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Home My WebLink About018-1041-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556310 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: Sutheimer, Cole Hammond, Town of 018-1041-60-000 CST BM Elev: Insp. BM Elev: BM Descri tion: Section/Town/Range/Map No: /00-0 106,6 U7' 18.29.17.288A TANK INFORMATION ELEVATION DATA TYPE 4- Ud A,;, el -MANUFACTURERS , CAPACITY STATION BS HI FS ELEV. " Septic .n v Benchmark 1.41 Dosing /000 Alt. BM X f KAe ; hf Aeration Bldg. Sewer y~. -73 -7 ~d Holding St/Ht Inlet 7 y y TANK SETBACK INFORMATION st/Ht Outlet y 9 TANK TO P/S W_LE L BLDG. Vent to Air Intake ROAD Dt Inlet 1 N S~ ~ ~,lo Sep ' Dt Bottom t6-0t 5' LST`1tJCT - ~o tn~l /3. D9sing > + d-y~ ( li/✓ Head r an. PL// ZS > k1 A O 210 j Aeration Dist. ' ` o,.l y7 9~.y Holding Bot. System UM /SIPHON INFORMATION (S 2 ooFinal Grade fi0 kz- ow .54o-e 7, S" memifacturer Demand St r jiwrl-- C".f- (04c, --si /00, Model Number GPM ov r i TDH Lit Friction Is System Head JTDH Ft '(l o - 3.S Forc 10 1 elain Le/p~gt / Dia. Dist. to We II /~0 , J _ SOIL A SORPTION SYSTEM BED/TRENCH Width J ength No. Of Trenches PIT DIMENSIO No. Of Pits Inside Dia. Liquid Depth O r DIMENSIONS I SETBACK SYSTEM TO 7 P/L LDG WELL LAKE/S EAM L CH G Manufacturer: INFORMATION CHAM R OR Typ f ystem: ~0/ Mf 00, 0 I Model Number: yj DISTRIBUTION SYSTEM L ti j g ys.e, 22,, cc~ao Heade::WLP Distribution j x Hole Sizf 2 x Hole Spacing o Air Intake Z~ Pipe(s) ~a r Z/# 2~~ r Z Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound r At-Grade S ems Only i Depth Over Depth Over xx Depth of f xx Seeded/Sodded xx Mulched GCQ Bed/Trench Center Bed/Trench Edges Topsoil Yes R No E] Yes C No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /121" Inspection #2: / ' ~ / (Z PQ Location: 920.160th Street Roberts, WI 54023 (SE 1/4 SE 1/4 18 T29N R17W) >35 acres Lot Parcel No: 18.29.17.288A 1.) Alt BM Description = f/QS r~ r~l v` ~~6K 7 U ' /~iZa 2.) Bldg sewer length = All-^ -amount of cover C"" Plan revision Required? Use other side for additional i Yes X No nformation. SBD-6710 (R.3/97) Date Insepctor's Signatur Cert. No. PLOT PLAN PROJECT Cole Sutheimer ADDRESS P.O. Box 9 Roberts Wi 5402 SE 1/4 SE 1/4S 18 /T 29 N%R 17 W TOWN Hammond COUNTY ST. CROIX _ t SYSTEM ELEVATION 9~,.0' BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000,gailons LIFT TANK SIZE DOSE TANK SIZE 650 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers BENCHMARK V.R.P. Top of wood corner post ASSUME ELEVATION 100' Filter SEAR I_1 BOREHOLE O WELL *H.R.P. Same as Benchmark ° Well 1320' Property Line Existing 3 Bedroom house r-41 Existing. Midwestern Precast Combo Tank, installed 1999. Z YQvy'A"" Area of failed system (7r~ q0°,yK SLJ4 VO ~ NhaC~ Za ~/L Grading is to be done divert - - run-off away from system - B-1 B.M.* ` 171 r - B-2 \ 200' 2295 i 3D I~ 94.5' B -.3 i Area. -15' below 2% Slope ernain is to undisturbed 1 Scale = 1 /4 I =1 O' 00 160th St. Safety and Buildings Division County commerce.Wl-90V p~ n . RECE VE t W. Washington Ave., P.O. Box 7162 sco n s i n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) 4tiepartumnt of Comma 55 V3 / b State Transaction Number Sanitary; Per, t~ plication Z Z In accordance with s. Comm. t13.21(4L}$iK~lIN1F. N submission of this form to the appropriate mental unit is required prior to obtaining a sanitaiy permit. Note: Application forms for state-owned POWT 'are Project Address (if different than mailing address) submitted to the Department of Commerce.. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law s. 15.04(1 (m , Stats. o 1. Application Information - Please Print All Informati r/d Property Own 's Name parcel # /S) _ f n t j p 60-7 t 10 Ljo}cation/ Property Owner's Mailing Address Property Govt. Lot City, State Zip Code Phone Number Section 09, le o E rW a a a- TN; R /_7 II. Type of Building (check all that apply) Lot # Subdivision Name 1 or 2 Family Dwelling - Number of Bedi ,.ms (K~ Block # t!~1 eet4,.w~. ❑ Public/Commercial - Describe Use ,i ❑ City of CSM Number El Village of ❑ State Owned -Describe Use - own of /Z~x o ~t III. Type of Permit: (Chec only one box on line A. Complete line B if applicable) A' ❑ New System eplacenicat System ❑ Treatment/Holding 'Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. [I Permit Renewal ❑ Permit Revision ❑ Change of Plumber D Pe Transfer to New Before Expiration Owner Permit oe- IV. T of POWTS S stem/Com onent/Device: Check all that a 1 ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground t-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil !1 ❑ Pretreatment Device (explain) ❑ Holding Tank El Other Dispersal Component (explain) V. Dis ersa iT) t ens Area Information: Dispersa Area Proposed f) System Elevation Design Now (gpgpd) Design Soil Application Ra gpdst) Dispersal Area Require (sf) 4 0 t_ J .S7_ 0 VI. Tank Info Capacity in G'Total # of Manufacturer o o gallons Gallons Units New Tanks Existing Tanks { a U N R^ Qdt /1 ` ~ t. Septic or Holding Tank 1 Dosing Chamber on the att VII. Responsibility Statement- 1, the undersigned, assume nsibility for installation of the POWTMp~RS Numbeached Bplans. usiness Phone Number Pill s Name (Print) Plumber's ure Plumber's Address (Street, City, State, Zip Code) 1 V 1. Coun /De artment Use Only Permit Fee D sue Issuin ant Signature pproved isapprov $ by ? ner Given Reason for i IX. Condi .8Tl! II QRfloMeasons for Disapproval 31 s .v`_ ~^p 1: Septic tank, effluent filter and dispersal cell must all be services l mairrtaPz G4u dC Q as per management plan provided by plumber, 2. AD se11QWk tequUements must be maintained tO+1 / ^ J G~►C). G Ca.l per q*4Wb* code / ordinances. Coti it A h to complete plans for the system and submit to thC County ap~er not { less than 8 to a 11 inchesiM. ✓ SBD-6398 (R_ 02/09) P✓ vti,PAAR Safety and Buildings 141 NW BARSTOW ST FL 4TH o~ WAUKESHA WI 53188-3789 Contact Through Relay K www.dsps.wi.gov/sb/ Gw www.wisconsin.gov O sSIOIL4 ~ Scott Walker, Governor Dave Ross, Secretary August 06, 2012 CUST ID No. 226900 ATTN.• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/06/2014 Identification Numbers Transaction ID No. 2132825 SITE: Site ID No. 782457 Cole Sutheimer Please refer to both identification numbers, 920 160TH St above, in all correspondence with the Town of Hammond a en . St Croix County SE1/4, SE1/4, S18, T29N, R17W FOR: Description: At-Grade, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1385491 Maintenance required; Replacement system; 450 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854 (N.03/07), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the At-grade Component Manual, Version 2.0, SBD-10854 (N.03/07), and the Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01) In the event this soil absorption system or any of its component parts malfunctions so ea a h d, the property owner must follow the contingency plan as described in the approved plans , the owner must comply with the operation, maintenance and monitoring duties as described in sec a at-grade component manual. A copy of this information must be given to the owner upon completio ~ project. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. SHAUN R BIRD Page 2 8/6/2012 Inspection of the private sewage system 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. Stats. Owner Responsibilities: • SPS 383.52 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. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 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. 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. 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. S' el_y, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Julia Lewis-Osborne Please Include a Copy With Your POWTS Reviewer 2, Integrated Services Payment Submittal. (262) 397-6005, Fax: (608) 283-7481 WiSMART code: 7633 julia.lewis@wisconsin. gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. f RECEIVED Cover Page JUL 302012 ;~FFTY & BUILDINGS Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 7/25/12 Owner: Cole Sutheimer Location:SE1/4 SE1/4 c, 18 T29 N,R17W 920 160th St. Hammond System type: At-Gracie Manuals Used: At-Gracie Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01/01) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil test 12. Filter Specifications o~- Shaun Bird f yf v, Signature v> a► License number 669100 - C PLOT PLAN PROJECT Cole Sutheimer ADDRESS P.O. Box 9 Roberts Wi 5402 SE 114 SE 1/4S 18 IT 29 N%R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 3 - BEDROOM CONVENTIONAL #T-GRADE M CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANIC SIZE 1000 ,gailons LIFT TANK SIZE DOSE TANK SIZE 650 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers BENCHMARK V.R.P. Top of wood corner post ASSUME ELEVATION 100' Filter BEAR ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark ° Well 1320' Property Line Existing 3 Bedroom house Existing, Midwestern Precast Combo Tank, installed 1999. Area of failed system N Grading is to be done divert run-off away from system B-1 B.M.* B-2 .f 200' 95` 94.5' B-3 Area. 15below 2% Slope system is to remain undisturbed Scale = 1/4" =10' 160th St. At-grade System Sloping Site Cross Section and Flan View ` - % E , M Dimension Feet r •"•'ti•,.'9ye rL L•L L•L•I•J•L JL •L L L L•L•ti L'L L• ■ B OR. 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F' ~J J,rjr•J~J;J.l l J.t J J J• J+ ~ • ■}■J■r•r■rir,•ti:,L ~;L':■ ~._o Ft Contour rJ r+J•r•r•r r•r r• ■r _ y.•r•yL L L L•L L• ,+!..~J••J Jir~rtilL~'~1'yr1.~~:.rI.~S.i'1~~~.'~'L~'L■ , i u Plowed Surface . C Slope Direction contour. Existi GENERAL INSTALLATION: The at-grade area is staked outoigs ao. d out and plowed with a vegetation is mowed and raked off the site. The basal area (L x ) plow moldboard or chisel plow. Plowing may not proceed if the soil is wet the ough at he A B apes ios hands. x form a `/4 inch soil wire when a sample is rolled between the palm care must used covered by clean aggregate deposited overhead by a backhoe. het psoileap is placed, placing the aggregate. to minimize compaction of the plowed surface the entire at-grade i.; seeded and mulched to promote vegetative 6 g c~ ~ and secured in p ac protect e. from freezing. The observation pipes are perforated to the to 03/05 lgj Page _ of Pressure Lateral Layout One Lateral - End Manifold 4--- Threaded Cleanout Lateral Turn-up Plug Force Main ll ~T L Long Sweep 90 Bend Pressure System Construction Distribution Netw ork S ecifications Lateral Diameter In. Laterals are constructed of Schedule 40 PVC Diameter $ '3L In. pipe. Orifices are drilled perpendicular to X (Orifice the pipe with a sharp drill bit and face down. Orifice fice Spacing) Z In. Lateral turn-ups terminate with a threaded L Lateral Length) Ft. In cleanout plug and are enclosed in a 6-8 inch Force Main Diamete r 47 . diameter lawn sprinkler valve box accessible Force Main Len h Ft. from finished grade. • • • • • • • Grade 6-8 Inch Lawn Sprinkler Valve Box Page of 03/05 lgj 'Septic-Dose 'Wank Cross Section And Pump Performance Specifications , Tank Manufacturer I r? c Pump Manufacturer Tank Model Number Pump Model Number- ~Q 'T'otal Tank Capacity ytsLa 6 Alarm Manufaatum,, arm Model Number Max. Bury Depth Al ~ q -_~-t!-~'-`"~ . Switch Type E,x,~,~%~ /7~ P ~uf Filter Manufacturer JE A Total Dynamic Head (TD R) Feet _ Filter Model Number Elevation Head Distal Pressure - - • /1~ _ _ Network Loss Minimum Pump .performance. Required !Force Main Loss 3.__.__ GP1VT; a~ Ft TDH 'fetal Outlet Manhole Min. 4" Above Grade With fv~ Looking Daiiew. Inlet Manhole Manhole Min. 4" Above Grade 6"' Below Grade healed Watertight Securely Mounted With Locking Device Weather-proof l Q +yV~' Junction Box ♦ Finished Grade 1j"r N" , f 1 'fir rw _ T Vent Min. 12" Disconnect ~ ~ Above Grade Means f ® With Vent Cap w i{I k, 11,: T T l,1 T I ! 1~ t 1 Y 1 1 r /,L f k, l 1 r>> 1• I F• T f T` • 1 I Y i'I~Y Y ,'Y'/ 1 Y`I Ia1 1• I,. > 1 1 Y'/ i f> 1 r"Y'/ ► ~ r~,`1 1 1 I•I 1`: •'Ii t''1 h'1 Outlet Filter Wept Baffle !inlet 1>;:; - - - - - irsvi#ch Sent ngs~ and Reserve Capacity %a°' Weep 1 1 Tank Volume ON Hole Dimension ; Inches Volume Gal. E3 : ` : (reserve) AA S 6.55 • S (alarm) B' _ 2 Off Elevation C 1 , li -2 IY-'F`,; (do9e) li' l.7 t !'6 • Bottom (dead) D. e] / S z - Elevation _ - lT Total i• ~ ~1'rri'aiTiTi~~r-4.1T~FF ~ -f'"r-rrT-c-r'rt-f- I',' 1'r•1'1'i1'1r'r`I'T'r'i r'r'/'~'1'' , 'r` , 'I'I'f'1' •;I'• : T f;i~ / / , / 1~ 'T >'I a > a r r'Y` , ✓ <r'f't 1 1 ,`r`r'1'/ 1 . a ,t'i r•,', ,;air>, a.{: :.ter, t'r . 1 , e . I,r tit;i. ~1~;1,,, t a 1 , 5. , i a , 1 . t t 1 s t t e 1 ,f, t, 1./`, !•1`, 111 r , i , +':1'i - - - - - t t.a ' t • a r • r a - u.'T:._'rir ' ta.i a.r~ GENERAL INSTAfLILATION: The septic/dose tank is bedded and back filled in accordance with the manu#actufaes product approval epeoifications. Maximum depth of bury as specified by the manufaetarer may not be exceeded without pFior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid ozz stable soil to prevent settling or sagging. The force main is sleeved with 4's Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.211, 02/05 L.l Page of- V a 1 - Goulds "''ut Submersible Eftuent Pimp: I WHO _ . EP04 3871 EP 05 APPUCATIONS • l asteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Soecificallvdesiojttedfo[.ttP„ stainless steel. grade turbine oil for f4r_ elf , ' following uses: • Capable of running lubriation and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- Homes immponents,., tic cover with integral handle Farms Motor: Available for automatic and and float switch attxhment • Heavy duty sump • 1=P04 Single phase: 0.4 HP, manual operation. Automatic Points. • Water transfer 115 or 230 V, 60 Hz, 1550 models include Mechanical • Dewatering I;PM, built in overload with Float Switch assembled and ■ power Cable: Severe duty automatic reset. preset at the factory. rated oil and water resistant. SPECIFICATIONS ' I-P05 Single phase: 0.5 HP ■ Bearings: Upper and lower 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EP04 built in overload with construction. • Solids handling capability: automatic reset. EP04 Impeller. Thermo- 31e maximum. •Power cord: l0foot plastic Semi-open design AGENCYUSTINQ • Capadties: up to 55 GPM. standard length, 16/3 SJTO with pump out vanes for • Total treads: up to 24 feet. vAth three prong grounding mechanical seal protection. Sp 10 ftaft* w • Discharge size: 1% NPT. Plug. Optional 20 foot ■ EP05 Impeller: Thermo- • Medranical seal: carbon- length, 16/3 SJTW with plastic enclosed design for (GSA listed model numbers rotary/ceramic-stationary, three prong grounding plug improved performance. end in "F" or "AC".) BUNA-N elastomers, (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104•F (400C) continuous superior strength and 140•F (600C) intermittent corrosion resistance. • Fasteners: 300 series MUM FEu stainless steel. 10 1 • Capable of running , _ - • dry, without damage to 9 components. so~ sow Pump: EP05 e - - - 25 • Solids handling capability: 25 Fr W maximum. °a 7- 0 Capacities: up to 60 GPM. x r-~ _ - - - _ - - • Total heads: up to 31 feet. ~ s 20 _ • Discharge size., I W NPT z s rt. • Mechanical seal: carbon- 0 15 + rota keramic-stationary, BUNA-N eiastomers. d - • Temperature: s 10 i ; 104•F (4000 continuous - 1401 (6O•C) intermitteent. 2 EP04 5 ~ 0 °0 10 20 30 40 so GPM 0 2 d 6 8 10 12 ~ CAPAWY 0 1995 maids Pumps, His. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner SYSTEM SPECIFICATIONS 0 le- Permit I Nt. _ Septic Tank Capacity IC&D gal ❑ NA Septic Tank Manufacturer DESIGN PARAMETERS _ ❑ NA Effluent Filter Manufacturer T 13 NA Number of Bedrooms . ❑ NA Effluent Filter Model 13 NA Number of Public Facility Units ~A Pump Tank Capacity Estimated flow (average) gal ❑ NA ~ al/da Pump Tank Manufacturer NA Design flow (peak), {Estimated k 1.5) J-~ al/da Pump Manufacturer ❑ NA Soil Application Rate ° al/da /ftz Pump Model Standard influent/Effluent Quality Monthly average ❑ NA Fats, Oil & Grea;;e (FOG) 530 mglL pretreatment unit O Sand/Gravel Filter A Biochemical Oxygen Demon a (130D s) <_220 m /L ❑ feat Filter g 4KNA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solicss {7SS) 5150 mg/L Pretreated Effluent Quality 11 Disinfection _ O Other: y Monthly average Dispersal Cell(s) - Biochemical Oxygen Demand (BObs) 530 mg/L 0 NA Total Suspended Solids (TSS) S30 m /L 0 In-Ground (gravity) ❑ In-Ground (pressurized) g NA At-Grade ❑ Mound Fecal Coliform (geomebic mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size in dia. ❑ NA Other: other: ❑ NA ❑ NA Other: *Values typical for domestic wastewate and septic tank effluent. - - 11 NA Other: MAINTENANCE SCHEDULE 11 NA Men ervice Event Service Frequency Inspect of tank(s) At least once every: ❑ onth(s) ears (Maximum 3 years) ❑ NA s of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA ell(s) At least once every: --~ear(s) (Maximum 3 years) ❑ NA r At least once every: l El month(s) ear(s) _ C1 NA Inspect pump, pump controls & alaon At least once every: month(s) h ❑ NA Flush laterals and pressure test At least once every: ❑ ear(s)s) ❑ NA Other: At least once every: ❑ year(ts) 11 (s) NA Other: MAINTENANCE INSTRUCTIONS ❑ NA inspections of tanks and dispersal (;ells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintalner; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to (deck for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the gro and 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 1 the tank shall be removed by a ieptage Servicing Operator and disposed of~inoacco danceewith chapter tNRe113, cWisconsn Administrative Code. All other services, including but not iiinited 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. START UP AND OPERATION Page of .For new construction, prior to rise of the POWTS' check treatment tank(s) for the presence of 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 -ervicing operator prior to use. painting products or other chemicals that 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 cells 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 IN- contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plu,nber 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 m er tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any moue i 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; cigaret,e 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 aintin pesticides; sanitary napkins; tan pons; and water softener brine. p g products; ABANDONMENT When the POWTS fails and/or k permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliEmce with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and prits shall be disconnected and the abandoned pipe openings seated. • The contents of all tank:, 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 sk did material. CONTINGENCY PLAN If the POWTS fails and cannon be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: O A suitable replacement ,rea has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area t,nould be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing arad proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 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. nd 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 u-'-~ Name F Phone Phone J i SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY E Name Name / ✓ , t Phone Phone 6 _ This document was drafted in compliance with chapter SPS 383.22(2)(b)(t)(d)&(0 and 383.54(1), (2) & (3), Wisconsin Administrative Code. Rr-CEIVED Nsomsin Department of Commerce SOIL EVALUATION REP R Page of " Division of Safety and Buildings AUG UMAnce with Comm 85, Wis. Adm. Code County Attach complete site plan on papel~lio' s#' - R114-inches in size. Plan must ` Ws"a include, but not limited to: vertirda'A@1Fl~tldzontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` d Property Owner it Property Location ~ k- S L'e /yr Govt. Lot 114 51/4 S I T Z N R E( 4)W Property Owner's Mailing Address Lot # Block # S . Name or CSM# 50 rC r' 6 o4e l City State Zip Code Phone Number ❑ City Village To Nearest Road a f . j is ( iJ 7286 ❑ New Construction Use: Residential / Number of bedrooms Code derived design flow rate > y GPD Replaoement ❑ blic or commercial - Describe: Parent material -fir! Flood Plain elevatipn if applicable X./ ~JA(- General comments and recommendations: SystemTypez~& lr',System Elevation ! S Boring # E] Boring .Pit Ground surface elev. Depth to limiting factor 1 In. ❑ - Soil lication 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 'E Z 'rX S~ C J ' r -Q--Y7 4114 Zak ❑ Boring ,tom Z eorin9 71 # Pit Ground surface elE " It. Depth to limiting factor in. Soil Application 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 Z 11 3 U s 6A • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation onducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 -2 2 715-246-4516 7 < / M 4 Property Owner _ Parcel ID # Page of Boring # ❑ Boring pit Ground surface elev.~~- . Depth to limiting factor- in. Soil Application Rate a 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 ► U rV L L` Z 3~3 u d r4-S~ t.rJ 3 - s S' sl lc ~J t i Q .i In iA6 Al 1,4 Co ❑ Boring # E] Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 I ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/_ ' Effluent #2 = BOD3 < 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. 0.8330 SB (R.6100) Property Owner Parcel ID # - - Page -.-of ❑ Boring # ❑ Boring ~ pit Ground surface elev. ~ `-eft. Depth to limiting fads- 77 - in. Soli Application 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 Z.. 13-3o d YZ --7 a Z V6 IVIA f4 E Boring # ❑ Boring ❑ pit Grouno surface elev. ft. Depth to limiting factor in. Soil Application 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 ❑ a Boring # Boring Groun a surface elev. ft. Depth to limiting factor in. - ❑ pit Soil Application Rate Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munseti Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#i -Eff#2 ` Effluent #1 =BODE > 30, 220 mg1L and TSS >30 150 m91L ` Effluent #2 = BOD, < 30 mglL and TSS < 30 mg1L The Department of Commerce a~ 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 608-266-31 S 1 or TTY 608-264-8777. seD-a»o (K-6=) Soil Test Plot Plan Project Name Cole Suthemeir Sha rd Address P.O. Box 9 Roberts Wi 54023 E Wm #226900 Lot Subdivision Date 7/25/12 SE 1/4 SE 1/4S 18 T 29 N/1117 W Township Hammond Boring (DWell PL Property Life County ST. CROIX BM or VRP Assume Elevation 1.00 ft. Top of wood corner post System Elevation 95.0' *HRpSame as Benchmark Well 1320' Property Line Existing 3 Bedroom house Scale is 1" = 40' Existing Midwestern unless otherwise Precast Combo Tank, installed 1999- noted Area of failed system 36 Acre Parcel B-1 B.M.* ❑ 95' B-2 200' 94.5' B-3. 2% Slope Scale = 1/4" =10' 160th St. 0jV FILTER CARTRIDGE INSTRUCTION'S Tttstallation STEP I pry fit the filter cage: onto the end of the outlet pipe to ensure it jr. centered under the atce" Gpening. It not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. S,; c P ? While the case is st Ili dry fitted on the outlet pipe, measure the length of 4-inch pipe needed to brxr.e the filter to the tank end wail if utilizing the optional supplemental side support, If side support method is hot utilized, proceed to step four .v9, ~ For installations utilizing the optional supplemental side support: solvent weld the Y -Inch pipe unto the filter case. If side support method is not utlli7ed, proceed to step four. _ fir, - Solvent weld the fiitai cage onto the outlet pipe. insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case. If a VAS switch is utilized: clockwise 90°. insert into the filter and lock by taming f''' R~1"f d r L+ Maintenance 1. 'rhe effluent filter should b:o- cleaned every time the septic tank is serviced. 2. Open the outlet access operting to inspect the tank and filter. - 3. Pump the septic tank campiutely, snaking sure to remove the sludge layer on the bottom of the nk and not just the scum and effluent. 4. once the effluent level has b can lowered below the invert of the outlet pipe, firmly pull up oa the fitter handle to dislodge the cartridge train the case. S. Slide the cartridge up and ot,t of the case far cleaning. rg 6. If a Vets switch connected to an alarm is present, the switch should be removed by turninrl countercio&wlse 90" and cleaned with water only, 7. While holding the cartridge iii its side (large flat surface faring down) over the access opening, rinse off the cartridge with water only, making sure all septago material Is rinsed back into the tank. f ` d . 7fi. . t a. if Vats switch is utilized, replace by Inserting ` turning clockwise 901, into filter and j, _a r( 9. Insert the filter cartridge back into the casef+!'n the filter locks into the bottati, of the case, y pressing down until d. 10. Replace and secure the attett, opening on the tank. lr •=:c ....:.pit, i.74X'e. ..•f r..:: GMt'i.tT :N1, i!r:~A?: www bearansitexom 8'77- fLFILTIERS (653-4583) ~I STATE BAR OF WISCONSIN FORM 2 -1982 WARRANTY DEED 60~ 1 3$ DOCUMENT NO.-___._ VOL _141r,FAI~it5~~KATHLEEN H. WALSH - REGISTER OF DEEDS Roger- E Li-ndctui-s-t and- J-unt - L_ ST. CROIX CO., WI Lind u i s t hu a d and w RECEIVED FOR RECORD 03-26-1999 10:00 AM conveys and warrants to Cole J . Suthei ner and Susan C. EYX PT DEED ! Svtheimer, husband and w fe, CERT COPY FEE: COPY FEE: TRANSFER - FEE: 288.00 RECORDING RECORDING FEE: 10.00 THIS SPACE R_E6 M FOR RECORONG OATA iI NAME AND RETURN ADDRESS - the following described real estate in St Croix County, WESTCONSIN CREDIT UNION State of Wisconsin: PO BOX 308 / I RIVER FALLS WI 54022 i} 018-1041-60-000 PARCEL IDENTIFICATION NUMBER The Southeast Quarter of the Southeast Quarter (SE1/4 of SE1/4) of Section 18, Township 29 North, Range 17 West, St. Croix County, 1} Wisconsin, EXCEPT Certified Survey Map filed March 18, 1977, { in volume 1'211, page 351, as Document No. 338659, St. Croix County, I~. Wisconsin Ij ~I I~ II 119 not homestead property. X00XX (is not) li Exrrptiont0warranties: Easements, restrictions and rights-of-way of record, if any. i I~ Dated this day of Marc- . A.D.. 19 99 . ` (SEAL) (SEAL) f Ro E. Lind uis vne L. Lindquist ' (SEAL) (SEAL) I 1 1 1 I AUTHENTICATION ACKNOWLEDGMENT ~j Signature(s) State of Wisconsin, I I ! ss. Count authenticated this day of , 19 Personally came before me this day of 9 9 the above named j I, March 19 ~I - Roger E Lindquist and June L. Lindquist, husband and wife, 1 7`17`1 V- MFMRFR GTATF RAR nF WKr..0NG1N I grelada Poulin Notary sbl~~sin ! f2 ~ State Of W 6-a I V '7 J...) r a-~t e. ~ D 1 Y1 Y` s: n a al Y~, A ~ `J o o oar p CD 0.ti o N ~ ti N c C j p U) 0 0.0 am_ N N 3~ c D w o O E - 2 El M E m • N O ~.•-:Fu t'0 0.-O m_O O U ti m 3 d .7' :p~N yp O N~ C v1 m N L O p N y 0-0 .Q O IM N' O N m W N C ss~~ O yOM m cm, -a M ~k > C f0 O O Q 0 c C m (O O N M . D O a O N E II O E O t z w L w L m 2 m EyU2a.o•~ cO o v c Z~ W r y Nc C E t 7 m O y U N W y m LL c ay a~ w N E 2 N O L - a v - O T - 'O m 0 E m L ct~ w 3 - E 3 o ova '~O EQm ~L'D O`~~yM Q rn 'D ru- a IM U) II M I fT0 v z L E fl! 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C 7 p 0 3 O J A O 1 W a d (7D CL N 1 O O -Q n O 0 n -I 00 WO o O O c fD 01 O O A7 A N O 7 N 0) 7 D O O O of CD O .'3 ~ c_n 9 D a W w 3 a 0 0> o O o w o N i C m to N co t0 00 N "0" C (D 3 C T M o .d. h • 000 r3- z (a co (a ~ D (a cr M a a 3 d v w ~o = R 3 m N ~ C Z i N z z o D o m O o o• Z) V7 (D = C O N C = N W fD o CL 0) z (D N C6 Ul O D n O A Z N C n~ a A GZj 0 U) N w W T ~ z I ;o 00 cn 3 r" w z CD C.0 drnm~ a 0S < a 3 y o°'m L c mg.@0 - CD Er z a o~c412. o 3 o~ d z .0 0 N O y r. o a e C fD ( N w _ ~ O A MCA w O ~"o v O n CND ul 0 CD 3 D 8 0) 0 o 0 n y C) a 7 A to ~ A z O O 69 O V ° ~ Parcel 018-1041-60-000 03/25/2005 11:05 AM PAGE 1 OF 1 Alt. Parcel 18.29.17.288A 018 - TOWN OF HAMMOND Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner SUSAN C SUTHEIMER ' SUTHEIMER, SUSAN C PO BOX 9 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: 36.200 Plat: N/A-NOT AVAILABLE SEC 18 T29N R17W 36.2 AC IN SE SE EXC Block/Condo Bldg: CERT SURVEY MAP IN VOL II PAGE 351 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 02/03/2004 753322 2502/610 QC 03/26/1999 600138 1413/585 WD 07/23/1997 944/285 07/23/1997 770/318 more... 2004 SUMMARY Bill Fair Market Value: Assessed with: 56260 Use Value Assessment Valuations: Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 35,000 276,500 311,500 NO AGRICULTURAL G4 5.000 600 0 600 NO UNDEVELOPED G5 26.220 23,000 0 23,000 NO Totals for 2004: General Property 36.220 58,600 276,500 335,100 Woodland 0.000 0 0 Totals for 2003: General Property 36.200 39,400 276,500 315,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 60.00 Special Assessments Special Charges Delinquent Charges Total 60.00 0.00 0.00 I Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of'Safety & Buildngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but Ste' C'~Lo lX 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. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R IEWEDBY DATE PROPERTY OWNER: RX~GAL L t tvD ©Ul$~ PROPERTY LOCATION COLE SUS ZI MER _ "aka t. t5x QQNa ' ^OTr S E 1/4 SE 1/4,S \a T ZC N,R 1`) E ( ) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # ~DX. 1,1 - - P top 0 SQ1) C S CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ROWN NEAREST ROAD RISBE~Z- S wl 'S ht S) 7q9- 316 Z MIM 1tir~ U SIt tZ New Construction Use ( I Residential / Number of bedrooms Addition to existing building [ j Replacement pQ Public or commercial describe !E tmT -rca~C- $\wbG 'til / OrT-t CE Z ~ -1 F. b. Code derived daily flow q Q gpd Recommended design loading rate - bed, gWI2 y ytrench, gpd/ft2 Absorption area required zzS bed, ft2 1 eo tench, 112 Maximum design loading rate •y bed, gpd/ft2 - tre Sh, gpd/ft2 . Recommended infiltration surface elevation(s) s Tl 3 , ft (as referred to site plan benchmark)' Y Additional design / site considerations sew ►y0'fL~ -r..) ► Pv S11S'Q. Or1 '~)&rse- 3 . Parent material S L LTti oy tR TL~L Flood plain elevation, if applicable t~ A It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for stem Il S0 U ®S ❑ U [RS ❑ U ® S ❑ U ❑ S O U ❑ S tKU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botndaty Roots GPD/ft in. Munsell C)u. Sz. Cont Color Gr. Sz. Sh. Bed Trench [ v o - ~ 3 1 b`'1 ~Z ~ ! Z - s i 1 Z s X12 C ~i - . S - Ground 3 3 Z-~l3 -1. S K R-3/ _ S CS b12 m CLJ ` S elev. ~o~•u ft y3-8`E .7 S`1cZy/ - 5~~ 0~„1 »rv'F1- • 3 •y Depth to limiting factor q,t Remarks: Boring # 0 -tZ 1 n 2 3! Z s i I 244 Z Z lz-Z8 1 opt R- 3) - s) I z'~s'a>~c >>7 C S - s b , f, ~s o Sg v,~ eS ~SyfLvl S Ground eel v. y 48_$3 -7-S V P- 31y _ S )i ow, yn~~. 1 ..J .:"j r 3 ` Depth to L,) VC 11 limiting 1 factor ' ST C Remarks: \'+vrro Nn"I' CST Name:-Please Print Phone: Arthur L. We erer 715- 51001-65 VTess: " . egerer Soil Testing & Design Service-P.O. Box 74 River Falls, Sgnature: Date: CST Number: 220254 1 J PROPERTYOWR Sv~}E)M~7-t SOIL DESCRIPTION REPORT Page Z o: 3 PARCEL I.D. # O i$- l U \I 1 -60 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 o~lb 3L -Z- - sil Z stilt m'fh cLv - .s Z 16 .3Z l 0 `t rZ 31 b S ~ I Z.`F'Sb>•c Yr~`~I- C 1-v - • 5 _ ~ Ground 3 Z-~l~ SyJ2 v - s 1 csblz vh`fh .S elev. q2-S ft. y yb -Z -S,--/ 2 VA. - s) 1`Es o M U-4 - • 3 s y Depth to limiting t factor 2 • N i 3 Remarks: Boring # 1 to-~z ~D~-l 3 z - s 1 z `fs b Iz wi~f1- e - . 5 El Z 1i 3g t p `rt R 3 L - S? 1 Z~Sblz v►~'F~ 0S - • S- 6 Ground elev. Jw,8 ft. Depth to 1 limiting j factor Remarks: Boring # o-Ly 10~ R j1 Z - s i 1 z~s bli wti`~h e~ •s ' -L S Z 1 ~I -~lZ 1 D li 3/ s i 2'(~S blZ Yn'f-1- GS . S 3 -L-S8 S7R vl(, ~S D S9 M eS _ • S Ground elev. $-86 1•S yR 31 - S l O W►`FI- C19•8 ft. Depth to limiting j N f?86 ~ Remarks: Boring # ►.~D`T~ R 'f~Dt A/G OF O• LS 'lh~l b ~U S I B ►uG v e 13 Ground 1 elev. SQ SKIS B LG ZS O G ft. Depth to V L I Z - fir 10 O G wh1 S C C limiting pp Qp~ DSO= ZS ~aP ;1 factor - - 62S Remarks: cnr) "InM nrInm f PLOT PLAN Page 3 of 3 ~ r SCALE 1"= y0 0 eZt oos 8.4 e1a, S g •3 J a. to ° TV-ew Ctrs $.Z wit L To B E ps'r uLRST so Plum -n'Lk-Ivtw'e~s- ~Cs~M~"~ Z 't~~tt~, ~e.~ 3'x t,Z.S` LcwG ttit`f}I ~1614 ct'Cp~ L y S10 E wirQDE x.4-1 ~4 cr~w~a~~z s. o `Z ►►i 1' )-10 NZ) Q) mr~ ST, ~w11FZ -~Z,1o2.6 oti ~Me~l -EL.m p' ow splvgz ~vC' of u"x y" 2.3' f'Bovl 6"WUt-:, `AtIX.a-J eow e~ ~N Pow~R. l~ol~. ~ PO'T, 2L c, (715 ) 425-0-169 _ 1400576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page %of 3 Labor and Human Relations Division of Safety & Buildngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but Ste' not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWS BY _PATE 9`t PROPERTY OWNER: R.U GM L t N4) ©~1L$~ PROPERTY LOCATION Cp L<` S U`yl} ~D M kENZ R, _QW1. '$T- S E 1/4 S E 114,S \ S T Z C N,R 1-1 E (EL PROPERTY OWNER'.S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # $DX. 1 L14 - - N> Q seD e S CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®rOWN NEAREST ROAD Rum wl s qo Z3 ni s) -)tt9- 316 z MM >v0 v g> t ~Z New Construction Use[ I Residential/ Number of bedrooms [ J Addition to existing building j J Replacement PQ Public or commercial describe sro~-rc a~ G ti1 / OFPi CE 2e)-V~--1 F. fl. Code derived dally flow q Q gpd Recommended design loading rate j bed, gpolft2 ' trench, gpd1ft2 , polft2 ench Absorption area required z-ZS bed, ft2 180 trench, 112 Maximum design loading rate -4 bed, gpolit2 .11 Recommended infiltration surface elevation(s) se XZ1:15 3 , ft (as referred to site plan benchmark)' tW SY 1 Additional design / site considerations "Tr✓ 1U 0v %1*L.f`Ef_ O)\j 'V*GW 3 • Parent material s t L121 MJ EQ T~t✓~ . Flood plain elevation, if applicable ►-N A It S = Suitable for system CONvEP(TIONAL MOUND IN-GROUND PRESSURE AT-GRADE 7SYSTEM IN RLL HOLDING TANK U = Unsuitable fors stem ~S ❑ U ®S ❑ U Es ❑ U ®S ❑ U ❑ S ®U ❑ S QU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft Bounclary in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rench J o - ~ 3 1 b`~l ~z 31 Z - Sit Z s ~1-c rn'~1- C ~i - ' S - l Z 13 32 1~`t R 3/ S1 J 1_-F lz yn1 l- CW - • S - 3 3ZA[3 ~•SYR3/ S) 1asbV( m `IV c>,0 • S Ground elev. tiou, 0 ft S [ Depth W limiting factDrt{tr Remarks: Boring # D -tZ I'z-1 SZ 3 l Z S i ► 24S ~1T_ Y►~' - C>v - S Z 1Z W -A R 0-S - S - 3 ~-S\-i rLUIL - ~s o sg I es Ground elev. y y$_$3 SyrZ 3/y _ S ow, ~1;*,. - 1:0 .O It Depth to i ' ` limiting f } factor T lip ? 4j Y coU x ,r,• OFF , Remarks: CST Name:-Please Print Arthur L. W e e r e r Phone. 715 -425 -0 t. I egerer Soil Testing & Design Service-P..0. Box 74 River Falls,WI 54022 Sgnature: 9 ` I - Q Date: CST Number: 220254 i PROPER ~O Sv'~}~1r-tt SOIL DESCRIPTION REPORT Page Z- of 3 PARCEL I.D. # O IS - 1 w-1 1-610 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench El ©.LIO 6p`1tZ31Z 2 Sb1•,, 7n`fh C~v - S z 16z t o ►z 31 b - S, r z~sbk m~~ c tiv - 5 -.b Ground 3 Z-~!~ 1 SyJ2 3/ - S 1 L sblt M-CF - Cg .5 elev. (I! S ft. A . 82 -7 •S 7 rZ VA. - s l 1`~s o Yr~ u'Fl" - } • 3 } ,y Depth to limiting i factor $Z" } t } Remarks: Boring # 1 o-~z ~o~-I,tZ 3c Z - s~'1 z~sblz wt~- ems, y Z ti 3 f 3 10 `'f R I L L ,1 S? 1 Z,'~'Sbl~ vr~`F1- - Cs •si•b Ground 3 -~S --)S V1L VIA sl a ids oh., vnu~F~ - , . y elev. )WIS ft. Depth to limiting factor > 85 ~ i Remarks: Boring # o-ti`( 10`.'l2 31 Z. - s i ~ Z.`FS d~ ~M`F1^ CJ.v - .s ~ S 2 1U-~12 !Q`iti 3l(, s > > 2'~S biz Yn ~1- C_S • S i 3 uz_s8 ~•srRvl6 - ~s o s9 M 1 es _ • S I-~ Ground el ev. ft. a46 1'S `-ff 2- 3! - s 01~►~ Wt ~1- - • Z!, • y 99-8 Depth to limiting factor ,86h t Remarks: Boring # R WC~:j A/G 0F C~• L5 r-O MM b CD,J B v e ~ . 13 Ground { elev. So CZ. h~ S~1S B ft. b LG ZS U G D . Depth to ~-0- U)-) U-?-k-7 F~ 10 O G Lw-J S C g oC~ 5Pn. S0= ZS G P factorC = 62 S a , Remarks: inn 04'lilin nr.n'n PLOT PLAN Page 3 of SCALE 1"= yO ' 0 a°~ dy ML 1130 j '9 ~ ea", d1 2 tNV~ tyt_-r~~1C ~ d~yo~tq'l S 9.3 C7 C13 U $ •5 / a. , V-lot) _ T we B-Z EL Ott o wiz L To B E ftT L~-Zfts'T" So' FtwM TR tiF' s ~cr-►►~1~~ z T2>`~ttt~, ~t`Ce-t1- 3 is ~ z.s ` LcY~/G !~J!`r?y N lG N Ct~pt°~etYy S! C wi D 1, ckl C C}-~ w~ f3 L`1Z s . - o - `Z 41 i 1bo MA. ST. i4FZ -,FL,to2.6 o~v t!1 1 -~1.100.O' am SP1tX.P-- ~oC' u `x " "rj% F 6 X4Uk t~ of y -ON c~zeTL P03r, r.' t o► t~o~~ `DELI DkJ ' q9-l'7- 8 FiEve, `1ct9 (715 ) 425-n7 65 1400576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division CountY INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permiti ST. CR IX Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 338828 Permit Holder's Name: ❑ City ❑ Village (R Town of: State Plan ID No.: SUTHEIMER, COLE HAMMOND CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 0e)/ reo, l r,04 _,3A 018-1041-60-000 TANK INFORMATION ELEVATION DATA A9900092 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic li\ AA,efl $feCA 000 Benchmark Z• Z OZ, O~ Dosing ~t Ud Aeration Bldg. Sewer 6100 Hol (g)Ht Inlet s TANK SETBACK INFORMATION t Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD &Inlet Air Intake Septic ~-~Sa l N Z d/ ' j Sp NA Bottom Dosing Z91 Z 1 I NA Header /Man. Aeration Dist. Pipe "r3 S 4- q zZ Holdin Bot. System 7'z -fe PUMP/ SIPHON INFORMATION Final Grade Z 99_ Manufacturer Demand JAA 0" z 9; Model Number '2fD 3`} ~~PM TDH Lift Friction .q~ System TDH R.-> Ft oss Forcemain Length Dia. Fi Dist. To Well N SOIL ABSORPTION SYSTEM BED / Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME N 31 DIMENSIONS- SETBACK SYSTEM TO P / L BLDG WELL -CAKE % STREAM LEACHING Manuf du~ r' or INFORMATION Type Of , Q I , ,r~ / f-KAMOW odel umber: System: 1(/ A DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length /9! Dia. Length / Dia. I Spacing 1 0 A 1 , 4 414- 4-- 9 4 I 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 ❑ Yes ❑ No COMMENTS: (include code discrepancies, persons present, etc.) LOCATION: HAMMOND 18.29.17.288A,SE,SE 920 160TH STAET Lo-i l KT INt Pr 04 l (D~@S- 4\I 4- reP~~cCI (pa4ke~ oV, G+rW I 1. v iL~~N ~T P k 6e C u rU~~ v i Vt fi ~~G16 G ~l w~ (~411-1 UC r Plan revision required? ❑ Yes to No Use other side for additional information. LZ SBD-6710 (R.3/97) Da Inspector's ature Cert No Safety and Buildings Division Box Washington Avenue Visconsin SANITARY PERMIT APPLICATION 201 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. S~ I'll, 6 Per it Number • See reverse side for instructions for completing this application State Sanitar7 3322 Personal information you provide may be used for secondary purposes ;ILC heck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property f~wn r Napa, opert Location ~ e er. !iL 1/4 1/4,S A T / N,R E(or Property Owngr'sMailgAddress Lot Number Block Number City, S e ~j Zip Co Phone Number Subdivision Name or CSM Number 6 2 ( T~- II. PE BUILDING: (check one) ❑ State Owned a it Nearest Roa Public 1 or 2 Family Dwelling - No. of bedrooms p Village Town of I'm 611 ia h 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo 0 N 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ 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. &L New 2. ❑ Replacement 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 -g 30Y2 do,- Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench f NAN*;,i; 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Requir d~sq. ft.) Prop ed sq. ft.) (Gal~day/sq. ft.) (Min./i ch) 95"0 K-& Elevation 6~ (r r 9 49< Feet t6 Feet VII. TANK Capacity ISite NFORMATION in gallons Total # of Manufacturer's Name Prefab. Con- steel Fiber- Exper. Gallons Tanks Manu Concrete lass Plastic App. New Existing structed 9 T nks Tanks Septic Tank or Holding Tank lov ~r ~lclt~5~ o"PCQj ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber D%' l~ ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sews stem shown on the attached plans. Plumb is Name: (Print) Plum= (No St imps) M PRSW Business Phone Numb r: Wo ii a s k,~A~? Plumber';Adcl (street,City,S iRCode ^ /~J/, IX. COUNTY / DEPARTMENT USE ONLY ❑Disapproved Sanitary Permit Fee (IndudesGroundwater ate Issued Issuin Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination #0 Z Z ~G X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: c, I/ L SBD- 6398 (R.11/97) 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, 608-266-3151. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. 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 all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental 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. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all 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 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner C Q le 3k Property Address e City/State rr r ' . Legal Description: Lot Block Subdi 'sion/CSM # t/4, Sec. TdN-R)W, Town of PIN # SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: ri-e&S iz v ~ el ImOSetback from: House 00 Well Z5D PAL >100 Tank manufacturer Pump manufacturer Go rt Moe F~°(~ ° Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: T~11 1fP416r! ' 3 < 7~' t Type of system: G U. Width Length Number of Trenches Setback from: House O Well ~S'D P!LD r Vent to fresh air intake ~ldD ELEVATIONS: Description of benchmark 76-.0 /?e 64,V Elevation 00 Description of alternate benchmark Elevation A60~ Building Sewer 9Z5 3 ST/HT Inlet `Z ~ ST Outlet ! PC Inlet PC Bottom Header/Manifold 0K Z` a Top of ST/PC Manhole Cover Distribution Lines O O ( ) Bottom of System 95" d ( ) Final Grade O / / , O ( ) I Date of installation Permit number PAP State plan number Plumber's signature License number 09 c2 Y6 Date Inspector Complete plot plan S r T 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 S. 0 , ~jODOGQ,1 ~UIM1~(G I + V SIP - A (ter. Ack x B~►•To~ )d~ ~eU~.l~ 3 ~ ~ s INDICATE NORTH ARROW ' t 7 Y J t \ - ODd CA,t jeprl(I `t' 0 0L-'ycL l PAGE OF ' PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS <l`fP~Vt~ z'ns~e~'inl\ scttiea~o -NEWT CAP WEATHER PROOF APPROVED LOCKIN MANHOLE COVER W/ Jumcriou box 25' FROM DOOR, L~4,rnoA~ ;~tlbt~ WINDOW OR FRESH IZrMiV' I AIR INTAKE _ I GRADE I `I" MIN. 18' MIN. CONDUIT 1 11l •P OVIDE ( - IAILE T AIRTIGHT SEAL . ~ II v APPROVED JOINT/ A I III APPROVED JOINTS W/C.I. PIPE I III W/C.I. PIPE EXTENDING 3' I II ALARM EXTENDING 3' ONTO SOLID SOIL I 1( ONTO SOLID SOIL B I I i i ON l7 Ga~~,n~~t c i I LLEV. FT. PUMP OFF O CO R TE BLOCK 54 io 3" APPROV 86ppING RISER EXIT PERMITTED Ly F'ANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIS S ..33~. DOSE ~'tYLc.~St ~~aS~ TANKS MANUFACTURER: NUMBER OF DOSES: -PER DAU ~ TAWK SIZE: )V-e GALLONS DOSE VOLUME ALARM MANUFACTURER: INCLUDING BACKFLOW: GALLONS MODEL NUMBER: CAPACITIES: A= INCHES OR GALLONS SWITCH TYPE' Olrr 014 14 INCHES OR _L GALLOWS C = --.t.-INCHES OR GALLONS PUMP MANUFACTURER: 00 A& Ut MODEL NUMBER: _ 0- INCHES OR GALLONS SWITCH TYPE: MOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE 29(UQ GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AIJO DISTRIBUTION PIPE.. ~ FEET III ♦ MINIMUM NETWORK SUPPLY PRESSURE . . . Z 5 FEET ♦ rEET OF FORCE MAIN X -L 4Fl X100 FLFRICTIOM FACTOR.. FEET TOTAL DYNAMIC HEAD = 22- FEET j INTERNAL DIMENSIONS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH SIGNED: LICENSE NUMBER: ~`c/?IX9- DATE: Combination Sep-I; c;Tank and PLJ-MP CHAMBER CROSS SECTIOW ARID SPECIFICATIOUS ' PAGE S OF -VC IJT CAP WEATHER PROOF JUIXTIOU BOX . '1'C.1. VEMT PIPC APPROVED LOCKING 2 10' FROM DOOR. MANHOLE COVER wIV ailUDOW OR FRESH wARIJI►JG L.t46EC.. At IUTAKE r ~ OZ ~ ~"t•+iM. i Y~ MIIJ. I _ 18-- IB'KIIJ. y"IUS~oIa PIPS PROVIDE I IAJLET AIRTIGHT SEAL a tLt=F~t=s ~ I I v APPROVED JOINT A I I I APPROVED JOI►IT: W/C.I. PIPEOR Tank construction I III W/C.1. PIPEoxIOC shall comply with ALARM ILH;< (83.15 and 33.20 d I II I i ow C I I I CLCY. u'~ S FT. PUMP OFF D COAICR. ETE 9y .~o Y RISER EXIT PERMITtED OuLy IF TAUK MAIJUFACTURER HAS SUCH APPROVAL 3,•APPRaFt 81:.t>0tN4 SEPTIC SPEC11FICATIOLIS DOSE W1tp►JE IJ S-2-'1--AST 1--1sT 3.1S TAUK MAIJUFACTURCR: WUM$ER OF DOSES: PER DAy TAWK 51ZE : l~-UO `~OV GALLOMS DOSE VOLUME I 3D ALARM MAIJUFACTURER: S` J ~~iST T t S IWCLUDIAIG 6ACKPLOW: COAL 0 MODEL WUMBER: CAPACITIES: A- uCHE5 OR ALLOIJS SWITCH TYPE: ~~u-U~ Y J b 9 = Z IUCHES"0K'16-'~rt {i Lu0 PUMP MAWUFACTUKER: _ ~UV I Q S D C- tUCHES CALLOUS MODEL WUMBER: Sul a y D- ft INCHES r~ C) 8 SWITCH TYPE: Y-1 Ini, N Y ~ TE: PUMP AND ALARM ARC TO 5E MIMIMUM DISCKARGE RATE 31'uy GPM INSTALLED OW 5EPARATC CIRCUITS VEKTICAL DIFFEREIJCE DETWfEIJ PUMP OFF AU0.015TRIBUTIOW PIPE.. S FEET - + MIWIMUM WETWORK SUPPLY PRESSURE . . . . . . 2 S2 FCET + SO FEET OF FORCE MAIM X Z.IY FoFtFRICTtou FAtrpR_. FEET TOTAL OtIMAMIC. HEAD FEET Pump chamber DIAMETER IIJTERLIAL DIMEIJSIO&1 OF TAWK: LELIGTH ;WIDTH LIQUID DEPTH BOTTOM AREA - 231 GAL/INCH AS PRR MANTTVArTMIPT) - 1 n C - r--AT /TrTru T ♦ 7 Uou~dS rn"C d b ~ i Submersible Effluent Pump ( 3871 EP04 EP05 98 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically desiarted.Jor.ttip, stainless steel. grade turbine oil for for WigjggtllQ.tWg t,, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas-11 • Homes components. tic cover with integral handle Motor. Available for automatic and • Farms • EP04 Sin manual operation. Automatic and float switch attachment Heavy, duty sump Single phase: 0.4 HP, models include Mechanical • Dewatering RPM, built Points. • Water transfer 115 or 2 It in n overload 15 with Float Switch assembled and ■ Power Cable: Severe duty automatic reset. preset at the factory. rated oil and water resistant. SPECIFICATIONS • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EP04 built in overload with construction. Thermo Solids handling capability. automatic reset. ■ EP04 Impeller. - s • plastic Semi-open design design maximum. Power cord: 10 foot AGENCY LISTING with pump out vanes for • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. SP Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding IN • Discharge size: l'/z' NPT. plug. Optional 20 foot EP05 Impeller Thermo- - lastic enclosed deli (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with p gn for rotary/ceramic-stationary, three prong grounding plug improved performance. end in "F" or "AC".) BUNA-N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104°F (40°C) continuous superior strength and 140OF (600C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10- • Capable of running i - - . - + dry without damage to s 30; components. i -►~•-SGPtiI Pump: EP05 8 ) - - ! - +-25Fr • Solids handling capability: o 7 2s Y' maximum. a W - - - • Capacities: up to 60 GPM. 6 20 I • Total heads: up to 31 feet. - • Discharge size:1 W NPT. z 5 - - - _ • Mechanical seal: carbon- 0 15 rotary/ceramic-stationary, _j 4 BUNA-N elastomers. - EPA • Temperature: I- 3 10 ' I 104•F (40°C) continuous ; - 140°F (60°C) intermittent 2 - ; - T- _ I _ ; EP04 j i 5 "Ilk i 0 00 10 20 30 40 50 GPM L , 'L A 0 2 4 6 8 10 12 nft CAPACITY O 1995 Goulds Pumps, me Safety and Buildings Division Visconsin SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue 7302 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 338BZ8 Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner N e Propert Laation m !Sm1Ae% Pi'. j vat t /a, S T, N, R E (or(g Im _,2 Property Ow er's Mailing Address Lot Number Block NuY mb1r rv•'J Cit St to Zip Co e Phone Number Subdivision Name or CSM Number , VZ) 11. TYPE BUILDING: (check one) ❑ State Owned Ity Nearest Roa / ~t Public 19 1 or 2 Family Dwelling - No. of bedrooms o Towann OFrC;i 4 PA III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo y~- ~o fig' 2~ • t1- WIA 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/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 on line B, if applicable) A) 1. R New 2. ❑ Replacement 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12'RSeepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp_ Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (s ft.) Proposed (sq. ft.) (Gals/da / q. ft.) (Min./inch) ~~r v Elev a on l~ `J 2 S, I ~ r p Feet ' Feet TANK Capacity VII. INFORMATION in gallonTotal # of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper. Site New Exist in Gallons Tanks Concrete strutted glass App. T nks Tanks ❑ ❑ ❑ ❑ ❑ Septic Tank or Holding Tank - lt,eS &-5 T (9 Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewa shown on the attached plans. Plumb 's Name: (Print) Plum r' ignature: ( amps) rP IN, ~ Business Phorle N mber: w If 4~ IX c2 Plumb r' Address ( treet, City, Sta Z Code) ~e _ s a IX. C UNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing A ent s urcharge Fee) Ap roved ❑ Owner Given Initial ~ s-- Adverse Determination / SG~J 3 3/ 7K A X. CO DITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: I $BD- 6$98'I(R. I I/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber _ INSTRUCTIONS f I 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, 608-266-3151. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. 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 all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII_ Responsibility statement. Installing plumber isto 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. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all 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. ~ API Ync~t i ~U L' c c LY Up, v f J ~y v g' 1 5 ~s~ Liu). 8~ ~ e b3 V n 4 Ni 'Vlrisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page ` of 3 Labor and Human Relations Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S~ • Lx 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 O t ~i - Vy - APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R IEWED Y DATE PROPERTY OWNER: D 6 LCt rPb W S T PROPERTY LOCATION v Q-Q LF_Z~ SU ~j Et - "6Uq sR GGVi.-I:@T SZ- 1/4 Sk:~-1/4,S L% T -La N,R Vq E PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # fox. 1t - - ~~~s~ i~ sw1 CITY, STATE ZIP CODE PHONE NUMBER (3CITY (]VILLAGE OrOWN NEAREST ROAD C~,bQ W I 's. \4o1-3 t5)') %19- 31'%Z l OfvL'~ 1 p Sl-• K New Construction 'Use K Residential /Number of bedrooms 3 f J Addition to existing building I Replacement [ I Public or commercial describe Code derived daily flow y SO gpd Recommended design loading rate - bed, gpd/ft2 ` V trench, gpdj2 Absorption area required 15 o O bed, ft2 11 Z 5 trench, 112 Mabmum design loading rate 3 bed, gpd/ft2 • y trench, gpd/ t2 Recommended infiltration surface elevation(s) SEle- V~"f; 3 OF 3 ftjas referred to sjte plan ~ ark) Additional design / site considerations h b ~ Parent material S I L.`M OU IE~t u Twf~ S L,4 Flood plain elevation, if applicable N 3N It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem 0 S El U 0 S 11 U 0 S ❑ U as ❑ U f] S U 0S ZU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BourxJary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmrich o- ~Z t o-1 1--- 3l Z s i Z S U r►N'~1- C_L~j • S b 1 ; Z 1Z-39 o ~-t R J/ - s 1 Z wl s Mme- e w - • S - Ground 3 q ~.S`1R3/ S~ 1 ts~*L- yy) e S y elev. CY9-6 ft ,S`~s1 o s9 ~ _ - • 3 Depth to ep to S d VA V s 1 Lp 1►v G - S E-tl ON) ov"d•• limiting > 6 y tam Remarks: Boring # S C - s~ l Z~g b X14'- w ~ Z Z ~~-~0 1 b `-i lz - 3i S *1 l 2 ~n sbk Y4 i - Cw - . S I Ground elev. e a y CL-t 9 Y >oo. g n 57.108 -s ~/6 ~s ` o s ~ M,1 Depth to limiting fac pa, Remarks: T Name:-•Please Print Phone: V Arthur L. We erer 715-4 ,egerer So l Testing & Design Service-P.O.. Box 74 River Falls, Sgnature: , q ` Date: F 1) CST Number: 220254 Y. a # PROPERTY-GWNER Sv`rv\ c,_r) ►vl L-~ SOIL DESCRIPTION REPORT Page of PARCEL W. # ws - 1 o A 1- 60 Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Consistence Bourxiary Roots Bed rerxh a-I Z 14 -z8 LO `t [Z 31 b s 1 Z S~Dk Im~~ e~J S . Ground 2~ 3 b s cZ sly _ s 1 r`sbk wt u`F't- •4 .S elev. ga.Oft. 36-tol-SKR - S~s1 p g9 - Depth to g rut, X31 limiting factor 7 I,O1M Remarks: Boring # iD. ~3 lp`1 31 Z 5M Z`Fs~4t ~Vlh ~bv - • S y Z t3-33 LO`-tD-3!6 - SZw+Sb~ )'t~C~ - •S i-r Ground - S Y!7 U`~ ~S L~ -S elev. ft. T u~_lo3 -i `22 S P- S - Q g Yv1 Depth to limiting j factor X1.03' i f Remarks: Boring # 1 ~ -LZ ~p..ti~ 3/ Z- ~ SL, Z-TS~k 'Fh c-vLU . S ` ,6 . S Z ~z zy >..o~t ~ 3! ~ _ st ~ Zvn s~k ~ ~fl- ~w . s 6 Ground 1 y??V tioo: ft 14 o bb-gas S~tQ-~l - s g s I S5 W '1 Depth to j limiting factor > lOS'' Remarks: Boring # 131 Ground i elev. ft. Depth to limiting factor Remarks: cnn n,2cnm n-n- PLOT PLAN Page 3 of 3 SCALE 1"= 4Q) ' F~'rJ wz - SOP ~z l LlW I- r o i r N ZL,Mi- O *j S/8' 7 I t~1oc~4' eiy Lsl.~lR? 3.S Z\ ZlI Zo1o - - ~r I 01 In of i 3 0 g,Z Z1'~ Zl ` ~3 ~Tl ~o ~L LOp o~ 8v'~~t z ~ Ll~v , X00.1' on> > u 4 ~t't 6H , 5/e" Diq-Q w/L+~TI~ R~c-O1'''►wl ~ vD 3 ~iti1 C~~ ~ t;-y~~ 3 ' x l ~ ' Lu r~1 G t,~~`Ttt i~ ltt 6H ~►a-p ~c..~'~y s t ~ E~..~ ~ ~ ~ ~ea,~- CL'1f ~~l t3 ~S. `2 ~,►vil-s ! ~1~~ C,l~ ~vvYt l~ 3t f'T LE"T 25` F-NzoM `VTZe►Cti 3 . w~u ti ~ h f S o ~ y 1 (715 ) 425-m f;5 1400576 CST Signature Date Signed Telephone No. CST # ! vY(wonsinDepartment ofIndustry, SOIL AND SITE EVALUATION REPORT Page `of 3 I.Abor,gnd Human Relations Division of Safety 6 Builkings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST • C~Z4 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. O l - l VU ( -60. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVI D BY ATE 3 l d -I- kT PROPERTY OWNER: R.0 6 Zt i-Pb u1 s T PROPERTY LOCATION C-10 LE:_~ SU` - Q0xtQ-R GOW-teT SE 1/4 St-.1/4,S l$ T ZP N,R J'q E( PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK If SUED. NAME OR CSM # 1~613k- ll - - PZ,pv-OSe;> csr7 CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®TOWN NEAREST ROAD ~,b~L. W I S~OZ-3 (ll~ 7u9- 3l6 Z ~''(~W'1.w10h1fl 1 O `~lF S1-• K New Construction '.Use pV Residential / Number of bedrooms 3 [ j Addition to existing building [ J Replacement [ ] Public or commercial describe Code derived daily flow y SO gpd Recommended design loading rate ~ bed, gPdtft2 - ILft~. 9pW Absorption area required k5o O bed, ft2 N < L5 trench, ft2 Maximum design bading rate bed, gPd/ft2 ' S try. gPd12 Recommended infiltration surface elevation(s) SE R B OF 3 ft (as referred to site plan benchmark) Additional design / site considerations h If Parent material S I UT4 OU IF~t ~ uTwf~S L~ Rood plain elevation, if applicable K3 K It S = Suitable for system 7CONVENTIONAL MOUND IN-GROUND PRESSU7as T-GRADE SYSTEM IN FILL HOLDING TANK u= unsuitable for stem ❑ LI 9S ❑ u IRS ❑ u ❑ u ❑ S u ❑ S KU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxxhry Roots GPD/ft in. Munsell. Qu. Sz. Cont. Color Gr. Sz. Sh. Brah o-VZ Ib tR-3t2 - si Z Sb yv'f~- c - •s •b 1 ; Z ~z-39 ~oHR JIb - s, 1 Zpn s~ ~w - •S -10 Ground 3 q ~o S`~RJ/ - S~ leg ~lvfr e~ ,3 y elev. ` a98fL y ~o_~ob 2-S LiP-VIA - S~sl o s9 w,l _ - • 3 •y Depth to eQ S c7 v+n v s 1 - Lo 1Q G - s cwt; limiting fob" Remarks: Boring # Z+gdEc ►Nt'~ Cw - 5.1, Z Z ~z ~o ~b ~ ~ 31 ~ ~ si ~ Z- sbk cw - • S ~ - ~ Ground 3 Y elev. y 57-108 S ~LYA qs o S M 1 77'_ 1~~n q S`Ptr~ N0 kS C3 Depth to limiting factor 1,9 sr c Remarks: T Name:-Please Print Phone: , Arthur L. We erer 715- ~r egerer So l Testing & Design Service-P.0'. Box 74 River Falls, Signature: / ; . q ` \7 ` N Date: ~ j ' i cy? CST Number: 220254 L kvy ~ yti- PROPERTY9WNER Sv`1~ ~~v1 SOIL DESCRIPTION REPORT. Page of 3. PARCEL I.D. C~ l - b L~ - 60 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ranch 3 a - l LO'-i iZ. 312 - S o Z Sblr~ Wl'~- a-k, - • S 1 -Z-B . b0 `t R- 31 b s L 1 ZW SVVL S ..b Ground za 3 6 S `'l CL- 3l 51 `C.SbI~ wW`Pl,- c~ .S elev. as .g ft. 36- tol R V16 S VIs l 0s,3 1M 1 - Depth to $ - h/0 oe- 31 limiting factor 7 1,01M I Remarks: Boring # _ y Z t3-33 ~ O`-Ltz-.316 - S ti ~ Zt~sb~ yyl `F cy~ _ , S 6 I' Ground 3 -~l7 S~! iL 3L - S e-+Z~ Yn U`f 0--5 . LJ i •S elev. ft. L41 `l~3 S Y 6 S G~, Q Saj Wl I • C] Depth to limiting factor > L03` Remarks: Boring # 1 o-1,Z Ip`1.tZ 3/Z- - SL Z`fS~k 'F1- ec~ _ ,S ~ ,6 . z ~zzy i o~trL3! b _ si Z+n S'b~( S `fl- ew , s 6 3 12-44,L ~•S'~R31y s~ ~co- ynV`f1- CS 3:-Y Ground elev. ft ~oS S~tR-~!f - S s l o S5 Depth to limiting factor > lOS" Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: cnn ninni►n nc,nn\ - PLOT PLAN Page 3 of 3 SCALE V'= 'Ax3 ' x~ k, Ft~.1 C~, - SOP ~vCtl LutJ ~ o I 1' sw~~ 1 -fit. W~1.0 Oki ~y" L~ L Gtr , s/8' r o~r~ Rf`c ~rCR w/L". 4 tTZ LOv 4 ~4 ~gq Z a.s z~ z~' i %71 '.:L Zo1 I ~ ~ r I . 0 I I 01 01 _rA I sue` I ~ SSA ~'rca 1'~~11 - ~ I 0 B.7 Z1 Zf ~ ~ ~ O I f ~ - LOO 4 0a~ 518" b►A ZE-kem ~►/~hTN I' ~`fE `lU LniS1~CLl_~~R RHO 1^1 wl ~ D ~i~J C~ ~S , ~ 3 x l S ` Lu +v ~.Jl`~t i~'~, ltt G N C tip Y~C~`1~ / S L D EL.~ ~vpL'~ t LL'~l\~1~ Cl1 f~~'l t3 L}1ZS. `2 Urvi.rs v Cli b{vv S il~T L-E"T 25 ` F,tZbm `jz._wCti es . w~u k 4 s S o k q j'~, 1 1 I ` ~ 715 4?,~-ni 65- 1400576 CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM S Owner/Buyer 06 1 l V (A G Mailing Address or IrU y 1 1I Property Address Q A (Verification required from Planning Department for new construction) City/State Co u t Parcel Identification Number LEGAL DESCRIPTION Property Locations Sec. T c~~l N-R / / ~ W, Town of /~f~ d1a61'l 3 Subdivision ~Lu-~de✓ , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # act 6 a a 1 , Volume - Page # ig13 Spec house ❑ yes ❑ no Lot lines identifiab e E 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification 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. 3 /30 / yy SIGNATUIff 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 1~a R 136199 SIGNA OF 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 r it v > STATE BAR OF W15COIdSIN FORM 2 - 1982 I WARRANTY DEED 6001 38 DOCUMENT NO. ~I VUL 1413 P{ KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI it and une L• RECEIVED FOR RECORD i. Ro er E. Lind u s Lind uist husband and wi a 03-26-1999 10:00 AM I Cole J. Sutheimer and Susan C. WARRANTY DEED conveys and warrants to I f e, # Sutheimer, husband and wie, CERT COPY FEE: COPY FEE: I TRANSFER FEE: 288.00 - I RECORDING FEE: 10.00 ~~,,~nn~~y~+. FOR RECORDING OA TA TM IS SPACE RE7L'IVCIO+ NAME AND' RETURN AODRESS I' St Crr,{ x County, WESTCONSIN CREDIT UNION I the following described real estate in _ PO BOX 308 / state of Wisconsin: RIVER FALLS WI 54022 ttJ~s 018-1041-60-000 I PARCEL IOENTIFIC AT ICN NUM6ER ~I The Southeast Quarter of the Southeast Quarter sECounty, of Section 18, Township 29 North, Range filed March 18, 1977, I Wisconsin, EXCEPT Certified Survey Map p in Volume 11211, page 351, as Document No 338659, St. Croix County, Wisconsin I I i II I it I This is not homestead property. X00XX (is not) of record, Exception towarrantiev Easements, restrictions and rights-of-way III if any. I I March A.D., 19 99 'I Dated this day of ' L. (SEAL) (SEAL) une L. Lindquist II' Rog E. Lindquist (SEAL) (SEAL) Is II i AUTHENTICATION ACKNOWLEDGMENT I'State of Wisconsin, I~ ss. I Signature(s) f 1 k Count I I day of da of , 19 Personally came before me this the above named I authenticated this day March 19 Ro er E. Lind uist and June L• i I; Lindquist, husband and wife, %I I~ II - !I TiTI F• AAr-MTkPR CTATF RAR nr- V✓1G('nmciN poUlin j/ Bre~aa public . / Notacyt~,scon5ln t fti /G 0 ~ State of V~J --c;' U-7 /8 Y r s~;r a Note: This mW- is- a- preliminary- certified- survey map`a.n'-d-presently is only to he used as. -a. visual_tool in the rezoning of the proposed Lot 4 as shown, CERTIPEEII SURVEY MAP COLE AND SUSAN SUTI MER Part of the Southeast 1/4 of the Southeast 1/4 of Section 18, Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin. E 114 CDR. SEC. lB, 729N, R17W, SUN 4A TIED LANDS IRON PIPE FOUNOI h OWNEO BY 07P , E7FT- h N 89.57'05 "E /321.53' N LINE SE I/4 SE //4 m 1288.53' 7wit 0 I ~I I Q H I JI 0 ~ ~ , ~ III W LOT 3 I o' y 71-1 2 20.454 ACRES, 23-9,476 S0. F7. I 2 V1I Q ~ 27.693 ACRES, 1, ?06, 293 S0. Fr. EXC. ROAD R.O.W. I ~ 3 Q J WI MIW ) Z' I Z 2 1 h v Q of LEGEND: I o f WI ` o Indicates 1" x 24" iron pipe weighing 1.13 lbs./lin. ft. set. Q i 3I h z o I W 0 m mi m Q ~ Indicates fence. ~ I a o o R (1.00')`Indicates previously recorded data:. I a ' Qa M ~ M M jW ~ ^ o f o N'• 4 3 a Owner's Address: m i o i a! ;I 213 West Warren St. M Roberts, WI 54023 ~ M o I I W O r This instrument drafted by Laurence W. Murphy I y I S89.39'S8"f 78/.90' I 2 3 0 o I q 2 L o r 4 567.00 •w 0 N90°00'00"W 600.00' ~~►L_ 2 H 7.176 ACRES, 3/2, 606 S0. Fr. 3 I H WWW v $ 6.592 ACRES, 287, /65 S0. Fr. EXC. O vn, g LOT I I LOT 2 I I HI OH WAY R. 0. W. D q hq0 ti t y m (CWNTY/ H/ONWAY SETBACK LINE A ~M V%4 C' S' M' ' VOL_Fj14 GE $29 °o I v m> OWNED BYOITHERS m 9I V _ _/S rA TEl_ _ P j H /6HWA Y_S-E_ 7BACK L /NE B _ O 2 M W S89.59'/5"W 270.04'I n 02 Ct ~I 2 O N 000 00'45"W 5.00' ^ CEN7ERL/NE it -L SB9.59115"W 432.07' /32107 0 M I O JI 00. 00' 722. OT' S LINE SE I14 6 M VAR. W10rN N90000'00"W 2644.14 ~il- M y SE CDR. SEC. /B, 729 N, R /7W, ICOUN7Y S/14 CDR. SEC. 18, r29N, R 17W, (COUNrY BERN7SEN NAIL) BERN7SEN NAIL) UNPLATTED LANDS OWNED BY OTHERS "tte41111I11~VCE ALL BEAR/N OS REF. r0 rHE SOUrN LINE OF rme SE 1/4 OF SEe. /B, r29N, RI7W, ASSUMED WN 90. 00,00 "W LAU m~W RPHY' Q; Dated: March 23, 1999 0) S 1713 RIVER PALL5,;'Q~ SCALE 200' Wisc. Q 0 50' /00' 200' 300' 400' 500' Ir,, /~r LAND SHEET 1 OF 2 J