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042-1071-70-100
r .o p I -o o I o I 3 Q 60 o O oa CD I a c o CZ y 3 eV I m I ~ ,n U m y n °o I ~ ~ I o I U Y I c a~ r I r ~ I ~ ~ C U L 0 f6 a h v c y o m 'w co w N O = .O N In f0 O 2 01 O v z 3 z a M o0 7 C U. L GO U. O co C14 L5 'am Q OO E Q a o U M O M a ~ 3 I y a~ ~ I Z co 4.; 0 €V y d a m co z a co N F- cn O C C9 li 'C V O d z O L Z N H 4' a~ U M O N O ~ O 41 v=y) N M G O (D Q O O Q Q w O Z co z Z Z Z 4i '0 C J N _ N V U O y E U) O N i Lo 0 LO LO CL (D C') CL g G G d G G a L ~cUp N N p Q p N N N E r N U) (A 4) O o Za= ~ 5 Z Zoo 0000 4i CL CL w CL CL IL o 0 L v, co co (D U) J V N O) O) O O O } 'fl N co ~ co M Cl) 0 O N O ,O co z O E ire v Y 0 0 ,j 0 0 0 m C a M y m y y QI U) f~00 LO U) QI d Q r- (D yy H N o) H O O O O N C otS M C E •C p 0 O Q U N N co N (D O O r 4) o ccoo ~ € c m co ~ c m _ M a~ r a 4.w p ~ I N W "a 'a (D N y N 'C C_ N~ CO of E w o o M • N N N E c) ~ Z 0_ m U N O O Vl O N U w N F- N N Z Z g to r~k 0 o a 4) d a • to o d° m c c 4: u = 20 rw A E R 3 Ov~ici 7= i `~1 c~ CL i o U) Parcel'#: 042-1071-70-100 01/10/2007 04:11 PM PAGE 1 OF 1 Alt. Parcel 26.29.18.404B-10 042 - TOWN OF WARREN Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 06/03/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - HENRY, BLAIR A & WADE C BLAIR A & WADE C HENRY 775 130TH ST ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ` 775 130TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 4.815 Plat: 4990-CSM 19-4990 042/05 SEC 26 T29N R18W PT W1/2 NW1/4 FKA PT Block/Condo Bldg: LOT 01 LOT 1 CSM VOL 4/989 NKA CSM 19-4990 LOT 1 (4.815AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-29N-18W NW Notes: Parcel History: Date Doc # Vol/Page Type 06/03/2005 796657 19/4990 CSM 09/12/2000 629691 1541/578 QC 07/23/1997 1125/575 WD 07/23/1997 909/207 more... 2006 SUMMARY Bill Fair Market Value: Assessed with: 7 S7 4//L 149603 297,800 7,P7 y5 p Valuations: Last Changed: 05/31/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.815 45,900 171,400 217,300 NO Totals for 2006: General Property 4.815 45,900 171,400 217,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 10/30/2006 Batch 06-18 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS l 3 SUBDIVISION / CSM# LOT # SECTION " T'~ N-R d W, Town of `et.1 e)3"t"t' ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Ctire. 4 ` I 10 INDICATE NORTH A Oh' A Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 1 h BENCHMARK: ~,irisr•~ `~F*i~ ~'X f^'n d~dc ^ { / ALTERNATE BM: Y} ra / ~.4` / V ,6' tslrt c!/~ f -t1.+~c1 ~C7 r I SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION r Manufacturer:, err fG~~, Liquid Capacity: Setback from: We q House --7- Oth 11-t Pump: Manufacturer 4. A Model Size Float seperation . f Gallons/cycle: Alarm Location 4 ::4 SOIL ABSORPTION SYSTEM Width: Length efi Number of trenches Distance & Direction to nearest prop. line: wa^ 1f\\~\\ Setback from: well : House Other ELEVATIONS Building Sewer ST Inlet. ST outlet rw PC inlet $ PC bottom .ro s Pump Off a✓ ~ Header/Manifold Bottom of system Existing Grade 9 Final grade Qom- a ie e DATE OF INSTALLATION: 01 PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wi: ocsfn Department of.lndustr j PRIVATE SEWAGE SYSTEM County: Lab.r and Human Relaty°/tis INSPECTION REPORT ST. CROIX Safety and Buildings Division ' D`Yti (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION` Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI COWLES, MYRON & DEBBI X -7 CST BM Elev.: insp. BM Elev.: BM Description: Parcel Tax No.: Warre.. A9500123 0- 4 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic fk~ t%x Benchmark /00 Dosing ) ~'Op Ild ,~9' /aa Aeration Bldg. Sewer Holding St/Ht Inlet y~- TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Vent take ROAD Dt Inlet js,5/G QS. d 3 Septic 'too r 3 a / >a r NA Dt Bottom ~pe3• Dosing >168' 1'17' ° NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System i' ' PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number 40 GPM TDH Liftq,4,~{ I Friction System~S TDH/~,oyFt Loss Head Forcemain Length 8()' Dia. a a Dist. To Well,-,To F _j SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /o y• i DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. 02~ Length 0✓2 Dia. Spacing -3 Y ° 76 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over v Depth Over xx Depth Of f xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges 1o2- /ff Topsoil to - ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Warren.26.29.18W, SW, SW, 130th Street Plan revision required? ❑ Yes ETIN'o bU Use other side for additional information. SBD-6710 (R 05/91) Date I pe r ignature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION ' !.'~L■7■1 In accord with ILHR 83.05, Wis. Adm. Code I Cs STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ oc33 8% X 11 inches in size. Check if revision to pr vious application -See reverse side for instructions for completing this application. [STA!Wq 1,D l R I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. (JU'~ PROPERTY WNER ROPERTYLOCATION e6011 +D ~ ~~►w/ t!J'/4,-9W'/4,S ®?(o T2~,N,R g E(OrQ( PROPERTY WNER'S MAILI G ADD SS LOT # BLOCK # 7K d-Y CIS(, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Val- II. TYPE OF BUILDING: Check one) CITY NEAREST ROAD ( ❑ State Owned ❑ VILLAGE : ❑ Public ['l 1 or 2 Fam. Dwelling-# of bedrooms -3- PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) O 'Y ~Z^ /97/ 70 ®04'D 1 ❑ Apt/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 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check onl one in line A. Check line B if applicable) A) 1.E] 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 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 120 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy. 130 Seepage Pit Pressure 43 ❑ Vault Privy 140 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 IO ELEVATION REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 0 1 Feet ld R U Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass PI;3stlc App. Tanks Tanks structed Septic Tank or Holdin Tank ~0 GreiVt P/ O Ej 0 F1 FTI I F-I Lift Pump Tank/Si hon Chamber ,o VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Printt))::~ / Plumber's Signature: (No Stamps) M MPRSW No. Business Phone Number: Plumber's Add (Street, C' State, Zip Code): -~7 -9 6 7 A/ le 9- ai Uhf ` IX. COUNTY/DEPARTMENT SE ONLY 0 1 ❑ Disapproved Sanitarryy Permit Fee (Includes Groundwater aE te Issued Issuing Agent Signature (No Stamp Approved El Owner Given initial D Surcharge Fee) Adverse Determination lq5 X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS T F * n 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by 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 & Buildings Division, 6013-266-381.5. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must: sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations April 21, 1994 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 ULBRICHT & ASSOCIATES ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN S94-00924 FEE RECEIVED: 180.00 COWLES, MYRAN SW,NW,26,29,18W TOWN OF WARREN COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the.appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the lan number hown above. Sinc r ly, Pe er E. Page l Plan Reviewer Section of Private Sewage (608) 266-2889 SUD-04831 K. 01/91) SAFETY & BUILDINGS DIVISION State of Wisconsin ,-c l 0: L Department of Industry, Labor and Human Relations" April 21, 199 '(Ol East. Washington Avenue V. 0, Box 7969 Madisnn WI 53707 ULBRICHT & ASSOCIATE; ROBERT ULBRICHT 655 G'NEIL.L ROAD HUDSON WI 54016 RE: PLAN S94•-.00924 FEE RECEIVED: 180.00 COWLES, MYRAN SW,NW,26,29,18W TOWN 16F WARREN COUNTY OF Sr CROIX MOUND SYSTEM The Department has reviewed the above --referpnced submittal. Conditional approval is ht~ vehy chanted for the Systviii plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapter`t;A(HR 8'1 and 84, Wisconsin Administrative Code, and is contingent upon 1:omp'liance with any stipulations shown on the plans,. This system has riot been reviewed for the code requirements set forth in chapter ILHR 82 or in chapter(, ILHR 50--64, Wisconsin Administrative Code. This plan submittal approval will expire two years froiil,11t ie approval date, or if y permitis nbtained, plan approval will,,16'xpire on the day the , ini a ti salanisat.anirtary.petrlt/,expires---> The lica..nsedf jlimher responsible for this installation' shall keep one set of plans with,` he Opartment's stamp of approval at the construction site. The i#ttai t_s*` shall notify the appropriate inspector when inspections can be madle All" pc'riitit uire.d byl t.~te ~'Ify, village, township county shall be obtained prior tt)fh' staYTatictfi. , ,41 Inqui r ie's~ h t#1 c !0'(`L #o me a .th_ umb , 1 t+!'d br;low f P ease ef.er to the lan umber hown ~ih~~ve., a.c t.y Sinc .r ly, r 1~, P Pe er E. Pagel v' ;r:r;( Plan Reviewer Section of Private 5(-,!wage (608)-e26672889! SBD-6423 IR. 01/911 • ;r SAFETY & BUILDINGS DIVISION d State of Wisconsin 1 Department of Industry, Labor and Human Relations Apr i t 1994 l ; I k+d !":hirltat.:fn ;lv(?f1+ak ULBRICHT R013FUT IJIBRICHT 6,5S 0'Nf Ut iMAD HUDSON X11 54016 l?F PLAN .-'11)4 009?4 Fft RF".:I iVI0. 180,00 COW E' , M RAN TOWN tll WARRI"N CIMINI,i #i" `J ("RO I X 0101INO `)V, FMI the 14,partwrit hw. reviewed 4hp Cof-idititnel riIipf-oval I% Itvrt-!lg grattivf1 fr,,r thf,~ ;whniifj.al. All rlotetl itr'tnS r~)tiot ht., r's.~fx~a~trr1. fl)(-, rr-var>sa jrO pr-(;v,-0 .0 thr ,y,toTi is ha vd i-,n :_haph-t 145,, Wi,,f ow0,) ail tll< s (,md 84, liar t7rt;itt I1ilsrtirri~l.r~.)Li t;t°rd~~, stn+l ) ; r.rsrrtiri~ r~r~i rrl;rlrr , rrrnl~l ;r3r~z wfh arr.y ~;t1p0at:i0n: Owwti ;,r, thf-, plcin,, fhi' ;ti,ySt~?rTi h.)% !;M twi rrvlelS ?t r~-4f Hw f.;-mjpra~ri)irrit►~rrf~; "ef, ftrrlh in thaptei tfi•Il; fl,-, w '+rr r.t)al,l=-- ill-lh '~is•-r~4< i~~6;r~~~7rt~;lrr Adtnirti,,tail lvr-, Cfr dr, rhi~, plat) .tiiih!)iiLfal al,l!r ovil Sril1 r-ypit- t_wr, v(=,ar-, i~imi il:r t)r if a ar0 t,)r y purii0 1. I,, rrlii (6mr:.d' i; lan .rppro,ra~l wi l 1. xl~i y t, at) the day ! hr, iriif ial "'aflif;iry poririif r-xp1rfhe iir r-r)",prl 1.0unillivi f ~-,fiof,i,,i111e tr r t.hi ltrstailat ;On,. 01,01 keep r:rrr_~ -Al, ~(if €}lar2-; with lhF= j~I=t3r trr~r rat' ~t,~ml~r trf ~ttttrr'r~i?<tt <.if: the r~~i)r)'.trllrfl „r; hht- t-1fI;KII n;>ifh ~wt;rnlrriafe 1w."pef f<rr wh in 1rf,,l:it<0 irrns ('m be. made All ptrriilt -,rrrltriat`r+' try,#hf- ,iry, v0i~o.' trwn;h;t; ,so rm.irit:y shs01 be ilihIa"ine F~rit r tiz~. iri5f.al 1.Itit)Ti. ~ Itttitattir-> <.hf11)ir'i'~ii'~ dirt,-zr It~!ri-~tn,rtt~ ~r# tl frr+r{it~r-fit'=.7 t ~~irYsi Irc~7r~r.~.: I'lr~rt5f? ~f~r I+r thta lcrrr rdtrtnher `.t10wrl ,,Ibovrt. irrr. r lY, 1' l a Tr It. F'. U # t'', 4d F' r' r , E(? (f i o ri i J f r l v a t. arwd rl 0 bllt3,~ 266- t' t rt SM-6423 M OMI) PROJECT TNDEX SH.,";ET - - ADDRESS: 7 7:57 13 ST • ~b/3ElPT5,/S. SITE LOCATION: f. Y ~ ea S w N w i cV Ar F~ S T ~2 0 r' JC Co v.~ T o cv ,u 61= PROJECT DESCRIPTION: Q E t hGE~-~ e~ T Jul o U~ 1' S S T~ 'f-° r Z 3 r r - Aso G•r/ /o~Y w~ st~~lo~ . I'AJ S p: /s 4-A'016- P C 'R <-c 6 /31E- 5 GIoD l f~1) To'P /k- Gov ,vim w o u sl.ad A- So( '4- 10A01'.06- ie Ar at= Gp D PAGE 1. PLOT PLAN VT-,','IS PAGE 2. MOUND CROSS SECTION & SYS'12721 PLAN VTE','IS PAGE 3. PIPE LATERAL LAYOUT PAGE 4. DOSING OR SIPHON CHAMBER CROSS SECTIONS PAGE 5. PUMP PERFORMAlTIC'' SPECS OR SIPHON SPECS ~5 PLUMBER : ('1' N R y ~j G A U i l l p^ r M PQ S 3 2. 5 ors oti DATE: f.200, S I': iIATURE : 594-00924 a~ x! ' i •t ' . 1 i, ,,~ti; ~°a. Its t ~ f w i r n._~ "w L:. y; ' ~t 1 J 0 10 o 3 ~ N• o ~ ~ M o cn -v Q n t~ d A. m N C Q. 1wh o d, av c C p V~J o w w w cr M cti 'v ~i X RJ ~~•~~moH r '11 16- En 1-." 4A ir, • r+ovmmm Z o ► L o° ~ m a~ . 0 S J -w n a ca ~-4 - - - - - -i Lnn r ro o R. CA r e 1-x-0 "Q rr V. m m n•o w R I m o _r A CA y 0 H. w ° R N- olr c+ 0 °0 p p z~ o ~ ~ 0 03 ILA H• o m 0 :3 v, m r • r toc, eo ~ w o ~ 1 sE CIO 1 ~ COS 0 ' - N A 6hST PROP. N (1n N c L m G D I n ~ ~ ~ ~ W G~ nn m 3 10 13 c ~ L ~ ~ ~ o rr R IIA Lb 0 p Q cn Z - m o Q ~ ~ ~e Qo ~ In ro % S94-00924 I A)vt.R T- o,- 2 1,4 7-c AP41s i 0 z' YO - EGEU~T~o~S ro P OF P-OCK d G ' 1~ - Page ? Of OP of T 1 A T-E 1,' i1 L S 10 2. 5 0 Synthetic Covering Distribution Pipe Medium Sand H _ G s y stem Topsoil E16VATI•N Fo 10 1`o 1 II 1 t~ % Slope uN R ?YE D Bed Of it Force Main Plowed ' Aggregate Layer ~0~•90 /.0 Ft. /O0. 0 ± . 10 • ross Section Of A Mound System Using E 1'2. Ft. F .8o Ft. A Bed For The Absorption Area G Ft. 6 ~~1P A (e Ft. H s Ft. ONo B y Ft. V' K /0 Ft. L toy Ft. 0~ ~N PFD G~ i o Ft. T I q Ft. e Main W Ft. L Observation Pipe A ° o ~p - ' M Distribution Bed Of i Pipe Aggregate 1 Observation Pipe Permanent Markers l~ ~ Pl~G GrjPPE1~ S~E6L ,PODS . Plan View Of Mound Using A Bed For The Absorption Area 1-3,1-514 Z- 14,Pt = vA y u ~ ~E ~«v y5~o y ~~oPos~o rj,~s f►-L. ,41PE~- X, f 1 S94-00924 A( t - st~• yr- Page 3 Of • I' j/ D /Um E of= 2 U C ~OR cF Perforated Pipe Detail z~qRiGti T rve v,4f v.tiE ~ t; VAC v4 i "'0 A-; End Vie- )Perforated End Cop)) PVC Pipe (I . \ Jo~~o o^c~s Holes Located On Bottom, Are Equally Spaced A ~ P . * w /P PVC ~ Manifold Pipe Distribution IS>- \ Pipe Hole Should Be Next To End MgN~iolD~ g(,(sa~c Distribution Pipe Layout P Ft. R 3.o ` F~ of f UG X Inches AQ`E Sys-MM - - - - 7a Y ` Inches ppIS1T'E S Hole Diameter ly Inc-, e~y,{i► Lateral_ Inches; ,r ~o Manifold 2- Inches ~'J E Force Main Z- Inches jhRENT 0~ FS A # of holes/pipe 15' pEPP►R p / nvert Elevation of Laterals R. C~NCE SEE CDRRES ~iST[Zif3urtp,~ 3>15CHR I26ff IQ ATE FOR E-AC N L 1!7 R A L I" AIr O T i S V5 . 2_7 17. S-5 ds~ M I /J . V / TOTAL- "D~s'TQtr3urlQ~ _D ISCHA1 C E E FOR tvE T w o R 4` 3 5. I p 2. 5 ~-I i'N t' M U M ll r} E ~1 D 74 5t~- ToTP-L 1~ iS C,,4 ARG-G" MI'/JI'M.UM (~~4T1:~- of :1) ~F,s G-~ s y S T_E~ M . 894-00924 PUMP CHAMBER CROSS SECTIOU Ak1D SPECIFICATIONS A4 E g OF 5 VENT CAP 4"C.M. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 25' FROM DOOR. rF T lu~fQA//o(~ 1AAC1 WINDOW OR FRESH 12"MILT I AIR INTAKE I R~D., ~~E~iIT~On/ GRADE I I 4" MIAI. 0 i COWDUIT 3.5 u ~ PROVIDE I INLET AIRTIGHT SEAL I III J/ I n I I I -7 APPROVED JOIN7 A 1(V ('`C I I I ( APPROVED JOINTS W~C.=. PIPE IN I I I (I W/C.I. PIPE EXTENOIUG 3' EXTENDIMG 3' '001- I I I ALARM ONTO SOLID SOIL i r l ONTO SOLID SOIL I 34 ~I I I ow 13. ELEV. FT. 1 PUMP OFF I BLOCK 40 V~'Q' J H ,c c~~•50 RISER EXIT PERMITTED OIJLy IF TAWK MAMUFACTURE:R HAS SUCH APPROVAL SEPTIC E SPECIFfCATIOAIS DOSE DECKS CO.uG~Q,~-~ Co* TAWKS MAIJUFACTURER: IJUMBER OF DOSES: PER DA-4 11A • S TAAIK SIZE: O OO 1-P GALLDMS DOSE VOLUME 13 ZS, S ALARM MAIJUFACTURER: E~- /41hIe~ co IWCLUOIWG 6AGKfLOW: GALLONS MODEL IJUMBER: U L CAPACITIES: A= INCHES OR 30o GALLONS SWITCH TYPE: M'EeCOA Y FIOA T- B = Z INCHES OR GALLOWS PUMP MANUFACTURER: 2vell,&x r -m G-1 ? INCHES OR SC GALLOWS MODEL NUMBER: yi tfP I'T'S D=LLr•=INCHES OR 333.5 GALLOWS SWITCH TYPE: -PIGGY PjkC/< nF-EWRy FMAT- MOTE: PUMP AWD ALARM ARE TO BE MINIMUM DISCHARGE RATE YO GPM INSTALLED ON SEPARATE CIRCUITS • AA* Sr1FGS^~. VERTICAL DIFFERENCE BETWEEU PUMP OFF AND DISTRIBUTIOW PIPE.. 5 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET EACGI„ O~- y~ p IV1. ♦ ~E0 FEET OF FARCE MAIN X 2'GLF?►ooFLFRICTIOW FACTOR..1 ( FEET It-40,A 2-0s f►~STOTAL D'J JAMIC HEAD = 3• ~5 FEET 1 ~PavNl2 8 3 9 INTERNAL DIMEMSIONS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH ~ M SEWAQ`S gYS 019stm r) odju-MA T 1A, p G. EPARTME%j pf IN AfE pIVIS1 EN \ SEE CpRAEsPO CE S94-00924 i HEAD CAPACITY CURVE 3 7/8yf-- 6 1/4 MODEL "93" 4 5/8 30 25 t3 I - 1 3 5/8 6 2 m P + O 15 - 4 3/16 j 4 ~ 8 i O 10 ! 2 1 1/2-11 1/2 NPT it 5 h. .r s z I 0 } U.S. GALLONS 10 20 30 40 50 60 70 so LITERS - 80 160 240 r' 0 FLOW PER MINUTE r yyy' TOTAL DYNAMIC MEAD/FLOW PER L;,.UTE EFFLUENT AND OEWATENING r CAPACI { Y 12 HEAD UNITS/MIN , - y ,i FEET METERS GALS LIRS 1 ' 1.52 72 '.13 10 3.05 61 "?it 71 15 4.57 45 1 /0 J'1 20 6.10 25 95 3 5/16 • _ + Lock Valve a ,y CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, fo, duplex systems, are avilable and • Mercury float switches are available for controlling single and supplied with an alarm. three phase s, stems. o Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for without. alarm switches. variable level long cycle controls. SELECTION GUIDE Standard all models - Weioht 39 lbs. - i% H.P. 1. Integral float operated 2pole mechanical switch,noexternal control required. 2. Single piggyback mercury Iloat switch or double piggyback mercury, float 98 Series Control selection switch. Refer to FM0477. Model Volts-Ph Mode Am; . Simplex Duplex 3. Mechanical alternator 10-0072 or 10-0075. M98 115 1 __Auto I 9.0 , tort &7 - 4. See FM0712, for correct model of Electrical Alternator, "E-Pak". N98 115 1 Non 9.0 098 230 1 4.5 1 2 or or 2 & 6 i 3 or 4 & 5 5. Mercury sensor float switch 10-0225 used as a control activator, specify duplex (3) or (4) float system. Aulo 1 & 7 6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in sim- ~i` t'. E98 230 1 Non 4.5 2 or 2 & 6 3 or 4 &5 plex or duplex operation, 10-0002. 7. Two (2) hole "J-Pak", for watertight connection or splice. CAUTION For information on additional Zoeller products refer to catalog or Combin anon Starter, FM0514; All installation of controls, protection dev;cee r r d wiring should be done by a quali- Piggyback Mercury Switches, FMO477; Electrical Alternator, FMO486; M•:chanical Alternator, lied licensed electrician. All electrical and ra:,Ny codes should be followed kwki & FMO495; Alarm Package, FMO513; Sump/Sewage Basins, FM0487; and '?implex Control Box, ing the most recent National Electric C%de jNEC) and Ilea Occupational Safety sad FM0732. Health Act (OSHA). 'l RESERVE POWERED DESIGN t For unusual conditions a reserve safety factor is Engineered into the design of every Zoeller pump. MAIL T0: P.U. BOX 1634 7 Louiswille, 256 034 Manulacturers of... ~ SHIP T0: 3280 0,':' P.hil'eis Lane a ~ra ti fees Loci>vu,r, Kr 4,,,.16 QUAU>•r~vs SAff /9.79 (502) .'78-2.731 0 FA V 1302) 774-3624 S94 - 0~0 9 2•4 4 i PROJECT INDEX SH*~:FT O~#' AER : 713-- 7`W, y/S/ ADDRESS : 7 7~ 13 D vz~L '5!7-. R& 3,6w r5, 3 SITE LOCATION: { / ff ~ilS S w~ N W S~ . Z~, T i-~t 1e l~ w cP-or'x CouA.)r PROJECT DESCRIPTION: E t,4~E~-,ear ~cov.~t~ sysT~t-t -pote 3 So//s'E Pk~ffA-ci4 131E' l1-~ wt' - ~oap S vc-IV RE- - /I v?- -,V 0'oex=r- RES f7, P Er- /,-D r go f t' I e- , T4x,,.-- ip A- pIrr-0to ~-tou-4--~ Peg-) 1-5 ash , us/o~ SDI L IOAD"A36- at= G-PD /'Ff . Z . PAGE 1. PLOT PLAN VI?~;',VS PAGE 2. MOUND CROSS SECTION & SYSTrM PLAN VTEWS PAGE 3. PIPE LATERAL LAYOUT PAGE 4. DOSING OR SIPHON CHAMBER CROSS SECTIONS PAGE 5. PUMP PERFORMATTC" SPECS OR SIPHON SPECS o &I PLUMBIC.: t' e N R,/ e G A U i I I C_--. l~ IP 12 5 3 2_5 PQ ~ O DATE: --:2••0 S I ~ ,NATURE : S94-00924 i t a ,Y 1 a 5 T. r k 0 N ~ ~ I ?Q ~i 7p 0 1.b w fit ~ a w p 1.m aa• H, o V1 -V Q A n W n d a• D • " W. (h m e O Wwtocrm Q M x m ? :3 :4 for w W m O H V 6~) 11, R n En C12 0 vo C: 0 =GQ Pi :3 T mm fpnc'r' H o ~1 'I~ ~ En aJ I 0 ~ 0) m M b "o r r .mm"1o co i tf Cu y 04 m ~ , I ~ wr*~wwo I s c~DOOmH~ 1 I u CIn ~ y rA 00 r7 R 03 D O a o -G~► 0 03 (D~ oo 0c mpi v,• y O c Q' N C ~v 0 Di r ' Q• QO N 4=0 Mo o ~ ~ ~ N i GOQQ, 8 49 1 I j o I 1 , Z 1 a► O o - elm 4 CUP o I~ - LA bhST ~Ro~, L . a G c c D I M ISZ In "i 1~ 'x o Q ~ zLA ° o o It w 3 ~ C ~ Ao ~ ~ O ~ 11 _ Q O 4' rq ~ O ~ w asp S94-00924 INVT- o~ 2 /4 TcAPf1/S I o z. yD FtEV47'1on) S 1'0 P u F R O C K I d Z. G ~ - z Of 57 Page Top of 61- 10 2. So Synthetic Covering Distribution Pipe Medium Sand H a S y fTEM Topsoil E16VATI00 -J IDI90 -LD 3 E r1 y % Slope ~N R Bt c7 Bed Of it Force Main Plowed ' Aggregate Layer ~vo•90 Uti~i:~2pM ToE G•/VE o o Ff. goo. o 401vtross Section Of A Mound System Using E i' Ft. PG~.y ad Fo`pgAhe Absorption Area F Ft. 'i G Ft. A Ft. H Ft. pg Ft. K /d Ft. L 10V Ft. X04 5Q O J ? Ft. QP~~~ 0' GOQQ~ I I q Ft. Main W 2 o' Ft. L Observation Pipe g --.i•- K A ` 0 ~o W ~•--1---------- *I Distribution Bed Of '120 Pipe Aggregate I Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Z- 14A6 X 74 /'/e'zO / ~ TA /'/C 0 S94-00924 ,4RE.+ (s/v~~,~G- ,.rte = G x A X ~ t _ / ~~D sty r-7 • Vold D 111M E 006 r). o RUC Page 3 Of 13. 5 /,4c~ /.4s r Rio/E. Perforated Pipe Detoll Zr,9,01'Gti r Foe bill v~E t, VA V 4 7--* *VA..) 0 End View )PerfOroled End Cop) PVC Pipe i. • Hole: Located on Bottom, Are Equally Spaced R P PVC / Manifold Pipe Distribution 15r \ Pipe Hole Should Be Next To End r Distribution Pipe Layout g~~. P Ft. R 3.o ` F~~g ~M - --'L f UG 7o" 4ole Inches Inches Diameter X/ Inrl-, E5 Lateral 10 Inch(es) v g Manifold 11 2' Inches ~ti Force Main 2, Inches #of:holes/pipe /S o,01A p NO Invert Elevation of Laterals • -Dt'STRi6L) O~ GHA QGE- RATE FvR e-AC N L.ATCR AL h;eir. OTiS 2- 7. S 5 • TOTAL "DiST12lr3url0,,1 DISC HAR6.., E RATE F0 Q, ►JtE Two R k 3 5.1 0 :2 1',4-f LtIA1 I•t iff ,t ~ uSt~' To-r,-4i- 11cS CAAR&- M f'Nf'MVM IZ~4T~' of Yo :1) ~'-s r G-Aa s y S --E- M . S94-00924 PUMP CHAMBER CROSS SECTION AkJD SPECIFICATIONS )R4jE OF rj VEUT CAP 4'C.I. VENT PIPE WEATHER PROOF APPROVED LOCKIAIG JLMCTION BOX MANHOLE COVER 25 FROM 000R, ill (~/WA#J.J(r IAIVI 12'MIU. WINDOW OR FRESH AIR INTAKE RAD./E`A7~ON GRADE I _ I `I0 MIAJ. 7f IB" MIN. ` COIJDUIT-- -3.5 v yso PROVIDE I IAJLET -T 13. AIRTIGHT SEAL APPROVED JOINT A 5,l(Y 1JC I I I APPROVED JOIAITS W/C.I. PIPE ~N I ~~~{~M I III W/C.I. PIPE EXTENDING 3' 'DO I ' 1 I (I gLgRM EXTENDING 3' ONTO SOLID SOIL ^ ~j I I I I ONTO SOLID SOIL 13 (3. / 1.- I I I ON l~ c 3~1 I ELEV. - FT PUMP / ,(AN v PPIAl BLOCK ~ lE _ 11.50 * RISCR EXIT PERMITTED OAJLy IF TAMV, MAMUFACTURER HAS SUCH APPROVAL SEPTIC E 5PECIFI'CATIOUS DOSE G~~ECKS CO.t~G►.Q.1-~ ~O TAWS MANUFACTURER: IJUMBER OF DOSES: PER DAy goo ~.p . 'MME TAAIK SIZE: GALLOIJS DOSE VOLUME 13 ~ ZS, s ALARM MAUUFACTURER: 1-~ EL_ AIhIQM co INCLUDING BACKFLOW: GALLONS MODEL IJUMBER: D') - L ' CAPACITIES: A= /I/ G INCHES OR 3Go GALLONS SWITCH TYPE: mEiecogy FtohT' B= Z IIJCHES OR GALLONS PUMP MANUFACTURER: 2otllA~5& r -a G-1 INCHES OR ~2 S' S GALLOWS tr- MODEL AJUMBEK. Vl' Ifp BLS- D=Lv• INCHES OR 33 3'5 GALLONS SWITCH TYPE: PI'lrGY "Cl< H>F-PCV y FLOAT- MOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE _ZO GPM INSTALLED OW SEPARATE CIRCUITS Srn>Ft;s ' Aak VERTICAL DIFFERENCE BETWEEN PUMP OFF AKIO DISTRIBUTION PIPE.. S FEET + MIMIMUM NETWORK SUPPLY PRESSUR~7E//. . . . . . . . . . . 2.5 FEET EAC(A, P- ♦ do FEET OF FORCE MAIN X 2'GiF/ooF[FKICTIOU FACTOR.. I FEET E-40A ~S 2-0. S ^/S. c TOTAL 09WAMIC. HEAD = 13, k'5 FEET T ,P014,10 S y 3,9 IMTERNAL DIMEWSIONS OF TAkJK: LENGTH ;WIDTH - .;LIQUID DEPTH ITE SAGE SYS~ pNS ZME~T fl~ INflV S ° `A ' I ~ OEPAR ~jIV1~lON S94--00g sss COaR~sP~N~ 2 i (n Ce W HEAD CAPACITY CURVE 3 7/8--~•-- s 1 MODEL "3s" 30 4 5/8 a 25 9 I. 3 5/B = 6-2 m L) -1- f 1 15 - 4 3/16 r- 10 y 1 1/2-11 1/2 NPT 2 5 { D f U.S. GALLONS 10 20 30 40 50 60 70 80 LITERS 80 160 240 0 FLOW PER IMiNUTL I - TOTAL DYNAMIC HEADIFLOW PER 1.1'r,UTE t. EFFLUENT AND DEWATERING CAPACi.i Y 12 HEAD UNITS/MIN y FEET METERS GALS LfRS 5 7.52 72 2 r3 10 3.05 61 271 15 4.57 45 110 g 20 6.10 25 95 - 3 5/16 Lock Valve 1 t CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, to, duplex systems, are av:Aable and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. { a Mechanical alternators, for duplex systems, are available with or a Double piggyback mercury float switches are available for without alarm switches, variable level long cycle controls. SELECTION GUIDE Standard all models - Weiaht 39 lbs. - s% H.P. 1. Integral float operated 2 pole mechanical switch, no external control required. 2. Single piggyback mercury float switch or double piggyback mercury. Boat 98 Series Control Selection switch. Refer to FM0477. Model Volts-Ph Mode Am; s Siimpllex- Duplex 3. Mechanical alternator 10-0072 or 10-0075. r M98 115 1 Auto_ ! 9.0 , 1 or 1 & 7 - 4. See FM0712, for correct model of Eleclricai Alfa!nalor, "E-Pak". N98 115 1 Non 9.0 2 or 2 & 6 I 3 or 4 & 5 5. Mercury sensor float sw tch 10-0225 used as a control activator, specify D98 230 1 Auto 4.5 EE2or or 1 & 7 duplex (3) or (4) float system. 6. four (4) hole "J•Pak", junction box, for watertight connection or wired-in aim E98 230 1 Non 4.5 2 & 6 3 or 4 & 5 plex or duplex operation, 10-0002. i _ 1 - 7. Two (2) hole "J-Pak", for watertight connection or splice. For information on additional Zoeller products refer to catalog on Combination Starter, FM0514; CAUTION Piggyback Mercury Switches, FM047T Electrical Alternator, or. Com ; M, achanical n Alternator, Ail installation of controls, protection dev;ces + r d wiring should be done by a queli- FM0495; Alarm Packs Switches, FM Sum tied licensed electrician. All ofectricaI and ra:,Ny codes should be followed ktgya. g ; p/Sewage Basins, FM0487; and implex Control Box, ing the most recent National Electra Cpa!e (NEC) and the Oeoupsllonal Safely and FMO732. Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factors d glneered into the design of every Zoeller pump. MAIL TO. P.U. BOX 16347 TOil/; 40256 0347 Manufacturers of... Q SHIP IP T0: 3280 80 0%:' 1'rfil,'ers Lane Loci: vide, KY 45._ 16 QUAL/7Y Aw" ANT T Aff (501) 778-2731 w F1.Y 1502) 774-3624 S94-00924 I Wisconsin Department of Industry, SOIL AND SITE I REPORT Page • Labor and Human Relations _ Of Division of Safety & Buildings in accord w' 83.0 ,5, WIS. Ode COUNTY57- Attach complete site plan on paper not less than 81/2 x 1t es in i n ust incl 401, ut not limited to vertical and horizontal reference point (BM) tiono ofloale PARCEL I.D. # dimensioned, north arrow, and location and distance to n t ro f ' ' APPLICANT INFORMATION-PLEASE PRINT ALL 1RMA•I"1N~^ REVIEWED BY DATE PROPERTY OWNER: (a R ATION .tiy~~t,v D (3~C3i ~DCV DES F ^ ^ w 1/4 Nw 1/4,S2.6 T 2L? N.R le E (or) W PROPERTY OWNER':S MAILING ADDRESS BLOCK # SUBD. NAME OR CSM # 775 13 o Ye, sr • CITY, STATE ZIP CODE PHONE NUMBER OCITY []VILLAGE EYMN NEAREST ROAD Ro,~3eRrs 40is, ss~oz3 (715 )75~~-R / ~v~Aee v 130 tt;. Sr. [ ] New Construction Use [ Residential / Number of bedrooms .3 ' [ ] Addition to existing building j.r'Replacement [ ) Public or commercial describe ri Code derived daily flow _f X0_0 gpd Recommended design loading rate bed, gpd/ft2 trench, gpd1ft2 Absorption area required 3 157 bed, ft2 3 -15 trench, 0 Maximum design loading rate ✓r bed, gpd/ft2_ trench, gpdftt2 Recommended infiltration surface elevation(s) S FF P 3 ft (as referred to site plan benchmark) r Additional design / site considerations See- N oT s P% • L ent material 5C5 GQ - 3A+.nWAG-0 ,j Ec4r` r7- Flood plain elevation, if applicable ft IO O Q L p 1 S = Suitable for system CONVENTIONAL MOUND IN-GROUND FSSURE AT- S DE rRT SYSTEM IN FILL HOSING TANK U = Unsuitable fors stem ❑ S t~'U [9.5 ❑ I I ❑ S L~' Blu SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 0-7 / YR 3/3 5r/. Z,~w►,Sdk 4"-FR cs 3f 5 f3zt 7-2o, 70 Y,e 1113 3 bye , f.e ~ s Ground 2C I ?0 •)-f /o yg'13 S1 -Z f sb/< C5- of , S .6 elev. ft. 2 L y. 3f s yR '//6, Am, S. n, s sZ .,0 Depth to ZC3 y y'o /o YR S/y 5 f S bk Avk U l N i,%3 fac~torg /o Y/e 6-,,`.3 ? 2-5' Y/2 /i• sir D ~f rs 3% ~xl•~ai Irt~ Remarks: [ oft ~'Zoa 2 C 3 i s m-m os 7- 14r4s s eas- ve-A r Boring # /o yie 313 s;/ 2 s6,C fie cs 3 `F 's 2 ~ 132t Z8 o Y,4 y .2u F s .G Ground uf- f elev. ft w 4• •5'.9~ 4g,+7~ if 5 . .-Depth to limiting. I•Zoa o2G gEGd~wES ES'Sivr?` dE S~ ~l O.S• factor & _2. S %OF DES N r¢SES . Ir IVY Remarks: _ CST Name:-Please Print Pogear I bQ fGGt"~ Phone: 71,5"= 3 RG Address: (p S D ~A i L • l~V DSo c~ I 5. v/0" Cp y- 7 ~ csr y Signature: Date: CST Number: ORIGINAL r 0'a , PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BoundW Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed w--ich S 3 O•/o /o v P- 31 -3 Si I, 2,f , S bK nM -Fr, C3 8f 13Z~ L710-u/oV4y3 SO 3 MAbk tm-fR S v~ .S .G Ground 2-C t Z-3v /O VA S/ - 5~ L A., S bk I of • S AP) elev. ft 2C, gp o S/ I-Fsbk imuf,' N age Depth to S ,aD Ctv- `D~ v ie limiting ' fac3 ~ ' Remarks: Boring # ~T•~ /ftiov Li o T 'cam/ /r'F• vo X /'.~i R ~ ~ c- o p~~ ~D ~~-h (M rri-<'.vlr 6v v:ovs, All 10,,Y5 Rollo /:v ~ cti ,~-~r~Ri'sfi c - ,y.~,v f~' ~i 'c / ~ i 5 ~f--~i• f v y OE sE- ~;p Ground vo r0 IfR&- T y VIA, -rA R uy 47 elev. ft. i /Tit W < 40 Depth to limiting h /1 I/•¢lv 5 /oYie 13 2 , G/2- tactor or 0 ec vie I N S,4 7~!>.,e/+ D C .v1~i T/ OA S - NdT Remarks: /}Pd''** 2/0 /~E S,¢ Tv /P~ TAO SUE 7-0 /fC7-1 E' 11' G. W . Boring # ~5~" S~ •v5 /PE- OV 'al 79b,e vll";,m~as"1111M Ground .L~~ G elev. O &l f r" f-r 7qkvU 4 ft. rj~ G7/tj~~l~ /¢~i~IDST fC yVC i2 yr U OD • Depth to limiting 71~5~ S ~/S lvol~LD .4D1~ S~0 f~Ec factor Remarks: s w o U LLB (3a7 p r' iF1=t' e v L. T To E X CA UAT E Boring # Ao T'Reo 5 aP, f r 5 1= S S'C'I' k~~ SO !S F: h s /N EF L-ve a PC-1)L)1' x ,Gu r d PT, Ground o c v R . /'S SG O U.v S I~ y`~ elev. ft. -W-6 PA-- 14- 77 'Depth to / , limiting 4-vAs 6- factor Remarks,,. con 0~13nio ACW" { r l 13 n TIC S7. . I RI O lab T 0 3 rC to •C 0 CIO tA -0 r% r h g . 0' o J `Q - • 1510 v► ~ . V ~ W ~o 0 r o - ~ ~o -c o~ h O lit W -e_ C. t o T L N N a ~ ~ c D n ,n C~ m m ~ v T t R ~ u+ W rr ~ ~ p vn d c -r C ~ M ~ r o n w v m 0 Q r4 u' 10 I-N 0,0 tA % o y STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County O V, ERIBLF ER 4V MAILING ADDRESS A8 PROPERTY ADDRESS ~I- (location of septic system) Please obtain from the Planning Dept. CITY/STATE ~~d s lvlk PROPERTY LOCATION -S U) 1/4, 1/4, Section T N-R W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUM13ER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. UWe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date SIGNED: DATI: - Q7 ° r- St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 _ This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property cu Location of property, 1/4 -9V 1/4, Section 0 j4; T N-R Township 1'/Vcz b h. N Mailing address 77.x" ! a A0 6 a 6017- Address of site S' a m j Subdivision name Lot no. Other homes on property? Yes !/No Previous owner of property AO,-Al~a Total size of property 51 Total size of parcel Al Date parcel was created Are all corners and lot lines identifiable? ---Y--es No Is this property being developed for (spec house)? Yes ✓ No Volume and Page Number J-07 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of Applicant Co-Applicant Date of Signature Date of Signature DOCUMENT NO WARRANTY DEED " -A L R!,r,rv ED FOR Rlf.n ROrNC DUA STATE: BIR OF WISCONSIN FORK 1982 471559 VOL PaIJE `0'7 REGIST'ER'S OFFICE .Richard .Harold Thompson and Konnle Kaye ST. CROIX CO., WI Thgmps.on,..husband and wife as marital Recd for Record survivorship. property - - JUL .16 1y91 conveys and n.rrrants co . Myren R. Cowles and _ Deborah 1*4-% 11:20AM L. Cowles, husband and wifa 0 gister of Deeds the followia4 described real estate in 0t_ Croix State of Wisconsin: Tax Parcel No Part of the N?D1-L of the NTV and the SAD,. of the AI,D4 of Section 26-29-18, Town of :Darren, more particularly described as follows: Lot 1 of Certified Survey r'.a'1 recorded in Vol. "4", Page 989, Doc. No. 366521, EXCEPT Parcel , Certified Survey Map recorded in Vol. "6", Page 1509, Doc. No. '045, St. Croix Register of Deeds office. I ~ 3 bra PEI! This i S_ hnme,tcad ,re I pert. (is) (is not) Exception try winrranties: Uatcd this ~ 2 rX day of July 18 91 . Richard Harol:i Lhomnson Konnie saye hompson (SEAL) 1SEAI. AUTHENTICATION ACKNOWLEDGMENT Signature(s) . _ . STATE OF WISCONSIN ' - ss. Count% authenticated this day of.......... - 19- Personally came be ore me this 12th day of ----------------ICY. _ , 19.-_91- the above named . Richard Hamm. Thai; and Kormie Kaye. - ihrnpsai, lu5®r] and wife TITLE: NIIENIBER STATE BAR OF WISCONSIN (If not, . authorized by § 106.05, Wis. Scats.) ' do me knowr, to he the per-on s- c!„ excc+ted tl:e 1' ere_ in<truw., !:t t^d aeknot, 1, d t "u . aen . ,-'..3 INSTRUMENT 'NAS DRAFTED DY n ristina r:-Ian,,, L,unde~ n O r y a t La ; i Marlene M. Peterson Notw Pu!,lir IT. Croix (Siznatures may authenticated nr ackn(ovlyd;erl. It(,th ~Tv t'r,wtgi--inn .1,- 1! Writ, ;r., r are not necessary.) dote: 4-5- I(t 92 i -flames of D^r%,- ?inning in Any -pro ity r. , .....i ! n r.. . WARRANTY Lf: F.7 A i F. RAa OF %%I1 Cr)l:. iN r i:N ':n. 1 AS BUILT SANITARY SYSTEM REPORT aN 1 4 1981 OWNER('r- Q, Y-- TOWNSHIK 3 EC. T N, R W ADDRESS ST. CROIX COUNTY WISCONSIN. SUBDIVISION , LOT LOT SIZE PLAN VIEW B 9~ Distances & dimensions to meet requirements of H62.20 lp SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ gas vz~ t. AR j NI 0 o - ~ Y - 3 I di ate o th Atrow ' SC L i SEPTIC TANK(S)t-10~c~MFGR.CONCRETE ^STEEL, No. oT rings on cover Depth PUMPING CHAMBER SIZE - PUMP MFGR. - ~L NO. GALLONS Per Cycle TRENCHES NO. of width length area BED NO. of lines width length " area cbzp Np dept to top o pipe NUMBER OF SEEPAGE PITS Outsi a diameter total pit area - AGGREGATE PERK RATE AREA REQUIRED AREA AS BUILT Disclaimer: The inspection of this system by St. Croix-Cdunty does not imply complete compliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to determine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYTEM. INSPECTOR DATED PLUMBER ON Jo 'hl LICENSE NUMBER tom. - 54 ?1 t 3:10 REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM Sani"t.zay PE nm.c t 7 State S e p-t.. c s"f_ 1 A M E~/_n~f~Jt~►~,., l o w n.~ G► E p S C n o x County u ca t on JSe.CxiuniLo t Subd~ vi~i on. 1PTIC TANK S4"ze___-_JQ_Q.© _._gatlon4 Nurnben oA cvmpan,tmen-t,6_ _ '('6tance An.orn: wekt. kj0 Building--_I- 120 6tope__ Highwa-telt 'NMPING CHAMBER S4 ze gatton4 Purnp ManuAaetuiteh. Mode.K Number- - JI_UlN~~ iANK Size gat'Lane Number aA Compantmen.6_, P u rn p e ft - - - A t a n m S y 4 -t e m _ An.tanc.e Altum: Wekt_- Buk'tding___. 12% stope___ Highwate.n (;SORPTION SITE Eie.d J T'ten.ch -1-t a n c e. A tt o. rn : W e t k_ B u-i..E din g.__._& s1~ f2% s tope Highwaten (;SORPTION SHE DIMENSIONS W('dth oA tneneh - At Requ-ined area At Length oA each tone A-t Depth oA noch be. ow t~Xe ~ ~ en Numbed (PA trines Depth uA hueh uven, titc T.n fo tax kenq-th OA fines A Depth uA ite be-tow D.i.Atance between T4'ne.1 _ At S.Lope oA tneneh--- ;-in. pe.n 100 At 1-otaf abA o&ption. atea_6jS~ (I t Type oA Coven: Papers on. a-.raw SIT DIMENSIONS Number oA pi to GnaveP. around pate yea nu Ott-tA.l'do d.i.ame..t(2n. At Depth be.Low ink.e-t iotak ub6on.ption ane.a At Ait cu )i cr1u-i1t-et 61t N VI C I I D I.S V- TITLE - DATE - 19 8 IPROVE D I JE CTED DATE 19 8 ' 1 A S ON F O I'Z REJECT 1 O N .13829 REPORT ON INSPECTION OF SANITARY PERMIT # 1 Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection - ?"o-1- I - Time of Inspection a ress, LiqenseN~. s a ing Plumber z C 3 INSTALLATION ONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepa a Bed ❑ Holding Tank ❑ Fill System N ermanen reference Point) Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: (7)DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO 8 HOLDING TANK: Manufacturer o ga ons construction ; depth to the cover ft; If septic tank is being used are baffles removed? YES ❑ NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ N0; Wired? ❑ YES ❑ NO; Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; li.neal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? YES ❑ NO DILHR-SBD-6095 N.05/80 Signature of Inspector: PLB State and County State Permit 67 s Permit Application County Permit # ~ for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: tn,► t 0I, B. LOCATION: hJ Y4 V-SR Section Co TZ N, R ~ E (or) © Lot# 1012 09City Subdivision Name, nearest road, lake or landmark Blk# ~J 2? 14'OE Village Township W 1; IJ C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) Variance Single family X_ Duplex No. of Bedrooms 3 No. of Persons D. SEPTIC TANK CAPACITY ~ O OO Total gallons No. of tanks HOLDING TANK CAPACITY - Total gallons No. of tanks Prefab concreted Poured-in-Place Steel Fiberglass Other (specify) New Installation- K Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab co~crete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: X_ Lengtha 5 Width -Depth 3(D Tile depth (top) 7-b No. of Lines Seepage Pit: Ins' a di r Liquid Depth No. of Seepage Pits Percent slope of land. - ~4 Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the ertified Soir Tester, NAME C.S.T. #,56-02140 Zand other information obtained from ~tuT I ( caner builder. Plumber's Signre P # Phone #4 z5 Co 3 7 7 Plumber's Address W t N / PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. E 1) 4 3 40 A, 2 5. A s . w 75 1QO~ s~c Bt t83 tar T Do N Write in FSpace Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application /d Fees Paid: State County Date Permit Issued/Rs}eeted (date) /d -o9-'2 -td Issuing Agent Name Inspection Yes X_No State Valid* Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 E is Rev. 9/78 /99616- V` Z 2~ acs , REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION: *C% NC%, Section 2 6 T_ N,R SE (or) W, Township or Municipality Lot No. , Block No. County Q, Subdivision Name Owner's/ uyer Name: ✓.~,PE& T m m&-ea m Mailing Address: - 6050; RV,&I. 'Re Q. A FTONJ 71 c*&-►'v ' 5500 TYPE OF OCCUPANCY: Residence X No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM - OTHER DATES OBSERVATIONS MAD SOIL BORINGS L/9-11000. PERCOLATION TESTS P-22-000 00'2-3-P2 SOIL MAP SHEET C NAME OF SOIL MAP UNIT ,fAAJZV2L40 PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE I`!UM- SINCE HOLE HOLE AFTER INTERVAL BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- P- P- P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES u A.10NE *7 8 D''/~iV 01, l L" Lf' $4 . Sj/ 13N-A4 Si. z B- s . B- NONE > H- /-u . Si , / 2 " L7/• 9a. • B.v Atee SL B- w C 6,} 4-/ 0--, " mw . B- IVOA)E 7 y~ / " ~b• Si / "L • /R,) . SS11, 2T- OAP. $G Li~vt spa v B- /3 47- " PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. s~ / /3.gf~i~t uT To A.4vE To/ T , oovP a s N E R 7/v' Dot' ~!lr z e .m SEwD~P~4i Ae~-` >E a ; T S~TE. ~L-_~M ? f~_ ?E.~ QM/~IPx . 12- a_/9 l 113 i N 13 y 13 a.. C, lad T 33~~ = z >9 MA _ - e 413 ae - E1 /~4io 1Df ~r- l~i~l I Two- ~ I, the undersigend, hereby certify that the soil tests reported on this form were made by me in a rd with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) 7, n 120bO r I b RI G0 Certification No. 5 5- 0:ZM_ Address i - E ' L- wI S S WIS ILL - Name of installer if known I Copy A -Local Authority CST Signature P ~ EPO 9 P" V RT ON SOIL BORINGS AND PERCOLATION TESTS G"'I ISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION: J5 Section 26 T l y N,R /6 G~/rjiP~EN~r, E (or) W, Township or Municipality C~ A Lot No. 160 A, Block No. AN AREA ~BELoNy/iV (r ~o J • GR R HAM County. .MM E Subdivision Name Owner's uye Name: / l7 Mailing Address: T(Op RPER )Pei . 4jrr,0A.-' ✓~Jr00~ C~ i TYPE OF OCCUPANCY: Residence X No. of Bedrooms -3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW A REPLACEMMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: IL BORINGS 18' PERCOLATION TESTS ~0 SOIL MAP SHEET SG NAME OF SOIL MAP UNIT s~1^~ ~y~ SiLT Lpr)M PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD I PERIOD 2 PERIOD 3 P- l 50 .l " G• Qa. VI 2-0 O 0 y O y P- AV - 5Z_ . P- Z 5*0 0" ,4AI- Al 12, "4f, 8A) Si/ L " ~ O l /.S- P_ P- 3 5 8 " a. s./ 13 s% 20" 0 3 'y s SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES e- No,;E 7 74 /0S,/ 13 /Jv. Si/ -~6 "4 SG 61;A AW-1 C44 B_ ;4J fAvj2 Oe,4 OA; B- 2 2.0 NOrc1c '712-0 0" /.1A1 . i/ 2.0" L J, v. Si/ 2/" Of - $Z 6Z B- G 6w . - c B- 'F NA0,F' 7 "'/1N. Si/ G •-QN , Si SC w Tc B- Fiat oq, races -A oc eTs of a PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of'square feet of absorption area needed for building type and occupancy 64C -SQ• F - Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. . ~ X M of l Pie" W~ -71 1 { r 3d' 1-24 909. ED i 14 vV5, 15 4, I o T_ v 17 1, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) T Certification No. J J _ 2- YP 2-- Add O' QQSoti ress . .Name of installer if known EC U E f/ / UJ Copy A -Local Authority CST Signature % r ~ y ~ e r ~~2 ~ yn, { t ' .i ~.A. ~ v ' . „y:. _ . .1 t v. i L \ 4 v ~ / 1 - P I y , A p 1 f Nip 0 u 9 (P N 0 47 # _ ro v Qu f . o%7 d) jog v _ a, C CP Q e 07 W N ro L)i i ow a~ • ✓1 ~ ° e, f~ Y i- T r c;, :T f'r~ ► i_F w r .r,r ,a"'f"' ~r:r d t i I , ~ ) I ' i < Si i I . 7 ' I t ' 1I r ` i i I i I ' 7 y f i : r 0 ~ I 1 I I - ( 4~ 1 , r ! i I ! i L. 1 ~ i 1. 4 ' l i I 1 ~ ~ I i I i S i ~ C . i ' d I 1 t Al I t' lr -T i 'I r_ Y 'i- . f' . 1 Cluj Ic in -in y, , :.1. 11` T 1 , f t.. j I a r .f r ZONING OFFICE ST. CROIX COUNTY CERTIFICATION STATEMENT S =t FOR UTILIZATION OF AN EXISTING SEPTIC TAKI~. `Y / r This is to certify that I have instank y dence located at: serving the `.4 s,s owl resi Sections , TN, R Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly.,. e Last time serviced: A Did flow ~Ck occur from abs rption system? Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes 1 C Q t"., ` r1 1 4y Capacity: Construction: Prefab Concrete Steel Other Manufacturer: (If known): cc~ Age of Tank (If known): 4 (Signature) (Name) Please rint (Title (License Number) Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet,bd`ffle). MPRS Name Signature -GOIMMERCIAL TESTING LABORATORY, INC. 514 Mdin Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.S 05568/01 PAGE 1 ST. CROIX COMITY REPORT DATE! 5/24/91 COWTHMSE DATE RECEIVED: 5/23/91 HUDSON, WI 54016 ATTNI THOMAS Co NELSON J OWNERS Richard Thompson LOCATIONS 775 130th St., Roberts COLLECTORS Mi. Jenkins SOIRCE OF SAMPLE1 Outside faucet COLIFOR"Of 0 /100 at INTERPRETATIONS BacterioLogicaLLy SAFE NITRATE-NS 5 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIANi Pam Gane WI Approved Lab No. 19 I O`A DEPENDf J v s < Means "LESS THAN" Detectable Level Approved by: o PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse a- 911 9th SLrcet Hudson, WI 59016 Telephone - (715)386-9680 The ft. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be clone as soon as possible after fee and form are received. WATER TESTING----------------------------- FEE: $ 25.00 oC~ OC~ (For nitrates and coliform bacteria, WATER TESTING FEE: $127.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 j (Determines if system is properly functioning at time of inspection) Property owner's name__ Property owner's address /30 Legal Description 1/9 of the 1/9 of Section T2N-R/_ Town of CYII•r~ Lot Number Subdivision Name FIRE NUMBER LOCK BOX NUMBER Color of house - Realty sign y house?- so, list firm: PLEASE INCLUDE, IF AT ALL POSSI LE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be b running purged y the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requestin services: Telephone Number-_,_ g 6 REPORT TO BE SENT TO: ~QQ Closing da e Signature "WARREN T29N:-R.18 W 29 E SEE PAGE 43 1 11 O Crania • ~ HRE r ~ ~ C/¢renee P • Lo n i E ON u /,.r,fcd A/~'ES, y r7a rt it ` s~sc Richo/uC Gcro/d G. SConnie Ken (jar, • /r%inti 9 Farrs7s, r ~yy, SrK, C/ub, .rrc. 7a .rte /urz¢ ,Poberf 63 C.Mue/%/' Ina SM o%. YJ • G n (L • lTohn 76 / r. ze nasm as n. 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CROIX COUNTY COURTHOUSE - 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 May 23, 1991 Judy Steiner Edian Realty 700 2nd St. Hudson, WI 54016 Dear Ms. Steiner: An inspection of the septic system on the property of Richard Thompson, located at 775 130th Ave., Roberts, WI was conducted on May 22, 1991. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Enrely, Maa ins Assistant Zoning Administrator cj II-GIs 'COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 FAX 715 - 962 - 4030 i i ST. CROIX COUNTY ZONING OFFICE REPORT NO.: 82945/01 PAGE 1 ST.CROIX CTY GOV.CTR REPORT DATE: 4/26/95 1101 CARMICHAEL ROAD DATE RECEIVED« 4/20/95 HUDSON, WI 54016 7 ATTN. THOMAS C. NELSON OWNERi (Myron 6 Deborah Cowles t LOCATION*# 775 130th St., Roberts Z COLLECTOR. Jim Thompson DATE COLLECTED: 4-19-95 w^ TIME COLLECTED. 11:00am 46 SOURCE OF SAMPLE; Kitchen faucet'. -I, DATE ANALYZED! 4-20-95 TIME ANALYZED 12:00pe, COLIFORM,MFCC. 0 /100 ml INTERPRETATIOW Bacteriologically SAFE" NITRATE-NI 8 ppm Above 10 ppm exceeds the recommended PubLic Drinking Water Standard. CoLiform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIAN: Pam Gane WI Approved Lab No. 19 OE."ADEDENO o O I A dJ, h C Means "LESS THAN" Detectable LeveL Approved by: O PROFESSIONAL LABORATORY SERVICES SINCE 1952 A ST. CROIX COUNTY .0",00 WISCONSIN _ ZONING OFFICE M p, p p p p M r~~~f ST. CROIX COUNTY GOVERNMENT CENTER ~a AW, 1101 Carmichael Road - - Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. 0 Water (VOC's) $185.00 ❑ Septic $50.00 O"'Water (Nitrate & Bacteria) 45.00 ❑ Nitrate & Bacteria retest $15.00 Owner: Yhu(&,j 1~ lam, C ),i ~,_r Requested by : Address 77 7 _ sf Address: ley % V, 13."Ii-j, o;, S ZIP536d ZIP, a U Telephone NQ: ( ) Telephone y1ri Property address (Fire N° & Street) : 7 Location:', Sec., T,~,?~N, R~ W, Town of ~crrch Realty firm: Lock Box Combo: Closing Dater - TO BE COMPLETED BY PROPERTY OWNER PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: _s«~ G w---a a Is the dwelling currently occupied? Yes 0 No If vacant, date last occupied: - Age of septic system: Septic tank last pumped by: Date: Previous Owner's Name(s): Have any of the following been observed? OY ON Slow drainage from house. ❑Y ❑N Sewage Back-up into dwelling. ❑Y ❑N Sewage discharge to ground surface or road ditch. ❑Y ❑N Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: ~ _ DATE : L f'~ 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION IN TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? []Yes ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system: []Below grd ❑At-Grd OMound Approx. size 'X []Gravity ODose []Pressurized ~Zll Ft.2 []Bed []Trench []Dry Well OHolding Tank OOutfall pipe OBSERVED DEFICIENCIES 00ther []Unknown Septic tank Setbacks: []House []Well []Prop. line 00ther Dose tank Setbacks: []House []Well []Prop. line []Other OLocking cover OWarning label []Pump/Floats []Alarm OElec. wiring Soil Absorption System Setbacks: []House OWell OProp. line []Other ❑Ponding: []Discharge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N i I ill Inspector Title