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� / o d $ ; \ M k g ® A U z ° -C, ;K § 2 g@ 7 f o )£ Q _ - g§ A\ e } i M § § PD 2 2 §§ [ i a k 0 0, 2 0ƒ; 2 r� G� K S t � ~ 3 / 0 » ! o o E E o £ o k( ( D� © m ® \ ± t � � / 3 0 § $ 2 k. CD m @ » 8 » 2 CL m R) e : 0 0 �, o r (A $ E 9 0 >' ca o c ° : Z ( &: . 0 0 0 m: 2 ƒ a R [ 0) C) ■ �; m Or o $ 7 ° U © elm @ �o: / z O z § z 0 0 9 EP /J- _ § § Z 2 Oro g 3 E � CD 72 I w CA I ca a a $ \ k ) z ¥ W ; m § o 2 z CL § i A 2 (n 2 @ &r) nn0> w.8[gƒ/ �`- § ��r CD:3 � / -; § #2G�£Oz R . a) o R�; -=me \OL a� < EI� E CL (D ; $ 0 - A) §_0 CO ®tea �m� q S\ ;i , a(n -m Ego 0 \ / ( . 2 - § 2 0 � , Wisconsin :eepartmentofCommerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 4792t7" 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: t Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. r �� Permit Holder's Name: City Village X Township Parcel Tax No: , el n e. ( I Eau Galle, Town of 0 L / ' Hof 2 ' Vo - CST BM Elev: sp. BM Elev: BM Description: Section/Town /Range /Map N /0) I 8 ifYl I GST 3a D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic j Z \ / Benchmark .9 1b l 13eeing Alt. BM Aeration Bldg. Sewer jq' Holding St/Ht Inlet b TANK SETBACK INFORMATION St/Ht Outlet 1�3 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / N 7 , — /3 3 �, Dt Bottom Dosing Header /Man. 46( Dist. Pipe 9. Z Bot. System Final Grade PUMP /SIPHON INFORMATION IbZ Manufacturer Demand St Cover GPM 3. 7- 6 i /67 Model Number --n y' .05 /40115 TDH Lift Friction Loss System ad Ft c 719` Z Forcemain D ist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length / No. Of Tr PIT DIMENSIONS No. Of Pits Inside Dia. Liqui Depth DIMENSIONS $•7 � 5 7 �� %-- `. SETBACK SYSTEM TO P/L G.. BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: ((�� ,�� 3(o' A,4 CHA UN OR Model Number: G t % d6i,� t Ov_ X � DISTRIBUTION SYSTEM f' h Header /Manifold Distribution ` x Hole Size x Hole Spacing ` Vent to Air take Length / Dia � Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over ' Depth Over xx Depth of j xx Seeded /Sodded Mul hed Bed/Trench Center Bed/Trench Edges Topsoil Y Njxx Yes No es U !� ( - 1 COMMENTS: (lnclu c de discrep cies, persons present, etc.) Inspection #1: / / Inspection #2: Location: oodvi11e,1N15 (NE 1/4 NW 1/4 36 T28N R16W) NA Lot 3 Parcel No: 36.28.16. 1.) Alt BM Description = J w� G[ i A,'rj 4 toe 2.) Bldg sewer length = Z,(' r - amount of cover = �� ✓t.� �j2fS I✓� — - - S Plan revision Required? 1 Yes No Use other side for additional Informa on. Date Insepcto s ignature Cert. No. SBD -6710 (R.3197) Saf TMM County 201 W. V ashin pet, - 0 7l 62 M9 fiff + M icon, WI 53707 -7] 62 i Sanitary Permit Number (to be filled in by Co.) .� Vns/ ( 608 )266 -3151 /SC i Department of Commerce i State Plan I.D. Number Sanitary7Fe a ' n In accord with Comm 8321, Wis. Adm. Co e,ti PW i 4 - 5 Project Address (if different than mailing address) may be used for secondary p oses Privacy s l jm� ' µ q _ ...; J Tk 1. Application Information - Please Print All Information P # Block # Property Owner's Name 6 Property Owner's Mai g Addre Property Location els 94 I / I • � � � / E- /., Section Zip Code Phone Number City, S p / circ one l �/ 0 ; N K E � T 11. a of Building (check all that apply) � 1 or 2 Family Dwelling - Number of Bedrooms 6 , 4 74M I fe ❑ Public /Commercial - Describe Use ❑ C i 11 State Owned - Describe Use City ❑Vella ownship o r� ITI. YP e f Permit: P Check one one box on line A. Complete line B if applicable) O 2 ►flBZ 40 - O D T (Che " A. ew System El eplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued Perm it Renewal it Revision ❑ Change of ❑ Permit Transfer to New p 2 L eta S ❑ � Before Expiration Plumber Owner Tr I IV a of POWTS System: Check all that appl 2 k • Sti 2 o Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil El < 24 in. of suitable soil El At-Grade ❑ Single Pass Sand Filter ❑ round ❑ Holdi Tank L1 Peat Filter El Ae Treatment Unit El Recirculating Sand Filter Constructed Wetland El Pressurized 1 G g Recirculating Synthetic Media Filt Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersal/1'reatment Area form 'on; Dispersal Area Proposed S tem Hie Deli Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) p„ Po ( Y. v Capacity in Total Number Manufacturer Prefab Site S I Fiber (r ib Plastic VI. Tank Info p 100 oncrete Constructed Gallons Gallons of Units W- 1- � f1' r New Existing ' (. Tanks Tanks Septic or Holding Tank S Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement 1, the undersig ssume responsibility for installation of the POWTS shown on the attached plans. Plum Name (Print Plumbe ' gnature MP/MPRS er Business Phone 7 � �� �S/ Plumber's Address (Street, City, State, Zip VIII. Coun /De artment Use Onl Sanitary Permit Fee i cludes Groundwater Date Issued Issuing Agent Signature (No Stamps) X Approved ❑ Surcharge Fee) r enial IX. Conditions o Appr a mussm \ SYSTEM OWNER: e 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber I1 f•� ,r /P 2. All setback requirements must be maintained dC �Ct �'� n o as per applicable code /ordiMar -, S g� .� " � X / Attach complete plans (to the County only) for the system on paper not less than 9112 x 11 inches in size 1 n,, n SBD -6398 (R. 01/03) �` ��� � ��. �, PLOT PLAN , PROJECT Euaene Klien ADDRESS Y Industrial St. #6 Hudson Wi 54016 NE 1/4 NE 1 /4S 30 /T 29 N/R 18 1 TOWN Warren COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE10 /4/05 BEDROOM 4 CONVENTIONAL XXX IN- GROUND PRESSew CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28 kk BENCHMARK V.R.P. Top of Lath ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 95.0/96.2 5 below grade upper setbacks required by Plans Designed Using s o f Cell WDNR Conventional Powts Property Line Manual Version 2.0 Scale is 1" = 40' Vent unless otherwise >6 °� Standard Biodiffuser of Cover Leaching Chamber noted with 3 1. 1 ft2 of Area 6' Long III? 34" Grade at System Elevation 100' 2 -3' X 88' Cells with >3' s 15% Slope B -1 ' Ve is 90' B -2 75' 0 ' 20' B -3 45' ST 25' 25' Pro 4 Bedroom House Property Line C OP I PLOT PLAN PROJECT Euaene Klien ADDRESS 1 Industrial St. #6 Hudson Wi 54016 NE 1/4 NE 1/4S 30 /T 29 N/R 18 TOWN Warren COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/4/05 BEDROOM 4 CONVENTIONAL XXX IN- GROUND PRESS CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28 BENCHMARK V.R.P. Top of Lath ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 95.0/96.2 5' below grade upper setbacks required by Plans Designed Using side of Cell WDNR Conventional Powts Prop rty Line Manual Version 2.0 Scale is 1" = 40' Vent unless otherwise >6 " Standard Biodiffuser of Cover Leaching Chamber noted with 31.1 ft2 of Area 11 6 Long 34 " Grade SXstem Elevation 100' 2 -3' X 88' L*BM- Cells with 15% Slope >3' spacing 1Vents 90' 75 1 20' 20' B -3 45' ST 25' 25' Pro 4 Bedroom House Property Line Property Owner _ Parcel ID # Page of [] Boring Boring # Z 3 J&pit Ground surface elev / ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 0 0 S o �'YI c �� , /V F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil tication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. saD.saw (a.6=) ' Soil Test Plot Pla VA Project Name Eugene Men Sh Address 1815 Industrial St. #6 Hudson Wi 54016 #226900 Lot 3 Subdivision -- - ----- Date 10/5/05 NE 1/4 NE 1/4S 30 T 2 9 N /R W Township Warren ❑ Boring 0 Well PL Property Line County S T. CROIX BM or VRP Assume Elevation 100 ft. Top of Lath System Elevation 95.0/96.2 *HRpSame as Benchmark Property Line Scale is 1" = 40' unless otherwise noted 100' 15% Slope B.M. B�- 10' 100' 90' 75' 102' 0' B -3 45' 25' Pro 4 Bedroom House Pr operty 'ne POWTS OWNERS MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner t-- Septic Tank Capacity Z al ❑ NA Permit # 4 � 1 — f I O Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer :_ ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model �_ ( ❑ NA Number of Public Facility Units NA Pump Tank Capacity g al NA Estimated flow (average) al /day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) &CV gal /day Pump Manufacturer Ff NA Soil Application Rate L9 - �_ gal /day /ft2 Pump Model I §rNA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit NA Fats Oil & Grease (FOG) 530 m I OG) g/L ❑Sand /Gravel Filter ❑Peat Filter Biochemical Oxygen Demand (BOD :_220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :_150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD :530 mg /L )6-ln- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) :510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: Other: 11 NA ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA a MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) 11 least once every: 3 month(s) earls) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third IY of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 ears) ❑ NA PI - year(s) y Clean effluent filter At least once every: ❑ month(s) ❑ NA year(s) Inspect um ❑ month(s) p p pump controls &alarm At least once every: ❑ year(s) NA Flush laterals and pressure test At least once every: ❑ month(s) A ❑ year(s) LOther: er: A ❑ month(s) At least once every: ❑ year(s) A 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; Se tae Servicing Operator. P p g g p Tank inspections must include a visual inspection p of the tank(s) to identify n missing or broken hardware identify an cracks or leaks, Y Y 9 Y Y e ks, 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 i es and to check for an ponding P P Y Po d ng 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) START UP AND OPERATION Page of 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 evalw6tion to establish a suitable replacement area. Replacement / syste s must comply with the rules in effect at that time. ZERACC � S /T6 1 S LJ&6L` -61 5 A+ ❑ A suitable replacement area is not availa 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 ' (- Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S-rt--, cut bttN l 'r 2DAjp Phone Phone ?C -Tv This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ArcIMS. Viewer Page 1 of 1 �s 3M 334 282.41 B?d) 2 22A 1 "0 4w 4M dd0 441 224.97 3 2 Warren BxC2 CoD2 46w 40 FoB 3D B )D2 44 1.44 u 1 NE 1 /4 -NE 1/4 HuA MC2 EmE http: //72.21. 230.178/ website /LRPortal /ARCIMS/MapFrame.asp ?PIN= 10/10/2005 Wisconsin Department bf Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Builde.t Divisl6v' INSPECTION REPORT Sanitary Permit No: 479440 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Klein, Eugene I Warren, Town of 042 - 1082 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 30.29.18.460D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding SUHt Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO I P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: UNIT Model Number. DISTRIBUTION SYSTEM Header /Manifold IlDistribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia ILength Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes 0 No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 991 80th Avenue Roberts, Wl 54023 (NE 1/4 NE 1/4 30 T29N R1 8W) NA Lot 3 Parcel No: 30.29.18.460D 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? 1J Yes 1] No Use other side for additional information. Date Insepctor's Signature Cart. No. SBD -6710 (R.3/97) • Safety and Buildings Division County ` 201 W. Washington Ave., P.O. Box 7162 Madison, ,��0��,� on, WI 53707 - 7162 Sanitary Permit Number (to b filled in by Co.) (608) 26 - � 1 440 Department of Commerce a1 I.D. Number Sanitary Pere 'catio �✓ /g�39� In accord with Comm 83.21, Wis. Adm. Cod ers , a f atio you pro may be used for secondary purposes Priva rt a )(m) H (� ?Pin Projec Address (if different than mailing address) I. Application Information - Please Print All Information ST. CROiX COU O v �tVE Property Owner's Name F /CE Par 1 # c Block # Property Owner' ailing Address Property Locati /^ C A�� 111V2 1 /4, Section City, late Zi Code Phone Number ircl he) T �N; E r W II. pe of Building (check all that apply) O�J ' �^ o 2 Family Dwelling - Number of Bedrooms �a AAS Subdivision Name CSM Number r ❑ Public/Commercial lic /Commercial - Describe Use El State Owned - Describe Use ❑City_ ❑Villa wn ip of 2 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) c4 OEL - - �� O A. System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS S stem: Check all that apply) f7 x) L ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required Dispersal Area Proposed (sf) System Elevation ( 1 / CJ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units ��� Gam. Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Z S Aerobic Treatment Unit Dosing Chamber VII. Responsibility tatement- I, the undersig ssume responsibility the attached plans. for installation of the POWTS shown on VII Plumb Name (Print) Plumber' MP/MPRS N umber e Busi D 900 Plumber's Address Street, City, Stat , ip de) I VIII. County/Department Use Only Si ature o Stamps) Sanitary Permit Fee dudes Groundwater Date Issued ZimuingAg gn (N Approved ❑ ed al Surcharge Fee n Reason eve i IX. Condition pp 3) — 0 , �k S o-rc -e_r a C.6 01- SYSTE WNER: 1 Septic tank, effluent filter and dispersal cell must all b e jo ryl ged I maintained �-- � as per management plan provided by plumber. ^ 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 8I/2 x 11 inches in size SBD -6398 (R. 01/03) Roi L.&�q gr; PLOT PLAN PROJECT Euaene Klein ADDRESS 1815 Industrial St. #6 Hudson Wi 54016 NE 1/4 NE 1 /4S 30 . /T 29 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 100.8' 4 BEDROOM CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # of chambers none BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE WELL *H. R. P. Same as Benchmark 0' Property Line Scale = 1/4" = 10' To 80th Av Ta is to be properly bedded 325' and p vided with lockdown • Property covers approved warning Line labels Pro 4 B.M. #2 Top o Bedroom Tall 3/4" PVC House B -3 Huffcutt Combo an Well is to meet all B.M.* setbacks found in B-1 radin 9 is to Comm. 83 A ❑ one to divert run -off away from system 3% Slope Area 15' below 101, system is to remain undisturbed 100.8' B -2 100' copy 99' Safety and Buildings 4003 N KINNEY COULEE RD COmmerdemi. LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 iscons'in www.w www.commer isco goWsb, isconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary August 23, 2005 OUST ID No. 226900 TN: POWTS Inspector s � SHAUN R BIRD ZO G OFFIC BIRD PLUMBING, INC ST C OIAC TY SPIA 1008 '192 ND AVE 1101 CA1%2W EL NEW RICHMOND WI 54017 > HUD S N 540 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/23/2007 Ident' ation Numbers V saction K o.1187396 SITE: a ID No. 88 Eu ene Klein Please re r to both identification numbers, 8 ve above, all corres ondence with the agency. Town o en St Croix Co. Ca%y NE1 /4, NE1 /4, S3 , 9N, R18W Lot: 3, / FOR: Description: Four Bedroom At , ade System Object Type: POWTS Componen anual Regulated Object No.: 1034922 Maintenance required; 600 GPD Flo ate; 71 in Soil minim depth to limiting factor from original grade; System: At -grade Component Manual, - 10570 -P (R.6/9 Biofilter The submittal described above has been reviewed confo ce with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CO TI ALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible fo mpliance with all code requirements. No person may engage in or work at plumbing in the sta 'un licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during cons ion or installatib nd prior to occupancy or use: • This system is to be constructed and located ' accordance with the approve ans, and with publication SBD- 10570 -P (R. 6/99) "At -grade Component ual Using a Pressure Distribution tem for Private Onsite . Wastewater Systems ".` • The pressure network is to be constructe 'in accordance with the sizing methods of publi n "SSWMP cP RTf :,T Publication 9.6 Design of Pressure Dis . bution Networks for ST -SAS (01/81) ". ( N OF • Per manual cited above, limited acti ,ties are allowed in the area 15 feet down slope of the component SEE CC," ,RE Soil compaction, excavation, vehi ar traffic and other similar activities that impact the treatment and dispe are prohibited. • The well must be a minimum 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must obtained from the county where this project is located in accordance with the requirements of Sec. 14 .135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat SHAUN R BIRD Page 2 8/23/2005 • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II, Integrated Services WiSMART code: 7633' (608)789 -7893 , 7:45 am - 4:30 pm Monday -Friday cbratz @commerce. state. wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 r r ° M = D AUG 1 5 2005 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 8/10/05 Owner:Eugene Klein Location:NE1 /4 NE1 /4 S30 T29 N,R18W Lot 3 80th Ave Warren System type: At -Grade Manuals Used: At -Grade Component Manual version 1.0 SBD 10570 -P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Page# 1. Cover Page 2. At -Grade Plot Plan 3. At -Grade Cross Section 4. Pipe Cross Section /Pipe Layout o a� 5. Pump Chamber Cross Section •,, „, r� 6. Pump Curve 7 -8. Maintance and Contig nc plan .,F C("' 9 - 11. Soil testb GS SP ONDEN E� , Shaun Bird Signature License number 900 PLOT PLAN PROJECT Euaene Klein ADDRESS 1815 Industrial St. #6 Hudson Wi 54016 NE 1/4 NE 1 /4S 30 /T 29 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 100.8' 4 BEDROOM CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # of chambers none BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑BOREHOLE o WELL *H. R. P. Same as Benchmark 370' Property Line Scale = 1/4" = 10' To 80th Av Tank is to be properly bedded Prop and provided with lockdown Property p Y p Line covers with approved warning labels be s Pro 4 B.M. #2 Top of 9" Bedroom Tall 3/4" PVC House B -3 Huffcutt Combo Tank Well is to meet all B M * setbacks found in A B-1 Grading is to be Comm. 83 ❑ done to divert run -off away from system 3% Slope Area 15' below 101 system is to remain undisturbed 100.8' B -2 100' 99, >5 B >5 PVC F0P E Mhi W t . 5� 2 — TURti1— UPS }-- DiSTltt w :.tTecrS tA't'�RAt. --� — — i Q STAtIlL: ZED oftV "AT1011 VII 5' 1/613 1 /6B _ � � � 1/2 B A t. 8 = R. t. CE t!. of fi 2 /Z AC=GREr=ATE 2- Pt SYU THEML Fabric + Distribution Lateral 5T�81 1��D Observation- - -,.,, �� � �--- Soil Cover Well 12 o f i. r� 2:5' A Z2 > .� f� sloQE Plan Viev and Cr ess Section of Wisconsin At -grade Unit with a Single Absorption Area on a Sloping Site Page Of Distribution Pipe Detail For Lateral Network ACCers' TuRM -uP (CLx tT - r) y - PVC Force Hain PVC 'Distribution Pipe P * Last dole Should Be Next To �'uRr�• uP __ q P 0 ft. Hole Diameter `1 C L Inch X inches Lateral Diameter ��-- Inch(es) Y Y Inches force Main Diameter G- Inches # Of Holes /Pipe Invert Elevation Of Laterals Ft. Signed: License Number: Date: F i,RMBER Cr�DSS S ECTION AOD SP£CLF ICATIOSS SEPTIC 'SANK � pump C ++ WCATWRPRWF T ABOVE GRADE £ 4 += GI VENT PIPE IZ M • JUNCTION BOX APPROYED FROM D441t, WjjvDoW OR WITH CONDUIT MANHOLE COVER .iR INTAKE Wf FADi flCK 5 FttESL� r� ! rn ........ WARNING LABEL FIl�x �D GRADE L f0 �" -_ ._" ,..... Him ;g" IN- _ T , INLET � GAS- + WATER TIGHT SEALS — T — TIGHT+ A SEAL ; S WITH FILTEK _ _ + ; ALM AP � PIPE ON SOLID Sol APPROVED i. PIPE 3` C wo SOLID FF SOIL pump OFF ELEY -/ l `� FT - D 30 APFROVED BEDDING UNDER TA41'- CONCRETE PAD SPECIFICATIO iISER DOSES ?ER DAY: SEPTIC f DQSE 2+F11 TANK MANUFACTURER: C DING y' GAL.. DOSE y��tSE FLLIUBACK: TANK SIZES SE PTIC 7„�� TGAL. DOSE _= � GAL. . ' I1�i�iES L�--� CAPACITIES: A AL -- _ —5—GAL- AM MANurALC2I3RERi: L._ f/ B = _2 INCHES - MODEL. NUMBER > J 1.2 7 JGAL- i SWITCH TYPE: i,� �✓ C = � IIIGHES = PUMP L'4ANU'rACTURE II = � I�HES = l � GAL ISODEL NUMBER TYPE= UMBER I. � > e /tu��. 16.23 WAC SWITCH At-ARM WIRING AS PER ILHR REQUIgED DISCH&RGE RATE =`_ —L- C ' - �� FEET .. ��-`�' FEET VERTICAL DIFFERENCE SETWEEN PUMPEOFF •AILB- flIST#tIBU"EION p_� FEET + MINT�iJM HET�IORK SUPPLY XR���FT /100 FT- FRICTION FACTOR EET + FEET FORCEM ; TOTAL DYNAM IC HEAD S F J DIAMETER L - i WID TH INTERNAL D IMENSSIONS DF PUMP TANK: LIQlAD -- MATE - LICENSE NUMBEg SIGNED: :t &8 - TOTAL DYNAMIC HEAD /CAPACITY • PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND DEWATERING MODEL 152/153 MODEL 152 153 g 50 Feet i Meters Goi. Liters Gol. ! Liters 5 1.5 69 261 77 291 153 I 10 3.1 , 61 231 70 I 265 4 2 12 0 157 15 4.6 53 201 61 31 20 6.1 I 44 i67 52 197 = 30 25 7.6 34 129 42 159 8 30 9.1 23 i 87 33 l 125 ' c 5 1 C. i -- 22 85 a � 40 12.2 I -- -- 1 i I 42 O 4 Lock Vane: 38.0 Ft. (11 Ft. (t3.4m) ousaa 10 O 100 20 40 60 80 GALLONS f-•- 6 �/� --� LITERS 0 80 160 240 320 _ 3 27/32 -r-- -+-tea 5/6 -•�•I ! FLOW PER MINUTE I I I i 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS ! • Timed dosing panels available. ( 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with _ _ —_ an alarm. • Variable level control switches are available for controlling single phase t systems. i • Double piggyback variable level float switches are available for variable 7. level long and short cycle controls. • Sealed Qwik - Box available for Dutdoor installations. See FM1420. I • over 130 °F. (54 °C.) special quotation required. 12 1/8 1521153 Series' I 1521153 MODELS Control Selection Model volts-Ph Mode Am Sim Ie: Duplex i I/8 N152 115 1 Nan 8.5 1 2or3 eK206 SN152 115 7 Auto 8.5 Included 2 or 3 ) E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2o,3 N153 J15 1 Non 10.5 t 2or3 SELECTION GUIDE SN153 115 1 Auto 10.5 Included 2 or 3 back variable level float E153 230 1 Non 5.3 1 2 or gy 3 1. Single piggyback variable level float switch or double pig SE153 230 1 Auto 5.3 Included 2 or 3 switch. Refer to FM0477. e CAUnoN 2. See FM0712 for correct model of Electrical Altemator E All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed Including the most, or (4) float system. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Louisville, KY 40256 -0347 Manulat�luersof.. SHIP 70. 3649 Cane Run Road �O Louisville, KY 40211 -1961 Q, p,o S,vcf /93.9 JI F (502) 778 2731.1(800) 928 PUMP p / /wwwzoeller cvm PIMP FAX (502) 774 -3624 0 Copyright 2000 Zoeller Co. All rights reserved. PLAN Page of S pV1fNtEEt'S MANUAL & MANAGES EF C TtONS POWT SYSTEM SP Septic Tank Capacity S S a ❑ NA FILE INFORMATIO e Septic Tank Manufacturer fl HA Owner '"' ❑ NA Permit. Effluent Titer Manufacturer DESIGN PA�ZS Effluent Filler Model O NA Number of gedMOMS Pump Tank CapacttY _ at O NA CQmme at Units p Tank Manufacturer N NA Number - �"'� ailda � � p NA� Esdmated flow (98) at/d . Pump Manufiaef D�gn flow (peak} allda Pump Model Son Apptt�' Rate r average" Pretreatment UruF; 0 Peat Filter Monthly p j ❑ Wetiand Infltrent<EAU U S30 nVA O Mecitianicat Aeration Fats.. Of 8 Grease (�G� �0 mg/L [ 3 Disinfection Q other' Biochemir;al Omen Demand {BODE Manufacturer Total Suspend Sorids (TSS) 515o m � rent cell(s) NA Monthly average" ❑ -ground (gravity) [3 Moundnd {pressure =ed) p Effluent Quai itY 530 mgn• D Mound en Demand (BO s) _gLin e c3 Other_ Biochemical SS) ded Solids {TSS) 530 mg/L e To t a l Suspended 510 cfu /100 � wastamterand Fecal C�ftftcle (geometric mean) values typical for d a Bstic ( Y inch diameter sept tank �gYem Max -mum Effluen Size netteatee wastewater. .• Values typical for P MAINTEMU4CE SCHEDULE service Frequency S Event [3 months r(s) (Maximum 3 yrs•) At least once every u is one -third (Y) of tank volume Inspect condition of tanks) When combined sludge and scum e4 co ntents of tank(s) 3 []month r(s) (Maximum 3 yrs.) Pump out m At least once every dispersal ceri(s) 13 months . r(s) Inspect Pe At least once every s) O [NA Glean effluent filter D months control S alarm s At least once every NA Inspect Pump. Pump At least once every ❑months ear(s) ❑ Flush laterals and pressure test p months ❑ year(s) 0 NA At least once every COW. At months 13 Y'Ws) O NA At least once every Other one of the following rcenses or Mpit�TiENpNCE 1NSTRUCT10N5 l eelis shall be made by an individual carryinr9�cto POY+r - S Maintainer, Septage Inspections of tanks and dispersa ;" or broken �: Master Plumber. Master Plumber Restricted Sewer; PO I tank(S) to identify any m1s back gig operator. Tank inspections must include -the a visual inspection om UP or teaks. me" the volume of combined sludge and scum and � �e gM uent � on t isYets hardware. identify any round surface. The dispersal calf {s) shall be visually inspected riding of effl the or pondtttg Of effluent on the g nding of effluent on the ground surface. The P° authority. in the observation Pik and to che condi for any n and requires the immediate notification of the local regulatory ground swfaee may indicate a faiTin tio or more of the tank volume, the e and scorn in any tank equals one - third ( o f in acrbM a Septage shall be re ance Witt' d1• NR When the combined accumulation of studs Senrid entire Contents of the tank ng Operator and dispos moved by ant components: and any Wisconsin consin Administrative Code. retreat#m The servicing of effluent filters. mechanical or pressurized POVYTS components p a CeRified ppyVTS Maintainer• tntenanoe or mondonng St ints rvais of V months or less shalt be F? � of any service event ofherma reg ulatory authority within 10 daP Of A ser ARe report sMil - be prided to the Coca[ resene of painting products or other START UP AND OpF.R�4T10N c hi gh concentrations are For Raw construction, Prior to use of the PO ss m age thekdispefsal cell(s). 9 chi that may imivde the treatment p and/or da rotor prior to use. detected have the contents of the tank(s) removed by a septage servicing ope i" Page cf._... -- conditions are frozen at the tnfil surface- start up shaft not occur when sots is restored the excess g Y outages Pump tanks M 1W above normal highwater levels. When power Du vvitt be dim the d wpersat ceit(s) in one large dose. o vQrioading the ceti(s) and may result in the b or surface dSc arge of eftttie[it To avoid this situation have the contact a puatp tank removed by a $eptage Servicing OperaUoc t to t estaortt19 P'� to the effluent pump a Plumber or POWTS Malrttainer to assist in MWUW Op the pump controls to restore normal revels within the ppmp tank - otherwise Do not drive or park vehicles over font`s and distser'sal Cells. Do not drive or park over otherwise dstvrb or compact, the area resin 15 feet down slope of MW mound or at -grade soil absorption area - Reduction or•errmtnation of the following from the wastewmter stream may improve the perfonnance and prolong the life of the POWTS: antibiotics; baby wipes: dgare butts; condoms; cotton swabs; degreasers: denfat toss: drapers; drsinfedants: tat; focrriifa�on drain {srurtp Pump) fruit and vegetable peerIngs: gasoline; grease, hertucid�s; meat �p6; Medications; off; paroling products: pestuzdes: sanitary napkins; tampons, water softener brine. ABA NDONMENT fatten out of service the fotlawing steps si�alt taken to insure that the When the POWTS falls and/or is nomad i n c with ch. Comm 83.33, Y�/isconsin Admkdsbm&e Code: � and safety abandoned n c "once system proPegY openings seated_ . All piping to tanks and pits shaA •be disconnected and the abandoned pipe open g Th Contents of an tanks and Pits shall be removed and property disposed of by a Septage Servicing Operator. After pumping all tanks and Pits shat[ be excavated and removed or their covers removed -and the void space Sled with soil, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS fats and cannot be repaired the folfowing measures have been, or must be taken, to provide a code compliant replacement system p A suitable neplaoement area has been evaluated and may be utilized for the location of a replacement soil absorption replacement area should be protected from disturbance and compaction and should not be infringed upon by required Setbacks from existing and proposed structure, be lines and welts_ Failure to prroted the replacement area will res ult 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. O 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_ The site has not been evaluated to identify a suitable replacement area Upon failure of the POWTS a soil and s uation must be performed to locate a suitable replacement area. if no replacement area is available a otdrng tank may be installed as a last resort to replace the failed POWT'S_ ound and atVrade soft absorption systems may be reconstructed in place following removal of the biomat at the frllhrative surface. Reconstructions of such systems must comply with the rotes in effect at that time <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANI3IOR INSUFFICIENT OXYGEN. oo NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSOHi FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMEN POWTS INSTALLER „ POWTS MAINTAINER Name L Nane Phoned �� Phone 7JJ SEPTAGE SERVICING OPERATOR PUMP LOCAL REGULATORY AUTHORITY Name Agency Phone ! !"= - v e /' Phone 7tus aoaarCnt was draRsd try tha staffs of VW `.amen Lake, Moquette and Waushara County Zoning and Sanitallort This document meets the minimum mquimmants of di Comm 83.22(2)(bXt3(d)&(0 and 83.56(7), CZ) &. ( Wisconsin Administrative Code Usa of fhJs document does not guarantee the performance of the POWTS_ GMW (BO1) Wisconsin Department of O - °- ==` ' OIL EVALUATION REPORT Page \ of 3 ✓� Division of Safety•and Buil gs r " * in accordance wi Comm 85, Wis. Adm. Code � Attach complete site plan n papA t IS �' x 1 inches in size. Plan must County S1 C�u _ include, but not limited to: erticzW h ztSntaal eference point (BM), direction and Parcel I.D. percent slope, scale or di ensions, north ar ��docati n and distance to learest road. O CROI ea eT ®!ID h Reviewed by •Date j Personal information you prove a may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner �� G ` �` -r Property Location p, ` p evt-tet �� 1/4�[ -} 1/4 S 3Q. T !31 N R '4 E (or ' Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road l`4 c�G-lu g I L-vl IS Q'01 -3 ( (Ds I)zZ6 -Q L— New Construction Use: Residential / Number of bedrooms S Code derived design flow rate S Q GPD ❑ Replacement 1 ❑ Public or commercial - Describe: Parent material I�C1 O V Zz!- 1 L L. Flood Plain elevation if applicable General comments and recommendations: - 'Lox) G - Cw (--TZ - 103 - 8 ' i F Boring # ❑ Boring ® pit Ground surface elev. a� 1 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture r P Structure Consistence Boundary oots GPD /ft z ry in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 CA_ ? S - �' ' 4 "w- C Lv a ❑ Boring # [] Boring ® Pit Ground surface elev. l uU' O ft. Depth to limiting factor ? in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o —E) l0 Hfz 3 1Z — s) 1 7 V YriUi 2`FS�h vYl Ct, j 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) Sign re CST Number Arthur L. Ilegerer 3 ,Zv� 220254 Address U e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Bain St. River Falls, UI 54022 1 ti - Z �'j C) 715 -425 -0165 I Property Owner Parcel ID # -! 0� Z ' Ll�-� Page of Boring # ❑ Boring ® �3 ft. Depth to limiting factor �- in. Pit Ground surface elev. �K 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 O_ 1 1 O`-t I Z j 2 - S 1� Z` �- M U G-5 ` h'1 S `$ . ( 1P 1 0 1 d 23A - (3j ) Z -V7 3b)f C�S 3 W- V3 L 2 31 s i t 1 LShk a h y3= �Z- S�2y�6 - vw,. VVj F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L • Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or M 608- 264 -8777. SOD -8330 (RAM) . PLOT PLAIN Page 3 of .t Scale 1' = SO ,LU'f L.1 Q 0 vL — %> l � �6) j 9 9 1S�1 l3 U UZ 1�1S MZL3 n" s 3� -. in�.0'cr, q`'Orn..U, PE 3N/ L - e C'_.V 1 -U3 715- 425 -0165 220254 0 — Z08 CST Signature Oate Telephone 1 CST No. Job NO. ' ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICA'T'ION FORM J:� � <i I YN owner/Buyer S'g04 Mailing Address p Property Address (Verification required from Planning Department for new construction) City/State iz D Parcel Identification Number �F SAL DESCRIPTION '� ` � }��� --• �� T� N_ � JL r/4 �f4, See. -- "�f — W, Town of property I,ocatiOII •' + Lot # Subdivision Page # Certified Survey Map # — , Volume t curs DDc� Volume 2 ��3— Page # Spec house ❑ yes)l no L fi identifiable► y es ❑ no SYSTEM �N- em could result in its premature failure to handle wastes. Proper maintenance Improper use and marntenanceof Your septic syst b a licensed pumper. What you put into the system consists of pumping out the septic tank every three years or sooner, if needed Y can affect the function of the septic tank as a treatment stage in the waste disposal systom- ent a certification form, signed by the owner and b The property owner agrees to submit to St. Croix Zoning Departm verifZing that (1) the on -site w astewater disposal system masterplumbcr, ourne r plumber or a licensed ), the septic tank is less than 1/3 full of sludge . is in proper operating condition and/or (2) after inspection and pumping (' to maintain the p 1 ith the standards private sewage disposal system w 1/wc, the undersigned have read the above requirements and agree ent of Natural Resources, State of Wisconsin - Certification set forth, herein, as sot by the Department of Commerce and the p e ted a Office within 30 rating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning days of the three year expiration date. -&/ /6 DATE SIGN OF AP LICANT OWNER CERTIFICATION our knowledge. I (we) am (are) the owners) of I (we) certify that all statements on this form tru on R� °gamer of Deeds Office. the property described above, by virtue of a warranty LL� DATE SIGMA OF APP ICANT mis- represented may result in the sanitary permit bring revoked by the Zoning Department. * * * * ** Any information that is Register of Deeds office •• include with this a pplication: a stamped w arra nty deed from the if reference is made in the warranty deed a copy of the certified survey map .` U 2 4? 3 P 4 0 7 -748,�:9,9$ �3 STATE BAR OF WISCONSIN FORM 7 - 2000 KATHLEEN H. WALSH TRUSTEE'S DEED REGISTER OF DEEDS Document Number I ST. CROIX CO.. MI Lowell J. Gillette and Leticia H. Gillette RECEIVED FOR RECORD 12/12/2003 11:15A?l as Trustee of the Leticia H. Gillette Trust dated October 6, 2001 TRUSTEES DEED EXENPi 11 for a valuable consideration conveys, without warranty to Eugene B. Klein and REC FEE: 13.80 TRANS FEE: 292.28 Meredith Klein, husband and wife COPY FEE: CC FEE: PAGES: 2 Grantee, the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): See attached Addendum Recording Area ame and Return Ad diva Realtgd Title, Inc. 40 eco uite 115 so$, WI 54016 042- 108240 -000 Parcel Identification Number (PIN) This homestead property. (is) (is not) / r Dated this : da f C ,� p* /. 6'i L we J. Gillette + Leticia . Gillette Tn.dtee Trttsfee AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. Ciro l y County ) authenticated this day of Personally came before me this < ( da y of �, Y a.14 C LY1rti 1<1� ; �' the above named * Lowell J. Gillette and Leticia H. Gillette, trustees of the Leticia TITLE: MEMBER STATE BAR OF I SCA W LARRIEU H. Gillette Trust dated October 2, 2001. (If not, Not to me kn to be the person(s) who executed the foregoing authorized by § 706.06, Wis. St ) tale O Wisconsin in ment an cknowledged the ame. THIS INSTRUMENT WAS DRAFTED BY . Brent R, Johnson - Locomen Nelson Law Firm Notary Public, S ate of WISCONSIN Hudson, Wisconsin My Commission 's 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. TRUSTEE'S DEED STATE BAR OF WISCONSIN INFO -PRO 800 55 -2021 www.infoproforrns.com No. 7 - 2000 ( I oprotorms.com 1 ' U 2473P 'i08 ADDENDUM TO TRUSTEE'S DEED PIN 042- 108240 -000 PROPERTY DESCRIPTION A parcel of land referred to as Parcel 3 in the NE 1/4 of the NE 1/4 of Section 30, Township 29 North, Range 18 West located in and forming a part of the Town of Warren, St. Croix County, Wisconsin more particularly described as follows: Commencing at the NE corner of said Section 30; thence S00 °3 1'00 "E, 525.4 feet; thence N89'1 2'00"W, 875.41 feet to the point of beginning; thence N89' 12'00 "W, 441.44 feet to a point on the West line of the NE 1/4 of the NE 1/4 of said Section 30; thence N00 °21'00 "W, 495.00 feet along the West line of the NE 1/4 of the NE 1/4 of said Section 30; thence S89° 12'00 "E, 440.00 feet; thence S00 °3 1'00 "E, 495.00 feet to the point of beginning, subject to Town Road Easement described as follows: Commencing at the NE corner of the above described parcel, the point of beginning; thence S00 °3 1'00 "E, 50.00 feet along the East line of said parcel; thence NWIy along a curved line, concave NEIy, having a radius of 50.00 feet and long chord bearing N44'5 1'30"W, an arc distance of 79.69 feet to a point on the North line of said parcel; thence S89 °12'00 "E, 50.00 feet along the North line of said parcel to the point of beginning. For the purposes of these descriptions the North line of the NE 1/4 of said Section 30 is assumed to bear West. Together With a non - exclusive easement for an access road and for the installation of utility lines over and across a parcel of land in the SE 1/4 of SE 1/4 of Section 19 and in the NE 1/4 of NE 1/4 of Section 30, all in Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin being further described as follows: Commencing at the SE corner of said Section 19; thence S00 °3 1'00 "E along the Section line 28.28 feet; thence NWIy along a curved line, concave NEIy, having a radius of 881.47 feet and long chord bearing N63 °47'55 "W an arc distance of 294.20 feet; thence N54° 14'14 "W 426.64 feet; thence S33 °52'50 "W, 33.02 feet to the SWIy Iine of the existing Town Road, being also the point of beginning; thence S54° 14'14 "E along said Town Road, 33.02 feet; thence S33 °52'52 "W, 405.74 feet; thence 242.08 feet along the arc of a 50.00 foot radius curve which is concave to the NE and whose long chord bears N56 °07'10 "W, 66.00 feet; thence N33 °52'50 "E, 407.90 feet to the SWIy line of the existing Town Road; thence S54° 14'14 "E, 33.02 feet to the point of beginning, Except any of the above described land which may lie between the true West line of the NE 1/4 of the NE 1/4, Section 30, Township 29 North, Range 18 West as established by survey and the old fence line located along and near, but not exactly on said West line. Mt _ 29 WARREN. T.29N. R.18W. E SEE PAGE 43 O are E N Lama �a C /aieisce P • S rF'o. c Ric/idrL . r • Gerald L. 4 For/res, Connie /l'en Fj¢i, 73 /s / Pobe /f 63 C. Mueller S x. Gob Inc. 76 - Z17C a & • G n V • tTahn C. " v.N , . �� 0 ' � Derrick. Dan z7ss Miake/son � /s9.ze sz.a Sb °� •v l v N � � � /s49 a_ eC - 260.27 �y icfni eta �TenKD' /f �.. a Nancy , y Pam- 5 z� 4a 140 l 1Q Thomas a Matey .917 f�ter , p S; ri 4 R .0 ` m n �y F Fink v' i s `�'� �o BNese Ma /one�c • • W � /52. 2874 C y ri7h fC. /3943 W� • .iV • V 4o.4 AVE 0 nd �G f�f [Tohn -Da /e nn EFnaric S • C y n �- f �oro%hy • t/ _ 9 a o /�edmon h'erin* Lehart�Groriees F/'ede�ic,E Rh!K Far/7i .Znc az /C V e (.0 1 9754 /n/i //1a177 Bo 80 h 0 �hf Kenneth J 6 Fr: ea'rich J • err Y gnnT f Pamela F e Wes.; Mary X //o y� m dQd Kur*onus*/' Herink Gib sio M¢ /ones/ / n y Frederiok 470 /LO do Ah B M! 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ROBERTS GROCERY .O. Box 4 Roberts, WI 54023 Phone 715- 749 -1718 MEATS - GROCERY - PRODUCE Fax 715 -749 -1719 I HOURS: NorthL_and Surveying, Inc. Monday- Saturday 7:30 a.m. to 9:00 p.m. Sunday 9:00 a.m. to 6:00 p.m. Boundary $veys e Certified Survey Maps a Major Subdivisions a Topography Surveys (715) 749 -3840 Edwin Fianum Michael Erickson ROBERTS. WISCONSIN t . RL.S. No. 2487 R.L.S. No. 2592 j 1 I o F c o c o o 3 �`•A CD (D m v • 1 d CD \ 3 a� 3 .� n _ o m u v o A < • O Q N O :f: A (D (.0 O S m O O m m c - N CD C v N N O ' Q co O a) A W= CD oo O 3 a o N90 o o C CD CD (D a o v y,FzI m �:;, D a =r p co c o c°o T 7t ID O wo �r Z s O 0 0 D N o Cl) - CD z O O O o m * ** m w 3 3 1p (a Ch w I m Q � Q N o :r d � CD _ y cn 0 H 3 m c) 3 CL w z ° z om z D o CD O N C N �• I a N !J O O N /yam N CD CD w N 2 N z O• fl 0 3 7 z 0 7c CD Cf) -� -j W �' � vi .p. O y -0 z a G7 o ma c O O z 3 N 0 00 m CjD CD ° 3 A A o z � 3 m w CL 7 N O CD A A I I a Q o o m c c O j N Q o o' o � -�� o' : o I .- m �_ c 00 '3 O a N n z CL O (� C" M. _ 'J O N (D O O0 N (D O v: / CD _. O � C) C3 CD o CD D) () cn O P fD A O p = =r C C2: Q O N D Q 6 C') N N =OCR a 01 N 7 p_ v O O V N O `p CD O CD % , a o Q w O CDD 0 Q w Parcel #: 042 - 1082 -40 -000 08/02/2007 11:59 AM PAGE 1OF1 Alt. Parcel #: 30.29.18.460D 042 - TOWN OF WARREN 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 - KLEIN, EUGENE B & MEREDITH EUGENE B & MEREDITH KLEIN 981 80TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 5.010 Plat: N/A -NOT AVAILABLE SEC 30 T29N R18W 5.01A PAR IN NE NE AS Block/Condo Bldg: DESC IN VOL 605 P 65 ORD ALSO REFERRED TO AS #3 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 30- 29N -18W Notes: Parcel History: Date Doc # Vol /Page Type 12/05/2005 813510 2938/475 EZ -U 12/12/2003 748998 2473/407 TD 01/30/2003 707607 2125/381 WD 07/23/1997 704/221 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/08/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.010 48,500 265,300 313,800 NO 2 Totals for 2007: General Property 5.010 48,500 265,300 313,800 Woodland 0.000 0 0 Totals for 2006: General Property 5.010 48,500 0 48,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00