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COO O O f00 O N O U O O N 2 N O Z C Z N O Z C Z rG Cn I v~ d~.a €a I €a • c m maw a~aZ` r~ y c m c r A tiara j0 0 v I Gu Q STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER )V&-J7 DOSE' /LlJ`FjQ%/N A D DR E S S __60 ff W?Ta ✓ yll o [ (P SUBDIVISION / CSM 52~l il~ UQ~• lU i Z~3s LOT y SECTION Z3 T Zf N-R W, Town of ~`UOSOti7 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ORIGINAL INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tanl; manhole cover. r , ► R o e 3/Y i s~ TT ~i~v. = i o o. D TP ~/a BENCHMARK: ALTERNATE BM: T'`'~ s~0~-uG- O,✓ lip~~C S c~J - SEPTIC TANK / PUMP CHAMBER / 41G&D NG TAN*--iipeRH QN Manufacturer: IzfiD~E. r&-; i✓ li1LLr1 T_ Liquid Capacity: 750 p Setback from: Well } 90 House !(el Other Pump: Manufacturer ZD L~~ Model# q00 Size r~- t "P !(s' V Float seperation 'S Gallons/cycle: Alarm Location ' -:SOIL ABSORPTION SYSTEM Width: S ~ Length Number of trenches 2- Distance & Direction to nearest prop, line: X25 _~D 13440VS ~D, lelz-O Setback from: well: 11j- House -SO ' Other ELEVATIONS Building Sewer ST Inlet. `1'0oy ST outlet 7/• q~ PC inlet PC bottom pump Off S D Header/Manifold Bottom of system G Existing Grade4 6 • s y Final grade I (.57o ~-7t1 }yam olJE7~ di's77?1'190 DATE OF INSTALLATION: .54-r. Oct , S - l ~ ~/~S ~ PLUMBER ON JOB: ~0(8E-e fbe- 66,,(A T___ LICENSE NUMBER: 330-,? INSPECTOR: HAR- 4f~ fc6o S l b 7 G~ 3/93: jt C7Gh `7 • v y ~ y ob ~ -1 TO a a ~ o 0 C O ~ R1 y o m 0 Itz rl~ m II Il l I I ills, I I I I~ I r,4 'Wisfons4 Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Woman Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268553 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: MARTIN, BRENT & ROSE HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic f'2. Benchmark 7 ~ 0 Dosing s. u~,a• rj Aeration Bldg. Sewer /3. i5 Holding St/ Ht Inlet SS TANK SETBACK INFORMATION St/ Ht Outlet a, qa TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Id,-1 Septic NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade aA Manufacturer Demand, S 6 Model Number GPM TDH Lift Friction System TDH Ft Loss mead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manu acturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION TypeO CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length _ Dia. Length Dia. Spacing 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.) LOCATION: Hudson.23.29.19W, SW, SE, Dakota Ridge .4- - Plan revision required? ❑ Yes ❑ No Use other side for additional information. 1/0 *T7 f6 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Wiscci~! eF;artmentofindustry, PRIVATE SEWAGE SYSTEM County: Labor an umanRes INSPECTION REPORT ST. CROIX Safety an uildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268683 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: MARTIN, BRENT & ROSE HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent iritontake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Lriction System TDH Ft Forcemai n Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Mode Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded T xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON.23.29.19W, SW, SE, LOT 4, BADLANDS ROAD Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: _ 4 ~__Ww al an 2- g ss 3 Idis Bureau of uilding WaterlSystem: ~~■~.r■n SANITARY PERMIT APPLICATION 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, Wl 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County :5-r. than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Saniittarryy PPeer~miit Nuujm~ber The information you provide may be used by other government agency programs P-dheck rf idrision to previous application IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name , Property Location T3,PAEv7- ~a-52f ~11 Pe77 J SCJ114 E1i4, S 2-3 T Lf , N, R E (or Property Owner's Mailing Address Lot Number / Block Number GAJ City State Zip Code Phone Numbe Subdivision Name or CSM Number QV / P 2Q~ Ups o.J C.v/ . S y e71 (CIS ) 3~Qro • 14, o CS.ti S z 9F// II. TYPE F BUILDING: (check one) ❑ State Owned ❑ Nearest Road ie Public 1 or 2 Family Dwelling - No. of bedrooms E] vil li wn OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 49 20 - /663 -50 - ZOC) 1 ❑ Apartment/ Condo 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 IL 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF ERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. L?Zew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System _ Tank Only___________ Existing System Existing System B) Sanitary Permit was previously issued. Permit Number SS 3 Date Issued (:~4v V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Se age Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 eepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit L.... 43 ❑ Vault Privy 14 ❑ system-In-Fill Z T~ e~C S S u O VI. ABSORPTION SYSTEM INFORMATION: ;F6, C) ' -z- 1f 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade /1 Required (sq- ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 1;7& '10 Elevation 7 J~~ S Feet f9•eO Feet TANK Capacity VII. FORMATION in gallons Total # of rs Prefab. Site Fiber- Exper. New Existing Gallons Tanks Manufacturer Name Concrete strutted Con- steel glass Plastic App Tanks Tanks Septic Tank or Holding Tank &7V / Al ffltd-fJ7f-`;( j,) 97 , ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 15 0-75?,) ( 6e-62tS 7-2-Cali f f F7 ❑ ❑ ❑ 0_ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) IMPRSW No.: Business Phone Numb : T-1, A&S PlumbQr'sAd_,ress (Street, City, State, Zip Code). l((~~O ~5 O e,- L IX. UNTY / DEPARTMENT USE ONLY ❑ Disapproved San tary Permit Fee (Includes Groundwater ate ssue sluing Ag nt Signa re No s) Approved E] Owner Given Initial Surcharge Fee) ~CL~•/ Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: 016 SBD-6398 (R. 05/94) 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, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. 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 8 1/2 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) fora 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. } ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants PROJECT INDEX DILHR PLAN ID # DATE 0 OWNER IjRE,V T /F~OS~ /GI~T/•t~ PHONE 713-- 3fio / ADDRESS y~ Z CA!t D ~4;,C I-Al LEGAL DESCRIPTION GOT- 52-1.1 It VD ~ . 10 ~ ~j Z-g35 SE, !9~pG . 2-3 , 1' x y 0 , 1~ I q to O TOWN OF 4-u p,S o,o COUNTY S ( G Rd 1 CSTM •'~-tlbeeettk Z49) LOCAL AUTHORITY/ SUPERVISION S T~ C P-0 t K Z-0 A.3 t A3 Cs---- PROJECT DESCRIPTION: 7-20 ~ ~T' Uri ~ S r iu o le t~G-~•~~ L.. Soy L AAA, G--P / f z l a >Aa .3 , of *V SCox /V 1EE11?1c- NEW RROMWW Ut6flICNT R Di P9.1 PLOT PLAN VIEWS P9.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEW SPECS. Pg.4 DOSING CHAMBER CROSS SECTION Pg.5 PUMP PERFORMANCE SPECS ~ _ z rn I d -j ~A - w N o 0 N o ~ ~ C3 w o O ' u" k a i ~ d o v v\ • I fl ~ II II I z m i X01 i ~ \ w I I ~ I~ p ~ (I I Q I I o ~ • ~ ~ • I I I I ~ • Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12".Above Final Gr'a de 2~ Above' Pipe _ 4" Cast Iron -to Final Grade Vent 'Pipe' Synlhelic Covering Min. 2" Aggregat6 Over Pipe Distribution + Tee Pipe 0 0 0 0 0 6o Aggregate 0 Perforated Pipe Below 9eneath Pipe 0 Coupling Terminating At . s~/ST, ~~7 Bottom Of System Fresh Air Inlets And Observation Pipe Approved Vent Cop Minimum 12" Above Final Grade 'rL- ~i.cl Sffz2 S~ yo LY Above Pipe 4" Cast Iron PUMP CHAMBER CROSS SECTION Ak)D SPECIFICATIONS Pi4 E f of 55 VCUT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING 2S' FROM DOOR, JUUCTION BOX MANHOLE COVER WINDOW OR FRESH 12"MIU. W/ 4 AIR INTAKE I Till 1~1j(,0lA) - 1A/&F Or ~/EI/117/ON GRADE I 4`. MIN. i I IB"MIU. COIJDUIT ~ 00.0 le- V,4 r7 0 4.1 olo, lh IIJLE T PROVIDE AIRTIGHT SEAL i III APPROVED JOINT A IN51 DG r I I I APPROVED JOIWT w/ C. I:. PIPE M I I 5 EXTENDING 3' I I ( W/C.I. PIPE I ONTO SOLID SOIL '001 '10 I (I ALARM EXTENDING 3' B I I I 3.3 ONTO SOLID SOIL I ~ C~/' 1 I 1 y° o1J ELEV. FT. i PUMP D I ~ OFF m VA f ~l BLOCK RIStR EXIT PERMITTED OULIJ IF TANK MANUFACTUR6.R HAS SUCH APPROVAL . SEPTIC E SPEGIFI'CATIOt~JS DOSE 3 TANKS MANUFACTURER: M~~~tlE•STZ?;tA) jc457-WMBER F DOSES: PER DAH TAWK SIZE: -750 GALLOMS DOSE VOLUME 4 1(00 ALARM MAMUFACTURER: LE?Ji5- /q "/4 INCLUDING BACKFLOW: GALLONS MODEL IJUMMR: d Gv CAPACITIES: A= INCHES OR 3a0 SWITCH TYPE; -300 GALLOWS t, /,Cy~ B = INCHES OR _ GALLONS PUMP MANUFACTURER: INCHESOR_ 00 GALLOWS MODEL NUMBER: A d~d/L D = I 5 INCHES OR 15 2--GALLONS SWITCH TYPE: /~lf!0 71W & f%/DiF~NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE 3 ~ GpM INSTALLED OU SEPARATE- CIRCUITS VERTICAL DIFFERENCE BETWEEIJ PUMP OFF ARID DISTRIBUTION PIPE..FEET *AA* S PECs • MIIJIMUM METWORK SUPPLY PRESSURE vd , FEET ~AGL1- ITO~' 4- FEET OF FORCE MAIN Y, / S FT/ G L ,FRICTION moo FFACTOR.. ' FEET tgoA) S 4f, 7.5 TOTAL DYQA.MIC HEAD 7Z-- FEEr `ii Y4 ~S- IIJTERAIAL bIME1JS10NS OF TAI.1K: LEIJGTH yo ;WIDTH ;LIQUID DEPTH i HEAD CAPAC17Y CURVE MODEL "98" 7/0 1/4 s 2 • F'RT- 4 5/a a s/a is ' o + + 4 6 4 J/I6 10 2 8 1 1/2-11 1/2 NPT 0 U.S. OALLq,Jg : U.S. 10 2 30 40 50 60 70 80 1a0 240 0 FLOW PER MINUTE 0""Ic UCNr 1011 rsli u~.wte ctw~TEalw . MEAD CAI I 12 YNITe/MIN . FEET METERS GALS L'rR& I b • 1.02 72 272 t0 3.05 s1 231 1 Ib 4.61 10 170 ~ E.10 ~ AS tack vslw 5 5/ 14 CONSULT FACTORY FOR SPECIAL APPLICATIONS' • Electrical aAernators, for duplex systems, are av:iliable and supplied with an alarm. • M three ercury sfloat e switches are available for controlling single and Q: Mechanical alternators, for duplex systems, are available with or • Double pig aback stems without. $larm swilcheg. gy mercury float switches are available for variable level long cycle controls. Standard all models - Wei ht 3ti Ibe, . H.P. aELECTION GUIDE i 1. 111191lrAI 110.1 operated 2 W aerle~ 2. ttlnpt. PipOYbsck mercury ~ Irlechsnicel switch, no exlelrull control required. double Model V p ea Control Se106110n switch. Rotor to FM0477. Iloal sw h of P2oyt/eck mercury, host Mode Am a aim lax Ou lox 1 S 1 a. 1 a ~ Mechanical WsrruUor 10.0072 at 10.0075, 4. Bee FM0712. lw correct model d Elscl "Ahernator ° . 6. MOO , D00 230 1 0 4.S t or 1 R 7 _ du ~ "(16" 11 ai switch 10-0Q25 ;Y ood y e cwWd aegvtlor Eae sa0 1 Non plsx ls) or l+1 float sysl.m pkg. 1.5 2 er o a - - l Four to K J- e_...... SANITARY PERMIT APPLICATION v'~~-n R In accord with ILHR 83.05, Wis. Adm. Code COUNTY 45L Cr STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than C26 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Brent & Rose Martin Stid % SF S e c 2 3 T29N, N, R 19 (or) W PROPERTY OWNER'S MAILING ADDRESS LOT # O iM C e I; 1 . 1 e LOCK # 412 Cedar Lane Par~e93~ In Vol 1 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Hudson, F?I 154016 1(715)386-160: II. TYPE OF BUILDING: (Check one) 1:1 State Owned 19 VILLAGE: Hudson N Zf F-1 TOWN OF: - I ❑ Public 91 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER( S) III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 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 in line A. Check line B if applicable) A) 1. 9New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 M Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) t/ Q' ELEVATION 6O.t> -716 0 8 7, v Feet ~~7QFeet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. on- INFORMATION New isting Gallons Tanks Manufacturer's Name Concrete structed Steel glass Plastic App Tanks Tanks Septic Tank or Holding Tank So Lift Pump Tank/Si hon Chamber G I E] E] Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Sig ture: (No mps) MP/MPRSW No.: Business Phone Number: I)a-4L Id, 01, 61. 0,014-5 ej- Ate it " n1_1, AIr e5 4e (71:5* ) Ae3 Plumber's Address (Street, City, State, Zip Code): 01 ,3 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sani ry Permit Fee (Includes Groundwater ate Issued Issuing Ag I Si r No mps Surcharge Fee) Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) 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 the 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 alicensed 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 8c Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. Il. Type of building being served. Check only one and complete of bedrooms if 1 or 2 f=amily Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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 8% 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) I I Z7 v Q I 1 O i" i f I r 1 t • Wisconsin DepartmentofIndustry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations - Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 57- CROIX Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: ,I PROPERTY LOCATION "f R.v/E ~/,4.vOEER / ow S T- GOVT. LOT SW 1/4 SE 1/4,S 2-3 T 2 9 N,R /9 E (a W~ PROPERTY OWNER':S MAILING ADDRESS LOT If BLOCK # SUBD. NAME OR CSM # 7M4_ ~.4OG~.vvs• RIP Cs ti p&.vviA.) 6- CITY, STATE ZIP CODE PHONE NUMBER CITY ❑VILLAGE POWN NEAREST ROAD HUOSoA-) &)IS. JZ1016, (715)3606-3737 NuI)So,J r3ADLANDS [ New Construction Use [ Residential /Number of bedrooms [ J Addition to existing building ( I Replacement [ J Public or commercial describe Code derived daily flow (06 O gpd Recommended design loading rate bed, gpd/ft2 • d? trench, gpd/ft2 Absorption area required 95-Y bed, ft2 75.0 trench, ft2 Maximum design loading rate • 7 bed, gpd/0• trench, gpd/ft2 Recommended infiltration surface elevation(s) 5-~- P $ • 3 ft (as referred to site plan benchmark) Additional design /site consi erations 5 r,090 t) 91Y ~f'E'co y,~ E,vp 7`A0& . J ei,~Lt S Parent material scs S 13 VA0k i ,,f~1e,97- Flood plain elevation, if applicable ft S = Suitable for system coN IONAL MOUND IN-G D PRESSURE AT-GRADE / SLYSN" FILL HOLDING TW U = Unsuitable fors stem ❑ U [I S 04 O S ❑ U ❑ S U LA'S ❑ U ❑ S 0'CI 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 Trench /0Ye3 z - S/ Z 3'0k cs s •G 0- ly 11 _0 /0 yle W Ze Ground -3 /D Y 516 55- elev. 7 7 ft. Depth to limiting factor Remarks: Boring # GS f S 3 S~ l~r► S~~ v~~ ' 61 11121- Ground el v. ft. This t Depth to limiting Onventi n factor „ elm. Remarks: CST Name:-Please Print R O QE R T- U LQ R t CGt T- Phone: p~~-- Address: (e55 0 'N e r L R E> 14 V DS6,J Gc)t - ,SLIQI t'o y- ~ y ys CST-44 z 4IP2_ age _of PROPERTY OWNER y~N UD>PS~ SOIL DESCRIPTION REPORT P 3 PARCEL I.D. # /-0- Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 62 -32- 41-1-5,11 -,e AJ)D Vr I rely Ground Z 1 ^ G Q4 C S o, elev. So ft. Depth to limiting factor Remarks: Boring # S 4m MMMM SL, o- /o lAO 311 k- Oil 4P e5 f 5 6 a -9G ~o s Ground elev. l7. oft. Depth to limiting factor Remarks: Boring # / -S /G .3/t- S~ 1.~ S6~ ~►+'J~iC G'„f" 2..f- 5 '~o mqg , k z s oQ~ c s S Ground elev. ft. Depth to limiting factor Remarks: Boring # > .t3 Ground elev. ft. Depth to limiting factor cC -5-711f o (h vj m Cn z N c o 0 00 ~ ~ z N 1 (n ov v, CR/ 77 AO Ap~-t- Ile C' ~ ~ o ~ JUN aBi 1995 ® 524991 1 C ER TIE 1 ED S UR V E Y MA P Located in the Southeast quarter of the Southwest quarter and the Southwest quarter of the Southeast quarter of Section 23, Township 29 North, Range 19 West, Town of Hudson, St.Croix County, Wisconsin. SE Corner Owner: \ o / Section 23 I Arnie VanderVorst flat of Fox Valley LOT-1- (BERNTSEN CAP) 752 Badlands Road? - S 001359W 615, 2' 7.44I Hudson, Wi°54016 399.11 216.4T. ~ I Bearings referenced to the South line of the m 1 SEI/4, assumed to be In W I 61 I N89°58'09"W ° a w w w % to ;0 Outlot 1 Pbat of- a a) w 1 ° 50 12 E 1 w Fox Valley_ sob ®N 0, c a U. 1 W 98' to 12 rnv a w cc (r IF m a I 0 Il U) = v a ti 0i NIa) ►W' w ti 'T .i NI 0 M U) r4) LEGEND CU Z all v c C4 3l J co 2 J rco I Iof = a Section corner in W rn0V. c I t Iri N monument (as i, N w w 00- m I ~I noted). a X a6 w v • Iron monument 0) vztz- a < ( W I mw ZI I 1 found. X24" Iron pipet W C' 1 ZZ O 1 weighing 1.68 lbs. N o 0 I per li i foot set. U1 '0s '0 . 65.23 .11239, 87 ' I I 2 PUBLIC SCALE IN FEET I = 150' 214.57 DEDICmTED TO THE N 00'01'51'W 00 t S 00'01'51"E W 0 75' 150 300 m I 04.81' h ' 0 LO SHED n 2 -0 cu > <T y~ 0) 'S 1 /4 ' en l M o W SHED ;3 > w N00° J( P. K. M LM U 'hl ac g o w :1 NAIL) w 0. 3 T c W CA - M c MI I I ' al * CU clu IV O Q t • I 3 r` Zi f0 I Q Q zz~ N 0) SDI- ' N HARVEY G. Ti ~~oiw IT - ` HOUSE. 3 w W` _ W,6 CJ STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OVVNERIBUYER Brent & Rose Martin MAILING ADDRESS 412 Cedar Lane ~ 0/ PROPERTY ADDRESS ~4r Dakota Ridge, Hudson, WI 54016 (location of septic system) Please obtain from the Planning Dept. CITY/STATE Huds / PROPERTY LOCATION SW _7t) City Hudson. TSdOF 11~~s 4A l/1<1 SUBDIVISION CERTIFIED SURVEY MAP Improper use and mainten wastes. Proper maintenance consi by licensed septic tank pumper. as a treatment stage in the waste St. Croix County resident., ,,.u~ w mucivc a g[a[U nor a maximum of ouio of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensedlpumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum VWe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date SIGNED: DATE- Cl - St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W1 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property Brent & Rose Martin Location of property :-SW 1/4 SE 1/4, Section 23 T 29 N-R 19 W Township Mailing address 412 Cedar Lane kill Hudson, WI 54016 Address of site 140n Dakota Ridge, Hudson, WI 54016 Subdivision name Lot no. Other homes on property? Yes No Previous owner of property Arnie VanderVorst, 752 Badlands Rd, Hudson, WI Total size of property 141,959 square feet Total size of parcel 141,959 square feet Date parcel was created Are all corners and lot lines identifiable? Yes No I~ Is this property being developed for (spec house)? Yes No volume 10 and Page Number 2935 as recorded with the Register of Deeds. Document #529911. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map,, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. S~S3<o/ and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of Applicant C p ican rte-: Fresh Air Inlels And Observotion Pipe Approved Vent Cop Minimum 12" Above Final Grade A= 20 - 42" Above Pipe 4" Cast Iron To Final Grade Vent Pipe Marsh Noy Or Synthetic Covering min. 2" Aggregate Oyer Pipe Distribution Pipe o 0 0 0 o Tea B= Min 6" A99re9ate Beneath Pipe ° Perforated Pipe Below o Coupling 7erminelinQ At Bottom Of System C= A= B= C l` Page Of~ COMBINATION SEPTIC TANK/PUMP CHAMBER (No Scale) 4" Cl Vent Pipe with ' Approved Locking Manhole Cover Approved Cap, +25 From Buildings With Warning Label Attached Weatherproof Approved _ Warning Label Junction Box Vent Cap 12" Minimum Final Grade 6" Minimum 4" Minimum i ' 6" Maximum 4" C.I. Quick 18" Minimum Insp. Pipe Disconnect I 1/4" Weep Hole Baffles L__1 ~ A Alarm B On 6 C *APPROVED Off JOINTS WITH APPROVED PIPE D 3' ONTO Conc. Block SOLID SOIL 3" of Bedding Under Tank-/ Note: Pump and Alarm Are On Separate Circuits Number of Doses: Per Day Gallons Per Day/ of Doses: /.S,q' g~Gallons Volume of Backflow:....... +=Gallons Tank Manufacturer: 14r16c. /r r--,, 7'T Total Dose Volume: =doGal 1 ons Tank Size-Septic/Pump:~,?so Gallons Alarm Manufacturer: o Model Number: 5,3' 1eCTYe Capacities: A X35 i nches or p/ /Gal l ons Switch Type: .mot t'Q1 u v, + B inches or ate',/ Gal 1 ons Pump Manufacturer: + C /D -inches or 7Dd 7 Gal Ions Model Number: + D 5'inches or allons Minimum Discharge Rate: GPM Total.....= inches orb%g Gallons Vertical Difference Between Pump Off and Distribution Pipe: Feet Minimum Required Supply Pressure:............. Feet Feet of Force Main x Friction Factor/100 Feet: + Feet Inch Diameter Force Main Total Dynamic Head:...= Feet Internal Tank Dimensions: Length Width ; Liquid Depth Signature License Number Date INDEX Page 1 Sanitary Permit Application 2 Plot Plan 3 Soil And Site Evaluation Report or EB 115 4 Cross section of soil absorbtion system 5 Septic tank cross section 6 STC-100 7 STC-105 8 Certified survey map 9 Warranty Deed Designer Vaughn D Monson Master Plumber ID Number, MP 6567 rs ruly Vau hn D Monson \\ARR:\N1\' DFFD - REG: ST.CRCIXCTY.,',ii Pa~wwxrl Arnold Vander Vorst and Karen Vander `.'ors- JUN 14 i996 f/k/a Karen E. Penman, husband and wife at 1:00 A. N, , 1 Pe;;'ercf Deed; a!n\c\,.tnd ,,.,:rent, to Brent A. Martin and Pose ~1 Martin, husband and wife Leo Bo ar ' v RODL , SKAR, BOLES & KRUEGER, thr h!Ih!\\+ne de,,wied real estate in St. Crol:: 219 No hMain St re. t Countl. State of t,cunstn PO B 1 38 Rives Falls, WI 54022 (Parcel lJenttficatwn AumherI Part of SWA of SEJ of Section 23, Townsnip 29 North, Range 19 West, St. Croix County, Wisconsin described as follows: Lot 4 of Certified Survey Map in Vol. "10", Page 2935, Doc. No. 529111. S Th jVS This homestead property. 1t,• (i, not1 F\ctptt,m to Aarrintie, Ea.•ements, Restrictions and Rights-er--Way of Record, if any. . Ik:tcd this / da> •,I June 1996 f (S EA I \1 • A_r old Vande7, Vorst//~ - • Karen Vander Vorst AUTHENTICATION ACKNO\\'LEDGIIENT Signature(,1 ST VT F F \A ISCONSIN 9 authenticated thi, da\ A 19 Pcr,,!nall% camr before me th+` ia, of .i une 19 96 the aht!,c named Arnold Vander Vorst and Karen sander Vorst T1111 f %1F INFR S"T\TF PAR OI \\'ISCONMN (If not. ter. ra au II,,rucd h% §70606, \\+s statNj ` ~nr i,nu„n to he the pcr,on s \ho -\ecutcd the vng + nnen i • chn,,~~ is +cr the amr. xTw~RR~ Ttti~ iN>r. 'gtENT :.A~ C'ngf'EG rav Leo A. ESK RODLI, BESKA R, BOLES & KRUEGER, S.C. ST. CROIX COUNTY WISCONSIN. ZONING OFFICE r w a w r n• M~~~i ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 October 11, 1996 Re: Septic Inspection for Property Located at 801 Dakota Ridge, Hudson, Wisconsin TO WHOM IT MAY CONCERN: An inspection of the septic system installed to serve the above described residence was conducted on October 7, 1996. This property is located in the SW; of the SE, of Section 23, T29N-R19W, Town of Hudson, St. Croix County, Wisconsin. At the time of the installation, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions with regard to the above, please do not hesitate in contacting our office. Sincerely, Mary Jenkins Assistant Zoning Administrator pe