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CD ° D c oq a) a) ti I c m N N C) _L uj N .3 0 � w c L) E m C Y) N Co E �3 3 a c O p E C N - a E O X O C 0 h a) U C N cu �I o z a > 0 z cu LL c > CO O LL c O 0) @ O c ti e- L Q U) "O C1 N U Q 3 V a) w ' � y Z N E E °' Z o = o _ ! - 0 0 v 0 � 4) m 0 m a m a m FN- Z O z �* - c ° of vc u o w o w m z I a ° vj c E c Ei 'O Y WJ C7 Q j 6 N N •� I' � O � a) N � O O Cl c Q U w O Q O O Q O N I Z C Z Z m Z Z) o Z E m E N LL h N Q N m LU > — o o a -0� C° o o a �� > � o E4 O N N N E N fn N > 1 0 L c U� N II C Q = a! C� •i a a a a a a a S � c a -a 0 Imo- I` N U) 'O C7 M O Cl N O V CO = N CD 0 Cl �c C 0 I O O N Y t 0 7:) F' c a _ C) CL n m Q n! O J N C C C M V) C 7 W p o2$ O O O O N ME_ ® ^ p 00 O x m 0- p C) CO '2 n i N cla I� O 3 U7 CC 'O N N Y to (6 N ;sg �� Q p p'. 2 C f9 (9 ," a0 N_ CI 0] O C � N 75 Z �I m .r ° v co 0 rn t) uc > > cco v m o c • ) o F- d v o Z U) 2 c� o Z m 2 F- C/ I! d m • � a�'� Via. � va w �1 U a O in v O in U 'COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 800 - 962 - 5227 CZ& ST. CROIX ZONING REPORT NO.: 03036/01 PAGE i ST. CROIX COUNTY REPORT DATE: 3/27/91 COURTHOUSE DATE RECEIVEDI 3/26/91 HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER: Keith Maxwell ` LOCATION: 372 Milwaukee Rd., River Falls COLLECTOR: M. Jenkins SOURCE OF SAMPLES Kitchen faucet COLIFORMI 0 /100 mi. INTERF'RETATIONt Bacteriologically SAFE NITRATE -N: 3 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria /100 ml Nitrate - Nitrogen, mg /L i LAB TECHNICIAN: Pam bane WI Approved Lab No. 19 OF ,NDEVEND FN 1, V C Means "LESS THAN" Detectabl.e Level. Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 � �. R � �'a ;,� � .. _; 1:i .. ... . . .. -�f _. �. .i:5 i ..,7 _. .i.. _. - i . ':7 _ � ... ... _ . .. 7. __ ., r _ __ _ ._ —. &M TESTING LABORATORY, INC. L 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 t, 715 -962 -3121 800 - 962 -5227 ST. CROIX ZONING REPORT NO.: 03035/01 PAGE 1 x $T. CROIX CfITY REPORT DATE! 3/27/91 COURTHOUSE DATE RECEIVED! 3/25/91 HURON, WI 54015 ATTN2 THOMAS C. NELSON OWNERS Keith Maxwell \ LOCATIONS 3 Milwaukee Rd., River Fails COLLECTORS M..lenk i ns SOURCE OF SAMPLES Kitchen faucet COLIFORMS 0 /100 ml INTERPRETATIONS Bacteriologically SAFE NITRATE —NS 3 ppm Above 10 ppe exceeds the recommended Public Drinking Water Standard. Coliform Bacteria /100 ml Nitrate — Nitrogen, mg /L LAB TECHNICIAN: Pam Gane WI Approved Lab Nu. 19 oE • \NDEPENp 1, O ` 9 A Means "LESS THAN" Detectable Level Approved byl o PROFESSIONAL LABORATORY SERVICES SINCE 1952 I CO' M414ERCI AL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 ! ' Colfax, Wisconsin 54730 715 - 962 0 3121 800 - 962 - 5227 Q ST, CMIX ZONING REF%T NO4 03036/01 PAGE 1 ST. CROIX COLWTY REPORT GATEi 3/27/91 MArPIOUSE DATE RECEIVED: 3/26/91 HUDSON, WI 54016 ATTN: TH "S C. NELSON OWNER'. Keith Maxwel LOCATION! 372 Milwaukee Rd., River Falls COLLECTOR! K. Jenk i us SOME OF SAiSP' I Kitchen faucet COLIFORMlo 0 /100 at INTERPRETATION1 BacteriolotyivatLy ; SAFE NITRATE -N: 3 ppe Above 10 Fps exceeds the recommended Public prinking Water Standard, Coliform Bacteria /100 aL Nitrat"itrogen, mg/L I , LAD TECNNICIAN1 Pam Gana WI Approved Lab No. 19 a � y nMaEP No, 1%@ S �� pp V I F ' c leans "LESS THAN" Detectable Level Approved by: PROFESSIONAL LABORATORY SERVICES SINCE 1952 COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 i 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.** 02966/01 PAGE 1 ST. CROIX COUNTY REPORT DATE! 3/26/91 COURTHOUSE DATE RECEIVED*# 3/25/91 HUDSON, WI 54416 ATTN*# THOMAS C. NELSON OWNER*# David & Rebecca Swanson LOCATION++ 1054 Cottonwood Rd., Hudson C Si et CI Ii Ly SAFE NI Above 10 ppm exceeds the recommended PubLic Drinking Water Standard. *NOTE: Test may be invali6 sample was old. Coliform Bacteria /100 ml Nitrate - Nitrogen, mg /L LAB TECHNICIAN. Pam Gane WI Approved Lab No. 19 oF A DEDEN V u s 5 < Means "LESS THAN" Detectable Level Approved by++ �� ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 re r COM61CIAL TESTING LABORATORY, INC. -514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 I 715- 962 -3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.* 02966/01 PAGE 1 ST. CROIX C"TY REPORT DATE* 3/26/91 C"THOUSE DATF RECEIVED* 3/25/91 HUDSON► WI 54016 ATTN* THOMAS C. NELSON r OWNER* David & Rebecca Swanson LOCATION* 1054 Cottonwood Rd., Hudson COLLECTOR; M, Jenkins SOURCE OF SAMPLE* Kitchen faucet COLIFOR14* 0 /100 ml INTERPRETATION* Bacteriologically SAFE NITRATE -N* 1 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. ATE* Test may be invali6 sample was old. Conform Bacteria /100 ml Nitrate - Nitrogen, mg/L LAB TECHNICIAN: Pam Gane WI Approved Lab No. 19 .OF NWEN,) 1 , O 0 v s Means "LESS THAN" Detectable Level Approved by* �'� d PROFESSIONAL LABORATORY SERVICES SINCE 1952 i Q + s l I ST. CROIX COUNTY ZONING OFFICE 911 4th Street m,4- 1 Hudson, WI 54016 J Telephone - (715)386 -4680 �' St Croix Co. Zonin g Office offers the service of septic and Tie ,✓water inspection to Lending Institution, Realty Firms, and private individuals. COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN BE LOCATED. Please provide the following information, enclose appropriate fee made payable to ST. CROIX CO. ZONING, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING -------------------------------- FEE:$ 25.00 (For nitrates and coliform bacteria) WATER TESTING -------------------------------- FEE:$175.00 (VOC'S) SEPTIC SYSTEM INSPECTION --------------------- FEE:$ 25.00 PROPERTY OWNERS NAME: r PROPERTY OWNERS ADDRESS : jG=C.�G I Legal Description 1/4, 1/4, Sec. , T N -R W, Town of ,Lot No. ,Subdivision FIRE NO. ^ Z LOCK BOX NO. Color of house Realty sign ? PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i.e., COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual _r uesti g services 2 Telephone No. REPORT TO BE SENT TO. CLOSING DATE: Signature: ST. CROIX COUNTY � WISCONSIN ZONING OFFICE 'xx ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, Wl 54016 _ - (715) 386.4680 Mar. 22, 1991 Margaret Strehlo Edina Realty 700 2nd St. Hudson, WI 54016 Dear Ms. Strehlo: An inspection of the septic system on the property of Keith Maxwell, located at 372 Melwauke Rd., River Falls, WI was conducted on March 21, 1991. At the same time a water sample was obtained for testing. The results of that testing will be sent to your as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Please note that this residence has been empty for an undetermined amount of time. Sincerely, P Mary J. s Assistant Zoning Administrator cj i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix oafetya Building Division INSPECTION REPORT Sanitary Permit No: 499280 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: Pilne , Mark & Laura I Troy, Town of 040 - 1207 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No /b0 65 - 1 16.28.19.978 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Sr, l 161. 1 /o0 Septic , Benchmark DQR "9 Alt. BM 1, /DG. 78 Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION O;,/�(�w V-1,,W TANK TO PIL WELL BLDG. Vent to Air Intake ROAD Dt -inlet .77. Z Z. Septic m �. 30 g$, $ Dosing Header /Man. t If 9l� • 0l Aeration Dist. Pipe f /61 3 Holding Bot. System /0 - % 95 m PUMP /SIPHON INFORMATION Final Grade Al Manufacturer Demand St Cover GPM F I I, 3 0 t'e• u- Model Number TDH Lift Friction Loss Sys em TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 �$ - 2— 7TLm �,M I SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: / / UNIT Model Number:Q ✓+ A 4 4 -.! DISTRIBUTION SYSTEM eM 22 4-7- 3 1 { 1 4 -aR Header /Manifold U Distribution x Hole Size x Hole Spacing Vent to Air take Pipe(s) �. ^ —3 Lengt Dia H Length Dia Spacing G 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 N__1 Topsoil Noes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:�/ "! / Inspection #2: / Location: 372 Milwaukee Rd Hudson, WI 54016 (NW 1/4 NE 1/4 16 T28N R19W) Glover Station Lot 24 Parcel No: 16.28.19.978 1.) Alt BM Description = 2.) Bldg sewer length = , j - amount of cover = , 6Y r n - 7'5 Plan revision Required? Yes No 10 Cert. No. Use other side for additional information. In I I _ 4 —_ sep tor's Si ature SBD -6710 (R.3/97) Date commerce.wi.gov Safety and Buildings Division County ■ 201 W. Washington Ave., P.O. Box 7162 St. Croix Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Dopes ba of commerce 4 4 S Z g- D Sanitary Permit Application State Transaction Number In accordance with s. Comm 83.21(2 Wis. Adm. Code, submission of this form to the appropriate governmental /) k unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal inhumation you provi may be used for secondary �� I L es in accordance with the Law, s. 15. 1 m )Stets. , t.JQ— � , /C L Application information - Please Print All Information Property Owner's Name Parcel # Mark Pilney RECEIV 040- 1207 -40 -000 Property Owner's Mailing Addreas Property Location 372 Milwaukee Road JAN 1 6 2007 Govt. Lot City, Stater I Zi pS ROIX CO f e N her NW '1., NE '/y Section 16 Hudson, WI 54016 715 -42 -7179 (circle one) IL Type of Building (check all that apply) Lot # T 28 N; R - - A W X 1 or 2 Family Dwelling - Number of Bedrooms 4 24 Subdivision Name Block Glover Station ❑ PublidCommercisl - Describe Use ❑City of ❑ State Owned - Describe Use CSM Number ❑ Village of Town of Troy 2 &t4- 4-- C.4l t, L,1 2.2- c �, �.,N•.b e(`S III. Type of Permit: (CheckonlyoneboxonUmeA. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only fyJ Other Modification to Existing System (explain) .• -q 1 & diver B, List Previous Permit Number and Date IS e/ y 1 R ❑Permit Renewal ❑ Permit Revision El Change of Pluriiber El Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that appl A Non-PressurizedIn-Gr ound ❑ Pressurized ]n- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil El ' Mound < 24 in. of suitable soilG�q „tn ,� ❑ Holding Task ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Disperunreatment Area Information: Design Flow (gpd) Design Soil Application dsf) Dispersal Area Required Dispersal Area Proposed op (sf) System Elevation 600 0.67 b .� s 1 857.1 EISA 891.6 96.7196.3 VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units u 'e Now Tanks Exisdag Tanks o rely t eS �' o Septic or Holding Tank 1200 1200 1 Wieser Dosing Chamber VII. PaSP0115ibilit Statement- I, the undersigned, asswne responsibility r Instailatio of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Jim Hurlburt r. MP 222997 715- 283 -4851 Plumber's Address (Street, City, State, Zip Code)" U N. 260 CTHW D, Eau Galle, WI 54737 VIII Coun /De artment Use Only o Permit Fee Date ssued Issuing Signature veer Reason 81 YA IX Condi M easons for Disapproval 31 s,y6��u� ✓ 5�' L _ e � o 1. Septic tank. effluent filter and f v D�- dhspefsal cell must all be servttces / maintained J � , r 61A C.�ti ; ,� b • 7 5� .5 as per management plan provided by plumber. I- 2. Alf setback requirements must be maintained as W applicable code I ordinances. Attach to complete plans for the system and submit to the County oil on paper not cis than 81/2 z 11 inches in sire rYl 0 6 County Commerce C�r�' �lc7mtier" -' 6,&Ze -n, Owner `f Mark Filney tawt��n,ti�,sia,tanv,atvw • TOM of'hvy, &,Cmfx Co, aloM Station, Lot 24 1" 40 a N ♦ - Bmbmxt ft 100.00 ft Top of 3/4" pva pE a •�C..,� �'`�`. - Alt Baaaimwk Ea& 100.10 ft Topaz" pvo pie © Q - i CX 8artn� P.lsvativa� 102.2o. ft p �� B2 - 102.20 Q/ � I B - I D0.80 f t B4 • - coo It i Le �4•, Ste. �� 41 r va kA, Mark Pitney A1W1 /�t�i81 /4,316,'t'IdN,R19W Town of Ivey, St.cmix Co, Glover St 6ml Lot 24 �ff N ~ - 40 1 ♦ ' Banaboxk Ste. 100.00 ft Tap of !/4" pvc p* Alt B400bawk 8U. 100,10 R Top of 314" pve PM C3 op cQ swb* a - I%M, It B2 - 102.20 It 100.50 n S4- - 4),00 It 4� �F la in 10 .E (�PiSer CD i V- O-44% N GI w A4- w ` ( 0k,3 - G g t0.r V�Q.� O O -2 $3, Lo 0 CT E,. SOIL EVALUATION REPORT #2043 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Steel's Soil Service Attach complete site plan on paper not less than 8% x 11 inches ' a,.n must S t. Croix include, but not limited to: vertical and horizontal reference point n County percent slope, scale or dimensions, north arrow, and location and hest Parcel I.D. Please print all information. Revi d By Dat Personal information you provide may b Law, s. 15.04 z d Property Owner Property Location Mark Pilney Govt. Lot na NW 4, NE1/4, S16, T28N, R19W Property Owner's Mailing Address DEC 2 s nob Lot # Block # Subd. Name or CSM# 372 Milwaukee Rd 24 na Glover Station City Stat Zip 63d6RQl0A(W i i`6er ❑ City ❑ Village Z Town Nearest Road Hudson WI Troy Omaha Rd New Construction Use: 0 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial - Describe na Parent material outwash Flood plain elevation, if applicable na ft. General comments Conventional system, system elevation 96.20ft. Trenches spaced and depth to code 6.00ft below grade or and recommendations: adjusted to sand depth at time of installation. E] Boring 1 Boring # ZI Pit Ground surface elev. 102.20 ft. Depth to limiting factor 140 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD /f: in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#1 *Eff#2 1 0 -8 10yr3 /1 none sil 2msbk mfr cs if .6 .8 2 8 -17 10yr4 /4 none sicl 2msbk mfr cs ivf .4 .6 3 17 -27 7.5yr4/4 none scl 2msbk mfr aw na .4 .6 4 27 -72 7.5yr4/4 none sl om na aw na .2 1.6 5 72 -140 7.5yr4/6 none / cos osg ml na na .7 1.6 tfd 10y6/4 silt inclutio due t6 texture changes 4 to 6 inches thick between horizion 3 and 4. 2] Boring # Boring pit Ground surface elev. 102.20 ft. Depth to limiting factor 140 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 -10 10yr3 /1 none sil 2msbk mfr cs lc .6 .8 2 10 -27 10yr4 /4 none sic[ 2msbk mfr gw if .4 .6 3 27 -48 7.5yr4/4 none sl om na cs if .2 .6 4 48 -140 7.5yr4/6 none cos osg ml na na .7 1.6 rl � * Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD <30 mg /L and TSS < mg /L CST Name (Please P ' Signat CST Number David J. Steel 248956 Address Steel's Soil Service Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 12/26/2006 715 - 760 -0347 SBD -8330 (R.07 /00) i Property Owner Mark Pllney Parcel ID # Page 2 of 3 - 5 Boring # Z Boring Pit Ground surface elev. 100.80 ft. Depth to limiting factor 140 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 -10 10yr3 /1 none Sil 2msbk mfr cs 1c .6 .8 2 10 -22 10yr4 /4 none sicl 2msbk mfr cs if .4 .6 3 22 -42 7.5yr4/4 none sl om na cs if .2 .6 4 42 -140 7.5yr4/6 none cos osg ml na na .7 1.6 I ❑ 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 # E] 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 G /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t *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 I 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 -8330 (R.07/00) Steel's Soil Service STEEL'S SOIL SERVICE 3 of 3 David J. Steel Mark Pilney 994200 th St. CST- POWTSM NWl /4,NE1 /4,S16,T28N,R19W Baldwin, WI 54002 Lic. #248956 Town of Troy, St.Croix Co. Direct 715- 760 -0347 Glover Station, Lot 24 Fax 715 -684 -3449 Legend N 1" = 40' ♦ = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • = Alt Benchmark Ele. 100.10 ft Top of 3/4" pvc pipe ❑ = Borings Boring Elevations BI = 102.20 ft _ B2 = 102.20 ft B3 = 100.80 ft B4 = 0.00 ft �- 3�0 4-- ` ' nsFuak'd"��� �5y5 Et— 1% bo r - ' . Parcel #: 040 - 1207 -40 -000 01/02/2007 12:02 PM PAGE 1 OF 1 Alt. Parcel #: 16.28.19.978 040 - 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): 0 = Current Owner, C = Current Co-Owner MARK A & LAURA J PILNEY O - PILNEY, MARK A & LAURA J 372 MILWAUKEE RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 372 MILWAUKEE RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.650 Plat: 1993 - GLOVER STATION SEC 16 T28N R1 9W 2.65A GLOVER STATION Block/Condo Bldg: LOT 24 LOT 24 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 16- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 897/104 2006 SUMMARY Bill M Fair Market Value: Assessed with: 159352 453,000 Valuations: Last Changed: 07/22/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.650 90,000 323,200 413,200 NO Totals for 2006: General Property 2.650 90,000 323,200 413,200 Woodland 0.000 0 0 Totals for 2005: General Property 2.650 90,000 323,200 413,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 212 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i •. G S �. �.; o � ✓ I T r �L AA.. f 1 Q d Zoe vgL0ti �.QAk Mark Filney NWlM 81/4,S16,'1?$N,R19W Tom of Tmy, 3t.Croix Co, Glover Mon, Lot 24 a N • - Bambro%t Me. 1 ft I Tap of 3 9 , pva plpe .�_ . - Ak Bmcbom k EU& 100.10 R Top ot3 /4" pvo pipe o - irievaeioa �a 8 102.20, ft �"�``','►- B2- 102.20 ft B3 - 100.90 R 54 - 0.00 I g C 's , Q, C-D y � y POWTS OWNER'S MANUAL MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner (`l ��t< I turtu4 Septic Tank Capacity \2a�n gal ❑ NA Permit # Septic Tank Manufacturer V.o r .�� . ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer O NA Number of Bedrooms 100 d/bedroom ❑ NA Effluent Filter Model 3 tgZ4 -osyi- ❑ NA Number of Commercial Units NA Pump Tank Cap acity al E2 NA Estimated flow (average)* a] /day Pump Tank Manufacturer NA Design now (peak), estimated x 1.5* o cz al /da Pump Manufacturer ® NA Soil Application Rate 0 gal/day ft Pump Model aNA Pretreatment Unit LSeN.A Infiuent/Effluent Quality (NA❑) Monthly Average ** ❑ Sand/Gravel Filter Peat Filter Fats. Oil & Grease (FOG) < 30 mg /L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) 220 mglL L.-- ❑Disinfection Other: � Total Suspended Solids (TSS) � Manufacturer: Model: S 250 m �t* Dispersal Cell(s) Pretreated Effluent Qu ity ❑ Monthly Average Biochemical Oxygen De d (BODs) 5 30 m IL ®'In- ground (gravity) ❑ In- ground (pressurized) Total Suspen Soli TSS) g ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) � 30 mglL C3 Drip-line ❑Other: 10`cfulI00ml M�Leaching Chamber Manufacturer `I'�, ;: ,K vav Maximum Effluent Particle Size 1/8 i nch diameter Model Approval Stipulation *Wastewater Flow Verification on and calculations: Soil Application Rate o b� gpd/ft Area Req. ;S _4. t fi (Other than bedroom based) Absorption Area Credit per unit ft' Minimum Number of Chambers 4-4- 0 Aggregate Desi n Flowf Rate= ft rrun - ** Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ** *Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA O "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al.1990) f D "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ❑ "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis - ASAE Publications 5 -77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems ". EPA 625/1 -80 -012 October 1980 D SBD - 10570 -P (R.6/99) "At -Grade Component Manual Using Pressure Distribution" r!K'SBD - 10567 -P (R.6/99) "In Ground Absorption Component Manual" ❑ SBD - 10705 -P (N.01 /01) "In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD - 10628 -P (N,6/99) `Recirculating Sand Filter System Component Manual" ❑ SBD - 10656 -P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ED SBD - 10572 -P (R.6/99) "Mound Component Manual" ❑ SBD • 10691 -P (N.01 /01) "Mound Component Manual" Version 2.0 O SBD - 10595 -P (R.6/99) "Single Pass Sand Filter Component Manual" O SBD - 10657 -P (R.6/99) "Drip -line Effluent Disposal Component Manual" ❑ SBD - 10573 -P (R 6/99) "Pressure Distribution Component Manual" C3 SBD - 10706 -P (N.01 /01) "Pressure Distribution Component Manual" Version 2.0 1=3 Drip -line Effluent Dispersal Component Manual for Multi -flo Onsite Wastewater Treatment Units I ❑ MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Freq inspect condition of tanks At least once ever 3 O months Z_< ears Maximum 3 yrs ) Pump out contents of tanks When combined sludge and scum equals one -third 1/3 of tank volume Ins ect dispersal cells At least once every ❑ months ears Maximum 3 yTs 1 j Clean effluent filter At least once every months ❑ year (s Ins ect pump, pump controls & alarm At least once every ❑ months ❑ ears a NA Flush laterals and pressure test At least once every ❑ months ❑ ears E' NA Valves At least once every ❑ months ears ❑ NA Other At least once every ❑ months ❑ ear (s) CVN A Page 2. of 3 START UP `,;� . , For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the.dispersal cell s). If high concentrations are detected have'the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible. for the operation' and't Uffitenance of t lf6TOWTS and submission of required reports. The quantity and quality of the wastewater stream will aPfecVthe performance �aiid lori' 6 ty of your POWTS. The installation of water- saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up, 1�5 Valves Valves shaall e operated thr�.,followingmanner: �V e-w. s o � o �� ; � 3 _ \\ ¢ � � e� l V U O Alarms Alarms should be tested on a regular basis by a home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve unde ular operating conditions, however water should be conserved until any problems with the system are eorrected'to prevent back -up of sewage into'the dwelling or surfacing. INSPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Septic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks j I or leaks, measure the volume of combined sludge and scum and to check for any backup or surfacing of effluent . Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank, t/ I When the combination of sludge and scum in any tank exceeds one -third (1/3) or more of the tank volume, the entire contents of the tank shall be remove by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin l Administrative Code. I The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. ✓ O Pump Chamber/Treatment Tanks C tnponent The inspection must include ate f ectrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfaci g or brokeii'security devices and other hardware and the condition of the filter. Any service needs or repairs aO taken care of START UP 'age Z of 3 For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell s), If high concentrations are detected have'the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil.couditions are frozen at the infiltrative surface. OPERATION The property owner is responsible.for the operation atid'Masntetiance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affeathe performant a and longevrty of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste;'showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable / fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. e/ Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up, tl_� (�5 Valves Valves shall e opera in th following manner: 4- S �A� ti u L S + 1 U I CD Alarms Alarms should be tested on a regular basis bylke hom owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve u ndetp4ular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into'the dwelling or surfacing. INSPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). I Septic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or surfacing of effluent . Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. l/ . I When the combination of sludge and scum in any tank exceeds one -third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR 113, Wisconsin , Administrative Code.✓ I The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's i specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. p Pump Chamber/Treatment Tanks C mponent The inspection must include ate f ectrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfaci ing of brokeii'sccurity devices and other hardware and the condition of the filter. Any service needs or repairs all be promptly taken care of i ti Page 3 of 3 Win- Ground GrIvity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. O Mound, At- Grade, In- Ground Pressure I The inspection shall include recording the levels o ponding, if any in th s rvation tubes and a visual inspection for any evidence of surface seepage or discharge. Any disc e to the gro surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of th om pifent may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided wit opening at the d of each lateral to be used for flushing. The laterals should be flushed at least once every three Q ears. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent ' occurring to promote the longevity of the system. j REPORTS Reports for maintenance, * pection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ./ ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. / All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with - soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures been, or must be taken, to provide a code compliant replacement system: I *A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. D A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. p The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation I must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. O Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name Agency Phone Phone ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer M l L K\ E Mailing Address 2 '(�1( t -_t y Property Address (Verification required from Planning & Zoning Department for new construction.) City /State \� U � Parcel Identification Number o 'Y6 - / Z a - 7 '40 - 06c�, LEGAL DESCRIPTION Property Location" 1 /a , �' /a , Sec. � � , T _W_N RALW, Town of Subdivision Lot # Certified Survey Map # , Volume , Page # Warranty Deed # I gb� , Volume , Page # t Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification staring that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms._. SIGN OF APPLIC T(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) ¢A"'gy,dq' s•xf+.''...1 ...�. 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Mi !4gFT -ADMF Ml�Fkm a ff"m A`54CaON, KVt£". 1'P'NE VtLti - 9A• 1 1 Kt �9WdJ TTM, 1d4 M YyXfl a S>R:M11- art A i,'Sd1�R3T* ca • rJ o 4�A xA EAUS, Ri '40 ' E4XFPTNIS���`r �'a�T13',iS79 a u `�� '• �^E'.t .h'S Fr. Ez r7 SEw"t .N� T du5TFa4EENX 05 [A4''if� BY :SF T 1 p' 9fX76 � Fs i _ . 77 -5_ xr i4#a._.. pt,7i_�,.)1,! Nr rY S!1 +� •° y L f•. i '.iP9 i H' r- Hti-.'J F R '.•. -t?Ht�hG O „• • E 1�Art,t,�;.TY 0 •-0 STATE B -k : OF WiSCONSIhi FORM HA Keith F. Maxwell. and 1`1an ^y A. Maxwell, ST, CROIX CO., Vii �'yti'j for Pe�Oed _. . husband "�aric� wife _ .......... 4:35 P. cor.\c•ys \n1 \..;rr nts to Mari A. Pilney and Laura J. PIIney, .husb - anl wife. as rlarital.. _. ... ge;,;vei of a surv.ivq; htp..prpb�rty St Croix - i -' the tr de>u n ibed real estate I _ ......... Co.lr.t}, St:: ?_ of WC ,con:ir: Tax Parcel No: .... ---------------------_-- Lot Twenty-four (24) Glover 3tatlon in the Towle of Troy, St. Croix County, Wiscors`n. This homestead propert.:. (is) (is nr,t) Exrepti L, Nvartanties: ea nts, restrictions and r!_c Cits —of —Way of record, is any. r-� I!a1 a er„ da of Mauch i �l �D - - (SE'ALt (SEAL, Keith A. Maxwell Nancy A. Maxwell AUTHRN- TICATION ACK- NOWLFDGMENT Sig ature(s) . C''_1_ +� �'�` 1 ` r � i STATE OF WISCONSIN - - -- - -_ -- - -- - - -- ... St. Croix ss. co ,nt� authnatle . ..� thes Lr da af ►�/1�,�. - _. 19 � �. F ersona ?ly c utte befr,. e me jl is - day of en a n J - t, i = � ^� GtL'. ►t _ n..... ---- 19.. 1 t e above 1\am' d E • N r� Keit.l '...bi a Y .�7 l iiaricy A 1 ";axwell TITLE; NfFKBER STATE BAR OF Wfo°`ONS1N (If not. ----------- ---------- - suthoriza by § 70�.06, Wis, ``tats.) 5 to ma sno to b� 0 nnrs „n u cxcczlteA tF,e fore�zoin;; instron)cnt :uul ackno:vla•1_e tie same. T4;5 INSTRU'N =N' WAS DRAFTED BY KristIna Oland Llindie - - _. - -- - Attorney at Law A11 ce o,� onrvr_ .; .. ... - -.... --- St, . Groix .___ .. .. .. .. .. .... Nota ,' Public Count }. R'i =. (Signatu, -s may he authenticated o- Both M.v C'ommi 4 inn is Tern): +n ;)t. (IC not, state c%i; ratinn are rrt s;ary -) date: July 12 _... 19 .) -SA S of in nny capa ^ity sF., u!'1 h, t;p.• r , 1, h Ih :r ;,! ,... . I W ?'°.A.M_? DeF.) STALE. BAR OF Yi - i :'t)ti'IN {F�• Orenco Product Catalog - External Effluent Filter Basins Page 1 of 1 ►� . C Product Scarch Begin Search , Choose A Product Family Choose A Product � External Effluent Filter Basins Orenco s 18 -in. external effluent filter basin, featuring patented Biotube filter technology, is an ideal way to improve performance of existing residential septic systems by reducing solids discharged to the drainfield. External filter basins eliminate the need to make costly and sometimes hazardous modifications to existing septic tanks with restrictive access openings or to unusable outlet baffles or tees. Composed of an 18 -in. diameter section of ribbed PVC pipe with a fiberglass base and 8 -in. diameter Biotube effluent filter. A grade ring insert (supplied) and a fiberglass lid are required to bring the unit up to finished grade. Product Nomenclature FTB 1824 -0812 I Filter cartridstc height: I 1 " Standard Filter diameter: fit" Ktandard Basin lic iglit: 2 l" .standard Hasin diameter: 18" standard 133Otulie cflltient filter basin Product Example Model Code FTB 1824 -0812 Description External Effluent Filter Basin, 18 -in. diameter, 24 -in. height with g- in. diameter, 12 -in. tall cartridge Related Products Large Lids http:// www. orenco. com/catalog/PF29PT117.asp ?pf =29 1/17/2007 . . o f o o e oe o) w o\ a& 0 \a 0 o a G 0 a a (6 e 2 § §§ 0 G G 0 § G >) ® _ �) 7 )� C14 C14 � e2 m m m§ 0 §2 G ea G G G §- _ Cl) Cl) 04 a , a, EN N� C14 q �a m§ /§ /§ #a /§ 2 �mL �a# # 2 ® # Cl) n_ n n N a m - . � k � c A §� 0 LL � K "�Q § ■£ IEw " §§ p p p . a. [1] t w w D m / §�2 t LL ) § 0 ) k §??q� 7- o o= o ` &� E CL O oZwwLUW ° b b N §b z R5§�� ,£do 0 0 a C - \ -E S \ � E j\ © k2k © ) \f R 2� E / / ml 0) 2��.2 2 ■ ¥�■ �� EI ~ ® # • IL 0z kf �§ k§�S§�22§_ c zw o 0 w oua w z ■§� z� � o �� a ° o �u0S� 75 - 5 °§@ % §�§§ § ƒ 77 § § S\$ % §\$ §§ 7L�f§ 7005 - NE§� u � 2 w q z « § 2 0 w \ LL < LL z Ix z j a a a IL < @ 4) z z 0 & / } Ez Eo 0 0 0 c 2 2 2 2 2/ � -6° -6\ 2 2 2 2 E § § § § § E �w § § § § (L Z 2 0 0 0 0 o w 2� 2 0 0 0 0 0 LU a == I== m a 00 a= = z =_ LU � w � 0 ) § § U § a U) k / / k / k z k k § ) ) § § R _ _ U) (1) CO) cn m k J k k 0 0 0 0 0 2 ® w 2 k k\ k k ■ z V) o _ d d d d d z 0 0 0 0 0 / 7 7 7 ■- k §2 B Ea a s a s - » w w� L 2 Z 2 k 2« « k f f ¥ J f ' (a C0 ' . z z z z z « § § CL § �� § �0 o o 0 o © 0 0 0 0 0 ° 2¢ a¢ LL: LL: � U: IL: § k o § k �§ w w w w o m w w W W 0 e §� o §R w w R R & w R W w a 20 a z z z z z • r RECEIVED ST. CROIX COUNTY ZONING OFFICE JAN 2 2 2007 ST. CROIX COUNTY CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the �-•4 residence located at: A w 1 /4, PAC i /a, Section _L(,O_ Town N, Range Town of , St. Croix County Wisconsin. Upon inspection, I ertify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service 1 Did flow back occur from absorption system? Yes No x (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: 4- Construction: Prefab Concrete Steel Other Manufacturer (if known): -\, Age of Tank (if known): jq 3 p, v, -e� icensed Plumber Signature) (Print Name) () w r�je M P ate- ? - 7 (Title) (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) AP- � . ` 0 g s i '° ■ E e � 0 ( 0 I / £ ° % CD , a E # @ , @ a - z 0. , ® \ © kk \B0 k /§ § § 2 2 % . a / i ' E @ > E CL ° CD (a a A .. / ƒ i f o (D i Ko 0 72m i \ Z ® \ \ I CD k 8 c n r■ cn w w CL i t z o o o \ - ® § % § § 7 13 E 0 \ } § e � \ z CD 0 .. / o \ \ \ C � � £ A : E a m f \ § --I \ U Q. # z 9 � [ I z $ w � OD � g 2 o r z . � 3 12 w 2 ƒ c � / A . � � @ � ■ NE CD I ] b � 2 � ƒ � N < \ ? o ® 2 � , � 0 w 0 3. 0 d (D o c 0 , O O N O A 6) A O• ,. -I 7 ,� N O CD fD N W CDG OD_ N CD CD :3 o 4 O 3 3 v -4 b ID o w o CD a o Q° °o H N y a Vi Z D D N a -4 N CD W o f � �+ W C CD r cl) rT C a 3 000CL "*A. N 13 N N N A O o Q v v m ' I N y !D .d (n lei I 3 d rn o _ 0 I v i I D D 0 O Oro N I c N. I 3 a cQ I y 3 A Z n Q .. I oo v Z CD a 3 � z I ° - ;u o z !" z m cD C) I I a I n � o I � � c I o a CD I I � I a I � a I � I a I � w I ti I o a I � 0 b CD A CD ~ I o O ~ a CD o CL r • AS BUILT SANITARY SYSTEM REPORT OWNER �Ct , i YVl ax �,, )J TOWNSHIP _ l_� SEC . T28N-RgW ADDRESS 7 ti o.j ST. CROIX COUNTY, WISCONSIN. SUBDIVISION _Glo o e t 571:1,, LOT 2 q LOT SIZE 2 . oo )L, PLAN VIEW Distances and dimensions to meet requirements of H63 Q _.EV Y HING WITHIN 100 FEET OF SYSTEM .. — - Y r QS to 0 - r 0 31 I di ate N A t'oy✓ SCAL BENCHMARK: (Permanent reference Point) Describe: J70L,' Elevation of vertical reference point: h�SS�P loo Slope at site: 4 �o SEPTIC TANK: Manufacturer: Liquid Capacity: j 2oo G l Number of rings on cover.: I Tank manhole cover elevation: , ?,6,/?, Tank Inlet Elevation: Tank Outlet Elevation: 96,5 - 9 PUMP CHAMBER Manufacturer: _ Number of gallons NA Number of gal. pump set for cycle d gallons- total capacity o distribution lines � MW A gallon: size o pump U A head; gallon per minute horsepower brand name of pump and model number ; Type of warning device HOLDING TANK: Manufacturer r "! A Number of gallons It Elevation of manhole cov r" Type of warning device 1 ' SEEPAGE PIT SIZE - um er o pits feet diameter feet liquid depth }'V - seepag pit in et pipe- elevation 11,J11 bottom of seepage pit elevation Y';/ fe � - SEEPAGE BED SIZE: number of lines width / lerigth depth _L0 SEEPAGE TRENCH: width yl) t� — length n PERCOLATION RATE -/p AREA REQUIRED �? AREA AS BUILT i2�o _ 3 Go INSPECTOR DATED S' 3 PLUMBER O JOB a,-/ p (is e LICENSE NUMBER T fR s a 3G 33 DEPARTAFNT OF IhrDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ' ` 91 CONVENTIONAL ❑ALTERNATIVE State flan I.D. Number. (if sationed) ❑ Holding Tank ❑ In- Ground Pressure 11 Mound NAME OF PERMIT HOLDER: RESS OF PERMIT HOLDER: INSPECTION DATE: ADD Keith Maxwell Plymouth, MN 4 - 30 ,44., BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF, PT. ELEV.. NW4 NE4, Section 16, T28N —R19W, Troy Township Name of Plumber: MP/ County: Mtaty ermit Number: Eugene F. Grove 5569 St. Croix 34793 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK11NLET ELEV.: TANK OUTLET E LEV.: RN GL LOCKING COVE r� (] V ED: PROVIDE «C ' ' f 7• 5 YES E NO El BEDDING: VENT DIA.'. VENT MATL.: HIGH NUMBER OF OAD: ROPERT WELL: BUILD( IVENTTOrESH ` ALARM: FEET FROM LINE. AIR I [D FEET ❑YES ❑NO NEAREST �� DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY PUMP MODEL, PUMPISIP MANUFACTURER WARNING LABEL LOCKING COVER PROVIDE PROVIDED: OYES 1:1 NO OYES ONO ❑YES ONO. GALLONS PER CYCLE: PUMP AND CONTROLS E O N NUM OPERTY WELL BUILDING: V O FR (DIFFERENCE BETWEEN F O LINE_ AIR INLET: PUMP R AND OFF) ❑YES A�iEST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plow' LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease it O the soil is dry enough to continue.) IN CONVENTIONAL SYSTEM: - WIDTH: LENGTH, N DISTR. PIP SPAsINLi: INSIDE DIA *PITS, LIQUID BED /TRENCH TRENCHES / IAL: IT DEPTH DIMENSIONS / ( / GRAVEL DEPTH FILLD H UIST 1 DISTR.PIPE I 1 1 NO R. UMBER OF WELL: BUILDING: VENT TO FRIES BELOW PIPES:. ' ABOVE COVER: JELEV . INLET - ELEV. END. ` � ' ^ �{� FEET FROM LINE AIPANLET. �1 VC / / �O7•,2S NEAREST M OUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM 1 4 and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- DYES ONO meets the criteria for medium sand. TIONS MEASURED. OIL COVER TEXTURE: RMANENT MARKERS: OBSERVATION WELLS PE ❑YES [ NO DYES ONO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED. SEEDED MULCHED. CENTER: EDGES: OYES ❑NO 1:1 YES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED /TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: DIMENSIONS MANIFOLD PUM MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO. DISTR OI TR. 1 DISTRIBUTION PIPE MATERIAL & MARKING ELEV, ELEV. DIA. ELEV.. PIPES DIA.: ELEVATION AND DISTRIBUTION HOLE SIIF HOLE SPACING ORILLEUCOHRECI LY COVFR MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS Y ONO _ ❑YES ONO COMMENTS: ERMAN NT A OBSERVATION WELLS: NUMBER PROPERTY WELL: BUILDING: FEET FR LINE: t p � je , • ❑YES LINO ❑YES El N U I A 5 I '�r 0 .o � IoG -3 k a 1 3 5 Sketch System on Ret I county file for audit. Reverse Side. SIC 1 L DILHR SBD 6710 IR. 01/82) DEPARZMENT OF APPLICAT qpq��'�/ SAFETY &BUILDINGS NDUSTRY, FOR SANK l j DIVISION LABOR AND PERM1 P.O. BOX 7969 HUMAN RELATIONS (PLB 67) d ''> OF F /� MADISON, WI 53707 Attach plans for the system on paper not less than 8' /z x 11 inches in size. Include r(, dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing A ess: f+ = & 1L Property Location: Cilyr14 ge-or Township: County: /1 4414 .NEE'' /aS !( �T�,c NCR E (or W 7CEd ' K�4t Z Lot Number: Blk No.r Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. r: i C ,/,, ZX - S GLavz ko A (lfassigned) —t TYPE OF BUILDING ,C• Number of ❑ Public ❑ Variance* ❑ Other (specify)* Bedrooms: Q'1 or 2 Family * State Approval Required. y TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specif SEPTIC TANK CAPACITY /tip, s� HOLDING TANK CAPACITY LIFT PUMP TANK /SIPHON CHAMBER MANUFACTURER: 3 EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA ,—,/ (Minutes per inch): PROPOSED (Square feet): U New ❑ Replacement ❑ Experimental Ie Seepage Bed ❑ Seepage Pit 3 — /o f$de ❑ Alternative (specify) ❑ Seepage Trench �D L /o , 3 Wa Su ply: Owner's Name as Listed on Soil Test Report (If other than present owner): ter Private El Joint El Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name �o?f �a. Signature: MP /MPABW'No.: Phone Num ber: / Plumber's Address: Name of Designer: qL COUNTY /DEPARTMENT USE ONLY Signatule of Issuing Agent: F e: Date: X APPROVED Sanita! Permit Number: ALL ( lad 4 ZWIZ) 00 -0-.- p '/ T� `+ ❑DISAPPROVED Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White - County, Canary- Bureau of Plumbing, Pink - Owner, Goldenrod - Plumber DILHR -SBD -6398 (N.03/81) j G . o MIDUS'fRY,NT OF REPORT 011E SOIL BORINGS AN °.,% A Y ^ �'r DIVIS LABOR HUMAN REDLATIONS PERCOLATION TESTS (11J) { N WI 53707 z j LOCATION: SECTION: OWNSHIP /�: LOT NO.: nr QbVC4x UBDIVISION NAME: A/W IV4WY /.c /T -z N/R /-p E (o T T -fQ a r l COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: . Zi i �7R / I,ca - pz f1Lt - E - f / 14 i USE DATES OBSERVATIONS MADE ] NO. EDRMS.: COMMERCIAL DESCRIPTION: ROFILE DESCRI S: PER TESTS' OResidence �>�w ❑Replace 31ZVIO RATING: S= Site suit for system U = Site unsuitable for system CONVENTIONAL: M D: IN- GROUND - PRESSURE: SYSTEM- ILL HOLDING _ A RECOMMENDED SYSTEM: (optional) INS ❑U S ❑U ® S ❑U ❑ U ❑ U e &A VV eJV % v ,v ia.t;. If Percolation ests are NOT required DESIGN RATE: S T Q If any portion of the lot is in the under s.H63.09(5) (b), indicate: ��� t 3 ��° `��� 3% Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED F-ST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 7,0 /o y :34 i4i"54 7 _1% c A. 0" S f B - 3 /o!J� 1 „ /3 r s,� i s ` �s SL /3 Cs ` � ni B- YP /O 3 13 ` a - 5 ' s , Is 04 gs Wqzp B -3 `JS JGy,� .. IT-5 s Ix�3 .2 e .- 5 :5 if 4 r, ,i .Il PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIO 1 PERIOD 2 PE RIOD PER INCH P- P L d x G r Era ' 12 P -. P- P- PLAN VIEW: 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 how their I cat in on the plot„ plan. Show the surface elevation at all borings and the direction and percent of land slop. v R � 9 -A 4�5`swMR tbb. ba • fOp b h " F,64 f -P4 P4 "v 44'7 CC ""t SYSTEM ELEVATION l a� . �� " _ ICAL9 V ,ya �R t Not 1 J— R.,. . E _ �t o C f .�' i tN } i 5i � fv A m � l a --a 1, the undersigned, he eby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin ' Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print ): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICAT ON NU BER: PHONE NUMBER optional): O .� CST SIGNATUR 9 DISTRIBUTION: Ori inal -Local Authorit 2nd a Bureau of Plumbin 3rd a e -Pro ert Owner, 4th a Soil ester. 9 Y. p 9e 9. P 9 P Y e P 9 DILHR -SBD -6395 (N. 03/81) A 1 .� ,- - ., � . a x 0 i _ � . +, . � ` _ .. - '. + ' .. a i - .. � .. _ � ., �-, _ .. _ -� i 4 , � i ' � , 6 .. !�1 .. j. a'� ..� a � • �♦ ;� .. �+! 0 � "p � 9 I ` r __ 1 • Form - S 'f C 100 Owner of Property Location of Property /YjV N F SectionN x W Township Mailing Address Subdivision Name jj Tjr Lot Number .2,y Previous Owner of Property Total Size of Parcel _ 2,G3 �ekcd Date Parcel Was Created /0 Are all corners identifiable? ✓ Yes No Include with this application one of the follow ✓:Certified Survey Map .Deed .Land Contract, or .Other Legal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. 3'gA.1VjS' ; and that I (we) - 3 presently own the proposed site for the sewage disposal system (or I (we) have 1 / obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. ). SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABL DATE SI NED OAT SIGNED y 1sT24 C4&VZK ST>�trc,nl Tai sF ,Ra�v ?,�'x � Nw % /►�,�" �l� � /� 13 aR� tie �• � T ,z � W ELL •. - 1 Ir y � $ -I 'Ex /o Q,3o l \ /l f` � ? t o e9W/� M A 00 (L00 s�►L8 ��/ S /tr B-3 .E.G t o �F. 8 d` p� �p'•,� Jac 4,3' �. UO 8- 7 ,EZ !/l . 7le B.,F $e'TTo not AF4, 104. 3/ , xp -5top6 06 aZp ,S.• LO'23 % 1 �- - - - a Y 8.•1 r _a woa'D�p A R�� r 53 66 1 p 1 19 � q rt /Y t 87 f AyPR o VEtdT ,0 "Al 1nr. ,LOT L;AlE ♦ i As .J�vw -f t A p f 1 1 1 I • r T. ock 3 0 �A 2.16 ACRES F ? 0 2.09 ACR !98 °2p'V., 15 101t. 30 F 2.41 ACRES ti V. - = 80 ; re . -40 M `` NPV i 29 •ui a ss k 2.56 ACRES /,.y% w ~ 28 co 6� 2.03 ACRES - M N, - co to Z / ---- 195.00— — .0d 2gp N °w so-00 S86 °43 30 W ° l� SET NOTE- THE BACI SHALL BE 133 FEE _ 100 FEET FROM TI' THE SETBACK FRO' RIGHT-OF "WAY L11 ER MONUMENT, BERNTSEN CAP FOUND' THIS PLAT CONTA IRON PIPE FOOT' 72.57 ACRES MO PIPE WEIGHING 3.65 t B K IH I � X,24 NOTE: ALL DISTAN( ER LOT CORNERS STAKED FO Ht EIG114ING 1.68 LBS• / LIN NEAREST ONE AC BS�OT / LINEAL FOOT, HAVE BEEN PIPE WEIGHING i•68 COMPUTED TO T ORi2£0 RECREATIONAL TRAIL, OR NON- B HOME pWNERS A5SOCIATION, TAINED HOWN THIS IN STRUMENT WAS DRAF1