 none gr Is 0 sg dl cw - 0.7 1.6 5 31 -73 10yr5/6 none s 0 sg dl gs - 0.7 1.6 6 73 -125 10yr5/4 none s 0 sg dl - - 0.7 1.6 Soil evaluation pit excavated to 114 ". Evaluation of soils from 11)4" - 125' completed with hand auger through bottom of excavation. �,�J i F-1 Boring # - Boring y r /to I Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -6330 (2.07/00) A.C.E. Soil & Site Evaluations i ,�XrS Ein Ynra e/w S.GJ. Cvf'ntf'oE/+.ouSG. EjCL: = /O/.i /,fu.dSon cJ /. S"/D /b �e� 5/S 2 %°�.�. �o park ✓ie,J Eslz .9EYy4E'1k/, 5 9, T- 29r1,.Ql9ca ,ZS�•� ds�6 $ s Vf i s /a6 -- -- -- --- -- — - - - --+ ue 5r SE eq 45p�t0l � oivaww y� A.r�C'�y � ' 0 , a I I I uJ:�scrCone- em fan 0utict e(�J 99.80' !! 98.E Coowr -Ace el T i 97.5/ /d:tX36d:3,Ceift/Ce/% 3 3 A uccm6al G Lei _ /00. Co.' °1 o,- Abs orption Soil Sectio g4 ft Sch edule Grade Cham El Soil Absorption System Plan View ft 4.00 ft Leaching I - Chambers Trench Vent Or Observation Pipe Trench 2 Header Leaching Chamber Specifications Manufacturer And M odel �1 EISA Rating -7-0. 0 sq ft per chamber Soil Application Rate C. 7 gpd/sq ft 66 0 .•• Design Flow 0 Soil Application - • Chambe 3 rows of chambers each. Page of Conventional Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10705 -P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with Comm. 83.54(1)(c). Septic tank to be located within 150' of service pad, with bottom of tank to be 5 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes 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 individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October - March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two -year schedule by use of a diversion valve. Valve to be switched diverting effluent from dispersal cell currently in use to resting cell on a two -year cycle coinciding with septic tank inspection and maintenance. Contingence Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248 -7767 or the St Croix County Zoning Department at (715) 386 -4680. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: m .Sac 0 / 1 4 -' (Street address) 991 S4x4-ma ? L& --ie, Wu.dsopl �„� /• rw4 located at: ' /4, 1 /4, Section /7 Range 12 W, Town of , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system? Yes t/ No (if no, skip next line.) Approximate volume or length of time: gallons 30 minutes Tank Capacity: j, ao Construction: Prefab Concrete Steel Other Manufacturer (if known): _Gt�l e se/ A ank (if known): e26 ye s ermit umber (if known) 3am69 �Wa aG,S icensed Plumber Signature) (Print Name) (Title) (License Number) /MPRS (D e) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner Mailing Address �rit Property Address �,e (Verification required from Planting & Zoning Department for new construction.) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location' /a , `lC-_ /a ,Sec. _17, T_N R _W, Town of 1 Subdivision &e tlje,,,.q 5 .S>� Ze,5 .Z i ��o ,Lot # �v . Certified Survey Map # , Volume Aw Page # Warranty Deed # 37 , Volume �o , Page # Spec house no Lot lines identifiable yes SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Nu a of bedrooms 'T SIGNATURE OF APPLICANTS) DATE ** y information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) i I 39 I 40 1 i i 2 20. 00 I 32 9.46 9 _ 6' Q� 41 01 1 I � 1.38 A AC RES ° N W ^ ' .L i. 249.50' 0 89 0 52 ' 40 ' W Q ) { 29203205" I 0 W _ Z - co I W a 45 � �r M I / 1.30 ACRES o - 42 I J ,� N 1o 2,ss'' N N d' >' - -- j� I I 10 co `° ° 296.50 T RUE -- +_ - -' -- � � I �_ BEARING N 89 ° 52 40 11 W ! �� YI lLl � L I { NE CORNER SECTION 17 CL a { T29N,R19W ° 44 N 1.53 ACRES N 43 { 9 POINT OF I I - BEGINNING { 6 6' o G j Ot' P N89°52'40 'W 8900 \� , I 366.01' ° A 276.79 9 /0' o QO. 0 N 89 =19 576.79' N 89 ° 5240 "W ° yj ,3 90 R McCUT ?H- NEO ROAD 759.29 — 0 9, to r 11 ROAD 04 h 0 � 11 354.37' Z--- - -—— °52'4 0 E °\� ., S 89° 52 40 E UNPLATTED LANDS 76 -W 2 o° ; �I SCALE IN FEET ACRES (s o zzl Z -I 2 00 100 0 100 20 -� LEGEND - 25.00' ai wl 19 W c7i QI CL COUNTY SECTION CORNER MONUMENT,f D{ BERNTSEN CAP 0OC1.0 tip 1 - - - -- _. _ 18T,AT>= wAi!cr<t�uM-aa _ a 3 71 7-4 VOLU�C9- f�w� �f+ ;emssr� evEeonta.+ooatuE #tC1TEfidS ±(UiC = SAID E. t►�R, a si.nfsle m" Graritc�z.. - - -_ - _ S e C$C(X to., `ddt5. Req'.. far Bs+oord .t3tcs 6th: "' V O L m_ cory ys andvresmer,lis to JAMES _ D EI3�SOET LER and � 31 SPSArI d' . OEERPSYI.LER .-huaban a wife - as joint tggants, antees for an n v - _ consideration of ttxE sum S t . CrO T Cactt►l 7 , the foitmw�ing 4ata�6aed raw aa'ate to _ $ _ State of W-3t�Ri`S7!!i Tat i(eyr No. i Lot 4 5, Park View Estates - Second Add tiah_ to - the Town of Hudson,, STSOJEr�T - to - record t easements, covenants anal- .restr ctions_- _ ThIals nOt hQ_.ri steed property. - - - -- (is) ¢a riot) - EzceGri.ton to warreAkI& t Dated this J$ day of May (SEAL) 1vJ'�c ► � — � — s (sEAy _ Sam E. M lle'l- 3 -- (SEAL) AUTHENTICATION 9 Signatures authenticated this NSA _ day of STATE. OF WISCONSIN ss. ST. CROIX County_ t personally came before me, this day of May ' 19 _ "TITLE: MEMBER STATE BAP. OF WISCONSIN the above named (It not, — authorized by § 706.06, Wis. Slats.) - -Sam E. Mille- This instrument was drafted by Hugh F. Gwin, Attorney G win, Gilbert. Gwin & Eiud.ge 430 Second Street - / to me known to be the person _ who executed the foregoing In- udson, WI s onSin S4 t i�l6 .. -1 H strumen�pd aGkn�wbt d m (Signatures may be authenticated or acknowledged. Bot:r are not ^ � / © eRS O Aj necessary.) Olf1 Notary Public St. Croix County, Wis. - Names or person signing in any oIpaelty mwt be tyred or orlgted below their signatures. _ My Commission iK�f�iRt {oY�xe�f3€tK�il��+itYc expires; ; S� f'7 // taEi�_ ) wax��mrra�c - � sT'zsEem+ wfsccsysffr, �rcaf��vo -- z= Tarr-- - - - - -- .. ... 3�o��Fi� - y 3_�f"Z i 'II c to O c g 3 d o !� 101 ! CD B �-* CA an d 3 o m N o • CL o _ r� CD c� w rn C •* z y m > Ct ^ ( m c CD Nl m fA y W C lV F m v cn � D C �o (n ZD ' � I � � m cn o , � n IW ° r ! a w - ° CD O N M Q go N Z ' f > co 0 r 0 o y ! y W CD y o ° 7 3 �+ c ! '0 cn o c viol n v c y f/J ca ca m Ic O I o m m 'a p O n < RL ° l ! A o m N l�V` 1 N w ! fl. w y Z y Z OW Z z W z O O D °- y o O D m a i m _• CD X v CD C CD CD N d ` C f�D d co _ w 'm _ CD ° n m ' to n W a 1 v n A 0 Z rrn M z a x 0 co w z H z CD Lo m I w a` I I © o m a ° ° a o CD o a Oo'v �w� m c Q ° - d rn N - � fD m o a vv o a v my cn 5 CD ° ° y t c � o n I �w s N C "' c o b 3 0 0 c ON CD m ti � s m ° o o o °p b CD m oa ti 69 0 (o0 a I ° 0 o C- ti r 98 Obermueller, Jim NE NE, Section 17 I-1=1 A i R f.,S7 C, T 2 9N- R l 9W, 7 ,� S' Hudson, WI Town of Hudson Lot 45,Parkview Estates San.Permit /643669 9 -27 -83 A. Zappa Conventional, New INSTALLED - 72 -6 -83 Parcel #: 020 - 1142 -90 -000 10/07/2005 10:36 AM PAGE 1 OF 1 Alt. Parcel M 17.29.19.738 020 - 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): O = Current Owner, C = Current Co-Owner JAMES E &SUSAN OBERMUELLER O - OBERMUELLER, JAMES E & SUSAN 981 SHERMAN LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 981 SHERMAN LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.300 Plat: 2276 -PARK VIEW ESTATES 2ND ADD SEC 17 T29N R19W PARK VIEW ESTATES 2ND Block/Condo Bldg: LOT 45 ADD LOT 45 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 17- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.300 27,800 212,400 240,200 NO Totals for 2005: General Property 1.300 27,800 212,400 240,200 Woodland 0.000 0 0 Totals for 2004: General Property 1.300 27,800 212,400 240,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 119 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r AS BUILT SANITARY SYSTEM REPORT OWNER - C Z T0WNSHIP p,�/ SEC ._/, -RaW ADD RESS A,,21� _rT�o7 i ST. CROIX COUNTY, WISCONSIN. SUBDIVISION fT,�gr / LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Al O T 6 a h rr w BENCHMARK: (Permanent reference Point) Describe: Top of /�Vb r /Sox ZA.7d `Y A-r 'P6147N _LVt1 C6 Elevation of vertical reference point: / & o Slope at site: c SEPTIC TANK: Manufacturer: ^ s E(L Liquid Capacity: /D0o n�� Number of rings on cover / Tank manhole cover elevation/. Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cycle gallons; Total capacity of distribution lines gallon: size of pump head; gallon per minute horsepower ;brand name of pum and model number ; Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover ; Type of warning device SEEPAGE PIT SIZE; Number of pits feet diameter feet liquid depth seepage pit inlet pipe - elevation bottom of seepage pit elevation /eet. /� OV�nAnV UVn CT7V. .....,.1.0,- ,.f 1 4— Wi(it -h F Length �/1 the den 4 DEPARMENT i)F INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINC LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISIC P.O. BOX 7969 BUREAU OF PLUMBIN MADISON, WI 53707 IN CONVENTIONAL E] ALTERNATIVE State Planl.D. Numb er: El Holding Tank F in-Ground Pressure El Mound (if assigned) NAME OF PERMIT HOLDER: J ADDRESS OF PERMIT HOLDER: INSPECTION DATE: ^ Jim Obermueller 1631 Aldrich, Hudson, WI _��3 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV.: NE NE, Sec. 17, Lot 45,Parkview Est.T29N— R19W,Town of Hudso Name of Plumber: MP /MPRSW No County Sanitary Permit Number: Anthony Zappa 1614 St. Croix 43669 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVWEP ........ PROVIDED: l/ v v ,J.1/,) �� �O DYES ❑NO DYES ONO BEDDING: I VENTDI , A.: I VEWJ T l_., HIGH WAT R NUMBER OF' ROAD: PROPERTY WELL: BUILDING: VENT TO FRES ALARM: LI Ny /l AIR INLET: El YES ❑NO OYES . 1j NO NEAREST I� J U Its DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODE L. 41p LMP /SIPHON NUFACTURER. WARNING LABEL LOCKIN COVER / PROVIDED: PROV DYES ❑NO ❑YES O Y ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATI L J. UMBER CAF PROPERTY WELL, BU D VENT TO FREI (DIFFERENCE BETWEEN �% j FEET FROM LINE / AIR INLET; PUMP ON AND OFF) ❑YES ❑ O j 1IEAIfEST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of ploy r 1ng FO LENGTH D7 ARKING / or excavation. (if soil can be rolled into a wire, construction shall cease /Until MAIN . the soil is dry enough to continue.) CONVENTIONAL SYSTEM: iy fir. WIDT LENGTH: NO.OF DISTR �lPE SPACING. Co V 1 '.INSIDE DIA.. #PITS. _ UOU 10 I °BE /TR EN�uI"I• I TRENCHES / i RIAt:t bEPTH: - GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: O. TR NUMBER OF PROPERTY WELL: BUILDING VENT TO FRE: 1-7 BELOW PIPES ABOVE COVER: ELEV NL T ELEV. END PI LINE: AIR INLET: FROM IV MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSf. SIDE. SHOW ELEVA- meets the criteria for medium sand., TIONS ME URED. DYES ❑NO SOIL COVER I TEXTURE 1 PEAMANINT MARKERS / 1 011 SERVATION WELLS. ❑ ONO •� DYES 1:1 NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL SODDED, SEE DE D. t MULCHED. CENTER: EDGES. DYES NO 1:1 Y' S ❑INO DYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DE, TH ABOVE COVER. ' IT F.IN FI TRENCHES: I '7 MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. ISTR. DIST . PIPE DISTRI TION PIPE MATERIAL & MARKING. ELEV.. ELEV.. DIA.. ELEV.: PIPE DI .: ISTR . IV HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIA VERTICAL LIFT CORRESPONDS TO APPROVED I IIFf F M TEON PLANS: DYES ❑NO OYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: 11tLll(�BF.R OF; BROPERTY WELL: BUILDING: 11 LINE: O ) ❑ YES 1:1 NO ❑ YES El NO NOAREff f f Sketch System on Rg n in county file for aud4t. Reverse Side. SIGNATURE �� � TITLE: DILHR SBD 6710 (R. 01/82) t� r wlsiAti APPLICATION FOR SANITARY PERMIT , DILHR C OUNTY �� oeaRRTmenTOV (PLB 67) UNIFORM SANITARY PERMIT �# r InOU$TRV, LRB01 /Y<366 9 — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /2x 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS iM 013 q vimA6 163 / /'�L�iP /�i f�vf SO,J W /�S 5 PR r , PERTY LOCATION CITY: /{� 1/4 E1/4, S , T N, R E (oW r V OWN O E �� SD v LOT NUMBER J BLOCKNUMBEF� SUBDIVISION NAME N EAREST ROA D, LAKE OR LANDMARK 7TATE PLAN I.D. NUMBER 1 AW 17 1fW tZXT_- S .4AJ �9-- TYPE OF BUILDING OR USE SERVED 1a jtS-1 or 2 Family Number of Bedrooms: - j Public (Specify): THIS PERMIT IS FOR A: 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 X Lift Pump Tank /Siphon Chamber Holding Tank capacity ,* Manufacturer: A/c / , M 60,04 'rrF Ue ]` Eti P O_ C­ / IF HIS 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): e X_ 6 3 0 ( L? `X3S` ` Private ❑Joint ED Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Si ure: .i MP /MPRSW No.: Phone Number: Plumber's Address: f 6 Z Name of Designer: W y . d f>Sa�cl COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: F /e: / Date: ❑Disapproved CJ (J ; El Owner Given Initial ,,,, -� Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber 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. Form - S T C 100 Owner of Propert .0 -- Af SOS" J N �2 Location of ` Property Section ,T N R W Township {-- ►tJDSa.J Mailing Address R0,27Ii j 3t?x / 7C Subdivision Name AIZK.V(��J ASST - ATGS 7uo_—Am_n ® Lot Number _ 4rj Previous Owner of Property 5» LL SP Total Size of Parcel Date Parcel Was Created Are all corners identifiable? Yes No Include with this application one of the following ✓.Certified Survey Map .Deed .Land Contract, or .Other 1:e9al Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I Iwo) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. : and that 1 (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. ), SI RR Of OWNi SIGNATURE OF CO NER (IF APPLICABLE) `�` cl/0 DATR SIGNED SATE S GNED r , QEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IWDUSTR'Y, : ' DIVISION LABO'R'AND PERCOLATION TESTS ( 115 P.O. BOX 7969 HUMAN RELATIONS 1 MADISON, WI 53707 (H63.09(1) &Chapter 145.045) LOCATION: SECTION: TOWNSHI /MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: N '/a '/a 1 /Ti9 N /R /9 E (o v so,� P Ui�cv C`s�,1 COUNTY: 11v USE 7/ UNTY: - OW /BUYER'S NAME: �� MAIL ADDRES U ✓ (/�'I l0 Gy1C G�1 DATES OBSERVATIONS MADE T b NO. BEDRMS.: COMMERCIAL DESCRIPTION: IPROFI E DESCRIPTIONS: PERCOLATION TESTS: Residence ,// New ❑Replace 15L4, a7 _R� T 23 — a RATING: S= Site suitable for system U= Site unsuitable for system se 0 g ze,4,41 I N VENTIONAL: MOUND: IN- GROUND•PRESSUR_E: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) S ❑U ®S ❑U ©S ❑U ❑S ®U ❑S ©U r dA I &A W/ DES Percolation Tests are NOT re wired RATE: n _ 4 If any portion of the tested area is in the under s.H63.09(5)(b), indicate: F i n d icate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER -IN CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH jC7 ELEVATION OBSERVED EST. HIGH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- l 7, N36 r 7'l > 7 0 ` •'o D. /_ , izs'BW. 4, ,5 'RA).s6 wj ' %4'V e I p B- 7- 7 d ` y �' - > 7, o ` � f ' ASE. � L .) - J�Q ' 06`0 - Z- 0� QA) . S (VIA40. 6r- TAW 0S B -3 go' 7 'f(P > g, o .5p'P, AA J. c. , .7S N 0 25 B- y D 9�, ?a �o— �? U ' • 9a ' �,�. ,ate . �. , . �� - ,au, o� B ,v, s� , s i7' 2SI A-1 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER IN ., AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERI002 PERIOD PER INCH P - 2- 4 n P- P- Z 3 < P_ I L 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. 13Q 7J0-,4 Q 13Ev e5W .4 L) SYSTEM ELEVATION F_T_T l 6 , tN t { ( 111 33 I ..... I .�.. L ----- --- i i t , i I I i I i AL A'�v 4- 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 whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new 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; 0. 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; 0. 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.R. in the appropriate box; 11. Sign the form arid 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 GAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Sail 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 Grot! „dvvater es — Coarse Sand Perc — Percolation Rate reed s — Medium Sand W Well fs - Fine Sand Bldg — Building Is — Loamy Sand > — Greater Than * sl - Sandy Loam < - Less Than I Loarn Bn - Brown * sil — Silt Loan BI - Black si — Silt Gy Gray * cl — Clay Loam Y -- Yellow sci — Sandy Clay Loam R — Red sici — Silty Clay Loam mot — Mottles Sc — Sandy Clay w; with sic -- Silty Clay fff few, fine, faint `c Clay cc - common, coarse pl Peat rnm — Many, medium m Muck d — distinct p — prominent HWL — Nigh water level, Six general soil textures surface water for liquid waste disposal BM — Bench Mark VRP - Vertical Reference Point Tip THIF OVVICIFR r PE . ESTS o�soi�13�RN�5 � - DA rE - St / 23 - HOMESiTE TESTING CO. RT.3, 01NEIL ROAD BOB UL1,R► cj; 4 AUDSON, WIS. __. 54016 C5 SS- d2 Y�Z /76 zrml4, 41� PR OPOSED "oVSE Mosr trtE 2_,� Fr• ,o .444 TE3 1%eEA5. PRo POSE 0 WELL MUST or 5o FT. o,p I'10RE F�PO,-� ,qLC T£sr' ��PE�45. = C3�Ckf�a£ PATS O = EX1sr1W (- We'l- �{ _ lE -fG locArlDAlf = f�Auh �}v9E�PE0 o,e 5 Bowe f r = Ho' iz • B VERric f1 ,PE Po ar -rQp BO X # 4 1 f"e_ Y II- T �o T CoiPti��2 LEGEND elEVArow ©f 1/,&r ,PEA. Pr, /o 0 . 0 f— . w Go T co ^ u ER , f e?rzrd F6,vcs— posr a ETA �o ICE O �? t� T -'r- Parcel #: 020 - 1142 -90 -000 12/05/2005 05:10 PM PAGE 1 OF 1 Alt. Parcel #: 17.29.19.738 020 - 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): O = Current Owner, C = Current Co -Owner JAMES E &SUSAN OBERMUELLER O - OBERMUELLER, JAMES E & SUSAN 981 SHERMAN LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 981 SHERMAN LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.300 Plat: 2276 -PARK VIEW ESTATES 2ND ADD SEC 17 T29N R19W PARK VIEW ESTATES 2ND Block/Condo Bldg: LOT 45 ADD LOT 45 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 17- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.300 54,200 223,900 278,100 NO 05 Totals for 2005: General Property 1.300 54,200 223,900 278,100 Woodland 0.000 0 0 Totals for 2004: General Property 1.300 27,800 212,400 240,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 119 Specials: User Special Code Category Amount 018 - RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM San.itan y Penm�.t State Sep-ti IA,ME ,/� Townbh.ip t. Croix County ocation � �? See Lot M Subd.iv.i4ion 1 PTIC. TANK Size gatto nb Numb en o compan.tmen,ta )iatance Anom: Wett Buitding 12% 4tope H.Lghwa.ten 'u MPING CHAMBER Size $atton4 _- ,Pump Manu6ae'tu4e4. Mudet Number OLDING TANK Size gatt oae Number oA Compa4tment6 P.umpen Ata,.m Sy4.tem i.atanee 640m: Wett Bu.itd.ing 12% H.Lghwatex 6 SORPTION SITE Bed Tne.neh iatanee 6hom: Welt Buitd•ing 12% 4tope H.ighwaten BS ORPTION SITE DIMENSIONS Width o6 t4eneh At Requ.ined area _ At Length o6,eaeh tine At Depth o6 hock betow tote in Number o6 tine4 Depth u6 4oeh uve4 Total xeng.th u6 t.inee At Depth o6 tile bet Dib.tance . between .t.ine,6 At Sto o6 .trench tin. p e.n 100 At � [ u.t u., ub6 v1cp t.iun anew At Type o6 Coven: -Paper on 6 thaw IT DIMENSIONS' Numbe.n o6 p.i.te Gxavet around pith _ y ea no Ou.t4.idg d.iame At Depth betow .inte.t At To.tat ab4 oxp.tion aKea At ,Aaea .n. equ.ixed At NSPECTED. BY TITLE ,IJP.ROVED DATE 198 'I JECTED DATE 198 10472 REPORT ON INSPECTION OF SANITARY PERMIT # (1 ) Name and Address of Permit Holder Person /Persons at Site (2 )Date of Inspection ame, Aaa ress, License NO. o a ns ing Plumber Time of Inspection 4L2Z � ( 3)INSTAJXATION CONSISTS OF: ❑Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System BEN ermanen reference Point) Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: (7)DOSING TANK: Manufacturer: # of gallons # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? []YES ❑ NO Wired? ❑ YES ❑ NO 8 HOLDING TANK: Manufacturer of gallons ; construction ; depth to the cover ft; If septic tank is being used are baffles removed? YES []NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? [:]YES ❑ N0; Wired? ❑ YES ❑ N0; Locking device on cover? []YES ❑ NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe - elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; li -neal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE E H: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (1 2) Has syst been i in a indicated on EH 115? ❑ YES [:] NO (13) Has system been installed in floodway? ❑ YES []NO Floodplain? []YES ❑ NO DILHR -SBD -6095 N.05/80 Signature of Inspector r j State and County State Permit P Permit Ap County Permit # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: E r Ya AZ 11 '/4, Section LZ, T2_q N, R E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village 1_ ► �`�. / � Towns t- 5.0"I 5 C. TYPE OF OCCUPANCY: * Commercial *Industrial *Other (specify) *Variance Single family I-" Duplex No. of Bedrooms 3 No. of Persons D. SEPTIC TANK CAPACITY 00 l} Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured -in -Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. � New Replacement Alternate (Specify) Seepage Trench: No. of LinealFt. Width Depth Tile depth (top) No. of Tren�(ies 12— A. : L f Seepage Bed: y Length ._ Width_ l� _Depth Tile depth (top ,; No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land ? 7 1 74 Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other t present o wner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified Soil Tester, �^ NAME ' r' C �a , ljnp , C.S.T. # 7 — j S f nd other information obtained from n ( vner /build Plumber's Signature 00 MP /MP SW# N —3 3 2- Phone # .Z�7 3 Z 3 Plumber's Address .7 ' a U i PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. e , A „ n r a w.. °. ....v .._ ..... ._m v.. _. _ i F r ` E 3 E „ E 3 � �. . m .. E .M r 3 a e E H 115 R,,,.79178 REPORT ON SOIL BORINGS AND PERCOLATION TESTS 10 II f WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 1 tt 16 '/ � ' � pp��,, LOCATION: L� 4, /o, Section ,T_N,R_.. �T'ownship or Municipalit � Lot No. , Block No. ibi`e" e County S Subdivision Name Owner's /Buyers Name: • // er' / Mailing Address: T y t TYPE OF OCCUPANCY: Residence X- No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW A- REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS ��16 PERCOLATION TESTS ? - , - , 2� 16 - O SOIL MAP SHEET _S� NAME OF SOIL MAP UNIT Dom. �? UA � O PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHE NUM- SINCE HOLE HOLE AFTE INTERVAL RATE BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN /IN P- / f - p �fj / / , 3 • P- 2 ' e 4P Aare 9 d 6 P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES / OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- b 'r � 4 /W e ;:p 4 " !, ii S B- 2— S B- q6" OAIF 7 s/ e ,S,C d r e- '� / cue � '� ' • L ' PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy p� OtaD A/ .Indicate scale or distances. Give horizontal and vertical refe // e points Indicate slope. l o J _ _ _ _ . m.._; 4 ... .. __ f' m. ,y S �r f i i l t s 4 k f e x a r c� R� a V IA NJ ' � d Z Ah 'f"C