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030-1032-20-300 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479225 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: Studelska, Charles & Roxanne I St. Joseph, Town of 030 - 1032 -20 -300 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 08.29.19.112D30 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark (,.nJ, 17 /051 • III /db Dosing Alt. BM Bldg. Sewer ► rz • J 6 3Z !Hl St/Ht Inlet 13.339Z. St/Ht Outlet TANK SETBACK INFORMATION "� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic i 1 1 ! / Dt Bottom ' ra Dosing 7 f 1 / I / Header /Man. Aeration Dist. Pipe t-, $ �- Holding Bot. System Y � 7.77 9c,,. PUMP /SIPHON INFORMATION Final Grade I7 IM Manufacturer Demand St Cover GPM ` ,�� � ti • Z Model Number C '3 _r, OV 1 1I M-47 "' IZ,-7 1* 1Z /d,. / 3 • z- TDH Lij� c6 Frictio Los 7 System ead TD� Zt r ��.. �� i Forcemain Length Dia. 11 Dist. to well 2 SOIL ABSORPTION SYSTEM BED/TRENCH Width r Length No. Of Trenc �+ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ?� Cj6 - a �t eh "I-, � SETBACK SYSTEM TO { P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. F /cam INFORMATION CHAMBER OR �/ Type Of System: ] // / /A_ UNIT Model Number: N / dot DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Atom ntake p � Pipe(s) Length 0 Dia Length � Dia Spacing 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 j Bed/Trench Edges Topsoil \ Yes ] No "' Yes F No COMMENTS (include code discrepencies, persons present, etc.) Inspection #1: ! / Inspection #2: / / Location: 503 Nelson F L e Hudson, W 54016 SNE 4 NE 1/4 8 T29N R19W) NA Lot 4 Parcel No: 08.29.19.112D30 1.) Alt BM Description =Ow�t 1 / J 2.) Bldg sewer length = 1 I - amount of cover = , ! Plan revision Use other side for additional o additional informs Xion � 11 �1Z ._� � ___ ______ _ _- _ _' ✓ _ _ — Date Insepctor Signat Cert. No. SBD -6710 (R.3/97) Safery and Buildings Division County 201 W. Washingron avc., P.O. Box 716_" 1 4. Madison tiV1 >3707 — 7162 anitary Permit Number (to be ]led in by C,;.; 1..1epartm Of Cemrnerce (608) _fm) e_ Stare ]an I.D. Number Sanitary Permit Ap licatii� In accord with CJntm 83.21, Wis. Adm. Code, personal information provide may be used fur secondary purposes Privacy Law, s I >.0 (1 ,_; ' proje Address (if different than mailing addi cssl ipplie�itiouInforination — PleasePrintAllInformation S_t Cku' „Outs; 5 e- 5 03M6C_SOAj r - �p+�t L,operty Owner's Naaw # Lot # Bloc + k kc-c 'roperty Ow s Mailing Address Property cario —` City, State Zip Code Phonc Number + %, fQ % <, Section I ` ctrc e} ' tea. `fyp,: of 33aildina (chccic all that apply) T 11 1 N; R � "1 E t �W ;.��,// S K L$ 4�ur Fautily Dwelling — Number of Bedrootrw 5 — (j Subdivision Name CSM Number i U Public /Con'tri'teroial — Describe Use — _ DStawOwned- Desciiba,Use ❑City_ ❑Village ownshipof I#, ' Type of permit: (Check oalv one box on line A. Complete line B if applicable) D p _ p 3 Z _ ��Z _ O Replacement System Tieatmenn'Holding Tank Replacement Only ❑ Other Modification to Existing System -- ❑ Penuii Renewal ❑ Permit Revision ❑ Change of i U Permit Transfer to New List Previous Permit Number and Dare Issued Before Expiration Plumber Ownzr IV. `ivj*pe ufPOWTS System: (Check all that apply) - j Njo( In- Ground ❑ Mound >_ 24 in. of suitable soil ❑ Mound c 2-4 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter Cunsuucted Wetland ❑ Pressurized hr Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ l eci rculating Synthetic Media Filter 0 Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe [a Other (explain) V. INS eYSrl/Treattnent Area Information: 0 4a N — Dcsip Flow (gpd) Design Soil Application Rate(gpdsfl Dispersal Area Required (si) ispersal Area Proposed (sf) System Elevation 9 cc V1. Tank Capacity in Total Number Manufacturer Prefab Site Steel Fiber PlaSti Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tatil -- a�roi:ic 7Yrattt>eut Uuit —_.._ _ Dosing Clamber G Vii. Responsibility Statement I , the undersigned, assume I-espoflsellity for installation of the POWTS shown on the attached plans. Pfunil oes Nance (Print) Plumb ' ig MP/NIPRS Number Business Phone Number n r t ti CA l 3 Plumber's Address (Street, i t, State, Zip ode) V 1 1L Coun IDe artment Oul -- Cx Aplaruved ❑ Dis• Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Sramps ) Surcharge Fee) u Given Reason for nial M Couditious o ' pprova SYSTEM OWNER: 3� R.�Qr,167C16,n �nX q 1 Septic tank, effluent filter and p � dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained �{) 0 vv as per applicable code /ordinances. I ta t Z Calk Attach complete plans (to the County only) for the system on paper not less than 81/2 a 11 inches in size SED - 6398 (R. 01iO3)) �s AAV� 3 , (\ 0 l ``fi cam. �`a-41 C U Tlwi A ZZA�W!47ka90 - G t � J � • G .`ht r.22��t Za -oova ter CA y co O 5> � t S tA rnn "ISCOn-Vin EVALUATION REPORT #2251 Department of Commerce in a with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings n 8%: x C; [? � E a 1 � County Certified Soil Testing, LLC Fy Ti i�,tkt Attach complete site plan on paper not les 1 inches in size. St. Croix include, but not limited to: vertical and h lz efere a poi t (BM), direction and percent slope, scale or dimensions, north r nd to ation stance, to, fl�5 030 - 1032 - - 000 nearest ro Parcel I.D. p Please print all ti ) n. S iewed By Date Personal information you provide may be used for rposesq�4F�h),(t) ( ` Property Owner V Locati Spangenberg, Ronald & Deloris Govt. Lot NE1/4, NE1 /4, S8, T29N, R19W Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# 497 Nelson Farm Lane 4 687298, V 16, P 4354 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Hudson WI 54016 715 - 386 -8030 St.Joseph Nelson Farm Lane New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial - Describe Parent material sandy /loamy outwash Flood plain elevation, if applicable NA ft. General comments install "conventional" in ground trench system @ system elevation of 96.4 w/ 0.7 gpd /sq ft loading and recommendations: 1 Boring # Boring Pit Ground surface elev. 99.4 ft. Depth to limiting factor > 84 in. iSoil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. M Qu. Sz. Cont, Color Gr. Sz. Sh. * Eff#1 *Ef##2 1 0 -12 7.5YR 3/2 - SO 2 f sbk mvfr CS 2flm .6 .8 2 12 -24 10YR 4/3 - A 2 m sbk mvfr Cs lm .6 .8 3 24 -47 7.5YR 4/4 - s 0 Sg ml gs - .7 1.6 4 47 -84 10YR 4/4 - s 0 Sg ml - - .7 1.6 / �(o • 0 3,r z some gr below 24 "; stratified 7.5YR 3/4 Is bands: 1" @ 68,73,76,09" 2 Boring # F [] Boring Pit Ground surface elev. 100.1 ft, Depth to limiting factor >96 in. Soil Application Rate Horizon Depth Dominant Color ` Redox Description Texture Structure Consisten Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 •Eff#2 1 0 -9 7.5YR 3/2 - sil 2 f -m sbk mvfr Cs im .6 .8 2 9 -22 10YR 4/3 - Sil 1 m sbk mvfr Cs Im .4 .6 3 22 -32 7.5YR 4/4 - sicl 1 m abk mfr gs 1m .2 .3 4 32 -44 7.5YR 4/4 - s 0 Sg ml gs - 7 1.6 5 44 -96 10YR 4/4 - s 0 Sg ml stratified 7.5YR 3/4 Is bands: 1" @ 59,63,65,71 04" * Effluent #1 = BOD 5 > 30 < 220 mg1L and TSS >30 < 150 mg /L * Effluent r2 j= D < 30 mg AL and TSS < 30 m g /L - CST Name (Please Print) Sig t re: CST Number Henry F. Grote 1 222774 Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number E. 4366 353rd Ave. Menomonie, WI 54751 5/21/2005 715- 233 -0398 SBD -8330 (R- 07/00) Property Owner Spangenberg, Ronald & Deloris Parcel ID # 030 - 1032 -20 -000 Page 2 of 3 , T Pit Boring Borin # g Ground surface elev. 100.2 ft. Depth to limiting factor >97 in. Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure ' Cottsls � B,6undary Roots GPDlft' in. Munsell Qu. Sz. Cont. Cola Gr. Sz. Sh. `Eff#1 `Eff#2 1 0 -13 7.5YR 3/1 - sil 2 f sbk mvfr cs lm .6 .8 2 13 -23 7.5YR 4/3 - sil 2 m sbk mvfr gs lm .6 .8 3 23 - 29 7.5YR 4/4 - sl 1 m sbk mfr cs 1m .4 .7 4 29 -58 7.5YR 4/4 - s 0 sg ml cs - 7 1.6 5 58 -97 10YR 4/4 - 5 0 Sg ml - - .7 1.6 H2 has occasional gy si coats on peds; stratified 7.5YR 3/4 Is bands: V @ 77,82,85,88,90,92 &94" I i I I ` Effluent #1 = BOD > 30 < 220 m !L and TSS >30 < 150 m JL " Effluent #2 = BOD < 30 m /L and TSS < 30 m !L s g g s g - g I The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00 ) Certified Soil Testing, LLC i I �U . S n5 �, > G —e-Ye" S Gtit L2Z'}� --xK�. OSO -1�bZ Za -Oog 4cO r t e 4 3 S. (V e. S i-J.-e n +` S l �e t - 6 1 POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner t ,; Septic Tank Capacity C gat C3 NA rSej tic Tank Manufacturer ❑ NA Permit ZZS uent Filter Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Model ❑ NA Number of Bedrooms I00gpd/bedroom ❑ NA Pump Tank Capacity gal ❑ NA Number of Commercial Units NA Pump Tank Manufacturer i — 0 NA Estimated flow (average)* � gal/day Pump Manufacturer E3 NA Design flow. (peak), estimated x 1.5* al/day p Model ❑ NA Soil Application Rate gal/day Pretreatment Unit 12TNA Influent/Ef#luent Quality (NA [I) Monthly Average ** p sand/Gravel Filter O Peat Filter Fats. Oil & Grease (FOG) 5 30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) [3 Disinfection r-3 Other: Total Suspended Solids (TSS) 5 220 mg/L Manufacturer: Model: 5 250 mg/L Dispersal ell(s) Pretreated Effluent Quality ❑ Monthly Average * ** In- ground (gravity) [3 In- ground (pressurized) 5 Biochemical Oxygen Demand (BODs) 30 mg/L At -grade ❑ Mound Total Suspended Solids (TSS) 5 30 mg/L [] Drip-line ❑ Other: Fecal Coliform (geometric mean) <I0 + cfu/looml ❑ Leaching Chamber Manufacturer 7T — Maximum Effluent Particle Size 1/8 inch diameter Model )C),() Approval Stipulation *Wastewater Flow Verification on and calculations: Soil Application Rate D, �_gp d/f Area Req. fi (Other than bedroom based) Absorption Area Credit per unit 5 O ft Minimum Number of Chambers I P) ❑ Aggregate Design Flow/Loading Rate= min ** Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMMM and be installed per manufacturers specifications ** *Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA ❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 Ci . "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 p "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis — ASAE Publications 5 -77 and "Design Manual — Onsite Wastewater Treatment and Disposal Systems ". EPA 625/1 -80 -012 October 1980 Q SBD — 10570P (8.6/99) "At -Grade Component Manual Using Pressure Distribution" BD 10567—P (8.6/99) "In Ground Absorption Component Manual" tj SBD- 1 0705 -P (N.01101) "In Ground Soil Absorption Component Manual" Version 2.0 p SBD 10628 -P (N.6/99) "Recirculating Sand Filter System Component Manual" p SBD — 10656 —P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" SBD - 10572 P (86/99) "Mound Component Manual" p SBD 10691—P (N.01101) "Mound Component Manual" Version 2.0 ❑ SBD - 10595 —P (8.6/99) "Single Pass Saud Filter Component Manual" ❑ SBD - 10657 P (8.6199) "Drip -line Effluent Disposal Component Manual" ❑ SBD - 10573 P (R 6/99) "Pressure Distribution Component Manual" E3 SBD - 10706 —P (N.01 /01) "Pressure Distribution Component Manual" Version 2.0 p Drip-line Effluent Dispersal Component Manual for Multi -flo Onsite Wastewater Treatment Units a MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Frequency Service Event Inspect condition of tank(s) At least once every O months ear(s) (Maximum 3 yrs.) Pump out contents of tanks) When combined sludge and scum equals one -third (1/3) of tank volume Inspect dispersal cells) At least once every !7 months 10 year(s) (Maximum 3 yrs.) Clean effluent filter At least once every [3 months years) Inspect pump, pump controls & alarm At least once every ❑ months G2ye arls) c3 NA Flush laterals and pressure test At least once every ❑ months year(s) 13 NA Valves At least once every .[3 months years) [3 NA Other: At least once every ❑months `❑ year(s) NA Page of START UP For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. Valves Valves shall be operated in the following g manner: Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. INPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Septic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more in the maintenance schedule to keep the stem . o eratin frequent intervals than stated p system operating. E3 Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. Cn- Ground Gravity Component Dispersal Cells E The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. page of ❑ Mound, At- Grade, In- Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil 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. [3 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. C3 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 CONTIAN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name Agenc Phone Phone K. WPDATMEWOWTS OWMEL'S MANUAL.doc Page of ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND . OWNERSHIP CERTIFICATION FORM cL fk P &°►h+ti.� 3 S kdc -c: Owner/Buyer C,�v _ Mailing Address 3 7 �J� v A Property Address c5b3 W ,O --i � ✓►'► G �'�— r [rim � �''� W `t �f to (Verification required from Planning Dep ent for new construction.) City /State - Oru 3 So/1 I W � Parcel Identification. Number LEGAL DESCRIPTION , ++�� Property Location 1 '/a I , 1 '/a , Sec. T c;�9 N R f W, Town of 5 0OWh Subdivision A) , Lot # . Certified Survey Map # �zq� , Volume Page # Warranty Deed # 3 Volume 2 5 d , Page # Spec house yes o� Lot lines identifiabl 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. 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 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. T ion stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Departme t within 30 days of th three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I/we certify that all statexpents on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the erty described above e fif a warranty deed re orded in Register of Deeds Office SIGNATURE OF APPLICANT DATE • * * * * ** Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. FORM - STC - 104 IL Y AS BUILT SANITARY SYSTEM REPORT l � - t OWNER =X.4TAl2444i z,4wroM TOWNSHIP SECTION a� N - R /Z — W ADDRESS - 19 - /0 ST. CROIX COUNTY, WISCONSIN SUBDIVISION A/A LOT LOT SIZE A d PLAN VIEW ad SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �✓�� Aso' i'v .t/n/!rM :.... .... Eir5 r CC 5',D�P' 3 403�•l O✓ r 1 0 1 . /oov Ott SepTi kvk, luSRc au �Np kAgPu�✓1 �j'oO5�4 J4 ", \ wctt p ti Sok rH �PoFEDr btu tf (, n/t DICA E NORTH ARROW r� /NC BENCHMARK: Elevation and description: 3.F5� Alternate benchmark NA SEPTIC TANK: Manufacturer - Liquid Cap loop r,A, Rings used :„LManhole cover elev: 00.si Final grade elev: ro' Tank inlet Tank outlet elev.: NO. Of feet from nearest road :Front , Side Rear Ft. 53S' Frow nearest prop. line :Front ; Side ' Rear Ft. !.*S: No. of feet From: Well Ito` , Building : 39 (Include this information in the Above plot plan) (2 reference dimensions to septic tank) i Private On Site Wastewater Treatment System (POWTS) Index & Title Sheet Owner: �� Y ��� Lr t L ) X C Q Ill Project Name and System Type: Location: Street Address Le d Descri tion � P . k S4, ,,V e"( y Township /County Contents: Page 1: Sanitary Permit Application Page 2: Plot Plan Page 3: Soil Test Page 4: State Approved Plans Page 5: Septic Tank Maintenance Agreement Page 6: Warranty Deed Page 7: POWTS Owner's Manual Ma Plan Page 8: POWTS Owner's Manual Management Plan Page 9: POWTS Owner's Manual Management Plan Page 10: Certified Survey Map Page 11: Copy of House Plans Attachments: Plumber/Designer: Mike Rogers Sign Credential Number: 225094 Date: o aoo i Chamber SAS SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Soil Absorption Systems L ! Owner's Name I 5/31 /05 Review Date �Y or N Highly Pretreated Effluent 3 ft Suitable Soil Below System 12 in Chamber /Unit Height 8 ft Maximum Bury Depth 3 Ezflow EZ1203HP & EZ102H 600 Igpd Estimated Daily Peak Flow 0.70 gpd/ft' In -situ Wastewater Infiltration Rate 857.14 ft` Chamber /Unit Area 50.00 EISA ft / Unit 18 # of Chambers /Units 96.40 ft Proposed SAS Elevation 26.50 Bottom Area ft` / Unit Soil Surface Acceptable Finished Grade EL 4 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 98.40 105.40 1 99.40 84 95.40 97 y Yes 2 100.10 • 96 95.10 9 , id Yes 3 100.20 97 95.12 97. Yes 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Total height of chamber in inches. 3. Maximum bury depth as per manufacturer's recommendations. 4. Based on chosen system elevation, and chamber height. Top of chamber is finished grade may be required to meet minimum or maximum code standards. D 7 G/L 7 15 " c fl v. h� ,.» f,:► / /rG� N1 ybi�r �tcT i� , Y� . a � Version 4.0 04/03 TDH Calculations TOTAL DYNAMIC HEAD CALCULATIONS Gravity or Pressure Dosed Systems Owner's Name 1 5/31/05 Review Date X g Gravity Dosed, or 600 gpd Design Wastewater Flow X Pressure Dosed ft Total Combined Lateral Length Y or N y Forcemain Drainback in Lateral Diameter 100 ft Forcemain Length 2 in Forcemain Diameter 20 gpm System Flow Rate T 0,92 9 ft Minimum Design Head (f �" ft Vertical Lift ft Forcemain Friction Loss 12.92 ft Total Dynamic Head 2.04 ft/sec Forcemain Effluent Velocity Choose Pump That Discharges At Least: 20.00 Igpm at 12.92 Ifeet TDH Maximum dose volume is }20% of design wastewater flow W gal Maximum Dose 0.0 gal 5x Lateral Void Volume gal Forcemain Drainback 16.32 gal Forcemain Drainback gal Maximum Dose Volume 16.3 gal Minimum Dose Volume Version 4.1 ( 07/03) SECTION: 2.20.010 ` QL'IW1TV I FINZF lff & 7 FM0493 0 0404 Product information presented ® Supersedes here reflects conditions at time 3 > ® 1103 of publication. Consult fac- tory regarding discrepancies or inconsistencies. MAIL T0: P.O. BOX 16347 • Louisville, KY 40256 -0347 visit our web site: SHIP TO: 3649 Cane Run Road • Louisville, KY 40211 -1961 http://Www.zoeller.com (502) 778 -2731. 1(800) 928 -PUMP • FAX (502) 774 -3624 COWiPARE THESE FEATURES • Non- Clogging vortex impeller. 53 - 57 Cast Iron Series • Float operated, submersible (NEMA 6) 2 -pole mechanical switch & variable level long cycle systems available. 55 - 59 Bronze Series • UL Listed 3 -wire cord plug; 9 ft. standard for automatic, 15 ft. standard for nonautomatic. (For Pump Prefix Identifica see News & Views 0052) Corrosion resistant powder coated epoxy finish. T `y No sheet metal parts to rust or corrode. Stainless steel screws, switch arm, guard and handle. .' _ A • No screens to clog. • Watertight neoprene "D" ring between motor and pump U SUBMERSIBLE PUMP housing. ®� FOR 2 I g � a� �• `� • Solid buoy Tested to UL DEWATERiNG SUMP s°Ra�S ant of ro lene float. ( SUMP) Y polypropy pY Standard UL778. Motor - 60 Hz 1550 RPM oil-fill OR hermetically sealed, automatic reset thermal overload protected. EFFLUENT (SEPTIC TANK SYSTEMS) SSPMA • Upper and lower sleeve bearings running in bath of oil. Entire unit p ressure tested after assembly. PASSES /z , .� SOLIDS MEMBER Y Car o n and ceramic shaft seal. CenredtocsA Standard C22.2 NO. 708. 1 NPT DISCHARGE Maximum temperature for effluent or AND SEWAGE dewatering -130 °F (54 °C). PUMP MFRS. ASSN. • Passes Y2" inch spherical solids. AUTOMATIC 1'/i' NPT Discharge. MODEL AL AL • On point —T / <" •Off point -3 ". = � p t Majorwidth- 103/32 ". • Height - 101/16 ". SPECIAL MODEL DEL FEATURES: NiODEL 53 MODEL 55 Cast iron switch case, motor & • Bronze switch case, motor & pump housing. pump housing. Glass- filled polypropylene Glass- filled polypropylene base. base. Engineered, glass - filled, plastic VORTEX TYPE Engineered, glass - filled, plastic impeller with metal insert. IMPELLER impeller with metal insert. • Stainless steel guard & handle. Stainless steel guard & handle. • Bearing • lower & upper oil fed Bearing • lower & upper oil fed bronze. cast iron. . , MODEL 59 iVIODEL 57 All bronze construction. All cast iron construction. • Stainless steel guard & handle. Stainless steel guard & handle. Bearing - lower & upper oil fed Bearing - lower & upper oil fed bronze. cast iron. Bronze impeller Cast iron impeller. ALL MODELS ARE COMPLETELY SUBMERSIBLE POWDER BN MODEL COATED HERMETICALLY SEALED TOUGH Watertight - dust tight. Permanent! oiled bearings. g 9 Y s. 9 MODELS AVAILABLE VARIABLE LEVEL CONTROL Automatic or Nonautomatic SYSTEMS AVAILABLE 53- 57 "-.3HP, 115Vor230V °55 - 59" 3 HP, 115V or 230V Note: The sizing of effluent systems normally requires variable level BE53 /BE57 & BN53 /BN57 available packaged float(s) controls and properly sized basins to achieve required with Piggyback Variable Level Float Switch pumping cycles or dosing timers with nonautomatic pumps. © Copyright 2004 Zoeller Co. All rights reserved. I UJ UJ TOTAL DYNAMIC HEAD /FLOW w PUMP PERFORMANCE CURVE PER MINUTE' MODELS 53155157159 EFFLUENT AND DEWATERING s 20 MODEL 53/55/57/59 w z Feet Meters Gal. Liters 15 5 1.5 43 163 } 4 10 3.0 34 129 0 10 15 4.6 19 72 0 2 009897 Shut -off Head: 19.25 ft.(5.9m) 5 3718 — 63116 4 5/8 1 112 -11 1/2 NPT Q 10 20 30 40 50 3 7/8 GALLONS ` LITERS 0 80 160 i FLOW PER MINUTE 4 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Variable level float switches available. Variable level long cycle systems available: Available with special cord lengths of 15', 25', 35' and 50'. Alarm systems available. ,o,ns • Duplex systems available. 33 SK858 Single Seal Control Selection Listing SELECTION GUIDE Model Volts Phase Mode Amps Simplex Duplex CSA UL 1. integral float operated mechanical switch, no external control required. M53155 & M57159 115 t Auto 9.7 1 -- Y Y 2. Single piggyback variable level float switch or double piggyback variable level N53155 & 057159 115 1 Non 9.7 2 3 or 4 & 5 Y Y float switch. Refer to FMO477. * BN53 115 t Auto 9.7 * y -- 3. Mechanical alternator "M -Pak" 10 -0072 or 10 -0075. BN57 115 1 Auto 9.7 N Y 4. See FM0712 for correct model of Electrical Alternator. * BE53l57 230 1 Auto 4.8 Y Y D53/55 & D57l59 230 1 Auto 4.8 1 Y Y 5. Variable level control switch 10 -0225 used as a control activator, with Electrical E53l55 & E57/59 230 I 1 Non 4.8 2 3 or 4 & 5 Y Y Alternator (3) or (4) float system. * Single piggyback switch included. � CAUTION Forinformation on additional Zoellerproducts refer to catalog on Piggyback Variable Level Float Switches, FM0477; All installation of controls, protection devices and wiring should be done by a qualified Electrical Alternator,FM0486; Mechanical Alternator, FM0495; Sump /Sewage Basins, FM0487; and Single Phase licensed electrician. All electrical and safety codes should be followed including the Simplex Pump Control /Alarm Systems, FM0732. most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Louisville, KY 40256 -0347 Manufacturers of.. 1( 502) SHIP 3649 Cane Run Road �7p ® Louisville, KY 40211 -1961 VQL,TY f7�,aps SNCf I� ® 778 -2731 ° 1 (800) 928 -PUMP Q http://www.zoellercom PUMP �0 FAX (502) 774 -3624 © Copyright 2004 Zoeller Co. All rights reserved, U 2584 764:�� STATE BAR OF WISCONS FO 1 2 0 WARRANTY DEED KATHLEEN H. WALSH Document Number R EGISTER OF DEEDS This Deed, made between Spencer E. Porter ST. and Shawn ST. CROI X FOR RECORD E. Porter, Husband and wife 05/28/2004 01:00PH Grantor, and Charles L. Studelska and Roxanne B. Studelska DEED EXEMPT MARRAkTY NTY 11 husband and wife as survivorship marital property REC FEE: 13.00 Grantee. TRAITS FEE: 540.00 COPY FEE: Grantor, for a valuable consideration, conveys to Grantee the following CC FEE: described real estate in St. Criox County, State of PAGES: 2 Wisconsin (the "Property ") (if more space is needed, please attach addendum): See attached Addendum Recording Area Name and Return Address Title One Premier Group 706 19th Street South Hudson, Wisconsin 54016 030- 1032 -20 -300 Parcel Identification Number (PIN) Together with all appurtenant rights, title and interests. This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, Easements, and Restrictions of Record. Dated this - d of , */ /,", " cer E. Porter *S hawn E. Porter AUTHENTICATION ACKNOWLEDGMENT AY PV STATE OF WISCONSIN ) Signature(s) P B ) ss. _ St. Criox County. ) authenticated this day Personally came before me this .2f- day of KAY V. _ , ;jge the above named PALM SDZncei E. Porter and S hawn E. Porter TITLE: MEMBER STATE BAR % (If not, ©F WIS , to me known to be the person s who executed authorized by §706.06, Wis. Stats.) the fore mst d a owl ged the same. THIS INSTRUMENT WAS DRAT I'ED BY -7— l!t; ;.k * lm Michael H Forecki, Attorney Notary Public, State of Wisconsin Eau Claire, Wisconsin My Commission is permanent. (If not, state expiration date: Si es be authenticated or acknowled ed. Bo are not necess December 12 004 . "Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No.1 -2000 tiorney Michael H Forecki 3452 Oakwood Hills Pkwy Ste 1, Eau Claire WI 547Jt -7928 Phone: (715) 835 -3029 Fax: (715) 835 -4112 Michael H. Forecki T6693762.ZFX Produced with Ziprcxm I try RE FormsNet, LLC 18025 Fifteen Mile Road, Clinton Township, Michigan 48035, (800) W-Q805 U 2584P 596 ADDENDUM TO WARRANTY DEED Legal Description: Lot 4 of Certified Surrey Map recorded in Volume 16 on page 4354 as Document No. 687298 located in the Northeast Quarter of the Northeast Quarter (NE% of NE /.), Section 8, Township 29 North, Range 19 West, Town of St. Joseph, including part of Lot 2 of Certified Survey Map in Volume 6 on page 1798. Together with an undivided 1/15th interest in a non - exclusive permanent roadway easement in Roadway 8, and an undivided 1 /15th ownership interest in the Community Park both of which are located in the NE% of NE% of Section 8, and the NW /. of NW/ of Section 9, all in Township 28 North, Range 19 West, as specified and described in Affidavit Establishing Easements dated April 29, 1973 and recorded May 9, 1973 in Volume 497 on page 410 as Document No. 315988. i i I i I I I I I I I I I I I 6 6 7 2 9 8 VOL___ 4354 KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX CO., NI RECEIVED FOR RECORD CERTIFIED SURVEY MAP 0 -16 -2002 12:00 P LOCATED IN THE NE 1/4 OF THE NE 1/4 OF SECTION 8, CERTIFIED SURVEY MAP T29N, R19W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSI EC FEE: 15.00 INCLUDING PART OF LOT 2, CERTIFIED SURVEY MAP, VOLUME 6, P 9g� s. 4 .00 LEGEND NORTH LINE OF THE NE 1/4 N 89 E COUNTY SECTION CORNER MONUMENT, N 1/4 COR. NE COR. ALUMINUM CAP, FOUND. SEC. 8, 2650.74' SEC. 8, • 1 1/4" OUTSIDE DIAMETER IRON PIPE FOUND. T29N, T29N, 0 1 1/4" OUTSIDE DIAMETER; x 24" IRON PIPE R19W LOT 1 R19W WEIGHING 1.68# /LINEAR FOOT, SET. B SOIL BORING PERFORMED BY JAMES K. THOMPSON ON APRIL 16, 2002. C. S.M > PROPOSED DRIVEWAY LOCATION I VOL. 8 _ LOT 15 C.S.M VOL. 5 PAGE 1266 I P 2187 cm NEL F LA ( A V E T a POINT OF — B EGINNI NG "A N 89 °52' 00" E 404.90' �- 48.71' 166,26' S 189.93'1 —� �� 31 0 1 356.19' 0 ` ° I I 3I i o0 1 B2 �� p.o0 40' I _� 1 I 1 75' SE LIN ®B1 B3 F w w-J> - I � B4 a I 2 S ak W 11 ® w I � I W V1 I O Q In MM v 1 N > 1 cn oo--7 Si) 11 �$ r o Go v I�- 3 CD Z Q I-, c ^I LOT 3 o c' - c6 ¢ i I O O ! I N 0 O M N 1 1 I.- t w fl) V I 3.045 ACRES �i o O p �a�n oao ICI o �I 132,651 S.F. ^ in� 1 I 0 in � 0 _v I Q I L' o wVGJH �1--0 Olr ^I Ml M �I � I JI M In�F wz c JIQ) v l0� a2`�Z moo= w iz � 1 0 �i I F 3 �8k 3 p0 0 1 I — �` $ I I I J p °0 EX /STING u� Zo I Q N O 5 TIC Y£NT 00 g I CD r Q , J I Cps I N § I i I ®B1 I 4 I APPROXIMA TE I °1 _ I EXISTING SEPTIC TANK ' rn � C'A w 1 `l FO /STI 1 g I LOT 4 O 9� N N 40' 1 131,764 S.F. I ui o I I = C) I C� 0 it v W I U17 — — uj :z I 0 48.71' 345.00 PROMED Ln 0 ° S 89'37'50" W 393.71' ST. CROIX COUNTY ?`' Planning Zoning and Parks Committee UNPL A T TED L AND m�sd — — — — — — — — AUG 1620OZ (MLL OW_ R S PARS SCALE IN FEET if not recorded within 30 days of OWNERS AND SUBDIVIDERS approval dab approval shall lea RONALD R. & DELORES J. (Oka 1.) SPAM ERG 497 NELSON FARM LANE 0 50 100 200 HUDSON, WISCONSIN 54016 THIS INSTRUMENT DRAFTED BY JAMES D. FILKINS PAGE 1 OF 3 Vol.16 Page 4354 s r 1531 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 2 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site on not less than 8% x 11 inches in size. Plan must Coin P� � P� St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and -- P I D. . d 0o percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. 03 -1032 Please print all information. Re Date Personal information you provide may be used for ndary purposes (Prwry Law, s. 15.04 (1) (m)). O Property Owner Property Location Ronald R. & Deloris J. Spangenbe G ovt. Lot NE 1/4 NE 1/4 S 8 T 29 N R 19 W ,j+ Owner's Mailing Address . Lot # Block # S . Name or CSM# 497 elson Farm Lane I pt"YK -aa -Proposed CSM �6 3 State Zip Code Phone Number �j City �j VIII #1 Town Nest Road Hudson WI 1 54016 1 715 - 386 -8030 St.Joseph I Nelson Farm Lane 1O New Construction Use: Residential /Number of bedrooms 3 Code derived design rat GPD Replacement Public or commercial - Describe: Parent material G outwash Flood plain if na General 9 2Q42 and ations: Soil evaluation conducted to verify suitability of soil 36" below existing soil spers` System elev. 92.25'. 20 COONry Ong # J.AR Boring JA Pit Ground Surface elev. 96.51 ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= *Eff#1 *Eff#2 1 0 -14 1Oyt3/3 none sl 2fsbk mvfr cs 2fm,1c 0.5 0.9 2 14 -29 1Oyr3/4 none sl 2msbk mvfr gs 2fm,1c 0.5 0.9 3 29-42 7.5yr4/4 none sl 2msbk mvfr cw 2fm 0.5 0.9 4 42-80 10yr5 /6 none s Osg ml gs - 0.7 1.2 5 80 -96 1Oyr6 /6 none s Osg ml - - 0.7 1.2 H #4 & 5 contain 1/ " bands of 7.5y4 4/4 Om a0" - 32" intervals. * Effluent #1 = BOD ? 30 < 220 mg/L and TSS > < 150 mg/L * E = BOD 30 mg/L and TSS <30 mg/L CST Name (Please Print) Sig ure: CST Number James K. Thompson 3602 Address AC.E. Sal & Site Evaluations ate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 0 4/16102 715 - 248 -7767 weS6 .�— l orap. hwe. dt /sore Fa�w, Lane ♦ E /e ✓��;o� -� eh nlar � 7cp o�'S +eel .F'enct Pest. A ssun.cd elev' /oo. 30 Gradc = 9G.3S' - E S /0,02 87 - --*0 �Xis�,'�y S0; /d:3�ousd/ cc//. > zo9 4 S /ope P� Z o P,2- sin Department of Ipdustry, PRIVATE SEWAGE SYSTEM County: is and Human Relations INSPECTION REPORT St. Croix Safety and Buildings Division Lot 9 (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION NE,NE, Sec 8,T29- R19,Nelson Farm Ln 145256 Permit Holder's Name: ❑ City ❑ Village EkTown of: State Plan ID No.: Patrick & Kathleen Crawford St. Joseph CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 4 "0 -� r Us�f7 ,�, 030-1032-20 TANK INFORMATION ELEVATION DATA A TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Gf lS c v , ' G , Benchmark i o y' 9,1 000 l <%� • Dosing Aeration Bldg. Sewer<� -� Holding St / Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet �,y q 7, F. TANK TO P/ L WELL BLDG. Air I to ntake ROAD Dt Inlet ir Septic S i ci q NA Dt Bottom Dosing NA Header /Man. - 7,43 Aeration NA Dist. Pipe n. Holding Bot. System PUMP / SIPHON INFORMATION Final Grade a.`�� �f N 5 Manufacturer Demand Model Number % GPM TDH Lift friction System TDH Ft ead Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Widt ength No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS � � SYSTEM TO P / L I BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O a Mod Number: OR UNIT System: £6� l� /0/ � I� z � ti /f DISTRIBUTION SYSTEM Header / Manifold Distribution Pipes) �7 7 ol e Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only _T Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center �1 " y± Bed / Trench Edges Topsoil C] Yes C] No []Yes C1 No COMMENTS: (Include code discrepancies, persons present, etc.) I I ' 1 - c7. Plan revision required? ❑ Yes ❑, No Use other side for additional information SBD -6710 (R 05/91) ate (' Inspector's Signature Cert. No. I Parcel #: 030 - 1032 -20 -300 05/09/2007 10:40 AM PAGE 1 OF 1 Alt. Parcel #: 08.29.19.112D -30 030 - 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): O = Current Owner, C = Current Co -Owner 0 - STUDELSKA, CHARLES L & ROXANNE B CHARLES L & ROXANNE B STUDELSKA 503 NELSON FARM LN HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 503 NELSON FARM LN SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 3.025 Plat: 4354 -CSM 16/4354 SEC 8 T29N R19W NE NE LOT 4 CSM 16/4354 Block/Condo Bldg: LOT 4 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 08- 29N -19W NE NE Notes: Parcel History: Date Doc # Vol /Page Type 05/28/2004 764319 2584/545 WD 04/10/2003 716658 2200/546 WD 08/12/2002 686763 1946/305 QC 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/26/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.025 178,200 500,000 678,200 NO Totals for 2007: General Property 3.025 178,200 500,000 678,200 Woodland 0.000 0 0 Totals for 2006: General Property 3.025 178,200 500,000 678,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/16/2007 Batch #: 07 -01 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER E I 4 TOWNSHIP SECTION ^ T s 9 N_R ✓� W ADDRESS S/O 46 r7r / e ,Qa ST. CROIX COUNTY, WISCONSIN SUBDIVISION /A LOT SIZE �A PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �!C/�rYJM?K - ✓/ISM OL L4fa�T <<,iV.. /00. CW Z/ f Afo&erY r� �, G•f 'ViFK �� S 1. iNE • O ©' . • i )000 rFe S�pl qv K. �uS�cc au clv/� AA*oy —'o �,' /FoO•5�4 �rQ'T�Tt I Gf G Sf N /� Gcu tf,('tit DICA NORTH ARROW SorifH�uF�i�t1'�/tia . BENCHMARK :Elevation and description or �E Q L - c� v. ic�_ o n • Alternate benchmark NA SEPTIC TANK :Manufacturer: Liquid Cap. jcoo Rings used:._L_Manhole cover elev: oo•Si Final grade elev: 'rank inlet elev.:- T'3'. Tank outlet elev.: No. of feet from nearest road:Front , Side ,--� Rear Ft. 5 From nearest prop. line :Front Y , Side Rear�Ft. l S' No. of feet from: Well , Building: gg' (Include this information in the above plot plan) _ (2 reference dimensions to septic tank) SEE REVERSE SIDE r • 4 t PUMP CHAMBER Manufacturer: Liquid-capacity: Pump Model: Pump /Siphon Manufact.: _______ Size Elevation of inlet: Bottom of tank elevation Pump on elev.: _Pump oft elev.: Gallons/cycle: Alarm: Man.; Switch Type: Location _ Distance from nearest prop. line: Front Side., Rear_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: c V. " Trenchs Seepage pits Width: 45/' Length 31 ' Number of Lines: / Area Built Exist. Grade Elev. /' Proposed Final Grade Elev. / 9.% Fill depth to top of pipe: " No. Peet from nearest ro • P P• line.Front ,_ , Side Rear _Ft.iS'o , No. feet from well: ' No. feet from building HOLDING TANK Manufacturer: Cepaoity: No. of rings ues ds`__:�$levation of bottom tank: Elevation of inlet: No. feet from nearest -prop. line :Front, Side No. feet from: Well buildin -.._� Rear. g nearest road Alarm Manufacturer: // INSPECTOR: DATE: (� / f fw P LUMBER ON JOB: • ' '_ ' LICENSE NUMBER :„_ GPs y S 6/90 : c j ' ;' �i¢/�i� / � s �`wU c . M �{ O z O V M 00 9£00 S M 3 , wo —. a' o M ,f�O'OOZ ,a bi o 9 ,00'091 � O + ^ gk. N 3 � z 0 w o �. z "� a X 00 CO o CO p p O z N OD I O� htil� O it u u \ p w Z — 01 O N �� a 000 Cn M V OD d to �6 r Oi / b W M ' QJ b m M,00 N y' 111'061 69.161 ,00'6L e4'bZ1 ' . N o ca N - M „00 ,9£ 00 S ' �% 0 N --- N N Z' 1 W .v o° _ M Id O m N 6 NOI103S 30 ti/I MN J0 N Wl MN 30 3NI 1S3M ti to ,6Z'Zl6 M „00 ,9£ ID S 3,9£ N ,ZO'Qb7 OP`0 ' J- N3W3SV3 Jlb'MOtJO ,1� 109 ,9 9 "" 00 9£ 00 N 1N3Sd3 AVMOgOli 3 ,9£o0 N ,zagtbz O O zz ao co ,bS'LSZ • , U 3 w w cr. o z z z M „0 I ,ZZ o 0 N W c`5. o cn U z Z cc ... W 10 M U fA W U a >c 9 Z16 . 59 96 OO ,08'Z99 as M 00 N CL M o 0 O � 4` cc O a 09 LL o rev? o ui M 01,ZZ o0 N z y _` r4 0 3 � T W W� ,61b99 CD N P- �` F Z Z C N M .0 I ,ZZ 0 0 N 3 H _~ 0 - I Q-5' QD o W z N O �, z c w r 8� ng� a M „OI,ZZeO col Arc _ cr Is !Y • FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ���,�,r �' /(� r�lE� - rdp� TOWNSHIP ST' oSEOt1 SECTION S �T _ N -R ADDRESS S/o / r,,,�/7 t� / « o _ ST. CROIX COUNTY, WISCONSIN /,s o .v L✓, 55/ o / G SUBDIVISION /A LOT�LOT SIZE—,A,.) A PW VIRW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM '�' :X.NC///yI�K •— TJ/I'S�°` OF L6fOST &ir 350' iv Alca�7N' ... I OFdGtrY 4,,vc . • e 3 ' l •� LE ViEK �is,7 L iNE �jD�, 3 30 3 / �✓ dot , /Oo itt l�pTic �ivK, _ �lvsp£c ou �Np lkAgPo��o �' �oO�5,a4 SGN �D . tiv�P / n1r GJZ�L '&`` DICA E NORTH ARROW SoaTN�uF��Pr1',��ti� . BENCHNARK:Elevation and description: .fs� L- aV- 1 Alternate benchmark NA SEPTIC TANK:Manufacturer: v/� S Liquid Ca • — - � 9 000 � Rings used:_L_Manhole cover elev: oo -Si Final grade elev: 01-(0' Tank inlet elev.: 9�.p3` Tank outlet elev.: '77. SG No. of feet from nearest road:Front Side Rear Ft . From nearest prop. line :Front Side____, Rear ,Ft. No. of feet from: Well /low ' , Building: 99' (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE t PUMP CHAMBER Manufacturer: `• Liquid - Capacitys Pump Model: Pump /Siphon Manufact,: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.:,Pump off elev.: Gallons /cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front —, Side_, Rear—Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: c v. " Trench: _ Seepage Pit: Width: 0/' Length 31' Number of Lines: —�_/ Area Built Exist. Grade Elev. 101. `�y3�•fT Proposed Final Grade Elev. Fill depth to top of pipe: .S ` " No. feet from nearest prop. p' .,._,., Side � No. feet from well Rear i �o feet from buildin • 9 —��/ HOLDING TANK . Manufacturer: Capacity: No. of rings used: ,+$levation of bottom tank: Elevation of inlet: No. feet from nearest prop. line :Front, Side — ' Rear - _.Pt. No. feet from: Well _ building , nearest road Alarm Manufacturer: INSPECTOR: DATE: (v / PLUMBER ON JOB: LICENSE NUMBER: ' �1��Ps s39s 6/90 :c j &Us. I • - . APPLICATION FOR SANITARY PERMIT STC -100 This application form is to be completed in full and signed by the owner(&) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. -------- - ------ ------------------ , Owner of property �f� Location of property A- ..-1/4 Al /4, Section T- .aL.l..ls'R -L�- Township - nailing address ii MqEPL � D r. A�1.b Add ress of site Subdivision name j�HE"-ffL-g dpmue) d2U1QEK . Lot number Previous owner of ptopetty Total sire of parcel J • /�C .- Date parcel was created a a Are all corners and lot lines identlflable? an �.� Is this property being developed for resale (spec house) ?_,_vas N o Volume ai3L Page Number 3 as recorded with the Register of Deeds. - - - - - - - - -- -- - - - - - - - - - - - - - - - - - • - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - -- - - -- - - - ---- -- - - INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL Of THE REGISTER OF DEEDS. In addition, a certified survey, it available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Cestilied Survey Map, the CertlEted Survey Map shall also be required. ----------------------------------------- PROPERTY OWNER CERTIFICATION live) cattily that all statements on this form are true to the best of my (out) knowledge= that I (we) am (ate) the owners) of the ptopetty described In this intotmation totm, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. 46-cp l W _ 1 and that I (we) presently own the proposed site for the sewage disposal system (at I (we) have obtained an easement to tun with the above described ptopetty, lot the co uction of said syst , and the same has been duly recorded in the Office o th Fo nty�R later o Beds, as Docume t No. ). Y-- s 9nature of Owner Iftgnatute of Co -Owner (tE ppllca ) , lq Date of tignatuce Date of S gnature �l .A6UMENT NO. STATE BAR OF WISCONSIN FORM 2 -1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 4 62046 :vm _ &SO PA,E J REGISTER'S OFFICE William E. Perk and Jane M. Perkins, ST. CRO CO., WI hu band a _ nd� R ecd d for Record w' f z ___....___.....__.� L a._ndvidual,ly5nd_ each r^ S E P 0 51990 as conveys and warrants to P Q. Crawford and. 11:25 A. M Kathleen M. Crawford husband a wife, as marital survivorship property Reaisterofp RETURNTO C�WIN LAW FIRM 430 Second Street the following described real estate in St • C County, I Hudson, WI 54016 State of Wisconsin: Tax Parcel No: 30 -1032-20 A parcel of land knawn as Parcel #9 located in the NI of t'!E', of Section 8- 29 -11), t of St. Joseph, described as follows: Part of NE; of NE'A of Section 8 -i-9 -19 described as follows: Commencing at the N,4 corner of said Section 8; thence S0 11 W (true `tiearinu) 1313,15 feet along the W line of the NW of Ili:', of Section 8; thence ;18903-1-50., 1326.65 feet alorg the S line of said NId'4 of NE3i; thence N0 "E 330.01 feet along 'he E lin of :s.: NW�i of NEd; thence N89 "E 941.34 feet to point of beginning; thence N0 10 "W bI. " . 8 feet; thence N8 52'E 356.19 feet along the Sly right of v: av l i ne of the town road; hence S0 36 E vu 1.44 feet; th ence S39 "W 345.00 feet to p �int of beginning. r '�gether with an uncivided 1 /15th interest in a non- exclusive perr,Inent rod-Away ease' -1nt in Roadway b, and an undivided 1 / uanership interest in the Cormwnity Pirk both of which ire located in the NEa of I E1 of Section 8, and the NWIA of NW'.; of Se=ction 9. all in MA, R19W, i,s specified and described in Affidavit Establishing Easements dated 4 - 29 - 73 and recorded 5 - 9 - 73 in the Office of the Register of Deed- for at. Croix, County, Wisconsin in Vol. 497, pages 410 - 412, as Doculneot No. 51 SLA4 -pct to recorded easements and Declaration Establishing Protective Coven -rats a,.ted 4 -24 -73 and recorded 5 -9 -73 in the Office of th— Register of Dc,�ds for Si. Croix County, Wisconsin in Vo1.497, page 407, ds Document No. 315887. TRAM ti � This is not homestead property. ! • (is) (is not) ■1�-r Exception to Warranties: Dated this 21st day of August 19 9 0 (SEAL) ` William D. Perkins (SEAL) ' ' Jane M. Perkins AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ NS A STATE AF WISC_ ?SIN �V i� �[ ss. �[NC County, authenticated this day of _ _ ' 19__ Personally came before me this day of = -1--AU G 1890 .19 the above named TITLE: MEMBER STATE BAR OF WISCONSIN - - - (if not,- to me known to be the person who executed the authorized by § 706.06, Wis. Slats.) foregoing instrufient and acknowledge the Sam . THIS INSTRUMENT WAS DRAFTED BY _Atty. Hugh H. Gwin, Gwin Law Firm r 430 Second , Hudson, WI 5401 Notary Public_ (Signatures may be authenticated or acknowledged. Both My Commission i permanent. are not necessary.) date: t. a Names of persons signing in any capacity sho:,!d be typed or printed below their signatures NOTARY ffm WARRANTY DEED STATE BAR OF WISCONSIN COLOM iC)Li ' 8-Q a rt L sk Form No. 2 — 1982 75, G °* ilNCit isIC7 ' 41 a Wisconsin Defartmentof Industry PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT St . Croix Safety end Buildings Division LOt 9 (ATTACH TO PERMIT) Sanitary Permit No.: GI:NERALINFORMATION NE,NE, Sec. 8,T29- R19,Nelson Farm Ln 145256 Permit Holder's Name: ❑ City ❑ Village EkTown of: State Plan ID No.: Patrick & Kathleen Crawford St. Joseph CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 4�1 ' (" `r - w �;:l ,2 030-1032-20 TANK INFORMATION ELEVATION DATA A / QQ A TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (Se Y �0 Benchmark /0 q �(y7 IoU >a Dosing Aeration Bldg. Sewer 6 S, Holding St /Ht Inlet /Q � q -7.86 TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic S ci ' NA Dt Bottom Dosing NA Header / Man. - 7, L/3 Jlo, 9� Aeration NA Dist. Pipe - 7,5g 9b,6`I Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number / GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Len th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS � T DIMENSION SETBACK SYSTEM TO P / L i BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of Z73) z ti Moe Number: System: f' 9 l� /or 1 � OR UNIT CHAMBER DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over �// L v Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center 4i" + Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) r � Plan revision required? ❑ Yes ❑ No Use other side for additional information. P q ) SBD -6710 (R 05/91) ate ( Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: " K ' r S 1 a QlLHR SANITARY PERMIT APPLICATION TY couN In accord with ILHR 83.05, Wis. Adm. Code MEN • STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than Iq 5 a 61 F' x 11 inches in size. 8% C 1:1 Check if revision to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION oo E'/s iUE /a, S g TR9 N, R/ E PROPER O 7AJ 7-a_-e S MAILIN ADD ESS LOT # BLOCK # / CITY STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER a.v G✓, 11. TYPE OF BUILDING: (Check one) ❑ State Owned 0 VILL NE REST ROAD 11 ❑ Public X 1 or 2 Fam. Dwelling -# of bedrooms P L Ax MB R( £ 111. BUILDING USE: (If building type is public, check all that apply) v // 1 ❑ Apt/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 in line A. Check line B if applicable) A) 1-JK New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit ## — Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 f9 Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill 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 �s� REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) ELEVATION O S -Pr. S -4 3 • ' Feet 1 ,1 2 7. ' Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name C oncrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank h anks /O Lift Pump Tank/Siphon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumbe ' ign re: (No $ p MP /MPRSW No.: Business Phone Number: P s 33 9S ?/S 31 - S 7 Plumber's Address (Street, City, State, Zip Code): / S0_0 w . IX. COUNTY /DEPARTMENT USE ONLY Disapproved San' ry Permit Fee J_ (Includes Groundwater Date I ssued Issuing A m Signature (No Sta App roved surcharge Fee) pp El Given Initial 07� Adverse Determination X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb-67) (R. 11/88) 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 may be renewed before the expiration date, and at the 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 maintained. The septic tank(s) must be pumped by a licensed 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 & Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. I1. 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 in 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 in ##1 -7. VII. Tank information. Fill in the capacity of every new and /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 Use Only. X. County /Department Use Only. Complete lans and specifications not smaller than 8'% x 11 inches must be submitted to the count The P P ty plans must include the following: A) plot plan, drawn to scale or 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 boxes; 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 loss; 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 115 form; and F) all sizing information. ---------- ---------- _�________ GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included 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, ground- water contamination investigations and establishment of standards. SBD -6398 (8.11/88) S 8 0 524 _ 109T AVE. co FENCE 356.19 FENCE 27 ' POST POST N ti a) RIBBON Z � � O 3 3 w N O Z N IL O 4D N 0 a � f W d _ Z FENCE F- Z POST 3 0 5 .33 ACRES 8 30 9 � o '000 o N C (D Z O � � Z t O to N W U-j 2 Q FENCE _ m POST } 0 _ ¢ I'n O N FLAG `c O Sri FENCE t LATH 345.00 POST SAC v 1_ RILIBON IN TREES AROUND IRON PIPE -500' �,�, -r lac t/c dM MK - 66F or TeE Pas r BewcNl1 To T 4646v- ioo -ou - AJ0e7d Pli'o �7 PLB 67 y� N� � Qy '� _ ' PLOT & CROSS SECTION PLANS � A a aQT C� ZAPPA BROS. EXCAVATING INC AEZ�-oN Fes? AANC S,rE PLUMBING UNIT 6A1,Fr A Q3 S[oOl . L, i.�c A6 S o T _ _ - ; - - �� 0 2 PROJECT -f r no•U 1r8A a To 6f e4A r AA1 of, 4 r v Iz c r /1�q x Q<PT gog A is 62 ay Q S r s OAK � O- Z Lssisr g P �P vO�Pnr' l 1--ksf SOQ o gPpO�IYY 4"-d •vr/, ins£ p T� OO as�o /000 se /� or�c K /a ASS r�RFraf �i/f'OOoStn uJI rN . Z.:rAjSpLerxW 1lT AA/O v✓r Ae'ri� !nlEtc l�l R�5 /QEn/ '1 , NO 5'0ur,4 SCALE FRESH AIR INLET AND OBSERVATION PIPE �4 APPROVED VENT CAP MAXIMUM 12' ABOVE FINAL GRADE 4' CAST IRON VENT PIPE MAXIMUM OF 42' ABOVE PIPE TO FINAL GRADE —.- SIGNED: MARSH HAY OR SYNTHETIC COVERING LICENSE: S 3395 MINIMUM 2' AGGREGATE DATE: OVER PIPE DISTRIBUTION PIPE TEE SOILTESTING BY: iewr ELEVATION BED W AGGREGATE Ems BOTTOM PER SOIL BENEATH PIPE PERFORATED PIPE BELOW TESTIS COUPLING TERMINATING FT. AT BOTTOM OF SYSTEM I SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYE C • r'�"� ADDRESS �D� �LS�IVyvt t FIRE NO: LOCATION: A 1/4, /v 1/4, SEC. _ T O?q N -R W, TOWN OF: � t - 14 ST. CROIX COUNTY SUBDIVIS ION :,_geoeTrLE : � - .6 eft&) i W LOT NO. 7 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 septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system: St. Croix County residents may be eligible to receive a grant to help with the cost of the 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 system properly maintained. The property owner agrees to submit to the St. Croix County Zoning 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 (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification from will be sent approximately 30 days prior to three year expiration. I /WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system•in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED A C PIE 1 I ' DATE: f e St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 A' F C CIL - D. P� e%A) -5 c� ; A z 0 X� 3 00, flPP i I VIII I I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INgUSTRY� cc DIVISION BOX +itJMAN REDLATIONS PERCOLATION TESTS (11J) MADISON W 53707 LOCATION: SECTION: .. TOWNS /MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISI N NAME: 'VE 1 / I / �? /TZ9 N /Rl E Lori W To s P tt 9 A. S� ' j, e,4v,_ COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: 1COMMERCIAL DESCR PTION: DESCRIPTIONS: IPEFJCqLA TION T ST Residence 3 XNew ❑Replace 2 /9f2 RATING: S- Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND PRESSURE: SYSTEM -IN -FILL HOLDING TANK: R COMMENDED SYSTEM:(optional) 7 S ❑U J S ❑U S DU F] S U I [IS ®U 61s s91 - FT If Percolation Tests are NOT required DESIGN RATE: SYSTE q If any portion of the lot is in the under s.H63.091511b), indicate: �dJ r/' y(p 6 F Floodplain, indicate Floodplain elevation: 1 374 xA-i PROFILE DESCRIPTIONS BORING TOTAL PTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED E T. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) Fr > 9 16 - A V-6y- Gt, /� " AA1 , SG, 12 "W SL 2- 10 B- / 7 ao./ dA - /S.) C B- Z 96 S00 r- r 1 3 " AA1 -cy. 4 5, / s L, 22 ''0,e -a J sL, �'*P PdA 13.v C B- io�.� rT > 90 �c- �y -oy Ls '�� s ,y" �� $Z B- /00.� > 9 IC u-6y. L S 7 ., , G, / "O sG� B yy �00,� fir - > y, 9"13.$ -6-y. /- s, /r N L s, & 6,f x4 G3 d.P I B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PER OD 2 PER1003 PER PER INCH P- P - SG $ O /C- ry •�• P_ .�. P Sot z- o P- d L! -- 1 F atoof PLAN VIEW: 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 slop. /j o>= ��PA /�f S/14GL Gi£ EXi4cTLy SYSTEM ELEVATION �• Fr' &4DW V�ic kf= PaNr I , e fy'r Fl�u�tTiol� o F ?6 .6 ter. r _ _- _ -. , a I pos T .Sc�r /too 7, .eF,�e - pa � N - 71� ► OVID ' �z 47'�'N�T�' o _,,,... hPb� 175E'... u�i/ �l rya 5 fT, d I wo I 3 &f ...745 It i � f o I, the undersigned, hereby certify that the soil ets. ported on this form were made by me in accord with the procedures methods specified in the Wisconsin Fy Admimistrative Code, and that the data recar- e location of the tests are correct to the best of my knowledge and belief, come- NAME (print ): ��`` L TESTS WERE COMPLETED ON: ADDRESS: C RTIFICATION NUMBER: PHONE NUMBER optional): CST IG ATU , i ~ L I VOUNTY: BUTION: Original - Local Authority, 2nd page Bureau of Plumbing, 3rd page - Property Owner, 4th page - Soil Tester, WNE 'S DATES OBSERVATIOkft. I NO.S EDRMS.: 1 COMMERCIL D R PT O FILE DESCRIIII!TJONS' Residence ti LNew ❑Replace ��. RATING: Site suitable for system U- Site unsuitable for system ONV NTt N L: MOUND; IN- GROUND,PR S FILL QLDING TANK: R COAAMENDEpSYSTEM ( S ❑U S U SL ❑U S U❑ S U vuwi�+! rr If Percolation "Tests are NOT required DESIGN RATE: (3 If any portion of the lot k in the under s.H63.0915)(b), indicate: X03' f4 . fr . d F ' Floodplain, indicate Floodplain elevation: UtVA4 PROFILE DESCRIPTIONS RING AL H GROUNDWATER- INC S HARACTER O . SOIL WITH THICKNESS, COLOR, " 1= AND ER DEPTH IN, ELEVATION: OBSERVED TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) /0" 1 G S /� „ AN, SG , /2 " p,P- . SL , B- �� uD./ Fr > 9G C B. 9� X00.3 Fr , � 1 „ 13N- y. 25,13 5 - 4 , T2 0,0 -A5V ,yea B 90 rr fr -- >jf” 9�?u -6y mss, 7 %/S,v. _,f / --o sc, !/„ B j 100.,2 fr' > yZ 9",{�v-�ry ;B PERCOLATION TESTS TEST PTH WATER IN HOLE TEST 41N, IN R L V L -I HIS IN E ' NUMB INCHE ER S AFTERSWELLING INT PER t PER INCH P. W SC , ER VA T e P- P_. iL E T E Ie o P d '^ L Mot PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zorttal 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 la slop. - . 13o; Of AA04 MELD 134,0 (E XC�f/JATIO,U) SN�LL GiC E X C U SYSTEM ELEVATION y� T• (3e law D UTlc AL PFF.. PaN�' i . t'. �qr E (F.ufIDo� a 9� -o �. E T/c L ` /a / ¢' { a A QS s , ;.t sv �N t �� µ� I., the undersigned hereby certify that the soil tests reported on this form were made by me in accord, with the procedures methods specified in the Wisconsin AamimistraUve Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. ` 14 (print : TESTS W RE COMPLETED ON: )Pah�,e7" /b�P� <h 13 / 9z DRESS: CERTIFICATION NUMBER: HONE NU BE optional): CST IG TU I -Local Autfority; 2nd Bateau of 'lumb <3rd page Property Owner, 4th pao-Soll Testes`. l � 7 F i v 2 •'`;`♦`1 = �� � `- `,' �' `�,?� �� • -> � , >,; �� J� tit, _. R � . `�' — �' .1 `,.� ?` �' �. )\ f.'\ 1� .y - Gi1�1 � \. a �'•dEl,��, =-�.� .... ti� � 1 ,1i s •, _ \ . \ y _. ., z "ter �.,� 5 ."'\ 171 � �� , l � '�S'�`f�. _ z l �... �, ... ". • . XA y; . APPLICATION FOR SANITARY PERMIT STC -100 This application form is to be completed in full and signed by the owner($) of t p roperty he being developed. Any inadequacies will only result in delays of the permit Issuance. Should this development be intended Lot tesale by and completed r �the eC property Is and s submitted rto should this office ta wlth the completed deed recotding. ------------------------------------ ----- ----------- - - - - -- - --------------- - - - - -- 7k4,6 Owner of ptopetty , Location of property _114 .Ll(�_ Section T •R Township Melling address -AC- iin A -90 /,6 Add ress of site 503 /1/ EZt'Sd n� lM Ifir-A . Oubdlvlsion Haar J ��' ��•-tTy — Lot number iv1 n+I Previous owner of property `.1� Kz Total size of parcel _ Date patcei was created e jAI - 73 Are all corners and lot lines identifiable? o Is this property being developed for r esale (spec house)? as V — N o Volume ind Page number as recorded with the Register of Deeds. ---------- aft --------------------- --- ------- ------------------------------- - ---• INCLUDE WITH THIS APPLICATION T11Z FOLLOWING: A WARRANTY DRRD which Includes a DOCUMINT NUMBRR VOLUM'R AND PAGZ NUMBER, and the ORAL OF THR REGISTER OF DEEDS. In addition, a certified survey, 11 available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Cestlfled Survey Map, the Certified Survey Map shall also be required. ----------------------------------------- PROPERTY OWNER CERTIFICATION t(wa) cattily that all statements on this form are true to the best of my (out) knowledge= that t (we) am (ate) the owner(s) of the property described in this Information form, by virtue of a warranty deed recorded In the Office of the County Register of Deeds as Document No. 44le - 2C? &a _ f and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, [Or the co uctlon of said syst , and the same has been duly recorded in the Office e th Vo n R later o seds as Docume t No. )• s gnatute of owner tgnatute of Co - Owner (tE pptte f I 2 / 1( o Iq / Date of ignatute Date of S gnature