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040-1185-30-000
d O CD co� 7 C) 3 p N p to H� p � O Z Z O �? "i O ? • 7 N p C << IV Q F•M o N (D 3 p oo O v Cp Y, 1 :-4 w o ,00 A+ a y CD O O Cp � a m o N a CD h o CL c� C co _ O m N ,"0 p w i N O C Q TI 3 � O i � o x v N M N f0 m (D CD 3 m ' y N z Z o Dom' S U) y (n C N N C N N a C t6 Z A cn a � �� o a Q I W T m CL z g» z �o y CD A W p1 C o��. m <p O_ c N n 7 c y O = 1 C CD = 3 Z 4 O C CD a w U 5' CL �° o cw No c m N � � N X Q CD T C D t-j C L m f. N �s ° o C Cn O A O O CD O L ti Parcel #: 040 - 1185 -30 -000 1oi21/2o05 05:10 PM PAGE 1 OF 1 Alt. Parcel #: 36.28.19.759 ST. CROIX COUNTY, WISCONSIN Current X j Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner O - MEULEMANS, PETER J, & CINDY L STARR PETER J, & CINDY L STARR MEULEMANS 59 WOODRIDGE DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 59 E WOODRIDGE DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.400 Plat: 2237 -OAK RIDGE ACRES SEC 36 T28N R19W LOT 6 EXC PRT DESC IN Block/Condo Bldg: LOT 06 T I NCLUDE PRT OF LOT 5 DESC LOT 5 DESC AK RIDGE ACRES PR- 993/227 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 1/2 INTEREST EACH 36- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1115/591 WD 07/23/1997 993/227 PR 07/23/1997 962/334 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: \ Last Changed: 09/06/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.400 33,900 208,900 242,800 NO Totals for 2005: General Property 0.400 33,900 208,900 242,800 Woodland 0.000 0 0 Totals for 2004: General Property 0.400 33,900 141,600 175,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 103 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 429959 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal informatin 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: MeLlifleman, Pete I Troy Township CWQ - l�$S- 30-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 36.28.19. 7 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet IL Septic Dt Bottom Dosing Header Aeration Dist. ip Holding Bot. Sy to PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only D Depth Over epth Over Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil xx Yes L No ] Yes No E] COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: Location: 59 E Woodridge River Falls, WI 54022 (SE 1/4 NW 1/4 36 T28N R19W) Oak Ridge Acres Lot 6 Parcel No: 36.28.19. 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes n No 1 Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 '$hSln Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608)266-3151 % 2 S If Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal iaforroadon you provide may be used for secondary purposes Privacy Law, s15.04(l)(m) Project Address (if different than mailing address) I. Application Information - Please Print All Info RECEIVED '�- Property Owner's Na me Parcel iY Lot 0 Block # MAY 0 5 2003 Property Owner's M ailing Address ST. CROtX COUNTY Property Location Ac. G(/ ZONING OFFICE City, State Zip Code Phone Number — lf' 12 '7 1S-_. (circle one) II. Type of Building (check all that apply) T N; R�E or W VI or 2 Family Dwelling - Number of Bedrooms 3 Subdivision Name CSM Number ❑ PublidCommercial - Describe Use ' ' F 11 State Owned - Describe Use - rE01citX ownship of T,�m V III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' ❑ New System y Replacement System ❑ Treatment/Holding Tank Replacement Only L7 Other Modification to Existing System MYXre# 4Y, /9�e ZZPZ B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. of POWTS em: (Check all that a 1) 2 J WN - Pressuri In -Ground ❑ Mound > 24 in. of suitable soil 11 Mound < 24 in. of suitable soil El At-Grade El SiW Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Chamber ❑ Drip ❑ ravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Info on: Design Flow (gpd) Design Soil Appl' tion Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) I cy��le�w�tion VI. Tank Info Ca ity in ' T060 Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units �- Concrete Constructed Glass New Existing GK.�G�t✓ Talcs Tanks Septic or Bolding Tank y�G(� Aerobic Treaunent Unit I�-f CAU -QcC 1'La���-2 � �• Dosing Chamber VII. Responsibility Statement- I, the assume respomffi for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plum 's Si gnat - W /MPRS Number J Business Phone Number Foge Plumbing .z a /� l Plumber's A City, State, in Code) / 28288 McKenzie Rd. VIII. Use Onl pproved Disapproved Sanitary Permit Fee (inrctudes Groundwater Da Issued o Stamps) Agent S' Surcharge Fee) / l s ®� Mu� ❑ Owner Given Reason for Denial oc IX. Conditions of Approval/Reasons for Disapproval Aovc Rn k; � !� SyS /Pil, - �o �uS-�irr� �2 v3a� s�, f�•y,, .Gr7�"•r �J Attach coo plans tv ty only) for th#kystein on paper amt less than 81/2 x kl inches in size VYisoonsin Department of Commerce SOIL EVALUATION REPORT � Page /of 3 QEtRsion of Safety and Buildings in accordance with Carne 85. Vft Ado. Code County � Attach complete she plan an paper not less than 8 V2 x 11 inches in size. Pbn mist include, but not liirrrhed to: vertical and hawonlal reference Pant (BM), drechon and Parcel 1.10 . percent slope. scale or tknensiats, north arrow. and location and distance to neauest road. Please polnt an information. - -law 1 by Date Personel iniormaGon Tar provide may be used for secord 1&04 (mp. Pity Ow,ter R E C LIVINOWW Location . . JM A I&AM S r` T � N R E( Property Ownees Mailing Addreis # Nock # Sk". Name or 6" gn dtw own Nearest road r State Ti p oN�fJG�OFFI ❑ ❑ New Construction Use: 1 Number cf bedrooms 3 Code dedwxI design flow rate GPD &i *Moernent ❑ Public or conrnerdel - Descnbe• Parent material xe z ir4,n Hood Plain eleva8on tf applicable and wommanendalions: taofiltT s1 /1 �T '" +bra' ft�E . ��47L ��d •�J ❑ 8arrn9 pit Gra.rd surface ete+r. b ft. Dep1h to irrrdrg eacw 7.?— _lo- Sop X8 Rate Horizon Depth Doa art Color Redox Description T"kKe swucb re Consistence Boatdary p4xm GPOJtP m it. Munsell ou. Sz. Cont. Color Gr. Sz Sh. 'EfM1 `Eiflf2 -- 3 / C 7 .2 2 d -- • i AV 3 X M h pre eorin� # ❑ F I pi Grarrrd surface elev. _ ft Depth to A 9 factor !d in. soir Application Role Horizon Depth Dorf& tart color Redor Description Texture Swucrse ConsbW= Boundar Roofs GPOW in. Witnuell ou. Sz. Coat Cdor Gr. Sz. Sh. - 'Effi1 'EW2 / LS a. 2- ` _.. Z Eflkwa #i = BOD, > 30 < 220 mM- and TSS >30 90 mpfl. #,2 = BOD, < 30 � and M < 30 age _ PST Now (Please Print) CsT Number address Fogerty Plumbing & Perk Testing Ode Evawation Ca Kkicled Telnohone Nun hor 28288 McKenzie Rd.____� Property Owner Parcel ID # page of -3 © HOW # ] �9 5 2 in pit Grorrrd strface elevr. _ 9 _ R b ^9 Sao mate Horizon Depth Domirrant Redox Description Texture StrueYre Corte Bo Roots GpnNF in. Mursell Qa. Sr- Cont. Color Cat. Sz Sh. 'Eif#! I `EM2 Z L s e— Z 2 3 as �._ ,w C . z if AIV.0 6KIC AVZ - A F A- # Pit GFOund surface etev. R tom+ 10 tacloc Sol AppocaT lisle Horizon Depth Oomirrard Color Redox Description TexUre Structure Garrsistenoe Boundary Roots GPDJIf in Muse• Ou. Sz. corn. Color Gr. Sz- Sh. 'Etf01 'EA/1 a aoundsuffaceelev. m. ('7f Pit tl D Depth a �9 � � Raw di D Dm*w* Redox Description S7- SYudure Corrsislenoe Borrrdary fools in. Munsell Qu. Sz cant. color Gr Sz Sh "Etflf2 'E1#1! ' Effuent #2 a BOD _< 30 mgll and TSS _< 30 mgft. 'Effluent #! = BOD > 30 220 rrxllL and •TSS >30 < 150 mglL s s 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 departm at 608' � 6L31.fl or T- TY 608 -264 -8777. SW4)30 (ItAM) I O B'3 X Exrsrsx/L A-z"') �ET� /JI�t4Gaz Mf¢if/ ti•T F�sr� r s� .r y -ix o-3 Fogerty Plumbing #221180 X a-Z 28288 McKenzie Rd. Spooner, WI 54801 (715) 635 -9609 .•va�r�: ,Err�rsKl�..+►rv.J ,�it.,et�itlG z Bt�N'+. scy�t,�.� -� w /GtFr srXr.�. 14v&Xa s yd7��•- T� E�t-rrsr.1� .�s�r�,D fi9�e �v'A- .� A�S�s d � dam% �p�gci9h�79 s�/T�Gp �ncT d y e� .rsrsJ S�7^tar - i Q N A N A+F2 ' XX fir, sF 1X'ZP 9 Ae2• f' Ow • _ � LvT Co'�rfIER �c oD. p = ,N,ES..�.S��K S G�iELL� ,r..t.U• yaT�fG/� BK ;NRpY (E) �N T.28N. - R.19W. E is ot99, ra,✓r:.r r ..pR> atT..�„N}6ta, S 28 _ - z z -. s - Walt.- F.#, tTr NAI @ S w Fmde ck = c M} 4 LYE 5 s S � • F JOn MAXI � 108 WiF�cu�obn m Ilt U 41 Ri.ua �3 uas _..�._. _i. <. i - Rw u . n ., ...._ _ s _R_ -- a W Hi Ridge s - „ . „ s } w 40 x ra a 81 CUPP UD ON 36 � . 1% curt . ° a A ReKF ... •63.44 s 66.37 t Ga s 40 u yari Iss NR, Gordan& Dodd& a C6RL ra;,nt Grad n & Helen '79.47 3v4u:e Paniaa Z", c R XG iTr WdF 40 98 s z ' s M 'e Iarsen ' 20 40 e<IM Raer xv ' o Knot Tr am r Diane law Ir& n r.iRw F t i t s l a sin T. 2-a 159 80 Sldamv 2 & o Daniel & Karla Malg t D vid z:: T. Jig 118 G 3t.9 Davij( & - a1n:c.s 49 }te{Ly} 40 yy 'K 1hle �,an R ker x Rebgaca r 6 ndl- FF 31.1x' T—' f Craid& 1 — Burt Ji 191 71t85 e ! 141.55 e--use Marl" T Ikummd 40.[41. ntce a 3732 Rohl 5544 a 652 Irreae ck & R Chim es & o sti1 "1•- p u R 80 Barbara Gatbe f 179'41 Leo > R An g Ameri an M rials etnt M 1RJ18 Ray P- k 76 C a • n 40 - R hl Tr 60.76 <, 40 t ns satr 2-o `', r 295.2', 9.63 Cary & �& &G Rolli Hills •2 — w 101. R M } a s 1• _ K '.2-.. an Glovm rw7 I Station Tr Tnist X40.3 Arno & 65.4 Hopper Bros Raaau M Bi 745 xa rr i41q 4 z. µ htaAiruy �+ V 15 2 . »,. Ts i 6 R Rob -lt,. , <dr 2 C & n6c� & ge9 Ronald v All & _ David I 184.42 $ o W l oxson 116 & _ C tie rF ♦ 1541 - .� �- .. y ms Parirtership tla inn a� juvene TlvlaLV = f Raen n k R + . ,12222 145.11 42-31 a3 sc 75 ; $ 7422 a 1 ar a ;. a E 0< y 4M lvor w tinder M Do4d & " _ > t 6791 Kathryn Dean & Phyllis ° x F Tr a 6` jean Hu �rt rc E Smith Alert 16.64 m `� 1 1 3 111,.81 1>atri<ia; Ctw6- Bas `- A4gae1 'kilo ) W.tis6r F a a adnn 1573 Glad r�1 M'i ael & _ 126.115 40 m o _ 1 Farm Famil a e '• land t DOriald 45.85 .44'u� 240 T[US 4F t �a a1 "ip Brown kTL. �, r4 m- a 6 Orin & ivlorman AI t & 19227 �"'-�' V " it 161.5 € Co al ry JohM1�n M aret re M 1 55 4 >30 Ti m erman 1 xa4 r I D.Y rmsa Carl Sue <r.co a & Rut w6n 40 & t �p1k i »� 40 War Ki�karney Golf 4e Houk . 4a 74 4Yy " Hi Is ton} I,{n lwlyn, sz99. r„ ndan r , 1 Bauer Uni 1[Slty q�w 170 Hill" 2 nu.raa..}+ L" . 36.13 5M of Wisconsi r....4.b 4t.(19 a. Daniel Diva ne `'" °t I J. . 10 R g�� & Te ta � Orin ue ye a 65 i Ir Ivw 1 _ ahl & Patricia _8c rtancy._._. ea . Jeann' ne 123.9 reisen 245 Ioh�son Ru1 G� 15 .4 Carl n o 1 4.9 1 107 56.9 o MM s a Ph i t 6 Vemalk Cindy* David Cheryl Harold & P4!na 4 ;194 j an . ' 40 Lynn June 84 Feyerosen -. _ a 1 RM I1Wl Morin 3- 41 NM h4t v�er4e1&I10 ^ a t L A a .; nder He Gary � 201 &Julie �t H de - M oe z , 796.06 cO TX FALL ".. x J9e1�oT1 77.47 m Cerriohous T8 110 3 10432 1 187.67 90 °0 63 nsx1. M r M 500 6tJ0 800 sao Pierce County f tail 'the shine i the smile � The thump o a 1n the r of happiness on the face of a devoted pet,., THE AREA'S ONLY FULLY EQUIPPED Remember it all in a tim photograph of your treasure. FRAME & UNI -BODY REPAIR CENTER 10W Hills S • •Complete Auto Body Repair • • Foreign & Domestic • Auto & Truck Insurance Work - Frame Straightening • Animals are our only specialty Auto Painting • Check Our Prices • Free Estimates • Farm appointments available .,r.. 812 Hwy 63 N • Baldwin, WI �I i o i B-3 E'xr�crxidL Fs�Gte)( 7, ' 1 / 1 Fogerty Plumb *221180 X 8-Z 28288 McKenzie Rd.- --- -3i Spooner, WI 54801 (715) 635 -9609 . Fv I I �t/�: .Err�rs+✓�� G z Lipycp'+. syy�t�m rd / L.rF�' STI�r -r�1, 1110th Leoe.SW/, TA / IC�ttT,ILsi+�G rf J r 8�r �,,�'v .wra �,+a arm, ..�v strsrF.as - for '� S9 SCALrE � + = 3D Q H = '4 M 7;;P is = Bar�sdiG . iBpw9d lof Cae+t+ER l��Q . J`-M7,Fiz 5C MAr,rCA/ g. 9j 7s � ` 3 4 , 7. i � r y 0 n �` \ g rA IWI (fQ N OQ • \ >/ O a. . p E � IQ ,.. � . ' � to o � � ►'t Iw a �. •�: • :.,: n C A. N rA rn �► :.:'• t fit. II l 1 h "s .•'. . �' \� \ ��. ' N N •rl co O I • � � � CD 00 (o cn 3 C v tTj °ooa u3a u II u V') POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner -10A-1,/S Septic Tank Capacity 000 a l ❑ NA Permit # 21 q Septic Tank Manufacturer H ❑ NA DESIGN PARAMETERS I Effluent Filter Manufacturer SAihcel ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model k - S , — /�' // jV ❑ NA Number of Public Facility Units '�OA Pump Tank Capacity S al ❑ NA Estimated flow (average) al /day Pump Tank Manufacturer UA k hdwv% ❑ NA Design flow (peak), (Estimated x 1.5) ��� g al/day Pump Manufacturer S�� ' ❑ NA Soil Application Rate g al/day/ft' Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit XNA Fats, Oil & Grease (FOG) 0 mg /L ❑Sand /Gravel Filter ❑Peat Filter / Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand IBOD 530 mg /L X In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :530 mg /L J, NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) :510' cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ Nq Other: ❑ NA Other: ❑ Nq 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: Z--3 ❑ month(s) (Maximum 3 years) ❑ NA NFy ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA ❑ month(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: `z� 3 0 year(s) Clean effluent filter Tom' IJ on � At least once every: Z ❑ yea�lsl(s) ❑ NA ' month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: I� Z ❑ mont mont ) Flush laterals and pressure test At least once every: ❑ month(s) ❑ 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. Page Z of 2 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 cells) 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: f. A suitable replacement rea_has been evaluated and maybe utilized for the location o a replacement soil absorption system. The replacement area should be protected fro m disturbance - — compaction ana spa no e m rmge upo 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. T alua ' a o ing ank b fZ 0411'B ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone (�� 3 s Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ST. ( d ZOrJI �(J Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54111, (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM I Owner/Buyer Mailing Address' l Property Address (Verification required from Planning Department for new construction) City/State Parcel Identification Number 0 LEGAL DESCRIPTION Property Location SR ' /,, ,�!/�J '/4, Sec. ,-? g� TZ_N -RZ 9 _ "A', Town of TRo Subdivision CAAs , Lot # � Certified Survey Map # ''— , Volume , Page # Warranty Deed # g.>71 f ? , Volume !1 / S_" , Page # Y Spec house O yes O no . Lot lines identifiable {dyes D no SYSTEM MAI 1eAr? xelsrc Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, 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. I/we, 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 Resourcet, State of Wisconsin. Certification stating that y ��LL ou �� r septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 the nyce vP9r Pyni""" 1.- IGNATURE 6F APPLICANT DA OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pr descri d above, by virtue of a warranty deed recorded in Register of Deeds Office. J / S GNATURE bF APPLICANT DAT * * * * *• Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Depa *• 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 I APR. 23. 2003 1; 50PM "" FILMTEC CORPORAT109 17'I56395288NO. 4690 P. 1/1! 7ir � i I ST- iCROIX COUNTy ZONING OFFICE CERTIFICATION STATEMmT FOR UTILIZATION OF AN EXISTING SEPTIC TANX ' I I Th s is to certify that I have inspected the 'septic tank presentl se i1i the - I residence'located at Section, s '�i , T .2� lI, R Town v I Upon inspection, I certify that i have found th !! k and baffles to be'in good condition,, and it appears;to b fmi ctioninc properly., Last me serviced: h I i Di fi w back occur f�om absorpti n system? _ ;Yes XI No (If no, skip next line) I Ap rox'mate volume or length f o time: allons 9 m 3,nutes ca'aci co structio Prefab L * on crete S ' � teel Other Mamufal tarer: (If knowi:) . Ag@ of Tank! (If known) i na ure); (Name). Please print i CrA a:4 - - � -� Mi le ' G i I ; (License Nunber) i Dat Z 0 Fo t� be completed Iby licensed lumber Sta ut s) or Licensed Disposer p 6 5 Adm wi,sconsin Cod) I I p (NR 113 Wisconsin Acboinxstrative Pl� _e i (applying for sanitar _ — — _ _ _ _ _ ... _ _ _; _ _ _ -„ _ I g y permit) Certification. ' In cc4pti;ng the above) statement regarding existing septic - tank con'iti n, I certify that the tank to the best of ay nowledge. will con o to the requirements of ILM 83, Wis. Adm de (except for fins ct'on gpeni.ng over outlet baffle). ; Signature P /M PRS ' I i I APR, 23. 2003 1:51PM�,S SF1,Lni iAollpNl INC. 'NO. 4692' P. 1/1 Soft Ta & Homing Tank PUMP, ,� Unclog S n3 rom Sin main I es with Muter Testing Li k Sewer fin electric rooter & Bonded - Wisconsin!& Minnesot O IN and ��D4nls� i (7 1S 27 1I7 or (715) 2 Trucks: 3300 Ga110n Tank - 200 Ft, H ose 5 57 th Avg. Efts portable T I wot'th� I 1 54011 oilets for Rent 4 ' G! ' y Drive T Ck —.Jklu� i —'/ Loadin _ Unloading Time MEMO i p TE i mp Site CHARGES CREDIITS BALANCE Lf! 2 Septic Tank gals. i� I Pu ping Chamber Lp i D Well I ga ls. 4 , i Holding Tank I i gds- I I D ' ~ —� ! Cha gals. rge j 7v pax i1�IEI/ '�S7 r rj � -.7s , i I l I I I 1 Vl % MONTHLY Fl RATE -IF, NOT P p N 3 , 0 DA _ 19X ANNUL PERCENTAGE IN 3,0 DAYS 50t MINIMUM CHARGE o��AB PM u�sr unou. w E co�uNw tree r,€lz C',�r lr•�i� Unplatted land S00°07�W 646. S 00° 07W 357.62 .0 110.00 ° e 123.81 123. 81 °4 ,00 � ° ° o o ° � '0 ° v 0 Z 'Q O 0 N � G,O� 0 ° 1I : '11 00 N OD 0 O v 0 0 - co co g � ) 500.00' w w m _ m 0 100.00 100.00 100.00 b O P o p • N j O N �W M 0) O CD 0. 42 12 3.81 -423-81 °O ° c" z 4 N 00 0 07E 2 . 92' OD w OD M pp N �0 % w 0� Sc enic 4* - — W ` O cn sD i� ti a �6' _ 4 N w 9 w o 8 ro W 00 E °q\ \ \ o 0 ' S00 1309. 36 j g °° 2 l�" 9 c y � 109.36 0°6 100..00 100-00 O N 4 ' \ \ �O o ce OL 100.00 1 100.00 100.00 N 00 5 .00 °\ 0 W _ _ — Dri ve 9) ° o ° s � OD 0 % b w_ O ) W 521-64' °'O0 SAO 000. 0- s 100.00 100.00 IOO.ao ' o - `D N ° ° �� �0 �4 O ' 0 0 0, 0 3,80 100.00 100.0 cn ro Z 1400 ao PI 00°07'E ' I � W O tD W I O O O C, 00 N O W c °° \ \ °� 41 00 0 O CL 9� O° 0 a 6 �► . O ° ; e 100.00 100.00 100.00 ° ° 87.20' N. 14 00 0 07'E 587,20' r Unplatted land s i DOCUMENT NO. i! STATE BAR OF WISCONSIN FORM I -1884 I THIS aracE acscav ►oR RECOaoINO oars WARRANTY DEED C��/' 111 This Deed, made between ..Patricia - Jil1 n ) ST c , . �, _ ......an .. J. ae. 1... C, ....Han.s.o_n.,...s.�.ng.1.e... person .s......---- •-- ------- - - - - -• i i ................................................................... ............................... ..... . . - - -• i MAR 3 0 1995 ............... ............. ..................................... ............................... Grantor. !� ana ... Peter ..J.....Meulemaus...an_d.. Cindy... [......5_tar_>;,______________ t 11:15 A. ' r sing le. .pe son s ... a.s..j.oint. tenants... .............................. I _ -._ . .......................... ............................... Grantee, ._ Witnesseth That the said Grantor, for a valuable consideration -__ - -. • conveys to Grantee the following described al estate in ..$.t..,...CrO1X........... RETURN TO , a e of Wisconsin: Lot Six (6) of Oak Ridge Acres in the Town — — --- -= Tax Parcel N 1185 - 30 corner of Lot 5, Oak Ridge Aces in the •••-••••• Town of Troy; thence South 89 53' East 100.00 feet to the point of beginning of parcel to be herein described; thence i continue South 89 ° 53' East 100.00 feet to the Northeast corner of Lot 5, Oak Ridge Acres in the Town of Troy; thence North 00 0 07' East 11.92 feet; thence Southwesterly 100.71 feet, more or less, to the point of beginning. !. Part of Lot Five (5) of Oak Ridge Acres in the Town of Troy described as follows: Commencing at the Northeast cgrner of Lot 5, Oak Ridge Acres in the Town of Troy; thence North 89 53' West 100.00 feet to the point of be� inning of the parcel to be described; thence continue North 89 0 53 West 100.00 feet to the Northwest cgrner of Lot 5, Oak Ridge Acres in the Town of Troy; thence South 00 07' West 11.92 feet; thence Northeasterly L00.71 feet, more or less, to the point of beginning. I ANSFE::l 3� 4 o• This ..... homestead FEE > $........_.._ property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And ..... . P. at. r. i. c. i. a..., T. i. ��._ He. tidre. kson- ..and..Joel- .C.-- • Hanso.n • __ •_ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except I easements, restrictions, and rights -of -way of record, if any, i and will warrant rnd defend the same. Dated .. .......... ............ .. ....... day of - - - -- .... _.March. ........................................ 19..95.. .................... _........................................... ( SEAL) k.C..[ -cc .GLC.. !^ ....... (SEAL) ' ............................................... • Patricia ._.Jll.._Hendrickson.... --------------- -------------------------------------------- ...— - .(SEAL) `/� --.4... Ems. <._.`. /..fc.r�r.� ................ (SEAL) ' ................. .. .................. • Joe_1 ._ Hanson.....---- • - -• - -• i AUTHENTICATION ACKNOWLEDGMENT �I Signature(a) ............................. ............. ............ ...... STATE OF WISCONSIN •-----------------------------• -••--•._...-••-------- ----- ---- as. - county. .......... ...... Mar I authenticated this ........ day of ........... 19 ............. ...... Personall h came before me this ...2 7th •_•day of --a r , 19.9 5 the above named ---•-----.--•------•-------------------------------- •----- •--- _--- _•----- - - - -_- Patricia Jill Hendrickson and -• - - - - ----•---------------•---------------....--•-•---..._.._.....••--••---- _.Joal Hanson_, . ......... TITLE: MEMBER STATE BAR OF WISCONSIN ... -.. ...................................... (If not, .............................. authorized by 1706.06. Wis. State.) � .fit ..... ..................................... ....... noab totDe *lhetrson .S ......... who executed the fltstru ,aed n ledge the same. THIS INSTRUMENT WAS DRAFTED SY Q , J� I C. :_._�,ty Gt�y..4 -rd -, Attorney ...... ........• -• - - -- , �I Riper Falls, WI 5402 ?. •� l -•--•--••-• • $.C.r.. Ct O.i.X County, Wis. (Signatures may be authenticated or acknowledged. Both MY ► pia permanent. (If not, state expiration are not necessary.) • ". Ms 14 ' date .... .... .... •--••--•_--_ __--- --•- ...X 19.. -) � •Names of persons sisnins In any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wi =consin leval Blank Co. Ina FORM No. 1 - 1933 Milwaukee. Wis. a a J �J { . *mo w '',, { +. { w s ,.. _: :.. • - AS BUILT SANITARY SYSTEM REPORT h .. Aw 1 . TOWNSHIP SECT ST. CROIX COUNTY, WISCONSIN. N t ON ' e LOT LOT SIZE q PLAN VIEW 'fis and dimensions to meet requirements of H63 HING WITHIN 10 FEET OF SYSTEM Y xt lt �p t I Zy(} r 1 X rPe t• ✓ F F SL' L ij . — .. ,F e re f eren t � ce Point) Describe ?_ pattical reference point Slope at site 4 �, Max of aeturer : i4seg 5 Liquid Capacity : an cover �, Tan ck manhole cover e'l.evat 6n: , . 3 lsvatio Z,, Tank 'Outlet Elevation: 1 Number of gallons 150 ram, set or a c cue S gallons;; total capacity o �£ pump 3' g al size o pump head; horsepower , ap ; tea _ ; ran name 'of pump 4 , ' p '" a Jj( L�r¢►'r t v� ; a jie t�caurer,. Number of gallans_____� ' manhole ;cover ,` um er o pits eet ameter � $ seepage pit in et P1,06 -elevation < j p. t "e ivat on feet, nok off' dines I width ler gth 57 t ile depth PY th `length - ,� INSPECTOR PLUMBER ON B LICENSE NUMBER a P � ��Ebn t4 x� Y1M { i s DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR .5 16- -k' SAFETY &BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. E OX 7969 • BUREAU OF PLUMBING MADIS4 WI 53707 ❑ CO N V E NT I O N A ❑ ALTERNATIVE Stare Plan I.D. Number. (lf assign / O / E] Holding Tank In- Ground Pressure ❑Mound NAM F P RMIT HOLD R: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: BENCH MARK (Perms -e" re erence point) DEESCRI BE IF DIFFERE T FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV.: / 3 Name of PI ben MP /MPRSW No.. Counry � Sanitary Permit Number: o _ SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELE V.. TANK OUTLET ELEV. WARNING LABEL LOCKING VE PRO IDED: PROVID 0J l l.' I c3 YES ❑ N O ❑ O BEDDING: VENT DIA.. VENT MATL: HIGH WATER _ ' ROAD: PROPERT WELL. BUILDI G: VENT T FRESH ALARM. T ._. c/ LIN AIR INLET'. YES ❑NO ❑YES ❑NO D SING CHAMBER: MANU BEDDING: LIOUID CAP ACI7V PUMP MODEL. PUMP /SIPHON MANUFACTURER. WA NING LABEL LOCKING COVER f i n R IDED: PROVIDED: YES ❑NO tZ I YES ❑NO ❑YES ❑NO GALLONS PER CYC PUMP AND CONTROLS OPERATIONAL 'PROPER WELL BUILDING: VENT TO FRESH (DIFFERENCEBETWEEN {�� u�uNE AIRwL PUMP ON AND OFF) 6/ " S ❑YES X10 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plow g LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until 4 D the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO.OF DISTR. PIP PACT COVER .INSIUE DIA.. #PITS. LIQUID TRENCHES. MATERIAL• DEPTH. GR FILL BELOW P PES ABOVE COVER. E EVR IN E S / END I R. PI MAT IAL PNIO�DISTR +�k r �R�O� ERTV WELL: BUILDING: AIR To RESH MOUND SYSTEM: Mound site plowed perpendicular to pe Che th ture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: f un stems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ts t e criteria for medium sand. TIONS MEASURED. ❑YE5 ❑N .SOIL COVER. TEXTURE. PERMANENT MARKERS: OBSERVATION WELLS. ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH'BED DEPTH OV TRENCH, ED DEPTH OF TOPSOIL SODDED. SEEDED MULCHED. CENTER EDGES ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: »re FILL DEPTH ABOVE COVER: WIDTH. LENG TH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE- S TRENCHES: Z Zq MANIFOLD PUMP M MANIFOLD DISTR PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE ATERIAL & MARKING. ELEV.. ELEV_ DIA. / ELEV. c PIPES. DIA.: '7 ° o� �1� Ci HOLE SIZ HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED qtr PLANS. ❑YES ❑NO YES ❑NO COM LINE: I D PERMANENT MARKERS: OBSERVATION WELLS: ROPE WE � BUILDING: I N.. v/ I rj ❑YES ❑NO ❑YES ❑NO 5•!C� 2.93 X15 !,I j Sketch System on Retain in county file for audit. Reverse Side. - SIGNATURE: -" . TITLE: DILHRSBD6710(R.01 /82) --�'r A l�T rz.N a TIC S' -lST� M Q py�yc,N Ms�t� .t 1 (6 D►m ?. PIP�C Qo M/N 4%%.L O G� s a� •SE G CI+�►o N ( l3 r�oa r _ -F— ` `i PE 94,0 PS�sr� Car�cT2uv'flew p�{al�: two -rTO►^ oc -- i ` l WXC-AVAT1oN rr ��rr ; r t n �r y qr 1£.t -EV = 9�J.�7. yi' To �' /i•.'A6�(aR.CbATbt Lu A$pVtS ! w QEtaW VISY. PIPt 2N�FOQ�+� MAIN 8 TsaCI ST i TSOQA� ��G.1. To f.ISPTIC.. GWVMM _ FoR.LL 1�1 1117J. ( LN - TOP I" MO PIPE PROPL STAM AS t5F_NC.M MAQ-V- MLMV • = 100.Q0 SW o l e ll Ir F yt tt inrit 4L. �i! EE1� h�'� l �Q BSA �6 • 0� V �P. srA �p_�` �O Z "Ga FoR�C /.AAlwl Will( R CH C , , , , - 9 W J TaP wuT cuMv. $b.91 r � 4 o fix, s 11a G. N o l l C 19 3 �I,� � TANK.. TOP M.►i. E.�,V• � 84.(. " Q lus covo G,t►�trona 1 POMP � 1 ~ti --EV . '9\ � °11 • (o .e. 1N D «A•C� s 'bow-(94, s t Yc '�� S SNECT 4A15 �a 2 j :Z E'AI G N 4,06A '1'! � N 7"4 4w kow i t Y it Y Y u OD I'I i 1' 1 S . r•: S. r IMF •. N�• Y4. t T { T a a t � rF r + r s'S 1 f � Y i } 4 r � s ago U �" �► x 1 -, I �O 1�► 40 ` S Y 1 0 t � + {� PL State and County State Permit # e Permit Application County Permit # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED 1/` 7-1q wb" V Date Approval Received from State if Required State Plan I.D. # a � A. OWNER OF PROPERTY; _ Mailing Address: 4�5�7 L�✓ B. LOCATION: /a ' /a, Section _qj,�, T N, R W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYP OF OCCUPANCY: *Com71" al Industrial *Other (specify) *Variance Single family �./' Duplex No. of Bedrooms No. of Person D. SEPTIC TANK CAPACITY fAjW Total gallons No. of tanks _ HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete �� Poured -in -Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber- Z:gTotal gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replac ent y.� Alte ate (Specify) / Seepage Trench: No, of Lineal Ft.Width Depth Tile depth (top No. of Trenches___L__� Seepage Bed: Length Width Depth Tile depth (top No. of Line Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land k % - 2 Distance from critical slope WATER SUPPLY: Private W Joint ❑ Community ❑ Municipal ❑ Owners name as Iisted on EH 115 if o ther than present owner: 1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certifi it Tester, L' NAME C.S.T. # ° 7 and other information obtained from (owner /builder). Plumber's Signatur {dq{aJMPRSW# Plumber's Address ' PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. a. 1 E E r = P i 3 i 3 i � Do Not Write in Space Below FOR COUNTY AND SIOTE DEPARTMENT USE 0 LY _ n Date of Application . 3 4� Fees Paid: State Date a� Permit Issued /Ro}oeed (date) 3 4 .2- Issuing Agent Name Inspection Yes k— No State Valid# Date Recd 1. county (w rt e copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7 /1/78 C) vwNIL-2.: Srn 4/ GHA'S-- DAW'sbN AC NA•TM S4 - r!5.tA S �ENrrN MAID 1 "�6 Cttb'C. PlOU' M»� - 4 o 3T. (*"Dc ` . r, C►+►av H t l - � ,0 t3err� C7vts p�(s�►t.: Ao'TToM _ � :•• � � WAC- AVA , 1 . /tt'. i t x /, t�t�EV - 93.4 tr Yi' ro �/a• , A+t�6o.+k L" AioY1C 4" OCAAW DtSY. Ptptt ''. i�.L. &4�(0 .....- ..,.., _.. ..- . --�•�` 2N M ANa tspl.Q �C t ST '7Q Foa.G� M q. tla G,arsc,Ac pv►«�p �,'�BlN6 CAkAO rsoc r w_. ►. Q� - T'pP I "l� It2oN PIPE PROPK¢T't+' ``- '//r AS >;3Eh1 GN M ARK t�I.EV • = t OpOQ q►1�t-4i1aAx N AN RELATIONS AR',VIEN OI UST LA NG5 ESE P ON OF 9U 6. EN E / to , ,, �4� c�-• �' � yb _ . ' 1 " • • + •�� v� J 2 "� CoRt� tv�wtw phC,p�'. rsC�iR.CZ W dl( RCall rmv t. $6.91 »XiSTItJ'G. SEP�Ttf- 1°5t9 TA%M K . T OP M.R. ELEV• 64.x. NOV � � A(C�. a 1il5TALl G,U4 A4.k.Owt � P V MP G ►i A MHt ttr l.. I G 9- i� I0fI A. .IMWcA'C65 $OCtKC, stiv 1yz A15. Q .% ptCsi.�ct.M� t1•�IC Vy3 t Cie. 8 r D�ft3 $d► � p �ra� NEI r5c SNEC 7" ¢ k". A W 9 w C T Ica t.� o z 4' N� �ty4v� 0. S J RCCEIVED r p w r NO V Z5 5 99$1 �� o� o PLU'MBIN'G SCTI Ul Ilk, OAI a ��`' J CL -wo 2 E- a u r , ID w �o r T ` ra a �r 04? N o �0,.. . D,a 5 r 4 S lOf ZS f t3 � s►, G .. Go NT outz. It-A d $Acvwom PlT V � A a i� PT1►► l!t 1E' ISO P!:lZM1�M 1CN'Y w rt I tJ1 RKM[ a e•/ z'` r RECEIVED i 1981 PLUMBIi a w s ct qh' 0 ` Foczc.t� MAC &, S p �i2 N fs3. ���t Fito PA.. PUMP 9 �� ~ �P'� c.a►,anK�s R 56•r-rom ac: TR041W ...4.. 0 ,,el w( 6q 'q �'_�. �+ AT �s oRle, r ; ai -Lavt i NR ®c G,QouNb vtl+cf"t�R Auto A-c mac, , 01) M1ra..kPyd�/�- N14N4; �+QowtDWA'C'�JC� 3 .l�►� A-t uwo -i v4,4 i [ -I tO ki g3llA, �,Z� 0 M l •Y °__ ... Q, W tea. �: GwnS , anu.(5anr ski 5vs::_..._. MOUE: 4. a l3r NLo F'RICTIOIV LOS! WIT111N) FO1 -CE MA1Q:_ — _ _� ���_ Z T �NL i1�'.S MEASUf t7.AAU ..11 RETNVC' f'I.IMP OW AMC) f LIMP OFf"_.,. -7S6q G A L L O►1 S f' It -fit 1' [ D PER C `J C L E_ --- — ^ --- ^-^ LIFT PUMP TA )K c ►ITh C+1 . T - AAIK., VLR11C.AL. rI1tIC.N4 �Fq,tA i�llhAF' 1NA 1 `� 10 U t S T R1011 1011 t i i7) A.J OLD U 1 i 1 f t E U C► i __ __ ___ �.. _- -_ --. - �---- ---- -- C%L`� 4 4 E AST Ic e►.1" V E IJ T - fa 12•'` ABOVE CRAVE y — I P1s 4- I I OUTLE 2. "MINIMUM I.D. If3LFuT E ©uYIwEY: I 4 leoN CAST IROU VI(�E: EX' TEkCDINb, 3 PLC 1' UUTO I ( I +a�c•1 v►zKern UWDISTUREISED enROUAJO NIGN WATER E aZb " WARUTA Ix DEVICE L " ASOV " rW" l ! t. tit. a,0�1 '7 6& , 1 0° gLac.►c (Co►JCRET P�VM�,Np RECE IVED` NOV 2' 1981 Cad 5 PLUMBING SI- C7'f'i 1 H NGS F E� D� N �E � ,DENG� r 2 42 x ONE PUMP - CHOICE OF 3 SEALED, LIQUID LEVEL SWITCHES. Now a high quality, dependable submersible sump pump (Modal 354 rt� is available from MMyers with a choice °rx of three sealed liquid level switches to 4i meet the requirements of most sump applications. r . , The pump and switch are sopsrn #e�: each with its own sealed power cord. This greatly increases reliability aM�d s simplifies service, a The pump can be pI ed into a ggrounded type' 115 volt receptacle In 4 switch cord fOrautomatic In pBra All liquid level controls are compleftl i sealed and energised by _a psrmianent magnet or mercury tubs switc eliminating all outside mechanical' connections and vent tube cords: , The adjustable level lit the SUMP.iss controlled by displacemen : l working n the pdriciple that u#tdlRr water the wsi ht bscgn'MW lighter p the welpht of the watt ii lt d��' „ 2 YEAR LIMITED N1ARRAiHT�!'- �"�'1t11�X reliability of the pump:tat d COCttlr units allows Myers tp!ifAl a v warranty, It the purMtl iswIte tlak,''',, within twp yeM� from,'#atwof purchase bec>9►tlse ofdefeotive material or workman>ehip� their wil =oft a z x, repaired or replaced tree of Cttat"4e �l The warranty doe or labor s e 'k •0"�'hl ,j ` remove pr re�instatC� ".pu�ttp ate �r' ' P�� � does not cover Co 14 k�� r ' damages or freight: Atxtse.or rfMt�gtsl o f the equipment is tart � ^� the warranty. SEALED CONTROL SWITCHES i 4 1 full i y Y • 7R 'a. + l ' '• �,,, m le i , 'i � fi•a Ft C,_r<IXEQ j EviLL,.EtONTROI. This control AM ADJUSTASt E LEVEL CONTtiOt.•- The AWS -t, W� UMP COAiTEI ;rills ttaataRf' 9 yet hss a mercury tuq switch seated to a solid weights of this switch are adjustable on the switch proof s a *on"", M., ltd% f0t,3hp p.�arw f(ost that bi,Mid to pipe with . stainless holding cable for any level within the and power fiord, It h used' M lratlft►i st�l am 9" clamp. Fixed draw o level Is limits of the sump. It is used in sumps having remote from the power mumo *1*4 a a Inches, OW W used in sumps having a s high Inflow rate as occurs In many base- cord cannot be used tlscaub 0t dantpnea• tow ittffow merits In wet weather. Prevents Short Cycling. x The housings on all switches are of porrosion proof plastic or aluminum. All springs sad fasteners are . stainless stool The displacement weights are of corrosion proof plastic that will not absorb water Rt - t - )CK ,olze fe I S RECEIVED IV U V vc.�tc,s� t/�co�Z 2 5 1981 PLUMBING SECTION hA G MC P p T ) L�i¢k /0 bEa f fG��E� J �IVN o� /Z� I e e Pc,c a r' a 2 / b,Cr vk -xow. .f�c.r Gva �l7 /G ti✓�. lG`?Gc7G`7' /a. PA IL' �/ �GGG�'7�l3G�" f i�. Z�epTiY SO �� WAJ -tl .V,.t A --rc')Q- 1:: vW ,3 00 C A4. Awe w0. Z sve M � �p 3 C>o GAS Y/0�1`t' F''t' Ri PSU�I"�6C71� A ZSO r J' Q't ( . •Z. C•,,,f' OA0 r,%LTu�) .....,..' � (1 `t" 101�� sir z 5 CASit4 G 1ZAZ ,. �, P \pl G l5 6pM ? C PM A& UC%A. z`' �1t41v 1 �v` D /C lT d Ca PAi v S L 2" � 1�1i1 A dv ► ��c.. p, t... O o% - umc- t OK.j5 x ?- x - Zo• 4AL 7S 4, AL 6, Al- - T - c, -rA L. RECEIVE® -T� '1-�� ,ti�ppkcn� iV UV � 5 1981 / L U flog I N G S �CTlOh] � /C �cLt� -- 7 S G RL. %R 3 01Q82 _ ( G.Gw �L g E�1N i �'o raa. clee-Le �co�cz� . SU Me CA P/kC- - ZY S14-t g: t�tz — 60 6AI... /M(t4 . r S 5 z�s i 0 l-�cPt o &z vv rmb z , z S `Z a� 4UA 1. -.osS t.$3r 6/17/80 WISCONSIN DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING, PLATTING & FIRE PROTECTION POST OFFICE BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an A ternative Private Sewage System In the County of �1I. r + Location SE 1/4 NW 1/4 S 36 T 28 N R 19 W Town or Municipality Troy. Township Street Address R.R. 5, Woodridge Drive K iver Falts, WT X022 Lot No, Block Subdivision Landowner's Name: Chuck Dawson The application for this site is to serve a: ❑ new construction use. replacement system use. If this is a NEW CONSTRUCTION USE, the alternative private sewage system is to be included as: 0 part of the 3%/5% limitation. This is number of the applications made through this office. one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. O . a lot that meets the site criteria for a conventional private sewage system. If this a REPLACEMENT SYSTEM USE, the mound is replacing: © a failing conventional soil absorption system. ❑ a holding tank that was installed and in use prior to February 1; 1980. ❑ a privy that was installed and in use prior to February 1, 1980. I certify that the above i;;forviativis is true and accurate to the bes wl ,tdge. Name _ -- 1hv C �c�son Sign e - -- Title L Date _august 10, 1981 DILRR -S 6138 (B.7/80) P No. er s name San . rm�. H63.05. PLOT.PLAN ` Show: Location of building served Q Dosing chamber Septic tank r �. Vertical reference point ✓, Building sewer Horizontal reference point Effluent system / Well Replacement system area Q Property lines w /in 50' of system 0 Distribution boxes Scale i tt �0� , or dimensioned t.=._J Pump and controls: M? M- , 5 S $ `�' 2—, Mfr. & Model N o. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Gal. per Min. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan below: \ � 1 �5vt- r�NtQ�t�uta 44- �` pteL IE MK Tb P N V f '75o G AL - G 133 = e 0. $ $ TA L- Pure Ci•1A� AZ - 7 ( 6 . r r : `! 5 -�o By the granting or approving of the above,plan, or upon the event of a subsequent permit being issued,SY.6W(,- County and the County Zoning Administrator, does not assume or hold itself liable for any defects in plans or specifications, plan omission, examination oversight, construction, or any damage that may result in or after installation. Plumber's signature 1/82 a State of Wisconsin ` Department of Industry, Labor and Hum 8 I CC kr' \ r i Please ly t®i /11 F/f SAFETY & BUIL GS DI�*,W &198 Bureau of Plumbi �N6 P.O. Box 7969 i �FF1C� Madison, WI 53707 Plan Identification Number J r : a PRIVATE SEWAGE SYSTEM ONLY— •� n 7 . The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative private sewage system to be installed at the above- mentioned location. The plans and specifications were prepared by r A :, • C� .� z" :a.. and received for approval on f The soil and site evaluation was conducted by �•• r e '.- The site meets the soil and site requirements specified in chapter H 63, Wisconsin Administrative Code, for the use of y,�iy ;, ' �• t h '�`'� 'y � � ""�" i.�' � .s ��; t .. .� ., 'C \f � . ` . r.(` - > w.it./�. . i The proposed system is fora Wastes from the building ill discharge to a ?= 9 g gallon capacity septic tank which will discharge to a gallon capacity pump chamber from which a pump having a capacity of - gallons per minute against a total dynamic head of `. i feet will I.. discharge through a inch diameter pipe to the soil absorption system. It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this approval and shall follow the directions or orders issued by the appropriate local or state authorities. In accord with ch. 145, Statutes, and ch. H 63, Wis. Adm. Code, the plans and specifications are approved contingent upon compliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep one set of plans bearing the stamp of approval of this department at the construction site. If the installation of this system has not commenced within two years from the date of this letter, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight, construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automatically void this acceptance. cc: OWS By: County Other Enclosures �� • r �� DILHR -SBD -6159 (R. 7/81) mes Sargent, B erector ' SBD 6678 (9/81) (Plb 100a) -'� STATE OF WISCONSIN DILHR D9tach And Return Upper, DIVISION OF SAFETY & BUILDINGS Portion Of This Form With BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 178 Any Return Correspondence P.O. sox 7969 MADISON, WI 53707 608- 266 -3815 DATE: March 30, 1982 PROJECT: Chuck Dawson - Resid Alternative System SB,NW,36,28,19W m � k.F�V Tn Troy, St. crolz iy.R ' 98 Paul Cudd & Sons, Inc. � 82 C-9 Rauch - l0#j River Balls, W1 54022 Offer PLAN ID. # 81- 04128 ti DETACH HERE PROJECT NAME Chuck Dayson Rasidence PLAN ID. # 81-04128 This is to acknowledge receipt of your plans and specifications for the above indicated project. Preliminary review indicates the required fee is $ ! _;,,f Fee Received is $ Underpayment - Please submit the additional fe ❑ gverpayment — Refund fortt) oming. Plan accepted for review. ❑ 'tans being returned. No fee has been remitted. Plans submitted with no fees will be ❑ Additional information required. SEE BELOW. { held in abeyance. L Plan Submission ❑ Complete data relative to anticipated use of bldg. Additional information shall be submitted in duplicate un- ❑ 2 copies of PLB 60 enclosed. less specifically noted. ❑ Deed restriction required (1 copy). ❑ Plans not clear, legible or permanent. ❑ Condominium declaration. (1 copy) All information submitted shall be signed, dated and sealed or stamped in accord with Section H 63.08(2 )(a) Wisconsin Administrative Code. El Affidavit enclosed. IV. Holding Tanks ❑ Profile of holding tank showing vent, manhole alarm and manufacturer if precast. Complete construction details if 11. Pressurize Distribution Systems (Mound or In Ground Pressure) site constructed. ❑ Application for use of an alternative system signed by owner ❑ Holding tank agreement signed by owner and local unit of and notarized. (1 copy) government (sample enclosed). ❑ County onsite required (1 copy). ❑ Design calculations ❑ Reason for installing holding tank. Soil test or statement for pressurize distribution. ❑ Soil boring & percolation from county (1 copy). test data. ❑ Plot plan showing location of holding tank with lateral dist- ❑ Cross section of system. ❑ Pipe lateral layout. ances to any building, wells, water service piping, water ❑ Plan view of system. ❑Plot plan. course, lot lines, swimming pools, all weather service road, Verification of Exception Status Form by County. (1 copy) Etc. Provide benchmark with elevation reference point. 1.1 1. Private Sewage Disposal Systems V. Lift Pump ❑ Ground slope with 2' contours in entire area of soil absorp- ❑ Calculations for total lift pump discharge, head and gallons tion system extending 25' on all sides. pumped per cycle. El Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main. ❑ Location of area suitable for replacement system provide 0 Detail & model of pump or automatic siphons including soil data. size, pump curves, drawdown and average flow rate GPM. ❑ Plot plan showing lot size and all lateral distances from ❑ Cross section of lift pump tank showing pump(s) or sewage disposal system to buildings, lot lines, well, water siphon(s). course, swimming pools, water servica piping, Etc: ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. V I. Systems In Fill (Fill must be placed prior to plan submission) ❑ Construction detail and cross- section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trench system. before side slope begin). ❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and type of fill. Co of onsite report b count or district staff. tified soil tester (1 Copy). ED Copy P Y Y r Pig .#I@a 1/78 s Wad Return Upper `'h is 10 1 An Return Correspondence , MACH a.k DATE:' .x: � 18, 1981 8 9 PROJECT ' l Chuck Dawson Rotl4en �h_ 1 Sewage Disposal ' 7 9'Q _ 5E,. NVh, See • X36 N Town of Trop, NT" ! Paul Cudd & Sous In Ofd St. `Croix Couvit d6 0 9 Ranch #. R ves FaIle, wi 54 022 PLAN ID. 81- 041U DETACH HERE . ..... Chuck Dawson - Residence 81-04128 I�RCJECT NAME PLAN ID. T1ais �,acknowfedge receipt of your plans and specifications for the above indicated p'retxmirry review indicates:the plan review fee required. is $: -- • E Plan accepted for review. Fee received is $ —, 3 Fee is being returned because of ❑ Overpayment. Underpayment. v i Providing one of the two catagories above is checked, remit correct fee in one payment.' No fee has been remitted. Flans submitted with no fees will be held in abeyance. ` 4 " Plans being returned. n x Additional information required. SEE BELOW. t. 1. Plan Submission f ? ❑ Additional information shall be submitted in triplicate unless specifically noted. A 0 Plans not clear, legible or permanent. .�.- 13 All information submitted shall be signed, sealed or stamped in accord with Section H 62.25(2►(a? ifii}} ❑ Affidavit enclosed. , i t ll. Alternate sewage Disposal Systems (Mound Systems) PLB 108, (Application for use of an alternate system).. ❑County onsite required.(1 copy). El Design calculations for pressurized distribution { ❑Cross section of mound, ❑ Pipe lateral layout. Plan view of alternate. '� ? Ill. Private Sewage Disposal Systems x Ground slope with 2' contours in entire area of soli absorption system extending 25' on all sides; A ' . El Elevation of permanent reference point (benchmark). ❑- Location.of area suitable for replacement system provide soil test data. $ C Plot plan showing lot size.and all .lateral distanrgs from sewage disposal system or holding tank to- El Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if x 0 Construction detail and cross-section of soil absorption system. -115 completed-6y "u y and percolation- test•on rM le ❑Soil boring g p tby certified soil tester (1 copy) ❑.Complete data relativaao anticipated use of bldg. .0 3 copies of PLB 60 enclosed., ❑ Deed restriction required (1 copy). ti IV. Holding Tanks x , r+ El Profile of holding tank, $ w Holding tank agreement signed by owner and-local unit of government (sample enclosed). Reason for installing holding tanksoil test or statement from county (1 copy). j V. Lift Pump C3 Calculations #or:total.iift g gallons pump dischar e, head and Ilons pumped per cycle. x 0 Size, length & depth of force main. , F Detail &model of-pump or automatic siphons including size; -pump curves,.drawdown average. fl r -� ❑.Cross section of lift pump tank showing pump(s) or siphon(s), x k. A N 'r!?; Sys #erns In "Fill (Fill must be.placed prior to plan submission) + ❑ Total area filled-;fill to extend 20' beyond edge of trench before side slope begin). ` Q Depth and type of fill. C3 Copy ©f;.onsite;report by county or district plumbing supervisor. 'D Length of time fill has been ire places ¢fi` r �- �. p d d h ,F -W ft p AND F1; etum Co , Ce MAIL, RCS 4, ' MADISQAG Y BATE: October 8, 1941 Pt OJECT r¢ , chuck Dawsols. _ 641111 i4 Alternative Systese, .. ` S' >, N. Sec. Tom Troy.,- To of Paul Cudd & Sons, Inc. St. Croix C ty,'�t� C-9 Rivor Balls, WI 54022 PLAN ID: # 81 -04° " ,. { Y ` DETACH HERE sr � * i �'�.x+r+:`- .:w,.a �,..-.. -•-. w--,+r. ...Y:r,- a...�..w•-- .wwn»wra�«- yen...+ -�:.w. ... e.—..-.. Q+... . r A --«...+ r •..........+ s.-. �..,,,....-. �--- s .�......n..y.- .....�.....-.... -.... '�. -•-,h Dawson Residence 81 -04128 r ?JECTNAME <' - PLAN ID. 4 wto acknoWe susipt of your plans and spec ficeti©ns for the above - indicated Pro im !nary review indicates the plan review fee required -is $ _ Plan accepted for review. -; Fee received is.$ ` Feeds being returned because of Overpayment Underpayment..._ x i Providing one of the two categories above is checked, remit , correct fee in one payment. i ! s, No fee has been remitted. Plans submitted with no fees will be held in abeyance.k Lj a Plans being returned. Additional, information required. SEE BELOW. k L Plan Submission iii O Additional information shall be submitted in triplicate unless specifically noted.x ❑Plans not clear, legible or permanent. , .: 0 Z( - All information submitted shall be signed, sealed or stamped in accord with Section. 62.25 a) rx T e ❑ Affidavit enclosed. ` '? i1 Alte ate sewage Disposal Systems (Mound Systems) , f <, R LB 108' iApplication for use of an alternate system). ` "`F a County onsite required 0 copy). ❑ Design calculations for pressurized distribution Cross section of mound. El Pipe lateral layout. ❑ Plan view of alternate.e$ E a ()'l. Private Sewage Disposal Systems C.7 Ground slope with 2' contours in entire area of soil absorption system extending 25' on all sides. r i , ., D Elevation of permanent roference point (benchmark). ' "' Location of area suitable for replacement system provide soil test data. . ",. a 0 Plot plan showing lot size and all lateral distances from sewage disposal system or holding tank.to b1dgs. t etc.,; ©Construction detail of septic, holding or lift pump tank , °if site constructed or tank manufacturer if 0 Corstruption detail and cross- section of soil absorption system. .. r' 0 SOii ti (ring and`percolation -test on E.H -1.15 completed by eertifie�deol) tester (1 copy). ' fl Complete data relative to anticipated use of bldg.' ❑ 3 copies of PL8.61) enclosed: CJ Deed restriction. requi red (1 copy). X �4V. Holding Tanks 0 , P o in r file of hg tank. 149 dingtank agreement signed by owner'and - local unit of government (sample enclosed). x << Q Reason for •installing,holding:tank soil test or statement from county:(1 copy). l v� • `.. Lift Pomp K ` :Calculations for total lift pump discharge, head and gallons pumped per cycle. 0 Size, length &depth of force main, �Qe�tail°l4i r6didel of pump or automatic siphons- induding.size pump cltrves,,drawdown and average flow rA4 I i �.Ctost•saption .of pump tank showing.pump(s) or siphon(s); #" ° ' t/1 aysten�s In F l (Fill must ia, placed Or ior,to plan submission k'+ta <k, ~"ot� .ales fipe€l (fill to extend 20' beyond edge of trench- before side slope begin). Depth and typlr.a ilL l , { ( ctp 'of `onsitt* report by county or district plumbing supervisor. � r O Length of tune fill has beers in place. " °' 4, •, ry ,1 •tlR iy . Upper TMs Farm With Arm Return Correspondence vEe` 1981 Ztyyj — j , pAT.> ,,fit , 19$1 �... C Davoon - I k Afteraat#ve ,�Irar I SE NW,36,,28,1 3 I PAUL Co" 6 Soas, Inc. fi+�dfs► of Troy F C-9 � St Croix county, . ., � r .� .�. BSvor yall»E, WX 54022 PLAN ID. # 81- DETACH HERE i NAME Cla Dawson - Residence 81- 04128 {' k, LAN 10. k d 'ice to ackwMefte rapt of, your plans and specifications for-the above-indicated pop » ►ertery reviaan%.indieates the plan review fee required is $ Cl n ` t e� n Phan acxpted for "review.. Eee received is $ % `r� } ' l c; - � t = g• ca i Fee is being returned because of Overpayment, Underpayment. Prowd►ng true of the two catagories above is checked, remit correct fee in one payment. v ;' 1' ' No fee has been remitted. Plans submitted with no fees will be held in abeyance. No r r 1.1 El Plans being returned. x 1 1,. 3 'Additional information required. SEE BELOW. is Plan Submission ❑`Additional information shall be submitted in triplicate unless specifically noted. �n Playas not dear., teg�bSe.or Rerrr►anertf __ °_ _ �t 4 , ,.�u( ►ll ifformation ubrtritted 9hotl be signed, sealed or stamped in accord with Section K 82.25( } a! ❑Affidavit enclosed. �< 1 11: ,AgPLB Hate sewage Disposal Systems (Mound Systems) y art` ' 108 (Application for use of an alternate system). County onsite required (1 Cvpy). ❑ Design calculations for pressurized distribution �f ❑Gross section of mound. F1 Pipe lateral layout. ❑ Plan view of alternate. ; Ill: Private Sewage Disposal Systems�6 F Ground slope with 2' contours in entire area of soil absorption system extending 25' on all sides.� ; lavation of permanent reference point (benchmark). .? © Location of area suitable for replacement system - provide soil test data. R ED Plot plan showing lot size and all lateral distances from sewage disposal system or holding tank to bldgs, tot film ours, c. ".. "© Construction detail of septic, holding or lift pump tank if site constructed or tank. manufacturer if precast.. s Q.Construction detail and Bross- section of soil absorption system. i r Q Soa,'iborin"nd pee on test on EH 115 completed by certified soil tester (.1 copy)- Complete data relative to anticipated use of bldg. ❑ 3 copies of PLB 60 enclosed. ' `: ", fl Lleed restriction requires! (1 copy). w e tV. Holding Tanks ° ❑ Profile of holding tank. 31 t Q Holding tank agreement signed by owner and local unit of government (sample enclosed).; ❑ Re*on for installing holding tank soil test or statement from county (1 copy). V. Lift Pump r 3 Calculations for total lift pump discharge, head and gallons pumped per cycle. �' 1 O;Size, length ;& depth of force main.' s 1 � etaif & model of pump or automatic siphons including size; purnp.curues, drawdown and averaga figw r8te� S r a Cross section of lift pump tank showing g pumps) or siphori(s }, $t (I Sy In Filt (Fill must be placed prior to plan submission) h S ' D lotaf area filled,(f'rll to extend 20' beyond edge of trench• befpre side slope begin). ; e : :t. t 0 Depth and type of fill. . ❑spy.of on e.repo t7by' ounty�ordistrict plumbing - supervisor, ❑:Lengt#r of time f"rll has been in place... , SBD 6678.(9/81) (Plb 100a) F �. STATE OF WISCONSIN DILHR bktadi And Return Upper DIVISION OF SAFETY & BUILDINGS Portion Of 'This F oal With BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 178 Any Return Correspondence P.O. BOX 7969 MADISON, WI 53707 q , 608 - 3815 DATE: Dmoubor 15 \ Z prn^ PROJECT: Crock Dawson - aassdwas 1 98? Altsrnati.. Systss OFF�� SZ. NW, 36, 2S.19W Town of Troy P W" i Sons, ; . �, St. Croix. County, W1 0-9 Rauch Z River Falls, W1 54 2 PLAN ID. # 81 - 04128 DETACH HERE - "PROJECT NAME ' Ack Daw110 — ftfide=* PLAN ID. # 81 - 04128 _ This is to acknowledge receipt of your plans and specifications for the above indicated project. Preliminary review indicates the required fee is $ +I Fee Received is $ — JGJi Underpayment— Please submit the additional fee. ❑ Overpayment — Refund forthcoming. Plan accepted for review. ❑ Plans being returned. No fee has been remitted. Plans. submitted with no fees will be ❑ Additional information required. SEE BELOW. i held in abeyance. €e 1. (#Ian Submission ❑ Complete data relative to anticipated use of bldg. ❑ Additional information shall be submitted in duplicate un- ❑ 2 copies of PLB 60 enclosed. less specifically noted. ❑ Deed restriction required (1 copy). ❑( Plans not clear, legible or permanent. ❑ Condominium declaration. (1 copy) ❑ All information submitted shall be signed, dated and sealed or stamped in accord with Section H 63.08(2) (a) Wisconsin Administrative Code. El Affidavit enclosed. IV. Holding Tanks, ❑ Profile of holding tank showing vent, manhole alarm and manufacturer if precast. Complete constfuction details if 11. Pressurize pi tr bution Systems (Mound or In Ground Pressure) site constructed. El Appli tion for °Use of an alternative system signed by owner ❑ Holding tank agreement signed by owner and local unit of and notarized. (1 copy) government (sample enclosed). ❑ County onsite required (1 copy). ❑ Design calculations ❑ Reason for installing holding tank. Soil test or statement for pressurize distribution. ❑ Soil boring & percolation from county (1 copy). test data. ` ❑Plot plan showing location of holding tank with lateral dist- Cross section of system. ❑Pipe lateral layout. ances to any building, wells, water service piping, water ❑ Plan view of system, ❑ Plot plan. course, lot lines, swimming pools, all service road, ❑ Verification of Exception Status Form by County. (1 copy) Etc. Provide benchmark with elevation reference point. III. Private Sewage Disposal Systems V. Lift Pump ❑ Ground slope with 2' contours in entire area of soil absorp- ❑ Calculations for total lift pump discharge, head and gallons tion system extending 25' on all sides. pumped per cycle. ❑ Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main. ❑ Location of area suitable for replacement system - provide ❑ Detail & model of pump or automatic siphons including soil data. size, pump curves, drawdown and average flow rate GPM. ❑ Plot plan showing lot size and all lateral distances from ❑ Cross section of lift pump tank showing pump(s) or sewage disposal system to buildings, lot lines, well, water siphon(s). course, swimming pools, water service piping, Etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. V L Systems In Fill (Fill must be placed prior to plan submission) ED Construction detail and cross - section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trench system. before side slope begin). ❑ Soil boring and percolation test on 115 .completed by cer- ❑ Depth and type of fill. tified soil tester (1 Copy). ❑ Copy of onsite report by county or district staff. D.I.L.H.R. F%. t -ti - VtSeon31Iro 0F*e t 7"-8t- 30MtSEnV1 l<s L Jansky O.W.S. - -, . 13 E. Spruce Street , i0{visia>IrvfHeal>t1r '- Section of Plumbing &Fire Protection System: Chippewa Falls, WI 54729 (715) 723 -8786 ON -SITE WASTE ' D►ISPOSAL INSPECTION REPORT T' - Name of Premises r /f. jJ $�reet ' city county �••�••— Master Plumber Address Owner _ }V `.s arJ Address L ' ❑ County Permits ❑ Appropriate State Permits Type of Building:, Public 2Efl r1t�ti ?.� 9�' �. Single Family.aF'D u'�Si�R' CHECK APPROPRIATE BOX FOR VIOLATION TYPE OF TREATMENT SYSTEM ❑ Building Sewer q {t_r *._ " , ,' Conventional Soil Absorption Syst ❑ Septic Tank -.fi_ 1,7 1 El Conventional System -in -fill ❑ Holding Tank ❑ Alternate Mound System ❑ Seepage Bed ❑ Holding Tank �- ❑ Seepage Trench Seepage Pit ❑ Experimental System 8 BRIEF, FACTUAL COMMENTS AND SKETCH: J, q — t - ,_ r� r ._. 4..� m 1 i �' c �_ 1_, LE i E w , / ° F' 'y �_ it. . — r � ✓�� E" .. / "._. i r cf d' 1 t i J i L' r 7 a , r l El SEE ATTACHED DISCUSSED.WITH- PLUMBER. ( ) Yes ( ) No SIGNATURE (Voluntary) DATE OF INSPECTION Signature of Inspector White - Inspector Yellow - Local Inspector Pink - Plumber or Responsible Party Y. I Plb..t -A WISCONSIN DEPARTMENT OF HEALTH - & SOCIAL SERVICE& Division of-+lealth Section of Plumbing & Fire Protection Systems ON -SITE WASTE DISPOSAL INSPECTION REPORT Name of Premises Street City County Master Plumber Address Owner. Address ❑ County Permits ❑ Appropriate State Permits Type of Building: ❑ Public Single Family-or Ouptek CHECK APPROPRIATE BOX FOR VIOLATION TYPE OF TREATMENT SYSTEM ❑ Building Sewer ❑ Conventional Soil Absorption System ❑ Septic Tank ❑ Conventional System -in -fill ❑ Holding Tank 0 Alternate Moand System ❑ Seepage Bed ❑ Holding Tank ❑ Seepage Trench ❑ Seepage Pit ❑ Experimental System BRIEF, FACTUAL COMMENTS AND SKETCH: 7 e , I 1 n: : E I a � i E f , ❑ SEE ATTACHED DISCUSSED WITH PLUMBER ( ) Yes ( ) No SIGNATURE (Voluntary) DATE OF INSPECTION Signature of Inspector White - Inspector Yellow - Local Inspector Pink - Plumber or Responsible Party IT" 11 7 TOW ' ST. CROI X COUNTY W I S C O N S I N y , d ZONING OFFICE 796 -2239 HAMMOND, WI 54015 ` s July 14, 1981 Division of Safety and Buildings Bureau of Plumbing P.O. Box 7969 z, Madison, WI 53707 G Dear Sir: An on site investigation for the Chuck Dawson property located at the SE'Ij of the NW4 Section 36, T38N -R19W, Troy Township , in St. Croix County, revealed suitable soils at a depth of inches, below which seasonable high ground water was noted. This site should be suitable for an in- ground pressure system. Should you have any questions, please feel free to contact this office. Yours truly, Thomas C. Nelson Assistant Zoning Administrator TCN:sl 4 DEPARTMENT OF REPORT ON SOIL BORINGS A TY & BUILDINGS INDUST DIVISION LABOR AN PERCOLATION TESTS ( 11 ° o ' P.O. BOX 7969 HUMAN R�LATIONS \ ��� M ON, WI 53707 LOCATION e : SECTION / : TOWNSHIP MUNICIPALITY: LOT N i S V N COUNTY: OWNER'S BUYER'S NAME: IMAILTING ADDRESS: USE DATES OBSERV ADE Z Z NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: S: TESTS: F-6� Residence ❑New ®Replace �v " RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: S STEM -IN -FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) ❑ S7U fl S ❑U 0 S ❑U 10 S ❑UJ S ❑U �•.�, 6 ,� a�,,,.� ,• �sr If Percolation Tests are NOT re uired ESIGN RATE: S ST M 4 If any portion of the lot is in the D under s.H63.09(5)(b), indicate: f — =5 . M I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED ES . I HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- B- a B -Z ¢,, w o Ada' .. �� .. B- B�. z� . ONE I ¢., / / B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PER IOD 1 PERIOD 2 P R PER INCH P- P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. In cate sca ista as what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surfs levation at all ho and the dl . -.; percent of land slop. SYSTEM ELEVATION 7 t �.. _ _ -- — i j _. ., ,.�+.......,_ .- ....._:.e... _.. a.i - ., ., .,.....e.... .... a..r,,, _... ........ .. .....„ ... ..�....,.._ „..... v -,....,..,. J.,_. .e._..�.,..........� .., d... a. _..._....c __:z�...__�..m........�.._. ., s.,. m. ..zM...... 1, the undersigned, hereby 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: .< v%-an iv C � -,� y . 0 -- / ¢ - -- a / ADDRESS: CERTIFICATION NUMBER: IPHONE NUMBER optional): Z-21'V- r ILS -• y''Z » 8 J p CST S ATURE: DISTRIBUTION: Original -Local Authority, 2nd page - Bureau of Plumbing, 3rd page -Prope Owne , 4th page -Soil Tester. DILHR -SBD -6395 (N. 03/81) �.- . ' f e/'` �, a __. _ . � --- _. ,� _- . � � ._� .._ t � f t . f. .. / •� i t . 3 r", �. re „' -' _...... ._. __�.__ _ .... .. ...4.�� .� s _.. - rte.... ....w... .. w . ... ..... �..'. >. �.—r _ _ _ _ __ kx �✓ k � - 5 �. ., �.. r -... -, - - ..�.�. . �'' / e � . � Y. / � � - r+ -/ ` `, �„ - y ` " . _ . .tee I_ >. .. _.. - _ ! � .. _ _� '� �� � % _. -- � ,` O - _ � !, _ ' - .--- iif� J /// -. _, .. , _ . -- _ __� -. _, ,. �. _ _- \,� f'. i s,I r r a { a� ih Ps 6ow 011W .r..+rwna.ii�.rwr..... � t ' t w ( ; �pp 0 I. jkt t� z21�� t 71fr t aY � ��� hr7i. f ° S t u } ,.k y X' , ►_yet.. I .!M f r, r'Vi i ( 1 500 G of s a wr to S OS° d MIK Nam ma s M WO } t _ ' Sce,te a 4m 0 I �i f�' fad �! ...... _ ,,... dIP._ h Um P t x � a; T D(S NT °F _ REPORT ON SOIL BORINGS AND SAFETY & BU ILDINGS DIVIS LAB AND PERCOLATION TESTS (115 P.O. MADISON WI 79 HUMAN RELATIONS LOCATION: SECTION: TOWNSHIP /MUNICIPALITY: T NO.:BLK N .: SUBDIVISION NAME: _- � �'v> P I", r. COUNTY: OWNER'S BUYER'S NAME: MAILING ADD E S: USE DATES OBSERVATIONS MADE � r1 NO, BEDRMS.: COMMERCIAL DESCRIPTION: A STS: V"IResidence G ❑New OReplace �/ __ c _. �• % _ /: RATING: S= Site suitable for system U= Site unsuitable for system r O � . M �. aV IN- G�ND•a URE: SD � IUUL ® �G�� .RECOMMENDED SYSTEM:(optional) • If Percolation Tests are NOT required DESIGN RATE: S S E 4 _ `, If any portion of the lot is in the I under s.H63.09(5) (b), indicate: �s :'' % T � iFloodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORINGI TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER IDEPTH IN, ELEVATION OBSERVED EST. 41 HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK. . B- _ �.... ._ _.... B a (L' _' ��f r �J Chi -' F / {;� / _ � �: - .- B '/ r Ile PERCOLATION TESTS ` TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHF: rINUTES NUMBER INCHES AFTER SWELLING INTERVAL -MIN. PE RIOD 1 PE RIOD 2 PERIOD ER INCH 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 show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION T f < 7 _ E ! ......_ ... ......,... s...,._. ,. .. _. ......_...... _.M i ? _�� ... _.. _.. s...„ r° . .ems^ .. . N z� F r — 4 I, the undersigned, hereby certify that the soil tests reported on this form Were,,jnacle 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: .cam .�, c_. , K,. � JC.� ��� • �,. ; �, ,, .R�- , ��`-_ .. �--- '�`--, y �' '-- � �. /' ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optio CST SIGNATURE: —� DISTRIBUTION: Original -Local Authority, 2nd page - Bureau of Plumbing, 3rd page - Property - Owner, 4th page -Soil Tester. F DILHR- SBD- 6395(N.03/81) kry, 1 t i { �{ z � wo � x Nt i a dip Mkl '�1 in 1 t z s � —row r r t RY# rte t x � At NOW llMJW s� f 4 t gyp Pk �J 44A, t 4 a y 4 y �r n � ty . it FtWl NO pp +Yt IwMwk r .: , - ,*' * - Oggw , .erwwwM.w . » k!' y OW NAM Jw t Al �Y + Y