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HomeMy WebLinkAbout020-1318-70-000 -0 0 a O~ O ur> M hhV^ U U 4 0 0 ti ~ •C O 3 Lo N E~ w~ ya a~ © N N N C n C1 N N Ol x ~ C O C CU C C U 0'0 U (p in O 3 m 0 a N o c y o c c c U O c L (0 . N C U O _ L O co O .0 O aD 3 O N N O N N L N j N N y 0) 0 CU o (n C) UO C Z 0. 7 0 C Z O N O 3 t6 3 L f0 _ c LL C E` LL C _ O) o _ O N N CL a) O ` O CY) Q.L. h Q c a x a) 3 M 3 ° Z ill z N E E 04 Z 0 £ 00 cl, v rn w a m a m N H Z I O O Z d c fY O 2 N '5 m z o F- ° N rn Z c E c E -2 m 2 E m N 0- U N O. 0 N N N Q7 i C • N ll N U N IL v .c a J o Z C c O C' C O U O o O Q O O Q Z F- Z Z F- Z o N z 4 N E 4) c N H E > y E > _ (D C4 G y r~+ O. f0 a~+ C O 2'V11 p N Gl i N N N ad. N O O D d D a d c\ LO E Q) 4) U) N N 0) U) U) U) 0) ) o Jw co r F- F- F- O F- F- F- O _ N O O O Q` LL O O O d LL Z° • w,i 0 c. n. a 0 a a a o U) T- CD (D 2 m Ly 0 to J U > °2 Z > rn rn ~V 0` N N N N w :3 _0 co 0) cn a) 0 o a d z co o m Q> u) m III C m~ C m 0) U) O C N N N N N N N C N C `r1V, +p C C O -O C O C E N L O F- O. N Q O N C C N C E C a) N o i° j F- Z v 00 • NO U U CO N f6 O 7 N E f9 V L. O 2 Y N O Z Y N O C!) O yam., = ~ a. E d E Cl sk o m a y a • m d d m a m rr~~ `~1 A QCL 0 U) v ONV J~ RIB IF0 STC - 104 AS BUILT SANITARY SYSTEM REPORT 49 OWNER *:/1/P/ CCl/2 /yaws/lam' ,U~rrr ADDRESS /ZS/~ r Clay S 1 SUBDIVISION / CSM#, [.q/ -P LOT , 7 SECTION / L T.il? N-R f -e9 W, Town of IY GJQf p/(/ ST. CROIX COUNTY, WISCONSIN WSHOW EVERYTHING 00 FEET OF SYSTEM btN~U~° 7,0 Sc~GE ! r3o ~ 5-XZ0 1-r 7 J f N TO 7-o f7 7 ,e we l s `'~/ZF wC !4 ,2 o~ r y,. Lax INDICATE NORTH ARROW I\ Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. K - BENCHMARK: TD/e C{ S' 1,0 Z-.,v Pe 4/ kg -p XPFC- /OO,p ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Gv,E7r_A5 Liquid Capacity:-/ ryo Setback from: Well _(_D House Other Pump: Manufacturer Model# Size Float seperation Gallon Alarm Location f SOIL ABSORPTION SYSTEM Width: Length 76 Number of trenches Distance & Direction to nearest prop. line: > ~o _ ~,/FST Setback from: well: > >s ' House 3 o Other ELEVATIONS Building Sewer. >ST Inlet. ST outlet PC inlet PC bottom Pump Off Z ,sb a Header/Manifold X39 3y- Bottom of system 3 go3I/ Existing Grade Final grade S- DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt W.` tonsinDepartment ofIndustry, PRIVATE SEWAGE SYSTEM County:__ L.-for-and human Relations INSPECTION REPORT Sr • CROJIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State Plan o.: RXIO fiSKI . TONY X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: i TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 166?, 0- - Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet J7 Vent TANKTO P/L WELL BLDG. AirIto ntake ROAD Dt Inlet Air Septic ) s Sa - NA Dt Bottom 1r, 0 1/ 1 q- 4 -2, Dosing NA Header / Man. g , p qy:3 R, Aeration NA Dist. Pipe a4, q4 % i i. yy' e. R 2 i Holding Bot. System 4: o°~ ac o. y' PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand xl~' Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Lengt►}, NoJf Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 9 DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of lkzo CHAMBER Mode Number: System. 50 -5 OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake -1 1 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 TxxE] Seeded /Sodded xx Mulched Bed / Trench Center Bed / Trench Edges Topsoil Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION : HUDSON-12- 29.20N I NE, SE. BRAND-ON DR v'J+- cv/ Plan revision required? ❑ Yes ff No r, Use other side for additional information. Q 30 SBD-6710 (R 05/91) Date I sp or's signature Cert. No. ADDITIONAL COMMENTS AND SKETCH y4 SANITARY PERMIT NUMBER: Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and buildings uivision (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268606 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: KURKOWSKI, TONY HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9600304 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer F olding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet rl 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 I LOSS Friction System TDH Ft TDH Lift Forcemain Length Dia. F f Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN I N SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Moe 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.12.29.20W, NE, SE, BRANDON DR 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 h SANITARY PERMIT NUMBER: t I SANITARY PERMIT APPLICATION BureaSafetyu o oand ff Bui BuiildinWater System: ing Water r 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size- • See reverse side for instructions for completing this application State Sanitary Permit Number C~A~ - O(p The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location !LC/ S 1/4 ;t= 1/4, S /Z T p, N, R 20 E (orol Propert Owner's Mailing Address Lot Number Block Number t r--~ City, St a Zip Code Phone Number Subdivision Name or cmtxri-- II. TYPE BUILDING: (check one) E] State Owned !t( Nearest Road age Public 1 or 2 Family Dwelling - No. of bedrooms S El Tow n OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo f,12to " /3/ 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 13E] Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. pl New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank OnlyExisting System Existing System B) A Sanitary Permit was previously issued. Permit Number ;Zjo'2 L13jrP Date Issued -jP4 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 ® Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14E] 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 ~r Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) -0 -2- 73:7 ` Elevation 3'" Ali APO b- . S W3 9s, S- "Feet ' Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Existing structed Tanks Tanks Septic Tank or Holding Tank Ta eve) / ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation orth nsite sewage system shown on the attached plans. Plum s Name: (Print) Plumber's Signature: tam /MPRSW No.: Business Phone Number: Plumbe ' Address (Street, Ci , State, Zi Code): IX. COUNTY/DE /DEPARTMENT USE ONLY ❑ Disapproved 4111c-it-1 "tdry Permit Fee (Includes Groundwater ate Issued Issuing A ent Signature (No mps), Surcharge Fee) Approved F1 Owner Given Initial .cAr Adve rse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS a , 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 a// 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 8 112 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 and establishment of standards. DAVE Foce Y PI umw4r2 Lkensed N T W && Plumber "M 03289 Road R48EF[fS,-VI SWWIN Phone 749.3656 , 7111-;; 1(,q JZ /-o 6<) S/rte f / k X Lnl Loy 41g X x x ss' 3 i ~`vr 8-~07 y/ LoT 7 ss i+cfzs ( f~bf L~ / " yo i 3~ d To/p or /rN%&:- F_ WOr qy<IUGb w SFYL/ loo. O ~ roati0 LoT ,Zoreiv~2 ~'s pF S,E E 93-7 PLo~ 3 yo.S~f'cAn/ ©A) DIVE FOGEMY PLUMBING LicensedPa Test PkwAw Road Fo=erty H ROBE V Phone 749- 5b a62 ,w yo X z ('9 X ApO / AE Sr x )e ys 31' r,E Z _ r 1f = ate, T o, or w.£r~`bcr/ 3 v SrLL l~~o rri Y 8o.~tNG O epra G>iI s r. ,//7 rr~ yF c~.,s~~; E EG r/ :/i z 93. 7 / 3 po^s 3 -37X 7a ' r/t`~ wc~~ S ~pr r^„ECC YrTJ C.rf cc /ir,rN ~srt►ti•~S ,,c~o~,P/t f"/~ ~o/?J a SE lk 'tit~d ~{1ifW~~~yfv ,?"3380;,. v 21 e^I'~ i I ti V fit d ~U 0 l i ~Y _ 'CC~-~ nJ ~ ill . r - _ ~ ~'`1 ~k~ ~ . _ c `'L it ~ ~y ~ i~ ? t;t ' ~ _ . _ f.. . i i _ ~ _ ~ I } Wisponsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page of 3 Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and -X! -3 7, percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # 6~-_o-/70 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 t Ct-ttcqsxx Govt. Lot NIdE7 114,51; 1/4,S /2 T > 7 N,R E (orb Property O ner's Mailing Address Lot # Block# Subd. Name or 66M# /-.71-/57 co~~ S%- L -Ad city State Zip Code Phone Number El City El Village [Z Town Nearest Road ❑ New Construction Use: Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement g Public or commercial - Describe: Code derived daily flow V5_0 gpd Recommended design loading rate bed, gpd/ft2_.~trench, gpd/ft2 Absorption area required bed, ft2 loy trench, ft2 Maximum design loading rate - bed, gpd/ft2 - S trench, gpd/ft2 Recommended infiltration surface elevation(s)%~. ffaS' 2 93 7 -*3 *,r ' ft (as referred to site plan benchmark) Additional design/site considerations /,.5- "L 4T tZ39/S TiC€A/c/r~FS * ('2 Parent material Flood plain elevation, if applicable 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 ❑ S ❑ U ❑ S r❑ U SOIL DESCRIPTION REPORT I Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 in. Munsell Clu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 13.7 z o -3 Z L I L r/ S c 0 ..a Ground 3 S_' y SiL S 3 c S iYl 3 elev. It. /o - S 4 SG 10L G Depth to limiting ; factor r in. Remarks: A- 3 rhUM) sEz c, DGfF Td T .~1Tivc3'~ - Boring # c O~ 3 z IVT,:53,X A17 FIZ G S -516 v rT ~N1 Z 9D•S"~ 3 71 7-5- U-E O l G - Ground ~j SG elev. ft. Depth to limiting factor in. Remarks: CST Name (Please Print) Signature Telephone No. 4'e' /-:1-? 74,50 ~ 7 -~"rX Address Date CST Number PROPERTY OWNER It 4/2 /t~ crJS~,~Z SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench n V FI 6,§ 3Nf Ground 3 3 ^ -T ~L /I 1S/ ~ .2 IV '5/3/< c s' S elev. Depth to 1-9 S- S e~/Z e G M L - .cal limiting factor - in. Remarks: Boring # L Ground G~ elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) NOIL33s 10 1p/139 3NL 10 3NIl LiYJ n I 3H1 OL 033N3tl313Y 3VV /ONINW34 • \ N + f~• IIFt(4 lI II ~r'~ O la i 0 ~ 1 1 N a:. ts• Z D _ r saljk 17WRI 1AlWtS 3 , S' ~ ~ r I ♦/13[ 3HL 10 01/13N Boa JO 3NIl Is" \ \ I ri Z ,ZZ•609 M.9£,ZI.ION ` W .00.0s grsix vi G ;R M (1) - ~i F N - r' \ z o $A 00 a my O 2 o u u r a b i~ O W N f y~~ uO ° r 1r repo O A N W O 0 im I fl If- -n A y . / ~ O Ill 10 C~ 'Q1 to ~to•w N N S O 1_YI , ,O►'[Yi 4%.9c.2yON m •p _ let ~ v o A D '1 ISIS. < I-I 0 y 0 :10 Sn r". s. ,m 1 u I -I n m 0 cn I ,=,1 ~ ~ I I ,►G't92 M.91,f0.20N ID ~ ~ ~ 0 ('7. --I to 61 ~ 8ti , ~ N g ~ 00-.r ,GL'91[ M.iI,G•,OON q : l`O \GG f4 ~ ~ ~ I IS D §K -Aa~ o 1 Ic•I c' s D, m o ~ ICJ O Q ,p o s. 7 ~ ~w 1U 0 [C) 60 9G'[.92 I $ dZ'ofLZ 3.ZO.e1.10S - m O P Q, z p P ~ w N135 3Hl 10 3NIl lfY3 f Q w 7.20,Y1,10[ v y N (n }y J f _ Icy ~:.o= 10 f :0 ~O N7 1-I 1-~ 1ir - A o O 1s' n SANITARY PERMIT APPLICATION Busafetyreau o oand ff BuilBuildiinateng Water-S ssi y ~ tems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. r / f 7 ' • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION 77 Property Owner Name .r If . , fir, ' Property Location 1/4 t 1/4, S ; T N, R , E (or Property Owner's Mailing Address Lot Number Block Number City, State f vr,F,f/ f"rid Zip Code.- l+j~ Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned El Cit Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms J' [a To wan of s`' F'``??r F'r III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ` fM1 r 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 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.~Z New 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 Number 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 j 120 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. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation Feet Feet 'i ;z VII. TANK Cag in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Manufacturer's Name Con- glass Plastic App New Existing Gallons Tanks Concrete strutted Steel Tanks Tanks Septic Tank or Holding Tank / > ~l❑ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of ',the onsite sewage system shown on the attached plans. Plumber's Name: (Print) r [f/ Plumbers Signattuu~re: (No S mps) ARP/MPRSW No.: Business Phone Number: Plumber's Address (Street City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanit Permit Fee (Includes Groundwater Date Issue Iss g Agent Signature (No Stamps) ~y Surcharge Fee) ,Approved ❑ Owner Given Initial Adverse Determination f 1 of X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:. r E 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 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, 608-266-3815. 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 E3 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 a// sepjc, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental p; oduct approval from DILHR- Vill. 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 or holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; strearns and 'akes,- pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the !ocation of _he 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 purnp manufact.Arer; 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 rihich can effect groundwater. The monies collected through th,c se surcharges are. ust d' for monitoring groundwater containinatior vestigations and establishment of standards. Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. . ; ,r, • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check`il revision to previous application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location 114 1/4, S r T ; N, R E (or)fW Property Owner's Mailing Address Lot Number Block Number City, State i.; a1 f ! Zip Code Phone Number Subdivision Name or CSM Number II. TYPE F UILDING: (check one) E] State Owned t Nearest Road p Village rr Public 1 or 2 Family Dwelling - No. of bedrooms Town of Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 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 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 appFicable) A) 1. 0 New 2. ❑ Replacement 3. ❑ Replacement of 4. E] Reconnection of 5. ❑ Repair of an -------System System Tank OnlyExisting 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 0 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 Feet Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App structed Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ Vill. 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) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): s F ~f IX. COUNTY/ DEPARTMENT USE ONLY " ❑ Disapproved Sanit Permit Fee (includes Groundwater Date Issue Issuigg Agent Signature (No Stamps) any f. Surcharge Fee) 4Approved ❑ Owner Given Initial Adverse Determination 11 L/ _1 X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: y 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 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, 608-266-3815. 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) for a number of regulated practices which can effect groundwater. 01 IU-T- The monies collected through these surcharges are used for rANifmrlg groundwater contamination investigations and establishment of standards. Job Number Name Date S v s V o~ H v o , l ~ o i x / '7 aC 2 kA v~ ° O L ti w 8 Q O W Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 12 x 11 inches in size. S7.' AP AnV~%,O 0 See reverse side for instructions for completing this application State Sanitary Permit Number Z/ff The information you provide may be used by other government agency programs ❑ Check iPrevision to prevIus application [Privacy Law, s. 15.04 (1) (m)I. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location / 11 6E { 114 1/4, S Z T~ , N, R E (o / 10 Property Owner's Math Address Lot Number Block Number t City, State 41"t M ~ j A1 Zip Coda Phone Number Subdivision Name or CSM Number I. YPE F B ILDING: (check one) ❑ State Owned 0 City Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms -1 Z Towan OF vF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 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 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 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 ❑ 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. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation ~l Feet Feet Capacity VII. TANK in galto Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of ;#e onsite sewage system shown on the attached plans. Me r's Name: (Print) Plumber's Signature: (No S ps) AMP MPRSW No.: Business Phone Number: Z t~ 60'e'd /X I. Plu er's Address (Street City, tate i Code): 2-3 IX. COU T / EPARTM T USE ONLY ❑ Disapproved SaniU&' Permit Fee (Includes Groundwater ate Issued ISSUID`Q Agent Signa re (No Stamps) ,,,,~Approved E] Owner Given Initial / O Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber L } INSTRUCTIONS e 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 lye applicable. 3_ All revisions to this perr it 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. Onsire sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumperwhenever_. necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your legal 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 8 112 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 and establishment of standards. M~ m ~ o M; 1~ ~E\ / x j o ~ 6 I i o n " a ~4 n ti 00 Wisconsinbepartment of Industry, SOIL AND SITE EVALUATION / Labor and Human Relations Page - of ' Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. i ? Attach complete site plan on paper not less than 8 1 /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. # 'WIN7rR TEST r~avs ~X s -1o --191-A FjP1vi-1 k ~ °I~-Lr APPLICANT INFORMATION - Please print all information. Reviewed Av- b I ~,,`,,Date . Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ Property Owner Pe vA,,f15 A9 TOA°.v ST•tD 4A.,P Property Location - r-11 z r/we AS A11 Q_ 5eA,1 Govt. Lot )OW 1 /4 SC 1 "S~01 .OwfN (or~ Property Owner's Mailing Address Lot # Block# Subd. Name or # 9a -7 !I/l//aw .kviDUE RP, 7 /MRTG/fl' ~ City State Zip Code Phone Number 7/Jr_ Nearest Road IfUPSoa wl~ 540110 (3pG )-9279 ❑ city ❑ Village Town ~pAti~o~ -Pk14 - ~ U f7So r`l New Construction Use: EE Re'sidential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: 11✓p- ti/ie ' NoT (ZEcpnn N . y Code derived daily flow loOG gpd Recommended design loading rate bed, gpd# trench, gpd/f12 Absorption area required bed, ft2 1X00 trench, ft2 Maximum design loading rate N/R bed, gpd/ft2 • trench, gpd/ft2 Recommended infiltration surface elevation(s) LS,-~ aoT E B&IO c7 ft (as referred to site plan benchmark) Additional design/site consi tions 4~r,N 7,ieF5041t15 .5^ ~X f0 " 44,:4- C. 4rooPl-ff •2 \ Parent material sus y9 S cuS its 01,o"p w f fN~.! 51 Flood plain elevation, if applicable Nl+ ft At S = Suitable for system Conventional 20's, MMound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system 2"S ❑ U ❑ U unl1s s❑ U 2s ❑ U ❑ S 2- ❑ S 0-0 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench O- G l d YR 2/3 104•4 If SA& cs 3 f 5 L - I /0K 3 f Q d ss a o 1 /D elev. ,c Ground r ff7./-ft 17 7 '3 /d yid yl~ •si~ Z,4* 64/C /„ie GW ~ l s, Depth to limiting 0 - fD /D l~ s O .5Dr-.5 factor 9;9 -in Remarks: Boring # -7 /0 YR Z/3 / fs,d~ ntir f e e S 3 f ~l , S L 2 7-1.-- Y 3 NNy X /7e~ cls CS /f ) •3 5k /W17~ie eft! /f Ci Ground /1 4VI C/ S elev. , s _ft. S ?//(,2- 70 V,4e S/ / s/✓I~ ~s G'~ Z/ to ~-P 7, 5 Y S/ n~tf e , s Depth to limiting factor in. Remarks: CST Name (Please Print) Signature 01 Telephone No. P ORI R r -24LGR i aT 7i5 - 3 06 - 8 1.6'S Address Date CST Number 1 tes 7 C:57-1t-1 1-H 9Z. Pflvate Sewage Consu tact S nur-u MA - - - - . - . . 6 SOIL DESCRIPTION REPORT PROPERTY OWNER Page? of PARCEL 1.D.# 4~T 7' ~7~L/r~117 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 r 0-3 lo yk y3 17 A- fe C~s 3 f hip: - 3 2- U- d' /0 be !Y13 X 7-- 5A /PM'6e Ground 3 144); elev. s512-3--ft- L Q f Y keg'- sit s , y 's Depth to limiting factor 04 _in. Q Remarks: Boring # I -S /o A"T9 C 5 J-F 3 Z -11- Io R A. i-f ccv rf- s 3 Al -37 /0 Si~ L,H, sLi,~ f R c f . S . ~o Ground f!/ ~'S L/ ; elev. 7 Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Boring # 0 _ (p p- Z/ 3 It l f , t, f C S ti • 3 2- 0 Y13 3 ~ D y~ Si, ~,sh,~ ~~~2 C~ 2 f ,S : Ground .2 7e,4 elev. ~jS•o ft. ' Depth to limiting factor " in. Remarks: Boring # d //ft . Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) T L.f TlAn mw wrm u.. mr. _ _ - _ _ CUl ,U~•Sh~ PT a M \ . ~S ~ nor o~ 1P SOT COIeN-P~ 5c4/5- 30 Lo-r O Ts ' r`90 f3 3 ~lEV,4r, ors B3 SS ~3 - t~ y s~ 7, s (3S S,So~.. k13, svss~-sr~ T~~,v svsT~•-r 133 ' 73 5 F J ULBRI°CHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants Re: Soil Test Sites, and Siting Your Home. To Owners/ Developers, Please be aware: All of the systems for lots #4,5,6,7,8 in Hartland Subdivision (tested under winter conditions March 11th & 12th, 1996) will require very large TRENCH TYPE conventional systems because of soil permiability restrictions.Conditions across other parts of each lot can/ and may require entirely different on-site treatment systems. Also, as required by state codes, an equally large replacement area has to be left intact UNDISTURBED with proper set-back distances to the well, other structures, etc. as deemed by code. Less space is required if the owner were to install a mound type system (i.e. no replacement area is required for mound type systems). Please understand, that in the process or procedure of selecting the actual homesite, if the owner will be using the soil test areas as provided and recorded by the seller/developer, the following is very critical: The installing plumber you select, or a registered designer or engineer should meticulously layout and plot the system as indicated from the soil report. And an equally large replacement area should be plotted out. Further information to be supplied by the owner is necessary in order to determine the actual exact size of the system. The final size of the system is dependent uponithe gals. of wasteflow to be generated from the proposed size of the home. The County Zoning Dept. must review the owners final house- plans`, only then can the installing plumber determine the final size of the proposed system. All of this has to be carefully addressed before a builder and owner can safely choose one's precise homesite. Often times the original soil test area, provided for subdivision approval by the seller as required by County Zoning Dept. ordinances, is not in an area prefered by the eventual buyer, or perhaps the size of the buyers home may require a larger test area. New or additional testing may be required, since a septic system by law has to be laid out exactly within the recorded spot tested; it cannot be shifted out of the area recorded with the zoning dept. Finally, it is our recommendation (and of most consciencous installers) that when soil permiability on a site is very slow (.5GPD/ft2 or lower) to install a presurized, dosed mound-type system. It is the concensus of most officals that mound systems will generally outlast in-ground conventional system (average life 10-15 years). This is a very important option to cautiously consider. Remember, the two most important systems you will be depending upon for many many years to come is your well and the quality of your senti evef-Am _ I --r f I all r r r f N l.E0,11 108 Yr]0 01 03"ANS11'il 1 r a f °N0110 /3 M3111 3N1 !O 3N11 15113 t} Y -I t r r'` " 3H1 ]01 033HIN34IN 3tltl SON1M1I3S 4 4 ~ \ O O O/~ff'. f, T ' J•~ c C:O'A yIF o z 2p I> 13~a.L ~ ~~vas \ /3 a ~ ►/1311 3H1 All ►/13N 3.LL 40 311I1 193M \ \ 1~ Z ,23,609 M.9£,ZI.ION . C) W `p 0o as to. il -1 .10 v or lei - j 2 2 M -j 11 --1 20 - r- ~y N - O'~~ O -n 'O -4 --i ~ ~ -n ao -i t en D 4? \ m = 01~ der \ mom ~o• g w p Z Nr~ g u p r4 Ir- m .p O N W O & im 1!~ 10 1-1 1*1 S M -j M P/ v ro r0 ° D < m 9~ z~ti Ir 8, t r-1` W N D Iowa w I It!. IlJ+ \ \ ,m ro IJ D M 0 _ Z I I ►S'1Si M.S1,i0.i0N IW0 I ~ n C 18z 1 1 Om I r --I~Z ,f1•e1c M.s1,er.ooN N j- Wt10t1 ir~i I ,4 S 1-0 Ni 3~ jsn IU 1!1 m Q ` V r- y~ r O 'I~w 1 J m 1 O Icy i \ ° I ICJ 10 O O o to _ 4 40 -n L 031 09E I I IZ'b£Z m 3.Z0,91.10S m Z A h o A - MI3S 711 10 3NIl 15113 ].iO,Y1,10i L 8 m N A 74 n♦ SCONVI 10 1U i:~o= f :0 :0 uy~ Fg~ Y O S fC-l0l SEPTIC TANK MAINTF,NANCF, AGREE NEWT St. Croix County OWNER/BUYER MAILING ADDRESS 3 .5- Co STS ✓~r n >1' PROPERTY ADDRESS -a ) 7 O9'-yy2 7 (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION /vim 1/4, 1/4, Section (,"I'N-R Zpo TOWN OF b4aJO 9q ST. CROIX COUNTY, WI _ SUBDIVISION 44 LOT NUMBER-7 CERTIFIED SURVEY MAP ^ U , VOLUME " PAGE o o , LOT NUMBERY 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which vas 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 licensed pumper verifying that (1) the on-site wastewater disposal systern 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. I[We, 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 y ~ar expiration date. ~ r SIGNI-D: St. Croix County Zoning Office Government Center 1101 Cann ichael road Hudson, WI 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. '4 Km""y 1'. A )14:~A4L Owner of property Location of property,,,0~1/4~_1 4, Section/> T,2Z_N-R.2e W TownshipMailing address ! y$- i ~ r t,-.o 1144 Address of site -~277 /k subdivision name /7"t Lot no.-Z Other homes on property? Yes L--' No Previous owner of property Total size of property qO Total size of parcel 3-:F-- Date parcel was created f1k Are all corners and lot lines identifiable? 1ZYes No Is this property being developed for (spec house) ? Yes No Volume M2 L and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 57q3 t-I.LS , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. AS-Vtl gn re of Applicant Co-Applicant Date of Signature Date of Signature WARRANTY DEED Document Number p _ YC?_ 11 7 f PAGE 85' 'r 0 01- 543428 4 0.L 'Il o, kieC'G !C. 'a~,i Return Address _ MAY 8 1996 11:30 A.M 77 l ra0~ Parcel I.D. Number d =-20 B & N Land Development, a Wisconsin Limited Liability Company, conveys and warrants to Anthony P. Kurkowski and Tracy L. Kurkowski, husband and wife, the following described real estate in St. Croix County, State of Wisconsin: Lot 7, Plat of Hartland in Town of Hudson, St. Croix County, Wisconsin. This is not homestead property. TRAN$~IER Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this ?jp day of April, 1996. B & N Land Development, a Wisconsin Limited Liability ny 12,-- oz~~~ (SEAL) (SEAL) Dennis M. B' d Thomas K. Nielsen AUTHENTICATION Signature(s) Dennis M. Bjornstad and Thomas K. Nielsen authenticated this 30 Q"~ day of April, 1996. Kristina Og d TITLE: MEMBER STATE BAR OF WISCONSIN THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54016 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Vhf ceY~~Lc~ MAILING ADDRESS e9 ' ~ - , - PROPERTY ADDRESS 77 /1 AAly- W DR / , W"~~+{ (location of septic system) Please obtain from the Planning Dept. CITY/STATE GyL SyO / 6 PROPERTY LOCATION AIR 1/4, 1/4, Section T_,2_f_N-R12_W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER --Z - CERTIFIED SURVEY MAP oq VOLUME~, PAGE A G , LOT NUMBER_~ 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% 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 licensed pumper 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. I/We, 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 ye r xpiration - Pte., J ~l' v~ SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 4 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 Location of property&Cl/4 S-1/4, Section /_.I.T_2f N-R 2d W Township Zl-"Jo l Mailing address -x;46 s`' -2 ll 626-* !u4l' ' Y®/;~ Address of site 277 1444AIPom PA. &A'22i, cut K `W Subdivision name ~cfftRl-L,~,y~) Lot no. ] Other homes on property? Yes___,.,- No Previous owner of property Total size of property c~ c2,~s Total size of parcel /,-,¢r/zcs Date parcel was created (9p6 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes __k~ No Volume //77 and Page Number_ as recorded with the Register of Deeds. 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. ,sy3 y1~' 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. 57 y3 y~8 JLA~ " , '-a--1 Signat e of Applicant Co-Applicant "7 gj~ Date of Signature Date of Signature