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HomeMy WebLinkAbout030-1011-40-000 7 A 3 G h. T d \ 1 I 3 3 S < 0. c g cn 3 L N 9 N N Q 0- f0 N S CJt ja R 0 0 C n v p N O O 0 N O a O d C 0 r�3 m (D 0 is w (n a c c = 3 c c TD ` D C1 C . CD N a Z o o= n r to cl y a_ a c N N y p 5 ter( ? ` O y 0 �' N a O w N C 3 m a Q I (D N N D D 0 0 S d PV• ro m � N CD c m m � N m 0-a p Z n [n C .a m e� Q A z _ �p .. y C/) -- I W W m CD m ! Z 3 .p M 3 Cl) m m `O CD .a. A p� 0 CD D 3 wmva,m a C CD 9 �;I z 0 v 0 v v c N 3 (0 7 d 7 N C 0 O d ° � a L m N oS. ,<v� x CD a o d C:2 <, -1 N O S N O t I 3 O W < <n C (D •J (D (D 7y N 03 � 0 4- 0 N 0 0 - 0 0 N C D C ou��m o S 3 CD ? �� -=r °O a j O. O O O o 00 00 0 x 0 m , O a co C 0. r I ST. CROIX COUNTY ZONING DEPARTMENT Q AS BUILT SANITARY REPORT w S�S�I' ' L t ,rJN•e -� :� Owner / / Address &6 7 % City /State 1 Pp re"') LU/ ^t• . �3 k Legal Description • N �t Lot A 1 + Block Subdivision/CSM # '/4 51 '/4 �:L, Sec. 3 , T�f N -R_ f f W, Town of S" S ' d,3D - /� // • y0 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: , Tank manufacturer Size ST/PC /T Setback from: House d Well P/L � S Pump manufacturer Model 37 n Alarm location /A) /9 4t_-:iy. . (u (HOLDING TANKS ONLY) 0 Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system. Width Length Number of- Winches Setback from: House _W Well 9 D P/L Z Z ' Vent to fresh air intake > Z-s ELEVATIONS CST Sf-u-g 0 Description of benchmark Elevation ' 0 Description of alternate benchmark 60 70 y /Yo J °!` 5 N Elevation 10<o - 7 6' 9� Building Sewer ST/HT Inlet ST Outlet Tg ' PC Inlet PC Bottom J Z�' Header/Manifold D Top of ST/PC Manhole Cover A- le) 3W rA � Distribution Lines _ Bottom of System ( ) 103. 7 ( ) n 0A'[ l 0"J 14 A> i & /QM Gp A17FDllx Zf v 1?47Q `� / C�/ • �,�d � �-�'(� •'I �-• Final Grade ( ) ( ) ( ) /D S , 3g s:-7(p 6S3/ D � ate of installation / / Permit number State plan number Plumber's signature A2 License number 2 - 1 •-& 31 S Date // o _ k� l Inspector yl � � 7f7 "1' ' J Ulbricht & Associates Complete plot plan �* Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 3. ZS /6- 7- 70 7 Z, 3s F ALL NON- CONFORMING To'l / TREATMENT TANKS SHALL BE ABANDONED PROPERLY . PER COMM. 83.33. �� S �7 7� - M • rn 0 o T I ts O N_ ; .V 1 � � I CIA C> 0 1 1 W 1 � o0 W N fo N0 NO � y J Z o � t j ■ \■■■■■■■■■■■■■ • ' ONE MEN ■� ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ��■■■■ NOON■■■ ■■�B■■ ■■■■■MEN ■ \ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■� ■■■■■■■■■■■■■■ ME I'm ME ,■�.IN 0■ ■nos ■■■■■� ■■■■ ■ ■� ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ - ■s ■.�■■■��■■■■ NOON ■ \ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ - ■■ ■■��■ ME ME ■ \ \►� ■ ■ ■ ■ ■ ■ ■ ■ ■■ , ■■ ■■MEMO ■ ■■►W IN ;■ . ► \■ \I I■■■■■■■■■■ NOON ■■ ■■■�.;. • ,111 ■Iii \ \ ■ ■ ■ ■ ■ ■ ■■ • : �!■\ ■111\ \NOON■■■ -, � Una 11\11.\XE■■■■■ O\■ ►11 ■I■\\®■■■■■ m ROME ■ ► \11 \I ■ ■�i \NOON 0301\9 1111\ ■ ■\ \;NONE ■ ■ ► \I9v IN O■■► \■■■ �__.,�11; \0 ■ ■ ■ ■\ \N■ 11 11" , NM ■ L • •• �• 53.. I / 'mil �(,J Sa tity and.Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ST Nyw onsin Madison, WI '53707 - 7162 Site Address De artment of Commerce CoJ Sanitary Permit Applica ' 12 , Sanitary Permit Number c In accord with Comm 83.21, Wis. Adm. Code, personal i you provide ❑Check if Revision may be used for second ses Privac La 1 �. I. Application Information - Please Print All Information ' KECEIVEU State Plan I.D. Number Property Owner's Name �; �/ Res S L yN� ✓� �� �!� v� S �-- i 0 , nn " Parcel Number / O O L7 �' O � ��l! �.. ca. a 30 / • _� Prop /er__ty y� / Ow Mailing Address /� /� Property Location J (.0c/ �/� / / / </ /� v! f`ZCNVIN(3E7F�M( "L (� ,SSG ,�, S 3 T N. R /" L�► City, State Zip Code 1?hafre , G Lot Number Block Number (/ !/ So r /• ��l�j 7/ s, , /Y 70 Subdivision Name CSM Number H. Type of Building (check all that apply) ❑City AY X1 or 2 Family Dwelling - Number of Bedrooms [Village ❑ Public /Commercial - Describe Use ATownship -T • 70s ❑ State Owned �^7 „ ! ( ? , c � � 14 Nearest Road ��GL IGL°�l v .�r;�r III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 ❑New 2Reptacement 3 ❑ Replacement of 6 ❑ AdditioCounty use System Tank Only Existin System B • ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that ap ZI)(numbering scheme is for internal use) 44 11 Non - Pressurized In- Ground 2 ound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Red cula ' g 30 ❑ Other V. Dispersal/Treat ent Area Information: 0 Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System levation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) 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 Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's N ' e (Print) Plumber's Signature h4P/MPRS Number Business Phone Number � • u l �P i ?- Lz 43 � P/5 - U6 .919 5 Plumber's Address (Street, City, State, Zip Code) . Coun /De artment Use Onl pproved ❑ Disapproved SAY Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) / ❑ Owner Given Initial Adverse. Determination / IX. Conditions of A proval/Reasons for Disapproval U � D R 9 Flo �ll t n - k.i�e C V0 4-tt 515 (� t - CV ►a a iwk« .. e� ,l�Y+ L �""w ^y � t,e t ww t+ ( ,t) g U . Attach complete p1m to the County only) for the tent on paper not lea than SW x 11 Inches in C�n alze a 1 t1 4 c t - lz .• ,�. <,o� Nom' *t ftc�� S 17tMtx `In f k -vt mot, t'sfa SBD -6398 (R. 05101) 1^SPec -feW 7 d1 5 1 4 eM . r Safety and Buildings NIfisconsin PO BOX 7162 MADISON WI 53707 -7162 TDD #: (608) 264 -8777 www.commerc .wis i www.wisconsonsin.gov n.gov Department of Commerce Scott McCallum, Governor Brenda J. Blanchard, Secretary August 16, 2001 CUST ID No.226375 ATTN: PO WTS Inspector ROBERT W ULBRICHT ZONING OFFICE ULBRICHT & ASSOCIATES CO ST CROIX COUNTY SPIA 655 O'NEIL RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL Identificati e PLAN APPROVAL EXPIRES: 08/16/2003 Transaction ID . 668314 SITE: Site ID No. 6343 RUSS SIMOLKE - RESIDENCE Please refer to both identification numbers, 607 OLD MILL RD, 54016 above, in all correspondence with the agency. TOWN OF SAINT JOSEPH, ST CROIX COUNTY SWIA, SE1 /4, S3, T29N, R19W FOR: DESCRIPTION: REPLACEMENT MOUND SYSTEM / INDIVIDUAL SITE DESIGN / 600 GPD OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 806718 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The submitted plans have been approved as an Individual Site Design that does not fully comply with the approved "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10691-P (N.01/01). Whereas the component manual requires system installation on natural (in situ) soil, the proposed mound dispersal unit will be installed over the effluent line of an existing onsite sewage system. The mound system design will overcome this limitation. The following conditions shall be met during construction or installation and prior to occupancy or use: + On page 1, the entire existing onsite sewage system shall be properly abandoned as specified in s. Comm 83.33., Wis. Adm. Code. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. ROBERT W ULBRICHT Page 2 8116101 Sincerely, > FEE REQUIRED $ 175.00 FEE RECEIVED $ 300.00 REFUND AMT $ 125.00 XE POWTS PLAN RE WER II, INTEGRATED SERVICES M 'cod �. �b33', (608)266-2889, M - F, 0630 - 1500 HRS PEPAGEL @COMMERCE. STATE. WI.US cc: RUSSELL SIMOLKE I _ _ lLBRIC.HT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Designers of Engineering Systems 715 -386 -8185 ���� Private Sewage Consultants i D ,, PROJECT �_X Plan I .D. �� I , -- T Date July 31 , 2001 Owner Russell & Lynn Simolke • Phone 715 -381 -1470 Address 607 Old Mill Rd. Hudson, Wis . 54016 Legal Description 3.0* acres. PIN 030 1011 40. SW, SE, Sec . 3, T29N, R19W Town of St. Joseph County St. Croix C.S.T. R. Ulbricht 226375 Installer R.Ulbricht Local Au+;hority/ Supervision "MRS #226375 S t. Croix Cty. Z onin g Dept- PROJECT DESCRY Replacement system, for a 4 bedroom home. Design daily wastewater load rate= 600 gals. Soils are fairly permiable (.49pd /ft2) but seasonally saturated at 18" and underlaid also with limestone dolomite at. 26". The existing deep drywell is sited in non -code cpmpliant soils. The system is failing. Note, the lot is very narrow, and probably could not provide for a 5 bedrm. sized system. The system proposed, using 18" approved sand fill, can sustain a bed (cell) only 60' long. P o.w.T.S. Conditionally N �: A A ME r y1brioht & AOoctates nta AI F EGS private Sevrage Cons ()'Nail Rd. Wis. 54016 SEE R E S 7 <� CORRECTION NEEDED SEE CORRESPONDENCE" Pg.l OT PLAN VIEWS STEM CROSS SECTIONS & SYSTEM PLAN VIEWS (REVERSE SIDE DETAILS INSPECTION PIPES & FABRIC /TOP FILL DETAILS) Pq.3 PIPE LATERAL LAYOUT (REVERSE SIDE SHOWS DETAILS OF LATERAL CLEAN OUTS) Pg.4 DOSING CHAMBER CROSS SECTION & SPECS. Pg.5 PUMP PERFORMANCE SPECS (REVERSE SIDE SHOWS PUMP DETAILS) Pg.6.OPERATION, MAINTENANCE REQUIREMENTS (REVERSE SIDE SHOWS SITE & SPECIFIC PROJECT DETAILED INFORMATION,UNIQUE TO LOCALE AND GOVERNMENTAL UNIT AREA) The attached plans and specifications are based on the following approved manuals: "Mound Component Manual For Private Onsite Wastewater Treatment Systems " (Version 2.0 SBD- 10691- P(N.01 /01) and "Pressure Distribution Component Manual For Private Onsite Wastewater Treatment Systems" (version2.0) SBD- 10706- P(NO1 /01). J go y, fl ,"Of' J�L gfl (AS o o 13 o o . ,, P G� O f ZID i o % l tl C 'Ilk 00, - c ��� -roP - • 52, 3�� PLV, 82, � q , 0 o ys r �`w' � ljo ft L NON -CONE ING t o ,4 TREATMENT TANK SH LL y BE ABANDONED R PE Y D FOR ILHR 83.03(2).1 P� 2 of 6 L cposs, SE'GT IOQ o M OUAJ D w i T ti4 B eD Oen O % ro A31 ec -JATE' 'Di St Ri(3uT� oN Cs � rkt Ck ps F 3 Pi rN 6- OF T cpso(L w/ T'ahi'am sysrEM U u iFOR M To ,,, H .' '' �� •3 Ploweo T o P So i r uN► FORM T SIoPE FORCE' 51EW1TA00 UuDEi; / MAW l� S Fr. — F-LEVAT' S -- /� E /, 9 Fr. 1mvERr o f / �' 1 ATERA(s 03 S� � • g 1 (=T. S To o F Pock I FT• • Top Is H A p FT. p o f I ATE A PLA VI Mow -- wi r" BED , EOD FvRcE MAW A /D Fr• T k 12- F r �•- -- a - -- 1. Fr w -------- -_,___ - j!! FT Fr W w 35 Fr l BE O F To I -" PV< cAppF-D i OBSERVATIO0 to gg�EShT PERMh,jE,uT MARKERS REcq uiRED 13A5 AReA _ 7) ! it- w �6s m - Fto co - Solt- ICJ 4 IrRAT)VE C A PA CE ry y :gat. Fr. PRopoS BAS A4 APeA = B ( A t a v S F T. r �iP�S s S�cTio,� of �IoUti fit= �- / Observation pipe Distribution cell 6 " 6 " Fill material. j' Cover material aggregate) f�f Tilled area 4( -- -Slope Force maim Figure 6. Cross- section of a Mound System I Water tight cap Top of 4" min. dia. leaching Repair couplings chamber Slot a 6" 6" min. min. Infiltrative surface Water Closet Collar Bar(3J8" min. dia.) Figure 8 — Observation Pipes ire lei 7 1��me �. Ay �,��sfi7� 41 7 pom ........ .. . . ... L 0 0 C C C 69 ) C /9`5y��s' r�T� G/tTePAL 1 '6 50 %G Sao J)' -rPir 0- PIPE' LAYNJ7- dw � p �c� F r F r �nRcE MAi X 36o INcge5 N 3S Fr. off- 2, P Y -- 1-�_ Iuc H �5 VRRi TOT V(gtD Ub1tJ S '� GA15, Pf ST^tit Hol bl- AmETER PA L- " f � li: f/JC D S . MAMIFOLD Z. _ Fopce MA w •#' �� NO1E5/ P; pE zo I -uvERT BLEVATIOo PF LATERAI - 5 SEE Pt DEPS15 SIDE Fob 103. 8y . 1 pr Ft� R ATE D P' P q NOTES IOCATEt:, o,v BC)T - 'o" E U ✓ All Y S P ACED v . 1 5 TRi durio" DISChAR &-E RATE FOR E�Ac LAT' L PAR *' � /3. &AL�Mi�1. TOTAL 17iSTRiBOTioO 'Di5cH^R(= PATE rZoR NET wo K 3 J 60 GAL /M(A). e a•5' Mi'NI'M M E40 Series `„$® 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 to 30 <L N 25 8 E Z t 20 6 J 1 t4- 15 - j 0 4 O L 10 5 2 0 0 0 10 20 30 40 50 60 70 80 90 100 CAPACIT GALLONS PER MINUTE 1 I F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. ME40 SERIES 4/10 HP Effluent and Drain Water Pumps POWER & FLOAT CORDS PLUG DIMENSIONS Quick-connect, watertight Replaces switch assembly fittings are interchange- for manual operation. -- able, replaceable from 1 Inu pump exterior. ° O (38. 1 l naree MECHANICAL FLOAT - ° SWITCH Mercury -free, 90 angle a - f ®, - operation. - - 5.66 (144mm 11.68 - -- - - - -- — -- 1 „ MOTOR HOU=rm Cast iron for efficient heat transfer. OVERLOAD SWPPCH Built -in to protect against overload conditions. 4/10 HP MOTOR 34. OFF' 8 1600 rpm, 60 Hz, 115 or v 230V, single phase. Oil - cooled and lubricated. i i ROTARY SHAFT SEAL Carbon, ceramic faces. P l � I eEWORMANCE CUM CAPACITY LITERS PER MINUTE 1 I O 50 100 150 200 250 300 350 J 40 12 VOLUTE/1MPELUMM SEAL 35 MNG 10 Maintains high efficiency 30 and reduces recirculation, » 25 e replaceable. ENCLOSED TWO VANE 20 6 IMPELLER High efficiency, passes HIGH EFFICIENCY AM 4 3 /4" spherical solids, with VOLUTE ' 1 o stainless steel wear ring. Corrosion resistant. Passes , 3 /4" spherical solids. 1 �4 5 2 THRUST WASHER SLEEVE NPT discharge. BEARINGS 0 0 Erftmype smooth operation O 10 20 30 40 50 60 70 90 90 100 and extend pump life. CAPACITY GALLONS PER MINUTE K3319 5/92 M"r F. E. Myers, A Pentair Company Printed in U.S.A. 1101 Myers Parkway Ashland, Ohio 44805 -1923 419/289 -1144 FAX: 419/289 -6658, TLX: 98 -7443 1 ' pg. 6 of 6 ' Mound System Management Plan. Pursuant to Comm 83.54, Wis. Adm. Code Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated 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 sludge and scum 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 a triennial 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. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg /L BOD5, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD- 10572 -P (R. 6/99)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. C , Septic or pump 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 a tank or component. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector. A SEE REVERSE SIDE Pg.6 FOR MAINTENANCE REQUIREMENTS SPECIFIC TO TIIiS SITE, DESIGN, AND COMPONENTS 1 1 ' 1 t PAGE 6 RE SIDS OWNER's MAINTAINCE OF SEPTIC SYSTEM 'T POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for the safe healthy operation 'of this system. The owner is required by code to submit all necessary maintenance /inspection reports to the controlling authorities. SPECIFIC CONTACT AGENTS ST elfolx �.��. * Governmental authority/ inspectors: ZOA,' �7�. -. 3006 • V6 aft * Licensed installer, responsible for providing an'operation/ maintenance "Users" manual: � * Licensed service / inspection agent other than installer: 3 * Electrician, for pump, electric controls, wiring units: IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic (sledding, shoveking, etc.) across the area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. Discontinuos use in the ' winter (a vacaction trip, resulting 1.11 no water use) can also lead to freeze ups. 2. Water conservation needs to be exercised! Or system can be hydrolically overloaded and destroyed. This system was designed for a maximum wastewater flow of ( gals. daily. 3. POWTS are not designed to accomodate wastes from a garbage disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system. 4. If a power outage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the I cell, which may adversely impact the cell (leakage). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your Installer immediately for advice. 4 5. Neglect of the vegetative cover (the cells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent the syst.eM h 7. O ' i r. " I I ., S N alone t0 maintain a grass covroer. 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressurized laterals, at each tip - for flushing and cleaning the laterals out. The filter system in the tanks (via a locked above ground cover /manhole). Only a licensed properly qualibied person should be performing this work which involves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. r NEW oGv vEiPS Y,v v e e,e. -S %�Io /��" 3 d� /• 7` 70 ; i 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 C4o / 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. Please print all information. Revi by D L 2-6 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). { Property Owner Property Location L Govt. Lot 5W 1/4 sG 1/4 S 3 T 2- 9 N R Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village KI Town Nearest Road ff 1/PSD AVY 5yoI6 (71.5) 38/- 723y 1 sr TosEpi I 0 / 1411 R D . ❑ New Construction User]- Residential / Number of bedrooms Code derived design flow rate ,� ' - - -`- GPD (Replacement ❑ Public or commercial - Describe: Parent material /OE$S OUE� !�'I��l'L ���5 Flood Plain elevation if applicable i N ft. Al General comments - �0�� DOh tiJjJ�� i ; ' T and recommendations: t O - T�7' f� 'C��i e' S' A- �'1 av-vv S ysT ' ..: , , r � � Mill t ST CFiC+iX y OuNTY 7QN *4G Ot =FtCE \ a Boring # Boring 3 � �.� Pit Ground surface elev. �� . ft. Depth to limiting factor in. 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 / o -Cv /o ,p zl L hf n�•t�iL' w z . 6, f S /�- �3. io 3 / S k /;14 -fl' .r _ 1 -1 � A) /o env © Boring # ❑ Boring I D ,• Q n(� / Pit Ground surface elev. 2 � i ft. Depth to limiting factor ` u in. Soil 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 I 'Eff#2 o Z /VW z 2 . L ifsAe Z 10- . 6- 2 /� • 19 1 0t 313 Si(- IrsAe .,tir Ae cGV 17 • 2 • 3 3 '2& 7•s Czee M ©TS CL . Z .3 /,e5 Uw 2 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L CST Name (Please Print) Signature / _ / CST Number 013ERT 2 A M Y O LSRIC�T - Y 2 2 43 - 73• Address Date Evaluation Conducted Telephone Number 7 1S 3N • J Ulbricht & Associate# Private Sewage Consuitant§ 655 O'Neil Rd. Hudson, Wis. "016 ORIGN I Omer 1"\n - Property Oer ` ' 1" \n Z 3 Boring # Parcel ID # Page of ❑ Boring 3 � 1CI Pit Ground surface elev. /o %� it. Depth to limiting factor in. /S'ea 41 s 4?: Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color 'Eff#2 Gr. Sz. Sh. D- 10 U � E 'ff#1 J 7 /p / L /7'FA ib+� ,e L 7� 17 2.57 1 GZ Mo CL OF Boring # ❑Boring IDS, y� s�t Sov,¢l s T Pit Ground surface elev. ft. Depth to limiting actor ? 2 9 J in. Soft Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz In. M/uns�ellll Qu. Sz. Cont. Color Gr. Sz. Sh. l ®• /L L 'Eff#1 'Eff#2 /Oy/1 7 ,Z io 3 — YI& 2fS /10 Yf Cs o 11f5 E EG" Dfl Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in, Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda ry R oots GPD /ft Soil Application Rate In. Mun sell Qu. Sz. Cont. Color Gr. Sz. Sh. . Eft#1 I Eff#2 Effluent #1 = BOD > 30 < 220 m _ g/L and TSS >30 < 150 mg/L Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.6 /00) PD, 3Y , o v !3 0 o �r T0P 5 r 70P ©r SD n 1 13 � Pi hiL to i0 3.0 y' s y�T -tw I i a ao _ 1 a5 , s5 i 2 v : �xrsTiNG- yA°- - al TS /�i� 7,i.107 s _ ST CROIX COUNTY SEP'T'IC 'TANK MAINTENANCE AGREEMENT AND -- OWNERSHIP CERTIFICATION FORM Owner /Buyer L %/�1O L-- 3 00 /' 7 Mailing Address ( �Po 7 ©l� ✓y /!� �� ���a� cS4�0/ � Property Address ' – (Verification required from Planning Department for new construction City /State Parcel Identification Number 0 3 0 LEGAL DESCRIPTION J C Property Location W '/,, ' /,, Sec. 3 , T Z� N - R /j W, Town of 5�7k �3 Subdivision _ /V/ /4— �►'` -�'e �' & Lot # Certified Survey Map ff N Volume Pa ge # > g Warranty Deed # �3 , Volume ' / , Page # Spec house O yes no Lot lines identifiable L yes 0 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. I /we, 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 o three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this fonn are true to the best of my (our) knowledge. I (we) 9m (are) the owner(s) of the pro y described abov�by rtu e of �artanty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * "" ** Include with flils 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 v 6471 Z3 4 y� STATE BAR OF WISCONSIN FORM 2.19W KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Jenn S. K and Kevin R. Kapl RECEIVED FOR RECORD wife and husband, _ - -04 -2001 9:00 AN ` WRANTY DEED Grantor, and Russell T. Simolke and L Y nnette M. Si molke, hu sband EXEMPT 11 CEkT COPY FEE: and wife, COPT' FEE: -- TRANSFER FEE: 598.00 RECORDING FEE: 12.00 PAGES: 2 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix _ County, State of Wisconsin (if more space is needed, please attach addendum): Recording Arcs (See Attached Exhibit "A ") RETURN TO: TITLE ONE 706 19TH STREET SOUTH HUDSON, WI 54016 i 030 - 1011.40- 0 Parcel Identification Number (PIN) This is homestead property. (is) RX00 Exceptions to warranties: Easements, restrictions and rights -of -way if any, of record. Dated this 2. day of May 2001 Jennifer pla _ . • Ke plr - -' AUTHENTICATION ACKNOWLEDGMENT Signature(s) Jennifer S. Kapla and Kevin R. Kapla, wife and STATE OF WISCONSIN' ) husband, ) ss' (County ) authenticated is 2� day of May 2001 Personally came before me this — day of the above named • Kristin Ogland TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by A 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogla Notary Public, State of Wisconsin Hudson, WI 54016 — My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both arc not necessary.) _ — . —• ) Names of persons signing in any capacity must be typed or printed below their signature. Info m tw Prof —onatr compe"r. Fond a, t.ac, Inn 800655.2027 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1999 aw yy �s • VOL 1651PAGE357 EXHIBIT "A" Pet of the Southwest Quarter of the Southeast Quarter (SWy. of SEy.), Section 3. Townshlb 29 North, Range 19 West, Town of St. Joseph, described as follows; Commencing at the SE corner thereof and running thence West along the South line thereof 488.3 feet; thence NWIy by a deflection 8ngle of 59°38' 455 feet to an iron pipe monument, said monument being the point of beginning; thence returning on the fine Just described 121 feet to an Iron pipe monument; thence by a deflection angle of 90' to the left 233,5 feat to an Iron pipe monument: thence by a deflection angle of 90 to the right 88 feet, more or leas, to a point of intersection with a line running parallel with the East line of said SWX of SEy, and 410 feet West of sold East One; thence South 59 teak more or less, on said intersecting ins to the NW comer of the Willow River Inn Property, sold Willow River Inn property being more particularly described as that certain parcel of land conveyed to Charles P. Smith by Warranty peed noorded in Volume 252 on page 425; thence East on a One drawn at right angles with the East ltnne of said tract 377 feet thence South on a line parallel to and 33 feet West of said East line of said tract 164 feet, more or less, to the North line of County Highway 'A ; thence East on said North line of said highway 33 feet to its intersection with said Fist Om of said track thence North along said East line of said tract 398.6 feet to an Iron pipe monument; thence West by a deflection angle of 90` to the left 618 feet to an iron pipe monur(rent; thence SWy on a straight One 293.5 to tits point of beginning. Shawna Moe From: Joyce, Jean Djoyce @commerce.state.wi.us] Sent: Thursday, August 30, 2001 11:27 AM To: 'Shawna Moe' Subject: RE: question.... Hi Shawna, The seller is eligible if they owned the property when the failure was verified or when the system was installed. They also must provide proof that they paid for the replacement system. On a situation like this, it's recommended that you ask for a copy of the closing statement that shows who was responsible for new system in addition to the cancelled checks or paid invoices. Don't worry if the names on the application and the permit application or final inspection report are different. If the applicant marks on the front of the owners application that this was involved in a real estate transaction, I'll check question #1 on the back of the owner's application. If you state there that you verified they were the owner when the system was installed or failure verified and that they paid for the system, I'll know why there are different names and won't question it further. I hope that answers your question. Have a good day, Jean p� • - - - -- Original Message - - - -- 0 • From: Shawna Moe [SMTP :shawnam @CO.Saint- Croix.WI.US] • Sent: Thursday, August 30, 2001 11:05 AM ( = • To: 'jjoyce @commerce.state.wi.us' �1 • Subject. question.... > Jean - > A gentleman submitted his WI application a few months ago. He just sold > the property, and the new owners are applying for the sanitary permit for > the replacement system. Even though the sanitary permit will not be in > his name, can we still go ahead and submit the paperwork? I understand • that the WI fund applicant must be the one that is paying for the • replacement system. Is there anything else I should know? > Shawna Moe > shawnam @co.saint - croix.wi.us <mailto:shawnam @co.saint - croix.wi.us> 1 r� ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road ,,,,- _ _�._.y_ -- Hudson, WI 54016 -7710 (715) 386 -4680 FAX (715) 386 -4686 NOTICE OF VIOLATION September 12, 2001 RUSS AND LYNN SIMOLKE 607 OLD MILL ROAD HUDSON, WI 54016 RE: Failing septic system at 607 Old Mill Road Town of St. Joseph- St. Croix County, WI Computer #030 - 101140 -000 Parcel # 3.29.19.55E Dear Mr. and Mrs. Simolke, As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of § 254.59(2) Wisconsin Statutes, COMM 83.32(1) Wisconsin Administrative Code, and Article 15.04 of the St. Croix County Zoning Ordinance. This system has failed under the definition in § 145.245(4)(b) and (c) Wisconsin Statutes (Category 1). This violation was first noted on 9/12/01. The violation noted is septic effluent discharging to zone of soil saturation and bedrock based on the soil elevation report submitted by Robert Ulbricht dated May 21, 2001. If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of 9/12/01 in accordance with Chapter 145.12(4) Wisconsin Statutes. THE FAILING SANITARY SYSTEM ON THIS PROPERTY POSES IMMEDIATE HEALTH CONCERNS AND NEEDS PROMPT ATTENTION. REQUIRED ACTION: The replacement septic system must be installed no later than September 12, 2002. If you have any questions or concerns that I can address for you in this matter, please feel free to contact me. I look forward to working together to resolve this matter. Sincerely, W Rod Eslinger Zoning Specia ist cc: file • Updated 99 -00 Wis. Stats. Database 8 145:20 PLUMBING; FIRE PROTECTION; SWIMMING POOLS UNOFFICIAL TEXT same manner that a city, village or town makes an assessment vate sewage systems constructed in a governmental unit after the under s. 66.0703, date on which the governmental unit adopts this program. The History: 1979 c. 34,221; 1981 c. 120; 1983 a. 192 s. 303 (7); 1983 a. 410; 1987 maintenance program shall include a requirement of inspection or a. 27, 160; 1989 a. 31; 1993 a. 16, 27; 1995 a. 201, 227 1999 a. 150 s. 672. pumping of the private sewage system at least once every 3 years. 145.23 Rules. The department may make and enforce rules Inspections may be conducted by a master plumber, journeyman Plumber or restricted plumber licensed under this chapter, a per - relating to lot size and lot elevation necessary for proper sanitary son licensed under s. aced t e e employee of the state or gov- conditions in the development and maintenance of subdivisions ern natural re unit designated en the department. The department of not served by a public sewer, where provision for such service has natural resources may suspend or revoke a license issued under s. not been made. History: 1979 c. 221 ss. 607 649. 281.48 or a certificate issued under s. 281.17 (3) to the operator of a septage servicing vehicle if the department of natural 145,24 Variances. (1) If an existing private sewage system resources finds that the licensee or operator falsified information either is not located in soil meeting the siting standards or is not on inspection forms. The department of commerce may suspend constructed in accordance with design standards promulgated or revoke the license of a plumber licensed under this chapter if under s. 145.02 or 145.13, the owner of the private sewage system the department finds that the plumber falsified information on may petition the department for a variance to the siting or design inspection forms. standards. (4) FAILING PRIVATE SEWAGE SYSTEMS. The department shall (2) The department shall establish procedures for the review establish criteria for determining if a private sewage system is a and evaluation of existing private sewage systems which do not failing private sewage system. A failing private sewage system comply with siting or design standards. is one which causes or results in any of the following conditions: (3) Upon receipt of a petition for a variance, the department (a) The discharge of sewage into surface water or groundwater shall require the owner of the private sewage system to submit (b) on which information necessary to evaluate the request for a variance. If the dversely affects the operation of a private sewage system. department determines that the existing private sewage system is (c) The discharge of sewage to a drain tile or into zones of bed - not a failing private sewage system, and continued use of the exist- roc ing private sewage system will not pose a threat of contamination (d) The discharge of sewage to the surface of the ground. of waters of the state, then the department may issue a variance to allow continued use of the existing private sewage system. The (e) The failure to accept sewage discharges and back up of department shall rescind the variance if the existing private sew- sewage into the structure served by the private sewage system. age system becomes a failing private sewage system or contami- (4m) CATEGORIES OF FAILING PRIVATE SEWAGE SYSTEMS. For nates waters of the state. the purposes of this section, the department shall establish the History: 1983 a. 410. category of each failing private sewage system for which a grant application is submitted, as follows: 145.245 Private sewage system replacement or reha- (a) Category 1: failing private sewage systems described in _ f bilitation. (1) DEFINITIONS. In this section: sub. (4) (a) to (c). �-� (a) "Determination of failure" means any of the following: (b) Category 2: failing private sewage systems described in 1. A determination that a private sewage system is failing, sub. (4) (d). according to the criteria under sub. (4), based on an inspection of (c) Category 3: failing private sewage systems described in the private sewage system by an employee of the state or a govern- sub. (4) (e). mental unit who is certified to inspect private sewage systems by (5) ELIGIBILITY. (a) 1. A person is eligible for grant funds the department. under this section if he or she owns a principal residence which is 2. A written enforcement order issued under s. 145.02 (3) (f), served by a category 1 or 2 failing private sewage system, if the 145.20 (2) (f) or 281.19 (2). private sewage system was installed before July 1, 1978, if the 3. A written enforcement order issued under s. 254.59 (1) by family income of the person does not exceed the income limita- a governmental unit. tions under par. (c), if the amount of the grant determined under (ae) "Governmental unit' means a governmental unit respon- sub. (7) is at least $100, if the residence is not located in an area sible for the regulation of private sewage systems. "Governmen- served by a sewer and if determination of failure is made prior to tal unit' also includes a federally recognized American Indian the rehabilitation or replacement of the failing private sewage sys- tribe or band. tem. (am) "Indian lands" means lands owned by the United States 2. A business is eligible for grant funds under this section if and held for the use or benefit of Indian tribes or bands or individ- it owns a small commercial establishment which is served by a ual Indians and lands within the boundaries of a federally recog- category 1 or 2 failing private sewage system, if the private sew - nized reservation that are owned by Indian tribes or bands or indi- age system was installed before July 1, 1978, if the gross revenue vidual Indians. of the business does not exceed the limitation under par. (d), if the (b) "Participating governmental unit' means a governmental small commercial establishment is not located in an area served unit which applies to the department for financial assistance under by a sewer and if a determination of failure is made prior to the sub. (8) and which meets the conditions specified under sub. (9). rehabilitation or replacement of the private sewage system. (c) "Principal residence" means a residence which is occupied 3. A person who owns a principal residence or small commer- at least 51 % of the year by the owner. cial establishment which is served by a category 1 or 2 failing pri- (dm) "Sewage" means the water - carried wastes created in and vate sewage system may submit an application for grant funds to be conducted away from residences, industrial establishments, during the 3 -year period after the determination of failure is made. and public buildings as defined in s. 101.01 (12), with such surface Grant funds may be awarded after work is completed if rehabilita- water or groundwater as may be present. tion or replacement of the system meets all requirements of this (e) "Small commercial establishment' means a commercial section and rules promulgated under this section. establishment or business place with a maximum daily waste (b) Each principal residence or small commercial establish - water flow rate of less than 5,000 gallons per day. ment may receive only one grant under this section. (3) MAINTENANCE. The department shall establish a mainte- (c) 1. In order to be eligible for grant funds under this section, nance program to be administered by governmental units. The the annual family income of the person who owns the principal maintenance program is applicable to all new or replacement pri- residence may not exceed $45,000. i1noNicial text from 99-00 Wis Stats. database. See printed 99-00 Statutes and 2001 Wis. Acts for official text under s 35.18 (2) stats. Report errors to the Revisor of Statutes at (608) 266-2011, FAX 264 -6978, email bruce.munsonglegls.state. Kl us COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 800 - 962 - 5227 S ST. CROIX ZONING REPORT NO.: 24089/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 6/15/92 COLF(THOIIS£ HATE RECEIVED## 6/12/92 HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER: Barry Dahm LOCATION: 607 Old Mill Rd., Hudson COLLECTOR: M. Jenkins DATE COLLECTED: 6 -10 -92 TIME COLLECTED: 3:30pm SOURCE OF SAMPLE: Kitchen faucet G DATE ANALYZED -12 -92 TIME ANALYZED :11:30am COLIFORM: 0 /100 m1 INTERPRETATION: Bacteriologically SAFE NITRATE -N: 4 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria /100 mL I Nitrate - Nitrogen, mg/L Cb LAB TECHNICIAN: Pam Game WI Approved Lab No. 19 d SA C Means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 d ST. CROIX COUNTY WISCONSIN � ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386 -4680 June 17, 1992 Eldon Bader St. Croix County Veterans Service Office 904 Third Hudson, WI 54016 Dear Mr. Bader: An inspection of the septic system on the property of Barry Dahm located at 607 Old Mill Road, Hudson, WI was conducted on June 15, 1992. At the same time a water sample was obtained for testing. You will find the results of the testing enclosed. At the time of inspection, the sanitary system was not found to be failing', however liquid was observed 20" below surface elevation, and non compliant materials were noted. 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. 'i erely, May.y- -J� Jenkins Assistant Zoning Administrator js �f ,1 ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 t e St. Croix C and water inspe< J private individt ,� �Q Completion of tti a 0 located . Please provide fee made payable along with form soon as possible WATER TESTING-- - (For nitrat WATER TESTING (For VOC'S) C , SEPTIC SYSTEM INl__ ___...�.---------- - - - - -- -FEE: $25.00 (Determines if system is properly functioning at.*t me of inspection) PROPERTY OWNER'S NAME: LV - V - L4 & kyq PROP. ADDRESS: I koa CITY Legal Desc iUttion 1/4 of the X2 1/4 of Section _ _ , T _ N -R_/2 Town of S JoesgA k Lot Number - Subdivision: --- FIRE NUMBER ADO 7 LOCK (� NUMBER — Color of house r ,L Realty sign by house ? A1Q If so, list firm: PLEASE iNcLubE, IF AT ALL POSSIBLE, A KAP, 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. & n n Firm or individual requesting services: e Telephone Number Aao 5 REPORT TO BE SENT TO : F I ✓ rr i e e ✓a o, r✓i ct 0 Act le q6q Sfvc CLOSING DAT -~�- Signature A, AAA r vef ko ; Q iJ; i l o +�✓ ���✓ Q ANN s low stc, TcL poaa( 4 T v C6L ""+ PO- A Abu ka,r � 1, � k l �r`y-d o��- .Fasf SJ o ad ff (11�� ❑ LANGUAGE ;ARTS ❑ MATHEMATICS MERRILL ❑ SCIENCE ❑ HEALTH ❑ SOCIAL STUD MERRILL PUBLISHING COMPANY 936 Eastwind Drive Westerville, OH 43081 -3374 614 890 -1111 Gen /pad 94608 -5