HomeMy WebLinkAbout030-1074-80-055 (2)Wisconsin 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 Holder's Name: City Village Township
BRETT E & MARY M BADER TOWN OF SAINT JOSEPH
CST BM Elev: Insp. BM Elev: B Description:
• •
• YL �1.
TANK INFORMATION ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
'
b0
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
UNA
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
County: St. Croix
Sanitary Permit No:
651313
State Plan ID No:
Parcel Tax No:
030-1074-80-055
Section/Town/Range/Map No-
2 6.3 0.19.2 59A- 10
STATION
BS
HI
FS
ELEV.
Benchmark
.1
3 .l
.
Alt. BM
Bldg. Sewer
St/Ht Inlet
VW
St/Ht Outlet
t Inlet
D o om V
\6
V/
Header/Man.
^�
Dist. Pipe
Bot. System
Nov;
INA S11
g
11,;
Final Grade
s<tk
,S5
G -3
q- �5
46
St Cover
Aq
�
Ivy.
apt
. 41t
�•51
• 4
53
JUIL ADOU1"' r I IUN J TO 1 CIVI
y
BED/TRENCH
DIMENSIONS
Width
Length
�j
V
No. Of Tren s
PIT DIMENSIONS
No. Of Pits
Inside Di
Liquid pth
SETBACK
INFORMATION
SYSTEM TO
P
BLDG
WELL
LAKE/STREAM
LEACHING
CHAMBER OR
UNIT
1
fa LA
T Of System:
� 1
�
� �
O
1 1
Mod mb
P�e7l— IF10
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 Svstems Only xx Mound Or At -Grade Svstems Only
Depth Over
Depth Over
xx Depth of
xx Seeded/Sodded
xx Mulched
Bed/Trench Center VBed/Trench
Edges
Topsoil
❑ Yes ❑ No
❑ Yes ❑ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 719 132ND AVE
1.) Alt BM Description V&% Vo COL4j (AS(AP d-f V' i- WL
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? ❑ Yes K No 44
Use other side for additional informatio ** lk 0 ;6 X49'.00 We - I &0)1gPv1
SBD-6710 (R.3/97) Date V I sepctor's S_ i g n al ure Cert. No.
i�
RECEIVED
County SAN-2023-243
09/14/2023
Industry Services Division
ro
St. Cix
Smiltar�- Permit Nlumb-.,r (to be filled in by Co.)
D S
P Paid via Ascent
1400 E Washington Ave
R 0. Box 7162
S #31276
Madison, W1 53707-7162
Sanitary Permit Application
State Transacuon Number
I -n a c L: 1 r(ia i i L-,,- I 11) I'S ')'8 1 2 11 ? i. WN A d 111 C4 idc. - i 11) n i i N,,: i L) i " I hil� 66i-n i to the app rt 11) ri ate izov e M Inc I i I k L I I I I] 'I I
-----
is rcquircd [irlor to obt;:nt1rig 2.i %�aniiare t)erniit. Note' Applicat i-:1F1 60rals for state-mviled POW I'S are subiliffled to
Project Add ress (i I'di ft rent than mai I i ng address)
)CPXtT11C11t koj'S�jj' 1% 'li- C -[cL:,*. Personal int'ormation you proryemav lx� u,,k:d I'qlr 1�0�011dary
tile I" C I (i ['T(l I' I () 11 �� I SC r�
1 719 13-I'LAye
p urposes in acco Fd<a I i k:c 1 [11 1 Il k� I �'r I V I I 3W, ,. 15,040 )(m ), S tats-
2
1. Applicatin n In (f) rin a I ion — Please Print A 11 Information
Property Owrye r's Name
Parcel 9
Breit & Mary, Bader
030-1074-80-0;55
Property Owns r-s Mailing Ada ass
Propeny Localwin
719 132'Ave
Govt. Lot
SW 1/4, SW 1/�, section 26
City., State Zip Code
Phone Number
Hudson, WI
4circle one)
T30 N R 19 E or
4
11. Type of Buildli n g (cheek al I that apply)
Z I or 2 Fai n i N I )we I h ti a N Lj I nbc r 0I.1 k d rok ri I S
7'
Subdivision Name
I I ri b I ic/Commm i a] — Des cribs U S C
Bloc- 4'
El City of
Suite Owned — Describe Use
0 r
CSM Numberac
4 o "- 11 4) r 'j t J oscph
m. 'r
pe of Permit; ( Check one box on line A. Complete line B if applicabie)
&
El New Svsaem
.0111y
M �Rep�lacem�ent .System �.Svstcrri
El Treatrnent/Hblding,rank Replacement ()T1 I V
El Other Modification to Existing System (explain)
B.
El Permit Renewal
❑ Pcmiit Revision
C1 Change of
EJ Penn it Tnm sfer to New
List Previous Pemift Number and DaLe Issued
Before Expiration
Owner
430267, &25/2003
ype of POWTS Sy stele/Co m2onenUDev ice: (Check, all that apply)
Non -Pressurized In -Ground 0 Rressurimd in4ir-ound E] Ai-(iradv ® N-Ili urid > 24 in- of suitable soil D Mound < 24 in. of suitable soil
HoldlngTank, 1[j Other Dispersal Component Prclreatmem IX -vice (explain)
Dispersal/Treatm-ent Area Information: 2- Y, �tD '4V��
,V.
Flow (g Pd I
Desion Soil Applicaillt I
N1 Dilspersal -%Tca Rcquired (sf�
Dispersal Area Proposed (sf) System Elevation
Rate(gpdst) 6 431
7W A
0.7
-- C2. 5& toi;zt�,.
V 1. Y a n k- I F) fo
Capacity in
gallonsTotal
� �
E;a5t, 2,6d A- kr
�
Uallons
� �� f
t! nil L'i
U
New Tanks J.mL,
CL
LZ
S L' [I i k I F f lk I I J I El L� 7 *a;l 1
1000 1000
1
Ilu ult cullerele
Dosing Chamber
V 11--. Res Po n s i lei I i "- Statem ent- 1, the undersigned. assu in e responsi hili t% for i ristal I.-i nion of the POMIN. shown on the attached plans.
111 umber' s N ai i I c t I I r."Li i i.) Phan 101. re MP/MPRS Numbeir Business Phone Number
John Schmitt 223760 715-7604W86
Plumber's A(1&0-,� (trcet. City, Qinic. 7ip Code)
586 Vaflev V lc%k I ri 11. Somer�ct, W I -rs 407
V1,11. Coun ps rtm ell t Use On ly
Approved
IS11 11) 15 Mi I'lre
Pennit Fee
Daie SS
1tin u
0Wner�S:,n rn
$ 5.35'1
lg l ?1a2
=2ent
IX. Conditions 0 A roy 0, A
&C re Sf
SYSTEM OWNER: ZV14�j 4M &4 0- Rer CL rA 0 a.& 6xt
1. Sopft 01 to , ueot filter -and dispersal oaP
must be sewcwJ.; mArrain-ed as per
ffmagernent plan pro by Diumber. 6U
2, AR setback Tequi remerrs be mainiakned
as perappilowie n&-, ; oriviinces 5) 6�
Piro
mic h to co m p We pl# as fo r the system and su hm i I to the Coun ty only a " p.-KI per nit 101,; th aill 9 1 a i n ches in si ze
6l & �POVt&- &S, a;t�04A N. C:4,�n pe,
ma4vf s -6&, N. 9 WM4
S111) te-r� A 112D-13 ON-4� cc*d44403 kra� zw&�" +---) I!fzjb tw�%c'Zl 50C�
-6398 ( K03 -14)
4w+
M r Pal :
ri
Bader 3 Bedroom Septic System
Project Address: 719 132nd Ave
RM1 Symbol-. A 8M Elevation- 1,06 15'
.a ri k Marihn- ie
13MIDlescilliptlon- TiopcifSeptic T
BM2 Symbol A BM Elevation- 101.95'
BM De:scripfion Septic Tank Outlet
Slope Gradient of Tested Area-, (10%)
Well Symbol (if applicable)
Notes-. See CSM for Complete Lot
Desigr) Flow- 450 GPD
Aliach design flow calculations for
commercial plans:
Pipe Materials I .A TM Standard
Tables 384.30-3 & 384.30-5
4{'SCH 40 PVC pipe ATM- D2665
4" SCH 3034 PVC pipe ATM-D:303#
Exi8tirlg
Shed
Onvmvay
4 N
-
- 60
Scale-, 1 11 4
0 60 90 120
7.77
Z
G ca-3 ir.039 e
Existrig
Well 0 Ex,sting 3
Existir.g Huffctijr 100OLF;
5 �u i i (-- T-n r) k w! .7 a be I A- 10 0
EMLIP.11t,
BM2A
PrOPOSed
Valve
3'x69'InfiIjral:or Preach E! z-,94 5C
B2 100,
<Tl-
T2. 3'49' Infiltrator trench E.I.=94 60'
T3- 3'�70' EZ FIQ-w trench Ei.=05.00'
TA- F? 1--low !reach El.=95 50'
gal
96,
941
A"
T?
#Zwel I'll 1_J U910AU111151441CRT
Residential Applei ca!lnn
INDEX AND TITLE PAGE
Project Name,
Bader 3 Bedroorn Replacement Drain Field
Owners Name-.
Brett & Mary Bader
Owner's Address
719 132nd Ave
Hudson, W1 54016
Legal Description:
SW1/41 SW1/4,526, T30N, 819W
I-ownship
St. Joseph
County:
St. Croix
Subdivision Name.
Lot Number:
4 Block Number
Parcel I-D. Number
030-1074-80-055
Plan Transaction No
Page
I
Index and title
Page
2
1.60 Plot PIS n
Page
3
1,100 Plot Plan
Page
4
Septic Tank Specifications
Page
5
Existing tank Certification
Page
6
Effluent Filter Information
Page
7
System Sizing & Cross Section
Page
8
EZ Flow Information
Page
9
Management and contingency plan
Page
10
Sanitary System Ownership/Address Form
page
11
Warranty Deed
Page
12
GSM or Plat
Attachment 1 Soil Evaluation Report
Designer: John Schn-titt
Date: 9/14/2023
Licnese Nurnbet, MPRS 223760
Phone Number: 715-760-0486
Signature -
In -Ground Soil Absorption Component Manual Version 2,.1 May 2022
P age 1
r
Bader 3 Bedroom Septic System
Project Address: 719 132nd Ave
R 1 Symbol-. A 8M Elevation- 1,015'
B IVI DescOptlon `. i op cif Septic k h l rlf7 1
BI 2 Symbol A BM Elevation- 101. '
BM Descrip ion Septic Tank Outlet
Slope Gradient of Tested Area-, (10%)
Well Symbol (if applicable)
Notes-. Sea CSM for Complete Lot
Desigr) Flow- 450 GPD
+Bach design flaw calculations for
commercial plans;
Pipe Materials f .A TM Standard
Tables . 0- & 384. 0-
{' H 40 PVC pip ATM- D2665
4" CH. 3034 PVC pipe ATM-D30
Ex 8 irig
Shed
. r
4 O n vmvay
4
Scale; 1 " '
0 60 90 10
7.77
Gcir.e
Existnig
Well 0 +`,song 3
F xisti r g H uffctijr 1 QOO'_, '
�-u!i(-- T-nr)k w! 7abe1 A-100
EMLIP.11t,
BM
Prap 0sed
Valve
T1'x69' Irrfillrator Preach E! _94 5U B 2ls;�7514a' 1 '
T2. 3'49' Infiltrator trench E.!.=94 60' �
T3 - 3')� f 0' EZ F IQ-w trench E►.= 5.00'
TA- J',�70' F? 1--low !reach El.=95 50' a ,
94'
I <
T?
tp alle
4154 123rd STREET N. P. C. A. CERVED PLANT
PROJECTL %j
CHIPPEWA FALLSo VI 54729 -a &
1,000 GAL. LDW PROFILE '�; MEMBER OF:
PUMPEPTIC,
I HUFFCUT'T (715) 723-7446 9 (BOW 924-1516 '.' — "— I
, SV. - ' & WTON&N PRECA5T CONCRETE ASSOCIATIONc�:
C:on . -7 NATIONAt
C 0 A C R E T E. inc FAX (715> 723-7111 X WwwhuFfCutt.
S
DR HOLDING TANK
ST. CR014 COUNT17 ZONING OFFICE
CERTIFICATION STATEniENT
FOR UT11-A7_ATION OF EXISTING SEPTIC TANK(S)
This is to certit'v that 1, have inspected the existing septic and dose tank
V
presently serving the following residence. -
(Street address) 719 132nd Ave located
at: SW '/41 SE 114, SeCtI01,1 26 ToVM 30 N, Range 19 W1
'rowil of St. Joseph St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of jilt'
knowledize will conforni to the i-equirem.ents of SPS. 384.,'21_5, and it �mdiev)C.,� 7"r
appear(s) to be functioning properly.
Most recent date of inspectioti or sei-vice
Did flow back occur from absorption system? Yes No
if no, skip next line.)
Aivroximate volume or length of tillie' aallons
Tank Capacity- 1000
Constniction: Prefab Concrete X Steel
- Huffcutt Concrete
Manufacturer (If known).
Age of Tank (if known): */25/2003
Pennit. number (If knoNVII) 430267
(Licensed Plumber SignatUre)
AM
(Title)
(Date)
John Schm'ttt
Other
(Print Name}
223760
minutes
(License Number) MPIMPRS
'For -in to be completed bey licensed plumber (Dept of Safety and Professional
Services Chapter _305 and s. 145.06, Wisconsin Statutes) or ficensed disposcr
a
(NR H sin in
3 WscoAdmini:trative Code)
01
PAGE 2 of 2
The interval for servicing septic tanks is set by state and local code. Throughout the United States, there 'I's a wide difference of
opinion on what this interval should be, but most regulatory agencies suggest two to five years. The Zabel filter, ,.,".dhh does not
increase the frequency of servicing for the tank, should be Cleaned when the septic tank is normally inspected and pumped.
However, our filter is virtually self-cleaning. The continued action of the anaerobic organisms on the Zabel filter causes lodged
particles to disintegrate and fall to the bottom of the tank. If your filter contains a Smar lFiItem alarm, you will be notified by an
alarm when the filter needs serAcing.
F S1
Step 1:
Locate the outlet of the septic tank
and remove the tank cover.
Step 4:
While holding the cartridge over the
access opening, rinse off the cartridge
with fresh water, being careful to rinse
,all septage material back into the tank.
Step 2:
Remove the tank cover and purnp the
tank if necessary to prevent any solids
from escaping to the the drain field
when the filter is removed-
4
Step 5.-
Ins ert the filter cartridge back in the
case, making sure, the filter cartridge
is properly aligned and completely
inserted in the case. Replace the septic
tank cover.
Step 2:
Firmly pull the filter handle and slide
the cartridge OLA of the case-
0
Residential Appliratio ns
CertMed to ANS IN
Staiiidard. 46
Copyrighf 2014, Polylok, Inc. All rights roserved
Producf�s) covered by one or more U.S. and/or international patent's, 0(her U, S, and �n(ernarionat patents may be ponding
1-877-765-9565 / www.polylok.com Page 6
0.
IN -GROUND GRAVITY DISPERSAL AREA
Stepped Elevation Trenches with EZ1203HP Bundles
3-ft Trench (down -sizing credit)
OGef)tcxt1le
SOIL COVE
12"'
min. trench
depth I-L
Highest Trencl
System Elevations= 95,50
95.00
TYPICAL TRENCH
k."MU00 %_Dr_kj I lur VIrZV,
(No Scale)
ft;
Septic Tank(s) Manufacturer-
Huffcut t Concrete
S,eptic Tank(s) Vofume(s)-
1000 — gal gal
Effluent Filter MnniJactuFer-.
Zabel
Effluent Filter MoAcl #: A-1 00
Lowes't Trench (as applicable)
TYPICAL TRENCH (,Show location of inlet outlet rApo connection on plan view-)
PLANVIEW 4 IN 0 OL4,,ervabon pipe qhall be in-stalW
(No Scale) Perforated Lateral C-11 jUndion beiween two unds.
Observation Pipe
(typical) (ty pi ca 1)
"INS! 70 ft
INSTALL PER TRENCK
6 1 0-ft bundles @ 50 f� EISNunit = ft� 350
IMPRESSION "MEOWS"=
0
.9-ft bundl P.q a 2 5 ff F ISAh i nit =
10 ft
(tipical)
I
Provide minimum 3 fi
separation between trenches.
OBSERVATION PIPE DETAIL
'NL) Si_-C-i i-1
MONEW ft Sc.,Pvo-TyPa or'vF
FknksheC Grade
shn C�113 floose)
(mulched & seeded)
4 'i
0 PVC Ppe
Topsni Covur
Too of pipe to terminate
7.
(rnkn, 1 forol)
tj t or a bvve finishe d q n, de
r4'1 1/4". 1 12" X 6" Slots
90 t-prnrt
A -17 h o r, n,- V ov Ice
S U rface
A - 3. 0 ft
EZ1203H Bundle
(typical)
(m fd by 1 nfl I trator S y ste, m s. i ne.)
Install pUrsuant to manUfachirers instructions,
Proposed EISA per trench = ftZ Required Infiltration Area =643 EMISSIONS W
x 2 trenches = Proposed Total EISA 700 ft`
E"R7 SE
Distribution Method',
branched manifold-
� IAL
Installation I nstructions for oo E Z;flio W TM
Iflo b, 1,
EZ X Systems in Wisconsin by I N F1 LTRATO R
0, q M 1P * ego E06160eef 0*006 **Oia S4.0 a 0 0 a a 0 0 0 a 0 a * 'D # i i i # A 4 # a a & & h * M
- site shall
Wiscorisin Department of Commerce, Safety and Buildings 15. The Absorption area (SF) necessary for a given site,
D 1, ""1 .11 ions and/or plans for this be Wed haled on r-raximum daily sewage flow (GIGOT and
R,,'s-on, has reviewe,4 the spec -+'cat'
pi-ci-11LIC", and determined it to be in compliance, with chiLipters the Permeability for the, site, If certain criteria, is met, the
k-101,1110M 82 through 84, Wiscor-I'Sirl Adron. Code, and Chapter5 F-ISA sizing can be used in Wisconsin, re-sultirig in a 40%
145 and 160, Wisconsin Statutes. All sites MUSt meet the Site smaller draintield.
& Soil Conditions & Lo(-,j-0oi-is & IS,, ion dist-ances as noted in
local regullations, 6. Place flow bundle(s) in the E. configuration ap-
proved by system design pert -nit specified for the partiou-
The approved products are 1 2'03H (3-12' bund1e.1,'.-_; vvi il-, pipc 111 lar site. Tht. trip or center -most bundles containing pipe
center bun cle in 5' or 10' lengths) and 1203HP (3-12" bundles are joined end to end Wttl--, an internal pipe coupler. Any
with pipe in each bundle in 5' or 10' lengths. additional aggregate only bpi ndles that may be required,
should: be butted ac ainsf th(-,, �her aggregate -only hun-
,
A l
jle pipe bundle cr%nlains a four perforated pipe cur Ics and do riot roqUirc: iof connection
.1
1UUHj(7d by EPS aygrejate and is held tog ether with poly-
etI c on tain s a -i i I te r D i i c
ehtviene ning. A single aggregate bundle contains aggregate 7. The top of each GEO cylinder I
aniv an
d is hold together with polyethylene netting. manufactured in between the netting and aggregate, The
fabric is inserted to prevent soil intrusiom The installs r
Materials and Equipment Needed shall rake sure the the GEO is positiloned upward and is
EZflow Bundles in contact merit l-i the fabric contained in the adjacent cylin-
EZflow Geolextile Fabric der befcv� tiackfifling.
0 EZfiow Interii-al Pipe
0 Pipe for Hcader and Inlet 8. The EZflow Drainfield Systemcs should be installed in a
0 Backhoe/Excavafor level trench in all directions (both across and along the
trench bottom and,5hould follow the contour of the ground
Installation Instructions 5urface elevation (uniform depth), with a11 can fir uous
The instructions for installation of EZ'flow oroducts are given ad1goining 10-foot C Ondrical bundles placed end to end,
1 03 1 -bah
[_)elow, This. product niust be installed in accordance- with citaie with central bUn Ile. distri ion pipe interconnected,
rules defined in chapters Comm 82 thlrou ' qh 84, Wmns
isconsin Ad- without any das, stepdawor other water stops.
ministrative Code, and Chapters 145 aiid ',60, Wisconsin tat -
et as well as the local heafth deparlment's current dc�siI gn 9. The trenc-n lop snall Le graded such that vvEtter ill not
nianual. pond. Ba,-kfill should be seeded or soddt--Ld immediately
after completion to reduce erosion.
1. After the local health department has determined sizing,
configuration, arid layout for the E,Zflow systervs, stake 10, EZflow ERS) bundles are flexible arid can fit in cur-ved
or mark with paint the location of trenches and lines. Be trenches as may be necessary to avoid trees, boSul ciers. or
caieful to set coirect tank, invert pipe, header line of dis- othei oL.).stacles.
tribufion box and trench bottom elevations before linstal-
lation of pipe bundles. 1 1.E1 Sj aggregate is lighter t!-`,1.-,7..1') water, therefore, it might
be expected that natut-al buoyancy forces would tend to
2. Remove plastic Uflow shipping bags prior to placing cause EZflc)w assemblies to float out of ground when
bundles in the trttrich�as). Remove any plastic bags in the pondiing occurs. Field experience has shown, however."
trench before system is covered, that this is not a problem when systems have a minimurri
• of 6' of soil cover as recommended by manufactur.�•r,
3. This product must have, peotextile fabric that meets re-
quirements of s, Cunirri 84.30 (6) (g), is, Aum. Code,
installed directly on tcjp of the product and extending 1203H-GEO
down along the sides of the product to a point at least six
.rn of product. Gectextile
inches froli fl-e 1-atto
V B
VV77VT7 ar�ei Ma Prial
4. 'Mien int-�.tailed in a ttench, the trench should be dug to
7
a width of 36 inches. This not only saves labor in excava
V V V V ...... .
tion, but also provides bette,-- ln-,id-he•.irino capacity after, 1 77-17 r " �7�7n c - v V V
"i V V 10 It 4 10 V V t. V 1 7 1 K
I? V 97 9? -F ;r V V ! .9'� C V 7 ;r a W Is V
baCkfilling is complete.
36
.n-ground Gravity Management Plaw
TM=I alk"A Ul Ll 16
The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384. Wisc. Admin- Code- Pursuant to SPS 383.52 (2), Wisc,, Admin. Code, this system shall
be considered a human health hazard if not maintained in accordance with this approved management plan.
Furthermore, all inspection and maintenance activities shall be perforrned by a registered POWTS Malintainer in
accordance with SFAS 383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area 0i
w_nQ U*mits:
A
Design Flow 1450 gpd; BOD5:5 220 mgL"; TSS Somm ISO mgL-'; FOG:5 30 mgUl
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
c age of'systern
o nuisance factors (i.e. odors, user complaints, etc.)
LD mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
o material fatigue (i.e,, leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., dist6buton drop boxes)
o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc,)
o extent of pending in distribution cell prior to dosing
o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc,)
o electrical components - if applicable (i.e,, Sri nrig, connections, switches, controls, timers, alarms, etc,)
distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design spedfi call on
surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
Se,ytic and dose tank(s) shall be pumped by a certified septa serer cing operator licensed under s. 281 .48 Wis-
Stats. when the volume of solids In the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or
as required by local ordinance. Disposal of contents shall be pursuant to NIA 113, Wisc. Admin. Code,
Effluentfit shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications- A servicing period Wil always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
of individual or company.,
�;chmitt & Sons Excavating, Inc.
Pholle, 715-760-04&ig
St. Croix County Community Develapement - 71,5-386-4680
Local government unit:Phone.
Local government unit address: 110 1 Cal'tlliChaEl Road, Hudson ZIP: 5401 6
Any defective part of this system shall be repaired, replaced, or removed pursuant to SIBS 383.51 (1), Wisc. Admin.
Code. Repair or replacement of failed or malfunction[ng components shall comply with ,BPS 383, Wisc, Admin. Code,
No product for chemical or physical restoration of the POWTS may be used unless approved by the department ire
accordance with SPS 384, Wl'sc- Admi�n_ Code,
Continpency Plan
In the event that any failed treatment component of this POS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be
abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils.
SYStem Abandonment
If use, of this POWTS is di continued, it -shall be abandoned In accordance with SPS 383.33, Wisc, Admin. Code.
Page 9
Sr. C!R!Ojl. -44UNTY SANITARY SYSTEM File #:
Office Use Only
OWNERSHIP/ADDRESS FORM created 212o2i
Community Development Department will utilize this 'Information to provide the property owner witli
information regarding operation and maintenance of your new or replacement nitar-y system' This
H'IfOrIlIdtion will be provided as part of ou(- ongoing efforts to protect public health, your well, groundwater,
sur-face water, property values, and county resources. Once approved.. this completed form and educat-lonal
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 'les Scanned weblink.
OWNER/BUYER INFORMATION
Owner/Buyer Brett &Mary Bader
Mailing Address 717 132nd Ave
City/State/zip Hudson, W1 5401 F
Phone Number {required} 75-381-007fi
Parcel Identification Number 030-1074-80-055
r.f
�roulld on the pj-upefty tax bill)
NEW SYSTEM: LEGAL DESCRIPTION
Property Locatiol-I SE ,,4 0 NW X4 ,Sec. 26 T 30 N R 19 W, Town of St- Joseph
Subdivision Plat: NA
Certified Survey Map # , Voiume , Page #
Warranty Deed #
Number of bedrooms 3
New Property Address
(Staff Initials)
(before 20,06)Volume , Page #
Spec house 0 yes N no Lot lines identifiable N yes 0 no
OFFICE USE ONLY
(Verification of new addre!5s required from Community Development Department for view construction )
This forin must be submitted with all Privote nsite Water Treatment Systen7 (POWTS.) opph-con'ons.
New System; Include with this forni u recorded warranty deed froin fhe Register of Deeds Office and G copy of the cei-tified
survey trap if referetice �s mode it) the worrarity deed.
I
Comm ur-ilty Development Depart:,i,ietit --- Land Use Di'v!'sicin
715-386-4680 St. Cr6x County Govemment Center
cwi, Q 0 V 1101 Carmichael Road, Hudson, Wil 54016
715-245-4250 Fax
A T EL rJ A R C-1 F= \N I �_- — F-_ (� R M I
WARRANTY DRE D I
TH P3 s i -o ik r_ r_ r,jr;riL:p4vu_-3 I-10FT II V G 0 P 1 U3 1 N G DAI A
Clifford, D. Noreen and
ThisPeed, made b-okwepenLuea H. Noreen, his wi'fii
............ ................ .................
........................ .......... ------------------------------------- -------------
G- rantor
---------- ......... ----------------- "' ---------------------------- r* ------------- ------
------------------- ...... --- ---------------- ........
and- rett Bader and MAry,,M.
and wife as__J.o3.nt teng,.AitA
............................. ----------------- ......
REG4TL-R5 OFFICE
T. CROIX CO., WLS6
Rac'd. fxDr Record
cicty of JuiX .-A.D. 1980
:30 A im d
................... ........ ................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . - _ ., - . . .- �*w I
* ........ 0 � * - * -G rant m,
Witt esseth, That the said Grantor, for a valuablic cowiiderntion__...
.................... ................. ......... -------- ro ix RETURN .10
coliveys to GrAirttee tlic folio -wing described real estate in ---------
CounLy, State of aaonsin; Part 0 f Coverntnent Lot "F9 rr
k0AN. --j -S4 0 1 IIIEW
of Sect iWiion 26 ToivInsh:1P 30 North, Range 19
West, described as follows: L o t 4 of C er t I f i ed
Survey Map filed Januar-v 31, 1-979. in Volume Tax Key No. ---------
"3"1 Page 759, EXCEPT the area South of the existing fence, (being
approximately the South SS feet of said lot).
Also a perma-Inenz non-exclusive easement to use sellers land Bast of
t'he Town Road as a means of access to Bass Lake This easenient shall be''
Ij
appurtenant to Lot 4, but shall applLy only to one family occupying
sa
id lot This deed is giveTi in fulf ill of a land contract between tl-le parties'
dated June 7, 1979, and reco-rded in the Office of tl-ie Register of Deeds
for St. Croix County, Wisconsin iTi Volume 595, Pa154, as Document
Number 3S7430if I
Thi's ------ i, s -.,n o.t ....... hoinustead prepurty.
(is) (is not).
Together with all r-tid %ingulur Chi liereditaments and appurtenarices therounto belonging,
___.Clifford D. Noreen and n
w a r r n T1 tS that the title is good, in fee sir- ple t1d Z'.Tld CIOZ11- Io, c icurnbrances exe e p t t h e r e s ha 11
b e Tic) hunt_ ng of wate-rf owl on the, pr ivate .fake surrounded b-ly the f oL-i-r
lots in the above mentioned certif ied survey map, and this rests jCLt jVe
,.Ing qv1F nand t s hA i3n with the IaTld
Da Led this ---------- day of ............ J U -I- ,r ..................... ......................... 19A 0...
--------- ------- ..... (SEAL) --------- (9 EA L)
CLT F D D. N0Rr-,.1_".1N
---------------------------------- ----------------- ...........
(SEAL) (SICAL)
-------- 2'�7
HEEN
............ ...... ------ LUELLA . NOR
--------------------
A U T H 3E N T I C A T 10 N
autliertiented this day or
--------
...........
' ZqOf4 S I N
_.�.,.%...�"--.,...
TITLE: MErvIBBR STATE BAR OF NSIN
M- j ---- W------ ----------------------------
'LU'1141111 Cl6 y 6.06, is. Stnts.)
. 1.
TH15 WAS 0AAPTED MY
I-IEIYWOOD,,-,.CAR I...4..MU,RP,.A,Y.I. .......
Hudson, Wisconsin 54016
. . , I . _ . . . , . . . . . . , , , . • , + - - , 4 b +, , I , , , . + . , , " I . . . . . . . . . . .. . . . . . . . .. . . . . . .
i Siirnatures may be stuthantlentail or acknowlecJged. Both
,-LA-U£ taut noo�ftnry_)
P- C K W 0 W LGBT
S"VATE OF WISCONSIN
ss,
Personally c4xrne before me. this ............--.__.day of
........ 1. . .... _ tl�e above named ------------ —
. . . . . .. . . . . . ... . . .. . . . . . . . . . . . . . . ... .. . . . . . .. . . . .. . . . . . . . . . . III . . .. . .. .... . .
......................... ..
.......................... ....... www,
to rna known to be the person who axiecuted 01C
1'orawolnw Instrument and Raknowledua tho iiamm
VP
Notal.y Public dicloul"Vo Wits
My Carviry&L"icm In titti-rnitnent. (If tint, strttcs expippottlon
d nto . . . . . . I - , , . 41 10'. - , - I I
"INaMOR 11 l> q F"rj1ftCjt,-0 Ak%k�k1j"t L.", tviioA wr j%Hitteif Wow "r
WIlkitaAm walm q-rA,r1 TIAIM ^V A*FJ`L*L_1 1�.0191 14141.4tv P., $tlm
DOCUMENT NO.
CA rs f
3�� A 9. 1 16
BY THIS DEEDINrxrxsingle man, and
Anthony Furgez-, a sing man,
ij BBader & Ma=y
re�tt� Eldorl
Grantor imanvcy5 asid waxnants to►
-husband and Marqa=et Sadeir, ji fe, as
Dofnt� tenants.
G r ant C. e
One Dollar` and other valuabl
cen e
for a valuable onsidratio
Cons±deratiOn
the follow.ing described real estate tn. ST—.&-CROIX County, 3 to to of W i UU4jn:5-irt--
FEZ
EX,E1\6PT
STATE BAR OF WISCONSW-FORTIC 2
VVAR]iANTV DEED
THIS SPACE RICS�C.RVFD FOR RECORDINQ DATA
RE.G1STr-.R.,,G Qr--Fro- rZ
-ST. cRaix CC>.., VVIZO
Red'd for Reco,-d
day of .y.....A.D.19.yLt
rn- CU
c9 cr o1 Deeds
.RF-TURN TO 'L w R , Re i n s -t �a
127 W. 2nd St,
New Richmondr WT
Tax Key
This is —
The Eas-L 26 rods of the Ncnc�h 40 rods of t-he
Sout�hwes-t 1/4 of -the Sout�hwes-L 1/4 c�_f_-'
Section 26, Township 30, Range. 19.
Exception tcx -%warrantief�.
Executed at New R±qhmq3�i�4:,,. Wi-scon8in
SIGNED AND 8EA`IFD IN PRESENCE ORR
hc>mestea'd property.
thivit 11 th day of july- 74
Z'
Law.rence Furgez-
Azatliczty Furger
-(SEAL)
Signatures of Law:cenoe Furger and Ant�hony-Fu_rger
autlienticated this 13-t:h doy of
L R. Reinstra
STATZ OP WISCONSIN
cuunty.
Personally camL- bcfore rne, this
the ftbov-e- narned
Title; Momber Statf_% Bar of WI-_;;Connin cz---<�tt :R__Q
A Rl zmecu._= =94:sc.
day of
to me knbwn to be the jperson_ Who exac:Utad the fategoing Instrumont and acknowledged the same.
Thim Instrument was drafted by
L* R. RE,INSTRA., Attorney
NeW Richmond,, 17
-rh'* U*V of WAtneszoo is opt1anal.
(SEAJ.o)
Notary Public county.0 Will.
167 comm"Olan (Xidpi"o) (18>
ay eeof pemoas alwalng In awl' capec Ity should kft typed cw pr Into d belamw tbabr aft 1 It, m.
1 WALARA34" DMICID—SMAVIC '*.An OP' VISCC64=W. PCMNF no. * ft& 1411
CERTIFIED SURVEY MAP
cb
GOV'T. LOT ,--
I QN 2 6 � A j 1979
BEARINGS ASSUMED
S69'-45'-OS' W ALONG
THE SOUTH LINE OF
T H E SW 1/4
BOARDMAN R D. 1 72 ,44
s-"- 22 _
47.4 78.4
R/NV 454. 4 4 _
f5-r.. sad - 5f-2-7" �> . � - " � � �` ,
7 1-5 2'^ 1 k" W ,,- 1 3. 4,
7' OIL 31T.20 �d
C, L - LAI
q
` 4I�
k0
EXISTING
HOME ti � LAKE
cp
cp
SOT4
�T w Lu 4 \ SOVR-Old-59"Ej 293,87
Y WEST .48
4 +T
a
6 9. B8
107,01
APB
MINOR
i l�r i "M S 3� —1 E. 5 7 2a
64.Z4 ` - tit ti 3,V-47-4`t4 4. -t
DOES NO MEANAPPROVAL OR � tS 5 -4 1''E
BUILDING E OR SEPTIC _ - t
ZL
�'� ! .
-41.65
44, 81 '.,
-ROVED
p CISTIER-
rQ
".I
T� C COIJNTY LOT I BASS
PAJ" p NNINQ
LAKE
CLI
" 7 7�
3 4. 40. A � .-- dwL— -
"!ra iwl"*- 3`�'� 8I 8" 134,7w 58-7'
�,14 DF.
wZ
SEC. 26
SOUTH LINE -SW 1 4
LEGEND
,:--? c' tv, 6
THIS INSTRUMPNT WAS
-- - - R K. NAIL SET DRAFTED BY -+C. 6,
10
+ T_ 1w68 LB3- LlN_ FT,
- 1"3 "' IRON PIPE SET I Cad zod 50d
'T, 1. G 8 LBL I N_ FT.
NOT E, SCALE IN FEET
ALL ROADS SHOWN ARE
as I TOWN FtOADS
L# :P1
CERTIFIED SURVEY KAFS
t rr^i w e" ^l onlh 1 `44' 4 Q')l mare I n,f '>
SHAFFER
Y
F 1SLrr) THIS 17TH. Y.
OFNOV.,, 1978 .
Z�
Q)
764
N V7 i
.,LOT 3
r�i
20
763
LOT 2
520
7". 7 1
c COVED
14 2 8 200Z
J Pe
T
ZONPING OFFICE
)X c TY
Pfannlm VI rl
,5 r
71
It not rt e(j ttlitl 3u
approv &Ke Proval sh e
762
LO T
8.53.79
5 2L- GL 1.52ND — A VE.
'm6w
Prcoposrod , 'Lot
lei +1
41b
h
0
3 t A40 re
SW l/4 SW //4
C259 :A
LOT -2 LOT I
257 E
c. S4. Mm VO L PG 19,
c. S. Mi, 'VOL* 8 4AG 2170
Iolodwo
C RTIF11
257A4
d: 41
I T
WisoDn5in Department ot cornmerm PRIVATE SEWAGE SYSTEM County-. St, Croix
Safety and Building Divislol sanitary Permit No:
A INSPECTION REPORT Wdul" 0
a ill dN (ATTACHTO PERMIT) Stai� Plan JD No- ' f
GENERAL INFORMATi, I �JZA
Persona I info rmation you a rQvid e mn y be u1sed for secondary puri:oOSes privacy Law. s. 16,04 (1)(m)]-1 -
Ifi
TANK INFORMATION
ELEVATION DATA
TANK SETBACK INFORMATION
PUMPISIPHON INFORMATION
x Pressure Sistems Only
7 --6u
ap NCB_
ZeYA25_H_'_.�
-ispection #2
COMMENTScl- clude code d1screpencies. persons present, etc.) In specfion #I
Parcel NO:
T N Ri 8W) -H-A t cot 1
Locatio n: 7 W 11
0%.� -F V11 I Lj t I ko T I 1%F_T &.. %0 k5W 4 SW 14 2 5 28
1 e) Alt BIM Description - Z ,_A j?fi7
YL
2.) Bldg sewer, length, '00 �".o
- amoijnt of Cnver
. . ..........
Plan revision Required? Yes /N o
Use other side fcw addiflonal lnforma�on, C@M No
1116ttPO&O signal re
S13[)-6710 (R.3W)
SO(L EVALUATION REPORT
Code derived WSW Mu" 10 w
Now ConstTUCOM U W. Resideriftl I Number of bodes
Ment
'dub k of commmrcial - UewtbB'
Rept"
r-t-od plain 6jevgWn K 8PP11CaN8
ftrent Matedol
S-I FRECEIVED
C,*SnBTW
and recomendaWns:
VII
Mftg #
pit GroundsurfimselOv.
> 3D -c 220 Mg& ISM TSS !30 < 150 ffqL
C)OW to jimifing fad __5 1 _ in -
..I-
- Ercom 02 a 80D, f 30 mg/L wW TSS < 3D
I
Pal ID N
-jr
Page _.� —
F i y, iMa 1r: Zf
i +df
� i f
[I Bofing
ring W,6Ww-
E:1 0 — -
pit
sBE)- ; R
Depth lb WTA09 bckw In.
is an equal oppormitY t vkV providcrand rmpjeyvr. I you ncr-d assistancc tjD 4kcccss services or
PAGE OF,,3
L
X7 A litr L
SCALE; I
BM I ELEVATION —
BM I DESCIUPTION 960
BM 2 ELEVATION MIIIIIIIIIIII w q d r OF
BM 2 DESCRIPTION
7 4#1
SYSTW ELEVATION- Ve ql, Lo
SYSTEM
COO
NT qj UR VATION Oo.4.q oot
zl_
j
3,
SICAKATUREDATE -c%
cw
STA�M 13AR OF WISCONSIN-- FORM I
00CUMEN'r NO. 5' ' WARRANTY DEEL)
VOL
T141S SPACE SLf,,qjF-gvjEo Ilos rtEcnnnitjC-, OATA 541 r A C. F i
0 j
Laurence and Anthony Furge-r'o
THIS DEED. m-udr! between
both singl�a-_?780ns
Grantor
and Brett - ice. E. Bader and Mar- -M. Bader, h sband and wife
s j aot tenants
Grantee,
witnaaseLh, That the said Grantor for a valuable cons iderapt ion
Ina h arLd T) a3'-d
coltveys to Grantee the following describud real estate in
State Q1 Wiscunsire:
'rhe sout-thwest Quarter (5-W 1/4) of t1le Soot
Quarter (SW 1/4) except t--he Eric Twe-nty-six (26)
r-c)(Tis of tj-,�No-rti., rio-rtv (40) rods thereof. In
rr h
'Wenty_Gj,X (26) Towriship ThIrty Nort-
sect
(30 1�) r,.angc--- Nineteen Wes (19 W) St. Crow County,
[des coz,5111. con tainl-rig 33.5 acres., more or less.
R
REGISTERS OFFICE
T. CC CP,01,1 .>.
L W is.
Read. for Record this
'fir Y of. D. 7 9 - 7 6
A Qt MP
e
R .9 Is? @A 64
TaN
- T- � I I- L, 3 � 1 7 1- - hofiwc.rezid property,
T I N
r�'ANSFER
$ 9
jj.6fL
1r:o 2 E I E
TQgolhar with all -And si-ngulnr the hered(tarnents and appurtenances thereunto 1>vlonging or in any wise appert0ining;
And 1,p�urepce ur-Ser and Anthony-Furg r both sjjlgle persorks
warrants !hal th�� title 19 E;iaud, indefensible in fee simple and free and clear of encumbrances except
and will warrant and defend the sorrit?.
Executed at
SIGNED AND SEALED IN PRESENCe OF
Signatures of
authCnticnted thiS day Ikf
tb in — 14th any ., —August —, 19
(SEAL)
( R r-- AL,)
Titir.,, 'Mvm:jr:-r Sta�.e Elar of Wisconsin or Oihtzr Party
AUthoriVuLd linder Sec. 706.06 VIZ.
:S'rA'rr-. OF WISCONSIN
-7
Personally cnme b-ofinrc: n.w. this d a y of -�-t 19 C.
the above named
to me known t o be the pers6n w ho a xe-c uted th c fore go inr, In%trunnent and 2cknowledgad the same. 00
0
%14
JWM
Thi n n r u i Ti e n i W a n d ra I Y 7�
t
7
Nocary Nblic n W j M.:
m
Tkiiu use of wttoesstics in opt4Qnal. Jin-- Tir--
N gamin of P*rabn a a ism its's 1'n U it Y c 40 0 c, i i y h k;w 141 be 9 YP404 air pr Anted be tow thair W&WOOLMM 0,
DEjtD-4!5T^'r1FZ r%AR 1PORM HID, I - 107't
45�- 1Y, COUNTY
1
7/1 132 F wr ZiVe 0
IrAtj xxxi'-i'm V-.' VV "-VL
OWNER VDQjEerF � MAfY&AtelL
..... ... .. . . .. .....
V NO@
7'1 qdj` U N-P
PLUIVIBER���1 ��t-T LIC.# 223760.
TOWN "O""'F S—r. �'pSEPN
ST"11 I&-%d
r-jU 2�,�9'1' 30 _-Nq
-W d-*%r M �
]L I
AND/1-Oxx q
csw.
c. � • I
............
e
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 permit.
(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 a
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: 1f you wish to renew the permit, or transfer ownership of
# ca authority.
t e erm�t lease contact he uu h
permit, P ty
1
MM
r M
1 !.
....... . . ..... .....
SBD-06499 (RI 1/20)