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CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Address I�np 1 U Ni ,.. City /State 1� 03 Legal Description: Lot 5 O Block — Subdivision/CSM # '/45 %4 NW , Sec. 2 U4 N -R L W, Town of A,,vs-u PIN # . -7, z9, SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: use a �,b + N) Tank manufacturer We) jef. ? Size ST/PC /goy Setback from: House as Well 6 t P/L So r Pump manufacturer Zoe 1 � e e Model 3 Alarm location 1--u p ov Se (HOLDING TANKS ONLY) Setbacks: Service road Water Line Meter location Alarm locati n SOIL ABSORPTION SYSTEM Type of system: Width 3 Length Number of Trenches Setback from: House o S Well I 0 O P/L a 8 Vent to fresh air intake 5 6'+ ELEVATIONS Description of benchmark I a o S� a �, i�� N Elevation 0 0. D Description of alternate benchmark Elevation Building Sewer ^� ST/HT Inlet ST Outlet _ �o PC Inlet �0�i PC Bottom -> - ( S Header/Manifold U Top of ST/PC Manhole Cover Distribution Lines Bottom of System Final Grade I's, ( j ( ) Date of installation M/ If/jq If/ Permit number 1532T2- State plan number Plumber's signature `�� 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. Teo o I`! u P PLAN VIEW aos 3 (boG 5pI t o Soo y p Sept < 2 CO INDICATE NORTH ARROW 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)). 353252 Permit Holder's Name: ❑ City []Village ❑){Town of: State Plan ID No.: Town of Hudson CST BIVI Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: 1fso "3 r T 020- 1126 -30 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic �- Benchmark Q • 03.8 100 -D Dosing (� 511b Alt. BM d (D. o , O Aeration Bldg. Sewer if Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet ,qo G 4, / TANK TO P / L WELL BLDG. Air I to ntake ROAD Dt Inlet (, g. Air Septic 50 F +- 50 (s r NA Dt Bottom 'a 22.E r ra Dosi ng NA Header / Man. S• 9 `� 4 ? - . TO Aeration NA Dist. Pipe 6•I� `j�, Holding (n� Bot. System. PUMP/ SIPHON INFORMATION Final Grade Manufacturer �°L Dem St cover Model Number) b GPM 4 T Lift - <k Friction � System *F TDH,,, , AZ Ft LQss t. Forcemain Length 791 Dia. H 2 � Dist. To Well SOIL ABSORPTION SYSTEM tq. ( 4- Y N p� 940/ E CH Width , Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME 3 �*� �� DIMENSIO N SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manu cturer: - INFORMATION Type O I i CHAMBER Mo Number- System: ��„�., " Z� 2vo 0 OR UNIT DISTRIBUTION SYSTEM Z ,f ((� •� _ 3 -� 17 , b " ' 3 Header/Manifold tf Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length -�t& Dia. Length Dia. Spacing 7 Zbp 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.) Inspection #l: 12/ Pf/ Qq Inspection #2: -f--4— Location: 368 Krattley Lane, Hudson, WI 54016 (SW 1/4 SE 1/4 7 T29N R19W) - 7.29.19.57 1.) Alt BM Description= 2.) Bldg sewer length = 22 - amount of cover = l$ -I- Se�-Q c�wcr a�o'� -C C1 - _ o•� I=' b s - O Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3197) Date Inspector's Signature Cert. No. I ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ...__.. j ____....,...._..�... W E A t x � i Safety and Buildings Division SANITARY PERMIT A FQIV 201 W. Washington Avenue Asconsin P o Box 7302 Department of Commerce In accord with Comm 83. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the s $te4, on �Pw ptlless C than 8 112 x 11 inches in size. , "� . � �2r., • See reverse side for instructions for completing this appl�lcaljion _. , 5tatt Sanitary Permit Number Personal information ou p rovide may be used for seconds u oses ` 35 A5 Y p Y second p rp ` ' Cox Qgheck it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. { GOUNTY . to Plan I.D. Number ZONING OFFICE X I. APPLICATION INFORMATION -PLEASE PRINT ALL' MATION s'\ Pr perty Own r Name 616 1 L /4-S / T 07Q1 r N ' R /9 E (ono Pro ert wner' ailin Address ) Lot Number Block Number A /� Cit , tate ( //I L 1 L Zip Cod Phone Nu Subdiviissii ameo ber Q I\j II. TYPE OF BUILDING: (check one) ❑ State Owned " !t '' // Nearest Road Public 1 or 2 Family Dwelling No. of bedrooms Town OF Nlsv� Ill. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo D /1 (o — 3o `mod 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. ❑ New 2. X Replacement 3_ E] Replacementof 4. ❑ Reconnection of 5. ❑ Repair of an ------ System System Tank Only 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 210 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12,] Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 []Seepage Pit / i 43 ❑ Vault Privy 14 ❑ System -ln -Fill 3j c Z 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 q. ft.) Props (sq. ft.) (Gals/d y /sq. ft.) (Mi . /inch) �yI Elevation s-8 s Prop 7� - 3o Feet 1 Feet VII. TANK Capacity in gallons Total # of r Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Ma nufacturer's Name concrete Con Steel glass App. New Existin structed Tanks Tanks Septic Tank or Holding Tank I }J ❑ ❑ ❑ ❑ hLIL f Lift Pump Tank /Siphon Chamber — $U(, I $OV J ❑ ❑ I ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu er's (Print) Plumber's Si ature: (No S amps) MP /MPRSW No.: Business Phone Number: 11 01AYWVIX� 0 60 Plumber's dress (Street, City, State, Zi Code): � jkj IX. COUNTY/ D9PARTRAF1UT USE ONLY ❑ Disapproved S nitary Permit Fee (includes Groundwater ate Issue Issuing gent Signature (No Stamps) Approved El Owner Given Initial Surcharge Fee) Adverse Determination a ---- X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL __=4e 1.4� tzi, Le 7PI ' t I SBD -6398 (R. 4/99) 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 licensedpumper 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 Buildfngs•Division, , 608- 266 -3151. - - - - 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. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ill. 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 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. and- Si AZ!M NI! No' M ti L`J , 3 V / l �� !33 ®� 31•IDILF �a�� ��� =�V�'Q Nd�'�Kx 'lop Ba Q MDYL � 1 To � A TftoN vtj. s9 -8 Pou� 3 �V MR P 1�UUYk� T N� CAIIs t. w N ) G ap O HIM f C D C o ca c� c E c ; co N *- M t ca (� O N X to N O ^ cd N E E p ac r X rnc*) cn p C O ca N a CO a 3 _� O a) rO F- O N U L C ( n - 0 -0 ?,� m to C D `m CO •O t) N CL E ca D. _ i c0 rn >��� x cys ��i I n LL O 0 U 0 X :3 O1 — a , F N O to (n . Wisconiin Hof Corm SOIL AND SITE EVALUATION Page 1 of 3 - Drvwron of Sakh► and in accord with Comm 83.05, Wis. Adm. Code Fmriremaaasl Rv r�eci Atlaeh complete site plan an paper not less laden 8%x 11 inches in size_ Plan mast �� include, but not knifed to: vertical and hork=W reference paid (Biro, direction and St Grow[ len;vt slope, scale or , north arrow, and Wc~ and d*U"ve to Wiest road_ Parcel IAS APPLICANT INFORMATION - Please pint all infommWon, t 020 -- 117-6 - 3n - C)IM € vdama60n yw pwwdr may be roar Ow socand�dy pu pm" lr§awary Lawn, a. 16 04 (i) (m)). "+ Dab rwAA- 2 —br 9 1 Properly Owner Property Location SNOW, GREG & DENNISE Gal Lot SW 1/4 SE 1/4 S 7 T 29 N,R l9 W Properly Owner's Maiing Address Lot # N Dock # Subd. Name or CSW 369 KRATTLEY LN 50 Figoe Ridge CRY State Zp Code PhareNumber U City E] VMape MTown Nearest Road Ht&- 'W 54016 386-5979 Hudsm KraUlcy Law New C.orlstrtudion UM R Residential I Number of bedrooms 3 nAddfion to existing busting Reldacernert [� Pubic or ©arrnercial describe Code Ind dad lbw 440 gpd Recornmended dam+ loading rale •7 bed, gpdAF s t enc:l% gpdffe Absorption area required 643 bed, IF 563 teach, iP Madam design loading rate .7 bed, gpdr .8 tendl. 9Pf Reoomllertdediriii min surhoe O ft (as ielen io siie plan bent rear Mdlional design I site amderaion t alerial Laws Over GlscW OutWash Flood elevaion, ft Na ft e for Sin come= Mound In fund Pressure AT - Grade System is FA Wk" Tar* ablefa's�rrt MS 0 u CA S[1 tl ® S CI u M S C1 u [IS M u El S N u SOIL DESCRIPTION REPORT H°nZ°n Depth Dominant Color Matl Texture les Structure gay Roos GPDr Boring# in. Mutlsell Qu. Sz. Coat Color 0% Sz. Sh. lied Trench 1 0-12 1Oyr3J2 - sil 2msbk mfr cw 2f .5 .6 2 12 -26 l Oyr4/4 - sal 2msbk mfr cw 1f 5 i .6 Ground 3 26-34 7.5yr4/4 - is 2msbk mvfr cw - .7 .8 elev .1 4 334-88 " 7.5yr4/4 - gs Osg ml - - .7 .8 Depth to II factor 26/ Remarks: 2 1 0-6 1Oyr312 - sat 2msbk mfr ew 2f 5 .6 2 6-32 10yr4/4 - sit 2msbk mfr cw if .5 Ground 3 3246 7.5yr4/4 - sl lmsbk mfi cw - .4 .5 elev 98.39 tt 4 j 46-88 7.5yr4/4 I gs Osg ml - - .7 .8 Depth b limiting tads 2S.o l0 X88 Remarks: CST Name (Please Prird) Signature: � Telephone No. Thomas C. Nelson 715- 246 -2454 Address Environr cnW By D*p Date CST Plumber Ref# 227387 Z07 1432 120th Street, Never Redmond, W1 54017 i a � PROPERYY ov*iErc; (ikw �&-Dlawww SOIL DESCRIPTION REPORT 2" Page 2 d 3 PARCi& I.D.# Fnvi e lByDcsiga Depth Daninaint Color mom" Struchire Bo� G Hbdaon PDNF in Munsel Ou. Sz. Copt Color Te*n i R Gr. Sz. Sh. 0* EW TwO I 3 1 0-7 1101yr34 A 2msbk mfr cw 2f .5 .6 2 7-22 1 Oyr4/4 s9 2msbk n* cw If -5 .6 Ground elev 3 22-86 7.5yr4/4 n4 cw -7 .8 100.45 ft Depth lo bclor' Remarks: Grand elev Depth 10 --J Remarks: Ground elev Depth 10 WX Ronaft: Ground elev Depth 10 wor Remarks: fKVf �Y 0[51 1432 Ile STREET, NEW RICHMOND, WISCONSIN 713- 246-2454 Tom Nelson Certified Soil Tester 227387 -- Registered Sanitarian SR00713 O Af 2 � 1 i s P i S<Ji nrti+ `� 3 be�r�or� iC -es`+ esreA ce /SCALE V= 0 , Tom Neb /BM 2 7 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer (: rcG 9 a e %U ,J Mailing Address 3(,4 L i Property Address 3 (Verification re wired from fanning Department for new construction) City /State I- UJZ C'1A , Ld C Parcel Identification Number b Lo i f Z 30 — 0 d o LEGAL DESCRIPTION Property Location `,L_ V4, S E V4, Sec. - 1 . T- W, Town of W Subdivision ����� , e- , Lot # 5 O Certified Survey Map # . Volume . Page # Warranty Deed # Volume Page # Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM RECE.NANCE 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 ye expiration date. I SIGNATURE OF APPLICANT DATE OWNER CERTIFI ATION 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 des cri above, by virtue of a warranty deed recorded in Register of Deeds Office. -L uu"M 1 2_/ L /9' SIGNATURE 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 82 PRIVATE SEWAGE SYSTEMS - II PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP - T 4 "C.I. VEVT PIPE WEATHER PROOF APPROVED LOCKING MANHOLE COYER JU BOX Zt FROM DOOR. , r AJCO OR FRESH r F AIR ;ILTAKE GRADE I `I "MIAJ. CONDUIT-/ ONDUIT lb - - - - - -- -- � 11� PROVIDE I - ---- IAJ LE T AIRTIGHT SEAL R7 I I v APPROVED JO!AIT� A I I I APPROVED :DINTS PIPE I III v/ /C.I. PIPE CXTENO PIPE 3' I I ALARM EXT¢AIOIuG 3' II ONTO SOLID SOIL ONTO SOLID SOIL B I 1 I I 0 C LLEV. FT. PUMP - --� OfF D CONCRETE BLOCK RISER EXIT PERMITTED G AJLy IF TANK MauUFACTURC.R HAS SUCH APPROVAL SEPTIC E y SPECIFICATIOUS COSE TA MAMU FACT UR.ER: S:Je��s NUMBER OF DOSES: PER DA.4 TAMK =•!ZE ' 8 ®G G LOUS 005E VOLUME �fp IAICLUDING BACKFLOW: � ea/ GALLONS ALARM MAULIFACTURC.R: 1 A. C MODEL LIUMBCR: „� CAPACITIES: A= 1— IAICHESORJJGALLOAIS SWITCH TYPE: 8 = � !NLHES OR GALLONS Z o PUMP MAAIUFACTURCR: H Q 4 0 C= i ' INCHES =R OP CA -LOAJS J GALLONS MODEL NUMIER: SWITCH TYPE: ul MOTE: PUMP AND ALARM ARE TO DE INSTALLED ON 5EPARATE CIRCUITS MINIMUM DISCHARGE RarE�GPM VERTICAL DIFFi.REAICE BETWEEAJ PUMP OFF AND DISTRIBUTION PIPE.. 03 � EET + MIAIIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . FEET + �+ FEET OF FORCE MAIN X � ,FRICTION FACTOR.. IS" FEET [[ QA TOTAL OtWAMIC HEAD — FEET3S- WTERNA'- DIME.MSIOWS OF TAUK: LENCaTH= 1— :WIDTH �.��L4QLIlD DEPTH SIGlk,�EC: 1 LICCOSE AJUMBZ'R: ^�� "� DATE: I ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the 'IRQg d & S NOL j residence located at: 5W ; , S ; , Section ' I T.� I N, R19__W, Town of JA k05 0 J-J Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: 9 Did flow back occur f om absorption system? Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: / Construction: Prefab Concrete V Steel Other Manufacturer: (If known): It w, Age of Tank (If known) : (*h ��riJ �ti V a I r*N UGLk1h41-41WT (Si nature) (Name) Please print n�p�fi,n VIL�,-6n Q0 Al t {� �� a - Aa9 ( (Title) (License Number) as 4 Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name M yh�L 1Yt S ignature c• MP /MPRS � q DOCUMENT No. I STATK SAR OF WISCONSIN — FORM 2 d 1 WAR,4AtM DEED ='� (, 6 49 9 j, , t 5y 5 THIS SPACE RESEnvEO FOR RECORDING DATA v REGISTERS OFFICE � ae F. Miller, a single person ST. CROIX CO., WIL Rec'd. for Record this 29th convoys and warrants to G r e v o r v Q . Snow and day of J ^ ulY AA 19j Denise C. Snow, husband and wife as t Md joint tenant N t)ssis KT To Gregory D. Snow the hNlowing debt r1 real estate In Sr- Croix County, 1273 Quinlan Ave. S. State 01 Wisconsin: St. Croix Beach, MN 55043 Lot 50, Eagle Ridge in the Town Tax Kay No. of Hudson, according to the plat thereof on File and of record in the office of the Register of Deeds, St. Croix County, Wisconsin. >xa This i s n o t homestead property. I(si(is non Exceptiontowarranties: Existing highways, easements, rights of way and restrictions of record. Dated this — day of Jul tg 82 (SEAL) (SEAL) • - Sam E. Miller (SEAU _ (SEAL) • AUTHENTICATION ACKNOWLEDGEMENT Signatures authenticated this day of STATE OF WISCONSIN St. C roix County. Personally came before me, this y day of July ,tg 82 TITLE: MEMBER STATE BAR OF WISCCNSIN (If not, the• above named authorized by $ 706.06, Wis. Stats.) Sam E. Miller . a i P a /. This Instrument was drafted by - : 4 : A T C " Atty. David J . Estrppn _ to me known to be the per�going in. 619 2nd Sc.. Hudson son, W I 54016 so �e s)I4 • strument and acknowled e. Asti �•.•' (Signatures may be authenticated or acknowledged. Both are not ~KV1.0 A. H3CH ' necessary.) Notary Public- State of 'r: j•rnn.tw Notary Public My Commissicn Expires June 17, 19a4 County, Wls 'NarMa OI persons signing in any capacity meal be typal or printed eNOw tMY aipMiwaa. My Commission Is permanent. (If not, state expiration data: , tg .) WARRANf'y GEED — STAT €"A�O9WtSC6N31�'1, —j StoCc V No. — f 302 �M N 4 7 h 1 Z g� = 1 .59 ACRES o 48 0 2 N 66 ° \2 A 0 2 '� ` 4p4 /8 0. , 1.39 ACRES I ` AO 62 °10 99 °04 55 <k 2 ` 3 1 o S co Ls Ck A ��, 1 1.82 ACRES 101°402 0 89 °4105 QP 0% `Sa, 1.80 ACRES s em u' j 12 1.09 ACRES 6� 9 5 1 ° °- 87°24'35'2� 2s � 1.98 ACRES 3� 2ckee � eo , 3 9 be 2 6 p 730 20 1 30 <1 �r � - 6 0. 98 ,co 0 0 0 ,gyp % 90 1.49 ACRES pb ° N 75° ° tv 106 9� �� 3 0) 36 0p 2 , 1 h6 OZ . g g• ° C O ° c w b uL °O 600 6 ��° ms s. 8 u' 103°53 2.32 ACRES 2.23 ACRES \y � .0�, S 2 s,, •0�, < �° c O , S� - t O N ry OM I `%' -P 10- 0015/10 -0016 The alarm package features a six inch double magnetic bell with either 115V/8V or 230V/8V transformer for mounting on a standard Alarm P utility box. The A -Pak is used in a duplex Mechanical Alternating System. When the A -Pak is utilized in a simplex system, 10 -0225 - Mercury Sensor float Switch is needed to actuate the alarm. Utility box is not included. UL listed components, CSA approval available. 10 -0053 "A -Pak" Alarm System consists of metal panel with light, horn, sensor float and water proof cable splice kit. 120V/12V, NEMA 1, UL listed and CSA certification on entire alarm system. 10-0028 (115V/1 Ph) "A -Pak" Residential alarm system features a 2 bell with 115V /BV, NEMA 1, 10-0015/10 -0016 transformer for mounting on standard utility box. Includes mercury sensor float switch to activate alarm. 10 -0053 I N ( HEAD /CAPACITY CURVE W SEWAGE and DEWATERING WARNING: Model 293 should not be subjected to less than 15 Net TDH. Y4 SO 75. 22 MODEL ' 70 295 - 20 65 ul MODEL i H 1, 18 60 294 >< V 55 115 t - -- - -- - - - -- - 18 50 110 --+ - -- -- - -- - -- - 14 1 MODEL 32 105 - --- - _--�-- I - - -- - - F 12 40 293 - I 100 -- - - -- �- - - — 35 30 10 95 30 8 28 90 _ — 25- - MODEL 6 20 202 _ MODEL �` 15 1 24 SO 10 MODEL MODEL 2 5 262 MODEL MODEL 75 169 286,267,2118 284 c 22 0 t 70 GALLONS /0 20 30 10 50 80 70 80 90 100 110 120130 140 150 160 170 180 190 200 210 220 230 20 85 MODEL LITERS 0 80 ISO 240 320 400 480 500 640 720 800 NO V 165 2: • 10 FLOW PER MINUTE � 55 r1 NODEL h ' ~ 18 163 MODEL - 1 188 j 14 45 _ 12 y 40- HEAD /CAPACITY CURVE 10 3s EL EFFLUENT and DEWATERING 165 WARNING: Model 185 should not be subjected to less tlwt 30 Net TDH. ; 30 MODEL 11 137, 139 _ 4 i 25 � S 20 MO EL 4 15 _MODEL 1St �.....' 1S 97 0 MODEL ~ 2 5 57,SS �' Z Aq1ZZ i; i TAT. GALLONS 10 20 30 40 50 SO 70 80 80 100110 120 130 140 150 180 3280 Old MN m Lags LITERS 0 so 160 240 3N 400 469 560 60 P.O. BOX 18387 FLOW PER MINUTE - Loulsvift Kwiftnky 40216 111 (602) 778-2731 v } Product information presented here reflects conditions at time of publication. Consult factory regarding discrepancies or inconsistencies. HEAD/CAPACITY CURVE HEAD CAPACITY CURVE EFFLUENT M Emm ®m ®��m��� ®� ®� m ®mmm�0 ®m�m�m ®mmm ®.��o����m�� ■ \ �� I ® a�mmmm ® ®imm ®mmm ®m ®0 ®��o� ®m ® ® ®� JIM mm 1111110M IWO loom I RIE1111111=11111101111 =1118111 mm -,'snI not be subjected to less than 30 feet TDH. NOTE: For Head Capacity on Model 112, Industrial �� a� one rrr I LI 0 all 411a MEN 141 ME N\9 11`.� IS 0 \AMEN Oki NII1■ 1►\ No NEW 0 M HEAD CAPACITY CURVE SEWAGE • © ®o ®�omomo ®om�mmmommm ®�,� © a I NS NONE a OEM a ONE w IQ MEN 0 Na SMSM, 15 feet TDH 10 S ®�. ®oomo.00mmmmmm ®mom ®memo • ������,���� No , 1 1 6v �6X., 0 a rk I q1_ all 0 MEN MOM • AS BUILT SANITARY SYSTEM REPORT OWNER u r l l ^ N TOWNSHIP SEC . _TIN -RJW ADDRESS 7_�' v K f r o ( ST. CRO IX COUNTY WISCONSIN. SUBDIVISION_ a r e? LOT a LOT SIZE r PLAN VIEW Distances and dimensions to meet requirements of H63 RHOU THING WITHIN 100 FEET OF SYSTEM FT G I di a e Fo#hl A ro I SM U: : BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: 60 Slope at site: �7, SEPTIC TANK: Manufacturer: - Wt Liquid Capacity: /G D0 Number of rings on cover : Tank manhole cover elevation: Tank Inlet Elevation: ti .S— S—y Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cycle gallons; total capacity o distribution lines gallon: size of pump head; gallon per minute horsepower brand name of pump and model number ; Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: - Number of pits feet diameter feet liquid dept` seepage pit in e� t pipe - elevation bottom of seepage p ^ it evation feet. SEEPAGE BED SIZE: number of lines width 2 length'�gtile depth_J_L� SEEPAGE TRENCH: width length PERCOLATION RATE 0--AR RE UIRED 1 Z RE S INSPECTOR DATED PLUMBER ON JOB LICENSE NUMBER MP t Q 7 tz, c 4LP' + f S G C l °a I I � I r DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABO & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. B X 7969 BUREAU OF PLUMBING MADISON, WI 53707 ( CONVENTIONAL ALTERNATIVE State Plan I D. Number: (lf assignedi El Holding Tank El In-Ground Pressure El Mound NAM�PERMIT HOLDER: R ESS OF P MIT HOLDER INSPECTION DATE: I i �-( gZ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FRO PLAN: ` REF. PT. LEV.: CST REF. PT. ELEV.. IS c �S '1 1 �o Name of Plumber: MP PRSW No.. County: Sanitary Permit Number: SEPTIC TANK /HOLDING TANK: MANUFACTURE t LIQUID CAPACITY: TANK INLET ELEV. I TANK OUTLET ELEV WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: • YES ❑NO ❑YES ONO BEDDING: VENT DIA.. VENT MATL: HIGH WATE A PROPERTY WELL: BUILDING VENT TO FRESH ALARM. �'" LINE � � AIR WLET: YES ONO ❑YES ONO OSING CHAMBER: MANUFACTURER BEDDING'. LIQUID CAPACITY PUMP MODEL. PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OYES ONO ❑Y ONO I ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL'. PR OPERTV WELL. BUILDING. VENT TO FRESH s LINE. AIR (DIFFERENCE BETWEEN PUMP ON AND OFF) ❑YES ONO SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing y P LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) CONVENTIONAL SYSTEM: "^� WIDTH LENGTFf NO. OF DISTR -PIPE SPACING. COVER "a' INSIDE DIA - #PITS. LIQUID s � • / TR EN � M Iy�A I x 7 j DEPTH: rvx €•d BELOW PIPES ABOVEEC DEPTH ELEV INLET ELEt/ END DISTR. PIPE MATERIAL: P DISTR PROPERTY WELL: BUILDING: AIR NLO�RESH po MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES El NO SOIL .`OVER. TEXTURE. PERMANENT MARKERS. OBSERVATION WELLS. YES ❑NO ❑YES ❑NO ❑ DEPTH OVER TRENCHBEO DEPTH OVER TRENCH/BED IL DEPTH OF TOPSO. SODDEO SEEDED. MULCHED. CENTER EDGES: OYES 1:1 NO 1:1 YES ONO 1 YES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH LENGTH. NO. OF LATERAL SPACING. JGRAVELFE �FTZT E. W PIP FILL DEPTH ABOVE COVER. TRENCHES: T = =, MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.'. ELEV. DIA. ELEV. PIPES: DIA.: .% HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. ❑YES ❑NO DY ES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: PROPERTY WELL: BUILDING: LINE: 1:1 YES El NO OYES El NO Sketch System on Retain in county file for audit. Reverse Side. SIG ATUR TITLE: -� DILHR SBD 6710 (R. 01/82) 4 �I lam? DEPARTMENT OF APPLICATION SAFETY &BUILDINGS INDUSTRY j FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/Z x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: ((Pr I Tdut iBro ' W ; ✓``9�O1� Property Location: QWA Township: County: F— %a 5f %aS 7 iT�1 N/R I N .51` t✓�'ol � Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: ro 4 1� t� P ICr a C O A (� ((f assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: P'Tor 2 Family * State Approval Required. 3 TOTAL NUMBER ­PREFAB POURED -IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TAN) S CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY QOQ N HOLDING TANK CAPACITY LIFT PUMP TANK /SIPHON CHAMBER MANUFACTURER: i. EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): 96hlew ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit 4 C ❑ Alternative (specify) ❑ Seepage Trench We Sypply: - Owner's Name as Listed on Soil Test Report If other than present owner): Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Sture: MP /MPRSW No.: Phone Number: roA6 cn a - Z af7) 3233 Plum er'i Address- Name of Designer: N OW 9 1 c4 M ,9 Flo' COUNTY /DEPARTMENT USE ONLY SignatuFfe of Issuing ge t: Fee: ^ Date: APPROVED Sanitary Permit Number: Mz& ( I d ; ft UTJ ��/ ❑ DISAPPROVED D �L eason for Disapproval• Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White- County, Canary- Bureau of Plumbing, Pink- Owner, Goldenrod- Plumber DILHR -SBD -6398 (R.07/81) } A R l l � S 40 N Q Ca R \ CA �U r � Q I T rr u --k- sn 0 T. T r EPARTMENT OF REPORT ON SOIL BORINGS AN ki �� BUILDINGS D TRY,e DIVISION � PERCOLATION TESTS (115) D I W 1 5 °N RE °ATIONS MAy l BO X 3707 1 ; 3707 IOy LOCATION: SECTION: TOWNSHIP/ LOT NO. BL : SU ON NAM .� ( COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: s� X114 , , cs, -S va /b/' USE DATES OBSERVATIO MADE y EDRMS.: COMMER�lAL DESCRIPTION: I� NS: E -� p ESTS: 713 e ce �CYNew ❑Replace I 1_ _ 2 r ea fro "t � S`� O RATING: S= Site suitable -kr sys m U= Site unsuitable for system df � fbv aoc L IONVENTIONAL:, MOUND: U RE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) M S DU OS I IN-GROUND-PRESS Z S ❑U DS R U OS Xu vlisl�e ° os If Percolation Tests are NOT required DESIGN RATE: S T 4 If any portion of the lot is in the under s.H63.09(5)(b), indicate: �(,�� 40 Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 /00 41V s ,BI TS .2" ShC1, ya„ 8 Sl 16 " 407 /s B- - o " /6x' A44 /o 9 P or, /a" ,g/ IM Awl g C / 'y s/ d e4 / B -3 `/6" /0/ l6" 16 `' I rs 3 .2 " eh c / yo,. s/ ''' /s / ,u� /of 7 l n " 8 C / .?Y" &I S 139" Bh /S B- - a •\,� , PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P - If A –3 .Z � –f P- a A,Lo - 3 0 / 30 P- m„ 0 0 3 O P P- P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. R �� 4neif /4r G4 �'Lau.47�s`v�v S 97.5' SYSTEM ELEVATION 6' 7` -� w.// do Atce.•dh4� ro )►,C P44 aP41t4j `e ANDS . (',s� .. . 1_ a r 4o .... CA WPROVED 9 • 7Q /. Date_ 5`�G 6 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ,R - 30 - ,Z ADDRESS: CERTIFICATION NUMBER: IPHONE NUMBER optional): LL e &e � o C 7` 6- CST TUBE: ., ION: Original -Local Authority, 2nd page- Bureau of Plumbing, 3rd page - Property Owner, 4th page -Soil Tester. , 6395 (N. 03/81) – .f L Art