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040-1115-90-000
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N N O O F m 3 0? °cc a m ° m j p m tr N O o o �' c" o CD OL O N Parcel #: 040 - 1115 -90 -000 06/04/2007 12:10 PM PAGE 1OF1 Alt. Parcel #: 30.28.19.473F 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): O = Current Owner, C = Current Co -Owner O - ANDERSON, JAMES T & MICHELLE B JAMES T & MICHELLE B ANDERSON 1215 E LAKE DR FT LAUDERDALE FL 33316 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description ` 312 GLENMONT RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 5.090 Plat: N/A -NOT AVAILABLE SEC 30 T28N R19W NW SW 5.09 AC W 168 FT Block/Condo Bldg: OF E 504 FT OF NW SW EZ -UT- 1499/350 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 30- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 04/30/2004 761198 2561/381 TD 07/23/1997 1150/297 QC 07/23/1997 1150/296 QC 07/23/1997 1110/386 WD more 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/06/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 100,000 107,000 207,000 NO Totals for 2007: General Property 5.000 100,000 107,000 207,000 Woodland 0.000 0 0 Totals for 2006: General Property 5.000 100,000 107,000 207,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 104 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Plti #67 10/69 Wisconsin Department of Health and Social Services Division of Health r ' PERMIT APPLICATION for i, PRIVATE DOMESTIC SEWAGE SYSTEMS A. OWNER OF PROPERTY TYPE OR USE BLACK INK Name Address (Stre City, Zip Code) County B. LOCATION OF PROPERTY WF ERE SYSTEM WILL BE CONSTRUCTED, ALTERED OR EXTENDED lee / Check One: CITY VILLAGE LEGAL DESCRIPTION: TOWNSHIP ,S [ /� �' �' ��� j/ v � 4 ,lJ A / �X.& 4� C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO � ` PERMIT NUMBER D. SEPTIC TANK CAPACITY Gallons ' EW INSTALLATION // REPLACEWT ADDITION MATERIALS Prefab Concrete Poured in Place Steel Other NUMBER OF TANKS TO BE INSTALLEDk E. TYPE OF OCCUPANCY Check One: One or Two Family Residence Cor�:neroial Industrial Other Specify Number of Persons to be Accommodated •.� Number of Bedrooms F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer YES NO Dishwasher YES _ NO Automatic Potato Peeler YES NO Other (Specify) G. EFFLUENT DISPOSAL SYSTEM NEW X EXTENSION ADDITION REPLACEMENT Tile Size No.Lin.Feet Trench Width Depth Number of Lines Seepage Bed: Length Width Depth Tile Size No. Lines Seepage Pit: Inside diameter _ '�f Liquid Depth s 1 P E R C O L A T I O N T E S T Test Depth Character of Soil Hours Water Test Time Drop in Water Level Inc Minutes Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Mast To Fall lst Wetted Overni ht in Minutes Last Period Last Peri Period One Inch Ex?.rmole P- 0 36 Too Soil 10" Clay 26 25 yes or no 30 1/2 1L2 1/2 60 J " RECORD DATA FROM MINIMUM OF 3 TEST HOLES ompute size of absorption area in accord with H 62.20 Wis. Administrative Code. S 0 I L B 0 R I N G S- Minimum 36" Below Prop osad Abso tion System oring Total Depth Depth to Ground Water Depth to Bedrock ') umber Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches xample - 0 72" 72 Black T0 2 Soil 12 "• Clay 18 "• Sand 18 Gravel / 24 1 1' r ^ Z � ., r"' '� PLC. ti [/ ' L � VQ.c.. <� •� -�' «� 7 � V 'i'�';�C r_ L'i j w i. JJJ RECORD DATA FROM MINIMUM OF 3 BORE HOLES COMPLETE OTHER SIDE I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under by supervision in accord with the procedures and method specified in Chapter H 62.20 (3), Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. _ Q / L NAME 1 /� J d , C� TITLE I/C' y Se - 7 (Type or Print) REGISTRATION NO. or MASTER PLUPB ER LICENSE No. ADDRESS I *� )� / DATE �1 / LJ� SIGNATU rte MAS'PER 4>LIR'C3 E R MAKING APP LI ° MP Signatures ' P��!�?��� Cleanse Numbers MP RSW (To be Completed by Issuing Agent) Date of Application //70 Fee Paid $ A 4 • Q Permit Issued (date) l 7 d Permit Number Agent (name) W '7 AM Fort / , /1N�J Town, Village, City, County, etc. (Specify) Notes The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the Permit (yellow copy) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below FOR DEPARTMENT USE ONLY DATE RECEIVED y J J ACCEPTED BY RETURNED (Initials) / (Date) (See Corress.T FE£ RECEIVED Y VALID. NO �" v PERMIT N0. (Yes or No) REVIEWED BY APPROVED DATE (Initials) (Yes or No) COMMNTS: r ST. CROIX COUNTY WISCONSIN PLANNING &ZONING DEPARTMENT 1 u N u N ■ loops ST. CROIX COUNTY GOVERNMENT CENTER - 1101 Carmichael Road Hudson, WI 54016 -7710 Phone: (715) 386 -4680 Fax (715) 386 -4686 lam Memo f To: Paul Steiner, MP From: Pam Quinn, POWTS Inspector 4 CC: James Anderson, Property Owner 1� Date: 1/13/2005 Re: Non - compliant building sewer connection at 312 Glenmont Road, Troy Twp. As a follow -up to my POWTS inspection of 9/30/04, the following items need to be corrected so that the septic system at this site complies with state code requirements for building sewers that are greater than 100 feet long (Comm 82.35(3)(b)). The reconnection permit plot plan had indicated that there would be more than 100 feet of building sewer, so the need for a cleanout should have been anticipated prior to installation. I was contacted after installation was underway and couldn't get to the site for inspection until after the sewer pipe had been backfilled. You were not at the site to discuss opening up the excavation to allow connection of the cleanout while the excavator was still there. The day after inspecting the system I called and notified you that the building sewer must have an exterior cleanout upstream from the tank inlet (required by Comm 82.35) and you agreed to install one approximately 75' above the tank. There is an 4" access pipe approximately 5 ft. inside the new building. I re- inspected the site on 1/12/05 and no cleanout pipe was visible. Comm 82.35(5)(a) states "Cleanouts installed in underground drain piping shall be extended vertically to or above the finish grade" and "2. A cleanout located outside of a building shall be provided with a frost sleeve." The section then continues with specifications for acceptable pipe materials, where the frost sleeve must terminate above the top of the drain piping, and that it must have a removable watertight top. The appendix for Comm 82.35(5)(a) shows a cross - section drawing of how the cleanout and frost sleeve must be installed. In addition to the cleanout installation, the manhole cover for the septic tank has been brought above - grade and needs a locking device to comply with Comm 84.25(7)(f). Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: s INSPECTION REPORT 80 GENERAL INFCAMATION (ATTACH TO PERMIT) State Ian ID No: Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holders Name: City Village X Township Parcel Tax No: Anderson, James I Troy Township 040 - 1115 -90 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: "0 - 6 Q d ' Q_t;C e7'_ 30.28.19.473F TANK INFORMATION ELEVATION D A TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark f'- t's -h� bid 5t I 1o0_6 Dosing C , /„ Alt. BM_ Aeration Bldg. Sewer Holding St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Se 'c Dt Bottom osi g �! Header /Man. nA V" f Aeration --/-& Dist. Pipe Holding Q Bot. System Final Grade PUMP /SIPHON INFORMATION Manuf cturer nd St Cov GPM 7 r i'1 ax q7' Model Number ✓mot TDH Lift Friction Lo System Head TDH Ft J Forcemain h Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DI ENSIONS No. Of Pits 4nside Dia. Liquid Depth DIMENSIONS l I i SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: ` /� � UNIT Model Number: DISTRIBUTION SYSTEM -fn Header /Manifold Distribution I x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) length Dii Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of odded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil T 2 � Yes :�'� No 0 Yes � No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_/ Inspection #2: / / Location: 312 Glenmont River Falls, WI 54022 (NW 1/4 SW 1/4 30 T28N R1 9W) metes & o nds Lot q� Parcel No: 30.28.19.473F 1.) Alt BM Description = J I f 2.) Bldg sewer length = 3 /0j'tkS 1 * 1 kt S ( - amount of cover = Gv T (juts Plan revision Required? Yes No (". S WD7 Ide for ditional information. J Date Inse cJ s Signature / Cert. No. .3/97) Q( �Q (�71 1xx N' c(pG2� �t� a C�at.cs� 1 s vr► CO,unty Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provid be used ENT CENTER jp[.secoc>d ST. CROIX COUNTY GOVERNMENT [Privacy S. 0 M(m E C EIV� 1101 Carmichael Road �7r•'�F� ,/� Hudson, WI 54016 -7710 a (715)386 -4680 Fax(715)386 -4666 m f Attach coete plans f m paper' _ s)S rJ x 11 aches in size. my Sanitary Permit # ❑ Check if evision to previous application OD m 1. Application Infonnation - Please Print all Information �'.. ocation: Property Name A V 7 � 1/4 5W 1/4, f 1 n �'e f S 0 Y� � � ,31� T Z N, /?R W Property Owners Malting Address Lot Number Block Number At-grade City, State Zip Code Phone Numer Subdivision Name or CSM Nu�r /d i em ells w � ,�H ©zz Cp/2 - 32f =1Ii of 11 Ty of Building: (check one) v pity ❑ Village Town of 1 or 2 Family - No. of Bedrooms: a f � ❑ PublidCommerdal (describe use): ❑ State-owned Nearest Road > Q 11. Type of Pennit: (Check only one box on line A. Check box on line B if applicable) !vt GAQ n thaw /iD( Parcel Tax Number(s) A) 1 1.0 Repair [ Reconnection [.12INon-plumbing ❑ Rejuvenation o Sanitation B) Permit Number ' / Date Issued uNZ p State Sanitary Permit was previously issued V. Type of POWT System: (Check all that apply) S �liyyl�/ tv &L- Non-xessurized 1 round ❑ ound ❑ Sand Filter ❑ Constructed Welland In-mg `D Pressurized In-mg Holding Tank ❑ Single Pass ❑ Drip Line `�2Q ❑ At-grade W '2.L Aerobic Treatment Unit ❑ Recirculating ❑ Other . DlsporsaUTreatment Area Inform S rn 1 Design Flow (g pd 2. Dispersal Area F Dispersal Area 4. Soil Application Rate 5. Percolatio to 6. System Elevation 7. Final Grade 76 Required (Gals. /day / (Min.lnch Elevation . Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New F- xisting Gallons Tanks �-—/ Concrete structed glass Tanks Tanks 5 f ` 060 1000 1 (,� ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 11. Responsibility Statement 1, the undersigned, assume responsibility for re i connenction/r venationfinstallation of non- plumbing for the POWTS shown on the attached plans. A icense is not required for terralift repair or the in a o non - plumbing sanitation system. PI s Name (print) Plum s m at e (�e s mp MRg Business Phone Number C S f t n4. i pr )- 2 - 5 S — Plumbees Address (Street, City, State, Zip Code) 11. Coun Use Only Disapproved Sanitary Permit Fee Date Issued suing Age t Signal o stamps) Approved Owner Given Initial Adverse 1 # Determination °? o G� IX. Conditions of Approval /Reasons for Disapproval: S�cel LOS �yp� i TUB GU "/t�✓t� er and � serviced / malntainQrl as nPr managgp�erit p16J1nrovided byplumber. 2. All setback requirements must be maintained f n _ as per applicable code /ordinances. b-e f ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the '-31 --), c7z'& �M o T residence located at: I�l 1 /4, SGJ 1 /4, Section 30 , Town Z N, Range I W, Town of — 7 - �''Q\/ , St. Croix County Wisconsin. Upon inspection, I ce ify 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. py _ / / /S- 96-00V- q73 Most recent date of service 14 ," 9 1? / L -,V0P Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: /60 0 Construction: Prefab Concrete Steel Other Manufacturer (if known): Age of Tank (if known): (Licensed Pl ber Signature) (Print Name) M VV 4 2Z5 5 / (Title) (License Number) MP /MPRS q (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) k i • � yet �.Lll� � E (. f ✓�� � {� Uf fe n S Ca (c 8 AA �ooyq r 5 i , Kiif(�r s A000 a Dr wells �� 1 r A '. J .,*5 "-5 Moo 1 Norio o �f \ i �e1I 1 i i t rr �- /�o ✓ hn A% d -e t*,s 1 L � # .2e2'f 5131 AS Ae 4 , � a 4 1' o 3 4kooi . M 50 66 1 20' 4731 999/57 4 7 3 W d`, � b ao. cW � � �' 416.e5 /� 3$ "' C. S.M. v_. I, pq. 289 ' ,�q w►'f 705✓3147 2 E 47 2 N Uca X43f,54 473 G 416.85' -- 2 1J' - W 3�6 75C 473 8 47' F t to e i v� r- > ZOT' 2 CC s� 4TH K 473 A 4,72 A se C_ S • M v o �-' c :472 H W) 13 ? a� 94►7, H LOT a Q .' I: a N� 1 'l2 e7 3 12 A�. h 472 F n'1 C. S. M. 8 /22 89 wt 168' V GLENMONT 1gtt4— - 208 21 d C. S. M. C. S. M. C.S. M. LOT 1 09 _ YOL._ U, fC. S. M. a 47. ��- PG. 32_ -- . 828 a p(;, 3141 M 7/2045 M 1 475 D ' 475 E 113.4' LOT i 475A-20 475 G • LOT 5 208' 210' qO , Wl 277. 447.96' ,93.40' 225.64 A6 '. m n� a� 1830 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 8'% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest Parcel I. D. 040 - 1115 -90 -000 Please print all information s 1.�'� Rev' y Dat Personal information you provide maybe Used fors yyyiposgsxl(wvm Laro s .1 '04 (1)1 Property Owner 'rope ovation Jim Anderson Govt. Lot NW 1/4 SW 1/4 S 30 T 28 NR 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or �C�SM# 205 Glenmont Road i na City State ip Code Phani; N�(f r, J City Village � Town Nearest Road River Falls I WI I "54U2Z 1 -- 612 Troy 312 Glenmont Road ✓ New Construction Use: 0 Residential / Number of bedrooms Code derived design flow rate GPD _j Replacement Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Existing residence (vacant & to be razed) served by two drywells. Propose to disconnect residence & reconnect to new accessory structure. Drywell elev. = 82.50'. Boring # J Boring Pit Ground Surface elev. 97.00 ft. Depth to limiting factor >219" 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 0-6 1Oyr3/2 none sl 2fsbk ds as 2f,1m 0.6 1.0 2 6 -18 1Oyr4/4 none sl 2msbk ds cs 1fm 0.6 1.0 3 1841 1Oyr4/6 none Is Osg dl cw - 0.7 1.6 4 41 -219 1 Oyr6 /4 none s & gr Osg dl - - 0.7 1.6 * Effluent #1 = BOD ? 30 < 220 mg /L and S >30 < 1 mg/L (fluent #2 = BOD < 30 mg /L and TSS <.30 mg/L CST Name (Please Print) ignatur . CST Number James K. Thompson —a 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceo , WI 54020 8/62004 715 - 248 -7767 SOIL AND SITE EVALUATION 1830 Page 2 of 3 PROPERTY OWNER: Jim Anderson PARCEL LD.# 040- 1115 -90 -000 A.C.E. Soil & Site Evaluations REPORT MtMO Existing residence is served by a concrete septic tank (capacity and structural stability unknown) and two drywell. Septic tank inlet elevation = 90.74'+ -approx. 8' below existing grade. Inside bottom of drywell = 83.00', 14.0' below existing grade. Interface of system with native soil estimated at 82.0 ' Owner proposes to disconnect septic tank from residence and raze structure. Newly constructed accessory structure to be reconnected to inlet of existing septic tank. Effluent filter must he adde d to system to bring system into compliance with current code requirements. l � f) c celsary ♦ Ele ✓a'c. SErfACL're "ndi r Lon tb {AG 4 P fI�(�. l c ca..fr e X /1fii�� FarY1 /. n� 1 J ca /�: ��•( S C� �L�O"�omoF e.l R"t _ I ea coo r"e e ice:: 99 Coo: rlo o Slope W �T L�rvelp. ! 0 I o` Ici AL p �I � ex ;st; Gancre.,Et. .. o{' S; J �1 - 99.Vs' nor., �., /t FOUL/ Ex iSEi l 7 7sl' i rc5idcnce j COX a E'Xis�.�y lG8 c ry' _,� 6 panmon'�E ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer i A n6cV'SOn Mailing Address 5`Z G (en nnon. -L Pog Property Address S "`'L l s �7 -P \ (Verification required from Planning Departmen for new construction) City/State t Vt.V FOAs t w= Parcel Identification Number LEGAL DESCRIPTION 1. 3 F Property Location W `-, 5-W-- V,, Sec. T�N -R -W, Town of T✓' Subdivision A Lot # Certified Survey Map # N A . Volume . Page # Warranty Deed # - 7 (ta 1 . Volume Page # Spec house ❑ yes [( no Lot lines identifiable yes 11 no &t = handle SYSTEM MAIlVTENANCE ce� Improper use and maintenance of h sys tem could result in its Z z t=�adure 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 masWplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank's less than 1/3 full of sludge. 1/we, undersigned the ' 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 tha our septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 of the three exp date. � l 6/0 SI NATURE APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to th best of my (our) knowledge. I (we) am (are) the owners) of FS**N e of a warranty deed recorded in Register of Deeds Office. OF APPLICA NT DATE y 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 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa / of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity �'es ©k /000 al Permit # d o Septic Tank Manufacturer U A ❑ NA DESIGN PARAMETERS r Effluent Filter Manufacturer A/0 0 XNA Number of Bedrooms f NA Effluent Filter Model = 152 57��'''� .� NA Number of Public Facility Units ❑ NA Pump Tank Capacity I/d al ,ANA Estimated flow (average) BQ gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) ( 75, 5 al /day Pump Manufacturer m NA Soil Application Rate tl ,-)e- r 1-4 , Z 6, al /da /ftz Pump Model T �-f �� � NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit? NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal ells) y V Z ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) / ❑ In- Ground (pressurized) Total Suspended Solids (TSSI 530 mg /L XNA ❑ At -Grade ❑ Mound Ll Fecal Coliform (geometric mean) <_10' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. "NA Other: ❑ NA Other: Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: [I months) (Maximum 3 years) ❑ NA ears) Pump out contents of tank(s) 2 , l 1 4� . 5 When combined sludge and scum equals one -third (Y of tank volume 19 NA Inspect d ispersal cellls �� w� At least once every: o-3 ❑ yea�(s)1s) (Maximum 3 years) B( NA Clean effluent filter At least once every: ❑ ❑ year(s) month(s) .f NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) 19 NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) A NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page of START UP AND OPERATION ' For new construction, prior to use of the POWTS check treatment 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. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. �h,e has not been evaluated to identify a suitable replacement a rea. _ Upon failure of the POWTS a soil and site ion must be pe ormed to IocaTe a s uitable replacement area. � A ❑ Mound and at -grade soil absorption systems may be recafistructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS 4 IL6A _ Gu� its POWTS INSTALLER POWTS MAINTAINER Name Name ,Ste Phone Phone _ J f'y[.( SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name f j Name Phone _ _ Phone This document was drafted in compliance with chapter Comm 83.22(2)Ib)11►Id► &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. U, 2 5 6 1 P 3 1 -7 6, 1 .1 9 8 STATE BAR OF WISCONSIN FORM 7 - 1999 KATHLEEN. H. WALSH Document Number TRUSTEE'S DEED REGIS . C ROIX O F DEEDS I RECEIVED FOR RECORD Bryan McAnnany as Trustee of William P & Mary Catherine Kirkwood Irrevocable Trust for valuable consideration conveys without warranty to 04/30/2004 01:00Pt1 James T Anderson, and Michelle B. Anderson TRUSTEES DEED Grantee, EST # the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.00 (if more space is needed, please attach addendum): TRANS FEE: 465.00 The West 168 feet of the East 504 feet of the NW 1 /4 of SW 1 /i, Section COPY FEE: 30, Township 28 North, Range 19 West, St. Croix County, Wisconsin. CC FEE: PAGES: 1 Recording Area Name and Return Address RETURN TO: METRO LEGAL SERVICES, INC. 330 SOUTH 2ND AVENUE, SUITE 150 WNNIWOUS, NN 55401.2211 kleh•o Legal Services EDIRET 46159 :a 040- 1115 - 90-000 Parcel Identification Number (PIN) 360488 TD 2802112 Dated this day of April , 2004 * * B ryan McAnnany - - -- Trustee — Trustee -- - AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ STATE OF ) ) ss. -- - ----- -- - - - - --- - - -- County ) authenticated this day of Personally came before me this day of 3' April _ 2004 the above named Bryan McAnna Notely Ptd*414INNeOta - ny, as Trustee of William P & -. Catherine P. Mary Cat ne -- - heri - -- * Ca l asron E Kirkwood Irrevocable Trust TITLE: MEMBER STATE � (If not, to me known to be the person(s) who executed foregoing authorized by § 706.06, Wis. Slats.) instrument know! same. THIS INSTRUMENT WAS DRAFTED BY - Attorne Ogland Hudson, WI 54016 _ N ry Pu tate of 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. Information Professionals Co., Fond du Lac, W1 STATE BAH OF WISCONSIN &W-655 -2021 TRUSTEE'S DEED FORAM No. 7 -1999 LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF TROY COMPUTER NUMBER 040 - 1115 -90 -000 Parcel Number 30.28.19.473F OWNER NAME: First WILLIAM P & CATHERINE TR Last KIRKWOOD PROPERTY ADDRESS: Hse # 112 PD -- Street Name -- Type SD Apartment 312 GLENMONT RD SECTION 30 TOWN 28N RANGE 19W '/4160 '/40 Line Description Line Description TOTAL ACREAGE 5.090 PLAT LOT BLK 01 SEC 30 T28N R1 9W NW SW 15 02 5.09 AC W 168 FT OF E 504 FT 16 03 OF NW SW 17 04 EZ -UT- 1499/350 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, 174 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit x S U `� PLAT T -28 -N • _ R -2 019_ W HUDSON'W' PAGE 26 See Page 112 For Additional Names, R20W IR19W MAYER RD a raig, Scott ' g i & Melissa LC I � )aM R 11 5 1 i t 'lt�u►t R[3 2 tr YMCA "ud.. nhhn LAKE Gr Of e ater school Greater D1�* 40 ST C RCS I X st Paul 3 � �wMd RC 15 _ � I 199 a Dew. a s m. o6wu h°us p r lac 32 �!W Tnut 401 O —V'f FFF 5 FF � RED `~ 1 24 BRICK a" RD i I STAG James & IRD LEAP Ma gg et Norman LN Woo 12 6 155 & shirlee I aaa rwt WHISPERING I RI K Feyere3sen 39 PINES RD CIR * 20WNS 10 ao co 6 p m 200, VALLEY I B 24 Aran,,,, '- g RD 193 Gam lac tr �l6 142 1.£wt Ronald — Valley Gagnon Land Com- tr tr _� 40 40 Pan? 40 Peril John do Trust Dal Q '�upenter Mr &B Schllt- Harriet 56 l6 = $ 6 gen salmon raR < 20' 94 9 ie 9 40 28 is 1 FaM R l4tJ FW 6 y tr HaH � ICOVE 3o G M 6S lD6ar to W Q 40 RD tr Rsuis James & Vey i ssl J s H Margaret Lanol 1 r �' R Os Woodruff Company Q 16 s s 139 _ _150 f w —_— — � F 1 ohn zz Ber a wa 46 James & I gman 601 M 2 Colette i Ruemmele ROLLING , Trust 5 tr I MEADOW o ' 159 80 DR 120 Artllur S cott & Halo I Part- rldp is ¢ ohn Thomas I Linda Thuper c7 Cole- &Rea« rye 40 p w man Patnode soon 3s 1 w ,R ? LP 40 I �,j 38 Donald 6 tr. Brenda To Frank I Becker 12 , Properties Brown (&Lois f —oho us us 771 LLP ' ry 136 _ _ I — — _ 120 60 _ � 33pp �1 l tr tr Nora 00 $ Cheryl f Has , tanalae Alin , Ben tr 2 I$aaU50 57 "S Dai3 9 w &Lynn I u , ; soon C o stock Cemohous if 3 , 1 I Trust 1 m 4�aaaR so DL 0 40 160 , 2 ol 120 i eR a Paul & \CR D � o d' n z Q Delphine ' 2 I 0 o' o I G al J -: tr m Cl hnson Ge rald d i rm,r O M 37 3 m �J x T, gust Armbruster N o Radch 92 40 i RO iX GLENMONT RD I Hahn tr 158 F [] Robert � 2 o f R i Farmssa tr 4 . 148 MM 4 1 0 w U g Y �L�G AS79 - - RD � — �— — -g � � � f I )Arme ac ~ i William & wouam 40 B I len & =h- I Rebecca s s 30 9 G e or gia s man 74 ' 42 Kasten ,o H tr 2 Eubank en ' l!i', m I Trust g Jennings 1 sal r 187' & Heather 2 RELANDER $rothers I _ Easton ` — DR 160 lobo a a la 73 3 °++ N ILWA O RD lean Nancy u I 00 ^' h hrroy u , tau_ u QJ +� o Paul & 3 r3 I sen Trust H go I 40 117 Rosemary IL - U WBBam b GaryO I Duseck I WACO Bet Nancy 8010 .nu ter 5 193 N —RD ea g -- Johnson Jr M 40 — 36 g .,.� F(lfl ST. CROIX COUNTY ZONING DEPARTME AS BUILT SANITAR REP >' 0 IN07 Y REPORT ,,s 3 d �, A1NfidJ Owner r Aqq( xb�� is 86 6t rn �l 1 Property Address ('Yt A I, - ) City /State r � (Z ��, 03�i� .' Legal Description: Lot Block — Subdivision/CSM # a i '7 %4 �G7 '/4, Sec., T Town of PIN # 04(0— /// /0 --oC'7L-) `-3o. 2,8. 11. ` :� , N SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFO ! p OC Tank manufacturer � � L'S 1 ��i�e ST / Setback from: House �d Well �D P/L Pump manufacturer a u Model P Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width Length Number of Trenches f " 9 ela Setback from: House Well P/L Vent to h it intake ZH�' /%! fres a ake 7D� ELEVATIONS Description of benchmark 6 6 ! p( 7 Elevation Az ,e) Description of alternate benchmark s; d' P 0 Elevation Building Steer ST/HT Inlet p ` ST Outlet PC Inlet PC Bottom �4 + M Header/Manifold /D 0 Top of ST/PC Manhole Cover Distribution Lines (1) 96 , () 9 , 9 () 7, Z SL Bottom of System Final Grade Date of installation 0'15 number 3>4W3q State plan number 1 Plumber's signature b a l icense number 9c / Date % / "- Inspector _ Complete plot plan i NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW x Ex is ►�� Ue� �y e w 9�0 �,, gull QuYn� Run tiO g vn r W� New �a Mes 90AN $ w► a &V,0 INDICATE NORTH ARROW ' Wisconsin Deparmentoflndusby, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations . Dhisionof Safety & Bukings in accord with ILHR 83.05, this. Adm. Code . COUNTY S`T'• C4Z4LX Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), directiomand % of slope, scale or. PARCEL I.D. If dimensioned, north arrow, and location and distance to nearest road. Oy o — M lb - APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Gay L GG 1 u S GOR–LOT 4.1W 1/4 SW 1 /4,S 3o T 1Z ,NR \q E (o W PRO N f` RRTERR*. MAILI ADDRE LO BLOCK SUBD. NAME OR CSM L°S1"1 vdL �9 Z�3 CITY, STATE ZIP CODE PHONE NUMBER OCITY []VILLAGE ®TOWN NEAREST ROAD Rt. Uo - z Ff tL6 kJl S \1 ozZ ( L12,6 _ G13Z6 [ j New Construction Use Residential / Number of bedrooms 3 [ ] Addikn to epsting building N,Replacement [ ] Public or commercial describe Code derived daily flow VSO gpd ,,�" y ��,�p Recommended design loading rate _ bed, gpd/ft ` 4 trench, gPdlft Absorption area required 1 CIS bed ft a o o trench, 9 Mabmum design loading rate q_ bed, gpd/ft • S trench, gldIR Pry' Recommended infiltration surface elevation(s) S - o ' ft (as referred to site plan benchmark) 'S`l - 's ► R'fTUU Additional design /site oonsiderations 7'S *a t C' 1 3 �X 1S " w�1rN61+ C*PRehv StDQ. PjbQrt I-Mli CYt'AkDEP- Parentmaterial U� ev.VSz G\-?j -LPri- OV'TWT0XA Flood plain elevation, ifappCcable 4 ft S =Suitable for System CONVENTIONAL I MOUND IN-GROUND PRESSURE I AT -GRADE SYSTEM IN R1 HOLDING TANK U = Unsuitable for tem 5� S ❑ U QS ❑ U IKS ❑ U E) S [I U ❑ S ErU ❑ S ICU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxlary Roots GPD /ft in: Munsell Qu. Sz, Cont. Color Gr. Sz, Sh, Bed ITrench ~' S Ground 3 - Ly -S '1•S`9R /% S dS ticsbk ash elev. q 9.3 it - I's 31 Depth to 3 ! — S $ L s9 cri�, t m�l� - • y limiting factor S > g6" Remarks: Boring # J. [� 6 Ground - SVIL31 y elev. t { X16-8$ -) •S`f R 3 q2•Z ft. Depth to smiting factor Remarks: CST Name: — Please Print Arthur L. We erer Pie 715- 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 Signature: o18 Date: CST Number: Z � PROPERTY OWNER GGIrUS SOIL DESCRIPTION REPORT 'Page — t- of 3 PARCELI.D. Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boi nd3y Roots GPD /ft In. Munsell' Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh 3 0 - Lo vo \Z 312 - s i I Z`f Sbk &S c-s ) - s Z 1•b -3$ . 1 .o`�R 3 16 •s� I Z►nS oQ � S -S -1 Ground 3$SZ 1 - v/ S � l `LSb YvL ``1- cS •�( .S elev. Ca-.3 ft. �4 S 2.1 Z -)-.s `M VA Ivi, I Depth to limiting factor Z " Remarks: Boring # i Ground ' elev. ft. Depth to flmltlng factor Remarks: Boring # Ground elev. ft. i Depth to limiting factor { Remarks: Boring # i f Ground elei. ft. Depth to limiting tactor Remarks: SBO- 8330(R.05/92) PLOT PLAN Page -3 of 3 SCALE 1"= yp ' Z r 0 6' b' � z z [ s 31 2 N DT `tU ��" t ii'Z - �l- • ° l s • 2 � ON '�p`1�pr'I OF POLE, 8L.�6 . S�Dl�v6 W�LC lS 7 SO' FW" 'SYS1 n W 98 -Z4 Z C) - ( 715 ) 423 1400576 CST Signature Date Signed Telephone No. CST # ST. CROIX COUNTY TONING DEP AS BUILT SANI`T'ARY RE I' �� R�c Owner 0 2� j Address R City /State ST _ �? c,t ..st�J ,.mot �y .2 AL '�' I e n \, aVIA/�:OF, Legal Description: ` = ;i' ce Lot — Block — Subdivision/CSM # 13 / ' 1 OV 3 I /. me- 1 4 S�,v sec. S c , T - N -R /9' W, Town of P e1 o SEPTIC TANK DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC/ / JWSetback from: House /o Well >so '.P /L -2� Pump manufacturer waG Model D o y// Alarm location (BOLDING TANKS ONLY) Setbacks: Service road Vent fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: _ 7.�,vc ht Width S Length _ S Number of Trenches Setback from: House - .2 7o Well > oo PAL 2 ;7d Vent to fresh air intake > ELEVATIONS Description of benchmark eo p . �' ���� ©r /'eG= �c i� Elevation Description of alternate benchmark i, x,14 , -'o t l e A- �z 7- Elevation Building Sewer , V � ST/HT Inlet fl > - g/, ST Outlet- 9/, o,' PC Inlet 90. 7y PC Bottom tS'. 24 Header/Manifol y',S y 7 Top of ST/PC Manhole Cover QS; S8 D>istribrition Lines Bottom of System p O ( ) Final Grade ( ) /�'�, f 9 ( ) ( ) Date of installation / /G /fj I'ermit nu ber -�15J73 State plan number Plumber's signature A, License number 2a- i, eVa Date /o%/ 8 Inspector/ cornplew plot plan K NOTICE Please provide the following: • A plan view sketch showing everything; within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate ark, if applicable. Z � 1 PLAN EW v v � a N N v p. s cr tG X' /oo.o lee '1 i \j ' KATE NORTH ARROW VVIA4.;V11 U1 vaNcuuilaur vi wnunarcti SUIL ANU SI I It LVALUA 1 IUN Division of Safety ano Buildings Page of - 'bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complet@ site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and �Z percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # R 5 APPLICANT INFORMATION - Pleas i i�fE, c off 1. Reviewed by Date Personal information you provide may be used for pu se vacy i a r `s. X 5.04 (1) (m)). Property Owner � /�D r'::, "Property Location �X) I ovt. Lot 1/4,q,,) 1/4,S .3G T ,N,R E (o y Property Owner's Mailing Address - <J r9 L. t # Block# -Navne or CSM# Sr CRax 3 City State Zip Co ) F/Cr 1-1 City ❑ illage 0 Town arest Road k :gut L I v F� New Construction Use: Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow V S - Z' gpd Recommended design loading rate J i bed, gpd/ft trench, gpd/ft Absorption area required bed, ft trench, ft 2 Maximum design loading rate bed, gpd /ft ^— trench, gpd/ft Recommended infiltration surface elevation(s) 60 It (as referred to site plan benchmark) Additional design /site considerations Aw" Parent material Flood plain elevation, if applicable It S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ❑ S [Z U VS ❑ U ❑ S 0 u 1 0 S ❑ U ❑ S Z U ❑ S [21 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench o —s 3 r s 2 64 - L .2 S .0 Ground 3 _ . 5- - — L GS elev. G SAX MVFR Depth to limiting factor Vin. Remarks: GG z' .r, - Ol Car orm OW ArKK . - Boring # z A 3 s G S Ground -� 7 r _ C F elev. Sct �l/0 F o Depth to limiting l�0 2oly ` factor il—in. Remarks: 3 ''� 0 L/f CST Name (Please Print) Signature Telephone No. Address Date CST Number G S o z 3 30 Z �?S .z z / /doo SUIL UESGHIPTION REPORT PROPERTY OWNER � A Sl£Z�!�' Page _di— Of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 - — 3 v 2- - 7.5'- 3 Ab S 44vlAe X Ground 3 elev. Depth to limiting factor > 74in. Remarks: #3 - A G — "s ir1 S T�'1� b Oki Boring # ZA r .ter Ground elev. ft. ' Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # M #Z Z # DS �•, —J, C itR 47 141890 !/ ro *,Of Ground A Me O O Me' !/6 h�N� elev. ft. N XV IV& x F Depth to "' limiting factor in. Remarks: Boring # 0 fig - L s r_ ,¢ Ground Lp 7 elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) DAME FOMM MARA s {Nr Licensed !Kk T*stiw i PNnnbwl i�3233 13289`; F I�Md. 54023 R0� 07 r 7 D ES /9C,e y-.t - 670 TOP VF 6wV'o0o flcwED K =r�E / w�tL sS > loo' +i i IfOPE ��' yo��= �mm� �r T•� . ,�s �utT ��' �or9S`1�[tc tto�. �ctiivER- rrius`T 8� *f W7,4.- SP /VX 70Z 11 -*! E ��cF T GvA>r p4v?CAn Zr-VF * v w AIN . 0 --- �— _ o I � � to $' _ , e I o z r .E/� �,POf:Eirry tswE o vu xoncin ueparuneni ui a juu.�uy, S U I L A N U 5 I I L C V A L U A I I U N ti L I U tl 1 Page I or 1-Ahor at d HuMian Relations Division of Safety & euildngs in accord with ILHR 83.05, Wis. Adm. Code [ f ► � / ' +v r d� �✓e ,�G. & 7' L .� 9 COUNTY W. �T- LX ttach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference int BM , direction and % of slope, scale or PARCEL I.D. # Po ( ) Pe dimensioned, north arrow, and location and distance to nearest road. p q 0 _ ! ! lS - 3 S APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION L F� S N Z GGW -E8+- IU L�r 1/4 5,W 1/4,S3 C> T -?-6 ,N,R 19 E (a PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM # 31 4 v3 G L iz-� v7 kyjY lz.v>"Vb — - - CITY, STATE ZIP CODE PHONE NUMBER []CITY E]VILLAGE ®TOWN NEAREST ROAD [ ] New Construction Use jkj Residential / Number of bedrooms 3 [ ) AdditiQn to e xisting building j>d Replacement , [ I Public or commercial describe Code derived daily flow 4SO gpd Recommended design loading rate • 3 bed, gpd/ft • `I trench, gpolft Absorption area required � S 0 O bed, ft N VL 5 trench, 11: Ma)dmum design loading rate • 3 bed, gpd/0 - �J_ trench, gpd/ft Recommended infiltration surface elevation(s) q q It (as referred to site plan benchmark) Additional design/ site considerations 'A S 'x S ' LwQ G w/ _rs o s F [ ur-1 P Parent material S t L." S ems- M @iT o U0k S 4 s 1 Rood plain elevation, 0 applicable 1v - A , ft S = Suitable for system CONVENTIONAL MOUND 7IN PRESSURE AT -GRADE SYSTEM IN RLL HOLDING TANK U= Unsuitable fors stem 13S ❑U as ❑U S ❑U LAS ❑U ❑S ®U ❑S ®U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BourxiarY Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 0 -10 ZLZ Z 'F S 'T l-w y,�� h C w - • S Ground 3 Z� 6 8 - 7 . S y 1Z 31 elev C b-S ft Depth to limiting factor Remarks: Boring # a_` L - L — S 1 Z h1 S 3 Ground elev. G Z ft Depth to limiting facto 4 �� Remarks: T Name.— Please Print Phone: �� Arthur L. We erer 715 -425 -0 g rer Soil Z esting & Design Service -P.O. Box 74 River Fa11s,WI 54022 Signature: - - � y�,� Date: 1 _ .L 9 - c4 , CST Nwnb 0 0 5 7 6 PLOT PLAN P 3 Of 3 . age o SCALE 1 "= _3 ' 0 . 1 KB M1 BA3 3 ,FL R6 - ' 1� �z z x �i.R'1 �oLo s�pT C 3 l�lv S� Fvvc-G 3y0 f _. goo o oN gorty� c " C)F Po%-(Z- BLQG y F ( 715 ) 42 —ni 65 M OQ 576 CST Signature �� Date Signed Telephone No. CST # r , n (A O S u n d C �" f c 0) C A � CD m \ 1 m u', o "* CD < ` IV Q H v v o 0 -< D C 4 m z N U) C L 3 co 3 °° N �o O { 0to �R CO 00 y 3 U Z g 0 g 00� °Y cn y' 3 CD K c v v N y v l A— A v QO c CL M m ' O 7 > ' co N m O C C N I 0. m -a CO) CD 7 (n C K a A I z -1 w aoM mom 0 CD — Z ° CL C z W f I n 0 m' c o c CD 0 VC I b A I � N I ti I ° o .q ti O j ST. CROIX COUNTY ZONING DEPARTMENT, AS BUILT SANITARY REPORT Owner PR- PropertyAddress 6 ►^� City /State IZ e alt ( � Legal Descriptio Lot Block Subdivision/CSM # '5 r ' /a W '/4, Sec. L6, T _aN -R I W, Town of Tku�4 PIN # D �-1 � gl U -ZD SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer �'S Size ST/PC 1 006 / Setback from: House � Well GG P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY Setbacks: Servi a road en a Water me Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: T "q I1g4vP.j Width 3 Length 3"-So Number of Trenches 1 Setback from: House y 5 Well B U P/L a y Vent to fresh air intake $ 5 ELEVATIONS Description of benchmark ; �{ L N e P (L Z oS - 1 �' � � Elevation Description of alternate benchmark Elevation Building Sewer ST/HT Inlet S ST Outlet i a \ 9 PC Inlet PC Bottom Header/Manifold 4 C Top of ST/PC Manhole Cover ► g I Distribution Lines () I 4 , 3 - () g 3 a ) 1 Ko`�se � Bottom of System O ( ) Final Grade () () g 910 I Date of installation / '; ermit number 33?'7 State plan number Plumber's signature License number a a a 9 Date 3 / 1 / OU for fro c� C S ( ► N (C Inspector � Complete plot plan NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW YVI -� Nv� o ap 0 y� �A,fi PR�p W N INDICATt NORTH ARROW Labor and.Hurnan Relations EVIL AMU 011 C CVALUA I IVN Page of bivislon;of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 112 x 11 Inches in size. Plan must County �• Q Include, but not limited to: vertical and horizontal reference point (BM), direction and '`/ ' C " Ol • X percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # r O r o �/0 / /�Ct y' APPLICANT INFORMATION - Please print all lnformatlon. Re wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). • J `Cj Property Owner • �' Property Location &i-P -4 '�+�� �ri°5�r3E(Z Govt. Lot S £ 1/4 90 11/4,S - i) T 2$ ,N,R 1 E (or W Property Owner's Mailing Address Lot # I Block# Subd. Name or CSM# 33 6:/ wA0Aj 7 - RA City State Zip Code Phone Number / Nearest Road RfU �i'i•`/S �/ SAO ( ?!S x/25 • Coi/!v 0 City g viii a cH" own 6�145;t, - . ❑ NPw Construction Use: Residentiai / Number of bedrooms Addition to existing building Replacement El Public or commercial _ Describe: ��� T itJO T eQECD,±I Code derived daily flow gpd Recommended design loading rate N� bed, gpd/ft • trench, gpd/fi Absorption area required &bed, tt2 0 trench, ft23 Maximum design loading rate bed, gp� . & trench. gpd/(t Recommended Infiltration surface elevation(s) 5 Z- 7Z- 1 64 (as referred to site plan benchmar/kl p Additional design /site considerations �f� Grief Qz- /01Sve�, wI VA61? /J Parent material /OESS OUP 0&7 4140— Flood plain elevation, If applicable S Suitable for system Conventional Mounr+- In- GGrounn ressure AAT Gr a System iDR- nFill Holding Tank U = Unsuitable for system [9 S❑ U G S g U NJJ"S ❑ U Ly'S ❑ U El ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft WPM In. Munseli Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench' / -g ioyX V3 iii DF L• 2m% oi� / a� � 41 p-s Ground elev 75.1-5-ft. z. V/ /G y� vD 3� �/ /f r / / $' 2f sd,& Ma fe Depth to 4 7 S ,s , 0, s /N, AY cto�g 3 • SG -s ye c. s / �s • s 7 � � in. S s • �0 %0 Y SO6 . J . (/ • C7 Remarks: Boring # / •28 /oyn 3 qoy 2 - 59 76*yR y/(o v& s l� -► vsQ c . S . Ground 3 /o S S. O n+, ,� -- -- . ? •� y �'8 elev. . o - �. I - D �D crl_ -•o G�� v Depth to limiting e B �/� lit. . 1-4 ctor '4q —In. Remark P/ /A. CST Name (Please Print) Signature Telephone No. 1 poQ E T' 24 L$ iR ( 7 11 • 3,P6 • Pl,P S Address Date CST Number p.. 22, &3 ?5 Privats Sewage Consultants 4 70P OF 3 3 9 Na , �3 i� ►� ii 11 4 - 13 ° x° l ' r ' PAY too yIE P,e ve -FA 14 /A; 6- Vr.V yo s-pr/C �� &� 'y B , k 33 v 23 3 13eW 4 j, sa v Gi4y0V T S l�1.v WSi�v G - I ( ,b = 3 'v4p o W C �y 54ei6 7aT ,f W Ell y� ro W & Associates Z private " Consultants ' ,Gyt 655 owell gd•54016 Hudson, 0. y Jay. 3 of - � — n ■ o ■ -0 n c k 7 § § \ k E T 7 � 3 i Q! & /ƒ 7=ƒ A 7 ®§ 2 Q �• \ t $_ w k 0 \ _\ ~ k CD § c , 2 \ ) ] ° ° ° E E E E 7 g m $ & E / § £ % : G \ \ � � 7 m 9 § / ® CL / 8 S m § E ~ ~ - cn i 0 § 0) CO) 3 \ 2 / E ° E m cr §,.. @ , E % / 0 .. E/f 4 2 / CL \ ® 7 5 \ § ( c C4 [ } \ z e ( E f E CD n % k k - - 0 4� § 9 0 .. z # § ■ M » co CL z k fT 2 � �ƒ / CD ± 2 R � a 0 ( 0 CD � $ � \ � § � \ Q5 � Q5 � \ 0 \ < § / ?o �k i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Bolding Division . ' k INSPECTION REPORT Sanitary Permit No: 420547 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information ou provide may be used for seconds purposes [Privacy Law, s.15.04 1 m Y P Y secondary P � [ cY O( )1• Permit Holder's Name: City Village X Township Parcel Tax No: Karlson, Ted I Troy Township 040 - 1115 -50 -000 CST BM Elev: Insp. BM Elev: IBM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septi Benchmark �3° tao•D Dosing � �t Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet # Z TANK SETBACK INFORMATION St/Ht Outlet %k Z' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet / 1% 34 t t Dt Bottom 12 Q SO' eptic F ? Sn Dosing �� u Header /Man. �► �� 9�.�0 Aeration Dist. Pipe 1 / ..fib %1 `lb -�S• Holding Bot. System 1 9`.es gb.lrr 9S• bs Final Grade PUMP /SIPHON INFORMATION Manufacturers GPM Dema St Cover Model Number 6b q •� TDH Lift 4 Friction LQs System Head TDH Ft 15 • • �� IPurcemain Lengt Dia, K 1 Dist. to Well SOIL ABSORPTION SYSTEM 13 6Ars t arr ENC Width I Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. liquid Depth DIMENStMS ^3 G1 -+ N i i SETBACK SYSTEM TO � P/L BLDG WELL LAKE /STREAM LEACHING Man uf ctur r INFORMATION CHAMBER OR Val rJw ,. Type Of Sy� �f ' tct t ' Ito / � UNIT Model Number: IL • DISTRIBUTION SYSTEM Header /Manifold UL Distribution x Hole Size x Hole Spacing Vent to Air Intake ' 1 1-ength is Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only L ia A. • � 6J*4.3 Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil `P Yes �; No Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: (w d�• / Inspection #2: -� Location: 158 Skyline Drive River Falls, WI 54022 (NW 1/4 SW 1/4 30 T28N R19W) NA Lot ' Parcel No: 30.28.19.473B 1.) Alt BM Description = = _ - n = zo - amount of cover = 2.) Bldg sewer length > �` S C _ •ss � Plan revision Required? ❑ Yes No ,4- Use other side for additional information. Insepctor's Signature SBD - 6710 (R.3/97) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings " in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Into iP '' // R iewed by Date Personal information you provide may be used for. d� ses rivacyt�v+r�. 5.04 (1) (m)). Property Owner y RECElVE� \Ptop rty Location N-J 1/4 SW 1/4 S 313 T Z8 N R l E (o W Property Owner's Mailing Address p 2 2�Q LoJ11 I Block # Subd. Name or CSM# S b S " Ll Iv L t U -- City State Zip Code PhAne Numb%OUNTY C' ❑ Village ® Town Nearest Road Z lUE2 � l_LS kl) S�LOZ•Z ( '�S''�; o, �IZ.U�( Siz.YLIWC b5ztut =� E] New Construction Use: ® Residential / Number Code derived design flow rate b 0 0 GPD ®'Replacement ❑ Public or commercial - Describe: Parent material 6 l^_l,tL., OV17-J - 314 Flood Plain elevation if applicable ft. General comments and recommendations: �' '�Z' C >vl�'1 p 3 OOSb� '1T h1 Q KS Q N* A} 3 r A B I- I S ( LOh/6 w F7 N F-11 Boring # ❑ Boring Pit Ground surface elev. 1 0 ft. Depth to limiting factor X Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cent Color Gr. Sz. Sh. 'Eff#1 ' `Eff#2 1 S .� Z Fs - 32 LO`2r'L 316 - St Z`F m 'EI- d. I1 y Llu -LO -1 •SLm - 3/ S E. o sc� w► , w /Lam v/ a Boring # ❑ Boring ® Pit Ground surface elev. ft Depth to limiting factor f O 3 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�'L,rz_j /z _ 30 34tck-6z � C-S lvf 75 •g Z. -L[ I-S 4 I'L - sly — sit ��� z`�Sbk WL`E't^ 3 qz -.-Lo - I.Svz3fiy _ s `F� o sg m 1 - . 5 .R 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) Signatu O CST Number Arthur L. Wegerer b _ Z� •7 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 Id, 1- St. River Falls, WI 54022 715 -425 -0165 PLOT PLAY) Page of � - IF CpO NH LD l L Prs�lj^, ' J o %L � 6 Y- x ��► O v ., 3 eAC1, ��cn�ar 2�, tars 131 v AFL 10 1 Z p- I. ��� (�d /S0,12 P.,ce C wor one - t UAjee PO C 0 c+ �* t� a 3 .-.. • 0� woo o ao gy CL 3 � 00 ►.K Iwo c £a p a "��� • n go �i �Wg V J 3 7 N CD - n O !� C W ! !Y fn z D a N . lD (p cH D �' a � t Aa C N N 3 0 co co 3 1. ,� p Z ° ° 3 Q �• n t�l T '0 V :: m I o U) � (D C °I 0 eo I C fu I � fu N O. 7 ° a (n z x o O d A m O f 3 I ` xC O_ N �• y O O O fp 7. a ID W 7 R m --I CO) Z 7 1 A 3 - R 70 o 0N ' i1 Z N O O C Q N m T G OD 7 c (D O. p 0 aCD 3 ° :3 m ° A FCC 3 fT m ^ ur J ^ ! ° C) V A I j I E;yN = co`� CD �� Ky o° m c a * j m � � C , 4m p x Vl fO -� O ? �o �m m Z n I m'� d m'o m c� o I _ N C� W� O� O. ? N N i O i C N y `2 fD Oc O I ai y 6. r. 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