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HomeMy WebLinkAbout030-1054-95-000 0 � 0 a* 0 0) 0 m a v ;'► ID m m U 1 to O F z o (A) O to E A 0 C/) N) O . O O y 0 s :a `G 01 y a) :r I ' , w w `C D coo _ is ° -, CD CT) cu 0 a Ch C 7 N (D a N ? D fo Ul Co n 7 7 cn C1 7 (D CD (D C7 O O O (D K _{ Cb Cn � O p _ C. O Q N O r p J tc cc ^; l� O O y cn ? . C A O ."S. C W 1 1 y Cl) m CD A'. y N a Q IQ A D a s .fir a CD (� C CD CD = o w rn C , o o .. N A o O Z N ONO 0 0 71 co m CD --I o o - - } I '' n r co CD co co y Cfl 00 N• y CD .4, p N, O = Z .+ T Z ll M 0 a I� a O O O O O O �. A Z !rl 0 cn c" = N N N 3 . 6 fn y y 3 c CD C7 c 1 N 3 °' 0 o A a o y - z -4 Z - 1 z ° Z Z O D cD 0 :3 ? n 0 m I m ° CD o 'D • a y (n cn Q y CD C CD C N C @ O C- W (D A a 3 m d 3 7 _ CD CD o Z m o o p vi r f � CL sv a O p n 3 i W W � ! 0 0 W W o a O ` z 3 0 3 o — o r: 3 r. � N � 'o 'a 'O Cl) p A N O N _ N S O (� C Q CD iS C" 7 0 0 N 0 C a CD y N `< a .�-. O C O C D 3- 3 3 3 O. K 0 =C 60 CD a CO O T CD C a' ro v N d O . (D M T CA ] 'O 7 7 0 fD O a N C m m z o v C a� z G =^tea o a 3 m 3 N.m o 0 0 'I, CD a y CD n CD CL 0 3 Cl) CD z O 0 3 y O 0) O N 3 a m y c b 3 O CD = N _ O 3 !n :E CD .: y a m• N °a m d 8 ?`• S . o(a Cr a m -4 � C CD F O o arow N d N cc 3 o N (D N v co n 'O O_ CD p y B O O O D 0' CD o O i o 9 w w CD = N CD CD Qp y O CD O N = C6 J, 'O CD S CD CD O CO 3 v C) CD ( a CL O y ? �. b CD ro pp w tv as O to O o m o ro O Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety-and Buildin'� Division `, INSPECTION REPORT Sanitary Permit No: 463165 0 GENERALJNFOAMATION (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: Ohmann, Clyde I St. Joseph Township 030 - 1054 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: Fa Section/Town /Range/Map No: 166 1 1M k C t a 23.30.19.198L TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic N Benchmark E�� r- 3.�� ro3.l �� Dosing ` 7 5� Alt. BM L,1 C / 4 - 9 Z t..1 e, `i Aeration /) /o Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 4 ?. iZ c 3 - )1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet T Sept' O Z , i i Dt Bottom \ D� �' / ` / Header /Man. Q � S 93.5 Aeration Dist, Pipe ' Holding Bot. System a PUMP /SIPHON INFORMATION Final Grade . 7 3 Manufacturer Demand St Cover GPM E, �Y, n 4 •46 IV- 2-7 M Number I d TDH Li Friction Loss System TDH Ft Tz II•i5 �Z�b I Forcemain Length Dia. Dist. to Well ; l' �� �� 1 S SOIL ABSORPTION SYSTEM BED/TRENCH Width Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 3 —� SETBACK SYSTEM TO l P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION I CHAMBER OR Type Of System: ti 5D i i �� UNIT Model Number: /l C� 6 �i DISTRIBUTION SYSTEM 7-1 C Header /Manifold IDistribution x Hole Size x Hole Spacing Vent to Air Intake Pipes) \ ` \ h-l\ LV L ` Length Dia Spacing \ � Q � 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 / _ ` 2 "1 Bed/Trench Edges Topsoil I N N,, Yes E] No Yes [: No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1430 Hidden Oak Trail New Richmond, WI 54017 (NE 1/4 SE 1/4 23 T30 R19W) NA Lot Go / v. 2 Parcel No: 23.30.19.198L 1.) Alt BM Description = U` c �, v` 5 4 2.) Bldg sewer length - amount of cover = n� Plan revision Required? Yes KNo 1\ F / 3 Gf Use other side for additional information. L _ — l0 Date Insepctor ignat Cart. No. SBD -6710 (R.3/97) i ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner C k C e, 0 V Ulbricht & Associates ^.ddi-, - 1�t3 �}�mc tanta n,&W_ �2 Private Sewage Consul Lift City /State AJFw Ruij�nn0Aj N 5 D!-_ 2812 10th Ave. Spring Valley, WI 54767 Legal Description: Lot AJL Block _�,_ Subdivision/CSM # _ft1p p-r5 16- pJov�pS '/" SW 'A _;ML Sec. 2a, T30 N -RAW, Town of ST.Zc�g� r�t�. PIN # 03o- IoTy -9S ooe SEPTIC; TANK -- DOSE CHAMBEIt — FOLDING TANK INFORMATION: Aj Tank manufacturer VJt - Size ST/PC 76 D/-- Setback from: House Well PIL76 Pump manufacturer Model � — Alartn location (rtOLDJN NKS ONLY) Setbacks: Service r Water Line Meter location A[ar lon SOIL ABSORI - TION SYSTEM: V l(sn- F_ Type of system: jDO:: - p Width Length 2? of Trenches 2 1 Setback from: House 5P_ Well A 0 1 -0 P/L q Vent to fresh air intake ELEVATIONS: Description of benchmark Tots o � E x�ST ►� T er, k w r) Elevatio /00.00 Description of alternate benclunark ToA crF w211 _ Elevation q9. (W Building Sewer STAIT Inlet 615'11 ST Outlet S• y`7 PC Inle -1_ PC Bottom _ I 015-ot Top of ST/PC Manhole Cover Distribution Lines 6) 9 q . 3 ( ) Q y • CQ 8 �) 9 �-(• b 8 - Bottom of System (g) 3 Final Grade ( ) `(7U • t,� ( ) ( } Date of installation Permit number - qLQ"3 1 (05" State plan number A- I'lumber's signature License number ZZ `7 `�� 3 D ate / I Inspector A. �A Ulbricht & Associates Cor►grkte plat pier Private Se wanp f.nncidtantc ke r Q x , z�G- 575 S � z NL -� E x=sr- N CB �ouSE _ f jw.L v A o °IS s' lU Irv) 0 VALUf A � ar 5. 2- 9y -bs Ulbricht & Associates a 3 C1 Private Sewage Consultants ToQ p 9 � s3 2812 loth Ave. ,�� Spring Valley, WI 54767 L Syske� Sys�e�•, � S POWT SYSTEM SHALL S3 INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # �1 _ oz � X39` E i i XT STT N <-" T iU W, A4 '' (( •. • tt• cp VI- hC E' N a 0:n.. Ulbri & Associate Private Sewage CoW tggft 2812 101h Ave, Safety and Buildings Division County ST 201 W. Washington Av P.O. Box 7162 is Madison, WI 5 7 - Sanitary Permit Number (to be filled in by Co.) consin Department of Commerce n ( 8> 2 3151 CEO 3 Sari Pe A io H D. Number 3' Off. T 2 b In accord with Comm 83.21. Wis. Adm. Code, personal informatio you provide 1Q may be used for secondary purposes Privacy Law, s15. )(m) ST. CRO /X C ` 0 Address (if different than mailing address) I. Application Information - Please Print All Information OFF /CE 3D • f� s �/� 9 • � Property Owner's Na me Parcel # J Lot B Block # Property Owner's M ailing Address Property Location Ail n o W 2 3 City, State Zip Code P�thone /Number Q r Q�) J��� � .,� sc /l� ` �U � � , 30 N. R I9 (c ircle W , �1�0/C.► H. Type of Building (check all that apply) !� 9 1 or 2 Family Dwelling - Number of Bedrooms oS Subdi 3 CS her ❑ Public/Commercial - Describe Use 0 3'X ❑ State Owned - Describe Use 3 1) 1 5! %. CW Lij ❑City_ ❑Village RlTownship of - S T. III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' ❑ New System p g Rep Y Repl acement System ❑ Treatment/Holdin Tank Rep Onl � Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS stem: (Check all that a I ) 9 Non Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis rn!gmatment Area Information. Design Flow (gpd) Design Soil Applica n Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation n -5 1 /a.o 1 12-2-0,1 F3.0 VI. Tank Info Capacity in Number Manufacturer Prefab Site Steel -Fiber Plastic Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 7 Q 6 t 2 Aerobic Treatment Unit f 4,A4f • L Dosing Chamber 4 _ io 66 � VII. Responsibility Statement- I, the undersigned, assume responsibility for installationn of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature MP /MPRS Number Business Phone Number lr zz 3 ?�S•77.1 Plumber Ae ss (Saw, C Stag Zip Code) �� (r- �rj ZVI/ • S 7 7 Ce VIII. oun /De artmentt Use Onl /',r/ "' ` Approved El Disapproved Sanitary Permit Fee q ncl ides Groundwater Date Issued Issuing A Si gna o Stamps) Surcharge Fee) ❑ Owner Given Reason for Denial�� 2 a IX. Conditions of Approval/Reasons for Disapproval STEM OWNER: 1 eptic tank, effluent filter and " C dispersal cell must all be serviced / maintained is (/Iti 3 fZD O as per management plan provided b �� �//� o � / All se ac requirements must be maintained / a as per applicable code /ordinances., , Attach omplete plans (to the Co ty or the not 1 than gl/2 x 11 inches in size SBD -6398 (R. 01/03) A 1 r THIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL 0 FILTER MODEL * I f — /z5o /a .I / �,, s n " r � o _ 1 i I e) 10 lal C Z G I I 1 1 ( i l •� � - � I 1 1 1 1 1 I {� v ' V\ -A% i It I _ rn 1 v l� I Q O I \A 1 I c! 101 1 Irp lot) S 1 1 0 1 r � ULBRICHT & ASSOCIATES CO. 2812 10fh Ave. • Spring Valley, WI 54767 Reg. Designees of Engineering Systems 715- 772 -3442 Prmte Sewage CoasWtar►ts PROJECT INDEX C?! 2 6 P PLAN ID # N /}�— DATE 2- O D OWNER CLyQe ohm lo ./V PHONE ADDRESS IL13 0 f f �Ol��� vf} X 7�e• 1 �p LEGAL DESCRIPTION /U A4,0.V17 4,1 S VOI � Gov r Gvf '1-, 5w , 5 mac'. 13 , - 3 OA) R f w i TOWN OF ITO r ee ory, COUNTY CSTM " l j`1/N /ui� �s�� 2- Z -7 317 -LOCAL AUTHORITY/ SUPERVISION ST � ie0j X �7kY. 7­0,v I A3 PROJECT DESCRIPTION: i ae 4u i Soi f y4of , Uibricht & Associates R li • �� • Private Sewage Consultants 2812 10th Ave, Spring Valley, W1 54767 M P Qs z1(e3 - 7 s P!•I INFILTRATOR SIZING WORKSHEET P9•2 SYSTEM PLOT PLAN Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. P9 .' " / is n 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 atta ched Pions a nd specifications are Absorption Component Manua based on "I reatment Systems I For Private Onsite / round Wa • (Version 2.0) SBD- 1075_p(NOI otewter I. r THIS POW SYSTEM SHALL INCORPORATE PER COMM. c 83.44(2)c A PROPER ZABEL _O FILTER MODEL # / I — /bp , s I i �CZ,� Iii t tv, I I I I �� i � I , 1 1 � 1 �• 1 i 5 V\ I ; I i ► iti, j I I i-� Ln el � l ei PS Qt } ,��f`�/f1 T y '�4v�G l�iP• U,� E4 sE-Ye v l r- i rN ►,; t t� A �A C� El ZI co cr CD F O r m z z � � o� a� O k " N w v1 c ° ws Ec T/e v CFo SS SCc 1 ion) 0,,C� TAEW4� Q o 1' K 4 e,5 w� • / QT.'l��•�'vv �>t,�.c�, Sic TI`oA-) C,-t mcrr y Abomileh UF CAjA . ,v sp� c - Ill .. y�•Iv° 9R�fJ S 1. (ot a � Z4 UAL �E'r4� p 7'e &Ve< y OVER: See Reverse Side for Vent/ Observation Pipe Details. etails. SEC Tio� 0 /4 1 : 7 Iff A6D yam, go r 9 Wisconsin Department of C4� IL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings "in to c I ; � 1✓oCJe My Cou St. Croix Attach complete site plan on paper not less than 81 11 inches in size. Plan must include, but not limited to: vertical and horizontal refer nce p"tjBM) and I Parcel I.D. 030 • �0 Sy' / s 670 percent slope, scale or dimensions, north arrow, and cation ist�fn� tq'ti2�nest road. Please print all Info at /cW C Rev Date Personal information you provide may be used for second os � i `: it 0`4 (1) Property Owner ions r • Clyde Ohman Govt. Lot 2 1/4 1/4 S 23 T 30 N R 19 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1430 Hidden Oak Trail B Ohman City 1 G Mpa! a Zip Code Phone Number ity � illage ■ own Nearest Road . M- 1 Wl 1 54017 1 ( 1 (S ) W & * 5 $ 7s Hidden Oak Trail St IQ-Seph &9-411 WE on Usejq Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 0 1 r, Public or commercial - Describe: Parent material Loess over outwash Flood Plain elevation if applicable � ft General comments Site suitable for a conventional system and recommendations: * Sand with pockets of loamy fine sand (Ifs) z e_3 a ❑ 1 Boring # 0 Boring Q Pit Ground surface elev. 99.85 ft. Depth to limiting factor >l 10 in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 10yr4 /2 1 2msbk dsh as 2f .6 .8 2 9 -27 10 4/3 si 2msbk dsh as if .6 .8 3 27 -34 7.5yr4/4 - ifs Osg ds cw _ .5 1.0 4 34 -54 7.5yr5/4 s Osg dl cw - .7 1.7 5 54 -65 7.5yr5/3 Ifs Osg ds cw - .5 1.0 6 65 -110 7.5yr5/4 fs Osg dl - - .5 1.0 I I ❑ 2 Boring # Boring 99.40 >108 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'EtW 1 0-6 1Oyr4/2 sil 2msbk dsh as 2f .6 .8 2 6-19 10 4/4 sil 2msbk dsh cw if .6 .8 3 1942 10yr4/4 sil lmsbk dh cw _ .4 .6 -108 7.Syr5 /4 s* Osg dl /ds* - - 5* 1.0* Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = B D < 30 mg/L and TSS _< 30 mg& CST Name (Please Print) Signature CST Number Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 9/18/04 715 -246 -2454 ST Ilk kA 2r�c,6 Property Owner Ohman Parcel ID # Page 2 of 3 3 on ... # Boring I 99.70 >11U Q Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /iF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 0 -9 10yr4 /2 - sil 2msbk dsh as 2f .6 .8 2 9 -32 1 4/4 - sil 2msbk dsh cw if 6 8 3 32 ='60 IOyi4 /4 - sil lmsbk d} .4 6 4 60 -110 7.5yr5/4 - s* Osg dl /ds - - . 5 1.0 7 . 3 - 0 t< w L F-1 Doting # Hpit Boring Ground surface elev. ft. Depth to limiting factor in. Soil A ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fr in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Efr#1 "Eff#2 I I , ❑ Boring # Boris Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Efr#2 " Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD < 30 mg/L and TSS < 30 mg& 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- 8330Ted (R07 /00) • C C Clyde Unman Gov Lot 2 Section 23, T30N =19W p d (r 0 4 � � Q C1 DA ' ma y- � ti �w»tiz owns scaatel " 3 E M M BM 1 B M W Pod top 1 00.00 ' BIRU Top of tank cover 10020' Thomas Nelson 8199 85' B2 98.46' 83 99.76' s DOCUMENT r,0. /� 34 OF WI WARRANTY GEED �} F�('F l sr�,'re of wlscovsl;v —FORM 9 MIS SPACE RESERVED FOR RECORDING DATA rims t\, DE,� n1,, e by Thomas ff. Cudd arid Dorn any titiGISTERS i. Cuoa, nis Wl?e and in her own behalf, ST. CROIX CO.. WIS. Recd for Record this grantor S �,( wit. Croix Cou t', AV'iecon 'n, I Cby con and w�arrant� day of _ _ ��'�" ]C to �1,; d�. :�. Oh,nanrn and wine 1. �rlinann, h u nu anti w i. f(' as joint tenants, /1 / tirantee " ,RETURN TO of (.t�>y.dGiw�O, fair the punt of �' �z�1�7 ;iC) -1�� the n univ A',l <i ,•:z�in; i vri� _ LU Lill :.I'titl x)11)':' .;l„ �-; v -L L L INT OF for -'AhC I ir`:Ci ' (I I` _. ;! I' „1: t %l ._' k2s .- _ — tans 1 iron z) :> 'a . r_ o"_ vI an r (;;i;�'. (Zl7;t?' „r? .,�• ..._ ..,Dill � .,: ,_'�...., ,. ._..... C'1 l _ -` ..� _ _.__., , yfr SL a 'J -1 >t �• � d,ti) F�i�UINNI�JG i' .. ;II '—j a U1 �1fiC;,, a �iil �,_ . >�•lh�. un uiie shcr�? of Of s:) f_'f .:1 cc of l',1 i ..',. ,.. t L �\ ,tlI_.. �i - -� -. ..� . I �. •- ._ zJ' -: i,cr_ i ,.�,, ; : ,. z ,_;1':. �I' lis❑ � � zn,l =u. {I .� t} `;it �N! \ .1 :I: -ALEI) ON t'R EIS EN(:L OF I'r;OTRau ti. _lG�J� _. Doro I Cudd - - - - - - -- 1 A. and Dcrothy I. ,.,, ; ! f- ce ;oinc inFtnim' lit z �_nozalr':;e 1 NOTARY SEAL Th:, in =tni:n.at Notary Public HEY WOOD AND HAYES, attorneys, Hu ; Wi s J Dty commission (r. <pire (ty) (Section 59.51 (1i of the Wisconsin Statutes prorldas that all instruments to be recorded shall have Plainly prtoted er typewritten thereon the name. of the grantors, granted, witn0.ses and notary). �� WARRANTY DEED —SL1TE OF Wl1 COASIN, FORM KO. 9 1 W DEED DOCUMENT NO. S 'I'ATF. OF WISCONSIN — FORM 9 THIS SPACE RESERVED FOR WORDING DATA 3245fG - -- - REGISTERS OFFICE THIS INDENTURE Made by__Joseph II Simon_ and Amelia ST. CROIX CO., WIS. M.__Simon husband and wife Recd for Record this_ 1st -- - day of Nov_ember - -- _A.D.19 - _ grantor S of S t• Cro _ County, Wisconsin hereby conveys and warrants to Clyde_Ohmann an(1 } lai ne OhmaLnn� hushanc} f II - - - -- e of Derds and wife Regist _ - - _ grantee _S . -_ RETURN TO of S t . l r o i x _ Count Wisconsin, for the sum of One dollar and other v:l1u;)hle coil 1lerati OT) g j - - - - -- - -- Count the following tract of land in _— S t. (% r o 1 x y, State of isconsm; i� Oommenci-ng at a point which is 686.4'South of the I %ast quarter corner' of Section 23, ['own s!1 30 P,orth Uan(ur 1.9 Best, SL. Croix County, 1Ji- scor)sin and 1554.0 feet West and South 16 West 350 feet; thence t;ast, 25 feet Which is the point of 1,I S22 59 1;eSt, 170 feet; tl�cnce S 74 25'Eas1, 40 feet', thence IN 22 59' Ea— P) feet; t'ience ' aor).hwe�;t 22 feet to point, o(' hey ilulin��. q III ,I ii FEE �I E MPT I i 5 vE thai r s IN WITNESS WHEREOF, the said grantor'___.. ha ____ hereunto set ___ __ ____ hand - and seal s - this day of ALUg St -- _ -- , A. D., 19 6 , SIGN SEAL D IN P EN E OF / �� / ' % y� > > (SEAL) I` Joseph If. Sir ]oil j • %r' %C, (SEAL) _Wm. W. Ward .1mel is N. Simon (SEAL) l - Lor ene Jo hnson (SEAL) STATE OF WISCONSIN, ss. St. Cro County. Personally came before me, this - 1 1 ___ - -- day of-- —, Auf� A. D., 19 69 — . the above named __ l}_ Simo and Arne Iia M. Simon husba a nd wi to me known to be the person swho executed the foregoing instrument and acknowledged the same. Lorene J rbnson• •j,C y NOTARY - -- SEAL % •,....•• ^,� This instrument drafted by Notary Public S't • C r o i x C ly, Wi s. Wm.W.Ward�Attorney, N My Commission (Expires) (K J an. 23, 1972 r • - ST. CROIX COUN NING DEPARTMENT = -� AS BUILT SANITARY REPORT Owner l , Address keddel d A-14 , vu City /State 199 I..__ Legal Description: hING y1 Fj Lot Block Subdivision/CSM # ZS '/, S'tJ ' /, S,C'. Sec. , T N -RL? W, Town of _ S7`�a s e.-Gi PIN # SEPTIC TANK -- DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer Ad2 , �S7`cv,y Size ST/PC/ 0 / Setback from: House Well 3V P/L, V;? Pump manufacturer -Model Alarm location" (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: 7`a��r��l Width S Length S �_ Number of Trenches �L Setback from: House zl Well &�_.l_ P/L //,P Vent to fresh air intake _ 4s- ELEVATIONS Description of benchmark a Elevation /dG . ° Description of alternate benchmark 2!"A4 OE: Elevation 9S- y0 Building Sewer l' ST/HT Inlet G'. 03 ST Outlet? el f4'1 PC Inlet PC Bottom Header/Manifold S' Top of ST/PC Manhole Cover 17 Distribution Lines () � z l & () ( ) Bottom of System Final Grade Date of installation I dL V Permit number 3� ?ld State plan number Plumber's signature License number ��79/�"d Date 1 / Inspector ' 401 1 10 d. /J)�� C)?t ( `4A ZW. Compicte plot plan m* 'Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: .Safety and Buildings Division ST . CROIX ' INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit NO.: Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 315870 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: OHMANN, CLYDE ST. JOSEPH CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Ta No.: 54--95 -000 pb OU ? i ro TANK INFORMATION ELEVATION DATA A9800256 TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic 3 zvPiJ N P l do U Bench `1•�I.S / ; /5 Dosing .0 ration Bldg. Sewer /� _ 3 Holding Inlet `fa .D TANK SETBACK INFORMATION S Outlet �.(o �S � TANK TO P/ L WELL BLDG. quake ROAD Dt Inlet eptic 4/D 0 '2�� �� NA Dt Bottom Dosing A Header /Man. Aerati NA Dist. Pipe ,-, 7 Holdin Bot. System 9.gr� 4 72. G)S/, j c�73 PUMP I SIPHON INFORMATION Final Grade 450 Manufacturer De nd 0 Cote $ (e�F 9% 7 Model Number PM TDH Lift riction em TDH Ft Forcemain Length Mest a Dist. To Well SOIL ABS RPTION SYSTEM B i R N idth / Length 1 No. Of Trenches PIT No. Of Pits Liquid D th 5 1 DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE/STREAM L CHING Manufacturer: SETBACK C INFORMATION Type / odel Number: Syste V �/ (r(� - OR UNIT' DISTRIBUTION SYSTEM 1 Header / Mani old � Distribution Pipe(s) r �/ x Hole Size x Hole Spacing Vent To Air tpke Length Dia Length Dia Spacing �jGt4 �ST►u( z7Z`T ��� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes E] No El Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 23.30.19.198L,NE,SE 1430 HIDDEN OAK LANE 1, A-1 . 8 M - TT � WYAV a� o � Plan revisionreq /red? Q Yes 2No Use other side for additional information. °l y F-z Vz 4 1 SBD -6710 (R.3/97) Date Inspector's gnature Cert. No- i x S NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW \ R %GDd Q s '^ o a � q INDICATE NORTH ARROW ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r E " , s " e E e � F 3 S I 4 i P e r i t e � m . m " 3 r 3 t . F 4 t { E %6 coiis i n SANITARY PERMIT A of E W ashington Ave sion P.O. Box 7969 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI W707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. S'T G • See reverse side for instructions for completing this application State Sanitary Permit Number Akd 3)T&7o The information you provide may be used by other government agency programs '❑ Check if revision to previous application (Privacy Law, s_ 15.04 (1) (m)]. /4 ?0 _1/ i'� 1dC_ r� CIS'/ /i r�' / (/ TIgC.�t.[la I �,+L/�. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name Property Location 4,e - 1/4 SC 1/4, S T �d , N, R lQ E (o r)62 Property ner's Mailing Address Lot Number Block Number 73 -S7'_ City, State Zip Code Phone Number Subdivision Name or CSM Number S "/ gloj 1 V1.2- )1 / y3o .r,'d� ,� 4 !r' A-, l II. TY PE OF BUILDING: (check one) ❑ State Owned ❑ It Nearest Road [] Village Public 1 or 2 Family Dwelling - No. of bedrooms pL Town OF sT,Tas g 4 III. BUILDING USE (If building type is public, check all that apply) p ! Parcel Tax Number(s) 1 ❑ Apartment / Condo 2 • ,:10 - / 9 • / 1 3 a Lam. Of 61 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1, ❑ New 2. a Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an ....... System ________ System_____________ Tank Only Existing xisting System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number 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 [,,Seepage Trench 22 ❑ In- Ground Pressure / r 42 ❑ Pit Privy 13 ❑ Seepage Pit r� S x 7 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation y d .�Q —I r 7 S Feet 57F, a,5' Feet Capacit VII. TANK in Ca allons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- steel glace Plastic App New Existing structed Tanksl Tanks. ptic Tan ( r ,✓ ❑ ❑ ❑ ❑ ❑ Li ump Tank /Siphon Chamber I I 1 ❑ 1 ❑ 1 ❑ ❑ ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): Q O r O IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued IssuingAgent Signature (No Stamps) . Approved ❑ Surcharge Fee) W Owner Given Initial oo Adverse Determi 00 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: )IWO-t l l & w► S� hV« ►�I,r�iti► `�� 75 SG7��J4 c - owc r ss L a . A f is W 400& ✓� 1519101-62198 (R.11/96) L STRIBUTION: Original to County. One copy To: Safety 0 ildings Division, Owner, plumber 1 INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. . 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD- 63919) 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 and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: Prope: Ly owner's name and mailing address. Provide the legal description and parcel tax numbers) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ili. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. Vil. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR VIII. Responsibility statement. Installing plumber into 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 plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The 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 contamination investigations and establishment of standards. C�y�e �� Ina.y ,r/�y� sE SR, iP /9GJ Ale �a S s 4 \� Z � t 6; w � lEbd r7`s .n ' cl y2 r4'uk Jun— •23 -98 09:14A P_01 OHMUND BASS LAKE TW HOMES I . y v / d 74 sotbsek r 9r %• 1 i / 1 i i , I r Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page ? of 3 LaSo. -and Human Relations DW.Jon of Safety & Puddings , in accord with ILHR 33.05, Wis. Adm. Code COUNTY St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL i.D. # dimensioned, north arrow, and location and distance to near 030- 1054 - APPLICANT INFORMATION PLEASE PRINT ALL INFOAMA , D Y" D TE PROPERTY OWNER: P LOCATION Clyde Ohmann ` ` GO NE 1/4 SE 1/4,S 2$ T 30 N 19 (or) W PROPERTY OWNER':S MAILING ADDRESS r , ..JBLOCK # SUBD. NAME OR CSM # 173 W. Robie St. na) na 1430 Hidden Oak Ln. CITY, STATE ZIP CODE PHONE NUMBER _ rim.. ❑CI VILLAGE tFOWN NEAREST ROAD St. Paul, MN. 55107 (612) 291- 1`+faZty Joseph Hidden Oak [ j New Construction Use [xk Residential / Numbe " ` �" (J Addition Replacement (J Public or commercial des _ Code derived daily flow 300 g pd Recommended design loading rate _ -7 bed, gpd/0 - 8 trench, gpd/ft Absorption area required 429 bed, 112 375 trench, ft Maximum design loading rate . 7 bed, gpd/ft .8 trench, gpd/ t Recommended infiltration surface elevation(s) 94.75 ft (as referred to site plan benchmark) Additional design / site considerations none Parent material stream terrace Flood plain elevation, if applicable na It CONVENTIONAL MOUND IN-GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK S = Suitable to; system U = Unsuitable for system 06 El ®S ❑ U ®S ❑ U ®S ❑ U 1 ❑ S ®U ❑ S fl U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. Bed I Trend f lx 1 0 -9 10 r3/4 none 1 2msbk mfr aw 2m .5 .6 2 9 -27 10yr4 /6 none sil 2msbk mfr gw lm .5 .6 Ground 3 27-84 7.5yr4/6 none o s Osg ml na na .7 .8 elev. 98 ft. Depth to limiting factor +84" Rer iai kS: Boring # 1 0 -12 10 r3 4 none 2 msbk 24" 2 12 -39 10yr4 /6 none sil lfsbk mfr lm .2 .3 >; . 3 9 -90 7.5yr4/6 none co s Osg ml na na .7 .8 Ground elev. 98. ft. Depth to limiting factor +90" Remarks: CST Name:— Please Print Gary L. Steel Phone. 715- 246 -6200 Address: 1554 20 h. Ave. , New Richmond, WI. 54017 Signature: Date: CST Number: 8 -9 -94 cstm 02298 PROPERTyOWNER Clyde Ohmann SOIL DESCRIPTION REPORT Page. of 3 . _ PARCELI.D.! 030 - 1054 -95 Boring # Horizon) Depth i Dominant Color I Mottles I Texture I Structure Consistence lBotrdary I Roots 1 B a DT in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 3 1 0 -8 10yr3 /4 none 1 2msbk mfr gw 2m 1.5 .6 2 8 -�6 10yr4 /6 none sil lfsbk mfr gw if .5 i.6 Ground 3 36 -84 7.5yr4/6 none sl Osg mvfr na na .7 .8 elev. 98 Depth to ! imiting factor + 84" Remarks: Boring # M . Ground elev. ft. Depth to limiting factor T-7 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. 1 ft. Depth to limiting factor i Remarks SBD- 8330(R.05P92) PROPERTY OWNER Clyde Obmann SOIL DESCRIPTION REPORT Paole, 2 of 3. PARCEL IA ff 030 1054 - 95 Depth I Dominant Color Modw Texture in. Structure Oonsis�ejftrctry Roots G P D/ft Boring # Horizon Munsell Qu. S Cont Cotor Gr. - Sh. Bed iTw& 9w 2msbk mfr 2m .5 0-8 10yr3/4 none 3 1f .5 1 .6 f AIMMU - 2 8-'- 10yr4/6 none Sil 1 f sbk mfr 9w Ground 3 36-84 7.5yr4/6 none S1 Osg mvf r na na .7 8 elev. 98.2 I t. Depth to limiting factor +84 Remarks: Boring # Ground elev. ft. De" to limiting taCtOr Remarks* Boring # !'Us Ground elev. ft. Depth to limiting factor Remarks: Boring # FT - Ground elev. Depth to firriting factor Kemarks: SBD-8330(R.05/92) , ,P 2d 2 SLL 'P I tyl Gary L. Steel 8-9-94 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address / ?R /,j S 7` ,,/ a ri Q 7 Property Address /'Y3 o :J e a- if 4. '-e (Verification required from Planning Department for new construction) City /State ffu , es - a, , O Parcel Identification Number Q - /6 41 LEGAL DESCRIPTION Property Location ,llC- ' /a, s ' /a, Sec. VS , T 3 N -R I4 W, Town of a.s'P.�� Subdivision 1' /. 6 ,� ,t,� �� AJ , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 3 A 15 �' . Volume �� / , Page # y7 Spec house ❑ yes 0-no Lot lines identifiable ❑ yes &no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year exp date. SIGNA O CANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, y virtue of a warranty deed recorded in Register of Deeds Office. �e-- SIGNA APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed i DOCUMENT NO. WARRANTY DEED i STATE OF WISCONSIN -FORM e 324566 THIS SPACE RFSIRVED FOR RECORDING DATA THIS INDENTURE, blade by - Joseph Ii. Si mon and Amelia REGISTERS OFFICE. M. Simon -,_ husband and wife - - ST. CROIX CO.. WIS. j - Recd for Record this 1st des Novemt)er I� - - - - -- - - -- y --- --- _A.D.197�+ grantor s__ of S t • (I' O 1 X ___ County, R'isconsin, hereby conveys and warrants to _ — Clyde Ohmann anti 1'lai11 e 01imann�husban(i t--- - : - -P• Q, and wife He -ter of Deeds RETURN TO of , _ S t . C r n i �c Count Wisconsin for the sum of Ij - Onc dolla n r a(i other vllunl>lt coils 1( erations the following tract of land in _1 t • ( %r O 1 X County, State of Wisconsin; 0oinIn enci.n� at Iz poini; which is 686.4'8outh of the E Est tlu<trter corner of � Section, 23, Townshil) 30 P,or +,h IZan)re 19 best, St. Croix County, Wiseonsin, and 1551.0 feet West and South 1035' West 350 feet; thence 11:ast 2 feet �� whiel IS the point of he,"inni 111! thence 822 59' Best, 17O feet,; i,h) nee S 74 25 40 feet; thence N 22 59' h:r(,st 167 feet; thence %orl.hw(• A 22 feet to paint, of be�rinnint�. FEE # E MPT i I� IN WITNESS WHEREOF, the said grantor S___. ha �' hereunto set t e i r S S 1 1 _-- hand - --_ -._ and seal _' _. _ this... -_- -_ day of --AI41 s t _ _— A. D., 19 6 r SI SEAL D IN P SEN E OF -I �} / (SEAL) ' Joseph lI. Szr.)on (SEAL) Wrl. W. Wartt Ari lit M. uirnon (SEAL) Lorene Johnson (SEAL) STATE OF WISCONSIN, 1 S C roi x County. ss Personally came before me, this _ 11 August 69 -- - -- of _._ � : _.--_ -- - --- . -_ --- A. D., 19. . the above named 11 :;i,mon and Amel M.._Simon „husband and wife to me known to be the person S who executed the foregoing Instrument and acknowledged the same. NOTARY Lorene J ) � ,'1C :1 SEAL This instrument drafted by Notary Public St. C r oix r CouIty, Wis. Wm.W. N s. My Commission (Expirea)( Ja n.23�1972 (Sectlop WN (1) of the WlsconaW Statutes provides that all lnstrnmants.sob grantors, grantees, witnesses and notary). ed ahaD ataly prints0 or typowrittea thereon the maples Of th E •J WARRANTY DEED -STATE OF WISCONSIN, FORM NO. 9 BOOK 5 V PA s. c. soon co.. rueeurer rat { z� r k MKIM t 10 «► - g VAUL C F 16 '8# 1 rv_ N'0' , 8 24' vo I i Not" 59M �` x ,,,,- �w z',. .�"', s s �, `p" ' .��,�+G.' e * �'� y -� > ry • •'�.� ''^ ^Mary a _ 4,�= Ju�:23 -98 09:15A P_02 • I ` A lower level G bedroom i IL, ult 1T4 a