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HomeMy WebLinkAbout030-1025-40-000 3; I= i n 3 I I n 031 .� !A O ° Co .� I O W • Z @ N O O I C`t D. „�„ 7 7 :O:a H v l N j j 7 C 3 0 1 N 7 O m CO N ti y CL m 0 3. 3. 0 Pr r 7 (7 N O 7 7 N ° S w cow goo° fDl cWg � O H COD m y l a s �i C ° o (n A a A I v (n z A i e coo w �' a OD m co A w a o `C CL c ° ° o I m a c_ ° W , O co C', c I N 3 O lo t o co 0) (A y ° 000 2 Z OOON Y � o c-° al o Cv Sao <z o � p G7 y N o l 3 ti N C A I c�D W ' C I O .�. f�D �+ ' W N � Y1 9 °-: rn ° z I I z ' o O O D o I @ I T m I m o y j • c p c !�1 c m c � m I Z m � -� to 0 o ° 7 3 3 p z CL J I I � z ° ao I ao w m I eo �o I CL z a� ` AX p co EP 3 CL co m o � ti y O O — t0 O ppV + N C I O N C x o z a o a V O_ -4 O I Q y M A C ` I (p y 3 I a O 0 °� I 'c I 3 I w °07 _a ~ N �0o I ° o v I �• m - I a o I o °p CD I m c 0 I c c o� I ° Oa �'' a Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 487976 0 GENERAL INNRMATION (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: Ryan, Michael St. Joseph, Town of 030 - 1025 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range /Map No: /(� M c T 06.29.19.103B1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. A'-1 a P t S, A1,3 11W. Septic ;1 Benchmark M- E x�6� w I00. '^ ��V Aeration Bldg. Sewer t Holding StHi4+rtlet ,y V A I) �kLt J 7 7 St/Ht o a v �— TANK SETBACK INFORMATION va lU t' I 9!c 8 5 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD &Llnlet ( 91) Septic Bohm bad- - 7 . o0 1 76,4 Z Dosing Header /Man. 7.%Z gC . y i i i i Dist. Pipe - 7 14 Z 7 /Cd Zo S Holding Bot. System I� PUMP /SIPHON INFORMATION Final Grade 5. sz, 1 71, Ci Manufacturer Demand St Cover �� g °J a'�It I t7 y -1 GPM F; a 4d71Z�` Mode tuber $ .13 TD Lift Friction Loss System Head TDH Ft -SZ $.ss `t5 Len Dist. to Well Forcemain � 9.7-5 q%,l'7 SOIL ABSORPTION SYSTEM T 9 49 — Z 9 1 9 BEDITRENCH Width / Length ob No. Of Trenches ( - PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ch DIMENSIONS 3 , 1 e 01- J ^ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR W Type Of System: i �d /�T UNIT Model Number. Q J ` G o r J o, 4,' N DISTRIBUTION SYSTEM We6+_ Low /T 17 25 ZS �� Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Ai Inta i Pipe(s) \ \ \ \1 Z e rp�"� Lengt Dia Length Dia Spacing c� 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 Yes j No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1148 Trout Brook Road Hudson, WI 54016 (NE 1/4 SE 1/4 6 T29N R19W) NA Lot 1 Parcel No:: 06.29.19.103B1 A 1.) Alt BM Description = F' Ga t) e� �t� a�e rti c J e,s X fix' v µ•ms 2. Bldg sewer length = G ;" U ' - amount of cover = Plan revision Required? Yes o Use other side for additional informal �_ � I — Date Insepctor's Signatur Cert. No. SBD -6710 (R.3/97) I r - of d ivision County C� G p d� /� n .7/' /l. 2 as mgton Ave., P.O. Box 7162 isconsin Ma 'con u7f c� j( 162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 Sanitary Permit Applic ti,,R to Plan I.D. Number N In accord with Comm 83.21, Wis. Adm. Code, personal info ation you provide may be used for secondary purposes Privacy Law, sl .04(1 xtlp�() oject Address (if different than mailing address) I. Application Information - Please Print All Information ST, CROIX COUNT' 312.10 2 J Property Owner's Name cel # Lo Block # I r'lMA +&(, /Q ll ' Proope Owner's M� Address M Property I ocation !/ � / )eW ng r gj/ oox �G '/., %, Section City, State ZippCode Phonee'Number (f 7/ s Number - / 3 5 � �( ctrcle IL Type of Building (check all that apply) T 2- N; R 7 - E o 8ebdivisimrMM - CSMNumber K- or 2 Family Dwelling - Number of Bedrooms E xifjd" 1 El l. . Public/Commercial - Describe se aaEE,, El State Owned - Describe Use t *_1 Z 1 +7-1 t7 4- Z�- a City ❑Vill 35123 3 . 47 Uo TownA 3 &6 o III. Type of Permit: (Check only one box on line A. Complete lin B if applic A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B, List Previous Permit Number and Date Issued ❑ Permit Renewal 11 Permit Revision 11 Change of El Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl on - Pressurized In- Ground ❑ Mound >24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ N - Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Ching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersaUTreatment Area Info rmation: Design Flow (gpd) Design Soil Application R�te(gpdso Dispersal Area Required (s Dispersal Area Proposed Syste E onn �D �Co ZS ��i (� 7 3 br e!' � VI. Tank Info Capacity to Total Number / Ma ufa urer Prefab Site Sleet Fiber Plastic Gallons Gallons of Units (� /� Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank O 4100 � /! � Aerobic Treatment Unit 4o, Dosing Chamber z 1 I .. oe!n VII. Responsibility Statement- L the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na a (Pri fit) lumber's Sign lure MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) Z / Z /D �U� • S� % Ulf U��/ �/. S �/ 7 4 VIII oun /De artment Use Onl A roved ❑ te�Zn Sanitary Permit W (includes Groundwater Date su Issuing ent Sign re o S PP Surcharge Fee) � r xC C1 R fo r Denial ( J(J UJ IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1. Septic tank, effluent fitter and dispersal cell must all be services / maintained as per management plan provided by plumber. 2. AN setback requirements must be maintained as per apptWable 00de I ordina ICO5. Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size SBD -6398 (R. 01/03) I el vek op- C� L o 7" ti co 5 00 S PE S� �� oa��'� YAM N r V4 GD � p, --D00/2 �f i �X 5 i aiV r' Sr57Z-iy / a YS s y \% p XX r N y � r ✓ f V 5 �1 G� 3 y Go d 5 co col t p O � R P o � � o �N 21° oaS� IV N w 21(3 I fop e t` t iN T � S Z S S� N N 3X Iq S '6',r Ilk r/ t '6 y S , 5 SyS7��y � D J r Y� sy 57�� 5iS u J Wisconsin Department of Commence SOIL EVALUATION REPORT page / of 3 Division of Safety and Buildings ' n accordanfftn t� county Attach complete site 112 hes in size. Plan must S T C O rx include, but not limited to: vertical and horizontal refernt (B , and Parcel I.D. percent slope, scale dFT1M eneien%aad and 1 nd P�V'ce� 4ea ad. 0 36 1,02,5 fQ Please print all inform Revi by Date Personal information you Provide may be used for secondary (f�c(raWi( WWNT'(16)). /A I y ) 5 Prw" owner M I cha el P14 an Govt. Isar E 1/4 5W 1/4 40 T 21 N R ,q E (or& PropeftOwnees, Mailing Address Lot # i Block # I Subd. Name or CSM# City State Zip Code Phone Number 0 City ❑ village fffTmn Nearest Road It w1 oito c 7/5 3? /- / . To9E7sQH w Tieov ?8 i ❑ New Construction Usq;fTResidentiat I Number of bedrooms { Code derived design flow rate &00 GPD eplaoement ❑ Public o c ommercial - Describe: Parent material r/,4- C /;t T/ W s Flood Plain elevation if applicable 010 ft General comments and a Boring # ° Boring ✓/ ® pit Ground surface elev. q �• !0 ft Depth to limiting factor 7 2 -' in Soil Application Rate Horizon Depth DominantColor Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Mursell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 l 0 -24 10 VR3 1 0 t 3 TbX mfr ew 3m •9 2 4 -31 IvYR 'SCI 2e bx M-fr � 5 .3 •� w 31 -5� - i •5Ye.iy - g 1 e bK hl�fr e s I l- o 51 'IL 7 •SYR � - S 1 2 Itn bK W1 1 - - � ! •d a Boring # p Boring ✓ 2 [3 Pit Ground surface elev. Depth lo limiting factor in. Soil ApplicationIttale Hodmn Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPM in. Mu nseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 twee- 3 /z — ,2 f r tr e s 3 f • G . 8' �- 13.27 10 YA-4/4 - / Z m be- mfr 5 3 Y • (, �3 27--'3 /0VA /1 - set 2 ft7bx rnf 1 5 a vF .4 4 1 7 •S Q 5 CI 2 b • Effluent #1 = BM > W < 220 mg& and TSS >W < 150 mg/1- • Elfin #2 = BOD I M mg/L and TSS < M mg& 99 CST Name (Please Prim u L f3 9 !!/F/ T 3'S! dflVdy Address Dais Telephone Number ZS l2 /bT" br 5p�te�lh & � wl �_3o-bf �7 1s) 772. 3A42, r O I, Property Owner R Y A N Parcel ID # Page 2. of 3 3 Boring # ❑ Boring ® Pit Ground surface elev. 9J ft Depth to flmiting factor in. Sol Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDM in. Munsefl Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 - 10 YR 11 — Q 2 f bK m f►'' ( a m • 1, • 8 2 - 14 loYiey /d 3abK M 1 0 w 3 f9 eu yR /� - sC� abK Wr a S 3 'f 36 - S i c f 2MbK mfg ¢ s t*vf •- �. 5 s2 - 7 swfe� /b S i C l 2 m b K M* i - - ..4+ . to Boring F -Ifl # ❑ ® Pit Ground surface elev. $ f ft. Depth to Umft factor > 83 in. f Rate Horizon Depth Dominant Cola Redox Description Texture Structure Conststence Boundary Roots GPDlfE in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. i 'Efr#1 I `Eff#2 0-1(0 10ye - /, - e / m bK m-f r C S 2- /4-3-5 1 - S W 3 v-f bK -f ; C 5 3 v-F -4 • (o 3 3 5-53 7 Sir- 3f bK prif i C 34 . •(m 'Y % - 93 5YR - ql (, — 50 3 C bx Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to grating factor in. Sorb Application Rate Horizon Depth Dominant Colof Redox Description. Texture Structure CorSisterm Boundary Roots GPDM In. Munsefl Qu. Sz. Con. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg& ' Effluent #2 = BOD 130 mg& and TSS < 30 nxflL 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. seM3w(L"O �Cd9e O � R_i v�R_ /•ZD OP 7�D U WEE KS Cone .CTS 12-00 L3 AL- L- oN S 22 F1 QL O WFLt -- q R.5 ►.� � � • g �x15T tNt-� N _ � 4�•too o �YS�r�Nt 20 Q- ff O' 2-0 < FR M Of = 100.00 TOP O F co /VC k;c D oop A PRor i B3 �• �'° ►3 #4z = 1 t? v 32 2t '`io' r' �O 77oM t ?' OF WOOA Sl ,p1Nr1 C) N '7' A -evn -) 9yD 5 0 + 50 �, o SduTHVRN PRbt'V P-r r I..tN E As 8ur4-T b i A I ULBRICHT & ASSOCIATES CO. ' 2812 10th Ave. • Spring Valley, WI 54767 Reg. Designers of Engineering Systems 715- 772 -3442 Private Sewage Consultants PROJECT INDEX PLAN ID # DATE O vT • 3" OWNER fVj1• ti Z24 V4A PHONE 3 9/ / 4* e 3 S. /l D tl � - T ADDRESS �/ R /`��•� S yo/ LEGAL DESCRIPTION C-SM 3 5 / 2 - 33 (���• 3 �y • (�►� S L.prL P i t1 d 30 - X0 15• • #'V • &VV M 9 , sc. 4fee. 6) TOWN OF cc J A 0/ JT COUNTY S CSTM �1 �A)p LOCAL AUTHORITY/ SUPERVISION s �" • G R4 f A C "t PRO JECT DESC e 13 Awv - AtViA.) )VOZO N04 L - 62,- C o ISOO 7, -F 91,44 ISe r 51 l 00 Co.`t 11:4,v T' .5'0 NIP srs7.,. 00 �° . 4,5 r - A; cr i - T g��� �'�-- ���N t :zv Gas IG` Ulbr icht & Associates "[ Private Sewage Consultants 2812 10th Ave. Sprinq Valley, P9- l' INFILTRATOR SIZING WORKSHEET a I • S P9.2 SYSTEM PLOT PLAN P9.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. P9 .4 t o it to It it y o r P9.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS ' P9.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG.7 (OPTIONAL) PUMP PERFORMANCE SPECS. The attached plans and specifications are based on "In- Ground Absorption Component Manual For Private Onsite Wastewater Traatmcn� fivaf -omc it 0rzrci nn 7.111 CRn_1 n7ri_P(mn1 /ni . � o d C t r,-' 1 0 ' -S� y CL -� z o M ti W vv •N TO M O � � �- o a l Z CAJ 00 kA F T, ,, 1�- € 14AP41 1 7 CA�� Uv �NS o 10iw. f2' iff t IN t� L� TEA Y Ao� qui c -L .? F ir' "`. - Iff r 3 �7�z y_ Y OVE R: See Reverse Side for Vent/ observation Pipe Details. t vv � �/saEc T /d � ilk, Iff 11 w s TEM '6 7 A'o SS TA6"ti�s" . ,9f' W &4 Usti T c,V 10W XWS 71,O A.) Iff q OVER: See Reverse Side for Vent/ Observation Pipe Details. POWTS OWNER'S MANUAL &MANAGEMENT PLAN Pa G' FILE INFORMATION SYSTEM SPECIFICATIONS Owner y / Septic Tank Capacity gal p N. Permit # w I =iLd Septic Tank Manufacturer * v S ❑ N. DESIGN PARAMETERS Effluent Fitter Manufacturer ❑ N, F mber of Bedrooms 1j.NAs Effluent Filter Model / o o ❑ mber of Public Facility Units .-�" R-MA Pump Tank Capacity al ❑ N, imated flow (average) al /day Pump Tank Manufacturer ❑ Nj Design flow (peak), (Estimated x 1.5) 50 gal /day Pump Manufacturer ❑ N, Soil Application Rate day /ft2 Pump Model p N, Standard Influent/Effluent y Monthly aver Pretreatment Unit ❑ Ni Fa , it & Grease (FOG) 530 mg /L SandfGravel Filter ❑ Peat Filter Biochemi Oxygen Demand (BOD 5_ 220 mg /L ❑ Mechanical Aeration ❑ Wetiand T at Suspended Solids mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ N, Biochemical Oxygen Demand (BOD,) 530 mg /L Ain- Ground (gravity) ❑ 1n- Ground (pressurized) Total Suspended Solids (TSS) <_30 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliiform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size YB in dia. ❑ JNA Other: 171 N! Other: ❑ Other: ❑ Ni Values typical for domestic wastewater and septic tank effluent. Other: ❑ N/ MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ monthis) (Maximum 3 years) ❑ NA year(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: l g months) (Maximum 3 years) ❑ NA years) Clean effluent filter At least once every: months) ❑ NP ❑ year(s) Inspect pump, pump controls & alarm At least once every: 0 month(s) year(s) Flush laterals and pressure test At least once every: /'� ❑ months) jlrNA J ❑ year(s) Other. At least once every: months) 0 - ❑ NA Other: year(s} ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certification: Master Plumber; Master Plumber Restricted Sewer; POWTS inspector; POWTS Maintainer, Septage Servicing Operator. Tan inspections must include a visual inspection of the tank {s) to identify any missing or broken hardware, identify any cracks or leak; measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pondin of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires th immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entir contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 11 Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or =pressurized components, pretreatmen units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. � � , [ ,e S (y O p C f l r c' g 1 ( t '� e p s sul 2 01"hi Ave Vey 'V%11 54767 START UP AND OPERATION Page 2 — of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemica that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the content of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater wilt b discharged to the dispersal cell(sl in one large dose, overloading the cell(s) l and may result in the backup or surface discharge c effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restorin+ power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls t" restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the are, within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings seated. • The contents of all tanks and pits shalt be removed and property disposed of a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN It the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: l] A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS �[ technology a holding tank may be installed as a last resort to replace the failed POWTS. JG� The site has not been evaluated to identify a suitable replacement area. U' PO placem area is available a holding tank and site may be installed as a last resort to replace the failed POWTS. 0 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLEPrivate Sewage Consultants POWTS MAINTAINER Name 2$12 9 Oth A ve. Name Phone Phone I 16o SEPTAGE SERVICING OPERATOR (PUMPER) OCAL REGULATORY AUTHORITY Name �'� t�19fR �i Name CAP /� • Phone . 0 X a� N d Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)f1)(d) &(f) and 83.5401, (2) & (3), Wisconsin, Admini strative Code. OWNER M AINTAIt3CE - - OF SEPTIC SYSTEM 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 CR-OtT C l y- y Governmental authority/ inspectors - a lA2 7 /s- 3 oO6 L L" * Licensed installer, responsible for providing an operation/ maintenance "Users" manual: t s — ?`7A 3 qL1 Z- . -2 LrL : G� -- M plus 2—Z Cc� 3 t J * Licensed service / inspection agent other than installer: * Electrician, for pump, electric controls, hiring units: 64447 40C 7W IMPORTANT OWNER MAINTENANCE RE UIREMENTS 1. Winter traffic (sledding, shove*ing, 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_ vacaction trip, resulting in no water use) can -also lead to freeze u p s . 2. Water conservation needs to be exercised! system can be hydrolically overloaded and destroyed. This sys�em 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 f result in a temporary overload of effluent being pumped into the cell, which may adversely impact the cell (leakkge). 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. 5. Neglect of the vegetative - cover erosion preventive (the cells insulation & can lead to failure. Compaction or heavy traffic also can des roY t he system. It IS NECESSARY RY T(3 REGULARLY THE VEGETATION OVER A SYSTEM!! fluent in the s Effluent ystem beneath IS NOT sufficient atone to Ef inta u a 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). Onl a licensed properl Person should be Performing Y qual3�ied & severe safety risks. Evidences ofQeffluent involves health system's treatment cell shall also be regularly lyinspected. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERT FORM Owner/Buyer 'w vl E2 �i�'a -�-ZV '�✓ /�- }�/�� Mailing Address M T % /PD U % A eao ie !� Property Address (Verification required from Planning & Zoning Department for new construction.) City /State IV49ra / Parcel Identification Number 0 3 0 - /0), S - zlo LEGAL DESCRIPTION S r. Property Location � E' ' /4 , V4 , Sec. , T N R W, Town of Subdivision Lot # Certified Survey Map # 3- t , Volume Pa e # G�-S , G Warranty Deed # - 7 7 46 8 7 , Volume F , Page # ' Spec house yes no Lot lines identifiable yes 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. Uwe 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. Numb0, f bedrooms - f i / Cd r SIGNATURE OF APPLICANTS) DATE 'Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) G -TX AL f . 6 OOCt ME!iT NO WARkANTY DEED -H FA E RC.,enYEC) 'I'M RE^.e1RC, .. DATA S1'.a1'E R OF WISCONSIN FORM Z -19,32 V0�• 636 A�� 57;3 David H. Strom and Diane I1. Gan.-I, as hia V1'FIU wife and in her own right ST. CROIX Co., WI 'Rec'd fot Record i cones >� ,It...I t..,rr:t:it- to Michael R. Ryan and F,l.izabeth FFB 2 5 1992 B. Ryan, htlsban and. wife, .. as survivorship 10:55 A. M ��V..� marital. propert.y 0 Register of t) described rta! estate i't .- St. . Croi x 5tah� ui �t't,consin: Tai Parcel No ...0.30 - Lot 1 of Certified Survey Map filed in Vol. 3, page 665 of Certified Survey Maps as Dcc. No. 351233. fKA N .w?t ES FEE This is . -- . home -1 property. [acrtttion u, tcarrantie,: Existing highways, easements and rights of way of re, Iliad thi, /f7Tr'� February ia92 ��D 'd H. Strom r t�E_1L) ! Diane M. Cangl AUTHENTICATION ACKNr W LEDGMENT Signature(s) __ ST.a'1'r. OF SC1= C0NS[N . eg S. -.CrolY .. - Count%. " authenticated this - - - - - -- -day of . ....... .... .. 19 ...... Personally carte before me . e thi. - �W G–da)'of -- --- -- -- ---- Februar •-- .. y...._..._... 199. the above named Dav- id.. H.._St -ron ; _ .. and Diane M.__ Gangl,_ husband -.and .wife . -. - -. '''ITLE: MEMBER STATE BAR OF WISCONSIN (If not. -- - -- - -- r authorized by § 706.06, Wis.Stats.) r D. SEVO- - QGEO pu �� t t t , me known to he the uv�nn S I u Lo executed the t NOIA71-Y SCA % *in"- in runt •nt nd acknotvled;:e the same. 7-4 :3 INSTRUMENT NAS DRAFTED BY �(+ �� •,� Ar o- rney--- David Estree b21 ... Second St. Hudson, W1 Not. Puhlic f , G k' Count %, Wis. (Signatures may be authenticated nr acknotcled�ed. Both II >• Ctunmi�.>ion i.s pterntar nt. (li not, Mate exl.iration are not necessary.) } LQ dates G % �� . / 7 _ _ 19' .l *Nan,-s of Persons signing in any capacity ..nou:d Lr ty pe•t .:' F: ina.d t,: !•etc 'h• ir - ..:....,.,... WARRANTY DEED STACF. P:13 OF LL "13COti5!N rnKN !: o. Z-- t• Bi <- . Lx:J I'.hr t'. 030 1015_ q0. e-oo 351233 20015 100 50 0 �.� 200 CERTIFIED SURVEY MAP SCALE IN FEET NE 1/4 SE 1/4- SEC. 6 T -29 -N, R -19 -W N BEARINGS ASSUMED NORTH LINE OF E V4 COR. S00 26' -23 "W ALONG SE 1/4 , SEC. 6 SEC. 6 THE EAST LINE OF (RIVER ROAD) Co. MON. THE SEI /4- SEC.6 66' TOWN ROAD N 89 52' -22" E 33.00' — A 332.80' r ..... I — ` -". _ �, � � .SURYJ;YOtt• C �;x TII!'ICnT;J : I, Uene C. Shaffer, registered Land Surveyor, hereby .� o certify that in full compliance with the provisions EXISTING I , 0 a: of Chapter 236.34 of the Wisconsin Statutes and under HOUSE I I 0 o the direction o1 Tom White, and Charles Copeland, O owner of said land, I have surveyed, divided, and i I z m mapped said parcel of land, that such survey correctly ' r� �0 represents all exterior boundaries and the subdivision M LOT I ' I of the land surveyed and that this land is located in 5.5 ACRES N (D a: the AS 1/4 of the Se, 1/4 of Section 6, T 29 —,i, A - 19 - 4, ai 1 'Town of St. Joseph, 5t. Croix County, Wisconsin, ' 1 further described as follows: Commencing at the E 1/4 corner of said Sec. 0, also NI being the point of beginning of this description; o, I coJ thence S 00 1 26 =23 "W along the East line of the SE 1/4, N M 1308.22 feet; thence S 89- 31 - "vi along the South 24 .35' ��I -' line of the N& 1/4 of the Sig 1/4 of said Sec. 6, 0 - 332.84 feet; thence N 026 � -23 1 1310.29 feet to the S 89 31' -07" w North line of the Sr: 1/4; thence (1 A 9-52 =22" , along 6 , ' i 332.84' /� 3' said North line, 332. feet to the point of W , I N beginning. Above described parcel contains 10 acres �! and of record. M � M I'1 ovE N N Ol 8; I (01 An 2 3 1978 GENE a Z a , LOT 2 o $1. C.torx C ; ,i, .1 T . SSA 325 4.5 ACRES a u COMPaB►IMV1 PAR0 ►LANNINO HUDSON a0D m Z W AND IOMMO COMAUTM 1. co I� Ar'PROVAI OF THIS MINOR SUBDrVJS10hP <O DOES NOT MEAN , ►- - APPROVAL FOR p ` I to w BUILDING SITE OR SEPTIC SY�TEAA. MIMS a 0 oa a w REFER TO H62.20. CSiMFIC A`TE Or' ST. JOSSFd 5 OWN 0" 24.35' �6's� 1 �..,.+.� S 89 °- 31' - 0 7" w J 1 Carlo• n barrette bein g the duly elected , 332.84 , 1O'. qualified and acting 'Town Clerk of' the Town of SOUTH LINE OF St. Joseph, do hereby certify that this Certified Surv 118. has been a y N E a/4 - SE 1/4 Y p a b the 'town hoard of `Down of St. Joseph this l0 day of 1978. LEGEND o = I "X 24" IRON PIPE SET, (P. K.) C 978 eeds tm AUG WEIGHING 1.68 LBS. /LIN. FT. fp � Carloyn barrette, Town Clerk D THIS INSTRUMENT WAS ESTABLISHE0 DRAFTED BY G. G S. BY CO. MON. TIES Nket� JOB N0. 78 - 34 y. C&RTIFIED SUR V,; X ;iT. ChOIX COUNTY, WI. Volume 3 Page 665 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the 1441 /eY ^ J residence located at: 1 /4, 5 F, V4, Section �(o Town Range / W, Town Of S la p k, - , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service 3- Z S Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length'of time: gallons minutes Capacity: /02 O O Construction: Prefab Concrete X Steel _ Other Manufacturer (if known): _ Age of Tank (if known): J �� (Licensed Plumber ignature) (Print Name) 7 S (Title) (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) tllbrichl & associates l'�'1 2s12 Swage Consultants Sprin av�. �x allay, Wl 54767 �: JJ Form - S T C 104 _ r AS BUILT SANITARY SYSTEM REPOR OWNER 00 TOWNSHIP �7 - � SEC. � -- T ADDRESS � Z /r /Ua 10P ST. CROIX COUNTY, WISCONSIN 11vJP1f0,v J0 j f S' y6i � SUBDIVISION LOT 7 7 LOT SIZE s PLAN VIE Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM � f f O f - _ 1 bff ` INDICATE NORTH ARROW w .�— /3,f0 1 5,e� 4�d11-4 4 1-0 7 BENCHMARK: Describe the vertical reference point used �-} ` e> ...Elevation of vertical reference point: - /� • y Proposed slope at site: f O t SEPTIC TANK: Manufacturer : COAX4f k- Liquid Capacity: f - -- - Number of rings used: ,J fr ' - Tank manhole cover 6Ievation': /OaZ Tank Inlet Elevation: �/• SU Tank Outlet Elevation: Number of feet from nearest Road: Front , ,Q Side Rear, O 7 Feet From nearest property line Front ReaX,O feet Number of feet from: well �/ building: �' } - tin - 104 Pte' CHAMBER Z Ma nufacturer ; Pima p Model: Liquid Capacity: P ump /5i on Ma nufactur . ; E levation of inlet: Pump Size Pum Bot P of f to — f swi Lank ele tch el evatio n: va Zon; tion: , Alarm ` ' Gall per c cycle.- Numbe of feet Alarm Switc from nearest pe. Property line: Front, OSid Number p feet from well: '' � Rear, 0 Fr_ Number of feet — - (Include from building; d istances - ces on plot plan). - SOIL ABSORPTION SYSTEN R e d : , 4 , ;Wrench' Width: Length : �7 ' �A R Fill depth to �- ----�. Number of- Lines.' to p o f Pipe: y ,. Area Built-: Number o f fe -- from nearest pro {1 :i perty lin •t , e. Number of feet Front,, Side , Ft. from well: Q� j W _ Rear O Number of feet (Include from building: (p i� ,distance on n plot plan). SEEPAGE PIS Size: umber ,o f pits: 1 i Liquid depth: D'ameter: Bottom of seep s e Area Built: g Pit elevati 'as either a drop box -- tbsorbtion s 0 O distr utio ox ytems? (Check one)`:. Y of `` been used on an OLDING TANK the above soil Man ufacturer : Number of rings us Capacity; E levation on' let, of •bottom of tank: Number of eet from re St i nea Property line:. W ' ont, Numb Side Number o f f Rea r from well: O r, Ft. ' Number of feet build from ilding : Number of feet from nearest road: Alarm. Ma nufacture r: v I nspector. ! Plumber I Job : HQblEStTE SEPTIC h11M81 License �►GCO. feet Number: R r . NHS MA QBFRT UtBRtCHT NS "P feet STAttER & t &GNER tlC. lyp -,:: wwxo wisronsu� - 0 3- L HR APPLICATION FOR SAI�I1TARY PEPV1 1 (PLB 67) "er'T, UNIFORM SANITARY PERMI] In005TRV.LR80R&HUrn rn ReLn7nOn5 — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /zx 11 inches in size. - —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER - MAILING ADDRESS - G kf�,d (�" 5 Ca �'Gi�NI� R 7-. R, �A �.s'o� wi s. SYo, PROPERTY LOCATION _ qq t�T'T"4'2 /V 1 s� 1/4, S , T N, Of E (or W TOW of ` � `�DS>��J �- LOT NUMBER J BLOCK NUMBER SUBDIVISION NAME INEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBI TYPE OF BUILDING OR USE SERVED ' 1 or 2 Family Number of Bedrooms. y [J Public (Specify): THIS PERMIT IS FOR A: �i New System ❑ Tank Replacement ❑ Repair i. Replacement Soil Absorption System ❑ Revision ❑ Privy i Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. X Seepage Bed ❑ Seepage Trench L} Seepage Pit ❑ Holding Tank System -In -Fill ❑ In- Ground Pressure ❑ Vault Priv ❑Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons ' Tanks Concrete Constructed Septic Tank Capacity f Z Q 1� X Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: 4)E_X; j' _ CQ.t3 Q / �e'y tJ IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In- Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump /Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOS D (Square Feet): ?2 1 •n' / r 1 G 1Q �jfP J„ Private I_1 Joint ❑ Public I, the undersigned, hereby assume responsibility for installation o the private sewage system shown on the attached plans. Name of Plumber (l;r,f SEPTIC PLUMBI CO. Signature: � � fdP /MPRSW No.: Phone Numbe p R7 3 O NEIL RD., HUDSON, WIS. 54016 3 3 G'7 ( 716) 3Q G d /� Plumber's Address: ROBERT ULBRICH Name of Designer: "S. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ❑ Owner Given Initial t7 lx — . pp roveJ Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR SBO -6398 (R_ 5/82) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber r PL �7 PLOT an'A SaTI o N FIANS 6, /y am° Soi( TFS/) Zo 614 14 N y,�M "ovt,,.e�X- f° fib dN " o T '4 T N� rip CO) 6XiSTjAj j X S, 6 f "2- N Y y Al SEPTIC PLUMBI . : ., HUDSON, YYIS. 54016 Mh& ROBERT LILBRICHT MINN. INSTALLER & DESIGNER LIC. NO. 00663 Fresh Air Inlets And Observation Pipe S OIL TESTIA5 gy HOMESITE 'iTEST;NG o:0. �.— Approved dent Cap RT- 3, HUDSON, WIS. 51*40116 Minimum 12" Above Final Grade �1 1�5 Fr " Ca r 4 Cast Iron y 2_ " Above Pipe -T'b Final Grade Vent Pipe. Marsh Nay Or Synthetic Covering ( " Min. 2" Aggregate Over Pipe R,� Distribution T Tee 1 " so , L" Pipe 0 0 o 0 o Aggregate 0 Perforated Pipe Below S (�•� Beneath Pipe 1 0 Coupling Terminating. At 9cttom Of System , . /.■a)0 f J % k a k T ° § _ % � « / / E o \ 0 @ & \ ° 2 E 7 � ® - § } z G © U / 9 / § c- / ]/m ® , § Z w § \ 2 Q / ` E E Z ! S r U) (n § ° © (D (a / ( C k co c CL a 0 � @ § ) CD / / 9 . o r ca z 0 0 0 x ' o 7- 2 § § C / / § \ \ 3-2 J \ k k & ° @ CL m $ � & z = z / 0 \ § / I D \ D a ° D N C CL 9 e , z_ \ 3 k CL z \ \ C R. y Z a o ■ m m CL z 0 e q $ 4 $ ® /D 2 r]]\ a $ #ems § CL CD D CL °/ +0 . c ) . � t( � §\ a /C { Q CD � qb � CD { 0 . , § @0 �t $0. ' �/ Parcel #: 030- 1025 -40 -000 04/08/2005 04:35 PM PAGE 1 OF 1 Alt. Parcel M 06.29.19.10361 030 - TOWN OF SAINT JOSEPH Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ' = Current Owner * MICHAEL R & ELIZABETH B RYAN RYAN, MICHAEL R & ELIZABETH B 1148 TROUT BROOK RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 1148 TROUT BROOK RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.500 Plat: N/A -NOT AVAILABLE SEC 6 T29N R19W PART NE SE LOT 1 OF CSM Block/Condo Bldg: 3/665 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 06- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 936/573 07/23/1997 705/89 2004 SUMMARY Bill M Fair Market Value: Assessed with: 4928 282,200 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 83,700 144,700 228,400 NO PRODUCTIVE FORST LANC G6 2.500 49,200 0 49,200 NO Totals for 2004: General Property 5.500 132,900 144,700 277,600 Woodland 0.000 0 0 Totals for 2003: General Property 5.500 78,100 116,300 194,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 311 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 • • ST. L Cju 351233 SURVEYOR'S RECORD 00150 100 50 0 100 20o CERTIFIED SURVEY MAP NE 1/4-SE 1/4- SEC. 6, T-29-N R -19 -W N SCALE IN FEET BEARINGS ASSUMED S00 26' -23 "W ALONG NORTH LINE OF E V4 CDR. THE EAST LINE OF SE 1/4 , SEC. 6 (RIVER ROAD) SEC. 6 THE SEI /4- SEC.6 CO. MON. 66' TOWN ROAD —24— N 89 °- 52' -22" E 33.00' —�► 332.80' c 11I I SURVEYOR'S CERTIFICATE 8' . I `3F. o,,, I, Gene C. Shaffer, Registered Land Surveyor, hereby Q 4' I I.� o certify that in full compliance with the provisions EXISTING a W of Chapter 236.34 of the Wisconsin Statutes and under HOUSE to Y the direction of Tom White, and Charles Copeland, % I °CO owner of said land, I have surveyed, divi e , an Iz m mapped said parcel of land, that such survey correctly �0 represents all exterior boundaries and the subdivision M LOT I ~ of the land surveyed and that this land is located in 5.5 ACRES N 0° the NE 1/4 of the SE 1/4 of Section 6, T -29 -N R -19-W C14 Town of St. Joseph, St. Croix County, Wisconsin, further described as follows: �I I Commencing at the E 1/4 corner of said Sec. 6, also N� being the point of beginning of this description; a ( oil thence S 00 W' along the East line of the SE 1/4, M� 1308.22 feet; thence S 89- 31 -0 " W along the South o , 24.35 I - line of the NE 1/4 of the SP �/4 of said Sec. 6, M 332 .84 feet; thence N 00 =26-23 E, 1310.29 feet to the S 89 31' - 07" W , North line of the SE 1/4; thence N 89= 52 =22 "E along 6 % ^ i 332.84 I � " MI said North line, 332.80 feet to the point of W 1 beginning. Above described parcel contains 10 acres N ' I NI and asements of record 1 a I 1'' oI AUIG 2 3 1978 s F L 0 T 2 LL SI. C�tOIX C:ici. •i Y • S•1325 rn _ Q 4.5 ACRES c i COMPBINENSIVI PARKS ►LANNINO KLWSCN. S co rn I W W AND 30NNG COMMITTEE WI5. CD I APPROVAL OF THIS MINOR SUBDIVISION <� I I DOES NOT MEAN APPROVAL FOR a 9 I I a W BUILDING SITE OR SEPTIC SYSTEM. NIf P . %* w "' REFER TO H62.20. �� 24.35 CERTIFICATE OF TOWN OF ST, JOSEPH 5' - S 89°- 31' -0 7" W I I I, Carloyn Barrette, being the duly elected, 332.84 _ *� IO' qualified and acting Town Clerk of the Town of St. Joseph, do hereby certify that this Certified SOUTH LINE OF N E I/4 - SE I/4 Survey Map has been approved by the Town Board of Town of St. Joseph this f0 day of 1978• LEGEND 8 8 o = 1"X 24" IRON PIPE SET, P. K ' ) Carloyn Barrette, Town Clerk WEIGHINd 1.68 LBS. /LIN. FT. CO FLE 6 THIS INSTRUMENT WAS ESTABLISHED6 AUG 2 1978 DRAFTED BY G.C.S. BY CO. MON, TIES GAMS o' CONNELL 1. \ bylaw of Deeds ( " JOB NO. 78 - 34 14 &six deeply, .� � ts►baosio �, VOL. PAGE 665 •! CERTIFIED SURVEY MAP S ST. CROIX COUNTY, WI. Volume 3 Page 665 Form -STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER �-s � � /�/U� TOWNSHIP JT ' S SEC. T . N-R 11 ADDRESS 1r Z A01 /�1) • ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT ✓ _4 LOT SIZE 4 �e f PLAN VIEW Distances and dimensions to meet requirements of H 63 5 7.„ FVF,RYTHING WITHIN 100 FEET OF SYSTEM r �0 9 i r r � O j , ,� Rff• P f�- poak - /oo*D r INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /'�� , Proposed slope at site: SEPTIC TANK: Manufacturer: 49 1EKS C,0A4 fR_ Liquid Capacity. Number of rings used: ( r Tank manhole cover elevation: !/� SO ' Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,© Si.de,O Rear, O feet From nearest property line Front ,O Side 1 0 Rear, O �a"� feet Number of feet from: well building: y" (Include this information of the above plot plan)( 2 reference dimensions to septic PUMP CHAMBER �" > Manufacturer: Liquid Capacity: Pump Model: Pump /Si n Manufactur Pump Size Elevation of inlet: Bot f tank elevation: Pump off switch elevation: Gall per cycle: Alarm Manufacturer: Alarm Switc pe: Number of feet from near:%Pert(from perty line: Front, O Sid O Rear, 0 Ft. Number well: Number of feet from building: (Include distances on plot plan). , SOIL ABSORPTION SYSTEM Bed: Trench: 8 0 �2- R3 Width: Length: - 1 17 Number of Lines: 3 Area Built: Fill depth to top of pipe: % r / Z- Number of feet from nearest property line: Front, © Side, O Rear, O Ft . 7 i Number of feet from well: S Number of feet from building: CIS (Include distances on plot plan). SEEPAGE PIT Size: umber of pits: D ameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distr utio ox O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings us Elevation of bottom of tank: Elevation of • let: Number of eet from nearest property line: \ont, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: � � / HOMESITE SEPTIC PLUMBING CO. Dated: Plumber on job: : ROBERT ULBRICHT License Number: WIS. MASTER PLUMBER I IcNa 3307 MPS IL MINN. INSTALLER & DESIGNER LIC. N0.00663 3/84:mj RTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION jX 7969 BUREAU OF PLUMBING )SON, WI 53707' s� XN CONVENTIONAL ❑ALTERNATIVE StatePlanl.D.Number: (lf ned) ❑ Holding Tank El In-Ground Pressure El Mound assig NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE p Charles Copeland R. R. 2, River Rd., Hudson, WI 9— BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: NE SE, Section 6, T29N —R19W, Town of St. Joseph Name of Plumber: MP /MPRSW No.: County Sanitary Permit Number: Robert Ulbricht 3307 St. Croix 49510 SE PTIC TANK/HOLDI MANUFACTURER: LIQUID CAPACITY. TANK L T ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKINGgOV R 1 p P ARMING : PRO IDE O ! 7. �1 YES ❑ NOES I_1 No BEDDING: VENT DIA.: VENT MATL.. J HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FR 5 � LINE 2 — ❑YES AIR INLET: NO ❑YES ONO NEAREST I i DOSING CHAMBER: MANUFACTURER 71 LIQUID CAPACITY PUMP MODEL. J PUMP/SIPHON MANUFACTURER ARNING LABEL LOCKING COVER OVIDED PROVIDED: ES ❑NO ES ONO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUIVI F PROPE WELL BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEE F uN AIR I NLET: PUMP ON AND OFF) ❑YES ❑NO I RE_ go SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing GTH DIAME R MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN' CONVENTIONAL SYSTEM: WIDTH LENGTH J NO�OF DISTR. PIPE SPACING. COVER INSIUE DI A.. #PITS. LIQUID NI TRENCHES M IA L: DEPTH: °�II�EIII�s , C � �� � �` ( f �L P IT ' GRAVEL DEPT} FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DIS UMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PI�P(E / ABOV COVE�t. ELEV. IN ELEV EN PIPE FEET FROM LINEr^ ` © C AIR INL 'F' 1 Z ( . / Z. r Z J NEAREST / j (7J J l / MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES NO SOIL COVER I TEXTURE PERMANENT 7's OBSERVATION WELLS "'A Ejvts N{7' DYES ❑NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL. O ED D. MULCHED: CENTER EDGES YES O ❑YES ❑NO ❑YES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH: NO.OF LATERAL SP ING. RAVEL EPT a LOW PIPE-. FILL DEPTH ABOVE COVER: k1El~ItRf�Ntslt " TRENCHES: r ee °�III�ENS1l�N^� a ` MANIFOLD PUMP MANIFOLD DISTR, jAMANIFOL tATERIAL. IN DI TH. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. P _ ELEV.: ELEV.: DIA.: ELEV.: PIPES DIA.: tI�TI�I#N HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERI L. VERTICAL LIFT CORRESPONDS TO APPROVED � PLANS. ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: N BEhI 6F PROPERTY WELL: BUILDING: FEET FRAM LINE: ❑ YES ❑ NO ❑ YES ❑ NO aEAREST �c a � Z L`1 In Sketch System on In my file for audit. w Reverse Side. SIG E. TITLE. DILHR SBD 6710 (R. 01/82) wlsconsln APPLICATION FOR SANITARY PERMIT , (`` DILHR (PL13 67) C OUNTY OEPRRTmEnT OF UNIFORM SANITARY PERMIT # 1n0UST&V LABOR & mumRn RELRTIOnS _41R5/40 — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /zx 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS e #,J �� 5 ro EGA'�✓D S T'. z �E'i'v 2i �o • 11 &P ro-J 401f. 5 Your. PROPERTY LOCATION qq crrr /V� /4 s�1/4, S , T N, Of E (or W Tow S � ' SOf� �— --] LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: y [� Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair l Replacement Soil Absorption System ❑ Revision ❑ Privy Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. X Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank J System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity X Lift Pump Tank /Siphon Chamber / V 1 4 Holding Tank capacity Manufacturer: GQ Q / �O IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In- Ground Pressure Total *of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROD (Square Feet): �Z v P 1/ 7 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation o the private sewage system shown on the attached plans. Name of Plumber ( AISITE SEPTIC PLUMBING CO. Signature: �� idle /MPRSW No.: Phone Nu : p 111T. 3 O'NE1L RD., HUDSON, MS. 54016 r !� 3 36 1 - 7 ( /S ► a 1 B Plumber's Address: ROBERT ULORICHT Name of Designer: "S. MASTER PLUM66R LIC. NO. 3307 M.P.R.S. MINN. iNSMLLER & DESIGNER L NO. 00663 COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved �U El Owner Given Initial ( 6 -&4 % Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR -SBD -6396 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber r , INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 ' Y To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.) ; 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. APPLICATION FOR SANITARY PERMIT S T C - 100 This form is to be completed i full and signed b the owner (s) of the n u PP, P g Y ( ) property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractQ]�,( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - -/,- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property e "` / 44t- Location of Property ' S 1 4, Sectio T N - R W Township �� • �6 n Mailing Address Subdivision Name Lot Number ,p Previous Owner of Property Total Size of Parcel ft S Date Parcel was Created Are all corners and lot lines identifiable? ' Yes No Is this property being developed for resale (spec house) ? Yes l` No Volume and Page Number Y 7 as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. -------------------------------------------- PROPERTY OWNER CERTIFICATION I (We) ce&tt 6y that at t btatement6 on .thin jonm an tAue to the bat of my (ou,%) knowledge; that 1 (we) am ( ace) the . owneA4.6) o 6 the pno peAty dea c i.bed in thi.6 injonmation jo,%m, by vixtue of a wavcanty deed %eco&ded in the 0jjice o6 the County Reg-%a.teA o f Deeds as Document No. Zbo 3 9 21 ; and that I (we) paeaentty own •the ptopoaed a.cte bo,% the sewage di,6 poZat byatem (on I (we) have obtained an easement, to nu.n with above deacti.bed pnope&ty, jon the con tAuction of said �ya.tem, and #ho name has been duty %eco in the 066.ice ob the County RegizteA of Deeds, u Document No. ) . X \ SIGNATURE OF OWNER SIGNATURE OF CO -OWNER (IF APPLICABLE) /�8< DAT SIGNED DATE SIGNED WARRANTY DZILD.—To Husband and Wife as Joint Tenants FORM 3" (Revised) MIL*.UL19 283341 Thi Indenture, Made this ........................ ....... ....... day of. .......... FetrU.Rry .................... ...... in the year of our Lord, one thousand nine hundred and ...... UX& Y.::,91A ............... between ........................... .............. .................. R 0 1 ,4 Fn . u v - r ........ r - 11 1 t - 3 1— V V I v -------------- ...................................................................... ... ......................... . ......................................... --- ..part.Aes..of the first part, and ...... �hu L. CopelsncL ond Joris J. Copelsjrd, his wife .............................. ................................................................................................................................... ............. ...... ... 2.1 ...... ...... _ ......... ........ ------------------------------------------------------------ ----------------------------- o . H.u.u.so.n .. . ­ husband and wife, as joint tenants, parties of the second part. Witnesseth, That the said part .... i.e.s .... of the first part, for and in consideration of the sum of ........ �QnA ( And other valuable consluer'-tions 1,�Q .... ) .... Jo-11sp -- u - y other ... ....... ........... to ...................__.. hand paid by the said parties of the second part, the receipt whereof is hereby confessed and acknowledged, ha__Ye .... given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and 1) � these presents do_..We. --give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said parties of the second part, as joint tenants, the following described real estate, situated in the County of ...... -----------_---- ..... ... S . Croix -------- ------------ - --------------_ - ----- __ ..... and State of Wisconsin, to-wit: ii East ten acres (10) of',tha hEl of the SE 1 - of Section 6, T 291\ R 19 IN. • ir6gether with all and singular the liereditaments and appurtenances thereunto belon or in an) wise apper- taining; and all the estate, right, title, interest, claim or demand whatsoever, of the said part. !e.19 ... of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their heredita- ments and appurtenances. To have and to hold the said premises as above described, with the hereditaments and appurtenances, unto the said parties of the second part, as joint tenants. VVL 4911 rvF548 • . And the said ............... .:Harold- .F...Bau�er and Roselle Bauer, his wife ............................................... ............................... .................. ' .............. ..................... ....._.._ • ...... -- .............. -- ... • -• --------- .......... -----.... ._........-- .....-- -- ..._.. - - -- part.,, ie sof the first part, for ... ....... their ..... . ..........h executors and administrators, do .... they ...covenant, grant, bargain, and agree to and with the said parties of the second part, and to and with the survivor of them, his or her heirs and assigns, that at the time of the ensealing and delivery of these presents..... ... _.... ...= re._..- ........ ----- well seizedf the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee Simple, and that • the same are free and clear from all incumbrances whatever, .--- .------------------------------------------------------------- ------------------- . -------- .------ • I n i ------------------------- -------------- ------------------------------ ..-. ------------------- ..._.-_-_.-_.-..____.._ -------- ....... .. ---------- ._..__...._.......................... .._.. ....... .. ---------- and that the above bargained premises in the quiet and peaceable possession of the said parties of the second part, as joint tenants, his or her heirs and assigns, against all and every person or persons lawfully claiming the whole or any I part thereof, ---- they - _.. - Will forever WARRANT AND DEFEND. In Witness Whereof, the said part _.i.e s.of the first part ha ... v e.._hereunto set__ the it _ -hand s -.and seal .... ­this ------- 7 �- �- - - -- - -- -__day of---------- -Febr -- - - - - -- A. D., 19_.E6._. I I l Signed, Sealed and Delivered in Presence of ....... ...... . . . . .. . EAL) ..... Harolu F. Bauer .................... F _ . ( SEAL) Rosell Da Richard J. Kinney n •- ------ •• --•--- ........ (SEAL) -- --- --- -------------- ---- ---------------- -- --------------------- - - - ---- - ----- (SFAL) . VATE OF RtI��;QNSIN, t -- ---- St- -•-Q Qli �... County. t rme sonal , this .----- - - - - - - - 7-------- ---- - - - - -- Ei � 6t -- -.day of------------- ---Eet�r_u� _��... - - -- -� - - - -- 9- -B p r the above A �3rold F. Bauer Kns osella Dauer, his wife I to me known to be the person.- 9_w•ho executed the foregoing instrument and acknowledged the dame. I� xichard J. Kinney tary Public ...... stt_t_..gxO.iX. ...... County, Wis. ` Commission Pxpires ...... 4-y .13 -,, 1919.... I I I I i •,• _ _� . _ _ ... .hall have plainly printed or typewritten thereon the L\n.0 "nteee, w,cawca and notary) rte, boy ril { O G -E t`'�e �v i • 1 i d w W z LLI Grj h " m O Q H a�i f a lCr d C H �'� o I I Z 7d q CS { Nc > { (� ti _ y ST C- 105 r ✓ SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z a H OWNER / $+%'iF&R c" DD ROUTE /BOX NUMBER 47 Z- ' �` /y'�' �`� Fire Number CITY /STATE � /zv'p ZIP PROPERTY LOCATION: `— '�, � �4, Section T N, R Lf___0 Town of 'sf' J - OS� / " St. Croiy County, Subdivision Lot number Improper use dnd maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con - sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. yo I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart - v ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. S I G N E D , 0 y� 4r, /e + A,�� /qty DATE f� tl�Y� // a St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715- 796 -2239 or 715 -425 -8363 Sign, date and return to above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION LABOR AN PERCOLATION TESTS ( P.O. BOX 7969 HUNAN RELATIONS \ / MADISON, WI 53707 • I (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIPWUP1f�FP�4L -IiY: LOT NO.: BLK. NO.: SUBDIVISION NAME: tiE 1 / 1 / G /T N/R /q E (o 5Y J 64-- P,4oe of /0 .4 4.e- COUNTY: OWNER'S NAME: MAILING ADDRESS: S� Cro USE DATES OBSERVATIONS MADE NO. BE RMS.: 1COMMERCIAL DESCRIPTION: PROFILE DE R T DNS: E A ION TEST 5: Residence 1 (1,4— El New Replace /� _ d RATING: S= Site suitable for system U= Site unsuitable for system f G —/A CONVENTIONAL: MOUND : IN- GROUND-PRESSURE: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ©S 01) � S ❑� ®$ ❑� ❑ S u ❑ S ®� �'o,v vEA7io.�l A/ If Percolation Tests are NOT required DESIGN RATE: 10 Q. F If any portion of the tested area is in the �J under s.H63.09(5)(b), indicate: /S�LrC�f�/Y� I Floodplain, indicate Floodplain elevation: * rJ — /N 3>ecimal Fr. PROFILE DESCRIPTIONS BORINGI TOTAL DEPTH TO GROUNDWATER -IN Fr CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B -1 7S /00. /d �� > 7S ' /08' &1 -6y. fl /.0'G!/ 5. , .5 ate . caw. /ca s/ w B - 8 5 / /C�1/e / /•tr" ), S" 1 /3a -G s•'/ / : /3 Si /, y/ , �- 8a CovRIA /6O • w B -.3 • ��' *16— Q ' '?S' u 6y si /u /o , /,d8' Bu. s, /� 7. /7' - /3 /6.0 ' K B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER IN AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERT D2 P R PER INCH P- P_ 2, P -_ P- Z * r Cr / G 1 1-33 P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 13oTjoM � �E'v c�,�'crlvar — 9(�. p r _ _ ____7 _ ( � S r C'Z jL Ar E r z �d2 D oT _ je 3 N M OSrI Tt('_ -31G'E U _ y I i I C i / .._L >._ .. T _ _ [ E all I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): QOM TESTS WERE COMPLETED ON: JATE ROVED SITE EVALUATIONS (PERC MSM 7- 1 ADDRESS: MINNESOTA LICENSE NO. 00663 CERT NUMBER: PHONE NUMBER (optional): NSIN LICENSE NO. 55-02482 f �� _. 2 IM0%QTTlCii RD J � �, CS NATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) — OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - S6D - 6395 To be a complete and accurate soil test, your report r trst include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial.project; 3, MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes, A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating Your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; B. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification nurnber; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10 ") BR — Bedrock cob — Cobble (3 - 10 ") SS -- Sandstone gr -- Gravel "(under 3 ") LS — Limestone s — Sand HGW — High Groundwater cs -- Coarse Sand Pere — Percolation Elate coed s — Medium Sand W Well fs Fine Sand Bldg — Buildinc Is Loamy Sand > ._- Greater Than sl Sandy Loam < — Less Than *I — Loarn Brn -- Brown sil — Slit Loarn BI — Black si — Silt: Gy — Gray ci — Clay Loan-i Y Yellow scl -- Sandy Clay Loam R — Red sicl — Slty Clay Learn naot -- Mottfes sc - Sandy flay vvf' — vvith sic -- `.silty Clay fff — feivv, f'lmr X h c Clay cc — cornrnon, coarse ¢7I feat rmin — Ma+iy, Wt;d;OM rn Muck d — distinc? • P -- prornir "er;t HVV L High watr.r level, Six g(ineral soli textures � surface water for liquid waste disposal BM - Bench f0laA V RP -- Vertical Reference Point TO THE OWNER: This soil test report is the, tit'st step in securing a sanitary permit. The county or the Department may request vei of this soil test in th field prior to permh ;ssuancc. A cormi)rr ,i*-° set of plant: for the private sevva 'Je system and a permit application must be suhnritted t6 1he arveipriaie local authority in order to obtain a permit:• The sanitary permit must -be cbtaified and.posted pj i.or to the start of any construetiorl,_ l f �f PL �7 A" T- s CEO PLOT Q„d CR o 55 20 _— ----y� 0 ---�. SECTI PIANS 6� 1 _ • 6 1 ' ,3 C7 poi T FS7 ( / �NE rSTw 67 rr /bo 0 Pif 0 1,GTT a te„ �,, ��.� ,A� N6 y f y s, �,, zyA, /I /lee sr • doPya, T co j . S' itGNFD �G�•i �CE�1/SE NUMESITE SEPTIC PLUM81 • ., HUDSON, ffl 54016 ROBERT ULBRICHT WIS M 4TFR Pt 1 IM2EQ LIC N9 -34? M•i .R.S: � MINN. INSTALLER & DESIGNER LIC. NQ. 00663 Fresh Air Inlets And Observation Pipe SOIL reSr1ay I3y HOMESITE TESi•'NG J :O. Approved Vent Cap RT -A O'NEiL Rte , ) HUDSON, WIS ' =4o16 Minimum 12" Above k Final Grade VJ � = / F r MAX' M v M c 4" Cast Iron 1-/2- ° Above Pipe Vent Pipe To Final Grade Marsh Hay Or Synthetic Covering Min. 2 Aggregate Over Pipe �6w L Distributi 0 0 0 0 _ Tee So' Pipe 0 y S T " Aggregate o Pertorated Pipe Below L� Beneath Pipe l Cou in Terminating o Coupling 9 At Bottom Of System