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020-1301-30-000
Q o ~:; ao N ~. .r n O N N i Y r'~ '^r s .~ N .~ ~v ~I^1~ ~• [O V •~ O r~ `~ Tr" O CQ w C H L~ C~ ~n~i A rn ~ ~ ~ v z r ~'w ~ z i. O Z v c 3 LL 3 3 0 a~ Z y .. O `~ O a m O Z V' 'D c 'U ~_ ~ o o> 2 d' ~ ~ H r C f O N D1 7 ~ N ~- N ~ ~ ~ a , ~ z° m z N N C f6 ~ 41 l6 W L (~ 3 m = °~ L Q ~ WI ~ I ° C D a` ~ ~ ~ N N N d i H F- H ~ O O O ;~ ,' o a a a a ~ ~, ~ o N l' ~ rn rn fA J U ':' = rn rn 0 0 ~ O O Y ~ O ~ ~ O ~ r m N N 00 O '. O N C ~ N O V 00 M ~ ~ I ~ o ~ ~ I ~ ~ ~ O ' T y '', ~ r N ~ 7 O ~ _ > M O w '~~' ~' •£ •~ m w'~t _a~'' ma d y V y~ C c i a ~ O v~ ti a~°i o a~i oo 3 0 ~ o U ~ ~ O ~ u C I ~ C I O I O ~ O ~ N C ~ w € ~ N d ~ ~ ~ 3 ,~ O I a o ~ I w ° T E m ~ E Y W " N N 0 N O = (Vp C N C T O N O. N y t6 ~ O ~ ~ y N N ~`• O C O 0. ~ >` fn C ~ t ~ . N p w~ z o 3E I ~ Z ~ i o b C N N U L LL C N C c O ~ ..~ t6 . '30~ I ~ ~ O ~ aTU ma ~ a~ n~ a> -o w rn E m y Q :- m <a E U d a>m ~ O O i a y I ~ ~ y O `~ O N r 0 y d n' m 0 N I O O O `~' U i C U ° C ' ~ p ~ ~ O 'V ~ w p ~ C N V1 N Z O ~ d C N Z ~ m .o U m a r~ ~ N N m 7 O G O ~ ~ ~ ~ 0- c ' I ~ `o v N O ~ I ~ ~ I d m 0 0 ~ I o - Q z c z w I ° ° z z ~ CO y .C O N ~ ~ £ O N N L~ ~ ~ ~ O ~ >_> 9 a + N d i~ ~I >. O ~ ~ ~ m N i C G C a ` ~ A N N ~) a~ ° po ~ i o ~~~ ~ _ a :mo o' a u . o ~ I ~ ~ ~ ~ d ~ o ~ v I Z° 2 0 0 0 z o 0 ~, I ~ aaa ~, I 0 Z I o r ~ ° ~ I _ -0 3 N ,N ' -o No O O ~ M r ~ O 'T,3 O ~ O O "Ci O ~ m) ~ d O ml ~ ~ ~ to N N .LSJ v N ~ ~ ~ N Q L3; ~ ~ Q } ~~ m ~ ~ Q Z ~~ ro ~ N 3 r ~ N Y N N y 'p N gts ~ Np ~ ~ O y0 #5 ~ p ~ ' ¢~ S~ ~ ca ~ p N ~ ~ 5 c E u d o ~ ~ g rn c c ~ ~- ra~ c m i, m N c c ~ c m~ s _~ I ~ O N y ~ lJJ _ ~ ~ ~ C N ~ ~ ~ O ~ q~9 N ~ ~ O ~ ~ r ~ N fD ~ 1 Z N Z d' fn C7 M O Z N Z~ (h w , £ a a ;: a ~ ~ :: c I ~ 3 O :°. o m v ~~ ~~ ~~ • ~ ~ S, °~ b X55 9 / ~ ~' ' ~'~ a~0 J /* w~sconsic,Oepartment of commerce PRIVATE SEWAGE SYSTEM Safety aad tirrildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) De.r,.ne~:nr.,.nrafinn vrn~ rxovice may be used for secondary purposes (Privacy Law, s.15.04 (txm)]. Permit Ho dvr's a , -` ~ _ _ City Village Town o ~ermeraad, .f'an"'~cees ~ludson ownship CST BM Elev.: Insp. BM//Elllev.: BM Description: ~ (7~ V ~~ e~l D C TeNK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~.~ ~_ Aeratio otding TANK SETBACK INFORMATION TANKTO P/L WELL SLOG. vent to Air Intake ROAD Septic ~ + ~3 ~' ~ ~. ~ NA Dos' __~ NA Aera~ien" Holding PUMP /SIPHON {NFORMATION durer and Model Number G M TDH Friction tem TDH t F cemain Length Dia. Dist. ell Count St'. Croix ~n383896 it No.: State Plan ID No.: Parcel Tax No.: 020-1301-30-000 ELEVATIVN uAI A STATION BS HI FS ELEV. Benchmark 3 - 3 a 3 . ~ It. BM Sldg. Sewer ~ ` d . St Ht Inlet d ~- 1U2, S Ht Outlet p L. yr~ Header/Man. ~~, Z Dist. Pipe ~ M - 4 f, ~ 9s is Bot. System nL. .~f ~ 9~''/L 9Y, 3 Final Grade /- 2 2 - D v Z o / 3 -~~ '~ ..Sr SOILA PIIVN~T~Itnn (0 G rs Pc~~ Inside Dia 8E0 ENC Widtfi / Le tfi ~ No.Of Trencfies PIT No.Of Pits . I E ~• S SYSTEM TO P / L BLDG WELL IM 1 N LAKE /STREA L G Mapu afiture ,~/' ~- SETBACK CHAMB a Num INFORMATION TYPe o System: /' .w,.. 1 ~ - ~ A v -~. ~ Z ~ / ~_ NIT ` DISTRIBUTION SYSTE Header / Mani o4d M Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake U ~~ Length ~ Dia. J ~ length ~.~ Dia. ~ Spacing ~-j 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 Topsoil ^ Yes ^ No ^ Yes ^ No Bed /Trench Center Bed /Trench Edges n ec Ion o Inspection #2: J / COMMENTS: (Include code discrepancies, persons present, Location: 429 Brookwood Drive, Hudson, WI 54016 (E 1/2 SW 1/417 T29N R19W) -172919148 Parkview Estates -Lot 142 y) a~s~iva.~~ p ~'!a• s •ks Fad/~c~ ~~ ~`~°I f ~°'"'"~~" 1.) Alt BM Description = fi2r~ ~~<~ ewe/ 2.) Bldg sewer length = eX%Sfw 9 S,~ ~' 36 ` ~rom. r~P'~:c ¢~.~. ~ •~e u 5 Go,~ ` -amount of cover = ~ ~ Q~~~~ ~ a ~~ ~y~ 3 ¢~~ ara~FOr` du,rtvr 3,~ 5<< ~(tiS~~U'6or~ A~ ~~~"~9f9 %r~sfal~~:or~wl~ loac.~Ctif~e~ be~r< «.s~oeG~o,~.-sr Plan revision required? ^ Yes ~ No ~ ~ ~ other side for additional information. U ~ S d se ' Cerc No SBD-6710 (R.3/97) . s azure Date Inspector 93~f3 ~,~--cE ~vT-- ~ Sanitary Permit Application Safety & Buildings Divisii In ticcurd ~i ith Comm R3.3I. Wis. Adm. Code 201 W. Washington A~ B 0 `~SC~ns~n Sec rep erne side tier instructions fiir completing this application 07-73i Madison WI5 37 rJepartment of Commerce Personal information you provide may he used tiir secondary purposes ~Privac) La.+. s. 15A4(1)(m)) , (Submit completed form to county if n stateowne< Attach com lete lans tw the county co ~ onl ~) for the system, on a er no[ less than R-1/2 x I 1 inches in size. Counry State Sanitary I'emut Number ^ C'heck it revision to previous appCcation State flan 1. D. Number r 1. A lication Information -Please Print all Information Location: Property Owner Name Property Location /~ ~ IV,~1J4 Gdl/4,S,I T.Z ,N, or operty Owner's Mailing Address Lot Number Block Number ~ 2 c~ Ciry, State ~ "Lip Code Phone Number Subdivision Name or CSM Nu l~ O S` t 7 cS-) ~6-.255 L,+~~'!~/ S .~ II Type of Building: (check one) / ` l of Bedrooms: ~~ ST` rL - No il Dw lli 2 F i ^ City ^ Village --- J y ng . e or am ~ Fii Town of Public/Commercial (describe use}: M ~ O State-owned dam" III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road q) 1. ^ New System 2. ,~1 Replacement 3. ^ Replacement ol~ 4. ^ Addition to Parcel Tax Number(s) System Tank Onh' Existin S stem d2~.- p/ "" Sw B) Permit Number Date Issued A Sanita Permit was revioush issued 2~ 3 ` - IV. Type of POWT System: (Check all that a ly) Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding "lank ^ Single Pass ^ Drip Line At-grade ^ Aerobic Treatment Unit ^ Recirculatin ~ ether: l zi~ rks~c u C ~ ~ ~i // ~ ~' ~ , _ ~..~ . Y, r r., o~ , T ~ 2~c V Dis ersaUTreatment Area lnformation: ' ' " ,,. .;~- 3~M "~ :~- r .- 1. Design Flow (gpd) 2. DispersalArea - 3. Dispersal Area 4. Soil Application 5. Percofation'Rate• 6. System Elevation 3 CElls 7. Final Grade El i Required Pm~~d~ ~ ~ Rate (Gall./~y/sq ft.) / (Min./inch) ~¢GL evat on t7~ Q ~'~ ~~ / 7. 4 .. VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks . ^ ^ ^ ^ ~ .~m0 ^ ^ ^ ^ ^ VII Responsibility Statement 1, the undersi ned, assume res onsibility for installation of the PO shown on the attached tans. Plumber's Name (print) ('lumber's Signature (no sta ps): ~Iv}f'/MPRS No. Business Phone Number umber's Address (Street, ity, State, ip Code e toy Z~'t ~.~- ,-' D VIII CountylDepartment Use Only • ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued r[ Signature (No stamps) A l proved ^ Owner Given Initial Adverse Surcharge Fee) ~ ~p,p/ ~ 3 1 0 ~ ~ ~ Determination / L)D IX. Conditions of Approval /Reasons for Disapproval: ' , ~ PG~tplwti• ~~~ .;~ ', `~ 'Mc. ~ ~ ~ ~ i-tsv ~~`l"titw.T ~ k 1 -~c.,~ 5 ~l~ ~ : (M rat +~~1,~c, ~ ~ p?~t ~~ wwr~.e.~t`^''`~S',~ G',KzG,ira't s , ~~~~o .. 5o'tl- d~,~ ~nk~ . r ~ \ ~ A ~ ~ b ~ • ~ 0 O.~G N h U ~+~ I} /~ t~ H ~ 1r ~ o a ~ e +t y a ~ ~ 3 C 1 o ~ ~ ~ ~ ~' s ~ ' ' a ~ ti ~ ~ ~ a ~, :o o b ~. r~ ~ ~ •\ y a ~P W y,, \/1 ~~ a ~ ~ c ~ ~ ~ N ~;' - - - --~ - - - --` a ~~~ ° ~- ,~ ^'v N A V C W r~ at ~ ~ ~ ~ 3 _~ N w n ~ ~~~ r r i 4 ~ ifl ~,~ 'o~ d - ~ ~~ ~~ ~~ ,~ 1 ~ -e f \~ `~;, x .~` `w v~ A x try & ~ 1~ y N ~ ~ +~ b ~ c~ Z~\ ~ a ~ a~~~~ ~ ~~ y n ~y x i w 4~ a o~ ~ U ~ ~ ~.~J ~~ ~ U N F-+ °~ ~-.a C~ ~ p • --~ ~ ~ .~ U a~ O U j ,^~ X II °s, b ~'1 b a~ w ,. ~. C/1 a ~ U ~ ~~ . ~ "'I ~1 a) , I~ ~ ~ ~ M II 0 1-~1 O V3 f,;~ v ~ ~ .~ II II ~ v ~ ~ •.., ~ ~ a ~ U ~ a~io o II ~'` w •~ ; ~, ~ ~ ~ W •.~ ~\ / '\, i y \ ,~\ ~\ ~ a ~\ ~~ ~~~ ~ Y ~ \ ~ • ..~ it '. v: ~ •~ ~ ., . ~ ~ • , • i •~~, .~ :a, ~. 3 8 :. ,, ~ . `o ~~- ~~~~, ~? ~, ~, . a ; i . ~ ~ 'b ~ ~ b . S~ ~• 1 ~ .... ~.: ~' - v ~l .~~ .~ s 6 i • ~. .. ,~ ~ ~ ,: ~ ~::I c :~ ~•~ ,~ ~ ~.p .' ~ a ; ~ , A, ~' _a .. .. , ,• .. .. r. ~. a , a~ . , o •. Q:.. ~ ~ ~ O ~~. ~ .. ~ ~ t `,w II ~ I~ II ~~ ~ ~ 0. L7' ~ W , ~! ~ ~ •~1 ~ ~ ~ O ~ ~i 8 •" ~` , ~sconsirl Department of Commerce SOIL EVALUATION REPORT Page _Lof Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ~ ~, Attach complete site plan on paper not less than 8 1!2 x 1 t inches in size. Plan must inGude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and IocayrarrSrid distans~to nearest road. ~2 p ~ f 30 / - p Please print all info '»,tion ~`~~ Reviewed by Date ~,. L c ~ ' ' Law s 1,5.04(1) (m)). ~C~ ~ ,~ ~yl 6 Personal information you provide may be used for dart' Qurpos Pn~Ry Property Owner ""~ / ~ ' ~~~ ..- Proptzi~jC ovation . . _- ~ec~ ~ ' ' ~.s , ,_, Govt. Lot , C' 1l4~f'(,rJ 1!4 8 T N R E (or, roperty Owners Mailing ddress ~ ~ 1 Il, t # lock # Subd. Name or CSM# ~. Ci State Zip Code Phone Num +NGOOtrF~ [,~'C~y,~ ^ Village Town Nearest Road ^ New Construction Use: Residential / Number of bedrooms"'-" ` ' Code derived design flow rate /df/J G Replacement ^ Public or commercial -Describe: Parent material Flood Plain elevation if applicable rtJ~iCt and ecommendations: ~©(/.HVr~ vy~J~~'/~ ~-r'ELv '~ F'~~~~ /'~/~s /V/T .~~~L'~•v I / I o~~~^ ~ ^ Boring ~~~ pit Ground surface elr ~. ~~_ ft. Depth to ummng racror ,~L_ .11. ` lor Redox Description Texture Structure Consistence Boundary Roots t C i h D Soil Appliption A GPDlft2 Horizon Dept in. nan om o Munst I Qu. Sz. Cont. Color Gr. Sz. Sh. ~ 'Eff#1 'Efts lG -- - - _7 3 L S l F S "~- 3 s4 r- ' _ - S .. ~ L -' ~. - - . h• /__ e ~ Z ^ Boring Bonny # 5`-' pit Ground surface elev. ~9 y ft. Depth to limiting factor ~ in. Spit Apptipfion R Horizon Depth in. Dominant Color Munsell Redox Description Du. Sz. Cont. Color Texture SWcture Gr. Sz. Sh. Consistence Boundary Roots GPDltt= 'Eff#1 'Etf# l r .EGG -- - -- ~ z SL ` " 3 S S __-- _ 7S_ ,~ '_." ~.S L .~ _/ 7 ,~-3 oS~ """.' z (~~ ~ 4• Y ~ ~- ~ _..,n _ own ~ ~n ..,.,f/ enei 7R& - a 3n me/t--~ . • Effluent #1 = 900 > 3u ~ ~ u mgrs ana 1 as you = 1 w 11,~~ - ' SST Na I ign lure CST Number zz rdv Addr Fogerty umbing & Perk Testing D e Evaluation Conducted Telephone Number 28288 McKenzie R ~ "D 7 ~ - 61 r^ o ,,... C~_~~~_. 11f1 C i0A1 . ~ r t Property Owner Parcel ID # ~20 - /~O~-.3 ~ Pape -Z a ~ 3 a Boring # ^ Boring _ ' ' ~ ' (f ( p;t Ground surface elev. „ fQ„~_ tt. Depth to limning taclor ~ /~- in. 7- Soll Applicaton Rab Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl= In. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. ~ ~ ~ 'Eft#1 'Eff#2 v- 0-z i ~s s . 7 /, z D! .! • ~~ (.' 7 ~] Boring Boring # pit Ground surface elev. ,~~ ft. Depth to limiting factor > 96 In. Soil Application Rai Horizon Oepth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 2 _ / •S ~ 3 _".~ G ,3 - tr jrr =- - Z ^ Boring # ^ Boring pit Ground surface elev. r L ft. Depth to Ilmltinp taclor ~ In. Soil Application Ra Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft2 in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ -- - - _10 _s G tir.- .z • r_ L C g Fie G .- .. ,3 --- S r=S C L ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Etnuent #2 = BOD, < 30 mglL and TSS < 30 mglL ' r" ~ ' _ _ .. =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 G08-26G-3151 or TTY G08-264-8777. seat»o ta.wool ... . , ~') .-.v 00 v o ~ v(3D ~N~ d W n r o ~~ ~ ~~ o o ~Oa w ,Q d A ~- P q om II ~ II ~ m ~ U 3 ~ ~ ~ N e G `~ ~ y ti~ o ~ h~ ~ ~ ~ © ~ y ~ ~ o ~ ' ~ y o y m ~, A ~ O ~ ~~ ~c 1~ ~~ A ~ N ~ It _\\ I `~ ` ~~ w_ ,. ~------~ -,0 w~ ~„ N x e Z ~~ ~' ^-~ ~ w x ~4'x '`~ r ~\ x ' ~ ~~ \^ 1 } \\ D~ ~r ~~ ~' so N V O ~ ~ ~; pp#s w~~~~ °.'~m'rc o~m °o°~ ~~a w ~~ y Q x h I I x ~, ~ C • Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number 3 3 Number of Bedrooms y Design Flow -Peak (gpd) G oO Estimated Flow -Average (gpd) ~ Septic Tank Capacity (gal) / v i Soil Absorption Component Size (ftz) S"fo ~- ~, ~// ,,e~ii Type of Wastewater Domestic ~7 r L .+-.~5 Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Com onent Design Flow -Peak (gpd) ~- ' ~ Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe di~cu/t or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years: The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair anti{ weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 ' ~ Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. ~~- `~"Inp ~ev~ ~ ~ s y S-~e~,n -~.;1,~,~n-c ~- ~to$e~ ~4lka~. ~iw~ e ~-F~~.e l` ~S~ 3~ '`~~S~D 3 y -, Owner/~er ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM l`°=' %' $ :::. _`_ ~:' _.. °~±~".'~ t ~ 2001 sr c~o,X .. ~') \ Mailing Address G/19 "I1/~Q7l~~cOrJ,~ ~~,. ;t1~~,~~~QL,~ Property Address y-z q ~i~~.f'G/,~D() ~ 1,e (Verification required from Planning Department for new construction) City/State f~GrL~SoJt/ /.G[z' ~/Dl~ Parcel Identification Number ,~.~D --/~y/-mod --t~DD LEGAL DESCRIPTION Property Location ~ '/., ~~ '/,, Sec. / 7 . TAN-R~~~~, Town of ~i/~1~~ Subdivision _~~i~/(' l.~rf/ ,~~}~?,~S' ;b "~ ~dl>>~ ,Lot # ~y-Z Certified Survey Map # ,Volume '~ ,Page # Warranty Deed # ~~~y3 Volume 1 y3y ,Page # ~~~ Spec house ^ yes (~ no Lot lines identifiable ~J yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resource3, State of Wisconsin. Certification stating that s tic ystem bas been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of ee year xpiration date. / ~~/ SIGNA DATE the I( SIGNATURI~ OF .~_~se---~,r.~ DATE ««ss•« Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department.'*'**' statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of by virtue of a yvarranty deed recorded in Register of Deeds Office. '• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed !~ _. ~I STATE BAR OF WISCONSIN FORM 1 - 1982 WARRANTY DEED Q DOCUMENT NO. vOi. i434PA~E185 This Deed, made between DELTA CONSTRUCTION INC. -- a/k(a Delta Construction _ Com an , a Wisconsin Cor oration Grantor, and J GERMERAAD a d husband and wife as survivor~hio maritaLprop~ty Grantee, Witnesseth, That [kte said Grantor, for a valuable mrtsidera[it*+ conveys to Grantee the Following described real es[a[e in St ('roix Coun[y, Slate of Wisconsin: G04943 Y.RTHLEEN H. WALSH STGICROIX CO EEWI RECEIVED FOR RECORD 06-14-1999 1:20 PM NARRNITY DEED ExEnPT rl CERT COPY FEE: COPY FEE: TRANSFER FEE: 539.40 RECORDIlIG FEE: 10.00 PpSES: THIS SPACE RESERVED FCR RECORDING DATA --~.. e ~,~NAME AND RETURN A~GI'Vrn To: Edina Realty Title 400 South 2nd Street Suite #115 Hudson, WI 54016 020-1301-30-000 'I PARCEL IDENTIFICATION NUMBER I'. Lot 142 Park View Estates Sixth Addition to the Town of Hudson, St. Croix County, !;' Wisconsin. ~'. This is not homestead property. (is) (is nod Together with all and singular the hereditaments and appur[enances [hereunto belonging; And e warrants tha[ the u[le is good, indefeasible in fee simple and free and clear ofencumbrances except - none and will warrant and dre~fend the same. Dated this ' y day of ,19_.__4_ DE A CON RU TION, INC. (SEAL) " ~ (SEAL) Virgil edorenko (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Stale of Wisconsin, ~' Signature(s) ss, I '~ St Grog x County. ;~ authenticated this day of , 19_ Personally came before me this l day of ] 92_, the above named P~6 t~. Poulin TITLE: MEMBER STATE BAR OF WISCONSIN Notary Public ~ (II' oat, wISCOriS1R Who executed the fore an State of authorized by 9706.06, Wis. StatsJ to me kno to be the pers t __ g g instrutne and acknowle. " ~ the same. TH[S INSTRUMENT WAS DRAFTED BY t - A orney BarYY (' T„r,A n , MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. St. Croix Cuunt wis. 16 Notary Public, X (Signatures may a authenticated or acknowledged. Btnh are not My commission is permanent. (If not star e~ I non date, 1 r g~~9 ) _._- _. • Names of pawns signing in any capaatc should by typed nr printed bebw Iheu signawres. wisconsul Legal frank Co., Inc. STATE BAR Of WISCONti1N M~Iwa~ke6, Wes WARRANTY DEED Fnnn .'JU. I - 1982 ti~ ST. CROIX COUNTY ZONING DEPARTMENT ,~, Z" ~ ' ~ ~ n ~ , A5 BUII..T SANTrARY REPORT Owner ~~~'C l~}~ Property Address _~l^~d~?/l'Gv~DL~ City/State ~t ,t/. mat . ~'tLD/6 - `~ ~ ,~ l --`t ~~~~ ~ ff ~~~~ ~ ~~, ~. s~r ~~aa-x ~- ~...~~ ~rx+ A r Legal Description: _ `~, Lot 1 yZ Block -- Subdivision/CSM # '- /~~ f/-t'~~~ /Ut-= '/4 ~ '/a, Sec. (,Z, TAN-R,(~W, Town of /,~G~dso~ PIN # ~~ ale / -3r o SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer G~E~'~'S Size STfPE/~, d/_ Setback from: House ~ Wellyb~EPIL -- Pump manufacturer Model ~-----' Alarm location (HOLDING TANKS ONLY) Setbacks: Service road- Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: ~~^.~ Width ~- Length .~"D Number of Tenches Setback from: House>//3 Well .~ P/L ~" Vent to fresh air intake ~ / 7.S-~ ELEVATIONS: Description of benchmark ~ ~ o~ ST~~-G /~efT ,r/F_' LOT ~o.~/r/~/Z Elevation _ ioo.D ~ Description of alternate benchmark Elevation Building Sewer /'d Y / ST/HT Inlet O 2 • ~ ST Outlet ~'y z • ~/Z PC Inlet PC Bottom --"- Header/Manifold ~': d Top of STFPE-Manhole Cover /D5!d `l~ Distribution Lines () !'~ 9 ( ) Bottom of System () ~. ~ () ( ) Final Grade O 9 7, a O ( ) Date of installation ,~/ /r / ermit Plumber's signature Vent toair intake Water Line ~ ~ State plan number '"' License number -Z ~ / / ~d Date Inspector IL oC/ ~ I ~~ lx .Gt' Complete plot plan ~ ~, NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. ~. PLAN VIEW i d _ ~~ P o ~ s frEC ~~~ ~,:d ~~ C~F~ N~ 3 11~ I Q~ 0~1 ~/ G-~'- INDICATE NORTH ARROW • Wi~cpnsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division - ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Lev, s.15.04 (1)(m)j. ~~ ~ ol~~ir~n~ ~~fl~ illage ^ Town of: CST BM Elev.:. Insp. BM Elev.: BM Description: l(Sa T ~1°~ne-2 s'~-. 1 MIYn n~~ vnw~r~ r rvw TYPE MANUFACTURER CAPACITY tl c (...j A..t.1,~ 12 an Dosing Aeratio Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Airlntake ROAD S 'r l3 (o~ N (a- ~ g / NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer De and Model tuber GPM TDH LI Friction S ste TDH Ft Forcemain Length Dia. Dist. To well ELEVATION DATA n ID No.: STATION BS HI FS ELEV. Benchmark 9',p~ ~(~.p Lip A (a ~ ~o~'• 03 2 . os 1as•~ Bldg. Sewer 06.03 ~ . ~2 ~o . / ~~E Inlet raa.p3 S'`f ~O~•<o 3 ~t ,N[ Outlet (OQ~.p?j s. !da • y Dt Inlet Dt Bottom Header /Man. ~d3„~? ~(.(~ 1( ~ ~ ~ Dist. Pipe (p3 -fo7 4. ~'~ °f cr 7~ Bot.System ~o~j.~ ~•(oQ~ gj,~ Final Grade ~ (03•l0? ~ `m ~v d• .7 S~ . ~~.~c,w6veo C /d~1, 0 3 ct -ll !d c{. o S 6 uc - ~ s [~-~ . ~~ I~~.~ ~ na S~JJ~ABSORPTION SYSTEM BE ENCH Width r ~~ Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid , pth MEN I N DIMEN I N SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM L CHING Manufacturer: INFORMATION Type /~ ` ~/ ~,,~3~ ~~ OR UNIT m er: ~~ Syste T ~ DISTRIBUTION SYSTEM Header / M~ajnyfold 1~ f1 ! ~ Distribution Pi/p~(~ / u ~ ~ ! ~ ~ x Hole Size 5~ w ' x Hole Spacing Z6 Vent To Air Intake l Length 4 Dia. I Length / Dia. Spacing Pc Z f SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Ov xx ee a /Sodded xx Mulched Bed /Trench Ce er Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 17.29.19,NE,SW 429 BROOKWOOD DRIVE ~ ~ ~-w ~~ ~e~u-rt. u~a i ~u~w2a~' -- ~xu,c~ 3 0 ~ w~ ~~ `~'~^~"" ~ `~ L ~'~`~°Ga-~~ ~~ Plan revision required? ^ Yes [~No Use other side for additional information. 5 SBD-6710 (R.3/97) Date Inspector' Signature t No. ~~" q4 ~ ~1 ~ ~~<<~~ ~~ ~~~~r ~~~_.,~~ ~/~ y/~~' `off ~oIS'ti~R / ~9SSU~E /Gbd ~ ~3 e/~ GvT ~` /38 i¢sfuss.rc ,`!. > 3 ~ 1~ _ 's~4'c''~~Gs' ~ u.v~ Lcr lo,t.V E'er' O _ /.2~ad 6~G. ~'. T. `~] c L'~~fZ (f '~ I ~f ~ ,~ f~~~ 7 ~~T~~ ~ L .Z ~ Gc~y' Yc~/°r~~ •t IL N~ /=.t/!~ D~ l'lE'L,/~ . ~< ~u r ,yet ~ ~CCo Ate, ~~ /~ ~ ~2 ~i ~~ ~ l~ I ~ ~ ,~ z~ ~~ccR t J t ~ r ~ .._..~~ ~ ~~ ~ ~St~_ anrisconsip Department of Commerce SOIL AND SITE EVALUATION Di i i fe ~ ~ - v s on of.~a ty and Buildings Page of Bureau of Jntegrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code ' Attach complete site plan on paler not less than S 1/2 x 11 inches in siie. Plan must `'` County ' include, but not limited to: vertical and horizontal reference point (B~; direction an ,, ~, percent slope, scale or dimensions, north arrow, and location and~li~tartce to r "" ~a el LD. # f r ! t APPLICANT INFORMATION -Pl ll i i t f ~l ati ~~ ~ D ~ JO - ~ ease pr n a n c ~? ~a m o ~ ~0~~ Ri<ui ed b Date Personal information you provide may be used for secondary purposes (Pn~ raeylaw s 15.Q4~,(1,,~ ~ Property Owner ~Jti Z 2 c ay o~cation~` ,~ ~ ~L,~/f1' ~O~t'/S ..., o o ~'~ l4fw 1/4,S T Z ,N,R ~ B (oF~ ` Property Owner's Mailing ddress ;~ Lz~t-#- ~ `t3t~c1< Subd. Name or CSM# ~2'-Q Z h , ~` ~~ C l~'~ City - / State Zip Code / Phone Number ~ ^ City ^ Village ~ Town Nearest Road' ' / G1vs0/!/ Gr/= ~Ib ~ ) I ~~ G1 O,f~ u~ L~R - I~/~OD U2~ ,~ New Construction Use: Residential /Number of bedrooms y Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow OD gpd Recommended design loading rate ~~ bed, gpd/fit . ~ trench, gpd/ft2 Absorption area required bed, ft2~trench, ft2 Maximum design loading rate 7 bed, gpd/ft2~_trench, gpd/ft2 Recommended infiltration surface elevation(s) ~ / 3 -'ad` ft (as referred to site plan benchmark) Additional design/site considerations F{?f~/C/~ ~ is 97.v Parent material ©G!j'4/i¢S~ Flood plain elevation, if applicable ~/.9 ft - S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ~ S ^ U ~ S ^ U ~ S ^ U ~ S ^ U ^ S ~ U ^ S ,~ U SOIL DESCRIPTION REPORT Z y6.~ Ground elev. 93` p~ft. Dep to limiting Horizon Depth Dominant Color Mottles T t Structure C isten Bou d Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. ons ce n ary Bed ,Trench Z ?3 3 6 LS / fit' ~ 8 3 3 3 S- y G cs v sG _- ~. ~ ' ~ j s •s v .raL~ ~t `t ~.~ ' Remarks: .3 -S/ "- -- C 5 yr L S 1- 7 -- ~t © G ~L - - ' . 8 taS.~2 r b~ to .S factor 7 m. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number PROPERTY OWNER 1~EGTi'l7 C®~iT•_ PARCEL I.D.# D2d - ~/JO/ ~3~ Boring # 1 ~~ Ground elev. ~~tt. Depth to limiting factor }/lam in. Boring ~ ~, D Ground elev. ~ct?~s~ft. Depth to limiting factor >l~~in. Boring # Ground elev. ft. Depth to limiting SOIL DESCRIPTION REPORT Page •Z , pf •3 ~ • Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. MUnsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench 2- P--/G s- Ls -- p 3 - 8 ~ o ~ ~ ~s - , ,, ~. 5 ~ !h L f>zs ~ -- . 7 ~ . Fl 7•S = ~ ~n ~L - -' 1~ y~ ~~. 2 } 3 ~ ct'3.5? '~ Remarks: S ~o - z 2 - L FJto Z6. v 1~o2ryrJ ip-f ' p Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/fit in. Mansell.. Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench O ~ D 1Z _~ S 1 /' D ~~- r ~~ O' t~O . Remarks: o 2~'° o .v factor in. Remarks: SBD-8330 (R. 07/96) ~`~~ ~~~~~~ ~~~r ~ ~~~~ ~sf ~~ ~-~~~~ /j~~~ ~r ~ iYL Sc~G ~J _ ~ .tluJ Gil C o/Zw~IZ~ ~Sj"u~E' mad X aoe.~-.~~s • _ ~Oc~ti ~ GoT Co~'~vE',~s s' #s ~, •~y~~/ ~X/ ~'f 0 r i x /y-~ #-3 ~'° ~/ v s~' ~ `~ X ~~ ~z ~ ---_` i ~ 7Y~ ~ ~rx~ ~w ~~~ .~% . d-~ ~ ~zvv~t yrw ~ - nor ~ `a~ „II ~~ ST CROIX COUNTX SEPTIC TANk MA[NTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OvVner/8uyer Mailing Address ~/ 6 Properi Address r! ~ ~y~~ (Verification required from Clanning Department for new City/Slate f~~~/~~t-r, w-~ Parcel IdentiCcation Number Ozo - /~~ - ~~ LEGAL llESCItII''T'IVN Property Location ~~ '/., _~ '/., Sec. 17 , T~_N-R_~W, Town of _.._~.~_• Subdivision ~ ~~~~, ti t~. Lot# ~¢~ CerH[ied Survey A'I:tp # ,Volume ,Page # ~Varranty lleed # 33~ ,Volume ~ d ,Page # .Sy 7~ Spec house d yes~1 no Lot lines identifiable J8 yes O no SYSTEM MAIN'T'ENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out t{ue 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. 11re property owner agrees to submit to St. Croix Zoning Department a certiGcativn form, signed by the owner and by a master plumber, journeyman plumber, restricted phumber or a licensed pumper verifying that (I) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than I/3 full of sludge. I/we, Clue undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration dale. ~~~-~ ~~ ~ z wzl9 SIGNA C APCLICANT DATE OWNER CER'TIFICAT'ION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the roperty described bove, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNA7U OC ACCLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ***'*** ~~ ** Include n~ith this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the wattanty deed . r r' . Safety and Buildings Division SANITARY PERMIT APPLICATION 20, E. Washington Ave. -~COnS,An In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707-7969 ~ Attach complete plans (to the county copy only) for the system, on paper not less county than 8 vi x 11 inches in size. (' ~~ • See reverse side for instructions for completing this application umber state sanitar ermit N The information you provide may be used by other government agency programs ^ Check i revisi td pre'vi~application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number f. APPLI ATI N INF RMATION -PLEASE PRINT ALL INF RMATION Pr erty Owner Name L ~- Property Location „ t is ~,wa, S ~ T ~ , N, R E (o Property O ner' Mailing Address Lot Number Block Number ..~- Cit , tate Zip C de Phone Number Sub Ision Name or CSM Number I1. TY ILD (check one) ^ State Owned ~ It~ Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms ~ Town OF /'b~ C '•~ 111. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) j 1, ~ ~ ~ Cl, I ~2. 1 ^ Apartment/Condo -"' ~- -~U 2 ^ Assembly Hall 6 ^ Medical Facility/ Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise:Sales/Repairs 11 ^ Restaurant/Bar/Dining 4 ^ Church /School 8 ^ Mobile Home Park 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 _ ~ New 2. ^ Replacement 3. ^ Replacement of q. ^ Reconnection of 5_ ^ Repair of an ~______System________System_____________TankOnly______________ Existing System _________Exlstin~System B) ^ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ~ Seepage Bed 21 ^ Mound 3Q^ Specify Type 41 ^ Holding Tank ~ 42 ^ Pit Privy 12 ^ Seepage Trench 22 ^ In-Ground Pressure / ¢ t x r / ~ 13 ^ Seepage Pit 0 7 43 ^ Vault Privy 14 ^ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Fina! Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation i~Q ~ ~ ~ ,, p Feet p Feet VII. TANK INFORMATION Ca aclt in allons g Total l # of Manufacturer s Name Prefab. Site con- l st Fiber- Plastic Exper. . . N i E i Gal ons Tanks concrete ee glass App . ew x st n strurted Tanks Tanks Septic Tank ~jr/ -- ~s ^ ^ ^ ^ ^ Lift Pump Tank /Siphon Chamber ^ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of th nsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stam ) AAE[MPRSW No.: Business Phone Number: z^ f - - ~~ Pa ~ r 6'~~ Plu is Ad ess treet, City, State, Zi de): ©i IX. C LINTY DEPARTMEN USE ONLY ^Disapproved sanitary Permit Fee llndudesGroundwater Surcharge Fee) ate ssue IssuingA entSignature~(NoStamps) Approved ^ Owner Given Initial ~J ~ 2~~ ~ ~ qp l ~ Adverse Determination / i X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: sBD-639a (8.11/96) DKTRBiUT10N: Original to County, One copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS ,.,~ 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Cade will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 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. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. 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. IX. County /Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the followiry~j: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; 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; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. r "~~ ~~ 1 $B ~ o o I 300.00 ~ ~ r,. ~ 833.2Y 871 to 10A• ~ 174.00' ~. 125.00 40224 208.24 147.74 0 1021 g 300 ' No 151.00 w LOT 134 LOT 133 ~ 105 o c"r 103 w 1016 o ~A 14 4 H 1473 ~ 1022 ~ 1020 °- 99 .LOT 135 0~,. ,~ 150.00 150.00 300.00 p 1475 ~' ~' ~ ~O a~ ~ 102 0 ~ ~~ ~` ~ti9~ ~ ~ 1019 ° ~~~ I LOT 132 ~ OT ~ " 1~6 ww .~ 3 .oo' Zoo.M N 342 3Q N / ~ -~ LOT 136 ~~ i 1472 1470 1023 101 ~ 10 o ~ 253.02 0 1018 101 1476 ~ ~ 300.00' ' LOT 131 ~ _ ';, ~ 1471 s ~' L 0 T 137 ~ ti~ 0 293.2s 243. m 217.47 ?. 2' 0 1477 o LOT 38 ~s~ ~\ ~,~ LOT 146 107 0 ~ 210.00 147 ° ,,~° ?e 1486 ~ 1024 1 C 'sue a~ / ~~;QT 14~e~ ob wL 0 T 139 ~ 1485 ti " 160 g6 ~ 243. .1479. ti6ti~° ' ~ , ~ '9Q ~b~ry L 0 147 129 ~~a~ ~4a ~ ~ 14 ~ 1228 ~ 1482 4' ~ e ~O j LOT 1410 ~° - 1_4_84 ~°oo _ _ ~ ~ _ 1.481 I~ ~ w LOT 144 0 1480 ~~~ ~~~ LOT 143 ~ ryo9° ~ 128 ^~ o LOT 140 ~ /~ Nw 1483 ~' ~ 1227 0" ~ •~ 217.37' ~ PA ~, $ 285.00=- ` 147.28 ~~` - - c _ 0 ~' ° N ~~" 12fi ~ 1. OUTLOT 2 127 T 1488 1226 1225 12~ .oo' . 159.81' 154.81' 151. 3' 155.38' 235.74' ],9].49 205.41~N ~ 2 6.63 18251 t S ~4 N ° 1077 1078 M 10 9 1080 83 w g4 ~ 85 0 86 ~ 8i N ~ 78 0 79 N 8o I ~ "~~ 1082a 1083 ° 1084 °° 1085 108 M ~, I g 81 m 82 ~. - ---- /4 _ lL L O _Rl~ E E S T _ -_ -- ~~ T 1081 - ~ 133.00 i ' ~ 75, 00' N 188.0 ' \ w 9 ~ h~ 92 ~ 1098 1097 10 93 1091 " 1090 ~~ 99 ~~_ ~ 0 6 w o~ 1092 i ~~~~ r~u Msct [.atarso •ea aec4~++~ ~*" ~ .~ . ~ ~ ~• rIOCUGeiE*iT 1~4 iTATN Sl1= O>E 'wi$~f-I~IE1N >ro>t>t[ ! ->18~ -- # ...... Edna G...,Smith:..,a/k/a...Ldna..Sniftt;:,...a single conreya and warranty to ~~ ......... PLazt....and..aeYar3.~..Ater.to...a/k/.a..aeY~axly...A.,...... ._ ......H~xt,,...~usbamd...and..hli~s..as...talaar~ta._.i.n ............... '~ . _..a~mnwn.=aad..mat..as.. ~ ' nt...temarata....... ................. the toliowrins desesibed teal estate in ........... St.~,,.Crox,,,,,,,,,,,,,,,C~.,nty. State of Wiaconsia: (See legal description on reverse side) TRANCE' is ~- X art nT" This ._.......i3._.n~t..... homestead property. t#id (is not) Exception to warranties: Dated this ............................................... day of ........ ........................................ (SEAL) ............. ..................................................(SEAL) ADTB$NTICATION Si6uatnre (s) authenticated thin ._......day of_.......°.---•--•-•--•--, 19...... ....................... N.~A...... ......--•- TITLE: a[EMBER STATE BAR OF WISCONSIN (it not. ---•---.....--• ............................................. authorized by ~ 706.08. Wu. State) TMfB INSTRUMENT WAS dWAfTED 8Y ..Attyx...Hlagh...~~.. Gwn,,_-.~win__&.,_Gwin.__ ._4,~Q_-,~~,~q.~ii~.. St_,,,,.. Hudson,._ WI._54.016, /Cimrs4.~noa .nna #r .n}Aantir.r.taA nr arknnarlar#var#. Anfh ~. rti R~/~A LN~~ R1 It'd far Read ar JAM 104~?0 M a.~ M'`~I~alO~d~ «trv«« to Galin ~& (twin P.O. Box 106 Hudsonr WI 54016 T~ Para] No :.............................. January... ~'`u~l--.....~ ................ Is 90 . ~(i",.y`~i.... ~" "-.'...~~°t..L "'- (SEAL} • .-Edna..G~...Smith ......... ...... ... . ., (SF.AL1 -~ ., ~' ~ ,•i~ v1 .~. AC SNOWLED~I~JlcsJT ~ 'U .~.,~ :~: STATE OF WISCONSIN ,~ ~ _ .... St,...Croix_..........Couney. ..,,., i Personal] came before me this ................day of Y ...... JdTiUdrY .............. 19. g~.. the above gamed ..... . _.Edna.•G.. Smith,•..a/k/a Edna Smith, a single woman ................................... . to me known to be the person .........-. who executed the foregoin instrument and xeknowledQe the some. St Croix Notary Public .............•. .........County, Wis. My Commission is ner^ianrnt.(If not, state expiration ,.~ ;• a ., ~~ FY ~ l - ~' . E t ~`.:_ ,~ ,~., , ~ ~ ~ r .. ",' ~~vr~... t f ~ ~ . "~ ^ a.. ~~ r ~ ~~. .~ g ~ ~ .. y r~ r- - ~ ,y ., ,« ~ ~ ` _ ~ '~ ~ • pU PAGE ~' ~ _ - A parcel of land located in the Northwest Quarter of the Southeast Quarter (NWl/4 oP SE1/4), the Southwest Quarter. of the Southeast Quarter (sw114 oP SE1/4), the Southeast Quarter of the Southwest Quarter (SE1/4 oP SW1/4}, the Southwest Quarter of the Southwest Quarter (SW1/$ of gMT3/#}, the Northwest Quarter of the Southeest Quarter (NM1/4 of 3W1/4), and the Northeast Quarter oP the Southwest Quarter (NE1/4 of SW1/4) of Section Seventeen (17), Toilnshfp Twenty-nine (29) North, Range Nineteen (19) West, in tht '"own of Hudson, described as follows: Commencing at the East Quarter (8114) corner of said Section 17, thence Westerly along the East-West Quarter Section Line 3 89~ 18' 41" W, 1,332.98 feet (previously recorded as N 89o S3'-20!". W, true beading, 1,332.90 feet), to the point of begeu~iag; thence S 00 03' 03" W, 1,747.21 Peet (previously rsooedelt 0 as 3 0 05' 20" W ,734.97 feet) more or less to a pp~~a-i~tt which is also N 00 03' 03" E, 880.11 (recorde$ as 1189# teed from the South Life of Section 17; thence S 89 09' 2Te Y .; (recorded as S 88 59' 10" W) and parallel to said 9ootg"'.:: Line of Section 17, 2,983.50 feet more or less to a point which is also on the East line oP the Plat of Trout Bl'oolt Woods; thence Northerly along said East line of the P3$t of Trout Brook Woods, N 0 41' W, 827.32 feet; thence N p 36r' 40" W, 924.65 more or leas to the East-West Quarter 3eot3on Line of Section 17; thence Easterly along said Bast-West Quarter Section Line, 3,006 feet more or less to the poiIIt of beginning. This Warranty Deed is given to correct the legal description in two prior deeds between the same parties, the first dated February 20, 1978 and recorded February 23, 1978 in Vol. 569, at Page 612, as Document No. 346777, and the aeaond dated August 30, 1984 and recorded September 5, 198# i.~ Vo1.695, at Page 565, as Document No. 396063, all in tLe Office of the Register oP Deeds for St. Croix county, Wisconsin. This transfer is exempt from a transfer fee pursuant. 3eation 77.25(3) of the Wisconsin Statutes.