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030-2108-10-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567264 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Flattum, Ryan & Rachel I St. Joseph, Town of 030-2108-10-000 CST BM Elev: Insp.BM Elev: IBM Description: Section/Town/Range/Map No: /b!5,3bi g LA �5 L o f 03.29.19.895 TANK INFORMATION ELItVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 62 Dosxag �'r-OG5 Cp Z. AIZt �� Bldg.Sewer C • L Holding St/Ht Inlet 1, 1 II LL TANK SETBACK INFORMATION sJ c3 SUHt Outlet T 9g 7 7.9 TANK TO P/L WELL BLDG. 7Ven Air In ke ROAD Dt Inlet Zof ie_-- Septic 8`f —� Z,C$t a 4-' ' c7 7-Dosing , 7 5a , 3S Header/Man. g `tJ Aeration Dist. Pipe • /- q-- t Bot.System Final Grade 9.PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM ` z Model Num er a �.e , 5 97.9 TDH Lift Friction Loss System Hea TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION YS EM BED/TRENCH Width I Length I N PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS ? -76 2 � Z'' ^� SETBACK SYSTEM TO v JP/L BLDG WELL LAKE/STREAM LEACHING Manufactur INFORMATION Type Of System: 36 / cD / CHA UNIT OR Model Nu DISTRIBUTION SYSTEM Se 1-7 —1-7 '3 44 Aj S Header/Manifold/ �/ Distribution x Hole Size x Hole Spacing Vent to Air Intake tY T Pipe(s) \. W eS Length Dia Length Di-_ pacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ` Depth Over xx Depth of xx Seeded/ odded xx Mulched Bed/Trench Center �J Bed/Trench Edges Topsoil Yes No Yes 7[] No COMMENTS: (Include code discrepencies, persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 119964th Street Hudson,WI 54016Me,(N 1� W 1/4 3 T29N R19W) uck Hill Lps Parcel No: 03.29.19.895 1.)Alt BM Description= I ��� L/C' 2.)Bldg sewer length= V stn Z(P = CeJ- �/s G /C,J -amount of cover 5 - - - Plan revision Required? Yes No Use other side for additional information. Z3 SBD-6710(R.3/97) Date Insepctor's ignature Cart.No. p9ap Akme �Yc ,� I' �r a.4, +acy\ 14 JI der il, 3i�1 J'I�i6 w- 1 ['° Ek►�'}NCB � (00� 100.3 hlwe -en l ac.�ya1;► p z � 1I; V as x►s }N I �,�► n J a jr, S �m Soy {-eU✓� q1 t--?I Z013 t 1 ( J v 09/17/2013 10:52 FAX 715 248 7764 A C E SOIL & SITE EVAL. R002 �yar��Qtc,(c/�/ate, /i99�as/��• f/Kd�a? aJ/. sy�6 4016.0,joke 0,-O&CeA66,1 GSl� ytri�� G'u.lr/G/'>rdrq;nS'�ur�k•ct wq,�.e,r •E�e.wt.SowY�.Sides of'dr,uCwk,+ l _ Pelt I ✓ � 1 L'�TTV, ow O�•_' � �� +�� �' 9s Std sncc ce 4]�•'�9 4C.�i�r�t s Q�O `� �`�ti�~�.,��' �'2� .%_.'�• �J�/S��7Q���G1dJ, � fir-y� ° � I♦�ky�Ci{�,SG wricc ele K9. 9d.. Pg. z`•Ez a�z'v °4 County Alr K ;V:;....,1. . Safety and Buildings Division ' x ''g >' 201 W.Washington Ave., P.O. Box 7162 St rV k r`M, � Sanitary Permit Number(to be filled in by Co.) Madison, WI 53707-7162 �',�1QLV�'L3°"' 56 -7 2 6 Lt s, • •t 14' a mit Application State Transacti n Number In accordance with SPS 383.21 ‘ d ode,submission of this form to the appropriate,governmental unit is required prior to SPS 3i 3 -. 1, it. Note:Application forms for state-owned POS submitted to Project Addr s(if different than mailing address) the Department of Safety. ,,, fe nal Servies. Personal information you provide may be u i t and purposes in accordance with h Privacy Law,s. 15.04(1 (m),Slats. ,� I. Application Information-Please Print All Information Q_i:)f- CiiYk2-. Property Owner's Name q iN Qi-le,\APA \---- \i4k-U PA .,. ,,, <n 1^ Parcel 4 Proper y wner's Mailing Address 108- i U'of Y� ff ''�`0,, Property Location City,State 1/97 e , — �f' _ (• fl ) s Govt.Lot _ Zip Code [ Phone Number /1 �� ,/ /Lig %, '%, Section 3 414.45oli W �T0%k p (circle oncts II.Type of Building(check all that apply) Lot 4 _ T / N, R �q E o 1 or 2 Family Dwelling-Number of Bedrooms /, Subdivision Name Block BLI.Lk 0 i ■1 ❑Public/Commercial-Describe Use A/ ❑ City of ❑State Owned-Describe Use CSM Number El Village of /,❑'Town of .51- 15e p h III.Type of Permit: (Check . • • ,ne e,.., '.a A. Complete line B if applicable) A. _ ❑ New System G Replacement System P Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B- DI Permit Renewal ❑Permit Revision ❑Change of Plumber List Previous Permit Number and Date Issued ❑Permit Transfer to New Before Expiration Owner 3(, 3 gL(2 S/2 Zt IV.Type of POWTS System/Component/Device: (Check all that apply) / Non-Pressurized In-Ground ❑Pressurized In-Ground ❑/At-Grade , ❑ o d>24 .of suitable soil ❑Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) 9 P C[.C 11-1 ii- ft •L Pretreatment device(expla in) _ V.Dispersal/Treatment Area Information: t cry,/ '/ /0%1 fir n - r „. .�9 i' ,dC k Design Flow gpd) Design Soil Application Rate(gpdsf) I Dispersal,Area Required s Dispersal Area Pro.•sed(/Ij System Elevation S 7 1 (0 3 ® b 0-1-,91,0 Os 93.00 VI.Tank Info Capacity in Total 4 of Manufacturer Gallons Gallons Units 2 New Tanks ^ c ^' ° ti C" Existing Tanks l3 U t> Is a U v") in v? ��yv�� j� ! u C7 ii, Septic or Holding Tank I /Pea - �W� r 1 M�c��ut� law Dosing Chamber �� �`� t l� K.1 ii VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWt S shown on the attached plans. Plumber's Name(Print) Pls S_ignatur MP/MPRS Number Business Phone Number Tm -BO 11. " - Wolk, 441704 71138b bap Plumber's Address(Street,City,State,Zip Code) ' Ib'7v -1-4uO4 35 A) W %5©n 1..01- ..�)/ - VIII. ounty/Departi Lt Use Only Approved ❑ Disapproved Permit FFeeee Un Date Iss ed ? I is ing Agent Si:. ature ` ❑Owner Given Reason for Denial /S-, - Iss / > ( / IX.Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: pp dip 5(/S �--., • �(t r, /. -fp d Qh��t o/u,,�e, 1.Septic tank,effluent filter and /�iet ZA -0 - 114 in C.ST .7%6-1417/24�'.' dispersal cell must be serviced/maintained v �� as per management plan provided by plumber. 19'n //2/Z 0 I3 _ p r/��S yx ,t=it/ S 2.All setback requirements must be maintained Se �G Of- -PazA as per applicable 41414 Wilkill flans for the systyw /W TerAck-od submit t2 the County i on ari rino_t less th/an[8 1/2 a 11 inches in size ' SBD-6398(R 11/11) AI X_ 5 i 3 6e A O • CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: 2yanSk:t.k..610\ 1 — Owners Name: Owners Address: Legal Description: AIE Y4, Xlid 6 3 _:149. kit) Township: County: 3+ Cpoi,i Subdivision Name: *_,TRa..ek kAt Lot Number: Parcel ID Number: Page 1 Index_and title Page 2 Plot Plan Page 3 SysternSizing& Cross-Seotian Page 4 , Filter Specs Page 5 Maintenance information Page 6 Management Plan Page 7 St, Croix Cty Septic Tank Maintenante Form Page 8 Warranty Deed Page 9 csm or Plat - 0-11-■ Attachments,: oil Tes House Plans Orl;vt-W: 21:a)+ 2°13 ve" Im-rt Designer/Plumber: - i License Number: Date: Phone Number 7/574o-ojjq Signature Designed;pursuant to t In-Ground Soil Absorption Component Manua;for POWTS version 2.0 SEM.10705-P(N.01/01). Page 1 , -7 ) / , ri7or /19,310 Aixine,:-Ry,„ 1:1,44-,., rork Zocdictin aq'q i?iii--A...51- t:iulscso .u3t s.40,0 . 4144.00e, **;414194, 14) )0 40 �A f j - '7., B 2013 11 j4, gi3)1, e 100.3 ,., f r i / a(09bl" S-f. . 4 �• Idi • ( — its: \ I II � C O / \ / 1 ' 1.Lg'4 / I I: I , -4 _a i 1 . 0144,45 -x)st;NS IkiN . 5 i rattAfi-6) -3>r (e --rrokials . Piviivtr),)be-e(2176.i76 j i r 17 c)10 .1cts F:n4.1.," • i 1 i1 I ii ‹). ii0- .-/-7. 1 i i • i "IS ,„(-f,---- .7-/i/k) "f:1 i se I , 1 " 5 fly'` c'-' 1 'm 1 soil' t7 1 ` / q71-2.10;73 14 i I i i _y I [ ./, S3 v 09/17/2013 10:52 FAX 715 248 7764 A C E SOIL & SITE EVAL. Z002 So:/e da/cator%p. ---^- & X13 6; - Bruck elev: Co. Hwy, he b --.._____ Cak: s •' 1 //(dsor; cJ/. 5-sicv6 NI .C-o d S Ate,70,60c-e.40,' irpAk.2E'c,SEC 3,7'.x /1., •i Ig■■■■■■... ...■■■■■■■■ Att311C" G1K 56-e4e i .. Car'G/T drains 5(..64. 4.0'a).c,r •(.•0m.5o&Ca.6,11;of''driveway ' Mlle Ace. `.3301.4•/ o/,.,, /u0.o• �" s (.c 4,c1.41/ Cs�r4o,,/l% 0' `. .- (o __ - ¢® g rags d ,6 /ail'c, rcdlztEm ■ 71 .2- N guy)A /eCas4/ _Aw. igeszis,cc i ` � -. . `7....."--'''''� $1 ,� /rr T' ' !: 0 • _....,,,I µ!'•'e4 (4.4t1,'-its a(O - , . -.'`.` 2/ $a (, /C t£,n, % 6 ` te `+∎'` '. � "4"e1C 4/4 SG iG P _ outlet e[t 39/PS'f zs,,Cye lc.5 �'4aceele.[w 7siA7:7! C vy ciee 1`s F B -kpi-r1-s vva Corr 6. 2 61-r.z 007 1)/ i r7 t: P2 a . ap Aixote:Rycu, i' 1 -1-u_m l'fiv‘ -Pettuffliterfer 4 :ta.:44,ior) illq 40,11-- .51- if.e., *ie. **441041 ' t4u.a601 ) Isii.(4,6 • 4 a . ' . . . . , w-el I_° I4 0 X o 50 yiftj tL GAnb� - i 4)Lni iNlbf44 I I ao5b1 0 , Te ,� U� y r ,o. 1' Puk L0t ' 131464 A,s i I ., -P / )-1 u e II it ' - -_C__F „, . si_9.-..1x. )3spj ilw.q.A.ps l a -3>cL -1'newAtiS / 1 ' I ! 1 i 1 . II Iii ' NGy I-I, s )._ So Absor ton S siwn prassaect!on 100.3 0 ft E-1 44— 7 „,,,,,, .993.0 ft _ FinalGrade 4”Schr:!Otile 40 --- PVC Vent Pipe Id With Vent Cap I /?-0D i ) fl/M1 • Leaohing Chamber 00 System Elevation 3 ft Soil Absorption System Plan Via! tot - --- ft — --- ,------- ------- "ff (- - - ' 1 - I MUIR III , ' , . . .i::•1 11114 : ._,.- I ' ) _ Leac.11ing y / - Chambers I :' ''*1:' ''' 11 .'Elliffell11121111111111111.1.11.[1.1.1.11:11111IJITEM f Trench 2 J Header --- Vent Or Observation Pipe 10,74,- ' impllimmovv—Te ,E. f . . 774!".11M7111 . r- _ i _Trench 3 ------------------L—reacbi-n—q1:0-b—a"--1114e-r-flo7e-t-le-a--#011-7-3 ---------------I I M a n Ufacturrer And Model_ ' .4_,11-407'r,K Q (-1( 9_ EISA Rating„Q.() sq ft per chamber 0 Soil Application Rate 7_____gpd/sq ft 1 , L45 b gpd Design How� ... Soil Application Rate -- CoVi F,ISA = 33_Chambers _ 4 1 rows of j 7 .__ chambers each. - 3y Page of ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I I have inspected the septic tank the t4 4 ��� /b presently kh% residence located at : ALE Y servin Sec. T 1 © N R Iv-� �i� �-L _w, Town of St . Cro f County, Wisconsin. - • e . Upon inspection, I certify St •tank anc baffles to be in good con Y that I have found the � baffles esme serviced ition, and it appears tank ly. PPear.g t.o be functioning properly. V Did flow back occur from absorption system? Yes s Approximate volume or length of time : " -N No + (if no, skip next Capacity: �bc,0 Construction: gallons _ minutes Prefab Concrete Manufacturer (if known) : Steel Other �J __.________ Age of Tank (if known) : '-�=" ,s2 (Signatur; M t (Name) . Please Print ��� (Title) ? a� d• � '1 r (License Number) (Date) �l Form to be completed b licensed be completed by licensed plumber (NR 113 Wisconsin Administrative Code) Statutes) or Plumber (applying for sanitary permit) T ' P lt) Certification: In accepting the above cnrtiy that the ta statement regarding existin certifments of ILta nk,83 to the best of m y g septic tank condition,knowledge,outlet baffle) , Wis. Adm. Code knowledge, will conform to the (except for inspection opening over Name M &Urn 5 1 q Signature QIN A* 14,1 MPf MPRS a9° . d 2347 4 SOIL EVALUATION REPORT Page 1 of 2 Wisconsin Department of Commerce Division of Safety and Buildings in accordance with Comm 85,Wis.Adm.Code A.C.E.Soil&Site Evaluations County Attach complete site plan on paper not less than 8%01 inches in size. Plan must St.Croix direction and percent slope,scale or dimemsions,north arrow,and location and distance to to nearest road. C ` _Parcel I.D. 030-2108-10-000 Pi . all information. NO n Re d By Date Personal in be uses]far secondary purposes(Privacy Law,x.15.04(1)(m). t•�8 ^r Ill,1 Property Owner /� Pro tfcation Ryan&Rachel ttufF1 Govt.Lot ' >A ooh y NE 1/4 NW 1/4 S 3 T 29 N R 19 W Property Owner's Mailing Address Lot# Block#�'Y Subd.Name or CSM# 1199 64th St. 5 na Plat Of Buck Hill City State Zip Code Phone Number J City J Village 16 Town Nearest Road Hudson I WI i 540161 St.Joseph I Co. Hwy E f New Construction Use ICI Residential/Number of bedrooms 3 Code derived design flow rate 450 GPD /f Replacement J Public or commercial-Describe: Parent material Glacial Outwash Flood plain elevation,if applicable Na General comments and recommendations: Evaluation completed to verify existing soil report on file and suitability of site for rep1.dispersal cell. Loading rate=0.7 gpd/sq.ft. Proposed sysem elev.=93.00'. J Boring 1 Boring# 16 Pit Ground Surface elev. 99.39 ft. Depth to limiting factor >116" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-8 10yr3/3 none sil 2fgr dsh cs 2fmlc 0.6 0.8 2 8-18 10yr4/4 none sil 2fsbk dh cw 2fmc 0.6 0.8 3 18-34 7.5yr4/4 none sl 2fsbk mfi cw lfm 0.6 1.0 4 34-41 7.5yr4/4 none gr sI 2msbk mvfr cw - 0.5 1.0 • 5 41-48 7.5yr4/6 none Is Osg dl cw - 0.7 1.6 6 48-71 10yr5/6 none s Osg dl aw - 0.5 1.0 Hff6 contains 2"-4"bands of 10yr4/4 Ifs. Loading rate reduced to reflect reduced permiability associated with banding. la Boring# J Boring 16 Pit Ground Surface elev. ft, Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 7 71-118 10yr5/6 none s Osg di - - 0.7 1.6 *Effluent#1 =BOD 5>30<220 mg/L an TSS>30<1 mg/L ffluent#2=8005<30 mg/L and TSS<30 mg/L CST Name(Please Print) Signatur . CST Number James K.Thompson // c,�0�'— 2 Address A.C.E.Soil&Site Evaluations G Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane,Osceola,WI 54020 9/12/2013 715-248-7767 r s I 5 a va/act.ios7i0,f - • s'Xi36 - rack elev.2. 1 . /e • 4' ' Ca e: • 'P 23 g7�` 4ar;cie 4de//r/a-6-6um /also.; in)/. 5-Yo4 N !_..ofS, Pke.ofDuct'/ // �Jr -1uA;Sec,3,r. z9rl, 4 // ,.Zd93t'' 0 Q/9�, Tn.a�'S�,\�OSe/o� • , \ ix Co.,cJ/. ioc �/�'�/.x`030.Z/Or ,d-coo 64/8 Stzee6 e,..1 ved.64 drain s 5 wle.ce •420,6Y .(ro..t,5ou:tl..5;414 of dei'veW(7 /ell ,ice_ /vv.o I Exit cJc u CwnEo�, 9go' •r 1 ' O garolt 1 t , C. 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I t 111 A . $ i ,, oi .pi i : gi 1 • , 0 . \\,"' 1110111111111111 -Li .„‘. ____,......... „ _ _ j,....v_ , .......,.... ...„ „......., i , PL-525 .Effluent.Filter,. ,Effluent Falters.: P0,1 40k 1Dae. Page 1 of Miikthe ih''tla I D S ti j w . L( c• Polylok i nc, 3 Fairfield Blvd„ "114t�Hen?: r n' r PrA(IJ „,,, .,.,,,, ale .lio-ii 1 en iLyxri yihlitlr,r+PrA.,11h Befalls rM,n T OP/�?�.'d, r$�" �i' $^?h."�-wWvr7r3� >:riaeNi€p !� c4nn i J ; E,i�i�fE�a,,,1E�d ����j1�,'��1�{ail'' !�'�iE i (11 P lri Ii(`i'11dt?��V 1?i1U! it I��1,+ii�,�Jl; � ii3O,, (.6/t .r tills+` '`ii v+°,,`„f'' 4 ► , if ,,/I i}li ,111 r�ydt``1)1 Iy ,('�ql w +ii IiIrA,It' 'J t 1{ ro'�,f(f, ,/J / 1 U it ,� ~ I I '' IIIF ii it ,S i,rl+f1 ( i't tt A'F r 3l ifs 1 3J 1F �R ;�(f7ti ti,i�°I�Eii°,t)'1F7i1 ri7iii `J�'I(irjr ,ji,i�f'i, � '1���t j i(I �� r fIEJ `rr� l t'�rl�r",�liit�,�',iJr Itj� )'�`I'I`� �F` �t f t1" ,f.:'(1�IFIS,'�a-',,hlr if+i''I[� Raising ` her is filter teehn'oIic ++i a{t 1f,Faa'1, 11 I1iiaP:nlflt111 .+,v 1 ,,A;;;,1 A uYk,R�E mr;:{, 4,6+fhk"k',,YStitvj;a vtaO d,o F,I p 'li ,y .� . . � gigsV 1 t. t I, n.-ji1 i r!a , . ...• ... • '' s ft . ';, !I��t., „LdG1c$).lir!"is?p . I '`' ,'171 1,03 If ,P1.42$Effluent. +lyoy ,107',.... �� n' ,, Ii1 , q' d Description #y1Fa♦ ilyey; 004400K; Polylok,Inc is uie�asetl to acid its new commercial filter to its existing lino of quality a�ffll<Wnt illi � krn, tilterc.The PL-526 is rated for over 10,000 GPO(Gailons Parr Day)making It on of the I""" """°"' "' '°�°�• ^°^� largest cOMmeroial filters in its class,It has 525 linear feet of 11W filtration slots. Like ma 1 Klan's&RIser CQwere 1+ ti: Polylok PL-122,the new Polylok Pi„^b.25 has can automatic shut off hall installed with every filter,When the filter is removed for cleaning, the ball will fiber:up and temporarily shut off �li� 'ibwtl,to l x � Ii i'1,T1'fi• the system so the effluent won't leave the tank,No other filter on the market can make that Ar ss�attes 1'3101 1r at' clangs! Pti9f ,, aiNp , PIWrik�y. �1 }1 :•' i)ter' Ordering Information Request i end Step Systems �11Q4p�,,�, .,,,..._ ...,_......... ....�,_,_. q iertit a(Hate Related Products � w� _ _ _ �,__, ._ rt piilttlld a �«,�,. „ 't1 i+i1'imetaN j Seals I Cas(cekaa I • li�rsilrry Tees is ,a Rated for 10,000 GPO(Gallons Par Day) 1 De,fiectrd �» :i2i3 linear feet of i/1C”filtration Enlarge for details Accepts 4"and�a"Sf HD,40 pipe° erSpecters * Bt.iiit in Qaas DefIeOtOr 0 Automatic shiiiioff ball when filter is removed Handles srnd eevehyeir, * Alarm accessibility • 4 Accepts PVC extension handle Signs 1 Land, pe/Drainage The Pi•525 Effluent Filter should operate efficiently far severe!years 1" . conditions before regtrlrina cleaning. It is recommended that the fit b CtP n verti Forms time the tame is pumped or at least every three years.if the inata,iteci filter co 'ins an f i _,.wt,..mSe Sealants _" optional alarm,the owner will be notified by en marl when the filter needs servicing, i '� eel 1'r1'k Servicincl should be clone by a certified septic tank pumper or installer, ies K�c�t'rcNata Accessories Iaintetxnce instructions: ' Tess Pressure+�IF Fi ikN• 1. Locate the outlet of the.septic tank. �aer Cro 1tr01 Product •7_, Remove tank cover and pump tank if necessary, -----and MAIM "'°V 3. Do not rase plumbing when'filter is removed, 'I Accessories CNA�P 4. Pull PI,�525 out of the housing, 5. Hose off filter over the septic tank.Make sure all solids fait back ��»M,_. 6, insert the filter cartridge back into the housing making sure the filterr is ' bar g r and I "" aligned and Completely in:erIed. p N . y , 7. Replace optic tank cover.pl,52 Installation;Ideal for residential and commercial 4Decorative Landscape waste flows up to 10,000 Gallons Prrr Day Y(GPO). Toeh nioal Spectiloatioi , Installation inst,rutti ns,? ro M^ 1. Coca e the .,�,. Rt lateri Prp,gy, s $ he nutlet of the septic tank. I imp, Filter and Sun 2. Remove tank cover and pump tank if necessary, l 3. Giur;the filter hntasinq to the 4"or 6"piglet pipe, IF the'filter is nc�tt cantered una.- i 211 x'1 "Riser ,he a�acess opening l& a F'arwnkxtrnr�( t net Or pier,"of ai,e i Filter Alarm Plans an 9` p r., I Smarr PlltarrM Control 4. insert the PIA-525 litter info its housing. E n to Canter filter. inrtt')','/)03l1n,-'r1 dolt t 990E 4 j•-,..,,..,_. . ., .,, , .,,.��m 11Tr'-131 rip,to bic MolII ;(, Illll7 '4,1 •tan Nov-11-2010 10 45 AM St. Croix County Plan/Zoning 715-356-4626 1/2 POW/TS OWNER'S MANUAL & MANAGEMENT PLAN !'age .__or FILE INFORMATION SYS _ SPOO AT'I�' S owner LL IR a: — • T - Septic Tank Cepeslty G) i C7 NA Permit# a / Septic Tank Menufaaturer 1J wi$4>" l r�NA DEMON P �J1�'f °S Effluent Fitter Manufacturer ' (o �(. I:1 NA ,1i Number of Redrooms 3 Ci NA Effluent Filter Model - i"1 NA Number of Public Facility Gnita Pump Tank Capacity gi 01: NA RSttmated flow(average) 3dU satldaV Pump Tank Manufaacturar '� NA Design flaw (peak), (Estimated x 9^5) V Jib tai ,a Pump Manwfaatwror NA Soil Application Rate . t at/ pump Modes a NA Standard Influent/gffluent Oueilty Monthly averapa* Pretreatment Unit . . .""I Fats, Oil&Breese (FOCI) -20 m9/l, 0 Sand/Gravel Filter 0 Peat Filter BinOhemieel©Xygen Demand (MOO( -,220 mg/i. 0 NA 0 Mechanical Aeration 0 Wetland Total Suspended Solids (TES) -,1E0 mg/i, 0 Dieinfecstlon 0 Other; Pretreated Effluent Quality Monthly average Dispersal Cells) — VM C3 NA f taahernlenl Oxygen Demand (E0081 420 mgIL !lit in.tzround (gravity) 0 In-+around (preesurfxedi tda 4n moll, Cl At' rade 0 Mound Total Su�apended 6cl (TSS) Fecal califnnn(geometric meeri) 470 b ofu�l0nnl 0 Drip-Line : others _ _- -- yin dtao f�NA otnbrt NA Maximum Effluent Particle Size 4 .s _ 0 NA Others I�NA 0t en "'— Other; Q NA *yawn typical far dornaado wastewater and septic link effluent . MAINTENANN, tit id'DULE vitae fi e^ �twray Service Event is r, (ItMaaim=2 years) II NA Inspect eondttion of tanklel At lent once every; is bar 4'l. When combined sludge and scum a usia oneathird )of tank volume 0 NA pump out contents of tankis) At least once every: �' r, _ (N1�isai► w► 3 years) Q NA Inapeat dispersal r,®Ills) Mont,,(g) CI NA At least once oven/; Clean Affluent filter 0 morithIs ,r NA Inspect pump,pump contralti&alarm At least moo every. Q *sr el Mont lei R NA Flush lsterale and presawra teat At least once every; " as <. x.-. ., Qti :( 1 NA Other At At least once every; 0 ear pCltar: MAINTENAN0E INSTRUCTIONS inspections of tanks and dispersal calla oat! be made by an Individual� Fcarrying V i!` trlt��llx ltrA the smog �tv)btng�psratar�e Tank Master Plumber; Meeter Plumber Restricted Sewer, POWTS insp measure the volume of combined sludge and scum and identify back wp or broken or pen-dirt;d (Affluent on the ground surface. The a dis dispersal y4i ls) pending Th dtapersal aellis) shalt be visually inspected to check the effluent levels in the ogse calm pipes and to ohiek for any p of effluent on the ground surface, The pending of effluent on the ground surface may indicate a failinrd aondtticn and requires the immediate notification of the local regulatory authority, When the combined accumulation of sludge and scum In arty tank equel and 'third ( )otrtn more ctr of the nkh rchapter the entire contents of the tank shalt be removed by a Septage servicing Operator iAiscanin AdminiAtrative Code, pretreatment All other services,Including but not limited to the servicing of effluent filters, mechanical or pressurized aomAonerlts,p units, and any servicing at intervals of: 12 months, shall be performed by a oertiffed PCWTS Maintainer. A service report shall he provided to the local regulatory authority rnrithin '10 deVs Of nmpietiCi)of any ee vIae event. answ t4/013 i vP00 EfAIninsiuguIPV (t1 71.)1/018 PUB GPVPHL/(q)(515Z'Ea UJU300,41=10140 LPIM eaMefidtilab PRZAJO BaM ZueuR100P BJQL 8 - : - B1401414 01104d y!0 • oweN 'WO - VaLVII*40 ONIOIXAS SEIVId35 1r10110.1....P.1111•11M111011111111111■11111•1“ 1111111•1111111111•111111, ettOild )4 1 1 (MI/ .5 eua4d AMMO' I • OLUeN -1: WLiii SINIOd METIVION1 SJMOi SIKEININOO 1VN0111Claki "3101000dVIII O Ilf101Ji1C1 ES AVIV NNW.V 40 id wham!EMI ROW NOSSEd V dO ano$Nu ulnfila AVW miVac "SSONVISINn011IO iv IttataNri Nein INEINIVESI klaITIAO blO ou4S0 V 81110 ION 00 "NEOAX°INSIOIddrISNI li.0/ONY SESSVEI 101E1 NIVINOO AVIA! WINV.1.INECNIVEILL k131,110 GNV round '011458 <<WIWI:Wm» .6,4;4.04 4,e BB el tiairm e 441tin.*Iwo 3entm su.iewshe Iona tilt)eutopnasuetteu °0014,111B 0413461.11 413 raweig lug j., SADWII4 INMOM ecteld UI pelarlowoce,i eq ACM $11.19A s uogresqe llas epegke pus pun*, 'SIAACkl PB114 soaleleJ 04. 41:1263.1 Nei B se pealoul eq hew 4us; Oulpla4 B ellakilitMe eSle 4memeceicieJ BU ,1 -von Iueweavritu vicivols B 040003 04 p01.4440140d BO 3.00W uop,enisAs Kirit pus UM SIM0e1 WA do mile; tanin .00JO 11.49LUBOBIOBJ eltligling s A143.1100I 03, peclergsne us er 40U Beg gels eta vjAche palm envidw 03,vow e se pelisisui 9 Asui 4ura Sulpjog e slam U! seousApe Bui,us ucoquill 11011 10/OLIEI NratCpS$ O enp eiqvusAs 4,014 51 ewe alealeasider suns v 0 Ils.q;Ma 4B 013043 ul cep Bq (pis Aidume 3SW1 suageAs wsuleesideg EBJB austuseelds.1 eginns B LIBIICIKE0 C usAartlens ns pus HOS MBU B 1(4 peen eta'4 linssu illm B8B;weirnevider eta 3.VOINCI Cn.smiled Ilion pus seuli 3.01 temzerule ptisotical pus Suaepie tuo,u stomas peobeJ uedn pelum eq leu ppteqs pus 11013.12orduleto puss eoueglrgelp tilo4 psuonold eq maw agla 1.usweasidiu ELL vt.tualeAu uolatilaqv gee lustuenicits tio U0131100f JOi pesos eq Aew pus pelenpme ueoq sag son 3.1anuauviclat elqinos v)11( :we;sito2.uoulooegOBJ wow:IWO* Opoo s pod cm 'yeller vg ;nu JO 't.yeag snug BeJnsegul Sup/tont:4 cp. popular aq umutto pus op; 51.1,m0,4 eq r NY1d AONEONIINOO itiveuw ripe 410t4 10440U0 1Q lem.16 toe trip pew yowls plan Eng pus paAaulea Suenuo,3043.Jo penakuw pue ouennoxe eq Hags sZicl pus slue3 II 'Oulthund JOIN IN '4(404131110 euy2vues eleades e Aq IM peel:dem Apetioni pun pencami at;iieqv vtici pus sus us 4.0 swEimuvo v4i, 6 'mess sliuluetio odi ci pouopuage egz PUB pol.osuuoos!p og flogs ogici pug slueO bUdd nv nept*enimelup.upy ugsuoosulq t "gig LLILuo Inutis LM eausildwea U peuepusqs?clips pus Apedezi B tiumaAs ay* B4 tiateq Q Letom,e9 flogs 5,404$ ritqmelluj,ot.11.tOtAISS j.0 vie ulmal Alluausuascl ei Jo/PUB 0094 sa,mag eLp.uetat INgINNOCINVEIV 'oUgig Jetitglos mom pun touodwez.,laeumdeU A.telitlas!esPIDPed!InDriPcmd UUBd 1110 :Igueaseipeux :edam g,vvv, teeppgre4 Alseo,03 foullosee iteugaod vicinefivi% pus 4In4 uetom (dwnd clinna) uleAp uogspunok `SatendeAllelp feledelP BOI PIMP istaiiNEUDOP ■equAS UO3-100 sWOpUOo sr4;nq mumble foorlim Ageg loo4olggua .tsimod • m B 4 titueield pus sousUANIpeti std.SAUKU,I.4131.11 weeza atiaMoUtiNt TeLp LUOJI. OUINtolic4 B1 .ist uopsulurp JD uagenpaki -se.ts uop,diesqs Nee oped140 io punow Aus o 0dt:its unnop mkt g L o va ow.'2.00dwoo Jo ginelp oaptillOwo JO 'JOAO Vati J BA) ;au co issiedelp pus mum.JOAO SSIONSA 1Jed JO',Op 4ou Ion dt.und e4 1.up.mm sone(LBWJOU same,: • simued dWn1:1 BL SUDIusda ituanugui ty. ;gissa to;JR/Ultaulell SIMOd w Isqtuniti B =slue° is dwnd 1uorvio ow. oz JBMOd 04.11,10480.1 Q agJol J00340410 eumvues satedes s iS4 peAcwoJ Nun dulnd el43. o Kuslueo 04 meg (4103nZIS 8141 plena 01 4.uonwo 4o ammo mows Jo dos;ow of 4.1notor Muir pus (Oa°Ka OUIPeopeita 'esop a3Jog SOO EA! (BMOC 1135O0d003 0143, poem:Now B flM loveMorattAis sestixo s entgasu mitnod usq .sian.131 J0m4E44 littLIJOU stAotia flu.Amu two;eluund seeartron amod Bupna *Uvemns BAReAltUi OL B llea043,EUe suopipuo0 Igoe uegm moot)aou Ionia(in ung LutosAg "NO 04..101113t Jemsdo SulaptISS OeindOs Aci peAOWSI()MUM eta Jo UAW=O44 entfl4 pigOlarip ere vuvReauequag 4131q 4 IBJIIBO les.tadelp 941 eBetliep 10/p1.03 88000.1C1 2.th9ugoo4 aPedin!Agin 1.1142, lopaiunno.1e4A0 JO nonpodd Ouptod j.0 Dougisaati v44.414 t8)1Zatit;4.ual.1125a4 10a40 Et.LNIOd Giga.Ao wort o2,4014e1'Ll0130B1121100 Met1 JO Nou.VIdado ONV cln WYLB ).0 egad /Z 989t7-9FP914_ 5wuoZ/uEld Alunc3D "cp.-JD kiV SV 01,0Z-WA°N ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer an zt- Ro..e.ke I (' Ica UPI Mailing Address rh S-t Property Address (Verification required from Planning&Zoning Department for new construction.) City/State , ` `a Parcel Identification Number 036-A169- 10- ow LEGAL DESCRIPTION Property Location Ai k- 1/4,Oki 1/4 , Sec. 3 ,T olq N R /q W, Town of 54- .7ose.pk Subdivision Plat: --au�k vk tk , Lot# . Certified Survey Map# //,,`` , Volume , Page# Warranty Deed # �� &l (before 2007)Volume [(4W , Page# o? rS Spec house 0 yeso Lot lines identifiable 0 yes 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§Comm. 83.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,.journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. Uwe,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Commerce and the Department of Natural Resources,State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning& Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 S NATURE OF APPLICANT(S) DEC3 ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.09/07) I0 vol 1449PAGE 245 601E5fs 1 O STATE BAR OF WISCONSIN FORM 2-1998 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number WARRANTY IIF.F.D ST. CROIX CO., WI This Deed, made between Steven W. Henning and Norma J. RECEIVED FOR RECORD Henning. husband and wife. 08-16-1999 9:30 AN NARRAHTT DEED Grantor, conveys and CEERT COPY FEE: warrants to Ryan M. Flattunt and Rachel M. Flattui t, husband and wife. COPY FEE: TRANSFER FEE: 110.70 RECORDING FEE: 10.00 PAGES: 1 _, Grantee. Grantor,for a valuable consideration, conveys and warrants to Grantee the following described real estate in St.Croix County,State of Wisconsin (The"Property"): Recording Area Name and Return Address gY�^ Ft .� !. —7 O3 ("',.5 5•-1 t�[�aso-, O30 - Z i c /O Parcel Identification Number(PIN) This is not homestead property. Lot 5, Plat of Buck Hill in the Town of St. Joseph, St. Croix County, Wisconsin. Exceptions to warranties: Easements,restrictions and rights-of-way of record, if any August Dated this 13th day of-July, 1999. *Steven W. Hennin . Y■ — * *Norma J.Hennin AUTHENTICATION ACKNOWLEDGMENT(((/// Signature(s) STATE OF WISCONSIN ) ss. authenticated this day of St. Croix County ) Au ust Personally came before me this 13th day * ofitdy, 1999, the above named Steven W.Henning and Norma J.Henning.husband and wife, TITLE: MEMBER STATE BAR OF WISCONSIN to me (If not, known to be the person(s)who executed the foregoing authorized by §706.06.Wis.Scats.) instrument and acknowledge the same. 1 r THIS INSTRUMENT WAS DRAFTED BY -AA Attorney Kristina Ogland * irg n°a R. Gartman Hudson,WI 54016 S A Notary Public,State of Wisconsin (Signatures may be authenticated or acknowledged.B y�not• •••-14,' My Commission is permanent. (If not,state expiration date: necessary.) _x. -. •so January 30, 200,0 .) car: :.t s • .t`r, VS 4'-• pV©'° • r.Y'Mc *Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-1993 INFORMATION PROFESSIONALS COMPANY FOND DU LAC.WI 500456-2021 Wiscon9in Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division Count Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanita,f6P�rtr}jt No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. �S 44GG Permit Holder's Name: ❑ City ❑ Villa e [] n of: State Plan ID No.: lattum, Ryan St. YosephoTownship CST BM Elev. Insp. BM Elev.: BM Description: Parcel Ta o • 15 x• 2 PuC =CST gw� 03�T108 -10 -000 TANK INFORMATION ELEVATION DATA 1, 24� 74, Yy,4 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 6 Benchmark Z 0 Dosing Alt. BM QO IOZ `{2 Aeration Bldg. Sewer �t— Z3 ' •o cl I Holding St/ Ht Inlet 32► 9 9- TANK BACK INFORMATION St /Ht Outlet 6.29 12.03' TANK TO P/ L WELL BLDG. Air i to ntake ROAD Dt Inlet Air Septic .�--p� 023 r NA Dt Bottom Dosing NA Header / Man. E o Holding n NA Dist. Pipe Q(- Bot.Syste / ° ' 2 � �s 0 PUMP/ SIPHON INFORMATION Final Grade Manufacture mand St cover S,oZ co•3o Model Number GPM TDH Lift Frict' System TDH Ft m ead I Force Dia. owes SOIL ABSORPTION SYSTEM S �, BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Zs DIMENSION SETBACK SYSTEM TO P/L I BLDG I WELL LAKE /STREAM LEACHING MTn}?f tur.lr: - - ' - '`o de INFORMATION TypeO , � CHAMBER Model Number: System: COW , ( '` 41 OR UNIT -C DISTRIBUTION SYSTEM Header/Manifold ii Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. ngth ng > : To , SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes E] No E] Yes E] No COMMENTS: (Include code discrepancies, persons p resent etc.) Inspection #1: 0511Z /aa Inspection Location: 1199 64th Street, Hudson, WI 54016 (NE 1/4 IOW 1/4 3 T29N R19W) - 03.29.19.44A Buck Hill - Lot 5 1.) Alt BM Description= Toe 2.) Bldg sewer length = z4' I/ - amount of cover= 18 t. °` . re � b 'r �►1C, 6e , C 'rPc-'�0 �•. sl� r loo Plan revision re uired. E] Yes U No Use other side for additional information. 0 12 as 524 SBD -6710 (R.3/97) Date Inspector's Signature Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: _ . 3 E e m � PE ..m. E i } e aee..e e.� i .....,.�..0 _ e ._.�.� e�ma.. �. a e. .a«_ e e. i E � n E j E 3 I i S me ef.e ... _ ,...,.. .... —. gw......, i E c L � g I € j t 9 i e 1 i 9. E ir } 6 } } F s.e a s { t e $ - a � 3 E i t }} f £ } E f v.� r ------ — E i m _ £ I r 3 I £ £ s v i �...e.. a y, m. _... � € i � 1 - ---- — r e r e e i y S May- ,11 -00 07:52A P_01 I UTGARD PLUMBING & HEATING 110 KELLER AVE N. AMERY, WI. 54001 715 - 268 -6995 TO: . IJ FROM: COMPANY: DATE: FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER: (01 Co PHONE NUMBER: l OUR FAX: 715- -268 -6095 RE: ❑ URGENT ❑ FOR REVIEW ❑ PLEASE COMMENT❑ PLEASE REPLY NOTES: May, -11 -00 07:52A P_02 1 H= lao T a ��c T q s �: s � e Nom" rt 6 M ;td° 3- / nn "Y X i 3? G -`I 13fK _ 30,3 • S / jDoc� G, 05/11/00 THU 08:21 FAX 715 386 4686 001 * ERROR TX REPORT TX FUNCTION WAS NOT COMPLETED TX /RX NO 4820 DEPT. ACCESS CODE 1241 CONNECTION TEL 18009098780 SUBADDRESS CONNECTION ID ST. TIME 05/11 08:20 USAGE T 00'00 PGS. 0 RESULT NG 0 #018 `h ... r ` 3 N 1 O r. `^Ip to -4 a /yam r . 1� V' °� e �p i� f�1�1 A -A � G _ I 1 O - 4 A m i 4 10' G 418. 6 1'11u a N �O co LCD / - sb, Leo 151.90 -1 0 m N r ro Y r O 1h N �. O Y 493 L �� 4 �. �e N Q .K-- -C1 I a N �. m 375.01 A � l � p 0 Q) I t. 281.72 m 1 • A .Q T� 1 1 10' C . IN 504.if1 . T N y y I �} ' I W ,w - 1 r - Q .2 N m �.� CD W 3 0 242 285 R2 u - 1'101 1 $70' 154 247 • � .r� � '�Y /� 347.87 ' / . � ...D�yG� / ✓sue 1 � Z5 644 W !, p y r �y %+ W a d m a1 y w W o A C 10D OP Ib 3/r 4/J 1 PI P 41 • 12 ` � / a ir � _ In N —� -- O . I g% -' F o 'o 6 W ti, W- p o i 1� uWfNpt _.�i r N o ti =� c S. p. � C (/I w r m - s, V 258 _ 258 220 1 / /9S�9y 4O co \ ,• \ Lr p / - 23}j'c'A9 Q) cn SO . (D /^9�9 W �o �S ( C E =. (0 � y w l0 O r- 0 ID ri. N Z N N v `Fe L $ O cn QD \_ P rp \ m m W (n N 4A tr A W 001 1 6 W F+ ` r -4 -4 0 W m N ,AL 92.75 \ \\ O) 4q �.� $ I a) ro �Pyo 0 r�Ea o `O W 4 -{ y \'Q yb` m 0 5$ .0 �S a CD N \ \ 01 O - - - m p) o m tr i m \`01 �� W I W / /- - \ y m N y I to C013> ss rn A N I cir' Im Department of Industry SOIL AND SITE E V A L U AT PORT Page 3 of 4 nand Human Relations ivision of Safety & Buildings in accord with ILHR 83.0 , ` ftf:'Code COUNTY .r � St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in sitan mustf'ifi'tfe,t not limited to vertical and horizontal reference point (BM), direction an 0 of slof�e scale or' PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. '. � 030- 2108 -10 -000 F1/4,S Y DATE APPLICANT INFORMATION- PLEASE PRINT ALL INFORMA ION : - PROPERTY OWNER: a :.'. '' ,R TION Steve Hennin � .LOT N ...AMf 29 N,R 19 k(or) W PROPERTY OWNER':S MAILING ADDRESS LO K D. NAME OR CSM # 1182 61st. ST. 5 Buck Hill CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [2rOWN NEAREST ROAD Hudson, WI. 54016 (715 549 -6094 St. Joseph CTH. "E" [x] New Construction Use k ] Residential / Number of bedrooms 4 _ [ ] Addition to existing building (] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd /ft trench, gpd /ft Absorption area required bed, ft trench, ft Maximum design loading rate bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations addn. to soil evaluation of 7 -15 -98 Parent material outwash Flood plain elevation, if applicabl ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ®S ❑U ®S ❑U ®S ❑U ®S ❑U ®S ❑U ❑S ®U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -14 10yr3 /3 none 1 2msbk mfr cs 2f .5 .6 2 14 - 10yr4/4 none sil 2msbk mfr gw if .5 .6 Ground 3 30 -98 7.5yr4/6 none ms Osg ml na na .7 .8 elev. 99.8 ft. Depth to limiting factor o +98" VY 4/9D. Y 0 Remarks: Boring # 1 0 -12 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 7 '< 2 12 -36 10yr4 /4 none sil 2msbk mfr yw if .5 .6 3 36-110 7.5yr4/6 none ms Osy ml na na .7 .8 Ground elev. 1 Depth to limiting factor +110 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200 e. New Richmond, WI 54017 Signature: Date: 5 -5 -2000 CST Number: m02298 PROPERTY OWNER SOIL DESCRIPTION REPORT Pages{ PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Steve Henning New Richmond, WI 54017 MPRSW -3254 NEJOWA S3 T29N -R19 (715) 246 -6200 town of St. Joseph lot #5 -Buck Hill This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown as permanent lot lines were not established at the time of this test. I VVI" =40' .= top of2" pvc pipe @ el. 100' t. BM.= top of 2 pvc pipe C el. 100.15' b� c 1 1 x k , 0 4 07 0 si t 1' 21 2 , 303 Gary L. Steel 7 -15 -98 • Safety and Buildings Division Vi scons i n SANITARY PERMIT APPUCCArQN 1 20 w. Washington Avenue P O Box 7162 Department of Commerce In accord with Comm 83.05,Wis. Adm. Code Madison, WI 53707 -7162 • Attach complete plans (to the county copy only) for the system, on prix less Cownty than 8 1/2 x 11 inches in size. ; • r evers e i f r ins r co mpleti ng State Sanitay Permit Number See s de o fo this a li afii r on pP 3 Z u 3 6 Personal information you provide may be used for secondary purposes ST GlriC1♦X ❑Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. }, 000NTY State'Plan Review Transaction Number I. APPLICATION INFORMATION - PLEASE PRINT ALL Prop e Owner Name e a W666—. fl,4� / ,S T a �,N,R / E(orlo Property ner's Mailing Address Lot Block Number 70 w r r: .6 City, St at Zip Code Phone Number Subdivis Name or SM Numb odlft= o/ (/ ) 3 _s IL TYPE OF BUILDING: (check one) ❑ State Owned ❑ Lil Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms �� I Iow OF G S �. III. BUILDING USE (If type is public, check all that apply) Parcel Tax Number(s) 03 0. �� 0e 1 ❑ Apartment/ Condo 2 [],Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5 ❑ Repair of an ________System __ Tank Only______________ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) 0 Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 []Seepage Bed � Q 21 E] Mound 30 E] Specify Type 41 [] Holding Tank 12 (Seepage Trench `' 22 [] In- Ground Pressure 42 ❑ Pit Privy 13E] Seepage Pit S� - / 3 43 ❑Vault Privy E] 14 System-In-Fill O ' ^ VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade SO Required (sq. ft1 Prol2ose (sq. ft.) (Galslcay /sq. ft.) (Min. /inch) Elevation r s SS '"~ /O Feet Feet VII. TANK Capacity in g all o n s_ Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer S Name Concrete Con Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank QQ� ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 1 ❑ A ❑ 1 ❑ ❑ I ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Nam (P int) Plumb 's Sign ure: (No amps) MPRSW No.: Business Phone Number: ux� .� 4 8 PI u be Ls Address (St t City S ate, Zip Code): 1) La SlelOO (f IX. COUNTY / DEPARTMENT USE ONLY Q Disapproved - Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) Surcharge Fee) Approved []Owner Given Initial Adverse Determination 9V S 2� X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: n- : � ` vv,Qu..ti� - a , � -►�QtY a S SBD -6398 (R.12/99) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly M' The septic tank(s) must be pumped by aficensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State.of Wisconsin, Safety and ,Buildings Division, 608 -266 -3151. 4 To be complete and accurate this sanitary permit application must include: I.- .Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate-prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department UsaOnly. X. Cou'nty / Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must-be submitted t ®the county. The plans must incT4de the following: A) plot plan, drawn to scale br with complete dimensions; Location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution bo <es; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction_Igss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a.1 15 form; ahld f). all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 inc uded the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. NE4NW4 S3- T29N -R19W \ town of St. Joseph lot #5 -Buck Hill This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown as permanent lot lines were not established at the time of this test. 4 � • N 1 =40' BM.= top oft" pvc pipe @ el. 100' Alt. BM.= top of 2 pvc pipe @ el. 100.15' 3 � o hoop I 1 � 1 r 2'� D M� � l dog � � �' ,�, , � "' �, « n� �� `ti. �. K� Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 v Lkoor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 030- 1008 -95 -000 APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION W BY DAT PROPERTY OWNER: PROPERTY LOCATION Steve Henning GOVT. LOT NE 1/4 NW 1/4,S 3 T 29 N,R 19 fir) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1182 61st. St. 5 na Buck Hill CITY, STATE ZIP CODE PHONE NUMBER [ ❑VILLAGE []TOWN NEAREST ROAD Hudson, WI. 54016 (715 549 -6094 St. Joseph C.T.H. " [x] New Construction Use [ x] Residential / Number of bedrooms 4 [ ] Addition to existing building j ]Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 857 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 96.10 ft (as referred to site plan benchmark) Additional design / site considerations area B -2 to be backfill to code Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL I HOLDING TANK U= Unsuitable fors stem I E7 S ❑ U �7 S U KI S❑ U El S ❑ U ® S ❑ U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITIrench 1 0 -14 10yr3/3 none sil 2cpl mfr cs 2f ap .2 2 14-4C 10yr4 /4 none sil lcsbk mfi gw if .2 .3 Ground 3 40-84 7.5yr4/.6 none ms Osg mvfr na na .7 .8 elev. 9 9.6 ft. Depth to limiting factor + 84" Remarks: Boring # 1 0 -10 10yr2 /2 none 1 2msbk mfr cs 2m .5 .6 `> 2 2 10 -3 .10yr4 /4 none sil lcsbk mfr caw -2 .3 _ Os my . 8 MS 3 30 11 7.5yr4/6 none g Ground elev. , ft. �9 Depth to limiting s� �' 1G factor +110" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. AvevNew Richmond WI 54017 Signature: - Date: 7 -15 -98 CST Number: m02298 PROPERTY OWNER Steve Henning SOIL DESCRIPTION REPORT Page 2 op PARCEL I.D. # 030 - 1008 -95 -000 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound;3y Roots GPD /ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Trench -8 10 r3 3 none 1 2msbk mfr gw 2f .5 .6 2 8 -16 7.5yr4/4 none sil l csbk mfr gw 1f .2 .3 Ground 3 16 -86 7.5yr4/6 none ms Osg mvfr na na .7 .8 elev. 109:3- ft. Depth to limiting factor Remarks: Boring # 1 0 -10 10yr2 /2 none 1 lmsbk mfr gw 2m .2 .3 4 2 10 -26 10yr4 /4 none sil lcsbk mfr gw lm .2 .3 3 26 -34 7.5yr4/4 none sl 2mgr mvfr gw if .5 i.6 Ground elev. 4 34 -84 7.5yr4/4 none co s Osg ml na na .7 .8 94 ft. Depth to limiting factor - -FE14" Remarks: Boring # 1 0 -8 10yr3 /2 none sil 2msbk mfr cs 2f .5 .6 2 8 -20 10yr4 /4 none sil lcsbk mfr gw if .2 .3 3 20 -34 7.5yr4/6 none fS Osg mvfr gw na .5 .6 Ground elev. 4 34 -84 7.5yr4/6 none co s Osg ml na na .7 .8 � ft. Depth to limiting factor +Rd Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Steve Henning New Richmond, WI 54017 MPRSW -3254 NE4Nw4 S3- T29N - R 19w (715) 246 -6200 town of St. Joseph lot #5 -13uck Hill This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown as permanent lot lines were not established at the time of this test. ✓N ✓ 1" =40' ✓ BM.= top of2" pvc pipe C el. 100' ✓Alt. BM.= top of 2 pvc pipe C el. 100.15' go b� p Iti 1 � Gary L. Steel 7 -15 -98 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 0-1! �� f��►„� Mailing Address !Z2,1 to t s tr 3 f' 4 ScA'- U3 Property Address Go lk (Verification required from Planning q N g for new construction) P City /State S � Parcel Identification Number - LEGAL DESCRIPTION D 3 a z q. Property Location A6S- ' / a, N 0 /,,sec. T Z I N -R /t W, Town of Subdivision N u G K 141 L G , Lot # Certified Survey Map # 46 U-e- Volume . . Page # Warranty Deed # �� U �� . Volume / yl / , Page # Spec house ❑ yes ff no Lot lines identifiable I yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site 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 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 3Y days of the a yea expiration date. Y /Zav SIGNA OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prop e escribe bove, by virtue of a warranty deed recorded in Register of Deeds Office. V 17-71 10e) SIEINNA OF APPLICANT DATE * * * * ** Any information that is mis represented may result in the sanitary permit being revoked by the Zoning Department.* ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed voi.1449 2 6056.1 O STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH Document Numher WARRANTY DEFY) REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Steven W. Henning and Norma J. RECEIVED FOR RECORD Henning, husband and wife, 08 -16 -1999 9:30 AM WARRANTY DEED Grantor, conveys and EXEMPT N warrants to Ryan M. Flattum and Rachel M. Flattum, husband and wife, CERT COPY FEE: COPY FEE: TRANSFER FEE: 110.70 RECORDING FEE: 10.00 Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property "): Recording Area Name and Return Address 12Y C4.n �43 WSCa�S-� 030 - Z!0 Parcel Identification Number (PIN) This is not homestead property. Lot 5, Plat of Buck Hill in the Town of St. Joseph, St. Croix County, Wisconsin. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any August Dated this 13th day of4ttly, 1999. r a OF Wis�o OWN ER DAUGLASi •den STEVE HENNING 7AIiCER NR IN PART Lj s °2145 y �. 1182 61ST.STREET W f1UDsaru• HUDSON." WI_ 54016 Wis. )IN, R19W, �-- _13tN, _ N1 /4 . CORNE SECTION � NORTH LINE OF THE NW� 1 4 EE HMAR 9 usS s .K: SET � J0 POWER `P6L ---_ Jop L�EVATiON .31.69.. „ g N 89 "1,x.,9 1 8 ,# W 3 3 94 _ = DEDICATED TO "�--�- THE P O 8 U I . LC 70.76' 289.34' 220,59 +63.35'4 �. �- i W Q. A tia r so 3.453 ACRES O 6 . 132,972 SQ. FT. .. �%