Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
030-2056-20-100
4isconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safe? and wilding Division , ` I ` ? INSPECTION REPORT Sanitary Permit No: 453481 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID : Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. IOZ17*1 N : Tt_14A1S. � Permit Holder's Name: Township Parcel Tax No: Krueger, Dave n 030 - 2056 -20 -100 CST BM Elev: Insp. BM Elew 9� 4BY Description: Section/Town /Range /Map No: 5"',`.r 27.30.20.552A TANK INFORMATION ELEVATIOAI DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark LNG• �•t o� 3.30 /'03,11. s115120 TZ Dosing L'.) &t Alt. BM Aeration Bldg. Sewer \ Holding St/Ht Inlet .Ql J1 q.b3 TANK SETBACK INFORMATION St/Ht Outlet ; 2. 3 3, TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 76 .= f it .� Septic Or + y e t Z I �_ Dt ott; � ' -� +- Dosing D /� � Header/Mb. ( $ r Aeration Dist. Pipe 1 4 5 2i. 4• 8 Holding Bot. Syst � Z� • 2� 9�,� Final rade (A PUMP /SIPHON INFORMATION �j [ (2 + " Op Manufacturer ;? 4, St Cover GPM M odel Number `� TDH Lift Friction Loss System Head TDH 1Ft • 3 2• ° 2• �`Z- 3 -ZS T QK� ��• Vicemain Lengt Dia. Z to Dist. to Well SOIL ABSORPTION SYSTEM 5.1 E Width r Length No. Of Trench s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth -11 MENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHI a cturer. INFORMATION CHAMBE OR Type Of System: ti ! ` �� ♦ UNIT Model Num DISTRIBUTION SYSTEM U.* -6 40e 7 & C.%.& P.*- . Header /Manifold tr Distribution Length t ' ct x Hole Size x ole Spacing Vent to Air Intake pipe(s) 3 b tr Dia Length � Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges To soil g p l Yes No I'" Yes COMMEN Include code discre nncie, s, s pe,�soy[� present? Inspection #1: / ` / O q inspection #2:t�i• 1 ( �F eQtlHQL'Y'i0 Location: 1356 Egard reet o(lton, �I 54082 (NW 1A SE 1 /0N R20W) Village Plat of Houlton Lot 2 Parcel No: 1.) Alt BM Description = JkJ/R CL• RA ok r SOt 2.) Bldg sewer length= t� 3 amount of c �. D `g `• V t 1e� ©, Q.KI . S •� .a ce�,or ' a /4't S A ) ,,,�, i Plan revision Required? [') Yes No • 1 2 � Use other side for additional information. .S ____ ___ ___ _ ___ . - -� - -1- - - -- - 6710 ate nsepc ors Signa re a - Safety and Buit6ings Division County m w 201 W. Washington Ave., P.O. Box 7082 T f sCQ�s n Madison, WI 53707 — 7082 Sanitary Permit Number (to bf filled in by Co.) De artment of Commerce (608) 261 -6546 O j7 I / Sanitary Permit Application State Plan LD. Number / In accord with Comm 93.21, Wis. Adm / O 2- -1 / ` Code, personal information you provide may be used f- secondary purposes Privacy Law, A 5.04(1 xm) Pn�c�ct Address (if different than mailing address) L Application Information— Please Print All Info atio O _ Q s / t0 Property Owner's Name Parcel # Z Block //# Property Owner's Mailing Address Property Location 35 �e 6 - 4t 2D 57 s t N w sw 2� Ci State '/a Y., Section ty. Zip Code - !'hene34+iw�bes.e..__ • _ /� y-oU� fVN �. 5 kf p f Z ;L �� • ZZ7 / 3 0 Aircleone) T N; R !or W IL Type of Building (check all that apply) 156 or 2 Family Dwelling - Number of Bedrooms - 3 Subdivision Name CSM Number ❑ Publicl Commercial - Desatbe Use - - -r P/11' d"` P 1 4 � r { � " () cro A) ❑ State Owned - Descnbe Use ❑Cit ❑Village Rkowoship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New S yg g Replacement ly ❑ Other Modification to Existing Syste m. System iRepiat S rem ❑ Treatment/Holding Tank R lacement On B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner V l!� / 2WO IV. Type of POWTS System: Check all that apply) ❑ Non - Pressurized In- Ground Amound > 24 is of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized infirrou o mg an Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe Q Other(explain) V. Dis ersaliTreatment Area Information: Design Flow (gpd) Design Soil Appli ion Ra 'I f! Dispersal Area Req iced (si) Dispersal Area Proposed (sf) S � Elevation 50 S� VL Tank Info Capacity in Total Number Manufacturer Mcfab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks , Septic or Holding Talc /.y� Aerobic Treatment Unit V �+ Dreing Chamber O `O / VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) I Plumber's Sbigiature 44NMPRS Number '+ Business Phone Number R' 2c I b t 1 - 7 1.5 • T?a' 3`/y Plumber S�A (S City, State. ZiCode) � 5 I / U/ 1 ! /• S� / T VII oun /D epartment Use Onl Approved ❑ Disapproved Sanitary Permit Fee includes Groundwater Ewe issued ing Agm Signature T rps) Surcharge I.) ❑ Owner Given Reason for Denial IX, Conditions of Approval/Reasons for Disapproval �� C �� S CTY) v 1 Septic tank, effluent filter and dispersal cell muss _Ili ue serviced / maintained Ila� 8S per ma gQ r�l Ilt C 212II - ; r ^��I�Tlumb ®r 2. All setback requirements must be maintained as per a licabiu code /ordinances. Attach complete plans (to the Cotwty only) fir tl a system on paper not less than 81/2 s it inches is" SBD -6398 (R. 08/02) I s I - 6 � ' Zt St �v�lv co0�" � / /i}u r i yy� �0 J A /000 ' Pas �- o 1 mm m � rn K Zmz z o z �l w0D0 w Z / o x�Q 3 y o °cn� ,' r X r Z c.op z = co '. . 4 n �• � sue i ! w ME •.S CD co co `.. � , w W t` A A °a �i b O N G C Q 1 l I Wisconsin Department of Commerce Safety and 1�uildings Division PRIVATE SEWAGE SYSTEM C ou nty : INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No,: Personal Information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 370299 Permit Holder's Name: ty ❑Village [I D6wn of: State Plan ID No.: ❑Ci Krueger, Dave Village of Houlton CST BM Elev. Insp. BM Elev.: BM Description: Parcel Tax No.: CM 10 13 4,,,� 030- 2056 -20 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION HI I FS ELEV. Septic tSV-D Benchmark 53.5 ris Dosing Alt. BM Aeration Bldg. Sewer Holding St /Ht Inlet -n) 0-, " �� 63' TANK SETBACK INFORMATION St/ Ht Outlet 13 85 Yi` �� • 33/ TANKTO P/L WELL BLDG. V take R T `(( P 89/2 97.00 Septic 5 D'+ Of 1Z ` NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand St cover ( (o Z� Qg 9 Z Model Number GPM TDH I Lift Friction System TDH Ft ead L oss Forcemain Length Dia. Ff Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits inside Dia. Liquid Depth D IMENSIONS DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing I Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over 78ed h Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Tren ch Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 037 1 * (3 Inspection #2: Location: 1356 Edgard Street, Houlton, WI 54082 ( 27 T30N R20W) - 27.30.20.552 Village of Houlton -Lot 2 1.) Alt BM Description= 2.) Bldg sewer length= - amount of cover = f owl, r,l Plan revision required? ❑ Yes No Use other side for additional info rmation. SBD- 6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings PO BOX 7162 co'mmerce.Wl.gov MADISON WI 53707 -7162 TDD #: (608) 264 -8777 I sco n s' n www.commercestate.wi.us /sb www.wisconsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary August 06, 2004 CUST ID No.226375 ATTN.• POWTS Inspector ROBERT W ULBRICHT ZONING OFFICE ULBRICHT & ASSOCIATES CO ST CROIX COUNTY SPIA 2812 10TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/06/2006 Identification Numbers Transaction ID No. 1027714 SITE: Site ID No. 687413 Dave Krueger - Dwelling Please refer to both identification numbers, 1356 Egard St above, in all correspondence with the agency. Town of Saint Joseph, 54082 St Croix County NW1 /4, SW1 /4, S27, T30N, R20W Lot: 2, Block: 6, Subdivision: Platt Village Houlton FOR: Description: Replacement Mound System / 450 gpd Object Type: POWTS Component Manual Regulated Object ID No.: 972915 Maintenance required; Replacement system; 450 GPD Flow rate; 28 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 Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. This system is to be constructed and located in accordance with the approved plans and with the component manuals listed above. R( 2. On pages 3 and 4, the following adjustment was made to the distribution network design as specified in C>( lu the approved pressure distribution component manual: Ar' ` Y = 24 inches A EDF Number of orifices (holes) per pipe = 22 Lateral discharge rate =14.41 gpm System discharge rate = 28.82 gpm SEE CORF A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. . i ROBERT W ULBRICHT Page 2 8/6/2004 In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerel , Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 P ter E Pagel Private Sewage PI n Reviewer , Integrated Services WiSMART code: 7633 (608)266-2889, M - F, 0630 - 1500 Hrs pepagel @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715)726 -2544 " ULBRICHT & ASSOCIATES CO. 2812 10th Ave. - Spring Valley, WI 54767 Reg. Designers of Engineering Systems 71 5 -772 -3442 Private Sewage Consultants 0 �R PROJECT INDEX Plan C� 7 O !� an I.d. # date Owner I DAUID K P, U e6-E? , - Phone 7�5 • s � <(• � s� H Address 1 6 AR ST. Otst,TDN 2 S/ja. 2.7. - 77 5 wt • SyD� L Ir• Legal description Lo r 2 t t3 I [C- & • U 01 A. 14ouc P G.14T , 5W t SA C. 27 . T 3 0 ,Rao w Town of :5-r. S o S e ph County S j C-Q O C X- C.S.T. R , Zt Ible.t � (-� 2�.Ct3'Z Installer R- 74 (b (47 Local Authority/ Supervision S T - - C 20 r )( Zo x.� i AN(r b a jo't' . PROJECT DESCRIPTION PIN) -0 0 30 . 1 054 - 2,0 - ioo RV M C e - ,At4.v T 5 Foie A F�4t�r �JCr Nom • 60 49.e e-0•4fp /, A) T 2> w ee S IZE-D , s�� 00A uY F0 AZ A 3 --m. N0A4E - dp s 4 J,4 tLy Fla RA -:t- 450 W S • 4V IA,, h 60 CAy P 16 fA.)7 1006 SOX. I & Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. F Fl o Spring Valley, Wl 54767 " B o 1�1 P R5 ii -1 5 CrO; & — * PRS NDPLAN vIEWS SEC CROSS SECTIONS,& SYST A VIEWS (REVERSE SIDE INSPECTION PIPES & FABRIC /TOP FILL DETAILS) g. IPE LATERAL LAYOUT (REVERSE SIDE SHOWS DETAILS OF LATERAL LEAN OUTS) 0 Pg. OSING CHAMBER CROSS SECTION & SPECS. �.� Pg.5 PUMP PERFORMANCE SPECS (REVERSE SIDE SHOWS PUMP DETAILS) Pg.6.OPERATION, MAINTENANCE REQUIREMENTS (REVERSE SIDE SHOWS SITE & SPECIFIC PROJECT DETAILED INFORMATION,UNIQ UE TO LOCALE AND GOVERNMENTAL UNIT AREA) The attached plans and specifications are based on the following approved manuals: "Mound Component Manual For Private Onsite Wastewater Treatment Systems '} (Version 2.0 SBD- 10691- P(N.01 /01) and "Pressure Distribution Component Manual For Private Onsite Wastewater Treatment Systems" (version2.0) SBD- 10706- P(NO1 /01). � o n m yc 0 ED >--i r v► 4 z O �,--�. OD m w�> 1 �' k - -T N r 15 �cn p 3 �P M M9 IND _ .z AK oo► C �• o CAM cxt _ V - sa % OD ` co 1n C%2 = J t cn t i Cl G O a co j k r ll� � Z, a n o 7o Z W PUMP CHAMBER CROSS SECTION! AMID SP ECIFICATIOAIS PA le of J_ -- - ------ VEIJT CAP 4 VEfJT PIPS= APPROVED LOCKIIIIG WEATHER PROOF JUNCTION) BOX MAN14OLE COVER f W 25' FROM DOOR. w� 4vA4NlA)(� 1 AM` W11JpOW OR f'RESH t2'MIU. •• j AIR wTAKE I y/1�rp1� f v�}7 /pn! GRADE � L TT ------ - 1 IULET PROVIDE 3- - AIRTIGHT SEAL I i �.�.. v APPROVED JOIM A `�� � K I I W/C 1. P PE O 1J/C.2. PIPE (} ' ZXTEAIDIAIG 3' �� ' f (4 ALARM EXTEt30fAIG i �JUTO OL113 SOIL B � 'Y� t I I ( ONTO SOLID . om . (90 t90 3 s !_LCV. FY. t PUMP - -3 OFF IW AG_ A BLOCK S/JiVD It Vet f RIStR EXIT PERMITTED OWL`S IF TAMK MAMUFACTURER HAS SUCH APPROVAL. SEPTIC •E S PE C I FI CAT1 0Af 5 D OSE �d.V y � �C TAiJKS MAtIIU FACT IiR£R: �+ � k1LIMBER OF DOSES: PER DA-4 S TANIK SIZE: II �J�Q GALLOK_S DOSEVOLUME 17 /07 ALARM MAWUFACTURER: L �V-� -Q A f M KJ„ IRICLUDIMG BACKFLOW: GALLO MODEL HUMBER: 3>•V- L 4<_ ��� CAPACITIES A= 15.(o oictIES OR �� GALLO! SWITCH T`JPE: J r Pi n Cl'. g= IMC14ESOR 3 G ALLO; PUP MANUFACTURER: ` � !`� �y G = • tWtHES OR / 5 7 GALLO M MODE 3 1 Y2- ff P F D— C IMCHES OR 30 GALLO SWITCH -r9PE:pf e PUMP AMD ALARM ARE TO BE MIMIMUM DISCHARGE RA 30 pM F INSTALLED OAI SEPARATE CIRCUIT'S VERTICAL DIFFEREMCE BETWEEIJ PUMP OFF ARID DISTRIBUTIOSU PIPE_ 124 FEET - rANk SPlEC 4- MIIJIMUM METWORK SUPPLY PRESSURTTE��. . . . . .. . . . . 25 FEET ICACtn, C r off' _lD + 6V © FEET OF FORCE MAINZ X `j F /jooFLFRICTIOts FACTOk. ` FEET "540Al -- TOTAL. OSIJAMIC HEAD = 1 -7' t FEET RouA30 IKITERMAL DIME.NISIOMS OF TAUK: LENGTH ;WIDTH _ DEPTH A THIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2 )c A PROPER ZABEL FILTER MODEL # 4- pa ts � a-o <�X I' TiAj6 /0ro geort pa 4 7 4V iP,75& ComZ4X4 1 ;D cat AJ / 5"* 7'!t %4tjk i c o9,ot1 t1 ?.. LI \1Fw%4t *Z-D l t� ti p HEAD / r U. 115 CAPACITY 34 100 - �� , 5 o f i 32 105 CURVE �° 190 28 90 26 85 EFFLUENT 24 MODEL I— and Q 75 MODEL log DEWATERING = 70 U_ PO 65- 4 18 G 55 1 - 1s 50 \AMOD p 3 MODEL i• 14 45 1S8 12 �40_ � 35 10 DEL 30 13 138 MODEL SEWAGE and DEWATER/NG ' 8 25 6 20- MODEL T M DEL 161 4 P7 10 01 2 MODEL 12 5 53, 55, ! 57, 59 I 0 GALLONS 10 20 0 40 50 60 70 SO 80 100 110 24 80 LITERS 0 so 1 240 3220 400 22 75 FLOVPER UTE 70 20 85 G 18 80_ MODEL 295 W SS Z /8 50 14 16 MODEL Z 264 , _j MODEL H 10 283 Q J MODEL F. 284 8 25 - — - MODEL 8 20• 282 i 15 4 ,OELLf/�' O. 10 MOOEL 2 5 267, 268 0 3280 Old M#hw Lane GALLONS 10 20 30 40 50 60 70 80 1 90 100 110 120 130 140 150 160 170 180 180 P.O. Box 16347 LouMvNe, Kentucky 46216 LITERS 0 s0 160 240 320 400 480 580 540 720 (5 776 -2731 FLOW PER MINUTE "13r Cast Iron Series "139" Bronze Series HEAD CAPACITY UNITS /MIN Feet Meters Gal. Ltrs. • Automatic or Nor:- Automatic. 5 1.52 104 394 10 3.04 79 300 • V2 H.P., 1 Ph., 115V, 200 -208V or 230V. 15 4.57 64 242 • Y2 H.P., 3 Ph., 200 -208V or 230V. 2a. 6.10 36 136 • Non - clogging vortex impeller design. 25 7.62 8 30 � •Passes 5 /e inch solids (sphere). Lock Valve: 26' • 1 1 12" NPT discharge. en Canadian Standards li .lP Assoc. Approval • Float operated, submersible (NEMA 6) 2 pole available mechanical switch. • Automatic reset thermal overload rotection. p 137 Series N -2225 • Stainless steel screws, bolts, guard, handle and 139 Series SB -1115 arm and seal assembly. Z�■ - Bronze motor and pump housing, switch NOTE: No UL listing for 200- 208V/1 Ph. case, base and impeller. numns Mound System Management Plan G f Pursuant to Comm 83.54, Wis. Adm. Code.., ` ' Septic lank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septi6 nk 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 filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retainsollds in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated 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,ch,emical 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. Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify 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 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 penetrption. Cold weather installations (October- February) dictate that the mound be heavily mulched for frost protection. ` Influent quality into the mound system may not exceed 220 mg/L B005, 150 mg /L TSS, and 30 mg /L FOG. 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 cell shalt be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual (SBD- 10572 -P (R. 6199)) 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. Gontinaency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or reps: red to keep the system in proper operating condition. 0 If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be Immediately repaired or replaced with a component of the same or equal performance. 11 the mound component faits 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 adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector. SFF, REVERSE SIDE Pg.6 FOR MAINTENANCE REQUIREMENTS SPECIFIC TO T111S SITE, DESIGN, AND COMPONENTS r OWNER's MAINTAINCE..OF SEPTIC SYSTEM , POWTS (landowner) is reponsible for proper o er maintenance of,this system. Regular l P sp ion and servicing is necessary for�the safe health c inspections and system. The owner is required by j' operation af:this maintenance /inspection reports toc g,a the controllin necessary g ,authorities. SPECIFIC CONTACT AGENTS s� • Levi X G7`Y. * Governmental authority/ inspectors: 3 �� - 7CO a * Licensed installer maintenance n Users : responsible for providing an operation/ " manual * Licensed serv&ce / inspection agent other than installer * Electrician, for Pump, electric controls, wiring units: fi'12p- 7,'F -Zv IMPORTANT OWNER MAINTENANCE RE UIREMENTS i. Winter traffic ` area shall not be Permitted, shove7ring, etc. permitted, or frost can /willoss the the cell, freezing u the s penetrate int winter. P s ystem. Discontinuos use In the {a vacaction.trip, resulting in no wate use} can "als lead to,freeze ups. o 2• Water conservation -needs to`be exercised hydrolically overloaded and destro ed• ! Or system can be designed for a maximum wastewater flow of fs sys hem was 4S a gals. daily. 3 • POWTS are not designed to accomodate was disposal unit, or an tes from Y other unnatural sources a garbage Any introduction of such waste materials will °f waste' destroy this system. Ii overload and 4 • If a power o��tage occurs in a Power ;I , or a pump fails, it may' result cell, which ma y overload of effluent being pum y adversely impact the cell recommended that a licensed (leaira g e into the. Pumper empty the ). It is e allowing the pump to rturn t dosing sing tank, Your installer immediatel y for advice, g the do correct amounts. �. Neglect of the vegetative cover erosion preventive) can lead t (the cells insulatio & tra ffic also can destroy ° failure. Compaction REGULARLY WATER THE VEGETATION system- It IS NECESSARYrToeavy the ystem beneath IS NOT sufficient aloneEto Effluent in `*4,cover, t0 maintai.l a h• Periodic inspections by the vWner, or his agents, is necessary. Inspection Pipes and ports have been incorporated into the system: on inspection the mound basal Pipes), cleanout area effluent level laterals, at each tip - for flushing and out. The filter the pressurized ground cover system in the tanks (via cleaning the laterals P co er manhole). Only a licensed ocked above & severe performing this work w Pro Pro qual!61ed safety risks. Evidence of Involves health system's tre?tment cell shall also be in p°nding in the regularly inspected. A0 I Wisconsin Department of Commerce SOIL EVALUATION REPORT Page f Of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code complete site Attach com -� 1 C R O (• X' cal plan on paper not less than 8 1/2 x 11 inches in size. Plan must S �-s� include, but not limited to: vertical and horizontal reference point (BM), direction and Panel I.D. o 2 0 2'0'5& ' '/ n • /v V percent slope, scale or dimensions, north arrow, and location and distance tpfiear road. J Please print all i9ftwMatif im-- I, J Aj Re ewes b Da Personal infortnation you provide may be used for'ndary Property Owner ! P Location �j �� V (l/ �� Lit Al 1 /4 S T N R 2*0 E (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 3�Co 5' City tate Zlp Code N r-, �a ❑ Yllaw Na Town earest Road Old TO,) W t s �/oQ� ( ?!S ST- zas el 1�•.. � � ❑ New Construction User Residential / Number of bedrooms 3 Code derived design flow rate a GPD (TReplacement ❑ Public or commercial - Describe: _ Parent material 0W WA - f(4 41- Flood Plain elevation if applicable ft. General r neral cwnents and ha* ? sT&P Solr�tQ /6 �ov'v 4J i4k J •, S 4,j �•� I 1 F /-1 Bori # ®P t rite Ground surface elev. �� ft . Depth to iimit�g factor Z O in SS Soa Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/t� M. Munsell Qu. Sz. Cont. Colo Gr. Sz. Sh. •Eff#1 •Eff#2 l 0 •A /Phe 1 3/ s 2-f Sk aQ S S . S /0 3 2- - 2-9 io YA S S a. - /.© • 0 C2 o +S 5 2 S yP. Yh etl2- N 4 P 019.04&2 r .� •gyp .4r- ��r ,� Z F Bodng # ❑ Boring ��• 2 SS-5 Pit Ground surface elev. ft. Depth to limiting factor in. Rate Horizon Depth Dominant Redox Description Texture Sbumre Consistence Boundary Roots GPDW in. Mtmsell Qu. Sz. Cart Color Gr. Sz. Sh. •Eff#1 •Eff#2 • z loYle,31W Z 0 D 3 — �o • G L •Z •4 X4 r S �� A s Do/ o i .e__ o c VA Effluent #1 = BOD > 30 < 220 rrr & and TSS >30 150 mg& ' Effluent #2 = SOD ffo& and TSS < 30 rrgiL CST Name (Please Prim) � 4 ; CST Number Address Data Evaluation Conducted Telephone Number Ulbric 2- — 9,0 • 772.3 2 Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 ORIGINAL owl ilk MIR �ejx, �MMW MOM WAS WE A,4r/7&�RMMMKWAJM=M :. i sul'i-j" — J�il mw MFR�m M��'mm CM:�i�"I , lo mr�� mm><a" MMEZME ®rte WA�� == ®� mm� � l . f ! of . . 1t !! - � ..� 1 r r1 1 • . 1 1 . . . � . X •; 1 . Y r`r, . ei co L�� �i� emu r � • �0 NFL / / �1 � ` `-L - > � t o / 000 Fdxs a -'" a o r- mrn 0�� g o m z 0 �0-4Z l w0D0 r W �ZZ O .�, A -n 3 y Co 0 `c XvZ � � 3 a / C G 1 �I A - Z � (A G' G -q QQ � • � p � � � Z '� ma c. ?° r Co i ST CROIX COVITrY SEPTIC TANK MAINTENANCE AGREEMENT AND :- OWNERSHIP CERTIFICATION FORM Owner /Buyer Mailing Address Prolperty Address (Verification required from Planning Department for new construction) City /state --- &U Irv 4)/- Parcel Identification Number 036 )-O-S �P ' 2.0 ' X 6 - 0 LEGAL DESCRIPTION Property Location N t � J OJC/�4 I Y 14, Sec. ?'� , T 3 4 N -R Z� W, Town of Subdivision 407 2- 131k. (P , U IIA� 411d'`FO Z Lot # Cet Survey M # / me Page # Warranty # / zj 0 7 sd / G Y , Volume Page # 3 2 -- Spec house 0 y es Y L-po Lot tines identifiable kyes 0 no SYSI'EN MAINTENANCE Improper use and maintenance of your septic system could tesul in its premature failure to handle wastes. Proper mainten consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the syl can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a cettirwation form„ signed by the owner and f fi master plumber, journeyman plumber, teAticted Plumber or a licensed pumper vetifying that (l) the en - site 2 wastewaterdis al s e Is in proper operating condition and/or after in p� y' () inspection and pumping {if necessary), the septic lank is Less than 113 full of scud thee, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the stand. set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certifica elating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within days of the three year expiration date. SIONATURE or APP / ! AZ OWNER C ERTIFICATION , (we) certify that all statements on this form are true to ti'e best of m ld y {our) knowege. t (we)'Am {are) the owner((; the pr"Perty 1 ' bove, by virtue of a warranty deed recorded in Register of Deeds Office. � c o S AP OF PLICANP / �! DATE * * * * ** Any information that is mis- reptesented may result in Y the sanitary permit being revoked by the Zoning Department. * * *' *; Include with this appticatlnrr a stamped warranty deed from the Register o f d OW ofi'iCe 9 copy of the certified surv map it reference: is made in lire wawa my deed 3 � � ;r, N C o . W N O O �p L W P.-4 O O y co f� O O N Q G) to CD y o CD c 0 ? (n O = fD O p 9 o CA U� z D — a m D m a to 3 W m CL = o a rn � O \ rn c@ O { m \ 0 0 r CO) N O ° o 0i CO) °c • a - Z 000 a4 N � c I S CAticn Q M a 0 _L I 7 O 7 A 2 � tb A z 0 oov mo �o z CL 3 p c z 3 ° U ) O A O 0 n i. 0 a O G _a CC 7 CD .. G r 3 w c z O F N O I w a, a I i ! o0 h i ti I g I � I � w a o CN MC Zz i 27L o e I "well -I"Id and tq - I) - are 4r a"ou- 5 BL ''Ch' S. --Y -2 [C4 CY ALLEY-. sel'itaAY anw ?%e wu v4r Malri ea,"Inci, 'n' /o.k r BL OP,*. ;FW meerd leg. -Let 3 (�l Aat.W Oel ZX I.-v xs ?/v. res. d Q S . C ' v a r r pQSNML�iT W.jiA sw OF VMS MME S RE 215 x DAVID KMIEIEBER�tso i David R. Krue�r. � '� }, �+dfotlaoo�i rr s •, .�.....M«..N. Mi�M•w..wrr• .:a.•w.••«•r.«i. «w+w•M«..•••.w.s«+« «.r«.••.''. •w . , . 8:00 M w. w. r. w...« ....�.ww.w.eMr`.•"".w....ti..."' .»Mw..«...w•.....w w s NNW MOWN is �. skew 101 Wb"N mt x r , . r Lot 2 Buck 6 of the Ptat of the Vitta9e of Houlton, SU, Croix, Wisconsin t _ f" PER Not ......«.. .......�....._:. A. 4 a +� #A f . �1 z K xn / ♦{ §�. �� 1} mat ,1 �.�..: �� �,r5 '# A e �� v !c s F 4r Y Ai LA_ Mw1Ml F"U"6 .y`. Ada dft of David , • •r aka 0 . - 16 R. Kruepsr • • �•.,. .. ••`. K .- ' .x.., F �' .q,K' . ;.. «/yr•r.w«. ... NMM«w..w«•.` � 1 >ti X .. P i .; • r �,' #.- .': -, t yt,d: e' ..... i... w•... rw. .• « « «.....w...w. «.w.•..fr.....w � � - a AIDIXs STICw?IC1f 1 ACZXOWXP s R szsrS os sasaoauss Mi nneso a M Tv t1bluton 1 '1's' 'I•1s Y � 3Tw'P�fwsF Or wulcoNsw ...............•...« -- - ' y , : , «..•.w-.«..•••ww«1'w•«r'w per. s+ eo .. a.... a be w a...g . r.w.....a+ w • v Vti sad admVisda 60 remit �__ i t P of scat of Eit,, pO _ my M lair y 1 tx.����'��� WYWw..w••wwrM•w.••R • �•.- � � . yy ••r•r••« IMS Low W 31 US p^ . , �w apt s�ati%} ` - ,,._' .,. i►4•r �� 'i •F a � � " ; �{ _� 4 te a. � � �" t .� .' �_. 1 � +, " � � � � .> . � - -�� -; - - , �� /-_ �I �, I �� -�- �- . _ rt�r �- � e Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). 370299 Permit Holder's Name: Cl City (3 Village ❑ T 6vvn of: State Plan ID No.: Krueger, Dave I Village of Houlton °�— CST BM Elev. Insp. BM Elev.: 1 BM Description: Parcel Tax No.: 01)1 0 I I tT& , O 6 , 030- 2056 -20 -000 TANK INFORMATION ELEVATION DATA --,2 -7. do, Z0, s'sa TYPE MANUFACTURER CAPACITY STATION HI I FS ELEV. Septic COD Benchmark 53.5 1W Dosing Alt. BM Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet i.13 85 % �3 33' Vet L TANK TO P/ L WELL BLDG. Air Intake ROAD �, `{(� 8q `✓/ 9� pp� Septic 50 + > q0 f ` NA Dt Bottom Dosing NA Header /Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand St cover Model Number GPM TDH Lift Friction System TDH Ft I I L oss ead I — I i Forcemain Length Dia. Ff Dist.ToWell SOIL ABSORPTION SYSTEM BED/ TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manu SETBACK INFORMATION Type Of CHAMBER Mod Number: System: OR UNIT DISTRIBUTION SYSTEM Header/ Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded J Sodded xx Mulched Bed /Trench Center Bed I Trench Edges Topsoil E] Yes ❑ No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 077 1 * 0 Inspection #2: Location: 1356 Edgard Street, Houlton, WI 54082 ( 27 T30N R20W) - 27.30.20.552 Village of Houlton -Lot 2 1.) Alt BM Description= 2.) Bldg sewer length= P� (L�(_C --�►tr T� a - amount of cover = 1 Plan revision required? ❑ Yes K No 44T] Use other side for additional information. � 1 �s SBD -6710 (R.3/97) Date Inspector's Signature Cert No i r - s Safety and Buildings Division Vi sconsin ARY PERMIT N& CATIONS- 201 W. O Box Washington Avenue Department of Commerce In accord with Comm 83.0 , is m. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the sy , on p ss ion y than 81/i x 11 inches in size. it • See reverse side for instructions for completing this appli a n JUN 2 3 2000 s to anitary Permi Number ST CROix '.37-0 7- Personal information you provide may be used for secondary purposes COUNTY C k if revision to previous application (Privacy Law, s. 15.04 (1) (m)). 6' zohfwV 0 F1 GE a Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL 1 P y Owner am N P o e/t L c Pro l Owner's Ullailjag dress Lot Number Block N mber City, State Zip Code Phone Number Subdivision Name r CSM Number / U o ( -> - >r faT" II. TYPE F BUILDING: (check one) ❑ State Owned !tyy Nearest Road Village Public W 1 or 2 Family Dwelling - No. of bedrooms a Town of III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) a 7 r O 5S 1 ❑ Apartment/ Condo ,j - 2 [].Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. ❑ Replacement 3. jeeplacement of 4. ❑ Reconnection of S. ❑ Repair of an ______System ________System __________ _ __ Tank Only __ Existing System -------- Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 E] Seepage Bed ound 30 ❑ Specify Type 4 nk 12 ❑ Se e T - --__ _._ __. 42 C] Pit Privy 13 — ge Pit Privy - _ . �. System -In -Fill ~ VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absor Area &h-- ',p_.Area 4- 1.oad4xj- Rate., rc 5, P e.Rate 6. System Elv. 7. Final Grade --- equ)re �sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch Elevation -- --- --w - e Feet VII. TA Capacity _ _t, gallons Total # Of Prefab. site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer r s Name Concrete con steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank ! ' ` 0o V ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 11111 ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumbe Name: (Print) P tier's Si ture: (No Sta s) MP /MPRSW No.: Business Phon Number: 1 0 - Plumber's er's Address (Street, City, State, Zip ode): e IX. COUNTY / D PARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issuing Agent Signature (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial 1 Adverse �s- Determination t � CONDITIONS OF APPROVAL/ REASONS FO DISAPPROVA Call s tr+r OT 5+ / SBD -6398 (R. 99)�L C f �y�D 1'(� DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber — " 7 -lNSTRUCI 1. A sanitary permit is valid for twb (Z) year's TJ -. `1 Y P V I 2. Your sanitary permit may be reng I , e� !!for tie "raticgr pte, and at a time of renewal any new criteria in the Wisconsin Administeative br"applicab p, 4), sr : : t_,, 3. All revisions to this permit must l bgN pro..y.e # ,der issuing authority. 4. Changes in ownership or plumberlr�q iY�*4 San' ry.Relyxlit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation `� i 5. Onsite sewage systems must be properly maintained' The sep tank s) must be pumped b a licensed " um' e 9 Y P P Y f ( P P Y P P� r whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safetyand Buildings Division, -608 - 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owners name and mailing address. Provide the legal description and parcel tax number of where the i 9 P P (s ) P Y ' 9 system is to be installed- II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type's public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type- VL Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin' Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. / r--nsm VDepa*.tofCommerce SOIL AND SITE EVALUATION Page 1 of 2 Division of and Butir WW in accord with Comm 83.05, W is. Adm. Code A.C.B. Soil & site Ev21ua60M Attach complete ske plan on paper nut Was than 8 x 11 inches In sine Plan nuust County include, trot not &Tilted to vertical and hatrontat reference point (13K, direction and St. Croix percert slope, scale or dimencsions, north arrow, and location and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION - P lease plot all Inform Mm. 030-2056-20 ID#27.30.20.522 Pwsonal 69brnration you provide may be used for secondary purposes (Privacy law, a. 15.04 (1) (m)). Reviewed By Date Property Owner Property Location Dave Krueg Govt Lot 3 1/4 1/4 S 27 T 30 NR 20 W Property Owner's Mailing Address Lot # Bbdc # S ame or CSM# 1356 Edgard St . 2 6 Vill eOfHoulton City State Zip Code PtwneNumber [] City Q Village ®Town Nearest Road Saint Joseph W1 54082 715- 246 -2277 St.Joseph Edgard Street ❑ New Construc lion Use: Residential / Number of bedrooms 2 ❑Addition ID existing building CK Replacement Public or commercial describe Code Derived daily flow 300 gpd Recommended design loading rate .7 bed, gpdr •8 bench, gPdfl' A bsmdon area required 429 bed, tF 375 bench, if Maxkmm design Wing rate .7 bed, gpolfF .8 hnCh, WIM Recommended Nitration surface elevations) Existing system elev. = 90.63' ft (as referred to site plan benchmark) Additional design / Sb considerations Existing septic tank collapsed. Evaluation conducted to determine suitability of soil 36" below existing drywell to Parent material Glacial outwash Food plal n elevation, ff bie na ft S= Sullable for system Conventional Mound In- Ground Pressure AT -Grade System in FIR boll% Tank tklklsuitable for system ®S ❑ u ® S O u ® S ❑ u ®S C1 ®S Flu ❑ S ® u SOIL DESCRIPTION REPORT fig# Honzon Do �nseU Qu. Cont. Color Texture Consistence Boundary Roots GPDr 1 1 0-6 10yr3/3 None sl - - - - - 2 6 -22 10yr3 /4 None sl - - - - - Ground 3 22-40 7.5yr3/3 None is - - - - - - elev 99.17 ft 4 40 -75 7.5yr5/6 None s - - - - - Depth to 5 75 -144 10yr5/6 None s - - - - - - limiting ti# contains 1 - 2" bands of 10yr4/4 sl 8 Ifs at 12" - 20" intervals. tacror >144' Reffe ts: Soil evaluation condo with band at Eguest of owner. Loading rates not calculated due to babft to deWmine structure of soil CST Name (Please Print) Signatu Telephone No James K. Thompson 715- 248 -7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, 54020 6/21/00 3602 1255 RED JUN 2 2 2000 S T C#IIJIX OOUWY 6% ZO0N80Ffrlt3E y � � g J+ , hand flee s/ope w >,Zo �Jvs�i�d� wcCC. E /ea: wi � AX I,� E 8 G eliE1M P Wo ke a 5 - tGt QI �.1E. a le&`. a4 top Co (Lq,a dS ad Se,,o6�c —� 5etbac�.s exe- aede Sys�w� -+ tan�:To6e�ero a� c S¢�aG�'fp S�rKC�r'e ntu3� df d e > �s ,ems. d{•• 5, e!: ssur+�eol ; resic� R ( ✓: = /OD. � s. �c o.'f elegy 90. 3.' , � L Ve 1-aY rr 1�.a c1e �ru ems' 4 /35(08ard- /�u 'S -Z 4 _ y , y : F - - �. ST. CROIX COUNTY WI SCONSIN z ZONING OFFICE " " "' ■�+� ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road .3c= Hudson, WI 54016 -7710 (715) 386 -4680 AFFIDAVIT OF RE- CONNECTION Property Owner: Address: 12\6_6 L�c✓f !"c� �� Day time phone: ( 715T 'ZC/6 - 2- 7-77 Parcel Legal Description of property: 1/ '/, Sec. T. N., R. ,p W. , Tn. of M _ 1okS St. Croix County, WI As.owner of the above described property, I acknowledge that the septic system serving this proposed _2 bedroom residence is undersized by current code standards, but otherwise meets all requirements of State Statutes, Wisconsin Administrative Code and St. Croix County Zoning Ordinances. I understand that the issuance of a sanitary permit to allow the re- connection of the existing system does not imply that the system will function properly after it is placed in service. I also acknowledge that I will inform any future parties interested in purchasing this property that this permit was issued for the re- connection of an existing septic system and not for the installation of a new system. Signature: Date: - L14 Moc' ','/ -rlc-� I- P oer A 1.4 Mk' Ql4f� ��,r oZ °o S / f3eN�1, MARX g O�j Sib IN ASSIn?n�d •� UU U � E)tv � � � D� w�e�l �lev_ Afi � 1 � o i3 oh o� A)w 9U.�o3 xisfi ►"'S IouoyA) Tiff( Q &DROO" M6" 1"n � p1ncP Cc,IlaPs TA>v� d1�)�ie� --J GA 6� tlblNg , PS's�n. {d � I�\ 1�1 � t f I Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 2 Division of Safety and Buildings in accord with Comm 83.05, W is. 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 include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimernsions, north a =r stance to nearest road. Parcel I.D.# 030- 2056 -20ID#27.30.20.522 $ APPLICANT INFORMATION - tion, eviewed By Date Personal information you provide may be seconds urposes (Privacy,Law, s. 15.04 (1) (m)). - ��— Property Owner ' Property Location Dave Krtle er Govt. Lot 3 1/4 1/4 S 27 T 30 N,R 20 W Property Owner's Mailing Address , Lot # I Block # Subd. Name or CSM# 1356 Ed rd St. ' 2 6 Villa e Of Houlton City State Zip Code Ph6ne dumber ❑ City ❑Village ❑Town Nearest Road Saint Jose h W1 54(* 11 �-2` t -2277 St.Joseph Edgard Street ❑ New Construction Use: °residential / Blum - . , f bedrooms 2 ❑Addition to existing building ❑I Replacement ❑ Putiflc`brvomifiercial describe Code Derived daily flow 300 gpd Recommended design loading rate 7— bed, gpd/ft g trench, 9Pd Absorption area required 429 bed, ft 375 trench, f1 Maximum design loading rate .7 bed, gpd/ft .8 trench, gpd/ft Recommended infiltration surface elevation(s) Existing system elev. = 90.63 ft (as referred to site pian benchmark) Additional design / site Considerations Existing septic tank collapsed. Evaluation conducted to determine suitability of soil 36" below existing drywell to Parent material Glacial outwash Flood plai n elevation, if applicable na ft S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ❑ S❑ u ® S❑ u Z S U Z S❑ u ®S ❑ u ❑ S® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Borin Horizon Texture Consisten Boundary Roots 9# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,, Trench 1 1 0 -6 10yr3/3 None sl - - - - - 2 6 -22 10yr3/4 None sl - - - - - Ground 3 22 -40 7.5yr3/3 None 1s elev 99,17 tt 4 40 -75 7.5yr5/6 None s Depth to 5 75 -144 10yr5/6 None s - - - - limiting H# contains 1 -2" bands of 10yr4/4 sl & Ifs at 12 " -20" intervals. factor oz- Y 8 >144" Remarks: Soil evaluation conducte with hand au r at request of ro owner. Loading rates not calculated due to inabili to determine structure of soil. CST Name (Please Print) Signatur Telephone No. c 715 -248 -7767 RFcFJvF_ 0, James K. Thompson Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, 54020 6/21/00 3602 1255 III 4 'ti ' �✓ � � � / JUN ❑�, ST C»OX (X3l:INTY ��'�., 2C�f4�td13t�f10E .2 uo/ an d a c c�¢r' N-0 °6 ,Sloye Gr � A ' b "" � '90.4, afo1 Dr W'tCC 8a 'a0)az&'X 60 de, .o . .J - 2Lt !31 EsE. a led` a-6 too of �-'_ �w' /al.�� ,se�,.�e.r; 97.RS,' •,f �11r C'oinM. '� 83, iO CoGCr�oSed SepdF� --� 5 e.xcee.de.d. Sy slw� tan/'( To 6e �e�oroced 1 ara c Sv�a UC�� SL�r yc�yc� r'e "'t�t3� kj f, 1py. CunC. xrS�xrr� to ,e > /S f��� `"'l PJ {Ccr»t1►l• OF'S, ); rw .�5s44en cd rz (e ✓ = �d G� ` � o de a / ' t'es�c�art o � C 51.artdcl /► Ye uJay /35(0 S£ //ou L�rrr,� L3 I. -5-<10,6 f ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer l/� / Lr G✓ Mailing Address / 3s Ecl���� Property Address c�l3rnQ (Verification required from Planning Department for new construction) City /State %�tcrr CJI Parcel Identification Number p 30 Z6 2 20 -S Z LEGAL DESCRIPTION (000411 /06ZI Property Location V4, '/a, Sec. .217 . T 30 N -R ZO W, Town of sab et P 01C f44 f �01 B la e-& Co , Lot # .Z Certified Survey Map # / . Volume . Page # r Warranty Deed # ` 8::� 5 - 0 1 , Volume Page # 3 �- Spec house ❑ yes [ono Lot lines identifiable Oyes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. , " I �, � a" 6 /,z 1 C.Q SIGNATURE OF APP IC DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property des 'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. G 1 2! ICD SIGNATURE OF APPLI DATE Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.**** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed DOCUMENT NO. STATE BAR OF WISCONSIN FfJRU 3_1982 *"SjtVg* F4M IttCOAQ044 6^1% QUIT CLAIM DEED 487501 REGISTEWS OFFICE DAVID KRUEGER, also k,�own as David R. Krueger, SE OW CO., M ............ . .... . . 4_.Aing!g..p§nQn ............................................. . .............. ♦ bCY bf 10cw . ... ........... . ............. ............................................................. . ................ AUG 2 41992 e3aitelatau to ...... MY.1.0 .. ?.,.ARUNER,. -a.. ainde-per ion.. and ......._.... ........................ d 8:00 A. M eM following described real aatab is St. Croix. ...._ County. - mom- - +1� =-�' _ _�. ....... ........................................................................... . ................ .................................................................................... I ...... . ... ............... State of Wisconsin: •91rum" ve Lot 2, Block 6 of the Plat of the Village of Moulton. St. Croix, Wisconsin TaxParcel No: .................... FEE tl This ......... ............... homestead property. (la i not) Datedthis .............. ..... day of .................. August ...................................... ...... (SEAL) ... .............. ... ............ (SJUL) David Kru ........................................................... 0 �.. pr D 4d R. Krueger • ................................................. .... .......................... . ............... . ............... (SEAL) ....................................... .............. ............. (SZAL) • ............................................................ ........... .....-•---------..... ............................... ................. I ............................... .. ................................................. AUTHENTICATION ACKNOWLEDGURNT STATE OF X=ASIN Mi nneso a a& . .. . . . . . . ............ . .... . .... . ........ . ......................... 40noty _Washington -- ------- County outbesticated this _.._....day of_..- _------ ._--- .. -_ -- It ------ Personally came before me this ...... � Q dsy of Au=t .................... ISE ---- the above named .......... . .................................... . . .............. . ......... ..... . 0 ................. ............................................................ .-A.-Single-per,50 ------------------ - ---------- - --- - -- - ------- TITLE: MEMBER STATE BAR OF WISCONSIN -------••--• .................................................. .................. ... ............................... ................................................................................ authorised by 706.06, Wia. State.) to me known to be the person ............ who executed the foregoing Instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY . . ... .................... ..... ........ ....... ................. A.S. Peterson of First State Bark of B ................................................... ................. ..... .. . ....... . ....... . . 1. . ..... . ...... ............. ....... 0 9M No- ' t gi ........... -tar . ............. Coun -Wbc MNi ................. ..... 1. M 5M '** ----- Notar blic ......... (Signature be authenticated or acknowledg Both jK C ratim are not necessary.) date : ...... xmLEN JUNKER I ------- of coo" qua CiArbg Dunn STATE RAR Or WISCONSIN roam Ns. 3 — IM Yil �sr 4 n, Ww6 2�pT �1 �a I 'I t 1 Z r1 T I T -- - o UAJ 2s� - - --- ---- 1 f O" O d 3 W O c ! c � a � o eD � cD 'a m • m ur [n 0 a j Z O W (!l ' = Z O N V W °�; ( ( y Oy �; • a 7 W y fC a= 7 0 N CO O O N C_ CD C7 CO CD C CD n CD y N 0 `A\ A CD O @ • O O O • ' � O� C 1 cn ° o ° d < O CD N < N NO W c o c m 4 c co c m o D y w �+ C4 o o In rn � __ � O __ ecD rn v� v� W F' o f m� = a m m cn a o CD cn CD a o CD a IW w l a c o o a May Oa o ° rn° c/� 3 0 co 00 V I CL arn� i oC'CD tO fA O O 0 o N ? A O cn qwft C G O Q !r z C1 000 3 Z GOO ' G • cn co) cl) I C co CA C4 N< d4 O COD I � v N O C � �D y N (D l� L 3 d cg 3 d O a 3 a C f Z z D m o D D o O m O v 0 v j CO C N "*A • CD CD C O C ( C 3 I W N w W CD O a 3 2 a 3 m CD 5i z CD m -1 N O Cn O O rn Xv A M rr z AA 7� I Al v CD A Q 3 j. O O CL fx � Z V I C p N o < I y M y W C I a o W 91 W N N d O D W 0 S CD O. CD p a S D Dj S O. O (a C a O ��"� -'". C3� A O C O a� N N O fQ Cn0=0� N C (D ap N C O N� C L p C CD CD a D p� F OZ d ff CD CD C O N O N Z 3 0 0 V) O d _. y CD fD O y p < a G y Cm cn ca m 3 D: " CD °' fD a Q oC, x � I 7 WOO mo �$C o. a °o t Dd a I pp 0 _L m era O CL Q j a N I CD a' o 1 m S CD c°n I o o b A m m v o 0 0 0 ti CD CD CL CL Parcel #: 030- 2056 -20 -100 02/16/2005 04:11 PM PAGE 1 OF 1 � Alt. Parcel # 27.30.20.552A 030 -TOWN OF SAINT JOSEPH Current Al i ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 *_ Tax Address: Owner(s): - Current Owner * DAVID R,& JILL L MILLER KRUEGER KRUEGER, DAVID R,& JILL L MILLER 1356 EGARD ST HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1356 EGARD ST SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 2111 - HOULTON SEC 27 T30N R20W LOT 2 BLK 6 VIL HOULTON Block/Condo Bldg: 6 LOT 2 EXC AS DESC 1542/537 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 27- 30N -20W Notes: Parcel History: Date Doc # Vol /Page Type 09/14/2000 629889 1542/537 QC 07/23/1997 965/25 - 07/23/1997 804/422 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 6184 277,100 Valuations: Last Changed: 07109/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 150,400 122,200 272,600 NO Totals for 2004: General Property 0.000 150,400 122,200 272,600 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 85,500 107,200 192,700 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 p 0 p 0 00 q 0.00 Total 0 0 r a y 0 l e N 0 l 3'0 c R R N F I C w= O A v w � 0 3 a Z ° N 2 0 3 N o ° 2 v ° w �C • y CD .�. �' Cp m N O 7 j' N A A D O N y w CD �o Oo N w m m ot°ii p rr W C C O t�D to y I W N H W 7 O O m C m y C O O CD o ? CD ED 1 N ° a a (D ° m N a a a -p CD y W d 0 CD a CL CD t (D O O O N A A O» C O � O z 00 00 0 z 00 00 0 t o. O y o Q '•i �7 N �/ Cj) `° P" COD w ID y N N CD y N CD mu L O1 CD CL �► C Z Z I D CD o o D D o ' O O v �° O z z 0" 5 5 CL m 3 °" • CD CCD mu M CD C (n C W CD N I W (D 3 0 n 3 a" 3 CD z CD . Z 3 C ..s -i Cl) CD Ell N N fD N 3 . = O 0 W N CD 3 0. o Z 0 0 :► ° N CD W °O CD W 0 W y S CD N O O t (3p 0O D�j 3 d C CD 0 (O N N c ,g 01 dp N c D m CL Sao o CD o a� m C F o CL m ov c o 3 0 = �U � __. to CL CD N n CCD N y N y O u c C 'O N -a � N O S fi K (D 0 <D f0 Q' C1 (� Q N j CD I Q. = 7 (D O ! O N O 0. QO CD > 0. o CL 7c O N 0 a 1 o CD f a =r CD ! o = N b <D (D N 0 o O N O i O L jjS7, I ti r� 1