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020-1346-70-000
n cn o K 2? tz 6 [ \ ) § 0 " ] ° # -0 n $ $ \ k 7 � k rr E 0ƒ E / 7 o�£ \ \ m , \ \ } \ ? \ / / \ \ / ° \ o \ \ \ / ƒ G ) § \ % 3 \ E } a § I § CO 7 2{ƒ i E m / 2 / (n { o o / 122 \ eyG 8 \ \ } / + $ E cn Q c ° : 3 o J. CD , _ * * I I C. § § C) '1 § o 7 2 E 0 / G � ; CL { 7 f z .. ' \ \ \ > 7 0 C) � 2 . 8 / ƒ / m § �\ f 2 § . ` 0 N of t \ w \ CD _ I / ) k k } o / ƒ E . � � .. $ § E § { z o = a { I z \ * 2 ® I > I } / § � e \ -n 41 0 % § ƒ F � � $ � a � ® I / CD \ / o w % § \ \ 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 - 7 c. Hr�? ® TC 1-4 i �y 4 At1- ` X31 �� � F i IVRT� W 4 _ 4 fWV.r . 3 b 'INDICATE NORTH ARROW i ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner lr /P / L L rle Property Address /Oo 9 L,&Ae&C City /State h k 4 3 a Al U/ Legal Description: Lot . 2 Block Subdivision/CSM # _/Zf &Lf Sec. /� Z , T 7 N -R , li� / Town of /4, �O Al PIN # © Zo - 70 " SEPTIC TANK OSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer Size ST/PC rem/ Setback from: HouseaL, Well 4 S P 9 Pump manufacturer Model Alarm location -° (HOLDING TANKS ONLY) Setbacks: Service road — - Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: LE Inc i Width 3 Length � � , Z5 Number of Trenches . 2 — Vent to fresh air intake 3 I P/L S t S Setback -from: House t —L Well �f �. � Ve ELEVATIONS Description of benchmark ' `� ���� �� /(� Gam` /� �` -L Elevation 1Da� 00 Description of altemate benchmark 134 EM E /0 D oy2 s /L.L._ 'Y, 9 7 Elevation „ 33 1 PC Building Sewer ST/HT Inlet ST Outlet '13 1 r PC Inlet PC Bottom Header/Manifold 7 ' f p'of ST/PC Manhole Cover Distribution Lines( I) fif 14 Bottom of System Q) = (Z-) T LM- 9 1 7 ( ) to Final Grade (C ),S YP (11) Z So' `q� ( ) Date of installation 3 /I / ?f Permit number 3 Z 'a State plan number Plumber's signatur� fit.! t -t - .. - License number 2 Z -� (c Date Inspector Complete plot plan a 6 V Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safeiyand�uildingsDivision ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary:3241" Personal information you provice may be used for secondary purposes [Privacy La)(, s.15. (1)(m FffFL a r'sgAN: EMD"lage ❑ Town of: State Plan ID No.: CST BM Elev. z Insp. BM Elev.: BM Description: Parcel Tf('�JA. ^ 1346-70-000 TANK INFORMATION ELEVATION DATA A9900032 3/ 50 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (�C,��'�3ef � rr1 Benchmark .ZO /ejd Dosi n 4--- Aeration Bldg. Sewer./ Holding St /Ht Inlet TAN'k SETBACK INFORMATION St / Ht Outlet 7, S 76-/ TANK TO P/ L WELL BLDG. Air I ntake ROAD Dt Inlet ir Septic p �3 2f1 i NA Dt Bottom Dosi `°" NA Headers -- 7 g5 9� c`r Aeration A Dist. Pipe Holding Bot. System 9� �3 &5 PUMP/ SIPHON INFORMATION Final Grade s,50 y'77rj' M rer Demand t ' `r 57 g,;, Mode Number v _ GPM TDH Lift n em TDH Ft oss ea ForcernAln Length Dia. t Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of j enches PIT N Inside Dia. Liquid Depth DIMENSIONS I dTMrN4QNS _ SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREA �,. INFORMATION Type Ot 44". / BER Model Number: System: edr DISTRIBUTION SYSTEd Header/Manifold �! Distribution Pipe(s) x Hole Size x Hole S o Air Intake Length Dia. Length i Spacing SOIL COVER x Pressure Systems Only xx Mound Or rade Syste Depth Over Depth Over xx Depth Q+ xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges To rl ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ' ? >`' LOCATION: HUDSON 11.29.19.1860,SE,SW 1009 LABARGE RD —HOM TEAD OT 17 • ' , �. h- ,{...� �- C.�- ;' �p•k 'Tart,., e l r Plan revision required? ❑ Yes al-No 1 2-9 �f Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert . No. ti ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ., ... .... �.�_ _ ,. ° : ...m,�a.m... E ^ s b , r x 3 ^ F h Q } y , 5 2 e E , . w i { s f a i E I § ........... 0 ,.am ,e e .,�...,. ,.. , ws .... . ..� _ .g , .... ..... € e f E a »�,��I € S € E S F t 2 t r � 2 � ....m....... E ^ 4 e s E �.�...._. ...... ,:. ¢ .... ...gyp- ..,,.. .,m. ._.__...... �........... , . r . s _.... . .. .._.. ,... _ �. € .. m. .. F E R t �..,, �.....e.� �...-. �.., ...r ^. ^.,... _,� .�. ,,.> , and E a j E F a 3 a �.. _ - i r m.,, se� ,.�.� sa.e, .,_., t � .. .m. a y a E m R� mmme hem . ^..�.., ®� . r q.. s SANITARY PERMIT APPLICATION Safety and Ave Avenue ' Vi sc6ns i n 201 W. Washington In accord with ILHR 83.05, Wis. Adm. Code P 0 Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number � Z # 7 Oho Personal information you provide may be used for secondary purposes Ch k if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. tate Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prop Owner Name / Property Location 1 ! �, 4.1 OL , 5F 1/4 W /4, S / T Z , N, R 9 E (o Pro erty Owln :s Mailing Address Lot Number , Block Number ''�F - ° City, State a2 Phone Number Subdivision Name or CSM Number O W 1 ( z9vZ7629 .L r II. 4 1 " P l Ee 0 F B U I L DING: (check one) ❑ State Owned 0 C Nearest Road , J �f Public 1 or 2 Family Dwelling ❑ Vil age - No. of bedrooms 3 Town OF (/ /T III BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) t '`� 1 E] Apartment/ Condo o �d ( �+ 70 r, o!!� P40 ev 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. E] Replacementof 4 E] Reconnection of 5. ❑ Repair of an System ________ System_____________ Tank Only______________ Existing System ____,___ Existin 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 Seepage Trench /�/Qt 'i`� ,gJ02 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 Seepage Pit go ENYI ed C 0fte, �.�' 43 E] Vault Privy 14 ❑ 1 System -In -Fill -[ 3v-/ W4Q 11 <-- 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 (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation / ( S0 Z,,,,, 0 4* - � Feet 141 Feet VII. TANK in Ca gallo acct s Total # of Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Existing strutted Tanks Tanks so Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installa of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) 9 1MPRSW No.: Business Phone Number: - o .s"z -L Z�-SD 3 - S Plumber's Address (Street, City, State, Z!'k Code): IX. COUN Y (D PARTMENT USE ONLY El Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued M issuing A ntSi ( mps) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASOWS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber R TI N INST UC O S , 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 -3161. 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. YP 9 9 Y P Y . 9 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 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. "�y. .Sl'L `,t� 7 `° ,�" s y s7",�in /, 9,� , ' 7A ii V S j C' t-' 3 -z3 - -� E asy Step ■ Excavate trench to required width and depth; level surface. Clear away any large stones or roots. Scour sidewall areas, if necessary. ■ Install EnviroChamber units on trench bottom and snap together ■ Install end plate and distribution pipe (pipe does not extend beyond end plate). ■ Complete backfill operations. See EnviroChamber unit Installation Instructions. This product is solely intended for the conveyance of fluids. Access into this product for mointe- nonce, inspection, or other reason should be done in strict accordance with OSHA recommendations for confined space entry. Configur Trench Bed ,I ad ,4 l C ompare Envir Adva 1 1 I / • NO Diffuserlm Unit 1 1 ' Ch l Size 12 11 x34 "x75" 12 "x34 "x75" 11 "x34"x75" o Sidewall 8 +33% 6" 6.5" Z Capacity 87 gal. +13% 77 gal. N/A H Invert Height 8 +14% 7 6.5" Size 17.5 "x34 "x75" 16 "x34"x75" 14 "x34 "x75" Q Sidewall 14.5" +32% 11 " 9.5" Q Capacity 138 gal. +13% 122 gal. N/A Invert Height 14" +27% 11 " 9 'Compared to Infiltrator chambers infiltratorTM is a trademark of Infiltrator Systems Inc. Bio DiffuserT" is a trademark of PSA, Inc. V /�N Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Emironmental By Design Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. — Parcel I.D.# APPLICANT INFORMATION - Please print all information. Reviewed By Date Personal irfformation you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). 1 Property Owner Property Location Miller, Sam Govt. Lot SE 1/4 SW 1/4 S 11 T 29 N,R 19 W Property Owner's Mailing Address Lot # I Block # I Subd. Name or CSM# Troutbrook Road 17 - Homestead City State Zip Code PhoneNumber [J City ❑ Village �JTown Nearest Road Hudson W1 54016 Hudson Labarge M New Construction 17 Residential / Number of bedrooms 3 ❑Addition to existing building F- Replacement f-1 Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpdff 8. trench, gpdfff Absorp area requited 643 bell, fF 563 trench, fe Maximum design loading rate •7 bed, gpdfftz .8 "i bb, 90dff Recommended infiltration surface elevation(s) 93.7 It (as referred to site plan benchmar Additional design / site consideration This is an amendment to the original soil tests as there was a need for a deeper system t Parent material Loes s Over Glacial Cutwash Flood lain elevation, if i able Na tr ble for system Conventional Mound In -Ground Pressure AT -Grade System in FBI Holding Tank itable for system S I u ! s rl U I ! S rl u I !— S u n S U !-! S u SOIL DESCRIPTION REPORT De DominarYl Color Mottles Structure GPDff Borin Horizon I � I I Texture I Consistencd Boundary I Roots I 9# in. Munsehl Qu. Sz. Cont Color G oun r. Sz. Sh. Bed Trench 1 1 I 04 I 10yr4/2 I - I sil I 2msbk I mfr I e. w I 2f I .5 .6 2 j 4 -19 7.5yr5I6 - s Osg ml ew If .7 .8 Ground 3 19 -25 1Oyr5 /6 - s Osg ml cw - .7 .8 elev 98.61'ft 4 125 -1021 7.5yr5/6 I - I s 1 Osg I nil 1 - - I .7 .8 Depth to I I p limiting factor I I I I I I I 1 >102 Remarks: 2 1 1 0 -13 1 10yr4 /2 I - 1 sil 1 2msbk 1 mfr I cw 1 2f I .5 .6 2 ! 13 -33 10yr6/6 - sil 2msbk tt�.fr cw if 5 6 Ground t 3 33 -140 7.5 5/6 - s Os ml - - r elev I I I I I g .7 .8 101'81 ft Depth to limiting rI factor >140 Remarks: CST Name (Please Print) Signature: 4 Telephone No. Thomas C. Nelson 715- 246 -2454 Address Environmental By sign Date CST Number Ref # 1432 120th Street, New Riclmiond, Wl 54017 3/23/99 227387 210 'PROPERTY OWNER: Miller, Sam SOIL DESCRIPTION REPORT 2,o Page 2 of 3 PARCEL I.D4 Environmental By Design Horizon Depth I Dominant Color I Mottles Texture Structure bonsistencel Boundary Roots GPD/fF I in. I Munsell Qu. Sz. Cont Color Gr. Sz. Sh. I Bed Trench 3 I 0 -10 I Oyr4 /2 - sil 2msbk mfr cw 2f .5 .6 2 10 -17 , 10yr6 /6 - I sil I 2msbk mfr I ew 1f .5 .6 Ground elev 3 117 -98 7.5yr5/6 - I s Osg I ml I - - I .7 .8 98.31 ft Depth to I I I I limiting favor I I I I I I I I I >98 I I I I I I I Remarks: I I I Ground elev I I I I Depth to limiting factor I I I Remarks: Ground elev I I I I I I Depth to I I I I I I I I iiniting factor i i i i ► i i i i Remarks: Ground elev Depth to limiting factor Remarks: f E NV190 NM E NTM BY D E 51GN 1432 120th STREET, NEW RICHMOND, WISCONSIN 715- 246 -2454 PROJECT NAME HOMESTEAD �`� r ' PAGE 3 DESCRIPTION SE '/ SW '/+, SECTION 11 T 29 N, R 19 W TOWNSHIP Hudson COUNTY St. Croix Wisconsin v �S eo acre C`J \ "4_ - 6 F 6�1 [G&IT Ur �, SCALE 1" = y n Tom Nelson BM 1. L — o ff' CvfLn e 91 1 00 T P �'F 227387 BM 2. ��se o� Frei 9 7 50 � y SANITARY PERMIT APPLICATION Safety and Washington Division ' N*I scons i � 201 W. Washin ton Avenue r with l q P O Box 7302 Department of Commerce In acco w t LHR 83.05, W IS. dm. 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. S • (rip • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes���l E] Check if revision to previous a (cation [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name Property Location Am fm I L.L r/2 1/4 1/4, S /1 T �7 , N, R/ E (o Property Owner's Mailing Address Lot Number Block Number ..� City, State Zip Code Phone Number Subdivision Name or CSM Number w oN w► s o J9 ) 2 0 4 Ill. TYPE F B ILDI : (check one) ❑ State Owned 0 Cit Nearest Road Villae Public 1 or 2 Fam Dwelling- No. of bedro 3 Town OF U(�S 0 � (A jT i41t 4 r PJ), III. BUILD( USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1I. . I q . &0 1 ❑ Apartment/ Condo L e_ ZO ` / 3 y (, - 70 40 C? O 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. ❑ 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 g[Seepage Trench LBACW TRFNg2 [] In-Ground Pressure 42 C] Pit Privy 13 E] Seepage Pit 91 / N F11 TR N"rV ti t 1if ZS 43 ❑ Vault Privy 14 ❑System -In -Fill '3, I t SGtF? S/D w /N� � to 1Ii;./4 Gf4 *A-c tTy V ABSORP 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 (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) g Elevation, K S fi �•- , $ ��* Feet g''s Feet acit VII. TANK in Cap llo s Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con Steel glaze Plastic App New Existin structed T nks Tanks Septi rrarrk• X (000 (.l>1! l S£2- ® ❑ ❑ ❑ ' ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: AD Sta ) MP /MPRSW No.: Business Phone Number: /W/iit-E DONF�L 0.35 38'lv-$(o f Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/ DEPARTMENT USE ONLY [:]Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing nt Signature (No Stamps) (' , Approved []Owner Given � �� � Surcharge Fee) � V Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber s. 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: 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. 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 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. � o Ca �' p W A rVN a 'w*l o -� N Orj m � ; j eo © tt vu, 1 CA ILA f 7b, z� w P r 'N b � u : --4 4i t 7k tr Qu r - 0 ILI Q / y R► 1' J rp �A � yt� p Z h t� 0 4 fl I M N >. cc '0 -C Q J x co 5 w c a -a � x a, o o cu C\J Q u CL U ° co r E a aa) a� J O c o 0 a - F- co A �' C�"1 o a x a' o a Q n mro >= 113 c' >. Q i x m cn p c U C p:3 \ M N> O > a) Q O J N u— E O S = U 'C 0000 v; t , a _ LLA 1 W I i oc 'Q y / C N C V a o $ 1 v C' :.t _ E 8 co W z co a 3 O �, t Cl) (� E • • Q vJ o .� n cp 9 C o� V cc m o �o O ° Q Cl- CO 3 C co C \ j CL W� W cz T °' y Fn cc "T J r Wisconsin Department oftommeroe SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Environmental B Design Attach complete site plan on paper not less than 8'/z x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimemsions, north arrow and distance to nearest road. Parcel I.D.# n� '''fit APPLICANT INFORMATION - se`pri .��itg afron. Personal information you provide may be u far secondary .p os ( cy a. 15.04 (1) (m)). F vie By Ate / q Property Owner _., » - _ Property Location MILLER, SAM -- Govt. Lot SE 1/4 SW 1/4 S 11 T 29 N,R 19 W Property Owner's Mailing Address 1:998 �- -, Lot # Block # Subd. Name or CSM# TROUTBROOK RD ST CkOix "' 17 Homestead City SVIe. Zip CodePWW&Iumber E] City ❑ Village ® Town Nearest Road Hudson 2 ON 1 > 02.4 Hudson Labarge New Construction Use:' 'elniai'tll� bedrooms 3 ❑Addition i0 existing building ❑ Replacement Pub I rcial describe Code Derived daily flow 450 gpd Recommended design loading rate •7 bed, gpolfts •8 trench, gpd/fP Absorption area required 643 bed, ff? 562 trench, ftz Maximum design loading rate •7 bed, gpd/ft? .8 tr ench, gpd/fF Recommended infiltration surface elevation(s) of ts • S o It (as referred to site plan benchmar Additional design / site consideration This is an ammendment to a report that was done on 8/18/98 Parent material Loess over outwash sand Flood plain elevation, if applicable NA It S= Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in fill Bolding Tank U= Unsuitable for system ®S El ®S ❑ u ❑ S® U 11 S® U ❑ S Nu El S U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure BoL y Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -4 10yr4 /2 - sil 2msbk mfr cw 2f .5 .6 2 4 -19 7.5yr5/6 - s Osg ml cw if 7 .8 Ground 3 19 -25 1Oyr5 /6 - s Osg ml cw - 7 8 elev 98.61 ft 4 25 -65 7.5yr5/6 - s Osg ml - - .7 ; .8 Depth to limiting factor >65 Remarks: 2 1 0 -13 10yr4 /2 - sil 2msbk mfr cvv 2f .5 .6 2 13 -33 10yr6/6 - sil 2msbk mfr cvv if .5 .6 Ground 3 33 -96 7.5yr5/6 - s Osg ml - - 7 8 elev 101.81 ft Depth to limiting factor X96 0 Remarks: CST Name (Please Print) Signature: Telephone No. Thomas C. Nelson 715 246 - 2454 Address Environmental By Design Date CST Number Ref# 1432 120th Street, New Richmond, W1 54017 9114/98 227387 60 PROPERTY OWNER: MM ER S AM' SOIL DESCRIPTION REPORT ® Page 2 of 1 3 PARCEL I.D.# ' 113Y Design Depth Dominant Color Mottles Structure GPD/fF Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. nsistence Boundary Roots Bed ; Trench 10yr4/2 - sil 2msbk mfr Cw 2f .5 .6 3 1 0 -10 2 10 -17 10yr6 /6 - sil 2msbk mfr Cw if .5 .6 Ground elev 3 17 -69 7.5yr5/6 - s Osg ml - - .7 .8 98.31 ft' Depthlo limiting factor ?69 rj � Remarks: Ground elev Depth to limiting factor Remarks, Ground elev Depth to limiting factor -j Remarks: Ground elev Depth to limiting factor l Remarks: ENVIgONMENTRL BY DE51GN- 1432 120 STREET, NEW RICHMOND, WISCONSIN 715 -246 -2454 PROJECT NAME HOMESTEAD PAGE 3 DESCRIPTION SE % SW %, SECTION 11 T 29 N, R 19 W TOWNsmP Hudson C St Croix Wisconsin eD acres C`J h d� Qg a SCALE 1" = yo Tom Nelson BM 1 I.._ of C.votn ea I o I op oYlf� '1ut�k _` ro Sv�v iii( �,1pe, , 2273$7 BM 2. �c.S'e of �f 'I Wisconsin Department of Commerce' SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Environmental By Design Attach complete site plan on paper not less than 8'h x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix _ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION - as pint 'formation. Rev' wed ey Date Personal information you provide may ba fbr secondary pJ cy Law, s. 15.04 (1) (m)). f (. Property Owner �, Property Location K MILLER, SAM - '� ` �'e� Govt. Lot SE 1/4 SW 1/4 S 11 T 29 N,R 19 W Property Owner's Mailing Address r f Lot # Block # Subd. Name or CSM# TROUTBROOK RD f 17 HOMESTEAD City State Zip Oddi "eNumbq ' ❑ City ❑ Village ®Town Nearest Road Hudson VII `' r - 9 Hudson LABARGE Z New Construction Use: � f bedrooms 3 ❑Addition to existing building Replacement 0i c rh lal describe Code Derived daily flow 450 gpd Recommended design loading rate 2 bed, gpolfP r. Z trench, gpd/ff Absorption area required 3 7 f bed, ft 7f trench, fP Maximum design loading rate r - bed, gpd/f 2 /- 2 tr ench, gpdVft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmar Additional design / site consideration Parent material Flood plain elevation, if applicable It S= Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ❑ S ®U ® S ❑ U ❑ S ®U ❑ S H U [IS ®U ❑ S ® U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure Consistenc Boundary Roots GPD/ftz Boring# in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench l 1 0 -36 10yr2 /1 - sl Imsbk mvfr cw 2f .6 2 36 -51 10yr4 /3 - sl Imsbk mvfr cw if Ground 3 51 -61 10yr5 /3 - sil 2msbk mfr cw - 5 6 elev f_ 4 61 -84 7.5yr - scl Impl mvfL np np Depth to limiting factor 61' Remarks: Z 1 0 -48 10yr2 /1 - sl Imsbk mvfr cw 2f 5 k 2 48 -56 10yr4 /3 - sl Imsbk mvfr cw if ,S '� -Cf Ground 3 56 -67 10yr4/3 - sil 2msbk mfr cw - .5 .6 elev 4 67 -72 10yr3/3 f2d5yr6 /4 sil 2msbk m - - np np Depth to limiting factor 67 Remarks: CST Name (Please Print) Signature: Telephone No. Thomas C. Nelson `� 715- 246 -2454 Address Environmental By Design' Date CST Number Ref # 1432 120th Street, New Richmond, WI 54017 8/19/98 227387 62 PROPERTY OWNER: MILLER, SAM SOIL DESCRIPTION REPORT ® Page 2 of 3 PARCEL I.D.# Envuo ental By Desi Depth Dominant Color Mottles Structure GPDifts Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. nsistence Boundary Roots Bed Trench 3 1 0 -12 10yr3/ 1 - sl l msbk mvfr cw 2f jr i ' fol 2 12 -21 1Oyr4/4 - sl lmsbk mvfr cw If Ground elev 3 21 -28 10yr4 /4 - sil 2msbk mfr cw - .5 .6 01� 4 28 -36 1Oyr4/4 f2d5yr5 /8 sil 2msbk mvfi cw - np np Depth to 5 36 -92 7.5yr6/6 - s Osg ml - - 7 8 limitin r Remarks: 4 1 0 -24 1 Oyr2/ 1 - A l msbk mvfr cw 2f ` ff i, 5A 2 24 -44 10yr4 /4 - sl lmsbk mvfr cw if r --fi Ground elev 3 44 -52 7.5yr4/4 - s Osg ml cw - .7 .8 �i 4 52 -56 10yr5 /4 - sl lmsbk mvfr cw Depth to 5 56 -73 7.5yr4/4 = s Osg ml cw - .7 i .8 limiting 6 73 -102 7.5yr6/4 - cs Osg ml - - .7 , .8 Remarks: k 5 Ground elev Depth to limiting factor Remarks: el ev round Depth to limiting factor Remarks: E NV13 0NMENTM BY DE 51G N 1432120 STREET, NEW RICHMOND, WISCONSIN 715- 246 -2454 PROJECT NAME HOMESTEAD PAGE 3 DESCRIPTION SE Y SW %, SECTION 11 T 29 N. R 19 W TOWNSHIP Hudson COUNTY St. Croix . Lo d 1-7 w L �6z � 63 Soy 20 SCALE 1" = 7eP Tom Nelson BM 1. 7 /V �,�,[� /00 csTMo 2605 BM 2. -13 o� f,�12h ,cil q' lop d� Q,�� ih o te, /17'- ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address L? 0 k Property Address -4> (Verification required from Planning Department for new construction) PP City /State HU u5 CH W I Parcel Identification Number © 2 0 — r 3 yG —7 0 " o 0 b LEGAL DESCRIPTION Property Location 5 IF '/4, 5 W ' /4, Sec. I( , T N -R / f , Town of 14 0 4 -591M zSubdivision 140 -5 T _4 D , Lot # ( 7 Certified Survey Map # 7 Q1 y 3 , Volume 7 , Page # 3 O Warranty Deed # t 2 3 9 , Volume 40 8 , Page # 29f"' Spec house yes ❑ no Lot lines identifiableg 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 wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to St. Croix County Zoning Office within 30 days of the e ear expiration date. T GNATURE OF APPLICANT DATE I0_WN R CERTIFICATION 1'(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 propttty, described above, by virtue of a warranty deed recorded in Register of Deeds Office. F ATURE F !PPncANT 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 �T.1Tt. WLIt tIF %%'ISCONSIN FO H \1 I - 19,32 " • •r+ l ": aCN. .:R R.coen.n. u +r+ wA V4 oe I y f This Deed IIIrJ.• betw'cen ;tong lc L. i. i I ie and Naoht. R. t,il l ie husband and t: -Ee R - 1 ; run:,,r, I13::30 A. "lid Sam C. `tiller, a single person , Gr•tnt,!c, Witnesseth That :he >aia l;rautar, for a valuable considerat.on - Rlr Vh., rJ t•, (;r,mtee the fulluwu i .; des,:rlbcd real estate in S.t,, Croix l',unt%. State of K See attached description. TRAN6FEF? FEE This is not. honlest,44 property. (1s) (Is not) Tog, -ther with all and singul.r the heredltaments and appurteu.,nces . :- ereunto bt::nging; and Ronald L. Willie and Naomi R. Willie \,arrant> th.lt the title is good, fn,iefr -,ILIe in fee slmule and free at,11 elral ,,: encumbri „nes ex'Apt easements, restrictions, and rights- of -way of record, :,nd will ,+nrt ant and defend if a Dated till., �� J:,y of `larch 19 90 . (SEAL) h�rjv (SEAL) • Ronald L. Willie (S-AL) /sc°r s �G ' �/ G LGL (SEAL) Naomi R. Millie AUTHENTICATION ACKNOWLEDGMENT sibmaturcls) .. -... . .... ............ STATE OF %%ISCONSIh -- -• ... ... .............. .......... ........ .. ...................... S.t.. Croix ...... t•auncy. 1 authve,ticated this _ day of 19.... Person",.: came before me this .0 .....day of 19 9 b .. the above named -- ... ........ Ro.nal.d...L..._wi. l Ue. -. and ................... • - ....... .......... 1.lie ............................ — TITLE: 51EN19ER s'l'ATE B.tlt'IF R _ ........................... (If nut, _ _. _. .... .. ........ _.._ ..... authorized by to me known t„ i,e the per -,-n .S.. .... whu executed the foregoing instr.went and,41}Lgowledge the same. THIS •,1 aTRUNI.Nr WAS C .f fJ fly •.�\ C. L. Gaylord, ?_tto et .. I y W1 540122 11 /,y River Falls, .. \ot.,�\ PL,ir `�.i... ;fK. "i•/�C� Cow, h•, JIB' ('unlnu,Cion iItoirtlipnbnt. state txpirutian dace: 19 4 � : ) ,,.\tik.a \Tl nkJ.11 : 1. \It I)1 % %1�. *It \,IY 1 \, I.• 1::.,..:. /',, irc. l Jk,l ♦•. I — 1142 Ui,., +� ►r,•. 1. ,. II I , m `!! [ f r'. .. R parcc] of land located in the SE -1/4 of the :1; -1/4 and in part cf tt:E S6' -1;4 of the 56 -1/4 of Section 11, Township 29 !north, R nic 19 l:e :t. lown of Hudscn, brirc further descrited as follows: beganriinp: at the S -1/4 corner of said Section 11 thence N89 h line 29'03 "6', along the Sguth line of the S�; -1/4 of said S ection 11, 2376. 9 feet; thence K02 2E'06"1;, 1322.61 feet, to the fort of the S -1 11 Of the SV -1 /4 Of Section 11 ; iF.E[:E o the �'`rt said north linc, 2446. , fEEt to the North - icuth 1/4 line of , said r � Section 1]; thence SOU 34'16 "1; a on� said North -S 1325.6h feet to the 1 E f ouch 1/4 line, point of be . acres ( Square feEt) and subject P to c all c easel,ents 3 of 2 Together with and subject to an easement for ingress and egress located in part of the Ern' -1/4 of the S1; -1/4 of Section 11 and in part of the SE -1/4 of the SE -1/4 of Section 1O I`c,rth , all in Townshi � 2 RanpE 19 best, Town of Hudson, being further described as 9 follows: Comr:.encin^ at the 5-1/4 corner of said Section 11; ti, nce N 9 29'03 "k;, along the Sguth line of the Sb. - 1/4 of said Sec:: 2376.39 fErt; thence K02 along 16'06 "1; 1256.54 feet to the point of bcp.innini; thence continuing NO2 26'06"1; 66.06 feet to the A lip of the S- orih Kb9� 6� 1/2 0 35'S0'� € f the 56 -1/4 of said Section 11; thence the Korth line of the S -1/2 of the S6' -1/4 of said Section 11, 179.28 feet to the NE corner of the SE -1/4 of the SE -1/4 of Secti.,n 10; thence KS9 41 "M, along the Korth line of the SE -1/4 of the SE -1/4 of said Section 10, 1318.24 feet to the VesS line of the SE -1/4 of the SE -1/4 of said Section 10; SOO 25'39"6', along said Vest line 66.00 , feet thence S69 4 on a line being 66 feet distant Southerly nd r 1 39 E, y line of the SE -1/4 of the SE -1/4 of saidSection10, 1 to the E line of said SE -1/4 of the SE -1/4; thence 569 35'50 "E; or, a line Leinz 66 feet distant Southerly and parallel to the Korth line of the of the S1; -1/4 of said S tt.0 oint of he�in Section 11, 162.54 feet to ni - n . b P contain c C ntal t n_ 2.2� ECrQS (9S,9r6 c'+Lcre FEEt and is sullect to right-of-way for town road (Scott F.oad) and subject to all easerents of record. '":. fnreari. ea- ,..._. � _ .....- c�:clus.•.e, i I 'NN 11.33' t NI °11'11'[ 4.11' 'N'1 Mal I NI°II'N't 1.16' UNPLATTED = ANDS NORM LINE OF THE 91/2 OF T)4: 9wW ® 5419'35'50 "E 2448.54' C9 ua:a' aaoe' e, CO3 •'— — {40.00' — / 20 �,. 94, Ate / M Kau >Q /T 6 / I L40 ACRES a� 12.0{ AC.1 �3 149,038 la FT � ' 13.24 AC.! 1O 1141,259 S0. FT.) Q•a�• J J' y. i' I = =16 `os� \ a 9 4u 90 R / ~ IS 27.32. �02 is a AC 1 64 / / coi to PIT) F3 \- -- 4 � rs I . 8 19907) O j h t:s AcaES / 1 99.996 R / / 8 ` If x 8.34 *010 18 3 N $ I [S ' 22 w1.9s3 {o. 8' 2100 ACKS ? \ Q� / of I ^' P,339 20. R �"/ 2.07 ACRD , '2 �•'• / b~r •F 90.127 SOFT. 621 u N / / t l 1.96 AC.) N / e� ✓ ` 9 4 / 105,202 90.FT.) J 3 . • V .CO 2)o — Si7.93' !04.20' 722.03 a, � ')• G� 9N'S6'O 0 / �?• GIs ----- — ocolcATio PACKEf� - '� 3 / "'�} ' 'OS'C N1 729.94' _ 20.00' 40 / p W 300.00 t - 73 9.94. 3 K• I/ co / -— J 3 23 Clio � � 7 � J sMa. as i 26 r— 2—J s /�; / 25' g 2 2!9 ACRES � I •• + Iw,so9 9o. R s ,<. II 1 3.93 CR! ,{ 2.p ACRE} In AM$ 0 � OM p ' 1 M0.676 S0. R/ N12 I� LMU7 30" T. 104,290 S0. FT . 69 1992.{1 I i ,�� / 1N291 I 619 's+ )1 u u Ar •� Gq 8 (901 , 11 \ 14 - - Go � ��K7 so 9 eI 01 406 22• — 117,.07'= EL 299.49' 4 12 Vsa 1 N89'29'03'w 2378.39' SOVI'm UNC OF THE swim a c-14 P \ \ 91N < 90T0 FROP;SEL` PLAT OF GkASS RANG: