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032-2006-30-000
° o 0 ° o 3 O O Gq 0 e y H O O O � � 3 C a o O c a C N m i 0 m Co C N O C 'O t4 T 0 o C O C C> N m U N a ' 0 m �-o w a m 5 c E N° co o ti a°'� Y may s ° o c TE o- j a w o a c 3 x o y C @ 0 w C O j c O W Y Oc N N N E co acoa o - �c U (0 i EE- @ w 'O Y y . N N 0 C 01 O 2 H a o o -�- E N [6 t6 Vl (0 N a '- ` X 3 a a O T N m a° 3 c a y w c� a _o v, _ a > co Y w O 'o O) _a L N C 3 p c - I6 fn u) O O N f0 'O m 'n 3 N a b+ N N c o O 1 w ! ? i6 N-a owl 1 L o N a ° 3 - ° @a y LL o a� c o ' N �`«- c� Co v m v ° '- co U a� E ac) a 0 aw - o�'om c v , a) ~°� a a E d 2 i ) 3ornyo0 c v `� ° t1 d �° - Za U I d' I c H Z N rn w E o o ° � d m a m FM- � c p i O Z d c L c w V O Q N p O j d Iz• °) V) 0 z °) a c CL E o c E 'D N O N a O) O Q O n N N W a V) N N I • a ° o a a �y a L d L O o o d ��-- o a) d Z m Z Z Z m Z a ° o r r y co N R E N ° N =) p U) O Lo a- a C U') a- i c a _ 4 .� .�.. O C _ O. R O N d i �` O N d tt o'''�oca .om �cca �m d ° ' Z N> E 3 ° °° z E 3� ° °° L 0 0 0 L 0 0 0 •w•� Q) aan. aaa fA J C) Z O O a N z i N N O 1- 7 W W } p N O Q O O ° L a ) O i m a ° 'd m a [r a _ N 7 .�.. N °o N C ` N C ° c a c a O ° oo H a c U 0 4. O a a C C r y M N E C •L3 N N E Y V C O Q y j C te a, C M Y C a E !' '', C M 3 - L C w 7 m • >> M o Co LO o N o E L ca N o h o 0 o cn a o z- Z w N 0 z- z x6 w = E E � E m E a m d CL a a 5 ° a :: a • R a d .� 4 E i y c a s C O c 3 A V a t 0 co V 0 N U • - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safely and Building Division INSPECTION REPORT Sanitary Permit No: 453253 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: Pana suk, Steve I Somerset Township 03 - 2 -3 - 000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /()0 "rte CAA 01.30.19.487B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark a o 5"O� . /a- ' L/ /OD Dosing Alt. BM 4�• v Aeration Bldg. Sewer o Holding o St/Ht Inlet TANK SETBACK INFIDR 1 Z St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 > S6 '4 i Dt Bottom l 7 ant: Dosing kea4erftarrr. IZ.it .Z Aeration Dist. Pipe Holding ot. Syste ar`in— irt8t PUMP /SIPHON INFORMATION f 3,yq. 9l.�1(0 Manufacturer Demand St Cover !' {'� 7 ( GPM o Model Number T Lift Friction L s e ea 7 U Ft Forcemain Length J W. r istito Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length y No. Of Trenches 1 / cep PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 - 7 ? Ct (kS 1 ' 3 e e 1 � -------- SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR i Type Of System: ` ,� /' 7 l DD n UNIT Model Number: r 7w I " onQC DISTRIBUTION SYSTEM Header /Manifold Distribution �xHole Size �Hole Sp acing Vent to Air Intake J�" ii Pi Length Dia 7 Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over v � xx Depth of Bedrrrench Center Bed/Trench Edges „[ T e No 67 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ZA// Location: 872 170th Ave. New Richmond, WI 54017 (SW 1/4 SE 1/4 1 T$(�t R ) NA Lot 2� � Par�0130 a 1.) Alt BM Description = -_' / I�Y�G � , " �," _ _-I 2.) Bldg sewer length = ? r}G�Sri /wUb � (.Ga j lrY t - amount of cover =,� TJ� ; „ I t'►� �J 1 pl ' d pu X12 Plan revision Use other side for information. No j SBD -6710 (R.3/97) Date 3 Signature Cert. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 GY m r ®��/� `vim �> Madison, WI 53707 — 71 Sanitary Permit Number (to be filled in by Co.) �/ (608) 2266-3151 s Department of Commerce Sanitary Permit Application state Planl.D. Number Q In accord with Comm 83.21, Wis. Adm. Code, personal information you provid may be used for secondary purposes Privacy Law, roject Address (if different than mailing address) I. Application Information — Please Print All Information -RECEIV ' 0 P rty Name MAY 2 4 2004 arcel Loth Block M er �� e— Gch� �" ropert} s Mailing Address L .7 7, roperty Location /fp� /;;'l `�L ZONING OFFICE Sys 70 cl_ /<, /., Section City, State Zip Code Phone Number / II. Type of Building (check a Sn (JG r 2 Family Dwelling — Number of Bedrooms (�(!/ — _ Subdivision Name CSM !V Num pr ❑ Public /Commercial —Describe Use �e C� T o[ ❑ State Owned — Describe Use LTI i�! a n-c 4 G, 5 •� ❑City_ ❑Village ownship of SD rP'le 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 I ❑ Other Modification to Existing System ❑ B • ❑Permit Renewal ❑Permit Revision Change of 11 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner c IV. Type of POWTS System: Check all that a 1 (N X Non — Pressurized In- Ground ❑ Mound > 24. in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized TeachingCharnber round ❑ Holding Tank [I Peat Filter El Aerobic Treatment Unit El Recirculating Sand Filter Recirculating Synthetic Media Filter ❑ Drip Line ❑ Gravel -less Pi ❑ Other (explain) V. Dispersal/Treatment Area Information: ► 1 PpU _ Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal ropos f) yster Elevatign . ' VI. Tank Info Capacity in ' Total Number Manufacturer Prefab Site Steel Fiber Plasti Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks eptic Holding Tank �e j Aerobic Treatment Unit / e7 Dosing Chamber J VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber' ame (Print) Plumber' ture P /MPRS Number Business P Number P, bpK Address (Street, City, State, Z' Code) VIII ounty /De artment Use Onl Approved 11 Disapproved S anitary Permit Fee (includes Groundwater Date Issued Issuing Age Signa e o ps) ` Surcharge Fee) �'f� �� / O ` ❑Owner Given Reason for Denial IX. Conditions ofApproval/Reaso3 for Disapproval �� � �✓yt_G*= vit�.0ina� - tom S YSTEM OWNER as �o f1.1ClS �) Septic tank, effluent filter and v dispersal cell must all be serviced / maintained ag6l•i as per management plan provided by plumber. o 2. All setback requirements must be maintained l�i42a�' as per applicable code /ordinances. / Attach complete plans (to the Coo�+lx}Sa� -the system n �,e ;n�t`�7�/ 1'2112 x Al inches in sizz- ea, SBD -6398 (R. 01 /03) PLOT PLAN PROJECT Steve Panasak ADDRESS 858 170th ave NewRichmond Wi. 54017 SW 1/4 SE 1 /4S 1 /T 30 N/R 19 W TOWNS. Somerset COUNTY ST. CROIX MFRS Byron Bird Jr. 220527 DATE 5 -23 -04 BEDROOM 4 CONVENTIONAL XX A rade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE EX 1200 =2609 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE a LOAD RATE .4 ABSORPTION AREA 1500 # of chambeqsr hL BENCHMARK V.R.P. Top of vent pipe ASSUME ELEVATION 100' ❑ BOREHOLE O WELL •H.R.P. NW comer of House Vent SYSTEM ELEVATION T -1 =92.7 T -2 =92.6 T -3 =92.5 T -4 =92.4 >122" Of Bio Diffuser with Cove 3 1. 1 ft ^2 per 6" chamber de at System Long 34" Elevation 94 At 9 - ---al- B3 75 ' 40' O ob pipe B2 1 35' 1 15' > 50 t o pn 90' 0 18'X85' BM v ve 94' 93' 170th Ave s Z (0 0 st d r'ad 2 &o 0 . U 30 Garage Driveway Alt BM 4 Bed House PLOT PLAN PROJECT Steve Panasak ADDRESS 858 170th ave NewRichmond Wi. 54017 SW 114 SE 1 /4S 1 /T 30 N/R 19 W TOWN S. Som erset COUNTY ST. CROIX MFRS Byron Bird Jr. 220527 DATE 5 - 23 - BEDROOM 4 CONVENTIONAL XX A rade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE EX 1200 =2609 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1500 # of chambe 49 ,► BENCHMARK V.R.P Top of vent pipe A SSUME ELEVATION 100' ❑ BOREHOLE O WELL aH,R.P. NW corner of House Vent SYSTEM ELEVATION T - 1 =92 7 T -2 =92.6 T -3 =92.5 T -4 =92.4 >12" Of Bio Diffuser with Cove 3 1. 1 ft ^2 per chamber , G Grade at System Long 34" Elevation 94 9 ' B3 75' 40 O ob pipe YLJ 96" B 35' B 1 15' to pn 90' 0 18'X85' BM 170th Ave s v De 94' 93' 2- & 0 St p 1 2 - &0 G � p. 30' (J _ Driveway Garage Alt BM 4 Bed House 0 N O' 0 N O 3 'o n d .. d m O k r Cn y' j Z O N 'D Z 7 0 ° A 0 0 O O • _ N d O W N O y f' = O to N= 3 C N d �+ � N N f_ CD N CT N O A c CD N = O fD 0 0 W e O O N O 7 ?� co (n LO w O4 t o m m l m CD o-4 Q a CD N N aD f y O S W° O l� m a cn Z D CD 4 co (o > a o U2 D �' n. 03 2 3 p ° 4 < p CL F m m F ° m O CD co (D m Z o m CA CD CD a� o �� N° c • A I ' 3 � n � z OO C O C O0 O000 °' vo O W G G G O W = C N Z L 3 N co ti n vi vi vi O D o mIm move X -0cOo C a co 1 0 = M ; to N O CL K O p 7 d= C-3 7 O 7 S O O CD CD 10 X � m y CD c CD c C N C N CD CL CL CL C. o 3 3 z fD co m cn (6 � � co ' I ° o o Z 0 CL 0 (� - I C C ` z a 3 O O 3 � 3 CD CL 0 CL m 0 X d F S� C d O j�.� j: �U) ov0� o 0C, c oy - <3En c 7 y S . O a 'p G N d d O O. CD CD Z C O ? y CD f0 O y= y aN I 0 ..,N O.3 N N O = N N C O O N N O N �] N Gl _� N it 3 m CD N 0 0 3 x 5 y CL x l0/1 S = CD 3 = O 'C - 3x cmm' t0 co d 0 U) O cc CD rn O a - d fl x, I O < - V.. o 0 � - 3 o ?�+� mac- >j Y= d �f 0 0 CD m op o �, � � v °° CL °° i ' C! PA JID `Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. 51/ R iew Date oZ� ` Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location GL`jQ Govt. Lot 1/451/4 S T ® N R E 'ef Property Owner's Mailing Address Lot # Block # Subd. Name or CSW R a Zip Code Phone Number ❑ City ❑ Village __ own Nearest Road � ❑ New Construction Us�esidential / Number of bedrooms Code derived design flow rate ev A GPD P �R eplalcernent ❑ Public or commercia k D J escri : Parent material Flood Plain elevation if applicable ft. General comments 1� and recommendations: ��^ —/ 9a. 7 s rr -' - 5� Boring # 0 Boring 1 � / � E] pit Ground surface elev. !� ft. Depth to limiting factor 7/O in. Soil Apphcation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 j o rn G 0� Aw >7,/ .wl e � �T U Boring # Ing ❑ pit Ground surface elev. ft. Depth to limiting facto in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Eff#2 ggv �-�-- -. sc s �-c._ .� .�- �r2 / Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS 1 30 mg/L CST Name (Plea nt) Sion ature I / CST Number t 4r me k 1 Address le Date Evaluation nducted Telq)hond Number i Property Owner Parcel ID # Page 2 of Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Appli cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 1151' r ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eft#2 E Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots !GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30:S 150 mg/L Effluent #2 = BOD c 30 mg/L and TSS a 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 2648777. I SBD -8330 (R.07 /00) Soil Test Plot Plan Project Name Steve )(anasak Byron Bird Jr. Address 858 170th st. ave NewRichmond Wi. 54017 GSTM #220527 Lot 2 Subdivision Date 5 123/2004 County CROIX SW 1 /4 1/4S T 30 N /R W Township So Boring 0 Well PL Property Line# Alt. BM Walk out slab Elv. 97.5 ,BM or VRP Assume Elevation 100 ft Top of vent Pipe System Elv T -1 =92.7 T -2 =92.6 T -3 =92.5 T- 4=92.4 H.R.P NW. corner of house 94 9 B3 40' 96' B 35' B 1 15' ' o p nd 90' 18'X85' BM 94' 93' 170th Ave st 30' Garage Driveway Alt BM 4 Bed House Well 8 25' cr— LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF SOMERSET COMPUTER NUMBER 032 - 2006 -30 -000 Parcel Number 01.30.19.487B OWNER NAME: First STEVEN & JOYCE R Last PANASUK PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 872 170TH AVE SECTION 1 TOWN 30N RANGE 19W 1 /4160 1 /440 Line Description Line Description TOTAL ACREAGE 9.050 PLAT LOT BLK 01 SEC 1 T30N R19W 15 02 PT S1/2 SE1 /4 16 03 BEING LOT 2 OF CSM 9/2680 17 04 9.05 ACRES 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer :�/e f - Z- j e< ., <-�- Mailing Address Property Address (Verification required from Planning Department for new construction.) City/State Parcel Identification Number d - Oct) LEGAL DESCRIPTION Property Location 1 /4 , 1 /4 , Sec. �, T �� R__/ `W, Town of Subdivision , Lot # Certified Survey Map # ��' O S r,Z 4 , Volume , Page # � Warranty Deed # Volume �J� , Page # 3 J� Spec house yes (a Lot lines identifiable �yt no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. 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 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 Zoning Department within 30 days of the year expiration date. 4,1 NA OF APPLICANT : 5, / o .a[ DAT OWNER CERTIFICATION Uwe certi that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property descri a s, by vi warranty deed orded in Register of Deeds Office / S NA F APPLICANT AT * * * * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity) ao-p �-- a l ❑ NA Permit # 5�j a 5-� Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer NA 1 4 Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer ❑ NA Soil Application Ra al /da /ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Month) average* Pretreatment Unit AA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 5530 mg /L Mn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L XNA /❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) c Oml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y ' in ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater ank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Ins Inspect condition of tank(s) At least once every: ❑ monthls) axi years) ❑ NA p ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ''NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA years) Clean effluent filter At least once every: ❑ month(s) ❑ NA years) Inspect pump, pump controls &alarm At least once every: month(s) ❑ NA ❑ year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: p month(s) e ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 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 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During 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, overloading the cell(s) and may result 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; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; 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 soil 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. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil 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 INSUFFICIENT 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 r POWTS INS LER POWTS MAINTAINER Name �,,�n G Name Phone �' Phone I SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name � v-+ Name Yd Phone — ` Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)0 )Id► &(f) and 83.540 ), (2) & (3), Wisconsin Administrative Code. Udr ldr U`! lilt. UL. 1'd•1 ! lU )OU iUOU 1.0 LUl IAU VWUl/ ' .. ..... .. .... ..._w.• ..r.. . � E � • i i "3 � Ill rA j • !C 1 1 F i w f p £ .D N L.n cq :11 `!31•f n 4 M W M B I R O r [n O y .• r i I, i a� i G *7 .^7 • a i � C '" $: r.a — K n ,. .,, �., !C MAY • Y` � ! V M. �� � A 1 i A A: d r s. L�,i y PIC -0 9 O :c p: p R � S 1 'xl� I ! �� I N '• H \fGl'� a'nu. n p n O r O ^J rw g q F 00(411 i �9 t9 m !rte oe C7 H e" i s m N y I T f I I n p `'V1 n w IV F• T ' ! � �rZ ' r ° �i m i Q ? ' H !J 9 ��6! g �•O o�a.� O�c�.c� 8 �•�I ? ��Fi N �: W' i I I p r r �� • 7F m F dOGy 0. i f — I • � O ' i i i � � f+ pp .. � ,y � 0�1 Sr, 7' in �- (��'' � '� • 4` I 7• �I I 11' ... 1 • � � � ' � � 7 g 1 � � C � � a � nN �j ~ � � � ID. �� ....N - ° � ? zi i i � f J r j(0y .n i o r .. ' �• i r if i b? O cc w i ? I ! w .�. M .. v : a tri.. N� r• r .~.. 1s 17 . m a o i i N � 42 c li .•gym w �i 3� waI H + "F W T : r r+• 1.` rl, l-. C :' Q m l I �j � , v U I C H I T �. iy . 1 t III...... �'J ;�.tl i ! I �, O N �� " If S��vv; �u ��ii �. i �p � I O 1 ni 1 0 :1` .R '� , (I 6• g �� O W^ i ly? 1 I I '� I 'p r ry I•w l; C^ ba ! R ` i I L7 •� I ? n nl `Y ry 3. C. W •�.' o M LA 0 �•. f » .. ' r � C • � ' � jj C C] T � •J 1� f6 17 S 7 n _ I k+ r oI r'V HL'''�m A � wmlo 4 • , m.7i 4 all ry :O 4 I; om rH A c am. m f o a j i reC T T • r OF CA ' r i �.�• •.�. �. -e 1•a uJ.-rJ 1:'.1 'JJ •,JJ JUJU J♦ t,1N.L t,U LU1t1Ab iqjVUb FILED 6 SEP 031993- 3 jmO C'f.':)NNEII Aeat:lrrlDaW3 4 505226 This lnrtruernt Ors F M LAND h!!F iron. Mo. IS.lA Yom _ ' ^G ttd Brsrnd rr& rrfrrinoed t! t ►! rout! • Nart IlI Gf thr t tins of hr SU of Srotiep 1, rUrNd to Srrtirrt 1 \ SAI °47'J2 "Y• Oerr 8511 w 0 397 e 75 , — 1 STRE N „ q � aae,Spr� �•_�— — I � Noollerouw � 1 m � If M•n I N oIR 1 \`✓ .� r D l rl •ti "• Tr IFn o Lr 10 01 1(n C I ; to + NaO "N 7DC.el f ,�•\ ` \+� H 41 1'M or r• 1� or C ti :rAMK ► n h 1" 'pM'rlrily� 900028 SA g ` 1 . aBAUe4llrwlMlN1 _JNF"A_TTEv �A�_C ' o - ' FMlyrMd _ \ o n td A t E 1 n \ JI O w O 1p S �• a e r 4 r. A � Vol. 9 F &6. 2680 I to UU4 SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code couN -� . a TE SI 11 Y RE 1 l - Atth complete plans (to the county copy only)'for the system, on paper not less than aL 6% x 11 Inches in size. Chaex K revision top 1 s-_1.u3 apptlsatlm -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFO RMATION - PLFtASE PRINT ALL INFO RMATION. PROPERTY OWWA PROPERTY LOCATION C $c.J %a '/a. S / T , N R / P or PROPE ow � LING ADD LOT # J BLOCK # CITY, STATE ZIP CODE ' PHONE NUMBER SU9 VIS ME OR CM NUMBER to NI. TYPE' OF BUILDING: (Check one) State Owned yjL A� : NEARE8 []Public ®1 or 2 Fam. Dwelling-4 Of bedrooms 1- - PARCELTAX NUM EMIJU) 111. BUILDING USE: (If building type is public, chock 811 that apply) 1 ❑ Apt/Cando v C/ 2 Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 Outdoor Recreational Facility 3 Campground 7 Merchandise: Sales /Repairs 11 RestaumnVBar (Dining 4 Church /School 8 Mobile home Park 12 Service Station /Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 LJ Other: Specify W. TYPE OF PERMIT: (Chock only one in line A. Check line 0 If applicable) A) I -KNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an t-� System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit# Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distrlbution Experimental Other 11 Seepage Bed 21 P Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 In -Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ASSORP. AREA 14. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL, GRADE ,/� REQUIRED (sq. ft.) PROPOSED (sq. fL) (Gals/day /aq. ft.) (Min. /inch) o / ?� ? Io reetj N l� 0 Q / 0 1 d !6. e? Feet VII. TANK CI Site In allons Total # of Protab. Fiber- Exper. INFORMATION New Teti Gallons Tanks Manufacturer's Nam® Concrete Con. Steel glass Plastic App Tanks Tanks strutted S optla Tank at Holding Tank L - R- -- -H - 171 1 Fj ift Pump Tanktgphqn Chamber 3E - - E2 --- Vlll. RESPONSIINLITY STATEMENT 1, the undersigned, assume r for inetailation of the onsite sewage system shown on the aftaohed plaits. Plumber's Name (Print). Plumber's tuna: (No Stamps) MP /MPRSW No : Business Phone Number: 3AIlin ) 0 -7el& u 's ddtoo (Street, City. lilleta, p e : e r C.c>� 5 oro IX. COUNTYIDEPARTMENT US Lj p pprpyed m ry mRFee erIF r e IseuingAy t on (No m Approved ❑ owner Given Ini JMA dvera r lion r x. CoNorrIONS OF APPROV oR 88a639e(R,o9/s3) DISTRIBUTION: ON" to County. One Copy To: Safety & Bulldings DIvlslan, Owner. Plumber i Q 01.13 W►s►ons'h Department of Industry PRIVATE SEWAGE SYSTEM oun:y: ' Labor and Human Relations ST. CROIX Sa and BvrildingsDivision INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit P ermit o der's Name: ❑ City village Town of: State P PANASAK, STEVE & JOYCE CST BM Elev.: Insp. 8M Elev.: Descri ption: Parcel Tax No TANK INFORMATION �4 • r� ' ,'��r.: ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �J ...�.�.(�. / �,pp Benchmark Dosing �W Aeration Bldg. Sewer Holding St /Ht Inlet I � ;L, �7ql, : TANK SETBACK INFORMATION St/ Ht Outlet,S' o TANKTO P/L WELL BLDG. vent to Alr Intake ROAD Dt Inlet Septic "4 ylsvr /� r yam' NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot System PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH I Lift Friction System TDH Ft ad Forcemain Length r pia. K Dist. To Well SOIL ABSORPTION SYSTEM OF-D/ Width j Lengthj Na. Of Trenches PIT NO. Of Pits Inside ora. Liquid Depth anu a urr:r: SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING INFORMATION 'Type - ol y)+,Z,,L- , CHAMBER Moe Num er: System: i) > rh qO y T- OR UNIT DISTRIBUTION SYSTEM HeaderrManifold Distn utionPipe(s L !t ° x Hole Size x Hole Spacing Vent To Air intake Length Dia. Length Dia. _, L Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over a Depth Over ^ 1 a: I xx Depth Of xx Seodad r Sodded xx Mulched Bad /Tre C enter �< o' Bed T Edge C' Topsoi ❑ Yes ❑ No ❑ Yes [y No COMMENTS: Qultlu code discr a Dies, persons present, etc.) _ S Li 5 1rt rjCLJ :e1 �! N 'L LOCATION: S SE, Lot 2, 170th Avenue Lid Plan revision required? ❑ Yes Q No Use other side for additional information. /G 1 0q � �',I '� ^a`. `' C� • '� 580-6710(R 05/91) Date • Inspector's Signature Cert. No. i UJ: IJ /U'! 111V vv — 1t1A /1J .,•VU qv.)U J/ �1W a.0 LUa11aV yy UU1 STC - 104 AS BUILT SANITARY SYSTEM REPO It j �� y�, - l � OWNERo ADDRESS 1. - e -P 1 ,14 � SUBDIVISION / CSM# LOT SECTION L T N -R r f W, Town of d yt -ter t 7� ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM D 0 y V ' 1 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form- Provide 2 dimensions to center of septic tank manhole cover. UJ 1J U4 In L- VV.-*J C_f.% 914 aOU -*000 Jl 1.1LL t.0 LUA%1AU 4(JUU1 BE N CfIMAR R • ALTERNATE BMt SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: G e- Tt 5 Liquid Capacity: Setback from: Wel House Other Pump: Manufacturer Model# size Float seperation Gallons /cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: � � - � Length 42; Number of trenches .r' Distance & Direction to nearest prop. line: ,y Setback from: well.- - / Other _ ELEVATIONS Building Sewer ST Inlet: - J ST outlet Y PC inlet 4 9F PC bottom Pump off Header /Manifold 4W Bottom of system 7 ��,d2 Existing Grads V41 Final grade G DATE OF INSTALLATION: .� PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/43:jt UJ/ 1JI U`I 1LL� UL.'1 / 111.1 i 1J )OU *UaU .31 UU W Ltl_ LAb 10 Vesoonsi*DepartmontofIndustry, SOIL AND SITE EVALUATION REPORT Pap _of LAbw and Human Relations Lhwlsbn5f safety A Buildings in accord with ILHR 83.05, Wis. Adm. Code F NTY Attach complete site plan on paper not lass than 8 112 x 11 inches in size. Plan rrwt include, but d not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or CEL I.D.# dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION /,� REVIEWED BY TE PROPERTY OWNER, PROPERTY LOCATION /� r GOVT: LOT—.5 U4 .114,5 T 3 V ,N,R E (or W PROPERTY OWNER':S MAIUNG ADDR8 BLOCK# SUBD. NAME OR CSM # - CITY, 5TATE ZIP CID HONE NUMBER ❑JTY ILLAGE OWN NEAREST RO S , K New Construction Use K1 Residential I Number of bedrooms _ _. [) Addition to existing building Replacement (1 Public or commercial describe Code derived daily flow- gpd Recommended design loading rate . bed, gpi:110 . trench, gpo14 Absorption area required /560'hed, ft trendy 0 Maximum design loading rate _ bed, gpdM' ; trench, gpd/RQ Recommended infiltration surface elevattm(s) ft (as referred to site plan.bsnchmwr Additional design 1 site comiderations r Par9nt material �! �{ Flood plain elevation, If applicable S = SUIWUe for system CONVENTIONAL MOUND 1N•GROUND PRESSURE T GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stern S❑ U RL O U as O U 13 S )KU C7 S ,1$U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color mottles Texture Structure Consistence 8atrfdely Roots GPDlft in, Munsell Chu. Sz. Cont Color Or. Si. Sh. Bed TIt�1ch 4 A .z _ . •_ > o a N vim-•— Gr� 01 14 V Ground i Pou Depth to limiting C _ facto �1 V i '. Remarks: Boring # or k ve ! XLL 7 1 At i. or t Ground 3 Depth to Drilling factor a•4 y, .L Remarks: T Nome: -- •Please Print t Phona: ess: Signature: Date: CST Number: PRDPFMYOW&R ��'t ✓.� . /`�+- r.� f� SOIL DESCRIPTION REPORT Pap x .._ 1 0 PARCFL I.D. Boring # Horizon Depth Dominant Color mown Texture Structure C"isisience ftni3y Roots GPD /ft in. Munsell Qu. Sz. Cont. Color I Gr. Sz. Sh. Bed Tierra M -/ 0 /p YA 3 O lint ANA s Ground �- A- e e tl Dep to riming i factor i J- Remarks: — Boring # le yL D bp "�"� e Ground 7 n Dep lo imldng ' tam !� Remarks: Boring # A sea- Gmund r i 8 �. � + ' ft. � • i De pth to liming ' lady ?� : j Remarks: Boring .# ' i i Ground eloU, ft Dep to imibir>d lector Remarks: S81343301R.05/02j U5 /1J /U4 iUL Ua. 10 I o1J 14U u;,u ,. �.w �• ..�- ,. P/ — IL vs ca i� f e b��o f - T . • V,#, IJI Ud IIAL Utl. iU L.'" IIJ JVU tiVaU rya UUa PLOT P LAN PROJECT .Sleje- Po- st. k. ADDRESS 5Y d)7 St,J 1/4S� 1/4/S / J 30NiR 19_ W N .S COUNT MPRS Byron Bird Jr. 3316 ATE BEDROOM CLASS PERC - CON TIONAL.Z IN -G OUND PRESSURE CONVENTIONAL LIFT__ MOUND HOLDING TANK SEPTIC TANK SIZE 2 '�LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA LSo� PERC RATE _ BED SIZE X Ilia. Benchmark V.R.P. Assume Elevation 100' Location of Benchmark L - � * H. R. P. O Borehole Well Scale = Feet O Perc Hole System Elevation f� Vent 12 . } TYPAR COVERING 2 I • ��•�,, 2' 3' 4 6' L:J 3' 3' :! 3'� 6 . Sewer Rock 1 2' 18' 1` t 4 r r . .� Va ...� �,...., ..a... .,J ..VJ :VJV J♦ V[YS Y.0 LUaY�i \V QUiu STC -105 I 1. SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNUMIR)YER �_ � r _ -I o u A, T MAMNG AI)DPJ S 7 5 9, -J 70" At�.� _ N U.J � : �, Q. EW PROPERTY ADDRESS ) L7 - 0 R A u-- - N r , d 9i rrt.as<d Wi (lo tion of ptic system) Please obtain from the planning Dept. CITY /STATE Nth R icy► w [,) Eqcl 7 PROPERTY LOCATION %J 114, S_ 1/4, Section _I 'Y' _ N -Yt _ t � VI► TOWN OF g ar9e.+ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMMER CERTIkUDSURVEY MAP ,*& VOLUME q PAGE ;2 &80• LOT NUMBER AL 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 it 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 acetification 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 113 full of sludge and scum. Me, 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. Certlfication 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: - DATE: - 7 ! 9 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W1 54016 11/93 UJ /1Jt'U4 IhU Ua: da rA.& i 10 oou *oau 01 11" w .•.•.� • S T C — 100 ` This application form is to be completed in full and s signed by the owner { ) 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 ��s,�,,�, ji 4, Location of p 1/4 _5j_ 1/4, Section �j T -I? g W Township r + Mailing address Address of site ff J71a' ��� I�iG�rr�anc LJiSC, Subdivision name Lot no. Other homes on property? yes No Previous owner of property -F _ , „ �o r K ca 14 w 42 Total size of property M ;,: Total site of parcel _ 9, a&Ms _ Date parcel was created 6R 6 4461. g jc�43 Are all corners and lot lines identifiable? V YeS __N Is this property being developed for (spec house) ? yes _ No volume and Page Number as recorded with the Register of Deeds. *7 y 0R -1,5i ------ ------------ - - - - -- •-- ----- - - - - -_ -- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT MJMBER, VOU ME 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. Xf the deed description references to a Certified Survey Map, the Certified Survey Map shall also bo 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) an (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. �iG i` -s;. �4J/ 4_ Sand 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 of Ce of the County Register of Deeds as Docurn(2nt No. Signature of Applicant co- pl'cant -23 Date f signature Date of signature STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER E" 1 ADDRESS z SUBDIVISION / CSM# LOT # SECTION ^ /_ T N -R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM b �d 10 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK. I ALTERNATE BM: SEPTIC TANK / PUMP CH / HOLDING TANK INFORMATION Manufacturer: (,(��� / t Liquid Capacity: Setback from: Wel House Other Pump: Manufacturer Model# Size Float seperation Gallons /cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: 2 c-r; , Setback from: well Hous Other ELEVATIONS Building Sewer ST Inlet. ��'' -� ST outlet PC inlet ' PC bottom Pump Off Header /Manifold Bottom of system Existing Grade - Final grade -� DATE OF INSTALLATION: C� f PLUMBER ON JOB: LICENSE NUMBER: jr INSPECTOR: 3/93:jt BENCHMARK • ALTERNATE BM: SEPTIC TANK / PUMP CH / HOLDING TANK INFORMATION Manufacturer: e_ e T[ Liquid Capacity: - V l Setback from: Well Z,E! / House Other Pump: Manufacturer Model# Size Float seperation Gallons /cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches g �5 , Distance & Direction to nearest prop. line: for, Setback from: well : Z6�s / House p Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header /Manifold OX Bottom of system Existing Grade -� Final grade DATE OF INSTALLATION: d PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR• 3/93:jt Wisconin Department of Industry PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State jig fttil5i PANASAK, STEVE & JOYCE X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: �.,.2.A -. (�;✓ :�L: � .i _ �.�_ , 4 TANK INFORMATION � �-�� —' l`:.l .i ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 7c.,)c� - /1)"100 Benchmark Dosing Aeration Bldg. Sewer Holding St /Ht Inlet 3 ;tom - ?.. TANK SETBACK INFORMATION St/ Ht Outlet 3 s 9 q, J TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 0 y /��� (� > ' NA Dt Bottom Dosing NA Header / Man. 5, / ?� 9 7, q Aeration NA Dist. Pipe 5 U / - 7- !i Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System H ead TDH Ft Forcemain Length ] :Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width �) Length�j No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS pp 1 1 DIMENSION L`7 SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION - TY - P — eOf P1X#AJ Mod Number: System: v DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) i x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. tF _ Spacing 6 _ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over r, xx Depth Of xx Seeded/ Sodded xx Mulched Bed / Trench Center t,� 6 Bed /Trench Edges �' Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: ( lude code discrepapcies, persons present, etc.) LOCATION: Somerset.i.33 SE, Lot 2, 170th Avenue d / Plan revision required? ❑ Yes ❑ No Use other side for additional information. 1 / 0 1 19 �/ y / .. ' SBD -6710 (R 05/91) Date Inspector's Signature Cert. No. 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 3 --� SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY c - er x STATES ITAR PERMIT # —Attach complete plans (to the county copy only) for the system, on paper not less than ❑ p p�% 110 8% X 11 inches in size. Check If revision to p evious application —See reverse side for instructions for Completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. S 1 Z PROPERTY OWNER PROPERTY LOCATION cS �C✓ C. p C� ccsu, S(,) %4 S %t, S j T�, N, R / E (or PROPERTY OW PR AILING ADDRESS LOT # BLOCK # !� Z CITY, STATE ZIP CODE ' PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 11 ,e �w > 7 7 - 7.3os a 11. TYPE OF BUILDING (Check one CITY NEAREST ROAD Chk ( ) State Owned O VILLAGE S /r ❑ Public ®1 or 2 Fam. Dwelling -# of bedrooms PARCEL TAX NUMBER( S) III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo O 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 in line A. Check line B if applicable) A) 1. 2. ❑ 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 issu P ermit # Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 KSeepageBed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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 /� REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) �� � ELEVN 07 a 0 �Q Feet Feet VII. TANK CAPACITY Site in ga ons Total # of Prefab. Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New isti Gallons Tanks Concrete structed glass App. Tanks Tanks Sep tic Tank or Holdin Tank Lift Pump Tank/Siphon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber M 's S' ture: (No Stamps) P /MPRSW No.: Business Phone Number: Plum is Address (Street, City, State, Zip Code): f 6 -�,.�- e Cam; 5y70 IX. COUNTY /DEPARTMENT US ❑ Disapproved Sanitary P mit Fee (IS 9 r�undwa er a e ssu Issuing Ag t Sign a (No m Approved ❑Owner( iven Initi Adverse Determi tion X. CONDITIONS OF APPROVA EASO OR ISIR VAL- SBD- 6398(8.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber PLOT PLAN S PROJECT An scc k ADDRESS _ l�Sd� i7U�.C��c a/ e < ,✓� �n��i�{(y; S y017 5L,�1 /4SE 1/4/S /' /T 36N /R /9. W N S �' COUNTY $�_ er-a �`•c 'fe MPRS Byron Bird Jr. 3318 �)ATE BEDROOM CLASS PERC . CON TIONAL A IN -G OUND PRESSURE CONVENTIONAL LIFT__ MOUND_ HOLDING TANK SEPTIC TANK SIZE /2ooagL t 1), r 'LIFT TANK SIZE DOSE TANK SIZE _ HOLDING TANK SIZE ABSORPTION AREA Z, Oao PERC RATE BED SIZE 111h. Benchmark V.R.P. Assume Elevation 100' Location of Benchmark c.v * H.R.P. Se�.�c_ 0 Borehole Q Well Scale _ Feet a +� 0 Perc Hole System Elevation Vent 12" TYPAR COVERING l 2" 12" 3' 6' O 3' 3' O 3' Sewer Rock 6 12' 18' ,G Q1 p o � D mss_ wi sconsjn Department of Industry, SOIL AND SITE EVALUATION REPORT Page _ of Labor and Human Relations Cwistion bf Safety &Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNT . 5 l n ',0 ; Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 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. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION j2 REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION h �� .� GOVT. LOT_SL,� 1/4s 1/4,S� T 3 J ,N,R E (or W PROPPTY OWNER':S MAILING ADDR LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP COQ PHONE NUMBER ❑CITY ❑VILLAGE ErOWN NEAREST RO O.S -r, ,PfJ New Construction Use K] Residential / Number of bedrooms r-/ [ ] Addition to existing building j ] Replacement [ J Public or commercial describe Code derived daily flow - gpd Recommended design loading rate ed, gpd /ft � trench, gpd /ft Absorption area required ,/,y0o bed, ft a6v trench, ft Maximum design loading rate { bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) - Fe. Z It (as referred to site plan benchmark) Additional design / site considerations 4�t,�5A_J/ L Parent material � � ^� ��t Flood plain elevation, if applicable ' g9 ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem I ijg S ❑ U t9S ❑ U as ❑ U ID'S ❑ U ❑ S ;KU ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tre & YA Ground elev. ft. Depth to limiting factor / • �� Remarks: Boring # ,::..... 0 ^� O �✓.z c� / r, r sal 4 4 ` Ground V 8 pN Depth to limiting factor a2•lo ,t Remarks: CST Name:—Please Print a Phone: Address: Signature: Date: CST Number: f PRoPERTYOWNER �� «- ��cttifT SOIL DESCRIPTION REPORT Page of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground 3 02 -7 Z .0 -0 ? — / 01 t elev. cft. Depth to limiting factor �o Remarks: Boring # v i e ' .� .� Gam/ s .. Ground ... elev Y/ ft. Depth to limiting factor �p 7;; �~ 5` Remarks: Boring # ..:. o t o S j 4 Woe Ground elev. Depth to limiting factor /"-S ".7 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) PROPERTYOWNER �1�« /still SOIL DESCRIPTION REPORT Page of PARCEL I.D. # Boring # . Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmnch Ground ✓� 2 - 7 � elev. ��ft. Depth to limiting factor Z� Remarks: Boring # ony VA Ground 10 �B R `�f� �l f" �" /�+�r' !� elev ft. Depth to limiting factor 7;1— 5 Remarks: Boring # Ground e lev . ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) r G1, CD 4 INI c3i f r 0 � Q M � h STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS _ 2 5 2 170 A �h � � f � �, G� � W i S G f �0l 7 PROPERTY ADDRESS _(Y72) 170 " k n" - N e i yhrn�&!4 Wisc.. 5V 7 (location of septic system) Please obtain from the Planning Dept. CITY /STATE N Cc i c, YY� rt c1 L S C a t�+ S I g o l 7 PROPERTY LOCATION SUJ 1/4 S'E 1/4, Section 1 T j_ N -R 14 W TOWN OF S o rn e. r se + ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIEDSURVEY MAP s° �a , VOLUME, PAGE a t80 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 esidents ry 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: DATE: 7 ! Z St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 r 44k-- 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 ';fe0 Vn Location of property 1/4 , Section I T R __ W Township Somer,5e'- Mailingaddress $59 17�' Awn. o N)w i�z4 Address of site 170' AVCjwG RtLhrnonor. Wise'. Subdivision name Lot no. Other homes on property? ✓' Yes nn No Previous owner of property _ S:tco t loc.�e,�, P o-rwsk K /Si;v1' y, Ji A�" cxu Total size of property SO, 60 ci(,rc;5 Total size of parcel q, OS g ores Date parcel was created }- P.w�b�� V . , Ig93 Are all corners and lot lines identifiable? v' Yes No Is this property being developed for (spec house)? Yes t/ No Volume and Page Number as recorded with the Register of Deeds �`�/ pQ .3� ------------------------------------------------------------------- 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 owner(s) of the property described in this information form, by virtue of a warranty deed recorded in th? office of the County Register of Deeds as Document No. ;jgfiWAQ16 4d1 6 S 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 of�f��c of the County Register of Deeds as Document No. ,.M 144 3 / P -5 Signature of Applicant Co- plicant 1 Z3 Q 7/2 31,?�4 Date cif Signature Date of Signature I DOCUMENT NO. STATE BAR THIS SPACE RESERVED FOR RECORDING DATA OF WISCONSIN FORM 1 -1932 3A I WARRANTY DEED REGISTE ' .li. RS OFFICE Il - - -__ , - - -- - - - - -- j ST. CROIX CO., WI . Recd for Record This Deed made between Scott - -G.__ DuFour__araC] ......... •_._ _. Diane... ur -- .husband and. - w e_.a -- .'o�i� . tenan.ts ................... ! Oct. 30,_1987 .... ................ . . . . .. .. .... ...... . ...... • --- - • - - -- - - - - • -- ---- ----- -- - - -- - - • - - -- Grantor, at AM f - ,...- - F p p y _ !� Jo ce Panasuk - .as.- surv�voxshz ._maxztal_. rs� srt_ ----- and_..Steve..._Panasuk..a .. a.- Steven_. C,--- Panasuk_.and-------- - - - - -- Register of Deeds ................... ••-------------------------------------- - - - - - -- - -• Grantee, 9 W That the said Grantor, for a valuable consideration.0 � j Dollar 1.00 an ood and d other -- ---- -- v ...........$_..._.... -------- ...••--- g ..... ....... .• - - -- .....able - _consideration, RFTUV TO conveys to Grantee the following described real estate in ----- 51.... a ... .._..._ County, State of Wisconsin: Tax Parcel No: •- -• -•-•- ......................... Part of SEk of Section 1, Township 30 North, Range 19 West described as follows: Commencing at the Southeast corner of said Section 1; thence S. 88 ° 40'32" West along the South line of said Section 1, 1313.64 feet to the point of beginning; thence S. 88 0 40'32" West along said Section line, 1322.5 feet to the South Quarter corner of Section 1; thence N. 00 0 28'04" West along the West line of the SFk, 387.75 feet to the South right -of -way line of the Soo Line Railroad; thence N. 66 ° 28'24" East along said right -of -way line 1437.18 feet; thence S. 00 ° 28'04" West 930.89 feet to the point of beginning. This Warranty Deed is given in full satisfaction of that land contract between the parties hereto dated September 23, 1983, and recorded in the office of the St. Croix County Register of Deeds on September 26, 1983 at 8:30 a.m. in Volume 673, at Pages 571 - 572 as Document #388032. This ...... ..._.is. ,not.,. -- homestead property. FEB ( (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And ... Grantors ....................... ............... ..................................... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, reservations, covenants, if any of record, highway rights -of -way and liens or encumbrances created by acts or defaults of the Grantees. and will warrant and defend the same. Dated this�_.V..+ -! — daY of October 19.87... • ...................... (SEAL) /.. �� G .7.t�!` ....................... (SEAL) III S G . DuF }- A ..... ............................... ............ .......... ........ * ..__ -... _._... _.......___.. t ... • - --•• ................ (SEAL) - - - -- .. GIG .! ........... (SEAL) '! * ..................... 11 ---- ---------------- ------- - -• - -- * -- Diane.. Du Fo.. ................. ......... ------- - - - - -- AUTHENTICATION ACKNOWLEDGMENT t71 i V111 !'5c7 Signature (s) .......................................... -- - -•• -- STATE OF ss. ............................... ................................................ 01iGt5 County. .............. '/ authenticated this ........ day of ........................... 19.... -. Personally came before me this ................ day of Oc_tober ................ 1 107... the above named . ........... ............ - - - -- SQQtt._G , -- - DuFour.- and -- Diane- .DuFQur,•. -• - -•- *-------------- --------- ------ - -- ------------ ---------- ---------- - ••-- -• - - -- ----- husband -- andl- wi. f_ e..as_-joiat--- tetats, ........ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ................................................. .......... authorized by § 706.06, Wis. Stats.) to me known to be the persons ........... who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY --------- -- - --C1!!2_ _...---- .---•---- - -•----- __•_..__._____ -_ . Edward F. ...... ,_ DAVISON_ &_ VL,ACK ........ ..... ...... Nota Public --- .... � tlS --- .------- • - - - - -- County, �•M (Signatures may be authenticated or acknowledged. Both My Commis sl /yyy��� I t e x iration are not necessary) �e� date: -. ,F� tigy __.. __._ 1R� LLBERT, 19 .. .. — — l - NOTARY PUBLIC M]N i TA -- .. _ - -- 'Names of persons signing in any capacity should be typed or printed below their Signatures. '� RAMSEY COUNTY My Commission Expires MAR. 12, 1991 WARRANTY DEED STATE BAR OF WISCONSIN XYyyyyyyryyyyyyvw Y W"Vf"V". FORK! No. 1 — 1982 D1ilu-n�,kee. Wis.. i...i�� SANITARY PERMIT APPLICATION ' In accord with ILHR 83.05, Wis. Adm. Code COUNTY C YD C. a STATES ITAR PERMIT # —Attach complete plans (to the county copy only) for the system, on paper not less than o a 8% x 11 inches in size. ❑ Check if revision to p evious application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. S r Z PROPERTY OWNER PROPERTY LOCATION - cS Scj % S %4, S / T.3c:�, N, R E (or PROPERTY O� AILING ADDRESS / LOT # BLOCK # CITY, STATE/ A ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER It%1 Ch r.� lt� i � a 11. TYPE OF BUILDING (Check one) CITY NEAREST ROAD ❑ State Owned ❑VILLAGE s ❑ Public ®1 or 2 Fam. Dwelling —# of bedrooms PA C L TAR NUMBS (S) Ill. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/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 in line A. Check line B if applicable) A) 1. 2. ❑ 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 ## 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 ❑ Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVAT N g j � 0 1 (Jo a Feet Feet CAPACITY VII. TANK Site in allons Total ##of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank i Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's S' ture: (No Stamps) P /MPRSW No.: Business Phone Number: r 33.. Plum is Address (Street, City, State, Zip Code): IX. COUNTY /DEPARTMENT US ❑ Disapproved Sanitary P mit Fee (Incl es er er ate Issued Issuing Ag t Sign a (No mp Sur Approved ❑ Owner Given Initi 9 Adverse Determi lion X. CONDITIONS OF APPROVAL EASO OR SAP SBD•6398(R.08J93) 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 the 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 & 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. IL 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 in 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 in ##1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing lumber is to fill in name license P tY 9 P ce se 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'/i x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD -6398 R.11/88 C L -'L� - 2 • 0� PLED " 3 JAMB O'CONNELL 4 Regislw d Doeds 505226 sG Croix Co. W, s This.instrument drafted ti eskacek Proj. No. 93 -28 u P`aTTL LatiU Bearings are referenced to the south line W . o West line of the of the SEA of Section 1, assumed to bear SEi of Section 1 S88 0 40 1 32 "W. r N 00 0 28'04 "W 85 th 387.75 ST REET W 2 CO N 1 \ \ 368.30' w \/ N00 04 11 W S s rt r, 0 ... 0 C. z OC ro 33 3i 4- m 0 ( CD CO \� o r - O � IR rj w 0 I F -� I— - w s cn \y I_.� I D ,'* - s � "y \ � \fin. •' O � A. Ir 1:37 \�0 z 4r { CJ C4 0 c rT, ED 0 - If II I z � o N00 ° 28' 04 "W 736.63' \ \r� 0 IC7 ' I(n IM .. — 33.00' Q 703.63' o A�' C/) OD \ 1-h 0, -C 0, = \ p 0 .13 t fn �d Fi CD O n 6 6' (n m = 33.00' C7 • ' C>.EitAX COUN7 897.891 \ O M W r"OwHwjSivv Plan Y S 0 0 0 2 8' 0 4" E 9 3 0. 8 9' k' gatx! I -- ----- -- — ° °\ Fon JNR �.atics � 0 0 - - -- O rt ' 1 kacOtd�d \ cn 1` X 00 O O O O C n 01 M H rn H N O • jn) N r r r r O > o 0 0 o r, o M o w• = t° cn H H H H t'' = z z a O rt rt� x H c O tri c c� c� c� i 3 z N o r 5' tzj O z a z o H o : > > o H a S a _ rt a , O d z � .• �, d • - • O O Of 0 CD C O rTJ w w w io r 4.1 Y CO > >> �O w o v 0 O N T O rt r o v �, M ,--• tzj '• c0 N O •• b 'r - I O' r • G Cn V1 Ul 01 Cr O N V y y i9 Cn N a o1 N G C! CD a tD G- 0 c! 7 A n X v N rt rl• C7 Cn cD (� N cn - 3 Cn '7 CD N ,-•• O '7 . . • N • N H• + � N "T1 T �'I "Tl tD r • , rr rt rr rt o o 0 0 Vol. 9 Page 2680 i ST. CROIX COUNTY u. WISCONSIN -- ZONING OFFICE r r a r ■ a ■■ a ■ �,..` ST. CROIX COUNTY GOVERNMENT CENTER , 1101 Carmichael Road Hudson WI 54016 -7710 (715) 386 -4680 October 27, 1994 Ms. Becky Hartman Hartman Homes, Inc. P.O. Box 326 Somerset, Wisconsin 54025 RE: Septic Inspection Dear Ms. Hartman: An inspection of the septic system serving the Steve and Joyce Panasuk property was conducted on October 4, 1994. This property is located in the SW, of the SE, of Section 30, T30N -R19W, Lot 2, Town of Somerset, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a four (4) bedroom home. Should you have any questions, please feel free to contact this office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator St. Croix County, Wisconsin mz f r-• t 6} U I a a 0 I 0 n � o i ° o @m o a c m m c I ° y C N c w o CL o mU 'D o N N N N N l9 C ° m �' ° O' 0) �v [2 a c 3t d N 0)N L Y y as c Q �1, O E O ` N N a.. co N 0).. O N C OL E E O- Y E a C N 0c N O y d o U) N U v c m w cn N 5 o 0 m m o c y c - >- E Y o Y h 0 ' N 0 o I o 0 2 I f0 m ,c U a O >% f6mo�3c "axiy� rcm 1 maw o0 O c i0 N +OO' co @ N r f/1 N I . L N C y Y O O '� N f m y + v o i mc 3 C o� I m WDo 1 o a) °? 3 -° - o o �� I a o a� c v� M c� O E D w u v o y . °) E Q 23� w v o v cv I Q �v'� � aai I y W E E V) a+ O w O d O O am am � I I o z a c v I c v w w m z °¢ 0 1 0 0 1 iL N M I N O M N .- 0 N 0 w N d I v) � 0 N C a` L a o r ° D c p 1 1 c D o c o ate) c Z m D 0 z m D 0 z z 1 o d c y c N N N E I n 10 O O a— d C O 0� d c CL s �g O c I a o c C) G G a n m c o a m m ;v I�wmm o `"�J aN> 0000 y 10aaa IL • v) J U cD ° o o o } 1 4)) 0) 0) } O ZZ v d �O M0 V I y N 0 N Q ., E Q o o .. E C) • c a L O I � c n� m rn Y o � m Q c to a m ¢zin m I o °-' Qua m �j O y O N C t� C Iv O N O 4 m 0 '� °I O O u a a c „ a o r• M CO (n •6 C N •0 N V Q N Y O 7 C M I Y p G O v) Ln ICJ J S •00 o w O N C') O O N 0) N �_' C N Co O N O C N �� 00 M O m LO O N E 'm u c N 0 rn m ro U N O O U) ! a 'W O Z c W r s' w a N 0 Z c U) V1 d a I m a CL • c� a m m y IL c d d c `1v E 2 'c c 1 c �1 A 0CLa �0U)L) 0 U) r Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page _ of Labor 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 8 112 x 11 inches in size. Plan must include, but �ii"4 r JC 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. APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY, OWNER- PROPERTY LOCATION l ev t— d G L /t ` GOVT. LOT 1/4 ��I /4,S l T p N,R E (o PROPERTY OWNER' MAIL NG ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # C TY, STAT 21P COD PHONE NUMBER ❑CITY VILLAGE OWN NEAREST ROAD 5 v�`� 7 D ©r d [ ] New Construction Use K Residential / Number of bedrooms [ ] Addition to existing building l Replacement [ ] Public or commercial describe Code derived daily flow 4,V,V gpd Recommended design loading rate _gy bed, gpd /ft l5 trench, gpd /ft Absorption area required 11A bed, ft 1`�DO trench, ft Maximum design loading rate _ bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) - ft (as referred to site plan benchmark) Additional design / site considerations Parent material �f�,7�„� ---.� ?� Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem I..2[S ❑ U aS 0 U ;'S ❑ U IRS O U CIS .®'U ❑ S E;v SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consists Roots Bed Trench Ground 0 —r �/t ` 4 • 4 ' S ellev. f�ft. Depth to c �G limiting factor 3- 3 Remarks: Boring # \ � 3- `••.... ```.' F / f v Ground elev. Depth to •� ,,y ` . �,r limiting r. factor z -,r 2 _2jL 02 Remarks: V CST Name:— Please Print r Phone: — Address: 1 Od Signature: Date: CST Numbs PROPERTYOWNER .1/ ��° ^�s�/i SOIL DESCRIPTION REPORT Page _of PARCEL I.D. # Y Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends Ground —2o 0 y �` °�"` �� /n Y �r • `F ' S elev. ft. Depth to limiting factor 7.2 .2-G Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor T ------- Remarks: Boring # ti r Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) l f I J ti �y 1 0 w o � w Parcel #: 032- 2006 -30 -000 o2/27i2oos 09:35 AM PAGE 1 OF 1 Alt. Parcel #: 01.30.19.487B 032 - TOWN OF SOMERSET Current LX j ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - WORSING, JOHN A & LADONNA C JOHN A & LADONNA C WORSING 872 170TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 872 170TH AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 9.050 Plat: N/A -NOT AVAILABLE SEC 1 T30N R19W PT S1/2 SE1/4 BEING LOT Block/Condo Bldg: 2 OF CSM 9/2680 9.05 ACRES Tract(s): (Sec- Twn -Rng 401/4 1601/4) 01- 30N -19W Notes: Parcel History: Date Doc # Vol /Page Type 06/09/2004 765317 2592/53 WD 2005 SUMMARY Bill M Fair Market Value: Assessed with: 77504 470,700 Valuations Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 9.050 78,200 300,600 378,800 NO Totals for 2005: General Property 9.050 78,200 300,600 378,800 Woodland 0.000 0 0 Totals for 2004: General Property 9.050 78,200 300,600 378,800 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch #: 123 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 y ,. 6 JA NAf o r ;rN •IEu 43z• 2�ob �4 AlF 7 � i R0�,e, T� Cb St. Croix Co•, 'W ' 4 e ' 2 1 Z ® 0526 � t4.:;0 This instrument drafted eskacek Proj. No. 93 -28 f utiP`aTT L-a�v�S \O N \ 0 \ Bearings are referenced to the south line o West line of the of the SQ of Section 1, assumed to bear = SEj of Section 1 S88 0 40 1 32 11 W. N 00 0 28'04 "W 387.75' 85 ° ST REET W 2 aD N 1 r~ � CD 368.30' f \i � _ 1 N00 °28'04 "W c s s rr � O ...... . 8 T o� ... O C_ p � c m rn 33 33I Ln t' 0 \\ FJ r t C/) / (D 00 00 m Co r--" p �� N N rn 4 O a o n Cn u) r r � ✓ I L 00 y F --) o \ Z C n CP I r 9 i =r ICJ Cn r 0 C I r I D tv sh ✓ \ T7 to rt —I I v < ( w° I ( T 17- o � N00 0 28 1 04 11 W 736.63' � �. O � M I(n �m — 33.00' 703.63' 00 �� M z+ ca 03- O 0 r r I 3 17 0 0 —•I s' UI 1-S :l ROVE o o o (D rt _ N f ct O ca AIiU t!' '9!V Ct Ct ID -- 33.00' C1 • ::.riUIX CO Y 897.89' \ 0 t " w+5iveP1W 500028' 04 "E 930.89' H' "r o� ' and O %. :conamitt.vl UNP' ATT`D `atir-S ° 0 ` rt N _ \� O O O O tzj +1O[)OV8(Nd3tQ — t - ) 0 C.1 -+ 0 0 o m m ►r N O 'w'Wvow n n n > W In O O O O t O 7 o r• r ~ c tiJ t-1 z a z a O rt rt La x — e s O c� N o' t=J z z o .-. o r = > c rt, d m - 3 v o 0 W 00 t=1 �c rn o m c c O r� w to r r .. > d co > > > �+ to w o o C/) �• a rt O t7j CO C71 r t o 4 m r� ,, v o o e0 rt tr .•.• e \� W U) Ln Cn 0) Cr O N V = N N a 0) N 0) N N n C/) N a f m r' N' V t0 D A d rt n N -3 7r b N M F .•'• O d N N co tD N 7 Cn •7 N N N• 1� N .0 fD O j = to N f' • 7 F� + co T T T T ca 1j 0 to O Vol. 9 Page 2680 I r _. .