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HomeMy WebLinkAbout040-1049-80-000 . isconsin Department of Commerce County PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479343 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: Wahl, Susan I Troy, Town of 040- 1049 -80 -000 CST BM Elev Insp. BM Elev: BM Description: Section/Town /Range /Map No: _• 3& ea 12.28.19.182A TANK INFORMATION ELEVAT ON DATA 1. 3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 13 M Z /.0 Septic C� Bench . ! ! - 1 Z 3 / 3& Dosing � Alt. BM Aeration ` Bldg. Sewer ` e 7 0 I S .-. Holding St/Ht Inlet . d b 1. �---- TANK SETBACK INFORMATION S t/Ht Outlet TANK TO P/L WELL BLDG. Vent r Intak D Dt Inlet p (L Septic 12.0 Dos' N !Z�/ 1 Header /Man. ' _20 �� rJ 95 Aeration n � •` � Dist. Pipe mac, Holding Bot q`f'szt Z. Final Grade PUMP /SIPHON INFORMATION PS� Manufacturer Demand S over Ot .s 93 GPM UU 410 1 131 Model Number N f fD TDH Lift Friction L ss� 1 8ystem Head TDH Ft Forcemain Le gth Dia. If Dist. t Well /u 07— 3 Cr Z_l%f SOIL ABSORPTION SYSTEM BED/TRENCH Width f Length No. Of Trenches PIT SIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS // Z SETBACK SYSTEM TO P/ BLDG WELT LAKE /STREAM LEACHIN Manufacturer: INFORMATION CHAPRER OR Type System: ` R � / \ f UNIT Model Number: DISTRPUTION SYSTEM X11, / 0 Header/ anifol Dia a Distribution / I x Hole Size �/ (/ x Hole Spacing ent o Air Intake l K Pipe(s) A f � Z / '/b l / I 'tai Z' fi 7i Length °' Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over 1 [Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center ! Bed/Trench Edges Topsoil c� Yes No ]Yes J] No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / °2 7 /0 Inspection #2: /25/jis_ Location: 457 County Road U Hudson, WI 54016 (SW 1/4 NW 1/4 12 T28N R19W) NA Lot ork Parcel No: 12.28.19.182APQ 1.) Alt BM Description = 2.) Bldg sewer length = 1 A 1 S 7 d - amount of cover = g ot 6 �4. , epr Plan revision Required Yes . i No Use other side for additional Information. - Date e Cert. No . '� SBD -6710 (R.3/97) — County Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 St Croix fseonsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled M by Co.) Department of Commerce (608) 266-3151 Sanitary Permit Application —�-- State Plan I.D. Numbe In accord with Comm 83.21, Wis. Adm. Code, personal Information you provide 7 &211 � _ 1 Cx may be used for secondary purposes Privacy Law, sl5.04(1)(m) Project Address (if different than tailing address) 1. Appiicition Inform Lion - Please Print All Info -- -" 457 Cty. . HWY. U P ` Hudson WI Property Owner's No m Parcel N Lot N Block a Fred & Sue ahl a () — NA Property Owner's M ailing Address rt 457 Cty Hwy U Q STCP01XC0UNPi ,/f2A• 1 , /,,rF City, Sate zip C e SW 4i. NW If,Section 12 (circle one) L D �hu 11. Type or Building (check all that apply) 14 a V1 T 28 N, R 1 9 E or w s Z I or 2 Family Dwelling - Number of rooms 3 Kra / / Subdivision Name CSM Number ❑ Public /Commercial - Describe Uae r ❑ Sate Owned - Describe Use A Ae, D1 _W 6 [")City I.1Viltage [ bwnahip of Tr oy be Zap.¢ 111. Type of P heck on y d6e boa on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Trestment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 2 6 / IV. T ype of POWTS System: Check all that "ply) ❑ Non - Pressurized In- Ground 11 Mound > 24 In. of sultab dpund < 24 in. of suitable soil Ll At -Grade U Single Pass Sand Filter ❑ Constructed Wedoind ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter 1 Aerobic Treatment Unit U Recirculating Sand Filter ❑ Recircala Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ravel -1 s Pi U Other ("plain) V. reatmett Area Information: 4 Design i Flom (80) Design Soq Applicar te(gpdsf) . Dispersal Arca Vur2 (sf) Dispersal At nosed (a0 System Blevation" v is o �j '� - 71 � a3 qY. -�Y ✓ VI. Tank Info Capacity in tal Number Manufacturer Prefab Site Steel Fiber Plastic (Wiota ns of Units Concrete Constructed Glass New Existing ranks Tanks Septic or holding Tar* 1 1000 1 Weeks x x Aerobic Treatmeta UMt Dosing Chamber 1 800 1 Weeks xx Vii. Res ponsmPtY Statement- I the undersigned, assume rlapontibWty for Installation of the POWTS shown on the attached plea. Plumber's Na me (Prim) Plumber's St ature MPIMPRS Number Business Phone Number meester 222904 715 - 386 -9020 Plumber's Addre as (Street, City, State, Zip e) 1070 Hwy 35N Hudson WI 54016 ViI1. cunt /De Partment Use onl Appros,� ❑ Disapproved Sanitary Permit Fee (includes Groundwater D e Issued Is ing Agent S (N ) Q Owner Given Reason for Denial Surcharge Fee) �' [ /� S L, 7 6 s IX. k�o ppr for Disapproval G, / 1 Septic effluent tank, euent filter and � dispersal cell must all be servic d / maintain as as per management plan provided by plumber. Q 2. All setback requirements must be maintained • as per applicable code /ordinances. �I z�� m e" soa to t only) for the systenron paper not less than Sin x 14 Inches M size SBD -6398 (R. 01/03) , JUN -13 -2005 09:34'AM A.C.E._ " Soil & Site Eva[. 715 248 7764 P.02 �a %er6fas�'�np� • Sa��la,'� R�w.d Ern it • �x >b lnali ds.� Aw'�i'A/�' 2 T . C V • PropxeAt �,Ia��.�R s.r, , '1`f Du�li$ aA�ed wet. i con" &ao'.Apkn�p uc..»ia; } M 4� 3rd. ✓. C. cat l(� E li (mak,W44H4 Prc.Aro•� .Pk�4►, ap x ��.uda►oa++al a�?.t. ,cuss' ,`� ` fi oF� TAcre t oe.( -� t r r. . COU 7� t 9 OD I rn x 10 OD s 1 x •A I w ;5k *, o0 N F �x. Ma 61 �c 1319.34 — — m` i � zs, y n Safety and Buildings 4003 N KINNEY COULEE RD commerce .Wl.gov LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commer goWsb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary June 17, 2005 CUST ID No.222904 ATTN: POWTS Inspector I JAMES W BOUMEESTER ZONING OFFICE BOUMEESTER & SONS EXCAVATING INC ST CROIX COUNTY SPIA 1070 HWY 35 N 1 101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/17/2007 Identification Numbers Transaction ID No. 1143925 SITE: Site ID No. 627393 Fred Wahl Please refer to both identification numbers, 457 CTH U above, in all correspondence with the agency. Town of Troy St Croix County SWI /4, NW1 /4, 512, T28N, R19W FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1022480 Maintenance required; 450 GPD Flow rate; 17 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD- 10691- P(N.01 /01). • The pressure network is to be constructed in accordance with publications SBD- 10706- P(NO1 /01) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and /or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81)". • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. r � yr.Z� A Y,' JAMES W BOUMEESTER Page 2 6/17/2005 • Comm 83.22(7) - A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633 jswim@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 I I I MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Fred S Sue Wahl 3 bedroom residential mound Owner's Name: Fred S Sue Wahl Owner's Address: 457 Co. Hwy U Hudson, WI. 54016 Parcel Address: 457 Co. Hwy, U Legal Description: SW1 /4 NW1 /4, Sec. 12, T.28N., R. 19 W. Township: Troy County: St.Croix Subdivision Name: Na Lot Number Na Block Number. Parcel I.D. Number. 040- 1049 - 80-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry RECEIVED Page 3 Mound drawings Page 4 Lateral and dose tank JUN 6 2005 Page 5 System maintenance specifications Page 6 Management and contingency plan SAFETY & 13UIUD Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report Designer Jim Boumeester License Number 222904 Date: / 31/05 Phone Number (715) 386 -9020 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) iPARI,I �4 _...__ P 1 of 9 Version 4.01 (R. 09104) biyl4)l)ri U a ETY AND BUILDINGS 9 t lli E CORRESP DENCE Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fib (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 8344 -3 in situ sob treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150%) coliform of - 36 kwhes. 450.00 Design Flow (gpd) 6.00 Site Slope ( %) 93.1 Contour Line Elevation (ft) 17.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd/ft Distribution Cell Information 112.501 Dispersal Cell Length Along Contour (ft) = 4.00 Cell Width (ft) 1.001 Dispersal Cell Design Loading Rate (gpd/ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) c Center or End Manifold 2.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 2.00 Estimated Orifice Spacing (ft) = 4.02 ft /orifice 2.00 Forcemain Diameter (in) 120.00 Forcemain Length (ft) Does the forcemain drain back? Y 62.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 19.57 Forcemain Drainback (gal) 12.24 Vertical Lift (ft) 70.79 5x Void Volume (gal) 5.16 Friction Loss (ft) 90.36 Minimum Dose Volume (gal) 23.90 Total Dynamic Head (ft) 46.14 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 1.50 x 1.25 x x 2.00 x 1.50 x 3.00 2.00 x 3.00 x Gallons/inch Calculator (optional) Treatment Tank Information 805.12 Total Tank Capacity (gal) 1000.001 Septic Tank Capacity (gal) 37.00 Total Working Liquid Depth (in) Weeks Concrete Manufacturer 21.76 gaUn (enter result in cell B49) Dose Tank Information Efflu Filte Information 805.121 Dose Tank Capacity (gal) JZabel Fitter Manufacturer 21.761 Dose Tank Volume (gal/in) JA100 Filter Model Number Weeks Concrete Manufacturer Project: Fred & Sue Wahl 3 bedroom residential mound Page 2 of 9 i Mound Plan View 1/10 B . observation Pipe a . J K . W E:. . B I L '♦ Mound Component Dimensions A 4.00 ft E 21.88 in H 1.00 ft K 10.42 ft B 112.50 ft F 9.25 in 1 11.32 ft L 133.35 ft D 19.00 in ✓ G 0.50 ft J 7.26 ft W 22.58 ft 450.00 (ft Dispersal Cell Area 1723.51 (f Basal Area Available 4.00 (gpd/ft) Linear Loading Rate 11.25 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 96.51 (ft) -► rrrr .... H 2 rriri�i G F Dispersal cep 95.24 (ft) Lateral Invert Dispersal Cell a Elevation E D ����-�' 4 �'.,�• _ � � V '� '`any 3 `� - •� . - 93.16 (ft) Contour Elevation 6.0 % Site Slope Geotextile Fabric Cover Shading Key Dispersal Cell See lateral details on 1Q _ Topsoil Cap c ° 1.5 ft .•. • •.••.••.••.••.•ti;. Page 4 for number, size, 'rrrr Subsoil Cap o o and spacing of laterals. ASTM C33 Sand • ; •`. � � • ,.ti.� ;. F Laterals are equally Tilled Layer 0.5 ft Typical Lateral _ .• spaced from the •;: ". distribution cell's Aggregate c • 5 t. *'' • "* centerline in the A distribution cell (AxB). Project: Fred & Sue Wahl 3 bedroom residential mound Page 3 of 9 Center Connection Lateral Layout Daigram Farce main connection via tee or cross to manifold at any point. Laterals are idendoal P S Ak •= Turn- upudbalivalve or X- -4Ka12r+J Lateais & Force main OF PVC Sch40 cleanautplug per COMM Table 84.30 -5 Holes &Hed on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.02 ft Lateral Length (P) 55.55 ft Orifices per Lateral 28 Lateral Spacing (S) 2.00 ft Orifice Density 4.02 If/orifice Lateral Flow Rate 11.53 gpm Manifold Length 2.0 System Flow Rate 46.14 gpm Manifold Diameter in Total Dynamic Head 23.E ft Forcemain Velocity 4.71 ft/sec Dose Tank Information LodwV cover with Wei and wwv device and styled watertight Electrical as per NEC 300 and - 0 Comm 16.28 WAC Disconnect 4 in. min. Tank cornponent is properly vented Alternate outlet location Forcernain diameter Weeks Concrete Manufacturer _ 2 in. Capacityl 805.12 Gallons Volume 1 21.76 gaUnch A Weep hole or anti - Dimension Inches Gallons B siphon device A 18.85 410.12 B 2.00 43.52 C Pump ump off e levation (ft) C 4.15 90.36 -- 83.00 D 12.00 261.12 D Total 1 37.001 805.12 1 Oose tar* elevation (ft) 3" Bedding under tank. 82.00 Alarm Manuafacturer I LevelArm Alarm Model Number I DLV Pump Manufacturer JZoeller Pump Model Number I N 140 —� Pump Must Deliver 46.14 gpm at 23.90 ft TDH Project: Fred & Sue Wahl 3 bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Jim Boumeester Phone (715) 386-9020 POWTS Regulator's Name St. Croix County Zoni Phone 715- 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 fl? Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 du/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspe and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pre ssure tested every 1.5 ears Mound In for pondin and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)01 , Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished .��••,........ ............... Grade ` 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long P Swee 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Fred & Sue Wahl 3 bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01 /01) and SSWMP Publication 9.6 (01/81)] and kcal or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids In the tank that may slough off the fiker when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the rwad service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, If such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg/L BOD 30 mg/L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this Installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed ft should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. ContiNsM Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Fred & Sue Wahl 3 bedroom residential mound Page 6 of 9 TOTAL DYNAMIC HEADIFLOW PUMP PERFORMANCE CURVE PER MINUTE MODEL 14014140 EFFLUENT AND DEWATERING 31M e5me ss 4 5M 1e MODEL 140/4140 50 Feet Meters Gal uters 329/12 H 5 1.5 86 326 L 10 3.0 80 303 + —L 15 4.6 73 276 12 40 20 6.1 66 250 25 7.6 59 223 1112- WNP7 35 1 , 4140 30 9.1 49 185 10 35 10.7 38 144 30 40 12.2 28 106 45 13.7 17 n 8 � Ot0910 Shu4008Head: 50 ft. 15.2m Ta.. 6- 2D 1213132 15 1 10 SK1524A 4502 2 5 0 10 20 30 40 50 80 70 80 90 Y , ��� Double ,® J • LnER6 0 so 180 240 320 FLOWPERI.BWM 37/5 5 &M CONSULT FACTORY FOR SPECIAL APPLICATIONS 45% 329m2 • Electrical alternators, for duplex systems, are available and supplied with an + --� alarm. • Mechanical alternators, for duplex systems, are available with or without t 1 R 1112 WT alarms. • Control alarm systems are available for 1 phase pumps used in simplex: system. See FM0732. JLI • Variable level control switches are available for controlling single phase sys- tems. • Double piggyback variable level float switches are available for variable level long cycle controls. ,e j 4 — • Sealed Qwik-Box available for outdoor installations. See FM1420. • Refer to FM0806 for applications above 130 °F (54 °C). —� 4 5 1 9KIW40 SELECTION GUIDE 140/4140 MODELS Control Selection 1. For automatic use single piggyback variable level float switch or Model Model Volts -Ph Mode Du Amps Simplex le double piggyback variable level float switch. Refer to FM0477. p p p 2. See FM1228 for correct model of simplex control panel. N140 N4140 115 1 Non 12.0 1 or 3 3. See FM0712 for correct model of duplex control panel. E140 E4140 230 1 Non 6.0 1 or 2 3 BN140 BN4140 115 1 Auto 12.0 _ o caunoN All installation of controls, protection devices and wiring should be done by a qualified BE140 BE4140 1 230 11 Auto 1 6.0 _ licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). 'Single piggyback switch included. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 Manulacturevs of. Louisville, KY 40256-0347 0 SHIP T0: 3649 gene Run Road 6 kL' L, KY 40211 -1961 (502) 777 2731.1 74,3 1928 PUMP www- roeflercom FAX f501) 7 74.3G4 ® Copyright 2005 Zoeller Co. All rights reserved. P� • 7# JUN -13 -2005 09:34 A.C.E.- Soil & Site Eval. 715 248 7764 P.02 S� /trl�/aa�intOb! Rs,�.r.� ♦ ewk� ndi tide 2 N M nA�N�sa7lyr� see, /,r, �°��Ity .P t9w TN. OFYsJ, s Ov /sf /.:•r of 37 e� Pro,pe7eAr ��� ss; kY�l ,1tone�'�a+E (ir'f�sr' d� ou{lt� _� epostot wetll�s Ca►��s�i► -AY Ru�cta�as �E.. : raw >t . ice. wctf� , tom &vie, Ise 19 av i I /�t�c•�.b� o d /s�><sxs� w� �7 #air - _. i 1918 1 of 3 SOIL EVALUATION REPORT A C E sod &sire Evaluations D d Safely and &"W in accordance with p04, W Adm. Code CourtY St. Croix q, Attach can** * on Pam not less than ,,A x 11 inches in s' parcel I.D. 04x1049$0 -000 n jude, but not landed to: vertical and honzantal reference pant (1, � percent slope, scale or 6memsiom, north arrow, and location and des Ri d BY Date please P !nt a 5 D s. 15. Pers� ifiomrefiton ya► P Property location SW 114 fV11111 14 12 T 28 N R 19 W Property owner JUN Q 2 2005 Govt. Lot lime or csrr Zca - Fred & Sue Wahl L t# Block# Subd.tN � -, a q' Address ST.CROIX000NTY i property Owr�'s R ` 457 Co. Hwy- Um S "° City I v _ly Town Nearest city � WI 54016 (715) 386 -6564 Troy Co. H". U Hudson Code derived design flow rate 450 GPD Use: yJ R /Number of bedrooms _ 3 New Public or commercial - Describe: Parent t Glacial drift over weathered limestone bedrock Food plain elevation, it applicable na General : site suitable for moun with 4' x 112.5' dispersal cdL Minimum system elevation 7 above and 93.16' contour. in. � Application Rate p ❑ # Boring 92.86 ft• Depth to limiting factor ---- — -- � Boring h Ground Surface elev. ___��- Texture Structure Ca>sisience Bout Roots .Epf#I�'Eft#2 Horizon► D� pornirrarbt Color Red= Dr`s Gr. Sz. Sh. Mur>se5 Qw Sz. Cad. Color mvfr aw 2f,1 m 0.6 0.8 in, Dom' sil 2fsbk 1 0-9 10yr4/3 , 2f,1m 0.6 0.8 �4- none sit 1 msbk mfr 2 9-19 7.5yr4/6 mfr aw 1vf,f 0.4 0.7 ' f2f 7.5yr 3 7.5yr4l4 5/8 sl 1 msbk _ 11ff 0.2 0.3 4 48-56 10yr514 ml p 7.50/8 std 1csbk mfi Heavy 10yr712 siN coats observed on faces in horizon #4. # - eonn9 93.11 ft. Depth to limiting facto' 17 ? - ----n. � Application Rate o Texture Ground Surwe� l Pit Consista� *Eff#i Serum Holtm Depth Dan�t Color Redox DesaiPtiab a, Sz. SK 0.8 in. Munsd Qu, Sz. Cont, Color mvfr aw 2vf,f 0.6 none Zfsbk 1 0-10 1 �2 sit 2fsbk mvfr cw 2vf,f 0.6 0.8 / 2 10-17 10yr4/6 none sil 0,6 0.8 2tsbk mvfr Cv 2vf 3 17-22 10yr4l6 f2f 7.5 stl sid mvfr 9w 2vf 0.4 0.6 m 2d 7.5 / 4 22 -32 10yr413 5 mfi _ _ 0 0 0.0 m2p �5yr5 /8 & sic 11sbk 5 32-41 7.5yr4/6 mlpManSa 10yr712 - coats on fades in horizons #4&5. Ef kw t #2 = BOD < 30 mg/L and TSS 4J0 MOIL TSS >30 < 150 CST Number * Effl S1 = BOD 30 < 220 mgil sig 3602 CST Name (Please Print) - Number James K Thompson Date Evaluation Conducted 715 248 - 7767 Address A.C.E. Sol & Site Ewakmfions 526/2005 340 Paulson Lake Lane. , Wl 54020 • Sod ¢ ✓kl,0; t Aa,*d • P eunsui& /e Fu,— ♦ Ewa 8rade ef eO ee - -�- EXisbr� Fence %%s c nt,1Yq Sac. �,�, T, ,ZBA� • A 14. do °r/z `p.V.c. eonelvll� rod at 6krYd;l� s,fc /off 1i�e COr�Du•- N ai ■ �< \ oaf' ako�w� .r \ d \ Q2 1918 Wisconsin Department of commerce SOIL EVALUATION REPORT page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than W1 x 11 inches in size. Plan must County St Crobc include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dxnemslons, north arrow, and location and distance to nearest road. Parcel L D. 040-1 049-80-000 Please print all infonnadon. Reviewed By Date %sonai Wormabon You prwids may be used for secandary WM- (R--y Law, s. 15.04 (1) (m)). Property Owner Property Location Fred & Sue Wahl Govt. Lot SW 19 NW 1/4 S 12 T 28 N R 19 W Property Owners Mailing Address Lot # Block # I Subd. Name or CSM# 457 Co. Hwy. U Coy State Zip Code Phone Number 2j City 2j Village 1/ Town Newest Road Hudson WI 1 54016 1 (715) 386 -6564 Troy I Co. Hwy. U N New Co utruction Use: f/ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement 3j Public or commercial - Describe: Parent material Glacial drift over weathered limestone bedrock Flood plain elevation, if applicable na General comments and recommendations: Site suitable for mound with 4'x 112.5' dispersal cell. Minimum system elevation= '94.75 at 19" above 93.16' contour. aBoring# �j Boring im Pit Ground Surface elev. 92.86 ft. Depth to limiting factor 19" lo• Soil Application Rate Hmm Depth Dominant Color Redox Desaiption Texture Stricture Consistence Boundary Roots GPD/fF in. MurseA Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 10yr4/3 none sil 2fsbk mvfr aw 2f,1m 0.6 0.8 2 9-19 7.5yr4/6 none sil 1 msbk mfr cW 2f,1 m 0.6 0.8 3 19-48 7.5yr4/4 f2f 7.5yr5/8 sl 1 msbk mfr aw 1 vf,f 0.4 0.7 4 48-56 10yr5/4 m 1 p 7.5yr5/8 sic 1 csbk mfi - 1 vf,f 0.2 0.3 Heavy 10yr7/2 sift coats observed on pod faces in horizon #4. Boring # J Boring 0 Pd Ground Surface elev. 93.11 ft. Depth to limiting factor 17 " in. Sol Application Rate Horum Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-10 10yr313 none sil 2fsbk mvfr aw 2vf,f 0.6 0.8 2 10-17 10yr4/6 none sil 2fsbk mvfr cW 2vf,f 0.6 0.8 3 17 -22 10yr4/6 f2f 7.5yr5/8 sil 2fsbk mvfr cW 2vf 0.6 0.8 4 22 -32 10yr4/3 m2d 7.5yr5/8 sic 2fsbk mvfr 9w 2vf 0.4 0.6 5 32-41 7.5yr4/6 ii / & sic lfsbk mfi - - 0.0 0.0 m 1 P Manganese 10yr7/2 si coats observed on pod faces in horizons #4 8 5. Effluent 01 = BOD 30 < 220 mg/L TSS >30 < 150 Effluent #2 = BOD 5 -5 . 30 mg/L and TSS <-0 mg/L CST Name (Please Prbt) Signature CST Number James K Thompson 3602 Address A.C.E. Sod & Site Evaluations Date Evaluation Conducted Tek ptxm Number 340 Paulson Lake Lane, , WI 54020 5!26/2005 715 - 248 -7767 property owner Fred & Sue Wahl Parcel ID # 040 - 1049 -80-000 Page 2 of 3 • F Boring 16 PA Ground Surface elev. 91.75 ft. Depth to limiting factor 17" in. S61 Application Rate Hortm Depth Dominant Color Redox DesaQtion Texture Structure Consistence Boundary Roots QPDtfF lo. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 1 0-10 10yr4/3 none sil 2fsbk mvfr aw 2f,1 m 0.6 0.8 2 10-17 10yr4/6 none sil 2fsbk mvfr cw Alm 0.6 0.8 3 17 -20 10yr4/6 f2f 7.5yr5/8 sil 2fsbk mvfr cw 2vf,f 0.6 0.8 4 20-33 7.5yr4/6 m2d 7.5yr5/8 sl 1 msbk mfr gw 1 vf,f 0.4 0.7 5 33-46 5 4/6 m2p 5yr5/8 & sl 1 csbk mfr - 1vf 0.0 0.0 Yr m i p Manganese Many 10yr 6/2 sand grains observed on ped faces in hor¢ons #4 & 5. Boring #ng Pd Ground Surface elev. ft. Depth to limiting factor in. S61 Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots QPQM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I F Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Applicator Rate Honzon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 ' Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD i_30 mg/L and TSS <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 -264 -8777. r— - s • � So. %Q via /ua.�i'e� p, f Ea !u u i5ai ,4 /e 4,,— • E,ri3 8. ao(e elcr� .., ncJYV-fOYY, See, 1.2, T, AfA., • Al 6. Tp CFA `P. ✓ c. Ccritroll radde ¢f 6cc.Ydii�q S�£e � -' s ~ �`o --fir► = 9 /S/ � V 9��0 «.- k.aese lee /,tee 63 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND :.� •:� O ERSHIP CERTIFICATION FORM Owner/Buyer d Mailing Address - 1 V1 CJ c S 0) W (, sgvto Property Address (Verification required from Planning Departntit for new construction) Nbl A -2r-, LA City/State tS'y L\J Parcel Identification Num er -000 046 - le)6 -ea -0co LEGAL DESCRIPTION Property Location SVJ 't.,' /., Sec., T $ N -R W, Town of ui ') rbdivision , Lot # 3 q CertiQed Survey Map # : Volume . Page # Warranty peed # ?T Volume IS Page # Spec house ❑ yes no Lot lines identifiable % yes ❑ no SYSTEM MAINTENANCE Imprapa 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 masterplumber. Journeyman plumber, restrictedplumber or .& licensed pumper verifying that (1) the on -site wastewaterdi:posal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 NU of sludge. Uwe, the undersigned have read the above requiremnts and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning office within 30 days of to three year 7ira tion O APPLICANT DATE •(' rQWNER CERTIFICATION i ' 4► - i' {we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owne(s) of the propt:kty.�de: above, virtue of a warranty deed recorded in Register of Deeds Office. - NATURB ON APPLICANT DATE •••••• Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.'••' •• Include with this application: a stamped warranty deed from the Register of Deeds office -a copy of the certified survey map if reference is made in the warranty deed VGl 1575 PAGE 201 • 636754 STATE BAR OV WISC'ONSIN FORM 2 - 1994 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Rolf H. Tiedema and Ilene A. RECEIVED FOR REC Tiedem husband and wife, Tracy D. Peskar, !C athryn A. — _ 01 -12 -2001 4:00 PH eskar husband and wife, — - — -- -- - --- --- YARRANTY DEER EXEMPT 1 Grantor, and Susan M. Sao — — _ — — — — —_..— CERT COPY FEEL — —* — COPY FEE: -- -- TRANSFER FEE: 555.00 _^ - -- - -.— - -- - - P FEE: 22.00 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Cr _ _ County, State of Wisconsin (if more space is needed• please attach addendum): Recording Area (See Attached Exhibit "A ") Name and Return Ad4ftiturn to: Edina Realty Title 400 South 2nd Street Suite #115 oao-t a9 go - 000 & oao loso- go -000 Parcel 1 dent i ftc at ion This is not homestead property. OE) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this _ day of January 2001 l H. erosion _ e_ _ P'es7 • Ro tar _ • + Kath n A kar +Ilene A. Tiedemann AUTHENTICATION ACKNOWLEDGMENT Signature(s) Rol H. Tiedemann and Ilene A. Tiedem - STATE OF WISCONSIN ) husband and wife, and Tracy D. Pe skar and Kathryn A. Peska ) ss' County ) authenticate thi f�day of Januar —_ 2001 personally came before me this —^ day of the above named e Kristi O lag nd TITLE: MEMBER MEMBER STATE BAR OF WISCONSIN to me known to he the persons) who executed the foregoing (If not, —� instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY • _ —_ —. Attorney Kristina 2gland _ --- , - - -_,. Notary Public, State of Wisconsin Hutison,V1'1 540 6 _ My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) .. -- ___.._..— ... - -_ - -- ') • Names of persons signing in any capacity must be typed or printed below their signature. wwmnroo Proie"ons4 Company. Fond du Loc. WI 600- e65-2021 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1999 ' + EXHIBIT "A" yet 1575 PA 202 Pan of SW % of NW % and part of NW 3t of SW Si of Section 12 -28-19 described as follows: Coassnerrciag at the w S4 corner of said Section 12. theme South 88 degrees 46 minutes 29 seconds East (assumed bearing along the FJW S6 line of said Section 12) a distance of 400.92 feat: theme North 1 degree 09 mia3,es 46 seconds Fast ( recorded as North 1 degree 15 miasnos 00 seconds wart) a distance of 139 -64 ENO to the point of beginums of the parcel to be here= de•eribed: theme contimm on said line North i degree 09 mimam 46 seconds Bart 55.74 feet; theme South 69 degrees 38 mix+rtas 04 seconds Eaat 116.28 feet; thence South 47 degrees 28 minutes 09 seconds Bast 212.46 feet; thence South 62 degrees 47 minutes 09 seconds Feast 265.36 Beet; Chance South 84 degrees 21 minutes 39 seconds Fast 407.70 feet; thence North 1 deltea 57 minutes 10 second Bast (on the E line of the NW it of the 8W 5t of said Section 12) a distance of 130.61 feet; thence North 1 degree 39 minutes 44 second- Fast (on the E line of SW 54 of the NW 54 of said Section 12) a distance of 1319.34 feet; thence North 88 degrees 38 minutes 32 seconds West (on the N.line of the SW % Of the NW W of said Section 12) a distance of 1309.96 feet; (hence South 2 degrees 16 minutes 14 seconds West (on the W line of the SW 'A of the NW 3i of said Section 12) a distance of 1158.68 feet; thence South 82 degrees 08 minutes 24 seconds East ; 235.55 Smea (r000aded as South 84 dgpwm 16 minions 00 seconds East 221.10 fact); tbenee North 90 degrees 00 minutes 00 seconds Fast 160.86 feat to the POINT OF HEGU NWG- EXCEF"D o gBg� leads described in Conveyance of Lands for Highway purposes in Yfavor of St. Croix Cotraty as shown in Vol. 321, Page 26, and in Vol. 345, Pale 538, as Document No. 253263. St. C4mint County. WUMUMin. i Parcel t 040 - 1050 -80 -000 07/08/2005 12:55 PM PAGE 1 OF 1 Alt. Parcel M 12.28. 9.185E 040 - TOWN OF TROY Current X', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner SUSAN M SYFKO SYFKO, SUSAN M 312 W GROVE RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.880 Plat: N/A -NOT AVAILABLE SEC 12 T28N R19W PART OF SW NW AS Block/Condo Bldg: DESCRIBED IN 644/240 ASSESS WITH P182A Tract(s): (Sec- Twn -Rng 401/4 1601/4) 12- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 01/12/2001 636754 1575/201 WD 07/23/1997 904/293 07/23/1997 862/382 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 a LEGAL ST. CROIX COUNTY WISCONSIN OLD CAppament 2 REAL ESTATE TOWN OF TROY COMPUTER NUMBER 040 - 1049 -80 -000 Parcel Number 12.28.1 OWNER NAME: First SUSAN M Last SYFKO PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD SECTION 12 TOWN 28N RANGE 19W 1 /4160 1 /440 Line D ri Line Description TOTAL ACREAGE 320 P T LOT BLK 01 SEC 12 T28N R 15 02 PT OF SW NW & PART OF NW SW 16 03 EXC COM S 114 COR, N 163.8' 17 04 S84 DEG E221.1 FTS2DEG 18 05 E TO S LN NW 1/4 TH W TO 19 06 POB & EX C SM 4/1126 20 07 INCLUDE P185 21 0cf0- 10; gO 08 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 r y VALUATIONS ST. CROIX COUNTY, WISCONSIN OLD TXSCR03 REAL ESTATE TOWN OF TROY COMPUTER NUMBER 040 - 1049 -80 -000 Parcel Number 12.28.19.182A OWNER NAME: First SUSAN M Last SYFKO PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment Lottery Card Printed? Y Claimed: Batch: Pass /Fail: TOTAL ACREAGE 37.320 Values Last Changed on 07/19/2004 Reason Codes: Classification Code _Acreage Land Improve TOTAL Residential G1 3.320 63000 401400-=464400 Agricultural G4 33.000 5500 5506 Undeveloped Land G5 1.000 100 100 TOTALS: 37.320 68600 401400 470000 PRIOR YEAR TOTAL: GENERAL PROPERTY: 37.320 56500 380600 437100 PRIVATE FOREST CROP: 0.000 0 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F6 -Legal Desc., F10 -Exit I j ST. CROIX COUNTY WISCONSIN PLANNING NG &ZONING DEPARTMENT �' 1 / M / / N / M �' ■, ■ ■,� ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road �.,. Hudson WI 54016 -7710 Phone: (715)386 -4680 Fax (715)386 -4686 July 26, 2005 Fred & Susan Wahl 457 County Road U Hudson, WI 54016 Re: Notice of St. Croix o x County Zoning Ordinance Violation Location: 457 County Road U, Hudson, WI Computer #: 040 - 1049 -80 -000 Parcel #: 12.28.19.182A Dear Mr. & Mrs. Wahl: It has been brought to my attention that you are in violation of the St. Croix County Zoning Ordinance, Section 17.14(1) — Permitted uses in the Agricultural District. These violations regard the following: Violation #1: Summer day camp for kids. (Hawk's Ridge Summer Adventures) ) According to your website ( www.thehawc.com) , the week -long camps are offered during the day for the months of June, July and August. Some of the activities include garden work, riding lessons, games, creative art works and science activities, guest teachers and demonstrators, farm chores, beach days, a farm field trip and yoga. A day camp may be allowed as a limited commercial recreational activity in the Exclusive Ag and Ag Residential districts with a special exception permit approved by the St. Croix County Board of Adjustment. To abate this matter, you must either apply for and obtain a special exception permit or cease all day camp activities at your property. Violation #2: Naturopath clinic. (Healing Arts Wellcare Center) According to the information you provided during our meeting on July 14, 2005, your existing naturopath clinic, which includes spa services and retail sales of various products, meets most of the criteria for a major home occupation permit; however, major home occupations are not allowed in the Exclusive Agricultural distri t ct unless they are agriculturally- related. To abate this matter, you must rezone the property to Agricultural Residential or Commercial and apply for and obtain a special exception permit for a major home occupation or p p P J cease the operations. Please be advised that the only retail sales allowed in the Agricultural Residential district is the sale of merchandise that is directly incidental to a service provided and requires approval through your special exception permit. Violation #3: Horse training and boarding. At our meeting on July 14, 2005, you stated that you no longer do any boarding or training of horses on the property, even though these services are currently listed on your website. You later acknowledged that some training is occurring on site through the UWRF, and that you may be interested in boarding horses again in the future. We informed you that any training or boarding of horses on your property requires that you apply for and obtain a special exception permit for a limited commercial recreational activity in the Exclusive Ag or Ag Residential district. I have enclosed a copy of Sections 17.14 and 17.15 of the St. Croix County Zoning Ordinance and a special exception application for your convenience. It is my understanding that you have already applied for the rezoning and will be applying for the special exception permits once a decision is made regarding the rezoning. We informed you that we would not issue the temporary occupancy land use permit or the sanitary permit that you applied for earlier this month until you had done so, and until we had visited the site. Please be advised that the next deadline for applications is August 15, 2005. Forfeitures of not less than $100.00 and more than $500.00 per day everyday the violation exists may be assessed to resolve this matter. Thank you. Sincerely, Jenni er Emmerich Zoning Specialist Enclosure Cc: Jennifer Shillcox, St. Croix County Planning & Zoning Department Bob Bezek, St. Croix County Planning & Zoning Department Ray Knapp, Town of Troy j �..,� ST. CROIX COUNTY WISCONSIN ZONING OFFICE 1 / M / / N / r ■ rrrrr ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 3864680 FAX (715) 386 -4686 July 26, 2005 LU0021 Fred & Susan Wahl 457 County Road U Hudson, WI 54016 Re: Temporary Occupancy Land Use Permit, Parcel # 12.28.19.182A, Town of Troy Dear Mr. & Mrs. Wahl: This letter confirms zoning approval according to the plans you have submitted to temporarily live in an existing home on your property in the Town of Troy while you construct your new house pursuant to Section 17.70(3)(c)3 of the St. Croix County Zoning Ordinance. Staff finds that the proposed temporary occupancy request meets the spirit and intent of the St. Croix County Zoning Ordinance with the following findings: 1. The existing apartment located in the arena, herein after referred to as the "apartment", to be temporarily occupied is connected to an existing septic system. 2. The existing apartment will be vacated upon completion of the construction of the new house and septic system. 3. As you have been notified, you are in violation of the St. Croix County Zoning Ordinance. (Please reference our violation letter dated July 26, 2005.) You have submitted a rezoning application and plan to apply for special exception permits for the businesses being conducted on the premises. 4. The approval of this project meets the intent and purpose of the Ordinance and will not affect the public health, safety and welfare of County residents. Approval of the land use permit is subject to the following conditions: 1. Prior to beginning construction, the applicants shall secure a building permit for the new house from the Town of Troy and a sanitary permit from St. Croix County. 2. Prior to commencing construction, the applicants shall implement Best Management Practices for erosion and sediment control as outlined in the enclosed document, Erosion Control for Home Builders. 3. The applicants shall contact the Planning and Zoning Department when all construction is completed. 4. Immediately upon completion of the construction of the new house, the existing apartment must be vacated and not used as living quarters as you are only permitted to have one single- family residence on the parcel. 5. Upon completing construction and vacating the existing apartment, the applicants shall submit to the Planning and Zoning Department an as-built drawing and photos of the completed project, as well as a floor plan of the arena. This plan shall specify the new use of the existing apartment area. 6. Within 30 days of approval of your rezoning, you must apply for the special exception permits outlined in our violation letter dated July 26, 2005. Failure to do so will result in the revocation of this permit, at which time all construction activities would cease until the violation is resolved. 7. The applicants shall have one (1) year from the issuance of this land use permit to complete construction of the new home and vacate the existing apartment. The applicants may request an extension of up to six months from the Code Administrator prior to one -year deadline. If the land use permit expires, the applicant will be required to secure anew land use permit. This approval does not allow for any construction, uses or activities beyond the limits of this request. Your information will remain on file in the St. Croix County Planning and Zoning Department. Please contact the Town of Troy to obtain the necessary building permits and the St. Croix County Planning and Zoning Department to obtain the necessary sanitary permit for the proposed construction. It is your responsibility to ensure compliance with any other local, State, or federal rules or regulations. If you have any questions, please do not hesitate to call. Sincerely, Ci1�7 +Jenniermerich Zoning Specialist Cc: Sharon Provos, Clerk, Town of Troy Jenny Shillcox, St. Croix County Zoning Specialist Pam Quinn, St. Croix County Sanitary Specialist Bob Bezek, St. Croix County Code Administrator o ' 3 MONO � C I d W : •� 3 0 O CL 3 n g S! O y Co (A CL (. M O y O c o. C Z CL -• O '* .... Ch O M y — a 0 Owe 1 04 V / a �� C. S. M. / Q * \lb � 1 6 � �� w4 0� D VOL. I , PG. 14 �- 1 104 F S a ti 7 ` 9, P,�� _ 104 W ll� 104 N 8 rn c 10 4--$ 567.7 1 � Q ap �s OUTLOT5 105 d 40 1016 s W //4 — SW //4 cq �s, �9 °' ^tio 10 � 'v►� 1009 575D (9 75D -80 28 1010 s3� ?ART O UTLOT4 7, 4 82.44' OF m I �7� J -20 10 208 C?) loos Ica ry ' 1011 / 0 �� � � N / TI �} WEST o 1 g .- 1007 7 N 6 d SE COR. SW COR, C4 SEC.7 006 N 100 CEMENT 351 aa► �g SW COO. SEC. 7 e 1 �r7 RECEIVED VOL 20 PAGE 5017 �A AY - RATALM H. M REGISTER OF DEEDS ST. CROIX CO. WI RECEIVED FOR RECORD 07/11/2005 11:45AN CERTIFIED SURVEY M SW - aP R CERTIFIED SURVEY MAP nze Pin LOCATED IN GOVERNMENT LOT 2, SECTION 12, T28N, R20W. D THE COPY FEE: 2 as SW 1/4 OF THE SW 1/4 OF SECTION 7. T28N, R 19W. ALL IN THE PAGES: 2 TOWN OF TROY, ST. CROIX COUNTY. WISCONSIN. INCLUDING LOTS 3. 4. AND 5. AND OUTLOT 1. CERTIFIED SURVEY MAP, VOLUME 16. S 1/4 CORNER i PAGE 4298, DOCUMENT NUMBER 680003. T R1 9W g SCALE IN FEET N W ��} O 100 200 400 / g POINT OF BEGINNING It OUTLOT 5 le .'ti / — — -- - - - , 10 / S OD 9 0 0 20 ?.. W ; 2 EAST Lm WEST GROVE ESTA TES / OVERAWNT /-01 = /` -' - - - ti / - N 0 C ORNER 0 °06' 01" W SECTIIO�V 12 S 1 45" E 404.84' SECTION - ~ 455.66,' T28N. R20W 150' 1 1� S 01'50' E 50.00' .� i c N 01.11' 51" W jp / - o, LOT 5 7.041 ACRES f ISO. ' r - - - I 306,719 S.F. t �) $. , � '� k "- I, 4. 0 1 L C.: M. I J C �i .1 ti �. 1 �. n- `al' DO. -04415 5 -023 al i ZF - ,� _ _ .s� . 6 , LOT 2, C.S.M +I N If 4 p W -., Va. �Ai (; 2023 too LEraEND COUNTY SECTION CORNER i ar I _ FOUND. ALUMINUM CAP, °f 7o PREVIOUS ('� 3, oQ. WEST LINE F z LOT 3 1 1/4" x 18" IRON PIPE ao of LOT 5 N N PREVIOUS 7.389 ACRES ± I O WEIGHING 1.68# /LINEAR Z ^ WEST LINE +I 321,871 S.F. f I z FOOT, SET. ` 3 ^aA OF LOT 4 H 1 • 1 1/4" IRON PPE, FOUND. \ x I 5/8" SQUARE RON BAR, FOUND. c O1 I�R UNLESS OTHERWISE OTHERWISE I WELL 1 � (SEE NOTE 2). + p \ z a I � J MIFO�RMOATLION RECORDED NOTES : ` � SEPTi�C WRED 0 ' FIL RS LAND SURVEYOR S -2246 \ 1.ALL MONUMENTS ARE DIMENSIONED \ t� AS OUTSIDE DIAMETER. o x OGDEN ENGINEERING COMPANY -HA 1234 SOUTH WASSON LANE N 2.517RUCTURES ARE NOT ALLOWED ON SLOPES ;.- RIVER FALLS. WISCONSIN 54022 GREATER THAN 12X FAC 1 NG THE LOWER ''G�, qe� DATE: MARCH 7, 2005 ' ST. CROIX RIVER PER SECT 1 ON 17.38 'S) (d) "� �ir� ° ag REVISED: APRIL 11. 2005 OF THE ST. CROIX COUNTY ZONING CO�E. T om.; N 3-THIS MAP WAS PREPARED FOR THE TRANSFER OF ° UNPLA TIED LAND LAND BETWEEN ADJOINING OWNERS AND IS EXEMPT - - - -- - - - - FROM LOCA ( ) UBD I VVISIO SCONS EGULATIONS PER SECTION 4.THIS MAP REPLACES THE CERTIFIED SURVEY MAP ' RECORDED IN VOLUME 16, PAGE 4298. DOCUMENT BEARINGS REFERENCED TO THE SOUTH LINE NUMBER 680003. OF THE SW 1/4 OF SECTION 7. T28N, R19W, ASSUMED TO BEAR N 90.00 E. THIS INSTRUMENT DRAFTED BY JEROD A. FINK PAGE 1 OF 2 O Vol 20 Page 5017 APPROVED ST. CROIX COUNTY A l art Planninn 7 -ni�n n. n Parks Cnmmittee 9 2002 L' MAY 2 4 2002 ST. CROIX COUNTY �CC SURVEYOR'S RECORD 6 8 0 0 3 If not recorc7fd�i R - TUlFakfD S U R V E Y M A P VOL 16 PAGE 4298 anproval ate a2proval shall be LOCATED IN ` RNMENT LOT 2, SECTION 12, KATHLEEN H. MALSH T28N, R20W, AND THE SW 1/4 OF THE SW 1/4 ggRTTEGISTER OF DEEDS OF SECTION 7, T28N, R19W, ALL IN THE TOWN OF TROY, ST. CROIX COUNTY� %N%W Mi, INCLUDING ALL OF OUTLOTS 3 & 4 OF THE PLAT OF WEST GROVE ESTAT!$WCRWE P#81F WORD LOT 1, CERTIFIED SURVEY MAP, VOLUME 7, PAGE 2023, DOCUM T NUIQE & 4249LJ15.1 :45 A CERTIFIfi Sj%V2 !1 4 , . BEARINGS REFERENCED TO THE SOUTH LINE / �( / 3 1 1 O 'w OF THE SW 1/4 OF SECTION 7, T28N, R 19W, / �/ I co 0 Z ASSUMED TO BEAR N 90 0 00' 00" E. I / �� / / ' 8 `' r .. — U co V �I O W N SCALE IN FEET Qi , � Vim_ G'k -; E" I N��� i R _80' so, �'�ZC, o z ' r . 0 100 200 400 \ 11 : / `'a: �'�, °� O z 3 I ° 3 z 0� N — OUTLOr 5 ° / OUTL0T 4 <a or ' '°' 8 :1 am EAST LINE OF GOVERNMENT LOT 2, / / S 00 0 02' 12" W 460.43' " 6: z D: - O SECTION 12 0� 190.20' 7 �' S O 1 45" E 404.84' C, — — — Z af — gg 4 o R- 339.84' to (R 4fi5.00' 150 270_23'' `� I u 00 01 I E fro r- \' 3 N 00 12 E C5 �� 1 t) v t O '` / 50.00' N 37 0 39' 54" W c l 1 or . a�' `� C 1 11 v v 148.91' 66.00' ti + cv zt o : 3 N 01 0 11' 51" W 3 I z 3 °\ Q��� �h ° ' ° 3 BRUGLER oN y ,1� �- �° �, OT 4N o io, / OT 1 COURT �W WIN Mlp p I� BLUFFLINE �v 10 F,S °' rn 00 1 � 0 04 12% 8- 0' S �- p.G F I0 C S. . _. M_, VOL. . 5 ° 1 0 0 c4 0 s�oPE �- °" . o ��� J ��" I N PA GE 2023 + j LOT 5 1��, �' DOC.�441515 �z ui 4.987 ACRES �`�� ^` , °��o °� �� — — � +I N 217,235 S.F. N LOT 2 v, z W�1 w M "' �, � - 3 Q �S A- �;= C.S.M. s 11 co 0 w ° '34 W o ° sL�ti�° I� VOL. 7_ 1� N 1 21 44' Al �S / o y ,2°�;' 1 PA GE 2023 1 Z �' ° PES' l �- 44 �5 �5 I� OUTLOT �S�o � I � DoC �— — — aq (TITLE OF OUTLOT 1 F LOT 3 I M `° LEG-END I o ao rn CANNOT BE CONVEYED 7.389 ACRES +_ in z SEPARATE FROM LOT 5) +l 321,871 S.F. + I z COUNTY SECTION CORNER 4.595 ACRES ± — 13 W MONUMENT, ALUMINUM CAP, 200,176 S.F. ± Q ;� - FOUND. to +I ; rn f ah ' 1 1/4" x 24" IRON PIPE SLOPES> 12� w '� I bo o o WEIGHING 1.68# /LINEAR �sr8 0 I ^ FOOT , SET. co 04 Q) co C C6 = 1 2 • 1 1/4" IRON PIPE, FOUND. o WEL L c �� tt W 1 5/8' SQUARE IRON BAR, �p 1 � FOUND . i BUILDING SETBACK LINE. +1 I BUILDING SETBACK LINE \ g S — — REQUIRING TOWN OF TROY OWNERS & SUBDIVIDERS ,°° �� SEPTIC — — ' VARIANCE ( 25' UNLESS JAMES & JOSEPHINE BRUGLER ,�� �N'DRAINFIELD OTHERWISE SHOWN). 271 COE ROAD HUDSON, WISCONSIN 54016 9�O�iQ p _ PREVIOUSLY RECORDED NOTES: C��F� rO Ic"I (R INFORMATION. 1.ALL MONUMENTS ARE DIMENSIONED FC C n og AS OUTSIDE DIAMETER. C� 0" +I N 0 4 - DOWNHILL DIRECTION OF 2 . LOT 5 BLUFFLINE WAS DETERMINED BY `rT �.� 9 TF o ro SLOPE. EUNICE P OST, WI DNR, ON MARCH 1, 2002.- p rn N THIS INSTRUMENT DRAFTED BY ROSS A COLLINS PAGE 1 OF Vol 16 Page 4298 o (A o n (A 3 0 d _1 C c m o T 5 0 CD rr rt r CC Cl) Z O W (A Cn j Z O v G N A O• < fCD N C N 3 N O CO ? N° 0 a � m o° a c H � to fl• N N N Q 7 7 O U) 7 O do „ ll C OO �V O O f C 7 C G A 7 N V 0 7 H -4 O Q O 0 1 i p O v cn v D a c m Cn z D A 4 CD D e CD cS �N a �I N a C CD g IW CD co rn a 0) 0 o v n V F3 25 CL CL CD 0) C V 4m C N o o c I y o o a N o c L v) 0 C c 3 �r Z 0 000 z 000 °' • Z ryt��l Sii N°o 0 r A N N 3 - N ` 3 m a All CL a z rn ` z z z r z z K v 0 0 D D S O D D G C Ch CD CD W C W a N Z p CD z O 3 co CD O (n O c ' n ' v p � � O) � O � j U) W T N c� I o 3 a� ID o FF 0 0 z CC C CD y Z Z G N 1 co 36 vmmvW cDa)aU) D mcovmy D O c c 74 : = CD CD 0- fD N fD a 03 S a n c m � 'ca o p o a s m ��v 3 m a oin 3d ^> 301°) : o oto3 cov mCn : ocn vi � = m ? 3�oCD m c oovm n� c m ` o U) y 0 ID ID CA ��' y o � X� CD 5 •m M o d 0 � I m CD CD CD O y 0) r m a v 0 x a N a c y N E CD =cow m ° @ 0 3 y Q. - �7 g 3 y 3 �- s� 3 N•0 Sm N y 7 Q 00. � w CD vi OL CD �O N a y ' m y n CD j . t 0 i) f�D 7 .0 �i d m a 0 O�i m m� v m m O < ry a — O or CD m cyC 7 A 07 5. ' QS O' N m 7 m m 3 7 m =w cog n f�D 0) i O c CO) 0 d .•. O. ? a a j 0 V o 0 5 7 CD ( O CD a ) CD > 1 O >> N 3 �o.o =r m o' c �` o ' ° o m - o CD CD CD g� a '^ CL a ck m o o tv CD CD Oa ~ A E» O v+ O ., w CD CD CD 0 CL CL og oCD `° §� /\ $$ &0 0 2 =©E A • m ƒ E a) � k82 §;« � A0> G e2£)8 \ \0zccc W �§ =0E- \ /\ 2E ! _ : U) r - a 2 a0 M , 2b =�` =� } � = ® / cq Cd \ mm= §8 2KQm,2)E . � . � 7 � k h -- c . i « • e = 0- z� N m a CL 2 § 7 0) �Rm 77$§ eL) k q oz {) {7 U) k 7 { E k k 0 k E 0 2 � \ t)\22 m � �) c » & E§ ESo R \0 \A2 [\3 } 7 % 2 ' % § ^ . 2 a { § c a a CL A ° k G a a a j j k k ( o Q Q 'D Q © 0) } \ k \ E = co @ a k / j � 2 -90 a') E # § 2 § G a a§ '/ 7 , ■ m e a o . § 2 c \ §/ ƒ\o }5} 2\ � � $ �a � - ' ! " CL » ��' '§a§ . : & 0 a & 3 & 3 Wisconsin Department vi Commerce PRIVATE SEWAGE SYSTEM t. C roix Safety and Buildiggs Division Coun INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitMNo -: Personal information you provice maybe used for secondary purposes [Privacy Law,R.15.04 (1)(m)]. Pe i old s Name: ❑ City ❑ bhijags Th�Igtf ate Plan ID Nn SyWo, e Susain `'7 TrcwtSac�e. 14� CST BM Elev.:- Insp- BM Elev.: BM Description: Parce -$ - tA . �' , �' 3l� 4 P JL IQ4 4 i49 i TANK INFORMATION ELEVATION DATA 1. L8, /I• �BZ- TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. I Septic > (� Benchmark Dosing Cy,� ----.- Aeration Bldg. Sewer (o • Ian 30 Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ESQ a& _ NA Dt Bottom 1 Z D qef & S - / Dosing vt� NA Header / Man., - D - , 6 S t Aeration NA Dist_ Pipe S.�' 6 I , 6 S Holding Bot. System S ' Q S I PUMP/ SIPHON INFORMATION Final Grade (� .b St Manufacturer C, Demand Z f ? t- 3.30 0 3.35' Model Number l{�: S e.� l� TDH Lift Friction z System3 30 TDH IZ, Ft Forcemain Length r� p Dia. FiI " Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width , Lent r o. f Trterrcfr2S pIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS $ DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEA anufa SETBACK cturer: INFORMATION Type O / / Model Number: System: M CHA B OR UNIT DISTRIBUTION SYSTEM Header /Manifold .A Distribution Pipe( sk r t x HoI Size x Hole Spacing Vent To Air Intake Length •� Dia- �- Length 3s•� Dia. �'� Spacing �� tt z Ir SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes , No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc-)Inspectio #1: O6/a5 /61 Inspection #2: ^ f Location: 457 CTH U H dson, WI 54016 (SW 1/4 NW 1/4 12 T28N R19W) - 122819182A 1.) Alt BM Description eKe- a-�on) 2.) Bldg sewer length = SO.a-�' - amount of cover = 3c, 0' (; NS 41 3.) contour = ' �.t �.Z i I T Plan revision required? ❑ Yes No Use other side for additional information. E6 21 SBD -6710 (R.3/97) Date Inspector's Signature Cert No. 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: , t ( € N / J t a a... w.. . s,.,,... , . W m v @._..wm ....... . ... Y , 3 I 1 E A 3 r i £ i J i j 1 � 1 j E 1 9 � g i 5 f.,w.e... ....vem. P @ ? g { 2 S .... ,. _. a # P Z I ( S i ae a c 1 a E E } s € 8 1 2 1 O A I= CT - u Sanitary Permit App on _ Safety & Buildings Division S In accord with Comm 83.2 1, (9fic ti Wi . Code 201 W. Washington Ave. owns Pe rson a l e reverse side for instructions for com i l ' g thi ► (� } PO Box 7302 Department of Commerce information you provide may be as secon t — Madison, WE 53707 -7302 [Privacy Law, s. 15.04(L (�thtnit completed forth to county if not N?: / state owned.) Attach complete plans (to the county copy only) forte System, an 8- inches in size. Coun� ►'v State Sanitary Permit Number ❑Check if revisionlicie(t plan , D I� $.� d <. 1 ,1 � Y I. A lication Information - Please Print all Information Location: Property Owner Name Pr operty Location LAJ wSLt4, AA . s O 1/4 /4, S To7�,N, ( W PFO PC Owner's Melling Address Lot NUmber lock umber qty. state Z p Code Phone Number 945 division Name or CSM Number S (2,/ )3X6 ms's I Type of Building: (check one) o city or 2 Family Dwelling - No. of Bedrooms_ 13 Village E3 Public (describe use):_ Town of State -Owned Nearest Ro 8 X 3g M eu.►nQ[ U. u r e a P arcel x a III. of Permit: (Check only one box on line A. Check box on line B if applicable) A) 1. ew 2. Replacement 3. ❑ Replacement of 4. S. 6. 0 Addition to System System Tank Only Existing System B) Permit um ate slue ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ❑ Non - pressurized In - ground and ❑Sand Filter 13 Constructed Wetland 13 Pressurized In- ground ❑ Holding Tank 13 Single Pass 13 Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dis rsal/Treatment Area Information: i, Design Fiow (gpd) . Dispersal Area , Dispersal Area 4.3o it Application 5. Percolation Rate 6. S ystem El evation Final Ora Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation -� /0 D D� Z VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel I Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks ❑ /�� ❑ 13 E3 5 O O O ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum s Name (print) um o (n p MP/MP S o. Business Phone um ba is �a �9a m 's Address Street, City, State, z IX. County/Department Use Only Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue I uing Agent Si tune (No stamps) J KApproved ❑ Owner Given Initial Adverse Sure a Fee) Determination dD X. Conditions of oval /Rea ns for - D �� 2eo t 65 fir. et. D �?hs tc� vvu Ak b e__ tom" . —z., �*-Qc- / —to S -k�S > 1S 7 ?) � ,,,,,�.s -� eQ►a.. 4�. ser�,-�..��!Q� -� -�-� �o ,P�'� w� s ✓e- cowt,r��er�I` . -ill_ — ' BI' e` 1 SBD -6398 (R. 07/00) PLOT PLAN PROJECT Fred Wahl ADDR s 12 WestGrove Rd. Hudson Wi 54016 SW 1/4 NW 1/4S 12 /T 28 N/R 19 W ?OWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE3 /11/01 BEDROOM 2 CONVENTIONAL IN- GROUND PR SU E CONVENTIONAL LIFT HOLDING TANK MOUND X)= SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE 600 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 300 Cell SIZE 8'X 38' BENCHMARK Y.R.P. Top of 3/4" Pipe ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION Plans designed using Mound Manual and Pressure Manuals version 2.0 1320' Property Line 1100 q0 Pro 2 Bedroom Pro Barn 100 Cabin 'j Gt B -4 CL CL Well is to meet all coMME ' 3 ) setbacks found in Huffcutt Combo TanW comm. 83 Sp � N pEN 100 � n Tank is to be properly E3 bedded and provided * B-2 with lockdown covers B.M. Alt. . with approved warning �B.M• labels 2% 9 9 Slope t r . e15' below tem a is to remain System is to be installed along the 99.5' contour undisturbed line I Safety and Buildings 10541N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 �sconsin www•commerc . o ns ov vrww.vriscnsin.gov Department of Commerce Scott McCallum, Governor Brenda J. Blanchard, Secretary March 27, 2001 CUST ID No.226900 ATTN: POWTS Inspector ZONING OFFICE SHAUN R BIRD ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/27/2003 Identification Numbers Transaction ID No. 629781 Site ED No. 627393 SITE: Please refer to both identification numbers, SITE ID: 627393, FRED WAHL above, in all correspondence with the agency, ST CROIX COUNTY, TOWN OF TROY; CTH U SWIA, NWIA, S12, T28N, R19W FOR: NEW MOUND, 300 GPD OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 784689 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in +' . chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. C The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10691 -P ( N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment - Systems" SBD - 10706 -P (N.01 101). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. . • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The maintenance plan for this system must be given to the owner of the POWTS. Site Specific Conditions: • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area. SHAUN R BIRD Page 2 3/27/01 • The maximum dose volume, 20% of the design wastewater flow plus drain back, calculates to be 64 gallons. • Maintain well and waterline set backs per COMM 83.43(8)(i). • The septic tank shall be serviced at least when the combined sludge and scum volume equals 1/3 of the tank volume per COMM 83.54(3)(b). • This system is designed for wastewater strength with monthly averages of less than or equal to 30 mg/L of fats, oils and grease, 220 mg/L of biochemical oxygen demand and 150 mg/L total suspended solids. • The designer proposes to install an outlet filter to achieve the requirement of wastewater particle size. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic tank outlet filter will be required. The outlet filter shall be installed per product approval stipulations. • The management plan / users manual must include maintenance of the soil absorption cell (i.e. what activities may or may not take place on and around the mound system, including traffic, plantings, etc). Amend your plan and provide this information to the owner. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 03/15/2001 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 PATRICIA L SHANDORF � BALANCE DUE $ 0.00 POWTS PLAN REVIEWER ,1°NTEGRATED SERVICES (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WiSMART code: 7633 cc: FRED WAHL PLOT PLAN PROJECT Fred Wahl :DI S 12 WestGrove Rd. Hudson Wi 54016 SW 1 / 4 NW 1 /4 S 12 /T 28 N/ 9 W WN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE3 / 11/01 BEDROOM 2 CONVENTIONAL IN- GROUND PR SU E CONVENTIONAL LIFT HOLDING TANK MOUND X)00( SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE 600 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 300 Cell SIZE 8'X 38' BENCHMARK V.R.P. Top of 3/4 Pipe ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION Plans designed using Mound Manual and Pressure Manuals version 2.0 1320' Property Line Pro 2 Bedroom Pro Barn 100 Cabin CL Well is to meet all setbacks found in Huffcutt Combo Tank comm. 83 100 Tank is to be ro erl p p Y ❑ bedded and provided * B-2 with lockdown covers B.M. 13 Alt. with approved warning �B•M• labels 2% 99, Slope Area 15' below System is to be installed system is to remain along the 99.5' contour undisturbed line r a Designer / No 0� b/ V r Data— — 7 4" Observation Pipe Perorated boa — Woven Filter Fabric Below Filter Fabric ,Disirlbution Pip AS'TM C -33 Sand -.. `�' " Topsoil _... J � trramr.trra F 1 Z % Slope ; a Bed 0 - 2 Farce Main ,Plowed Drain Rork From Pump Layer ID �•� Cross Section Qf A Upund System UsFn , .�C..L..� — A - Bed For The Absor fion Area F 6 .0 A ,� „ Ft. H Ft. 1 Ft.. y�.�. Ft. K IZ 7 Ft. L Ft. ►� 43. Ft 4 pipe -a-or, - -__ __- o , Farce Main From Pum c -- r..� ....._.... p O Distribution Bed Of � �— 2 L r Pipe Orain Rock n 4 Observation Pipe Permanent Mocker Pipe or Rod* Plan View Of Mouncl Usina A Bed For The Absorption Ar Per for* Ied Pipe Wail End View (For I ore Ito / PVG P.pe ,0 Holes LOeelOd On GGOIOP+- w` Are Equeny specie r 6P � 0 PVC fate MON1 f FtAbT TA4N.L Ndx�' rb CenneC��en PVC Monilow Pipe 7�ee r� -• u.� �, . ni4lrib p ip e �oroui P .3_fFt. R R. X InChes Y �a Inches Signed: Hoye Diameter Inch License Number: �� {7�(l Lateral �;Z Inch(es Manifold a Inches Date:, � -_ // � Force Main " oZ Inches # of holes /pipe Invert Elev4tion of Lateral s4 Ft. Page SEPTIC TANK & PUMF CHAMBER CROSS SECTION AND SPECIFICATIONS 4" Cl VENT PIPE 12" MIN. ABOVE GRADE WEATHERPROOF ?:25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER FINISHED GRADE W/ PADLOCK E WARNING LABEL -7 --- wm. 4" MIN. 18" IN. y� C.z. Q�rRu+arioa ty" 'ICE 1� tB u MIM. FNLET I ' WATER TIGHT SEALS GAS- TIGHT, �� PROVED F ILTER -- -+ A SEAL ' i JOINTS WITH APPROVED —}-- ; ALM. APPROVED PIPE PIPE 3' B ON 3' ON ONTO SOLID F i i SOLID SOIL SOIL PUMP OFF ELEV --�-- OFF T. D 3" APPROVED BEDDING UNDER TANK 4e CONCRETE PAD SPECIFICATIONS SEPTIC ! DOSE TANK MANUFACTURER; � NUMBER DOSES PER DAY: TANK SIZES; SEPTIC Z GAL. DOSE VOLUME INCLUDING DOSE � ___.. GAL. FLOWBACK; GAL. ALARM MANUFACTURER: � � CAPACITIE�O =o27 6 INCHES = GAL. MODEL NUMBER: A - SWITCH TYPE: ,�,�a ` 0��� G = 2 INCHES +: AL. PUMP MANUFACTURER: / O���G���SQ� C = ; ' INCHES MODEL NUMBER: SWITCH TYPE: r r t D = INCHES = _ GAL. REQUIRED DISCHARGE RATE .S� GP PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETW EN MP OFF AND DISTRIBUTION PIPE 9 FEET MINIMUM NETWORK SUPPLX E j U � RE . . . . . . . . . . . . FEET FEET FpRCEMATN X � FT /I00 FT. FRICTION FACTOR � . ' FEET TOTAL DYNAMIC HEAD - FEET r INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH r/ � DIAMETER LIQUID �. SIGNED: LICENSE NUMBER: 4f� 6°�OO DATE: }./88 'r En gineering - • Performance Data 40 30 § haracteristics sstw IZ 20 SHU40M 1 SNIF40M2 Am, b SHIF4OAr SWF48AZ 4 ro t0 12 Sre1f,11 Dote 4 Pole) tsso ° to 20 30 ia. 60 70 Pr»M t® - I TS 2$0 GPM 4o Neh total Head (feet) 10 14 17 21t 29 30 35 1t0° F 1Nox, Notd M 6 3 L 6.1 7.6 •. MIN A OPM (US GPM) 70 60 30 40 30 . 20 10 0 IuWe�e Qaa A ( eecj 4.4 3. 3 1.9 t. M 1 t rFnt S Dim 3 4" ensional Data oidr 4i Ma. care^ s. "oe,s71 Perry cord li /` S � t�, � _ (ee. �e) s" ( 1. AB dimensions in inches. (MeMc for m, ,27) ieternoilOnO{ used. c 2. Co dNrlea"my Materials of Construction ,�js;,,�h, WE Nd aan" oiscHa 3 . Not for coast d1on purpose {98.421 1.1/2" NP P Lertified MAW KWdFA fL.0 P COW 4. Dfinemions and wghfs are SOW approximate" Sw SW � � r S. We reserye the right to mdse 0i4eem bw revisions to our proict and their hom specificatiw wwim notice. b=ldm* go" hwK t, 3tb• c2+ie.921 ' AM} 6012 cow MW %10*11 fit (so.ej (92,47) 1. ' Q va V 8 Hydrornutic" Pumps, Ash xf, Ohio, All Rights Rex � NYDROMATIC Your Au Local Distributor 1 844110"y A Ad*" OW 44805 70: 419.299 -Se42 Fax: 419281.4081 WA S48: www,pOnlo ff*.tw saes fU/#►Ci! NM A!i MAIn11 MW AMY COG NrCjjS r Bsfn m � fd qr. yrwr MfK d Ire 'Ohm a J1.rnM W.6�0 Jfp 8M lrOfyOy � Jg M ( �hd7�wJDI �1� / �� Maintenance and Contingency Plan for a Mound System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7. The owner agrees to save this plan. Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump without float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715 - 246 -4516 Pumper: Kolve's Septic Service 715 - 425 -9188 St. Croix County Zoning: 715 - 386 -4680 Shaun Bird „/1, i %� #2269 3/11/01 Vl - ,.consin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code S �- - L° Attach complete site plan on paper not less than $ 1/2 x 11 inches in size. Plan must County � Z x 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. 0 y u - 1 Q 4. R - 8 O Please print all info rr��trcrrt.'.' Z iewed by Date Personal information you provide may be used for secoadat urposes (P�acy Law, S. 15.0A 1) (m)). Property Owner '['7 - p r C� �� 4 Property cation B V-.) �Z S L— S� F1'z- ' -? r , i St.J 1/4 N W 1/4 S l T Z N R L R E (or W Property Owner's Mailing Address lock # Subd. Name or CSM# 3tZ IAjST 6 V--UVE CQ'D c 'cix City State Zip Code Pone u mber pFF1 ❑ Village [ Town Nearest Road �so►v wl S�to1b (�i k�, ��., T�� y cTr�" u y (� New Construction Use: ❑ Residential / Number of be Code derived design flow rate u 50 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material LO e S a u X12 CC t_/} e.t/ t 'n L !. Flood Plain elevation if applicable lv ft General comments and recommendations: µ.} UV w/ 6 'K S t - I �18`1'S1U f l I 18 OF S f'ct b FI LL, M Boring # t ❑� Boring tit Pit Ground surface elev. C 1 4- (c ft. Depth to limiting factor , Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft In. Munselt Qu. Sz: Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 3 )oy 2 31 Z - s 1 I z`Fs bar M, 0- - -s - Z ll -t9 10 tiTI- 316 3 19- Z8- S�tz3ty C1� 1.S`�R S/� sl o�, z� 39 �s �R�! f �� >zsis sI C 0 V', _ , C) . a Boring # ❑ Boring ® Pit Ground surface elev. 9 R Z ft Depth to limiting factor 3 — 7 - 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 Z 10 - 1Q, Lo`tiz.3l6 - s I: 1 Z`�'$ �►� m �. cS - . S •� 3 t� 33 -7.S y V- - �Zy - S 1 1 c S b►2 wl v'FF e S , 6 S3-Vo S.' IQ- Sly `F l`F l SL1 S I 01,,, Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = 13013, : < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sign lure CST Number Arthur L Wegerer ''0 g 220254` Address W e g e r e r Soil Testing &. Design S e r v i c e Date Evaluation Conducted Telephone Number 421 N. Main St. River Falls, WI 54022 j �_� (.(�(� 715 - 425 -0165 x • r , Property Owner S 1 1=1t b Parcel ID # O �{ 0 — 1 Q CL4 _ Q, p Page Z of F Boring # ❑ Boring ® Pit Ground surface elev. 1 00.7 ft. Depth to limiting factor Z 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 1 b -q 1��2 3 �z � si S �.b�c �'Fr- �-k., - • S -8 ' Z 9 - i y' L p iZ 3/6 — s, i Zwl s bar rn 0-S 3 )L -Z.-7 - 7 .S`ilz Sly s I Zcabk )I \. — .0 -6 tf Z"1 q 0 S '1IZ 3/y PbP - 2,5L& Sly S ► o ti►.r yrr - — . 3 S M Boring # ❑ Boring y ® pit Ground surface elev. 100 ft. Depth to limiting factor _ = Z in. T -- 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 I •Eff#2 o _ 0 / 1 644-- 3 1 s it Z`FS h 4 cw . 5 .8 Z 4 -ZZ 1oYrz 3/6 — s) 1 m sblt nl 3 zz- 16 rz 3/( l F s `t l? .5/ 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 GPD11111 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 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 -264 -8777. SBD -9330 (x.6100) ti PLOT PLAN Page 3 of 3 s cale V= 40 ' "ZoNz.> Eyl-'hl u 13zo' - t; P J ro to ) J U ® , 3 C �, i8' r 41 �' L w14F ��t5' - - - - - -- 4 T 3" t+ Z �Dp P-) 07 CAMP "-r - O2 G19 J U 07 q ----------- L S'N23 - rrH.T /7 t{ qr1... 1 0.0'_ON 3 /t�`.` DtA- P\,C P1Pk9 -_ 715- 425 -0165 220254 oO - 3 o$ C3 CST Signature Date Telephone Ito. CST No. w Job PTO. S FrJ i (q) a CL-- o� L. �t- • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Bu er Sit ►�. y i c� Y Mailing Address , 2 °J Iq L.� c ,Son t ,�I ;S LI U) (a Property Address P—C) L `' �., I (Verification required from Planning Department for new construction) - City /State / �A- 0) 1S C'Y"� Parcel Identification Number LEGAL DESCRIPTION Property Location S ' /a, N w '/,Sec. W, Town of D Subdivision , Lot # Certified Survey Map # . Volume . Page # Warranty Deed # ��%Y' i & , Volume � Page # � 01 Spec house ❑ yes V Lot lines identifiable ❑ yes Jff no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastor plumber, journeyman plumber, restricted plumber or a li cense d p 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 Office within 30 days of the three year expiration date. — Y V ! � 0 SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office . SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. «« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed f ST CROTK COUNTY SEPTIC TANK MAINT9NANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buye Mailing Address Property Address S 7 ` r (Verification required from Planning Department fbr new construction) city/State Parcel Identification Number �$ DESf`RIPTION Ia.a� , i8a�9 Property Locatiol Z_ ' /�, N 'f4, Sec. . T N•RL'�_W, Town of Subdivision . Lot # Certlfled Survey Map # � Volume � Page # � Warranty Dead # 6" 3 `� J T Volume ..Z . Page # 26 Sec house O F Yes 9- -no Lot lines identifiableb-yes O no Improper use and ma kustaneeof your septic system could result is its premature failure to handle wwstea. Proper maintenance consists of pmq"s out the septic tank every theca Yom or sooner, if needed by a Ucensod pumper. What you put into She system can affect the ilmedon of tie septic tank aa. a tresttaaat ttage in tie 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 plumhber, jouuaeymath plumber. restrictedptumber or a licecsed pumper verifying that (1) the on-site wastawater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is lea thaw 1/3 full of sludge. Uwe, the undersigned have read tin above mrikemnts and agree to maintain the private sewage disposal aystem with the standards set fortis, hereiq a: sat by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system bas been maintained must be completed and returned to the St. Croix Couto Zoning Office within 30 days of three etrpiratloa date. S1dNA7VRJf OF APPLICANT 5 DA I1 O WNM QMMICA,,,_ MN I (we) certify that all statements on this form are true to the best of my (our) izowledge. I (we) am (are) the owner(&) of the pr desc lbed boos, by virtue of a warranty deed recorded in Register of Deeds Office. v SI ATURB APPLICANT DATE ssss An imfomution that is * "•"• Y mhs- repta+seatad may result in the sanitary permit being tcvaked by the Zoning Depatt:mrst• ss Include with this application. a stamped warranty deed from the Register of Deeds oPfico a copy of the certified survey map if reference is made in the warranty deed i _ - f •a f 1 1575 ' 636 ?54 STATE BAR OF WISCONSIN FORM'_- 1999 KATHLEEN H. WALSH DocumeniNumber WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Rolf H. Tiedem and Ilene A. RECEIVED FOR RECORD T iedemann, husband and w ife, Tracy D. Peskar and K A. 01 -12 -2001 4:00 PM Peskar, h usband and wife, — _ - - - WARRAHTY DEED - - _- .- ..- ----- - - - - - -- EXEMPT M Grantor, and Susan M. Syfko _ -__ -, ___- CERT COPY FEE: COPY FEE: -- — - - -- - TRANSFER FEE: 555.00 - - -- RECORDING FEE: 12.00 PAGES: 2 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Cr _ _ _ _ County, State of Wisconsin (if more space is needed, please attach addendum)! Recording Area (See Attached Exhibit "A ") Name and Return Adi%tu1T1 t0: Edina Realty Title 400 South 2nd Street Suite #115 �2- Zg• 1% f F Hudson Wi54016 — 'Coco loa9- so- oo�g &�ao- 1050- so -000� . $ `� aXA9- g� Parcelldentifica on mber(PIN) U \ This is not homestead prope Pw (12.2$,t`4 CK) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this t day of January 2001 • Rol /J H. demann _ es ar * Kathryn A kar wlleneA.Tiedemann _ _. - -- -.. - y.. ..t- -- - __ ---- ..._. .. - - -_ - -- - - -- AUTHENTICATION ACKNOWLEDGMENT Signature(s) Rolf H. T iedemann and Ile A. Tiedem STATE OF WISCONSIN ) hu sband and wife, an Tr acy D. Pe skar and Kathryn A. Peskar, ) ss. - -- County ) authenticate thi ay of Januar -- 2001 personally came before me this - day of -.- the above named . Kristina Odd _ - -- TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, . —.. -- instrument and acknowledged the same. authorized by 0 706.06, Wis. Stars.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Oglan _ _ -- Notary Public, State of Wisconsin on, _ Huds WI 54016 —_._ My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) — ) " Names of ersons signing in an capacity must be typed or printed below their sig nature. nlormaGOn Pro esswnals Cwnpany, Fwd du Lac, W P B g Y YP P g 800455 -2021 STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 1999 EXHIBIT "A" 'O - L 1575PAU202 pact of SW 'b of NW '% an d part of NW 'A of SW 'A of Section 12 -29 -19 dcscttbcd as follows: Commecwiag at the w 14 comer of said Section 12, dunce South 8S degrees 46 mimttes 29 seconds East (assumed bearing along the ENV %line of said Section 12) a distance of 400.92 feet; the= North 1 degree 09 mi"m 46 seconds East (recorded se North 1 degree 15 mimeses 00 seconds West) a distance of 139.64 feet to the point of beginning of the paioel to be hercm described; thence continue — said line North 1 degree 09 mimes 46 seooads Eart 55.74 feet; thence South 69 degrees 38 minutes 04 seconds East 11628 feat; thence South 47 degrees 28 minutes 09 seconds Fast 21 1 mi feet; tbMw South 62 seconds Fast degrees 47 minutes 09 seconds East 265.36 feed: thence South 84 degrees 407.20 feet; thcnoc North 1 degree 57 minutes 10 seconds East (on the E line of the NW 14 of due SW W of said Section 12) a distance of 130.61 feet; thence North 1 deg= 59 nWwA a 44 seconds Fast (on the E line of SW ' of the NW 5Q of said Section 12) a distance of 1319.34 feet; thence North 88 degrees 38 minuses 32 seconds Wed (on the N m 11309.96 feet,• thence South 2 degrees 6 minutes 4 seconds West (on the W line Of the SW LA of the NWf , A of said Section 12) a distance of 1158.68 feet; thence South 82 degrees 08 minutes 24 seconds East 23855 feet (recorded as South 84 degreca 16 minutes 00 seconds But 221.10 feet); thence North 90 de p,m 00 minutes 00 seconds East 160.86 feat to the POINT OF BEGINNING. EXCEY17ING of St ' Croix THEREFROM lands described in Conveyance of Lands for 5 &WQY PwPOS t n 2S 263. St. Crow C oun t y as shown in Vol. 321, Page 26, an d in V 345, Page 8, as County, Wisconsin. i Wi -onsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County S r, L° Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must � � X 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 nearest road. a L q u - 0 y q - S o Please print all inform r�p�, . �i Reviewed by Date Personal information you provide may be used for secon ry' Moses Privas�l aw, s. tig.(� Property Owner 7 7-Pv C FMS I , : rope lion SI-1 F1r-0 (-) k1 1/4 N W 1/4 S l Z T Z N R L 4 E (or W Property Owner's Mailing Address I ck # Subd. Name or CSM# 3tZ WES SI� Vt_ V2.dwcp ST CRCIX _ Z — — City State Zip Code Phone N t�01 ❑ Village aTown Nearest Road �hSON WI S� -I.OIh (�tlS � 3,86- 656 ;'• � � r� y 07)4 U ® New Construction Use: ® Residential / Number of bedroorrl Code derived design flow rate / -ISO GPD ❑ Replacement ® Public or commercial - Describe: _ SO 6 P Parent material ' 1U. Flood Plain elevation if applicable iV ft. General comments and recommendations: Mb%1 lkjl 0 1 Z ' D VS LZL3 - n 0 �J aLTL l F'1 1 A H ]N� F LL F T] Boring # ❑ Boring ® pit Ground surface elev. v') 0 -'2 ft. Depth to limiting factor Z 4 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 D -1 �p`112312 - St� Z Sb 17- M 0 - s Z V f •S .8 Z 1 S - Z� t o `-t li 3! G - S i I 2 'Fsb� -r wt_'F►,- c _ . S .� 3 2 Q-1 �SyRsi$ s�C ow, Y),`f►- - •C) .n Boring # ❑ Boring ® pit Ground surface elev. 4 3 ft. Depth to limiting factor Z S 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 1 0 =�1 l0�1.23LZ, - siI Z�� mf►- �s z„f , 5 .� sbk try 4 3 ZS -3S 10LIFL -Yl CIF 1 /8 Stl ov" htf Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) signature CST Number Arthur L Wegerer 00 =3a$ � - 220254 Address W e g e r e r Soil Testing & _Design Service Date Evaluation Conducted Telephone Number 421 N. Bain St River Falls, W7I 54022 !i� - l6-00 715 -425 -0165 Property Owner S �k-O Parcel ID # - 10 4 9 – 80 Page Z of Boring # ❑ Boring ® Pit Ground surface elev. °t q .O ft. Depth to limiting factor Z " � 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 o —l� lbycz 3LZ — SI Z'�sb► -z m - eS ZUf Z l� zb td�2 3 to 16`1 i2-3jb - I S,/F5 s 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. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/11 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 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 -264 -8777. SBO -8330 (R6100) PLOT PLAN Page 3 of 3 Scale 1' _ IAO ' I i I 1 F- U 211ZOlt a.1 ` X00 I CoN'Nv�L B �rtivv� or -LL k' 30 . o 1 E011 it _ 49 d V T l-F l S PrIZQA V'�- LI N O 37,3 Z - Pc�Z -�S P ►°r1Z L �.31y ° -Dc9 _ ('Ve .p1 p wL- LprT?+ - -- I ! p_� 715 - 425 -0165 220254 dp,3o� A CST Signature Date Telephone Ilo. CST No. � Job N0. VWsconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings Page I of 3 in accordance with Comm 85, Wis. Adm. Code L Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County �Q �)( 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. O 1 4 0 - l O ti q - $ Q Please print all information. Reviewed by Date Personal inforrnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner - zf, -Cam( Pi�MVL-P 2 Property Location Govt: - SI-J 1/4 N W 1/4 S I Z- T Z N R 14 E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 3 tZ W LS T 6� t; R,owm — — city State Zip Code Phone Number, [3 City ❑ Village 4 Town Nearest Road ` � s ON wl Sg0I6 ( IS ) 386- t;S6 7 cTr� �J 4 ® New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate 4 -1 S O GPD ❑ Replacement Public or commercial - Describe: 1 S O 6 P p Parent material 6L^ 0k1 'TI" Flood Plain elevation if applicable Iy 9) fL General comments and recommendations: r'1 1 til, H v IK LL, F T1 Boring # ❑ Boring ' ® Pit Ground surface elev.- - 2 fL Depth to limiting factor ? _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 p -15 14 - 1 R -312 — SI) Z SU�c Y+' CS Zvi •S .8 Z 1S -Z� lob Ii31L - s r I 2 �sbk m'F► -- �S _ . s . 8 3 2%4 33 Q-1 1 SyfZS�$ s[`c ow, Y - -o .o a Boring # ❑ Boring ® pit Ground surface eiev. 9 ':� - 3 fL Depth to limiting factor Z S 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. •Ef1#1 - •Eff#2 I.. p .l1 LD `'I.tL� 1L ,: — Stl Z.�� mf►- cS zv'� . 5 -.� Z 11 2S - L'Fsbk rn S .13 3 ZS 3S .1 r3 1-1 rL V LA CIP ISVLS /S S vvh ntft- • Effluent #1 = SOD, > 30 < 220 mg/L and TSS >30 _< 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Arthur •L .Wegerer 0 p " 220254 Ad d ress W e g e r e r Soil Testing & .Design Service Date Evaluation conducted Telephone Number .. , . 421 N. Main St. River Falls, WI 54022 �k) 0 715- 425 -0165 Property Owner S Yk-O Parcel ID # - 1 4 – 80 page Z of Boring # ® Poring Ground surface elev. q q •o ft. Depth to limiting factor �' IO in. it Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 l0`1 tz � C z. - s I � 2'Fs b► m '�- eS z v � , S . t3 Z l � -"2.. tp`1 3 (i, - SII Z�sb►z y►t'�,- eg — . S .� 3 z� -�. �b`� tZ.�16 Ctf� �•S�r2 Sig s; t o ti,,, � •- . � . Z. 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 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 I • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 m < and TSS 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 -264 -8777. SBD -9330 (R6100) PLOT PLAN Page 3 of 3 Scale 1' 1 a U 2 )l z to �b5 goo 8.1 s- —` I Co�Zv�vt � LOo•o� �J r —J 3u o�= ems-`- 3 D J • 8 2, 1t • —4 •� (�� F - i e-Lb flrcly� o 02 ��sT�ta3 F� Cam— N e`�T Ll N E OF 37,3 Z_ ftc4 P r'C1ZC�L 715- 425 -0165 220254 A CST Signature Date Telephone Iso. CST No. Job N0. INDO j TP T�T OF R PORT ON SOIL BORINGS AND SAFETY &BUILDINGS IND(1S C DIVISION LAMAN�DATIONS PERCOLATION TESTS (115) F� -/W 3 MADISON W BOX 796 53707 (ILHR 83.0911) & Chapter 145) LOA N: SECTION: TOWNSHIP OT N0. LK. NO.: SUBDIVISION NAME: C SAr s�v4� /z /T2' N/R 19 E for W 7,f?oy �.t,� of 4o sf�es - p E,vO! COU' Y: MAILIN ADDRESS: s�'�Paix -',Po y PEs,��,e z � US ¢ - DO S Z- DATES OBSERVATIONS MADE NO. BEDRMS.: COMM R CIAL D S RIPTION: : : Residence 3 /v, ,+ New ❑Replace /�f�jP 1�7 - fy�� �j/� ! RATING: S= Site suitable for system U- Site unsuitable for system 7S �Eit�l'v� �' ,S / ONVEN fIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -IN -FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) ❑S ©U ©S 11U DS DU DS CDU ❑S DU •�lov - moo ovcy If Percolation Tests are NOT required DESIGN RATE: 4 If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: G L/ 331 1 Floodpl i ndic at e Fl o o dp l ain ele PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIMrST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BAC K.) o- yN /o p UDOLf p Z g y,� il 5, p /ow .*v 7-/,21 goy B- -72 �O�o�� 9T SO ,n tv�r,cw ,� /z- /8 "SDY� `- ; 3 bfic l,C�u�_3(,,, R 31e, St 2,,,,.,9 h� . v f I' C&U, w.'tj, C Ha - f-f . . B 72 , Mows T /O y e 611 S/ 2 n~ r AK f1r,' eS w , A, 6 1 ,( 4 Of 75 Y 6 5/ 2,.,66 nry ! GS B -Z 34 ^'r'T hvvi tt,lt 16, 51"- 95 $, - EXCEPT flOTTGfD � r' ((� ' — B- 3 3Cr 5 v°r s.% /O yR ¢ -3 f !Z -!G ' / D ye 41 -4 svl 27•+ S 6k B � ��-3, l00 32 A vl, c 4 i /G -1.7 - /0 Y/2 f</(, f. / z,,, s bk, hn v f w -, B_ r C W w w C 2 ,4 & e - G/' --s o r PERCOLATION TESTS TEST DEPTH . WATER IN HOLE TEST TIME DR I WATER LEVEL-INCHES RATE MINUT NUMBER INCHES AF TERSWELLING INTERVAL -MIN. PERIOD t PeRIOD2 PERIOD3 PER INCH P _ / Z 0 3 d ► /(, fS1 I �+ 3 7 7 — '40 30 1y/ O p- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. , ! SYSTEM ELEVATION �7_1' Lep�_ G!,v S! (/ ',C'lr�i .f fii'ol✓ r p .: �H r I � I� I 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with t e prbc6&Vr,gt jA spec in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my know 69e and NAME (print ): TESTS WERE L T -" !,, 1LSiTE SEPT'JC PLUIMBING CO. �R UL UNDI Rn HUDSO WIS5 gQIF ADDRESS: I ROBERT ULBRIGHT CERTIFICATION NUMBER: PHONE NUMBER (optional): NIS. MASTER PLUMBER LIC, NO. 3307 M.P.R.S. 2 ' yd Z 3J - POO '.'INN. INSTALLER & DESIGNER LIC. NO. 00663 CST SIGNATUR : G�CIGt / DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DtLHR.SRDFi3B5IR 1ILR31 nvco i s� 1 �. t kA � w $ o 0 4 \ ` N h� A m QAI CL kA 0 1 � J nor Z DEP,.49TMENT OF REP O RT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, 2 DIVISION LABOR HUMAN NDATIONS PERCOLATION TESTS (115) I"y MADISON W 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP /�; OT NO.: LK NO.: SUBDIVISION NAME: Sto 1 / Nw 1/ L I ANI E (.X 7w e COU TY: MAILIN ADDRESS: s4A0 /x Tr Ac -2p &-p. J USE 4x DATES OBSERVATIONS MADE NO. BEDRMS.: COMM R IAL DES RIPTION: FR Residence -? �/, New ❑Replace I RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN- GROUND- PRESSURE: r E]S YSTEM -IN -FILL OLDING TANK: RECOMMENDED SYSTEM:(optional) ❑S QU_ 0 DU ❑ QU Cat! ❑ ©U If -0 v "i jc> T If Percolation Tests are NOT required DESIGN R I If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, ind ica t e Fl elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIG HE TO BEDROCK IF OBSERVED SEE ABBRV. ON BACK.) /D YR Y13 //, y -/s /o`7 s G Si / 1w►,aG B -.; GO 1 2- ,Cw ,s 3 o ".oy,P Vel s/ 2f ,,,,,, w /tkC /f OR y -r B- 36'x- 5 C/ 3 b 3 P e >R —G -ec Ts B- B- B- PERCOLATION TESTS EST DEPTH. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PER 1 PFRI0132 PERIOD 3 PER INCH P- P- P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION. S� TH • 1 I { i I i I i 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print : 8;i�, O'NEIL RD., HUDSON, 5401 R]Nr 6 TESTS WERE COMPLETED ON: G ROBERT ULBRIGHT } ►'Idu64- ADDRESS: F - LTA N M.P.A.S. CERTIFICATION NUMBER: PHON UM� ptional): '`i JALLE9 & DESIGNER LIC. NO. 00663 2. �� Z 3��' 3 4 EFS CST SIGNATURE- W4 11 4-4r DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. IN DU S TRY, TMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INQUSTRY, C DIVISION LABOR AN D LATIONS PERCOLATION TESTS `115) F� 10a3 MADISON WI 53 07 BOX 796 HUMAN RE (ILHR 83.0911) & Chapter 145) SW 1 / 4 LOCAT ION: I /Z TOWNSHIP OT N LK. NO.: SUBDI VISION NAME: c5,44 %T? N/R 17 E (or 7e0 ,Dit,P of 4 0 1�qe - , 0 6.V v1 ,o COUNTY: MAILING ADOR SS: St ��Po /X ko y PE-51 -,4A z �y w 7 o l vso , R1'0,6:R / � 5 W 2 - 2 - USE ¢ZS -" OOS2_ DATES OBSERVATIONS MADE NO. BEDRMS.: COMW00AL R PTION: ��yy G [Residence 3 y, - JnNew ❑Replace /NIfjP -20 - ",tO64, j/- ! � RATING: S= Site suitable for system U- Site unsuitable for system 7GS 7S 17�i 'tJ/' /}- $ � ONVEN NA : MOUND: IN- GFIOUND -PR : S S EM -FILL — G - TANK: RECOMMENDED S Y STEM: r os ©u as ❑u as au IN - STEM:(optional) as ou as au �o�No � If Percolation Tests are NOT required DESIGN RATE: i E::1 If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: G 4ASS Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL -DEPTH T R UNOWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HTG TO BEDROCK IF OBSERVED SEE ABBRV. ON BACK.) B- / �p�,� Pvoo «v Z g o- 9„ /0 Y,< ¢ 5,/ piowEV- 9 /z� /oy s/G s; 7 if 516 7 Z '"' !/ �' I , c w , /2 - 8 " /O Y� s /4• kv 3 'h+ S t, K r►n 4 C r r� ' 60-36 I S b M.� i w W + c e2 o - t r+ 2 r� A" u f (' cw, 4 j.t , 4 C See- fro -As. B- P- 72 " M D%S r /0 Yle r-/I S l .2 M r nn Vro CS B-2 34 $, - EXCr P7 - fo rrze - D 4 T 1 B _ 3 3G sN� �vo /v� / 8 s�t�yE qs l3, - xc�a, T- �1oT7'GED •fT ��,. B- J�8 i Z v /Z " 04 s/ � /O yA 4/3 j /s - /re / ye 3 f: 2 9.r S x 10 3, t'00 "� 3 �vi, /l' -,7z /a Y/? f /G s• / 2Sbk, ' B- M+f r, w, W / t d1 a ,e -G/' -, ors PERCOLATION TESTS TEST DEPTH , WATER IN HOLE TEST TIME DR WA LEVEL-INCHES RA MINUTE NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD t p I PERIOD 3 PER INCH P. P. 1 - L 3 0 P. io moo V P- P. P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate axle or distancm. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. k) a� y - � � � �'��D -rill � /6� �✓ � SYSTEM ELEVATION. I } }} 4 it /z - I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print F ITESTS WERE COMPLETED ON: HWESJTE SEPTIC PLUAMING CO. _. A5sn Rn HlmSnnl WjS W t6— ADDRESS: ROBERT ULBRIGHT CERTIFICATIO NUMBER: PHONE NUMBER (optional): WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. Z yO Z ' ? 1 3 J J < S MINN. INSTALLER & DESIGNER LIC. NO. 00663 CST SIGNATUR 1 DISTRIBUTION: Oriqinal and one copy to Local Authority, Property Owner and Soil Tester. � ^ O r I 0 w a Q Q4 �J �I d o -• • cv N W y h` a S tA z S2 �i a 1 a Ir J W o Q� CL JR& q � �c z � w a o � DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS I1VDUST ° r� Y, ' A C !� DIVISION LABOR AND PERCOLATION TESTS (115) Pg '30� 3 MADISON WI 3707 P.O. BOX 7969 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECT TOWNSHIP /MUR • 1LTFA'EI I T: OT N0. BLK NO.: SUBDIVISION NAME: sw t 4, t / L /T z�l /RAY E (.. Q// Pith �� g p .9GrtlS COU TY: MAILING ADDRESS: .s b�x 1 1 �Gs��ip z ,P y w. 0- 0 tl 'j S0.j, USE 41 S —cos L DATES OBSERVATIONS MADE NQBEDRMS.: COMM R IALDESCRIPTION: PROFILE DESCRIPTI COLAT1 TES Residence N New ❑Replace RATING: S= Site suitable for system U- Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE' OLDING TANK: RECOMMENDED SYSTEM: (optional) ❑S Q CAS ❑u ❑S ®u ❑S (A 1 ❑S ©u I If Percolation Tests are NOT required DESIGN RA If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: ii��TrL Floodplain, indicate Floodpl elev PROFILE DESCRIPTIONS BORING TOTAL P H TO R UNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED H TO BEDROCK IF OBSERVED SEE ABBRV. ON BACK.) /a3 3y Z y 4r1 y „ p,6w� y y/3 , s -is ~ Aoy s 4 s; J'"" R� CU, 4/G V f , Cif o -6y - - vor_l* 1iok Art 3 P o,P G y - rs B- B- B- PERCOLATION TESTS TEST DEPTH , WATER IN HOLE TEST TIME D WATER LEVEL-INCHES RAT MINUTE NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PER10131 PER1012 2 PERIOD PER INCH P- P- P_ P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION. Ll 11�r r I 1 I1 I : I I T I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): 655 O'NEIL RD., HUDSON, WIS. 54016 TESTS WERE COMPLETED ON: ROBERT ULBR )1'IA IGHT A 14, " ADDRESS: PLUMBER'LTC _ N - T 3307 M.P.R.S. CERTIFICATION NUMBER: PHON UMBERI Tonal): k1INN. INSTALLER & DESIGNER LIC. N0.00663 Z- Ya , Z 34-0 �/ CST SIGNATURE ` y W DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. nti HR_can .A'tar, IR mini►