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• Parcel #: 030 - 2029 -20 -000 01/05/2007 04:30 PM
PAGE 1 OF 1
Alt. Parcel #: 22.30.20.442B 030 - TOWN OF SAINT JOSEPH
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
NORMA M SINGER O - SINGER, NORMA M
84 HWY 35/64
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 84 HWY 35164
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 3.170 Plat: N/A -NOT AVAILABLE
SEC 22 T30N R20W SE NE LOT 1 OF CSM Block/Condo Bldg:
4/976
Tract(s): (Sec- Twn -Rng 40 114 160 1/4)
22- 30N -20W
Notes: Parcel History:
Date Doc # Vol /Page Type
12/20/2005 814629 2946/331 TI
09/02/1980 366061 616/356 QC
2006 SUMMARY Bill #: Fair Market Value: Assessed with:
169715 207,600
Valuations: Last Changed: 07/09/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.170 62,000 118,100 180,100 NO
Totals for 2006:
General Property 3.170 62,000 118,100 180,100
Woodland 0.000 0 0
Totals for 2005:
General Property 3.170 62,000 118,100 180,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch #: 310
Specials:
User Special Code Category Amount
es
Special Assessments Special Charges Delinquent Char
P P 9 4 9
Total 0.00 0.00 0.00
Parcel #: 030 - 2029 -20 -000 06/13/2005 10:00 AM
PAGE 1 OF 1
Alt. Parcel #: 22.30.20.442B 030 - TOWN OF SAINT JOSEPH
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): " = Current Owner
SINGER, JACK D & NORMA M
JACK D & NORMA M SINGER
84 HWY 35/64
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es): " = Primary
Type Dist # Description " 84 HWY 35/64
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 3.170 Plat: N/A -NOT AVAILABLE
SEC 22 T30N R20W SE NE LOT 1 OF CSM Block/Condo Bldg:
4/976
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
22- 30N -20W
Notes: Parcel History:
Date Doc # Vol /Page Type
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/09/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.170 62,000 118,100 180,100 NO
Totals for 2005:
General Property 3.170 62,000 118,100 180,100
Woodland 0.000 0 0
Totals for 2004:
General Property 3.170 62,000 118,100 180,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch #: 310
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel #: 030 - 2029 -30 -000 06/13/2005 10:00 AM
PAGE 1 OF 1
Alt. Parcel #: 22.30.20.442C 030 - TOWN OF SAINT JOSEPH
Current X' ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
* M ONTAG NE , ROBERT M & LORNA
ROBERT M & LORNA MONTAGNE
86 HWY 35/64
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 88 HWY 35/64
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 3.430 Plat: N/A -NOT AVAILABLE
SEC 22 T30N R20W SE NE LOT 2 OF CSM Block/Condo Bldg:
4/976
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
22- 30N -20W
Notes: Parcel History:
Date Doc # Vol /Page Type
2005 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/09/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.430 64,600 115,800 180,400 NO
Totals for 2005:
General Property 3.430 64,600 115,800 180,400
Woodland 0.000 0 0
Totals for 2004:
General Property 3.430 64,600 115,800 180,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 112
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel #: 030 - 2029 -10 -000 06/13/2005 10:00 AM
PAGE 1 OF 1
Alt. Parcel #: 22.30.20.442A 030 - TOWN OF SAINT JOSEPH
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): ' = Current Owner
* MONTAGNE, L K, & N K SINGER
L K, & N K SINGER MONTAGNE
86 HWY 35164
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description ' 86 HWY 35/64
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 33.500 Plat: N/A -NOT AVAILABLE
SEC 22 T30N R20W SE NE EXC CSM 4/976 Block/Condo Bldg:
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
22- 30N -20W
Notes: Parcel History:
Date Doc # Vol /Page Type
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
Use Value Assessment
Valuations' Last Changed: 05/31/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 34,900 73,300 108,200 NO
AGRICULTURAL G4 5.480 1,000 0 1,000 NO
UNDEVELOPED G5 1.520 400 0 400 NO
AGRICULTURAL FOREST G5M 23.500 47,100 0 47,100 NO
Totals for 2005:
General Property 33.500 83,400 73,300 156,700
Woodland 0.000 0 0
Totals for 2004:
General Property 33.500 130,500 73,300 203,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
I
Parcel #: 030-2028-95-000 ✓j
06/10/2005 09:47 AM
PAGE 1 OF 1
Alt. Parcel #: 22.30.20.441 030 - TOWN OF SAINT JOSEPH
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): " = Current Owner
"
L K, & N K SINGER MONTAGNE MONTAGNE, L K, & N K SINGER
86 HWY 35/64
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description t `
SC 2611 SCH D OF HUDSON -1 O VILO
SP 1700 WITC 1�
Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE
SEC 22 T30N R20W NE NE Block/Condo Bldg:
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
� S /I ( 22- 30N -20W
/f 6
Notes: I Parcel History:
2 I L � Date Doc # Vol /Page Type
2005 SUMMARY Bill M Fair Market Value: Assessed with:
Use Value Assessment
Valuations Last Changed: 05/31/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 9.000 1,600 0 1,600 NO
AGRICULTURAL FOREST G5M 31.000 41,300 0 41,300 NO
Totals for 2005:
General Property 40.000 42,900 0 42,900
Woodland 0.000 0 0
Totals for 2004:
General Property 40.000 84,300 0 84,300
Woodland 0.000 0 0
Lottery Credit Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM
San.itany Percm,it Q
•
State Septi
NAM Town,S hip N St. C toix County
La / lt ion ecianLa # Zbdivision
SEPTIC TANK
Size l 6 o Q gattons Numbers o6 compantment4
Distance 4Aam: Wett _�o Building Z,L t2% stope �—
H,ighwateA
PUMPING CHAMBER
Size /0 _gatton,�, __ _.P_ ump Manu6actune Model Numbers
HOLDING TANK
Size gatfons Numbers o6 Compartments
Pum n
e A.�anm S �tem
p y
Di 6AOm: Wef-f- Buitd-ing �,S 120 6tope_
H.ighwatek
ABSORPTION SITE
Bed TAench //O
D.i6tance bnom: wett Bui.E'd.ing 3S` ?20 stope
HighwateA
ABSORPTION SITE DIMENSIONS
Wi dth o6 ttench J �o 6t Requ.ined a • 0 6t
Length o6 each tine � -� 6t Depth ob Aock below tite in
/ Number o6 ti-nes 2 Depth o6 Aock oven tite o 2 - in
Totat .1'ength ob tinu 6t Depth a6 tite below grade 0 in
D,iztance between tine 1�7 6t Stope o6 trench tin. peA 100 6t n
Tatat absoAption area � d 6Z Type ob Coven: PapeA oA sxnaw ^"
PIT DIMENSIONS
Numb en o6 pi-t.5 GAavet around pits yes no
Outside d.iametvL bt Depth below .intet 4t
Tatat abbonptio anea
Area Aequ.in.ed At
INSPECTED BY TITLE
APPROVED DATE / 1980 �
REJECTED DATE 198
REASON FOR REJECTION
of
i
EH : 115 Rev. 9/78
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
_T® S@ (-
LOCATION: %,�'/4, Section Z Z ,T.�N,R_d19 (or) W, Township or A ie' +#fir
Lot No. , Block No. P 0 c, Sc C• S• AA County v d l '
-} Subd ivision game
Owner's /Buyers Name: V%Cte <
Mailing Address: wm{ - A/1 k , V1 tl 5 570 6 Z
TYPE OF OCCUPANCY: Residence No. of Bedrooms __ COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW 1 � REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS /I / 8 0 PERCOLATION TESTS (' /Z P 6
SOIL MAP SHEET 33 NAME OF SOIL MAP UNIT 1 Lb "09 o 0 Sq
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 MIN /IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
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- I Z " 6" - 72- S . 118 S a 'r n o 2 "
B AJ 0 V G - 7Z" - 3 S. S2�S 7 ' S 6 r.
B 3 -72_ Aj o L rt 3l0 "S '� C'e
B_ 1 a
B_
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the Igcgtion and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy 5 .Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
fro. ?o S. 1..01 - -1 p C•S, nn \ Z90. S Q. = YOn p +
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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.
• / c�
Name (print) ► e +✓ Certiticatlon No.
Address l CjQ ( n v St:. i4L) CI-S0 h
ie of installer if known
CST Signature
A —Local Authority C
PLB 67 State and County State Permit #
Permit Application County Permit # JK' C
for Private Domestic Sewage Systems County SY C&o I x
"DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
K ' x
B. LOCATION: _ 5 I '/4, Section .,?r2 T D N, R „2-0 4P (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# A Village
Township
C. TYPE OF OCCUPANCY: Commercial "Industrial 'Other (specify) "Variance
Single family X Duplex No. of Bedrooms '77Z�w o No. of Persons
D. SEPTIC TANK CAPACITY 1000 Total gallons No. of tanks 01V2
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete x Poured -in -Place Steel Fiberglass Other (specify)
New Installation X 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 X Replacement Alternate (Specify)
� No Seepage Trench: X _No. of Lineal Ft. /ZQ Width SA `' Depth Tile depth (top.�i ��
. of Trenches_
Seepage Bed: Length Width Depth Tile depth (top No. of Line
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land 21 Distance from critical slope
WATER SUPPLY: Private 1K Joint ❑ Community ❑ Municipal ❑
Owner name as li o E H 115 if other than present owner:
I, the undersigned, do hereby certify that the information 1 have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared
by the Certified oil Tester,
NAME G C.S.T. # and other information
obtained from . ON 7�oR- (owner /builder).
Plumber's Signature MP /MPRSW# Z4 P `7/ Phone # 71:5
Plumber's Address /- .v S
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.
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Do Not Write in Spate Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY _
ti J - -c' ,`3' ; `
Date of Application ` Fee P aid: State County Date
Permit Issued /Rejected (date) U1' ti Issuing Agent Name
LL Yes , X _No State Valid# Date Recd
(white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
pink copy) 4. plumber (canary copy) Revised Date 7 /1/78
T
1""449
REPORT ON INSPECTION OF SANITARY PERMIT # %_�'!"
(1) Name and Address of Permit Holder Person /Persons at Site (2 )Date of Inspection
` ,Name, ss icense o. o Ins plumber Time of Inspection
3 INSTALLATION CONSISTS OF: ❑ Septic ` Tank [:]Seepage Trench ❑ Dosing Chamber
❑ Seepage Pit ❑ Seepage Bed []Holding Tank ❑ Fill System
N ermanen reference Point) Describe:
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
(7)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 []YES ❑ NO Wired? ❑ YES ❑ NO
8 HOLDING TANK: Manufacturer of ga lions ;
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 ❑ NO; 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 TRENCH: 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.
(1 2) Ha s system been insta in a rea indicated on EH 115? ❑ YES [:]NO
(13) Has system been installed in floodway? []YES ❑ NO Floodplain? ❑ YES ❑ NO
DILHR -SBO -6095 N.0 /80
Signature of Inspector
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
' Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 4$798$ 0
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary puipost:s [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Singer, Norma I St. Joseph, Town of 030 - 2029 -20 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
I 0 I C5 T 22.30.20.4426
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing ` Alt. B
0—V
Aeration � / Bldg. Sewer
Holding SVHt Inlet
SVHt Outfet
' TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic / Dt Bottom
- 7ZS z<S a o
Dosing` -7 , Z5 Header /Man. y
Aeration — Dist. Pipe 4 .4L 9'f . 9g
�6,vl 94.77
Holding __,_ Bot. System 9 . Syt - . N5
1 .7s 9 s
PUMP /SIPHON INFORMATION Final Grade , $ ( 9$ • 5`I
Manufacturer g el 'ems' Demand St Cover Z) 99 Z
GPM 3.
of �J
Model Number c O (PS -7.y7 9c�
5 3
TDH Li Friction Loss System Head TDH Ft V qs
(, •�3
0. 1 � \ - 7 ,
Forcemain Length I Dia. �i Dist. to well
1Z 7 i 7. - ;bl 95 -
SOIL ABSORPTION SYSTEM
BED/TRENCH Width i Length i No. Of Trenche _ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS � � � � � re"I�
SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type
^ �� / Z > C n 9 UNIT Model Number. `
Co J ,v n
DISTRIBUTION SYSTEM - 7 ea 3�
Header /Manifold Distribution \ I x Hole Size x Hole Spacing Verltto Air Intake
J/ Pipe(s) J
Length Dia Length Dia Spacing .w
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
� es ..J No 'Yes 'I No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /
Location: 84 Highway 35/§j Houlton, WI 54082 (SE 1/4 NE 1/4 22 T30N R20W) NA Lot 1 Parcel No: 22.30.20.4426
,, CoJtACMe
., ,Z� Nu,) C a, - �� 0`1
1.) Alt BM Description = UP�/j d
2.) Bldg sewer length = � -� p�
- amount of cover = C t t
- - - - -- — - _ -- — r ?-
Plan revision Required? Yes No 1 '2—'
Use other side for additional information.
Date Insepctor's Sig ture Cert. No.
SBD -6710 (R.3/97)
and Bu lid
i `, ty
1 Was ' gton Av ., P.O I V
(S`C��S, n WI 53 07 - Sanitary Pe it Number (to be filled in by Co.)
Department of Commerce 60 66 151 t 5 79
Sanitary Permit App \a�w('Xm) State Plan Number
In accord with Comm 83.2 1, Wis. Adm. Code, personon u rovid (ST GROIX C UNTY may be used for secondary purposes Privacy ZONING OF ss (if different than mailing address)
I. Application Information -Please Print All Information
030. 2029• moo dun
Property OvRer's Name � ' Parcel # Lo � Block #
/'
Property Owner's Mailing Address Property Location
3 S �D�SdN Z
City, State / Zip Code Phone Number / 59 %, N 6 �. Section Z
' 51 o /V/ 0 S7 y CO(S 3
O N R .Zdcirc,e
T ; E t
2
r )
II. Type of Building (check all that apply) � `J
I
�l or 2 Family Dwelling - Number of Bedrooms Seb6m"ien -Name CSM Number 3 � 5 �5 3 Vol . 9' � � 7
El Public/Commercial - Describe Us / e � l
❑ State Owned - Describe Use Z. 1) a S� ��`�j W 17 i 7pE' ❑City_ ❑Village (Township of
�- S T. o
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A.
❑ New System Replacement System ❑ Treatment/ folding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of El Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS S stem: Check all that appl
11
�-Plon - Pressurized In- Ground ❑ Mound >24 in. of suitable soil El Mound < 24 in, of suitable soil ❑ At -Grade El Single Pass Sand Filter El Constructed Wetland
❑ Pressurized In- Ground ❑ Holding Tank ❑ Prat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drie. Line ❑ Gravel -less Pipe ❑ Other (explain) r
V. Dis ersat/Treatment Area Information: /
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (s I) System Elevation 0
1 1.50 V •7 ✓ �Y3 ✓ (06/ ✓ .
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing f
Septic o Tanks Tanks 1
rHddiey �'�mde A l k IV
Aerobic Treewueatjjait
Dosing Chamber C0 5 (/l • x
VII. Responsibility Statement- IL the undersigned assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's N e (Print) Plumber's Si afore /MPRS Number Business Phone Number
R. . d q zz &3�S Its •?7a•3V4"
Plumbe r ( Cuty , Stat `� A_ bee)
D U� J�/V jj� U L /Aj I V S 1174?
VIII. Coun /De artment Use Onl
Approved ❑ Sanitary Permit Fee (includes Groundwater Date sued Issui �jgnature oS ps)
Surcharge Fee)
= ve. /D
❑ eas Ron for n ial
IX. Conditions of ApprovaMeasons for Disapproval
SYSTEM OWNER:
1. `Septic tank, effluent fitter and
dispersal cell must all be services / maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code / ordinances.
Attach complete plans (to the County only) for the system on paper not less than 81/2 x I I inches in size
SBD -6398 (R. 01/03)
1
r
t �
PO%hT SYSTEM S'
- : r,P0RATE PER COWa ->.
REL
A PROPER 2A t
ut , ER MODEL #
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Wisconsin Departm ent of Commerce SOIL ttancerd"nearest UA TIO Page of 3
Division of Safety and Buildings � �� ��
in accordance with Com ''�! c _ CMA
Attach complete site plan on paper not less than 8112 x 11 inchePlan must J 1 /
include. but not limited to: vertical and horizontal reference point '#ndo 20 arcel - D.
percent slope, scale or dimensions, north arrow, and location and st road. G 3 b - Z O 2q' 2_0 -000 Please print aB information. ST- C ROIX COU TPteDate
Personal iMormation you provide may be used for secondary purposes (P, a. �,6;
Property Owner Property Location
J A C K_ 5 /Al6r e R / O etAj ¢- 51; Govt Lot 5,4E 1/4 NE 114 S 21 T 3p N R 2 0 E (or
Property Owners Mailing Address Lot # Blodt # SuW. Nam or CSM#
7-41 6/`✓y 35
C'lly State Zp Code Phone Number ❑ city ❑ Village P town Nearest Road
ffo u & TO,✓ I w/ I 1 (71S ) 67 . v0ee>1t�i qw f- 3
❑ New Construction Used Residential / Number of bedrooms Code derived design flow rate 50 GPD
O�Replacerneri ❑ PubH or commercial - Describe:
Parent material 007 — j,(J/fS Flood Plain elevation if appl ble N� ti R
� aorrrrle Area Spot Tested suitable for law .1
Ci � i �� 9'� • C7 a Conventional Inground system (PO.W.T.S.)
P-1 Bing # Boring
® Pit Ground surface elev. I /0 ft. Depth to limiting factor � 4 i in.
Sol Rate
Horimn Depth Dominant Color Redox Description Texture Shucbxe Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Efr#1 I TOM
0 -s IUy /l — S1 2m Mf es 3f ( 1.0
2 5-15 lUYl2'S� - ' /s o s m ► CS 3V-F .7 I.io
3 15-- v 1'R'�/ _ 15 0 5-9 M I - I Vf .7 l (o
44
F �s # C] Borin
® Pit Ground surface etev. ` LG ft. Depth to limiting factor R2 in. Sod Application,liate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 'Etf#2
1 0 -1 OYr2 — s o. 2e bK Mfr es 3M .(V • d
2 7 -2 Y1Z /4 /S O s9 m I s t 3 of
3 -q YQ A41 - /S p s m l - - . I • tP
�Z
Effluent #1 = SOCk > 30 < 220 mg1l. and TSS >30 1 150 m&& ' Effluent #2 = BOO 130 V& and TSS < 30 mglt.
Je n?? �U l,bY ;c hit 9
Address V Mile Evaluation Condlfceed Telephone Number
u"kt_t'e'r, w! e-q_j- Sjt>AT /3 20 e� — !S, 772 3- z,�4 -�2
RI G IN AL
Property Owner S 1 ee e r Parcel ID # 0 30- 2 0 29'2-0 - O oo Page 2 of 3
Fal Boring # ❑ 80" /
Pit Ground surface elev. 9 ?L ft. Depth to 6rtri6og factor 2 J in.
Sod Application Rate
Horimn Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. '0101 '011#2
/ 0 -l0 10 Yet s — 6 , e , Ila bK m.r-r c S 3 m .(o /-0
0 YP_ ` � /b - ,QQ 0 s ✓1�1 - ! 1(� I • to
,
F ems# ❑ Boring
[] Pit Ground surface elev. ft. Depth to limiting factor in.
Sad Appficatjon Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl-
in. Munsen Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 '0102
❑ # ❑ lon
❑ Pit Ground surface elev. R Depth to leruting factor in.
Sod Application Rate
Horizon Depth DorrinaM Color Redox Description. Texture Structure Consistence Boundary Roots GPDM
In. Munsel Qu. Sz. Cont Color Gr. Sz. Sh. 'Ey#1 *E} f#2
v
• Effluent #1 = BOD > 30 <_ 220 rng& and TSS >30 5 150 rng& ' Effluent #2 = B01) :5 30 mg& and TSS 130 rng&
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.
SOD43300t.6mo)
ti
arty Owner S i ng e r Parcel lD # 30-2-021-20 qD00 Page z of 3
P P # ❑ 7
& Pit Ground surface elev. `r 7L ft. Depth to limiting factor 8 2 in. soe Application Rate
Hoitm Depth Dominant Color Redox Desc iptlon Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz- Sh. 'Eff#1 I '5#2
0 -10 1 0Y0_ z — e bK , C s 3 m .to 1 1.0
2 10YP_ ,Q 0 3Y •7 1.49
,
Boring #
❑ D
❑ Pit Ground surface slay. ft. Depth to limiting factor in.
Soli Application Role
Horizon Depth Dominant Color Redox Description Texdme SinxAxe Consistence Boundary Roots GPDIff?
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *1011#2
soft 'Soring
I
Ground l
surface eev.
❑Pit G ft. Depth to ftir>iting factor
Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Stricture Consistence Boundary Roots G PDMF
In. Mures Qu. Sz. Cont. Color Gr. Sz. Sh. 'EM '042
i
v
I
I
I
Efikxwd #1 = BOE 6 > 30 1220 ffv& and TSS >30 < 150 mglL • Effluent 92 = SOD, 5 30 not and TSS _< 30 nv&
The Department of Commerce is an equal opportunity service provider and Y
employer. If ou 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.
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ULBRICHT & ASSOCIATES CG.
2812 1 Oth Ave. • Spring Valley Wl 54767 Peg. Designers of Engineering Systems
715 -772 -3442
Private Sewage Consultants
• '
PROJECT INDEX r
PLAN ID # DATE
OWNER PHONE 7 �S • SY ' � 7
ADDRESS 0 4 -7V ,cam
LEGAL DESCRIPTION 7 l (?Stl 36 5T-5 -3 170/ i /, p ! 34
�, �c 20
TOWN OF COUNTY s�• `ev X_
CS TM S & ,00 y 2!l bit ia4 59 y31
LOCAL AUTHORITY/ SUPERVISION <S_t. G� 01`�C CO 0 A.3
2. 40 r'Z6-
PROJECT DESCRIPTION:
• �S' ys 7?� . {-viz? Z�
0 c� s 7 - S �
�x rS 7 G-- ODE �.�� ��, ',f T •� r c
C!�/r /S 177� / 5171 C*s
P C4 zf 4 /kt� (7 5 0
14 /t /,Pr- W
S�0& 19 its
zG�s �
1iv - tf 7
Uibricht & Associates
Private Sewage Consultants
4 ._v 7 N A 2812 1 t}th Ave.
` Spying Valley, ��111 54767
f
Pg•l INFILTRATOR SIZING WORKSHEET
P9.2 SYSTEM PLOT PLAN
Pg.3 CROSS SECTION OF'SYSTEM, WITH ELEVATIONS.
Pg . 4 1 p N if it 11
P9.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS
P9.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK.
PG.7 (OPTIONAL) PUMP PERFORMANCE SPECS.
The attached la s d s
"
p n an s are based on In - Ground
Absorption Component Manual For Private Onsite Wastewater
TraAfmanf f voro i nn 7 _ n l GRl'1 -1 n 7q_P (vn1 /A1 _
kA d
A
CL
Cl) 4:. ' 'f
C F Aj
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m m �)
® = gyp M z
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y
y o
OVER: See Reverse Side for Vent/ Observation Pipe Details.
f x r 5 AJ
VEMT CAP I Pi P
E
VENT PIPE APPROVED LOCKING
WEATHER PROOF
. O , JUMCTIOAI BOX MA Hai E COVER
/" I2 "Mill. �'� IvA�CNia& A/SEf
I
GRADE I
!8 "MtIS.
COIJDUiT V-- � -- - - - - --
PROVIDE I - ---
} E
IAILT AIRTIGHT SEAL
- T 1 �� r I i
/ APPROVED .lOIIJT A ��� t , A�PROV P CE O};
/ 1-4/ PIPE + '! �{( I I I t EXTEMDIIJG 3
LXTENDIAIG 3 'DO�- ( I ALARM ONTO SOLID St
OMTO SOLID SOIL B I
164.40 P06 I � OIJ
ELEV. FT.
PUMP --� � OF �SE
�10iPE of
OP k `Lja DOta BLOCK
- ;a,✓;v
- z.�- --
R150L EXIT PERMITTED OIJL4 IF TAUK MAIJUFAGTURER HAS SUCH APPROVAL
-jr, SEPTIC _ SPEC,iFI'CATIOUS
DOSE
TAMKS MAQUFACTURER: - / Z WtAll R OF DOSES PER DA-4
TAWK SIZE: J SO 6ALLOWS DOSE VOLUME 13 '63
ALARM MAMUFACTURER: INCLUD1WCs BAGKFIOW: GALLON
MODEL HUMBER: L CAPACITIES: A= t � ImCHES OR - GALLOKI
w - 2 I"CV4ES OR GALLOtJ
SWITCH TYPE: �n)'!1' r B -
PUMP MANUFACTURER: ��� Y G= IMCHES OR , - - 3 GALLOM
MODEL NUMBER: D= 12- INCHES OR. z GALLOt.
SWITCH TUPE: ��y.SI'/�r1"`a�— <�� IJOTE: PUMP AND ALARM ARE TO BE
MIMIMUM DISCHARGE RATE_ _ _GPM INSTALLED OW SEPARATE CIRCUITS
VERTICAL. DIFFERENCE BETWEEt1 PUMP OFF ARID DISTRIBUTION PIPE -- FEET * - r o SP
-I- MIIUIMUM KIETWORK SUPPL9 PRESSURE �........... �� FEET CCAG,,
Gi of J
+ �— FEET OF FORCE MAIM X �f/ooftFRICTIOU FACTOR. �' j FEET " I
TOTAL Dy1JAMIC. READ = FEET �[
INT.ERIJAL DIMEtJSIOMS OF TAtJK: LENGTH - ',WIDTH :LIQUID DEPTH
.. E^O' �T SYS I EM SHALL
°` ^ORPORATE PER GOMM.
45�c
83.44(2)c A PROPER ZABEL
FILTER MODEL # / 8d D
y SEPTIC TANK, per Comm.83.44 (2) (c) shall be equipped with an
outlet attached approved filter device (Zabel
fliter). Tank shall have an approved above
ground locking manhole cover for regular (every
12 months or less) inspection S. servicing by a
licensdd service pumper.
_ __
POINTS OWNER'S MANUAL & MANAGEMENT PLAN page . ( of Z_
PILE INF O RMA'noN SYSTEM SPECIFICATIONS 6 X I.S T/ ,o 6
Owner 5-1;v j 5 Septic Tank Capacity ��� ga l ❑ NA
Permit # CT e
Septic Tank Manufacturer (,t, %&—.,.5'�j � ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer - 7,A ❑ NA
Number of Bedrooms 3 ❑ NA Effluent Filter Model le0o ❑ NA
Number of Public Facility Units ,--- Pump Tank Capacity C,) ga l ❑ NA
Estimated flow (average) 300 al /day Pump Tank Manufacturer ❑ NA
Design flow {peak }, (Estimated x 1.5)SO gal /day Pump Manufacturer 2{JE ❑ NA
Soil Application Rate 7 day /ftz Pump Model ?I? 1 P ❑ NA
Standard Influent/Effluent Quality M ly average Pretreatment Unit NA
Fats, Oil & Grease (FOG) 430 mg /L ❑ Sand]Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids ITS } 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality average Dispersal Call(s) ❑ NA
Biochemical Oxygen Demand (BOD 530 mg /L Xin- Ground (gravity) ❑ 1n- Ground (pressurized)
Total Suspended Solids ITSS} 530 mg /L ❑ NA ❑ At -Grade ❑ Mound
Fecal Coli €arm (geometric mean) <10' cfu1300ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. :01 Other: ❑ NA
Other: Other: ❑ NA
* Values typical for domestic wastewater and septic tank effluent. Other. ❑ NA
MAINTENANCE SCHEDULE
Service Event k Service Frequency
Inspect condition of tank(s) At least once every: months) (Maximum 3 years) ❑ NA
❑ year(s)
Pump out contents of tank(s) �( When combined sludge and scum equals one -third (Y of tank volume ❑ NA
(aspect dispersal cell(s) At (east once every: 11 month(s) (Maximum 3 years) ❑ NA
l N year(s)
Clean effluent filter At least once every: month(sl ❑ NA
❑ year(s)
inspect pump, pump controls &alarm At least once every: months) ❑ NA p years)
Flush laterals and pressure test At least once every: 3 ❑ month(s) ❑ NA
ear(s)
other' 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 1
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.
`Vage CO l'1S(! to
v I Oil Ave.
'j 1. ,•; "41 547e7
-7-7a 3
START UP AND OPERATION Z
For new constru
coon, prior to use of the POWTS check trea tment Pa m of
that may impede the treatment roc a'tment tanks) for the
Of the tank(sj removed b Process and /or damage the dispersal cell(s), if hig of Painting.
Y a Septage servicing operator prior to use. detected a
gh concentrations are Produ Or thchemical.
content,- g
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above norms( highwater levels. Wh
discharged to the dispersal cell(sj in one large dose, power is restored the exce
overloading the cell s
ss wastewater
effluent To avoid this situation have the O and may will P ower contents Y result ' be
p to the n is of m the b
effluent pump or contact a Plumber or POWTS Maintai b a in menus(( o ackup or surface discharge of
restore normal levels within the pump tank. Operator prior to restoring
Y a Septage Servicing vehicles over tanks and dis y op erating ft'e
Do not drive or park
within 1 5 feet down slope of an persal Pump controls tc
cells. Do not drive or park over,
Y mound or at -grade soil absorption area. or otherwise disturb or compact, the area
Reduction or elimination of the following from the
POWTS: antibiotics; baby wipes; cigarette butts; wastewater stream condoms; cotton swabs; d
foundation drain (sure pum p) eam may improve the performance and proton
p pum water; fruit and vegetable egreasers; dental floss; di s the life of the
Painting products; Pesticides; sanitary getable peelings; gasoline; diape disinfectants; fat;
ary napkins; tampons; and water softener btine.aSe; herbicides; meat scraps; medications; oil;
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall b e taken to insure that the system is
Properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administr `
• All piping to tanks and Pits shall be disconnected and the abandoned p ipe at
Code:
p p
• The contents of all tanks and pits shall be removed and Properly dispos °# b by �p - seated,.
• After Pumping Septage Servicing Operator.
g. all tanks and pits skier excavated and removed or thr covers removed and the void space soil, gravel or another inert solid mate
their ONTINGENCY PLAN fill with
It the POWTS fails and cannot be repaired the folio measures have been, or
replacement system; 9
A suitable replacement area has been evaluated and may be utilized must be taken, to provide a code compliant
system. The replacement area should be protected from disturbance and compaction and shoo( not be i nfrin g ed
required setbacks from existing and proposed structure, es and welts. Failure
lot tin for the location of a replacement soil absorption
result in the need for a new soil and site evaluation to establish a suitable replac to protect the repla ent area o w ill
comply with the rules in effect at that time. ement area. Re
Q A sortable replacement area is not available due to setback and/or Placement systems must
technology a holding tank may be installed as a last resort to rep the failed �mrtations. gamin
1 � The site has not been evaluated p POWTS 9 advances in POWTS
evaluation must be to identify a suitable replacement area...
Performed to locate a suitable replacement area, if no replacement area is available a holding tank
Upon failure o€ the POWTS a soil and site
may be installed as a last r to replace the failed POWTS.
f±I Mound and surface. de constructed in place following infiltrative surface Reconstructions of such soil absorption systems may be r econstructed must comply
with the rules i
WARNING> > systems 9 of
PTIC, PUMP AND OTHER the biomat at the
T n effect at that time.
REATMENT TANKS MAY CONTAIN LETHAL GASSES
TER A SEPTIC, pUMp OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES OpEA� INSUFFICIENT OXYGEN. DO NOT
3SON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT RIONAL COMNJE� -g OR IMPOSSIBLE, MAY RESULT. RESCUE OF A
ric
i
rs INSTALLER 2812 1 Oth Ave.
lame r _ , POW S MAINTAINER
)one f' • 7 7 o f ' j Z_ Name
Phone 3< - Z t 3 c5
,GE SERVICING OPERATOR (PUMPER)
3me LOCAL REGULATORY AUTHORITY
one Name cs'7-'
:ument was drafted in compl Phone 71 S • ` j �� �/ jyQ
com Iiance with chapter CO Q
pier Comm 83,22 (Zllbl(1) {d) &(f) and 83 .5411), (2) & (3), Wisconsin Administrative Code.
II
START UP AND OPERATION Z
For new construction, prior to
that use of the
may impede the tie POWTS check tr eatment Pam
tre atment process and /or damage the d a snent tan of
ks) for the presence of p a i nt i n g.
of the tank(s) removed by a s Persal cell If hi h con praducts or oth� chemical:
epta$8 senrsCing operator prior to use. are detected ha th con
g centrations
System uP shall not occur when soil conditions are frozen at the i n filt rative surface,
During power out Pump tanks may fill above no rms! hlghwnit
discharged to the dispersal cell(s) in one large ater levels. dose, Overloading g the cell(s) When and may r
effluent. To avoid, this situation have the contents of the pump tank removed b power is restored the excess w
power to the effluent um Y exult in the back w astewater will be
A. p or contact a Plumber or POWTS ' Maintainer to assist Sn manuall � or surtace discharge of
restore normal levels Within the urn ptage Servicing Operator
A p tank. prior to restoring
Do not drive or park vehicles over tanks and dispersal operating the p Controls tc
within 15 feet down slope of an persal cells. or park over, or otheryvise disturb or corn act ,the area
POWTS: antibiotics;
Y mound Do not drive or at -grade soil absorption area.
Reduction or elimination of the folbwrng from the wastewater stream R bah
foundation drain (sum Y wipes' cigarette butts; condoms; cotton swabs, improve
dental floss; di
A Pum Performance and Prolong the fife of the
Painting products; pesticides; sanitary fruit and vegetable peelings; gasoline grease; herbicides a p p dise c oons fat;
ABANDONMENT a<Y napkins; tampons; and water softener brine. 'meat scraps; medications; oil;
When the POWTS fails and /or is Permanently taken
properly and safely abandoned in con out of service the -followi
compliance w' Steps R rth chapter Comm 83,33, Wiscons in Ad nas Code:
insure that the system is
m
• All piping to tanks and pits shall be disconnected and the abandoned
• The contents of all tanks and pits shall be re pipe °penjn sealed.
moved and properly disposed of by a Septage Servicing Operator.'
• After Pumping, all tanks and pits shalt 1. excavated and removed or their covers removed and the void- space soil, gravel or another inert solid material.
ONTiNGENCY PLAN filled with
It the POWTS falls and cannot be repaired following aired measures have been, or
replacement system;
Q A suitable replacement area has been evacuated and may be utilized for the location of a replace
must be taken, to provide a code compliant
system. The replacement area should be protected from disturbance and con
required setbacks from existing and proposed ment sot} absorption
result in the need for a new and wells.. o ent soil and site evaluation to establish a suitable
re p la cement area. not be k*in
p structure, lot tines Failure to protect the r ) acement area will
ged upon by
comply with the rules in effect at that time, eR
A suitable replacement area is not available due to setback and /or soil li m i tat i ons.
a Replacement systems must
technology a holding tank may be installed as a last resort to replace the failed POWTS,
rmrtations. Barring advances in POWTS The site has not been evaluated to iden '
evaluation must be performed to locate a suitable replacement area. If no
t�fy a suitable replacement area. iJpon failure of the POWTS a sotl
may be installed as a last resort to replace the failed pplq/Tg, replacement area is availabl and site
Q Mound and e a holding tank
at grade soil absorption y
infiltrative surface. Reconstructions of such systems must comp I with the rules in the blomat at the
systems may be reconstructed in place foUowing remove! of
WARNING> > R y effect at that time.
TER PT
A PUMP AND ANp OR •I•REATMENT TANKS MAY CONTAIN LETHAL GAS
TER FROM SEPT PU
THE OR OTHER TREATMENT TANK UNDER ANY HAL CIRC UMSTANC ES. G AND/OR INSUFFICiENT O
XYGEN. DO NOT
3SON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ITIONAL COMMENTS EATH MAY RESULT. RESCUE OF A
€'iC
rs INSTALLER 2812 1 Oth Ave.
lame x POWTS MAINTAINER
Name 99
gone � • 7 7� • � �_
Mo na
ne 38� • .� 3 d
.GE SERVICING OPERATOR (PUMPER)
sme LOCAL REGULATORY AUTHORITY
one Name C R t ZOuf� Il?�i—
:ument was drafted in p Phone WS • 3 ��
con !lance with chapter Comm 83,22(2)!b)(1 ){d } & {f! and 83.54 (1), (2) & (3}, Wisconsin Administrative Code.
�1
ORIGINAL
X5853 nAUG191980
CERTIFIED SURVEY MAP e we
E 1/2 - 1/4 - SEC. 22 , T 30 N, R 20 W �
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S 83° -08'- 14" W gryo 1 � CO. MON.
290.50' * z y y NE COR.
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INCLUDING RD. R/W S 83 0 -19'- 14 "W 167.03'
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290.50 m EXCLUDING RD. R/W
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LEGEND 9 ,00,
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0 -- 1" X 24" IRON PIPE SET y 33 329.50'
WEIGHING 1.68 LBS. /LIN. FT. 0) 1 N 83 -08'- 14" E
0 -- FOUND IRON PIPE u y I y l
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THIS INSTRUMENT DRAFTED NIO A� ( LAND
BY B. R. P. rn 1 rn WE °ea co pq
JOB NO. 79 -61- IBO O ON ) ALLEN C .
a - - E 1/4 COR.
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APPROVED P o s-1407
g m HUDSON,
y WIS. .r Q' °`
AUG 19 198o �' ° • C
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ST. CMX COUt4TY '�~ !— oath "h it Sim
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COMPff"U M PACKS PtANNINO 50' 66.sg'
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S. r�HW Y „ 35 8 6 4 „
Vol, 4 Page 976
r
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 g the
S residence located at:
N6 4, Section 2Z , Taws 3 0 N. age D W Town
of 5 T- ToSe P� '
St. Croix County Wisconsin, Upon
Inspection, I certify that I have found the tank(s), to the best of m
knowledge, will conform to the r y
requirements of Comm. 84.25, and it (they)
appear(s) to be fimb inning properly.
Most recent date of service
Did flow back occur from absorption system? Yes No
(if no, skip next line.)
Approximate - -lume or length of time: gallons minutes
Capacity: _ / O d
Construction prefab Concrete r /` Steel Other
Manufacturer (if known): /� - � -� -- "�
Age of Tank (if known):
R 0 aE P- 7` albR /G TQ!ets Plumber ignatare) (Print Name)
7 S
('Title) (License Number) MP/ME'RS
�u.g o
0 S
(Date)
FQa. n to be completed b licensed plumber (s. 145.06, Wisconsin Statutes)
or licensed disposer (NR 113 Wisconsin Administrative Code)
U1br j & Asso
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Pr` e
lusts Sevy a s
28,2 t S a e-, Consultants
Spri�p Wt 547 '
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DOCUMENT NO. ��±± ��++ f INIT CLAIM 11990
VOL UlU ' "_" 356 TnIS 31`1149 lltiLOY[Iflit A1644911 /ATA
36�U61
- - - - -- -- - — REGISTERS OFFICE
THIS IND1itY'[ LqM Made this ..._ 2g th._._. day nt Au gust _ _ _ -_ -- ST. CROM CO., WIS.
A. D., l9 8Q-. bec«e a WALTER- L. KR and FREDA KRIESE Recd. for Recoftl this 2
hi&_srife._ Grantors, day of Wept A.D. 192
at ,
part itS of the first part, and J ,
JAOK D a 1NGEfLand— N.?RMA_bi h ust�an_ and
wife as - tenant4 GranteF'_s °ht" of D eeds —
psrtiP_S of the second part. -- -- - -- -- i R E T 0 A R TO
W i t o e s s e t h, That the said part iesof the first part, for acd in consideration I /' /
a# the sum of ...0ne Ia4�._.lar- aind_other_ good - -and - _v_aluakl )•r , u eT �I'�'
c onsideration(1.00L - -- -_ -- -------- - - - - --
__.� - -- - --- Dol:ars, to _the-I11 in hand paid by the said partie_ — the second part, the receipt whereof is hereby
confesseti - ' acknowledged, have -_ given, granted, bargained, sold, remised, rekased, and quit - claimed, and by these presents do— give,
grant, bargain, sell; remise, release and quit -claim unto the said r arti-CZ of the second part, and to tlleiAeirs and assigns forever, the
following described real estate, situated in the County of — fi e SL_4.1]G and State of Wisconsin, to -wit:
A parcel in the Elf of the NEh of Section 22, Township 30 North,
Range 20 West, described as Lot 1 of the Certified Survey Map
filed in Volume 4, Page 976, Docunent N;j. 365853, in the
Register of Deeds office for St. Croix Codnty on August 19, 1980.
F E
TAX EXEMPT: 77.25(8)
To Have and To Hold the same, together with all and singular the appurtenances and privileges thereunto belonging or in anywise
thereunto appertaining, and all the estate, right, title, interest and claim whatsoever of the said parties_ of the first part, either in law or
equity, either in possession or expectancy of, to the only proper use, benefit and beheof of the said part ].@I of the second part,
- - .their heirs and assigns forever. q ��
In Witness Whereof, the said parti—S of the first part haVe— hereunto set -the J hand --L--- and seal S— this s7L—"
day of - -_- August _ -- . A. D., 19 p
SIGNED AND FEALED IN PRESENCE OF ,� ' / (SEAL)
W alte L. Yriesel
(SEAL)
----- - - - - - - -- ------ - - - - -- — "Fr Krie
(SEAL)
I
(SEAL)
STATE OF WISCO \SIN, 1 — --
St. Croix ?ss.
- - - - -- - -- - -� County.
u
Personally came before me, this tay of AuCW.s_ , A. D., 19
the above named —_ Walter L. Kriesel and Freda Kriesel, his wi
to me known to he the person -_S —who executed the foregoing instrument and acknowledged the
t . NOT�RV •_ 9 -- —
This instrument drailed by = q; i. , , votary Public . St C roix County, Wis.
Hugh F. Gwin, Attorney
Gwin Gilbert Gwin & _Muck , d fn• , qty Commission (Umpires) (Is)___
' Hu dson W isconsin 54015
1 (Section 51S1 (1) of the Wleconsin itatutee t.idM mo iR *a�la nsenrs to be recorded .hall hove plainly printed or ty"o thereon the
I� wines of the arentars. Grantees, witnesses and notary).
OUIT CLAIM DEED —STATE OF WISCONSIN. FORM NO. It
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Bu erisu No�l 1 q . Sj ,116-
Mailing Address b / 11 • 3. / U &TD Al . IV
Property Address
(Verification required from Planning & Zoning Department for new construction.)
City /State Parcel Identification Number (930 20 �- f - ZO "Oem
LEGAL DESCRIPTION y f
Property Location S C� '/4 , `� i/4 ,Sec. � Z , T 3 N R W, Town of S T TO
Subdivision c Lot # /
Certified Survey Map # J � , Volume / , Page #
Warranty Deed # 3 Volume �f G , Page it 3S
Spec house ye 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 bra% signed by the
owner and by a master plumber, ioumeyman 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 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 Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe amlare the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms
SIGNA QF AP ANT(S) DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. � #*
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
7 /7)
Ub icht & Associates
i v lc Sewage Consdtai—".Z