HomeMy WebLinkAbout032-1073-60-100 (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:
Lawrence & Sandi Hecht
City Village Township
TOWN OF SOMERSET
CST BM Elev:
Insp. BM Elev:
BM Description:
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
ing
/
- -
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
Dosing
- t
Aeration
Holding
PUMP/SIP ON INFORMATION
/lanufa turer
Model umber
T DH Lift ictio Loss S y s t He
I 1 17 A / I T
V
ain ILeWh Di I D t. t well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Len
1 DIMENSIONS 10
SETBACK SYSTEM TO
INFORMATION
Ty OfU��J��VwLk
System-
DISTRIBUTION SYSTEM
ODE mand
G F'M
TDH F
ELEVATION DATA
County: St. Croix
Sanitary Permit No:
651352
State Plan ID No:
Parcel Tax No:
032-1073-60-100
Section/Town/Range/Map No:
26.31.19.361 A
mum=
Bldg. Sewer
St/Ht Inlet
a
mif
St/Ht Outlet
�.r.�aWAI
n
nr.Dt
Dist. Pipe
Final Grade
946M
0 -
U11, M
LOIN, wo- t
M
rim
mmm
No. Of Trenches I IPIT DIMENSIONS INo. Of Pits IInside Dia
P/L BLDG WELL LAKE/STREAM LEACHING Maopkcilvi
CHAMBER OR
UNIT Mo IN
Liquid Depth
4
Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia Length Dia Spacing I
SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only
Depth Over
Depth Over
xx Depth of xx qQZ ri xx Mulched
Bed/Trench Center
Bed/Trench Edges
Topsoil
❑ Yes ❑ No I ❑ Yes ❑ No
r
COMMENTS: (Include code discrepencies, persons present, etc.)
Inspection #1: Inspection #2:
Location: 1915 60TH ST
1.) Alt BM Description
0`
✓
2.) Bldg sewer length
- amount of cover -
Plan revision Required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R.3/97)
Date
In a ctor's Signature Cert. No.
Safety and Buildings Divisition
County
Oro
Sp A
201 W. Washington Ave., P.O. Box 7162
Sanitary Pcm3it Number (to be filled in by Com)
Madison, Wl 53707-7162,
Sanitary Permit Application
State Transaction Number
In accordance with S PS 383 1(2), W Us. AdrrL Code, subn:�s s I on of this form to the appropriate governmental unit
Prqj ec t Addres s (i f different than mail in address)
is required prior to ol)talaing a san r tart' permit. Note- Application forma for state-owned POWTS are submitted to
the Doparment of Safetv and Professional rvies. Personal inf6rmation you provide may be used for seconday
p4Moses in acclardaz.," with the Ph-vacLaw, s. 15.04(1)(!Laj, Stats.
Application Inform2tion - Please Print All kformation
Property Owner's Name
a uv ro /1 c- e e C
Parcel #
632 101-,5
Propery 0%vncL,'s M"- ing Address
Property Location
Gout. Lot
5,CV yq, 5- 1AV sez,'i on
City, Stale
Zip Code
Phone Number
YO 2
11. Type of BoUdWS (chwk sffi that apply)
Lot #
I or 2 Family, Dwelling - Numbcr of Bedrooms
Subdivision Natt7ot
Block #
?uhl.ic/Con=erc1a1 - Describe Use,
City Of
State, Owned - Describe Use
E] V"'age of
CS]VINumber(O., ZZ40)
Town of
E2*E K
DD C V 4o i9R
111. Type of Permit: (Checkonly one box can UneAim Complete line if applicable)
A,
New Sys rp lacement System
--------------
Treatment/Holding Tank Replacemmt Only Other Modification to Existing System (exp lain)
B Pc=t R=ewal
Pera-ut Revision
0 Change of Plumber
Ll P=nit Transfer to NCW
List Previous Permit Number and Date Issued
Before Expiration
Owner- 9 -
161
I z%'TG'9 30 )/7 0
." V
EL_V._1.Tvr)e of POWTS SY Ste fla/compon enm" t/Dce: (Check all that apply) e71111*11 �e-^ed"-A r:!!> �2
Non -Frey s LM'zed In- round Ll Prcsstazed In -Ground IJ At - Grade Mound > 24 11, of suitable soil LJ Mound < 24 in. of suitable soil
Holding Tank Othrr Diapmal Compotent (explain) 7 Pretreatment Device (explaim
V. Dispersal/Treatment Axes Infdrmatiow,
Design Flow (gpd) Design Soil Application kate(gpdsf) Dispersa I Area Required �f) Di5pcml krea Proposed (5f) System Elevation
,"7 V
6
1 Vj 6
V - q�lo
V_L Tank Info Capacity in Total # of Manufact"er U
Gal]onfi Gallons Units 2�
New Tank& Existing Twks 57.1-< k+ex-
_5` U
Septic ar Holdiftg Tuk Week)' Tj P,'l N
singer
V11. Rey poasibi1i!Y_StSttMe1kt- 1, the uudersigned, assumt responsibility for instdiation of the POVVTS shown on the attached plans.
Plumber's Name (Print) Plumber's nffe
UTPVIPRS NumbeT B IUS inCSS Phone Number
13ir ?c2/ -i e f
2,3 12 Y
I a
Plumber's Address (Street, City, S,.atL�., Zip Coded
ell A 0
V1111. Coun epartment Use Only
A, pproved
r C V
Permit Fee
Date Lmued
Issuing Agent Signature
$
/262
IX. Conditions of Approval Reasous for Dil'sa"Pproval
SY S TE ryl (),V� R
1. 84-phr tz1;-J,:, 0% r, �t filiar 3,,9d dispr rsal Geli
must be seDlccad I fflalnialn&d as per
managenk-ni P12rl FrOvit.'LA by plumber, (I
n all -n@'':niained �(r_ Lou LItoMA
sell-ack requm�wnis rru5j 0c.
as er appfibt, cods? 7,rdiri!vice,�
attic h to eamplek plans for the system and submit to the County only ou paper net lem titan 8 1/2 111 inChel in B&C
:]WEER i\TR
N am e_La bu /04e4 c c gecA -i-
A
S-01h trs-er 5-ye)..2.r
Benchmark i
AL Bench -mark, 2
L7 Soil Boring
®J Suitable Area
0 ' 4 Scale
,
I T- ---I
Base oP&epok�w jr-:Z-, /ou"111,10
Mol 1%le C-64fer OF4. /0 0 c
Page 3 of 3
Arian Pam e I I
CST 23 1.3'14
Date /s=c2az3
:]WEER i\TR
N am e_La bu /04e4 c c gecA -i-
A
S-01h trs-er 5-ye)..2.r
Benchmark i
AL Bench -mark, 2
L7 Soil Boring
®J Suitable Area
0 ' 4 Scale
,
I T- ---I
Base oP&epok�w jr-:Z-, /ou"111,10
Mol 1%le C-64fer OF4. /0 0 c
Page 3 of 3
Arian Pam e I I
CST 23 1.3'14
Date /s=c2az3
NWden Rock* III
Portage, WI 1-800-362-7220
Fond du lac, Wl 14300-641-5937
Website: vriovw.wIleserconcrete-com
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Inspect pump, penrip centrdle & al
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1 ! 1 O' • Must I wo '.■l U I. "5■ 7 of r Ran 10 LDIFTY1 ary 54000041 #° bmkm hwdwwe,. ! - *any cracks aa
meamure Ote vokowe of otmbktod k, f* e r scuin andW check forback r or pcondkV offluem an
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DO NOT USE PLU G
WHEN FILTER IS RI;L--- a.di ov D
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�- L,- - RAM
�FILTRATOR'
tanks
The Infiltrator IM-540 is a lightweight strong and durable septic/pump tank.
This watertight tank design is offered with Infiltrator" s line of custom -fit
risers and heavy-duty lids. Infiltrator injection molded tanks provide a
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I LVA 11*11111
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Lightweight plastic construction
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Integral heavy-duty green lids that
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Structurally reinforced access
ports eliminate distortion during
installation, and purnp-outs
Reinforced structural ribbing
offers additional strength
Can be installed with 6 to
48r' of cover
Can be pumped dry during
Pump -out$
Suitable for use as a pump tank
or rainwater (non -potable) tank
•No special installation, backfill
or water filling procedures
a. re rep u i red
•No special water filling
requirements are necessary
The tank may be backfilled with
suitable native soil. See installation
instructions for guidance.
VAI
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IM-540 General Specifications and Illustrations
The IM-540 is an injection molded two piece mid -seam
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for accepting an engineered EPDM gasket. Infiltrator's
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The two-piece design is permanently fastened using a
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locking seam clips. The 'IM-540 is assembled and sold
through a network of certified Infiltrator distributors.
Must be backfilled and installed in accordance with
I nf i Itrator Water Technol og les, I nf i1trator I M -Series Septic
Tank General Installation Instructions and for shallow
ground water conditions reference the Infiltrator IM-
Series Tank Buoyancy Control Guidance.
Please visit www.infiltratorwater.com/images/pdf/`
ManuallsGaide sfTANK01.pcif for the latest information.
7T61 a I 'C 'app a c i t Y!,
552 gal (2090 Q
Length
64.9" (1648 mm)
Width
61.7" (1567 mm)
Height
54.6" (1387 mm)
Maximum Bur'211 Depth
48" (1219 mm)
Minimum GLjriial Deot�
6" (152 mrn)
Maximum Pipe Di-,amete(
4 *F (100 Mrs)
Weight
L LL
169 lbs (77 kg)
51
-NFILTRATOR"
water technologies
4 BL1,,-un8S5 Pwk Road
P.D. Box 768
Old Saybrook, CT 06475
860-577-7000 - Pax 8430-577-7001
1-800-221-44,36
www. i nf i It ratc>rwate r.com
A
I N LFT
CONNECTION
Mp)
54.6
1,3871
EXTERIOR
HEIGHT
tl; R
T H
NG STRAP
(TYR)
TOP VIEW
L4ZIMIMA45N
24 JF)'D: A'�'CESS CPENING VViTH LOCKING LID
SECTION A- A'
INUOUS
TANKTOP
HALF SE.AM CLIP
TANK
INTERIOR
AL IGN MENT TANK ooTTn. m
DOWEL
HAJ
MID -HEIGHT SEAM
SECTION DETAIL
,-. S. Pat wts : 4.759,66 1; 5.017,041: 5.1 56.4M, 5,336,017: 5,40'. 116- 5,401,459: 5.511.903: 5, 71 M 63; 6, b88. e'� 8 ; . 8 39. 134-4 Canadian Patents: I , 329,959: 2, 4,564 Oth& patents pending. 1"fiftmbEw.
E (I Ui3hZef, Qkj is k, and Sidaftndar Em reMstered trademarKs of Infiftmtor Water TeciMok)9les. Infiftmtor i s a register &,I 'radevlarK In Fnance. I nfiltrator Water Techmlogis a registwed tradernark in Mex ico,
Cor tf; UF. M iur vl_taching, PoIyT4M. CtiamberSpacer- Mufti%M. PoSiLock. QuickCkg. OuickPlay, SnapLo,ck anci S! r a`g ht Loc k an? trademaft of I nf9tr=r Water Technc4ogies,
PoIyLok is a trada-7arh of Polyl_ok, Inc. TUF-TITS 7s a regisb.ared trademark of TUF-TFrE, INC. Uftlra-Ro is a trade naN of 1PEX Inc.
6') 2013 lnfltrafor Water Technologk3s, LLC- Al nghts reserves. Printed w U S.A.
Imil 1116
File
S-r. CRa : I. J N TY SANITARY SYSTEM Office Use Only
-= --���� OWNERSHIP/ADDRESS FORM crmw2l.2o2y
I I
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.
OWNER/BUYER INFORMATION
Owner/Buyer
Mailing Address f I is �4 �'h s 7�
City/State/Zip -e a,, s�
-r f epe
,��4�s
Phone Number (required) 71S � {/�� �� / `{
—
Email Address (require(])
Parcel Identification Number
(found an the property tax bill)
03z- /073- 66-/ao
NEW SYSTEM: LEGAL DESCRIPTiON
Property Location SW 1/4��` 1/4 , Sec. 26 IFT 3� N R/�'W,Town of
11 -
.�Q "h e,-Po--
Subdivision Plat Lot -
Certified Survey Map # -11-0 Volume , Page #
Warranty Deed #
(before 2006)Volume -- , Page#.
Number of bedrooms � Spec house E3 yes 0 no Lot lines identifiable 13 yes E3 no
New Droner Address
(Staff Initials)
OFFICE USE ONLY
('Verification of new address required from Community Development Depar-trnent for new construction,)
(Date)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
New System: Include with this form c7 recorded worronty deed from the Register- of Deeds Office and a copy of the certified
survey map if reference is made in the warranty deed.
Cornrnunit y Development Department — Land Use DIvision
715-386-4680 St. Croix County Government Center
cdd@sccwi.q,gy I 10,' Carmichael Road, Hudson, W1 54016
7 15 - 2 4 5 42 _5 0 F a. x
f
Document Number
THIS DEED, made between
State Bar of Wisconsin Form 3-2003
QUIT CLAIM DEED
Document Name
Lawrence P. Hecht and Sandi J. Hecht
husband and wife
("Grantor," whether One or more),
and Lawrence P. Hecht and Sandi J. Hechtas Trustees of the
Trust Agreement of Lawrence and Sandi Hecht
("Grantee," whether One or more).
Grantor quit claims to Grantee the following described real estate, together with the
rents, profits, fixtures and other appurtenant interests, in St. Croix
County, State of Wisconsin ("Property") (if more space is needed, please attach
addendum):
See Addendum A, attached.
8628718
Tx:4535091
1093133
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
11/26/2019 09:50 AM
EXEMPT#: 16
REC FEE 30.00
Recording Area
Name and Return Address
Johnson Law Group, P.A.
6465 Wayzata Boulevard
Suite 304
Minneapolis, MN 55426
PAGES: 2
03 2- l 073 -60- 100
Parcel Identification Number (PIN)
BARRY SCENT BAIN This is homestead property.
Notary Public (is) (is not)
State of Wisconsin
Dated A-0VEM9
(SEA P(SEA L)
* Law ence P. Hecht
(SEAL) — (SEAL)
* *Sandi J. Hecht
AUTHENTICATION
Signature(s)
authenticated on
*
TITLE: MEMBER STATE BAR OF WISCONSIN
(if not,
authorized by Wis. Stat. § 706.06)
ACKNOWLEDGMENT
STATE OF WISCONSINqSV
}
} ss.
• �31 COUNTY }
Personally came before me on iti e
the above -named Lawrence P. Hecht and Sandi J. Hecht,
husband and wife
to me known to be Ae person(s) who executed the foregoing
instrument d ackno th ame.
THIS INSTRUMENT DRAFTED BY:
Kevin C. Butzen, Johnson Law Group, P.A. ISKT * r
1610 Maxwell Drive, Suite 200, Hudson, 'LEI 540I6 Notary Publi tWisconsin
M Commission permanent) (expires: x ires:
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: `I`HI5 IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
QUIT CLAIM DEED (D 2003 STATE BAR OF WISCONSIN FORM NO.3-2003
* Type name below signatures.
St. Croix County 1093133 Page 1 of 2
f
3
F
a
ADDENDUM A :
Legal Description for Lawrence P. Hecht and Sandi J. Hecht
Parcel I
Lot One (I) of Certified Survey Map recorded in Volume S of Certified Survey Maps at Page 2240 as
Document No. 460499, in the Office of the Register of Deeds in and for St. Croix County, Wisconsin.
Said Certified Survey Map being located in the Southwest Quarter of the Southwest Quarter (SW I l4 f
SW I /4) of Section Twenty-six (26), Township Thirty-one (3 I) North, Range Nineteen (19) west, Town
i
of Somerset, St. Croix County, Wisconsin.
St Croix County 1093133 Page 2 of 2 �`
APPROVED
i u L 1,-, 1990
S1. CROIX couNly
460499 -CC*=1aN1&VU PArZK4 PLA14NINK:-,
CERTIFIED SURVEY MAP
L 0 C A T- E D r N T H E 53) W 1 4 0 T H E S w 1 OF S E C T t 0 N Z 6 p T 3 j N F? I cj, W , T--0W N S C) m ,IF? S F T . q T C R 0 1 C C)
w I
OWNED BY J C 'Y-r Lr H C C HT
N 0 L 0 S
c; nMERSE T. W1
W f /4 CORNIER OF SECTION
2 6 , T -3 1 N R 1 9 W - f c; o uN 'r y Af'iciavit Vol., 678 pi--.273
#W 0 N U ME N T FO U N 0�
NOTE: Sit A1q1 14GS AFPE PtE P iERF NCED
TO THE WEST LIME OF THE SW 1/4.
A S S U TO L 0 1
di
FILED
UNPLATTED A N 0 S
J U L 16 199 all&--
VV-14 JAMES O'CONNELIL
I Fmomil* of asoft
Z:p a oft 40, tot
a 9 cl 4 6'2 t3 "E- 500
4to- 92 219 6 1- 40
460,531 - -
SET CHOSLED llx', AN'll
0 E 0 6 RA N i riE 8 OUL-,
DER, 0
I 11w
114- CAI
�
224 4
Ira
1 *9
A C, 7 4 8 Ap,
Ah
LI is 65 372 .48,
Na 9 04 6 L5 �wi 4 7 -5 0 5
L 0r AREAS
UNPLATTED LANDS -r,4e Ar-1 T9*ATER's,g"E
7. 14 AC T6 MEANDIIIR L .
Ai 7. 0 5 A C, TO M. L - A: X
iUn ROAD RIGHT OP" WAY'-
C 3 015 L 9 3 15 Sir. F T.
.y
Z, 02! 5FT 11" X 24" IRON PIPJL WEJGHIIVG
).13 LOS PER LINEAL P"00y,
Li
C)
Ar
Ln
kmi
WE13ER
S- 180.4
33' .3 T1 SPRING VALL"
wm
AL
SW C019NIER Or -9.14CrIOF11
k
Y 3 p pa R 1 9 W, 2 FR 0 N
P P L':- PrOU NID�
WF9iFR AN0 !;I I R V F y IN 15
DAT'ED
0 100, 2 00 400'
SHEET I OF 2-
9T'06f"'rRyR4y,�-,,pRAFr&0
22 0
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. . ...............
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: G h t
Owner's Name: lC,. Ce ck Sogood' I'lGC4 -il'
OwnePs Address: �6 �, �Poe,
J 7VOA Wr
Legal Description: S� �`7� o � � w �Z1 1 '� v 7D/ Y / ` /5� 4u
r-
Township: 5,0 &1 P/'.L{
County: Sf . ceool�"C
Subdivision Name:
Lot Number:
Parcel ID Number: 0,3 2 " /0 60— /0(:)
Page 1 index and title
Page 2 Plot Plan
Page 3 System Sizin2 & Gross -Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix C!y Septic Tank Maintenance Form
Page 8 Warranty Deed
Page g GSM or Plat
Attachments: Soil Test 8 House Plans
r
Designer/Plumber: l�/� I 4 n fa /of if License Number.
Date: /,S = 93 Phone Number
Signature
z3 /z/_((
71r 7dro - a y8r
Designed pursuant to the In -Ground Soil Absorption component Manual for POWTS Version 2.0 SBD-10705-P (N.01101).
Page 1
s� Dept. of Safety an
.and professioal Service4- , � SOIL EVALUATION REPORT Page I of
Vie.-f
DiVision of Safety and Buildings
in accordance with SPS 385, Ws- Adrn, Code
Attach mplate site plan or paper not less than 8 112 x 11 inches in size. Plan must County K
include, but not limited to: vertical and horizontal reference point (W), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and lorat*n and distance to" nearest road.
Please print all information. Reviewed by Date
it
Personal informat[ori yQu provide may be used for secondary purpQse(Privacy Law, s. 15.04 (1) (m)). 101 121
Property Owner Property Location
01— S4, Ye C. GoV.- Lot so- 114 5�1 14 S 2 N R N (or)o
Property Ownei's Mailing Address Lot # Block# SLAbd. Name or CSM#
6
City State zip Phone Number L city [7 Village OTown Nearest Rcad
S 4
New Construction Use: Ll Residential / Number of bedrooms
PS.Replacement Q Public or commercial - Describe -
Parent material
General comments "4e 4. 'I
and recommendations:
30dng #
pit Ground surface elev.
��
-7
Horiizon Depth, Dominant Color Redo x Descriptlorl
in. Muns,ell Qu- Sz- Cont. Color
7A
Yo ���
T5
57. 3. eo
3 Code delved design flow rate. !_GPD
Flood Plain elevation if applicable
/V*
ft,
ft.Depth to lirrilting factor in. Soil Application Rate
Texture Structure onsistence Boundary Roots P Difi
I
Gr. Sz. Sh. ff#2
/M mill O's
L otS
0 ,
0,-7
Boring # L] Borg
/I �y
pit Ground surface elev. 0 ft. Depth to limiting facto-F in. Soli ���tion Rate
Horizon Depth Dom mall n I Coio r Redox Description Texture Structure r__onsisfence Boundary RoWs GPD/ft
in- Munsell Qu. Sz. Cont, C010T Gr, Sz. Shy. ff#1 E_ ff# 4
1 6 CA,
:Z /0-21 10 Yl? 6-- ms4,t Or 9
........... .
0c b Ocg
21. 10 1012
I I y Idr yR 0,�-j
> 30 < 220 mgAL and TSS >30 < 150 rng/L Effluent nt -#2 = B 0 D c 3 0 m L a n d < -JU Mg (L
*Effluent #1 = BOD r, -
CST Nam- 'Please Pdn Sig Q CST Number
nr. 1�?Cue/l -e / 4 2.3
Add rem /) el Date Evaluation Conaucted Telephone Numoer
F 1-7.4 Ve YOM fv/7�( I,- eT .41 "4Z
Boring # L] Borg
/I �y
pit Ground surface elev. 0 ft. Depth to limiting facto-F in. Soli ���tion Rate
Horizon Depth Dom mall n I Coio r Redox Description Texture Structure r__onsisfence Boundary RoWs GPD/ft
in- Munsell Qu. Sz. Cont, C010T Gr, Sz. Shy. ff#1 E_ ff# 4
1 6 CA,
:Z /0-21 10 Yl? 6-- ms4,t Or 9
........... .
0c b Ocg
21. 10 1012
I I y Idr yR 0,�-j
> 30 < 220 mgAL and TSS >30 < 150 rng/L Effluent nt -#2 = B 0 D c 3 0 m L a n d < -JU Mg (L
*Effluent #1 = BOD r, -
CST Nam- 'Please Pdn Sig Q CST Number
nr. 1�?Cue/l -e / 4 2.3
Add rem /) el Date Evaluation Conaucted Telephone Numoer
F 1-7.4 Ve YOM fv/7�( I,- eT .41 "4Z
> 30 < 220 mgAL and TSS >30 < 150 rng/L Effluent nt -#2 = B 0 D c 3 0 m L a n d < -JU Mg (L
*Effluent #1 = BOD r, -
CST Nam- 'Please Pdn Sig Q CST Number
nr. 1�?Cue/l -e / 4 2.3
Add rem /) el Date Evaluation Conaucted Telephone Numoer
F 1-7.4 Ve YOM fv/7�( I,- eT .41 "4Z
Property Owner ZO W rt4 c C � .��i: Acre, 4 !�' Parcel ID # 0320M �d 7,�-� b 6 /Oo pie � of 3
Boring # ❑ Boring
pit Ground surface env. Y��d ft. Depth to limiting factor //7 in.
Soil liption Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft z
in. Munsell Qu. Sz. Cont Color Gr. Sz Sh. * {#1 2
I
o��
oY �
NA�
G
/rh �
/rt�' _
c.u•.
3 c
D.
&J.-
/09 �t
4/Ar
/Psri&
"PI
6 co
61
7.s'YRIMP,*
a.A
oil
l �
It
A/A
MY
0sy
04
40
Boris # ❑ Boring
g ❑ pit fL Depth to limiting factor in.
Ground surface elev. g
Boil lication Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox description
Qu. Bz. Cont. Color
Texture
Structure
Gr. Bz. Bh.
onsistence
oundary
Roots
GPD/ft F
ff#1
ff#2
Boring
Boris #
g ❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Sail lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft F
in. Munsell Qu. Bz. Cont, Color Gr. Bz. Bh. '' ff#1 ff#2
5'
* Effluent #1 = BOD 5 > 30 < 220 mg/L and TBB >30 < 150 mg/L * Effluent #2 = BOD s < 30 mg/L and TBB < 30 mg/L
The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services -or need material in an alternate format, contact the department at 608-266-3151 or TT Y 'through Relay.
SBD-8330 (Ri I/I r )
-'WNER
Address
.5 Y0,0,2
f? �4v
Benchmark i iq� &L-� C- Ck, 45zr /00., 0
A& Benchmark 2 M oq 'moo le, ufa "I 4!FZ 4 0
Soil Boring
Suitable Area
1" 40' Scale
T ---7
o
F 174
=nip E
Page 3 of 3)
Brian Parnell
CST 231314
l.
Date-LIS =Zoe 3
-
W11nL
man
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR iTH•r/eTION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the misting septic and/or dose tank
presently smving the following residence:
(Street address) f'71-s' 6'01"11;e- ,so✓Ne�lcr GAT located
at: SJ!�Ad V49 SGv V4,, Section 2- ,Town �/ N, Range /97 W,
Town of S4 rn e�.se t- Is Croix County Wisconsin.
Upon inspection, I Certify that I have found the tanlc(s), to the best of my
knowledm will conform to the requirements of Comm. 84-25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service 2 Ocz3
Did flow back occur from absorption system? Yes No
(if no, skip next line.)
Approximate volume or lengthti
of me: gallons minutes
Tank Cgspacifiy:
Construction: Prefab Concrete Steel Other
Manuficw= (if known) e e lcl
^- r� nr�i rr �. .r� r�r ■�-i rr r it �rn�i .�.r.
Age of Tank (if imown): If
Permit (if known) - /,2 e -75-9
(Licensed Plumber Signature) (Print Name)
(Title)
/0-1r� -.I-
(Date)
z3i2 100voe
(License Number) MP/MPRS
Form to be completed by licensed plumber (Dept of Commerce Chapter 5
and s. 145,06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin
Administrative Code)
FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER -ZA"�e I'leaf TOWNSHIP /Y • � � erSt
SECTION�T,,�N-R�W
ADDRESS_�,� ST. CROIX COUNTY, WISCONSIN
412 �y 0 O-Z �7
SUBDIVISION
PLAN VIEW
LOT --- LOT S I Z E r--.
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
BENCHMARK:Elevation and description: &A-.19'Le Ae 1/7
Alternate benchmark vor' d
SEPTIC TANK:Manufacturer : 1d2e--e-1f5 Liquid Cap. Z epz>---ram
.te.—
Rings used: o Manhole cover elev: Final grade elev: .
Tank inlet elev.: 5
.Tank outlet elev.:
No. of feet from nearest road:Front Side Rear Ft. �00
From nearest prop. line:Front, Side , Rear �Ft.
f
No. of feet from: Well oo� Building:.
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
4.-w.1� I s
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufact.: Pump Size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.: Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front Side , Rear -Ft. -
Distance from: Well Building
SOIL ABSORPTION SYSTEM
Bed: X Trench: Seepage Pit:
/Ir 9 0,
Width: Length Number of Lines:Area Built
Exist. Grade Elev. Proposed Final Grade Elev.
Fill depth to top of pipe:_
No. feet from nearest prop. line:Front__,Y, Side , Rear Ft.,.&2
No. feet from well: No. feet from building
/7�c�
f
HOLDING TANKS
Manufacturer: Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line:Front Side , Rear Ft.
No. feet from: Well , building , nearest road
Alarm Manufacturer:
INSPECTOR•
DATE • � v'/ � PLUMBER ON JOB
LICENSE NUMBER:
6/90:cj
DEPARTMENT OF INDUSTRY,
INSPECTION REPORT FOR
SAFETY & BUILDING
LABOR & HUMAN RELATIONS
ON -SITE SEWAGE SYSTEMS
DIVISION
P.O. Box 7969
OFFICE OF DIVISION CODES & APPLICATION
SW�t Mffi,JSON�WI 537Cjr T3T �`_ T r�r
W2u, 1 IV 1 W
State Plan I.D. Number:
Town a4 Same et
®CONVENTIONAL ❑ALTERATIVE
[If assigned]
64�Gt S�Jx.�e�
ElHolding Tank ❑ In -Ground Pressure
Mound i0 14iQz0Q
NAME OF PERMIT HOLDER:
ADDRESS OF PERMIT HOLDER:
INSPECTION DATE:
Lv&ty Hecht
Box 325, SameAz etW1 54025
i§tW4 ;eE56
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN:
REF. PT. ELEV.:
CST REF. PT. ELEV ;T
10
Name of Plumber:
MP/MPRSW No.:
County:
Sanitary Permit Number:
u n Bi&d Jn ,
3 318
St . Cn
128759
SEPTIC TANK/
„�Q'
7'
MANUFACTURER:
LIQUID CAPACITY:
TANK INI ETItEV.,
TANK OUTL
WARNING LABEL
PROVIDED:
LOCKING COVER
PROVIDED: &_L" CO
e.
`'an
ce
ES ❑
NO
❑
YES NO
BEDDING:
id DIA.:
'
VrW MATL.:
C
HIGH WATE
ALARM:
NUMBER OF
ROAD:
PROPERTY
WELL
BUILDING:
VENT T RESH
❑ YES gj NO
rf
V
r4.
CA16,�.❑
YES W NO
FEET FROM
NEAREST
LINE: ,
r
e
AIR I ET:
DOSING CHAMBER:
If
MANUFACTURER: BEDDING:
LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER:
WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: PUMP AND CONTROL NAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN EET FROM LINE: AIR INLET:
PUMP ON AND OFF) ❑ YES ❑ NO
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: ETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
BED/TRENCH
DIMENSIONS
WIDTH:
/� �
I
LENGTH:
C �
J 0
NO. OF
TRENCHES:
DISTR. PIPE SPACING:
�
(r
COVER
MATERIAL:PIT
INSIDE DIA.:
# PITS:
LIQUID
DEPTH:
GRAVEL DEPTH
FILL DEPTH
DISTR. PIPE
DISTR. PIPE
DISTR. IPE MATE I L:
NO: STR.
NUMBER OF
PROPERTY
WELL:Ct
BUILDING:
VENT TO FRESH
BELOW PIPES:
f •
ABOVE COVER:
ELEV. INLET:
ELEV. END:
�efA, � /
IPES:
T
LINE:
r
AIR INLET:
v?��r�11
NEARESFEET
C�
mvuNu 7T71 cm; (� lJ -1,4S AICJ �=1c�T
Mound site plowed perpen icular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
❑ YES ❑ NO ❑ YES ❑ NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH
WIDTH:
LENGTH:
NO. OF
LATERAL SPACING:
GRAVEL DEPTH BELOW PIPE:
FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS
MANIFOLD
PUMP
MANIFOLD
DISTR. PIPE
MANIFOLD MATERIAL:
NO. DISTR.
DISTR. PIPE
DISTRIBUTION PIPE MATERIAL & MARKING:
ELEVATION AND
ELEV.:
ELEV.:
DIA.:
ELEV.:
PIPES:
DIA.:
DISTRIBUTION
HOLE SIZE:
HOLE SPACING:
DRILLED CORRECTLY:
COVER MATERIAL:
VERTICAL LIFT CORRESPONDS TO
INFORMATION
APPROVED PLANS
❑ YES ❑ NO
❑ YES ❑ NO
COMMENTS:
PERMANENT MARKERS:
OBSERVATION WELLS:
NUMBER OF
PROPERTY
WELL:
BUILDING:
FEET FROM
LINE:
❑ YES ❑ NO
[:]YES ❑ NO
NEAREST -----00�
Sketch System on Z11 ain in county file for audit.
Reverse Side. SIGNATU TITLE: 11
SBD-671 o (R. 06/88)
XO
2a vu ng �ldm.n .atan
000............ .....
CKo�X
.. .. .............
.. . . ........ . .... ..... . ........
. .... .. ..
..............
qq
44AX 0%
eor"
NO. �,513�2
f� 7 D►�/ [�117.Y►[�a
- . ... .. . ............ ..... ........ .............. ....... .
. . . ..... . ................................... . ........... ..... . .
r-"E" ISSUING ul"FFICE11%,
AUTnkjRlz-j ij
Ll f
........ ....... .. . . ...............
: .. . . ..... ...........
1290+507
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
R -E T lux A'I-' A I TE,
W B"r- j
... . . ...
MM14. F. 41MMIRLIMUM
NLESS R-EN'"
..... .....
SBD-06499 (RI 1/20)