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N CD C - ) O c Cn ti O O cD N W EA O EA O O * O C CL Wisconsin Depaftment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 405107 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Elert, Gary Hudson Township 020- 1167 -40 -000 CST BM Elev: Insp. BM Elev: .ki.0"cription t�A A-4. z9• tq ial; C7O.D �7b.O� TANK INFORMATION V ELEVATION DATA to •e �I�'•+� /) TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic • QMD Benchmark OI •0 I Alt. BM Zlo Aeration Bldg. Sewer Holding St/Ht Inlet SVHt Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD 9t I ) � 6.q8 � . 52 Septic IL a ,S3 i � Pt-B ottom �,, 6 � 6, �� C17- � R0911 ly • Header /Man. Aeration IvV 6 •43 4 •� Holding Bot. Syst p ' (lo. % qT- 0 � , Il•Se t Final Grade PUMP /SIPHON INFORMATION Manufacturer D emand St Cover 2 AL xvtt /�•�} l 1 33 Model Numbe TDH Lift F ' ss System Head TDH Ft Fo:21 ength Dia. Dist. o e S L ABSORPTION SYSTEM jj BED/TRENCH Width t Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 30 rot -11:5 Z SETBACK SYSTEM TO P/L G IWELL LAKE/STREAM LEACHING Manuf r: INFORMATION ER OR Type Of System: t CHA 5 (� 6) Model Nu b2 u 1µO DISTRIBUTION SYSTEM • y 119' So Header /Manifold tl Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) CDI,� L Leng is cing 7 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of eeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil xx S *i Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 12"w, Inspection #2: / Location: 473 Country View Rd Hudson, WI 54016 (NW 1/4 SE 114 29 T29N R19WW)�Cou�ntry View Lot 4 Pa cel No: 29.29.19.10 1.) Alt BM Description = r v g -.� S' "�'""'" — t �/ � ! is 1 .� 5� 4U U(OFA— sewer length 2. Bldg - amount of cover = /e kia"'aU tat9a4 ►+ >r; 4 information. Plan revision Required? Yes No Use other side for additional ' SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division City 201 W. Washington Ave., P.O. Box 7162 . 5 -(- C.Vt consin Madison, WI 53707 - 7162 Address De artm nt of Commerce -zp -O Z, .0 /y0 Si 13 if (t-m f Sanitary Permit Application Sanitar Permit Num o In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑Check if Rdvision may be used for secondary purposes Privacy Law, s15. 1 m I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name Parcel Number 1 a nnni O v - — Property O er's Mailing Address MAI I Id L Property Location 1 i // ROIX COUNTY AJ S4 Sriy; S,Z T N, R /? City, State Zip Cod Pht�opNtttii&fl Lot Nil-- ' r Block Number Subdivision Name CSM Number II. Type of Building (check all that apply) Dory A or 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public /Commercial - Describe Use Rrownship ❑ State Owned ( Nearest Road y7 as �� J��f,� $ `x6s•�s III. Type of Permit: Check only one box on line A (numbering scheme for internal use). Complete line B if a licablie) A. 1 ❑ New 0 Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use S stem Tank Only Existing System B . El Check if Sanitary Permit Previously Issued Permit Number Date Issued l:V. Type of Permit: (Check all that apply) (numbering scheme is for internal use) -I(� 44 )4 Non - Pressurized In- Ground 21 El Mound 47 ❑ Sand Filter 50 ❑ Constructed Wedand 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area I nformat ion: Design Flow (gpd) Dispersal /°`yea Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required( (_43 Proposed ((_$ Rate(Gals. /Days /Sq.FtJ (Min./Inch) ,/ t ` J r Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank & 4 44 2� $ C � K �( Dosing Chamber VII. Respon sibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/ Number Business Phone Number •2Z Z � /� -77Z - 3z /� Plumber' Address (Street, City, State, Zip Code) 517 Z r" /fir &Jt l Z VIII. Coln /De artment Use Onl A pproved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) � ❑ Owner Given Initial Adverse . � Determination Co t Approv"emons ww t for r lk(.l r r��t Nt�M�S2At> - c. IM ta rn s X- C,5 � Ane�#��'"�c� Attach complete plans (to the County only) for the system on paper not Ien than 81/2 x 11 inches In size SBD -6398 (R. 05101) rrlrl��art��r��rr .r���.r�r����..��..�.r�.■i1 rrlrilri '�r'�'��i�i�lrll,�l�rrr�rrr�' �E��E���r�■ rrirlirfi, ,� /LIr►ilr�..�rrrr�r�rrrrr�r Ell r11HE li�i�WNW1011l111111 rrrrrNrrMOrrONE 1111111111111050 rmMMuMwMMMMMMMMMMMM MEN ■ rlrlr���lr�rlr��lrrr�rrl�� /�..�rrrr��� ■ rlrllrrr��r�rr�r��rrrr / /�rrl�r�rlL�rJ ■ rirllrr�rrrr��l l��Il�rrrrrrr��i�irrrrrr■ 011MINE���r�� l rrr�r� 1►�'i�r�lrrrrr�■ ■ rlrllrr��rr���Z ''��Irr ©'- ���� /rrrir��rr�■ ■11111 r���rr�l�lr�irir�����al ���r�r��rl��■ ■ rllu�rrrlr�rr�rriri��rrrr�lc�rrl���rr�■ ■ rlc�lr�rlrrrr� .srr!�r�r��rl��l�r��lrrrrr�r rrll �Ilr�r��r�/ r�r .,..r1r�"/��Il��r...��l�rrr�r■ ■ ri�llr���rr�r ■�I�Irllr��r���1��'lir�rr�r■ ■ r1�Ir���rr��r�Irlrlir�rr�r11�r11���rrr� ■rl lrr�r�rrll g - Irirllrrrrr1101101r11011rrNONE 0111MINMEMr1110113110 10 rrmoLr!IlrMEMNON ■llIfrr� r33Mii�il loll r��r����r�rrr r�11 oil oil go ��rr101100m i ■ No��r ■ ■r1E�lrr��rrrr� :r�r Ilr ■ ON ■r ■Ilmlr��! ec � rrlr��rlrMEMO rNONE rlr1No ■11�13�r�E�Jr r��r�r rrommo mon on rll1lrmE OMEN 0rl r�MENEM ME No oil Irrrrlrr111mr m a MEN Ell No Illl r m Ems 111 1000 �lIln�lrlrrrr __��� Ir�l��lr�eroll ! rrlr INNrl�rE111111r11 M,r Ems ME Em mm um ONE ME rrLI rli11r19 % WIBr rr m�rr rrr =r=SON no LEMON �M r�r��r�r►MEMEME� rOEM EME ME Timm Excavating 3128 20th Ave. Wilson, WI 54027 W3716 U.S. Hwy. 10, Maiden Rock, WI 54750.715- 647 -2311 • 1- 800 - 325 -8456 • FAX 715 - 647 -5181 2815 Riley Road, Portage, WI 53901 • 608 - 742 -4464. 1- 800 - 362 -7220 • FAX 608 - 742 -3769 u z 5z i 1 +4 .n �n 3 f / A{ E ' 1 i r. 0 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code //�� Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County X include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ///,7— Yo— Poo Please print - R viewed by Date Personal information you provide may be up6d ary p ( acy Law, s. 15.04 (1) (m)). Property Owner 40 Property Location EIV - a T- 6e� - 114 5,� 1/4 S T gel N R E (or)g� Properfy Owner's Mailing Address Lot # Block # I Subd. Name or CSM# City State ZIP Code Ph e r ❑City ❑ Village Town Nearest Road,��73 f i l7 [JL7 - d i✓ 1 ❑ New Construction Use: 9 Resident r d Code derived design flow rate ' 3-0 GPD Replacement ❑ Public or Comm scribe: /g Parent material W Al Flood Plain elevation if applicable General comments and recommendations: /4/24r,+ 1:5 ,U6 T Sff o w,,/ d - , I/ zrX e S T "& 6 ' 0¢ vlt « 9 4�,c R +-co Z�s , Tom 's r�'v�tc��r, -! ®.✓ tci,a s ,7v ti� 7'o p2.41 "v i:. 'I RZ,,ae�,e /qe.�26 , vr,*f X:oc.- -�Cv R .� v /¢ 4( OV�,.�E�i� ff/ —CsFP /.JFI�Tr'Zrl7`v/C Cls`il"r/v�Tt2s. D Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor 00 in. Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD)ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 - 5 ry A- 5` (2 ,a- S S� /o to Y�e 3 kt -- o,71 , Z- ! O Boring # ❑ Boring P1 ' [� Pit Ground surface elev. 7 /y 0 LT ft. Depth to limiting factor �2! g in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 D- "7 o / C .k- Z b awoq 19a 1 0,7 Z ZirS: f b� 0,9(ee 916, " Effluent #1 = BOD > 30 < 220 mg/L and TSS >N 150 mg/L ` Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) ignature CST Number o It A) hl, Al e,< 4 Z Address ate Evall#lon Conducted Telephone Number O /� 6 rko* O — go / try r Property Owner 4 ILK , il Parcel ID # DzO' 11t. 7 )" pO Page 2� of Boring # 0 Boring Pit Ground surface elev. b - 7z — ft. Depth to limiting factor l�G in. Soil Application ft; Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff# ?i S -� a2zv �ht ' r m<S —3 0 /( -- p�� ti Cti e 3 M},fle r r 7 2 Z 3 - 10k Boring # ❑ Boring ® Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application R Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Effh Z -1 2 � v C W 2 -to v 3 6,7 2 ❑ Boring # ❑ Boring Fit Ground surface elev. ft. Depth to limiting factor in. Soil Application F Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Effi ' Effluent #1 = BOD, > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 BOD, < 30 mg/L and TSS < 30 mg /L service you need assistance to access services c provider and employer. er. If n equal opportunity se p Y Y The Department of Commerce is a q pp ty P 2 lease contact the eed material in an alternate format, department at 608 - 266 -3151 or TTY 608 - 264 -8777. p P SBD -8330 (R.6/00) PR0J1:'.(.",I': PLAN ID # OWNER : T TAX PARCEL # µ /l6 7 0-000 MAILING ADDRE LEGAL DES( LOT It CO v.vT -'RIPTION. SUBDIVISION: FIRE#�7- DRAWING BY.JQHN N, NMRRAY (CST # AND MP# 12077) SCALE P' BOX 9 CL Wl 54004 PWNE (715) 948-2155 S E- DATE 7- 33 ,dl - 7 7' r - A- Po vx v Me A u9 t 1<44196C- 5 T S FA- Aerx I O I I r P '0 1 y 7L POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner CAit -Y /, ,_ Septic Tank Capacity 2` ( gal ❑ NA Permit # ) O Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A- - loo ❑ NA Number of Public Facility Units L� NA Pump Tank Capacity a l 'KNA Estimated flow (average) 3dro gal /day Pump Tank Manufacturer WNA Design flow (peak), (Estimated x 1.5) 43V gal /day Pump Manufacturer CONA Soil Application Rate O - '�f- al /day /ft2 Pump Model �NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit 0:!NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODd 530 mg /L 7f Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Co liform (geom etric mean) :510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: .MA Other: ❑ NA Other: PCNA *'Values typical for domestic wastewater and septic tank effluent. Other: CYNA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 0 month(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA Z i9year(s) Inspect um um controls & alarm At least once ever ❑ mo year(s) NA pump, pump y� ❑ year(sl Flush laterals and pressure test At least once ever ❑ mo year(s) JNA P y' ❑yearls) T' Other: At least once every: ❑ month(s) ❑ year(s) Other: "A 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 tank(s) 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 (Y 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 :512 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 tankls) 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 will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) 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 repaired the following measures have been, or, must be taken, to provide a code compliant replacement system: • A suitable replacement area has been evaluated and may be utilized for the location of a 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. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 POWTS MAINTAINER Name RCC T� Name Phone l 1 _ 1440 — I T Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 5--, C3WtK fit' �IAJ 6 DEP Phone Phone 4f5— , 3 — This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5411►, (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM � ll Owner/Buyer Y u ( ,2 ✓ T Mailing Address 13 4 ) 1) h� Property Address y7 CC (Verification required from Pl g Department for new construction) City /State l v4 sati (c, Parcel Identification Number D Z o — /14 7— y — oo 0 LEGAL DESCRIPTION Properly Location A, jg- ' /o, ­5 F '/4, Sec. 2 q , T Z- N -R Iq W, Town of !% Subdivision ? V eLJ Lot # Certified Survey Map # Volume , Page # Warranty Deed # !� 6 Volume 75 1 , Page # 207 Spec house ❑ yes 4 no Lot lines identifiable 0 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration — date. V PA - < SIGNATUR APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ✓ /� / j SIGNA OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed e o. v� - - g0 a I • f o b* N W; •w* rn a �o �z oo�; o ao IN = 1 z W . w I rn ; ITO X „E A� N WD 0 97' " W � N m Al -4 a N Z Z p C 226.00' I UTILITY EASEMENT o m - - 206.00 0 �- N 00 17 55 E 440.50' -- Z I w N00 17'55"E 796.50 TQ_.I H E_ P U 6 >! c w °f - 0 NTRY VIEW ROAD a w N00 55 "E 861.02' 33. 33. - - 265.00 I r_Y --- - - - - -- - - -- 66. ' I - — 264.9 -- 298.03' q '� t11 ti N � O C 0 x m o, ? A q C _ t0 f7 D cx q N .I �► Z to to 0 n W a � � O a N Z N W i - _; m Q m p b 'O O y m N m (A m N RIP 0 m m m ....:i a a x v m W 0 mm m ax. c Nn, m0 m Z Z CC c' m c z= 1. 97 , . 97' 2 9 8.03' 265.00' 284. ' S00° 17'55 " W 1076. 33' CACIP 00=M 4"Y f, S3TAT2 SAX OF WISCONSIN FORM I 1001 nas e�►oa aesawm rues wseo =+a acres WARRANTY DEED am r, TWO De Wa& betweea —A" S ; „a single _sen 5T %,A= aQ., Wi& r ..._sees .......... . .... r. ..._...... : .................... Recd for Record 19t .................... . ......................................... ........ , Grantee, !� OR Au A.DQ 9 6 t F ............................ cad ........ , WA[_A6..SUTYIY.QT6 ;�,p. AMR yak. D- 3. 9p. 0rty .......... ................. r , .._sees. f ............ GTa11tp, f -ar f WitnWeetk That the said Grantor, for a va:wble cowlideratiou....._ . ................................................................................. ........._....._............... ssruaN re -' -� eou" to Grantee the following described real estate in ..St,...CTQ lac .............. County, state of Wisconsin: Lot 4, Country View, in the Town of Hudson, a plat �! located in part of the Wx of the SEk and part of Tax Parcel No: .... . ........ the Sips of the SEk of Section 29, Township 29 North, Range 19 West. i O i i is not This ...... .......... homestead property. (14 (is not) Together with all and singular the hereditament, and appurtenances thereunto belonging; And..... $ rantg.;, ... S. M.1,--- 14WAX......................... ........... . ...... ... .................... ................... --- -.............. warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and protective covenants or restrictions of record, If any, and will warrant and defend the same. Dated this ......... ................................. day of .......... ... August -- ....................................... 19.86. -• ................ ....................... •• -•• --- -..........._.......(SEAL) - -- ......... !J G.!...... -j`- ....... .....(SEAL) SAM E. MILLER- ......... ...... .................................................. .................................. ........................... ................................................... (SEAL) ...... . ..... ........................................... - - - --- .(SEAL) � ..................................................... ........ ..................................... AUTBBNTICA ?ION ACHNOWLBDOMBNT i __ STATE OF WISCONSIN .__..._...._.-----_._.._---- ------------------- County. authenticated thin _...._.. of---- ------------- ---- - - - --- It Personally came before me this - - -1 S!4_ -- -day of ................................................... ............................. -- • ... . . . . .. .............August....., 19ft .... the above named ......................... ller----------------------------- ------ . ........................ ..................... . . . . .. sees._..----- - - - -•- ._._.....----•------------•--------._................._.....----------------•--- TITLZ: MEMBER STATE BAR OF WISCONSIN (If not, ----------------------------------------------------------- . ...................................... ........................................ authorized by # 706.06, Wis. Stats.) to me known *'* the person ............ who executed the f n ^ tinment and acknowledge the samr. TMIG INT.AJMENT WAS DRAMD SY Q TA r Y j Heywood, Cari, Murray b Sherburne r�lr, •------ ----- •---------•------•-- - - ---- .� 6”' M --------------••----•------...--••--•-•- bq Doha : �ieywood - V. . --- •-- •-- --------- ....................... F•.0.- li�X. -Z29, $ud r JAM .._._..5►4Q1b ........... Notary 1C'ao ...............Cnunty. Wis. (Signatures may be aatUnticated or acknowledged. Both My Commits Qent. (if not, state expiration w Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 11 TOWNSHIP SEC. a7 T 2 7�N -R ADDRESS % / J r ST. CROIX COUNTY, WISCONSIN SUBDIVISIO V 4 44) LOT "1 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I-LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM J b f �ti n 4; I 5 t i INDICATE NORTH..ARR W 11 r� BENCHMARK: Describe the vertical reference point used . W l o e„4,Y j i I �1 Elevation of vertical reference point: • 0 Proposed slope at site: // "'.-* PUMP CHAMBER i 1 Manufacturer / Liquid Capacity: Pump Model: G 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, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Cam, � ��,:,, ( Trench: � J � Width: Len the 7 r, Number of Lines: '"� Area Built:(. Fill depth to top of pipe: 7 Number of feet from nearest property line: Front, Side, O Rear,0 It Number of feet from well: m(n Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: $ottom 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, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Parcel #: 020 - 1167 -40 -000 02/04/2005 07:48 AM PAGE 1 OF 1 Alt. Parcel M 29.29.19.1035 020 - TOWN OF HUDSON Current X, CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * ELERT, GARY A & KATHLEEN J GARY A & KATHLEEN J ELERT 1378 HILLTOP RIDGE HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 473 COUNTRY VIEW RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.530 Plat: 0211 - COUNTRY VIEW SEC 29 T29N R1 9W W1/2 -SE1 /4 LOT 4 - PLAT Block/Condo Bldg: LOT 4 OF COUNTRY VIEW Tract(s): (Sec- Twn -Rng 401/4 1601/4) 29- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 751/201 07/23/1997 745/188 07/23/1997 687/386 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 49075 256,900 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.530 32,700 166,000 198,700 NO Totals for 2004: General Property 2.530 32,700 166,000 198,700 Woodland 0.000 0 0 Totals for 2003: General Property 2.530 32,700 166,000 198,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M 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 1 DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMA RELATIONS PRIVATE SEWAGE SYSTEMS DIVISIOf P.O: BOX 7969 BUREAU OF PLUMBIN( MADISOI,,W,l 53707 T Ri CONVENTIONAL 1:1 ALTERNATIVE State Plenl. D. Number El Holding Tank ❑ In- Ground Pressure El Mound (If assigned) N AME J Rt 1, 282, Hudson, WI 54022 NSPEC ND E /FD BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. RE . PT. EFLEV.. CST REF. PT. ELEV. SW SE Section 29 T29N -R19W, Town of Hudson,Lot#4,Country View Name of Plumber: J MPIMPRSW N,, Cnunty. Sanitary Permit Number: Doug Strohbeen 5432 St. Croix 79135 SEPTIC TAN /HOLDING TANK: 111F 0 MANUFACTURER LIQUID CAPACI TY . TANK INLET ELEV. TANK OUTLET ELEV_ WARNING LABEL LOCKING COVER Q PRO IDED PROVIDED: �� YES ❑NO DYES ❑NO BEDDING: VENT CIA, : VENT MATT HIGH WATER NUMBER OF ROAD: PROPERTY JWFLL JBIRL VENT TO FRESE Ca FEET FROM f'J ALARM LINE _ AIR INLET: f�-�g / S — M YES ❑NO pC S ONO NEAREST --j !6 !.7 �.l DOSING CHAMBER: MANUFACTURER 71 Y NG LIOU ID CAPACITY PUMP MODEL PUMP;SIPHON MANUF ACTUREII WARNING LABEL LOCKING COVER PROV IDED. PROVIDED: ES El NO E] YES ❑NO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING VENT TO FRESF (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST -��► SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I I N(,TH 1 111A1,11 7EH MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until F the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH NO. OF DISTR PIPE PA(;IN(� COVEt .INSIDE DIA SPITS LIQUID DIMEN / THEN 'FK� �� PIT DEPTH [?IMEN>S10NS // J GRAVEL DEPTH FILL DEPTH DISTR PIPE UISTH PIPE DISTR.PIP MATERIAL NO UI$TH NUMBER O PROPERTY WELL. BUILDING VENT TO FRESt BELOW PIPE ABOVE COVER ELEV FT EL NU PIPES LINE 'J BUILDING AI NL FEET FROM MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES NO SOIL COVER TEXTURE 1 1 1 1HIIANINT MARKERS OBSEHVATION WELLS 1 YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVIII TRENCH BED 7F� T OPSOIL SOUDFD SEEDED MULCHED CENTER EDGES F-1 YES. ❑NO ❑YES ONO DYES 1:1 NO PRESS URIZE DISTRIBUTION SYSTEM: _ BED /TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION ELEV, '. ELEV. DIA ELEV. PIPES DIA E' ANI3 ' DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS EYES 0 N ❑Y ES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS NUMBER OF PROPERTY WELL: BUILDING: FEE NEA FRAM LINE DYES 1:1 NO [:]YES ❑NO RES - Sketch System on Retain in county file for audit. Reverse Side. SI NAT E: TITLE. DILHR SBD 6710 (R. 01/82) F w coneln APPLICATION FOR SANITARY PERMIT D 1 L H R (PLB 67) OUNTY RRTmEIITOF UNIFORM SANITARY PERMIT # MEME� 6 HURIRn RELRT10nS — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /zx 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS '54 W M l I Id'r R P d 5 q PROPERTY LOCATION C+*,. Vfti -fr@E: 5GJ1 /45 1/4, S aq , T0? N, R 9 E (or W TOWN OF: u 0% LOT NUMBER I BLOCK NUMBER ISUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER AI 14 r TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench U Seepage Pit ❑ Holding Tank ❑ System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity AOO Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: V- IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: [__1 Mound F In-Ground Pressure ,/i Total *of Prefab. Site Steel Fiberglass Plastic IV ,�}+. Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump /Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): /__ 3 1p Private ❑ Joint ❑ Public the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. 3me of Plumber (Print): Sign ture: MP /MPRSW No.: Phone Number: mber'l Address: Name of Designer: COUNTY /DEPARTMENT USE ONLY Inature of Issuing Agent: Fee: Date: El Disapproved a. / .� r � �` Q J ❑ Owner Given Initial IW d 0 Approved Adverse Determination aso or ap va ate course(s) of Action Available: SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber �T INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.) ; 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. I TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. 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. Owner of Property .5A I2 9 4 -Xle- Location of Property 5 w_k S E , Section ay , T a N - It Township Mailing Address 0 - 111-- / u �S , k - 1 Subdivision Name Cak K 1': y Lot Number 4?t Previous Owner of Property �, ��✓ /'v� Total Size of Parcel 1 02 0 Date Parcel was Created _ •S'- Are all corners and lot lines identifiable? �_ Yes No Is this property being developed for resale (spec house) ? _ Yes No Volume �o and Page Number 3 g G as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING 1. Warranty Deed Land Contract .e-. .•Other recordings filed with the Register of Deeds Office ' 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 the Certified Survey Map shall also be required. -------------------------------------------- PROPERTY OWNER CERTIFICATION I (We) centi.6y that att 6tatement6 on thiA 6otm ane true to the beet o6 my (ouA) knowP..edge; that 1 (we) am (aAe) the owneA (6) o6 the ptopehty d eb cAtbed in th•iA .in6otmati.on 6o4m, by viAtue o6 a wattanty deed Aecotded in the 066.ice o6 the County Regic6teA o 6 Deede a6 Document No. 3 q 3o Z ; and that I (we) pte6entfy own the pxopo6ed 6-cte bon the 6ew age pod byb tem (oA I (we) have obtained an m ement, to tun with the above dedcA bed ptopehty, Got the con6t4ucti,on o 6 aid 6y6tem, and the Game ha6 been duty %ecokded in the 066.iee o6 the County RegiAteA o6 Deed6, a6 Document No. 39 3a 7 Z— ) . v9L ► r�, ;f fib DOCNMiNT NO, MATS BU OF WISOONSIN FORM 11 11l11ill i TMs e.•ca assaavo sat ascomma DATA LAND CONTRACT 3�9307i: t e» W 1 � tt ACT NaACrtol•s) �l 49"Tms OFFICE r+ . b said Retires... latlwth .Ac...1hx11a.._.�t. xldtax. ! ST. C110M CO., AMR. ........ "LWIL-IN ARa ........................................... ............................... Roe d. F r Nuwfd 06 7th wReRlter sae er mme) aai... . Sa..S�..M1.111M ......... ...... ....�~Vesaor, ri , 3y of May AO. 1914 ...... .... . .... .. .. ................... ............ . " c t 8 : 30 A . Vander aft and agren 6o oaney to Purehawr � whaithe go* of mad fun ). Par. twumm of Will sssteaet by Purchaser, the following property, together with the rests. p' UN tliWNU said 06W appnsteasnt crtaatts (all ealled the "Property"), ha. ......... --. tG.X XI MLJL ... ............................... Cosaty. State of Wiseansta: asruaN TO US Southwest Quarter of the Southeast Quarter and (%R,:, 4~4w- A three (3) acres off the South side of the Northwest - ` -- - - - -- - - =- Quartet of the Southeast Quarter, all in Section 29 North, Tonsship 29 north, Range 19 West. Tax Paroe! Na This . ....... .i-s..nc homestead property. 5709 Hyland court Drive, aleemis18ron, Purchaser agrees to purchase the Property and to pay to Vendor stMinneaot ..55432..e1Q.jiaoata..tAzrell tee tax. of 0A4, 500. 00 ........ ............................... in the following manner: (a) $5,00LAQ .......................... ..... at the ezaeution of this Contract; and (b) the balance of $ 69,500.00 .................... together with interest from daft hereof on the balance outstanding from time to time at the rate of...... ... 13% ............. per seat per esasas Gs P" It fu1. fellows: Payments of principal: 6/6/84 $5,000 3/6/86 $5,562.50 In addition, the purchaser will on December 6th 9/6/84 $10,000 6/6/86 $5,562.50 of each year during the term of this contract pay 12/6/84 $10,000 9/6/86 $5,562.50 interest at the above specified rate on the balance 3/6/85 $5,562.50 12/6/86 $5,562.50 of principal from time to time outstanding. If 6/6/85 $5,562.50 the purchaser makes his final payment before the 9/6/85 $5,562.50 required date all interest accrued to the date on 12/6/85 $5,562.50 which payment is made will be paid on that date. Provided, however, the entire outstanding balance shall be paid in full on or before the.. .6t11 ............... day of ..............CL.........., 111... ( the maturity date). Following any default in payment, interest shall accrue at the rate of ..1.3..... % per annum on the eatin asroest is default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the so** Pri"44 )• No amount of principal or interest may be prepaid except as std a V. r+sies t ed - ewdsr.•ne*«e-�� � a7e�irly -to ends i a•meunts attieieaeta ad"d".eata mail_ M — Woad. ina ms�wc�a .aWt �srtaiumaaxl�eadae..Ta ti► Yandoc..s o .t.- iipplp ►�woc�se.sl,...miei— _ . o. «.w,+«i -lip %he UwAss Seep" "et femme... aaaeaeawiwtaawd_ iawroaw- wY1 .i►Jelosited.iwto.ea�wew�.iw�eF �rwiw- awewu�but.si+eil- met- beas•�ateaees sales ethers:.- s.,�s: ad.tycJats. f {p a �� Payments shall he appl ie*iwi. �n� e Mwj.,,i , .6,, Any amount may be prepaid without premium or :ee upon principal at any time after. _..lanuar.y..1........ thea�aiay. aa;sepiaiaoea& yr+wipaLaiihwaLpam M=;W rr& rood".* , In the event of any prepa)-ment, this contract shall not he treated a+ in default with respect to payment so tong as the unpaid balance of prmcipul, and interest (and in sucii case accruing interest from month to month shall be treated as unpaid principal) is leas than the amount that said indebtedness would l,a•re been had the monthly payments been made as first specified ahe,ve; provuUed that monthly payments Shall be continued in the event of credit of any proceeds of ineurt ece or condemn .,t,on, the condemned premises being thereafter excludes herei roro. Purchaser •fates that Purchwer is satisfied with the title u shown by the title evidence submitted to Purchaser for examination except: none. In the event of partial condemnation. the inability of the Vendor to convey full title shrill not constitute a default on' t:ne part of the Vendor; but the Purchaser shall be entitled to the entire amount of the condemnation award. Purchaser arree. t„ pr,t the rest rri ,njture title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor tint;; t!„ full pnrcb :, -e price is paid. H G H Y ST C- 105 r r • 9 r' • SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County C OWNER /BUYER s,4Z2j .0 i' /.r ROUTE /BOX NUMBER agy _ *' 2-Cd Z Fire Number CITY / STATE #t, Sort w ZIP s7O I �o PROPERTY LOCATION: W k, SE k, Sectio T R _ W, / Town of #e4 _S O rt St. Croix County, Subdivision Co - r✓ ` i, Lot number ,", Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con - sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper What you put into the system can affect the function of the septic tank as a treat - ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% 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 veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. • 3 I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with t the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNE DATE 4 - / U St. Croix County Zoning Office P.O. Box 98. Hammond, WI 54015 715- 796 -2239 or 715- 425 -8363 Sign, date and return to above address. 0 v r N S � S m N F C r: 6 5 N 0 N G N W c CD W CD c 3 0 N CD 0. cD A n n cD 0 7 9 ? o W 0 . o 3 c0ww o c o '�`� w �0 ?CD' - 0 aCDCD °o la a ° CDCn m ..Cn o � f O�r.f 0 :E CD m cD A 0 OD CO CD O CD Q ID O 0 O0 CD CD OD A C.) > > (O 0 N 0 9 3 o c 0 `< C_a - M C ww� c °�Qrm n ° oc� CA CD 7 ° CD o CD O O W A c D C n CD CO c Ch 0 Q C — N, O n D (D� o ,�aQO w O elm oCnCD vavw C w i �f c p �cQ' Q a Cn CD� v m CD g -1 • C ° m o CL C D 3 a » CA a a =a °who0 m � �"� ° cw -� a m ? a(a w ?A�' ac n g cD f CA v 3 CD O 6 'A c m , cDC> 0 avm v � XI m CD 0 ° � emu, 0 1 o a co A> > Q CAo -_ -Co a -+ A. 0 CD M CO a0 f C c C nw o m O n 0 m cr OL CO . = �co �(D (a O �° c m° 3 n ao pca a c N o ' € CL o tv -. CD ?CD ° s CL O CD woc .;:. a- — m 0 3 e ry 3 a CD ° O 3 CD Cn 3a o< Co w CD '� s 0 1 O DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115 P.O. MADISON WI 3 69 Hl' AN R9LATIONS • (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP /m4offetp*H -FY: LOT NO.:BLK. NO.: SUBDIVISION NAME: cy ' /U "/a z /T270/9 0 COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: S Cro,`,c A . 4 Ai M , - Ile, B iooIr j. USE DATES OBSERVA IONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PR FI E DES RI TI NS: R O ATION TESTS: Residence -3 �yi /.4 L<New ❑Replace so • �,� P ,C3>t O Z- RATING: S= Site suitable for system U= Site unsuitable for system ' – /0 -1 CONVENTIONAL: MOUND: PRESSURE: rYSTEM N - FILLHOLDING TANK: RECOMMENDED SYSTEM:(optiona ) ®S ❑U ®S ❑U ®S ❑U ❑ S DU I ❑ S ®U I CuwG. -f ,IS- If Percolation Tests are NOT required re DESIGN RATE: 4 I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: �/ II Floodplain, indicate Fl elev 11h PRYFIV DESCRIPTIONS BORING TOTALS ELEVATION DEPTH TO ROUNDWATER -F ES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH44. OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 7 t f t 0' r X81 S S 7 RA ge S IV B- q .Zarce �d ' , 3 1315/ h B- 3 r� i/ /� e— ro 8 15 ) /i As S , .Z h S V le B- /// W40,ge 7 1 0 ` 51 A3 Akth RA-V YIN,, s B- S' �,D ' !ll• 1' /Lla e, 0 A 7 bla r /s -5 X B_ PERCOLATION TESTS L-3 DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES FPdGd --FES AFTER SWELLING INTERVAL -MIN. PERIOD t PERIOD 2 PER PER INCH .S' o 3 ' wlo 3 L 3 o 6 3 P - - P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dim sZltleble soil areas. Indicate scale or distances. Describe what are the hori- �I zontal and vertical elevation reference points and show their location o purr �Shir he surface elevation at all borings and the direction and percent of land slope. \i SYSTEM ELEVATION 112. , � 1 __ _ F_4 _ _ r -- _ _ _a _ LiJ F s. �\ I i P _,_ -- 7r_.,�JN _._ p ai s I t ___ -0 (' I � � ? E i I r It e t 3 p, E � o ek___ ._._ S lC.#_._. �- >D I € u dot /•9 ! �il� �fs7Rl. I INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 5395 1 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The Use sectioa rnusi: clearly indicate whether this is a residence or commercial project; 3, MAXIsMUM number of bedrooms or commercial use planned; 4. Is thk a nevv or replacement syster 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTH - SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6 . PLEASE us the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A sexparste sheet may he used if desired; S. Male snare your benchmark and vertical elevation reference point are clearly shown, and are permanent; ;t. complete all appmpl iate boxes as to dates, names, addresses, flood (slain data, percolation test exemp- tiorl, J appropriate; 10, If ',reformation (such as flood plain, elevat:ior7) does not apply, place N,A, in the appropriate box; 1 i . Sion i he form and place your current address and your certification number; 12, Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOC:i;L AUTHORITY WITHIN 30 GAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil 1 3cparates and Textures Other Symbols st — Stomm (ov"r r 10"l BR - Bedrock (rsr3 Coo 1)ie {3 - 1d ") SS Sandstone gr .- Gravel (under 3 ") LS — Limesione s __ Sarld t-IGV1 High Groundwater cs - coalt;I Sand Perc Pt- -oIation Bate rYi!?f lril n? &i rir:3 Vv -- ,4 E- ine <� €ro Bich -� t3uiic3I I I; ..- Lo my Sam! greater sl . _. Sandy L.oarn < Le ss ss r� i -- Li32m i Brl _._ B t (Y -A '? "sd - Sill Loann BI Black si Silt G — r l y CI — Clay ,-cast Y r 3k sd Sa .�'!y Clay Loan) R - led s i e __ silty clay Loam mot N1o1 '0S sc - Sawly cl,'ly w - ojt:l< i S! t:y . °y r Ic inr f irst Upi"c7 CC l >t _ r'fsat rxsrs'r — nfa €sy, ,re :churn pro IT1ir'ten WAIL - High w^ ,itor le,ued, 'iX gentiral soil texfines L;' f jc ' vl alet for licterd waste disposal BM - Bench Marl: VRP -- Vertical Refewnce Point TO CI E OWNER: , � I b O � o £ j r t L I gi N a f.J ` r .p 0 i V*% I _ N N r , 9 _ `� Jr ("\ P 3 LA -0 fi o P kft A-. ICI s 0 -A o o f N O N T -d o P T a s . f ST. CROIX COUNTY - 5 WISCONSIN ZONING OFFICE L yam, 34 796 -2239 (HAMMOND) 7 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 May 7, 1986 Mr. Sam Miller Rt. 1, Box 282 Hudson WI 54016 The house located in the SW-4 of the SE of Section 29, T29N -R19W, Town of Hudson, Lot #4, Country View, is a three bedroom home. The sewer system on this property is designed and installed for a three bedroom home also. Should you have any questions, please feel free to contact this office. Sincerely, Harold C. Barber Zoning Administrator mj