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030-2060-10-000
Wisconem Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515268 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village X Township Parcel Tax No: Zastrow, Donna St. Joseph, Tow of 030 - 2060 -10 -000 CST BM Elev: Insp. BM v: BM Description: (3 � ( Section/Town /Range /Map No: f 27.30.20.578 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , /d � Benchmark d 8 �� � 14!� Dosing Alt. B, k 4 , e G� , 9F 2 Bldg. Sewer Q Holding N SVHt Inlet 0 St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet DC 1 Septic _ Dt Bottom Dosing , f L ! Header /Man. Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer �� � GPM St Cov � 6 Model Number � , • S3 3l TDH Lift Friction Loss Isystern ea Hd TDY • A Forcemain Lengt� Dia Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO �/ BLD WELL LAKE /STREAM LEACHING Manufactur . INFORMATION CHAMBER OR Type Of System: Model Number. DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Ve o Air Intake Pipe / �+ Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes R No R Yes No /D , I.L COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1385 Main Street Noulton, WI 54082 (NW 1/4 NE 1/4 27 T30N R20W) Village of Houlton Lot 24Blk7 Parcel No: 27.30.20.578 1.) Alt BM Description = 0 C.,_ 4=6. ,,%, 73 ✓�-- 2.) Bldg sewer length = 2 1 - amount of cover = rn � 4Cf J •., Plan revision Required? M Yes XNo j ' ►� �j Use other side for additional information. Date [ 4� = Insepcture Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division county 201 W. Washington Ave., P.O. Box 7162 S f isconsin Ma dison, Wl 53707 - 7162 Sanitary Number (to be filled in by Co.) Department of Commerce (608) 8) 266-31 5 Z 1. • `' Sanitary Permit Applicatio - State Plan LD. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you p -_-_Iw AA may be used for secondary purposes Privacy Law .04(1x-) Project Address (if different than mailing address) L Applicadin n Information — Please Print All formation 57 u.) Y V46; Property Owner's Nance Parcel # Lot Block # Property Owner Mailing Address M A Y 2 Property Location 4 5?� (� J %ol ® QLy ' 57: ST. CROIX COUNTY (�6�� /1= J City, State Zip Code LP ,4)"L JtJ W V T 3© N; (circle go�eee R� E or1177 IL Type of Building (check all that apply) M err 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number � 4 ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use 4 ❑City IDVillago ❑Township of Gr ®mot/ HL Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System Q Replace -cut System gTreaUmenUHolding Ta Replacement Only ❑Other Modification to Existing System B. ❑pe Renewal ❑permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Is sued Before Expiration Plumber Owner PV of POWTS stem: Check all that a pply) ❑ Non -pressurized In -Ground 11 Mound _ 24 in. of suitable soil 11 Mound < 24 in, of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constricted Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit. ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. DispersailTreatmenit Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (id) System Elevation t VL Tank Info apacity in Total Number Manufacturer Prefab Site Steil Fiber Plastic ons Gallons of Units / Concrete Constructed Glass New Ddstmg J �O�L`1�Gd� SAS Tanks / Septic or Holding Tank Oro 6 f SE Aaobic Treatment Unit Dosing Chamber 0 AP O / VIL Respo nAbility Statement I, the indera 1p - sssome responsibility for installation of the POWTS shown an the attach" plum. Plumber's Name (Print) ature MP/MPRS Number Business Phone Number t4 ,u 5ewilt (it �19 3 7G 0 7l -a y Plumber's Address (Street, City, State, Z riv l(v 15 0 7 C VIIL Conn !De ent Use O nly W Approved 9 te r ro Sanitary Permit Fee (includes Groundwater ;r7// 0 liumin ent Si o II66 Surch Fee) G iven Reason fa �J U JUL Conditions of Approval/Reasons for Disapproval Attach complete plan (to the County only) for the system on paper net less than SW x 11 taebes to sire r e ` Pagf, � 1 , 11yS12EG T /U/1( 4 /Wr /- II l .. • • C �N p SYST�ir/ EL. YS, .3 far G T sEEp -ic gec-A ONE Fcc � C � i TR Nch`eS i 6 3 ® J Q ivAr e.c 5 i , �ti a �OUO�(o00 Z � Nes T W 4t bV r CONVENTIONAL DOSED COMPONENT DESIGN Residential Application INDEX AND TTI LE PAGE Project Name: Zastrow / Sammon Conventional Dosed Septic System Owners Name: Donna Zastrow and Daniel Sammon Owners Address: 1386 Main Street Houlton, Wl 54082 Legal Description: NW' /., NEA $27, T30N, R20W Township: St. Joseph Subdivision Name: Village of Houlton Lot Number: 24 Block: 7 Parcel ID Number: 030 - 206940-000 Page 1 Index and Title Page 2 Plot Plan and System Cross Section Page 3 Tank Specifications Page 4 Filter Information Page 5 Tank Cross Section Page 6 Pump Curve Page 7$8 Maintenance & Management Plan Page 9 Septic Tank Maintenance Form Page 10 Soil Absorption Area Report Page 11 Warranty Deed Attachment: Map Designer/Plumber.. John Schmitt License Number: 223760 Date: May 19, 2010 Phone Number: 715 -760 40486 Signature Des VW p v=aW to the bAhamd Soil Absorption CaWom t Manual for POWTS Vass 2.0 SBD- 110705 -P (N.01/01). I Pag f!1�4fl f 1 i/y S 7 Ar at�5W FZP yOk �C� _ 1 0 2 �-- S' SYST�/rj EL. YS. far SeepncG AQC -A oNF ,2 -6 75 ' � + �' f3 � k L, _ / �'C� . (,' C C- r� � ►14 E Sup ►3 + u + a3 J X8 1 Q P.0 cc's 5Z,5 8M v �^ ' 3•Bro � �' G 7 4t ��Ai1Y 5 r s 694" AS 93" z REQO c a 57" n z m UP 56" I N� 4" CAS g" 61" 5" > ° 51' S °' \ / N E4" 14 \ / 54" c v � rn n C ZO Z Z O Z D { i z �X off= y+;Z g o m oo No ox m A � ��� I -0 � ��Q 20o -vq2 j O y► m D D Q m2 C � \ (A - '�i r z �o �n �, O x �� A T _ -�1?j n D N I*1��r =(':� O D o D v 7; 811 _ � ( D f�1 A O . Iwtpo+1m I �O� -�C N- O CA r v m z W A� [� O D (- � =- z f $ O n m ` 'mA$ H \ c s �p'!t v o it7 -n fri O m ;� 9 70 o Of rq rq D r (� 1 O r m Fj A Z Z X (�000 i600-MR 11BER 1111ETE AWN BY: SME SCALE: 4 " 1 -1'-0" -POUR: \° - 4 SEPTIC MANUAL ATE: JANUARY 201 ATE:. -POUR W3716 US HWY 10 MAIDEN ROCK. VA 54750 \ n onn '7nE OAEO PO]; kl: INSTALLATION INSTRUCTIOIW Innovations in Precast, Drainage Zabel' PL-525/PL-625 F I LT E R & Wastewater Prodacts A Division of PoMok trio. INSTALLATION INSTRUCTIONS Center filter with opening ' 40 k. K WW i. Z J F1 e e Additional pipe or Polylok Extend & Lok Glue wq for centering. Step 1: Step 2: Step 3: (A) Locate the outlet of the septic tank. (A) Before installation, place the (A) Glue the filter housing on the (B) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe. if necessary. (B) Make sure that the housing (B) Insert the filter cartridge in the is positioned so the filter can be housing, making sure the filter removed from the tank for cartridge is properly aligned and maintenance and service. completely inserted in the housing. MAINTENANCE INSTRUCTIONS I W1111111111=111111 1 Step 1: Step 2: Step 3: Locate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter cartridge back if necessary. into the the housing making sure DO N OT FILTE • � the filter is properly a{{ (B) Pull the filter out of the housing. p � y hed WHEN g (C) Hose off the filter over the septic tank. and completely inserted. USE RUBBER GLOWS I Make ciirP all solids fall hark intn tha (B) Replace septic tank cover i Page 5 of 11 Septic -Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Wieser Concrete Pump Manus Zoeller Tank Model Number W1000/600-MR Pump Model Number 53 Total Tank Capacity 1,600.00 Alarm Manus SJE Rhombus Max. Bury Depth 8.00 Alarm Model Number 101 -OIH Switch Type Mechanical Filter Manufitcturer Pol lok Total Dynamic Heed (IDH) - Feet Filter Model Number 1525 Elevation Head 7.00 Distal Pressure 0.00 Network Loss 0.00 Minimum Pump Performance Required Force Main Loss 1150 20.00 GPM I @ 19.50 Ft TDH Total 9.50 G Outlet Manhole Min. 4" Above Grade with 2 J Locking Device. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed 'Watertight Securely Mounted With Locking Device --► weather -proof Junction Box 1 ♦ F� hed Grade ' r r •� s.. +ua 'v 1 Depth over f Vent Min. l2" Disconnect Ft Above Grade Means With Vent Cap a s ssssssssese< s<< s< < < <<s < < +<sss >< >+ outlet Outlet Filter Inlet Inlet Baffle .; - A < .< Switch Set m and Reserve Capacity :' >' K " Tank Volume = GPI 4 weep Hole Dimension Dimension Inches Volume Gal. B reserve A 26 307.32 >` y . <'< '< ( alarm) B 2 23.64 Off Elevation C a •` (dose) C 7 82.74 ? F, t > > Bottom ( D 16 189.12 >� D Elevation '< Total 51 602.92 ,s < < < < < < < :; Ft > G FNg:RAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufwturw may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved maftrial, connected to the tank with wstertiglrt fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is staled waatigbi. Electrical service complies with NEC 300 and Comm 1628 WAC. 02/05 LJ Page of POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page Pagedofll FILE INFORMATION SYSTEM SPECIFICATIONS Owner Donna Zastrow & Daniel Sammon Tank Manufacturer Wieser Concrete DNA Permit # D Septic D Dose D Holding vol. gal DESIGN PARAMETERS Tank Manufacturer Wieser Concrete ❑ NA Number of Bedrooms 3 ❑ NA D Septic ❑ Dose D Holding Vol. gal Number of Pubic Facility Units ❑ NA Effluent Filter Manufacturer P o 1 y 1 o k D NA Estimated (average) flow 300 aVda Effluent Filter Model 525 Design (peak) flow = (Estimated x 1.5) 450 al/da Pump Manufacturer Zoeller D NA In Situ Soil Application Rate al/da /ftz Pump Model 53 Standard Influent/Effluent Quality Monthly average` Pretreatment Unit 0 NA Fats, Oil & Grease (FOG) 530 mg/L D Sand/Gravel Filter D Peat Filter Biochemical Oxygen Demand (BODr,) 5220 mg/L ❑ NA D Mechanical Aeration D Wetland Total Suspended Solids (TSS) 1 5150 mg/L D Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Manufacturer Biochemical Oxygen Demand (BOD5) 530 mg/L Dispersal Cell(s) D NA Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ In- Ground (gravity) D In- Ground (pressurized) Fecal Coliform (geometric mean) :510 du/100ml D At-Grade D Mound Maximum Effluent Particle Size 1 % in dia. ❑ NA ❑ Drip - Line D Other: Other: D NA Otw & e 0c.t A) , ER NA 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 9 ear s s (Maximum 3 years) ❑ NA Pump out contents of tank(s) D When combined sludge and scum equals one -third ( %) of tarn volume D NA ❑ When the high waiter alarm is activated Inspect dispersal cell(s) At least once every: D month(s) (Msxhntnn 3 years) ❑ NA OR year(s) Clean effluent filter At least once every: D months) D NA 1.1 ® year(s) Inspect pump, pump controls & alarm At least once every: 1 �, yonr( ❑ NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other. At least once every: ❑ month(s) D NA ❑ year(s) 011w: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tasks and dispersal cells shaft be made by an individual carrying one of the following I"icer>ses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to identify arty missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in arty treatment tank equals one -third (%) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of !_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. AM 11 91091 Page Page ,of 11 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage serviang operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area- Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; Amon swabs; degreasers; dental floss; diapers; disinfectants; fectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage servicing operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: • A suitable replacement area has been evaluated and may be utilized for the location of a replacement sod absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. • A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 18 The site has rant been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sod and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFRCIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER = Name John Schmitt Name John Schmitt Phone 715-760-0486 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Haute Apostle Septic Service Name St. Croix Count Zoning Phone 715 -497 -5929 Phone 715- 386 -4680 This rinmomoM Wac r4rafforl by tho ctaffc nt the (goon 1 ako Marnllotto anti Waiichara r4winty 7nninn and gnnitatinn wwrrioc in ^mmn iarrs+ uMh nhaMor W TOTAL DYNAMIC HEAD/FLOW age 6 o PUMP PERFORMANCE CURVE =X PER MINUTE MODELS 53/55/57/59 EFFLUENT AND DEWATERING 0 6 20 MODEL 53/55/57/59 Feet Meters Gal. Liters 5 1.5 43 163 2 15 10 3.0 34 129 4— 15 4.6 19 12 a 10 Shtk off Head: 19.25 ft. (5.9m) f- 0 F- 2 ooeee� 37B sans 5 45e 11112-111 ION" 0 ins 10 20 30 40 50 GALLONS LITERS 4 0 80 160 FLOW PER MINUTE 1 � CONSULT FACTORY FOR SPECIAL APPLICATIONS ! • Variable level float switches available • Variable level long cycle systems available 1 i • Available with special cord lengths of 15', 25', 35' and 50' to , I • Alarm systems available • Duplex systems available —� 3&W SELECTION GUIDE 1. Integral float operated mechanical switch, no external control required. 2. She piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 3. Mechanical attemalor "M -Pak° 10-0072 or 10-0075. 4. See FMD712 for correct model of Electrical Alternator. 5. Variable level control switch 10-0225 used as a control activator, with Electri- "Easy asserflbly' cal Alternator (3) or (4) float system. om & d°dgirp ope not uktuAed.) shwksad Control sewton Model Voile Phase Nods Amps Simplex Duplex UL M53155 & N67159 115 1 Auto 9.7 1 — Y I Y & 9 115 Nxxr -- 4 & 5 Y Y BN53 115 1 Auto 9.7 Y Y BaJ57 115 1 Auto 9.7 N Y ' 8E53157 1 1 Auto a.s Y Y OPTIONAL PUMP STAND PIN 10-2421 D53155 & DUO 230 1 Aub 1 4.8 1 1 1 — Y Y • Reftm potential C E53%& E57159 234 1 Nm 4.8 2 3 or 4 & 5 Y Y ��9 by debt 'single pggyt>adx swildt included. •Replaces rocks or bricks tinder the pump. • Made of durable, norworrosW a ABS. s c�u xxt • Rehm pump 2' off botbm of basin. All installation of protection devices and wiring should be done qu t . Pnwldes trim ab�i to raise intake by adit sections of 1 incensed electrician. an. All electrical and safety codes should be followed the most recent National Electrical Code (NEC) and the Occupational Safety and Health or 2' PVC piping. Act (OSHA). • Attaches securely to pump, FauftmabmonaddimdZoebrploductsr eterbxattsbgonMgWba*Vw*L"Fbet • Accommodates sump ,drwralm" mid elRuerdappkabixts. SMir*m FMD477; Bex4ricelAlemslor FM0486; Medmrw xUNerrm x. FMD495; SumptS w- (VOTE: Make stye fad Is free from obskmiti n. see Bees, FM4487; and Single Phase Snow Pump Oxtird%erm Syseemc, FM4732. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. I - ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM r Owner/Buyer !C 7_/4 s i o o ct Mailing Address �` �� G_ l/2 /'� 2� C /��G Property Address 13 �36 M 4 1 IQ S T HOO I V (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number LEGAL DESCRIPTION lAti- 6 c Property Location Y k) t/ , A I _ t/4 , Sec. 0?7 ' T OO N R 2Q W, Tmm of #o L r [ LC Ay Subdivision , Lot # 'f Volume Pa Cerh ied Survey Map # e # g Warranty Deed # , Volume , Page # Spec house yes Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Itwe 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 of bedrooms SIGNA OF APPLICANTS) 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) Page 10o f 11 IX. SOIL ABSORPTION AREA A. Type: IN- GROUND IN- GROUND PRESSURE AT -GRADE MOUND OTHER (type) B. Distribution: GRAVITY mDOSED PRESSURE C. Configuration: mTRENCH r__j BED D. Dimensions: Length: 75 feet/cell Width: 5 feet/cell Number of Cells: 2 Total Absorption Area: 7x q qft E. Depth: Grade to Top of Unit: inches inches Grade to Infiltrative Surface: AD inches 65 inches Where Measured: SF nhspr ❑nrt WE obser port F. Material of Construction: [Z]GRAVEL ❑GRAVELESS Specify Product: G. Observation Ports: Present:mYES QNO Number: Terminate at: Top of Unit Distribution Pipe Infiltrative Surface Other H. Effluent Distribution: Distribution Box: ❑YES [2] NO Drop Box: ❑YES m NO Material: Condition: Access:Lj Above Grade � At Grade Below Grade Condition: I. Flushing Apparatus: Present: ES NO ❑ UNABLE TO LOCATE Flushed for Evaluation: ES 0 NO Resufts LEAK SLIMESDLUDGEDOTHER J. Setbacks: Separation Distance from: Well(s): + 100 feet Structures: +50 feet Property Lines: — 8 feet Other: K. Observations: General Condition: Good Ponding: YES NO th of po i g: 0 Surface Appearance: Lush Vegetation: YES NO Soggy: YES Z NO Ponded: YES � NO Breakout: ES NO Location: Runoff Area: ES NO Traff ic: YES NO Other: L Comments: Something was built on top of the soil absorption area. Part of the area is bare and there is at least one post footing in the area. Reccomend reseed bare area and keep structures off of area. Tier 1 Evaluation 8 of 9 r t , c L4 (mo E i I I jr� C) 00 (,C) 00 LO LO LO Lr) - 3 Yt r U G QO a _y N N U w CL U cy LIL LO � 3 0 3 D C\! C`�I C\j D a C, `0 m2 V E2 K Na E Yt my 9 1 6 6 9 4 2$ State Bar of Wisconsin F orm 1 - 2003 9 16694 WARRANTY DEED BETH PABST REGISTER OF DEEDS Document Number Document Name ST. CROIX CO., WI RECEIVED FOR RECORD 05/27/2010 06:30AM THIS DEED, made between Chritpher J Henning, A Single Person WARRANTY DEED EXEMPT It ("Grantor," whether one or more), REC FEE: 13.00 and Daniel Sammon and Donna Zastrow TRANS FEE: 294.00 PAGES: 2 ("Grantee;' whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area 2 estate, together with the rents, profits, fixtures and other appurtenant interests, in J. Saint Croix County, State of Wisconsin ( "Property (if more space is Name and Return Address needed, please attach addendum): L Title, Inc. Lot 24 Block 7 Plat of the Village of Houlton 1900 Silver Lake Rd, #200 New Brighton, M 55112 #341126 030 - 2060 -10 -000 Parcel Identification Number (PIN) This j g homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Dated A A !��i (7 4/ * Chri�heT Henn in KIMgE• EFILER BUC - MINNESOTA ACKNOWLEDGMENT NO IRES Dt - 35 2412 co last TE OF WISCONSIN ) ' COUNT ) Personally came re me on , TITLE: MEMBER STATE BAR Of WISCONSIN the above -named Ch n her ennin A Single Person (If not, to me known to be th erson who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and ac owledged the e. THIS INSTRUMENT DRAFTED BY: K im �� Kcrohlel Ancona Title & Escrow, 4750 White Bear Parkway_ No Public, State of Minnesota ii t White Bear Lake, MN 55110 y Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures. 1 of 2 o 0 co f! 3 0 0 rD c ro T m m c n L L y O O W f .- n . V W `C • S 3 c '* A L W ° Hy - 4 rt '� N N N CD O O N `A} O C S. 3 O O 3 O fD O O 0 1 N N N a II/ 3 3 U� (T 0 Cl 0 f O O n C -•� O O R O O co O C 7 O O� (r 3 ° :E ° (� N O C w m w vs < D m \ N cc] N N G CT c N c to 3 O - cr p 0 o m =p w cn o (0 LO co - fT �I n p a `i - 3 _ C X11 ch -' 9 = N W p I 3 a -t� to (D a m m N 0' O O m N !V w _ 7 ° N °_o_o z -iz Q o 0 D > > �r CD C =3 D N - �f CD C I lD � :3 O A Z N ry C R 7 G D. to W A C O v CD CL z a 3 A p r: I z NO m CD A v 0 a V ? 'n O N C C z O. � fD fD N 'L7 O 4 C. J\ 111 90 n CD CD w 'i o I o �I o CD aro o STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �ACJ A/? T� ADDRESS /.3 SUBDIVISION / CSM# - LOT � Z SECTION -R o W, Town of �►S,� ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r � _---- ► - 6 - x 75 - TANFMC//ES i o � v .�- Soo Gc- R G ro /QOU Ft. SrT. INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: r ,o o� V4n A &�s6 o ` ALTERNATE BM: 7q Z 13 e1. SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: J06 ' �OdP Setback from: Well f House f3 Other Pump: Manufacturer 20aLL& - 12 Model # Size / Float seperation Gallons /cycle : Alarm Location &a S E SOIL ABSORPTION SYSTEM Width: Length zS Number of trenches Distance & Direction to nearest prop. line: 91 Setback from: well: House 40 Other ELEVATIONS Building Sewer�� ST Inlet: outlet: PC inlet S9 7 L PC bottom Pump Off Header /Manifold �,' Bottom of system Existing Grade Final grade�r DATE OF INSTALLATION: ��j - 7 PLUMBER ON JOB: LICENSE NUMBER: 314 s� INSPECTOR: t 3 93: / J BENCHMARK: z PL. /OV , vo ALTERNATE BM: G- ,q�pgG�' 54-43 �La 9A, t ab SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION 0 Manufacturer: Liquid Capacity: Setback from: Well _V * House J3 ' Other Pump: Manufacturer Zo - A Model # _,/6Z Size Float seperation Gallons/cycle: Alarm Location &c1SC" SOIL ABSORPTION SYSTEM Width: Length 7S Number of trenches Distance & Direction to nearest prop. line: C� f Setback from: well: House O Other ELEVATIONS Building Sewer © 4_R ST Inlet: — a._i ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade ---, Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: 310 S' INSPECTOR: 3/93:jt WisconsimDepartment of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Woman Relations INSPECTION REPORT ST. CROIX .Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284326 Permit Holder's Name: ❑ City ❑ Village 61 Town o : State Plan ID No.: BARTLETT, PAUL M., JR. ST. JOSEPH CST BM Elev.: Insp. BM Elev.: BM D scription: Parcel Tax No.: /e rid ' Z:;? TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic (�,/ S sz(_C' , G ,J� Benchmark Dosing Aeratiop, Bldg. Sewer , Holdi St /FttInIet � �p' � ( ANK SETBACK INFORMATION St /Outlet TANKTO P/L WELL BLDG. vent to ROAD Dt Inlet Airintake Septic —�'� >aS i3 ' NA Dt Bottom 41, 3 Dosing --�}� >aS 2S, � NA Header / Man. 7a� Aeration NA Dist. Pipe r. 17 Holding Bot. System 9 9 PUMP NFORMATION Final Grade Manufacturer Q.r Demand , Model Number GPM TDH Lift Lriction System / TDH Ft oss Head Forcemain Length 70/ t- d / ` I Dia. of "j Dist. To Well >�S SOIL ABSORPTION SYSTEM BED/TRENCH Width Length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S DIMEN I N SYSTEM TO P/L BLDG WELL LAKE STREAM ?LE Manufacturer: SETBACK MBER INFORMATION TypeO k: 5P , � 4 Mo&U MInrb System: u,-. / NIT DISTRIBUTION SYSTEM Header / ,� Distribution Pipe(s) / x Hole Size x Hole Spacing To Air Intake i Length 1a l Dia- Length _L Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Gr yste Only Depth Over - 3 Depth Over , -7r �� xx Depth Of xx Seeded/ Sodded xx 'Mulched /Trench enter _2),?- � ' Trench Edges 3� ` Y / / Topsoil ❑ � Yes C] No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.)�� LOCATION: ST. JOSEPH 27.30.20.578,NW,NE HOIULTON PC( L ct AU U) c...✓ OV1 C am - C F' � V Plan revision required? ❑ Yes ❑ No ✓// Use other side for additional information. I Ll I SBD -6710 (R 05191) Date Inspector's Signature Cert. No. i ADDITIONAL COMMENTS AND SKETCH 4 ' SANITARY PERMIT NUMBER: ' E a °-: Safety and Buildings Division SANITARY PERMIT APPLICATION BureauofBuilding Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County 6 - % ` than 8 112 x 11 inches in size. , (�, / • See reverse side for instructions for completing this application State sanitary Permit Number .Mq_ 3 2 o The information you provide may be used by other government agency programs []Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property O ner Name Property Location A(Iff A C 1/4, S T �V , N, R E (orel Property Owner's Mailing Address Lot Number Block Number 7 City State Zip Code Phone Number Subdivision Name or CSM Number WAI II. TYPE BUILDING: (check one) E] State Owned 't� VNeare;st p VII age r Public 1 or 2 Famil Dwellin - No. of bedrooms � own OF csr r C III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 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. p Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank 12 PtSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade i,p Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq_ ft.) (Min. /inch) Elevation Sly 5'Q 7 ,f, 3 Feet fo Feet Capacit VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con steel glass Mastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank V IVO 9 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 8 !l ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage s stem shown on the attached plans. Plumber's Name: (Print) Plu is Signature: (N Stam ) PR SW Business Phone Number: ZAC /S 66 P umber's Address (Street, City, State, Zip Code). 77iliP J am' IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved E] Owner Given Initial Surcharge fee) Adverse Determination I au X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 58D -6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained The septic tank(s) must be pumped by a licensed pumper 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, Safety and Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the 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 is 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. VI. 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 p p pp 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 mpst include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding p 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 ofthe 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 9 9 g g ater contamination investigations and establishment of standards. I ywP(iC pySIOEC ove/-7 ccic �2 v fir, p• o R. — s'— ---- sysT�� N CCIT AQEA ONE Fir cNcftes r P r I - Te f SPIKE *T f��Fsi of craRG� siu.�R // ,�'•ee 63 �► jfl'7- P o m Soo GC AG /000 G1- S. T. MOUSE SCA LD / ,• s ,S D � i ticu j/ 3 5 1'7, 11Y 57 97 �).Phw 1385 /%A /./v ST. V14-7tu Tie, W". S Y0 8,,2 Lo v - S' y,o1 S HEAD/CAPACITY CURVE EFFLUENT and DEWATERING WARNING: Model 185 should not be subjected to less than 30 feet TOW TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING 53-55 BERIES 49 40_ 51.19 9!._ 137 -139 161 163 165 185 186, In 11 M_ 44 tht 40 Llic 1W I W. ow 1 40 L110'. #W 011 "A 111► 44 I;11q, 414 ill#,, 441 k4p_ 4.1 1 44 1:4, 5 149 1 st- 28 IO 43 163 12 . 173, 104 304 106 401 61 231 61 ill as Ito, its 1ST.- Iss w... _m j1L 61 11411 58 � 148 161 is 20 SAO.: 2 7 : l 25 OS< 36 82 So 60 2g? So J90. 136 140 4*1 25 8 74 308 -i 53 490 1 126 57 gic so N:l 12 :.:.1 30 1 65 246.: 55 : 206:: 58 90 340. 56 :290; 121 43V 127 :441.. V) w 40 xltio 46 01 46 : 172:: 55 :20 G . ;: 75 : 14 103, 58 _2go 105 :.W W. W ....... ... . ..... lyj 21 W.: 33 Its:. 51 i 100 50 :0.24: Ld 59 419.i� 55 �mei� go *f M LL 60 A119 43 1SU:1 36 20:: 7t :269::: 15 :37. IX: 58 2 $5 70 81 1. so 30 10 52 10, 51 70 11 28 54 .04::::: �A � ': 1 5 100 �:A,40� 14 5V:. 45 1w: 00 J70 37 34 21 :1.0 110 x39k0 7 _2A :. 105 Lo* V*a: 21 .. 2 . 192 5 ' . .2 . T 2 . 6 56' Is' 87' 73' tit : oil iL" -9 112, 31 32 100 30 95 28 90 N 26 85 24 75 k1 86 — L L 22— 86 70— L 20 65 IN 165 18 60— F55 16 163 so 14 45 12 40 35-- \85 10 30 __ 8 25 14 6 20 L 854 go r 15 \161 4 10 2 IL 98 5 42 4113 53,55 13A139 0— U.S. GALLONS 10 201 30 401 50 601 70 80 1 90 100 1110 120 1130 140 1150 160 LITERS I I Bb lio 240 320 460 480 560 640 0 FLOW PER MINUTE Note: For Head Capacity on Model 112, industrial column-explosion pr000f pump, see FMO219. PUF1P CHA,t ^.BAR CFGcc SEC`IC'J 0JG SPECIFIC /.fiUAl�. VE1.:T CAP - T 4"C.I. E "JT PIPE WEATHERPROOF APPROVED LOC.',!^JG � � - JUIJCTIOU BOX MAfJHOLE COVEF. W1wAftNlNb C.^fLtF n r,' �r7n A t)rirm T w1IJUuw a1+ F 1�!_6I1 Ir Ml ►I' I AIR IAITAKE I GRADE i 4" MIN. G IB" MIN. COIJDUIT - -- 16 "MIN. PROVIDE INLET r,7 I AIRTIGHT SEAL I v I I I APPROVED JOINTS APPROVED JOINT A I I I W /C,I. PIPE W /C.2. PIPE I I I ( ALARM EXTENDING 3' EXTENDING 3' I II ONTO SOLID SOIL ONTO SOLID SOIL I I I I ON . C I I I ELEV. FT. PUMP -� -� OFF r D CONCRETE BLOCK RISER EXIT PERMITTED OWL4 IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E , SPECIFI'CAtIOU DOSE TANKS MANUFACTURER: S�I��X 15 IJUMBER OF DOSES: PER OAy TAWK SIZE: A90 CALLOUS DOSE VOLUME 3 GALLONS ALARM MAIJUFACTUR.ER: f // ss ACAPL2 'Co INCLUDIMG BACKFLOW MODEL KJUMBER: 0�1 L CAPACITIES: A= , INCHES OR `/ GALLONS SWITCH TYPE: 27 40A-r - B = __ INCHES OR y � ! 3 D y � � GALLONS GALLONS PUMP MANUFACTURER: ZCJC LL��L G= 7 INCHES OR ly — MODEL NUMBER: /h/ �p //,Ti/ D - — INCHES OR GALLONS SWITCH TYPE: 17�/ cJj,0jL r,(=Cf7 = MOTE: PUMP AMD ALARM ARE TO BE q GPM INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE VERTICAL DIFFERE BETWEEN PUMP OFF AN0 DISTRIBUTION PIPE.. _ham 2 FEET + MIIJIMUM METWORK SUPPLY P FEET / . . . 2.5 +- FEET OF FORCE MAIN X � F /100 fTFRICT101J FACTOR.:�1 - — FEET TOTAL Dy JAMIC. HEAD = 30, FEET INTERNAL. DIMEUSIOMS OF TAUK: A (00 ;WIDTH ..ZZ-- - ;LIQUID DEPTH �d.L� SIGti1ED: LICELOSE DUMBER.) / rP 390-6 DATE: YS9 " - 7 Wi sconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page, of 3 I ,; or and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code ` COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but -s not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. — p —/p APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT 114X� 1/0�27 Tj N,R E (or)5V PROPERTY OWNE ':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR C # S , — 7 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY VJVILLAGE ❑TOWN NEAREST ROAD O ( ) [�] New Construction Use J/] Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow yso gpd Recommended design loading rate ..S bed, gpd /ft gpd/ft Absorption area required e 4 'P' , 0 bed, ft 7S0 trench, ft Maximum design loading rate _ bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) 9S. 3 ' ft (as referred to site plan benchmark) Additional design / site considerations 7` 4 O 2. Parent material /' -C 4* Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT -GRADE SYSTEM IN FILL I HOLDING TANK U= Unsuitable fors stem OS ❑ U ❑ S O U 0S ❑ U ❑ S 01.1 El m U ❑ S I I U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxlary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench �r Ground .3 3— 5' ?•s - L S O s c S ~` 7 X elev. /0` ' ft. y s , ,� LS sG NIL — — •7 Depth to limiting factor t ? /3 I Remarks: Boring # g?. 2— ryti. v:.:•i:•iiiv S .4 CIS L cs : \ \:�:ti ?:iti} ' 3 .1-10 5 3/3 ---- LS ©.5G cs Ground elev. 99� ft. Depth to limiting factor Remarks: CST Name:— Please Print �C_1=-A7-I Phone: A ddress: r? _ S Signature: O � Date: � , �CST Number: PROPERTY OWNER D( SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BourxI3y Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench L G Ground 5 p Ar Ik L elev. , 7 ft. Depth to limiting factor r Remarks: Boring # l OG Llr �- E'G .ri O Ground elev. ft. S 7/f 0 ~ E' v .C/ T �f lfG� Depth to rf 13k S, limiting 76 Q S. factor Remarks: Boring # 4v' .................. 0 Ground elev. ft. Depth to &1� T 6'x/c Y�elc A)A C z . x ' limiting factor i Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) PROPERTYOWNER Dg SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boun la Roots Bed Trench Ground 3 •S — 4 .s m elev. , 7 ft. Depth to limiting fact Remarks: Boring # Ground 4-E Z elev. ft. 1< uta ~ E' �`.rr 7`ff .� CG� Depth to '� nz 2T1FAI limiting 0 factor Remarks: Boring # e Ground Fr elev. ft. Depth to C Z X 7S ' limiting factor Remarks: Boring # hv: Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05 /92) • '' FOGERTY PLUMBING B PERK TESTING, INC. Y 9 �� P.O. Box 130 S z/9' 676'1 J o13 l �iS'S /G ROBERTS, WI 54 3 F , Ivr_ FinaT c uT >S X lt- X = dotrNG, 90' /Z o - FOaivi� Lv� [o/Z�veR� x, 1/ 10 3 1 = Ur1�6L SsL uFK W,,4 P `E 1 P, i> Y r i S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property / 64Z Al, 41a r'% /e Location of property AtW 1/4 &E 1/4, Section 17 T _-Y_0_ N -R _A_0_ w Township Mailing address ---a S ,n w ST, Address of site 1 F3 Al 'o S T At a L, srv/ra Subdivision name Lot no. Other homes on property? Yes No Previous owner of property v _ �g�r G Total size of property / Total size of parcel 4 o ; Z 0 0 C f e— Date parcel was created Are all corners and lot lines identifiable _ Yes No Is this property being developed for (spec house)? Yes __ No Volume 6Z30 and Page Number y3 f as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed' description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owners) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. ` S - :7VI $ , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of Applicant Co Applicant y - �? - 2 Date of Signature Date of Signature STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER i /' r?' . MAILING ADDRESS a ��, / 10 .�. !.� . ; A 4 2 PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY /STATE 14 y Cj p `, T PROPERTY LOCATION AeaZ_ 1/4, h 'LC7 1/4, Section T -R TOWN OF - t -"-� -4 / TU r� ST. CROIX COUNTY, WI SUBDIVISION fL 47 Q,- 7*C 111CCAee a LF_Acc L ran/' LOT NUMBER ILI_ CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: Od DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 ` �- .1 -4 g a YOL �3OPAGE49 557418 WARRANTY DEED REGISTER'S FFICO DOCUMENT NO. ST. CROIX CTY., WI Wd for R�ooiel APR 2 1997 This Deed made between CHIUSTOP11ER J. HOG13ERG, a at 9:00 A. M single person, and MARY J. HOGBERG" - a single person, formerly k .. * husband and wife, Grantors and PAUL M. BARTLETT, JR. and Hes + of Deals ' MARIA PATRICIA BARTLETT, husband and wife as survivorship marital property, Grantees, *a /k/a Mary J. Murray Witnesseth, That the said Grantors, convey to Grantees the following described real estate in St. Croix County, State of Wisconsin: Lot 24, Block 7 of the Plat of the Village of Houlton, St. Croix County, Wisconsin. RETURN TO: Paul & Maria Bartlett 1385 Main Street Houlton, WI 54082 TRA PFEA Tax 11D# 030 - 2060 -10 This is homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Christopher J. Hogberg and Mary J. Hogberg warrant that the title is good, indefeasible in fee simple and free and clear of encumbrances, and R w ant and defend ame. A ,'I Dated this °r day of A, 1997. (SEAL) Christopher ve Hogberg `7'y> SEAL) Mary J. H , a /k/a Mafy j. Murr STATE OF WISCONSIN ) ss. ST. CROIX COUNTY ) Personally came be o e fi-1)(OrvirMle this day of 97, the above -named Christopher J. Hogberg and Mary J. Hog - --_, 11 %% a on o executed the foregoing instrument and acknowledged the same. D v J. Estreen Notary Public, State of Wisconsin My Commission Expimsx is Permanent THIS INSTRUMENT DRAFTED BY: Barry C. Lundeen MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. 110 Second Street, Post Office Box 469 Hudson, Wisconsin 54016 COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 ST, CROIX ZONING REPORT NOA* 04954/01 PAGE ST, CROIX COUNTY REPORT DATE*# 5/10/90 COURTHOUSE DATE RECETVED'* 5/09/90 HUDSON, WI 54016 ATTN*9 THOMAS C. NELSON C4 4 j, , O"R#f Chris & Mary Hogberg LOCATION*# 1385 main St., HouLton COLLECTOR*4 M. Jenkins - 7Y 3 0. 2-0. 5 SOURCE OF SAMPLE! Kitchen faucet COLIFORM 0 /100 MI. INTERPRETATION'4 BacteriologicaLly SA NITRATE—N*. 5 ppm Under 10 ppm is safe for human consump CoLiform Bacteria/100 mL Nitrate—Nitrogen, mg/L LAB TECHNICIANt Pam Gane WI Approved Lab No. 19 A DE Means "LESS THAN" Detectable Level Approved by'* PROFESSIONAL LABORATORY SERVICES SINCE 1952 a a. ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street ;. Hudson, WI 54016 Telephone - (715)386 -46 The St. Croix County Zoning Office offers the Realty Firmsa and water inspections to Lending Insti tutio n s, private individuals. of 4h a form is essential ng that the vrooertl can DA locat • Please provide the following information, enclose appropriate fee made h f address. Zo Testing f will be ai done an along with form soon as possible after fee and form are received. MATER TESTING--------------------- - - - - -- -FEE: $ 25.00 (For nitrates and coliform bacteria) FEE: $175.00 WATER TESTING (For VOC'S) $25.00 SEPTIC SYSTEM INSPECTION--- - - --•- - - FEE. • (Determines if system is properly functioning at t me of inspection) Property owner's name_ R Property owner's address 3gs Ir N 54- HO LL I+O o l W Legal Description 1/4 of the _____1/4 of Sect on _, Town of LI ZA4 r, Lot Number eA Subdivision Name FSBS.�LV�BB► Z / f G 3 0 Box HUMBER /, .. U, Color of house (` Realty sign by house? If so, list firm: PLEASE INCLUDS, IF AT ALL POSSIBLE, A MAP, .e,COPY OF PLAT BOOK• WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned oft, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: Qfm Telephone Number 1 39 - 6 - 90 REPORT TO BE SENT TO: 3 &M . Clos ng date Mnj Signature .. .,,..... ,. a— w•..................,• rY•, e., 6•.+ r.: yR7„ T.•.,, is. nn........_.. �. �. I ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 � A hone - (715)386 - 46 80 Telep _ The St. Croix County Zoning Of fice t o ffers the s F f se ptic and water inspections to Lending Ins and private individuals. C gt on of t his form is essential so that th oroner can be located • please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING-- - - -- --- - - - - -- -FEE: $ 25.00 _ (For nitrates and coliform bacteria) FEE: $175.00 WATER TESTING (For VOCPS) - FEE. $25.00 SEPTIC SYSTEM INSPECTION--- - - - -- - (Determines if system is properly functioning at t me of inspection) Property owner's name l fly I S 1' Y41R14 M � ? Property owner's address / 3g5 rn /� Srt. I f o ��.. I'f 6 A) I Legal Description 1/4 of the `1 /4 ofisioniName #I T N -R Town of ,lip z ../ Lot Number - FIRE 3 K Lock agx mmim _ Color of house r At4 Realty sign by house ? so, list firm: ro, -e r ril� �qoA - 1�e 4 PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLA BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned oft, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: Qr(h l a,QUDA Telephone Number 3$b A DS REPORT TO BE SENT TO: �JT Goot� 2 rl e a of re S� +Ifw closing date Signature ST. CROIX COUNTY rK WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 >> (715) 386 -4680 May 9, 1990 Jim Lagoon Merrill Lynch Realty 2020 Washington Ave. Stillwater, MN 54082 Dear Mr. Lagoon: An inspection of the septic system of Chris and Mary Hogberg, located at 1385 Main St. Houlton, WI was inspected on May 8, 1990. At the same time I also obtained a water sample for testing. The results of that test will be sent to you as soon as we receive them back from the laboratory. At the time of the inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. it is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system is totally dependent upon proper maintenance of the system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator cj