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Home My WebLink About006-1058-40-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Permit Holders Name: I City Village Township Al White "ST BM Elev: W TANK INFORMATION 0 TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding w��. ✓n TANK SETBACK INFORMATION (+V10-I 4 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding ' FIVA PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Fricti L System Head TDH Ft Forcemain Length Dia. . to Well SOIL ABSORPTION SYSTEM TOWN OF CYLON ELEVATION DATA a :.�MEW BEOrTRENCH Width Length No. O renches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DlMrNSIONS SE BACK SYSTE O BLDG ELL /STRE M LEACHING adur INFO MATION Type System. I I 7 CHAMBER O UN Model Number DIST ION SYSTEM der/M old Distribut x Hole Size x Hole Spacing Vent to Air Intake \L Length DeLengtt h Oia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over m Depth of xx SeededlSodded Mulched BedfTrench Center BedfTrench Edges Topsoil �I Yes � No (�) Yes r COMMENTS: (Include code discrepancies, persolns present, etc.) Inspection #1: D145— �ZI1IZpZy Inspection #2: Location: 2450 HWY63164 S)�( � 9p� r -,�1L—T l ✓� , �`'� �I _ .may(/_ �/— ►^/ 1.) Alt BM Description = �� ""r - v— ��11%l� t.S l n S it S-4L 2.) Bldg sewer length,-�-} T, a -amount of cover = � Z�i1 � — Ue p u, t _ /).GNP u - td�KO�st ay � "J.Q� lat�lrt plan �evislon-equired? [] Yes ' No ad Use other side for additional information. Can. No. I Dale nse o s Signatur y3-6a0 (R.319 7)a�— `� wCI %MS R.. ;lir C4.IJ-?,p22-3o2 1.S 2. All per"T"'"+ my e� `3(2 3 's SEP 0 2022 Indust Services Division 4822 Madison Yards Way Madison, WI 53705 P.O. Box 716z Madison, WI 537 62 ou r�unyy., Sanitary Permit Number (to be filled in by Co.) / fp � Z �t pplication G In accordance with SP In as on of this form to the appropri governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, a. 15.04 I (m , Slals. r StateTrensactimtNumbL-.JMaft Project Address (if diffe.enl than mailing address) -1. A llcat on linfornfatlon - Please •Print Alt nformatlon Property Owner's Name arcel g i(ALtoµ Property Owner's Mailing Address Z L.� rj / Property Location Govt. Lot Section T� N R or W City, Snare ZipCode e�lS—LC211/, L Phone Number .ld. Ty-pgpfDullding (check allSthat apply) . or 1 Family Dwelling - Number of6edroorna Lot a Subdivision Ns ❑PublidCommercial -Describe Use eState Owned -Describe Use Block H []Cityof 11 IVillage of CSM Number own o1-5111 I'1I. Type. ofTOWTS'•Permit: (Check elther "New"'or `%eplacetnent''.and.athei• appIUahltgrit lint,X' Check--one-box o linen, Complete linetC if OppIlcatile: A. []New System eplacemettt System other Modification to Existing System (explain) OAdditional Pretreatment Unit (explain) B• oldi ng Tank ❑ (conventional) IJ'I-Grade Mound ❑ Individual Site Design Other Type (explain) C• ❑ Renewal Before Expiration Revision Change of Plumber OI'ransfer to New Owner List Previous Permit Nurr.ber and Date Issued IV. Dis ersaVTreatmenfArca and Tank Information:' Design Flow (gpd) Design Soil Application Rate(gpdOsO Dispersal Area Required (30 Dispersal Area Proposed (s0 Syslen Elevation Tank Information Capacity in Gallons Total Gallons g of Units Manufacturer 6 : $ g n ,� w V a New Tanks Existing Tanks Septic or Holding Tank Dosing Clumbu V. Responsl6W Statemenf= 4 t mdersigncd; assu es flEllity'for4nstallatloo ofthe;ROWTS sbbwn on-the.atteched plans Plumber's Nair (Print) Plumb taturo MPIMPRS ber Business Phone Num T e aa�` -, Plumber' g•Ad s (Strecl, City, Slate, - Code Count IVQ ear-tma2n YApprV1. ovcd ❑ Dis for Datial Permit Fee s6 Dale Issu Issu g Agent Signature Conditions RLPpo^ n l SYSTEM OWNER: ptic tank, effluent filter and dispersal cell as> � , d� � f,&� cast be serviced I maintained as per l " nagement plan provided by plumber. 4 t� �/ tback requirements must be maintained a SaAS lv-XiE ws*" e-1 Po. �f CL- ew Nat appliCauic tAme ►tQgprglill{eftle plans for the system` an submit to ` Cayfty�nlly on p/per n less lh■ 11 Inc In d 9� p 3BD .03/21) f Y�"lv •Vt ��1b��`'-1 SPr aed1,� I PROJECT Al White SE 114 SW 1/4S 26 SYSTEM ELEVATION TBD System PLOT PLAN ADDRESS 2450 Hiahwav 64 Emerald Wi 54013 /T 31 N/R 16 W TOWN Cylon COUNTY ST. CROIX CONVENTIONAL AT -GRADE MOUND SEPTIC TANK SIZE 9/30/22 BEDROOM 3 DATE _ CONVENTIONAL LIFT HOLDING TANK %00( LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 1000/2000 LOAD RATE n/a ABSORPTION AREA none # of Chambersnone (i,ENCHMARK V.R.P. Top of well ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE O WELL *H.R.P. same as benchmark .,C PI SrgiP = 114" = 1 n, Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 9/30/22 Owner: Al White Location: SE1/4 SW1/4 S26 T31 N,R16W 2450 Highway 64 Cylon System type: Holding Tank Manuals Used: Holding Tank Component Manual Version 2.0 SBD-10855-9 Page# 1. Cover Page 2. Holding Tank Plot Plan 3. Holding Tank Cross Section 4. Maintance and Contingency Plan 5. Holding Tank anchoring sheet Signature License nupWer 226900 PROJECT Al White SE 1/4 SW 1/4S 26 SYSTEM ELEVATION TBD System PLOT PLAN ADDRESS 2450 Hiahwav 64 Emerald Wi 54013 /T 31 N/R 16 W TOWN Cylon COUNTY ST. CROIX CONVENTIONAL AT -GRADE BEDROOM 3 HOLDING TANK %00( MOUND SEPTIC TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 1000/2000 LOAD RATE n/a ABSORPTION AREA none # of Chambersnone (i�,ENCHMARK V.R.P. Top of well ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE O WELL ■H.R.P. same as benchmark gala — 1 /d" — 1 n, 9/30/22 DATE CONVENTIONAL LIFT LIFT TANK SIZE KABCO BUILDERS AID-102 16 X 80 Approved Vent Cap iter Tight alb HOLDING TANK CROSS-SECTION Weatherproof Junction Box -- 4" C.I. Vent Pipe I y '� Final Grade Approved Joint I I approved Ru. Pip e I High Water Alarm Switch ' Blind PVC or CI Plug 2J"IJ7J LCJ��iI� Owner's Name: Address: Legal Discription: Township/Municipality: County: _ PLUMBER/DESI Signatur License r: Date: 0&e �9 Approved Locking Manhole Cover With Warning Label Attached 12" Minimum r--1 SPECIFICATIONS Approved Joint With Approved Pipe Extendinn 3' Onto Solid Soil 3" of Bedding Under Tank 4" Minimum 18" Minimum Both Tanks Typical of Each Other TANK Ne,4� Existing � Manufacturer: M6,P.� Tank Size:ztzo// Gallons ALARM Manufacturer:,S Model Number: r.. Switch Type : NUMBER OF BEDROOMS: GALLONS PER DAY: 347v 0 HOLDING TANK MANAGEMENT PLAN CONTRACT FOR: /"/110 Owners Name This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to SPS 383, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10855-P N. 03/07), and the County Sanitary Ordinance. 1. This POWTS is designed to accommodate a wastewater flow of less than 57Z, gpd 2. The owner of this POWTS is responsible for system operation, maintenance, manhole Security, and all provisions in this management plan and maintenance agreement. 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), a licensed pumper must be contacted to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. The POWTS owner must allow and maintain access so that the pumper can service the tank(s) with pumping equipment. The owner further agrees to pay the pumper -for all charges incurred. - - - 4. At each service event, the service provider should visually inspect the condition of the tank, risers, manhole cover(s), verify that the alarm system functions, and that the manhole is secure against unauthorized entry. Discrepancies are to be reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and SPS 383 and 384 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 30 days as required by SPS 383.55, Wis. Adm. Code. 6. The owner may not remove any wastewater from the holding tank(s), or allow such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastewater to the ground surface, including unintentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of orders for correction or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement _ _hQldingtankmaX be instated in.the s_arne location, (A new sanitary p-ermit_lstequiro for suQ .a-- replacement) Connection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced or its use discontinued, components no longer in use it shall be abandoned in accordance with SPS 383.33 Wis. Adm. Code. 10. If there is a problem with, or questiCIA about this installation, the following persons may be contacted: a. Installer:�A Phone: !'�/J b. Service Provider: 7*� Phone: G c. Co. Zoning Department:: --//. ro;1( d?a/14 Phone: C�U 11. Special management requirements Holding Tank Management Plan Contract-01/01/2015 irDimensionsl ' WN K� rscM ,`= w.`�.�� r. +yew. fir. -err,.... A � r. ,2- . AM,:, Septic Tank Size Dimensions Weigh i(lbs) Anchor Weight (1130 Solt Cii%w4in.) 5000 ga(:.. _ 204 L> 9K'Vl! x 93"H ` 41,00 —30,850 .24 3000ga1 .165"Lx 92"Wx 76"H 20,300 . -- 23,320 - 23 2600 gal 147'L )Y.90"W x 73"H 18,100 20,625 24 — 2'000'gal- 16211L'x 78'W x 64'eH 16,100 - 15,675 1600 gal 145"L,$ 78"W x 61"W 14,900 11:,270 16 1200 gal 11.1 "L x 78"W x 61 "H 11, .m 9,532 17 � 1000 gat Low Profile 120` * 67'W x 57"H 9�,500 8,705 1y 17 `f'OOO gal Heavy Duty 96'Lz 78"W x;61"H -`--- 9;200 8,945 --- 800 gal' 96'L 6T'W x 57"H -- 8,000 6,560 16 600 gaf 78"L k 56,* x' 60"H _-- 6,800 3,810 1600/1400:ga1 174"L 9 "H 23,Q00.. 22,410 i2 1250/750 gal 16rL { 7$"W x 64"H 16,400 15,725 1000/600-ga1 145"Lk78"W x 61"H 14,,700 12,7//05 17 � -}'. '-' { d,�lt��jy♦ �.j$S �S .,"Y_J'�i� l_,!}t s .A'� J; . '< .. 4"i. i=` F�Y 1`'x �''u/S�Y?/I.�/ H � �} ♦7�4� y ��G# } �y�.fl S-�Ui f �•.,f •3 _ �_l'f7�Y �. „1 fit_ !iiiiS�Sr�� TS i�1:W�"�k .i,ti.•1i:n1`!. s,O Fri ::: { � , '� :2w ... v t: '.ti icy-y��•.i ^ �.9a Wf- Document Title Emirip 111$11111 Tx: 124150 St. Croix County Ho/ding Tank Agreement Permit Number - At 1r V 11A+e Nam�er) Typed or printed being duly sworn, states, under oath, that: 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume Page Document Number Osj o G't iSt. Croix County Register of Deeds Office: A parcel of land located in the_Sa Y. of the SW '/4 of Section ci In T_aL_ N — R ItQ W, Town of C1,4lnYl . St. Croix County, Wisconsin, being d y described as follows (include lot no. and subdivision/CSM or detailed legal description): �f c) -�Q Ckped Agreement flats:/ -GO -Z L 1159301 SETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 09/28/2022 10.38 AM EXEMPT A: REC FEE 30.00 PAGES: 2 R,t (.)Xzf'Tt aks� NWr os. r.y %rr>7cr�.rtd rr..'c. SHo y3 e0d-1 ss'd^lye _4eo i We acknowledge that application Is being made for the Installation of (a) holding tank(s) on the above described property or that continued use of the existing pnmlees requires that a holding tank be Installed on the property for the purpose of proper containment of sewage. Also, the property cannot now 4e served by a municipal sewer, or any other type of private onslte wastewater treatment system as permitted under Ch. SPS 383, Wis. Adm. Code, or Ch. 145. Wis. Stats. As an inducement to the county to Issue a sanitary permit for the above -described property, we agree to do the following: 1 . Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tanks. If the owner falls to he" the holding tank property serviced In response to orders Issued by the governmental un or the Department of Commerce to prevent or abate a human health hazard as described In a. 254.59. State., the governmental unit (ToWnymsy enter upon the property and service the tank or I ause to have the tank to be serviced and charge the owner by placing the charge, qn the tax bill as a &pedal assessment for current services rendered. The charges will be assessed as prescribed by a. 56.0703. Slate. J 2. The owner agrees, pursuant to a. SPS 383.54 (2). and SPS 382.40(3)(o), Wis. Adm. Codb,,to haw a water meter Installed In the structure. The water meter shall be Installed by a plumber authorized by the Department to make suek Installations, with sald Installation complying with Slate regulations and manufacturers specifications. The owner agrees to be finandal responsible for the purchase, Installation, maintenance, and repair of the water meter, and agrees to allow the governmental unit or the Department of Commerce to enter the above - described property on a regular basis to read and/or Inspect the water meter. 3. Owner agrees to pay all charges and costs Incurred by the governmental unit or county for Inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank In such a manner as to prevent or abate any human health hazard caused by the holding tank. The governmental unit shall n9WY the owner of any mats which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does noYpay the costs within thirty (30) days, the owner specifically agrees that all the costs end charges may be placed on the lax roll as a special assessment for the abatement of a human health hazard. and the tax shall be collected as provided by law. 4. The owner agrees to contract with a person who Is licensed under Ch. NR 113, Wis. Adm. Code, to have the holding tank serviced and to file ■ copy of the contract with the govemmental unit. The owner further agrees to file a copy of any changes to the servica contract, or a copy of • new service contract. with the governmental unit within ten (10) business days from the date of change to the service contract. 5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the county an a semiannual basis a report detailing the servicing of the holding tank. The governmental unit or county may enter upon the property to Investigate the condition of the holding tank when pumping reports and meter readings may Indicate that the holding tank is not being properly maintained. e. This agreement will remain in effect only until the county office responsible for the regulation of private onslte wastewater treatment systems canlfles that the property is served by either a municipal sewer or a private onalle wastewater treatment system that complies with DSPS 383, Wis. Adm. Code. In addition, this agreementmay be cancelled by executing and recording sold certification with reference to this agreement In such mannerwhich will permit the existence of the certificatlon to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the helm of the owner, and assignee& of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds In a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is Installed. Owner(s) Name(s) - Please Print Subscribed and swom to before me an this dale: ALFxk kyr6f- f� �4 ZtY12 `N? ` Jac�na� ., Notarized Owners Signsture(s) Notary Public IN I Governmental Unit Official Name, Title - Please Print My Commission Expires '��''';rTATE -�t"ttt.rta'�" `N��`• -OY Governmental Unit Official Signature Drafted by: w h 4-e A\ Personai inrornauon you Provece mey us &sea car wwna.,y Pug v L I—, .. -THIS PAGE IS PART OF THIS LEGAL DOCUMENT- DO NOT REMOVE - This dhfamn tlon must be completed by submitter document Utie. name & mium address. and EINr (If requited). Other #Aormation such as the gm,,,tdng dauses,,feagol dssonplion, etc. maybe placed on this Rnt page of the document or maybe placed on additions/ pages of the St.199"MRV(F49"T 1gf8if joyf�page adds sere page to your document and 12 rM to the M29MMo fee. Wiaconaln Statutes. 59.43. . . k I iWXMIaM2 Pal of the Smlbe" Qmrter of the Southwest Quuter (SE 114 of S W 114) or Section TweatySix (26), Towoahip TbkV-Ooe C71) North, Ruse Sixtem (16) Wart, Town of Cybn, St. Croix County, Wiaconsi4 drsawsbod a follows: CoomaociM at the South"a cane of the SW 1/4 of Seabn 26, Towship ] 1 North, Rao`e 16 Wert; Ibcoce Wcn 14 Rods; tbwcc North I1.3n Rods; thence Past 14 Rods; thmce Soath to the Point of Bcgi m ll. u 2of2 t St Croix County 1050672 Page 2 of 2 St. Croix �Cotr_,1_J, Q2 1 PpQ�20f 2 ST CKO —' L�.NTY SANITARY SYSTEM File #: h'/.;rvuLrin Office Use Only OWNERSHIPIADDRESS FORM Created212027 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. Owner/Buyer /7 Mailing Address ys2- City/State/Zip Phone Number Email Address (r Parcel Identifica (found on the property tax bill) OWNER/BUYER INFORMATION k!YC NEW SYSTEM: LEGAL DESCRIPTION Property Location, --IF 1/4�wA , Sec T �N R�W, Town of Cid f Subdivision Plat: 61 , Lot # Certified Survey Map # Volume . Page # Warranty Deed # _lljSv (Lri� (before 2006)Volume . Page # Number of bedrooms .5 Spec house O yes o Lot lines identifiable yes O no OFFICE USE ONLY New Property Address --S-61J2� (Verification of new address required from Community Development Department for new construction.) (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cddPsccwi.aov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov HOLDING TANK MAINTENANCE AGREEMENT Contract Date � �4i iZ Z This contract is made between the Holding Tank Owner(s) Name(s) and Pumper's Name 141TP01- ✓nay,P� We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:) 1/, Tax Parcel # 0,) 6 ,,/ —OP-7 -5 f (L), V� 1. The owner agrees to file a copy of this contract with4gbRe County. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purposes of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit reports for the servicing of the holding tanks as required by DSPS 383.55, Wis. Adm. Code. A report for the servicing of the holding tank(s) shall be submitted within 30 business days. The pumper further agrees to include the following in the report: a. Name and address of the person responsible for servicing the holding tank; b. Name of the owner of the holding tank; c. Location of the property on which the holding tank is installed; d. Sanitary permit number issued for the holding tank; e. Dates on which the holding tank was serviced; f. Volumes in gallons of the contents pumped from the holding tank for each servicing; g. Disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change of this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local governmental unit and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed and sworn to me on this date: ` U41 1c,, Today's Date Pumper's Name (Print) Pumper's Pignature Notary Public Signature Pumper's Registration Number Commission Expiration Uratted by the Land and Water Hesources Uepartment Form 12-003 Revised 1 /2015 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following esidence: (Street address) / located at S� '/4� ''/4, Section Z , Town__N, RangeW, Town of Cy�i�. , St. Croix Count Wisconsin. Upon insp on, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. C7 vd n Most recent date of inspection or service Did flow back occur from absorption system? Yes N6/ (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: X oCrU Construction: Prefab Concrete Steel Other Manufacturer (if known): Age of Tank (if known): 3v� yid Permit 16er (if known) / censed Plumber Signature) (Print Name) (Title) (Date) z Z6�� (License Number) MP/MPRS Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 Wwoonsrn Deperonen, of Cocvner-* SOIL EVALUATION REPORT Page _ of — Dwesior, o• Safet? an` Bindings I'accorcance wit, Comm, 85 Wts AoT.. Cooe Atlech complete site pan or. Paper not less than E " x ". inches in size. Plan must include. but not limited to vertica: and honzonta' reference point 'BM! direction anc Parca paroem stops, scale or dimensions, noun amo*. anc loosbon and distance tc nearest road. Please print off Information. Rewwwad ry late Pwwnw plfpmww Yp vrwwe ms> be us" to sscon"I punts" t'PrwaC? Law. e. 15.01 ('! (m)1. Property Owner PropeM' location / GovL Lot S' 1. (�' %4 S Z tL7 T N R �j E f ; W _31Property Ownels ng Address Lot # Block # Scbd. Name or CSW City to zie Coda Phone Nsnrber I] City O Village Town Nearest Rcad ' 0 13, 1 (91 3 6 G C ❑ Nat Construction Uset-Rewdenbal i Number o' bedrooms Coda dedved oeWr. Gotrate J V GPD pianemenl J Public or 1xv rDescribe- —�__ Pararlt motor* Flood Plain sieve if applica sJAL. — -- -- R Gwr' oy merts tr r r I and recYrrraxle tons: N System Type System Elevation Bong # Bodrg ❑ Pit Ground surface elev. ft. Depth to knbV factor n_ in. qRoots Rate Flortmn Depth Dorrtk>ent Redox Description Texkre S. Sx. Sh Conslaterlca Boundary GPOM in. tvltrnel ou. Sz. Cori Color Gr. SZ Sh. fr#1 T02 46. 8 ® �a # ❑ &Sorinp Pit Grand surface elev.� fL lDepltt b Ymifirg factor n. Sns errArm&t Rsrw M®� EJlklart #1 s Boo. > 305 420 "WL sn0 T55 >30 <_ 150 PW - emuent a2 - Bou• 1 ju ffwL am t a3 -- au MWL CST Name (Please Print) re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evakratlon Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 —Z 715-246-4516 71 EJlklart #1 s Boo. > 305 420 "WL sn0 T55 >30 <_ 150 PW - emuent a2 - Bou• 1 ju ffwL am t a3 -- au MWL CST Name (Please Print) re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evakratlon Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 —Z 715-246-4516 71 Property Owner 3 # ❑ Boring Q Pit Parcel ID # Ground surface elev. ft. Depth to limiting factor 7 in. Page of u®� MKMWIM==M a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Saul Aj)Nicabon Rate Boring❑ # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to IirrilOnp factor in. ' Effluent #1 - BOOS > 30 < 220 ng4. and TSS >30 < 150 mg& ' Effluent #2 - BODr � 30 mg& and TSS 130 mgrL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SB68330 (RAW) Property Owner __ 3 Boring # ❑ Boring Pit Parcel ID # Ground surface elev. �U ft. Depth to limiting factor Zk: - Page of Cnil Amlirafim R�.e Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Deptlt lb lirnitirg factor in. Soil Aoolicatbn Rate ' Effluent #1 = BODE > 30 < 220 nglL and TSS >30 < 150 nglL ' Effluent #2 = BOD6 � 30 mg1L and TSS < 30 nglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SOD-1330 (RAM I Soil Test Project Name Al White Address 2450 Highway 64 Emerald Wi 54013 CSTM #226900 Lot ------ Subdivision -------- Date 9/30/22 SE 1/4 S W 1/4S 26 T 31 N/R16 W Township Cylon El Boring 0 Well PL Property Line County ST. CROIX t Plan Shaun Bird BM or VRP Assume Elevation 100 ft. Top of well System Elevation TBD *HRpSame as Benchmark ScaIP = 114" = in, -' - Property Line Vents i B-3 Property Line 15' 50' 1 Acre Parcel T 25' 40' SB.M ) I F 100' Well 60 Old trailer house Removed 100' 50' B-2 Property Line Highway 64 9A ""��'�K 645432 �CRe�/c_co rvry STATE SANITARY PERMIT #: 2q5D #wy 63/by �AL PREVIOUS NO. OWNER SEC_9T_3 I _N, R 16 AND/OR LOT BL 11. CK SUBDIVISION CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit Is to allow installation of the private sewage system described in the permiL (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for ■ specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal Is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. 0 wy►,/ H RI ED ISSUING OFFICER -DATE /'Ct(Z PERMIT EXPIRES Lak"A UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)