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HomeMy WebLinkAbout016-1001-20-000 � � 7 3 f7 3 '�'• �1. T 0 M O w W G7 ° • M m v, o o+ o— < <_ c ID CL ro = f 1 o cn W U N N N `- '', a °oN d d A j O D o O1 3 q * o 3 N v 3 O CA O v C y m° o CD <C" m C4 a c m Ico C a A ? d X y 3 � 6 CD F °o r . 000 n tv o V O O N w N < ° Is = Ln CD Ot " A N3 (D P a � Nz .. c =� D D o m O c _ n o' ro "A • CD = jo C m W �' 3 N Z m + z m O 3 c A Z N J n N p Z O 0 fD � N Z W W m ° CL Z O A C " cn N CD N A W p� N a m c Q m CD o < o o (D d. 3 T - 0 fl N C K 3 (D O� N O OZ O. 3 N a y N O CD -0 � N A A N B 20 a 1 00•. Q `OG� y N CD L 3 t�lf S 7 S 7 fD Co O CD (D CD N N O p� O O O. _ I q I p 0 N m b a CD do Qn O o C) g c Parcel #: 016- 1001 -20 -000 04/05/2007 02:46 PM PAGE 1OF1 Alt. Parcel #: 1.30.15.11 A 016 - TOWN OF GLENWOOD 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 - BOEKER, JOHN E JOHN E BOEKER 1745 CTY RD X GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 1745 CTY RD X SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 21.810 Plat: N/A -NOT AVAILABLE SEC 1 T30N R15W PT NE SW & NW SE & PTS Block/Condo Bldg: GOV LOTS 8 & 9 NKA LOT 1 CSM 10/2914 INC 016- 1000 -95 -100 (9A) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 01- 30N -15W Notes: Parcel History: Date Doc # Vol /Page Type 07/08/2003 729249 2305/511 QC 04/20/1999 601531 1419/624 WD 10/20/1998 589478 1367/493 QC 07/23/1997 1124/042 WD more 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/06/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.000 20,000 133,600 153,600 NO UNDEVELOPED G5 1.000 500 0 500 NO PRODUCTIVE FORST LANDS G6 16.810 20,100 0 20,100 NO Totals for 2007: General Property 21.810 40,600 133,600 174,200 Woodland 0.000 0 0 Totals for 2006: General Property 21.810 40,600 133,600 174,200 Woodland 0.000 0 0 Lottery Claim Credit: I im Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 016 - 1000 -90 -100 04/05/2007 03:31 PM P AGE 1O F1 Alt. Parcel #: 01.30.15.8A 016 - TOWN OF GLENWOOD 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 - ADAMS, GORDON T & CAROL L GORDON T & CAROL L ADAMS E580 N CTY RD X GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 2.360 Plat: N/A -NOT AVAILABLE SEC 1 T30N R15W GOV LOT 8 LYING S OF CTY Block/Condo Bldg: TK X 21.81AC EXC PT LOT 1 CSM 10/2914 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 01- 30N -15W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 933/188 07/23/1997 933/187 07/23/1997 905/52 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/24/2002 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 2.360 300 0 300 NO Totals for 2007: General Property 2.360 300 0 300 Woodland 0.000 0 0 Totals for 2006: General Property 2.360 300 0 300 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 o a ll r pkeo OR 2 1 995 KO'l NH. yV,s�g ST. CR01X COUNTY 14 St Crcix�f Deeds SURVEYOR'S RE R 5 %8249 Go.,WI CERTIFIED SURVEY MAP LOCATED IN GOVERNMENT LOTS 8 AND 9 AND IN THE NEI /4 OF THE SWI /4' IN SECTION I, T30N, R15W,TOWN OF GLENWOOD, ST. CROIX CO., WI. ' IN THE NW I/4 OF THE SEI /4. PREPARED FOR: GORDON ADAMS NOTE: BEARINGS ARE REFERENCED TO THE E- W QUARTER LINE•(ASSUMED), GOV. LOT 9 GOV. LOT8 N- S QUARTER LINE •U N A T T E D LANDS N ' E - a P, 0.8. O S 2 S 82 ° 5014 "E M 482.62 I>r-- — 1 - 200 0 .0 12 .59' /......... v 157.85' \` V O S7- N E -W QUARTER LINE ` / 4;' aO om .25' ✓�./ / O _ .••- j, .•'.,- 2673.72' -- ..........n � S86,•19 ' 4 /` • �'�• H O U S E W 1/4 COR. SEC. 1 w • / 2540.51' M In cr L0 T h 3 v 21. 81 ACRES w (949,840 SO.FT.) 20. 27 AC. EXCLUDING ROAD W. 1 8 8 2, 8 24 SO. FT. 1 O 2 /,1 0 c0 t0 I JOHN 'S N.QZ BUILDING SETBACK IS N M 1 00 FROM R.O.W. LINE CREEK M z rm g arid' _ S COnt ti tit�lt • uE 1284.67, ..._..,.. '. 0 I N 86 0 25 38 W 1317..67' ; + • ' • , - UNPI.ATT EO LANQS. I ' ��lf►OOi4�►$ I ®; COUNTY MONUMENT FOUND, OSPRINGVALLEY S � 0= SET I "X 24" IRON PIPE WEIGHING I 1.13 LBS. PER LINEAR FOOT. dl SCALE I" = 2 0 0' i ���� O 0 100 200 400' /d0 13�� JAMES M. WEBER S -1804 m ug", NELSEN- WEBER SURVEYING DATED SHEET I OF2 95 -41 THIS INSTRUMENT DRAFTED BY JIM WEBER VOL. 10 PAGE 2914 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner � Property Addres City /State - Legal Description: Lot Block -- Subdivisio CSM /� t /4 SOJ ' /4, Sec. �, T N- .� W, Town of - t� PIN # = /do -�r O�G - /tea/ -moo SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: m�,9Vjc's rn'� Tank manufacturer , x t- - Size ST/PC/ �57�Setback from: House � �S Well P/L Pump manufacturer An�z , 01A rir r_ Model O P Alarm location (HOLDING TANKS O Setbacks: Service road ent to fres Water Line Meter location Al SOIL ABSORPTION SYSTEM Type of system: A Width �� Length 7 5� Number of Trench f s Setback from: House -'jkq- Well P/L Vent to fresh air intake / 7`t' " 7 /A � ELEVATIONS Description of benchmark /to Elevation 140 Description of alternate benchmark - 7 - 0/ 1 o �' Elevation /60 Q3.7a Building Sewer ST/HT Inlet FZ, 5-% ST Outlet PC Inlet PC Bottom g 0 / Header/Manifold Top of ST/PC Manhole Cover -Y- Distribution Lines ( ) /,Q/, () ( ) Bottom of System () / O O. Z () ( ) Final Grade O f o r-� , Date of installation /d/ /111 Permit number c�5�,3J28 State plan number `/ D Plumber's signatur 1 License number Date Inspector Complete plot plan Or NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW t„ 5 V� I 1 1 BA4 L d �f 16 a PA ty) 6sa P av X� INDICATE NORTH ARROW I r . Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353128 Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan ID No.:. Town of Glenwood oZ 8 CST BM lev.: Insp. BM Elev.: BM Description: Parcel Tax No.: ao . o ao , o ' - F TANK INFORMATION ELEV ATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic p L01YO 4SV Benchmark �l, 1 3 l3 6D •a r Dosing Alt. BM .�� (�• 3 Aeration Bldg. Sewer S,I�C d r I3.qo Holding St /Ht Inlet �3•S} �ip,S(p TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. vent to ROAD Airintake Dt Inlet Septic ��p� �t �-r NA Dt Bottom Dosing ��pp 1 S} `` �- NA Header /Man. Aeration Dist. Pipe a }3 p /, qO Holding Bot. System 3 ' 1,(76.4 PUMP / SIPHON INFORMATION Final Grad IS+ C.evq' ao pwv Manufacturer Demand St cover 1D .+ `T 3 , 4.3 Model Number osP Za•t3GPM TDH Lift 1 oss q,� Friction 1 System TDH g•Z�t M e Forcemain Length o' u Dist. To Well SOIL ABS PTION SYSTEM TRENCH I Width Length i No. Of T•�ewc4ies PIT No. Of Pits Inside Dia. Liquid Depth DIME 1 7�s 1 DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING acturer: INFORMATION TypeO 1 t-�� ( to ---� CH UNIT R Mo umber: System: — 1 DISTRIBUTI N SYSTEM Header / Ma rt Distribution Pipe(s) � -7 �� x Hole Size x Hole Spacing Vent To Air Intake Length Dia- �i Length �_ Dia. 2 Spacing 34 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed / Trench Edges Topsoil ❑ Yes No [E] Yes EE] No L 1 COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 10 /14 /11 Inspection #2: `7" - 7 — Location: 1745 County Road X, Glenwood City, WI (NE1/4, SWl /4, Section 1 T3 - Rl - n © A(�- `° Ot > u_ tJ�p o - a +- Plan revision required? ❑ Yes &nNo / _ x Use other side for additional information. I 1 [j� SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: „ , . E i € e r , , .rev z� € I s E { E .ms s .. ......- .,... �. ... .i.,,,, €. ..e..� . . .......... .. .. .e..... ._ ..m, t _,., e. _.. . .,,, _�. .. .,,,,, .... _..� .... �...._ .... , 9 � 2 1 i j b y. E E b 9 t , p,... ,.w e. ,... � 4 i t Z E a E ...._.F.. 7 € t 4 ��.� �A _.... .. Wv `.. ---4---- —41— y € .m T . i a c _e s � E k 6 4 � a E � i •` °°^ "" Safety and Buildings Division ��.�■,.' SANITARY PERMIT APPLICATION Bureau of Building Water s 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Ad $ ._9y P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the syste `b per not Less toy than 8 112 x 11 inches in size. f ry` � � tt�� P .t/ Permit Number • See reverse side for instructions for completing this applic fw n _ i StateSanitar y y ou p rovide may be used b other overnm n n r �: 531 ?�' The information y p y y 3 g e t age cy pro art $ f t , rr,• ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. ST c8aa ,11, .1 1 State Flan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL � - V Property Ow,Z Name Y ticv G 1/4 S �114� T3,6 , N, R ''E (or) W Property Owner's Mailing Address _ ^ t4�Cl m �r Block Number C , tate lip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING1 (check one) ❑ State Owned ❑ cit Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms t] Io w a n OF 111. BUILDING USE:. (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 E] Assembly Hall 6 E] Medical Facility/ Nursing H me /jM Outdo r Recreational Facility 3 E] Campground 7 E] Merchandise: Sales / Repairs s aurant /Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable) A) 1. ❑ New 2_ XReplacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an _____System ________System Tank Only Existing System .Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 XMound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure r ./ Y / 42 C] Pit Privy 13 El Seepage Pit 5 ��S [ mnG 43 ❑ Vault Privy 14 ❑ System -In -Fill 5R VI. ABSORPTION S YSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/ q. ft.) (Min. /inch) Elevation fib, 73 Feet /e •7.3Feet Capacit VII TANK in Ca gallo s Total # of Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. New Existin strutted Tanks Tanks t Septic Tank or Holding Tank i El El 1:1 ❑ Lift Pump Tank /Siphon Chamber ejv ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. PI r b 's ame: (Print) Plumb ' S, ture: o Stam s) r P/MPRSW No.: Business Phone Number: / D .2. ;? Z j Plum er's Address (Street, City, ate, Zip Cod �'v - , - - 5 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Surcharge Fee) Permit Fee (Includes Groundwater ate Issue Issuing Agent Signature (No Stamps) � pproved ❑ Owner Given Initial 1 I Determination• X. CONDITIONS OF APPROV A -- RE ASONS FOR DI APPROVAL: SBD -6398 (R. 05/94) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. ll. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information Provide all information requested for numbers 1 through 7 VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for al/ s:.•ptic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experiments product approval from DILHR. VIII. Responsibility statement Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX_ County / Department Use Only. X. County/ Department Use Only. C .0 - let . pl-.I, �-ncC `.peciflcaticns not coal + ")an 8 12 X 11 II' i1e$ must be sut .. fitted - .Q the aiunty_ The plans must nt_,uue t`,e fo: A) plot plan, draw scale or with ocat cn of holding tank(, }, septic lent ('Ink" c�.. �_; ,. tvc!Is wa,er " - vot� �. r W . d lake;, �cumporsiphon repla enl� +l:. t,_�' c)' .. t i .3Y1 rfthe bi�cldlllg'�erVed; .Cal Vu?; Ot' Q rp� pun zinc control;; Joie volume; F s� = re�1C rICClO I � S; F _ � j � . � r !1Ce CUrVe " ^r0_iel a( _ U','iT F ^.idir, '�7; .urer_ cross sec of the sol absorF >ticn system ifrequiaed by ;-in, , a'I sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. I Safety and Buildings PO BOX 7162 MADISON WI 53707 -7162 TDD #: (608) 264 -8777 isconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary September 23, 1999 CUST ID No.227618 A7TN: POWTS INSPECTOR ZONING OFFICE TOM GUSTUM ST CROIX COUNTY SPIA N13450 937 ST 1101 CARMICHAEL RD NEW AUBURN WI 54757 HUDSON WI 54016 RE: CONDITIONAL APPROVAL Identificati rs APPROVAL EXPIRES: 09/23/2001 Transaction ID . 248901 Site ID No. 181221 SITE: Please refer to both identification numbers, ST CROIX County, Town of GLENWOOD above, in all correspondence with the agency: NEIA, SW1 /4, S1, T30N, R15W JOHN BOEKER 1745 CTY RD X, GLENWOOD FOR: Description: MOUND SYSTEM Object Type: POWT System Regulated Object ID No.: 492490 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 10101(10), Wisconsin Statutes, is responsible for compliance with all code requirements. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincere DATE RECEIVED 09/16/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 P TER E PAGE W S PLAN REVIEWER II BALANCE DUE $ 0.00 Integrated Services (608)266-2889, M - F, 0745 - 1630 HRS PEPAGEL @COMMERCE.STATE.WI.US 1IA1T' cc: JOHN BOEKER r MOUND SYSTEM DESIGN SEP 1 6 1599 Residential Application INDEX AND TITLE SHEET �FETY & BLL�S ) w Project John Boeker Owner John Boeker Address 1745 Cty. Rd. 'W' Glenwood City W1 54013 Legal Description NE SW Sec 1 T 30 R 15 W Township Glenwood County St. Croix Subdivision Name N/A Lot No. N/A Parcel ID Number Plan Transaction Number ` S t P.O.W.T.S. p� Ws Index and title sheet Page 1 Conditionally Mound calculations Page 2 TORM PROVED � Mound drawin s Pa e 3 THOMAS D. , � 9 9 E OF C ME RW GUSTUM Pres. dist. caics. and laterals Page 4 TY BU 01 GS 1201 TDH and pump tank drawing Page 5 Plot Plan Page 6 ®�SiGt� Pump Curve Page 7 SEE CORRESP DENCE ,r Designer Thomas Gustum License Number D1201 Signatur Phone No. 715- 658 -1344 Date 9/13/99 Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 145,10, Wis. Stats. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. SBD- 10462 -E (R.05M) Pagel of 7 r i MOUND SYSTEM DESIGN Complete red boxes as necessary. 1000 gpd maximum design flow. Inch - pounds Metric Residential or commercial? r (r or c) (y or n) u Replacement system? Creviced bedrock site? n (y or n) Slope 3 % Wastewater flow rate 450 gpd 1703 Lpd Depth to limiting factor 14 in 35.6 cm In situ soil infiltration rate 0.5 gpd /ft 20.4 Lpd/m Contour line elevation 98.9 ft 30.14 m Use standard fill depths? I x OR Design depth? in cm Place X in box to use standard depths (24 and A +4 inclusive) OR specify design fill depth. Center Or end manifold 0.121, 0.152, 0.128, o 0.25, (c or e) Hole diameter 0.25 in 0.221, 0. 1.313 inch only. Lateral spacing 0.00 It Use 0 lateral spacing for trenches. Estimated hole space 3.00 ft Not a final calculation. Number of laterals Pump tank elevation 90 ft Outside bottom of tank. Forcemain length 70.0 ft Forcemain diameter 2.0 in 1.5, 2, 3 or 4 inch only. 2.067 in Actual I.D. HOLE DIAMETER CONVERSIONS 1/8 =0.125 1/4 = 0.250 SYSTEM SOLUTIONS Inch-pounds Metric 5t32=0.156 W32=0.281 Estimated daily flow 450 gpd 1703 Lpd 3/16 = 0.168 5116=0.313 7/32 = 0.219 Absorption cell Design load rate & area 1.2 gpd/ft 375.0 ft 34.84 m Linear loading rate (LLR) 6.00 gpd /ft 74.4 Lpd/m Design width (A) 5.00 ft 1.52 m Cell length (B) 75.0 ft 22.86 m Depth of cell (F) 10.0 in 1 25.4 lcm Sand filter Upslope fill depth (D) 22.0 in 55.9 cm Downslope fill depth (E) 23.8 in 60.5 cm Basal area required (gpd /infiltration rate) 900.0 ft 83.61 m Supporting components Topsoil depth 6.0 in 15.2 cm Subsoil depth at center 12.0 in 30.5 cm Subsoil depth at cell wall 6.0 in 15.2 cm End slope toe length (K) 12.73 ft 3.88 m Up slope toe length (J) 10.10 ft 3.08 m Down slope toe length (1) 12.60 ft 3.84 m Total mound length (L) 100.46 ft 30.62 m Total mound width (W) 27.70 ft 8.44 m Project: John Boeker Transaction Number: Page 2 of 7 f MOUND PLAN VIEW observation pines (typical) J 27.7 ft A = 5.00 ft 1.52 m 0 A 8.44 m B = 75.0 ft 22.86 m W B J= 10.10 ft 3.08m I K I= 12.60 ft 3.84 m K = ft LI.Mm _ 100.46 ft 30.62 m typ. obs. pipe (anchored securely) I = down slope dimension = absorption cell (AxB) J = up slope dimension O = plowed area (LxW) K = end slope dimension 1W 6' (152 mm) T MOUND CROSS SECTION � D = 22.0 in 55.9 cm lateral topsoil H subsoil cap E = 23.8 in 60.5 cm invert 101.23 ft F= 10.0 in 25.4 cm elev. 30.85 m _ F G = 12.0 in 30.5 cm ASTM C33 H = 18.0 in 45.7 cm W Sand Fill E sys. 100.73 ft elev. 1 30.70 m 98.90 ft contour 30.14 m elev. 3 % slope D = upslope fill depth plowed layer E = downslope fill depth Note: Absorption cell media will consist F = absorption cell depth of aggregate and pipe with laterals G = subsoil + topsoil depth at cell wall centered across AxB media. The cell H = subsoil + topsoil depth at cell center media is covered with geotextile fabric. Designer notes: Deep chisel plowing to break up top layer Project: John Boeker Transaction Number: Page 3 of 7 PRESSURE DISTRIBUTION CALCULATIONS Absorption cell Inch-pounds Metric Width (A) 5 ft 1 1.52 Irn Length (B) 75.0 I ft 1 22.86 im Lateral specifications Number laterals 1 Holes/lateral 25 holes Lateral length (P) 72.00 ft 21.95 m Hole diameter 0.250 in 6.35 mm Lat. dis. rate 29.13 gpm 1.84 Us Sys. dis. rate 29.13 gpm 1.84 Us Hole spacing (X) 36 in 91.4 cm Lateral diameter Pipe d i ameter Design options Design choice Designer must 1 in (25 mm) Place X in red X' one choice 1 114 in (32 mm) box of chosen from the options 1 1/2 in (40 mm) diameter. provided. 2 in (50 mm) x x 3 in (75 mm) X Manifold diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) X" one choice 1 1/4 in (32 mm) None required. from the options 1 1/2 in (40 mm) No choice necessary. provided. 2 in (50 mm) 3 in (75 mm) 4 in (100 mm) Distribution system contains: 1 Lateral(s) LATERAL DIAGRAM - END CONNECTION Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram into this area. Laterals centered over the A & B dimension end cap P Last hole drilled next to end cap k- X � Laterals & force main of PVC Sch 40 Holes drilled on the bottom of the lateral (per COMM Table 84.30 -5) equally spaced e : permanent end marker Inch-pounds Metric Lateral length (P) 72.00 ft 21.95 m Lateral spacing (S) 0.00 ft 0.00 m Hole spacing (X) 36 in 91.4 cm Manifold length 0 ft 0.00 m Hole diameter 0.250 in 6.4 mm Lateral diameter 2.00 in 50 mm Forcemain diameter 2.00 in 50 I mm Project: John Boeker Transaction Number: Page 4 of 7 TDH and Pump Tank Drawing Total Dynamic Head Operational head 2.50 ft 0.76 m Vertical lift 10.43 ft 3.18 m Are laterals the highest point in the Friction loss 1.03 ft 0.31 m system? Yes 'W here. Total dynamic head 13.96 ft 4.26 1 1 m If no, what is the highest elevation Dose Volume downstream of pump? Dose is > 10 times lateral volume Forcemain drain Lateral void volume 12.5 gal 47.3 L back to tank? ('k' one) Minimum dose 125.0 gal 473.2 L x Yes Drain back 12.2 gal 46.2 L No Dose volume 137.2 gal 519.4 L Typical Pump Chamber Layout In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC. approved manhole cover with weather proof warning label and locking device grade levels junction box -� disconnect 9rnde levels altern ate 4" vent pipe electric as per NEC 300 and : �-- outlet 16.28 WAC location 18"(46 cm) min. wall of pump �- approved chamber or outlet joint combination tank A Provide 114" weep hole or anti - alarm on siphon device as necessary pump on B Grade levels pump 90.8 ft - pump tank manhole = 4" (10 cm) Off elev. 27.7 m Ok minimum above finished grade D - vent =12" (30.5 cm) minimum above finished grade 90.0 ft Pump tank elevation 3 " (75 mm) of bedding under tank 27.4 m bottom of tank Tank manufacturer Midwestern Precast Pump tank capacity 17 gal /in Pump tank volume 650 gal Pump manufacturer lHydromatic Inches Gallons Pump model number losp33 o A 22.2 376.8 'o B 2 34.0 c Alarm manufacturer JSW Electro I E C 8.1 137.2 Alarm model number 1101 Q D 6 102.0 Project: John Boeker Transaction Number: Page 5 of 7 Coum 4- Rd x 8,ekt, P1c.h 17ys c4 y Al x' G ( Cnft/oof) cr S w Sd '4� D/ zo' q� 3 /99 �� SyS ftw �OvSe -- ago, 10 00 S A eJ 6 SD c,M6� PA I- clot 1 8� 3o 3 q rr 11 (PVC � P�p[ T• l3C C r \ P � S`oty btlow G„cJc S A �s Are, t a� F Sf r t/ S ?r kL � Rq, i Co„ fow� 2 = q1, 3.S ,Bo w aF S,d; ,, oy� S ci at KGr O� SLtcdTO� So l ' ( /= 'y �a9c 6 a F 7 j . .. • • Performance Data ;.32 Pump Characteristics PtrtttP /Molw Ud1 stt "Mrs" m wd Mtl" OSP33M1 MUM 24 v At Is"k Models 0SP33A1 I OSP33A2 1$'Z 1/3 HP Nwsopowu 1/3 1s Fell load Amps 1.8 4.6 Mstw T a ►Po SPlit -Mieso � R.PJ L 1750' F t Phase 0 1 Yolttlgo 11 S 230 Hal: o A.., edw 6 0 0 10 q2" 40 so 80 ` w lolwollll01 S. G.P.M. 2.-1. Te"m 144OF AmbWov Total Nona (foot) 4 8 12 16 20 24 25 NWA DWp 8 b"Wed 11 Gas F GPM 1/3 NP 60 • 55 48 39 28 7 0 Nse Sw 1-1/r NPT S" Howiell 5/81 Dimensional Data Uoit Wtt * SO tbs. 3-7/6 6• Paver Cwd 18/3, I nW, li//3, SJTW SAM 10' sIl 120' Ml.) 40' Sid. 1. At rlwwm" N Melia 4.1/4 1-1/2 NPT 2. (wp W a"NI M Materials of Construction Mrrw73)nM 3. NM far axvvft ll�.dl6 stow 1a1na whK ar1Aw 3 -�/4 1. PWWW .t Mel WWok ukwmq ON DWsdfk Oil s '" w ei" S. W1 MM 1k d*A to AWw Nerdy Cost has adw Mwwc w wr PMP CW" Cost kw mbar wd sMuf�MMAC •111�M 9wh slow Stud Faas: Cwbu /Cwmk ' s6h Sod sod Mr. bus S ` id slt 51N1 dwws. NM-N 12.1/6 � b1yt6Nw Ihlatl 9 -1IA U " iw Row w he* 11.3/A v PUMP Lsww low* Sio816 Kew MN low* . Cat kM 2 3 Fa lNwti Stsidess S l ow PUMP OFF AURORA /HYDROMATIC Pumps, Inc. 1 1840 danay Road, Ashland, Ohio 44805 • (419) 289.3042 n �Q e 7c:)-F t .Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division 9f Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 016- 1001 -20 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION IEWE BY DATE R PROPERTY OWNER: PROPERTY LOCATION Julie Laird GOVT. LOT NE 1/4 SW 1/4,S 1 T 30 N,R 15 fC (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM # 1745 Ct . Rd. "X" na r csm CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD Glenwood City, WI. 54013 (715) na [ ] New Construction Use [ Residential / Number of bedrooms 3 [ ] Addition to existing building (] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd /ft .6 trench, gpd /ft Absorption area required 375 bed, ft 375 trench, ft Maximum design loading rate • 5 bed, gpd /ft •6 trench, gpd /ft Recommended infiltration surface elevation(s) 101.82 ft (as referred to site plan benchmark) Additional design/ site considerations system el. based on contour line of el. 98.90' Parent material glacial drift over sandstone uplands Flood plain elevation, if applicable na ft F U = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK =Unsuitable fors stem ❑ S ®U 13 S ❑ U I ❑ S ® U EIS ®U EIS ®U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrench 1 0 -10 10 r4/2 none sil 2msbk mfr cs 2f .5 I .6 2 10 -19 10yr4 /3 none sit 2msbk mfr gw if .5 .6 Ground 3 19 -33 10yr4 /4 c2d 7.5yr5/8 sil lcsbk mfr gw if .2 .3 991,7--ft. 4 33 -50 10yr4 /6 c2p 7.5yr5/8 sil M na na na np .2 Depth to limiting factor 19" Remarks: Boring # 1 0 -8 10yr4/2 none sil 2msbk mfr gw 2f .5 .6 2 2 8 -14 10yr4 /3 none sil 2mbk mfr gw if .5 .6 3 14 -23 10yr4 /4 c2d 7.5yr5/8 sil lcsbk mfr gw if .2 .3 Ground elev. 4 23 -55 10yr4 /4 c2d 7.5yr4/6 sil M na na - .2 9 8.9 ft. Depth to 1\ limiting factor 14 " t f •, ��kC? Remarks: ST CRax INTY CST Name: -- Please Print Gary L. Steel Phone: 715- 246- 6200 vlNc; 0FFICF Address: 1554 200th. Awe., New Richmond, WI 54017 Signature: Date: CST 8 4 -13 -9 i PROPERTYOWNER Julie Laird SOIL DESCRIPTION REPORT Page 2 ` bf 3 PARCEL I.D. # 01601001 -20 ' Boring # FHorizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 0 -9 10 r4/2 none sit 2msbk mfr cs 2f .5 .6 9 -17 10yr4 /3 none sil 2msbk mfr gw if .5 .6 Ground 3 17 -30 10yr4 /4 c2d7.5yr5/8 sil lcsbk mfr 9w if .2 .3 elev. 9 8.0 ft. 4 30 -60 10yr4 /4 c2p 7.5yr5/8 sil M na na na np .2 Depth to limiting factor 11 Remarks: Boring # Ground elev. ft. — Depth to - limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. j ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Julie Laird 1554 200th Ave. CSTM2298 NE4SW4 S1- T30N - R 15W New Richmond, WI 54017 MPRSW -3254 town of Glenwood (715) 246 -6200 t N 1 =40' BM.= top of 1 steel pipe C el. 100 Alt. BM.= bottom of siding, se corner of shed @ el. 99.35' douse 0 Gov r � 3 a Z h 6 Gary L. Steel C*643 4 -13 -99 r � ST CROIX COUNTY • SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Z 7 C' / Property Address (Verification required from Planning Department for new construction) City/State ( 9Z. , ,50G lf r arcel Identification Number (Q 16 tom e ) LEGAL DESCRIPTION Property Location N� V4, sw V4, Sec. T 349 N -R_L ,W, Town of Subdivision 2 Lot # Certified Survey Map # ��? , Volume / n , Page # Warranty Deed # Volume l Page # . Spec house ❑ yes g no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. *SI ATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SI NATURE APPLICANT DATE * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed f WAARAIM Dig&D s _ Jimk 1K. Laiirtt fJkJa Jntle iiG Wrl, . a single Pte• whether one or mope), conveys and warrants to John E. Boduer and Patricia L. Myers, ainw]e =atys as ( "Grantee", whether one or more), _ asr„u+ro yens in consideration of $1.00 and other vahuble cons on, 1745 County Road "X' the following described teal estate located in St. Croix Glenwood City, WI 5401 C.o1mly, Wisconsin: ` - r.. r.� rr� 016- 1000 - 95-100 & ,. .. 016- 1001 -20 Part of Government Lot: S anti 9, and part of the NEIA of SW% and part of the NWI of SE%, ALL in SectionE 1, Tom 30 Notch, Range 1S West, St. Croix County, Wisconsin, described as follows Lot 1 of CejjhW Survey Map filed April 27, 1995 in Vol. 10, Page 2914, Doc. No. 528249. µ SUBJBCT TO the (1) Conveyance of Lands for Highway Purposes to St. Curia County as recorded in Vol. 302, Page 107•, (2) Public road right -of -way for County Trunk "X', and 100 -foot building setback as i slomn on said Certified Survey Map: and (3) Right- of-Way Authorization to General Telephone Company of Wisconsin recorded in Vol. 456, Page 510, Doc. No. 295352. r fiogaher with and subject to any easements, rights -of -way, covenants, reservations and restrictions of record, if any, but this shall not extend the term or expiration of nay encumbrance on the above described property beyond that stated in doEawxm of re Ord or otherwise provided by law, unless expressly stated herein. TW is honnestead property. z� Dated dib 15th day of April, 1995. f (SEAT.) - J K. Lakd fFVa Julie K. Bien A rIMEN nCATION ACKNOWLEDGMENT - Signature(s) of Julie K. to d Vk/a STATE OF WISCONSIN - Jobe H. Eieri, a single person ) ss. COUNTY OF ST. CROIX } auttbenticated April, 15, 1999. Brcada Poulin Personally came before me this 15th - Nocary Public , day of April, 1999, the above named State of Wisconsin Judie H. Laird f/k/a JWle K. Biers, a single person, • to me known to be the n(s) who executed the TITLE: MEMBER, STATE BAR OF WISCONSIN forego' nt acknowledged the rime. (If not, f authorized by Sec. 706.06, Wis. Stats.) F s DraBed By: ' William J. Gilbert, Attorney at Law Notary Public, St. Croix County W' ' '?6 Second Street, Hudson, WI 54016 My Co.amissioc Expires: ! /g OR FILED ,1 KATHCEE H ALS S R ff r i of D SL Crc;;; Ws 528249 C E RTIFIED SURVEY MAP LOCATED IN GOVERNMENT LOTS 8 AND 9 , AND IN THE NE 1/4 OF THE SW 1/4 ;ALL IN SECTION I , T30N , R 15W, TOWN OF G LENWOOD , ST. CROIX CO., WI. *ALSO IN THE NW 1/4 OF THE SEI /4. PREPARED FOR: GORDON ADAMS NOTE: BEARINGS ARE REFERENCED TO THE E-W OU4RTER LINE•(ASSUMED). GOV. LOT 9 GOV. LOT8 N- S QUARTER LINE ,U N P,L,ATTEO LANDS, N E o P. 0. B. S I 2 S82 0 50'14 "E M 482.62 / p y' ��ff1 •; 95 -- ._'200.00'•1_�S.Sgo 157. 85 a- 7 \` 4 s O S 7. 09'46 "W- N E-W QUARTER LINE N ® m 673.72' •....... ...._ S96,•19' d �`I" SHED HOUSE a) / / v 4 CDR. SEC. I w / \ - 2540.51' 01 (n 01 .� LO T N ` 21.81 ACRES w (949,840 SQ.FT.) 20. 27 AC. EXCLUDING ROAD W. /`'`1 (882,824 SO.FT.) 0 d _ o w / c0 at y,, BUILDING SETBACK IS R K N in: - 100 FROM JOHN'S R.O.W. LINE C EE Corn Zz 'rtes rrt 43 3. dOd • 1 N3' 6 "E 1284.67, Q ;. <I :6 k1 N 86 38 W 1317. 67" .:.�,. I UNPLATTED L,A4PA 33' 331 1 I ®= COUNTY MONUMENT FOUND. I I 0' SET I' :( 24' IRON PIPE WEIGHING 1.13 LBS. PER LINEAR FOOT. ` JAMES M � �T WEBER S 180d SPRING VALLEY WIS. f, SCALE I " = 2 OO ' i��r,�� .,••''�.t�„�a'�° su 0 100 200 400' to -W �$ JAMES M. WEBER S -1804 NELSEN- WEBER SURVEYING DATED SHEET 1 OF2 95 -41 THIS INSTRUMENT DRAFTED By JIM WEBER VOL. 10 PAGE 2914 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ■ N N ST. CROIX COUNTY GOVERNMENT CENTER �� ■�6 1101 Carmichael Road Hudson, WI 54016 -7710 - a (715) 386 -4680 Julie Laird April 1, 1999 1745 County Road X Glenwood City, WI 54013 RE: SANITARY VIOLATION #99 -V -04 LOCATION: NE' /<SW' /o, Sec. 1, Tn. of Glenwood, St. Croix Co, WI. Pcl.# 130.05.11A Dear Ms Laird: While inspecting the septic system that serves the residence that you are selling at the above address, I observed violations of state and county codes that require that we condemn the system. This letter serves as formal notification that the system is hereby condemned and must be replaced with a new code compliant system. I have observed that your septic system is discharging sewage effluent to the ground surface through an overflow pipe that extends from the drywell and extends over the hillside to the wetland located south of the house. This condition constitutes a violation of s. 254.59(2) Wisconsin State Statutes, ILHR 83.01(2)(a), 83.01(2)(c), 83.05(5), 83.06(4)(d), and 83.09 inclusive, Wisconsin Administrative Code, and Chapter 15 of the St. Croix County Zoning Ordinance. As required by the above regulations, the septic system serving this property is hereby condemned and must be replaced by one that is code compliant. This can be accomplished by contacting a Certified Soil Tester who will conduct a soil evaluation of the site. The results of that test should then be given to a licensed plumber who will design a septic system to serve your home. The plumber can then obtain a sanitary permit from our office and install the new septic system. We would appreciate any efforts that you can make to resolve this matter within the next 30 days. You may be eligible for partial reimbursement of the cost of replacing your septic system through the WI Fund Program. To qualify for the program, the house which the replacement septic system is to service must have been built and occupied before July 1, 1978 and must be your primary residence (meaning that you personally occupy the house at least 51% of the year). There is a qualifying annual income limitation of $45,000 total household income. You may check this from your 1995 Wisconsin tax returns. If you filed Form 1, use the total on line 5, Form I use line 7 or Form WI -Z, line 1. Should you wish to apply, please contact our office for further details. If you have any questions or concerns that I can address for you, please contact me at the Zoning office between the hours of 8:30 ough 5:00pm, Monday through Friday. Sincer ly, es K. Thompson Zoning Specialist cc: file ST. CROIX COUNTY WISCONSIN "" ti- ✓�� ZONING OFFICE r r r r N Nma ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 K ast 400 South 2' Street Hudson, WI 54016 Dear Mr. Bast: At your request, I.have conducted an inspection of the septic system serving the Julie Laird property located at 1745 County Road X in the Town of Glenwood. This inspection was conducted on March 31, 1999. I also obtained a water sample from the property and have submitted it to Commercial Testing Laboratories for analysis. The results will be forwarded to you upon receipt. There are several concerns that I have regarding this septic system. I observed very slow water drainage through the plumbing inside the house, water backing up in the kitchen sink after running water for a short time, sewage effluent ponded to the inside cover of the drywell, and most notably I observed that the system has an overflow outlet that discharges sewage effluent to the ground surface and to the wetland area south west of the house. This condition is a violation of state and county codes and must be rectified by abandoning the system and replacing it with one that is code compliant. We will forward a copy of this letter and a violation notice to Ms. Laird apprising her of this situation. This inspection was based upon a surface inspection of said system and did not involve any excavating or chemical analysis of the septic system itself. Accordingly, there may be additional defects within the system not discoverable by this inspection. Should you have any questions or concerns that I can clarify for you, please feel free to contact me. Sincere , / /0 J es K. Thompson Assistant Zoning Administrator cc: file ST. CROIX COUNTY WISCONSIN ZONING OFFICE I mooing u ST. CROIX COUNTY GOVERNMENT CENTER mill � 1101 Carmichael Road Hudson, WI 5401 6-7710 (715) 386 -4680 April 13, 1999 Kernon Bast Edina Realty 400 S. 2' Street Hudson, WI 54016 RE: Water Test Results for Julie Laird located at 1745 County Road X, Town of Glenwood, St. Croix County, Wisconsin Dear Mr. Bast: Enclosed are the original water test results from Commercial Testing Laboratory for a water sample that was taken at the above referenced property. If you have any questions regarding this, please call our office at (715) 386 -4680. in ely, s ames K. Thompson Zoning Specialist Enclosure /sm COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 L7 715- 962 -3121 800 - 962 -5227 FAX - 715- 962 -4030 ST. CROIX COUNTY ZONING OFFICE REPORT NO.'. 15685/01 PAGE 1 ST.CROIX CTY GOV.CTR REPORT DATES 4/07/99 1101 CARMICPAEL ROAD DATE RECEIVED! 4/02/99 HUDSON, WI 54016 ATTN3 JIM THOMPSON OWNER, Julie Laird LOCATION*# 1745 Co. Rd. X, Glenwood City COLLECTORS Jim Thompson DATE COLLECTED*# 3 -31 -99 TIME COLLECTED*# 1315pm SOURf,E OF SAMPLE: Kitchen tap DATE ANALYZED*4 -02 -99 TIME ANALYZED:12*#00pm COLIFORM,MFCC*# 0 /100 ml ` INTERPRETATION*# Bacteriologicaliy SAFE NITRATE-N! 3.2 ppm Above 10 ppm exceeds the recommended PubLir Drinking W?,ter Standard. Nitrate - Nitrogen, mg /L Conform Bacteria /100 ml LAB TECHNICIANS Pam Gane WI Approved Lab No. 19 t deans "LESS THAN" Detectable Level Approved by: Received: 3/22/99 4:12PM; 715 386 4686 -- EDINA REALTY HUDSON WISCONSIN; Page 2 042Z /99 MON 16:10 FAX 715 386 4686 ST CR% CO ZONING 11 002 ST. CROIX COUNTY R WISCONSIN "`�_ ZONING OFFICE _ i I mono gROIX COUNTY GOVEFINMENT CENTER ST C30,k -1101 Carmichael Road �rTIV udson. WI 54016 -7710 (715) 386 -4680 SEPTIC INSPECTION / $1� `;T�$6 REQUEST FORM Please specify desired tests) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. ❑ Water (VOC's) $200.00 Septic $125.00 ,(Water (Nitrate & Bacteria) $55.00 0 Nitrate & Bacteria tj Water (Lead Concentration) $21.00 retest $15.00 Owner: T" 4Ai9 Requested by: KeRo1oN T. 6gST'- Ow4 &4(7y Address: 19WS Cn._4Q . X Address: yft s. Sycow 53: affawcQp _ _ Inry Z I P Stib /3 fiVft Wr Z I P Telephone NO: ( #76:s-7380 Telephone N°: ( 386 y9 Property address (Fire N' &Street) : 174.5' cry, Qp. X . G[�p .CffY _ A)6r S WI& Location: NE ,, -6 Sec. I , T 3o N, R t5 W, Town of Gi 1A3k)i.06 Cfr:' Realty firm 1D1NA - 10 " Lock Box Combo: %CTS Closing Date: �jllo �1�1- 10.ow 1•aro. IS. IIA TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Water sample tap location: It rc Is the dwelling currently occupied? JW Yes ❑ No If vacant, date last occupied: u/A Age of septic system: — ao y Septic tank last pumped by: AC $EU.I y5 SA+urfA„y Date: 3119'199 Previous Owner's Name(s): 3 Have any of the following been observed? ❑Y ON Slow drainage from house. OX W Sewage Back--up into dwelling. ❑Y AN Sewage discharge to ground surface or road ditch. OY RN Foul odors. other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. c, 3�a3� OWNERS SIGNATURE: � DATE: 1/94 Received: 3/22/99 4:12PM; 715 386 4686 -> EDINA REALTY HUDSON WISCONSIN; Page 3 03/2.2499 MON 16:10 FAX 715 386 4686 ST CRX CO ZONING 121003 OWNERS DRAWXNG OF HOUSE & SEPTIC SYSTEM LOCATION y TO BE COMPLETED BY INSPECTIONAGENCY System design & /or permit on file? ❑Yes IgN soil series per SCS Soil Survey: sheet # Type of soilabsorntion_ system R9 grd OAt - Grd OHound Approx. size 'X ❑Gravity ❑Dos__e// O P ressu rized N Ft. ❑Bed OTrench 06ry Well Molding Tank OOutfall pipe OBSERVED DEFICIE CIES pother OUnknown Septic tank `/, ,` ��.�� Setbacks: House Owell ❑prop. line ❑other Dose tank ` etbacks:OHouse Dwell ❑Prop. line ❑Other Locking cover OWarning label ❑Pump /Floats V ❑Alarm ❑Elec. wiring soil Absorption System ��// �/ setbacks: ❑House ❑Well t]Prop. line � QOther / OPonding: , t.S ❑Discharge: S o General commen s : ( S . Cdr INSPECTORS SR TCH OF SYSTEM LOCATION �I N V i o Inspector P �` Title ,