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024-1005-80-000
ST. CROIX COUNTY ZONING DEPA `�.. AS BUILT SANITARY REPO t>'"` Owner N enN%gv\ 0 y Svh R c F I mJ RECEWD Address 1 24 C o (/ P T RO fo - z 'rf� City /State 1fi KMNIVV y/J-S ! 1999 G. ST CROIX �(7lJNTy Legal Description: .z0► �, Lot Block Subdivision/CSM # '/4 SW Ya _2JE, Sec. S , T Za N -R_W, Town of heel t- ,t V8ll -r 4 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Cdr4Qv Tank manufacturer. Ng" yr a t Size STJPC Setback from: House — Well I P/L 1 3 0 Pump manufacturer 20 e 11 — Model `I Y Alarm location 9n,, fe, 1, 4 -r✓ -X (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location , �- Alarm location SOIL ABSORPTION SYSTEM Type of system: I ��UNYJ Width Length ` 7 ) Number of Trenches 1 Setback from: House _i -- V Well 15 O P/L 4 10 — Vent to fresh air intake $� ELEVATIONS Description of benchmark t [Quit✓ ���"� 1 h h owl v o� S e Elevation Description of alternate benchmark P = taik mo-plHok-b�- R=IVb Elevation P�^�P F1- 0C ., r I.E'r Building Sewer ST/HT Inlet 9k' 7 1- 1 � / d PC Inlet PC Bottom q� + Header/Manifold 103 Top of ST/PC Manhole Cover Distribution Lines( r 13 �� O 103 I/ O f 0 3� 1 Bottom of System( ) I ( ) (d Z Sb ( ) Final Grade ( ) 10 I � () ( ) � " j Date of installation /3 ` Permit number 1-: 1 ��(State plan number a Plumber's signature License number 0 l j Date /'7 Inspector Complete plot plan 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. o ' V? r. i �Cu Vr vi N E Or > J U pi Oi p O --� Ix H >* –Oa0 y+' [ U {jyj U Ot \ i0 -E0 O 'r t� Q u ~ ' fi r >V O'OO I-7 9 >4 11 LLI {+ H4' X L a-P E 0.0. 0 E S Go 3 --Z a i UF O I�JIY�I+ d OM V J U r r d U Cu V J d O Oi S %S W k 3 > O X O) f 00.9 1 00 U+ d _a o 0 0+ L4- 3� CL L Go C) + S cu E Lt i E�C3 00 3 --. L q Or p EE3GoEQ~ V d UI FUSE O a i –ONLd o 94 U E +'O E L;_U ~ L NOOd W Or E O L N W L d Ul > > U 2 -5 1 4 E +- > O. cz i O d cu (4- 3 d s r�4.w�wr i'f`7 d q iu o d 6 4. 3 ogre t x, d re d O ? 15 O J�Gpt'�QPG CL Z Rk N Z \ Z pooa A:�unoo I ' i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -: IX Personal information ou rovice may be used for secondary purposes (Privacy Law, x.15.04 (1)(m)]. 344546 Y P Y Perrt�,i�t H Id r' Name: E] City E] Villa e Town of: State Plan ID No.: ri EIAUCH, HERMAN PLEASANT VLY CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: 024- 1005 -80 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 10 * 6 Benchmark"' .2.1K 0& D y. /f 6q Ig' Dosing /Yl G. / 00.22 Aeration I Bldg. ,. Sewer Holding t=om Inlet TANK SETBACK INFORMATION St/ TANK TO P/ L WELL BLDG. Ventto ROAD Dt It4et Air Intake Septic > 5'0 f >5D 01 ! NA Dt Bottom /34 qa• Z ' Dosing u � ` o't� NA Header /Man. 3. t ` 103• I� Aeration NA Dist. Pipe W X 2- 1* 3. t2 Holding Bot. System 3O(/ PUMP/ SIPHON INFORMATION Final Grade S Manufacturer GZ� Dem nd (,.Z l00.i Model Number ✓ lip CM �34.1 TDH LiftOj�(/ Friction System TDH t iA Forcemain Length ��� Dia. 2 "` Dist. To Well SOIL ABSORPTION SYSTEM g • 3 Q(^ 6 BED/TRENCH Width - Length I No. Of Trenches PIT No. Of Pits n e i Liquid Depth DIMENSIONS � �J IMEN I N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING CHAMBER Manufacturer: SETBACK INFORMATION Type O � i r .> s.,� Model Number: System: 0�, .2 �j�- OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipes) 1 �� x Hoe Size x Hole Spacing Vent To Air Intake Length arQi Dia. _ Length rt Dia. Spacing � a r--. 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.) LO �P6 A�S,AN'�' VALLEY �5� . 28.1? . 31, SW, SE 164$ CTY RD Z a , Cet k94Q A % - 6 w r l� rec Plan revision required? ❑ Yes [K No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E 3 k e - 3 t b 9 v . e 1 t . & d 9 m 6 - F s . m. m r a p k f i E t t p e..m 1 �. w� .. e ..,. a ... r .. ....«..,.. a ..e ..m- . v... . ...... .., ..n. .. .. _ . e .... e... ..,, ... i j ? } i c { 4 1 4 � ; 4 = m e, .v D t J ...� �. . .. a k � v E e e e g 9 s t _ y ve E k Safety and Buildings Division 14.4consin SANITARY PERMIT APPLICATION 201 Box Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. 0 See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes ❑ Check if revisioWto'previousbpi, ion [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION 139147 Property Owner Name ii Property Location ® r►t i n W 1/4 S f_ 1/4, S T s2 8 r N, R/ P (or) Property Owner's Mailing Address Lot Number Block Number J C2J Coon Rd4) City, State Zip Code Phone Number Subdivision Name or CSM Number 6 n�I (7 > II. TYPE F BUILDING: (check one) E] State Owned �t ,,// Nearest Road // Public 1 or 2 Family Dwelling- No. of bedrooms -3 & own of /��/ C ove III BUILDING USE: (If building type is public, check all that apply) Parcel Tax Numbe Z', / �, 3/ 1❑ Apartment/ Condo 2 I V v� 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 1V. TYPE OF PERMIT: (Check only ne box on line A. Check box on line B, if applicable) Y pp A) 1, ❑ New 2. X eplacement 3 [] Replacement of 4_ C] Reconnection of 5. [] Repair of an ------ System ________ - ystem _____________ Tank Only_____________ ExistingSystem ________ Existln- 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 2 Bound 30 E] Specify Type 41 []Holding Tank El Seepage Trench 2 In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill ("art levm._ /Of/. 3 VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. Sy�e 7. Final Grade 5-0 Re uired (sq_ ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation r 3 9, J 140 Feet a acft VII. TANK in g Total # of Site INFORMATION Manufacturer's Name Prefab. Con- Steel Fiber Plastic App- Gallons Tanks Concrete glass App. New Existin structed Tanksl Tanks tic Tank r an �r� ❑ ❑ 1:1 ❑ ❑ ift Pump Tank pl a44v"Tber 0 6JV El 1:1 11 El 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) Plum er's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: 1-e k r G �3 7 �s s 3 � Plumber's Address (Street, C jr'51 State Zip Code): AI v H "d U1 S IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent gn ure (No Stamps) Surcharge 1y Approved ❑ Owner Given Initial SM l e� Fee) / -1 . I Adverse Determination l ND OVAL/ A RE�NS FOR DISAPPROVAL: °l SBD- 6398 (R.11/97) DISTRIBUTION: Original to county. One copy To: Safety & buildings Division, Owner, Plumber i 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. i 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 forma IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans aMtl s{1s'cifications 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 manuffcturer; 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. ---------------------------------------------------------------------------------------------------- GROUNDWATIR 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. f • Safety and Buildings 2226 ROSE ST LACROSSE WI 54603 -1905 TDD #: (608) 264 -8777 N visconsin www.commerce.state.W.us Department of Commerce Tommy G. Thompson, Governor Brenda I Blanchard, Secretary June 28, 1999 CUST ID No.220499 AT7W. Rod Eslinger ZONING OFFICE BRUCE ALLEN WEBSTER ST CROIX COUNTY SPIA N3659 CTY RD C 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 06/28/2001 Identification Numbers Transaction ID No. 233147 Site ID No. 175150 SITE: Please refer to both identification numbers, Site ID: 175150 above ;"all correspond with the agency: St Croix County, Town of Pleasant Valley SW1 /4, SE1 /4, S5, T28N, R17W Facility: Herman Heinbuch Rental FOR: Description: Repl. Mound Object Type: POWT System Regulated Object ID No.: 476135 ( � 1 c L �7 The submittal described above has been reviewed for conformance with applicaoic les and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Adm. Code. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. � incerely, DATE RECEIVED 06/17/1999 FEE REQUIRED $ 180.00 D ennis R. Sorenson FEE RECEIVED $ 180.00 Wastewater Specialist BALANCE DUE $ 0.00 (608) 785 -9336 dsorenson@cominerce.state.wi.us Wi MAR cock„ 3', i t " PUN p P � N5 Fog M ERft*N hfTP P EAML- o f 'lq sec, 5 7T 8X A/ R 17 w P Vg Jj ej Tc u✓h Aip Pa „e T s dt Pc y t Two / Alcie 5 C p 14 h vi p 4✓' ��� C r� +� �� tyc s TA CV055 a F��Y pip, �9 ` C�►�� 6�r rJ�� ���`'��� RECEIVED D JU 17 1999 SAFETY & BLDGS DIV. �h8CON�N; f �q�ainua�a ►+""`T G'� � County Road Z 2�ob$9 � � 9 Q 9 � a bd a d s LAP I ° C�' �° c � ;, g� TAY m a s a 1 W m � � N X N W 0 N r0 O 0 C3 C3 £ "+r- fi O `+ h N- W Es-,+ n C . � n o ° g � � RECEIVED o�o o�•� ' N Q JUN 1 7 '1999 �,-o c am, 8 c `�� fD I -q ° o Z SAFETY & SLDGS DIV. m In rp N O r !] ` ` p ° F n � � � z PRIVATE SEWAGE SYSTEM 3m fo Conditionally 0 3 ,AP P ROVED Ul N ` DIVIS ON OF SAFETY ND BUILDINGS ON 3 N P O r C-) tA m£ c 3 n cn SEE CORRESPONDENCE - 1 ro N, NQ- H 2 Z -0. r-' 3 = Q o�uu :a: amc' ;rriiy� X `+ �1 C O N S�� %�i 0 p V 0 O fl O j BRUCE ALLEN : _ S h = WEB S� S } = 3 N }' U1 = 95 `� TM ISCONS ro N rp fl avp ` i` � �, �f� r t •.i.:* .r .. a u � ** :n = � a a� �., ' ° ;�� ` r : f y��'Fq° ir'• M14 '�',�* * .� 4 fl r ^v "�a i i +: "t,�'�'�_ � � �,,•,. . rc IL J ' • PageLOf 6 Cross Section Of A Mound Using A Trench For The Absorption Area . �OZ s T 0 m Sand Fill ° F 6" Topsoil E D « ' Plowed Ld�er� Trench Of 11 - 2 Aggregate, 6" Below Pipe, Covered With D Ft. Straw, Marsh Hay Or Synthetic Fabric 2oeler 5 45 f{t-j Rely l 'kX el'e rhil.0%Vn elc Ahl 0- E �• Ft. G Ft. Mode PM � ,tt,►, For m o� .# ar v55 �` %t F Ft. H �^ Ft. 53 /ro +s I II � `'`�� , S - '`�� RECEIVED JUN .17 1999.' Mna' Plan View Of ;'found Using A Trench For The Absorption Area ' SAFETY & BE ®GS DIV. .1- ¢ Force Main) �,,,,,...,...... J Distribution Pipe Permanent Markers Observation Pipe M E SYS� W 0 , � \\ B ® K \ " Aggr t ' Trench Of h 2� v 5 I � , � ANA NCE p0 DE r L A t. I. .. �. Ft: K r I��Ft. W B Ft. J. Ft. L Ft. License po Signed: Number: Date: l ,/. v Page_Of Distribution Pipe Detail For Two Lateral Network Holes Located On Bottom Are Equally Spaced PVC Force Main End Cap 7 f Y P X X PVC Distribution Pipe P * Last Hole Should Be Next To End Cap P4 P Ft t! X n ' Hole Diameter Inch b Inches Lateral Diameter �1� Inch(es) Y Inches Force Main Diameter Inches # Of Holes /Pipe 7 i Invert Elevation Of Laterals Ft. y � S!��► A � � �� � y t la f Signed: 00 �-- I !' License Number: � p Date: A ?E St*pGF gY$ PO V iti orta 11 Y a „nCO111111a,� Cott CON G� I BRWUCEALLEN * _ rt SAFE A 0 W ►M =' �SI N C E R E S P OND E SEE COR 'F x Pa 9 e Of C r P COM L B SEPT IC TANK /PUMP CHAMBER - PVC I (No Scale) 4" >< Vent t Pipe e w th .Approved Locking Manhole. Cover Approved Cap+ �5; With Warning Label Attached From 13uildings } , W - Weatherproof A arming Labe} Pproved _ Junction Box . Vent Cap _T �-- 12 Minimum F " Final, Grade 6 Minimum , -.� N 4 Minimum 6 Maximum t� PVC �, 4 � I �8 F Minimum• Quick Insp.' Pipe � Disconnect t 1/4" Weep i Baffles -. Hole "gtttnun;r• u„ � I . 1 . ��j -� • � � b f BRUCE ALLEN Ala D-1195 s = On � tip c M EuswoRn+ _ stN j' t P CON "E �s � K r SyS d�` fi pGE PT Na S .. • (��`' „nm di ITH Off Q” J q3 VED PIP E ti ONTO 'ix c o OLID SOIL Conc. Block 1 r OF SaF: of Beddi nq Under Tank-/ Pu and NGE R Q eparate Circuits Number of Doses' P C pR e r Day SSE Gallons Per Day / o7fi Doses: Gallons Volume of Backflow:.......+ �. Ga }Ions Manufacturer: ! tyres yH rec4f4 .Size- Septic /Pump: QOp Total Dose Volume: ........° 1 Gallons 'a Manufacturer: a ons � .h Type: Capacities: A inches or �� Gallons Manufacturer: ° ��� wr + B — � i nches or 't (Number: C , _ h�-� + = inches orGallons hum Discharge..ate: + D !8 inches or o Gallons • Total .....- __jj__ inches'or C Lo Gallons Ical Difference Between Pump'bff and Distribution Pi e: F ` I hum qui red Supply Pressure: .........:. p Fe et a� rrtrt te- ..:..:..:.....+ l .I Feet r 'Cl M �ei f '_Fed o ,g f Force Main x Friction. Factor/100 * Feet: *' + i — 0 - eet D I ch Diameter Force Main e e St� r 1 Total Dynamic Head: _ , tl 5 �3 Feet p �� S nal Tank Dimensions: Length 13 Width �O • Liquid Depth Signature License Number b S Date 1 a HEAD /CAPACITY CURVE EFFLUENT & DEWATERING TOTAL DYNAMIC HEADICAPACITY PER MINUTE 53-65 SEWS 07-60 N 137A30 ,0114164 1103/1443 1051/106 1-6114106 /Q14106 10410 104in 34 R 14; OAL L7k GAL :l'rll:: GAL -:ETJE GAL :''112:<. GAL ;;61yt:� 6Al :LYlF: "L; GAL 43 105:'! n 2 '. 100 :'i06.� Iq ..; :?!61". tN '� 10 u 4 of n too : >< et e i ,ao .. tq 164 15 10 71 q 170' N 60 3l4F::; ` p -.::: 142 30 N 9e 1 25 36 Afts; 2 s 16 a 74 74 67 M t I 90 >p {... 00 56 Sa 20 q . 4Z1R' ::i . q q es 33 11r ! 61 12.1 16 cl>R 611 14 80 q >• :`i21�:` a0 Zbl' q 22 n i'3;fIS> , aa. a0 70 t,ea 14 0a : q : 474 i 2a .i: si iq 2t3 > > ; 32 2 37 1S 21 110 to Lock Va 1925' 2r M' S0• 00• or 7r 115' 91' tir 55 183. ,a 1 WARNING: Model 185!4185 should not be subjected to 50 I 30 feet TDH. tF 45 OTE: Head Capacity on Model 112, Industrial 4o column ex sion proof pump, see FMO219. \ 3s a.4,as 30 1-69,4189 Is? 151 4 IS 10 788,4188 /A� i �y s 53,55 137,1]9 O'` 57.59 U.S. CkLONS 10 0 1 30 40 1 1 70 80 90 100 110 120 10 140 SD 190 00 SKS413 :..; 0 FLOW PER WNUfE ' SEWAGE & DEWATERING TOTAL DYNAMIC HEADICAPACITY PER MINUTE 75 SERIES 202 no, 267 .264 2-62/1262 2W42M 202/4292 20314293 2W4294 29514295 22 :: FT. 01 4An Gal lh#" Gall p,l 1 Itis: Gal. Lfilk: Gal..ktrjt.; Gal.1E p4{i GaL tAy fial.:' Gal: 70 s fl2c< 90 .144 =124 in A to Aft. 130 :: tao 901 .tit 2u - :2E} Bs 10 :'St ao a 411' n - ;511' q 'l:': 95 :: i5a 1f10 121 iNt:. ta1'.`:iRR 200:1'110 is , 225:10 50 140 s0 aq 50 110. 83 2J6 135 544: 100 >161: 130:4/1: t66 ;:4?b 146 '704 t B 0 20 tlx: 10 ?0 t0 :: 10 7F 33 106 as 7511: • tt0,1154' 100: i t0t;::Nld: 2s x r0 11 q : 106 - Yljt. 1x.YNiI 153:"110.k: 55 30 :RfO: 43 164; q : 171f: 90 714p u1::#a1 1q;i1f70' 60 4d2rz " se � 09 k; 14 ' 60 4R21s> t3 M q;? 45 - .. 12 ±O - 11 Lock VaNa: 110' .:. 21.5• 21.5' 21.6' H• 30' 1r ' 00• hY 7T' 35 WARNING: Model 293/4293 should not be subjected to ' 1111; less than 15 feet TDH, 30 8 ?< 293,4293 r 25 , d \11tl1R41I1 Mill/ 71111,i 1 s 282.4282 ga��� 1S C U 4 10 2e4,42e BRUCE ALLEN ` WEBSTER S 5 292.4292 0 t D -1195 S 266,267.268 262 t g 294.4294 295.4295 ELL$WORTH t3CdN3M AA U.S. GALLONS 1 0 201 30 40 50 1110 1 70 80 1 90 1;0 120 130 140 150 160 170/8019 200 21 220 230 iy 80 160 240 w. 32Q. 7 1 4' G 1_ �.�I` >�u .: ', .,,.:X < ;. <_ ,294 ................ ::,.:.,..<:.:,;., :::> r► r n/Iryl tt ►1111\ \\'° i. FLOW PER MINUTE r� r f Wisconsin Department of Industry SOIL AND SITE EVALUATION m REPORT Page _ of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code ` COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REMWE Y DAT —i r. PROPERTY OWNER: PROPERTY LOCATION vr►m an k6 r' V h GOVT. LOT � 114s 1/4,S T N,R 7 X( W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE MOWN NEAREST ROAD [ ] New Construction Usp ] ;ts3 Residential / of bedroo 3 [) Addition to existing building [ ' Replacement '; [, ] Public or comme�aN describe � "! Code derived daily flow gpd '? g g a gpd/ 2 _�trench, gpd /ft y r Recbmm nded desi n loadin rate 5' bed, ft Absorption area required a Y bed, ft gfench, ft2 i Ma imum design loading rate bed! gpd /ft trench, gpd/ft Recommended infiltration surfs 96! ation s f �( ft (as referred to site plan benchmark) Additional design / site considera rte,. AWL r Parent material Flood plain elevation, if applicable 1V it S = Suitable for system CONVENTIONAL D IN - GRO ND P ESSURE AT - GRADE SYSTEM N FILL HOLDING TANK U= Unsuitable for system ❑ S U S❑ U ❑ S ❑ S ❑ S I ❑ S 3OU SOIL_ DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Botndary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trer& D-$ to R 2 - ro d 3 I d YR 4 /1 C 1 r 5 rR 5k 1 I( f S V' 0 G .Q e o ng facto g Remarks: Goring # 2 x E3 I i i± MC k s o. Ground 10 0 f 5 1 elev. ID L( tt 10YR S N 1� ' 0.9 � 04 Depth to 31 -17 t7 YR 5 /9 I tr 5 YR 5/y S T S 1 0 'V 'i b 3�.yq ] 6 51R 5 s 0,� pe �� ',. /�[le �/� 1 I �11' �/V � r"y �O .1 �� ✓ e OV Remarks: hay .V i CST Name: — Please Print Phone: tC�� � 7 Shy )V ddress: Signature: > f �f// r Date: r � O CST Number: (zwso'a!oemoss :Smjeweu 1 JON Bu.4!wg of Woo i •na!a WOE) E3 # Buuog mliewaa Am Bu" W U!da0 Vla Puna) I O # Buuoe :s�l�ewaa AM Buq!wg o! y(daa - 'l1 .AGIa punoig # Buuoe J CQM o6Lodea s� Sir 11 h �'AOP 9 , 0 Mr � ---, oti_fiz, pun(q) i LpLai P US 'zS '�J ao u n stood �Geptnoa aou8ls!suOO. amlxal IOO oo O Ilesunol u! uozuoH # Buuog I ll /OdJ ainlonilS S9MOIN aoloolueu!wo0 UidaO 13OHVd to —aged laOd3b NOIldIHOS30 1108 �:nCvi d3NMOLW3dONd Noe County Road Z I a� a tj S a0 M 0 0 a p m 0 U a W W w N N N W ai.°` = e � r0 t < n < UI N O o 0 0� m c +0 p 0 h 3 N v (W D p cl 3 n (n a p A Oti 3 :T n m F- � N p o C :) M N P s 3 , t 8 �+ fi 0 �F !n M Q MtA�� �m N a ° �0 ` I -fp n ,+n FIV 3 co s 0 c (n to o �_ bd -q m � 3 r 3 p m U1 0 p 3 n Ln m Ul 3 n 3 (O 0 :5 Z P ► 3 3 x e+ 70 0 < c+ "0 — 0- m U1 K 1 3 C \ 3 O n o 3 rp -A to P l< to 3 m 17 n N 3 P P 3 UI c++ P ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM I 796 S1.) Owner/Buyer J) Mailing Address -16 ©v n ice, 0 5� �-��, rhos �✓� s Property Address i c,0 n D ., m o h j �' S (Yuificatioa requirrd from Ph=iag Dcpatmcat for new construction) IV of Fok of w C A&9heV 1 l L '" city/Statc ���?kY?cn ") ICJl ohcln Parrci Identification Numb - J�o i E AL DE Oa �s = so -zed Property Location 44� �( . Sot. T / N R Town of ! _ Subdivision Lot # - > YO Recs Certified Stuvcy Map ff Volmno i'agc # Warranty Deed # Volume . Page # SPcc.bouse ❑ yes no Lot lints ideatifiable 0 yes ❑. no 0L91 •WMA'IIHMWANCE Iu � cv p aa9eurd �yooaIdzbtmia�tt4 . iafaanW bandlewastcs.Proper oetesists of pumping oat t CVay t= Yc= oc zo=cc, if accdcdbq a YioaLSOdpua Wlrtt yua put.into >#x system eaa:ffoct�ic of tfLe septicfiank as s. ti�atm�nt stage in du v�asGc d'i IsysGcm, .. . � so owner ago= to mbmit SL Crolm Zadwg DTactmcati =affica foray, cigacd by ge aowncc sad by a > PT, j amcnc y uzaa P lmmbcr t + atridplramticror ' :fixa9odpmuperifyiagQzat(I) tiieoaaitcvrastcwatadssposatsystem is in Props orating eonfitwn an&or (2) afta•mspoctioa and pmgmg.(rf w=uy), the uVd tank is less dran II fa of sludge. ifs �mdczsigued i�av�e.rad the abovr t sad sgroe to maaotaiit i Pn sewage disposal system wiaL staadaids ect fob, �� set bq the Depart scat of tbmaretve and the Dc�rtmcat of Natzual Rcsomrocs;, State of Wrsonusia_ Qttxfcahan tfiat Y oar tcPt'c has ban mafib cd must be eom*tcd and rrbamed to the St: Qmix County Zoning - Officc wM a 30 days•of the M= year c3q iMtica data 1 +!`/ Sl TURE OF APPLICANT DATE OV'G'NM . MCAMON Y (we) =Z* that all stags on this form arc t= to floc bat of my (our) knowledge. I (we) ant (arc) the owna(s) of tic property dcsa bed above. by vir* af- aaty dcod rocord' od in Register of Dodds Office. X SIGNATURE OF APPUCANT DATE s «a « «s Any iaformatioa that is mis mn « « +•t° ed y result in the sanitary permit being ncvoked by the Zoning DcparhncnL «« Include wi(h this appticaffoa: a etampod warranty deod from the Register of Deeds ofroc a copy of the certifod survey map if mfcrcaoe is made is the warran ty deed t aa at"*Vto "01 Wee"I DA TA [1CX:vMEf�IT NO. BTATIC BAR Of Wtli�I+IEI3�i' lit0 1-- 1>ll�: Tum ar WARR On-0 VIP p � 1 RECA3TERS OPRC! This Deed, made between -_- Hen _R._.t hjCh_aW- a.___•• 5T. CR04X CO., WISr ;I tie t+» Naiabt ti..•- atg3.DeltaY s.G... HF►dr , �r?�_ a_IJ�l�r ... ket'd. for Ro=d llsi 18th Heinbuch,. Husband, and Wife- ss Venan:s- .in.- Co[[m,_- an..._._.. --�— undiviided one°half..interest._each. _________ ________ ........... Grantor, Oct AA 148 and .__- ....9ur1.- RLdge.. a=s,... Inc -,. a_ Wisconsin_Corporation. -_ - - -- of 0 A M. ! .......... .. ............ .......•......- _...................... ........ - •---- ...._ ......................... e } _ .............................................. Grantee, at Wit nesseth, That the said Grantor, for a valuable consideration._..._ � r _ .......... ............................................ • - RaTuFm To conveys to Grantee the following described real estate in - . - 5`t. - X - ._._._.._ County, State of Wisconsin: The East Half of the Southeast Quarter WiSgh) of Section s; Six (6), and the Southwest Quarter (SA) of Section Five all in Township Twenty-Eight (28) North, Range Seventeen a: reel No: ................. _ ...... _.......... i. (17) West. That portion of the East Half of the Northwmst Quarter (F3 ) of section Five (5), Township Zesty -Eight (28) ,Range Seventeen (17), lying South of Interstate Hi.p qy "94 ", consisting of ten (10) acres, more or less. Northwest Quarter of Southwest Quaxtier (I SW4) and West Two (2) rods of Southwest Quarter of Southwest Quarter (SW hSA) of Section Four (4) ; West 11 of Southeast 4)arte' (W% S' ) of Section Five (5), all in Tawn&Ap 28, Range 17. r. V FEE This _...is. --_ _ ...- ._. -.., homestead property. (is) (is not) Together with all and singular the hereditament= and appurtenances thereunto belonging; And-, _ -- Herunar, R_ Ileinbuch,a/k /a- .Herman Heinbuch, ..and Delores C.Heinbuch,-- .a/.k /a. Delores warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except Heigh easements, restrictions, and rights -of --way of record, if any and will warrant and defend the same. Dated this .. - LSt _... ._.. ... .. day of .....septg3hber -- -- - ---- ----- --- ---- ... 19_ 84. (SEAL) C /.T"t LLLC� f P L . .... .(SEAL) . ..... .Hern�n Reinbuch, a /k /a Herman Heinbuch -- _. . - -- _ . - . Ii . . . _ . ...... ....... - - (SEAi) ]l f �t '�.<��1 .... _(SEAL) / . ' Delores C.Heinbuch, a /k /a Delores Heinbuch AUTHENTICATION ACKNOWLEDGMENT Signat of. Herr!- ra .R.._j ich,..a/k /;� STATE OF WISCONSIN Hen fieinkxlch, y arx3 Delores C. Beinixich, sa. a/k Delores -------------------- - - - - - -- -- - - - - -- County. aut e t Js�.. ., of. ' `'t._.__ 19_ n 84 Persca i - came before me this ............. ...day of r .......... - -------- ---- ---- -------- 19.. .... the above named -- - --• .. tT- ..._ .. -- s Lech - .A -.Beskar..- - ------ ....... TITLE: "' =EMBER STATE BAR OF WISCONSIY Of not, - --- -•- t suttorixed by § 711'.06, Ris Stats.) to one knu r to he tF,e person ....._ - -.. . who executed the foregoing inakr)ment ar-d acknowledge the same. �. TH.S -'J31AUMF.Nr WAS DRAFTFn BY loo A. Beskar, Attorney - Rodli, $es;�� . A . . wle§ S C. ........ _... _ . ` River - Falls kU -54022 _..--- r .- -- -....- ------ :VOta-v Pu._':c - __ . ^oar`.., is. (S'i *�tRSt��ES May be a,;tp,enticJ tzl or ac':-^ow Prth Nly Commiss*r'n is permanent. (lf not, state expiration i ar- not nevk-ssary.l q •Naas -e of �urwins a .,_q in ary ,:-y :'y annald Dr sc r , ri�.Fw; b«B; [h r uKr.atsn•s. I ° wT.. HClf:t'e.G >- y F t•tiRd S!iJ Rio. 13001 ST. CROIX COUNTY WISCONSIN ZONING OFFICE I spits NUN ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road �• " innn Hudson, WI 54016 -7710 (715) 386 -4680 NOTICE OF VIOLATION April 8, 1999 NUMBER 99 -V -04 Herman Heinbach Sun Ridge Farms, INC. 1624 County Road Z Hammond WI 54015 RE: Failing septic system at 1660 COUNTY ROAD Z LOCATION: SW `/., SE 1 /4, Sec. 5, T28N -R17W, TOWN of PLEASANT VALLEY, SAINT CROIX COUNTY, WI Computer # 024 - 1005- 80 -000, PIN # 5.28.17.31 Dear Mr. Heinbach: As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of § 254.59(2) Wisconsin Statutes, COMM 83.01(2)(c) Wisconsin Administrative Code, and Article 15.03 of the St. Croix County Zoning Ordinance. This system has failed under the definition in § 145.245(4)(d) Wisconsin Statutes (Category R). This violation was first noted on March 23, 1999. The violation noted is discharging sewage to the surface of the ground. An on -site inspection on March 23, 1999, did reveal the septic effluent discharging to the surface. I also noted at the inspection that the cover for the septic tank/drywell was not code compliant. If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of March 23, 1999, in accordance with Chapter 145.12(4) Wisconsin Statutes. THE FAILING SANITARY SYSTEM ON THIS PROPERTY POSES AN IMMEDIATE HEALTH CONCERNS AND NEEDS PROMPT ATTENTION. REQUIRED ACTION: By June 1, 1999, contract with a certified soil tester to have a soil evaluation conducted. The soil evaluation will determine the type of septic system needed and its location. Then contract with a licensed plumber who will design the septic system and obtain a sanitary permit through this office. The septic system must be installed no later than July 15, 1999. If you have any questions or concerns that I can address for you in this matter, please feel free to contact me. I look forward to working together to resolve this matter. Sm`3 ly, Rod Edinger Assistant Zoning Administrator cc: Verla Solberg, Town Clerk file T 0 d O CD nf. A M ' .. .. �' m CA FF 0 2 --4 2 v, z 2 c°n cn 3 CD 0 m z o v v o (D • 0 d 7 7 m m y v 3 a m y °� v y OD '. E N N N(D 3 01 t() m ? O N U) ? -4 I I G N O o Q p (D m 2 7 a' m 2 m OD c O So R N C N C O (D C1 CD fD b 3 S in 7 fA N 7 W d F j 0 p. m cn cn -< D en a (D (O y N d OD (O N N a Co �. CO () W 0 C C� 3 O- .+ 00 O-4 C r r C p p O Oy 0 0) CL _1 ;o 0 co co 0 0rtn CD y (p t0 O. y CD Z N N T CD 0 00 00 S00 3 0 S 0 SS 0 3 Q V O 0 Q T 0 G C O 0) 05= N A N G C N 9 y <' y 2 3 ; 3 N Ol D D o D m 0 O v O O a o a m m CD �• ( ( m C C N fD w m a cn O 7 p p A Z n v (). A o. (1) a cm 0 e CD � � ° CL a z z D N N aMCC n CD v o a CD CD 7 T Er > Or 7 a�'N 41 C @ - 0 D) CD N C 0 — n NN Z C. W ().p Z C. �. (D Q O w d O O O Z O O 0 C y x to J y (D p- t0 ar (D CD N (D .J N O a v p O a fi p=j N ,_ 0 . W ol v -0 x A co W C O O. 7 .-... N iL O. p C O n _ ti U y Cpl :- CD O, (D N � O N Z (D 7 T V O =. y O O E (D (D Gq A EA O FA O ti N CD CD CD 0 L O a I � 17 Parcel #: 024 - 1005 -40 -000 101 17/ 2006 03.0 nn PAGE 1 OF 1 Alt. Parcel # 5.28.17.28 024 - TOWN OF PLEASANT VALLEY Current XJ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co SUN RIDGE FARMS INC O - SUN RIDGE FARMS INC 1624 CTY RD Z HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 1648 CTY RD Z SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: \ Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 5 T28N R17V� SE SW 'OWN- SHIP Block/Condo Bldg: PLEASANT VALLEY. Tract(s): (Sec- Twn -Rng 401/4 1601/4) 05- 28N -17W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 698/321 2006 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations Last Changed: 04/20/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 12,000 104,100 116,100 NO AGRICULTURAL G4 31.390 4,100 0 4,100 NO UNDEVELOPED G5 0.610 100 0 100 NO AGRICULTURAL FOREST G5M 4.000 2,400 0 2,400 NO OTHER G7 3.000 4,500 56,000 60,500 NO Totals for 2006: General Property 40.000 23,100 160,100 183,200 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 23,200 160,100 183,300 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments S p 0 Special Charges Delinquent Charges Total p 0.00 00 0.o0 . Parcel #: 024- 1005 -80 -000 10/17/2006 03:04 PM PAGE 1 OF 1 Alt. Parcel #: 5.28.17.31 024 - TOWN OF PLEASANT VALLEY Current �X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co - Owner O - SUN RIDGE FARMS INC SUN RIDGE FARMS INC 1624 CTY RD Z HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 1660 CTY RD Z SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 5 T28N R17W SW SE TOWN- SHIP Block/Condo Bldg: PLEASANT VALLEY. Tract(s): (Sec- Twn -Rng 401/4 1601/4) 05- 28N -17W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 689/321 07/23/1997 450/636 2006 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations Last Changed: 04 /20/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 37.000 5,000 0 5,000 NO UNDEVELOPED G5 1.000 200 0 200 NO OTHER G7 2.000 15,000 58,300 73,300 NO Totals for 2006: General Property 40.000 20,200 58,300 78,500 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 20,300 58,300 78,600 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount I I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I 1 w AS BUILT SANITARY SYSTEM REPORT ' f 1e�s�KT OWNER j/j L TOWNSHIP j, SEC. j T at N R jS T , ST. CROIX COUNTY WISCONSIN. SUBDIVISION LOT LOT SIZE PLAN VIEW /`Tw Distances & dimensions to meet requirements of H62.20 SNOW EVERYTHING WITHIN 100 FEET OF SYSTEM f �t r t k a e oath Arrow, SEPTIC TANK(S) MFGR. CONdAftE STEEL N0. of rings on cover Depth PUMPING CHAMBER SIZE PUMP MFGR. MODEL NO. GALLONS Per Cycle TRENCHES NO. of widt — length area BED NO. of lines width length area deptK to top of pipe NUMBER OF SEEPAGE PITS Outside diameter total pit area AGGREGATE PERK RATE AREA REQUIRED AREA AS BUILT Disclaimer : - The inspection of this system by St. (Croix County does not imply complete compliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to determine cause of failure.' GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYTEM. pp INSPECTOR DATED n 0 PLUMBER ON JOB V' LICENSE NUMBER 3a ;� A AS BUILT SANITARY SYSTEM REPORT PnER , TOWNSHIP SEE. T N F 0. ADDRESS , ST. CROIX COUNTY, WISCONSIN. � - • - :BDIVISI0,1 , LOT LOT SIZE PLAN VIEW -Distances dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF TEM 1. i AOL i Ir d ' + ota N Mr SCA I ,tPTIC TANK(S) MFGR. CONCRETE EL N0. of rings on ve Depth DRY 'LNCHES NO. of width V6en th ,area no. of lines width h area -. depth to top of ipe AC REGATE RATE AREA REQUIEED AREA AS BUILT t►Sciaimer: The inspection of this system by St., Croix County doe,. compl .oipliance with State Administrative Codes. There are other areas tha possible +c inspect at this point of construction. St'. Croix County assum ty or ystem operation. However, if failure is noted the County will e.every effort to ;etermine cause of failure. ,fFASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. Alk , "INSPECTOR - DATED PLUMBER ON 'JOB ti . LICENSE NUMBER • k w y a 'kEPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM Sanitary Penmtita?30 State Septic VAME 4 0444 � own"ip St. CAoix County i oea-t4on Sec s Lox # Subdivi,6ion :O PTIC ,TANK size, afton,6 NumbeA o eom -tment4 9 � at p i.a,tanee 6AOm: Wett Bui..ding� 1.2% .6tope Highwa-teiL ' UMPING CHAMBER Size gatt6n,6 Pump Manu6actuteA Modek Numbeh +BO LDING TANK Size gattone NumbeA oA Compattment�s Pumpe.A AZatm Sy.6 tem ! �-tance 6 tom: .:We.tt n Building 12% mope_ Hghwa.teA K SOR PTI O N SI TE _ Bed Trench , s'-tanee beam: Wett , Building A ^Z t2% 6tope Hxghwateh . BSO RPTION SITE DIMEN,$ NS Width o tAench ` Req u� Aed area //� 6t 0 ek !A fjs Length a 6' each S7 it Depth 06 to ch b e.Eow 'Lite - - �in Numbeh ob tines �' Depth ob rock oven -tile. 2. tn. Tot .a. ngxh 6t Depth o6 t.i..Le bekow gAade___ 4n 04,s tance `between 4.E:i,►�ee bt. Slope o6 -tteneh� �`" in. pen 100 6t ? I L,tu 11) ti o?i " 'a'& e -- b't Type o b Covet: Pape-4 o 'I[ DIMENSIONS, Numb e.A o6 pits , " " Aavet around pi t.6 yeas no r „ Outside d.i.amete ,,,,v Depth below -i.ntet bx Tota.E ab.6UApti&n-- a4Le — a 6 Atea Requited bt INSPECT TITLE 1PPROVED DATE 198 :EJECTED DATE 198 'EASON FOR REJECTION k _ Sin 3 PLB 6 and County State Permit Permit Application County Per it # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERT / Mailing Address: #e � r In c L' B. LOCATION: Z� ' / �w Y4, Section , T9,Y N, R 12 E (or) (�V Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village /� Towns /wec - 1 5j C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) Variance Single family X_ Duplex No. of Bedrooms - No. of Persons 3 D. SEPTIC TANK CAPACITY Total gallons No. of tanks HOLDING TANK C Y Total gallons of tanks Prefab concrete Poure -in- Steel Fiberglass Other (specify) New Installation ent Lift Pump Tank or Si p amber Total gallons Prefab concrete Poured -in -Place Other (Specify)_ E, EFFLUENT DISP SAL SYSTEM: Percolation Rate is O Total Absorb Area ! sq. ft. New Replacement A Alternate (Specify) Seepage Trench: No. of l,inaj Ft. Width Depth Tile depth (too) No. of Trenches Seepage Bed: : _�_Length (� Widt � Depth36Tile depth (top ��' No. of Line Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land v �G Distance from critical slope 4LO 4 1f WATER SUPPLY: Private � Joint ❑ Community ❑ Municipal El Owners name as listed on EH 115 if other tha pre owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the C ti ied Soil Tester, NAME �t} . C.S.T. # " �� and other information obtained from (owner /builder). Plumber's Signature MP /MPRSW# 5 J / Phone # 'v ? Y J140 Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. —4-4-1— -- _...- d ® .., € E e _ .......... ® e W 3 I .. _ — »rW --- e ., iV �.,.. g aemm� a. �...c ..,w,� }_.. .... ..nm am..... -..n ,i.: ...e ®x. m 3 m ,. e .. t f � fl � .�.e. f .yam e.��.. ..�., ...p.�.. 3 7 e a t � 3 Do Not Write in Space B low FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application Q Fees Paid: Stat ,•�j County /, O-O Ls Date -o Permit Issued /RviecMI (at Issuing Agent Name Inspection YestXNo State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7 /1/78 L - - - - Pre stkit 0i ►U� f rc . 3 VIT S Wit - Pf esevrt Or Sfiee� A ;oz' } _1 b3 a I / ,0 g�e tteu rA,, O uel( - ���� Rev. 9178 I!7 ZOAMG 980 s ' ' REPORT ON SOIL BORINGS AND PERCOLATION TESTS Off/( WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION' '/ <,'/4, Section ,T (or).1p(�i'ownship or Municipality S (Z � I Lot No. , Block No. County ld r SupdivisionjName Owner's /Buyers Name: 17 a L'G� 1'► t-° 1 /'1 L2 Is Mailing Address: — JA d n flit J TYPE OF OCCUPANCY: Residence No. of Bedrooms -� COMMERCIAL �j EFFLUENT DISPOSAL SYSTEM: NEW REPL CEMENT ALTERNATE SYSTEM OTHER `` DATES OBSERVATIONS MADE: SOIL BORINGS r 1V PERCOLATION TE TS SOIL MAP SHEET Z k AME OF SOIL MAP UNIT� PERCOLATION TESTS TEST DEP71� CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE BOLE AFTE INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 V P- f/ O / 2 "f /5 f 15""! S -'l c 'N o , ?Q r /t /� i/ go P— P— P— SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INC ES B- a B— B— B— PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy Q.Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. Y � ©' 0 ow4— f a a 3 Y f AN s i e l Ef Ai 3 l ¥ M � ... E ...� _. I i i I I r t ; u� e C { _..._ 1, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. ko �Q' 4 Certification No. S c g 6 Name (print) � � r 1 Address lv .Name of installer if known Copy A -- Local Authority CST Signature t• it - > '� �,� ., i. ... � - �, � ._. �� ,�` �.:� y ., � I I i � �- � _. ... - ,.. f � ,. � .. - -. � � .' .. 3 .. `, 1 '� ; .... _.� ' 4 . 7 i t E �: ���'� � � - -- __ _..._r_ ._W -- �.._._..... r � � ' I t � � � 1 f � t v 1 � t ' -- .. _ ...... ... _. _.,fix - - ..., -� � � __ j :� f � ! ,_ � _ _._. � '' � ,� , i i ! x .. .�. i. 138837 REPORT ON INSPECTION OF SANITARY PERMIT # (1 N e and A dr ss of Permit Holder Person /Persons at Site (2 )Date of Inspection Time of Inspection N ame, AdareSs, License rio. ot instaning plumber &LL � 1,231 (3 )INSTALLATION CO ISTS OF: ❑ Septic Tank [] Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepa a Bed ❑ Holding Tank ❑ Fill System ermanen reference Point) Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: (7)DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES []NO Wired? []YES ❑ NO 8 HOLDING TANK: Manufacturer of gallons construction ; depth to the cover ft; If septic tank is being used are baffles removed? YES []NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ N0; Locking device on cover? []YES ❑ NO; Diameter of vent and material Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe - elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE R . Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? [] YES []NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO DILHR -SBD -6095 N.05/80 Signature of Inspector i r I 1 , i f, 1 r • •, i t ... ._.. . t - •... 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M» a2s6/ ua c 0 % o t l p CE NTER Dania /son o 9` CSabb e .) c5'w s i crane l C 0 Lo a f Cd / E V'� p \ � i� /¢n � 9 b \ 'P /' Peterson h nb �Teanrre Rrch d p w 3 :9u ey B C/7a /es May NUS 6J VGn o � /,zo Q i � Owerss fJ¢ kE Thorn Mott N�\� /96B.Poe.Efo dM¢ e.6 /� Inc /Pei. rP79 99 � '¢'o /zo OJy(� PIERCE COUNTY c K` PL EA$ANT VALLEY TMP, -}� e RIVER TWP, 2812 MALL DRIVE OFFICE 717 MAIN STREET ���� EAU CLAIRE, WISCONSIN ST MENOMONIE, WISCONSIN FEDERAL SAVINGS Business: 273 -4945 113 True Value AND LOAN ASSOCIATION Residence: 273 -4155 REALTOR Car: 792-2732 Hardware .IL DAR -RAY Realty 314 EAST GRAND AVENUE Raymond Huppert Authorized PAINTS EAU CLAIRE, WISCONSIN Dealers 207 NORTH BRIDGE STREET 372 WEST MAIN STREET 332 West Main Street 698 -2377 CHIPPEWA FALLS, WISCONSIN ELLSWORTH, WISCONSIN Ellsworth, Wisconsin 54011 Woodville