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004-1032-95-100
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: C 344663 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. � ZT Permit Holder's Name: City Village X Township Parcel Tax No: I Butler, Rtehefd -A I Cady, Town of 004- 1032 -95 -100 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 14.28.15.225B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � /QU d Benchmark Dosing v Alt. BM Aeration a V BI Sewe / t � G . . q 7 ' Holding St/Ht Inlet 7 D . �s Ss 4 . r'� St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / Dt Bottom ` .00 04 Dosing Header /Man. DG y a (� Aeration t r Dist. Pipe Holding Bot. System t PUMP /SIPHON INFORMATION Final Grade d! Manufacturer Demand St Cover 11V X " GPM Model Number TDH Lift Friction Loss System Head TDH Ft 4 D ep t h Fo rcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size I x Hole Spacing ]Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Syst Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes 0 r No 0 Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 3160 30th Avenue Wilson, WI W27 (S(W' 1/4 SE 1/4 14 T28N 15W) N, 1 Parcel No: 14.28.15.2258 1.) Alt BM Description = 1 4 2.) Bldg sewer length = tj �2 �v 9 - amount of cover - -- - Plan revision Required? ❑ Yes F] No —� Use other side for additional information. I Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) S a Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division y: INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. 344663 Per B I C1 UR Na RICHARD ff age Town of: State Plan ID No.: CST BM Elev .: , Insp. BM Elev.: BM Description: ` Parcel Tax No.: 0 c7o .c7 00 1032 -95 -004 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic - L00113 Benchmar 9 Dosing ( -Ito- g 6 I nb • `� . Aeration Bldg. Sewer 1e44 Holding St /Ht Inlet t20lI TANK SETBACK INFORMATION St/ Ht Outlet lz�(o " �Z )50 F y". TANKTO P/L WELL T3I ejntake ROAD Dt Inlet Septic t nr0 5 t NA Dt Bottom Dosing red ( b ` NA Header / Man. Aeration NA Dist. Pipe b' ° Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade off Manufacturer v� Demar}d ( 3 s Ci Cy !, Model Number JG`O ; 0k, GPM as TDH Lift j,0'4 Friction � at System. TDH 2.5�ot Forcemain Len the z g D Dia. " Dist. To Well SOIL ABSORPTION SYSTEM B£$ THE Width t Len t No. f T nches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS I DIMENSI SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manuacturer: INFORMATION Type of CHAMBER Mo Number: System: 33 ( OR UNIT DISTRIBUTION SYSTEM Header /Man Id u Distribution Pip w x Hole Size x Hole Spacing Vent To Air Intake Length w j Dia. Z Length 2 Dia. Spacing q ----- 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 E] No El Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ' C , I Io 4.�3 $` S`lL c„-,4.,. LOCATION• C Y 1 4.28.15.225,SW,SE 3160 30TH AVENUE g5= Tom^ Y i�. c � �-— t w I I P -* 4% , Plan revision required? ❑Yes No - (I 1 Use other side for additional infor ' l i q l op 114.U S Z SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. 07/22/.05 FRI 14:24 FA 71 5 986 4686 @1001 pA d m� � I�cation ST. CROIX G0 TY WISCONSIN County Sanitary Permit APp ZONING OFFICE in accord vdth 15.04 St- Crorx Couoty sanhary Ordinance CROP C4UtJTY GOVERNMENT CENTER personal ob(rls8on you pMVNe may be used for se 1101 CarmidjW Road (privacy Lew. S.15.04(1)(m)l Hudson." 54016 -T110 15y30646g0 Fax (TiSASS 4656 Attach co plans for Uta ram on ape not less than 8.112 x 11 inches in size. Co,afty Permit deck if revision to previous apptkalion Ll . A pion Inforrlralbn -Please Pant all hati nimli" w sl J 114 SE 1 4 Sec ownerwe"m R /S V( W B N, /1 K �i/ 1'L ER r N stock Number ply owner's Maukv Address / `IX COUNTY Zip Code Phone R@tAC G O F F I C c msbo Name CSM Number +ty, slate v� � � 3 Lftess 4J S Syo37 7/s 71.?- y�3 .awn of pe one) • Bedrooms. LAD 1 or 2 Fan* O"- No. of "ia p,"aComrnercial (desedbe use)' IVeBm Raad �o p d �dE. Stake- owned - N- TYPa of Pefftdt ( Y one box an Iris Check box on Lino t3 if apple) arcel Tax pkpnber(s) 06 ® Recomacion bkq aReMotafm 0, -/031 A) ®Rapac Sanitation Date lssjcd Parnif Number 3 yyC G 3 � - 3 ! - 9? B) / Stall Sanitary Permit was pravbusly issued V. Type of POWF System: (Cheek all that apPIA MOII;92 y Sand FOter ❑ Gonshueted wadand © Non -p lurked k4fotmd. Holding Tank U f'1 Simi: Peas o �� R Pressurized in-9round LJ Rec�rculalina L� Al-grade ❑ Aerobic Tfeaknent Unit L-1 was Ir bcMatlorc . DkPersaYTroablwrN Area 4. Sok APPFc7%, a 5. Perco ion Rate 6, m l:tevation G rade EkvaUor+ 1• n Few ( R Area Proposed (Ga a O ) ?,9 �aa. / Z St Fiber- Plastic rer Pm Site Tank nformatfan y n Gallons eta o Concrete strutted glass New Erddating Ganons ranks Tanks Tanks Eprrc A�/K _ _ o oa o l u /c rT �OwK. urYO rA�/K Do Oo l Raep "sa''tt� Staturwe rt akheconr >erralonhejuvata00*1staullon of non fiiumb'ng for the POWTS shown on ft altadwd plans. A (M undersigned. afsrrrt`e responslflY sanitation m. tract is not owed for lerram re ail or the installation of MP/MMS No. awineu Phone t ru of tanben Name' tsp,a f' (no sta ,? g /3 y � )' /S G7 Torf'� I E�KE bar's Address (Stfeet. City. S °�) c/�I.IVD GJ I Sy73G /.? 9* S:, ✓ r..7S "L Only Disapproved San' I tssued ukrg S stamps) proved o own Initlai Advarse /%b Dote mimatlon Condillot of Aopto,lallRealao� for ipW C�,� � owe- �.N,,�O� - ✓iu� �� � �'- �°�- -� S STEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all serviced / maintained as per management p provided by plumber. be maintained 2. All setback requirements must _ n - �ocr S� ro I I lyurLit 4441cr Qv4n rda! �'' of L.I,oY Sr. Laox Lo. I 'v 3'rt SLEr��D a SNEErs a f K y xB , EX rAaACD /YAY F /EcD i G rlAOE Ewsri,✓4 .�L x 97 Aou�lO / - SLrE!!EO EX /Sf /•JC r4 AIKS eA a? �dG / a.tcE/�Ai�J ` I Y pA /V ,444 �orrr�l. X3'/7 Srrg,oc,es /Ytrl' �� AG4E �i1it G d RELo.✓aEcT T'o Aralaw! lvo-oo /.✓s7 OR /L /,do 4,lo -o :r 4 � , 3OY 6 /S-CV" 7 9 f o S7 , REPAIR ❑ CR OIX CO UN T� NO. STC - 0 / 3 RECONNECTION SANITARYP Y NON - PLUMBING ❑ IT SANITATION REJUVENATION ❑ � . (a) The purpose of the sanitary permit is to allow repair, reconnection, OWNER A 7A %_AJ L rejuvenation, or installation of non - plumbing sanitation as described in the v application for permit. PLUMBER (b) The approval of the santiary permit is based on regulations in force on L I C . � Z '31 the date of issue. (c) The sanitary permit is valid for 2 years from original date of issuance and TOWN may be renewed for similar periods thereafter. Application for renewal shall be LOCATED made through the county and shall comply with regulations in effect at the time. (d) Changed regulations will not impair the validity of a sanitary permit until SEC / irr T Z N; R �j the time of renewal. (e) Renewal of the sanitary permit will be based on regulations in force at AND /OR LOT BLOC Y the time renewal is sought. Changed regulations may impede renewal. (f) The sanitary permit is transferable. A sanitary permit transfer shall be obtained from the St. Croix County Zoning Department. C S M 1 If you wish to renew the permit, or transfer ownershi of the e SUBDIVISION p p 1 3 15 - - l — please contact the St. Croix County Zoning Department. le0o do • AUTHORIZED ISSUING OFFICER - DATE /0 THIS PERMIT EXPIRES Z a UNLESS RENEWED BEFORE THAT DATE TWO Y ARS FR ORIGINAL DATE OF ISSUANCE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION Parcel #: 004 - 1032 -95 -100 10/16/2008 08:11 AM PAGE 1 OF 1 Alt. Parcel #: 14.28.15.225B 004 - TOWN OF CADY 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 - BUTLER, MARK R MARK R BUTLER 340 WILLINK DR BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 3160 30TH AVE SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 9.700 Plat: 3952 -CSM 14 -3952 SEC 14 T28N R15W PT SW SE BEING CSM Block/Condo Bldg: LOT 1 14/3952 LOT 1 9.70AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 14- 28N -15W SW SE Notes: Parcel History: Date Doc # Vol /Page Type 03/24/2008 871345 WD 03/02/2001 639652 1595/131 QC 10/13/1997 566832 1270/034 WD 02/11/1976 331496 533/572 LC 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/31/2008 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 28,000 0 28,000 NO UNDEVELOPED G5 7.700 4,900 0 4,900 NO Totals for 2008: General Property 9.700 32,900 0 32,900 Woodland 0.000 0 0 Totals for 2007: General Property 9.700 32,900 28,900 61,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 547 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 2 sEe 2.�N�" X315 ° � ORO�X S OVN OR Q � � c . Qon`l� 1� s OR REC w N CERTIFIED SURVEY MAP LOCATED IN THE SW 114 OF THE SE 1 OF SECTION 14, T28N, R 15W, TOWN OF CADY, ST. CROIX COUNTY, WISCONSIN. NOTE ;: BEARINGS ARE REFERENCED TO THE SOUTH L I NE OF THE SE 1, (ST. CROIX COUNTY COORDINATE SYSTEM). N 114 CORNER OF SECTION 3 14. (St. CROIX CO. ALUMINUM CAP MONUMENT FOUND). M � M • I � , UNPLATTED LANDS y N 88 42 "E 293. 74' S NASLFENCE hpUND ' A /3 2s'03. 0 19' 33" E 417. 19' SYSTEM , N 83 s8- F W Z: MOBILE HOME 4: d LOT 1 4 M u 9. 70 ACRES o .4 4 1 ►; U w ( 422, 661 SO. FT.) WELL O1 �' J; a 9.06 AC. EXC. R.-'W Q M ( 394,474 S0. FT.) DRIVEWAY Q! 2 4 0 9 .4 2 . . HIGHWAY BUILDING SETBACK LINE y ............... .................................. ............................... ................ W -- M - - - -I -- - - - - -S 89°52_ - - -8 I' - - - - -- - -- $ - - - -- w /q , �,� _ 1786. 7 0' AV I. U w S 89 0 52' 59" W 854.51' S 89-52' SOUTH LINE OF THE SE Ie4 S 1i4 CORNER OF SECTION 14. SE CORNER OF SECTION 14. (COUNTY (RAILROAD SPIKE FOUND). SURVEY NA IL FOUND). ..UA !. A:I.T.r"4.. LA. NAS CItOssh,', % O SET I' X 24' IRON PIPE WEIGHING APPROVED 1. 13LBS PER LINEAR FOOT. ST. CROIX COUNTY JAMES M. Planning Zoning and Parks Committee WEM S E P 2 1 ZOQO ` snwo" iM m. If not recorded within 30 days of 9-v0 VA I" - 150' approval date approval shall be SUFN null and void O 75 150 300 JAMES M. WEBER S -1804 NELSEN —WEBER LAND SURVEYING DATED SHEET I OF 2 c�e.,.g,� g t, �. �o l ea i 2000141 THIS I NSTRUAENT DRAFTED BY JIM WEBER orr Vol.14 Page 3952 H VIA i GW Page 1 of 1 Pam Quinn From: The Butler's [butlerd @wwt.net] Sent: Thursday, October 16, 2008 7:29 AM To: Pam Quinn Subject: Reconnect Permit for Mark R. Butler- Sketch of House Plan Attachments: Email0010.jpg Pam, Enclosed is the sketch of the house plan for Mark R. Butler that we talked about yesterday afternoon. If there is anything else needed for the reconnect permit just give me a call. Duane Butler (father) 715- 772 -4423 715 - 556 -9559 cell 10/16/2008 Safety and Buildings Division o SANITARY PERMIT APPLICATION 201 W. Washington Avenue N v ,� P O Box 7302 - n O In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 O� t to the county copy only) for the system, on paper not less County in size. 1 3 i (fit instructions for completing this application State Sanitary P ermit Number u provide may be used for secondary purposes ❑ check if revision to previo application OH State Plan I.D. Number rON INFORMATION - PLEASE PRINT ALL INFORMATION Name Property Location 1/4 1/4, T , N, R E (or) W' ,vner's Mailing Address Lot Number 'M Block Number .ate Zip Code Phone Number Subdivision Name or CSM Number -; ) 4 YPE F B ILDING: (check one) ❑ p Vil l State Owned i Nearest Road • A age Public 1 or 2 Fami Dwelling - No. of bedrooms - 0 Town OF 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ,._, r 1 E] Apartment/ Condo o 0 4 f 3 � p `0 o 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF`"PERMIT: (Check only one box on line A. Check box online B, if applicable) A) 1. K New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5 ❑ Repair of an System System _ _____________Sys______ Tank Only______________ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑Seepage Bed 21,87 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 r] Seepage Trench 22 ❑ in- Ground Pressure 42 ❑ Pit Privy 13 []Seepage Pit 43 ❑ Vault Privy 14 ❑ System - In - Fill VI. ABSORPTION SYSTEM INFORMATION: 1_ Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft_) (Min. /inch) Elevation 1 r -? 6 1 Feet Feet VII. TANK In llo CapaElty gans Total # of Prefab. Site Fiber- Exper- Manufacturer's hame con steel Plastic INFORMATION Gallons Tanks Concrete glass App. Existing a Tanks strutted Septic Tank or Holding tank} �� s ' i -. :, , s c El 11 11 11 11 11 Lift Pump Tank /Siphon Chamber ( % <.J , : - _ r , a ' '❑ ❑ ❑ ❑ ❑ Cl VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans_ Plumber's Name: (P Plum ber'stigna�ure: (No S �frrips) MP /MPRSW N - Business Phone Number: j Plumber's Address (Street City, State, zip Code , 4 , IX. C UNTY / DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater ate slue d Issuing Agent Signature (No Stamps) � Surcharge Pee) PfApproved Owner Given Initial r . . ( Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 TDD #: (608) 264 -8777 www.commerce.state . wi.us = ;f Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary X 1999 ,'UST ID No.3412 ATTN: POWTS INSPECTOR ZONING OFFICE ERB J PELKE ST CROIX COUNTY SPIA N6298 STATE HWY 25 1101 CARMICHAEL RD DURAND WI 54736 HUDSON WI 54016 RE: CONDITIONAL APPROVAL Identification Numbers APPROVAL EXPIRES: 08/17/2001 Transaction ID No. 241081 Site ID No. 178990 SITE: Please refer to both identification numbers, Site ID: 178990 above, in all correspondence with the agency. St. Croix County, Town of Cady SWIA, SETA, S14, T28N, R15W Facility: Richard Butler Proposed Residence FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 486113 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes 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. Stats. • 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(2)(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. Sincerely, DATE RECEIVED 08/10/1999 f FEE REQUIRED $ 180.00 —� FEE RECEIVED 180.00 erard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim @commerce.state.wi.us WiSMART code: 763'3', ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner L_ I1.cz ci i_� e r Property Address ?, I(, o 3o tk a ye'n e. City /State C , d Wit) 1 Legal Description: Lot Block Subdivision/CSM # 5w '/4 5E t /4, Sec. iq, T 2�8 -R SSW, Town of Cacjv PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer MA.�c" ft Size ST/PC /,tom/ Setback from: House a3 Well 5 P/L 1p0+ Pump manufacturer 11j1J rorr,a t, c- Model S P 570 Alarm location c r if r � �Q, ie, (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: m yu AJ Width d,6' Length '1'? Number of Trenches Setback from: House a90 ,, Well �3 i ' P/L 0 t Vent to fresh air intake ELEVATIONS Description of benchmark t\(: , I ,. re e C o i^ ne r c A w o o d.5 Elevation 106 Description of alternate benchmark Elevation Building Sewer ST/HT Inlet R L, 17 ST Outlet .S' PC Inlet 85 8i PC Bottom 9,), Header/Manifold Top of ST/PC Manhole Cover Distribution Lines O / DO S' R O ( ) Bottom of System( Final Grade O O ( ) Date of installation cl //6/ Permit number 3 qq 66 3 State plan number Plumber's signature License number Q31 3A Date 9 / /d/ 99 Inspector Complete plot plan St. Croix County Planning and Zoning Thursday, October 16, 2008 at 8:16:04 AM Detail Sanitar information Page 1 of I Computer #: 004 - 1032 -95 -100 Sub /Plat: NA Section: 14 Parcel #: 14.28.15.225B Lot: 1 TN /RNG: T28N R15W Municipality: Cady, Town of CSM: Vol. 14 Pg. 3952 114 1/4: SW 1/4 SE 1/4 Owner: Butler, Mark R. 3160 30th Avenue Wilson, WI 54027 State Permit: Issued: 10/16/2008 POWTS Dispersal: Mound 24" or more suitable soi Permit: Reconnection County Permit: 134 Installed: POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer /Inspector As Built Plumber Other Requirements Additional Notes Money Owed Pam Quinn >4/1/00 - Not Required Pelke, John needs record of pumping and new living quarters in pole building - 1 Br right now, but $0.00 Not determined Sinned Off: No maintenance agreement for new owner may eventually build house and get another reconnection permit Owner: Butler, Richard A. 3160 30th Avenue Wilson, WI 54027 State Permit: 344663 Issued: 08/31/1999 POWTS Dispersal: Mound 24" or more suitable soi Permit: New County Permit: 0 Installed: 09/16/1999 POWTS Detail: NA Bedrooms: 3 WI Fund: No POWTS Pretreatment: NA N Issuer /Inspector As Built Plumber Other Requirements Additional Notes Money Owed Mary Jenkins Yes Pelke, Herb trailer being removed and a new house built - file $0.00 Kevin Grabau Sig €red Off: Yes 1999 permit with 2008 reconnection Maintenance Notification Scheduled Pump Date Pumped Notification 9/15/2002 04/20/2006 ST. CROIX COUNTY ZONING DEPARTMENT ` AS BUILT SANITARY REPORT Owner .i c,kn r d B (k-� l e r- Property Address I ti© 3© fit. o e-n (A e City /State C a d)t WT Legal Description: Lot Block Subdivision/CSM # 5w ' /4 , ' /4, Sec. I�, TAN -RCS W, Town of Caj '� � # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFO ON: Tank manufacturer Size ST/PC / Ct� / SCw Setback from: House Q3 � Well 5T P/L 1004 Pump manufacturer Model 5 P 5 Alarm location cl n ? r -ti tea; ie r (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: m yu naJ Width ol Length Number of Trenches I Setback from: House a90' Well 33 i ' P/L 106 t Vent to fresh air intake ELEVATIONS Description of benchmark 11a:, I ree e orner woods Elevation /00' Description of alternate benchmark Elevation Building Sewer ST/HT Inlet ST Outlet PC Inlet gS, Sl PC Bottom 9,) a - 710 Header/Manifold Top of ST/PC Manhole Cover o Distribution Lines () / nO , s R () ( ) Bottom of System Final Grade () () ( ) Date of installation 9 / /6 /9q Permit number 3'4'4 66.3 State plan number Plumber's Sig ture l" License number X313 q6 Date 1 11 , 61 9q 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. • Show alternate benchmark, if applicable. PLAN VIEW wooc�5 y r ago" • � �d3' ,� S X15 r oa k cc� well pr',�ewa N i S a , �c 30 -- INDICATE NORTH ARROW A u e Wisconsin Department of Commerce Safbty and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST. UJKUIX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 344663 Permit Holder's Name: ❑ Cit []Village Town of: State Plan ID No.: BUTLER, RICHARD 6ADY CST BM Nev.. - Insp. BM Elev.: BM Description: Parcel Tax No.: a-o cYO c7 004- 1032 -95 -004 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic C_* ��d0 Benchmar �,L 1a0. ,� —�— C u ILIA• � �a Dosing If to Aeration Bldg. Sewer (e.q V t tl Holding St /Ht Inlet /z ` z o P`6. !•:�•- TANK SETBACK INFORMATION St/ Ht Outlet IZ�6 d 131.5-0 r1r-. g'`f TANKTO P/L WELL BLDG. Air I to ntake ROAD Dt Inlet Fr( irl 1 Septic t �p� �'}- r 2Z �—. NA Dt Bottom Dosing >,&o' 6T' 33 3 b r NA Header / Man. Aeration NA Dist. Pipe d b' ° Holding Bot. System A g w PUMP/ SIPHON INFORMATION Final Grade 3 Manufacturer o p,,,,,, l ,,,,, G Dema Model Number 50 as " GPM TDH Lift -1,03 Lriction . q System• TDHq;S,��t i H Forcemain Length�Oj Dia. Z, " Dist. To Well z SOIL ABSORPTION SYSTEM ff THE Width Len r No. f T riches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER I i Model Number: System: 10D �`� 3 ( �— OR UNIT DISTRIBUTION SYSTEM Header /Man Id K Distribution Pipe(s) / „ x Ho x Hole Spacing Vent To Air Intake Length Dia. 2 Length 3---Z Dia. Spacing 7q 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.) " , q f to ' u Ta• O LOj�ON.CA,)DY 14.2$ M „SE 3160 30TH AVENU P,5 = L • g o , A I - 9% - uz P m, J Plan revision required? ❑ Yes No Use other side for additional infor l iq 1 00 S 2 9 SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. SANITARY PERMIT APPLICATION S afety and Buildings ton Avenue ln V sc6ns i n 201 W. Washin P O Box 7302 Department of Commerce In accord with 1LHR 83.05, Wi Vin. Cody' , Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the Sys ��n p ergot less- unty than 8 1/2 x 11 inches in size. �;` `. • See reverse side for instructions for completing this appli n �' t Sanitary Permit Number A pr - Personal information you provide may be used for secondary purp °' p v �� k if revision to previous application [Privacy Law, s. 15.04 (1) (m)). OT • i�, tat Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALLY coy a (6q Property Owner Name J Property cation Cla 6L L S' tia v / Y T Z. , N, R � E (or� Property wner's Mailing Address Number Block Number )7Z C dl Cit , Stat I Zip Code Phone Number Subdivision Name or CSM Number 2 11 O L- II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ qt Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF fJ D T W v - III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) i4 . Z* - 1 5 -- 1❑ Apartment/ Condo 0 0 I / 3 Z" – 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3 ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an ______System ________ System____ _________TankOnly______________ Existing ________ Existing System B) E] 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 21J1 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 17 . Final Grade r Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation � 3)5 / 75 / Z — Feet 02,,2, Feet Cap acity VII. TANK C in gal Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass , Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank 000 b D(7 U " r n trt , ❑ ❑ ❑ ❑ ❑ ❑ Lift P ump Tank /Siphon Chamber 0 U OO ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb is Name: (P Plumb r' Ign , ure: S s) MP/ PRSW No.: Business Phone Number. 311 Z., eff Plumber's Adgreess (Street, City, State Zip Cod w IX. COUNTY / DEPARTMENT USE ONLY ' ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date I ssued Issuing Agent Signature (No Stamp Approved E❑ Owner Given Initial I- & Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, plumber INSTRUCTIONS • . 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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: L. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vlll. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water rnains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and.establishment of standards. 4 Safety and Buildings 2226 ROSE ST LACROSSE WI 54603 -1905 TDD #: (608) 264 -8777 isconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary August 17, 1999 CUST ID No.3412 ATTN: POWTS INSPECTOR ZONING OFFICE HERB J PELKE ST CROIX COUNTY SPIA N6298 STATE HWY 25 1101 CARMICHAEL RD DURAND WI 54736 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 08/17/2001 Ienttfica ` ers Transaction �241081 Site ID No. 17 SITE: Please refer to both identification, Site ID: 178990 above, in all correspondence St. Croix County, Town of Cady SW1 /4, SETA, S14, T28N, R15W �- Facility: Richard Butler Proposed Residence FOR:� Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 486113 �a 4/ Y 19 9 4/ Y+ 9 The submittal described above has been reviewed for conformance with applicable Wisc " siti` . �tive Cosies. , and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. � F t 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. Stats. • 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(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during constriction 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. Sincerely, DATE RECEIVED 08/10/1999 r FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 &erard. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim @commerce.state.wi.us Wig miu :163' Safety and Buildings 2226 ROSE ST LACROSSE WI 54603 -1905 TDD #: (608) 264 -8777 iseonsin www.commerce.statemims Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary August 17, 1999 CUST ID No.3412 ATTN. POWTS INSPECTOR ZONING OFFICE HERB J PELKE ST CROIX COUNTY SPIA N6298 STATE HWY 25 1101 CARMICHAEL RD DURAND WI 54736 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 08/17/2001 Identification Numbers Transaction ID No. 241081 Site ID No. 178990 SITE• Please refer :to both identification numbers,' Site ID: 178990 above, in all correspondence -with tho agency, St. Croix County, Town of Cady SWIA, SE1 /4, S14, T28N, R15W Facility: Richard Butler Proposed Residence FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 486113 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes 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. Stats. • 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(2)(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. Sincerely, DATE RECEIVED 08/10/1999 I s FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 Oera Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim @commerce.state.wi.us MOM o4o=: Pagel of --i:L PRIVATE SEWAGE SYSTEM INDEX AND TITLE SHEET Ptgerty Owner(s): !4 rt ed Project Name.' rx- Project Location: Stott A3dross .» s ozattion y T - O wn orMwucpaity Contents: Pagel: �.✓oEx� �,cis�r Page I Page 3: C �eJJ �EG riew Page 4: /'L.e✓ !/ /tom/ �` f"iPa' L•/r�.tea L.ire.rT' Page S: / "Uao �'�f.✓K l ile .rt - .�e�G T /o.✓ Page 4: ` uevP 'A1tfdAey,4A)ef ef dle Page 7: Name: , �'E c.r� Sid CredentialNmuber: 00%�- "12. Date: Address: 8 .? . C! AwlD L✓ Phone Number: 71sr L7.?- IRr-CFIVE� AU G 1 u 1999 AFETY & BLDGS DIV. lam-- • A- > liS./'�. •' /00 �' NA16 /•J T �it rE C �,��.✓ rro OtLAn/t r, /for Firoo /s7 Iacar 0 4,crrt t c coi•/.�/. 83. sa /1 r 3 ,$ x 7S Wo K 6s•0 0 cp „7G'x f7 / iso�..o .cys rt y ' i 6✓oopS �r �p4 C� y y x �Ea Sao t.ot. �/. Sao c w. rAS4.✓o �.yo t%�K S. T E'iovo r...✓ ,411A 6)( CO O �.✓r r rrs IN �_ �l✓�6 s o.J is 0. J .�Q � I O . Z i'/it re 4.o or 317-r 6rl r '"� CROSS SECPION OF NCM PAGE of D- E - Z.J�JT F - . 9 FT G- _ FT H- /, S FT a SYNIfiLmc C DVERIN i 0 s rr C - 33 H MEDIUM SAND ---`�— TO P SOYI. l E LEV . 99 g , o.✓ 3 J E 8 co.✓ r•.wC Bed of aggregate FORCE MAIN � LAYER F �- o 7 SLOPE S X 7S' .? ',Joe PAGE_ of PLAN VnN OF MOUND A S- 'ET - B- 7S FT L J - S FT K J �_... B F K L- ZZ— FT �-- — — — — — --- — — — — W a� FT l O* _-TObservation • Pipe A X Observation Pipe Distribution Pipe- ,gy PaG Bed of h -2h" aggregate foccl�ys Permanent Markers (2) K PIPE LATERAL LA Bole Diameter —IN -?S i✓ozEs x f /7 Lateral Diameter - R IN /f Aoe � ' 0? 9..?,f E. � - _g Sys rE� a �.JdE.c r EL / e re) Manifold IIi.ameter �2 _ IN /ter rr�.rc = /eo, y Force Main ■ - End 7.� Cap � P- 72 FT X - _.L FT Y Y- 3 FT 3 3 � r Permanent 3 Markers - - -- Permanent End Cap Markers anifold Force Main • �/oLts Lsc rro oda'.vt o.✓ QesTo eF Pr /t V PAGE -s or Z_ PUMP CHAMBER CROSS SECTIOU ANG SPECIFICATIOUS „� sur.yo v EWT ca • H"C.x. VENT P IPC T APPROVED LOCKING d, WEATHERPROOF .J000TIOW 80X MAIJHOLE COVER /O FROM DOOR. W14DOW OR FRESH IL MIU. I AIR INTAKE I GRADE I I '!" MIIJ. r • COIJCIUIT IIJLET PROVIDE I I - - - -- -T AIRTIGHT SEAL I I * A I I I I I I ALARM J I ON *APPROVED •.� JOINTS WITH E.LEV. Ft APPROVED PIPE 3' ONTO PUMP --` Orr D SOLID SOIL COUCRETE BLOCK RISER .EXIT PERMITTED OIJL`J IF TAWK MAUUFACTURER HAS SUCH APPROVAL SEPTIC F 8PEGIFI'CA - f'IOM DOSE- �YuFF�� t"& Idle - IJUMBER OF DOSES: a• 3 PER DAU TAIJ M KS AWU FACT URER.: TAIJK SIZE: 1000 - s. T., 8-V - 4 4 Y GALLOW S DOSE VOLUME �A"p 6 �` 3S, V r INCLUDING SACK FLOW: ��8 GALLONS '' L�ARM1 MAUUFie.CTURER: - -f• 77 E Etriro . MODEL IJUMBER: CAPACITIES: A= __1 OR ..,I$ GALLOWS SWITCH TYPE: - �ltee4.t Y g a ? IIJCHES OR V J - - CALLOUS PUMP MAWUFACTURER: /!TS'D.�erf.IPic o� c. • /D IIJCHES OR a7BG GALLOWS MODEL IJUMBER: -< Ds 9 .— IMCHES OR �°s 2 ;GALLOIJS SWITCH TYPE: - ZEid caw y MOTE: PUMP AWD ALARM ARE TO BE M DISCHARG RArc �5.� -S cPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIrrERENCE BETWECIJ PUMP OFF AND DwrRIBUTIOIJ PIPE.. d FEET + MIIJIMUM WETWORK SUPPLY PRESSUR .. 2 . 5 FEET + a„ FEET OF FORCE MA X �•s` /portF KICTIOIJ FACTOR. - 3 t _ FEET TOTAL 0 WAMIC. HEAD = - FEET IQTERWAL DIMEWSIOWS or TAWK: LEIJGTH 492 -_;WIDTH - .— ;LIQUID DEPTH 3� Typical Ap lip cation• High caQacitysump /effluent, Sewage Typical Application' Sewage, DewoteriN Capacities to 120 GPM (7.5 Vs) (opacities to 140 GPM (8.8 Vs) . _ He ads to 28 h (8.5 m) _ Heads to 28 h (8.5 m) _ - - -- -- - -- - - - - -- _ Electri ca l 1 l 9.5FIA, 60H 23 0y, le_4.7F.LA, 60Hz Electrical 115V, lo, 11FlA, 60Hz;10OV, le, 6.8FIA, 60Hz; Motor 4/10 HP split phase w /thermal overload protection, 230V,1 e, 6.OFLA, 60Hz; 2004, 3e, 4.1 FLA, 60 Hz; 1750 RPM 230V, 3e, 3.5FLA, 60Hz; 46OV, 3e,1.8FLA, 60Hz; ---- - - - - -- - -- - - -- - - -- Minimum Recommended Simplex =18" (457mm); 575V, 3e, 1.4FLA, 60Hz Sump Diameter Duplex = 30" (762mm) _ _ Motor (single phase) 1 /2HP Split phase w /thermal overload Automati Operali Diaphragm rare switch (manual available) protection, 1750 RPM ; (three phase) .1 /2HP Materials of construction Class 30 cast iron polyphase, 1750 RPM _ Impeller Ther!nqlastic non•cla_ Minimum Recommended Simplex = 24 (609.6mm) Discharge Size 2 (50.8mm) — Sump Diameter Duplex = 30 (162mm) Solids handlin 1.1/4" (31.8 mm) Automatic Operation Diaphragm pressure switch (single phase only) _ Power cord 10', SJTW, ( 20' optional (manual available) -- -- — -- - Superior Features • Carbon /Ceramic type 21 mechanical seal Materials of construction (lass 30 cast iron • Oil filled motor w /automatic reset thermal Impeller Thermoplastic_ non -clog overload for maximum protection Discharge Size 2" (50.8mm) 3" (7 6.2mm) optional • Upper and lower single row ball bearing construction Solids handling 1-1/2* (381 mm) • Piggy -back plug available for easy maintenance Power cord 1 e 10' , STW A(20' optional); 3e . 20', STVA and replacement Superior Features • Carbon /Ceramic type 21 mechanical seal • Oil filled motor w /automatic reset thermal overload for maximum protection • Upper and lower single row boll bearing construction . • Piggy -back plug available for easy maintenance e' and replacement , at confidently p romise W iir i 9 30 ................ N LAJ SP50 SP50AB ,.. b f20 tZ o .�aaisg = 3 010 i SP40 i 0L 0 ' ~ apacity -U.S. G.P.M. 0 20 40 60 80 100 120 140 Liters /Second 0 2 4 6 8 . r +' . Wisconsin Department of Commerce SOIL AND SITE EVALUATION Div(siori of Safety and Buildings Page of ? Bureau of iritegrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all Information. Re ed by D Personal lnfomretion you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location "4 uTL Govt. Lot " 114SE 1/4,S %,f/ T,8 ,N,R % s - L' (or& Property Owner's Mailing Address Lot # I Block# I Sabd- Nameror CSM# J/ 7,? �o. Al City State Zip Code Phone Number 9-GRy QWage ®Town Nearest Road /L XvW A✓X I Syod 7 ( S ),13 3- ,a lao r ® New Construction Use: ® Residential / Number of bedrooms - Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow ysO gpd / ZJ�'✓��'j s Recommended design loading rate : _, _bed, gpd/tt . S_ trench, gpdtS Absorption area required _?75' bed, ft 17•x• trench, ft Maximum design loading rate _ _S bed, gpd/it gpd/ft Recommended infiltration surface elevation(s) 1`"98 oW y8 8 Cod re— it (as referred to site plan benchmark) Additional design /site considerations Di°l ✓ iV.IY Parent material xddw 7Yt` Flood plain elevation, if applicable -4/W ft. S Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U - Unsuitable for system ❑ S ®U ®S ❑ U ❑ S ®U ❑ S ®U IDS ®U ❑ S [au SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/it2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench z -1v s Ground 98 fin. yr Y e/ • • %r Depth to l limiting factor 0. Sreur Remarks C 'f'rc, Ile /S�.s CJ-r�� - si irE i✓ .vt �i Boring # � o rr s 3 — ✓ IP,' 6 1 I se I r S Ground Sjit V/ / ,r .sYS �' /? NE�rr / s6 �'► � ''? _ -- : • rs Y.r elev. re sf in. Depth to limiting factor A?_Y.in. Remarks: CST Name (Please Print) r Telephone No. /6/✓,EL / i z, /o Address / Date CST Number ,$ .9 /�ls✓Ir -: �A G L /i.�! 'L�� - e_ ! 9 .? 7 1 �c•ly.►�o �� rt �- SOIL DESCRIPTION REPORT 4-P Apr Pa %? of PROPERTY OWNER 9 a PAMEL I.D.# Boren # Horizon Depth Dominant Color Mottles Structure 2 g In. Munsell Qu. Sz. Cont. Color Texture Or. Sz. Sh. Consistence Boundary Roots Bed .Trench of PA Ground 3 Ncr%r ,., elev. ; .15'1.4 r r r.[ / F jlf r ro y Depth to limiting factor ` .Jn. ,y A .vO Remarks: Boring # / AMA .3 2 3 17 --as. Yf Ground elev. Depth to limiting factor 7 8 in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure PD Consistence Boundary Roots In. Munsell Qu. SL Cont. Color Or. SL Sh. Bed , Trench Boring # Ground elev. ft. Depth to w limiting factor 1n ' Remarks: Boring # E3. Ground elev. , ft. Depth to �, • limiting . factor I "' Remarks: SBD -8330 (R.9/98) y O O y Or CZI i\ z L � N NN ej h `T Z • 1 � h � r 0 ro r ' z 0 a � a a � o N t3 e s 3 �o zo o � a a � a 3 � Ai w a `' � L n � ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Richard H. Butler ailing Address 3172 County RD N Wilson, WI 54027 roperty Address 3 Q (Verification required from Planning Department for new construction) City /State Wilson, WI Parcel Identification Number aDh�- /o3� - - 000 LEGAL DESCRIPTION Property Location SW 1 /4, SE 1 /4, Sec. 14 , T 28 N -R 15 W, Town of Cady Subdivision , Lot # Certified Survey Map # Q , Volume , Page # Warranty Deed # .5 b g 3 - 2- , Volume Z 7 , Page # Spec house ❑ yes ® no Lot lines identifiable R> yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, j ourneyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. Z--- SIGNATURE OWAPPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 9!6� E Aa�-- - T �' SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 56633.' VOt 127QPA STATE BAR OF WISCONSIN FORM 2 — 19% DOCUMENT NO. (+ W A RR ANTY DEED 13, r /f,- iV REGISTER'S OFFICE conwsys and warrants to ST, CROIX CO„ W Rev'd for Rocord OCT 13 1997 10:00 AM -# Rejlstor of Dsds k � a the following described real estate in Sr, � - r o Y State of Wisconsin: County, RETURN TO ff A s �— G ?• 9 c c O Parcel Identification Number (PIN): B� Sout. Belt o n y ! j.2 31 y y— G Q 3. . ( Of the Northeast Quarter (NE ) t and the �� Meat Galt (1i+} of the Southeast v d Quarter therefrom a pereel beginning at the East (SEf szcepting 60 , ` Quarter corner of y « �/ 7 o p n said •eetioat thence South 89' 28 10" We alon the ' -" thence North 0e 31 30* Eaat 283.49 teed at a g the 8 rte section Iinc 30 Last 4`39 feet. j to the center line of toga )road♦ thence South 81008 the center line Of the tovt: road 263 to point of bejinaing. Said e=cepti0a containing 2.753 acres. All of the aforesaid property being suLjeot`to in Section 14, Tovusbip 28 North hange 1; M eg. all easeseats Of reearrd r , / S / c' T �� �s n �' n v u .r �r ��u a,, .f •t RY o 12 [� r.t '2 / 3 7 Ct J its 3 3 /ye , 2 j ThW }- homestead property. I (� (is) (is not) I Exception to Warranties: ` I Dated this _ day of _ c' (SEAL) (SEMI II '� (SEAL) (SEAL ) _ 1 . � I I -�"�- Al CC. t 'Y /^\/ D (( ZX s � t $ ,mom .'`� ,�Y a r s�; CTO x -», �A.$ a 4 5 -✓ . 4 " a '£ a - I A4 st g AU 1d g st ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT �'FrEIVE� AND OWNERSHIP CERTIFICATION FORM � OCT ` i 2008 Owner/ uyer / " 444 ST. CROIX COUNTY kk - - FILE Mailing Address 3yD ai h , 4 1L J !2. Property Address 3/6o _ 44 Av-a Z � (Verification required from Planning & Zoning Department for new construction.) City /State i'` /o') 7 c� ,v, ftfbtffr? V-117 arcel Identification Number 00 z1 /0 3 2 -r LEGAL DESCRIPTION ZZ Property Location'� /4 , �J '/4 ,Sec. T 7 K N R �W, Town of Subdivision Plat: , Lot # �. Certified Survey Map # 6s30 3/5- , Volume J , Page # 3�5 Warranty Deed # O � l 3 1S (before 2007)Volume , Page # Spec house ' yes ono Lot lines identifiable es ! no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than 1!3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 J /v/70/ o9 SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application 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. (REV. 08/05)