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020-1172-80-000
ry c mo I ~°~ I o ~ o I o I Mi 4' ~ I ,~ I ~ ` I a rn ~ I o aNi N O ~= O ~ d' d' 00 otS C w NO C C N Y N d ~ O U ~ N f~ ~ , C „ ~ C tp C 3 . ~ inop_ ~~ m ~ I 0 0 m~ o~ I m oh t~3 °~ c Q I o ~ 'G _ ~ ~' rC y ~, ~ Ona~ I ~a._N I ' d ~ I C C `'~ o j C L~ 4= a o-- o E ~ o I ~=d `~ I i $c o c I c oy m e ~ €~ I o o v'v' € I ~ o m c~a c O I Z~~ a~ ~ V o~ z , d ~ LL o ow ~ o I a a~ ao o aEi I ~~ v aY a>~ I 3 ~ 'v ~M > m a I m E . v oc.cm Qm«°.oa I -o oo Q'm~ a~~ I I I ~ M ~ ~ I ~ I rn~ ~~ I Z E I ~ ~~ r o an r °o ~ ~ ~ ~ d a m I I a m I I o I o I p z v ~° ~' v ~° v o ~ ~ I ° o I i 2 a a m 1- .- E I m L c Z ~ c Z c ~ v I ~ v I N N M N N M Y N U ~ '.-` N y 7 .N ~ ~ .N ~ m N~~ c I ~' °' ~ C I a m p ~ ~ ~ I a~ °c L ~ '~ I 0 4- c w I o a~i c != Z c~ o Z m~ o Z I E z I y c I d '~ c I N <0 ~ d N ,, lp ~ _ ~ N O) ' ~ .. c6 . ~ ~ ~ .. l0 . 0 Y Q 3 ~ w d y d~ a~ t o R r d t o w d~ d co C S o - coca ~ o j '~ ,~ooa a ~ ~ '~ N ~ frrn frrn frA d ~'~ ~ Nr Nr Nr ~ a~n w ~ooo N I o00o ~ a ~ I •~ ~ « ~ I o v ~ I = r~ ~ I t~ J U v °o ~o ~ I~ rn rn Z 3 N N N O '~ a ~ ~ I ' v N O d ~ r _ ~ O Y N O ~ O r ' G ". ~ _ p ~ p ~ O d m O~ u~1 Q Q Z fA y f ~ 'O O ' ~ m Q ~ yy Q Z (n N N _~ 0 p C c y O r o y 5 ~ P l a ~' ~ ~ ~ d 3 0 O o o~ ~ o o a o I o u a~ l V Q m o N~ N E H m p C c ~ ~ M ~ O c C N~ ~ ~~ ° ~ W ~~ a I ~ ~ ~ I c ~~ d a M M d c a i '~ E m O i d i a a `~ N O a i ~ U ~~ ~' o ~ 2 I Y v o N Z ~~ ~ N I m rn o Z ~ Z ~ tq 0 ~ I I ~' v~ a; .~ at ~a I da ,~ '" m a U `ate I Lam • p a y v y c °' m e C i+ ~ m t~ t A a~ ° oa ~ oi ° c ~ ic nc ) r N~/,v S`I'. C~tOIX COUNTY ZONING llEPART ~ N AS [3UILT SANITARY REPORT' ~C~/~ '' NI ~~a s Uwner / / /?~~ ~ .S5.2.~ s AFC ®R 2 ;dtit c^s D ~ S S ~ cRo 004 Cityr'State ~nS~r~)/• s~f0/lo 2~~~N p~~~. Legal Descriptivt~: ~~~~ ~ ~~pG-E ~ffS ~ \,/ Lot ~Z Rlock Subdivision/CSM # `h '/4 ,Sec. , T N-R W, Town of PIN # GZ.O • I17~' 80 bv0 SEPTIC `I'~1.NK -- bUS~ CIiAMBLR -- HOLDING TANK INhnRMATiON: ~o~/ D S•T. - Wi Tank manufacturer Pump manufacturer-,~ Alarm location ([IULDIiVG TANKS UNLY) Tyhe of system: Wtdth , Length Number of Trenches Setback from: house ?~' Welt ~' So p/L } 20' Vent tv fresh air intake Size STIPC / Setback froth: House (8 Well ~ P/L ~ ~ Setbacks: Service road Ven es t air intake Water Line Meter locations Alarm location SOIL AI3SOIt1'~I'ION SYS'I' { Cam//s 3 9.Z Z CLCVATIUNS: ?o p of ~eu~fz off'/a~`~v~y Uescriptivrr of benchmark -sW C6R~vE72 % llescription of alternate benchmark ~_jLd~__ e~ Sj _[•~G- I /!!~'w '7S 0 Building Sewer ~` ~ S"I'it~ Inlet _ ~r /oa.o Elevation Elevation ~ ADO. ~~ ST Outlet PC Inlet PC I3ottotn Header/Manifold Top of STII'C Manhole Cover Distribution Lines ( ) Qottvm of Sysfem ( ) O O Final Grade ( ) ( ) ( ) NoV. 3 b - AEG . 3 • boo ~ Uate of {nstatlation ,/~!, Permit number State plan number Ttutnber's signature t~~ License number Inspector ~~~"N ~ - • 2~.~3 ? 5 CE ~~!~. ~ Ulbricht & Associates . Private Sewage Consultants 2812 1 flth Ave. Spring Valley, tNI 54767 Da#e / / ~lzG . C~ Compicte plot plar 2 v6 y ~ `-~, ~ ~ ~ ;- ~ ~~ "~ ~ b ~ ~ p v( 7C ~ ~b - ~ c ~ z ~~ C c~ ~ N ~ ~. ~ ~d ~ 1.~ ~ C ~ ~ ~ O ~ M ~~ y ~ ~~ ~ ~~ ~~ II ~~' -~ ~~ ~ ~~~~ ~~ ~ ~ - ~- J '-~ ~ s o ~ ~ oo ~N ~ ~ 4, o ° ~ _ - ~, ~ o -~, w ~ ~~Z ~--. 0 d i ,~ I_ - ~o~ i - ~ ~ ~ I ~~ ~4i~oi y ~ ~ I ~, ~ ~i ;I ~ 7 I i ~I II ~ I I ~ I, I I `~ w ~ I ~ i ' I I ~''' w I I '~ to i t -°_ I I ~~ °O I ~R ~~ II ~ ~ I G I I ~ I I-- -I ~ ~, y I I I ~ ~ ^ I I I l w Z. ~~ ~ J I ~ I I s, ftt \- ~ li II 1 I) II N ~ b I I I ~ ' ~ ~i I Il~~n O s Z I I I I ~= ~ ~~~U~ o, to I ~_ ~ ~ o -o l I~ I I o D~ l ~ K tnDm~ T N ~ ~ ~i- ~ -~ ° ~ ~n -v ~ ~ N ~ ~ ~ ~ ~ ~' ~" ~ ~ N -i~ ~ .~ 9-~ p w ~ , v, -~ ~+- o mU'i ' m ~ ~ ~~ Q r, n cn cos mzD r• r b a y~ I j~ 6 3 s t~ N v c Wisconsin Department of C`mmerce Safety and Building Division ~ PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes iPrivacy Law, s.15.04 (1)(m)l. Permit Holder's Name: City Village X Township Kno s, Tim Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Z ~- ,. ~., . ~ ~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Z ~ ~ .~ I~ t ~L ~~ ! ~ l Dosing Aeratio Holding PUMP/SIPHON INFORMATION Manufacturer Demand M Model er TD Lift Friction Loss System H TDH Ft Force Length Dia Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 463130 0 State Plan ID No: Parcel Tax No: 020-1172-80-000 Section/Town/Range/Map No: 17.29.19.1081 STATION BS HI FS ELEV. Benchmark Alt. BM ~~ ,~~ ! ~ ~ 7 Bldg. Sewer 1r ~ ~ ~~~ -_ SUHt Inlet ~, , ~ ~ .~ ,~ SUHt Outlet ~ `~~ ~~ Dt Inlet Dt Bottom Header/Man. q ,~tt ~T 1 °! 2 i ~ Dist. Pipe ' c:.~ ct u~. ot. System ~ , 9 ij ~ I • 7 rfl. 3~ Final Grade ~~// St Cover ~- ~,~.( 9tu~ BED/TRENCH DIMENSIONS Width ; ~ Length I ( ~ ~p No. Of Trenches ~ `.~, PIT DIMENSIONS No. Of Pits \ Inside Di` Liqu' Depth INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER OR Manufacturer.~~n. t 1 „~ M-~ ~"fd T f S ype ystem: ` r- ~C~~J~N ~-t 0 I 1 ~tl' 1 Q~ t , ~~ ~' ~ UNIT Model Number: ~ ~~ L~ DISTRIBUTION SYSTEM ~~ Header/Manifold t 1 t Distribution Pi e(s) x Hole Size x Hole Spacing Vent to Ai~~yy))Intake 'b' ~ ~ L th c ~ Di p ~ ~ e v~-cJr L eng a Length Dia Spacing ` SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center ~ Bed/Trench Edges Topsoil - .; Yes ] No Yes -~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / `Inspection #2: / /. Location: 440 Overlook Pass Hudson, WI 54016 (SE 1/4 SW 1/4 17 T29N R19W) Willow Ridg Lot 82 Parcel No: 17.29.19.1081 1.) Alt BM Description = 2.) Bldg sewer length = ~; ~ ~.. ~ ~ ~ t ~~ l J.~ + ~-~ ~O` ZSSx- -amount of cover = i ~ e-?C~ ~}-~'nc~ c ~,t/- Plan revision Required? ~ Yes No I'~ ?~ ~ C~~ ~ i~~ /~~'I Use other side for additional information. ~~' ~ `_I ~__ ___. ______ _ Date Insepctor' ignat Cert. No. SBD-6710 (R.3/97) Safety and Buil 'vision County s~ Cile O! x ~ ~, 7162 ~ox 201 W. Washington e. n _ 2 f ll d i b C ) * b P i N b isconstn Madison, WI 537 /' e i n y o. t e (to e erm um Sanitary Department of Commerce (~S) 266-3151 ~ ~?. ~ ?)~ Sanitary Permit Appl _ . In accord with Comm 83.21, Wis. Adm. Code, personal nfor ~~~~ t°*, State Plan I.D. Number N~~ may be used for secondary purposes Privacy La, s15.04(1)(m} `"° ' Project Address if different than mailing address) So,«~e I. Application Lnformation -Please Print All Information -; ~ ~l l; fl ~ ~ Q .. ~~•~ ~ . ~~ . ~~ ~~ Property Owner's Na me ~ ~ ~I~ ~~:i~ ;q ~~ ~y ~"~'~ ~~j(J ff ZONING OFFiC;E Parcel ii 17 Lot 1/ Block;<l ~/ ~Z. Property Owner's M ailing Address ~-~f- D Ol~~`~ /ao ~ f ASS Property Location sw ~~ 'k Section S4 City, State ,c~.~ p~'~,~ w/ Zip Code s yo~~ Phone Number ~1 • ssZ I zq tq (circl T N; R E W Type of Building (check all that apply) ~CQ ~l ~ II . ~.1 or 2 Family Dwelling -Number of Bedrooms •/ Subdiv' ion Name {~ /C~S~M rN~umber ~a'/~dW ~/ //~ ~/`1J 1 ^ Public/Commercial -Describe Use --~--- ^ State Owned -Describe Use ^Villa e Township of ^City _ voso~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ^ New System ~ Replacement System ^ Treatment/Holdin Tank Re lacement Oni g p y ^ Other Modification to Existin S stem g Y B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) 2 Non -Pressurized In-Ground ^ Mound > 24 in. of suitab a soil ^ Mound < 24 in. of suitabi soil ^ At-Grade ^ Singte Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) i V. Dis rsal/Treatment Area Information: D~gn Flow (gpd} - Desig, Soi pplication Rate(gpdsf? Dispe~ 1 Area Required (sf) DispeLsal Area Proposed (sf) 85 System Elevation r~ Z o b S . , VI. Tank Info Capacity in Gallons Total Gallons Number of Units Manufacturer w ~ ~p,~q;Q. {~ --~(~ Prefab oncrete Site Constructed Steel •Fiber Glass plastic New Existing .~ Tanks Tanks Septic or Holding Tank '1 C N1 !JV ,~ /'~CD ! •r Z • Aerobic Treatment Unit Dosing Chamber , VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print} RoSEeT' Z(IbR~~7 Plumber's Si nature ~+' MP/MPRS Number zzC.3`7.5' Business Phone Number ~lS • ~7~• ~ ~~ Plumber's Addre ss (Street, City, State, Zip Code) • VIII. Count /De a Onl Approved ~ Disapproved Sanitary Permit Fee Includes Groundwater Surcharge Fee) Date Issued Is uin gent Signa (No Stamps) ~ l ~~ ' Ow en Reason for ial - IX. Conditions of Approval/Reasons for Disapp oval ~~ ~t3 ~ s~-5-~-~ J~ '- SYSTEMOWNEF2: ~-~gl ~o Marc Sa~.Q a ~ ~ C ~ . ,. , _ a ~1 1 Septic tank, effluent filter and ,, f~ __ __ /l~'' dispersaV cell must all be serviced i maintained ~^~'~~~ ~`t° ~'~ ~~ S Y~ ~ / as per management plan provided by plumber. ~t /~ .~- ~ fff~~_ - ~ ~ ~ c~... ~ ~~- 7~S ltd S 2. All setback requirements must be maintained t as per applicable code/ordinances. S i .- ~,.~ s S ~ , ~~ Attach complete plans (to the County only) ror the system on paper not less than 81/2 x Il ifiches in size D ~/ 2 >~ SBD-6398 (R. 01!03) d ~_ SYSTEM ~r'H'-`' THIS POWT pER OMM. -NCORPORAT.A PROPER BEL g3.44(2)c FILTER MOpEtI/ /4'~(~ !~ " X2,0 y~R~ o. ~..1________i Wr/ 3a ~S ~~~~~ S• P~ ~ ~~ ~ ap. 0 ~x,s ~~~y ~~~ ~~ . W i~s~ s~,rj~ /Oi0 r ~ ~ ~(~, <vD ~,~ ~ ~~ ~~ ~ ~~ ~~~ ~`~5 y~ r, ~ S U E`~ 1~ . ,~~ '' - s YS r~ ~" / /, 4v, ( 9 v ~ . f ~ ~ ~ ~~~~ ~ io ~ Abe ~'~ / ~ ry ~~ `~~ ~i /Q~ r j e ~ ;~~ , -~ , y i ee/ ~ i ~ ~.~~ e ! ~ ~/ // ~, e ~f ee ~'~/ ea e ,'J z ~ e i~ /j/f ~`~ L ~; ;. ~, ~a r o ~,~~~~ ~• ,.~, ~~pT1G ~, G ~,,~ r ~.-- a q S,o ~ o -~oM o f sia%U Gr ~~~~~~ + .~ ~3 _----- 1, 4~ fv ~s T ~`~'~ b~ G~ ---- 'V'6 ~~ ~~ ~~ ~ 2 DoT ~~ °T ~5~`~ 2812 10th Ave. • Spring Valley, W154767 Reg. l]esigners of Engineering Systems Private Sewage Consultants 715-772-3442 PROJECT INDEX PLAN I D # ~l ''7- DATE ~~" f ~ ~ OWNER TI ~ ~NO~,~Sy~ PHONE ~~f ' '~`S~"' f ADDRESS l7O ~ ~L~~i./~Ga~D~C° ~,~.S~S /'~11~~t~•c.J S'y/O/ ~- LEGAL DESCRIPTION G~ ~'~' 8~ ~(f/~~~ ~/L~ ~s¢~S T^ ~+~, ~ nr TOWN OF /''~f~~.S"D,c1 ~~ . C/~lJ/',~. ~~rr COUNTY CSTM ~. ~ ~-37.1 GEicT ~Sr'f"~ C~ LOCAL AUTHORITY/ SUPERVISION ~~' / ~'~-d~~ ~ ~/ - ~+~ ~ ~~ ~ PROJECT DESCRIPTION: -~ ~~~rs ~4-- ~~ .---.~._ C ~3'.rS~ <s~uCC ~'~ ~zt',~,,e, l22 " 2l ~- ~~~ 7s a ~~. c~r~-sue ~a ~~-27- 7•~~3 C2 c c L~T° Pt~ivate Sewage Consultants ~~~ 2 1 Qih :eve. MARS `7~#- ZZ Ca3 ~l i Pg.I INFILTRATOR SIZING WORKSHEET Pg • 2 SYSTEM PLOT PLAN J,~ j~ T]~~ Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. _'°~ llr.~~ Pg . 4 ~~ f~ , ~~ C C n _~ vm D ~, m ~. n t~D ;._ ~~ a b. `~ Z ,a ~n~ ~~~~ ~. ~ ~ ~ ~ ©1 ~ ~ ~~ ~ ~'` ~. ~_ ~ ~ ~; `~ b `'o ,~ ° ~. ~ ~ ~, ~ ~ ~. -~ ~ ~ ~ ~ ~~ -~- ~ ~ C ~ ~ lv-~ . CFl ~~ V ©7 ~ ~~ ~~ ,y v,, L . ~, ~ ~: b ~ ~ ~ ~'1 xx ~ ~ ~ ~ •- ~ ~~ ~ ,~ ~ ~ ~~ ~ N W o~oa~ f~sS 1'iAL4 THIS POWT SYSTEM OMM. INCORPORATA PROPER BEL $3.44(2)c FILTER MODEL # ~ f~} I~ ,+ ~ ~ +r s C !.- { "f' . ~~ ~ 5~~ S ~ r c~~p. <oC~ t ~~ ~5~~ ~ ~ tt ~ ~ ~~' .~ Coo ~G~~ ,~ sus Q, ~ ~ ,;! ----- S ray i3 z ~~ ~ ~ ~ . 9l s ,~~ yam' 0 1~1n~,~ i ,~~~ ~~~~ ~ ~ f Q •--- - - - - - - -- - - - ~ ~y , , ~ ~ J ~ `/ Y a tS yS rpr ~ ~~ r ~r ~/~~ ~% I ~ ,. / j` ~ '~ i ~~\ ~ ~ x is ~'N f ~~s`~ ®~. ~a s oar ~~' ~ - ~ ~~ -€ J~t ~3 ~~ b~ -..------- G1 ~ n ~ - I~C~~~~ ~ ~-s r ~o r ~E ~a ~PP~a~~ y~~".~ ~, .~iN. i y 1/~ ~ r ~'~ ~NS~1~'cTfav f~/~ inf. a ~ ,, 1 - ~~~~ -~ ~ ~ ~~ -- - -- ~ -s ~~ ~~L .~'i3~~l~ s~,•y~p 9~~f~~° y~.o , ~ ~---.. ~~~~ ~~ ~~ .~ ~i~v, 9~.. (~ 1 ~. ~ S. ~~( ~ l~ ~~ ~ ~. 1 i ~,~ ~,~spEc7~®,v p/~ ,~Iiv. i2 f' !~// ., K /~/'.~~ ft~f i ~71~1 `T4~' sc~, yto n-~~c 9~~~~^` ~--- ~~~~ ~~ << n .~ ~7 OWNER'S MAIIdTAIi~TCE OF~ SEPTIC SYSTEM POWTS {landowner) is reponsible for proper operation and maintenance of-this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of. this system- The owner is required by code to submit ail necessary maintenance/inspection reports to the controlling ,authorities.. SPECIFIC CONTACT AGENTS * Governmental authority/ inspectors: 3~~•yGBo * Licensed installer, responsible for providing an operation maintenance.~~Users~~ manual: _ / '71 s "* Licensed servwce / inspection agent other than installer: Electrician, for pump. electric controls, wirin un' g its: ,~/~- IMPORTANT OWNER MAINTENANCE RE UTREMENTS 1- Winter traffic area shall not besledding, shove ring, etc.} across the the ce11, freezin Permitted, or frost can/will penetrate into g P the system. Discontinuos use in the winter. (a vacaction trip, resulting'in no water use) can also lead to freeze ups. 2. Water canservat-ion needs to be exercised! Or system can be hydrolicaliy overloaded and destro ed. designed fot a maximum wastewater flow offs svs~em was CD ~ gals. daily. 3' POWTS are not designed to accvmodate wastes a garbage.... disposal unit, or any other unnatural sources of was Any introduction of such waste materials will aver te- destroy this system. load and 4. rf ~ power outage occurs, or a '. in a temporary overload of effluent beins' it may result cell., which may adversely impact the cell Pumped into the recommended that a licensed pumper em t (leakagej' It is allowing the pump to return to Basin P Y the dosing tank, Consult your installer immediately fortadvicerect amounts. ~• Neglect of the vegetative cover erosion preventive (the cells insulation traffic 1 can Iead to faiI.ure. Compaction or heavy also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYS'PEMtt the_.Ystem beneath IS NOT sufficient alone tp maintai;~ in .~ x '-~ cover . a 6- Periodic inspections by the owner, or necessary. Inspection his agents, is i n to +~ ~.,,. --- - . P 1 Aes a n r~ ~,.,,. ~... L ~ -- - tVV~~VJr ~ y'' Wisconsin Department of C n{p~r e/r`-J ~ D OIL ALUATION R PORT Page_ I _ of 3 Division of Safety and Buildir~ ______~D in accoraance wr n t,orrQ~a~ vv~.:r+arnt' wvae Attach complete site plan on paper not less than 8 1/2 x 1 inches in size Plan must County S ~ C Rb tX ... . include, but not limited to: vertical and horizontal referenc point~(c~e°tiar4-an'~ i ~ parcel LD. Q ZQ • ~~~ ~ . O ~ . ~-U percent slope, scale or dimensions, north arrow, and locat n and QI~(~dl~aa4e~t road. ~ Please print all information. evi ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Q(,T, t9 Property Owner Property Location `r l /~ L N ~ (~ S Govt. Lot c5 ~ 1/4 .Std 1/4 S /lf T a9 N R ~ ® r Property Owner's Mailing Address ~-~ Lc~oK P~s~ Lot # $~- Block # - Subd. Name or CSM# i~~dw 2,n~~t ~~sr City State [ip Cod'e ~ Fnone Number ity ®Village own Nearest Road ~~•~..x~~ W ~ 5•~DIb (?15) 3~!/-55aI .DSOnJ ova ~a New Construction Use esidential / Number of bedrooms __~"__ Code derived design flow rate _ (~00_____^_GPD 'Replacement Public orcommercial -Describe: _~______~__~_____ __~__ Parent material /OFS~ O(~~Q S/}~t7D OU~Z(J11"~, _ Flood Plain elevation if applicable ___ ~~ ~ ____`_ ----- ; - General comments ~ i'1~ ~ ~'x j 5~` f /~ (r ,S'/,S'T'C`~H 1 S 1 N CQ L7C ~/+ and recommendations: ~JN~ ,' ~~IT S D% ~S ~~ CAN t3 E ~~ ' Zl.S Ev /N T V } ~'~t~ ~~ i4' A- a~// UA/u-e- . ft. ® Boring Boring # pit Ground surtace elev.~~_5s _ ft. Depth to limiting factor q~t _ in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~ O'// l 0 4~2 3~ - • w 2 / I'2 io Y2 3 - SbK V ' 3 ~?- ~o Y24 - a e 5bJ< / a w of • (o /, o ~- af- qz.o 2 Boring # ~ Boring ~ Pit Ground surtace elev. ~5_~ _ ft. Depth to limiting factor ~1Q7 _ in. Soil A licetion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 l b-i I u Y23 .Q, a-F r V-Fr' C 5 3 v-~ • ~ ' 2 ~$- , 4 _ r/I v aw ~O 3 `~ ~ - m I - '~ v-F `t2,o~ ql • '~ ~ * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L _ CST Name (Please Print) ignature CST Number J ~ rJ N U t- 3 I`Z--1 c.1-t T ~5 ~!'~ '~ Address ' Date Evaluation Conducted Telephone Number Z f~,z io ' ~`~ S~2t~ y~llc`yrf,J t 9'• i3~ 04 7i5~ "~~Z-~,~ .C'p~ Gp ~ ~Z Property Owner __ ~~~ O ps ____ Parcel ID # w r //Ot,~ ~i1~G'~ ©~o•/l~~•Sa•~ Page ?- _ of __ 3 Boring # Boring ~ -_ ®Pit Ground surface elev. _ _5'~'Sft. Depth to limiting factor - 9~ ~ in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 l ~ b YR.3/3 -e o~ V~r a f ~ (o 2. -l o yR`~l -- Q. IL Q w ~ • ~o oJ~" 9l •Y~ .2 g'Z~?A ^ Boring # ~J Boring Pit Ground surface elev. ________ ft. Depth to limiting factor __~___ in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring Boring # Ground surface elev. ________ ft. Depth limiting factor ____ in. ® Pit Soil A ligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330Test (R.07/00) f, r ~ ©U~/~L4D1~ IQ S ~s r ~G.U~ 41 w ~ ~-~- ~ cn ~ E3E'URM 1-~b US C M #' OTTq n.~t O~F 81 OIN ~ = /tip, g3 = t~ M ~1= t 1n1 M b5T G DRN£f~?, a~ r~W V€v~l fl/ ~t f 5 ys-r~tit q.yi.. fo5 ~' Lev = , -5 --off/ E'X1STrrJl~- T,ANK EF`~u ~~-r o u-r-t~ E-7- w ~5 T' P RoP~R.-rL~ y.~r.~ C~ ~_ 0 0 i 45 ~ ga _- n 3 0' r FbUN D ~ ~~ GdRNE2 LO'T' L~1 rJE ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGRBEMENT AND OWNERSHIP CERTIFICATION FORM OwnerlBuyer I i ~ /~/(10,~ S' L o /~~ ' /~~t1 d /~ S --r Mailing Address 4~0 o~~2/ao ,~' /~~ s s property Address (Verification required from Planning Department for new conshudioa) . J~~ ~ CitylState ~ ~ " ~`S~~ ~/ • Parcel Identification Number ~ 20 • //~ a '~ .io~~) LEGAL DESCRIPTION Location Y~, ~ %., Sec. . T N-R W, Town of ~V ~`r ~ ~ p'i'oP~Y e ~ ~ Subdivision ~~~~d Lu !~'ci p{r-E/ ~~t.S T" .Lot # Certified Sarvey Map # # Warranty Deed # S ~ ~ ~ ~ ! .Volume ~~~~ .Page # ~ Spot house ^ yes C;~no Lot lines identifiable yes ^ no ~Yi~wI'E11~ ~ZAINTI• NANCE Improper use and maintenanceof your septic system could result in its prernatur+e failure to handle wastes. Proper maintenance consists of pamgiag out the septic tank every three years or sooner, if needed by a licensed pumper: what You part into the system can affect ~e function of the septic tank as a treatment stage is the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification fours, signed by the owner and by a mastorPlmnber, joumeymanplumbet; restrictedplumber or alicensed pumper verifying that (I) the on-site ~vastevvaberdisposal system is is propex operating condition and/or {2) after inspection and pumping (if nocxssary), the septic tank is less than 1/3 fell of sledge. t/we. flue uadersign~od have read the above regnirem~eats and agroe to maintain the grivata sewage disposal systcm with the standards act forth, herein, as set by the Department of Commerce sad the Department of Nataral Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of ~e three year expiration date. .>-~ '; wz ~ ~®/ /~ SIt3NA PLICANT DATE OyVNRR CERTIFICATION I (we) certify that all statements on this farm are true to the best of my (our) lauowledge. the descn'bod above, by virtue of s warranty deed recorded in Register of Deeds Office. SICINA PLI I (we) am (are) the ownct{s) of ~~ , y, ~~ DAB ««««*« be" revoked b the «««««s _ Any information that is rare-represented may result is the sanitary permit mS Y ~g ~' «« Iitciude with this appUcatlon: a stamped warranty deed firm the Register of Deeds office a cropyr of the certified survey map if reference is made in the warranty deed ~~ ~ `~ . __..,,:~toc RECEIVED ST. CROIX COUNTY ZONING OFFICE ~ ~ ~ 2 2 2004 CERTIFICATION STATEMENT ST.CROIX000NTY ZONING OFFICE FOR UTILIZATION OF AN EXISTING SEPTIC T ~l'his is to certify .that I have inspected the septic tank presently serving the /,~_,~/V~I~S' zesidence located at: S ~ 1/4, S~ 1/4, Sec., T Z~ N, R '/ W, Town-- 4f ~U 1750'`/ Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. fast time se v ~~ ~ ~ G/ r icel r ;~7id flow back occur from absorption system? Yes/` No (if no, skip •~. next line } Approximate volum~e(~or length of time: ~~ gallons minutes Capacity: ~~ ~i~lt~ ' Construction: Prefab Gonczete /l Steel Other Manufacurer { if known) : ~t~~,S~~ Age o f Tank { i f k nown) : ,1~./~~ X ~ "~~ ~/Q .S (Signature) (Name} Please Print (Title) (Date} (vicense Number) Fora to be completed by licensed piumbex {s.1~~5.06, 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 ranform to the requirements of`"ILH;~-83, Wis. A.dm, Code {except far i~ispection opening over outlet baffle}. ~Iatt~e^~~ ~~-~ Sigr~ature'=/-Q.l~~ SIP/MFRS ?~~h~t~~7--_ zZ4~3~~~ ~ ~ ~- DOCUMENT NO. STATE] BAR OF WISCONSIN FORM i-198i TNtt MAee Inumrw roq IItC011DIN0 DATA S1r~144 I VIfAtR1RppANTY DE~~E++D - .. ~ IIOL 1QO~PAf',E Up -.~ .--- - .. `.._ _.. .3. This Deed, made between ..S~RI~ON• C,,,.F.t•;~~?..~nd..~~~~4X..... 4- ;: ~,.. ., ~.: i ... FLOOi~s..hu-~bai~i,and.t!!Mfg ........................................................ ... ij 't~'fl M1x F:r• tr) •-•---• ..................................................................................-........, Grantor. MAY 2 7 1934 and.....TIMOTHY J.•-1CNOPS..and-_LORL_A.•_KNOPS•~__husband•_and_________ ;~ ~ 12: ~ ? r !~ ....wi..fe-. as survivorship maxi.tal p>~ap~rty. ;~ ~„~,,t~~ ~ ~ , ....... ...........................................................•--------.._..................----....., Grantee, Witnesseth, That the said Gratttor, for a valuable wnsideration...... {~ ...........................................~.......................................-St....~=o_..:... II Ilarulw To _.- -~ = --: _.. _~ l conveys to Grantee the followin described real estate ir .................. ....i?~... ~ County, State of Wisconsin: '~ I! ~~ Taz ParcP1 No:.-----------------• ............... it Lot 82, Plat of Willow Ridge East in the Town of Hudson, St. Croix Couaty, Wisconsin. ~-.~~' ~~q2s ~,~_ ~= TOGETHER WITH and SUBJECT TO reservations, restrictions, easements and rights-of-way of record, if any. ai, This -•-•--•-- g_....... •-.-. homestead propertp. ;~ (is) (is not) ,, Together with all and singular the hereditaments and appurtenances thereinto belonging; I{ And ........................................................................ .--------..-.........----...-.................. ~,~ .warrants that the title is good, indefeaaibla-rerfee simple at-d frees and clear of encumbrances ezcept and will warrant and def//end the same. Dated this .........•..~.C?~ .................... day ot .....__...-•-----•--.-?"~Y..._....._°_.....-•--•-----._..._..._.._, 19.84.... 7 Q_~ ---•--•--•--..-.....-•-~---• ........................(SEAL) -... -.~.~,./~----•--•--.....(SEAL) .....G.Q .I4..Cew._FT.QQI2-..-. .. ....... ....... .......-------•--•-••---------------------•----._.._......_......._..(SEAL) --•-- --•-•---~ - •• ---•---...----(SEAL) BETTY pOB AVTHBNTICATION Signatare(a) authenticated this ...._...day ot....__ .................... 19__.._. TITLE: MEMBER STATE BAR OF WISCONSIN (It not. .................... authorized by ~ 706.08. Wis. 3tata.) THIi INSTRUMENT WAi ORAFTEO 8Y •-~Xi:orney Barry C . Lundeen „__,__,,,,,_„_____, ._I. LQ__~~ao_nd..~tr~aLa..1311~$Qna..~~._~4Q~4....._.. (Signatures may be authenticated or acknowledged. Both v.e ..,.* ,.d.~.e_., . ACHNOWLSDOMSNT STATE OF WISCONSIN as. PeraonaUy came before ms this _ ~SS~~h..dsy of .._.._._---~!y .............._..___._-, 19_._9 the abovaed _Gordon C:_ Flood and Better. Flood________________ to ma known to be the per who ezecuted the foregoi g iaatroment a ~ same. (3a~bk Notary Public ... S ~ o ... un Wis. My Commiasios is k to expiration ,. i ~- s "SVt!~ 1.T"~ ~I 1'~ 3W V4 OF 'f __ t"~+E 1 . . ., _ .. ,; CAI 1/~4 ~ lllE~:1'it~N ~L 1a ~$ ~~1, 4F Q!~QN~ S1: C# ~OUN"T'Y, IM~ISOON~1 Ccdx Gcxn~Y Re~~r °~ EJeed~ ~ • ~ ~~~ UUt~I ~' ' ,.,o- -_ - -~-- ~ ~ M A~ +/ S ~~ • (Rs Soo-pow -- _ITY ~:HG sAlk~At -its.oo' r~ r \\ ~1 • s~s' li DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING; LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS Dlvlslon P.O. BOX 769 BUREAU OF PLUMBING MAGI(SON ~ 53707 SE!, SW~, S17,T29N-R19W CONVENTIONAL ^ALTERNATIVE State Plan l.D. Number: Town of Hudson ^ Holding Tank ^ In-Ground Pressure ^ Mound ut assigned) Lot $2 Willow Ridge East NAME OF PERMIT HOLDER-. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Bjornstad Construction 910 St. Croix St. North, Hudson, WI 5401 `I~ ., _ . ~~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: MP/MPRSW No.. County: Sanitary Permit Number: William Schumaker 6382 St. Croix 96064 SEPTIC TANK/HOLDING TANK: MANUr AC I unen. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING L.vneL LUCKING wveH PROVIDED: PROVIDEC. ^YES ^NO ^YES ^NO BEDDING: VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD. PROPERTY WELL. BUILDING VENT TO FRESH ALARM: LINE: AIR INLET: FEET FROM ^YES ^NO ^YES ^NO NEAREST _ __ DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY PUMP MODFI_. PUMP(SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ^YES ^NO ^YES ^NO ^YES ^NO GALLONS PER CY CLE: PUMP AND CONTROLS OPERATION AL. NUMBER OF PROPERTY WELL: BUILDING. VENT 70 FRESH (DIFFERENCE BETWEEN FEET FROM LINE. AIR INLET: PUMP ON AND OFF) CJ YES ^NO NEAREST-~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ~ r m.. rN u~AMETER MATERIAL AND MAR KING or excavation. Ilf soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVFNTION01 SYSTEM: WIDTH: LENGTH- NO. OF DISTR. PIPE SPACING. COVER WSIUE DIA. #PITS. LIQUID BED/TRENCH M ~ ~ j TRENCHES: MATERIAL: PIT DEPTH: DI ENSIONS S GRAVEL DEPTH FILL DEPTH DISTR. PIP DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV. INLET ELEV. END. PIPES. FEET FRDM UNE: AIR INLET-. NEAREST-- -~ 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. TI'IONS MEASURED. ^YES ^NO SOIL COVER TEXTURE: PERMANENT MARKERS OBSERVATION WELLS. ^YES ^NO ^YES ^NO DEPTH OVER TRENCH/BED DEPTH OVER THENCH;BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED. CENTER. EDGES. ^YES ^NO ^YES ^NO ^YES ^NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENG TH. NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.: ELE V.. DIA.. ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBU710N INFORMATION HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. ^YES ^NO ^YES ^NO COMMENTS: PERMANENT MAflKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ^YES ^ NO ^YES ^ NO NEAREST-~ Sketch System on Reverse Side. DILHR SBD 6710 IR.01/82) Retain in county file for audit. (SIGNATURE. (TITLE Zoning Administrator ~ D1LHF-~ SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code .~ ~ , ~ • -Attach complete plans (to the county copy only) for the system, on paper not less than 8'/z x 11 inches in size. -See reverse side for instructions for completing this application. 1. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. COUNTY STATEQSANITAR//Y PERMIT # / ~J STATE PLAN I.D. NUMBER PETITION (~ FOR VARIANCE ^ YES ~ NO PROPERTY OWNER PROPERTY LOCATION .7~0 S'~a-~ Z.°o.~5' llPv ~ i~ S~'/a s6r/'/a, S T ~, N, R Q' E (or PROPERTY OWNER'S MAILING ADDRESS ' ' ` LOT NUMBER a BLOCK NUMBER SUBDIVISION NAME = ~ 6 G t~f-/s' ~•/ . ~ ~ 7 ~ ' C/~~ ova ~ CITY, STATE ZIP CODE PHONE NUMBER CITY : NEAREST ROAD, LA E OR LANDMARK -~ ^ VILLAGE : ~ / of ~ s ~~V~ti l~ J'' Q <~i - ,^ ~ 11. 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 System System Septic Tank Only an Existing System Existing System 2. ^ A Sanitary Permit was previously issued. Permit # 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 I n-Fi I I Tan k V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. See a e Bed b. ^ See a e Trench c. ^ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): .'~ ~ /'~ / ,~ 1a~ Feet Private ^ Joint ^ Public VI. TANK CAPACITY in allons Total # of ' N M f Prefab. Site Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks ame anu acturer s Concrete strutted glass App Tanks Tanks Se tic Tank or Holdin Tank Q(J ^ ^ ^ Lift Pum Tank/Si hon Chamber VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system sho on the attached :plans. Plumber's Name (Print): Plumber's Signature: (No mps) P PRSW No.: Business Phone Number: Plu/m~ber-'s Address (Street, City, StateA, Zip Code): / Name of Desry~nf r~ VIII. SOIL TEST INFORMATION Certified Soil Tester (CST ame CST # CST's ADD S (Stre ,City, State, Z//ip Code) A Phone Number: IX. COUNTY/DEPARTMENT USE O LY Approved ^ Disapproved ^ Owner Given Initial Sanitary Permit Fee J' Groundwater Surcharge Fee ate Issuing Agent Signature (No Stamps) /~v ~~ t(Q ( "" ' ~5~~ ~~~~~ ~) ' ` Adverse Determination ' ~ X. COMMENTS/REASONS FOR DISAPPROVAL: ~ j~~ ~~~~~~ by ~o~~ ~. ~ ~s~ SBD-6398 (formerly Pib-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owners name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public: is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; lil. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a// septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g.. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/2 X 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tanks} or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the ~-, 1.' result of over 2 ears of stead ne otiation and ublic debate. The roundwater bit! ~~'`' Y Y 9 P 9 Groundu+~~ter included the creation of surcharges (tees} for a number of regulated practices which Wiscor~sin's can effect groundwater. The surcharge took effect on Juiy 1; 1984. All of the water !hat. bused #reasure ~~ ig used in your building is returned to the groundwater through your soil absorptic~rr o s stem or the dis osa! site used b your holdin tank urn er. Y P Y 9 P P ~ ~~ ~`~ Tne monies collected througi; these surcharges are credited to the groundwater f:~r~d admini:~- to°ec by :ire i~epartment of Natural Resources. These funds are used for rnonitori,~g ground- ,~~,_ite~:, grourdwater contamination inv=estigations and est-~biishment of standards. Oroundwat~-!, ~~~.y e~~uc~rt"~ protecting. STC- 100 i This application form is to be completed in full and signed by the owner(s) of the I,rul,~t-ty being developed. Any inadequacies will only result in delays of the permit 1:;::uau~e. 5tw uld this development be intended for resale by owner/contractgr,("spec lu~us~~"), then a second form should be retained and completed when the property is sold ai-d submitted to this office with the appropriate deed recording.. c-wn~~r of Yrope~rty / ~ d12y(d CJ ~Q~'I ~/ ~ . Lucat tuu of Property ~~ ~ ..Sinl ~, Section ~~, T v?y N - R ~~ W -r-- '1'uwnship !~~/~ ~ n/ Mailing Address __. ` ~ APPLICATION. FOR SANITARY PERMIT Subdivision Name /~i Lut Number 0~ - ------_ _. --___._ .. --- Yrrvluus Owner of Property ~~~ //~ ~C '1'utal Size of Parcel ~~p/l~ ~ ` I/att Parcel was Created Ar4 all curnera and lot. lines identifiable? __~____„_ Yea No 15 ti~l;; property being developed for resale (spec house) ? ~_ Yes _ No Vulumu ~~, and Page Number ~~~ as recorded with the Register of Ueeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 1. Land Contract . 3. Other recordings filed .with the Register of Deeds Office 1« addLtion, a certified survey, if available, would be helpful so as to avoid delays cal tl~e reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OGINER CERTIFICATION (we) eeht%6 y .t<i.a.t a~?,f. atatemewte an .th.ia . bohn ane .th.ue .ta ~h.e bed.t o 6 my (uun krcuwY.ectge; .that T (we) am taae) .the ownen(a) ab .the pnopehty deaati.bed ~.n .th.i.a %rcbunmat%un ba~un, by v.ch,tue ob a wcvvtan.ty deed neeon.ded ~.n .the.066~.ee ob .t<ce Cuur-ty Reg.e,eten ub ~eeda ab Uae.u.ment No. 3 5 ~0 ;and ghat I (we) ph e~ er~~X y c~wn .the , pnopoa ed a-ite bon .the a ¢wage poa a ya.tem (un 1 (we) have ul--ta.i.r~~d an easement, •to n.un u;.ith. ,the above deae~ei.bed pnapen,ty, bon .the c~,rv~-tnueti.an ob bcu.d dya.tem. and .the same has been du.Cy neeonded ~.n the Obb-gee u~ z{ce. County Regtiazen 06 Ueeda, as Uoeumewt No. ~g56a`t0 1 ^ . + 5~:, • t1 3~SO~U wog. 693 Pa~~ ~~ LAND CONTRACT Contract, by and between Arnold R. Bertelsen a/k/a Virginia A. Bertelsen, husband and wife, Vendor, and B. a Wisconsin corporation, Purchaser. .~."':~~'' .:, . ~. ~•~ ~xr_ 11_ ~~_._ A • l:4a /~n . t^pa~a~ ~I ~ A.' R. ertelsen and & ti. evelopment, Inc., Vendor sells and agrees to convey to Purchaser, upon the prompt and full performance of this Contract by Purchaser, the following property, together with the rents, profits and other appurtenant interest (all called the "Property"), in St. Croix County, State of Wisconsin: ,. . South 53 1/3 rods of South Half of Southwest Quarter (S~SW'~) and South 53 1/3 rods of Southwest Quarter of Southeast Quarter (sW~xSE~) of Section 17, T29N, R19W. That part .of Northwest Quarter of Northeast Quarter (NW's NE's) and of Northeast Quarter of Northwest Quarter (NEB NWT) of Section 20, T29N, R19W, lying Northerly of the centerline of St. Croix County Trunk Highway "A" (formerly known as Hudson-New Richmond Highway), EXCEPT the following parts of the above described tracts: All land included within the Plat of Willow 'Ridge Second Addition to the Town of Hudson as described in Vol. 4 of Plats, page 25; Parcel deeded to 24arlin 0. Amdahl and Ruth L. Amdahl as described in Vol. 517, page 26, Document No. 324368; Parcel deeded to Roger E. Hetchler as described in Vol. 517, page 114, Document Number 324430. TOGETHER with an easement for street purposes aver the Easterly 33 feet of said parcel deeded to Roger E. Hetchler as described in Vol. 517, Page 114, Document Number 324430. ~'i ; .x ~.I; i~~~ ~~ ~~ ® ~ jT« SUBJECT TO the right-of-way of said St. Croix County Trunk Highway "A" and to telephone easement adjacent to said highway as recorded in the office of said Register of Deeds. Purchaser agrees to purchase the Property and to pay to Vendor at: St. Croix Heights, Hudson, Wisconsin, the Base Purchase Price of $100,000.00, together with additional payments per lot, as follows: 1. Base Purchase Price. The base purchase price of $100,000.00 shall be paid in the following manner: $15,000.00 at the execution of this Contract, and the balance of $85,000.00 together with interest on such portions thereof as shall remain from time to time unpaid, at the rate of lOti per annum, until paid in full., as follows: (a) For each individual lot developed and sold by the Purchaser, Purchaser shall pay to Vendor a $2,000.00 principal payment, to be applied to the $85,000.00 Lase contract balance outstanding. (b) A minimum annual payment of $15,000.00 principal shall be paid each year, excluding the year of sale. Each per lot principal payment required above, shall be credited toward this $15,000.00 annual payment. (c) On December 1, 1985, and on December 1st of each year thereafter, Purchaser shall pay to Vendor the differential between the required minimum principal payment of $15,000.00 and the total $2,000.00 per lot payments made during the preceding twelve (12) months, until the Base Purchase Price has been paid in full. • f . , ~ - ~ " ~ von ~~3pacE 47 (b) Purchaser shall pay to Vendor the elan of $3,000.00 per lot on all residential lots developed and sold by Purchaser, subject to the condition that the minimum amount of payments to be made to Bertelsen under this Paragraph shall total at least $150,000.00. (c) During each year of this Contract that there is an outstanding contract balance of the Base Purchase Price (Paragraph 1(a)) there shall be no minimum annual principal payments under this paragraph. Commencing with the year following completion of payment of the Base Purchase Price, Purchaser shall pay to Vendor .a minimum annual sum of $15,000.00 per year. (d) On the 1st day of December of each year, Purchaser shall pay to Vendor the differential between the minimum annual paymenC of $15,004.00 as provided in this Paragraph, and the total $3,000:00 per lot payments made during the ~~ preceding twelve months, until the entire $150,000.00 minimum sum has been paid. Thereafter, if Purchaser sells any lots in excess of 50 lots, Purchaser shall pay to Vendor the sum of $3,000.00 for any such additional lot sold, up to a total of 53 lots. ($159,000.00 total hereunder) Purchaser shall not be required to pay monthly payments to Vendor sufficient to pay reasonably anticipated annual taxes and special assessments. Any amount. may be prepaid without premium or fee upon principal at any time. In the event of any prepayment, this Contract shall not be treated as in default with respect to payment so long as the entire balance of principal, and interest where required, is less than the amount that said indebtedness would have been had the monthly payments been made as set forth above. Purchaser states Ghat Purchaser is satisfied with the title as shown by the Abstract of Title submitted to Furchaser-for examination, except: Real estate mortgage to Sam E. Miller, dated February 1, 1980, recorded in Volume "608", Page 152, Document Number 362685.. This mortgage shall remain the obligation of Vendor, who shall keep said mortgage current and in good standing. In the event Vendor fails to pay any required mortgage payment, Purchaser shall have the right to make such payment, and to deduct any payment so made from the sums due under the terr.-s of this Contract. Purchaser agrees to pay the cost of future title evidence. Purchaser shall be entitled to take possession of the property on Closing. Purchaser promises to pay when due sll taxes and assessments levied on the Property or upon Vendor's interest in it and to deliver to Vendor on demand receipts showing such payment. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditons shall be full performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the c . .- . VUI. ~J~~PAGE ~}~ Vendor shall consent to the platting of the premises into residential subdivisions by Purchaser and Vendor shall be under an obligation to approve and execute subdivision plats prepared and submitted by Purchaser. In addition to the Warranty Deed which Vendor shall deliver at time of . ultimate closing, Vendor shall execute and deliver to Purchaser, individual Warranty Deeds covering the separate residential lots which Purchaser may sell, upon payment of the per lot payments set forth above. All costs of platting and costs incurred in preparation of individual deeds shall be Purchaser's expense. Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of 60 days following the specified due date or (b,) in the event of a default in performance of any other obligation of Purchaser which continues for a period of 60 days following written notice thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract shall become immediately -due and payable in full at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject ~~ to any limitations provided by law) in addition to those provided by law or in equity; (i) Vendor may, at hie option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously paid by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract and as rental far the Property if purchaser fails to redeem); or (ii) Vendor may sue for specific peformance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on`title in a quiet-title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys .fees of Vendor incurred to enforce any remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as incurred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the Court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property Eby assignment of any of Purchaser's rights under this Contract or by option, long-term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. .1 ' All terms.. of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Dated this 29th day of May, 1984. VENDOR: ' ~ ' 6 ~ `Arnold R. Bertelsen a/k/a A. R. Bertelsen _ V ^ Virg a A. Bertelsen Authentication: Signature(s) of Arnold R. Bertelsen, yirg'n.,i 'a A_$prtelsen, his wife ~yld Donald ~„ B~ornstad and William C. Harwell ~ President and Secretary. ~,espectively of B_& H_Developments Inc., authentic ~ i ;~"-~ day of May', 19~ i n iJilliam J. Radosevich Member State $ar of Wisconsin. This instrument drafted by: PURCHASER: B• & H EVELOPijENT, INC. ~eO ~ . ,- Donald E. Bjornst4d, President ATTEST: W (, • r William C. Harwell, Secretary William J. •Radosevich Attorney at Law Hudson, Wisconsin 54016. ~ _ c_ 5TG~.lU SEPTIC TANK Mi1iNTENA CE AcK~:r:M~N•r , St. Croix oun~y •~ t U W N E k/ B U Y E k ~f}r 4 ~ b i b -2- t~S-S~A-1~ „~~ry~,,• t, ----- // // ~ kUUTE/BOX NUMBER Gt ~ D 1 /~ 4D f1.S~ ' /_.rr~ ~(~ .~_Flre Nuulbar -_ _ _. ~, ~~ ~ ~ C 1TY/STATE iiv(/S0~. lN~', ^Z 11' .S~/d~ _,_:__ YItU!'EkTY I.UCATIUN : 5E 1L. ,S h1 ~ll. ,S~c t ion~~-_, , Subd~visiot- % <~~ ~,(1S/ r '~'.~~ _ . N . h.__/_/ ...W . 5t. ~rulx CuQu/n7ty, 1rUC tlUlnbeC 1JpC^. 1mNruper use, and maintonaace of your septic r;yst.•ni ~uuld result in iLrr pCalnature failurtr to handle Wairteu. 1'Cu~~Ur Inilllltt7ntipCe cun- e-1>,ey ut .pumping out the septic tank evexy clrr.•~ yuurd ur buunvr, tt nuc:ded. by a llc__ eared ea tic tank Y,un~ar. Whuc you glut into the ~yseerm can affect thQ function o^f- ~t-~ 5-eptic cook as a cr~,-c- aenc lfc~~e Ln the wae•te dltlposal system. • St. Croix County reliidentr; ma be eligible to ruceivu a grant lur v lo..xlu-um of 60X of ChW Coat of replacelaent of a failing syelalu~ which was in aperstion pti-ci `- ~ ,. ~----St. Croix Cauncy accepted this program in August' of 19tlU. with tl-e reyuir~wc;l~t clluc :,wners of all new s a~tems agree to keep their systems properly lus tntained. ~'--- 't'hr: pruNerty owner agreew to >aubmit to St. Croix Caullty 'l..anln~; :- certlficution form, rignod by the owner. and by a alaater {~luull,4r, journeyman plumber. rsstrleted plumber or a licensed pun-per v~:rt- fyLng that (1) th• on-~ito wastewater dlapos~rl system is to proper operating condition and (2) after inspection and puu-plnb (iC ncc- ebsary) ~ Cha septic 'tank 18 less Chan 1/3 full of siudbe slid ycua~. Certification form will be sent approximately 30 days prior eu three year expiration. I/WE, the undersigned. have read the above reyuiren-ents and abree to maintain the private sewage disposal system in accordance with the standards set forth, herein. as set by the Wisconsin Depart- sent of Natucal Resources. Certification form must be completed and returned to the St. Croix. Coua~y Zoning Offi.~e within 30 days of the three year exp~,ration date. _ _ SIGNED ct,N DATE 7-j3~~ St. Croix County Zoaigg Office P.O. Box-98 N •'1 y r r y •-! 0 y .-i m H 0 'L x M 'v 1 Hammonds WI 54Q15 715-796-2239 or 715425-8363 Sign data and return to above addresb. 'IEPARTMENT OF INDUSTRY, LAi34R ANI? HUMAN RELATIONS xATlvty: S 5~ 1/vl rr•ra REPORT ON SOiL BQRING~ ANA SAI~~.I DIV iSION PERC.OLATiON TESTS (115) MADISON W153707 - (H63.09(21'& Chapter 145.0451 ~~ Z4N/R19 G'Ro I X I NST P~MIUNIC'f/PALITY: vt rvv.: ~~. CJ~So /Y t3 Z mN~~-nvV nv/we~~a.w~. A/ 'Qt1L'ti~FV ~IO 'STc~d~X Si' /vO~TN , R TION: •~New ^Replace Reekknt:e ` N N K 14(.(yt., f~'1~~~( (~rj'j I /~ui~s~N ~V ~ Sao i 6 DATES OBSERVATIONS MADE ,/ S: sons ~ a~~ ~~ a:ai~s Bx exNa+~nT ltY~,i: ~ 8tte ruiteielr for system U~ Site utnuitsbb for syetetn • IN=-~ ~ ~~ s nu ms's $1(;- `.~d -- - -_ - N-FILL OLDIN T K: RECOMMENDED SYSTEM:{optio taq nu ns cp,~~~N ;,.,,,~,~:~ ~>G~ _ __~ DESIGN RATE: If Asrcotstion Tests are NOT required n If any portion of the tested area is in the r undev s.Fi83.09tt~};b}, indicate: t-f~N3S ~ Floodplain, indicate Floodplain elevation: r~~j Via; ~, PROFILE DESCRIPTIONS BO P ATER-INCHES CHARA T R O SOIL WITH TH~KNESS, COLOR, TEXTURE, AND DEPTH ELEVATipN B V TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.1 e- / 5.7~ ~ 3:. t 7 n/on,e S > ~' 7 5 BLL~ 4 QRtJ ~ 39~ LS L. 6i~ ~T•15RN /`~I 4" ~co4 s , ~s S" S B- ~ $~d7 /C~ ./U l~e»A/~ )4.67 r~~Btt • $,o~c.+~ 9o""BR~I CS~6 6e Cab covet St 6a«s ~,~- ~ Q .b? /~5,3 t Nontt ~ B .6? g'8~c.~s 9y BittNStl 7z"6,e-~ M-CSf6+~ /~~~RN C'Sf6t ~t G R S 4'7' C pt M- Q- ~ ••'~ ~ ••t/~V~ ~j ~~1 7 /~ ~j t ~•} ~1 ~ t a ~.3w ~L`T~ IIMYG~•i ~l~ Z~N~J QN /-r•4~ /8'&e-~t CS~~ ®Yr S, 6~ti•• 3S" B2N M- CS ,p 7' Q~•~' ( I JO C ~ 9• S 6 7"8~L-rS r2"6aN5tL zC"Baw M~CS 32~$e.~ GS~+tCiiL Ce>a F Y~0 S, 6QGL~ 3>" $EN C.-M S~k-Ei Q ~'" PERCOLATION TESTS t O TEST TIM V H S RATE t UTES FtERS ~LLIN INTERVAL-MiN- R t RI PER 1NCH p Z 3© ~ 3 >Z > 2 < 3 .4 ~ / ,0 7 Z _ 2 ~ 3 p. tf" YATt ~G.. r - _ _" PLOT PLAN: t3ttOw IoCttions of pereolatibn teen, soli borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what arc the hori- zpRttta) e+~d'ttKtigtt eletratlon retbrenoe points and show their location on the plot plan. Show the surface elevation at all borintts and the tlirectieni and percent tit i~ slope. 69 • _ - - -- ,~- 4 -, ,~ S~`S'~ ~l~1tATIUN /03.60 ~_._ _. I ~ P 3 \ SITE Ltx-a~ loN ~.. , V / ~ t ~ ~ ~ t _, ~, ~ ~' ~. ~, .. ; ... TN ~ (Sy~TCM Et„~JAT IoN ~ ._ _ ;. ~, @ 99.70 ~ ~ Scdcr 58r- `~4 I ~ "` - I t ._ r ~ . __._ __:~i t zz' ~' ZZ z' ~ RoN Pt PC F I , ,- , 79.59 • ~ 1 3.. • i p ~ 1 ... ._. ... ... 'I..~._- F __ ._ 2 ICON 1-i P[ S __ P , P~ - +e . R D ~- dSS 2 aN Pt PC - - L ~J N , /OC1 ~ ;.._ .. v,~- ~`~ ,~,,.~ ~ ~ ~ ~~ ~~ a~ ~a f~ i 1 1 --°-r~ _~- /a ~ ~ ~- ~~3 prr ~~ 6~ J ~r ~ y ~ ~aeb ~; ~ 5~~1 ~ '~ 1 ~~ T ~ ~~~/~` ~~~~~~ ~~ ,~ ,~ ,C.,e ~, ~ ~- ,.