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020-1166-30-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Gerard, Jose h & Me an Hudson, Town of ;ST BM Elev: Insp. BM Elev: BM DQescri tion: / /^/ TANK INFORMATION EVATION DATA TYPE MANUFACTURER CAPACITY Septic °- ~~,~4~s r•s z~ ~ Q, Aeration / ~7e~Jf ~''~ ~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic r Dosing $ S ~ / ~ /~ ~ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Hea T H Ft Forcemain Length " - Dist. to Well C(lll ~RS(1RPTIAN SYSTEM county: St. Croix Sanitary Permit No: 514913 0 State Plan ID No: Parcel Tax No: 020-1166-30-000 Section/Town/Range/Map No: 17.29.19.1023 STATION BS HI FS ELEV. Benchmark ~• ~~ ~ i~ • U /aa Alt. BM Z ~~ Bldg. Sewer t SUHt Inlet ~ sv `du~ (, . z 9 .3 j ° s,., ~ • 73 9~ • 3z ~~. 6~ ~ . z 9g . 3 Header/Man. Q ,L q J 1 Y cf5 • ci, Dist. Pipe 4 g. 9,L. ~~ Bot. System 9 • ~ R y p O Final Grade S _S'~ X9.9 Z St Cover C a ~ • ~q / ole~ e~ Zlal auk- 7.15 c!7• BED/TRENCH DIMENSIONS Width / 3 Length / ~~ No. Of Trenches /{ 1 ('ems / v PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ~~ SETBACK INFORMATION SYSTEM TO P/L BL DG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer:~~ i ~' ~! It~fs TYp~f ~vm L / ~ ~ I S~ ~ ~ ]~ UNIT Model Number: Ou ,~ / (IICTRIRIITICIN SYSTEM Header/Manifold ~~ Q Length ~ (1 Dia ~ Distribution Pipe(s) \ ~~ ` Length Dia Spacing x Hole Size ~- x Hole Spacing '---__ Vent to Air t 3! O SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Bed/Trench Center ~ ~ , Depth Over Bed/Trench Edges - ` xx Depth of Topsoil ` xx Seeded/Sodded ~~ No xx Mulched s l J No ~ es COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /_ Location: 940 Wert Road Hudson, WI 54016 (NE 1/4 SW 1/4 17 T29N R1'97W) Park View Estates IV Lot 106 Parcel No: 17.29.19.1023 1.)AItBM Description = ~, ~oJ~'_ ~(~ C.~tJt~., ~'~- ~~ ~ r'~ / ~~'~~~ 2.) Bldg sewer length = / ; ~~~ -amount of cover = ~ Plan revision Required? ~ Yes {No ~ ~ ,.~,1 Use other side for additional information. ~O Date Insepctor's Sign e SBD-6710 (R.3/97) Cert. No. C0111171@rCe.Wi.gOV Safety and Buildings Division County ~ ] ~ t ~I ~ ~ 201 W. Washington Ave., P.O. Box 7162 ' ~ t ~O ~ ~ ~ ~ Madison, W 153707-7162 S'(~~ry Permit N ~ ber (toe fille in by Co.) 1 Department of Commerce 1 Sanitary Permit Application star nsaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the approp g ental /~ unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Pro'ect Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary u oses in accordance with the Privac Law, s. 15.04(1 (m , Stats. ~~~ 1. A lication Information -Please Print All Information Properly Owner's Name L J Parcel # a- ~ ~N • ~ as v~o- / --.3v~~ Property Owner's Marlin Address 1~D W-e v 1Z d Property Location ~ /O Z > Db Govt. Lot City, State Zip Code Phone Number ~~ /<,S ~ /., Section ~y ao ~ ~ SSG, s40) (p ^~ l~~ 3 •'I~t~.3 Tao (circle on E or~V N; R ~ 11. Type of Building (check all that apply) Lo _ ~I or 2 Family Dwelling - Number of Bedrooms ~~ V ~ v Subdivision Name ~ ~ ~ ~ ~S ~~~ o ~ . . ~f r ^ Public/Commercial -Describe Use ~1 ^ City of p ^ State Owned -Describe Use ~I~l. o ~ LO SM Nu fiber ^ Village of ~ t ~. w Zbt•20+'Zb ST. CROI COU TY Town of 1dOSQA1 1[[. Type of Permit: (C eck only one box o line AZ icable) A. ^ New System (Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued ~ Before Expiration Owner _ r IV. T e of POWTS S stem/Com onenUDevice: 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(I'reatment Area Information: Design Flow (gpd) Design Soil Ap lication te(gpdst) •••~ r ( Dispersal 1 a Required ) Dispersal Area Proposed~ s i S~ste~Elevation~ / S t 1 Co 0 U ~ ) d U~ ~ l . D + J VL Tank Info Capacity in Total # of Manufacturer o Gallons Gallons Units ~ ~ $ New Tanks Existing Tanks ~ ~ ~~/ / / y c d ~ ~ ~ "~ ' `~ a ~t~~ _~ "`t•~ n. v iii u~ rn w C7 Septic or Nolding Tank ~~~ Dosing Chamber ~ ~~, eli t- S VII. Responsibility Statement- [, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) ~~-~ ~~ok~ Plu a MP/MPRS Number aaa oy Business Phone Number ~1~s~381,-9a~o Plumber's Address ( reef, City, State, Zip Code) 1' S -~ ~ ~ ~ ~ J ~ v SuN `l 1JZ-- VIII. Count /De artm t Use Onl proved Disapproved Permit F /~ ~ $ Date Issu~ed~ ~ ~ e Issuing nt Signature i G R f ~ / d ~' " r r ven eason or I !/ ~~ ~npp~~ yy~~, IX. Condiggwvvtneasons for Disapproval ~ iiPP L t 7~ O effAte~tt filter and 3 ~ar`•vYG••.ti ~CJ ~ a tank ti S , c ep 1. / dispersal cell mtrsf all be seTVk:es'! Irtaitttsi!]4t1 ~~ ~ as per management plan provided by pktrrtbM. 9 2. AU setback tsquirernents Irltlst be trtti~inhittsd ' ' Attach to complete plans for the system and submit to tlce County only on paper not less than 8 t/2 x I 1 inches in size SBD-6398 (R. 01/07) Valid thru 01/09 a a t~ me ~ds~ r~ ~ m~ AN G~~p~~ rm I~ u ~e g mees ~ LUca~ion ~~~a.~v',~ew ~~~~5 y}~ ~ada~ ~ > > 9 y b w-~~~ ~o~b G, G e use a!~1d qo ~ Q~TI~,~ V~~v e l~bb~r ~~ ~~~ ~ ~ i~ ,a, ~ C3c~,Q~~~,,, u~2 ~)f ,~ Q t ~~/\ sAe~ ,~~~ a 4 ~ ~ a~ ~~$°~ c. w~~-~~~n r33 ~ ~~~~ t~r~+~K.~ Raj ~'~ IG~S~ Sib jN,g ;7.5`. 3 T~ti~~ S 3x b f$n 1 rz.c-c:1~ --~ V i AI fi ~tNC~, ~+~~,~. V~ ~ ~ ~~~ 1 ~(~,U ~CQPY a a ~1e ~os~ r~ ~- rn~9 AN G-~~~~.n T' M 1~ouMees~er La-.a.~~on ~~AR~-V IOW ~,{~'~4S ~t~ ~d~ ~ 9~b W ~~ Rob G ~ ~I.se ~~dqo~ ~i t ~N~~m~~.k awTl~~, Vn`v ~ ~r ~, ~ tp~ Sgs~'cr.~ v s~,a 7~~ I~~~y~~ is ~ w[~ol~n y Qid~uv-~ ~vrn~ , at) f X33 ~,~zl r~~~1.K- R~vz,, 3 Tn~ ti ~~" ~G4NS'~ S-b j-v L~ S ~ SS-i~ rre..~~ ~ )~ ~ ~ f ~3U. v 3 x b ~Q~~ ~ ~~ ~® c1,~M~e r~ f ^ = Baran ~-~~-e .f ~n 1n.~.c,~ ---,-~ w _---, rf, 2127 Wisconsin Department of Commerce SCa~L EVALUATION REPORT Page 1 of 3 Division of Safety and $ulldingS in accordance wish Comm t35, Wis. Adm. Code A.C.E. Soli 8 Site Evaluations County Attach complete site plan on paper not less than 8%: x 11 # in size. ust St. Croix inducts, txrt not limited to: vertical and honzor>tat reference point {BMj, and percent slope, scale or dRr>amsions, rarth arrair, and k+cation and d' Parcel I.D. 0-1166-30-000 Please print all inforrnatlon. R awed ~' Date ^ / U Pefsnnat inkxmatim uni movicln may ha uceti fro earnrviarv nvmaac IPriunrv 1 sw c 1 S M (11 /m 1 i i / X J V~/•~/VV/ ~ / r Property Owner PropeAy Location Joseph L. & M an J. Gerard Govt. ~ NE 114 SW 1/4 S 17 T 29 N R 19 W Property Owner's Mailing Address JUN 1 ~ 2008 Lot # stock # Subs. Name or csM# 940 Wert Raod 106 Park View Estates 4Th Addition Cily St to Z~~~~(~I~°~b>v'rY'r _j City _J Vllage ~ Town Nearest Road Wudson i I 54061 G ~~5 7-142 Wudson Wert Road 8~ Brookwood Drive J New Construction Use: ~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPO ~} Replacement _1 Public or commercial -Describe: Parent material Gfacial Outwash Fio atio , ' ppiicable Na General comments and recommendations: Site suitable for replacement conventional dispersal 11 with 0.5 pd/sq.ft loading r e. Installll tre at 95.50'. Existing dispersal cell elevatoin =96.26'. Boring # .J Boring ~ Pit Ground Surtace elev. 99.34 fl. Depth to timRing factor >99° in. Soy gppi Rye Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots !R* in. Mansell Qu. Sz. Cont. Color Gr, Sz, Sh. *Ef[#1 ff#2 1 0-5 10yr3/2 none 1 2fgr mvfr cs 2vf,f O.S 0.8 2 5-14 10yr4/4 none sl 1 msbk mvfr cw 2vf,fm 0.6 1.0 3 14-20 7.5yr414 none Is 0 sg mf cw 2vf,fm 0.5 1.0 4 20-27 7.5yr4/6 none cos & gr 1 0 sg ml aw 1vff 0.7 1.6 5 27-36 10yr4l6 none s Osg mi gw - 0.7 1.6 6 36-99 10yr5/6 none s Osg ml - - 0.7 1.6 orizon displays a high clay intent. Loading rate adjusted t re ed reduced permiabr it)r of horizon associated with high day content. o~ring# uj Boring ~ Pit Ground Surface elev. 98.01 fl. Depth to limiting factor ~92~~ in. SoM AppficaUon Rate Horizon Depth Dominant Cobr Redox Descriptan Texture Stnx~ure Consistence Boundary Roots GP D in. Mansell Qu. Sz, CoM. Color Gr. Sz. Sh. "'Eff#1 *E 1 0-14 10yr312 none 1 2fgr mvfr Cs 2f,1mc 0.6 0.8 2 1422 10yr414 none sl 1msbk mvir cw 1fmc 0.6 1.0 3 22-27 7.5yr4/4 none cos & gr 0 sg mi cw 1fm 0.5 1.0 4 27-36 7.5yr4/6 none Is 0 sg mf aw 1f 0.7 1.6 5 36-50 10yr4/6 none Osg ml gw 1fm 0.7 1.6 6 50-86 10yr5/6 non t~ s Osg ml iw 1fm 0.7 1.6 Horizon #3 displays a high day con t. Loading rate j tad rafted reduced pertniability of horizon assodated with hig day content. 7 w Z contains ii regular, discontinou f 10yr4/61fs. * Effluent #1 = BODS> 30 < 220 mg/L TSS >30 ~_ 1 mglL Effluent #2 = 8Qb < 30 mg/L and TSS < 30 mg/L CST Name {Please Print) Signatu CST Number James K. Thompson '~..~..------ 3602 Address A.C.E. Solt ~ Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake lane, Osseo a. WI 54020 6/9/2008 715-24s-n67 Property Owner Joseph L. & Megan ]. Gerard Parcel !D # 020-1166-30-000 Page 2 of 3 Boring # :-1 Boring Pit Ground Surface elev. 99.33 ft. Depth to limiting factor >97" in. ~ Application R~ Horizon Depth Dominant Caior Redox Desrxiption Texture Stnx~ure Consistence Boundary Roots in. Muns®N Qu. Sz. CoM. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-15 1gyr3/2 none 1 2fgr mvfr cs 2vf,fm 0.8 0.8 2 15-28 10yr4/4 none sl 1 msbk mvfr cw 2vf1 fm 0.6 1.0 3 26-36 7.5yr4/4 none Is 0 sg ml cw 1 vf,fm 0.5 1.0 4 36-44 7.5yr4/6 none tcos & g 0 sg ml aw 1vf,f 0.7 1.6 5 44-58 10yr4/B none s Osg ml gw - 0.7 1.6 6 58-97 10yr5/6 none s Osg ml - - 0.7 1.8 Horiaon #3 displays a high clay content and approx. 30% gravel. Loading rate adjusted to reflect reduced permiability of horiaon associated with high clay content. ^ Boring # _I Boring _J Pit Ground Surface elev. ft. Depth to limiting factor m, ~~ ~ Rers Horizon Depth Dominant Color Redox De~xiption Texture Stnidure Consistence Boundary Roots in. MunseN Qu. Sz. Cont. Color Gr. Sz. Sh, *Eff#1 *Eft#2 Boring # --1 Boring J Pit Ground Surface elev. it. Depth to limiting factor in. ~ Applic~ion Rate Horzon Depth Dominant Color Redox Description Texture Stnicture Consistence Boundary Rood in. Mansell Qu Sa. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mgtL and T5S >30 < 150 mg/L * Effluent #2 = BODS ` 30 mg/L and T5S <_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 b08-266-3151 or TTY 608-264-8777. SBi.I-833o (R.o?roc) A.C.E. $dl & Sipe Ev~agons 2127 wrsaonsin Department of Comrtteroe SOIL EVALUATION REPORT p~ t of .3 Division of Safety and t3uNdings ac.E. SoN 8 She EraluAtiens in aceordanae with Comm 85, Wis. Adm. Cade Coungl AtmrJr oompfate alts also on paper not has dean HYS:1, Inatee in s a~ ~ St. Crobe irrdude, but not UmNed hx Vertlr~l and f+ortaoMel retererr= pokK lfl ), Parcel I.p. Pad ~Da. stela dr direnabrs, noAh snow, and Iarirdorr and distance m nearest toed. 020-11 t~-30-000 p/eaae print all felormstlon. ptevieWed By Date r+eraond kAorrtation you p~ovlda may m used b wormy purpaeea lPi"iac-' ~"'. €,5.tM (1J (m))• Properly Owner ~PeM l.ocadon Jos h L. & M an J. Gerard t3o+A. lot NE 1/4 SW 114 S 17 T 29 N R 19 W , Property Owners MalYng Address Lot # aleck S Subd. Name or CSMrI- 940 Wert Rand 106 Park View Estates 4Th Addition CKy Stale Zip Code Phone Number J City .J Vlllaps jQ Town Nearest Road Hudson (WI 54016 (775) 377.1423 Hudson Wert Road & Bneokwood Orive ~,J New Construodon ~~ i~ Residendal /Number of bedrooms 4 Coda darined desrBrt flew rate ~ 600 GPD !d Repleoement _„~ Public or commerrlat - t]eecrlde: Parem malarial Glacit3l Outwash Flood plain elevation, N appli~ble Na_~ General comments and reeommendetbns: Site suitable for replacement conventional dispersal call With 0.5 gpd/gq.it loading rate. Install trenches at 95.50'. Existing dispersal cell elevatan ~+ 96.2s'. ~ ~ Bork~g e J Boring - ..l ~/ Pit Ground Suttees ekv. 99 ft. Depth to Ilrftitiry factor ~~„ in. pplYalion SoN A ~ Raritan Depth QortanarA Cobr Redo= Dea~xiptlon Testate Struduit: Consbteroa fjoundary Roals "Efr~tkl " ~ ~ AlurroeY in Qu. St. Card. Cobr Or. Sz. SA. 1 . 0-5 10yfJ/2 none I 2fgr mutt cs 2vf.f 0.6 0.8 2 5.14 10yr4/4 none sl 1 msbk mutt car 2vF,fm 0.6 1.0 3 1420 7.5yra/4 none is 0 sg ml cw zvf,fm O.S 1.0 4 20-27 7.5yr4/e none os & gr 0 $9 m1 aw 1vff 0.7 1.t3 5 27-36 10yr4/B none s Osg ml gw - 0.7 1.6 6 3&99 10yr5i'6 none s Osg ml - soc - hig 0.7 ay conte 1.6 n n lays a h Clay con t Lo ng rate a tore d aced perm o neon as L.- J Boring 4 .J Boring " ~ Plt Groun4 Surtece elev. 8~,.b1,.,. it. 9 Depth to Ilmitin0 fador ~92~~_ in. SoN Atplir~rrien Ram Norizor'i D ColOt l~ Rede~l Dearrlplbn Tmdule S'hudurs Gr Sz ah Cotrelsterr9 8ourdary Road 1 ~~ ' 0u. Sz. Cant t;dor I . . 2tgr mutt ~ 2f,1mc o.s a.s 1 32 o-1a 10yr none 2 1422 10yra4 none s( lmsbk mutt cvv lfmc 0.6 1.0 3 22-27 7.5yr4/4 none g g 0 ~ ml cw 1fm 0.5 1.0 4 27-JB 7'.5yr4/t3 none 1s o sg m1 s:rr 1f 0.7 1.6 5 3650 10yr4/B none s Osg ml gw 1im 0.7 1.6 s Osg ml iw 1fm d.7 1.6 B 50.E 10y~/8 none 0 5 1.0 7 t36.92 10yr'S/6 none ~, silts 0 ug rttl - - . ~ > c eni41= GODS 30 _220 rttglL TSS >34 ~ 1 mpll Eftlue •#2 ~ BOD c_30 mg/L and TSS ='.~ rnglL Number CST Name (Please Print) nanure• ~ - ~_ 31302 James K. Thorrtpson Dale Evaluadpn Conauded Telephone Number Addroes A.C.B. Sofl S Site Evaluations _ • _ _ _ . _-- s/erZQgB 715.24&77'6 _ Took "IVA~ 8ZI5 '8 'IIO5 ~ ~ V i'9LL St~Z 5TL %~3 Tt:~9T Boot/TO/Lo .,~ ~ 1 ~ ~ i ~ ~ __ - ~,~,. - _~ s~~ _ __ , ~~ t-Shed ~~ i i~ ~~ / e4 ~ n~ ~ ~;~i ~r ~~~~p~ ~~Q ~~V~, ! ~0 _-~ - ~'° yi r- 1 --- /OD.d - '" /i '! -^'- h i ~ n E-leJ , Icy. D/.' ~ ~1 ~.~~ ctiwwl:w ~v~ a .. (S v~Eom o f /occ9~` S~ d ~ riq. Ass u, m ~d , Q ~e./.- ~ I~ ~. oyi ~E. B. v of'S. T. C/laVibrcf• .~ Q¢Slds~tO~ S fPU~ C'oie..ST. ~~ ~ara~e 8~a Jcl~inG ,~ , 90 AsPkal{ d~;/auar 5C1?/e: /=~s~~ 6 9~a ~t,~oa~ !S/ccd5oY7, try/. 5~a/~ Got /o(o P/a E of Pw'X'v'e~J Es tea-acs V «4dd.~ ~, nf~s~•Wi sec. ~ ~, ~ 24~r•, P~ *~ oxo-/!GG-3o-~ Qou.cf 8r'cd,c~c~/ ~. ~- _ 3 0~'.3 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to celrtif~y"that I have inspected the septic tank the ~0~ hd'c~1 ~uI,QAN o~~pY[a residence located at Sec. ~~ T ~r N, R ~ T W, Town of ~abSaN 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 ~ S ol,U a g Did flow back occur from absorption system? Yes No ~ (if no, skip next line. Approximate volume or length of time: gallons ~ minutes Capacity: (U~u ~~ / Construction: Prefab Concrete V Steel Other Manufacturer (if known) : -' W-~~~3xrK Age o f Tank ( i f known) : -' (Signat (Name)• Please Print 1'~1 ~ ~S aaa 4~~r -. _ (Title) (License Number) ~3~b (Date) 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 ~a~ ~~k~1.prQ' Signature MP/MPRS ~Za 0 presently serving St. Croix ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwuerBuyer ,, /o ~ ~ /~'~e opt n ~: Mailing Address Property Address (Verification required Planning & Zoning Department for new construction.) City/State ~ ~1 ~~ (,~~ Parcel Identification Number Q~(U -//~~.- ~p-~ LEGAL DESCRIPTION Property Location /(/l~'/4 , ~ y4 ,Sea ~~, T ~N R~W, Town of /~/1~~C~~f Subdivision~n~ I /,;~~~ s ~s~~ ~p c ~~~.~.~.'~:'. Lot # Certified Survey Map # ,Volume ,Page # Warranty Deed # ~~f ~~7 ,Volume /'~9~ ,Page # ~ Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Propet 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 nesponsibilides are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The ptapetty 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 leas than 1/3 full of sludge, Uwe, the undersigned have read '~, * ~ ~ _° .,~µ is and agree to maintain the private sewage dlap0~tl system with the standards set f y orth, herein, as set b the a and the Department of Natural Resources, Stye of Wisconsin. Certification stating that your septic system his ' ed must be completed and returned to the St. Croix County Planning & Zoningbepartment within 30 days of the three, ~,,, . `„y on date. ~ ~ ~~F -Uwe certify-That all statements on thtst fo ~ tfpy to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a watrAaty , . 1;ooprded in Register of Deeds Office. Number of bedrooms ~_ ,. ~, ~~ /~/~ SI NATURE OF APPLICANT S) ' DATE ***Any information that is misrepresented may ~n~be sanitary permit being revoked by the Planning & ?oztittg Department. *** F ti ,, ~`,;.'.` Include with this application a recorded warranty'dpgd foom the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/OS) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE fNFORMATION Owner OS~ ~R ~ Permit # DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ANA Estimated flow laverage) gal/day Design flow (peak), (Estimated x 1.5) U gal/day Soil Application Rate . ~ gal/day/ftZ Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) <30 mg/L Biochemical Oxygen Demand (BODS) <220 mg/L ^ NA Total Suspended Solids ITSS) <150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODS) <30 mg/L Total Suspended Solids ITSS) <_30 mg/L ^ NA Feca! Coliform (geometric mean) 5104 cfu/100m1 Maximum Effluent Particle Size %$ in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity (a(o ~ gal ^ NA Septic Tank Manufacturer 4Jt1 SDK rW-e~~1 ^ NA Effluent Filter Manufacture r (~s~' ^ NA Effluent Filter Model V /~ ^ NA Pump Tank Capacity gal ~ NA Pump Tank Manufacturer NA Pump. Manufacturer NA Pump Model NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: NA Dispersal Cellls) ®+In-Ground (gravity) ^ At-Grade ^ Drip-Line ~ ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Ins ect condition of tankls) p At least once ever y' ~1 « ^ month(s) .yearls) (Maximum 3 years) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dis ersal cell(s) p At least once ever y' ~ ^ month(s) (Maximum 3 ears) ]yearls) y ^ NA Clean effluent filter At least once every: 1 ^monthls) ) l ^ NA ~ year s Inspect pump, pump controls & alarm At least once every: ^ month(s) ^yearls- ^ NA Flush laterals and pressure test At least once every: ^monthls) ^ yearls) NA Other: At least once every: ^ month(s) ^ year(s) NA Other: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Seryicing .Operator. Tank inspections must include a visual inspection of the tankls- to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (%31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cellls-. If high concentrations are detected. have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) in one large dose, overloading the cellls) and may result in the backup or surface discharge of effluent. To +avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and sa'rely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify,.a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a Suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~}~, VAl~tw~ n Phone `71 S -3gL~9 U~ ~ SEPTAGE SERVICING OPERATOR (PUMPER) Name ~ p~,~ ~ ~ } Phone y~,S'- ~ ~a~~ POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Name S~ • (`.2p`~c }J~IV Phone 3~L i L ~U This document was drafted in compliance with chapter Comm 83.22121(b-11-(di&(f) and 83.54(1-, (2) & (3-, Wisconsin Administrative Code. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence.of painting. products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected. have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To tavoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback andlor soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to ideratify,.a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate,~a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name J 1~'r• ~64t~.tt Y1 Phone '7iS-3gti-9oa0 SEPTAGE SERVICING OPERATOR (PUMPER) Name ~ p~,~ ~ ~ Phone y ~,S'-~ ~a~~ POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Name S~ • C2pj~c )•.tohl Phone 3~~ i G 8~ This document was drafted in compliance with chapter Comm 83.22(21(b111)(d1&(fl and 83.54(1), (2) & (3-, Wisconsin Administrative Code. ~I~ 1.~~5pb~~5t~0 SPATE BAR OF WISCONSIN FORM 2 - 1998 pocument Number WARRANTY DEED This Deed, made between Juanita L Gerard a singLP rgrcnn uramor, conveys and warrants to Meaan J McAluine and Joseah L Gerard atxl June C C~-rard a~ ion nt t~nantG Grantee. Grantor, for a valuable consideration, conveys and warrants to Gratttee the following described real estate in St. Croix County, State of Wisconsin (The "Property"): /~ 61.9t,~7~ KATHLEEN N. WRLSH FtEGISTEk OF DEEDS sT. citnlx co. , wI RECEIVED FOR RECORD 03-15-2000 10:00 RM uaRRANTV DEEn EXEMPT N CERT COPY FEE: COPY FEE: TRANSFER FEE: 540.00 RECORDING FEE: 10.00 PAGES: 1 Na~m~e and~Return Address 9~ .~//~ D2U_1166-30 Farce! Identification Number (PIN) This is homestead property. Lot 106, Park View Estates Fourth Addition in the Town of Hudson, St. Croix County, Wisconsin. Exceptions to warranties: Easements, cestrietions and rights-of-way of record, if any. Dated this ---day of March. 2000. * uanita L. Gerard [,_ _~, `_-- ACKNOWLEI)GMFIVT AiTPIiENTICATION Signature(s) authenticated this day of March, 2000. * Krishna Ogland TITLE: MEMBER STATE $AR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) TIiIS INSTRUMENT WAS DRAFTED BY Attorney Krishna Ogland Hudson, WI 54016 STATE OF WISCONSIN ) ~ ) ss. County ) Personally came before the this~~~~ day of March, 2000, the above named Juanita L Gerard to me known to be the person(s) who executed the foregoing instrument and ac led tt~- '7 . rv + i' .i,. i1 ~~ Notary pu6fic,~State of Wiscdnsin 'on perrp~(If not, state expiration date: (Signanires may be authenticated or acknowledged. Both are not necessary.) ~~~~ F~~~}+i< •Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAB OF W ISCONStN FORM No. 2 - 19% INFORMATION PROFESSIONALS COMPANY FOND DU LAC, HNI BOn-655-2021 ~,~~~_ 1~?p~o~~ 4~0 QUIT CLAIM DEED This Deed, made between. Grantor(s) JUNE C. GERARD and, Grantee(s), JOSEPH L. GERARD AND MEGAN J. GERARD, HUSBAND AND WIFE WITNESSETH, That the said Grantor(s), for a valuable consideration conveys to Grantee(s) the following described real estate in S7 CROIX County, State of Wisconsin: LOT 106, PARK VIEW ESTATES FOURTH ADDITION IN THE TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN (SEAL) 020-1 166-30 PARCEL IDENTIFICATION NUMBER /1r0~ This is homestead property. Together with ali and singular the hereditaments and appurtenances thereunto belonging; And above named grantors warrant that the title is good, indefeasible in fee simple and free and clear of encumbrances except any easements, restrictions and reservations of record, municipal and zoning ordinances, and will warrant and defend same. Dated: JUNE„ ~ 2001 1 _ ~ _..~ _! ' . ry .~ h .z_n cil (SEAL) NE C. GERARD (SEAL) AUTHENTICATION Signature(s) authenticated: TITLE; MEMBER STATE BAR OF CONSIN Patricia Coates-Knutson Notary Public State of Wisconsin TH[S INSTRUMENT WAS DRAFTED BY: HUDSON, WISCONSIN 54016 (SEAL) /6~ 6497 37 KATHLEEN H. WALSH FiEGISTEF( OF DEEDS ST. CROTX CO.~ WI kECEIVED FOk RECORD 06-28-2001 10:45 AM QIIII CLAIM DEED EXEMPT M 8 CERT CDPY FEE: COPY FEE: TRRMSFER FEE• RECORDING FEE: 10.00 ~'AGEfi: 1 THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS ACKNOWLEDGMENT State of Wisconsin, ) } SS. ST CROIX County. ) Personally came before me on JUNE 2001 the above named JUNE C. GERARD to be known to be [he person(s) who executed the fore oing instrument and acknowledged the ame. j i (type or print) Notary 1'uhlic, ST CROIX County, Wisconsin. My c~missi/on is perma n[. (If not, state expiration date: Q ~ p ~ ~ c ~ b Q ~ c H ~ ~ .~ G\ . ~ ~ H z H ~ ~ 1 4 y ~ `v ~k ` ~e ~ ~ ~ d ~' ~ A i W N ° ~ ~~° ~ ~ ~' N rn Z d • ~ ca eS ~ ~ , ~ t'w ~ v {`ae~. a- ~ Q ~ , ~ C CA ~ ; ~' v n ~ 3 n d G ~ d eo _ 11 ~ t ~ y :: ~ ~ ~ ~ ~ ~ ~ ~ ~ o ~ ~~ ~~Z O y _ ~ I _ ~ O C V N C °C K 1j~- • N 7~ A N p y N IH c ~ O. n N O tD ~ O ~_ ' ~ ~ ~ C ~ 3 N N~ 7 O O~ ~ ~ tD ~ O O O O ~ ^ 1 \ O ~ N ' ~~ pp 7 W 0 ~ O b O O ~ Q !~ f~A N ~ w C fD i. - ~ I cn C D ~ a ~ m co x ~ C. o I ~~ N 3 a 0 W j~ a 0 o O O C ` r1 1 O L O ~ CO y O V _ W p O J ~ p ~ ~ N ~ o~ ~ 3 ~ I ~' _ 01 z 0 0 0° .. ~ • ~ ~: a= ~~~°' o~ l~l dq ~' ~~ ~ °'~. o' ~ ~ ~vv w ~ w C ~ 7 ~ ~--' ~ ~ ~1 i v _ 3 ~ m (~ 3 a ~ ~ ~ ~ ~, ~ y Z y ~ N O ~ o ~ ~~ ~ D ~ ~ ~ m N m y ~+• N N C I fD ~ N G ~ fD W ~ O. d Z ~ ~ 7 ~ ~ AZT I p - ~ ~ a C ~ ~ .~ I ~ . a A Z G1 I o .. I m~~ oov o, ~ ~ 3 ' z 'P ~ I c ',~ I ~ H ~ m 2 I I z w f _ ~ I ~ D _ Q I m ~- ~ I I O ~ N C I o o a ( ~ cn N I a _~ ~ I ~ F ~ A S ~ O O~ N O I ~ n I o b N I ~ I c o ~., a a ° ~ o ti COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 -962 - 5227 ST. CROIX ZONING ST. CROIX COIN~lTY COI~tTl~I~.lSE HIJD~AI, WI 54016 ATTN; THOMAS C. NELSON REPORT NO.i 0898/01 REPORT L1ATE. 8/07/91 DATE RECEI~D: 8/06/91 PAGE i S. k x ? i~ F OWNERS Bennis Price ~.~~ ~ ~ ~ LOCATIONS 940 Wert Rd.,Hudaon ~~~ ~~~ ~, COLLECTORS M. ,lenkins ~;~ SOt~tCE OF SAMPLES Kitchen faucet COLIFORMS 0 /100 mt ~~" INTERPRfTATION2 Bacteriolo9icatly SAFE NITRATE-P!S 7 ppe Above 10 ppe exceeds the reconded Public Drinking Water Standard. Colifore Bacteria/100 a-l Nitrate-Nitrogen, mglL s.: LAB TECHNICIANS Pam Gane E WI Approved Lab No. 19 OF.~NDEPEI.pEN~ „y b _ Y d f j~+~~; O •~ v .," S Means "LESS THAP!" Deter#able Level Approved by! ~ ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 f, .. ~ - . ~i D ST. CROIX COUNTY ZONING OFFICE o' St. Croix County Courthouse ~~.~ ~"~- 6 I r 911 4th Street ~~,~p~~9' Hudson, WI 54016 f( ~ `ja'Y" U ~~~'~(~, ephone - ( 715) 386-4680 ~~ ~' ~ sr t . Cro~1c County Zoning Office offers the nd water inspections to Lending Institutions, v ~ private individuals. ~4~-a1 service of septic Realty Firms, and ~om~letion of this form is essential so that the property-..can be ocated. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING------------------------"'---FEE: $ 25.00 (For nitrates and coliform bacteria)FEE: $175.00 WATER TESTING (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE:. $25.00 (Determines if system is properly functioning at t m of inspection) n Property owner's name ~~ N I S ~" 2.1 G F Property owner's address Legal: Des ription --- 1/4 Town of ~,O S O k ~ Lot Color Subdivision 1?i PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET: Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry .may be gained. Firm or individual re uestin services: Telephone Number - REPORT TO BE SENT TO: _ Closing date Signature i su~~~~~ lire ~. ...~~_ ._ m BER7ELSEN-CUDD i~i~ .9.h Street South Hucson, 1N,sCOnsin 540?0 (6?2) 436-ca33 '® MLS Ew L-1708 COUNTRY ATMOSPHERE Tastefully decorated 4-bedroom split entry close to town. Spacious family room with fireplace, central air. PRICE: $109,.500.00 Lot Size S'~4FL 1.078 AC.I 1344 TFF 2300 Tax Yr 19s0-( S 2157.21 L C D i Approx Rm Size t~ Baths [ [ 1r~r' Sch gudson __ LR ~ JPJiB [ EB PARS St. Pa 's, DR D ~ ~ [ Dwshr [y] Disp. [~j,ig Bal. _ Kit V B 11' ' (~ Refrig_(Y] R60 ~J,tg T)'~e FR L C D 26x18' 2 (~ VAS f) R [Y] 0 A•,~g Ht 5 ~~hB M C D 14x13:8 (] C. 1~dtr [) C. Svdr.__ Avg Util S BR M C B 11x11 ('$ ~"Fell [~ Septic Fess Dale Ne o BR M C B 11x11 ['$ Frplcs [~ C. Air 5smt w o BR L C B 13x12' 8 3 Gar (~ GDO [~ Decac [ [Patio [) Rec Rm [Yl Ldr ~UFFI [) Y [N] I~ [ ] UKN Legal; Disclesu•e Lot 106 Parkview Estates atn aaa - n. Sattelite dish, shed, central vac_ Many features- tastefully decorated home- bar in FR exc1~7955 SB/C 2.8 - Lis;~•GEARHART/BERRY 'F'`t38G-8715_ 6rkr CENTURY 21 Bertelsen-Cudd_i;;! 230__ ,Fh3867 Directions: I-94 to Hudson Exit 1, left on St. Croix Street, left on Couaty A, left on Wert Road . Information is considered accurate but we accept no liability for error. Listing may be changed or withdrawn without notice. ~r~d'-:'zrerntrks ~f Cen`,:ry it Feet E tale Co~rz'~cn. Ee~uzl Ho•.ainr~ Cr ~,';ti;nit}' ~ E1.CHOFFICEJ51\DEPE~DE1'TLYC1ti~ED.4`~DCPERATED• ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Aug. 5, 1991 Arlan Henke, R.S. Commercial Testing Laboratory, Inc. P.O. Box 526 Colfax, WI 54730 Dear Mr. Henke: ~JJ~ ~ h - S ~r r~ C~ (d-zc.~ ~ c3~- , cis 1~ Enclosed you will find a water sample for VOC testing. Please see that the results are sent to our office as soon as you have received the results. Should you have any questions, feel free to contact this office. Si cerely, P A4a J enk ns Assistant Zoning Administrator cj ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Aug. 5, 1991 Sue Gearhart Century 21-Bertelsen-Cudd 706 19th St. S Hudson, WI 54016 Dear Ms. Gearhart: An inspection of the septic system on the property of Denis Price located at 940 Wert Rd., Hudson, WI was conducted on Aug. 5, 1991. 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. ' cerely, ~~ Mary Jenkins Assistant Zoning Administrator cj ~ ~ ~J~~~LSLC/ ~i~~Z~ Form - S T C - 104 s ` AS BUILT SANITARY SYSTEM REPORT OWNER ~~ ~ ~ ~ ~ ~~ TOWNS~TP s~ h SEC . ~~_ T ~N-R l W ADDRESS ~~ (bb7C~ 4~"2 ST. CROIX COUNTY, WISCONSIN ~t~~sa~ t,~ s~~i ~ SUBDIVISION-~y~~~~~~Q'~`g_~~ LOT j©CO LOT SIZE ~~~7~ ~CIe~S PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM '~ /~ ~~~ ~ ^4 - ,,, ~~~ ,~~~~ ~ ~ ,, `N M ~IOU9E, •~ ~~ ~~: a~X y ~ ~+ 1 ~ 0 ~,S -- ~ ~ ~~ ~~, I ~ • loatc..,~ bl - Z ~ ~` Zy ~ r 1i y CL lJ 0.\/ -._._.._._._.~ 7 I s INDLC TE NORTH ARROW BENCHMARK: Describe the vertical reference point used ~`~~•yn~-~; ~ ~ ~~~ Elevation of vertical reference point: = 1~~~ Q Proposed slope at site: .~~~~!~~~,/~ PUMP CHAMBER Manufacturer: /j/~ Liquid Capacity: Pump Model: ~r"~' Pump/Siphon Manufacturer: _ Elevation of inlet: Pump off switch elevation: Gallons per cycle: 1r Pump Size Alarm Manufacturer: Alarm Switch Type: ^ Number of feet from nearest property line: Front, O Side, O Rear,E j Ft. Number of feet from well: "`~~~"` Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed:~~~j~~~sQ~ Trench: ' Width: 1st ` Len~th:~~o~ Number of Lines:_~` Area Built: (pt ~~ Fill depth to top of pipe: ~ Z Number of feet from nearest property line: Front, O Side, Rear,O Ft.~c~ w Number of feet from well: ~© f ` Number of feet from building: ~ ~ (Include distances on plot plan). SEEPAGE PIT ' Size: --- Number of pits: Diameter: Liquid depths Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK ' Manufacturer: ~ ~ ~ Capacity: ~"' Number of rings used: Elevation of bottom of tank: r 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: Bottom of tank elevation: Front, O Side, O Rear, O Ft. Alarm Manufacturer: DEPA~FiTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING; LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS Dlvlslor P.O. B(iX 7969 BUREAU OF PLUMBIN( MAdISON~ WI 53707 " CONVENTIONAL ^ALTERNATIVE State Plan LD. Number: ^ Holding Tank ^ In-Ground Pressure ^ Mound (lf assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HO LDER~ INSPECTION DATE: Sam M-i.P,2etr. Ttcau.~ 8fcaofz Raad Hudson, G!T ~ aQ,. ~ ~ : d ~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELE V.. NE SGI Sec. 17 T29N-R19G1, C.(.ty a~ Hu.d3on,La~#106,PanFz V~.ew TV ~ /~:~~' Name of Plumber: MP/MPRSW No.: County Sanitary Permit Number- Dau S~Gvcabeen 5432 S~. Cna "x 54929 SEPTIC TANK/HOLDING TANK: ,~ - ~" MANUFACTURER: - LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: W ARNING LABEL LOCKING COVER ,p A I r~ r(, ~ ~~- q ~f, P ~t / ~ ~ ROVIDED: ^YES ^NO PROVIDED: ^YES ^NO BEDDING: VENT DIA.. ~ VENT MAIL: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESF ' ~ r ALARM: OM / r ~ LINE' ~ ~~ j `~ AI ~N~LSET: YES ^NO L-' ~ ^YES ^NO NEAREST I /` W i L DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ^YES ^NO ^YES ^NO ^YES ^NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESF (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) ^YES ^NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moistureat the depth of plowing LL~u,n+ DIAMErER MATERIAL AND MARKING or excavation. Ilf soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN f`fl1U\/C NITI[1lU At CVCTCM- ~ BED/TRENCH D MEN WIDTH: ~ ~ LENGTH- /' " ~ NO. OF TRENCH ~ DISTR. PIPE SPACING. / / COVER M TE IAI~~ ~ ' /I PIT INSIUE DIA.-. #PITS: LIQUID DEPTH: I SIONS >. {G (~ j[~ GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING. VENT TO FRESF BELOW P,IPF~S ' ABOVE COVER. N ELEV INLET 4~ . EL .END- ~ , ~r~~ ~ ' / ~y ~ PIPES ~ FEET FROM LINE ~ ' {mil .~ ~ 7 AIR IN T: ~ ~ r. ~) .S 7 ~ c NEAREST--s / i O '(, ` Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ^YES ^NO SOIL COVER TEXTURE: PERMANENT MARKERS. OBSERVATION WELLS ^YES ^NO ^YES ^NO DEPTH OVER TRENCH/BED DEPTH OVER TR ENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED: CENTER. EDGES: ^YES ^NO ^YES ^NO ^YES ^NO PRESSURIZED DISTRIRIITIDN SVSTFM~ WIDTH. LENGTH. LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: BED/,TRENCH TR ENCHES~ DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DIS~rRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES. DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY: COV ER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. ^YES ^NO ^YES ^NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ^YES ^ NO ^YES ^ NO NEAREST Sketch System on Reverse Side. DILHR SBD 6710 (R. 01/82) APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contracto..z,("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property ~ct,//y~ , ~~~ ~` Location of Property ~~ Sw '~, Section ~_, T ~ N - R ~_ W Township N G ~ ~ p, h Mailing Address _T/Qu~ ~ /po ~ c~ct ~~ ~8~~~ Z~2_ Subdivision Name ~qy ~ V ~ ~ c.~ ~ C~a~~. 5 Lot Number ~ ~Q 40 Previous Owner of Property ~af~'~) ~~~ Total Size of Parcel ~° (~~~ ~ ~~ ~~ . Date Parcel was Created /o~ /~-- ~/~ Are all corners and lot lines identifiable? ~` Yes No Is this property being developed for resale (spec house) ? rte--- Yes No Volume '~ S'" and Page Number ~~ as -recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OGINER CER7IFICA710N 1 (wel ce~.ti-by .th.cct aXX. a~atemen~ an ~th.vs ~anrn ane ~ic.ue ~a xhe be~s~ a~ my (aural hnaw.~edge; .that 1 I we) am I cute l .the awnelc 1 e) a ~ .the pna pe~ety de.~ e~r.%bed ~.n .th-ia ~,n~ah.ma~:%an ~anm, by v-vGtue a~ a wcVVcan~y deed neean.ded ~.n the Ob~~,ee ab the Couvtty Reg-u5~eh a~ ~eed~ cv5 Voeumen.~ Na. ;~ Z and ~ha~ 1 (we) pn.e~en~y awn the pnopobed bete ion ~h.e bewage pa~~5y~~tem (an I (we) have ab~a.ined an ea.6ement, ~o nun w-c.~th -the abave debcte.%b:ed pnape~y, ion the canbfiJ~.ueti.an ab bai.d by~5.tem, and .the game hay been du.~y neeanded ~,n the 0~~~.ce a~ .the Caun~y Reg.u.,~en a~ Deedb, a~ ~aeument No. ,3~~.f~Z ) . SURVEY4RtS [NF1tTIlTt;AT£ i, rm'e JC, Ruactt, Raelstersd Yiiacoailn Land Surveyor, hsseGy onrxify to the bast of ,icy pra(easional Icno~rl edge, uadar atat.aiing aad uella2' sAat 1 base sarv4yed. dindad and mapprd Park ti'ls5r F=*tate, f't+urth ~dditlon, located in the NSF/4 d the SW I i9 and the :~W i14 of the SE1/3 vt Section 17, 'ZL9N, R 19W , Town of Hudeoa, St. Croix County, tNiscoosin: That I haw roads such survey, iaad division tad plat by thn direction of Darrel E. wart and sev. °ly A-, Wert, owners of said land, described as tallows: Comm~aaiey~,at t5s S1/4 co:as: of said Seetiaa t7; thence S8q,.22tnA"W (aesumod baaziags xafesaasati.Letlr tnanumirntad EA37-WEST 114 Section lies of Section 17, beaxiaS aaant~ SH9'2.Zt68"M j {zacosded as SH9'2It40"W on that Gertiti~d Surrey Map . recorded to Volunua 14 Pago 284), l332.g8t along said EAST-w EST 1/4 Section line: thence SO'Obe3AMq 22:7,T3t to the pnini of bsgiaaia~g; theses N89'52t40'°W 412,00[; thence !QO.06'30",E 212,AOe to its SoutMrly right-of-way line of Green Mill Lans: theses N94'SLt40"W 66.OW along said ri;ht-ef-way lint; thanes SO~Obt30"'w 254.00[: tlieeee S79"F6t52"W I9d.35t; tlsaes 589'15[14"7[ 236,7d~: tMxs N75'57~05"W 142, I7t: thence S84'iR*14"W 538.00[; thsaas NO'06t30"S 104,00': thsses S89'15t14"W 300.00': thanes NO`06t30°E 155.00[; theac• 589'15'[4"W 66,01[; theses SO'Ob'30"W 310,03; throw S89'15e14"W 152.OW2 thoaee Np37R51" lt+ 54.1Ht; thaerca 589'22'09"W 145,30[; thanes SIC'Obt30"M 204,4N; tttssias N89'25'14"E 150,00[: tAenc• SO-06t30'"7Y SI2.97t: thence NB9' 151 l4"& 1b0.00ti fitness 5odheasterly 66.25[ siong the are of a 383,00' radfua curve eotteare I4oseLawaa+rly wAosa chord brass S4'S0tS0"E 6b. 171; theses N89'15°i4">: b7.Oil; thsstn-8wtasastsrly 136.Sbt along the arc of a 317,00[ radlw curve concave ?iostttaestssly aiOas sward bsass 324 09[02"E 135.51 : thence S3G23t30"S 143.141: theses NT1'36t30"L' l6P,96t: thsrue ~IS9'15~14"S 243,00+; thsoce SO'06t30..W 108,00[; thence Sb7'3$t3C"x 2154.Li+; tlaesls So:.Lheastar2y 9c,14t along the arc of a 217.OW raditts eoe++ ~q 2iotrtlwasferly whose chord trsasa ST8'03t16•'E 95.35[: ehsace N89.1Sr1b" ti 9iO,HMTtl~wes I4astltsadesly gi,21t atoag tba asc of a 300,OUt radius curve cowoaso Iters~weabezly whoes chord bears NHO'32t40"1= 90,85[; thanes North- r.e*i+rrly 91.44[ atsie~ tlu* era at a 308.00[ radius curve concave Nortl-eastsrl~ whose ::: tease 24g17t'LSl'rJ 91.04[: trues i+t0~06t3A"E 150,OOe: thsne• N89'15e14'S 418.05;: t].eaaa~ 2!lr-i16t30"'E H34.5bt to the paint. of neginaing. The! sr4leplat is a cosract reparesaatatiaa of aL the exteztor bouadarias of the Sand ruzwyeii eri tLa saDdirisioa t2ureoL made. and That L Aaw foIIy aomNi+d wttk tl,e Proviai~aas of Chapter 23f1 of the W iseonaia Statutes, tAs ~D~ieiow and Zoaiag Regulations of St. Croix County, the Town uE kudsaw SuOdivlMon Ordiaaya~c'e, end flu City of l;odsoo SuEdirieion aad Plattia; Ordi- sewers li ~Pdlrld..y aad Rlapplag till ra7ae• Dst+d tMa Is"~ dty at jk~F-Iirl! 1984 ~1 R vsaed t i l3tA st Apri1. 19P.4. case 2t. aesti - R. . T~"7b ~ Ru9W 421 3eeaad Strad ~ ~ lltxisaa, Miseeasia 54016 ~ ~~ ~ ... COUMT° TRE118tiR11ReS CERTIFICA?E j' STATE O& 79'18CO1~fSIN) ~ ~ S7. C2303X COUi4TY ) 1, Macy Jean Liwrmaza, being duly elected, quaiitied and actu+p Treasurer of St. Gralx Caaaty, do hezs~r crrtify that the reeurdr in my office show ao uaradremed tax raier and t.o unpaid taxer or special sasersmeat• tr ot_'1-..i-~3 ._,r._.s affecting the leads iuciudod in the flat of F'azk View Estate, }'ourxh Addition. Dente unty 7seaeurer ZOaiNC COIAMCI'?6,E RESOLUTION This piK is hereby approved by the 5t. Croix County Comprehensive Parks, . Pianaing aad xoning Committee. F ~. ~ 1_ ._ t` +ea..~'-ems .1~e C ~l s ~a. __ __ -- _ _ ~`?-.~s~---- _ Date A Amini strator _ •. tti~',lf+i':~3s:4~, ..a: yJ.. diYS .:`+. - 3a~'~;.._' -•:i.l.tiygpiM147f _ ...s~.....~...r..«-. ~. rs_ l` ~1a f ~ ~ 1 . • ~ Y . ~.4 ty~OVl J / -l .,. s ~ ._ .. A ~tUR~ ~3~G(`>nS,J~ ~.DCAfr~ !1! TNT +r~-S~r~tElt+iW~+-sEV,,ScGi~i~~J I"I, T29iV., Ft1JW, TD4VN 0~ Ht1D~J, ST GRCN?C COt1NTY, WlSGC?NSaN CER?iF;CATE OF'I01Y?V TREASURER S7A7'e. OF WLSCONSLti) SS ST. CROLX COUNTY ) 1, Pavarly A, Johnson, being the duly elected, gttalifiad and acting Town Treasurer of the To~xn of I-ludsor., do hreby certify that in accordance •+rtth__t~}e-regards Sa myoffice, there are ao unpaid taxaa or special aaaasaments as of _^yf [~ oh any i:nd included in tyre Tlat of Park Yiaw Eatatea Fouzth Addition, /// ~ a Neva-iy has own Treasurer TOWN HOARD RESOLUT20I` RESO.t_Y,ED, that the Plat of Park View Estates Fourth Addition in the Tovrn of }ludxon, l-'Etrrel F:. Wert and Bave A. Wart, owaezs,is hereby approved by the Town :ice rd La~ own h 'zman~r Signed own rman t hereby certify that the foregoing is a cop;% of a rasol,ttion adol,c rd bj thr lawn Board of the Iowa of Hudsoa, .r ::, i..,:,.~ .ti~_ _~.. i .. , Datte ' Town Clrrk OiYNiRSt f.,F~2T1E'1t;ATE OF DL~'D?CATION As ownera~ wa hartby certifyy that wa caused the )and daeeri;i<ad car, !+,:s Fiat to be surveyed, divided, mapped aad d+edirated at repre srnt«d an this }'I xt. W r al sc~ crrtit th:t.t this k'ls• ?s requirCd by S, 2'.6.10 ur S, 3h. [L to be ..+,:bm:ttrd to thu EolSowie:~ for rp,~roral oz o1>jectiont Daparttnent of Development I3epaz'.mert of industry, Labor and Hurr;an Ralationv, Town o[ Hndaon, City of Hudson and St, Croix County. MI[TNESS the hand and seal of said owners th+s - ~ day of f ,;,~ r~' "' ?n pp erenca of• //T/// r I)arrei er. .t !?everiy A. Wart STATE OF WISt;ONSlti ) SI. C;tO[X COU`1TY ) S` F'.zsor,alSy came before mr this, __ ~ day of !r . __. the at>umr nas-cte~i Uarre 1:., Wert and Bevezly A. Wert, to meknown to be thr_ peraor-,a who ezrcuied the foregoing instrtxmetat aad acluaowled¢rd the •ame. Nvtar}• Publicly' ~.. -r:.cL• .Wisconsin biy co:Tarniasion exprca.;,_~ ~,~!c~7 • ~~^~~~~~~~(~~~ !41ar: R.taeh,. Noear~• F:,taic c''EFi? iFTCAT ~- C1' TOWS C1 ~"i` R SS I, ?isa :•brne, being the duly apF'~i^ted, 9aatiEird :,r•! :acne;; ~I.,u:. Cic•zk ~.,. ,... 7u++n c: Hudson, do hereby ce tnfy Lhat copiev rf rhtb Plat ~u rc for ~~rrird t+ era t. it ~d ::y s. 1.30.12 on the ~_ day of - ... ___ I ~i, x ct ~ithir: ihe...fr_s,y !in'a ~r et i`Y e. 130. I.t (ij (n-, c,tyj,,ctihns t i.r F 'r ,.i., it n~ fall :, ;rrti.~nn-~o the plat ha~~r r,._r.n :nrci. c,. / ,i~;~ Rtt fFarne, Town C'Icri. STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~ }'' ~,,I~2/ ROUTE/BOX NUMBER~~~ ~ J`'~Qa' `~2 g 2- Fire Number /U!4 CITY / S T A T E _~_,_~ S n vl ~9 ;~ Z I P S .~~ ~ ~~ PROPERTY LOCATION:~~~4, ,SLtJ ~, Section~~, T~~N, R~W, Town of ~kd~ S© -1 St . Croix County, Subdivision,. Uie~~ Lot number /D~ 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 treaC- ment stage in the waste disposal system. St. Croix.County residents maw a maximum of 60% of the cost of which was in operation prior to accepted this program in August owners of all new stems 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 'toning Office within 30 days of the three year expiration date. SIGNED ~~[[~m~ o (/11Q,[~~ St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 DATE La~~Ie` ~'7' Sign, date and return to above address. DEPARTIVCENT+OF - INDUSTRY, LAE~OR ANU HUpJIAN RELATIONS REPORT ON SOIL BORINGS AND PERCOLATION TESTS (115) (H63.09(1) & Chapter 145.0451 SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, WI 53707 LOCATION: l/ ~/ s SECTION: 2 N/R/ i~ l /T OWNS IP LOTNO.: //0 BL~NO.: SUQ,pIVISIO~e ~r// a a k (or o C.c./ !! 66 TT COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: 1 ICF ~$esidence NO.BEDRMS.: ~ COMMERCIALD SCRIPTION: ~t /. ~lew ^Replace Soy/ ~~ RATING: S= Site suitable for system U= Site unsuitable for system DGL .C'-~ DATES OBSERVATIOfQS MADE PROFI DESCRIPTIONS: ER OLA ON TESTS: ~ /~ 6 / • ~ CO ((N~~VENTIONAL: !1y-S ^ U MOUND: ,,~ S ^ U IN-GROUND-PRESSURE: ~S ^ U SYSTEM-I~-F,1L ^ ~ ~ HOLDING TANK: ^ S ~U RE~COO~MMENDE/D SYSTEM:loptNOnal-/ (__Otctl~-1's ~~i~''~ ILL ~ ~ 36 ~ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(51(b1, indicate: ~(-~ Floodplain, indicate Floodplain elevation: ~° //l PR~IL~ DESCRIPTIONS BORING TOTAL/ D PTH T GROUN DWATER CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH LEVATION OBSERVED EST. HIGHES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- r ~~ ~.S ~ ¢~-. ~ dr ~3~~/egti~ S B.r S/ , ? Bsr S +~r., /.3 Bh s'~' B- ~- D . ~ xc.~ '7 r D ~/ 6 Ba s S: ,Bn S B- ~0 9P~ ~ ~'1o so ks B- ~ ~ ~ ~ 6 ~ /+rw /~ 4 i O ~ ~ ~ ~+l S ~ ~ l~h..f ~ . ~ h /.5~~'/ / .3 /4~ -S °~'r'y/ B- PERCOLATION TESTS TEST DEPTHS WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCH S RATE MINUTES NUMBER A i i6F}E$ AFTER SWELLING INTERVAL-MIN. PE IOD 1 PERIOD 2 P RI D PER INCH. P- / ~~ / 7.3 f ~ R !e7 L P- ~- 3~?` v 3 ~ G~ P- 1 P ~ ~. P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distan zontal and vertical elevation reference points and show their location on the plot plan. Show the surface a vation at all boring of land slope. ~/ ~~, . ~,~ ~40~ Y3~ ~i 6/S/ ~.rQh f~ SYSTEM ELEVATION ~f.~' ~~ s~'~ ~~r ~.-s~y~ ~eG~- ~~ ~ ~ ~_ __~- _- ~, , -~-_ ~ i ~ ~ p~ ?' ~ . ._ - _ - __ _ ~_W._. .~. ~_v _~ __ _e ~ ~_ _-- ~~- ._~ _ _ ~ ( . __ ~ ~_ L - ~ ~ ~ ~ i r I 3.- a. I' ( I i E t Q ~ .€ ~i i ` ` \ ~ ~ /~~'~~iG , 3 . l F I a ~ d ,_ ~ ` ~ t ~~ j [ i i ~ i 7 i ~ ~ I j _ ~ - ~ ~I -i I , ~i ~ t t i t I i { I ~ €, ~r ~ ~ ~ ~ _. ~ /1 ~ ~ ~S ~ ~ ~ I ! f ~~i ~o ,,__j ~ r /~J ~C' ~ ~ ~ ,~ i __ ~ __~ ~ ~ , _ ~~ r i 3 _.._.L .............c.,_..._._ .......r...__.._. ..... ,_..._ .._.. _ ..l_ ...._ ._ .. _._._ ,_._.__ ._,....._._._ ___'"_ B~ ~~ WA~I • :.. ~ _ ,...,._ ~.. /'/ ( G lY (~f a~/ ~ a / ~~ 0~ ~ s _ ;~ TN ~a + " •, r .. "~°t~F~~l®101 F~ "~~PLETIl11 C3RIVI 11 - SAC) ~Tc~ ~ ~ ! aecurate sail to _ ,; - repart must ir~clucle: ~ ti 1. ~o~~ipl, ue ::rit~Yion, 2. ~ e use s- `clearly indica' ~3ig is a ~; '=nce <3r e ; ,ial ,projectt; ,, ,, F ~R A NL!~tNG TANK ON L°( IF ALL e~. ~ y r ~ -~it~n~ '~ r~escriptions u~~t~ eon~pletir~g'the plot plan; ~ y ~~ ytions. Lrau~~inc~ to scale: is pre#erret~. A on ~~f ~I~°rt art; clearly shauvn, ar~ci are perrr~aner~t; ><; t<> tlat ~~ nan7ss, < ~ ~~ ,flood plain r3ata, percolatian test exernp- ~t:, p1 the app _ . x; - .-.. ... -.. ._3Y14-. i ,. ~' :. (L TEST B~ F(L~D 'ITN THE \ ~ _ __ ®~ -~~ ~~ '*i"~°,~5`°^S.^ -' APPLICATION FOR SANITARY PERMIT ~~ D ' L H R COUNTY ~ °EOfiRTmEI"IT °F {~~~ ~~~ UNIFORM SANITARY PERMIT # ~ 11"IDUSTRV,LRB°i76MUTRn pELFiT1°I-IS ~~f 9 a 9 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/Zx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS PRUPtRTY LUGA I IUN CITY: ~i 114 ItJ1 /4, S , T 2 N, R {or T H `~ ~ :• ~ v\ l~-) 15 c 4n 1(0 LOT NUMBER BLOCK NUMBER SUBDIVISION AME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ^ Public (Specify): THIS PERMIT IS FOR A: 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 Gallons #of Tanks Prefab. Concrete Site Constructed SteeV Fiberglass Plastic Septic Tank Capacity ~('0 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ^ Mound ^ In-Ground Pressure ~ / ~ Total Gallons #of Tanks Prefab. Concrete Site Constructed Steel Fiberglass Plastic Septic Tank Capacity !~ Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet1: PROPOSED (Square Feet): (,~ ~ Private ^ Joint ^ Public Signature of Issuing Agent: Fee: Date: ^ Disapproved ~. / / ~ (p !!7 '~ ~~ pL '~' ~O 7' Approved ^ Owner Given Initial Adverse Determination rseason ror ulsapprovai: Alternate coursels) of Action Available: DILHR-$BD-6398 (R. 5/82) DISTRIBUTION: Original to County; One Copy To; Bureau of Plumbing, Owner, Plumber COUNTY/DEPARTMENT USE ONLY 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(s1. 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. ., R. s 0 S R P ~- ~N s ~ L / ~~ ~ ~ ~ ~ x 0 c P - 5 E N --~ LO c r 0 c -d ~" P ~~ U~ ~ P _1' a ~_ s-~ ~ ~ ~ ~. ~_ o ~~ Q ~ R ~~ s o _ 5~ (~ v` Cd`~ ~- M c Y P ~" ~. P P '~ ~ ~ ~ -~ ~ ~ ~~,~~ __ ~. ~! ~~ w ~. ~ S N w ~- ~ . V\ ~_ ~ _~ . .. ~ I, I (ter/at~`•oKa~ ~cU C-~'z3~ $~ 81 Fo ~- *r~ 14009a~. , , ~~i ~f3 ~ ~ ~ ~ a ~ ~ ~ } ~ •~ l1~ ~-~ ~O ~,83 ~OG.S (i~ I ~ ~ y I ~~~ . +BS i0~- -Qla~ Vo~ra56 ~6 ~~Xro•~ ~ ~ ~ ~ ~ S.w.tof'terv-~~ , s o-fi , °_ / Spy- \I ~c 3 \I ~~.r k U% ~.~ Fsfi~.t~. s T.~ -~ ~' ~fi32 ~~.~~~d ScR. ~ a_ %yii_ ID d B, M. ~ s tta V~~-~-H~,; Z ~`~. ~e~ ~,t at r~~ s . W. Lot cor qav d k~o~ oft a- .~ .Zrd+h P ~p~ ~ Bo~~S~~k>,a~) `~. _ - r S ti: iQbl<. Aran Cv/3-S/ o ~ Sln~~ /Ilorlf'~ ~ , 1 ~ ~ ~ YNa ~ ~ G (,ct 'to b~ ~d ~ t ~ !/e-r 1'. ~Q~t'h Ids, q a: re,~i~ts /~~iaok ~oa~ ~f; vex .. . ST C- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~d...;,i ~ C ~ ; C 4:- ROUTE/BOX NUMBER ~ L`~ W~~r~ -~ ~ Fire Number CITY / S T A T E ~ ~,` \ ~ o ~ ~~ `,, ~ Z I P ~yQ / ~'® PROPERTY LOCATION:~~,.~~, Section,_~, TN, R~_W, . Town of~~~(o~ , St. Croix County, Subdivision~~~/,~ ~/~d-~L /1/ Lot number ~~ 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. St. Croix County Zoning Office P.0. Box 98~ Hammond, WI 54015" 715-796-2239 or 715-425-8363 SIGNED DATE H z H a r r 9 H H O z Sign, date and return to above address. ~. ~ 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/contractpr,("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property _ ~ ~~ ; S ~r ~ ~ ~ Location of Proprerty ~u ~_~ ~~ 1~, Section _ / ~7 , T ~ N - R ~ W . Township }~~i~l < eo v. _~~ Mailing Address ~ ( ~ "~ W ~~~ Subdivision Name ~~~~ k ~~, ~ ~ ~~ct °~~_ Lot Number ~ ~ Q (~ , Previous Owner of Property _ ~a f / ~ \ ~ ~~ Total Size of Parcel ~ a (~ ~) Date Parcel was Created S ~'2- dL ~ ~ ~f Are all corners and lot lines identifiable? -~ Yee No Is this property being developed for resale (spec house) ? Yee X No Volume ~~~~ and Page Number ~~ ~~ as recorded with the Register of Deede INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract .~, 3. Other recordings filed ,with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so ae to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. • PROPERTY OGINER CERTIFICATION i (wel eehti.~y #hat a~E e#a#emen#e on #hid bonm an.e xicue #o the bee# o~ my (oun) , hnow.ee•dge; .that I (we) am (ane) .the owneh. (e) 0 6 the pna penty dee eh,i.bed ~.n #hi.e ~,n~onma#i.on bonm, by v.ehtue ob a wa~.a.n#y deed neeonded ~.n .the 0~~~.ee o~ xJ~.e Coun#y Reg.e.e#en o~ Deede ae Uoeument No. ; and #hat I (we) pneeentey own the pnopoeed e.cte ion the eewage pob eye#em Ian i Iwe) have ob#ained an easement, #a nun with the above deee~u.bed pnopen#y, ban .the eone~.uati,on o~ eai.d sys#em, and .the same hae been du.ey neeonded ~.n the 066.iee o~ .the County Reg.ce#en o6 Deede. as Document No. ,~~ 7 S'S/Z ) . 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