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030-2084-60-000
,CAM :0 SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636 -7173 FAX (612) 636 -7178 LABORATORY ANALYSIS REPORT NO: 30059 PAGE 1 01/15/93 St. Croix County Zoning DATE COLLECTED: 01/06/93 911 4th Street DATE RECEIVED: 01/07/93 Hudson, WI 54016 COLLECTED BY : CLIENT DELIVERED BY : CLIENT SAMPLE TYPE WELL WATER Attn: Mary J. Jenkins SERCO SAMPLE NO: 1593 SAMPLE DESCRIPTION: Millar 1/6/93 ANALYSIS: ---------------------------------- - - - - -- -- - - - - -- Bromodichloromethane, ug /L <0.2 Bromoform, ug /L <0.5 Bromomethane, ug /L (Methyl bromide) <1.0 Carbon tetrachloride, ug /L <0.2 Chlorobenzene, ug /L <1.0 Chloroethane, ug /L (Ethyl chloride) <0.4 2- Chloroethylvinyl ether, ug /L <0.4 Chloroform, ug /L <0.5 Chloromethane, ug /L (Methyl chloride) <0.6 Dibromochloromethane, ug /L <0.4 (Chlorodibromomethane) 1,2- Dichlorobenzene, ug /L <1.0 (o- Dichlorobenzene) 1,3 Dichlorobenzene, ug /L <1.0 (m- Dichlorobenzene) 9 1p 1,4- Dichlorobenzene, ug /L <1.0 (p- Dichlorobenzene) v >> Dichlorodifluoromethane, ug /L (Freon 12) <0.5 g 1,1- Dichloroethane, ug /L <0.1 N 1,2- Dichloroethane, ug /L <0.2 �' c�2�p O (Ethylene dichloride) v 1,1- Dichloroethene, ug /L <0.2 trans -1,2- Dichloroethene, ug /L <0.1 1,2- Dichloropropane, ug /L <0.1 �� £ cis -1,3- Dichloropropene, ug /L <1.5 trans - 1,3 - Dichloropropene, ug /L <0.9 < means "not detected at this level ". 1 mg = 1000 ug.�,,, i r SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636 -7173 FAX (612) 636 -7178 LABORATORY ANALYSIS REPORT NO: 30059 PAGE 2 01/15/93 SERCO SAMPLE NO: 1593 SAMPLE DESCRIPTION: Millar 1/6/93 ANALYSIS: ---------------------------------- - - - - -- -- - - - - -- Methylene chloride, ug /L <5.0 (Dichloromethane) 1,1,2,2- Tetrachloroethane, ug /L <0.2 Tetrachloroethene, ug /L <1.5 1,1,1 - Trichloroethane, ug /L <5.0 1,1,2- Trichloroethane, ug /L <0.1 Trichlorofluoromethane, ug /L (Freon 11) <0.7 Vinyl chloride, ug /L <1.0 Benzene, ug /L <1.0 Ethylbenzene, ug /L <1.0 Toluene, ug /L <1.0 Trichloroethene, ug /L <0.4 Total Xylene, ug /L <1.0 Wft This sample's analytical results aarr � JiSQ3 below the U.S. EPA's SDWA Maximum Contaminant level of T /30/91 for those requested compounds which are also on the SDWA MCL list. < means "not detected at this level ". 1 mg = 1000 ug. Ira 7 SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636 -7173 FAX (612) 636 -7178 LABORATORY ANALYSIS REPORT NO: 30059 PAGE 3 01/15/93 All analyses were performed using EPA or other accepted methodologies. Samples that may be of an environmentally hazardous nature will be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, Diane J. Anderson Project Manager < means "not detected at this level ". 1 mg = 1000 ug. �B AAC SAO CO 4 COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962-3121 800 - 962 - 5227 1 FAX - 715 - 962 -4030 f� �Q ST, CROIX ZONING REPORT NO.. 35334/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 1/11/93 COURTHOUSE DATE RECEIVED. 1/08/93 HUDSON, WI 54016 1 ATTN. THOMAS C. NELSON OWNER. Mike G Sandi MiLLar I . LOCATION. 264 Red Pine Trail, Hudson COLLECTOR. M. Jenkins DATE COLLECTED. 1- 06--93 TIME COLLECTED. 3.00pm r SOURCE OF SAMPLE. Kitchen faucet DATE ANALYZED.1 -0 8-93 f TIME ANALYZED.12.00pm COLIFORM. 0 /100 ML INTERPRETATION'# Bacteriological.LY SAFE NITRATE -N. < 1 ppm Bove 10 ppm exceeds the recommended Public Drinking Water Standard, Coliform Bacteria /100 ml Nitrate- Nitrogen mg /L 9 1p ` �tio r LAB TECHNICIAN. Pam Gane 0 f �` of .WpEPEND EHj WI Approved Lab No. 19 0 q 8 : ^0 t .Means "LESS THAN" Detactahle Level Approved bY: PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST —CROIX COUNTY ZONING OFFIC (� St. Croix County Courthouse 911 4th Street Hudson, WI 54016 V L� � Telephone - (715)386 -4680 S The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form ja essential so that the property can §e 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: $ 35.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) SEPTIC SYSTEM INSPECTION---------- - - - - -- -FEE: $25.00 1� (Determines if system is properly functioning at.time of inspection) PROPERTY OWNER'S NAME //� / f,F,Slivo i - M LG PROP. ADDRESS: CITY Legal Desc ip ion 1/4 of the 1/4 of Section, T Town of Lot Number 14 Subdivision: FIRE NUMBER o2 LOCK OOXX NUMBER Co of house � y Realty sign by house ? If so, list firm: / e , t / 9.to ►-�^ -•-- /�� "/' mow °,.- 2 ° 1 PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.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 off, 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: Telephone Number S94 - 0 REPORT TO BE SgNT TO: 6Lr / � W CLOSING DATE* Signature -�� � `` � �C 7 o a -'� �� -� Z a ST. CROIX COUNTY y WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 - - - _ - (715) 386 -4680 January 7, 1993 Andrea Kary Century 21 - Premier Group 706 - 19th St. S Hudson, WI 54016 Dear Ms. Kary: An inspection of the septic system on the property of Mike & Sandy Miller, located at 264 Red Pine Trail, Hudson, WI was conducted on Jan. 6, 1993. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of 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 may be dependent upon proper maintenance of the system. Should you have any questions, please contact his office. sincerely, Mary J. Jenkins Assistant Zoning Administrator cj r Wiscone,nDep.^rtmentofCommerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 499175 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)]. Permit Holder's Name: City Village X Township Parcel Tax No: Neale, David I St. Joseph, Town of 030 - 2084 -60 -000 CST BM Efev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: / 0 0 &A t GS /� 36.30.20.719 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. I l /W. 9 I cc, Septic 3 Benchmark idler_,- � � F 4, /Zoo o 1� Z. zg /OZ•zS /a `� Dosing Go 1 O �UV Alt. BM � Q1� . 7 /65 .5 '7 r. Po 16 A L SZS , l Bldg. Sewer Z /bZ . Holding V St/Ht Inlet � / ,'yst. toy • fl}' � Z , 0 9a , Z l TANK SETBACK INFORMATION St/Ht Outlet /Z• 5 11 . 7 (o TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic /4D 7 c 55 / S5 / _ Dt Bottom Dosing 7 56 / 5 5 St / Header /Man. a el 3 Aeration Dist. Pipe 7 • CS . a'T 9 3 . `s I Holding Bot. System Final Grade PUMP /SIPHON INFORMATION L Manufacturer Demand St Cover �o� s GPM .`7 Model Number / t vf, I / 9 -7 Q Z. s$ T Li Friction Loss System Head TDH Ft Forcemain Length Dia. // Dist. to well '7 O i 2 SOIL ABSORPTION SYSTEM BED /TRENCH Width Length / No. Of TnenchesA PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (� • , %-- _` -- SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of S I i 1 60 I Vt 7 /W � I d �L� UNIT Model Number: DISTRIBUTION SYSTEM Ga 7 t 7 Header /Manifold i/ r 11 Distribution C I/ it x Hole Size I x Hole Spacing Vep�to Air Intake p O l 1 J J Length Dia l z Length �JO Dia Z Spacing 2 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded ulched Bed/Trench Center ' �� Bed/Trench Edges \ Topsoil , � xx M �s I No ' N' <es '', No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 q : /0 / / /� [n pection #2: / / G';�;V plb,j Location: 264 Red Pine Trail Hudson, WI 54016 (SW 1/4 SE 1/4 36 T30N R20W) Pine Tree Meadows Lot 16 Parcel o: 36.30.20.719 t3 t1z• "� u : �•. OlJ S sd� - u $j clS dK 1.) Alt BM Description = J � la 2.) Bldg sewer length <r cololr 1. i ON. , o E.r 51-:1 l ,.,. - amount of cover = i Plan revision Required? j Yes No lb Use other side for additional informati _ r '_' SBD -6710 (R.3/97) Date Insepcto Signa a Cert. No. r Safety and Buildings Division Coun 201 W. Washington Ave., P.O. Box 7162 t ` Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266-3 De artment of Commerce State Plan I.D. Number Sanitary Permit Applicatio -: 0 In accord with Comm 83.21, Wis. Adm. Code, personal information yo vide Protect A dress (if different the ilin address) may be used for secondary purposes Privacy Law, s15.04(I)(m) l t d I. Application Information - Please Print All rmati P rty Owner' Name 1 8 ZOO Parcel # t #' Block # SEP ninn Property Owner's M 'ing Add ST . CROIX CO Property Location U L4 �Q, ; y NU) /., _aE 'iti Section 3 o City, State Zip Code Phone Number q S o I fa ,{circlepncl l• - 7/ I - IS r T N; RE o1 / ) I. Type of Buil ing (check all that apply) . / 1 Subdivision Name CSM Number X I or 2 Family Dwelling — Number of Bedrooms c� ❑ PublicJCommercial — Describe Use / X �� e ❑City_ ❑Villagel ownship of [3 State Owned - Describe Use _ ly III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. (I Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS system: Check all that a pply) ❑ Non — Pressurized In- Ground X Mound > 24 in of suitable soil ❑ Mound < 24 in. of suitable sail ❑ At Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressuri zed In Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculati g Sand Filter ❑ / Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line raveHess Pipe ❑ Other (explain) . c5 V. Dis ersalfffIr meat Area Information: `--"' Design Flow (gpd) Design Soil Application Ra gpdsl) Dispersal Area Required Dispersal AreaProposed System Elevation / VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Facisting Tanks Tanks c HoklingTanic lo�o(� s }� C7 ✓ erobic Treatment Unit V posing Chamber ' C r• VII. Responsibility Statement— I, the undersigned, assume responsibility for in Aflikpfthe POWTS shown on the attached plans A bet's Name (P t) Plu s Signa re /MFRS umber Business Phone Number �� �S (0 5t �35 P umber's Address (Street, City, State, Zip C e) _ S� h A v e 0 VIII. Coen /Dc artment Use Onl Approved �sapproved Sanitary Permit Fee (includes Groundwater Date ued Issuing Ag ignature S Surcharge Fee) 55D n� q I; Q Owner ' en Reas�f�o.r n o IX. Conditions of ApprovaVReasons for Disapproval SYSTEM OWNER: 1. septic tank tlfYluerit rtker and l dispersal con must all be servilces / mailer 4b VM J as per management plan provided by PkWd er. 2. AN selinck requinilmOnts must be ffseintalrod as per appicabb code / ardiniww". aj Attach complete plans (to the County only) for the system on patter not less than 81/2 x I1 inches in size SBD -6398 (R. 01/03) RIOWO 103T2vg 19i:i7tLIU 1 f,?r;. .. ?ry ?,b' b ^r tqt. eC; })�i!?76 }ffi6�t1 94 % -w (I r'n9rYiri *.,6iQ�Nl :Ira ' • i9y(?6!}Ih ?U ' 9hCi� 91ULJ�Is�fj6 � gg I P1 0 - noN I ab _ _ a � — to r oo mb /ma -' s q the q ro�ird t /0 1 v - - � II �} r �� t � Sec3(o T30 lQr�aW - - a , �� - P oA P hz 1 v�c� t r t !R 2 f.Q " L� uo _ � - (Q - o- - -Q tA's - IQ -(`fM 6v`cr 1� A ro u.rd ' - -' a- 1! Vftwnsin Depwftw t of Cm=nwm SOIL EWATION REPORT page / or 3 tli�Asion dSafigr+sM 8�iigs ra.00ana.na..Uh cc* cxm•+r ST C v- a i � aonrpAdt �. pion an pager nvt I�ss a�.n a ut z 1� +natrsaR In r . eut,aoea+ al ocwiar .nal�oe�o�ilwlr�+c.voMrt(81q, Powd u)_ . v�ossltYoA.aartaer�ibns, loara�aa�i 30- -4 ,9 —gyp mss w r...r.M.■ws�•w•�+•••r �ws.w+�.� so. air S E P 18 2006 . @6�Rfst Alk in-5F, In T _14 it ` . �,_ 0' x (.: ; td# BNd�• BRbd. t�safC91� R ur,; FY, t $ 2 crJ S 0�r vow "owed PARd IS T- lMr v=wr ww userm FL.de. ifl&mftm as Coft *Ad , It toswa. ono -- !' p PAft roaaw w ""OWN � i wooaPat. xaw _... I. ©s+�sAtooasm.ne aaaeooara�d��a� emwwmWftw4ft IL o.pwaaa eftw ? h G., swift" A. & .... a. tea... w. W CWL C" sz sk o - o r y3 Y�l r �� •d �� a o ►- 6 S ,bk m�,- U3 1 6m yn F 3-1 ty rieoua0wn4�s►e%m 93, R Ds1+t►/mi pis 2,-- -h 1!011111! Q 1irilrat 1UIbm o NL "Mud CAL SL Cma cmw or. SL IUD Q a U) rs I m 636 /8 r5 FS p Moo c-� y� •Eil.ntst >ao_?�ssdLandT�BS>la <�D11gll Sam j3D and1Wj__3S "WIt aeanrs: � � orl. E11�1+�eR 2 62 �y6 X13 i e ,• - w � � � •i S �1� a 0 mom Ilia r' i• • ,• ICI P. V = � ® FIMM � it lll� E5: ma Q �� OWN � v �j w S / Sew 3CP - r3O u P, vJ y f r\Q� r..� m �a. O ,, S Cdr i 1 / � U .� I �J �? f � w y Safety and Buildings 4003 N KINNEY COULEE RD commerce.wi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary September 15, 2006 CUST ID No. 220537 ATTN.• POWTS Inspector CALVIN W POWERS ZONING OFFICE POWERS EXCAVATING, INC ST CROIX COUNTY SPIA 1969 185TH AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/15/2008 Identification Numbers Transaction ID No. 1318901 SITE: Site ID No. 718099 David Neale Please refer to both identification numbers, Red Pine Trail above, in all correspondence with the a' enc 1 Y4 Town of Saint Joseph St Croix County NW1 /4, SETA, S36, T30N, R20W Lot: 16, Subdivision: Pine Tree Meadows FOR: Description: New Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1096697 Maintenance required; 600 GPD Flow rate; 84 in Soil minimum depth to limiting factor from original grade; System(s): Ezflow Mound Component Manual, (N.6/03), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01) 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: • This system is to be located and constructed in accordance with the enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county. official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the tank/filter for maintenance purposes must be provided per Comm 84.25(7), Wis. Adm. Code. • Comm 83.22(7) - 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 De artment which mqy include local inspectors. Conditionally APPROVED DEPARTMENT OF COMMERCE nIVIRMN OF SAFETY ANn BWLniNGS CALVIN W POWERS JR Page 2 9/15/2006 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swi-in@wisconsin.gov cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 EZFLOW MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Cn �n M rn Project Name: DAVID NEALE -a n m CID z Owner's Name: DAVID NEALE C 00 M Owner's Address: 264 RED PINETRAIL rn Z HUDSON, WI 54016 C�l� Legal Description: NW 1/4 SE 1/4 SEC 36,T 30 N R 20 W Township: ST JOSEPH County: ST CROIX Subdivision Name: PINE TREE MEADOWS Lot Number: 16'' Block Number: Parcel I.D. Number. 030 - 2084 - 60-000 Plan Transaction No.: Pagel Index and title Page 2 Data entry Page 3 EZFIow mound drawings Page 4 Lateral and dose tank Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 PLOT PLAN Page 10 PERK TEST Page 11 SEPTIC TANK/PUMP STATION S PECS Designer. CALVIN PO WERS License Number. 220537 Date: 09/06/06 Phone Number. 715 -246 -5135 Signature: Designed Pursuant to the EZFIow Mound Component Manual (N. 06/)3), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01181) EZFlow Mound Version 1.2 (R. 02/04) Page 1 of 11 SEE CORRESP�ENCE EZFIow Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) r Residential or Commercial Design Note: sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 8344 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 =150 %) coliform of - 36 ins. 600.00 Design Flow (gpd) 7.00 Site Slope ( %) 93.50 Installation Contour Line Elevation (ft) 120.00 Contour Length Available (ft) 96.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpde) Distribution Cell Information L��11 Cell Width (ft) 3. 4, 6, 7, 9, or 10 Only 100.00 = Dispersal Celt Length (ft) Dispersal Cell Design Loading Rate (gpd/fl?) Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution FY Pressure Disribution Information network? Enter Y or N (c or e) c Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 2.00 Estimated Orifice Spacing (ft) = 6.00 ft /orifice 2.00 Forcemain Diameter (in) 150.00 Forcemain Length (ft) Does the forcemain drain back? F Y 88.00 Inside Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 24.47 Forcemain Drainback (gal) 7` 5.67 Vertical Lift (ft) 90.37 5x Void Volume (gal) 2 5.23 Friction Loss (ft) 114.84 Minimum Dose Volume (gal) 17.39 Total Dynamic Head (ft) 41.19 System Demand (gpm) (- Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 x 2.00 x 1.50 x x E 3.00 2.00 x 3.00 x Gallonslinch Calculator (optional) Treatment Tank Information 800.001 Total Tank Capacity (gal) 1200.001 Septic Tank Capacity (gal) 36.001 Total Working Liquid Depth (in) WIESER Manufacturer 22.221 galrn (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.00 Dose Tank Capacity (gal) POLYLOCK I Filter Manufacturer 22.22 Dose Tank Volume (gal/in) F01-5 ____]Filter Model Number WIESER Manufacturer Project DAVID NEALE Page 2 of 11 Mound Plan View t ..................... J 1/10 B :Observation Pip M:. -:•. :r:l:r•r:: .••J:r: rm:.•:r.: :r. S•s•s +5.5•Srti . . . . . . . . . . . . . . . . .. . . r -1•: :r A ....... ..... .. _ .1.•..511... . �S.ti�'.r s•5•s . .. 5. 5.5.1..��5.5•s•5••.- •.;s.5•'... .4.5.•..5..•. �. .•.'•'.'.'.- .'.•.• -•. •. •.'. •. •.'. •.'. •. •. •. •.'.'. ••• _ I . . L Mound Component Dimensions A 6.00 ft E 11.04 in H 1.00 ft K Aft ft B 100.00 ft F 12.00 in I 9.19 ft L ft D 6.00 in G 0.50 ft J 4.96 ft W 600.00 (fe) Dispersal Cell Area 1 1518.99 (fl?) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate I 10.00 1 (ft) 1 /10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area i Fi hed Grade 96.00 ft ---♦ Finished ( ) /!! /!! /! G I F Dispersal Cell 94.50 (ft) Lateral 94.00 (ft)--O- — ;:; 6.. :.:. =:::: Invert Elevation Dispersal Cell ::.:::............•. Elevation :::: E D []3 GC. t x'1� Z. ���.?, ��t� lt��J �� X�. >, ?icy >.� tea Z� � � !� �1';�� ✓��� - ;� 93.50 (ft) Contour Elevation 7.0 % Site Slope Typical Dispersal Cell T Shading Key ° See Page 5 10 Topsoil Cap i o 2.0 ft Geotextile Fabric over Q � Subsoil Cap � � • • r. - f r.:•. r:: • r•r •.• :.r-r• ASTM C33 Sand ;5 Z ?r�r:r •.r r J ? 4 rs` .n4 1�, Q h, Tilled Layer c F 0 .5 ft s1s:• 5..• L.t� rM. 5 is s 4 .• .jSK•..:..- Y r: S'ti.•:` l lti . .? J :.•L .r 05 EZFIow Media O --�-- �— A See details on page 4 for number, size, and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. Project: DAVID NEALE Page 3 of 11 I Center Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below Force main connection via we or cross to nuvd*k M at ary point. Laterals are identical Orifices port up, except every 5th one K P points down for drainage. ' •= Turn -up vdball vaNrs or X— *'Eaf2 td2� laterals s: farce main of PVC S* 40 oleanoutplug per CMW Table 84 .30-5 Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.01 ft Lateral Length (P) 49.25 ft Orifices per Lateral 25 Lateral End (Z) NA ft Orifice Density 6.00 fe /orifice Lateral Spacing (S) 3.00 ft Manifold Length 3.00 ft Lateral Flow Rate 10.30 gpm Manifold Diameter 1.50 in System Flow Rate 41.19 gpm Forcemain Velocity 4.21 ft/sec Dose Tank Information Locking cover with warning label and locking device, and �� sealed watertight Electrical as per NEC 300 and ---� Comm 16.28 WAC 4 in. min. Disconnect — component component Tank component is property vented �– Alternate outlet location Forcemain diameter WIESER Manufacturer �_ 2 in. Capacity 800.00 Gallons Volume 22.22 gal/inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 18.84 418.52 C B 2.00 44.44 Pump off elevation (ft) C 5.17 114.84 88.83 D 10.00 222.20 D Total 1 36.001 800.00 1 JLI Dose tank elevation (ft) Min. 3" Bedding under tank. 88.00 Alarm Manufacturer Alarm Model Number Pump Manufacturer 5 _� Pump Model Number Lu FG 5 Pump Must Deliver 41.19 gpm at 17.39 ft TDH Project: DAVID NEALE Page 4 of 11 EZFtow Distribution Cell Media Layout 6.00 Cell Width (ft) 1.50 Sidewall to Lateral (ft) Distribution Cell Cross - section Arrangements Drag appropriate drawing to space below. � 6 ft Wide 64NDSOO Component Legend ® 6" EZFtow Bundle - EZ0601A, 5 or 10 Foot Lengths 12" EZFtow Bundle - EZ1203H, 5 or 10 Foot Lengths 12" EZFtow Bundle - EZ1203HP, 5 or 10 Ft Lengths O 4" Distribution Pipe With Pressure Lateral Inside 0 Tumup Enclosure — — — — Lateral Distribution Cell Plan View Layout - Typical 6.00 Cell Width - A (ft) 100.00 Cell Length - B (ft) Center Connection Lateral Layout Diagram Drag appropriate drawing from left to space below. Force Main -- — — — — - -- - -- 6ftWtde Center Manifold P U "' s� �t Mound System Maintenance and Operation Specifications Service Provider's Name CALVIN POWERS Phone 715 -246 -5135 POWTS Regulator's Name ST CROIX CO ZOING Phone 715- 386 -46A System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 fe Maximum FOG 30 mg/L Type of Wastewater Domestic 1 Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month Pressure System Laterals should be flushed and pressure tested every 1.5 ears Moundl Inspect for ponding and seepage once every 3 ears Other Miscellaneous Construction and M..#ater`lals Standa 1. Observation piper are slotted and materials conform to Table Comm 84.30 -1 have a watertight cap. and are secured in as shown in the EZFlovf mound component manual. 2. Dispersal cell media conforms to EZFlow products approved far use with the E7-Flow Mound Component Manual approved 613103. FZFIaw media is covered with an approved geotextile fabric. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished •iwwwwwsaw +see wwwwwwwwwwwwwww Grade 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Bait Valve Lateral Ends at Last Orifice Where Variable Length Cleanout Begins A AA Long Sweep 90 or Two 45 Degree Bends Same EZFiow Media 1.26 Fe Diameter as Lateral et 4 -- Distribution Lateral Lateral Cleanout -- ►1 Project: DAVID NEALE Page 6 of 11 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code G eneral This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [EZFlow Mound Component manual 6/3103 and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the fitter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent fitter 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 113 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. 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 fitter 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 penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg /L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 30 mg/L TSS, 10 mg/L FOG, and 10 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice dogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continkiency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: DERRICK CONSTRUCTION CO INC. Page 7 of 11 ST, CROIX COUNTY SEPTIC TANK MAINTENANCE AGREE AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ' �:)Cx, y N C7t` Mailing Address O - � 2 -P_ r.Q„�ine► 1't etc_ �t! ©� Property Address (Verification required from Planning & Zoning Department for new constmction.) City /State u &0 A Parcel Identification Number 0 08 O-O 00 LEGAL DESCRIPTION Property Location N W '/4 S r /4 , Sec. , T 3 0 N R a (� W, Town of Subdivision T ` �� M , Lot # / Certified Survey Map # , Volume , Page # Warrant Deed # Volume P e # 0 31 ?,5�3) Spec house yes (no J Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNE R 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. Uwe certify that all statements on this form are true to the best of my /our knowledge. I/we am/we the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. tmber of bed o0 GNA O LICANT {S) lT ** *Any information that is to may result in the sanitary permit being revoked by the Planning & Zoning Departaent. * ** 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. 08105) ,[ GOULDS PUMPS Submersible Effluent Pump M OD EL .. WE - Series PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS ■ Shaft Corrosion - resistant, Single phase (60 Hz): can be operated continuously Specifically designed for the stainless steel. Threaded • Capacitor start motors for without damage when fully following uses: design. Locknut on all models maximum starting torque. submerged. • Homes to guard against component • Built-in overload with ■ Bearings: Upper and • Farms damage on accidental reverse automatic reset. lower heavy duty ball bearing • Trailer courts rotation. • STTOW or STOW severe duty construction. • Motels ■ Fasteners: 300 series oil and water resistant w Power Cable. SeYere duty • Schools stainless steel. Power cords. • Hospitals •'A - HP models have rated, oil and water resistant P ■ Capable of running dry Epoxy seal on motor end • Industry without damage to NEMA three prong 9 provides secondary moisture • Effluent systems components. grounding plugs. barrier in case of outerjacket prevent ■ Designed for continuous 9 • 1' bare lead cord ends. /z HP and larger units have damage and to il SPECIFICATIONS operation when fully wicking. Standard cord is 2U. ) ha Three phase (60 Hz: Pump Submerged, Optional lengths are available. 0-fin g: Assures positive • Solids handling capabilities: • Class 10 overload protection ■ 0 MOTORS must be provided in g' Y4 maximum, separately ordered starter sealing against contaminants • Discharge size: 2" NPT r Fully submerged in unit, and oil leakage. • Capacities: up to 140 GPM. high -grade turbine oil for • STOW power cords all have AGENCY LISTINGS heads: up to 128 feet lubrication and efficient heat bete lead cord ends. ;DH. transfer. "rested to OR 778 an CSA 22.2108 S tandards • Tk m erat a Class P in ulation an ■ De for Continuous 4 Canadian standards 104'F (40C) C1 continuo : - 1'. < , , �{ models. Operation: Pump ratings are r'; Msedatiun ° � c u 140 (60 C0 intermittent. N Class F insulation. on 2 HP within the motor manufacture s Fii #trr3asas • See order numbers on .models. commended working limits, Goulds pumps is t50 9001 Registered. reverse side for specific HP voltage, phase and RPM s MET KS FEET available. ! yq =75NH SERIES - 35 120`— _ _ _. y �� . eRPM 3500 & FEATURES 110 tj E�i[ i ■ Impeller. Cast iron, semi- 30 100 f— r= - r i r sFT -,— -- - - -' open, non -clog with pump- out vanes for mechanical zs so' r _t 4._ I I I �_ # seal protection. Balanced for v i I I I_Td i ' i _ r__ t 70 smooth operation. Silicon q 20 ? l } bronze impeller available as 0 60, f ��� — I an option. ¢ is ■ Casing: Cast iron volute ° 40 e for maximum efficiency. tYP cY 10 30 2" NPT discharge. i { _! _ .i- i r , _f ■ Mechanical Seal: SILICON I 10 't CARBIDE V5. SILICON � i � � - I - I —� � � CARBIDE sealing faces. 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM Stainless steel metal parts r i I i i i L A i A BUNA - elastomers. 0 5 10 15 20 25 30 35 m rapaO^v G oulds Pu 02004 tTr water Teehnology, Inc. ITT Industries Effective Deeernber, 2004 www.goulds.com 83885 wisoosssin ompwftmt of comnome SOIL EVALUATION REPORT Pegs vi Di 'lip a rsoft �/and6drings in aooaedm»e vft f7vsesPe �.5. Inft . t&M Cc*,, tbs"y �f.ds compI Iamo pom n�per "m Imm � m a le x I'l bubm In t ". 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If you ou aced aulsWum to acme swvtm w need, in an aoe *Irz�a% pkw c omam 111t dvaMnow at 608-266-3 151 w "I`f Y 601- M44M. — S C '` S B • � G E/ cz: \ lt.u'� - �: —{ ( Le {{ -- Caw ��C .' ell _ lo r � l l s�' 1 4 i - w - I _ Wt-W OdZkrVA � 99►9—szt —oos soot •gym n3a eon A tronrtm 3tva Was NA *)DO OWN OWN VUAW Sn 9LL ien Nvn mcas Z ` ° JASM wMVW x C _3ALVO ams aw— oos /oaac�rw► �z w Z W J � N U) a D tl) D Z N v N � O -pp @ V ° — c 0 � hey t �� M �A °� a e � W O W a NQ d C' y 1— >r" I 0 W U ICI U W j pp Q� � t7U QU - W q Z z $m�'� atn U Z U N t z o a d ` U 0 C% ? :3 r U) o U) a � a r a � t g 1 1 . 1 t t r r r , r { { �vo f z . � r) rr w �l »96 wr7 r �Cr 7v is V }••" v I ci ., pa - N t J Q ` '�•i �; � ti �~ `•~ �'2�• �5 Ic s ^• ^C $ mil �. � �' Al �v v 2.25 .I �. } FT t • ►- W h . C� •S, r, N lT.i -- w -- j • �• t n Ic SA j c s• Sate Ut of Wisconsin Form 2 — IM 5 3t"1, WARRANTY DEED DOWME14T NO. COL 1145PAG: 231 °- --�- -� R REG1STfR'S OFFICE ST. Ci�X CO., WI Ra6'd a FWord Maynard W, Sdwltz and Ellen D. Schultz ht stand wif O CT 2 3 1995 1 8:00 w M Conveys : warrants to David A. Neste and %man J. `fir. *. i UA. er D.ws S�irov TNq arACa Ra*tPV O FOR AGCOPA)" OATH NAME AND RiTURN A001114111 P-0/40 4e �- the (ogowinE desimbed real estate ie St. Crei Y County, Smut of Wb k. cons (Pkml IdendfiattioR Number) Lot 16, �e Ti�te 1�adoeMo � 4te Ybw�ot>llip d St. - '1i0t3SiA8R w1'i8 t�N :�k 2044xdUbw m mmm owe 20 he wide drivwwal h m WLiea NO Drive a (r" N/Wwi y be of UN Lot 16 deoo116ed as bDowt Commemd.6 Y career of x at 17 of Pk% dteaoe Kwo 1"r But on Swmdlt Him of acid Lot I'll, Ift" fief a Aoirrc cc Dtaog; tire" $a& on F Wat M* Int *Ami ftmawaveft 70.31 " an =0 to AN" try AMR I I 31101111101111w a" 1 toodl lP 1v0" sac &A lee. Riwoe 1ft*r, cioedbeeRin! Wocl� 6!9'S9'�' Wee u > ft fto"W 91.9 leaf as IpA %a =00 OUN'R oaoarfa a" %o ft 11<" www Am !a.» toes own xei* W27 Dian 111.11 hwr dmm SoA 1fJ 2r Wee as SOMOV Blot: Of Wd Lot M, X91 lad to raw ot D . Tile ; s bomemad property. Fsoeptioa w warranties: Easements, restrictions and tights -of -way of record, if any. Dated this da of October x (SEAL) (SEAL) ' (SEAL) (AL) Ellen D Sch llt-2 AUTUNMATION ACKNOWLZDGMZNT , ms STATE OF WISCONSIN rt, • St_ Crn4m Cmity. art witica ed ebie day of ,1! �aRte berme rue dds ay of It- 6 gbore maw W. F11jM D, Schul husband tad wife,__________ w TITLE: MEMBER STATE BAR OF WAN (Irma, aatlwris:ed by §706.06, Wit. Saw) to tae tiwwo to be die pereoie • i imam gad TFRti ttMMUMi6stT WAS iMTtto BY ' Kristine► Ogl uld OF Alice Joy a Attorney at Law Notary Pabtic county, wit. (SiEntwes may be authenticated or acksc+w . 201111 care art My eeHStntim on periRgn t. (If act„ eteta espirat3AR dste aecYSSgr v. s •Wows a penow eipiy is say opal >h'aM N typal :w p"td beiow tAetr Zeuarea wARRAMTY QEfp STATE aAR W MtaCt7NSiN Wisconsin LM �tAHM is dtal, a � � ��; _. _ ' [�. �C'"+ YE. 'l �T � ffi e rr': w u '�'.>iP , t sl ' _ M A �S�S' _•� l . :d d► -. - A Safety and Buildings Division County, 201 W. Washington Ave., P.O. Box 7162 C op i Nvisco Madison, Wl 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) f u, Depar tment of Commerce l I -+ Sanitary Permit Applica on St te Plan J.D. Number In accord with Comm 83.21, Wis. Adm. Coda personal iriftnu i- rrl ' 8 2 00 6 may oe useu for seeonuary rnvacy r.aw, sr.). 1 ) ) Pn j ect Address (if ditterent than mailir ) L Application Information - Pkase Print AN ST. CROIX COUNTY rroperty tnvrrer's frame # Lot # Block # N A - p 00 Property Owner's M ' ' g Property Locatiar 1x1 t, �uTrvc t Iw_A S city ,S Zip Code 0 Phate S Number S . � S `1 Y � rcl H. T of Bui i - / Type rtg (check all that apply) I or2 Family Dwelling -Number of Bedrooms Subdivision CSM Number N ❑ PubiiclComnx=ial - Describe Use i U state Owned - be UCi ` Viilagevlowushipof �.�,p w - -T III. Type of P it: Check only one box on tine . Co Iete line B ' lcable) A A. (_I n VN B. ❑ Permit Renewal 0 Permit Revision ❑ Change of ❑ Perm ransfer to List Previous Permit Number and Date Tsaved Before; Expiration Plumber Owner IN. Type of POWrS $ m: Check all that a pply) Non -Pressurized In -Ground ❑ Moroni > 24 in of suitable soil ❑ Mound <24 in. ofsn' soil ❑ At Grade ❑ Sir�k Pass Sand Filter 0 f`nner..•.•ro.i WL 1.....1 n D..a..•....:..r.1 r» � -a n er..Ia;_- •r -u r n..... v. - rl T�_. -__.. r .. _.._.:_ _ .. n Recircuhttin Synthetic Media Filter -- 0 - _ h Chamber a..» Lane w. Gravel w other ( ain) V. Dispersalfrreatment Area Information: Des• C7 8 gpd) Design Soil Applicatiou Rate(w1d) Dispersal Area Required ( D Proposed Of) System Elevation / a 3 9 VI. Tank Info Capacity in Total Number Man b Site Steel Fiber plastic Gallons Gallons of Units Constructed Glass New I Exiatins_ T=ks Tanks Sapdc Hold�gTM* t1 1 Aerobic Trcstwwrt Unit CJ 1 uosra8 a:aamoer VII. Responsibility Statement- !y the respoasi for the pown shown oe attached plans. A mbers Name (Pti s Phone Number 0 � ,� I I'V CRC/ b S uT 1 P um s Address (S City, State, Zip Code) s - s VM. co"afttDMrtment Use onl 0 Approved ❑ D'rsapltroved San Permit Fee (includes Groundwater Date Issued issuing A ignaUUe (No Stamps) s Fee) (7 Owner Given Reason for Denial I^. 4.0111011000S of wpprovaiixeasons for yisapp l ABaeh an*k4e peas (to dw Ca®ty wry) for the system an papa swt less than 812 x I l i cbm is size S13D -6398 (R. 01/03) n ■ ■ -0 n e 2 E f§ q§ a J } J � I � 7 � _■ I I E z \ w I m w c n , 0 0 o w. i § k Cl. \ (A ° ' § g . \ %) 7 w 7 ƒ� k R o - _ CL , , ! Z d 6 § 8 ƒ ° CD ( e �° EE k \ g [ § 2, a © @ > E a T; \ CD m .. 2 » / § 2 : @ \ $ 2 : � ` / 4 § g n r co 00 co $ % 2 T T �. • �. o k k k \ C, / ƒ § CA CD CIO) & J ° C R B § <. ƒ \ 5 z \ p I k \ CD } 2 Ov ® ƒ \ / § / CA & CL z R � ( : ■ 2 / 0) E ° z § % § q z \ % � ^ §k 0 ( a ƒ 3s&\ c ' §$F 7 %iƒ \Cn k § 55 * » 7%§ a % �® �m \ . { 0 a . G / ) o / � \ � � Parcel #: 030 - 2084 -60 -000 05/03/2006 04:22 PM PAGE 1 OF 1 Alt. Parcel #: 36.30.20.719 030 - TOWN OF SAINT JOSEPH Current L ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner DAVID A, &SUSAN SHROYER NEALE O - NEALE, DAVID A, & SUSAN SHROYER 264 RED PINE TR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 264 RED PINE TR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.450 Plat: 2323 -PINE TREE MEADOWS SEC 36 T30N R20W PINE TREE MEADOWS LOT Block/Condo Bldg: LOT 16 16 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 36- 30N -20W Notes: Parcel History: Date Doc # Vol /Page Type 0712311997 1145/231 WD 07/23/1997 991/462 WD 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.450 101,900 194,800 296,700 NO Totals for 2006: General Property 5.450 101,900 194,800 296,700 Woodland 0.000 0 0 Totals for 2005: General Property 5.450 101,900 194,800 296,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 111 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 N 1►- a 40W '1, 4'' T 30 N., R It c e - 1 - bossed Un atf•d �� 8 J ee•,fN "r S e O� ♦°a4. as 39 v Joa 00 - Y r S i 8 s This inelrumant was dr•affed b James R. a 17 ii)O - aa 7,1 976. y lei 3.dt A Revised this 0Sth day 16 of Marah, If M AS \ S.4SA petit �a ms s'• o Sfwfe of Wisconsin � Gounty of Jf: Groix o I, Being +A* duly a/aafa.d,qual- v ✓ ) ifiad and acting Mwn tr.a arar of the 7bwp of Jt.Jeseph, do hereby certify that in eaasrdonce or ,il i'� \ e`' 3 with racer - dx in my offiaa, fbsra are s7a 4n $ paid Loxes or Wnp,aid spseia/ aaaasarnOnts as # �� o4 \ S of /Pro on any of the land /s7- - anger) N3! °s3'W 6 0 3 E a Doe d in fha P�q /f76. ^76 Tree Meadows. �, Tonge`n N3 /S3 ` i \�,� \ TsWn 7faN4rar 1 - Staf•• of W4consin22 Count y of StCra /xj 1 \ e\ \ rang =rjt xrsys'w o I, bein the duly Nested, uo / 2.Od \\ \ \� ifiod end ecHris traeivrer of Sf Croix ebun +y, do 6 ti hereby aerfify that Ohs. ds roear in my Officetheer Tan en-L• /'/T 3s w si•\ Tan nt N7 --O'W 1!5 no a and fwwoo or a Pe ara/ ass eesmarrts we of !Jeers• 9 .9e i P ,r � • 'o '� , • if><•eS. � 'f`••�sA , t97s gffaeting fha /ands included M K 1 of 2 t TO r in the plot of Ain• 71-ea Meado~- v o oo Doted 19M b .4 s .js 4 t4 i . 0o sore �s. W e0 u b i rir Cowrrtg Treeaurer $ , o e• Tgnyent•N1liJra " qQ F r sna s a AYR., 3pY� ( iodic +e, soil borin . "Reto /wd, that the peat of Pina The Maadoe+s �• 9 ih th4 Tewn of 'T Joseph I , K. a. Miea*or Rae/ /00'buik/ ' �, ��/ psroo /a'fion feafe EJteta XnC., 14,860 Li nftrOrn, and Anna LOW r� setback2' s o� s' ti ®� Lirrstrorrr, ownara,if hereby approved by the r.o + I Z \ 9 St. Croix County Board.' ° sic f,` `y •vrreY Date Hr6. A�preved e /. S9 A �xl � R ic o ,' Tgngtnf •N7 W Nas•//'ry Cl/q,Iman r ' Est / aafa 1976. Jrgnad �.' Gert,fied S�r_vayNjo� i Chairman eJ.•le E5 �^� •a Vo/u.ne 1, oeye /Se I hereby certify that the ferayeirry is a copy of a• w tY s iS �� o.ss 6 g rosolation adapted by the JJ-0 Croix County i St �\ " y, 4'� Soard• o bq M ° County Clark 2 � a 'Rtaolvad, that the p /at of pine 7Faa Maadowt < { in the Town of Jf. Joseph, K• E. Ari•star Raw/' 15 Est *Denotes 2'd,om. iron pipe Esiata, Inc., Leal;* Linitrom, and Anna Low �t 0 ty 4 30 " /ong, 3.&5'* /fA Linatrom, owners, is haraby approved by -l'ha n 13 6 'h St. Joseph Tbaun Board: 0 o.Denetet / - diets. Sete Q yr /. 99 A A 5 +s iron pr�a SO " /eng, /� a Dote �°'� ss 1 � M p I. V.9 A I hereby certify 7 t hot the foreggoing is a Copy e t _ of a reso/ufion adopted 6y the Sfr Joseph Tbwn ss a u °. j Beard. fe 90 ieaoo • e na.MJ r e"rt Town Clark •- ,v ss sr w ess.or' !/np/otls„g� s+,-em, ownsru of said Town 9oard of Town of St Joseph, County Beard of Si. Croix County; .State of Witeonein2 rre.fe.nfaficn ofoll axe- Director of Regional p/am4ly and Commwnity Ass /rtanca,Depwfwenfa Coen of StCrorx *d. arrd oho rw64ivi3ion Local Affairs and Dove%pm&nf; Division of Highweyyt,Dgarfmpnl of A►rvon. //y uwra'baf ra era +44 dqy of , y oorrrplr:d with the Transporfafion; Division o{ Hea /th,Deprfinenf of Halm and Sovo/ f976, KB. Prretfer, PiasiaLn•f, and Tarry E. btufet en; the aubdivia rn Sarvices. Sa;d corporgtion and comers haraby rsatr,at Of /eft Piriw. Secretsry e { the above ner•ted car- y, dividing, end mapping the and b /ecks, in fhat no owner, pesteaser, war, nor /i64MjA nor perg4ion, grrd L as /ia Llnstrem 4174407074 other person shall have any right of direct vehicular ingrate or Ley Linafrem, to me known •te 6a the par - agress with S.T.H. SS ae shown on this p/q•bi it being express /y eons w OxaoWte4 7'ha 74regeirty i17s*1 mesR•Grubb, R.LS.'r 722 intended that this rsstrir shall conrhifuta a rfsrric ntant, and *o rite known t0 be aue/7 *ion forbonafit of *17& public according to T2S6.L9$ af•iyia. officars of ,said Oerporation Ind oek- Stafutas, and shall be enforpaa6le by the. Jtat•e Highway new /ad thee• *hay exaoutad said ir/- Cowrrnission, afrum•rrt ee Offices, or ownaw, as the PM duly orgbnlzad grid ax In Widnost whsroef, the indiv,due/ owners hove arraeutad fete dead of said eerporotien, by ilcs aptherity. the 000fe. of Wisconsin, foregoing instruMan-t and the said K.E. R'issfer Ree/ Eatata, Net4ry Public •am' as awnera do hereby Inc. has caused these pre.aants to be signed by K.S.A•iesfar, HWdsen,Wis. Ore "Wed the /and da- ift Pratidant, and cow7ter- siy07ad by Tarry E. Piriva, i+w Aarntanan•F Comrvtisfion, ubhn 0 Naywoad oided,npppad, and dadi- Seeratary at Hudson, Wisconsin, and , s corporots sea / to be amporetfiat and . owners horounto Off;we d on fhi a__ day of , /97i.In presanm *4 Tired by 4236.10 orSLS6/2 e,.va /orob/satien: Lea /it Linafr.m Anna LouLritatrom PruidenF Sscrofar 324672 o ���� r' M i IIITTI, TE T ) SU BVFY 'I I A P \� l >>� PART OF ST. COUNTY CO/ 1) OF TIF SCTTrII E UART7 THE AST QU.Al- T Lca SU RVEY 0-. 7 \r T '3 D TI 20 W St.CROTJX CO 0 NOV 1 2 1974 jAAES ol CON4ELL T T T CO j."I S T,'! r of z iA COUMY, 7' N . COrt7Cr Of SW 0 o -FSec. 36, T-TON, �Iv 20 W, 5-1- C)-O/ Co., W/*S. 13 32S• 00 ZY 00 500.00 o pt o AO P IA4 h) 6 1-041 L o f W ^ �ti 327 7- p 89 4- 7 re- -e- . S 2 9 0 °acl 4 014 xZ5 W Easement for �' o travel over ex- All corners isting road to M47rketd by i ron 1970#0, C; �� S.T.H. 35 is 1"'Y30" 0 1ranted. to all P/pe 5 4,7 C.) WCI 1.13 /6-5 Lots. par //h . 77. . '� + << l Pf c6 Q) 0be9 IYWP7 I Iq Soc44 '/ 7r Y corp7ej off' scqle '200 Se 30 -zo Surveyed for Leslie Linr�.strolrrl S °•2 /' 1 1" I ov- 197 Description: That certain parcel of land or tract of real estate' located' in the southiapst quarter of the southeast qi2arter"of Section 36, T 30 N R 10 W, Town of St. Joseph, St. Croix County, Wis., more fully described. as foi- Lows: from the south quarter corner of sairl Sec. 56 go S 89 21 7, along tho soi.th line of said Sec. 3 a distance of 1311.0 feet to the east line of said quarter-quarter; thence N 1 00 E with said east Line -a dtils- tanec of 438.03 feet to point of beginning for parcel herein described; thence N 88 11 W a distance of 4 77-8 4 feet; thence along the east anrll north side of a road as follows: N 7 35' W a distance of 275.00 feet-, thence aLonr- a curve, concave southwest whose chord bears M 25 15' W a distance of 125-00 feet; thence along a curve, concave southwest - vahose chor bears N 64 15' W a distance of 358.85 feet; thnec 3 33 2 3' W a W distance of 327.89 feet; thence Leaving sairl road ' 10 001 a dis- tance of 339.53 feet to the north Line of said quarter-quarter; thence with said north line S 880 54 E: a distance of 1225-00 feet to the north- east corn-: r of said. quarter - quarter; thence with the east Line of same S 10 HI I i beginning. a distance O 8 35-00 feet to point of beginning I L I hereby certify that I :nave surveyed, divided and. mappec', tl Lan(Jsf described above; that the above description is a true description of the exterior boundaries of said lands and the above map is a true and correct representation of said lands; that I have fully complied with the provisions of Wis. Statute 236 in surveying, mapping and divi(ling said lands. 324672 J. z St. Croix County Certified. Maps J ames T? Grubb o L ut page . 68 stered Land Surveyor S-72� AS BUILT SANITARY SYSTEM REPORT 'NER AM5 LL , TOWNSHIP 9 SEC. T N, R W .0. ADDRESS , ST. CROIX COUNTY, WISCONSIN. TF k _:3DIVISION ep !� - s LOT -LOT SIZE PLAN vlEw Csm 1 7 Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ?TIC TANK(S) MFGR. CONCRETE STEEL N . of rings on cover - - - � ^ Depth 6 DRY WELL - 3NCHES NO. of width length area 3 no. of lines width length are depth to top of pipe 5'z 1 . 3REGATE -?.K RATE AREA REQUIRED AREA AS BUILT sciaimer: The inspection of this system by St. Croix County does not imply complete plance.with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for 'item operation. However, if failure is noted the County will make every effort to -ermine cause of failure. yASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. '-INSPECTOR DATED �� ` -$ PLUMBER ON JOB LICENSE NUMBER 3�l9 Z REPORT OF INSPECTION SEWAGE SYSTEM Sanitaxy Pexmit -� State Septic NAME Towns hi St. Cxoix County Loca % o L '1., Sectio► T &N, R -?e SEPTIC TANK Size %D o gattond. Number a6 Compan,tmentd I Distance Fxom Wet E ��. 12% ox g zt ope A, it Buitd..ng o ZO it. Wettand.s 6t. N.Lghwa�en � ��. DISPOSAL S Distance Fxom: We.2� � � ��. 12% ax gxeatex ztope J,,;) it. i" Buitding o; 6 it. Wettande Ft. / Highwatex it. FIELD DIMENSIONS: Width o6 txench _ it. Depth o6 xo ck b etow tite / 2 - in. Length as each tine it. Depth o6 tack ovex tite - 7---i n. Numb er o 6 tined � �i Depth o6 tite b eZow gxade '' z in . Totat Zength o 6 ti ne s it. S gape a6 txeneh --r in pen 100 it. Distance b etween tines fi t. Depth to b edno cFz Totat abb oxbtion axea p g � � Depth �a xoundwatex �. ",.Requi&ed axea 6t PTT DIMENSIONS: Numbex o6 pits GxaveZ# axound pit.6 yea no Outside diamete 6t Depth beZow intet ix. 2 Totat ab.b axbti n axea it z A Axea V'equixed it2 rn INSPECTED By -' `,' ' r t.. f'` rfe ;' s ;f r y TI TL� APPROVED ,DATE 197 REJECTED ,DATE 197 i I State and County State Permit # , PLB67 Permit Application County Per i# for Private Domestic Sewage Systems County -� * DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: It ce 1 444c— t Z SS O/f1 . B . LOCATION: 4 SW % Y <, Section 6, T 3 0 N, R ?IE --fer) W Lot# City _ Subdivision Name, nearest road, lake or landmark Blk# Village c m7 , SU e.I; M A 5 u3 It Township S njm s c�� C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms_ No. of Persons 7— D. TYPE OF APPLIAS: Dishwasher YES NO Food Waste Grinder YES NO # of Bathrooms_ Automatic Washer YES NO Other (specify) E. SEPTIC TANK CAPACITY _ Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation Addition _ Replacement _ Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) J 2) 3) Total Absorb Area sq. ft. New Addition Replacement *Fill System ZD Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length _" Width A— Dept Tile Depth 10 No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land 7—P- Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Ceffied Soil Tle ,ter, NAME # and other information obtained from i. (owner/builder). Plumber's Signature MP/ RSW# Phone Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). Nora 4 r 7o _.f3a - -,wAvA -? or _ QaEl�leE . iN STt3tc.,�?roi✓ of ' sY5 w! i t.1.r �r�Pb1 �c,uS SEPT "mMit oe 6r Do Not rite in Space Blow - FOR DEPARTMENT ff 0 Date of Application Fees Paid: State © County -` Date !T Permit Issued /Rejected (date) Issuing Agent Name Inspection Yes No Valid# Date Rec'd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, Wl 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1/76 l EH 1 1. r ` WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS f LOCATION: 5 `x' /4, = ' /o, Section 5 _ t , T _ , R Z`' �E-4vr) W, Township aU' Lot No. , Block No. r' 11F1 � W VC / Y HA P rd'- l..a.!� N`' L L V_ Subdivision Name Owner's Name: )�� i �t Mailing Address: Z � Q / �1 Ave N , s %�Le , W , 4Z�x, /�n0 TYPE OF OCCUPANCY: Residence 1 No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW K ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS �'l�! / jf' PERCOLATION TESTS G ' SOI L MAP SHEET ���` `f " �L ' SOI L TYPE (��7TL = R 91 ' f' /�/r'i N► A - C HETE K PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 � �.7•�4•n� 41 Opp W$ KNag SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B- J Id,� 51-, ; c ON E. T � 1 �.:. -� �, - �, c 4 I B- z NoN 4 4 1 'E �4 N4 Sri f� 4 bN 4 PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. lo�S� c�' t Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. /SXd sQ • IT SV r-� t v I? 1 4 az L I N tom' r o , 4. 2 7 -100 L P � u r S D I the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) J11 `' f _ `� ' ` " Certification No. Address 01 11 fg7_c--- Name of installer if known l / CST Signature '� ^�•� "^ < � t= COPY A — LOCAL AUTHORITY -