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020-1300-70-000
C 7 C N t0 n� U I\ 2 O CD E i V � V O N Ul N N a ; O E CL X1 I `o y r H L ° ;noHeajB Z Z Z Q Q c _ o d T- O o w E co U) A a° > 0. c v °° 0 CL Z � w w c LL N r � Y as m O p m v m Q O a• cc CL r p � � � 3 O O O N a a9 a C 'U � a UE N r 49 2 o W 0 0 d p � cn a a •� c J J d. V ° in in peyslueldea w w w c ;uelnooul r r r .2 c pauealo 3 LU O e° Mild HIV k° d Z > } o poueelo c N 0 3 euejgwayy 4) Z Z > > 0. m m �asn}y!0 a v W waned @ Y Y Y y elggn9 c 0 0 O Q O V = 3 Z Z Z �+ Q Ac a a G1 R o p.w O 0 m � ? �o 0 0 CL w c C i aNc cn CF O _ H L u u O O O M N eF el' cc r _ e (, C 3 a O N N N N r t.= a to N [ �, Q _ = O N E E 0 o N 1c C O Q. M O Cc (A ano)leajg z z o0 °° 0 Im N " o ai L c u O M 3 m> d 00 c \, CD v m :: Eto g �' � W w w C V afAHNLL V Z rZ E � Y e Q O O O 0 Y a . d w 3 N O C ° y v 3 O Y C5 IL E IL ol d w 0 OW E 2 Co co 0 L O c 5 O p c E � p � 3 � Q G1 Z mom E ° o I-- m 0 - c w a o V v (7vM 0 d cm E. c •� s- 0 m V J d C o U E 7 a 0 P Yayslualdaa Y ui c weln0ou CO) t c pauealo v Ly W Im° JOIRA nd 0 Z >- mCD o paueal� c O t # auejgwayy E c w w d c W Z �asn la °: t •' H waned Y Y U) alggn8 c L 0 0 Y F- O >' CL Z�Ly V ` z z 49 a 110, Y w t �.L�j N m o p'�V X3 9 � to °w 0 a 0 0 07. O O� p s= O 0 N J r s H en V E w � � t O O 01 R O O V Oj M N w W N N N ; � v T� C w Q N _N 0 0 N Q T C o N N 1(7 O Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567288 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: Peterson, Brian D. & L nn Hudson, Town of 020-1300-70-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 17.29.19.1476 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / Vv //°411 Benchmark Dosing geo J Alt. BM ly dwA-c�4 F-C t.,-.. Aeration + 1 ;I� / Bldg.Sewer `��) r Holding St/Ht Inlet $ a �—. St/Ht Outlet �� I q ` / TANK SETBACK INFORMATION "- TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet. tej..4 Ol\—' Septic Dt Bottom Dosing I Header/Man. Aeration Dist. Pipe Holding Bot.System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover / eKZ0�`^..1 GPM Model Number (90,3..0_5 3 // TDH (Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO 6;4 1.54.4 BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION �� CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes 0 No 0 Yes El No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 934 Carter Circle Hudson,WI 54016(NE 1/4��NEq��1/4�� 17 T29N R19W) Park View Estates VI Lot 136 Parcel o: 17.29.19.1476 1.)Alt BM Description= /�C.w LiL 44_ 4--4 44-0 ;"64-...u. 2.)Bldg sewer length= /-. t z� L /- -amount of cover= 1 9 �� 64:fkal riL Ze.thtli 1 1 19ai CLukwiti"-- Plan revision Required? K Yes o / 13 , 1 j� J�L/3 ryy_(, Use other side for additional information. 1 _ SBD-6710(R.3/97) Date Insepc/� s Sign. re Cert.No. County _ 1 /01- -",. Safety and : �` ivision 5 ✓, C /C.Q/ e . 201 W.Washington Av . . x 7162 Sanitary Permit Number(to be filled in by Co.) . . N % Madisotj ,l 53707— '' 0 -.* SC,7 2 e s? v...14,i,;„,,,--74, Vtajlt*•il S ry Permit Applicatio0,'i c! U State Transaction Number In accordance with SPS 38 . 1(2),Wis.Adm.Code,submission of this form to the apps pnat4ovemmental unit //' is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s.15.04(1)(m),Stats. 5/�.i 4 j I. Application Information-Please Print All Information Property Owner's Name /1-7"- -"t-?,C Parcel# BRtik iJ A N✓J L 'Vi /J1E O /V 0 z 1360 - 70-ODD Property Owner's Mailing Address Property Location (i./ 1....74) 9'33 / C/T/ 7°�/C C I k C'e 4 Govt.If � � / City,State Zip Code Phone Number 7V / y,, 5 Vs, Section / 7 t44 S o i U 1,/ t ve/Co rcle one) 7 I/✓ J7 C T Z� N; R f r Eor� II. pe of Building(check all that apply) Lot# 1 or 2 Family Dwelling-Number of Bedrooms 13& Subdivision Name r de at I.",.(c) , Block# $74 7`,c- (O ?11 4-vpr ❑Public/Commercial-Describe Use ❑ City of ❑State Owned-Describe Use CSM Number 0 Village of Q'Town of /-/a lt1 S C)4) III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑New System y 0 Replacement System ❑Treatment/Holding Tank Replacement Only lY Other Modification to Existing Syste (explain) c,!v, B. El Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number ated Date slued Before Expiration Owner -33,S t q--r 1/61q 7 IV.Type of POWTS System/Component/Device: (Check all that apply) 6-X/57Jyv(7-- E Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) EtPretreatment Device(explain) ti 4/0 V.Dispersal/Treatment Area Information: tX/ T//)(,7-' Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required(st) Dispersal Area Proposed(st) System Elevation 600 9 7 ef35-`B 86 ?'s® 7g VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units mid, �.<�7� .o g u New Tanks Existing Tanks / � 4 G :u b B g i� ---�_ //V-/l/l/L t rL w c� g w a7 a Septic or Holding Tank /Z (C'' 0 /zoo I I f��% �k- ,s Dosing Chamber t5 0 0 f/OD I WWE'. '`. r - VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's ' to ysi, MP/MPRS Number Business Phone Number a®hF /U Sc r t? 2.1-( /744-----el ZZ3 7,6 0 ?/J- 76 c -ovo6' Plumber's Address(Street,City,State,Zip Code) /6 /s 0 T N or 5:9 •-,/,e/e s r Iv.-- s— S'o . . VHL County/Department Use Only �' Permit Fee Date s Issuing Agent Signature Approved ❑Disapproved oD ❑Owner Given Reason for Denial $/C�' -i / I/ /3 ("---- "44 '---"KtC1---Y -' - IX.C ing prpval/Reasons for Disapproval / ! I �1 ('�1,0"� q )// i f�Z�/ /✓l /,ry `17 -� (N 1 1.Septic tank,effluent filter and �% / ' 77 ( r, / Z r 1 dispersal cell must be serviced/maintained 5 5 as per management plan provided by plumber. lkli`i ( ae., /Lt 12fk A i— - -6)-_aeu OS V EO 3 L- 2.All setback requirements must be maintained 41 , _ G/ as per applicablP code/ordinances l > - iA/`(-<L/- 6° Y," &i y �l�tj /)//;�1.i- Attach to complete plans for the system and submit to the County only on paper n ''than 81/2111' in size � -rr- GIiU� / /)1A - /A-- 1/14 d-ei h4..±417- ! "C (/ m SBD-6398(R 11/11) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT 5T. c ketSC GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST. CROIX Personal information you provice may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 338984 Permit Holder's Name: 1 ❑ City ❑ Village Town of: State Plan ID No.: PETERSON, BRIAN HUDSON CST BM Elev.; Insp.BM Elev.: BM Description: Parcel Tax No.: Ibp,), 100,0" 10-1 (etn 020-1300-70-000 TANK INFORMATION ELEVATION DATA A9900246 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic VvgS _ l ZBO Benchmark 1 ). )_ //PO- d Dosing W s 4ROI /o-3 qs-9z Aerati Bldg.Sewer j 51 a $5; Lz Holding St/Ht Inlet fe. /3' II+fD/- TANK SETBACK INFORMATION St/Ht Outlet /7.3(0 '3.8'6 TANK TO P/L WELL BLDG_ VAientto rintake ROAD Dt Inlet I.42 V.% O Septic > D >So > 30' is j' NA Dt Bottom 2a.al. T 9C' Dosing > - >6-0 >th, >40 NA Header/Man. .S.2 3 '16, 19 Aeratio NA Dist.Pipe s S,33 etb•' Holdin Bot.System G. (('f 9f 78 tv PUMP/SIPHON INFORMATION Final Grade 3' O1 99 19- l t .fig) Manufacturer S De nd O .� w..Yt4�Q�Q ryes (b.rf T. ieis Model Number w r-0 3) I L a � q�1 TDH I Lift 4.131"1 Loss o 1'a I=moo T '1 t Forcemain Length 0.100'l Dia. 2," I Dist.To Well ?50 SOIL ABSORPTION SYSTEM 20. I .4- 0 , c = 2-0. (o - I-1 BED/TRENCH SEM Length / ..• No.O Pits Inside Dia. Depth SETBACK SYSTEM TO BLDG WELL LAKE/STREAM LEACHI ' INFORMATION YPe• ) 4-5„' > -S OR a,.+.... S stem: �� DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) , a , x Hole Size x Hole Spacing Vent To Air Intake Length 1-P1.-- Dia. 'T Length 0 Dia. T Spacing 6 )(J 0 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: HUDSON 17.29.19.1476,NE,NE 934 .CARTER CIRCLE ,0 gif/uNt7. Q/- >412 " c cam , 9- u.- 4q -t • .���4to - 1414--Use other revision required?addi ❑ Yes fo tit No 1 VO.A.ILAJ MilliSeA Use other side for additional information. Q 3108 OD SBD 6710(R.3/97) Date Inspector's Signature Cert.No ■ •, reiloillIAIltre -„, ..,• .-... • • • .., . ...... , • ,... L..,bIlt h..4 \.., /66474 rd./040m) .. . Curves Pumps • METERS FEET - 9°11.111111111111111111 MIMI ----i-----4---i MODEL 3885 . , 25- 60 11-11111111111111111111111111111.0". --I' imiSIZE 3/411 Solids IIIMINIIIIIII MEN maiwii.1911100 NumMINIIII - -BM -- mama k.1- " wE7oralermulomEllumEllt f almill .4. ,... , 1.1 .... milleamomm _i_._. • • .m..rilumsaivamignisliffli .., __!.._..___I MIMI= immillirA11111111111b..1111 Illboopm ' : I-Emma 15- reaglINNIMMEIMMINhitINNIA _ ,_ _ ,_ : __,_11111111111 WEC4M wilinsimill20:11111ahm.. lit 4 mum . 10.•••0......7 _ ao w03m 10111111.1111IRSHIIkh — \: -—f. . 1--Ini f., Illummnw,"111111111N1111111111101 11. --7 - 2-a. - --len*pi. ---71.1rmiln11111n NI 1111111:- k --!---- , s _ ' immurgiummahlag....migus - ‘ -- --I . . 10 IMIIIMMINCIIIIIIIIIIIIMUMIWIN.... mislit - 7 ---1- -r1 rf- f 1' MI1111111•111111111111111111111111111M06.11111 a , -cf-- 111111110111111.11110111111111111NUOIM—MI ---i--a o. o 0 10 to fil 30 40 50 60 70 80 SO 100 110 120 GPI4 I 2( 0 10 0m CAPACITY it:.;taiimm•i; 7110milielimaisaimiaileniummvasha".." :"." ''.,4: j. r(-73 Gal LPS. 1)011 UPS INC. ...., -,.......-.. ,,,.. ,,.. MITERS FEET naIIIMIIII • 1111111111111111111 III . MODEL 3885 120 argiannill 1111.1111111 _ ' 34- 110 rilMIMMIN .1.1111 i-Er— SIZE 3/4" Solids Manii"411111111111 - --1-77-' ---*-- - - 1111111 - . 100 111111111b. Ill • 1 1 1 . __II - .......„.... . r___ ____F______I. ...u. ............m. • i •li. ao..........imi . . _ Ns 25- 80 NINININININIIIIIMINIINI= IN - - MN NONNININININIMINIUMNBINI r _. ___. EN al 7 immoimmo•mmiimai 1.::_ _ me °muummaisummumas I_ _ . IN IN 20 r• - ■ - 4 60NIIIIIIIIIIIIIMIIUNIIIIIIIIMIIIIIMII --f - -T- s MhZ.IIRIIMIMIIMIIIIIIIIIIIIIII T_FT.-_ _ II _ :,-__.111 603e91 511111MllktIIIIIIIIIIIIIIIMLIIIIIIII . '5- i 11014.111111111111114-__f_ .___. 40 111111111111111111■1111111111111 . . 1 1 1 : 1.11111111111111111111111111111011111110477 • -. . 111 .11 10- IAIIIINIIIIIIIIIIIIILIIIINIIWINIIL II i ...._.. _1 -111111111111111111111113111,1 iiii _ AN Nomminimorm. . - INN • , . _. 5 - 2°11111111111111011.11110.31 al ir_111.7 •;.•_ ____ _ ,, al ! i Immummunilavi _-_N 1_-__ • : , 0Innommummumm. __...._ . i _._._ ., ilv 0 immanummommum 1_71:111-1 °- 0 10 20 30 40 50 60 70 c,) CA ICJ 110 120 OPM 0 i0 3:3 in't11 CAPACITY •1665°auks.Pumps,Ine. C)I.' ro ATU COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Peterson ATU Owners Name: Brian & Lynne Peterson Owner's Address 934 Carter Circle Hudson, WI 54016 Legal Description: NW1/4, SW1/4, S17, T29N, R19W Township Hudson County: St. Croix Subdivision Name: Park View Estates 6th Addition Lot Number: 136 Block Number Parcel I.D. Number 020-1300-70-000 Plan Transaction No. Page 1 Index and title Page 2 Existing Plot Plan Page 3&4 Asbuilt Page 5 ATU Tank Cross Section Page 6 Dose Tank Cross Section Page 7 Effluent Filter Information Page8&9 Management& Maintenance Plan Page 10 ATU Servicing Agreement Page 12&13 Maintenance Contract Page 14 Septic Tank Maintenance Agreement Page 15 Deed Page 16&17 CSM Page 18&19 Knight Treatment System Approval Letter Attachment# 1 Existing Septic System Documents Designer: John Schmitt Licnese Number: MPRS 223760 Date: 11/21/2013 Phone Number: 715-760-0486 Signature: ,t ./.1°=-117Z-°�/��/ I , ..,.• , ------- , .....4.1 ,z S`4- ' C .. . . \1 , I , - -- . ' ''.1-1 ■ Itte , ' s•<' .._ iv) 1. --...„.. .A. --a i 'N. S\ ■■ 4 •t -...1, ‘1 ■*., ,f. 5 I ko I , t ' s') ,\ 1 o• 't 0._ --ii 4,, ,)) 1 i R ,.7., r...,„ N' ... -..,, tn----v, \< % ,Al. ") ) 4 _ __ _____ Tank 1 SEPTIC TANK DETAIL/SINGLE COMPARTMENT Project Name: Brian Peterson Tank Manufacturer: Week's Concrete Products Tank Model: 1200 Construction Type: Concrete Tank Volume: 1200 gal ATU Manufacturer: White Knight ATU Model#: WK-40 84.07 ft Inlet Elevation Outlet Elevation 83.86 <-23"Minimum-> Manhole w/locking device <----- and warning label E E E E E E E E E A E#E E E E E E E Y E E E E E.S E E i.E t f IF E 6 F } 'd E E E E 9 R fi E E • Airline Baffle - st: t White Knight MIG WK-40 3" :-•ding Under Tank Plumber/Designer Signature: Lic#: 223760 Date: November 18, 2013 s . DOSE TANK DETAIL Owner's Name: Brian & Lynne Peterson 83.6 ft Inlet Elevation Weatherproof Manhole with Locking Device Junction;' and Warning Label 'r 2 fV RRRR R R R�.rtRrRRr.RRR ia7..� .... .Quick disconnect fitting @ Y R R R RIRR ^ Alternate forcemain outlet M y - Sim/Tech Filter ol MININENIMINI reserve(a) Dimensions Inches Gallons a 19 413.44 alarm on II separation (b) b 2 43.52 Ic 6 130.54 dose volume(c) pump on a 10 217.6 Total 37 805.1 4 off 80.6 ft Intake Elevation r Tank Manufacturer Week's C. P. Pump Manufacturer Gould Tank Model 800 Pump Model WEO311 L Tank Capacity 800 gal Alarm Manufacturer Existing Tank Volume 21.76 gal/in Alarm Model Existing Filter Manufacturer Sim/tech Filter Model STF-100 DOSE VOLUME CALCULATIONS TOTAL DYNAMIC HEAD CALCULATIONS Design Flow(DWF) 600 gal/day Min Network Supply 0 ft Number of Doses 5 /day Passive Vertical Lift 16.37 ft-(Header/D Box elev.-Pump intake elev.) -(Forcemain Length x Friction Loss Max.Dose Volume 90 gal Friction Loss 1.2+0.5=1.7' Factor)/1OO+Filter Friction Loss Drain Back 7 gal Total Dynamic Head 18.07 ft Design Dose Volume 97 gal Min Discharge Rate 20 gpm NOTE: Pump and alarm are to be installed on separate circuits. INTERNAL DIMENSIONS OF TANK Diameter 80 in Liquid Depth 37 in I I Plumber/Designer Signature: License#: 223760 Date: November 18, 2013 rld PRESSURE FILTER INSTALLATION &SERVICE INSTRUCTIONS JI 1455 Lexamar Drive Toll Free 888-999-3290 Office 231-582-1020 Boyne City,Ml 49712 Fax 231-582-7324 Email',lie', ,�w .1't4.41 ,, ∎11 Web ygy■. ■ sa-sum e, 011'. INSTALLATION: When installing an STF-100, screw filter into discharge port of any pump that has a 2" National Pipe Thread. Pumps with a smaller discharge port may be adapted to fit. When installing an STF-100A2 a tailpiece and male adapter will need to be added to the inlet end of the filter(end opposite of the cap)to the desired height and a 2" union will need to be added to the outlet end (the end closest to the cap&on the side of the filter). Always install the filters in a position where they can be easily serviced. **Always use caution when starting threads to avoid cross threading*". Plumb force main into the 2"sch 80 PVC union. **We recommend that the union remain together during gluing to insure that glue or cleaner does not ruin 0-ring or sealing surface**. For best performance, if a check valve is installed it should only ne after the outlet of the filter. SERVICE: Service of filter screen is dependent on usage as every system is unique. For most residential systems we recommend inspecting the filter within the first year to determine the necessary service intervals for the filter. In high volume systems we recommend inspection within the first 6 months to determine necessary service intervals for the filter. Once the service interval is determined it should be consistent unless something changes in the system. Always inspect the filter screen for any damage or corrosion and replace if necessary. If our STF-101 service alarm switch has been installed and adjusted properly it will alarm when the filter requires service. It should be serviced no less than when periodic pumping of the septic tank and pump chamber is performed. Servicing will be more frequent if using any one of our optional filter socks(600 micron, 150-190 micron,and 100 micron). Check your local health department for septic system servicing recommendations. If the screen becomes clogged before the periodic pumping requirements, a high level alarm or light will indicate the need with a"pump on light"that stays on longer than normal, this also may indicate a need to P . Ifs stem is equipped P for service y service filter. To service filter screen, unscrew the 4"cap. Pull filter screen from canister and wash out thoroughly in appropriate location with proper protection. In some cases an additional filter screen allows quicker service allowing dirty filter tom washed later at the shop. that coed a s the + be * to remove' or pour warm water over the c rernovfng. Once the is installed k7 the tank it maintains a denature and removing the cap wM not be s problem. If the system is equipped with our Service Alarm Switch, the filter screen does not need service until the Service Alarm Switch activates a light or audio alarm. We still recommend that the filter be inspected once a year for damage or corrosion. NOTE: The total dynamic head loss of the system must be increased by 0.5 feet of head to overcome friction loss through the filter. SERVICE ALARM SWITCH The alarm switch is available in three pressure ranges, low head, medium head, and high head. Installation is simple, on SIM/TECH FILTER systems, remove 1/4"plug from base of filter chamber and connect tube fitting. Next, run the tube up into the tank riser and connect to service box. hswitch.ce alarm switch tcan be weed with lits own alarm or with the high water provided. Run alarm wire to alarm box. T alarm. Pressure adjustment is made by removing the end plug, and inserting the 7/32 alien. Clockwise increases pressure. One turn equals approximately 3 PSI. The low head alarm switch comes factory preset at 8 PSI and is completely field adjustable within it's range(3 to 24 PSI). We recommend the use of a ball valve when using an alarm switch. Once you have installed the filter and alarm switch, the ball valve can be closed off to simulate a plugged filter so that you can make sure the alarm switch is working correctly. ****TRY OUR LID/SCREEN REMOVAL WRENCH. Our wrench holds filter lid firmly and hooks screen for easy removal and installation. Made of PVC plastic. WARRANTY All products are warranted against defects in material and workmanship for a period of two years from the date of purchase. In no event shall GAG SIM/TECH FILTER, INC. be liable for any consequential damages or any labor, material,freight or is expenses required to replace, correct or reinstall the product. GAG SIM/TECH FILTER, INC.'s liability r n limited d,touepair or to replacement of the part. All warranties are void if the product has been improperly modified, applied misuse or abuse. Except as stated herein,there are no warranties expressed or implied, CTIVE Septembee war ant of merchantability or warranty of fitness for a specific purpose. ' .0/0.71) . DIVISION OF INDUSTRY SERVICES a o Plumbing Product Review o� I \' P.O.Box 2658 .c? ! �g 1�} Madison,Wisconsin 53701-2658 i.2\ Ps N TTY:Contact Through Relay 0q ¢ Scott Walker,Governor WS'0*Pl Dave Ross,Secretary October 29, 2013 KNIGHT TREATMENT SYSTEMS MARK C NOGA, PRES. 281 COUNTY ROUTE 51A OSWEGO NY 13126 Re: Description: CHEMICAL OR PHYSICAL RESTORATION FOR POWTS Manufacturer: KNIGHT TREATMENT SYSTEMS Product Name: WHITE KNIGHT MICROBIAL INOCULATOR/GENERATOR Model Number(s): WK-40,WK-78,WK-150 AND WK-200 Product File No: 20130302 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters SPS 382 through 384, Wisconsin Administrative Code, and Chapters 145 and 160,Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of October 2018. This approval supersedes the approval issued on 10/02/2008 under product file number 20080513. This approval is contingent upon compliance with the following stipulation(s): • This product must be utilized in accordance with the manufacturer's printed installation instructions and this product approval. If there is a conflict between the manufacturer's installation instructions and the product approval,the product approval requirements will take precedence. • The elevation of the system's infiltrative surface must be above the estimated highest groundwater elevation or bedrock by the distance prescribed in column entitled "Fecal Coliform >10000 cfu/100 ml" in Table SPS 383.44- 3,Wis.Adm. Code. • A copy of this approval letter and the manufacturer's printed installation instructions must be supplied to the buyer of this product. • The outlet baffle of the septic tank, which has this product installed, must have installed an effluent filter capable of filtering particles of 1/8 inch in size or larger. • This product must be installed by a properly licensed plumber. • A state Sanitary Permit must be obtained when this product is installed. • The IOS-500 inoculant must be exchanged at least on an annual basis. • This product is approved to be installed in existing and new treatment tanks to rejuvenate failing soil dispersal areas. The product may be installed in single or two compartment tanks. The product may be installed in the second compartment of a septic tank;preference is to have the product placed in the main compartment or inlet side of a two compartment tank. . To rm vi p o ote having ng an area of quiescence and that of settling in a single compartment tank, locating the product off center--towards the inlet side of the tank--is the preferred procedure. SBD-10564-E(N.10/97) File Ref:13030201.DOC s. KNIGHT TREATMENT SYSTEMS Page 2 October 29, 2013 Product File No: 20130302 • For installations where the access opening is not directly above the desired product location within the tank, a standard installation practice involves the use of a flexible air line between the air supply's riser entry point and product; in some installations to existing tanks, access modification may be needed. The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may result from its use. Sincerely, Glen Jones, M.S. POWTS Product Reviewer phone: (608) 267-5265 fax: (608) 267-9723 email:glen.jones @wi.gov Document Number Document Title Maintenance Contract for Septic System This Maintenance Contract for a Private On-Site Wastewater Treatment System(POWTS) is Between Brian& Lynne Peterson and John Schmitt. Recording Area Date of Contract: 11/18/2013 Name cor and Area Address: Location of POWTS: 934 Carter Circle, Hudson, WI 54016 Legal Description of Property:NEI/4,NE1/4, S17, T29N, R19W John Schmitt Part of NW 1/4 of SW of Section 17-29-19 and Part of Lot 136, Park 616 150`h Ave. View Estate Sixth Addition in the Town of Hudson described as follows: Somerset, WI 54025 Lot 3 of Certified Survey Map filed December 26, 1996 in Volume "11", Page 3199, as Document Number 553702. 020-1300-70-000 As Inducement to the County of St. Croix Zoning Department to Issue a State Sanitary Permit for the Above Described Property, We,the Owners Parcel Identification Number Agree to the Following: (PIN) 1. The Owner agrees to have the POWTS inspected and maintained by a qualified maintenance provider. 2. The owner agrees to provide access to the POWTS for the qualified maintenance provider in order to service and/or maintain any and all components of the POWTS. Accruing to the maintenance and monitoring schedule provided by the POWTS manufacturer(including Knight Treatment Systems, St.Croix County Zoning Department, and Wisconsin Department of Safety and Professional Services-Division of Services.) 3. Minimum performance monitoring will include: a. Type of use b. Age of System c. Type of Fill Material Used(If Applicable) d. Nuisance Factors, Such as Odors or Complaints e. Mechanical Malfunction within the System. Including Problems with Valves,Mechanical or Plumbing Components f. Material Fatigue, Including Durability,Corrosion,or Integrity of Construction and Design. g. Neglect or Improper use of POWTS. Examples Include Exceeding the design rate, Poor Maintenance of vegetative cover, unapproved covers over the POWTS or inappropriate activity over the POWTS. h. Pump Malfunction. Examples Include Dosing Volume Problems, Pressurization Problems,Breakdown, Burnout,or Pump Cycling Problems. i. Ponding in Distribution Cell. Ponding Prior to Dosing is Evidence of a Developing Clogging Mat,or Reduced Infiltration Rates. j. Overflow or Seepage Problems. Often Apparent When Sewage Effluent has"Ponded"at Surface of Ground. 4. The Owner further agrees to pay the qualified maintenance provider for all charges incurred while inspecting, pumping, or otherwise servicing and/or maintaining the POWTS in such a manner as to prevent or abate any human health hazard caused by the POWTS. Contract Drafted by: John Schroeder • 5.* The Owner agrees that if required by the qualified maintenance provider,to have any components of the POWTS corrected by a Wisconsin Licensed Master Plumber that has knowledge regarding the installation and/or repair of the POWTS. 6. The Owner contract is binding for two years from the date in which the final inspection is made for the fully installed POWTS. This date will be located on the inspection report filed with the St. Croix County Zoning Department. 7. The Owner agrees to contact the qualified maintenance provider to have the POWTS inspected and maintained annually(or at intervals required by the county or state governmental unit)after the initial two years. (Additional evaluations may be required if warranted by operational condition of POWTS.) 8. A qualified maintenance provider shall possess a POWTS maintainer credential from the WI Department of Commerce. 9. The qualified maintenance provider shall agree to submit an inspection report to the St. Croix County Zoning Department on an annual basis. (Or intervals required by the county or state government unit.) 10. Recordation/Acceptance Conditions. This agreement shall,upon execution, be recorded with the Register of Deeds for St. Croix County, WI. By the recording of the easement, Grantee,or itself and its successors and assigns accepts and agrees to abide by all of the terms and conditions hereof. Qualified Maintenance Providers Name: John Schmitt Lic. #223760 John Schmitt Septic Systems Services Qualified Maintenance Providers Signature: 91) 41 ---The Following Requires Notarization--- The Owner(s)Name: Owner(s gnat e: Brian Peterson Lynne Peterson Personally came before me this day of 2012, The above-name To me known to be the person(s)who executed the forgoing instrument and has/have acknowledge the same. Signature of Notary Public Notary Public, State of: WI Contract Drafted by: John Schroeder 111111111 IHh1III'i Il Ii1 8 1 9 8 9 5 Document Number Document Title Tx:4163476 989510 St. Croix County BETH PABST AEROBIC TREATMENT UNIT (ATU) REGISTER OF DEEDS ST. CROIX CO., WI SERVICING AGREEMENT RECEIVED FOR RECORD 11/22/2013 1:51 PM IState Plan Transaction Number- EXEMPT #: REC FEE: 30.00 Brian D. Peterson PAGES: 1 Name—(Owner) Typed or printed Being duly sworn, states, under oath,that: He/she is the owner/part owner of the following parcel of land located in St.Croix County, Wisconsin, recorded in Volume 1433 Page 613 Document Number 604861 St.Croix County Register of Deeds Office: Recording Area A parcel of land located in the NW '/4 of the SW V4 of Section 17,T Name and Return Address John Schmitt 29 N R 19 W, Town of Hudson, St. Croix County, Wisconsin, being 616 150th Ave. duly described as follows (include lot no. and subdivision/CSM or Somerst,WI 54025 detailed legal description): Part of NW1/4 of SW 1/4 of Section 17-29-19 and Part of Lot 136, Park View Estate Sixth Addition in the Town of Hudson described as Parcel ication Number(PIN) 020-13000-70-0-70-000 follows: Lot 3 of Certified Survey Map filed December 26, 1996 in Volume"11", Page 3199, as Document Number 553702. Agreement Date: 11-22-2013 As an inducement to the county to issue a sanitary permit for a POWTS equipped with an Aerobic Treatment Unit on the above-described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of SPS 383, Wis. Adm. Code relating to Aerobic Treatment Units (ATU) and the maintenance requirements for the proposed POWTS (Private Onsite Wastewater Treatment System)technology. If the owner fails to have the POWTS and ATU properly serviced in response to orders issued by the governmental unit or the Department of Safety& Professional Services(DSPS) to prevent or abate a human health hazard as described in s.254.59, Stats.,the governmental unit(St.Croix County)may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s.66.0703,Stets. 2. The owner agrees to maintain a contract with a licensed POWTS maintainer for the life of the system.The POWTS maintainer will perform periodic inspections and maintenance as required by the manufacturer and the DSPS, including, but not limited to: the blower, electrical controls, and treatment unit operation and sludge depth. These inspections are to be scheduled every 6 months for the first two years of operation and yearly thereafter. 3. The owner agrees to contact the POWTS maintainer immediately upon any malfunction of the treatment unit and to maintain the unit so as to not create a human health hazard as described in s.254.59,Stats. 4. The owner recognizes that the county, DSPS, or POWTS maintainer may make periodic inspections of the. components to complete performance monitoring of the unit. 5. The owner or the owner's agent agrees to report to the department or designated agent at the completion of each inspection,maintenance or servicing event in a manner specified by the department or designated agent within 10 business days from the date of inspection, maintenance or servicing. 6. This agreement will remain in effect only until the county office responsible for the regulation of POWTS certifies that the aerobic treatment unit no longer serves the property. In addition,this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the owner,the heirs of the owner,and assignees of the owner. The owner shall submit this agreement to the Register of Deeds, and the agreement shall be recorded in a manner that will permit the existence of the agreement to be determined by reference to the property where the Aerobic Treatment Unit is Installed. .... I• HA1is ,. Owner(s)Name(s)-Please Print I. Subscribed a worn to before me on this date: : pTA ▪ ` Brian D.Peterson _ q r —▪ / . a/3 Notarized • neYS Signature(s�/ = P,!B``G y`Notary P V Governmental Unit Official Na , Ile-Plear� W�5 \\ My Commissionptr:s 4._ //flllti" Govern/: tal Unit Off ial ',.'nature Drafted / '77v.onal infyt�ation you • •vide may be used for se .;:ary purposes[P ' acy Law s. 15.04(1)(m)] THIS PAGE IS PART OF THIS LEGAL DOCUMENT_DO NOT REMOVE" • This information must be completed by submitter. document title,name&return address,and PIN(if required). Other information such as the 9rahting clauses,legal description,etc.may be placed on this first page of the document or may be placed on additional pages of the document.Note: Use of this cover page adds one page to your document and$2.00 to the recording fee. Wisconsin Statutes, 59.517. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of'2-'"--- FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Brian&Lynne Peterson Tank Manufacturer: Week's C. P. E NA Permit# L57 2 g 8 /= Septic E Dose r Holding Volume:_1200 gal r DESIGN PARAMETERS Tank Manufacturer: Week's C. P. NA Number of Bedrooms: 4 r NU Septic i_ Dose E Holding Volume: 800 gal Number of Public Facility Units: P NA Vertical Distance Tank Bottom(s)to Service Pad: ft Estimated(average)Flow: 400 gal/1 Horizontal Distance Tank(s)to Serivce Pad: ft Design(peak)Flow=estimated x 1.5:_600 gal/c Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.7 gal/dayt horizontal is>150 feet.Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: SIM/TECH 7 NA Fats,Oils&Grease(FOG) 530 mg/L Effluent Filter Model: STF-100 Biochemical Oxygen Demand(BOD5) 5220mg/L NA Pump Manufacturer: Gould 7 NA Total Suspended Solids(TSS) 5150mg/L Pump Model: WEO311 L High Strength Influent/Effluent Monthly average Petreatment Unit Fats,Oils&Grease(FOG) 530 mg/L Manufacturer: Biochemical Oxygen Demand(BOD5) 5220mg/L f NA IT/ Mechanical Aeration r. Peat Filter x— NA Total Suspended Solids(TSS) 5150mg/L r Disinfection _ Wetland Petreated Effluent Monthly average C Sand/Gravel Filter _ Other Biochemical Oxygen Demand(BOD5) 530mg/L Soil Absorption System Total Suspended Solids(TSS) 530mg/L P NA r" In-Ground(gravity) I- In-Ground(pressure) r" NA Fecal Coliform(geometric mean) 5104cfu/100m1 r Mound Maximum Effluent Particle Size: Ys in dia. P N, r Drip-Line r- Other. Other: P Other: R NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third('A)of tank volume Pump out contents of tank(s) When the high water alarm is activated r° months) Inspect condition of tank(s) At least once every: 6 C reams) (Maximum 3 years) NA ✓ month(s) Inspect dispersal cell(s) At least once every: 6 1__ reads) (Maximum 3 years) ' NA ✓ month(s) 1 NA Clean effluent filter At least once every: 1 r year(') r monn'(s) NA Inspect pump, pump controls&alarm At least once every: 6 1- yar(s) (-- month(s) NA Flush laterals and pressure test At least once every: - year(s) ✓ month(s) Other: Maintain White Knight At least once every: 6 r Year(s) NA r months) s--' NA Other:Add Bacteria At least once every: 1 r° year(s) MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:Master Plumber;Master Plumber Restricted Sewer;POWTS Insepector;POWTS Maintainer;Septage Servicing Operator(pumper).Tank inspections must include a visual inspeciton 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 a check for any back up or ponding of effluent on 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 ground surface may indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third('h)or more of the tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,Wisconsin Admininistrative Code. All other services,including but not limited to the servicing of effluent filters,mechanical or pressurized components,petreatment 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 30 days of completion of any service event. (Rev.2/05) i y Page of START UP AND OPERATION For new construction,prior to use of the POWTS check treatment tank(s)for the presence of painting products,solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s)removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels.When power is restored the excess wastewater will be discharged to the dispersal cell(s)in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells.Do not drive or park over,or otherwise disturb or compact,the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics;baby wipes;cigarette butts;condoms;cotton swabs;degreasers;dental floss;diapers;disinfectants;fat;foundation drain (sump pump)discharge;fruit and vegetable peelings;gasoline;grease;herbicides;meat scraps;medications;oil;painting products; pesticides;sanitary napkins;tampons;and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33,Wisconsin Administrative Code: •All piping to tanks,pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. •The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. •After pumping,all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been,or must be taken,to provide the opportunity to obtain a sanitary permit for a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure,lot lines and wells.Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area.Replacement systems must comply with the rules in effect at the time of their 174/ permit issuance. A rehabilitated d replacement nd barring advances in POWTS technology,a holding tank may be installed soil as a last resort. cannot be ❑ The site has not been evaluated to identify a suitable replacement area.Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area.If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface.Reconstructions of such systems must comply with the rules in effect at that time. WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE.NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE.DEATH MAY RESULT.ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name:John Schmitt Name:John Schmitt I Phone:715-760 0486 Phone:715-760-0486 SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name:St.Croix County Zoning Name: Owners Choice Phone:715-386-4680 Phone: This document is intended to meet minimum requirements of Ch.Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. (Rev.2/05) ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Property Addres City /State ? Legal Description: 1^r, Lot Block Subdivision/CSM #" � ,, �ON1Nu '/4 ' /4, Sec. ,, TAN -R�W, Town of P # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC a& / Ron Setback from: House Well , a P/L _7 Pump manufacturer Model u � ?mil / 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: Zj.� Width ^/, 2 Length 7zl Number of Trenches Setback from: House Well, 1eo P/L Vent to fresh air intake is�o ELEVATIONS Description of benchmark Elevation I W- /-7 9-�77 5L2 Description of alternate benchmark , a �,�e� Elevation Building Sewer EC22 ST/HT Inlet ST Outlet PC Inlet gel PC Bottom 799X: Header/Manifold ,9C. 9q Top of ST/PC Manhole Cover 9, Distribution Lines () 2, R ° r () ( ) Bottom of System( l q-j' 79 () ( ) Final Grade O 9 / 7 O ( ) Date of installation 2 / P rmit number ��_ State plan number Plumber's signatu e License number , Date Inspector - Complete plot plan Or I 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 INDICATE NORTH ARROW Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT iT- C4LO( GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: ST CR IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 338984 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: PETERSON, BRIAN HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: t oo �' 1 r ti 020 - 1300 -70 -000 TANK INFORMATION 0 ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION • BS HI FS ELEV. Septic eat— �Z&v Benchmark Dosing ( gS•9z Aeratio Bldg. Sewer 5 Z2 Holding St / Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet ��, 3(0 $3• TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet (02 SS Air Intake Septic > Sn > 5-0 > 30' e� NA Dt Bottom Dosing r S > `(a > '(O NA Header / Man. Aeratio NA Dist. Pipe s• 3 3 qlb• Holdin Bot. System , �'>` 95r :78 PUMP/ SIPHON INFORMATION Final Grade 3• a5 q, 19 - Manufacturer S Dem nd J ( dk"10_r ` w_`yl2 ryes c r t.IS Model Number W � 3i ( L IST C.e - E H Lift �•tij Lrictiol �2 System TD q.I t Head cemain Length .rf Dia. Z " Dist. To Well ?50 T_ SOIL ABSORPTION SYSTEM BED/TRENCH Width 1 Length N f T enches PIT No. O Pits Inside Dia. d Depth DIMENSIONS � - DIMEN I N SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHI ufacturer: SETBACK _ CHAMB INFORMATION Type O e�NUmber: System: �� / 5 OR T DISTRIBUTION SYSTEM Header /Manifold ,, Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length � Dia. 'T Length - -7 -0 Dia. Spacing b 5 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 El I No El Yes [I No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 17.29.19.1476,NE,NE 934.CARTER CIRCLE - 54 AU ct �.n- �.,p�. ►tee , - 1 F N I �- > Plan revision required? ❑ Yes ja No ' Use other side for additional information. b 3 08 1 m y_�:a Aab K SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Division Vi scons i n SANITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 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 I, than 81/2 x 11 inches in size. s • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes ❑ check it revision to pr evious application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATI N Pro pe Owner Na Property Location �q kA 1/4 1/4, 5 T , N, R (or Property 6w ing Address lot Number Block Numb Z_ Al gt� City, t e Zip Cod Phone Number Subdivision Na or CSM umber / ,911 ( ) II. TYPE OF BUILDING: (check one) ❑ State Owned it Nearest Roa ❑ Village Public 9 1 or 2 Family Dwelling - No. of bedrooms y dr Town OF ZL _,,_ I A III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo ©', �d " /S 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 R Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit X 7d 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 (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /i ch) Elevation Feet _ 1e,0,0 Feet VII TANK in g allons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks M anufacturer's Name Concrete Con- steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Q / ❑ ❑ ❑ 11 11 ift Pump Tank ipbwt- eKember �- r yt!!S ❑ El 1:1 ❑ ❑ ONSIBILITY STATEMENT 1, the undersigned, assume responsibility for I stallation of the onsite sewage system shown on the attached plans. Plum er' Nam (P ) Plum er' Ign N� t p MP /MPRSW No.: Business Phone Number: / - s - Plu ber's Address (Street City, Sta e, Zip Co ): IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue ' Issuing e t (No Stamps) S /� Approved []Owner urcharge Fee) •�� Owner Given Initial �� !� /VS[: 4r/ Adverse Determination ; 0 L X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber Ai 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 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. ���ZZZ222 (v ,e� IC,�GNikA✓l � f�F� �`. I b� a � � � D o y w U 13 1 ?AGE Of PUMP CH AM BER CA055 SECTIO AlJO SPE CIF I CATIO NS_ VENT CAP r VENT PIPE WEATHERPRooF /1PPAOVED LOCKING _ JU UCT10JQ BDX MANHOLE COVER WITH :lb 2.S FRO DOOR, I WAMIING LABEL WINDOW OA FRESH IL�MIU. AIR INTAKE GRADE I I y.. M11J. COUDUIT `- la'nw. ` --- - - - - -- PROVIDE I - - -- IAJLET AIRTIGHT SEAL APPROVED JOIUT A I I APPROVED JOIW / ( II Wf ' PIPE EJ(TCNDP 3� I I ALARM CXTEUDIUG 3' ONTO SOLID So AUTO SOLID SOL I II I D I I I I OKI C `- CLEV. FT. PUMP -� - -, b OFF 0 CO UCKETE DLOCK RISER EXIT PERMITTED OULy IF TAUK MAUUFACTURCR HAS SUCH APPROVAL 3" APPA OVEN 6E.CDIn+G undcr Tome -.4K SEPTIC If SPECIFICATIQfJS DOSE TAWK MAQUFACTURE:R: IJLL^1HCR OF DOSES: PER DAB TAWK SIZE: __ Ron GALLOWS DOSC VOLUML / INLLUDIKJG DACKFLOW:_ {���� C. ALL0WJ ALARM MA►JUFACTU MODEL UUMDCK: 101,40 CAPACITIES: A= IUCNES OR �D GALLOUs SWITCH TYPE: i � , l B = ? INCHES OR GALLOWS PUMP MAKIUFACTURCR: 1 IU sLCHES OR ,1.� LI GA i MODEL UUMDER'. � 1 � D - —�_ INCHES OR ArS-2 GALLO►JL SWITCH T`JPE: / MOTE' PUMP AUD ALARM ARE TO DE IN5TALLED C)Q SEPARATL CIRCUITS MIKIIMUM DISCHARGE RATE .��� — GPM VERTICAL DIFFEKEKI DETWEEKJ PUMP OFF AUD OISTRIBUTIOW PIPE.. 6 /? FEET + MIUIMUM mETWORK SUPPLY PRESSUR . . . . . . . . . . . FEET -} . 6 FEET OF FORCE MAIN X ,Z.2 / o,)rr.FRICTIOU /C/� FACTOR.. �. 5 FEET TOTAL 09WAMIC HEAD = — + FEET IUTER DIMEKIS Uc OF T "A U K: LENGTri - J WIDT14 jUQUkV DEPTH r ,r/ SIG ►JE D. LICCOSE NUMOCR: DATE: i Curves Pump METERS FEET 00 - - - -- !MO DEL 3885 is _ SIZE 1 /4 „ Solids WE 15N -- - — 70 ?U W E t OH — -- - WE06H - 40 10 WEOJM — - —1— WEOJI 20 - 0 0 0 10 20 30 40 50 60 70 60 90 100 110 120 GPM j p 10 ?0 30 m'/h CAPACITY 'rill•,. +';f� „v: ff °'�'1°aYo""T,•[ �ityy'+� ,`M.y 2t ,.1 u0U �1 lD5 P UMPS, INC. l METERS FEET 120 - MODEL 3885 35 j__�i— SIZE 3 /4 Solids 110 WE15HH -- (— i—•1 -- -� 100 30 fill — 90 BO — _ - -' 70 20 _. r - I WEOSHN 30 0 0 - 0 10 20 00 40 50 60 70 4 b0 t W 110 )w GPM i L _ — 0 10 N 30 m'/h CAPACITY •1908 GouIC# Pump#, Inc. Lap"Ve C)114` Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # ISM 7_22 APPLICANT INFORMATION - Please print all information Rev' ed by ` D ate Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 1/4 �� 1/4,S T ,N,Ro� 17 Properij nee $ Mailing Ad Lot # Bloc k& Subd. Name or CSM# %CnI I / s City Statq Zip Code Phone Number pst R d I El city Village � Town Nea New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 0 gpd Recommended design loading rate 7 bed, gpd/ft gpd/ft Absorption area required 5 8 bed, ft2rench, ft,2� Maximum design loading rate 7 bed, gpd 1ft gpd /ft Recommended infiltration surface elevation(s) ,%�1 �� It (as referred to site plan benchmark) Additional design /site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U Unsuitable for system ® s ❑ u 1Z S ❑ U ® S ❑ U [� S❑ U ❑ S ®U ❑ s V[ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench o- 3 S Ground �✓ / elev. Depth to limiting PJ factor /lb in. rU Remarks: Boring # / Z ' " IN T Ground �• ,� elev. ✓ Si ft. s� — `- Depth to limiting factor >Z20-in. Remarks: CST Name (P as Pri ) Signature / � Telephone No. Address Date CST Number !� '�' f PROPERTY OWNER t SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D.# =„719 Boren # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary .Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench c, b Ground e elev. 7 ' 8 Depth to limiting factor lb Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ; 13 Ground elev. ft. Depth to limiting factor ' Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) w w 0 R D P o 3 � � a F �y � V r scdnsin department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division,of Safety & Buildings 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 St. Croix not limited to vertical and horizontal reference point restion and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and dis 020-1300-70:_- APPLICANT INFORMATION —PLEAS ALL*IFORMATtqN REVIEWED BY g DATE K. PROPERTY OWNER: V PROPERTY LOCATION Brian Peterson aGOVT. LOT NE 1/4 NE 1/4,S 17 T 29 AR 19 k(or) W PROPERTY OWNERS MAILING ADDRESS � t` °t?Q� LOT # BLOCK # I SUBD. NAME OR CSM # 911 Wert ]Rd. STCROIX 1136 na Parkview Estates Sixth Addn. CITY, STATE ZIP C E'" P R ❑CITY ❑VILLAGE [SOWN NEAREST ROAD Hudson, WI. 54016 " ,".(f .fig! ; Hudson Carter Cr. [ :4 New Construction Use (c ] Residential/ nl` d �rbo' R [ ] Addition to existing building [ J Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd /ft .6 trench, gpd /ft Absorption area required 900 bed, ft2 750 trench, ft Maximum design loading rate • 5 bed, gpd /ft •6 trench, gpd/ft Recommended infiltration surface elevation(s) 93.65 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem EIS ❑U R) S El R) S El WS El ®S ❑U ❑S ®U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed jTwich 1 0 -18 10yr3 /3 none 1 2csbk mfr gw 2f .5 1.6 2 18 -36 10yr4 /4 none sicl lcsbk mfr gw if .2 .3 Ground 3 36 -55 7.5yr4/4 none sl 2mgr mvfr gw na .5 .6 4 55 -84 7.5ry4/6 none is Osg mvfr na na .7 .8 9 9 ft. Depth to limiting factor +84" Remarks: Boring # 1 0 -15 10yr3 /3 none 1 lcsbk mfr 9W 2f 1 .2 .3 8 2 15 -36 10yr3 /3 none scl lcsbk mfr 9W if .2 .3 3 36 -86 7.5yr4/4 none is sOg mvfr na na .7 .8 Ground elev. 9 7.7 ft. Depth to limiting factor +86 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave., New Richm nd WI 54017 Signature: Date: 9 -12 -98 CST Number: m02298 I PROPERTY OWNER Brian Peterson SOIL DESCRIPTION REPORT Page 2 ' of. " 1 PARCEL I.D. ff 020 - 1300 -70 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 0 -16 10yr3 /3 none 1 lcsbk mfr 9w 2f 9 " 2 16 -28 7.5yr44/ none sl Icsbk mfr If .4 .5 Ground 3 28 -38 7.5yr4/4 none sicl lcsbk mfr 9w if .2 .3 elev. 9 6.9 ft. 4 38 -84 7.5yr44/ none sl 2mgr mvfr na na .5 '.6 Depth to limiting factor +84" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) of Safety & Sulidings in accord with ILHR 83.05. Wis. Adm. Code COUNTY Attsdt complete site plan an paper not Was than B 1/2 x f1 Inches in size. Plan must include, but PARCEL I.D. # not knited to vertical and horizontal reference point (BM), direction and % of sbpe, wale or Croix dimensioned, north arrow and location and dnrtanoe to nearest road. 020 - 1300 -70 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Tom PerilIg GOVT. LOT NE 1/4 1I4A 17 T 29_ •,N,R 19 fM W PROPERTY OWNER'..S MAIL ADDRESS LOT N BLOd(+e SLED. NAME OR CSM s 457 Jensen In. 136 na Par CITY, STATE ZIP CODE PHONE NUMBER QCITY OVILLAGE SOWN NEAREST ROAM Hudson, wT. 54016 (715 381 -2902 Hudson ICJ NOW Ccnatntction . Use I Residergial/ Nwtber of bedroans 3 (J Addition to existing halft 1 R flt ( J Public or COrrNrocial deaCr�e Code derived d* now 450 gpd RerAmmertded design W" rate ' 7 bed, 9MM2 - 8 trench, gpd* Absorption am required 643 bad, f1 563 trench, 4 Maximum do* t mft rate _.2— bed, g w _..a _ trends, w Reoommended infiltration strrtwce elevatiort(s) 96.00 ft (as rellwed to sea plan t wdvnark) AddiidonaidesoI aft comidsratim alt. site xeauires a mound svatam 0 81- 47 .fi' Parent material Pitted outvash Flood plain O etion, d t� d S : Sudable br systarn CONYEAfT101AL MOUND KGROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TAW U• UWAAWie br stem (3 S o u ca S ❑ U ! S U icy s Q U l S Q U S U SOIL DESCRIPTION REPORT Boring # Horizon Oe%h Dominant Color M Texture Structure C.onsisbor" idly Roots G P D Mwd In. Munsetl 4u. Sz. cmtt. Colas Gr. Sz. Sh. Bed 1. 1 2 -17 7.5 r4/4 none 1.s os mvtr if .7 .8 Ground 3 17 -84 7.5 r4/6 n one ms os .7 .8 . elev. 10 (t. Dep1h to fir rig ; factor +84� Remarks: Boring # 1 -8 10 r2 2 n 2 2 -17 7.5 r4/4 nacre sl 1 1 .5 G 3 17 -80 7.5 r4/6 none cos ail .71 . 98 M iercta +80 Remarks: CST Nama -Pkan Print gM L. Steel ph 715 - 246 -62 0D A a: 1554 UOth e. 1Ve Ric o�nd W1 irk 54017 Si�nepu Date: 9 -24 -96 CST Nte k ntOQM mnm� �ws��n r - e STEEL'S SOIL SERVICE Gary L. Steel Tm Perillo 1554 200th.Ave. CSTM2298 NEV4% S17- T29N -R19W New Richmond, Wl 54017 MPRSW -3254 town of Hudson (715) 246 -6200 lot #136- Parkviewr Estates Sixth. Addn. N 1" =40' BM-= top of NE lot stake 0 el. 100' for borings 1 -6 BM. for borings 7 -9= base of elec. transformer C el. 100' Alt. BM4 for borings 7 - 9= top of tel. ped. @ el. 102.40' �!' 31 � C �• �l 5 9A � tea A 4 , 5411- 01 .�� 0 .9° JZ7 2•�p d' 0 9 -12 -98 Gary L. Steel 9 -24 -96 i Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Laboi and Human Relations Division, of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code v COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # ti dimensioned, north arrow, and location and distance to nearest road. 020 - 1303 --70 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DAiE F i PROPERTY OWNER: PROPERTY LOCATION Tom Per' o GOVT. LOT NE 1/4 NE 1/4,S,17 T 2g N;R 19 0 W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #° 457 Jensen Ln. 136 na Parkvi w E CITY, STATE ZIP CODE PHONE NUMBER [:]CITY (]VILLAGE [MOWN NEAREST'ROADA•' Hudson, WI. 54016 (71-9 381 -2902 Hudson Carter Circle (x] New Construction Use [ )4 Residential / Number of bedrooms 3 ( ] Addition to existing building j ] Replacement ( ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate ' 7 bed, gpd /ft ' 8 trench, gpd/111 Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate __,L bed, gpd /ft . B trench, gpd/ft Recommended infiltration surface elevation(s) 96.00 ft (as referred to site plan benchmark) Additional design / site considerations alt site requires a mound system n t-i c)7 6 1 Parent material pitted outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for s stem 13 S U IR S EI U IR S E1 U 0 S ❑ U J�7 S❑ U EIS C7 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed lTw& ';.....1 1 0 -9 10 r3 3 none 2 9 -17 7.5yr4/4 none is osq mvfr qW if .7 .8 Ground 3 17 -84 7.5 r4/6 none ms osq ml na na .7 .8 elev. 10 ft. Depth to limiting factor + 8 4" Remarks: _ Boring # 1 -8 10 r2 2 none sl 2m r m L 2 < 2 8 -17 7.5 r4/4 none sl lcsbk mfr CIW if .4 .5 y y y 3 17 -80 7.5 r4/6 none cos oSQ ml na na . 7 .8 Ground el 98.9. ft. Depth to limiting factor +80 Rem arks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th e. New—Rictftnond, WI tgllklik 54017 Signature: Date: 9 -24 -96 CST Number: m02298 PROPERTY OWNER Tom Per illo SOIL DESGMIN I iurr ncrun i rayc 2 v, • 3 PARCELI.D. 20- 1300 -70 Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer W Z39§ "` 1 0 -9 10 r2 2 sl k: 3 .4 .5 . r . '{ 2 9 -22 10 r4/4 none sl lcsbk r Crw .4 .5 Ground 3 22 -80 7.5 r4 6 none elev. 9 8.8 ft. Depth to limiting factor +80" Remarks: Boring # :n 1 -16 10yr2/2 none Si 2c P1 mfr qw 2f n .2 4 2 16 -40 10 r4/4 none sil lcsbk mf' Crw if .2`: .3 :}pi:•i:4:•ihi: ii: Ground 3 0 -80 7.5 r4 6 n cos os ml na na .7 .8 elev. 9 7.9 ft. Depth to limiting factor +80" Remarks: Boring # 1 -12 10 r2 2 none 2 12 -31 10 r4 4 none sil f .4 .5 ................ 3 1 -50 10yr4 /6 none fs osq mvfr qw na .5 .6 Ground elev. 4 0 -70 10 r4 4 c2 7.5 r5 8 sil M na na na n .2 9 6.9 ft. Depth to -- limiting factor 50" Remarks: Boring # ::: ,.... 6 ._ 1 10-14 10 r2 2 2f .5': .6 2 114-25 10 r4/4 none sil lcsbk mfr 9w if .4 .5 3 125-44 10yr4 /4 none fs osg mvfr 9w na .5 .6 Ground elev. 4 44 -60 1 10 r4 6 c2 7.5 r5 6 sil lcsbk mfr na na .2 .3 96 ft. Depth to limiting factor 44" Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Tom Perillo 1554 200th Ave. CSTM2298 NE4NE4 S17- T29N - R 19w New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246 -6200 lot #136 - Parkview Estates Sixth. Addn. 1 N 1 =40' BM.= top of NE lot stake C el. 100' 311 ' (� -5 Sys „? 9A 3� th a C� /V 40 4e ` / � ) d Gary L. Steel 9 -24 -96 "OCT -09 -99 10.02 PM BELISLE EXCAVATING 713247303e+ P.01 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer b ri k h n e- we_r� 'I adi Mailing Addres d Property Address r �' (Verification required from Planning Department for new construction) City /State 9 1 4 2NI 01 - Parcel Identification Number 0 20 LE GAL DESCRIPTION Property Location � V., Y., Sec. 1 - 7 , T N- i.L.W. Town of Subdivision ,AAek" 11 ;!) Z &), 4- Z 1AW . Lot # Certified Survey Map # x �5/� 4 -� , Volume Page # Warranty Deed # 7/ -3 , Volume , f,. �� 7 ,Page # Spec house ❑ yes I g no Lot lines identifiable Kyes ❑ no OMM 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 purrtper. what you put into the system can affect the ftmtion of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zonin Department a certification form, signed by the owner and by a master plumber, journeyman plwnber, restricted plumber or a licensed pumper verifying that (l) the on -site wastewaterdisposal system is in proper operating condition and'or (2) after inspection and pumping (if necessary), the septic tank is leas than 1/3 full of sludge. I/wc, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as b• the Department of Commerce and the Department of Natural Resources, S tate of Wisco nsin. CemT'"dott statin hat your p ' yytem has been maintained must be compacted and returned to the St. Croix County Zoning Office within 30 da f the thre ` r expiration date. S IGNAT A APPLICAA'C DATE OWNER, CERTIFICATION (we) 90 that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the ownet(s) of the p ed above, by virtue of a warranty deed recorded in Register of Deeds Office. S_ / SIGNATURE OF APP LICANT DATE. 0 . 00 •• Any infomution that is mis- represented may result in the sanitary permit being revolted by the Zoning Department. 00000 •• Include with this application. a stamped warranty deed from the Register of Deeds office in the warrant deed a copy of the certified survey map if reference is made Y ,)0(7U NO STAT.' BAR O�F�l ONS LAND CONTRACT lndkiduA .�d (—p—t. S 714 i , IiZ= b SH) FOR ALL TI1AN. %VHFRF OVEK IS FINANCED NNI) IN ortivii NON - CONSUMER ACT TRANSkCTIUNS, ContraCt by and betw-en . Robert E. Oestreich, a/k/a 5T. "CROJX C o., ICS 1 - •------------------------ * ---- --------------- LRE 1� , T � Robert Oestrelch, and Barbara A. Oestreichl h us b and yyJ ..•..• __ .............. ....... ... . ..---- ------- -------•--- ------- ------ ----------- vvo and wife, as marital survivorshi _)Of�K�Y ( "V en do r ", SEP _�Kia Se ----------- I ...... -------------------------------- -- 1. 1998 whether one or more) a, 1 ... d__.n D_ Peterson and Lynne M. . ------- ----------- _ - - - - - Feterson, husband aiid wife as survivorship ivorsh ma r i ip t a 1 X4 ------ - --- - ...... .. - -------- -------- --------------- - ........ ("Purch-ser", whether one or more)• d1 Ven.r sells an airrees to convey to Purchaser, upon the prompt and full per- Of 0*6do formarce of this contract by "urchiver, the following property, together with the rents, profits, fixtures and otter appurtenant interests (all called the "Property"), in.. .... ---------- - 9. t — _QjZQ ix... ..............• --- County, State of Wisconsin: RETt RN To DUNLAP LAW OFFICES P.O. Box 129 Hudson, WI 54016 Tax Parcel No. , ' 0-10 34 -60, - 020-1039-80, 020-1300-70 Part of NW 1/4 of SW 1/4 of Section 17-29-19 and Part of Lot 136, Park View Estate Sixth Addition in the Tcwn of Hudson described aF follows: Lot 3 of Certified Survey Map filed December 26, 1q96 in volume "ll", Page 3199, as Document Number 553702. TRANSFER so * a/k l /a Barbara oestreich, s 5 FEE Th 'lo homestead � -1 homestead pro,.erty- (is (is not 1. agrees to purchase the Property and to pay to Vendor at _ vendor's direction - -------- -- - ... ------- ----- ---------- the sum of $___ A@�t.5 - " - ------------------- -- ----- * ----- in the ffillowing manner: (a) $ .... , ----- _ ---- _ -_ at the execution of this Contract; and (b) the balance of $ . 38 - .5 ' 0 - 0 - . ' 0 - 0 - ,: --------- together with interest from uat hereof on the Lalance outstanding from time to time at the rate of seven-, per cent per annum, until paid in full, as follows: Monthly payments of $346.00 principal and interest commencing on Octobe- 15, 1j98 and on the 15th day of each month thereafter, Provided however, the entire outstaridinr balance shall be paid in full on or before the _ ,Ith ----- - -- day A* ------ l t -, .- ( the maturity date). Following any default in payment, intere st -shall accrue at the rate of per annum on the entire amo in defaiilt (which shall include, without limitation, (YinLjUent interest and, upon acceIcratlion or maturity, the entire p balance P�ircbaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonnbly antici- ued annual taxes, special assessme fire and required insurance premiums when aue.To the extent received by Vendor, Vendor agrees to a payments to these obligations when due. Such amounts received by the Vendor for payment of ta.s�s, assessments and insurance will be deposited into an escrow fund or trustee account, but shall n, bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be preppid without premium or fee upon principal at any tirr.e/a�i4 / /Z/z / t / i / -/-/-/"/.'Z/Z/iS(//-, / /� OA4 IV,&A#Ay /Yptogy /opt) i10,4r/,6f 1 In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unnaid balance of principal, and interest (and in such case accruing interest fr)m month to month shall be treated as .repaid principal) is less than the amount that said indchtedne,;s would have beer. had the monthly paymer•LS been ma de as first specified above; provided that monthly pa merits shall be continued In the event of tredit of any proceeds of ;nsuranue or condeninati the condemn. - ^d premises being thereafter excluded herefrom. Purchaser states that Purchaser ` satisfied with the title as shown by the title evidence submitted to r•-irchasef f, examination except. No exceptions. Purchaser ag-rees to pay the ct,�t of future title evidence. If title evidence ..i in the form of an abstract, �t shall 1 retained by Vendor until the full purchase price is paid. Purchaser shall beent to take po.F,sswn of the Pr- Petty on. ..date -Qf- ------- ----- - Out 0' AN'U 1 C0 1 . 7RACT Individual and ICXTIV iiLP OF WF P:.' Cu. CPor.ce FORM No, 11-19s� li0t 115 PAX339 0 -Pun-chi,ser promises to pay j F! j e a Joe all taxes and a:< sn?:tq !E-vic'i c the 11 )r up Venv :or's interest In t- --id to del ver W Vendor cii receipts showing such paynient• *fy tjl , , . 4 , ' , Win J , I)A�Zpr �0 A '�n / �' A)l a X /J'/ it ,r inai tA ?6114'*% ir� � " 'n"P r I I t 4) ig u'rk A�J VkVk�f( W9 41 ' , - 71 Purchaser co%enant,t not to commit waste nor all waste to be committed on the Properly to keep the Property in tenantable condition and repair, to keep the Propert, tree from liens superior to the lien of this ;ontract, and t _ with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other xiion shall be fully paid an" all condit shaii te fully performed at the timei and in the manner above specified , Vendor v6ill on demand, execute and deli to a and encurnbrances., '�ept ,he P a Warranty Deed, in fee simple, of the Property, free ild clear of ail liens any .-ens or encumbrances created by the act or default of Purchaser, arid except: easeme. re�e and restrictions of record. ----------- ...... ...... ... .. .... ........ ...... ----------- ------------ Purch - a grees - - that . time . i . e is o . f . the essence a . nd a in 0:e event of a default in the payment Of arty principal or inter�_zit which continues for a period of _.J.Q.days following; the sp due «late or (b; in the event of a def:lult in . N& n performance of any other obligation of Purchaser which CCI•ltir.Lles for a period of ..-(_k - days 'allowi 9 w ritten notice tl Vendor (delivered personally or mailed by certified waii), tb-!, under this contract shall become immediately due and payable in full, :,t Vendor's option and without notice (which P urchaser hereby waives), and Vendor shall also have the following rights and ron-lic, ' :Cct to any :intitatiom; provided by law) in acci zi In to those provided by law or in e quity: (i) Vendor may, at his (,)pt:,)n, turininate this Contract and Purchaser'.; r throagh strict f with any equity of rt�� title and ititere,. operty bac', 1)4 , t in the Property and mcover the Ill I, "u" redemption tt, be conditioned upon Purchaser's full payment u� the ciitir I tAII&IIg halati,e, with interestthervonirom the date if default at the rate in effect on such iiteiAt,d,)ther,tniotilits,lue),.er�urt(i(,r (in whicheventidl amounts Previously g ;',,r failure t fulfill this Contnatau) a; rental for the pa;,! by Purchaser shall be forefeited as liquidated d el this ( o tract Yo ccompel . or (ii) may' sue for �pt,eifie perf ormance of ; il Prop-erty if purchaser fails to redeem) in effect on the d of ir•rr., -ii.d full payment of the entire outstandim- balance, with interest thereon at he rate default and other kniounts due hereunder, in which event the Property ,bell he auctioned at ,judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof: or (iv) Vendor may declare this Contract at an end and remove this Contract-isacloud on title in a quiet-title a--t',3n if the equitable inter o f Purchaser is insignificant: and (v) Vendor may have Purchaser ejected from posse"ion o 're Property and have a receiver appointed to collect any rents,, issues or profits (luring the pendency of any action or (iv) above.\ot. any oral or written statements or aetions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litization and 11 costs and expenses Av Inc U�iinv reasonable attorne.vs fees of Vendor incu-red to erforce,:ii:: reinu . ht-eundvr (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- currvA, ind shall be included in any judgment. Cpon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to °e appointment of a receiver of the Property, including homestead intervit. to :oilect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and app:.ed as the court shall direct. Purchaser shall not transfer, sell or convey any !egal or equitable :nterest in die Property (by assignment of any of Purchaser's rights under this Contract or by option, long-term lease or in any other Way) without the prior written consent of Vendor unless either the outstanding balance payable under t' '-:s Contract is first paid in full or the interest con eyed is a pledge or assignment of Rurchaser's interest t under this Contract solely as security for an indebtedness of Purc' In the event of ariv such transfer, sale or conveyance without Vendor's written consent, the entire outstanding ba:afire payable under this Contract shall become i-, due and payable in full. at Vendor', option without notice. fault of Purchaser. ik7 V COP, a 5, 1 �'F/ 2 T / 7 W7 any other subsequent or prior de en or may waive any default without waiving representatives, All terms of this Contract shall be binding upon and innire to the benefits of the heirs, legal rep or a valuable succe--sors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor f L-r_sMeratlon joins herein to release honwtead rights in the subject Property and agrees to join in the e of the deed to be made in fulfillment hereof.) liated this 15th day of September t9 g8 --- tSEAL, (SEAL) ROBERT E. OESTREICH, a/k/a BRIAN D. PETERSON ROURT 08STREIC14 4 (SEALi C 4 . / .(SEA BARBARA A. OESTRET CHf a /k/a LYNNE M. PETERSON }BARBARA OEStRtICH AUTHENTICATION ACKNOWLEDGMENT Signatureks) ------- ---- -- -------- ------ -- ----- ---------- .... STATE OF WISCONS ss. ------- ---- ---------- ----------- --------- ...... ---------- County. henticate(i this .__._. of_ -. -- -- ...... Personally 1, came before me th .- - -- .-.day of _Se_p _g r 1 the above r "an" C-d . �f�v�b - ----- ....... ---------------- -- ---------- I ..... Robert E. Oestreich, _13 r_ek A. -. C . streich, Brian D. Peters(?n, and L Peter ------------ ---------- - -- --- ---- _1 - ---- ------ ........ TITLE: MMIBER STATE BAR GF WISCONSIN -- -- ---- - - --- -- -- I ------ (If not, --- -- -- - -------- -- authurized by § 706.06, Wis. Stilts.) t me known to be the persnn S W for,2goin- in rUnIc"t and ackno ge t AR r THIS INSTRUMENT WAS ORNFTED BY � r � STEPHEN. ,J_. J._ Hudson, ,W -. Notary Public St. Croix - --- -- - -- ----- -- ;.mature- may be aut�,entieatod or acknowledir(d. Roth c is pernianent.kF- .e not necessary.) �� ` \arn,`y of Prr.�r.r ;i¢ninti• � .ar,i_..y .. .. — State 13- nr Wi—n4n, Form No. 11 - 11S= s FILED DEC 2 61996 110 5 KpTM�IH.WAL6H �� ' CroL CO 553'702 a � CERTIFIED SURVEY MAP Located in part of the NE1 /4 of the SE1 /4 of Section 18, and in part of the NW1 /4 of the SW1 /4 of Section 17, all in T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; being Lot 136 of Park View Estates Sixth Addition and also Lots 1 and 2 of Certified Surve Map recorded in Vg L l l N 7 Pg. 3169 at the St. Croix County Register of Deeds Office. n B Aluminum County Section Monument Found 4J C w 1" Iron Pipe Found 0 0 � 0 2" Iron Pipe -Found OWNER 0 1 x 24 Iron Pi:.e Set, weighing 1.68 lbs Robert Oestreich 0 04P c v'o per linear foot 955 Trout Brook Road Hudson, WI 54016 L_ c co • • • • • • • • • 50 setback line 0 z d c L_ Previously Recorded Dimension ■ Aluminum Pipe Found i „ ° 0 Existing Well N N 1 E , o Existing Septic *' UNP ,�I T,1NUS �— F - -� L Ek. Corner of Section 17 OP� Wk Corner of Section 17 East-�West k, Line of Section 17 Ek, Corner of Section 18�� (N88 E N88 945.48') ° , 11 �. N88 54 1 54 E 945.02 4339.28' J� .•' 040154 11E (N88 °11130 "E) 11.35' N54 0 36'27 "E o t tt 185.291) i 2 i L -' 185.37' (N55 12 20 E �v, o_' ry� vil r)1 (DI PARCEL IN 533/471 Ix „� ; Cn ul >I 0_1 Lrtas ��- LOT 1 N W W ciI 0 � r• •.D o House Shed N C0 cv o ;t xtP trn 15.82 Acres Ui 688,958 Sq. ft. M <�11 Shed LIN UI N88 0 58 1 23 11 W 477.43 ' .9 r , \� \� •0. 427.40' a Vi LOT 2 ° MATCH LINE i° SEE SHEET 2 of •3.35 Acres °z 2 SHEETS' 146,050 Sq. Ft. 5t u' �...!' ..• . �� 'v' 275.34' 400.80' S88 0 02 1 �2 11 W 676.14' ci— r (N88 0 28 1 00 11 E 675.911)I 4: �! �O o 0 Q� TROU I �ll/QQ�S T BROOK 19 18 17 16 NOTE Lot 2 can not be further subdivided. The bearing and distance from point ®(NW cor. of lot 1) to the Wk, cor of Sec. 18 along the east -west 4 line is S88 ° 40'54 11 W, 5292.45 feet. Scale in Feet 50 100 260 300 This instrument drafted by Michael Erickson Job No. 96 -79 SHEET 1 of 2 SHEETS Vol. 11 Pale 3199 I r ,t a CERTIFIED SURVEY MAP Located in part of the NE1 /4 of the SE1 /4 of Section 18, and in part of the NW1 /4 of the SW1 /4 of Section 17, all in T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; being Lot 136 of Park View Estates Sixth Addition and also Lots 1 and 2 of Certified Survey Map recorded in Vol. 11, Pg. 3169 at the St. Croix County Register of Deeds Office. OWNER Robert Oestreich 955 Trout Brook Road Hudson, W154016 _l71 1' PARK VIEW ESTATES ,5p•03 342 2 °48'25'►E - - -- MATCH LINE L QT 1 36 -32, /1 SEE SHEET 1 of 2 SHEETS LOT ` 3 801) 2 \ 50.00' 365.86' •0 ` 9 : �' S88 0 56 1 55 11 W 415.86' S88 0 56 1 55 11 W 386.40' P 0 1P 0 o, SIXTH �� 0 9I TI�?v -� 0 L OT 137 CURVE DATA t� 1 -2 RADIUS = 80.00' CENTRAL ANGLE = 45 0 11 1 35" AREA LOT 3 CHORD BEARING = S10 024112.5 11E 1,27 Acres CHORD LENGTH = 61.48' 55,165 Sq. Ft. ARC LENGTH = 63.1e' TANGENT IN = S12 ° 11'35 "W TANGENT OUT = S33 ° 00'00 "E ?; Ct N N CT N 4 a 0 o c -° rt c o 1i YC L o \!\\ a w m m O 3 i.+ a-) N N L C rr N f i E L N 7 2 m d m O t0 I 1 V t0 SCALE IN FEET 0 50 100 200 300 SHEET 2 of 2 SHEETS Vol. 11 Page 3199