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030-1097-20-000
nMO nco0 n co 0 3- c C � cn Mn ��`° `D am,.• • CD r: w n rr 3 M O I Z= Z ° N O C m Z ° w O o ZW N w �C• o m o v l tv m o o c0 0 to C]. CD M to a CD 3 (D N ° a (D CD 0 O O :7 11 C 0 N W CD N a N OD 7 Z O N N W CD Mrt m m n O N C- 7 O O_ O S W N co 2 CD 3 H V 3 j O O .Ni C CO . C CO C cn Z D CD a o Cn Z D ID a o �? D Co 4; Co D a m n D a — I n N N a o M� m co CO c (D c m CD c V p ? 3 a0 = CO N) 2 p - I A cn W N CD co co I j W= N A W= N Cl CD = 3 .+ 0 a Q l�Y1 C C CL c CL v o I vMMo MMN nr. 000? o 000? O000 can p N N N 0 o N N N 3 N N N o D t� M °' — @ _ M °) Z e'o c �m rn cn CD 3 m N 3 3 m 3 m w t� I 3 °' o O D D o D o o D co o p � � (D CD C c N CD CD • N N N CD N �7 C U C tl p C :3 CD j N N. C CD C CD C CD lD CL w o. I a 3 a 3 3 3 CD (o Z M C5 co CD (C —I N m ° D � 2i CL CL O U¢) W CD CD CD CD W CD G O N I c c 3 ! c z 3 A M ° o cn COQ H N .Z1 y Z < I CD CD - I CD A W W CD = W I > 3 z a j Ono a n m Q I » _ * = ° ° _ m c CD fD m c CO °m CO v c =3 - m v o CD o z a 'amo o 0. 0 ° a, ° m o a c D m N I U '0 CD c I 3 m a � y, C 06 n m o o� � n I Oc CD $ CD 3 — � 3 q X CD N CD N .+ CD Cl. O a to O 0 O O O b I CD (D I CD ~ A p 0 p 0 p 0 Parcel #: 030 - 1097 -20 -000 03/21/2005 10:17 AM PAGE 1 OF 1 Alt. Parcel #: 32.30.19.354B 030 - TOWN OF SAINT JOSEPH Current 1_X I ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * GARDEN, JOHN W & BARBARA L JOHN W & BARBARA L GARDEN 1219 ROLLING HILLS TRL HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1219 ROLLING HILLS TRL SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 9.280 Plat: N/A -NOT AVAILABLE SEC 32 T30N R19W PT SW SE NELY OF TN RD Block/Condo Bldg: BEING LOT 1 OF CSM 2/486 ALSO STRIP DESC IN 620/331 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 32- 30N -19W Notes: Parcel History: Date Doc # Vol /Page Type 08/18/2000 628442 1535/446 PR 07/23/1997 888/321 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 5629 272,100 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.280 96,200 110,300 206,500 NO PRODUCTIVE FORST LANC G6 6.000 61,200 0 61,200 NO Totals for 2004: General Property 9.280 157,400 110,300 267,700 Woodland 0.000 0 0 Totals for 2003: General Property 9.280 92,400 84,900 177,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 311 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 430618 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: Garden, John I Hudson Township 030- 1097 -20 -000 CST BM Elev: Insp. BM Elev: BM Descri pt' t Sectionrrown /Range /Map No: / D b- D j} D R 3 4f eyh - -g/ ; 32.30.19.3548 TANK INFORMATION ELEVAYION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / �/Z) n Benchmark 135 o3 t (/VC V Dosing / lam✓ Alt. BM Aeration V � Bldg. Sewer V6 cnmk" Holding SUHt Inlet 4 o-Ale �11-11 R03 A 7 .3 TANK SETBACK INFORMATION St/Ht Outlet S 3 9 �- �-7 TANK TO P/L WI BLDG. ke ROAD Dt Inlet Septic ' �q > b a _ 7 / Dt Bottom t UlJ Dosing Y 1/v`f Head n. v S-/ Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Y . 6o ifs Manufacturer Demand St Cover / GiG� GPM NIS e4 Z ` I^ 0 Model Numbe TDH Lift Friction Loss ste TDH Ft Forcemain Length ia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / r Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG 1WEL LAKE /STREAM LEACHING anufactu /L -�,- INFORMATION CHAMBER OR Type Of System: Model Number. DISTRIBUTION SYSTEM Header/Manifolq„ Distribution Tole Size x Hole Spacing Vent to Air Inta e c� p Pipe(s) to t Length J Dia Length �/ Dia y Spacin r �0 — SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only — av - � - Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center -3 , Edges Topsoil E ,, � Yes �� No L _ Yes I No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / 2 1 /d Inspection #2: / / Location: 1219 Rolling Hills Trail Hudson, WI 54016 (SW 1/4 SE 1/4 32 T30N R1 9W) NA Lot 1 00 Parcel No: 32.30.19.354B /� 1J I Alt Description = S hy � �2 (1/t�CP� 2.) Bldg sewer length =Z4 wJ d e - - 4v (o ' cA a44 FAO C��(,tAz. viU 4 - amount of cover = p i j �• L,�, _ � ( p It Plan revision Required? Yes [" No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Sig ture Cen. No. f Safety and Buildings Division County N v isconsi n 201 W, Washington Ave., P.O. Box 7162 Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) f 6 - De artm ent o Commerce (608) 2 Sanitary Permit AP lie State I. Nttmbar In accord with Comm 83,21, Wis. Adm. Code, pers I Information you p may be used for secondary purposes Privacy Law, Project Address (if different than mailing address) — 1. Application Informution - Pleuse Print All lttl'urtnutiut g�uT��-- CROIXCOUN G OFFICE Property Owner's Na me Parcel X Lot / Block N { 03 6 - 109T - Z0 - . 3 Property Owner's M ailing Address Property Location _AX — <J"Z Skt) t'i, u,Section City, S ate Zip Cock Phone Number (circle ) T N; R�E or� II. Type of Building (check all that apply X 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ❑ Public /Commercial - Describe Use El State Owned - Describe Use li�� (� off— 3 T� ❑City_ ❑Villa a ownship of III. Type of Permit: line A. Complete line B if applicable) A ' ❑ New Sysm t Replacement System) 4'rreaunent/Hulding Tank Replacomotu Oaly ❑ Other Modification to Bxieting System B, Cl Permft Renewal ❑ Permit Revision !Plumber Change of Permit Transfer to Now List Previous Permit Number and Data Issued Before Expiration IV. Type of POWTS System: (Check all that u I ) Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil U Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ELHolding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit O Recirculadag Sand Filter ❑ Recirculating Synthetic Media Filter Leaehin Cham ❑ Drip Line ❑ Gravel -lass Pipe 0 Other (ex V. Dispersal/Treatment Area Infor at Design Flow (gpd) Design Soil Application Rate( so Dispersal Area Required (so Dispersal Area Proposed (sf) yttem Elevation VI. Tank Info Capacity in Total Numtxr Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber V11. Responsibility Statement- 1, the undersigned, ussui responsibility for installation: of the POWTS shown ou the attached plans. ^ Plum s a (Print) :P1:um;beer' MP /MPR S Number Etuhau Phone Number Plumber's Address (Street, City, State, Zip C VIII. Count /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee Jincludos Groundwater I Date Issued sui Agent Signs ra Stamps) Surcharge Fee) _ ❑ Owner Given Reason for Denial z-L 19 zo IX. Conditions of Approval/Reasons for Disapproval w . SYSTEM OWNER: 3J f S10 1 Septic tank, effluent filter and C/� 2>w dispersal cell must all be serviced I maintained (� ,�,,�0 / &r. r�x.xaC Q as per management plan provided by p I"l'� " �t.W� t 2. All setback requirements must be maintained C o as per applicable code /ordinances. Attach complete plow (to the County only) for On sy sraa on paper not less than 8141 a 11 In" V *a SBD -6398 (R, 01/03) A A/ �Cb. �1eusE w ` Q� G ` D — .16J��/ C�•�,�a' �rv� ..�,s'� s.F .�- Tom.+/- �/� A A/I 6cIWW- r-- �.7 � o� o 5 , r1C y4 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pago _J_ of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity g al NA Permit # Septic Tank Manufacturer S ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer - ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 4 l ❑ NA Number of Public Facility Units ID(NA Pump Tank Capacity al 121�NA Estimated flow (average) g al/day Pump Tank Manufacturer 0� NA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer ff NA Soil Application Rate al /da /ft2 Pump Model ANA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ONA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: 1 Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOO,) 530 mg /L J1 In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At - Grade ❑ Mound Fecal Coliform (geometric mean) 510` cfu /100ml ❑ Drip - Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑monthls► (Maximum 3 years) ❑ NA ICJ earls) Pump out contents of tank(s) When combined sludge and scum equals one -third %) of tank volume ❑ NA Inspect dispersal cell(s) At least once ever ❑ month(s) (Maximum 3 ears) 13 NA y' _� year(s) y C month(s) C3 NA lean effluent filter At least once every: y ear(s) Ins ❑ month(s) NA pect pump, pump controls &alarm At least ones every: ❑ ear(s) Flush laterals and pressure test At least once every: ❑ monthls) JZNA • year(s) Cher; At least once every: ❑ month(s) ❑ NA • year(s) Other: ❑ NA 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 Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any 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 ponding 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 (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, 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. GMW (4/01) Page,2 of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tankls) 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, overloading the cell(sl 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 Maintalner 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 area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall tie 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. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. ONTINGENCY PLAN If the POWTS fails and cannot be ropaired the following measures have boon, or must be taken, to provide a code compliant replacement system: fj A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 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. O Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT, RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDIT IONAL COMMENTS OWTS IN STALLER t POWTS MAINTAINER Name Name - -_ - 4 'j— -1 Z , Z, 2, d - ` 'hone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone 'his document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Divisiop INSPECTION REPORT Sanitary Permit No; 429973 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: Garden, John I Hudson Township 030 - 1097 -20 -000 CST BM Elev: Insp. BM Elev: T Description: Section/Town /Range /Map No: 32.30.19. 35 CST BM Elev: Insp. BM Elev: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil [fl Yes [7] No [:] Yes [ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1219 Rolling Hills Trail Hudson, WI 54016 (SW 1/4 SE 1/4 32 T30N R19W) NA Lot 1 Parcel No: 32.30.19. 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? es � No . Use other side for additional information. SBD -6710 (R.3/97) Date lnsepctor's Signature Cart. No. y A 5 Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 N011sco Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce (Privacy Law, s. 15.04(l)(m)J (Submit completed form to county if not state owned. Attach com lete tans to the county copy only) for the system, on paper not less than 8 -l/2 x l l inches in size. County `� n 1 State S , Pqn lytmber ❑ Check if revision to previous application State P lan 1. D. Number 1. App lication information - Please Print all Inform ation _ Location: Property Owner Name Property Location d a,- /i ri 543 1/4 66 I/A 3 W Property Owners Mailing Address Lot Number AV Block Number 1& D� l s Qi� ST. CROIX COUNTY' ` l City S tate Zip Code Subdiv' Name or CSM Number S /�t t- a( S29 S W-5'- II. T ype of Bui g: (check one) ity 1 or 2 Family D ling - No. of Bedroom 3 Village \ • Public/Commercial cribe use) :_ A ta'l own of • State-Owned �OS2 Nearest Road wi lls T/iz i 2, ts Parcel Tax Numbers) 20— III. T ype< Pe it: C n line A. Check box on line B if applica ' A) 1. w 2. Repla ent 3. ❑ Replacement of 4. Al 5. 6. ❑ Addition to S to System Tank Only Existing System B) Permit Number A e Issued ❑ A Sanitary Permit was is + IV. Type of POWT System: (Check all that a ) Own pressurized In ground ❑ Mound Jfi #, ❑ Sand Filter ❑ Constructed Wetl ❑ Pressurized In ground Holding Tank ❑ Single Pass ❑ Drip Line ❑ At-grade Z CILALerobic Treatment it ❑ Recirculati ❑ Other V. Dis ersat/Treatment Area Information �a2 L'± a( / / "C�o a t 1. Design Flow (gpd) 2. Dispersal Area 3. Di r al Area 4. Soil lication 5. Perco System Ete 7. Final G e Required Proposed to lday /sq. ft. inlinc Elevation n A/ G. P .O. 8�s ,�. �as<aa �.� 4. 95 VII. Tank Capac in Total # of anufactu r refab Site tee lactic Information Gallons Gallons Tanks Con - New Existing t Tanks Tanks NOV C3 o oil )i VIII. Responsibility Statement 1, the undersigned, assume responsib ili for insta tion of the POWTS shown on the attach lans. Plumbers Name (print) Plum es Si cure stamp NWT1MPRS No. Bus vs I'Fon :umber - Plumber's Address (Street, City, State, Zip Code) / ©70 IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I gent Signature (N stamps) K Approved ❑ Owner Given ial Adverse Surcharge Fee) ¢ Determination }{� X. Conditions of Approvagheasons for Disapproval: 66x. SQnr�- {� a r►a�c �� L `lam c1�eo�04� t��at�t� � Q.r,, 1628 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 8% x 11 County inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 03G-1097-20-000 Please print all information. e ' By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). M Property Owner Property Location John Garden Govt. Lot SW 1/4 SE 19 S 32 T 30 N R 19 W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 1219 Rolling Hills Trail 1 na CSM Vol. 2, Pg. 486 City State Zip Code Phone Number _ City `J Village ie/ Town Nearest Road Hudson WI 1 54016 1 549 - 5895 St.Joseph I Rolling Hills Trail _f New Construction Use: 01 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 0 Replacement J Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install two trenches at elev. = 95.00' using 21 leaching chambers. Boring # I Boring i/ Pit Ground Surface elev. 98.91 ft. Depth to limiting factor > 105" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr4/3 none Is lfsbk mvfr cs 2f,1mc 0.7 1.2 2 4 -28 7.5yr4/6 none Is 1 msbk mvfr cs - 0.7 1.2 3 28 -78 1 oyr5 /4 none s & gr. 0 sg ml gs - 0.7 1.2 4 78 -105 10yr5/6 none s & gr. 0 sg ml - - 0.7 1.2 qS. o `fk' • q2 g2 ,q H#3 & 4 contain 5% gravel. a Boring # _ Boring i/ Pit Ground Surface elev. 97.95 ft. Depth to limiting factor > 102" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr4/3 none Is fill 1fsbk mvfr as 2f,1mc na na — 2 10 -13 10yr32 none sit 2fsbk mvfr as lfm 0.5 0.8 3 13 -20 10yr4/4 none Is & gr. 0 sg ml cs - 0.7 1.2 4 2 7.5yr4/6 none Is 0 sg ml gs - 0.7 1.2 5 36 -102 10yr5/6 none s & gr. 0 sg ml - - 0.7 1.2 3s. �-1 H corrtains 5% gravel. H#5 contains 10% gravel. * Effluent #1 = BOD 5 > 30 < 220 mg/L and T S >30 < 150 g/L ent #2 = BOD <30 mg/L and TSS <,0 mg/L CST Name (Please Print) ignature: CST Number James K. Thompson S 3602 Address A.C.E. Soil & Site Evaluations ate Evaluation Conducted Telephone Number 340 Paulson Lake Lane Osceola, WI 54020 4/302003 715 - 248 -7767 Property Owner• John Garden Parcel ID # 030 - 1097 -20 -000 Page 2 of 3 F Boring $ Boring # /� Pit Ground Surface elev. 9 ft. Depth to limiting factor > 105" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10yr4/3 none Is 1fsbk mvfr cs 2f,1m 0.7 1.2 2 6 -24 7.5yr4/6 none Is 1 rnsbk mvfr cs - 0.7 1.2 3 24 -71 10yr5/4 none s & gr. 0 sg ml gs - 0.7 1.2 4 71 -105 10yr5/6 none s & gr. 0 sg ml - - 0.7 1.2 ;.Ie $3•Ib H#3 & 4 contain 10% gravel. F—I Boring # -} Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 ❑Boring # Boring _j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil 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 *Eff#2 * Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD i 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. ♦ EI e ✓a £o.� N CA Pl It Comm. 83 54t ba.c -' r e9 u, "rY.ndn frs haae 6ten met i / /o& l n .es ar'e ? / ow SySf ciiea. Yard Exi's , Bz Pc /r � Shed �bcrna�e d.M. � Tep af' dreP a nN,Jo�s� ce ' �� - 5 y sfe.n e lei: = 97 /o. SIo�oP S/oAe Ql �— Abandb� as /°L'' code. SSwm�ti » o►►'� f e /36, q 3 bGclecon We ✓ o f a / e yard re5&enoe halE. dr�Ue�o`y i P� 3 - ,,-3 MAY -14 -2003 11:09 AM A. C. E. 50 i 1 tsi 5 i i.e tea r 1 r1 All C&"m. $3 Set 6&c.<.- eff "rr Asr t &t`n /Aat or 4rts SystV*W yMrd �Xi'lfJ.r' prop•s�tcl c� ispr/sa�C a 8� •Tip eFdrp s CL Two (� 1�+,.+rJ�es a.�. 4E rii» JG►� f/. � btI tjLj b= al(• Of / �wAuec U-se Of kydm14 r drs p•rso-1 a reA c St�6'ef : ��� Aba.�atKl es P� ols. Sew— Pr°po sc4 1, ono . S.T. wf XAAAr A-r &Off -A.It Fi c� •.t. lit +''Y�'"' y� resid Am ° tl. dr�ueu� e � �lls rral t i1 MAY -14 -2003 11:09 AM A.C.E. Soil & Site Eval. 715 249 7764 P.01 ■ �o,/ crd/�r�in PiE ♦ Ele&0 A Comm. $3 /'s.Ptwrr.sA'� iIAC boon ; hat or 4rec'mcko% * Ae S /aot 7dror;l, l/ /at 4014j are syrif r, sreQ. waoc�Qd Sys oL�co1. ycrd � ^ Pa propose -d c>< i a 8� �� • T p of'dr; O c Two (IQ aE �:�►� ar,E f/. ' 3 � bd.•r5�r��+ I/ At'usz st1 cie //. r.L 'r 1'E f ten ✓a.l�t S�A� b � in AnAled im alley ' f k�►•�'c � oE' )u�efre ll� r EX,� SV6c•6s„it: Pro po seal /, ago . 3.-r s4Ae< as I✓ &A-Y Xof A-1 cRFhsnt 9ar.' w�cd� ysld re �a ae�,1n o s�•.+�del. /�so '�, Trap` ejis�^ a�l��l� dr�Ut�,.9Ay �,•lls J BioDiff user Specifications 76" _ I C: 7-1 00 OD 00 00 OC 00 r O 00 00 OO 00 00 OCR OD —�' 00 OO 00 OD 00 00 00 00 �namee- _= 00 OD 00 OO 00 OD 00 00 '; �r _� OD OO 00 OD 00 00 OCD � 00 ,F,y ` I,OO OD 00 00 00 OD 00 7- 'I C O O OG� O OO C OQ AlNt { h) ree`:'Bj W I th a , n S taRC� f ins,�alled Yyrl d:comp r esgn! a .. 6 ie qm m m of 12 {' . for;H .10 loa End View Capacity Biop designed f0 ? 34" A mini murzi required f 4" Knockout Universal End Cap i Available Sizes 76 (j i♦<Y A � I 1 f . Width l 1, „ >> 4 � f `� 34 34 (� 1 4 1�.(c Hei r,' 1 I '4" 16" Invert, ry, ' 9 y,l `' 9 11.3 Conventional Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10567 -P (R.6/99). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is not recommended. Soil compaction may hinder aeration of the infiltrative surface within the system and will promote frost penetration during cold weather months. Cold weather installations (October - February) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by removing biologically clogged adsorption and dispersal media and replacing said components as deemed necessary or by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to installing plumber, Mike: *Wonell at.(715) 248 -7767, or the St. Croix County Zoning Department. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer -a prv'' �' P'0-de r� Mailing Address �-1 - (�c✓S oz-� G J� SSG /� Property Address cis cz buafe (Verification required from Planning Department for new construction) I1,4 City /State tf s ay--, _ (,D /. Parcel Identification Number 030 - /b 97 -- LEGAL DESCRIPTION Property Location S40 1 /4, 1 /4, Sec. 3- , T 3 o N - R / 9 W, Town of Subdivision , Lot # Certified Survey Map # 3 4 /yo6f , Volume A , Page # M Warranty Deed # 6a8 5/ , Volume /S3S , Page # Spec house ❑ yes lY Lot lines identifiable 0 - yes ❑ no ' SYSTFMMAINT -- 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 licensed pumper 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 a =year x7iration date. ATURE OF APPLICANT 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 de cribed abov , by virtue of a warranty deed recorded in Register of Deeds Office. X SIGNMtCRE OF 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 344062 CERTIFIED SURVEY MAP SWI /4 -SE 1/4 -SEC. 32 ,T30N,R19W UNPLATTED LANDS N 88 22 "W 0 \ 38 922.29' , jj 0�1 M \ cJ * O 02 _�� - .� F1C uj Ep O CT LO �� iAUS 0 4 1977 N O �!�►K of oNkftl N w � Go °• *d. z w \ , wl �r1 4► Lu W W r \ WSW IN ZWF a - W 2° 9.2 8 ACRES m 2 J D JOQ y! 6 6 v cl C _� z, 300' 150' 100' 0 a' to to J' SCALE: I ° = 150' — o O� z 0 LEGEND • �,'Z W; 0 - I" X 24" IRON PIPE Q• WEIGHING 1.68 LBS./ LN. FT. SET �` %P a % 49 APPROVAL OF THIS MINOR SUBDIVISIO UNPLAT - N DOES NOT MEAN LANDS 9 __ __ APPROVAL Fnn STATE BAR OF WISCONSI iFORM 5 X2 5442 R R T T ' PERSONAL EPRESEN � Y�;E y S • KATHLEEN H. WALSH •. Document Number DEED.` : REGISTER OF DEEDS ST. CROIX CO. WI Corey R. Burton a RECEIVED FOR RECORD 08- 18-2000 10:50 AM as Personal Representative of the estate of Robert C. Burton PERSONAL REPRESENTATIV EXEMPT 11 CERT COPY FEE: COPY FEE: ( "Decedent "), for valuable consideration conveys, without warranty, to TRANSFER FEE: 480.00 RECORDING FEE: 10.00 John W. Garden and Barbara L. Garden, husband and wife, PAGES: 1 Grantee, the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Part of the SW 1/4 of SE 1/4 of Section 32, Township 30 North, Range 19 West, St... Recording Area Croix County, Wisconsin, described as follows: Lot 1 of Certified Survey Map filed Name and Return Address October 24, 1977, in Vol. 2, Page 486, Doc. No. 344062. EK y �� �Q� J COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 -3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.: 35215/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 10/201/89 COURTHOUSE DATE RECEIVED: 10/17/89 HUDSON, WI 54016 ATTN: THOMAS C. NELSON - -3z- 30 (/, OWNER: Robert & Barbara Burton LOCATION: 1219 Rolling Hitt Trait, Hudson COLLECTOR: St. Croix Zoning SOURCE OF SAMPLE: kitchen tap COLIFORM: 0 /100 ml INTERPRETATION: bacteriologically SAFE NITRATE -N: i ppm Under 10 ppm is safe for human consumption. COLIFORM + NITRATE LAB TECHNICIAN: Pam Gane WI Approved Lab No. 19 DEPE y � F .N Np 2� �s 3' g Means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 c rn, ST. CROIX COUNTY ZONING OFFICE 6J St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386 -4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the prop erty can be located Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING------------ -------- - -- - -- --FEE: $ 25.00 L1__ (For nitrates and coliform bacteria) WATER TESTING FEE: $175.00 (For VOC'S) SEPTIC SYSTEM INSPECTION---------- -- - - -- -FEE: $25.00 (Determines if system is properly functioning at time of inspection) Property owner's name bb e � ar 0.. Gu14t4 Property owner's address lmq �el��+�c k�A S 7ra'A , N Ste, L U' Legal Description 1/4 of the 1/4 of Section , T N -R Town of Lot Number Subdivision Name FIRE IMOM t;M LOCK BOX NUMBER Color of house n Realty sign by house? If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, 'I WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual request'ng services: c_�C %�c�Tt3c�o� Telephone Number 11 r_3LAct_ _ REPORT TO BE T TO: c ►'-\ l 1 - n ;1 54 C> 1 Closing dat Signature 0 - P I d� CD, a a � x �o � X7 a I �� ST. CROIX COUNTY k WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON WI 54016 (715) 386 -4680 October 16, 1989 Robert Burton 1219 Rolling Hills Trail Hudson, WI 54016 Dear Mr. Burton: An on site investigation of the septic system on the property of Robert and Barbara Burton at 129 Rolling Hills Trail, Hudson, WI, was conducted on October 16, 1989. At the same time I also obtained a water sample and submitted it to the laboratory for testing. The results of that testing will be sent to you as soon as we recieve them back from the laboratory. At the time of the inspection, the sanitary system appeared to be functioning properly for the existing use. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system is totally dependent upon proper maintenance of this system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Mary Jenkins Asst. Zoning Administrator TCN:cj AS BUILT SANITARY SYSTEM REPORT OWNS R TOWNSHIP��- f/ SEC . z T_W, R /� W ADDRESS Q1 1 , -5-1 - .1 ST. CROIX COUNTY WISCONSIN. S , •� SUBDIVISION LOT LOT SIZE oZ PLAN VIEW Dist a e & imensi �t eet requirements of H62 HOW RYTHING WITHIN 100 FEET OF SYSTEM - ----- - - - - -- - -- - r Itiditaie Wo ath Atrow SGkLF. I T SEPTIC TANK(S) _ MF o _ CONCRETE STEEL 4— N0. of rings on cover a Depth �• PUMPING CHAMBER SIZE PUMP MFGR. MODEL NO'. GALLONS Per Cycle TRENCHES NO. of wick length area BED N0, of lines width _ , L2,; length S�? area dept to top of pipe NUMBER OF SEEPAGE ITS Outside diameter otal pit area AGGREGATE _ ' /�" r ' PERK RATE AREA REQUIRED 6 AREA AS BUILT Disclaimer: The inspection of this system by St. Croix County does not imply complete compliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to determine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SY M. �.. INSPE ZV DATED % !" �" 'PLUMBER ON JOB -' �' LICENSE NUMBE f -REPORT Of INSPECTION - INDIVIDUAL SEWAGE SYSTEM Sand tarry Pehmi l Pvr St S epti c 2AME Townahip I St. Cnoik Cnuniy ucattion 560 S' # Sub viacon i PT I C TANK Size o / gattona Numbers oh eompantmenta )(',stance. (lnom: Wett�4L4 Buitding 12% atope - -- Highwa-ten 'LIMPING CHAMBER Size._ g p Manujae tut e4 Modet Number. IOLD TANK , Size_ gattona Numbe o6 C pan ents Pumpers A m S to �a a r(c e nom: We.tt — _ _ B 't. cng 12% atope Hi.ghwa-ten._ .BSORPTION SITE Be.d T&e.neh iatance nom: Wett I�•L Buitding IF Highwate - k�SORPTION SITE DIMENSIONS W,i,dth o { tn.eneh j.• 6t Req uined anea �/ t Len.q th o6 each Zine. lI 6t Depth o6 Hoch betow Numbe7 o6 t _nea ,Z Depth o6 n.ock oven tote Z. in To.taX t.eng.th o6 Una 6t Depth o6 tite betow gn.ade_,;,_CV _ 04h.tance between tine.6 �6t Stope o6 trench _ in. pen 100 64 i ,, 1 ,, t ab s un p-tiuna anea . 6t • Type v6 Coven.: Papers n a th If DIMENSIONS NumbeA o6 pita Z avet abound p� to yea i kill Ou.ta < de. di ameteh Depth betow intet t Totat abaon.ption a n. Aa e a n.eq uia d t NSPCCTED TITLE PPR ED DATE_ 198 Z O f t .7t CTED DATE 19 'LASON FOR REJECTION 19 1765 REPORT ON INSPECTION OF SANITARY PERMIT # y (1 ) Name and Address of Permit Holder Person /Persons at Site (2 )Date of Inspection j Z�� I ress, 1 ens o, o install Plumber Time of Inspection (3)INSTALLATION CONSI S OF: [:]Septic Tank []Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepa a Bed ❑ Holding Tank ❑ Fill System B ermanen ref erence Point) Describ Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well M DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? []YES ❑ NO Wired? []YES ❑ NO 8 HOLDING TANK: Manufacturer of gallons ; construction depth to the cover ft; If septic tank is being used are baffles removed? YES []NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ N0; Wired? ❑ YES ❑ NO; Locking device on cover? [ ❑ NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe - elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO DILHR -SBD -6095 N.05/8 Signature of Inspector Q State and County State Permit PLB 6 7 # 7 Permit Application County Permi # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF ( PPROPERTY Mailing Address: My% T 1 mys - r_ - i B. LOCATION: rMLiD% 6 /4, Section Z, T_5QN, R -f-- (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village C A ,JS6 � Townshi C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms _ No. of Person D. SEPTIC TANK CAPACITY 1000 Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured -in -Place Steel v Fiberglass Other (specify) New Installation V� Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New "r Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top No. of Trenches Seepage Bed: L/" Length .572' Width 12- '� Depth - 9" Tile depth (top 2—. No. of Line �— Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits _ Percent slope of land E 2. CZ, Distance from critical slope WATER SUPPLY: PrivateA Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 1 15 if oth er than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Cegiied Soil Tester, NAME Q ioF— YFt L.J JO V Q , 6 C.S.T. # 6 C yf»li ff?—and other information obtained from (owner /builder). Plumber's Signature MP /MPR�W# Phone #��6— S Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. It 8 t a E -�. � .. JJJ 3 l E i E . T I. f ... r� _ _ a e E .. e e. r E � r i a . V 3 T a a e a Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application Fees Paid: State Jy,4 County . Dat At Permit Issued /Rejee+ed ( ate f Issuing Agent Name Inspection Ye No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, W1 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 • 1 4 � w ' �' ,. .� EH < 1 1 6 Rev. 9/78 / Z ,q � REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES i P.O. BOX 309, MADISON, WISCONSIN 53701 5 p J �d S � �• „ LOCATION: f� ' /a, � Ya, Section 3 Z ,T N,R L % E (or)@ Townshi or Municipality , L - � Lot No. Block No. County .�1yi�,V,jO� f�ip0 •�/ CiPO/ �` / Owner's /Buyers Name: he li es t' 06��P T � (1 O rn Mailing Address: 2-1 s% • C440/ S'f' (J�� Wl s `"� 4; TYPE OF OCCUPANCY:. Residence X No. of Bedrooms 3 COMMERCIAL O EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM DATES OBSERVATIONS MADE: BORINGS & 1 fP 0 PERCOLATION TESTS S 7 SOIL MAP SHEET SC yZ- -� NAME OF SOIL MAP UNIT /,/ �D PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTEF INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN /IN P— /i - JdA1 d` J ry �ilO G� 3..0� / Z .t9t P - S a4 {!;J &e - P_ 2�p 11 Q C SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B— Alp N�it1E 7 fo / / /J'IBN.LS /Dl.� GO•t LZ'IQP.LS �W_r 31"? B- > 1 21 " Sc Z "LS 6 a ° G,P C 44 A4 B- NoNt Z ",( c 4r.0 o�P_ CS 04 fe . B- Nk > ey F "a,- 6y SL yAP �s (�,,, 2,P_ ,M•�cP. s B- 7 Z Al f tJF > 72— .2 W S4 „ 2rP. Cie '4_V ff ''p r Awo, j r, B- 6 FY NL� > ?$ 5 / 1 " d') G 0 63 PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy &�J- A JO Indicate scale or distances. f Give horizontal and vertical reference points Indicate slope. Z> fj N T 97E �nwh, •. � � f F�� E 3 • � ....'.,.. - ,......�. .....n w _.. . ,� __„ € _..a- ...dam,._ .. ...n: .a .. _ t _.....»j...._W_. �. N 1 6 I 14 0 r 6 G i .y. .. o.m. m.d ., use... .. ..,. . ...� E E s 1, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. 1?04Cer 711ke, c47 ss =o Z y�Z Name. (print) .Certification No. i Address � 101, .3 /Z d A Name of installer if known Copy A —Local Authority CST Signature �/ EH 115 Rev. 9/78 Z REPORT ON SOIL BORINGS AND PERCOLATION TESTS SERVICES ES WISCONSIN DEPARTMENT OF HEALTH AND SOCIALS IC f P.O. iBOX 309, MADISON, WISCONSIN 53701 LOCATION: %, Section 3Z ,T`3 0 N,R ZZE (or) W , Township or Municipality ' y 'T Lot No. , Block No. 4 AC , 54141 S'clA2 A'P 1px'�i County ei4:P01X ubdivision Name Owner Bu / S • �� 0 ,0"49" ...� ers Name: f y Mailing Address: 2,13 e S'f 7yU" W/ TYPE OF OCCUPANCY: Residence X No. of Bedrooms 3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW X REPLA EMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 16 1 1% ? PERCOLATION TESTS SOIL MAP SHEET 5? 7Z-- NAME OF SOIL MAP UNIT PERCOLATION TESTS TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE I NUM- DEPTH CHARACTER SOIL SINCE HOLE HOLE AFTER INTERVAL BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN /IN P— P— P— P— P— P— SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B _ 4AIA B— e- B— PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of.suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. F/I0 4 W - 5 »m ®� o / .,DDuN E E 3 X Uj % v O �/frI _ vj� MA � F LF �/� 40 N _ E 1 12 P 3 m i e.._._ . F I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) G i' Certification No. f� — � L y�� Address X 3 .Name of installer if known Copy A —Local Authority CST Signature �� 4:99/1!4� b E%`r' t I I o e ' \` �cw �� 3E V wl,�r S