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Home My WebLink About020-1166-00-000e~consin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Kelley, Stephen Hudson, Town of Q~. TANK INFORMATION i . ,.1 TYPE MANUFACTURER CAPACITY Septic ~ i (,.~. ate...-- ~,. a~-: /ooo Dosing ~~ I / G z ~' Aeration ~ r r Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Sept~icy~ / /cc.l~ xi L~g' s7 / ' ~ Z / ~ Aeration a Holding PUMP/SIPHON INFORMATION Manufacturer Demand PM Model Number TDH Lift Friction Loss System Hea TDH Ft Forcemain Le Di Dist. to Well S[lll ARSI~RPTInN SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 514917 0 State Plan ID No: Parcel Tax No: 020-1166-00-000 Section/Town/Range/Map No: 17.29.19.1018 STATION ~ ~ 1a ~ilt~ l FS ~LEV.~ Benchmark 3, I ,~ Z •~ ~, Z$ Alt. BM ~:4~'~A %L. ~~ ~~ ~ q/ Bldg. Sewer SUHt Inlet ~ ~ ~ n SUHt Outlet l r~ q.a5 q~l 3 7 Dt,Q~ttom ~~// ut~ ~J~^ t~~ ~ '~ 9~~ ~~ I Header/Man. ~ g.~L J ~~. `Q 7 0 Dist. Pipe y ~ 7 C, ~ 7 ~~ ~~ . Bot. System L J~ o, r I' ' 3 Final Grade S. 5 9~ ~~j Z st Co der , ~X ~:-~ s ~ 3 ~ ~~ ~• Z ~ Z~p ~ =y` 1 /~r QZ 2(~ 1 d~~- g •~ 93. $ ~~ BED/TRENCH Width ~ Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (_f~j • ~ ~~PP v ~ f I C,~.ILi~N ~_ ~ ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer,~~ OR ATION ER OR CHA -.L s. INF M Type Of System: ~ J~IO G S 1 ~ / ~~ Sa ~ ` J I 1 ~ /1,J uN Model Numbe~~ d w ,R nISTRIRLITION SYSTEM KaG . ) ~ ~-~ ~ ; ~ ~ Header/Manifold N Q' ~f Length D Dia ` Distribution Pipe(s) ~ ~ Length Dia ~ Spacing x Hole Size ~ x Hole Spacing ~'_ Vent to Air Intake ~ 3 3 / S(lll C(1VFR ., o~e~~~~re c..~•e.,,~ n.,i.. ,... Mn~~n'1 [lr Af_C;rarla Svstams Only Depth Over Bed/Trench Center 5 ~ 5~ Depth Over - Bed/Trench Edges \ xx Depth of Topsoil \ xx Seeded/Sodded J Yes ~~ No xx Mulched Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 937 Wert Rd Heudson, WI 54016 (NE 1/4 S/W 1/4 17 T29N R18W) Park View Estates IV L,,ot 1 /0~1 Parcel No: 17.29.19.1018 1.) Alt BM Description = GKg~ ny ~~~~- ~"-' ~aL~ 1^~-d~a-~6t aK, ~p~-: ~, / 2.} Bldg sewer length = /J /~ "-"T `OJT` -amount of cover = ~j5 ~ EZ ~~'Q-'~ wl 5e..<<.K~ Plan revision Required? ~,') Yes No '~1 L~ /~Q ~j 3 7 Use other side for additional information. / V ~u Date Cert. No. SBD-6710 (R.3/97) r 1 commerCe.wi.gov Safety and Buildings Division Cnunty ~ i s 201 W. Washington Ave., ox G2 ' ' ~' co n s ~ n Madison, WI 5370 62 Lary Permit Number (to be filled in by t:o.) Department ad Commerce L ~ !~ ~ ~7 Sanitary Permit Applica tion fate Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this fo it i i d i rm to the appropriate governmental N~ un s requ re pr or to obtaining a sanitary permit. Note: Application F submitted to the Department of Commerce. Personal information you p orms for state-owned POWTS are Project Address (if different than mailing address) u ses in accordance with the Privac Law, s. 15.04 I m , Seats. ~ 1. A lication Information -Please Print All Information ~J ~ tN ~i ~~ ! Properly Owner's Name ~ Parcel # ~e JUL 0 2 2008 Sao- // -~-~, Property ner's M~ilin Address ST. CROIX COUNTY Property Location / ~` $ Cit~tate Zip Cnde ZONING OFFICE one um er / Govt. Lot ( ~ / / So 1 ~-/~~ I~~"~ ~~~ e~ irrlE° ~ 11. Type of Building (check sll that apply) L o T~_N: R V I or 2 Family Dwelling - Number of Bedro s ~ ~D / / Subdivision Name ~ d.~ ^ Public/Comm i l D f I7Ll erc - a escribe Use --~---~--- ^ City of ^ State Owned -Describe Use CSM Number ^ Village of Z ~ ~,' / ~~~d~M~ A v ~ ,~ ItJTown of ~~/l~ Ill. Type of Permit: (Ghee only one box on line A. Complete ( ine B if applicable) A. ^ New System Replacement System ^ TreatmmVHolding Tank Replacement Only ^ Other Modification to Existing System (explain) B• ^ Perrnit Renewal ^ Permit Revision ^ Chan a of Plumber List Previous Permit Number d Da 1 sued g ^ Permit Transfer to New Before Expiration Owner tel., IV. T e of POWTS S stem/Com onent/Device: Check all that a ~ 1 Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. ofsuitable soil ^ Mound < 24 in of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) V. Dis ersal/Treatment Area Information: Design low (gpd) sign Soil Applica-ion 4Yate(gpdsf) Dispersal Area Required (sl) Dispersal Area Proposed (sf) System k ation S/ ~ ~ ~ ~~ V + (~~ ,2, ,~v Vl. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units .o u o u NewTanka Existing Tanks ~ ~ ~ ~ 4 3 ~ u c ~(~~~ ~ a U h ~2i va 'u'. a Septic or Holding Tank ' 5 Qi r Uosing ( hamber VIL Responsibility Statement- 1, the undersigned sauaat respoaslbllity for Installatbn of the POWTS shown on the attached plans. ' Plumber s Na int) PI m SignaC MP/MPRS Number Business Phone Number 7 ' ~ r t ~ er ~ d /~ ~8~ ~ o Plumber's Address (Street, ity, State, Zip Code) r" c~7~ ~~ Vlll. Count /De artment se Onl Approved ^ Di pprov Permit fee Date I sued Issuing Signature ^ O iven Reaso rDenial S ~ • ~ 7 ~ ~ O ~ IX. Condit~~~easons fo isapproval 1. Septic. tank, etflulnt f(fter and dispersal cell must all be st~vlcesl maiMaitttad as per management plan provkted byphlmbar. 2. All setback faquir+errtents must 6e mtWtta)i~d Ailacll In rnwnlaw nlwm fn« O.. .u...... .,.,~ -..~..-,.._ .. , .... ..... «.,...rn, .v .nc .,vn only VII tlstlCr 1101 Ilia 171an n n{ x 1 r InCaea In SI>Z! SBD-6398 (R. 01/07) Valid thru 01/09 ~/off 1~1a~ /11~-1~1~ SteP~en l.1J 1~jel~ey .Ti 11f~ ~I~~eE3~E1' Lo~ca~io~ ~~~ i ~~~~~ G;~e~se ~~.9d9o~ ~,~. , 3x b~.7~ g ~ ~ ~~~~ br ~ ~N~i' 3 a5z 9 I ~~ ~ ~ ~ ~ ~~ ~, Ub~ ~~ ~ 3 ~~~~ p1 ig _~ ~NC~ ~pt~~ ~ ~paRO,~, Q~~~~ ~~ S,b, A 1~ ~~e~ ~i~'~n~~.,k. S o' un ` '~"~ p ~ s~ , ~., G M ~N ~, +.F r__ IQu ; 4 9 a~ wtllo ;~ I I mCOPY - w.M1~ a~ ~ N F- /V~-~-'~~ S~fep{~en ltl 1-~ef~ey Tm l~umees~e~ Caca~ion 937 ~~t i~,~. G;cense ~~.~d9o~ ~~ f ~~ ~~c- s ~ ~~ S~ s ~~,~. ~~, d---_------ 3 t~ - ~Y ~ u' ~oov ypl ,g ~~°1 L ~~ ~~2N G~'~1~I~,~ S ~ ~ ~~p ~~ sj~'; ~ I~a-.~~dlp r_~~v; g~ao wt,1o di ~3 3 ~`~ uo~ ~ qM 3 x ~ ~ . ~5' 1- y N~. ~'rvh,d Dr ~ ~J~i I ~ ` 35 ~ ___-____~ X31 ~~ 9 . a lr ~ gn) 5~,~~'~ c 41~ ~i ~~4 r -s ~11~+v=1~jo.p ~o'I'IUYh 01 ~Ik?,~ N F- F 2131 Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in atxordance with Ceram 85_ Wis Adm. Cede Page 1 of 3 A.C.E. Soil 8 Site Evaluations Attach complete site plan on paper rat less than 8'/: x 11 incFres in size. Plan must incl d t t li it ti t d t l d h ¢ t~ i f B County St. Croix u e, w m ra e o: ver ca an on re or erence po nt ( M}, direction and percent slope, sr~e or d4nemsbr~s, north arrow, and location and d' nearest road, Parcel I. o2a11 000 Please print all information. Revi By Date Personal infatuation You provide may be used for secondary purppses (Privacy t.aw, s. 15. ' J Q 8 Property Owner RECEIVED lion Stephen W. & Jane tw. Kelle got NE 1/4 SW s 17 T 29 N R 19 W Properly Owner's Mailing Address L # Block # Subd. Name or CSM# 937 Wert Road 101 Park View Estates 4Th Addition City State Zi Code hone Number City ~ Village Town Nearest Road Hudson ~ Wt 016 T.~~~9~~~~~~ Hudson Wert Road New Construction Use: ~ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ~/'f Replacement ~ Public or commercial -Describe: Parent material Glacial Outwash Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for replacement conventional dispersal cell with 0.7 gpd/sq.ft loading rate. Install trenches at 91.50'. Existing dispersal cell elevation = 93.50'. -~~ I 7 ~ Boring # J Boring ~ _, ~ ~ Pit Grourxi Surface elev. 96.66 ft. Depth to limiting factor > 111" in. Sod Appli~n Rate Horizon Depth Dominant Coku Redox Description Texture Stn.rclure Consistence Boundary Roots in. MunseU Qu. Sz. Cont. Color Gr. Sz Sh. *Eff#1 `E 1 0-20 10yr3/2 none I 2fsbk mvfr cs 2fmc 0.6 0.8 2 20-40 10yr4l4 none sl 2msbk mfr cw 2fm,1 c 0.6 1.0 3 40-47 10yr4/4 none is Osg ml cw 1vf,f 0.7 1.6 4 47-52 10yr4/6 none s 0 sg ml cw - 0.7 1.6 5 52-111 10yr5/6 none s Osg ml - - 0.7 1.6 Boring # Boring \pG ~j Pit Ground Surface elev. 96.80 ft. Depth to limiting factor > 1 i4" in. Sot gpaigaon Rath Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP Dlft' in. Mur~seH t'kr. Sz. Cont. Cobr Gr. Sz. Sh. *Eff#'1 `Eff#2 1 a33 10yr3/2 none I 2fsbk mvfr cs 2fm 0.6 0.8 2 33-45 10yr4/3 none sl 2msbk mfr cw 1fm 0.6 1.0 3 45-52 10yr4/4 none sl 2msbk mfr cw 1fm 0.6 1.0 4 52-62 10yr4/6 none Is 0 sg ml cw 1vf 0.7 1.6 5 62-114 10yr5/6 none s Osg rat - - 0.7 1.6 I,5 ' ~D `Effluent #1 = BOD y> 30 < 220 mg/L and T S >30 < 1 ot1 /L ~ uent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) 'nature: CST Number James tC. Thompson ~~-- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osceola. WI 54020 6/24!2008 715-248-7767 Property Qwner Stephen W. & Jane M. Kelley Parcel ID # 020-1166-00-000 Page 2 of 3 a Boring # Boring Pit Ground Surface elev. 97.53 ft. Depth to limiting factor > 119" in. ~ A~ Rate Horizon Depth Dominant Cola Redox Description Texture Stnkture Consistence Bourxiary Roots in. M~sell Qu. Sz. Cord. Color Gr. Sz. Sh, *Et7#1 *Eff#2 1 0-18 10yr3/2 none I 2fsbk mvfr cs 2fmc 0.6 0.8 2 18-36 10yr414 one sl 2msbk mfr cw 2frn,1 c 0.6 1.0 3 36-42 10yr4/4 none Is Osg ml cw 1vf,f 0.7 1.S 4 42-50 10yr416 none s 0 sg mi cvi- - 0.7 1.6 5 50-119 10yr5/S none s Osg ml - - 0.7 1.t3 r a goring # J Boring '~y /J Pit Ground Surface elev. 98.93 ft. Depth to limiting factor > 115" in. ~ Application Rate Horizon Depth Dominant Cobr Redox Description Texture Stnkture Consistence Boundary Roots in. Mw>sell Qu. Sz. Cord. Color Gr. Sz. Sh. '"Etl'#1 'Etf#2 1 0-4 10yr3l2 npne I fill na na na 1vf,f na na 2 418 10yr4/4 none sNs fill na na na 1vf,f na na 3 16-65 10yr4J6 none s fill na na na - na na 4 65-115 10yr5/6 none ~ s 0 sg mt - - 0.7 1.6 y3. ~~ ' Horizons #1 - 3 are comprised of backfdied material pia fter existing ispersal cell was installed. Horizon #4 consists of undisturbed nathre soil. Elevation at bottom of existing dispersal cell = 93.50'. a Boring # J goring J Pit Ground Surface elev. ft. Depth to limiting factor in. ~ p,p~ Rate Horizon Depth Dominard Odor Redox Descriptbn Texture Stnudure Consistence Boundary Roots in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 * Effluent #1 = BOD 5> 30 ~ 220 mglL and TSS >30 < 150 mglL " Effluent #2 = BODS <30 mgll and TSS <_30 mgll The Department of Comnnerce 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-a33o ~mroo) A.C.E. Soil 8 SPoe EvaNstlorrs ~x,.~ 6'~ graale e.le%' • Lo cse~c ~ Projo. 5~ ca/Q: = ' L~ 1 S~cpA~ ~.,Ta^e ice //Q j,~y ~ ~ 93~ w~, t ~Pd. ~ds~, ~/. sYcW Wei P{.one Qd l,.t/o% ~~t'Y'~~r~z,` s J~E'/lCf/jG'ErCa.7S~r'.wCr^ ~. ~y~ 1• /9u~, T.4F~lI~- I ~ S~. G!'~I L'i.~ Lt7~ ,G~/.'d ~~D-//GG -IY~ -CLAD Cf 64 \;•.; \d -~ ~ -~. ` `a ~ ~o /t.( t~;,~.• , orso~..P. cJ: esc~C.s~.crc.tSe.- Sc p~•c, S•.,h! ' E,ris~i /B'X 3b ~ d,~/saJ ~. r ~~~ ,; '6.5~' ~~,~ ~ ~ , ~ / 64 ~ ~ ' ,Qpp/e tlc c !9y.B~ - r ,- ~ ~~- 9T.R~~~ •' '' ~2 ~ . ,96.sr1' Atop/c free h,~~~1 ~ _ - - , _ y D , ~' ~'~ ~ 4 ~' -' ___ .q ~ ~.' asP~a/t dr~vlt,JA~ ~, ~ ~ - a 1 ~'X~:S~.% ! 3 btd~.,., ~c • ~ ~esids acs, ~ dswtir 5; s; ~ Assu~nc~ e cc~• =/D El¢/,' = 99..28.' s. r ow`I.vE. _ ~~87 ,3a9' 6~~~~~ -~- -~-- P . 3~~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address (Verification required from Planning & Zoning Department for new construction.) City/State 1 j,~ ~~I Parcel Identification Number ~~ /~~ ~ i~D LEGAL DESCRIPTION Property Location ~'/a , ~'/, ,Sec. ~, T~~N R~~W, Town of~}~~sy~ Subdivision Certified Survey Map # Warranty Deed # Spec house yes no ' ~h Lot Volume ,Page # Volume ,Page # Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if ne4ded, 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 mairtenance 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 & Zoniag Department a certification foam, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read `~ ~ is and agree to maintain the private sewage dis~ystem.,with the standards set forth, herein, ae set by the co and the Department of Natural Resources, StsOe ofVVi~eonsin. Certification stating that your septic system hays , ,, ti ~' must be completed and returned to the St. Croix County Planning & Zoning'Department within 30 days of the three ~ ' on date, '' ''``"~r,. ~~ Uwe certify that all statements on tkwE fo~ue to the best of my/our knowledge. Uwe am/are rho owner(s) of the property described above, by virtue of a wantlnty dthrppprded in Register of Deeds Office. Number of bedrooms ~/~~~ SIGNATURE OF PLI S) DATE ~~ ~':: ***Any information that is misrepresented may 1 t44i~e sanitary permit being revoked by the Planning 8t ~gpig Department. *** Include with this application a recorded qty"~ ~, firm the Register of Deeds Office and a copy of rhocertiSed survey map if reference is made in the warranty deed. `"~~ ~~ (REV. 08/OS) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the residence located at : ~~, ~,~~ Sec . / 7 T~_N, /9 W, Town of ~1,~ ~1,~ St . Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced ~ k~.t.{ 3 a u~ ~ Did flow back occur from absorption system? Yes No (if no, skip next line. Approximate volume or length of time ~v gallons 5 minutes Capacity: / Construction: Prefab Concrete '/ Steel Other Manufacturer (if known) : U1eaS~X Age o f Tank ( i f known) ~~ r (Sign ) {Name) Please Print C~1~ YZ S (Titl~e)~ v (Lic~nae Nu ber) (Da-- t%~ ~®0 Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle) . Name ~~ ~ ~~~~-~-~(~ Signature MP/MPRS p POWTS OWNER'S MANUAL tit MANAGEMENT PLAN FILE INFORMATION r"ae . ar Owner h ~ -~~r.L~ ~e e ---- SYSTEM SPECIFICATiONS ___. Permit X ~ _ - __ Septic Tank Capacity -- r 1 ~ ~ 1 D ESIgN PARAMETERS --_ -- NA al _ _ -----~ Septic Tank Manufacturer ~jkK ~ ~,~~ p NA --` S _- - Numb~r of Bedrooms Effluent Filter Manufactur ---- -- - er ~ S O NA ___ -.__ Number of Public Facility Units _ ___ _ O NA __- ~ 1 ----- Effluent Filter Model _. -- _. _ _ ~ -~,,n /r ^' r ~C~P (f~ O NA Estimated flow (average) 9,Nn __ ._ _ f unrrr Tank f'nrrar rty _ ----- ------ _ ~ Design flow I eakJ _ _ ~ ~ `~~`- - -ilel~de-Y- - -_ - - .__. Pump Tank Manufacturer NA al --- -- p , (Estimated x 1.S) -- ~ 0 -__ __ -__--------------- P --_ NA - '----- ------- Soil Application Rafe ...._Sal/day ---_ ._...!_-_ - - - - urnp Manufacturer ----- ,__~ NA - Standard Influent/Effluent Qualit y _ gal/ ay~lt~ Punrp Model - _.. ats, Oil $ Grease (FOG) Monthly avers e' g ------ --- ------ . -- Pretreatment Unit _ NA Biochemical Oxyaan Demand (Hnh r.) <30 rr~p/~ ~ .72t1 rap/t f O Snarl/gravel Pillar NA ra rear r-Ilrer Total Suspended Solids (TSS) --- P ^~~ -- l Nn 5150 m /~ g r.i Machmricnl nrrntion C i t Wr,Uand retreated Effluent Qualit ~-~- y __-__.-----_-- ~""~"---- Monthly avara r a l Disbriection _ ---_ - U Other: 8iochemical Ox ( YgAn Demand BODR) , 530 rag/l hispersal Callls) ~ - ----- O NA Total Suspended Solids (TSS- 530 rrt /(. a L7 NA ~ Irr grormd (aravity) O In Ground (pressurized) Fecal Coliform (8eorrtetric mean) 510^ cfu/100m1 ^ At-grade O Mound Maximum Effluent Particle Size~ ------._._.__ Y in die fJ Urip-Line _ .__ _ ._ --.- r) h O Other. - Othe~- _ -_. _ n . C7 N/1 ._-__ t ar -- " _ - _..__. - f] Nn ___ oUrrtr. _ O NA .. ~ Values typical Ior domestic wastewater and aaptrc tank alfluant. -- _ -- C)tharr ____ _~ DNA -------- MAINTENANCE SCHEDULE DNA Servlce Event Inspect condition of tanklsJ Service Frequency Pump out contents of tankls) ------- _ -.~ /1t least once every: --- - ~ ---- monthls) -----~-- ~ earls) IMaxmmum 3 years! O NA Inspect dispersal ceiils) Wizen combined sludge and scum equals one-third tJ',) of tank volume "`---- --- ^ NA Cl -- - ~--_-- At least once Avery: ~' - - __ O monthls- iM ean effluent filter ~- i9 yearls) axmmum 3 yeah) O NA _ ins e t At least ones ovary: _ .__ _ ..._ s) ^ p c pum p, pum controls $ alarm -.__ ____._____ At least once every; _ ye GIs) L7 rnonth(s- ^ NA Flush laterals and pressure test other: ---------..._-___ _. - 14t least once every: ------~--._ ^ Yearls) ^ monthls) NA Other _ _ _- --- -_.._ __ At least once every: _ _ .. _ ^ yearlsl , O rnonthisl NA D Vearlsl wow MAINTENANCE INSTRUCTIONS ~ ~ Cf~IA Inspections of tanks and dispersal cells shali.be made by an individual carrying one of the foflowin )lean Master Plumber; Master Plumber Restricted Sewer g ass or certifications: p POWTS Maintainer, Septage S inspections must include a visual inspection of the tattkO1jNtosdentity any missing or broken hardware, measure the volume of combined sludge and scum ervioing Operator. Tank The dispersal ce{ilsi shall be visually inspected, and to check for any back up or ponding of effluent ton the ground surface. of effluent on the ground surface. The pondingof e~ft~luent onftheegrvundlsurface may indicate a failin condi immediate notification of the local re ulator pipes and to check for any pond~g g Y authority, 9 lion end requires the When the combined accumulation of sludge and scum in any tank equals one-third IS',1 or more of the tank volume contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance w Wisconsin Administrative Code. ,the entire All other services, including but not limited tp the servicing o1 effluent filters, nrecitanicaf or r Ith chapter NR 113, units, and any servicing at intervals of 512 months, shop be performed by a certified POWTS Main p essurized components, pretreatment A service report shall be provided to the local re ulat tainer. 9 ory authority within 10 days of completion of any service event. Pegs of ~AiTI' UP AND OPERATION 'or new aonstnrction, prior to use of the POWTS ohesk treatment tanklsl for the presence of panting products or other cfiemioals may impede the treatment process and/or damage the dispersal cetllsi. If high concentrations are detected have the oontenta the tankis) removed by a septage servicing operator prior to use. system start up shell not occur when soil conditions ors frozen at the Mfiltrative surface. .,, -t >txing power outages pump tanks may fill above Hormel hlghwater levels. When power is restored the excess wastewaterwEl bs~ Iboftarged to the dispersal ceNlsi in one large dose, overdosd~ng ttie ceN(s) and may result M the backup or aurfaos diaoharpa of ` iffkient. `fo avokd this situation have the' contents of the pump tank removed by a Ssptsgs Servicing Operator per to ~eatakq.• power to the effluent pump or contact a Plumber or POWTS'Maintainer to assist in manually operating the pump controls to satore normal levels within the pump tank. )o not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact. the srs~~ nrithM 16 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the Efe of tlw ` POWTS: ~ antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; ' ioundatkm drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; msdfcations; oN; painting products; pesticides; sanitary napkins; tampons; and water softener brine. 3ANDONMENT Nhen the POWTS fails andlor is permanently taken out of service the following steps shall be taken to insure that the system b properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be dfssonnected and the abandoned pipe openings sealed. M *NM wMiw111i1it1~ws ~1111iMfl~i flaw 11+~Ai rNlMil fik ~'~i`wMe+t~ Mwe Wsiiila:ii o1MMwfiIM Ei 8i y arMlYilie ir.iCr~~iilwM rNMi~I~Wlt • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the vokf space filled with soil, gravel or another inert solid material. , ONTiNt3ENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant ,,, replacement system: ~~~1 suitable replacement area has been evaluated and .may be utilized for the location of a replacement soil ..1~~ .~ system. Ths replacement area shoukf be protested from disturbance and compaction and should not be.infringed upon bll required setbacks from existing and proposed structure, lot Nnea and wells. Failure to protect the replsaement area wNl rsauh In the need for a new soN and site evaluation to establish a suitable replacement area. Repaaoement systems swat ' comply with the rules in effect at that time. D A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in ~ POWi"S' technology a holding tank may be Metalled as a last resort to replace the failed.. POWTS. O The site has` not been evaluated to `kfentify a suitable replacement area. Upon failure of the POWTS a soil and site,; . evaluation must be performed to locate a auitabk replassmsnt area. If no replacement area is avaNabls a holding tank .' ; may be MstaNed as s lest resort to r I e thp,.taNsd-POWTS. ~•. ' ~' ep ~~,tr~ q~,,, , .F M ~;• ,, O Mound end at-grade soil abaorpt be reconstructed M place following removal~o!ha,' blomat at the infNtrative surface. Reconatrustion must comply with the rules in effect at tha ,~k'' '" ..; ~ i. $EP'TIC, PUMP ANO OTHER TREATMENT T~-NKB N)AY CONTAIN LETHAL. fItA88E8 ANDIOR INSUFFICIENT OXYDEN. DO NOT , :. ;' ENTER A $EPTiC, PUMP OR OTHER TREATNI. , K<UNOER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE bF A` ~= PERSON FROM THE INTERIOR OF A TANK MA~~ ~~CULT OR IMPOSSIBLE. ~ ••-~~~ . { •, .+ , ADDITIONAL COMMENTS . " '" '~ ... »:«~,.-- .;._ ~ ` t •'.t41h - ~. POWT8 INSTALLER ~ ~ ~ '~~' POWTS MAINTAINER n." ~. r~ Name :~ii ~ `~ ~'~11i~,. , Name ~- r; ~~,~r, ' ~. .i',. , Phone ,,.~, r ~,,, Phone g - ~ ~,; ~,~:~~`', SEPTAOE SERYICINO OPERATOR (PUMPER) ~' "*R;z,y, ''~ ` • LOCAL REGULATORY AUTHORITY ~ x~ Name ` •~ ~ `~- ~, ~ : Name ~.lZU ~ ~ ~ " ~~''' S v~ Pitons ,'~ ~ Phone A F~•'k ' ~fi n t'=A~ Tf~is document was d-ahed M oomplisnce wkh cheptir Comm A3:~iZ11b11111dISN- end 83.64111, (2) d t31, Wisconsin AtMrdlligMive Cods. Pegs of t'T UP AND OPERATION new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other cherrtlcals t may krtpede the treatment process and/or damage the dispersal cell(s-. li high concentrations are detected have the oontents the tank(s) removed by a septage servicing operator prior to use. stem start up shall not occur when soil conditions are frozen at the infiltrative surface. ~irtg power outages pump tanks may fill above normal hlghwater levels. When power is restored the excess wastewater will be . ~targed to the dispersal cell(s) in one large dose, overloading the ce(lls) and may result in the backup or surfaos discharge of went. ~o avoW this situation have the contents of the pump tank removed by a Septege Servicing Operator prior to restorittg rarer to the effluent pump or contact a Plumber or POWTS' Melntalner to assist in manually operating the pump controls to tore normal levels within the pump tank. ' not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area hin 15 feet down slope of any mound or at-grade soil absorption area. duction or elimination of the following from the wastewater stream may improve the performance and prolong the gfa of the ' WTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasara; dental floes; diapers; disinfectants; tat; mdation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; inting products; pesticides; sanitary napkins; tampons; and water softener brine. NDONMENT ~t the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is ~perly and safely abandoned in compliance with chapter Comm 83.33, Wlaconsin Administrative Code: • Ali piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. g ~~M irNfiaii~titi trt iiiii liMh~lli Ifftli Iii+N rNMN kk ~M~,.w-rMr Mwt+ wrflit+t.ili AitlNllfwii iti tit .~ M«Miwilr -rw-~i-NikN w»+~iiMBlti • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. ITINOENCY PLAN the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compilant placement system: ~~ ~- suitable replacement area has been evaluated and .may be utilized for the location of a replacement soil abaorption`_` system. The replacement area should be protected from disturbance and compaction and should not be.infringed Mort by requ{red setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area wNl result in the need for a new soil and site evaluation to establish a suitable replacement area. Repiaaement systems must comply with the rules in effect at that time. O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. O The site hasp not been evaluated to kientify a suitable replacement area. Upon failure of the POWTS a soil and site., evaluation must be perfomned to locate a suitable replacement Brea. If no replacement area is available a holding tank` may be installed as e lest resort to replace the.taUsd POWTS. ~ ~ +' ~ ',e'{tpoA Vr, O Mound end at-grade soil absorptio ems be reconstructed in place following removah'o>t~!tM bbmat at the , ~~ °. infiltrative surface. .Reconatructions> Oft sys~gms must comply with the rules fn effect at that! s'~~' '' iEPTIC, PUMP ANO 07HER TREATMENT Y~-NK8 MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ,. , ;' ~11TER A SEPTIC. PUMP OR OTHER TREATMEt~I'I':TANK UNOER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A ; ~tSON FROM THE INTERIOR OF A TANK MAlt~l3@~O~FICULT OR IMPOSSIBLE. , ~~-~-~ ~ '° . y. ~ITIONAL COMMENTS "~,.~•-~«~. . ~ ,a•, t' °~~~it 1' ii. , +n' ' . " ++ ~y~~~{{ ~ ;y ~YS f~ 6',{px 'NSF N~-~ ,i «d~ t~Ftf~hrl. ', f~ u , ~ twtr'. ' $fi CISI4 l _ ~~1~'.i .. .. !frtt f 1 ~ .y, ~If itk1,~ !f: .. al OWTS INSTALLER ~~~i~~c~. ~~:" POWTS MAINTAINER . ~R•_~~4 r ~ . r~.~; rat ..,.... Name ,, ~" Name .~,-j ~"~~ ~Eli-,' Phone ~ ~ i ,~..t:'~`~' i' , Phone .rsti.' ~,:, .< ' f.'S ~EPTAOE SERVICING OPERATOR (PUMPER) ~,>~-o I~:c - t .~ LOCAL REGULATORY AUTHORITY +li~ f~!~;'~N'~'~' t Name S `v::~. Phone r , ~h,t', Phone 1 ~ ~ ~,+ -, . fhb document wee dratted In oomplience with chapter Comm 83.~Zl211b11 i lldld~lfl and 83.6411 i, 121 6 131, Wleconein Adnt~trtltive Code. Vr ~ ~J~FAr,~ WARRANTY DEED DOCUMENT NO. This Deed made between RICHARD H. MOSSONG and LISA s • RUDEEN, husband and wife, Grantors and STEPHEN W. KELLEY and JANE M. KELLEY, husband and wife as survivorship marital property, Grantees, Witnesseth, That the said Grantors convey to Grantees the following described real estate in St. Croix County, State of Wisconsin: Lot 101, Parkview 4'~ Addition in the Town of ~o4s~as KATHLEEhE H. WALSH kEGISTEf: OF DEEDS ST. CFtOIX CO. , WI RECEIVED FOR RECORD 06-07-1999 9:30 AM YARRANTY DEED EXEMPT N CERT COPY FEE: COPY FEE: TRANSFER FEE: X56.00 RECORDIFIG FEE: 10.00 PAf~S: 1 HUdSOri. Tax Parcel No. 020-1166-00 RETURN To: David J. Estreen This is homestead property. S~-~9 304 Locust st. Hudson, Wis. 54016 Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantors warrant that the title is good, indefeasible in fee simple and free and clear of encumbrances, and will warrant and defend same. Dated this ~ day of May, 1999. ~ , ~ ne ! }N} ~>~ *vL (SEAL) Richer H. Mossong '~ ~ .l fl } . ~/? . ~ ./ l~X 1~ L l~l ~ (SEAL) Lisa s . Ruderin STATE OF WISCONSIN ST. CROIX COUNTY )SS ~R~cs+O'rially.came before me this ~ day of May, 1 9, th above named Richard H. Mossong and - ~ ; Rudeen; to me known to be the persons w o e uted the foregoing instrument and ac l~lggd the sarhi3. ~., >j.A { ~ - t .I~t ~ ... ' Notary Public, State of Wisconsin My Commission O: ti.:"~ "~su> ~ caZ~%r_ THIS INSTRUMENT DRAFTED BY: Robert W. Mudge, Attorney MUDGE, PORTER, LIJNDEEN & SEGUIN, S.C. 110 Second Street, P.O. Box 469 Hudson, Wisconsin 54016 ~~~ ~~~ E~ i H~3 ~~~ ~d~'~~ ~`~ ~ A N ~ Krtsl~e , ~tnow i~, T2~, air, tt~t t~ +co~ort, n tea tutrfr, ~ 3d!L-IiSZ LiS70. ?~°_i -. !'i4i .:!C?SI 1 ; 3 4 lA8( ._ "_.__ - --- -- - -- ---- ~ rT Ia , ~a~ _ _ _ 3r nritw ~,~' ~ ~a~~ ~ 1F I i ; ~ ' ;~~, ~' ~ ~ 3 ~a ~ as e. at a~ a~ 8 Q~ ' a4 r Ins ~jf(11 , s t r ~~ ~ 't 40'tN Q yes .m : Ai IiR ,w w -(''~ 1 ~( ~ ~- ' ~ taenr x } rat ~ ~ lay _~~g `` ~ ~-0 ~ ~' C ,~ e" ~~a S ~ +a3 ~ ~I -0I ~ I ;~r,p' ~ SV ~~~ $ . ~ ~ 1.- 'fur . 4,~ ~ f[F~ Fq§ /`rCi'IS M'C SJOOp r~~ !~~~1!.T~..ue ~ ; ~ ~Id n.u c ~ ~ ~~ g4 n nr ert >t`ld ~ ~,. p p~ g an~ii ~ ~ A• '.~ tql qft l^~' ~`. RiM Mn ip6 •L7 EEkk $$~ ~..$vr~n 1~ rvlaxt ~ rdrir~+r.ri.r,u~ 92 '~ ~~Pf ~e,tn! $i' v ~. 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V-0~kt' Ir17'L 1r,N 11.-01' !4'117i°- iPlMIW S 'I RL'!L'Y 13.e r} Ie,w fra'1a~ u.tr 3„u' rrltm'r wengr^r i IE•13 R.00' i^r11'il° li7,tk t f,3F KW31%C'1 1N'334t't 4C!:/'.;E-. :2 E -0 3 C! 4t WCR u[A91tk8p v~4 I(FII Mtl[ A1[ IE,C[it >>~91 i q~ 91 1c.k1 fIlfhF" ;h,r1• ++„klr MI'St4rt e.. AO1JA1~p.L9lR1OiA WIR RA -II bA[ 1~AYA M wYt 97. N,dd' 1?'y4i" t',}S~ 11,7r %3YN41"Y [d--pltl6bMrutssa[ n k.h"s IfS"U' 7r,.14' SS;S}' +aIYKYP'1 l~L 1S !l.Os" 44t}Zk' 41,SY 86Q".. SSt!-071"~ A0.1d ~ ~ec'n~r.La1 .f S' ..oµ x N.63' !)'164!' 11a 11 P SIr137','L r ~ « II,aN+1+J iGr it ,; ASry ':c4 !] Il a 17;tQ' WN'W' et,n 61 61: Ry'14"[ 9f91"tZ"'C b. {~~c p{~(~ II 13 N N.N frN111' F1.~t3 f! Y' %71"1171'[ 11f!'}C4MC 1 ~4 (1((1~~{1b1/1E~NG1W7l~` Il{~k7Yf7 . lSJd Ik.18'. 7rrlPir.3^,EP tll,-0M >twSVN'r MrSrN'L ~4~ - pfAY~Cllnt~ [ ~ '::, ~a lr.la' ux':r fl,5: Y,~r slruar* , n k,~ ,?iP~^. it,1N {1,13' N#i1RYY ;~- - , t w >s,3a >ru71• -S./P N,N' NISNO'T H 19,IN Ff16xC 'I;W 1I,1f1 SftlCV6f°1 ~"""'", ~ - i133a1,M lt~INl~. H.1Y. N.d' Cllyl4l'R - 1A~1uo1k/fa-0rer 4a Mn+1e b.I1H E/A'f LOQ N,W- : H'fCW H.4F' U.li' lni~ld"L fr18'#+IS A(Sk11Lk 3tlat - ' . YtbIW YI CI-0U i1U.lrl~.~IRY ~Y1Ct~.-.... ••-. . 3 ~i ' ^~,t . 5 5 } ,liJ• .COMMERCIAL TESTING LABORATORY, INC. k 5~4 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 FAX-715-962-4030 ST. CfiOIX ZONING ST. CkOIX COtlNTY C~THOtlSE HUI~OAi, WI 54016 ATTN: THOMAS C. NEt.SON FtEkOkT NO,S 42174/01 fiFF'OkT IRATE. bf02I93 ikaTE kECEIt1ED+ 5/2819:1 PAGE i OWNEk; Duane Scholz LOCATION: 937 Wart kd., Hudson COLLECTOk. hi. Jenkins DATE COLt.ECTED: 5-~6-93 TII~ COLLECTEDS 2S15pm S[~JRCE OF SAf~'LEI Outside faucet DATE ANAL.YZED25-2B-93 TII~ ANAt_YZED+I1.OOam COLiFORM. 4 /104 a-t INTEfiPkETATION: Bacteriofogicatty SATE NiTkATE-N± 5 PPm Ahove 10 ppm Pxceeds the reco+r+~nded Public Dr 'inking Wafter Standard. CoLiform Ftacfiei-ia/100 mt _ Nitrate-Nitrogenr mg/t_ ~ '~(~ .~ s~, ~ ~ c ~ '~kti~~y~Q~ .~99~ ~~ ~~ i.AB TECHNICIANt Fay Cane S ~1 ~ ~.1NOEVENpfy~ _~~ ~ WI Approved L.ab No. 19 ~ ~ C Means "t.E55 THAN" Detec#abte t_evet Approved by: 5 3~'~raAg''~ PROFESSIONAL LABORATORY SERVICES SINCE 1952 SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612} 636-7173 FAX (6i2} 636-7178 LABORATORY ANALYSIS REPORT NO: 31550 05/26/93 St. Croix County Zoning DATE COLLECTED: 911 4th Street DATE RECEIVED: Hudson, WI 54016 COLLECTED BY DELIVERED BY SAMPLE TYPE Attn: Mary J. Jenkins - CLIENT'S ID: Scholz SERCO SAMPLE NO: 56063 SAMPLE DESCRIPTION: Scholz Sample of ANALYSIS: 5/10/93 ---------------------------------------- -------- Benzene, ug/L <1.0 Bromobenzene, ug/L <0.2 Bromochloromethane, ug/L <0.4 Bromodichloromethane, ug/L <0.2 Bromoform, ug/L <0.5 Bromomethane, ug/L (Methyl bromide) <1.0 n-Butylbenzene, ug/L <0.3 sec-Butylbenzene, ug/L <0.4 tert-Butylbenzene, ug/L <0.5 Carbon tetrachloride, ug/L <0.2 Chlorobenzene, ug/L <1.0 Chloroethane, ug/L (Ethyl chloride) <0.4 Chloroform, ug/L <0.5 Chloromethane, ug/L (Methyl chloride) <0.6 2-Chlorotoluene, ug/L (o-Chlorotoluene) <0.2 4-Chlorotoluene, ug/L (p-Chlorotoluene) <0.2 PAGE 1 of 3 05/10/93 05/11/93 CLIENT CLIENT DRINKING WATER Dibromochloromethane, ug/L <0.4 ~ g 1,2-Dibromo-3-chloropropane, ug/L <1.2 ~l ~ 1,2-Dibromoethane, ug/L <0.2 ^ ' (Ethylene dibromide) `' ' ~ ~~ ~~ ~ ~ Dibromomethane, ug/L <0.2 ~ ~ ~ ~' ~ ( ~ i~ ?S ~ ~ ~ 1, 2-Dichlorobenzene, ug/L <1.0 ?~' ~ z r' c ° ~, '~.; ` (o-Dichlorobenzene) -°~ ~ '~ ~ ~ 1,3-Dichlorobenzene, ug/L <1.0 ~ ~ rte, w ~ (m-Dichlorobenzene) . , ~~~' . \:. < means "not detected at this level". 1 mg = 1000 ug. N ~?.. ~1~_ SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 31550 PAGE 2 of 3 05/26/93 SERCO SAMPLE NO: 56063 SAMPLE DESCRIPTION: Scholz Sample of ANALYSIS: 5/10/93 ----------------------------------------- -------- 1,4-Dichlorobenzene, ug/L <1.0 (p-Dichlorobenzene) Dichlorodifluoromethane, ug/L (Freon 12) <0.5 1,1-Dichloroethane, ug/L <0.1 1,2-Dichloroethane, ug/L <0.2 (Ethylene dichloride) 1,1-Dichloroethene, ug/L <0.2 cis-1,2-Dichloroethene, ug/L <0.1 trans-l,2-Dichloroethene, ug/L <0.1 1,2-Dichloropropane, ug/L <0.1 1,3-Dichloropropane, ug/L <0.2 2,2-Dichloropropane, ug/L <0.2 1,1-Dichloropropene, ug/L <0.2 cis-1,3-Dichloropropene, ug/L <1.5 trans-l,3-Dichloropropene, ug/L <0.9 Ethylbenzene, uc~/L <1.0 Hexachlorobutadiene, ug/L <0.3 Isopropylbenzene, ug/L, (Cumene) <1.0 4-Isopropyltoluene, ug/L <0.5 (p-Isoprop~ltoluene) Methylene chloride, ug/L <5.0 (Dichloromethane) Naphthalene, ug/L <0.2 n-Propylbenzene, ug/L <0.4 Styrene, ug/L <1.0 1,1,2,2-Tetrachloroethane, ug/L <0.2 1,1,1,2-Tetrachloroethane, ug/L <0.1 Tetrachloroethane, ug/L <0.2 Toluene, ug/L <1.0 1,2,3-Trichlorobenzene, ug/L <0.2 1,2,4-Trichlorobenzene, ug/L <0.2 1,1,1-Trichloroethane, ug/L <5.0 < means "not detected at this level". 1 mg = 1000 ug. ~~a~"„'4j~5 . __1L ~ ' ~: SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 31550 PAGE 3 of 3 05/26/93 SERCO SAMPLE NO: SAMPLE DESCRIPTION: ANALYSIS: 1,1,2-Trichloroethane, ug/L Trichloroethene, ug/L Trichlorofluoromethane, ug/L (Freon 11) 1,2,3-Trichloropropane, ugJL 1,2,4-Trimethylbenzene, ug/L 1,3,5-Trimethylbenzene, ug/L (Mesitylene) Vinyl chloride, ug/L Total Xylene, ug/L 56063 Scholz Sample of 5/10/93 <0.1 <0.4 <0.7 <0.2 <0.2 <0.3 <1.0 <1.0 This sample's analytical results ar / below the U.S. EPA's SDWA Maximum Contaminant level of 1/30/91 for those requested compounds which are also on the SDWA MCL list. All analyses were performed using EPA or other accepted methodologies. Samples that may be of an environmentally hazardous nature may be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, ~!~Z~ cam' Diane J. A Berson Project Manager < means "not detected at this level". 1 mg = 1000 ug. .:aryl; ~.,~%A: ~~lQ- Q3 ~~ ~" ~~ U ~ r, 1 "\ ~ J~~ ~, ,~, ~~, ~~ Specify desired test(s) outside water lines are ST. CROIX COUNTY ~ WISCONSIN 1 ZONING OFFICE it;7. CROIX COUNTY COURTHOUSE FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 REQUEST FORM fee with application. during winter months, make arrangements with be gain Septic $25.00 (Visual inspection) appropriate turned off making access to the home necessary. Please this office to insure a time when entry can 9-dater ^ Water (VOC's) (Nitrate & Bacteria) $185.00 $35.00 Owner: - Requested by: ~- Address: `~ Address: City & State: , l`1~. City & St. _,~ Zip Code : -`~~~p,. Zip Code : ~~~~_ Telephone N4: (~7~) ~G t~ Telephone N4: Property address (Fire N4 & Street) : `1 '( Location: ;, ;, Sec. , T~~N, R~_W, Town of St. Croix Co., WI. Tax I N4 Parcel ID N4 House color: ~alty firm: Lock Box Combo:~.•~ ~ ~b'~ Water sample tap location: TO BE COMPLETED BY PROPERTY_OWNER PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Is the dwel-ling currently occupied? Yes ^ No If vacant, date last occupied: Septic system installed byf-~~ '~'~~~ -Q.~ Year: Septic tank last serviced by ~~~y~ ~ ;~~'~. Date: ! r- Pre~~ i ous OTOner' s Name (s) Have any of the following been observed? ^Y ~1~ low drainage from house. ^Y ~~ewage Back-up into dwelling. ^Y ~1a" Sewage discharge to ground surface, ~/ r~oad ditch or body of water. ^Y BIB low drainage from the dwelling. ^Y '~2d' Foul odors . Other comments relative to system operation: I certify that the above best of my knowledge. OWNERS informati n is complete and true to the S IGNATIIRE : U~CAM~ DATE : ~~ r° OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION p r~ Q[oi.y .~, I ~o-`~ ~ 1~p v.S~- (~` TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ^Yes ^No Soil series per SCS Soil Survey: sheet # Type of soil absorption system: below grd ^At-Grd ^Mound Approx. size 'X 67Grravity ^Dose ^Pressurized ° ~ Ft.2 ^Bed ^Trench ^Dry Well ^Holding Tank ^Outfall pipe OBSERVED DEFICIENCIES ^Other ^Unknown Septic tank . Setbacks: ^House ~~5 ^Well~ ^Prop. line ^Other Dose tank ,.---~- Setbacks: ^House. 1 ^Prop. line ^Other ^Locking cover ^Warning label ^Pump/Floats" ^Alarm ^Ele wiring Soil Absorption System -~ Setbacks : ^House 5 SU ^Wel l ~SC~ ^Prop . 1 ine~~o5 ^Other ^Ponding: ~~ ^Discharge: ~.¢~+ General comments: k ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 May 11, 1993 Duane Scholz 937 Wert Rd. Hudson, WI 54016 Dear Mr. Scholz: An inspection of the septic system on the property of Duane Scholz, located at 937 Wert Rd., Hudson, WI was conducted on May 10, 1993. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as-soon as we receive them back from the laboratory. 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. Should you have any questions, please contact his office. Sincerely, Mary Jenkins Assistant Zoning Administrator c~ ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 June 4, 1993 Carol Farrell, Realtor Century 21 706 - 19th Street S. Hudson, WI 54016 Dear Carol: On May 10, 1993, I collected a water sample from the Duane Scholz residence, 937 Wert Road, Hudson, Wisconsin, and forwarded it to SERCO Laboratories for testing. The testing results were received by this office on May 27, 1993. There seems to be some confusion as the client is listed by the laboratory as having collected the sample. This simply means that they received it from St. Croix County Zoning Office, who is their client for billing purposes. I hope this will clarify the issue. If I can be of further assistance, please contact me. Sincerely, Mary J. Jenkins Assistant Zoning Administrator ~S~- 9..~ Y~ ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 ~~~ SEPTIC INSPECTION / WATER TEST REQUEST FORM Specify desired test(s) & remit appropriate fee with application. G~ Outside water lines are often turned off during winter months, (~ making access to the home necessary. Please make arrangements with ~j' this office to insure a time when entry can be gained. ii0! Water (VOC's) $185.00 ^ Septic $25.00 /L~\Water (Nitrate & Bacteria) $35.00 (Visual inspection) Owner: !~vlc~,~e S~~~l~ _ Requested by: F~w+'1.y- Address: 7 ~ Address: ~ ~ City & State: son wa. City & St. , Zip Code : ~yo /( Z ip Code Telephone N°: (ZIS) 3gG-~~a y Telephone N4: ( ) Property address (Fire N4 & Street) : ~'~~ tu~ l~~ Location: ;, ;, Sec. , T N, R W, Town of St. Croix Co., WI. Tax ID N4 Parcel ID N4 House color: Q~~2. Realty firm: C- a ~ Lock Box Combo: Water sample tap location: ~`"~`~~ ~ TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM Is the dwelling currently occupied? If vacant, date last occupied: Septic system installed by: Septic tank last serviced by: Previous Owner's Name(s): Have any of OY ^N ^Y ^N ^Y ^N ^Y ^N ^Y ^N the following been observed? Slow drainage from house. Sewage Back-up into dwelling. Sewage discharge to ground surface, road ditch or body of water. Slow drainage from the dwelling. Foul odors. Other comments relative to system operation: I certify best of my that the above information is complete and true to the knowledge. OWNERS SIGNATURE : ~jv„` DATE : s`-(q-~~ -~ Yes ^ No Year: Date: ~ac~c~ ~i~, I s,~q-q3 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION 4 M 1~ TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ^Yes ^No Soil series per SCS Soil Survey: sheet # Type of soil absorption system: ^Below grd ^At-Grd ^Mound Approx. size 'X ^Gravity ^Dose OPressurized Ft.2 ^Bed OTrench ^Dry Well ^Holding Tank ^Outfall pipe OBSERVED DEFICIENCIES ^Other ^Unknown Septic tank Setbacks: ^House ^Well ^Prop. line ^Other_ Dose tank Setbacks: ^House ^Well ^Prop. line ^Other ^Locking-cover OWarning label ^Pump/Floats ^Alarm ^Elec. wiring Soil Absorption System Setbacks:.^House ^Well ^Prop. line ^Ponding: ^Discharge: General comments: ^Other Fo rtn - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~~„ ~I'//oY TOWNSHIP /-/k ~~,~a v~ SEC. L~ T '~~J N-R /7 ADDRESS ~~"~/ ~~ ~ ~. ~ -z., ST. CROIX COUNTY, WISCONSIN SUBDTVISION~/;~( ~i~ %S~ ~~, T ~~D / LOT SIZE /- 20 ~7 ~~/ j PLAN VIEW Distances and dimensions to meet requirements of I•LI1R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 4 ~OD y~, r iY" i~ ~` i ~. ;I i ti o R. ht. ~ /vo, d ~ ^ . .~. ~~~ .,~. .~~ ~~~t, i. S INDICATE NORTH ARROW ,_ - ~ BENCHMARK: Describe the vertical deference point used ~" ~,-~ c~, p,~ ~ In~{- ~~ia~ ~~ Elevation of vertical reference point: Iw .O ~' Proposed slope at site• - a%~' ~ .. s- t PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Elevation of inlet: Pump off switch elevation: Alarm Manufacturer: Pump/Siphon Manufacturer: Pump Size Bottom of tank elevation: Gallons per cycle: 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 : [,,„, J~~ ;o ~, ~) Trench: ~~ i , Width: /~, Length: ?~ ~ Number of Lines:~~ Area Built: L~~ Sq'F7 Fill depth to top of pipe: ~ z ~ Number of feet from nearest property line: Front, O Side, ® Rear,O Ft.~/c~~ Number of feet from well: (p(o~ Number of feet from building: 3 a (Include distances on plot plan). SEEPAGE PIT Size: ~ Number of pits: Diameter: -"' i Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box ~ 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: Number of feet from well: Number of feet from building: Number of feet from nearest road: Front, O Side, O Rear, O Ft. Alarm Manufacturer: DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR ' LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS P.O. BOX 7969 MADISON, WI 53707 NE4jSW4,S17,T29N-R19W [CONVENTIONAL ^ALTERNATIVE Town of Hudson ^ Ho{ding Tank ^ In-Ground Pressure ^ Mound SAFETY & BUILDINGS DIVISION BUREAU OF PLUMBING State Plan I.D. Number: (11 assigned) _aLn.v.L.cw LvL .LVi NAME OF PERMIT HOLDER: Sam Miller ADDRESS OF PERMIT HOLDER: Route 1 , Box 282, Hudson, WI 54016 INSPECTION DATE: ~ ° ~ ~~gg ~ - BENCH MARK IPermanenl reference ppintl DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. Name of Plumber: MP/MPRSW No.: County: Samtarv Permit Number: 102863 Douglas Strohbeen 5432 St. Croix ocr r rt, r rsty n/nv cv n..a MANUFACTURER LI UID CAPACITY. TAN N T TANK OUTLET ELEV.: WARNING LABEL PROVIDED: LOCKING COVER PROVIDED. ~~~~•-~ ~~ O Q~ / $, ~ ~ YES ^NO ^YES ~NO BE DOING. VENT DIA.. VENT MATL. ' HIGH WATER ALARM ` NUMBER OF FEET FROM ROAD: PROPERTY LINEr WELL: BUILDING. 'S/ VENT TO FRESH AIR INLET ~CJ ^ ~ ( ~ `~ ~ ~~ r ^ NEAREST ~ ~~ - v ~~ ~) YES NO YES L JNO DOSING CHAMBER: MANUFACTURER BEDDING- LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MA NUFACTIIRER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ^YES ^NO ^Y ^NO ^YES ^NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WEL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ^YES ^NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTR DIAMETER M E ALA D M RKwG or excavation. Ilf soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN vrv v crv t rvrvrs ~+ W~DTH:•• LENGTH. NO. OF DISTR. PIPE SPACING COVER INSIDE DIA at Pl fS LIQUID BED/TRENCH `y\ 1 ~ ~ rRENCRES pr I '~" MATERIAL: PIT DEPTH DIMENSIONS 11 \Q GRAVEL DEPTH FILL DEPTH UISTR PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DI R. NUMBER OF PROPERTY WELL BUILDING V NT TO FRES// AIR INL BE LOW 11P~ AB~ COVER. \ EL~V IN~1 E .END: / a s „~ ~ - ] PIP FEET FROM LINE ~ 4 ~~ ~ ~ `v~ d ' ~ `p 7 ' c NEAREST- -- e. ~.~r~ Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM 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 ^NO SOIL COVER TE%TURE PERMANENT MARKERS OBSEH NATION WELLS ^YES ^NO ^YES ^NO DEPTH OVER TRENCH'BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES ^YES ^NO ^YES ^NO ^YES ^NO 'RESSURIZED DIS TRIBUTION SYSTEM: WIDTH: LENGTH. NO.~ BED/TRENCH TREI DIMENSIONS MANIFOLD PUMP MA<\ ELEV. ELEV.. DIA. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE :OMMENTS: PERM (,.3~ - ~~ ~ 2 _~ ~c ~ 1~ ~~ Sketch System on Reverse Side. DILHR SBD 6710 IR. 01!821 ~~~ DISTR. PIPt mnNiru ~u iviwrenrH~ ivv ~ ELEV.: PIPES :TLV COVER MATE RIAI ^ Y 7~ c~~- ~+ J / PLANS ^YES NUMBER OF PROPERTY FEET FROM LINE: NEAREST q `~ ~ 1 4` ~ <A . 0 (.~, D' Retain in county file for audit. ^NO nv' 1 - `5 ~ {~ ~ SIGNATUREA ~~~'~~ ~~ /~ IllLt Zoning Administrator ~ L(a0 ~11 a ~..dCiG~/ ~aD- Il~~ ~C~ -e~-~ ~, ~?- amt- ~~t /~ i8 *•T-~~1 NEB, SW~, Section 17 Route 1, Box 282 T29N-R19W, Town of Hudson Hudson, WI 54016 ~ T.ot 101 Parkview ~S~ address of site: Hudson, WI 54016 Permit No. 102863 3-9-88 Douglas Strohbeen Conv. i3ew I ~ ~ p~j O w O_ N 7~ d (D ~ j ~ 4 ~ ~ ~ N ~ 7 N d ~ I ~ ~ ~ ~ I ~ a I I ~ ~' m N ~ j ~ a ~ ~ N ~ (~ 0 i ~ 0 I I A O ~ .II O =,~ „ C N ~ ~ ~ ~ p~ ~ N N ~ N I o ~ co d ei Z W O I m O o ~ ~ ~ I ~ C W (D ~ a. N Z ~ ~ N ~ ~ I o. I I I m a ~ n 0 0 I ~ v I ~ o I F• ~ ~ N f $ I ~ I O p ~ O L C~mO 3~n d ~ 3 o ~ f'f ~ A `~1 rt l ~ ~ ~ ~ ~ C ~ ~' • ~ ~ ~ d ~ ~ '- ~ ~ O 0 0 3 - _ C V N • N ~ ~ d N Q ~O :. y ~ W 0 ~ ~ O `O O ~ c K 3 ~ a ~ ° ~ ~ o °° °o H N ~ -w O O "~ ~ a ~ a a c OD W N s O fi ~ t0 ~ J r ( ~ N M C !~ ~ 3 ~ ~ _o ~ r. • , d Ul fA UJ ~ t~D H N f w 3 .°-', v, m e~ M N N Z ~ Z ~ O D Q ~ m ~ ~• m y N ~ ~ C fOD ~ d c ~' Z ~ C ~A r* A a (? 7 ti m ~ ~ ~ a ~ ' B z p ~ o o :' ~ -' H Z r (D ? C a A ~,e O O O~ A t ti O N O O H N d0 `,NO ~ ~ ~ O APPLICATION FOR SANITARY PERMIT STC-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/contractor, ("spec house"), then a second form should be retained and completed when the property is s~ • • - ---~--•~---~ •.. ~t,~e nff{ro mtth the anoronriate deed recording. ~ La1LHR SANITARY PERMIT APPLICATION COUNTY ~.~~~: In accord with ILHR 83.05, Wis. Adm. Code ~~ STATE SANIT RY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ~~ $~ X 11 Inches In SIZe. STATE PLAN I.D. NUMBER -See reverse side for instructions for completing this application. I. APPLICANT INFORMATION - at FeCF oriurT er r rucno.. wT~n.~ PETITION !~ ~ -' ---° - PROPERTY OWNER "-"' FUH vAHIANCE LJ YES ,1! J NO PROPERTY LOCATION ~y PROPnERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER B IVISION NAME ~-- CITY, STATE ZIP CODE PHONE NUMBER f ~ ~ ~~ -~ ~- ~ ~~ CITY N~~~ OA~E OR LANDMARK ~ VILLAGE : ~ ~ ~ ~~ d~ 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. New b. ^ Replacement c. ^ Replacement of d. ^ Reconnection of e. ^ Repair of an S ystem System Septic Tank Only an Existing System Existing System 2. ^ A Sanitary Permit was previousl issu d P it y e . erm # Date Issued 3. ^ An Existing System has been inspected and soil conditions meet minimum requirements. 4 ^ . The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a.~ Conventional b. ^ Alternative c. ^ Experimental 2. a. ^ System- b. ^ Holding c. ^ Pit Privy d. ^ Vault Privy e. ^ Mound f ^ IGP . In-Fill Tank Y. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. See a e Bed b. ^ See a e Trench c. ^ See a e Pit 2 PER OLATION RATE AB 3 . (Minutes per inch): . SORPTION AREA REQUIRED (Square Feet): 4. ABSORPTION AREA PROPOSED (Square Feet): 5. SYSTEM ELEVATION 6. WATER SUPPLY: G ~ ~/s~ ~7- ~ ~~`s ~- ~~ 7 /Feet Private ^ Joint ^ Public VI TANK CAPACITY . in allons Total # of prefab Site INFORMATION New xisting Gallons Tanks Manufacturer's Name . Concrete Con- Steel Fiber- glass plastic Exper. A Tanks Tanks structed pp. Se tic Tank or Holdin Tank OD 4.t:• % 3 ~r ® ^ Lift Pum Tank/Si hon Chamber ~ ~ ^ ^ ^ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamp-s)~ MP/MPRSW No.: Business Phone Number: ~ocr ~ /~ s~/v ti bra,, ~.~..~.~~<<., .,15.1„ ..~L ~,,, _ .~'l/~, ,c-d ~ ~ ~ -z u~ r~~ ., .. i ^ .i .. r i1 y ?7 fr ~~ `'.'~: t _. r -.. ... ... - .. ... _._ , $s:'Arc • i - - ' . .. ~ ~ • . - 3IIIlY'lTt0~t3 CZ31T'LFZC.kTS.: L, 3amso le• ttseah, Se~atrrad Wtatoeania Laad 3uxveyoz, 6axeby cwrtify to the beat of miy°p~vteeaiooal Imoel.d8e, aadereOtadtn8 asd ne11eL• TAas 2 Rato w~wryw~i, dSr~ded sad reagy+ad Ps:k Ytew £itstea;Fattsth Addition,. located it lb+u NSiI/1 et the SW !l4 aed tie N`y'!~ 4 0l the 5E1/4 a[ Sectloa' 17, ?29N, R l91l, Toaa.at Ho,deaa. 9t. CTSixCoaaty, Witcenrin; Thsl L httvw nettle each ausvey, land divinion sad pLxt h'y tis dlsartioe of Darzs3 C. 9fe:t sent Devszly..i. Wozt, ovseze o! eaid ia,ed, deeezibed so tolletn: CoemiaasatiaQ at.tis iCl~4 toznez of /eid Saction 17; tbeeeee 389.2,;.M8"W (alstttried bes:isOs retsseaeed 20 !be tttoaatnested TZA3'T-:I E3T 1 /4 3eedoa ilae ei`. 3ectioa 17, bassty ssaetnset[ SYt9°22'O8"1V) (z•oo:ded as 38it21140'^M oa fiat CeztlGt+d Snstey flap reo.ri+d:lea Yelrm+ lw Pssr 184). 1312,9it slarad aald EA37-W lST' 21t :3+edoe llawi ' t " r ' . titoteFiO Oi 30•M-227.TS tothe pedal r1 ~e~oa;a~ t3er-es N87~S2~30 IP :{12.OW: theaee." T{C'ob+3t/"S 122.041 m ti. Swsieziy ztsht-of-~w~sy lias of cs«a ui11 Lserr: ehraeo ?r~~"~a4a"w- a8.OC1 aloe; aid rrtt~~il~ot•rsy lase: theate 50'oh13o"!Ir as~.hot; !hbne• ~ 571r'361il2!'W 194.351; theme 589'151!4"N 2~6.7'tt; theaee Y7'rl7105"'w :12.171; theeee s89"25124"S't '!3d'.OOt;:iltere+ Nil'D6130"L 104.001:; tbeaee $8y/13114"Nr 3t4.DOti t~rnes _ .. NO°!vr30"E'lS3.041:titesao Sii`13t14"11t b6.0i11 thesaa SO'OW30"'1R 316,131: thsats . 38!"IStll"W~ 1ll.0ot;.t3eencs NO'371i1^X !d, ltt; 2hesee 889'22'09"yM"14l..50'1 theaee j 30~06s10~'X 2d4.fAj; ttv+ets N89'11114"1C 151.001; tssneo S~ON30"^it:31L.971i tJece:e I N8!'-lSsl4"TC-1'.la.QO~•th.ncs. Soatirrtarly b6.2S't alrnn~~ th- aza-of w:3d3.90t radfu• ~ curvw•eonca~e: Yortiesrte:l~r tubew chord bsars ~i'SOLSO"E 6iT17~: tluenca :Y6Y 11114"C ~ 57.0211 ti~es~ar3ottth.stterly.13b.341 aiona.tie at~C of: 3i7.001'rxdlae tarMe eoaeaw '; Nasthsstttez~r xhoea chord bess• 92A 03142")t: 2.311.511; thaau83b'23130'`: 14x,141; ihenes 1t71'3bt30"3: 160.%t; tbento N8l15~14"E?y43.001; eheaeo 90~0613W'H 108,001; thaw a83!36130"~ 259,161; theories SoutieaatezlT %.141 :lost t4~ sse et s 217.,01 ~, 1 " ' 1 . lb t: 45.3;e ; t3anee radSas~~titts^tis.vaoeave i~(ortLesotody, w&seo shord bens: 578 03 PiAll!tli~tll'3~• 920.041: lReaee SVeztRosstesIy 91 «t 11. a1es0 tAe aza'.ad a.300.f1t71 radius . es::+:sies~se-res lieztittrvtsslq weose'ehozd braze tt1p32140"L.94.8'S'f ti+stwe North. , wets`ip+92:4t1 slonet{~~ the axa of w 300.001 radluo esr.e eaaeaet Nasthesetnzl~r .Rose eRozdE bears Dl0'37K4"77 41,091; thet+.ee tt0"Obt30"E 1!0,001; tbenes Nty'lSrl4 470.tL3yy tkaato N1TOb1301'7C 834.Sb1 W.tbe pai..t of besieaJnp.. ' That avaf- plat is. a taszeet rapxeaexlatioa of sU the sxteriot booedel9ee of the Land wsreyod lead tRe etebdtvirioe thawed mad., led Tban L Roes dd1T eoaglisd with tLe provlsiona o! Cbsptez 236 M tha'F.fiea:onela StaOetse, tAs lsbdittof/ea reel Zesina IteXalltloeu of St. CzaLt: Cettaty, 2Se :outs ul ---~. 1ladeee. lwidlvtst1ra t?zdLmate. emi the G!!T e+t Hsdsoa Sntetllvteten sed 3/idtfa0 brAt- . ,.. _ ""- acres„ L -arrayltt0. tMvidieQ sed erapple.g the came. Dated this,.„ day of .dAbGd3~. 1984 ~' ' Sl R vlred t t llth do of April, 1984, -~ ~ s Z. ss R.L.~~'~ ~~ ~ 422 tEt:oed Strrot ~ ..., 84t'I lla~deoa, Wiscottsia 840ib ~ ~` ~ N ~ ~ CtWMTT ZA1<Altl2tIA13 CERTISrICATY ~ t+'?ATt OIP t'diSCt7NAIN) S3 ~~+ ST. CRGi]C COtIFtTY 2, iltay Jeaa i,ivermore, beln0 duly. elacMd, quolifisd and aa.i•e0 Srnaaeuer of 3t.. Csotz Gaomgr, do berrby certify ehst tho reeorde to my ofllee rito+v ar wredremed tax sslss sad so uupald taxes er epeainl alseoemeMr a of /~- J'/-dl s[teettat; tiv lstrts laalttdsd !n the PLtt of Ark Vlew lCetstea Tonrth Addtt»n, - ~ ~- P-1~ I ~s..n,./ . . Dsto y Trenesrrs . - ;+ , i ~ . I ;.' .~.~r.'` .~ - ' -.y ZOl41tiC C07~!?.t2'2'Rt:1- RY.DOLU721Jti TRie past ie hereby lppsered by the 5t. Croix County Comprahnn,rive Prrkt, I ?lsnoint a nd ZonlnB Gommit<ee, J/ YJ 1• _.L.'., t~~rY.3 2'lrlt•4f N':!'~'7~a ~ e~ Ult r ~ GfLSIy"ft~ ~ is 41~ ~ .. f~i!fY_ ~.- - Date Adtnlni trt rator ~: • ~ .~ t£sISTf~'t ~ii1~ ~ .. ~~,.. ~---.. . y`. _ .. 'i y,: ra~~K ~r~r ~~~1 T~`~Ea F~~~JR~-f • ADDIT~~N ;~ r~ ' AC SV~wIVtS~CI+} ~.CCAT~?• 1M~ 7NE ^~~--S~tJ~4 ~ IvWIk-S£i~i, 5cC77CN !7, . 9(~ , R19tN. , rcA~rN ~.v, ~' cox c.~wtvrY, vr9~ca~, , . t~ -. -, 3 - - ~ ~ ~ '-NY. , CS..tT2TLCA7. JT 7O'MNT3tLISQltZR SZATx Of 7/?3GCN~.Y} SS., ~T.- C7tOtS COt,t'~'~1'Y I', Heeesly A. 3oMaoas. bbfaR the ,3sty efecied+ qualitiad'aad acting Tmro Trtasures aF tke Town of iittdroa, do hsrebY caa'tity that in secozdaac• rorarda !a my offiu, t3e=e ar• tao unpaid tsatp oz ayeefai- aaeeasraenta ra of ..''... on aay land lawltri~ is she Pict of Pazk Vtas =atstao Fourth Addition. - ~` ~' ~.S y • Beverly . „ohna own reararer TOt-!f BOARD RrSOLi+T1ON R^a.SOLVED, that the hlst of Pazk Vl.w Estates ~'ottzth Addition in the Town of Itndson, P.acrel ~, Wart and $evs A, Wert, nwners, is hereby approvrd by the - La • •~pt ~S otovtd aawnC •-rma~--n, . D igned owo t.rutrrttan 1 aerebv ea.-tity that the for.goinq is a copy o! :, raaulutSon adopted by Lha Town board al the !own of t'ludwa. ~ .• Dt a ~" o~-n Clesk O1M:1lAS+ Ce'RTISLCATE OA DEDICATION As owners, we hereby urtify that we eavaed the Land ducribed on thi: flat to be iurvsyaE, ~:•.-idad. rrappad sad doddte><ted as rapra+ent.,d on tbls Pial.. Wa alsra certify that t`Ss F1et is :squired by S, 23b, i0 or 5, 230, 12 to Ge aubmStted to tier loStuwinR Eor apptor+l or objection: Drpa:trraaet t.J Developattead liewtrtmrnt of Industry, Labor and F{umaa Relatia•ta, Town of Fludson, CIq of Hndron and St, Croix County, W;T!v~SS the luau and real of said ownerr tirJr_~-.-t day of ,-.,r~~t• ~t , ~~ -, G fl.v.rly ~,. wer STAT£ OE WfSCONSIN ) ST, CROLX COUNTY ) J3 laaraonally came before me thir .'~• ~° daY of ~~ ='ti, r-' ' '' ___, the ahoy narasd Darrel E, `Xer! +nd Beverly A, Wert, to me anown to be the perecns wfto exscutrd the fo:egoinR instrument sad aclatowiedged the same, Notary Publle r'~' i..i.. ~ „~, , Wiuonain My eommfaalon expires . ~ ~'~~ J r btar~Rtech, \`otary ?ttblfe ~','-`C)C'iiTIFTCATE OF' TOSYN CLERK- ±'-.S'TATLr OF Wf5CON9IN) _ )~~ . ~,:~51; CROIX COUNTY ) I, Rtu ;iarnr, befa{I the duly appointed, gttaiitfed and aetlnF Toon Clerk of the 'Town o! L.+:•dson, do harebj ce,]~ il_lyy that copie of this Plat were forwarded as required by a. 23b. !2 on tMaZ,,r° day of ~ 1984, and that within the Z~•day Itrnit ref i-y e, 23b: f2 (7} {no ob}ecti n.b to the plat have been filed) (all n%+}+.ainns to •h.~ pist have b~.n met}, II f ! i ~. j Date ilft Nornr, Town Glerk STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~' ~Jj /i/,~~~~ ROUTE/BOX NUMBER~~~ ,~oX~~~L-- Fire Number - CITY/STATE~4gS4!? ~.~ .S~/f ~L ZIP .~ye~y PROPERTY LOCATION:, ~~, Section, T~N, R-~--~~" Town of~k'~p~t - St . Croix County, Subdivision/,~l/~ttJ~/a/s.1JL--_ , Lot number1o/ Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents m_~ a maximum of 60% of the cost of which was in operation prior to accepted this program in August owners of all new systems agree maintained. be eligible to replacement o July 1, 1978. of 1980, with to keep their receive a grant for f a failing system, St. Croix County the requirement that systems properly The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year. expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County 'Coning Office within 30 days of the three year expiration date. a SIGNE ~ w DATE ~ " St. Croix County Zoning Office P.0. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 H z H a r r a H N 0 z d a H r~ H 0 E z x H ro Sign, date and return to above address. ,OEPARTMEN"( Uh ` _ INDUSTRY, LABOR AND ~?UMAN~RELA7IQNS 1'f. C/'o;K I S~ 1SE N0. BI ~esidence iATING: S= Site suitable for REf~I~RT a~ ~C?IL R+~RIIVGS AI~L~ ~'ER~OLAT"IOIV TES~'~ ~~.15) (H63.09(1- & Chapter 145.045) f~ U=Site unsuitable for system IN-G(RO~UN~D~PR j ~S SST ~J ~Ei{II 1 LJ New ^Replace 'v: ~ ~ ~p If Percolation Tests are NOT rec(uired DESIGN RATE: ff any portion of the tested area is in the under s.H63.09(51(bi, indicate: LFloodplain, indicate Floodplain elevation: ~~~ PRL)FILE DESCRIPTIONS BORING NUMBER TOTA DEPTH LEVAT I ON P H T R UN gSERV D DWATER.I~AiCHSS H E CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, ANO DEPTH TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.I ,, 11 / ~ +~ e- ~- . a ~ v.~~ ~l ' ~ ~ o' Y r~~-t s , ~ si a - /~ ~ ~- . , B- ,d ~ ~~r~,~ ~ ,~ ~ A ~ , , s i / s. ~ ~: PERCOLATION TESTS NUMBER DEPTH• WATER IN HOLE AFTER SWELLING TEST TIME IN D O WA E V - N H RA E INU ES P- ~ ~ TERVAL-MIN. I PER INCH `. ~""" ~ P- ~ t? ' P- o ~. 6 ~ . P- 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 horn zontal end vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the directi n d rcent of land slope. SYSTEM ELEVATICDN . 7 ' ~/ ~~ ~Y`~ e~~s '' ~ - - - ~` ~ i ~~ r ~ ,~~. 3s~ ,~1 ~3. _ .., ~;~ ~~} ~~ ... ~ _B'~ Up3~~~ ~ ~ ~'~ ~~Pli ~' A SAt=ETY & BtJlLD4idG 131V 1$1C3N P.Q. E#OX 79~i;1 MAOIS!ON, W 153707 DATES OBSERVA IONS MADE ~tt~ICE-6E~Z`i'i71s1TpF1 : O~C.A`FiQN~E TS: ~ilti-.(Ar-~'t ' s~ ~~.. iECOMMENDED SYSTEMaeotienall _ "~~"'-1 ,iJl ~ iB.M. ~`j ~ i~~r-fr ,~--,~,.~. ~~`' t~raL~tC"sA- ~~ ~Q~ Q~ ~ 6or~~ f~~ ~~ TH ~ ~~-~s ~ ~-~.s t ,~, ~~_ y~ ~,~ ,~ ~ Ju ~ ~~4~~ ~¢rc~1 ~ ~,_ ,~r- ~!/ ~ v~ ~'t ~ s~o~'~' . ~. 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