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020-1136-80-000
WiseGnsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Fe estad, Richard Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: ~=~i S~dli-~-' TANK INFORMATION ~ ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic 7"'/ 21 / Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ Q(~~ r`l1~" r ~ ~` ' , , Aeration Holding PUMP/SIPHON INFORMATION I ~,t,ci_-~1~, Manufacturer Demand GPM Model Number TDH Lift Friction L System Head TDH Ft Forcemain th Dia. Dist. II Cf111 ARRCIRPTII)N SYSTEM / ~ r7Ar ~t2PJ} ~0~ County: St. Croix Sanitary Permit No: 514864 0 State Plan ID No: Parcel Tax No: 020-1136-80-000 Section/Town/Range/Map No; 20.29.19.678 STATION BS HI FS ELEV. Benchmark ~ v I~ /b~ ~ oo` Alt. BM ,.j- Bldg. Sewer ~^ St/Ht Inlet ~ .~ ~i SUHt Outlet --- b.S~ ~- 3.2 s ~.~ 3 3 t ~/'~.1 ZG i •s 3.5' ~'3. o ~ Dt 13ct~enT ~y~~ V 3. % ~2, gY Header/Man. ~ ~~" Q 3 ~,~ Dist. Pipe SC ~ ~ !-1 • ~ ~~ ~ 7. Q Bot~ System 3.- p, ~ 1J (o-Q `f Final Grade ~ ~ ~ 6 C a S~,pver / ~ .S cf a (0.`3~ ~D~~ 1n's.~ Ir T~L~~C- Q /-tvL ~' BEDITRENCH DIMENSIONS Width ~ 3 Length - No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK I N SYSTEM TO P/L ~ BLDG WELL LAKE/STREAM EACHING HAMBER Manu urea _ ~ /~ !/ It~rC!-' (.~ `i INFORMAT O Type f System^:'..~ ~,. ~/J ~ ~~ ~j ~ (~ ~ 1 1 ~ U Model Number: IIISTRIR11Tl(~N SYSTEM Header/pM' ifold ~~ ~ ~ Distribution / ~ ~ Pipe(s) ~ $ ' f" ! x Hole Size x Hole Spacing /~ Vent to Air Intak~ '~'U g Di acin {Q th Dia S L a length g p eng A.~t Coll r^r'IVFR ., n.e~~..~e c,.~fo.,,~ n.,r,~ ..,. Mnnnrl Ar Af_C;ratle Svctems ~nlv ~wv~ Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~• ~Tb4 •S BedlTrench Edges ~- Topsoi~_ l"-'" I Yes 1:-, I No ~ I Yes ~`~, No ~h COMMENTS: (I elude de dis~cre~Iles, persons present, etc.) Inspection #1: ~ /~/~ Inspection #2: / / Location: 880~~`-tdefe~Pas;~ ~sa , WI 54016 (NW 1/4 NW+1/4 20 T2 N R19W) Willow Ridge 2nd Add Lot 69 ~~ Parcel No: 20.29.19.678 1.) Alt BM Description = I ~,P ~~ ~h~ ~~` ~~ 2.) Bldg sewer length = (S ~'.~.k.'~' Z~ ~CN ~r7 ~~ - amount of cover = ~ ~f 1 Plan revision Required? ~~1 Yes I_?l No r ~!j r. ~ ~ 5 Use other side for additional information. ~ ~ G ~~~/y~- Date Insepctor's ignature Cert. No. SBD-6710 (R.3/97) commerce.Wi.gov Safety and Buildings Division County ~ 201 W. Washington Ave., P.O. Box 7162 St. CrO1X i sco n s i n Madison, WI 53707-7162 Sanitary permit Number (to be filled in by Co.) Department of Commerce S ty( Sanitary Permit Application State Transaction Number ff In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to th ropri ove ntal erent than marline address) Project Address (if di unit is required prior to obtaining a sanitary permit. Note: Application forms for eta weed S submitted to the Department of Commerce. Personal information you provide may be u or seco Same ~i $$~ I,.;'; ~ I p~ v ~~~ u oses in accordance with the Priva Law, s. 15.04 1 m , Slats. ` I. A lication Information -Please Print All Info a to ~~~ _ d/ Property Owner's Name ~ Parcel # Richard & Lila Fe estad 020-1136-80-000 ~~ Property Owner's Mailing Address Property Location 553 Wa on Wheel Crt. ~ ST. CROIX COUNTY Govt. Lot City, State Zip NW v., NW '/., Section 20 (circle one) Hudson, WI 54016 715 381-1595 T 29 N; R 19 w II. Type of Building (check all that apply) ^ 1 or 2 Family Dwelling -Number of Bedrooms 4 69 Subdivision Name lock # Willow River 2"d Addition ^ Public/Commercial -Describe Use dit. Na ^ City of ^ State Owned -Describe Use CSM Number ^ V' a of n ~ Town of Hudson III. Type of Permit: (Check onl one box on line A. Complete line B if applicable) A' y ^ New S stem p y Re lacement S stem ^ Treatment/I-Iolding Tank Replacement Only ^ Other Modification to Existing System (explain) B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 3gy~3 S 3J S 3 IV. a of POWTS S stem/Com onent/Device: Check all that a 1 Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (ex ^ Pretreatment Device explain) V. Dis ersaUTreatment Area Informs oa: 42 Infiltrator "Q-4 'chambers 20.0 sq.ft EIS A /chamber 3 air end 5.8 Design Flow (gpd) ~ • Design Soil Application ~spersal Area Requued (sf) Dispersal Area 7 40 fr ystem evation 86 00' 600 gpd . 0.7 in-situ soil ~/ 857.15 sq. ft. . sq. 85 . . VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units a ~ ~ New Tanks Existing Tanks ~ / ~,.., ~ ~ U U ~ y ti `' " w C7 ' c? ~ D d H . sepfic or Holding Tank 1,000 1,000 1 Wieser Co Crete X 261 261 1 Weeks Concrete X Dosing Chamber ' VII. Responsibility Statement- I, the un reigned, ass a responsibility for i 'on of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb Sign MP/MPRS Number Business Phone Number James K. Thom son ~ 30021 715 248-7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceo , WI 54020-5413 VIII. Coun /De artment Use Onl Approved is Permit Fee Date Is ued Issuing t Signature $ys~.~ s~sa$ r Given Reason for ial IX. Condil~glg~-gp~rp~~teasons for Disapproval / / ~ v 1. Septic tank, effluent filter and dispersal cell must all be services !maintained as per management plan provided by phlmber. Z. Aii aet`t~ck retytlirements must be maintained es per rxlde ! ordinrncs~. Atfach to complete plans for the system and submit to the County only on paper not less than 81rz x I l inches ;e size SBD-6398 (R. 01/07) Valid thru 01/09 E/e cfr, ~.al , Tr4 2s {ohm <,-- YY .~ ,~ 8d , -' ~ .~~ -.. ~' .' ~ W Qt~c~~d r .' • ~ ,' 88.'~ • ,~ 89.ao' 83 ~, ~% ~ ~ K~4o~ r \ I i 89.sa' ~ B9.BJ,~~ ~. 90,07, -i' ~!~ O ~ a ,, 5 _'~' W 1Q 'U Y. ~, gz ~ ~ ~,/ `~ y~.7ti+ .` 90.00' .Srdiii AS$u.r~ld t ~ GU's s /00, l~O,~ / '~ a ~°_ hjoP~sed d,-Sp.c.rsa/ C e /% ~, rc c ~~ t~nc~uS ~t 3.v'xSB.o'~uc~da,E. ~~~'~ ~~ (1-~GDo~¢.d ~` w ~o a..d ~Q~n ~ so,/eda/ua~,•o~-,,o,~E • E,r.'s f,'•~ 9 !'adp e 7e . /o~~d~~a~. see ca/e: ., I~ ,~,~~d~~,~QFyfes~ o $BO u~,Y/OcJ ~ dCJQ, ,Co4d h c..JYyil wt'~ se c. zo r,z.~+~ .P. /yam., T . of f1ti ~ st . /Oc/ ~D~o_//36-Bo~~ E: /8r ~ \ X S~~ I ~ d~sfr~l+w~,~n /o.lve I I 1 I L.. ~SC~'S Cvnu'~.'~C~.~/c~ ~~Pa/yLo~e'R~-s1s'e~'/u~~ ~~~iCS</ ncI' S ,.~. A~~ ~ C/OEYG ~hii/~~~[j,~• ~~ j noel ry `\ ~ v 1 !t ~ .~ ` ~ a ~ ~` - - / .' ~' 9a~~ ~~~ ~~ A~ o ,q,p~afE d~; dcw~.r E'y,•s ~ ~J ¢"uJ 2 (/ go.ra' e lob' 38 , Q 2f r' ~~ E/e c~''~ ~a1._ T~4 zs form c r ~ ~, , '18~~, . ,, BdQ~' ~ '~~ g9.%T .. ,- ,,- ~ W dac~Rd ~ r r • i ~ ~~ i a ~ i ~ 89.u~' B3 ~ r ,, ~ yy~ ~~~~ 89. S4 • ~ 89.6~;~ ,, is O ~ a0 4 ,, `~ 5 v ~ ~ ~U 'nP ~. , ~ 8Z„ '~ A~~~ ~~ e~ kc3 % Mc yc, sd' ., 90.DO ~ /din ,~SSun1td e ~ Gi.7~ : /OD, dd / 'm 0 -`°` I~leP~sed d,'Sp.crsa/ Ce/% Tlircc ~~ t~ncluS ac~~V XSB.4,"3~ucadat p'on Cdrr~er us;il 5/.2 ~/ ~l~o~r't /'cnc+ti/ . ~~ w; I 1 a~ ~o o..d JQ~h E,r;,yE;.~ /8 x r ;d,-s pcrsa/ca/1, 1 1 j d~s~Er;6.~b~h i • E~r~s~;~~ grade elegy ~ocat~dPro/p, .s~¢ ~a ~Q h cJYf/iI wy,~ Sc c. 20 T. ,z.~~1 ~Oc% ~O~O-//36-Bo-~ ~~/~olyLa~RL-.sZSeFF/k~~+ _ _~,'_"~i e5cr~oncr' ~ ~ravef ~ ~'7~ ~~ Ejri ;St`.Yf~ ~ C/ i < ~eS~d¢~7GE. ~a~ .. ~, ~~ ~o-i"ata~ L-Cc a...9.1 A~'o A~pl~afE. EXlS Fi nJ d c~ac~td gara'e. 1ob,38~ f~c 2r --- ~~~ --~ +JJiS? ~ I iz~~ ~~~ ~ ~~~ ~~~~~~~~ ~ ~ ST. CAOIX C011NTY LOCATED IN THE SE 114 Of SEC t8. THE SOUTH 112 OF THE SW III OF SEC ANG iNE kVS 714 OF SEC. 20 ALi IN L 29 N.. R. 18 W. . `•-, - r ae roaGrr r;: •ss~aks L•SIS, GtRYf DATA rA8L1 - * !6 t;iFu c,Grl ::^4 ae7 6:rr ' R..n lwsa Cnu C~irur '' t ~ ' ~~\v ~ ar "ia.. k Gu c,r .• . n's 9en ~.. Lwr !c[a dwrrt ~ .:,u ~~ NrY 37.'1/ f~INi~ro iV~ ~e ~ ~.tts 7Sf ...~^-sY .....:i.1'~, ,, i °+ F 9,c,•( iAT iL;J7n"s l !'ff01' I i r4TC.v lN( ap9 o o /rry~, ~~ - y ~ tM11 gfn•lrB 119'4rl( r ~ c , o„ UNPC AT fCO iAN93 ' _•• f"' '~ J <. ..... R 137. N/N3T'{ 117a'eY /... A ~ ~ .,.. .. AK .,-,...e _ t r ~ 441 - dc7 :vnu4ar! O'14'!r 'F Sr,dt~ ~` S81:r - 40 ~ !s.n mill /!sdrl.e:~'19J, 4/'li;9' ` r`'7 3 _ l~C Saoza NBf'K~! 31S a _~, . '1 1d~A am--"' 4a/ub3t84'!t!la']rm' 1, ' ----.-... __-~.._~,_..... ~ $ Sam NJI'Ri7'!rY.lf4r' !: •J a A n ~s4es sa7mr,+* ,f'k/a ,`'` , ' `~`.",p ,;f~ __-•- ,:~ d ~~ Nes'!aGO7 3ti7s gj tafer v8N3S?CI,,-'M:e', ySY a..s q',>. a . OurzaT S qi p t .t'; 7o7r I J:..xllfalf AI'iD'm"! 11'la'ro' , ~.Y~ , \~ 4 _ ' 89'S4 ;"/ r'ma an, n1)a~zro~ixlavr lnn,a l / 11 4 ~ ~ a rr_:, !t '--- m ----- „'i`-------80~'- +,tl 111!7 _P~OPr 41x48 r i -~ l+ 1ma0 ,aam ~ . A ~_~\...._ / t s - ~' "cam '~4 11j 7 rxa>a~,M r,vr.,r} nli .J~ MC GA.yJ N•N 7134 rots 1N 7P Sf 7149 /0 A • ~ .'<..,ai ;7 " - 7a /~ I~ Ir I' 1' ,b _ _... &?tl` i- fast -r)dsa ?N ~ .I 1 f p {{ - .~,j___ !4fl l0rrl :4414 a/d A)a I1a'$0)~ ; ^ V`rt~ ~S1 `. i ;I _ b ~ _°1 __. ~_ . p_~~--~ a. I tf S89Y9 J0"f _ .__ 4 I R 1fI. ', __ P'Y 814a rx.rfiraJ.or nlsao- 1 S ~NI, ~ ___ .._......_ _ . F~A Jz5)~ 7f1i SA97idf 4 149 ~ 1 n gIa ) ~ ~° I / -- d8'AY' fbBr q;`Ilh' 4S GIs q oM 4i 7'. e / .~ r+.rr:• JFJr T7nJ6 wK r;nrfs{ 3:tSS• ga. ~B i 1 li Z,a ~'R 48 't° ri'• ,'~~'".- .-~-! 7f•J4 31141 :4B.n N:t1Ydv !/'I~10' i~. ~i\ }4 'I~ ., .-•'~,~' 911 87.04 /58.49,NR'34:4![ir'Sr ]7' ~ ti~ I i 1~,1 `'.:~xu:~c •' 47 G a/57:AJS' Ars :0118 4i/ro a4r0.ra';a 613em ra fac.i 1 I ~ ~~.'I~,40~b~ ~,...s=.~ .r4PSi q,~ D'u , ~'~ e l i 1 (~ i0 17fd0 Oy'Klff 17'.710- sd'~T- 11 1 N 1 i4' sx`...w r, ~ 4 sll~:, N6~fa0 a0 ~~~ v 17 \, `I\ it /99.Oi N{8fl01J 1a'19'Of' { 1 :'Yfi ~J ;' 1'.l ; d1 ~ Js: ~ ;-rasa '4 ~ SSI~r .% ~A ~ u ,Z ;ap qf/ LYfJ'A' l'd'19' ~" 6 2 I I 'Q / ~, -'hrve9nse r. j as1 ~~ ~ ` '~P , i~ as to 1 •• ' af71 4uyv'4'N 19973x" Q i y ~:. ~ 'I 1 '•I I ~ /I!AR7NV/!W -~ .• ~: `0 ~B ' 164. x77; 3Pu71+'W 4bfld' v' i` 1 ' .cv- / •.~~ va01'T0'»' .. ~'~ ~~k1` `~ SZ ~$A Q e i a,n Off 9J, K4s'd Y1t%1R',418'Ntt i 1 i I o ,•/ ~~,~am-~..~' a ,,,4 21~ 14V `Q ~ I may. 111 a. N _, ` .!~ y,4r u1v N1afN7rin Atr7r' ,e, 4~ <• ~.,-'~ ,r~•1+x.° „~ 1 1' 10 u~17 paa m4 ar0,ma aam' ~ o '~.?B I 1 '•., ,,.d 1 , Iv,1rn0; P o~, S3 ,+'""\ ~ s lnaynr,r~JN s1'Ja' $ ^ \ 7 r ~ n• . r S iP u xundrx .bn' p r~, v~° I 1 161 S ~ ~y1 ~ . ~- 1~ ma mJm r~,)IN)r1,tr.'~ol_'°.' p ` li ~ 111•. t~;f6a~ ~• {s,r `dNgN ~ ~,`~~ ~, S4 - ~ •,n Trr! ryN ~ ;2 N•N saz" 1 /amlu,a'm'm'w!m'Yra• 1 ; 11 /sJ r ,1 1, ~ ~': ~ 1~?~ ~ ~ rd `u 17 i 9tH 71'Y777/VJ'01a!" i ~ __ Jdrl9aa 1 S ' 1+1 % P'/11601 ~~ ~' 11 d c I .5' l6 ` ' :~ ~<aG !ae ~ r~ ru,<~"r,rr,n~ i '~ l-n n'ra3a7a l z'oJai I ~ t~ a,r 1 1 1 1 V.~ 7 Ij ~, sus 12 1 4 /y?• a;r',I ` \ . Y yr, ./:.~N'• Je r Ja4si m1m u'tf'm;v ,traaa' ~ / \r ., 1 ~ ~ /~raA 65 \:` \ ~ 1J• •n`a" 1 ~:j n 44ro 4NVlanv /at4n' ~; s ,o e t ' -`~ ~ p,~U " ;w r \,'. ~ 1°' y 'tw+"'' a . u ~ a ~, \ 1 V L 1411P 9n'J7adfu! 4.3'x1 r~ :.., 1(1^..-'- ! '~. ,4e ~'• 8 ;7fJ 311.;1 naar vN'nu':v In•roro' 0: h 8 ~ `-y; a•~\\ ''.• \ ~G qxt _ ~ , ~ ~ a ~' IQ •• J9,q 17}faTri I /0'.A1a4' z7 -~. '/ ~ i ,: ;p; M r .„,' ' A,~~ , r• ~,~rl,n• 641 ~~gcuzc ~~1 a , t 1 80, ~ t6. 1 ~ a ~ `.e.i satf na.re Ym:f9urPo';aarc Jrw'ro' ~: ~I, ~ i"p,-'':._l~w~r :its ~g,~o al,s f5 ~ 1~`u' lm4r arn5sr! •vN7!' 0 ; 1,.+ i' Q;'e \ / _ \ $ S(o ~ r . s> ru.,'9 V3t'J7Mr't 7'nr Q ; ~ ~ ; ~ , + dm ~` ~\ `t. ><n 40a14~Ifiet 789x!-! 1170 a' i ~ ~ \ ~~ 1 '1 ~ "'p„r} IS S ii / i i ' ~' +i ~ ~' , ~ 11 dP~ a•~ 41N JN4t Nu:nx'! ~3a'ziro ~ n'39' ql' 1 / G4 , "'ri~ ~.,. o f "~'''^ j; 1 +'T,~ tel ~ 9197 Nerlr4'{ i b'nsr, g I 4o'rs•w Sty ' <. t~ ~ ~' ,r / KI ' 'zro.maarn~rfrin'r,l, ~ ~ i , ts~ \1 9',, ~\ ~, 1 (o-e 7fi s7 vU7~Nn'N'.ros! aJ•rY4i r18 t 7Jy'" ~ ~~ ~45~~°L ~ ~\ ~~, t-~~e, `d'W`Po-~~ ~dta ee pi) /elel /7193 NM+1)r'N 7f'm'k'~ ~. ~J ~ 1 ~ :`SI' 1111 Q ~ 1 A ~ /1" r$ ap e as \ ~ ~' J~ ~ 1 q e ~` v4a n.a ~ 3a9r JY 4a1'w l ass91r j ~ / •, h a ; / mow, a ~ ~ . ~7. ~, 1;d wl ~ P ~ro m's c4~'~ Cd B ~ `' rrnr. . ~; ~ f ~ U ~ a,t 6r T h, q1 Ar,Sag6 W i rod,, ~... ~ M AA ua JnN 71310 NSrnu u' 4J'f9J," ~` i i b a ~ ~ 1 ~'~ 4r!,r' ~6B I ~, '~ ~'--~ J ~?Ri+ ° \ ~ qe m4a /m.7r 1aalaN11a,1,ri rrrra , ~ ,,rl ~ /yt I + _- ~s ".,„i ~ ',,r9'\, ~1' \1 Aru•G /47 erlN/!'rt a7rn fe'!!x' ~: 1 as srr +:~ 6i \~~\` N Ora r kur r ~ \ ) I, e ~ vi n lay lNrr'anre ~r4'm'w 6 'e ) t4 I r o,,aoe. .S~ +1 'I' 70'n tia.Jr a7G.7a1x4',2'orN fl'rold ~ a! bpf , T~ ti ` ~ 61~ ,~ ~, +~ ~ I azta Nn90 n'{ S'OfJa' 0' I ~ , ~67')I` ~ '/ ,. s" 59 QI~: ~ 1 1 ;`~~. 1 71anN1aevrFJnstr' v 4r 6t L' t~ 6B ~, $iA oI~~ oIn o„~a1"a d+ml 71,a Nmasa a~xreas ~: ~ 1t~ t '\ ' s •~ 0l6 6~ hi; 60 ~~ I i 1 m4s d11N 711.90 NJf)11!(f yrrrl 7 ear a ~ ', ..:rrw w ~ ~ q mA r,v ~ *.rr~ M ~ + ~~ ~ I~ roM,ie tia a;t j ~~ ~ ~~ •~a, ~ nuwnr X~'a 1~q 1 1 u.a. f5Y 51 s743 n: ~ ~ .r, ~ ' ~ -~ ~ w 7 \ !'~ \ ~Vi (7y ~° '' NIA I ~ a 1 - i;0 7Ven' Nasr. e.n f srCMrs or Wi:-px, ~ a `' ` . N/ i ~ / RiaalAaa,raxeraAarnnrraG,utnr I ., 'p`, ~9 ,,\ ~ r ~ 411 E /d~ n YatOw R,m[1p0 Aaa,noe saewa ~ ~~~. °~u 1 ~~., ~i' 7;fp .~/05~7r ~ '•/~~Df~END PCUav ear CJMMax exa !eLVnU[ , ~lt •''w~"urr>1 t 1 }~IGA~ iw.n. Do,raxrn,.•,Breertrea ? 7roN yyAJ' Rrsu<s ar aswie0,rc«ra, F•rrrxra<r I a \ 'A,Hlrpfi, t1 n,UK 7`.p7-" NICK~j/ 0-1`,10-;".,a.~Prr.W,w,.rc 3llln.~Luaa Far ra. Bev: ar Asso,+ro t7csawrs ~ 'y N ~^ ~u(l '93-w l4 /"~ At: prne!ar lar.'les sruro ~/N/"r 19~ ., n , { \ 1as o „5110'43 Rla / Rav ~K, :VI,CWmL LII !es~ ru fKr au ,~•- f - .~ / a N. nnp N ~,u'at' ,y ., .;~.- ~ Aa •°:r; Buans ea Rarorm Tp T.r Wm {' ` _. 3WJB C 011r/ N T Y/ / /,,wr rr Snrm• 10 W.ve Res AN A4smD Bu4ar< c !!q ~. ,"da„•:9c I Pol~ ~-i 1i ,. CQ~~i IANAS. a.NO'0390"W _ \1611 Casma(lJc .Cep s•aaa.' I ,i ~ ' i ,, ,! // ~7^ - Slitcr 3 u 3 Sxcns l~rr~ '~ ~ `'s'6u ,arJrnrcd aas drytrd dr -~rnl.-~1.t~+a4G-- I _ -___ _ Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in arenni~nrv wi}h Cnmm A5 Wis Aram Cnt1P 2119 page 1 of 3 A.C.E. Solt & Site Evaluations Attach complete site plan on paper not less than 8%: x 11 inches in size. Pan must ' County St. Croix include, but not limited to: vertical and horizontal reference point (BM), di n a parcel I D percent slope, scale ordimemsions, north arrow, and location and ills r>Ba . . o2a113s-saooa Please print all information. Re d By Date Personal information Yoe P~~ ~Y 1)1m))• Property Owner Properly Location Richard & Lila Fegestad Govt. Lot NW 1/4 N 1/4 $ 20 T 29 N R 19 W Property Owner's Mailing Address MAY 0 2 Lot # Block # Subd. Name or CSM# 880 Willow Ridge Rd 69 Willow Ridge 2Nd Addition City Stat Zip @isd6v~#f-b~e`f J City f Village /_J Town Nearest Road Hudson ~ WI NIN F Hudson Wilow Ridge Road New Construction tJse: ~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD dj Replacement J Public or commercial -Describe: Parent material Glacial Outwash Flood plain elevation, 'rf applicable Na General comments and recommendations: Site suitable for conventional dispersal cell at 0.7 gpd loading rate. Recommended installing 42 Q-4 chambers in 3 trenches at elevation 86.00'. Boring # J Boring ~98~, Pit Ground Surface elev. 89.13 ft. Depth to in• limting factor Sod Application Rate Horzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rails GP /ft= in. Munsell tlu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-7 10yr3/2 none sl 2fsbk mvfr cs 2fm,1c 0.6 1.0 2 7-12 10yr4/4 none cosl 2fsbk mvfr gw 2fmc 0.6 1.0 3 12-30 10yr4/6 none gr Is 0 sg ml cw 1fm 0.7 1.6 4 30-62 10yr4/6 none gr s 0 sg ml cw 1vf,f 0.7 1.6 5 62-98 10yr5/6 ~ none s 0 sg ml - - 0.7 1.6 r, orizons #2, & 4 contain app rox. 30°k gravel and cobbles. Boring # J Boring Pit Ground Surface elev. 90.65 ft. Depth to limiting factor '99~~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stn~cture Consistence Boundary Roots GP DIft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-8 10yr3/2 none sl 2fsbk mvfr cs 2fm,1c 0.6 1.0 2 8-18 10yr4/4 none cost 2fsbk mvfr gw 2fmc 0.6 1.0 3 18-27 10yr4/6 none gr Is 0 sg ml cw 1fm 0.7 1.6 4 27-39 10yr4/6 none gr s 0 sg ml cw 1fm 0.7 1.6 5 39-99 10yr5/6 ne s 0 sg ml - 1vf,f 0.7 1.6 v Horizons & 3 contain approx. 20% gravel and cobbles. Effluent #1 = BOD S> 30 <_ 220 g/L and TSS >30 < 1 mg/L uent #2 =GODS <30 mglL and TSS <_30 mglL CST Name (Please Print) Signatur : CST Number James K. Thompson ~ 3602 Address A.C.E. Soil i3< Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson lake Lane. Os a. WI 54020 4/30/2008 715-248-7767 Property Owner Richard & Lila Fegestad Parcel ID # 020-1136-80-000 Page 2 of 3 Boring # .J Boring i~ Pit Ground Surface elev. 89•'f3 ft. Depth to limiting factor >93° in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 0-9 10yr3/2 none sl 2fsbk mvfr cs 2fm,1c 0.6 1.0 2 9-18 10yr3/6 none gr roscl 1 msbk mvfr gw 2fmc 0.2 0.3 3 18-29 7.5yr4/6 none gr Is 0 sg ml gs 1fm 0.7 1.6 4 29-39 7.5yr4/4 none gr s 0 sg ml gs - 0.7 1.6 5 39-93 10yr4/6 none s 0 sg ml - - 0.7 1.6 ~ Horizons #2 contains approx. 20% gravel and cobbles. \~ .~ Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stnxx:ture Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. `Eff#1 "Eff#2 ^ Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stnx:ture Consistence Boundary Roots in. Munsed Qu, Sz. Cont. Color Gr. Sz, Sh. `Ef<#1 '~~ `Effluent #1 =BOO 5> 30 < 220 mg/L and TSS >30 < 150 mglL `Effluent #2 = BODS < 30 mglL and TSS <_30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) A.C.E. SON 8c Site EYd1U0tlOn5 .. E/e~fr~~.a~ \ Tr'4 ~ {orm </~ /~~ ~ 1~ o n Q ~ `' S v dJ h -- \ ~ -g~,,, ~ ~ / ~ ~~ 8a Q7, ~~, I ~~ /~ ~" r n~',~' .' ~ ,' W ~ ~ ~ ~ i r ~ / ~ • 83 ~ 89, cn ~ , ~' ~,~, •' ~~~~~ i a9.sa' ~ 89.BJ,~ ~. 90.07 ~~ ~, ~M , ~ 8Z ~ ~ o ~ -} ~ft- yo. sfl' .` ~` 9o.ao ~rd:il f~SSun•1~ c 1 GJ~ s /00, Od., N~ \~°, C,c.~i l ~ Gtc~ ,~~_ ~~ d~ ,eo a.d Ex,sb.~ i~ r~ T ed,'s~OCrSa/Ca//, ( SySEa.-i a fcr,~ n 1 ~ ~--,-J ~ E,rlsf;~~ ~radp eleJ: • ~oc.4.-"~d~A/'e~. Stage ca/e: ~~ $8D ~,,~-~/ocJ ~ dc~e ~o4d hcJYyrJW1'~ Sec.zo, T~ P~% ~ own-/i36-~-~ ~~i c~ 5l./ n c/' o SeyoEy~.,~n~. `. ~ f~"avel 1 I~~+1 ~ ~ EXi sL`.'ri q ~/ ~~ /C25~c%rJC¢. ~¢~ ,' A~p~slf ~` dr'i oc~.>'.~r ~' ~e~~, ~~~ l~~ pa.t'o d e~cl~e,d gara't 10 ~°~ Cr' r~ f ~ 3 0-~'~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/ c~ ~` eS Mailing Address 8~ ll~: /~a ~ ~ ~~ /moo a.saf Property Address s ~Q (Verification required from Planning & Zoning Department for new construction.) City/State /~~s~h, ~ /~ Parcel Identification Number O~ - // 3 /O " ~~ ' LEGAL DESCRIPTION ''// Property Location h t:J t/a , /? ~ t/a , Sec..Zd , T ~N R_f~W, Town of h'~~sO" ~'1 Subdivision (~i /~~ ~i ~-4-e .2 ~~~ ~"i ~--- ,Lot # 69 . Certified Survey Map # ~~ ,Volume ,Page # Warranty Deed # ,Volume ,Page # Spec house no Lot lines identifiable SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms ___~__ ~'~.,~-- SIGNATURE OF APPLICANTS} _/ / DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) Conventional Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.O1/O1). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be <_ I S' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. 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 offthe filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes 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 individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and azound the system should be seeded and mulched as necessazy to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soi] compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March} dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BODS, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for ei~luent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Contingencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the St Croix County Zoning Department at (715) 386-4680. Pg. 5 of 6 ~~,~~~ TM STANDARD CHAMBER Quick4 Standard Chamber SECTION VIEW MultiPort End Cap ---- - --~ ~ , __. . ~~ --~A'-_ _ -- 1 -3r~- -- - ~`__ -~ __ _~ 34" FRONT VIEW 48" (EFFECTIVE LENGTH) =_°== ~ ====1 =1 ~I`=s~i SIDE VIEW ~ ~, r~ I --- -~~ I! !I ii ~~ ~ I it li SIDE VIEW Quick4 Standard Chamber Nominal Specifications Size(WxLxH) 34"x52"x12" Effective Length 48" Invert Height 8" ~~ it _I _~ -~ is ~~-_ ~` (- /~ ~. ,~ - -f ,/' -1---~ -- --~°'~ TOP VIEW MultiPort End Cap Nominal Specifications Size(WxLxH) 34"x16"x12" Invert Height 8° or 1.25" INFILTRATOR SYSTEMS INC STANDARD LIMITED WARRANTY _ ~_ - ~ -?a^^ ^narnner. End plate. wedge and other accessory manufactured by Intlnral0~ "Unlis~l, When installed and Operated i, i „ - u - ~ ecuroance won Infltratcr'g n;vt cbOns, ~s warranted to tl le v ~g 'il P~m:hasLr i' Holdrr) ayaur,t defeaive~ _ - - ,ar born Ina date that the septic pens t s sued for the septic syslc r c~mtaining fhe Unns, provided, however, _ - ;.ireo ~. epplicelJie law, the wa~rgl~iy penod wJl begin upon the date ;ha; installation of ;he septic system commences. - nus: no!lry InAltlaipr in wnling at l(5 Corporate Heatlquaners ~n Old Saybrook, Connecticut wnhln Arleen ft51 ~_ ~. sttp, y replacement Un,fs for Units deterrnrned by ln(Itrator to Ue covered by this L~nuted Warranty. - , ~- tr- ;t of removal andro~ tnstauauon of the Urnts ,= _'''~~'... - -. _MeDIES IN SUBPARAGRAPH tai ANE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT --, - - .. ~ . - . _ _IE ~ n/ARHANTIES OF MERCHAN iABIUTV OR FITNESS FOR A PARTICUTAR PURPOSE. _ -. r, nl ire hat -. 3 ,itactureU by nyone oft tl an lr ~ti!irator The Limned War enty dues -- ~ - ~' rWri oa ~~ ~. ~-. ~ ~hdll opt bo iablC for Pemre~ Jr.4~ dated pamayea, clt n ng o9S of _ _ - o - ~ ^~. erheap costs. o TOSSES ~r expenses incu, red by the Holder pr any third pang. Specifically .. ., ,e ~, - pamage to the Units due :o oa~ nary wear and teat alteration, accident. n9suse. abuse or neglect of - ....~ „ -.,cp I ~nicle vaAic or timer cond.tipns which are not nermi¢ed by the Installation Insvuctions, failure to maintain the ^iY 7r .'- se'th in the insiatatlpn In StrJCtiOnS; me placement O ,mprpper n1alEnas into the Sysi P,m Cgnlaining the Un115, failure of _ ~ ~ C c .o ~inuropai sung or Improper sz iy excessive water usaga, Improper yreas2 dsposal, or Improper operellon, or _. _... - - I l .ra:Or This L.imiied Warranty shall be void i! Ih2 Helder IaiIS .0 comply with all of the lefms set fOnh in this Limited -.~ ~. ~ ~ - - -" - ~'~-- able nor any l'- -na.~ to [ne Holder, Ina Un is or any thirty pang result ng fro r nstallation or snip- - ..I. , ~I I sGei or ~ _ Hoed Warranty iC apply- the Unts must be Installed In accordance .. , ,,:. ~ end aC l c ~c ail r"~ ~~ Ii 'aws. and In IL alors mSlailal on r Slruct tins c ,.:.:,- t i„i, '.Y ~ a., ~ ' t0 Chany o ~ tp Ilya L mitep Warranty. Nc warranty applies 10 any pony other than the Oriyl- - Je! ~_ " 'c = _ ~ :he 5fanva~7 Lil:i(C-'C7 Niai~an(} OKE/ed Dy 1ll~ili/2I Gr- A lirhned numpEr Of S1alE5 and COUn~iPS naV2 dinF',lenl wa~~anty requlfe- - ,.... .•. ~~)nn= 'J ::Cn~aC' 't` Itra;or's Corporate HeadquanerS in Old Saybrook, Co ~neci c.it. poor tp such purchase, to ohtaln a .--, i_;.1. ,_ ranty. and Snpuld parefulry veep !het ~vartenty p~iOr tp the purGhaSe Of Un!IS- • SYSTE M C I N C Environmental Onsite Wastewater Solutions" 6 Business Park Road • P.O. Box 768 Old Saybrook, CT 06475 860-577-7000 • FAX 860-577-7001 800-221-4436 r t r[ y o6 017 0~ i 5.156,488; 5,336,017, 5,401.1 .6: 5,401,459: 5,511,903; 5,716,163; 5,588,778: 5,839,844 „~ r ~ r t 32g X59 2,00 S64 Other patents pending. . ~ ~.1 . cl l a oia.,W naer are reglsiere0 trademarks of Infiltrator Systems Inc- Infiltrator is a registered trademark in France. Infiltrator Sys'!ems Inc. =0 _r_. tra,te ~ k n Mcxlco. Contour, Contour Swivel Connection, MicroLeaching, PolyTuff. SnapLOCk, ChamberSpacer. PosiLock. QuickCut, QuickPlay RECYCLED PAPER _ era e ~ , ar"s o; InLltrator Systems Inc, ©2003 Inti4rator Systems Inc. Printed in U.S.A. ~~ ,,'~=hi=- ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the ~~~d ¢'.~./a ~s~~esz~~ residence located at: ~'/4, ,~'/4, Section ~ ; Town_~_N, Range /9 W, Town of ~udsor , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service Did flow back occur from absorption system? Yes No J (if no, skip next line.} Approximate volume or length of time: ~s~. gallons minutes Capacity: /, 011D Construction: Prefab Concrete ~ Steel Other Manufacturer (if known): 1.~~ e.Sci C~.,c~~e ge o. ank (if known): .c ~/0 3,~8'~ ~~ 5__--. Plumber Signature) (Print Name) ~'~ . I~ ~~ (Title) / ~~ (Dat (License Number)iPRS Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) State Bar of Wisconsin Form 3-2003 QUIT CLAIM DEED Document Number ~ Document Name THIS DEED, made between Richard A. Feggestad and Lila M. Feggestad, husband and wife as survivorship marital property ("Grantor," whether one or more), and Feg4estad Revocable Trust dated February 15, 2008, Richard A. Feggestad and Lila M. Feggestad, trustees or successor trustee (s), ("Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): See attached legal description M. AUTHENTICATION Signature Richazd A. Feggestad and Lila M. Feg~estad t' a A~riI~12008 tel M. jo 1 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) lillll IIIII IIIII IIIII IIIII IIIII IIII 111111 IIII IIII * 8 7 2 3 7 0 2 ~~~J~~ KATHLEEN H. WALSH REGISTER OF DEEOS ST. CROIX CO., WI RECEIVED FOR RECORD 04!08/2008 11:50AM QiJIT CLAIM DEED EXEiIPi N 16 REC FEE: 13.00 PAGES: 2 Recording Area Name and Return Address Daniel M. Tjomehoj, Atty. 104 13° St., Hudson, Wl 54016 020-1136-80-000 Parcel Identification Number (PIN) This is homestead property. (is) (is not) ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. COUNTY ) Personally came before me on the above-named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Daniel M. Tjornehoj, Attorney 104 l3 St., Hudson, WI 54016 Notary Public, State of Wisconsin My Commission (is permanent) (expires: (Signatures may be anthenticated or aclmowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED ®2003 STATE BAR OF WISCONSIN FORM N0.3-2003 " Type name below signatures. 1 of 2 ~~.t ~.~ 1'Y) . 7'~",1.~~ .~! (SEAL) (SEAL) t 69 illow kidge 2nd Addition to the Town of Hudson, T that part of said Lot 69 described as follows: Beginning at the SW corner of Lot 69; thence N27°45'05"W (beazings referenced to that part of the centerline of County Trunk Highway "A" lying in said NW 1/4 of the NW 1/4, assumed N79°53'38"E) (previously recorded as N26°55'00"W) 15.74 feet to the pzoposed Northerly right-of-way line of said highways thence along said line N79°53'38"E 61.89 feet] thence S10°06'22"E 15.00 feet to the existing Northerly right-of-way line of said highway; thence along said line S79°53'38"W (previously recorded as 58843'43"W) 57.12 feet to the point of beginning. 2 of 2 - ` --- a • . l F yl ~ W ~ $ _~ .~ ~ ,' •~ ' S a h t, t7 po ° 'ys ~1S' .~ m `"~ _ -- ,_ RED oa-»' ,_ ~• a ~g 0. b V j,0 p~, 8 ~3' 0.00.05 4 ~~ , "~~ „, 8 ~ ~ , ' ~~~ $ ~ ~ Mal ~, o .~ 1 ~ ~ N _ ~ ~ n ~ ~ 0 ~e ~ ~ 1 ~ ~ I h ~ ~ ~ ~ 4~ . { a v 2~ ~i ;~ W' 1 - , a d5 V , I J?1 1 V d 1 _11 •'~ 1 0 oa a v - ~o , 1 <~i~, .~ ~~ i, ~' W a o a _ u w icn oa /~ . ~ po 0 A M M1 ~ ~ yb~ ~ _-- PASS ~ ,, -~ ~,,~ P`~ - °NJJaro~ ~, ~ v ~ v \ t ~v 1,, 1 1 f~ ~~~ O _ °o o I~ //gyp{ .. -~ o ~ °~', h C~- `` 0 0 h ". 1 ~ C x") 1 ~ ~ ~ fi° ~~ ~~ ~ y ~~ v h~ 1 $ 1 N `^ ti ~ `' 0 i ~r`-9 oL/1 ~ ~~ °ztor •~~ I ~~,°~~(P ~ `~~ aN f l ~ ~~`~n h ~ ,~~~ ~ ,- =y ~~ ~~ J / p ~ ~ d~°~eo ~3 s'( _ '~ .rid' G9 Slt ~ ~ i-a ~, 0 .. ~' ~ ~~ ~ al eo.n.a ~~ F~ti: .. ~ ~' ~ \_' ~~ - , t ~ Y " ~ ~ ~ : ~~ o c .~.~ „, ~ , = \ ee eer .-_ ~a •~a \ \ ~ ~ M WCi.On. i ~ N \ ~ r~ \\ ~\\\N -- 4. <~. 1 r z \ ~\ c ; . * \ \ ~P ~4 ,\ \ ~ ~~\~ ~ ~~ ~ \ c ~~ ~ ~ ~ 1 \ \ I . ~ P l/~~! ~~ 1~ ` * \ C ~ ~, ~ - _y;~ ~ it ~~ ~~ ~~ , n ~ ~ ~.:~ ~ ~~ ssrd_-_,_ _-_,~_ ~~~ ~~ ~ Z .~ / ~~ _ __ U ~ n i ---- .d / ; ~` • > IM U ~ p UU D j ~% ~~ (~`~~' ~ v i ~ 4 4 ~ ~ m~ ef ~ ~~,; ~~ ..a*r e" i tii a ~ ~v h ~ o Q 0 ~ t v ~ C ti 1 t n ~ i ~ ` , , ~ 3 3;~~: (() \ ~ \ t ` t ~ ~ V o Z OS 1 Of \ ~~ Q l ~ i ~ R i ~ °~ ~ ~ ` D V c ` 0 ti ~ Q ~ \ O Q V 0 R Q I ~ I i I .~ ~~t Q :. ~ ni W ~ ~~ .. ,, ~ ~ g ~ ry r. V 111 ~ a °, `"3 Z~'~ ~ ~~. ~ ~~~ , ~~ a ~~~~ ~ ~. ~. c' ~ ~ ~ i=, ~``.~ o Q, v ~ alt e n ~~.y S ~:S g ~ ~1 ~ ,v~, h 0 ~ Y, , F 3 ~ h ° J . ti Q ~'. Q J ~. C ~ I V ~_ ~ m J'. a ~ ~ a >'. 1 ` ~ ~aS ,:,' O. ~ / ( V.I ~Z // ~~~ 3 ` , // ~ ,~ '~I ez .a ,/. % ~i \ 1 v .' T I 1^.° y~ 1 ~ 5e~ 2 T ~~ 5 .I 6S \5 b~~ ~ ~os °S I 55 ,.. ~ z~ s ~' 8 . a '$ ~= 1°° = 4 .4 ~ ~ v ~.J r - 6 ,~~,6g /o ~o. ~ ~ ,y1nvs sv v~oew.»o~, .voilvoy ~~oi~ .rro~ii e ,, m' v ! ~,. ' ~o I'M I, ~ t. I ~.. I '., o ,. ~ H C_ ,. _ ~. ,. _ .. ,~ ,. P o .., ,. ~: R ~ .. ~ ~ ~ 'n ~ 'o ~ .. M ti s ° ~ .Y ~ a 0 W 2 3 i ~ o f; ~ i k I 06-12-1992 15:38 612 636 7178 SERCO LAB P.02 e SERC(~ ~ Laboratc~ri~s tglt w~eet ca,nty Roca ~, St Puw. Mlnnaaa b61+3 P1+onr ta~z! 0367+73 Fi-x to+~a~a-~+~a Lr~B17RATCRY ANALYSIS FcEF~JRT NL7; :17'43 Obl11l9~ at. Lroix C©unty Zaninq i~~1TE CDLLECTED~ 9S1 4th Etreet DwTE +~ECEIVED: r~ud5on . W I :441 b GQLLECTED ~ Y : t~L I VEttED B Y : SAMPLt T'fF`E Attn: Mary ~i. Jen~ins SERLD 5liMPLE NO: ~75~2 SAMPLE DE't Y PT iOri-: {~ f to ANALYSIS: Eiron~odichloroaethane, ug/L «.2 Bre~mofor~e, uq/L <0. ~ 8r•oawaethane, up/L (Methyl broad de3 ~ i . 0 Carbon tetra~hioride, up/L [0.~ Chioroben:enr, uq/L {1.4 Chi~rroethane, uq/L tEthyl chloride) <t?.4 ~-ChlorvwthYlvinyi ether, up/L X0.4 Chi orof orn~, . up/L <0.5 Chioroeethanar, ug/L tMrthyl chloridf) <Q.6 Di broa~ochioroaaathanei ug/L {0,4 t Ch l oral i broa~oawMthane ) i,~-Diehiorobenaene, up/L to-[1lchlorabenzmr':r) 1,3-Di ehlorobrnx~rnt, uplL tm--Di chiorobmnzmne) 1,4-Dichiorobenzene, ugtl. t p-Di ch 1 orobenzana? Di chiorodi~luaromethane, 1, i-Dithloro~rt~hane, up/L {1.Q {1.0 •~ <1.0 up/L tFrean i2) ~Q.S <O. i i,2-3~lchior"oethane~, uplL ~0.~ tEthyiene dithiartde) 1, l~llichloroethene, uq/L <c~.2 trans-l,2-Diehioroethe~ne, up1L t0.i 1,2-Dichloropropane, uplL. ~c1.1 ci s~-1, 3-Di chl araprap+Mn~r, ug/l. ~C i . 5 tran~r-1,3-DiehYoropropene, up/L tD.9 F~iL;E. ~ {i6/ t~4! y2 CL~eNT CLiEN7 DFtXNi~YMCy WA7EFt r ~ means "not tlatwctad at this level". 1 mq ~* 1~lt~fi ug. M~rnWr 06-12-1992 15:39 612 636 7178 SERCO LAB P.03 • '1i~ s SERCa Laboratories 5931 VW,t County Floes CZ. 5t. P~11. tAN~„ot• 56113 PhpM (81Z109d-71i'9 FAX (81218387178 L~r~or~wroRV r~+uNLys ~ s Ff~,Ff]f%iT nru: ~ ~ 79 f;~b! i ~ rQa 5~Rlr0 ~t~r7PLt NU s ~17i3~2 f3AMPL,E L?ESU1R I FAT I Otv s Whit e ANALY$I$t Metnyien• chloride, uglL ~5.u tDichiaronuethanr*~ i,1,2,~-Tetrachlaroethane, upll. <D•~ Tetrachloroethene, uglL ~i.~ 1, r ,1-~7richlorf~ethanl, uglL <3. U i,i,~~trichloroethane, uglL +~a.l Trichlora~fluoroswth~-ns, uglL t~rfa~t 11) ~p.7 Vinyl chloridf~, uq/L X1.0 13811nx1ln88, up/L C 1. D Ethyl6enzene, uplL ~1.d Toluene, up/L Tri chl curnsthenfs, uplL {ir~ <~.4 This sample's analytical rRSUlts are, are not, below th• u.S~ ERA's SDW~A haK i aHUm Contaminant 1 fxvfxl caf i /~0l9i for tnosr: requestt3d compounds which are also On 'Ch• SDWA 1'ICL.. list. ~ means "nf~t detected at this 1 evel ". Y mg ~ i f)~;bU ug . MNnb~r 06-12-1992 15:39 612 636 7178 SERCO LAB P.04 '~ .. s .~~ R r. { t ~)` SERC~ LaboratQri~s ,931 weu Cartty rued CZ. 61. PeW. Mu+neeots 66113 ~ (61Y1 e36.717y FAx (61>!1 ~l6.717E LABI~R(4TQRY ANALYSIS kEF~Of~T N~1~ ~1i5>.]~ Pf-tLwE .~ t~6~ 12 ~9~ r"111 anal yeas weere perfcarm~t u>Fi nq EPA or other accepted methodol oq i e1=~. Samples that may be of an •nvironmwntally Hazardous na,rlsra will b• returned to you. ether sampla~ will De stared tar 3G days tram the data of this report, then disposers of by SERC~ l.abvra~Cories, Please contact nne if other arrangements era neeoao. This report may not bt reproduced, except 1n its entirety, withoyt prior written approval from 9£R~0 L.aboratorles. Report submitted by, ~'~ i~irn• J. Berson Project Manager ~` mean~- "not detected at th>`s level". i mq ~ 104 ug. M~n11W~ 06-12-1992 15:38 612 636 7178 SERCO LAB P. 01 SERCO Laboratories SI. Paul, Minnesota 1931 West County Road C2 St. Paul, Minnesota 55113 Phone: (612} 636.7173 FAX (612) 636.717'8 ~: ~ ~ Please deliver i'a~ediatsly 1~t: 1~L1 ~LL] x~er of Pages (ir,~cludit~ aywer sheet) _~ If ycli dp rat zeosiv+e all of tl~m pages, please call (612) 6367173 as soap as pasaiblo. When Quali-y end Service Count UATE: TU: FFFFFFFF A X X F A A X X F A A X X F A A XX FFFF A AAA A XX F A A X X F A A X X F A A X X ST. CROIX CDIlNTY CO(IRTHOgSE 911 Foun#h S~hee~ Nud6on,wl 54016 ~__~~_~~ FAX N NAME: FROM: FAX Nl1MBER: (715)385-4628 NAMF: _l~rY„ NUMBER OF PAGES INCLUDING CDVER SHEET: y IF COMPLETE AND LEGIBLE INFORMATION IS NOT RECETVEU, PLEASE CONTACT: NAME: L a TELEPHONE NUMBER: t~, ~(g - y~j (~ _ n ~~t ~/u.. D ~ _____ __ COMMERCIAL TESTING LABORATORY, INC. `514 11A~in Street, P.O. Box 526 Colfax; Wisconsin 54730 ' 715-962-3121 800 - 962 - 5227 ST. CROIX ZINlING ST, CkOIX COUNTY L`tX~tTHOU5E HUDSON, WI ~401b ATTN: TI'#]MAS C, NELSON ~io~~m REPORT NO.: 23751l4i REPORT DATE: 6/08!92 RATE RECEIVED: 6/Q4/92 PAGE 1 OWNER: Frank 6 I{ev White LOCATION: B80 Wi slow Ridge Rd„ Hudson COLLECTOR: M. ,lenkins DATE COLLECTED: b-43-92 TIME COLLECTED: 1:3~e SOURCE OF SAMPLE: Kitchen faucet DATE ANALYZED:b-Q4-92 TIME ANALYZED:2:DOpe COLIF~M: 0 /ioo el INTERPRETATIGM[: Bac ter i o t og i ca L ly ° SAFE NITRATE-N: b ppe Above 10 ppe exceeds the recoeeended Public Drinking Water Standard. Colifor~ Bacteria/i40 ~l Nitrate-Nitrogen, e9/L .~.~ _ _. 9 '~' /, ~ ~ sT o r LAB TECHNICIAN: Pae Gane ~p ~i,~~_'9q~ !S'9~ ~NDEPFN ~' _~~ ~?`.~" °EH~. WI Approved Lab No. 19 s q ~-~` P o < Means "LESS THAN" Detectable Level Approved by. ~{ A `Sda~,~ ® ~w ~ _ ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 ~zc.c~ 5=o7~-q~ V ~~ /~ V J~`~ CROIX COUNTY ZONING OFFICE V" St. Croix Count Courthouse Y ~~ .~ ~O "" r~" 911 4th Street ~/ ~ ~.~ ~ III" Hudson, WI 54016 Telephone (715)386-4680 ~ y ~.~ `~ °'The St. t Croix County Zonin Office offers the g and water inspections to Lending Institutions, private individuals. ~a3-~~ service of septic Realty Firms, and CQLnp~etion of this form is essential so that the property can e 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 fee and form are received.~~+ c~v+OJ WATER TESTING----------------------------FEE: $-$ r,~$0 ~`~' oa (For nitrates and coliform bacteria) ~ g~ d~ WATER TESTING FEE: D ~8 5''°'' (For VOC' S ) ~^' ~~ ~ ~ , ~ J SEPTIC SYSTEM INSPECTION-----------------FEE: $2f€~'0 (Determines if system is properly functioning at time of inspection) Property owner's name ~~,~ ~-- ~.~rr (.~~~ Property owner's address ~~a- ~~~o-vim l; IJ1 ~ ~~r~e.t U' / Legal Description 1/4 of the 1/4 of Section •? O , Tel? N-R_~ Town of ~~,(,~~-,~ Lot Number ~_Subdivision Name /.~J~r ~_, ~~ FTRF. NLT~fRRR SI ~ O T~C'K RnX NL?MRF.R / L-~,. ~ U"fT`"'~~ Color of house Realty sign by house? DC~. If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services : e _ ai 3;~T~ ~-S e -U -~°[t o%( Telephone Number ~ /5 :3~f _ ~'~ o REPORT TO BE SENT TO: Closing date, Signature (ter ,G~!.~...-~~P ~-- ~ ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 June 4, 1992 Carol Farrell Century 21, Bertelsen-Cudd 706 - 19th St. S Hudson, WI 54016 Dear Ms Farrell: An inspection of the septic system on the property of Frank and Bev White, located at 880 Willow Ridge Rd. , Hudson, WI was conducted on June 3, 1992. At the same time a water sample was .obtained for testing. The results of that testing will be sent to you as soon as we receive them 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. Sin erely, ~, ~~ ~x~ P Ma Jenkins Assistant Zoning Administrator cj NOTE: Please note this home has not been liven in for several months. MERCHAK, JOE NW NW, Section 20 231-13th St-. T29N-R19W Hudson, WI Town of'~iudson ~~ San.Perm.~~ 38463 5~ -83 A. Zappa Conventional, Ne ~~ .Christopherson INSTALLED 8-3-$4 ~ ~ o o ti o~, w ~ et 0 0 N erj O i tl ;~ ~L ~r •~ N .~ ~'V ~a `IV' V •~ "iv ~.' O W ~i FBI RS .r~'.i ~'. A V ° Z ~ `F z rn N H Z C C7 o z v tin H v C N rn a _O ~ ~ a v~ J U $ o O O ° O Fo- M ~ C `~ O ~ ~ N N y 7 O N 2 ~ *t a a ~~ ~ 'c L ciao I ~ ° I O °~ ~ °~ I ~ I ~ I I ~ I .- ~ I I o c a I a I w V y I c .°-' I ~ I N ll ~ ai I ~ I a~ N I ~ I O aQ I m o I ~ o I o ° I o • c ~~ o I ~.~-~ N Yp ~ ai y c L I a~ i ~ io M I C Z •-' E~ ~ Z f0 x I L ~~ C I 7 (0 d~ I { C o dN° LL oNo 3 ~ m a~ <- I 3 ~. Y I a Q ~ Q H I c o 3 :° N ~ N M I Z ~ I Z ~ I :: ° ° I o ~ o G ~ I C I a m a m I I O I ~ I ~ ~ I 'o ` w I o ~ o I c c c c z ~ I ~ -o I ~ ~ I ~ ~ m I m y 'g m y •~ ~ o. i ~ I ~ a o I v i ~' a~ N ~i ~ a~ c o a m L I a m t I o Q ~ ~ I o~ 4 ~ `~~- I a i zmz z m z . _ ° z I m I aCi N I R E .. I m £ I ~' .. R a~ ~' .. ~ Z U N@ ~ O~ y d i I N ~ I coa ~° ~ ~ cca ~ o. .~ N NNr N ~ ~ ~ n't- I cc y frry N ~ °~ _~ ~ aN ,~ I 33 ~ 3 1 o Z aaa aaa ~ I v, I. - Z -o } ~ . ern ~ 1 = .- M za I N ~ c„ p V1 ~ _ Q ~ I a o .~ ~ ~ o o .~ ~ a I ~ d ml c m l a a~ v ml N c rn d ~ v ¢ z in I -o ~~ Q~ in Q I ~ 3 a~+ I O w C °p o O H C I a00o o E I a~ a~i °' o a~i ~' c a v ~. g l ~ ~ ~ O C ~ N L ~ C m Y C m y ~ a~ M N ~~ LL ~ M N~ V Z ad+ 'i7 ~ ~ ~ cc}} ad.. 7 ~ C y ` ~~ I « 7 ~ ~ o ~ L I U N ~ Z `~ S Z ~~ O I Z y 2 F - L (n I i+ ~ :: ~ I a I € a I a ~ I ~ a ~ 3 I 3~ 0 1 ~ o 1 t Parcel #: 020-1136-80-000 Category SPECIAL ASSESSMENT Alt. Parcel #: 20.29.19.678 020 -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): O =Current Owner, C =Current CaOwner RICHARD A & LILA M FEGGESTAD O -FEGGESTAD, RICHARD A & LILA M 880 WILLOW RIDGE RD HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 880 RIDGE PASS SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.420 Plat: 2624-WILLOW RIDGE 2ND ADD SEC 20 T29N R19W WILLOW RIDGE 2ND ADD Block/Condo Bidg: LOT 69 LOT 69 EXC .02 AC TO HWY AS IN 6641153 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 956/128 07/23/1997 702/617 07/23/1997 673/122 9f1A~ CI IMMARV Bill #: Fair Market Value: Assessed with: 92550 355,100 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.420 63,100 299,100 362,200 NO 05 Totals for 2005: General Property 1.420 63,100 299,100 362,200 Woodland 0.000 0 0 Totals for 2004: General Property 1.420 32,500 290,100 322,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 130 Specials: User Special Code 018-RECYCLING 12/13/2005 07:53 AM PAGE 1 OF 1 Amount 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00' DEPARTMENT OF'INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & .OMAN FeELATIONS PRIVATE SEWAGE SYSTEMS Dlvlslo P.OmBOX 799 BUREAU OF PLUMBIN MADISON, V1(I 53707 CONVENTIONAL ^ALTERNATIVE SLatePlani.D.Number: UI assigned) ^ Holding Tank ^ In-Ground Pressure ^ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Joe Merchak 231-13th, Hudson, WI ~'~~--~y ~v~O BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN ~ ], Ow Z g e REF. PT. ELEV.: CST REF. PT. ELEV.. NW NW, Section 20, T29N-R19W., Town of Hudson,Lot 69 Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Anthony Zappa 1614 St. Croix 38463 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOC NG C ~ f ~ ~ M91~ q I ~ C ~ q ( ~ o ~ P O DED: ^ PRO OE ' ' - • U V~.J (_ ) r . 1 YES NO S NO REDOING: VEN7 DIA.: VEN7 A L. HIGH WATER NUMBER OF ROA PROPERTY WELL: BUILDING: VENT O F ~ ALARM: FEET FROM ~ LIN ~ ~ ~ ( I~ L ~ AIR I T~ ~ ^YES ^NO ^YES ^NO NEAREST ~ DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUF ACTOR ER. WARNING LABEL LOCKING COVER - PROVIDED: PROVIDED: ^YES ^NO ^YES ^NO ^YES ^NO GALLONS PER CYCLE: PUMP ANUC N RO O E ATIONAL NUMBER OF PROPERTY WELL. BUILDING VENT TO FRES (DIFFERENCE BETWEEN ~ FEET FROM LINE AIR INLET: PUMP ON AND OFF) Y ^NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at edepth of plo Ing I ENGTII UTAM ETER MATERIAL AND MARKING or excavation. Ilf soil can be rolled into a wire construction shall ceaseluntil FORCE , the soil is dry enough to continue.) MAIN CAN\/FIUTIfIIUAI CVCTFM• BED/TRENCH WIDTH: LENGTH. NO. OF DISTR. PIPE SPACING. C INSIDE DIA.. #PITS: LIQUID DIMENSIONS ~ TRENCHE& '~ MAT I PIT DEPTH: GRAVEL DEPTH FILL DEPTH DISTR. PI F DISTR. PIPE DISTR. PIPE MATERIAL: N DI R. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRE; PES BELOW/PI ABO E COVER. ELEV. INLET. ELLEV. END: q -~ ~J PIPES2 FEET FROM LINE: '1 /f q~ N 7 ~ _ ~v ~ Iii 2 I ~ S .CO 1 ~. °~ ~7 NEAREST---s ~~ r v~p ' I OUND SYSTEM: ~ Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAMOFSYSTEM nd furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ^YES ^NO ,\. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS. \\7``, ^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 PRESSURIZED DISTRIBUTION SYSTEM: WIDTH-. LE NGTH. NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF, FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: . DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.: ELE V.. DIA.. ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING. DRILLED CORRECT LV COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: ^YES ^NO ^YES ^NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: 1 ~~;, _ ^YES ^NO ^YES ^NO NEAREST V cr Sketch System on Reverse Side. DILHR SBD 6710 (R. 01/82) ~%~i~,ti~ 605 10 =" --- ~~:z~ Retain in county file for audit. DEPARTMENT OF APPLICATION ~ sAFETY & BUILDINGS INDUSTF#Y, fOR SANRARY DlvlsloN LABOR AND ~ PERMIT P.O. BOX 7969 HUII~IAN RELATIONS ~PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/z x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points. must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed., sealed and dated by the designer. If designed by a Master Plumber, the date,. signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: Property Location: City, Village or Townshi County: ~1/kl t/4 ~t11(~'/aS 20 iT l~ NiR ~q E (or W~ ~t1OSa.t~ S'~• ~'CO/.r Lot/Number: Blk No;: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: Cp ll~/~/~Gt3 ~Qj~ ~ ip ~ dss (lf assigned) ' /~ rre ur esu~~uirvc~ Number of ^ Public* ^ Variance* ^ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. TOTAL GALLONS NUMBER OF TANKS PREFAB CONCRETE POURED-IN PLACE STEEL FrBERGLASS NEW INSTALLATION REPLACE- MENT OTHER (Specif SEPTIC TANK CAPACITY /d~0 HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: W/ES CO~tJC.,PeT~ r t~ODGt` $ /QE,t> Gs~ !{~l.S . EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE (Minutes per inchl: ~~.- ABSORPTION AREA PROPOS D (Square feetl: C03~ ~~~~3J New ^ Replacement ^ Experimental ~ Seepage Bed ^ Seepage. Pit ^ Alternative (specify) ^ Seepage7rench Nater Supply: Owner's Name as Listed on Soil Test Report (lf other than present owner): Private ^ Joint ^Public C'~fj/'~/~'-5 ~U1~1~ c~vc.~ I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Sig e: MP/MPRSW N Phone Number: Z~l~f k l' c ) z$Sd PI~#mber's Address: Name of Designer: Z2 /~ID.J~PO~ ST Opp ~ vD~D.J L(,/S . COUNTY/DEPARTMENT .USE ONLY Signature of Issuing Agent: Fee: Date:? ~ APPROVED Sanli~tar(yyP~er/mit Number; Q ~ ~3~~~~ ^ DISAPPROVED ~J d T Reason for Disapproval: Alternate coursels)'of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber , DILHR-SBD-6398 (R.07/81) ~ ~ ~' '~ Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT - OWNER - TOWNSHIP ~~ SEC. ~~ T N-R W ADDRESS ~ 3 ~ J/~ ST. CROIX COUNTY, WISCONSIN SUBDIVISION ~~~ln~ ~~~~~ LOT ___..LG..! LOT SIZE PLAN VIEW Distances and dimensions to meet requiremEnts of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM .: i-~~ ~f'cz~n~27 r L;,v,~s v:,.~z /c'a' .~.~ .!',s-.rr~.~ Exc~~r r-~~_ ~,~sr nzv~t~Tr ~;N,~ ~~~,4-r ~.~ .l-o; ~.o I ~;,o r ~ + /,10 ifJ f /.SELL .~ _~~ ~ < ,. /~~6 ~ ~~~~ ~ . 3~` /8 ~ ~~ ~-----96 ---~ 33 ~~,~,- S7AC!< i~ I ~ INDICATE NORTH ARROW BENCHMARK: Describe the ver[ical reference point used ~7liiG~oL sow~~.t /~~x~~ Elevation ~~f vertical refere~~ce point: 1D~,~~ Proposed slope at site: --~--~=- • j, PUMP CHAMBER Manufacturer: 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 ABSOR~'TION SYSTEM Bed: /1 Trench: ____"7 ~' / / l Width: 1~ Length: ~b Number of Lines; ~ Area Built: d~ " ii Fill depth to top of pipe: ~~~ So~rTh+' S~'Dfs . ~3 ~~.3t-CL~C ..r'7,~~ Number of feet from nearest property line: Front~~OSide, ~ Rear,(QyFt .~ Number of feet from well: ~ / ~ „ ~V7' Number of feet from buildin ! ~~ g : ~U (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Numbert.of feet from nearest property line: Front, O Side, O Rear, OFt.' Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm ranufacturer: ,. Owner of 1'roperty~ Location of Property Township Mailillb Address `~6 'v .S Furw - S '1' C lU0 '4~~f:, 5t'CtlVll 2~ a'1' ~/ N t2 ~/ W ' ~v /C r ~~ s. // /, / ~-ya Subdivision Name (,V/~~~~ ~~~~ ~~~~~, jL~oy ~o ~~~ o~/~lrrf'6~ Lot Number ----L_. Previous Owner of Property ~i4~9,%~ `7d~d~N 'Dotal Size of Parcel ~ ~Z QC2~ Date Parcel Was Created ~UN~. ZZ~ /f 76 Are all corners identifiable? Yes No Include with this application one of the following: .Certified Survey Map . Deed .Land Contract, or .Other I:egal Document which describes the property PROPERTY OWNER CERTIFICATION (We) certify that all statements on this form are true to the best of g~ (our) knowledge; thatq (we) ~ (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. ?~ s'~5 ~_ ;and that (we) presently own the proposed site for the sewage disposal system (~a~ SIGNATURE OF OWNER ~ ~~~~ ~J~ ~~ SIGNATUR CO-0WNER (IF APPLICAD<_E) DATE SIGNED OATS SIC:NED ~ r'+.4 ' ~sv~~yt) IYOL Ol'+J PACE Jv J' ~~ ` I ,~ t~~ ,~ ~(ti ;.' r' sailor ~4~LA 1\7AVi"ir ~ Y~ .. r~~.~~ • . r• ... • ~y Vi 7 ice. ~~. • ~~ .~ • • . ~~s~ •,. ~ 19`1° . betwreA tho Mort~ot,..~J~! ~r.~'!'!~'!4~"" . ~.~.!'+~1.~~. r ~!M! ~~~'~.. ~. r' (herein "Borrower"), and the Mortgagee, .~?'it ~?`~. j nt~er the btu ai, .:'~R~.l. ~ .~#~ . :`~~R~1$~ .,,,,-boee addreet~~...~.+h4. ~fs,+~,. • . ~ . ^. T~ .~~i . .... . • • . c • . • • . .......... . (YGrela ~i.GY{Rri~). ~. - G~ ~ indebted•tio'I.endmr i. the p ~.. ~~t-!~t .~ .~~. ~ ~~ . , ...... . ~olhtra. which ~rtdobtedness is evidettcod b7 Bosro~ar~ ~+ ~, dalod....fi~~. 31#~~, .19~....... (he[s~t "No6e"): ~rowi~ng for monthly iasfsllmenb at pd?demand ~tawt,` 't wM- tht`1lala~oe of the indebtedness, ff not :toner .paid, sue ~ payable on , ... !-~.!~ . ~ ~~ . 07 v ...... , . . To Stcvas to Lamdes (a) the repay o! the ~~~ideaomd by toe Note, with iaeeaeat.;thareoa, t1~ paymaot `oi aR other anaoa, -with interest theraoa, advanced in aocordabce bertvviffi m pr+ntect the aac~- o[ -this >r~et~ye„ #nd the perforemtaoe of the onvenauta snd tgraeu~eatr of Horeowet hercia contained. sed {b) the ~l~it ~ of #ny hutnraadvanas, with interest the~t~eon, aasde to H4rcower by Leader pursuant to psragcaph ~1 ttet~ooE ~ .. ,. Future Ad~raacea ), $orrow~er don hereby mortpgc. vey to Lender, with power of gab, tip ~p~ ~ aka deac~ribed pr~opetty locatsd is the Cpunty of .. ...... ~t ! !~"a~ ..... ..... ......... -Sate d Wiaodtu~: Lbt '3~Ct (2~, ®! that Csrhifisd Man rssordsd is Yolny iF, am Fap 9~ @t Grtitiad 8ai'o''a HtPs, as Dostssptt loo. F~3 3a tbs OtiYos of tb R~istsr of Dssda !or nit. (bt~o3z Cvasrt~jr, Nyssmsia. "'!ltie is a ~'aroltaes Moaw~ ls~. REGES7ERi Off1fE ST. CROUC CO., WiSr Rsc'd 1ex Record this~..1._... dtry ~I~D.` I S-~ of 11x30 ,- which bas the address of ...... ~. ~, .~i .1 ~.. ......... .......... . .... Rival, ~~~ t .......... , ~Fisrsnns4n ~It?Z2 tsc...v ~ .... .. . .............. .. (herein "Property Addrsas"); hbb ind ZiP Coda Toc~eTxER with all the improvements .now or hereafter erected on the property, and all easements, -rights, appurteeances, rents, royalties, mineral, oil snd gas rights and profits, water, water rights, and water stock, and all fiztams now or hereafter sttached to the property, a!1 of which, including replacements and addetions thetcW, shall be .--- • . . ~wicwrrro LANOa Iu.wL,. y a. -o _ - -. -.Ifl il-' II1N `~, • ~: i ^~ l~ti e"a ~ 7~ --lstte-- .ice.. L 4 n _.as ~•• rR ~~ s i ~• + •~! y kt -~~ a ~~ S ' L. ~ ~= 1 ~ «rj/ ~' is ~ p =s '~ ~. ~ ~ ,_. j t ~ a ; ~ 1, i Na ~' W ~ ~ 3 '` , ~ ti ~, c ~ r w ~ '1 ~ + - ie s ~ n O i. di ~ ~ C'' ~ i u ~o ~~ > t N ~ I ~ ~. ~' ~ ~ sj a~ o e as 3 ~u y~`~ \• 1~ h • 4 ~E Q,.Q ~. A. - ci' .vr,. e~ I _ I+.r.n ~ ~ ~~}~~~~ \~~a~~~ ~ 5`~r s~ ~ :~~ ~ ~ ~ ~ ^~-• ~ #;~~ n _1,~aow IQ_ IYJ! ~.~IOO/7/IN .R ~~ ++~ $~ii '~ - ~ ~ ~ ~ werrrro wt swvsor ~ ~ / '4-ti / /i+ ~ 4 ^ _ _,..._._.~___._~_._._,~. ~-- w•e•o~'so'w sr. ~.. i ti• ^- -nr ~. -4 ` i~ * x iii nr m ~ o i ~ ~ ,~ ~` ~I~.~•' a .~ f ~ ~'. ~~ O. ~~ a~+j~'~`~~ \~~r A r~~++1~ -__ -__".-.~/~ le~~ ~~/~ f' ~/' i~,•~ t° dry ,ci .. n Z d ` •< _- __ - 1 w ~~,~ ";.. •~ ~95r.~•tL ~ .off - Ni~;, j ~• ~~~ac.,~ i ~ ` ~vZ "' +. },~.'j~Y}.+~/.. ~ ~°?~A ,' 'Fr ~eA l-9" ya~°.I ~t Y~~o~ ~~4 `~~a~knL~ ~ y it ~ ~ s l~+ ~,,~'2~L~ c /` ~3~='~"'• t ~~ y 1 ~ - ~ a Y ~ \ s n .~~/ ~•. iii. .!+t/ • ~ t ,+~,++ a` +• II ``, + 1 0 i ~`<h W '. a1` A ? ~ `'"~ ~ ~ ~, '~ ~ ,t ~4 ~~ t` ~ Y+ .rivr r'w ~ a ti's w aip °~ b``.~~ ~ II •~~• a ~~ ~ ~ Vie. ~ ~ d, ~~h'~ .1 i=i ~ e•« -,,, y ~ !11 ' ~x ~ 7V by ~" Fie A~r+t i F y ~' iris .imaa 4 + ~~ mr.>. `/: I ~+ ' >. ~ ai+111 ~~~ ~ `` +~ ~. »'.. I ~'`L 7~ ~ is .µr ,1 1 e 7 15 I ` .: a -~ Rev.9~ 8 ~ ~ , REPORT ON SOIL BORINGS AND PERCOLATION TESTS ~ "', ~';~ ~ I~VISGONSIN pEPARTMENT OF HEALTH AND SOCIAL SEIiYICES '~£ ~ ~ ; ~.'` ,- ~~i': P.O, ROX.309, MAdISON, WISCONSIN 5~70'~ ' ,;;: j~IQN: '/~.4,~%4, , ° ~ /, Section:. • ,Township or Municipality ' f ? T__-_.' N,R...,.`` E (orb Vy > ~, q, ` ~ , R~aGk Na. ---~-,- ~ ,~'~~~ {' t 1 " ,r ~ '' •, ' County s ~ , 'f , . , `~ / r '~~lSuyers Name: ', ~, ,, U IVISIQR am8 , , ~ Address.: ' ~ , ~ r ~ • r ,~ ~ ,, ~ , ~ ~` 1 , .. ,. ~~ ~~ QCClJPANGY: {iesid~:nce ~`"~ No. of Bedrooms `'~ COMMERCIAL ~~~~~~1~NT AISPOSAL SYSTEM: NEW ~` REPLACEMENT ALTERNATE SYSTEM OT~IE~t F~~'~~ORSERVATIONS MADE: ,SAIL BORINGS. "~ ~ ` ' ~ ~ } PERCOLATION TESTS `~ ~' ~~-' ~~~'~ ,~ r ~ .-.~(~~..aIdFF*--~.T~•.~..~r .-,Fu.. r ,^ -._ _` NAMk UR SOIL. I~IAf UNl7"_ •r ts.:._. f _- ~~ i ,.;; ~ ; I ~h ~t ( ..•e..y , t't i.' i 1k•~~~ ~~~ • PERCOLATION TESTS i'GJ~'~{ f`~X /~ ~: ~~T #~~~ pEw1Yl CHARACTER OF SOIL HOURS SINCE HOLE WATER IN HOLE AFTE TEST TIME INTERVAL pROp Iry WATER LEVEL, INGHE RATE ~ 8 INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOp 3 MIN/If p ~~ ~r F. ~ _ _ r 1 1. .. ~ .! S' _. F°- k ~. . P-~ •, .r SOIL BORING TESTS TI,~T "' TOTAL DEPTM DEPTH 70 GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR. ' • ~~~ER IIVCNI=s OBSERVED ESTIMATED HIGHEST TEXTURE, MOTTLING AND OE• TH TO BEDROCK. IF OBSERVED IN INCHES p /l~ • ~:, ~ / p I .: , . B "" ~ .: . , ., mss" , ~ ~ .,~ ...... ~ ! y , r :~~ u~~w !{,pcata percphtipn tests, SOiI hPfe x1018& and SUltabl8 so li Hreas_1 IndlCBte Uq the elan 4he Inratinn and cnuarn font n4 c~,ir~LJn ~.o- ~~~~~, Pumber of square feet of absnEptioil a(ea needed for. puilding type and occupancy ._ Indicate scale G!; ~IStancl anzupt;ll anc~ Vertjcal reference points. Indicate slope. ~" ~` >;,, ~ ,,~~ c tl ' ''~"' _ v- - ~ r ,, ~ j • , 1 ` ~' , .. ~.~, F ,. _ ,} •d ~ r .jt.. / 1 • ~ . ~r _ ~~ _F ~ ~ ~ , ~~ • ~ r r --t. ~~ l _ _ ;l ~_.~ { ;.. - ~~ -~v1 ' , I - ° • wi . / ... ~ __. ~_._ ~. -...~. _ . -._. «. ..._..... .n.. .. .. .. . ~ .. z ~ . ,;~... i~ . (d 7~ (~ t i i. '. I i ~'~.. •• ~ 'i" r - ~ ~ - _ _- -- - ~ "~~~i =- - - - -.~ r.~-_.~. y , !~4J,~ , ~. S ~ r C TE'si ~ ~ ti • t /oa, o `~' y~a a~~sE~ Mate ~'0`"";~ s ~~+~t. PtoT aid CRO55 SEcrtoN PISS ~o,,Ev SC p;; hrP ~ w~LL - f,Qd,~ fEPT `~ ~~ p~0 b ~ ~ ~~ `s'`x~ . '` ~ ~ _ ~\ ~~ F I~ ~ ~ ~ ~ b~ ~ ~ ~ ~, ~~ ~ b ~ ' ,r` ~~ ~ /r/ _ ~~~p~5 f. \ ~~' b ~~ ~aR ~ -~ 3 ~ D~ PEQ sore r ~,y = ~o~: nh~ P~'o ~~~ ~E,~c~~-k ~ nor ~ p wi//rr w ~, p~ 7~` /~v©sa,~ ~iS . S ~~G~tI~D L/cE,vsE~ ~ ~~ ~c Fresh Air Inlets And Observation Pipe Minimum 12" Above Final Grade ~_-- Approved Vent Cap MA Fitt d~ ~~ ~2- " Above Pipe 'ro Fina! Grade 4'~ Cast Iron Vent Pipe Nov Or Synthetic C -. ' :, REPORT OF INSPECTION - INDIVIDUAL SEIUAGE SYSTEM San~.zany PE`nm~.~ 7 S~a~e Sep~.~:c NAME Tawn~h~.p S~. 'Cna~.x Caunzy -_ ~ . Laca~~.an~ (,() Sec.t.%an~la~ #-1~-Subdtiv~.~~.an ' SEPTIC TANK S~. z e ~ ga.2.2a n~5 Numb en a ~ ca mpan~me.n~b D~.~~ance {~nam: Gle.2~ Bu~,.~d~.ng 1.2 o a.2ape H.~ghwa~en PUMPING CHAMBER Stize MOLDING TANK ga~..2an~ ~_ .Pump Manu~aczuhen. S~. z e g a.~.2a n~ Pumper D~.~.tance ~jtcam: we.~.2 H.Lghwa~en. ABSORPTION SITE Bed Ttcench D~.~s~ance ~nam: we.L~ H~.ghwa~en` ,~R~~~RPT,nni c7TE DIMENSIONC w~.d~h a ~ ~nench Length a {~ each .2.i.ne N u mb e h a~ ~.~.-n ens Ta~a~2 .2eng~h ab .~-i.ne~ Dti~~ance between ~.~.ne~s` Taxa.~ ab~ anp~~.an ahea. PIT DIMENSIONS Numb eh a {~ p~.~ Ou~~s~.de d~.ame~eh Ta~a.L ab~anpxtian ahea Axea nequ~.rced INSPECTED By APPROVED Made.2 Numbers 120 ~~.ape Bu~..2d~.ng ~2 0 ~.~ape ~~ Requtined area {~.t ~~ Dep.th a ~ ha ch b e~aw ~t~..Le tin Depth a ~ n.acf~ avers z-%.~e ~.n ~~ Depth a~ ~.i.2e be.~aw grade .in 4~ S.~ape a b ~nench ~.n. pen 100 ~z ~ ~~ type a ~ Caven: Papeh an ~ ~tcaw i^~ ~x ~i~ ~~ Numb eh ~~ Camparc~men~is A.~anm S y~ hem Buti~.d~,ng Grcave~ atcaund p~.~b yep Depth b e.Eaw ~.n.~e~ na ~~ TI TL E DATE 19 ~ °1~44~ ~.__ __-__-_ K_ - •_ - T. . REPORT ON INSPECTION OF SANITARY PERMIT # ~%~ y (1) Name and Address of Permit Holder Person/Persons at Site 2 Date of Inspection ~~ ~ <t,~r~ ~~. ,t~ /~' ii, ~% -, ~ `,: l ~' ~~a -< <~~~~~ Time of Inspection ame, ress, ~cense o. o n a~ Ong p umber ~ ~ , - r - ~ ~ ~ . ~ ` ;~ ~ `~ 3 INS? ELATION CONS S S OF: ^ Septic Tank [] Seepage Trench [] Dosing Chamber ~ ^ Seepage Pit ^ Seepage Bed ^ Holding Tank ^ Fill System ermanen re erence oin escri e: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: (7)DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute horsepower brand name of pump and model number Is the warning device installed? ^ YES ^ NO Wired? ^ YES ^ NO 8 HOLDING TANK: Manufacturer o ga ons construction depth to the cover ft; If septic tank is being used are baffles removed? YES ^ N0; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ^ YES ^ NO; Wired? ^ YES ^ N0; Locking device on cover? ^ YES ^ N0; Diameter of vent and material Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; t he depth.; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAG R H: Total length of seepage trench ft; width ft; t he depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% failing away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ^ YES ^ NO (13) Has system been installed in floodway? ^ YES ^ NO Floodplain? ^ YES ^ NO DILHR-SBD-6095 N. 80 Signature of Inspector: ~- '` ~'~ ' ~ State and County Per it A lic tion m pp a for Private Domestic Sewage Systems Lot # "DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: ~(,~Ya /U(nl Ya, Section ~Z_d, T ~~jN, R 1g ~ (or) Subdivision Name, nearest road, lake or landmark Blk# State Permit # ~c_~ County Permit # ~~ County ~~-~ ~ '/ at City Village Township N~~~ri C. TYPE OF OCCUPANCY: 'Corr~ercial "`Industrial 'Other (specify) "`Variance Single family X Duplex No. of Bedrooms No. of Persons D• SEPTIC TANK CAPACITY /1OD Total gallons No. of tanks _~_ HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation X Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify- E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate ~ Total Absorb Area- 8 38 sq. ft. 8~0 / New X Replacement Alternate (Specify) O Seepage Trench: No. of ~I Ft. Width Depth Tile depth (top)es No. of Trenches Seepage Bed: X Length~Width-Depth '~ Tile depth (top! -3~ No. of Lines -3 Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land.. ~7 t~ i~ l~ Distance from critical slope WATER SUPPLY: Private ~' Joint ^ Community ^ Municipal ^ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I Have sized the effluent disposal system from the EH-115 prepared by the Certified Soit Tester, NAME 17st,r~v~`!g ~ Ci{~,r~s~o~~'Lp/~S,ur C.S.T. # J~.S-%SSf and other information obtained from J (owner/bull Plumber's Signature '~ MP/MPRSW# 3ao~ ~ Phone # 7/g' - ~~( ~(o( Plumber's Address 3/O ~1 i~ s c,~. ea n GJ~'s . ,S~fa i/o PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. EH~ liJ Rev. 9/78 t a~ - v. r~ REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION/:/q"~''/a,[-_'fa, Section~~ ,T~N,R~! (or}Township or Municipality Lot No._!2L ,Bloc Owner's%Buyers Name: Mailing Address: D \' A ~ ~~~G SD,~.I ~. TYPE OF OCCUPANCY:. Residence-_ ~L No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW__~S__-REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 8 ~` g~ PERCOLATION TESTS - 6- a SOIL MAP SHEET ~~ NAME OF SOIL MAP UNIT X 2- GGr t- /'~ PERCOLATION TESTS CO.~t~ QX TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHE RATE NUM- BER INCHES THICKNESS IN INCHES SINCE HOLE 1ST WETTED HOLE AFTE SWELLING INTERVAL IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN p_ / y8., ee ~ L o P-Z c[ " @~ re Q ~Y o P- e re ~~ a 3 6 ~ 5' P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, MOTTLING AND DEPTH TO BEDROCK TEXTURE NUMBER INCHES OBSERVED ESTIMATED HIGHEST , IF OBSERVED IN INCHES B- ~ ~ ~ +~ U" 6 ~~ S,~ o" B- Z ~ L 7 `~ " s "S ~" r. B- y fce._ ' ~~ N k~ G N .r PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the Ian ~e location and square feet of suitable areas Indicate number of square feet of absorption area needed for building type and occupancy p~ Indicate scale or distances Give horizontal and vertical reference points. Indicate slope. - , ,Su .`j'~,4 >fl ~F ~ ~.~~_.. ~_ a imp ~~ __ I'll A.. _: .~~.: IS . . R + A G 1~ W ~~ '~~ r"" ~_ ~~ Q~ / / ~ ~ / f /. r ~ 3 T CO ~ -J O .__., ~ ~ °~ C~ " 1 ~. ~ W s .~ •~~'?~ 4 ~.LI :~+ s -~~ l- ~ ~' ~• `~~ -~' y1~t9 ~~~