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ti ~ p N O N ~' ~ i y N ~ y ~ i o I o I ..,, ~ ~ I I ~ I I N w I I ~a o d m a~ I I ~ •c E I I ~ o 0 ° a~ c w w I I I I .o ~ „ ,~ ~ a ~ I I ~ o a = o- I I ~~ ~ °- E I I a~ ~ o ~ > a I a~ ~ z ~ ~ a I = Z I 7 f0 Y ~~ 3 f6 I O 0 {) r O ~ I 3 ~ I 3 I ~ Q~ c 3 I E Q I ~ U I M ~ M ~ ~ I ~ I Z ~ Lll ~ ~ rn Z :.: ° _ o I ~ ~ ~ o ~ ~ I ~ V Z ~~ z an d a m I d y I a m I , I o I o z v c I ~ m z a' ~ I ~ ° I v~ i- ~ 4' °' z ~ E I ~ E v I ' I ~' N N N ' f6 y O ~ y ~ . `~ ~ ~ r I ° a ~ t ~ I a I ~ a o c ~ ` ~ d s I o Q . ~ -_ I Z m ~ Z Z ~ ~ I Z I ~ a=i ~ I o .. a~i c I N C ~ W E w O p ~ ~ I~ y ~ a I ~ y __ d _ ~ .. ~ O ~ ~ d ~ ~ G a N N a= N d ~ I co 'c a N a v O '~ I E r °~~ au~ rr ~ ~ a~ ~ 3 v I 3 ~ ~"aaa l oaaa ; I a ~ o ~ ~~ ~ oc~n o~~ o I ~oNO l a N o m J U y rn rn 7 r `- Z o 0 O N N } O = M W ~ ~") N O ~ '6 ~ ~ o ~ ~ `'' ~ o ' ~ o ~ 'C CD c N y rn I ~ O ~ 00 h Q c ~ a :: a v °-' ¢~ in I~ ti °' ¢ z in m I C ~ ~ ~ :°. I o~$ ~ :° o v ~ O~ ~ U j V V! C I ~ N ~ ° E O ~- c O~ O ! m M C I ~ C ~ o V d p r ~ V ~ r- M M ~ E O C I C 'p N_ C j M ~ C ~ O y ~ y I O 7 U ~ ~ `~ I r~ d N ~ d N ~ r ~ ~ ~ ° ' E ~ ° ' •~ ~ ~ 1V ~' o °r 2 ~ ° o ~ ~ Fes- 2 roi o Z ~ d ~ ~ I = I I U ~ sk a a~ I a ~' I _.( A U a~ O ai V i 0 in U COMMERCIAL TESTING LABORATORY, INC. `~ 514 1Gtain Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 , FAX - 715 - 962 - 4030 ST. CROIX ZONING ST+ CROIX COUNTY COURT'riOtSSE HUDSON, Wi ATTN; THOMAS C. NELSON 5441b h REPOnT NO,; 35872/01 REPORT DATE: 1/22!93 DATE RECEIVED: 1!21/93 PAGE 1 OWNER: Janice Iverson LOCATION: 3b1 Caspersen Dr., Hudson COLLECTOR: PS, Jenkins DATE COLLECTED: 1-19-93 TII'~ COLLECTED; 3;OQam SOURCE OF SAi'~'LE: E;itchen faucet DATE ANALYZED21-2I-93 TIME At~IALYZED;2;OQpo} COLIFt~f; 0 /1U0 mt INTERPRETATION: Bacteriologically SAFE NITRATE-N; 5 pP~o Above i0 ppm exceeds the reco~nended Public Drinking Water Standard, u Goliform Bacteria/1(1Q ml Nitrate-Ni#rogen, mg/L ~~.\NDECFiyCpMl o ~~ t .~ ~1~(9 N ~p ~ ~ Ts ~ ~ . ~ ~ - Ci Z€ ~ Cry Cs ~ ~, ~ v , LAB TECHNICIAN: Para Gane ~ ~ ` ~ ~ WI Approved Lab No, i9 ,~ 1 1 Z { C 14eans "LESS THANE" Detectable Levet Approved by: PROFESSIONAL LABORATORY SERVICES SINCE 1952 ~c;d I~ ~o-4~ ~aK-ti°L -. ~. ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse ((~~ia' ~ 911 4th Street rYl ~ .Hudson, WI 54016 1~ ~ Telephone - (715)386-4680 ~~ he St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion g~ this form ~ essential HQ ghat Y~g property can ~g located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after tee and form are received.. WATER TESTING-----------------------------FEE: $ 35.00_ (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at.~time of inspection) - ~ PROPERTY OWNER' S NAME : ~,4,J ( L' t=. .L (J~~c S O~ PROP . ADDRESS : _~lli / ( ~5~~% SO~ Q/Q CITY 1~' v ~ S ®~ Legal Description 1/4 of the lf4 of Section , T ~ N-R') Town of ~y p Sow Lot Number Subdivision: /(, ~Jr= ~IitE ER 3 ~ r OX , ~' _ .~~a - ~ v 3(~ p6 -lC~'~ ~ c Color of house ~ OAR Realty sign by house? If so, list fir I5~ ~'o~,v~ ~K~~ 1 PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOR, WITH LOCATION SHOWN, AND A Ct3PY OF TH8 LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm qr individual Telephone Number_ REPORT TO ~ SENT CLOSING DATE:i~ Signature_ ~~ requesti TO: erv}ces. ~-~rL.~iJ (~fi-S~ !+ ~. •• M ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 January 20, 1993 Kernon Bast Edina Realty 700 - 2nd St. Hudson, WI 54016 Dear Mr. Bast: An inspection of the septic system on the property of Janice Iverson, located at 361 Casperson Dr., Hudson, WI was conducted on Jan. 19, 1993. At the same time a water sample was obtained for testing. The results in that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact his office. Si cere~~y' Mary J. Jenkins Assistant Zoning Administrator cj Wiscons;n Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildin~-Division ~T INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Henderson, Dou & Ma Hudson Townshi CST BM Elev: 1 Insp. BM Elev; BM Description: TANK INFORMATION `' u ~ ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing p r °~" Aeration -° - ~: Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~,~ ~,~~.~"' ~~ ~ ~E~ 1 Dosing ` ~ ~ ~~/ d/j~ ~~~ ~ 1 Aeration _._.._ '\ Holding PUMP/SIPHON INFORMATION Manufacturer ~~~~~ Model Number ~,, /, ~ 7 TDH Lift Friction Loss, System. ead TDH Ft ~ .~I ~ ~~ , ~-S ~ Forcemain Length r Dia. // Dist. to well / county: St. Croix Sanitary Permit No: 399580 0 State Plan ID No: Parcel Tax No: 020-1036-80-100 STATION BS HI FS ELEV. Be chmark Ili r Alts. $M ~ ~ - ~~ `' S~"fh•' ~i' ~11=ft~ Chv-b~ --- + ~ Bld ewer i~u 1. - ~.; " - r~ it ~ ~ -r Ilti II TI ~~t'~C'C~j'v'l" ~~ ~~~ 3 Stet Outlet ~~ i g -I ~L /f ~ S'7 t Ihlet a1 iY ,~ ~3. ~, .~ Dt Bottom -- ' 'tarns ~~,~:C ~ .~r~/~., ~«r~~ i~3~ ~ L '~ ~J~ Herder/Man~K I- ~:J Djst. P'pe ,~ ~ ~ ~ ~) 0~~ '~br ~ ~. ~ • !o Bot. System t -Y ~ . ' ~'~'- ~ / Final Grade ~: ;,~ ,~u,~~ ~ - . p n ~ d , ~ 3 St Cover SOIL ABSORPTION SYSTEM > ~, ~,,~~, ~- ({y ~tiwh,'Y~'~~ ^ . # Length j BED/TRENCH Width o. Of Trenc es L c ~ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth , ~ DIMENSIONS ~~~ ~~! ~ ~ ~ "~ ,/ ?j ~ LIGbY-` ~ ~~ i SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Ma slur / ~~~ INFORMATION ~~ _ CHAMBER O ~ `~'~~ Type~f System: ( / ~ ' ~ °ti` i~ ~' ~ Model Nuf~E ~ ~- ~ ~ ~ ~ -- •) 'TlC CLL~ DISTRIBUT ION SYSTEM ~r ,.,,,,,::.~ '; ~;-, . ~.. ~~...;-,~~: '),,."~ ~~~',,,,,Y; i,>~(-:~ Header/Manifold1~~~ ~ ~~ ~ ist utinn / V ~/ ~~ ~ ~ ( I~~- ~ ~ x Hole Size ~ x Hole Spacing ~ Vent`to Air Intake i n Dia L Dia ~ Spacing ~ Length ' SOIL COVER x t7fPSSIRR Svsfamc Only YY Mound Or At-Grade Systems Onty Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes ~ No ~ Yes ~ No ~~. U' i /i COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ ~~ /~ Inspection #2: / / Location: 361 Casperson Dr Hudson, WI 54016 (NW 1/4 NE 1/4 18 T29N R19W) NA Lot Parcel No: 18.29.19.15701 ~ r 1.) Alt BM Description = '"f ! ~-~ ~ /,~~ 2.) Bldg sewer length = 7irA/(,~"' ~_ ` / - amount of cover = ~~~Sl ;.~--~ ~- Plan revision Required? ^ Yes ~o ,~ . ; ~ ~ ,~' _~ 7 ''~ "" t = ,~ Use other side for additional information. ~'_ ~~ ~ ~ ' ~ irf~~':"~-1 ~ ~ ~ /~ .~ti ~~ ~~ ~`~ Date Insepctor's Sig tune Cert. No. SBD-6710 (R.3/97) ~1'd , i -z d -o i ,~rf- -~ D,~~ i ~s ~) t~ Safety and Buildings Division County s r eeo~' ~ ~ ~ 201 w. Washington Ave., P.O. Box 7162 I S'C~ns'~n Madison, WI '53707 - 7162 Site Address 3 6 ~ C~S~E~Jd„~ D~ Department of Commerce Sanitary Permit Application Sanitary Permit Number 3 ~ ~~ In accord with Comm 83.21, Wis. Adm. Code, personal information yon provide ' Q ^ Check if Revision ma be used for seco ses Privac Law, x13. 1 m I. Application Information -Please Print All 1[nformatlon State Plan 1.D. Number ~/ . A Property Owner's Name 1~0 ~ !s• ~ ~I~'i ~ /~~ti~~/ .IO~V Parcel Number ~ . Z ~. ( r C / o 2 t~ ' /O d ~ ' ~D ' /d d Property//Owner's Maiddling Address T /~ 3 (O ~ C~7~~~~t'A~ .LJYC Property Location G /~~~ ~~~~ S ~~ T ~ N. R ~/ E City, State Zip Code Phone Number Lot Number Block Number LLi 9~~~~ ~~ ,SyO/G • Q~~~ Subdivision Name , CSM Number II. Type of Building (check all that apply) ,\~,.~ ~K,lpx ~.~ ~ ~ ~~~ ^Ciry or 2 Family Dwelling -Number of Bedrooms f1OQ ~~" ~ ^~~ ^Villa e g ^ Public/Commercial -Describe Use XtE~ '~ •; i-- ~S~ hi ~ _._ i p~ w ,__„~ owns p ^ State Owned -~-•> LlJ ~..._ Nearest Road III. Type of Permit: (Check only one box on line A (numGea'btg sc a ernal~ .Complete line B if applicable) A' 1 ^ New 2 Replacement System 3 ^ Replacemeilt~of ' 6 ^ Addition to •- " ~ For County use S stem Tank Onl Existin S stemy B• ^ Check if Sanitary Permit Previously Issued Permit Number ' - ---- Date Issued N. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter SO ^ Constructed Weiland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Uttit 49 ^ Recirculating 30 ^ Other V. Dis ersal/Treatment Area Informat ion: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade ~~^ '~ Re?quired ~S ~ Proposed ~~~ ~ ~~ Rate(Gal/s.lDays/Sq.1Ft.). Z Cue CL; ~', ~ ~ (Min.Rnch) S~~ Z l Elevation s~~ v J ' r l - ~- 0 ~ .S ~/~ VI. Tank Info Capacity in Tonal Number Marnrfacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank r~ ~ Dosing Chamber ~"~ -~ ,$'D ~ ~ , VII. Responsibility Statement- I, the undersigned, asstnne respoasibillt~ for installation of We POWT3 shown on the attached plans. Plumber's Name (Print) Plumber's Sig tore RS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) ass o ~N,t',~G ~~ f ~~fo~ ~~. ~sy~,~ VIII. Count /De ailment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) ^ Owner Given Initial Adverse Surcharge Fee ~ ~ l~ d ~ 1 ' Determination I L FJC. Conditions of Approval/Reasons for Disapproval 1. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. System shall be installed <42 inches below uniform contour line to ensure adequate separation distance from a limiting factor. 3. System must be setback 5 ft from recorded easement to insure proper setback. `- -~---- ~ ~-" ~-`- nczzacn cvmp~ae pwna ao me rro®ry onryt nor me ayatem oa paper oa ras rasa sus: ii menes m stza SBD~•6398 (R. OS/Ol) ~~ Safety and Buildings Division Cotmty ST' CieO~ a, ar 201 W. Washington Ave., P.O. Box 7162 ,S'C~n~~n Madison. w1 '53707 - 7162 Site Addles: 3 6 ~ egs~EX~Jo,~, D~ De artm~nt of Commerce Sanitary Permit A lication s~itary Permit Number pp 3 ~ ~ In axord with Comm 83.21, Wis. Adm. Code, personal information yon provide ' ~ ~ ^ Chx if Revis o>~ ma be used for ses Priva Law :15. 1 m I. Application Information -Please Print All Ltformatton ~ State Plan I.D. Number N~ Property Owner's Name DOl~ (,r -~ ~Il~'j y /~~ti~Ei'P.IO~V Parcel Number ~ - L q. / G / O 2 D • /O ~3 ~o ' ~D ' /O d . Property//Owner's MaidlingcAddress T ~ 3 (O ~ Cr7J~~~~~ .L.yC . Property Location j~ . ~~yt ~U~. S ~O T ~ N. R ~y E City, State Zip Codt: Phone Nmnber Lot Number Black Number (L~ j~~~~ ~~ SyO/G • Q~/p~ Subdivision Name , CSM Number II. Type of Building (check all that apply) ~y t7N~ ~i ~ ~~ ~i~, (~ C + ` ' ~ ~1 or 2 Family Dwelling -Number of Bedrooms ~~ ^Vilia e B ^ Public/Commercial -Describe Use '-~, X1Gd t i_..- _ ~ n r-~ ~~p l~,S~ /~ }--_ --? ~~ ^ State Owned Nearest Road i ~ III. Type of Permit: (Check only one box on line A (nmtsiie~irtg sc a ernal ' .Complete line B if applicable) A' t ^ New 2 Replacement System 3 ^ Replacemer)tof ~ ~ 6 ^ Addition to ~ " ~ For County nse stem TankOni '' S stemy B. ^ Check if Sanitary Permit Previously Issued Permit Number ' - Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter SO ^ Constructed Weiland 22 ^ Pressurized In-Ground dl ^ Holding Taiilc 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. Dis ersaUTreatment Area Informati on: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade ~5^~ ~ Required 375 Proposed ~~~ 37 Rate(Gals./Days/Sq.Ft.). ~<, L «~~:~~ (Min./Incb) 5~~ Z ~ Elevation s~ ~ , o P ,~,~ s VI. Tank Info Capacity in .Total Number Mar+ufacturer Prefab Site Steel F'ber Plastic Gallons Gallons of Tanks Concrete Constntcted Glass New Eaistin= Tanks Tanis Septic or Holdi~ T ~ra-n (/U ~ ~ Dosing Chamber ~D -~ S ~ ! ~ , VII. Responsibility Statement- I, the tmderatgned, assume respotts[bWty for Installation of We POWT3 shown on the attached phuv. Plumber's Name (Print) _ ~ ' Plumber's Sig lure RS Number S zz ~ 3 ~ Business Phone Number '~'~ .T c R . 2l ~~ ~ i I 7~s •~~~ . Plumber's Address (Smet, City, State, Zip Code) 0~, /_ ~/' ~ v/ ass o ~,v,e,'~ ~~ ~ ~~~f ~-rJ y ~ VIII. Cotmt /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee ('tnclndes Groundwater Date Issued Issuing Agent Signature (No Stamps) ^ Owner Given Inidal Adverse . Surcharge Fee .~ ~ ~ ~ ~ ~I Z ' Determination IR. Conditions of ApprovaUReasons for DIsapproval 1 ~ ~ '~ ~- 1. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. System shall be installed <42 inches below uniform contour line to ensure adequate separation distance from a limiting factor. 3. System must be setback 5 ft from recorded easement to insure proper setback. Attach complete plain (to the Comte eol~) for fhe system on pper not leaf thas EI/2 s: 11 loehn m size SBD-6398 (R. 05(01) ' ' ULBfiIGl~l' & ASSOGIAT ~S CU. - ~ , 655 O'Neil Road • Fludson, WI 54016 715-386-8185 , ~'ROJECT INUEX Heg.,Uesigners of Englneerlrrg Sysferns Private Sewage Consvllarrfs PLAN I U # BATE ~~~' `/ ' ~ t1 OWNER ,,.I~QUC/ ~/ ~'(~~G ~~~~ PHONE ~O (y. c7lp~~ AUURESS 3(D~ ~/¢.SI>~.f4-~ ~~t ~~(/' /";Tl/~.I•D-rJ cSY~~ LEGAL UESCRIE''I'ION 7'owN or ~l~,p,~O.v COUNTY •~/~~ cs'rt~ ~• 21~~/t'i Gt~.T a z~ 31S LOCAL AU'I'110RI'1'Y/ SUE'ERVI5ION s T G~/X ~.v /~~ C.~"'" ['ROJECT UESCRI['TION: ~ ~,~ ~'~ /071 ~ ~~ ~.. S 7 a-e ~ . ~'~ ~~~ ~ ~ ~ ~~ ~ z~~~ ~ T - ~i • ~iC ~~ ~~~ ~'~~. 3 ~'~ ~ ~ 2- ,~ ~PPRO~ ~~ euE{ ~ P`~Mg1N~ PBD~E'GRQU ~ aREASI PE & ~~g~E AgSM DDDNG IEaDM ~ANKpVC MEETING PMDS~ 8 R p2 6 ~S~AND~`RDS• D~~a5 ° ORIGINAL GO.v lr ,~v ~ ~r~ ~ ~'~ fates Ulbricht & Assoc sultants wage Con prlvatO~Ne11 Rd. 655 Niis. 54018 µudaon~ ~/~~1 '~ _ _ _ t ,~ z~ ~ ~/ ~~~~ ' Pg.l INFILTRATOR SIZING WORKSHEET Pg.2 SYSTEM PLOT PLAN Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pg . 4 ~~ n n ~~ 3 o ~ ~o 4 i f f (jtie, ~l~ 3y~ I ~z zg ~~,c„c~~ ~ ~ ~ ?~~215~ c0 U~ r. \ f~N ~ ~T S' ~ ~ iSM~I ~~a ~ ~ GO t zq' I .i = Za , 5~.9 ~~ : / ~s o ~~ # 1h~ k'S ~~~~'~ TiG ,~cTia~ i. 5E7~ -~~~-- y~~ DNS = /~~. c ~ --~e ~y ~~ w ~ ~w ,Ball UAId- ` wi 1'L' avty G-- NFL ~. ~'' ,~--..., N ~ ~~'~ y~~ ~ ~ ~ ~ ~~ ~x~ s ~ a~ ~ ° ~~ , /,~ 5 y D ~ / ~~ ' ~ ~' ~~ ~~ ~N~~r X :~ ; ; ~, ~~ ~ ~~ II__ o ~-- > --~, ~' k ' • .I ~ - 1 ~ ~~~ I I Gb D / ~ o ~, 11 ` ~ ~ . ~ II y ~ ;c l~ J I ~M -~ ~- Tip ~ ~~ ~ ~, 1~ ~I ~` y'' ~ /U-M , V~tiT 'I ' I ~ ~ j ~~ ~/ ~. ~8~ - ,o / r 1 ~ 2 9 CI :~~. o r ~ Y~,S~ D j3 3 ~ 8, Qo ~g ~ .~w~ ~l s ~ ~''a _ ~ 4~ ~..~ s t, q 3 1 o~,~ , ~~ 0 y~/ ,4 o ~^ ,o ,~ 1 3 ~ ~1 ~~1 i ~j,~, , ~l~ 3y I „~ ~ 2- I ~ ~r-SCE ~ zq ,% ~ f 7'D P , ~ iSnN ~T S' T ~ S~T~G ~cTia.~ MP y' iNsP o ~ O ,~ p~~~ _~_-- vt~ 1y ~~ w ~;, ~ ~,~~~ ~ ~~w ~Bnll Alva w%~'~' a ~~~ ~" NFL ~ ~ ~~ w,~~ ~~'° y~~~-,,! ~ ,, 0 k °J ~~~' ~ tik o5~~i~~ Q~ 0 ~,~ yg.~u , ~ 3 - ~ 8~ P4 lit ~~' T ~~ !>' ~'~4 ~~~~'~~' ~ ~ ~ o ~'-' ~ 5"~ ~/~ X I S s ~,~.1 a,~ 7n Di S ~ 3~ i ,~ ~~ ~ ~ ~ ' ~ ~ ~~ ~ i t ~ ~~ i , i sv y~~ ~ ~~ ' I ~ ~ - . ,.- ~ ____~ ~ ' IL` / I I ~ I ' ~~ ~ ~i j~Gb / ~ % ~ I ~ ~ k1 I ~°~ y ~I ~ /U~ I v~N~ ~ ~ M ~~ I ~ ~ ~ ~~ ~~ ;, c~ /~ ,, _~^___ ~ r o ~ 1 33 Y5~5~ ~D~ ~` ~ ~~ o s ~ ~S ~g . ~ ~--~ lv ,2 v .~ 3 0 '~ `~• v\ M ~ ~ `~ ' ~ M a ~~ ~- ~I .~ 0 ~~ vl '~ ,\~ _~ ~_,,t n „ -~ ~' v ~~ ~,. ~- ~ ~ ~ .~ . ~ ~ ~ ~ v J ~ ~~ ~' ~ ~ .V ~ ~~~ ~ ~ 0 N i~ ~'1 C 4 ~ ~ t v o ~ ~1 ., ~~ ~~ . g3 ~hT~ ~oMM- D ~~~D~ ~~o~~ S ~ . ~ ~~P P. ~ , -~ ~ A Hi. ~~U ~' ~ ,~ P ;~l P~ i, i, ~ .a i -,-, , I.tiS ' ~~ v~L ~'~~~D t N ~~~ ~~ ~,v ic/S~J~c T/ov ~~~ iii sc~. Qo ~-~~c 9 ~" r~ ~' "'z_... F/i~// S QED 99a ,~---. T~~~ ~ ~ ,,~ .~ ~ s ys r~M 9 ~ ° Dg's ~~%/~ . ~i~v, 9,~.~0 ~_.,, ivLET" To Cho SS S~- c Tiov ©~ T~E~vG~ls ~~ ~ ~~ 3~' ~ SQL FT ~ Tv T~9 L. /~-~iL S ~~c T%d,v . .~ 5~ 1, y`' '~ ,~ I ~~~ ,, ~~~~r~T-off ~ ,.~ ~9Pf ~r/~h v~-ti T c~ j° U,v ~,vsp~c T/ov ~ ~~ Olin/. ~ 2 '' ,, ~ ~~~/ 5c~ .Oro ~~~9. "~._ Fiir/i S ~~"D q~.~~~= ~~. o Ti~~ti ~ ~ ,, ,, ~3 ~vG . VENT PIPE 990 ~---- ClllAfJl.' ~~~r ~~T~ON ~~ 7, D ~ IE v+n ~~ q~ . o' INLET R,PPROVED JOINT 1J~ PIPE ~ ~XTENDIAJG 3' !?I.ITO SOLIb SOIL s~.~ , ~¢o Pac D~~ ELEV. ~ FT. PUMP CHAMBER CROSS SECTI0~1 AND SPECIFICATIONS P/4~E `{ of ~o ------- - ~-1•,,,~-- V E IJ T CAP ( P I P E ~ WEATHER PROOF JUAICTION BOX 12"MIU. •• GRADE - I COAIDUIT ~-- ~ vE -- A iN y;~ a-~ K M ~~ B ~g~ ; ' t D 130 APPROVED :LOCKING MAIJHOLE COVER w/ ui~iiGU/~uG-~ ~A/3E~ v ~~~ ~~.~ PROVIpE I AIRTIGHT SEAL I ,~ J ~1 ) ~ Da 3.3 ~ I i PUMP -~,` ,[~~~ 4° MIN. L~ IB" MIIJ. • III III III I I I II ALARM II I b oN I APPROVED JOINTS W~ PIPE EXTEAIDIUG 3' ONTO SOLID SOIL 5~ . ~U PC OFF til ~ ~(ANK ~~ 0~l ~ I ~ I BLOCK---1 I I ~~~v~t ~- RISER EXIT PERMITTED C)NLy IF TAIJK MAW.UFACTURER NAS SUGN APPROVAL --~ SEPTIC E SPEGIFICATIC)NS ~ DOSE ~/~~ /.~C~~~ I YYJJ TANKS MAIJUFACTURER: OF DOSES: PER DAy IJUMBE R ~ / TANK SIZE : ~ S ~ GALLONS ~ / DOSE VOLUME ,S 12O • f• ALARM MAUUFACTURER: L.~~1'C~ /4~I~/"I GALLONS INCLUDING BAGKFLOW: ,4, ~ V ~ d~ /~ MODEL NUMBER: '"' GALLONS INCHES OR / CAPACITIES: A= ! SWITCH TYPE: ~~~~ ~ GALLOIJS IIJCHES OR g = ~ ~ PUMP MAIJUFACTURER:2 O ~ ll~ ~ ((Jf ~~ ~ (~ C=~• 7 INCHES OR .~- CALLOUS i ~ G 'O MO Al M ~ J H ~~ ~ Z 2 DEL U BER: ~! ~ ~ GALLO1 ES oR s D= INC / SWITCH TYPE: ~ C -~~'4"~ NOTE: PUMP AUD ALARM ARE TO 6E MINIMUM DISCNARC~E RATE 2' GPM INSTALL DON SEPARATE CIRCUITS VERTICAL DIFFERENCE 'BETWEEAI PUMP OF DrD15TRIBUTION PIPE..? ~ 'FEET '1~ANk Sf~~GS -}- MINIMUM NETWORK SUPPLY PRESSUR E . . . ~ FEET:, ~AGG1., I ~ ~{ P~~ 77 // -{- ~D FEET OF FORCE MAIN X /~~ F/ooFr.FRICTIOf'J FACTOR. ~"•~ FEETr ~ ~g,~s ~Ur I S A ~ ~ = TOTAL DYNAMIC. HEAD ~ " ' FEET = JPb ~aD y ~o IAJTERNAL bIME1JSIONS OF TANK: LENGTH / ;WIDTH •ILIQUID DEPTH , ~~ S~~l/~ i,v Z~uS ~r~,S%~l 1~D Cdv ST~~~f-~'1 d ~ ~,r%ST7,~~ use 3 ~~e~ ~10~f'E eF Sit.~l~ j~G~iv G -~. ZOELLER EFFLUENT PUMP MODEL.'98 €, ~~ ror•t erruua r~tkNlow -rA a,.~urt trrrvtrn uie aw~n~we ,'~ ~ eu~r:rrt tlNt1eM~N IIt T MIrt11t tUll• lrflf ~ h 11 ~ 1.11 t 10 x~r 1/ 1 ro ~ t! ~k Y•Iw 10 'li coNSUIT FACropY Fop SPECIAL APPLICATIONS ~ E-eclrtcel eAerl-efor~, lot duplex Byetem~, ere ev:rllable end ~uppNad wAh an elerm. • Mercury (foal swdches ere aveAable for controlling single and 1 _M•chenlcel eAsrnetore, Idr duplex Byelems, ere aveilebl• with or • Three phew eystoma. 'r'-~houl Norm hvhchew. Double piggyback mercury Iloel ewdchea era evellabie Iw varlebla Ievsl bng cycia conlrola. 8landard ell models - WNgh1 ~tl lbe • ~/, II.P. N S•r1e• y p~,Ph Con~rel seleejlo~ ---~-~----- .Mode Am • eim le. ?1~---_L -tom 0.6 p--- .. bu I.x ~ ~~~L -~' -=-t~c3lL ?JO _l~ulo 1 l a l t r ~Alr~ .~: ~'a_Ilb11y Ebc4ktl Mu~.~ r.~°,~."bLv:e°^ Bung I HeOrd~e eELECT10NgUlOE ' !. eln le I perysd 2 pole rr-eeherrlcel ervheh, ho e~lerner earbol rtgrrhed, 0 p OOYbeek mercury soy ewkch a double pliey~k mercury, IIoiN twhch. IMler b FM01I1. E. Meeherrkal ehernslor t0 O02? a IQ-001i 1. Bee FAIO) t?, ra oorr•cT model d EkreUlcai ~e f1yler, " '~ 6. Mercury eenea spy Iwhch 10~ E•Pek , du ue:d y, • oorNrol tuedvya pNr (?) a NI eey.~tlem. .peepl• per a duplex ~ ri1~,~ Ir"~~ ~ ~n.slbn a wlrea ln.kn. /, lwe ~ ~ r~.E~.•~ la wMer~,t r,gvl..._.. ul tpNot. •r ._ _. .. .. rl..~..... > >/E t 1/1 ~ s/e ,,. I ~ s/~ ~ ~/1~ 1 1/?-il I/2 NPI r~oW pEp MINUTE ~Msconsin"Department of Commerce SOIL EVALUATION REPORT iivision of Safety and Buildings T ~ 3 Page of in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limned to: vertical and h i t County .S T G~v~• ,/ ~ J4 or zon al reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance fo nearest road. parcel LD. ~ ZD , ~Q~ / , t~~ , ~~ f O d Please print all Information. R wed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Properly Owner ~Q V ~. ~ ~~/`~ ~ /7~N~~/~,Sd ~J Property Location ~J~ ~~ G ' N I Z~ Property Owner's Mailing Address ovt. Lot 1/4 / 1/4 S ~ N R T ~ E (or) W 34/ CftS iEiPS©~ ~Ds~' • Cit Lot # ~ Block # /,4- Subd. Name or CSM# fs ~ /3ov.r,OS y State Zip Code Ph . one Number ~ ~ ` • ~U~,~~ / ' ~ syo~G 7~ ^ City ^ Village ®Town Nearest Road j ( ^ New Construction Use: ~ Residential /Number of bedrooms ~ C ve fl S/ _ ow rate ~ ~ IL}Replacemenl ^ Public or commercial -Describe: ~.~ ~.-..~~~ n GPD Parent material F , ain eley~(on if ap cai8 General comments i it• and recommendations: -SEA /V d T~s ~~o~ (~,~'f ~~~E~~O ~1~~ ~~ `~ gT t.il~ ~ . q ~_.,- ( ©Boring # ^ Boring I O,• cr/ ~ ~Fill~ ~lK o / 7 . pit Ground surface elev. fL p 1 ~ ~ "~`iQ~/ In Horizon Depth I Dominant Color Redox Description Texture Stru y islence Boundary Roots Soil AppNcation Rate GPD/tt' n. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eft#1 •Eff#2 ~sy s- a ~ _ • ~ ~ ~• Z ~, ~oy~s~ s. o dec .~ ~z~ "` ~~ N S ysrF ~oi~~s To ~ ;v coo - • Go.~ /~ oi/ ~, ., /.3v GG lJi'i jwe v ^ Boring # ^ Boring ' ~~ n .o 9~ Pit Ground surface elev ~~ ft ~ . . De th to limitin O P g facto in. Horizon Depth Dominant Color R Soil Application Rate in Munsell edox Description Texture Structure Consistence Bounda ry Roots GP Dift' l . Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 2, ; o.~ b ~ ~j ,_.._ SL Ifs/~ s c f y ~ ~ s z . ~ . ~ S. D, .S .~ ~.S - .~ r. Z~ ~o ,e s t:z ~e Mo s ~~~ p ~e ti s -- - o - - a y ~ ve- T . ' a'ss' ~Z« ,. 'Effluent #1 =GODS > 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) e Signature ~~~~_ , `~ „ ~!~ ~ • wd Ro~3~ ~ ~~,6 /[ ~ G!z T~ i7. ~ CST Number ' U l ! Address ~zG3 ~ S Date Evaluation Conducted Telephone Number DU • / Zoo/ ?/S•,3 •f~/BS Private Sewage Consultants 1355 O'Neil Rd. ~ ~ l"L~- ,~V~-- O .,.5 % G D Hudson, Wis. 54016 T b L /PFSTi~~ T/' .vs' ~-~ ~/aal.'fF~.r~~. o~.s~Rv~D ~N f~2. ~ !/~i ~/ ~S'~~~G~ G T%PE~ T•~'-~~~, tj p Property Owner ~' ~L~yG ~ J U~ ©Boring # ^ Boring pit Ground surface elev. ~~ ~~ Horizon Depth Dominant Color Redox Description in. Munsell Qu. Sz. Cont. Color ~ ~ ~ ? i~y~ 02 ~ ~ /O ~ ~ a O , /~ Parcel ID # Page ft. Depth to limiting factor '/~" In. Texture Structure Consistence Boundary Roots Gr. Sz. Sh. s~ /,~ cs ~ ~ Z of Soil Application Rale GPD/its •Eff#1 •Eff#2 , ~~ . ~ ,, . LS ,o yR y s D, ~ c - . "7 i. ~.- 7 ~. Z~ ^ Boring # ^ Boring ^ pit Ground surface elev. it. Depth to limiting factor in Horizon Depth Domin nt C l R In. a o or Munsell edox Description Qu. Sz. Cont. Color Texture Stricture . Gr. Sz. Sh. Consistence Boundary Roots I I Boring # U Boring ~--J ^ Pit Ground surface elev. (t. Depth to limiting factor in, Horizon Depth Dominant Col R d in. or Munsell e ox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary ' 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 gqual opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at G08-266-3151 or TTY 608-264-8777. SDD-83)0 (Rbl00) S ~, 3 .~ o ~ ~o ~ ~~ ~ 3 ~~D~~1 I ~~ ~ ~~~ I i ,~ a~t~ Zy ~ i Jti' ~0 ~ ~,v (r- 1 ~ i9 ,~ o-- _ ~i !~''~ ~ l1' S3 ,` o~~° -~ ~ kfk~~~ ~ o5~~,v Q~ 0 ~~- yg•~~ ~2-9~,0 ~ 3 " ~ 8- ~~ ~X' S ~ ~~' ~~3Cv 5 STE~%~ ~~ ~D y 9'3,0 ~3 ~ f ~-~ P ~~ 5'Ep T' G .e c~a•`' y'' ~NSP ~~~, o r ~ ~ 1, ~,. ~I II ~~ fl it .I , ~ ~ Gb II . II ~I ~ ~` I I ~ I I I, .I II 1 0 ~3 3 q 5- n iS /~ ~`'~, ~3D i ~ ~~ ~ ~ I I~, I I . ,~ , ~ ~~ ~ w ~~ ~a ~ 1 ' __________ ~ ~ y , r I I ~~ IY, ~ ~ ~ i I / ~ ~ ~ I ~ II ,,\/ ooh ~; xl l3M .~- ~. -Top ~ F ~, , I ~~ ,q /vim , v~~~ ~ ~ y ~~ 'i II ,` fig. ~'~ r . ~. s~w~ ~~ ,-~ ~I q5,5~ „ ~ za - S~~ ~~ : l S~ ~~- ~~/ C~}5'p~2so.~ ate. ~ ~ ~v~sa ..~ ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK _; This is to certify that I have ins ected the se tic tank //// p P presently serving the ~D ~ y ~7"~~Cl~~ j O,tJ N~ 1/9 ~~ residence located, bt; '_'--- ~ 1/9, Sec. ~~ , Tl/ N, R ,~ ~.SI ~/ - W, Town o f ___ Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to functionin be g properly. Last time serviced ~~/vT ~~ ~ " Did flow back occur from absorption system? Yes No (!E no, skip Approximate volume or length of time: ~da"D next line) _____.___ga 11 o ns m i n u t e s Capacity: /~-~ Construction: prefab Concrete_~ other Steel ' Manufacurer ( i f known) : ~j~'~~--y~ ~~~,/(~J Age of Tank ( i f known) :' ~9~Z - (Signature) !Title) (Name) Please Print (License Number) (Date) Form to be completed by licensed lumber or-Licensed Disposer (NR 113 Wisconsin Administrative Code)nsin Statutes) Plumber (applying for sanitary permit) Certification In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name ~ C`7~ 1 Zl`h~~`~ T-- 2 Z Signature .M~P/MPRS ~~ 7 S s/ae S7' CItUIX CUUN'I'Y SEP'I'TC 'T'ANK N(AINTENANCE AGREEMENT ........_.~ -AND OWNERSHIP CERTIFICA'T'ION FORM Owner/E3uyer ~~ Utz' ~ /f~~/~ I .v1> Mailing Address 3 ~~ L'~Sp~j .S~O,c~ ,J~/~ . Properly Address (Veriticatiorr required from Planning Deparltnenl for new construction) City/Stale _ ~ ~1OS0./ '~~ • parcel Identification Number ~ ~' ~ ~ ~ 03 ~° ' ~O • /Q-a LEGAL DESCRIP'T1VN tW p Property Location /V '/,, ' '/,, Sec. ~o , T Z9 N-R ~y W, Town of ,~v~so~ Subdivision _ ~ /N.P~~ S ~ ~ O U.t~~~ Let # Certified Survey Mate # ~/~ ,Volume ""~~ Pa e # g y~yy3 Z Warranty Deed # ,Volume fy9T ~ ,Page # ~ 7 / Spec house ~ yes ~ no Lol lines identifiable O yes O no SYS"!'EM MAIN'!'ENANCE_ Improper use and maintenanceof 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 effect the fi-nction of the septic tank as a treatment stage in the waste disposal system. . ~1re property owner agrees to submit to St. Croix Zoning Department a certi[ication form, signed by the owner and by a tnasler ptrrnrber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) alter inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. lhve, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certi[ication slating drat your septic system has been maintained must be completed and returned to the St. Croix County Zoning Oftice within 30 days of the three year expiration date. ~ l/3/of SIGNATURE OC APPLICANT- DATE OWNER CERTIFICATION 1 (we) certify that all statements on this Conn are true to the best of my font) knowledge. I (we) Am (are) the owner(s) of the operty described above, by virtue of a warranty deed recorded in Register of Deeds Of[ice. ~~ siGNn'ruRE of nrrl,lcnN~r " ~-- DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning 1)epattment. ****** , ** include wtth lhts applicalton: 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 OWNER's MAINTAINCE OF SEPTIC SYSTEM PAGE 6 REVERSE SIDE 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 all necessary maintenance/inspection reports to the controlling authorities. SPECIFIC CONTACT AGENTS S T. Glbl`x G ~~ * Governmental authority/ inspectors: ~iaN~•~~ d/~~ . *.Licensed installer, responsible for providing an operation/ mai:~tenance ~~tlsera'~ manual: C * Licensed service / inspection ~.~5' ' X33 G agent other than installer: ~i av i~ G- Electrician, for pump, electric controls, wiring units: ~v ~~ ~~J 0 IMPORTANT OWNER MAINTENANCE FEE UIREMENTS ,~ i. Winter traffic (sledding, shove ring, etc.) across the area shall not be permitted, or frost can/will penetrate into the cell, freezing up the system. Discontinuos use in the winter (a vacaction trip, resulting in no water use) can also lead to freeze ups. 2. Water conservation needs to be exercised! Or system can be hydrolically overloaded and destroyed. This~/system was designed for a maximum wastewater flow of--iJ v gals. daily. 3. POWTS ar.e not designed to accomodate wastes from a garbage disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy 'this system. :, 4. If a ' ~ power outage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the ~' cell, which may adversely impact the cell (leakage). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative cover (the Cells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in the system beneath IS NOT sufficient alone t0 maintain a grass cover. 6. Periodic in~ne..~.d,...... L ii .DOCUMENT NO. 494432 WARRANTY DEED ~I TNI• s~~c[ rtcacrtvcc ,oa R[f•OROiNO a•*• 9TATE BAR OF WISCONSIN FORM 2-1Yat f Janice J. Iversun, a single person conve s and warrants to - DOUQ E. Henderson and Mari!--N. -....enderson.r-..husband. an~..W.i..~~... ... ..... .............. the following described real estate in ......St....CrQiY ....................Coun!y, state of wisconain: see attached legal description ST. CR01X C4,, IM Recd for Reccrd JAN 2 8 1993 ~ 8:55 A• M i; i ReQlster d Deeds Ta: Parcel No:........ ~~~ ~ ~,,~~~ , This --. i.s .................... homestead property. (ia) (is not) Exception to warranties: easements, restrictions and rights-of-way of record, if any. Z~H January 93 Dated thin ..... day of ----• ................. .. . ............... .•-•---- -- _ ---., 19. - . •---------•-----.(SEAL) ..~.. - -- --•-•- •- -• - • . ..................•----.(SEAL). . anice .T. Iverson - --------------•-•--......----•---••-----•--....-.-..---...--..(SEAL) AaTBSNTICATION gir,,,,~(a) -_-•-, Janice J. Iverson anthetiticated this~v of___. Januar~--.-., I'- .93 Irristina Ogland TITLE: ![E1[BE$ STATE BAB OF WISCONSIN tt,, - -•-----------------------------------------• anthot3sed by-~?06.OA. Wb. 8`.ab.) TMIt INSrRLMEM WAS ORARTED SY Kristine Ogland x tcsra~p~--a•~--z•~v .................. (Sigaatares may ba authenticated or acknowledged. Both an not necessary.) •----- --- --• -•------- - ••----- ----•--•--- --__ - -(SEAL) ACHNOWLI3DOM13NT STATE OF WISCONSIN as. •-•-----------------------------------County. Personally came before me this ................day of ..---••-----••-•---------------°--•------~ 19...----. the above named to me known to be the person -----._._._. who executed the foregoing instrument snd sdcnowledge the same. Notary Pnblic ....................•--.•--•.-.-•---.•---_Connty, Was. Yy Commission is permanent. (If not, state expiration date: --------•-------------------°----------••------._ _., 19...---- -) ,~ {411 that part of NW i/4 of NlE i/$ of swo. ii, TTZ9 N, Rig W, Mvdso» ~_ ~ Ta~+nsh l p, Qt. Croix County, 411 scone i n, dK~@ri bsd ~ as tol lows ~ Coauawrrcir,p at the 8outhwast aarra~r of NW 1/4 of N& 1/A of 6•e. 1A, T$9 N, R 19 Wi 8t. Croix County, Wi sc+oris i n~ thrones S~lit-t wrl y or ar+ assumwd bwarinp of South 68 drprsws 44 Minutes i:3 swro»dx Wwt alenS thw Southwrly linty o1 waid NW i/4 of 7VE i/A al >iwa. l8 tor•bRb.' tw~rt to thw point of bwQirininp o! this d•scriptionl thdnC, North 38 . .. dwarsss 36 ~uinut+~s Wsst t'or 36tl.3g twwt tv • point in the csntwrlinw of a bB toot road wasssw,ntl thwncw North Si dwarsws 84 Minutes iEast along said cwntsrliru~ of thw road wa~wn+wwnt for 3.42.3 twot! thsnrw North 49 dwprwsr ~ atn+~!rs Est a2,}o-h-a Bald cr++t•ri ins, far 2@3. i@ r0! ~1 ~_ _ - ... _ . - ' PAGE ' ~ ~ ~ta•-t! thwnew North 74 dwsrwws 12 aainutw~s West along wi-id centerline for 80'1. 10 iw•t f thwnce dus 6outh for 6.c"''!. • twat to said South 1 int of NW i/A of NQ 1/4i thanes I~rth 00 dwpreis ~-~- Minutes !3 11•COrids Ei-st alanp said South lino of NW 1/4 of NE 1M for 2~.4 fret to the paint of bwpinninQ. Togwthwr with sn easwMwnt over a b6 foot wide strip of lsr+d for roadway purpawirs drwcribed as loilowsi A i!b loot wfd• road easwMwrt~ Owing 33 twwt on roach side of thw toilewinQ dasariOwd ernlwriir-•f Coro+Mwric1 np ae the Swot ion aornwr to S~wa- s 7, !'~ ! 3 and i •. 10'! N~ Rig Ut, Hudson Township, et. Croix Cawnty, Wiscomuir! the++ef North along thw Wwst limos of waid Stye. 7 for 47A iNt to the cwnt•rlinw of the township roadl therioe d•tlestinQ to th! rlQht ari angle of 68 dwprsrs 21 Mirrutww and or a bwarinp of N f+6 d•Qr•ws 21 Mirutws S, aionQ said awnLwrllr+w of thw Taw»ship itoad, ler $UO,t twet! th•~ce N lib drnrwww 81 Minutes E atonq said esntwrlinw el th+r Township Readf for 890.• twwti thsnrw 8 81 depraa~s $m Minutes t alo»a said c•tn~wrl ir+w of the Tocfriship Rwd, for 197. • lst to the point of OwpinrtilnQ of the csnt•r•line deseription of said b6 foot wide road saswaent descri pt ioy+t :htrrcw 5 is dwnrvws 09 e~inut•s B for 876.0 fwetl thence S 63 depre~n l~ Minutes E for 411.7 teatl thence S 43 dwprwes 3S Mi»utww E to-~ i.'sb.9 teett the»Qe ®'33 degrees 09 Minutes IE tAr 332.6 lent ~ therirw 6 34 dwprwrs 33 Minutes E for 341.4 tNt 1 thw~rticw S 28 dsnrews 40 Minutes E for 139.2 feet i the»c• s 76 dwareas. 83 Minutes E for 230.• lwetl thence S S4 depress 04 Minutes E fpr 103. b te~rt 1 thenos N S6 d•prews 08 Mi»utes It !or 8~.8 test { thwnaw N 81 drrt.•rss 43 Minutes E tar A7b.0 lewt 1 thwnce i 7A deprews iT roiriutes E for 476.3 twwt to the end of thi wwterlinw descriptio+~ of said b8 toot wide road easwMwnt. z Nome Addraee psscriptlon N W E S . S ~ N LAND StJRVEYIN~ . HUOSON , WISC0H51N 54016 t T 15) X86-2007 First Federal of LaCrosse 201 South Second Street HudSUi-, .lI 54A ~~ Part of the NWT. of the NE's of Section l8, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin. (Janice J. Inerson~ PLAT DRAWING This. is not a complete Land Survey ~~- ,\ ~_ b N~qo 1~ `^~ 9g \ . ro G Deck ~dp3A , B . ouse E ~".jp~ \ ~• ~ Garage t Overhead Utilities~~ h~ Q~ / ~• ~p`b~p ~ / ~yy o / ~ 66' Roadway Easement ~ ~~' Electric Easement vol. 256 pg• 486 w '~~..~/ ~~~~ , ~/ ~• ~ ~ Nas 4A'23°E The location of improvements on this drawing are approximate and. are based •' on a v:asual insandtdeedsf fhcountylrecordse Thisddrawingnisafortinformational recorded plats purposes only and should NOT be used as a complete Land Survey First federal of LaCrosse has agreed to waive the minimum standards of AE-5 ,, ,. .,, woe 2 _ LOT 3 ~ i ~ t _ ~ tp LOT 4 0 _ ti (V ;~ 157E ° 157 D S. M. VOL. 7, PAG _ 2053 !36 / ~~~ 57 B 157 B I 157 B 2 / ~ °i ~ N l/4 NE l 4 / 0~ ,~~ ~~\~~N o .05 ~ o of ~`' 1~ pis ~ '~ ~ ~~ •~P F 3 ~ P L.OT 4 ~ ' . ~`,,; ~,; ' 2 ~ 157F4 ~~ m ~, 2 ~/ 5 P f~a~~I R3 w~ 0 322.28' ~ ~~y G/ ~ ~`S ~~~ ~~ J~i ~h ~ p~ o vQ~. _ Zo% ~ Q o~ p.~ eat 5 , , ~ PAGE ,370 - ~F• ~ Q, ~~ `~~ \ `~`~O ._5 ~' ~, C~ ~. 2 LOT 3 ~ ~ ` • 7 5 157 F6 ~ ~ ~ ~~ ~. ~`~ F 1570 157 ~ 322.28' i --- '_ -- (~,~ ~ //oN~z7~ /,u~' /lb`~l Parcel #: 020-1036-80-100 12/20/2004 04:52 PM PAGE 1 OF 1 Alt. Parcel #: 18.29.19.15701 020 - TOWN OF HUDSON Current ^X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * =Current Owner "' KLABON, JASON A & TAMARA L JASON A & TAMARA L KLABON 361 CASPERSON DR HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description "' 361 CASPERSON DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.035 Plat: N/A-NOT AVAILABLE SEC 18 T29N R19W NW NE COM SE COR NW NE Block/Condo Bldg: ' SEC 18 S 88 DEG W 606.9 -POB N 38 DEG W 368.55' N 51 DEG E 342.5' N 49 DEG W Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 103.10' N 74 DEG W 207.10' S 629' N 88 DEG E24 0 .4'-POB 18-29N-19W g ~ Notes: Parcel History: Date Doc # Vol/Page Type 12/10/2001 664706 1786/292 W D 07/23/1997 991 /179 W D 07/23/1997 820/298 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 47881 270,800 Valuations: Last Changed: 11/27/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.035 40,200 169,300 209,500 NO Totals for 2004: General Property 2.035 40,200 169,300 209,500 Woodland 0.000 0 0 Totals for 2003: General Property 2.035 40,200 169,300 209,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 314 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSM ENT 27.00 001-WATER SPECIAL ASSESSM ENT 0.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT ._ N~ Owner ~~A-50 ,J ~ ~'hM.~ G~} 1.30 /tl Address C City/State Legal Description: Lot ~_ Block Subdivision/CSM # N '/, ~,j %, ~, Sec. ~, T~N-R~W, Town of RECE~~ED MAY 1 5 ?pp2 ~1 G~ sr.~ l ~ ` ZONIN ~F~ CITY ~~ ,. PIN # b20 ~ ~6~ (o ~ rQo SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: ~rsi iN lr Tank manufacturer ~il>I PS~ ~ Size ST/PC ~ ~u / Setback from: House Well P/L Pump manufacturer Zo~GI~ Model ~~ %-!~~ _... Alarm location /,y51~E_~,(~i,tir~ (HOLDING TANKS ONLY) Setbacks: Service road Ve fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: 8i ODi ~S~ ~ Type of system: Width 3 Length Number of Trenches 3 Setback from: House ~'S - We117 7~! P/L ~Z ` Vent to fresh air intake ~' S © ' ELEVATIONS: _ 7a~ o~ S~j ~ ~ ~.,~,~~C S ~ ~~C - Z ' ~~ ~~` ~ a i ~M~~ ~ ~ ~ Description of benchmark Elevation Description of alternate benchmark _ ~o o A`U~ . IJ _ ~ Ol0 Elevation Building Sewer ~(~ ST/HT Inlet N~~ ST Outlet ~y ~ PC Inlet !~ 3- ~° ~ PC Bottom ~~+ ~~ Header/Manifold ~ ~' ~~ Top of ST/PC Manhole Cover N~~- Distribution Lines ( ) Bottom of System ( ) Final Grade ( ) O 5~e ~f ~vi~T " 1 2~' ~~ ~D ?~ Date of installation / / Permit number J? 7~'yS~'y State plan number ~/~ ;7~, ,~... 2 M~ y ~ 3 Plumber's signature ~~~-"`^''1 ~G'~~ License number 2 ~ 3 7/ Date / / Inspector ~~'/~ ~ ~ 2 Complete plot plan ~ ORIGINAL r \N 3 4, ~ ~ ` 'o ~ J ~ ~ '~ ~ ~ ~ ,; 3 ~ ~ ~ ~ ~ ~ ~ q -~.. ~ ° ~ ~ o ,. . M ~ ~ ~ ~ M 2 ~~ .-z ~ ~ ~, ~ _ o ~ l~ ~? r~~ ~0 2 ~- ° ~ ~ 3 ~ o w ~. 1 O V ~- ~ a 3 ~. ,~ `Q3~ 3~ ,?~ ~ y ,~ ~ ,~ o _o ~ ~ v / ~ ~° ~ ~ ~ ~ ( ~~. ~ -~ I. ~N ~ ICI I0~ I ~' o 1 w ~g t /~ h l i ~ l~. ~ n~ ~ ~ ~ ~~ ~ ~ J M v. ~ ~ I i t ~ v, ~ ~(, ~` p ki~ I S M ~ \ I I _ I I ~ 4~ 0 1 ~ ~ ~'1 ~ ~ ~ ~~ ~ ~ ~~ ~. -~ 1 -~~ x ~ ~ o ~~' ? 4 ~ of ry q! V Form-STC-104 AS BUILT SANITARY SYSTEM REPORT OWNER S'4~ 11Z; //~,• TOWNSHIP ~..~ ,/So,-~ SEC. ~ ~ T e~-' N-R /S ~WJ ADDRESS ~~ ~/ doX ~'` ~,cr -Z ST. CROIX COUNTY, WISCONSIN SUBDIVISION ~•S fir, ~ / S'j J ~G,~Z~LOT PLAN VIEW LOT SIZE 3 . ~ /~ ~~/ 5 G Distances and dimensions to meet requirements of I•I,I~R 83 ~~/ ? SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ~/Z ~~o~'~,~c. -sw /o'f' /,'ham Elevation of vertical reference oint: ~ ° P ~DD_ O Proposed slope at site: l / S € - T ..t • r PUMP CHAMBER /' Manufacturer: ~l* Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump-Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: ' Alarm Manufacturer: Alarm Switch Type: ;`_; Number of feet from nearest property line: Front, O Side, O Rear, Ft. ~++'' Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed : /nor, de„'t:or o- 1 Trench: Width: /~' Length:_.~~ ~ Number of Lines: .? Area Built:lo~'s,~~' Fill depth to top of pipe: y 2 ~~ Number of feet from nearest property line: Front, O Side, Rear,O Ft ./ O ~ i Number of feet from well: /-1S Number of feet from building: ~-~ / (Include distances on plot plan). SEEPAGE PIT Size: 1lL '! .._ Number of pits: Diameter: Liquid depth: Area Built: Bottom of seepage pit elevation: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: ~(~~ Capacity: Number of rings used: Elevation of inlet: Elevation of bottom of tank: Number of feet from nearest property line: Number of feet from well: Number of feet from building: Number of feet from nearest road: Front, O Side, O Rear, nFt. Alarm Manufacturer: f; DEP,S~'TMENT OF INDUSTRY, .LABOR & HUMAN RELATIONS P.O. BOX 7969 MADISON, WI 53707 NWT, NEB, S18,T29N-R19W Town of Hudson CacnPrenn nrive INSPECTION REPORT FOR PRIVATE SEWAGE SYSTEMS ~$CONVENTIONAL ^ALTERNATIVE ^ Holding Tank ^ In-Ground Pressure ^ Mound SAFETY & BUILDINGS DIVISION BUREAU OF PLUMBING Sf ate Plan I.D. Number: (lf assigned) NAME OF PERMIT HOLDER: Sam Miller ADDRESS OF PERMIT HOLDER: Route 1, Box 282, Hudson, WI 54016 INSPECTION DATE: ? , ~ /' ~~ BENCH MARK (Permanent reference pom p DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. Name of Plumber: MP/MPRSW No.: Coumy: Sanitary Permit Number: Dou Strohbeen 5432 St. Croix 102824 r., r r.,~.,.r... . MANUF ACTURER LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER . PROVIDED: PROVIDED. ^YES ^NO ^YES ^NO BEDDING: VENT DIA.. VENT MATL.. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. VENT TO FRESH AIR INLET ALARM. FEET FROM LINE. ( ^YES ^NO ^YES ^NO NEAREST DOSING CHAMBER: MANUF ACTURER BEDDING. LIQUID CAPACITY PUMP MODE L. PUMP/SIPHON MANUFACTURER WARNING LABEL PROVIDED: LOCKING COVER PROVIDED: ^YES ^NO ^YES ^NO ^YES ^NO GALLONS PER CY CLE: PUMP AND CONTROLS OPERATION AL. NUMBER OF PROPERTY WELL B UILDING VENT 70 FRESH AIR INLET (DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) ^YES ^NO NEAREST Check the soil moistu SOIL ABSORPTION SYSTEM re at the depth of plowing LENGTH. DIA METER MAT ERIAL AND MARK ING . FORCE or excavation. Ilf soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) MAIN ` V v WIDTH •• LENGTH. NO OF DISTR. PIPE SPACING COVER INSIDE DIA SPITS LIQUID BED/TRENCH TRENCHES. MATERIAL'. PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTH PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPER 7V WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV. WLET ELEV. END. PIPES FEET FROM LINE 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. TIONS MEASURED. ^YES ^NO SOIL COVER TEXTURE PERMANENT MARKERS. OBSEH NATION WELLS ^YES ^NO ^YES ^NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. ^YES ^NO ^YES ^NO ^YES ^NO SYSTEM: BED/TRENCH DIMENSIONS TRENCHES: MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTH UIST R. PIPE UISTHIBUTION PINE MATE HIAL & MARKING ELEV.'. ELEV.'. DIA.. ELEV.' PIPES DIA.. ELEVATION AND DISTRIBUTION MOLE SIZE HOLE SPACING. DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS ^YES ^NO ^YES ^NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE: / ~ ^YES ^NO ^YES ^NO NEAREST ~ ~ "' 1 1 , 5 ~' Sketch System on Reverse Side. DI LHR SBD 6710 IR. 01 /82) ~~~~ ~.3~ ~ ~ 2 ~ ~ ~, ~ - ~,~~ - 6~ cl'' S~ ~ r ~j ~° Retain in county file for audit. (SIGNATURE. I""` Zoning Administrator sANITARY PERMIT APPLICATION COU ~ C~ ~I HR ~ C L Code Adm 05 Wis - ith ILHR 83 I d . , . . n accor w STATE SANITARY PERMIT # ~o ~ ~a ~ -Attach complete plans (to the county copy only) for the system, on paper not less than sTATE PLAN I.D. NunnBER 8'~ x 11 inches in site. wee reverse side for instructions for completing this application. PETITION ~ ^ I. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION. NO YES -FOR VARIANCE PROPERTY OWNER -S~~y1 /I7 ~~/~/ PROPERTY LOCATION /I~~N'/a/yJ<'/a, S /~ T~ , N, ~ E (or~Y~V PROPERT OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY, STATE ZIP CODE PHONE NUMBER c CITY NEAREST ROAD, LAKE OR LANDMARK ^ VILLAGE : ~_ c~ o ~ 0~ ~~ ~~~ J ~~ I1. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family ~3 OR ^ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2, 3 or 4, if applicable) ^ Replacement of d. ^ Reconnection of e. ^ Repair of an ^ Replacement c 1 ~ New b a . . . . 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. F SYSTEM: (Check only one in #1 and only one in #2) IV. TYPE O n ~ 1. a. l.,al Conventional b. ^ Alternative c. ^ Experimental 2. a. ^ System- b. ^ Holding c.^ Pit Privy d. ^ Vault Privy e. ^ Mound f. ^ IGP In-Fill Tank 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): G REQUIRED (Square Feet): ~ ~ ~ PROPOSED (Square Feet): ~ ~ ' 7 r ~~ Private ^Joint ^ Public Z D , p $ Feet • VI. TANK CAPACITY in allons Total # of Name t ' f M Prefab. Site Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks urer s anu ac Concrete structed glass App Tanks Tanks Se tic Tank or Holdin Tank ~~~ Gdci 6,/ ^ Lift Pum Tank/Si hon Chamber VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: ~ ~f r - ~ ~ ~ ~~~ ~ ~ ~ ~ Z 3 t~ h b~.-~ , . Plumber Address (Street, City, State, Zip Code): Name of Designer: ~- ti ~ w.J ~ ~ ~,(~ eve o ~ ~ wT_ SEf o /7 D o ~. S-F- ~a h b~. VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST ~~r\~~ C~~' o ~az.rsr CST's ADDRESS (Street, City, State, Zip ode) Phone Number: ~a~c a- ~~-. o tt/Z . 0 7~S 38'G' S~ F IX. COUNTY/DEPARTMENT USE ONLY ~i Approved ^ Disapproved ^ Owner Given Initial Sanitary Permit Fee ~/ v ~ y, I ~ Groundwater S~Fharge Fee ~ ate f S7 / ~J Issuing Agent Signature (No Stamps) Adverse Determination v ' X. COMMENTS/REASONS FOR DISAPPROVAL: ~ SBD-6398 (formerly Plb-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: f. Property owner's name and mailing address. Provide the legal description where the system is to be installed; ll. 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; 111. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check al! 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, IifVsiphon 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; Vlii. 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'f 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 tank(s) 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 result of over 2 years of steady negotiation and public debate. The groundwater bill Ground included the creation of surcharges (fees) for a number of regulated practices which Wiscor~ can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried ~ is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (R.03/86) ~i muter - iin~$ reasure 1 o c s i APPLICATION FOR SANITARY PERMIT STC- 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the peLmit .issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property ~Q.~ ~,1/¢r Location of Yrnperty ~~ -~/~--~, Section ~ , T v2 `1 N-R /9 Township cc G ~~, _ . ~'llailing Address ~~'-~/ /~p 1( "~ 'Z $~ ~__ Address of Site ~ ~'~ ~ ~ ~ ~Q. /Sm .•r /~ ~, c ~~ ~_Sm ti ~~ SAO / ~ _._ ~_ Subdivision Name C- 5. ~}'1, UD /. S7 3 ~~. ~z3- ,Lot Number Previous Amer of Property ~s~ ~.~.~ S4r~'~ q : .{- /war, ©~ Ls. ~i~ss ?otal 8ise of Parcel • 3.7; ~~¢y~ J _. .r Date Parcel was Created ~- /- -7 s' -- 'Are ell corners and lot lines identifiable? ~ Yea No Is thi• property being developed for resale (spec house) ? ~ Yes _ __ No Voluma ~ 93 and Page Number ~ 5~ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Narranty Deed which includes a Document number, volume and page number, and the '' Seel of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ' antes to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY O(ciNER CERTiPICATION i I~~el cvh.Li.6y .that aCf. ~tu,temen,t~s on .th,i~s ohm cute ~.ue .to .the be~s.t o6 my loon) hnauCedge; .that i Iwe1 am (she) zhe owneh(~s od the nnon~rtu do~s~hlborl :M fti:A ,,~„ t:. ~ ti? yAc .. ;~., 1f r , nt d ~w.... ..«.. ....... .......r...«.....»...............».....«......~. ~iu 0 . ~ ~ K ~ • ~. !1311. ~lil, Mde~"°~° , ~7s 1Ml~oeela. +iescrilld ae " ~' ; } ~ `at the iw~theast coeaer of NNk of lee Mit~......,,.,,,;~;,,,,j ~« ~• u. ~~' RllY. fit. fi'olu Coosty. Yiacoasie, thssn ice. ~•~!ta" Meat aloes the iortherlJ lice Yit 4 , i`iMt.'i0i# lit is=ehe piaet 4t iaiianint of this ~~i~laili .-- ~R ~r ~.SS.feetto a pint fa tM ~eeaterline of s 6i foq~ t !1•!r saet a2e~ said e~aterlice of ebe road - ~~ ~. ~'~ ~111KU 4!-•+ii• test ~,lo~ p~ ceatlrltae. for 103. i9 fist 1- . ~t ~~ r1Le for !b?. !~ filet z thence die loth tat ,~ 1~ -.!~ ~ +oL ~i the~lee ~oe~th ~A•i4.23" s.et aloes said ~oerli ~` _ ='fi! 1~4 ~ the lMaiE Of s ~ ~ resireias, coataisi~s ?.0 aQSes rs~t ref ~. 4t e~iii ii foot r~sad i~e~e'st. ` ~-~; .. _. ee sF ~eseaest oMar a b6 e~de ot>~ , a!- lasd ~, ~~~_ ~ ~r fo13Aw: ~ fi 'feet x!~ roai ea~ese~t. 1~ .. ~ ~ ~ ~ deeerib~ed twtarliae: Corwc 3~~°' ~• .Js ~..13 aei is ?2!A ~~lli ; fodeoa ToMaeh ~ at .the ~icti~wr s • ~ ~-s =t. ~,~~Oe ~ _~ t6e Illest line of Mid Sec. 7 for oJi tNt.,t+e 'fit ` ~ ~ tMace defleCeles to the risht aR a~lset f!•`~• ~ ~° "~ .~~'Z..~~ eaid ceaterlitr of ~~ ,~~ the Toeoehip load. Eor 2r~9.d t' ~. •'~'~, ~Y M ss# ai~~1~r ire i~eillaeew sr ~ x `'~.~s~~l~s ~~ s+estsLctiroae of record ~'~.'~I~Mr4/~ei its rena ,. ~{ '~ line ys.;:_,,..:~ » . ........ .. .. ~...........:.......~~L) of Let -,~.r s!~!1 O! .*J~00~, ,. ~"~~ ~. , x.. ~' ~t ` a . [ ~'~~ e } ate. ~ f " ;` t~s ~~~~~4 ~ '. 1 ~` V ~y i ~ ~h ~ ~ ~ t ~'~'k J Y ~ .. : ~. u s ~ ~ . ~l . ~. ~c~ - ~+}.~~, ~t~c ~ , ,~ p~o r.. q ~ ~~ ~~ . ^. ~ ~ Y tt t y ~ ~ ~ X. ` - f ^G " h x Y` f ~ a~Y ~ ~ Eoa~~ loac 147.0 lest eaR ~~~ ' ~ 7 f et t~~ 11 ` '' w ~- ~ ~y ~. ~ e . , _ K E fos i 34 '~Mrt~ tM~e if-3 ,~, , ~ "" , ~vt 3~t.i met; tlMaci s34.3~`E #o~ ~i3.,i ~ . ,~, ~ fist ; ~ ~ae- E7i''E~`Z 14o~e, 2'l8.0 lest; tlreacs lili"Oi'R . , - i ~t ~ X53.2 fiat; si~mi ~!'4S'E fat 476.0 feet t' ti ~" ~ ~~ ~'~~ wd vi ~+ #~ i~sl~iooa a! ~at#d 65 foot ~#ii4~ s!v~# ; ~ `, ~~ ~ - p ~ ,~ ~ ~~` ~~ ~. .. _ .. l _ ~ ~iN w -:o- fi ~r. ' ~'.$`. ~ ~ .~., R +!{~ .. r N .. "~ - ~ ~ ~ . . /~~~ a' ~ _. t .. l d M ~ A~ `~. _ ~ ~ 1 ~ F ~ ~ ~ Y` p" t 4 ~ ~ t. .: .. _ - _ ~ aa~~a ~'~~. ~. "i r _ .. k .YS r~,~Ii . ~~ F~~ _ ,. ".t ~r 3 N " k-. y y ~1: _ i t } ~.YY M•C ~. ` 2 ~. fi '. ~ T` r ~ .. K rl ~ 4 , - ,~ 2 ~ l . ' A ~ 1 t. hr y f H z H a STC- 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o ' St. Croix County z t7 a t~ OWNER/BUYER~.r~ ~J. ~Id/ H ROUTE/BOX NUMBER ~ ~ ~~ ~caX ~ ~-~~~ Fire Number ~ CITY/STATE tfc~./5orr vCJ~, ZIP~~O/~ PROPERTY LOCATION:~[~_~, /~~~, Section ~ T~N, R /9~, Town of {~~dS©.-. , St . Croix County, SubdivisionC~S,~~o~~~3 ~',y2~Lot number --- Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents m-~ a maximum of 60% of the cost of which was in operation prior to accepted this program in August owners of all new systems agree maintained. be eligible to replacement o July 1, 1978. of 1980, with to keep their receive a grant for f a failing system, St. Croix County the requirement that systems properly The property owner agrees to submit to St. Croix County 7,oning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank. is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. '~ 0 I/WE, the undersigned, have read the above requirements and agree ~ to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- H ro ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. ~ S I G N E~ < ~(7 AM ~ / 1 +ti~ DATE St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS If~DUSTI~Y, CC DIVISION HUMAN REDLATIONS PERCOLATION TESTS (11J~ MADISON W 53707 (H63.09(1) & Chapter 745.0451 ION: LOCA T ~ ~ ~ SECTQION: Q p/qr TOWNSHI OT NO.: BLK. NO.: SUBDIVISION NAME: / ' ~ ~ ~ W ~J /~~ 1 H`It/ I ~lor LG d/~ ,.~, ~iM. ~ - 7 ~~ OUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: C./'>9 ~ M /~'f ~`//e,^ oar. f,vo Ioiu W ~l. S v/ iE NO.BEDRMS.: COMMERCIAL DESCRIPTION: Residence ~ ~//~ New ^Replace /~'- sa: / ~gP ~ DATES OBSERVATIONS MADE PROFILE DESCRIPTI NS: PER A ION TESTS: /0-3/-87 /~- ~-~' RATING: S= Site suitable for system U=Site unsuitable for system ,S" C ~ ~ S ~~/9/~t CO NVEcNTIONAL: ~S ~~ MOUNQD: ®S ~~ IN-GROUND-PRESSURE: ®S ~~ SYSTEQM-INnn-FfLL DS I~~ HOLDIQNG TANK: DS ®~ RECOMMENDED SYSTEM:loptional) CV ~ ~ ~ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(bl, indicate: ~//4 Floodplain, indicate Floodplain elevation: /(,~/A PROFIIjE DESCRIPTIONS BORING TOTAL• D PTH TO GROUN DWATER-I~1CW~6 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- ~ ~. d ~ . 9 ~ ~. ~ 7. ~~ , s w~~ s ~ B- ~ d ~ , a s ~o B- .3 . d ' . 8 ~ Oict ~ T 'J. d ~ .S 8J/~ .'/ B~/, /.c ~n jitf /CS, S/./B~c fr/GSA- ~ Cd M '~ t B-.~ ~• d' . 02 ~ 6~f ~ 7 'J• O' ~ 7 B/ ~, • ~ l3^- ~ir /e9 lan ~- /CS /.3B•,~- /es •~r-cx B- PERCOLATION TESTS TEST DEPTHI WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER F1dGd--hES AFTER SWELLING INTERVAL-MIN. P RIOD t PERIOD 2 PER D PER INCH P- .Z 3 O' o s 3 ~ 3 Z P-. P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION q y 7 ~ ~, ` ~~ ~'~~ % ~( ~ ~ E 1 h` t ~._~.. ... ..~.. ~,__ ,~,a._,.e„ __ _ ~,..,_ .~~. ~~~___jG._. ~_ /~ i ~ ~ -- F a T ~ ~ ~ ~ ~ i _ r~ ._.c'Ajjcn, __ ., ~,~,d ~. ~.~ ~ ^ { i ~W ~~\ ~~ ~ ,~ q .t'~ ~ _ ~s ~~~~ r M_ ~ ., F I ~~ ~ ~ ~ ~~~ ~ ~ ~ ~, ~ ~ D /'. ~ (~ ~o~'~ ~~ (~~ ~; ~- -~ -~ __ ~ _ e . •~ / ~ 4~~8'~~ -~ Tll '' i i ~ I ! y ~.~ € ~ ~ ~ '~-~~ ~. ~. ~~I11Q. ~,'~' ~ ` d- ~ ~ ~ - _ _~ a , _ --~ f i c? ;-- ~. ~~_ TH _-~~~------r' . __ d ~~ -___ ~_~ , !1\tSTRL1T10NS FOR DOMPLETINO FORM 115 - S8D - 535 .. To i~e,a complete and accurate soil test, your report must include: -~, ' 7. Complete Icgai description; 2. The us€; section must clearly Gndicate whether this is a r~sidenee or commercial {project; 3. MAXIMUM number of hedraoms or commercial use planned; 4. Is this a new or replacement systerY~, 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULECI OUT BASED ON SC3iL CONDiT10NS; 6: ~PLE~SE u~ the abbreviations,shown here far, writing profile descriptions ar~d completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet iitay.ti~.u3ed if desired; . 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9., Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 1~}. If tl7e in#ormation {such as flood plain, elevation) does not apply, Place N.A. in the: appropriate box; 11 . Sign the form and place your current address and your certification number; 12. Make legii7le copies ar~d distribute as required. ALL SOIL TESTS MUST BE !=ICED tNITH THE`. FOCAL AUTHt}RITY INIT!-IIN 3a D~,YS~OF COMPLETIOI\l. - ~ _ ~_ , .. _ ~ ~ y j~ -y AEiEGIAT.I~ONS FOR C~ERTIFI® SOfL TESTERS y • •Soil Separates anti Textures Other Symbals st -Stone hover 10") BR -Bedrock cols _ Cobble {3 - 10") SS -Sandstone gr - Geavel {under 3"} LS -Limestone '°s -Sand HG~V -High Gro~~: cs _ Coarse Sand` ' Pere - Percolati~ ~ ~, - med s - Med1~m Sand . ~ UV - LNell fs Fine Sand Bldg -- Building 1s - Loar-ny San€!~~ ~ -- Greg=~~ `~sl - Sandy Loam ~ - Less Than ~i - Loam Bn - Brovvn ~siE -- Silt Loarrr BI -Black si - Si!{ Gy -Gray "cl -- Clay Loam Y .. Ye(lo>v sci -Sandy Clay Loam R -, Red , sicF -Silty Clay Loarn rnot - Mottles` sc;"~-- Sandy Clay ~a1 - !with _ sic -- Silty Clay fff - few, fine, f~,:i ~ ~- > '"t. -... Clay ~ ~.~ '•~`~~ cs, - eorrin~on, ~ ».- :~ P{ -- Pcv~~t t~.~ rnr-n -= Marry, rrrgu,,:r, rn -. Muck <Y; .a. d - distiFrci , p - prominent HWI~ -High wai. level, . '` S~ ~r~~' soil textr.rres surfa,~:'~` ~. `rid tivaste r:fispo§aj BM - Bench iVi~ i. , f VRP - Vertical F. ~:erence Point _' ~. T .i r .. ,. ~ ICI ,. TlJ Ir'iiJVV1V ~9'S ." ~ _ - Jct. /Y~ ~ t ~ (m-r d f3. i?9. %s tk~. ycr~"~ ~cr; Z Qa,~ ~"o~Ml ct~ S.'~. ~~~ ka.. ~10',~'1'i ssti"ro~° ~ °~ ~lz , ~o1~Pi~~ A s s ~ rn mod' ~ l Y. = OCR d l o ~ ~4 r~ s~,eaC~.~o~.~ ~ ~~-rG .5 C7t..sf~ ~807~'e~,a~- 9~ 7', ~ 1/ \\ U_ P ~ ~ .~- 3 ', tU,u~, loft Cc~ n~.~ ~o ~ , eQ ~ ~y /Q..ry ~ .. ° S~_ . \ti~ ., ... ... ~ ~ .. \~. d ~ J ~ ~ ,t Y. " ` ~ ~ . ~ s ~ ~ H ~ ~~' Q . H . d Q ~ 0 . J. P- . a M ,n= •CL - 1x ~ ~ ~ ~~ ~ ~ fir- H _ ~' J > ~-t. ~ ~ ~ '~ ; ~n > ,i ,..... a {i, ., ,' ~' ' •r; ~, .~, ~.:~. .. .~ s+f:'.:~~' .. .. ~ . i ~ ~~ '.v ~~ d +- J d A 4 1-1 -~ J i cJ T .~ ~ ~'~ b .~ s 0 ti- J L H 0 d b 7 ~ o d v .~ d N . s+ d ~ a _ ~, . ~! I~ +I . ~~ !, ~~ I i i ~ i ! t~ ;F- ~-~~ s 0 0 Sr ~~f ~~•. J 1ST Q-- O 1~ d d c9 ,~ ~ ~J ~? ~' ~ ~ 0 ~ '~ d , ... .. ~ . _ ~ ~ ~ G N .y ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT N~ Owner ~1q-50 ~ ~ ~lfM~ y /~G~} l30 Address s C RECEIVED City/State M~'~ ~ 6 2002 Legal Description: Lot N~~ Block Subdivision/CSM # N ~ sr. ct~o~x co '/, ~ '/. ~, Sec. ~,, T„~N-R~W, Town of V ~ ~ ~Fi SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer ~il~l ~~ ~ Size ST/PC ~ ~v / Setback from: House Well P/L _ Pump manufacturer off' ~.. _ Model ~ /~~ _ . . Alarm location /,V Si jZ~' ;; ..,~~,.N ~ (HOLDING TANKS ONLY) Setbacks: Service road V Meter location Alarm location SOIL ABSORPTION SY5TEM: j3/DOi ~s~ 3 / Type of system: Width Setback ftom: House ,~' Well ~ P/I, ELEVATIONS: _ Length Number of Trenches 3 ~2.' Vent to fresh air intake ~ .s ~ ' ~~v(r= sa o t Description of benchmark Elevation Description of alternate benchmark ~afJ Off' A`U.~ . ~~ G~ 0l0 Elevation Building Sewer N(~ ST/HT Inlet ~~~ ST Outlet Iry~ PC Inlet /~ 3" ~° O gyp. Og S ~• OG ~ ~ ti/~- PC Bottom HeaderlManifold Top of ST/PC Manhole Cover Distribution Lines ( ) Bottom of System ( ) Final Grade (, ) O ~^rl ' y J'k- v O 5~e tl-S U%!i% - ~~ ~ Date of installation ~ mit number D3 l~rS~y State lan number ~/~ / Per p Plumber's signature ~~~-`-"^''~ ~C'~'W"' License number Date / / Inspector ~~/~ ~ ~ 2 Complete plot plan air intake Water Line ,~~ 1 ~t~~~1~~Q{ ... _ ~ 'N ~,, • 3 Ao ~ `° h v ~` ~ ~ '~ ~ ` ~ ~ ~ ~ ~ ~u~ ~? ~~ ~' ~; ~ ~ ~ v ~ ~ 1 o ~ ~ w ~ ~ v, ~, -~ ~, N ~ O M ~ ~ ~ ~ ~ M .-Z ~ ~ 3 ~, ~ ~ ~ ~ J ~ ` s -° ~ ~ ~. 0 ~Jl s ~ ~ ~ U ~- ~ ~ ~ ~ ~ ~ K .... ~~ ~~~ ~~ I ~ ~ ~ ~ ~ ~ 1~ 1 ~ ~ ~ ~ 2 1^~ ~ 0 2 ~ 3 o f \ `~ ~ w ~ ~ ~ ~ I p ~ \,, ~~` ~ I ~ ~~~ ~~w~ ~ ~ ___. ~~-,,, ~ 3 ~ 2 _~ ~.. ---- ~i ~ ~ ; r 3 N ~ ifll ~ ~i ~ o `9 ado ~ i ~ ~ 6. I ~ ~ I ~ ~ i~ ~ ~i J r, v. t„ ~ I I I °~Wty ~. N ~ ~,(, ~ p k1~ I jM V ~` ~, ~ I ~1 ~t V p~ ~ ~ ~ ~. ~ ` ~ I ~ 11 ~ o ,~ ~ 0 1 ~ ~~i O o o V ~ ~ ~ ~ ~- ~ ~ \