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030-2080-50-000 (3)
epanl�ent of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix nd Build0'ig Division INSPECTION REPORT Sanitary Permit No: 'T°LL 0 INFORMATION (ATTACH TO PERMIT) State Plan ID No: — al information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. [ LDeckar d, t Holder's Name: City Village X Township Parcel Tax No: Ronnie & Deborah St. Jose h, Town of 030- 2080 -50 -000 ST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 25.30.20.682 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St /Ht Inlet II I TANK SETBACK INFORMATION St/Ht Outlet 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 BED /TRENCH Width Length No Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. T7 pth 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 Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing I SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over IDepth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil F - �� Yes ° No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1382 Pine View Trail Hudson, WI 54016 (NW 1/4 NE 1/4 25 T30N R20W) Woodland Hills Lot 5 Parcel No: 25.30.20.682 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 Insepctor's Signature Cert. No. y commerce.wi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St. Croix i scons i n Madison, WI 53707 -7162 4 Sanitary Permit umber (to be filled in by Co.) t oopartment of Commerce J!. 2 3 Sanitary Permit Application State Transaction Number Trans. ID# 148 In accordance with s. Comm. 83.21(2), Wis, Adm. Code, submission of this form to the appropriate governmental Project Address (if different th mailing address) unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are submitted to the Department of Commerce. Personal information you provide may be used for secondary # �15 8'Z f n 1~ Vi purp oses in accordance with the Privacy Law, s. 15.04 1 m , Stats. Same I. Application Information Please Pri Property Owner's Name ( D � Parcel # Ron Deckard � �� 030 - 2080 -50 -000 Property Owner's Mailing Addres Property Location 40 f � f ST. CROIX COUNTY 1382 Pine View Trail NNING 8 ZONING OFFICE Govt. Lot City, State one Number NW , /,, NE %, Section 25 (circle one) Hudson, WI 54016 (715) 549 -6921 T 30 N R 20 w 11. Type of Building (check all that apply) ❑ 1 or 2 Family Dwelling — Number of Bedroom 5 5 Subdivision Name ' Block # Woodland Hills ❑ Public/Commercial — Describe Use Na ❑ City of ❑ State Owned — Describe Use CSM Number ❑ Village of ❑ Town of St. Joseph . 5 X /CYO toy t Na IIl. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration o wner #514822, issued 12/21/07 IV. Type of POWTS System/Component/Device: Check all that appl ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) PolyLok PL -525 effluent filter V. Dispersal/Treatment Area Information: 6' X 100" dispersal cell Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (s Dispersal Area Proposed System Elevation 750 gpd 1.0 ASTM C -33 sand 750 sq. ft. g��J 750 sq. ft. 93.85 at 12" above 0.4 in -situ soil 92.85 contour VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o d v New Tanks Existing Tanks w c d C e o w U C6 H r7) w C7 p.. Septic or Holding Tank 750 1750 1 'Wieser ConcreteAJ X Dosing chamber 1000 _ 1000 1 Wieser Concrete X VII. Responsibility Statement- I, the un rsigned, assume esponsibility fo tall - on of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's a r MP/MPRS Number Business Phone Number James K. Thompson 30021 1 (715) 248 -7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceola, WI 54020 -5413 If V141. Coun /De artment Use Onl Approved ❑ approva Per Fee Date sued Issuin ent Signatur El xven Reason for Denial $ IX. Cc NA for Disapproval t. Septic tank, effltt6d fiRsr and dispersal cell must all be aervlce j mai as per management plan provided by plumber. 2. All setback requ&'ttrnents WWd bs TWIllttbd as per appk;" toeN I orb. Attach to complete plans for the system and submit to the County only on paper not less than 8 1n x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 t mmerCe.Wl.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St. Croix sco ns i n Madison, WI 53707 --7162 Sanitary Permit Number (to be filled in by Co.) Mooparb"em of Con"Tterce , L1'�' Z. Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21 2 , Wis. Adm. Code, submission of this form to the 1# ? (o 7(o-3 () sPProPn� governmental d ) unit is requited prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing a , submitted to the Department of Commerce. Personal information you provide may be used for secondary o ! p Q i1L„ . CL Purpose in accordance with the Priv Law s. Stats. / 3 0 Z .—•-- t I. Application Inform 'on - Please Prink All I t l�cr. Property Owner's Name Parcel # Ron Deckard f DEC 2 030 - 2080 -50 -000 Property Owner's Mailing Address Property Location ST. CROix COUNTY Govt. Lot (� 1382 Pine View Trail ZONING City, State Zip 4Wne Number NW %, NE /., section 25 (circle one) Hudson, WI 54016 715 549 -6921 T 30 N R 20 w IL Type of Building (check sill that a ) ❑ 1 or 2 Family Dwelling - Number of Bedroo 5 4 1*W J :n5 Subdivision Name Block # Woodland Hills ❑ Public/Commercial - Describe Use Na ❑ City Of ❑ State Owned - Describe Use l o t X CSM N ❑ Village of 7 k 160 a d N Na um ❑ Town of St. Joseph III. Type of Permit: (Check only one box on line A. C4plete line B if livable) A. ❑ New System "placement System ❑ Trea UHoldin sink Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of P bet ❑Permit Transfer to New List Previous Permit Number and Date i %ui Before Expiration Owner /Z IV. Type of POWTS S stem/Com nent/Device: Check all t1st a i Lo ❑ Non - Pressurized in- Ground ❑ Pressurized In -Ground ❑ At side Mou � 24 in. of suitable soil ound < 14 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: It X Design Plow (gpd) Design Soil Application Rate(gpdsf) I f ispenal Area Requ' (s ispersai Area Pt (sf) S Elevation 75OWd 7 1.0 ASTM C -33 sand 50 sq. ft. 4 sq. ft. 7 .L, 93. at 12" above /// � .✓✓ 9 . ' contour VI. Tank Info Capacity in Total # of Man turer , Gallons Gallons Units T� v New Tanks Existing Tanks Po 10, s2 U rZ Septic or Holding Tank 750 1,000 1,750 1 Wieser Concreteqjnknown X > gcbaml>cr 1,000 1,000 1 Wieser Concrete X VII. Responsibility Statement - 1, the un ersigned, assn responsibility as tioa of the POWTS shown on the attached plans. Plumber's Name (Print) Pfumbet' Si MPMIPRS Number Business Phone Number James K. Thompson 30021 715 248 -7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, 4sceol Wl 54020 -5413 VIIL Coun /De artment Use Onl �pproved ❑ PMVPQLVSR Permit Fee Date I sued Issuing t Signature ❑ iven R �tt�€er Denial $ 6 DD ' °° 1 /L/Z)/67 IX. Co Tweasons for Disapproval 1. Septic tank, effluent finer and 3) dispersal cell must all be'senrtces / maintakod �CG .�. - 6 t as per management plan provided by pkmter. Z. All setback requirements must be mak taN►sid .- If . 5 '1 7 � Attack to complete plans for the system and submit to the County only at paper not fees than 8 112 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01 /09 `• /,n? V //'Q�� � Soi�QliQ�l�a�o.�r,� �2 SO. CO -'J S /ode c /L C4"o a / /oO 6� I Q 6e6o , l)tC. -a. & o•, > a a Vv /38,2, Rae Trai7 �co 2� n o ri, /CS 1240 Eyy Sac. zS T 30 , 1. A� .40 )., T. c .c � �U. �U�D•2p� -SG -mac e E,xjs6.I 7 e/e C. cll� G"a++s {orntr� �\ N I- Y . 7y, �i E,Y, J�nc{ � /�l�iC: ! Olr(�, ii Q.IC ✓dl.�ld. I i1 d 1 li � �orn o f �' /eo/jdtt.S � 5h� j � ,.,4. /lLSde�xe $ � /BO.CD, �►"o� 9S.Q3' S � _ Dec.' EXi.sfj S.T. oe t /et 9a$; ro Arrm 3o3V da � P used t��esefG „c�c�Ee R e� lutnt „� —EX� � d'apWS -aam. LO 750-/rfWSeic,, r rc�ade n r P.C. t �- �/� %,L�.NP.C-S•Z5” - ftz.sa'cr+�w C- o -6ow'c(t ✓a�E;o►, : 9t BS MC14c e.,1 - , /tcsa�tou.� ''- dal sys bow, e 1 ✓a �,'oY, : 9� 86 IQ'' oP4S4�t.t7.�GStiC� a C.r't�Q o _ _ _ " gi So /r�acyda ->< z s� sC�X //8.33; �''• ` �` � `'� ' 7 at Z 5 D % ' L; ee�S �vb�S e c c✓ c-6.?.s3' � /o Pe ' f'krp ccy�i SyStc..n `, � 9.Z.So. 93 sa' �.e�y Ale o;/ eda /limo„ � EXistS'�9�r�e eJE�.' 6 �onn,- Qe6o�a� e 6 C, Pi o P ines d� Pan o z:S uJaLella"o1 4 " 1 7-3011 P •20 c,2., T. c X Ga. , r 7 ^+� I'�c � U�{'•tim �:� •��c�•i YI�J. �I..m t.f� G�• � /CO•iZ � v �e Sa I ,`� E,Y�'str'n� � . _[j�e'. l�orcl. �s elc ✓a�cd• � i � Bg�m o p �'ldorja'rts 5 h rd erke 't5 b • ; _ _ h b++'`- EX�:sE.• � goo � pac.X Shed fos��jn S orb S� Po�cI� /oca(CP` tc1�o" v tom toy.,d� cJa //. ' E,risfi S.T. ov lct 90-50 w�� Pro R,sedc.,�;e. sei'Concrc�-E,e flu 3c�?V ,�- -EX� ',� d,'spRr'sa/Ce,i /. /-tC. :85,� �TSD -/KrP c �a,,,(i �� ^� remade a.0 A0 — : _ _ cAo." I z "sue • y0R4 n �. /' YD,0 r1 / da.L�z i�X 7 rec (3) /,a. a ,e/&.�JmK- /ra�X W. G 7 s�ccc✓ �/ `, •Q1 �' ``. 4 t,Z.sD: ' /8'o��'C �v6eS/aa�ee✓�.?.s3' lv�'/>1a�; /S / � •� ' ><- krocy -!� ,SyStcin �• � 9R.So' 93.ro' Safety and Buildings PO BOX 7162 commerce MADISON WI 53707 -7162 TDD #: (608) 264 -8777 isconsin www•commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer, ALA, Secretary December 06, 2007 CUST ID No. 30021 A7TN.• POWTS Inspector JAMES K THOMPSON ZONING OFFICE A.C.E. SOIL AND SITE EVALUATIONS ST CROIX COUNTY SPIA 340 PAULSON LAKE IN 1101 CARM ICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL identificatio No. 1486763 N umbers PLAN APPROVAL EXPIRES: 12/06/2009 Transaction ID No.1486763 SITE: Site ID No. 732675 Ronnie and Deborah Deckard Please refer to both identification numbers, Town of Saint Joseph, St Croix County above, in all correspondence with the agency. NW 1/4, NE 1/4, S25, T30N, R20W Lot: 5, Subdivision: Woodland Hills FOR: Description: Replacement Mound Object 557 'ect T e: POWTS Component Manual Regulated Object 2 7 YI? mP � ect ID No.. 1 J Maintenance required; Replacement system; 750 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2:0, SBD- 10691 -P (N.01 101), Pressure Distribution Comp onent Manual - Version 2.0 SBD - 10706 -P .01/01 p � � ) II I The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above, The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code b requirements. No person may engage in or work at plumbing in the state unless licensed to d o so y the D p er s. 145.06, stats. I A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection b authorized representatives of the Department, which may include local inspectors. All permits p Y P eP � Y P P required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safe & Build reserves the ri ght to re require cha or additions should g g pp h' g q conditions arise making them necessary for code compliance. As per state stats .101.12(2), nothing in this review O lt shall relieve the designer of the responsibility for designing a safe building, structure, or component. 1 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address q g lm Y p � R F on this letterh ` d. FQ P P 10 The above i t a dressee shall provide a copy of this letter to the owner and any others who are responsible for e nsla latio 'per ion or maintenance of the POWTS. inei re ,y, ' Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 ark Finge POW S Plan'R�'viewer, , Integrated Services WiSMART code: 7633 (608) 1 -7735, Fax: (608) 267-9566, M -f 7:OOAM - 3:45PM mark. finger @wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. 4 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN RECEIVED Residential Application INDEX AND TITLE PAGE N OV Z 9 1007 SAFETY & EUILE)INGS Project Name: Ronnie & Deborah Deckard 5- bedroom residential moun Owner's Name: Ronnie & Deborah Deckard Owner's Address: 1382 Pine View Trail I Hudson WI 54016 Legal Description: NW1 14NE1/4, Sec. 25, T.30N., R.20W. Township: St. Joseph County: St. Croix Subdivision Name: Woodland Hilts Lot Number: 5 Block Number: Na I Parcel I.D. Number: 030 - 2080 -50 -000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry ! p Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan - s� Pag I g 9 Soil Eva l uation Report Designer: om s n g o License Number: 30021 Date: 11/161 7 Phone Number: (715) 248 -7767 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.0 (03/01/01) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) ' _ R Residential or Commercial Design Note: Sand fill (D) calculations assume a 500.00 Estimated Wastewater Flow (gpd) Table 83- 44-3 in -situ soil treatment for fecal -_.- 1.50 Peaking Factor (e.g. 1.5 = 150 % conform of <= 36 inches. 750.00 Design Flow (gpd) _ 7.00 Site Slope ( %) _ 92.85 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 0.401 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 100.00 Dispersal Cell Length Along Contour (ft) = 7.50 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/fl?) F 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest int in the distribution L Y - P ressure Disribution Information network? Enter Y or N (c or e) e Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation 3 Number of Laterals of the highest point. E r �_ 0.125 Orifice Diameter (in) (e.g. 0.25) 2.50 Estimated Orifice Spacing (ft) = 6.25 fe /orifice i 2.00. Forcemain Diameter (in) 75.00 Forcemain Length (ft) Does the forcemain drain back? i 85.50 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 12.23 Forcemain Drainback (gal) 7.97 Vertical Lift (ft) 135.80 5x Void Volume (gal) 3.66 Friction Loss (ft) 148.03 Minimum Dose Volume (gal) 18.14 Total Dynamic Head (ft) 49.43 System Demand (gpm) Lateral Diameter Selection Ma Diameter Selection in. dia. options choice in. d ia. options choice 0.75 1.25 1.00 1.50 x x 1.25 100 x 1.50 x x 3.00 2.00 x 3.00 x ...... . . . Gallonslinch Calculator (optional) Treatment Tank Information 1001.88 Total Tank Capacity (gal) 750. Septic Tank Capacity (gal) 36.00 Total Working Liquid Depth (in) W ieser Concrete 1 Manufacturer 27.83 gal /in (enter result in cell B49) Dose Tank Information Effluent Filte Information 1001.881 Dose Tank Capacity (gal) l PoI +ok Fitter Manufacturer 27.83 Dose Tank Volume (gal /in) 1PL-525 ,Filter Model Number Vieser C oncret e (Manufacturer Project: Ronnie & Deborah Deckard 5- bedroom residential mound Page 2 of 9 Mound Plan View 1110 B • Observation Pipe 3 ' J K .................... ' — l 70 -x- • .- `r 8 • . I . l?J. I J L Mound Component Dimensions Down slop toe extension made. A 7.50ft E 18.30in H 1.00 ft K 9.16ft B 100.00 ft F 9.50 in 1 11.25 ft L 118.33 ft D 12.00 in G 0 - 5 - - 01 ft J 5.68 ft W 24.43 ft 750.00( ) Dispersal Cell Area 1 1875.00 (fl?) Basal Area Available 7.50 (gpd/ft) Linear Loading Rate 10.00 (ft) 1110 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 95.64 (ft) - -� H 1 /iii /fits Z f�f�ff /r G 1 93.85 (ft) --►• F Dispersal Cell — 94.35 (ft) Lateral Invert Dispersal Cell Elevation J'•. •, .+ {`i ti ��,r , •y -•••`. j'r . •, r, .C i • 1. J, A. 92.85 (ft) Contour Elevation 7.0 %Site Slope Geotextile Fabric Cover Shading Key T Dispemal Cell See lateral details on © —Topsoil Cap 1.5 ft Page 4 for number, !!!f! Subsoil Cap a o 5 f ;' ....• :rti size, and spacing of ASTM C33 Sand F laterals. Laterals are 05 ft pical ;ti r ti ..., • .,, f;_ ? Tilled Layer t '•r m . .•' Ty Lateral �' equally spaced from _ ,.,... r.,..r. Aggregate �'� �: �:• �: �s�'•" �' the distribution cell's *--- -- A ---* centerline in the distribution cell (AxB). Project: Ronnie & Deborah Deckard 5- bedroom residential mound Page 3 of 9 End Connection Lateral Layout Diagram Center the laterals over the A & B dlmenslon •– Turn -up wf ball valve or of can out pi u8 FI.I.. P Wontical I E X — `31 Holes drilled on the bottom of the lateral equally spaced laterals & force main of PVC Soh 40 (per COMM Table 84.30A S onnootion via tee or cross to manifold at any point. Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 98.67 ft Orifices per Lateral 40 Lateral Spacing (S) 2.50 ft Orifice Density 6.25 ft /orifice Lateral Flow Rate 16.48 gpm Manifold Length 5.00 ft System Flow Rate 49.43 gpm Manifold Diameter Ealft/sec in Total Dynamic Head 18.14 ft Forcemain Velocity Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and - --► Comm 16.28 WAC 4 in. min. Disconnect 7 Tank component is properly vented 1E Alternate outlet location Forcemain diameter Wie Concrete Manufacturer 2 in. Capacityl 1001.88 Gallons Volume 27.83 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 18.02 501.56 C B 2.00 55.66 Pump off elevation (ft) C 5.48 152.45 � 86.38 D 10.50 292.22 D Total 36.001 1001.88 iF D ose tank elevation (ft) 3' Bedding uncTer tank. 85.50 Alarm Manuafacturer SJE Rhombus Alarm Model Number Tank Alert SJE1011421 Pump Manufacturer Zoeller Pump Model Number 153 Pump Must Deliver 1 49.43 gpm at 18.14 ft TDH Project: Ronnie 8t Deborah Deckard 5- bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name J. Thompson, DOC Credential #30021 Phone 715 - 248 -7767 POWTS Regulator's Name St. Croix County Zoning Phone (715) 3864680 System Flow and Load Parameters Design Flow - Peak 750 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 500 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 600 gal Maximum TSS 150 mg /L Soil Absorption Component Size 750 ft' Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once eve 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Miscellaneous Co r nst uction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished ......... ...•• ............... Grade 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral = ---- -- Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Ronnie & Deborah Deckard 5- bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD- 10691 -P (N.01 /01) and SSWMP Publication 9.6 (01/81)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole 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 a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions II ' are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is ui ed with an alarm �i PP . the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Puma Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and um s shall be tested to veri p p e fy proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for i vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations o s (October - February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg /L B0 30 mg/L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal celt shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as 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. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Ronnie & Deborah Deckard 5- bedroom residential mound Page 6 of 9 • � PUMP PERFORMANCE CURVE MODEL 15111521153 TOTAL DYNAMIC HEADIFLOW 50 PER MINUTE 14 , EFFLUENT AND DEWATERING 12 40 MODEL 151 152 153 10 15z Feet Mon Gat ulers Gal. uters Gel. Lion g0 5 1S 50 189 - 69 261 77 291 10 3A 45 170 61 231 70 265 0 8 25 151 15 46 38 144 63 201 61 231 d 20 8.1 29 110 44 187 52 197 6 m 25 7.8 18 61 34 1 129 42 159 30 9.1 - 23 87 33 125 4 36 10.7 22 85 t0 40 122 - - 11 42 2 Shu4oMHead: 30R 9.tm 38R(116m ) 44A.(13.4m s 014!086 0 10 D BD I D 8D 90 1 C+ lJl�a 40 80 1 14 266 24 40 g FLOW Pj 14N11E 0 Model 151 Models 1521153 M.1n:4: mu rn .5%4 o✓ rye red fig CONSULT FACTORY FOR o SPECIAL APPLICATIONS .7»z $114 $708 4 3VM 4 • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied Wth an alarm. 374 32742 • Variable level conlyd switches are available for controlling ® 1 Single phase system. 374 327132 • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Seated QYA -Box available for outdoor installations. See FM1420. • Over 130•F. (54•C.) special quotation required. 15111521153 Series 11 +via 12 ve 1511621153 MODELS con4rol "scum --T dal Mo Toi -P6 Mode Am sim D4 ax A 41 5 va N151 115 1 Non 6.0 1 2 or 3 BN151 115 1 Auto 8.0 included 2 or 3 E151 230 1 Non 3.2 1 2 or 3 BE151 230 1 Auto 3.2 Included 2 or 3 SK34" SK2084 Ni 52 115 1 Non 8.5 1 1 2 or 3 SN152 115 1 Aub 8.5 included 2 or 3 E152 230 1 Non 4.3 1 2 a 3 U Aub 43 Included 2 a 3 Nan 10.5 1 2 a 3 Auto 106 Included 2 a 3 Nan 5.3 1 2a3 SELECTION GUIDE Aul3 5.3 Included 2 a 3 1. Single piggyback variable level float switch or double piggyback variable level float a CALM switch. Refer to FMO477. Ali installation of controls, protection devices and wiring should be done by a qualified 2. See FM0712fatxxrect model of Electrical Alternator E Pak. licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). 3. Variable level control switch 1 D-0225 used as a contra activator, Specify duplex (3) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. AWL T0: P.O. BOX 16347 Lou"", KY 402580.117 Afenufectnsra of.. �O * SHIP 70: 3649 �2 �8 001 e Run Road m Al Loulsvl8e, K11-1961 • n p p hupJ7wwwzoeil4►r4�fr1 P !0 () 778.273! • 9z8 PUMP �lLd[/Ti /-[Cult? 15 " {,73,7 FAx (602) 774.3624 0 Copyright 2004 Zoeller Co. All rights reserved. ti 2100 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site Ian on County pl p paper not Tess than 8%: x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 030 - 2080 -50 -000 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 Ronnie & Deborah Deckard Govt. Lot NW 114 NE 1/4 S 25 T 30 N R 20 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1382 Pine View Trail 5 Woodland Hills City State Zip Code Phone Number J City I Village J Town Nearest Road Hudson WI t 54016 1 (715) 549 -6921 St.Joseph I Pine View Trail I New Construction Use: Vj Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD 0 Replacement J Public or commercial - Describe: Parent material Glacial drift Flood plain elevation, if applicable na General comments and recommendations: Site suitable for mound system with 12" of ASTM -C33 sand placed on 92.85' contour. System elevation = 93.85'. FT] Boring # I Boring 16 Pit Ground Surface elev. 92.23 ft. Depth to limiting factor 48 " in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 `Eff#2 1 0 -9 10yr2/2 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 2 9 -19 10yr3 /4 none sit 2fsbk mfr cw 2fm,1c 0.6 0.8 3 19-34 10yr4/6 none sicl 1msbk mfr aw 1fm 0.2 0.3 4 34 -41 7.5yr4/6 :::::nee Is 0 sg ml cw if 0.7 1.6 5 41 -48 10yr4/6 none s 0 sg ml cvv - 0.7 1.6 6 48 -88 10yr4/6 f2d 7.5yr5/8 fslAs /fs 1csbk/Osg ml - - 0.2 0.6 H#6 consists of a stratified mix of 10yr4 14 TSI, 10yr4 /4 its, 10yr4/6 Is & 10yr 4/6 fs. Boring # Boring 1/ Pit Ground Surface elev. 91.55 ft. Depth to limiting factor 2 8" in. F Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 10yr2/2 none sil 2fsbk mvfr as 2f 0.6 0.8 2 12 -17 10yr413 none sil 2fsbk mvfr cw 2vf,1 f 0.4 0.8 3 17 -28 10yr5/4 none sit 2f &msbk mfr cw 1vf 0.6 0.8 4 28 -36 10yr5 /4 f2f 7.5yr5/8 sil 1csbk mfr - 1vf 0.2 0.3 * Effluent #1 = BOD? 30 < 220 mg /L 4d TSS >30 < 1 0 mg /L Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Signatur CST Number James K. Thompson "o► 3602 Address A.C.E. Soil & Site Evaluations V Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osce , WI 54020 10/30/2007 715- 248 -7767 Property Owner Ronnie & Deborah Deckard Parcel ID # 030 - 2080 -50 -000 Page 2 of 3 a Boring # Boring 6 Pit Ground Surface elev. 93.58 ft. Depth to limiting factor 24" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0 -9 10yr3 /3 none sil 2fsbk mvfr cs 2fm,1c 0.6 0.8 2 9 -19 10yr413 none sil 2fsbk mfr cw 2f,1mc 0.6 0.8 3 19 -24 7.5yr4/6 none Sid 1f &msbk mfr aw 1fm 0.2 0.3 24 -36 7.5yr4/6 f2d 7.5yr5/8 sl lcsbk mfr cw 1fm 0.4 0.7 5 36 -50 10yr416 c3p 5yr4 /6 fsl /Is /fs 1 csbk mfr - 1 fm 0.2 0.6 4 6 H#6 consists of a stratified mix of 10yr4/4 fsl, 10yr4 /4 Ifs, 10yr4 /6 Is & 10yr 416 fs. � Boring # Boring j Pit Ground Surface elev. ft. Depth to limiting factor in, Sal 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 F-1 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 i * 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 need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (K07 /00) A.C.E. Soil & Site Evaluations • ' /`;ne l�'e� • Soi /eda /L�a�o.�r,r ♦ C,rist5'� �i:: . i — ��P gcJyy�/7c�'y� -sac. z= .r EXi'sfs�� to ��s {ormtr� � I � I � 6f 1 i � � S� C��/1 �j. �Lcm� Cl• = i�...�i i r d Por�1. ; s 21c ✓atcd. ` i r � �om of {'lo0i � 4 : ,BO.C�; Ord•= YS.c°�' - - - -- 4 — 4 �e 6 D Dec't' ❑ Past ��sti,. -�� 6 f✓hroccyl� Systcir+ ..� 9,z,so' fur J 93. so' 2100 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page f 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 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to neares a M�� 0 00 Please print all information. By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / z / Lo - Property Owner t,:. operty Location Ronnie & Deborah Deckard G M. Lot NW 1/4 NE S 25 T 30 NR 20 W Property Owner's Mailing Address L )t# Block # Subd. Name or CSM# 1382 Pine View Trail L � O � 5 Woodland Hills City State Zip Code FPhone_Num I bIN TY City I Village e Town Nearest Road Hudson I WI 1 54016 z0(Fi1 W4=j St.Joseph Pine View Trail _ New Construction Use: ioll Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Glacial drift Flood plain elevation, if applicable na General comments and recommendations: Site suitable for mound system with 12" of ASTM -C33 sand placed on 92.85' contour. System elevation = 93.85'. Boring # I Boring 0 Pit Ground Surface elev. 92.23 ft. Depth to limiting factor 48" 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 -9 1Oyr2/2 none sit 2fsbk mvfr cs 2fmc 0.6 0.8 2 9 -19 1Oyr3/4 none sit 2fsbk mfr cw 2fm,1c 0.6 0.8 3 19 -34 10yr4/6 none sicl Imsbk mfr aw 1fm 0.2 0.3 4 34 -41 7.5yr4/6 none Is 0 sg ml cw if 0.7 1.6 5 41 -48 1Oyr4/6 none s 0 sg ml cw - 0.7 1.6 6 48 -88 1 Oyr4/6 f2d 7.5yr5/8 fsUls/fs 1 csbk/Osg ml - - 0.2 0.6 H#6 consists of a stratified mix of 10yr4/4 fsl, 10yr4/4 Ifs, 10yr4 /6 Is & 10yr 4/6 fs. a Boring # j Boring o fd Pit Ground Surface elev. 91.55 ft. Depth to limiting factor 2811 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /f 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *Eff#2 1 0 -12 10yr212 none sit 2fsbk mvfr as 2f 0.6 0.8 2 12 -17 10yr4/3 none sit 2fsbk mvfr cw 2vf,1f, 0.4 0.8 3 17 -28 1Oyr5/4 none sit 2f &msbk mfr cw 1vf 0.6 0.8 4 28 -36 1 Oyr5 /4 f2f 7.5yr5/8 sil 1 csbk mfr - 1 of 0.2 0.3 Effluent #1 = BOD? 30 < 220 mg /L d TSS >30 < 1 0 mg/L Effluent #2 = BOD <30 mg/L and TSS < mg /L CST Name (Please Print) Signatu CST Number James K. Thompson a--- -- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Os WI 54020 10/30/2007 715 -248 -7767 j , Property Owner Ronnie & Deborah Deckard Parcel ID # 030 - 2080 -50 -000 Page 2 of 3 3 ] F Boring # J Boring Pit Ground Surface elev. 93.58 ft. Depth to limiting factor 24" in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 10yr3/3 none sil 2fsbk mvfr Cs 2fm,1c 0.6 0.8 2 9 -19 10yr4/3 none sil 2fsbk mfr cw 2f,1 me 0.6 0.8 3 19 -24 7.5yr4/6 none sicl if &msbk mfr aw lfm 0.2 0.3 4 24 -36 7.5yr4/6 f2d 7.5yr5/8 sl 1 csbk mfr cw 1 fm 0.4 0.7 5 36 -50 10 r4/6 c3 p Y r4/6 fslAS& 1 csbk mfr - 1 fm 0.2 0.6 Y i H#6 consists of a stratified mix of 10yr4 /4 fsl, 10yr4/4 Ifs, 10yr4/6 Is & 10yr 4/6 fs. F-1 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # J 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 GP 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 , 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) A.C.E. Soil & Site Evaluations fine ♦ EXi3fi' Y "lz e c)c,.` �r� ' / P in¢S �� v 3 Pants I U ( � u V l - /.�82 ��e U •2w'T�a / �P t � � �o� S LtJ�el /a•n U /� • //S � AWy�hEy� SdC..ZS trans fon.�ti� ` p IS- r4V' r p�� p D orc1. ; s e,tc Ja�c d. t �� �om of �'Jopr- JoittS 5n.ed � � ��' � /�es�de�xe . d•= 9s�' '�q i Cork rZ St d+ Shed PosbIgV6, sW°j'u''vLr+9 4.-, -A, /o z5z (/ 1 t- c�C�'� ,�.— EX. : d•apersa./c�,i/ cam+ &Areuyk Systcm.4rea � 9.Z,so• 93.sa' i�. 3 �3 .. 014 :1 ° WOODLAND HILLS WOODL A RURAL SUBDIVISION LOCATED IN THE NEI /4 OF 25, T`3O R 24W, TOWN OF ST. JOESPH, ST, CROIX cwory, WISCONSIN LOCATION SKETCH i /� r l LEGEND /gyp COUNTY SECTION CORNER MONUMENT, 2 ° %3fi IRON F1PE,WEIGHING 3.05 LByIINEAI SURVEYOR � CERTIFICATE 1 �I FOOT,WITH BERNTSEN CAP ' I 1> 0 2 IRON PIPE, WEIGHING 3.65 LBE /LINEAL FOOT. N1YV4 II ALL O HER LOT CORNERS STAYED WITH I °X;I IRON P1PE,WEIGHING L68 LBSAINEU I, FRANCIS H. OGDEN, REGISTERED LAND SURVEYOR, HEREBY / / FOOT. - CERTIFY THAT .i HAVE SURVEYED DIVIDED AND MAPPED WOODLAND HILLS, LOCATED N. ��� W II'X 24 IRON MPE,WEIGBING 1.69 LBS./UNEAL FOOT, ON LINE. MARSH THE WI /2 OF THE NE 1/4 OF SECTION 25 AND THE SE !/4 OF SAID NE I/4 OF SECTION SECTION LINES I 25, T 30 N, R20W, TOWN OF ST JOSEPH, ST CROIX COUN - t Y, WISCONSIN, DESCRIBED AS NOTES FOLLOWS COMMENCING AT THE N 114 CORNER OF SAID SECTION 25, THENCE N88`530 "E ALL DISTANCES, LENGTHS AND WIDTHS ARE MEASURED TO THE NEAREST ONE (TRUE BLARING) 392.61 ALONG - ;HE NORTH LINE OF SA10 NE 1/4 TO THE POINT OF j HUNDREDTH OF AFOOT. ALL ANGULAR MEASUREMENTS RAVE BEEN MADE TO THE $WI /4 SE 114 NEAREST TWENTY SECONDS AND COMPUTED TO THE VALUES SHOWt BEGINNING; THENCE N88 °59'30 895.57' ALONG SAID NORTH LINE OF NE 1 /4, THENCE I ALL ecaAlNDS ARE TRUE FROM SOLAR OBSERVATIONS MADE AT THE 917E S OW4'30 ° W 13470 ALONG THE EAST LINE OF THE hlWl /4 OF SAID NEV4; THENCE ' THENCE � N 89 °00'04 "E 890.19 ALONG THE NORTH LINE Of THE SEIl4 OF SAID NE i/ 4, SO'0910 w F F PRESENT COUNTY I I T- _ 0 Ea _� ---- -- S N 1HE NORTHERLY RIGH T-OF-WAY LIN 0 � A POINT WHICH I. 0 1.63.56 TO LO CATED IN THE n1 S AI D C Y LINE; - LD ° ° ° ' N 1 SAID NORTHERLY RIGHT -OF -WA L , ' SECiN1NR; 730N, TRUNK HIGHWAI E ,THENCE S 89 5642 W , 65.16 ,>.ONG ME y4 , F ROW, TOWN OF ST. SEPH °Fr Sl, CA01 %CCUNTY,WIS ISCCNSIN TH ENCE SO °03'B'E 1200 ALONG SAID NORTHERLY RIeHT•OF -WAY LINE, THENCE S89 „o 42'W 385.82' ALONG SAID NORTHERLY RIGHT-OF•W'AY LINE; THENCE WESTERLY 126.36'ALONG SAID :E coRNeR CHORD BEARS N 6640 126 30 A 1'12.51' RADIUS CURVE CONCAVE NORTHERLY WHOSE U�,TTED PLA. LANDS sealoN2s, NORTHERLY RIGHT-OF-WAY LINE ON T Nd4CORRER 1 PD,NY OF efG1•NNG ........ -. TwN,R2oW THENCE N 6oT02 ° E 22.x ALONG SAID NORTHERLY RIGHT I SECTION 25, ` ^.Y—_ N BB'S9 30 E e576.35 - NORTH LINE OF NE U4 B 557 � OF-WAY LINE ;THENCE WESTERLY 358.64 ALONG D NORTHERLY RIGHT•Oi•WAY LINE ON A 3928'5930`E 78000 % d 12&k I8 113N 683 A �4 157 5 7 5 so 33 'ap W "�" X 41 10.0'9 2' RADIUS CURVE CONCAVE NORTHERLY WHOSE CHORD BEARS N 74'07 ' W 35703' j f SW,91' h0 R''r> [go Do' o ^ ? 0 °90, W THENCE N64 °42'48 232.38'ALONG THE NORTHEASTERLY RIG'dT Of WAY UNE OF SAID PRESENT a W COUNTY TRUNK HIGHWAY V; THENCE N25 °17'12 15.0kONG SAID NORTHEASTERLY RIGHT OF WAY LINE; THENCE N64`42'48 ° W 1025.07'ALONG SAID NORTHEASTERLY RIGHT-OF-WAY Lit( 21 h ° \a, z 62 ACRES N °%7 THENCE N 0`40'271 226.41' ALONG THE EASTERLY RIGHT- OF-WAY LINE OF PRESENT STONE LAKES 0 T � 8 9'30"W 290.00' NC S 8°5 THENCE A ROAD; THENCE N88 °5930 E 29000, THENCE NC 402T� 400.00; E 22 P° e 3s a THENCE NO ° 40'27''E 66.03' ALONG SAID EASTERLY RIGHT OF WAY LINE OF PRESENT SiavE LAKES • III Q , nES ROAD THENCE N 88'59'30" 350.00 , THENCE N O`40'VIE 1183.82' TO THE POINT OF 8EGINNklING. �w I CERTIFY THAT I HAVE MADE SUCH SURVEY, LAND DIVISION AND PLAT BY DIRECTION OF ( v \ THE OWNERS OF SAID LANDS (HAT SUCH PLAT IS A CORRECT REPRESENTATION OF ALL THE EXTERIOR 80UNDAR)ES OF THE LAND SURVEYED AND SUBDI';ISION iI�FRECF MADE, THAT HAVE ?1S50"W 329.0. N 87 FULLY COMPLIED WITH THE PROVISIONS OF CHAPTER 236 OF THE WISCONSIN 9 N " 2E 411.13 ° z _ n ; STATUTES,ST. CROIX COUNTY _70MNGORUNAPCE, AND THE TOWN OF ST.JOSEPH,iN ---- X ° J ' SURVEYING, DIVIDING AND MAPPING THE SAME. y]µ� Y ((V O' J FRANCIS H. OLDEN 19 o REGISTERED :AND SURVEYOR N0.5.882 n 23 a I 1 II a 210 ACRES Ej6 ` 2501CAE5 " n 'll�� CURVE DATA TABLE DATED THIS 161H DAY OF DECEMBER, 1975 .I w ry II r71il 'h ° O �, DWI 0T Rw (no cx°no cCxrNFI LPxGENt IV�D THIS 29TH DAY OF JANUARY; 1976 OCCUPIES m X0. lFNb3N LEXC7N N N01E A!0 nK TAtE 3305 0 _ N0. BEpAIN6 htlGlf 9EpxINb 1 o THIS PO!Ni P ' 0, ry C, 1.2 5 20°.07 191 EE4 °05'02'E 55 °5056" 937'09'H'f I��11 y C S 0 0 0 9° Np 6 = N89'091 ° 'M1 �� 46 se9 °SN2o'E A 45...d ° 1$.07 �t d 283,19' 3A< °55'OSE 90 °08 E W 1 mmnW, _- 3.4 266.00' 236.6, SE5•.4'2YE 5 �I O 3.6 Zoo M' Id130 S70°035BE 39.50 SB' )0 I0, _ GQN 4' I 1 06 _ 1 37665 9o_OP1 _ �, y„_Sr , Q" I n 3, • 30 \ 1�9 2F600� N44 °5505`W 90`00 M' k6 ° °59'2Gw ^� 14�'�; 1 I °O` �I 2 44.X9 x o'ao'so'w 9 ° A'IlCISH Zd n4s1' N2E4r v "w 5e'22'la OGOEM ,,; I .. -... ...0 N o { __ 66s2' µ� 'sa`T— sd0 1 r i urr Arre6 N X35 ° °4D,' _ • 240.9G N64TYI bYW 918' IB 0 , 21 of i I I ° 2.64 ACRES 0 9 -ID 2o0.o7 _ 45 X37 °0974'W ZI p� a 215 ACRES o 3 0 ., co LANDS xt h I. 266.00 15805 NS/ 14'33 557 1 F-{ N NN�•f- N 11.16 266.00 W 33 ° 5015 SBCSd MXW 44 II SUEL +1 IY•!5 266.00' 67C4 NiB6Y52 25566" 00'It40w Nry1PM I NWI /4•NEl /4 PMP 9, w 13.11 90.00 1466'1 NB9'1953'W 226'St4b' S2Z ° 45'59 , ^ Z 0 0 ry 9 N99r09.38 9W.52 Dap„ I9 3616 N11.Ot38'f 26'Od2B TMn N Mf ,,% bS. 235.)5,. 9 189.84 Y' I 20 . I il.l9 X29 °26'S5w 5X4554' �I ' a e e 2n.6e` } Dom+ asm �i3 33, 06 01 2 K 5de�, 6MD4� Wu NA paMld + 21 62.7 ___ - - - -- •O Y9 MATCH LINE- MATCH SHEET 2 — 22 Bo' 6 2u.Iq: NW Nn Fbbo fry S+A NB8 375. WR -- -�- - S MATCH LINE- MATCH SHEET 2 3a \U �. �f� W Y3 3S W` 5lo °OYSYf 25 °16'ob' j I. 1 \y _ .• 3N4d dds ,tltN'dol 3 �.2[lNh4'•191�: 9 °. 0 3 33 a 17' 0 Z Ifi•W' N 26fi.00' 2216 1'_ N BB9d3f 4'dt'SD' �6e°5956'W 3 S ?+ 25 0 I 1718 10 1112.92' 12670 X68 °16091, b °30'20' 1119, S6 A 19.20 109592' .351,01' p74.07 IE °W b' _ N6942'9Bw •• ••.•. �(( r CERTIFIED SURVEY MAP 0 n753 H75 °IO S3w 6 ° +4'm' BN4ery Ecyad perNy NOW wnNY AWMw VOLUME I PAGE,L88. SCALE IN FEET 39.95 Nes•+Y49'W 2 'oate DpamnAadAtlox AONwNpWM _ - 200' 100 b' i0U 209 THIS INSTRUMENT WAS DRAFTED BY / SHEET, 10F3 . E3lzi t f Vl i 82 55 ) EO���,o�`►52.7'3� 6�? 350.00 153°4' 32_ S 88 59 30 7 0 2.7 3 8895330"F- 704.66' � C _ t6 _66 S SW59 36 414-656� , iED SURVEY 1 +CA! 1 '0 �� MAP 5 �, a 4 �rw�i�i � 2.29 PACRES 3.i� —�� z z _4�► i • 'S 0!> f SOX o 290.06 Ste, �r�' 250.0 Al Z 1 3 8.67 , ��, .t• a =. i . �' v �� c 81 i 0 0 .13' Or M -- !j 68 °59''�0'YE 4 28,667 , i 3 4. 5 f � (y °1 •� rn• N 88 0 53 30 .o 2.43 ACRES `} o� nj 33219 + I 1 24 X15 I UNPLATTED. LANDS I . �MAra LIN MATCI� s EEi .... -• ! �MAICH UK -M4TCR SHEET I _. . } c _ >➢3B4 _ .0 ---F WOODLAND HILLS - _ N .. _.. v . , ...._ - .. V08 °5930'2 37503 6 i m 0 i c '�' ° a b y ' n S� ° . C _am ,�, 09'fOE 461.52 _ li m P ?Y 0 fl p9 e e 1 0 v `. CEASIfIED SI�RVY � Nc�N m o A RURAL SUBDIVISION LOCATED IN THE NE1 /4 OF SECTION 25,T34.N, VGIUME I PAGE 188 N f « vJu I R 20W, TOWN OF ST JOESPH, ST, CROIX COUNTY, WISCONSIN J33',33 ' 25 0� �1j .o 2.19 ACRES u�za 4.41 ACRES . �/ o m 4 0 P 0 4b : I o W I 1 .1824355: 165 " i - i I yd 9cv0, gE` a0'° A 33 00 ! ' B� 400 °593CiE 3 35213 �S6R ((( p ry'' i I N �,46 3`,110 'm 1570432 �'' n 'ro 5 68 102.7 m Oti UNPLATTED LANDS_ I fl• oae m wB8'S9_?0E ?OC �6 \ ,�6y __. _. 1 H LINE SE l / N i 6� „'� 91 h P Ac 4 41465 0 0f E 174 290.09 I646 y $� •°. °" � ° Z e N S9-0004'E 6SU.IS NO �. S88'S330w A 9 0• 's \ R7gp' 10.12 © Uf 180.20 350.00 j, cf 6,98.96 VI; 1 1 JN ro d v 02.91 107.28.�p 9 ,9 I 350.00 tliI n 0 e 190.1 6 Z 1. 9 b i46J v g l CERTIFIED SURVEY_ . 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State 6W o y� •° �� , rRANClS H OGUEN CwNRd BIN „�;.�.' uF;,.G•R4/! .. 19�� ` n n 232J9 271 ACRES m REGISTERED LAND SURVEYOR 5.882 VATED DOS 16TH DAY OF DECEMBE11,19 ... • ^° � NORTHERLY w6xT -a -war UN'E7 PFVISED THIS 29TH Ditf OF JAM1M7',1916 DMtlm, hyaaal FhPdnP S tmnuniry AniRame \ 'P // "rry Oewn,.0 •! v,l Alklo A ^",eDp -r, \ P 1 165,16 IIIIIOIUNNNIMI y 1 ” 273 °!310 99. 92 6 seY5 219.04 G 42W .. ... ; r� l ' hQ 3 m 38 509 -_ -J_- 56 =1V 5.02 n 2 ' 1 CENTER OF SECTION. 25, 5 ' , ^ — ^ LFRA0 _' - -I 2594.46 7 - -� UNPLATTED UNDS <CTI 'S, , 4 ° ` s �, ----- r3oN,etow �E,,1� NOTE OUIIAT 115 TO DE OWNED IN COMMON BY THE pwVER$ OF Iar � 4 SUk P LOTS I, 2, 3 AND 4 FOR ACCESS TO A ?UBLIC ROAD. 'wuluww' , THIS INSTRUMENT WAS DRAFTED V SHEET 2OF3 Safety and Buildings PO BOX 7162 commerce MADISON WI 53707 -7162 TDD #: (608) 264 -8777 i s c a n s i n w wvcemmerce.wi.gov /sb! www.wisconsin.gov l t Departmenti Commerce Jim Doyle, Governor Jack L. Fischer, AI.A., Secretary December 06, 2007 CUST ID No. 30021 ATTN.- POWTS Inspector JAMES K THOMPSON ZONING OFFICE A.C.E. SOIL AND SITE EVALUATIONS ST CROIX COUNTY SPIA 340 PAULSON LAKE IN 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 APPROVAL OF PETITION FOR VARIANCE Identification Numbers Transaction ID No. 1489457 SITE: Site ID No. 732675 Ronnie and Deborah Deckard Please refer to both identification numbers, Town of Saint Joseph, above, in all correspondence with the agency. St Croix County NW1 /4, NEIA, S25, T30N, R20W Lot: 5, FOR: Petition for Variance Comm 83.43(8)(1) The submittal described above has been reviewed for equivalency to applicable Wisconsin Administrative Codes and compliance with Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in section 101.01(10), Wisconsin Statutes, is responsible for compliance with all conditions of this petition approval and other applicable code requirements. Plan submittal and approval to the department or its agent may be necessary prior to construction undertaken per this petition. The code section petitioned requires that the exterior subsurface of a treatment tank or holding tank component be at least five (5) feet from a building. The variance requested is to permit an existing 1000 gallon concrete septic tank to be 16 inches (1.3 feet) from a supporting footing post of a 3- season porch. The intent of the code section petitioned is to protect the waters of the State, structures and the treatment and dispersal components in the event of a component failure. The petitioner submitted the SB -9890 application form including additional page(s) of supporting documents and/or O� Q plans. r Reviewer's Comments: C 1. The supporting footing posts appear not to be affecting the integrity of the septic tank. Q O � 2. The septic tank manhole cover is accessible for service and maintenance. C �4 3. Examination of the septic tank by the designer and/or his agent found it to be physically sound and no appearance of the threat of collapse. 4. The existing septic tank will be included as part of the replacement onsite wastewater treatment system serving the residence. Departmental Action: CONDITIONAL APPROVAL Reviewer's Conditions of Approval: None All of the petitioner's statements of fact or intent included on the variance application form, any other documents submitted to the Department, as well as any other conditions of approval listed below, shall be carried out. Any recommended conditions of approval by the fire department and/or municipal building inspection department listed JAMES K THOMPSON Page 2 12/6/2007 above shall also be carried out unless otherwise stated below. This variance is specific to the subject petition and cannot be used for any additional modifications. This decision will become final unless the department within 30 days from the date of this letter receives a written request for a hearing. A request for hearing should be sent to the address shown on this letterhead. A copy of this letter must be - included with the request for a hearing. The request for hearing should state the reasons for objecting to the depa ent's decision, because a request for hearing may be denied if it does not present a significant question in ct, 1 or olicy. In uirie nee g this correspondence may be made to me at the telephone number listed below, or at the address on this 1 rhea . S'' cerel Fee Required $ 225.00 Fee Received $ 225.00 Balance Due $ 0.00 ar S inger PO TS n iew tegrated Services WiSMARTcode: 7633 (608) 61 -7 5, Fax: (608) 267-9566, M -f 7:OOAM - 3:45PM mark.fi er @wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. t.ommercwiov APPLICATION FOR REVIEW PETITION FfRCEIVED 103 qq,5 7 iscop VARIANCESBD -9890X u(; — 5 2007 - Cornpleteallpages- Dep®rtrneM Safety & Buildings Division This page ma tments Bureau of Integrated Services Complete and indicate date plans will be in our office 1. Facility Information Complete for confirmed appointments *: Facility (Building) Name: Ronnie Deckard residential mound Transaction ID: 1486763 Number and Street 1382 Pine View Trail, Hudson, WI 54016 Previous Related Trans. ID: Commerce Site Number (if known): Na Assigned Reviewer: Legal Description: NW1/4NE114. Sec. 25, T,30N.. R.20W. Assigned Office: County of: St. Crrok Review Start Date *: () City () Village (X) Town of: St. Joseph *Submittal must be received in the office of the appointment no later than 2 working days before the confirmed appointment. NOTE: Personal information you provide may be used for seconds u oses [Privacy Law s. 15.04 1 m , Slats. 2. Owner Information Customer # 3. Designer Information Customer # Name Ronnie Deckard Designer Jim Thompson 30021 Company Name NA Design Firm A.C.E. Soil & Site Evaluations, LLC y Number and Street 1382 Pine View Trail Number and street 340 Paulson Lake Lane City, state, zip code Hudson, Wl 54016 City, State, zip code Osceola, WI 54020 Contact Person Ronnie Deckard Contact Person Jim Thompson O 2 Telephone Number Fax Number Telephone Number Fax Number (715) 549 -6921 715 248 -7767 715 248 -7764 4. Plan Review Status Plan previously review by (please enclose a copy of review let�lt) _ Plan submitted with petition A State _ Municipality _ Approved X Held _ Denied Plan will be submitted after petition determination Code Being Petitioned r Requesting revision _,-, Other: _ Building _, HVAC _ Plumbing X Private Sewage System Commerce Transaction Number _ Swimming Pool _Electrical 6. State the code section being petitioned AND the specific condition or issue you are requesting be covered under this petition for variance. s Comm 83,43(8)(1) Existing septic tank located at 0' from e, lgvated 3 season porch supported by post footings nearest footing located at 16" from edge of tank. Tank is also located 52" from existing deck. 6. Reason why compliance with the code cannot be attained without the variance, Existing POWTS has hydraulically failed and must be replaced. Existing septic tank cannot be re -used without variance approval Excavating to remove tank or attach to building sewer upstream could result in damane to the structure or disturbance of structural footingg. 7. State your proposed means and rationale of providing equivalent degree of health, safety, or welfare as addressed by the code section petitioned. Existing concrete septic tank has been examined and found $,g be physically sound and does not gopear to present a threat of collapse Porch is elevated with bottom of floor joists 50" above grade — 54" above top of tank maniple cover, providing adequate access for safe inspection service and maintenance As tank and structure are already in place, there will be no physical damage to the component or structure if left in place 8. List attachments to be considered as part of the petitioner's statements (i.e., model code sections, test reports, research articles, expert �(}� opinion, previously approved variances, pictures, plans, sketches, etc.), Tank / structure detail. Existing tank certification statement VERIFICATION BY OWNER - PETITION IS VALID ONLY IF NOTARIZED WITH AFFIXED SEAL AND ACCOMPANIED BY REVIEW FEE Note: Petitioner must be the owner of the building or system or credential applicant for a Comm 5 petition. Tenants, agents, designers, ntr g��gp� attorneys, etc., shall not sign petition unless Power of Attorney is submitted with the Petition for Variance Application. Ronnie Deckard being duly swom, I state as petitioner that I ad the foregoing petition and I believe Petitioner's Nam r tint it is true and that 1 have significant ownershi r hts tO the subject building or r 'ect. e c c Si vtu Subscribed and sworn Note Public My commission expires t �e me this date S•� on Complete other side for va kance requests from Comm 20-26 and Comm 6-65 MAKE CHECKS PAYABLE TO DEPT. OF COMMERCE TOTAL AMOUNT DUE $ 225.00 Attach check here. SBD989OX (R. 11/2005) (Check our website at littn: / /www. commerce. state .wi.us /SB /SB- DivFonns.html for the most current version of this form) V 1862P 3y1 STATE BAR OF WISCONSIN FORM 2 - 1999 4 7 6 1 Document Number WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Chelan N. Patel and Meena C. Patel, RECEIVED FOR RECORD husband and wife 03 -28 -2002 8:25 AN WARRANTY DEED Grantor, and Ronnie Deckard and Deborah Deckard, husband and EXEPPT # wife REC FEE: 11.00 TRANS FEE: 814.20 COPY FEE: PAGES COPY FEE: Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot 5, Woodland Hills in the Town of St. Joseph, St. Croix County, Name and Return Address Wisconsin. First National Sank of New Richmond PO Box 89 New Richmond, WI 54017 030 - 2080 -50 -000 Parcel Identification Number (PIN) This is homestead property. (is) I�ai�Q Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of March 2002 c4- AJ � + + Chetan N. Patel + ► Meena C. Patel AUTHENTICATION ACKNOWLEDGMENT Signature STATE Chetan N. Patel and Meena C. Patel, husband and E OF WISCONSIN ) wife ) ss. I County ) authenticated this Z� S day of March 2002 Personally came before me this _� 3,3 6 day of the above named + Kristina O land , Mttn.. TITLE: MEMBER STATE BAR OF WISCONSIN ,. (If not, to me known to bt; h&J)ersan(s) who executed the foregoing instrument and acct owladged the same. authorized by § 706.06, Wis. Stars.) � THIS INSTRUMENT WAS DRAFTED BY + Attorney Kristina Ogland Hudson, WI 54016 Notary Nota Public, !eat of Wisconsin 1'4 My Commissioda_ l rntanent. (If not, state expiration date: (Signatures maybe authenticated or acknowledged. Both are not necessary.) " Names of persons signing in any capacity must be typed or printed below their signature. f*r j ,i o,metw,tnraressI�Ws c ompany, Fond du Lw, WI WARRANTY DEED STATE BAR OF WISCONSIN 600-655 -2021 FORM No. 2 - 1999 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND f� OWNERSHIP CERTIFICATION FORM Owner/B �� IC on *7, Ze4,xt Mailing Address 13 8 z - A � uJ a i Property Address `� t / (Verification required from Planning & Zoning Department for new construction.) City /State ?'it Parcel Identification Number 030- ,2 -' 0 6V ' SO `CC0 LEGAL DESCRIPTION Property Location . t/a , �E t /a ,Sec. -Z S , T 0 N R -2--0 W, Town of • �a SC�s� Subdivision l ' /l5 , Lot # _ Certified Survey Map # /1a , Volume , Page # — Warranty Deed # (e 7 761 , Volume 1,662 , Page # •3 5�� Spec house no Lot lines identifiable es SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition,and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number Vbnis LI.EIs SIGNATURE OF APPLICANT(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) ST, CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the t<'Ot7 nre– residence located at: AIJ '/4, Af - '14, Section zS , Town 36 N, Range .2d W, Town of 5�.�aso� , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service 1 1 1 1016 7 Did flow back occur from absorption system? Yes No k- (if no, skip next line.) Approximate volume or length of time: gallons — minutes Capacity: GPI Construction: Prefab Concrete Steel Other Manufacturer (if known): ;wn): ank (if kno 30 y2aaf sed Plumber Si Signature) (Print Name) (Title) (License Number) MP /MPRS z&t a� 7 (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rarcel #: 030 - 2080- 550-000 07/13/2007 10:33 AM PAGE IOF1 Alt. Parcel #: 25.30.20.682 030 - 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 O - DECKARD, RONNIE & DEBORAH RONNIE & DEBORAH DECKARD 1382 PINE VIEW TR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ` = Primary Type Dist # Description # 1382 PINE VIEW TRL SC 2611 HUDSON SP 1700 WITC i Legal Description: Acres: 2.290 Plat: 2644- WOODLAND HILLS SEC 25 T30N R20W WOODLAND HILLS LOT 5 Block/Condo Bldg: LOT 5 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 25- 30N -20W Notes: Parcel History: Date Doc # Vol /Page Type 03/28/2002 674761 1862/341 WD 07/23/1997 838/610 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.290 77,600 205,900 283,500 NO I Totals for 2007: General Property 2.290 77,600 205,900 283,500 Woodland 0.000 0 0 Totals for 2006: General Property 2.290 77,600 205,900 283,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 10/10/2005 Batch #: 05 -30 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 00'0 00'0 00*0 Ielol soBJe4a;uenbullaa soBJe4a leloadS s;uewssessy leloadS ;unowV ti0604ea epos leloadS Jas :s1epedS 60Z :# 40Ie8 :a ;ea uoneoliljaa 1, :;unoa wlel0 :11pa.lo Aial}o 0 0 000'0 puelpooM 009'££L OOE'69 OOE'bb 000'£ A:pedOJd leJauaE) :£OOZ Jo; sle;ol 0 0 000'0 puelpoom 00L'L91. 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