Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
030-1095-70-300
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ,Safety and'F'uyding DI INSPECTION REPORT Sanitary Permit No: 514914 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: Lyon, Cynthia Duane St. Joseph, Town of 030- 1095 -70 -300 CST BM Elev: Insp. BM Elev: T Description: Section/Town /Range /Map No: CST BM Elev: Insp. BM Elev: �- A X e 32.30.19.347E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. r Septic Benchmark Pao if C week L Alt. BM � S G,k� 6 l,bl 9S•3� Aeration Bldg. Sewed X 0111 ` Holding St/Ht Inlet l � � TANK SETBACK INFORMATION St/Ht Outlet i4 r 3 1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD filet ; i 3 9D • Q Septic 4 � :5,7 q n l, a 7 , , �� Header /Man. y�� �� f 7S 7z Aeration Dist. Pipe 6 • `t 16 - %1 7y - Holding Bot. System n PUMP /SIPHON INFO Final Grade 1 7 7. Manufacturer Demand St Cover �✓ i . �� If- 32- GPM Model Nu 7 6r 76. 3 6 TDH Lift Friction Loss System He TDH Ft 73 C5A\ Forcemain Lengt Dist. to Well P 1 l ``ii 2 3 9+� 3 3 SOIL ABSORPTION SYSTEM V4 Ise 1 6 3 t BED /TRENCH Width j Length t No. Of Tre PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS +Z 9 Z Z t( e SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: -too N A- UNIT Model Number: DISTRIBUTION SYSTEM j Z 3 +` Z 3 = ' L Header/Manifol � � Distributior� \ ` x Hole Size ` x Hole Spa cng Vent 3 toAir to Pipe(s) � ` (u Length / 6 Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over e . Depth Over xx Depth of xx Seeded /Sodded 1 xx Mulched Bed/Trench Center 3, Bed/Trench Edges Topsoil ` Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 445 Old E East Hudson, WI 54016 (SE 114 NW 1/4 32 T30N R19W) NA Lot 2 Parcel No: 32.30.19.347E �� 1.) Alt BM Description = � 4 � cc, u — 2.) Bldg sewer length = x, > 1 - amount of cover = Plan revision Required? [!q] Yes No D.;j 3 Use other side for additional information. 00 Date Insepct s Sign Cert. No. SBD -6710 (R.3/97) 5 core merce,Wi,gov Safety and Buildings Division County , 201 W. Washington Ave., P.O. Box 7162 C U� s V V n S i n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 5 ! ,q Sanitary Permit Application State Transaction J Number In aecordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate ve /1/T• unit is required prior to obtaining a sanitary permit. Note: Application forms for statue Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide a secondar � 6�� u ses in accordance with the Privacy Law, s. 15.04(1 )(m ), Stats. 1. Application Information - Please Print All Infor n 11W 00 Property Owner's Name / Parcel # T . L b ti 036- 16q6 - 70 - 36c> Property Ow is Mailing Address Property Location S ����� (�• 31 E Govt. Lot City$ State Zip Code Phone Number \ '1 �_ /., �_ ' /., Section et Nt 6U " 5 � � 11 S y 9 � 3 g (circle on 11. Type of Building (check all that apply) Lot # T 3 V N; R Eo *I or 2 Family Dwelling - Number o roolmms - Subdivision Name Block ❑ Public /Commercial - Describe Use L ^ ❑ City of ❑ CSM Number ❑ Village of State Owned - Describe Use ` p i 15 w Z3�Z ST. CR NG OFFICE, l 3 ❑Town of Sfi ��fPh 4. Ill. Type of Permit: (f heck only o e Complete line B if applicable A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. I El Permit Renewal El Permit Revision ❑ Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner t t IV. Type of POWTS System/Component/Device: Check all that a 1 14 0 (Non Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in, of suitable soil ❑Mound < 24 in. of suitable soil / ❑ Holding Tank ❑ Other Dispersal Component (explain) _ ❑ Pretreatment Device (explain) V. Dis ersalffreatm tArea Information: Design Flow (gpd) Design Soil Applicati e(gpdst) Dispersal Area Required (sf) Dispersal Area Propo d (sf) System Elevation S U on R 0 7S.. ,13 a , � Vl. Tank Info Capacity in Total # of Manufacturer �j 2 Gallons Gallons Units I J1' New Tanks Existing Tanks 0. rn r'n rn Septic or Holding Tank Qt) V wFldd wC, l e l k/ Dosing Chamber 1 Vll. Responsibility Statement- 1, the undersigned, assume r3kponsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) MP /MPRS Number Business Phone Number 1&4 Plu is Si to �,t� es 9 ?13 "3$ti -40)a Plumber's Address (Street, City, State, Zip Code) u u �w S N w+o0 VI11. Count /De artme Use proved Permit Fee Date 1 ued Q issuing ent Signature eason for e $ 5o ' W 9 IX. Condi§VVgt*#.Utpgf&r#Reasons for Disapproval 1. Septic tank, effluent filter and dispersal cell must all bg styrvlcss / mahthittety as per management plan provided by plumber. 2. All setback requirements must be MWAsM as Per applicable code / erdirwtoes. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 A4 J yys nid HW � �a *O LUca. j01� � �1 Ge�se .Iuq logo 0 Will 1 N� s 3 xga )fly )oo.b 6PA " 1 V q Ecopy a M A4 ine. c , c % L s rs*v\ 7 LOC Old yy nid Hw FbA y 3 S' Ow 5 P - IT 3 gapR�or,., 1�bh, g� ©W( �p� a PAN V, T414 V0 Y-c ft Sy ��pM 13- Noy I i N I U" Waw Corcrr(l P *, J 1g V_I ��. D 1 V t W p 2126 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8Y: x 11 inches in size. Plan must County St. Croix Include, but not limited lo: vertical and horizontal reference point (BM), ' ' n and percent slope, scale or dimensions, north arrow, and location aril d' road. Parcel I.D. 0- 1095 -70 -300 Please print all information. Reytwed _ Date Personal inbrtn�on you provide may be used for secmday Wm� (Pn s.15.04 (l) to ' �jGl/vt/i`' �P t / 0 Property Owner RE,CEI ED Pro tron Cynthia P. on Govt. lot SE 1/4 NW 1/4 S 32 T 30 N R 19 W Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# 445 Old Hwy E East 1 1 2008 2 1 CSM Vol. 6, Pg. 1736 City St4e Zip Code Phone Number J City I Village 16 Town Nearest Road Hudson 1 A 1 W 16 1 01 7�t 9 -631 1 St.Joseph Old Hwy. E East New Construction Use: Ij Residential / Number of bedrooms 3 Code derived design flow rate 450 GPO 0 Replacement J Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable Na General comments and recommendations: Site suitalbe for replacement dispersal cell with 0.5 gpd/sq.ft. loading rate. Step trench elevations at 75.0 73.00 ". - Boring # I Boring 1A PH Ground Surface elev. 77.05 ft. Depth to limiting factor >95" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'E 1 0-8 10yr3/3 none sil 2fsbk mvfr cs 2fm,1 c 0.6 0.8 2 8 -26 7.5yr4/4 none gr Is Osg ml gs 2fm,1c 0.5 1.0 3 26-43 7.5yr416 none Ifs Osg ml gw 1vf 0.5 1.0 4 43-95 1 Oyr4 /6 none s 0 sg ml - - 0.7 1.6 / 2 Boring # I Boring 16 Pit Ground Surface elev. 75.23 ft. Depth to limiting factor >96° in. Soil P 9 Application Rate Horizon Depth Dominant Color Redox Description Texture shdure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. " ft1 'E 1 0-8 1Oyr3 /3 none sit 2fsbk mvfr cs 2fmc 0.6 0.8 2 8 -13 10yr4/4 none sil 2fsbk mvfr gw 2fmc 0.6 0.8 3 13-26 10yr6/4 none sil 2fsbk mfr cvv 2vF1fm 0.6 0.8 4 26-34 7.5yr4/6 none rs 0 sg ml cw 2vf1fm 0.7 1.6 5 34-54 1 Oyr4/6 none It rs & grf Osg ml cw 1 me 0.5 1.0 6 54-96 10yr5/6 none trat s& Osg ml - - 0.5 1.0 Horizons 04 9 contain approx. 2 vel & coNles. Horizon #6 contains stratified medium and fine sand. Loading rate reduced to re flect reducedkpermiability associated with textural changes. Effluent #1 = BOD? 30 < 220 mg and TSS >30 < ' Effluent #2 = BOD < 30 mg/L and TSS 130 mg/- CST Name (Please Print) Signatu CST Number James K. Thompson s- ---- -- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane Osceola, W154020 6/4/2008 715- 248 -7767 r ` Property Owner Cynthia P. Lyon Parcel ID # 030 - 1095 -70 -300 Page 2 of 3 3 ] F Boring # Boring Id Pit Ground Surface elev. 79.51 ft. Depth to limiting factor > 105" in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots COW in. Muraelt Qu. Sz. Cont. Color Or. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10yr3/2 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 2 6 -12 10yr4/4 none sil 2fsbk mvfr gw 2fmc 0.6 0.8 3 12 -28 10yr5/4 no sil 2fsbk mfr cw 2vf1fm 0.6 0.8 4 28 -38 7.5yr4/6 none grlfs 0 sg ml Cw 2vf1fm 0.5 1.0 E662 8 - 62 10yr4/6 none 'f �J & g Osg ml cw 1 me 0.5 1.0 IOyr5/6 none H strat s& Osg ml - - 0.5 1.0 #4 & 5 contain approx. 20% gravel & cobbles. Rorizon #6 contains stratified medium and fine sand. Lo4ding rate reduced to reflect reduced permiability associated with textural changes. VI , Z — ! # —i Boring Pit Ground Surface elev. 96.00 ft. Depth to limiting factor > g" 4 �in, Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Or. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10yr3/3 none sil 2fsbk mvfr - - 0.6 0.8 2 6-28 1 Qyr4 /4 none sil 2fsbk mvfr - - 0.6 0.8 3 28-43 7.5yr4/4 none sci 1 msbk mfr - - - - 4 43-53 7.5yr4/6 none Is 0 sg ml - - 0.7 1.6 5 53 -98 1 Oyr5/6 none s 0 sg ml - - 0.7 1.6 Soil evaluation completed with hand auger to verify suitability of soil to accomodate continued use of existing dispersal cell. F Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sol Applies Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Or. Sz. Sh. *Eff#1 *Eff#2 " Effluent #1 = BOD? 30 < 220 mg/L and TSS X30 < 150 mg/L " Effluent #2 = BOD a 30 mg/L and TSS <30 mg/L 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) A.CE. Sol & Ste Evelu8tbn5 6 y br cklt -Je 9:5 oil e✓a/u -a4v., b h an c- p ♦ C- �r.'sn�c elegy FZ .Pe,C ;►2,1.2.6 Q �S/S Gld hlwy. EEa s ,cot -Z, a6.( ro/. 6 P . 1734, SCi�qu,l�'f; Sec, 3�T, R. /9 w, Ti. o,F 66. 7osV c, se. aro1X do: � ' Oe /•dojo 90 --3m ( h , W W 0 `fJ 7 t "good tq IC� Corn e,- o 1 r ► ► r 1 , r E";p :5 '54L/ I t ole � 1 1 3 6a (e% - ScL- •�� 7-' ecs dco�' > Tie�.% 36Z;. 83' r/ . 3 o,-'& • ���a� 23 CERTIFIED SURVEY PAP LOCATED IN PART OF THE SE} OF THE NW} OF SECTION 32, T30N, R19W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. r N OWNER � �• rqu`,� (� -' SCALE IN FEET a H William McKinnon �^ N 7 4520 Douglas Hwy. Gillette, Wyo. 82716 a C:;ti 200 100 0. 200 a Cr M 0 LEGEND o Cn It m =- 1" x 24 iron pipe weighing 1.68 lbs /linear foot, set. ° „ v a - N cn rr V 1 unplatted lands owned by others �+ N �+, S88 51 NN E... .-.o 38.521 CD 37 A .Z] n • < rt rt town r 7 7 W "OLD E E o+ o, cn r .-- n Cn �— A w o, �-• o M a i 0 o w to c S88o5112911E 133 33 cn � ° 8.8 - - - - w o I I AILED ° ~ N OV 61986 0 o N w a n °, , N N rn 1 l0 N= N 1 � N W � O O O �O CO = n l0 Cf O D W 4- O I 1.1, I V- cn o cn .-. rt -� � � 1 0 r o cr+ ° � m 4 - 0 .- w w o �• In .o rn a s I v O w co y r 1 fi rY r of YO$& _ C"* i (I O W CO I a co O I c; I I "'n R !� a = o = rt rt j rt ZO tD ✓ ; o �� R la Or s 'V -iNM� X ;a w LOT 2 1 N O O V V (D 0 Z 1 W N W N a O n n '~ O I I >_ 0 0 0 0� r r la I rt m lc W Qn 4 d c 1 7 r r+ w F= p c0 Ia Vt T r Ito IG r-i •-a ' N - N . 1 K N A t N Z Z 1 +'i rt v I r N u n L I• 1 3 cn m V, m ` \ 356.38 M m s g S8803715711E 323.17 1 N N r f) 1 fi I I >3 w.�a) m ° 33.21 I ° 1° w t0 V = O t0 W W V -i ., I t0 •O (Jt S t0 ,O t ry N O c0 1 co C1 N a v a w dl � v � ao a ter„• v .� �-' �� l,n = n N V V - 1 Ln w cc m I 1 a+ O O v rt W LOT l I I • O CO C7 N C./) r• rt •--1 m O 0 o cn cn a x c o 0 v 0 w0 c c S88 365.001 N8803115711W _ _ _ = v Cl W — -b 12.801 LI l0 O O Cr N rt Z Z W I C!! O O O = m m r*m ni w N88 39 l ° E S T N cn N� 0 rt o N CD ° �° co = a 66 foot wide Private Road Easement r� 0 r� O CO Cn rt 7 w o c 0 0 0 0 ,o W W rt o cn � i 1 1 2 f = Certified Survey Map C:> - - - - '* --------- ----- ------ o .I- Cn W N N - v , C2 1O t O volume 6, page 1587 m n, m m ---------------^---- 0 WT corner section 32 2650.01 county monument east - west } line S88 E} corner section 32 1" iron pipe this instrument drafted by Douglas Zahler job no. 83 -15 -286 ti ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the Cu ��'p Lh residence located at: Sec. T_3_!)L_N, R ( $ W, Town of Lt. Stj St. Croix County, Wisconsin. Upon inspection,'I certify that I have found the tank and baffles to be in good con it'on, and it appears to be functioning properly. Last time serviced Q Did flow back occur from absorption system? Yes No V if n line. ( o, skip next Approximate volume or length of tim gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacturer (if known) : Age of Tank (if known) : Y�114)rA -ee A O L (Signa y r y� e) (Name) Please Print (Title) 1 '' Q ?S 4!3 (License Number) 09 �9 Ol V (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In ac cepting tin p g the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name �1 Y*� �pw 1�1r�J� Signature MP /MPRS a a b ST. CROIX COUNTY ' SEPTIC TANK MAINTENANCE AGREEMENT AND ! OWNERSHIP CERTIFICATION FORM Owner/Buyer J� ' Mailing Address ia_ JA �- Property Address (Verification required from Pl ing & Zoning Department for new construction.) City /State Parcel Identification Number D3 F- 7d LEGAL DESCRIPTION Property Location 1 /4 , '/4 , Sec. �, T �b N R_,�LW, Town of 5� J©.5ea�j Subdivision , Lot #— Certified Survey Map # '// q^ rJ 3 , Volume , Page # Warranty Deed # Volume, Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read. nts and agree to maintain the private sewage dispQ�l,ya�em,with the standards set forth, herein, as set by the and the Department of Natural Resources, Stda cdWisconsin. Certification stating that your septic system has . , fined must be completed and returned to the St. Croix County Planning & Zoning'Department within 30 days of the thgce . 'on date. Uwe certify that all statements on this f to the best of my /our knowledge. Uwe amlare the owners) of the property described above, by virtue of a wattty ed in Register of Deeds Office. Nunlber of bedrooms _ 171 SIGNATURE DATE h ** *Any information that is misrepresented mey, 14,w sanitary permit being revoked by the Planning & Zan g Department. * ** Include with this application a recorded watiwpty'¢ the Register of Deeds Office and a copy of the cer� survey map if reference is made in the warranty deed., atl (REV. 08/05) • . POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION Paae or _ Owner T SYSTEM SPECIFICATIONS Permit ;fi - - �� N. _ Septic T Ca a al ❑ NA Septic Tank Manufacturer 4 _ ❑ NA DESIGN PARAMETERS - -'�� - Q 1 n Effluent Filter Manufacturer &A ❑ NA Number of Bedrooms _ 9 NA Effluent Filter Model t Number of Public Facility Units _ _ ❑ NA Pump Tank Capacity — ______ - - -.__ _ -__ __. ETNA 1-3 NA Estimated flow (average) q al - - - -.. VV gal / - - L Pump Tank Manufacturer $ NA Design flow (peak), (Estimated x 1.51 - - -- ----- - - - - -- - - Soil Application Rate _ — gal /day Pump Manufacturer 17�NA al /day /ft Pump Model ____ __ _ t� NA St Influent /Effluent duality Standard Monthly average' Pretreatment Unit — Fats, Oil & Grease (FOG) <30 m /L 17�IVA g ❑Sand /Gravel Filter D Peat Filter Biochemical Oxygen Demand MOD,) 5220 mg /L 0 NA 0 Mechanical Aeration Total Suspended Solids (TSS) 5 ❑D 150 m /L ❑Wetland g i ❑Other. Pretreated Effluent Quality M onthiy average Dispersal Cel(s) Biochemical Oxygen Demand ($GD 530 mg /L ❑ NA Total Suspended Solids {TSS) 530 mg /L ❑ NA 1�1n "Ground (gravity) ❑ In- Ground (pressurized) � 0 At-Grade O Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line Maximum Effluent Particle Size -- 11 Other: Y, in din. ❑ NA Other. - - -- - - - - ❑ NA -- ❑ NA Other: "Values typical for domestic wastewater and septic tank effluen Other. t. 13 NA MAINTENANCE SCHEDULE E3 NA Service Event Service Frequency At least once every: ( Inspect condition of tank(sl 3 months) 7of 7volume ars► ❑ Nq Pump out contents of tank(s) fit ears) When combined sludge and scum equals one -third (% ❑ NA Inspect dispersal cell(s) At least once every: Is month(s) Clean effluent filter (Maximum 3 years) 11 NA y At least once every: ❑ monthis) um - -- -__ -- 10 year(s) ❑ NA Inspect ' -' P p pump controls & alarm --- ----- --- -.� —_ At least once every: p r earl i lsl QJVA Flush laterals and pressure test y At (east once every: ❑ month(s) Other: - -- - ❑ year(s) J-RNA At least once every: ❑ monmis) Other. ❑ yearls) MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sower; POWTS Inspector; POWTS Maintainer; Septage inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify anyc cracks or I leeks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any Pondin of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one - third IY or more of the tank volume, t contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at Intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that may Impede the treatment process and /or damage the dispersal cellls). 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. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloadjIng the cell(s) and may result in the backup or surface discharge of effluent. `To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the am" within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. A BANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. ii 64d 1111wrJoe* ,i * 1011 0160i0r1 &-o wk%o 0001640 qw pikma MAft 4411" w I r 14•0110 '4 060010A64 s. 400 • 00006lnY 4 6l111f+11'n10 8111106061601 • and removed or their covers removed and the voids ace filled with Af er pumping, all tanks and its shall be excavated P t p p P g soil, gravel or another inert solid material. C ONTINGENCY 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 Osorptlon' system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the blomat at the Infiltrative surface. .Reconstruction# "wdh cyst comply ems must with the rules in effect at that thne0ow o� . P Y < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A' PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLE. -- ADDITIONAL COMMENTS IWI }I POWTS INSTALLER POWTS MAINTAINER Name J \ r-� Q>sL, -. . Name 1/ �^�w- tiiti ' Phone - 71S ' t 61 1 3 7 J., , , Phone T .... ... S EPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ?, Name S Cn bl Zw Phone J O a S Phone This document was drafted in compliance with chapter Comm 83.2212)Ib)(11(d) &IfI and 83.64(1), (2) & (31, Wisconsin Administrative Code. !1 ` THIS S ►ACC RESERVED •OR RECORDING DATA I 1 QQGUMENT NO. �I {YARR�iIf�V !]�E�. I - , ii r I �amAm� BAR O OF WISCONSIN WISCONSIN FORM n_1—Rai: 44858 REGISTER'S OFFICE ST. CR CO., W! Ree'd for Record William N. McKinnon and Phyllis M. McKinnon, = �(JNQ7igS9 as ...... is wife_ and i_-- her own right, ___ ________ ____ S! of 3.00 P /w ! ------ • - - - -- -------------•.----------•--------------------•---------- .....- ••-- •- •- • - -•... Ir l= . ............... _ __ __________ _____ ____ __ _ __ ________ ______ ______ ___________ ___ _ __ _ ________ _ __ ___ .- conveys and warrants to _I?h_ - __C _nt i ? of ___ chaff--x L. y _on.-,- -hushand ... an-d --- wJ.E-e- - -; - 5-_a-urv_ vorshl p i' � OASQs --- -- - -- -- ma .ri_La L p r o hex t3' • ----- --- - - -• - -------- - •- - -• --- - -- -- _-- -• - • - - - - •-- - --- --- --- -- •- - - - - -- !: ----- ---- --- -- --- -- --- - - - - - -- - --- -• - - -- -_ ....... ...................... i, ------------- ----- ----- _- ____- ___- _- ._ _....._.- RETVRN TO 4 ___•__--.-.---._• .... ...... ........ .......... . .... .. t the following described real estate in ._....- . Sz_,_..irr. o_i x ... .. .. ... ...... ...County, i State of Wisconsin: Tax Parcel No: - ------ ----- --------- •- -- -- - -- t T. r 9 of 'Srlrvey Man filed in Vol. "6". page 1736 in the Office of the Register of Deeds, St. Croix, Wisconsin. 1 t FEE This deed is given in fulfillment of that certai -n land contract between the above named parties, bearing date of Novenber 21, 1986 and recorded November. 21, 1986 in the Office of the Register of Deeds in and foT St. Croix County, Wisconsin, appearing i.n Vol.. 760, pages 596 -597, as Doc- ument No. 419577, This ...... i s --- not-------- homestead property. (is) (is not) Exception to warranties: Exi sti ng highways, easements and rights of way of record, if any, and any liens or encumbrances suffered of suffered to created by the acts or defaults of the above named grantees. sr a Dated this - -... ---------•-- day of+. y �_.............. . .... . . ..., 19.89 (SEAL) .. C:.. .......... (SEAL) :: William N. McKinnon , z c_ ........ - - - --- -- - -- ------ ------ -- --------------(SEAL) L 1.::4 { � :` -' �ir ' _._...- _(SEAL) ,. r .- _..Ph.Y.I 1- ?-- °...M ...... Mck-i.nn.pn ..... . AUTHENTICATION ACSNOWLEDGMENT Signature (a) W i_ 1_l, i a ln___N_, __M_�_K1_n n o n___a n d _ STATE OF WISCONSIN QA--- --- -- --- •- ----- --- -- -- - -- - I es. c ----------------------- authenticated this _ .day ef_.__ �9a_Y________________ 19 - Personally came before me this ---------------- day of _ 19 -------- the above tamed - -------------- ---------------------------------------------- .:_ -._ D a_v i d... J..... TITLE C_r e e n - - -- .......... -- --- - -- -•--- ------- --'--......... : MEMBER STATE BAR OF WISCONSIN ------ ........ (If not- ----------------------------- --- -- --- ---- -- --------------- -- _ - --- - -- -- -------------"- authorized by § 706.06, Wis. Stats.) to me known to be the person ........... who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ............ .. ...... .. .... D V l (i J I.5 L f • ` - .... .. � --- ' L . '. n.r..- } ... . _ ... ._... " -. -. Notary Public County, Wis. f:ii -. _ - ' -. .., i,._ gtl t.rw ..s - erk s.,.p.inri onri _p }• - .........; a.. -.. _� r. ... _.._... .. .. . ._ c - I -•- are not necessary.) -_ -- a -- d a te: STATE, H O Wi >Clitv:+t'v Stock No. 13002 FORM N. 2— 1'-Z \ 'z- . . 7 E jk % / . ] §\ % 0 k ¢ 22 => ! : \ a) / \\ &7 0CN \ ] ¢ \ 7 ^ /G� CM rf2A C .� ca ) f \2 LL %n�)7 §/ ■ \ 1 -0 E » = 2�a §/22 ! ID 41 @ \ \ \ CL co ! \ � z / 7 § \ E 0 a) a) . ) \ \ < © ) � z m z Cl) 4) \ � 2 ) E ~ C ƒ CL 3 co ma ! b § 9 0 o a 6 k 04 \ \ / k k \ E N -� �/ a a 2 . 2 2 § § § % p . \ \ 5 0 E k_ \ / / 5 f s & ) w \ } E r Q ® o® © c x 0- 8 { I';- ) / \ & $ ) 7 / % , Q z a / $ , ■ o o, c � 2 e c o w k §\�/ f o z f/ )\ k a \ ! { IL k / 0 a 2 3& 0 r— o Parcel #: 030 - 1095 -70 -300 02/18/2005 03:41 PM PAGE 1 OF 1 Alt. Parcel #: 32.30.19.347E 030 - TOWN OF SAINT JOSEPH Current XJ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * DUANE D & CYNTHIA P LYON LYON, DUANE D & CYNTHIA P 445 OLD E EAST HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 445 OLD E EAST SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.990 Plat: N/A -NOT AVAILABLE SEC 32 T30N R1 9W SE NW 3.99 AC LOT 2 CSM Block/Condo Bldg: 6/1736 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 32- 30N -19W Notes: Parcel History: Date Doc # Type 07/23/1997 842/593 c n h " " 07/23/1997 � ffyis- 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 5603 191,500 Valuations Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.990 87,600 100,800 188,400 NO Totals for 2004: General Property 3.990 87,600 100,800 188,400 00 0 0 0. Woodland 0 Totals for 2003: General Property 3.990 51,500 86,100 137,600 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch #: 212 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 p ° vi� d m ryi 0 . 0 o °a E o E I A c o a y > a m O1 � ~ N D Q N V d X O U 2 a r m w — t C O> O C C A — C O Y O w N C Z = cv 6 N CD U.O. @ L C E 0 7 F a .0 i N eY y z E z c g ° a m M � j I o I O z 0 ul d z ° Z S E o N 0) O C lC N d • y N a � °- Q Z m Z w N zl M d E 04 a a i 2! 1 co r ca` I ce ° 0 3 3 3 m cL 16 L za> ny 0 ;A000 Z •N aaa IL !mil , 0 y c rn rn O N J U y rn rn Z N j y 0 m E O O O = - O W pp rn IL ^l O C f C � O M f p j In o - w O (n p n Z y N m o w v O y ?� O M lq J O z C I•- Cn I C40 d M € a 3 a L a • a d ;2 m t `1�1 E c c t A c�IL I�caU ti Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT I OWNER, IA-Al-' 4 u TOWNSHIP SEC. .? T 3 N -R /`r W ADDRESS �S/S� 0 , 4 ,0 .6 BAs T ST. CROIX COUNTY, WISCONSIN SUBDIVISION �,� LOT LOT IZE • - 1 �� PLAN VIEW 0 3az� Distances and dimensions to meet requirements of I1HR 83 14 (S 01d G r 3 � � SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N, � 3 0� o pt .aR�v��✓�i � � h � O f i.uE -r 5? 90 ° 0 1r ,1 0 0 1nl q1' /( i A l ��T' L- /Z.tI�GS S�PTtc TANK fig' i i INDICATE NORTH ARROW A10 S chc E BENCHMARK: Describe the vertical reference point used / " .:�*GKJ / A7 S�,�arC Elevation of vertical reference point: A00 Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: 10W Number of rings used: f T ank manhole cover elevation: Tank Inlet Elevation: "Tank Outlet Elevation: Number of feet from nearest Road: Front,0 Side, Rear, O S/gS` feet From nearest property line Front,OSide,�ear,0 fig' feet Number of feet from: well �2, , building: c7 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE I PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Z2C✓ V Trench: Width: ! �` Lenth: o`�S ` Number of Lines: 3 Area Built: �/SO Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, G-Rear,01?t of feet from well: 7/` Number of feet from building: q1' (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil i absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nea est property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: i t Inspector•. Dated: Plumber on job: f License Number: 3/84:mj DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN R&LATIONS, DIVISION P.O' BOX 7969 ON -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: S NCJ, 32 , 30 , 19W (If assigned) T of St. Joseph � CONVENTIONAL El ALTERATIVE ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound NAME Dua E H OLDER Lyon AD DRES S O1dRLTHRoad � INSPECTION T f /7 C✓ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV: CST REF. PT. ELEV.: Name of Plumber: MP /MPRSW No.: County: Sanitary Permit Number: Mark Stahnke 3395 St. Croix 119527 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST -- DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: P PUMP /SIPHON MANUFACTURER: WARNING LABEL I LOCKING COVER PROVIDED: PROVIDED: El YES El NO I ❑ YES ❑ N@';. YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUM WF PROPERTY WELL: B VENT TO FRESH (DIFFERENCE BETWEEN FEET M LINE: AIR INLET: PUMP ON AND OFF E:1 YES ❑ NO N ARES SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: ° °" DIAMETER: MATERIAL AND MA KING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: I BED /TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID , I � V ^ C , TRENCHES: MATERIAL: PIT DEPTH' DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE I DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET: NEAREST �♦ MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVEFI7 TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; DYES ❑ NO [__1 SEEDED: ❑ NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES El E] YES E] NO ❑YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BEDITRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE I MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS FEET FROM LINE: YES ❑ ❑ YES ❑ NO NEAREST 2 �cj 5 , t00 of Retain in county file for audit. Sketch System on Reverse Side. SIGNATURE: TITLE: SBD -6710 (R. 06/88) Zoning Adminis trator Thomas C. Nelson i �- MMMMMM SANITARY PERMIT APPLICATION DI�HR In accord with ILHR 83.05, Wis. Adm. Code COUNTY - STATE SANITARY PERMI # - Attach complete plans (to the county copy only) for the system, on paper not less than / ! 9',5a 7 8% x 11 inches in size. ❑ Check if revision to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION E !' SC j A/N/ %,S Z? T30,N,R E(o PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # r , CITY, STATE I ZIP CODE PHONE NUMBER SUBDIVISION NF�NJE AR CSM NUMBER Aa _Sao 6-J ryo/ �!/ ,C; II. TYPE OF BUILDING: (Check One) El State Owned ❑ VILLAGE : NEAR ST ROAD �_] 040 159-TOWN QE. ❑ Public ,I� or 2 Fam. Dwelling -# of bedrooms __ PARC T NU M13 036 10 — <U AQ III. BUILDING USE: (If building type is public, check all that apply) 45 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. RNew 2. ❑ Replacement 3. ❑ Replacement of 4. El Reconnection of 5. El 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 Bed 21 [__1 Mound 30 El SpecifyType 41 ❑ Holding Tank 12 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) ELEVATION 3 00 4 / /0 -(o7 / • 7 Irk/ Feet .9 Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App. Tanks Tanks structed Septic Tank or Holdin Tank /® 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. Plu bar's Name (Print): PlX ure: (No Stamps MP /MPRSW No.: Business Phone Number: Z S 3i3 Plumber's Address (Street, City, State, Zip Code): IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved SaWry Permit Fee (iSurchargerFee� water a e ssue Is ing Agent na a (No mps) Approved ❑ Owner Given Initial Adverse Determina i n 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 I 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: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Cheek 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 plans and specifications not smaller than 8% 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, ground- water contamination investigations and establishment of standards. SBD -6398 (5.11/88) ---3 `Ill u'J 2_ /n , r�7J�-' 03d- I `fLr_ CERTIFIED SURVEY MAP LOCATED IN PART OF THE SE} OF THE NW} OF SECTION 32, T30N, R19W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. N 44— Cr OWNER unk William McKinnon N0V 0 > 11 ': SCALE IN FEET N `" � 4520 Douglas Hwy. M Gillette, Wyo. 82716 " -' { c" 200 100 Q 200 0- ry ro LEGEND o� d '7 O co c M 0 1 x 24 iron pipe weighing 1.68 lbs /linear foot, set. (� �` , w m 7 vW N Cn et n I unplatted lands owned by others rn y h S88 N N 38.521 O c \ Co \ O < a o E :3 eD 1 rt r+ w �� town road w "OLD E EAST cn� _ g 4 W CT ... m (D Iv .. S 05112911E 7 1 3333 1 0 o to co rt c oocncnTrn w w..r 8.891 �"l FILE cn w o 1 1 �, I 86 11 OONW 0 Cry NOV VS 1 N -9- CO N� N W r+ 0 (b V1 CJ1 N 0 0 0 o to o n m n o n < I cI 1 n XQM 01 CORM o rt. cn cn .� � - v+ v co F M -1 m rn Co 0 m I N CCD r° t � 1f et DNdt F w W o rn a y o u I v o w w _ I �• • . V1 O W co ro _ _ _ '1i 'iY I rh Z Cp l0 �'' _ 1 ✓• VfM� v v O 1 d O Cn Cn cn cn n m 1 w LOT 2 I I N O O W V 0 S Z X I �-• CT cp ' SV C 1 W N W N N O r- C") o O O n � 7 r r I O r I S I< w v r O' a O O 1 (.n ~ I K W N A N Z Z . 10 v (jhr 1 3 .-• A N U1 C) C) 1 7 1 O cn m cn m z � I m 3 56.38 1 nn rn S Z 1 d o I 11 1 to S88 37 57 E t I ` 323.17 r ► n n m N N p 1 1 1 0 33.21 0 o C" rn m �' 1 ►-• v 1 � t W CO V O to O W� 1 W 4-. r'• 1 p,, _ Cn � U.,�I w r o Irt o I 7 N t0 O cn rt d t0 W W V -r N t0 CO t+ Cn S l0 + 10 '7 co CD N I� y I/ O W O I IN N V N W A w I../ 2 r N N 0 N CD co N V V A 7 (D N A N f+1 Cf1 l0 — co 0 0 0 .0 0.0 Cn l0 t0 c0 t+1 TI 01 W O O V rt _ _ w - a o N `0- N? rt rt w LOT 1 I� v v p O O Cn Cn Iv Z X 2 1 II C) Co o cn W m c c S88 5.001 N88 37 57 W � �.. rt — -b' 12.801 �+ r + w O O N N 12 12 rn o m rn ri m N88 399.83 JI I z �' c \ 1 rt Vv S Certified Survey Map ° Z °' Cn Cn Cn CA ° 0 ti• I 0 0 ° ° c W 66 foot wide Private Road Easement N O co co ft = N r+ O 1 v O O O O CO co O C Cn Cn - O to M rt Cn W -. r. F � o � W w 1 Cn w N N O.o 1 2 1 2 volume 6, page 1587 r,i — r 0 W} corner (1 section 32 2650.01 J county monument east - west } line S88037157 "E E} corner f section ^ 1 iron pipe this instrument drafted by Douglas Zahler job no. 83 -15 -286 Voltz::e 6 Pi -c 1736 .',,r 4 CERTIFIED SURVEY MAP LOCATED IN PART OF THE SE} OF THE NWJ OF SECTION 32, T30N, R19W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. N APPIFZOVED OWNER NOV O SCALE IN FEET N William McKinnon (, 4520 Douglas Hwy. Gillette Wyo. 82716 " l'r` 200 100 0. 200 rD Iv rt LEGEND N r•h co CO O 0 1" x 24t iron pipe weighing 1.68 lbs /linear foot, set. _ y V unplatted lands owned by others m y h S88 0 51 1 29 11 E NN►+ �.._ - 38.521 O C Cf O CI •7 � \ rD \ CD < O O W \ \ town road c _ "OLD E EAST" � _ 4M, Ln � -3 _ W O) ►+ co N co F V V7 N = °• ra r• S 0 51 1 29 1 'E 0CD to W rr - 13333 r 0o rrcn� 0 W w�•r 8.89 I �"f r1 W Co NOV 61986 0 O + N O O N W n O) �+ N t t0 N o rD C, t N co C) ts f-n 0 0 0 0 to = o n o a v o c I 0 1 c� ME 010011tI1'Ll to V t0 ID y 12 N a a I= N t0 O v 1) lgWw at Deeds 1rt (Jl O W O t.- ; N - - O O IN 1 "h C r o ix w� -h -n I r+ Z t0 t0 r rt IM- O _ I rD ►•• r I 1 d Or v v CA N Cn N a n �--� m I W 1 ro 0 o v v m =- z X I t -•• rn W N W N 0 O C') C7 i _ L0 I S O 1,1�! 0 0 0 0 -7 - 7 r- r i= W Cn Cn .P H . CL c c I d. CIt t o W = O D 1 to - to r t « i 0, t m cr r t ME I£ I• v 1 N cn m cn m z i 356.38' 1 O m m a X i °- S8803715711E 10 ° 323.171 1 N N ►-• n I v o 3 3.21 1 I o (b O O) CD S I N V _ £ I W t0 V O = O W b-• W H r I N Cn IL�1 W N r0 O .-. 0- r0 W W � 1 rt /�. N - I C2 r0 j Ln S t0 co r0 O N i - �' {..,�yV O OIw °. (t o W v w w i0 / ��,7,.pp N 1 n V 0 co :Z:. .� V � _ Ito O- I N .-• N Na I 0) '7 - 7 �. O ' Cn O Ca t co N V V (1) 7 rD N CD N m to l0 -' O W O O ►+ = C) N 17 N .O D V V v, I 1.11 ra co i0 m rn W o o v C7 1V rO r2 ? w LOT 1 _ o v v O C6 Cn N Cn r• M. O O Cn rn = D) Z X 2 0 0 0 v w C c c 488 57 5.00_ N88 371571iW v_ = o 0 12.80' rt r-i I w O O Ln N Z Z W 7 te rc rn o w N88 399.83 m m m r;1 z �7 I �• - 2 � lv --J z s 0 0 00 co � 66 foot wide Private Road Easement cc o r (� 1 0 0 0 0 to w W rt• 1 v w � � rt Certified- Survey -Map °o — N C.71 W N N - Ln -I!- Cb to 12 volume 6, page 1587 L O � Z r m m m m + 2 V M W} corner _ 1 0 section 32 2650.01vu f GLS /O� G county monument east - west } line S88037157 "E E} corner section ^ V— 1" pi iron pipe \,(�J,J \ this instrument drafted by Douglas Zahler job no. 83 -15 -286 I PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ,e�2E✓ Vy IV Trench: Width: / eel Length: Number of Lines: 3 Area Built:�/ h. Fill depth to top of pipe: 3 3 Number of feet from nearest property line: Front, O Side, G��ear . Nu mber of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector -_ / Dated: / _ Plumber on Job: License Number /�iO�S 3395 3/84:mj 1 APPLICATION FOR SANITARY PERMIT STC -100 This p s to be completed in full and signed by the owners) of a p application for m i com the ro ert being developed. Any inadequacies will only result in delays of P P Y the permit issuance. Should this development be intended for re sale 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 Duane D. Lyon & Cynthia P. Schaffe Lyon Location of property ___ NW 1/4, Sec tion 3_ 2 , T �3G�, N -R _ 9 W Township St. Joseph Mailing address 445 Old E. East Hudson, WI 54016 Address of site 445 Old E. East Hudson, WI 54016 Subdivision name Lot number 2 Previous owner of property Mr. & Mrs. William McKinnon Total size of parcel 3.99 Acres Date parcel was created Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house)? Yes X No Volume and Page Number 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, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ------------------------------------------------------------------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) • the property knowledge, that I (we) am (are) the owner(s) of p p y described in this information form, by virtue of a warrant deed rec ded in the Office of the County Register of Deeds as Document No. 3 7j � :5 9•V ; and that 1 (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, for the construction of said system, and the same has been duly recorded in the Office oEhe Countygi -ter of Deeds, as Document _ ). Signature of OwniiVI" - � gnature of Co -Own b ) Date of digdature Date of S gnature s a , • ♦w•wM,��O ;..�O�l� �� .,.Mw.....,,,1111oftw•w» ..� w ... ....w.... •'� *y r • • ..w •• ... ... ••� � - L,i��a,w,t ■•[!• s.�J i ��w��� . T�� �ii.� ��iw; •w w ♦' - 1R�rY •�/�...M....... ..... ... ........ ...........u�� t •... ..........� -. •....�.Hww.N »w ».............. .. ... ..• w»»» ww «w»�w w� Lot of Certified Surrey Map filed i " 3s tAe Office of the 'Kepistet of Deed 'Vol. Croix _ r • Page 1736 , Wisconsin, <: �aN is sirea in fslfillwent of that certain *' 1, parties bsarin Nosewber 2 land contract .der 21 t date of I �E 'e'Oix C 1446 in the Offics of the Rster of Deeds Di sad *f first egi Wiaconsln, appearing in Vol. nt* 4 ,`t D ii�iS7T. �./ wif Y f j . record if an 8xiatiag highrays, ease #eats and rights of w• ! olr "' iCr eated b y, and any liens or sncanbrances x �rt :i'i y, the act and or defaults of the abore nawedesranteeaufte A .., 04M l ... .. j .... .... ........ Ilyr O[ ............1! X....... , �•.. ♦..... .... ............. fMA�t .... .... .. ...N ............................. .r ........... ' " .rl. . ...... .� . ...................... .................. . ...... . .. . ............tss�l • .....W1,11 i sm N ,Mc�lj anon ,t ............... ........ ............................... C . r ..t.c.. *.. / •Vlsai!!Qi'1'IOi ., .... •o ssowyias#si ! � x � f� nr399.. ...» .. ....................... s .:.................... .......» /fib .... »,.«.,,..,, 'i'ftis si'si'!S .......» ............................. , _Will &Ul ft as Js Na1. "�-.Kr r ,r CERTIFIED SURVEY MAP LOCATED IN PART OF THE SEI OF THE NWI OF SECTION 32, T30N, R19W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. �c N co ►r W OWNER �' �• William McKinnon SCALE IN FEET H 4520 Douglas Hwy. Gillette, Wyo. 82716 200 100 0. 200 c 17 rt co 0 CD a 0 LEGEND ' ° to rt o s co CD 1 ";x 24 iron pipe weighing 1.68 lbs /linear foot, set. w w ci N + rt V I unplatted lands owned by others • - 3C m ctr y _--- _- _�- -- ------- -- --- ---- -- U C* S88 51 "E N N 1•+ r O Cf � o c 38.52 1 �CD < — rt rt. c ` \ town r co Z ., 11 OLD E EAST" 01 r+ r r C" cn W w rn ►. ao m W i� V -Cn N 7 CL C. Co to to to c' S880511 29 "E 133 33 o o cn cn s m -- - W �. W N r 8.891 i cnrn crl W o I oo-� n o r to I = CCD P W coo ~ w O o 0 0 o is = 0 n to C1* Co o a 00 o O G .. i- C* 7 - 3 = I e O tJt ° N cn Co t m� 0 to o to m 13 N to CO O r w W O �-+ to .p to .O V. I'C OD W " I � : I 1 t)1 (2 W 00 I W 0D O N CD -- -- - rt 1 fi O t0 ... ... 10 ►+ f*1I �' 1 d LOT 2 W" W N W O n C".. 1 F+ Of C 0 0 0 0 *7 9 r r W o Cn 1+ W d c c I C cn ~ 1 M I � V I i m 1 4" N c�i c i s �' 1 W _ cn m tn_ m o j 356.38 - �a ^' i" x A i CL S88 tr Co _ i'< to 323.17' i 0o .. rn rn cn i ,°.. ° 33.21' w o 0 0 o c,,, r w �+ r I N �;..� to CL to W w V O to t0 r . Cn eD to 7 1 Oo rn N j '�i o O P . I I N W O V 0 0o a •�+ v �'' � t0 O. 1 � co CIO .+ f N N W CD 0 M O V V N 7 t9 N N N m 00 pf O 1 I 1 00 W O O ►+ 7 A N .° N .0 y V V 1 1 co C N N LOT 1 I I V V, o v v v v O N CA CA CA W. rt ►r r•'I - O O Cn Cn 7 W 2 X 0 o w w m c c 488Q37 "E 365.001 2 N88o3715711W — — — — - 12.801 O O CJ1 N Z Z W I m m' r+, m w N88 399.83 I — — — — rt se INC s Z I 0 0 eo c C Cl. 66 foot wide Private Road Easement N o N o co o tt = o cc 0 0 0 0 to W w e+ u w_ �_ _ � Certified Survey Map o °-' '- C* -------------- - - - - -- o ... +y -. Cn W N N Cn r T tD `O volume 6, page 1587 m' m In m m -- -- ---- °-- -- A WI corner section 32 2650.01' county monument east - west I line S8803715711E E} corner section 32 It iron pipe this instrument drafted by Douglas Zahler job no. 83 -15 -286 1 •asuadxa 3TTgnd aq pTnoM jagjeajauq sgsoo aoueua4uiew peod oTlgnd e se A4TIedioiunw e Aq .zano u9xe4 aq AeMpeod agenTJd aq4 pTnouS • siauMo Agjadoid 6uiutoCpe aq4 Aq eqej -oad pajeus aq TTet4s peOJ p.zepue4S a se JOgPJ4siuiwpy 6utuoZ aq4 Aq Tenoidde SIT Ja4je AVM peOJ 94enTid aq4 jo s4soo aoueua4uzew AUV •AeMpeOU ageATJd a sT dew STg4 uo uMOus AeMpeOJ aus INEWHIVIS AHMCIVOU 986T` jo Aep sxg4 udasor •qS jo uMoy auk. Aq pano.zdde uaaq seu dew AaAjnS paT�jM;aO sTgq 4eu4 AjT4aao Agajau 'I ® o O � Y!y� : a�eot�i� za0 uMos 'SIM r ua6 N 0 U TV 'd1t LOPS N30 , 143 • awes 6uid . aA,ans UT XTOJo • 4S jo Aquno0 944 Jo aoueuip.z0 UOTSTATpgnS puej aq4 pue sa4ngegS pasTAaU uzsuooszM 7£'9£Z .zagde4o JO SUOTSTAoid 4uaiino 9u4 g4TM POTIdwoo ATTn3 anew I geuq !pagTjDsop pue paLaAjns Aiepunoq jOTJOgXa aye JO uozge4uas9.zdaj 4OGJ aoo a ST dew AaA.anS paT jTgJa0 ST44 4euZ • p.zooaj jo 4uawasea jag4o Ile pue dew sty4 uo uMous se M/H peoU uMos o4 4oaCgns orsTe pue dew STg4 uo uMOus se quawasea p 94eATJd apTm 4 003 99 e o4 goaCgns pue ggTM jag4a6os •6uiuui6aq jo qutod aye off. gaaj ZO'OZT aA.zno pies jo oje aye. 6uoTe ATaaygnos aouayI :�aa� 66'6TT sainseaw pue g „7Z .LS - o ZOS saeaq pjoyo asogm pue „0£ .LO - sainseaw 9 1 6 ue TvJ4uao asoyM AIJ94saM aneouoo aAino snipe.z 400J 00'L99T e 3o aingeAjno jo 4uzod aq4 o4 4aaJ LT'TT8 'peOB uMOy a44 Jo 9uTTJa4ua3 ay4 6 uo1e '21„60 aouag4 ! aaj ZS'8£ 'auTlia4uao pies 6 uoTe S 116Z oTS aouay4 :Aoua6ue4 jo quiod ay4 04 4aaJ ZL'TLZ auTTja4uao pies 6uoTe AT.za4sea aouay4 :4aaj ST-99Z sainseaw pue S„SZ -,77- o ZLS sivaq pjouo asogm pue „80 - ,7T - Z£ sainseaw aT6ue Tea4uao aso Alaag4jou aneouooaAjno snTpeJ 400J S6 e 6utaq allTTJ94uaD pies ' „4s'28 3 pTo„ Jo au'TJG4uao ay4 04 4 LO'666 `2uST -.9£- 0 TON a0uay4 :4a9J £8 `MuLS -.L£ 0 - 89N 6utnut4uoo aouay4 !uoi4dTaosap STg4 JO 6uiuuibaq jo 4utod ay4 pue peod uMoy aq4 jo auTIja4uao aq4 off. 4aaJ 08'ZT 'M„LS- ,L£ - a0uay4 !4aaJ 00'£8Z `auxl 7/T ugnoS-g4JON aq4 6 uoTe `3..ST-.9£ - 0 TON aouayq !Z£ uOT40GS JO Ja4uao a44 04 aG9J TO'OS9Z 'auTT 7/T 4saM 4seg ay4 6uoTe 21.,LS .1-£ 93uay4 'Z£ uOT409S pies Jo J9uJO0 7/T M 9y4 It 6ui3u9wwo0 :sMOITo3 se pagTjosap ,aag4jnj ' uzsuooszM IA4uno0 xto.z0 '4S `ydasor 'IS Jo uMOI 'M6TH `NO£.L 'ZS uOT439S JO 7/T MN 9 y4 3O 7/T RS aye. 3o q,aed uT pa4eooT pueT jo Taoisd V : sMoTToj se pagTjosap sT paddew pue pay GAins Taojed pueT aq4 jo Aaepunoq joiaagxa ayq geyq ! deN A9AjnS pai jT4Ja0 STy4 Aq paquasa.zdaa ST yoTyM Taoied pueT ayq paddew pue pagTjosap 'paAaAjns anew I 'uouuixoN weTTTTM Jo uoTgoa.zTp aq4 Aq 4egq AjT4jao Agajay ' JOAGA.znS pueZ uzsuooszM pajagsi6aj ' ua6egAN -0 ually ` I 31VOIALLE30 SHOI.RAHnS CERTIFIED SURVEY MAP LOCATED 1 ,*ART OF THE SE} OF THE NW} OF SECTION S :�,iUON, R19W, ' TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. N ' M• 1 OWNER SCALE IN FEET William McKinnon [4 ()V �� ��'`�''� T 4520 Douglas Hwy. 200 100 0 200 a Gillette. Wyo. 82716 '' ",`', , rr A Y 'f 0 O LEGEND m s 0o r. 0 C 1" x 24 iron pipe weighing 1.68 lbs /linear foot, set. - N � A V 1 3 t unplatted lands owned by others ;^ „� \ S88 11 E N N .•. ... o n 38.521 ' M 3C rt 000 .001� O C \ n v. Q `' r �' "' IN ,' o. S88 V �3 33 ��L`°rt` e.e91 FILED Zn Ln Ln W O 1 NOV 619b b � O P � H O O N W a n C O. r t.n to H O C�O�y�y N t 10 N 7 N N — N cc co t � Q1 W.�•" O O O. 0 7 n IG n O a' V 07 I O Ln O ll. r rt 7 '7 70 l e t ,�,. O ; �W r et Qom' C/� b r n 7 o a A m O r N N Q N Ja a 1 c W_ W . - i ". >A `ab C: r w W O ►.' 1 N CO o L" w Ce .,� _„ 1 e+ z to "' s s o rt rt I rr o rn' re+ 1 11Y �r LOT 2 s C7 N N to P n ."� f.1 I W I I G 0 0 0 0� � r � ,o .•. t ►' 1 �• w Cn .�.. r .+• t�. C C 1 d Ln "� I.i ' G7 G1 I Z �� 1• = I Y r '" U 1 356.38 m tn . - " m = r 1 ,_.S88o3715711E ,, 11° I Cr w 323.17 n ' 33.21' W .O V nD 7 O W .r W A O 1 ' �O 7 v W 'D V -1 I A A _. 'J ' Cn_ 1 no O N v V to '] A N A N ref N w 0 14 _J fn l 1 OI `° wpo er N o LOT 1 1 o r1 C) cr "+ '* rt rt i v v v O V1 CA Ce1 N S. o n Ln Ln N 2 N88037157 c 0 ° �° o o S88 365.001_ - 12.80' o ` ° °- " " w N88 399.83! }� I s X O N N H H N 0 66 foot wide Private Road Easement '' ° o a w co c N 00 o e rJ O co co n 7 :~ 't S j O O O O 10 - C Ln L" L Certified Survey Map °o ,. w .. a -- -- ------ ------ ---- an Ln w N N 1587 -------- page �+ �• r o O D volume 6, c . U rn rn rn m - - - - -- ,. W} corner section 32 16 50.01' county monument east - west } line S88 "E E} corner section 32 1 iron pipi this instrument drafted by Douglas Zahler job no. 83 -15 -286 (., i::v U i n"'t 1736 (Continued on following page) i , • _- E., _��` ..JL�.. _ 1-� C�� 'I 1 Icn v im- ,,. ,� 160TH1 0 � AVE.y.. `• =fi J 1 18 �z 1J I RICH OND, A�VEJ H ;JI I Y .-1 o r • O I L �rl3rv�h Buss I I o fI0U1tOt ° � `�-�- 1 " � 140TH AV_E. E Boardman a Perch L. S T. off_ o 130TH c. 35 - H P H A b , 31 - - (1) II NII. tn UK. E E E 115TH_ A _ C WILLOW I �r1 RIVE t1 rl o l)u,) 1.1 r' x N / —; r flclf t Q- - -y o N O l �� /:nll:; / I I ° W A R E N .t pot b�t�l /l ��\\• McCUTCH�ON' i d8 X10 s Hud o 3 i' o v I udson - i Ro erts I Z U _I �_ u U J I JACOB y. �. - 80TH AVE. HUDSON 94 ;�� , 4 r„ III 65 � J._ r H .� - -- d L1 l uk.i x cn 12 en I ��... F TOWER T ,� 0 _ I N ' - F I I I Croix ' COULE 12. �L—' _�� Ail, 35TH GLOVER RD 13 l LAVE. STC - 105 II I SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER Duane D. Lyon & Cynthia P. Schaffer Lyo ROUTE /BOX NUMBER 445 Old E. East FIRE NO. CITY /STATE Hudson, WI ZIP 54016 PROPERTY LOCATION: SE 1/4 NW 1/4, Section 32 , T 30 N, R 19 W, Town of St. Joseph , St. Croix County, Subdivision , Lot No. 2 Improper use and maintenance of your septic system could result in its prmature 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 for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper 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 form 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 Department of Natural Resources. Certification form must.be completed and returned to the St.Croix County Zoning Of a within 30 days of the three year expiration date. S I GNE /' L DATE In .5 St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street L' Hudson, WI 54016 715 386 468 ( ) 0 1 Sign, Date and Return to above address �' g , p € PARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, I DIVISION LA a PERCOLATION TESTS ( P.O. BOX 7969 HLNAN RELATIONS \ / MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION: I SECTION: TOWNSHIPA�14WN+&W46LEY: LOT NO.: BILK. NO.]SUBDIVISION NAME: 5E" 1 / 1 /a 3y M? N/R 17 E (or) W s 70s P fig 2. cs /_1 PE.J v 1,4j ( COUNTY: OWNER'S 'S NAME: MAILING ADDRESS: sr eW0 1x �i� , Mc �.,v,� d,� y��o `�ov /.t s �I w y , Gill � rr4f w �, d'a 7/6 USE DATES OBSERVATIONS MADE NO. BE7�: COMMER IAL DESCRIPTION: P OF LE DES RI NS: PER O A ION TESTS: esidence ? New ❑Replace I 7— Z G I O/_ f- -2 RATING: S= Site suitable for system U= Site unsuitable for system J oy�� �� �� �� — v vY �� -rO/L CONVENTIONAL: MOUND: IN- GROUNDPRESSURE: S STEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑ U ❑ S U 0 S❑ U ❑ S 21U ❑ S ®U �'D,c> tXC-t ss t� r3 If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: GG -s S Z � F l oodp l a in, indicate Floodplain elevation: PROFILE DESCRIPTIONS /N :D&eI- FT• BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. H I GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B 2 //o ;722.1 o-- //o a.� . . s. & i ,I? s . SIR v y c s, i /G ' N 15 , (3 S ' ?. AJ CS / . / 7 � 13,E cs Gam- • B -� / /.S� ���i � > / /. • � �,rI3�.G.r�y s,•� .s• ,, ,�N S ' N i X . f '3a • CS w (111 71+400-ft to " o c�t'.ty o'P �S . . 7s • v�r a� S ,, . y z ' aN - g y. P17 1,P,3 ` 7,� S , . S B- 1 0 3 3 } /1 . Q T S� i 6,C ' ,Z3/j . s 3 G R , w 1 dam. ?Iew S Tg,E'E -✓ Ai✓ 1 Cf 6�,e SYRi 4V(4'; PERCOLATION TESTS Is / f "DG'ffTS 6- Q TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL- INCHES RATE MINUTES NUMBER INel1*S AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIO 2 PERIO PER PER INCH P w,✓ P- P- Z L ra P -- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION r .wse.. ._ f } $ 1 G S Te a 1 b 9 - - ih %T q �►.�E I '' a -t- --- _'- 0l4 E € ._ .._... Ref- P f So v y LO T 41;0 E I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED O HOMESITE SEPTIC PLUMING CO. / — 2 — / G ADDRESS: ROBERT ULBRICK eA �7 � ERTIF A/or NUMBER: PHONE NUMBER optional): !� 77 (dJ ` MINN. INSTALLER & DESIGNER LIC. N0. 00664 C* r's ' SIGNATURE am =2 dot DISTRIBUTION: Original and one copy to Local Authority, Property 0 nd Soil T " DILHR- SBD- 6395 (R. 02/82) r 44 INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; S. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS: B. PLEASE use the abbreviations shown here for writing profile descriptions and cornPleting the plot plan; 7. MAKE A LEGIBLE diagram accurately Iocating y(')ur test locations. Drawing to scale is preferred. A separate sheet may be used if desired, � S. Make sure your benchmark and vertical elevation referen ce point are clearly shown, and are permanent, 3, Complete all aplaropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10, If the information (such as flood plain, elevation) does not apply, place N,k in the appropriate box; €1 . Sifpn the form and place your current address and your certification number; 12. Make lecibla copies and distrif)ute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL ALITHORITYWITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Sail Separates and Textures Other Symbols st Ste)rst; { €a,er 10°;i FAR Bedrock voh Cobble (3 - 10 ") SS — Sandstone gr - Caravel ifinde i :3 ") LS Limestone, 's -- &ind HGW — High Gre> €. =id water cs - Coarse Sand Pe.r c Pi i c:olat on Fate rrled s - Madium Sand W 1 is ... F ;no Sand Bldg _ Bu dding lss — Loamy Sails# Greater r =pan `sl Sandy Loam < -- Less Than 'I _._ Loam Br) — Brown * sil - Silt Loam BI Black s — Silt Gy - Gray �cl - Clay Loam Y -- Yeliovr scl Svidy Clziy Loarn R --- Ron sicl — Silty C:Iay Loam mot Mottles sc - Sandy lay ,vi -- o"i th sic — Silty Clay {ff __ f.,�v, fide, ;a nt c _ Clay cc c'ommc r C�Xsa pt _ Peat n)rr) — Many, roes €firm rr) — Muck d — distinct I — prominent HWL -- High vvatol level, Six general soil iextiire:>s surface r,v tcer for liquid waste disposal BM — ;(;r)ch Mark VRP Vertical Ref € =rence Point 'FCC THE OWNER This soir test report is the first step fit securing a sanitavy permit. The county €)r the Department: play request k..,, ihcatinn of tll l:? stli, test : in the fi( (l print to p t:;inilt, issuance, A cornpli.te, see o' plans, for thf,, private. sys #m and a pervi`lit c,,, must be submitt t.C) the apt)i"opF i,)If local authority in Order to sWai'Ei 0 C en Hl. Ille sanita3 v rwrrmt ill op o !ftainet -1 ar)d posted pi "ior to m , srart € f a':)y congtructif)n. • 4� 30 ')j rat PiPc�PosE�D \ PLB 67 /00?/ PLOT & CROSS SECTION PLANS vet w.4Y �qs-r I��,Pry ZAPPA BROS. EXCAVATING INC PLUMBING UNIT t1 ss g ' / /g � \\ PROJECT Quhue ,O. Doti G`�65 f vvs, OL E "'64 sr S7 s h° J o& - P iNo 30 /000 �Ir o � 1 } S�PT/c `I—iWK Ty. l � ca loll vPpS g,p sd 1 E �0 !0 3D' NO O L — — — _ y y o u roc p,�v�- ,�,� „v.� SCALE x3 o v P,oE FRESH AIR INLET AND OBSERVATION PIPE 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: MINIMUM 2' AGGREGATE DATE: OVER PIPE DISTRIBUTION PIPE TEE SOIL TESTING BY: ELEVATION BED W AGGREGATE • BOTTOM PER SOIL BENEATH PIPE PERFORATED PIPE BELOW TESTIS COUPLING TERMINATING FT. AT BOTTOM OF SYSTEM 1 r ST. CROIX COUNTY WISCONSIN ZONING OFFICE ` ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386 -4680 August 22, 1989 Duane Lon & Cynthia Schaffer-Lyon Y Y Y 445 Old E East Hudson, WI 54016 Dear Mr. and Mrs. Lyon: A code complying sanitary septic system was installed on your property located in the SE 1/4 of the NW 1/4 of Section 32, T30N- R19W, Town of St. Joseph on August 17, 1989. The system was inspected by this office at the time of installation. The system was designed for a Two bedroom home. Should you have any further questions regarding this matter, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator TCN:sma