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030-2017-90-000
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O .. a N N 7 7 CD 7 (D N Cc m 3(c N 0 N o y A N 3 N O W 3 n p cu 3 7 nC-D 3 CD _ :3 < fi 7 N - fi N N f ' c CL ° m goo 3 d Cb � � A O O b 7 7 A CD (D d0 b O 0 0 �o O e v °O CD ° o a fo v ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner To N y ,eo sy9 .. a ss R >ddi ti , s 1 4- 1 L OpjGINAL City/State !� sD.v 4V/. d/ 4 Legal Description: Lot 2 115, U t t �_ Block Sr+bdicrsiert/CSM 11 3 7 �, � A W, Sec , T4LN -R W Town of G.S PIN # 630 ' 2.ol ] SEPTIC TANK -- DOSE MANDER -- HOLDING TANK INFORMATION: w 1r-s,i, , p„ec,4sr eo , / i s a a � 8 A z s Tank manufacturer Size ST/PC � / Setback from: House 35 Well p /L SO Pump manufacturer .70& FA Model 7 0 X2L 14. P- . 115 vol, 7- S Alarm location MI t Ek — (IiULi)ING WANKS ONLY) 4 z57.733 4 Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location / i! 7VR5 Ce& SOIL AT3SORI''l' N S YS'T'EM : r � . Type of system: Width 3 Length 90 Number of Trenches Setback from: house — Well >$!7 PAL Z0 Vent to fresh air intake 1> ELEVATIONS Description of benchmark S4 � * 7- Elevation Description of alternate benchmark D Q oF 64 7X40 Elevation Zo !S ,xi SYI,3 � g o , , TI' Building Sewer ST/IIT In et ST Outlet 7•G / PC Inlet PC Bottom f '73 _ 1 /Manifold Top of S PvM p 11.70 ' Distribution Lines {) ( ) Bottom of System () ( ) S�- P � / o Av Final Grade ( ) ) ( ) llate of Installation / / Permit number �s 3 2 State plan number Plumber's signature License number ZZ�37S Date J / Inspector �iiK�Gy/ C/Q jUNE , .20 0 7 p a Uibricht & Associates Comp ete plot plat �,m s D Private Sewage Consultants -M ,,J 2812 10th Ave. I Al L 2. 3 Spring Valley, WI 54767 i S y f LtfU,4--- - o o� /3v�/I/� � pe �� POmf or� 4 6 /:5 bie),P /90y-' P o l U4 1 VE tS0 � (A c " a ' �(D k (" �, C t ! (D (D 0 � a a y � �l O � F I cr 3 bl N I � > v+ --- ` — o vi Vi Al I 1 o Zx p1 k> kN4 ct N o < M N 4Z� a Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453225 0 GENERAL INFORMNOnON ' (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: Kunz, Donald I St. Joseph Township 030 - 2017 -90 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: Ii �V . d – vrxoQ.r►ea✓u�b ✓ �13N1 �� 01.29.20.422A3 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmar 7-SD l S:o /oS.o /Uo .d Dosing Alt. B ©o Aeration Bldg. Sew r 1/ Holding St/Ht Inlet . W 1 St/Ht Outlet TANK SETBACK INFORMATION _Z0 W loo Flike -- TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. °L Aeration Dist. Pipe Vic c/o T6 .s Holding Bot. System Fast - io./ ! d fl,oa PUMP /SIPHON INFORMATION Final Grade Sfj Manufacturer IV i6emand St Cover ' GPM Model Number ^5 ®l7 u I I Val" ? TDH Lift Friction Loss System Head TDH Ft , '3 — 1 (0, Forcemain Length Dia. Dist. to Well l / !! O 3 � b SOIL ABSORPTION SYSTEM 1 -3 20 5 BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 .0 s1 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:, INFORMATION Type Of System: CHAMBER OR �r ' 2�! 41 g*' y `� i UNIT Model Number. 5 LAI DISTRIBUTION SYSTEM f Header /Manifold IlDistribution x Hole Size x Hole Spacing Vent to Air Intake f/ If Pipes Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of 1xx Seeded /Sodded xx Mulched ?� ��b Bed/Trench Center y "���'�1 / Bed/Trench Edges I To p sol' Yes 1 . COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / - / d I Location: 1169 Appalousa Trail Hudson, WI 54016 (SE 1/4 NE 1/4 1 T29N R20W) NA Lot 3 Parcel No: 01.29.20.422A3 1. Alt BM Description 2.) Bldg sewer length r }"W amount of cover = 40 Oj^r^}O�O�U valvt 11 ,u� ��Sirtirl.� Plan Required? 0 i Use other revis for additional information O L_ ` `^' Le SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. I y Safety and Buildings Division County C-f lviM 201 W. Washington Ave., P.O. Box 7162 J �����,� Madison, WI 53707 - 7162 S ry Permit Number (to be filled in by Co.) Department Cofnmerce (60R) 266 -3151 �5�3 2 2� Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, sl5.04(1)(m) Project Address (if different than mailing address) I. Application Information - Please Print All Information 0 30 �,ai� • 90 D� Property Owner's Na me � J � Parcel # Lot # 3 Block # "JDv 44 / f / l/ �— Property Owner's M ailing Address P F O R XI F T JProperty Location City, State Zip Code Pho bg ` 'A= S4,Section •" /(/ �lx� ) 0 " � 'Z �J ZC/ (circle o U. Type of Building (check all that apply) r N; R 1 E or V �1 or 2 Family Dwelling - Number of Bedrooms f= F.Cl _ � Name p �1 CSM Number ❑ Public /Commercial - Describe Use S v^ w� r 31 a 5 / 1/0 , / / ❑ State Owned - Describe Use 4 b I ! % ' t t/ ❑City_ ❑Village;"ownship of s T Jai III. Type of Permit: (Check on line A. Complete line B if applicable) A. New System Replacement System Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. ❑ Permit Renewal IXFermit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner ype of POWTS System: (Check all that apply) I I Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ ons a Pressurized n- ound 11 Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit El Recirculating Sand Filter 11 Recirculating Synthetic Media Filter Leaching Cham r ❑ Drip Line ravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Infor atton: Des i n Flow (gpd) Design Soil A plication Rate(gpdsf) Dispersal Area Requi (sf) Dispersal Area Proposed (sf) System Elevation too /56 / / 3 .7 1 5 -j2 PId" S VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel -Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing /-?� . -- Tanks Tanks L-eA v Septic or Holding Tank 2 _ Z S 0 , Aerobic Treatment Unit Dosing Chamber ('J h-,� jS UV VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature MWMPRS Number Business Phone Number R. -UMP /c11 1 7/S 7 7.1 • 3 Plumber's Addre ss (Street, City, State, Zip Code) VIII. ount Department Use Onl Approved I El Disapproved Sanitary Permit Fee (incl des Groundwater Date I pIssy idg / Age) Signature ( trips) Surcharge Pee) ,( A � El Owner Given Reason for Denial ' 2 IX. Conditions of Approval /Reasons for Disapproval SYSTEM OWNER:, 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. (!h S/ - tv 2. All setback requirements must be maintained Z / A as per applicable code /ordinances. GCUG Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) A 1Q 74zl �� S i 0 0� GdAW11C Vr 4� P cr- P (A-51' s SRS ply OF .tit, ogc1� g P IiAA)t',e- W� 3 C a pe � L )I( 410 Al ,,,Cr 3 . P3 A S S 619 z-A, S,f' / p 9 i b o $D 7N q / / /1 , D r /oo• s y5 ir a o / ® THIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # Ulbricht & Associates private Sewage Consultants 8 2 12 10th Ave. 7 76 Ile WI 54 Spring Valley, P " 30 5,!:P�p T rc Pom T I S 5 COMM. 94yob cop 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 �r !�• � OWNER ' D o ? /�'f l/ A Z - 7 1 5 - . S � 4 5 / PHONE 11 ` • ADDRESS f�'�OSS }�'" 7R. 11_VpjdA) .S qt? Cr LEGAL DESCRIPTION 40— ff- 3 CSAi 32 k657 • U01• I P� . 17 1 PW 0 30- -Ao • t0 -Mz S6, iv,, sue. 7, Ti S. 2zocv TOWN OF 5 T • Q S.� `�o LL COUNTY G CSTM . Ze `hle( " LOCAL AUTHORITY/ SUPERVISION 54 • G Po(' X C ry- ZoA3 (')j Cr— PROJECT DESCRIPTION: s y s -� 3 s '• z- �,��s�•,� s ysr. 1+Ppfidx / 6-L � 6v i ' s �j sys�M t L L Ulbricht & Associate • Private Sewage Con 2812 10th Ave, Consultants Spring Valle W1 2 � �, 54767 P9.1 INFILTRATOR SIZING WORKSHEET P9.2 SYSTEM PLOT PLAN P9_3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. P9.4 11 f, it of P9 -5 OWNER MANAGEMENT PLANS & ZABEL FI P9.6 (OPTIONAL) CROSS SECTION S FO SPECS AND SPEC PECS FOR DOS (OPTIONAL) PUMP PERFOR DOSING TANK. PG.7 RF SP ECS. The attached plans and specifications are based on "In- Ground Absorption Component Manual For Private Onsite Wastewater Treatment SYstems.91 (Version 2.0) SBD- 1075- P(NO1 /Ol. i �. IZ CA Q m . �I CL 9 O4� S so a m T y�y 5 mm N AMON m Cs kA A&M614P 145 7 NO G A 7'eEM:�Kt .-r tit �. � t, w IW 6- 1/V j c�l L 7e,4 7 - f4 , �9Pf'�� V�ti T c �4p rZ � a,v ws's1 EcT /�,c� p! 101A1 2 ., Iff t t/M U y OVER: See Reverse Side for Vent/ Observation Pipe Details. f , I ts- 4PPI . 04 EP titiv. 12 1/r IN S� • '�� yiP,��L= �7 c , K L.6 7`IC'&t&K y Ci O SS 5EC 110A-) O/OCI WS/� 1 1 /L7�t'i4 14e ��• y S• sc , vv �,vsp�cT�o� PEA Iff j 1/ // NO S >C) Y OVER: See Reverse Side for Vent/ Observation Pipe Details. l SEPTIC TANK & PUMP CHAMBER CR OSS SEC AND SPECIFICATIONS :>� syOW,v n 4" CI VENT PIPE 12" MIN. ABOVE GRADE & "WEATHER PROOF Z' "► 2: 1©' FROM DOOR, WINDOW OR JUNCTION FRESH AIR INTAKE BOX APPROVE WITH CONDUIT MANHOLE Se C 40 W1 PAD L WARNING 4$ IN. OU&A -- IAJL&T AaAe T' : INLET r q3 •D� _ t tt = = GAS - /��` LET' Z �7► - = TIGHT SCD.4o -- A I SEAL APPROVEL F � �— r ALM JOTNTS G, 3'16 SOLID M019 CL. A'10 a 5 O PIPE 3' SOIL go. C `• SOLID SC PUMP OFF ELEV. FT. �y 1 OFF '�'� R U ?�D D PERMITTE �L. IF TANK MANUFACT pp 3" APPROVED BEDDING UNDER TANK HAS APPR 0 t•� CONCRETE PAD SPECIFICATIONS SEPTIC t DOSE TANK MANUFACTURER : 49IE5&2 �900 NUMBER DOSES PER DAY: tZ 0 TANK- SEPTIC 12 5-6 GAL. DOSE VOLUME INCLUDING DOSE GA 5 -�— L. 5 LOWBAC K : GAL. ALARM MANUFACTURER: MODEL NUMBER: _ � 4 CAPACITIES: A = /t, 5 INCHES = y1jO SWITCH TYPE: P11QA T B = 2 INCHES = I PUMP MANUFACTURER: 21D &1f6 C = (, MODEL NUMBER: �J INCHES = 1 05 SWITCH TYPE: p �(" 10,,x,7-- D = (-(, i INCHES = REQUIRED DISCHARGE RATE Z S GPM PUMP & ALARM WIRING AS PER ILHR 26.23 VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE Co. FEET + MINIMUM NETWORK SUPPLY PRESSURE . + ? FEET FORCEMAIN X IY FT /100 • . • FRICTION FACTOR • , FEET 3g r TOTAL DYNAMIC HEAD = • C .3 FEET ,Sj INTERNAL DIMENSIONS OF PUMP TANK: LENGTH "1 t3 /r WIDTH ~ DIAMETER LIQUID DEPTH 3 �r SIGNED: LICENSE NUMBER: DATE: Vo/ U61 aw S a 2 'F Pct /4,4141 P/c SPECS s � y of a 0, 5 � -- SEPTIC TANK, per Comm-83.44 (2) (c) shall be eq uipped q Peed With an outlet attached ap pro ved s Elite,). Tank sha have filter device (Zabel ground locking manhole cover s for o regular v (every 12 months or less) inspection & servicing by a Z EF FLUENT PUMP MODEL,'98 IIEAD CAPACITY CURytr MODEL "99" s tla a 1/4 0 i I s a/a s 4 s /{a lo_ a_ t 1/2 -11 1/2 wt --� f. o�uoNS t -? tMEA so eo _ so to Flo so 160 FLoW PER UINUtE tors tmw,a r aM u..mn trttwrrt Are oawarrMao : I tA►Attrf li eMl ►tJMNt rltF bttlM auU 1r11! Pra !i let tt 71 1 1 2e Ito 2! fs 29 is LockVatw CONSULT FACTORY FOR SPECIAL APPLICATIONS Elscirlcel allerrlelors, for duplex eySlems, an e end availabl alipplled *kh an aletrn. a Mercury "Oat switches are evaAable for cont, nic Mechaal alisrnelore, fdt duplex evatems, are avepebte wtlh a a po @ phase eyslems. oMklg aklgle and **%OtA Norm "Ches piggyback mercury float switchae Ore re avallabie for vellable lsysl long cycle controls. Standard All models - Wel ht 9916!. • �/, l f ,p, 1. Inte aElLcuo" auloE elasr {stt �9 op. tdM2pol.en.eh�Ncd.wheh,no.xl.rtW Mode, COeh01 Solactlon P. Si ngle 4hl:h pb9bback mercury 4 -y avrhch of 411M" cat�a taqultad V ht Ph 11oda Am t awheh. Mlsr to FM01II. �i0k R►arerny, goal M9<f elmplt. _ . 11 1 ulo 0.6 1 N Du let !. M.chankal ahttnalw t0 oo12 at 10.001'1 — L_� 1. Eta f Mol 1!, of txweaf Shade! Of Ekac4kaf IlMarnator, "E -Pak ". a!a 200 a. Mercury a.mw east •wkch 10� ui4 £ a tte�vyN p !7p t 1 « 1 t 1 duplex W) w (4) east pretsrn N e cotwol , 1 Nat, t - r� a i i w 1 t • � . rfl�r.111 hpb "1 Pak ", lundlor� pow_ kx d'M*x epara0or% to 000a. Leo^ a woad b tktr• t. vre ps holo - J POk ; IN watatllattt eoww._ op*n ,~ tiaray�ys M ty �� MUr MsdyaM r•rw b cat tt Mrreary tbtl l E f d !• at0tee; V , f M061t; AN lnaleNal6o or _ CAUTION laet>t! Pia' q e ktl M•tnda, ARarnata, �. pei •eUas �0 ea•ty FMOVt; and Ai•�pt. carted 11.1 /c•n••1 •I..trk4r. AM •t••lrls•f s.l � aMrU M Ierta ►r t tu+� c A0 °� ht 16. 0,04 •.••nt N•Iles•i Igoe" C•1. 'tF �d.a she ult M lelowN M•U.1 N••kh Ad fotNAX file) aN ow C a�rNe•w•1 t•t•Rr sn1 RESERVE POWEpED DESIGN • (`or tlrtu suel Conditions a reserve safety (actor fa dnginee•ed Into the dest n o 9 t o,rery Zoeller Pump. .. ran to r.0. sox ►6Jr1 Manulacl ers o L L SNIP 10: 3 a0 !1 A60an 1&* i � t a4lr h; KY 16218 arrAJI&S fft r � (30 - 213i O lAr j50?)11I -J6 ?I OWNER' s MAINTAINCE..QF SEPTIC SYSTEM POWTS (landowner ) is.re main tenance tenan for. ce of.this era ' proper o servicin system. Regular pons g is periodic inspecti an d necessary for the safe healthy operation o. /inspection reports system.- The owner is required: "b f maintenance /inspection code to submit all necessary to the controlling ,autho ' ri °t es SPECIFIC CONTACT 'AG ENTS Gov 54 - Rio/ y/ - G� ernmental authority/ Z inspectors: * Licensed installer, responsible for maintenance.. "User s" manual providing an operation) * Licensed servikee / inspection agent other than installer: 3 , 130 *. Ele ctrician, n fcr pump, electric con tr ols, wiring units: 'D Tv X. IMPORTANT OWNER MAINTENANCE RE UIREMENTS .- 1• Winter 'traffic `(sieddin area shall not be etc.) 9, shovelring, the cell permitted, or filloss the freezing up the system. Disrost can/will us int winter_ a vacacti ( on . tr.i lead P. resultin .in the to ups, g in no water use can also 2, Water cansery ation �needs"to " exercised.r hydrolically overloaded and Or system can be destroyed. This s wastewater flow of f�em was designed for a maximum 3• POWTS are no gals. :daily. t designed disposal unit, aeeomodate wastes from a Or any other unnatural sources of``wast "ebage Any introd uction of such Waste mater -• destroy this system. materials will overload and 4. If a power st Data e n a temporar y g occurs, or a pump falls, it ma cell, which overload of effluent Y"result' may adverse l being Pumped into"the recammended that a Y impact the cell (leak&ge). It is allowing th licensed pumper em t Consult Pump to return P Y the dosing tank, your installer tO dosing the correct amounts. immediately for advice. 5 • Neglect of the erosion Vegetative cover (the cells insulation traffic preventive) can lead to failure. also can destro REGULARLY WATER THE V Y t he system. It Compaction or heavy the,Ystem beneath ISEGETATION OVER A I S NECESSARY TO ' SYSTEM!! Effluent in yl jcovwr• NOT sufficient alone t0 maintain a ° 6. Periodic i nspection$ b necessary. Inspection y the owner, or his a i nto .the he sys tem: Port Pipes and gents, fe in t on the mound s have been incorporated Pipes cleanout asal area (effluent level terminals laterals, at each ti on O O The filter p - f ior flushin the Pressurized round system n the g and cleaning the laterals cover /manhole). Only tanks (via a locked above Person should be y a licensed P & severe Performing thi erly quali6led safety risks_ Evidence of s work Pro which involves system's trejtment Cell s effluent health hall also be regul arly i in the s r AS.BUILT SANITARY SYSTEM REPORT "tER r TOWNSHIPS EC. T a�N, R a0 W — — ,� , ADDRESS S IX COUNTY, W SCONSIN . -D 7. 3DIVISION `ice` I s � r LOT SIZE Ivyr CSyVI / )� PL N VIEW Distances & dimensions to meet requirements of H62.20 SHO G WITHIN 100 FEET OF SYSTEM Ai r I i i I - ' ' I f ' f"0 ; I Indicate Noxth' ATro i SCALD : O ! TIC TANK(S) MFGR. L eS CONCRETE X STEEL NO. of rings on cover — Depth_ DRY WELL ;'vCHES NO. of width length area no. of lines width lengt area depth to top of pip '- SREGATE �K RATE REQUIRE AREA AS BUILT s- 1aimer: The inspection of this system by St. Croix County does not imply complete — :-nliance with State Administrative Codes. There are other areas that it is not possible ;inspect at this point of construction. St. Croix County assumes no liability for - -tem operation. However, if failure is noted the County will make every effort to ermine cause of failure. :]ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. - "INSP FATED ( 7 PLUMBER ON JOB LICENSE NUMBER �3 � y zo • .REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.itaxy Pexm.it - 17.Y State Septic 77,775 NAME 1 r'Sc�� ec� Town.6h.ip Cxo.ix County Locat.ion oA 110 4 -, Secz.ion_L_T22N,R 20 0 SEPTIC TANK Size Al212 gattonz. Numbers of Compartments D.i4tance Fxom: Wet.b 767 it. 12% on gxeatex ztope At Bu.itd.ing z� At. Wettandz bZ. H.ighwat =— At. DISPOSAL SYSTEM D,iztance Fxom: wet Az. 12 %, ox gxeat Mope At. Bu.i.2d.ing it. W ettands Ft. H.ighwatex �' St. FIELD DIMENSIONS: Width o6 txen ch ix. Depth o i no ck b etow x.ite � in. Length o6 each tine _ At. Depth of r ock oven t.i.Ce 2 i n. Number of tined ,3 Depth of t.ite be.2ow grade 30 .in. Totat .length o b t inez it. Stope o s trench in pen 100 At. D.i.6tance between tines �/ i t. Depth to bedrock - - it. Totat ab o axea/J 4t Depth to gxoundwatex , At. Requited area At PIT DIMENSIONS: Numbers o6 p.it.6 Gxavet around p.it.6 yeb no Out,s.ide d.iametex Depth below .inlet At. 2 Totat abd oxbt.ion axe At z Area %equ.i At rn INSPECTED B TIT L t—,& c APPROVED , DATE 3 197 REJECTED ,DATE 197 l s � X 1 1 c , P State and County State Permit # � Permit Application County Permit # /75 for Private Domestic Sewage Systems County - � *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: .[ NP\LD AF-PSC -4AL D OZ 70 ST, `ou c -<J/s, S�ICo B. LOCATION: ,5(j % NF- %, Section _f___, T aN, R_gg_t (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village 7 3S 4 JD C:"!I J Township ST JO6-PR C. TYPE OF OCCUPANCY: Commercial * Industrial *Other (specify) * Variance Single family _ X Duplex No. of Bedrooms .3 No. of Persons A 4- D. TYPE OF APPLIANCES: Dishwasher X_ YES NO Food Waste GrinderYES_NO # of Bathrooms-?b Automatic Washer _YES NO Other (specify) E. SEPTIC TANK CAPACITY I&OO Total gallons No. of tanks 1 *Holding tank capacity Total gallons No. of tanks New Installation v"' Addition Replacement _ Prefab Concrete 1✓ *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1)_? 2) ZZ 3) _ Total Absorb Area JJ SZ _sq. ft. New _/ Addition Replacement *Fill System 1121 2L rQ Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length &q, Width / $ / Depth Y#$ It Tile Depth No. of Lines 3 Seepage Pit: Inside diameter Liquid Depth Tile Size 4 1' Percent slope of land Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified Soil Tester, NAME C.S.T. and other information obtained from .fD C (owo&0wAd rWdfe, Plumber's Signature MP /MPRSW# * 09 Phone # y�,r� .3✓ � 3 • 3 Plumber's Address i&ze 4-✓ �. PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). -1 t � �t.�u• ��:r�+M��= c�Ji•� Q�c�rcv� 0 o ��11 ��,, MM �^� o• 0 1• 4 O 0 0 V 4 i..O _ . c o M M 8i o �t ho /4LTE /�lATr SYS Tr AA ALT( =KNh"f i I m L.OU'.T(W ( ► C LAND t I � 1 Q I I 1 ) 1 l 613010 N _ Do Not Write in Space el FOR DEPARTMENT USE ONLY U Date of Application 14? Fees Paid: State l L County Date (ho �U Permit Issued /Rejected (date Issuing Agent Name v- r eh Inspection YesNo Valid# Date Rec'd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/11/76 s WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, PUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 �j REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: SE' /4, , Section T� I (or) W, T ow wn ns_hi� or Municipality 5 fOSEP Lot No. , Block No. County s7= C/PO /X Subdivision Name (}vvr�e s hame: 'G �S�i4,tyL C'4R6Cf�GT) Mailing Address: e�0160M /302- 4I HU w s� /6. TYPE OF OCCUPANCY: Residence x No. of Bedrooms 3 Other EFFLUENT DISPOSAL SYSTEM: NEW x ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS TUNE 11 r7 � PERCOLATION TESTS 3v,.'e �Z X 1 7� SOIL MAP SHEET 2 L �CG CS SOIL TYPE 6_4 2 0/✓/9M /.4 Cf{FT'E C' /EX PERCOLATION TESTS TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE CHARACTER OF SOIL SINCE HOLE HOLE AFTER INTERVAL NUM- INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN /IN BER P- / 'fO „,. S 3o `` Si L . � i CoBl Z- j� b /C7 � � 32 ��O 4 �G �G P_ 10 T5 30 1 /4 /. l SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B / 7 b 7 7 7 "TS 3v " 5,' _ wi g o0$, `�/ ' 5 wi� �' GP 2 ?J? 0 &"r5 3o` S;/ u,iA Coo 4s" 5 e—,^ Gh B- 3 '7k 0 4 '' 7S . 5,'L w ill, COB 4 5 w i' G h 4 72 O 7 72 P , T5 /G" 54 Ali `�A C04 s '�uiA Gh B 7 72 „ TS 2 1" 5 6VIA C-6 - 5 A' G/+ �0 7 t a > 71 7 "T5 /3" 5i1 l "0y,, ce'a 'l " 5 PLAN VIEW (Locate perco lat io n tests,so i I bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. 1!a )*�R Tit'F_V e_A 1j2_ r2,9 fjgV Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. V#% t0 c R o hIR .� W it R /E RA A Ro oeD , �iDQ0 r tN - I >=L, 3 �- F v F 8355'- 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 location of test holes are correct to the best of my knowledge and belief. Name (print) eoh r, eT Z/ /6W /c 4. 7 Certification No Address e Z 11 - 125 -v Gy /S 5' 401 Co Name of installer if known CST Signature COPY A -- LOCAL AUTHORITY SaWy and Buildings Division County ! • C/t: t� / . N an 201 W. Washington Ave., P.O. Box 7082 pisconsin Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 261 -654 2 S Sanitary Permit Application State Plan I.D. Number ,v /,¢- iin -com a76 Coteau 83.21, Wis. Adm. Code, personal information v, may be used for secondary purposes Privacy Law, sl5.04(1 xr4) _ Project Address (if different than mailing address) I. Application Information - Please Print All Iaformattpta__..: o __ _ y 0 • 101 O . &VV RE Property Owner's Name Parcel # Block # 7V0 A - A,y ;e _ a 3 s Mailing Address , • ' e Property Location city, state Zip Code y., Y., Section 4 101 2-0(cucle,;w) 7 P�POCt��fi T N; R E W I1. Type of Building (check all that apply) 0 -1 or 2 Family Dwelling - Number of Bedrooms _ CSM Number ❑ Public/Cotna,er 3a, S7 V, Dl• /, • 1 7/ cial - Describe Use 11 State owned - Describe Use _ 3 ID 1 55-r- C �� C, v wS �� ❑City ❑Village &owndtof III. Type of Permit. (Check only one box on line A. Complete One B if applicable) - A ' ❑ New System eplacen,emt System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B• ❑ Permit Renewal ❑ Permit Revision ❑ Chy4 ❑ Pe4,it Trans f List Previous Permit Number and Date issued Before Expiration Plum IV. TYPe of POWTS S stem: Check all that apply) I I I / d )lon - Pressurized in- Ground ❑ Mound >:24 in. of suitab in ble soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Weiland ❑ Pressurized Im d ❑ Holdin . o su, ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter hing D Pipe Other (explain) V. Dis ersanreatment Area Inf m lion: Design Flow (gpd) Design Soil Application Rate(gpds0/ Dispersal Area Required (so Dispersal Area Proposed (st) Sy stem ti ' sv `/ rra. 3 p�A� S VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New I Existing Tanker Tanks Septic or Holding rank / �, A AJ 4 Aerobic Treatment Una Dosing Chamber VII. Responsibility Statement - the undersigned, assume responsibility for installation of the POWTS shown on the attached Pu na. Plumber's Name (Print lumber's Si IMP/MPRS Number Business Phone Number '� • Lt R i ��,7 2 S 7/S • 7 7,2 • 3 yY 2_ P1ZiZ (S treet , Cit Zip Code � • Sp/f::v 6— U tA 4 'S s y 24 7 VIII. oun /D epartment Use Onl proved _ ❑ Disapproved Sanitary Permit Fee (includes Groundwater ing Si (N ) Surcharge Fee) ❑ Owner Given Reason for Denial IJCY� covaVReasons for Disapproval "7�7 1 Septic tank, effluent filter and t9A dispersal cell must all be serviced / maintained as per management plan provided by plumber. �¢ d 2. All setback requirements must be maintained as per applicable code /ordinances. Attach eooupkk pleas (to the County only) tort as paper sot kss than ill/2 s 11 laches latize SBD -6398 (R. 08/02) r op Dp 66AWI -' /b o, o ' r old OF JfA.1rAVktW i. �cRc�. Z cau lily C O � ZGv ..- 4.0 Ino I DO -# Z 1 0, � p o � 61ec • sysT�� yi, o T��NS � 1p0, 15 a , a i rslS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # �v� x a2 D I Ulbricht & Associates e.,..,nnp Consultants ULBRICHT & ASSOCIATES CO. 2812 10th Ave. - Spring Valley, WI 54767 Reg. Designers of ftineeiing Systems 715- 772 -3442 Private Sewage Consonants PROJECT INDEX t/ PLAN ID # DATE �r !�• ��j OWNER SON ? /�'j �(/�y Z PHONE 7 S • 5 q ( r • 60 S( ADDRESS CP /��iq' /OSS �-- 7R 11_Vt2 S 1 101 C, LEGAL DESCRIPTION 40r - f- .3 CSA1 3 P�. F7 171 030• a 617 . , 0 -mz .. 5 fi 1 ti6 s 1�c. 7. Ti S. 2zegco TOWN OF ST- ;70 S C`�0(�t� $ COUNTY T' 6e0( CSTM Zl `hlef l- 7 c- LOCAL AUTHORITY/ SUPERVISION ST . G P�0( x c r y- ZQA3 C AJ G— PROJECT DESCRIPTION: /1 ,&44Y4, Sys lzt, - . 3 WA s( 'z,� �f �,t;� sr�•,�, s ys r . �4p p red x D W �� S 16�_ &Len S. T 5 kaZ 1�e p1 S / S i r P osSi /t Ulbricht & Associates Private Sewage Consultants OPJGIN 2812 10th Ave. Spring Valley, Wl 54767 P9•1 INFILTRATOR SIZING WORKSHEET P9.2 SYSTEM PLOT PLAN P9.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. P9 .4 is 11 is to n n 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 Treatment Systems.,, (Version 2.0) SBD- 1075- P(NO1 /01. f kA kA Zi Q CD m z-P� cr -= m m \t to m 1 — n m ` c �-- - QA /6 0 - 0 t r 5 -r, 0 amp JjAVU, VX, 3 C, .• I _ _ ,� 9a 3 X-�� 0 Sill, �,,' 3 , 4 l • i/ ice, .riM �1.e� • s y sr�M 9�, /0 0.1 a a T i IIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # / Ulbricht & Ass Consultants Private Sewage 2812 1Oth Ave. Spring Valley, W{ 54767'`' 30 5" rrc 7"4 ,uj 3 POM c0'r -4m . ao*2� C- i IV jA 0V D 5 j r, I , vv �ivS�JFc T /ov p/ G D Iff V /W rl he rae c Ceo SS Sic Tiov ©� Trp�".uc�ls /r 744 7'0;e,5 / Sic r/eAj, A&, 11Eu T cep I ff -'ao 35 V-mt y y3. 50 OVER: See Reverse Side for Vent/ Observation Pipe Details. Clf'O SE C T /off- OF 7A�f �S �r Z- 7/' 7 Q vi C K y Ifs AIAI. i K -sr4. 5 l cv - 0 ,qR 41 Wt /,0 7,*fT 5 y6 T ,E, P o s s B Lt - AjE w i s A.4d Ag ue_ 7 y" 1yAA4kd1 Dv��2 s •-t-. c NLET ALsv 4 SEPTIC TAN & PUMP CHAMBER CR OSS SECT A ND SPECIFICATIONS n 4" CI VENT PIPE 12" MIN. ABOVE GRADE & WEATHER PROOF "l 2! !O' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE 544 4d _ W1 PAD LO / WARNING c �- `, i t� rte -� -- �..----.- 4 " MI Ole 7 INLET �� — - GAS- ' Zr916F.�. �''' � _ TIGHT � Sw.4v -_ _ A E SEAL i APPROVED QUG Qt Pte, t, —� ' ALM JOINTS W, 3 SOLID M opCL - /� -� b it ON PIPE 3' c ��•� Y 3 3 SOIL C �� SOLID S PUMP OFF ELEV . F1 . I OFF RISER P Sipe bt ' D � PERMITTEE t �/►�► IF TANK MANUFACTI ��' NK � ► �� 3 APPROVED BEDDING UNDER TANK HAS APPRC Q 7 CONCRETE PAD S PECIFICATION S SEPTIC / DOSE TANK MANUFACTURER: NUMBER DOSES PER DAY: TANK SIZES SEPTIC �O 9 LUME INCLUDING �--- ---- GAL. DOSE VO DOSE GAL. 5 FLOWBACK: ` GAL. ALARM MANUFACTURER: L,Q17.1.�" f�lZiLst CAPACITIES: A = Id INCHES = 4� MODEL NUMBER: SWITCH TYPE: A�} _ B = 2 INCHES = 32- PUMP MANUFACTURER: C - S•$ INCHES = MODEL NUMBER: _ SWITCH TYPE: ` t c 1041 D = C -7 INCHES = 2 Z 3 REQUIRED DISCHARGE RATE Z,j GPM PUMP & ALARM WIRING AS PER ILHR 16.23 VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . 5 • MINIMUM NETWORK SUPPLY PRESSURE FEET • 4 2 S • FEET FORCEMAIN X 01—FT/100 �FT..FRICTION FACTOR . 5 FEET FEET TOTAL DYNAMIC HEAD = FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ` y ; WIDTH _ _ DIAMETER / / LIQUID DEPTH YO SIGNED: LICENSE NUMBER: DATE: 1101,1 fete ` P/C SPECS • , ^I Lt - T O A11 AJ 1)1 130 X 90, D ' CAC& I o f be -- SEPTIC TANK, per Comm.83.44 (2) (c) shall be equipped With an outlet attached approved filter device (Zabel fliter). Tank shall have an approved above ground locking manhole cover for regular (every 12 months or less) inspection & servicing by a 1- i ('PnMeld nnr -wrl r... ........�..... ZOLLER EFFLUENT PUMP MODEL 98 NEAP C APACInr cunvE 3 7/1 s— 4 s/e 2s— e 3 5/a is— 0 - - 4 3/14 so— !-- 1 1 /2 -1i 1/2 NPi a— e U .S. tuuorts LtrERS i ce? 30 40 50 so 70 00 f 240 0 FLOW PEfi MINUTE tOrai Dtiutlq ntA2kftOW till iu.nfrt iftturgt Ana MW"I'ma 11[� CAPACrIT 12 ttrltty • •[tT M[ttn• !SAItSc tttl• v to SOS of 2)1 t IN l41 19 9S 20 •. t0 25 eS Loekvalye ��; 3 S /Is CONSULT FACTORY FOR SPECIAL APPLICATIONS • f_tectricat atternelors,'or duplex Systems, are av_ilae and bl lupPlled with an alarm. si Mercury float switches are available fOr controlNng single and ►,M*Chs<ticd allernalole, I& duplex !V!tlms, ate available with Of s ee thr p Systems. W NW Ns►rttchee. Piggyback mercury "oat Switches are available (of variable level long Cycle controls. 8bindard 2 11 Inada - '/ N.P. SELECTION Quirt: 1 Single Boat operated 2 polo rr»ehariteol Switch, iw extarrui eo+iLoi toQuirod. tIN larbe - Wei 3e lb! -- -- t. Single pippybaek mareury 110161 i►„hci� of doubts Model VOh$ - Ph Control selection +witch, paler to Ft.to +71. Pa"b..k mercury, flog lliod• Am • llmpiex 1619! its j 0 6 Ou tali k. Machatdca+char ruNOt f O Ot172 or 10-0073 of 1 1 — 4. &o MOM, for correct model ei Eiec" Akee not, .••E.P O 230 2w j� t. Met" argot now twitch i0-0M acid y a eorwoi acdvalot t" t 11uto i t of t t T _ �a M or Ni anal syatern 'PaaY f 3o 1 Non +! 2 x 3 l 3 a 4 t t .F41 f►ote "1Pak Frricdoti t>o>` ra PUN ;DC &Jplas"ratbr% t00002. peotrradionawarad- Inoim• 7. two M hate "J Pelt .. , for oasse" ta li 0 4Mi M •�/wi,w heeler paa,ctr rated to Cat m Pe fU"?I• vOC CO "' ` �r.f�6t+; CAUit0N ELctkY AR arnalOt, f AN iruitMallon of "Meek Arai *oiion'�a( ji Atw iariya, i!• tbt•e; a.'achanicai t(, tot. a snA ivitinp sham w 4ona Sr a Mull. IY•t1! Ma _ :• � i'•Qa a4rM, fKbtel; am R;mp!•. rw*,* Lon, f{•� Mcenwd sMotrklnt Aft st.c4ba4 ant elf atf cod.* a W+• rr.� +coat recant National [raced, C oAculd N re[owel tnelul- WaNA Act f0$HA), °� MCC'r an4 fife coeupallonat talot, aM RESERVE POWEPED DESIGN ror'unususi conditions a reserve SaletY lactof Ia ditgineered Into the design of e,ie Zoel !Y ter pump. VAR 10: ;.0. 16347 . 1 Qi!ViWf.,XY 40 ?56 - 0347 AfanukawelS 0l... - e iNIP 10: 3ZB004• Aegis rant N i or ><: XY t Qururr /�aips ,f svnr /9.s'9 l50Ij 770• ?7 1 :o tell {' .504 SOIj 774 -36 ?4 I � _ f Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code c,P o i - Attach complete site plan on paper not less than 81/2 x 11 inches in siz ust county ST' include, but not limited to: vertical and horizontal reference point (BM), rection Parcel I.D. 3 O , �/ qO . percent slope, scale or dimensions, north arrow, and location and dis t road. Please print all information. eviewed Date Personal information you provide may be usee fo low. %1 15.04 (1) (m)). ZD Property Owner , rty Location G D OAJ ? IMP Y S vt. Lot 5 t. 1/4 1 G 1/4 S T 2 � N R 2 ' 0 E (or) W Property, Maili � doss j A 1 o # Block # Subd. Nam or CSkW fP 3 CS14 3z 9957 1/o� /' v b d City State Zip Code W/. Sy of ' �; city ❑village Town Nearest Road r1 ST 1oSEPhl 4PP01-0 -9 7 ❑ New Construction Use: Q!�Residenfial /Number of bedrooms Code derived design flaw rate GPD K Replacernent ❑ Public or commercial - Describe: � Parent material Flood Plain elevation if applicable N ft. General comm Kiati 19A % /'�" 77 2 and ooM pi,�ti�r 501 M�4 g *Wr !//%- /3 v// 1//f /6-t l ebe 0 -zer . • N,�w •S' y S��iw w / �/ ,P,e vim ft L�G'r �v�1,0 T�g,v,� - M Boring # ❑ Boring / 1 ' �� > D u� Pit Ground surface elev. ft. Depth th limiting factor tJ in. Horizon Depth Dominant Color Redox Description d Rate f� Texture Structure Consistence Boundary .Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eif#2 YT 3 ( 3 4-"-FR- w 3 ,4 . g v Y)e 9 Q 0 1 3M 7 5 y2 /L / K ,wt.FR cS ! y Y2 1g l L 5 Boring # � Bon ILF Pit Ground surface eiev. ft. Depth to limiting factor ` tn. Sod Appkafion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 / 017 k �� BMW Si'L 2 f 02 iw► -F I2 CS 2 i 11 -C70 7 f y Effluent #1= BOD > 30 < 220 n & and TSS >30 < 150 mg& • Effluent #2 = BOD < 30 and TSS < 30 n4l. CST Number CST Nam (Please print) Signature -- Address Date Evaluation Conducted Telephone Number ' 3 0 • a o 7 1S• • 3 Z, Contact: Ulbricht & Associates Registered private wastewater consultant and plumbers 2812 10th Ave. Spring Valley, WI 54767 715- 772 -3442 ORIGINAL • i C= M- IVASMFAls , I/ TV mmm� m WA ON rim UNAM mm mm�, EM m •- �r�...__.. r , .� mm�� ■��■a����� mm ■ mm� ���►.���� mm ��■���s��� mm r:r« . « «.. s � r i r s pis jv old o� Vil w 3 ,u� i yz Z. 0 al 8 �I 4 ��50 2 d f fteG TOP rR, AJ5 ap p, t5 r a d Ulbricht & Associates iates Con sultants' R private Sewage 2812 V0� Ave. VV 15470 Spring Sep rrG T4we PomA r6MA4 -2 WQS OWNER I s MAINTAINCE (3F SEPTIC SYSTEM POWTS (landowner) r epo , maintenance Of.thissSystemsible for proper operation and servicing Regular e is pe 9 ne is ' necessary inspections and system, The Y for the safe health owner is Y operation n o � ma i qu i red. b f. th i s , ntenan Y code to c e /inspection re submit all. necess ports to th es.. e controlling, authors -ties; SPECIFIC CONTACT AGENTS * Governmental authority/ inspectors: _3 y& * Licensed installer, responsible for maintenance-"Users" manual: Providin 9 an operation/ - 7 7d • 3gy2 - 7 * Licensed servikce / inspection agent other than installer.: S ,g - r - io.0 * Electrician, for Pump._electric controls, wiring units Via- 5 , � 3 3 w rw � T�.,v�c. _ IMPORTANT OWNER MAINTENANCE RE UIREMEN 1. Winter. TS tra ffic'(sledding area shall not be. • shovefcing, etc.) across the the csha Permitted, or frost can /will freezing up the system. Disnuos 0 wint conti . ( _ freeze a vacaction tr -iP, resulting'zn no water us lead to ups, ej can-, lso 2 • Water - conser -ion , hYdrolicall needs to be exercised! n desi for a maximum Y overloaded and destro ed, Or system can be geed Y This syskem was wastewater flow of 3. POWTS g daily, are not designed to accomodate wastes from a disposal. unit, or any other unnatural Any i ntroduction of sources of '�waste 1 . d6stro such waste materials will overload and Y this system. 4. If a power outage occurs, or a um In a temporary Pump fails, Y overload of effluent bein it may- respit Cell ` . which may adversely ii 9 Pumped into the . recommended that a licensed pact the cell all (le dosin ) . It is 9 the PUMP return to dosinmPty the dosing tank, Consult .your installer 9 the correct Imme amours. t s. 5• Neglect immediately for advice. glect of the vegetative erosion preventive lls insulation cover (the ce traffic also ca ) ca n lead to failure. � REGULARLY n destroy t he s Compaction or heavy WATER THE VEGETATION OVER A SYSm'IS NECESSARY TO the system beneath IS NOT sufficient alone Effluent in . -L , cover, t0 maintain a 6. Perio4ic in s pections by the necessary. rter Y• Ins ec , or his Inspectio a i o e � n ag ents, Int pip i the s P P s and o s int s r system: Ports have av e 0 n been e h n ns e e mound Incorporated P ction Pipes), clean and basal area (effluent rverated inspecti at each ti terminals on level out: The filter system p - fo r flushing and cleaning la ground cover licensed prop in the tanks (via a locked above aterals Person c manhole). only a Severe ould performing this work whichinv Ives health sy s t em's s afety ks. Evidence of Involves health cell shall also be regu ly In g the regularly inspec ted. I J S'T' CROIX COUN'T'Y SEPTIC 'TANK M AINTENANCE AGREEMENT AND t OWNERS1111 CERTIFICATION FORM Owner /Buyer M AR Y /"Uti l Mailing Address Q. X0 SS 4-- ']"/f j'�% #vPSeA) S yd!r Property Address ' (Verification required from Planning Department for new construction) City /State Parcel Identification Number 30 ' 2d ( 7 X0 O dd LEGAL DESCRIPTION C n S � Y. N £ t/. � ,?-d � Z 2 A 3 Property Locatio S , T N -R W, Town of Subdivision I.oi # ✓ Certified Survey Mnp # 3 Z S 7 , Volume Page a 17/ J �7 oo g D eed # ! 3 z 5!/ l 2 Wsarrnnty b , Volwne / ' O ,Page t# Spec house 0 yes 16 no Lot lines identifiable Al yes Cl no SYSTEM MAINTENANCE imMopet use and maintenance of your septic system could result in its premature failure to handle wastes. Proper mainte consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the s3 can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and mastet plumber, joutneyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal sy Is In proper operating condition and/or (2) aflet inspection and pumping (if necessary), the septic tank is less than 1/3 full of slu ihve, the undersigned have read the above requirements and agree tb maintain the private sewage disposal system with the Stan+ set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certific elating that your septic system 1,as been maintained must be completed and returned to the St. Croix County Zoning Office withi days a the dn!!r, year expiration date. SIGN T of APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form ate true to the best of my (our) knowledge. (we) ' *m (are) the owner( the Property d sctibed above, by virtue of a warranty deed recorded in Register of Deeds Office. �-� SIGN ? E Or APPLIC NT�� DATE +* * " *` Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. *• * Include wlih lhis szpplicatlon- a stamped warranty deed from the Register of Deeds office 8 copy of the certified survey map if referenceis made in the warranty deed At t *` DOCUMENT NO. ITATS BAR OF WISCONSIN FORM 1 -1900 TNU s�Aee aarawo roe aaaeaullte eaves WAR 'flow RANTY DEED ��i Fi ta7�PA6E This Deed, made between . AR nAU .N...HAxsi:Al,el......... lht.. �i,xASh2+tb,..b11+�bAnd . .�►Ea.amd.ladiv :........ .................................... . .........................Qs��. NOV 3 01987 1Mn _Kunz, husband and_ri�e� • •- �survivoacahip t,er tal d C ............................................................. ..............................0 Grant@% % *W oo } _ Witneweth, That the said Grantor, for a valuable consideration...... s .: ........................................................................... ............................... ""UF l To ' oosven to Grantee the following described real estate in ...Stt:..•.Cr41X ............. County, State of Wisconsin: Part of the South Half of the Northeast Quarter of Section 1. Township 29 North Range 20 West, Town of Tax Parcel No:.. ........_..........._.......... St. Joseph, St. ro unty, sconeeacribed as follows: Lot 3, Certified Survey Map, recorded August 26, 1975, in Vol. 1, Page 171, as Document Number 328857. Subject to and togsther with a 66 foot wide easement Southeasterly to County Trunk Highway "V" as recorded in Vol. 536, Page 320. By accepting and recording this deed the grantees for themselves and for their heirs, grantees and assigns, covenant and agree that so long as they own the land conveyed they will share equally the cost of snow removal and all road maintenance subsequent to the original cost of construction with the owners of the other parcels of land abutting on said road and who use it as ;their access road. This agreement runs with the land and it is binding upon all future owners of the land above conveyed unless and until the road is dedicated and accepted as a public road. - R ?A0 a This ........ is ............... homestead property. (is) OMNI th. �e t � . Together with rantora Donald N I HeisCh� eb ap anT ry " And ... $ ...... ............................... - warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants and restrictions of record, if any, and w:2 warrant and defend the same. October 87 Datedthis ....•......... day ot .... ._-.. ...................................... ... _M_, 19........ .._. SEAL ...:: . t4&273�".,. Z-4. DONALD N. HERSCHLEB I • • Y / ,! ...... ....... ........................ ....... .........................(SEAL) -- -..�� /7�MAN7C i _.1- . __A��l:�fl..- (SEAL) � • HER SCHLEB { AUTNSNTLOATION AO1KN0WLZDG1 R`kT ! j' Signotm(s) _ – . ... .-- ..... w . ...... .. .... _ .... .. .... _ ......... .... STATE OF W ISQQ&W N �/ �I .............. .........._..._.�.------- -_.... ....... ........ _ ... _......... SlrGwsfx iC County. . auamoCated this - _..day of.. . . ... .... _ . .. ...........10...... P � ° ctoisei n°e. before all .-.__/ ........ day of ._..... -. -- ._ ................ 19 .... the above named .......• ...................._...............---- .........--- ........_....._. ......... -- ..... Dwald_sl�_ He=schleh..and._Ma�1...Ia. TITLE: MEMBER TA ....... - -.. w .- .Be=achleh �� husband. and. : : - - - -- ..... ......... ... _......- --•- -•..... 1 8 TE BAR OF WISCONSIN (If oak ............................................................ ----------------- – ......................................... ..--- °. � authorised by t 706.06, Wis. Stets.) to me known to be the P R ing instrument a THIS INSTRUMENT WAS DRAFTED aY c� NOTART PUSUC- NMNEaOTA CARL S HURRAY ._. WAfNIN6TON COUNTY _ - - ..- •.... .. ... ..... °_- o. 6oin. JAN. 2e. t9Si. ---. . ..... - & •_ By Samuel R. Carl • .... P: Box -- 229;-•Hudson• #- *1--------- 4414- - - - -- Notary Public County, wis. �! (Signatures may be authenticated or acknowledged. Both My Commission is perm lent. (if not, state expiration are not necessary.) date: .......................... ....... ..... (I •Names et -waves sin he is nay capacity should be typed or printed bellow their eignamrae. ( � WARRAII!! DaND III BAN OF WISCONSIN Wisconsin Iweat Blank Ca Ise. I , TONY N& I —Ion YSwaokee. WY. 328857 Volume 1 Page 17 CERTIFIED SURVEY MAP N 88 0 23'55" £ 530.00 'bO . ti 0 . M �z2�A3 0 LOT 3 to - 5.137 ACRES "' W 0 O M °O �"� 0 ' 00 % 436.20 — t '0 0 � 4 66 ROAD EASEMENT S 88 °2355 W 435 © 495.59' a 0 ��` �tig 1 120.00' n ti $�ti °o r �%� //y w 8 04''30 /V W N 37 W LOT 1 rp 9.53' � 5.459 ACRES rn •. N 88 0 23'55" E 363302 ''. .� 0 00 sb rn • 4 .� 1.28 .��, co 328857 • • • /s os .. oa 305 .. FS O ��. 187°29 25 40 0 11 • • • • ` `' S 88 W 449.23 0 FRED o FI C o AUG • • s� LOT t w G O' 6 1975 • • S► ` 5.026 ACRES ."pno3• mss,, z +.. of 0 00 4 • • X 57•, h : �j . c� ciak Comer, 4 ' ° s a Q ,g • s 88°48 X35" W p °J 141 37 5 SCALE-.I"=200' ' • QI . 2 94.53 \ .T4 .. • N T°55 30 w' 70,27 • SB ° 0 W2 36.08 O = ! " X 24 IRON PI •cP WEIGHING 1.13 LESS. •• o C.T.H• • • • ' � o PER LINEAL FOOT • Z W • O • U � • • • N (n U • 4 • W (n • CURVE LOT RADIUS CHORD CHORD CENTRAL. NO. NO. LENGTH LENGTH BEARING ANGLE 1 -2 1985.08' 517.54' N 38 °05'35" W 14 3 -4 ROAD 199,00' 299.27` N Ito 26'45' E 97 °31`00" 4-5 ROAD 199.00' 96.94' N 74° 18'05" E 28c'11'40" 6 -7 3 133.00` 102.75' S 65 0 40'33" W 45 0 26'44" 1 6-8 2 1 13 3.00' 236.70 S 25 32' 35" W 1 2 5 °42'40" I � (SEE OTHE SIDE)