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020-1081-40-000
A Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Hoffman, William Hudson, Town of ;ST BM Elev: Insp. BM Elev: BM Description: /06 C 5 TANK INFORMATION TYPE MANUFACTURER ` 5 CAPACITY Septic I 1 L` A- ROAD F: Friction Loss 6� Aeration 7 Length Holding Dist. to Well 29.29.19.331 D TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Friction Loss 6� TDH Ft 7 Length Dosing Aeration Dist. to Well 29.29.19.331 D Bldg. Sewer —�— _ Holding SYSTEM TO St/Ht Inlet JBLDG IWELL LAKE /STREAM PUMP /SIPHON INFORMATION Manufacturer St. Croix Demand GPM Model Number ELEV. TDH Lift Friction Loss System Head TDH Ft Forcemain Length Section/Town /Range /Map No: Dist. to Well SOIL ABSORPTION SYSTEM County: St. Croix Sanitary Permit No: FS ELEV. 488299 0 State Plan ID No: 17. ZZ� Parcel Tax No: 0�6 Alt. BM eQ_Q 020 - 1081 -40 -000 Section/Town /Range /Map No: D ,9S 29.29.19.331 D ELEVATION DATA STATION BS HI FS ELEV. Benchmark b ' -71 17. ZZ� Liquid Depth 0�6 Alt. BM eQ_Q le Z 11 C& 1 D ,9S , Z Bldg. Sewer —�— _ SETBACK SYSTEM TO St/Ht Inlet JBLDG IWELL LAKE /STREAM LEACHING St/Ht Outlet INFORMATION Dt Inlet CHAMBER OR UNIT 1 � Dt Bottom 2 / V 7 , ) — N Model Number: y ` VJ Header /Man. $� • �-, Dist. Pipe A, 57 1 6 . 600 115 S Bot. System 1I,75 87. -1'j Final Grade St Cover BED/TRENCH Width Length No. Of Trenches Vent to Ai Inta PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 le Z 11 C& 1 �. -� —�— _ SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: - INFORMATION CHAMBER OR UNIT Type Of S� m: 6 6 e_.v ZS 2 / V 7 , ) — N Model Number: y ` VJ '"T DISTRIBUTION SYSTEM A-, L Pik (1a.clr 17 t !7 = ;7`f d-a V-*_ Header /Manifold i/ Distribution x Hole Size x Hole Spacing Vent to Ai Inta / Length 7 Dia `F Pipe(s) ` Length Dia Spacing �� j XX Yes E] No ern SOIL COVER v PrPSSllra SVStPmS Onlv vv Meund Or At -Grade Svstems Only Depth Over Depth Over Depth of Seeded /Sodded xx Mul hed Bed/Trench Center LI 73 Bed/Trench Edges \ j xx Topsoil j XX Yes E] No Yes [:] No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 423 County Road U H dson, WI 54016 (NW 1/4 NW 1/4 29 T29N R19W) metes & bounds Lot Parcel No: 29.29.19.331D 1.) Alt BM Description i 2.) Bldg sewer length = Z� , t J fa �� �`(� U - amount of cover = , 4 u Plan revision Required? Yes Co �y Use other side for additional information. Date Insepctor's S nature Cert. No. SBD -6710 (R.3/97) Attach complete plans (to the County only) for the system on paper not less than 81/1 x 11 inches in size SBD -6398 (R. 01/03) Safety and Buildings Division County 1 *isconsin 201 W. Washington Ave., P.O. Box 7162 St. Croix Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 Z1-7 Sanitary Sanitary Permit Application St Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you pro �t oject Address (if different than mailing address) may be used for secondary purposes Privacy Law, s15.04(1)(m) ***a AFM I. Application Information - Please Print All Information e -11Z3 G Property Owner's Name Parcel #: Pending Lot # Block # r 020 - 1081 -40 -000, Na Na William & Deborah Hoffman Property Owner's Mailing Address Property Location 423 Co. H W ST. CROIX COUNTY NW ' /,, NW ' / <, Section City, State Zip Code Phone N T 29 N; R 19 W Hudson, WI 54016 (715) 377 -0013 II. Type of Building (check all that apply) X 1 or 2 Family Dwelling - Number of Bedrooms 3 `S �. Subdivision Name CSM Number ❑ Public /Commercial - Describe Use Na - existing 1 acre parcel ❑ State Owned - Describe Use PC;ty_ E]Village XTownship of Hudson III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ` ❑ New System X Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B• El Permit Renewal Before Expiration El Permit Revision El Change of Plumber ❑ Permit Transfer to New Owner List Previous Permit Number and Date Issued J IV. Type of POWTS System: Check all that apply) S(,cl ( X Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -G d ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leachi amber ❑ Dri c_&j V. Dispersal/Treatment Area Information: trenches @ 3' X 68', thirty four (34 total - 17 per trench) "Quick 4" Infiltrator Chambers at 19.1 s . ft. /chamber + 2 r. end caps= 661.00 s . ft EISA Design Flow (gpd) Design Soil Application Rate (gpdsf) Dispersal - A s on 450 gpd ,� 0.7 gpd sq. ft. / 642.86sq ft / 661.00 sq ft EISA 87.25' 1 --,' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass w YO � A k New Existing Tanks Tanks Septic or Holding Tank 1,000 1,000 1 Wieser Concrete X Aerobic Treatment Unit Dosing Chamber VII. Responsibility Stat eut I, th undersigned, assume re sibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pl er's S' MP/MPRS Number Business Phone Number James K. Thompson MPRS #30021 (715) 248 -7767 Plumber's Address (Street, City te, Zip Code) 340 Paulson Lake Lane, Osceola, WI 54020 VIII Coun /De artment Use Onl Approved Sanitary Permit Fee (includes Date ssu Issuin gent Sign tore o S =i ?en Real or Denial Groundwater Surcharge Fee) �Q(� .8C) �/ ( g 7 610 IX. Conditions of Approval/Reasons for Disapproval � SYSTEM OWNER: _1 an , effluent filter and C '' 33 dispersal cell must all be serviced / maintained PIA as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/1 x 11 inches in size SBD -6398 (R. 01/03) ,Z os. 72' 3 d J Pro postal C J: aer. ('pnc/'cic N e x 3 a�2 /QsSidmnc& Soi/ cda /ua�'o.� � E/¢da� ion • ,(.o�.cd/�rv�. ,56,E A,* mot n sE. <-•b; �; Lj! qC 9 � 7s . Ce?logt4r 'e s 6 Suofic `t a., ev at.-Y "Xi /. 7 be aba.,o�ifee/ a 5,4� eo de $2 , Ile e 2 o B 72' k5o�l i py � E /¢da lion s Slc, 29 - Tr,, o,." ,cl .SE. ctv,,e X9' W! Wisconsin Department Commerce SOIL EVALUATION REP Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and ,cent slope scale or dimensions north arrow and location and dist ce to nearest road Parcel I.D. 1981 Page 1 of 3 A.C.E. Soil & Site Evaluations St. Croix pe an 020- 1081 -40 -000 Please print all information. ev' Piersonal information you provide may be used for secondary s. .04 (1) (m)). Property Owner �� P party Location William D. & Deborah K. Hoffman . Lot NW 1/4 NW 1/4 S 29 T 29 NR 19 W Property Owner's Mailing Address Q 1 Lot Block # Subd. Name or CSM# 423 Co. Hwy. UU P City State Zip C e Phone�plDle City I Village ,t/ Town Nearest Road Hudson I WI i 5401 i 51 Hudson I Co. Hwy. UU J New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 16 Replacement Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional POWTS @ 0.7 gpd/sq.ft. Install tow trenches at 87.25' using 34 Quick 4 Infiltrator chambers. Boring # J Ong 0 Pit Ground Surface elev. 92.09 ft. Depth to limiting factor >105" in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD& 'Eff#1 'Eff#2 1 0 -25 1 Oyr2/1 & 5/4 none 1/sil fill 2fsbk mfi aw 2f,vf 0.0 0.0 2 25 -30 10yr2/j none sil 2fsbk mfi cw 1f,vf 0.6 0.8 3 30 -36 1 Oyr4/4 none gr Is Osg ml cw - 0.7 1.6 4 36 -105 1 Oyr5 /4 none s 0 sg dl - - 0.7 1.6 rl A ll ' f (O 5 10 a Boring # I Boring Pit Ground Surface elev. 92.64 ft. Depth to limiting factor >108" in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDff 'Eff#1 'Eff#2 1 0 -14 10yr3/2 none sil 2fsbk mfi aw 2fmc 0.6 0.8 2 14 -35 1Oyr5/4 none sil 2fsbk mfi cw 2fm,1c 0.6 0.8 3 35-40 10yr4/6 none gr Is Osg ml cw if 0.7 1.6 4 40 -108 1 Oyr5 /4 none s 0 sg dl - - 0.7 1.6 ' f (O 10 ' Effluent #1 = BOD 5 > 30 < 220 mg/L and iSS >30 < 1 mg/L ent #2 = BOD < 30 mg/L and TSS <-0 mg/L CST Name (Please Print) ignature: CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osceola. Wl 54020 5/17/2006 715 - 248 -7767 Property Owner William D. & Deborah IC Hoffman Parcel ID # 020 1081 - 40 - 000 Page 2 of 3 3] Boring # J Boring 1/' Pit Ground Surface elev. 91.16 ft. Depth to limiting factor > 102" in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots QPD *Eff#1 *Eff#2 1 0 -11 10yr3/2 none sil 2fsbk mfi aw 2fmc 0.6 0.8 2 11 -26 10yr5/4 none Sil 2fsbk mfi cw 2fmc 0.6 0.8 3 26-31 10yr4/6 none gr Is Osg ml cw 1fm 0.7 1.6 4 31 -102 10yr5/4 none IS 0 Sg di - - 0.7 1.6 << �1 2 F-I Boring # Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots QPD *Eff#1 *Eff#2 F—I Boring # I Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots *Eff#1 *Eff#2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. P . .So cda /ua G'on � E/¢da Sian Sca./G•• / = Y� Ste , 29 s�. cry ,r �6 3 a rj�ncl, r�'lurk: 40� 1 e/.'ittir! RsSi dsncQ N u�epa- e r a 0 0 a�' • 9B. sS • c P.to 9 ' • .. T be 4 6anairuA n s�� bode • r 20 B. 72- r � J. 3 0!,3 W m Q I G Z Q Y J a w ouu P n 3 w w q 3 w z 0 u w V) a- u 0 Z LLJ H O a_ J V u r j z �, or ,T 0 c " V O Q v � cS �'b J v V 0� e +� I II I�� e 4 W -T °U s� o c d ll c ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/ 6,7 14 fr`O -ino Mailing Address Y� 3 6o • hw GC Property Address 6�, ,, (Verification required from Planning & Zoning Department for new construction.) City /State /�U071 t,J/. T*116 Parcel Identification Number 020 - ld fl " `O'" LEGAL DESCRIPTION 33/ Property Location /9 tJ t /a , /� Gtr t/ ,Sec. y' , T �N R_ZL , Town of aa6so7 Subdivision 17a , Lot # Certified Survey Map # , Volume — , Page # Warranty Deed # & , Volume , Page # 612 Spec house p* no Lot lines identifiable yes 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 3 X 4 ::Ag�f SIGN, OF APPLICANTS) , - ) <' 7 //0( 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.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Seotic 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 <_ 15' 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 off the 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 around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil 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 - February) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 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 effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two -year schedule by use of a diversion valve. Valve to be switched diverting effluent from dispersal cell currently in use to resting cell on a two -year cycle coinciding with septic tank inspection and maintenance. Contineencv 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) 3864680. 'r O, C c. r l.'. X.29PAG'_L;1� Document Number WARRANTY DEED CHERRIE L ST. GERMAIN a single person Grantor, and,WII LIAM D HOFFMAN and DEBORAH K HOFFMAN husband and wife, as survivorship marital property Grantee. Witnesseth, That the said Grantor, for a valuable consideration of one dollar and other valuable consideration conveys to Grantee the below described real estate in St. Croix County, State of Wisconsin. This is homestead property. Together with all and singular hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants, and rastrlctions of record, and will warrant and defend the same. (Parcel Identification Number) 020 - 1081 -40 101 1113111:�Elll 1 �1111 Z5 10b KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 05-26 -1999 10:45 AM WARRANTY DEED EXEMPT M CERT COPY FEE: COPY FEE: TRANSFER FEE: 375.00 RECORDING FEE: 10.00 PAGES: 1 WILLIAM D. 4 DEBORAH K. HOFE24AN 423 COUNTY ROAD UU HUDSON WI 54016 A PARCEL OF LAND LOCATED IN PART OF THE NORTHEAST QUARTER OF THE NORTHWEST QUARTER AND THE NORTHWEST QUARTER OF THE NORTHEAST QUARTER OF SECTION 29, TOWNSHIP 29 NORTH, RAtvGE 19 WEST, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN, DESCRIBED AS FOLLOWS: COMMENCING AT THE NORTH QUARTER CORNER OF SAID SECTION 29; THENCE SOUTH 89 DEGREES 23 MINUTES 46 SECONDS WEST A DISTANCE OF 1236.52 FEET TO THE POINT OF BEGINNING; THENCE SOUTH 89 DEGREES 23 MINUTES 46 SECONDS WEST A DISTANCE OF 208.72 FEET ALONG SAID LINE; THENCE SOUTH 00 DEGREES 07 MINUTES 32 SECONDS WEST A DISTANCE OF 268.72 FEET; THENCE NORTH 89 DEGREES 23 MINUTES 46 SECONDS EAST A DISTANCE OF 208.72 FEET TO THE WEST LINE OF LOT I OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 1, PAGE 62 IN THE OFFICE OF THE ST. CROIX COUNTY REGISTER OF DEEDS; THENCE NORTH 00 DEGREES 07 MINUTES 32 SECONDS EAST A DISTANCE OF 268.72 FEET (RECORDED AS N 00 DEGREES 19 MINUTES E) ALONG SAID LINE AND AN EXTENSION NORTHERLY THEREOF TO THE POINT OF BEGINNING. Date his day of 1 1 14 , 1 JVAA 7— crrsRRIE L ST. GERMAIN AUTHENTICATION Signature(s) authenticated this — day of signature type or print name TITLE: MEMBER STATE BAR OF WISCONSIN (if not, authorized byg706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Robert F. Wall (Signatures may be authenticated or acknowledged. Both are not necessary.) ACKNOWLEDGMENT STATE OF C4� 0 — COUNTY SOat 1�(JtS ,A q Personally came before me this 1N day of ,' ` X99 the above named CHERRIE L ST. GERMAIN to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. • " r - F- YD'Cortnel type or print name �enn Notary Public County. . M co !,_fermanent. (if not. state expiration date: zf 2 'Names of persons signing in any capacity should be typed or printed below their signatures. _ JENNIFEn O'CONNt31 1% Commission # 1197120 Nototty Public - California Son Diego County MyC mm.BWkwSe Parcel #: 020 - 1081- 40-000 08/03/2006 03:08 PM PAGE 1 OF 1 Alt. Parcel #: 29.29.19.331 D 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 Co -Owner O - HOFFMAN, WILLIAM D & DEBORAH K WILLIAM D & DEBORAH K HOFFMAN 423 CTY RD UU HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description 423 CTY RD UU SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.000 Plat: N/A -NOT AVAILABLE SEC 29 T29N R19W PT NW NW N 268.7FT OF E Block/Condo Bldg: 158.7FT OF NW NW & W 50FT OF N 268.7FT OF NE NW EXC HWY ROW Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 29- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 05/28/1999 603956 1429/619 WD 08/25/1998 585800 1351/385 QC 07/23/1997 1215/282 QC 07/23/1997 1147/216 LC more 9nna CI IMMARV Bill M Fair Market Value: Assessed with: I Valuations: Description Class Acres Land RESIDENTIAL G1 1.290 52,700 Totals for 2006: General Property 1.290 52,700 Woodland 0.000 0 Totals for 2005: General Property 1.290 52,700 Woodland 0.000 0 Last Changed: 10/25/2005 Improve Total State Reason 130,600 183,300 NO 130,600 183,300 0 130,600 183,300 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 504 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 « r 0) o � n ■ ;Esm , M I § q E C 9 ) �\ § o / a 8 § E c T � . 3 . � 0 } k i B E a \ c co f © I � � k R g 7 § g � � � § g 2 � � � � � � � � � � � � � � � � \ � $ 7 $ / \ � / \ � 7 0 � � @ � } F 0ƒ 0 ° E = 7 0 CD i CD R a § A / ƒ �8 Cr °o �. �, o E§ U , m > « a m ® E § ¥ c A \ = 2 S ( e c , e c z co co 0 00 00 k § i T V " ' \ e J § d \ ƒ CO) £ - PO � & § \ rr ƒ ƒ R > 2 k \ f ƒ § 2 = 2 @ ` & E \ / / � C { � E / k ® � k i / uƒ m§£± 2 � § (a CD f j @ °§ F A £ /([ E� Vi m/ 0.6 � _� kf k# � � �� 0 km : ° o f k 8CL r 0) o � n ■ ;Esm , M I § q E C 9 ) �\ § o / a 8 § E c T � . 3 . � 0 } k i B E a \ c co f © I � � k R g 7 § g � � � § g 2 � � � � � � � � � � � � � � � � \ � $ 7 $ / \ � / \ � 7 Parcel #: 020 - 1081 -40 -000 02/03/2005 05:00 PM PAGE 1 OF 1 Alt. Parcel M 29.29.19.331 D 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * HOFFMAN, WILLIAM D & DEBORAH K WILLIAM D & DEBORAH K HOFFMAN Last Changed: 12/04/2001 423 CTY RD UU Acres Land Improve HUDSON WI 54016 Reason RESIDENTIAL G1 1.000 Districts: SC = School SP = Special 110,500 Property Address(es): * = Primary Type Dist # Description * 423 CTY RD UU SC 2611 SCH D OF HUDSON General Property 1.000 SP 1700 WITC 110,500 141,300 Legal Description: Acres: 1.000 Plat: N/A -NOT AVAILABLE SEC 29 T29N R1 9W PT NW NW N 268.7FT OF E Block/Condo Bldg: 158.7FT OF NW NW & W 50FT OF N 268.7FT OF NE NW EXC HWY ROW 1.000 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 110,500 141,300 29- 29N -19W 0.000 Notes: Parcel History: Lottery Credit: Claim Count: 1 Date Doc # Vol /Page Type Batch #: 504 05/28/1999 603956 1429/619 WD 08/25/1998 585800 1351/385 QC User Special Code 07/23/1997 1215/282 QC Amount 07/23/1997 1147/216 mOf eC 9nne cl IMMeRV Bill M Fair Market Value: Assessed with: -- - - - - 48280 182,700 Valuations: Last Changed: 12/04/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 30,800 110,500 141,300 NO Totals for 2004: General Property 1.000 30,800 110,500 141,300 Woodland 0.000 0 0 Totals for 2003: General Property 1.000 30,800 110,500 141,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 504 Specials: User Special Code Category Amount 018 - RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 44Sf)E'L , BRU72/ TOWNSHIP t /l7SO.cJ SEC. T o?5 N -R Al W ADDRES 3 6=:Sr 7k u u ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM - j 1423 lJRi ✓�� c.�,1.Y �� sf Brow,? r y &13 T1 ,v L L �(f ST / NE GiOnAG� � 5 (-�A!: 57 � f-CGr T r `,fNE �To - �:tooTfc Tib ;T 1; E R fvE VTv 5 E'PT x -r&k, .cdEA/T Sy" INDICATE "NORTH ARROW BENCHMARK: Describe the vertical reference point used 1:�1 ®c V" r- Q,y x'�A y k. Elevation of vertical reference point: /Od ' Proposed slope at site: S i/lo } w PUMP CHAMBER Manufacturer: ... Liquid Capacity: 4 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, Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, 0 Side, O Rear,0 Pt. Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: I 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: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: DEP OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDING LABON & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 T✓1 State Plan I.D. Number: ITA, MI',, S29, T29N- R19 CONVENTIONAL ❑ALTERATIVE If assigned) Town of Hudson m,....,..,_ TrrT ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound R R: DDRESS OF PERMIT HOLDER: INSPECTION DATE: Albert Dabruzzi 7 423 County Trunk W, Hudson, WI 54016 COVER BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: "REF, ELEV.: Name of Plumber: LOCKING COVER MP /MPRSW No.: County: Sanitary Permit Number. Zappa Brothers Inc. I 33 St. Croix 119426 SEPTIC TANK /HOLDING TANK: WIDTH: LENGTH: NO, OF MANUFACTURER: COVER LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER TRENCHES: TRENCHES: I PROVIDED: PROVIDED: DEPTH: DIMENSIONS ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: DISTR. PIPE PROPERTY WELL: BUILDING: VENT TO FRESH WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM ELEV. INLET: ELEV. END: LINE: PIPES: FEET FROM LINE: AIR INLET: ❑ YES ❑ NO AIR INLET: ❑ YES ❑ NO NEAREST —00' NEAREST 10 HOLE SIZE: HOLE SPACING: DOSING CHAMBER: MANUFACTURER: I BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP /SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO I I I ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ) ❑ YES ❑ NO NEAREST --- 00- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED /TRENCH WIDTH: LENGTH: NO, OF DISTR. PIPE SPACING: COVER LATERAL SPACING: INSIDE DIA.: # PITS: LIQUID TRENCHES: TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. GRAVEL DEPTH FILL DEPTH DISTR. PIPE I DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: DISTRIBUTION AIR INLET: NEAREST 10 HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unsiope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER I TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH /BED I DEPTH OVER TRENCH /BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO I ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL &MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION I APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM I NEAREST LINE: ❑ YES ❑ NO ❑ YES El NO —� Sketch System on Reverse Side. SBD -6710 (R. 06/88) Retain in county file for audit. SIGNATURE: TITLE: Zoning Administrator CAKIITADV DCDBAIT ADDI Ir'_ATInki1 Ca`DILHR `7 In ' .,-,.... —...-... —.. - - -- - - - - -- n accord with ILHR 83.05, Wis. Adm. Code COUNTY e Di,1 y STATE SANITARY PERM T –Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ Check if revision to previous application –See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION – PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION %a Y4, S T , N, R E (or W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # Z T CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER S ' 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned VILLAGE : j ❑ Public ®1 or 2 Fam. Dwelling -# of bedrooms— PARCEL TAX NUM ER() l III. BUILDING USE: (If building type is public, check all that apply) d 0 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one 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 12 ❑ Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY ABSORP. AREA 3. ABSORP. AREA 14. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE 12. REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) ELEVATION app 1 Feet Feet VII. TANK INFORMATION CAPACITY in allons Total Gallons # of Tanks Manufacturer's Name Prefab. Concrete Site Con- Steel Fiber- glace Plastic Exp App New istin Tanks Tanks structed Se tic Tank or Holdin Tank o O ' Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT 1, 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) f*P /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): IX. COUNTY /DEPARTMENT USE ONLY Approved Disapproved Initial ❑ Owner Given Sanitary Permit Fee (Includes Groundwater Surcharge Fee) Date Issued ping Agent Signature (No mps) A Determinati 7 X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11188) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 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 a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608 -266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. Ill. 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 8 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 all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% 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 investigations and establishment of standards.- - - SBD -6398 (R.11/88) APPLICATION FOR SANITARY PERMIT STC -100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ---------------------- �- r - r- ----------------------------------------------- - - - - -- Owner of property F. 4— DILM DA E0Ll 22- / Location of property /vLl 1/9 `a1 1/9, Section , T •2� N -R W Township �� �lac 19/ Mailing address u0 3 c'to"L i y v l 6 Address of site %� ;Z ,� L a 1 1) �c t D_Sd 14! Subdivision name Lot number Previous owner of property M1�fj' Je se N Total size of parcel _ / &ij F' Date parcel was created �/9//f/ye LUG Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes No Volume i 4ji and Page Number t4j. as recorded with the Register of Deeds. ------------------------------------------------------------------------- - - - - -- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the 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(WO 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. 2 T I' -zi 5"6 ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document o. 4 ). , Sianai-rnra of nwnar 4 — I'tet DOCLIM,FNT N O. Q 0 L; THIS INDENTURE, Made this 13th day of March A. D., 19 EL5L , between Marvin J. Josephson and Katherine Josephson, his wife, part 1 eSof the first part, and Albert E Dabruzzi and Diana R. Dabruzzi, husband and wife as mint tenants, 1 . .... l i . . I . STATE OF WISCONSIN —FORA 11 THIS SPACE RESERVED FOR RECORDIr.6 DATA frc Ci TLP7 C 7. ST. CROIX CO., V Recd for Record this__ 18th day of__ March ___A.0, 19_65 t r f Deeds part ig$ of the second part. R E T O R N TO W f t n e s a e t h, That the said part i-PSof the first part, for and in consideration of the sum of One Dollar and other good and valuable considerations. 7D3C to them in hand paid by the said part leS_of the second part, the receipt whereof is hereby confessed and acknowledged, ha given, granted, bargained, sold, remised, released, and quit - claimed, and by these presents do give, grant, bargain, sell, remise, release and quit -claim unto the said partite of the second part, and tot hela'birs and assigns forever, the following described real estate, situated in the County of St rrni x and State of Wisconsin, to -wit: Part of the Northwest Quarter of the Northwest Quarter (NWi -NWb of Section Twenty -nine (29), Township Twenty -nine (29) North, Range Nineteen (19) West, further described as follows: Beginning at the Northeast (NE) corner of said Northwest Quarter of Northwest Quarter of Section Twenty -nine (29), thence South along the East line of said Northwest Quarter of Northwest Quarter a distance of 268.7 feet, thence West parallel with the North line of said Section Twenty -nine (29) a distance of 208.7 feet, thence North parallel with the East line of said Northwest Quarter of Northwest Quarter a distance of 268.7 feet to the North line of said Section Twenty -nine (29), thence East along the North line of said Section Twenty -nine (29) a distance of 208.7 feet to point of beginning; the North 60 feet of parcel being highway right -of- way., subject to an easement 33 feet in width for road purposes over the West 33 feet of the above described parcel. To Have and To Hold the same, together with all and singular the appurtenances and privileges thereunto belonging or in anywise thereunto appertaining, and all the estate, right, title, interest and claim whatsoever of the said part i e of the first part, either in law or equity, either in'possession or expectancy of, to the only proper use, benefit and behoef of the said part of the second part, their heirs and assigns forever. In Witness Whereof, the said part i e-S of the first part have hereunto set _tJLe__jxhand S and seal S th 13 t h day of March , A. D., 19 12.L . SIGNED SAL IN,I� ENCE OF �" ✓ Hugh F. Gwin- � r Sally Richie (SEAL) (SEAL) STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County r o0947k OWNER/ 20M �. G' 1.�� l �� AFl g 1°�Gc z 7- ( I� %i�'!�� ROUTE /BOX NUMBER FIRE NO. CITY /STATE /7. iGCi6u�, GCJid21i's.�c�v ZIP 16 PROPERTY LOCATION: X 1 /4 Wkil 1/4, Section , T _2�.L N, R Town of JV a D-56rl , St. Croix County, Subdivision , Lot No. 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 $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning 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 (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 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 Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE ` L�-a vx �, t 7 St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386 -4680 Sign, Date, and Return to above address DEPARTMENT OF INDUSTRY, ,LABOR-AND *HUMAN RELATIONS SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, WI 53707 DATES OBSERVATIONS MADE DESCRIPTION PROFILE : TESTS: ONV C s ❑U MOUND: CI S CJu IN GROUND Ei E] S Du S N -FILL CJ s CJU OLDING TANK: CJ s CJU RECOMMENDED SYSTEM: (optional) If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under &.1463.09(5)1b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING NUMBER TOTAL IN, ELEVATION P H T N R UDWATER- OBSERVED INCHES H S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) PER IOD PER1002 PERIOD 3 P- B- P- B- B- P- B- P- B- P- PERCOLATION TESTS TEST NUMBER DEPTH INCHES WATER I HOLE AFTERSWELLING TEST TIME INTERVAL -MIN. 6ROP IN WATER LEVEL-INCHES RATE MINUTES PER INCH PER IOD PER1002 PERIOD 3 P- P- P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- xootal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION �. 1 6. r,. - T/dt SW Co ItrvER 0,0:f ,.. ._ , .. EXSJZ2NG 2ES.t:giNe.lc TNB t�.2S71Nb G�NC/tETB' - J ^ LA13 AT ? NB LOwsa LFvEL ",Lkeur F� we OEG Eltb.- /Da ad 7SA. 6ve4L _. 3 k�F ;. 51 ' tH /Vv SCALE :. EXxsz.�j .CCPTScTANK� J � Eiotr � �%"�I' JAL OpF LrA,C FxssTLr✓9 4tiy�Ett1 S' S0idTi /q/v0 h-P.('T A4vpF1tTy REPORT ON SOIL BORINGS AND PERCOLATION TESTS (115) (H63.09(1) & Chapter 145.045) RATING: Se Site suitable for system llm Site uneuitehle fnr &w*& - — (A 4 -- — G,L I,v 4Z ,O/ix A Y la -)eX x 7'Y /V 6 Y: XZS7 - Z N6 I /iESZ&E�VCE 'CA AAGE I DECK ExtSTSNG I ✓F_ L L AS / l_x1STI/v6 13Lg6 SEwt/k, C GOOD Con/OSTSO/v) f- -OVE2 /00 / ?u LvEST PnUp,E&T� L2,Nc A 2Er4 OF Ex fm.iG FA ILED - 4- S E , OTZC, TANK 0 Tr "E L / Top ES72DYE0 ) 1 3-y ' tvEL.i /ODD GAL TEp 77G S Tip rvl� ( Ge/v cn ETE) _ 0 JQ I .CLope o � �X rsT=Nc� r- ��Cu�N-r L rNEs t � CGDt�.O C�.v4272 Jn/, � I ,EXSr U,.j& C GDa� Co...nxrzo..i� , i L AST �2opE2TY 2X E OVK/L /SO To .rOUTN &oAF_rLT LS vE I I oLz? � 7 LOT 1 // O 4.5 C XL /.04eZwzu J,rIDT -Tc TArv/< /7.51 -,L /0 CE/ / vT T /�v/✓ O c zVa a rory J7 C.2az k Couv ?Y N _ W S /Ira Irr—ALE I I I I 0 O a 0 i co n m i v a a n N C � m 0 Q N m m 3 I I o v v> Z D m 0. D N D W 3 ° o L o i 0 I 0 N � C v v 3 o d m 3 � I ro C CL Z 0 O o . X CD C { W fD n 3 Z CD cn 0 I � I I I a Q O. N Z 0 CD I I I I I I I I 0 CD CD A 0 0 L 9v�0 3v c Cy c f v r°. 0 T 7! ~ � O C) i = N O (y o • IV "'{ W .� 7 N ? c a N 1 d i co CD C C O O CL !! 6 G 7 9 �1 • 000 * i N fA N T D �000C) A y i i N O N z a) a O (D fD N 7B CD f(D d a ' AZT C C L p 7 (Z co co iz C .. ZZ co y < i C G i `D G O V � I C Z a A A tr fi A O N N O O to A ti ti b ° "+ A 00 !� A � O APR-27-99 03:30 PM ROBERT F WALL LTD. 715 386 9309 P, 02 APR-27-89 TUE 1 310 GLOBEFLEX CAPITAL FAX NO, 8196589CB- 1,01/02 I P.. ez OPP-2?-99 0218V PM RORCRT F WaLk• 6TV, Soo "a'a INIA's UPAVIV W is!*$ F 7 u is 04 46#8 n cco 201KIN41 affik, 1 COUNT Y A $T. R fPCONSIN 4, ZONING OFFICE IT, C otoix W" r roTr!rm 1: o, �, Mz �X 10i OWMIdil "I HI W1 Mall 5211 1301PRevzov vivolla v1sw Sao D C Kease speffy desired test(s) a remit approprL4tv too. VIth - 0'4JN ApPILcation. Qutglds vater lines are aftall turne'd of'r rlurinc.,, wirkeer month*, oaking someti& to tho hoz In a nvO*sabry, Pleao* alka I IN G arr,orqtinants with this off ice to insure th^k miltry pan be Joined- U oetav (voc 0) saptie. v obtar (Nitra, a 4 ifitratTl C1 Writer (Load Ct;noontroftion)_ $21 00 Mr,heir J- R ad bys— j 3 illd &Alta h4dress % I ! !:t Wress 9 JAA 4 A i 4ft J* A At - 411fiz , -4 .06- 3: Iralerho JJ, AP " Lxr P Property addreat I nxv 0 & street) TAGation. M— , Wok, Sac, , T_ja.N, 0C_-h&14jfi92-- Stuck Sax ag I...; L 40 00 b L> ap tq Up BY noplu v RM *PYAQVzvv A SKET OUSP. & SEPTIC praTiff ON pzvg"t er Title, FORM* W:%4x Gainplo tap losations - 4b,4k - I I -- A I the dvalliriti currently -oddufted? I.J. Us A � so 41 vagamt, data last' occupivid$ 5 1 1 k9a at vaptle v►otsm T. � Flotio tank lost ;Z� ProvLous ownerts m=6 ow liave any of tho follOWSM9 been obierved? 131 olow araL"MqG zrvn h"Is. of savage 140%=Up into dwelling. cy 5ftVaQA dischmega to qvaund surfaaa are read dinatt, 0Y i Foul o"re. Other coxmiAnts rolaltivo to systan oparationt. GACtifY that-' UO 4bGV8 LhidrMAti*31 in c9op1hLe and %19U4 to thIR 6686 of my knaviedge. � f ��� .. , 04MAS BTas1AT - W-44 k1bk AA ji APR - -9 9 03:30 PM ROBERT F WALL, LTD. 715 386 9309 APR-27 -99 7UE 13 GLOBE'LEX CAPITA'. FAX "IG, 6196583061 OPR -27 -99 92:1!3 aM PngrgT W WALL. 67r. T!C 300 0605 u40'14'06 IMM J6'ZV f" 71! 1&1 JIIQ 62 CAI co WN!N(i m �an�nv wcwwze� or M9959 f SEMI f i 1�y�11 . .W we all empRRpsO ■ x IBilpiomil gos+xc.v m eilskr6aign i /nt pern�,t 'on Li1vT - OYss ' Ott p•r. eCS! lvil survey: ghost 0_,.,__ m; of an&z MIX UG' fat jW Ogal and CU►t -Grr] QK oll nd 11P9R'vR. s! =a ' � CkrAVitr ODaso Clsega�cictQ : ZF E03aftimm Gees, Ofte b DDrr well ancidi Tank Doettall plea GOther C'unknovn se� OltaliNo, QN :11 GPcap. Lim Cother____� etDi4kE+ Qt{otse� DSti+il Cleop. ],inn Oa�het ML irq cover Uek �Nsrnir+r abal mp /lloets_�� 09 ara. Ylriltq ' kOxs; �'�spw..,.•_ QRsll„•.,�., Cprvt. 1lce tbtnar...... -.�_. OftrAitR4: �� ODieeharaer i o U ✓Q �I . ' U F. 02/02 �.ro. P.03 APR -27 -99 03:29 PM ROBERT F WRLL L TD. 715 386 9309 P.01 Robert F. Wall, Ltd. .522 Second Smeet ffudson W}9consln 54016 (715) 386 -5881 PAX (715) 38&9309 atLaw CONFIDENTIALITY NOTICE The documents accompanying this teleeopy transmission contain information from ROBERT F. WALL, LTD. which is confidential and/or privileged This information Is intended to be jor the use of the in4ividual or entity named on this transaction sheet. If you are NOT the intended recipient, be aware that any disclosure, copying, distribution or use of the contents of this Information is prohibited, and may constitute an invasion of the privacy of the intended recipient. If you have received this telecopy in error, please notify as by telephone (collect) Immediately so that we can arrange for the retrieval of the original document at no cost to you. Fhx TO: Shawna Fax: (715) 386 -4686 Phone: (715) 386 -4680 Re: Cherrie St. Germain / septic inspection 423 County Road UU / Hudson ❑ Please Reply From Robert F. Wall Pages: 3 Date: April 27, 1999 CC: ❑ Original to Follow by Mall e Comments: Shawna: We received the signed request back by fax today. Please initiate the inspection as soon as possible. We have already had the water and pressure tested. Only the septic inspection remains to be done, If you have any questions, please call me at 386 -5881. Thank you for your cooperation in this matter. Robert F. Wall / mm Robert F. Wrall, Ltd. 522 Second Street Hudson Wisconsin 54016 (71 S) 386 -5881 FAX (715) 386 -9309 Attomeyat Lazar April 20, 1999 St. Croix County Zoning Office St. Croix Government Center 1101 Carmichael Road Hudson WI 54016 Re: 423 County Road UU Enclosed is our firm's draft in the amount of $125.00. Please test the septic system at the home located at 423 County Road UU and send the test results to me at the address listed above. Thank you for your cooperation in this matter. Very truly yours, ROBERT F WALL, Ltd. e�- aa.,4_y '_ 0 1,1 Robert F. Wall RF W /mm Fnc. r .04/14/99 WED 15:29 FAX 713 386 IIN�rrr +� At 4686 ST CRY CO ZONING ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST_ CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 SEPTIC YNSPECTION / WATER TEST REQUEST FORK Please specify desired test(s) & remit appropriate tee with .application. outside water lines are often turned off during winter months, making access to the home necessary, please. make arrangements with this office to insure that entry can be gained. fi k (VOO's) $200.00 )( Septic $125.00 1l ter (Nitrate & Bacteria) $55,00 © Nitrate & Bacteria C1 water (Lead Concentration) $21 - 00 retest $15.00 Owner: C 4 e S P . ✓ ma 1 1 Requested by: " ;4� at 99 d 'ekddress: 4A Address: - j. rte ZIP s`ygr/ H -on K/,` ZIP ,ice 4)A Telephone PP. ( ) Telephone If: ( 1L,Ff 380.58'8',1 .Property address (Fire W & street) Location: h, 1 4 , Sec. , T_N•, R W, Town of Naserl Realty f irm:_ Luck Box Combo: _ Closing Date; ,S TO BE COM BY PROPERTY NNER 1 PROVTDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* water sample tap location: :I's the dwelling currently occupied? © Yes 0 No If vacant, date last occupied: kge of septic system:____ Septic tank last pumped by: bate: Previous Owner's Name !',lave any of the Fallowing been observed? ❑Y ON Slow drainage from house, OY ON Sewage Back -up into dwelling. DY ON Sewage discharge to ground surface or road ditch. 11Y ❑N Foul odors, Other comments relative to system operation- 2 certify that the above information is complete and true to the k1est Of my knowledge. OWNERS SIGNATURE:: I9)tiTX zoo2 1/94 04/14/99 WED 15;29 FAX 715 386 4686 ST CRX CO ZONING OF HOUSE & SEPTIC SYSTEM LOCATION TO BE COMPLETED BY INSPECTION AGENCY System design & /or permit on tile? OYes ONo Soil series per SCS Soil Survey: Type of soil absor t' s stem: Approx. size ' X — Ft. sheet ❑Below grd ❑At -Grd OMound OGravity ❑Dose ❑Pressurized ❑Bed ❑Trench ODry well Molding Tank DOut Fall OBSERVED DEFICIENCIES pipe ❑Other C7LTnkn own Septic tank Setbacks: 014ouse (]Well ❑Prop. line 00thez Dose tank Setbacks: OHouse. ❑well OProp. line ❑Other OLocking coven ❑Warning label, ©Pump /Floats OAl GEiec. wfrind — Soil Ab;oEption System Setbacks: ❑House Nell ❑Pxop.line ❑other DPonding: DDischarge: -- General comment INSPECTORS N SKETCH OF SYSTEM LOCATION � Inspp Title 0 Z003 May 3, 1999 Robert F. Wall 522 Second Street Hudson, WI 54016 RE: Legal Description: Dear Mr. Wall: ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 5Q1&7710 (715) 386 -4680 Septic evaluation at 423 County Road U NW 'A, NW 'A, of the Sec. 29, T29N -R19W, Town of Hudson, PIN # 29.29.19.331 D, Computer # 020 - 108140-000 On April 30, 1999, an inspection of the septic system on the Cherrie St. Germain property at 423 County Road UU, was conducted. The dwelling has been vacant since December 31, 1998. Original sanitary permit information was not located, so the date of installation and size of the system is unknown. At the time of the inspection, the sanitary system appeared to be functioning properly, however there was approximately 24 inches of sewage effluent ponded in the dry well. I did not observe any effluent discharging to the surface. Ponding of sewage effluent (liquid) in the soil absorption system (SAS) could indicate that the SAS is reaching its life expectancy, but not system failure. It did appear that there was sufficient area available for a replacement system in the rear yard. The drain field must meet all applicable setbacks if replaced in the future. Ponding results when microscopic bacteria and sludge plug the soil pores forming a clogging mat. This clogging mat decreases the soil's ability to dispose of the sewage effluent. Over time, this clogging mat becomes thicker, causing less and less liquid to percolate through the system. As this mat becomes progressively thicker it leads to failure of the system. To prolong the life of the system could be as simple as fixing or replacing plumbing fixtures with water conserving fixtures, reducing shower time, washing dishes when the dish washer is full, avoid using a garbage disposal, using a wash machine with a suds saver feature, etc. The inspection of this sewage disposal system was based on a surface inspection of said system, and did not involve any excavation 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. Sincerely, Rod Eslinger Zoning Specialist