Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
032-1024-40-000
WYrsconsin Department of Commerce 1 � PRIVATE SEWAGE SYSTEM ° "ty safety an d et,ngsswn INSPECTION REPORT S Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sani84231 ta 2 9STit No.: Person m al W ftn you provice may be used for seoondary purposes (Privacy Law. s.15.04 (1)( 3 Pe��g er's Name: ❑ City - villa ge �� Town o : state Plan ID No.: n�, Wllllam y gOmerset Township CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.: (� i t oo a cAh-Q -1 032- 1024 -40 -000 TANK INFORMATION ELEVATION DATA q 3 k` 1% tZK A TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 2 �� Benchmar T-, Z t2 2 r► Ob Dosing It. BM — � Aeration Bldg. Sewer , 0 Holding St /Ht Inlet 5.9�5' C W to T 1 TANK SETBACK INFORMATION St/ Ht outlet 5y to • c(S + Y + TANK TO P / L WELL BLDG. Ventto Air Intake ROAD Ot inlet r7. 8 Septic O / NA Dt Bottom 0 -V`( r Dosing ► 9 fl S0� / NA Header / Ma B ' `� 96 • l(o i Aeration NA gist. Pipe Ct l •Z Holding Bot. System ►O `� PUMP / SI ON INFORMATION inal Grade L� `�`� � �' W �• 36 Manufacturer ue�ma over 2-1Z av •D / Model Number O '�`� M `E•• � 2.. Xit N 0 TDH I Lift. 1.Or Friction •q� S stem Hgc(oFt Loss 1 > " Forcemain Length (po ` Dia. 2_ 11 Dist. To Well S 90 SOIL AB TION SYSTEM '7 4 E CH Width 1 L n f N�•Of Trenches PPI � 1 N ZR Inside Dia. Liquid Depth Dim EN 3 S Manu act rer. SYSTEM TO P / L BLDG WELL LAKE/STREAM ING ��,,, ` c,� SETBACK BER o e Num er:� INFORMATION Type Of y + } t3a 5 31 IT System: �, (� DISTRIBUTION SYSTEM [ Leng th ader /Mani old tt Distribution Pipe(s) x Hoe Size x Holes pacing Vent To Air Intake ��� Dia. ia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over jxx Depth Of �OYes ed 1 Sodded xx Mulc�hed Bed /Trench Center Bed /Trench Edges opsoil ❑ No (0] Yeo COM MENTS: (Include code discrepancies, persons present, WRWCtion #1: off-/2 ©/0 1 Inspection #2: t Location: 2238 50th Street, Some set WI 54Q2 (NE 1/4 SE 1/4 9 T31 R19W) - 0 1.) Alt BM Description = L%Ge- 5 T D •f Coue�S f °^"S�`"i 2.) Bldg sewer length= – :6 / �S - amount of cover = IQr* +. 3`�" lc� D� Plan revision required? ❑ Yes No c` I � Use other side for additional infor at on. 1 ak S80 -6710 (R.3/97) tola' L c 3r Inspectors Signature Cert No Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W Washington Ave. `�SCOIfS See reverse side for instructions for completing this application PO Box 7 Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of commerce [Privacy Law,,s,_1.5 I (m)] (Submit completed form to county if not - state owned.) Attach complete plans (to the county co ty) j&r-th 4 aper not less than 8 -1/2 x 11 inches in size. County State S itary Permit Nu i' j ❑ Check if revisit to vious application State Plan I. D. Number sr. �. A � �„ AW" WAIPPGO I. Application Information - Please Print all Info ion Location: Property Owner Name Property Location I /4' 1/4, S T3 ,N, (o Property Owner's Mailing Address Lot umber Block Number ,�V/ City, State Zip Code Pion b Subdivision Name or CSM Number Svn c,� /c 0 9 .7 ?Z f�GRES II. Type of Building: (check one) ❑ City I or 2 Family Dwelling - No. of Bedrooms 3 ❑ Village 15 ❑ Public /Commercial describe use):_ frown of ❑ State -Owned -- GV — t ABEW ;'00*4e' .4CT - ?) _r _ 1 -- - Nearest Road — �4 �S - _ / i Parcel Tax Number(s E 2 i - III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) 3 ;t / Q - 0 O A) 1. ❑ New 2. P Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only q' �✓� X ��N4 Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued /rip IV. Type of POWT System: (Check all that apply) X Non-pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland - )) ❑Pressurized In- ground ❑ Holding Tank ❑ Single Pass , ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. DispersaVrreatment Area Information: N 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System ' n 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) '(Min. /inch) T Elevation T L /SD s� 377 e 93 3 loo VII. Tank Capacity in Total # of Manufacturer Prefab Site ter- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks _ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ caE VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the P TS shown on the attached plans. Plumber's Name (print) Plumber's Signature (no stam MP /MPRS No. Business Phone Number t& g. T oar= I ZTV z / - 0 /337 - 5P .40f Plumber's Address (Street, City, State, Zip Code Yoe 2 ,F ofeerwz. �,c o IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Iss ing Agent Sign re (No stoups) l Approved ❑ Owner Given Initial Adverse Su arge Fee) Determination ALM4 J 2M X. Conditions of Approval /Reasons for Disapproval: jo� - ks . " -• o w►ww. t% t � CrvC� ) 4 ou-Ga Le , K Si-etlu w' SBD -6398 (R. 07/00) NHS I 1 O ,,- rr a S'0 ST, I F"u ty Plumbkg 3z At ?"Xce: 4 #221180 28288 McKenzie Rd. Spoone WI 54801 (715) 635 - / /uR0• - . wrccrsrs+ flu�1' �aanxa� -3� aµ2 ,,ter �.r•, rod �co AFAW o = ocD ' 04vr el4p ti) '�yrttNG fu.rr/L CdY�Artr y�/[�st' fiTTiKM+ED. Q `, tc[L EGE gyp -Fo/� .►cc T,at L i Q , LiM � �'IfD�• - -- - 7/Y #& ,dam its ti►,,o ISM A V — f _ / � -S 3 1 O le � 4 1 r � , 1 X97 GB L �n/6f c� .ti✓ /od F6�T o= s ufr �► e T -50 _ sr �4 F"a ty Pk mbNS _ #221180 28288 McKenzie Rd. Spooner, w l 54801 _ (715) 635• � xis 7v? o,- s r, IvEIC l✓rc� in+ iv/ /{ ��i a/iZ Aw, 1 AF /w & i I X = /3oMsuC- ' _ o = BAD /�rEtt> �4iVr eAP �.� ko "X j�rttfNG Furrx - ?Ktr r it 9D 0,0 A-14 rMAI LEVEL •rt�kD�• ,r d X - 3 I : 7y / f .. i 4 7 7S �3 1 1 f97; If 4 I "00' �oB trnl6r cv F 6E'T ir s s rE.++ e Go / Y T PA r, I (;F - 1 PUMP CHAMBER CROSS SECTIOU AIUG SPECIFICATIOuS VEUT CAP 'I "C.I. VEUT PIPE _ WEATHERPROOF APPROVED LOCKIAIG __ffT JUtJCTIOU BOX MANHOLE COVER 25 = RO.^1 DOOR, WINDOW OR FRESH 12 "MIU. AIR IAITAKE I GRADE I `f" MIAI. COWDUIT IB "MIN. ---- - - - - -- PROVIDE' I -- INLET AIRTIGHT SEAL * A I I I ALARM I I *APPROVED c JOINTS WITH LLEV. FT. APPROVED PIPE I 3' ONTO PUMP —� OFF i D SOLID SOIL CONCRETE BLOCK RISER EXIT PERMITTED OULy IF TAUK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIOAIS DOSE ' TAWKS MANUFACTURER. IJUMBER OF DOSES: PER DAy TAWK SIZE: DOSE VOLUME ALARM MAUUFACTURER: �c % EG Ecr ea c,Tr� I 15ACK ILO : 4/L 0.33 GALLONS MODEL UUMBEK: T /0/ CAPACITIES: A= le,s_IWCHES OR 97 GALLO►IS SWITCH TYPE: 0N,6 /T4t e-fA B= 2 INCHES OR -/ 36 GA PUMP MAWUFACTURER: 'COU4 /0 C � IULHES OR 41 GALLONS MODEL UUMBER: 'EDo4( D �INCHES OR 7 -'- GALLOMS SWITCH TYPE: �Lt��[ MOTE: PUMP AMD ALARM ARE TO BE MIAIIMUM DISCHARGE RATE y.� GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFEKE BETWEEAI PUMP OFF ARID DISTRIBUTIOM PIPE.. S FEET + MIUIMUM METWORK SUPPLY PRESSLHL FEET + - 43 — FE ET OF FOR MA X 3 27 Y,. ►L FRICTIOW FACTOR.. Z" FEET ��I F '"*' DyWAMIC. HEAD = 7-If G FEET IIJTERMAL DIMEWSIOWI: OF TAUK: LEUGTH ;WIDTH . -;LIQUID DEPTH Slt;�IEC).���t ��i. /.•< _' � i i�F�lcr 1111MAC0• � 7 � c 1 ^• — ^• MODEL 3871' • ' • '14 •1 Su bmersible Pump GOULDS r . um P n .S ectfications� p METERS FEET to 0 GPM q to MODEL: 3871 �Disctiarge size`1�." NPT�� 9 3° Solids �e`maximumr� '. Motor �, ' ..4 25 Single ph5se:115V a ° Materials of C astruction : 6 z° Brass/thermop�stic k ? 5 ,5 Features and Benefits { > 4 t EP05 •Top suction eliminates in impeller clogging. 2 Boa • Corrosion resistant , 5 construction. , • Float actuated switch. ° °° 20 1 30 ° • 8 12 m r METERS FEET K e C MODEL DVP03 Pump Specifications Features and Benefits s Q 6-20 4 Ao and 1 /2 HP • EPO4 impeller- semi -open design 5 Up to 60 GPM with pump out vanes to protect Z 4 15 Maximum head to 32' mechanical seal. 9 10 Discharge size 1' /2 NPT • EP05 impeller - enclosed design ° Solids: 1 /4" maximum for improved performance. z : 1 E u.s.crm °° s 3° Motor • Rugged glass - filled thermoplastic All motors feature ball casing and base design provides ° bearing construction. superior strength and corrosion as o z resistance. Single phase: caPncm s e 'o°am� Materials of Construction • Cast iron motor housing for Cast iron efficient heat transfer, strength, and durability. Thermoplastic � Corrosion resistant Stainless steel s ant threaded stainless steel shaft. Available for automatic and manual operation. • CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. 'i y Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of �S Division of Safety and Buildings _ in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 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. _ ) - /D oad Please print all information. tewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot WE 1145C-- 1/4 S T3 N R E (or Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village aTown Nearest Road C] New Construction Use: Residential / Number of bedrooms yam_ Code derived design flow rate GPD VReplacement ,n ❑ Public or commercial - Describe: / Flood Plain elevation if applicable Parent material /l/ �/�} • ft• General comments T- Y and recommendations: T - 2 W. j o 1 T -3 Es low rf © Boring # ❑Boring Pit Ground surface elev. ft. Depth to limiting factor > /D� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /(t' in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. _' Eff#1 E G s 2 3 7� -s - L ' 0 � F goring # Boring �� G fl. 9 p;t Ground surface elev. • Depth to limiting factor � in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots .E GPD/ft Eff#2 in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. LS e jg11pCA7 S l _ .� G Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg /L * ) Effluent #2 = BOD, < 30 mg/L and TSS < 3Q rri L- - Si na syct3 CST Number PST N me (Please Print) t� -2-w f'U e��4 --- JF Date Evaluation Conducted Telephone Number Add s Fogerty Plumbing & Perk Testing 28288 McKenzie Rd. Cnnnnor WI 51R01 Property Owner Aa. / Parcel ID It 0- Page —2— of y� 7 Boring # ❑ Boring Pit Ground surface elev. /a 9 ft. Depth to limiting factor In. Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftJ in. Munsell flu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 Is GS G 7 1,2— Z Ms L .2M 7 2 3 - G 3.Z 1D`(. F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev, ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent 01 = BOD, > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L + T he Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or + need material ui an alteniate fonnat, please contact the department at 608 -266 -3151 or TTY 608- 264 -8777. seo-ulo (R 6M) I • tf ST - Fogwly Plumbing 3 =. ,• ,�•,u 4 #221180 28288 McKenzie Rd. s x° Spooner, WI 54801 (715) 635.9609 QY! = It'"/ Tod of T, AWAO" taYJE _ t✓tttrf+.w f,IvvT I� t1µ 2 � ,vtT. Jrr, j °/ ,saf ♦co Fsctp fEwE/e' tsvE I X _ ZOAZAAC �fXt� c fiarLrNG 1 4j Y L EpE L • Nl�Tir : 7/�/��C was 6E iof �r►wc�/ // i i► �'' CuT TN k 3 + Ae ". IAIZ- 1 IDI •D � 2 _X l G— 7 75' - ) I � i 197 G — (,)o 6oT lrnl6s wlr v /ov Fccr mr s y r�E•�� r Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department,. agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567 -P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number Z3 Number of Bedrooms Design Flow - Peak (gpd) S� Estimated Flow - Average (gpd) c3'o Septic Tank Capacity (gal) y Soil Absorption Component Size (W) Type of Wastewater DNnestic Table 2: Soil Absorption Component - Limits of Reliable Operation - p p Septic Tank Component - Soil Absor tion Component , Design Flow - Peak (gpd) —� Maximum Influent Particle Size (in) 0 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease' Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se tffletfilt k and outlet filter shall be assessed at least once every 3 years by inspection. Th ou shall be cleaned as necessary to ensure - P roper opt ion. The filter cartridge should not be removed unless provisions are made to If the retain solids in the tank that may slough off the filter when removed from its enclosure. Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scull and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an 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. 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 the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with.Comm 83.33 Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption pone nt - The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in r Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather Conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. I INSTALLER'S NOTES: RECYCLE GREASE! Do not pour grease down the drain. Your septic tank and filter will not handle it. into your stem. The bacteria in tic our se NO BLEACHES. Do not introduce bleaches y y y p tank is what makes your system work. Bleach kills the bacteria. When that happens, your septic tank will no longer function correctly. This will cause premature failure of your system. WATER SOFTENER! Do not run the brine solution into your septic tank. This solution has a high concentration of lime (that's what makes your water hard). The lime tends not to settle out in the septic tank but goes directly to the drain field. Lime is an excellent. sealing agent, and yes, it does the same thing in your drain field. Think of your sewer system as you would your car. Treat the attached information as you would your car manual. Remember, also, that your car requires regular maintenance. tare must be exercised as to what you put into it. And like your car, your system eventually will wear out. The question is - how quickly. If you have any questions, please call: Dave Fogerty " 715- 749 -3656 - Roberts ' 715- 635 -9609 - Spooner If you have an emergency, and you only get voice mail at these two numbers, call Keith Knutson at 715- 796 -5436 - Hammond I have read the attached information regarding the construction and maintenance of my sewer system. Owner's Name Date ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerffivM Gtiz 44274 ► AYWL -- - Mailing Address ? * JLF SZ9 ST �o�rs�!s� •. s` '� r Property Address (Verification required from Planning Department for new construction) City/State Parcel Identification Number O 3 A — 2.0 7/ — /o Z O LEGAL DESCRIPTION Property Location 4 '/4, SG '/4, Sec. �_, T -R /_' - W, Town of _ .Pa ref'X�' "`— Subdivision Lot # Certified Survey Map # Volume , Page # Warranty Deed # ___1 T'0I , Volume _S �' , Page # Spec house ❑ yes 0 no Lot lines identifiable 14 yes ❑ no SYSTEM MAINTENANCE - premature failure to handle wastes. Proper maintenance Improper use and maintenance of your septic system could result in its consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What You put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastor plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system and pumping (if necessary), the septic tank is less than 1/3 full of sludge. is in proper operating condition and/or (2) after inspection 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' �r 30 within stating that your septic system has been main ed must be completed and returned to the St. Croix County Zoning da o the thpe year exp' do e. r J DATE A OF "kP#LIC OWNER CERTIFICATION the owners) of I (we) certify that all statements �this m are t rue to the best of my (our) knowledge. I (we) am (are) the pe escribed aboe, b rtue ty deed recorded in Register of Deeds Office. L DATE JAtIbNAARy OF APPLIC may result in the sanitary permit being revoked by the Zoning Dep artment- * * * * ** Any information that is mis- represented * * * * ** «« Include with this application: a stamped warranty deed from the Register of Deeds office - a copy of the certified survey map if reference is made in the warranty deed [7U1.UNIEN'r NC STATE nAR OF W'500 - -FOBr4 t WAA ANTY OPEC) 't D V O L (�I �,�j( 11 T,+1 .-A E V o. ,SF V:J v :. +. nt,,V �.•� J tNl'1� �i This Deed made between Frederick C. Krogman and Lorraine REGISTERS OFFICE Kroc�rtzfn, his wife ST. CROIX CO., WIS. Grantor Recd. ')r Record this and William C.- Hrunt, day of August A.D. 19 7 9 ... ....Grantee, WitIICSSeth, Chat the ,a:.: grantor, for a valuable consideration Of. one dollar and other good and valuable considerations. ,rV,',.< to I ;rantae the following described real estate in . St. Croix II L + 11-m C Tf"Lnt ('tunt >, Mate of Wisconsin: 1 1 J)1 University AV© S.E. The Northeast 41s, r.n 55,a Quarter of the Southeast Quarter (NE�t of i.inneapol M0 of Section 9, T31N, R19W, E}CCPT that part Conveyed T,tx Key No. to James M. Madison and Carole L. Madison as contained in the Warranty Deed dated January 5, 1973, and recorded October 1, 1973, in Volume 503, page 552, as Document No. 318787; Subject to easements of right -of -way of Town Road as presently laid out and travelled which right -of -way is hereby dedicated by gran - rs to the Town of Somerset, St. Croix County, Wisconsin; TRANSFER S 0: d0 This deed is given in satisfaction of Larld Contract between parties dated FE8 March 1, 1978; is not homestead property. timl lis not) T, :r :er with ali and singular the hereditzments and appurtenances thereunto oelonr;ing; A-.d Frederick C. Krogman and Lorraine -Nrog a<n, his wife, grantor, r..nt^ that the ti *la is good, indefeasible in fee simple and free and clear of eneumbruMes except easements and restrictions of record ".•i '.c ;; arrant and defend the same. 31 -' " da of ... July Is.79. (SEAL) �"Z..L•- � � .11t�t�!4.('S EA L ) .. .......... • Frederick C. KrogT In (SEAL) �� %IGrr2 -,. t ,` ��jprcn-h�c.s.�..(SEAL) _ sine Krog ..'an AUTHENTICATION ACHNOWLEDOMFNT �ignat•+;r; ut . this 7 �.- day of STATE OF' WISCONSIX z' y 7 County. Personally came before me, this - _.d ^y of 14 1 1a n 0. (' ( ^^ a k the above named i'ITLE: MEMBER STATE BAR OF WISCCiNS1Y _ t Tr-rm 3 ;u$Ar,, Wls, itat,; tH,b iNSTRL :"E`+r on AFrED av . to me known to be the person who executed the Maki & Ludvigson, Attorneys at Law luregoing instrument and acknowledge the same. Osceola, Wisconsin 54020 �knah.lrr.; I .� ; � ; • r•,, ;tulhenticated ur aokm,wle,l tury Public County, Wis. r Ked. Both ' + :;are.) ,lty l'ummission is permanent. (If not, state exairaion date: 12 ) • \amra n( p.nnna d c in any rave ,tv ..h ,id i, r. r•••: 1 —rit•d below their iignarurw WARRANTY DEED STATR BAR OF WISCONSIN lc i L Wank Cn. Inr, FORM No.1 — 1977 1ldwaukcr. Wia. (J"by36E31 POLK COL"rlr u 7s.. .� • 14p�4 r ) q, } , $ fn.d. k hsa� • 1 `+ wa l 4is N "m Y_ a4 t.cy+.1 r,..4.a tv.w: a 17vOr •. e7„�, •& O ./' [� 7Z t.y1s 1 %6k*W. 9K.1. 1 ' 77+w r'.w. +.. >w � awM I °• It hnu a4rWOnt M'^) 1.0 lrr VY31'y to ' A MmNn ntnwrm • Kowski u.'.sw. 1 •••• ••• ' Gerald QI[ r ' ° Dup.ry Farm Inc 11rp.M rw.w 121. Rtulhm • Fat'm.'W c.aatu.e. CwNy •C �ClUiIfC! POW a0 165.7 tV a tA..wu•p A1a,1n7 WIl13ar11 PAM f..+ur Lawnture C-A, 7a� kAw•� )crryLilltim4. .1}. al p w i.at. ]1 1.y.•nn. H � d1C Chn tc1*On 1.+ .. a 4 1 111 M _ rnn.' • 153,6 1 tward •t Haase s „' R 1 t u IM 13 WOO N l ml M.+«A.4 ■.: r NN w' 'rtal►rr Nrlwm tl I411eha•I�' '�• 6 LiV 4a4 7 flu 111!rMr" } ac !41ran A + xrA to , $s ltaOA. la. wn. tlll 3` 73 4.61 ANlwnl i v tlull 293.5 +' A ItR • L. 1a,1. .; s •. 11'. , 31•,Ln r+ s W. N t+ .e Y + Iw• Tr . th 1..1. Ikrk T lem}itiy n 1. w s H twrwkl d:A'bra • A tMae.a r:. aullic .Lrt•i.,. a e..a' 41 1 }T ..n C11Muaiwr Barbara •^ • Paltiltg : M^ w laey SItCrHll ~ •M Lt>= Tt1 F:tm li 5 wn. t�� w. ^2 4U NW. k1 Iwvtk A7rn Art. 1 • Ma n • t -WA tmntvw 16ktr• 3 7 Z- 11 4.4 1255.9 210 thew:. ,tnxWt • ass • a «N , P *M,,- A 'r • ' rwwlt WU4 Gmg4wy "' Richard : 161} Elaine Rk'hatd A1tne1 73.5 1huvcl :o C:rii 7i Mtdm ` I'lauick Pklurde i Qanm ti7ilHatgron C}tU!{}I Rc bct! 46ll 3` 611 A e 4 • Rev Tit 155 • Trustees irtk7o•r C"I" w, 1SR .1512 NlildlYd en Limited 1w 1, $ rc on 1674 Jo hn n ..�'" $�tathhte atuYa++ 4 a °1 " 4Quw L.wmwu. �+anr. ncr'!r . Im.aiw Walsh as r.+R HA II 10 Family Aa 1r 77 +' tvwttn 1e y _ so t nrlkt " 711.6 AEotdl�,f71 sNa - Z • t 11 K` NaA1 M7[haal 100 2 r , Oaka Falatis 7'''t �r Tiertnai7f s r VA flat ' r awe !753 tA.%. .w• • t arK>a _ '7 John 1 t6 ' +�» VAIW4 t+s +» 4. • O tv,•,. P 3lydwe}rrikElMh CsnW i % 57:1 Tn75t 652 ">aw' k t ea W w41 w J" bra \Jarrell a { gg I aw 79 arrahl ' t '� C OD AU sa; it a'..,. eqw 8t1 a 1 ^' • 7}..x atal ^' y a" ' i ` Pi• A1N R(tltcrt Utxta� & so3 w �tt•I.be Wa lter Debra Iw.: •t L ww , Martell Renee 23 Germain 1x0.5 rnaw. aaiwx«, ., . errrle } Ot10 ntwu7 tw. 1SS.8 rn- 1 kr. Carulcl •�{ 41 40 $ilha 1 Lyra uA 1 twt w� Lout. i5 �e O NafdA4 160 a y s " Y r 't M R4v4rai i - � 11U4 v r. r ,T r �• Zwickle>.' . ;.. ] ra+w.1. I+Awn Y. 1iatNans +wa}wl 1'alb ar.,1n. 70 ,�'t rotumarv. TWt1c rr 3 5 ! �( 5 A s 2 2, y W Ly4. t 4 w� { il4w ' Y+ •1 Laois & Igrrata• lake DM t +k Y" C , r.�,a p k44 a7 n+ tx 4 q <iCrMau1 jJ& to 1 .r. • sba 1n s: 7v Ilti.N N f} 2759 tvl 121 «. 1"vnaro • a, K'CC"r 7 ' • h! �� [krwiadl L)twn IM '. 1.1w1.= &71Nie Itttkn, �i,. +t PI.«wm �. ar a c 41 Nrummn m u : _ 1 '" lalw►a• 10Pfy 3 J? Gf QI� m 46.' 7h/ 4Li % 4 Au.te t� ai l.w:r rwdx, Tr (a l.rrtn ¢ : d• - Am,wg1 item 4 • Earl & Elizabeth Paernt t.ndes C 4 L A.K.• py, 7 M.„1. /:Nwiv AQ 11U Wu 71, ,ulSAtntt. li9 A AN•. 34 ie+..an 7 331 a Wl 'F1 *r a w a Wu IN,&4 art w7 6w Edward L t • 7 i r 7wkk k711n Di�}It Lippw ti r• •p7 ty r • Y) 061 IAI.J Cliff Sa m 1T •lassrlA4wwi P} 1 • lwia 1 Far1r1M- Pa t+ tx m w AO KH w1n Latr kB t4 1' k 's' 1'it 15118 .' 45.3, Le.vee414.• (wrN• Y.1 f Tr ! 6fndoNS Lt, 0 k tau PIS 4.4 'f .. �•rr • 91�. 57 Atuye4kvt k': s at > " 1Aawtt7 � law •t K �4 • Gx., 117 rn 14artatl Mal 44 to . f l !. a u: .�- prr +sJ kaa+i:. �� • mac'. _R �{ � , nn:' ��.. ♦ I JOIN, • 7hwna. aP i'a r. kanera SAnden Plwm7r .Ain 51.7 i itaar� k Marisa B141 1tlfnaht A - 1t. r _ 1 4 } Irewtc '� NalarH ... SO'M ERS`ET ., 144 Carat oc�n c:r•a ' . • !:rani tia +r!. R81C 1'k4ed4 tiw ae.:s yri, .r .x &'.7p Mihteril R.>W rn v7v tu i+i z 1'burd.• 3s 3 6 Hal - ttxyarr - wr 4 Y 7.'' a«.'4 p V ,r 11i14I t4 77 f '{ 1. `•• 3 JamrA 1r ll i b'.trbo. a 4. •M.. KL �� la � N LaeVben 1 WyWa. 1 Y1tMr 1i 4e rb. tI! a. •a�rwwnrt WS �. A'Ary, 11. � .'4 M..A My 1e�`i QM I.k itl RR �p ao • a 101 4; lr G 4." ' • a� _ NA 44 3 rn t 'GO San yV'sco"si"papartme"tcA°n""ek`� PRIVATE SEWAGE SYSTEM Co Safe and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1 )(m)). 13 Permit Holder's Name: City Village Town o : State Plan ID No.: unt, William Somerset Township CST SM Elev.i Insp. SM Elev.: BM Description: Parcel Tax No.: 032 - 1024 -40- 0 TANK I ORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Hol ding St! Ht inlet TANK SETBACK INFOR ATION St/ Ht o et TANKTO P/L WELL BLDG. Air I to ntake ROAD Dt I et Air Ser�tic NA t Bottom erasing NA Header /Man. Aeration Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Dema d t Cover Model Number GPM TL>H Lift Friction tem T( Ft Loss ead Forcemain Length Dist. To Well SOIL ABSORPTION S TEM BED / TRENCH Wilt Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME NSIONS IME LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE I STRE CHAMBER mo Number: INFORMATIO Type OR UNIT System: DISTRI TION SYSTEM Header/ ani o Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Leng Dia. Length Dia. Spacing ,56 1L COVER x Pressure Systems Only xx Mound Or At -Grade Syste Only Depth Over Depth Over xx Depth Of xx Seeded/ Sod d xx Mulched Bed /Trench Center Bed / Trench Edges Topsoil C1 Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, ion #1: / / Insp ction #2: / Location: 2238 50th Street, Somerset, WI 54025 (NE 1/4 SE 1/4 9 T31 RI 9W) - 093119124A 1.) Alt BM Description = tD 2.) Bldg sewer length = S �# '�4— - amount of cover = � � (` ts ` 35423 I t � la nrevision required? Yes ❑ No Use other side for additional information. �O `3 sf3e -6710 (a.y97) Date I Cert No. ry L Coun ty Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE G p Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m)j 1101 Carmichael Road , &to Hudson, WI 54016 -7710 (715)386 -4680 Fax(715)386 -4686 Attach complete plans for the sy em a paper not less than 1/2 x 11 inches in size. County Sanitary Permit # ❑ cfCif revi*pn revious app cation 00 ` G� 1. Application Information - Please Print all Information z Location: Property Owner Name ^�'' 1/4 114, Se �. T N, R E (o Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phond Number _ Subdivision Name or CSM Number 11 T pe of Building: (check one) amity []Village own of 1 or 2 Family Dwell' ,g - No. of Bedrooms: 3 ❑ Public/Comme (describe use): �- ❑ State -owne Nearest Road 11. Type of Permi Check only one box on line A. Check box on line B if applicable) t Parcel Tax Number(s) L�f A) 1 Repair 2. Reconnection ❑Non - plumbing ❑Rejuvenation /007 v_ Sanitation B) Permit Number Date Issued ❑ State Sanitary Permit was previously issued • it 9 • �or IV. Type of POWT System: (Check all that apply) Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other . Dispersal/Treatment Area Information: A Al d 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Min. /inch) Elevation O i VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks _7 GU,e ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ II. Responsibility StatementOW44r;w4c t'r� W 1, the undersigned, assume resftensibility for repair /reconnenction/re' vena on/installation� non - plumb g for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non -pl mbin sanitation system. PI bees Name (p' t) Plum igna mps . -MP /MPRS No. Business Phone Number Plumber Address (Street, City, St te, Zip Code) 2f,2,V oof VIII. County Use Only Disapproved Sanitary Permit Fee Date Issued Issuing Agent Signature (No stamps) Approved Owner Given Initial Adverse I /- Determination l�� • 3 IX. Conditions of Approval /Reasons for Disapproval: `�nti a�{tQ- ,� -�; Q r^�w- a- �:� > 44d • -e-1�5 o-.. i S t h s E _Nt7 4L "� S is 1n0 f e-- Cr x, . a vi 11 cr lk � G r 1 a b ° D y � a #• .03 a ra 1 k i fry , G M A 0 I to h r � a i x- G tia r r i I I , ' I : . I -r I I ' ! I , � I r I I i ' i � I i I i • I-- i . I � i CA ITJ -- • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Gt r�i^ -t k /•r LLB *1 1 Mailing Address fo fI' Y L-- Property Address AN@ � (Verification required from Planning Department for new cons truction) :`iVl /tI,�SZY� City /State Parcel Identification Number &3s • 7 4W LEGAL DESCRIPTION Property Location er,- a, -C- /4, Sec. T3-Z- N R- L?-W, Tawti of 5 !yi ICSZ97 . Subdivision . Lot # - / W. Certified Survey Map # '�— . Volume , Page # ---- -- Warranty Deed # �? d'' ©� , Volume Page # y� Spec house ❑ yes Lot lines identifiable u'yes ❑ no SYSTEM MAINTENANCE r Improper use and maintenance of your septic system could result in its premature failure to handle wastes- Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeymanplumber, restrictedplumber or a heensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. vwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days f the three year exp tion l` GNATURE OF ICANT DATE - OWNER CERTIFICATION I (we) certify that all statem nts on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the perry described above by v' f a warranty de d re r d in Register of Deeds Office. S GNATURE OF AP ANT DATE * * * * ** y p y perm b revoked b he Zoning De artment. * * * * ** An information that is mis -re resented ma result in the sanitary p g Y t _ g p ** Include with this Application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed F-C ° .� s'r/ `y t � 'y °� c7z 00L_UMENT NC: STATE PAR CF WISCONSIN -- FOP4A 1 11 WARRANTY DEFD .L TH,'_ ,-A-.E n� !: v�D , .! R. This Deed, made between Frederick C . Kroc�Ilan and REGISTERS OFFICE _. _ ... Lorraine Kam, his wife _.... ST. CROIX CO., WIS. - Rec'd. - .)r Record this Grantor -- and William C.. Hunt, -.- day of August, A.D. 19 79 at 1:15 P A. _..._...Grantee, • W itnesseth, That the sai. Crantor, for a valuable consideration Of. RWb ads one dollar and other gcx.;d arld valuable considerations. once.. to l'rantce the following described real estate in . St.. Croix - "� � t � . � � 11. am C .i'= t ( 'cuntY, State of Wisconsin: 1P University Ave S.E. The Northeast Quarter of the Southeast Quarter (NEh of t.inr,aapolis, P:n 55414 SE;) of Section 9, T31N, R19W, F,X(= that part Conveyed Tax Key No. to James M. Madison and Carole L. Madison as contained in the Warranty Deed dated January 5, 1973, and recorded October 1, 1973, in Volume 503, page 552, as Document No. 318787; Subject to easements of right- of-way of Town Road as presently laid out and travelled which right- of-way ishereby dedicated by grantors to the Town of Somerset, St. Croix County, Wisconsin; TRANSFER $a d o � This deed is given in satisfaction of Land Contract between parties dated FEH March 1, 1978; I I i I I Tbi is not . homestead property. (in) (is not) T�et ;_er with ali and singular the hereditrments and appurtenances thereunto belonging; A!i,.l Frederick Q, Krogman and. Lorraine ,scxyltzn, his wife, grantor, - ---- ..... ;: r:utta chat the ti *le is good, indefeasible in fee simple and free and clear of encumbrances except easements and restrictions of record , - .� arrant and defend the same. II �� this '3 da of July 19.79... (SEAL) �Zt- ��V��. t 1��. �.�- r1N�'�ti(SEAL) Frederick C. Kroglman _(SEAL) — a1 'cs- s.- .. Krogen i I AUTHENTICATION e ACKNOWLEDGMENT lI Slvr.at , ut'aenticated this - day of STATE OF WISCONSIN tt 19 county. 1 - Personally came before me, this, . _. - -- --- of 0. - Mak, .. the above named TITLE: MESiBER STATE BAR OF WISCONSIN - �� ;U:uitcd r)y § - o)6.06, Wis. Stat, T".'i i1ISTRUMENT WAS DRAFTED ev to me known to be the person who executed the loreroing instrument and acknowledge the same. Maki & Ludvigson, Attorneys at Law Osceola, Wisconsin 54020 ,Sit naG.l -r3 map ba authenticated or a knowledged. Both tart Public County, Wis. ire n ,, nvc, 5:c;Ir }.) My Commission is permanent. IIf not, state exdiration date: ]3 ) •N..1. 4 P —on, signing in Any c* ,tv -. �n id 6 F ;int. -A h,ln their .iBra�urc. WARRANTY DEFD STATr. BAR OP WISCONSIN Wt r. osin 1 IC.nk G,. Ina. FORrd No.I — 1877 M-I.a.ke . Wis. (J.Jh136E3 l c f c c 3 m c o I c o I c ,. � I c .. � �� 3 r► ' .Z� I 'gam`•: I `���'o gc� � • CD vcD �� 1 rr Do c z O 3 x Z N W Z Z Z C — <;> c O N Z vy, ` • o w o o o o ^� G' 0 1 m � � am � N) aac -Z ao m � � -4 3 CL CD va ' m CD y m a y co p� C owl @ fD cn < fD fD y < fD O N < CD fD N O pj 07 d ! N C a a 1 m e CD a CD 3 m or n 3 I CD � .o°. 3 ° D b � 0 O. O N O. O. O N O. ON O SI r 0D r 00 00 cn cn v, v ca D y CL 1 (5 > o. a =r co y N CL s l CD IW o o m IW o (� n co co N 3 OD O) CD fD O fD 0 a N N c Z N c Z cN�o a CD CD 0 CD CD co Co CD r CD CD a � z 000 000 000 r! rn CO) CO) o c8 = CO) CO) to f E � to N D 0 1 CD 3 c ° %* '° 5'i y o a b'i to o m 3 m CD 3 m �• 3 m N OL •• •• K , z ` l \ _. Z Z Z Z Z Z OD Z O D m O D D O D a O ° o l�l T m a• CD C m m ;o v y w cc n n ° n a 3 m 3 3 z m cn m m - cn n n n A 0 Z -1 c0 W W A � m I m co CD M u� I u 3 I o Z � � 0 0 o L7 co 3 9 m H N y z D n CD A W O O W CD 7 1 7 C2 a CC a C m o a 0 a G ^' Q (D D) ; D) ; ? .n. D) m o a o a o a �T 07 y N '00 CD f�D N o n �• (D =r n O 0 3 -» o w Nv 07 0 CD o n cn - o W. y m N I I I °• c 0 c E c y c 0 o o w b O O fD N C, 0 o 0 o 0 O L _ O: O L • - AS BUILT SANITARY SYSTEM REPORT SEC. T . y R _. W . WE r r ,TOWNSHIP - • ' , -L.� -- .O. ADDRES' 7 r , ST. CROIX COUNTY, WISCONSIN. r. BDIVISIOy , LOT LOT SIZE • PLAN VIEW - -Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM FT s `l ( . I 4 I - i I di ale North j Arrow { S CALL : e ' '� ( ! �� TIC TANK(S) MFGR. CONCRETE )( STEEL NO. of rings on cover Depth DRY WELL )INCHES NO. of width length area no. of lines �— width length �" are I It i AGT dept to top of pipe 3'AK RATE AREA REQUIRED [ S'� AREA' AS BUILT �� IiSCiainer: The inspection of this system by St. Croix County does not imply complete ;s'spliance with State Administrative Codes. There are other areas that it is not possible 10 inspect at this point of construction. St. Croix County assumes no liability for otem operation. However, if failure is noted the County will make every effort to itermine cause of failure. "EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. `INSPECTOR DATED - e 1- ^ �� PLU 1BER ON JOB LICENSE NUMBER Z ` 4 REPORT OF INSPECTION_INDIVIDUAL SEWAGE SYSTEM 7i State Septi NAME i- ! c L( 2 4� c c (own.a � } i�,_r � � S$. Cxo.ix County Locat.iort Section SEPTIC TANK 37A-c�� Size ga.Z.Zon4. Number o6 Compa4tment4 D�4tance Fxom: We.Z.Z 12% on gxeatex 4.Zope At Building 6t. w ettand4 6t. H.ighwazex _ At. DISPOSAL SYSTEM D.i.4tance Fxom: We.Z.Z At. .12% o g 4Z ope _ 6t. Ba i.Zd.ing 6z. Wettand.d F t. • H.ighwatex 6t. FIELD DIMENSIONS: _- Width o6 zx ench 6z. Dept o6 x ock below t.ite .in. Length o6 each tine 6t. D o6 xock ove t.i.Ze .i n. Numbe)L. o6 .Z.ine4 Depth o6 t.i.Ze be-Zow grade .in. Totat .length o .Z.ine4 6z. S.Zope o xxench in pen 100 At. Di.6 ta.nce between Z.ine4 6 t. Depth to b edxo ck 6 . Totat ab.b oxbtion axea 6A_ De to gxoundwaten 6t. _. Requ.ixed axea it Type o6 Cove Pa.pen ox S PIT DIMENSIONS: Numbers o A p.it4 Gnave.Z around p.it4 ye no Outside d.iametex 6t. Depth be.Zow .in.Zet 6t. 2 Totat ab4o4bt.ion area At �z Area xeq u.;xed Ate INSPECTED BY TITLE APPROVED - ,DATE 197. REJECTED ,DATE 197 EH 115 Rev. 9/78 i REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION: r � ' /a, 'S ' /a, Section I ,T N,R.�E (or) 1�1 Township or Municipality Sc�c"✓ s r clexg Lot No. , Block No. County S ubd ivlsion - Name Owner's/Buyers Name: r I On, v Mailing Address: -s • TYPE OF OCCUPANCY: Residence Ni. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW )(— REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS J � a ' ?7 PERCOLATION TESTS S 1 0 . - 9 � SOIL MAP SHEET NAME OF SOIL MAP UNIT ,24, 010 ,41ej 46e M+3 s'amyn _ F � 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 AFTEP INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN /IN P— I C J P— Z I ; , P- 3 I , r P— P— P— SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- 'S B— A Ze6 a — T s' ; Z — z 7, c. s 9 16 s B— 0 — S - S B- 75 2 - S PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the pl t the l oc lion and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy f .Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. m F. � F ; L) t o E s e E E a ` e f a � t }} , , . ...?.� m., j .......... Y y t —ax L_ 1, the undersigend, 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) Cffi= i.,� i in ( G Certification No. 63 Address Name of installer if known Copy A — Local Authority CST Signature PLB •� State and County State Permit # 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: a1 . a ss� B. LOCA ON: tl L 1 / 4 5; Section If , T N, R E or) W Lot# Ci y Subdivision Name, nearest road, lak or landmark Blk# Village Township C. TYPE OF OCCPNCY: Commercial *Industrial *Other (specify) Variance Single family Duplex No. of Bedrooms No. of Person D. SEPTIC TANK CAPACITY f 0 Q Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concret Poured -in -Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New >C --- Replacement Alternate (Specify) Seepage Trench: No. of Lineal �Ft. Width Depth Tile depth (top No. of Trenches Seepage Bed: ,�_ Length S Z Width Depth Tile depth (top Z Y No. of Line 2- Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope Z ' WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than p re s e nt owner: 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 Certified Soil _ter, NAME _ h S C.S.T. # and other information obtained from 42 (owner wilder). Plumber's Signature Mp PRS 3 Phone # - T/3 S _ Plumber's Address c�-w PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. h - � F f^ N t 1 x � 1 E � e f i s �l, aka r �1 t m � _ E .e i a a e .. ry E i 3 t 3 [ I . E V 1 t Do Not Write in Space Below - OR COUNTY AND STATE DEPARTMENT USE ONLY Fk Date of Application /D , Fees Paid: State , 0 County 4 P, Date • E Permit. Issuedt$octed (ate) /U — .5� l� Issuing Agent Name 7 Inspection Yes4No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF SOMERSET COMPUTER NUMBER 032 - 1024 -60 -000 Parcel Number 9.31.19.124C OWNER NAME: First WILLIAM C Last HUNT PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment SECTION 9 TOWN 31N RANGE 19W '/4160 '/440 Line Description Line Description TOTAL ACREAGE 6.000 PLAT LOT BLK 01 SEC 9 T31 N R1 9W 6.A IN NE 15 02 SE LOT 1 CSM VOL 3/619 16 03 1 04 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 LEGAL (MAGI REM, :STAT ##���S pp ((y pp ,qq qq aa((��ypp�g �' ✓i9 /, BR .x §.ti7 032 - 1024 — '40 - 000 /2 Fig zF 1 ,i. 21-920 02 ll"%'C 1 EXC GSH VOL 3/6, 10 PIS 19 t16 Ig1 09 2 i 10 2 Al t 1. 1 gE 12 13 2V F''I- Gr-neval, F4-- Pi Pat -cel, FS- -Next Parcel, F? - Uall tat:iorr;. FS lli,A,ovv,