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Home My WebLink About030-1099-40-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 399517 GENE *in.,Mati.n ORMATION (ATTACH TO PERMIT) State Plan ID No: Personal 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: Ga vin, Dan St. Joseph Township 030 - 1099 -40 -200 CST BM Elev: { Insp. BM Elev: BM Descripti TANK INFORMATION U U r ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 10•'6 Septic w t Z } Fe ' D / a " r ft lit) • Lob .a Dosing Alt. BM Aeration Bldg. Sewer (� Holding SUHt Inlet - u 3 M I .09 t � �S O r TANK SETBACK INFORMATION St/Ht Outlet 3 liz TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / > 2 OO ( / Dt Bottom Dosing Header /Man. S Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer GPM nd St Cover Model Number TDH Lift tion Loss System Head TDH Ft Forcemain ength Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length lNyUlNches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLbG IWELL LAKE/STREAM LEACHING Man ufact u n INFORMATION CHAMBER OR t�cVe�Ce•' Type Of System: / 1 f UNIT Model mbar. DISTRIBUTION SYkT, Header/ an fol istribution x Hole Size x Hole Spacing Vent to Air Intake ipe(s) '' Length Dia Length Dia Spacing SOIL x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of ed /Sodded Mulched Bed/Trench Center 113ed/Trench xx Seed Edges Topsoil � Yes 4 No xx Fn] Yes * No COMMENTS (Include code discrepencies, persons present, etc.) Inspection i - / W / a2-- Inspection — Location: 559 Perch Lake Road Hudson, WI 54016 (NW 1/4 NE 1/433 T30N R19W NINIal - e- arc el N ?3.30.19.357A �Mp+r t9�+K" �yti L W4 Jan 1.) Alt BM Description 2.) Bldg sewer length 3 p l LQ - amount of cover = q R rr l 2 1 D 1 1 l " 3) \ l 1 Plan revision Required? ® Yes No Ito Use other side for additional information. SBD - 6710 (R.3197) 011k Date Insepctor's Signature Cert. No. ` i4t1 LA+J G — P -V . 3clol —I D3o- 1099- ` 0 - 1.,o�cRS t-�ek- � � �3 - 1 1i _ 13. `{ b . 3+ 1 �,�ylp,�• �ti.,,lc� �. • . � .� , I 1 � � � `/ = I l s y _ 9°1' • Z9 I Tot !, t 4 � oz , 1 a . �3 _ 1 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 399517 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: Gavin, Dan I St. Joseph Township 030 - 1099 -40 -200 CST BM Elev: Insp. BM Elev: 7 Description: 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 T DH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold IDistribution x Hole Size x Hole Spacing Vent to Air Intake Pipes) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil �] Yes Yes No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 559 Perch Lake Road Hudson, WI 54016 (NW 1/4 NE 1/4 33 T30N R19W) NA Lot 1 Parcel No: 33.30.19.357A 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctoes Signature Cert. No. Sanitary Permit Application Safety & Buildings Division s 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 iS Cansin Personal information you provide may be used for secondan purposes Madison. WI 53707 -730" Department of Commerce [Privacy Law. s. 15.04(1)(m)] (Submit completed form to county if r state owne Attach complete plans (to the county cop) only) for the system. on . t less than 8 -1/2 x 1 I inches in size. - PAW County _ State Sanitary Pernik Number ❑ Check if rev to previous app lion State Plan I. D. NumbeJ ��C CO ti I. Application Information - Please Print all Information, �' Location: Property Owner Name roperty Location LC 411 AAAA r 1/4. S T N. WAE or ' Property Owner's Mailing Address I OCT q ?UUI EL !.Number Block Number to /. City, State Zip Code Plrfii dumber ubd0ision Name or SM Nu 7./ V �a II Type of Building: (check one) r ❑ City ❑ 1 or 2 Family Dwelling - No. of Bedrooms: �� -- Y° ❑ Village • Public /Commercial (describe use): Town of • State -owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest R ..LfiG A) I. ;9 New System 2. ❑ Replacement 1 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) System Tank Only Existing System 1 0 B) Permit Number Q Date Issued ❑ A Sanitary Permit was previously issued 3sb3o. 7.3�, W IV. Type of POWT System: (C,iteck all that apply) C. A Non- pressurized In- ground ./ ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade J- ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: �0 V Dis ersaVTreatmen Area I formation: I. Design Flow (gpd) 2. DispersalArea 13. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate(Gals. /day /sq.ft.) ,Pin. /inch) r1 q7. Elevation VI Tank Capacity in Total # of Wnufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks A /O ❑ ❑ ❑ ❑ ❑ VII Responsibility Statement I, the undersigned, assume n ibility for installation of the POWTS shown on the attached plans. Plum r s Name (print) Plumber's Signature (no scam MP/ No. .� Business Phone Number Z l� Plumbe )111 ddress (Street, City, State, Zip Code) 31,1W 1 A4 l Z VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) X Approved ❑ Owner Given Initial Adverse Surcharge Fee) Determination �� 10 3-P D / 12d6�� IX. Conditions of Approval /Reasons for Disapproval: 1 - lAe 4i rc MA" _t f o r r 7 .u..Sd►s `l �-e > /�i wl es a co ✓Q r. 1 t 74 "t? S Al , �it w.: n . t� Fk �'�� `{Za Pow (5 /y , sr..� a �r i • So' C��' r jw, l �. �oi(� 9 S� /p h4164 • pow r O' to efn'� /a, 33.3a,�9• " -ate � 3 � 9. Z3 Cc.�r� -5 — .5.��.m•..a.Q C�Jj'J �+ SBD -6398 (R. 07/00) / '� /°�� }G✓c�1 4c-1W r i _ JOB �j,[,y� �' ci-�►v�. TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 �� 16> WILSON, WISCONSIN 54027 CALCULATED 9Y P e r ' ' �" DATE (715) 772 -3214 (715) 386 -5443 MPRS 03224 WI MPCA 0696 MN CHECKED BY DATE SCALE ........ >........ ..., .............. ............................... ....... —' C°. .... ..... .... i € ..... ....., ......................... . .. ........ :....... ..:........... :....� .... ._.. ... . _ . i .... .............?...............,v .......... .... ......... ........... . ........... :........... :...... . - ..... ........... .......... > Y-... �......'. ....... —may- -t .... .... ..... .... 1 � F ` a ma � . +: ... \`t ._.... < / ... 1 L ....... a ............. ....:.......................... ...... s.......... .. .. ....:........ :... �.. i .a.. r \ L. / '..... i' � ...:................� ....:.......:.. �.' ..... ........ ......... ........ ....... r, .. ......... ... ... .... .... .... ... .... .... v :........................ ................. .... !> _.......... �D ` ..... . _.4._.....: .. .. s _ .... ,. o . . _. ... ., ..- ..��.. _.. . _....... ....... ........... ....... _ .. ... /.. O . ........ - y ........... ...... v __ .......... PRODUOT 20St Groton, Mm 01!71. To Order PHONE TOLL FREE 1-BOP225 M ' JOB TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED By DATE (715) 772 -3214 (715) 386 -5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE .... ... .. ... € 0 i .... ........... ..... .... .... .......................... ..... ..... .... ...................... ............ <...... .. .............. ........... .. .....?.:....................... ' .... ... :.. ... .... — ..... ..... .... ..... ..... .... .... .............. �Af ; 3 � `S� , ..... .. ..... .... .... ... j .. .... ....... c f . ..... .. .i.I.... _ . . .......:.... -- ... .... ........... .............:................. I . ......... '....... .... .... _.. ..........s. .... > ............. .. . �..:.... ...' 4 .....:... tt .. ... .. .. .. ... .. ..... .... .... .. t 00 . O: �� 1 ... -... i ............ ,F ! /...� a� cf . - sue - ,. .�� ' c � ..... ................... ....... :.......! :. ...... :. ....... :..... ... .... .. .... .. .... .... ... .... h .... , V :....) ....... ... .... :.. .. �. �. N .. .. T.:. s _ ..... .......... - .. ... __ _ _. d PRODUCT 205-1® Inc., Groton, Mass . 01471. To Order PHONE TOLL FREE I - 800-225 -0380 l System Management Management of this system is critical. As a condition of approval of these plans this system management section must be rep ie"ed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop �k ith the adsorption system or any other system components, the installing plumber, Timm Excavating, 715- 772 -3214, or the St. Croix Count\ Zoning Office, 715 -386 -4680, should be contacted for assistance. General Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. I If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. Install water- saving appliances whenever and wherever possible. Repair even small water leaks as soon as possible. a tiever pour grease or oil down any drain or stool. Garbage disposals are not recommended; if you must have one, use it sparingly. 6 \ paper products other than tissue should go into the system. \o chemicals should go into the system. Avoid surge flows of water; try to spread laundry throughout the week. Maintenance The septic tank must be inspected every three years by a properly licensed person. 1 f necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the t q tank volume. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back - washed into the septic tank to remove accumulated material. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6 The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve �apacit% to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or '.��u days should pass before any necessary repairs can be made. avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system. s A o d disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. a Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 0 Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 ( T) Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and. or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 ORIGINAL 1424 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 4 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing C ounty Attach complete site plan on paper not less than 8 %x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 030 1099 - 40 - 200 Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Gavin, Daniel Govt. Lot NW 1/4 NE 1/4 S 33 30 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM 555 Perch Lake Road 1 CSM 444476 7/2061 City State Zip Code Phone Number City 11 Village 11 Town Nearest Road Hudson WI 54016 715 - 549 - 6540 St.Joseph 130Th Ave. New Construction Use: ® Residential / Number of be ms; 4 .`i , ode derived design flow rate GPD jq Replacement Public or commercial - cr "? Parent material till I plain elevation, if applicable NA General comments �,` =� and recommendations: install 4 - 2.7' x 62.5' stipulati 99 chamber tren e at s elevations 2' below contours; sys. elevations = 97.9, 96.9, 95.9, OC T sa pr. � M F - 9 Boring # Boring �/ctor Pit Ground Surface elev. ep t > 88 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Consistence Boundary Roots GPD/ff in. Munsell Cu. Sz. Cont. Color I r. 1 0 -10 7.5YR 3/3 - sl 2 m gr mvfr cw 1f /m .5 .9 2 10 -42 7.5YR 4/4 - sl 2 m sbk mfr cs 1m .5 .9 3 42 -88 7.5YR 4/4 - sl 0 m mvfr - if .3 .5 i I irregular d s ra i ie s ands, is , apart in onzon Boring # IM Boring Pit Ground Surface elev. 105.8 ft. Depth to limiting factor 90 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. 1 0 -5 7.5YR 3/3 - sl 2 m gr mvfr gs 1 f/m .5 1 .9 2 5 -18 7.5YR 3/3 - sl 2 f sbk ds gs 1m .5 .9 3 j 18-57 7.5YR 4/4 - sl 2 m sbk mvfr cs if .5 .9 4 57 -90 7.5YR 4/4 - sl 0 m mvfr - - 3 5 - — ------- Y— i - -- –�— irregu ar �discontinuous s ra i ie s an s: - ou- i Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L • E uent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST N ame ease Print) i na re: T C5 I Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 10/8/01 715- 233 -0398 Property Owner Gavin, Daniel Parcel ID # 030 - 1099 -40 -200 0 . Page , 2 of 4 Boring # Boring P P-1 it Ground Surface elev. 105.8 ft. Depth to limiting factor 34 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. 1 0 -3 7.5YR 313 - sl 2 m gr ds gs 1f /m .5 .9 2 3 -10 7.5YR 3/3 - sl 2 f sbk ds gs 1M .5 .9 3 10 -34 7.5YR 4/4 - sl 2 m sbk dsh cs if .5 .9 4 34 -48 7.5YR 4/4 c3p 10YR 6/2 sl 0 m dh - .3 .5 i I Boring # Boring is Pit Ground Surface elev. 99.9 ft. Depth to limiting factor 90 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -6 7.5YR 3/3 - +8t 2 m gr ds gs 1f /m .5 .9 2 I 6 -18 7.5YR 3/3 - sl 2 f sbk ds gs 1M .5 .9 3 18 -47 7.5YR 4/4 - sl 2 m sbk mvfr gs if .5 9 4 47 -90 7.5YR 4/4 - sl 0 m mvfr - - .3 .5 41, o - r1 I guar & discontinuous n s: 51 Boring # &Boring Pit Ground Surface elev. 99.5 ft. Depth to limiting factor 31 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -4 7.5YR 3/3 - sl 2 m gr ds gs 1f /m .5 _9 2 4 -8 7.5YR 3/3 sl 2 f sbk ds gs 1 m .5 .9 3 8 -31 7.5YR 4/4 - sl 2 m sbk dsh cs if .5 9 4 31 -48 7.5YR 4/4 c3p 10YR 6/2 sl 0 m dh - - .3 .5 -- Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 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 ' n alternate format lease contact the eed material )n a , department at 608 -266 -3151 or TTY 608 - 264 -8777. p P III S1313-8,30 (R.07 /00) Certified Soil Testing t Property Owner Gavin, Daniel Parcel ID # 030 -1099-40-200 Page 3 of 4 Boring # Boring Pit Ground Surface elev. 99.4 ft. Depth to limiting factor 64 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -8 7.5YR 3/3 - sl 2 m gr ds cs 1f /m .5 .9 2 8 -21 7.5YR 3/3 - sl 2 f sbk mvfr gs 1 m .5 .9 3 21 -43 10YR 4/3 sl 2 f -m sbk ds cs 1 m .5 .9 4 43 -64 7.5YR 4/4 - sl 2 m sbk mfr cs if .5 .9 5 64 -74 7.5YR 4/4 f2f 7.5YR 2 sicl 0 m mfr - - 0 0 l OYR 6/2 molt Ing ecomes c2d below FTI Boring # Boring Pit Ground Surface elev. 94.0 ft. Depth to limiting factor > 84 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -10 7.5YR 3/3 - sl 2 m gr ds gs 1f /m 5 .9 2 10 -20 7.5YR 3/3 - sl 2 f sbk mvfr cs if .5 .9 3 20 -53 7.5YR 4/4 - sl 2 m sbk mvfr cs 1M .5 .9 4 53 -84 7.5YR 4/4 - sl 0 m mvfr - if .3 5 - - -- occas +ona +nc us+ons 4 4 s +n onzon ;stmt+ +e 4 ,Q s 4- a Boring # B,pring Pit Ground Surface elev. 95.6 ft. Depth to limiting factor > 84 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -15 7.5YR 3/3 - sl 2 m gr ds gs 1Urn .5 9 2 15 -48 7.5YR 4/4 _ sl 2 m sbk mfr cs 1m .5 .9 3 48 $4 7.5YR 4/4 _ sl 0 m mvfr - - .3 .5 _ I i i strati +e 4, s 5 , 5 - 9- Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L 5 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 -8730 (R.07 /00) Certified Soil Testing ? r'^ ID jr �- o d cy •d- s rj d c� v _ d t C� r o s � � o I� \ \ d� _ C 4 r a rj * r? , 2(,S _ 1 INDUS T TR Y, OF RE PORT ON SOIL BORINGS AN D SAFETY &BUILDINGS INDUSY, 1 1 c DIVISION LABOR AND PERCOLATION TESTS (115) MADISON W BOX 76 I 537 9 53707 HUMAN RELATIONS (ILHR 83.0911) &Chapter 145) LOCATION: SECTION: TOWNS H I P/1 ITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: NW �/4 NE 1 /4 33 /T 30 N/R 19A5qor) W St . Joseph n/a n/a n/a COUNTY: OWNER'S/ AME: MAILING ADDRESS: St. Croix Thomas Seim 529 Co. Rd. #E, Hudson, Wi. 54016 USE DATES OBSERVATIONS MADE NO. BEDRMS.: I COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1 PERCOLATION TESTS: �� esiiclence New ❑Replace 3 n/a 7 - 31 -90 n/a RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) H S ❑U CAS ❑U MS EA EIS � S ®U conventional If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: class 2 Floodplain, indicate F l oodp lain elevation: n/a deciaml' PROFILE DESCRIPTIONS page 42 BrC2 BORING TOTAL D PTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH= ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 6.75 98.22 none >6.75 1.00bl.l. 1.25bn.sil. 4.50bn.s.1. B _ 2 7.17 98.17 none >7.17 1.25bl.1. 1.25bn.sil. 4.67 bn.s.l. B 3 6.83 97.90 none >6.83 1.33bl.1. 1.17bn.sil. 4.33bn.s.l. B 4 6.92 95.92 none >6.92 1.00bl.l. 1.00bn.sil. 4.92bn.s.l. B_ 5 6.92 96.27 none 2.42 less 1.25bl.1. 1.17bn.sil. .75bn.mot. sil. 3.75bn.s.l. than 1.00 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PE R PER INCH P- P- s ee desLgn rate P- 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 94.40 iL � a i , E f E l I - .�.wtm -'_, 3 i E T 3 N E E ) 3 ( i [ F E y r I, the undersigned, hereby certify that the soil tests reported on this form were made by me iq 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 ON: Gary L. Steel 7 -31 -90 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. Ave., New Richmond, Wi. 54017 2298 71P-246-6200 CST SIGNA DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ' -SBD -6395 (R. 10/83) — OVER — FOIRI OCV� '�ORNPI 3, Y 1 A L L S- . ER SY s ("LASE' 0 e IsC� of 'J: Ay box , i, STS 1 L E 1 N! i HE M: 0 N so ii I r y n o o 3 'j TO THE OWN FR- This soil test repor� iE �'& P :11 1 } a t r?l.;+11: rT" a y C8 (I u S't, verffication th;s cot, J:t L fjt or the private ir wde obtaho a pprolit, The ii , -'anstruct ion. f - \ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Ll4'.."n Mailing Address SS9 Property Address t A -C--ek (Verification required from Planning Department for new construction) City /State Al�Saj Parcel Identification Number .6 LEGAL DESCRIPTION Property Location 11f u) %4, IIrk r / 4, Sec. 3 , T 3v N -R�W, Town of I LA _. Subdivision Lot # Certified Survey Map # �yrf`/7e, , Volume 7 . Page # d Warranty Deed # , Volume . Page # Spec house ❑ yes ,2J no Lot lines identifiable N yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restrictedplumber or a licensedpumper 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. yL ` 6 / '0//5/ 0j SIGATURE 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 described above, by virtue of a warranty deed recorded in Register of Deeds Office. - SI TURE 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 r 1507PAGE 17 DOCUMENT NUMBER WARRANTY DEED 622194 KATHLEEN H. WALSH Robert E lgonowski. /k /a Robert Klonowski and Sarah L. ST G ISTER OF DEED 1: ono: ski. a /k /a Sarah Klortm��>ri 1ivRhand and wife. individually llv and e ach in their own r3¢ht grantors RECEIVED FOR RECORD 05- 02-2000 9:30 AN Convey and warrant to Daniel C Cap "^ ° ^d Janice K Gavin. WARRANTY DEED EXENPT t husba and wife as marital survivosshiv vroverty Grantees CERT COPY FEE: COPY FEE: TRANSFER FEE: 68.40 RECORDING FEE: 10.00 all of Grantor's undivided one -half interest in PAGES: 1 S:57 J" n trc-,k Lk— Ra the following described real estate in St Croix County, State of THIS 9PACC RBSSRYiD FOR RECORDING DATA Wisconsin: NAM& AND RgIVM z w/er;L- e GAVi,tJ part of the NW '�4 oC NE % of Section 33, Township 30 North, Rang e 19 West, described as Lot 1 of a Certified Survey Map dated March 9, 1988 and filed January 9, 1989 in Volume 7 of Certified Survey Maps at Page 2061, aa/ ` Document No. 444476. - Huii°n Y` � HJ.dro.✓;- - 1G� 030- 099 -40 -200 3 3 ' • t l 3 �7 G 3-170 4c t pARCEL I.D. NUM R O.I.S. This homestead property. Isis o_tl t 0 �/ —' ! !O p 3 3.3 (�• f . 3 � A) O q• i3 O Q t r L S (isj (is not} Exception to warranties: TOGETHER WITH AND SUBJECT TO any other easements, covenants, reservations or restrictions of record, if any, but this shall not be deemed to extend any such other recorded encumbrances beyond (`�� WOO ;rte 1 S _ the term established by law therefor. Dated this day of April A.D., 2000 S Pte, �.h Lt� (Seal) (Seal) FS V a • Robert E. sl • 1 (Seal)1 (Seal) owns. I�Ig • Sarah L. o wski AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN } Signature(s) } St. Croix COUNTY } authenticated this day of , 2000 personally carne before me this 1 day of April , 2000, the above -named Robert E. Klonowski and Sarah L = ski Robert MEMBER STATE BAR OF WISCONSIN (If not, authorized by 5706.06, Wis. Stats.) to me known to be the person s who executed the foregoing instrument and acknowledge the THIS INSTRUMENT WAS DRAFTED BY: same, Attu H wh H Owin, OWIN LAM M"—, "—, S.C- 430 e -road 8trcet Hudson WI. 64016 (Signatures may be authenticated or C'I a� �orary public, St Croix County, Wl. acknowledged. Both are not necessary.) C> ` Ly commission is permanent (if not, state, NOTE Names of persona signing in any p l.. ,expFption date: o e 1 t . 7 20 0 - capacity should be typed or printed below their. j 1 .a 44447(; CERTIFIED SURVEY MAP Located in part of the NA of the NEa of Section 33, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin. Unplatted lands owned by others ------------------------------- North line of the NEJ of Section 33- N89 Tow Roa R/W- S 89 0 55 ' 11"W N89 °04' 58 "W 533.19' - ?SUE 244.93 288.261 250.00 o 253.71' °o�— — NJ Corner of � I rn �, ;' — 310 -P ; NE Corner of Section 33 -L- 1 - M V7 ` -Ivc ° i o Section 33 ni ° °� - N N I O1 I I °- of W I > En N i rn o v 1 d i 1 N ^I M $4 W w I 1 I 3 1 M _ I a 4- 1 t0 I r+ I I cot LOT ` LOT 2 I 'n C_;' U) o m i FYI Un p I 1 �1 D z� -, I ° o�� M 1 1 j O 0 v S89 ° 04' 58 "E N L 33.00' 3 o�� 133.50' 260.15' N80 20 "E o o S89 0 04'58 "E 393.65' 170.98' Wo W Cn N00 053'37 "E CO Uplatted lands - owned -by- platter 133.97' Iv " L L b 4- N N O L W d O LOT AREAS Including R/W Excluding R/W = e L � � IV L N LOT 2: 150,299 Sq. Ft. 130,686 Sq. Ft. m A 3.45 Acres 3.00 Acres LOT 1: 138,090 Sq. Ft. 130,772 Sq. Ft. SCALE IN FEET 3.17 Acres 3.00 Acres 0 100 200 400 LEGEND OWNER County Section Monument Thomas Seim • 1" Iron Pipe Found R.R. 2 0 3/4 x 24 Rebar Set, :neighing Hudson, WI 54016 1.50 Lbs. per linear foot. FUR 4. LAS ALLEN C W y' JAN Q g am, '+mss a ^' r. , alfi C 1989 sL:� t °'��,� r ' COUNTY ,( This instrument was drafted by Fran Bleskacek Job No. 83 -16 -187 VOLUME 7 PAGE 2061 ,I