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HomeMy WebLinkAbout020-1168-30-000 °/ 3 3 3 rD CD N A A I 3 - 3 �. cn w S S 0 O o cn = o < < C O A N J N d N NOs (p ( D O O 7 (r> rn > n (D W cn N O (0 A c O G7 rn m co :3 o N N N un N 0) (n R h Q Q O ° O w V C.0 5 c c c n cr a a� SR N O ° O y N n N N n ! �"' O w D C7 d (D W m s; v D C o s:• < D a o In G Ln s„ (D CO fl. Ui M cn (O (O O lot O O O R O A W O oD 0) Z N o oN ° o o° o m o o a ° 00 rn° ° O O 9 N CL CD � O O a= 0 0 0= !�i • c (° V N N N v O CL CL ' N N N p j A N n� - 0 a D 0 O D? 0 h c m m = CD U, N C y o v 3 °' o (D A p z 5 z z Co Z Q D ° D _D (D (� A W N T d 3 �I 3 N W (n N N o - iz< x� o (D @ m m !""�• <. N ADO m Cn �N ° o na n S. m o a CD o N ° v 3 ci -° (D N (p (O Z ( ° .°: N 0 o N �b q tU 3 D a a a Z m m F (n rn O .. I � ^: co ° cn -i C N N o m N K (D ((D Q (D Z o CL 3 , 3 A CD 00 '. 00 » I Z o (O 3 N m � m o m N3 d v = m D 3 ° v D D O 57 O N X Cl (p Q O 4 M CD a:) ° i ° : 7- x °' r °' (a N O (D C Ul O G D N o c (D d m a R c � Cn n °' O O O. 3 N d a =r OSN (D z pj d O CD i W =3 �(�� 00 ° 00.0 O ° mmE Q� m° _a m =ro Q Q V (D :3 N ° 7 O O (Oi N 3 d (D � - cn o 6 S S 7 (D O N CO, (D O `y O N N 3 p CCDD (0 (O �N dN O d 7 :3 O (D O C N O cn � Q Qm ° o CD m ° ° (D 3 ° o cn 0 0 I o o ± ti CD (D 'c rn 0 O ti o g 0 g COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 -3121 800 -962-5227 ST. CROIX ZONING REPORT NO.S 03035/01 PAGE 1 ST. CROIX COUNTY REPORT DATES 3/27/91 COURTHOUSE DATE RECEIVED* 3/26/91 ` HUDSON, WI 54016 ATTNS THOMAS C. NELSON OWNERS David R 6 Rebecca L Swanson i R LOCATIONS 1054 Cottonwood Rd., Hudson COLLECTORS Mi. ,enk ins ti SOURCE OF SAMPLES Kitchen faucet COLIFORMIS 0 /100 ml Cf INTERPRETATION'# Bacteriologically SAFE NITRATE -NS 2 ppm Above 10 ppe exceeds the recommended Public Drinking Water Standard. COliform Bacteria /100 ml Nitrate- Nitrogen, mg/L LAB TECHNICIANS Pam Gain WI Approved Lab No. 19 .OF %NDEPEN 1, O �A V D = g t Means "LESS THAN" Detectable Level Approved by'. �� PROFESSIONAL LABORATORY SERVICES SINCE 1952 COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 -3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.#+ 02967/01 PAGE i ST. CROIX COUNTY REPORT DATE: 3/26/91 COURTHOUSE DATE RECEIVED#+ 3 /25/91 HUDSON, WI 54016 ATTN. THOMAS C. NELSON OWNERS Keith Maxwell LOCATION: 372 Milwaukee Rd.. River Falls COLLECTOR: M. Jenkins SOURCE OF SAMPLES Kitchen faucet COLIFORM: 0 INTEW l ;AFE NITRATE / (� recommended Public *NOTE: Te -446 Coliform Bacteria /100 ml Nitrate - Nitrogen, mg/L LAB TECHNICIAN: Pam Gane WI Approved Lab No. 19 DEVEA A A V D A < Means "LESS THAN" Detectable Level Approved by#+ PROFESSIONAL LABORATORY SERVICES SINCE 1952 I I _ r COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 �4,j 715- 962 -3121 800 - 962 - 5227 P ST. CROIX ZONING REPORT NO.S 02967/01 PAGE i ST. CROIX COJNTY REPORT DATE: 3/26/91 CO1RTHOLISE DATE RECEIVED: 3 /25/91 HUDSON, WI 54016 ATTNS THOMAS C. NELSON p OWNERS Keith Maxwell k LOCATIONS 372 Milwaukee Rd., River FaLLs COLLECTORS Mo Jenkins SOURCE OF SAMPLES Kitchen faucet COLIFORMS 0 /100 mi , 4 a INTERPRETATIONS ,BacteriotogicatLy SAFE l NITRATE -NS 3,;pp>a live } 10 ppm exceeds the recommended Public Drinking Water Standard. ' *NOTES Test may by invalid� sample was ol.d. Coliform Bacteria /100 ml Nitrate - Nitrogen, mg/L LAB TECHNICIANS Pam Gane WI Approved Lab No. 19 '`. 0, A DEDEN. O G 9 v s 5 A < Means "LESS THAN" Detectable Level Approved by! �� o PROFtSSIONAL LABORATORY SERVICES SINCE 1952 f ST. CROIX COUNTY ZONING S OFFICE 9 4th / J j� Hudson, WI 54016 Telephone - (715)386 -4680 The St. Croix Co. Zoning Office offers the service of septic and water inspection to Lending Institution, Realty Firms, and private individuals. COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN BE LOCATED. Please provide the following information, enclose appropriate fee made payable to ST. CROIX CO. ZONING, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING -------------------------------- FEE:$ 25.00 (For nitrates and coliform bacteria) WATER TESTING -------------------------------- FEE:$175.00 (VOC'S) SEPTIC SYSTEM INSPECTION --------------------- FEE:$ 25.00 L"-- PROPERTY OWNERS NAME: D6 i/ 1� K �' 2 CC C— S t i.� /4 to 5 O N PROPERTY OWNERS ADDRESS: 5 CITY: c/NSd/v Legal Desc f iption 1/4, 1/4, Sec. , T N -R 90 W, Town of AJ , Lot No. Subdivision �i4 NC h FIRE NO. e)� LOCK BOX NO. �— Color of hous p,V of R ealty sign ?_ Firm: �- PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i.e., COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. S N Firm or individual requesting services: -u , J vcf A-i^J 5 � Telephone No. 3 p REPO TO BE SENT TO: A t/c' 50 i 5 o i 6 -- r s t S Fiiv ,v M r tc# &,4 ,� K CLOSING DATE • HUO(svN Signature: c i ST. CROIX COUNTY ` WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, W154016 (715) 386 -4680 Mar. 22, 1991 Judith Kaiser Mid America Bank, Hudson 600 2nd St. Hudson, WI 54016 Dear Ms. Kaiser: An inspection of the septic system on the property of David & Rebecca Swanson, located at 1054 Melwauke Rd., River Falls, WI was conducted on March 21, 1991. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Since ely, 9 N Mary J in Assistant Zoning Administrator cj 1 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y- Safety and Buildings Division Count St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) PermitNo.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 3 Permit Holder's Name: ❑ City ❑ Village ❑ T n of: State Plan ID No.: Swanson, Rebecca Hudson Township CST BM Elev. Insp. BM Elev.: BM Descriptio : Parcel Tax No.: 9'c k ;-k 020- 1168 -30 -000 TANK INFORMATION ELEVATION i dATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic C I Benchmark /l 70 , �O Dosin Alt. BM Aeration Bldg. Sewer�� Holding St / Ht Inlet z TANK SETBACK INFORMATION St/ Ht Outlet Ventto TANK TO P / L WELL tLD Air Intake ROAD Dt Inlet Septic �1 p NA Dt Bottom ,�- Dosi ng b S NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Ito Manufacturer De a St cover Or ode! Number a,' PM TDH Lift -�� Friction System , Z0.0Ft i Loss 11241 mead Forcemain Length J�v I Dia. 2' Dist. To well SOIL ABSORPTION SYSTEM 9ED TREN Width Length N Of s PIT No. Of Pits Inside Dia. Liquid Depth DIME N DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Mn� urea INFORMATION Type of f 7! W ' r OR UNIT DISTRIBUTION ° e Number: System: 1J• ( — DISTRIBUTION SYSTEM Header/Manifold Distribution P' x Hole Size �xHole Spacing Vent To Air Intake Length Dia. gth Dia. pacin �(to 9 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over 7Bed h Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Trench Edges Topsoil E] Yes E] No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #l:D9 / /IF / Inspection #2• Location: 1054 1054 Cottonwood Drive, Hudson, WI 54016 (E 1 1/ 12 T29N R20W - 1229201041 Rang - 1.) Alt BM Description = n/ //- 2.) Bldg sewer length = 16 - - amount of cover = ? �`�`"`�( �`t`� / 3 } Sys- lac W, .f 1.u4,c I a.-,,P 3 = t !. I = �9.�� g. b = lem 4►e,� '�,v VV, Plan revision required? e ❑ No Use other side fQr additiQ or on y e, Qt �j ,,1�- � A SBD fi7 (R.3/97) �jca� Datep �-( t 't.... -�pc in I CJ j2�va3tb[el"— '.(��w ert. F[a v a.. , " L.-� ---A ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: _ ... gg B � r ......_.. __._ _�� k ._.__ ._.. ..... _.. A . ,�....,,m _.,®. y<«�.. ...®...�...: � I A....,�.- ».�...,«ttm.m..�... t �..« q..,. .,..�- «�,.».m.....<s ».5�.....a. m ^. «^#- ,.�.^.. (Y'37 ..y� .,�.�.,.� -• S E t ( € W " d f Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave. �� seonsin See reverse side for instructions for completing this application PO Box 7302 Personal information you provide may be used for secondan purposes Madison, WI 53707 -730.^ Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if r state owner Attach com fete plans (to the county copy only) for the St`ie rt off er not less than 8 - 1/2 x I 1 inches in size. Coun State San itary �ermit Number ❑ ck if "t visiFin. o;p o application State Plan 1. D. Number r I. Application Information - Please Print all Information Location: Pro pe Owner Name Property Location 1/4 N,F—1 /4• S J;LTa ,N, o W Property Owner's Mailing Address \ Lot Number Block Number ST CNUIx City, State Zip Code h Subdiv ion Name or CSM Number II Type of Building: (check one) �:_� .__ ❑ City 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Village 31jown of ❑ Public /Commercial (describe use): ❑ State -owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road 1 0 57 V A) 1. 'New System JkReplacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) System Tank Only Existing System Q "116 - B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued 2.29 , 2 -O 1 IV. Type of POWT System: (Check all that apply) - ,FLNon- pressurized In- ground ❑ Mound Sand Filter ❑ Constructed Wetland ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Drip res g P Line g g ❑ At -grade 3)3 x. 4-Z .5v r i ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V Dispersal/Treatment Area Information: 7 — 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation J-00 - i e-j a .0 7 VI Tank Capac in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Y P Information Gallons Gallons Tanks `� Con- Con- glass New Existing A , crete structed Tanks Tanks ❑ ❑ ❑ ❑ p- L 8 �. 04 1 I Responsibility Statement I, the undersigned, assume responsibility fer installation of the POWTS sho wLwn the attached plans. Plumber's Namt (pr t) Plumber's igna re (nos ps): M /MPRS No. Business Phone Number �Rkkv baA Plumber's Address (Street, City, S e ip Code) VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse S harge Fee) Determination `+1' c 3- zWD f Approval /Reasons for Disapproval: - IX. Conditions o ro pp roval: * Sy s`',. r., pd��/Qa�.e/,�. � `- ,,,tiorSS1>< setX A ^- ,e,QSWct� - cdMs +t s 44eAAA- t, SBD -6398 (R. 07/00) . N ✓ �a q - its qo r _ q 8, 70 13 5 0 3n3'� s << y X, UO� X - /Oo Fl-:I -0 To y i as � � �. . _ z . „� h 1 /. � E '� l ..'_: t �\ \„� � � -, ;,_ i r `�__ -_ `-�- _� . 1 v .�� ', ; 'Mscansh Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 '�ivision of Safety and Buildings in accordance with Comm 85, Wis. Adm . Code minty St. Croix Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must Include, but not limited to: vertical and horizontal referencepoint (BM), direction and Parcel I.D. 020 - 1168 -30 -000 percent slope, scale or dimensions, north arrow, andlocation anCdistance to nearest road. Please print a)Y {Aforrrtaffon. Reviewed by Date Personal information you provide may be u r`aeaOndary urpAm (Priv sJt5.04 (1) (m)). Prey Owner Property Location Rebecc a J ll, I©o Lot SE 114 NE 1/4 S 7 T 29 N R 19 fo W Property Owner's Mailing Address ! -' ` i) Block # Subd. Name or CSM# 1054 Cottonwood Dr. O' ST CROIX �4., na I Ranchwood Cit State Zip I pe E City ❑ Village W Town Nearest Road Hudson, WI 54016 - :'%5)386- 50�Z %c Hudson Cottonwood Dr. ❑ New Construction Use: ® Residential / Num y +oin� , Code derived design Row rate 600 GPD ® Replacement ❑ Public or comimercial - Describe: Parent material o n .wa GYn __ Flood Plain elevation if applicable _ R• General commends and recommendations. trenches 4.00 below grade, spaced to code. Area of B- 3,trench to be 60 from original grade, ❑ spring , I Boring # © Pit Ground surface elev. 100.20 Depth to limiting factor +92" rrn. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cord. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -14 10 r3 s' 2 2 14 -38 10yr4 /4 none sil 3 38-921 7.5yr4/4 none ms Osq ml na QS.�� 5 1 [-2] Boring # ❑ Boring Pit Ground surface eiev. 102.50 R_ Depth to limiting factor +90" in. Soil icauon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots I GPD/ff in. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. 'Elf #1 `Eff#2 1 -6 10 r3/3 none 1 2f .5 .8 2 -28 10yr4 /4 none sil 2mshk 3 28 -60 7.5yr4/4 none is 06cl mvfr C1W na .7 4 0 -9 bo ! d _ 16 . Effluent #1 = BOD > 30 :5 220 mg/L and TSS >30 150 mg/L #2 = B < 30 mg/L and TSS _< 30 mg/L CST Name (Please Print) Signature . CST Number Ga 02298 Add Date E illation Telephone Number 1554 200th. ave., New Richmond, WI. 54017 8 -30 -2000 715 246 -6200 Property owner Rebecca Swanson Paroel ID # 020 - 1168 -30 -000 Page 2 of 3 ❑ Boring # ❑ Boring 3 ® pit Ground surface elev. -- —5Oft. Depth to limiting factor +110 in. Soil &pokstlon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots MIN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 1 0 -6 10 r3 2 6 -60 10 r4/4 none sil MA 3 60-110 7.5yr4/E none fns OSq ml 13 Boring # O Boring ® pit Ground surface elev. 99.00 ft, Depth to limiting factor + in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2 1 0 -5 10 r3 3 non 2 5 -15 10 r4 4 none if .5 8 3 15 -90 7.5yr4/4 none His OSq I ml na 9. . Boring # ❑ Boring — ❑ Pit Ground surface elev. tt. Depth to limiting factor in. Sal ic:etio^'✓_-- i iorazcara i Uepth DorninantCollor Rector Desaiplfon Texture Structure Consistence BOUnderyl Roots GPDA? ~^ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Z - ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L • Effluent #2 = BOD < 30 mg/L and TSS < 30 .: y a Tl'a ^-garment 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. 58134330 (RAM) L STEEL'S SOIL SERVICE Gary L. Steel Rebecca Swanson 1554 200th Ave. CSTM2298 SE4NE4 S7- T29N -R19w New Richmond, WI 54017 MPRSW -3254 town of Hudson (715) 246 -6200 lot #4- Ranchwood �IN v =40 = top of 1 pvc pipe C el. 100.00 BM.= bottom of siding of shed C el. 98.70' 43 119I)AJ l x� 'Ole Gary L. Steel 8 -30 -2000 • -••• �.�.,+�.as, LAOSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" HTN. ABOVE GRADE E WEATHER PROOF !25' FROM DOOR, WINDOW OR JUNCTION BOK APPROVED FRESH AIR INTAKE wITH CONDUIT MANHOLE c FINISHED GRADE 4 CZ RISER Y/ PAOLO( 6" MIN. YARNING 1 ---. -. A80VE G ADE � -- Ess__ MIt 18" IN. 6" MAX. INLET WATER TIGHT SEALS GAS_ 4^ T TIGHT CI PIPE BAFFLE A SEAL APPROVED "�"' 3' ONTO LM JOINTS W/ � SOLID � PIPE 3' 0 - � ON SOLID SO! SOIL C � PUMP OFF ELEV. E'T. -t- OFF " RISER D PERMITTrD IF TANK MANUFACTU! 3" APPROVED BEDDING UNDER TANK HAS APPRO'_ SPECIFICATIONS CONCRETE PAD +EPTIC / DOSE - -- - - -•... TANX MANUFACTURER: NUMBER DOSES PER DAY: TAN - Sins: SEPTIC 6 GAL. � —i DOSE VOLUME INCLUDZNG DOSE GAL. FLOWBACK: oZ 7 GAL. /ALARM MANUFACTURER: CAPACITIES: A : MODEL NUMBER: �,,NCHES = -- L�•.Z.� SWITCH TYPE: B : _` INCHES = L d C PUMP MANUFACTURER - MODEL NUMBER: C = jj-/�INCHES SWITCH TYPE: D = - � INCHES = - ` r KEOUIRED DISCHARGE RATE GPM pVHp E ALARM MIRING AS PER ILHR ' 16.23 VERTICAL DIFFERENCE BETWICEN PUMP OFF AND DISTRIBUTION PIPE . • MINIMUM NETWORK SUPPLY PRESSURE _ FEET FEET FORCEMAIN X �FT /100 FT. FRICTION FACTOR . 4;&rEET TOTAL DYNAMIC HEAD o FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH FEET WIDTH LIQUID DEPTH !� IGNED : LICENSE N UMBER.. a ©'37 �'n Sep -08 -00 11:40A P.01 Goulds Submersible Effluent Pump '� try �. � ,.- t► , C�] 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. Available for automatic and tic cover with integral handle • Farms Motor: and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, manual operation. Automatic points. • Water transfer 115 or 230 V, 60 Hz, 1550 models include Mechanical RPM, built in overload with Float Switch assembled and ■ Power Cable: Severe duty • Dewatering automatic reset. preset at the faclory. rated oil and water resistant. SPECIFICATIONS • EP05 Single phase: 0.5 HP. ■ Bearings: Upper and lower 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EPO4 built in overload with construction. • Solids handling p ty ca abili automatic reset. ■ EPO4 Impeller: Thermo- Y." maximum. • Power cord: 10 foot plastic Semi -open design AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO with pump out vanes for • Total heads: up to 24 feet. with three prong grounding mechanical seal protection. Canadian Standards Association • Discharge size: 1' /2" NPT. plug. Optional 20 foot • EP05 Impeller: Thermo- • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for (CSA listed model numbers rotary/ceramic - stationary, three prong grounding plug improved performance. end in "F " or "'AC" ) BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 continuous superior strength and 14D °F (6D °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running dry without damage to 9 30 ��� 5GPM components. Pump: EP05 e L 2 - 5 FT • Solids handling capability: c 25 1 14" maximum. a • Capacities: up to 60 GPM. i • Total heads: up to 31 feet. • Discharge size: 1 W NPT. z 5 • Mechanical seal: carbon- c 1s rotary/ceramic- stationary, 4 BUNA -N elastomers. 09- EP05 • Temperature: ° 3 10 104 °F (40 °C) continuous 140 °F (60 °C) intermittent. 2 EPO4 5 0 00 10 20 30 40 so GPM 0 2 4 6 a 10 12 Will CAPACITY (t4 1995 Goulds Pumps Gll•r..... kA." ooc 1� Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6199). Table 1: S ystem Design Specifications Sanitary Permit Number - `1 q (v b Number of Bedrooms Design Flow - Peak (gpd) fQcro Estimated Flow - Average (gpd) Septic Tank Capacity (gal) 1Z C* l2s Soil Absorption Component Size (ft') z — S� Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) 1 1 Z9V z Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se tic t and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet filter s hall be cleaned as necessary to ensu proper operation. The filter cartridge shou o be removed unless provisions are made to re ain solids m the tank that may slough off the filter when removed from its enclosure. If the r Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole 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 one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer R e, f, C . C4 S VU(n s D/1 Mailing Address Property Address (Verification required from Planning Department for new construction) City /State � (t�_ Parcel Identification Number 0 00—// 6 8 �� - baO LEGAL DESCRIPTION Property Location V4, ' /., Sec. , T 2� N -R 1?�Y W, Town of Subdivision Sandi wood . Lot # Certified Survey Map # . Volume . Page # Warranty Deed i - 3� 5 `T . Volume C) 60 S , Page # Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM CE im ope r r 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 masterplumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal 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 Coerce 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. ../— J4 2- SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowled e g . I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. JAJI�� 12 �l ZIJ IGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. i ** Include with this app)ication: 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 ,. �.. pp- DOCUMENT NO j'ISTATF. BAIT OF WISCONSIN FORM 3- 19&it'! *M.s srAcc wc.uvro FOR wccowou+c DATA QUIT CLAIM DEED 5i3954 a � I •...- CG David R. Swanson, a single person and �I ST. CROIX CO., Wf former_ spouse of_ grantee:; ._llebecca._Z:_____________ I P�se'diorR*cord II _.. _... Swanson f .a1.kLa... Raymond Swanson, II MAR 9 1994 quit - claims to -__ Rebecca . ...._Swanson .. 10.30 A .. ... . • -- ------ - - - - -- --- .- - I ..... ------------------ -. ..... I ... ....... - - ---- - ------ ..... .......... i; ►rtti i, - - -- - -- . -- . ---- ....... ..... - - -- the following described real estate in ------- $.t CroiX___--_-_....... County, State of Wisconsin: 11 w[TUwn To Tax Parcel No: ......................... .... 7 ' 9 Lot 4, the Plat of RAnchwood in the Town of Hudson, St. Croix County, Wisconsin. This deed is given pursuant to the texas of a Marital Settlement Agreement between the grantor and grantee dated January 8, 1993 and incorporated into a Judgment of Divorce between said parties granted January 8, 1993, and signed by the Court on February 2, 1993. r This 13 homestead property. (is) (is not) T Dated this - __- .- - -- -i ._ . -_ .. -- day of . -..._. February -. 1994.. ---- --- -------- .... .... ..(SEAL) `'&.GA�jj..^ -��� (SEAL) David R. Swanson - -------- - - - - - - -- -- --- -- - -- - -- -- - - -- -- - -- ---(SEAL ---- .. .... -- . . - -- . •. . --........(SEAL / ---- -- - - - --- - -- - - -- - -- -- - -- - - -- - -- - -- AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN L ;.* f Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Df�VQ U ji'f J jOf'l TOWNSHIP NJ S(}n SEC. T N -R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM HO rn e ig _..INDICATE NORTH ARROW RO NCHMARK: Describe the vertical reference point used dU c) �u e i4u AA�C nn of vertical reference point: )00 Proposed slope at site: 06 Manufacturer: (JJ�e ks Liquid Capacity: 1000 qr, I used: Tank manhole cover elevation: Tank Outlet Elevation: nearest Road: Front,O Side, Rear, 1 6 feet Ist property line Front,OSide,ORear,® �V feet A from: well 50 , building: S ..nformation of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: / Trench: Width: �0 Length: ,5 3 Number of Lines Area Built: J l / Fill depth to top of pipe: o�� Number of feet from nearest property line: Front, 0 Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: 5 l (Include distances on plot plan). �* SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: `.J Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 1 3/84:mj DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS IBQ,R &f{UP wtN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7989 BUREAU OF PLUMBING * MADISON, WI 53707 XX CONVENTIONAL F ALTERNATIVE State Plan 1. D. Number: If assigned) El Holding Tank El In-Ground Pressure El Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE David Swanson 615 Front Street, Hudson, WI 54016 IQ I -I BENCH MARK {Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. - SE NE, Sec. 12, T29N —R Town of Hudson, Lot#4, Ranchwood Name of Plumber MP /MPRSW No County. Sanitary Permit Number: Richard Hopkins 1059 St. Croix 83775 SEPTIC TA NK /HOLDING TANK: MANUFACTURER: f� LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARN Y LABEL LOCKING COVER , PROV E PROVIDED 1 1 . '1t", - (`J/ - 9� YES S ❑NO I DYES ONO BEDDING: VENT DIA.. VENT MA71 HIGH WATER NUM BER O ROAD. PROPERTY WELL: rll�DINI, (VENT TO FRESH C ALARM FEET FROM I LINE6 AIR I NLET ❑YES NO OYES ❑NO NEAREST O U� N DOSING C AMBER: MANUFACTU ER. BEDDING- LIQUID CAPACITY j P11MP MODEL 1 1`1110P,11PHION Mn N OF ACTUHEH WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: El YES ❑NO ❑YES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER O ' PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FRO LINE AIR INLET' PUMP ON AND OFF) E:1 YES ❑NO NEAREST' SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing j i IN(.TH J DIAMF TEH I MATt HIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until F ORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH ' O. OF PIPE SPACINCI COVER INSIDE UTA xPITS LIQUID BED/TRENCH O THE / / M EHIAL: PIT DEPTH DIMENSIONS ,' I 0 S 3 J DISIH �O GRAVEL DE TH -- FILL DEPTH USTH PIPF BER PR E DISTH PIPE DISTR. PIPE MATERIAL NO DI H NUM � OPERTY WELL BUILDING: VENT TO FRESH BELOW PIPE ABOVE COVER I E EV INLf T ELEV. END /� y /n�p� ' . LINEE AIR INLET T / (o � �0 Id 7, a Ot / taC / PIPE NEAREST -- �►1► L/ w L T FEET 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- DYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PFHMANI NT MAHKE HS J OIISEHVATION WELLS _ ❑YES ONO ❑YES 1:1 NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED OF PTH OF TOPSOIL SODbf D j S11DFD MULCHED CENTER EDGES ❑YES. ONO OYES 1:1 NO DYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO OF LATEHAL SPACING GRAVEL DEPTH BELOW PIPf- FILL DEPTH ABOVE COVER EIW/TRENC14 TRENCHES. 14ENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE J MANIIOLDMATEHIAL NO DISTH DISTR PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELE I�N Al'AND K3 ELEV_ ELEV. DIA ELEV. PIPES DIA.: IS INFO rAT HOLE SIZE HOLE SPACING DRILLED CQHHEGTLY COVER MATEHIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO OY ES ONO COMMENTS PERMANENT MARKERS: OBSERVA TION WELLS: NUMBS O F PROPERTY WELL: BUILDING: / FE T FIOM NE. ❑YES 1:1 NO ❑YES r__1 NO NERE T + Ile 1 ,A" yt� � Ion 0 101' �L Sketch System on n 0 in in county file for audit. Reverse Side. f �_ . "�� _ V SIGNATU TITLE: ,R SBD 6710 (R. 01/82) �j' - uasconsln APPLICATION FOR SANITARY PERMIT. ; ©ILHR *% � 0...�1� ✓'- I � OUNTY DEPRRTmEr1T OF (PLB 67) � C ; UNIFORM SANITARY PERMIT # - InOU5TR4, LRBOR 6 MUmRn RELRTIOns — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /2x 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWaR MA LING ADDRES I 5 5 RO rj St � Ujsotj Wis PROPERTY LOCATION ff CITY: 5 C. 1/4 1/4, S t o� , TJj N, R QLOE (Dr) TOWN OF: R ud pN LOT N MBER I BLOCK NUMBER Ts NAME NEAREST RQAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER i Rptm I w cl TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: - 3 F Public (Specify): Come t A i THIS PERMIT IS FOR A: W New System ❑ Tank Replacement E Repair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. X Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank EJ System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit i 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 1000 Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In- Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic 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): EX Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. N of lumber (Pr' fl: Sign re: ! MP /MPRSW No.: Phone Number: t � R , tR 11�/ a / O (2 Piumber's Address- 1 Nam f Designer: COUNTY /DEPARTMENT USE ONLY Sign ture of Issuing ent: F e: Date: ❑ Disapproved y r d `17 A ❑ Owner Given Initial J d pproved Adverse Determination Reason or Di ppr l: Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber 7 �• 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. 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. _ L P OT A r S S S F T _ PLU MHEk - WL 0 C AT 10 N er c l �3 I_ i C C 1 S E f /__�� I-) A.TE—:::�11-... _ _ p 0 I k/1 A_P H ?)p Q 10! O P P� P3, ` I M3 W s zz �i 1 3 4 x 5 10 _ 10 7o 16 r /0 1 B i � r k Toc KR. k FRESH All' _HLETS AND OBSERVATION PI -VE C11 0 )S SE CTION Approved Vent Cap �. Minimum 12" Above: Final Qr d s MAX ' 4" Cast Iron �bove Pipe Vent Pipe To Final Grade -. __ . _ M Hay Or Synthetic Covei:i.ny Min. 2" Aggr_eg _ Over Pipe Distribution i l Tee Pipe Aggregate Perforated Pipe Below Beneath Pipe 4 Coupling Terminating At Bot l of System r .DEPARTMENT,OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 7969 (H63.090) & Chapter 145.045) LOCATION: SECTION: rOWNSHI /��IPALITY: LOT NO.: BLK. NO.: SU 1 ISI NA E '/a �� /a ?k /T H/ o #(or C UNTY: OWNER'S BUYER' NAME: MAILING ADDRESS: f- Cr>s Da v I d 5 u)cuh 4v w (o /_1' USE DATES OBSERVATIONS MADE NO. BEDRMS.: cOMMERCIALIDESCR IPTION: PROFI E D IPTIONS: PER O A N TESTS: t [Wesidence New ❑Replace 3 / RATING: S= Site suitable for system U= Site unsuitable for system O ENTIO M IN -G ! � If Percolation Tests are NOT required DESIGN RATE: If any RE: I SYSTE �� M 1 L H S Grv�� TANK RECOM 16 � / SZ �pti / a T ��� F3� y portion of the tested area is in the under s.H63.09(5)(b), indicate: g Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTALM DEPTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH j* ELEVATION OBSERVED EST.Hl GHEST TO BEDROCK IF OBSERV D (SEE ABBRV. ON BACK.) 417'81 l .43 Is,.y36,• 0 KS.,. 17 B- 7. �9, J N 0IVE .3, OSS 08 il siqr 3, Z� A 45 dfr D B- 2 , ,� 1 �! 92 ' , s'Y�3 , >" /s � ,gar 1s,� c "130 -PIS, . y2 -�, s �. 0 01 B -3 pQ.1 3i` /, 33 S B -y 74 >T0' .y�e,% a / . s H /se I r , 446,5 B -5 $.IOb 2,/ > 1 .66' 1 5611 2. S` 914 l Is r 3. y 3Qn B- �o ­ 41 50 1, 2 Sa n , , O SH4 ,OKIf'h lS r' , G e- l�J 3 S PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD2 PE HI PER INCH P- 1 `' TO e s P- 3 (06 ./ P P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 192 0 tN 3 __ u, �/ �'�✓ � _,_,. �-a-- . � � _ � - _ . . _ �- -k --- fi r— � - �- --- -�- -- - 0►- ( I� t i 1 mm I .j-_..._ _ 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME( rin : TESTS WERE COMP ETED ON: G ADDR SS. CERTIFICAT ON UMBER: PHONE NUMBER (optional): 3, 3 3 01 5Y CSfido s 9 6$3/ CST I RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. l D I LH R-SB D-6395 (R. 02/82) -OVER - I ` � INSTRUCTIONS FOR COMPLETING FORM 1 - SBD - 5395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement systent; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use 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 separate sheet may be used if desired; & Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- 'tion, if appropriate; 10, if the information (such as flood plain, elevation) does riot apply, place N.A. in the appropriate box; 1 1 . Sign the 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 LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10 ") BR - Bedrock cob - Cobble f 3 - 10 ") SS - Sandstone gr - Gravel (under 3") LS Limestone "s - Sand HGW - High Groundwater cs Coarse Sand Pere - Percolation Rate med s - Medium Sand W Well fs Fine Sand Bldg - Building Is - Loarny Sand > - Greater Than sl - Sandy Loam < -- Less Than *I Loarn Bn - Brown *sil -- Silt Loam BI - Black si - Silt Gy - Gray *cl -- Clay Loam Y Yellow scl Sandy Clay Loam R - Red siel - Silty Clay Loarn mot Mottles sr, _ Sandy Clay w1 - Willi sic - Silty Clay fff - few, fine, faint �c Clay cc - cornmon, coarse pt - Peat mm - Many, medium in - Muck d distinct p prorninent HWtL - High water level, Six general soil textures surface water for liquid waste: disposal BM Bench Mark VRP -- Vertical Reference Point X TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county Or the Department may request verificat;oti of this soil test in the field prior to permit issuance, A complete set of plans for the private sewacoe system) and a permit appliCat €l)ra nsust he sut>rnitted to the appropriate local authority in order to obtain a pt;rmit. The sanitary permit: mras`: he obtained and posted prior to thk> start of any cor}struction. APPLICA'T'ION FOR SANITARY PERMIT S 1 1' C - 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 /con tractgr,( "sped; 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 #t 1���c,�ti Location of Property St;, Section lL , T 2�_ N - R Ze W Township Subdivision Name At-AcHwao51 Lot Number Previous Owner of 1'r:,po: 1. y Total Size of Parcu S.F. Date Parcel was Creatud Li t % S Are all corners and lot lines identif lable? `� Yes No Is this property bean}; developed for resa (spec house) ? Yes ✓ No Volume ?TS and Page Number $41 as recorded with the Register of Deeds INC1.tJ1*? WIT '1111:; AP1 ONE OF THE FOLLOWING Warranty Dead 2. Land Contract 3. Other recording© filed with the Register of Deeds Office In addition, a certiflod survey, if avaltab.le, would be helpful so as to avoid delays of the reviewing procuo:i. If the deed description references to a Certified Survey Map, the the CerL Survey Map shall also be required. 1 1 1, 1 01 1 111 1 7V OIU N[:R CERTIFICAT70N I (We) centi6y tlla.t a.E'e- statement.6 on tI.is 6ontm ane tAue. to the but 06 my (ouh) know edge; .ghat I (we) am (wt -e) the om'ie!t (s) 06 the p)copenty desenibed in this ,in6o4mation 1 6onm, by v- i�ytue 06 a wcvv:a,ify deed )teco /tded in the 066.ice o6 the County/ Regi.e o6 Deeds as Document No. C z> 4 and that I (we) pnuentey oun the proposed bite bon the sewage (ftzposa aystem (on. I (we) have obtained an easement, to nun with the above, demos ciLi.bed pnopen ty, bon the coMtnuctior, o6 sa.id system, and tlye scone lyas been dyy.Ey seconded in the 066.iee o6 .the Coun4 y Regi�sten o6 Deeds, as Docwne_YLt No. 4. z> -47 - J . SIGNATURE OF OWNER SIGNATURE OF CO -OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H G N y Y STC - 10 r ' r Y i . SEPTIC TANK MAINTENANCE AGREEMENT r' 0 St. Croix County ' o OWNER /BUYER Ave �/' pEc��Cv �WAn1S�w1 m ROUTE /BOX NUMBER 6rs 'F(2c _ ST. Fire Number CITY /STATE I��s�.� c.� S 1 N _ZIP �Q co PROPERTY LOCATION: 4, *4 `L, Sectiun__!Z '1' It W, Town of 01-101,_- " St. Croix County, 1 V"A(.4 C•4 '), Subdivision - f - , 0 0 14 Lot number 4 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 li censed septic tank LmLer. WhaL you put into the system can affect the function of the s.htic tank as a treat- ment stage in the waste disposal system. SL. Croix County residents may be eligible Lu receive a bract fur a max of 60% of the cost of replacement of a failing system, which was in operation prior to`July 1, 1978. St. Cruix County accepted this prugram in August of 1980, with the ruquirement that owners of a new systems agree to keep their systems properly maintained. The property owner agrees to submit to SL. Croix County Zoning a certification form, signed by tile. owner and by a masEer pluu ► her, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal SySLew is in proper operating condition and (2) after inspection and pumping (if ep nec- essar Y ), the septic tank is less than 1/3 full of sludge and scum. t Certification form will be sent approximately 30 days prior to three year expiration. 0 E I /WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x r - , 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. SICNEll 0 DATE I .� St. C�oix C.,unty Zoning, Office r r P 0., f- ox,a 9fi g ti ♦ f". , Y. ` gT !, .Y 'T y .Y' t $ms`s+ r' - L ° Mfr 'gL Hammon d, :WL I C 715 7r 6 2239 1'S 425 =83b3 z� x r . <xg p x Sign, date and returrito above "address. -u ..::, iJ .•�' ..mot � `.. ^. . �` Y+h�,'f`: i ■ a a ¢ / � / � j j % ���3 � \�=r ■'� _ E ° � o c 0 J f � 2 G 7/ 2 \%% J- | . c (=D @ « p OR Q n § R a% CD X ' \ § 2 / m % 0 |§ 7ƒ 7W ' CP 0 k J a° 3 | . q\ J 3 g o c k _ & E ] - | g �cc��� - 0 o ] a a ° & 2 c « k (7 ■ � & \ \ o K & / %$ 2 3uG Q /' k q/ G F CD 2 @ k & � \ O , CL n � w _ a � a ■ & ƒ §\ / $w\ Z � a i J . E(a p = /CD m CL m am ],$m &� D @ - o J n . ® a ■ % G 0 � § J 0 & § § � Cr Cn E m a a Q E C C w_ a c n « m. g 3 o J q q■& e m c S o m � § - & � to .. . o 1 � q E 2 D 6§ ����i� CD § ] 0 - c « c :E \ c w$\ Ak ƒBk J K &�7 / C / D 2 § \ 2 c n K ° § § m = / / \ C 4 • §: E cl = E m. o o . . a\ o g o - f . K2: 3+ƒ f Cl / 2 k \ - ° & • o - m z 9 . o o . , ' . 6`eRANT01: GRANTEE: T Name _ I S;cial Security Number Social Security Number Full Address - New address if property transferred was residence Full Address Is grantor related to grantee? Relationship includes, Name and address to which tax bills should be sent if not the same as above marriage, blood relative, partner, lessee-lessor, ❑Yes* ❑ No co-owner, parent corporation or joint owner. 0.� - •If yes, explain how related Grantor is ❑ Individual ❑ Partnership ❑ Corporation ❑ Other Grantee is 0 ❑ Partnership ❑ Corporation ❑ Other Telephone: Grantor ( - Telephone: Grantee ( - PART I - PROPERTY TRANSFERRED PART 11 - PHYSICAL DESCRIPTION AND INTENDED USE Check proper box and enter name of municipality and county 1. Kind of Property 2. Principal IntendedUse ❑ City ❑ Village El Town a. F1 Land Only a. El Residential d. El Agricultural County ❑ New Construction b. ❑ Commercial e. ❑ Recreational Street address of property transferred. Include road name and /or fire number. ❑ Building Previously Used c. 1:1 Industrial f. 1:1 Other (Explain) ❑ Solar Design ❑ Earth Sheltered Home 3. Land Area and Type Estimated Legal Description (Fill in complete legal description in space below or if metes ❑ Condominium a. Lot size — x ❑ and bounds description attach 3 copies of it as shown on the instrument of b. Residential Units, if any b. 1. ", —Total Acres ❑ conveyance. If certified survey map number is used in description list town, F One Family 1. —Tillable Acres ❑ range, section and acres.) Tax Parcel Number ❑ 2 and 3 units 2. W.T.L. Acres ❑ Lot No. — Blk No. — Section Town Range ❑ 4 or more units 3. F.C. Acres ❑ Plat Name t C. Ft. of Water Frontage ❑ 7, 1 - PART III - TRANSFER (One answer is mandatory for questions 1-4, 5a or b must be completed, questions 6, 7 & 8 as apply) 1. ❑ Sale 2. ❑ Gift 3. ❑ Exchange 4. ❑ Other transfer (Explain) 5. Ownership interest transferred a. ❑ El Full b. ❑ El Other (Explain) 6. ❑ Deed in satisfaction of land contract - What was the date of the original land contract? 7. Amount of mortgage assumed by grantee? $ l!"11 1 8. Does the grantor retain any of the following rights: ❑ Life estate ❑ Easement PART IV — ENERGY Is this property subject to the Rental Weatherization Standards, ILHR 67? ❑ YES ❑ NO If NO, enter Exclusion Code from instructions NOTE: If YES attach the appropriate DILHR Transfer Authorization form (Cert. of Compliance, Stipulation or Waiver) to be recorded. PART V - COMPUTATION OF FEE OR STATEMENT OF EXEMPTION (See instructions) 1. Total value of REAL ESTATE transferred (purchase price, etc. rounded to next even hundred). Include real estate exempt from local property tax (Solar, wind, M&E etc.), but exclude personal property ........................................................................................................... $ 2. Value of personal property transferred but excluded from line 1 ..................................................................... $ 3. Value of property exempt from local property tax included on line 1 ............................................................ $ 4. TRANSFER EXEMPTION NUMBER if exempt for Reasons 1-13 (see instructions) ........................ Sec. 77.25. 5. Fee - thirty cents per one hundred dollars of value (line 1 times .003) Make check payable to Register of Deeds .................................... $ PART VI - CERTIFICATION The transfer must be reported regardless of the grantor's state of residence. Information on this return will be used to administer Wisconsin Income and Fran- chise Tax Laws, Wisconsin Real Estate Transfer Laws and Wisconsin Rental Unit Energy Efficiency Laws. We declare under penalty of law, that this return (including any accompanying schedule) has been examined by us and to the best of our knowledge and belief it is true, correct and complete. Signature of Grantor or Agent Date Print or Type Agent's Name SIGN HERE Signature of Grantee or Agent Date Print or Type Agent's Name If Signed By Agent Agent Address Phone Document No. Vol. (Reel) Page (image) Date Recorded Date and Kind of Conveyance LEA u 7 19 19 THIS Parcel Number Code: County Tax District Assm't Dist AREA L — L Id 2 Fi ff i 1 Off 1 BLANK I — I — U se 1 4 Reject I A 1 8 C D I E F I T — T — Ratio Consideration School District No. PE-500 (R. 7-85) PROPERTY OWNERS COPY .............. .........________. 1V_qS! .._ the above named ................................................................................ ..................................... .............................................................................. ............................................................ I " 7 -r- 1 ....... i; TITLE: MEMBER STATE BAR OF WISCONSIN (If not ... ......................................................... ................... ...................................... ...................................... authorized by § 706.06. Wis. Stats.) ------------- .................. . to me known to be the person .......... —z �Mllo qx"iftteci foregoing instrument and acknowledge _the same. _J TH IS INSTRUMENT WAS DRAFTED BY CJ 71 Wi ................................................... ..... lliam J. Gilbert . --- mubGf P ORTER ........ . ..... r U 0... I' _Q,16 .............. C un , Notary Public s Z W i. (Signatures may be authenticated or acknowledged. Both d y Commission is permanent. (If not, state expir ation are not necessary.) te: ......... — - ' ....................... ....................... •Names of persons signing in any capacity should be typed or printed below their signatures. KQMiII9rC;orrip&w STATE BAR OF WISCONSIN W., ...... I......... FORM No. 2 — 1982 Stock No. 1$002 � l DOCUMENT N o. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 �I 409042 �'ipn,.E 541 ; <� »NISI "LKS OFFICE ST. CROIX CO., WISE Mary Ann..Windolff, not remarried- • -• - , - •• Rcr'd. for Record this 6th !' ....... Feb. -- $6 ...... ...... .••-•-•---- ..............._........... ............. - -•- -- ••- •..........G i A. Ar..... of�A.D. 19 i -- --------------•-•--••-••......•---•-....--•- .... - -••- •-•-•-......--•--• ................•------------•--•--••------•-........ ....-- •-- •......._......- -• -••. 8. _ • 30 conveys and warrants to ..... R�__.�Y�?ai)SQJJ _.�x2�.._����CC� _.� -1 S. wanson .,.."sband_and _wife ... as..j oint...tenants...._._.._. e.oMt.r W Dywk II Grantees - - - - - - -- - ......------ ... •---- ._....• - -- - ... •••••-- • • - - -.•• ....................... . . i� -- --.. - -•-•• - •• .................. in - c o deration_ 000 D . O .............. _.. - -- RETURN To 615 & Front Street SWanS0 ----------------•-.....----...-----..._.........-•-•----•--------•--- •- •...._..-- •---- •- •-- ....... Hudson, WI 54016 the following described real estate in ....... 5t, Croix . ................... County, State of Wisconsin: Tax Parcel No: .............................. Lot 4, the Plat of Ranchwood in the TRNSF�$ Town of Hudson, St. Croix County, Wisconsin. TOGETHER WITH AND SUBJECT to any and all easements, covenants, reservations and restrictions of record. FEE Reserving to the grantor personally, but not her successors or assigns, a non - exclusive easement over the South 66 feet of said Lot 4, for ingress and egress to Lot 1 of a Certified Survey Map filed October 24, 1985, in Vol. 6 of CSM, Page 1596, Doc. #406462, in the office of St. Croix County Register of Deeds. This easement shall automatically terminate at such time as grantor no longer owns said Lot 1 of said Certified Survey Map. From the time that said grantor constructs any structure upon said Lot 1, until termination of this easement, grantor shall be obligated to bear 50% of the cost of maintaining! and improving any shared driveway within said easement and 100% j of the cost of any driveway within said easement between such This --- S ... B9. t........... homestead property shared driveway and said Lot 1. (is) (is not) ! Exception to warranties: li Datedthis ............ .................. .................. day of - •- -- .........._ .. -- •- •--- •-- ..........., 19...86.. it I; - ................... ...................................... (SEAL) GZ...�if_.0 =� ...... (SEAL) DZar Ann Windolff !` I ----• ......................... ......................... . .•••• .......(SEAL) ............ ................•--- ...-- -..... .........................(SEAL) i '. AUTHENTICATION ACKNOWLEDGMENT Signature STATE OF WISCONSIN g (s ) .. ............ ----•---------•--------------•---------------...------- •- ••----------- •- ........ St. Croix ss. ....... .......................... .•• -- County. authenticated this ........ day of ........................... 19 ...... Personally came before me this _ 5.�K::1.day of ............. ................... 19.86_ -- the above named I' ............................•--•---.....----•--•---- ...- •- •-- •---- ••----- - - - - -- A Wi ndo 1 f f dry_..._D ..-•-••---•-•--•-••----•--•------••••--•--•---- �► `.. 1 ji . .......................... .................................................... - ....._.. ......-- •__........-- _- ........ _........... _.. _._. _. .... ...... 1, .. TITLE: MEMBER STATE BAR OF WISCONSIN 1- (If not, . .................... .......................................................... �..,....: -; . �• -- •tea .................. authorized by § 706.06, Wis. Stats.) to me known to be the person .......... x. mho 4eiiited foregoing instrument and acknowledge the same. Z –.j F A. THIS INSTRUMENT WAS DRAFTED BY C'J a_ _ • Wi • lliam J. Gilbert . ............... . ...................................... ....... ° °'�-•-_ ---•• ��' GILBERT, MUDGE, PORII'ER & rITjNI En'N sr�t,.. --- •a - -• -•- y� � _..••�' , SeCOIId.. S..�..�1]C1SASl_a...��--- _Q.�.6 Notary Public --- _S_:.�.:`S.�.i- X�--- -- --- - -- --Coen �Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) -- 3 "Names of persons signing in any capacity should be typed or printed below their signatures. FlC MillarQoRlpeny® STATE BAR OF WISCONSIN w� FORM No. 2 — 1982 Stock No. 1300 L -- - %( I \ 66 ?` I EDG_EWO_OD_ ��Q \��y� ESTATES - -- _72 �L NO � OUTLOT I 0 S 89 ° W I UNPLATTED JP�\ Z.AA6 _ � S 89 ° W- 226.79' ur1P�� 3 150.00' S 86.11'50"W 181.11 ,� 75. 0 151.19 0 d) _ONj 0 �� "P b; ?' ' 780 20 , 190 s6" W y -- a\ 9. 1 2 a te• �s p 8 53,294 S.F. 209 S� m 4G S• /, � tnl OI 2•, , 4 N0 9 , !y 6p o; t� J1 3 ?9, vT / rY t0 N 18 • 1 58 "yy 2 N S. 7S •0%. 0. E. ' ' u+ S e r 39,830 F, . • 14 H edo38Qe 3 Z o EASEMENT �� �.. •�ZT.49 u' O �. ' � C4 O � s w N ?5 24 Zg �, 230 6S;Q N N TS o p 124, � I \ OI A_ • . 9 . 1 '° N 4 :W a 161,7 S. F. .4 1 dl M N O 74,985 S.F. { 'I ° 0 p. 0 0 N 89 °0417 "E 360.00' M: _ ; h / 2 IRON PIPE 0 r 725.00' 18 6.91 N �8O 4' 17 °E 758.00' CENTER OF SOUTH LINE THE NE 1/4 33.00'-' SECTION 12 UNPLATTED LANDS T29N,R20W - -------- - - --- POINT OF BEGINNING 1 66 4 " \ EDGEWOOD ESTATES \ \ \�O�'y \\ EDGEWOOD ESTAT -- - - -- - - -- - - - -- S 87' 1184.66' i� 200.02' 78. 42� 222.08 100.00 100.0( 14 -� d ' d0 3 O'. s 20 '�:. 40 a 0 39 0 38 ro 2 S.F. - 21,486 S.F. u i 21,503 01 48,966 S.F. 6 !� - M N 9� �O \ N N N ao 3 'h n� • s ® ,. z w 13 Z t ' F. 73.75 IOO.0 HIGH : � 28,736 S.F. \ o °, h • 9a � co .0 0g N 184.73' \ = a 78.22 u -- N. a•i•aa 12 l' E .. .�u J � .r . L o w 1 r O � [ • ` � - •Tie. 'a ro - v .- ^ = lit i ' • e'., e e •'e i p ` y p ' b5 O Z r pt _ 3^iyo En rn 4 n fZTI CD 0 G z a ° r ci Z —i f• z n :7 i C rD rn Ln if.i +''too:ob• 'i�.i •i r' :o � � ' y ri ,� a . ♦ ^ f • I O • 0 l n "•TZ O �� .P tL s _ � . r. _N . 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