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004-1046-70-001
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Divi * sion INSPECTION REPORT Sanitary Permit No: t 60 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)[. Permit Holder's Name: City Village X Township Parcel Tax No: Hanson, Robert I Cady Township 004 - 1046 -70 -001 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: -- 20.28.15.317B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer K t!� Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe r Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. t. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Len No. renches PIT DIMENSIONS No. Of Pits Inside Dia. Li d Depth DIMENSIONS SETBACK SYSTEM TO BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Nu er. DISTRIBUTION SYSTEM Header /Manifold Distribution rxHole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia _��acin g SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of = ded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil n [ Yes C I No L , Yes i No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1 w : u . /�3 Inspection #2: ____/ / Location: 209 Cty Rd N Wilson, WI 54027 (SW 1 S W 1/4 20 T28N R15W) NA Lot Parcel No: 20.28.15.317B 1.) Alt BM Description �l�) �(.�9,,, Nfl.�C�[�o� '0 v l� � �,� 4 t '— � 2.) Bldg sewer length u"' /• - amount of cover Plan revision Required? Yes to (_ \ m . _ Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. v '!" 1`t6 �i� t � ' County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER (Privacy Law. S. 15.04(1)(m)j 1101 Carmichael Road Hudson, WI 54016 -7710 (715)386 -4680 Fax (715)386-4686 Attach complete plans for the system on paper not I 1/2 x 11 inches in si County Sanitary Permit # ❑ r wvft t IkW - ap lication U !o G 1. Application Information - Please Print all Information Location: Property Owner Name � .5 1/4 W1/4, Sec __� D ce s4 r) ST,CRO!XCOU � n T 2g N, R /_S_ E(or Property Owner's Mailing Address / Z Lot Number Block Number , City, State Zip Code Phone Numer Subdivision Name or CSM Number V ol p t 8 2 15 .� /�, �, L��/` 3 &6 11 Type of Building: (check one) (7 x# A -- OCity ❑Village ❑Town of ❑ 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Public/Commercial (describe use): S S4.e fRgg ❑ State -owned Barest R d . I 11. Type of Permit: (Check only one box on line A. Check box on line B if pplicable) T K - NN 4* Z Parcel Ta Number(s) A) 1.0 Repair Reconnection ❑Non- plumbing ❑Rejuvenation Sanitation e C9 - / O 44 - 7 0 DO B) Permit Number Date Issued ❑ State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ❑ Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetiand ❑ Pressurized 1 round ❑ Holding Tank ❑ Single Pass ❑ Drip Line At QR ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other . Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Min. /inch) Elevation 1. Tank Information Capaicty in s Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tan 0 ❑ ❑ ❑ ❑ �o ❑ ❑ 1 ❑ ❑ 11. Responsibility Statement 1, the undersigned, assume responsibility for repair/ reconnenction /rejuvenation/installation of non - plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non - plumbing sanitation system. Plu bees) Name [print) PI bees Signature (no stamps): MP /MPRS No. Business Phone Number Plumber's Address (Street, City, State, Zip Code) r 111. County Use Only Disapproved Sanitary Permit Fee D�te Is ued Issuing Ag t Si natur tamps) Approved Owner Given Initial Adverse i� Uo 5 � / O 2 Determination J IX. Conditions of Approval /Reasons for Disapproval: BOLDT'8 P�BG & HTG Fax : 715 - 684 -3144 May 19 '03 12:17 P.01 _ 05/10/03 MON 10:11 PAZ 713 330 4060 ST Cn CO ZONING ®ooa 8T. CROIX COUNTY ZONING GFFICE CERTIFrCATION STATEMENT Pon LTTILTZA ?SON OF AN EXISTING SEPTIC TANK This in to certif 7 190, I have inspected the septic tank presently Serving the /1 D/� r' fy . V.- -1* residence located at: V. sec. 40 T ju N. R �/5_ Town of �q� St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appeaxo to be functioning properly. Last time serviced Did flow back occur from - absorption system? Yes No wO' no, ship next line. Approximate volume or length of tine: gallons minutes. Capacity! 'eaoo Construction: prefab Concrete .- Steel -� Other Manufacturer (if known) ; _ Age of Tank (if known) J / Usignatgre) i (Name) Please Print o e'J e vr ?st a LZcense Number) �-' zf' Dj Date Form to Mae completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Cercificazion: In aCc*yting the above statement regarding existing septic tank condition. I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83. win. Adm. Code (except for inspection opening over outlet baffle). Namw Signature MP /MFRS ZZ.O y BOLDT'S PLBG & HTG Fax 715- 684 -3144 May 19 '03 11:20 P.01 _ O 'S v �IY91NY i NOA11IN WC. "Swving You For 40 Ysars" ao Mein Start Bridwln. VVI 54002 (715) 0e4 -3379 Fax (718) W&3144 Fax Transmisslon Daft: TO: Gompary: r . RS: Phone. 71 3 �6 — s/6�o Fax From: Including this pipe, tl'W9 are —. —L---pages in this transfer. MESSAGE: Signed Jr BOLDT'S PLBG & HTG Fax : 715 - 684 -3144 May 16 '03 08:31 P.0 i0i,ma iz�m�P P.QM7- — .d -,9Z F � I CU A L 3 Lei .M. J .I La U Li Li 1 0000 0 00[]0 O O[1QO ( 1 1 G 0O 1 I :3 O :3 O O000p Q ! OoOop .� �O O 17Cp� ! o st- G O ©a 0 ._•i- er ❑OD y0 Jm 4 0 000' 30 C - 0 4 10 [7000GC?C OOJCbDOOOpOClO QOO• Dat�OGOLto Q GOO OCL�]dC, d n CD r . IDOO a0 O \7000C G �` C]DOcl0F.0 OC;Cp 0000 000000c O GO ad. 00000000 O OQQODOODODO �• C311 0! GOD; \ 1 Q O O i0 cn N..e E-- 0 M0 LJ 000 / 1 L- n OC) 99 39Md XVd A ACiiFGT.R V / G F.p : T. t CAa7 T.p ICO 1607MGE 256 STATE BAR OF 1 0SCONSIN FORM 2. 1999 641295 ruGrantor, mber WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS made between David D. Juen, a single pers ST. (ROIX CO., WI EUIVED FOR RECORD 03 -2t4NI 3 :00 PM bert A. Hanson and Pamela M Hanson, husband and VARRANTY DEED EXEMPT I ivorshi CERT COPY FEE: COPY FEE: TRANSFER FEE: 180.00 RECORDING FEE: 10.00 PAGES:,. 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix State of Wisconsin (ifmore space is needed, please attach addendum); Recording Area Part of the SW %» of the SW '/. of Section 20, Township 28 North, Range 15 Name and Retum Address West, St. Croix County, Wisconsin described as follows: Lot 1 of the Certified Survey Map filed July 11, 1986 in Volume 6 of Certified Surve WESTconsin Credit Union Maps, Page 1682 as Document No. 414366. y PO Box 415 Amery, WI 54001 004 - 1046 -70 -001 Parcel Identification Number (PIN) This is homestead property. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. tis) 0i}id0 Dated this / 511- day of February 2001 + David D.Juen AUTHENTICATION ACKNOWLEDGMENT Signatures) STATE OF WISCONSIN ss. authenticated this day of County ) Personally came before me this [A — day February - day of Notar Pub IC 2001 the above named ry David D . Juen, a single person TITLE: MEMBER BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stars.) instrument and acknowledged the same. THUS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogiand + Hudson, W154016 Notary P blic, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not necessary.) My Commission is permanent. (If not, state expiration date: «Names of persons signing in any capacity must be typed or printed below their signature. Infomretion Prafa+aionala mpany, Fond du Lay Wn Co WARRANTY DEED STATE BAR OF WISCONSIN eooass -sozr FORM No. 2 -1999 ST. CROIX COUNTY ZONING DEI'ARTME = >: AS BUILT SANITARY REPORT Owner tT4 C, j j OCT / Address y' 2 g - X998 ^� 3Ur� `� �o� ROIX v City /State r_3 c . ,( �t. ,• A ,, � z n ONING OFFIC, Legal ascription: C Z Lot � Block Subdivision/CSM # '/, S y, 4 i Sec. W , T 2k-N-R J r W, Town of A. pl N PIN # SEPTIC TANK — DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer w tc, 1Q G v -& d es +. Size ST/PC ,�� Setback from: House � Well CGS ' P/L Pump manufacturer _q1 1 - Model Alarm location 'jJ /--/A s Q i 3 u 1 k r W 0 o (HOLDING TANKS ONLy) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: At & Iflk Width � � Len / Q Setback from: House � � Number of Trenches • Well I b 1 p/L, Vent to fresh air intake ELEVATIONS: Description of benchmark _tGn' G w� t / /049 Elevation Description of alternate benchmark Elevation Building Sewer P ST/HT Inlet 0 ! < < l ST Outlet 6 _ V 7 PC Inlet PC Bottom Q/ AL Header/Manifold . 5 Top of ST/PC Manhole Cover g 3. Distribution Lines Bottom of System ( ) () ( ) Final Grade ( ) ( ) ( ) Date of installation /�` ermit number G ' In 5 ZO� State plan number D 5 �r Plumber's signature License number 27 $�' Da4 /.N/ Inspector -- (bmplctc plot plan a 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 C V 1 a LY16-4r—f---j SAFETY AND BUILDINGS DIVISION 201 East Washington Avenue P.O. Box 7969 Madison. Wisconsin 53707 Wi sconsin Tommy G. Thompson, Governor Department of Commerce William J. McCoshen, Secretary At _(trade System Stn ,g t e Veri f cati on BP- t Are the soil and landscape features accurately reported on the Soil and Site Evaluation Form E yes no If no, provide a further description by including an onsite report, which may consist of a soil profile report, or provide a brief explanation below. If yes, what other type of Private Owned Waste Treatment System (POWTS) could be used? o �nd County Offi �jal Signature Date \ 5�,.1 SW Ste' . 20 i 2 - v n v Property Location C "I Lando rs Name J y 7S/7 SBD- 10513(N.11/96) Wisaons FL,NDFv01RMAT,0N Commerce PRIVATE SEWAGE SYSTEM Count • Safety*aon INSPECTION REPORT ST. CROIX GEN (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)j. 320203 P > tHolder Name: ❑C ttb❑ Village Town of: State Plan ID No.: CST BM Elev. V 1lUU Insp. BM Elev.: BM Description: }( Parcel Tax No.: 100 low 1 A t'� _ 004 - 1046 -70 -001 TANK INFORMATION EL VATION DATA A9800388 TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic i w ,�„_ iru "Zoao Benc r 2 7— M o Dosng ; w ) b� \� 12•�Z Aeration Bldg. Sewer /po •y cf py 96 .g Holding St! Inlet X /�{1� ��j 7 `7 TANK SETBACK INFORMATION S * Outlet /V5 l ySa f 9 • o? TANKTO P/L WELL BLDG. Air to ir ntake ROAD Dt Inlet 16 3,5� / / q �s -Z Septic (�a 05, h/l/� NA Dt Bottom A 3 . Dosing s(� 1 (� , �/ NA Header / Man. (oo ,9 g •�7 �'j'2 S Aeration NA Dist. Pipe Do �J g 3 Holding Bot. System /CD PUMP / SIPHON INFORMATION a Final Grade Manufacturer -F , Demand &, 3.5 1 Model Number 92�> a3 GPM Wlavr c� / io. c/ 3 TD H Lift ((,J 1 1 Friction ! 2 System 2 TDH (Ft a oss i H Forcemain Length � 3 Dia. ,f Dist. To Well WkAB SORPTION SYSTEM I' TRENCH Width I [ Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid De th DIMENSION - DIMENSION S SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING u a INFORMATION Ty 'A O i CHAMBER del Numbe Syst , t I ' OR UNIT DISTRIBUTION SYSTE Header/Manifold Distribution Pipes x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length 5 Dia. —�--� Spacing i 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.) '9,0 �� y5 , "q S LOCATION: CADY 20.'&8.15.317B,SW,SW 209 COUNTY ROAD NN — LOT 1 ZZ f t�f e vie �- u�� 5 ""t L41,X'> Plan revision re%uir�d? [:]Yes 8 No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Safety and Buildings Division , SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 D nt epartme of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County 5 +. c than 8 112 x 11 inches in size. � • See reverse side for instructions for completing this application State Sanitary Permit Number 3�. (D 7.9>3 Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N 1 t g�'r° ?' Pro erty Owner Name SW ogert Lo cat io n q v � d f S ab Ta , N, R 15E (or) W Property Owner's Mailing Address v � Lot Number Block Number t St to U ZI Code Phone Number Subdivision Name S Number C5rA � 9 twin Lol Code ('ll5 )7q(o -g8 P F BUILDING: (check one) ❑ State Owned ° It Nearest Road Ej Public 1 or 2 Famil Dwelling - No. of bedrooms ° Town OF Cad �')- R N KI III. BUILDING USE (If building type is public, check all that apply) Parcel Tax / umber(s) 1 ❑ Apartment/ Condo G '" 7 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sates/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 Q Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 Q Office/ Factory 13 Q 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) ❑ 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 ❑ Mound 3011 Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13E] Seepage Pit A+ Grade— 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/da /sq. ft.) (Min. /inch) p Elevation; ( ) 3d 8 0 , Feet �4• /% Feet _ Capacrt VII I NFORMATION in gall Total # of Prefab. Site Fiber- Exper. g Gallons Tanks Manufacturers Name concrete Con- Steel glaze Plastic App New Existin structed Tanks Tanks eptic Tank o Ing Tank 1 (�0 1 Mt we_5�rr ® El 11:11 ❑ 11 1:1 ift Pump Tank ! /00b J WG j r ® ❑ ❑ ❑ ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibili for in alla ion of the onsite sewage system shown on the attached plans. Plumb is Name: (Prin Plu er's Sign ur . o S ps) MP /MPRSW No.: Business Phone Number: 3c) Plumber's Address (S reet, City, ate, Zip Code): Soto � w l n \AjZ, 5q o; IX. COUNTY / DEPARTMENT USE ONLY ❑Disapproval Sanitary Permit Fee (Includes Groundwater D ate Issued Issui gent Signature (No Stamps) S Approved E] Owner Given Initial 80/ Surcharge Fee) Adverse Determination ��� / /a � ` X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: ' 0 ai h ✓7sit, ��t1w•'f o w,.S :p C 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 may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary; usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application 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 mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump 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 I' and establishment of standards. 4 f ce, f e►� 71-57-42,6— SAFETY AND BUILDINGS DIVISION Street 1SCONS� _ LaCrosse Wisconsin 54603 �sconsin Tommy G. Thompson, Governor Department of Commerce William J. McCoshen, Secretary Transaction ID No. 118562 Date: 8n198 Juen The Transaction ID No. noted above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters Comm 50 -64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. The following conditions shall be met during construction or installation and prior to occupancy or use: • 'This system is to be constructed and located in accordance with the enclosed approved plans and with the Wisconsin At -Grade Soil Absorption System Manual (Pub. 15.21). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard by discharge of partially treated or untreated liquid wastes to ground surface or into surface waters or groundwaters of the state, the owner will employ a properly licensed plumber to repair, modify or replace this system (including the possibility of installation of a holding tank with proper disposal) with such action approved by the Division and appropriate local officials. • 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(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, !eraird M. Swim Integrated Services POWTS Plan Reviewer (608)785 -9348, Mon.— Fri. 7:15AM to 4:00 PM j swi m @commerce. state. wi . us. SBD- 5524 -E (R. 2198) 7t 'n T L R ECEIV Ep AUG - k 1998 State Plan # 118568 sAFE c G 8(.O� DID Parcel I,D, # 004 - 1046 -70 - 001 Dave Jug Phone 715- 796 - 8804 C TOWNSHIP W 1/2 SW 1/4 SW 1/4 of SW 1/4 Sectlon 20 T 28 N R 15 W St Croix County Page 1 Title Page Page 2 plot Page 3 cross section and plan view Page 4 Distribution Pipe detail Page 5 Pump chamber Page 6 Pump Curve Adress of Owner Adress of Site -4&—Y 30th Avenue 209 County NN Baldwin Wisconsin Spring Valley Wisconsin 54002 rte. Goltj itionallY kov v) OMMER ppRjtJ1ENT Of LDIN� AUAR SE E CORRE ��rypnw +�aa • � o Bi0 1 I G1' �� INE � Co ntou r , 4 r Q g1% p er , �% 4 e Z Z CL oB9 w 0 . 1000 gQtl on - Midwest Precas* U Pulp TQnk Cl Rl 0 B 1200 gallon Midwest Pr cast o N Septic '� aa +b w Future Four w o as Bedroom House O d > ! i O 1— F- E Septic. and pump tank may be moved to fit needs. Septic must be low enough to have bullding serer under future 4 bdrm B8 ele 88.1 home footing. Pump outlet. should be B9 ele 93.8 low enough to hit possible 0 50 replacement site. About 813 Ef O 30 40 ipe B10 ele 79.1 outlet p. 1 Bil ele 86.15 Well Top of casing Seale In Feet Elevation 100 P CJ y 4t 3 PLOT PLAN eA Dave Jul At Grade Plan IID, # 118562 W 1/2 SW 1/4 SW 1/4 SW 1/4 Sec 20 T 28 N R 15 W St, Croix County H8 20 40 Plan View a swo SCALE IN FEET s k78 g Force M u Ion PIPE °,,i�`S'i�'a 1 1/4 dlstrlb X X Co"tomp at a7.9s bkrr% = e�Pe OF M X DOPECTMI 4• PVC i1a by u toot bd a ft rack nbew p�. nYr fool rock balm p ss Latoralo fro" aerber are feat 1-0 122 " X 21 "' i MAL 5t5. AREA CROSS SECTIEV 0 2 4 i I I 6 8 1 1/4 distribution pipe scale in feet 10 Inches of approved aggregate at least 6 Inches below pipe Good black aArt o �Prowd a00►'epate / PLOWED filter cloth between rock Countour at 87.95 LAYER n"d good black dirt 2 foot rock u�Nl1 of lateral 9 foot rack doeriAl of lateral 5 foot of Mack� t blended to natural 3 observation wells at toe peace an aU akbka of rack black d" above rokik of bed. One In middle and 1 foot of one at each end rage_ Ofd._ r� Distribution Pipe Detail For Two Lateral Network Holes Located On Bottom Are Equally Spaced PVC Force Main End Cap 7 P X X PVC Distribution Pipe P - * Last Hole Should Be Next To End Ca P X 7 P Ft. I p Hole Diameter A Inch X �O Inches Lateral Diameter � �_ Inch(es) Y g y Inches Force Main Diameter Inches # Of Holes /Pipe Invert Elevation Of Laterals 0 0059 Ft. Signed: X3.4 Gfr) License Number: Date: 3 OV W ICOM _ • PAGE (;F PUMP CHAMBER CROSS SEC T IOrJ AND SPECIFICA'rlOkJ5 VENT CAP 4" �"�(VEUT PIPE —7 WEATHERPROOF APPROVED LOCKIAIG JUNCTION BOX MANHOLE COVER � 25' FROM DOOR, WINDOW OR FRESH 12 "MIU. I AIR IIUTAKE I GRADE I y MIIJ. i J 18" Mlu. COMMIT 18"MIN. PROVIDE I - - - -- INLET _T ��gCiGlVafd + IRTI&HT SEAL ALARM 8SIG, I I O . C JOINTS WITH I ELEV. 0 FT. APPROVED PIPE PUMP --� — ' j 3 ONTO. OFF D SOLID SOIL CONCRETE BLOCK i ?� RISER EXIT PERM1lTED OWLy IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFI•GATIOAIS DOSE TANKS MA NUFACTURE R: d ye5kvn Le ms IJUMBER OF DOSES: PER DAS TANK SIZE: 1000 GALLOWS DOSE VOLUME Is df3)L 1�(' ALARM MANUFACTURER: ; � � /9 ✓yy INCLUDING 5ACKFLOW [ v GALL MODEL WUMBEK: QL V CAPACITIES: A= ? 2 1MCHE5 OR GALL( SWITCH TSPE: M ed c. w g c INCHES OR ` q " � GALL( PUMP MANUFACTURER: Zc `ev C, ( 7 OR 2) !' GALL( MODEL IJUMBER: / b D INCHES OR 19 GALL: I SWITCH TYPE: ► le MOTE: PUMP AND ALARM ARE TO BE MINI M M U DISCHARGE RATE 2 • GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. T,6 FEET + MINIMUM NETWORK SUPPLY PRESSURE ✓✓ .. . . . .... .. 2•5 FEET + �QU FEET OF FORCE MAIN X )' I F /,, FLF KICTIOIJ FACTOR. 2- 1 FEET = TOTAL OtMAMIC. HEAD = 1_.1.. FEET iNTERWA DIMEWSIOMS OF TAWK: LEWGTH ;WIDTH _tiZ ;LIQUID DEPTH SIGNED: DATE: LICEMSE AIUMBER: // ) � �" TOTAL DYNAMIC HEADICAPACITY PER MINUTE m■■■■■■i■�e��� \■■ ■■■■■m &�■■■■■■■ ■ \ammo■■■ ■\\■N\■N■ ■\ ■► ■■ EMS moan N 44 R Oki OW NEM ZEN= No ■■\R► ■11 \■■ M I■■■■■■ . ■ ■ ■�: \III \� ■� \ \ ■ ■ ■ ■■ -' .. _ - :' ■ ■ ■m \� ►I ■mom \ ■ ■ ■ ■■ ■ ■ ■m��' \ \ ■ ■ ■ ■\ \gym CINUM92 omw =mm■ \■■ . \i►?� \Ili � \ \ ■\ ■ ■� \�■ ■wmKo■ I gmana■■ ■ \► \m SEWAGE & DEWATERING F TOTAL DYNAMIC HEADICAPACITY PER MINUTE k, IM3 G: Model 29314293 should not be subjected to less than 15 feet TDH. P OEM= MCI MM EX3=M ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■■ ■gym 1 . 1 b b .b 1 7 :b 1 •b 1 PP 1 1 0 1 . b •. b .. P :. •. Pb P b P Wits S in Department of Industry SOIL AND SITE EVALUATION REPORT Page of Labor and Human Relations r' Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY • Attach complete site plan on paper not less than S 1%2 x 11 inches in size. Plan must include, but St 'C; Of not limited to vertical and horizontal referenc iil Tv"-fiction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location a inatoetfir4 road. 70 —Q01 APPLICANT INFORMATION —PL • RII�.j AWL INFORM�ITION I {� REVIEWE _ DATE 7 / 9 r PROPERTY OWNER: , PROPERTY LOCATION ki vu ) v �� - :`i " p LOT, y,�S�li /4,5, T ,NR (oW PROPERTY OWNER :S MAILING AD '. LO T BLO # SyBD. NAME OR CSM # ," �0L . r I' .. �7w� sq ? CITY, STAT Z1p CARE' pH UMBER ❑VlC GE OWN NEAREST ROAD i C� 1, - CIL- [ New Construction Use Res i4 Bedrooms Addition to existing building t j J Replacement [ ] Public or commercial describe Code derived daily flow � gpd Recommended design loading rate S bed, gpd/ft L trench, gpd/ft Absorption area requirett bed, ft2 j�a U trench, ft Maximum design loading rate L) bed, gpd /ft e. trench, gpd/ft Recommended infiltration surface elevation(s)) c. G..4, /� 7 -Y 5 ft (as referred to site plan benchmark) Additional design / site considerations A + , I Parent material t ° p55 r.s Flood plain elevation, if applicable _ r _ ft S = Suitable for system CONVENTIONAL I MOUND ,IN- GROUND PRESSURE I AT -GRADE SYSTEM IN RLL HOLDING T K U= Unsuitable fors stem EIS U S❑ U ❑ S U ❑ U ❑ S U El S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft * x in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench P f.. o >k Fri r i,- r o r- Ground 3� 3 Y' �� r, { 4 �,�- C -I elev. LL ft. r �,)'f) V J - � rw(i'i (��' i (/ (✓�J Depth to limiting factor Remarks: Boring # -2 vb Ground elev. J��� r �,! '�� �� �,. ft. Depth to limiting factor 77 Remarks: T Name: — Please Print n Phone: ',' 2,; 7 Address: 1 I �. Signature: , Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT IF age PARCEL I.D. # Depth Dominant Color Mottles Structure G P DM Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trends C cS i n' 7 >S 11 Ground 1 7 p s { F ,j d Depth to limiting factor Remarks: Boring # ,F Y 6 h ........... :.v4 `hiv4•`• QQ Ground elev. �6•} ft. - Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # x Ground elev. ft Depth to limiting factor Remarks: SBD- 8330(R.05/92) Edge of Btacktop NN e !r Vp 7 � Ln bd ko - E7 2 k ad LOT m Lu -4 ai bd T td o CO ro M M 00 14 %0 OD W PD Ln 6 -0 3 13 —0 C3 - h 0 n P In :3 0 Wilwonsin Department of Industry, rand Human Relations SOIL AND SITE EVALUATION REPORT Page _of f Sa a Div ;ion Safety .& ngs & •Buildi t' in accord with ILHR 83.0 -, -, Wis. Adm. Cody ,*. COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan mu*,incf6, ut RCEL LS � Y01 j not limited to vertical and horizontal reference point (BM), direction and I% of slope, dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION ) `_ "'eta _ , IEWED BY DATE i PROPERTY OWNER: RROPERTYUp#►rTION v U �T v GOVT y� /4 /4,S T AR ! S ( W PROPERTY OWNER'. MAILING ADDRESS 0'f_# ;; BLOCK #;� ,SU NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER ❑CITY rjftLAIM AI ®TOWN NE SST ROAD NN I New Construction Use Residential / Number of bedrooms 3 [ j Addition to existing building Replacement [ j Public or commercial describe Code derived daily flow 7 �� gpd Recommended design loading rate 0 1 bed, gpd/1111: trench, gpd /ft Absorption area required bed, ft trench, ft Maximum design loading rate 6 bed, gpd /ft trench, gpd 1ft Recommended infiltration surface elevation(s) +o be 6e evr» F") by ft (as referred to site plan benchmark) Additional design / site considerations dev�yti a•/ ins/ y�f Parent material o tsSrs Flood plain elevation, if applicable /V 4 ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem El U 'faS ❑ U ❑ S � O S [:3 E3 S f g4l ❑ S p'U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerx io r R Lt/3- s; i 2 P A fn rr � 0 0,6 Ground 3 36_ t o Y `t/3 - 5 2 F 1 %� 1.4 le v. n I DY8 q/ PF 6 — O's 104 Depth to limiting factor Remarks: Boring # to c s>c 0,5 a. q Y/3 .s o q Ground -7z 10 y/V F� 5 Yfti'SI8 elev. 7.0 ( ��li S $ d nJ d ` — 4,7 10 ft. Depth to limiting factor Remarks: CST Name: Please Print arv� e- A fife) �✓" a Phone: '2 1 9Y 3 0 9 0 Address: 6 S9 cc C' ecoa C Fly w rth 5 M Signature: / 9 Date: CST Number: " D 9a2 PROPERTY OWNER UNF SOIL DESCRIPTION REPORT Pagef PARCEL I.D. #I Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Conl Color Gr, Sz. Sh. Bed Trench 70 0 I 0yR y Y b - rh r 2� 0 0.d 2 6-K 16 IN r► C s �� 0 -S' -16 Ground �fy-60 0 `fa 3 /Zf M 6 �' / s �q�� 1 a, 014 elev. , eft. 6� 7 Z -S R y F rd i� 3 „� s — 0 -7 8 Depth to limiting factor Remarks: w�fi� �aY�p 7, Boring # �4 Ground elev. ft. - Depth to limiting factor Remarks: Boring # �i'+� + i Ground elev.. ft. Depth to limiting factor Remarks: Boring # w Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) NORTH Edge of Blacktop NN o S 0 ! w 3 a ° ee Cil� � w b d ° tcl O O dz N v 9 ° l p a A W `C� ' QQ u4 l r p ° p p ° ° ° p V N + w N A A A A A CIO do 00 Ole Q4 O � O� ^ 3 v , 3 m c ` � r S SAFETY AND BUILDINGS DIVISION 201 East Washington Avenue P.O. Box 7969 ' Madison, Wisconsin 53707 isconsin Department of Commerce Tommy G. Thompson, Governor Wiliam J. McCoshen, Secretary e System Onsite Verification Repor Are the soil and landscape features accurately reported on the Soil and Site Evaluation Form yes no If no, provide a further description by including an onsite report, which may consist of a soil profile report, or provide a brief explanation below. If yes, what other type of Private Owned Waste Treatment System (POWTS) could be used? 00 0r)j It iS7 7 /a /fig County Offi ial Signature Date w % , Sr•./ ,t - Sw ' /4 S \rI V4 I Sec 20 l 281J - 215 ! l yW --7 v Property Location Cc d jN �J Douct J une- O Co v A/ A/ /'111 Landown4rs Name 9A, SBD- 10513(N.11/96) W1gconsin Doparttnent of Coon " tena' SOIL AND SITE EVALUATION Division of,Safoly.and Buildings Page of Bufoau of1fitegraled Service!: in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 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. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location �� tJ Govt. Lot 1/4 1/4,S 20 T 1 ,N,R E (or) W T un e Property Owner's Mailing A ress Lot If Blockff Subd. Name or CSMff City State Zip Code Phone Number ❑ City Village [ Town Nearest Road ( C >J A-) New Construction Use: Residential / Number of bedrooms q Addition to existing building ❑ Replacement ❑ Public or commercial - Descripe: //� Code derived daily flow 6�_ gpd ,�,�p Recommended design loading rate bed, gpd/ft _ - (0 trench, gpd/111 Absorption area required bed, ft trench, ft 2 Maximum design loading rate _bed, gpd/ft • b` trench, gpd/ft Recommended infiltration surface elevation(s) ;;)I1prJ Co t4puar' D'T' Pp f34 ft (as referred to site plan benchmark) Additional design /sfl@ considerations Parent material Loess Flood plain elevation, if applicable ~ 0. ft S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system EIS M U ® S ❑ U ❑ S Da U [X s ❑ U ❑ S ®U ❑ S 1191 U S OIL D ESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 53 1 6_7 tole 31S = CS 2-3 wwkl, Ground 3 31 10% 41q ''"�' able mf-r Cw 1 S elev. Depth to limiting factor Jin. Remarks: *1 ,, -o r V.✓ '1L.►,M1 rt r u�ttt �10j, b C, "7(2)-jg8 ' 60nAj 75 "T t 0 1'40 cc►'►'1 Fil,tnp -1 etr ko l�e. MtlwS I►�av .a lrox. w 916 fie --f- we s+ 6 w'ef,-' S ► inn, lti AV 8. - totL�ih fr v � a n � zD,l f a,�>f- �. �( i o� � (wv►� lr�Pl� { ��h� -lac u T� f�le'Wg*s s6;1 r 4p" dµ9 � awl. �- Inc -��r -� _.-C� dare- i-A t L 5" a�t� VeWj. - P%� A v+N►b e-e - be lr z i SS Lo "- fl�ervAA . -2 +- 1 S-7 _ f lee- 1 l ✓��t. of I l � LAW - o 0 NORTH z 0 m �o Edge of Blacktop NN 0 m ut d ❑ tzi fi ❑ ❑ td tzj N Q to ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND __II OWNERSHIP CERTIFICATION FORM Owner/Buyer D (a V, U .J tJ en Mailing Address � "[ G( eDGj iYl Property Address J0 q CLIL -6 Kf (Verification required from Planning Department for new construction) 1� City/State Parcel Identification Number DO 10 q6 - 70 -W LEGAL DESCRIPTION Property Location SW %4, S ln/ '/4, Sec. c�Q, T c2 N -R 15 W, Town of Ca Subdivision , Lot # Certified Survey Map # �go� , Volume to , Page # 1 �DFa Warranty Deed # 5 1 0 , Volume ) 3 33 , Page # 0 7-3 Spec house ❑ yes IN no Lot lines identifiable IL9 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 masterplumber, journeyman plumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal 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. Itwe, 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 e r iration date. 6 /a5 /n S14JNATUkE O APPLICANT 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 p rty de ribe bo , by virtue of a warranty deed recorded in Register of Deeds Office. r DS /'IS/ 98' S14YNATURE LICANT 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 a $TATE BXR OF tiVISCONSIN FORM 2 - 19152 WARRANTY DEED DOCUMENT NO. S ' Dougl Chilso _ - - Rt! iCT ER'S nc� ICE -- - - - - -- — -- ST. � ? C X :0. W - - -- — - -- - - -- - - -- - -- JUN 1 8 1998 — Dav D . Juen a si per coneys and warrants to _— — - - - - - -- 9:30 A -- -- -- rKS SPACE RESER'vED FOR RECORDING DATA A"E AND RETURN JPOR ThOMSS A. M cCormack the following described real estate in - - - - -- - State of Wisconsin: IAW OFF 740 Main St;reat Baidwh, `-TI 54002 ' 004- 10 -70 - 0_0 1 e PARCEL IDENTIFICATION NU' e 'A 1 : Part of Southwest Quarter of Southwest Quarter (SW% of SW4) of Section Twenty (20), Township Twenty -eig: (281 North, *I °ange Fifteen (15) West described as follows: LOG One of Certified Survey Map filed July 11, 1986 in Vol. 6, ?age 1682• _ V TRANSF Thu - - -_ i S not -_ homestead property X*X (is not) # ' Exc_ptiontowarranties Easements and restrictions of record. Dated this - __ - - -- /'?T - day of _ vJ r_ _ - -• A.D.• 19 98 t - - - -- -- - - -- (SEAL) -. e fZc- -- - - (SEAL) r Douglas C hils on - - + t - -- — (SEAL) AUTHENTICATION ACKNOWLEDGMENT StYte of Wisconsin, Signature(s) ?. — - - - - -- -- --- - - - - -- _ St Cr oi x -- County E PeT- Oh- came before me this _. • Z r � day of authenticated this — —day of __ - -_ 19_ —_ �v.�.sc- __ —• l9 98 , the above named � ---- ____-- -___ -- - D las_ Chilson — — "; TFI LL. MEMBER STATE BAR OF NVISCONSfN - - -- - - L ,. (If not, -- - -- - - -- - -- - -- +� t authorized by §706.06. Wes St tom . k .. n to be the person ____who executed the forL;oulg Stz } _ it ra c d ai kno,t led ,e the same. rH IS ;NS rRUMENr WAS DRAFTED By f , — Thomas A. McCormack -- - - - - -- --- - - - - -- Baldwin, WI 54002 ... - - -- c ounty, �t,> a , — 1i `,.� �Otl S t[ llt <Tit ' If state. expii, won dsve . y (Signatures may be a.tthentitatrd or atkno%lledged Bt4h are no I�t ry t -�, le �''�jit�:xwn t ) ncttss;ln) -- #4y E'aDrttr'crt zzg>r*rss'. ii, -21)32 .9- __ _ •^ear - �I a n'�or. , .t „�,� of t._'� n. ;�y.nF n ar,, i .F ,. ,. r.. h,. r !Keenlr•�< StIIF'kAR of 1 \I >C�l\ w';\sti� 1)Uft:, Fornr u. —t4a2 g Y , 414V CERTIFIED SURVEY MAP NO. 1682 VOLUME 6 1 PAGE 1682 . L OCA TED IN THE SOUTHWEST QUARTER OF THE SOUTHWEST QUARTER OF SECTION 20. T.28N..R.15W.. TOWN OF CADY. ST.CRO/X CO.. MS. WEST QUARTER CORNER SECTION 20- 28 -15. SET RAILROAD SPIKE 8 UNPLATTED LANDS N 8979'42" E 329.80' m JU ��� E� saw* 279.80' � 0, 1986 W 50• N OLD I 2 O WELL to S 89.47'18' E O f7.00 to Q BEARINGS ARE REFERENCED TO THE I 3 WEST LINE OF THE SOUTHWEST QUARTER OF N SECTION 20- 28 -15. ASSUMED AS N0072 I Z � r C) SCALE: 1 " = 100' I C j y 0 5 0 - 1700 200 o I 1 N ° LEGEND ~ LOT 1 0 SET 314' x 24' RE —ROD WEIGHING 1.502 LBS./L.F. O 2 a ACRES FT PREPARED FOR V I (WITHOUT R/W) BERNARD HAMPTON.OWNER ( 182.573 SO. FT ) ROUTE 2 ( *19 ACRES) SPRING VALLEY, W! 54767 M SOUTH QUARTER CORNER SECTION 20 -28 -15 — SET 314 "x24 o RE —ROD S 8979'42 =W 29640' WEIGHING 1.502 LBSVI.F. AbL 20TH WI S 897942" W 329.80' ; A V •• e F SOUTHWEST CORNER �• JER I —SEC7701V 20. T.281V..R.15W. FOUND BERNTSEN ALUMINUM MONUMENT APPR OWED • • W IS. �� •• X102 � •• A-671 � StJ 0 9 1986 '`',►'�' ST. CROIX C0LINI'Y COAIAMHE'NSIVE PARKS PLANNING AND ZONING COMMITTEE CEDAR CORPORATION 604 WILSON AVENUE MENOMONIE,W/ 54751 (715)235 -9081 Volume 6 Page 1682 PAGE LOF�. 8 o � 0 o � 0 m DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BU INDUSTRY, � cc DIVISION LABOR HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.090) & Chapter 145.045) LOCATION SECTION: TOWNSHIP /11 WF6tPfctF�F: OT NO.:BLK. NO.: SUBDIVISION NAME: S V4 1/4 1 / ao /TAe N /R/s (or) W C A'D y r�fa f�a rte- COUNTY: BUYER'S NAME: f} tf �. MAILING ADDRESS: s�- . C� >< ii o u a �,-. iS o n D 1a,x�(' �`n �, o o c�,� SI,/ fo USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: IPROFI LE DESCRIPTIONS: PERCOLATION TESTS: Residence ( ?a ❑ New CAReplace RATING: S= Site suitable for system U= Site unsuitable for system r ONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) os ou as ❑u os ou os au as ou mou�d If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: C� ( Floodplain, ind Fl elevation: No— PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ft ELEVATION OBSERVED ES . GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) nn O - - 7-T /3/ St l - • t 1 ✓7 - f -d 6N S;,/ B' �. 2S 1Q ' { f� �° �.7� •7S - /. /7 !� /�,> sil - S o .Z_ 1311 St G'o6 r Ff r►+v -E . �s "1.5 - -.,767 63m s C PF ('58 .�1 �.ss �� / a�� S - 5 �� ,o� B- 3 ZS T 1 (o �O v}. '�.� •(, . /JS D n/ �� / S 7.252 6.2 n S 4 �-' R m e •f- o O 0 _7r 131 5 -4-s � B G.o, . '= �� 3� •75 - -10 rn• siL 4 -3 -o iP {� B- 5 -! h/ o I g3 � - -;. � „k , 4 s. 3.0 - �. 7 sc /� ;' < . s, o .3 0_.83 - 6 3.6 Q, , No 3. 0 B/ xZ4 PERCOLATION TESTS TEST DEPTH WATER IN,HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL -MIN. PE RIOD 1 — PERIO D 2 PE RIOD PER INCH P_ 1, 93 A/o 2. � � � , � Y x ^/' P - .2 /. X3 n 0 P- 1.9 te P-_ P- P- _ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale o distance Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent o land slope. ,S Y STE M ELEVATION 81 �r4 _ a _ so �� ofc 1[ �� ( F3 . : ok Z7 CIV 1 q ,_ a tN E + + r_ = W Y b I r `r ��w _.�_�__ I the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: 1 Q fi VA, f, 11 /, - / " ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): t 1 s o / ! •: - ; Y Ir CST $( NATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) E ' ER — .. t INSTRUCTIONS FOR COMPLETING FORM 115 - SBV - 6395 To be a complete and accurate sail test, your report must ir7clude; 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3, MAXIMUM number of bedrooms or commercial use planned; 4, Is this a new or replacement systern; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 0. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. IViAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; S. N'lake sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; S, Con",plete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exernp- tion, if appropr late; 10, If the information (such as flood plain, elevation) aloes riot apply, place N.A. in the appropriate box; 1 1 . Sign the form and place your current address and your certification number; 12, Make legible copies and distribute; as required= ALL SOIL TESTS MUST BE FILED 'WITH THE LOCAL AUTHORITY WITHIN 30 GAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols s - St.orw (over 10") BR Bedrock Cob Cobble (3 - 10 ") SS - Sandstone gr - Gravel (rander 3 ") LS Limestone `s Sand HGV% - High Groundwater c - Coarse Sand Perc Percolation Rate med s -- Medium Sand V% -- WeII fs - Fine Sand Bidg _ Building is Loamy Sand > - -.. G? - eater Than 'sl - Sandy Loam < -- Less Than ' i - Loam Bn - Rrovvn sil - Silt Loam LEI - Black si - Silt G -- Gray "cl -- Clay Loam Y - -- YreIIow sci - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot Mottles sc - Sandy Clay vvi - lvith SK; - Silty Clay fff - fevi, fine, faint c - Clay cc - Coll ornon, r"O'irse pt: - Peat inin - Many, medium m - Mu d - distinct h - prominent HWL - High water level, Six general soil textures surface water for liquid waste disposal BM - Bench Marie VRP - Vertical Reference Point TO THE OWNER; This soil test report is the first step in securing a sanitary permit. The county or the Department rnay request verification of this soil test in the - heid prior Im permit. issu<anc.e. A complete set of plans for the private ivagr: systern and a permit application must he subMitted to the, aporopriaie local authority in order to, oot:aln a permit. The sanitary permit must be ob'ialned an(] p € 3sreG prior to the start of any constructiorae O- :mot ST CROIX COUNTY SEPTIC TANK MAINTETIQ CE AGREEMENT A�1D OWNERSHIP CER'C[FICAMON FORM Owner/Buyer _ �U b Mailing Address - C 7` IV SiZ 1 Property Address s,4-1V (Verification required from Plowing Department for new construction) City/State 4' t S Parcel Identification Number LEGAL DESCRIPTION Property Location i td ' y, S w y., Sec. 20. T N -R /,S' W, Town of Subdivision Lot # Certified Survey Map # Volume 46 , Page # Warranty Deed # Volume /6 7 , rage # Spec house ❑yes (! no Lot Imes identifiable Gr yes ❑ no SYSTE - AfADnENANCE IfPoPcrt = and maiatenanoeofyonrseptic systemcouldresalx in. itspremaZurefailure to handle wastes. Propermaintenanoc consists of pumping out the septic -tank every three years or sooner. ifneededby a ficensed What yar pm into die can affm tlfn finction of flee septic taalcas.a trestmeatstage mthe V=ftapord �system. The. pc+operty- owner agrees to submit" St. t Zauag Department i .catification form., signed by the owner and by a ;M?aP P r sWceedpb mrberor= odpmnperve fying that (I) dee oa wastcwaterdisposal system is m IWPa op= ooadrfion and/or (2) after inspodion and pumping. a necessary), the septic.tamk.is less dm I/3 full of sludge. Uwe„ the undersigned have read the above =qukemeaft and agree tO maintain ttea private sewage diVosd syAcm with the standards set fatty, . as set by the DTa tment of Cie and the DT nt meat of Nattual RcsomcM State of Wiseonsia. Catifcation StIttilIg drat YOM scpfic mtcm, has boat maintained mnst be oomplctOd and rcWalod to the St. Croix.Couaty Zoning Office within 30 days-of die three year expiration date. SIGNATURE OF APPLICANT DATE OWN>✓R CERTI�CATION I (we) eutify that all status on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property dcuxabcd above, by virtue of a warranty deod recorded in Register of Deeds Office. GNATURE OF APPIICANT / &7 - ®� DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. rt' • "' ** Indude with this application: a sumpod warranty dood from the Register of Deeds office / a copy of the certified survey map if refe eucc is made in the warranty deed