Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
020-1293-10-000
o ~ 3 m o C o d f ~ c ~ ~ A `i1 `T I ~ ~ 1 I ~ ~ ° ~ c :. ~ ~ ~ ~ ~ M yy y + I » » F ~ ~ O cn ~ ?o~ ~ s z ~ v, o o~~ ~- I Z~ z o m o o~ G7 ~c ~ = N o ° J° "S `c . ~ tD O fD A O - N N A CT A CD ~- cD ~ (D ~ ~ N N' ~. CD N n N X .~.. N .f O ~ N Q M N ~ • W tU CAD ~ _ ~ n"ti N N N d 7 V ~ ~ n ~ ~ 1 O O O~ n N N ~ V O ~ ~_ ~~ O O 01 N O S Q j 7 tl d ~ 7 N O ' ~ r l W N N v N N Cr , . O Q r~7 I ~ cn ~ D ep 4 (~ I V? Z~ ~ a W a m co ~ N N ' a v 2 ca D a j I N~ O C\T ~ W m ~' ~ I O O ~ m W ~ ~ ~ ~ O C O r O I ° ~° ~ ~ W~ I A m - W GO r CD ~ N r N W W c a COJi f=D N M I 3 a N I c I x ~ z 000 OOOo O .~+ ~ ' ~ Cc~ ~ ~ ~1 ~' W ~ c ~ _ N = N t~l ry~ ` o ~ dJ fA fA d1 fA d1 ~ c ~ ~ I ~ O S ~ N ~ G d~ ~ N O N ~ Q ~ fD A G O CD N ~ A ~ ~ ~ ~ . - •- d v N C D ~+ Si v o a I 0 o 3 m I ~ 3 d y I ~ a co eo I M 3 ~ 1 rn ~ ~-• ` o m o D o O I ~ _ I D a O o ~ ~ I ~ v o ~ ~ ~ ~ ~ ~ . ~ ~ y ~ ~ ~ ~ C CD ~ C , N I ~, ~ a I ~ v a C1 ~ 7 ~ 7 ~ Z I ~ v (O I ~ ~ S ~ ~ o D 'i ~ ~ p ~ ~_ ~ c ~ I ~' a I a ~ A Z 3 ~ .. I ~ I fA -1 N ~ J a ~ I ~ n ~ ~ ~ z ? ~ ° ~ ~ I o ;* I $ z I I y w m ~ 2 Z ~ i I ~ I v W ? N ~ O Q d d 7 7 ~ C G ? ~ ~ » O. y ~ fQ O I ~ y~ o a I y o o a ~ N F ~ N I ~ of 7 I -' ~ t/i O O N a N OD ~ N I ~" I m M ~ O O O I O ~ N .~ O A Od d O y d 7 N N yv I ~ y C~+i ~ ~ ~ w O I ` ~ b ti I ° I m o-o `:' op I o0 ~e '" a ~ ~ ~ a Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM `Safety and Building Di~ision INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes iPrivacv Law, s.15.04 (1)(m) Permit Holder's Name: City Village X Township Gullixson, Scott Hudson Town of CST BM Elev: Insp. BM Elev: / O J '/ (7 BM Descrip,ti/on: ~7TZ1 ~-~ .1 ~ ~SQiyytQ ~J Q I TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic / b b ~ 2. (p I Aera ' Holding r /~Y ~. TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic )s 'ng > (~ p' 3d-E- Aeration Holding PUMP/SIPHON INFORMATION C~tiZGt,(,~~ Manufacturer D mand PM Model Number TDH Lift Friction Loss m Head TDH Ft Forcemain L Dia. Dist. to we SOIL ABSORPTION SYSTEM BED/TRENCH Width ~ ~ Length / DIMENSIONS `7 SETBACK SYSTEM TO INFORMATION T f S stem: YP~'Q Y Of Trenches , ELEVATION DATA County: St. CrOIX Sanitary Permit No: 487941 0 State Plan ID No: Parcel Tax No: 020-1293-10-000 Section/Togqwn/R~ar~nge/Map No: ,at -!. STATION BS HI FS ELEV. Bencrh_mark (N~t Alt. BM ~~~ 5 ~ , d ~~ • ~~ Bldg. Sewer St/Ht Inlet~~~.,~~ SUHt Outlet OZ .) ~ ~~ 9S, 3 Z/ ; ~`.~``> .2. to ~ ~ (0-8~ 9s- 31 ~. ~ ~~~ ~ Z Header/ an. _ ~/~ ~ Z ~ _~3 9Z - (~ 3 Dist Pipe ~,rtv-r~.~ -b wt le. / z ~ o . (~ ~ ~ 9~- -z,~ Bot. System I ?~ / z.: QD • ~ a ~ Final Grade St Cover ~~ ~~ Z~ ~~ T~ h.e_ ~ ____- 3 ~~ ~~ i Of Pits Ilnside Dia. LAKE/STREAM LEACHING CHAMBER O r D~TI~IBUTION SYSTEM /~ ~" G~ror~y,,.f,~~ ~`ti, rteaaer arnroic uistnDUno(Cn--~~ ~~ ~ x Hole size x r+oie spaang vent~ro wr ~nwKe~ 9 ~ Pip 9 s)~ _~ P 9~ 'f._,. ~'---- 7 7S Len th Dia Len th Dia S acin SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes 0 No ~+~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/~ Inspection #2: / / Location: 756 Blue Spruce Lane Hudson, WI 54016 (SE 1/4 NE 1/4 27 T29N R19W) Humbird Hills Lot 22 ~~ Parcel No: ~!2~t~t~'8' 1.) Alt BM Description = ~ 7- a~ ~ l `I ~ ~ ~~ 2.) Bldg sewer length = ,Qn~ITf~~ j~ ~ /~ ~y -amount of cover = -~ / ~~J f " ~ S}'~-~- vl.- s'-ct~.~ O ~ _ _ -I Plan revision Required? ~ Yes No ~W _ / Use other side for additional information. ~~ ~ _ t , __ __ ~(~~'Lrv _ _ ~ v~~ ~~ :' __ SBD-6710 (R.3/97) Date Insepctor's S nature Cert. No. Saf au uildings Division ~ ___ ~~y _ ~s~ons~n on Bex~~-- s ~~ ~ 3~` ° ~ ~I;,~ ~ M~~~ etmit N (to be filledm by Co.) 8) 2 151 ~ ~ Department of Commerce Sanitary Permit Application ` - ~ i P LD. Number to accord with Comm 83.21, Wis. Adm. Code, personal i~'ocmation y provide '~ ~ ~t1> l C '' ~~ (if different than mailing address) ~~~ : ti. ( ~ may be used for secondary purposes Privacy Law, s15.04(1 x : L Application Information -Please Print All Information .,,° -~ - ue Spruce Lane Property Owner's Name Parcel # Lot # Block # 020-1293-10-000 22 Na Scott D. & Melanie R Gutlixson Property Owner's Mailing Address Property Location (/( f ' ~ 756 Blue S race Lane / / sE 'i+, NE 'i~ Section 27 . City, State Zip Code Phone Number Hudson, WI 54016 (715) 381-6821 T z9 N; R 19 w II. Type of Building (check all that appty) X 1 or 2 Family Dwelling -Number of Bedrooms 4 (~ Subdivision Name CSM Number ^ Public/Commercial -Describe use Lot 22, Htlmbird Hills 1~` Addition ^ State Owned -Describe Use ^City_^ Village X Township of Hudson Id Type of Permit: (Check only one boz on line A. Complete line B if applicable) A. Neu` System X R lacemertt S ep yseem ^ Treatmettt/Iiolding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit N and Date Issued Before Expiration Plumber Owner / ~ ~ ~ ~ A I I TV. a of POWTS S stem: Check all that a 1 X Nan -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in of suitable soil ^ At-Grade ^ Single Pass Sand Fitter ^ er ^ Constructed Wetland Pressurized In-Gro d ^ Holding Tank ^ Peat Filter ro i Tr t Unit ^ Recirculating Sand Filt / Recirculating Synthetic Media Fitter g Chamber ^ Ih~ip Line ^ Gravel-less tpe Other exp am S7~ . ~ 1 V. Dis ersal/Treatment Area Information: Twen ei t 28 standard or Chambers at 31.1 . ft. EISA/chamber = 870.80 . ft. EISA Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required ( Dispersal Area Proposed (s~ System Elevation 600 gpd 0.7 gpd sq. ft. 857.15 sq ft 870.80 sq ft EISA 2 @ 89.00' & 2 @ 87.00' VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concre Constructed Glass New Existing ~ Tanks Tanks ~eO'~ 1,000 1,000 1 1,000 Wieser Concrete X 1 260 al. Weeks Concrete X E~eCOblc T ~n~untl TNt VII. Responsibility Statement- I, the undersign assmne responsiblltty for htstaDation of the POWTS shown on the attached plans. Plumber's Name (Pricrt) Pl 's Si a MP/MI'RS Number Business Phone Number Jimm Boumeester MP #222904 715 386-9424 )'lumber's Address (Street, City, State, Zip Code) 1070 H . 3 5 N., Hudson, WI 4016 VIIL un /De artment Use Onl Arproved ^ Disapproved Sanitary Pemtit Fee (in lodes Groundwater ~ Date slued ing Agerrt Si ) ^ Owner Gives Reason for Denial Surcharge Fee) 3ob r .i f(~ , D ~t~t o8c~~proval/Reasons for Disapproval ~~ C~~ri ~ ~~ J~ ~ ~ /_ /_ 1 S ~-efflUent fi er and T~ ~h/ dispersal cell must all be serviced /maintained ~t ~ Q ~~~ ~ as per management plan provided by plumber. ~ , 1 ~~ ~ se ac requiremen s m d L'd ~ ~- 2 . as per applicable code/ordinances. ~ ~~~~~~-~~ ~ ~IG,~7Y~a,/L~iL. ~ ~ ~, Altach complete plans (to the County only) for the system on~per n~t 1~()hdG 811~/ll inch ~n ~ ~i "' ~/ (~~ ~'~'L v .,. lu t f~I ~, «~k~ _S ~ ~l ~. ccJi n~~e rs~ S ~~ ..... _ ./ . /. .~, , _ h? L, tivb J k~ ._ ___ .._ ~ U>>_u~ ~~~r ~ .. (~~I ~~ y - fr~,~G~.. s ~k y3.~S _ New at,o yp- ~ fi;~ w~~ ~~ A-fc,r, 2k~1 ~A "~`~ Na Vk~-~ ~ ,s1~,!!~ ~ So~~S~ 5~/ ~"2 jwn p~ '~ TIZD ~ G ~ t r r ~ U ~, ~ b N~1yl, ~1-tl-eK1 $7.v~ ~,oU ~h~~~ • •~ •~ QQN ~1, l~-w•~ n ~ (,o~ C°N I ~ t.~N .:. P .B ~? ~~~ f: ~7~ ~., u~k~, _S~ ~l ~. ~incle rs. ..~.~..f .... ...._.__....._ ./~/ _ _.__.._. --~-~'~ __. a ~ ._ ~a -Ia _ a~- .__ PKiv~w~ y ~r~cour~ 1~on-~ a y - fr~N~'~ s ~,~ y3.~S '. ~~~/~xlt~'1~S 10~U yb) NQ,~ at,~ ,~ ~` b A-lov z ~~ Cfia~ w~~ ~, -°~~ yF~/p~) f~~h ' -- Wisconsin Department of Industry, Lat~'ancf Human Relations [yvPsion of Safety 8 Buildings SOIL AND SITE EVALUATION REPORT ~~ - Page ~ of 3 ,..,a . ,a~, u ~ in nn nr per... n.~... n,..~.. ... ~ ................~.....,.,..,.,, ...... ,.,......,,,.,,, COUNTY ~ ~~ ~ ~ Attach complete site plan on paper not less than 8 1J2 x 11 inches in size but Plan must include , . not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PAR EL I.D. # .- dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION RE DB D PROPE OWNER: "`~,tt d~ ~ / ~~~ PROPERTY LOCATION GOVT. LOT j ~ 1/4l?~f s~ t/4,S~~ T Z ~ , ,R / 9' E (or) W gE ~ P~ ERN OWI~ ~':S MA IL I NG DR L.ZOT„2# BLOCK # SU ~ ~~ QR ~~ / `` ~ t ~ ~ - ` ~$ - t~ CITY STATE ZIP CODE PHONE NUMBER ^CITY ^VI LAGE OWN N REST ROAD Q(t New Construction Use (0(,f Residential / Number of bedrooms ~ [)Addition to existing building j [Replacement [ ) Public or commercial desaibe Code derived daily Bow ~~d gpd Recommended design loading rate Q . 7 bed, gpd/ft2 O •g Uench, gpd/ft2 Absorption area required `~ bed, ft2 56S trench, ft2 Maximum design loading rate ~ -7 bed, gpd/ft2 ~~~ ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) Wtlrs ~ ~' ~(~ . c~~ ft (as referred to site plan benchmark) Additional design /site considerations /~;qsT '- gETLJ4''FA/ ~`~. ~~~~ ANA ~/,.4~ Parent material Flood plain elevation, if applicable _. _ __ ft S = SUltable for System n CO VENTIONAL S O U OUND ~ S ^ U IN- ROUND PRESSURE ~S ^ U AT•GRADE l~ S^ U Y TEM IN FILL ~S D U HOLDING T ' ^ S U suitable for s stem U=U SOIL DESCRIPTION REPORT Boring # >;v~ixaok~~ a.~`w• Ground glev. ~9 ,Q~ ft. Depth to limiting factor ~ f/).~5~ Boring # ~Z ~~~~v t Ground elev. `+~ , 7~ ft. Depth to Nmiting f for ~ ~.~S .. :., .. ~r H Depth Dominant Color Mottles Text re Structure Consistence Baaxlar Roots GPD/ft orizon in. Munsell Qu. Sz. Cont. Color u Gr. Sz. Sh. y Bed rerrlt ~f -1 l(~°~te 4 3 i Sr~ 1 I'~+ 5~~` n'~r C 1 i Remarks: ~ - ~t~~/+2 3 / --~ C~. 1 r ~ RRmarkc~ OWNER S~4M ~~~~ SOIL DESCRIPTION REPORT Page? of 3 ~.~.~ LZ~. v~MB~R~. ~~t,s . = Horizon Depth in Dominant Color Munsell Mottles Q S C l C Texture Structure Consistence Baxrlary Roots GPD/ft . u. z. orrt. or o Gr. Sz. Sh. Bed teridi 1~ 3 I ~ ~••~ ~ C r fh t~ C Z, ~g, 9-s-~ .~ y~e ~ 3 -~ s a. ~, ~,1 ~ ~ o.. .~ g3 ~-,z 4 4 ~-- s 0 sh l , 7 d ~, Qn n.L.. A -5^ OY 3 I -- ~ r n~ ~r C ~ pp L53 ~5~~3 - t 2S .5 ~ ~ 1O` ,2 '~- -` J ~ Yl~ ~ O rn 1 ,~, ~ •Q ~ ~ l O. 0,7 O, Rnm~r4e• Q Y 3/ ~ ~ ~ C r 9~,~r ~~ 9-7~ .~y,~ 3 --~ S n, l ~ t o y O.g ~ -~i9 0~ 4~ ~ ~ n~ I X 0 7 nemarKS: rsemartcs: SBD-8330(8.05/92) ~~ ~~ ~ ~~N~ A ~~J~~ ~~ "~ ~ I- ~ „ r- ~w ~ ~ a ~ U J 1 1 M~ N~ 4~ `~~ ~~ ~` •--5 \1. ~ ~ . ~ ~ ~ ~ ~ r ~~ r o .~ s ~ , ~r - ~ ~.~„ ~~~, ~, ,~ ~~~ ,~ ~~`--- ~, N1 Hai ~~ ., ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXIS`T'ING SEP`1'IC TANK This is to certif that I have inspected the septic tank preseCCntly serving t,~e S Ga ~ ~~,~ I~ ~ ~ b~N residence located at : SL ~. N c~ ~ ~ , Sec. ate, T a I N, R~^W, Town of ~ ~ 1~J a~ , St. Croix County, Wisconsin. Upon inspection, I certify that I leave found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced S Did flow back occur from absorption line. Approximate volume or length of time• Capacity: 10 b u ~-~~ Construction: Prefab Concrete Manufacturer (if known): '~`j~ Age of Tank ( if known) :. -~ ~ ~, R ~ (S ign~ure ) - _ ~~ (Title a ~~ ~ l0 a~~s (Date) system? Yes No~ (if no, skip next gallons._~ minutes Steel Other (Name) Please Frint ~~ ~ 4oU (License Number) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 133 Wisconsin Administrative Code) Plumber (applying for sanitary. permit) Certification: In accepting the above statement regarding existing septic tank, condition, I certify that the tank , to the`<best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). _ Name ~~rn ~6H ~~e~~ Si nature 9 `MP/MPRS ~1 ~ d ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/lF- S CO~. ~. ~ f)'~e~.~._;~~~LL; ~ 5U r-) Mailing Address 7 SG ~ /~ P SAO r'u Ce,. /....z. n2 Property Address 54-rye.. (Verification required from Planning & Zoning Department for new construction.) City/State ~cc.~Sar y c.~/. SyQ'6Parcel Identification Number ~.~0 - /~1~.3 - /0-~ LEGAL DESCRIPTION Property Location SC"` tla , ~ t/a ,Sec. z7 ,, T ~9 N RAW, Town of ~~o~son Subdivision l~ic.m br'i"d /,~•~~s ~'~~ Add; ~.`ers ,Lot # 22. . Certified Survey Map # _yj~ ,Volume '- ,Page # -` Warranty Deed # ,) p ~ ~ (7 G ~~ 6 j~ D lI ,Volume -~$Z7`' ,Page Spec house 3~' t~" 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 8r 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 Plantung & 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. Nu ber of bed ms ~. __ ATURE OF APPLICANTtS) i~,S/~ 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. Og/~) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of 7/ FILE INFORMATION Owner S'CO 1 a- ~ 1 N"- -e (~ . G ~.~1 "1 x .taw Permit ~ DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ~ NA Estimated flow (average) gal/day Design flow (peak), (Estimated x 1.5) G U ~ gal/day Soil Application Rate • ~ gal/day/ftZ Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) <30 mg/L Biochemical Oxygen Demand (BODS) <220 mg/L ^ NA Total Suspended Solids (TSS) <150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand Total Suspended Solids (BODS) (TSS) S30 mg/L <_30 mglL ~NA Fecal Coliform (geometric mean) <_1 ° OOmI Maximum Effluent Particle Size Ye in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS ~~ ~ ~ ~n/1 Septic Tank Capacity 1 1, ~, v gal ^ NA Septic Tank Manufacturer i''~`l~r ^ NA Effluent Filter Manufacturer ~ ~ h.C 1 ^ NA Effluent Filter Model ~,1 Uu ^ NA Pump Tank Capacity al @ NA Pump Tank Manufacturer NA Pump Manufacturer Z'J NA Pump Model '61 NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration O Disinfection ^ Peat Filter ^ Wetland ^ Other: ANA Dispersal Cellls) ~ In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ANA Other: -CJ NA Other. ~ NA MAINTENANCE SCHEDULE Service Event Service Frequency Ins ect condition of tank(s1 p At least once ever y' ^ month(s) (Maximum 3 ears) ~ ~ yearls) y ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cell(s) At least once every: ~ ^monthls- (Maximum 3 years) 19 yearls) ^ NA Clean effluent filter At least once every: ^monthls) -{~. yearls) ^ NA Inspect pump, pump controls & alarm At least once every: ^monthls) ^ year(s) ~tNA Flush laterals and pressure test At least once every: ~ yea~~s~1s1 'O~NA Other. At least once every: ^monthls) ^ year(s) NA Other: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls- to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page ~ ~/ of !/ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s- for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s-. If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater wiU be discharged to the dispersal cellls) in one large dose, overloading the celllsl and may result in the backup or surface discharge of effluent. ~To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repairs the following measures have been, or must be taken,, to provide a code compliant replacement system: ~ ~rn~ ~L .s/ „~ ~~ ~./ A suitable replacement rea as been evaluatecd/IandG~m`laly~ be utilized fo(7tjhe location of replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. site a t been ev ua d to iden ' a suitable rep ent area. failure oft OWTS d site iatio~ us be perf med locat a suit le replac ent a a. If n replac ent a is av ' e a holding tank be i ailed s a I t resort to ace the fai P S. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~ ~„~ ~y ~ Phone 3 ~ ~~ 9 U~ SEPTAGE SERVICING OPERATOR (PUMPER) Name ~,p ri ~ S Phone '~, ~ _ 1 b d POWTS MAINTAINER Name ~ .,~ ~w. Phone ~ ~ ~ ^ ~ Q LOCAL REGULATORY AUTHORITY Name S ' , C x -) ~,o N ~+N Phone ~ o ~ . ~ gj (~ This document was drafted in compliance with chapter Comm 83.22(2-(b111-(d-&(f) and 83.54(1-, (2) & 131, Wisconsin Administrative Code. L~A~'li'slpertlil~t?Tirti?y7.29.19 LC~I`~J~T~~~~~c~E~~M ', Labor and Human Relations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Permit Holder's Name: ^ City ^ Village ^ Town o Insp. BM Elev.: ~ BM Description: X TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic (~~-~ / ~~ Dosi Aeration Holding TANK ~TBACK INFORMATION TANK TO P / L WELL BLDG. Vent to Air Intake ROAD Septic ~~~ ~ ~ ~ ~ NA Dosing --' NA Aeration Holding ---- PUMP /SIPHON INFORMATION r Demand Model Number GPM TDH Li Friction Syste Ft Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM ELEVATION DATA n ax A9300234 Ili/~~ l~'3 STATION BS HI FS ELEV. Benchmark 3, ~/ ~~~~ ~. ~ , ~~ ~ i Bldg. Sewer St / F~Inlet ~ 7 ' ~r St/I~EI' Outlet ~ 3~ I Dt Dt Bottom Heade~p~ _ ~ ' ~?~ ~~ Dist. Pipe / i Bot. System c~. f!f/ d~' Final Grade P', ~') ~ 3a o ~~r~- BED /TRENCH width Length ~ No. Of Trenches PIT N Of Pits Inside Dia. Liquid Depth l I I N I N SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manu adurer: INFORMATION Typeo 8t,,~ one / ? ~ ~~ ~ CHAMBER Moe e • --- System: ~p m . OR UNIT DISTRIBUTION SYSTEM / Header / Mani old ~~ i L h ~~ Distribution Pipe s ~ ~ / x Hole Size Hole Spacing o i to e engt Dia. Length ~ 7 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grad ste 1 Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx u c ed Bed/T~eRtl~Center Bed/I~MrEdges Topsoi ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) LCICATIO~N : HUDSON. 27.29.19 22 (SPRUCE E) _ /~ 1 Q /' ,, ' ©(?" ~Ga.?{~~ ~?~>` c~ ~~,~ca~ z~-. ~,~nC~ r",~ ~, ~<% ~~: ) ~~ S~ { ~C?~>7-Q.i1 /t c~:'lC / n _- ~¢ ! Plan revision required? ^ Yes ~- ~L p~C. .~/S 38~ l Use other"side for additional information. [ ~ 8a/ r'~J Imo- ~ 9 1 ~~~/ rjCiV1~ SBD-6710 (R 05/91) ~,~ 1. /` (~~-f Z0~'•.ZS~-z Cert No. v ~ ~, ~-~.« ~, « , "ol~y.~ 1~ 4 , •• AOCUMI=tYT NO. 509409 .-rI1A wAL" YnL1C1~~Fa~F~~g S~ ~E BAR OF ISCGiVSIN FOR3f 2- _ WAR~ANTY DEED This Deed, made between - Ste. E,.-Mi-l ler,•• a••single-man ...................°-...-•---•-•-•--...--------•--•--.......-..----•-•--........---.............., Grantor, and-....-..S~ott- D,-• Gullixson-aud-Melanie,-R.,, Gul lxson,. _,•--•__•-- -.__--_...__hu~band and wife as survivorship marital property-- . .. ..... ..... ....... ........ ........ ............... ----------------••---.-......--•----...----• ---••----•-•---•------•--•-°........._.._.-._......., Grantee, Witnesseth, That the said Grantor, for a valuable conaideration_..._. conveys to Grantee the following described real estate in ..St..-Croix-••-•-,••.,-.- County, Statc of Wisconsin: Lot 22 in the Plat of ltumbird Si12s 1st Addition in the Town of Hudson. ~~ /~a ~. THii S/AGi REi[RV[D /OR R[CORDINO DATA ~~ , :ccC'd ~ R~,.~ ~ NOV 2 2 1993 ,,, 10 :45 A. ~ , Tas Par ~ N,.:.. ~.' ~~ ~ Y This warranty deed is being re-recorded to include the Notary Stamp. REGiSt~~i~yy',M/-i~ , .,,~ N11NA W.i ~~ S . •-~- . ~``~ • L AUG 2 ~ 1994 _~ 3:30 ,~~ This .-.?.t!__I1S2L ............. homestead propertY• of Grantors-f ~` `" (ia) (is not) ~~09~ Together with all and singular the hereditamenta and appurtenances thereunto , And..._ Sam_-~.--mil-Ier- warrants that the title is good indefeasible in fee simple and free and clear of encumbrances except small ponding easement as shown on Plat. and will warrant and defend the same. Dated this ..................~ ~? ~_..... day of November -_....., 19..- 93, _.:.._(SEAL) '~^~C.~_.t~'"' f~ ~ /, L .. (SEAL) . _.•.. I Sam E. Miller ...............••------••-•---•-----•--•-••---•---•-•--•-•-• •--•-•-- (SEAL) a AIITBSNTICATION 3ignature(s) .................:.-•------------------...._..._..._..._..-- authenticated thin _______.day of___________________________ 19__.... S TITLE: MEMBER STATE BAR OF WISCONSIN (If not . .......................•-------..._..---...----..... authorized by $ ?06.06, Wis. Stats.) THIS INSTRUMENT WA$ DRAFTED BY Heywood 6 Cari, S.C., by John D. Heywood P.O. Box 229, Hudson, WI 54016 (S~gnatures may be authenticated or acknowledged. Both n.o ,,,, ,,..,.va.e_.,. • ACSNOWLSDt}MSNT STATE OF WISCONSIN ss. .S.'L._ CRULX_.._•• .............County. Personally came before me this ......!.b....day of ----.Hgymgber_.-__------•---------+ 19._3.. the above named ss~, .....-- to me known t,he'pei•SttR.,O~.,l..._ who executed the • f_fri11s ~rt~ Notary Rtblir. d. .... f ,'F.... _._.County, Wis. My Commissiols~.i~~ iler:q,~pnn~:hot, state expiration ~~. s~',~ . a ~, R %.1~`" - r• i ~-~ f ~,,- ~:. . ~.. .. ~; .- i , i r< :, r - 1-•. s , .-. 5 '~,- F. :; ~ti, 9 4~~ .1 i~'. _ ,_ a.., - : f f ", i r ~, STC - 104 AS $IIILT SANITARY SYSTEM REPORT OWNER- J ~i/i'? ~h~y (i / ADDRESS ~y ~ Z~ Z ~s~ 1'~^'" (i~ SUBDIVISION / CSM~ ~C/,, ,,.~~,',,rf /-I ~~ ;~,~ ,S LOT ~ Z ~ SECTION . a ~ T a ~ N-R /~ ~ Town of ~~ ~~ a ~ ST. CROIX COUNTY, WISCONSIN PLAN VIER SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM w~. ~~ ;s ,~~--~ ; ~ ~ ~~ ---------- ~`'~X3a I~fouS~ ~~~X: spr - --- __ ws~~( 65~ Sp r N -~ ,~ ,~ 4 S ~~ _~ ~- e ~t ~ o _ 7Zl -_ o .±, ~ ,r W_- o _-~ " i - ~~~~-d,~ '~ , ~~ F , A a r i `~ ~ M. 2 /2~ , ~~_~ jn-r /% ~"'"" INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover- BENCFBrIARR: ~~aF/~~ (j~~- ~~ S~ ~/ir~r ~~~ /dO,c~d - 3, ~Z- ALTERNATE BM• o~ o SEPTIC TANK PUMP CHAMBER / HOLDING..TANK INFORMATION Manufacturer: IN~,~~ Q,~ Liquid Capacity: c~t~o , Setback from: Well ~O ~ House /9 ~ - Other 72~~`or~,~,~-f" /df /,'~~ Pump: Manufacturer ~--- Model# ~- Size ~_ Float seperation ---- Gallons/cycle: Alarm Location c_ SOIL ABSORPTION SYSTEM Width: $ ~ Length ~/a ~ Number of trenches ~ Distance & Direction to nearest prop. line: Z5~ ~t~ So~f~ ~~ rt ~~ ti~- ' Ta Ea s~ /07` i'"~_ Setback from: well : 70 House ~ g ~ Other yz ~ ELEVATIOxs Building Sewer - ST Inlet : ~ 7 g ~ _ ST outlet ~, z o PC inlet -- PC bottom Pump Off Header/Manifold //, d ~ / Bottom of system / Z -/mar Existing Grade ~ G S~~ Final grade `~ lvs ~ DATE OF INSTALLATION: PLUMBER ON JOB: - CEO LICENSE NUMBER: ~ Z INSPECTOR: 3/93 : j t LQ,+~1~~`sTpert~l~u61~y7 . ~ 9.19 L~` I~'1alT~ ~3~c~ E~~ M Labor~nd Human Relations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Permit Holder's Name: ^ City ^ Village ~ Town of: .: /~~ . ~~ Insp. BM Elev.: G~' , G,J ~ BM Description: F 'r~ ~~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic (~-~ _/~ ~~ Dosi Aeration Holding TANK ETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Airlntake ROAD Septic ~~~ ~ ~ ~ ~ NA Dosing NA Aeration Holding PUMP /SIPHON INFORMATION r Demand Model Number GPM TDH Li Lriction Syste H Ft Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM n ita ELEVATION DATA A93©Q234 ~~/mod STATION BS HI FS ELEV. Benchmark 3. ~I /IfLJ, (~ ~ =L~ /17 v? ~~ ~ , Bldg. Sewer St/Ij~lnlet 7 ~ ~ St/~ Outlet ~ 3.~ Dt Dt Bottom Headed ~~~ ' ~a ~~ Dist. Pipe ~ ~ ~ Bot. System a flf/ (J~ Fi nal Grade - ~', ~ ~,3a ~~ TT oo r'i~, ~ ~~~ ~, l~ ~ .~a BED /TRENCH Width Length/ ~ No. Of Trenches PIT N Of Pits Inside Dia. Liquid Depth DIMEN 1 N 5~ DIMEN 1 N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O /f,~ ~[~ ~ ~~ ~ CHAMBER OR UNIT Mode N System: ~G( o? DISTRIBUTION SYSTEM Header /Manifold ,~ i Distribution Pipe(s) ~ / ~ 7 x Hole Size Hole Spacing o i take Length ~ Dia- Dia. Spacing Length SOIL COVER x Pressure Systems Only xx Mound Or At-Grad ste I Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx u c ed Bed / a-Center Bed / I~h Edges Topsoi ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON. 27.29.19 22 (SPRUCE I,A~t'E} -~~ /~ G~/~'~~ ylLc-~ ~' C y'~C:%'.' l~ c t. C'_~E ~~?` ~yz-~P .~~-~~!c~k` ` , }-~ ~"',c1~~t6~ , i ~ !~ / _ // ~ V'-' " Ciu_JY- ~ C.~'Z C:i~"l ~ / / G(~(~/ \ ,[~L/ 4 C c-.~C (~'~ ~ / ~y~ (?C,.,~/ C / j"` ~l ~ ~ ~ ~ ~ S~ C ~ [' C% / '~ . / /~ / 4. 0 ~ ~, J c i~~ Plan revision required? ^ Yes ~-A~cf" Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ~ _ _ __ ~ -~ CeNITeRV D~RIIAIT ADDi ICeT1AN ~' OILI"IR -- -- -- - - -- - - - -- ----- - - -- - -- -- - - - - - - In accord with ILHR 83.05, Wis. Adm. Code couNTY STATE SA TARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ~ Q' 8'~z x 11 inches in size. ^ ~ ~ ~ C ac if r via on previous application -See reVerS@ Slde for InStrUCtIOf1S for Completing thlS appllCation. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION SAr~'1 L ,E 5~ '/a ~i '/a, S Z 7 T Z/ , N, R / E (o PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # O,r ~ZS ~ Z ?~ ~".. CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ~!U So CJ SY~/~ s~,6 z7G9 /~!J/V1 ;(;.t,~,d ~t/GL S II. TYPE OF BUILDING: (Check One) ^ State Owned ^ VILLAGE ' NEAREST ROAD ASO E SPRUL G~~~ nn . DWellin ~# Of bedrooms 3 PARCELTAX NUMBER( ) ^ PUbIiC 4~`J 1 Or 2 Fam . g 111. BUILDING USE: (If building type is public, check all that apply) ~ 2 ~ ,~ ~ 2 g 1 ^ ApUCondo _2 ^ Assembly Hall 6 ^ Medical Facility/Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sales/Repairs 11 ^ RestauranVBar/Dining 4 ^ Church/School 8 ^ Mobile Home Park 12 ^ Service Station/Car Wash 5 ^ Hotel/Motel 9 ^ Office/Factory 13 ^ Other. Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ~ New 2. ^ Replacement 3. ^ Replacement of 4. ^ Reconnection of 5. ^ Repair of an System System Tank Only Existing System Existing System B) ^ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank ~ Seepage Trench 22 ^ Jn-Ground 42 ^ Pit Privy 12 13 ^ Seepage Pit Pressure 43 ^ Vault Privy 14 ^ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2, ABSORP. AREA 3. ABSORP. AREA 4. LOADING-RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION ~ 9~ ~ Feet 3 .4~ Feet ~~ , ? 4 7 Z O ~ ""' ' D VII. TANK CAPACITY in allons Total # of ' Prefab. Site C l S Fiber- Pl ti Exper. INFORMATION New istin Gallons Tanks Manufacturer s Name oncret on- tee glass- c as App Tanks Tanks strutted Se tic Tank or Holdin Tank ~ ~C / [~.,, S Q /' Lift Pum Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the. attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Dou S %~a/~ ,3 E,EJi~ ~-~~ zs~7 3 Z ,~ 3 P iu mbe s Address (Street, City, State, Zip Code): / ) l'-~6 Z ~f IX. COON /DEPARTMENT USE ONLY ^ Disapproved Ss nary Permit Fee (Includes Groundwater ~ Surcharge Fee) a e ssue Issuing A t Si Approved ^ Owner Given Initial j~ ~~ ~ ~~ ~ A v rse Determination _ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11!86) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber _ ,~ INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Yoursanitary~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 1:he permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped bjr a licensed pumper whenever necessary, usually every 2 to <i years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety E~ Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Chedk only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. if building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a// septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from D{LHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix ~(e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8'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; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigation`s and establishmenfof~standar~s.~~ ' "~" `'- - SBD-6398 (R.11l88) s~~M z« ~,~ NUil~fsl~C'.D ,~I«s t~~""~`2~ s~sr~~{~~ 89. yo= 9i~io~E~~r Sc4~~-- ~~s~ ~~= /G> " O B• h'-. Tod, o~ I„ ~; ~s....E/, =. /Oc7, oct ' ~•!_ ~- - 9(o.0'O~ ~/VE ST~ Z -_ S~Zu c.E LAKE a.. ~6~ `- w~c I, ~_ ~~`_ _ ,s- ___ ~ i __- q ; µ ~u S E _ 3 Z -._.~ ss' ~ ~S~X~D ~ARa6c . M, 1 ~~ I Ro N /~/P,E AT ~ 5.E- LcT LO/z N~1~ F~, _ /oD.Oo ~, ~0 .~ - ~'~ So' _- _ d G - l _ ~A~2-ER's ~ ~ i ~ ~L j- -~ ~~~- R N A T ~ sL' SO A R E P ^ ",~-- ~ .~ Q- Z ` ss"J ~~ a ~~ ~' ~ a, ~oT23 0 b' N LoT 2 ~/ ~ v 0 v h 0 M Wisconsin Department oflndustry, SOIL AND SITE EVALUATION REPORT ~~ " Page! of 3 Latwt'and Human Relations Division ofSafetvB.Buildinos :_ _____J.__:.~ ~~ ~~r,.,.,.,~ .~r:_ wJ~ n_J_ ,., ~ ............... ." ., ..,...,,.,....... , ........,.,.... COUNTY ~ ~~,t) ~ ~ Attach complete site plan on paper not less than 81/2 x 11 inches in size: Plan must include but , not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION AEVIEWEDBY DATE PROPE OWNER: ~,~' ~~{ ~ ! ~.~.~~ PROPERTY LOCATION GOVT. LOT 5 ~ 1/4 i!~f t~ 1/4,S~~ T Z. ~ ,N,R / ~ E (or) W PROPERTY OW R':S MAILING~DRESS LOT # BLOCK # SU NAME R C~SM # ~ <` $ CITY STATE ZIP CODE PHONE NUMBER ~~d ~~ ^CITY ~VI LAGE OWN '~S ~ N REST ROAD ~ ~ ~ ~ ~ ~.~ ' ( ~ d..~ ' ~ CS71i +~bi..~h1 Q ' New Construction Use [~ Residential / Number of bedrooms ~ [ J Addition to existing building j ]Replacement [ ] Public or commercial describe Code derived daily flow ~~~ gpd Recommended design loading rate ~ . 7 bed, gpd/ft2 ©,~ trench, gpd/ft2 Absorption area required `3 bed, ft2 5 6`~ trench, ft2 Maximum design loading rate ~ .7 bed, gpd/ft2 ~~ ~ ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) hIYS ~ ~' ~~ . <~~ ft (as referred to site plan benchmark) Additional design /site considerations I~~isT -- ~E rta~~~ N ~s `~~ ~~~~ A~v4 ~/~`{d Parent material Flood plain elevation, if applicable ft S =Suitable for system CO VENTIONAI. S^ U OUND ~(S O U IN- ROUND PRESSURE ~S O U AT GRADE J~ S^ U Y TEM IN FILL ~S O U HOLDING T ^ S U=Unsuitable for s stem SOIL DESCRIPTION REPORT Boring # 4}i::vJk3:L:v}u:} ~~~~ >~ •~~' ~< Ground lev. ~~ ,4~ ft. Depth to limiting factor i~~.~C~ Boring # n • ~~ Z .:. ~~ . .:.< a~~:vk:<:<>n~> Ground elev. ~8.78~ ft. Depth to limiting f for .25 "~ .. Depth Dominant Color Mottles Texture Structure Consistence Bax>~r Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y Bed Trertctt r - ~ ~~~'~~ ~ ~ S , f. t ~• s J<i K r~ ~r C 1 ~- 9- 9 7.s ~ 3 _ S ~ rn c ~ ? .$ 7rl~t~ ~ ~ ~~.. J ~ r, l -l ~ ~ ~ ~ :CJ. U Remarks: ~ - ~~~I+2 3 / ---- ~ 1 ~ , r ~, Remarks: Name:-Please Print Phone: ~~_ ~ C~~O ~ddress: .~ ~~~ ~ ~ 5~ (~a J ~ - - - -1 Signature ~ ~ a ~ \~~~~ ~ Date: ,~, jA ~~~ CST Number:~~~~• I PROPERTY OWNER Sxt~ ~~lir.~R SOIL DESCRIPTION REPORT Page? of 3 QARCEL I.D. # L ZZ. NU-M 8l ~,~ ~ ~ LC.~ Depth Dominant Color Mottles xture T Structure Consistence Bouxiar Roots GPD/ft Horizon in. Munsell Qu. Sz. Cunt Color e Gr. Sz. Sh. y Bed rend -~~ 3 1 -' C., i cr m ~~ C Z ~, -/~ ,~ 3 ~ S :~, , ,~,, abi ~~r (h 1 $3 ~~-~z 4 4 `~ s a ~~ ~ ,7 ~ ~~ Remarks: -15 /pr rE 3 -- S ; ~ j ~ ~ /~, ~r C ~ $ »-s3 .5 ~ 4 3 -- S ~, ~ , ,,~ 1 a ~ p.7 .~ g3 3~- ~ zs ion ~. 4 `- ~ d ~, ~ ' 0.7 ~o Fs Remarks: ~^I ~U~/U~ 3 ~ ~ ~ 1' C r ~~r ~~ IC-~~ 0~1~ 4 ~' ~' ~,1... ~ ~ s%K Yk~r C $~ 9-7~ .sY~ 3 --~ S ~ I ~ ~ o ~ ~o.~ ~ -~~9 a, 4 ~ ~ -- S n~, l ~ 0.7 o, Remarks: Remarks: SBD-8330(8.05/92) ~~ ~ ~ ~~~ ~ A ~RJ~~~ '~ . , // M) N~ QI ~~ 2 ~ ~~ 1 w 4 2 ~ j ~ ~J U a J 1 i ~ 4 --~Q\` . ~ ~ ~ off' . ~ ~.¢.,~' ~ , r ~ ~~~ - ~ ~ ~ t ' ,~ ~ ..J . ~ '~ ~ S ~ ~~ ~ ~ ~ ~~~ l ~ ~ . !~ ~ ~D ~~ ~ .~ ~. 1 w 4 ~- w 0 ~~ w = >~ ~.d. ..~_ M O M ~ ~ D.. wH _~ rUn a. W a ~ ~~ ~~ x ~~ 0 00 ~~ R~ z p0 .- w a 0 R~ ZU W ~ N ~ O _ ~ O o~ _-~~ ~r w 0. z 0 U w a z z a ~ a 0 m a w z o ~ ~ > w (~j n. Z '~ a3 ~ to ~' e~ ~x o~ 0 i I I ~ ~ M ~ I ~~ I `~- w 0. 4 O 4., z ate, ~ w w a 3 0 w m J~f ~,..._. ~. ~. ~, ~;, .~`~' ~',r'c.. S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER SA/n i"ti~LG~,~, ADDRESS ~5'O.C ~Z9 L FIRE NUMBER ~S~S CITY/STATE~~/pSoJV UJ.Z' 2IP Syd/G PROPERTY LOCATION:s ~ 1/4,/U~ 1/4, SECTION Z 7 , T~N-R ~~ W TOWN OF/~tJ~S1~/Y , St. Croix County, SUBDIVISIONyU~I~'Iy~,L>.f~dLL S , LOT NUMBER zZ . 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 septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment .stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in o~~eration prior to July 1, 1978. St. Croix County accepted this program in August of 1.980, with the requirement that owners of all rew systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper. verifying that (1) the on-site wastewater disposal system is in proper operating condition and ( 2 ) after inspection and pumping ( if necessary), the septic tank is less than 1/3 dull of sludge. and scum. °' r' . I/We, the undersigned have. read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic Yias been maintained must be completed and returned to the St. Croix Co. Zoning Officer within 30 days of the three year expiration date. +. SIGNED: DATE •~'1'~' ~ ' % ~' . -, St. Croix co. Zoning Office 911 4th St. N.udson, WI 54016 a. sTC-loo This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only rESUIt ~.n delays of the permit issuance. ,should this development be intended for resale by owner/corttractor,(spec House), then~~a second form shottld~be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. -------------------------------------------------------- owner of property S~ 11'7 M ? LL,G~2 Location of property SE 1/4 ~~ 1/4, Section ~ ? , T ~ ~ N-R I f W Township ~ ~ b~ a Mailing address T'ox ~ZS/ ~ ~~.s ~.. WT s'yv Address of site _~~5'G /~,~// ~~~ri`-'Y, /~ds Subdivision name 1-/k ~6%r ~{ j~-/;~/s Lot no ._ ~- Z Other homes on property? ________yes~_,No Previous owner of property ~a'r> 6; i ~ ~~r~[' ~~• Total size of parcel .3. 7~//~G Date parcel •was created 7-/~ -13 'Are all corners and lot lines identifiable? -~t~ Yes _______No i Is this property being developed for (spec house)? X Yes No Volume /0 z/ and. Page Number ~g'L as recorded with the Register of Deeds. INCLUDE WITIi THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & TIIE SEAL 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 .references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my ( our ) knowledge that I ( we ) am ( 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. d'a, zo,9 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the o~PPice oP County Register of deeds as Document No ..{6 ~ 2 A+s1 ~ +, . i i i 3ignature(s) ...................:........°--°--•_-.........--_...__.... STATE OF WI/SJCONSIN --------------------- Y ..-•----------County. authenticated this .._.....day o!___________________________ 19..__._ Personall came before me this ...__.~t~day of ----------'$1~}t..--•-------------•--.-, 19..9.. tha abLbe`.`ngFied ,~ '------------------------ - - - Baill Presiden_t___o__'f_ ~~~"' ~j~o ~ TITLE: MEMBER STATE BAR OF WISCONSIN ` ~ ~~ " ` b' d an or oratio ~ (If not. ---._....-•------•-•• .............•----•------..._..--•--•-- p _ . n_ .~ P ~ ." „1' authorized by § 706.06, Wis. Stars.) --------------------•-••-----....-•-- -- • -••----- ~--•..-.~,r-- - :.. to me known to be the erson ...___..O k~r ee,,~~ecuted t ~~ f foregoing strument and acknow]edg~P4Q eafn~ Q r { V ~ :: THIS INSTRUMENT WAS DRAFTED BV ~ /~ ~ N h . ~ f /- // ~O•~~h ,,.• •`1 ~ `'I!~ -Kueppers,..Hackel..~..KuepReta ......................... G+, .,.•-' ...... .... ................... .•--- .............--- --.......-...... .1 .1350-.Capital..Gentre,..-St....PAUl,_.MZL JS.LO2._ Notary lie ....S.T......G .Q./.~.......--.County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: `~', DocuMENT No. STATE BAR OF WISCONSIN FORM 1-18621 TN.! tr~ci RE9ERVEO roe RECOeoiNO OhTA ~ WAAAANTY DEAD w - Y"~ _ (~ P1..lr `_ _ F~EG!51 ~ft'S Cr=FIC~ ': ST'. C~~01X CO., bti7 This Deed, made between --Humbird Land Corporation, ,, - •-•••••• Fl;;c J for record ' ,l..Minnesota_•Corporation authorized to do business .1 in.-Wisconsin .................•--------•--••---.....-•-----------........---•-------.....------•----- ~UL 12 1993 ..... Grantor, and.... ~am-: ~~.: -Miller; -•---• --'•-----• .........................................•--------._....._.. `'t 4:20 ~. ~~ D.1 •~ Register of Deeds ..............................................................................•--................., Grantee, Witnesseth, That the said Grantor, fos s valuable conaideraHon.._._. ............................................................................._..... _............................. RCTV RN TO nn"- t~ conveys to Grantee the following described real estate in ...$.~.,..GIsIX .............. ~ a~n/ c:~/~" n County, State of Wisconsin: y -~.Geta/~- - '•~ Lots 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12 Tax Parcel No: ----------•------------------------ in the Plat of Humbird Hills, Town of Hudson as filed ,~ and recorded in the office of the Register of Deeds for ~~ St. Croix Cou.ity on April 7, 1993 in Vol. S of Plats, Page ' 99, Document No. 497107. Lots 13, 14, 15, 16, 17, 18, 19, 20, 21, l2, 23, 24 and 25 ; in the Plat of Humbird Hills 1st Addition as filed and recorded "~ in the Office of the register of Deeds for St. Croix County on April 7, 1993, in Vol. 5, Page 100, Document No. 497,108. R~~,j~ryl~ C !$~~D/ ~ ~~ ',~ `~ This .......7.~..AQ1;._...__.. homestead property. (ia) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; Ana...tiuulbi.>;d..I,aast..Co c.P4r.~i:4n ....................................................................................................... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements shown on the above mentioned plats. and will warrant and defend the same. Dated this .....---12th-• ......................•---..._ day of ...July......----•-•--•---....-•--•--..... ......., 19..93... Humbird Land Corporation, a Hinnesota Corporation authorized to do business in Wisconsin ..........................................................•--••---...(SEAL) BY.-..------•------.......... ... • .........(SEAL) Austin J. Baillon, President ...-•--••--•--• ........................................••---.._......(SEAL) ----._..........................................................----(SEAL) 0 i" AIITHSNTICA ION ACSNOWLSDGMSNT