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006-1027-95-100
St. Croix County Zoning Thursday, September 23, 2004 at 11:46 :23 AM Detail Sanitary Information Page I of l Computer #: 006 - 1027 -95 -100 Sub /Plat: NA Section: 13 Parcel #: 13.31.16.188B Lot: 1 TNIRNG: T31N R16W Municipality: Cylon Township CSM: Vol. 18 Pg. 4653 1/4 1/4: SW 1/4 NW 1/4 Owner: Waldschmidt, Richard 2161 250th St New Richmond, WI 54017 State Permit: 430551 Issued: 11/17/2003 POWTS Dispersal: Mound Permit: Replacement County Permit: 0 Installed: 09/23/2004 POWTS Detail: Bed Bedrooms: 2 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Pam Quinn NA Gille, Dennis 9/23/04 - Revised state plan based on new soil $0.00 Signed Off: Yes report was not given to zoning until system installation. Installed in new location per approved state plan. building new house on an existing property. Will not be replacing vault privy to existing house. Will house and old privy be abandoned? Be sure to check- can't have 2 dwellings since this has now been made a 2.71 acres Lot 1 of CSM #746900 and remaining 37.29 acres sold to someone else. Renovating old cabin and privy Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 9/23/2007 — — — — — — — — — — — — — — Owner: Waldschmidt, Richard 2161 250th St New Richmond, WI 54017 State Permit: 249750 Issued: 10/13/1995 POWTS Dispersal: Non - plumbing Sanitation Permit: New County Permit: 0 Installed: 10/13/1995 POWTS Detail: Vault Privy Bedrooms: 1 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Mary Jenkins NA Unknown inspection report was never signed - appeared no $0.00 Signed Off: No inspection took place. The signed state application indicated a 200 gallon vault privy would be installed by the owner for a small cabin on their 40 acre property. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: S t. Croix Safety and Ifuildins division INSPECTION REPORT Sanitary Permit No: 430551 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Waldschmidt, Richard C Ion Township ' -016- 1927-55- -1 CST BM Elev: I Insp. BM Elev: BM Description: ction/Town /Ra a /Map No: n0, p /60. 0 13.31.16.188 TANK INFORMATION ELEVATION DATA tr TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Cam ' Benchmark n, S ' 3 /d Dosing � �� 6kL `D Aeration - /00 / Ida. -Sewer - i N Holding St/Ht Inlet StNK-Outlet TANK SETBACK INFORMATION h 1 2 �o Gl - 0 7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet �•-� Septic I> z ( Dt Bottom q �, t L Dosing �a Q r� Heade /Man „ I 'T /hOAfStk ..E S y / O Q Aeration D ist. Pipe , Holding Bot. System h=is 10 Final Grade PUMP /SIPHON INFORMATION — Manufacturer Demand St Cover GPM 3 1 `5 Model Number i o 3.18 TDH Lift Fria* Loss System Head TDH Ft D 23 L Z:5 ( Fore �i� Le tth /4 _ Dia. Dist. to II a V a SOIL ABSORPTION SYSTEM �3 BED/TRENCH Width Length No. Of Trenches PIT DIMENS10 No. Of Pits Inside Dig. Liquid Depth DIMENSIONS O SETBACK SYSTEM TO PILVJ JBLDG WEL LAKE /STREAM ACHING Manufacturer: INFORMATION CHA Type Of system: - \ ��, \ - , I Model Number: DISTRIBUTION SYSTEM ,/ �(/ Header /Manifold IDistribution x Hole Size 3 x Hole Spacing Ve Intake Pipe(s) r / �� / �i / Lengthj5_ Dia > Length D / • J Spa cin g I ITT /(0 2 SOIL COVER W Pressure Systems Only xx Mound Or At -Grade Systems Only rt k' L et- Depth Over y L133 h Over xx Depth of xx Seeded /Sodded xx u c e Bed/Trench Center ' "I 4 f Tren h d es� Topsoil S ]Yes I No q Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / 2�/ Inspection #2: 1 / / 2 •'7 / c,� n Location: 2161 250th St New Richmond, WI 54017 (SW 1/4 NW 1/4 13 T31 R1 6W) "^ _ /� �m _ Parcel No: 13.31.16. 1.) Alt BM Description = C -a I- 2.) Bldg sewer length = I z — P - wv - & - amount of cover = 3V a Sr 3.) Contour =C1 C) Z 3 _ / Plan revision Required? „� es � � No Use other side for additional information. ___ Al Date l) Ins�ep S�i��natu�e / Cert. No. SBD -6710 (R.3/97) jPWYUj4 09/22/2003 ](ON 09:42 FAX 715 485 9246 POLK COUNTY IM 002 ' Safety and BulldiM Division cbuwlv 201 w_ 'Washington Ave., P.O..Bok 7082 � C r � f x on Madison. WI 53707 - 7082' Site Address Dapartment.of Commerce aWtary a nary Permit Application � 5 � f 3o Number 55 In aeeard with Comet 88.21, Wis- Adm. Code, ptxsuval ❑ .Cbeck if Revision tagy be used f+or M2 PrPWY IA . sty I. A pplication Inroratation - -pkase $xint All Information State Plan im. Number Pc ;Clwner a Nam Pen:et x nunbcr i ,. S _ ��6 - �oZ Prop" 0woor'sMailing Addr+ets 2.i' �i,L, ZONING OFFIC �C E prO p°o ,�6 S �P� 2_ VJ r tv 'A N W 34.S T3 N I B City. Stm • Zip Codc Phone NuajW lot Num Block Nuudw �/ Subdir' ' n Nam n CSM 1 d1Ub" K `-e ✓� / S '7 Z —� /��p Ot C/tR PAC II. Tna of Bedding (Check alt that appLP.) -- ❑ 1 or 2 Fatuity Dwcliing - Number of Bedrooms ❑Village O Publi XommoreW - Dw4r be US � e )KTowmb" dA M swc owned (.tv '- , rt Nearest Road %, I>tI. 7`ype or Permit: (Check only one lox on line A. Numbering is for hd4raill use.) (Ca nplete line H If applic2hle. 3 ❑ ]teplacenoent of 6 O Atid dw to For 'eunt Rcplaccttw� 5 m Tank Only Bxisti S Stem y vane B. ❑ Permit Number �3 Q Datc bsued IV. Type of poor System: (Check all tryst apply. . Numbedug is rar Internal use.) 44 ❑ Non - Pressu+aod In-Grauml 214 Mound 47 ❑ Sand Filter; 5o O Consirumd Wedgmd 22 ❑ Pressurized hi-Ground 41 Holding Tank 48 O Siugie P 51 ❑ Drip Line t 45 11 At -Grade 46 ❑Aerobia 1`re.sa�t Unit 49 O lteckadatW 3U Uther / s ated V. Dis reatmeut Area luformstion: Design Flow (Wd) Dispersal Arca Dispersal Arcs Soil A ppliati6 a Per¢ola ion Rate System Plevation T "rod Proposed ltam(GalS.MayslSq -Ft) (MhLll Th) o a W 3Q d , o VI. Tank Info Capacity in Total Number M�an�ufa�s;uuer Frcfab Sire Fbi er C Gttlhorn Gallons of "Tanks . r G� Concrete Construntnd New Rddq tt Tanks Tanks }olquiTank V•II. Respoodbility Statement- L the undersigned. assume reypuacibluly for r the PC WT5 shown on the atcaclted PL- Piutnbtr's Name (Print) P `s Sigrp tuber Business Pbo� Plumber , a, 114 Plumlrcr'a Addrftx (SUM. City. State. Zip Code) VIII. C me tuent Use Onl Dlsapprovcd Mary Permit Fee Ludes Groundwater pare Usubd Agent StgnaUm (A t Stamps) Approved O owner G iven lrutiai Advccse guranarge Pee) 350 -- �U. a T ZGU.� Determitgtion l L ConMons of ApprovaMovorW far bisupproval '$ pQrNn . t / SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced 1 maintained as per management plan provided by plumber. J 9 - All must be maintai g as per applicableAE'i !! ll ° taw Cit s ty) for sy rn on papa Nd lass m i x !e KIM ` • 23 a y Sam � Sf� -� ��� `� I Sd ' ry SBD --639$ (R. 051 01) Safety and Buildings commerce.wi. OV 4003 N KINNEY COULEE RD g LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commerce.state.wi.us /sb til epartment of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary August 11, 2004 CUST ID No.221471 A7TN: POWTS Inspector DENNIS J GILLE ZONING OFFICE GILLE TRUCKING & EXCAVATING, INC. ST CROIX COUNTY SPIA 352 140TH ST 1101 CARMICHAEL RD AMERY WI 54001 -2840 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/11/2006 Identification Numbers Transaction ID No. 1026757 SITE: Site ID No. 667354 Rick Waldschmidt Please refer to both identification numbers, 250TH St above, in all correspondence with the agenc Town of Cylon, St Croix County SW 1/4, NW 1/4, S13, T31N, R16W FOR: Description: Two Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 971952 Maintenance required; 300 GPD Flow rate; 25 in Soil minimum depth to Iimiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01101); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. Condh No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, FLA stats. APPF% The following conditions shall be met during construction or installation and prior to occupancy or use: DEPARTMENT OF Ff. General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORRE "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /O1) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST (0 1/8 1) • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat DENNIS J GILLE Page 2 8/11/2004 • Comm 83.22(7) 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. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of cons truction/installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 "'Z Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART'code: 7633 (608)789-7893, 7:45 am - 4:30 pm Monday - Friday cbratz @commerce. state. wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 C F/ MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGW * GQ Commercial Application //�� INDEX AND TITLE PAGE O Vs O �� Project Name: RICK WALDSCHMIDT Owner's Name: RICK WALDSCHMIDT Owner's Address: 2161 250 TH CLEAR LAKE WI. 54405 Legal Description: SW NW S 13 T 31 NR 16 W Township: CYLON County: ST. CROIX Subdivision Name: VOL. 18 PG. 4653 Lot Number: 1 Block Number: Parcel I.D. Number: 006 - 1027 - 95 - 0000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank 1 0,0 1 7jf Y Page 5 System maintenance specifications Page 6 Management and contingency plan' Page a and specifications Y c ��A1 o arNCs 'PONDt;N Designer: DENNIS GILLE License Number: 221471 Date: 07/24/04 Phone Number: 715- 268 -6637 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.11 (R. 06/01) Pagel of 7 Mound and Pressure Distribution Comp onent Design Design Worksheet Site Information (r or c) r. Residential or Commercial Design Note: Sand fill (D) caiculations assume a 200,00 Estimated Wastewater Flow (gpd) cable 83.44 -3 In -situ coif treatment for fecal 1.50 Peaking Factor (e.g. 1.5 : 150 %) collform of <-;,36 inches. 300.00 Design Flow (gpd) 00 Site Slope ( %) ol Contour Line Elevation (ft) 23. Depth to Limiting Factor (in) 0.60 In -situ Boll Application Rate (gpd /ff) Distribution Cell Information 60.00 Dispersal Cell Length Along Contour (ft) = [ 5. 0 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /fe) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disributioln Information network? Enter Y or N (c Center or End Manifold 1.2 teral Spacing (ft) if N above, enter the elevation (ft) d Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e -g. 0,25) 2.00 Estimated Orifice Spacing (ft) = 5,00 ft/orifice 100 Forcemain Diameter (in) 80.00 Forcemaln Length (ft) Does the forcemain drain back? Y 93.00 pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 13.05 F=orcemain Drainback (gal) Vertical Lift (ft) 55.51 tix Void Volume (gal) 2.56 Friction Loss (ft) 68.56 Minimum Dose Volume (gal) Total Dynamic Head (ft) 39.32 :system Demand (gpm) Lateral Dim ter Selection Manifold D iamet er Selection in. dia options choice in. dia, options choice 0.75 1.25 x 1.00 1.50 x X 1.25 x 2.00 x 1.50 x x E 3.00 2.00 x 3.00 x Gallonslinch Calculator (optional) Treatment Tank Information 627.00 Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) 42.00 Total Working Liquid Depth (in) HUFFCUTT IManufacturer 14.93 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 627.00 Dose Tank Capacity (gal) JZabel Filter Manufacturer 14.93 Dose Tank Volume (galtin) A100 Filter Model Number MUFFCUTT Manufacturer Proiect: Rage 2 of 7 Mound Plan View 1i ...... C3bservabon Pipe 3[] K. 1. L.L••, '� 1• LY1•L• ' r•AYr ,r AY r.r•rY '1. "'S. t L S•'L� °• rd� •f•r °r r.rwr�.•wr. '.f::w: ' s s.r, AYA - r •rwr.••Y,.. . 5 { " t•h•'4 'tY$ S.L�� S•h•t• .� Y•L• S.SYb ,•ti•tiw•Y••4•Y.•L.rr'r ;rAYr.r,: .rY1rr•r.r.rYr,.w ."- •� r•r- W • -'� . � •r•r•r'r•r,'�•r•r ?r•r.r: }YY••A� S �` A' ti•'e•'••1.•"L.'L.wm...•.,.w,i.y . �.�,. A 1%N1 a t.r ;r; rYr.r r.A.r.r., .rYs. ' $, . .L:1. T L Mound Component Dimensions A 5.00 ft E 14.00 in H 1.00 ft K 8.50 ft 8 60.00 ft F 9.50 in Z 8.68 ft L 77.00 ft © 11.00 in G 0,50 ft J 5.76 ft W 19.44 ft 300.00 (ft) Dispersal Cell Area 820.59 (ft) Basal Area Available 5.00 (gpd /ft) Linear Loading Rite 6.00 (ft) 1/10 B Obs. Pipe Placement Mound ClrOSS Section View Aggregate Dispersal Area Finished Grade 102.81 (ft) —• - ---�.. H v`" rrfrrrr,� z r�rrrrr . G .: (ft) --•► F biapersel cell 401 52 Lateral Dispersal Cell _ 3 Invert Elevation E p q 4 _ 5.0 9r Site Slope - U*. 0 - (ft) Contour Elevation Geotextile Fabric Cover Shading Key Dispersal Cell r See lateral details on = Topsoil Cap 1.5 fit .. Pa and 4 for number, size, rrJ!"r .� g Subsoil Ca 0 5�,�a�,,L �.�•:•• spacing of laterals. C33 Sand :.�.�f: ?` •�• r x r d p ASTM + r r. r �,•��. � z"''�`' "' �'` "-'`'�':~ %:: �� F Laterals are equally Tilled Layer 0.5 ft Typical l ateraI spaced from the yYLYti ti Aggregate r � N ti•'• °� `liwtivhvl. • aYr•r- f Lit ►iL?41i 1Y " •r • r ' � „ �� . o r r.Y••r•r...r.r•A3;r�r 5�" distribution cell's _ A centerline in the distribution cell (AxB). Project. Page 3 of 7 Center Colnnoction Lateral Layout Dalgram F=orce main connection via tee or crpgg to manifold at ang point. Laterals ary idwntic al p S •T Turn -up %Wball Valve or IE X----.)J102 gr2 ++ Laterals & Force main of PVC Sch 40 ml eanoutpl u g Per COMM Table 84.30 -6 HQies drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0. in Lateral Diameter in Orifice Spacing (X) Lateral Length (P) ft orifices per Lateral Lateral Spacing (S) �. 5 tz?6 ft Orifice Density 370 ff /orifice Lateral Flow Rate 9.83 gpm Manifold Length . 5 ft System Flow Rate 39.32 gpm Manifold D 9.50 . Total Dynamic Head i:°.S k4-57k4 ft 1~orcemain Velocity 4.02 ft/sec Do Tank Information Locking cover with warning label and locking device and Seated watertight L Electrical as per NEC 300 and ---- -0- Comm 16.28 WAC 4 In. min. Disconnect """`����ii--- Tank component is properly vented Alternate outlet 1000tion F Forcemain diameter HUFFCUTT Manufacturer 2 in. Cap aeft - il 527.00 Gallons Volume 14.93 gal /inch A Weep hole or anti- Dimension Inches Gallons B elphon device A 26.40 394.11 C 8 2.00 29.86 P ump off elevation (ft) C 4.60 68.66 83.75 D 9.00 134.37 Total 42.00 627.00 D Do se tank elevatlon (ft) 3" Bedding uncTer tank. 1 93.00 Alarm Manuafacturer ILEVEL AEARM Alarm Model Number I DVL Pump Manufacturer 2OELLER Pump Model Number 1140 Pump Must Deliver 39.32 gpm at 1 1;" ft TDH Project: Page 4 of 7 Mound System Maintenance and Operation Specifications Service Provider's Name DENNIS GILLE I Phone 268 -6637 POWTS Regulator's Name ST. CROIX CTY. ZONING J Phone 715- 386 -4680 System Flow and Load Parameters Design Flow - Peak 300 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 200 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 300 fl? Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Moundi Inspect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Tum -up Detail Finished •.......����s• Grade 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: RICK WALDSCHMIDT Page 5 of 7 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code Ge neral This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. if the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance Is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg /L BOD 30 mg/L TSS, 10 mg/L FOG, and 10" cfu1100 mL for highly treated effluent. Influent flow may not exceed maximum design flow speed in the permit for this installation, The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice dogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: RICK WALDSCHMIDT Page 6 of 7 TOUL DYM-wic w n-Din-mA A " Be • PUMPI PERFORMANCY GUAW PER mliquTE MODEL'WIW40 L-PFLIJEWAND M"WAfMiWi MUNI A Wit of$ ow. 1.6 73 Va 2BIJ 40 % 1 lip. - L I N go do lob 20 , in 20- ..... .... — tz tr1JE �.�. .10 20 80 Ab to ifU . 10 Ila Ila MEN r 0 W IUD T1 Pl.t1w P O [AkUT9 Uammua cONSULT FACTORY FOR VrzCIAL APPIM-MONS .... . .... .. Elantrical 4ilh-3matorg, for duplux sygteme, are avaeble wtd suptillud with an alaart. • MBohariltal ti& mators, fat duploix syster are -V911tible W111 or viliflaut alarms, contral darm By8term Eire avall'sible rlPhasepui Tttrs -. in See 14A0732, V l control g Wit u l le s as aVMIlLIbIa for contruillfig 6111glU lAintas t3yolemi;. • Double plugykLck VaTtable lev fi w ciat sw1him, are available for WrIfIblo 1001 VA lung Cycle contruls, Smiled Qw1k.8ax uvallablu for autduar 111stalfg1lons. See 5W 420. • hurter to FM0806 for "llipiluatlans above 881_8arlohl GUIDE -jgle plij ick va 1001 float ewl Or I.. Fur mtornpAtk j�a sil . gybt ul, r4wfar to rmuc"t w. UAW MODELS double piggyback vaftbla IMI fluattffil parjol, r curratil roadel of SiNIPW Out Mad O d a ( Volts-Pi Bode Amps SIMPIOX _r I see Fmi Tag f(I duplex 00 IIWE !Fl N4140 Mott 3 1:1V10 im 00tract aludw of Nutt 6.0 3 y . r-, 1 4.0 V 414 U d "0 (111(1 W11thij 011061d 60 ( W l oli ; stlatillibufulluviad 1110tid14 a thu tAlIM 'autIft Iguailififtak. 111i uttleMuLd Quit unruly kwliug ttroly ailtj 14001h Ila (0. Aklkj� .0 _11fiflid 0.1uttlyll; todu ifffic)IIII(I t1lb0abulwilullal e Irudiffill 10 *61riple lAggy1nick owltoh Included. Vlt� POWERED 00,1'011 rar unusual carwIltiorw to reserve safety twor Is stiginatited Info the 110:111an of every zoeller purrip, . ...... .. . . . . . ........... . ......... . ...... fij;tjtm- Pc. BOX 1054? 1. Xy 400-Ody MWIT). WU6 Louiotiftla. XV 492 190' BMW y i fonp) 828-PUIAP PAX (021 714..3t?14 . ...... . ...... ....... . P . yy . I 2tjfj� zuollue 00, All flahte rumej vird. .......... . ell .... .. ... .. . .4 L16L Y r . ... 1. �- � -` � . ... _�.. . i, ,_ ..�,..,, , . 1. , � i' { f.. i +_ � i , . +,. ! � I' a ' 1 14/141 7iv I T �' i. I� � • r E� '. I, � 1 j i s 1 �� �� i .............. ok-� 07/0 05 °15 7152483588 SUPERIOR AUTOMOTIVE PAGE 04 ........aay in part of the S OVt-�Y 'IF MAC' 11 /18/2083 Township 31 N gcfthwast tq,+arter of the II 1 Q:38An North, Range N . IV West, Tarrn of C e 5 h est o Qu of Section 13. CERTrFIED SLjitvEY MAA y. Wlscons ►n. r REC rEE . 13.00 Prepared for and at the request of: copy Fi~E: 3. Q0 A1 Street PAGfs "Si WI 54007 NOTE; The Pa c c Deer Work. Drafted b y- f lotrard M. Township lass °n #leer map it rub,� t to State County and M�rrlld Ni to pat -ew. eta.). Before purt�ta[ng 'or 1k weflandy minimum lot epee. occese Cxo►x Caur,ty Zoning Offfca unit ties o aN g any Partial, tiontact the St. PProprlate TorrfY Board far advi Navlmwsr caw*R 1j-.Y1 uectivn. Comer Mcnumsrtt (I 2 mw PAOE or Reoord 4 our or Set I" x 18" Iron pipe wefghFn Q' figlm 5�1'A'E x - .... .. t.t 3 pounds per linear foot g d t7k'�Y1! 71E5J - - Iundingg Setback Una 100' fram Right --of —,soy) A Denotes Wetland No1E: plow SHOWN pERMIT7ED UN l)1jz. PPjVY IN STALLATioN 3J ENT, DpCtJMENTJ 04111177 IN M)L.UME 1144 PACE 200, I UNP4A T ECH LANDS' OF� C7b1!/V R 1� •� I `L A 'L N89'5W25" 432.57 3.�. .21' r 155.36' _, I� ' y� - LOT. I I CA IQI& AfILA, I� 1 1 1 - 11 18.2 1i � SQ. FT l 2.71 CRES ` ' " I� ., 10 .1 T. IN I N l 4 2. 1 CaES R, OCUMENT I w IC tIN1= ' M � 0° pNSMI UMr 579 „ I �Q l 33. 0` oe7d 35 399.57' N89 "58'25 "E 43257' { x UNPLA MED LANDS OF OWNER i I+` A special exception ure permit la required for the disturbance of slopes I 20A or greater riot Identified on the approved plot or CSM.. This permit • Is applied for through the xanlnq office and 1r reviewed through a public hearing process by the St. Croix County Board of Adjustm�rtt. � "'""^—•- �e�tit��utrururp APPRO i , -' 0'r. CROIX CO U N �,�.��` I o IWSr 114 frO WETt Sm 13 - 31 ►�tanrting xwtinp rend Facets Corrimii ,� * .•' rY R. ' it (Srr 1' O?av AW BY NOV 18 1`003 °R�o PRQPWnOVA IF AOrA SURC) a 8.24ti4 t , r -- -.SLR' 77E S1�A'Er �'s CLEAR LAKI�, Q' it not teGOrQaO wiinfn 3t7 days of •. ►..•Y ..• �• i approval dafs approval shall be r� f"PN O' NO TH•1 bSUFiW 77�i1ES7' L'UiR1NtER 8 — 'j - 3neROO�'!`�r Arf» 13-- JI--18 Rt�sr►> - as -aJ, ffOUND ,ALUM CO. NGIN.) Rr'"w •.q - o3� � J08 Y41057SU1 too Prepared hr. . Wisconsin Department of commerce SOIL EVALUATION REPORT Page f of L ) Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County 't / G �(�'► Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal refe parcel I.D. percent slope, scale or dimensions, north arrow, and ocatiolE MW F" rest d. (�, - .. g $ -0000 Please print all i r a " n. a tie ate d/O Personal information you provide may I used fors s (riva t rqv, (1) ( ). _ G(i`wt Property Owner Property Lo lion i ( -} , t�bil. Lot W 114 A)W14 S ► T 31 N R 16 E (or U;- Property Owner's Mailing Address m � do # Subd. Name or CSM# a5ci 11 1 JoI - 1 N . yes City State Zip Code Phone Number ❑ City ❑ Village E4 Town Y4earest Road CICAY 4ke. L-tt I SY005 H 715 ).722 -51Y6 C !J) ❑ New Construction Use: ES Residential /Number of bedrooms oil Code derived design flow rate 3 D Q GPD Replacement ❑ Public or commercial - Describe: Parent material I ne-ile. C U d v I Flood Plain elevation if applicable ft. General comments and recommendations: 5 "s �j S� al. lilC 75 0 +� ► — Sc Q�I /D O , / p F—t Boring # E] Boring A 59 pit Ground surface elev. - 1 c D. r3L ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EfT#2 I D- (a A 3 )` S' L S� K M F vr A W Q to G -5 ►b -tRsl S: L aF56k vAPr c•&2 1 104 , t 3 13 -143 0 Pqq S , L FS k F w 1-0 .� a s 3) S y Q yJ �J C S L � k rr� i w _ Boring # Boring c l I ® Pit Ground surface elev. J ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I 'Eff#2 ' -S o s : L aF-�h Mf r a w olm , s v I vY S L aF Sbk r ti 'Fw . 'R JvF 9 -as 6�P- y 5 L I F6bs-t. "F; Cw IMF - y .7 2154 D s R.y Y F 1 F 7.5 %1A s L Q- r' A ►v<,i F. _ a * Effluent #1 = BOD > 30 220 mg /L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L s � T Name (Please Print) Signa CST Number 4--o n YJ A Z :5+,-#- ,r12 Address ;L ©„ r k -54 Date Evaluation Conducted Telephone Number 44 q O 71 6 - qS Property Owner S&. M i dX + Parcel ID # Page of _ Y ❑ q,� 3 4 F-31 Boring # Boring pit Ground surface elev. / D •, ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I2 / sf ---� -- 5: L A FSbtiL rnr-v- Cw Fj , ra eZ- 7.S'�R /L --� ''` L) a sk Ir" Ge✓✓ ! vF Y /i-;l SIO L i F 5 6te, qtr; CVV .7 F Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Boring (� pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 - 4 - * Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mgA- * Effluent #2 = BOD 5 30 mg/- and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 /00) Seta. 13, T3 N A14 � 3995 7' n • 3 , ' �9�.r'�' f' �'►t�i(` � a No.s - up •D lob.Da �tec,re"c e -#- �. IOZ X11 Pl' , v y --- -v-- -, 99• aS �Vo tl f3 98 .3b ao VI rb t N \ O n LO C'b s�o <:( «r � U=HTIFIED SURVEY MAP 11/18/2003 10:30AK Located in part of the Southwest Quarter of the Northwest Quarter of Section 13, CERTIFIED SURVEY NAP Township 31 North, Range 16 West, Town of Cylon, St. Croix County, Wisconsin. COPY OPY F E. • 13.00 . FEE. 3.00 PAGES: 2 Prepared for and at the request of: Undo llnda Hilton P A s e. `� V ton I` i' 2161 th Street Deer Park. NOTE: The parcel shown on this map is subject to State, Count and k, WI 54007 Township Iowa, rules and regulations (i.e. wetlands, minimum lot size, access Drafted by. Howard H. Herrild III to parcel, etc.). Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and the appropriate Town Board for advice. I FGENn: NAR7HNEST CQRN£R SEC. 13 -31 -16 Section Comer Monument (FOUND 2" /RAN PIPE of Record APPED OUT OIF' • Set 1" x 18" Iron Pipe weighing Z POSY770N, SET 3/8" x 1.13 pounds per linear foof o 8" / RAN SP/KE ....... • ... Building Setback Line o ci FRAM RES) (100' from Right —of —way) uwi JL Denotes Wetland g NOTE: PRIVY SHOWN PERMITTED UNDER PRIVY INSTALLATION AGREEMENT, DOCUMENT# 534977 IN VOLUME 1144 PAGE 260. UNPLA TTED LANDS OF OWNER I ------------------ o _w, I� AL `! I JIL '�`N89'58'25 "E 432.57' h Z I - N ICI c 33.QQ' j .21' \ 155.38' I� C3 Z I�_� LOT 1 h I 1 (A 1 0 c 9 TOTAL AREA: w _ ts i it` I I a 1 � 118,211 SQ. FT = w (� I cA 2.71 ACRES ly iv I� I AREA EX. R_O_W_• m I(O w I� I v 109,193 SQ. FT. �� v I N I w I 2.51 ACRES ��� MENT 1 O I� I� oNO . EA S EMENT OOCU N I� I� I I~ D = �AN'MISLUME 57 A W PAGE 267 cn m IlJ w 33. 0' 35p870 399.57• N89'S8'25 "E 432.57' a I z3 UNPLA TTED LANDS OF OWNER w (� A special exception use permit is required for the disturbance of slopes 20X or greater not identified on the approved plat or CSM. This permit a is applied for through the zoning office and Is reviewed through a public I hearing process by the St. Croix County rd of Adjustment. N MI RO Y 1111UIIpi1QN ///jy�' °D NEST 1 /4 C04N£R ST. CROIX COON ` `����� �yr,SC - t4S g y a Parks s Commitie ��� Plannin Zorurl , w SEC 13 -31 -16 (SLAT 1" /RAN PIPE BY NOV 1 II 2003' �Q�a:�,.�� Z PRC PAR77AVA 7E MEASURE) o —SLR£ AE SHEET __ S•2484 s CLEA LAKE, iw d If not recorded witnin 30 days of approval date approval shall be I mo,, �, OQ►� rn l! r.nrl �niQ NO TH ' ".y (FOUND ALUM CO. MQN.) Re��s•a JOB W1057SU139 _ Prepared by: 100 o 100 GENERAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR01 REAL ESTATE TOWN OF CYLON COMPUTER NUMBER 006 - 1027 -95 -100 Parcel Number 13.31.16.188B Claimed Date Re- certified 04/17/2001 Relate Number: OWNER NAME: F' LINDA HILTON Last WALDSCHMIDT CO- ER Mailing Ad ress 2161 250TH ST City EER PARK tate WI Zip 54007 - Type Vol Pag Rec.Date Type Vol Page Doc # Rec.Date HISTORY EZ -U 2469/ 471 748443 12/05/2003 WD 1397/ 307 596134 01/20/1999 PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name- Type SD Apartment Post Office 250TH ST School District: 1127 - CLEAR LAKE Special District: (1) 1700 - (2) - (3) - W ITC Plat Code: Last Changed on: 04/14/2004 Book Number: 1 SECTION 13 TOWN 31N RANGE 16W '/4160 NW '/440 SW Map Number: 00 - Sales Area: Parcel Control 0 TAXABLE Number of Units: ZONING: Permit Number: Type: Bank Numbers: F4 -Prev, F5 -Next, F6- Legal, F7- Value, F8- History, F10 -Exit, F12 -More LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF CYLON COMPUTER NUMBER 006 - 1027 -95 -050 Parcel Number 13.31.16.188 OWNER NAME: First MARTIN R & SHERYL L Last SCHNEGELBERGER PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment ,q 1 �5 q 250TH ST SECTION 13 TO RANGE 16W '/4160 NW '/440 SW Line Descrip ' Line Description AL ACREAGE 37.290 PLAT LOT BLK 10 01 SEC 13 T31 N R16W SW NW 1 02 EXC CSM 18-4653 16 2 a ,, Q� fC��'Y✓�l 4 3 E -U- 2469/472 17 18 0 19 06 20 T 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, 178- History, F10 -Exit Jessie Nye Subject: #430551 Gille / Waldschmidt - Final - Replacement Location: Cylon Start: Thu 9/23/2004 9:00 AM End: Thu 9/23/2004 10:00 AM Recurrence: (none) 006 - 1027 -95 -100 W qty U 13.31.16.1886 O 0 s� C-7� 1 1 .- `11/04J2003 17:04 7152687080 GILLE TRUCKING y PAGE 02/02 IL i I : I i ' I , I , JJ - ' IT f i I I ; I . I I i j I P. St,� uws� rs73 � R I'(. w i .. , I � r. i• � � } , ; /3 f1ye1! op - I r i ( ; r i ' I t _ I , Safety and Buildings 4003 N KINNEY COULEE RD 4 LA CROSSE WI 54601 -1831 TD #: (608) 264 -8777 erc 1 \vi MN seonsin www www•comm .wis c ons .wisonsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nett Secretary November 05, 2003 CUST ID No.221471 ATTN. POWTS Inspector DENNIS J GILLE ZONING OFFICE GILLE TRUCKING & EXCAVATING, INC. ST CROIX COUNTY SPIA 352 140TH ST 1101 CARMICHAEL RD AMERY WI 54001 -2840 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/05/2005 Identification Numbers Transaction ID No. 934923 SITE: Site ID No. 667354 Rick Waldschmidt Residence Please refer to both identification numbers, 250TH St above, in all correspondence with the agency. Town of Cylon, 54017 St Croix County SW 1/4, NW 1/4, S13, T31N, R16W FOR: Description: Two Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 927624 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes Condit and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in APPR chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: DEPARTMENTI i N OF General Approval Requirements: SEE CORRE • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /01) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST (0 1/8 1) • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) 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. DENNIS J GILLE Page 2 11/5/03 Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 763' ) (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz @commerce. state. wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 PRESSURE DISTRIBUTION COMPONENT DESIGN OG Q� Commercial Application INDEX AND TITLE PAGE Project Name: RICK WALDSCHMIDT Owner's Name: RICK WALDSCHMIDT Owner's Address: 7741 CHANHASSEN RD. CHANHASSEN MN. 55317 Legal Description: SW NW S 13 T 31 NR 16 W Township: CYLON County: ST.CROIX Subdivision Name: Lot Number: Block Number: Parcel I.D. Number: 006- 1027 -95 ®�rnlly Plan Transaction No.: Page 1 Index and title 'RcO RC6 Page 2 Data entry o DING$ Page 3 Mound drawings �. Page 4 Lateral and dose tank ' Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications 5 - -// so: Te3/- Designer: DENNIS GILLE License Number: 221471 Date: 10/09/03 Phone Number: 715 - 268-6637 Signature: �2 , Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.11 (R. 06/01) Page 1 of 7 11/04/2003 09:42 7152687080 GILLE TRUCKING PAGE 03 Mound and Pressure Distribution Component Design Design Worksheet Sites Information (f or c) r. Residential or Commercial Design note: sand n (D) calculations assume a 700. Estimated Wastewater Flow (gpd) Table 88-444 in-situ soil treatm for fecal ` 1.60 Peaking.. Factor (e.g. 1.5 = 150,) conform of < 36 inches. 300. Design Flow (god) r90 Site $10pe .(9�), Contour line Elevation (ft) 29. Djapth. to L igniting Factor. ,(in) .40 In - situ Soil Application Rate (glad/ft) Distribution Cell information 50.00 Dispersal Call Length Along Contour (h) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest oint in the distribution y Pressure Dlaribution Information network? Enter Y or N (o or e) C 00 n r car End iV�nfal�i 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of- Laterals .of the.highest,p9k4t. 0.125 Orifice Diameter (in) (e.g. 0.25) 2.00 Esti - 0rifitce - Spacing (ft)- ti.2�s. ft�blii<ce 2.00 Forcemain Diameter (in) 75;00 'Forcemain - Length(ft) Does theforcemain tfrain'back? Y 88.00 Pump Tank Elevation (ft) Enter 'Y of '14 6.50 System Head (ft) x 1.3 12.23 Forcemain Drainback (gal) 12,11 Vertical resift (ft) 44.53 5x Void Volume (gal) 0,57 Friction Loss (ft) 56.76 Minimum Dose Volume (gal) 19.28 "total Dynamic Head (ft) 19.77 System Demand (gpm) Lateral Diameter meter Selection Manifold Diameter Selection in. dia. op ons choice in. die, op tions choice 0.75 x 1.25 x 1.00 x 1 1.50 X 1.25 x 2.00 1.50 X I X 3.00 2 -00 x 3,.00 x Gallonsfimb.Calculator (optional) Treatment 'dank Information 600.001 Total Tank Capacity (gal) 1.000:00 Septic -Tank Capacity. (gal) 42.00 :Total - Working Liquid Depth-(in) HUFFCUTT Manufacturer . S_, 1 gal /in (enter result in cell 849) Dose Tank Information Effluent Filter Information 600.001 Dose Tank Capacity (gal) Wbel Filter Manuifacturer x'314141 Dose Tank Volume (gal /in) A100 IF11ter Model Number HUFFCUTT Manufacturer Project: RICK WALDSCHMIDT Page 2 of 7 11/04/2003 09:42 7152687080 GILLE TRUCKING PAGE 04 Mound Plan View tlbservadtarr pipe K • �' �� ��w^'w" h"' L»' 4 ^e• », • 1.L•ya,n. ° „� • W W r =,»C.r r:;r.r, �dr•r -• ^r• „ s::�„rr r., ,r•r r °'�`r- .•.,r, J:1 I L Mound Component Dimensions Down s10 ,® toe .extension made. A 6.00 ft E 11.60 in H 1.00 ft K 7.83 ft B 50.00 ft F 9.50 in I 9.00 ft L 65.65 ft D 8.00 in G 0.50 ft J 5.11 ft W 20.11 ft 300.00 (ft) Dispersal Cell Area 1 750.00 (ft) Basal Area Available $.Oq I (Qpd/ft) Linear Loading Rate (ft) 1/10 8 4bs, Pipe Placement Mound Cross Section View Aggregate, Dispersal Area Frnishted Grade 101.90 (#t) rsr�rrirr 2 rrrfr✓r ,. G �' ,rsrrr Jl�r 100.11 (ft ) --o Dispemal Oak 100.61 (ft) Lateral Dispersal Cell ; Invert Elevation s D t 4 W '� 9 .44 (ft) Contour Elevation 5.0 % Spite. slope Geotextile Fabric Cover Shading Key- � � Disper9el- See - lateral details on . Topsoil Cap 1.5 fk Page 4 for number, size C ^ rJ ?'4 r' A1f"hd»� f.°»".. I1t SWbsO.il..Cap f,s, andd.spacing,of,laterals_ ASYM C33 Sand �w r,�fs •.; .. ti• F Laterals are equally 'Tilled Layer 015,ft i9ol t;steXal r4 spaced from the 5 Aggregate " �. " dlstrlbution cell s - 4 — , :::':�:»r�r'`a �•; j centerline in the •` A ---- -* distribution cell ( Project". RICK WALDSCHMIDT Page 3 of 7 11/04/2003 09:42 7152587080 GILLE TRUCKING PAGE 05 centar Laterai Layout D m I'orw main comwation via.tee tx aross to Manifold* any.point. Eaterals"Idwitioai � P 4- %wboll valwo or �FX-�- �IEtrf2 e12 oloanoutplup of PVC Sch 40 pw COMM Tabu 84.30.5 Holes drilled on owbottem of t1w latoraL Number of Laterals r Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 211 ft Lateral Length (P) 24:27 ft Oriftces.pec,Lateral - 12 Lateral Spacing (S) 3.00 ft Orifice Density 6.25 fe /orifice Lateral Flow Rate 4.94 gpm Manifold Length 3.00 ft System Flow Rate 19,77 gpm Manifold Diameter 1.50 in Total dynamic Head 19.25 ft Forcemain Vebcity 2.02 ft/sec Dose Tank Information Locking cover with warning label and locking device and Electrical as per NEC 300 and -- - -o► sealed watertight Comm 16.28 WAC min. Disconnect Tank component is properly vented E-- Alternate outlet location Forcemaln diameter HUFFCUTT Manufacturer 2 in. Ca ci 600.00 • Gallons Volume 147291 gal /inch A Weep hole or anti. Dimension Inch@s Gallons B siphon device A 30.02 428.92 B C .2$,55 C � off eieua>!on ti; C' - 51. 4- 5:76 sa.so D 6.00 65.74 Total 41.99 800:00 DageCank elevatlorr R 3" Bedding un er tank. Alarm Manuafacuurer LEVEL ALARM__ Alarm Model Number. D L Pump Manufacturer ZOELLER P U MP Model Number 140 Pump Must Deliver 19.77 gpm of F 19.25 ft TDH Project: R!CK WAL0$CHMlDT Page 4 of 7 ' r Mound System Maintenance and Operation Specifications Service Provider's Name DENNIS GILLE Phone 268 -6637 POWTS Regulator's Name ST.CROIX CTY.ZONING Phone 386 -4680 System Flow and Load Parameters Design Flow - Peak 300 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 200 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 300 ft Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should ins ect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Tum -up Detail Finished •�������������� •�������������• Grade 6 -8" Diameter Lawn ♦ Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral `�► — - Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: RICK WALDSCHMIDT Page 5 of 7 r Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01101) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 84nches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the finer when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent finer alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. (Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 30 mg/L TSS, 10 mg/L FOG, and 10 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in W present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: RICK WALDSCHMIDT Page 6 of 7 ��' �� � Y111 �in, f �•« iwtJSle 1 r'.r:wl� 45�r�tdd�� I�YY�'llUGf� •V fix.. YJy y ' J Y tl +.9191 x w xY - o.,wrh7w w `iirx rA, Pi .. y • . x--.w. 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I 'I r 1 I i f r r r • I � I , I i i , I I , I _.., t l r , _ I i 10/00/03 THU 11:14 FAX 715 386 4686 ST CRX CO ZONING Q 001 Ldb&;knd HWnan ReYativr�s Depyirtrnent of industry SOI AND SITE EVALUATION REPORT Page — of , , bo7 and Division of Saf6ty & BuUditgsy i n accord with I q S Code .i Attach complete site plan on paper not leas than 8 'U2 x I I i n siz ust i l t ! •C ) not limited to vertical and horizontal reference point (6M), di i n and �p a rsat@ PARCEL I.D. # dimensioned, north arrow, and )ooation and distance to no oad � �. 0 0t- _ 10 7 APPLICANT INFORMATION PRINT ALL RM TIj Nl ' ° REVIEWED BY DAT; 0ROPERTi' OWNER: t l fhl �' ?MfM T L N4 lA) 7 /4S) T,31 .N,R It, E (or) PROPERTY OW NERS &WLING A9 13RESS, # SUBD. NAME OR CSM # P ITY, STATE W CODE PHONE NUM t, fY11\1 5317 (60911S_S9 3 iLLAQE owN NEAREST ROAD - Intl X5 New Construction USe 9) Residential I Number of bedrooms ,2_ � 1 ) Addition to existing building f) Replacement j I Public or commercial describe — Code derived d low 00 gpd Recommended design wing rate i..z bed, gpW 1, bench, Absorption area required 50 bed, t1 0 kenCh, ft2 MaXknum dettign toadng cafe !Z—bed, gpd0 1. A trench, gpolft Recommended in611ra surface elevatuan(s 99. �ft (as referred w site plats benchmark) Additional design / site conWderations Parent rn ode ial : �d le) 1 7"i i Flood plain elevation it applicable 1l� it S m Suitable I . system OONVLAt71 AL ND IN GpdUN p AESSt1R)r AT GRA SYSTEM III Flll S NG K U: Unsuitable br stem ❑ 5 U S D U D S Di U ❑ 5 ® U O 5 Q�I U SOIL DESCRIPTION REPORT Baring # Horiz Depth Dominant Color Moldes Texture Structure GPD /ft in. MunSell Qu. Sz. Cora Color Gr. Sz. Sh. ��►y Roots Bed marl h 1 j rns v � 5 1 , 3�--' �5 Ground 3 )a ao 113 "Y 1Z 5 14 e!e yy J sl Depth to -, h7a ". e 41 limiting Remarks: Boring # el � U�Il� IV 1 P �r)1 rh 3f Ground 4/ 7 Y)i 4�r'" q -F—co 3 elev 42d _Wyl 91'N ft. Depth to limiting fac f , Remarks: ST Marne : -- Please Print i j, phone• „7 to Add ress. a Signature: Date: � �� taSTNumber:30, •10/09/03 THU 11.14 FAX 715 386 4686 ST CRX CO ZONING 17J002 rrvw -unII Van" h11..7� +'l l.,� - iJ `'�' ` �'��' SOIL DESCRIPTION REPORT ; PARCF.i: LD. It' PagA ! of 1 1 Boring # Horizon Depth pomi Color mom Structure in. Munsell Ou.3z, Cant.Color Texture O►, Sz. Sh. kne �►Y Roots GPD /ft j E 17 �/ 3 �,. - Bed i CS 3 f - co . 7-� l (� ;Zmsbk m �r y a q -ate Ground $" l oieLl b a ms rr S r f c6 vYR Depth to Ijmillng Remarks: Boring # 4M3 !oY P, s 3f-" 3-$ {dI 1J cad 5 Y m5 5► 1 rn ) U�r 6,S �r� N�'�' 0 , ; ' Ground "? l O % { k it '14 sl rn Depth b 3 R7 r — �. -F,40 �7 limiting E i Remarks: Boring # 13 i 0mund ' elev. t 090 10 lim'itiing factor Remarks: Baring # UF1 Ground ' re v. ft DsA b) limiting factor Remarks: S8D- e330(R.0M2) 1Y1 N M t IL _ as � •�- tom -^ •.•� .. ea 14 �} 4 �c t lul 9�k PIZ £OQQ� ONIUOZ 00 XRO is 999V 98£ STL XVil VT :TT LIHI £O /60/OT WiscomAwDepartmentofIndustry, SOIL AND SITE EVALUATION REPORT Page? of LaW and Human• Relations DiviskM of Safety & Buildings in accord with IL S Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 i n sizjyls jtust inc ut not limited to vertical and horizontal reference point (BM), d' i n and *'3t -C ale PARCEL I.D. # dimensioned, north arrow, and location and distance to ne oad �' " r APPLICANT INFORMATION- PLEASE PRINT ALL RM �'IdN1 8 95 E WED BY DATE A10V- l 3 PROPERTY OWNER: ERTY L N 114 1/4 13 T 3 N,R (p E (or)g) PROPERTY OWNER':S MAILING A DRESS K # SUBD. NAME OR CSM # y 1 C hays se Ka • �- - - ,C ITY, STATE ZIP CODE PHONE NUMBER []VILLAGE OWN NEAREST ROAD I n 1'�1� 'x311 (e Js -5934 a5 �: New Construction Use t�] Residential /Number of bedrooms o2 [ ] Addition to existing building _ (] Replacement [ ] Public or commercial describe — Code derived daily flow 30 gpd Recommended design loading rate bed, gpd/ft trench gpd/ft Absorption area required 50 bed, ft a90 trench, ft Maximum design loading rate , A bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) , ft (as referred to site plan benchmark) Additional design / site considerations 'SIDR W oAd i f e - fi x ya I Parent material _ 'g IQ c f c, / Ti U Flood plain elevation, if applicable /U ft S = Suitable for system CONVENTIONAL M ND IN- GROUN PP RESSURE AT -GRADE SYSTEM I FILL HOLDING TANK U = Unsuitable for s stem ❑ S NU S ❑ U 1 ❑ S L'AL EIS lA U ❑ S ® U ❑ S IdU SOIL DESCRIPTION REPORT C94k Ao�n J I i 'Z(?p& Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bax>daly Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench -- ` > D- 1 U b m 5 V �r C 5 .,.,4 1 ••.' ( rr-, b`l` m �r r 3P-c , S L S Ground 3 ).) -.? o 10 Y R 5 1 4 3 m 5.b g �r ;W-co ele q 9.q�{ ft. .3 Depth to �j �'r l o� Y � 4 c ad 5 -7.1 � G ! 5 m - �r .3 .y limiting fact r Remarks: Boring # M 1 D P. 3 Ground '' ff �t elev. "1 33"y� S i � CSC s Y (. / 1 !'t'1 f('' �'_ , 3 9L ft. Depth to limiting fact r „ ` Remarks: ad CST Name: — Please Print ` 1 f e,f Phone: -7 c- / s-3 _o�3a Address: / 2 3 of W C C,� 7 Signature: \ Date: 5 //S ISIS CSTNumber:3,o/ 1-- VZf-';; � L PROPERTY OWNER 21&- - la1`00A V- &C 'a + SOIL DESCRIPTION REPORT Page - b , 4 1 of PARCEL I.D. # ~ .w Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Botrxiary Roots Bed Trench 03 3 rm Q-Fr c - 7 - ;zo t o ,i .2 msbk mfr 3�cn e'� -S • `� Ground � O j � 3 �--- C � pi bK Vn� r •s - � lev., ,hg ft. q S`(-Q ` cad SCR 5 l s I rn r4r Depth to limiting f tg� Remarks: Boring # ©-3 1 01 0 1A -- � 5 + I o2 mfr C Y-a 9 101 c'd 51 1 a m Q V- r C5 3r-(- tip" : 0.a' 1 0\ 1 5 1d i G 1 a m5 3f to , q : :, g - Ground `( q 7'a ft. 1� S R y f rv- 5 Depth to 5 N- 5\( P- 3 Sy (- /B' S 1 )MP) �m mfr —L— �� lw�- c 0. limiting f�to l Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # - 11. *i.. Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) PRDPERT OWNER - L� rJCA WaA&&i'd DESCRIPTION REPORT Page a of ✓' •'PARCEL I.D. # s Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 103 � 3 A --z-- - S - 1 1 2 r n Sh K rr, f - -e�o .5 .6 Yw 7 -;Z0 t o Sic. l 2 rnsbk mfr 34 a q .S Ground C be, yy-,� r X .5 gN�ft. q 2V 51Q c SJR 5 S) r'n ,•nfr Depth W limiting t3 Remarks: Boring # s . w.: µa;< O-3 r O l R 3 /A --- 5 I o2 m s bk r n� f r c s 3-f-a ►mufr tip" o.a' iv "' . . . . . . . . . . . . . . }:h'iv eei and L(o s R yl �--- S m ,m S �w , L ) q � �a ft. Depth to limiting rol, Remarks: Boring # Ground elev. ft. Depth to limiting factor L I Remarks: Boring # n:: Ground elev. ft. Depth to limiting L I Factor Remarks: SBD- 8330(R.05192) ' D 7�, P3 • 3-3 Coe DRi vE re r c �� e rm vst.c� L FT 2 r)a� I +0 e- e Rl b6n $�i s,�� #w.3�' i' Ae �1c(1a{ ion J • % 1 e your # o �CC LQ S l � n cow lCrr�Ime. Fine, PlaeA/ /or/ P a WLllmd 1 0 cv Ul- r6n qq,q 99 i J J W g 0 �` of �c a 0 a Q a a ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerjBuye l d- kS P -- m - ailing Address / �, /O ' ��% )T y`�� 0 Property Address 15i 4Q k (Verification required from Planning Department for new construction) City/State L-0-4 PC4.� _ ) s Parcel Identification Number 006 - V Z-'7 - O0 / ) LEGAL DESCRIPTION Property Location Sl ✓ %,, N1 ' /,, Sec. 1, T3 I N -P W, Town of Subdivision u p arcX Lot # Certified Survey Map # , Volume , Page # Warranty Deed # l 3 y , Volume A) 7 , Page # -3'0 7 Spec house ❑ yes li no Lot lines identifiable { yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days f three ye r on c4,ate. i ,� 1 1/ l 6 3 SIGNATURE OF APPLICA 7 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 th ro ery desWab y vir tue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICA 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 U L 1 0 0 1 L L U `+ ti9=:f ed 3 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEE WI ST. CROIX CO. RECEIVED FOR RECORD This Deed, made between Richard Waldschmidt and Linda 12/04/2003 02.30p?1 Hilton. husband and wife Grantor, and Martin R Schnggelberger and Shervle L. Schnegelberger, husband WARRANTY DEED and wife Grantee. EXEMPT # Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.00 the following described real estate in St. Croix County, State of -Wisconsin TRANS FEE: 296.10 (if more space is needed, please attach addendum): COPY FEE: The Southwest Quarter of the Northwest Quarter (SW 1/4 / NW 1/4) of CC FEE: - Section Thirteen (13), Townshi a Sixteen PAGES: 1 (16) West, Town of on, t. Croix County, Wisconsin. EXCE 'be urvey Map in Vol. 18, pg. 4653 t�* vt� auk 0-If a � � Gr✓2�P/�� :Re mB Area Name and Return Address — "ke f�P ^k eZ FltitfSc P. G / --c-c(, uoz- S t-1 G ! S_ 006- 1027 -95 -000 p T kV—d— if Parcel Identification Nu ber (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions, and rights -of -way of record, if any. Dated this day of December , 2003 * * c and Waldsgmi& * Linda Hilton AUTHENTICATION ACKNOWLEDGMENT Signature(s) Richard Waldschmidt and Linda Hilton, STATE OF ) husband and wife ) ss. Jlu County ) authenticated thi day of December , 2003 Personally came before me this _day of the above named * _K ristin Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Slats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY _- Attorney Kristina Ogland Hudson, WI 54016 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond d- Lac. WI STATE BAR OF WISCONSIN 800655 -2021 WARRANTY DEED FORM No. 2 -1999 N N n Ave N o 221 st Ave. 2 06 2213 2,96 O N 15 2 , a 5 14 215 h A 13 N rk 2105 willow N A ve. 22 23 2058 2061 24 N 2050 N N N �` 2037 3 � N C4 nm r / / � C �3 7 46.900 VOL 18 PAGE 4653 KATRLM N. Mf1IL5R REGISTER OF DEEDS ST. CROIX CO. V I RECEIVED FOR hECORD CERTIFIED SURVEY MAP RTI 2003 10:30A Located in part of the Southwest Quarter of the Northwest Quarter of Section 13, CEERTIFIED SURVEY HAA P 31 North, Range 16 West, Town of REP FEES 13.88 Township Won, St. Croix County. Wisconsin. COPY FEE: 3.00 PAGES: 2 Prepared for and at the request of: Linda Hilton 2151 250th Street NOTE. The parcel shown on this map is subject to State. County and Door Park, Wf 54007 Township laws, rules and rneggulations (i.e. wetlands. minimum lot size, opcaa Drafted by. Howard H. Hw vd III to parcel. etc.). Bofors purchasing or developing any parcel. contact the St. Croix County Zoning Office and the appropriate Town Board for advlciL 1F.2m � — � NCRWNE$r CORNER Section Comer Monument .SEC. 1.3 -31 -16 of Rem FO6WD 2" OW P40E Set 1" x 18" Iron Pipe weig QFG a/T • 1.13 pounds per Knew foot z 8 �V �� x ull Setback Line d FROM IX-5) 100 from Right –of –way) 8Vc Donates Wetland NOTE PRIVY SHOWN PERMITTED UNDER PRIVY INSTALLATION AGREEMENT, OOCUMT# 534977 IN VOLUME 1144 PAGE 260. I J3 lC UNPLA TTED LANDS OF OWNER I I� J jL AL JL N89'M'25 "E 432.57' J�, j .21' 155.36' (t z 1(z a a J IS3 LOT 1 8 j : j N '� d TOTAL AREA � w a 11s w 2.71 ACRE ° iQ � 6vw li i i� f N 109.193 �SO. FT. 5T 10 iu I - w 2.5 RE 1 ACS �r �+ 1r- at IN I N I = � �/ ENr D°� i O 579 P Z6 N I SM 370 399.57' N89 57 ' `25'E 432 SD'7•�� c 1 Z.� UNPLA TIED LANDS OF OWNER - 6� y,�t d I Ti A special exception use permit is required for the dfsturbanceslopes 20R or greater not identified an the approved plat or CSM. This permit • 1s applied for through the zoning office and is reviewed through a public 12 ` hearing process by the St. Croix County Board of Adjustment. �► AP P ROV „wstrauru # • °N° NEST 114 =04M ST. CAM ���.�4 ..... SEr 1.�J1 -16 s to PlwlingzoNn 4W psrkt e r 1" dROV AW BY NOV 1 QQ. OQQ E S -SW 11E swrr S•246� N $ u na W.t ao days of ' S � ' :mod ;u approve) date s� mvval8W be lqN ••.....•••' OQ• °t NO TH �BURV THNEST CORNER SEG 1J -31 -16 Rt +u<� 74 JOB JOB J W1057SU139 (FWND ALUM. CQ MOv. t a too Prepared by. 1W C P ay, kX GRAPHC SCALE IN F Inch 100 feet Phone No. (715) 246 -4319 BEARINGS ARE REFERENCED TO THE WEST LINE OF THE Fax No. (715) 246 -3830 NW 1/4 OF SECTION 13. TOWNSHIP 31 N., RANGE 16 P.O. Box 325 W. WHICH IS ASSUMED TD BEAR N00'01'35`W. New Richmond, WI 54017 Short 1 of 2 Vol 18 Page 4653 VOL 1397ma'117 m STATE BAR OF WISCONSIN FORM 2 – 1982 ! 596134 WARRANTY DEED KATHLEEN H. WALSH '! � ST. CROIX WI DOCUMENT NO. RECEIVED FOR RECORD I j Robert Hilton and Wanda Hilton, it 01 -20 -1999 9:30 AM j; husband and wife, as joint tenants, !� i VARRAKTY DEED ITT COPY FEE: 12 COPY conveys and warrants to Richard Walds chmidt and li TR Linda Hilton. husband and wife, as RECORDIB6 FEE: 10.00 survivorship marital property PAGES: I I i I !� THIS SPACE RESERVED FOR RECOROING DATA I I NAME AND RETURN ADDRESS / the following described real estate in St. Croix County BERT D PETIwRS�:IV State of Wisconsin: Attorney At Law The SWk of NWk, Section 13- 31 -16, St. Croix PO Box 117 County, Wisconsin. !' Clear Lake WI 64006 ii 006- 1027 -95 PARCEL IDENTIFICATION NUMBER C/ This deed is in satisfaction of a land contract recorded in Volume 1117 of Records at page 124 as Document No. 527548. This i s not homestead property. (is) (is tot) Exception to warranties: MLmicipal and zoning ordinances of record and recorded easements, restrictions and reservations; and any liens or encumbrances created or suffered to be created by the acts or defaults of the grantee. Dated this 23rd dayof November An, W 9 L. (SEAL) ' (SEAL) Robert Hilton (SEAL) (SEAL) Wanda Hilton AUTHENTICATION ACKNOWLEDGMENT New Mexico, Signature(s) State of Mime: ss. Valencia CDUnty. } authenticated this day of .19— Personally came before me this 23Yd day of November 19 , the above named .. Robert Hilton and Wanda Hilton TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 9706.06, Wis. Stats.) to the known to be the person S who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY L l 94 n Rert D. Petersen, Attorney at Law A. zru 1110 _rlpar Lake, WI 54005 Notary Public, Valencia (Signatures- may -be authenticated or acknowledged, Both are not My. commission_ is permanent. (if not, 'starT, necessary.) April • Names of persons signing in any capuity should he typed or premed brow heir ngnaturcs. STAT WARRANTY DEED Form No. OF WISCONSIN WI Wiscarli;:r tl�8ls� 2 1982 CYLON DIRECTORY * F_ T -31 -1V � -�6 -W : See Pages 135 -140 For Additional Names. (Residents - Owner or Renter) POLK CO. POLK/ST CROIX RD DEER PA — — — etsch _— ■Rodney Earl ■ ■ Thomas Pi — Carr ■ — — — — — Michael wittstxk ■ Kevin Ninke ■ N N Gerhard N ° ■ M 1�1 a ark Monnot ■ Craig Krogh a �eterson ■ 2._ vE Ibertson Scholz / I Burke eP8 I ■ Vot-im- rnr,C�,e�kc, ,.,, p M ike O 1 M,cluel N 236th AVE ■5 qy Dale ■ g1 ■ 5 I 4 I 3 i K ■ 2 NAVE I 2 Mayer 6 Kbmps h / 1 7h I ■ Richard 2351h AVE I / ■ � Ki y W v L ( ■ xa ■ zmarsid N M roec ■ Thomtxon G I � on m N Kud rer I 230th ■ ,g avh Vern ary ■ r ■ ■ — - - -_ � ■ ■ ■ ■'� ■ ■ ■ •Nichols � - -_ s ■ q ■ a ■ Vernon t Elden Pa y p ■ Arthur ■t ■ David ■` Setter ■Wilson,, ER P-A"RK David Ma ■ Moore 1 a 9 A x M eff Brett Mon d2 3 : Carroll R�b� ■Rodger Karz- ■, AY le ■ H ■ on G�st ■ Doe 9 ■ GUST RD Milton ■ ■ Kevin 1 0 Flo ■ �■ ■ h ■H Mark ■ Geh Luk Ronald F . C a +� Berglund Kaczmarski Rilm is 222nd AVE ■Boe ■Jason Boe rn gg 221st ■ Tim ■ ■ �� 0 ■ Icard ■ o ' AV Hammelman Kuhn tercott K ,card N • Lois _ -G�avi ___ ■t_i - -- -- -- - -- - Dollet�_ —_ -- -- -- _ Erk Glenn ■ soems ■ 220th AVE Thoe Ltl Q A - — _ ■David — Burton Harsh t alrbard Brantne ■ e C Z Christensen 218th AVE o ■ Walduhmidl >� I 'wg 8 K N e 33 FO Burton ■ �+ m ■ � 1 grime I 215th AVE : �■ 5 1 near 16 -:, p� 15 14 215th AV a axaalt ■ - 2 g s Keith Randy 'q N W � Fouks �p� Lehrman 1 ' h Ness rr,h— M L .t St Steven �- I ,� ■Sherman Hum a. N O skinner ■ . Joh ts ■H ,a ■nson h�a i _ — _ — _ RIVER ■ ■ ■#its ■ ■q ■ C Dense ■ 210th AVE Gerald a 7 JAnton Jut Erickson K I ■ G ck FRzer ■ W ro 1 Scott 0 71 207th AVE„ Din a 4 ELL old Douglas MA 1 ■ Al Thompson Radlgan 24 19 �� 46 20 2ostn ■. ■'—.� :sue 22 1 23 AVE Mark m Cellotti .a I ca 1 F S t `n 11 Thomas ; ' g 1 Gan ,� ' Duane Hawks - Robert ■Robert °c Spoo ford Denis K obert slu N N ■ GIIIiS Dall � O N I fid ■ A ee- is I ■ ■ ■Derosier ■ Berndt Olen ■ ■ ■ R,Chard ■ 1 - — - - — _ — ' — _ — _ N ■ 1 200th AVE Me:.. 0., Schachtner ■Carol Lawrence George Olson Olson ■ Bos Luterbach ■ Mark It ■ I N Salmon ■ St *hen 1 l ■ I Hahn Gary ■ KcLLeagerd 29 Olson 28 1 27 G= rt: -- iwredxe� ■ Kemll Erickson �� I ■ 1 ° \ ■ BE ■ David q c Krue Goodrich __ -- BILETAL {g$� David Ray g q Thomas p�'y' 2280 SNOOD EP t �O sp a Karts 1 N F Ziemer Marvin ■ : L' ❑ Weeks GY L � �Ie}' ♦w ■ 1 ,y 1 ■CrIm P\J N ■ ■ O ■ ■ 69 N N ■ ■ ■ ■ 64 ■ ■ 64 ■ M-ft Albert ■ ■ Fr Iack f Des= 1 MazHn � ron ,ay O Tuner Konu{a Mal ■ Croes won' 187th I � ■ v L.. i I O Coreelim I �o`N , ■Mike man AVE ■ Ronald ■ N Thomas ` Lt\ N L ■ Lee Ma Dorsey ■ Karprnske ■ 1 0 � 3 Kemnng ., SOUTH FORK 1 1 35 i � � q ■hlarly •Gary Nagy ■ °■e Bernard ■ Powers L robardo 1 Francis 184th db 2468 63 wcr RR ■Jerome Bill 1BE AVE ~ a 1 Rd 1 lames ■ 5 ■ Richard Jarosch IH S m I ST F]iason N Casey ■ ■ z� `. ■ Lt1 180th AVE ERIN PR S AIRIE PAGE 53 CYLON EMERALD PAGE 55 3 71 ..! ,...:. � Safety and Buildings Division L1'ia' 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 8112 x 1 i inches in size. • See reverse side for instructions for completing this application State Sanitar Permit Number a 7 The information you provide may be used by other government agency programs ❑ Check�it revlsioli to prev ious application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N Property Ow r Name t -t- I,/ AI ! l �3o4erty LoUY4 S l T , N, R &E (Orlo VIA r Wl�c� l Pro perty Y n er's Ma' h Ii g Ad c� ess SS( A/ � n Lot Number Block Number ,v CJ/ City State Zip Code Phone Number Subdivision Name or CSM Number I. P it BUILDING: (check one) ❑ State Owned y Nearest Road lag / v Public 1 or 2 Family Dwelling - No. of bedrooms r7l To OF C Ill BUILDING USE (If building type is public, check all t hat apply) Parcel Tax Numbe (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. 91 New 2_ [3 Replacement 3. ❑ Replacement of 4. E] Reconnection of S. Repair of an ------S ystem 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 ]gVault 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 VII. TANK Capa ity Site INFORMATION in gallons Total # of r Prefab. Fiber- Plastic p- Gallons Tanks s Name Concrete r New Existin str utt Steel glass App Tanks Tanks Septic Tank or Holding Tank Q ;ko a Lift Pump Tank /Siphon Chamber I I I 0 Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. s Name: (Print) e's Si nature: (No Stam str MP /MPRSW No.: Business Phone Number: e r I Plumber's Address (Street, City, State, Zip Code : IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved San "tary Permit Fee (IrKlu G roundwat er ate ssue Is g Agent Signatur (No Stamps} Appro Surcharge Fee) pp []Owner Gives Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. WWII DISTRIBUTION: Original to County. One,<opy To: Safety 6 Buildings Division, Owner, Plumber n E 0 -C CE N 7 s 3 Wisconsin Department of Industry PRIVATE SEWAGE SYSTEM County: N Labor and H Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: P VA B&AMT, RICHARD /HILTON, � wity ❑ Villa R Max D No.: Town of: State PI CST BM Elev.: Insp. BM Elev.: BM Description: 7C Parcel T No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosi ng Aeration Bldg. Sewer [ Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet irl 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 T Lift Friction Syst n em TDH Ft oss Forcemain Legth Dia. If Dist. To well SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N DIMEN I N SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING _ Manufacturer: INFORMATION Type O CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distributiion Pipe(s) I x Hole Size I x Hole Spacing I Vent To Air Intake Len g th Dia. Len th Dia. S p acin g 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: Cylon.13.31.16W, SW, NW, 250th Street Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R 05/91) Date Inspector's Signature Cert. No. ,• S afety and Buildings Bui Wa Div SANITARY PERMIT APPLICATION Bureau of Buildin 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. • See reverse side for instructions for completing this application state Sanitar Permit Number The information you provide may be used by other government agency programs ❑ Check — if revisioA t previous application [Privacy Law, s. 15.04 (1) (m)] State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT 4LL INFORMATION Property Ow r Name I l Property Location Y' (ilf A G'f fi r! ,J N 4 N Sl�v4 r UJ14, S ( 3 T 1 r N R &E (orlo Property Owner's Mailing Add Lot Number Block Number 77 Y l A,vh 4 S>rO I ts � City State Zip Code Phone Number Subdivision Name or CSM Number C 1 55'3 / 7 1 (4,12) 5 II. TYPE 'OF BUILDING: (check one) E] State Owned E] arest Road ity Ne Public 1 or 2 Family Dwelling - No. of bedrooms To w a n OF h v� 1 ' .� ! III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 [] Apartment/ Condo b D& / Oa 7 7S 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. 0 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 S. Perc: Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation Feet Feet Capacit VII. I NFORMATION in gallo Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. New Existing Gallons Tanks concrete strutted glass App. Tank Tanks Septic Tank or Holding Tank d AO a PS'OAI AA C , ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ I ❑ 1 ❑ 1 ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. %V s Name: (Print) _ il e r's Signature: (No Stam s� MP /MPRSW No.: Business Phone Number: `y -W1)� a A r ./ Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved San'tary Permit Fee (Includes Groundwater D ate Issued Is g Agent Signa�(NoStamps) X Approved ❑ Owner Given Initial l- surcharge fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASON FOR DISAPPROVAL: MIJ SBD -6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety 8 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. Theseptic 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: 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. Ili. 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. 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 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. I � 6adJYlerS s�ra e d Fi t V�/ s ��ehe a men} - w1tdCrJ a inset}, VArtm't+ ro0� CriClos�rG 3e \caa'�� lee.ihfo fi6tY-g�a3s Floor ( V.o 4 G$uNrt and poi i�rt'se�t wi}h � ven p ar vr►w nentty 1 9OV4eot +o NI AU1 }. waden+ ReSis�rnht 3.. s Ah geddlv%5 4h G�-A `r Crowe ►'+He soh �Ivi C. (p s - ) 3 a q 61 ;z - I st , ?,'Ce �� � C.13 - f r i E e V , � Leo �3 1 `S \ *No s i R i ` eY rP, t i KlTTLE$ON'S, INC. " 2401 27TH ST. " RICE LAKE, WISCONSIN 54868 (74SY234 -4657 FAX (M) 234 -4294 FIBERGLASS PRIVY VAULT (Approximately 36" Square - 36" Deep) (Approximately 200 Gallons Approximately 120 Pounds) r - ** - * - Rodent Resistant * Rotting l a , z ***Jelcoated, Reinforced Fiberglass Floor (40" Square) and Toilet Stool with 4" Vent Permanently Bonded to Vault. ��-*Standard Seat Fits (not induded) LAa� ** *Can be hauled in a pick -up or trailer. ' Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page? of •3 Labor and Human Relations Division of safety & Buildings in accord with IL s Code g COUNTY Attach complete site plan on paper not less than 81/2 x 11 i n siz j Amust inc l ut '� f not limited to vertical and horizontal reference point (BM), d' n and 99���att � rRfcale PARCEL I.D. # dimensioned, north arrow, and location and distance to ne oad] N wt, - APPLICANT INFORMATION- PLEASE PRINT ALL RMATION 199 REV BY DATE ST PROPERTY OWNER: �� N L N Z& t- t�.1 4 m w 1 /4 ► 3 T 3 ,N,R ) ( a E (or)6 d �t PROPERTY OWNEIT:S MAILING A DRESS # SUBD. NAME OR CSM # � n ITY, STATE ZIP CODE PHONE NUMBER ❑VILLAGE OWN NEAREST ROAD fRtJ 55311 (Gt�g75 S0 a o2G j� New Construction Use t�I Residential / Number of bedrooms o2 [ [ Addition to existing building Replacement [ I Public or commercial describe — Code derived daily flow Sad gpd Recommended design loading rate bed, gpd/ft 1 - trench, gpolft Absorption area required 50 bed, ft o 60 trench, ft Maximum design loading rate , ,L bed, gpd/ft / • trench, gpd/ft Recommended infiltration surface elevation(s) q 17, .4 ft (as referred to site plan benchmark) Additional design / site considerations siop o i l. Cd - 6 x Parent material � /a C ia, I Ti f Flood plain elevation, if applicable 1U ft S = Suitable for system cONVENTI ND IN- GROUND RESSURE AT -GRADE SYSTEM 1 FILL HOLDING TANK U= Unsuitable for System El U S❑ U [3 S (3U ❑ S ft U ❑ S A U [:I S ®'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 rertdi 1 D- iO`jR — S i 1 a m shr in V -Pr C 3 4 cc 5 -�-- S I IL Ground 3 )a ad �fl 3 mshk, Ynf r q ; • L l s 4� ft. 34 - T S - f E' m rr-, ar Depth to limiting Remarks: Boring # p_ I O `( P 3 --� s (n Si m �U fr C 3f � p • n w fr 3f of Tr Ground elev� 33 S Q I q y le i 9Z� ft. Depth to limiting lac Remarks: a� T Name:— Please Print I /„ Phone: -7 - a3a ress: A ' r ' �' :5 rc n WE -7 a SignaGue: � Date: � l5 / CST Number.3��/ PROPERTY OWNER � C-t-O rJG V33A& �: \A SOIL DESCRIPTION REPORT Page � of ✓' PARCELID.# ' -F Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 3 col � 3 A - 'S b m Q tr c 5 3f- -co .5 .� 7 - ;Z0 l o `�2� /y , �-- 5ic m5 bK m fr 3f-� G �p � lb�� � (3 --7-- C.� o? m S bK Mh r He n q 2$70 S`fQ q/q cad S\1R 5 S I rn 04r Depth to limiting ,r Remarks: Boring # 0 IO`f R 3/A MO r C S 3-�-a 2 5 ..6 E ,J, 3 -$ 101 12s /► c ,d 5y�� /$ s� 1 am l n)V�r C-5 3�� Np'� o.a' Ground 3 �'-1Co 1 0\j 25/� �`" ; a mS C f n c 3FU ; y , S 9 ` a ft 4 tc,, S\1 R LI --�— s) rn 5 3q 5*( Q- fQ `3 51 g 5/ �m 1 m o.a Depth to limiting 1 j T I Remarks: Boring # E3 Ground elev. ft Depth to limiting facto Remarks: Boring # Ground elev. It Depth to limiting facto Remarks: SBD4330(R.05/92) 3 loop� eR W LP vc v 1 � I � W U! 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 ' r e - cording. ---------------------- 4 O wner of property 9� Location of ro erty tc) 1/4 1 u W 1/4, Section ( 3 , T 3I N -R ) (O W Township D l� Mailing address - 77 4 41 a ss S'S 3 1 Address of site Subdivision name Lot no. Other homes on property? Yes No Previous owner of property Mn+ Total size of property LC y 1�c r-f--5 Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes u No Is this property being developed f r (spec house)? Yes X No Volume 1 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 th� ,o fice of the County Register of a Deeds as Document No. _I y , and that I (we) presently own the proposed site for the sewage and 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. ignature of- Applicant Co- Applicant )0-13 -GS Date of Signature Date of Signature i���>. VOL t ,DOCUMENT NO. STATE BAR O1- 1 1 \I li - 1982 T HIS SPACE RESERVED FOR RECORDING DATA LAND CONTRACT [ Individual and Corporals _ F :U13 � ^1 e ^' ^! cro BE USED FOR ALL TRANSACTIONS WHERE OVER b t��S Of l ��� 52'7548 AND 1N OTHER NON- CONSU \IER S C(�OtV � ., / 32��.000 IS FINANCED n 4C 1 ACT TRANSA(TIONSi n 'O Rcc'� icr E 1 �:d Contract, by and between ...... Robert HiltQn...and ... _........ _ APR 10 1995 Wanda Hilton. husband and__wife_,___as___jo n ________ at 10:00 A. ----- - - - - -- - -- - -- tenants... - -- - -- -- .... ......... ( "Vendor ", x a1 M whether one or more) and. R Cl?ard_.W la G�lII1l.s?t_--- a-rid... , i ''l+ 4)61,L ........ i,inda..Hil ton,..hus_band...and..wif e- ,...as .. jzint.... - -.. Fl"Uorof Deeds -------- t. enlalit. s .. ............................... ( "Purchaser ", whether one or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- formance of this contract by Purchaser, the following property, together with the b ents; profits, fixtures and other, appurtenant interests (all called the "Property "), v'�-- St • CroiX - _ in ........ ---•-°-------------- -------------------- -- --- -- ---- County, State of Wisconsin: RETURN TO, Tax Parcel No. -- 006 - 1027 -95 The SW, of NW4, Section 13- 31 -16, St. Croix County, Wisconsin. F This ... .is -- .not._- homestead property. (is) (is not) Purchase gr a to u chase the Property and to pay to Vendor at ...their order 8 / 2.5-0 .:.� 6-------------------------- the sum of $- ------- - -t- - -- -- '--------- ----- ----- -- --- ----- ----•-- -- In the followin manner: (a) $- - -- • - • - - - -• - • -- - •--- • -•-•- ....... at the execution of this Contract; and (b) the balance of 8 ------- 10 .:- 058 • 75 - together with interest from date - hereof on the balance outstanding from time to time at the rate of .... - ------------------------------- per cent per annum until paid in full as follows: Monthly payments in the amount of $250.00 commencing with a payment on the 15th day of February and continuing on the 15th day of each month thereafter. Provided, however, the entire outstanding balance shall be paid in full on or before the ------- 1 - th_.... - - -. day of - -- ---- DecPm .er--------------- 19__.9$ ( the maturity date). Following any default in payment, interest shall accrue at the rate of .... 8_.. -% per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance) . x�xc�a�> �dtxac�x��i�. x�ac�ox> ic��i��c; a': �dx> i�� '�>�xx�Exx�>x���x� ] i�tesx��K�ii�i�sY�xla��i�� .Sr�CoY��rX�If �€ i?LI�Xi�bkXxr�F341X$�J6bX1Kxr3f X�a�XI}kf x 2�di�Xl >�i�i?r�if£rXU'����►C74a�ivX Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium pr fee upon principal at any time after .�te hereof ,XJ$XXXXCiX �A�Mt+Ftff �MtA}# nc94i�lePCtX�4f:? p1CiS4s�lD���CB4� 'FO7d�QD�x4dX1?�d974.k In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: This contract ratifies and confirms the terms and conditions of a verbal contract entered into between Vendor and Purchaser on January 15, 1995. Purchaser shall pay the 1995 real estate taxes when due and payable in 1996. Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. Purchaser shall be entitled to take possession of the Property on_.- .----- .-- January 15 19 95 11 -Cross Out One. LAND CONTRACT — Individual and STATE BAR OF WISCONSIN Wisconsin l.renl Biank Co. inc. Corporate vF01M >o. li Nliiwau,ec• 1�1_. Purchaser �OL 111 (PASS l�� promises to pay when due all taxes and assessments levied on the Property or upon Vendor's interest in it and to deliver to Vendor on demand receipts showing such payment. _ ' 3 u`rchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, ex- tendedreoverage perils and such other hazards as Vendor may require, without co- insurance, through insurers approved by Vendor, in the sum of $�. none -land- .only__----- - - - - -, but Vendor shall not require coverage in an amount more than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be economically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and enc mbran es, except � ,_ an liens or encumbrances created b the act or default f Purchase ___ a d except ___ Munici _ __ _ -------- .___..____...._ y zoning ordinances of record record easements, restrictions --------------- -•- ------ - - - - -- - -- ----------------- - - - - -- and reservations . ------------ - ------------------------------------------------------------------------------------------------------------------------------------- - " - - -- ............. --------------------- ---------------------------------------------- - ------------ _------ - ------- - - - - -- -------- - - - - -- ----------------------------------------------- Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of .___30__ days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of --- 3 Q_- days following written notice thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously paid by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem) ; or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at nn end and remove this Contract as a cloud on title in a quiet - title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce.an,y remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long -term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediatelydue and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstandinn against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all pa yments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made -in fulfillment hereof.) Dated this __ -_ ___..__J ay of --- February , 19 -- 95. - d ------------ - - - - -- --- --- - -- ... •. (SEAL) �/I� -- ----- ----- -- --- - - -- ... -- (SEAL) Robert Hilton Richard Waldschmidt - -- -- - - - - -- ---------------- - - - - -- ----- - - - --- - --- - - - - -- - - - - - -- - t -- -..ff �I<Ll l / ?T.� -: � - -- -(SEAL) - - -J Cam` - -- - - ---- U'Z (SEAL) - Wanda Hilton Linda Hilton -------- -------------------------------- - -- - ----------------------------- - - - - -- -- --- - - - - -- ACKNOW LEDGMENT OF N 1M�X1L ACKNOWLEDGMENT N1h;X1(� COUNTY STATE OF .• r so S� - -- - -- befo --------- this __ tt" da -- - of 9 S _ the above nameer Ss. Hilton to me kii to be ---- - --- ----- -L`` - Vin --------- _County. __.__. Personally came before me this .cT � -------- day of �o ,' o execute -- t t - e oregding in- 95 - .`�---- _-- --- ._•-. -____ 19_ ____ -- th above timed t�`ad._acknaFt�,es� e__he _same. -- - _- - - - - -. Richard Waldschmidt anc Linda -- � Hilton - ------------ -- -------------------------------- ----- v �►�� -- ----- - - - - -- ---------------------------------------- -- o a 1C encia M r, ffl ---------------------------------------------------------- ColTmissio Trees: �� te+m+ osrfr�e 17t"'t e' tom' ~ � - - - - -- v,ho executed the `' .A g nMJ0PJiEhr dniD URnow dge the same. ore of THIS INSTRUMENT WAS DRAFTED 6Y � --, NOTARY PUBLIC-MINN pert -_D, Petersen Attorney at Law! ------ - - - - -- -- - - - - -- �x rek ,;an. 33, 2W0 My C4rr °71. .. pi .v. Lake WI 54005 - - ----- - - - - -- ------------ - - - - -- Pub.. ------------------------------ C -le - l -✓I/�; MN - Notary ______.__ _ ._____County, sK --------------- (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: ------ 3 ._?c.7__ -- ------ 19 - _1T •Names of persons signing in any capacity should be type or Printed below tbeir.lnatures. `- 4 LAND CONTRACT — Individual and Corporate - -State Bar of Wisconsin, Form No. 11 — 1982